Sir David K Henderson and the origins of British occupational therapy

David Kennedy Henderson was born in 1884, the sixth son of a Dumfries solicitor; he attended school there and in Edinburgh. ¹ He graduated MB ChB from the University of Edinburgh in 1907 and spent six months each in psychiatry and general medicine in the city after which he worked with the renowned scientist and psychiatrist Adolf Meyer at the New York State Psychiatric Institute from 1908 to 1911. There followed studies with Alois Alzheimer and Emil Kraeplin in Munich, and short periods in Edinburgh and London after which he returned to work with Meyer as senior resident physician for the Henry Phipps Psychiatric Institute at Baltimore’s Johns Hopkins Hospital in 1912.

His time working at the Phipps clinic may well have led to Henderson’s enthusiasm for occupational therapy. It was at this time that Meyer, appointed Professor of Psychiatry at Johns Hopkins in 1910, was refining the fundamental theories of the psychobiological approach to psychiatry. ² Already a keen advocate of occupational therapy by the 1890s, Meyer’s administration of the Phipps clinic saw him enlist the assistance of Eleanor Clarke Slagle in establishing occupational therapy at the institution, also in 1912. Clarke Slagle was an early pioneer of occupational therapy in the United States of America, and would later become one of the founding members of the American Occupational Therapy Association. ³

During the two-year period in which Meyer and Henderson worked with her in Baltimore, Clarke Slagle developed the habit-training approach to therapy. ⁴ Stressing the importance of using occupation to rebalance and habituate activities between work, leisure and self care, ⁵ this approach was undoubtedly influenced by Meyer and his ideas of psychobiology. He would later explain in his 1922 paper, The Philosophy of Occupational Therapy;

The whole of human organization has its shape in a kind of rhythm. It is not enough that our heart should beat in a useful rhythm, always kept to a standard at which it can meet rest as well as wholesome strain without upset. There are many other rhythms which we must be attuned to: the larger rhythms of night and day, of sleep and waking hours, of hunger and its gratification, and finally the big four—work and play and rest and sleep, which our organism must be able to balance even under difficulty. The only way to attain balance in all this is actual doing, actual practice, a program of wholesome living is the basis of wholesome feeling and thinking and fancy and interests. ⁶

Henderson would later lead the introduction of these ideas and techniques to the UK as he instituted a more dynamic approach to psychiatry, considering social, environmental and psychological influences as well as biological factors in the aetiology of mental illness. ⁷ He returned to the UK in 1915 after the outbreak of the First World War and worked in the Glasgow Royal Mental Hospital, Gartnavel; in France; and in various war hospitals in Lancashire, Hampshire and Scotland. After the war he returned to Gartnavel in 1919 as senior assistant physician, later becoming physician superintendent in 1921.^8,9

When back at Gartnavel in 1919 Henderson enlisted the assistance of the hospital matron and began providing classes in craft and occupation, albeit on a limited basis. ⁸ In December 1922 he appointed Miss Dorothea Robertson as teacher in occupational therapy. Robertson was born in Glasgow and educated at Elgin Academy and Newman College, Cambridge. Graduating in 1915 she was appointed as welfare supervisor, firstly at the UK’s largest munitions factory near Gretna Green, and later at another plant in Sheffield, positions which combined the roles of manager and social worker to the female workers. Although receiving no formal training other than, ‘a course of instruction in handicrafts at the Glasgow School of Art’, ¹⁰ Robertson learnt on the job and could be considered the UK’s first occupational therapist. Indeed, at the time Clarke Slagle herself asserted that the most important qualities in those providing occupational therapy, rather than specialist training, were an appropriate character and a good knowledge of arts and crafts materials and processes. ¹¹ By 1925 arts, crafts and creative writing were embedded at Gartnavel with the majority of entries in the hospital’s journal, The Gartnavel Gazette, produced by patients. ⁷

