Each symptom and its treatment by Takehisa Kora
Each symptom and its treatment
The second series written by Takehisa Kora
1. Fear of imperfection, fear of making an error.
Everyone wants to be perfect. Perfection is pleasant and imperfection is unpleasant. Because we want what we do to be perfect, when we try to do something, we prepare for it thoroughly and become more attentive. If we didn't have a desire to be perfect, we would leave what we did alone and we wouldn't be able to achieve our goal. So the desire to be perfect itself is important for our life and isn't a symptom of illness.
But if you inquire into what perfection is, you will notice it is very difficult to answer. When you polish window glass, how much you polish it is a problem. How many clothes you should wear at the present temperature, how much your handkerchief gets dirty before you wash it, how fast the best speed is when you walk, each of them is a problem. Some people add sums even twice, but they still can't believe the result and add it three and four times. Some aren't satisfied with checking a locked door only once. Some open a letter many times to check it after sealing it. Then, after dropping it into a mailbox, they worry if it is in the mailbox properly and put their hand into the mailbox many times. They know it is useless to repeat the same thing many times, but when they have something to worry about, they try to ease their mind. They don't endure their worries. A student was worried if gas escaped from a gas stove. He woke up five or six times in the middle of the night to check it. A housewife watched the clothes she washed and dried in the sun many times a day to see if they fell on the ground because of the wind. They could not think about anything but feeling relief and getting rid of their worries so they took such unusual action. When you have a worry and you check it once and make sure it is all right, you must bear the worry. If you do so, you can conquer your fear and create a fresh mental state. Of course only one or two times is not enough. You must carry out this practice in your daily life. It is the same as someone who is too afraid of making mistakes to concentrate on his work.
We make bigger or smaller mistakes in most of what we do. Making mistakes teaches us a good lesson. If we must avoid all mistakes, we can't do anything. The biggest mistake is to do nothing. People suffering from neurosis don't notice that mistake.
When we live a busy life, the rhythm of activity leads us to do many things. Our power is distributed depending on the occasion and the situation. We pass a proper judgment on many things without our noticing it. The first important thing is to make a rhythm of activity. We practice in order to lead a life in which we can carry out anything we notice at once whether our mood is good or not. We should carry out tasks immediately. But we must not do anything just to ease our fear.
2. Heart palpitations
This spasm usually happens suddenly. It normally lasts for a few minutes but sometimes lasts for a long time. While experiencing this, a patient is attacked by a strong fear that he is about to die or his heart will stop beating, although the degree of fear depends on the patient. The patient calls for help, sees a doctor and requests to be given an injection. The symptoms often include dry mouth, a stuffy head, feelings of cold or hot hands and feet, exhaustion, throbbing around the body, dizziness, faintness, a stabbing pain in the heart, fast breathing or slow breathing, buzzing in the ears, tightness in the throat, worries about going crazy. The patient looks pale and breathes quickly. Although sometimes his pulse rate rises above 90, normally it beats at a regular rate and is small and weak. There are many patients who insist that they have pain, but their pulse rate doesn't change very much.
Once patients experience this spasm, they are afraid it will come again and are always worried. They suffer from their unease and from their ominous imagining that they might be attacked by the spasm in a room alone or on a train or while walking and so forth. So they have difficulty in going out, their range of activity gets narrower and narrower. Finally some of them can't go out of their houses and stay in bed. Those people are often afraid of taking a bath. Some of them have not taken a bath for a few months. Others can get into a bathtub but rush out of it at once because of worries. It is unthinkable for them to enjoy taking a bath. The reason for this is that they are afraid of their temperature's rising while taking a bath. Many of them don't like going to a barber shop because they have to sit still and don't have any distraction, so they must face their worries and feel them strongly. Once they have experienced a spasm a few times, they are withered by anticipatory anxiety. They don't know when the spasm will come again even if their prior attacks are few and minor.
The reason why this symptom happens by a mental mechanism can be easily understood if we see a motive for the first spasm. For example, a public employee who I had treated went skiing on a mountain and encountered a snowstorm there. It was near sunset. He had very strong anxiety and noticed his heart was beating very fast. After that he had a spasm of heart palpitations. A young man saw his friend die of a heart attack when he was a junior high school student. Since then he was afraid of heart attacks and often heart palpitations. Especially on the monthly anniversary of his friend's death, the anxiety became extreme and the spasm became severe. A woman noticed her heart was beating very fast after having a nightmare; she also sometimes has palpitations.
Emotion and the function of the heart are closely related. That is why people in the old days believed that the mind is in their chest, especially in the heart. Experimental psychology proves that emotion and the function of the heart are related. A small change of emotion causes a change in our pulse rate. Excitement such as anxiety, pain, fear, and anger normally strain the sympathetic nervous system. As a result, the heart beats more.
People who have experienced a spasm usually have the anticipatory fear that it might happens again. They pay attention to the possibility unconsciously. When the terrible memory of the spasm occurs to them they are startled and feel something unusual in their chest. The sudden fear that it will reoccur happens, and their pulse becomes faster. But the patients can't think about anything but the fear of their spasm, so they can't pay attention to their emotional mechanism at all. That is why they don't understand that their symptoms are caused by emotional conditions. They feel sure they have heart disease. It makes their fear of spasms increase. Put simply, accelerated heart palpitations are an expression of fear. The nervous system is disturbed by the fear and anxiety producing a tightness in the chest, dizziness, exhaustion, dry mouth, chills and hot flashes, naturally.
No matter how serious these symptoms may be, they can be overcome without fail. Some conquer them by themselves or by hospital treatment. Even if they have a spasm they shouldn't respond to it. They should bear it and view the pain objectively. If they take the attitude that they welcome it, it will disappear in a while. No matter how serious the worries you have, it is important to keep doing physical work and not to limit daily life because of fear. Spasms never kill you. So keep working to help you to get over it. On the other hand, if you don't try to live an aggressive life, working while bearing suffering, you won't get over it.
