Patient Case Formulations and Oppressive Disability Discourses in Occupational Therapy Education PDF

Article Canadian Journal of Occupational Therapy 2021, Vol. 88(3) 266–...

Article Canadian Journal of Occupational Therapy 2021, Vol. 88(3) 266–272 DOI: 10.1177/00084174211005882 Patient Case Formulations and ª CAOT 2021 Article reuse guidelines: Oppressive Disability Discourses sagepub.com/journals-permissions www.cjotrce.com in Occupational Therapy Education Formulations de cas de clients et discours oppressifs sur les incapacités dans l’enseignement de l’ergoth érapie Marie-Lyne Grenier Key words: Affirmative model; Crip theory; Critical disability studies; Disability; Occupational therapy. Mots clés : Ergothérapie; handicap; incapacit é; modèle affirmatif; théorie crip; théories critiques du handicap. Abstract Background. Patient case formulations have become a standard feature in occupational therapy (OT) education. Despite their demonstrated benefits in optimizing student learning, patient case formulations may unintentionally convey oppressive disability discourses. Purpose. The purpose of this paper is to illustrate and invite critical reflection on the use of patient case formulations in reinforcing ableist discourses and assumptions in OT education and practice. Key Issues. Through the lens of critical disability theory and Crip theory, the author demonstrates how patient case formulations are often reflective of institutionalized ableism that functions to support oppressive disability discourses in the profession, contributing to harmful healthcare practices. Implications. The ongoing use of patient case formulations rooted in oppressive disability discourses perpetuates oppressive constructions of disabled people in OT education and practice. A radical shift towards pedagogical materials and practices that support identity-affirming disability discourses would be more aligned with the profession’s expressed values. Abrégé Description. Les formulations de cas de clients sont devenues une pratique courante dans l’enseignement de l’ergothérapie. En dépit de leurs bienfaits avérés sur l’apprentissage des étudiants, il est possible que les formulations de cas véhiculent involontairement des discours oppressifs sur les personnes en situation de handicap. But. L’objectif de cet article est d’illustrer le fait que l’utilisation de formulations de cas peut renforcer les discours et les a priori capacitistes dans l’enseignement et la pratique de l’ergothérapie et de susciter une réflexion critique à cet égard. Questions clés. À travers le prisme des théories critiques sur le handicap et de la théorie Crip, l’auteure démontre de quelle manière les formulations de cas de clients reflètent fréquemment un capacitisme institutionnalisé qui a pour effet de favoriser les discours oppressifs sur les personnes handicapées dans la profession, ce qui contribue à des pratiques dangereuses au sein des services de santé. Implications. Le recours à des formulations de cas de clients fondées sur des discours oppressifs concernant les incapacités perpétue les conceptions discriminatoires des personnes handicapées dans l’enseignement et dans la pratique de l’ergothérapie. Un changement radical vers du matériel et des pratiques pédagogiques propices aux discours qui soutiennent les processus d’affirmation des personnes en situation de handicap correspondrait davantage aux valeurs énoncées par la profession. Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Social Sciences and Humanities Research Council (Grant Number 752-2018-0151). Corresponding author: Marie-Lyne Grenier, MScOT, DOT, erg. School of Physical and Occupational Therapy, McGill University, Quebec H3G 1Y5, Montreal, Canada. E-mail: [email protected] Canadian Journal of Occupational Therapy 88(3) 267 Introduction influenced by this lens. Note that the terms “non-disabled” and “disabled” are used throughout this paper to highlight the Educational activism: “Research that is explicitly committed social/systemic roots of disability. I would like to emphasize, to critiquing the status quo [within educational institutions] however, that some members of the disability community pre- and building a more just society” fer terms such as “person with a disability” or “person with (Lather, 1986, p. 258). [insert diagnosis/impairment]” or “Crip” as a form of disability-identity affirmation. R esearch in the realm of educational activism tends to focus on “studying down,” that is, studying the experi- ences of learners from marginalized groups (Priyad- harshini, 2003). Yet, commitment to building a more just Occupational Therapy and Evolving Models society demands “studying up,” that is, studying those who and Theories of Disability shape attitudes and control institutional structures that create Arising out of the moral treatment movement (Peloquin, 1988), marginalization in the first place (Nguyen, 2019; Priyadhar- the profession of OT came to take its present form in the early shini, 2003; Wisniewski, 2000). There are many reasons why