Car­o­line C Rav­el­lo

Dur­ing my con­fine­ment at the San Fer­nan­do Gen­er­al Hos­pi­tal back in the 1980s, twice a week we had oc­cu­pa­tion­al ther­a­py (OT). Mid­morn­ing, we dressed up and went off to an open room for 90 min­utes of so­cial­is­ing. For me, OT was an ex­cit­ing time, if on­ly to be out of the con­fine­ment and con­stant ob­ser­va­tion of the ward. Much lat­er, I'd dis­cov­er that OT was more than recre­ation time and an im­por­tant part of my eval­u­a­tion, where the ther­a­pists em­ployed a va­ri­ety of as­sess­ments, us­ing their ob­ser­va­tions, to cre­ate a per­son­alised pro­file of my is­sues. This in­for­ma­tion aid­ed the at­tend­ing team in their di­ag­no­sis and treat­ment of my con­di­tion. It's on­ly dur­ing hos­pi­tal res­i­den­cy that I'd ever had that op­por­tu­ni­ty to be in group ses­sions with ther­a­pists, nurs­es, (and or­der­lies) and in­ter­act­ing with oth­er men­tal health pa­tients. It seems, how­ev­er, that OT is not a promi­nent as­pect of re­cov­ery.

There is an or­gan­i­sa­tion of OT pro­fes­sion­als in T&T, with a mem­ber­ship of about ten, whose work is not lim­it­ed to men­tal health­i­ness but in­cludes ther­a­py for phys­i­cal in­juries; chron­ic con­di­tions such as arthri­tis; eat­ing dis­or­ders; am­pu­ta­tions and every­thing in be­tween. No­tably, in the USA and the UK, where men­tal-health OT is a longer-stand­ing as­pect of psy­chi­atric re­ha­bil­i­taiton, it's al­so re­port­ed that the pro­fes­sion and its prac­tices are be­ing giv­en less im­por­tance. Psych Cen­tral notes that OT is a col­lab­o­ra­tive method where the OT ther­a­pist con­sults with many oth­er pro­fes­sion­als to as­sist in an in­di­vid­ual's re­cov­ery plan. The role of the OT ther­a­pist is one that over­laps with oth­er pro­fes­sion­als, but "the oc­cu­pa­tion­al ther­a­pist pro­vides a unique the­o­ret­i­cal and clin­i­cal con­tri­bu­tion to the re­cov­ery and treat­ment team; thus, oc­cu­pa­tion­al ther­a­py should be con­sid­ered a vi­tal part of a com­pre­hen­sive and in­te­grat­ed treat­ment pro­gramme (psy­ch­cen­tral.com). "The men­tal-health treat­ment jour­ney," it says, "re­quires a col­lab­o­ra­tive ef­fort by many peo­ple –the in­di­vid­ual, his or her care­givers, sup­port providers, doc­tors, nurs­es, teach­ers, aides, coun­sel­lors, ther­a­pists, and so­cial work­ers.

This col­lab­o­ra­tive process al­lows every­one to work to­geth­er to reach a spe­cif­ic goal: im­prov­ing the in­di­vid­ual's qual­i­ty and en­joy­ment of life by iden­ti­fy­ing and meet­ing ap­pro­pri­ate be­hav­iours and skills." This ap­proach is that in men­tal­ly ill peo­ple, oc­cu­pa­tion­al ac­tiv­i­ties such as work, rest and play have be­come un­bal­anced. Ear­ly oc­cu­pa­tion­al ther­a­pists in­tro­duced ther­a­peu­tic oc­cu­pa­tions such as weav­ing, art, and book­bind­ing. These goal-di­rect­ed ac­tiv­i­ties were used to help in­di­vid­u­als learn new skills to be pro­duc­tive, and de­rive ther­a­peu­tic ben­e­fits of a bal­anced dai­ly sched­ule. Dur­ing a pe­ri­od of cri­sis about ten years ago, I tuned in to Oprah on one of those days when she had a men­tal-health ther­a­pist who gave the next best al­ter­na­tive to for­mal OT�plant­i­ng a kitchen gar­den. My in­cli­na­tion for out­doors then had been bent to ze­ro but I knew I should not re­main cooped up, get­ting carpal tun­nel syn­drome from hold­ing on to the TV re­mote. Go­ing out­side was ex­treme­ly in­tim­i­dat­ing, though, be­cause the de­sire to so­cialise was sub­sumed by ter­ri­ble sus­pi­cions of every­one, in­clud­ing those in my house­hold. Liv­ing in an up­stairs apart­ment made for an­oth­er ex­cuse of not be­ing able to lo­cate a kitchen gar­den but I knew I was fid­dling and the words of the ther­a­pist kept taunt­ing me.

Even­tu­al­ly, I gave up, got out and drove to the agro shop and em­barked on the project that changed my sta­tus from "shut-in." My ver­sa­tile nephew, who, prov­i­den­tial­ly, lived close by, in­stalled plas­tic grow box­es with built-in drainage on the bal­cony rail­ings and there I grew pars­ley, sage, rose­mary and thyme and sundry oth­er herbs and spices. I be­came very ex­cit­ed about the project and for a while my ill­ness lost its self-cen­tred­ness. Soon af­ter I sub­ju­gat­ed those months of so­cial anx­i­ety and noth­ing­ness with my gar­den project, I was of­fered a job in a news­room and was ac­tu­al­ly ex­cit­ed to get back to work. It was a su­perb ex­pe­ri­ence–not with­out chal­lenges, as I clashed with peo­ple from time­to time– but since then I've nev­er re­turned to such a slump. In May 2010, I com­plet­ed my last cor­po­rate stint and lat­er that year, I re­turned to rur­al South Trinidad and a change of tem­po.

I've since gath­ered for my­self a num­ber of in­ter­ests, which re­quire dai­ly ac­tive par­tic­i­pa­tion. For me, oc­cu­pa­tion­al ther­a­py now in­cludes hor­ti­cul­ture, rais­ing a grow­ing pet fam­i­ly of dogs, cats, and Lar­ry Bird, the par­rot, bot­tling sauces us­ing lo­cal­ly-grown pro­duce and, as well, dab­bling in acrylics as I pur­sue an on­line art course si­mul­ta­ne­ous­ly with Har­vard Uni­ver­si­ty's free on­line course in Jus­tice. I'm al­so the vol­un­teer di­rec­tor of the pri­ma­ry school choir in my vil­lage. It's my ex­pe­ri­ence that with­out the stress of cor­po­rate ex­pec­ta­tions and with the em­ploy­ment of more plea­sur­able ac­tiv­i­ties, which re­duced my pen­chant for stay­ing in­doors, I've ex­pe­ri­enced more sta­bil­i­ty and have en­joyed bet­ter health over­all. With­out much op­por­tu­ni­ty in T&T for OT and with an in­creas­ing in­ci­dence of men­tal ill­ness, hope­ful­ly, my im­prove­ment will spur some­one to a ther­a­peu­tic ac­tiv­i­ty that can al­so see the re­ver­sal of his/her di­min­ish­ing men­tal health.