3. Efficiency reduction
We all experience tiredness while working or studying. But this sense of tiredness is not always the same as true fatigue. Enjoyable work doesn't give us fatigue easily, but unpleasant work tires us quickly. If you stay up late to read your favorite novel, you don't feel fatigue. But if you don't like mathematics, you are bored in an hour after you started to study.
Neurotic people think this tiredness is fatigue, and they are worried if they easily get tired, worrying that their nerves are weak and that there is something wrong with their body. Such people have already anticipatory fear of fatigue before trying their work or study. They focus on their uneasy feeling so if they feel tired just a little bit they make an immediate decision that they are fatigued. And it makes them feel weak. A young man was afraid of this fatigue so he didn't work at all for four years. But a few days of hospital treatment freed him completely from his sense of tiredness. It is difficult to know when our nerves are truly fatigued. If we are not active and don't experience it, we never know it.
Efficiency reduction is the same. Our activities have small and big waves and a rhythm. Being in good condition and bad condition comes by turns. There is a rhythm to our day. If we look at it carefully, experimental psychology shows that there are waves of tension and relaxation within a minute. When we listen to the clicking of a clock carefully, the sounds become higher or lower because our attention has the rhythm of tension and relaxation. The clicking of the clock doesn't actually become higher or lower. When we try to do work we don't like, in the beginning we can't concentrate on it. It doesn't go well. But while keeping at it, we get absorbed in it without our realizing it. Then later we get tired and want to stop. Normally people think it is natural, or they think nothing about it. If they are in the mood to work they just work, and if they are not, they have patience with working. So the wave doesn't prevent us from working. But neurotic people have a strong sense of being perfect and care about improving efficiency. So if an ability lowers they are worried about it and don't concentrate on their work. It actually causes efficiency reduction. They think that everything went well in those days when they didn't care about their efficiency. They think that there is a great difference between those days and now. But in those days they had both high and low efficiency depending on the occasion and situation. Like normal people they don't notice it. They compare the present condition with their best condition, so every time seems bad for them.
4. Insomnia
People suffering from insomnia think that it is the most painful thing. They just want to sleep. To have sleepless nights is painful. They are anxious that they will not be able to sleep tonight again when the evening is coming. Nights that should be the time of rest become the most hateful enemies.
Why does this happen?
There are many kinds of reason depending on the person but the emotional mechanisms are the same. We sometimes can't sleep by chance. For example, anxiety, excitement, too much coffee, pain in the body, or a nap prevents sleep or we wake up at midnight and can't sleep any more. Ordinary people recognize that it may happen sometimes and don't care much even if they have one or two sleepless nights. They get back to be normal soon. However people suffering from insomnia regard sleeplessness as very serious and firmly believe their bodies and minds become weak because of it. So they want to sleep somehow or other but that desire makes them excited and they can't sleep. They always concentrate their attention on sleeping. To be able to sleep or not is always their problem. Then the sleepless time seems longer than it actually is because they are afraid of it so much. Dozing is not sleep for them. A sense of the passage of time is subjective. When we doing something fun time passes in a flash. But when we wait for a train even ten minutes seems very long. Also when we have misery in our body we feel that the time passes very slowly. People suffering from insomnia naturally feel that the sleepless time is long. However, sound sleep time passes without their realizing it so it is not recognized. Thus they don't know what period of time they actually sleep.
We notice that they are eager to sleep as much as they can so they go to bed early at night and get up late in the morning. Their bedtime sometimes extends over ten hours a day. Normally six or seven hours' sleep is enough for adults. Even just five hours' sleep is no problem because if the time is short we sleep soundly. Just as some people want to sleep more than they need to we eat more than we need for our nutrition. If people suffering from insomnia lie in bed for ten hours, naturally they have four or five periods of dozing or sleeplessness. They feel that time passes slowly so they think they didn't sleep all night long. Thus, such people don't realize the fact that they sleep even if they actually get enough sleep. Dr. Shigeki Hotta in our class proved it experimentally.
People put the blame for all the unpleasant conditions of their minds and bodies on insomnia. If they think that the last night's sleep was not enough, they have no doubt that their head and body are in bad condition the next day. They create their symptoms by autosuggestion. Their heads feel heavy, dizzy; they feel sluggish, fatigued; and they think all these symptoms are caused by insomnia. Moreover, new neurotic symptoms other than insomnia show up.
What treatment is needed for insomnia? A clever or mature person's symptoms become much lighter or are completely cured simply by knowing the true character of insomnia. Only one treatment clears away the long years of insomnia. It is important to know the nature of sickness not only for insomnia but for all neurosis. Then the practice is to limit the time in bed to seven or eight hours. At the beginning, this is a little hard to do. We want to have a longer time in bed the next day after a sleepless night, but it is important to carry out the limits on time in bed. The instruction on going to bed is not to try to force sleep. If you can sleep, you sleep; if you can't, there is nothing you can do about it. Let things take their course. Your worries and suffering are the same. This is the same as the treatment for obsessive-compulsive neurosis. In short, it doesn't matter whether you can sleep or not, just staying in bed is enough for you. You should concentrate on working during the daytime whether you could sleep last night or not, no matter how you feel. You need the experience that how much you sleep doesn't prevent you from working. If you do so, you can understand that insomnia is not so terrible. Your fear of insomnia fades away and sleepiness is brought about naturally. Most of the patients who are treated in a hospital recover completely. Some of them made such marvelous progress so quickly that they were surprised. One woman I treated said, "I wondered if you cast a spell on me while I was sleeping." But it is no wonder. Anybody can recover by a change in the state of mind. This change of mind and body cannot happen by making efforts to sleep.
Taking sleeping medication is not only unnecessary for neurotic insomnia but is actually harmful. We find some cases for whom taking a sleeping pill becomes a habit. The dose gradually increases and reduces the power of activity. We must beware of the danger of attaching too much importance to pharmacotherapy. Manic-depressive psychosis is a diseases that can cause insomnia. It looks like neurotic insomnia but experts see that there are some differences between them. Without going into detail here insomnia caused by manic-depressive psychosis sometimes needs drug therapy or electric shock therapy. Though different from neurotic therapy it can be cured, too. Many patients suffering from manic-depressive psychosis actually can't sleep, but they quickly get over that by electric shock therapy.
