Working for Health in the Anthropocene: The Environmental Imagination in the Establishment of Occupational Therapy, 1890–1920

Abstract

By the end of the nineteenth century, the view of labour as control of the environment for human benefit was being re-evaluated. In the United States, the conservation movement of the Progressive era (1890–1920) brought new attention to the problem of the ‘wise use’ of resources. Progressive social movements also developed a concern with holistic health and social conditions in rapidly industrialising cities. This paper argues that the formation of the new allied health science of occupational therapy in the early 20th century can be understood as a response to the health and conservation implications of changing relations between labour and resources. An analysis of published sources on the aims of occupational therapy in the Progressive era concluded that the early stage of the profession was structured by dominant Western narratives about humans and nature. Those narratives included the trope of redemption or transformation through labour and the importance of conservation as a response to the squandering of resources, both natural and human. I argue that the early development of occupational therapy was significantly influenced by environmentalist discourse as a therapeutic response to industrialisation and emerging Anthropocene awareness.

1. Introduction

The Anthropocene marks a radical transformation of earth systems and of human ideas about the earth. Scientists concerned with the Anthropocene have—so far unsuccessfully—attempted to assign precise dates to the start of the epoch, but for historians a major question is also how societies came to perceive and understand (or not understand) the momentous changes that were taking place. It is this latter problem that Lowenthal (2016) called ‘Anthropocene awareness’.

This paper deals with the first post-1800 period of widespread public realisation that environmental ‘business as usual’ was no longer possible—the Progressive era in the United States (1890–1920). The Progressive conservation movement was ‘the first large-scale national political movement in American history that sought to grapple with environmental dilemmas like waste, pollution, resource exhaustion, and sustainability’ (Cronon 2004, p. viii). This movement was not just about wilderness preservation but attempted to engage with broader social change involving urban poverty, pollution, education, medicine and social welfare.

A crucial aspect of the Progressive conservation movement was the re-thinking of links between labour, health and the environment. This resulted in the development of a new medical profession of occupational therapy, which began as an organised association first in the United States in 1917 (Quiroga 1995) but was soon thereafter introduced into the United Kingdom (Evans 2007). This paper analyses the role of environmental thinking in early occupational therapy. In building a history of ‘Anthropocene awareness’, it is argued that occupational therapy is important because it linked health and well-being to both a Romantic reaction against industrialism but also to a firm belief in how labour (which it termed occupation) could be used to control environments and therefore (re)build conditions beneficial to human welfare.

This paper focuses on the early history of occupational therapy in the United States during the Progressive era, which is here understood as beginning in 1890, with the massacre of Lakota Indians at Wounded Knee, South Dakota and thus the effective closing of the Western frontier, and ending in 1920, when the Nineteenth Amendment gave women suffrage throughout the United States (Jaycox 2005). From around 1850, industrialisation rapidly transformed American society, especially in the northeast. By 1910 the industrial production of the United States was almost twice that of its nearest rival, Germany (Rogers 1978, p. 27). Against this background, the political and social concerns of the Progressive era were explicitly articulated as early as 1892 in the Omaha Platform of the People’s Party, which expressed anger at a system wherein ‘The fruits of the toil of millions are boldly stolen to build up colossal fortunes for a few, unprecedented in the history of mankind’, an injustice that bred ‘two great classes—tramps and millionaires’ (Nugent 2010, p. 22; Stone and Kuznick 2013, p. xxi). In reaction to the growing disparities and alienation of industrialisation, the Progressive era saw important advances in social welfare programmes in many parts of the United States, although this was also the time when blacks and poor whites in the South became increasingly disenfranchised under the so-called ‘Jim Crow’ laws designed to enforce racial segregation at a state or local level (Nugent 2010). Overseas imperialism also became significant in this period when the United States annexed Hawai‘i and acquired the Philippines, Puerto Rico and Guam after a short war with Spain. The end of the Progressive era was marked by the First World War which, as discussed below, had a major impact on occupational therapy.

