Anne Lang-Étienne - OT Legacy website

Muriel Driver Memorial Lecture
In praise of dissidence: Anne Lang-Étienne (1932-1991)
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Rachel Thibeault
Human activities and occupation
History of occupational issues
Professional issues
F
ive thousand words. How do you summarize, in only five thousand words, a
spirit that has moved and shaped a generation of occupational therapists?
How do you express a penetrating vision that soared beyond convention to
reconcile seeming opposites? How do you capture a complex thought that took a
lifetime to elaborate? This is my challenge today: to introduce, in just a few pages,
the spirit of Anne Lang-Étienne to those of you who haven’t had the privilege of
knowing her. I cannot fool myself. My words will never render her radiant smile,
her vivacious disposition or her fierce determination. For Anne Lang-Étienne was
not for the faint of heart. She slowly, thoughtfully distilled what she believed essential and passionately fought for her values. She knew herself to be unfashionable.
Who else, in the sixties and seventies, spoke of meaning, maturation and
justice as core elements of occupational therapy? Who else would discern the flaws
of the then dominant medical model and propose changes? Only a visionary, an
early-day dissident. Only Anne, a lone but persistent voice in a profession on the
verge of profound transformation.
Who was Anne Lang-Étienne?
A dissident occupational therapist
Rachel Thibeault, Ph.D., OT (C)
is an Associate Professor in the
Department of Occupational
Therapy, University of Ottawa
451 Smyth Road,
Ottawa, ON K1H 8M5
E-mail: [email protected]
World events somehow destined Anne for a career in dissidence. Born in France in
1932, she lost her mother early in life and was raised by her father and two aunts.
During the war years she was sent, for her safety, to a farm in the country. There,
she experienced unrelenting cold and hunger and felt utterly abandoned. Her
childhood was forever gone and until her passing, she would always refer to those
times as years of bleakness and pain. As a result, she grew mistrustful of the
political body and of all systems that dictate how one should think and behave
without allowing for individuality. She tried to understand how a human mind
could evolve to see virtue in war and how the lack of wisdom and maturity in our
societies pave the way for dictatorships, silent oppression and madness. She chose
to embrace a career in health, specifically occupational therapy in mental health.
Trained in Paris at La Salpêtrière, one of the best institutions for psychological
inquiry even by today’s standards, she delved into psychoanalytical theory and
devoted herself to the care of people with a mental illness.
After a few years, however, she decided to withdraw. Anne retired to the hills
of Provence, as she wanted to experience for herself the full benefit of occupation.
As a potter, she reconnected, in her own words, with "the magic of touch, the
strong dialogue between hand and matter, and the awareness of inner images."
(Lang-Étienne, 1984, p.23). She lived by her craft and honored, as she did all of her
life, the artisans’ tradition and their mode of experiential apprenticeship (LangÉtienne, 1988).
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occupation out of the therapeutic realm to re-introduce it
into daily life, as a health-sustaining measure. Drawing
from the teachings of Karlfried Graf Dürckheim, a German
psychologist and philosopher acknowledged for his exhaustive works on the nature of true well-being and the therapeutic process, Anne explored occupation’s untapped
potential for self-discovery, connectedness, mindfulness,
and even wisdom. An avid reader and a most erudite mind,
she cross-referenced her observations with the writings of
such intellectually imposing figures as Bachelard, Plato,
Jung, Master Eckhart, and John Dewey (Lang-Étienne,
1982, 1984a, 1984b, 1990). Towards the end of her life,
Anne came to the inescapable conclusion that beyond healing through meaning, occupational therapy’s role was also
to promote real maturity and produce unity, inner depth
and peace.
To achieve such results, however, she understood that
occupational therapists needed to work as one community.
She was searching for a concept to convey that most
peculiar notion of a whole body of professionals evolving as
one mind towards unity and wisdom, and having a
systemic impact on society in doing so. For lack of a better
word, and after much discussion, she and I coined the term
collective conscious. As a trained analyst, Anne was well
versed in the collective unconscious, and she wanted to
make accessible the power and creativity inherent to the
phenomenon. She conceived of a profession that would
consciously nurture and embody positive, meaningful
values to the point of transforming its members and the
world around them.