5. Noises phobia
Some people are so worried about noises that they cannot concentrate on their work or sleep at all. In the old days, it was considered that they were worried about noises because they were sensitive. But it has nothing to do with sensitivity. Someone who cares about the ticking of a wall clock doesn't care about the noise of a train when he gets into it. So noise phobia is connected with the state and mechanism of the mind.
When we are involved in work we are not interested in, we notice noises. We are distracted as we are getting tired of it. We think that the noise disrupted our work so we can't concentrate on it. We try not to listen to the noise. But the attention already fights against the noise so we pay attention to it and it rings in our ears more and more. We get irritated.
If we don't reject the noises and listen to them, on the contrary, they stimulate us to work and improve our efficiency. If we work in a quiet place, we are not stimulated and we become lazy. When I worked at a big hospital, I wrote many theses and books and read books in a medical office where many medical personnel were. I didn't care about their chatting or playing a radio baseball game at all. On the contrary, I experienced that it encouraged my mind. When I got tired, I joined their chatting or enjoyed listening to the radio. Then I went back to work again, and I knew that I didn't care about their voices and the radio. In my high school days when I suffered from insomnia, I took off a wall clock, and I was irritated by neighbors' talking, walking, even the rustle of their clothing. My mental attitude in those days was completely different from my present one. If we accept noises without rejecting them, we allow ourselves to take an interest in them.
6. Fear of idle thoughts, inattentiveness
There is no difference between fear of idle thoughts and noises phobia. Who on earth doesn't have idle thoughts? Our organs always try to work hard. Therefore when our eyes open, we must see something. Also, when we are awake, our brains always sense something, and we must think something. Only when we are under anesthesia or we are unconscious or we are fast sleep are we free from all distracting thoughts. I explained this to patients who suffer from fear of idle thoughts. They said that they were in trouble because they think not only necessary ideas but also unnecessary ones. This is a selfish opinion, but when people are at a loss, they can't judge how selfish this is. When I look at a clock on my desk to check the time, I notice its decoration, an inkbottle and a match beside the clock. They are unnecessary to my looking at the clock but I see them. If forced not to see them, there is no way to see the clock's hands. In this case, we accept the fact that it is natural to see both the clock and the other things. So we don't care about them at all even when we notice that we see them. Also, when we do some work or think of some problem, it is next to impossible to think only about things necessarily connected with the work. Our associations come from many areas. Even things that may have nothing to do with the present problem occur to us. It is natural and normal. We select useful ideas for the present problem from the many associations and put them together. This is useful for thinking. But usually we select suitable ideas for our purpose without noticing it. When we try to take a pen off a desk, we may see an ink bottle and notebooks, but we don't care about them and naturally reach out our hand to the pen.
Thus when things other than necessary things for the present problem occur to patients who suffer from fear of idle thoughts, they call them idle thoughts and try to suppress them and fight them. Efforts to try to deny and get rid of a mental state which naturally exists, it is like trying to change impossible things into possible ones. Their troubles get complicated more and more and they can't concentrate on work. They said that they hadn't had idle thoughts before they contracted this disease. But it is just an extreme lack of understanding to think that they have never had idle thoughts before. They just accepted them as natural without rejecting them. It is the same when people suffering from anthropophobia say that they haven't had their symptoms before. Everyone surely has human feelings and metal states whether he is sick or not. They think that idle thoughts are obstacles to their work, and they try to get rid of them. So their idle thoughts squarely stand in their consciousness, and their idle thoughts actually become obstacles to their work.
Nervous people who have strong perfectionism think that they must perfectly concentrate their attention when they study, but they are betrayed by the fact that they can't escape from their idle thoughts. Perfect concentration is not necessary. Taking idle thoughts as they are, we can have many idle thoughts We work and study without rejecting them. By and by we notice that they are never obstacles, and they contain useful and important ideas. The word "idle" makes us want to get rid of idle thoughts. Alpine flowers we value highly are just weeds on an alpine meadow. If we get rid of our idle thoughts, we get rid of our important ideas.
7. Trembling and occupational trembling, especially hands trembling when writing.
Some neurotic diseases that have organic disorder cause trembling of some parts of the body. But there are many more neurotic trembling symptoms caused by a mental mechanisms than by organic disorders. Trembling caused by mental conditions have the peculiarity that trembling happens under specific conditions. This is the difference from diseases caused by organic disorders. For example, the whole body or hands and legs are trembling when doing something in public or the hands are trembling when writing or holding a wine cup or a teacup in public. They are not so bad when alone but very bad in public. A very bad case of hand trembling while writing occurs even when alone in a room and gets worse in public. Every patient has some story about the cause of the trembling. Many patients don't notice the cause.
One patient suffers from trembling since he noticed his hand's trembling when writing in front of his section chef. A middle-aged gentleman drank with his friends, and a geisha poured sake into his sake cup. They made fun of him because his hand was trembling. Since then his hand trembles when holding a sake cup in the presence of others. So he is miserable when attending a party. A bureau chief got into the habit of holding an easy chair firmly when meeting others since he had noticed his body trembling when giving a lecture to his men.
Many cases of trembling are related to patients' occupations. For example, a person whose job is writing at an office suffers from writer's cramp, when a teacher of the tea ceremony holds a tea cup her hands tremble, a music teacher's hand trembles when playing the violin, an accountant's hand trembles when calculating. Such cases were called occupational twitching in the old days (there are some doctors who believe this still). It was thought that a specific occupation needs a specific muscle to work hard so that it causes trembling. But patients never recovered no matter how long they rested or received massages or electric therapy. . So occupational trembling has nothing to do with a specific muscle's fatigue. Not to be able to write because of the hand's trembling and twitching is called "writer's cramp". There are many such patients. Scholars classify the symptoms into many subcategories such as twitching type, trembling type and paralyzed type. But actually many cases indistinguishable and subcategories are not so important for treatment. It happens a lot that one patient has more than one type. It was the late Dr. Masatake Morita's achievement to discover that trembling and occupational twitching happening in public are one neurotic phenomenon. It became clear that the symptom is caused by a mental condition and can be cured by therapy for neuroses.