1.1. Labour, Occupation and the Environment

Human labour has long been a central factor in discourse on the human domination of nature that resulted in the Anthropocene, such that Bonneuil and Fressoz (2013) might well have added ‘Labourocene’ to their inventive list of neologisms. Since classical times, it has been proposed that human labour accumulates value through the transformation of nature for human benefit, and it is for this reason that many histories of environmentalism begin with a history of attitudes to work (e.g., Kline 2007, p. 6). In his 1843 Past and Present, the philosopher Thomas Carlyle claimed that

A man perfects himself by working. Foul jungles are cleared away, fair seed-fields rise instead, and stately cities; and withal the man himself first ceases to be a jungle, and foul unwholesome desert thereby … The man is now a man.

(cited in Thompson 1976, p. 32)

By the end of the 19th century, however, aspects of this ‘triumphant anthropocentrism’ (Lowenthal 2016) were being re-evaluated. Lowenthal (2016) discussed the impact of George Marsh’s 1864 Man and Nature, a book that described the physical effects of ecosystem degradation. Another critique concerned itself with the role of labour in human well-being. Writers and activists such as John Ruskin (1819–1900) and William Morris (1834–1896) placed special value on human labour as a way of perfecting both the environment and workers themselves. Like several of his contemporaries, Morris concerned himself with how humans could avoid becoming alienated from the fruits of their labour and engage in what he termed ‘useful work versus useless toil’ (Morris 2008).

The writings of Ruskin and Morris fed directly into the question of how labour might be re-imagined in the industrial era. This was perhaps the first social problem of the Anthropocene. One emerging profession that attempted to respond to this question was occupational therapy. Adopting the term ‘occupation’ to denote all meaningful activities and not just work, occupational therapy first became established as a formal profession in the United States in 1917, with the National Society for the Promotion of Occupational Therapy (renamed the American Occupational Therapy Association in 1923). The individuals involved in establishing occupational therapy in the United States came from a range of different backgrounds and professions, including social welfare, psychiatry, nursing, education and architecture (Schwartz 2009), and for this reason their writings can be assumed to reflect broad trends in the Progressive movement.

As discussed below, occupational therapy did not at first develop an explicit concern with the natural environment, let alone with issues of sustainability. In fact, it is remarkable just how recently such concerns started to become accepted as part of mainstream debate in the profession (Ikiugu 2008; Hudson and Aoyama 2008; Aoyama et al. 2012; Aoyama 2014; Wagman 2014). However, this does not mean that occupational therapy did not employ narratives about nature and human interaction with the natural world. Such narratives might rarely be explicitly articulated but still existed in the thoughts and writings of occupational therapists. This essay attempts to tease out such narratives, asking questions such as: How did occupational therapy and its Progressive era antecedents understand the role of the natural environment and human interactions with that environment in its theory and practice? Did early occupational therapy develop environmentalist positions that aimed not just to utilise nature and natural resources in treatment but also to conserve and foster the natural world? To what extent did an emerging Anthropocene awareness influence these ideas? Buell’s (1995) concept of the ‘environmental imagination’ is proposed to be a useful way of approaching these questions. Following Buell (2001, p. 2), the environmental imagination within occupational therapy would refer not just to how occupational therapists relate to trees, rivers or polar bears, but also to more fundamental questions of how humans engage with the world, how we connect with the experience and sufferings of others (both human and nonhuman), how we envision alternative futures and how we care for the things around us. Thus, the environmental imagination is not only about ‘green’ nature; the human-built environment is also important, not least because of parallel developments in Progressive era ideas about the preservation of nature and the social reform of urban environments (Buell 2001; Hays 1959).

1.2. Occupation as a Critique of Industrial Society

The emphasis on rehabilitation through occupation, which was central to the emergence of occupational therapy, is usually understood to contain a critique of industrial society. Even if that critique did not extend to the fundamentals of society, the excesses of capitalist labour are invariably singled out for attention. Such an approach was radical in that it appeared to oppose the bourgeois ideology behind industrial capitalism. Hocking (Hocking 2008a) argued that Romanticism was an important source of ideas for this critique within occupational therapy. At the same time, she noted that many early occupational therapists held very rationalist views about the significance of their work (Hocking 2008b). While Hocking’s studies deal primarily with the United Kingdom between 1938 and 1962, the same basic conclusion can also be applied to the United States in the Progressive era, where there was a similar tension between ‘Romantic’ and ‘rational’ views of nature and labour.