twentieth century in response to returning injured World War educational researchers may avoid studying up, such as unspo- veterans (Meyer, 1977 ). Early occupational therapists, ken sensitivities, difficulties accessing data or participants, fear comprising primarily of White, non-disabled, heterosexual, of embarrassing the academy, fear of negative career implica- middle- to upper-class women (Kin ébanian & Stomph, tions, and/or fear of exposing the practices of the powerful 1992), adopted the tragedy/charity and medical models of dis- (Priyadharshini, 2003; Wisniewski, 2000). To this list, I would ability that prevailed in political, social, and healthcare con- add the following: fear of facing the fragility/defensiveness that texts at the time. The tragedy/charity model of disability can come from those who control institutional structures, fear (Swain & French, 2000) views disability as a tragedy and dis- of facing one’s own complicity in supporting oppressive dis- abled individuals as deserving of charity and/or in need of pity, courses and practices, and fear of social exclusion that can while the medical model (Swain & French, 2000) views dis- result from challenging or critiquing members of one’s own ability as a medical problem intrinsic to individuals necessitat- “in-group.” In White Fragility, DiAngelo (2018) acknowledges ing curing or treatment to restore “normal” function (Albrecht the inherent difficulties in challenging/critiquing oppressive et al., 2001). Both models adopt a deficit-focused view of dis- discourses and practices from members of our own social ability. These models prevailed in OT until the disability rights group(s); however, she stresses that doing so is a key strategy movement of the 1960s forced healthcare professionals to con- for changing the status quo and building a more just society. sider factors such as attitudinal, environmental, and institu- Note, however, that DiAngelo’s focus is on racism specifically. tional barriers as disabling forces (Albrecht et al., 2001). The In a recent article, I emphasized the need for a “radical dis- disability rights movement focused its advocacy work particu- mantling and rebuilding of key professional frameworks and mod- larly in the areas of equal access to employment, housing, and els” in order to address discourses and practices that reinforce community accessibility and catalyzed what is now known as White supremacy in occupational therapy education (Grenier, the social model of disability (Wendell, 1996). The social 2020, p. 8). Working toward this objective will require special and model of disability (Swain & French, 2000) views disability sustained attention to “studying up” within our profession. In this as an outcome of systemic barriers and exclusion from society article, I take a “studying up” approach to critically examine the and is, therefore, in opposition to the medical model (Albrecht ways in which oppressive disability discourses are reproduced in et al., 2001). This model grew in popularity and evolved to our foundational texts. More specifically, through the lenses of form a branch of social sciences in the 1970s termed disability critical disability theory (CDT) and Crip theory (CT), I aim to studies (Meekosha & Shuttleworth, 2009). demonstrate how case formulations in OT texts often reflect insti- In the latter part of the 1980s and 1990s, with the advent of tutionalized ableism that functions as a tool for the reproduction of critical studies (e.g., critical legal studies, critical feminist studies, oppressive disability discourses and practices in OT education and critical race theory, and queer theory), critical disability studies practice. Patient case formulations, in this paper, refer to any (CDT) (Swain & French, 2000) emerged to push disability studies patient/client cases used for instructional purposes, whether from beyond a subject focus on disability to an analytic and activist textbooks or developed by an instructor. focus on the normative assumptions that pervade in specific con- To be transparent, I argue this thesis from my self- ditions of power and oppression (Hall, 2019). Minich (2016) identified position as a currently non-disabled, White, franco- defines CDT as a methodology that involves “scrutinizing not phone, Canadian, non-binary, queer, occupational therapist, bodily or mental impairments but the social norms that define and educator from a working-class background. I am posi- particular attributes as impairments, as well as the social condi- tioned as a non-tenure-track faculty member in a university tions that concentrate stigmatized attributes in particular and writing this analysis within the context of a second doctoral populations” (n.p.). Activism for social change is the goal of degree focusing on the use of critical pedagogies in post- CDT; that is, “producing knowledge in support of justice for[/ secondary healthcare education. I acknowledge that as a cur- with] people with stigmatized bodies and minds” (Minich, 2016, rently non-disabled person my