Arts and Crafts Movement Basket Weaving in Occupational Therapy

Jacob Schor, ND, FABNO

During our time at abode this by spring, I took upwards ii new hobbies: chair caning and handbasket making. I can't merits to exist especially accomplished at either. If you want to joke near me existence a basket case, don't feel also clever; the suggestion has already been fabricated.

In the process of acquiring these skills, I ended upwardly learning some things about naturopathy and the origins of our earth views that I want to share with you lot.

I launched my chair-caning hobby by caning several canoe seats. I discovered that the action has a meditative quality to it that was surprisingly calming and, at the aforementioned fourth dimension, addictive. It took effort to cease. I moved on to basket making, initially weaving classic Adirondack basket packs. Basket making has a long-standing reputation equally a useful pastime for those in need of mental rehabilitation, at least before the advent of psychoactive medications. Less politically right people nonetheless utilize the term basket-case to describe someone in a far-from-ideal state of mental equanimity. Caning my canoe seats was mentally soothing and slightly addictive; weaving baskets was fifty-fifty more then. The repetitive over-and-under manual repetition does something pleasant inside my head. Once I kickoff a project, I hesitate to stop. Moving an agile strand over and under the standing strands may be the mental equivalent to a concrete cross-crawl. It is like shooting fish in a barrel to imagine that either craft would have beneficial effects on mental role and that research would acquaintance these activities with all sorts of cerebral and emotional benefits and changes on brain scans. Notwithstanding repeated PubMed searches, in hoping to validate this hunch, came up empty.

That'south considering the therapeutic utilization of basketry and other handicraft activities is an one-time thought. It dates dorsum to an era when the opinions of eminent practitioners were reason enough to implement a do; our mod evidence-based-medicine thing had withal to occur. I learned much of the following afterwards reading a 2011 celebrated review by J. Laws titled, "Crackpots and basket-cases: a history of therapeutic work and occupation."¹

Laws explains how a convergence betwixt the social miracle known equally the "Arts and crafts Motion" intersected with an epidemic of an ailment called neurasthenia. This intersection gave rising to the profession now known as occupational therapy.

The Arts & Crafts Move

Allow's support to the mid-1800s, when the Industrial Revolution had just swept across England and then the U.s.a., causing major upheavals in social order and quality of life. Non everyone was happy with the changes. This is precisely when John Ruskin and William Morris initiated the Arts and Crafts Movement. Information technology was in their writing and philosophizing that my appreciation of basket making probably originated. Ruskin was of the belief that machines and factory work limited human happiness and that people should return to a more authentic and simpler way of life. He preached a highly romanticized version of the Middle Ages, where people all made their livings engaged in cottage crafts. He judged that manufactured, factory-produced goods, which were becoming commonplace in the 1800s, were "… both aesthetically and morally unsatisfying because the worker was treated similar an extension of the auto, completing only a part of the finished production."^two In my heed, that life according to Ruskin would exist like living in one of those historic theme parks listed online as "living history museums" – places like Sturbridge Hamlet.

William Morris expanded upon Ruskin's philosophy and, in modern terms, monetized Ruskin'due south ideas, creating a decorative arts empire selling textiles, piece of furniture, and wallpaper. He put the fine art into artisanal. Their Craft philosophy and their ideas virtually habitation furnishing styles crossed the Atlantic and became popular among America's well-to-do. If this style isn't familiar to you, expect online at images of Stickley furniture, as they are perfect examples of the American version of Arts and Crafts.

"Proponents were eager reformers celebrating nature, accurate experience, and honest design. Like their British contemporaries, they displayed a patrician contempt for the arrangement of mass production, which was keyed to lower course tastes. They advocated the use of natural materials and processes and the buy and use of handmade items that were straightforward and simple in design. Indeed, for some advocates, the Arts-and-Crafts motion meant quality of design as much equally quality of life."ⁱⁱ

The Arts and Crafts Movement reached its high point at virtually the same time that the neurasthenia epidemic swept across America. Neurasthenia isn't a term used in modern medicine anymore; even so, it was a huge thing dorsum in the solar day. The term offset appeared in print in 1829, just it wasn't until 1869 that it was popularized equally a medical diagnosis by George Miller Beard and E. H. Van Deusen of the Kalamazoo asylum, though they didn't agree on a definition or etiology.^3,4Van Deusen believed that the status was caused past social isolation and a lack of engaging activity among rural women, while Bristles saw the condition every bit something that overly decorated club women and overworked businessmen were prone to.

