Leisure and meaning-making: Implications for rehabilitation to engage persons with disabilities

Abstract

BACKGROUND: Humans strive for meaning-making, which refers to the process by which a person derives meanings from an activity in life and makes sense of one’s life.

OBJECTIVE: This paper summarizes the research-based knowledge about the role of leisure in meaning-making, and describes implications of this role for rehabilitation to engage individuals with disabilities.

RESULTS: The key themes of meaning-making through leisure include: (1) identity, (2) creativity, (3) connectedness, (4) harmony/balance, (5) stress-coping and healing, (6) growth/transformation, and (7) experiential and existential aspects of leisure. These seven themes seem to converge for the idea that engagement with life is an overarching theme to describe these functions. Specifically, a meaningful engagement with life can be achieved by maintaining several elements including: (a) a joyful life, (b) a composed life, (c) a connected life, (d) a discovered life, and (e) a hopeful and empowered life. Research has shown that leisure can promote all of these elements of meaningful engagement with life.

CONCLUSIONS: Any leisure activity that has an element of engagement in a broad sense (e.g., with self, others, and nature/world) can facilitate meaning-making, while meaning-focused leisure practice emphasizes the value of people proactively leading the process rather than people being told what to do in a prescriptive way.

Keywords

Engagement meaning of life purpose of life recreation

1 Introduction

Humans strive to pursue a meaningful, enriching life (Baumeister & Vohs, 2002; Frankl, 1985), as a source of happiness and wellbeing (Hicks & Routledge, 2013; Raskin, Bridges, & Neimeyer, 2010; Wong, 2012). Meaning-making, as a key concept in this paper, refers to the process by which a person derives meanings from an activity in life (Morgan & Farsides, 2009). Among many activities, leisure is considered a key domain of life, in which people seek to gain valued meanings of life in a number of different ways – psychologically, spiritually, socially, and culturally (Heintzman, 2008; Hutchinson & Nimrod, 2012; Iwasaki, 2008; Iwasaki, Coyle, Shank, Messina, & Porter, 2013; Kleiber, Hutchinson, & Williams, 2002; Trussell & Shaw, 2009; Watkins & Bond, 2007).

The purpose of this paper is to identify and map the current research-based knowledge about the role of leisure in meaning-making, and describe its implications for rehabilitation to engage persons with disabilities from a practical perspective. To provide a context for such discussion, the paper begins with reviewing the literature on engagement in leisure for people with disabilities. Then, informed by the literature on meaning-making through leisure, this paper identifies the key themes of leisure-induced meaning-making. Guided by such literature, the paper also summarizes implications of meaning-making through leisure for rehabilitation with individuals who live with disabilities.

1.1 Engagement in leisure for people with disabilities

The Universal Declaration of Human Rights, endorsed by the United Nations in 1948, explicitly stated that engagement in leisure should be recognized as a human right. Accordingly, it is very important for rehabilitation professionals to promote engagement in leisure opportunities as part of integrated care, as reminded by Shikako-Thomas and her colleagues (2014) in their exploration of leisure pursuits for children with cerebral palsy and their families. Shikako-Thomas et al.’s study found that adolescents with cerebral palsy place a high value on the ability to engage in leisure activities of their own choosing and on interacting with friends, since engagement in a variety of leisure activities is important for a healthy development. Besides behavioural, health, and social benefits of leisure for people with disabilities, it is vital to acknowledge broader benefits of leisure for those individuals. For example, Jessup, Bundy, and Cornell’s (2013) study found that young people who are blind intentionally engaged in leisure to resist some constraints and stereotypes of disability. In particular, empowerment through resistance in leisure was related primarily to gains in self-confidence which, in turn, have the potential to contribute to social interactions and perhaps influence some of the discourses that operate as ‘truths’ about people who are blind (Jessup et al., 2013).

To further illustrate the importance of using a holistic approach to leisure engagement for people with disabilities, Burns, Paterson, and Watson (2009) explored the attitudes of individuals with disabilities towards and experiences of woodland and countryside leisure. They found that the reasons for being outdoors among study participants with disabilities are more complex than simply seeking ‘rehabilitation’; and, like their non-disabled counterparts, access to the outdoors is perceived for some as an integral aspect of wellbeing and revitalisation. Through engagement with the outdoors, people with disabilities challenge normative constructions of who they are and their purpose in being in the countryside (Burns et al., 2009). The researchers concluded that rehabilitation professionals including providers of outdoor leisure services need to go beyond barrier removal, and understand the views and motives of those with disabilities about the outdoors in planning the provision of services.

