Social Occupational Therapy:

Theoretical and Practical Designs

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Social Occupational Therapy: Theoretical
and Practical Designs

Roseli Esquerdo Lopes, MSc, PhD

Professor
Occupational Therapy Department
Federal University of São Carlos (UFSCar)
Metuia Network – Social Occupational Therapy
São Carlos, São Paulo, Brazil

Ana Paula Serrata Malfitano, MSc, PhD

Associate Professor
Occupational Therapy Department
Federal University of São Carlos (UFSCar)
Metuia Network – Social Occupational Therapy
São Carlos, São Paulo, Brazil
Elsevier
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 Changing the world is as difficult as possible
(Mudar o mundo é tão difícil quanto possível)
Paulo Freire

(Freire, P. (2000). Pedagogia da indignação: cartas pedagógicas e outros escritos [Indignation

pedagogy: pedagogical letters and others written]. São Paulo: Editora UNESP).
AC K N OW L E D G E M E N TS

The book organizers acknowledge the occupational therapists who supported the English language review process of the
chapters of this book. They are:
Amelia Di Tommaso
Anne Kinsella
Antoine Bailliard
Ben Sellar
Clare Hocking
Dikaios Sakellariou
Elizabeth Townsend
Gail Whiteford
Geyla Frank
Lilian Magalhães
Lisette Farias Vera
Lynn Shaw
Matthew Molineux
Natalia Rivas Quarneti
Nerida Hyett
Nicholas Pollard
Niki Kiepek
Pamela Block
Roshan Galvaan
Sarah Kantartzis

Cover
Ana Lua Contatore

Translation-funding

FAPESP - São Paulo Research Foundation

Grant 2019/02674-5

vi
 CONTRIBUTORS

Marta Carvalho de Almeida, Patrícia Leme de Oliveira Borba, Hetty Fransen-Jaïbi, MSc
MSc, PhD MSc, PhD Senior Lecturer
Assistant Professor Assistant Professor Division of Occupational Therapy
Department of Physiotherapy, Health, Education and Society University Tunis El Manar, Tunis
Communication Science & Disorders Department Tunisia
and Occupational Therapy Federal University of São Paulo
University of São Paulo Metuia Network – Social Sandra Maria Galheigo, MSc, PhD
Metuia Network – Social Occupational Therapy Assistant Professor
Occupational Therapy Santos, SP Department of Physiotherapy,
São Paulo, SP Brazil Communication Science & Disorders
Brazil and Occupational Therapy
Mayra Cappellaro, MSc University of São Paulo
Giovanna Bardi, MSc, PhD Occupacional Therapist São Paulo, SP
Assistant Professor Ludens Clinics Brazil
Occupational Therapy Department Campinas, SP
Federal University of Espírito Santo Brazil Debora Galvani, MSc, PhD
Metuia Network – Social Assistant Professor
Occupational Therapy Luciana Assis Costa, MSc, PhD Health, Education and Society
Vitória, ES Associate Professor Departament
Brazil Occupationial Therapy Department Federal University of São Paulo
Federal University of Minas Gerais, Metuia Network – Social
Rafael Garcia Barreiro, MSc, PhD Belo Horizonte, MG Occupational Therapy
Assistant Professor Brazil Santos, SP
Brasiília University Brazil
Metuia Network – Social Samira Lima da Costa, MSc, PhD
Occupational Therapy Associate Professor Maria Isabel Garcez Ghirardi,
Brasília, DF Occupational Therapy Department MSc, PhD
Brazil Federal University of Rio de Janeiro Occupational Therapist
Rio de Janeiro, RJ University of São Paulo,
Denise Dias Barros, MSc, PhD Brazil São Paulo, SP
Assistant Professor Brazil
University of São Paulo Patricia Silva Dorneles, MSc, PhD
Metuia Network – Social Assistant Professor Sarah Kantartzis, MSc
Occupational Therapy Occupational Therapy Department Senior Lecturer
São Paulo, SP Federal University of Rio de Janeiro Occupational Therapy Department
Brazil Rio de Janeiro, RJ Queen Margaret University,
Brazil Edinburgh
Sandra Benites, PhD United Kingdom
Guarani Teacher Regina Celia Fiorati, MSc, PhD
Indigenous School Assistant Professor Roseli Esquerdo Lopes, MSc, PhD
Paraty, RJ Department of Health Science Professor
National Museum University of São Paulo Occupational Therapy Department
Federal University of Rio de Janeiro Ribeirão Preto, SP Federal University of São Carlos
Rio de Janeiro, RJ Brazil Metuia Network – Social
Brazil Occupational Therapy
São Carlos, São Carlos, SP
Brazil

vii
viii CONTRIBUTORS

Maria Daniela Corrêa de Macedo, Beatriz Prado Pereira, MSc, PhD Marina Jorge da Silva, MSc, PhD
MSc, PhD Assistant Professor Assistant Professor
Assistant Professor Occupational Therapy Department Occupational Therapy Department
Occupational Therapy Department Federal University of Paraíba Federal University of São Carlos
Federal University of Espírito Santo Metuia Network – Social Metuia Network – Social
Metuia Network – Social Occupational Therapy Occupational Therapy
Occupational Therapy João Pessoa, PB São Carlos, SP
Vitória, ES Brazil Brazil
Brazil
Paulo Estevão Pereira MSc Carla Regina Silva Soares, MSc
Ana Paula Serrata Malfitano, Brazilian Company of Hospital Occupational Therapist
MSc, PhD Services Department of Physiotherapy,
Associate Professor Rehabilitation Unit Communication Science & Disorders
Occupational Therapy Department Federal University of Triângulo and Occupational Therapy,
Federal University of São Carlos Mineiro University of São Paulo
Metuia Network – Social Uberaba, MG Metuia Network – Social
Occupational Therapy Brazil Occupational Therapy
São Carlos, SP São Paulo, SP
Brazil Nick Pollard, MA, MSc, PhD Brazil
Senior Lecturer
Gustavo Artur Monzeli MSc, PhD Occupational Therapy and Letícia Brandão de Souza
Assistant Professor Vocational Rehabilitation Occupational Therapist
Occupational Therapy Department Department São Carlos, SP
Federal University of Paraíba Sheffield Hallam University Brazil
Metuia Network – Social Sheffield
Occupational Therapy United Kingdom Elizabeth Ann Townsend, MA, PhD
João Pessoa, PB Professor Emerita
Brazil Debbie Laliberte Rudman, MSc, PhD Occupational Therapy Department
Professor Dalhousie University
Aline Cristina Morais, MSc Occupational Therapy Department Halifax, Nova Scotia
Occupational Therapist University of Western Ontario, Canada
Municipal Secretary of Social London, Ontario Adjunct Professor
Services Canada Faculty of Education
Franca, SP University of Prince Edward Island
Brazil Carolina Donato da Silva, MSc Charlottetown, PEI
Occupation Therapist Canada
Livia Celegati Pan, MSc, PhD Albert Einstein Israelite Hospital
Assistant Professor São Paulo, SP Inés Viana-Moldes, MSc, PhD
Occupational Therapy Department Brazil Associate Professor
Federal University of São Carlos Health Sciences Department
Metuia Network – Social Carla Regina Silva, MSc, PhD University of A Coruña
Occupational Therapy Assistant Professor A Coruña
São Carlos, SP Occupational Therapy Department Spain
Brazil Federal University of São Carlos
São Carlos, SP
Brazil
 CONTENTS

Foreword, xi 11 School and Youth: Contributions of Social

Preface, xiii Occupational Therapy, 112
Roseli Esquerdo Lopes, Carla Regina Silva,
and Patrícia Leme de Oliveira Borba
SECTION 1 Conceptual Outlines: Colors
and Textures 12 Social Occupational Therapy, Offenses, and
School: Complex Plots in Fragile Relations, 123
1 Citizenship, Rights, and Social Occupational Patrícia Leme de Oliveira Borba, Beatriz Prado Pereira,
Therapy, 1 and Roseli Esquerdo Lopes
Roseli Esquerdo Lopes 13 Social Occupational Therapy and the Eradication
2 Social Occupational Therapy in Brazil: A Historical of Child Labor in Brazil: The Challenge of
Synthesis of the Constitution of a Field of Articulating Social Protection and Autonomy, 133
Knowledge and Practice, 11 Carla Regina Silva Soares and Marta Carvalho de Almeida
Sandra Maria Galheigo 14 Informing Social Occupational Therapy: Unpacking
3 Occupational Therapy and Socioeconomic the “Social” Using Critical Social Theory, 143
Processes, 22 Debbie Laliberte Rudman
Maria Izabel Garcez Ghirardi, Ana Paula Serrata Malfitano, 15 Occupational Therapy on The Move: On
Roseli Esquerdo Lopes Contextualizing Citizenships and Epistemicide, 151
4 Occupational Therapy: Social, Cultural? Diverse Nick Pollard, Inés Viana-Moldes, Hetty Fransen-Jaïbi,
and Multiple!, 29 and Sarah Kantartzis
Denise Dias Barros and Debora Galvani
5 Social Context and Social Action: Generalizations SECTION 2 Sketches and Scenarios
and Specificities in Occupational Therapy, 48
Ana Paula Serrata Malfitano Theoretical, Practical, and Contemporary
Scenarios in the Metuia/UFScar Experiences of
6 Occupational Therapy in the Context of Social
Developing Social Occupational Therapy, 164
Protection Expansion, 57
Roseli Esquerdo Lopes and Ana Paula Serrata Malfitano
Luciana Assis Costa
16 Resources and Technologies in Social
7 Occupational Therapy and Social Assistance:
Occupational Therapy: Actions with Poor
Building a Critical Thinking about the Field, 69
Urban Youth, 169
Marta Carvalho de Almeida and Carla Regina Silva Soares
Roseli Esquerdo Lopes, Ana Paula Serrata Malfitano, Carla
8 The Theory of Communicative Action: A Regina Silva, and Patrícia Leme de Oliveira Borba
Theoretical-Methodological Contribution to Social
17 Social Occupational Therapy in School:
Occupational Therapy, 80
Experiences with a Student Association, 177
Regina Célia Fiorati
Lívia Celegati Pan
9 Citizenship and Cultural Diversity in Management
18 The Caravan for the Promotion of Rights:
of Cultural Policies, 91
Disseminating and Discussing the Child and
Patricia Silva Dorneles and Roseli Esquerdo Lopes
Adolescent Statute (CAS) in Schools, 182
10 Traditional Peoples and Communities: Traditional Letícia Brandão de Souza and Aline Cristina de Morais
Occupation as a Theme of Social Occupational
19 Youth and Education: The Path Constituted by the
Therapy, 101
Nonplace, 187
Samira Lima da Costa, Maria Daniela Corrêa de Macedo,
Carla Regina Silva
and Sandra Benites

ix
x Contents

20 Paths of Life and the Marks of the Juvenile Justice 25 Activity Workshops: Exploring the Use of Digital
System, 191 Media by Brazilian Youths, 212
Patrícia Leme de Oliveira Borba and Beatriz Prado Pereira Rafael Garcia Barreiro
21 Social Occupational Therapy and the Support 26 Under and Between Trees: Social Occupational
Contextures: An Experience Beyond Formal Therapy in a Public Square, 217
Devices, 195 Marina Jorge da Silva
Giovanna Bardi 27 The Planting Has Become a Plantation:
22 Poor Youth and the City: Violated Rights, Denied Germinating Relationships to Sow Ties, 221
Spaces, 199 Carolina Donato da Silva and Letícia Brandão de Souza
Paulo Estevão Pereira
23 Overcoming Invisibility: Carla’s Story, 203 Index, 225
Mayra Cappellaro
24 Social Occupational Therapy, Gender, and
Sexuality, 208
Gustavo Artur Monzeli
 F O R E WO R D

As men [and women] relate to the world by responding to the challenges of the
environment, they begin to dynamize, to master, and to humanize reality.
(Freire, 1989, p. 5)

In Education for Critical Consciousness, Paulo Freire (1989) and researchers anywhere with an educational resource
challenges us “to dynamize, to master, and to humanize for practices that do not rely on medical funding. Medi-
reality” by directing our attention to “the environment.” cal knowledge is integrated with social, economic, politi-
Social Occupational Therapy takes up that challenge, inspired cal science, and other knowledge to guide occupational
by creative thinking, actions, and nonmedical funding. therapists as leaders and partners taking action on social
With examples from Brazil, the book asserts a radical call challenges. Instead of illustrating practices that aim
for occupational therapists around the world to practice mainly to restore the mind and body in health care
in social contexts with funding beyond health services. systems, Social Occupational Therapy focuses on the en-
The key strategy is to develop practices with populations, vironment as an integrated force in everyday life. Here,
communities, and groups more than with individuals. the environment is not viewed as an abstract idea or an
The phrase “social occupational therapy” is fairly new, inanimate object. Rather, the stories here show how the
although I see ALL occupational therapy practices as real lives of poor youth, children in conflict with the law,
inherently social. We cannot practice any occupational and issues of sexuality, for example, are shaped by and
therapy effectively in any country without knowing the shape the environment. Readers will see in the 10 stories
environment in which people work, play, plan, grow, and how the environment is embedded in everyday life and is
adapt to life challenges. Where people cannot participate simultaneously social, cultural, economic, political, geo-
in society or have nothing meaningful to do, for example, graphic, and historical. The examples will help readers to
this book shows how occupational therapists can address think about ways of helping people to develop their ca-
social problems, especially where there is funding support pabilities instead of being frozen, seemingly unable to act
beyond health services. in everyday life. In other words, Social Occupational
The inherent social nature of occupational therapy has Therapy takes an activist view of occupational therapists
drawn me to support this book with great enthusiasm. as leaders and partners who engage people in changing
I love the 10 stories that point to the social relevance of their lives.
global life issues and practical occupational therapy actions The ideals and practices described in Social Occupa-
that can be adapted in any country. Social Occupational tional Therapy revive early aims in the founding of this
Therapy is a bold text, prompting education for critical profession virtually everywhere in the world. Occupational
consciousness for occupational therapists to learn from therapy education and practices have arisen typically where
Brazil how to be a creative, highly practical profession. How there have been veterans of war or people struggling to live
lovely it is for Brazil to lead the way. The examples show with chronic disease or disability resulting, for instance,
how occupational therapists anywhere can advance the from polio. Some early occupational therapy practices
humanizing reality of everyday life. Readers will find an were highly social, such as establishing children’s early
integration of theoretical designs and practical actions that development programs, setting up vocational training for
demonstrate how funding and partners outside health adults with disabilities, and advocating for services when
services enable us to work with poor youth, territorial work, older people are isolated with too little support. To me, the
public schools, the “Estatuto da Criança e do Adolescente” authors of Social Occupational Therapy are capturing not
(Brazilian law about children and adolescents), youth, and only the historical promise but also the untapped future
conflicts with the law, drugs, gender, and sexuality. for occupational therapists.
One reason that I’m strongly attracted to this book is The focus on social occupational therapy reminds me
because it challenges the Western medicalization of oc- of stories that inflamed my imagination when I started my
cupational therapy. Social Occupational Therapy provides career as an occupational therapist more than 50 years ago.
students, educators, occupational therapy practitioners, I was drawn unconsciously to work with populations,

xi
xii FOREWORD

communities, and groups, not only with individuals. And I theories and practices that make occupational therapy
was driven to explore solutions where people’s daily lives uniquely relevant to today’s societies everywhere!
were deprived, alienated, marginalized, oppressed, or oth-
erwise restricted in a range of social contexts—what we Elizabeth Townsend
now call occupational injustice. I feel that this book ad-
vances my dream for a profession that has so much more
to offer than we have seen in the world to date.
I applaud the authors for their celebration of what I see
REFERENCE
as the heart and history and future of occupational ther- Freire, P. (1989). Education for critical consciousness. New York,
apy. May readers use this book to bring forth the social NY: Continuum.
 P R E FAC E

Gathering the theoretical assumptions and practical and realities. This situation directed the professional paths
propositions arising from social occupational therapy in of occupational therapy beyond functional rehabilitation
Brazil has significant value to us because it represents our and the pursuit of therapeutic activity (Lopes, 2004;
collective work since the late 1990s, when a specific context Nascimento, 1990).
motivated occupational therapists, academics, professionals, The expansion of the professional field initially arose
and researchers to address issues arising from the “social from discussions about the limitations of the biomedical
question.” This material was originally published in perspective in occupational therapy; although its relevance in
Portuguese by the Federal University of Sao Carlos Publisher the profession is acknowledged, this perspective is incapable
(EdUFSCar) with support from the São Paulo Research of representing occupational therapy in its totality. This issue
Foundation (FAPESP) in 2016. The first version of the was a subject of discussion in the late 1970s and early 1980s,
book consisted of reflections from occupational therapy with advocacy for an occupational therapy that was politically
researchers and professionals representing various higher committed to its target population (Lopes, 1990). The debate
education institutions in Brazil, as well as former master’s was influenced by authors such as Antonio Gramsci (1988),
and doctoral students in the “Social Networks and Vulner­ Franco Basaglia (1979), Franco Basaglia and Franca Basaglia
abilities” line of research of the graduate studies program in (1977), and Paulo Freire (1970), among others, who
occupational therapy at the Federal University of São Carlos encouraged questioning of the social function of professionals,
(PPGTO/UFSCar), a pioneering program in Latin America. pointing out the relevance of the contexts and the pre­sence or
This English edition broadens the symbolic value of this absence of rights, justice, and social injustice as elements
work by expanding the dialogue around occupational inherent to occupational therapy practice. Since then,
therapy, sending it worldwide. Brazilian occupational therapy has recognized that “the
The Brazilian account begins in the mid-1950s, when social” should be present in the practice of all occupational
occupational therapy courses were first created in the states therapists and that it should occupy different levels of
of Rio de Janeiro and São Paulo. These courses were directed centrality depending on each particular set of actions.
at the education of “rehabilitation professionals,” especially In the context of the “Global North,”1 where the voices
physical and occupational therapists, based on agreements that dominated (and still dominate) occupational therapy
with the United Nations (UN) and UNICEF. These courses worldwide originated, such discussions pervaded what was
adhered to the framework of health rehabilitation in a broad termed the “renaissance of the paradigm of occupation”
sense, although they were quite focused on rehabilitation (Kielhofner, 1992). For some of these voices, the central
after work-related injuries, understood from the perspective concern lay in the need for occupational therapy (and
of physical disability. A psychiatric dimension was also occupational therapists) to address the occupations
included, and both types of rehabilitation aimed to restore performed by people, encompassing their social
people to life in occupations (Lopes, 1990; Soares, 1991). perspectives (Townsend, 1993), and not “only” their duties
This rehabilitation-oriented axis was (and remains) and/or performances. Whiteford, Townsend, and Hocking
important and controversial for Brazilian occupational (2000), who drew on postmodernism as a theoretical
therapists, their identity, and professional practice, which framework, discussed the relevance of this idea on the
sometimes focuses on the function itself, sometimes on the grounds that it contributes to approaching the relations of
occupational function and/or occupational performance power, diversity, and institutional issues, which are part of
(Barros, Galheigo, & Lopes, 2007). occupational therapy practice. They associated the
It is difficult to reconstruct the history of occupational renaissance of occupation as the profession’s central
therapy in Brazil prior to the 1980s, the time of its concept with the history of occupational science and its
professionalization, which effectively occurred in the late commitment to challenging forms of capitalist hegemony
1970s. For most occupational therapists at that time, it was that generate inequalities or, in their words, “occupational
essential to develop a local point of reference, that is, to deprivation.” In addition, discussion about the contexts of
consider the demands and realities surrounding them in
their Brazilian context. As a consequence, a specific 1
The “Global North” refers to a group of capitalist countries that
occupational therapy was designed, with its own vocabulary, dominates the world economic order, which includes the
based on practices that addressed those particular demands sociocultural dimension (Lewis, Dwyer, Hodkinson, & Waite, 2015).

xiii
xiv PREFACE

injustice and their influence on people’s occupations was occupational therapy in this process2 and, on the other
highlighted, leading to proposal of the term “occupational hand, fostered a uniquely Brazilian path in the local history
justice” (Wilcock & Townsend, 2000), which has influenced of the profession, especially for those occupational therapists
diverse practices among occupational therapists (Malfitano, linked to a critical perspective. Along the way, the word
Souza, Townsend, & Lopes, 2019). Therefore, while the “activity” predominated among occupational therapists in
occupational paradigm was central to discussions about Brazil (Magalhães & Galheigo, 2010). More recently, the
occupational therapy practice in the Global North, for some term “cotidiano” (which translates into “everyday life,”
researchers, it also represented tensions and demands to be although not having the same meaning) has been used in
explained critically. theoretical publications and professional practices in Brazil
Thus, it should be noted that the moment, the period, (Galheigo, 2020). In this context, the chapters that compose
the paths, and the theoretical influences shaping discussion this book make little use of the term “occupation,” with
about the identity of occupational therapy in both Brazil “everyday life” (cotidiano) being more frequent.
and the Global North were diverse, albeit addressing similar Recently, the word “occupation” has become more
concerns about the need for the field to go beyond widespread in Brazilian occupational therapy. It is
biomedical intervention models. However, when we analyze hypothesized that its increased use is attributable to a
the Brazilian context, it is worth pointing out the specificity greater dialogue between Brazilian occupational therapy
of occupational therapy vocabulary to its local historicity. researchers and researchers around the world, which has
The literature clearly shows that the return to the use of the occurred because of the greater academic institutionalization
term “occupation” in occupational therapy in the Global of this field in Brazil and the consequent demands and
North was marked by the broadening of a critical perspective interests involving the internationalization and circulation
for the profession (Whiteford et al., 2000). In contrast, of national knowledge production. However, some Brazilian
critical perspectives followed other paths in Brazil, where researchers still have reservations on the grounds of the
the word “occupation” retained its pejorative sense. On the importance of maintaining the historicity and relevance of
one hand, it was associated with the notion of work (for local developments and the necessary concern for academic
which it is a synonym), and its practitioners were therefore dialogues not becoming new colonizing processes within
tasked with rehabilitating/enabling people with formal or this area of knowledge, through the de-historicized and
informal work-related disabilities or injuries (Soares, 1991). decontextualized assumptions of some concepts.
On the other hand, it was associated with alienation, In Brazil, in addition to the debate around the health–
especially with processes related to “moral treatment” in disease dichotomy and the unsustainable individual-society,
psychiatric institutions like asylums, where occupational individual–nature, and individual–culture dichotomies, occu­
therapists were responsible for keeping patients occupied pational therapy has moved toward discussing professional
without disturbing the institutional order (Nascimento, practice specifically intended to address social needs. These
1991). This understanding of occupational therapy remains needs cannot, or should not, be tied to theoretical and
prevalent when it is understood as an approach for therapeutic principles applicable in health contexts. To
difficulties and resistance that are encountered in the approach specifically social needs, some Brazilian occu­
context of a “total institution” (Goffman, 1961). pational therapists designed and developed what we call
Therefore, the word “occupation” has not undergone its “social occupational therapy.” Social occu­pational therapy
“renaissance” in the historical development of Brazilian refers to politically and ethically framed professional actions
occupational therapy; on the contrary, it has been linked to that target individuals, groups, or systems to enable justice
negativity or coercion, associating professionals with and social rights for people in disadvantageous social
processes that alienate people. Thus, the word assumes a conditions (Barros, Ghirardi, & Lopes, 2005).
pejorative meaning among Brazilian occupational Brazilian social occupational therapy developed from two
therapists, notably those who struggled to separate their complementary theoretical perspectives. The first had the
professional practices from alienation processes, seeking, analysis of social processes as a parameter, especially from the
in contrast, means of mediating emancipatory actions. For late 1970s to the mid-1980s, a time of heightened unrest
this reason, some aversion to the term “occupation” was, regarding the demands of the social question in Brazil.
and still is, quite present. This process arose from the capital–labor relations, as well
Nevertheless, it is necessary to consider the language as from the construction of the public sphere mobilized by
barrier that shut out Brazilian occupational therapy from civil society, during a period of political opening and
the debates occurring in Anglo-Saxon countries in the early
2000s. This fact, on one hand, led to a lack of participation 2
According to the British Council (2014), 5.1% of the Brazilian
because English was not the language being used by population over 16 years old has some knowledge of English.
 PREFACE xv