Eventually, Anne felt a need to return to a more
mainstream career, but couldn’t apply her new-found
insights in France where occupational therapy was strictly
monitored by the medical profession. She immigrated to
Canada and made Montréal her home. Working in private
practice, psychiatric facilities and schools, Anne quickly
realized she could contribute a great deal to the training of
occupational therapists in Canada. She taught for several
years at Laval University and founded the Occupational at
Therapy Program at the University of Ottawa in 1986.
Always grateful for the freedom and the natural splendor
she found in her new world, Anne elected to live in rural
Ontario where, with her husband, she never ceased to marvel at the geese migrations that each year would grace their
Sarsfield land. Together they admired, sketched and
breathed the beauty surrounding them. To this day I feel
that Anne’s soul took flight, one fall morning, with a flock
of Canadian geese, a just and tender tribute for the love she
showed for her country of adoption.
What did Anne believe in?
Healing through meaning
To find the meaning of one’s life is to realize one’s
immaterial aspirations in the material expression that
is the body.
Lang-Étienne (1985, p.17)
Anne was marginal, to the end. Her ideals for the profession
seemed unconventional when she formulated them and
they still remain on the fringe of current occupational
therapy practice. For Anne, the occupational therapist’s
core goal was to heal through meaning. Without meaning,
there is no motivation. Without motivation, there is no
engagement. Without engagement, there is no lasting
healing. Her argument stemmed from years of clinical
experience and an in-depth understanding of the human
psyche. She had dealt with the unshakable inertia we sometimes face in clients who haven’t discovered or revealed
their source of meaning. We all know this listlessness, this
indifference that can permeate the therapeutic process and
make it abort. Anne’s answer to this roadblock was first to
stimulate her clients’ awareness and second, to help them
cultivate meaning.
She saw in occupation the most fundamental tool for
becoming mindful, present and mature, both in illness and
in health: "Action in itself does not transform, but it
contains the seeds of transformation…Action is redeeming: if our clients are open and aware, it induces in them a
process of transformation and regeneration." (LangÉtienne, 1985, p.17). Long before health promotion was in
style, Anne adopted the use of selected occupations for the
general purposes of well-being and balance. She pulled
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What was Anne’s definition of
meaning? A heretic’s voice
The religious geniuses of all ages have been
distinguished by (a cosmic religious feeling) which
knows no dogma and no God conceived in man’s
image… Hence it is precisely among the heretics of
every age that we find individuals who were filled with
the highest kind of religious feeling.
Albert Einstein (Sinetar, 2002 p.43)
Anne would have no doubt celebrated the publication of
Enabling Occupation: An Occupational Therapy Perspective
(1997). She would have enjoyed the tone of the book, with
its emphasis on the individual’s dignity and worth, and
experienced a special kinship with the authors, deeply
appreciating their concern for social inclusiveness and
meaning. Would she have spoken of spirituality, though? I
don’t think so. Anne would have shared Unruh, Versnel and
Kerr’s (2001) uneasiness with regards to the word
spirituality. For Anne, to frame the universal quest for
meaning in spiritual terms would have been an act of
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willful exclusion. What about Albert Camus, Martin
Heidegger and Emmanuel Levinas? Some of the greatest
thinkers of the twentieth century, who dismissed the very
concept of spirituality, suddenly ostracized because of their
adherence to existential philosophy? This, Anne would not
have accepted. Despite their absence of faith in spirit, these
ground-breaking philosophers all worked on meaning and
cut across social classes, cultures and eras. So, in Anne’s
eyes, meaning – not spirit – became the most significant
golden thread connecting the human race. Deeming the
existentialist quest equivalent to that of the religious soul,
Anne always maintain that: "To find the meaning of one’s
life is to realize one’s immaterial aspirations in the material
expression that is the body." (Lang-Étienne, 1985, p.17).
She held the possibilities infinite and beyond judgment.
It is not that Anne was a religious or anti-religious,
quite to the contrary. Raised in the Christian tradition, she
maintained close ties with her spiritual roots. But she had
also been profoundly influenced by Martin Buber, a
brilliant Jewish scholar and philosopher who fled the Nazi
regime in 1938, moved to what was then Palestine, and took
part in the nascent dialogue between Jews and Palestinians
(Mendes-Flohr, 1983). A specialist in comparative theology,
Buber clearly distinguished between the dogmatic and
mystical streams present within each of the world’s great
religions. (Buber, 1958, 1964, 1967, 1996) In his views, the
dogmatic aspects constitute the necessary structure for
preserving and transmitting a given tradition – the vehicle
– while the mystical side generates direct communion with
the divine – the destination. He was often quoted for saying
that if you put a Jew and a Muslim in the same room,
chances are they will fight. But if you put a Kabbalist (a Jew
practicing Kabbala, a mystical form of Judaism) and a Sufi
(a Muslim practicing Sufism, a mystical form of Islam) in
that same room, chances are they will pray together, for
they know that they both share the only Ultimate Reality.