Figure 1. George Miller Beard

George Miller Beard is considered the "begetter" of neurasthenia.

Treatments for Neurasthenia

Neurasthenia was considered a weakness of the nerves. Medical thinking at the time considered the trunk as a sort of electric machine, with the nervous organization acting similar wires that distributed free energy. The fast paced, chop-chop shifting modernistic earth dorsum so, with people moving from the farm to big, busy cities with as well much stimulation, led people to expend likewise much of their "nervous energy" and become depleted as a effect. Daily newspapers delivered more than data on current events than people could keep up with. Railroads immune fashion too rapid travel. New ideas and styles spread like epidemics. It was all likewise much for some people. The resultant country of collapse was termed neurasthenia.

Symptoms of neurasthenia included headaches, muscle pain, weight loss, irritability, feet, impotence, low, "a lack of appetite," and both insomnia and sluggishness. Julie Beck, writing in a 2016 issue ofThe Atlantic, described neurasthenia, equally, "… a disease of culture as much as of the mind and body. Beard thought that people in before societies could not have been neurasthenic considering they weren't exposed to the modern things that depleted nervous free energy, particularly 'steam power, the journal press, the telegraph, the sciences, and the mental activity of women.'"⁵

The first treatment for neurasthenia to come up into style was called the Balance Cure. It was developed by Silas Weir Mitchell (1829-1914) in the mid 1800s.⁶ Mitchell specialized in nervous diseases in Ceremonious War veterans for almost of his career, merely developed the Rest Cure to treat neurasthenia and hysteria in women. The treatment involved 6-8 weeks of isolation, bed residual, a high-calorie nutrition, massage, and electrotherapy. For men, he suggested a very different arroyo. In his 1871 book,Wear and Tear or Hints for the Overworked,^vii he suggested that neurasthenic men should strengthen their nerves by engaging in "a sturdy contest with Nature." This thought became known every bit the "W Cure." Neurasthenic men were sent out west to engage in vigorous concrete activity for prolonged periods – activities such as cattle roping, hunting, roughriding and male bonding – and to write about the experience.⁸ Teddy Roosevelt and Walt Whitman were both among the many neurasthenics who underwent this treatment.

Figure 2. Silas Weir Mitchell

Silas Weir Mitchell developed the "Rest Cure."

These handling ideas for neurasthenia obviously reflected underlying beliefs in traditional gender roles that some today would find objectionable, what nosotros might call historical medical misogyny. The thinking back and so was that God created men to work outdoors and that spending also much fourth dimension indoors put them at risk for neurasthenia. Women, on the other hand, were supposed to stay habitation disposed their households; too active a social life and time spent outside of the home left them vulnerable.

As old fashioned as some of these ideas now seem, we owe many popular conventions to the views preserved from that era on how to reduce chance of neurasthenia. Creation of our national park system is credited to the conventionalities that neurasthenics needed to retreat back into nature to heal. Nature is the healing force, an idea that still remains at the cadre of naturopathic medicine. Having recess times in public schools is also a practice leftover from neurasthenic prevention strategies. There was a fear that sitting as well long in a classroom was bad for children's nervous systems. Activities such as traveling on vacations, wheel-riding, and sports leagues were promoted by medical thinkers to reduce the hazard of developing neurasthenia.⁵

In 1910, Herbert Hall, MD, opened a clinic in Marblehead, Massachusetts, and promoted a "workcure" for neurasthenia based on ideas he borrowed from the Arts and Crafts Movement. A similar plan was begun in Worcester, Massachusetts, past Adolf Meyer at about the same time. William Rush Dunton started a program in Maryland. Patients spent a skillful part of their 24-hour interval engaged in art and craft activities. Apparently, this arroyo worked well and quickly spread widely. Residential workshops were created to both foster skill development and generate income through the selling of the items produced by participants.