democratization of Brazil, in the struggle to end the of research, integrating and supporting the first stricto
dictatorship imposed by a military coup d’état in 1964. The sensu graduate studies program in occupational therapy in
Brazilian state, which was in a process of transformation South America in 2009. This was the PPGTO/UFSCar,
rooted in the struggle arising from social movements, was which had master’s and doctoral courses implemented in
founded on democratic and legal perspectives, within the 2010 and 2015, respectively. The objects of study in this
limits of capitalism. This process, which involved review of line of research are occupational therapy interventions
professional postulates, reached different segments of with socially vulnerable populations and the development
society, including occupational therapists. Professionals’ of social technologies of inclusion, participation, and
responsibilities in shaping social values were discussed, as autonomy, which intersect with social themes such as
well as how to consciously exercise a political role within poverty, social policies, urban occupation and mobility/
their practice, deciding between consensus and dissent, circulation, cultural identity, access to social services
and also participating politically in the struggle for (health, education, culture, social assistance, justice, etc.),
hegemony (Gramsci, 1988; Lopes, 1993/1996). This review and entry into the labor market, among others. This
of professional practice fostered questions, propositions, research program has been developing studies focusing on
and a theoretical perspective that underpinned social socially vulnerable children and adolescents, contemporary
occupational therapy (Barros, Ghirardi, & Lopes, 2002). youth, homeless populations, the inclusion and social
The second perspective stemmed from the questioning participation of people with disabilities and mental
of medical-psychological knowledge. Its reductionist ways disorders, and the generation of income and value in
of understanding and dealing with phenomena that relation to the world of work.
were categorized within the “health–disease” dichotomy After more than 15 years of activity at the METUIA
was problematized, based on the disciplinization and Laboratory in the Department of Occupational Therapy at
institutionalization of social problems—that is, because UFSCar, we felt an obligation to organize the knowledge we
they are bounded by certain dominant values aimed at were producing, in the form of a book, to stimulate dialogue
controlling and suppressing the freedom of people, both at a national level. The book materialized in 2016. Now, after
individual and collective (Barros, Ghirardi, & Lopes, 1999). more than 20 years of university teaching, research, and
There was discussion about how much the medical/ extension activities at the METUIA/UFSCar Laboratory, and
psychological/clinical disciplines were impregnated with as a result of our efforts to bring Brazilian social occupational
these values, with strong influence from psychiatry, as therapy into dialogue with other occupational therapies
well as various psychological approaches, which offered a worldwide, we were urged to expand the circulation of our
series of propositions that shaped professionals’ actions. book by translating it. This is how this project arose4 and
Therefore, it was necessary to adopt concepts relating to developed, with the hope of contributing to ongoing
the dynamics of social negotiations, to incorporate relevant reflections on critical perspectives in occupational therapy
sociological and anthropological theories into occupational worldwide, from the Brazilian theoretical and practical
therapy, and to invest in individual and collective actions experiences, specifically those that have been configured
that were informed by transdisciplinary, interprofessional, based on social occupational therapy. Twenty-six Brazilian
and intersectoral perspectives. In short, there was a need to occupational therapists, all involved in teaching and research
define what was meant by “action” in the social field and in in social occupational therapy, have contributed to this
social occupational therapy (Barros et al., 2007). book. For this edition, we also invited five colleagues of
Thus, there was opportunity for dialogue on the creation, different nationalities to grow this “conversation” with us, in
proposal, and analysis of practice in the social field. This addition to the foreword by Elizabeth Townsend (already
began to be carried out with a sense of urgency in Brazil in the present in the Portuguese edition of 2016).
late 1990s, specifically from 1998, when occupational therapy This translation work has not been simple. It not only
academics in the state of São Paulo created the Metuia Project, involves a literal translation of the text from Portuguese to
actually named by Metuia Network – Social Occupational English but also gives rise to different cultural forms of
Therapy.3 Since then, reflections, debates, proposals, and verbal and written expression of arguments and rationalities,
social appeals related to inequalities have been intense. providing them with consistency in another language.
A great deal of this work, within the realms of both Therefore, it is important to say that the book is not “easy”
teaching and research, served as a foundation for the to read in its English version because, although we have
creation of the “Social Networks and Vulnerabilities” line
4
We would like to thank Elizabeth Townsend for strongly encouraging
3
Metuia is a word from the native Brazilian language of the Bororo us to believe in the viability of this project. Her determination and
ethnic group that means friend, companion. encouragement have helped us achieve this publication.
xvi PREFACE

conducted a careful process aimed at better translations, we 2018; Ramugondo & Kronenberg, 2015; Whiteford, Jones,
have chosen to maintain some words, some rationalities, Rahal, & Suleman, 2018). Thus, references to everyday life
and the historicity of Brazilian occupational therapy in this book encompass a broad understanding of the
(specifically social occupational therapy), believing that social, historical, economic, and cultural contexts of the
they are essential elements of the theoretical and individuals and groups that occupational therapists work
methodological frameworks herein presented. with5 and the forms of individual and collective
This process included authors reviewing and updating participation they engage in.
the Portuguese versions of their chapters, translation into Another word that is difficult to translate is “sujeito,”
English by a Brazilian professional, linguistic revision which has been translated as “people.” In Portuguese, there
by a native English-speaking professional, review by are two ways of speaking of individuals: a word that is
occupational therapy researchers domiciled and/or with strongly concerned with individual aspects (indivíduo) and
professional experience in English-speaking countries to another that encompasses an association of individual and
suggest modifications to better enable understanding, and collective issues (sujeito). However, in the context of social
then a final proofreading of the chapters prior to being sent occupational therapy, we are concerned with both individual
to the publisher. We would like to thank the translation and and collective issues. Trying to approach this meaning, we
proofreading professionals who have helped us considerably have used people. Such debate is supported by theoretical
and who, although working in the field of language, are now contributions drawn from different lines of research (Spink,
much more knowledgeable about social occupational 2011), but this is not our focus here. In this book, due to the
therapy. We are also very grateful to the occupational impossibility of using the second definition (individual and
therapy researchers (whose names are listed as collaborators collective subjects/people), which frequently appears in the
to this book) for their availability and generosity in reading original version of the texts, the expression “individuals and/
the texts and thus assisting us in achieving a greater or people” is used in some passages in an attempt to include
understanding of our work. Finally, we have added two the collective dimensions in themes and/or practices in
chapters written by colleagues of other nationalities, occupational therapy. This demarcation is relevant to us to
demonstrating our ongoing dialogue. However, despite this the extent that social occupational therapy includes the
process, we recognize that there are limitations to commu­ inseparability of micro- and macro-social dimensions as one
nication, which may generate difficulties in understanding. of its assumptions. In other words, it would be contradictory
We therefore count on the willingness of the readers to speak of individuals when we focus, centrally, on economic
interested in accompanying us on this journey to enter into inequalities and the consequent impediments those
dialogue with us and the ideas discussed. inequalities pose to participation in social life. Therefore, the
To support this dialogical reading and facilitate collective dimension of social life is embedded in the
understanding, we would like to introduce some frequently references made here to individuals and/or people.
used words. The first point refers to the aforementioned Some terms in this book are seldom used in the English
discussion of the term “occupation,” its historicity, the language or are used differently: for example, “territory”
reasons for its limited use in Brazil, and the preference for and “life sharing.” The word “territory” is associated with
the word “cotidiano.” Cotidiano was translated herein as the place, the community in which actions are carried out,
“everyday life,” based on the work of Agnes Heller, a as opposed to closed institutional settings. According to
Hungarian philosopher who focused on defining this term Santos (1979, 2007), a Brazilian geographer and intellectual,
based on dialectical historical materialism in a study with the concept of territory is hybrid and is understood as the
the English title Everyday Life (Heller, 1984). The concept “used territory,” which means a geographical space shaped
of cotidiano has been adopted by occupational therapists in by historicity, social and material relations, and the use
Brazil since the 1990s, based on critique of practices that that people make of it in their everyday lives. As for
narrowly focus on an individual’s life and take an “community,” according to the theoretical proposition of
instrumental and technical perspective, ignoring other
aspects of life. Studies addressing cotidiano incorporate
“subjectivity, culture, history and social power as elements 5
We present here an informal conversation we had the opportunity
that influence the understanding of the phenomenon;
to have with Ann Wilcock in 2019, when she told us about the
they definitely break with any more positivist reading” relevance of discussions coming from occupational therapy in
(Galheigo, 2003, p. 107). From our perspective, there is a South America and the need to further discuss our vocabulary
dialogue between what we understand here as “everyday and possibilities for understanding occupational therapy practices
life” and the notion of “occupation” used in the Anglo- critically and with social responsibility. Specifically, she referred to
Saxon literature (Dickie, Cutchin, & Humphry, 2006; cotidiano and the possibilities of incorporating these elements
Fogelberg & Frauwirth, 2010; Laliberte Rudman, 2013, into occupational therapy.
 PREFACE xvii

community psychology, it is defined as a historical social subarea of social occupational therapy. She articulates
group under constant transformation and evolution, concepts that were central to her academic trajectory,
interconnected by a sense of belonging and social identity, detailing the unfolding, in concrete reality, of what is
with common interests, needs, and sometimes organization understood as social needs, professional actions, and the
(Montero, 2004). Therefore, territorial (and community) role of occupational therapists. From the fundamentals of
work in social occupational therapy refers to practices “citizenship and rights,” she, in an academic partnership
conducted in the streets, in people’s homes, in the with colleagues in the area, seeks to support what is defined
community, at school, in health and social assistance as “social occupational therapy.”
services, and in other real life spaces of people. Hence, In Chapter 2, “Social Occupational Therapy in Brazil: A
territorial practice necessarily includes that the professional Historical Synthesis of the Constitution of a Field of
be available in places that have meaning for people, in the Knowledge and Practice,” Sandra Maria Galheigo highlights
territories where their lives are constituted. some historical notes on the constitution of social
When in the territory, one of the goals of occupational occupational therapy, examining its emergence in Brazil in
therapists working from a social occupational therapy the 1970s. Arguing that this is knowledge of the “South,”
perspective is to develop spaces for life sharing, which with local theoretical-epistemological roots, she claims
requires facilitating different actions, both individual and that social occupational therapy supports its ethical-
collective. Life sharing occurs through relationships political commitment through sensitively listening to the
between individuals and is necessary to staying together, as individuals and collectives with whom it develops projects
long as the people involved have a shared regard for each and by adopting a critical perspective of social and political
other, contextualizing the historical moment and their contexts. At the intersection of sensitivity, ethics, and
choices for the production and reproduction of social life. politics, permeated by a critical approach, she writes in
According to Freire (1988), living together is a collective dialogue with Lopes’ text, defending autonomy, citizenship,
learning process that should involve aspects of social and law, searching for new strategies to construct and/or
consciousness. Therefore, the work of occupational strengthen the collectives.
therapists aims to foster spaces where experiences and ways Maria Isabel Garcez Ghirardi, with coauthors Ana Paula
of being are shared, where solidarity can be woven into life. Serrata Malfitano and Roseli Esquerdo Lopes, in Chapter 3,
The development of social occupational therapy workshops “Occupational Therapy and Socioeconomic Processes,”
has had this objective of bringing people together and defends the fundamentals of social occupational therapy,
discussing projects, weaving solidarity through activities in which are anchored in collective actions aimed at creating
a joint and shared way. Inspired by the Brazilian poet conditions of democratic intensification and social
Mário Quintana (2006), we can speak of the art of creating integration in response to the problems exposed by the
life-sharing spaces: “The art of living is simply the art of life thinning of the social fabric. In contrast to clinical and
sharing.… I said it simply? But it’s so hard!” (A arte de viver individual practices, they emphasize that collective doing is
é simplesmente a arte de conviver… simplesmente, disse eu? an essential element of social occupational–therapeutic
Mas como é difícil!). Certainly, there are other terms used in action. Based on a university extension project and research
this book that may cause some surprise to the readers; experience developed with the support of an economic
however, we have highlighted those identified by our enterprise working with the homeless population, the
collaborators as the most difficult to understand, hoping authors illustrate the challenges of creating instruments that
that they can be read beyond their literal translation. assist with social participation and activate trust in
The scientific outputs contained in this book bear the themselves and others, by constructing a place of collective
marks of the present time, and one of those is the diversity of belonging that values know-how regarding economically
theoretical influences permeating the field. The 27 chapters relevant productions in the market of goods and cultural
presented here in two sections are a sample of the thematic values.
and epistemological pluralism that currently characterizes Denise Dias Barros and Debora Galvani, in Chapter 4,
research in social occupational therapy. Section I, entitled “Occupational Therapy: Social, Cultural? Diverse and
“Conceptual Outlines: Colors and Textures,” is composed of Multiple!” describe an array of experiences developed
15 chapters arrayed along an axis encompassing different between social and cultural issues, weaving a mosaic of
theoretical perceptions and practical formulations. populations, approaches, and discussions that demand that
Roseli Esquerdo Lopes, in Chapter 1, “Citizenship, social occupational therapists deal sensitively with various
Rights, and Social Occupational Therapy,” presents her populations who are frequently othered. With contributions
thoughts derived from a lecture given during her from anthropology and urban sociology, they highlight the
application for the position of full professor at the need for reflection on methodologies in social occupational
Occupational Therapy Department at UFSCar, in the therapy, designing a plurality of theoretical-methodological
xviii PREFACE

perspectives for the construction of actions and social as a profession shaped by capitalist policies to address
technologies. problems that have been produced historically, often by
Ana Paula Serrata Malfitano, in Chapter 5, “Social capitalist policies. In this macro-social path, the authors
Context and Social Action: Generalizations and Specificities also present this process in Brazil, which culminated in
in Occupational Therapy,” brings to the debate a question recognition of occupational therapy as one of the professions
that is always present in occupational therapy: is the social qualified to work in the social assistance sector. This process
in everything? In agreement with Sandra Galheigo, who has been of great relevance in encouraging occupational
claims that the bases of social occupational therapy are therapists to work in spaces beyond the health and education
unambiguous, she discusses the social context as an sector, bringing other challenges.
overarching element that should be present in every Regina Célia Fiorati presents a dialogue between Jürgen
occupational-therapeutic practice. Based on this recognition, Habermas’ theoretical framework and social occupational
the author describes the specificities of developing a social therapy in Chapter 8, “The Theory of Communicative
occupational therapy under the principle of social law, Action: A Theoretical-Methodological Contribution to
committed to expanding access to social goods for all Social Occupational Therapy.” The author conceives
through technical, ethical, and political work. possibilities grounded in the concepts of communicative
According to Luciana Assis Costa, it is not possible action, dialogicity, intersubjectivity, democracy, and
to separate social occupational therapy from the trans­ emancipation as, for instance, in the promotion of service
formations of Brazil’s political regime and corporate networks, named “decision-making forums.” She highlights
organization, which resulted from the democratic opening. that social occupational therapy presents a basis for the
In the course of that process, the issue of social inequality development of technologies that focus on the expansion of
and poverty was placed on the political agenda as a democratic spaces for individuals, groups, and communities.
problem of the state and law. The expansion of occupational In Chapter 9, Patrícia Dorneles and Roseli Esquerdo
therapy practice to deal with social problems emerged in Lopes propose “Citizenship and Cultural Diversity in
the paradox constituted by the process of reinstating Management of Cultural Policies.” For these authors,
democracy. On one hand, it celebrates the extension of cultural diversity and cultural citizenship are diffuse
citizenship rights, especially in the political and social emerging concepts that intersect with the agendas of
spheres of life; on the other hand, it faces a developmental current policies in this sector in Brazil. Cultural policies
trajectory of the state with strong liberal traits, marked by that are presented as democratic are charged with
a historical social debt, sustained by extreme inequality responsibility for interrupting processes of exclusion
and poverty. In Chapter 6, “Occupational Therapy in the caused by traditional Eurocentric and elitist views of art
Context of Social Protection Expansion,” Costa discusses and culture, as well as assimilationist political practices
the sociopolitical conjuncture in which the problem of associated with neoliberal globalization. With a view to
poverty and social exclusion is shaped, to consider the fostering and ensuring respect for people of all cultures
possible contributions of occupational therapy to this area. and, horizontally, the broad concept of cultural diversity
The proposal to synthesize our knowledge of occu­ and the more localized concept of cultural citizenship,
pational therapy practice in Brazilian social assistance commitments and efforts to reorganize investment and
opens a wide range of possibilities, considering the challenge promotion proposals in the field have been initiated by
of qualifying the debate and preparing professional public cultural managers at different levels. The authors try
interventions in this field. There are many possible ways. In to contextualize the theme of cultural public policies
Chapter 7, “Occupational Therapy and Social Assistance: within citizenship and cultural diversity, reflecting on the
Building a Critical Thinking About the Field,” authored by possibilities of occupational therapy practice in the area of
Marta Carvalho de Almeida and Carla Regina Silva Soares, culture. The paths for such action have been associated
the direction chosen prioritizes the gathering of themes with social occupational therapy and its current paradigms.
that enable a foray into some social processes that affect Continuing with the theme of culture, along with the
professional practice in the social field. The authors privilege different theoretical currents related to the concept of
a narrative path that understands social assistance as a set of tradition, Samira Lima da Costa, Maria Daniela Corrêa de
actions supporting the general plan of the political and Macedo, and Sandra Benites-Guarani Nhandewa work on
historical development of social interventions. That narra­ this concept from the perspective of collective meaning built
tive makes it opportune to discuss the emergence and in time and space and legitimized by a particular group. The
development of social policies in the context of capitalist authors understand that, in tradition, there is always something
socioeconomic formations, marked by the contradictions that changes and something that remains, so what changes
of this production mode. Occupational therapy, a profession supports the maintenance of what remains within a code of
that also emerged within these contradictions, is approached meaning for a given collective. In Chapter 10, “Traditional
 PREFACE xix

Peoples and Communities: Traditional Occupation as a to tackle child labor, with actions involving different social
Theme of Social Occupational Therapy,” they consider sectors and movements; the executive, legislative, and
occupation as the various everyday actions that people perform judiciary powers; and participation of the national, state, and
individually and collectively. The authors propose a reading of municipal management levels. In Chapter 13, “Social
traditional occupation as an object of interest in social Occupational Therapy and the Eradication of Child Labor in
occupational therapy. Traditional occupation is presented as a Brazil: The Challenge of Articulating Social Protection and
relevant element in the organization of the lives of collectives Autonomy,” Carla Regina Silva Soares and Marta Carvalho de
known as traditional peoples and communities, in their Almeida highlight those policies linked to the National
relationships with each other, work, and nature. Program to Eradicate Child Labor. In 2005, this program was
Roseli Esquerdo Lopes, Carla Regina Silva, and Patrícia integrated into the Unified Social Assistance System (SUAS), in
Leme de Oliveira Borba contextualize relevant experiences which occupational therapists work. These professionals have
in social occupational therapy when working with youth: been striving to contribute to the development of strategies
the school space and, especially, the public school. They and the implementation of actions that promote the social
understand public school as a privileged setting for protection of children and adolescents who are experiencing,
occupational therapy practice. It is a setting that, in Brazil or have experienced, early work situations, in conjunction with
and many other parts of the world, has begun the those aimed at family autonomy and emancipation. They seek
21st century demanding contributions from different to enhance the ability of families and communities to achieve,
professions, including occupational therapy, since one of produce, and sustain a decent everyday life, as well as to
its basic dilemmas has not been solved: how to be a school promote the rights of children and adolescents.
for the masses while responding effectively to collective Finally, there are two chapters written by authors
and individual demands. Moreover, how can education who have become important interlocutors for social
concerned with human emancipation be promoted, that is, occupational therapy. Debbie Laliberte Rudman, in
with the priority of developing the intellectual and cultural Chapter 14, “Informing Social Occupational Therapy:
autonomy of the people? Despite all the historical and Unpacking the ‘Social’ Using Critical Social Theory,”
contemporary dilemmas inherent in the educational addresses the relevance of a dialogue between occupational
setting, it should be affirmed and reaffirmed that the therapy and critical social theories. She points out the
public school is an indispensable part of society and a existence of an ethical imperative in contemporary times
priority partner, because it is where the vast majority of through the development of professional practices that
children and adolescents are. Public school is the focus of combat individualism and question the possibilities for
these considerations in Chapter 11, “School and Youth: social transformation, moving toward an occupation-
Contributions of Social Occupational Therapy,” in which based social transformation. It is in this context that the
the authors consider the essential elements of actions author contextualizes social occupational therapy, placing
based on social occupational therapy developed within this us in dialogue with other initiatives that function under
institutional structure. such perspectives in occupational therapy internationally.
Staying on the theme of school, Patrícia Leme de To close this section, Nick Pollard, Inés Viana-Moldes,
Oliveira Borba, Beatriz Prado Pereira, and Roseli Esquerdo Hetty Fransen-Jaïbi, and Sarah Kantartzis, who are members
Lopes present a study conducted with three adolescents of the citizenship project group of the European Network of
whose offences were the result of unruly acts occurring Occupational Therapy in Higher Education (ENOTHE),
within a public school. Their experience reveals the present Chapter 15, “Occupational Therapy on the Move:
existence of complex relationships and the fragility of On Contextualizing Citizenships and Epistimicide,” closely
possible supports at a certain time in their lives, both dialoguing with the frameworks that inform social occu­
within the school itself and in the juvenile justice system. pational therapy’s production, such as the concept of citizen­
Informed by the assumptions of social occupational ship. By advocating multiple perspectives that cross Anglo-
therapy and Freire’s concept of education for freedom, in Saxon barriers, the authors defend territoriality and the need
Chapter 12, “Social Occupational Therapy, Offenses, and for locally rooted knowledge, as we believe Brazilian
School: Complex Plots in Fragile Relations,” some possible occupational therapy has been doing. In the necessary
contributions to occupational therapy are outlined in the debate on citizenship, capitalism, and processes of colo­
dialogue between the social assistance and education nialism, they advocate the link between occupational therapy
sectors. There is a focus on conducting individual and and citizenship as an ethical and moral responsibility.
territorial follow-ups with students facing vulnerability Section II “Sketches and Scenarios,” presents con­
and difficulties around staying in school. temporary themes that have challenged social occupational
In Brazil, since the 1990s, public policies have been therapy. To this end, it draws on experiences of teaching,
developed in response to international conventions on ways research, and projects developed by the university in
xx PREFACE

partnership with the community, government, and/or pointed out in two chapters. Marina Jorge Silva shares
nongovernmental organizations, called university extension an experience of social occupational therapy in a public
projects. These are experiences developed by the METUIA/ square, and Carolina Donato da Silva and Letícia
UFSCar Laboratory team. Twelve chapters examine themes Brandão de Souza reflect on an experience related to a
of youth poverty, community and territorial work, public community organization to plant trees, a process that
school, the Statute of the Child and Adolescent, offending, strengthened ties.
drugs, the Internet, and gender and sexuality, to discuss With this selection of texts, drawn from the reflections
social relevance, academic knowledge, and professional and individual research of academics or in partnership with
practice. colleagues and alumni, we composed and formatted this
This section begins with Chapter 16, which synthesizes book, hoping that it will be a contribution and a stimulus for
what we have so far proposed as “resources and technologies further and necessary research. We hope that this work can
in social occupational therapy: actions with poor urban broaden the dialogue around the diversity of occupational
youth,” co-authored by Carla Silva and Patrícia Borba. therapy worldwide, based on Brazilian experiences in social
This chapter points out that the importance of social occupational therapy and its commitment to social change,
technologies and the work of social occupational therapists a change that could produce more participation, with more
do not lie in their mere existence but in the fact that the freedom, autonomy, and solidarity.
existence of social technologies is a means for professionals
to help tackle the harmful consequences that stem from Ana Paula Serrata Malfitano
social inequities. and Roseli Esquerdo Lopes
In the context of social occupational therapy experiences
in education, four chapters are presented, addressing public
school, education, and the issue of rights in occupational-
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therapist education]. Revista de Terapia Ocupacional da change: Three contrasting case narratives. Journal of Occupa-
Universidade de São Paulo, 4/7, 27–35. tional Science, 25(4), 497–508. doi:10.1080/14427591.2018.
Lopes, R. E. (2004). Terapia ocupacional em São Paulo – um 1504607
percurso singular e geral [Occupational therapy in São Wilcock, A. A., & Townsend, E. (2000). Occupational terminol­
Paulo - a general and singular way]. Cadernos de Terapia ogy interactive dialogue. Journal of Occupational Science, 7,
Ocupacional da UFSCar, 12(2), 75–88. 84–86. doi:10.1080/14427591.2000.9686470
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 SECTION 1 Conceptual Outlines: Colors and Textures