In the United States, the Romantic movement developed in rather different ways from Europe, but there was a shared critique of industrialisation and its negative social impacts. For Americans, especially those in the North, one of the most troubling aspects of industrialisation was its dependence on wage labour, which went against the Jeffersonian ideal of self-reliant work and democracy (Rogers 1978). On one level, occupational therapy marked a cultural move back to what Henry Ward Beecher called ‘homely clad, old-fashioned Industry’ (cited in Rogers 1978, p. 37). Litterst (1992) argued that the upper and middle-class practitioners of occupational therapy played an active role in using anti-modernist ideas that would not have necessarily been shared by their clients. The anti-modernist ideas of the Progressive era privileged ‘alternatives in medieval, Oriental, and other “primitive” cultures’ (Lears 1994, p. xi). Yet, as Lears (1994, p. xii) has noted, such ideas were matched by new therapeutic understandings of ‘self-regeneration through self-manipulation’.

2. Sources and Methods

This paper uses a historical approach to analyse the place of environmentalism and the natural environment in published texts relating to the early development of occupational therapy in the United States. Although the texts used are not literary works—in fact they are doggedly practical and prosaic—the method adopted could also be termed ecocritical in that it examines the relationships between writing and the environment using an environmentalist praxis. Buell (1995, pp. 7–8) lists the following four elements that can be said to comprise an environmentally oriented text: (1) the nonhuman environment is present not merely as a framing device but as a presence that begins to suggest that human history is implicated in natural history; (2) human interest is not understood to be the only legitimate interest; (3) human accountability to the environment is part of the text’s ethical orientation; and (4) some sense of the environment as a process rather than as a constant or a given is at least implicit in the text. Buell’s classification provides a key structure to the present analysis.

Wilcock’s (2001, 2002) two-volume compendium Occupation for Health was used as the initial source of the texts used for this study. Wilcock’s work is the most comprehensive history of occupational therapy and its antecedents yet published, and its focus on the history of ideas makes it especially suitable for the analysis here. In addition to Occupation for Health, a range of other published sources on the history of occupational therapy were used, together with primary and secondary texts on the environment and health in the Progressive era. In particular, six works by the pioneers of occupational therapy in the United States were analysed in detail. These works were Susan Tracy’s Studies in Invalid Occupation (1910), William Dunton’s Occupation Therapy (1915), Herbert Hall and Mertice Buck’s The Work of Our Hands (1915), Herbert Hall’s The Untroubled Mind (Hall 1915) and Bedside and Wheel-chair Occupations (1919) and George Barton’s Teaching the Sick (1919).

3. Results and Discussion

The two volumes of Wilcock’s Occupation for Health and the six other Progressive era texts contained few references to the natural environment and no writings that could be termed ‘environmentalist’ as defined above. By Buell’s definition, environmentalist research within occupational therapy began in the 1990s and has only become more common in the last decade. Despite this, it is possible to identify a number of themes in how early writings in and about occupational therapy have dealt with nature and the environment. These themes are common to many ecocritical analyses (Buell 1995; Garrard 2004). Moreover, the themes are not incidental to the history of occupational therapy since they overlap with many of the basic objectives of the profession as outlined by the early practitioners.

The first theme identified here can be termed redemption through labour, a concept which involves the transformation of nature by human hands. The idea of recovery through work is central to the whole philosophy of occupational therapy, and, even before the formal establishment of the profession, it was recognised that work in/with nature can play an important role in such recovery. A second theme wherein the rehabilitation of injured soldiers back to productive life after the First World War was mirrored to ecological concerns was that of conservation versus waste. The importance of working in nature can also be envisioned in terms of a third theme of the pastoral, which in occupational therapy became interpreted in terms of the joint rehabilitation of lost bodies/places. Finally, a fourth theme is the importance of the holistic environment in influencing human well-being. These themes can be linked with several narrative structures about nature, human society and human labour/occupation that are not unique to occupational therapy but widely shared in the Western tradition and in cultures of modernity. Each of these themes is examined in more detail below.

