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Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

Classical Morita therapy: the power of silence, paradox

and Zen

Peg LeVine

Introduction: Historical and cultural overview of Morita therapy

Morita Shoma, MD (1874-1938) was a pioneering psychiatrist who practiced in Japan

at the turn of the last century. Though a contemporary of Sigmund Freud, Maria
Montessori, Jean Charcot, and William James, he was philosophically aligned with Zen
Buddhism. In response to his own clinical observations, he created a highly structured
form of residential care consisting of four stages. Morita was disillusioned with the state
of mental health care, particularly as he watched patients being confined in dismal places
and treated in ways that reinforced their despair. In response, he began treating patients in
his home environment in a rural setting, with an initial emphasis on rest. He progressed
his therapy to include diary, art, and outdoor activities with observations of nature, while
noting how the safe familial environment participated in responsive therapeutic
outcomes.
Morita treated those suffering from excessive worry (anxiety) and an over focus on
their bodily discomfort (a Japanese syndrome known as shinkeitshitsu). He challenged
the standard biomedical models of psychopathology and developed a treatment that was
less reliant on verbal exchange and medication. He found, paradoxically, that the more
one tries to get rid of symptoms by speaking about them, the more symptoms stay in
one’s field of vision. An over focus on symptom reduction can actually decrease the
wellbeing of one’s mind-body-spirit (rendered as kokoro in Japanese).

1
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

The first stage of Morita therapy usually lasts for one week and consists of social
isolation, silence, and rest wherein patients remain in a prone position and is deprived of
stimulation – until they are bored with their own self-complaints. Morita, who wrote of
Freud’s therapy, was intrigued by his contemporary’s use of the prone position in
psychoanalysis and free association (Morita, 1998). But Morita was most interested in
how the reclined position on bed or futon as a therapeutic method leads a patient to
wander freely in her/his emotions and thoughts with less worry. This process is made
possible because the isolation period extends subjective time, and the patient experiences
safety within the contained and supervised place, which decreases the range of anxiety.
Following from this, he contended that the therapist does not have to verbally direct or
interpret a patient’s feelings and thoughts about the past since the staged sequence of
therapy generates this integrating purpose. In this regard, the therapist uses silence
strategically. Also, the first stage of therapy induces rest so that the patient’s natural
rhythms of eating, sleeping, and waking are re-established before s/he engages with the
social and natural environments.
Morita therapy has taken a long time to propagate outside Japan and China –
perhaps because the Zen Buddhist strategies embedded in Morita’s treatment have yet to
be fully realised as a viable, paradoxical intervention. One of the earliest Euro American
psychiatrists interested in Morita Therapy was Karen Horney (1885-1952) (Ingram, 1987;
DeMartino, 1991; LeVine, 1994). Horney’s interests in Buddhism increased when in
1950, Zen scholar Daisetz T. Suzuki received a grant from the Rockefeller Foundation
and resided in New York.1 Coincidental perhaps,2 but Akihisa Kondo, MD, scholar and
practitioner of Morita therapy and Zen also went to New York at this time to study under
Karen Horney as he was interested in the intersection of Zen and analysis. As a result of
these associations, Horney travelled to Japan in 1951 with her daughter, Brigitte, and met

1
D.T. Suzuki published two key books, Zen and Japanese Culture (1959), and Zen Buddhism and
Psychoanalysis (1963). During that era, Karen Horney, DT Suzuki, Richard DeMartino, Akihisa
Kondo, Paul Tillich, Erich Fromm, Harry Stack Sullivan, and other scholars gathered for French
salon-like evenings in Horney’s New York apartment to discuss philosophy, Zen, and psychiatry
(personal conversations with Kondo, 1990).
2
Kondo once told me that coincidence is a fabricated notion.

2
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

with Suzuki, Kondo, and DeMartino, and other scholars and practitioners of Morita
therapy, Takehisa Kora, MD, and Yoshiyuki Koga, MD.

