027 – Morita Therapy and Ikigai with Dr. Holly Sugg

How does therapy relate to nature?

What is it like to live in harmony with nature? Sometimes we tend to focus on things which we don’t have total control of. We try to change things that we don’t like whether or not it’s actually within our power to do that.


In this episode of the Ikigai podcast, join Nick and Dr. Holly Sugg as they discuss a Japanese psychotherapy called Morita Therapy, its relation to ikigai, and how it helps people understand that they’re a part of nature and can live in harmony with it. 


Podcast Highlights:

  • The Man Behind Therapy. At 3:35, Holly talks about Shoma Morita, the Japanese psychiatrist who developed Morita therapy.

  • What Is Morita Therapy? Holly explains to Nick what Morita Therapy exactly is at 6:03.

  • The Balance. At 10:04, Holly explains Morita therapy’s perspective on emotions and behavior.

  • What Does Arugamama Mean? Nick asks Holly what the Japanese word Arugamama means at 12:18.

  • Toraware And Hakarai. Holly explains what Toraware and Hakarai mean at 17:49, and how these two fit into Morita Therapy.

  • Morita Therapy’s Different Approach. The two talk about how Morita therapy contradicts the traditional western approach at 21:57.

  • The 4 Stages Of Morita’s Methodology. At 26:09, Holly talks about and explains the 4 stages of Morita’s original approach - isolated rest, light monotonous work, intensive outdoor work, and preparation for daily living.

  • Ikigai And Morita Therapy. Nick and Holly talk about the similarities between the ikigai concept and Morita therapy at 40:14.

  • Dr. Holly Sugg. Holly mentions her profile in the University of Exeter where you can learn more about her and their publications.


Dr. Holly Sugg

Dr. Holly Sugg is a Lecturer in Education and Research for the Academy of Nursing at the University of Exeter Medical School.

Holly specializes in mental health services research and, in particular, the development, evaluation and implementation of psychological therapies for depression. Her research interests include using mixed methods research to personalize treatment, and evaluating Morita Therapy, a Japanese psychotherapy in the UK.

Links:




Why Dr. Holly Sugg decided to study Morita Therapy 

Asked about what attracted her to study Morita Therapy, Holly shared that she found interest in Morita therapy because it offered something very different from that of the Western psychological therapies.


Holly has been doing research about psychological therapies, such as cognitive-behavioral therapy, which is often used in the UK. She found out that this treatment could be beneficial for some, but not for everybody. That’s why she decided to study Morita therapy and thought of it as an alternative for those people who didn’t find the other treatments helpful. 


Holly shared she’s always had an interest in learning about other cultures and the differences in how they define and treat mental health difficulties. And studying Morita therapy gave her this great opportunity to learn about this therapy treatment from Japan, which very much reflected the cultural and socio-historical context in which it was developed.



The man behind the therapy

As Holly shares, Shoma Morita, the man behind Morita therapy, was a Japanese psychiatrist and an academic. Growing up, he learned a lot about Chinese philosophy. He took an interest in Buddhism and aspired to be a philosopher, but went on to work as a psychiatrist in Tokyo. 


It was around 1919 when he founded Morita therapy. He took an interest in various different approaches for the treatment of what at that time people called neurosis. He developed Morita therapy based on his observations of his patients who were suffering with neurosis, as well as his own experience of neurotic symptoms. He offered Morita therapy to patients in his own home as part of his inpatient treatments. 


According to Holly, Morita’s interests in philosophy and the training he had in Zen Buddhism are reflected in Morita therapy.



What is Morita Therapy?

Holly defines Morita Therapy as a Japanese psychotherapy which is influenced by Zen Buddhism. It’s used to treat various conditions, particularly anxiety or neurosis. She thinks the key aspect is that it doesn’t target any specific symptoms. It’s a holistic approach, which looks at the person as a whole. 


According to her, the therapy focuses on three areas which are:

  • Accepting your feelings as they are

  • Being purposeful

  • Taking the action that you need to take

She goes on saying that Morita Therapy is helping patients to understand themselves as part of nature, and to help them accept their authentic natural selves, to understand within that, their thoughts and feelings are natural things that are beyond their control. 


Morita therapy helps to shift a patient's attention away from their symptoms and their emotions, which aren’t within their control, towards their behavior and actions which they have control over.



Morita Therapy is all about nature

Holly states that Morita therapy is all about nature, the reality of how things are, the reality of all the things in the world that are beyond our control, which includes human nature. 


She explains that people are natural beings, and that it's natural for people to experience a range of emotions in response to the circumstances of life. She points out that when people are removed from the natural world it leads to conflicts where people seek to control things rather than flow with them.