3.1. Redemption through Labour

If nature provided the means by which labour was transformed into human value, it was the proper transformation of nature through occupation that improved health. In the United States, the ‘restorative and regenerative power of the land’ had always been emphasised, especially on the Frontier (Slotkin 1985, p. 39). In linking regenerative occupation with the land in the American context there was, of course, a fundamental contradiction that the Frontier myth saw wealth as lying ‘outside society’ and not as the product of social labour (Slotkin 1985, p. 45). Occupational therapy, like other movements of the Progressive era, did not attempt to challenge this contradiction directly; the actual occupations prescribed by early occupational therapists were primarily those that provided an alternative to industrial labour and yet attempted to rehabilitate the social relations that had been lost to the factory and mass production. Arts and crafts of various types were the most representative examples of such occupations and many of the texts examined here discuss the teaching and therapeutic applications of craftwork in great detail.

At a time when the majority of Americans still worked on the land, however, agricultural occupations were not ignored. Garden and other outside occupations had played an important role in the earlier moral treatment movement. At the York Retreat, in the 19th century, gardens with an ‘abundance of fruit and vegetables’ and animals ‘such as rabbits, sea-gulls, hawks, and poultry’ were used to therapeutic effect (Wilcock 2001, p. 317). Care of domestic animals became a common occupation in many asylums in the same period. The Bethlem hospital in London had ‘pet birds and animals, cats, canaries, squirrels, greyhounds &c’ (Wilcock 2001, p. 481). Some early occupational therapists such as Herbert J. Hall, who established the Devereux Workshops with money from Harvard University in 1904, emphasised arts and craft occupations instead of garden or kitchen work (Quiroga 1995, p. 98). Others, such as Dunton, continued to use gardening to therapeutic effect. Another therapeutic activity briefly mentioned by Dunton (1915, p. 178) is ‘nature study’, comprising the observation of ‘Birds, trees, wild flowers, weeds, grasses, the soil, and the stars.’ This link between nature and therapy continues today with horticultural therapy, though usually utilising a more prosaic suite of resources.

As noted already, the rise of occupational therapy as a profession is a story in which labour came to take a central role in thinking about the human condition. Since Classical times, there had been conflicting views of labour within the Western tradition, but by the 19th century most Americans assumed that work was good (Rogers 1978). A 1939 lecture by medical historian H.E. Sigerist linked work with both health and the ‘control’ of nature:

The greatest advance in the history of human civilisation was the step from the Palaeolithic to the Neolithic Age, … when man had learned to cultivate plants, to domesticate animals, to perfect his tools. Man struggled with nature, and he is conquering it gradually through his intelligence, inventiveness, and skill.

Man has to work in order to live—and this is good. Work gives significance to our life. It ennobles it. … Work balances our life and is therefore an essential factor of health.

(Wilcock 2001, p. 41)

The early development of occupational therapy was influenced by the notion of medicine as self-help and writings within this trope clearly suggest the role of nature in recovery from illness and disability. Historian Carolyn Merchant argues that two types of ‘recovery narrative’ have structured Western relations with the natural world. The first is the biblical story of the Fall from the Garden of Eden and humanity’s subsequent redemption through Christianity, but also through ‘reclaiming and redeeming a fallen earth by human labor’, turning wilderness and desert into Edenic gardens (Merchant 2003, p. 7). This narrative ‘is a story of upward progress in which humanity gains the power to manage and control the earth’ (Merchant 2003, p. 12). The second narrative proposed by Merchant is one of decline from a pristine and more just and equitable prehistoric past to the present. Although this ‘decline continues to the present, … the possibility and, indeed, the absolute necessity of a precipitous, rapid Recovery exists today and could be achieved through a sustainable ecology and an equitable society’ (Merchant 2003, p. 12). Both of these narratives are reflected in the history of occupational therapy and both are important in understanding how that profession has concerned itself with the natural environment.

With the scientific revolution of the Enlightenment era, the Recovery narrative was transformed from escape to an Eden in heaven to the rehabilitation of Eden on earth through science and reason. Especially ‘In the Protestant countries of northern Europe, human labor was glorified as the means of improving nature’ (Merchant 2003, p. 66). An originally Christian story thus became transformed into a secular narrative with a much broader appeal:

An interpretation of the state of nature as potentially good but worthless without improvement is integral to the Enlightenment’s narrative of Recovery through progress, property, and polity. While nature has the potential to provide humans with the necessities of life, it is doomed to lie in waste unless transformed by human intellectual and physical labor.

