Unpacking the middle-class worldview in occupational science using cultural-historical activity theory

Abstract

Background: Occupational science continues to study occupation from a Westernised, Eurocentric, and middle-class perspective despite efforts to incorporate Global South perspectives. As such, this middle-class worldview is used as universal, following normative ways of thinking and doing while neglecting the socioeconomic, political, and historical conditions that shape class. This paper unpacks the middle-class perspective in occupational science by drawing attention to how this concept shapes occupational therapy practice. Methods: Cultural-historical activity theory (CHAT) was utilised to problematise the concept of the middle-class in two activity systems through analysis of a collaboratively created case that connects social class to the authors’ experiences as professional occupational therapists. This analysis was supplemented by the theoretical perspectives of Latin-American Collective Health and Social Occupational Therapy to compare the existing literature for both activity systems. Results: Using CHAT, the case portrays practitioners as subjects who reproduce and adopt a normative middle-class view in different contexts. Findings: Analysis of the two activity systems resulted in the identification of a subject, object, tools, rules, community, division of labour, and outcome. The first contradiction entails knowing where the health problem lies: is it from the individual's diagnosis or from the limitations of institutions and social systems? The second contradiction refers to how do we design health interventions: do we develop individual abilities or do we also facilitate critical thinking skills of individuals and their families to contribute to institutional as well as structural transformation? The last contradiction focuses on the position of the care provider: do they acknowledge when they are positioned as ‘instruments’ that further institutionalise biomedical practices or as ‘subjects’ who are more in control of the work that they do allowing them to actuate their purpose of care and service? Conclusions: Class is a social category constituted and reproduced through occupations. It is argued that professional practice is performative, and therapists ‘doing’ practice need to consider class assumptions and the imposition of these assumptions on groups/individuals. Critical reflexivity is needed to problematise further how normative interpretations of middle-class shape and are shaped by doing practice, perpetuating dominant views while neglecting other experiences.