Buber repeatedly deplored our insistence on structure
rather than substance, on dogma rather than spirit.
However, little progress has been made since he first
opposed intolerance: indeed, many of today’s conflicts still
reflect our tragic propensity for confusing vehicle and
destination. Dogmatic wars rage on while the sheer
memory of a mystical common ground is being obliterated
from collective mind, along with any hope of lasting peace.
Buber’s writings irreversibly altered Anne’s perspective
on spirituality and meaning as she was suddenly thrust
outside the familiar boundaries of religious practice into
the lived mystical experience. Destabilized, she sought
other guides and found Albert Camus, John Fowler,
Karlfried Graf Dürckheim and Erik Erikson, who all
further reinforced her belief in meaning as the central
endeavour of human existence, even in the most secular
milieu. She took from Camus a love of nature, rapturous
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incarnation and social justice that molded both her
personal life and professional orientations. From Fowler, an
authority on moral and psycho-spiritual development, she
learned of the universalizing of faith, the last step of normal
growth where mystical awareness supplants dogma and
yields the kind of tolerance so dear to Buber. From
Dürckheim and Erikson, she understood the urgency of
cultivating greater maturity in a society where healthy
models have been nearly eradicated. Maturity in the
post-modern civilization is reduced to the functional
mastery of our environment: have we succeeded in securing
a job, feeding a family, or buying our share of goods? Then,
according to Western standards, we have met the social
expectations and completed the human agenda. The ideas
of generativity, of giving back to life, of bearing witness to
wisdom and serenity find few echoes amongst our contemporaries. And yet, the drive to fulfill our natural destiny is
etched in our souls: we are meant to evolve towards
congruence, unity and radiance. But for lack of proper
guidance, we settle for superficiality and thwarted growth,
forever seeking wealth and power, forever suppressing a
nebulous malaise, the sole remnant of a stifled, dying spirit.
What was Anne’s dream?
A dissident profession
Occupational therapy reveals not only reality in its
concrete form, but also one’s inner world and its many
facets. And this world, if we know how to
decipher it, touches the very core of being, the
meaning of life, and all that is essential.
Lang-Étienne (1986, p.14)
Anne dreamt of a dissident profession that would resist
social pressure and challenge commonly held views. She
dreamt of a profession dedicated not only to the functional,
but also to the essential (Lang-Étienne, 1983). Through
focusing more on mindfulness and less on conformity, she
hoped for renewed awareness and maturity that would
revitalize our collective engagement and restore our ontological interactions with clients, each other and the world.
Hers was not a shallow, obdurate position. She acknowledged the primacy of efficiency and cost containment in
health care, but refused to limit intervention to the confines of
these two criteria. She always moved beyond the quick fix to
address issues rooted in the heart. With each one of her clients
or students, she strove to create conditions conducive to
metanoïa, this inner metamorphosis thought in ancient
Greece to be the source of centredness and compassion. For
she knew that individual change results in due course in social
change. Systemic social action starts with each citizen. The
client who, because of us, embraces a healthier, more peaceful
life will exert a healthier, more peaceful influence around him.
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Anne used to liken this maturation process to alchemy
and regarded occupation as the best crucible. Since occupation confronts us with matter and clearly delineates our
strengths and weaknesses, it has the power to refine
self-knowledge and galvanize growth. And because it is our
specific tool, Anne saw us as perfectly situated to become
models of professional maturity in a system that increasingly neglects humanistic values. Yes, she dreamt of us as a
profession that would foster true maturity, complete the
natural sequence of development and show concern for
social justice. She envisioned the contribution of occupational therapy to socially or environmentally devastated
communities with collective healing as our aim. And she
yearned to instruct students on how to become good
stewards for our world. I will never forget the three
questions that resonated like mantras throughout her
teachings: "What do you need to do in order to remain
centred and compassionate? What are the social consequences of your professional decisions? And what are their
environmental consequences?" I still hear them as I
measure the gap between Anne’s vision and our reality.
