Each symptom and its treatment by Takehisa Kora

General advice for symptoms

The second series written by Takehisa Kora

1.Know the essence of your symptom

Patients tend to believe that their symptoms are caused by organic diseases in their bodies, but neurotic symptoms are never like that. They are caused by their minds. That is to say, patients must realize that their symptoms are psychogenic. If excess attention is directed toward their heads, it causes a heavy or dull feeling in the head. If it is paid to their hearts, it causes accelerated heart palpitations. If it is paid to their fatigue, they worry about exhaustion. Once they are conscious of one symptom, they feel sensitivity toward it, and then they tend to pay more attention to it. Mental effects and bodily effects spiral, and they convince themselves that they are ill. The causes of many kinds of obsession are complex. Patients think that unpleasant sensations and feelings, which everyone may have on some occasions, happen only to them. They regard these sensations as special, signs of illness and disadvantageous for self-preservation so that they try to get rid of them, deny them, or run away from them. All obsessions are caused by mental states. They must understand this process well and stop all physical treatments.

2.Leave your symptom as it is

Once a symptom is set, it is difficult to get rid of it in a short time. No, the harder we try to get rid of it the more we are hounded by it. The harder patients who suffer from insomnia try to sleep, the less they can sleep. The harder patients who suffer from heart palpitations try to run away to a safe place, the more they worry about very small things. The harder patients who suffer from anthropophobia try to make themselves calm in public, the more nervous they become. The harder they try to manipulate all symptoms in order to erase them or run away from them, the more complex their symptoms become and the more they worry about them. They must understand this principle very well. They must take their symptoms as they are and understand that this situation is normal for them. Even if they feel fear or have some difficulty, they should accept their problems without objection. Patients who suffer from insomnia must not try to sleep by forcing themselves. There is nothing they can do about it when they cannot sleep. If they are given sleep, they should accept it. If they can think of their symptoms in that way, they can fall asleep naturally. Other symptoms are the same. Get together with fears and troubles without objecting to them. Do not try to escape from anxieties but lead your life with them. To take things as they are does not mean to do nothing at all because you are troubled. It means to endure many kinds of anxieties and fears without attempting to remove them and to do what needs to be done.

3. Live so you are always doing something

Neurosis is a condition that limits observation of the outside world, and directs attention strongly only toward one's own mind and body. That is to say, one becomes introverted. In order to become extraverted it is useless just to hope to become so. The best way to become an extravert is to work. One starts doing easy tasks while having symptoms, and gradually one tries tasks that are more difficult. It is better to chose tasks that involve movement of hands and feet. It is wrong to aim to start working after getting rid of suffering and fears. It is important to accept the reality that there is pain, and to keep on doing something. It is better to do a variety of tasks. The variety allows rest while moving from task to task, making naps and the like less necessary. I advise my inpatients to clean up the inside and the outside of their rooms, to take care of rabbits and chickens, to raise vegetables, to make handicrafts projects, and to practice calligraphy.

Human beings can't keep their minds calm without working regardless of whether they have neurotic symptoms or not. People who can be cheerful without working are exceptions. Ordinary people fall into unhappiness if they don't work. Ordinary people always lead a disordered life if they don't work. They lapse into an unhappy mental state. Keeping working trains them to be more extraverted and makes them have the confidence that they can do anything they try even while having pain. Then their pain eases gradually. If they don't work because of pain and fears, they will feel their pain and fears more terribly.

4. Fix your appearance first.

Anyone who is untidy in appearance can't have a sound mind. It is impossible to have happy feelings while grimacing. To make your mind better requires you to make your appearance better. It is not improper to leave your feelings as they are, but to show them without controlling them means to be ruled by them. There is no self discipline, but rather a lack of willpower. If you have pain and fears and tell others or show them on your face, or through gestures, words and behavior, your mind becomes weakened because of your appearance. If you keep your appearance tidy and maintain it while bearing your suffering and fears, your mind naturally matures.

5. Don't depend on your mind.

If you work only when you are in a good mood, and do nothing if you are in a bad mood it makes you lazy. You should understand that moods are like weather. You should do anything that you can do regardless of your mood while accepting it as it is. It is not good to think that it is impossible to do something before trying. Also if you are in an uneasy mood, you may think even everyday occurrences and ordinary physiological phenomena are abnormal or signs of illness. For example, people who suffer from anthropophobia have timid feelings. They think they are being laughed at when others are laughing. They read imagined meanings into a cough. They misconstrue anything that happens by chance to be concerned with them. They must understand well that a life depending on moods tends to cause such conjectures and stop them.

