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"Comment on Prof. Iwama's Occupational Therapy Theory"

The Kawa Model was introduced at a Japanese academic society in 2000 and it was very impressive to me. The reason was that I had a sense of anticipation that the Model would enable occupational therapy in Japan, which had been generated by importing foreign theories, to develop its original theory.

After that, however, the Kawa Model was rarely dealt with in academic journals of occupational therapy and I had an experience that although I submitted a short sentence criticizing the Kawa Model to an academic journal it was rejected. I did not know at the time what made my paper rejected. About 10 years has passed since then, and I have never dreamed of discussing the Kawa Model at the University of Tokyo. I am really happy to be here today. Today, let me introduce the revised version of my discussion about the Kawa Model which was prepared at the time.

I have not had enough time to read all the articles on the Kawa Model Prof. Iwama has contributed to foreign journals. Therefore, my comment on the Kawa Model might be partly miss the point. If so, please point them out.



1. Introduction
“The Kawa Model” has attempted to relativize the traditional, western-oriented theories of occupational therapy by using “culture.” Although “culture” is an effective concept to do so, I do not think it is necessarily effective to explain both its good points as a model and the originality of “the Kawa Model.” Let me explain why I think so and then examine two significances of “the Kawa Model” by using the concept of “identity.”

2. Emphasis of “Culture”
The reason the advocate of “the Kawa Model” emphasizes “culture” is that the Japanese clinical professionals might not make use of foreign-made theories/models in Japanese clinical settings enough due to differences of culture and ways of thinking between people living overseas and people living in Japan.

There are two critical viewpoints for this sentence. The first one is the criticism against uncritical use of foreign-made theories/models. This is the indication that such uncritical attitude toward foreign-made theories/models should be criticized. The second one is the criticism in which a theory/model should fit various people in various cultural areas. I consider “the Kawa Model” is suggested as a response to these criticisms. That is, I think that “the Kawa Model” is generated with the concept of “culture” to overcome these criticisms.

Furthermore, there might be an aspect of the criticism against the recognition of superiority of foreign countries and inferiority of Japan by Japanese occupational therapists in those days (even now), which is the background of their being uncritical of foreign-made theories/models.

Based on my own understanding about these characteristics of “the Kawa Model”, let me critically examine “the Kawa Model” from two viewpoints?position of “culture” and “individuals”, and consistency with “the Kawa Model.”

3. Concept of “Culture” as Strategy
It seems that many Japanese occupational therapists acknowledge the academic superiority of foreign-made theories/models compared to the Japanese ones and regard foreign ones as exemplary/dominant. In that case a lot of energy is necessary to express an objection that foreign-made theories/models also have problems among majorities because insisting an anti-value against the value shared among majorities is a political activity. Moreover, persuasive strategies are required. Therefore, I thought in those days that the advocate of “the Kawa Model” strategically used the concept of “culture.”

It seems that emphasizing differences of “culture” has some significance. In other words, emphasizing “culture” (e.g., generating the confrontational structure between Japan and foreign countries) enables Japanese occupational therapists to overcome their existing inferiority against foreign occupational therapy, thus creating an equal position between Japanese occupational therapy and foreign one. I feel that the impact of “the Kawa Model” at the Japanese society at the time probably comes from such position. That is, I think that “the Kawa Model” has some influence on eliminating exemplar and superiority Japanese occupational therapists have toward foreign occupational therapy. I also think that the reason “the Kawa Model” had not only original but radical impression on Japanese occupational therapists in those days was that suggestion of an original theory/model had not been made from such position with political and strategical intentions in Japan before.

4. Question of Emphasizing “Culture” (1) : Position of “Culture” and “Individuals”
I believe there are also some negative effects of emphasizing “culture.” This is a question concerning the position of “culture” and “individuals” in the theory supporting the “position respecting the culture/group” that “the theory/model should fit the Japanese characteristics.”

If a theory/model is open to some cultural characteristics, it is closed to other cultural characteristics. That is, if “the Kawa Model” is going to open to some cultural characteristic(s) (if this is the emphasizing part of characteristics of “the Kawa Model”), then the theory/model is biased toward some cultural characteristic(s). If so, it is not so different from the bias of the western theories/models.

Also, I think there are various attitudes toward culture and society. Some place emphasis on cooperativity others negate it and prefer individual freedom. Maybe there are people who have skeptical of these two. The position supporting “culture” can be basically said to be a communitarian position. However, it is only one way and it is in some conflicts with the position respecting individuals. And as it is previously stated, the communitarian position has a logical structure that cannot help excluding other communities. In other words, although the concept of “culture” is effective as strategy, it also has a danger of losing the direction between “individuals” and “culture.” Therefore, I believe such orientation should not be ignored when the theory/model is used to explain.

5. Question of Emphasizing “Culture” (2) : Consistency with “the Kawa Model”
Let me respond to the other question, consistency with “the Kawa Model.” What is emphasized as the significance of “the Kawa Model” is that the Model serves oriental “cultural” characteristics. However, I feel that its significance is “respect of individuals.”

I would like to pay attention to the point in which “the Kawa Model” negates “disability” only as what prevents a person’s “inherent life” (i.e., what prevents the flow of the river). There are two significances for this. Firstly, it is not biased toward the ways of individuals. Some foreign-made theories/models are based on the presupposition of strong individuals who can self-determine by themselves. I believe this aspect can have dangers of generating both a new discriminatory structure of identifying human beings by the presence or absence of self-determination and responsibility and a human view of only acknowledging the value of people with self-determination and responsibility.

On the other hand, “the Kawa Model” takes a position of guaranteeing more freedom of the way of the self by expressing “inherent life” as “the flow of the river.” In other words, I believe it is possible for us to insist that “the Kawa Model” be a theory/model of individuals and characteristics in the sense of respecting a person’s “inherent life.”

The other point is the whereabouts of negativity of “disability.” According to the recent trend, negativity of “disability” is mentioned as inconsistency of “interaction” and “relationship.” However, the way of assistance from the point toward elimination of “disability” cannot affirm the existence of the involved people. That is, if “interaction” and “relationship” are stressed, rehabilitation and occupational therapy identify with meritocratic social values, thus providing negative value to bodies with disabilities and providing positive value to rehabilitation and occupational therapy which aim at being able to do things and bodies without disabilities.

However, I think that “the Kawa Model” is a superior theory/model which negates “disability” only as what prevents individual’s “inherent life.”

Based on my discussion of “the Kawa Model” stated above, I suggest “the Kawa Model” have a possibility of becoming a universal theory/model which is open to affirmation of identities of various people rather than a communitarian theory/model in charge of “cultural” biases.

In the end I believe concerning the western theory/model critical discussion should be made about the human views and meritocratic values in order to establish a more universal theory/model. What do you think about my point?