A textbook titledStudies in Invalid Occupation: A  Manual for Nurses and Attendants, written past Susan Edith Tracy, was starting time published in 1912.⁹ Tracy offered detailed descriptions of the arts and crafts grooming courses she used at the Boston Nervine Infirmary, and her program was widely copied. Her book became the blueprint for preparation practitioners in what afterward became known as occupational therapy. Our retained image of patients weaving baskets dates all the mode back to that era. No wonder there are no randomized controlled trials demonstrating efficacy; they may not have been needed. Information technology might be similar prunes with results then obvious that no i felt obligated to test the treatment.

World Views of Neurasthenia

We don't hear much almost neurasthenia anymore. The ailment disappeared in the United States by the 1930s, though not necessarily in the balance of the earth. The diagnosis was dropped from the DSM in 1980. Withal, the World Health Organization retains neurasthenia as a medical diagnostic category to this day.^x Neurasthenia has persisted and may take worsened for periods in other countries.

In Nippon, neurasthenia is calledshinkeisui-jaku, meaning "nervousness or nervous disposition."¹¹ The condition is often treated at that place with a process called Morita therapy, which involves a menstruum of mandatory rest and isolation that is followed past progressively harder work, eventually leading to resumption of one's social role. This treatment was developed by Japanese psychiatrist Shoma Morita, (1874-1938) and has its footing in Zen Buddhism. Information technology is aimed at breaking a wheel of sensitivity and anxiety past getting the patient to "accept life as it is."¹² Role of this treatment involves the Japanese practice of "forest bathing,"shinrin-yoku, which has been part of their national health program since 1982 and which many of united states of america take heard of.^thirteen

In China, neurasthenia also remains a valid medical condition defined in terms of Traditional Chinese Medicine; the etiology, no surprise, is described as a subtract in vital energy (Qi). There was a significant increase in neurasthenia cases in Mainland china during the Great Spring Forward during the 1950s to mid-1960s, to such a caste that information technology was considered a major national wellness event.^{one 4} Both exogenous and endogenous harmful factors reduce operation of the 5 internal organ systems, (heart, spleen, liver, lungs, and kidneys). In Chinese, neurasthenia is calledshenjingshuairou (weakness of fretfulness).^{1 5}

The ascendant fatigue expected in our American version of neurasthenia is not required in Red china for a neurasthenia diagnosis. But 3 of the following 5 symptoms are required: "weakness," "emotional," "excitement," tension-induced hurting, and sleep disturbance. The duration of disease must exist at least three months, and 1 of the following must accept occurred: disruption of work, written report, daily life, or social functioning; significant distress acquired past the illness; or pursuit of handling.

Chinese immigrants to the United states of america appear to retain a susceptibility to neurasthenia and exhibit a symptom picture singled-out from a US diagnosis of low or other categories that have been suggested as equivalents. In a 1997 study, Zheng et al showed that Chinese immigrants to Los Angeles continue to brandish symptoms of pure neurasthenia.^{one half dozen}

Modernistic medical government tell us that neurasthenia has "no organic basis," and their current assumption is that the condition was psychosomatic. This thought doesn't sit that well with me.

Historically, for many patients diagnosed with neurasthenia, gastrointestinal symptoms predominated, and sufferers in this subset were diagnosed with "neurasthenia gastrica." At the time, "… in that location was considerable fence equally to how the gut interacted with the cardinal nervous arrangement in the development of these ailments. Some of these discussions may exist seen as historical precedents for the current debates on the brain-gut-microbiota centrality, specially in relation to the and so-called functional gastrointestinal disorders."¹⁷ Other researchers argue that modern maladies, such equally fibromyalgia, chronic fatigue, and depression are merely updated manifestations of the aforementioned disease.^{i 8} Modern-24-hour interval naturopathic doctors apply a range of possible diagnoses that are generally not used past mainstream medical providers. Adrenal fatigue and hypothalamic dysregulation seem to be our closest modern equivalents to neurasthenia. Over the terminal century, the world has not slowed down. While we may be more aware of the wellness risks posed by stress, the pace of modern life and the caste of modify to which people must adapt have not decreased; if annihilation, our situation is worse. There is little question that, at to the lowest degree in today's pop wisdom, a spectrum of dis-ease stretches between feeling stressed to post-traumatic stress disorder (PTSD). Neurasthenia probably belongs somewhere on that spectrum.

