**3.2. Animals as socialization agents**

psychological, and social environments. These methods consist of two basic topics, namely animal-assisted activities (AAA) and animal-assisted therapies (AAT). Both AAA and AAT can be implemented in an interdisciplinary team approach. Occupational therapists (OTs), physiotherapists, speech therapists, special education specialists, and psychologists are core elements of these approaches. In recent years, these methods have also been used to increase social interaction with physical structure and functions in neurodevelopmental disorders such as autism spectrum disorder and cerebral palsy in addition to mental health disorders such as depression and anxiety to increase the independence in daily life activities and social

The American Veterinary Medical Association has been involved in human and animal interaction as psychological and physical functions between human beings and animals. In this interaction, they define individual's quality of life as a structure that contributes positively to their improvement [1]. Animal-assisted rehabilitation, the inclusion of animals that can interact with humans such as cats, dogs, and horses, has an active role in the rehabilitation process with the aim of achieving rehabilitation goals [2, 3]. When such approaches are incorporated into rehabilitation programs, the general condition of the individual and the treatment principle that the rehabilitation team has followed are taken into account [4, 5]. Animal-assisted rehabilitation approaches, rather than a stand-alone approach, are a strategic concept where multiple professionals work together to achieve interdisciplinary goals within a single goal [5]. This framework consists of three basic questions. The first question is "what are the benefits of the individual animal and therapeutic activities including animals?" The second question is "how to include the animal to the rehabilitation process?" The third question is "what are the most appropriate activities for the individual?" [1] Based on the answers of these questions, animal-supported approaches are grouped under two main headings: animal-assisted activities (AAA) and animal-assisted therapies (AAT). When therapeutic properties of AAA are investigated, it has been found that it helps to reduce the level of stress and anxiety and indirectly increasing the self-confidence and socializing. It is stated that AATs were predominantly used to support neurodevelopmental substructures of individuals and make a positive

Animals play an important role in the history of the disease with different ideas about disease and its treatments. However, the precise characteristics of these roles depend not only on the prevailing views of animals but also on supernatural or "scientific" belief systems in which they are buried. Probably, the oldest of these belief systems, often called "animism," includes the concept that all natural beings, as well as other natural objects and phenomena,

participation.

**2. Overview of animal-assisted therapy**

92 Occupational Therapy - Therapeutic and Creative Use of Activity

contribution to their well-being [6].

**3. History of animal-assisted therapy**

**3.1. Animal souls and spiritual healing**

The end of the seventeenth century which was called "Age of Enlightenment" brought some changes in the public perception of animals that are well documented by historians of the modern age [13, 14]. Among these changes, contrary to the pre-medieval and renaissance periods, sympathetic thoughts began to dominate attitudes toward animals and nature [15]. While perceptions of wildlife and threats to wildlife have diminished from prevalence, petfeeding habits have expanded to aristocratic and middle-class communities living in newly founded cities. This change in animal-related attitudes and behaviors could at least partly reflect Europeans' migration from rural areas to the towns and cities, and the rapid spread of the human population. This rural migration made it possible for the population to be adapted to systems designed for growth [8, 14]. The reformers of the eighteenth century, deriving their authority from the works of John Calvin and Thomas Hobbes, thought that they could indirectly learns from the innate, unfavorable characteristics of children by using children's behavior to take care and control real animals [16]. Compassion and anxiety for the health of animals became one of the didactic themes of children's literature that lived in the eighteenth and nineteenth centuries; the main aim was to inspire the morality of the good and sex, respectively, especially in boys [17–19]. In the late eighteenth century, theories about the social effects on animal care were initiated in the treatment of mental illnesses. The bestdocumented studies took place in The York Retreat in England. The York Retreat used more innovative methods than the mental treatment methods used at that time. In this study, prisoners were encouraged to do handwriting, writing and reading books, and they were also allowed walking freely around the courtyards and gardens of the Retreat, where small pets were also part of the Retreat and prisoners could interact with them. In his description of the Retreat (1813, p. 96), Samuel Tuke, the founder's grandson, described how the internal courtyards of the Retreat were supplied "with a number of animals; such as rabbits, sea-gulls, hawks, and poultry. These creatures are generally very familiar with the patients: and it is believed they are not only the means of innocent pleasure; but that the interaction with the sometimes tends to awaken the social and benevolent feelings." In the nineteenth century, pets became an increasingly popular feature in the psychiatric departments of hospitals in the UK. For example, in a highly critical report on terrible conditions for patients in Bethlem Hospital in the 1830s, British Charity Commissioners proposed that the shelter of people with a mental problem is provided support for treatment of sheep, rabbits, apes or other domestic pets, they have also been described as social animals. Such recommendations are clearly taken seriously. According to a paper published in Illustrated London News of 1860, the regulations at Bethlem Hospital have been redesigned according to the stimulus [20]. It has been observed that animal companions have beneficial and therapeutic effects in the treatment of physical disorders. Florence Nightingale, for example, observed and wrote in Notes on Nursing (1880) that "a small pet is a particularly good friend, especially for the patient, long chronic cases" [21].

