Employment status was a key factor in evaluating the patients' postoperative condition and in determining whether the operation was successful. Restoring the ability to lead a useful and productive life was, for Freeman, one of the main goals of the operation. However, it was not only the work ethic and values of the physician that emphasized the importance of employment and productivity. The capacity for work and productivity defined patients and family members' perceptions of individual health and well-being.

Adolf Meyer, the Swiss-born American pathologist and psychiatrist, developed a theory of maladjustment to replace the primacy of the discourse of disease in psychiatry, shifting the focus to the functioning of the individual within society. Within this framework, efficient functioning was the epitome of mental health. Meyer's model became widely influential, providing a theoretical basis for American psychiatry for at least half a century. Terming his vision of psychiatry “psychobiology,” Meyer's views gained widespread popularity and acceptance in the United States. Closely tied to values such as functionalism, pragmatism, and pluralism, while relying on common sense, Meyer's approach has been described as a “distinctively American achievement.” Meyer's approach emphasized the sum of developmental processes that ultimately enabled an efficient adaptation to reality. Throughout his career, Meyer was interested in the nascent field of occupational therapy, and his work provided an important impetus to the field's intellectual development.