The causes are completely the same as for other neurotic symptoms. Once someone notices that he is trembling in public on one occasion, he feels it is disgraceful behavior or a heavy blow for his career. So the next time, seized with expected fears he was extremely nervous, and with autosuggestion his trembling got worse and worse. What was even worse, as a result of efforts not to tremble, his trembling increased more and more. Finally his symptoms were solidly established. If he tried to fix them or to escape from them he felt strong unpleasant fears. Even in his daily life he was troubled. The proper mental attitude for dealing with this symptom is the ordinary treatment attitude. One should not concentrate on curing just one part of symptom, but rather should aim to improve the whole life.
The treatment for the symptom itself is to accept it because there is nothing to do about it at the moment, not to compete with it. On the contrary, one should do what needs doing while allowing feelings and hands to tremble naturally. It does more harm than good to try many kinds of treatment in order to stop trembling. Especially patients suffering from hand trembling when writing change how they hold a pen and writing brush and the placing of the paper and their postures in order to stop trembling. But these efforts must be stopped. It is important to write as ordinary and healthy people do. Also it is good not to try to write beautifully or to write in block style so that others can read the words easily. This symptom has many of the same characteristics of anthoropophobia, so please refer to the pages about that topic. Basically, through the general treatment for neurosis the specific symptom will be quickly cured.
8. Nosophobia
All people have fear of contracting an illness or worried feelings about existing illness although there are some differences among them. A psychiatric patient who lacks the desire for self-preservation, the low IQ patient, and the extremely psychotic patient are exceptions. As devotion to good health develops, nosophobia patients focus on the negative side.
There are many nosophobia patients who have a comical image of perfect health. They look rather strange to ordinary people wasting huge sums of money and time and distressing themselves unnecessarily.
The main foci of their fears are pulmonary tuberculosis, mental illness, venereal disease, heart disease, high blood pressure and a gastroenteric disorders. Some of them vaguely fear a weak condition or others are worried whether a slightly unusual sensation is a sign of serious disease. Actually there are many pulmonary tuberculosis patients, and we see and hear about their deaths so that fear of pulmonary tuberculosis is the most common. Some people actually have some infiltration of the lung and have a slight fever, but others don't have the symptoms at all. Medical specialists note that some who have slight symptoms also have insomnia because of the fear and that their worries are apt to make the symptoms worse. Some people are surprised when they cough up bloody phlegm, and others seriously suffer from the fear of pulmonary tuberculosis after they were told by a doctor that their lungs were slightly weak. Patients who are put on complete bed rest by a doctor because of a slight fever may easily have many kinds of neurosis. We see that their symptoms are very slight so that they are active enough, but long-termrest prevents their activity. This unnatural life is apt to make them turn inward more and more and cause many kinds of fears. I assign these patients many kinds of light work depending on their symptoms as well as psychological treatment. For the patients who have serious symptoms, I have them write songs, haiku poems and a diary or suggest handicrafts depending on their interests. These always produce good results. A desire for activity is natural in a human being. So if it is suppressed, he or she is extremely distressed and loses the balance of mind and body. How long he should rest must be adjusted depending on his symptoms, so that a doctor's ability is required. The same treatment for every patient would be attended with many problems.
By the above treatment I cure the neurotic symptoms of patients with a light case of tuberculosis who are extremely worried. Their neurotic symptoms change for the better quickly, their temperatures go down to normal, and their weights increase without exception. Thus I believe that it is very important to give psychological treatment to tuberculosis patients. A 24-year-old woman I treated had a bad pulmonary apex, and her highest temperature was 37.4 degrees. A doctor ordered her to complete bed rest, but she began to suffer from doing nothing and became nervous. One night when her husband was gone, she became very lonely. Suddenly her heart began to pound, and she had a severe pain in her chest. She nearly died of the pain. After that, she feared that the same symptom might attack her again. So she needed a constant nurse and suffered from insomnia at night. Her ordinary condition turned for the worse. When she entered my hospital I told her to let her pain and worry happen freely. I prohibited her from complaining about them to others and from trying any means to stop them. I persuaded her to just look at them and encouraged her to write a diary and make her favorite songs, paper crafts, embroidery and so on. I asked a nurse to stay with her only at night and finally stopped that duty, too. Also I allowed her to walk around a garden, and I guided her to lead a human-like life step by step. For example, she was to take care of rabbits and chickens, and she was to memorize the names of plants and flowers. She gained 4 or 5 kilograms during the 40 days, and her temperature rarely went up to 37 degrees. Furthermore, her neurosis symptoms were completely cured. In this way tuberculosis, which involves neurotic symptoms caused by an unnatural and idle life, isn't cured easily by only medical treatment for tuberculosis. I emphasize that treatment for tuberculosis always needs rational psychological treatment.
Fear of tuberculosis is sometimes caused by the death of an acquaintances or relative. A slight fever might also be the cause. Some patients feel sure that they are hopeless tuberculosis patients because they feel severe pain in their chest on one occasion, they have a cough, perspiration, or feel sluggish. They ask for an X-ray examination seven or eight times, and they don't believe the doctor's words that nothing abnormal showed up on the X-rays. They are terribly pessimistic if they are told that there are some weak organs in their body.
Although there are many patients suffering from fears about venereal disease, they usually see the urology department. After they tried many kinds of treatments and examinations, they discovered that their symptoms were caused by neurosis. Dr. Kitagawa, Professor of the Urology Department of Keio University, has deep understanding of our treatment for neurosis. He said that patients who didn't actually get venereal disease or who had completely recovered from it persisted in asking for treatment visiting him almost every day. Patients suffering from syphilis felt terrible fear if their blood test showed a weak positive reaction even once. A patient who visited me showed me eight blood test results. Only one of them showed a weak positive reaction, and the others didn't. The remaining examinations were meaningless to him. Nosophobia varies so that in some cases fear of venereal disease is primary, and in other cases fear of lung diseases is primary. Thus nosophobia can change and develop into other neurotic symptoms.