INSERT 2 ARCHIVAL PHOTOS:

(1) Karen Horney and Takehisa KORA in Japan, 1951
Photo is a gift to author from the archives of A. Kondo

(2) Shoma MORITA and Takehisa KORA (approximately 1927)

Photo is a gift to author from the archives of A. Kondo

Horney observed Morita therapy methods employed in Japanese psychiatric hospitals

while discussing the philosophical foundations and practice of Morita therapy. Following
that trip to Japan, she delivered lectures in New York about her ‘new’ analytic theory,
which after her death were gathered into a publication and later edited by Ingram (1987).
Horney claims that the real self is the possible self (in contrast to the ‘idealized’ self,
which is impossible to attain), and that patients often seek consultation about headaches,
sexual disturbance, or work displeasure when, in fact, they have ‘lost touch with the core
of their psychic existence (Horney, 1950, p. 157). Though Horney’s theory approximates
Zen notions of self-nature, she remained bound by analytic interpretations of ‘psychic
existence’ that restricted a more encompassing Zenist view of self as Nature. In the
following passage, Wood (1957, 117-118) points to this Zen perspective on human
Nature.
What you are you are, and you are unique in nature and in Nature. This
applies to all things. A piece of stone here appears to be similar to a piece of
stone over there—same shape, size, color & composition. But it is here and
that is there…so your attempt to see yourself as only part of yourself –
namely, a thing of thoughts and feelings and actions – is bound to lead to a
piece of false knowing, lessening the fullness of life, and not permitting the
response of the whole self to its whole environment…one’s own nature is
not the same as that of anything known to the mind.

As with any practitioner and theorist, one’s profession is an evolutionary process,

determined by the context in which one is socialised. Morita (1998, edited 1927
translation) and Horney (1939) disagreed with Freud’s theory of repression and neurosis

3
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

and advocated a broader formulation inclusive of social and environmental factors.

Horney invited her contemporaries to enter a dialogue with Japanese practitioners as a
way of reflecting on nature, self, and transcultural approaches to treating sufferings
embedded in the human condition. She facilitated the development of ‘social psychiatry’
and eventually established and became Dean of the American Institute for Psychoanalysis
and founded the American Journal of Psychoanalysis. As another historical note, when
Horney was in Japan she was struggling with cancer and spoke of a ‘yielding calmness’
while sitting in Zen gardens in Kyoto (Kondo, personal conversations, 1994). After
Japan, she wrote about how excessive dependence on approval or affection from others
becomes disproportionate to what humans can realistically exchange (Ingram, 1987). I
want to emphasise that Horney and Morita were renegades in their times, and their
mutual quest for a more integrating, humane and sustainable therapy led them to account
for the environmental (ecological) milieu. Horney extended theory into this domain,
whereas Morita extended his theory into practice by constructing his structured,
ecological-based therapy.
After Horney’s death in 1952, Morita therapy became nearly invisible in the
United States as a viable psychiatric and therapeutic treatment. Following the Horney-
Suzuki era, David Reynolds conducted an ethnographic study on the classical treatment
in Japan as part of his doctoral dissertation in anthropology (Reynolds, 1969) and further
published a series of books on the subject (Reynolds, 1976, 1980). However, Reynolds
stood behind his cultural premise that Morita’s therapy was too Japanese for Westerners
(personal conversations with Reynolds in 1990). In particular, he insisted that non-
Japanese people could not endure the first stage of isolation rest nor could they invest in
the time needed for treatment. That reasoning led him to develop a guidance framework
for daily living and to shape his broader discipline and philosophy into a life way that he
calls Constructive Living, which has a large following today primarily in North America.
Other English language texts and journal articles have appeared since the 1980s.
Fujita (1985) produced a book on Morita Therapy: A Psychotherapeutic System for
Neurosis in which the theory and classical practice are defined. Meanwhile Ishu Ishiyama
has transferred Morita’s inpatient theories into outpatient counselling modalities (1990).
Additionally, Ishiyama generated the International Bulletin on Morita Therapy as Chief

4
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

Editor through the University of British Columbia Press in the 1990s, on which I served
as the Associate Editor. But the publication was difficult to sustain because there were
few trained clinicians outside Japan to administer the treatment, and this restricted
qualitative and quantitative research development in North America, Europe, Australia
and New Zealand. In this regard, theory and outpatient use became a focus of the journal.
Also, Reynold’s Constructive Living tended to compete with the potential for the
development of ‘classical’ Morita therapy3 outside Japan. There have been Japanese
contributors from hospitals in Japan.4 For instance, Jikei University in the Tokyo area is a
major public hospital with a Morita therapy unit; Kei Nakamura, MD has been committed
to maintaining the four-stage practice at Jikei.5
The assumption that Morita therapy is too Japanese for transfer across other cultures is
interesting to ponder. For instance, practitioners of Euro American-based treatments such
as Cognitive Behavioural, Gestalt, Narrative, Mindfulness, and Psychodynamic therapies
rarely consider how these systems mirror Euro American values. In fact, these therapies
often reflect particular worldviews that categorise actions, feelings, thoughts and
symptoms into desirable or undesirable (rational or irrational).6 Also, the field of
treatment prioritises indoor settings. By contrast, Morita’s theory as formed from Zen
does not qualify or quantify feelings, thoughts, and behaviours into an either-or-
experience, which reduces morality-based judgements. (A case study on pornography use

