Preface

Growing up, I have always wanted to write a book. In my mind, writing a book was the epitome of academic excellence. That was before the advent of the internet. Now, with the internet being accessible to most of the world’s population, anyone can write a book and publish it themselves, so why write a book? There are many reasons why not to write a book, including ‘it is time-consuming for very little benefit’. A colleague of mine advised me to just write an article and publish it! “It takes way less time, and you get better metrics from journal articles,” they said. By the way, these so-called metrics are tied to one’s promotion and career advancement opportunities. I had to write this book in my own time and in secret, without sharing what I was doing with my colleagues for fear of ridicule. So why did I write this book?

First, there were some encouraging people along the way. Notably, a colleague at Waikato Hospital in New Zealand, Dr Basil Bunting, a psychiatrist from South Africa and author of Psychiatry in Easy Steps, wrote a message in a copy of his book that he gave to me in 2002, which was as follows: “Hi Tawanda, It is very nice working with you. It’s a pleasure to have a colleague from Africa. Hope this book inspires you to write your book. Basil”. Twenty-two years later, I have now written my book in response to this call to action.

Secondly, I am an occupational therapist working and living in Australia. The first thing you should know about me is that I identify as and am biologically male. At the time of writing this preface, there were only 9% registered male occupational therapists in Australia. Now, that is a familiar story worldwide, but the point is that I belong to the minority in this profession. The second thing you should know about me is that I am a black African of African origin born and bred in Zimbabwe. Now, without doing the maths, you get the picture that I truly belong to the minority (probably less than 1%) in this wonderful profession of occupational therapy.

‘My people’, meaning the group of people I am similar to or belong to, are, however, not the minority as the current population of Africa is close to 1.5 billion people or 18.2% of the world’s population. Culturally, I also belong to the non-western or collectivist cultures, which constitute about 85% of the world’s population. It is baffling to note that occupational therapy practice is meant to serve the world, and yet people who make up 85% of occupational therapy clients are probably less than 10% of the world’s occupational therapists. This figure is far less when one looks at people who then go on to produce the knowledge that informs what occupational therapists know and do. So, the reason for writing this book is to contribute towards making the occupational therapy profession a truly global profession that is applicable to all people and representative of the views of all people, not just those who are ‘privileged’. Okay, this needs a bit of explanation- I have been an occupational therapist for almost 3 decades, have a growing publication record, and my highest qualification is a PhD, but at the time of writing this book, I had never been invited to write a book chapter! My story is not dissimilar to many other people of a similar background to mine in the profession of occupational therapy. I think you would have quickly discerned that I wrote this book out of frustration and also purpose. The frustration was that I realised that I did not belong to the group of usual book contributors who often get invited to write popular occupational therapy texts. The purpose was that I felt we were being fed information from one worldview and, more specifically, from the views of academics only, most of whom had not seen or treated a single patient in two decades. By the way, this is not a criticism of academics; I am one of them. They know stuff, and they do important research. Rather, this is a call to action for academics to also value the contributions from clinicians and other minority groups, which include not only culturally and linguistically diverse people but also people with a lived experience.

Decolonising OT: Historically, occupational therapy has been referred to as ‘a white middle-class female profession’. This is still the case today. Many authors of a similar background to mine are calling for the ‘decolonisation’ of occupational therapy. This call emanates from the 2015 ‘Rhodes Must Fall’ campaign at UCT, which quickly spread to other universities in South Africa and sparked a worldwide debate on decolonising curricula. Some argue that this is a sensationalist or cheap way of gaining political mileage, and others argue it is a much-needed transformation in academia and, indeed, in occupational therapy. It must be noted that the concept of decolonising a curriculum was first discussed in Ngũgĩ wa Thiong’o’s book, Decolonising the Mind, which argued that the annihilating ‘cultural’ and ‘psychological’ consequences of colonialism had to be taken as seriously as, though not separately from, its economic, political and military ones.

As I understand it, ‘decolonisation’, as used in occupational therapy literature, describes a process of critically examining the current curricula, which is Western culture dominated with the intention of removing the cultural and psychological impacts of colonialism on the axiology, ontology, and epistemology of occupational therapy. It is argued by many in the profession of occupational therapy that occupational therapy is based on Western culture because of the existing structures, processes, and systems in the profession that continue to perpetuate the status quo. There are no deliberate efforts by occupational therapy professional bodies to seriously change the status quo, and in fact, some are becoming an occupational therapy out of reach for most minorities by constantly raising the bar and increasing the level of qualification and years of training needed to become an occupational therapist. Such practices are precipitants for some to call for ‘decolonisation’ of the profession.

Let me be very clear here, I totally agree with the intent of ‘decolonisation’. Whilst I agree with the intent of ‘decolonisation’, I tend to disagree with the use of the term ‘decolonisation’ to describe this noble intent. Let me explain a bit more about myself, i.e., my positionality. I was born in Zimbabwe, then Southern Rhodesia, a British colony at the time. I grew up during the time of the liberation struggle in Zimbabwe. I experienced colonisation as a brutal matter of life and death, and I am living with the after-effects of the war and the colonisation practices of the time today. Colonisation should never be minimised, and using the term ‘decolonisation’ when referring to curricula is minimising the real evil nature of colonisation. For lack of better words, ‘globalisation’ and ‘indigenisation’ to me seem more appropriate terms to spark the transformation that is needed in the profession. To me, these words are more in line with the principles of ‘allyship’, and that is what we need rather than the revolutionary message that is latent in ‘decolonisation’.

Occupational therapy is a relatively new profession, new to the world and new to non-Western cultures, so yes, there is a lack of non-white voices, and we certainly need to be heard. To me, this is about inclusivity and making the profession more applicable and relevant to all people. I think, as people, we should refrain from divisive and sensationalism and instead focus on progressive and inclusive talk whilst acknowledging our history. As occupational therapists, we want our beloved profession to be more relevant to all people, more encompassing of diverse views of people around the world, and to be informed by all forms of knowledge, not just Western ways of knowing. Here is a fun fact: not all black people or people from minority groups think the same; it is racist to assume they do. So, my views are my views, and I am not representing any other person or group’s views here.

Many of the authors of the chapters of this book are themselves from ethnic minority groups. Most authors of this book are practising clinicians, and some of them are consumers of occupational therapy and mental health services. The authors reside in different parts of the world, including Africa, Australia, India, North America, and Europe. This was a deliberate effort to ensure that those diverse voices are heard, and their diverse worldviews included.

Occupational therapy theory and practice is complex. For many people from around the world, the concepts do not have meaning in their own cultures and contexts. This book deliberately uses simple English, pictures, tables, and illustrations to aid the student or occupational therapy practitioner to clearly understand the concepts. The case examples used are from different contexts around the world to give relevance to the reader. This is the goal of this book, to increase understanding of occupational theory and practice in mental health practice for everyone not just native English speakers or those from the dominant western cultures. Although this book can be read sequentially, this is not a necessity. In fact, I anticipate that this book will be read like a smorgasbord where each person will pick what they wish to devour first according to their taste.

To conclude, I hope that every reader will reflect on their values, their way of thinking, knowing, and practice and, to some extent, motivate them to question, adapt, change, confirm, or re-affirm it and consequently move them towards a new understanding. To me, through critical thinking and reflection, being truly person-centred and value-driven and deliberately being inclusive in our ways of knowing and doing, we can actively eliminate the remnants of colonialism and globalise occupational therapy.

Yes, to responsible transformation as we march together in this journey towards doing, being, and/ or becoming evidence-based, value-driven global occupational therapists. Let this book be a vehicle for transformation and the first to many more editions to come.