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Modern and Traditional Japanese Culture: The Psychology of Buddhism, Power Rangers, Masked Rider, Manga, Anime and Shinto. 在日イギリス人男性による日本文化論.

Friday, January 23, 2015


Japanese Psychotherapy for PTSD

As war continues around the globe more and more veterans suffer from post traumatic stress disorder characterised by aggressiveness, nightmares, flashbacks, and feeling like one is under a spotlight in crowds (e.g. in this collection of testimonies - one can ignore the politics). One veteran characterised PTSD as generally not being able to get over certain painful images which affect ones perception of the present. If so then perhaps Japanese psychotherapeutic methods might be of some help.

Lacan argues that if we can’t express something to ourselves, because we have mixed emotions about it, or it is too shameful or painful, it returns as a symptom. So, he said, symptoms are expressions or signs. Many psychologists including Lacan tend to emphasize language, so his theory becomes “What we can’t think, i.e. say to ourselves, return as symptoms, and if we say the experiences, talk about the experiences, then we stop producing the symptoms. However, there are lots of therapies that are not about talking, and several of them are popular in Japan.

Morita Therapy
Morita therapy is a bit like becoming a hermit for a while. Morita was a psychotherapist who treated Japanese people with “social phobia”. Such people often become hermits. Rather than going against the flow, he confined his patients to their rooms. Then gradually as the patient got bored, he would give them tasks such as cleaning the corridor outside their room, or weeding the garden outside their window, and encouraged the patients to realize that in fact that want to reintegrate with society. With respect of other symptoms as well, rather than going against the flow, Morita encouraged patients to accept their symptoms -- trying to stop them makes them worse – and generally aim towards ‘a whatever will be will be’ (‘ari no mama’ in Japanese) mentality towards them and life in general.

Dohsa (movement) Therapy
Dohsa just means movement in Japanese. This therapy is defined consciously in opposition to talking cures. While many therapies proceed using words as the medium or vector between the client and the therapist, movement therapy uses movement, massage, and other bodily contact. I have a picture of people massaging the backs of people in crouched position, or getting into a sort of T-shape, with intertwined legs. Since this therapy is so non-verbal it is essentially difficult to describe. Books on Dohsa therapy contain little theory, but lists of positions and movements. I think that it may be difficult to get good Dohsa treatment outside of Japan since the therapist would also have had to have had bodily experience.

Tsubo (Pot or Potted) Image Therapy
Seiichi Tashima, a professor from Kyushu University developed this for his clients due to his in ability to use image therapy with them. Image therapy again uses not words but images, asking patients to visualize various images associated with their symptoms. Prof Tashima found that his patients would become too emotional if they did this, or they were too scared of the rush of emotions to do it. His solution was to create a controlled form of image therapy by the most direct of means. He first encouraged his patients to image a large pot with a lid – the lid being the important part. He would then encourage them to image that the pot contained certain positive images. Then the clients would practice experiencing those positive images by opening and closing the lid of the pot that they imagined in their mind. Once they had mastered this use of an imaginary pot to control images, he encouraged them to imagine another pot containing the problematic images. The clients are at first encouraged to open the lid only a little very briefly, just to take a glimpse, and then shut the imaginary lid firmly, and repeat this until they are sure that they can control the flow of images in this way. And then, alternating between positive and negative images, clients are encouraged to increase the amount of time that they can spend with the negative ones until, eventually, they are able to get into the pot with bad images, and just let them flow, like Morita therapy. Rather than a pot one might use anything with a lid or a door.

Sand Play Therapy
This was imported by perhaps the most famous post-war Japanese psychologist, Hayao Kawaii. He studied Japanese mythology from a Jungian perspective and claimed that Sand Play Therapy is Jungian, having been developed by a Swiss Jungian called Kaff who called it the sand play technique. Kawaii gave it a new name “boxed garden therapy” and it became very popular for treating children in Japan. In a box about 2 feet square children are encouraged to make a mythical world representing their own. Clients use lots of figures, trees, vehicles and the therapist just watches the client make this world. It is found that while at first the children may start by making an island in the garden surrounded by monsters, they one day add a bridge and give the monsters hats, or otherwise gradually create a new more peaceful garden. And all the while even though the therapist just watches, the children eventually express themselves to the extent that their symptoms go away. And of course, it is noted that the primary characteristic of sand play therapy, or boxed garden therapy, is its non-verbal, visual nature. Further, it occurs to me now that the “box” of the boxed garden may have a function similar to that of the pot in Potted Image Therapy – to confine the images within a physical and mental location so that the client can interact with them in controlled way. I can't image Veterans playing with toy monsters,or toy soldiers, but it is not inconceivable.