Also there are many who fear high blood pressure and cerebral hemorrhage. One patient I introduced in my book Neurosis and Neurasthenia was an influential man in one district. He was a very active man, but when he was forty years old he saw a doctor because he felt dizzy. He was diagnosed as having high blood pressure. He needed complete bed rest because of fear of hemiplegia. Since then he was afraid of a cerebral hemorrhage and fainting. While he was walking he felt terrible fear, and his face was dripping with perspiration. Finally he couldn't go out alone. He was treated at various university and hospital outpatient clinics and also received inpatient hospital treatment. But his efforts didn't have any effect. He lived as good as dead for four years. After that, he visited me and was hospitalized.
To quote him, "I was completely in trouble because I could not work and talk. So I consulted with my regular doctor, and he introduced Dr. Kora to me. I was examined by him once. He said to me that my symptoms were caused by neurosis, so if I would follow his advice I would be completely well in thirty or forty days. Although I hardly believed that the sickness I had suffered from for four years could be cured in thirty or forty days, I made up my mind to be hospitalized on October 2nd. His treatment was strange to me. He never gave me a single pill or injection so I was amazed.
I only half believed his advice, but I did bed rest as instructed. While I was undergoing bed rest, I seriously doubted that I could get over by illness by this treatment. I got up after one week's bed rest, as planned. I was ordered to do some work then, and I began to do it even though feeling uneasiness. Until then I had never done anything like it. While I had to force myself for two or three days, I noticed that I recovered day by day. As four days and five days passed I was getting better day by day. So I could welcome his advice that I hadn't believed before.
I could notice that my mind was changing every day. I was deeply impressed and convinced that he was a true doctor. I thought that the doctors I had met only sold medicine. Soon, incredibly, I could work harder and harder. I could also have great interest in work. I had new strength every day, and I gained confidence. During that period I got up at six o'clock and kept working until 10 p.m. without rest.
On the 28th day, he took me to Jikei University to speak about my experience to students. Although before then I could not speak in public, I remained completely calm and talked clearly about my feelings at the university in front of many students. This experience gave me more and more confidence. So I realized that I was completely recovered. I didn't know how to thank him; I was just very happy."
Like this patient, a patient who is terribly troubled by nosophobia caused by autosuggestion can recover in a short period by his experience alone without any medicine. This patient was very active before he got ill, so he worked hard and conquered his painful condition getting back his healthy mind. If neurotic patients can conquer their distress they can recover without fail. This is a unique point about neurosis. If they give in to their sickness and try to escape from it, it is as if they are waiting for a dream that never comes true.
9. Sexual neurosis
Skin and urinary diseases are deeply related to sexual neurosis as mentioned above. Most of these patients firmly believe that they actually have organic diseases when they see a doctor of the urology department. Also the doctor often believes their words and carelessly treats diseases that don't exist. Although there are various symptoms about sexual neurosis, I offer some examples of patients' complaints below. Of course, these are mainly caused by their mental condition. The patients don't have essential diseases in their genitals as they believe.
If they find a little secretion of semen after an erection, they think that their semen is leaking and are deeply worried about it. They extremely fear nocturnal emissions believing that they make their body and mind tired. Some of them regard the physiological sensations they feel when they brush against their genitals to be morbid, and they are afraid of them. Some of them have a mistaken belief that their genitals smell bad and give offense to others. Some of them are worried that others know about their masturbation. If they happen to be impotent because of drinking or psychological states they become extremely fearful and anticipatory fear causes further impotence. They are always afraid that it might happen again. Premature ejaculation is caused by neurotic patients' perfectionism. They expect to satisfy their partners and themselves perfectly, and they are in a hurry to do too much. Most of the patients suffering from this problem are single. One of the important reasons for their sexual difficulties is the lack of a settled life, as can be found in proper married life. So such patients can get back to be normal after marriage.
I see still other patients who suffer from their belief that they have underdeveloped penises. They are worried that their penises are short. If we examine their penises they are all within a normal physiological range. We see neither underdevelopment nor poor functioning. But many of them think that masturbation prevented their penises from growing. The size of the penis mainly depends on how it is congested with blood at that time. These patients think that their penises are short compared with others they see when they take a bath. As the spongy body of the penises and the urethras are congested with blood when taking a bath, they become bigger than usual. But patients think that their penises are short, and they are afraid that others might see them. Their penises are naturally withered by this mental effect. They deplore their withered penises compared with others' congested ones. They regard their short penises as a symbol that they are not masculine.
Almost of all patients who have these sexual symptoms have other neurotic symptoms at the same time. They have symptoms such as insomnia, heart palpitations, fatigue, anthropophobia, timidity, anxiety, and vague feelings in the head. They guess that their short penises, masturbation, and premature ejaculation cause these other symptoms, so they suffer basically from their sexual problems. All sexual symptoms or accompanying neurotic symptoms are mere physiological phenomena that can happen to anyone on occasion, but neurotic patients tend to obsess and decide that these symptoms are signs of illness specific to themselves. Their psychological state holds these symptoms to be serious. Therefore when doctors treat these patients, doctors need to explain the mental mechanism underlying them and let them know their essence. Some of the patients can recover only by understanding what the essence is, but this happens only if they are mature. Others can understand it intellectually, but they can't recover easily. So these patients need to work on all their neurotic symptoms by experiential treatment. However, a doctor who doesn't know the essence of these symptoms very well would diagnose patients' withered penises, short penises, and premature ejaculation as organic disease and give them a sex hormone injection. This treatment never has permanent effects even if it has some temporary psychological effect. Most of the patients who visited us were given sex hormone injections more than one hundred times, but they didn't have any effect. I want to warn doctors about this point. Doctors should know where a symptom comes from. If they see that there is no room for doubt that it is caused by neurosis, they must stop the treatment for a single organ and offer treatment for the whole neurosis. They should offer reasonable mental treatment to their patients.