1
Citizenship, Rights, and Social
Occupational Therapy1
Roseli Esquerdo Lopes

INTRODUCTION without questioning the social structure and its inequali-

This chapter proposes an articulation of the nexus between ties. The implied aim at the root of this question is to insert
“citizenship,” “rights,” and “social occupational therapy.” and reintegrate individuals into their environments with-
This is a central reflection that I have considered in the tra- out questioning the reasons for their exclusion or their
jectory of my work, driven from the unfolding, in concrete resistance to reinsertion. Failure in reintegration attempts
reality, of what is covered by “social needs,” “technical ac- was almost always attributed to the specific difficulties
tions,” and the role of occupational therapists in the social faced by individuals, their chronicity, and the attitudes of
field. Based on the foundations of “citizenship and rights,” I their families and only sometimes to society itself and its
have sought to establish, in academic partnership with some rejection of these individuals, its dismissal of their remain-
colleagues, a definition for “social occupational therapy.” In ing capacities, and its failure to provide them with the
this context, I wish to introduce to the dialogue the searches necessary opportunities (Galheigo, 1997). The understand-
and encounters that have enabled me to understand the ing of structural issues as the causative agents of this failure
propositions of occupational therapy and that have contrib- began to be included in conversation between occupa-
uted to the design of social occupational therapy. tional therapists in this period.
I decided to study occupational therapy in 1976 and
Why Citizenship, Rights, and Social Occupational joined the course at the University of Sao Paulo (USP) in
Therapy Should Be Articulated 1977, integrating into what Elio Gaspari, in the fourth vol-
What is the social function of occupational therapists? This ume of his tome about the military dictatorship in Brazil,
question, which had been ubiquitous since the end of the A ditadura encurralada (which roughly translates to The
1970s for those of us involved in the processes of profes- Endangered Dictatorship), calls “the generation of struggle
sional education and in the practice spaces of Brazil, is for democratic freedom.” This excerpt from the book is
based on the critique of the need for social adaptation, illustrative of what I experienced:
1
This paper was part of the Academic Test of the Public Contest for The demonstrations gathered two types of students.
the Position of Full Professor in Occupational Therapy, Social Oc- In the first category, there were the leaders of organi-
cupational Therapy subarea, Department of Occupational Therapy, zations set up in universities and a few hundred
Centre of Biological Sciences and Health, Federal University of São
followers. . . . In the second category, there was the
Carlos (UFSCar), held in 2012. Part of these reflections were pub-
lished on: Lopes, R. E.; Malftano, A. P. S. (2017). Social occupational crowd, composed of youths who had incorporated
therapy, citizenship, rights and policies: connecting the voices of some of the 1968 ideals into their customs. In less than
collectives and individuals. (pp. 245-256). In: Dikaios Sakellariou, a decade, women had taken a part in politics and the
Nick Pollard. (Org.). Occupational therapies without borders. 2ed. labor market. They all shared with the Trotskyists the
London: Elsevier. cultural refinement and horror of the dictatorship and

1
2 SECTION 1 Conceptual Outlines: Colors and Textures

the Partidão [the Communist Party], in that order. In references; to be able to design the desired occupational
the assemblies, there was the vanguard of a part of the therapy; to understand the role of the professionals and
youth, united by their contempt for the conservative especially of occupational therapists; and to more autono-
habits and tactical alliances of the traditional left. mously determine their professional paths (Lopes, 2004). It
(Gaspari, 2004, p. 408) was a matter of seeking an instrument of understanding, a
theoretical framework that would assist us with unveiling
I was part of that crowd. the contradictions and possibilities of technical action.
What mattered was individual and collective liberty, the What did it mean to transform/enable the everyday lives of
valuation of people. The late 1970s was characterized by a people at whom occupational therapy was directed and for
political boom in which there was space in Brazil for the whom it intended to “care”?
participation of the population, which was mobilized and Historical materialism, seized and relocated by Antonio
discussed a large number of issues, with the basic axes be- Gramsci (1977, 1987, 2002), helped me delimit the possible
ing democratization, the struggle for the rights of citizen- spaces for the professionals to consolidate the hegemonic
ship, the contestation of the then-current status quo, and consensus involving the conservation of the interests of the
the corresponding debates on alternatives to the economic, dominant social class or to construct a counterhegemonic
social, and political exclusionary order established by the dissent that sought to transform the then-current estab-
military regime. Civil society was organized into different lishment. It was a continuous construction/deconstruction
representations—labor unions, popular movements, reli- movement. One of the pillars of the old model was worth-
gious institutions, and professional associations—and po- less: the biopsychosocial individual—the individual on
litical parties began to resume their space in the Brazilian whom interventions should be focused. Under the tradi-
scene (Lopes, 1999). tional occupational therapy model, collectives and social
The permanent, daily suppression of the rights of “the groups with their own identities were not a focus of
insane,” who were subjected to authoritarian repression in attention (Galheigo, 1997). According to Sandra Galheigo
institutions, also became a focus of questioning. The theme (1997), by questioning the role of social adapters, occupa-
of psychiatric reform in Brazil emerged as part of the pro- tional therapists began to participate in the construction
cess of the liberation of the mentally ill. However, beyond of the collective, the construction of public space, albeit
that, the struggle against the situation of these people in quite timidly in the professional category in general.
psychiatric institutions, which was denounced by the me- Liaison with other fields of knowledge was essential for
dia and scandalized public opinion, was part of a more those who tried to offer paths of understanding and, per-
general feeling of rebellion against the suppression by force haps, solutions to problems/issues we were faced with.
of the will of “the weaker”—not only of the mentally ill but
Professionals who intended to specify their social mis-
also of the workers, the unemployed, political prisoners,
sion would need to seek a new way of conceiving
and excluded people of all kinds (Amarante, 1995). Au-
knowledge, and their technical knowledge should be
thors such as Franco Basaglia, Felix Guattari, Robert Castel,
based on the needs of the group or population to which
Erwing Goffman, and Michel Foucault, representatives of
their actions were directed. In order to reach an under-
the currents of critical thought in the area of mental health,
standing of what these needs are, it would be necessary
came to exert great influence among the professionals
to recognize in the population the true interlocutors,
working in that area with their theoretical elaborations and
who have a history and knowledge of their own.
practical propositions in the most varied forms.
It was thrilling to attend Basaglia’s (1979) speech at the (Barros, Ghirardi, & Lopes, 2002, p. 97)
Pontifical Catholic University of Sao Paulo (PUC-SP) and It was believed that provoking collective consciousness
to hear him address, based on Gramsci, the pessimism of and broadening the spaces of freedom would enhance a
reason and the optimism of practice. We were particularly different type of relationship in which the assisted indi-
optimistic at that time. We were growing professionally. It viduals would be the subjects of personal and social pro-
was the time of the first boom in occupational therapy cesses and would be recognized as such (Barros, Ghirardi,
courses, and through the Association of Occupational & Lopes, 2002). In other words: what should we do and
Therapists of Brazil (ATOB), we were fighting for the con- how should we do it so that the real people with whom we
solidation of quality professional education that was tech- are in contact in our daily professional life—the mentally
nically and politically competent and for the definition of ill, the handicapped of all kinds, the personally and socially
a new minimum curriculum (Lopes, 1997). Occupational vulnerable children and adolescents, the poor elderly—
therapy was becoming professionalized and beginning to could aim to be autonomous, participatory, inserted
perceive individuals in society. It was essential for a large part people? Working based on this premise, it was necessary to
of that generation to understand the general, macro-social struggle to transform the places of exclusion, and hence
 CHAPTER 1 Citizenship, Rights, and Social Occupational Therapy 3

the studies of many of us, occupational therapists, focusing bring about social change. We propose that this concept be
on the problem and processes of institutionalization/ defined based on a theoretical and historical framework,
deinstitutionalization, together with the commitment to within a materialist conception that parameterizes the
achieve innovative proposals of intervention. Nevertheless, general context of the democratic, capitalist state in which
the possibility of these practices was also due to the incor- the problem of social policies is included.
poration of the populations to which we directed our One of the central and always current issues in the
actions as people we should seek to “care for,” from a analysis of the contemporary state is the understanding
perspective of health and social assistance as derived from of the genesis of public policies—in our case, with par-
the rights of citizens who are also a part of these groups. ticular focus on social policies—from the existing eco-
“Citizenship” and “public policies” were included in the nomic and political-institutional structures. In the
lexicon of Brazilian civil society, in its interlocution with capitalist state, based on private valorization of capital
the democracy and rights that then existed in Brazil. This and on the sale of labor as commodity, in which these
was also true for occupational therapists, who were then structures are intrinsically classist, some questions are
focusing on the processes involving the creation, invention, pertinent: What are the functions inherent to those
and construction of the demanded care, services, and pro- policies? What are the objective limits to which they are
fessionals. To this end, the Brazilian health reform and subject, within the paradigmatic array of elasticity of
the implementation of the Unified Health System (SUS) the capitalist state, regardless of the actors situated be-
were of paramount importance, as well as the incorpora- fore it? What are the possible actions in this context,
tion of the Unified Social Assistance System (SUAS) into and to what extent do they define observable and stable
the field of social security, which occurred with the 1988 changes? How can the themes of citizenship and social
Constitution (Brasil, 1988). Health as a right of all—with transformations, in the sense of constructing a socially
“all” meaning all, not just the majority—entails providing fairer world, be included in this analysis?
assistance to special population groups. This means under- Democratic capitalist states can be understood as insti-
standing social assistance not as charity or philanthropy tutional forms of public power that, in their relation to
but as the right of all citizens to a guaranteed social mini- material production, are basically characterized by three
mum in terms of income, goods, and services. Access to functional determinations: privatization of production,
health care and social goods was operationalized through structural dependence on the process of accumulation, and
the implementation of social policies and their concrete democratic legitimation. This state undergoes a double
employment in services and actions, including occupa- determination of political power: from the standpoint of
tional therapy (Oliver, 1990; Lopes, 1999). In the early content, it is defined by the development and requirements
1990s, there was an important incorporation of occupa- of the process of accumulation; as an institutional form, it
tional therapists into social services, with an emphasis on is subject to the rules of representative-democratic govern-
health care and assistance associated with childhood and ment through the mechanism of periodic elections. Thus,
youth in the Brazilian municipalities that adopted the im- the policies of the capitalist state can be defined as a set of
plementation of constitutional precepts as a guideline strategies according to which agreement and compatibility
(Lopes, 1999). between the structural determinations of that state are
It can be said that Brazil reached, with a delay of over constantly produced and reproduced. Nevertheless, their
40 years, what had been experienced by the most central general strategy of action is to create conditions under
countries of the world economy during the postwar pe- which each citizen is included in the exchange relation-
riod. Labor and capital were at the core of struggles for the ships (Offe & Ronge, 1984).
constitution and access to the public funds of the state. This definition indicates the strategy that should pa-
Thus, these concepts, strategies, and processes were sub- rameterize the creation of those policies, so that determi-
mitted to the scrutiny of Brazilian civil society, including nations of the capitalist state are fulfilled, as a condition for
occupational therapists. the continuity of its existence. Therefore, the elected offi-
cials have to govern within the limits of the self-preservation
THE CAPITALIST STATE AND SOCIAL of the system. To a great extent, however, policies arising
from the executive power will have to be articulated and
POLICIES employed within and by the system of political institu-
At various moments and spaces, we were and continue to tions that exist in the state, which in principle presents
be faced with a certain view of public policies, especially great temporal stability and is the most internal and effec-
social policies, that immediately leads us to a conception of tive guardian of the status quo. Consequently, we should
a “reparative,” “access broadening” policy that would inter- seek in its internal structure the elements that, by exerting
fere with the field of inequalities and social divisions to filtering power and preventing the effective concretization
4 SECTION 1 Conceptual Outlines: Colors and Textures

of events that are potentially harmful to the continuity CITIZENSHIP

of the accumulation process, can ensure that only strategies
that preserve it are executed, while addressing the following On the Concept of Citizenship
three problems: (1) the integration of interests resulting In the last decade of the 20th century, we witnessed a
from the valorization process—that is, reconciliation of multiplicity of studies on the theme of citizenship world-
the internal edges between the various sectors of capital wide, as part of a great analytical effort to improve the
inherent to the very logic of competition, with the estab- conceptual approach to the notion of citizenship. Citizen-
lishment of a common global denominator; (2) the protec- ship and Civil Society (1998) by Thomas Janoski high-
tion of capital against anticapitalist interests and conflicts; lights three theoretical strands of thought addressing
and (3) the concealment of these two actions, because the phenomena related to citizenship: Marshall’s theory of
votes of individuals of all social classes are needed in the citizenship rights, Durkheim’s approach to civic culture
processes of democratic legitimation (Offe, 1984). (previously anticipated by Tocqueville), and the Marxist/
In contrast, social policies of the capitalist state are de- Gramscian theory on civil society.
fined as a particular case of public policies: they constitute The concept of citizenship as the right to have rights,
the organized relationships and strategies that aim to cre- among several approach perspectives, has as a classic refer-
ate conditions for labor-force owners to be included in the ence the writings by Thomas Marshall of 1949, which
terms of trade. Sociopolitical innovations are needed to proposed the first sociological theory of citizenship in de-
expand social policies: changes adopted in the way state veloping the rights and obligations inherent to the condi-
managers generate, finance, and distribute social services, tion of citizen. Focusing on the British reality of the time,
reconciling the accepted requirements and already sanc- which majorly addressed the conflict between capitalism
tioned human needs (Offe & Lenhardt, 1984). Thus, from and equality, Marshall established a typology of citizenship
the standpoint of domination in the capitalist state, the rights, namely, civil rights, achieved in the 18th century;
social classes act on a system of political institutions that political rights, achieved in the 19th century; and social
outline the range of potentially achievable events. As a re- rights, achieved in the 20th century (Marshall, 1950). Sub-
sult, the actions of these classes delimit, by reflecting the sequently, several authors analyzed their national realities
result of the correlation of forces between the various seg- using this typology, adding theoretical nuances. Based on
ments of capital and between capital as a whole, labor, and the studies by Vieira in her book The Argonauts of Citizen-
other social actors, in which region—among the structur- ship (2001), we present a summary of the theme. Durkheim’s
ally permissible—the equilibrium of the system will occur theories point out that citizenship is not restricted to that
at a given moment and conjuncture. enacted by law, focusing on civic virtue. As a result, space
The social question spells out its genesis in the way is opened for volunteer, private, nonprofit groups to form
people organize themselves to produce in a given society civil society in the public sphere. Marxist theories, in turn,
and historical context, and this organization is expressed emphasize the reconstitution of civil society, an idea previ-
in the sphere of social reproduction; that is, the social ously explored by Hegel, taken up by Marx, and signifi-
question is determined by the singular and peculiar trait cantly revisited by Gramsci. Gramsci operated a paradigm
of the capital/labor relationship: exploitation. Without shift with his threefold view: state, market, and civil society,
destroying the exploitative devices of the regime, in every considering that for Hegel and Marx, civil society encom-
struggle against its sociopolitical and human manifesta- passed all organizations and activities outside the state,
tions, the social question is bound to confront symptoms, including the economic activities of companies. The cur-
consequences, and effects (Netto, 2001); however, we do rent reference to civil society evokes the Gramscian bias
not find it difficult to face them and, in this space, we of protection against abuses on the part of the state and
also seek to move forward. It is important to analyze market. For some authors, this could be understood as
the social question as a political, economic, social, and an intermediation between the state’s approach adopted
ideological matter that refers to a specific correlation of by Marshall and the focus on civic virtue centered on soci-
forces between different classes, included in the broader ety based on Durkheim. Looking for other theoretical
context of social movement of the struggle for hegemony. frameworks to better understand citizenship, it is interest-
Certain moments are more favorable to express the de- ing to point out that citizenship is not a central idea in the
mands of work and its inclusion in the political scene of social sciences (Vieira, 2001). Addressing the attributes of
society, demanding their recognition by capital and the the term, Janoski (1998) defines the sociological perspec-
state, and requiring other types of intervention apart from tive that citizenship is the passive and active belonging of
charity and repression, and this occurs, within the limits of individuals to a nation-state, with certain universal rights
capitalist society, by means of citizenship and social rights. and duties at a specific level of equality.
 CHAPTER 1 Citizenship, Rights, and Social Occupational Therapy 5

Belonging to a nation-state is understood as the estab- with an emphasis on the individual, proposes that most
lishment of a personality in a geographical territory. His- rights involve freedoms inherent to each and every person;
torically, citizenship was provided to restricted groups of despite a few obligations (taxes, military service, etc.), civil
the elite—wealthy men of Athens, English barons of the liberties and property rights are central issues. Individual
18th century—and only later was it extended to a larger rights are vital, whereas social rights or those of groups
portion of a country’s residents. Thus, there would be two represent a violation of liberal principles. The relationship
possibilities of belonging: one that defines how a nonciti- between rights and duties is essentially contractual, entail-
zen, within the limits of the state, acquires rights and ing a heavy burden of reciprocity: each right corresponds,
recognition as a citizen (population groups stigmatized by in general, to an obligation.
ethnicity, gender, and class), and another that establishes Communitarianism prioritizes the community, society,
how foreigners obtain entrance and naturalization to become and nation, appealing to solidarity and the sense of com-
citizens. As for the second element of this definition—the mon destiny as a touchstone of social cohesion. Society
distinction between active and passive rights and duties— exists through the action and support of groups, in a way
it can be said that citizenship consists of both passive rights contrary to liberal individualism. Its main objective is to
of existence, legally determined, and active rights that pro- construct a community based on core values such as com-
vide the present and future ability to influence the political mon identity, solidarity, participation, and integration.
power. The third aspect of this definition excludes the in- Thus, duties predominate over rights. From this perspec-
formal or particularistic character of citizenship rights, tive critical of liberalism, the decline of solidarity between
which should necessarily be universal rights enacted by law citizens and the absence of common destiny would be at
and ensured to all. People and collectives may have their the root of the great evils of modernity. Communitarians
own moral imperatives and specific customs or rights, but give citizenship the character of virtue. Under the liberal
these will only become citizenship rights if they are univer- view, citizenship is an accessory, not a value in itself. In the
sally applied and guaranteed by the state. The fourth ele- communitarian view, individuals are members of units
ment refers to the idea that citizenship is an affirmation that are larger than themselves, such as the political com-
of equality, which balances rights and obligations within munity, which can be understood as a social unit and space
certain limits. Equality is formal, and access to courts is for the exercise of the virtue of participation. Citizenship
ensured. It is not a complete equality, but in general it would then be fundamentally an activity, a practice, and
guarantees increased rights to the subordinates in relation not, as advocated by liberals, a “status” of belonging.
to the dominant elites. The rights and duties of citizenship The theory of expansive democracy (Janoski, 1998) is a
exist when the state validates citizenship norms and adopts third strand. It advocates the expansion of individual or
measures to implement them. From this perspective, the collective rights to historically discriminated people—
processes of citizenship—the struggle for power between notably based on their class, gender, or ethnicity—claiming
groups and classes—are not necessarily citizenship rights increased collective participation in decisions and greater
but independent variables for their formation; that is, these interaction between institutions and citizens. Despite sha­ring
processes would be constituent parts of the theory but a critique of liberal centralization of the individual, it empha-
not of the concept that defines citizenship. In this sense, sizes the right to participate, resisting the secondary role
citizenship concerns the relationship between the state and assigned to rights, as in the communitarian perspective. A
its citizens, especially with regard to rights and duties. balance between individual rights, group rights, and obliga-
Theories on the theme of civil society, concerned with the tions is claimed, resulting in an identity system built on the
institutions that mediate citizens and the state, add a varied notion of individuals as participants in community activities.
range of possibilities to the understanding of this relation- As early as 1949, Marshall envisioned citizenship as a
ship (Vieira, 2001). Civil society is constituted mainly in the true element of social change in the context of industrial
public sphere, where associations and organizations engage reality and the correlated experience of the welfare state in
in debates so that most struggles for citizenship occur the postwar period. The expansion of rights would corre-
within it through the interests of social groups, although spond primarily to the strengthening of previously ac-
civil society cannot constitute the locus of citizenship rights quired rights, as well as to the incorporation of new groups
because it is not a sphere of the state that ensures official into the state. The territorial basis of citizenship has his-
protection through legal sanctions (Vieira, 2001). torically been transformed, from the Greek polis to the
It is necessary that political theory and empirical reality Roman Empire, then to the medieval city, and finally to
be discussed in the search for and understanding of the re- the modern state. The centralization process from which
lationship between civil society and citizenship. Liberalism, the state emerged corresponds to the expansion from the
which is dominant in industrialized Anglo-Saxon countries, local to the institutional form of citizenship. From this point
6 SECTION 1 Conceptual Outlines: Colors and Textures

of view, the expansion of rights is part of a democratization between the multiple traditions of citizenship based on
process, understood as the popular classes’ acquisition of status, participation, and identity, some authors have
rights that were originally created by and for the elites. sought to formulate a complex system, with access to rights
Three generations of citizenship rights can thus be la- guaranteed by local, national, and transnational institu-
beled: civil, political, and social, as previously described. tions (Vieira, 2001).
First are civil rights, corresponding to rights necessary for Two main approaches are highlighted. The first, based on
the exercise of freedoms; next are political rights, estab- Iris Young (Shafir, 1998), addresses the need to institutional-
lished in the 19th century, which guarantee active and pas- ize multiple citizenship, aiming to ensure justice and equity.
sive participation in the political process; finally, in the 20th It is necessary to materialize rights in relation to social groups
century, are the social rights of citizenship, corresponding because, under the auspices of universality, exclusion has al-
to the acquisition of a minimum standard of well-being and ways existed and will continue to exist: ironically, formal
social security that must prevail in society. However, the equality generates substantive inequality. Specifically, the
recurrent ambiguity of equating welfare state rights with question of oppressed groups in the North American context
social citizenship should be avoided. The former is based on is raised (Afro-descendants, women, “Chicanos,” indigenous
means and highlights vulnerable individuals who need pro- people, LGBT people, the elderly, the poor, people with dis-
tection, whereas the latter is universal and acquired as a abilities). Will Kymlicka’s (1996) proposal of differentiated
right by belonging to the community (Vieira, 2001). citizenship is endorsed, which states that rights should not be
Addressing the conflict of cumulative expansion of guaranteed only to individuals but also to groups. The pur-
rights, Marshall (1967) focused his attention on the antago- pose of the identity criterion, as in the specific case of im-
nism between civil rights, which establish protection of the migrants, does not consist in a movement of self-exclusion of
individuals before the state, and social rights, which must the social body but rather in ensuring its inclusion while
ensure the right to real income through benefits guaranteed maintaining respect for its culture. An extension of Mar-
by the state. Thus, social citizenship collides with the condi- shall’s linear scheme is proposed: the guarantee of a fourth
tions of capitalism, and its exercise creates conflict. Marshall generation of rights—the cultural rights of citizenship.
concludes that social citizenship and capitalism are at war, In the second approach, based on Michael Walzer (1992),
but he argues that citizenship and social class are compati- the center of this diversity of citizenship lies precisely in one
ble in democratic, capitalist society insofar as citizenship of its traits: politics. He makes clear his admiration for the
has become the architect of legitimized social inequality. Greek tradition, in which political participation assumes
Such ambiguity echoed loudly in the debate between Marx- the highest form of humanity as a principle of social incor-
ists and social democrats in later decades. poration and unity. It also explores the concept of civil
Empirical studies have demonstrated the multiplicity society as an arena of confrontation: while citizenship is the
of relationships between different types of rights in vari- basis of social unity, civil society, by allowing critical con-
ous forms of social organization. In contrast to the linear frontation between several social demands, performs its
evolutionary model outlined by Marshall, it can be said classic task of generating civility. Respect for diversity and
that in the United State of America, the traditional strug- social pluralism should be an integral part of the citizenship
gle for civil rights hindered the growth of social rights of discourse.
citizenship. Fascism and communism were presented as
forms of social achievement at the expense of civil and The Challenges of Citizenship
political rights. The social democratic strand was also and the Articulation of Rights
criticized for leaving gaps in the critique of the liberal There is renewed interest in citizenship at the beginning
perspective, having restricted its attention to the working of the 21st century. The concept of citizenship seems to
class to the detriment of other conflicts, such as those of integrate central notions of political philosophy, such as
gender, ethnicity, nationalism, and so forth (Vieira, 2001). the claims of justice and political participation. Citizen-
ship, however, is closely associated with the idea of indi-
Multiple Citizenship vidual rights and belonging to a particular community.
In this context, contemporary concern is fundamentally The numerous studies of the 1990s seem to point toward
directed toward the search for compatibility of the existence a theory of citizenship. There is no overriding accepted
of different possibilities and levels of citizenship: life in theory of citizenship to date, but important theoretical
small communities, reformulation of citizenship in the contributions have already been made regarding the ten-
nation-state or at a global level. Within this collective ef- sion between the various elements that compose this con-
fort, citizenship can no longer be seen as a set of formal cept, clarifying the reasons for its timeliness (Vieira, 2001).
rights, but as a way of incorporating people and groups Two interpretations are put forward in this context. In the
into the social context. To solve the conflicting relationship first version, the role of citizens is seen in an individualistic
 CHAPTER 1 Citizenship, Rights, and Social Occupational Therapy 7

and instrumental way, according to the liberal tradition Human resources were an issue of vital importance
initiated by Locke. People are considered private individu- throughout the process; they have the power to convert (or
als, external to the state, and their interests are prepolitical. not convert) the sociopolitical innovations theoretically
In the second form, a communitarian conception originat- proposed by managers into practices and real improve-
ing from the tradition of Aristotle’s political philosophy ments to be made available for the population. With re-
prevails, with the proposition of active citizenship. Indi- spect to occupational therapists specifically, there was a
viduals are integrated in a political community, and their genuine identification between those professionals and the
personal identity is a function of common traditions and ongoing projects, and there was a joint and spontaneous
institutions. There are two models: the first is based on in- effort to implement them to offer the population services
dividual rights and equal treatment, whereas the second and alternatives in which they believed (Lopes, 1999).
defines participation in self-government as the essence of
liberty, a critical component of citizenship. There would be SOCIAL OCCUPATIONAL THERAPY: A FIELD
passive citizenship, from “above,” via the state, and active
OF COMPLEXITY AND BORDERS
citizenship, from “below.” Thus, there would be conserva-
tive citizenship (passive and private) and revolutionary citi- In the late 1990s, we were facing a neoliberal avalanche in
zenship (active and public). It is from this premise that we Brazil—an avalanche that still stifles our hopes. In the
advocate the context of citizenship and rights, the expan- world of the minimal, privatizing state focused on selective
sion of equality, and the recognition of differences as pre- actions, in a society that trivialized the word “citizenship,”
suppositions for social occupational therapy or citizenship where democracy seemed restricted to bourgeois precepts
and rights as axis (Galheigo, 1997; Lopes, 1999). of the cyclical exercise of voting, and, fundamentally, with
the intense transformations that have occurred in the
OCCUPATIONAL THERAPY IN THE SOCIAL world of work, leading to intensification of the exploita-
tion of labor and degradation of the associated protection
POLICY
systems—against this background, the growing vulnerabil-
As previously stated, in the early 1990s, there was an im- ity of groups and people has brought a new configuration
portant incorporation of occupational therapists into so- of the old “social question” (Castel, 1999; Donzelot, 1984).
cial services in Brazilian municipalities adopting the pre- This transformation process of social rules has contributed
cepts of the Constitution. At that moment, a new generation to the emergence of people considered “cyclical invalids”
of occupational therapists was poised to take the lead. They (Donzelot, 1986) or “superfluous people” (Castel, 1997),
had been educated by the theoretical and practical courses who develop “integration deficits” (in work, housing,
developed by the first generations; they possessed a more education, or culture) and undergo disqualification, social
general understanding of Brazilian society, of their profes- invalidation, the dissolution of ties, and even explicit threats
sional role based on Gramsci’s and Basaglia’s concepts, and of exclusion with discriminatory treatment. It was in this
of the role of their interventions in the production of life. context that Denise Barros, Sandra Galheigo, and I started
Questions were posited about how occupational thera- the Metuia Project in 1998, which was a part of what we
pists acted. How did they practice a type of occupational named the resurgence of the social issue for occupational
therapy that was feasible in the 1990s? How could occupa- therapy in Brazil (Barros, Lopes, & Galheigo, 2002).
tional therapists, considering the education they had been In the article “Social Occupational Therapy,” which I
receiving, be able to respond to the needs of users of the wrote in partnership with Denise Barros and Maria Isabel
different public assistance services? That question was an Ghirardi, we identified, from a sociological standpoint,
important motivation for my doctoral research. How were two target groups of the action of disciplinary discourse,
the categories of citizenship, rights, and public policies both medical (in a broad sense) and legal, which consti-
articulated in the case of occupational therapy? Seeking to tute a population to be assisted by social occupational
produce responses, I concretely studied the experience of therapy:
the city of Sao Paulo between 1989 and 1996 (Lopes, 1999). I. Individuals who undergo processes of social exclusion
In my study in particular, at a more general level, the expe- that justify their institutionalization aiming at their re-
rience in Sao Paulo City Hall revealed, in a very hard and covery, education, and/or repression; namely, those
direct way, the magnitude and complexity of the tasks in- who have populated and continue to populate closed
volved in the struggles for citizenship endured by most of and isolated spaces of the community, such as psychiat-
the population, of which the implementation and consoli- ric hospitals, therapeutic communities, nursing homes
dation of policies in the field of mental health and for the and institutions for people with disabilities, and pris-
disabled constituted a small fragment. The enormous ef- ons; poor children and youths; the institutionalized el-
fort required to implement any such projects was evident. derly deprived of their rights.
8 SECTION 1 Conceptual Outlines: Colors and Textures