Anne would have rebelled against convenience and
acted for the greater good. Would there be a better place on
earth to try out her ideas than a war zone? What about
implementing Anne’s dream in Sierra Leone? First, it came
as a flash, but the idea kept growing, almost outside my will.
Slowly, it took a life of its own and demanded to be born.
In Sierra Leone, our mandate covers three main populations: amputees, child soldiers and young bush wives, girls
abducted in their pre-school years and reduced to slavery
by rebel troops. Some have also become combatants and all
have been repeatedly subjected to rape. Above and beyond
their psychological scars, many have also suffered torture
and mutilation, their own body perpetually reminding them
of the abject conditions they have once known. If Anne’s
vision could work here, it could work anywhere. And so it
went, with the first program tailored on Anne’s approach
initiated in the Spring of 2000. Instead of presenting additional theoretical considerations or a detailed framework, I
will illustrate the process with real-life anecdotes drawn
from my African experience.
Our collective conscious in action
I had needed all my tact and skill to secure a meeting with
B.D., a local official responsible for many of the young bush
wives’ future. When it was granted, I would know my good
luck. In a context where resources are exceedingly scarce,
competition is fierce and unforgiving. You rarely get a
second chance if you start on the wrong foot, so I was
determined to make the best of it. The cold stare, as soon as
the door opened, stopped me in my tracks: B.D.’s irritation
was palpable. Mustering all the persuasiveness I was
capable of, I pleaded for access to the girls and explained
the program goals. His reply was curt, unbending: "These
are only girls, 30,000 of them, all damaged goods, unworthy
of help. Next!"
I tried to argue, to no avail. The door closed, the battle
was lost. Back at the UN headquarters, just below the
helipad and in the incessant roar of transport, I just sat and
stared at the ocean, aware of the magnitude of defeat. As
sometimes happens in those moments, the strangest image
popped into my mind. I could see my long dead
grandmother telling me: "Rachel, pray to St-Jude, patron of
desperate causes." Well, Grandma would have disowned
me, because I found myself praying instead to Sue Baptiste
and Judith Friedland. The funny thing is, I don’t know Sue
and Judith a great deal more than I know St-Jude. Our
paths have barely crossed over the years. But the memory of
how they had conducted themselves around difficult issues
with the Ontario government suddenly surfaced. I remembered how I had observed, from afar, their acumen in
negotiations and their strong commitment to their values.
For me, they embodied occupational therapy’s highest
ethics and I wondered what they would do in my situation.
Anne’s dream today : The acid test
of Sierra Leone
An authentic spirituality does not cater to culture; it
calls culture to accountability.
Joan Chittister, Order of Saint Benedict
(Alternatives for Simple Living, 2001, p.25)
Many among you may consider Anne’s dream a utopia.
It sounds so far-fetched and unrealistic in our age of
Cartesian, evidence-based practice. But let’s not forget that
evidence is not only of a quantitative nature; some in fact
could never be summed up with figures and numbers and
bears names such as courage, generosity and self-sacrifice.
Several times a year, my research with a United Nations
implementing agency takes me to war zones. From the
refugee camps of Lebanon to the orphanages of Sierra
Leone, I see unspeakable destruction and despair brought
on by greed or fanaticism. In some areas, it feels like standing at the end of time: shapeless mounds of dirt smolder
and stink while the remaining vegetation slowly dries up
and shrivels in the heat. Rocky, barren chasms now gape
where gardens used to be tended, and rivers carry death with
the bloated, rotting carcasses floating downstream. In neighbouring villages, starvation and poor sanitation routinely
claim lives, a revolting aberration given the planet’s wealth
and technology. Every time, Victor Gollancz’s words ring in
my ears: "The plain fact is that we are starving people, not
deliberately in the sense that we want them to die, but
willfully in the sense that we prefer their death to our own
inconvenience."(Gollancz, 1946, p.192).
