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Kids Can Be Kids A Childhood Occupations Approach
1st Edition Shelly J Lane Phd Otr Faota Digital Instant
Download
Author(s): Shelly J Lane PhD OTR FAOTA, Anita C. Bundy ScD OTR
FAOTA
ISBN(s): 9780803612280, 0803612281
Edition: 1
File Details: PDF, 11.72 MB
Year: 2011
Language: english
1228_FM_i-xxxiv 15/10/11 12:12 PM Page i

KIDS
Can Be Kids
A Childhood
Occupations
Approach
1228_FM_i-xxxiv 15/10/11 12:12 PM Page ii
1228_FM_i-xxxiv 15/10/11 12:12 PM Page iii

KIDS
Can Be Kids
A Childhood
Occupations
Approach
Editors
Shelly J. Lane, PhD, OTR/L, FAOTA Anita C. Bundy, ScD, OTR, FAOTA
Professor Professor and Chair of Occupational Therapy
Department of Occupational Therapy Faculty of Health Sciences
School of Allied Health Professions University of Sydney
Virginia Commonwealth University Australia
Richmond, Virginia, USA
1228_FM_i-xxxiv 15/10/11 12:12 PM Page iv

F. A. Davis Company
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Copyright © 2012 by F. A. Davis Company

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Library of Congress Cataloging-in-Publication Data

Kids can be kids : a childhood occupations approach / editors, Shelly J. Lane, Anita C. Bundy.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8036-1228-0 (alk. paper)
I. Lane, Shelly. II. Bundy, Anita C.
[DNLM: 1. Occupational Therapy--methods. 2. Child, Preschool. 3. Child. 4. Cultural Competency. 5. Mental Disorders—
rehabilitation. WS 368]
LC classification not assigned
615.8'515083—dc23
2011030469

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Frontispiece: Photo courtesy of Gudrun Gjesing.

1228_FM_i-xxxiv 15/10/11 12:12 PM Page v

To the Muses — past, present, and future.

1228_FM_i-xxxiv 15/10/11 12:12 PM Page vi
1228_FM_i-xxxiv 15/10/11 12:12 PM Page vii

foreword
Kids Can Be Kids: A Childhood Occupations Approach is a self-care, play, and leisure. Within this Part, readers will
comprehensive compilation of knowledge that occupa- find defined what children do, and how what they do
tional therapy students will find useful for their begin- changes as they grow older. These chapters also describe
ning practice with children, and experienced therapists how family circumstances, cultural heritage, and the set-
will find to be an excellent reference book. ting itself influence expectations for what kids can do.
In pediatric occupational therapy, we provide services Part II: The Context of Pediatric Practice fosters
across a variety of settings, including schools, home understanding and respect for cultural traditions, ethnic-
care, other community agencies, and hospitals. Our ity, beliefs, and values by presenting information on
assessments and goals are designed to enable children to aspects of the ecocultural contexts in which children
function in their everyday age-appropriate activities; we function. A chapter on how to use frames of reference in
focus on children’s participation and engagement in practice is followed by separate chapters that describe
occupations. ecocultural theory, general concepts of culture, and
Kids Can Be Kids reflects the profession’s focus on oc- the cultures of children. Laws, policies, and regulations
cupations. A central premise of the text is that the ability affecting practice in the United States are complemented
of children and their parents to lead ordinary, everyday by the description of practice in other English-speaking
lives is crucial, and that facilitating engagement in every- countries such as Canada, the United Kingdom, and
day activities must be central to pediatric occupational Australia.
therapy. This concept underlies the ecocultural frame- Part III: Overview of the Intervention Process and
work, which is threaded throughout the text. Part IV: Pediatric Conditions and Their Impact on the
The text also adopts a second major premise: Children Lives of Children introduce the reader to specific assess-
must be viewed in the context of the physical and cul- ment- and treatment-related knowledge that is essential
tural environments: where they live, go to school, and to the practice of occupational therapy. Readers will find
play. Therefore, work with kids and their families must information on the intervention process, including
be done within everyday contexts and be focused on sup- chapters on assessment, setting goals, direct and indirect
porting engagement in ordinary, everyday activities. intervention, and consultation. Finally, once readers have
The approach of the book is to describe the occupa- the essential framework for understanding the child and
tional roles of children in an ecocultural context and family in multiple contexts, diagnostic information and
examine the influence of context on a child’s participa- treatment considerations are examined, specific to issues
tion. The ecological context refers to the physical places commonly encountered in pediatric occupational ther-
where children are typically found, such as home, apy. Importantly, these are presented with a view toward
school, and playground, as well as to political and eco- how each condition can affect a child’s participation.
nomic factors that influence those environments. The In Part V: Putting It All Together, the book ends with
cultural context includes ethnicity, but is more broadly two synthesizing chapters.
defined to include the culture of any setting in which a Kids Can Be Kids: A Childhood Occupations Approach has
child participates, as each of these settings has its own been written by an impressive group of more than 40 in-
culture of shared beliefs and values. Thus, every child dividuals who are experts in many aspects of pediatric
participates in occupation in many different cultural set- practice around the world, ensuring that the reader is
tings, and both the child and occupation must be viewed provided with up-to-date, relevant knowledge. The many
in context. student-friendly features include chapter outlines, learn-
The ecocultural framework is elaborated upon in the ing objectives, and Here’s the Point summaries. Practical
first half of the book. In Part I: Childhood Occupational ideas and tools that can be readily used in practice are
Roles, the occupations and occupational roles of chil- presented in Practice Wisdom, Prove It!, and Active
dren in each of four age-related settings are examined Learning boxes. The book is rich with vignettes that
and discussed in separate chapters: Home (early illustrate the approach of the text. An added plus is the
intervention), preschool, school, and transition after use of lighthearted chapter subtitles and the inclusion of
school. Vignettes illustrate the ways in which the physical quotes from real children.
and cultural environments of the settings influence Shelly Lane and Anita Bundy both have extensive
participation in occupation. These four chapters acquaint experience in pediatric practice and teaching, and they
the reader with the typical age-related occupations have put that experience to good use in designing the
of children, and separate chapters address the occupa- text. Their frame of reference, that pediatric assessment and
tions that are particularly germane to children, such as intervention must be planned within a framework of occupation
vii
1228_FM_i-xxxiv 15/10/11 12:12 PM Page viii

viii Foreword

embedded in an ecological and cultural context, provides a hensive description of current pediatric practice make
unique conceptual basis for pediatric occupational ther- this a valuable pediatric textbook and a useful reference
apy practice. This sets the book apart from other pediatric for occupational therapy practitioners.
textbooks, and the chapters that support the framework Anne Henderson, PhD, OTR, FAOTA
provide a wealth of information about childhood occu- Professor Emeritus
pations and the different cultures of children. Boston University
The articulation of the ecocultural framework, the in- Department of Occupational Therapy
formation on occupation and culture, and the compre- Boston, Massachusetts
1228_FM_i-xxxiv 15/10/11 12:12 PM Page ix