II. Groups that, owing to social transformations, are ex- knowledge about mediation of the activity, occupa-
posed directly to precarious work or relational vulner- tional therapy can contribute in intervention fields
ability and, therefore, remain on the social margins and that have traditionally been outside its area of concern.
experience the disruption of their social networks. For (Barros, Ghirardi, & Lopes, 2002, p. 101)
these individuals, the integration deficit is associated
with the degradation of the world of work and its con- We can consider these arguments to constitute the basis of
sequential impact on quality of life: housing, education, social occupational therapy, which is reformulated by the
sociability, and culture, leading to processes of disaffili- challenge to create links between the demands of the social
ation (Barros, Ghirardi, & Lopes, 2002). process and the actions of occupational therapists (actions
Constitution of the social field, as one of occupational that grow out of the knowledge and experience that the
therapy’s subareas, was highlighted at the end of the 1990s profession has collectively accumulated). This link needs to
by the disconnection of occupational therapy from the area be established based on the use of the activities as a media-
of health and, therefore, from the necessary mediation be- tion process (and their concepts and implications) carried
tween health and disease. The processes involving social out by occupational therapists.
participation in Brazil created an environment that en- It is also worth mentioning two fundamental elements
abled the identification of serious social problems, and borrowed from Paulo Freire to design social occupational
broad sectors of society and professionals were involved in therapy: awareness and dialogue. Awareness refers to the
the search for solutions. Occupational therapists were not transition from immersion into reality to distancing from
left out of these processes. this reality; this process goes beyond the level of awareness
“Occupational therapy mirrors what its professionals through the unveiling of the reasons for being of a given
think and produce” (Barros, 2004, p. 92) and how they situation followed by a transforming action of this pro-
position themselves politically in the face of social de- jected reality (Barros, 2004). Paulo Freire (1978, 1979), as
mands. “Their methods are conditioned to certain prob- well as Basaglia and Ongaro-Basaglia (1977), do not dis-
lems perceived and incorporated as pertinent and, for these sociate professional action from political action; or, to put
problem areas, possible solutions are articulated” (Barros, it in terms of a Gramscian formulation, intellectual equals
2004, p. 92). Inequality and poverty are relevant problems technical plus political (Gramsci, 2002).
and are important factors in the origin of the Brazilian Considering these assumptions, since 1999, we have
social question, as in many other countries, acquiring con- been developing several intervention projects, working in
figurations that require a revision of the professions and partnership with governmental and nongovernmental or-
the pertinence of the professional role. ganizations that act for the universalization of citizenship
rights and for the strengthening and/or creation of social
Since the mid-1980s, citizenship has been positioned as networks to support populations that face processes of
the guiding principle for the action of occupational disaffiliation. We have also sought to educate occupational
therapists. Initially, [there was] a political struggle therapists to work in the territory, community spaces, and
through active participation in various social move- social institutions, working based on the demands of the
ments. . . . Then citizenship became a parameter of a population, to contribute to meeting their needs and to
new way of acting professionally, transforming itself in listen and intervene in the lives of people who have been
an axis that articulates the action of occupational understood as the “other.” But they, the “others,” need to be
therapists. Individual and collective interventions have approached professionally, with an understanding of their
been, since then, perceived as inserted in their contexts context and history (Barros, Lopes, & Galheigo, 2002;
and as part of historical processes of production of Lopes et al., 2012; Lopes, Malfitano, Silva, Borba & Hahn,
meaning and cultural negotiation. 2012.).
(Barros, Lopes, & Galheigo, 2007, p. 352) Today there is another generation of occupational thera-
Thus: pists developing their professional practices and paths of
research and knowledge production, looking at how to work
Without losing sight of the fact that the struggle in a complex field of borders—for example, that of children,
against exclusion implies combating the deregulation adolescents, and youths who do not have the means for their
of labor and the distribution of wealth, without ne- realization as individuals and are subjected to violence and
glecting the fact that actions must be embedded in a that of adults in street situations—and seeing how to take
conscious political process; we believe that through its advantage of opportunities (such as several current focal
history, the accumulation of discussions built on criti- projects/programs) and instrumentalize them in the strug-
cism of segregation institutions and, above all, through gle for rights.
 CHAPTER 1 Citizenship, Rights, and Social Occupational Therapy 9

Different demands call for the construction of specific reality; on how, on the one hand, to systematize specific
knowledge and methodological procedures. The experi- knowledge and, on the other hand, to solve problems of
ence accumulated by the core of the Federal University of real people and/or population groups; and on how to inte-
São Carlos in Metuia Project (Metuia/UFSCar) has pro- grate disciplinary knowledge and, within it, concepts,
duced social technologies that have been able to foster new methodologies, and techniques of occupational therapy,
possibilities of action, integrating and articulating macro- with interventions that occur in a field of complex knowl-
and micro-social actions. From this perspective, the fol- edge production. If the specificity of occupational therapy
lowing social technologies are highlighted: (1) Articulation lies in the quest to enable people and encourage them to
of Resources in the Social Field—understood as an interven- have greater autonomy and social insertion and participa-
tion strategy that weaves actions focused on certain people, tion, how should we act professionally without advancing
groups, collectives, and communities with those at the level from their core of knowledge to an interdisciplinary, inter-
of civil society, political action, and management; (2) Dy- sectoral, interprofessional field? In my opinion, this can be
namization of the Assistance Network—to certain popula- achieved by articulating citizenship, the universalization of
tion groups and/or communities and their interaction with rights, social policies, the radicalization of democracy,
different sectors and levels of intervention; (3) Workshops public power, social movements and participation, labor,
on Activities, Dynamics, and Projects—taking advantage of education, health, justice, housing, art, culture, and recre-
the formative and transformative potential of the activity, ation in a technical and political way. In other words,
because the sociopolitical and cultural dimension of the being and acting in the social field. That was how I and
different actions pervades every life, favoring the self- the occupational therapy with which I dialogue entered
valorization of people and enabling production of life with the 21st century.
senses, with a view to personal and social emancipation;
and (4) Individual Territorial Follow-Ups—starting from
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 e1

Keywords: Social rights, Citizenship, Social inequalities,

Social-history, Professional practice
 2
Social Occupational Therapy in Brazil: A
Historical Synthesis of the Constitution
of a Field of Knowledge and Practice
Sandra Maria Galheigo

Achar To find Brazilian occupational therapy scholars, it is possible to

A porta que esqueceram The door they forgot to trace parallels with the debate on social field or terrain as
de fechar. close. developed by British social scientists such as Squires
O beco com saída. The alley with exit. (1990). A discussion on the use of the concepts of field in
A porta sem chave. The keyless door. Bourdieu and social field in Squires (1990) in relation to
occupational therapy in the social field is more thoroughly
A vida. Life
developed in Galheigo (2011a).
(Leminsky, 2013)
Perspective is used here as the set of theories and meth-
odologies related to certain currents of thought that ex-
press a particular vision of human beings and society. In
INTRODUCTION
this chapter, positivist/functionalist, humanist, and critical
The production of knowledge and practices, carried out by perspectives are addressed. Reference is used here both
a given profession in a given field of knowledge and prac- for the theoretical knowledge produced by authors within
tice, must, in my view, be understood as a sociohistorical certain theoretical-methodological perspectives and for
construction. The concept of a field is used here to refer to practices developed according to approaches, methods,
a broad interdisciplinary area of knowledge and practice, and techniques applied to certain existential conditions
such as health, mental health, collective health, social care, related to life, health, and access to rights, among others.
rehabilitation, and education, among others. From this Having established the concepts used in this chapter, it is
perspective, individual professions develop their practices important to address what is meant by the creation of new
or areas of practice within different fields. Practitioners practices and initiatives motivated by an ethical-political
may use various perspectives and references to provide commitment. In my view, the inaugural moment in which
consistency in their work, which might follow previous a new area of practice or a new perspective is born occurs
standardized recommendations or engage in a completely in response to events, contexts, and perceptions about the
new initiative, due to an ethical and political commitment needs of persons and groups and to a sensitive, compre-
to a cause. hensive, and critical reading of collective, institutional, or
To start, some concepts need to be clarified. In this con- political demands. It arises, therefore, when professionals
text, the use of the concept of a field is inspired by the no- feel uncomfortable with their practices and become aware
tion of field put forward by Pierre Bourdieu (1989), who of undetected problems or conditions; thus, professionals
argues that the social space is composed by the articulation are able to deconstruct them in their preconceptions and
of diverse autonomous social microcosms, with their vari- forms and learn about their complexity. From this moment
ous logics, orders, and needs. In addition, naming an oc- on, they begin to reflect on possibilities, strategies, and
cupational therapy area of practice as one developed in the courses of action, as well as seeking to ensure the success of
“social field” is a result of an initiative that has been devel- their efforts. The questions posed at such moments could
oped in Brazil since the late 1970s, as we will show later. be described as follows: What contributions can this body of
Although this may be a conception mainly referred to by knowledge and practice bring to the human condition before

11
12 SECTION 1 Conceptual Outlines: Colors and Textures

me? To what extent can professional activity, informed by the prison, and the institutionalized elderly living in precari-
social, cultural, and political scenario, contribute to changing the ous nursing homes.
conditions of life faced by these people, groups, and collectives? The term “occupational therapy in the social field” first
Undoubtedly, there is a theoretical and methodological appeared in the Fifth Scientific Meeting of Occupational
belief underlying these initial reflections. An ethical-political Therapists in the State of São Paulo, Brazil, in 1979, when
commitment can be perceived behind the intention to Jussara de Mesquita Pinto delivered an oral presentation
change a condition, situation, or cause, and this commit- entitled “Report of an Experience in Occupational Therapy
ment is established by listening to the needs and demands of in the Social Field” about her practice with young people
people, groups, and collectives. A responsive discourse is institutionalized at FEBEM (Pinto, 1979).
constructed through a critical reflection on the “instituted,” As important historical milestones, it is vital to note
the “hegemonic,” the “normalized,” and the “given.” that at the end of the 1970s, the occupational therapy
This conception of professional practice, therefore, does programs of two universities—the Federal University of
not result from the search for evidence or the construction São Carlos and the Pontifical Catholic University of
of hypotheses, nor from the implementation of previously Campinas—introduced into their curricula a discipline
defined procedures. It is not committed to achieving pre- called Occupational Therapy Applied to Social Condi­
established goals. Moreover, it does not propose to comply tions, offered at the two institutions, respectively, by
with an “established” norm, nor to reach a previously es- Jussara de Mesquita Pinto and Maria Heloísa Medeiros. In
tablished standard of normality as an adequate condition July 1980, the Associação dos Terapeutas Ocupacionais do
of personal existence. Brasil (Association of Occupational Therapists of Brazil,
Summing up, in economic and political terms, a profes- ATOB) (1980) submitted to the Ministry of Education and
sional practice inspired by an ethical and political commit- Culture its Proposal for the Reformulation of the Minimum
ment does not result from the neoliberal perspective Curriculum for Occupational Therapy, conceived by its Ed-
according to which professional practice is seen as offering ucation Commission. This proposal presented, for the first
products to potential consumers and that dictates that a time in an official professional document, the request to
“niche market” should be sought. In addition, it is not include the discipline “Occupational Therapy Applied to
guided by a corporate logic that defines professional prac- Social Conditions: Including Situations of Social Margin-
tice by what is unique to professionals: their roles and alization,” among other disciplines within the Cycle of
merits, resulting from their skills and competencies. Professional Topics (ATOB, 1980, pp. 15–16).
It can be seen, then, that occupational therapy in the so-
cial field began to be developed in Brazil by a double initia-
HISTORICAL MILESTONES IN THE CREATION tive: the design of intervention proposals for marginalized
OF OCCUPATIONAL THERAPY IN THE SOCIAL populations and the creation of disciplines in undergraduate
courses in occupational therapy. In this, it had to overcome
FIELD IN BRAZIL
some challenges: to develop its own theoretical bases and to
design appropriate methodologies of action for people liv-
I’ve been thinking what I could characterize as Social OT.
ing in marginalized conditions. It also had to deal with the
The ideas that I put forward will not end here, because
difficulties of proposing emancipatory speeches and prac-
social occupational therapy will not be defined in one
tices during the dictatorial civil-military dictatorship, as
meeting. . . . [W]e still have twenty years to define it.
some scholars pointed out at the time and since:
(Galheigo, 1981, p. 2)
Given the range of existing problems and the lack of
Occupational therapy in the social field emerged in Brazil
specific occupational therapy resources, occupational
in the late 1970s based on an ethical and political commit-
therapists have attempted to adapt, at first, the meth-
ment, as it would be referred to some decades later. It
ods and techniques already known to [fit] the aims of
originated out of a concern with the social issues of its
this type of practice.
particular time and context and the possibilities envisioned
(Pinto 1979, p. 5)
by some occupational therapists on developing alternative
practices. The processes of institutionalization of the populations
The first initiatives in this new area of practice focused living in marginalized conditions . . . opened a new
on marginalized groups such as the youth who lived insti- reality in the area of social programs: how to character-
tutionalized in the State Foundation for the Well-Being of ize this population? How to deal with the marginality,
the Youth (FEBEM), poor children and adolescents attend- language and culture of these populations?
ing public day care and community youth centers, adults in (Soares, 1991, p. 174)
 CHAPTER 2 Social Occupational Therapy in Brazil: A Historical Synthesis 13

The definition of so-called occupational therapy in the critical framework of the time, were also partially incor-
social field, the formalization of its object and objectives porated into the content of the existing disciplines of
of intervention, and the establishment of its theoretical social occupational therapy. Besides these authors, the
bases were the initial concerns explored in the first bibliographical references of these disciplines also included
academic events to delve into the subject. The very first scholarship from the social sciences on marginalized pop-
one was a panel entitled “Social Occupational Therapy: ulations, as well as journalistic texts of social critiques. The
Philosophy, Definition, and Fields of Action,” which was experience of the discipline of occupational therapy in the
presented in the Second Scientific Occupational Therapy social field, offered by the Pontifical Catholic University of
Week, held at the Federal University of São Carlos in Campinas, revealed that the studied topics and literature
1981, an event at which oral presentations on practices in varied throughout the following years, according to the
public childcare centers and prisons were offered. Also, historical, political, social, and epistemological trends of
one presentation reflected on the creation of occupa- the time. Practical settings were predominantly developed
tional therapy in the social field, an extract of which is by university projects in public childcare centers, commu-
presented here: nity programs, orphanages, and institutions for adoles-
cents in conflict with the law, among others.
What would this theoretical and practice body consist
Certain strategies were crucial to the development of
of? . . . Could a public childcare centre always be con-
the occupational therapist role in the social field, namely:
sidered a social area? The prison? The asylum? So, in
(1) listening to people’s life stories, which served as a
this sense, is the psychiatric hospital? Community
means of learning about social realities, and (2) reflecting
work? . . . [T]o be able to define an area [of knowledge
critically on daily professional practice, demystifying the
and practice], we will have to discuss the criteria, since
professional as the one who holds the knowledge. These
our proposal here is to reflect on what Social OT is. . . .
strategies enabled occupational therapists to get to know
Considering that the object, objective and priority of
people’s unique ways of being, existing, and surviving and
Social OT has to be different from the object, objective
to grasp their perspectives, living conditions, needs, and
and priority of other areas of practice . . ., what would
demands (Galheigo, 2011b).
it be? . . . [W]e lack a sociological basis.
The first reflections of the social field were based on the
(Galheigo, 1981, pp. 3–4) critical theoretical and methodological frameworks used at
Therefore, the search for theoretical and methodologi- the time in Brazil, which were derived from the proposi-
cal bases for occupational therapy in the social field, which tions of the occupational therapy philosophical models
was perceived to be needed, started to take place during the developed by Pinto (1990) and Francisco (1988). Their
1980s; however, it is noteworthy that it happened under the works identified three possible occupational therapy per-
influence of a singular historical-political context. On one spectives: positivist/functionalist, humanist, and historical-
hand, professors and researchers of occupational therapy materialist. Some studies in the area began to explore how
sought postgraduate training in related areas of knowl- a situation within a session could be differently viewed
edge, such as social sciences, philosophy, education, and according to these different standpoints, as well as how
psychology. On the other hand, the new proposals were social occupational therapy practices could either repro-
largely influenced by the political effervescence for country duce the status quo or be transformative, as the following
redemocratization, the emergence of new social move- session extract and analysis show:
ments, the debate on sanitary reform, and the anti-asylum
movement. Youth: Have you ever been arrested, madam?
OT: No.
The regular participation of the occupational thera- Youth: No? But someone in your family, for sure.
pist in social programs has become reality in the There is always a black sheep in the family. I am
1980s. This fact, associated with a vaster debate on the black sheep of mine. Everyone there is worthy,
the National Mental Health Policy and the process except me.
of redemocratization of Brazilian society, has con- For Miguel the world was a reproduction of his
tributed to the discussion about the social and house. He did not clearly distinguish social classes and
political roles of occupational therapy. their mechanisms. He referred to the Judge of the Juve-
(Galheigo, 1988, p. 79) nile Court as the highest rank in the social hierarchy,
In theoretical terms, the ideas of Althusser, Basaglia, who [in his view] was powerful and wealthy—“very
Bourdieu, Castel, Donzelot, Foucault, Goffman, Gramsci, rich indeed” [in his words].
Illich, Marx, and Paulo Freire, which constituted the (Galheigo, 1988, p. 77)
14 SECTION 1 Conceptual Outlines: Colors and Textures

This master’s dissertation first presented how this dia- idea that epistemological perspectives mattered more
logue could be understood within a more conservative than specificities of the areas of occupational therapy
standpoint: practice prevailed in some circles for a few years. The
fragility of the maintenance of a field of knowledge and
According to the first perspective [positivist], Miguel
practice called social occupational therapy resulted in the
would be attributed to a disease or “weakness” of per-
elimination of its specific disciplines from the under-
sonality since his brothers did not opt for delinquency
graduate courses of the two universities where this area of
and were raised under the same conditions. Yet the
practice originated. Thus, teaching, research, and aca-
second conception [humanist] would highlight the so-
demic production in the area ceased to gain institutional
cial background that caused Miguel’s delinquency.
status during the early 1990s, a period when, in contrast,
Both, however, would propose therapeutic strategies that
the occupational therapy practice in other fields actively
ensured his adaptation to society. Either would no doubt
sought dialogue with the ongoing social policymaking
lead to an alienated and alienating understanding.
restructuring. Not even the enactment of the Organic
(Galheigo, 1988, p. 79) Law of Social Assistance (LOAS) (Brazil, 1993), which
Then the author considered how the dialogue could be could foster the practice in the field, was enough to invite
understood within a critical perspective: an organized professional response to sustain this area of
practice; however, a few teaching, research, and extension
An occupational therapeutic practice can only be
projects in the social field, although scarce, continued to
said to be transformative when: it enables Miguel,
take place.
Claudinéia, João and Maria to understand the histori-
During the 1990s, with the restructuring of social poli-
cal dimension of their lives; [the practitioner] does not
cies in Brazil, the philosophical models proved insufficient
take ownership of knowledge and, instead, shares with
to provide theoretical bases for the diversity of fields of
them the construction of the therapeutic process/proj-
practice engaged within the profession (Galheigo, 1999).
ect; [the practitioner] does not impose a direction, but
Even so, it took nearly a decade for social occupational
instead, gives them elements for reflection on their
therapy to re-establish itself again in Brazil (Galheigo,
position and the choice of their life path; when [the
2003). In 1998, however, this situation was reversed with
practitioner] perceives, denounces, denies and reposi-
the creation of the Metuia Project, a university-based joint
tions oneself against the traps of power implicit in
effort to develop theoretical and methodological bases for
social relations; when [the practitioner] carries out
social occupational therapy.
a self-critique in relation to the disciplinary mecha-
nisms rooted in professional practice since its creation.
(Galheigo, 1988, p. 79) PROPOSAL OF SOCIAL OCCUPATIONAL
This example shows how occupational therapists in THERAPY BY THE METUIA PROJECT: WAYS
Brazil started to address the first guiding questions of the OF DOING OF THE SOUTH
social field: How do we make the practice of occupational
therapy not serve as a mechanism of social control? How An epistemology of the South is based on three orienta-
can we do it to enact social transformation? tions: to learn that there is the South; learn to go to
Despite these first academic works during the late the South; learn from the South and with the South.
1970s and the 1980s, the activities of practice, teaching, (Santos, 2010, p. 15)
and research in occupational therapy in the social field
were not sufficient to produce a body of knowledge that The interinstitutional group of studies, education, and
clearly affirmed its domain of action and its theoretical- practice for the citizenship of children, adolescents, and
methodological bases. In fact, although not clearly docu- adults in the process of the breakdown of their social sup-
mented, the constitution of social occupational therapy port networks (Metuia Project) was created via a partner-
suffered a setback in the early 1990s, when the naming of a ship of professors from three universities in the state of São
field of professional knowledge and practice as “social” Paulo: the Pontifical Catholic University of Campinas, the
came to be seen as a reductionism. Federal University of São Carlos, and the University of São
This movement was partly the outcome of the propo- Paulo. The main motivation of this initiative was to rein-
sition of the philosophical models of occupational ther- sert the social field in the academic agenda by producing
apy (Pinto, 1990; Francisco, 1988) mentioned earlier that what they would call social occupational therapy, as
sought to establish the epistemological differences be- the project’s objectives in its inaugural website in 2000
tween professional practices. At the end of the 1980s, the described (see Box 2.1).
 CHAPTER 2 Social Occupational Therapy in Brazil: A Historical Synthesis 15

