Australian Occupational Therapy Journal (2004) 51, 43–48

Blackwell Publishing Ltd.

R e s e a r c h A r t i c l eMargaret Mort: A history

Powerful practices: The legacy of Margaret MortMichael Lyons

Discipline of Occupational Therapy, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia

History is our present in the making. An appreciation of occupational therapy’s origins, and of key people who contributed to its development, are important to understanding the current place of our profession in health care. This paper sketches the story of Margaret Mort, an historically significant Australian occupational therapist, from her early years as a wartime therapist to her later years as a pioneer in geriatric rehabilitation. Her work exemplifies principles which underpin contemporary occupational therapy practice and which this article chronicles for the edification of those curious about our profession’s rich history.

K E Y W O R D S aged care, occupational therapy history, rehabilitation.

INTRODUCTION

Some readers will be familiar with the novels of DymphnaCusack, particularly those which chronicle Australian lifeof the 1940s and 1950s. In one of her novels, ‘Say no todeath’ (Cusack, 1951), a vibrant young woman who is thecentral character is struck down by tuberculosis (TB). Thisyoung woman struggles to cope physically and emotion-ally as the disease takes its toll. She languishes in a TBsanitarium on the far western fringes of post-war Sydney.Cusack paints a vivid picture of life in a sanitorium andthe sense of hopelessness that pervades the lives of peoplethere. At the most optimistic, people with TB were subjectto months if not years of enforced idleness, with completecessation of all daily occupations and prolonged bedrest — prescribed to allow affected parts of the body(e.g. lungs, spine) to fight and overcome the TB bac-terium. However, many people succumbed to the ravagesof the disease and death rates were high. As places ofillness and death, inactivity and social deprivation, thesanitarium of Cusack’s book is in many ways a physicaland psychological ‘purgatory’.

This is the world into which Margaret Mort steppedwhen she began her professional life as an occupationaltherapist, a world which, for most of us today, is difficult to

imagine. This was a time without antibiotics and beforetelevision, a time when people relied on an operator toconnect their telephone calls (if they had a telephone atall), when women were required to leave paid work to getmarried, and when hotels closed at 6 pm!

The intent of this article is to present snapshots ofthe professional life of a pioneer Australian occupationaltherapist. Through these snapshots, younger occupationaltherapists will have a chance to view and appreciate some-thing of the powerful practices of an early leader of ourprofession in this country. These practices represent a proudlegacy for occupational therapy as we know it today, andhelp us to interpret the present through an understandingof our past. The article will trace the history of Margaret’swork from the beginnings of her interest in the newprofession of occupational therapy to her retirement andthe wider recognition she received for her pioneeringwork in the field of geriatric rehabilitation.

BEGINNINGS

Margaret’s story began in the last days of the Great Warof 1914–1918. She was born in London. Her parents wereAustralians who met and married while doing war work

Michael Lyons BEcon, BOccThy, MS, PhD; Associate Professor.Correspondence: Michael Lyons, Discipline of Occupational Therapy, Faculty of Health, University of Newcastle, Callaghan, NSW 2308, Australia.Email: Michael.Lyons@newcastle.edu.auAccepted for publication 15 May 2003.© 2003 Australian Association of Occupational Therapists

44 M. Lyons

in Great Britain during World War I. With such a familylegacy, it is hardly surprising that Margaret Mort’sprofessional career began while she was a serving memberof the armed forces in World War II.

Margaret was born into a time when Australian ties withGreat Britain were still very strong. It is within the livingmemory of middle-aged readers of this journal, I’m sure,that the term ‘going home to England’ was still in commonuse by many Australians. So it was only natural that Aus-tralians should gravitate to ‘the mother country’ particu-larly in times of war but also in peace time, as Margaretherself was to do. Indeed, her professional experience inGreat Britain was a major influence on her subsequent workin Newcastle, Australia, for which she is best remembered.

While just an infant, Margaret moved back to Aus-tralia with her parents and grew up in Sydney. After com-pleting her schooling, the young Margaret Mort studiedart and design at East Sydney Technical College — notablefor its distinguished alumni as diverse as artist MargaretOlley, actor Rod Taylor and designer Jenny Kee. Shecompleted her studies just as World War II broke out.Margaret wanted to join the army, and her first thoughtwas to work in the army unit developing ‘camouflage’materials (to make good use of her design and art skills),but to her dismay, only men were allowed to do thiswork! So instead, she took a teaching job at a private girls’school in Melbourne, but she still harboured thoughts ofthe army in the back of her mind.