3
I use the term “classical” Morita therapy to designate the four-stage treatment as Morita
originally designed.
4
Among other places, classical Morita therapy (informed by Zen) is found today at Shinchi Usa’s
hospital in Kyoto (who is the son of the founder of Sansei Private Hospital, G. Usa), and at
Tomonori Suzuki’s hospital in Tokyo that is famous for its rose gardens. [I acknowledge the
dedication by the late Takehisa Kora, MD and the former staff at his private Morita hospital, Kora
Koseiin, which was dismantled after his death].
5
In fact, Morita was a professor at Jikei University School of Medicine in the early 1900s, which
continues as a foundational training and practice centre today (directed by Kei Nakamura MD),
with gardens, an art room, kitchen, and chickens, fish, pigeons, and rabbits. (I note that the late
Mr Yozo Hasegawa assisted outpatient support groups for former Morita therapy patients in
Japan).
6
Across many of the ideas embedded in these therapies, there is a strong emphasis on human-
centred relationships and values akin to Christian views that reinforce dichotomous worldviews,
such as forgiveness or retribution, victim or perpetrator, alongside splits on good (God, heaven)
and bad or evil (devil, hell) -- with faith attached to one ‘all good’ supreme being conceived in
human form. This is in contrast to Shinto perceptions of animating and transforming forces and
perceptions, and non-retributional justice in Buddhist regions throughout SE Asia.

5
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

is presented later in this chapter as illustration of Morita’s amoral orientation). I have

observed often how Euro-American based therapies are introduced into SE Asia by
foreign aid agencies in ways that presume universality of application -- despite regional
phenomena, such as multiple gods, karma, luck, and animating forces.
More personally, I took the challenge to test the cultural resilience of Morita’s
therapy by personally entering the treatment in Japan in 1989 under the care of Akihisa
Kondo, MD in Tokyo. I wanted to know about the therapy from the inside. Though I
attempted to conduct a participant-observational study, to my surprise, I found the
isolation-rest stage had a remarkable impact on my delicate history of grief related to the
death of my husband. My heuristic account is published in Japanese with notes on
Morita’s use for treatment of trauma (LeVine, 1991).
Following my own experience and with the direct supervision of Kondo sensei
(mentor, teacher), I conducted a single-case clinical trial to determine the resilience of the
four-stage treatment outside Japanese culture and geography. I administered the therapy
to an Australian man in rural Victoria, Australia in the December summer of 1992. At
that time, Kondo came from Tokyo to Australia and provided direct supervision for me
during the patient’s isolation-rest stage. I presented the outcome of that first inpatient
case of Morita therapy at the Second International Congress of Morita therapy in
Fukuoka Japan in 1992. Since then, in Australia, I continue to find that Morita’s four-
stage treatment moves through the stages with progressive and effective outcomes.
Henceforth, the reader is asked to take into account that the reflections put forth in this
chapter come from my training as a scholar and practitioner of Morita’s treatment as
classically designed.

Morita’s terms of reference

Before describing the four stages of Morita therapy with case illustration, it is
useful to give terms of reference, as some concepts sit outside Euro American psychiatric
nomenclature. For instance, as patients move through the progressive stages of therapy, a
natural desire to engage in purposive and creative activity arises spontaneously.
Meanwhile, the therapist assumes an indirect role and relinquishes to the power of the

6
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

stages. Rather profoundly, the unfolding of the 4-stages (and the experience of such) is
what challenges the beliefs held by patients, rather than any verbal challenge by the
therapist. My patients often report that they gain an understanding into the origins of their
thinking during and after the isolation stage. Once free from conventional influence, they
gain a lens into ways past experiences of neglect and abuse may have disrupted or frozen
them developmentally. Again, insight is not the goal, but it is often an outcome. What
makes Morita’s outcome unique when compared to cognitive-behavioural systems is that
change runs deeper than a thinking-feeling-acting shift. Rather, a visceral and perceptual
re-patterning accompanies behavioural change – it not that one leads the other. This shift
can be observed in the way a person writes in the Morita diary; a diary illustration is
provided in the Case of Raol later in this chapter. In this regard, there are some guiding
principles of emotions that are foundational to Morita therapy (Morita, 1998).
Morita (1998, p. 31) stated that his therapy focuses on emotional facts, rather than
a ‘system of logic or volition...pain and suffering gradually subside if one endures them
and lets them follow a natural course. Ponder the old lesson…when one is angry and
wishes to fight, think it over for three days before taking action. This lesson supports the
fact that an intense emotion will decline naturally over the course of three days.’
- When emotion is left to follow its natural course, it assumes a parabolic
course. It flares initially, reaches a climax, then lessens and/or disappears.
[This premise is perhaps a reason that residential Morita therapy has been
successful in Australia because once one enters the treatment, s/he endures the
initial discomfort in a safe environment, while emotional pain subsides over
time if left to run its natural course. Paradoxically, change becomes
predictable, and the person begins to rely on this fact.]