The more I have read near neurasthenia, the longer my list of unanswered questions. Were those who were diagnosed with neurasthenia a century ago the aforementioned sort of people who today would have fibromyalgia or chronic fatigue? Could neurasthenia have been infectious, the aftermath of a bacterial or viral infection? We know today of some rather strange repercussions of parasitic infections that seem to take control of the host's behavior. Toxoplasmosis is probably the most famous of these.¹⁹ Testify is mounting that fibromyalgia has a genetic component²⁰ and that something distinct is chemically amiss in the blood of those with chronic fatigue.^{ii ane} Perhaps in that location was a genetic piece to neurasthenia.

A Rest vs West Differential?

The primary question is whether neurasthenia is, or was, a existent condition? Or were those patients just an before version of the "worried well" that we even so run into on occasion? If the many physical symptoms attributed to neurasthenia were but psychosomatic with no organic footing, and so we are left in an awkward place. Historically, many fundamental beliefs of the naturopathic profession were adult in parallel to the neurasthenic "epidemic" in the United States, and many of the philosophic and treatment approaches nosotros notwithstanding employ reflect that history.

Our critics could say that naturopathic medicine evolved around treating an imaginary condition and has connected into the present solar day treating other imaginary conditions that take come along to replace neurasthenia. Recollect of the many conditions that we and our colleagues specialize in that accept never been accustomed every bit "real" past mainstream physicians. Many of these "conditions" take come into and then gone out of fashion over the years, even in our own practices. Think when most of our patients' health issues were caused by yeast? Of course, we adopt to view our profession as on the cutting border of scientific discovery and to believe nosotros just adopt new theories and treatments ahead of mainstream medicine.

Modernistic occupational therapy does non announced to rely on basket weaving or other arts and crafts anymore. Rather, it now focuses on preparation patients to perform the activities of daily living later on accidents, strokes, or functional degeneration caused past illness. The practice of arts and crafts may be similar the practice of spinal manipulation by osteopathic doctors – and so very "old school."

Some therapeutic interventions may not need randomized controlled trials to prove their utility. Handbasket weaving is an uncommon hobby, but knitting remains mutual. Find a habitual knitter among your circle of acquaintances, and inquire if they would concord to finish knitting for a few weeks so that you might assess changes in their mental well-existence. Few will agree to do this; their adamant refusal is in itself a measure of the benefits they derive from the activity.

We can make guesses as to what physiologic benefits are conferred past basket making by looking at other therapies once used to care for neurasthenia. It's a practiced guess that the furnishings are like. Spending time in nature was seen equally curative. Today nosotros know a lot about what nature exposure does to our physiology and mental health. There's a skillful chance that basket making has similar effects.

Exercise was also considered therapeutic for neurasthenia – at least for men, as part of the West Cure. The gender distinction betwixt Rest Cure and West Cure is curious, only we may be hesitant to ponder the implications lest we be accused of some form of discriminatory paradigm. Still, there is a possibility that a dichotomy exists betwixt patients, some who will recover amend with enforced residuum, and others who might answer more to rigorous activeness.

What would be the modern equivalent to a West Cure? What kind of impact would more than time in nature, rigorous practice, and fresh air have on adrenal dysregulation, as compared to enforced rest? We know that among our patients, some are drawn to do yoga while others crave adrenaline sports. Perhaps we need to assess our "adrenal fatigue" patients to make up one's mind which path will exist more helpful – a Rest vs West differential? One approach might lower cortisol demand and production, while the other might increase it. Either arroyo might serve to rebalance hypothalamic office.

The UPS truck has dropped off the needed supplies for my next project – a picnic handbasket – and I'one thousand feeling impatient to send off this draft and become started. And so, if this conclusion sounds a bit hurried, my apologies. Did I mention that there is something about basket making that I notice addictive?