10. Anthropophobia (fear of blushing, fear of eye contact, fear of facial expression, fear of being in public.)
Although there are many neuroses, nosophobia and anthropophobia are the most common, they are the kings of neurosis. Anyone without anthropophobia at all is extremely rare, and we can say that he is rather strange. Ordinary people have some degree of anthropophobia, but they think that it is natural and don't especially care about it in their daily life. The ancients used to say that human beings are social animals; they can't exist if they are isolated. Robinson Crusoe, alone on an island, became friends with a dog and a parrot because there were no human beings. Still, he felt very lonely. Most schizophrenics don't like human beings very much and avoid others as much as they can. They cut connections and lead a lonely, hidden life. They are a special case. They have lost their human feeling. Anthropophobic patients, too, want to avoid others. But they are never satisfied with their isolated condition, and they have strong desires to be sociable, to be liked, and to be respected. Nevertheless, they can't become sociable because of their obsessive-compulsive neurosis. Schizophrenics don't have the desire to associate with others, so they don't care about avoiding people. So schizophrenia is completely different from obsessive-compulsive neurosis.
It is difficult to define anthropophobia in detail because it varies depending on patients' tendencies. So I shall comment on the most popular kinds.
(1) In erythrophobia the patients suffer from blushing in public. They are ashamed of it because they think that people notice it. They don't want to meet people. If someone says to them that they have a healthy complexion, they feel quite unpleasant because they think that they refer to their blushing faces. They try to fool others by pretending that they feel hot in order to make people believe that the heat makes their faces blush. They wash their faces with cold water again and again. They hide their faces while drinking. They are deeply worried about it, as though they go to hell for having a blushing face. Some patients assume that their faces blush because their face feels hot, but actually their faces don't blush.
(2) In fear of eye contact the patients are upset because they don't know where to turn their eyes when they are face-to-face with other people. They hate the unpleasant feeling, so they avoid meeting other people. If they think that they must not allow themselves to avoid eye contact and force themselves to stare at others' eyes their pain becomes worse and worse.
(3) In fear of facial expression the symptoms vary depending on patients. Some patients think that their faces are ugly so they can't meet other people or they think that it is impolite to be seen with such an ugly face. They are worried that their faces freeze when meeting other people or that their faces look as if though they are crying even when they laugh or that their lips have a strange shape. They suffer especially because of their eyes. They think that their staring makes other people feel unpleasant and that the whites of their eyes are too wide. They find various faults with their faces, and they grieve that they can't be seen in public. Therefore, some of them change their glasses many times. Furthermore, some of them go to eye doctors in order to have an eye operation. Others think that they are despised because their eyes don't exhibit strength.
They suffer not only from their faces. They worry that their hand movements are strange or that their way of walking is strange or their body smell is unpleasant for others. Some of them assume that they have a strong body odor or might have such so they won't go out without washing their shirts every day.
Anthropophobia exhibits many forms of symptom. Some patients don't have any symptoms when meeting one person but they hate to be seen in front of many people. Some of them are worried that they don't generate conversational topics when talking with another person. Some of them hate that they are nervous and awkward in their movements. Others are afraid that they tremble.
As mentioned above, our real desires are to be liked, to be sociable and to be respected. Such conditions allow a convenient life. However, if we obsess on these desires we have the concurrent anxiety that we might cause others to feel uncomfortable or that they might dislike us. Especially when we are with older people, a large group, and with men, we have a stronger desire to be seen favorably, so we have a stronger anxiety not to be seen unfavorably. This is a natural human feeling. We should understand these feelings of fear, distress, and shame and let them be as they are. Ordinary people associate with others while accepting that they want to be liked. They don't try to get rid of anthropophobia, so they aren't particularly troubled by it. But neurotic people hate distress and the shyness they have in public. They wage an impossible war in order to get rid of those feelings with the result that their fears turn into obsessive-compulsive neurosis, and anthropophobia gets worse.
If when we see flowers we regard them as beautiful, if when we see hairy caterpillars we regard them as revolting, if we take things as they are, we never get obsessive-compulsive neurosis. If we allow ourselves to be flexible in public, then we can associate with other people. It is as if we balance on a swinging horizontal bar and our bodies swing together with the bar so that we keep our balance. Anthropophobic patients must associate with other people while enduring their pain, fear, and shyness. If they keep avoiding their misery and avoid other people, they will never recover.
If they try to run away from necessary human feelings or if they try to deny them, they fail and have increasing distress. Worrying about eye contact is clearly disobedience to ordinary human feelings and results in becoming fettered by neurosis. These patients never consider the simple truth that it is natural for everyone to avert the eyes when looking at other people's eyes. We don't focus our eyes on one point when talking with someone. We sometimes look at the whole body or at the face vaguely or around the chest. It is normal that our eyes don't stay still. If the other person doesn't look at our eyes, we can look at theirs, but if our eyes meet, we will be embarrassed and avert our eyes in an instant. If we stare at their eyes, we must be very angry or our mental condition must be abnormal. When we see a drunk's eyes taking on a fixed stare, or when crazy people stare at us, we feel quite strange. Ordinary people feel some embarrassed discomfort when their eyes meet others' eyes. But neurotic people think that to turn their eyes away means to lose or to be a coward. They force themselves to gaze into others' eyes so that they naturally feel strange. They try to look at others' eyes more and more, so they feel more and more discomfort until they can't even see the other person's face. Some neurotic patients even wear sunglasses. To resist a natural mental state exaggerates their troubles.
