2016 was a year of turning points. Earlier in the week of my Casson lecture, the referendum in the UK had taken place and, beyond the conference centre in Harrogate, there were new waves of political and social unrest as the outcome of the vote to leave the European Union started to play out.

As well as writing the Casson lecture, I’d been working hard with the team at the University of Essex to get our new BSc and MSc programmes approved for delivery later in the year. In education there is an unhealthy culture of intensive working which spreads from the students and their assignment deadlines to all aspects of programme delivery.

The morning after the Casson lecture, I was relieved and then intrigued to find my right hearing aid had broken. I thought it was definitely time to switch off. Without knowing what I was getting into, just three months later, I started the painful process of switching off and ending my career, to make room for my new unwelcome and unpredictable life-threatening companion, ANCA associated vasculitis.

I’d worked in rheumatology for just six months in 1986 and had heard of it, but knew no more than it was very rare and was like arthritis of the blood vessels. Two years later I retired, grateful to be alive but shocked at impact of the disease, which continues to dominate my life.

Four years on from my Casson lecture, I balance an interesting life, managing my condition, creating and recreating my home so I can enjoy many occupations, being an Honorary Professor at the University of Essex and being one of three editors for the forthcoming 6th edition of Creek’s Occupational Therapy and Mental Health.

These days I don’t hesitate to ask for help – it makes life easier and more enjoyable in many ways. So two friends have recorded a fictional interview I’ve written, to share some of the additional material on Elizabeth Casson that I couldn’t fit into my lecture.

A fictional interview is a contemporary way of bring history alive, although I would like to imagine this as a documentary rather like the amazing “Letters from Baghdad” about Gertrude Bell, a contemporary of Elizabeth Casson. They would have never met, for Gertrude was always away exploring Iraq. For this fictional interview, it is not long after the Second World War and my grandmother, Elsie Jones, has met Dr Casson, for a long overdue catch up.

I knew the lecture had to be about occupational alienation. Why? Because it’s quite difficult to find the time and space to do the scholarly work needed for a concept like occupational alienation. In 2003, Ann Wilcock challenged me to do this work, seeing that my MSc research had enabled me to understand occupational alienation deeply and telling me it was the most difficult concept for occupational therapists to understand (Bryant et al 2004).

The Casson lecture seemed like the best opportunity I’d had to share my understanding. I didn’t explore occupational alienation in my PhD because I wanted to focus on participatory research methodology (user involvement) not theory. I am perennially anxious about imposing theoretical frameworks and concepts on experiences, preferring to move between different ways of seeing and thinking as experiences unfold.

So, to create the lecture, I wrote out the possible questions and assumptions that would drive and influence my reading. I revisited what I knew about occupational alienation. I worked my way through other Casson lectures to get ideas about structure and content. I went for a day to the RCOT library in Borough, London, and worked through the Casson archives there and longed to go to Oxford, for another trip to the Dorset House Archive.

But I had to stop myself, so a friend took me instead to see the outside of the original Dorset House in Clifton, Bristol. With another friend, we had a particularly exciting drive along a very private road to see Jane Walker’s hospital building near Nayland in Essex, now luxury flats. I’d forgotten my old Ford Fiesta can draw attention so we didn’t linger. Wished I had the elegance of Elizabeth Casson with her car (love that photo). Jennifer (Creek) read through my first draft, making helpful comments. I’d been recording audio clips of reflections to put in the lecture, but scrapped those and focused on creating the slides, a process I particularly enjoy. Finally, the week before, I did a rehearsal at the University of Essex to local staff. You might not believe it, but I did enjoy doing all of these things very much.

There’s no doubt I would approach the lecture differently now, simply because of my ill-health. I’m not sure I could do it now, but I would still see it as a unique opportunity to speak to occupational therapists and others. It would be tempting to go back to the thread about Elizabeth Casson’s life and work, pulling together more findings from archives.

It would be a welcome challenge to reconsider occupational alienation in today’s context of the pandemic and the Black Lives Matter movement. I defined occupational alienation in the Casson lecture as being “when a person is doing something they are not engaged with or that they are struggling to engage with”.

Wearing masks could be seen as provoking occupational alienation. For everyone, whether wearing full protection at work or a mask to visit a café, the masks have changed how we do things and communicate in a way that none of us would have wanted. For some, the requirement presents a threat to personal liberty but for most, masks represent our shared responsibility to address the pandemic. They could symbolise the many sacrifices people have made and show solidarity. The transformation from occupational alienation to occupational engagement is in the sense of belonging, to the shared efforts to survive the pandemic and by owning masks that are now part of our everyday occupational lives.

The Black Lives Matter movement raises a challenge directly to occupational therapy as a profession. White privilege continues to carry the power to determine which occupational forms are considered suitable, from how meals are prepared to which jobs are offered to people from black and ethnic minorities. This is the power to create occupational alienation for the people we work with: colleagues, service users and carers. This power has to be questioned. In our occupational therapy practice, rather than starting from a justification of addressing occupational deprivation, we have to start thinking about what we are asking people to do and how we think they should do it. This can be rooted in assumptions associated with racism, sexism and other discriminatory beliefs, fostering occupational alienation rather than engagement. Collaboration and critical reflection will challenge these assumptions. I am now imagining future Casson lecturers will take us forward to new understandings for occupational therapy.

The opportunity came at an important time for me, seizing opportunities for leadership but also realising that people might want to hear what I had to say. Never underestimate that possibility: it’s probably true of you, too.

To bring history alive, Wendy Bryant and two of her friends recorded a fictional interview to share some of the additional material on Elizabeth Casson that she couldn’t fit into her lecture. Listen here!