Discourses on Sexuality and Occupations: Reflections for Occupational Therapy and Occupational Science

Abstract

Sexuality and occupation are two constructs studied in different fields of knowledge. Particularly, in occupational therapy and occupational science, their relationship has been sparsely explored from a philosophical perspective. In the following reflection, we present some philosophical approaches to sexuality, occupation, and performativity to inquire about the impact of discourses about sexuality on the practice of occupations. For this analysis, we take an example developed by Foucault in one of his classes at the Collège de France. We believe that this helps us question the established discourses surrounding truth, especially concerning sexuality. Subsequently, we address the concept of occupation, taking into consideration Schliebener’s proposal from existentialist philosophy. Understanding occupation as a dimension of being, we explain how it can be comprehended through Butler’s theory of performativity and, consequently, express a sexual dimension. Finally, we establish an interconnection between the preceding concepts, taking sexual dissidents as an example. We propose that this reflection can broaden the possibilities of understanding occupations as points of resistance against normative discourses about sexuality. This may be relevant for contemplating practice and research in occupational science and occupational therapy, as it expands the understanding of sexuality beyond mere activities and centers it as a form of expression of being through occupation.

1. Introduction

Within the academic disciplines of occupational therapy and occupational science, reflections on the relationship between sexuality and occupation have been quite limited [1,2,3]. In the field of sexuality and occupational therapy, various occupations or activities have been understood as relevant to individuals, such as dating, kissing, masturbating, or engaging in sexual intercourse [2,4]. Other activities related to daily life and connected to sexuality, such as personal hygiene or self-care, have also been recognized [5].

The American Occupational Therapy Association [6] includes sexuality as an occupation that is part of basic activities of daily living, conceptualizing it as an individual experience of the body without considering the sociocultural and political constructions implicit in this aspect of human life. Meanwhile, the definition of sexual activity is presented as involving engagement in a wide range of sexual expressions and experiences with oneself or others (e.g., hugs, kisses, foreplay, masturbation, oral sex, sexual intercourse, etc.), reducing it to eroticism without taking into account aspects related to reproduction, gender, and emotional bonds, among other factors, that allow for a comprehensive and antihegemonic understanding of sexuality.

In the particular case of people with disabilities, occupational therapists have pointed out that issues with sexuality are related to a loss of control over their lives, barriers to participating in sexual activity, distortions of body image, or difficulties in openly discussing their feelings. The needs of this population are often not addressed by healthcare professionals [7].

In occupational science, it has been recognized that sexuality is a central aspect that requires further study [8,9]. Several researchers have specifically focused on sexual orientation, identity, and gender expression, which is a valuable contribution in this field [8,9,10,11,12,13]. Since sexuality is understood as a central aspect to comprehend occupation [14], there is a need for further development in order to achieve a broader understanding of sexuality.

Furthermore, these topics have been acknowledged by a significant number of occupational therapists and occupational scientists as essential to be integrated into practice and research, although little has been done in this regard [1,15,16].

Among the reasons for this, the lack of training or knowledge on how to address sexuality in practice has been mentioned as a limiting factor [3,15]. There is also a belief—a product of an invasion of stereotypes through the media—that sexuality refers only to sexual activity. However, sexuality is built on the history of life and, therefore, influences self-perception [17]. Additionally, it is related to feelings, beliefs, and the way we interact with other people. In this context, we believe that re-evaluating the discourses regarding the relationship between sexuality and occupation could be an important aspect to address.

Theoretical approaches to sexuality as a relevant aspect within both disciplines could contribute to a fundamental dimension of individuals [4,18]. Simultaneously, it enables the development of perspectives and broadens the possibilities for research and interventions [1].

Given the aforementioned situation, one possibility is to generate proposals that delve into aspects related to sexuality and its relationship with occupation. On one hand, this could allow for a deeper exploration of the more philosophical concepts of occupation. On the other hand, these reflections could contribute to a more critical approach to the practice and research of both disciplines. It is within this framework that this essay is constructed.

The aim is to share some reflections about sexuality discourses with the objective of broadening the debate. In this way, philosophy can provide guidance for conducting a reflection that integrates theory with practice. By engaging in such a process, we can gain a deeper understanding of the complex relationship between sexuality and occupation and explore how they intersect and impact individuals’ lives. This, in turn, could inform and enrich both the practice of occupational therapy and research in the field of occupational science, leading to more holistic and effective approaches to supporting individuals in their daily lives and experiences.