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That thought opened a floodgate. Anne Carswell was
next, advocating for women’s rights. Liz Townsend
followed, calling for social justice. Louis Trudel, Huguette
Picard , Danielle Massicotte were all there persuading me to
be true to myself and our deepest beliefs. Geraldine Moore
and Suzette Montreuil assured me I had the strength to
fight. And my colleagues from the University of Ottawa
pledged their unfailing support. It went on until sunset, an
unbroken stream of occupational therapists’ voices reaching me all the way from Canada. I don’t know if the
therapists whose influence I had evoked felt any stirring,
but the following morning we all walked back into B.D.’s
office. Their voices steadied mine, their ideals fed mine,
their dedication strengthened mine. And guess what? We
won! And I say we because at that moment I was keenly
aware of a collective victory. I doubt very much that the
people who inspired me foresaw that their actions in
Canada would eventually change the lives of thousands of
African slaves, and yet they did. It was the power of intent,
the collective conscious of Anne’s dream. The shaping of
our intent and values here triggered more than a ripple
effect. With time, it picked up momentum and might, to
bring our most cherished principles to life.
Had she lived, Anne would have applied our collective
conscious to counter ignorance. According to her, the main
hurdle to the expansion of occupational therapy lied with
ignorance: not only are most people unaware of who we
are, but we, ourselves, tend to shy away from vital roles. She
was convinced that the values intrinsic to occupational
therapy, if expressed more forcefully in the public sphere,
could provide appropriate solutions to some pervasive ills.
And I would like again to give three examples of how occupational therapists can have an impact at the individual,
societal and environmental levels.
though chronic depression is a rare occurrence in these
parts, PTSD is rampant and understandably so. Several
amputees had been forced to perpetrate atrocities prior to
being mutilated. More had seen their relatives hacked to
death before their own eyes. And we were expecting them to
resume daily life as if nothing had happened? The
enormity of the oversight was staggering and it brutally
highlighted the relevance of our holistic philosophy. As the
only rehabilitation professionals with training in physical
and mental health, occupational therapists must protect
their clients’ well-being when the system fails to meet them
in their integrity.
The societal cost of ignorance
The young medical doctor hired by one of the relief
agencies was the typical product of our North American
university system: disciplined, logical, competent. Eager to
offer the best possible care even in a war zone, he lobbied
long and hard to have funds ear-tagged for micro-credit
transferred to the purchase of some fairly sophisticated
diagnostic equipment. He proudly won his case and set up
the $2,500 device under the newest tent. A year passed, that
saw it used less than 10 times. Together, we ended up visiting the village for which the money was originally meant.
Because of his ill-informed interference, the women who
would have been earning a living with their micro-enterprises, supporting up to 250 people with a modest income,
were starving. Several children and elderly had already died
of diseases associated with malnutrition and lack of clean
water. Many others had developed unremitting conditions
and a whole community had been condemned to dire
poverty. The man was shocked, baffled. He blurted out,
obviously shaken, "No one ever told me about the big picture." No, he hadn’t grasped before then that his meager
$2500 was in fact an entire village’s life blood. Not once had
he asked himself, "what are the larger social consequences
of my professional decision?" And I felt that is what we
occupational therapists are about, with our faith in social
justice: reminding our fellow health care professionals of a
picture broader than our immediate disciplines.
The individual cost of ignorance
"I’ve had it with their laziness! They’re just here to take
advantage of us, to squeeze the lemon to the last drop!" The
Caucasian health care professional stormed out of the
barrack housing the rehabilitation facility. Inside, about 40
amputees, newly fitted with artificial limbs, were sitting on
roughly hewn wooden benches, waiting. A few would howl,
terrified by apparitions visible only to them. Some would
burst out in uncontrollable laughter. But, staring blankly
into space, the majority would remain motionless, in a near
catatonic state. The health team’s objective was to train the
amputees in the use of their prosthetics and there was
extreme frustration at the poor collaboration. Nothing
seemed to work: be it to threat or bribe, the response was
apathy. As an occupational therapist, I quickly realized that
what was labeled lack of cooperation by my co-workers was
in reality Post Traumatic Shock Disorder (PTSD). Even
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The environmental cost of ignorance
With the psychosocial healing program well underway,
a group of young bush wives was now ready to address
vocational opportunities. Surveying their alternatives,
traditional or not, they agreed to establish a fish-salting
cooperative that would allow them to tap a still unoccupied
and lucrative niche. Diligently, they honed their management and technical skills and prepared for the launching of
their business. The granting agency, however, favored fish
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Throughout the healing cycle, FAWE teaches its
trainees greater maturity, trust and respect for their human
and non-human world. To government and nongovernment agencies, it keeps advocating gender equality
and social justice as crucial pillars of a new social order;
certainly, long-term peace and stability cannot be achieved
without equity and inclusiveness at their core. To stand in
Freetown or Bo is to witness the birth of Anne’s dream,
alive and well in the heart of Africa. But what about here?
