Naikan Therapy

“Nikon therapy?”  I was thinking to myself.

Psychotherapy using photography? 

I was confused! 

My wife, my mother-in-law, and myself, were sitting in on an intake session at Kansai University Department of Psychosomatic Medicine. 

The patient was a middle-aged taxi driver with abdominal discomfort. 

The doctor first did a typical Western medical intake along with a dietary and an in-depth social history. 

He then went on to do an in-depth physical exam, and an in-the-room abdominal ultrasound, no technician needed. 

My wife and I were visiting her family in Japan. 

I got to give a talk at Kansai University. 

Due to my interest in mind-body medicine I was invited to sit in on this patient’s intake.  As my wife is a nurse also with a long-term interest in mind-body medicine, she was invited as well.   My mother-in-law was invited as an additional translator. 

Psychosomatic medicine? 

That practice had not existed in the US since the 1970’s, but now is being reconsidered as a legitimate field of medicine, recently being recognized as a psychiatric subspecialty. 

http://www.medscape.com/viewarticle/726444_2

In Japan and Germany, Departments of Psychosomatic Medicine never went away. 

The doctor recommended dietary changes, supplements, no conventional medications, and Naikan Therapy.   In Japan, Naikan Therapy means you spend a week or more in a hospital contemplating 3 questions: 

What have I received from __________ ?

What have I given to __________ ?

What troubles and difficulties have I caused __________ ?

http://www.todoinstitute.org/naikan3.html

Dan Goleman wrote a nice review article on Naikan Therapy in 1986 for the NY Times. 

http://www.nytimes.com/1986/06/03/science/in-japan-gratitude-to-others-is-stressed-in-psychotherapy.html?pagewanted=all

I’m writing this today because of an article entitled Naikan Therapy written by Gregg Krech in this month’s Tricycle, Winter 2015. 

This article started my thinking about our visit to Japan in 2008. 

I am the course director for our first and second year medical student’s elective in Complementary and Alternative Medicine. 

Accent on the fact that this is an “elective” course.   Maybe 10-30 students, of 175, take this course each year. 

There is no required teaching on mind-body medicine in my medical school. 

Is that crazy, or what! 

Yes, I am a medical heretic. 

But, ignoring mind-body medicine?   

Ignoring psycho-neuro-endocrine-immunology? 

Yes folks, we are still in the dark ages. 

There is even a Mindful Magazine. 

Come on now.  This is the year 2015, and there is no required course that teaches about meditation, supplements, acupuncture, yoga, or tai chi in our conventional medical school education.   

Maybe Naikan therapy might be a stretch for our students to learn.  But, maybe just what some of our patients need! 

What a shame… 

I guess that is why there are so many alternative practitioners out there. 

Our patients are crying for better therapies. 

Many discomforts of the mind and body are poorly addressed by our conventional medicine. 

The rich have easy access to these alternative therapies.  

The poor much less so… 

These medical institutions are like steering immense ships.   Very slow to turn… 

They will get there. 

Some day… 

However, much suffering along the way…    

The Veterans Administration may lead the way.   There is great promise for alternative therapies in treating PTSD. 

http://www.research.va.gov/topics/cam.cfm

Recent research is looking to MDMA, AKA ecstasy, and marijuana in treating PTSD. 

http://entheology.com/research/treating-ptsd-new-studies-offer-hope-for-trauma-victims/

The entheogen, psilocybin, AKA magic mushrooms, is showing great promise for treating cancer-diagnosis-associated anxiety. 

http://www.newyorker.com/magazine/2015/02/09/trip-treatment

I wonder what caused psychosomatic medicine to wither away in the US? 

Was it our love for the quick fix? 

The power of the drug companies? 

Our patients wanting that magic bullet? 

Well, that magic bullet might be waiting in the wings. 

But, it may not look like magic… 

At least at first glance… 

It may take hard work by the patient and the guides… 

In a proper set and setting. 

Not simple recreational use. 

http://geoffgilpin.com/state-journal-article-outtakes/

From what I have seen there are miracles on the horizon… 

It is just so hard to be patient! 

Namaste

Bliss and Enlightenment

My wife is taking an advanced yoga course, studying the yoga sutras.

She said she read that bliss comes before enlightenment, and was wondering if I agreed. 

I had to think about that. 

I usually think about this as:  First comes the agony of ego loss, then we may enter the emotionless state of basking in All-That-Is and All-That-Is-Not, then coming back to bliss or ecstasy when you touch back down into the ego. 

http://enlightenedmdphd.blogspot.com/2014/02/first-agony-then-ecstasy-and-then.html

Although, others have argued that ecstasy is a prerequisite for enlightenment.

http://www.aypsite.org/382.html

Their answer is also:  “It depends on what we mean by ecstasy, and also on what we mean by enlightenment.” 

Aye, there's the rub…  (Thanks Shakespeare). 

Let us quote Adyashanti:

“Enlightenment is a destructive process. It has nothing to do with becoming better or being happier. Enlightenment is the crumbling away of untruth. It's seeing through the facade of pretense. It's the complete eradication of everything we imagined to be true.” 

And more here:

http://www.meditationplex.com/nondual-awareness/enlightenment-altered-state-consciousness-adyashanti/

My take on the pre- vs post-bliss or ecstasy is that these feelings are only a distractor. 

Often people get a taste of this positive feeling and chase after it. 

Let this go. 

 

Let everything go…  

Agony may arise. 

Bliss and ecstasy may arise. 

Neither are of importance. 