BOX 2.1 ​Objectives of the Metuia Project of “adapting the individual to society” and creating
ones where professionals worked as “social mediators”
1. To develop and disseminate knowledge in the field of (Galheigo, 1997, 2003). The research and practice projects
social occupational therapy. developed by Metuia’s members aimed at urban and rural
2. To create partnerships with governmental and non- youth, people living on the streets, and children and ado-
governmental organizations, developing initiatives for lescents in public schools, in shelters, or in conflict with the
granting citizenship rights. law. These studies and practices served as resources for
3. To study the features and living contexts of the popula- critical reflection on the field, resulting in a constant pro-
tion undergoing a breakdown in social support networks cess of the production and problematizing of theory and
to develop practice methodologies that consider the practice. Paraphrasing the title of an article by Denise Dias
complexity of their living social conditions. Barros (2004), the path of social occupational therapy was
4. To enable occupational therapy students and profes- made while walking.
sionals to develop studies and practices with children, Therefore, social occupational therapy was constituted
adolescents, and adults undergoing a breakdown in as a professional knowledge and practice based on a critical
their social support networks. reflection on the social place of the occupational therapist,
5. To enable professionals and students to develop prac- seeking to characterize the population form whom their
tices where the people’s and communities’ stories actions were designed and to develop methodologies of
are heard, and the solutions for their own needs are action that aimed at autonomy, citizenship, and access to
fostered in an action that is jointly built and historically rights of persons and collectives:
contextualized.
Social occupational therapy is intended for people
Source: Metuia’s former website (now defunct), 2000. whose greatest needs are based on their exclusion from
access to social goods and whose problems are mani-
fested by the worsening of living conditions to which
they are subjected. Such a problem can be acknowl-
From the start, the development of Metuia’s teaching,
edged as poverty or also understood as a situation of
research, and university practice and learning projects, car-
vulnerability, of “apartheid,” since access to the rights
ried out in partnership with nongovernmental organiza-
of citizenship, even if constitutionally guaranteed, is
tions, followed a strategy of promoting the field through
unequally distributed, translating itself into an experi-
theoretical and practical articulation. Thus, through sys-
ence of no-citizenship, of not-belonging.
tematic meetings, Metuia’s members sought to create a
theoretical-methodological alignment between university (Galheigo, 2003, pp. 34–35)
professors and practitioners working in the services in- The aim [of social occupational therapy] is to develop
volved to ensure the cohesion and coherence of their theoretical and applied studies on activities in occupa-
proposals. The strategy entailed the periodic holding of tional therapy as resources for self-valorisation and the
seminars, workshops, and discussion groups that presented production of personal and social meaning that aims
and debated (1) the theoretical bases produced for the at the expansion of opportunities and personal & so-
field, (2) ongoing research conducted by the group mem- cial emancipation by means of focused (but always
bers, (3) practice projects developed with partner nongov- contextualized) projects of improvement of quality
ernmental organizations, (4) methodologies of action used of life.
in teaching and care, and (5) the very structuring of the (Barros, Lopes, & Galheigo, 2002, pp. 367–368)
Metuia Project through the elaboration of its guidelines for
action and the preparation of dissemination materials, Metuia’s academic production, using Castel (1994,
such as folders and the website. 2003) as a reference, placed the debate on the social
In these meetings, some points of debate were impor- question—and its production of vulnerability and disaf-
tant. First, the professional role was problematized to de- filiation—as the result of the extreme social and economic
construct traditional practices; the intention was to make inequality lived by a large contingent of the Brazilian
students and professionals aware that practices should not population (Barros, Ghirardi, & Lopes, 1999, 2002, 2005;
produce institutional conformism or the reproduction of Galheigo, 2005, 2011a; Barros, Lopes, & Galheigo, 2007a,
the status quo. Second, the discussion moved around the 2007b, 2011a; Barros, Lopes, Galheigo, & Galvani, 2005,
idea that a different social and political commitment 2011). This theoretical framework helped social occupa-
should be entailed by social occupational therapists by tional therapy approach the social question by articulating
criticizing practices guided by the functionalist perspective the understanding of the social, cultural, and political
16 SECTION 1 Conceptual Outlines: Colors and Textures

contexts lived by the people in the process of breakdown of cooperation projects that point to the creation of new in-
their social support networks: ternational exchange networks (Galheigo, 2011b; Galvaan,
Galheigo & Saha, 2013).
The occupational therapist devotes him/herself to a
Exchanges imply intercultural and intersocial actions
reading of everyday life and its contexts, the intermedia-
in which reciprocal recognition and availability for ex-
tion between the macro and micro-social structure, the
change are present. They allow for the articulation of
re-signification of doing, the individual and collective
ideas, practices, processes, and contexts, but they require,
intervention, developing strategies that seek to strengthen
on the other hand, the clarification of differences, which
personal and social support networks, with the objective
points to the importance of sustaining academic dialogue
that these will translate into a greater autonomous sus-
(Galheigo, 2011b).
tainability of people in the complex social structure in
This conceptual, historical, and epistemological dia-
which they are inserted.
logue is also necessary at the national level. After all, from
(Malfitano, 2005, p. 6) the beginning of the 21st century, occupational therapy in
Social occupational therapy therefore appears as a the social field in Brazil has expanded and diversified, com-
proposal that differs completely from the perspectives of ing to include teams from sectors such as social assistance
Anglo-Saxon occupational therapy, both those perspec- as well as expanded academic dissemination in congresses,
tives focused on the recovery of functionality and those seminars, and journals.
centered on the person. On the contrary, its knowledge and In this new scenario, the theoretical-methodological
practices are produced in the South by using epistemolo- issues and tensions of the past seem to persist, as Lopes and
gies of the South, viewed by Santos and Menezes (2010) as collaborators (2012) point out when studying the papers
a metaphor for the epistemic challenges used by the coun- approved for presentation at the 12th Brazilian Congress of
tries of the South to confront capitalism and colonialism. Occupational Therapy and 9th Latin American Congress
The dissemination of social occupational therapy on of Occupational Therapy. This study identifies the fragility
the international level (Barros, Ghirardi, & Lopes, 2005; of the conceptual basis of the references used and “a simul-
Barros, Lopes, & Galheigo, 2011; Barros, Lopes, Galheigo, taneous use of different approaches, in a kind of bricolage
& Galvani Barros, 2005, 2011; Galheigo, 2005, 2011a), of conceptual references” (Lopes, Borba, Silva, & Malfitano,
which was mainly carried out in the two volumes of the 2012, p. 29). The study also pointed to the core of the
book Occupational Therapy without Borders (Kronenberg, contemporary problems related to occupational therapy
Algado, & Pollard, 2005; Kronenberg, Pollard, & Sakellar- in the social field when it criticized practices in fields
iou, 2011), ended up revealing its similarity with practices where professional action is reduced to the developmen-
that had already been developed in Latin America and talist approach, decontextualized from the social, politi-
South Africa. This perspective shares concerns for eco- cal, and existential scenarios of institutional emergency
nomic, social, ethnic, and gender inequalities; the rescue of placements:
the knowledge proper to its peoples; the search for com-
An example of such a situation is related to the reports
munity/territorial intervention alternatives; and the educa-
of interventions in shelters, which represented a signifi-
tion of new professionals with a focus on political literacy
cant number of works. In these, approaches to child de-
(Duncan, Buchanan, & Lorenzo, 2005; Lorenzo, Duncan,
velopment and the use of play as a beneficial resource for
Buchanan, & Alsop, 2006; Trujillo, Camacho, et al., 2011;
the child were predominant, elements certainly related
Trujillo, Torres, Méndez, & Carrizosa, 1991; Watson &
to childhood; they lacked, however, what effectively hin-
Swartz, 2004).
ders the development and play of our children: poverty,
The close ties among academics and practitioners in
family and/or social abandonment, vulnerability and
scientific and academic events have also contributed to
violence to which they are subjected, that is, the im-
the development of a sense of the South. In 2010 and
mense inequality with which we must deal in Brazil
2011, several international events contributed to bringing
and in Latin America as a whole.
Brazilian social occupational therapy closer to coming into
action in other countries in the South: the 15th Congress (Lopes et al., 2012, p. 29)
of the World Federation of Occupational Therapists, the For an academic dialogue without borders in the context
12th Brazilian Occupational Therapy Congress/9th Latin of occupational therapy in the social field, it is fundamen-
American Congress of Occupational Therapy, and the 2nd tal to give voice to differences, to go in search of their
International Symposium of Social Occupational Therapy. contexts, and to problematize existing tensions or contra-
Since then, there has been an expansion of Latin American, dictions. It is a necessary exercise as well as one of the most
Ibero-American, and South African–Brazilian–Indian important contemporary challenges in the area.
 CHAPTER 2 Social Occupational Therapy in Brazil: A Historical Synthesis 17

INTERVENING IN THE SOCIAL FIELD: ON THE result, new (though not always) practices and knowledge
are produced and reproduced:
IMPORTANCE OF THE REFRAMING OF THE
There is therefore no knowledge without practices and
EPISTEMOLOGICAL DEBATE social actors. And since both exist only within social rela-
tions, different types of social relations can give rise to
To intervene. 1. Take part voluntarily; get in the way,
different epistemologies.
come or put yourself between, on your own initiative;
interfere: Intervened in the contest. 2. Interpose your (Santos & Meneses, 2010, pp. 15–16)
authority, or your good offices, or your diligence. 3. Be Since the late 1970s, epistemological questions related
present; help. 4. Occur incidentally; to emerge. to occupational therapy in the social field have emerged as
(Ferreira, 1999, p. 961) essential for the definition of this area of knowledge and
practice, among them: What are the central ideas of this
Every social experience produces and reproduces
field, beyond which it loses its legitimacy?
knowledge, and in so doing presupposes one or more
In the early 1990s, Soares (1991) argued that the first
epistemologies. Epistemology is any notion or idea, re-
experiences in the so-called social field did not differ from
flected or not, on the conditions of what counts as valid
those developed by other areas of action; furthermore,
knowledge.
they did not address the issue of social marginalization or
(Santos & Meneses, 2010, pp. 15–16) institutionalization, at least as far as the methodological
The professional practice of the occupational therapist is approaches used are concerned:
characterized by intervening, whether or not one likes the He/she [the occupational therapist], working with the
term and whether or not one prefers to use other concepts child and youth clientele, aimed at correcting develop-
that seem more appropriate in their meaning. Based on the ment delays and accelerating the integration process. In
Portuguese definition of the term “to intervene” in the working with the elderly population, in turn, the therapist
dictionary Novo Aurélio Século XXI (Ferreira, 1999), it is focused on organic degenerative processes or support for
possible to sustain that, when intervening, practitioners emotional problems such as loneliness, terminal illness,
voluntarily take part; they interpose their good tasks or etc. In relation to both clienteles, the charitable nature of
diligence in the face of any problematic situation, need, the program and its institutionalizing logic were evident.
or demand. Therefore, they intervene along with their (Soares, 1991, p. 174)
colleagues from other professions who share practices
in health, education, culture, work, and social support Going further, Soares problematized the theoretical-
services. methodological question of occupational therapy in the
The character of the intervention, the principles that social field as follows:
define the act, the ideas that give it meaning, and the act The limited adequacy of professional models to this real-
that reveals the habitus are what bring practitioners and ity raises the following controversy: should we develop a
social actors closer or farther apart, reveal their conso- new specific model—social occupational therapy? And
nances or differences, and lead them to partnerships or does the psychosocial approach, elaborated by North
dissents. It is important to highlight that differences and American professionals, respond to these needs? Or do
dissent may occur not as an outcome related to professional we have to focus on Brazilian occupational therapy and
training but instead by the way practitioners understand look for alternatives within it?
and relate to social actors who come from different back- (Soares, 1991, p. 174)
grounds and henceforth different habitus. This is a central
Of course, today the debate takes place differently from
concept, in Bourdieu’s theory, that can be defined as
20 years ago because there is already a scholarship that
a system of enduring dispositions acquired by the indi- unequivocally establishes the bases of social occupational
vidual during the process of socialization. Dispositions therapy. However, differences exist in Brazil, both in terms
are attitudes, inclinations to perceive, feel, do and think of the interventions carried out and in the theoretical argu-
internalized by individuals as a result of their objective ments that support them, which need to be better known.
conditions of existence, and which function as uncon- Thus, the debate can be enriched by the ideas of Santos
scious principles of action, perception and reflection. and Meneses (2010), who, when discussing epistemological
(Bonnewitz, 2003, p. 77) differences, affirm that
The social practice of intervention, attention, or care, as The differences may be minimal but, even [if they
one may prefer to call it, generates understanding and, as a were] large, they may not be the subject of discussion,
18 SECTION 1 Conceptual Outlines: Colors and Textures

but in any case, they are often the source of the tensions by health professionals and social workers to deal with so-
or contradictions present in social experiences, espe- cial issues. This strategy was also highly recommended by
cially when, as it is usually the case, these are consti- the National Policy on the Welfare of Youth (underage),
tuted by different types of social relationships. implemented by the civil-military dictatorship in Brazil
(Santos & Meneses, 2010, pp. 15–16) (Galheigo, 1996). Case studies, incorporating a biomedical
perspective, use clinical, psychological, psychiatric, and
To resume the debate on the epistemological differences social references to know and prescribe interventions for
that underlie social interventions, it is essential to indicate people and families considered “deviant,” “unstructured,”
ways of approaching the social field. Three perspectives or “dysfunctional.” They are based on the idea that it is a
that, to a certain extent, may be rooted in social practices professional responsibility to perform a psychosocial diag-
and influence interventions in the social field are high- nosis of the individual and to prescribe interventions.
lighted here: the structural-functionalist, the humanist, Critics of this theoretical perspective maintain that
and the critical. These perspectives demarcate both great these interventions resulted in what came to be seen as the
differences of approach to the social question and different psychologization or medicalization of social problems
understandings about the human being in its relationship (Galheigo, 1996). Social care, education, and health in con-
with the world. Therefore, these perspectives are not inter- temporary Brazil are still rooted in this perspective.
changeable, and if they overlap, they reveal an important The humanist perspective is usually considered to be
lack of theoretical-methodological cohesion. phenomenological inasmuch as it deals with “subjective
The structural-functionalist perspective of Talcott individual experience, the personal ‘worldview’ that each
Parsons had a strong influence on Brazilian health and individual develops as a result of his/her unique life, feel-
social services, including those designed to deal with what ings and perceptions” (Hagedorn, 1997, p. 64). Its most
was conventionally called the “problem of the minor,” influential theorists are Maslow, Frankl, and Rogers.
relating to adolescents and youth (Galheigo, 1996). Par- According to this perspective, each individual’s position
sons (1991) argued that social integration was the result on one’s own life should be valued. Authenticity, honesty,
of the process of socialization experienced by individuals, and respect for the other are regarded as important, and
a process that produced in the individual the desire to the search for meaning for the subject is essential. Thus,
internalize rules and adapt to social norms. Thus, from self-knowledge and control over one’s own life are the con-
his perspective, social order was the result of the sharing of ditions that lead to self-realization. The client-centered
a culture of common values by social actors (Turner, 1991). approaches that underlie psychotherapeutic practices and
The deviant or dysfunctional attitude was understood by occupational therapy models in Anglo-Saxon countries
Parsons as the tendency of some people to oppose the sys- have originated from this perspective (Hagedorn, 1997).
tem of values standardized institutionally, which brings The humanist perspective was widely discussed in
imbalance to the process of social interaction. This view, Brazil in the works of Pinto (1990) and Francisco (1988).
therefore, applied to unrelated conditions, such as disease, For these authors, the humanist perspective began to be
poverty, and crime. used by Brazilian occupational therapists in the 1970s as a
In Parsons’ view, social control mechanisms must way of opposing the positivist perspective. It aimed at re-
thwart deviant tendencies “by teaching the social actor not placing “man at the center of the universe . . . through
to embark on them” (Parsons, 1991, p. 298). Thus, in case the main argument that there is no opportunity without
of failure of the socialization process, social control mecha- exercise of subjectivity” (Pinto, 1990, p. 42).
nisms should be used to impose limits. Parsons (1991) es- According to Francisco (1988), in the humanistic oc-
tablished a relationship between the processes of socializa- cupational therapy model, the role of the occupational
tion and social control, where the former would serve as a therapist is to “facilitate learning in new ways, offering a
reference for the latter. Thus, socialization would teach model of relationship in which it is possible to learn, re-
“what to do,” while the mechanisms of social control would hearse, make mistakes, teach and accomplish something
teach “what not to do” (Parsons, 1991, p. 298). The profes- that could not happen in another place” (Francisco, 1988,
sional role could thus be equated with that of executor of pp. 63–64).
social control. Among the critiques of the humanist perspective is the
Based on this perspective, interventions with the mar- view that “the opportunity for the individual to control,
ginalized population should be based on a thorough direct and shape his/her own life may be minimal and,
knowledge of this population. Thus, “case studies” have whilst choice may be beneficial, some clients are over-
become widely diffused to peripheral countries (Midgley, whelmed by being presented with too much of it”
1981), making it one of the main strategies used worldwide (Hagedorn, 1997, p. 64). The client-centered approach,
 CHAPTER 2 Social Occupational Therapy in Brazil: A Historical Synthesis 19

therefore, is limited since it starts from a liberal conception In a critical conception, the ethical aspect guides the
that man is naturally free, disregarding the social and po- application of knowledge. From an ethical-political com-
litical inequalities that lead to the core of the social ques- mitment, the professional “takes sides with those who
tion. By not recognizing this sociopolitical context, it also have less power” (Santos, 2012, p. 159) with an inclination
disregards the importance of popular social organization toward social transformation. As Santos (2012) states:
and collective action (Galheigo, 2012).
The enriching application [of knowledge] seeks and
The humanist perspective manifests itself in a pluralis-
reinforces the emerging and alternative definitions of
tic way, and there are different approaches whose detail
reality; for this, it delegitimizes institutional forms and
does not fit the scope of this discussion. It is a perspective
modes of rationality in each of the contexts [domestic,
that provides a foundation for social practices that aim at
work, citizenship, and world], in the understanding
facilitating people’s self-knowledge and autonomy but hav-
that such forms and modes promote violence instead of
ing only individuals in their personal development as the
argumentation, silence instead of communication,
focus of intervention.
alienation instead of solidarity.
Summarizing critical perspectives is a difficult task,
given the breadth of theories that would have to be dis- (Santos, 2012, p. 159)
cussed in an examination of their nuances, consensuses, The contemporary social practices developed in Brazil
and dissent. Therefore, what can be done in this chapter is by social and health care workers have been largely influ-
to present some key issues that guide critical perspectives. enced by critical—theoretical and methodological—bases.
Luckily, the main authors who have contributed to the In parallel, in the scope of occupational therapy, the critical
critical debate within occupational therapy have been pre- perspective is increasingly based on Brazilian and Latin
sented earlier in this chapter. American experience:
Some problematizations are highlighted in the formula-
These new theoretical positions, comprehensive in occupa-
tion of critical perspectives. In general terms, critical per-
tional therapy, require a permanent questioning. From a
spectives question (1) scientific knowledge as a statute of
critical position, which is transformative of the social
truth, produced in a neutral way; (2) knowledge produced
world we are part of, [the world requires] asking ourselves
by distancing subject and object and by subordinating the
about the assumptions of OT, the obvious, the natural.
object to the subject; and (3) knowledge that understands
[This means] [n]ot only thinking about the political,
the social fact as a natural and universal phenomenon.
ethical and economic considerations of the problems that
In contrast, critical perspectives recognize both the pro-
affect the community and the implications for OT, but
duction of subjectivity and social relations as sociohistori-
also considering that criticism is the privileged place to
cal processes. Thus, they hold that to address society’s
produce knowledge. Criticism as knowledge.
problems, it is important to understand historically the
macro-processes that influence social relations and the (Guajardo, 2012, p. 23)
material conditions of existence. Critical studies, as well as
emancipatory practices, highlight the importance of local
and contextual knowledge and the value of diversity and SOCIAL OCCUPATIONAL THERAPY IN ITS
culture. The question of power also permeates the critical CRITICAL AND COMPLEX PERSPECTIVE:
debate, whether in the search for an understanding of the
FINAL CONSIDERATIONS
role of the state, an understanding of institutional power,
or an understanding of the capillarity and inequality of Social occupational therapy, as conceived by the Metuia
power relations. Project, uses a critical perspective to ground its theoretical-
Critical perspectives have been an important marker for methodological bases. The guiding principles that define
the discussion of the technical application of knowledge. In what is meant by occupational therapy in the social field
the hegemonic conception, the practitioner ends up being are unequivocal, even when some differences in framing
a reproducer of the dominant discourse and the status quo. projects and theories may appear within the various
When “applying knowledge, [he/she] is outside the exis- practices.
tential situation to which the application is referred and The practices of social occupational therapy are sup-
[he/she] is not affected by it” (Santos, 2012, p. 157). The ported by an ethical and political commitment that takes
practitioner does not mediate between the universal and place through a sensible listening to the stories of persons
the particular; he or she does not value the subjective and and collectives with whom projects are developed and by a
local knowledge and so adopts one-dimensional thinking critical perspective of their social and political contexts. It
(Santos, 2012). is sensible by listening to and holding people’s ideas,
20 SECTION 1 Conceptual Outlines: Colors and Textures

affections, and experiences, and critical by problematizing Occupational therapies without borders (Vol. II): Towards and
macro-processes in which their everyday lives are interwo- ecology of occupation-based practices (pp. 209–216). Edinburgh:
ven. It has an ethical commitment by intervening in life Churchill Livingstone/Elsevier.
and in movements of resistance and affirmation. It has Barros, D. D., Lopes, R. E., Galheigo, S. M., & Galvani, D. (2005).
Chapter 30: The Metuia Project in Brazil: Ideas and actions
a political commitment by the continuous clarification
which bind us together. In F. Kronenberg, S. S. Algado, &
of the existing macro- and micro-political forces; by the N. Pollard (Eds.), Occupational therapy without borders -
defense of autonomy, citizenship, and rights; and by the Learning from the spirit of survivors (pp. 402–413). London:
search for new strategies for the construction and/or Elsevier Churchill Livingstone.
strengthening of collective action. Barros, D. D., Lopes, R. E., Galheigo, S. M. & Galvani, D. (2011).
Chapter 34: Research, community-based projects and teach-
ing as a sharing construction: The Metuia Project in Brazil.
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crítica [Approach and praxis in occupational therapy. realización y libertad [Occupation, meaning, realization
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 e1

Keywords: History, Vulnerable populations, Professional

knowledge, Professional practice, South perspectives
 3
Occupational Therapy
and Socioeconomic Processes
Maria Izabel Garcez Ghirardi, Ana Paula Serrata Malfitano,
Roseli Esquerdo Lopes

INTRODUCTION demand for rehabilitation services formed the basis of the

When it comes to consolidating courses of social participa- need to restore and maintain the workforce available to
tion in scenarios that make up the landscape of the working that market (Soares, 1991).
world, socioeconomic processes articulate the encounter Occupational therapy was a component of those reha-
between occupational therapy and daily life activities. This bilitation services and began to be used to reduce the dam-
chapter intends to discuss some forms of these encounters, age caused by the capitalist mode of production. However,
based on the premise that the world of work and the world dealing with the social question from a clinical perspective
of assistance materialize in different places, at their own of health overlooks the causal relationship between dam-
times, unyielding between themselves. However, with refer- age to workers’ health and the social question.
ence to occupational therapy, there are possible synergies Thus, the issues of the world of work were integrated
that establish different ties of sociability among the assis- into the field of rehabilitation and, more specifically, into
tance recipients. occupational therapy by the health – disease matrix and by
an intersubjective therapeutic relationship. This reduced the
The Social Question and Occupational Therapy social question to a binary conformation in the exclusion-
One of the purposes of occupational therapy is to intensify inclusion syntax. With reference to its current globalized
conditions of social integration and democratic participa- form, this social question keeps alive the dispute on the
tion. This requires professional care that comprises a set of liberal contradiction that intends to individualize social
professional, political, and ethical actions that translate problems and thus destroy bonds of trust that create social
into complex social interventions, such as interventions cohesion (de Leonardis, 1998).
directed at resolving suffering and daily seclusion, which It is important to emphasize that the transposition of
result in the deterioration of social ties and individuals’ the health care model to the field of social care resulted in
marginalization. a paradox in the practice of occupational therapy, since this
Often social ties weaken due to the restricted access practice tended to imprison the minds of social participa-
to employment resulting from processes of economic tion in an individualized and culturally decontextualized
globalization, which, since the second half of the 20th relationship, insofar as it isolated the complexity of inser-
century, defined new concepts with reference to the old tion in daily life, leaving it out of the clinical environment
social question (Castel, 2003). Historically, the concept of (Barros, Ghirardi, & Lopes, 2005). In a certain way, this
the social question has been dependent on the popular reac- movement of the transposition of the clinical model to
tion of denouncing the exploitation of the labor force in address social phenomena produced a disconnect in profes-
the industrialization process and the liberal capitalism that sional practice, a specialization of knowledge in rehabilita-
emerged in 19th-century Europe (Ferreira, 2008). In Brazil, tion that contributed to the capture of individual experience
the social question deepened with salaried employment of those for whom this practice was intended. This special-
and the exploitation of the labor force that was required for ization of knowledge that produces the capture of indi-
the capitalist reproduction of the coffee industry, and the vidual experience when dealing with social phenomena