Indeed, such call for a more holistic and strengths-based approach to leisure engagement for people with challenging conditions is not a new concept. For example, more than 13 years ago, Breslin, Reed, and Malone (2003) suggested that a substance abuse treatment should recognize the importance of replacing the use of alcohol and drugs with a healthier, holistic lifestyle, by providing an opportunity for patients to express thoughts and feelings through holistic modalities. Specifically, Breslin et al. noted that these modalities can include dance/movement therapy, Tai Chi, art therapy, leisure and recreational skills, spiritual growth and development, cultural awareness and appreciation, vocational services, psychiatric care, and physical health. Breslin et al. then described features of this holistic and strengths-based approach that focuses on ways to help patients develop a stronger sense of self-identity, self-esteem, and self-confidence.

More recently, the rehabilitation literature recognizes potentially an important role of leisure engagement in: (a) improving life satisfaction among individuals with a physical disability especially through social leisure (Kim et al., 2015); (b) providing opportunities for personal choice, social interaction, and challenge among youth with severe disabilities (King et al., 2014); and (c) enhancing social capital and richer patterns of community participation among individuals with disabilities within the general population (Araten-Bergman & Stein, 2014).

Also, from an intervention perspective, Fenech’s (2012) study participants having a neuropalliative disability who involved in aquatic leisure sessions reported being in control, learning about themselves or others, and feeling healthier after a session, as well as experiencing a sense of achievement and novelty, which was interesting and enjoyable. Fenech concluded that ‘aquability’ appears to be a satisfying use of free time for participants with neuropalliative conditions. In addition, people with aphasia in Worrall et al.’s (2011) study were able to articulate a wide range of post-stroke goals that encompassed all of the ICF (International Classification of Functioning, Disability and Health; WHO, 2001) components but had a particular focus on the Activity and Participation components in which leisure plays a key role. Specifically, Worrall et al.’s study identified the importance of engagement in social, leisure, and work activities as well as regaining their physical health and wanting to help others.

In addition, Ashby, Fitzgerald, and Raine’s (2012) study with men having chronic low back pain revealed that leisure was far more important than anticipated, by building social networks and sustaining subjective wellbeing, and constructing their identity. Ashby et al. suggested that occupational therapists are in a position to help overcome a potential negative impact of chronic low back pain through assisting in re-engagement and participation in leisure, for example, by identifying alternative leisure activities that enable the maintenance of roles and social networks.

Furthermore, according to Kvam and Eide (2015), when prolonged work disability occurs, leisure activities may be important to maintain meaning or find new meaning in everyday life (Hammell, 2004), as well as to uphold health and contribute to the community (Kvam, Eide, & Vik, 2013). Finally, Lecomte, Corbière, and Théroux’s (2010) study on the recovery of people with a severe mental illness emphasized the importance of relational capacities cherished through social leisure not only as protective factors against relapse, but also as essential factors in the recovery of individuals with psychosis. Despite an increasing understanding about the role of leisure in promoting positive outcomes among persons with disabilities, very limited attention has been given to the role of leisure in meaning-making, which is considered essential for happiness/wellness and improved human conditions for many people (Baumeister & Vohs, 2002; Frankl, 1985; Hicks & Routledge, 2013; Raskin et al., 2010; Wong, 2012), as noted earlier.

More than 12 years ago, Hammell (2004) claimed,

Although espousing the importance 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. The fundamental orientation of occupational therapy should be the contributions that occupation makes to meaning in people’s lives, furthering the suggestion that occupation might be viewed as comprising dimensions of meaning: doing, being, belonging and becoming ... Focusing on meaningful, rather than purposeful occupations more closely aligns the profession with its espoused aspiration to enable the enhancement of quality of life (p. 296).

Endorsed by the above claim, constructive leisure engagement can provide people living with disabilities with important opportunities for meaning-making by emphasizing its dimensions of “doing, being, belonging and becoming,” as emphasized by Hammell.

2 Key themes of leisure-induced meaning-making

Guided by the research-based knowledge about the role of leisure in meaning-making especially for people with disabilities, this section summarizes the key themes for contributions of leisure to meaning-making. This summary offers a literature-informed framework that rehabilitation professionals might be able to use as a strategy for meaning-focused leisure practice. Specifically, the seven themes of leisure-induced meaning-making include: (1) identity, (2) creativity, (3) connectedness, (4) harmony/balance, (5) stress-coping and healing, (6) growth and transformation, and (7) experiential and existential aspects of leisure.