FIRST ENCOUNTER WITH AN INFANT PROFESSION

After some 2 years of teaching, she happened to meet awoman who gave her the opportunity she was looking for.Major Joyce Keem, an army officer and occupationaltherapist (one of the first in Australia) (Anderson & Bell,1988), was on the lookout for occupational therapy aidesfor the army. These aides needed to be experienced indoing arts and crafts which they could then use under thedirection of an occupational therapist for the treatmentof injured soldiers. As an aside, a major impetus for thedevelopment of occupational therapy (and physiotherapy),as we know them today, came from the realisation (in Europeand America) during World War I that these ‘therapists’(often termed ‘reconstruction workers’) could make adramatic difference to the recovery of soldiers sufferingthe effects of being gassed, wounded or shell-shocked(Schwartz, 1998). So it was hardly surprising that the Aus-tralian Government also should be looking to providesome form of occupational therapy for its injured soldiers.

Margaret enlisted in the army and took on occupa-tional therapy aide work. She quickly rose to the rank

of sergeant and so impressed her superiors that she wasoffered the opportunity to undertake officer training.However, she refused the offer because she was enjoyedthe work she was doing. Some time later and unable torecruit enough occupational therapists, the army decidedto train its own therapists. Margaret Mort was one ofsix women selected for training in Sydney at the newOccupational Therapy Training Centre, which had beenestablished under the sponsorship of the AustralianPhysiotherapy Association (Anderson & Bell, 1988).

To assist today’s readers to better enter into the cul-tural context of health care at that time, it may be helpfulto point out that occupational therapy in the 1940s wasvery much ancillary to medicine (Pasquinelli, 1996). This isindicated, for example, in the American Medical Associa-tion’s definition of occupational therapy as ‘treatment forillness or disability through remedial work actively pre-scribed by a doctor and directed by a trained technician’(The Gift, 1943, as cited in Schwartz, 1998, p. 857).

THE YOUNG PROFESSIONAL

On completing her training, Margaret was assigned to anarmy hospital in Brisbane, treating soldiers who had beeninjured in the Middle East. Unfortunately, she found whenshe arrived that much of the hospital’s equipment hadbeen shipped to Borneo; the idea being that the hospitalwas to be relocated there close to the war action. With noequipment, Margaret had to improvise — begging, borrow-ing, and cajoling materials from wherever she could findthem (including rescuing discarded materials from thelocal ‘dump’ to be recycled for their therapeutic proper-ties). They even had to make their own furniture fromboxes.

Margaret set up a ‘rehabilitation’ programme, a con-cept then in its infancy (Pasquinelli, 1996), with the assist-ance of two occupational therapy aides and a clerk whoseskills were used in teaching typing to some of the soldiers.Looking for ingenious ways to engage these incapacitatedmen, she started a hospital newspaper which includedas contributors everyone from medical personnel at themilitary hospital writing short articles about various ill-nesses and treatments (i.e. giving patients information), topatients writing about events taking place in each ward,‘their sort of thing, not mine’ said Margaret. Patientswould do things like type up the news stories and operatethe duplicator (borrowed from the hospital office) to runoff copies of the newspaper — encouraging them to useand further develop residual skills (of the body and themind) but also very importantly to ‘feel’ involved andinterested, and committed to ‘doing’ as an important ele-ment of their recovery. They engaged in real tasks of daily

Margaret Mort: A history 45

life matched to who they were as people. ‘We tried to getthem involved in what they felt they wanted to do; ratherthan prescribing’ explained Margaret — in other words,tapping into what was meaningful to them, a principlewhich lies at the core of sound occupational therapypractice (Kielhofner, 1997).