22
 CHAPTER 3 Occupational Therapy and Socioeconomic Processes 23

operates a typical specialist disjunction of modernity and processes oriented toward productive action with an inclu-
allows rehabilitation actions to be circumscribed to the sive profile. The unveiling of the reductionism covered by
health universe, limiting the conditions of the understand- rehabilitation actions in the field of health care, directed by
ing of social determinants of participation in social life the proposal of inclusion in the world of work, is a condi-
(Giddens, 1990). tion for discussing the possible technical deeds in the con-
In Brazil, at the beginning of the 1980s, a movement of text of economic and social complexity under which any
critical formulation of the profession sought to analyze form of work falls.
social phenomena in the context of occupational therapy By wishing to contribute to the intensification of demo-
and resize the ethical and political aspects of the profes- cratic participation in the world of work, occupational ther-
sion. This point had been overshadowed by discussions apy should consider the complexity of collective and social
around instruments, techniques, and clinical procedures of dimensions that such participation involves. To plan action
the biomedical model (Barros et al., 2005). However, de- strategies that contribute to tackling the social question (i.e.,
spite every effort to defuse this contradiction, there is still to reverse situations of isolation, vulnerability, and the weak-
a tension between paradigms in occupational therapy. ening of social bonds), social occupational therapy seeks
Particularly, with regard to the world of work, there is a to create social intervention methodologies that strengthen
simultaneity of practices, incompatible among themselves, the conditions necessary for participatory paths guided by
that operate, sustained by the discourse of citizenship and creative capability and collective self-organization. In other
social inclusion. Hence, interventions in workshops, coop- words, occupational therapy undertakes the social object of
eratives, and job support, among other designations of action, proposing strategies for the facilitation of participa-
technical-social instruments, are operated in the field of tory paths, which, if successful, should create the conditions
rehabilitation and occupational therapy, sustained by the for an individual to overcome the status of a recipient of as-
discourse of social inclusion and the proposals of varied sistance services and proceed toward the status of a producer
clinical settings, which do not provide an account of the of social goods and services.
complexity of the phenomena that make up what is recog- Thus, when the authors of this chapter intend to under-
nized as a social question. stand the complexity of a social phenomenon, the care
Reflecting the social question and, more than that, pro- context is necessarily a hybrid place in which one produces
posing practices in occupational therapy that address this social value from the creation of bonds of trust and there
question depend on unique conditions of intervention, is a decrease of uncertainty and mistrust in oneself and in
which demand different methodological procedures and others. It is a place in which one avoids negative discrimi-
courses of action, conditioned by the capacity to analyze nation based on physical, psychological, or social excep-
and to interfere in social phenomena whose nature is irre- tions and which moves from the universe of the exception
ducible to the isolated individual fact. These conditions of individual conditions to the universe of communities of
have been pursued in the field of social occupational ther- collective doing, organized in projects that allow an open-
apy based on the proposal of interventions guided by ing up to the perception and valuing of the exchange of
humanities and social sciences, which are outlined by knowledge that potentiates a community of doing. There-
means of solid field analyses (Cefaï, 2006). We intend, fore, the development of tools that forge common places in
therefore, to compose collective actions aimed at creating the midst of exceptional situations is a prerequisite to any
conditions for democratic intensification and social inte- practice of occupational therapy that aims to engage in
gration as a response to the ailments exposed by the fraying social care.
social fabric, which also derives from the processes of eco- The economic theory developed by Amartya Sen (1992)
nomic globalization. is a theoretical framework that allows one to observe and
activate organizational resources that can be used effec-
Economic-Social Processes and Occupational tively in favor of a social valorization. This economic the-
Therapy ory proposes to operate from the granting of credit and
The proposal in this chapter is to highlight the socioeco- recognition of individual capabilities to create the neces-
nomic processes that interfere in the panorama of occupa- sary conditions for those capabilities to operate in the
tional therapy actions aimed at creating conditions to production of values of use and social exchange (Mozzana,
overcome, at least in part, the capture of experience to which 2008). Put another way, it opens up the possibility of
some practices of rehabilitation contribute. These practices moving from one place to another or from a fixed place of
tend to insulate the intrinsic sociological complexity in the exception and of guardianship to transitional, common
world of work by reducing it to a type of panacea for the places, in multiple shared production networks, based
social problems, which would be overcome in rehabilitation on the power of collective capabilities and possibilities
24 SECTION 1 Conceptual Outlines: Colors and Textures

(Sen, 2006). This interpretative key can assist the occupa- When addressing the economic-social aspects of doing
tional therapy field when it comes to dealing with eco- within the context of a less personalist and more systemic
nomic issues linked to the production of social value and vision, it is possible to find similarities in doing that over-
to participation in the world of work, taking into consider- come any differences in the modes of being, especially
ation the complexity of social phenomena that anchor the considering that poverty does not designate an individual
whole mode of material production. condition but is instead a collective and complex position
Economic production presupposes confidence in one- of specific sections of the population. The approach of oc-
self and in others. Trust is therefore a valuable social value cupational therapy cannot maintain a posture alien to the
that is not always available among the situations occupa- social question, remaining in a universe of actions bounded
tional therapy deals with. Addressing work with reference by groups of individuals recognized by their particularities
to occupational therapy in economic and social processes of paths, as if the lack of economic resources was due to an
presupposes that work is central in what is known as the individual failing of any order, and likely to be treated in
social question and acknowledges that it is important the universe of the rehabilitation actions that understand
to consider ways to connect the world of assistance to work as a factor of social inclusion.
the world of production, thus avoiding welfarism and the Occupational therapy, proposed with a focus on socio-
fetishization of income. Thus, the rationale that one should economic processes, considers collective positivity instead
follow economic-social processes in occupational therapy of individual negativity, observes affinities of capabilities in
in economic-social processes is this analytical displace- place of exclusivity of limitations, and operates considering
ment in which collective and common dimensions are the systematics of doing and of social organization around
prioritized, which is in detriment to the individual clinical doing that are needed for the collective economy. This
relationship and the particularist dimension of action or approach emphasizes the public and common sphere, the
doing. This idea is supported by the horizontality of care, collective dimension of everyday social life that occurs
with places in which the common doing gains power. In in the encounter between differences in various orders—
contrast, it is avoiding the maintenance of interventions gender, class, and culture, among many others—and that
sustained by the verticality of places of care in which the determine variations in the way of being and of creating
exceptionality of individual situations is addressed by worlds. Occupational therapy is interested at this time in
health in a clinical perspective (de Leonardis, 2008). the multiplicities and the singular conditions that lead to
Work is a collective right, not a special need. Thus, the the creation of places of encounter and exchanges, sus-
interventions of occupational therapy in socioeconomic tained by the diversity of doings and forms of production.
processes propose the observation of the collective place It is possible, then, to establish another syntax to expand
of work, understanding its dimensions and relations of the professional image to discuss the collective occupations
knowledge and power, the contradictions and social de- in public places, in a pragmatic shift that brings into play
terminations that are established in the process of the what is common in social phenomena.
organization of work, and the everyday context of collec- Social issues are irreducible to forms of therapeutic
tive production. Exercising the right to work is therefore or clinical relations (with specific groups or individuals);
a collective challenge, especially when the indices of dis- therefore, the challenge is to enable the encounter of radi-
engagement and flexibility, added to the globalized forms cal differences in the process of the production of goods
of work organization, transform this right into a privi- and of social values, without wishing to adapt either of
lege; it is necessary to invest in collective actions that them to pre-established conditions. It is not, therefore, the
allow the redrawing of the valuing pathways of the capa- learning of techniques or relations of production that en-
bilities of the many people excluded from the productive sures the inclusion of people who do not have this right
market. When addressing socioeconomic processes, oc- assured in the labor market; rather, it is proposing alterna-
cupational therapy considers that a collective of produc- tives to the production of added social value to material
tion is not a place where people meet to discuss their production. However, it is not compromised by the pacify-
individual problems and seek support to face them; it is ing logic and conformist relations of guardianship.
the opposite and refers to the ability to, for example, gen- It is important to remember that participation in the
erate income and overcome economic misery. A collective world of work, in whatever form, does not refer to health
of production is a place in which common reflexivity may contexts, rehabilitation processes, or equipment, since
be enabled and a social condition can be criticized and work is not an inclusive therapy, but a collective social right
eventually overcome in the encounter of collective solu- shared between actors of equal social conditions. The so-
tions that escape the liberal and individualistic logic of cial place of work cannot be reduced to a space shared by
economic production. subjects in the processes of recovery from individual ills.
 CHAPTER 3 Occupational Therapy and Socioeconomic Processes 25

The workplace, conquered through the struggle of many displacement of the status of a recipient of assistance ac-
workers, is a place inhabited by people with limitations and tions to the status of a producer of social goods and
possibilities that complement one another in everyday ac- services (Mozzana, 2008).
tion, which unfolds through flashes of being with others. The Italian paradigm of social enterprise is another
The workplace is therefore a common and temporary place theoretical framework that can provide tools for the sys-
in the cultural universe of exchanges of symbolic values in tematization of a methodological approach of socioeco-
which people come and go, searching, with diverse stories nomic issues in occupational therapy. This focuses on the
that weave new social bonds daily. Experimentation, on the communicative action, on individual and collective skills
border between provision of care and economic produc- producing their own solutions to everyday problems. It is
tion, shows the feasibility of promoting social participation guided by the organization of services that they use to pro-
from real contexts of work by means of strategic pathways duce goods, adding social value by investing in the produc-
that result in a scenario of improving conditions of social tive capabilities of human capital, and valuing the collec-
justice (Vitale, 2005). tive path of economic production as a way to overcome
As Hammel and Iwama (2012, p. 386) affirm, “occupa- individual limitations of social participation. In spite of the
tional therapy is clearly concerned with the conditions that cultural differences between the European and South
enable or constrain actions, and particularly with doing,” American contexts, it is believed that this paradigm is an
and consequently we should be focused on rights and so- innovation in the field of assistance because it proposes
cial conditions, but “much of the occupational therapy courses of participation that seek to move from the depen-
theoretical literature focuses predominantly on individual dent condition of assistance servicing to a position of a
issues” (p. 388). producer of social goods and services (de Leonardis, Mauri,
Therefore, it would be naive to think that occupational & Rotelli, 1994). Thus, the epistemological assumptions
therapy can contribute to the generation of income in eco- that consider the economic-social dimensions of interven-
nomically marginal populations. Generating income is not tions in occupational therapy unveil elements in a field of
the same as the allocation of technical care actions, nor is reflection and research. These assumptions are concerned
it a sufficient condition for the transformation of social with investment in the capacity of collective self-organiza-
relations. An occupational therapy intervention can, at tion and in individual creativity to define participatory
most, contribute to the generation of social value to the work pathways that establish conditions of displacement
extent that it manages to establish collective dynamics con- from the position of simple recipients of actions of assis-
ducive to common reflexivity, from redemption of confi- tance. Additionally, this would help us proceed toward the
dence in oneself and in others to the appreciation of the position of the producer of social goods and social values.
collective know-how. The reconnect that stems from this
reflexive activation enables the subversion, through shared A Possible Encounter Between Occupational
doing, of the alienating inertia that intends to define Therapy and Economic-Social Processes
income as a value in itself. As an example of what has been outlined previously, the
Assuming income as a value in itself is the basis of the following presents a brief report of a case that articulated
various social welfare programs that operate the logic of the field of occupational therapy in an encounter with
should be to can do; that is, the possibility of access to work economic-social processes. This case followed the everyday
and income depends on the acceptance of a place of assis- lives of people in a care project that aimed to generate in-
tance and, with that, of institutional guardianship by the come for the homeless population. A goal was to create
institution that shapes the forms of sociability through the conditions for sociocultural transformation and the inten-
fetishization of income (de Leonardis, 2004). Thus, it is sification of democratic participation on the margins of
important that occupational therapy finds courses of ac- the socioeconomic welfare system, considering the contra-
tion that, guided by collective doing, recognize the rights dictions concerning care limits when it comes to investing
and voices of the recipients of professional actions and in the social participation of economically marginal popu-
promote the visibility of their participation in the activa- lations (Malfitano, Lopes, Magalhães, & Townsend, 2014).
tion of individual capabilities in the context of collective This section entails examples from a report based on past
production. The course of actions involves creating places studies.
that facilitate interactions and confidence. It requires places A nongovernmental organization (NGO) oriented to-
that overcome practices that understand work as a form ward providing assistance to the homeless population in
of rehabilitation and that desire productive meetings, Brazil produces a street magazine that has the dual purpose
which, by means of public action that is guided by the logic of being a vehicle of social communication and, at the
of negotiation rather than hierarchical logic, render the same time, constituting an alternative project of generating
26 SECTION 1 Conceptual Outlines: Colors and Textures

income for the homeless population. To achieve this goal, The intervention started from the approach of an oc-
the NGO proposes that the sale of copies of the magazine cupational social phenomenon (i.e., the low adherence to
will be carried out exclusively by homeless persons, result- the magazine sales project) through the observation of care
ing in a joint venture in the context of urban movements actions that were involved in this project, as a way of avoid-
with global bindings that characterize a new global politi- ing approximation with an individual focus and relational
cal economy (Appadurai, 2002). Therefore, the magazine character inappropriate to studies in the social field. The
would be an instrumental aspect of an occupational course intervention also aimed to experiment to create an ap-
par excellence, aimed at strengthening social ties and creat- proach that would avoid the perspective of individual
ing the conditions for the homeless to migrate from a place action and, at the same time, bring elements of complexity
of dependence, tied to care services, to a place of autonomy to the observation of the collective doing, based on the
in the management of their own life. The magazine may be theoretical framework of the social, economic, and work
classified as a socioeconomic strategy since it intends to field. This approach facilitated the outline of an initial pic-
contribute to the rehabilitation of an economically and ture of the socioeconomic context of the population with
socially stigmatized, marginalized population. potential for adherence to the sales project, as well as the
Undertaking an economic activity and offering a cul- organization of care actions. Thus, the magazine—its orga-
tural product in the information and communication nization and operation, its production, and its divulgation
market requires investment in human resources and in policy—featured the observation of the common doing
conditions of cooperation between all those involved in the and of creating collective action in its production and sales,
joint venture (Sennett, 2012). In this case, a larger part of in detriment to listening to the unique demands of each
these resources is composed of homeless persons, whose person, in order to value the sales organization and the
workforce and labor are socially and technically not ade- sociability of the active and potential sellers.
quately qualified. Consequently, they are also recipients of The intervention was based on the shared doing and its
care services. Notwithstanding the proposal, it was ob- analysis, taking into account the conditions peculiar to that
served that the adherence of the homeless population to population facing the production process. The interven-
the magazine sales project was not accomplished. This led tion was intended to create a reflexive environment through
to the implementation of occupational therapy in an inter- an initial observation directed toward daily sociability,
vention project, based on the assumption that the search to which grew around the assistance proposed based on an
understand the resources and the difficulties surrounding economic deed and avoided the interpretation guided by
occupations of daily life is an integral part of the occupa- individual signals or symptoms. A delicate approach was
tional therapy practice, an approach that avoids diagnosing pursued by means of observation and description of the
and instead intends to consider the various occupations field through incursions to the various places where the
that shape individuals (Piergrossi, 2006). production and the dissemination of the magazine oc-
The methodological approach that guided this interven- curred and concurrently with an analysis of the workplace
tion was based on the Italian methodology of social enter- responsible for the reception of sellers and the mapping of
prising (de Leonardis et al., 1994) and the economic theory the assistance facilities of the central region of the munici-
of capabilities approach (Sen, 1992). The aim was to delin- pality. The publicization actions of the magazine sales
eate a course of intervention that permitted the displace- project and awareness of potential sellers were followed,
ment of deeds to migrate from occupational rehabilitation and the actions that organized the sales taskforce of the
with a focus on subjectivity to a perspective of community magazine at public events were monitored. The observa-
of deeds with a focus on public and collective action. The tion and analysis of these various field elements enabled
matrix of research-action enabled the approach of institu- the identification of relevant aspects of the cognitive orga-
tional cognitive organization and the conditions of expres- nization of NGOs through the analysis of vocabulary,
sion of the target population in a hybrid context, whose institutional grammar, and organizational practice.
operation was unveiled by means of dense observation and The process of occupational therapy intervention that
description in a form of pragmatic ethnography (Cefaï, stemmed from preliminary observations was guided by the
2006). From the point of view of occupational therapy in- organizational capabilities imposed and the conditions of
tervention, we sought to encourage the creation of bonds of expression (voice capacity) of the target population in the
trust and the decrease of uncertainty and mistrust in one- decision-making process regarding magazine design and
self and in others through a common doing mediated by sales strategy development. The contact with active sellers
economic production. It also sought to enable organiza- put into motion a form of activation and visibility of the
tional resources so that their effective use favored the place of sales, contrary to what was proposed, which until
projects of the target population. then was the visibility of the seller and his or her access to
 CHAPTER 3 Occupational Therapy and Socioeconomic Processes 27

care. This displacement wished to forsake the personalist transition from a position in which the individual con-
logic of the assistance of care and establish, starting with ferred value to a point of sale that became a kind of in-
weekly meetings, a scenario in which it was possible to get dividual and fixed property, a kind of showcase for the
closer to the sales project of the magazine. seller constituted a priori, to discuss the place of sale as
As such, these meetings, which came to be known as the a transient condition settled in common agreement, a
sales meetings, created a valuation environment of the collective configuration built by the know-how of vari-
participants’ occupational backgrounds and the recogni- ous sellers. This strategy was proposed to create the ac-
tion that their experiences could enable recovery pathways tivation of collective reflexivity in the displacement of
from a place of productive social insertion from their own occupational therapy action so as to migrate from an
occupational skills and not just the institutional expecta- approach of the meritocratic doings of an individual
tions. Thus, these weekly sales meetings, which lasted and the rehabilitative perspective to an approach of col-
2 hours each week, were formulated and led to strategies of lective action in the organizational qualification of a
activation of collective ability, focusing on the complexity community of doings.
of the sales exercise, as well as the necessary conditions to During the year in which the sales meetings were con-
occupy the place of the seller of a cultural product. ducted, various suggestions emerged on the management
The sales meetings focused on collective ability and of the NGOs’ assistance projects. The participants sug-
collaborative action to encourage the strategies of ap- gested, for example, that in events oriented toward the
proximation with the occupation of magazine sales. They dissemination of magazine sales, the expression “sales
were, in practice, stages of conversations whose emerging representative” be used instead of “seller.” According to the
themes included conditions of collective production, of opinion of the participants, being identified as representa-
production and sales strategies, of difficulties, and of insti- tives of the magazine confers value on the sales activity,
tutional obstacles that hindered adherence to the magazine whereas being identified as a seller deferred them to a
sales project. The consolidation of the sales meetings was place of dependence of care, as the magazine is recognized
not always able to count on the mobilization of active sell- for its purpose of generating income. It was possible, on
ers, who complained of excessive debates proposed by the the other hand, to understand that the existence of the
institution and, until then, of their own suggestions having magazine depended on adherence to the sales project,
limited repercussions for the institutional dynamics. This without which the institution of assistance has no visibil-
was an interesting strategy to leverage the voice and par- ity, and not just conversely, as propagated by the care
ticipation of the homeless population in the magazine team, making us believe that salespeople are the sole ben-
project and to create conditions of collective reflexivity in eficiaries of the magazine sales. It was identified that the
relation to the care project. This point was important for magazine also depends on the sales performed by the
the intermediate conflicts that occurred during the sales homeless, which it depends on to define its identity as an
meetings, since some arose out of a conception that the organization. The aim was to outline an occupational
occupation of the seller was eminently of an individual and therapy pathway that activated the collective reflexivity
competitive character, which meant that the point of sale1 when considering the power of the capacities of choice
became, in a sense, the owner of its seller, evidencing a and collective action and to observe the modalities of or-
logic sustained by the design of a liberal market. The logic ganizational logic and practices that can make depen-
of possession was contrasted by the logic of the shared use dence on the system chronic.
of points of sale, suggesting that a point of sale does not On the other hand, examining the demands of the
result from the isolated capacity of a seller, nor is it re- population that arrives at the organization’s port of entry
stricted to a defined geographical area, but rather is the allowed for identifying strategies for institutional opening
sum of variables such as geographical location, frequency for those interested in knowing and trying the magazine
of the seller’s presence, and nearby cultural events, among sales project. In general, the requests that appeared at the
other factors. The discussion was guided toward natural institutional reception evidenced the dependence on as-
elements that constitute the place of sales and the condi- sistance services of those who presented there. Whoever
tions for building a shared place that is recognized by arrives seeks recognition of their own needs and immedi-
the consumer as a place of sales. That is, we sought to ate solutions for them in an attempt to capitalize on the
assisted condition.
The approach of capabilities sought to establish a
1
Point of sale is how we denominate defined locations and times transition from the condition of being assisted to that of
determined in the streets of the city in which a seller offers copies being a producer, constituting a middle layer in the pro-
of the magazine. cess of approximation of the place of sales—the seller in
28 SECTION 1 Conceptual Outlines: Colors and Textures

training—which tended to minimize the fear of not being de Leonardis, O. (2008). Da luoghi di cura allacura dei luoghi
able to perform sales. Finally, it is important to consider [From places of care to the safety of places]. Animazione
that the freedom to participate in economic exchange has Sociale, 226, 3–11.
a fundamental role in collective life (Sen, 1992) and that de Leonardis, O., Mauri, D., & Rotelli, F. (1994). Limpresa Sociale
[The social enterprise]. Milano: Ed. Anabasi.
occupational therapy can offer various forms of benefits
Ferreira, S. (2008). A questão social e as alternativas da sociedade
when it comes to dealing with economic-social issues. civil no contexto das novas formas de governação [The social
What has been reported here is one of these possible question and civil society alternatives in the context of new
ways of conferring positivity onto collective production to governance forms]. Ciências Sociais Unisinos, 44, 28–38.
intensify social participation and to enable confidence in Giddens, A. (1990). The consequences of modernity. Palo Alto,
oneself and others by means of constructing a place of col- CA: Stanford University Press.
lective belonging that values the individual’s know-how Hammell, K. R., & Iwama, M. K. (2011). Well-being and occupa-
regarding economically relevant production in the market tional rights: An imperative for critical occupational therapy.
of cultural goods and services. Scandinavian Journal of Occupational Therapy, 19(5), 385–394.
doi:10.3109/11038128.2011.611821
Malfitano, A. P. S., Lopes, R. E., Magalhães, L., & Townsend, E. A.
(2014). Social occupational therapy. Canadian Journal of
Occupational Therapy, 81(5), 298–307. doi:10.1177/
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occupational therapy: A socio-historical perspective. In F. Piergrossi, J. C. (2006). Essere Nel Fare. Introduzione Alla Terapia
Kronenberg, S. S Algado, & N. Pollard (Eds.), Occupational Occupazionale [Being in doing. Introduction to occupational
therapy without borders: Learning from the spirit of survivors therapy]. Milano: Franco Angeli.
(pp. 140–151). London: Elsevier Science Ltd – Churchill Sen, A. (1992). Inequality reexamined. Oxford: Clarendon Press.
Livingstone. Sen, A. (2006). Identity and violence: The illusion of destiny.
Castel, R. (2003). From manual workers to wage laborers: Trans- New York, NY: Norton & Company.
formation of the social question (R. Boyed, Ed. & Trans.). Sennett, R. (2012). Together: The rituals, pleasures and politics
New York, NY: Routledge. of co-operation. New Haven, CT: Yale University Press.
Cefaï, D. (2006). Due o tre cosette sulle associazioni . . . Fare Soares, L. B. T. (1991). Terapia Ocupacional: Lógica do Capital ou
ricerca su contesti ibridi e ambigui [Two or three little things do Trabalho? Retrospectiva Histórica da Profissão no Estado
about associations . . . Doing research on hybrid and ambigu- Brasileiro de 1950 a 1980 [Occupational therapy: Logic of
ous contexts]. Rivista delle Politiche Sociali, 3, 201–217. capital or work? Historical retrospective of the profession in
de Leonardis, O. (1998). In un Diverso Welfare. Sogni e Incubi Brazil from 1950 to 1980]. São Paulo, Brazil: Hucitec.
[In a different welfare. Dreams and nightmares]. Milano: Vitale, T. (2005). Contradiction and reflexivity in social innova-
Feltrinelli. tion. A case study from the deinstitutionalisation movement.
de Leonardis, O. (2004). Le Istituzioni. Come e Perché Parlarne European Urban and Regional Studies. Social Innovation,
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Roma: Carocci. University Press.
 e1

Keywords: Work, Capitalism, Social rights, Social exclusion,

Economic exclusion
 4
Occupational Therapy: Social, Cultural?
Diverse and Multiple!1
Denise Dias Barros and Debora Galvani

MULTIPLE PERSPECTIVES ON THE engaged in a collective effort to construct experiences in