- Emotion intensifies when the stimulus is continuous and when attention is

over focused on the emotion or stimulus. Thus, emotion remains in a
heightened and unnatural state when a person over focuses on its intensity.
For example, quarrels become more dramatic when one brings up past
injustices.

- Emotions are learned through new experiences and cultivated by repetition,

akin to the development of emotional muscle. For instance, one endures the
discomfort that accompanies physical exercise in order to increase aerobic
capacity and muscle tone, while a sense of ease increases over time.

7
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

I constructed the following glossary of Morita’s concepts when working alongside the
late Akihisa Kondo, while he translated Morita’s original work; this project took six years
to complete (Morita, 1998). Many of Morita’s terms were rendered in Kanji (Chinese
characters) and often have more than one meaning; such nuance in terms led to long
discussions and demonstrations about the Zen-based nature of Morita’s concepts during
our translation project. Again, this debate on just how much of Zen influenced Morita’s
work continues today between practitioners and scholars inside and outside Japan. As a
practitioner of the classical treatment, I observe how Zen is embedded in Morita’s
therapy. For instance, when a patient stops categorising feelings as good or bad, angst
diminishes. Likewise, when someone experiences the movement of stillness; or realises
that ‘telling’ the therapist about her or his experience is not about the experience at all. In
this way, they are grounded by Nature.
Mind=Body. In order to decrease the tendency to dichotomise mind and body as
two separate entities, the term is rendered as mind=body, which is the same as
body=mind. This shift in orientation impacts assessment and diagnosis. For
instance, psychosomatic is a psychiatric term used in North America and implies
that the mind leads body, and thus the symptoms. For Morita, psychosomatic is the
same as somata-psychic since mind=body.

Musho-jushin. This means, literally, ‘peripheral consciousness’ or consciousness

that extends in all directions. According to Kondo (1990, personal conversation),
even Carl Jung’s concept of the ‘collective unconscious’ was not as extended as
Morita’s Zen-based concept. This ‘peripheral consciousness’ is as foundational to
Morita therapy as the unconscious is to Freud’s interpretative therapy. In fact, the
construction of consciousness determines the interpretative nature of treatment. By
constructing consciousness as peripheral there is less likelihood that the therapist
will conjecture meaning onto behaviours.7

Obsessive thinking. This is different from obsessional thoughts. It is not the

content of one’s thinking that requires treatment (as in the emptying of mind via
meditation). Rather the filling of one’s mind=body with thoughts that requires a
reorientation to mind – wherein attention is extended in all directions. The isolation

7
During the training I underwent by Kondo to learn the practice of Morita therapy,
I was instructed in ways to extend consciousness in this regard. Unfortunately
English language sometimes equates ‘consciousness’ with the states of mind;
however, Morita’s ‘consciousness’ means to be aware with all the senses (Kondo,
conversations, 1990-92).

8
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

rest stage of treatment begins the breakdown of over-thinking before the person
moves into the successive stages.

Sei-no yokubo: This literally means ‘the human tendency to preserve the self’
which is linked to the natural fear of death. This represents the natural human desire
to live, and to live to one’s capacity or potential, to avoid harm to the physical and
psycho-emotional self, and to direct life energy towards creative and generative
endeavours. Anxiety occurs when this desire to ‘preserve self’ is exaggerated. As a
person focuses on fears or inadequacies, her or his potential is inhibited. The
stronger the desire to actualise the self to perfection, the more the self becomes the
centre of awareness (‘self-centredness’ or over attachment to self). Paradoxically,
this focus/desire minimises one’s potential to live responsively within the
environment and the original desire-for-life enhancement gets misdirected. Morita’s
staged therapy redirects Desire-for-Life to its original state. This is a keystone
concept that directs the 4-stages of treatment. The first isolation stage is the stage
that breaks down the paradox and increases the life-desire potential for expression.