work has and will continue to be Canadian Journal of Occupational Therapy 268 Grenier n.p.). In this way, CDT is intended to be an emancipatory dis- with disabled individuals. The null curriculum here refers to course that leads to emancipatory praxis (Goodley et al., 2018; materials or concepts that are altogether absent from a student’s Meekosha & Shuttleworth, 2009). educational experience (Eisner, 1994). This points to an impor- In the 2000s, Queer Theory and CDT merged to form what tant conflict between the formal, hidden, and null curricula in is now known as Crip theory (CT) (McRuer, 2006). Williams’ OT education with regard to disability discourses. (2020) articulate definition of CT is used here: In the following section, I use CDT and CT to explore these Crip theory considers disability to be a viable identity variable ideas more concretely through an analysis of a patient case for- to be recognized, acknowledged and celebrated. Crip theory mulation included in the latest version of Enabling Occupation II: also recognizes the importance of the intersectionality of Advancing an Occupational Therapy Vision for Health, Well- one’s disability identity with all other identity variables. By Being, & Justice Through Occupation (Townsend et al., 2007), doing so, Crip theory acknowledges the historical exclusion a foundational textbook used in most OT programs in Canada. It is of diverse groups within the disability community (e.g. per- acknowedged that this foundational textbook is currently being sons of color, gay, lesbian, transgender) as a consequence of revised, with a new edition scheduled to be released in the near internalized oppression within the disability community. future. OT educators are invited to complete their own in-depth Unique to CT is the reclaiming of “Crip identity” as a poten- analysis of patient case formulations used in their own teaching tially universal identity and one which ought to be “recognized, using the guiding questions provided below in Table 1. acknowledged and celebrated” (Williams, 2020). Crip identity reclaims the historically negative/oppressive connotations associated with the word “cripple” and transforms it into a A Patient Case Formulation Through positive identity within the disability community. This reclaim- ing is reminiscent of the reclaiming of “Queer identity” by the the Lenses of Critical Disability Theory 2SLGBTQIAþ community. That is, that all and any of us can and Crip Theory become “disabled” at any time for a multitude of medical, Patient case formulation I social, environmental, and/or political reasons. With that deep *Reprinted with permission from CAOT. Copyright 2020, existential and practical acknowledgment comes a radicaliza- CAOT. All rights reserved. tion of the understanding of worthwhile lives, a sea of knowl- edge and experience. Both CDT and CT are part of what is more widely understood as the affirmation model of disability, which views disability and impairment as “positive social iden- Rick and Dick Hoyt tities, both individual and collective [... ] grounded in the This love story began in Winchester, Massachusetts, 43 benefits of life style and life experience of being impaired and years ago, when Rick was strangled by the umbilical cord during disabled” (Swain & French, 2000, p. 569). birth, leaving him brain-damaged and unable to control his Although occupational therapy practice models, such as the limbs. “He’ll be a vegetable the rest of his life,” Dick says Canadian Model of Occupational Performance and Engagement doctors told him and his wife, Judy, when Rick was 9 months (CMOP-E) (Townsend et al., 2007) and the Person- old. “Put him in an institution.” Environment-Occupation (PEO) model (Law et al., 1996)) make But the Hoyts weren’t buying it. They noticed the way Rick’s explicit the links between disability and social/environmental eyes followed them around the room. When Rick was 11, they causes of disability in the formal curriculum, case formulations took him to the engineering department at Tufts University and within OT texts often continue to reflect tragedy/charity and/or asked if there was anything to help the boy communicate. “No medical models of disability (example to be discussed later in way,” Dick says he was told. “There’s nothing going on in his this paper). This speaks to underlying institutionalized ableism brain,” “Tell him a joke,” Dick countered. They did. Rick laughed. within the hidden curriculum that can negatively affect the way Turns out a lot was going on in his brain. Rigged up with a OT students think about disability and interact with disabled computer that allowed him to control the cursor by touching a individuals. The hidden curriculum refers to “embedded, latent switch with the side of his head, Rick was finally able to commu- messages within an educational environment that are produced nicate. First words? “Go Bruins!” And after a high-school class- through contradictions and inconsistencies within and between mate was paralyzed in an accident and the school