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Journal article review

Meaning in life for people with schizophrenia: does it include occupation?

Meaningful occupation has been a concern for occupational therapists, possibly to sustain a distinction between occupational therapy and other approaches to activity within mental health, which can be more concerned with filling time and diverting people. Eklund and her colleagues moved beyond this concern with professional practice and service delivery. By directly asking people with schizophrenia what they found meaningful, they were able to investigate the place of occupation in a meaningful life and its relation to other aspects.

The study involved 10 participants, all residents of supported accommodation in Sweden with a diagnosis of schizophrenia. All were interviewed individually, followed by content analysis of the transcripts. Five categories were identified: social contacts, engagement in occupations, precious memories, experiencing health and positive feelings. Each of these categories contributed to a sense of meaning in life, and the authors suggested that positive feelings were particularly influenced by the other categories. Positive feelings could be an intrinsic part of the other categories, but the subcategories (feeling safe and feeling needed) suggested that positive feelings should be recognised as a separate and important element of a meaningful life.

One of the strengths of this study is the strong theoretical base, which is clearly explained. It is widely understood that there are different levels of meaning in life, from a sensory level (making sense of what you see/hear/taste and so on) to ideas about human existence. This study was clearly located between these extremes, being concerned with meaning in everyday life, making it relevant to occupational therapy practice as well as adding to understanding of occupation. The doing-being-becoming-belonging synthesis offered a useful, practical framework for discussing the findings (Wilcock 2006).

The importance of social contacts, and precious memories of relationships and roles, clearly indicated the importance of social life in a meaningful life. This aspect of the study could have been more rigorously investigated as the authors make few links with current thinking within mental health practice. Issues of social inclusion/exclusion or a social perspective on mental health were not clearly indicated. In particular, the observation about becoming, and the absence of ideas about the future, could have been linked with current thinking about recovery.

Having said that, I’d really recommend this article for discussion. The clear and broad focus would make it suitable for exploring with colleagues, service users and carers. The conclusion that occupation does have a place in a meaningful life is welcome, but the simultaneous recognition of the importance of social life, memories and feelings give the study a credible balance.

Laying the tableEklund M, Hermansson A, Hakansson C (2011) Meaning in life for people with schizophrenia: does it include occupation? Journal of Occupational Science, iFirst 1-13

Wilcock A (2006) An occupational perspective of health. 2nd edition. Thorofare: Slack.

One of the participants in Eklund et al’s study described the importance of laying the table for meals