Shinkeishitsu: This is a category of dis-order in Japan akin to ‘anxiety disorder

with somatic over-sensitivity’. This occurs when someone has a character that is
prone to hypochondriasis via an over sensitivity to visceral sensation. It is often
found in those with introverted characters. Those with shinkeishitsu often have an
understanding about the origins of their symptoms, and they often have high
cognitive ability.

Shoichinen: This is a Zen term that indicates one’s “original intention”. Morita
therapy attempts to decrease a patient’s critical judgment and self-analysis. The
goal is to return the person to the state of experience before the moment of
criticism. This is akin to the Zen phrase, Know your original face before you were
born.

The four-stage therapeutic sequence

Nearly 100 years ago, Morita discussed how emotional angst arises as a natural
response to trauma. Though his therapy was designed originally to treat the Japanese
disorder, shinkeishitsu, it has since been found effective in treating a range of anxiety
disorders, including post-traumatic stress disorder, depression that accompanies
existential anxiety, and various adjustment disorders (Fujita, 1986; Kora, 1989;
Kitanashi, 1987; Nakamura, 1995; Suzuki, 1987; Tamai, Takeichi, & Tashiro, 1991).
Morita strongly recommended a strict screening for patients before they undertake for the
four-phase treatment. Mostly, the intensity of social isolation can be disorienting for

9
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

those exhibiting suicidal ideation, psychosis, extreme dissociation, severe depression,

intellectual disability, and antisocial behaviours.
Each stage of the treatment occurs between five to seven days. The therapist looks
for concrete signs of progress from which to transition the person into the next stage.
Thus the total inpatient treatment typically lasts between 20 to 30 days.
STAGE ONE consists of social isolation, silence and rest. This stage generates
the highest paradoxical impact on the person’s attachment to her/his symptoms. Morita
contends that the rest stage is the place from where his therapy begins. The person is not
allowed to speak to anyone, to read, to smoke, or to listen to music, radio or television.
When a person enters the initial stage, she or he is often detached from her/his body and
the external environment. And when trauma history is evident, detachment from one’s
self, time, other, and place is like second nature to the person (LeVine, 1999). Most
often, people are less engaged in the physical and animistic environment (nature) when
they feel acute anxiety. Social isolation in a silent state begins to break down the person’s
detachment tendency, self-absorption, and angst that accompany the desire for another
experience. The person is not allowed contact with family members during this initial
stage, and family members are informed of this restriction.
Regarding procedure, the therapist enters the isolation room once a day, while an
attendant brings meals three times a day and makes observations about the patient for the
therapist. During the visit, the therapist keeps conversation to a minimum. The purpose
of the visit is to observe the patient’s safety, to generate an assurance that someone is
near, and to invite the person to persevere in her or his discomfort – while experiencing
humane care.
The therapist dismisses any complaints made by the patient, and the person is
asked to endure and observe the rise and fall of emotions and thoughts while in a silent
state. The purpose of this dismissal is to break down the person’s judgement of emotions
as negative or positive since such judgement contaminates the full experience of emotion
and all its varied textures. In this way, the patient begins to observe the ‘nature of
emotion’ and notes how it mimics the changing nature of sky, light, and landscape. In
other words, if a person simply notices the discomfort without attaching meaning to it,
then s/he is less concerned with intellectual interpretations of such ills and can observe

10
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

other states of being. There is no need for cognitive acrobatics since the person
experiences a kind of Zen ‘isness’ about her or his state without pushing or pulling to
make it different. Paradoxically, as one speaks aloud about pain, pain remains in the
person’s field of vision and may actually increase symptoms over time. The state of
imposed silence in a safe context thrusts the patient into full sensation – into the full
spectrum of tasting, hearing, seeing, touching and smelling. Emotion and thought find a
natural course – without meditation or medication.
During the first stage, only natural light is allowed in the isolation room through a
diffused window. Artificial light is discouraged because someone filled with worry is
usually out of sync with the natural rhythms of sleeping, resting, playing, working, and
eating. Being deprived of artificial light actually enhances an experience of the flow of
dark and light so that the person returns to her or his natural diurnal rhythms.8 The
therapist uses fine-tuned observations to determine the readiness of the patient to move
from Stage One to Stage Two.
STAGE TWO consists of light repetitive work wherein the patient is encouraged
to leave the social-isolation room and go out of doors. Instruction is given for gardening,
such as weeding, planting seedlings, or light raking. In this second stage, the person
moves from the isolation room to reside in another room. She or he is invited to notice
the adjustment of moving from one room to the other. The person may have settled into
the environment of the first room, and sometimes is reluctant to move. Overtime,
however, s/he notices that comfort increases as the new room becomes familiar. The
second stage begins with a sense of boredom and discomfort. Yet once the person begins
to notice activity in the natural environment, because of the silence, interesting
distractions emerge. At this time, the therapist studies that which interests (moves) the
patient, and encourages participation in those identified curiosities within the
environment. Over time, the patient observes that the more she or he partakes in
purposeful activity, the more worrisome symptoms decrease. The patient may notice the
patterned sounds of insects or birds, watch the activity of spiders or ants, or note the