Therefore, the guiding question of this essay is: How do discourses about sexuality impact our occupations? To approach an answer to this question, we address three central concepts: sexuality, occupation, and performativity. In particular, towards the end of the paper, we focus on an example regarding the relevance of addressing these issues with consideration for sexual dissidents.

In this way, this essay unfolds as follows. First, we take an example developed by Michel Foucault in one of his classes at the Collège de France to account for the construction and permanence of discourses of truth surrounding sexuality [19]. Second, we address the conceptualization of occupation and its relationship with sexuality to then continue with a focus on performativity from Judith Butler’s perspective [20]. Finally, we establish an interrelation between all the previous concepts from the perspective of dissent—mainly sex–gender and bodily dissent—where the possibility of engaging in occupations is constituted as an exercise of resistance against the power of regimes such as heteronormativity and the heterosexual matrix.

2. Representations of Sexuality

In the class of 7 January 1981, Michel Foucault began his lecture by talking about the life of elephants, quoting part of the book of Saint Francis de Sales of 1609:

“The elephant, as is evident, is nothing but a huge beast, but the most dignified of all those who live on Earth and one of those with the greatest judgment. I want to refer to a characteristic of his honesty. The elephant never changes female and tenderly loves the one he has chosen, with whom, however, he only mates every three years, and then does so for barely five days and so secretly that he is never seen in that act. I have seen him, however, on the sixth day, when, first of all, he goes directly to the river and washes his whole body, not wanting in any way to return to the herd before being purified. Are these not beautiful and honest behaviors in such an animal?”.

(Sales in Foucault, 2020, p. 17) [19]

Foucault points out that Sales exemplifies in elephants the most recommendable acts for human beings and that all married Christians should be inspired by them. This example is taken by Foucault to account for the model of good conjugal conduct that, however, does not come directly from Sales. That is, it does not come directly from a spiritual rhetoric of the early seventeenth century but from further back. Its authorship is attributed to Aldrovandi, a very influential naturist in the so-called natural sciences and zoology, who pointed out the elephant as one of the highest representations of morality. Of the elephant, “he praised the munificence, the temperance, the equity, the fidelity, the meekness. (…) And among all those good qualities (…) they are consecrated to the greatest chastity” [19] (p. 18).

The moral example of the elephants in terms of monogamy, lack of interest in sex, and heterosexuality, while they may represent modern family standards, can be traced back even further. In the 16th century, Foucault rescued Gessner, who pointed out about elephants: “they do not know adultery, they never have the idea of fighting over a female and they only have relationships for the purpose of descending, and once their partner has been fecundated, they are already they do not touch it” (Gessner in Foucault, 2020, p. 20) [19]. Thus, Foucault goes back to the origins of the story of the elephant as a moral example, transcending the purely religious, reaching some examples from the 1st or 2nd century.

Some interesting issues that account for the sexual behavior of the elephant have to do with some rites, such as retiring to some remote place seeking privacy; the eminently reproductive nature of the sexual act; the assessment of chastity; or washing the whole body, post intercourse, by way of purification.

These characteristics are being installed as truths or, as Foucault (2020) [19] points out: “true discourses concerning the subject that, regardless of their universal value of truth, work, circulate, have the weight of truth and are admitted as such” (p. 27). And here appears a question that the author asks himself: “what experience do we make of ourselves every time that these discourses exist?” (p. 27), and, we could add, what implications do these internalized discourses expressed in social values such as monogamy or modesty in the face of sexual appetite have for our behaviors? What restrictions or openings are produced in people in front of these imposed truths? What repercussions do these discourses have on sexuality? And in a particular way, what consequences are involved in gender–sex and bodily dissent? And going more towards therapy and occupational science, what are the implications of these discourses in the occupations we carry out every day? The discourses about us: do they delimit our ways of doing things? Do they limit or shape our occupations?

3. Occupation, Sexuality, and Performativity

To approach possible answers, we could go towards a concept that has been worked on by Judith Butler: performativity and, more specifically, the intersection between performativity, sexuality, and occupation. But first, it is important to think about possible relationships between occupation and sexuality.

3.1. Occupation

Historically, within occupational science and therapy, there have been various understandings of the phenomenon of occupation, where its own ontology has been put in tension. Approaches from the most holistic to the most political have been present in our discipline [21]. However, a perspective that has conceptualized occupation as divided from the person has prevailed, which has been exemplified in models such as person, environment, and occupation [22] or the first versions of the human occupation model [23].