The soldiers she treated (young men mostly in theirtwenties but some as young as their late teens) had arange of disorders from tropical diseases such as malaria,gunshot wounds, fractures and loss of limbs, throughto accidents and psychiatric disorders; this being pre-antibiotics and pre-psychotropic medications. The aim wasto get them back to the front lines as quickly as possible tomake way for further casualties, or to teach them newskills in circumstances where their injuries rendered themunfit for further service or indeed unable to return toformer occupations. But Margaret’s occupational therapyintervention was about more than just physical restorationand work retraining. It also focused on enabling soldiersto form links back into their civilian lives, to help thempsychologically find their path back to those relationships,habits of living, and ways of thinking that had beendisrupted by the horrors of war. For example, while theywere ‘doing’ with their hands, they were encouraged totalk about where they lived, about their families and theirhopes and fears for the future.

A FRESH CHALLENGE

From working with these soldiers who were generallyfairly active, she was then sent to work with soldiers withTB at a sanitarium in southern New South Wales and laterat a similar facility near Perth, Western Australia. She saidthat she needed to completely reorient her thinking aboutthe use of therapy activities as these people were treatedprimarily by a regime of complete bed rest for 6 months ormore (and some ‘rather horrific’ surgical interventionssuch as thoracoplasty and phrenic nerve crush) (Anderson& Bell, 1988). The soldiers were physically greatly weak-ened and in some cases psychologically troubled. Imaginethese young men who had not only endured the horrorsand deprivations of war, but who now were forced to liein bed, not allowed even to feed themselves, at leastinitially — truly complete rest! Working closely with hermedical colleagues, she graded activities according tochanges in the soldiers’ condition. ‘We tried to find whattheir interests were (and tailor activities accordingly)’,commented Margaret. She engaged them in educationaland other activities particularly, with a vocational focusbecause many of them, once diagnosed with TB, weredischarged from the army and, even when recovered,may not have been able to return to former employment.

As the war came of an end, Margaret continued towork with war veterans, including prisoners of war (invery poor health) who had been released from Japaneseprison camps. Then, drugs were gradually and cautiouslyintroduced to treat TB with very good results. As part ofthe rehabilitation of these veterans, Margaret was instru-mental in establishing a sheltered workshop, of whichthere were very few in Australia at that time (Cocks,1998), where these men could engage in such tasks aswoodwork, metal work, leather work and packaging asthey became stronger. Part of the therapy for some of thestronger patients would be going for walks in the bush,which not only increased their physical endurance but alsowere made interesting and meaningful by searching forand collecting wild flowers which could be pressed anddried by those on bed rest and made into greeting cards.

Following her discharge from the army, Margaret con-tinued to work in Western Australia over the next fewyears, being the first occupational therapist appointed to acivilian hospital in that state, the Wooroloo State Sanato-rium. In reference to her work, Anderson and Bell com-mented, ‘From the start she established high standards ofoccupational therapy practice in the treatment of tuber-culosis patients’ (Anderson & Bell, 1988, p. 39). At thattime, occupational therapists were still very few in number,for example there were just three in the whole state ofWestern Australia.

EXPANDING HORIZONS

In the early 1950s, drawn both by personal curiosity aboutthe country of her birth and by a professional desire tolearn more about developments in TB treatment, Marga-ret travelled to the United Kingdom. It was there that shemade the transition from working with people with TB todiscovering what proved to be an enduring interest in thenew field of ‘geriatrics’. After several short-term appoint-ments, she eventually found her way to a position inOxford. Dr Lionel Cosin, a pioneer in geriatric medicine,had established an aged-care unit in a former Victorianworkhouse. This facility, the Cowley Road Hospital,housed severely disabled people, middle aged or older,who had been institutionalised and largely overlooked.Having been confined to bed for years and with littleattention to their health needs, many had developedserious contractures and other debilitating sequelae.

The ambitious plan with this new geriatric facility wasto ‘rehabilitate’ these people, to reactivate and returnthem to their best possible level of functional perform-ance. A key to getting activated was of course gettingpeople interested in life again. Margaret told the story ofan old man who had been a carpenter but who was terribly

46 M. Lyons

crippled with rheumatoid arthritis. He was unable to usehis carpentry tools, but he could get close to this major lifeoccupation through the polishing of another patient’swoodwork. She pointed out that this was not really aboutthe tangible behaviour of exercise but rather about some-thing much deeper; his finding meaning and satisfaction inhis daily life. With the growing pressure on occupationaltherapy from the early 1950s for ‘a more scientific ration-ale’ for practice (Kielhofner, 1997, p. 38), this view lostfavour in the face of a strong biomedical orientation thatcame to prevail for several decades. Nevertheless, Marga-ret’s work was never to lose its attention to the complexi-ties and intangibles of the psychosocial domain.