organized a an institution’s structures and culture” (Giroux & Penna, 1979; charity run for him, Rick pecked out, “Dad, I want to do that.” Hafferty, 1998; Murphy, 2019, p. 85). Yeah, right. How was Dick, a self-described “porker” who Ableism is not simply about devaluing disability, it also never ran more than a mile at a time, going to push his son includes the disproportionate positive valuing of “able- 5 miles? Still, he tried. “Then it was me who was handicapped,” bodiedness [... and] able-mindedness” (Dolmage, 2017, p. Dick says. “I was sore for two weeks.” That day changed Rick’s 7). Educational materials that offer identity-affirming disability life. “Dad,” he typed, “When we were running, it felt like discourses are frequently absent from OT education, reflecting I wasn’t disabled anymore!” And that sentence changed Dick’s the null curriculum (Eisner, 1994), which can further nega- life. He became obsessed with giving Rick that feeling as often tively affect the way students think about disability and interact (Continued) Revue canadienne d’ergothérapie Canadian Journal of Occupational Therapy 88(3) 269 Rick’s high school classmate) are described as “objects”1 of (Continued) pity and charity throughout. Since Rick’s high school classmate as he could. He got into such hard-belly shape that he and Rick is never actually identified by name, his identity remains one were ready to try the 1979 Boston Marathon. “No way,” Dick that is fully entwined with his tragic accident and the charity/ was told by a race official. The Hoyts weren’t quite a single pity he receives from others in the form of a literal “charity” runner, and they weren’t quite a wheelchair competitor. For a race. Rick’s identity is also fully entwined with his tragic acci- few years, Dick and Rick just joined the massive field and ran dent, victimhood (“strangled by”), and resulting deficits anyway and then they found a way to get into the race officially: (“brain-damaged,” “unable to control his limbs,” In 1983, they ran another marathon so fast they made the “vegetable,” “not able to communicate”). Rick’s strengths are qualifying time for Boston the following year. not described as inherent to Rick (e.g., ability to communicate Then somebody said, “Hey, Dick, why not a triathlon?” with technology and his sense of humor) but rather strengths How’s a guy who never learned to swim and hadn’t ridden a that are given life only through his parents’ charitable actions. bike since he was six going to haul his 110-pound kid through a The charity narrative remains strong throughout, with Rick’s triathlon? Still, Dick tried. Now they’ve done 212 triathlons, occupational engagement seemingly only possible via the hard including four grueling 15-hour Ironmans in Hawaii. It must work and sacrifice of his father. The final sentence (“The thing be a buzzkill to be a 25-year-old stud getting passed by an old I’d most like,” Rick types, “is that my dad sit in the chair and I guy towing a grown man in a dinghy, don’t you think? push him once.”) confirms for the reader that Rick’s character Hey, Dick, why not see how you’d do on your own? “No should ultimately remain an object of pity and tragedy. way,” he says. Dick does it purely for “the awesome feeling” he Disability, in this patient case formulation, remains firmly gets seeing Rick with a cantaloupe smile as they run, swim and represented as a medical problem intrinsic to individuals, rather ride together. This year, at ages 65 and 43, Dick and Rick than socially constructed. At times, disability is depicted as a finished their 24th Boston Marathon, in 5,083 rd place out literal burden/weight (“to haul his 110-pound kid”) on family of more than 20,000 starters. Their best time? Two hours, members and friends. Disability as a personal/family/societal 40 minutes in 1992—only 35 minutes off the world record, burden is a common discourse characteristic of the pity/charity which, in case you don’t keep track of these things, happens to and medical models of disability. The use of the word “kid” be held by a guy who was not pushing another man in a wheel- here is also noteworthy, seeing that disabled individuals are chair at the time. frequently infantilized in popular media. Rick was an adult “No question about it,” Rick types. “My dad is the father of when he and his father began participating in triathlons. I the century.” acknowledge that the use of the word “kid” here may have “The thing I’d most like,” Rick types, “is that my dad sit in been intended to mean “son,” but, the word “son” could have the chair and I push him once.” been used instead. Additionally, disability identity is undeni- ably portrayed as a negative and undesirable identity, not one which ought to be “recognized, acknowledged and celebrated” (Williams, 2020) (“[t]hen it was me who was handicapped,” Arguably, this patient case formulation offers occupational “When we were running, it felt like I wasn’t disabled any- therapy educators a supportive example for key concepts of the more!” “He became obsessed