Anthropophobic patients always compare themselves with other people. They think that they are weaker and more timid than others. They try to avoid feeling inferior. They try to avoid losing their presence of mind. They try to avoid defeat. And so they deny the natural mental flow around personal relations. Because the mental mechanism that produces obsessive-compulsive neurosis is activated, it is very important to go with the natural mental state. We had better take a modest and likable approach to interaction than to try to beat other people. We had better become a good listener rather than become a good talker. Having timid and uneasy feelings around other people, we meet them with as much smiling as possible. Anthropophobic patients unnaturally make efforts to avoid defeat and to avoid the appearance of uncertainty, so they appear rather arrogant and unlikable. If the other person doesn't bow first, then they won't bow. They are likely to have such an attitude. They have a self-centered narrow idea that they can't meet someone with smiling because they don't truly feel close to that person. The idea makes their world narrower and narrower. When I was young, I suffered from anthropophobia for a long time. I give anthropophobic patients especially caustic remarks because I know their thinking processes. If they keep accepting my remarks without objecting they will know my real intentions as they recover. Neurotic patients are apt to have a lot of arguments. Among them, especially anthropophobic patients show this strong tendency. Arguments from spiritual ignorance are apt to fall into dogmatism and vary with the current mood.
The patients who have serious anthropophobic symptoms tend to worry that others are talking about them and that someone is laughing about them when they see someone talking or laughing. This is called thoughts of association. They believe that something which has nothing to do with them has some relation to them. They have difficulty uncovering this mistaken thought process, but as they recover they notice their groundless fears.
11. Heavy feeling in the head, headache (dull feeling in the head, other abnormal feelings)
These patients always have a heavy feeling in the head as if they wear a lid, or as if their head has paste stuck on it, or as if there is something inside the head. They have a headache, and their heads have a dull feeling that prevents proper thought. They feel so dizzy that they are about to collapse. Their ears are ringing. Or they feel as if they are not themselves. They feel as if there is a big gap between themselves and the people around them. They have a stiff neck, and they feel as if the right part of their body and the left parts are different, or as if something presses on their chest. There are various symptoms. All these neurotic symptoms are caused by too much attention, autosuggestion, and mental interaction so that it is not necessary to explain each symptom. Many neurotic patients complain that they have vague sensations in their head. This is also caused by too much attention to their heads without paying attention to anything else. Originally our minds work properly by contact with the outside world. If we don't have connection with the outside world, our minds naturally become dull and we get sleepy. If I try to make my head dull, I can do it easily. If I don't pay attention to the outside world and concentrate on my head's condition, my head becomes dull. It is natural for neurotic patients who have an introverted mental state to have a dull feeling in the head. Other symptoms, such as feeling separated from other people or feeling as if they are not themselves, are the same. Everyone who focuses on his condition can experience these symptoms. Neurotic patients just make these symptoms neurosis because the patients give too much attention to them. The way of the treatment is the same as that for other neurotic symptoms. Patients must live a busy life with their abnormal feelings just like healthy people.
12. Inferiority
This problem is common to all neurotic patients but especially anthropophobic patients have strong inferiority without exception. They feel inferior to everyone in everything. They think that they are stupid, that they have no ability for understanding, memorizing and practicing. Everything is inferior. They have an inferiority complex about everything, so that they think even their faces and bodies are miserable. It makes them more withdrawn. They don't have a positive attitude so, in fact, they don't actually do what they are capable of doing.
The result is that they become inferior to other people. However, if we teach them to do various things, they are not actually inferior to other people, and we can see that fact. If they make a small mistake they exaggerate it in their minds because they are perfectionistic. If they are obsessed with something, they can't judge properly their real ability. Even if we give them an intelligence test and prove by the result that their ability is in no way inferior they don't readily accept the results. They say that the results were pure luck and obstinately refuse to believe in their own ability.
People who are really inferior aren't bothered by their inferiority. Those who really have no ability don't worry about it. People who deplore their inferiority aren't really inferior; it is just a sign of their perfectionism. It is like people who have a strong fear of death are such just because they have a strong desire to live.
Patients suffering from inferiority feelings worry that they can't see a sign well. However, few people can see it at first. The patients feel inferior compared with people who have seen the sign many times before. They don't think of the fact that they never saw the sign earlier. They don't notice other people's efforts so they think that other people can speak, study, and work without any trouble. They decide that they are the only ones having difficulty doing anything. Patients suffering from feelings of inferiority can't recover easily unless they experience that they can do almost everything by making effort. If they stop doing something because of discomfort or initial difficulties they will never be able to break away from their inferiority feelings. Many of them say that they don't like certain foods without ever having tasted them. If they don't try anything because they think it impossible from the beginning, it is no surprise that they are regarded as genuinely inferior persons.
If they recover they can understand that having feelings of inferiority stimulates us to make efforts and to be active. Such feelings spur us to lead a diligent life.
13. Gastrointestinal neurosis
Almost of all gastric weakness symptoms that aren't cured by various diets and medicines are concerned with gastrointestinal neurosis. Symptoms include foods sitting heavy on the stomach for a long time, distended stomach, a nauseated feeling, a stomachache, long-lasting constipation, and diarrhea. Patients are very sensitive to food. They avoid foods that cause indigestion, eat only rice porridge and gradually their meals become lighter and lighter. They used to feel full by eating three bowls of rice but now two bowls of rice are enough, even only one bowl of rice makes their stomach feel distended. In this way, most of them lose weight and weaken. They don't eat enough and don't do enough exercise so that their stomachs actually wither and become less effective.
We correct their oversensitivity to their diet and let them have the average amounts of food at mealtimes and encourage them to work hard and train their muscles. Their essential sickness is nosophobia. So with our treatment they naturally recover from gastrointestinal neurosis. A young man who I treated weighed about 39 kg because of diarrhea and constipation lasting over ten years. Within three months his weight gained to more than 52.2kg. Also an old scholar had taken a laxative every day for twenty years because he hadn't had a bowel movement without laxatives, but while hospitalized he completely broke through this bad habit. To be obsessed with something affects greatly not only our mind but also our body, especially our digestive organs, hearts, and blood vessels. But it affects only their function not their essential cells, so if the patients aren't hurt by medication they are unharmed. They can stand hard training; they can recover simply by hard training. But if their symptoms are very serious, they may be defeated by their symptoms. Sometimes they are able to conquer their symptoms by themselves.
