Autonomy and Culture

Autonomy is a fundamental concept of Occupational Therapy. As OT's we hope that our patients can achieve functional independence to the maximum. Independence doesn't mean being able to perform all tasks without assistance. Sometimes independence can mean performing little tasks or part of a task independently. Just achieving this little independence can make a huge difference to the quality of life of a disabled person. It is activities, or as we call it in OT 'occupation', that adds meaning to our lives.

Before I became accustomed to the OT way of life, I did not realize how vital gaining that little bit of independence can be. Brought up in a traditional Muslim and Indian household, elders and those who are physically or mentally disabled are considered to be of great value to the family, as they bring God's blessing and mercy onto the household. As a result many traditional families such as mine, emphasis the importance of caring for these people as it will earn us great reward. 'Caring' can be quite objective. Often we do what makes us feel good instead of doing what makes the patient feel good. As we feel great sympathy for them, we overcompensate by assisting them in all tasks. Helping makes us feel good, but for the patient loss of independence and relying on others for their every need can become terribly distressing.

For much of my teen years I assisted my mother in caring for my elderly grandmother, who had 2% vision in one eye and had difficulty mobilizing. As a result we strived to take care of her every need. What we didn’t notice is that we slowly took away bits and pieces of her independence to the point that she could not function without our assistance. We also did not realize that this is what may have caused her to be down and depressed at times. Her passion was cooking and caring for others, and now she was being cared for! Reflecting back on those years, I now realize that by trying to help her, we in fact took away her independence and disabled her even further.

What I learnt from OT is that we can care better by encouraging the patient to do for them selves and achieve independence, even if it may be minimal. Remember, caring for someone means you must care enough to do what's good for them and not for you. Allow them the freedom of choice, assist only when necessary and adapt situations where possible to allow for participation in previous occupations. This  can drastically improve their self esteem and self confidence and make them feel worthy once again. As Franklin D. Roosevelt said;

"Happiness lies in the joy of achievement and the thrill of creative effort".