smoking over fish salting or drying. Its bureaucrats had
analyzed the bush wives’ project through their European
lens and concluded that smoked fish would constitute a
more popular item. Loans would therefore be issued as
soon as the marketing plan would reflect the necessary
changes. While Sierra Leone knows no shortage of salt or
sun, it suffers major deforestation; consequently, hills
around most sizeable communities are bare and women
must walk several kilometers to find fire wood. Going along
with the granting agency’s wish would have been very easy
and unquestionably shortsighted. The only defensible
choice was to negotiate the implementation of a sustainable
project in line with available resources. Initially, the
promotion of sound ecological practices within what was
truly a health care program appeared somewhat odd, but as
each scenario’s environmental and social consequences
were underlined, new understanding arose and the viable
fish salting option was selected.
What about here?
Anne’s dream in our community
If Anne were here, she would count on our profession to
show a collective will to value balance and maturity in a
world that doesn’t. And she would underscore the clinical
supervisors’ critical role as the agents of change in occupational therapy. It is no secret that the university system
doesn’t lend itself anymore to personalized contacts or
attention. It is those of you, generous enough to devote
time and energy to the training of students, who are the key
to our future. Day in and day out, you observe and guide
each one of our therapists in becoming. Through your
example and advice, you get to mold the practice of the 21st
century. In doing so, Anne would also expect you to rise
above dogmatic intolerance and fight ignorance and fanaticism by exposing students to the big picture, those realities
that lie beyond our narrow interests.
From universities, she would request systematic
integration of issues of healthy maturity, social justice and
environment in all curriculums. Competent occupational
therapists should first be decent human beings and decent
citizens. I would like to remind those who doubt that
mentalities do change. Several of my older aunts, as young
women, were denied the right to vote. Under Canadian law,
they were not considered persons. If today a woman were to
show up at a polling station and be told: "Sorry, Madam,
you can’t vote, for you’re not legally a person," it would
trigger a revolution. And yet, this was the fabric of our
society, a mere generation ago.
As citizens, occupational therapists could accelerate
change, casting their vote in support of candidates
favorable to sound environmental and social policies. As
health care workers, they could wield their professional
influence to request from manufacturers recyclable, less
polluting products.
Finally, in each of us, Anne would like to sense an
individual will to pursue growth, become whole, cultivate
meaning in our own lives, and thus contribute fully to our
collective conscious.
Anne’s dream and the women of
FAWE
The program depicted above is the brainchild of FAWE, an
acronym for Forum for African Women Educationalists.
These women, retired female educators from across Sierra
Leone, constitute a powerful social force. When the war
broke out, they were among the few who had the means to
emigrate as their national and international connections
could have made a quick exodus possible. They chose
nonetheless to stay and help rebuild the country, sometimes putting their own lives at risk. Opening shelters,
treatment centres and schools, even in rebel-held areas,
they created one of the best networks to assist young war
victims.
Intuitively, they turned to occupation as their medium
for intervention. Since the severity of trauma often
precludes long verbal interactions, treatment begins with
the restructuring of routines through activities of daily
living. Very early in the process, other occupations are
introduced, following a reflection on what is truly meaningful for each victim. They revisit traditional and not so
traditional occupations, marrying trends to suit individual
needs and boost self-esteem. In some instances, they even
use occupation to restore civil society: when rebel soldiers
are demobilized and reintegrate village life, they suddenly
find themselves in the presence of their own victims. A
communal, constructive occupation, such as the rebuilding
of a clinic, becomes the first bridge between the perpetrators and the wounded. Initially, the two groups stay apart,
working in silence, paralyzed by shame, fear or anger. Little
by little, a dialogue emerges, hesitantly, cautiously, opening
the door to the resumption of bearable collective living.