(Merchant 2003, p. 83)

Such ideas reached early occupational therapists via a number of sources, one of which was William Morris, who wrote that ‘the race of man must either labour or perish. Nature does not give us our livelihood gratis; we must win it by toil of some sort or degree’ (Morris 2008, p. 375). For Morris, and the more progressive occupational therapists, the problem was not the toil itself but the fact that ‘the fruits of our victory over Nature [have] been stolen from us’ (Morris 2008, p. 10).

3.2. Conservation versus Waste

Although many studies of the early history of occupational therapy have emphasised the anti-modernist or Romantic worldview of the pioneers of the profession, rational ideas were also common (Hocking 2008b). The first page of Barton’s Teaching the Sick begins with the following paragraph that is almost legalistic in its language:

Because the number of dependents which can be maintained by any community necessarily rests upon that proportion of the population which is not dependent—the producers; because the great war has so rapidly increased the number of dependents and decreased the number of producers as to make this fact apparent not only to the student but also to the common business man, interest in the subjects of Occupational Therapy and Re-education has developed so rapidly that it is impossible for but few to keep pace with new ideas, methods and developments contained in those subjects.

(Barton 1919, p. 5)

Barton’s approach was by no means unusual in early writings in occupational therapy and is mirrored in even more striking passages in the work of Herbert Hall:

Every stroke of the shovel and hoe that does not overtax the strength is clear gain to the patient, and to the commonwealth. … The time has come when economy and therapeutics both demand the raising of crops, road-making, the grading and draining of land.

(Hall and Buck 1915, p. 18)

Some time ago I watched with keen interest the clearing of a rocky New England pasture by the patients of an asylum. They not only picked up the small stones, but they dynamited the boulders and carried the crop of stones to a crusher which produced first-class material for road building and cement construction. … It was a sight to cheer the heart of anyone who has understood the burden of the handicapped.

(Hall 1919, p. 39)

In the second of these extracts, the ‘clearing’ of nature produces a ‘crop’ of stones that reduces the rock-like ‘burden’ of handicap, while also providing building materials for new Anthropocene deposits. While Hall mentions road-building and other engineering projects, agriculture remains the most important occupation, although it is accepted that not all people are suited to working on the land: ‘There are in the cities great numbers of people who need protected occupation but who would never make good farmers. They are shop workers, city dwellers from first to last; they cannot live happily and successfully in the country’ (Hall and Buck 1915, p. 44). The link between agriculture and occupation is especially clear in Barton (1919), who cites at length a 1917 French pamphlet ‘Le devoir agricole et les blessés de guerre’ by Jules Amar that extolled the benefits of going back to the land. Though health benefits are mentioned, it is clear that the main aim is national wealth.

To modern readers, these writings may appear at odds with the social aims of the Progressive era, but calls to improve the lot of the worker at this time increasingly included the views of new experts on the efficiency of industrial labour (Hays 1959). One influential proponent of this approach was the French physiologist Jules Amar (1879–1935), whose work was extensively cited by George Barton. Amar managed to combine rationalist ideas on industrial efficiency with influences from the arts and crafts movement (Quiroga 1995, p. 152). Neither were utilitarian views of the use of natural resources necessarily foreign to the new field of conservation. Gifford Pinchot (1910, p. 27), a pioneer of the conservation movement and chief of the United States Forest Service, argued that the best way to oppose the control of nature by ‘the privileges of concentrated wealth’ was for people to work on their own land. He wrote ‘The first principle of conservation is development, the use of the natural resources now existing on this continent for the benefit of the people who live here now’ (Pinchot 1910, p. 43). Pinchot (1910, p. 50) further summarised his views as follows:

The outgrowth of conservation, the inevitable result, is national efficiency. In the great commercial struggle between nations which is eventually to determine the welfare of all, national efficiency will be the deciding factor. So from every point of view conservation is a good thing for the American people.

In this passage, the term ‘rehabilitation’ could easily be substituted for ‘conservation’; during the Progressive era these were two concepts that were perceived as having a close relationship. Both conservation and rehabilitation stressed the frugal use of resources and the avoidance of waste, and yet both acknowledged the existence of beauty in frugality. As Tracy (1910, p. 14) explained: ‘There is perhaps no greater principle to be taught than that of the quick recognition of beauty in despised and discarded materials.’ In explaining craftwork, many authors also displayed a detailed knowledge of the natural resources involved. Dunton’s (1915) discussion of basketry is exemplary in this respect.