First, identity appears to be a key theme for the role of leisure in meaning-making (Kim & Kim 2013; Mata-Codesal, Peperkamp, & Tiesler, 2015; Phinney, Chaudhury, & O’Connor, 2007). Not only is this theme concerned with personal identity, but it also involves collective identity. Discovering who the person is both individually and collectively seems vital for the pursuit of a meaningful life, and such discovery can be facilitated by meaningful leisure (Banfield & Burgess, 2013; Csikszentmihalyi, 2002, 2014; Iwasaki, Messina, Coyle, & Shank, 2015). The significant role of leisure in promoting positive identity has been found among young people who are blind (Jessup et al., 2013) and men having chronic low back pain (Ashby et al., 2012). Also, Burns et al. (2009) reported that outdoor recreation including woodland and countryside leisure enhanced the identity of people with disabilities by challenging normative constructions of who they are, while Fenech (2012) found that aquatic leisure sessions for adults with a neuropalliative disability facilitated learning about themselves.

Second, creativity has been noted as another theme for the role of leisure in meaning-making (Banfield & Burgess, 2013; Hegarty & Plucker, 2012; Mata-Codesal et al., 2015). Some researchers have coined creative leisure to describe opportunities that leisure can present for self-expression as a meaningful form of leisure (Hegarty, 2009). As reported in a special issue of NeuroRehabilitation on leisure in rehabilitation, Creek (2008) emphasized the role of leisure in providing opportunities to enhance creativity (termed “creative leisure opportunities”), which can promote effective adaptation and the pursuit of meaningful goals. Also, Yuen, Mueller, Mayor, and Azuero’s (2011) study offered practice implications for occupational therapists using drama as a creative leisure occupation to promote health among older adults with chronic conditions.

Third, connectedness has been shown as a key theme for leisure meaning-making (Chun & Lee, 2010; Phinney et al., 2007; Wensley & Slade, 2012). This theme appears to have several dimensions including social, spiritual, and cultural connectedness. Not only is building interpersonal, social relationships essential to this theme, but connectedness has spiritual and cultural elements including one’s connections to nature, religion, and culture (Heintzman, 2008; Iwasaki et al., 2015; Phinney et al. 2007; Wensley & Slade, 2012). The importance of leisure opportunities for social interactions and networks has been found among youth with severe disabilities (King et al., 2014), individuals with a physical disability (Kim et al., 2015), adolescents with cerebral palsy (Shikako-Thomas et al., 2013), and men having chronic low back pain (Ashby et al., 2012). Lecomte et al.’s (2010) study on the recovery of people with a severe mental illness emphasized relational capacities developed through social leisure. Also, Araten-Bergman et al.’s (2014) study of Israelis with disabilities showed a strong association between community participation, especially through leisure, and civic engagement and social capital.

Fourth, another key theme appears to be contributions of leisure to maintaining harmony or balance in one’s life (Hutchinson & Nimrod, 2012; Iwasaki et al., 2015; Watters et al., 2013). Compared to the other domains of life (e.g., work/employment), leisure seems to provide less restrictive and more flexible and liberating opportunities to change or adjust the pace and tone of life so that the person can experience a more harmonious, balanced life (Newman, Tay, & Diener, 2014; Wensley & Slade, 2012). One of the key themes identified by Cook and Shinew’s (2011) qualitative study with people who have physical disabilities was the role of leisure in helping them maintain a balanced life. Also, Iwasaki et al.’s (2015) study with individuals who live with mental illness found the importance of leisure in promoting a balanced life, as exemplified by one participant’s description about her recovery from mental illness:

Leisure is part of my daily activities, you know, and it helps me in every aspect ... Recovery is being an advocacy for myself, advocate for my rights .... It has to be a balance in everything in order for a person to be successful in their recovery ... Knowing about myself and my abilities and my potential — that really helps me to continue my journey to recovery (p. 549).