8
I note that patients who have grown-up in homes or places with violence that occurred
in the dark, tend to be more detached from their natural diurnal rhythms and have sleep
difficulties. Thus Morita therapy is useful for treating such trauma history without
medication to induce sleep.

11
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

movement of the sun across the sky and the changing length of shadows. In addition,
during the first stage, the patient’s body begins to atrophy, and when outside work begins,
the person feels her or his body’s movements – which leads to a kind of re-embodiment.
STAGE THREE consists of labour-intensive work and focussed diary writings,
art projects, and communal meal preparation. In this stage, the patient begins to speak
aloud to others in the environment. However, talking is restricted to tasks at hand.
Though appearing harsh, the therapist does not respond to the patient’s attempts to
engage in emotional-based dialogues. For instance, I recently wrote along the margins of
a patient’s journal: Show me where in the garden I might find the anguish you have about
your lover’s affair. I do not see any betrayal hidden in the trees. Such an intervention re-
shapes the patient’s perceptions, spreads the focus of relationships that can be trusted, and
‘re-places’ the self into place and time. I note that this directive is different from asking
someone to go inside the self to meditate. All too often people with excess anxiety have
the habit of forming intimate social relationships based on an exchange of anguish.
Morita therapy breaks this cycle. The person is encouraged to provide care to the
animated environment on the premises (birds, sheep, chickens, pond life, and flower and
fruit tree care). I sometimes teach patients how to prune roses, transplant pot plants, or
how to bonsai plants.9
The patient writes in the diary about observations related to work during the day. S/he
can sketch as well. The therapist collects the journal at the end of the day and makes
comments in the margins. If the patient indulges in emotional disclosure by recording
personal history or worries, she or he is re-directed to observe and record concrete
activity in the natural environment. The therapist’s strategic comments shape the patient’s
observations, and this exchange becomes a kind of rehearsal for forming intimate
relations from wonder-based shared experiences, rather than misery-based ones.
Moreover, I think the personal nature of the writing between patient and therapist
conjures a kind of object-relations exchange. The patient holds the diary in her or his
hands and sees the therapist’s personal handwriting; some patients have described this

9
Note that animal care reflects the environment in which the person resides during
treatment; for instance, in Japan there are smaller animals and plants, while in Australia, I
have some sheep and fruit and nut trees.

12
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

contact as comforting. Also, the patient can refer back to concrete notes by the therapist
during treatment and after treatment since the diary is taken home at the end of therapy.
Within the diary, I often prescribe readings in the area of plant, rock and insect
identification, seasonal sky patterns, or calligraphy and art. I give reference books to
patients to read after observing the activities that naturally intrigue them. In Morita
therapy, there is a saying that ‘to fight reality is to suffer’. If one evolves her or his
natural tendencies of interest, s/he works with the grain.
STAGE FOUR is focused on social re-integration. In larger treatment centres, the
patient in stage four teaches other patients who are in Stage Three to use a potter’s wheel,
transplant a tree, or prepare a meal. This is the first time that the patient travels away
from the centre’s grounds (by walking or taking public transportation) and does
communal errands, such as posting letters, or buying groceries. Over the course of this
final stage, the person returns to the social world, but with the added perception of being
refreshed by the environment – a literal shift in ‘world’ view. In essence, the evolution of
moving through the stages is the therapeutic process that fosters wellness (Morita, 1998;
1921 translation). This sequence of moving from isolation to ecological engagement to
social reintegration is like a sandwich. Essentially, one’s relationship to self is one piece
of bread, and one’s relationship to other people is the other slice of bread – but one’s
relationship to the ecosystem is the core filling. The four-stage therapy offers great
potential for treating people with trauma-based histories across various geo-cultural
contexts, particularly since therapy is not founded on talking indoors. Morita’s therapy
makes use of the animated world of plants, sky, water, rock, sand, fish, insects, frogs and
other life forms that exist in the respective places where treatment occurs. Also, the place
provides the interaction-exchange for patient and therapist.
The following is a diary excerpt from one of my Morita therapy patients who was in
Stage Two.