References:

1. Laws J. Crackpots and handbasket-cases: a history of therapeutic work and occupation.Hist Human being Sci. 2011;24(2):65-81.
2. Levine RE. The influence of the arts-and-crafts movement on the professional status of occupational therapy.Am J Occup Ther. 1987;41(4):248-254. Available at: https://docplayer.net/99923479-The-arts-and-crafts-movement-ultimately-came-to.html. Accessed Apr 17, 2020.
3. Beard G. Neurasthenia, or nervous exhaustion.The Boston Medical and Surgical Journal. 1869;eighty(13):217-221.
4. Van Deusen EH. Observations on a form of nervous prostration, (neurasthenia) culminating in insanity.American Journal of Insanity. 1869;25(iv):445-461.
5. Beck J. 'Americanitis': The Disease of Living Too Fast. March eleven, 2016.The Atlantic. Available at: https://www.theatlantic.com/wellness/archive/2016/03/the-history-of-neurasthenia-or-americanitis-health-happiness-and-culture/473253/. Accessed April 17, 2020.
6. Goldberg J. Beyond "The Yellow Wallpaper": Silas Weir Mitchell, Doctor and Poet. April eight, 2016. Books, Wellness, and History. The New York Academy of Medicine. Available at: https://nyamcenterforhistory.org/2016/04/08/beyond-the-yellow-wallpaper-silas-weir-mitchell-doctor-and-poet/. Accessed April 17, 2020.
7. Mitchell SW.Wear and Tear or Hints for the Overworked. Philadelphia, PA: J.B. Lippincott; 1871.
8. Stiles A. Go residual, young man.Monit Psychol. 2012;43(ane):32. Bachelor at: http://www.apa.org/monitor/2012/01/go-rest.aspx. Accessed Apr eighteen, 2020.
9. Tracy SE.Studies in Invalid Occupation: A Manual for Nurses and Attendants.  Boston, MA: Whitcomb & Barrows; 1912.
10. Earth Health Organization. International Classification of Diseases, Eleventh Revision (ICD-xi). Geneva, Switzerland: WHO; 2018.
11. Lin TY. Neurasthenia revisited: its place in modern psychiatry.Cult Med Psychiatry. 1989;13(2):105-129.
12. The Morita Schoolhouse of Japanese Psychology. Morita Therapy: Basics. Available at: http://world wide web.moritaschool.com/read-me. Accessed Apr 17, 2018.
13. Haile R. 'Forest Bathing': How Microdosing on Nature Can Aid With Stress. June xxx, 2017.The Atlantic. Available at: https://www.theatlantic.com/health/annal/2017/06/forest-bathing/532068/. Accessed Apr 18, 2020.
14. Wang WJ. Neurasthenia, psy sciences and the 'nifty leap forwards' in Maoist Prc.Hist Psychiatry. 2019;30(iv):443-456.
15. Chinese Medical Association and Nanjing Medical University.Chinese Classification of Mental Disorders,Second Edition, Revised (CCMD-2-R). Nanjing, China: Dong Nan University Printing; 1995.
16. Zheng YP, Lin KM, Takeuchi D, et al. An epidemiological study of neurasthenia in Chinese-Americans in Los Angeles.Compr Psychiatry. 1997;38(5):249-259.
17. Lillestøl K. 'Neurasthenia gastrica' revisited: perceptions of nerve-gut interactions in nervous burnout, 1880-1920.Microb Ecol Health Dis. 2018;29(2):1553438.
18. Overholser JC, Beale EE. Neurasthenia: Modernistic Malady or Historical Relic?J Nerv Ment Dis. 2019;207(9):731-739.
19. Parlog A, Schlüter D, Dunay IR. Toxoplasma gondii-induced neuronal alterations.Parasite Immunol. 2015;37(3):159-170.
20. Park DJ, Lee SS. New insights into the genetics of fibromyalgia.Korean J Intern Med. 2017;32(six):984-995.
21. Germain A, Barupal DK, Levine SM, Hanson One thousand. Comprehensive Circulatory Metabolomics in ME/CFS Reveals Disrupted Metabolism of Acyl Lipids and Steroids.Metabolites. 2020;10(1):34.

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Jacob Schor,ND, FABNO, graduated from NCNM in 1991 and has practiced in Denver, CO, ever since. He has been active in state clan politics, taking his turn as president of the Colorado Association of Naturopathic Doctors and Legislative Chair. Dr Schor has also held leadership positions in the Oncology Association of Naturopathic Physicians, served on the AANP Board of Directors, and chaired the AANP'due south speaker selection committee. For the past decade he has been the Acquaintance Editor of theNatural Medicine Journal, and is a regular contributor to theTownsend Letter.

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