Christopher Harding

Japanese psychoanalysis and Buddhism: the making of a relationship

This article explores the making of a relationship between Japanese psychoanalysis and Buddhism, in the life and work of Kosawa Heisaku. Kosawa did not work out the compatibility of psychoanalysis with Buddhism in abstract, theoretical terms; rather, he understood them as two different articulations of the same practical approach to living well. He saw this approach in action in the lives of Freud and Shinran, the latter a thirteenth-century Japanese Buddhist reformer. For Kosawa, both individuals exemplified the ‘true religious state of mind’, at the achievement of which Kosawa understood psychoanalytic psychotherapy as ideally aiming. This article uses newly available documentary and interview material to examine the historical dynamics both of Kosawa’s work in this area and of the broader ‘religion-psy dialogue’ of which it is an early example.

Religion, Psychiatry, and Psychotherapy: Exploring the Japanese Experience and the Possibility of a Transnational Framework

This article offers a four-part framework for exploring the complexities and nuances of a modern and contemporary phenomenon in health care and broader public discourse in many parts of the world: the “religion-psy dialogue,” the increasing interchange between the thinkers, leaders, and laypeople of the worlds religions and the professionalizing and expanding “psy disciplines”—principally psychiatry, psychology, and psychotherapy. The four parts outlined here—circumstances and orientations, the human person, language, and complementarities and antagonisms—reference the Japanese context in particular but build on experiences elsewhere in the world and are intended to be useful multinationally and transnationally.

Mind, soul, and consciousness: religion, science, and the psy disciplines in modern South Asia

ABSTRACT This introductory article lays out some of the key intellectual, therapeutic, political, and social concerns where religion, science, and the psy disciplines have come together – including what we ‘do’ with our experience of the world, and of ourselves; the means we choose to use in ordering our thoughts and emotions; the language(s) we deploy in doing so; and the authorities we look to for guidance. Short introductions are offered along the way to the work of scholars in this emerging field including Ashis Nandy and Nikolas Rose, alongside illustrative comparisons drawn from the Indian and Japanese contexts in the modern era. These latter span a range of concerns: the extension of interventionist ambitions by the modern state to include the utilization of the psy disciplines – theories, practitioners, institutions; the appearance of language associated with these disciplines in everyday life, sometimes using the health of individuals as a putative barometer of society’s health more broadly; and the power of entrepreneurial individuals to steer these disciplines in personalized directions, thanks both to their relative newness and the liminal nature of their subject matter. The chapter goes on to offer a survey of the articles featured in this special issue of South Asian History and Culture, contextualizing them and laying out the principal aims of the issue.

Buddhism, Christianity, and psychotherapy: A three-way conversation in the mid-twentieth century

Abstract This article explores the scope of ‘religion-psy dialogue’ in the mid-twentieth century, via a case study from Japan: Kosawa Heisaku, a Buddhist psychoanalyst based in Tokyo. By putting this case study in brief comparative perspective, with the conversation that took place in 1965 between Paul Tillich and Carl Rogers, the article discusses both the promise and the pitfalls of the modern and contemporary world of ‘religion-psy dialogue’, alongside the means by which specialists in a variety of fields might investigate and hold it to account.

Culture and psychotherapy in Japan

102 www.thelancet.com/psychiatry Vol 4 February 2017 Long after the global community turned its attention away from Japan’s “3/11” (an earthquake, tsunami, and nuclear reactor meltdown in March, 2011), a Zen Buddhist monk was to be found cruising around the desolation in northern Japan in a pick-up truck. A sign on the roof of the truck read “Café de Monk”. Taiō Kaneta was meeting Japan’s triple disasters with a triple entendre: a Buddhist monk playing Thelonious Monk records in a mobile pop-up café, listening to people’s monku—their “complaints” about life. Kaneta’s café, still running today, was part of a wider set of coordinated medical, therapeutic, and interfaith relief initiatives developed in the spring of 2011. Grouped under the umbrella of Kokoro no Sōdanshitsu (“counselling room for the heart”), they were the fruits of a sophisticated national conversation in Japan about how psychological distress is best understood, talked about, and treated. Junko Kitanaka, a professor of anthropology at Keio University (Tokyo, Japan), points to a previous earthquake disaster in Kobe, Japan, in 1995, as helping to kick-start this conversation. People began to talk about survivors’ need for kokoro no kea: “care for the heart”. The sheer openness of the phrase helped it to catch on. Kokoro (“heart”) helpfully steers clear of conceptual complications and professional turf wars regarding the nature and causation of mental illnesses. Kea (“care”) is a value and aspiration to which all can happily sign up. Largely missing from the growing public awareness about mental health that followed from this, however—at least from a Western perspective—has been psychotherapy and counselling. Funding is a factor. Japan’s national health insurance model is based on partial reimbursement of doctors for provision of specifi c tests and treatments, with patients paying a proportion of the costs themselves. For many years, outpatient psychotherapy was only covered if it was provided by a psychiatrist, but there are too few psychiatrists, with too little time to spare in each working day, to make sustained psychotherapy a practical option. The long-awaited passing into law, earlier this year, of a national licensing system for psychologists may partially alleviate these problems. However, as Andrew Grimes, a British clinical psychologist based in Tokyo, points out, the extent to which counselling and psychotherapy will be covered by Japanese health insurance as a result of licensing remains to be seen. Beyond the question of how psychotherapy will be paid for lies an even more fundamental one: “What is psychotherapy for?” Toshihide Kuroki, a psychiatrist in Fukuoka, points out that although cognitive behavioural therapy has been expanding in Japan since gaining limited health insurance coverage back in 2010, many Japanese doctors remain opposed to it on the basis that the therapy tries to off er psychological solutions to what they regard as physical problems. Psychotherapy did exist in Japan during the early decades of the 20th century. But it developed away from the medical departments of prestigious universities that might have given it clout with government funders and kudos with the Japanese population at large. And while a lengthy love aff air with talking therapies began in Europe and the USA, Japan’s early equivalents seemed to be based almost on a repudiation of words. The psychiatrist Morita Shōma, who founded Morita therapy, thought that trying to use the mind to control the mind was philosophically nonsensical and therapeutically self-defeating. A residential Morita therapy designed to treat what he called nervosity involved a week of bed rest, followed by increasingly demanding physical tasks. The aim was not to delve into a person’s troubles. The patient would learn to accept nature—including his or her own nature—the way that it was, steadily integrating that acceptance into everyday life until his or her anxieties were less easily and extensively triggered. Two other therapies, both of which drew inspiration from Japanese Buddhism, dealt in words but treated them as a means to an end rather than as carriers of precious knowledge. Kosawa Heisaku, who studied briefl y with Sigmund Freud and his colleagues in Vienna, Austria, created a form of psychoanalysis that featured no religious references but whose ultimate aim was to produce in the client a profound sense of his or her dependence upon, and loving acceptance by, a transpersonal power that Kosawa understood as Amida Buddha. Yoshimoto Ishin’s residential Naikan therapy, adapted from a Buddhist meditation practice, interspersed long periods of solitary refl ection with verbal exchanges between client and “guide”. These exchanges were brief and ritualised, intended as a short report rather than an open, probing conversation. The therapy’s healing eff ect came from the deep gratitude to others that sustained refl ection naturally produced. Although these therapies answered the needs of small numbers of people at the time, none of them achieved widespread recognition in Japan, and later Western commentators were a little too enthusiastic in Feature Culture and psychotherapy in Japan

