Work To Live: Work Kills Us

During the time I lived in Japan from 1968 until 1992, Japanese salarymen–office workers–worked from morning till late at night. Many of the mid and upper managerial class put in eighty to a hundred – including unpaid overtime hours – each month.

Perhaps Americans would not call going out to bars and drinking work, but salarymen are forced to go out with their associates after work and they are expected to drink whenever someone orders drinks or pours for them. They cannot say I have to leave now, my wife is expecting me home for supper. Rarely do they get home in time to share a meal with their family or in time to see their kids awake.

After years of returning home late at night and getting up for work the next morning, hangover and all, this work ethic takes its toll. These workers are disengaged from their families. A large percentage of Japanese males smoke and this contributes to their health problems. It is not unexpected to hear of men in their forties and fifties dying of heart or brain conditions, of acute cardiac insufficiency, and subarachnoid hemorrhage. By the late 1980s, this became a virtual epidemic in Japan, and newspapers and other media coined a word for it, karoshi (kah roh she) “death from overwork.”

Work as Therapy: Work That Kills

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Sometime in the early 1980s I first heard of Morita Therapy and went to visit the chief psychiatrist at Daisan Hospital in Tokyo where Morita started his program. Morita Therapy centers in large part on adjusting to the world of work. The Zen-based therapy developed by Japanese psychiatrist Shoma Morita in the early 1920s, in ways similar to Metacognitive Therapy (MCT) and Insight Meditation, makes no direct attempt at reasoning with, changing, or fixing disturbing thoughts and feelings.

Stage One – Focus: Be the Pain

The first stage lasting four days to a week is in isolation and rest. Even family and friends are not permitted to visit during this initial stage of treatment. Morita expected patients to suffer in agony during this phase because they would be left alone to focus on their disturbing thoughts and feelings. He called this stage “the agony period.” This isolation stage is absent in Morita Therapy in the U.S.

One reason for the isolation is so the client may come to realize that others cannot be relied upon for sympathy or assistance. It is not possible to instruct someone to become independent and self-reliant. The client must come to this conclusion on his/her own.

Morita would tell his patients to let themselves experience the pain. Even if the anxiety and pain were unbearable, he would tell them to let themselves experience it. During this phase of the treatment, he allowed patients to obsess about their personal affairs, discomforts, and pessimistic views of their past and future.

Morita reported that when a patient reached a climax of anguish and pain, within a relatively short time, even within hours, the pain would dissipate and disappear. By fully confronting and experiencing the symptoms and pain with nothing to distract them, the patient would gradually enter the state of what he called natural consciousness.

Stage Two – Focus: Observe, Describe, and Evaluate the Pain

In the second stage of treatment, though patients are still isolated and restricted from conversation and amusement, they take part in light work such as raking leaves, weeding the garden, or wood carving. During this stage, they are not allowed to do anything to divert their minds, not even going for a walk or whistling. They maintain a serious attitude and continue to ride out their physical and mental distress and take obsessive thoughts calmly and with patience just as they are, without trying to change anything.

In Morita Therapy there are two ways of freeing oneself of disturbing thoughts. The first, especially in Stage One and continuing to a lesser extent in Stage Two, is to completely become the pain and suffering without attempting to fight or change it. Morita calls this “obedience to nature.”

Morita explains this with a metaphor of a donkey tied to the post with a rope. The donkey attempts to escape by walking round and round the post, but the rope gets shorter and shorter until the donkey is immobilized. When you try to think your way out of obsessive thoughts, you go round and round and become immobilized like the donkey.

If you persevere through the pain and treat it as something inevitable like the donkey that no longer attempts to escape, you will not become entrapped and can graze freely within the limitations of the rope and post. You are freeing yourself by obedience to nature.

As the patient leaves Stage Two, he/she still focuses on the pain, but rather than becoming the pain, he/she observes, describes, and evaluates it without attempting to eliminate the discomfort or distract him/herself. The pain and suffering become objective entities projected onto the external world. Morita says this is like observing a mountain by stepping away and keeping a distance from it. As much as may be possible, you step away from yourself and see more of the total picture, much the same as viewing your problems from a third-person POV.

Following the fourth day of Stage Two, the work becomes more diversified and patients are encouraged to learn new work they have never before done. There is no classifying of work in terms of social status, gender, or lifestyle. As their mental and physical health improves, and when clients seek more difficult work, treatment moves on to Stage Three. The second stage can last one or two weeks, but there are no borders between stages.

Therapists deal with a client’s complaints by ignoring them. By the end of the second stage, clients complain with less frequency. And if the clients then report that their headache or heaviness of the head or chest has lessened, therapists ignore this as well. This is because comfortable feelings are always accompanied by an opposite uncomfortable feeling. Morita Therapy breaks down clients’ self-evaluating attitudes and constant focus on feelings of comfort and discomfort.

Stage Three – Work and Play Hard

Clients engage in more labor-intensive work, often work they feel is beneath their sense of dignity, such as chopping wood or cleaning toilets. The goal is to acquire patience and endure work of any kind assigned. Clients acquire the self-confidence that they can do anything others can do. The work is often hard and long hours and presents a challenge in the beginning. But it moves the client from being the treated victim to being the recovering survivor.

During this third stage, clients are encouraged to spend time creating art, writing, painting, anything that puts them in contact with the flow of creative activity. It is through creativity that the client learns to experience a sense of joy, a joy not dependent on practical value or a product, but rather on achieving something beyond expectation and through great effort. This can be considered a stage of spiritual enlightenment that accompanies knowledge and confidence that much is possible in life.

