Life is a Matter of Attention: Lessons From Japanese Psychotherapy

“Neurosis is misdirected attention.”

- Shōma Morita MD (1874-1938)

Western psychology has entered its second century and, to say the least, results are mixed.

Certainly progress has been made and our insights on personality and learning have been impressive. As a species we know more about some of what makes us tick than at any point in our history and with the increasingly sophisticated understanding of neurobiology now available through MRI scanning and the like, the scope of understanding will do nothing but expand.

Psychopharmacology has become one of the largest – most profitable – growth industries in the western world. A river of medications ceaselessly flows through our society and the implications – both good and ill – are yet to be fully comprehended. While no doubt the suffering of many has been greatly eased by some of these amazing concoctions, the shift to an overly simplistic “medical model” of psychology and personality threatens to reduce the art of living a good life to a matter of high priced chemistry.

Despite the progress and – some might say, because of the – pervasisve presence of psychology throughout our culture, we are not happier. Despite a heady increase in overall household wealth, happiness levels remain essentially unchanged from those recorded a half-century ago. Half of all marriages dissolve and a growing number of American kids are born into single family households.

Our growing national prison population siphons away huge chunks of public funding from schools and healthcare programs. Adding insult to the injury to the dwindling public purse, despite a 300 percent in prison populations since the 1970’s, the ever profitable illegal drug business is fueled by an apparently insatiable American appetite for pretty much any substance even rumored to provide a few moments of a high.

In a nation of plenty obesity and eating disorders are common and shopping has become a kind of reflexive addiction.

What, we might ask, are we so hungry for? How can psychotherapy help?

Helping west by looking east

A clue to easing some aspects of western angst can be found in looking east, to the work of Japanese psychiatrist Shōma Morita MD, founder of Morita Therapy. A later, related school of Japanese therapy, Naikan, dovetails nicely with Morita in a kind of therapeutic yin and yang. Combined, they provide a practical, common sense and, best of all, workable approach to dealing with many of the more common psychological ailments.

A contemporary of such early 20th Century western intellectual giants as Sigmund Freud, Carl Jung, William James and Mario Montessori, Morita was the chairman of the Department of Psychiatry at Japan’s Jikei University School of Medicine. Morita was a student of not only Japanese and Buddhist thought but was familir with western thinking of the time.

At the risk of oversimplyfying a subtle and nuanced psychotherapeutic approach that at first glace appears simple, I will lay out a few basics of the Morita approach to psychotherapy and how it can be a powerful adjunct to such western therapeutic approaches as cognitive behavioral therapy, transpersonal psychology, experiential therapy and 12-Step recovery programs.

Morita’s area of focus was on neurotic anxiety based disorders typified by the Japanese diagnosis of shinkeishitsu. These patients were viewed as prone to anxious thinking with a strong streak of introversion and self-absorbtion. They displayed some limited insight into their condition, as opposed to those with hysteria or dissociative disorders.

To say the least, Morita’s clinical approach was unusual by our standards; patients would move right into Morita’s home and spend a period of weeks in quiet participation in the work and routine of the household. After an initial quiet period of several days to a week, patients were expected to be active and move their focus from their grim inner mental landscape to the infinitely more interesting world about them.

So what to do about those difficult feelings?

While the western view of psychology is grounded on an assumption of the primary role and importance of feelings, Morita viewed emotions as only part of the human condition; not the primary focus of life.

Feelings are no more important than the many other things that enrich life, but, Morita noted, the neurotic was overly tangled in their emotional state to the expense of all else in life. The patient had adopted an illusion that assumed nothing could happen until difficult emotions were quelled.

Drawing from Zen Buddhist psychology and Shintoism, Morita made the following three observations about emotions:

• Accept your feelings. Feelings are a natural part of life. The Morita concept of arugamama (acceptance of reality as it is) notes that emotions are natural, changeable and largely beyond our control. While feelings can and do provide valuable information and clues about our environment they may not necessarily provide an accurate view of the world. Acceptance of the current condition is the first step toward bringing about positive changes in life.

• Know your purpose. Pay attention to the world about you and construct near, short- and long-term goals. Evaluate what needs doing to achieve your goals.

• Do what needs doing. Whatever your emotional state you are responsible for your behavior and your actions will either work to serve your purpose or work against your purpose. Further, Morita observed, while feelings do not control behavior, action can serve to calm and moderate difficult feeling states. The task is to ground behavior in the reality of life and one’s purpose. Instead of trying to “fix” feelings, Morita calls for living purposely in order to live constructively.

“Behavior wags the tail of feelings,” Morita declared.

In Japanese psychotherapy the task is to be fully aware and present in the moment while being fully focused on the work at hand, be that weeding the garden or doing one’s taxes. An old Zen saying advises, “Chop wood. Carry Water.”

A simple example of how it works

Recently I had set aside a full weekend for some writing projects that were coming due. My purpose was clear and I made sure I had my notes and reference materials handy. I had to run an errand to a nearby town Saturday morning but I told myself I could be home at 3 p.m. and would then work the rest of the weekend.