In this regard, in the last decade, transactionalism has opened up the understanding of occupation, allowing occupation science to think of other ways of considering the place that occupation takes in the human being. Mainly, the contributions of pragmatism, in the voice of John Dewey, have been crucial to propose how it is possible to understand the occupation as an inherent part of the person, where it is expressed in a “transaction” with the environment but not from the split understanding of the person with the environment, if not, understanding a functional coordination that does not allow their separation [24].

Thus, at an international level, different authors [25,26,27,28,29,30] have proposed that the transactionalist perspective gives new airs to the way of studying the occupation, since it establishes it as a part of the person and not as something separate from it, which makes the ways of understanding it more complex.

In a similar vein, other authors in Chile have also pointed out that there is no such thing as an occupation that is remote from the person, since the occupation is the person himself, understanding both constructs as a whole [31,32,33,34,35]. The person is and is expressed through occupation, so our nature would be occupational and we would be in occupations all the time [36].

In particular, some authors have questioned the way in which certain truths around the occupation have been established. Taking Wilcock’s theory of the occupational nature of the human being as an analysis, they point out that occupation would be established as an attribute rather than as a “nature” [35,37]. Even so, Schliebener takes that premise to think of “the occupation” as a way of relating to the world [38], as what defines that the human being is what it is and that allows its expression [22] and which establishes that the things of the world are to the extent that the being deals with it [33] (Schliebener uses Heidegger’s Dasein construct to account for this situation). That is to say, since the human being is an occupational being, a way of relating interdependently is established in a network of permanent and continuous occupations whose purpose is significance and their own existence in the world. Schliebener [33] refers to this issue that the occupational nature of individuals is reaffirmed, understanding the inseparable interdependence of human beings and occupation, dispelling the notion that they are separate entities.

In this way, the occupation “appears” in doing, since it is the human being who exists through the occupation or, as Gutiérrez [39] puts it, as part of the constitutive processes of “doing” oneself. Therefore, the occupation is that expression of “the human” that builds “the human”, establishing a permanent recursion that crosses all our ways of doing–being in the world.

Going back to the previous section, what relationship could be established between this way of understanding occupation with sexuality? Considering meeting points, we could, later, think about how the discourses regarding sexuality affect occupations and also to consider how sexuality is expressed and constructed through occupation.

3.2. Sexuality

Sexuality also corresponds to an expression and part of human “nature”. It has been pointed out that we are sexual beings, although for Foucault [40], there would be no nature but practices, discourses, and sociohistorical processes that produce sexual beings and therefore regulate their behaviors.

Following the author, since the 18th century, there has been an incitement to talk about sex in different disciplines, such as politics, economics, and biology, among others, with the aim of analyzing, counting, classifying, and specifying sexuality through research. This in a “complex deployment of the network that links them” (p. 36) and goes against the theory of the repression of knowledge about sexuality, instead seeking its delimitation in closed fields of knowledge.

This proliferation of the introduction of sex into discourse could be aimed at the expulsion of forms contrary to the reproductive logic of daily life. In other words, it focuses on considering only practices that align with a crucial objective: ensuring population growth within the capitalist economic logic. However, in a broader sense, the proliferation of the mechanisms of power seeks to solidify each of these apparent contrary forms in order to make them visible, classify them, and analyze them, that is, to make them intelligible. This builds a technology of health and pathology linked to sex. The proliferation of perversions, for example, is a reflection of the interference of a certain type of power over the body [19,40].

Thus, sexuality is administered through the participation of public power, demanding procedures and assuming a role similar to that of the police. This is done in the sense of regulation and promotion through useful and public discourses. In this sense, Foucault explained that conceptions about sex are shaped at the origin of various economic, political, and cultural issues, such as the initiation of sexual activity, contraception, fertilization processes, pregnancy as a feminine projection, and other phenomena [40].

Thus, sexuality could be understood as a permanent expression of human experience, which will be subject to power relations and means of production in particular and historical contexts. Therefore, both sexuality and occupation could be intertwined on the same level: expression through doing. Sexuality also includes thoughts, subjectivations, and ideas that are expressed through occupation; therefore, their relationship is inherent.

How is sexuality expressed through occupations? One way of thinking about this issue is from the perspective of performativity.