Fifth, meaning-making through leisure has been found to be a key process for effective stress-coping and healing that can lead to subjective wellbeing (Carruthers & Hood, 2007; Fredrickson, 2002; Newman et al., 2014). Leisure pursuits appear to have a unique, powerful property to provide a person under stress or trauma with opportunities for effective coping or healing (Deschenes, 2011; Heintzman, 2008; Iwasaki, MacKay, Mactavish, Ristock, & Bartlett, 2006; Kleiber et al., 2002). Cook and Shinew’s (2011) study with people who have mobility impairments due to physical disabilities highlighted the contribution of leisure to managing and coping with disability, while Kleiber, Reel, and Hutchinson’s (2008) literature review paper highlighted the role of leisure in coping with and adjusting to living with a disability. Also, Mock, Fraser, Knutson, and Prier’s (2010) study findings emphasized the sense of belonging as a component in how participation in physical leisure activities helps adults with rheumatoid arthritis cope with disability and enhance well-being.

Sixth, such stress-coping and healing functions of meaningful leisure seem to facilitate growth and transformation, which represents another theme for the role of leisure in meaning-making (Deschenes, 2011; Heintzman, 2008; Mantero, 2000; Waters & Moore, 2002; Watters et al., 2013). Resilience, post-traumatic growth, and empowerment through leisure (Chun & Lee, 2010) are several key concepts related to this function. Kleiber et al.’s (2008) paper reviewed the research evidence regarding the value and utility of leisure in coping with and adjusting to living with a disability, including the role of leisure in affording a context for personal transformation. Those researchers then offered considerations for incorporating leisure as a key aspect of treatment and care for those working in neurorehabilitation settings. Also, Jessup et al. (2013) found that young people who are blind intentionally used leisure activities to resist some constraints and stereotypes of disability and to promote self-confidence and empowerment through resistance in leisure.

Seventh, illustrated by meaning construction of “flow” experiences (Csikszentmihalyi, 2002), giving attention to both experiential and existential aspects of leisure seems worthwhile (Banfield & Burgess, 2013). The former primarily addresses expressive processes (e.g., through creative leisure), whereas the latter deals with vitality, identity, and sense of achievement as a key leisure-induced meaning-making function. Indeed, these two elements are often intertwined through the fusing of thought and action, and the integration of mind, body, and spirit (Banfield & Burgess, 2013; Csikszentmihalyi, 2014). Fenech (2012) reported that aquatic leisure sessions facilitated a sense of achievement among adults with a neuropalliative disability. As a “spiritual person,” one participant in Iwasaki et al.’s (2015) study with individuals who live with mental illness spoke about his love of gardening as an outdoor leisure activity, termed “existential prayer”:

I do love to be outdoors. The natural world is a constant source of joy for me. It’s a real good counterbalance to indoor activity. Well, I am a spiritual person. Gardening is a kind of existential prayer. It’s my way of celebrating life in its most basic form (p. 546).

Finally, all of these seven themes for meaning-making through leisure seem to converge for the idea that engagement with life is an overarching theme to describe these functions. Importantly, there appears to be a connection between engagement and meaning-making for the pursuit of a purposeful and enriched life (Hutchinson & Nimrod, 2012; Iwasaki et al., 2015; Silverstein & Parker, 2002; Watters et al., 2013). Consistent with the key themes for leisure meaning-making described above, a meaningful engagement with one’s life seems to be achieved by maintaining: (a) a joyful life, (b) a composed life (e.g., making one’s life more composed, focused, collected, and/or in control), (c) a connected life (e.g., socially, spiritually), (d) a discovered life (e.g., promoting self-identity and self-discovery), and (e) a hopeful and empowered life (e.g., showing a sense of strength).

Engagement through leisure has been shown to enhance all of these functions, which can result in broadly meeting human’s aspiration for an engaged and meaningful life (e.g., Hegarty & Plucker, 2012; Hutchinson & Nimrod, 2012; Lloyd, King, & McCarthy, 2007; Phinney et al., 2007; Stuckey & Nobel, 2010). For example, the role of leisure in promoting a composed, focused, and collected life is a key function of leisure as diversionary activities, described by Kleiber et al. (2008) on the relevance of leisure to adjustment to disability. The idea of diversionary activities represents the role of leisure in coping with stress, ranging from physical activity and social leisure to relaxing leisure and even a “flow” activity described earlier. Also, Iwasaki et al.’s (2015) qualitative study with persons with mental illness found that creative activities (e.g., arts, crafts, and collages) promoted a discovered and connected life, while poetry, church activities, and walking through nature promoted a connected, discovered, and hopeful/empowered life. Overall, Iwasaki et al.’s study that focused on exploring the process of recovery from mental illness highlighted the connection among three key concepts including leisure, meaning-making, and engagement in life. Conceptualizing the role of leisure in meaning-making based on the above framework seems to help researchers and practitioners better understand the specific mechanisms by which people seek to gain meanings of life through leisure.