14. Other obsessive-compulsive neuroses
A woman visited me and complained that an idea of an herb, "Rohdea japonica ," kept appearing in her mind, and she couldn't think about anything else at all no matter how she tried to stop thinking about it. While she was awake, Rohdea japonica occupied her mind. Judging only by what she said, her symptoms looked strange. But if we turn our attention to the cause, they were not essentially different from anthropophobia and nosophobia. She was in a troubled family situation. When her friend visited her, she gave her friend some advice about curing a health problem with Rohdea japonica. After talking about it, she began to worry that her advice wasn't absolutely correct, that she didn't know enough about the herb. She felt ashamed about the subject. After that, whenever she remembered Rohdea japonica, she felt upset. So she decided that she had better not think about it and tried to repress it whenever it occurred to her. In short, she disliked the upset feeling and tried not to think of the herb. But actually the idea "Rohdea japonica" reminds her of that event and makes her upset. It is natural and could happen to anyone who has experienced such an event. Normal people know that such a thing sometimes happens and forget it soon. However, neurotic people can't forget any upset feeling at all and force themselves to try to get rid of it. They are adversely affected by their obsession. When crossing a river it is easy to swim with the current, but if we swim against the current we feel the water's resistance strongly. This symptom is like that experience.
I once defined obsessive-compulsive neurosis as follows: "Patients regard a mental or physiological phenomenon that can occur to normal people on occasion to be a sign of illness, abnormal, or disadvantageous to self-preservation because of their self-centered attention; they try to get rid of the situations or anxieties that cause their suffering or to escape from them. But they do not succeed. Obsessive-compulsive neurosis means this complicated mental state and the whole process of suffering and anxieties incidental to it." This definition seems difficult but it is easily understood if it is put into realistic practice. The mental complications in trying to get rid of or escape from the anxiety actually cause more suffering and trouble. Obsessive-compulsive neuroses have countless symptoms depending on the patients' experiences, so it is impossible to explain each of them. I will introduce briefly some symptoms that are seen comparatively often.
Fear of dirtiness
It often includes a fear of germs and fear of contagious diseases. Patients won't touch anything directly because they feel everything is dirty. If they can't wash their hands immediately or disinfect their hands with alcohol after touching something it is difficult for them to lead their daily life. Some patients wash their hands twenty times a day, and some patients use an excessive amount of toilet paper, and others spend the most part of their day cleaning house. One woman I treated washed her clothes again if a person even slightly brushed against her clothing. If another person opened her closet containing washed clothes even a little bit, she worried and couldn't help washing all of the clothes again.
Fear of guilt
Patients are worried that they might have done something illegal or wrong. When they are in public, they fear that they accidentally stole other people's belongings. They fear that they might become violent suddenly or that they might hit someone on the head. With these fears it is difficult for them to be in public. In one case, a patient feared that if he had a match he would set fire to his house impulsively, so he couldn't approach a fire. Other patients worry that they might think an evil idea. Although they have no intention to carry out the evil, they suffer even to think of it. The more they try to avoid thinking of a strange idea, the more it occurs to them. There are many patients who feel great fear that they might think impious ideas at a shrine, a temple or a ceremonial hall; it is called fear of impiousness. They avoid walking in front of a shrine or temple. Some patients think an obscene idea that wouldn't be socially acceptable to say to others. The more they think they must not express the idea, the more odd ideas they think of, exhausting themselves. Some patients feel worried that they might suddenly push their children over a high place.
Fear of superstition
This also has various symptoms. A simple one is to care excessively about numbers. Each number has good luck and bad luck--three is good luck or four is bad luck, for example. The particular numbers depend on the patient. A patient who doesn't like the number three becomes nervous when three people meet. If he goes up stairs with three steps, he returns and goes up again. As he avoids everything concerned with "three", his daily life becomes inconvenient. Some patients like even numbers, others like an odd numbers. Also some patients must count numbers compulsively whenever they begin something. After a bad accident, some patients hate anything concerned with it. For example, they don't want to even see the clothes they wore when injured. If the accident happened on a Sunday they worry every Sunday. When a patient took an examination and got a bad score, he hated the road he walked to school on that day. On the contrary, if a patient got a good score, he worried if he had to go to school on a different road. Thus the patients have superstitious feelings about any accident.
Fear of pointed objects
Patients are afraid when they see something sharp because they feel it might hurt them. A woman couldn't sew because she was afraid of needles. A patient was distracted from work where a knife was near him. A patient had to move because there were splinters of glass inside of a neighbor's house wall. In an extreme case, a patient is afraid of a sharp leaf. If a pair of hobnailed shoes in a shoe case was higher than a patient's head he couldn't sleep.
Fear of heights
According to one study, when we are threatened by a knife, a bloodcurdling feeling runs down through the back from the shoulder, and when we stand at the edge of a precipitous cliff it runs up from the soles of the feet. If a patient had an unpleasant feeling of danger at a high place once, he couldn't even go to a safe high place because of fear. Another patient suffering from a fear of fainting couldn't go to a high place because he worried that he might faint there.
Calculation symptoms
Some patients can't help adding anything they see one by one. Others must always count numbers internally. So they have trouble in their daily work.
Inquisitiveness symptoms
These patients can't help investigating anything even though they know it is senseless. Why does a desk have four legs? Why are there differences between men and women? How many leaves does this tree have? How many fish are there in Tokyo bay? They spend every day meaninglessly in order to probe such questions. The treatment for these obsessive-compulsive neuroses is not different from other neuroses. They always think only about easing their mind. They try to repress their symptoms in order to avoid obsessions or they obey their symptoms because they want to be relieved and to escape from their anxieties. Such efforts make them depressed. If they wash their hands many times or disinfect their hands, they are only temporarily satisfied. If they don't repeat the same activity, they become worried. So they repeat it inefficiently. They go round and round in order to avoid pain. If they don't have an attitude that they stand discomfort and anxiety while having their neurotic symptoms and working hard at necessary tasks they have no hope that they can break into a new mental state. After they gain the experience that they know that they can do actual work even if with the obsessive-compulsive neurotic symptoms their symptoms go away gradually.