preface
The idea for this book was “born” over Sunday brunch FAMILIES AND CLASSROOMS
in Grand Lake, Colorado — on the porch of the Grand ARE THE CLIENTS
Lake Lodge. The two of us sat with paper and pen, waffles
Growing out of family systems theory, the notion of
and coffee, imagining a textbook that would support the
“family-centered services” replaced “child-centered care”
learning and practice of pediatric occupational therapy
about two decades ago. Family systems theory empha-
in ways that we recognized as possible — with kids, fam-
sizes the mutual impact of family members on one
ilies, and classrooms genuinely at the center. The book
another. Children, with and without disabilities, influ-
began, unashamedly, as a self-serving project. We wanted
ence one another and their parents just as parents influ-
a textbook to support the way we taught pediatric ther-
ence their children. When all family members feel as
apy. And if we could create the book we imagined, we
though their needs are being met, they are more able to
were willing to share it — assuming there were others
interact in ways that promote the well-being of all. Thus,
who approached teaching and practice in the same way
family-centered services involve more than working di-
and who also needed a textbook to promote their vision.
rectly with a child who has a disability (e.g., Rosenbaum,
We imagined a book firmly rooted in several beliefs.
King, Law, King, & Evans, 1998). We adopted a family-
First, as different as they look and act and are, and no
centered approach, making Ecocultural Theory as
matter where they live, all kids just want to be kids. They
want to do the things that other kids do. And, as different described by Gallimore and colleagues (e.g., Gallimore,
as they look and act and are, families and teachers want Bernheimer, & Weisner, T. [1999]) the unifying theory.
to engage in meaningful, predictable everyday routines Most contemporary therapists agree that family-
centered care represents “best practice.” They use the
that they choose. But circumstances conspire against
term proudly in reference to their own services. However,
some kids, families, and classrooms. To be able to do
“kid things” or to have sustainable daily routines, they implementing true family-centered care can be extremely
need help from an occupational therapist. Thus, the sec- difficult. Professionals have been well trained and they
ond belief underlying this book is that the primary role carry with them a wealth of knowledge; they know what
“should” be done for and with children, and they have
of occupational therapy is to enable kids, families, and
the “skills” needed to see that this happens (i.e., child-
other participants in children’s daily lives to engage in
centered care). But genuine family-centered care gives
the everyday tasks, activities, and routines that they
families the ultimate responsibility for their children
choose.
and the right to choose their own level of involvement
in decision-making — even when professionals do not
like their choices (Rosenbaum, King, Law, King, & Evans,
A Textbook with Children 1998). As Campbell and Halbert (2002) indicated,
“When practitioners view family participation as a series
at the Center? of statements about what parents . . . should do, providing
services in ways that fully implement principles and prac-
When we conceptualized this book, we sought to place tices of family-centered intervention is not likely to hap-
children and their needs — rather than diagnoses or pen. (p. 223; italics added).
specific service delivery sites — at the center. We thought Family-centered-care means giving control to families.
of this as a “child-centered approach” in the way that But it does not mean that therapists simply ask families
Bronfenbrenner (1979) positioned the child at the center what they want and then comply. It is much more diffi-
of his Ecological Model — surrounded by family, friends, cult than that. Most families do not have “shopping lists”
classmates, teachers, community members, and, ulti- of things they want to be different for themselves and
mately, cultural and legal systems. Unfortunately, the their child. Even those who know what they want do not
term “child-centered” had long been associated with an necessarily know the full ramifications of those choices.
approach in which doctors and therapists (i.e., the Family-centered care means professionals working with
experts) set goals and developed plans to change the families to ensure they know what is possible and un-
child (i.e., “fix” what was wrong with him or her). Fam- derstand the consequences of their choices, honoring the
ilies deferred to the opinions of the experts. Clearly, we family’s perspectives and choices, and working hard to
could not adopt the term “child-centered.” help them realize their goals.

ix
1228_FM_i-xxxiv 15/10/11 12:12 PM Page x

x Preface

Most families have no reason to know what occupa- ORGANIZATION

tional therapy is or what occupational therapists can do
The order of the content reflects these intentions; it gives
for them or their child. Most families do not have access
a message about what content we feel is most (and least)
to evidence regarding particular approaches. They want
critical to practice.
to learn, and they have that right. They are entitled to
The text is divided into five parts. In Part I: Childhood
make decisions — even bad ones — as long as those
Occupational Roles, we lay the groundwork for under-
decisions do not result in harm to their child (but even
standing important aspects of participation in childhood
deciding that a child is likely to be harmed is no easy
occupations: play, school, and activities of daily living.
call). When implementing family-centered service, occu-
In Part II: The Context of Pediatric Practice, we explore
pational therapists have the responsibility to listen
multiple facets that contribute to the context for inter-
(being critically aware of our biases) and teach without
vention. Here you will find an overview of Ecocultural
cajoling, recognizing that every issue has multiple sides.
Theory and of several theories and approaches laying the
The notion of family-centered care is easily extended
groundwork for pediatric occupational therapy. You also
to classrooms (e.g., Tharp & Gallimore, 1988). Many
will find chapters describing the laws and guidelines that
children with disabilities, even very young children,
govern practice in several English-speaking countries. We
spend a high proportion of the day in school or in facil-
hope that students and instructors will take the oppor-
ity-based care (e.g., daycare or after-school care). The
tunity to compare legislation and practice across coun-
issues of teachers and classmates are in many ways par-
tries. We are very aware of the number of occupational
allel to those of parents and siblings. Both groups want
therapists who seek professional and personal experi-
to establish and maintain meaningful and predictable
ences in other parts of the world. We hope that this book
everyday routines. In many countries, occupational ther-
apists support children and teachers in classrooms. The will help to prepare them for practice in other places.
role of the therapist in a school is very similar to that of In Part III: Overview of the Intervention Process, we
focus on processes associated with intervention: assess-
a therapist working with a family.
ment, goal setting, and the different forms that interven-
tion can take (i.e., working directly or indirectly with a
THE LESSON OF SIMILAR BUT DIFFERENT child, and consulting). In Part IV: Pediatric Conditions
and Their Impact on the Lives of Children, we look at
One of us (Anita Bundy) moved to Australia as the
some of the disabilities and impairments commonly
plans for this book unfolded. The move prompted the
encountered by occupational therapists working with
reminder of a lesson we knew well but did not always
children, describing ways in which those conditions may
have uppermost in our minds. No matter how similar a
child, family, classroom, or community seems, the one interfere with everyday life. We have intentionally left
in front of us will always be subtly different from all oth- this content until last because the emphasis in pediatric
ers. No matter how similar Australian students appear to occupational therapy should not be on disease or dis-
students in the United States, their culture is subtly ability but rather on promoting participation in everyday
different — and they are very different. The laws that gov- life. Part V: Putting It All Together, does just that with
ern the two countries, while similar, yield very different cases as synthesis and reflections on pediatric practice.
service delivery decisions. Even the language, which is
nominally English in the two countries, differs markedly. FEATURES
The lesson of “similar but different” also provided an
important basis for this book. We wanted the book to be A number of features appear throughout the text:
useable in curricula throughout the English-speaking ✤ Chapter Outlines provide readers with a “roadmap”
world. And so we sought both authors and reviewers to content
from Canada, Australia, the United Kingdom, and ✤ Objectives clarify learning expectations
the United States who held our vision of what practice ✤ Vignettes put a “face” on pediatric OT therapy
can be. ✤ Here’s the Point summarizes key points of chapter
sections
✤ What Else Is in the Toybox? provides the reader with
AN OVERVIEW
additional readings to enrich knowledge
In this text, we have crystallized the guiding principles ✤ Prove It! boxes emphasize available evidence
that we made explicit on the porch of Grand Lake Lodge. ✤ Practice Wisdom highlights the skill and knowledge
We have endeavored to stay true to our beliefs, strived to of clinical experts
give more than lip service to placing children, families, ✤ Active Learning engages the reader in the process of
classrooms, and everyday life at the heart, and embraced learning
the concept of similar but different.
1228_FM_i-xxxiv 15/10/11 12:12 PM Page xi

Preface xi

In general, these features are meant to provide read- the basics of occupational therapy, but one that is long
ers with avenues to obtain additional content and overdue.
mechanisms for thinking critically and reflectively
about the materials. We also begin each chapter with a
References
quote from a real child: a bit of silly advice or an
idea about what constitutes a perfect world. As we Bronfenbrenner, U. (1979). The ecology of human development.
uncovered and read these simple yet meaningful state- Cambridge, MA: Harvard University.
Campbell, P. H., & Halbert, J. (2002). Between research and
ments, we found ourselves laughing until we cried.
practice: Provider perspectives on early intervention. Topics
These are meant to remind readers about how children in Early Childhood Special Education, 22: 213–226.
see the world, which is something we all need to do Gallimore, R., Bernheimer, L. P., & Weisner, T. (1999). Family
more often. Children are, after all, the reason this book life is more than managing crisis: Broadening the agenda of
came to be. research on families adapting to childhood disability. In R.
Gallimore, L. P. Bernheimer, D. L. MacMillan, D. L. Speece,
& S. Vaughn (Eds.), Developmental perspectives on children with
CLOSING THOUGHTS high-incidence disabilities (pp. 55–80). Mahwah, NJ:
Between the covers of this book, many highly respected Lawrence Erlbaum Associates.
authors have woven together theory, evidence, practical Rosenbaurn, P., King, S., Law, M., King, G., & Evans, J. (1998).
wisdom, and the stories of countless children, families, Family-Centred Service: A Conceptual Framework and
Research Review. Physical and Occupational Therapy in Pedi-
and teachers with whom they have worked. Together,
atrics, 18, 1–20.
we have created a comprehensive textbook describing Tharp, R. G., & Gallimore, R. (1988). Rousing minds to life:
occupational therapy in pediatrics with participation in Teaching, learning, and schooling in social context. Cambridge:
everyday life at the heart. It is a different approach to Cambridge University Press.
1228_FM_i-xxxiv 15/10/11 12:12 PM Page xii
1228_FM_i-xxxiv 15/10/11 12:12 PM Page xiii

contributors
Leisa C. Aberli, M.S., OTR/L Anne Cronin, PhD, OTR
Senior Occupational Therapist Associate Professor
Weisskopf Child Evaluation Center School of Medicine
Department of Pediatrics Department of Occupational Therapy
University of Lousiville West Virginia University
Louisville, Kentucky, USA
Patricia L. Davies, PhD, ORR, FAOTA
Marie E. Anzalone, ScD, OTR, FAOTA Associate Professor
Assistant Professor Department of Occupational Therapy
Virginia Commonwealth University College of Applied Human Sciences
Department of Occupational Therapy Colorado State University
Richmond, Virginia, USA Fort Collins, Colorado, USA