People try to change something if they don’t like it, whether or not it’s within their control. Holly says that Morita therapy helps people to move away from that delusion. It makes them understand that they’re part of nature and can live more in harmony with it rather than fight against it.


 

The Balance

Morita therapy emphasizes that emotions are beyond people’s control. The essence of that is that they’re not only natural responses to life, but they’re actually unavoidable and functional as well.

Anxiety is necessary for survival. Emotions are beyond our control. They're not only natural responses to life, there's a reason we have this spectrum of emotions and it's inevitable. - Holly Sugg

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Morita Therapy


She cites anxiety as an example, stating that anxiety is necessary for survival. She shares that according to Morita therapy, when people have desires for things, they will also have corresponding fears or difficult emotions. If they have a strong desire to succeed, they will also tend to have a fear of failure. And, emotions aren’t seen as positive or negative, but simply as pleasant or unpleasant., Not good or bad.

 

Morita Therapy


Holly states that Morita believed that emotions naturally ebb and flow and pass with time if people just allow them to run the natural course. Emotions are not considered controllable, therefore people are not considered responsible for them, and can’t be judged badly for them. But Morita did emphasize that behavior is controllable, and that people’s actions don’t need to be dictated by how they feel. Morita believed that people are responsible for taking the action that they need to take regardless of what emotions that might come along with it.



Arugamama

Nick then shared that he learned this amazing word from Dr. Holly’s paper which is now something he’s sharing with his students - Arugamama.


Holly explained Arugamama, which literally translates to “as it is”, means to accept things as they are. It means to be actually one with nature, which enables people to just leave symptoms or emotions as they are and live life as it is. And Holly thinks that understanding the difference between what people can and can’t control is the key to that.


 

Living in a state of nature in the here and now

When people are engrossed in their activities, solely focusing on what they are doing, they are living in a state of nature. They are not thinking about how they feel. Nor are they lost to the past or future. Holly and her colleagues refer to this as living in a state of nature, living in the here and now.


That is what Morita therapy means by an embodied experiential acceptance of the self. Holly states that this is not an intellectually-induced state of acceptance, but an embodied, empirical, intuitive state in which one is immersed in action, has no awareness of the self as set apart from nature, and thus no self-consciousness and resulting difficulties.


True acceptance of the self can only come through experiences of being one with action and nature. It can’t come from your own mind.


Holly shares that it is similar to the state of egolessness, which is talked about in Buddhism. In egolessness, people forget themselves completely, having no self consciousness, being no longer bothered by the ego, devoid of any emotions.



Toraware and Hakarai

Other terms mentioned in Holly’s paper are Toraware and Hakarai, some of the things that people do naturally in an attempt to remove those unpleasant thoughts or feelings, but because these interfere in the natural ebb and flow of those thoughts and feelings, they actually end up making them worse.


Toraware is when you’re preoccupied with how you’re feeling. There are two parts to it. First, is the tendency to fixate your attention on that sad feeling. Thinking about the fact that you’re sad can make you more sensitive and feel worse. Then another aspect of Toraware is the contradiction between the real and the ideal. It is when people believe that there’s a difference between how things are and how things should be. People think that they have no good reason to be sad, or that they don’t deserve to be sad. There’s a contradiction between how they feel and how they think they should feel.


Hakarai is when people try to control or remove those unpleasant states that they feel. People undertake activities to distract themselves from feeling sad. They try to control their emotions which according to Morita therapy is impossible to do. It is impossible to control or remove those emotions because they are all natural, it’s beyond people’s control. The more you keep your attention on those unpleasant feelings, the more you feel worse.



What does Morita Therapy treat?

The symptoms or conditions that Morita therapy treats are conveyed in this Japanese term, Shinkeishitsu. According to Holly, it is a psychiatric diagnostic term Morita developed for neurosis, anxiety and personality disorders.


She says that Shinkeishitsu is characterized by very strong desires for success and social approval, and people with these characteristics tend to be perfectionists, self conscious and self critical.

 

Morita therapy is still often used to treat anxiety disorders. It is also used to treat a wide range of conditions, depression, bipolar disorder, schizophrenia, eating disorders, and chronic pain, to name a few.


As for Holly, Morita therapy is holistic, it doesn’t focus on addressing certain symptoms, it can actually be applied to many different conditions.



The 4 Stages of Morita’s Methodology

As Holly mentioned, Morita therapy was a structured inpatient treatment delivered in Morita’s own home. He created a sort of ecologically based environment to help people reconnect with nature. He kept it to four stages which are isolated rest, monotonous work, intensive outdoor work, and then preparation for daily living.



