by Wataru Kaya

The author notes that he arrived at his approach through
his relations with many psychologically disturbed patients
and the psychoanalysis he himself has received.

In this essay I advocate the use of an interspiritual approach in medical care, illuminating this subject with what I can offer as a psychiatrist and a religious person.

Japan's Medical Care System Today

What people would like me to write about is not, I suppose, the Japanese system of medicine or the current situation of health care. Still, it is a fact that a mountain of serious problems has arisen in contemporary Japan, including a short supply of medical practitioners in emergency treatment, pediatrics, obstetrics, and in remote areas. Just in my own field of psychiatry, we find ourselves struggling with various thorny issues, such as an increasing trend toward depression, more than thirty thousand suicides per year, and despair among the young. These are major issues that need to be addressed through the combined efforts of people in many quarters, not just those of us engaged in medical care.

Luckily, Japan's system of universal health insurance is continuing to function as it should, even if just barely. Some doctors may not be satisfied with the way this system works, feeling it does not enable them to make full use of their skills, but it is nonetheless a precedent-setting system guaranteeing that everyone, regardless of income level, can receive standard medical care. No doubt it behooves us to hold this system up as a model for the world.

My Standpoint

Since my standpoint is somewhat unusual, allow me to introduce myself briefly. I am the chief priest of a Shinto shrine established in the thirteenth century. After graduating from medical school, I initially worked in pediatrics, later undergoing training in psychoanalysis and gaining credentials to practice as a psychiatrist. Until today, when I have reached the age of fifty-five, I have continued to undergo educational analysis (in which a psychiatrist or psychotherapist receives psychoanalysis from an expert in it), for reasons I describe below.

Needless to say, psychiatry and psychoanalysis arose out of Western culture. In particular, they were born in the context of modern rationalism dating from the time of Rene Descartes. These Western medical disciplines aim for universality, and treatment has come to be applied to the psychological health of people in the non-Western world. I am a supporter of Western learning, but there are aspects of it I am unable to accept, especially in the case of psychiatry. There seems to be no problem with the psychiatric medicines used, but even in the prescription of medicine, we must note that it takes place within the doctor-patient relationship, which is one of spiritual trust. So when prescribing medicines, the spiritual condition of both doctor and patient cannot be disregarded.

This is even truer in the case of psychotherapy. If we use the heart and mind of the Western individual as our standard, can we safely presume it to be universal and apply it as is to non-Western individuals, whether in psychoanalysis or in some other psychotherapeutic treatment? I have my doubts. For this reason, I wished to become a subject of psychoanalysis myself, to gain firsthand familiarity with its possibilities and limitations and to give the spirit deep thought. Then, if possible, I hoped to utilize my experience under psychoanalysis in the development of an improved methodology, one that as far as possible could be effectively applied to non-Westerners. To be sure, I readily acknowledge that psychoanalysis already has within it a certain degree of universality. But it also has aspects that appear to lack universal validity, and it is proper to subject them to a radical review.

Since 2005 I have frequently been involved with the indigenous people of Canada. In his 1981 work Indian Healing: Shamanic Ceremonialism in the Pacific Northwest Today and in other writings, Wolfgang G. Jilek at the University of British Columbia argues that it is exceedingly reckless and often injurious to treat native Canadians using the psychiatry developed in the West without modification. I quite agree. Naturally there is no reason for Western medications not to have some effect when prescribed for emotionally troubled non-Westerners, but when crude medical treatment is applied without regard for the traditional and cultural healing tools of these indigenous people, side effects may become more pronounced than intended effects. When the hearts of indigenous people are being treated, there is much that can be gained from dialogue with the medicine man--a shaman serving his people as a healer--and from prayer, healing dance, and other such practices.

A Shinto priest is like a medicine man in some ways. At the same time, I am also engaged in the clinical wards of Western medicine. My standpoint as a doctor is one of constant contradiction and conflict, and it is also one of harmonization.

Disease Cases

The hospital at which I am employed has psychiatric and internal medicine departments coupled with a ward. Conspicuous among the patients of the psychiatric department are schizophrenics in poor mental health, while the ward has large numbers of victims of severe dementia and terminal patients not far from death's door.

In relating with these patients, I approach them more as an individual than as a doctor, greeting them and saying a few words from my heart. In the beginning, of course, they do not respond. Take the case of Mr. A., a patient suffering from severe schizophrenia complicated by a developmental disorder. When I would say hello and give him a smile, he would make no response at all. Mr. B., who has an advanced case of dementia, similarly remained absolutely expressionless. Such an absence of reaction was by no means limited to Mr. A. and Mr. B. For the first few months after I began working at the hospital, I found in many cases that my greetings and other actions were ignored.

As time passed, however, there was a small but clear change in the response of Mr. A., and the nurses also noticed it. Mr. B., meanwhile, began somehow to appear more relaxed, and he would follow me with his eyes and return my greetings with a slight nod. I also sensed change in the reactions of other patients in the ward.

From the viewpoint of psychiatry, even a patient in very poor mental health will benefit from the repeated application of appropriate stimuli. Slowly but surely, healthy functioning of cerebral nerves will be invigorated, and the patient will begin to respond to others. The changes I witnessed, then, only stand to reason. I believe, however, that more was involved.