The work of Margaret and colleagues at the CowleyRoad Hospital was quite widely recognised in the UnitedKingdom and indeed beyond. Anderson and Bell (1988)have recorded that a medical officer, charged with estab-lishing a rehabilitation centre in Sri Lanka (the country’sfirst such centre), ‘had been impressed by some of theideas of the Australian occupational therapist, MargaretMort, particularly by her system of analysing, grading andcontrolling activities for tuberculosis patients’ (p. 183).One of the unit’s innovations was the establishment of aday hospital in Margaret’s occupational therapy depart-ment for elderly people, many of whom had dementia(Cosin, Mort, Post, Westropp & Williams, 1957, 1958).Again Anderson and Bell, noting the influence that Mar-garet’s work at Oxford’s Day Hospital was having even infar-off Australia, recorded that ‘increasing numbers ofconfused patients were saved from certification and manyothers kept in their homes who would otherwise havebeen placed in old people’s homes or hospitals’ (p. 180).In speaking of these days with great satisfaction, Margaretstressed the importance of a close-knit professional team(of therapists, nurses, medical practitioners and socialworkers) to the success of the unit.

BACK TO AUSTRALIA — A NEW BEGINNING

Eventually, Margaret felt it was time to return to Australiaas her elderly father was ailing. A trip to Newcastle to visita cousin, and the persuasive powers of her friend BettyMcIntyre (another pioneering occupational therapist)(Wilcock, 1999), were instrumental in drawing her toNewcastle in 1959. Building on the work that Betty hadbegun, Margaret consolidated occupational therapyservices at the William Lyne Geriatric Retraining Unit(Royal Newcastle Hospital) (Mort, 1964, 1966) where sheremained until her retirement in 1979. She had a passionfor exploring new ideas, not being content to rest on herlaurels. With her colleagues: physician, Dr Dick Gibson;social worker, Miss Grace Parbery; and of course Betty

McIntyre, she was instrumental in developing ‘the New-castle Method’ of rehabilitation (Grant & Mort, 1972;McIntyre & Mort, 1973). Their ‘day centre’ model cateredto people whose disablement was severe and about whomit was thought their prospects of being sufficiently capableto remain living in their own homes was poor. Margaretsaid ‘The patients that were sent to us were the ones thatpeople didn’t hold much hope for’. Through their work,the unit’s intervention enabled many of these people toreturn home.

Margaret’s work highlights the importance of team-work for good practice, based on clear and continuingcommunication and mutual respect for each other’s capa-bilities. These qualities were integral to the effectivenessof the Newcastle Method. Margaret emphasised the neces-sity for creative thinking to address people’s complex,seemingly insoluble, functional difficulties (starting fromthe optimistic position of ‘What can he/she do?’ ratherthan from the pessimistic mindset of ‘He/she can’t do it!’).

The Newcastle Method emphasised a consistency ofapproach among all people helping the person with thedisability (i.e. family as well as health-care staff). There-fore, education of both caregivers and recipients of careabout the Newcastle Method (and in particular its ‘drills’or routine movements which were learned through repeti-tion) was the key to its efficacy (Mort, 1985). The Methodemphasised pragmatism in functional positioning andmovement, thus enabling people to use whatever residualcapacities they had.

Betty McIntyre, in writing about the success ofthe model of management instituted at the William LyneUnit, has said ‘So unique in the southern hemisphere wasthe Newcastle approach … that professional and adminis-trative staff from hospitals throughout the nation and NewZealand were seeking more information. Formal educa-tion programmes had to be introduced after some 485people visited the unit in 1975’ (McIntyre, 2000, p. 11). Afilm describing the Newcastle Method, accompanied by abooklet written by Margaret, was produced to help meetthe demand for education (Mort, 1976). In 1977, Margaretwas created a Member of the British Empire (MBE) inrecognition of her services to elderly people. Some yearsafter her retirement, Margaret produced a book, pub-lished in the UK and Australia, detailing both the philo-sophy and procedures of her work with elderly peoplewith disabilities (Mort, 1985).

