Occupational Therapy: First World War Centenary-Growth from Conflict

By Murtagh, David Lee | British Journal of Occupational Therapy, July 2014 | Go to article overview

Occupational Therapy: First World War Centenary-Growth from Conflict


Murtagh, David Lee, British Journal of Occupational Therapy


The First World War centenary gives us an opportunity to reflect on lessons learnt through war. Psychiatry and occupational therapy have grown, adapted, and changed through conflict. Occupational therapy roots in the United Kingdom (UK) were embedded during and soon after the First World War. During the 19th century, clarification of thinking brought about a more humane way to treat mental illness. The most revolutionary movement was moral therapy (Miller and Blanc 1967). The principles of moral therapy lay within work and social conformity; the attitude that to be part of society you must have regular work habits and be perceived as a productive member of society. As moral therapy grew, it developed into 'reconstruction therapy' and/or 'programmes', and saw the introduction of reconstruction aides and vocational rehabilitation during and after the First World War (Laws 2011).

In 1916 the British Army introduced the PIE principles (Proximity of treatment, Immediacy of response, and Expectation of recovery) (Jones and Wessely 2005). These principles were practiced in stationary hospitals close to the front line, which aimed to return physically sound men with war neuroses to duty as quickly as possible. Reconstruction aides were an integral part of treatment.

Craiglockhart Hospital near Edinburgh had an occupational approach to treatment during the First World War. Wilfred Owen and Siegfried Sassoon were treated here for war neurosis and were actively encouraged to write; they co-edited Hydra, a hospital magazine that patients designed and contributed to. This approach was led by Captain Brock, who believed that soldiers became disconnected from the world through their trauma and needed to reconnect with their environment through purposeful activity and function through working. He was quoted as saying: 'If the essential thing for the patient to do is to help himself, the essential thing for a Doctor to do--the only thing he can profitably do is to help him to help himself (Webb 2006, p344).' Treatment included teaching at local schools and farm working, allowing servicemen to gain new skills and express themselves (Webb 2006). Seale Hayne in Devon was another military hospital that also treated service men with shellshock. Arthur Hurst was credited with pioneering treatment at Seale Hayne based on basic principles of occupational therapy, those being vocational activities to increase self-esteem and function (Jones 2012).

So what now? Occupational therapy retains the practical foundations from the First World War but has grown conceptually and adapted to meet the complex needs of military veterans, including post-traumatic stress disorder (PTSD). …

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