Osamu Kitayama’s Looking Together
Osamu Kitayama noted that images of women and children were a popular theme in pictures from the floating world, appearing when pornographic pictures were under strict censure. Sometimes the faces of the children resemble those of older men. The viewers of these mother and children pictures may have gained therefore some kind of libidinal pleasure from viewing them. Their prime characteristic is that mother and child are viewing something together. Generally the mother is holding up something, or pointing to something ephemeral, such as bubbles, cherry blossom, or something dangling by a string. In the above images by Harunobu Suzuki, the mother and child are watching a little bird or some fireflies in a cage. These ephemera are the quintessence of Buddhist impermanence - ‘the floating world. The child and mother are looking at this floating phenomena in wonder. As a result of his awareness of this genre of images, Kitayama moved towards attempting, rather than to talk about, to “see together” with his patients. I believe that Kitayama, his students, and their clients face the same direction and while using speech, do not attempt to rationalize but simply use speech it to call to mind images in both client and therapist. Kitayama referenced the cinema of Ozu, such as “Tokyo Story”, where family members have sparse conversations facing the same direction, seeming simply to share the same images, sunsets, and memories.

Naikan Introspective Therapy
Naikan therapy is rather like Freudian psychoanalysis in that it encourages clients to look over their past and restructure
their view of themselves as the world. It was developed from a Buddhist practice of “self-searching” where practitioners
would isolate themselves, and go over their lives, asking themselves whether, if they died now, they would go to heaven or hell.

Ishin Yoshimoto, the founder of Naikan therapy removed the Buddhist and supernatural elements, and gave clients a framework. They are to think about specific relationships (such as themselves and their mother, themselves and their spouse) over specific periods of time, and given three questions:
1)What did that person do for you
2)What did you do in return for that person
3)What aggravation did you cause for that person
Clients find that, especially in their childhood, they were in receipt of a lot of love, affection and hard work on the part of their care givers, and that they have done very little in return, but have rather caused a lot of aggravation. This is almost the complete opposite of Freudian therapy where clients are often encouraged to find trauma caused by care-givers (sometimes purely imagined, false memories). Naikan also differs from Freudian therapy in that all this process is carried out in the clients imagination. Clients confine themselves to a small space the size of a cupboard, and go through their lives from childhood to the present time a year or two at a time and imagine all these instances of kindness in images, reporting to the therapist for only 5 minutes in each hour. These reports are merely to ensure that that the client has not wavered from the task. The therapy itself is carried out by the clients. Clients generally find it difficult to call to mind the images at first, but as they learn to see themselves from the point of view of the people that loved them, the images come in waves. Clients generally cry in the realization of how much they have been loved. So while on the face of it, it can seem that Introspective therapy is very self-negating, it is conversely very positive because it is the realization of how much aggravation that one has caused that one realizes how much one has been loved.
This therapy is particularly useful in treating anti-social problems such as alcoholism (one of very few therapies to have any effect), drug addiction, prevalent among veterans.
Japanese people come out of a week sitting in a cupboard (or behind a Japanese screen) feeling really sunny, refreshed
and with a will to help everyone that has helped them.

Auto-Photographic Method
This therapy was influenced by my early research asking students to take 20 photographs expressing themselves. The Japanese are not good at expressing themselves verbally often mentioning others and their groups, but they are very positive and self-focused in their auto-photography. Japanese pose, stand up straight, and care about how they look. Mukoyama has her clients take photographs representing themselves, of the things that are important to them, and their issues, and looks at these photographs with her clients.

Returning to Lacan's theory, it seems very possible that it is not only “things not said” that return as symptoms, but also things that cannot be seen -- called to mind. And that in order to cure symptoms, both saying and seeing – or calling to the minds eye - are effective ways of preventing or, rather encouraging, the return of the repressed, in a controlled way, with other people’s help. This sort of image therapy may ordinarily be more appropriate to Japanese but perhaps also for those who have been exposed to traumatic images.

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This blog represents the opinions of the author, Timothy Takemoto, and not the opinions of his employer.