I didn’t get home until 9 o’clock that evening. Oh well, I told myself, after a good night’s rest I can work hard Sunday. Morning came and the coffee was good. I lost myself in some reading. I dozed off for a nap. Next thing I knew it was 5 p.m. Sunday and I hadn’t put a single word into the computer.

As I slumped on the couch my head began to fill with all kinds of negative and judgmental talk. I could feel myself slipping into dispair as anxiety rose in the face of the looming deadlines. To make matters worse, my energy was evaporating as quickly as the difficult emotions grew.

What to do?

I got up and folded a load of laundry. I then put a load of whites in the washing machine and unloaded the dishwasher. I sponged down the countertops then went outside to water a couple trees. I rolled up the garden hose before I sat down and wrote out checks for a few bills and put the checks in their envelopes. I stuck stamps on the envelopes and put them on the dashboard of my car.

I sat down and wrote up a list of phone numbers and e-mail addresses for the writing projects and stapled it inside my day planner for the coming week. While the writing project was still undone everything was in place to do the work.

Even though the writing projects were no nearer being done, I felt calm and energized. While nothing about my situation had changed – certainly the deadlines hadn’t shifted – I slept well that night. My anxiety and funk had cleared in the process of focused action in necessary tasks that needed doing.

The Naikan attitude of gratitude

Where Morita is an externally focused approach to inner turmoil and confusion, Naikan – which means “looking inside” – provides a useful internal therapeutic counterpoint.

Initially developed in the 1940’s by Japanese businessman and devout lay Buddhist priest Ishin Yoshimoto, Naikan evolved from a rigorous form of self-reflection called mishirabe and teachings of Pure Land Buddhism, which stresses the importance of faith over effort. The roots for such faith come from an awareness of two profound truths about life: The first is the great kindness and compassion of life; and the second is the instinctive selfish and limited nature of our thinking and behavior.

Having experienced the great benefits of mishirabe, Yoshimoto wanted to develop a simpler form of structured self-reflection for daily life. Naikan was the result.

When properly seen, the bounty surrounding us helps us to view, then experience our life in a new reality in which we are grateful for the many gifts that flood our existence. Our perception of reality is broadened. When done fearlessly, the Naikan process awakens us to the indebtedness we have and the troubles and disappointments we routinely cause others.

Naikan therapy begins with three basic personal queries:

“What have I received from _______?”

“What have I given to ______?”

“What troubles and difficulties have I caused _______?”

What Yoshimoto knew was routine grudges, grievances, complaints and sour feelings dissolve in an ongoing current of conscious gratitude. In combination with Morita, Naikan offers a powerful and elegantly concise addition to many traditional western psychotherapeutic approaches.

The path from there to here

First Morita and then later Naikan therapies found their way to North America in the 1960’s and 70’s through the work of David K. Reynolds, Ph.D. Through a series of wonderful books, including his most well-known work, “Playing Ball on Running Water: The Japanese Way to a Better Life” (1984), Reynolds became a fluent cultural conduit between eastern and western psychologies. He developed the approach that has become known as Constructive Living, which is a rich blend of both Morita and Naikan. Reynolds and his Constructive Living training program can be accessed by e-mailing: dkreynolds@juno.com

Others, such as Gregg Krech, director of the ToDo Institute in Vermont, have added their voice and experience. Gregg’s 2002 book, Naikan: Gratitude, Grace, and the Japanese Art of Self-Reflection” is a wonderful handbook for both professional and lay readers.

The ToDo Institute sponsors numerous residential and distance learning lay and professional workshops on both Morita and Naikan therapies. For more information on ToDo Institute publications and programs contact: www.todoinstitute.org

Putting it into action

Due to the focus on direct experience and practical application to the challenge of the everyday, many of the numerous books to be found on Morita and Naikan therapy can be useful guides for lay readers. A residential training and certification process with ongoing learning in Japanese psychotherapy is necessary for mental health professionals looking to incorporate Morita and Naikan into their work with clients.

In my work as a psychotherapist I have found both Morita and Naikan approaches to be useful additions to my more traditional western psychotherapy practice. I have found the Japanese approach – particularly Naikan – especially well suited to incorporation with the kind of 12-Step work done with many substance abuse clients.

The Morita view of emotions is particularly useful in helping clients to take steps to move forward in their life by placing their emotional struggles in a more realistic – and healthy – context.

While any treatment modality requires some degree of consistent buy-in from the client, this is especially true of Morita and Naikan. Since both are based on the concept of direct experience, the client who is stubbornly unwilling to follow through on assignments between sessions will likely remain immune to the potential benefits of Morita and Naikan.

Finally, while Buddhist thought is definitely a source for both Morita and Naikan therapies, a spiritual conversion is certainly not required or desired. The Buddhist take on psychology has been honed over 2,500 years of practice and offers direct applications and benefits to western psychology regardless of spiritual or religious orientation.

Mark L. Taylor MA LPC CADC

RoundRiver Institute LLC

P.O. Box 35

Genoa, WI 54632-0035