3.3. The Pastoral and the Rehabilitation of Lost Bodies/Places

This trope has deep roots in the Western tradition, stretching back to Classical authors such as Virgil (Gifford 1999). The pastoral ideal was re-vitalised in the 18th–19th centuries as a reaction to the Industrial Revolution and grew particular valence in the United States (Marx 1964). The importance of the pastoral theme in occupational therapy is reflected in the profession’s sometimes optimistic view of the environment as something to be ameliorated for human welfare, an optimism that spills into hubris in a proposal that therapeutic gardening might still be conducted with desert plants even under global warming (Blijlevens 2010). During the Romantic era there was a growing re-evaluation of the power of wild nature to bring humans closer to God. As Romantics found ‘personal solace and wisdom’ in nature, ‘human passions allowed the apprehension of [God’s] awesome power as manifested through the majesty of wilderness’ (Merchant 2003, pp. 136, 89). The conservation movement used images of repair. Marsh’s 1864 bestseller Man and Nature argued that ‘Humanity could cooperate with nature to repair the human damage and restore the lost harmonies’ (Merchant 2003, p. 138). ‘Persuade a careless, indolent man to take an interest in his garden, and his reformation has begun’ wrote Susan Fenimore Cooper in her 1850 Rural Hours.

Recent research on Progressive conservation has stressed new contexts: urban as well as rural, and female and working class (Straddling 1999; Judd 1997). Closure of the frontier led to a perceived crisis wherein loss of wild nature was thought to have diluted human and especially male vigour. ‘J. Horace McFarland of the American Civic Association stressed in 1908 that “the noise and strain of the market place” caused people to flee to “the very bosom of nature … for that renewing spirit and strength which cannot be had elsewhere”’ (Merchant 2003, p. 142). In this context, Buell has made an interesting comparison between Jane Addams (1860–1935), the leader of the urban settlement house movement in the United States and an important figure in early occupational therapy, and the naturalist and conservationist, John Muir (1838–1914). Though different in many ways, Buell (2001, p. 13) argues that both can be seen as ‘self-appointed physicians to a society sickened by industrialization’s growing pains. Both Addams and Muir valued open space as therapeutic.’ For Muir, open space meant Yosemite and the Sierras; for Addams, it was the urban playgrounds of south Chicago. Yet, as Buell notes, both Addams and Muir emphasised the process by which ‘embodied participation’ (Jackson 2000) in these spaces could lead to improvements in human welfare.

Although nature was becoming increasingly recognised as a resource for well-being, the analysis here found no clear evidence that ‘wilderness’ was an important concept for early occupational therapy. The importance of the farm as a site of meaningful labour was, by contrast, emphasised by several authors, with Barton (1919) providing the most explicit arguments in this respect. Such calls for a return to the land were deeply ambiguous in the context of the late Progressive era when there was widespread anxiety that the First World War would only increase the trend in American life from farm to city. A 1918 article cited by Barton (1919, p. 44) asked ‘But would the soldiers, back from Europe, be willing to take up farming? Isn’t there a danger that they would think of it as exile? … How could we expect our bravest and best to give up their expectations for life in the cities with the rest of us, when it is so obvious that Americans are losing all taste for the farm?’ The title of a popular song from 1918 put the problem even more directly: ‘How ‘ya gonna keep ‘em down on the farm (after they’ve seen Paree)?’ Yet, this was a boom time for agriculture in many parts of the United States. After the Turks blockaded wheat exports from southern Russia, Europe looked to the Great Plains and by 1919 American wheat was selling for 2.4 times its 1914 price (Worster 2004, p. 89). Higher profits enabled farmers to purchase tractors and other equipment but calls to bring veterans back to the land raised more idealistic aspirations. ‘To what finer task could [such veterans] consecrate themselves than that of giving back its fertility to our soil, still vibrating from the violence of the barbarians?’ wrote Dunton (1915, p. 35), quoting Jules Amar. Closeness to nature and especially to ‘wilderness’ had long been regarded as an important element of North American identity, often positioned in (artificial) opposition to the industrial modernism of Europe (Marx 1964). Dunton’s use of Amar’s writings shows how the First World War reinvigorated ideas about returning to the land from the perspective of a European country devastated by a brutal conflict.

