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Dimensions of meaning in the occupations of daily life
Resumen
Background. According to the existential philosophers, meaning, purpose and choice are necessary for quality of life. Qualitative researchers exploring the perspectives of people who have experienced health crises have also identified the need for meaning, purpose and choice following life disruptions. Although espousing theimportance of meaning in occupation, occupational therapy theory has been primarily preoccupied with purposeful occupations and thus appears inadequate to address issues of meaning within people's lives. Purpose. This paper proposes that the fundamental orientation of occupational therapy should be the contributions that occupation makes to meaning in people's lives, furthering the suggestion thatoccupation might be viewed as comprising dimensions of meaning: doing, being, belonging and becoming. Drawing upon perspectives and research from philosophers, social scientists and occupational therapists, this paper will argue for a renewed understanding of occupation in terms of dimensions of meaning rather than as divisible activities of self-care, productivity and leisure. Practice implications.Focusing on meaningful, rather than purposeful occupations more closely aligns the profession with its espoused aspiration to enable the enhancement of quality of life.

Canadian occupational therapists have placed spirituality
at the centre of their Canadian Model of Occupational Performance (Canadian Association of Occupational Therapists [CAOT], 2002) and have declared that: "Spirituality isa universal concern, growing where
people feel alienated, isolated, lonely, oppressed, marginalized, demoralized, or trapped in bureaucracy, abuse or meaningless occupation" (Townsend, DeLaat, Egan, Thibault & Wright,1999, p.3). It has been suggested that Canadian occupational therapists are wrestling with issues pertaining to spirituality because clients who are facing life disruptionsconsistently raise issues of meaning, values and purpose (Hammell, 2003a). Yet current theory, with its focus on the doing of self-care, productive and leisure activities, is inadequate to address issues of meaning in people's lives (Hammell, 2003a). However, the belief that occupation is a primary source of life's meaning (CAOT, 2002), and recognition that enablement of meaningful occupation (notspirituality) falls squarely within our mandate requires that occupational therapists explore the concept of occupation as this
relates to the experience and expression of meaning in people's lives. This paper examines the contribution that occupation makes to the experience of meaning and quality of life following profound biographical disruption. In so doing, it draws upon theories and research fromphilosophers, social scientists and occupational therapists to support an alternate vision for theorizing occupation in terms of "the sources of meaning found in occupation and the contributions that occupation makes to meaning in our lives" (Hasselkus, 2002,p.xi).



The concept of occupation in occupational therapy theory
Current occupational therapy theory states that occupation "iseverything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (productivity)" (CAOT, 2002, p.34). This definition does not delimit occupation to three categories but subsequent statements in the same publication list the "purposes" of occupation as being self-care, productivityand leisure (CAOT, 2002,p.37). This is neither a random nor an
alphabetical ordering (Suto, 2004), but a hierarchy that reflects the specific values and priorities of physically
independent, employed theorists (Hammell, 2004a). Some disability theorists would argue that by prioritizing self-care and productive (economic) activities, occupational therapists act as agents of the state, actively...