However, the title of being the first occupational therapist in the UK is usually given to Margaret Barr Fulton, the daughter of a Scottish general practitioner working in Salford. After her father’s death in 1919 she visited relatives in the USA with her mother and completed formal training as an occupational therapist at the Philadelphia School of Occupational Therapy. ¹² On returning to the UK she approached Henderson who, unable to offer her a position, put her in touch with his former colleague Dr R Dods Brown at Aberdeen Royal Hospital who was able to employ her in 1925. She was later joined by a male teacher and by 1927 the department boasted thirty different craft activities. ¹³ Fulton was a founder member of the Scottish Association of Occupational Therapy (SAOT) established in 1932 and later became the first president of the World Federation of Occupational Therapy (WFOT) in 1952. ¹²

In 1924, Henderson presented a paper on occupational therapy at a meeting of the Royal Medico-Psychological Society. Attending this meeting was Dr Elizabeth Casson from Bristol who, inspired by Henderson, visited occupational therapy departments in the USA and proceeded to establish the first school of occupational therapy in the UK, Dorset House, in 1930. ¹⁴

While Casson undoubtedly contributed significantly to the development of occupational therapy in the UK by establishing the first institution for educating therapists, assertions that she, ‘in effect, imported the profession back to England by starting her own clinic and education program’ ¹⁵ is perhaps an overstatement given Henderson’s earlier efforts. Examination of the papers presented by Henderson and his colleagues at the 1924 meeting indicate how well developed their ideas of occupational therapy were. Indeed many of the ideas they articulated remain core elements of the profession today.

For instance, as the following excerpt from Dorothea Robertson’s contribution shows, they tried to ensure the occupations used as part of treatment were suited to the patients’ interests and abilities, rather than simply being diversionary in nature, as well as ensuring pathways for progression, elements that remain essential to therapeutic practices today ¹⁶ :

The Occupation Department, too, meets the requirements of the individual in a way that the routine work of the hospital cannot do. It offers a choice of various crafts, and it is a question of finding out which is best suited to each patient … The classes are graded and patients as they improve are moved up. ⁸

Likewise, Henderson himself was clearly aware of the value occupational therapy, as part of a wider programme of treatment, with its focus on re-establishing routines, preventing further loss of ability and restoring physical and mental capabilities. In concluding his paper Henderson asserted that,

I have not attempted to maintain that occupational therapy is the only way of treating cases of mental disorder, but I do wish to insist upon its great practical importance. I am certain that by its means many recoveries are hastened, many improvements are effected, good habits are substituted for bad ones, physical and mental deterioration are retarded, and life is made more endurable for the great bulk of our permanent population. ⁸

After leaving Gartnavel in 1932, Henderson was appointed Physician Superintendent at the Royal Edinburgh Hospital and Professor of Psychiatry at the University of Edinburgh. During the Second World War, he became Co-Director of the Brain Injury Unit at Bangour Hospital, West Lothian with the neurosurgeon Norman Dott. ¹⁷ They recruited a Canadian occupational therapist, Amy de Brisay, who had previously been a major contributor to the establishment of the Occupational Therapy department at the Astley Ainslie Hospital in Edinburgh. ¹⁸ Dott was very fulsome in his praise of de Brisay and occupational therapy as part of the multidisciplinary approach to brain injury rehabilitation. ¹⁹ A training course for occupational therapists had been established in 1937 at the Astley Ainslie Hospital and despite being suspended in 1939 restarted in 1941 with Henderson again proving helpful in arranging lectures, clinic attendance and practice experience in psychiatry for the students. ¹²

As stated above the SAOT was founded in 1932 at Gartnavel, hosted and opened by Henderson. He encouraged the development of training and the publication of a journal of occupational therapy. ²⁰ The Association of Occupational Therapy (AOT) serving the rest of the UK was formed in 1936. The SAOT was suspended in 1939 during the Second World War but was reinstated in 1946 with Henderson speaking at the inaugural meeting. The principal of the University of Edinburgh was made the first president, but died only seven months later and was succeeded by Henderson who remained in office until 1951 when he was succeeded by Dott. ¹² From 1949 to 1951 Henderson was President of the Royal College of Physicians of Edinburgh. ¹ The inaugural international congress of the WFOT was held in Edinburgh in 1954 during which Henderson chaired a session. ¹²

The profession of occupational therapy today is well established in the UK with degree level courses at over 30 universities. While no longer dependent on medical patronage the pioneers and early founders of the profession did depend on the enlightened support of medical leaders and Henderson must be considered one of the most significant.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.