with giving Rick that feeling profession. For example, writing about the Rick and Dick Hoyt as often as he could”). Implied here is that the goal should patient case formulation, Davis (2016), wrote that “[t]radition- be to notfeel disabled and to momentarily transcend one’s self ally, occupational therapy practitioners have focused on occu- because that disabled self is not desirable or enough. Indeed, pational performance as their outcome, ensuring that the people Rick’s identity is not celebrated in this patient case formulation they work with are able to ‘do’ or carry out [their] occupations” and we learn very little about his identity separate from that of in an active way (p. 155). Davis contends that this patient case his father’s. Instead, it is Dick’s physical prowess and determi- formulation highlights an important distinction between occu- nation to go above and beyond for his son that is celebrated. pational performance and occupational engagement. This Dick is the hero and centerpiece of the story, while Rick patient case formulation also speaks to another dimension of becomes quickly part of the backdrop. Dick’s athletic achieve- occupation that occupational therapists are especially con- ments are placed in constant and sharp contrast to Rick’s phys- cerned with; that of “belonging” (as described by Rebeiro, ical “deficits.” Dick represents everything that Rick is not and 2001). In this case, the father-son pair’s sense of belongingness embodies in every way the epitome of Western male norma- to a community, a community of athletes, is well demonstrated. tivity (athletic, White, caring but assertive, heterosexual, and However, an analysis of Rick and Dick Hoyt’s patient case upper-middle class).2 This patient case formulation ultimately formulation through the lenses of CDT and CT reveals impor- reinforces our most basic ableist societal views; that is, non- tant oppressive disability narratives that demand our attention. disabled equals good and disabled equals bad. As previously mentioned, patient case formulations within Finally, the placement of this patient case formulation in occupational therapy texts/courses often reflect tragedy/charity the book is noteworthy. The case is in Chapter 1 of the book; a and/or medical models of disability: both models are repre- chapter dedicated to introducing and defining the domain of sented here. The main disabled characters (namely Rick and concern of occupational therapists, namely occupation, to its Canadian Journal of Occupational Therapy 270 Grenier audience, namely occupational therapy students. Typically, Concluding Thoughts: Where do we Go from this chapter would be assigned reading early in the academic Here? coursework of students. Given that this patient case formula- tion reflects tragedy/charity and medical models of disability, The above analysis placed into focus some of the commonly introduces disability identity as a negative and undesirable one, seen oppressive disability discourses in patient case formula- and celebrates ableist views and Western male normativity, tions in occupational therapy education/literature. More specif- what messages about disability are such patient case formula- ically, it highlights the ongoing use and reliance on the charity/ tions conveying to students from the very start? What messages tragedy and medical models of disability, as well as ableism do they convey to students about how occupational therapists and “inspiration porn,” in patient case formulations. The atten- should relate to disabled individuals? What hidden norms, val- tion in this analysis was on ableism, to highlight this specific ues, and beliefs are being transmitted? system of oppression; however, an intersectional analysis could also be completed to reveal intersections with additional sys- tems of oppression (e.g., classism, racism, and sexism) (Nixon, 2019). Beyond “Tragic”: Inspiration Porn and the A quick glance at the mission statements of OT programs Idealized Objectification of Disability in and professional associations reveals the centrality of the hero Patient Case Formulations narrative in our profession, as well as the domination of char- ity/pity and medical models of disability. For example, the In 2014, comedian, editor, and disability advocate Stella Canadian Association of Occupational Therapists’ (2020) web- Young coined the term “inspiration porn” to characterize site states that “Occupational therapists [... ] assess an indi- images or narratives that objectify one group of people for the vidual’s situation by drawing upon evidence-based approaches benefit of another group of people. Examples would include and applying their specialized knowledge and skills to recom- images of a young child with prosthetic legs running a race, or a mend a course of preventive or corrective action that will help swimmer with no legs and arms swimming in a competition. people lead more productive and satisfying lives” (n.p.). Not Referring to such images and narratives, Young (2014) states: only is an