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Cum Spiritu Sancto: Living the
moment’s richness with J.S.Bach
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I have now reached the end of my words, and there is still
so much to say. I don’t want to let go of the page: it feels too
much like letting go, for a second time, of a warm, almost
motherly presence that was irremediably taken away in the
fall of 1991. To find comfort, I nestle by Anne’s passion and
presence, hidden in her prose: "To live is to be open to each
moment’s richness, and thus to our own richness. We
interrupt our superficial agitation … to delve into existence." (Lang-Étienne, 1983, p.179)
Delving into existence will be my tribute to Anne, the
only fitting one. In a few minutes, I will play Bach’s Mass in
B-Minor, specifically the Cum Sancto Spiritu, Anne’s
favorite, and let the music reverberate through the late
afternoon. It will spill over into the garden, fill the already
fragrant air, enhance the vibrant purple hues of the
Japanese irises. And my resident cardinal, always exalting
life, will leave its nest to sing its own homage to the legacy
of my mentor and friend, Anne Lang-Étienne.
Sometimes our light goes out but is blown into flame
by another human being. Each of us owes deepest
thanks to those who have rekindled this light.
Albert Schweitzer
Anne Lang-Étienne
1932-1991
Acknowledgement
The author wishes to thank the World Rehabilitation Fund for
its ongoing support and commitment to the FAWE project.
Précis
bien gardé à la barrière des langues où à la nature nettement
visionnaire des propos de Anne Lang-Étienne, on est saisi,
encore aujourd’hui, devant leur pertinence. Rachel
Thibeault, fidèle disciple de cette pédagogue incomparable,
nous dresse un portrait saisissant et nous entraîne aux
confins des réflexions de Anne.
D’origine française, Anne s’est heurtée très tôt aux
réalités d’un monde tourmenté par la guerre, l’injustice
sociale et les luttes pour le pouvoir. En choisissant
l’ergothérapie comme véhicule de ses convictions, Anne
Lang-Étienne a d’abord été déroutée par la rigidité des
milieux hospitaliers européens et, après quelques années de
pratique en psychiatrie, elle a senti le besoin de se retirer
Apologie d’une profession dissidente : Le
rêve de Anne Lang-Étienne (1932-1991)
Les pensées des grands esprits de ce monde ne sont souvent
réalisées et comprises que bien longtemps après leur mort.
Disparue en 1991, Anne Lang-Étienne compte parmi les
plus grandes visionnaires de notre profession; pourtant, de
son vivant, peu de membres de la communauté
ergothérapique ont eu le privilège de découvrir ses écrits et
sa vision. Peu importe que l’on puisse attribuer ce secret
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THIBEAULT
pour poursuivre sa quête de sens personnelle, à travers la
poterie. Elle fait un retour dans la profession après sa
découverte de l’Amérique, qu’elle considère plus ouverte
que l’Europe. Après avoir œuvré en clinique privée, dans
des établissements psychiatriques et dans les écoles, Anne
découvre sa vocation d’enseignante, qu’elle exerce d’abord
à l’Université Laval, puis, à l’Université d’Ottawa, où elle
fonde le programme d’ergothérapie.
Anne Lang-Étienne croyait que pour trouver un sens à
sa vie, il faut réaliser ses aspirations immatérielles à travers
l’expression matérielle du corps. Pour elle, le but premier de
l’ergothérapie était la guérison par la quête et l’attribution
de sens. Car, de son avis, il n’y a pas de motivation possible
si notre vie est dépourvue de sens. Sans motivation, aucun
engagement n’est possible et sans engagement, aucune
guérison véritable ne survient. Devant l’inertie de certains
clients qui n’ont pas découvert le sens de leur vie, Anne
nous proposait d’éveiller leur conscience puis de les aider à
‘cultiver du sens’.
Elle voyait dans l’occupation l’outil le plus fondamental
pour aider le client à faire preuve de réflexion, à vivre le
moment présent et à atteindre la maturité, qu’il soit victime
d’une maladie ou qu’il soit en santé. Selon Anne, l’action en
elle-même ne transforme pas la personne, mais elle
contient les clés de la transformation. Ainsi, l’action a un
pouvoir de transformation et de régénération seulement si
les clients sont réceptifs et conscients.
Vers la fin de sa vie, Anne en est venue à la conclusion
que par-delà la guérison à travers la quête de sens, le rôle de
l’ergothérapie était de promouvoir la maturité véritable et
de créer l’unité, la richesse intérieure et la paix. Pour ce
faire, Anne croyait que les ergothérapeutes devaient former
une communauté unie. Le concept de la conscience collective, soit un corps de professionnels évoluant avec une
vision commune vers l’unité et la sagesse et exerçant une
influence systémique sur la société, s’est alors précisé dans
son esprit. Anne rêvait d’une profession qui nourrirait et
représenterait des valeurs positives qui entraîneraient
éventuellement une transformation chez ses membres et
dans leur entourage.