Stage Four – Break from Attachments and Interests: Adjust to the External World

Stage Four prepares the client for re-entry into the external world. Training in the fourth stage aims to break all attachments, including fixations on one’s interests. Clients are trained to adjust to changes in external circumstances. This is a phase where the client learns to integrate a new lifestyle of meditation, physical activity, and clearer thinking. They are now equipped to function in a world where they will not always like what they are doing and their lives will not be trouble-free. They will no longer be wasting so much of their lives attempting to avoid feelings of displeasure and boredom. They will become more genuinely themselves.

Morita said, “One becomes conflicted when he/she projects his/her experiences and subjective facts onto the external world as an objective model.” This gets us in trouble because just as we can never view ourselves, only a mirror image, photograph, or video, we cannot project our thoughts and experiences onto the external world.

Morita of course did not know of the concept of the Narrator, but perhaps he may be referencing the same concept. It all is rooted in Buddhism. The Narrator is the world of subjective “facts.” When we take our story and project it onto the external world as reality, this gets us into trouble. Many of us live our lives as prescribed by the Narrator.

The core of Morita Therapy involves a shift of focus from disturbing thoughts and feelings to actively working, writing, painting, gardening, and engagement in projects. And in this way, it is similar to the Four-Step Method.

The in-hospital patients I observed were dressed in casual civilian attire and engaged in various activities. They calmly and actively engaged with what they were doing and you might have thought they were hospital staff rather than in-treatment patients with debilitating mental illnesses.

Rooted in Zen, the focus is on living in the present moment. Rather than focusing on one’s emotional state or feelings, the emphasis is on living a full and engaging life and not being ruled by one’s emotional state.

Focus: Goals Over Mechanics

Acting with nearsightedness does not mean a lack of focus. It means a focus on the objective, not the component parts. A pitcher or batter performs well when they go with the flow. They focus on the objective of hitting the ball or getting the pitch over the plate (Open Focus). If the focus shifts from the objective (goals) to the specifics of form (narrow focus) – motion, and timing – athletes will likely choke. It is the same for a concert pianist who suddenly shifts in performance from playing the piece with feeling to a focus on each individual note and placement of fingers corresponding to each note.

Morita would say with a focus on specifics or mechanics you lose a wide peripheral vision (Open Focus). You lose a vision of the forest when you try to figure out where you are from a focus on a plant or tree. In Zen, the state of mushoju-shin is when the mind is alert in all directions rather than a single, one-point focus. This is extending Ki in all directions or Open Focus.

If it all starts to sound repetitive, it is. Mindful therapies are based on schools of Buddhism that have been around for more than two thousand years. Morita therapy began in the 1930s, Fehmi’s Open Focus in the 1960s. Both encourage the development of a diffuse focus. I’m sure Morita would have adopted Fehmi’s phrase, “Do it in Alpha,” had he lived on into the era of access to EEGs.

A restricted, narrow, objective focus lifts brain wave frequency out of the alpha range, affecting our perception, emotion, and behavior in a sometimes unpleasant way. Everything is affected including muscle tension, heart, respiration, neurotransmitters, and hormones.

Morita Therapy directs attention away from a narrow focus on symptoms. The work stages are designed to guide clients to spontaneous activity, to concentrate on the goals of the work, and to expand peripheral consciousness away from narrow, repetitive, self-observations.

Morita Therapy is behavior therapy, but not the stimulus-response (SR) or operant conditioning we know in the West. It is a focus on behavior over feelings or thoughts. Key concepts are to do, to act, and not to focus on worries and symptoms. Morita therapy is not about controlling or trying to understand your thoughts, feelings, and impulses. Our minds are fluid and changing; focusing on symptoms is static and unchanging.

Like Albert Ellis, Morita favored “to do” action verbs. He made an effort to minimize the use of the verb “to be.” When you use the verb “to be” to describe someone, you put them in a box. I taught school for more than twenty-five years, but I would not say I am (the verb “to be”) a teacher. I taught school and did many other things that were equally as important to my life. I tried to get my students to see people and life in this way.

Do It in Alpha

Morita Therapy is about keeping an Open Focus. If you keep up a prolonged tight focus in teaching, you feel a buildup of stress and tension. You respond to a fearful situation by narrowing your attention and separating yourself from the world. Teachers fear losing control. Students reflect this uptightness in disorderly behavior.

When I first started teaching, lunchtimes I would sit in my classroom and pour vodka into my tea, so right after lunch, I embodied Zen. The kids were focused and communication flowed wordlessly. I would sit at my desk smiling beatifically and they sat smiling beatifically back. I spoke quietly and they got every word. These were low-income, inner-city kids. We entered an Open-Focus state of flow of mind-blowing oneness.

I used alcohol back then, but it is how we balance attention between the world around us and our inner world of thoughts, feelings, and emotions. It is about maintaining an Open Focus where we shift from narrow to all-encompassing diffuse focus. I was able to shift my focus out with the kids, releasing a tense, narrow, inner focus, dissolving I-versus-thou boundaries.

Pain, tension, negative emotions, and feelings accompany inflexible, rigid attention, or what Fehmi calls rigid attention syndrome, RAS. The simple basic thing we can do for our physical and emotional pain and confusion is developing the ability to shift from rigid, narrow, objective attention to a wide, peripheral focus that takes it all in as I did spaced out on vodka. It is a skill you practice over and over like a close-up sleight-of-hand routine. Once you get it, it can be performed relatively effortlessly in almost any situation. Without vodka.

It is about attention, 45 bits of it. Therapies come and go, constantly rediscovered and repackaged. Morita Therapy incorporates many facets of Buddhism and so does MCT, Open-Focus, ATT, and Insight Meditation. The new is in with the old. And the old simply focuses on attention.

Self-help books that help:

Total Self-Renewal through Attention Therapies and Open Focus

The Open-Focus Brain: Harnessing the Power of Attention to Heal Mind and Body