Clear seeing…   dropping all lenses…

http://enlightenedmdphd.blogspot.com/2013/05/the-first-commandment-part-2.html

This natural state is already present, at all times. 

We just cover this natural state of being with our ego desires, distastes, and confusions. 

When we enter this state, compassion arises, we are interested in everything, everything is new and fresh. 

We dance into the world with child-like fascination. 

And we can not help but act within right-action…

However, we have transcended and included our old cynical “adult-self.”

http://enlightenedmdphd.blogspot.com/2013/04/innocence-to-sophistication-to-innocence.html

That is what is different from our original child-level fascination with the world. 

So, don’t worry about agony, bliss, ecstasy, or even enlightenment…  

Drop all desire… 

Drop all distaste… 

Drop all fear… 

Like the empty sky it has no boundaries.  Yet it is right here, ever serene and clear.   When you seek to attain it, you cannot see it.  You cannot take hold of it.  But neither can you lose it. -  Yung-chia

http://enlightenedmdphd.blogspot.com/2013/03/favorite-quotes-and-entheogens.html

So sit quietly, and let this natural state arise.  

Then when you have seen through “The Game.”

Sit back and enjoy the show. 

Namaste

This Struggle to Die

Grasping onto

This one life

Not realizing

This temporary life

Is also a concept 

Animated stardust

Borrowed stardust

Animated by Source

Dust to Dust

Source continues to be… 

Always has… 

Always will… 

An infinity of infinities… 

This bullshit we create

Within these memories

Stored in this

3-pound gelatinous mass of flesh  

Just stories… 

Stories we create

To preserve

This one life

This small self… 

Can we finally let it go 

Whether

Within this life

By ascending to a higher level of being 

Lighter… 

With more laughter… 

Can we finally let go 

Then

Really finally

 

Letting this body

To Rot… 

Dehydrate… 

To Dust… 

Ashes upon the hearth of doing...   

No more doing

No more being… 

Psychedelics, Meditation, and Death

Actually, the risk of clinical death with psychedelic use is extremely low.

Any clinical deaths are due to recreational use in an unprepared individual, likely with tendencies toward psychosis.  The therapeutic index of psilocybin is 641. This is the ratio between the LD50 (lethal dose in 50% of subjects) and the ED50 (effective or therapeutic dose in 50% of subjects), meaning that the LD50 is 641 times higher than the ED50.  This number is 199 for aspirin, and 21 for nicotine (lower numbers indicate greater toxicity).  (How heretical!)

https://drugs-forum.com/forum/showwiki.php?title=Category:Magic_Mushrooms

There have been no deaths from psychedelics used in the clinical or research setting. 

On the other hand, the EXPERIENCE of death may be the CENTRAL event in the healing that occurs with the clinical use of psychedelic medicine. 

The healing that occurs with meditation likely is also mediated through the “experience of death. “

(Photo of Artemio Rodriguez's, Mickey Muerto, 2005)

Ego death. 

https://en.wikipedia.org/wiki/Ego_death

Perhaps, recognizing how this sense of self is formed. 

Then transcending this current ego. 

Identifying with something beyond, and bigger, more complex, and maybe also simpler, than this small self (yes, paradox again!). 

The centrality of confronting our own mortality is central to the psychotherapy developed by Dr. Irvin Yalom. 

https://en.wikipedia.org/wiki/Existential_therapy

Interestingly, often the fear of death is sublimated, transformed, repressed, or displaced, and then manifested as another fear, or anxiety and/or depression. 

Dr. Yalom lists several inner changes he has observed in patients with cancer confronted with death:

-       A rearrangement of life’s priorities: a trivializing of the trivial.

-       A sense of liberation: being able to choose not to do those things that they do not wish to do.

-       An enhanced sense of living in the immediate present, rather than postponing life until retirement or some other point in the future. 

-       Deeper communication with loved ones than before the crisis. 

Other quotes:

If you die before you die, then you won't die when you die - St Paul's Monastery on Mount Athos

To philosophize is to prepare for death. – Cicero. 

No man enjoys the true taste of life but he who is willing to quit it. – Seneca. 

It is only in the face of death that man’s self is born. – St Augustine. 

Why do you fear your last day?  It contributes no more to your death than each of the others. – Montaigne. 

The after effects of a near death experience for some individuals have great parallels with guided psychedelic experiences and long-term meditation. 

http://www.medicine.virginia.edu/clinical/departments/psychiatry/sections/cspp/dops/greyson-publications/mystical-Shift.pdf

So how do you practice dying right now?

There are many methods.  Take up a meditation practice. 

http://enlightenedmdphd.blogspot.com/2013/02/enlightenment.html

One of my favorite mediations is Wes Nisker’s death reflection.  You can download this and listen:

http://dharmaseed.org/teacher/191/talk/4779/

You could try psychedelics, but they are illegal in all of the United States, except within research studies.  And, perhaps, they are best used with guidance. 

http://enlightenedmdphd.blogspot.com/2013/05/helicopters-and-enlightenment.html

In our own, legal, research work, death or its equivalent, occurs commonly. 

We note that this death, this ego death, is central to the healing we have observed. 

See this amazing commentary from one of our volunteers: 

http://geoffgilpin.com/state-journal-article-outtakes/

Further, for those diagnosed with cancer, who cannot get past their anxiety or depression, guided psychedelic experiences have been central to their psychological healing. 

For stories and videos see here:

http://www.heffter.org/video.htm

So, why is alcohol and nicotine legal, while psychedelics are not? 

A very good question…   

Perhaps, we can do something about this travesty… 

Namaste