AOTA Responds to Portrayal of Occupational Therapy in the Movie Downsizing


The movie Downsizing, starring Matt Damon as an occupational therapist was released nationwide today. The social satire, in which a man realizes he would have a better life if he were to shrink himself, does not portray a full picture of occupational therapy. Downsizing is classified as “comedy, drama, sci-fi”—emphasis on the science-fiction. It does not depict the world we live in, so it’s not a surprise that occupational therapy in the movie is not the same occupational therapy we know. The fact that he is an OT is a crucial part of the film in that it does move the plot of the story forward, but it is a minor part of the movie considering all the other aspects of the plot. It is possible that Writer/Director/Producer Alexander Payne knows someone who is an occupational therapist, but we were not able to ask him that directly.

In 2016, when AOTA heard first heard about Downsizing’s production, we were excited and hopeful that it would portray the profession in a positive light. When the trailer was released, we contacted Paramount Pictures to get more information on how and why occupational therapy had been selected as the main character’s profession. After repeated attempts, we were told that they would pass on the opportunity to speak with us.

Matt Damon and Director Alexander Payne on the set of Downsizing from Paramount Pictures.
Photo courtesy of Paramount Pictures.

Paul’s character represents the average, middle class man of Middle America. He just finished paying off his student loans, yet he and his wife are still struggling financially. They cannot get a mortgage because their debt-to-income ratio is still too high. They believe that downsizing their bodies would decrease their monetary spending (it does come with a federal tax credit), create less waste, and therefore they will save the planet from natural disaster.

At a high school reunion, Paul is asked what he does for a living. When he says occupational therapy, someone responds, “Oh, like career counseling?” He says, “More like physical therapy…my focus is preventing and treating work-related injuries—carpal tunnel, limb rehab, lower-back issues, stuff like that.” He says he works in-house at the local Omaha Steaks packaging and distribution center.

While it’s possible that Paul is an occupational therapist specializing in Work & Industry, the movie does not represent the holistic aspects of the profession that distinguish it from physical therapy, relying instead on the setting to make that distinction.    

While we are honored that occupational therapy was chosen as the main character’s profession, we wish the scope of the profession had been conveyed.

How is OT represented?

  • A factory worker tells him that her hand is hurting from repetitive motion. He feels her hand and recommends exercise. He asks, “Do you have tingling?” He encourages her to “keep up with the exercises. Just 15 minutes a day. I even laminated [the exercise worksheet], so you have no excuse.”
  • When his wife has a headache, he says, “Let me do the head thing.” He holds the base of her skull and tells her to relax while he seems to provide some kind of physical manipulation.
  • [Spoiler] He gets mistaken for a medical doctor by a maid who asks him to make her friend “feel good.” Her friend is dying from stomach cancer. He did 2 years of pre-med in college, although he stopped to care for his sick mother. He says only that she should be moved every couple of hours to prevent bedsores.
  • [Spoiler] He diagnoses the maid as having arthritis and attempts to adjust her prosthetic foot (it starts below the knee). He ends up breaking the prosthetic, though.
  • [Spoiler] Later, when he no longer has his OT license because he moved to a new state, he gets a new job taking phone orders for the company Land’s End. In one scene, a coworker says, “Thanks for telling me to raise my monitors, Paul. I don’t have tingling anymore.”

Although Downsizing does not give a full picture of what occupational therapy is and how it helps many diverse populations, it does create an opportunity to talk about it and correct misconceptions.

We contacted Paramount Pictures again to let them know what an occupational therapist actually does. It’s too late to change the movie, but it’s not too late for you to share your feedback. There’s a Downsizing Facebook page and Twitter account, where you may share your thoughts about the depiction of occupational therapy. 

We will continue to promote the work of occupational therapy practitioners, and we encourage you to do so as well. AOTA’s website has general information on occupational therapy, along with a video about the profession for you to share if you’re looking for materials to help tell your story.