INTERPRETATION OF REALITY: CHALLENGES social occupational therapy in dialogue with the problems
of populations that, for social, cultural, and historical rea-
In this chapter, we address the need to construct method- sons, find themselves disconnected from social and affective
ologies of action for social occupational therapy. Social support networks. The Metuia Project therefore provides an
occupational therapy practice calls for constant question- opportunity to reflect on the profession’s role relating to the
ing about the space occupied by practitioners and the na- social and cultural dynamics of situations and spaces in
ture of their action. It demands reflexive action in the which people experience inequality and disqualification of
midst of interpretations that are in dialogue; thus, social identities (Barros, Ghirardi, & Lopes, 1999). The Metuia
occupational therapy assumes a hermeneutic that is also Project further aims to develop approaches for action by
characteristic of interpretative anthropology (Geertz, social occupational therapists that can meet the theoreti-
1989), which is a highly narrative form of description in cal, technological, and methodological challenges in such
which cultural realities are inscribed by the researcher in situations or spaces. Thus, social occupational therapists
texts that attempt to capture the layered meanings and nu- working in this manner have had to make theoretical and
ances of lived experience. Because of their rich or “thick” practical choices for each new project, drawing on a dense
descriptiveness, these texts then require careful interpreta- archive of experiences and reflections relating to social
tive engagement by readers and become understandable and cultural matters in a range of settings and situations:
through multiple readings and intertextual perspectives. urban, rural, and peripheral, with various sectors of society
Interpretation must be present in ethnographic work. Po- in Brazil and in Africa.
tential conflicts and alignments of interpretation are al- With the reflections in this chapter, we intend to revisit
ways present in ethnographic work, since the researcher the aspects of this work associated with the practices of
has a position in relation to social groups, communities, university research and activities of teaching and extension
and the personal trajectories of specific individuals de- work (i.e., partnerships between the university and com-
scribed through the research. Therefore, multiple perspec- munities). We will do so by selecting emblematic situations
tives occur and need to be assessed both during fieldwork for description and analysis in terms of social occupational
and in the analysis process. This same plurality of perspec- therapy’s key concepts and methods (Barros, 2004; Barros
tives also needs to be analyzed during the construction et al., 1999; Barros, Lopes, & Ghirardi, 2002; Barros, Al-
of social actions and technologies in social occupational meida, & Vecchia, 2007). Emphasis is placed on the experi-
therapy. ences and strengths that ethnography brings to our work
Since 1998, the Metuia Project (Barros, Lopes, and its processes.
Galheigo, & Galvani, 2011), conducted by a group of uni- The term “ethnography,” an anthropological method
versity academics in occupational therapy who have based on prolonged immersion in a culture and rich nar-
been developing actions, research, and teaching, has been rative description, can be translated as “writing about a
culture” (Atkinson, 1992). Understanding that there are
1
We are grateful to all the people mentioned in this study, with multiple ways of seeing culture informs the attention that
whom we have shared discussions, ideas, experiences, and pro- professionals need to take when they are working in the
ductions and have learned together. social field, where the actions they take as practitioners

29
30 SECTION 1 Conceptual Outlines: Colors and Textures

must be carefully designed to fit specific situations and in Brazil and Mali were developed also to provide oppor-
contexts. Since the beginning of the 21st century, we have tunities for undergraduate and graduate students in the
developed this approach by engaging in dialogue with Metuia Project of the University of São Paulo (USP). Thus,
those for—and with whom—we anticipate that our ac- in the selected ethnographic descriptions from our work in
tions and activities can help to expand or even guarantee social occupational therapy in Sao Paulo, we highlight the
possibilities of social and educational life, support aes- theoretical, political, social, cultural, practical, and educa-
thetic and cultural expression, and strengthen social devel- tional dimensions of life on the streets and in activities
opment and rights among socially and culturally diverse associated with the Casa das Áfricas community center.
groups. We initially began this undertaking while working Finally, we touch on public policies related to social assis-
with children and adolescents, later expanding to work tance, culture, human rights, and migration.
with adult street people. These practice-related encounters
included discussions about housing, quality of life, and The Streets Open to Our Inquiries about
community action in both urban and rural environments. Occupational Therapy
This chapter, then, concerns our university research and Our first contacts with social groups—including the so-
the extension of social occupational therapy in projects we called street people in the city of Sao Paulo—were rooted in
developed in the states of Sao Paulo and Minas Gerais, the need to cross borders and break down mutual misunder-
Brazil, as well as in the Dogon Country of Mali, West standings. The narrative in Box 4.1 reconstructs one of our
Africa. It is important to keep in mind that the projects initial visits to the group’s spaces of everyday living, such as

BOX 4.1 Preliminary Approaches3

It was a scene of devastation, as in a science fiction movie station “provoking,” aiming to be arrested for a while. But
based on pessimistic global predictions about there being before doing this, he finds out which police chiefs are on
no more water for everyone, machines controlling the duty, because some of them are tough guys.
world, or monkeys dominating humans. In this case, the Across from the police station, on a street from which it
mice reign. As a man living under the viaduct said: “Rats is possible to observe the frantic movement of cars, Edu-
are more organized than men!” One sleepless night, he ardo showed us the tree where he sometimes sleeps.
could observe their routine of leaving and bringing food to According to him, sleeping on top of the tree is safer,
their shelter! because the thieves come out at night: “. . . during the day,
The Minha Rua, Minha Casa Association (AMRMC) is street people are all good people, inoffensive . . . at night,
located under this viaduct. On top of it: traffic, speed, they are all thieves.”
passage. Under it: the street and the home of few people, Besides the tree, other places to spend the night in-
undoubtedly a borderline place. AMRMC appropriates a clude under a cart, a shack built from wood or cardboard,
public space (the area under the viaduct) and gives it a under a viaduct, on a square bench, and some unusual
private sense, with organization, established routines, spaces, such as inside the structure of a viaduct. Accord-
and space limits. The tables arranged on the association’s ing to Eduardo, the preferred spot is right in the middle of
patio give a family atmosphere to the place. We met this structure, because the floor is not flat on the sides:
Eduardo in this protected space. It was curious to observe “ . . . in these spaces, people put sofas, beds, rugs, and
how he daily brought materials here: pieces of rope, even stoves.” But how do they come in? Only after Edu-
wool, umbrellas, magazines, etc. At that time, Eduardo ardo showed us was it possible to understand. When
lived on the streets and, over the course of the 2 months viaducts are being restored, small holes are made at their
that we knew him, he explained and demonstrated his base, big enough for a person to pass through, and that
“strategies,” as he used to say. Without denying that we becomes an entrance. Eduardo reported that he had even
were in a situation of rights violation in which there was a met a person who had made a rope ladder that could be
lack of access to housing, work, health, safety, and cul- rolled up and down, which was very practical to climb up
ture, we wanted to look closely at it and into it. What to his makeshift home.
were Eduardo’s “strategies”? What could we learn from We learned from our experience with Eduardo that
them? Eduardo was our guide during two strolls around street people make many efforts to guarantee a living
the neighborhood; he showed us the first police station in space: it requires that different situations and resources
the city and told us that one of the “strategies” he uses need to be articulated and there are established relation-
to have lunch is to be arrested and taken to this police ships that ensure the protection of people and space.
station. He reported that he hangs around the police There is also the availability of resources in the region and
 CHAPTER 4 Occupational Therapy: Social, Cultural? Diverse and Multiple! 31

BOX 4.1 Preliminary Approaches—cont’d

what it can offer. In the vicinity of 25 de Março St., a busy in!” That scene of devastation became familiar, intelligi-
commercial region in Sao Paulo, Eduardo invited us to ble. We could identify the rug, the door, the sofa, the
search through the garbage and showed us one of his kitchen, the bedroom; we had some coffee and chatted,
sources of materials. When we returned to the area under and one of the most important themes is the fear of the
the viaduct, at dusk, Eduardo pointed at Laurinda, whom rapa.1 And we could understand many things, including
we had previously met at AMRMC. As we approached the most important: the rapa takes away much more than
her, she said gently: “Please, don’t mind the mess; come just the belongings of street people.2
1
An expression used to refer to city hall’s actions to remove the objects and belongings of homeless people; sometimes even
documents are taken.
2
Claudia Turra Magni (1994) explored the cultural dynamics established by urban nomadism relating to space, body, and things in
the experience of homeless people in Porto Alegre, state of Rio Grande do Sul, Brazil.
3
This text is part of the research field diary Circuits and religious practices in the lives of adults living on the streets in the city of
São Paulo, developed by Debora Galvani. (Galvani, 2014, p. 28)

the Minha Rua, Minha Casa Association (AMRMC)2 in an undergraduate term paper on the survival strategies
(Galvani, Sato, Reis, & Almeida, 2006), a reference center adopted by street people living in the central region of
for the homeless, where we met one of its users, Eduardo. Sao Paulo by Ushidomari (2005), who argued that existing
We started at the AMRMC social center because of its social services offered to this population were insufficient
mission to meet the needs of the street people as a social to satisfy the varied everyday needs of each individual.
group. Once there, we adopted strategies of proximity and As the Metuia/USP Project continued to develop,
territorial mapping, inviting users of AMRMC’s services students and professionals discussed the central ideas
such as Eduardo to construct narratives about the city from on urban anthropology developed in Sao Paulo by José
their own perspective. Such strategies were needed to initi- Guilherme Cantor Magnani (1996, 2002, 2003), whose
ate us and allow us to understand the social dynamics work focuses on networks of belonging (social member-
among users and be able to break though spatial frontiers in ship) among urban social groups. Bringing together urban
the city that we would not typically be able to cross given studies and ethnography, Magnani proposes to “look
the differences between our and their everyday experiences. closely at and into” the experiences of the social actors,
We were also motivated to use this mapping strategy versus “looking distantly and from the outside.” This in-
because of the presence of our students in social occupa- volves seeing street people
tional therapy. Given the perspective of most of the street
not as isolated, dispersed elements subjected to inevi-
people whom we were accompanying, it would not be pos-
table massification, but which, through vernacular use
sible for occupational therapy practitioners and student
of the city (of space, devices, institutions) in spheres of
interns to do research and work with this social group
work, religiosity, leisure, culture, survival strategies,
“from within an office.” We came to understand the
are responsible for their everyday dynamics.
mapping strategy as a way to construct shared knowledge.
Barros et al. (1999) articulated: (Magnani, 2002, p. 18)
Concerned with the dynamics of sociability, Magnani
It is based on knowledge about the reality, necessities,
understands that social practices provide meaning or resig-
and way of understanding the world of these people
nify the conventional meanings of urban spaces. Based on
that we should direct our investigations and search for
the work of identifying and analyzing different forms of
answers. (p. 70)
use and appropriation of such spaces, Magnani proposes
We also realized that while social welfare services were key concepts to interpret the dynamics of the city that have
important in the everyday organization of this social helped us in the Metuia/USP Project to gain a deeper un-
group, social services are by no means the only thing that derstanding of the social groups with which we develop
is important for this social group. This was demonstrated university research, teaching, and extension activities.
Thus, the concept of a “part” seeks to explain a particu-
2
Community center for homeless adults located in the central re- lar type of social relations established in a space that be-
gion of the city of Sao Paulo, under the Glicério viaduct. More comes a reference point for belonging to a specific network
information and images are available at http://www.usp.br/jorusp/ of relationships, regardless of territorial limits. As de-
arquivo/2003/jusp666/pag03.htm. scribed by Magnani, the part interests its habitués and the
32 SECTION 1 Conceptual Outlines: Colors and Textures

relationships established between its members through the she sold the Ocas magazines and had fun at the same
handling of symbols and common codes, which are the time. We could observe Pilar’s work, the way she in-
determinants. The notions of “part,” “itineraries” (moving volves people as she joyfully tells her history with pride
about in the city), and circuits (network of spaces, parts, and presents her literary productions, sometimes with
and devices referring to certain practices or service offers) a few declamations. It was interesting to note that even
would serve as a foundation to understand the dynamics of when she realized that a person would not buy the
the city associated with specific social groups: adult street magazine, she still showed the same friendliness. We
people, people in permanent interaction with the streets, also noticed that, quite often, Pilar met someone she
street artists, and immigrants. knew, and who admired her. From these encounters,
Julia Nascimento (2012, p. 3), an intern linked to the invitations to conduct poetry soirees and proposals of
Metuia/USP Project, described one day of circuit in down- new places to sell the Ocas magazine and her poetry
town Sao Paulo guided by two street people, Pilar and books were made, and we could clearly observe the pos-
Salvador. The theme Pilar chose to show the students was sibilities of strengthening and enlarging affective ties
the experience of “Pilar who has fun selling Ocas3 maga- and of work. Those who stayed until the end of the
zines and her poetry books. It strengthens and creates new day could understand how Pilar works, has fun, and is
relationship networks.” always producing art and culture.
Finally, Salvador showed his interaction with a
During the visit to the center region, I joined the group sculpture located in the region. In his opinion, it was a
guided by Pilar. First, we visited the Lâmina4 Studio to way of occupying the city and expressing himself. The
get to know the work and the points of view of artists circuit and the reflections of our guides have led us to
about the city center. The works exhibited in the gal- perceive different ways of defining art and culture.
lery are very interesting and inspiring, they show each
artist’s perspective on the city center in unique ways, In partnership with our interlocutors, we developed an
and it was interesting to hear from the artists them- understanding of different perspectives of Sao Paulo city.
selves about what they meant with their works. I be- From singular histories, we participated in parts, circuits,
lieve that the comments made by Salvador enriched and itineraries that are invisible to the “look distantly and
the discussion and brought many elements of reflection from the outside of it” approach, which configures possi-
for all, as well as the comments of Pilar and Paulo bilities of social belonging in movements opposed to social
(Salvador’s friend). The work of the cart touched ev- disaffiliation (Castel, 2005) and disqualification (Paugam,
eryone in different ways. Salvador, for instance, was 1999), seeking to uncover singularities in the process of
disturbed by the work. A cart, a working tool used by constructing identities capable of redimensioning and
some street people, turned into a work of art in an ex- conferring historicity to the experience of street situation
hibition, in his view, appealed to the use of an image (Galvani, 2008).
that represents this social group. It was possible to real- Some students affiliated with the Metuia/USP Project
ize how important it is that each person understands shared with us the perception that the guided circuits
that there are several points of view, and that there is around the city by our interlocutors, in addition to provid-
not only one reality. ing critical reflection, were situations of intense learning.
After our visit to the gallery, we gathered to decide Camila Exner (2012, p. 2), dialoguing with the concepts of
what to do next, and many students left because it was Magnani, discussed this in her internship report:
past the finishing time for the activity. Those who
stayed decided after a brief meeting to go to Vale do The circuit aroused an essential perception for the con-
Anhangabaú, where there was a celebration in honor struction of my career in occupational therapy. Walking
of the 100th birthday of the musician Luiz Gonzaga. through places that are part of the everyday life of
Pilar took advantage of the movement to show us how another person has transported me to a new place, full
of things to discover, learn, and rethink. It is remark-
able how people who are exposed to situations of
3
The Civil Organization of Social Action (OCAS), affiliated with
vulnerability/disaffiliation are grouped in a homoge-
the International Network of Street Paper (INSP), is the publisher neous mass, characterized by absence and necessities,
of Ocas magazine, which is purchased by the seller for R$3,00 or and thus seen as having nothing to offer. However,
U$1.08 and sold for R$7,00 or U$1.89 exclusively on the streets of what I noticed were people with many ideas, experi-
Sao Paulo and Rio de Janeiro (reference values of 2018). ences, desires, and enriching stories to share, who
4
http://spcultura.prefeitura.sp.gov.br/espaco/635/. are actively searching for spaces and resources through
 CHAPTER 4 Occupational Therapy: Social, Cultural? Diverse and Multiple! 33

income-generating programs, political organizations, A Casa Acolhe a Rua,8 a pioneer in the construction of
and religious and artistic circuits. housing alternatives for this social group, was one of the
spaces of action for occupational therapy practitioners and
Lack of housing was one of the main issues we faced,
students linked to the Metuia/USP Project. We shared con-
whether in the experience with street people or with
cerns with the residents and the project staff: How can the
organized groups struggling for urban housing (Barros,
coexistence of such different people in a single space be
Lopes, Malfitano, & Galvani, 2001; Lopes, Barros, Malfit-
improved? How can the new demands of everyday housing
ano, Galvani, & Galluzzi, 2001; Lopes, Barros, Malfitano, &
be met, considering that most residents had previously
Galvani 2002; Lopes, Barros, Malfitano, Galvani, & Barros.
experienced situations of living in the streets and staying in
2002). In the case of street people, plenty of money5 and
shelters? What can be done when the maximum term of
energy6 are spent on solving the lack of access to what
stay in the project (6 to 24 months) expires?
would be a constitutional right. The shelters have been the
We then proposed to remain in the community space,
main public policy alternative offered to this social group.
seeking to establish relationships with the residents. In ad-
Alternatives such as provisional dwellings7 seem to offer,
dition to the five dwellings that housed approximately 10
during the period in which a person may stay in them, a
residents each, the project had a community center for the
welcoming space that provides the homeless with greater
collective use of residents and community members. That
freedom and possibilities of everyday life management
was where we met a group interested in cinema. The group
than the shelters. Amanda Campana (2005, p. 7), in her
began to gather around the film collection of Gilvan, one
undergraduate final term paper for the occupational ther-
of the community center’s residents. After having slept in
apy course at USP, sought to understand the operation
the streets and in shelters for a long time, he proudly ex-
dynamics of the Dormitory Assistance Service and its
plained that he had managed to keep them in his luggage.
meaning for users based on her experience in the streets.
Many of his belongings had been lost, but not these! In a
She understood that the project
negotiated manner, a common project named Cultural
offers a better quality of life for people during their stay Tuesday was born among residents and team members of
in the provisional dwelling, providing better conditions the Metuia/USP Project. Occupying the community center
to meet their basic needs (bath, rest, feeding, etc.), as with cultural activities pertinent to its residents, in addi-
well as fostering a sense of living together with the tion to participating in other cultural spaces of the city,
people in the dwelling and allowing greater autonomy guided the construction of the activities. We reflected to-
for the residents, who begin to manage their everyday gether on the importance of culture, especially because
life activities. social policies aimed at this social group were not directed
at addressing this aspect of life at that time. We were im-
However, she also found that most people remain de-
mersed in a field of contradictions where the dominant
pendent on the homeless support network after being as-
discourse emphasized the need for work and housing. In
sisted by the Dormitory Assistance Service. We understand
this sense, the thoughts that Armand—one of the residents
that the Dormitory Assistance Service has brought impor-
interested in cinema—expressed in an interview led us to
tant demands to social occupational therapy. The project
reflect on the importance of culture:
When you have access to culture, you have the possibil-
5
In downtown Sao Paulo, the rent of a tenement can reach ity of formulating ideas, and in formulating ideas, you
R$50,00/m2 (reference value of 2015). The tenements serve people have the possibility of getting out of the situation you’re
with no access to the formal labor market and no guarantor or in. You can think better about these things, can’t you?
permanent job to facilitate renting a house/apartment, but who
Because the ideas are fantastic! You can also see an-
need to live in the central part of the city to be near work possi-
bilities and infrastructure. See Kohara, Comaru, & Ferro (2015).
other world, that there is much beyond. Yesterday, I
6
It is not so simple to find a place in a shelter for the homeless, and was watching a program on backyards. Some people
on many occasions it is necessary to wait hours until a vacancy is said: What is your yard? Some people believe that the
available, especially in winter. The vacancy may be in a shelter far backyard is just that, it’s a small thing. Then they in-
from the region where the person performs his or her activities terviewed a man in the Northeast, and he thought his
and concentrates his or her relation networks, hindering the per- yard was his simple life. A famous writer was saying
son’s already precarious everyday life organization.
7
With the National Typification of Social Welfare Services (Brasil,
2014), the provisional dwellings were named Dormitory Assis- 8
An OAF that temporarily responds to the demand for housing
tance Services, configured as a high-complexity special protection for the homeless who already have some alternative income. This
service within the Brazil Social Welfare System (SUAS). project’s name translates as “The House Welcomes the Street.”
34 SECTION 1 Conceptual Outlines: Colors and Textures

BOX 4.2 ​Excerpt From the News Report Rebellion at Provisional Dwellings in Sao Paulo
“We’ve had enough of alms; we want a future!” This is or “community dwellings.” Today, the OAF, in partnership
how the letter written by Sebastião Nicomedes, a user of with the SMADS, maintains five houses, each with room
the Dormitory Assistance Service who lives in a provisional for 10 people and a communal kitchen equipped with a
dwelling located at 518 Mercúrio Ave., downtown Sao stove, refrigerator, shelves, and tables. Close to these
Paulo, begins. Somehow his letter ended up circulating houses there is a community center that serves as an
in the 11 provisional dwellings scattered in the city and had area of sociability and leisure for the residents.
the adherence of many residents who intend to demand Now, many contracts are coming to an end, and the us-
the continuity of this program of the Municipal Department ers of different provisional dwellings are disgusted at the
of Social Assistance and Development (SMADS). possibility of having to return to shelters or the streets. In
The Dormitory Assistance Service began in 2003 and the shelters, they do not have the freedom to come and
functions as follows: people living on the streets or stay- go whenever they want, take a shower whenever they
ing in shelters are interviewed at the SMADS, and if they want, or stay during the day (they can only stay overnight).
can prove conditions to generate some income, they are There was a claim to extend the 6- to 12-month contract
allowed to live in a provisional dwelling, a house rented by to an 18-month contract, but “the real problem does
city hall, with a 6-month contract renewable for a further not lie in the length of the contract, but in the issue of
6 months, paying a condominium fee that ranges from provisional dwelling.” The issue is that there is no continu-
R$25 to R$35. Before becoming a modality of city hall, ity. The residents claim “Bolsa Aluguel,” social housing.
over 10 years ago, the nongovernmental organization “Instead of being managed by the Secretary of Social
(NGO) Fraternal Assistance Organization Program (OAF) Assistance, the Dormitory Assistance Service should be
rented houses and invited the homeless population to managed by the Secretary of Housing,” explains Regina
inhabit them, but these houses were called “dormitories” Maria Manoel, general coordinator of the OAF.1
1
Available at http://www.midiaindependente.org/pt/blue/2006/04/350461.shtml.