Jennie Brentnall, BAppSc Carolyn Dunford, PhD, MSc, DipCOT

Senior Research Assistant Head of Research
Faculty of Health Sciences The Children’s Trust
University of Sydney Tadworth
Sydney, New South Wales, Australia Surrey
United Kingdom
Imelda Burgman, PhD, OTR, AccOT
Conjoint Senior Lecturer Luisa Ferronato, BAppSc(OT) (Hons),
School of Health Sciences Grad Cert OT (Env Mod), BBus
Faculty of Health (Marketing)
University of Newcastle National Manager Assistive Technology Services
Callaghan, New South Wales, Australia Vision Australia
Enfield, New South Wales, Australia
Ted Brown, PhD, MSc, MPA, BScOT
(Hons), OT(C), OTR, AccOT Maureen H. Fitzgerald, RN, BIS (GMU), MA
Associate Professor (Hawaii), PhD (Hawaii)
Undergraduate Course Coordinator Medical Anthropologist, Retired
First Year Undergraduate Program Coordinator Greenwich, New South Wales, Australia
Department Postgraduate Coordinator
Department of Occupational Therapy Dido Green, PhD, MSc, DipCOT
School of Primary Health Care Lecturer
Faculty of Medicine, Nursing and Health Sciences Department of Occupational Therapy
Monash University - Peninsula Campus Sackler School of Medicine
Frankston, Victoria, Australia Tel Aviv University
Ramat Aviv, Israel
Debra Cameron, PhD, OT Reg (Ont) and
Assistant Professor Honorary Clinical Expert Occupational Therapist
Department of Occupational Science and Occupational Pediatric Neurosciences
Therapy Newcomen Centre
University of Toronto Guy’s & St Thomas NHS Trust
Toronto, Canada London, United Kingdom

Reinie Cordier, PhD Barbara Hanft, OTR/ L, MA, FAOTA

Lecturer Developmental Consultant
Discipline of Occupational Therapy Silver Spring, Maryland
Faculty of Health Sciences
University of Sydney
Sydney, Australia
xiii
1228_FM_i-xxxiv 15/10/11 12:12 PM Page xiv

xiv Contributors

Jim Hinojosa, PhD, OT, FAOTA, BCP Shelley E. Mulligan, PhD, OTR/L
Professor Associate Professor and Chair
Department of Occupational Therapy Department of Occupational Therapy
Steinhardt School Culture, Education, and Human University of New Hampshire
Development Durham, New Hampshire
New York University
New York, New York Steve Park, MS, OTR/L
Doctoral Candidate
M. Shone Joos, MSc, BScOT, OT Discipline of Occupational Therapy
Reg(Ont) Faculty of Health Sciences
Clinical Associate University of Sydney
REACH Therapy Services Australia
Mississauga, Ontario, Canada
H. J. Polatajko, PhD, OT Reg (Ont), OT(C),
Stephanie J. Kain, BAppSc (OT) FCAOT, FCAHS
Service Development Manager, Children’s Service Professor
Vision Australia Department of Occupational Science and Occupational
Kooyong, Melbourne, Australia Therapy
Graduate Department of Rehabilitation Science
Natalie Kaine, BAppSc (OT) Hons University of Toronto Neuroscience Program
Pediatric Occupational Therapist Dalla Lana School of Public Health
Sydney North and East Team University of Toronto
Vision Australia Toronto, Ontario, Canada
Enfield, New South Wales, Australia
Nancy Pollock, MSc, OT Reg (Ont)
Gwynnyth Llewellyn, Associate Clinical Professor
PhD, DipOT BA Med DipContEd School of Rehabilitation Science
Professor and Dean McMaster University
Faculty of Health Sciences Hamilton, Ontario, Canada
The University of Sydney
Lidcombe, New South Wales, Australia Jo Smith Read, PhD
Director of Curriculum
Susan Lowe, PhD, AccOT Vance Charter School
Director and Senior Occupational Therapist Henderson, North Carolina, USA
Skills for Kids
Occupational Therapy and Speech Language Patricia J. Rigby, PhD, OT Reg (ON)
Pathology for Students and Schools Associate Professor
Blaxland, New South Wales, Australia Department of Occupational Science and
Occupational Therapy
Zoe Mailloux, MA, OTR/L Faculty of Medicine
Director Of Research And Administration University of Toronto
Pediatric Therapy Network Toronto, Ontario, Canada
Torrance, California
Sylvia Rodger, PhD, MEdSt BOccThy
Sheryl L. Michel, OTD, OTR/L Professor and Head
Chief, Rehabilitation Services Division of Occupational Therapy
Warrior Transition Battalion School of Health and Rehabilitation Sciences
Brooke Army Medical Center The University of Queensland
Ft. Sam Houston, Texas, USA Brisbane, Queensland, Australia

Christine Doyle Morrison, MS, OTR/L Pat L. Sample, PhD

Director Professor
Morrison and Associates Pediatric Therapists Occupational Therapy Department
LaGrange Park, Illinois, USA Colorado State University
Fort Collins, Colorado, USA
1228_FM_i-xxxiv 15/10/11 12:12 PM Page xv

Contributors xv

Winifred Schultz-Krohn, PhD, OTR/L, Stacey Szklut, MS, OTR/L

BCP, SWC, FAOTA Executive Director South Shore Therapies, Inc.
Professor Weymouth and Pembroke, Massachusetts, USA
Department of Occupational Therapy
San José State University Kerry Thomas, BSc (OT), GradDip
San José, California (Health Science)
Director, interPART and Associates (International
Ruth Segal, PhD, OTR Partners in Action, Research and Training)
Professor and Chair and
Department of Occupational Therapy Advisor with the WFOT Disaster Preparedness and
School of Health and Medical Sciences Response Project
Seton Hall University Macclesfield, SA, Australia
South Orange, New Jersey, USA
Scott D. Tomchek, PhD, OTR/L, FAOTA
Jayne Shepherd, MS, OTR/L, FAOTA Chief Occupational Therapist
Assistant Chair, Academic Fieldwork Coordinator Assistant Professor of Pediatrics
Department of Occupational Therapy and
School of Allied Health Professions Assistant Director
Virginia Commonwealth University Weisskopf Child Evaluation Center
Richmond, Virginia, USA University of Louisville, School of Medicine,
Department of Pediatrics
Susanne Smith Roley, MS, OTR/L, FAOTA Louisville, Kentucky, USA
Project Director
Sensory Integration Certification Program Jenny Ziviani, PhD, MEd, BA, BAppSc (OT)
USC Division of Occupational Science and Professor
Occupational Therapy Allied Health Research
Los Angeles, California, USA Queensland Children’s Health Service
and and
Director of Education and Research Conjoint Professor
Pediatric Therapy Network School of Health and Rehabilitation Sciences
Torrance, California, USA The University of Queensland
Brisbane, Queensland, Australia
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1228_FM_i-xxxiv 15/10/11 12:12 PM Page xvii

reviewers
Kathi L. Adams, MS, OTR James Harper, MD
Assistant Professor Associate Chair for Medical Education
Shenandoah University University of Nebraska College of Medicine
Division of Occupational Therapy Department of Pediatrics
Winchester, Virginia, USA Omaha, Nebraska, USA

Carmela M. Battaglia, PhD, OTR/L Anne Henderson, PhD, OTR, FAOTA

Professor Professor Emeritus
Keuka College Boston University
Division of Occupational Therapy Department of Occupational Therapy
Keuka Park, New York, USA Boston, Massachusetts, USA

