Four-Walls Treatment

Just as a country's artistic and social institutions usually reflect its particular outlook on life, the kind of psychotherapy that is practiced in a nation often expresses its characteristic philosophy. Morita therapy,* for instance, is a uniquely Japanese creation. Last month many Westerners heard about it for the first time when Psychiatrist Noatake Shinfuku described it at a psychological convention in Tokyo.

The treatment is most often used for a group called the shinkeishitsu (nervous ones), who suffer from anxieties, phobias, obsessional states and hypochondria. Hospitalized for a month or so, a patient spends the first week in an "isolation hell," lying in bed doing nothing except "facing his sufferings all day long." During the second week, he does light work such as gardening or sweeping. In the third he undertakes harder physical tasks, and in the fourth he begins to go out into society, perhaps to shop or just walk around.

Even during the isolation stage, a doctor or aide is always at hand. He tries to avoid conversation, but maintains contact with the patient through "personal communication beyond words." Explains Psychiatrist Shinfuku: "Buddha was silent. Kasho [one of Buddha's disciples] heard nothing, and yet he apprehended all."

The doctor also makes written responses to a diary that the patient keeps. If a patient writes, "I worked well today," the doctor may respond, "I am not sure you worked well, yet work is important. Try to work only for the sake of working." Or if the shinkeishitsu writes, "I can't believe I am getting better," his psychiatrist may advise, "When you are not sure, please suffer--don't try to get rid of the suffering."

In fact, one of the main aims of the treatment is to persuade the patient not to try to eradicate his symptoms by force of will. Instead he is encouraged to establish "control without control." The idea is not to understand the symptoms and their origins in the Freudian sense, or even necessarily to get rid of them. As one Japanese explains: "Once you are friendly with your symptoms and accept them as a reality, you find yourself cured--able to function --whether or not you still have them."

According to Shinfuku, Morita therapy has brought about this kind of cure for thousands of Japanese neurotics. Typical of those who have been helped is a high school girl unable to study because irrelevant ideas kept crowding into her mind. But after two months' treatment by Shinfuku, she was well: "There were still many ideas in her mind that were irrelevant to her studying, but nevertheless she was able to study."

In Shinfuku's view, "Morita therapy is superior to other treatments for this type of patient," and should be added to the long list of Japanese exports to the rest of the world. Some Westerners suggest that Morita might be appropriate for the increasing number of Americans who are attracted to contemplative philosophies like Zen Buddhism. Others believe that the method can work only with Oriental patients, whose culture fosters not active struggle against the world but passive acceptance of things as they are. In fact, say some psychiatrists, the increasing Westernization of Japan may make Morita decreasingly effective even there.

*Named for the late Shoma Morita, the Tokyo psychiatrist who developed it.

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