affirmative disability-identity stance absent here, but So, in this case, we are objectifying disabled people for the the hero narrative is made central. The hero narrative is proble- benefit of non-disabled people. The purpose of these images is matic for the following reasons: (1) it creates oppressive power to inspire you, to motivate you, so that you can look at them dynamics within the client-therapist relationship that can lead [disabled people] and think, well, however bad my life is, it to paternalistic and oppressive actions (in opposition to rights- could be worse. I could be that person. But what if you are that based and client-centered care), (2) the therapist becomes the person? presumed “authentic knower” or the solution to the problem In the above patient case formulation, the two disabled char- and the client “becomes the problem to be solved,” placing the acters (Rick and his unnamed high school classmate) are por- client in a position of dependency rather than agency (Razack, trayed as objects of tragedy and are meant to inspire and 1995, p. 70), (3) the therapist becomes the attentional center of motivate the (presumed non-disabled) reader into similar chari- the client-therapist relationship, (4) the gains and achievements table actions as those demonstrated by Dick. Dick substitutes made by the client are credited to the charitable actions of the for the reader in the story (the student) and demonstrates to the therapist, rather than the resiliency of the client, and (5) it reader how they too, through charitable acts for disabled peo- reinforces internalized ableist beliefs for both parties. ple, can become the hero of the story. Such discourses have It is time for a radical shift in pedagogical content and direct implications for the perceived role of occupational thera- practices that support identity-affirming disability discourses pists in relation to their patients (the hero narrative). In tragedy/ in occupational therapy education to transform the way OT charity and medical models of disability, the power dynamic students think about disability and interact with disabled indi- between the healthcare provider and the patient becomes viduals. For example, patient case formulations could include largely unequal, increasing the risk of paternalistic and oppres- examples of peer mentoring successes (i.e., a Deaf person sive actions on the part of the healthcare provider. demonstrating the skills they have gained as a result of their Furthermore, in this case formulation, we observe that disability to instruct another Deaf person), examples of inno- Rick’s personal and embodied experience of disability goes vative ways of doing, being, and belonging that (with or with- unrecognized. Rather, his experience is made visible only when out the assistance of occupational therapists) have supported it approaches an ableist norm. For example, his intelligence, his disabled individuals to contribute to science, technology, the communication style, his humor, and his physicality become arts, etc., and examples of occupational therapists capitalizing “acceptable” only when they approximate those of non- on the strengths of the patients/families/communities with disabled individuals (e.g., verbalized intelligence, verbalized whom they work to achieve desired goals. Challenging oppres- communication, verbalized humor, and athletic physicality). sive/dominant discourses of disability will require increased In essence, Rick becomes a “source of inspiration” for daring occupational therapy research with a focus on “studying up”, to desire something that is clearly out of his reach, an ableist as well as intentional and iterative critical analysis of our own norm based on athleticism. practices at all levels of the curriculum (explicit, hidden, and Revue canadienne d’ergothérapie Canadian Journal of Occupational Therapy 88(3) 271 Table 1 model can become foundational at all levels of curricula, with a Reflective Questions for Critical Analysis special attention to exploring the role of occupational therapists in facilitating affirmative disability identity with patients/clients. The following guiding questions were adapted from the Seven Step Framework for Critical Analysis by Nixon et al. (2017) and critical There is also a pressing need for radical dismantling and rebuild- reflexive questions by Phenix (2019) and can be used by the reader as ing of key professional frameworks and models to eliminate able- a point of departure for a critical analysis of patient case formulations. ist disability discourses as the default position in occupational  What is the intended purpose of this patient case formulation? therapy education and practice. This process must be led by mem- Who is the audience? bers of the disability community, with members holding key  What assumptions does this patient case formulation make? decision-making ower and remunerated equitably.. Finally, and  Whose interests are served in this patient case formulation? Who perhaps most importantly, actively recruiting students, faculty, is painted in a good light?  