Paula Bray, PhD candidate Heather Hunter, MSc, DipCOT

Lecturer Lecturer
The University of Sydney Queen Margaret University, Edinburgh
Discipline of Occupational Therapy Department of Occupational Therapy and Art Therapy
Faculty of Health Sciences Edinburgh, Scotland, United Kingdom
Lidcombe, New South Wales, Australia
Tracy Jirikowic, PhD, OTR/L
Kimberly Bryze, PhD, OTR/L Assistant Professor
Program Director, Associate Professor University of Washington
Midwestern University Division of Occupational Therapy
Department of Occupational Therapy Department of Rehabilitation Medicine
Downers Grove, Illinois, USA Seattle, Washington, USA

Patricia A. Burtner, PhD, OTR/L, FAOTA Kathryn M. Loukas, MS, OTR/L, FAOTA
Professor Associate Clinical Professor
University of New Mexico University of New England
School of Medicine Westbrook College of Health Professions
Occupational Therapy Graduate Program Department of Occupational Therapy
Albuquerque, New Mexico, USA Portland, Maine, USA

Reinie Cordier, BSocSc (Hons) (Clin Annette Majnemer, OT, PhD

Psych), BOccTher, MOccTher, PhD Professor
Lecturer McGill University
The University of Sydney School of Physical & Occupational Therapy
Discipline of Occupational Therapy Montreal, Quebec, Canada
Sydney, New South Wales, Australia
Vicky McQuillan, M Ed, SROT
Jean Deitz, PhD, OTR/L, FAOTA Lecturer in Occupational Therapy
Professor Emeritus University of Liverpool
University of Washington School of Health Sciences
Department of Rehabilitation Medicine Liverpool, United Kingdom
Seattle, Washington, USA
Keli Mu, PhD, OTR/L
Janet V. DeLany, DEd, OTR/L, FAOTA Associate Professor
Associate Professor Creighton University
Towson University Department of Occupational Therapy
Department of Occupational Therapy and School of Pharmacy and Health Professions
Occupational Science Omaha, Nebraska, USA
Towson, Maryland, USA
xvii
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xviii Reviewers

Jane O’Brien, PhD, OTR/L Karen C. Spencer, PhD, OTR

Associate Professor and Department Director Associate Professor
University of New England Colorado State University
Westbrook College of Health Professions College of Applied Human Sciences
Department of Occupational Therapy Department of Occupational Therapy
Portland, Maine, USA Fort Collins, Colorado, USA

Tanya L. O’Callaghan, Michelle Spirtos, BScOT, MSc

BSc(OT)Hons,OTD, PGCert Lecturer
Lecturer Trinity College Dublin
Oxford Brookes University Faculty of Health Sciences
School of Health and Social Care School of Medicine
Occupational Therapy Course Department of Occupational Therapy
Marston, Oxford, United Kingdom Dublin, Ireland

Margaret J. Pendzick, MOT, OTR/L, BCP Elizabeth A. Stephenson, SROT, PhD

Senior Instructor University of Liverpool
The Pennsylvania State University School of Health Sciences
Occupational Therapy Assistant Program Occupational Therapy Course
DuBois, Pennsylvania, USA Liverpool, United Kingdom

Merrolee Penman, MA(Educ), DipOT, Debra A. Tupé, MS, MPH, OTR/L

NZROT Assistant Professor of Clinical Occupational Therapy
Principal Lecturer and Academic Leader Columbia University
Otago Polytechnic Programs in Occupational Therapy
School of Occupational Therapy New York, New York, USA
Dunedin, New Zealand
Judith C. Vestal, PhD, LOTR
Kathy Perrin, PhD, OTR/L, FAOTA Associate Professor
Chair, Division of Human Performance Science & Louisiana State University Health Sciences Center –
Associate Professor Shreveport
University of Mary Department of Rehabilitation Sciences
Division of Human Performance Sciences Program in Occupational Therapy
Department of Occupational Therapy Shreveport, Louisiana, USA
Bismarck, North Dakota, USA
Renee Watling, PhD, OTR/L
Stacey Reynolds, PhD, OTR/L Adjunct Faculty
Assistant Professor University of Puget Sound
Virginia Commonwealth University School of Occupational Therapy
Department of Occupational Therapy Tacoma, Washington, USA
Richmond, Virginia, USA
Susan B. Young, MA, OTD, OTR/L, FAOTA
Patricia Rigby Associate Professor
Associate Professor Belmont University
University of Toronto Department of Occupational Therapy
Department of Occupational Science and Nashville, Tennessee, USA
Occupational Therapy
Toronto, Ontario, Canada Jenny Ziviani, PhD, MEd, BA, BAppSc (OT)
Associate Professor
Heidi Schwellnus, BHSc OT, MSc The University of Queensland
Assistant Clinical Professor School of Health and Rehabilitation Sciences
McMaster University Division of Occupational Therapy
Faculty of Health Sciences Brisbane St. Lucia, Queensland, Australia
School of Rehabilitation Science
Occupational Therapy Program
Hamilton, Ontario, Canada
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acknowledgments
Like all important undertakings, this book reflects the graphic illustrations, communicated with authors, picked
effort and support of numerous people. Without them, up batons that we were at risk for dropping, and tried to
it would not have been possible. keep us moving steadily forward: Jennie Brentnall, Reinie
First, we owe an enormous debt of gratitude to the Cordier, Lina Engelen, Tim Luckett, Anita Niehues,
hundreds of occupational therapy students with whom Stacey Reynolds, Jo Ragen, Jayne Shepherd, Lawrencine
we have worked over the course of more than 30 years. Smith, and Shirley Wyver. Apologies to those we have
Their quest to understand the lives of the people with undoubtedly missed.
whom they would work prompted this book. Several individuals and institutions contributed
Many people at F.A. Davis ensured that an idea born significantly to the look and feel of the text through use
on a porch in Grand Lake, Colorado, would become a of their photographs and often their accompanying
reality. We began the journey with Lynn Borders Caldwell stories. For that, we are immensely grateful to Angie
and Margaret Biblis. They believed in our ideas and Carter, Australian Hearing in Chatswood, New South
encouraged us to take pen to hand. Christa Fratantoro Wales, Australia; Cochlear Americas in McLean, Virginia,
offered support and the gentle “nudge” at many crucial USA (www.cochlearamericas.com); Do2Learn in Raleigh,
points. Joined by Elizabeth Stepchin, the two of North Carolina, USA (www.dotolearn.com); Great Lakes
them saw us through to the end. We knew we could Burn Camp in Jackson, Michigan, USA; Gudrun Gjesing;
call on them when needed—and we did. Nancy Peterson Laura Horowitz; Arthur Hsieh; Kristen McDonough;
and Laura Horowitz read every word—sometimes mul- Allison Mistrett; Jaime Munoz; Northcott Disability Serv-
tiple times. They prompted and encouraged in equal ices in Parramatta, New South Wales, Australia; Pediatric
measure—and we are grateful. The office support offered Prosthetics (www.kidscanplay.com); Jo Ragen; Jayne
by F.A. Davis appears to be unparalleled in the publish- T. Shepherd, MS, OTR/L, FAOTA; and Lise Hostrup
ing business, and we are thankful for the partnerships we Sønnichsen.
have forged with them. Our thanks also go to Robert Bender, for the gracious
Through generous financial support, F.A. Davis facili- use of several children’s quotes from his books, Lima
tated our cross-continent collaboration. The University Beans Would Be Illegal: Children’s Ideas of a Perfect World
of Sydney supported Shelly’s three-month stay in Aus- and Never Eat Anything That Moves!: Good, Bad, and Very
tralia as a visiting research fellow in 2009. That experi- Silly Advice from Kids, published by Dial Publishing.
ence was once-in-a-lifetime. We accomplished a lot as a Finally, those who are closest to us offered (nearly)
result. unending support and to say that we are grateful is pos-
The contribution of each contributor was especially sibly the understatement of the century: Rick Thornton
critical. Although that almost goes without saying, we and Ginny Deal, and Hannah and Lucas Thornton. As
would never want it to. This group of scholars is amazing always, the pets played their part. Cody and Sadie (of the
and amazingly patient. It has been our great pleasure to dog variety) provided contact comfort by sleeping at our
work with them. feet; Amy, Bree, Lucy, and PJ (of the cat variety) provided
The reviewers, too, played an important role. F.A. Davis moments of humor and comfort as they alternately
is the most careful and caring publishing company walked on our keyboards and curled up nearby. PJ has
we have ever encountered. Each of these chapters was seen us through two books. She spent more time sleep-
reviewed multiple times. The reviewers’ feedback was not ing on her heating pad than typing this time. So any
always easy—but it was always right. We hope we have errors are unquestionably our responsibility.
done it justice. Shelly Lane
Numerous colleagues and friends contributed in other Anita Bundy
enormously important ways and they reflected on ideas
and content, helped us to capture our thoughts as