recurrent animal images of his patients' dreams and "freethinking" as metaphorical means that hid the unacceptable thoughts and feelings of humans. "The Wild Beast" he argued, "It makes him happy that other dreams come true while the passionate spirits of the dreamer are afraid of himself" [23]. These crude thoughts and impulsions threaten the "ego" so deeply that they can be ignored in the dark corners of the consciousness in proportion to the capacity of the subconscious within the hours when at least one person is awake. According to Freud and his followers, the aim of psychoanalysis is to reveal these scary residents of the subconscious, to reveal them as they are in their true nature, and thus to neutralize them [24]. The notion of "id," Freud defines as the basic "animal" essence of human nature, contains more than a superficial resemblance to animistic and shamanic ideas about animal spirits and protective spirits, including bad thoughts/"evil self" or spiritual origins [24]. In the study on Carl Jung, especially his discussions of mythological archetypes in dreams and visions, and his concept of the "Collective Unconscious," this resemblance becomes more or less explicit [25]. It is also echoed in the writings of Boris Levinson, the founder of "pet-facilitated therapy." In his book

Animal-Assisted Therapy in Occupational Therapy http://dx.doi.org/10.5772/intechopen.76468 95

*One of the chief reasons for man's present difficulties is his inability to come to terms with his inner self and to harmonize his culture with his membership in the world of nature. The rational man has become alienated from himself by refusing to face his irrational self, his own past as personified by animals* [26].

According to Levinson, the solution to this growing sense of alienation is through positive relationships with the animals, as if dogs, pets, and other domestic animals are within themselves. It is emphasized that this relationship has increased the quality of life by positively contributing to the solution of the problems experienced by the individual in the spiritual sense [27]. Levinson went one step further to the idea that Freud propagated and suggested symbolic patterning system of things where we fear to confront animals; in order to argue that their relationship with animals is an important part of human evolution and that it is now an

There has been considerable development in the theoretical substructure of animal-assisted approaches during the last 20 years and, at least in part, in response to the skepticism shown toward blood-based medicine. This substructure offers the basis for demonstration as a psycho-mental mediator by providing relief from relatively metaphysical-based thoughts about animals [24]. The primary catalyst for this change of emphasis was a single, groundbreaking study of 92 outpatients from a cardiac care unit who, statistically speaking, were found to live longer if they were pet owners [28]. This finding prompted a whole series of other healthrelated studies as well as stimulating a lot of discussion concerning the possible mechanism(s) responsible for the apparent salutary effects of pet ownership. Of these, at least two have stood the test of time. According to the first, animals are able to induce an immediate, physiologically de-arousing state of relaxation simply by attracting and holding our attention. According to the second, companion animals are capable of providing people with a form of stress-reducing or stress-buffering social support [29, 30]. Although the de-arousing effects of animal contact have been demonstrated by a considerable number of recent studies, little evidence exists at present that these effects are responsible for more than transient or short-term

*Pets and Human Development*, Levinson states that:

integral part of our present psychological well-being [26].

**3.4. Animals, social support, and relaxation**

#### **3.3. Psychotherapy and animals**

Despite the success of animal-supported institutional care in scientific studies during the nineteenth century, with the development of evidence-based medicine in the early twentieth century, the use of animals in hospitals has declined dramatically [20]. For the next 50 years, animals were used in the context of zootomic illnesses, public health concerns, or psychoanalytic theories of the origin of mental illnesses. Sigmund Freud's ideas concerning the origins of neurosis tended to reiterate the Hobbesian idea of mankind's inherently beast-like nature [16]. According to Freud, infants and young children are in fact similar to animals, as long as they are governed by instinctual desires or could be influenced by organized basic biological functions such as nutrition, defecation, sexuality, and self-protection. Freud describes this basic and animal-like instinct of human nature as "identity." As children mature, their parents' behaviors will either cause too much impulsive behavior by reacting to the child's inner aggression or induce their sense of fear, guilt, and socialization. The suppression of these children under the consciousness of children ensures that their behavior in their daily lives is healthy. But they are like animals in their 30s. Freud refers to this as a bottled animal chart. It results in explosive situations where the individual cannot go out on regular outings [22]. Freud interpreted the recurrent animal images of his patients' dreams and "freethinking" as metaphorical means that hid the unacceptable thoughts and feelings of humans. "The Wild Beast" he argued, "It makes him happy that other dreams come true while the passionate spirits of the dreamer are afraid of himself" [23]. These crude thoughts and impulsions threaten the "ego" so deeply that they can be ignored in the dark corners of the consciousness in proportion to the capacity of the subconscious within the hours when at least one person is awake. According to Freud and his followers, the aim of psychoanalysis is to reveal these scary residents of the subconscious, to reveal them as they are in their true nature, and thus to neutralize them [24]. The notion of "id," Freud defines as the basic "animal" essence of human nature, contains more than a superficial resemblance to animistic and shamanic ideas about animal spirits and protective spirits, including bad thoughts/"evil self" or spiritual origins [24]. In the study on Carl Jung, especially his discussions of mythological archetypes in dreams and visions, and his concept of the "Collective Unconscious," this resemblance becomes more or less explicit [25]. It is also echoed in the writings of Boris Levinson, the founder of "pet-facilitated therapy." In his book *Pets and Human Development*, Levinson states that:

*One of the chief reasons for man's present difficulties is his inability to come to terms with his inner self and to harmonize his culture with his membership in the world of nature. The rational man has become alienated from himself by refusing to face his irrational self, his own past as personified by animals* [26].

According to Levinson, the solution to this growing sense of alienation is through positive relationships with the animals, as if dogs, pets, and other domestic animals are within themselves. It is emphasized that this relationship has increased the quality of life by positively contributing to the solution of the problems experienced by the individual in the spiritual sense [27]. Levinson went one step further to the idea that Freud propagated and suggested symbolic patterning system of things where we fear to confront animals; in order to argue that their relationship with animals is an important part of human evolution and that it is now an integral part of our present psychological well-being [26].