that her yard was the world, everything. And for an strength of the people in this social group that does not
astronaut, it would be the universe! What is your back- accept alms and, on the other hand, the need to discuss and
yard? What do you allow yourself to do? Today I can reflect on the construction of necessity hierarchies.
say that my backyard—I can’t say that my backyard In the experience with the adult street people in the city of
is the world or the universe, but I can say that it is Sao Paulo, relationships with different public policies (health,
ample, because I know it has other possibilities. social assistance, culture, housing, human rights) and other
(Interview available in Galvani, 2008, p. 131) resource networks were widely used. In the territorial activi-
ties, for instance, we were given information about people,
Cultural Tuesday also included more individualized projects, and services that could be used, including in emer-
projects and situations involving larger collectives. An in- gency situations, as in the case of finding a night shelter,
teresting, though tense, moment was the mobilization of which we observed to be a frequent occurrence.
residents of several provisional dwelling projects in the city As posited by Magnani, there are circuits and parts in
around the discussion of access to housing. Box 4.2 shows the city that are invisible to those who “look distantly and
an excerpt from the news report by Graziela Kunsch (2006) from the outside of them.” Through close contact with
on this issue. street people and nongovernmental organizations (NGOs),
Cultural Tuesday, a day on which there was already a we were able to map a circuit of political participation in-
certain mobilization of residents for collective activities, was volving forums, assemblies, social movements, public dem-
chosen by the National Movement of Street People (MNPR) onstrations, parties, special dates (e.g., the Street People’s
to hold an assembly to discuss such mobilization. Members Day of Struggle9), and historically established rituals (e.g.,
of the Metuia/USP Project supported and participated in
this historic moment. In the assemblies, the need to discuss 9
Every year since 2005, the MNPR has organized demonstrations
housing as a right was clear, and the voices against the mo- on August 19 against the lack of public policies and violations of
bilization drew attention, and in this sense, one of the most the rights of street people in several Brazilian cities. This date
forceful and paradoxical opinions was the assumption that was chosen because on August 19, 2004, homeless people were
“homeless people need to work before complaining about murdered at Sé Square, downtown Sao Paulo, in one of the most
housing.” What was evident was, on the one hand, the violent actions against the street population in Brazil.
 CHAPTER 4 Occupational Therapy: Social, Cultural? Diverse and Multiple! 35

the March of the Excluded). This circuit of political par- another participant told me to be careful ‘cause there
ticipation gathers people and groups into a joint struggling were several college students participating, and he be-
for the guarantee of rights and public policies for this so- lieved that I would diverge too much. I told him that
cial group (Costa, 2007). The circuit provides possibilities that was exactly what I wanted! This is the reason, be-
for exchanges that often transcend the typical hierarchical cause if everyone is going to say the same thing, I don’t
relationships between researchers/researched, therapists/ need to go, they already know what I’m going to say and
population, and coordinators/subordinates. We recom- I already know what I’m going to hear! If we want to
mend that mapping, knowing, and participating in such reach a consensus, the ideas have to diverge, otherwise
activities—which have become part of the practices of so- we will only see one side of the question! So I went there,
cial occupational therapy—should be seen as an important and that’s important! The other day, I said that the
part of what occupational therapists do. Such activities Forum is a family, every 15 days I had to go there, and
provided privileged spaces for discussing and understand- I would go there with the greatest affection, but some-
ing problems associated with the social group. They also times I would miss it, when things were too rough! There
helped to establish contacts and expand the possibilities for will always be a split of ideas, and this is very important,
exchange, and, as was observed in a few situations, partici- it’s no use imposing one thing; for me, taking a position
pation in the circuit strengthened networks of belonging in is something else, I’ve always fought for it and I’ll fight
a wider movement against social disqualification. The nar- the rest of my life, there’s no point in imposing some-
rative of Francisco, a proactive participant in the Forum of thing on me, sure you won’t get anything!
Debates on Street People10 and one of the early leaders of (Galvani, 2008, p. 240)
the MNPR, invites us to reflect on the importance of po-
Castells (2002, p. 20) conceptualizes social movements
litical participation and of the discussion and controversies
as “collective actions with a specific purpose whose result,
that occur in such spaces:
both in case of success and failure, transforms the values
In the last general strike during the Figueiredo govern- and institutions of society.” These are processes that, ac-
ment, I was beaten. I remember it as if it were today, I cording to Castells, are the basis for building collective
dream about it sometimes, those truncheons. We were identities. For this analysis, it is also interesting to resume
taken onto the buses that took people away. In the after- Castells’ discussion on territorial identities. He concludes
noon nobody worked, there was no commerce. It was a based on his observations and studies of urban social
victory, really, a lot of fighting, the union was really movements in various regions of the world during the
united, people that fought, as if they were at war . . . so 1970s and 1980s that people resist the process of individu-
this is very important, feeling useful, not doing it for alization and atomization, tending to group into commu-
yourself, looking at your bellybutton! . . . It is necessary nity organizations that, over time, generate a sense of be-
to know that others have the same rights as you and longing and, in many cases, a communal identity. Regarding
have to have the same possibilities as you do. I’ve never urban social movements, Castells understands that, regard-
accepted that, since I was young, I’ve never accepted it! less of the more evident achievements, their existence in
We have to look at people the way they really are, as themselves produces meaning for social actors and the
human beings, nothing else, forget the rest, as human community—both at the time that they take place and as
beings that have the same right that you have, the same part of the community’s collective memory.
amount, they are in a poor condition, without money, It seems appropriate to include the description of the
maybe without a home, they’re just like you, there’s no Solidarity Christmas of 2007 (Galvani, 2008), one of the
other difference other than that, social difference is noth- activities of the MNPR in Sao Paulo, in which students and
ing, so it is very important that crowds come and fill the occupational therapists participated actively for some years
Forum of Debates, it is necessary to bring these people (Box 4.3).
closer to us, so that we can change this situation. We are
putting into the minds of those people that it is worth Culture as Articulating Axis: Diversity
politicizing, fighting for something better. . . . So when and Cohabitation of Difference
I went to the Forum of Debates, right in the beginning,
On the one hand, we understand, in agreement with our
interlocutors, culture as a right and, on the other hand,
10
The Forum of Debates on Street People was held in biweekly culture as mediation and the possibility of strengthening
meetings with predetermined themes. Researchers, professionals, the person, collective identities, and networks of interde-
students, welfare service users, and leaders of social movements pendence. The relationships that occurred in the experi-
participated in these meetings. ence of Cultural Tuesday, in the Forum of Debates on
36 SECTION 1 Conceptual Outlines: Colors and Textures

BOX 4.3 ​Solidarity Christmas, December 2006

The year-end celebrations are a very delicate time for the some just watching, perhaps surprised by the nov-
street people, a moment when the absence of family is felt elty, others happy, who freely danced spontaneously
more intensely by some of them; the city stops; loneliness or chatted with friends, and many others working to
reigns. Aiming to “confront” this season with a dose of make everything work out right. And it did! A day of
solidarity, the National Movement of Street People (MNPR) encounter, despite being, as they say, the saddest
has been organizing the Solidarity Christmas since 2004. day of the year for those who live on the streets and
If in 2004 its realization seemed like a daydream, in 2005 in shelters.
and 2006 there was anticipation surrounding the event.
The Solidarity Christmas, in addition to marking the exis-
Anderson, a leader of the MNPR, talked about the meaning
tence of the MNPR as an organization and expressing the
of the Solidarity Christmas:
capacity of the movement, subverts the usual order of
Let’s do it at Sé Square again, not because of the things by showing that those who are considered depen-
massacre or anything, but because it is there that the dent and in need of charity can offer a party to the city. It
street population is more concentrated. It’s no use tak- seems that the various expressions of this movement
ing the Solidarity Christmas to Paulista Ave.; how are contribute to the construction of collective identities insofar
they going to get there? The bite to eat1 is in the cen- as even those who are not directly involved with the move-
tral area; those who donate food are downtown. … ment feel themselves responding to its actions. Regard-
And also, we want to go in search of the places where less of its most evident achievements and its constant
the food is, but for the sake of the culture, not the tensions, the movement seems to contribute to the con-
food. On that day, you eat a lot and forget the person, struction of a feeling of belonging. As noted by Castells
and we don’t want that. We want to show culture, joy, (2002, p. 24), actors in social movements construct “identi-
dignity, respect, credibility, and tell who the homeless ties capable of redefining their position in society and, in so
people are, what they really want, and why they are doing, of seeking the transformation of every social struc-
living on the streets. … This year, Christmas will be ture.” In some sense, the MNPR offers participants the
Solidarity Christmas, a “Happy City” for everyone, this opportunity to redefine themselves through an identity of
is our theme this year. A “Happy City” for the rich, the resistance.
poor, the black, the white, for whoever uses the city. Another emblematic event for our discussion is the
… May the city embrace these citizens, make them Street People’s Day of Struggle in 2012, which had
even more united. This is Solidarity Christmas. moments of protest marching and camping, as well as
the organization of a meeting with the candidates run-
The 2006 Solidarity Christmas was indeed a great party
ning for mayor of Sao Paulo. This remarkable act of
that featured several cultural events (music, dance, graf-
citizenship involving various social actors (MNPR,
fiti, workshops), adequate stage and sound infrastructure,
clergy, nongovernmental organizations, and the uni-
and the collaboration of many people. Occupational thera-
versity) gathered three of the candidates running for
pists and students affiliated with the Metuia/University
city hall at the time: Fernando Haddad, Carlos Gia-
of São Paulo (USP) Project participated in the party as
nazzi, and Soninha. One of the highlights of the event
collaborators and were assigned to help at a table
was the presentation of guidelines and commitments
where people had access to materials to produce their
prepared by the MNPR regarding assistance policies to
Christmas cards. This intervention in the city center
street people, finalized by the signing of a memorandum of
roused the curiosity of passersby, who stopped to appre-
understanding with these candidates. Two of these guide-
ciate it and wanted to understand what was happening.
lines are:
Many of them asked whether they should pay to have
• active participation of society (movements, organiza-
access to the cards; others simply cried. The newspaper
tions, clergy) in the construction of effective public
O Trecheiro published a report on the event that, in our
policies for the city, considering that social issues
view, conveys the “spirit of the moment”:
should not be treated as a case of public safety and
There was everything: many singers; musical groups violence, and
of various tones and sounds: rap, Brazilian country • support and improvement of policies to assist the home-
music, pop; puppet theater with audience interaction; less to leave the streets, such as income-generating
Christmas trees decorated in real time with recycled projects, social leasing with the possibility of permanent
material and cards made by passersby; many people, housing, vocational courses and service incubators,
 CHAPTER 4 Occupational Therapy: Social, Cultural? Diverse and Multiple! 37

BOX 4.3 ​Solidarity Christmas, December 2006—cont’d

cultural projects, opportunities to return to studies, and This matter will be mentioned in several situations in this
so forth. text when addressing the everyday life of street people.
In its first claim, the MNPR draws attention again to the In the second claim, it demands that street withdrawal
violence of the state by stating that “social issues should policies involve a series of intersectoral actions, highlight-
not be treated as a case of public safety and violence.” ing the idea of cultural projects.
1
Local expression to say a place with free food.

Street People, and in the actions of the MNPR led us to invention and improvisation. There, what counts is the
propose the concept of Point of Encounter and Culture power of plurality: the greater the diversity, the better.
(PEC) as a space of articulation and encounter between And the members of the project also enjoy the city: they
diverse forms of knowledge and languages for cultural ex- go to cinemas, theaters, exhibitions, debates, and every-
pression. Freire (2012) showed us that we are authors and thing else they want or suggest. Many among them saw
actors of our culture, and as we write it, we also experi- a film projected on a big screen for the first time through
ence it. The PEC was constructed by professionals of the the actions of the PEC. Others, likewise, have discov-
Metuia/USP Project, leaders of the MNPR, artists, students ered through the PEC that they can attend cultural
of the occupational therapy course at USP, street vendors, events for free on any day of the week—they can go to
volunteers of the OCAS, and other people in the commu- various SESCs [social and cultural services], cultural
nity. PEC meetings were held at Casa do Brás, initially the centers, movie clubs, etc. We learn that the city is also
main office of the Ocas magazine and the Landless Rural ours, that it is a place of culture that should
Workers Movement (MST), and, later, the MNPR. be enjoyed, discussed, and ceaselessly constituted in
The PEC experience has been described and analyzed in collectivity.
greater detail in other publications (see Barros, Galvani,
Almeida, & Soares, 2013). We excerpt Valdir Pierotti Silva’s The constant presence of occupational therapy students
(2009, p. 2) perception of the PEC from his internship re- in university extension activities has fueled the need for
port. After delimiting the concept of culture, Silva sought context-rich research over the years. One such study was
to discuss its effectiveness as a right, understanding that motivated by the arrival of new students at the PEC that
culture is a fundamental aspect of social occupational coincided with a period of repression of street artists in the
therapy practice: city. Our intention was to understand the movement of
street performers and performers living on the streets.
Quite often, the concept of human culture is reduced to Among them we found artists who understood the public
a meaning that refers to the field of arts and perfor- space as a privileged place to disseminate their art and
mances. However, culture does not concern a single those who, due to a series of disruptions, were merely exist-
area or department; it is, in fact, the result of individ- ing in the streets.
ual and collective creations, ranging from works of art, The study was conducted by a team of occupational
thought, values, and even of behaviors and the imagi- therapy undergraduate students, occupational therapists, a
nary. . . . Aware of these issues, the Point of Encounter street artist who worked in Sao Paulo, and two street peo-
and Culture seeks to promote, perhaps in a much more ple who enjoyed the cultural activities available in the city
instinctive than systematic way, several forms of cul- center. Two meetings were held to define our itinerary, the
tural manifestations. In the soirees held there, for use of resources, and our purposes. The research began at
example, there is space for everyone, for everyone’s cul- a historical moment, when city hall had started to restrain
ture and knowledge. The diversity of ideas and actions the presence of artists and at times seize their musical in-
is celebrated. The poems written with difficulty, there, struments. Guided by João da Viola, a poet and musician
at the time, are valued; declamations lacking rhythm who identifies with sertanejo de raiz (original Brazilian
and with misspellings are valued; any mode of expres- backcountry music), we followed the itinerary of his per-
sion is valued and given legitimacy. People sing, recite, formances, engaging in about 10 significant encounters in
and present their performances. People listen to rap, these spaces: Sé Square, 15 de Novembro St., São Bento
Brazilian country and popular music. Reading ranges Square, Ramos Square, República Square, and Luz Park.
from the poems of Castro Alves to ergonomics manuals, On 15 de Novembro St., for example, we met Marcos
from Paulo Freire to Tula Pilar, the house poet. There is Rasta. Born in the interior of the state of Ceara, he has
38 SECTION 1 Conceptual Outlines: Colors and Textures

circulated in several cities in Brazil and Latin America and on dimensions complementary to politics, religiosity, edu-
exemplifies a type of itinerant artist who performs in pub- cation, culture, and work. Such dimensions allow partici-
lic spaces and feels that this artistic work is somehow sa- pants to leverage their experiences to bring about new life
cred. His criticism of the criminalization of street artists perspectives (Galvani, 2008; Barros et al., 2013).
was overwhelming: Concern with the relationship between researcher
and researched group is inherent to the ethnographic
I am an African-Brazilian and I play African-Brazilian
method; however, predefined ethical parameters can
music, but when I’m broke I play Amado Batista, Bra-
generate discomfort. In an academic publication, for
zilian country music, whatever the audience asks for!
example, preserving the identity of the interlocutors is
But I think the 50-year-old generation is still support-
not always the expectation. From the ethnographic per-
ing the street culture manifesto actively. To perform in
spective, ethical care should be taken mainly in a nego-
the streets, we look for ways, if you stay it is because
tiation relationship to produce dialogues between the
you are a street artist, you have the courage I do . . . .
cultural differences of researchers and interlocutors. So-
It’s a spiritual wave, I think, it’s mystical, it’s a guiding
cial occupational therapy is enriched by this perspective.
force, because it’s hard to play and sing in the streets. I
However, researchers and occupational therapists are
make a living through music, singing in the streets, and
inserted into a historical process that values technical/
I’ve been on the road for about 15 years. It would be
scientific knowledge excessively, often considering it as
great if the street culture manifesto grew in Sao Paulo,
the only true form of knowledge; that is a reason the
and people valued it, especially the authorities who
contributions of Paulo Freire are very valuable for re-
need to learn to distinguish an artist from a bandit!
flecting on the dialogical relationship between educators
. . . I’ve seen an officer in a uniform kicking the face
and students. Here we will provide an excerpt from the
of a guy who was sleeping on the street, is that right?
report by Olívia Ishiki Resende (2009) on her internship
And how will people get to know that? That’s also
experience, because it illustrates something we have ob-
why I perform music, this complaint is in my lyrics.
served many times, the surprising discovery by students
(October 2009)
of almost unimaginable proximities with marginalized
This particular study resulted in a series of audio people who seemed so distant:
(songs, interviews, spontaneous statements) and image
The (re)construction of the look begins at the very first
(photos and videos) recordings that served as a basis for
PEC, where I meet João and Jesus and can hear their
producing a collective text entitled “On the Streets, Where
ideas and listen to their life histories. What had been
the People Are,” later published by the Ocas magazine.11 It
crystallized is somehow dissolved when I am welcomed
also resulted in the production of a manifesto in support of
by João, a person in a situation of social vulnerability
street artists, prepared by the research group and distrib-
who, in describing the PEC, creates an image of it as “a
uted to the artists and their audience along this same itin-
place of welcoming, friendship, understanding, love,
erary of downtown Sao Paulo. One of the main demands
and sharing.” Furthermore, his ideas impress me by
the artists put to our research group was the possibility of
their proximity to Paulo Freire’s words: “. . .no one edu-
expanding their collection of images, a commitment that
cates anyone, no one educates himself alone, people
the group assumed by ensuring the return of the images
educate each other, mediated by the world” (Freire,
produced. In addition, other projects unfolded from this
2012). I begin to notice that those meetings have much
contact. For example, the research group became engaged
to offer me, and so the crystal that was thought to have
in the project to record a live album with João da Viola and
much to teach these people begins to dissolve, and
Nogueira, his partner at the time. Although satisfactory
opens to intent listening, realizing how enriching the
audio quality could not be achieved due to the limitations
dialogue is.
of our equipment, the event was a great opportunity for
the musicians to disseminate their work. In addition, João There are innumerable situations in which we were
and Nogueira felt that a live recording attests to the quality surprised at these encounters. When the frontiers between
of the musicians, and thus it would have better chances to social class, generation, gender, and ethnicity become more
be marketed. Moreover, it is worth noting that the project permeable, we are faced with new challenges. One of them
sealed the partnership between the two musicians. We ob- is to think: What are the boundaries between people of this
served, then, that networks of belonging are constructed encounter in territorial and community works? When does
this work start? In the subway, for instance, when we would
meet people who were going to the project and walk to-
11
Issue 70, March/April 2010. gether with them? There is a need, therefore, for constant
 CHAPTER 4 Occupational Therapy: Social, Cultural? Diverse and Multiple! 39

reflection on the construction of this praxis, as Resende in the theory and practice of the Metuia/USP Project,
concluded in her report: notably in partnering with the Casa das Áfricas.12
In 2003–2004, the presence of people from the African
This shift in learning did not occur with brief contact,
continent living in shelters in the city of Sao Paulo was one
in an encounter; but through supervisions and reflec-
of the concerns addressed by student Miki Sato (2004) in
tive writings (reports), where shared impressions in
her final term paper, which was later revised and published
supervision were instigated to be reflected and elabo-
(Sato, Barros, & Santos, 2007). At that time, it was possible
rated, or discussed and/or clarified.
to observe the increased presence of recent immigrants
The experience with people under processes of dis-
from the African continent living in shelters; this situation
ruption of support networks impressed me by the rich-
was verified in a survey carried out at Casa do Migrante, a
ness of exchanges and learning. During this process,
shelter located in downtown Sao Paulo that specializes in
many certainties dissolved and became questions. For
welcoming immigrants. Although there was no public
instance, I imagined that I could offer a lot to the
policy for the reception and assistance of such immigrants
participants through the theories read during my
at that time, Casa do Migrante was one of the NGOs as-
studies, but with practice, I noticed that relating with
sociated with the Catholic Church that offered shelter and
them taught me many lessons, which may not be a
legal counseling and coordinated action aimed at guaran-
part of any theory. Thus, it can be noted that wisdom
teeing the rights of these individuals.
is not in only one place (in academia, for example), it
In 2011, Metuia/USP resumed working with the theme
is in the contact, in the relationship with what is dif-
of human mobility through a program to value the pres-
ferent, in the questioning, in the multiplicity of sources
ence and contributions of Africans living in Brazil, as well
(practice, theory, the other, poetry, dialogue).
as to assist and follow up with African students. Partnering
(Resende, 2009) with Casa das Áfricas, the program promotes activities to
It becomes evident that the places between those who expand the training of occupational therapists in diversity,
teach and those who learn, those who observe and those focusing on racial, gender, generational, religious, and ra-
who are observed, are part of a game of “musical chairs,” tionality issues. These are concerns endorsed by the World
whose rhythm is established according to the context and Federation of Occupational Therapy (WFOT, 2006, 2010,
possibilities and limits of the real. 2012). More recently, a proposal has been developed to ad-
Concern with the encounter with the other has been dress African migration more broadly in the Brazilian
a constant theme of our reflections. In the experiences of context, particularly as it relates to student mobility and
university research and extension quoted in this chapter, the circulation of intellectual and cultural products. These
it is a matter of thinking ethnographically within an ur- preoccupations have been consolidated in projects ad-
ban environment, and thus, as suggested by Magnani dressing specific aesthetic and cultural universes, such as
(2003) and Oliven (1995), of accepting the challenge to contemporary African children and youth literature, cin-
the researchers and, in our context, to the occupational ema, and arts. The concern is to train teachers and cultural
therapists to interpret their own culture. According to agents, as well as occupational therapists, in the under-
Magnani, in this type of work, there is a need to try standing of otherness through knowledge about Africa and
and overcome the feeling of closeness, creating a certain its aesthetic and linguistic expressions.
distancing to transform something familiar into some- With this view, we became a part, in the context of the
thing necessarily strange. Magnani emphasized that Casa das Áfricas, of discussion groups that addressed the
approaches that isolate social groups should be avoided, matter of migration and, in 2013, of the recently created
reinforcing the need to consider the network of relation- “interinstitutional network in favor of immigrants,” a net-
ships maintained between social groups and the sur- work that unites a series of initiatives and social actors in-
rounding society. volved with migratory issues in the city of Sao Paulo. One
of the main topics on the agenda was the legal framework
Diversity and Culture: Territories Covered
for immigrants and, consequently, efforts to change law no.
in the Partnerships With the Casa Das 6815 of August 19, 1980, which defined the legal situation
Áfricas of foreigners in Brazil and created the National Immigra-
The theme of Africa and African migration in Brazil, and tion Council (Brasil, 1981). Discussions focused on the
its related challenges and issues for social occupational urgent need to change the paradigm, hitherto supported
therapy, has been an important aspect of our work (Barros,
2004; Barros, Bahi, & Morgado (2011); Sato, 2004; Sava-
dogo, 2014; Pastore, 2015). It remains currently significant 12
Institute of culture, training, and studies on African societies.
40 SECTION 1 Conceptual Outlines: Colors and Textures

based on the philosophy of national security, to the para- country with welcoming people. Recalling the words of
digm of human rights and full citizenship. In 2017, new Chauí (1998, p. 80), “we are the good savages, by nature and
immigration legislation (law no. 13.445, May 24, 2017) divine providence, for we are heirs to the innocence of the
came into force and, despite failing to meet some of the natives from Paradise (though we have decimated them in
demands of immigrants and human rights organizations, a systematic genocide).”
such as the right to vote, the new law has brought signifi- Senegalese sociologist Alain Kaly treats the idea of the
cant advances and no longer views immigrants from the “terrestrial paradise” in his article on “The African Black
perspective of a national threat (Brasil, 2017). Being in the Brazilian ‘Terrestrial Paradise,’” reflecting on
Within the complexity of social occupational therapy, and analyzing racism in his trajectory as a researcher in
we have focused our practical and reflexive investments on Brazil and, above all, the experiences of African students in
the possibilities of action in contexts marked by differenti- Brazilian universities. Kaly (2001, p. 112) opposes the idea
ated, multiethnic cultural practices in spaces coinhabited that racial discrimination in Brazil is associated with the
by social groups that are religiously and multiracially di- social condition of African-Brazilians:
verse. The notion of culture as a collective human right and
The so-called African students who came to Brazil left
the theoretical and practical repercussions generated by its
their respective families, neighborhoods, and cities, e.g.,
application are not new (UNESCO, 2002). But this notion
Mancagne, Peul, Serere, Diola, Ibo, Banto, Soninké,
is not yet common among occupational therapists. Never-
Bambara, Dioula, Ewe, Touare, Dinka, took the plane
theless, applications of the notion of culture as a right in
as Senegalese, Guinean, Cameroonian, Gabonese, Ivo-
the Brazilian context have helped transform serious situa-
rian, Algerian, Egyptian, Cape Verdean, Angolan, Mo-
tions of disqualification and discrimination affecting
zambican, Sao Tomean, and arrived here as “Africans.”
African immigrants. For example, activism around the
In the country that welcomed them, cultural, linguistic
notion of culture as a right and the political recognition of
and ethnic diversities are eliminated, and they find
collective identities has resulted in important initiatives
themselves reduced to a single group. While European,
at the national level: federal laws no. 10.639/03 and no.
Asian, and American foreigners are treated according
11645/08 now make the teaching of African-Brazilian,
to their own nationalities, those from Africa are not.
African, and Indian history and cultures compulsory in
We are “Africans,” with all the negative burden associ-
all school curricula in arts education, history, Portuguese,
ated with it.
and literature, as well as the roles of academic staff (univer-
sity extension activities and education) and professionals It is in this context that the project “Africa Circles: Con-
(professional/political action) in the dissemination of cul- versation Circles about the Intellectual Production of Afri-
tural rights as rights to participate in a collective identity. can Students and Researchers in Brazil” emerged, one of
One of the objectives of this partnership is to develop the outstanding projects we have conducted with the Casa
methodologies (and activities) to work on issues that con- das Áfricas. Box 4.4 is based on the report by Ana Carolina
verge on the theme of recent African migration in Brazil, de Medeiros Laki (2012), an undergraduate student in oc-
including issues of gender, religiosity, and artistic expres- cupational therapy, and refers to one of the meetings held
siveness in contexts marked by racial, socioeconomic, and/ in 2012.
or cultural inequality. In general, Brazilian society’s per- We believe that to achieve a society more open to diver-
ceptions about Africa have been ignorant. We have lived, sity and difference, it is necessary to increasingly favor
historically, with the construction of stereotypes surround- spaces for debate on the meanings of diversity and on in-
ing the African continent: misery, wars, backwardness, clusion and participation policies. It is about creating
and naivety. As observed by Sato, Barros, and Santos, spaces for differences to coexist and sharing the dynamics
(2007, p. 13): of the social process. In Brazil, as elsewhere, this must also
translate into actions against racism and xenophobia.
In Brazil, African immigrants are perceived only as
Several occupational therapists have been attentive to
people from a continent known for misery and wars. In
issues regarding Africa, whether through study or action
addition, they are inserted into Brazilian society
works, to broaden the worldview and the contribution of
through referral services for the homeless, which con-
occupational therapy. Talita Vechia worked on the project
tributes even more to increasing the stigma and preju-
“The Threads That Bind Us,” run by Casa das Áfricas and
dice towards the African population.
the Songho Dere wo Dere Association (SDDA) together
Added to these observations, there is need for question- with Denise Dias Barros, between 2003 and 2005. We have
ing in two directions, in relation to the ideology of Brazilian worked in support of projects creating means to value the
racial democracy and the myth of Brazil as a welcoming weaver culture of the locality of Songho, Mali; a literacy