3.4. Well-Being and the Holistic Environment

Early occupational therapy stood in a complex relationship with respect to links between health and the natural environment. On the one hand, the profession developed at a time when germ theory saw the human body—and not the environment—as the main source of disease (Nash 2006). At the same time, occupational therapy, continued to emphasise a holistic view of health that critiqued the growing trend toward medical reductionism (Quiroga 1995). Both Muir and Addams believed in what Boyer (1978) called ‘positive environmentalism’ or ‘belief in proactive shaping of public policy in light of the principle that human welfare is conditioned by physical environment’ (Buell 2001, p. 14). As president, Theodore Roosevelt organised the first conference on conservation, held at the White House in 1908. This meeting was important for recognising ‘for the first time, that protecting human health is the main goal of conservation’ (Kline 2007, p. 55).

All of the early writings in occupational therapy consulted for this research assumed that men and women would often require different occupations. As Tracy (1910, p. 123) explained, ‘It is worth while trying to keep man’s work manly.’ However, none of the writings made an explicit link between women and nature; farming and gardening were almost always seen as primarily male occupations. Domestic occupations related to crafts and the home were recommended for women by Tracy (1910) and others. By the early 20th century, it was increasingly accepted that, even for women, work was something essential to well-being. Even in cases where women had to work too hard or too long, ‘more serious still is that [condition] in which there is no work at all. For women must work. They must work, because to be deprived of the right to exercise “lordship over things” is to be denied a satisfaction essential to full human life’ (Breckinridge 1910, p. xi). Such comments resonate with recent research on how capitalism has negatively impacted the role of work in women’s lives (Hamilton 2004). Nevertheless, the writings of the occupational therapy pioneers analysed here tended to reproduce the new division of labour increasingly found in the cities in which ‘productive’ men worked outside and ‘unproductive’ women managed their homes as a refuge from industrialisation.

New approaches to holistic health were again a mixture of the Romantic and the rational. Occupational therapy valorised the anti-modernist ‘therapeutic ideal of self-fulfilment … through exuberant health and intense experience’ (Lears 1994, p. xvi). At the same time, the Progressive era saw a change towards a system of medical rehabilitation that was heavily influenced by the European experience (Linker 2011, p. 4). Although there had been an increasing use of prosthetic limbs after the 1870 Franco–Prussian war, there was little or no concept of rehabilitation at that time. ‘The establishment of charitable funds immediately after the war and the dispensation of none-too-generous pensions cannot hide the fact that French society wished to forget those people, to ignore their plight and shame their unproductive bodies’ (Taithe 1999, p. 181). After the First World War, however, the rehabilitation model now attempted to make even damaged bodies productive once again.

4. Conclusions

While Hamilton and Grinevald (2015) are suspicious of deep histories of the Anthropocene, for historians a key question is to understand how views of society and the environment changed—or did not change—after the onset of the Anthropocene (Lowenthal 2016; Renn 2020). This essay has discussed what was perhaps the first period of public realisation that ‘business as usual’ was no longer possible in a new age that was not yet imagined as ‘the Anthropocene’ but which was certainly acknowledged as a time of deep social and economic change. The Progressive era was marked by a growing conversation movement that concerned itself not only with national parks and wilderness but also with broader issues of social change, including urban poverty and health. The various strands of the Progressive movement in the United States were influenced by European anti-modernism and led to a broad re-thinking of the links between labour, health and the environment. One result was the establishment of the new social/medical profession of occupational therapy in 1917.

For several reasons, occupational therapy can be seen as a direct response to growing awareness of the Anthropocene. Occupational therapy went beyond the anti-modernist reaction of Ruskin and Morris to industrialisation and attempted a humanistic reflection and praxis on the social and individual value of work in a changing economy. As life expectancy grew due to the scientific advances associated with the Anthropocene, there was also a realisation that medicine needed to invest more in rehabilitation after illness and accident. Anthropocene awareness fostered a new sense of control over environments, which fed into the optimism of the rehabilitation model. Contemporary views of health and the environment still remain profoundly shaped by the changes discussed in this paper.