xix
Discovering Diverse Content Through
Random Scribd Documents
 CHAPTER XIV

Unfailingly every lady who entered, in all the splendour of her ball
dress, stopped a moment at the threshold of the hall of the Palace
Hotel, to give a glance at the hall, which is divided into two or three
parts, curiously divided and united, where the fortunate inhabitants
of this Olympus of the Engadine were standing, sitting, or walking
about in pairs or groups. And by the lady's rapid and indicative
glance, which embraced the spectacle, she was at once recognised
as initiated or profane. The initiated was the lady of other hotels of
the Bad or Dorf who, by her rank and habits, was constantly in touch
with the Olympus of the "Palace," who often came there to dinner
and took part in all the balls; she was the great lady living in a
sumptuous private villa with her family, retinue, and carriages, and
hence she was not only initiated, but was a goddess of an Olympus
more Olympian than the "Palace," if it is possible to imagine it. The
initiated halted a moment to look, at the threshold of the hall,
merely to search with her eye for an especial friend; and she, if
there, would come towards her with a rustling of silk, with a shining
of sequins and diamonds, and would take the initiated away with her
to a corner at the back to chat, as they waited for the ball.
But in the glance of the profane, at the threshold of the sacred
vestibule, which they had seldom crossed in the daytime or never,
and who were certainly crossing it for the first time at night,
everything was to be seen: uncertainty, curiosity, vanity, humility,
embarrassment, fastidiousness, and perhaps even a slight feeling of
pain. The more vainly audacious of the profane adored and hated
the "Palace" from afar, and they were dying to go there to mix with
those Olympian surroundings, yet none of them ever succeeded in
being invited there; so they pretended not to mind and spoke badly
of the "Palace," though they would have walked on their knees to
enter and remain there on one or all of the guest nights. Other
profane were anxious to gain an intimate knowledge of an
atmosphere famous for its refined luxury, for its exquisite pleasures,
for a sense of exclusiveness, and secretly tormented by curiosity and
desires beyond their station, had eagerly waited the chance of living
there for one evening only, even as intruders. Some other profane
living at St. Moritz apart from great festivities, meetings, and
amusements, wishing for one night to show the rich dress they had
never put on, and the hair tiring they had never tried, wishing for
one evening not to be bored, had firmly believed in satisfying this
complex desire of theirs by passing an enchanting evening at the
"Palace." And since for twenty francs one could reach this lofty,
closed Olympus, since for only twenty francs one could enter this
terrestrial paradise, all the profane—the vain, the covetous, the
dreamers, the curious, the bored—had been preparing themselves
for a week for this supreme approach, had been agitated about their
dress, their hair tire, their cloak, their carriage, and their escort. In
appearance they were happily agitated, but secretly they were
preoccupied about cutting a poor figure in some way, and they
pretended ease, distraction, simplicity, as if from time immemorial
they had been frequenters of the "Palace." But the moment they
penetrated the first vestibule of the temple dedicated to the god
"Snob," in that temple which seemed to bear written, in its shining
lights, in the superb wealth spread around, in the powerful luxury of
its atmosphere and its people, the prophetic and violent motto of an
ardent and feverish society: "EVVIVA LA VITA!"
When these profane, these intruders, entered there, all their
emotion, all their fervour, in the long glance, changed into doubt,
regret, and pain, and they would almost have turned back, as if they
felt themselves profane, more than ever and eternally profane.
However, hesitation, contrition, and pain were but for a moment:
with the deep, civil courage of which women give a hundred proofs
every day, of which no one is aware, though often it reaches to
heroism; with an act of resolution and valour, with feigned
indifference and ingenuousness, the profane entered and advanced,
as if they were initiated. No one came forward to meet them; they
knew not where to direct themselves, whether to right or left or to
the rear; but followed resolutely by their husbands and brothers,
they went and sat down in some place, fanning themselves or
playing with their shawls, tranquil in appearance, as if they were of
the house, as if they had lived for years at the "Palace."
Soon the profane were in every corner; and if their number
increased, their worldly condition at that festival was not bettered.
No one knew them there, they knew no one—they remained
isolated. After chatting a little with a husband or brother or son who
accompanied them, appearing to smile and joke, to be interested
and amused, they became silent and discouraged. They watched
with badly concealed anxiety the elegant crowd that surrounded
them, that was seated or grouped together or divided, as it greeted
each other or chatted livelily; the poor profane watched to discover a
face they knew of man or woman, to exchange, if not a word, a
greeting, a smile, a nod with a human being of that crowd, and,
disconsolate, finding none, they lowered their eyes upon the figures
of their Louis XVI fans. Still more deeply irritated were the profane
who by chance knew someone at the "Palace." The loud,
presumptuous, very wealthy Frau Mentzel came from the Stahlbad,
and as she held a privileged court there, she had succeeded
sometimes, merely by chance, in having at her luncheons, her
goûters, and her dinners some gentleman of the "Palace" itself, or
some initiated of the "Badrutt," of the Grand Hotel, the Château, the
villas, on days in which one of these gentlemen had absolutely
nothing better to do; this Frau Mentzel was absolutely scandalised
because among the three or four of those she knew one had greeted
her, saying two words, and had turned on his heels; another had
merely bowed to her without speaking; another had not seen her;
and the last had openly pretended not to have seen her. Covered
with jewels, in a sumptuous Parisian toilette, with an enormous
feather in her hair, she did nothing but grind her teeth, chewing
curses against the four lâcheurs, while her husband and her two
cavalieri serventi, two colourless and humble parasites, listened
terrified and silent, as they bowed their heads servilely.
As for Donna Mercédès de Fuentes, profane of the profane, who
looked very beautiful in a white satin dress trimmed with silver, who
was always beautiful, in spite of too much rouge, bistre, and pearl
powder, with which she spoiled her brown, Spanish face, she had
seen three or four faces pass before her; and among them her
Italian friend, Don Giorgio Galanti. Every time the perfidious Italian
gave his arm to a different lady and only once had he directed at
Donna Mercédès a greeting and a distinctly cold smile. And she had
hoped to be led round in triumph by him through the salons of the
"Palace"; she had dared to hope to dance the cotillon with him.
Deluded and deeply snubbed, she had not even the strength to
quarrel in Spanish with her poor husband; her beautiful black eyes,
which were too much underlined with bistre, filled with tears.
As if they wished to show even more markedly the distance that
separated them from the profane, matrons and maids and
gentlemen of all ages treated each other with such domesticity, with
such familiarity, that they seemed to be the closest relations, the
most intimate and inseparable friends. The women particularly
tutoied each other; many men and women called each other by
name. French diminutives and English endearments were to be
heard and strange nicknames. One greeted Fanchette, another
excused the absence of Bob, one gave news of Dorine, another
asked after Gladys or spoke of Bibi's illness. In that society it seemed
as if no one any longer had a surname or title; all seemed brothers,
cousins, husbands, lovers of one race and caste, of a single country
and house. Whatever did the wretched, profane intruders know
about those names, endearments, and nicknames, whoever they
were, wherever they came from, whatever they did; if Bibi were a
man or woman, or if Gladys were young or old? However could the
profane intruders understand those conversations in French, English,
or German, conversations which seemed to be carried on in a special
and incomprehensible, aristocratic jargon, full of sub-
understandings, references to people unknown to them, allusions to
events they knew nothing of; however could they understand that
chaff full of completely conventional wit, whose formula escaped
them? What could they see in the malicious smiles, in the little
sceptical bursts of laughter? What could they grasp of the subdued,
half-uttered phrases said with a sneer—a regular cryptic language,
let us say? How could they imagine from a word thrown into the ear
an assignment, a refusal, a consent, a warning, a malignity, a
trouble, a scandal especially; words underlined by a fleeting but
expressive glance, by a rapid but suggestive squeeze of the hand?
Ought not the profane intruders to be astonished, stupefied, almost
oppressed by all this, while the curious, alluring spectacle was
augmenting their wonderment and secret pain?
A curious, most curious, yet alluring spectacle! Not one of the ladies
of the "Palace" or of the initiated resembled each other; not one was
dressed alike; there was not one whose jewels resembled another's;
not one whose beauty was equal to another's; not one whose
ugliness was similar to another's ugliness. All were truly Olympian,
by an almost mysterious sign that made them seem of one race and
caste, of but one country and family. But beyond this indefinite sign,
each preserved a personal character in face, dress, features, and