3.3. Performativity

We have seen the inseparable relationship between sexuality and occupation, where everything we do integrates both dimensions: occupational and sexual. In this way, occupations operate as means of expression of “the gestures, movements and concrete actions that people perform to build their gender, which constitutes an ‘apparent’ identity and located at a particular moment that seeks to reproduce itself to maintain the fixed state belief” [34] (p. 79). Thus, one way of looking at the expression of sexuality through occupation is through gender.

Continuing with the above, Butler proposed that gender, understanding it as an inherent part of sexuality, is expressed through performativity [41]. Performativity is not an individual and intentional act. It is a reiterative and referential practice through which a discourse produces the effects it names within a given political constraint [42]. In performativity, there is a forced iteration of the norms that temporarily constitute that subject and enable it in a ritualized production as a modality of power [43]. But this act is not mechanical; it is improvised and is constituted with another and occurs in what is understood as a heterosexual matrix. In addition, the very structure of performativity opens up possibilities to denature what is given, to the extent that the naturalization process is understood and interfered with, as we will see later [41].

Performativity is linked to the forms of recognition of the subjects, which would lead us to suppose that it implies a recognition before political life [44]. Thus, Butler wonders who can be recognized—who can be intelligible—since performativity makes it possible to configure those who are living a life as subjects capable of being recognized in contrast to those who are in a precarious condition—whose lives are not intelligible [44]. For example, thinking of couples that represent the moral ideals raised at the beginning of this writing, as faithful reproductions of a heteronorm system, makes these experiences more appealing and less disruptive to society’s moral standards. This, following the example, can materialize in public policies that crystallize some ways of understanding sexuality over others [45].

At the same time, understanding the actions of the subjects as performative acts, there is the possibility of threatening the essentialist naturalization that the processes of subjectivation submerge in the bodies, causing “the parodic proliferation and subversive interaction of meanings” [42] (p. 99). Thus, true discourses about truth, detached from the heterosexual matrix, can influence the performativity of gender expressed in occupations. According to this logic, there is no previously constructed subject; we build ourselves to the extent that we constantly perform our gender, and this occurs through occupations that, for example, reproduce a hegemonic masculinity [34], gender stereotypes [46], or gendered occupations under a capitalist logic [47].

In this way, we do not exist as previously constituted subjects, but we would be in a permanent and infinite process of construction. Butler proposes that preexisting identities are articulated to a gender identity in a regulatory fiction that seeks to maintain the social, heteronormative, and patriarchal dominance that it is precisely possible to resist [20].

By understanding performativity as iterating a ritual expressed in acts of speech, gestures, body movements, and discourses from the subjectivity of each subject, which, in turn, are the product of a process of subjectivation within the heterosexual matrix exercised in power relations, and integrating the perspectives of Foucault and Butler, we could say that the subject never finishes constructing himself as a sexual being and, therefore, as an occupational being, in a relationship in favor or resistance with respect to the heterosexual matrix and the representation of social norms. In this sense, heterosexual bodies, genders, and processes of subjectivation are produced in the heterosexual matrix [42], making subjects assume, for example, that the cisgender heterosexual family corresponds to a product of nature and that everything that is outside of it is branded by the devices of sexuality as the other.

In this way, returning to our initial question regarding how the discourses on sexuality affect our occupations, we could point out that they correspond to “internalized molds” with which our expression coincides or not. In this sense, we have subjects for or against those molds (of course, understanding moments and not absolutisms in those forms of performativity, nor fixed identities). Considering that occupational therapy and occupational science have worked with subjects who do not conform to certain molds, we could ask how a dissident, diverse, or resistance subjectivity is established within the heterosexual matrix or social norms that restrict the exercise of various occupations.

4. Resistance, Dissidence, Sexualities, and Occupations

The understanding of sexual orientation, sexual identity, and gender expression corresponds to social, political, and historical productions, so there would be no gender roles or sexual roles from a “natural” biological essence [48]. People who have gone against the moral standards of each era, such as LGBTIQ+ or dissident body activists, have been understood as unmentionable, abject, unintelligible, and abnormal at different times in history; they are products of knowledge/power devices within essentialist conceptions of gender and sexuality [48], which is why they represent that resistance to the hegemonic exercise of sexuality. The same happens with women who have expressed their sexuality in a threatening way in the face of the moral regime and those who have suffered various medical diagnoses or stigmas over time.

