years ago, flaked stones found among
the fossils of australopithecines indicate they were already
exploring the possibilities of handicrafts, and fashioning simple
tools from pebbles.
35,000 BC Homo Sapiens invents art
10,000 BC The first evidence of surgical treatment, trephaning.
2600 BC Chinese taught that disease was caused by organic inactivity
and thus used physical training for the promotion of health.
BC Oldest medical text describes poultices in Sumerian tablet.
BC The Egyptians described diversion and recreation as a
means of treating the sick. (Egyptian Kahun papyrus written
approx. 1850 BC)
1700 BC Code of Hammurabi-Mesopotamia-Summerians (now Iraq)
282 malpractice laws concerning surgical procedures. Treatment
by nonsurgical means was not covered by malpractice laws.
1000 BC Ancient Persians realized the beneficial effects of physical
training and utilized it to fit their youth for military duty.
AD Asclepius' Temple and Cult
460 BC Age of Pericles in Athens
420 BC The Greeks described diversion and recreation as a means of
treating the sick.
400 BC Socrates and 347 BC Plato understood the relationship between
physical status and mental health.
359 BC Hippocrates (460-361), the father of medicine, recommended that
their patients exercise in the gymnasium as a means of recovering
340 BC Aristotle felt that the "education of the body must precede
that of the intellect."
AD The Roman Asclepiades advocated massage, therapeutic
baths, and exercise for improving diseased conditions. He also
recommended activity treatment for patients with mental diseases.
This included diversions and entertainment, but only the diversional
value was recognized.
476 End of Western Roman Empire
477-900 The Dark Ages, the mental and physical influences of play were
regarded by the Church to be evil. (The first half of the Middle
Ages, until the 10th century)
900-1453 The Middle Ages, Middle Eastern scholars protect and develop
the ancient Egyptian, Greek, and Roman knowledge. 476-1453
1454-1605 The Renaissance, the mental and physical influences of play
are again recognized after Arabic texts are translated into
1537-1543 Vesalius at Padua
Hospital is established in Philadelphia. Benjamin Franklin was
involved in drafting the petition for its establishment. Inmates
were provided with light manual labor such as spinning and carding
wool for activity.
1780 Clement Joseph Tissot publishes the book "Gymnastique Medicinale
et Churgicale" recommending "prescribed craft and
recreational activities as therapeutic exercise for the treatment
of disabled muscles and joints following disease or injury."
Pinel introduced work treatment in the Bicetre Asylum for the
Insane near Paris.
1798 Benjamin Rush, M.D., one of the signers of the Declaration of
Independence, advocated work as a remedial measure for the treatment
of patients in the Pennsylvania Hospital.
1801 Pinel publishes a book "Medical philosophical treatise
on mental alienation" describing the method as "prescribed
physical exercises and manual occupations." It is the first
reference in literature to the medically prescribed use of activity
in an address to the Board of the Pennsylvania Hospital, advised
that "certain kinds of labor, exercise, and amusements
be contrived for them, which should act at the same time, upon
their bodies and minds."
1803 Johann Christian Reil suggested the use of exercise and a special
hospital gymnasium along with patient participation in dramatic
productions and fine arts, in his book "Rhapsodies on the
psychic treatment of the insane." This is evidence of one
of the first uses of psychodrama in the treatment of the insane.
1816 Samuel Tuke, an English Quaker, established a Retreat Asylum
for the Insane at York, England. He used work or occupation
therapy as Pinel did but placed special emphasis on humane treatment
or treating of patients as rational beings who have the capability
of self-restraint. He called it "moral treatment." "...of all the modes by which patients may be induced to
restrain themselves, regular employment is perhaps the most
generally efficacious; and those kinds of employment are doubtless
to be preferred which are accompanied by considerable bodily
action, that are most agreeable to the patient, and which are
most opposite to the illusions of his disease. ....every effort
should be made to divert the mind of melancholias by bodily
exercise, walks, conversations, reading, and other recreations.
Those who manage the insane should sedulously endeavor to gain
their confidence and esteem, to arrest their attention and fix
it on objects opposed to their delusions...and to remember that
in the wreck of the intellect the affections not unfrequently
1817 Thomas Scattergood, a Quaker minister who visited Retreat, brought
the principles of "occupation and nonrestraint" back
to the US, and helped establish the Friends Asylum for the Insane
Asylum opens near Boston under the supervision of Rufus Wyman,
M.D. He established, and was probably the first physician in
the country to supervise, a program of occupational therapy.
1821 Thomas Eddy, New York merchant and member of the Society of
Friends, was another visitor impressed by treatment methods
at Retreat. He submitted suggestions for the "moral management"
of the insane to the Governors of the Lunatic Asylum of the
New York Hospital. As a result, Bloomingdale Asylum was opened
in New York City and began moral management including "occupational
Leuret wrote a book "On the Moral Treatment of Insanity."
He said all psychiatrists recommend diversions and work to prevent
the effects of idleness and boredom. He utilized exercise, drama,
music, and reading along with manual labor. Nearly synonymous
with occupation therapy, it is considered the first book entirely
devoted to the subject. (Susan E. Tracy is credited with writing
the first book on occupational therapy, titled "Invalid
Occupations" in 1910)
(Dr. William Rush Davis, Jr. is credited with writing the first
recreational therapy text titled "Principles and Practice
of Recreational Therapy for the Mentally Ill" in 1936)
Story Kirkbride, M.D. becomes superintendent of Pennsylvania
Hospital, and begins a program of mental care that stressed
occupation therapy. He said that the value of occupational therapy
cannot be measured in dollars and cents but must be judged in
regard to the restoration of comfort to the inmates of the hospital.
Crafts, amusements, and hospital occupations were used therapeutically.
He helped to organize the Association of Asylum Medical Superintendents,
which later became the American Psychiatric Association. Through
this association, Kirkbride influenced its members regarding
the value of occupation therapy.
1841 The first structure for the Pennsylvania Asylum for the Insane was completed in 1841. The facility offered comforts, "humane treatment" philosophy, and mental health treatment programs that set a standard for its day. Unlike other asylums where patients were often kept chained in crowded, unsanitary wards with little if any treatment, patients at the Pennsylvania Asylum resided in private rooms, received medical treatment, worked outdoors and enjoyed recreational activities including lectures and a use of the hospital library. The facility came to be called "Kirkbride's Hospital."
Brigham, superintendent of the Utica State Hospital in New York
advocates the therapeutic value of occupying patients. The idea
that only the therapeutic value should be considered in selecting
the activity was a new and important advance toward a more scientific
use of occupation as therapy.
Nightengale provides recreation to casualties of the Crimean
War dubbing her the Mother of Hospital Recreation.
1860-1885 Economic pressures felt in all hospitals during and after
the Civil War, busy physicians, lack of public interest and
insight, and an underestimation of the therapeutic value of
occupation as well as "the real returns as compared to
the incidental returns or possible economic proceeds from the
treatment," all contributed to the sudden decline and de-emphasis
of the allied health therapies for more than 25 years.