Whose interests are not served in this patient case formulation? and leadership with lived experiences of disability in occupa- Who is painted in a bad light? tional therapy programs will be critical if we are to move the  What societal patterns of privilege and oppression are profession toward safer practices. reproduced in this patient case formulation?  What model(s) of disability is/are represented in this patient case formulation? Key Messages  Does this patient case formulation leave room for collaboration  Patient case formulations used in OT education are often and partnership with the client? based in oppressive disability discourses;  Are oppressive disability discourses imbedded in this patient case  Oppressive disability discourses risk contributing to unsafe formulation? If so, how could this case be reformulated to decrease the oppressive disability discourses? healthcare practices by occupational therapists;  There is a pressing need for patient case formulations that support identity-affirming disability discourses in OT education. null). Furthermore, and perhaps most pressingly, it will require a serious review of our fundamental professional texts, models, competencies, and regulatory documents to align our profes- Acknowledgments sion with an affirmative disability-identity stance (moving The author would like to thank Dr. Hiba Zafran, Dr. Brenda Beagan, away from the charity/tragedy and medical models of disabil- and Dr. Elizabeth Patitsas for providing feedback on the first drafts of ity, and being judicious with our use of the biopsychosocial this paper. The author would also like to thank Dr. Laura Bulk, Dr. model). As clinicians and educators, we must critically analyze Sally Kimpson, Dr. Heather Lambert, Danielle Lorenz (PhD candi- our patient case formulations through an intersectional lens to date), and Dr. Susan Mahipaul for their support and feedback on this identify the explicit, implicit and hidden discourses being con- work, as well as their fearless leadership in critical disability veyed. Team editing in collaboration and consultation (remun- scholarship. erated) with individuals with lived experiences of disability while using a critical/intersectional lens should be considered best practice to help decrease our use of oppressive disability (and other) discourses (see Table 1 for suggested reflective ORCID iD questions to aid in this process). An intersectional and critical Marie-Lyne Grenier https://orcid.org/0000-0002-8314-7176 analysis of required/recommended student readings and pre- paratory work, lecture material, lab materials, etc., is also needed to ensure that authors and educators from multiple Notes positionalities in relation to the experience of disability are 1. This verbiage is used intentionally to highlight the objectification included in the curriculum - not just the perspectives of of the disabled characters. White/non-disabled scholars. As such, this article should be 2. A class assumption is made here owing to the training hours required used judiciously, with this consideration in mind. to maintain the fitness levels needed for completion of triathlons/ Mandatory critical disability studies courses, although not Ironman competitions, travel expenses required for participation in currently part of the majority of occupational therapy or health more than 200 international competitions, and Dick Hoyt’s position profession programs, could be an important avenue to pursue at a as a Lieutenant Colonel in the USA Air National Guard. curricular level to better prepare students with the tools needed to think about disability in ways that unearth normative assump- tions. If we are to move toward better healthcare equity in Canada, healthcare education must equip students with the tools needed to References question, challenge, and change the status quo when the status quo Albrecht, G., Seelman, K., & Bury, M. (2001). Handbook of disabil- is recognized to be a source of oppression. Occupational therapy ities studies. SAGE Publications. https://doi.org/10.4135/978-1- program administrators and accreditation boards are encouraged 41297-625-1 to think about how disability discourses rooted in the affirmation Canadian Journal of Occupational Therapy 272 Grenier Canadian Association of Occupational Therapists. (2020). A career in informal curriculum. Sexuality Research and Social Policy, 16, occupational therapy. Canadian Association of Occupational 84–99. https://doi.org/10.1007/s13178-018-0336-y Therapists. Retrieved from https://www.caot.ca/site/rfs/res_for_ Nixon, S. (2019). The coin model of privilege and critical allyship: students?nav¼sidebar implications for health. BMC Public Health, 19. https://doi.org/ Davis, J. A. (2016). The Canadian model of occupational performance 10.1186/s12889-019-7884-9 and engagement (CMOP-E). In M. Curtin, M. Egan, & J. Adams Nixon, S., Yeung, E., Shaw, J. A., Kuper, A., & Gibson, B. E. (2017). (Eds.), Occupational therapy for people experiencing