Historical Reflections on Mental Health and Illness: India, Japan, and the West

This chapter reflects on how modern concepts of mental health and illness emerged in India and Japan both through dialogue with Western paradigms and practices and by drawing on cultural inheritances and sociopolitical conditions—especially in the context of colonialism and anti-colonial nationalism. A comparative analysis of the Indian and Japanese contexts illuminates five themes in particular of interest in understanding Global Mental Health: dilemmas over how imported Western categories of knowledge can be made to fit with long-standing local ones; the role of cultural nationalism in encouraging local innovations in mental health practice, and frustrating the progress of foreign counterparts; a tendency to use the prevalence of mental illness in society—whether documented or presumed—as a means of critiquing Western modernity and its ill effects; tensions between state policy/provision and private entrepreneurship in catering for psychological and emotional suffering; and the importance of social, and especially family, structures and relationships in determining which sorts of experiences and patterns of behaviour are most readily labelled as ‘illness’ and those which are not.

Psychiatry in India: Historical Roots, Development as a Discipline and Contemporary Context

The authors provide an overview of the development of psychiatric services in India. They track the early developments in ancient and medieval periods, and after Western medicine made its appearance. Lunatic Asylums were established in India by the East India Company, and extended to various parts of the country, under British rule. The spread of medical education and services was quite slow, and there were very few psychiatrists, and a small number of beds by mid-twentieth century. Publicly funded universal health care, planned on similar lines as the NHS at the eve of Independence, did not develop sufficiently in subsequent decades. Economic and social disruption, and low priority to spending on health care thwarted efforts at extending the services. The development of pharmacological treatments in the 1950s raised the possibility of general hospital-based psychiatric services, at least of severe mental illness. Importantly, efforts to understand the psychosocial causes and correlates of both common and severe mental disorders were slow to develop. There was unease expressed with ‘Western’ models of psychopathology and intervention, and there were attempts at incorporating indigenous ideas and philosophical traditions. These remained sporadic, however, and did not give rise to any pan-Indian approach to understanding psychiatric illness or its cure. Although epidemiologic rates for psychiatric disorders are lower than in high-income countries, the rates in India are higher compared to other average Asian prevalence rates. However, there have been few concerted efforts at understanding these differences and the local psychosocial factors producing psychiatric illness. Further, inadequate human resources to deal with the existing problems and serious operational problems with the National Mental Health Programme are ground realities. The growing number of private for-profit and not-for-profit mental health facilities is welcome as some have innovative mental health care reach-out strategies. However, they also remain a cause for concern due to their poor regulation and sometimes human rights violations. The new mental health policy hopefully provides a framework for better partnership, quantity and quality of care. With the re-emerging interest in global mental health and ‘universal’ treatment guidelines, it is an appropriate time for serious reflection on the way forward and to examine the relevance of local and sociocultural contexts in understanding and treating psychiatric illnesses.

Christianity in India. From beginnings to the present . By Robert Eric Frykenberg. (Oxford History of the Christian Church.) Pp. xxxi+564 incl. 8 maps and 13 ills+13 plates. Oxford: Oxford University Press, 2008. £75. 978 0 19 826377 7

literature. This is undoubtedly a tour de force of sources in English and English translation (almost no German sources are referred to), and although the sheer quantity of information is at times overwhelming, readers will gain a rich impression of the way in which the book of Esther has provoked responses from many and differing spheres over a long period of time. A small technical point is that transliterations from Hebrew sometimes begin with an opening quotation mark which has no corresponding closing mark. This makes it look as though the Hebrew letter ‘ayin is being transliterated, when this is not the case.