Kami and Buddhas

According to Japanese Buddhism, one can perceive a buddha deep within the heart of every human being. In Shinto, similarly, kami, the various divine beings considered to have come from something great, are seen as residing within the hearts of human beings, whatever kind of individuals they may be. Some people may be inclined to criticize such beliefs as unsophisticated, but I believe they contain a deep truth.

In the hospital, while greeting patients in a casual fashion, I am actually giving thanks and paying my respects to the kami or buddhas residing in their hearts. The patients may ignore me, but that does not matter. I just continue to extend greetings, patiently and pleasantly. When I behave in this way, in most but not all cases the patients begin to respond. The kami or buddhas within them return my greetings. This is a moving experience. So in my greetings, I express thanks with my whole heart.

To adherents of modern medicine who recognize no authority other than the natural sciences, no doubt my attitude and behavior seem stupid.

The Interspiritual Approach

Modern psychoanalysis has a methodology known as the intersubjective approach. It was the philosopher Edmund Husserl who initially introduced the term intersubjectivity. Simply expressed, it tells us that meaning is not comprehended by the subjectivity of the individual; rather, what is important is the understanding or agreement on meaning arrived at through the mutual coming together of subjects. Husserl's view of understanding was incorporated into psychiatry by the psychiatrist Harry Stack Sullivan, who in his 1953 work Conceptions of Modern Psychiatry introduced the notion of "participant observation." Subsequently, Robert D. Stolorow and others, who are carrying on the school of self-psychology in psychoanalysis, developed the concept as the intersubjective approach. A feature of this approach is the notion that therapeutic meaning comes into being and is comprehended in the interrelations between analyst and analysand. We need to note, however, that the theme of this approach is the mutual relationships among selves or subjects. In other words, this is a theory that exists within the framework of modern Western rationalism. Accordingly, it is somewhat insufficient as an explanatory concept for talking about kami and buddhas and treading into the dimension of spirituality, or for entering the realm between life and death.

Here, using the intersubjective approach as a foundation, I would offer the methodology or explanatory concept of the interspiritual approach. This is an approach I arrived at through my relations with the many psychologically disturbed patients I have been discussing and through the psychoanalysis I myself received. Above all, it is a way of thinking that arose naturally within me through my involvement in terminal care.

An interspiritual experience is not all that unusual. For instance, when Mr. C. was approaching death and going through an extended and intense delirium, he suddenly returned to a state of clarity and politely expressed his thanks to me and the other doctors, nurses, and caregivers at his bedside, then passed away. I can find no other expression than an interspiritual experience to describe the experience of Mr. C.

Again, the interspiritual approach is not that hard to understand. It refers to relationships that are a matter of course to religious leaders and believers. When engaged in meditation, religious leaders and believers come quite naturally into contact with their own kami or buddha, and they may encounter the kami or buddhas of others. Furthermore, it is hardly unusual for them to have moments when they sense the existence of some great presence.

It is to be admitted, however, that while this sort of talk is easy for religious devotees to understand, it does not readily get across to many medical practitioners. In this situation, using the definition of spirituality offered by Susumu Shimazono in the 2007 work Supirichuaritii no Koryu (The Rise of Spirituality), I would propose the use of interspiritual experience as a technical term for describing my distinctive experiences with mentally ill patients and with the terminally ill at the gateway between life and death. Furthermore, I would propose that we speak of "the method of the interspiritual approach" when referring to efforts to remove the impediments within our hearts to these spiritual encounters and to discover what these encounters tell us, each in his or her own way, about the meaning of life.

In Place of Concluding Remarks

Application of the interspiritual approach is by no means limited to situations involving families, volunteers, and people engaged in medical care. It can be applied to the natural world around us, pets we are fond of, and the community we live in, as well as to tradition, history, and culture. When one thinks about it, one can appreciate that nothing can make us richer than undergoing healing and facing the end of our days in the spiritual relationships of the home, the neighborhood, and the natural world rather than in spiritual encounters we may have with doctors and nurses in the enclosed space of the hospital.

Finally, let me cite the famous poem "Today Is a Very Good Day to Die" of native North Americans, who continue to sustain a healthy spiritual relationship with their community and Mother Earth.

Today is a very good day to die.
Every living thing is in harmony with me.
Every voice sings a chorus within me.
All beauty has come to rest in my eyes.
All bad thoughts have departed from me.
Today is a very good day to die.
My land is peaceful around me.
My fields have been turned for the last time.
My house is filled with laughter.
My children have come home.
Yes, today is a very good day to die.

(Nancy C. Wood, Many Winters: Prose and Poetry of the Pueblos [Garden City, NY: Doubleday, 1974].)

In the foregoing, as a psychiatrist and a religious person, I have presented the case for use of the interspiritual approach to shed light on modern medical care. Although I developed my argument using mainly the perspectives of ancient Shinto and the beliefs of native North Americans, I have a great respect for Buddhism at the same time. It will be pleasing to me if you have read this essay as the earnest aspiration of such a psychiatrist for this kind of medical care.