6. Don't complain.

If you complain about your symptoms, it may ease your mind for a short time, but if you keep doing that it will make your symptoms worse. You trap yourself. Avoiding complaining makes us strong. A person who is called a great man usually doesn't complain. It is difficult for ordinary people not to complain. But if you can just do that, it helps to train your mind.

7.Don't make your illness an excuse.

When you have a touch of cold but you have an appointment to attend a meeting and you don't want to go, you suddenly feel your cold is serious and excuse yourself from going under that pretext. But when you are going to see a movie that you look forward to, you don't mind a slight cold at all. People feel guilty about simply avoiding their distress, so they are likely to use their sickness as an excuse. Especially people who have neurasthenia tend to do so. To avoid reality makes life more and more difficult. It makes you believe that your sickness is more and more serious. If you have an attitude that you are sick whatever you do, you can't recover from neurosis.

8. Don't be obsessed with ideals

Work and study are different from play. They are usually hard, therefore they breed genuine satisfaction. Nervous people have strong desires and hope to work without feeling distress. If they think in this way they are distressed more and more. They become obsessed with their best condition as though it were their standard. They think they must always be so. It means that their present condition is unacceptable in comparison. They are always betrayed by the reality because they want to be impossibly perfect. They want to feel no nervousness when meeting others. They want no idle thoughts and no fatigue when reading. They want always a clear head and cheerful feelings. Their ideal is always in contradiction to their reality because they turn their ideal into what must be.

9. Do have confidence.

Nervous people often have an inferiority complex. They think that they are inferior to everyone in anything and complain that they don't have confidence. Thus they don't try to do anything. They tend to try after gaining confidence. That is why they can't do anything. There is no need to have confidence to be able to swim well at first. While you practice swimming without confidence, you will be able to swim. Then you naturally gain confidence.

We usually do many things before gaining confidence. We are nervous and uneasy because of lack of confidence, but we force ourselves to do them. Thus we acquire our confidence. When you are at a loss whether to do something or not, you had better do it without confidence. If it is impossible for you to do, you don't even think about whether you should do it or not. In such a case, when you are at a loss, it is usually possible for you to do it if you can make effort. In this way you can acquire confidence that you can do anything if you make effort., You can develop a strong will to take risks. The only way to overcome your perfectionism preventing you from taking risks is to go ahead and try.

10. Know what the truth is and follow it

The great Buddhist priests, like Honen and Shinran, read through thousands of books in order to be spiritually awakened, but they could not give up their worldly desires. So they could experience that everything they did to give up their worldly desires was worthless, and they made up their minds to devote themselves to the Buddha. That is Ojyo. It means to know the truth and believe it firmly and never yield.

It is not necessary to devote yourself to the Buddha. What you can do is to make sure of the facts and to believe and follow them without objection. No matter how we seek to be good, we have many delusions. We can't tell others about evil and stray thoughts, crazy ideas and absurd thoughts going hither and thither in our mind. Unless we are saints, we can easily know that we have them inside. No matter how we hope to do something actively, we have laziness, we want to avoid difficulties, to be at ease. We sometimes feel weariness and fatigue. Though we may have a mind that willingly goes ahead, it is true that we have many fears, anxieties and doubts in our mind at the same time. The ability to memorize and to understand, will power, joys, anger, sorrows and pleasures, they aren't directly controllable.

Talking about our health, we feel daily that there is something wrong with our body, for example, with our head, chest, abdomen or other organs. An ideal is boundless, so it can never be achieved. There is no perfect attainment of limitless desires.

As mentioned above, to make sure of reality means not only to admit our faults but also, in a more positive area, to admit that we have limitless ambition. Through our neurotic distress we can notice our real intentions and ambition. We are afraid of being sick because we hope to be healthy. The reason why we hope to be healthy is that health is important for us in order to be active and improve ourselves. That is our real intention. The desire to be active and to improve ourselves is our real intention so illness phobia is just a word that comes from that desire. Because people who suffer from nosophobia confuse the order of things, they seem to live in order avoid sickness.