She (therapist) came to the herb garden where I was weeding; she pulled a leaf
from one of the plants and rubbed it between her fingers and asked me to do the
same. The smell reminded me of my mother’s cooking. I remember times when I
used to collect things when I was young, and how I was so fascinated by the world
in those carefree years of my life. I am so worried that I do not smell food or the air
anymore. But perhaps carefree really means ‘spontaneous wonder’. I wanted to tell
her about all of this, but she said it was my memory to keep alive inside me, rather

13
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

than to tell aloud. She asked me to write a description of the smells of the herbs in
the garden (without associations to my past, ‘just describe the smell,’ and to make
sketches of the plants, ‘just sketch what you see’. (LeVine: Diary of a Morita
patient from 1990, Melbourne)

Goals of treatment

When a patient is contained in a simple and safe environment, s/he gradually

learns to observe and endure internal discomfort. It is vital that early treatment meet the
following goals: (1) to foster the person’s experience of a safe containing place; (2) to
decrease the urgency to solve anything; (3) to increase the person’s capacity to endure
discomfort and contradiction; (4) to decrease one’s tendency to tell other people about a
discovery – which quiets the so-called ego and heightens one’s discerning intuition (or
visceral knowledge); (5) to increase a sense of boredom with one’s own anguish, and (6)
to increase the active observation of and participation in the ecological world, inclusive
of the social (LeVine, 1994). Morita strongly recommended that a clinical assessment of
patients be maintained, particularly since symptoms may increase in the first few days of
isolation before they dramatically decrease after the first stage. Silence plays a role by
decreasing the patient and therapist’s tone of therapeutic urgency (my concept) to fix
anguish. Morita states:

If patients report that their headache has disappeared or that they feel refreshed, the
therapist should explain that such a feeling is nothing but an expression of self-
awareness. Good feelings are accompanied by their opposite, such as discomfort.
If patients ponder over the type of work that will be effective for their condition, or
search for something to do as a distraction from their suffering, they will suffer
even more when they can not find suitable work (Morita, 1928 in LeVine, 1994, p.
153).

Thus, activity is to be directed towards an external purpose rather than to serve the
self in its quest for feeling more comfortable. When a person struggles to control emotion
or to cover up emotion by intellectual interpretations of what constitutes good or bad
emotions, s/he works against the fact that emotion has no valence. Pure emotions are
those that exist before intellectual interpretation and judgement are given. It is the goal of
Morita’s successive stages to dismantle such ideational contradiction so that one can
directly experience uncontaminated emotion. Often, a patient holds an intense conviction

14
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

that justifies an emotion or an analysis about an event in one’s past rather than simply
feeling without any qualifiers or justifiers. In silent-isolation, the patient is given an
opportunity to remain still so that emotion can just emerge as it is. Morita refers to this
‘as isness’ as arugamama.
Again, therapy is about returning one’s experience to its natural state before
convention stepped in. This is akin to the Zen koan (challenging puzzle): Know your
original face before you were born. The entire four-stage treatment is designed
progressively to engage the patient in nature, which in turn, reveals how ‘self’ mimics
nature (Fujita, 1986). It is from that state that the person appreciates ‘emotion as fact’
without an intellectual overlay, which opens desire for self-preservation, even in the face
of anxiety. A most interesting paradox is to feel anxious and desire for self-preservation
simultaneously. And while in this paradoxical state, anxiety and depressed-desire are
unsustainable, and life force is accessed.

Zen-based influences

In Zen, disturbance occurs through too much stimulation of emotion and will, and
by the mind’s opposition to emotion. Re-order occurs when the person returns to ‘original
mind’ with heightened intuitive knowledge that is not sourced by the self or social
mores.10 According to Suzuki (1949), jinen11 is the natural state that is experienced when
one is free from self-willed intentions, and free from intellectual reflection – when one
gives self over to mystery and responds to the mundane.
Similarly, Zen notions of introversion and extroversion influenced Morita’s theory.
Indeed, being extroverted in the Zen sense means relating to the ecological world as
much as the social. Herein one goal of treatment is to assist the patient in spreading her or
his self-awareness and engagement into the social and natural world – as a kind of middle

10
In Zen, ‘original mind’ is akin to pure consciousness, or ‘the state of mind before it is
contaminated by convention and dualistic thinking’, as in being without desire and fear
(Kondo, personal conversations, 1992).
11
Jinen is also regarded as the ‘necessary working of the law of karma,’ or the ‘ultimate
reality’ which relates to wisdom that is ‘awakened’ in oneself established once the self
sits outside social influences (Hisao Inagaki, 1992, p. 134).