Anne aurait sans aucun doute accueilli avec enthousiasme la publication de Promouvoir l’occupation, tant par
l’accent mis sur le respect de la dignité de la personne que
par la préoccupation des auteurs pour l’intégration sociale
et la quête de sens. Par contre , elle aurait eu des réserves
quant à l’emploi du terme spiritualité, car, à son avis, le fait
de définir la quête de sens universelle en termes spirituels
aurait été un acte d’exclusion volontaire. Pour Anne, le
sens, et non l’esprit, est devenu le lien le plus important
entre les êtres humains.
Le rêve de Anne était de voir s’affirmer une profession
différente, qui résisterait aux pressions sociales et qui
remettrait en question les perspectives courantes. Elle rêvait
d’une profession se consacrant non pas uniquement au
‘fonctionnel’, mais également à ‘l’essentiel’. Bien qu’elle
reconnaissait la priorité de l’efficacité et de la réduction des
coûts des soins de santé, elle refusait de limiter l’intervention aux frontières de ces deux critères. Elle était persuadée
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que le changement individuel entraîne, au fil du temps, un
changement social.
Anne comparait la maturation de l’individu à
l’alchimie et elle considérait l’occupation comme le
meilleur creuset. Comme l’occupation nous confronte à la
matière et qu’elle délimite clairement nos forces et nos
faiblesses, elle a le pouvoir de raffiner nos connaissances et
de galvaniser notre croissance. Et, comme il s’agit de notre
outil de prédilection, Anne croyait que les ergothérapeutes
pouvaient devenir des modèles de maturité professionnelle
dans un système où les valeurs humaines sont souvent
mises à l’écart. Elle avait le sentiment profond que
l’ergothérapie pouvait secourir des communautés dévastées
tant au plan social qu’au plan environnemental, si
l’intervention était axée sur la guérison collective.
Même si plusieurs pourraient considérer le rêve de
Anne comme une utopie, parce qu’il semble si éloigné de la
pratique centrée sur l’évidence scientifique, il ne faut pas
perdre de vue que les données probantes ne sont pas toutes
de nature quantitative; certaines portent en effet le nom de
générosité, courage et don de soi. Ce rêve s’est matérialisé
en terre de guerre en Sierra Leone, au printemps 2000,
grâce à la persévérance de Rachel Thibeault, qui a mis en
action les principes de Anne. En puisant à même la conscience collective en ergothérapie, Rachel est parvenue à
convaincre les autorités africaines de mettre en œuvre un
programme destiné aux femmes victimes de la guerre. Ce
programme est une idée originale de FAWE (Forum for
African Woman Educationalists), fondé par des
enseignantes à la retraite de Sierra Leone. Tout comme
les ergothérapeutes, elles ont choisi l’occupation comme
modalité d’intervention, en basant la réadaptation sur la
restructuration des routines par les activités de la vie
quotidienne et par l’introduction progressive d’occupations significatives pour chaque victime. Parfois, la
réadaptation prend la forme d’une restauration de la
société civile, où les victimes et les assaillants se retrouvent
face à face et doivent conjuguer leurs efforts pour
reconstruire une vie collective supportable. Le rêve de Anne
est donc bien vivant, au cœur de l’Afrique.
Mais comment peut-il se réaliser ici, dans notre propre
communauté? Si elle était encore avec nous, Anne soulignerait l’importance d’éveiller la conscience des étudiants en
ergothérapie en les exposant à la réalité, afin qu’ils puissent
s’élever au-dessus de l’intolérance dogmatique et lutter
contre l’ignorance et le fanatisme; elle exigerait l’intégration systématique de la maturité, de la justice sociale et des
questions environnementales dans tous les programmes
d’études; elle nous rappellerait qu’un ergothérapeute
compétent est avant tout un bon citoyen, respectueux de
l’environnement et des autres. En tant qu’individus, elle
nous inviterait à poursuivre notre croissance personnelle et
à cultiver du sens dans notre vie personnelle afin d’enrichir
notre conscience collective.
Par-dessus tout, Anne Lang-Étienne nous convierait à
suivre la voie qu’elle s’était tracée, à interrompre notre
agitation superficielle pour plonger dans l’existence et vivre
intensément toute la richesse du moment présent.
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