3 Implications of meaning-making through leisure for rehabilitation to engage persons with disabilities

In terms of application to rehabilitation practice, there seems to be a great potential of incorporating the role of leisure in meaning-making into practice to work with and engage persons with disabilities. Specifically, a meaning-focused leisure practice can be developed by adopting the above framework that consists of the seven themes of leisure and meaning-making, and the five elements of meaningful engagement with a life.

Speaking of the rationale for using this meaning-focused leisure practice, it has been documented that meanings or a meaning system represent a broader, more holistic concept to one’s core values and inspiration for life than personal behaviours and experiences per se (Baumeister & Vohs, 2002; Frankl, 1985; Hicks & Routledge, 2013). Accordingly, this meaning-focused leisure practice can help rehabilitation practitioners conceptualize leisure more than just from an activity/behavioral or experience-based perspective. Rather, this approach allows them to focus on the meanings that leisure activities can promote, which are appealing and important to their clients.

A key reminder is that any leisure activity that has an element of engagement in a broad sense can facilitate meaning-making. For example, a relaxing low intensity activity (e.g., listening to music, reading) can be as engaged and meaningful as a flow-like high intensity activity (e.g., rock climbing, tai-chi, artistic activity), whereas a small leisure event (e.g., casual leisurely conversation over coffee or tea, dog-walking, gardening) can be as engaged and meaningful as a “big” leisure event such as an extended vacation to Hawaii, for instance. These examples illustrate a broad spectrum of leisure engagement, regardless of intensity and size of leisure events, as a way to promote meaning-making.

Another key idea is that meaning-focused leisure practice emphasizes the value of people proactively leading the process rather than people being told what to do in a prescriptive way. This describes the distinction between a proactive approach and a prescriptive approach. This means that what people do with leisure, rather than what leisure does to people, should be emphasized to promote constructive people-led engagement through meaningful leisure (Brooks, Dashuk, Poudrier, & Almond, 2015; Lashua & Fox, 2007; McClelland & Giles, 2014). The former concept (i.e., what people do with leisure) is more people-driven than the latter concept (i.e., what leisure does to people), which is more prescriptive in nature. Rather than strictly using a highly structured top-down approach to rehabilitation, the use of a more collaborative, iterative approach is desirable by respectfully engaging and working with clients (van der Voort et al., 2015). Because of leisure’s unique characteristic of being intrinsically chosen and defined, meaning-focused leisure practice can be an innovative, client-centred approach to rehabilitation practice.

Overall, a key message stressed in this paper is that leisure is a key activity in life that promotes meaning-making for the pursuit of an engaged, enriched, and fulfilling life through one’s active engagement with self, others, and nature/world. Considering the increasing diversity in our global society, a meaning-focused leisure practice seems particularly relevant to often socially marginalized and disadvantaged population groups such as people with disabilities and ethnic minorities including immigrants and refugees.

4 Conclusion

This paper summarized the current research-based knowledge about the role of leisure in meaning-making, and described implications of this role for rehabilitation to engage individuals with disabilities. As highlighted in this paper, contributions of leisure to meaning-making have important implications for facilitating this inspirational process. The key themes of leisure-generated meaning-making identified include: (1) identity, (2) creativity, (3) connectedness, (4) harmony/balance, (5) stress-coping and healing, (6) growth/transformation, and (7) experiential and existential aspects of leisure. Human’s inspiration for an engaged life is considered as an overarching theme to broadly capture these functions. Specifically, a meaningful engagement with life can be achieved by maintaining several elements including: (a) a joyful life, (b) a composed life, (c) a connected life, (d) a discovered life, and (e) a hopeful and empowered life. Research has shown that leisure can promote all of these elements of a meaningful engagement with life.

In addition, the paper provided insights into strategically focusing on meaning-making through leisure for rehabilitation to engage persons with disabilities. Any leisure activity that has an element of engagement in a broad sense (e.g., with self, others, and nature/world) can facilitate meaning-making, while meaning-focused leisure practice emphasizes the value of people proactively leading the process rather than people being told what to do in a prescriptive way. Building on this emerging research-based knowledge, further efforts are needed to more systematically capture the role of leisure in meaning-making as a key avenue/pathway to an enriched, inspiring, and fulfilling life by appreciating the diversity in our global society.

Conflict of interest

The author has no conflict of interest to report.

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