gestures. And all these women seemed to be detached from a
background even more phantasmagorial, of exquisite French
women, who caused the flowing lines of their Parisian dresses to
undulate gently from their hips, amidst light lace and soft silk,
purposely brought from the great ateliers of the Rue de la Paix for
balls at the "Palace"—le Palace, ma chère, vous pensez—detached
from a background of Austrian ladies, with rich and graceful dresses,
certainly beautiful, but rather more pleasing than beautiful;
separated by a background of Egyptians, Greeks, Roumanians,
Argentines, Spaniards, who owed it to their immense fortunes, their
natural, humble sweetness of temperament, that they were enabled
to be introduced and placed in the Olympus of the "Palace";
detached from a background of Italian women, majestic and grave,
or pretty and witty—each figure, amidst those more prominent and
those more in the shade, with her own character and own life
forming a curious, singular, and alluring spectacle. The profane
intruders, with dazzled eyes and bewildered glance, went from one
to another of these feminine figures and now and then, tired of
wondering, they lowered their glance, a little pale, before a world of
such varied appearances, multiform and dissimilar, a world from
which every moment they felt themselves separated for ever: they
raised their eyes, ever less anxiously, ever more fatigued, for some
new, wondrous apparition.
At last, amidst the murmurs of the whole crowd, appeared, late as
usual, the famous Miss Miriam Jenkyns, a divine girl—ah, elle est
vraiment divine, ma chère—with whom already ten to thirty
celebrated personages were in love, and numerous unknown
personages. Amongst the illustrious were an hereditary prince of a
powerful empire, an Indian Maharajah, a grandee of Spain, a
celebrated scientist, a renowned painter and father of sons; but Miss
Jenkyns loved none of them, and instead, contented herself with her
unrestrained desire of conquest, being now a Europeanised
American girl, full of the deepest scepticism. Nevertheless, as she
came from Pontresina she appeared one of the last, desired and
invoked especially by those who had never seen her. She appeared
in a wilful simplicity, dressed in a tunic of white wool, like the
"Primavera" of Sandro Botticelli, adorned with a branch of flowers
which crossed the skirt right to its hem, with hair knotted a little
loosely as in the picture of the great Tuscan, and covered with loose
flowers, with a white tulle shawl, like a cloud, on her shoulders and
arms. Her natural beauty had been recomposed and transformed by
her according to the purest pre-Raphaelite type, and it was very
difficult to discover the subtle and minute art of the recomposition
and transformation. There was another great murmuring, one of the
last, when the Princess of Leiningen entered, an Armenian who, in
the strangest circumstances, had married a German mediatised
prince, a military prince, whose appearances were rare. Not very tall
of stature, in fact rather small, but moulded to perfection, with little
hands and feet, the Princess of Leiningen comprised within herself
the poetic legends of Armenian beauty. Beneath a mass of black,
shining hair, her forehead was white and short, her two immense
black eyes were shining like jewels; she had a pure, oval face, very
white, on which the long eyelashes cast a slight shadow, touched up
by the inevitable but pretty maquillage of Eastern women, with
rather a crimson rouge on the cheeks and the lobes of the ears, a
slightly violet shade beneath the eyes, some black, the better to arch
the subtle eyebrows, and a little of the rather crimson rouge on the
lips. She was dressed completely in black, and since she was so
white she seemed to rise from a background of shadow; an
immense hat of black tulle strangely framed her white face and
splendid eyes. She always wore an immense hat, black or white,
even with her décolleté dresses, and she never danced. She crossed
the room with her light little feet, shod in white satin, without
looking at anyone—a dream creature, unreal as one of Edgar Allan
Poe's characters, unreal as a vision in an hallucination. She remained
at the back of the salon silent beneath the shadow of her black hat
and black dress, completely white with her unreal countenance.
At this last strange appearance the profane felt their impressions to
be founded and they settled themselves into two different parties.
The one, proud and impertinent, like Frau Mentzel, openly hated the
surroundings they had wished to penetrate and began to vent their
anger and their humiliation, finding all the matrons and maids of the
"Palace," who were unaware of their existence, ugly, awkward,
indecent, shameless, venting their anger on their husbands and
followers who, poor people, through cowardice agreed, though they
were frightened at heart lest these vituperations should be heard, as
they looked around them carefully in fear of a scandal. The other
party, true snobs, blind and deaf adorers of that surrounding,
venerated it even more deeply, felt themselves even more
humiliated, and oppressed, bewailing even more their own
anonymity, nullity, and lack of existence. They felt they deserved to
be anonymous there and non-existing for ever: they understood that
they had no right, that they never would have any right to belong to
that superior, unarrivable, sublime humanity that lived at the
"Palace"!
The which superior, unreachable, sublime humanity, while it aroused
such vain disdain, such empty proposals of revenge, such sterile
lamentation among the wretched profane, was troubling itself with
nothing else at that lively and intense hour of the ball but with that
deep and supreme feminine interest—to see, observe, study, value,
and put a figure on the jewels of the other women in the ballroom.
To note, analyse, and value these jewels and compare them with
their own; at times to smile in triumph, or enviously, or really
bitterly, according as their own jewels succeeded in being superior,
equal, inferior, or very inferior to the others. Their eyes seemed not
to rest on the pearl necklaces, on the rivières of diamonds, the
diadems of pearls and diamonds, the emerald solitaires, and the
ruby sprays. Their glance was fleeting, their lips offered other words,
but the women did nothing but mentally make rapid calculations,
after which they smiled carelessly, or suddenly sighed, or were
unexpectedly disturbed. For on that summer night in the high
mountains, in a landscape of the purest beauty, amid proud peaks so
close to the stars, amid eternal glaciers that told an austere and
terrible tale, in that room there were collected, in the shape of
jewels, the fortune perhaps of a populace. At the splendour of
thousands and thousands of gems, at the scintillations of those
thousands of precious stones, in the presence of all that bewildering
brilliance, women's beauty, girls' grace, and richness of apparel were
concentrated into a furnace of light, lost their value, and were
completely eclipsed. Each woman's hair, neck, bosom, and arms
were so thickly crowded with pearls and diamonds, sapphires and
emeralds, while the jewels of some were few, but enormous, that
nothing took the eye or mind, at once astonishing and frightening,
but that mad, frenzied luxury up there in the high mountains, in the
still summer night, not far from the whiteness of the peaks profiled
against the sky. But suddenly even that madness and frenzy seemed
conquered, and in spite of the studied reserve of all those women,
and in spite of the studied indifference of the men, a word passed
from group to group, from room to room, murmured a hundred
times, softly or loudly:
"The tiara! The tiara!"
Mrs. Annie Clarke appeared in the hall, coming from her apartments,
although her daughter had been dancing for an hour, having for her
partner in the cotillon Don Vittorio Lante della Scala. Being lazy,
Annie Clarke always arrived late, or perhaps she did so purposely.
That evening she was wearing a rather dark dress of purple velvet,
trimmed with quite simple lace; from neck and bosom descended a
rivière of diamonds, which were very large at the neck, and
afterwards became less large, in long streams of small, shining
diamonds, like streams of running water, falling to the waist, whence
neck, bosom, and corsage assumed a luminous, strange appearance.
But what was astounding in Annie Clarke that evening, what had
never been seen before, was her diamond tiara. It was not a single
diadem of large diamonds, but three diadems, one above the other,
in flowers, and leaves, and Arabic work and points. It was a veritable
little tower of diamonds, perched on a suitable coiffure. It was a
tiara that bizarrely resembled those of the High Priests of Buddha in
Indian temples, a tiara that strangely resembled the jewelled triple
crown of the Pope of the whole Catholic world. It was the tiara of all
the great American ladies, the famous tiara of the house of Clarke,
like a lighthouse or like the torch which Bartholdi's "Liberty" holds
aloft over the port of Brooklyn, to show navigators the entrance to
New York. As Annie Clarke crossed the length of the hall quietly and
indifferently to pay her respects to Her Serene Highness, the Grand
Duchess of Salm-Salm, this Clarke tiara, beacon and torch of
America, eclipsed, annulled, destroyed—a unique, inimitable jewel—
all the other jewels of the women who were gathered there. After a
great silence of wonderment amongst the throng, of groups near
and far, after a silence of stupor, spite, annoyance, envy, anger, and
sadness; after some instants of these atrocious, seething sentiments
of every kind, a chattering began and spread everywhere about the
tiara and against it, about Mabel's marriage and against it.
"Puis-je me congratuler pour les fiançailles de votre chère fille?" the
Grand Duchess politely asked Annie Clarke.
As she bowed, the tiara threw a stream of light around. Beneath her
tiara Annie Clarke smiled, bowed, and expressed her thanks.