In the above sense, it is important to understand that “where there is power, there is resistance” [40] (p. 91), although it is scattered in the various ways in which power relations, immanently and multicentrically of the heterosexual matrix, operate. Dissident bodies to normative sexuality resist hegemonies, being marked in many ways and being expelled from normative spaces. These actions restrict occupations that would potentially allow them to otherwise inhabit/build the world.

This relationship between sexuality and occupation would be a performance of performative acts carried out from a politically significant body and which is read from parts of an authoritarian discourse that produces what it enunciates. This allows us to think about how heterocentric hegemonic power acts as a discourse that creates social realities (apparently stable and coherent) and produces discipline through power relations [42].

Accordingly, diverse and dissident sexualities can operate as unintelligible for some fields but are the object of knowledge for others, especially for the devices of sexuality, which classify, measure, problematize, theorize, pathologize, etc.

In this sense, it is possible to think of resistance as a category that challenges power, as in Foucault, but in Butler as a form of performativity as well [49]. In this process of expression of sexuality, performativity allows for the execution of dissident acts, for example, against the moral principles exemplified at the beginning of this writing in the sexual behavior of elephants. An interesting example in this matter is the performances of transvestites, which are used as forms of denunciation and resistance against situations of injustice [50].

In any case, those that favor both the heterosexual matrix and the dissident practices of resistance correspond to performative acts. And performativity has the potential to—to the extent that bodies break through—threaten restrictive powers, breaking the crystallization of fixed identities, criticizing hegemonic forms of power, and producing political subjectivations that allow for the construction of alternatives to heteronormative regimes [20,48,51].

Thus, performativity can be constituted as a “liberating pole” [51] (p. 24) that challenges civil society, promoting subjectivities of resistance and solidarity forces. It would allow a process of desubjection to the extent that, in addition, the subject opposes the identity coding mechanisms (subject productions) to work on himself as a form of resistance [52,53]. Observing carefully the present to give an account of who we are allows us to know possible transformations in freedom. This does not imply an absence of coercion but “a deliberate exercise of resistance” [52] (p. 17).

5. Final Thoughts

From the above, the very existence of gender–sex and corporal dissidence constitutes a performative act that calls into question totalizing discourses and the heterosexual matrix itself [50,54]. Other alternative forms to monogamy in our expressions, such as polyamory, the breaking of actions linked to the heteronorm, sexual practices that call into question the value of chastity and sexual abstinence, criticism of the phallocentric elements that flood the discourses about sexual practices, the role of sexual assistants, post-porn, and the construction of discourses on sexuality that transcend imposed moralities, which, for example, include users of occupational therapy as sexual beings, are practices and discourses that contribute to thinking about sexuality from another logic.

These practices/discourses can be constituted as axes of resistance with the prevailing models on sexuality that have done us so much damage and that have limited and shaped unique and already obsolete ways of understanding sexuality.

This is how a critical perspective on sexuality in the discipline is central, above all, in our ways of thinking about it as an occupational dimension that is more inherent to people. Along with this, the possibility of critically considering how we collaborate so that occupational therapy users rebuild their occupations or participate in new occupations has a performative dimension that must be attentive to normalizing frameworks [39] that can operate as curtailers of possibilities of expression outside of the hegemonic powers.

Traditional ideas about sexuality reinforce ageist, adult-centric, patriarchal, and ableist logics, contradicting more contemporary theoretical currents within the discipline. The risk is that internalized hegemonic discourses by occupational therapists or scientists can perpetuate discriminatory practices against gender and bodily dissidences. Approaching sexuality as an occupation in all its dimensions, beyond the reductionist view of eroticism and phallocentric notions, would contribute to providing emancipatory tools for historically marginalized groups, such as people with disabilities, women, children, and dissident individuals.

Thinking about and addressing occupation in therapeutic intervention processes and, at the same time, as research axes, contributes to highlighting situations that could be invisible to historically marginalized groups, for example, people with disabilities. Particularly in this group, it has been documented how the absence of an approach to sexuality is a permanent aspect in their treatment processes [18]. And when this is addressed, it is usually from the perspective of heteronormative frameworks that do not expand the occupational possibilities of sexuality [55].

Thus, the understanding of performativity as an emancipatory—or at least critical—possibility allows us to think of new forms of expression that account for diversity beyond the labels and understandings that limit our existence.