illness, Seven-step framework for critical analysis and its application in the injury or impairment (pp. 148–168). Elsevier. field of physical therapy. Physical Therapy, 97(2), 249–257. DiAngelo, R. (2018). White fragility: Why it’s so hard for White https://doi.org/10.2522/ptj.20160149 people to talk about racism. Beacon Press. Nguyen, P. (2019). Suspect communities: Anti-muslim racism and the Dolmage, J. T. (2017). Academic ableism: Disability and higher edu- domestic war on terror. University of Minnesota Press. cation. University of Michigan Press. Phenix, A. (2019, August). What is cultural safety and why it matters Eisner, E. W. (1994). The educational imagination: On the design and as you go out into practice—Where everyone should start in rela- evaluation of school programs. MacMillan College Publishing tion with indigenous peoples. Presentation given during the Company. Lavigne-Smee Visiting Scholar Award ceremony, Montreal, Giroux, H. A., & Penna, A. N. (1979). Social education in the class- Québec. room: The dynamics of the hidden curriculum. Theory & Research Peloquin, S. M. (1988). Moral treatment: Contexts considered. The in Social Education, 7(1), 21–42. https://doi.org/10.1080/00933 American Journal of Occupational Therapy, 43(8), 537–544. 104.1979.10506048 https://doi.org/10.5014/ajot.43.8.537 Goodley, D., Liddiard, K., & Runswick-Cole, K. (2018). Feeling dis- Priyadharshini, E. (2003). Coming unstuck: thinking otherwise about ability: Theories of affect and critical disability studies. Disability “studying up”. Anthropology and Education Quarterly, 34(4), & Society, 33(2), 197–217. https://doi.org/10.1080/0968 420–427. https://doi.org/10.1525/aeq.2003.34.4.420 7599.2017.1402752 Razack, S. H. (1995). The perils of talking about culture: Schooling Grenier, M. L. (2020). Cultural competency and the reproduction of research on South and East Asian students. Race, Gender and White supremacy in occupational therapy education. Health Edu- Class, 2(3), 67–82. Retrieved from https://www.jstor.org/stable/ cation Journal, 79(6), 1–12. https://doi.org/10.1177/ 41674709 0017896920902515 Rebeiro, K. L. (2001). Enabling occupation: The importance of an Hafferty, F. W. (1998). Beyond curriculum reform: Confronting med- affirming environment. Canadian Journal of Occupational Ther- icine’s hidden curriculum. Academic Medicine, 73(4), 403–407. apy, 68(2), 80–89. Hall, M. C. (2019, September 23). Critical disability theory. Stanford Swain, J., & French, S. (2000). Toward an affirmation model of dis- Encyclopedia of Philosophy. Retrieved from https://plato.stanfor ability. Disability & Society, 15(4), 569–582. https://doi.org/ d.edu/entries/disability-critical/ 10.1080/09687590050058189 Kinébanian, A., & Stomph, M. (1992). Cross-cultural occupational ther- Townsend, E. A., & Polatajko, H. J., & Canadian Association of apy: A critical reflection. The American Journal of Occupational Occupational Therapists (CAOT). (2007). Enabling occupation Therapy, 46(8), 751–757. https://doi.org/10.5014/ajot.46.8.751 II: Advancing an occupational therapy vision for health, well- Lather, P. (1986). Research as praxis. Harvard Educational Review, being, & justice through occupation. CAOT Publications ACE. 56(3), 257–277. https://doi.org/10.17763/haer.56.3.bj2h23 Wendell, S. (1996). The rejected body: Feminist philosophical reflec- 1877069482 tions on disability. Routledge. Law, M., Cooper, B. A., Strong, S., Stewart, D., Rigby, P., & Letts, L. Williams, J. (2020). Crip theory. Wright State University. Retrieved (1996). The person-environment-occupation model: A transactive from https://www.wright.edu/event/sex-disability-conference/ approach to occupational performance. Canadian Journal of Occu- crip-theory pational Therapy, 63, 9–23. Wisniewski, R. (2000). The averted gaze. Anthropology and Educa- McRuer, R. (2006). Crip theory: Cultural signs of queerness and tion Quarterly, 31(1), 5–23. https://doi.org/10.1525/aeq.2000.3 disability. New York University Press. 1.1.5 Meekosha, H., & Shuttleworth, R. (2009). What’s so ‘Critical’ about Young, S. (2014). Inspiration porn and the objectification of disability critical disability studies? Australian Journal of Human Rights, [video file]. Retrieved from https://www.youtube.com/watch? 15(1), 47–75. v¼SxrS7-I_sMQ Meyer, A. (1977). The philosophy of occupational therapy. The Amer- ican Journal of Occupational Therapy, 31(10), 639–642. https:// Author Biography doi.org/10.1080/1323238X.2009.11910861 Minich, J. A. (2016). Enabling whom? Critical disabilities studies Marie-Lyne Grenier, MScOT, DOT, erg. is an occupational now. Lateral: Journal of the Cultural Studies Association, 5(1). therapist, Faculty Lecturer at the School of Physical and Occupational Therapy at McGill University, and PhD student https://doi.org/10.25158/L5.1.9 in the Department of Integrated Studies in Education at McGill Murphy, M. (2019). Teaching and learning about sexual diversity University. within medical education: The promises and pitfalls of the Revue canadienne d’ergothérapie