Of the hundred and twenty ladies who were present at the "Palace"
festivities that evening but eighty, perhaps, were seated round the
ballroom for the charity cotillon; and among the eighty only thirty
were dancing. Thus even in this that reputation for theatricalism and
parade, which everything assumed in the "Palace" Olympus, was
maintained: that reputation was maintained, so that there was
always a spectacle and a public which at times changed sides,
passing from the stage to the stalls, and vice versa. There were not
many couples, then, to dance in the long and undulating whirls of
the "Boston," in the rapid if rarer twirls of the waltz—so much the
fashion now the "Boston," so out of fashion the waltz! There were
not many couples, hence those who danced had plenty of room in
which to turn round, now languidly, now more resolutely, in the
difficult modern art of the "Boston." There was no bumping of each
other; trains gyrated in their silken softness without being trod upon;
voile and tulle skirts seemed like revolving clouds. Thus the dancers
could display all their mastery of the dance if they possessed it, and
those who did not possess it dared not expose themselves on the
stage, since all around the curious, attentive public followed such a
dance spectacle as if they were at the theatre; observing, criticising,
approving, and scoffing. On that stage there were some of the
dancers of the first flight: the slender Principessa di Castelforte in
her white dress and with her string of pearls, worth half a million;
another Italian, the Marchesa di Althan, a reed of a woman with an
attractive, ugly face; Signorina de Aguilar, a Brazilian, dressed in red,
with a vigour quite Spanish, dancing like a lost soul, like an
insatiable flame. Madame Lawrence danced like a Grecian bas-relief;
Miss Mabel Clarke with perfect harmony, in the grace and ardour of
the dance; Miss Miriam Jenkyns glided as if she were a shadow or a
nymph on the meadows. And there were other celebrated dancers,
celebrated in all cosmopolitan salons, at Biarritz, at Nice, and at
Cairo.
In the first flight among the men were Count Buchner, the diplomat,
who had danced in all the capitals of the world for thirty years on
end, and at sixty, dried and withered as he was, was still a beautiful
dancer; the beau of beaux, the Hungarian, the Comte de Hencke,
the famous dancer of the majourka to the music of Liszt; Don
Vittorio Lante della Scala, one of the most graceful and vigorous
dancers of Italy; the young Comte de Roy, the little Frenchman;
Edward Crozes, the twenty-year-old son of Lady Crozes. People
came and went from the hall, the saloon, and other rooms, and the
audience at the performance changed and was renewed around the
famous dancers. The performance continued, each performing his or
her part with artistic zeal, amidst the approval or adverse criticisms
of the audience. In a dress of tenderest pink crêpe, surrounded by a
silver girdle, with a small wreath of little roses around her riotous
chestnut hair, Mabel Clarke, one of the chief characters of this
worldly comedy, was dancing the beginning of the cotillon with
another of the chief dancer-actors, Vittorio Lante della Scala; but
seized by the truth and the force of their feelings, they forgot to be
actors. They had no thought of pleasing others, of being admired by
others. They forgot altogether their surroundings, with their artifices
and pretences and obligatory masks; and only the perfect, tranquil
joy of being together held them in its beautiful frankness, of not
leaving each other, of being able to let themselves go to the rhythm
of the music in harmonious turns, where they seemed to depart and
vanish afar in a dream of well-being led on by the languid murmur of
the music. In their sentimental absorption they seemed even more
to suit each other, and the public of the boxes and stalls around
them wondered at them, then with a sneer the fashionable
gossiping, calumny, and back-biting began again, subduedly.
"... Lante has hit it off."
"... The girl has lost her head."
"... Of course, he has done his best to compromise her."
"... In any case, he won't be the first."
"... St. Moritz is a great marriage mart."
"... There are plenty of men, too."
Every now and then the music was silent, and the dancers
promenaded arm in arm or sat down for a moment, the girls with
their hands full of flowers and their figures crossed with ribbons of
brilliant colours, the cotillon gifts. Then matron and maid would
approach Mabel and Vittorio with a smile of satisfaction on their lips,
asking in French, in English, in German:
"May I congratulate you?"
The American girl's beautiful head, crowned with roses, said "yes"
with a gracious, frank bow. Vittorio Lante, unable to control himself,
for a moment paled with joy, and twisted his yellow moustaches
nervously. The friend would be profuse in her compliments.
"Merci, chère, merci," exclaimed Mabel Clarke frankly, in her limpid
voice.
"Oh, thanks!" scarcely murmured Vittorio Lante.
Once alone, they looked at each other, enjoying those delicious
moments intensely. Then, without speaking, in simultaneous action,
they joined in the dance again, between the Countess of Durckeim,
the Hungarian, a charming eccentric, and Beau de Hencke, who
astonished the room, or they danced between the Comte de Roy and
Miriam Jenkyns, who danced as if in one of Corot's pictures. Then
the friend, maid or matron would rejoin her own set. With spiteful
glances, correctly veiled, with slighting words and unfinished phrase,
the chorus about Mabel Clarke began again:
"... Oh, these American girls, all the world is theirs. It is disgusting."
"... These American girls pretend to be strong, and as soon as they
see an Italian's moustaches they fall."
"... These American girls; their dowry is always a story, a fable, a
romance."
"... Dowry? A settlement, and uncertain, too."
"... Papa Clarke may go under."
"... He has gone under three times."
"... Mabel's dear papa is a faker of pig's flesh."
"... The mother is silly and vain. Poor Vittorio, what a father and
mother-in-law!"
In a dance that became ever more lively, the first and second parts
of that theatrical spectacle passed—the "Palace" cotillon. A more
precipitous movement led the couples amidst gauze, tulle, ribbons,
paper caps, streamers of fresh flowers, and Swiss bells of silver
paper.
Now and then, during a moment's pause, a friend stopped beside
Mabel and Vittorio, formulated a courteous inquiry, bowed at the
reply, and offered his congratulations, seemingly complimentary and
full of worldly good-nature. The orchestra gave forth its fervid recall;
the couples danced anew in a hurried whirl. The friend would
withdraw to form the centre of a group of men, old, middle-aged,
and young, to whom he brought the news, and where the worldly,
masculine choir, with disingenuous air, with an air as if it did not
matter, occupied itself particularly with Vittorio Lante.
"... He hasn't a farthing."
"... Seven hundred thousand francs' worth of debts."
"... Refused five times by five girls."
"... His mother mends silk stockings to get a living."
"... He can't pay his hotel bill."
"... Oh, now his creditors will wait."
"... Is it true that he paid his attentions to the mother?"
"... He hasn't a title. The real princes are the others, the Della
Rovere."
"... He can buy it back; it is there in the family. He has only to pay
well for it."
"... He can do that now."
"... It seems that the girl has already given him money. It is the
custom in America."
More gaily, naturally, and simply towards its close, the cotillon
gathered together all the couples in the room. By now all the actors
had forgotten parade and performance, and were merely
abandoning themselves to the great and intoxicating pleasure of
living. The cotillon ended, because all wished to go to supper, to the
extremely dainty, exquisite supper which, in an extremely new chic
aspect, closes every special night at the "Palace." In two or three
rooms the tables were ready. The company was chosen carefully,
sympathetic and antipathetic were again carefully expressed, with
bizarre reunions and cruel exclusions. In the ballroom the final
picture still kept the crowd. Upon two little chariots, drawn by hand,
appeared two great piles of green branches and wild flowers, tied
with ribbons. Drawn joyfully into the middle of the room, the
bundles were opened, revealing in the one Miriam Jenkyns, in the
other Mabel Clarke, the two leaders of the cotillon. The greatest
applause greeted this final picture, and while the pair led the final
gallop, there were still some discreet exclamations directed at Mabel
and Vittorio:
"Vive les fiancés!"
Blushing in her pink dress as she left the room on Vittorio Lante's
arm, Mabel Clarke passed into the hall, to look for her mother to sup
at the great Clarke table. And now everyone surrounded her, to
congratulate her and Vittorio, and both, happy and composed,
returned thanks. A few moments afterwards all were seated at table.
At a table for men only, amidst young and old, all more or less
dowry-hunters, their less happy and less fortunate chief, the Vicomte
de Lynen, was telling in a low voice, between the langouste à la
Colbert and the chaufroid de gibier, how three years ago Vittorio
Lante had seduced a poor cousin of his house, how she had had a
baby by him, how he had deserted mother and little daughter, and
how the mother had threatened to vitrioler l'Américaine.
 CHAPTER XV