LOOKING BACK

It is revealing to read about the principles of this interven-tion approach, introduced some 40 years ago. In manyrespects, they are as relevant to practice today as they

Margaret Mort: A history 47

were powerful practices when they were developed. Forexample, the Newcastle Method’s emphasis on the elderlyperson’s own sense of purpose in the treatment offered tohim/her (including the sense of self-efficacy, interest andsatisfaction) heralds what Kielhofner and others have rep-resented as volition when they kickstarted occupationaltherapy’s interest in conceptual practice models some20 years later (Kielhofner, 1997). Then, there is theMethod’s attentiveness to the needs of not only the eld-erly person but also his/her family and its promotion of ashared sense of responsibility between individual, familyand health professionals, which aligns with modernapproaches to client-centred practice (Law, 1998). Fur-thermore, in Margaret Mort’s work there is an unambigu-ous and unashamed commitment to the use of activities(such as music and singing, arts and crafts, hobbies andgames, alongside more ‘functional’ self-care and voca-tional activities) as central to the therapeutic process. Thisview lost favour during the occupational therapy pro-fession’s quest for ‘scientific and medical credibility’(Schwartz, 1998, p. 855), only to be revived and celebratedover the past decade with our burgeoning interest in thescience of occupation (Wilcock, 1998, 2001). MargaretMort and others of her era were beacons, casting a stronglight over the profession of their time and into the futurethat is our present, and thus providing an important linkbetween the foundations of occupational therapy almost acentury ago and the profession of the 21st century.

After Margaret and I had spent several enjoyablehours exploring the treasure trove of recollections fromfour decades of professional life, I asked her what shewould most want to convey to others from her wealth ofexperience. What she had to say won’t surprise readers ofthis journal, even though it can easily be overlooked inpractice and thus is so important to hear again and again.Margaret said:

I think the main thing is to treat everybody as an individ-ual and think what their needs are; not what ‘old people’(as a group) need. That’s the biggest one. Because theysurprise you sometimes with what they can do when youthink ‘Oh, she’s too old for that’.… If you can look forwhat is specific to the patient, you can get a start (withthat person). If they like and they trust you, then you cango further.

Rapport and trust in the relationship between thehealth professional and the elderly person are particularlyimportant. However, enmeshed within that effective help-ing relationship has to be a commitment to searching forwhat is important to each individual patient, not just whatis important for that person. In her work as an occupa-tional therapist, Margaret sought to tap into the ‘insider’view and so engage people in occupations that werevalued by them.

THE LEGACY

So what is Margaret’s legacy? A colleague in nursing hascommented to me on the high level of regard with whichMargaret Mort and Betty McIntyre were held by their healthprofessional colleagues in the Hunter Valley of New SouthWales; he spoke admiringly of the influence of their work inhealth care, particularly aged care, during their years of prac-tice (O’Dea I, 2002, personal communication). Let me finishthen by summarising what I think are just a few of MargaretMort’s many important contributions to the care of elderlypeople, in the domains of knowledge, skills and attitudes:

Knowledge — of what elderly people in seeminglyhopeless circumstances could still be capable of achievingand how this might be facilitated with a pragmatic, func-tional focus on occupation.

Skills — in working to enhance the quality of life formany people who, rather than be subjected to immediateinstitutionalisation, were able to stay longer at home andto engage in occupations of value to them.

Attitudes — that embraced a more positive view ofolder people with severe disabilities; this included whatthey could and should be enabled to achieve in terms ofthe best possible outcomes rather than being ‘abandoned’to an unfulfilling old age.

This paper has shone light on a ‘gem’ from the treasurechest that is the history of occupational therapy in Aus-tralia. The contributions of Margaret Mort and othercolleagues at the ‘cutting edge’ in the early years of ourprofession’s development are all too easily lost with thepassing of time and the pace of change. I hope thisaccount has kindled your interest in the birth of our pro-fession, your pride in its evolution and your admirationfor a great occupational therapist.

ACKNOWLEDGEMENTS

This article is based on an Invited Presentation to the Aus-tralian Association of Gerontology (Hunter Chapter)Conference, ‘Horizons in Aged Care’ (28 February 2002).Much of the material for this paper was drawn from aninterview with Miss Margaret Mort and from archivedpapers of Miss Betty McIntyre held in the AuchmutyLibrary of the University of Newcastle, New South Wales.

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