Isolated rest

In isolated rest, the patients are asked to be with any thoughts or emotions that they can come up with, and try not to fight or control them. If you sit with your thoughts and feelings long enough, you become bored with fixating on internal states and develop a genuine desire to take action.



Monotonous Work

In monotonous work, the key purpose of this is to completely absorb the patient's attention and engage their senses. It’s using tasks to show patients that they can choose what to focus on. And that’s where the patients start to increase their capacity to undertake purposeful activities in the presence of their symptoms.


 

Intensive Outdoor Work

This is called anxious action taking, involving challenging and practical activities using whole body movements. It’s very much about learning to respond in a sort of natural instinctive way to the environment to move on to purposeful activities.



Social Re-engagement

Then the final phase is social re-engagement or preparation for daily living. It is preparing the patients to re-enter society social activities. It helps patients to get back in contact with nature and help them understand where they’re engaging in the vicious cycle, and help facilitate a capacity to be with their symptoms and their engagement in action.


But now Today, Morita therapy is delivered in lots of different ways, according to Holly. It is delivered in inpatient or outpatient formats. Inpatient formats tend to stick to those four stages, while with outpatient formats there is a lot of variation. 



Morita Therapy is not derived from Buddhism

It was mentioned in Holly’s paper that Morita clarified that his therapy was not derived from Buddhism. Holly then explained that for some, Morita therapy and Buddhism may seem to be very similar, but Morita didn’t see it in that way.


But a lot of authors have noted the connection with Zen Buddhism. For Holly, there’s lots of ways in which the two overlap, such as egolessness being common to Arugamama and Zen Buddhism. She thinks that the value of non resistance and going with the flow, are things that Morita is trying to get out, which are also seen in all these Eastern philosophies as part of their thinking.


 

Ikigai and Morita Therapy

There are some connections with ikigai and Morita therapy. To feel alive and live in the moment over trying to intellectualize everything. That is also important for ikigai. As Nick mentions, there’s a word called “Ikigai-kan” which means ikigai feelings, perceptions, or awareness. And for Nick, the most genuine thing about ikigai is feelings, how it feels to be alive, with which Dr. Holly agrees, because in Morita therapy, it is allowing oneself to feel what it feels like to be alive.


Nick shares that it was mentioned in Ken Mogi’s book about ikigai, that people should try to embrace a childlike mindset, where they embrace these actions or activities, and just enjoy them without processing them. This idea has a similar take to Morita therapy - going with the flow, being one with nature, and living in the moment.



What do Morita therapists actually do?

Morita therapists understand that patients know how to live meaningful natural lives, but over the course of growing up they put up all these obstacles that get in the way to authentic living. Morita therapists try to help these patients remove those obstacles.


They facilitate the patients’ movements through the four stages and help shift patients’ attentions, reinforcing focus on action taking on the external environment, and not reinforcing focus on emotions.


Another term mentioned is fumon. According to Holly, it means selective non response or strategic attention.Traditional Morita therapists don’t dwell on a patient’s symptoms in any way. They don’t delve into them. They don’t consider patients’ pasts in any way. They draw the patients’ attention to other aspects, move them towards the actions that they could take or inquire about something else entirely. They shift the patients’ attention to something that is happening in the natural world.



The different approach of Morita therapy

Morita therapy has a different approach compared to other therapies. According to Holly, lots of therapies are based on understanding and tackling symptoms. Their effectiveness varies for every patient. Some patients prefer western therapies, but there are also some who find the eastern approach more helpful.


If you want happiness, there's also suffering to deal with. - Nicholas Kemp

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Happiness and Suffering


Nick shared he learnt that Buddhism helps people move away from suffering. That the acceptance of suffering is part of life. If you want happiness, there’s also suffering to deal with.


In Morita therapy, happiness is not a state that a person can achieve, but an emotion that comes and goes. One can’t experience happiness without experiencing the flipside. Holly says, suffering is a truth that both Buddhism and Morita therapy recognize.


Happiness and Suffering


As Nick states, without suffering, happiness wouldn’t be as enjoyable and wonderful as it is. To which Holly agrees. For her, happiness is something you experience. It won’t be there forever. It comes and goes.


Morita therapy is receiving interest internationally. Holly shares that there has been a gradual internationalization of the therapy over time. She thinks that the general premise of Morita therapy resonates with a lot of people.



Conclusion

Morita therapy is a passive approach to treating suffering with these ideas of acceptance, focusing on what we can control, our behaviors, and being one with nature. It is accepting that suffering is inevitable and a part of life. We can’t experience happiness without suffering. Sometimes, it’s better to just accept things which are out of our control and just live with it. Morita therapy helps us realize that we are all part of nature and should live in harmony with it.


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