Again, on the 23rd of August, the whole Engadine was encompassed

and surrounded by rain, not one of those rough, short showers of
the high mountains, which pass from valley to valley like a seething
whirlwind, and leave the sky cleansed and serene where they have
passed, while the sky they overtake becomes cloudy and obscured;
but it was a soft, close, continuous, almost tireless rain. The rain fell
upon the ground indefatigably, and impregnated it with profound
damp and pungent freshness; it fell on the waters of the lake, from
the great lake of Sils to the melancholy little lake of Statz, imprinting
on them thousands of little circles, thousands of little ripples; it fell
upon the leaves of the trees, the meadow grass, the last flowers of
the Alpine summer, and leaves and grass became lucid with a new
and intense green, and the flowers became brighter. It fell on roofs
and verandahs, on villages and countryside, and cleaned and clothed
them with a bright mist, renovating the air and ever purifying it. At
windows and balconies, at the glass doors of the hotel vestibules, on
that rainy morning there waited for some time all those who in the
Engadine go out every morning, sooner or later, many longing for
the fresh, free air, many for amusements and diversion, while others
were sighing for the usual meetings, of accident or design, for
adventures begun or about to begin. Each as he watched the sky
and the horizon waited for the rain to tire, diminish, and cease; but
the rain seemed even more regular and tranquil, as it fell
methodically and monotonously in an immense veil of light grey that
held the whole Engadine.
Then men, women, and children who were unwilling to renounce the
open air, their distractions and meetings, gradually vanished from
window, balcony, and the glass doors of vestibules, and by degrees
the roads of St. Moritz Bad, which had been deserted for one or two
hours, began to be filled with people sallying forth from the hotels,
dépendances, pensions, and villas, who descended on tram and foot
from St. Moritz Dorf to the Bad in search of life, movement, and
people. But beneath the fine downpour, and through the continuous
silvery drops, people were of another colour and assumed other
lines. All the white dresses of the women were changed to black,
dark grey, and blue, and all the white, transparent blouses had
vanished, or were hidden beneath woollen jackets, closely buttoned
at the bosom, with collars raised; and skirts were shorter than ever,
showing the feet to the calf, shod in strong boots with short nails. In
place of white, blue, or pink veils, that formed a cloud round hats
and faces, were substituted dark veils which surrounded hat and
face tightly. All the variegated summer suits of the men had
vanished, with straw and panama hats, and all were dressed
gloomily in black overcoats; the Germans especially had drawn on
their ulsters, cut as it were with an axe, like the side of a chest of
drawers, with a belt behind held fast by a huge button. But beneath
the incessant rain all seemed another people, with other faces and
bodies, with other gestures and movements. All went with rapid
steps, without stopping, along the beautiful clear roads of the Bad,
amidst the gardens full of trees and the public park, only slowing
their steps beneath the famous porticoes of the Bad. Nearly all came
and went to and from the great wooden promenoir, where is the
Serpentquelle, a new spring, to and from the galérie de bois, which
is the meeting-place of meeting-places when it does not rain—but
there is no promenading when it rains—while in the background the
orchestra plays the more passionate airs from Carmen, and the more
penetrating from Manon, and on the other side the ladies pretend to
drink the waters while they walk up and down and flirt. That
morning the promenoir is all humid with the rain, and there is a light
vapour and steam in the air; but the meetings, the distractions,
adventures even, beneath the rain, developed themselves, while the
notes of Aïda caused Italian hearts to beat.
In the afternoon, as the rain continued, a different way of using the
time was organised. In the vestibule of the Hôtel du Lac was hung a
notice, on which was written "Kinderballet," that is to say, a
children's dance, the celebrated, pretty dance for children which
takes place at that hotel on a wet day. At the "Stahlbad" Frau
Mentzel invited, through the telephone, fifty people to tea, when in
the salon there were already fifty people belonging to the same
hotel. At St. Moritz Dorf, at the "Palace," twenty bridge tables were
set, instead of the usual eight; at the "Kulm" a billiard match was
started. Everywhere ping-pong tables were set up for boys and girls,
everywhere the reading-rooms overflowed with people, and as an
exception each took tea in his own hotel. Towards six the rain began
to diminish, at half-past six it rained no more; so nearly all the men
went forth for a quarter of an hour or five minutes for a breather, as
they said, or to buy a paper and flowers. All breathed a very fresh
air, and he who tarried found it very cold. At eight in the evening in
all the hotels, as the ladies came down to dinner in low dresses, the
large fireplaces had been lit; on entering their rooms at midnight
they found their fires lit, and the stoves roaring with heat. The
thermometer had descended rapidly to one degree below zero. Next
morning the whole Engadine was covered with snow; it had snowed
for five or six hours during the night.
As from his windows he watched the landscape become white with a
wintry aspect, but without any of the cruel sadness of a winter day,
with a slight whiteness in which he perceived grass and earth, with a
whiteness almost ready to melt and vanish, Lucio Sabini moved
impatiently. He opened the windows to see better, and leant out. He
perceived that on the roads the snow had already vanished, but that
the woods and meadows were still covered with it, and that the
mountains around were covered with snow right to their base.
"But the roads are free," he said to himself, striving to conquer his
impatience.
Impatience, uncertainty, and irritation disturbed him, as he dressed
rapidly, glancing now and then at his watch. During the night he had
slept little and badly, owing to a dull restlessness which he attributed
to the idea of having to rise early that morning for the excursion
with Lilian Temple and Miss May Ford to the Bernina Pass. He had
slept little and badly, perhaps because his heart, nerves, and senses
were overflowing with life, in a fullness that was sometimes too
tumultuous, which he strove in vain to repress and hide. In the
presence of the snow that had rendered white and cold all the
landscape of mountains and woods, of meadows and houses, the
fear lest that expected, desired, invoked excursion, that excursion
which was perhaps to be the most beautiful and exalted of that
month of love, could no longer take place, suddenly conquered him
and bore him down, like a child who has had what he most desired
snatched away from him.
"They will not go," he said to himself, as he finished dressing.
And the day that was a mistake and a failure oppressed him with the
weight of a mortal sadness. The carriage which was to take them to
the Bernina Pass ought already to be in front of the "Kulm,"
according to the instructions he had given the driver. Already he
should have walked the short stretch from his "Caspar Badrutt" to
the "Kulm." But with all the snow on the mountains and the woods
and meadows perhaps even the coachman had considered the
excursion postponed.
"Postponed—till when? The month is ending," thought Lucio Sabini
to himself bitterly.
At eight in the morning it was very silent at his hotel; most of the
early risers, perhaps, having seen the snow, had remained in bed.
He went into the long corridor, where at the end was the telephone;
he asked for and obtained communication with the Hôtel Kulm, and
begged that they would ask if the Misses Temple and Ford still
decided to go to the Bernina. He waited at the telephone, pale, with
his eyes a little swollen from want of sleep, chewing the end of a
cigarette which had gone out. Suddenly the "Kulm" telephone rang,
and told him that Miss Temple was at the telephone. He strove to
restrain himself, and said quietly from the telephone:
"Good day, Miss Temple; look at the snow."
"Very beautiful indeed," replied a fresh, sweet voice from the
telephone.
"Aren't you afraid? Are we still going to the Bernina?" he exclaimed,
with a trembling of the voice which he could not conquer.
"Yes, we are still going," she replied, in a secure and tranquil voice.
"Can I come, then?"
"Of course; au revoir."
He crossed the silent, deserted little streets of the Dorf in a great
hurry; the shops were scarcely opening their doors; the window-
panes were dim, and behind the window cases the shutters were still
barred. At the hotel doors the little chasseurs, in dark green uniform,
were beating their feet against the road. Not a soul was going up or
coming down; not a soul was on the square before the "Kulm"; but,
faithful to orders, the coachman was there with his carriage, only he
was wrapped up in a heavy cloak, and had placed rugs over his two
fat, strong horses, so that they should not catch cold while he
waited. Now and then the horses shook their heads, causing all their
bells to tinkle. The air was calm and equable, but very cold. Lucio
Sabini entered the vestibule, and found himself in the large Egyptian
hall, where there was not a soul; after a moment he saw Lilian
Temple coming towards him. The dear girl was dressed in a short
dress of black cloth, with a short, pleated skirt. She wore a close-
fitting jacket of otter-skin, buttoned up closely, brightened by a
cravat of white lace; she had on a little black hat, with a white lace
veil fitting closely over the rosy face and blond hair. Like a boy of
eighteen in love, Lucio Sabini found her more beautiful than ever. On
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