Anthropophobia is a sign that we want to be regarded as a good person, to be considered important and to be loved. If neurotic people realize that their anthropophobia is only a mental phenomenon they must understand naturally that the realistic way to cure is to abandon their efforts to get rid of their fears and to be loved. Other symptoms are the same. The proper course for neurotic people is to stop worrying about trivial details and to improve themselves by leaving trivial details as they are. Ojyo is not to give up. It is to obey inevitable facts without resistance and to do what we should do just as we are. I call it "positive obedience".

11. Healing takes time

Some things can't be solved easily. If there is dust on a desk, to wipe it at once is the solution. But we are unlikely to be able to erase an impression we receive in our mind. Using the most familiar example, we don't regret loss of 100 yen for long, but if we lose 1000 yen, we would regret it longer. And if we lose 10,000 yen, we can't forget it easily. We understand this in theory but not emotionally. Because regrets are unpleasant, we try to forget them at once; trying to change the impossible into the possible, causing complications. If we leave regrets as they are and don't try to erase them and do daily work willingly, they fade away and disappear in the end without our noticing them. If there are some regrets left, they aren't so troublesome.

Agitation, pleasant or unpleasant, fades away with the passage of the time while being left as it is. . As people get older and gain more experiences, we notice the fact and cleverly leave our suffering and unpleasant things to the passage of the time. However some people try in various ways to escape from present suffering. This effort prevents their emotion from progressing naturally. Especially neurotic people tend to do so. They concentrate on getting rid of the present suffering at once by various means. They go against natural law. They don't know enough to leave suffering as it is to the passage of the time. When we encounter tragic events, such as the death of our parents or children, if we strive to do daily work while sad, even if we can't forget, a year or two later the strong emotion gradually fades. So most of our unpleasant feelings and anxieties about small happenings in daily life disappear in a few days if we let them alone. The more we try to forget something, the more we are held by it. It is like people suffering from a phobia of noises. They are annoyed by noises, even a clock's ticking. If they work while listening openly to what they can hear, they are no longer annoyed by the noises, even loud train noises. They must change their behavior and realize that, like some children's diseases, these problems cannot be solved at once.

12.Treatment in a hospital

I treat people suffering from neurosis in my hospital. There must be some people who get over neurosis by themselves, but most of them can recover in a short time by treatment in a hospital. Patients tend to be too free and too lax to carry out their treatment at home even if they know the theory. Some people can understand the theory simply by reading our books, but we can't expect all of them to do so. The best treatment for neurosis was originated by the late Masatake Morita. He was a professor of the Department of Psychiatry at Jikei Medical University. I took over his work and treatment of neurosis as my life work. Even we who have average ability can help many people suffering from neurosis by Morita Therapy, so I realize keenly how great his achievement was.

At first patients start their treatment in a hospital with complete bedrest for four days to one week. During that time, they do nothing but eat, go to the toilet, and wash their faces. They gradually suffer from boredom Many questions gush up in their mind, and they feel foolish. They also have a desire to be active. While enduring without resistance these many thoughts that naturally spring up, the suffering and worries, the patients let things take their course. After finishing bedrest patients start with light work and gradually do heavier work. They write a diary every day and submit it to me. I read it and write my comments. I gather the diaries in the daytime or at night every day and write comments of general guidance and personal notes. The purpose of my comments is to guide patients' lives as concretely as possible. By this means symptoms which have lasted even many years are completely cured or remarkably eased in about 30 days at the earliest, in about 70 days at the latest. If a patient is completely cured, it means for him not only to be free from his symptom but also to have a deeper awakening. So he becomes active, takes the initiative and becomes a mentally healthy person. I usually apply this special educational treatment for neurosis without medicines or physical therapies. But I use electric shock treatment and extended sleeping treatment in cases of schizophrenia or melancholia at first. If the symptoms are eased, I then apply the educational treatment.

Some schizophrenia symptoms are similar to neurosis. They have depression, loss of interest, no spirit, sluggishness, and insomnia. Distinguishing between schizophrenia and neurosis should be left to a specialist. Many cases of this disease are completely cured within a month if psychotherapy is added to shock therapy and extended sleep therapy. Almost all of the schizophrenic symptoms don't last over one year if allowed to take their course. From this point of view, even though schizophrenia is a serious disease, it is conveniently cured .

But these physical treatments don't work easily on neurosis. So those of us who treat neurotics have difficulty guiding them. However, if neurotics completely get over their symptoms, they never suffer from them again.


Copyright (C) 1999-2009 The Mental Health Okamoto Memorial Foundation