15
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

path of relating (introversion-extroversion balance). As stated above, Morita’s stages are

designed to lead a person to re-experience the mysterious and the mundane – life forces.
Having said all this, there is a split among current practitioners of Morita therapy
regarding the links to Zen Buddhism (Kora T. & Sato, 1958; Miura, M., & Usa, S., 1970;
Ishiyama, 1988; Suzuki, 1971). In personal conversations (1994) with the late Takehisa
Kora, MD (who had been Morita’s supervisee), he said that Morita made a political
decision early on in the development of his treatment to play down the Zen influences in
his therapy, as such underpinnings did not fall into the scientific rigour for medical
science. I notice ‘Original Zen’ embedded in Morita therapy while applying the four-
stage treatment, particularly when I move my patients from Stage One to Stage Two
(from isolation to the garden – as this is like going from beige into a pulsating green
world). I actually observe a particular kind of silence and pause in my patients as they
become engaged in the mystery of the non-mystical (author’s conceptualisation).12 As a
qualitative researcher, I am beginning to devise methods for mapping this intrinsic
change.
Morita’s construction of consciousness is very Zen-based when compared to the
Freudian notion being advanced during his time. For Morita, consciousness is not linear;
nor is it an entity that sits as something unconscious, ready to surface. Rather,
consciousness extends in all directions and is peripheral rather than layered. In this
regard, Morita’s therapy as designed -- advances a peripheral field of awareness wherein
time and place spreads out in all directions. Morita called this peripheral awareness,
mushoju-shin, and contended that this quality of consciousness exists at birth but slowly
erodes during our social development. Herein one’s peripheral consciousness can be

12
The following haiku (17-syllable Japanese poem) captures the mystery one might
experience during Morita therapy. [From, In this house of fresh air, by Basho, late 1600s,
translated by Nobuyuki Yuasa]

I felt quite at home,

As if it were mine,
Sleeping lazily
In this house of fresh air.

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Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

trained by such Zen-based practices as Kendo (marital art with swords) or archery, where
one has to be aware of an attack from any direction.
Moreover during application of treatment, the therapist is silent and reflective, still and
active. Herein sits another Zen paradox. When the therapist assumes an unassuming state,
s/he has access to experiencing the patient’s unspoken history.13 And unlike a
psychoanalyst, the Morita therapist is descriptive rather than interpretative. For example,
one patient of mine asked me, Who is the gardener that works here? I responded,
Perhaps watch him and you will know. This intervention facilitated a perceptual shift in
the patient because he entered treatment with a deep dissatisfaction about his social and
love relations. Through the course of treatment, he realised that he had been basing his
relationships on status, rather than his capacity to comprehend the true nature of the other
person. As his therapist, I strategically trained and finetuned his capacity to observe; from
this, he had access to a deeper sense of knowing. Essentially, I trained him to suspend his
categorising mind so that he could observe things arugamama.14 In Morita’s therapy, one
cuts through illusion15 generated by the mind, which is different from directing the mind
to access the here and now. Consider the following passage on Zen:

…za, in Chinese, literally means to sit, and Zen comes from the Sanskrit term
dhyãna which actually means to contemplate…Recently somebody asked me, ‘Is it
useful to practice zazen even for a layperson?’ I replied, ‘No, since man is an
animal, for him to walk is more (natural). However, it is rather unusual for us to see
a man who is walking in the true sense…The mind…is filled with so-called
instinct, habit, thought and intellectual judgment. These do not comprise the real
self, but they delude the real self...For mind and body are not separate; they are

13
I note that this description is based on my personal training under the directive of Dr
Akihisa Kondo. I am aware that not all Morita therapists are trained from Zen. It has been
my great honour to have done so, and I am committed to this process in my role as a
supervisor.
14
I note that there is no such thing as acceptance if one has a non-categorising mind.
15
‘Illusion’ in the Zen sense is formed as a person’s anxieties accumulate to the point
where she or he becomes less able to perceive, experience and respond to reality-as-it-is.
This is different from delusion, which represents faulty thinking. Morita’s therapy is
designed to break down illusion by engaging the phenomenal world as part of the
therapeutic experience. In this engagement, perceptual adjustments are made in the
patient’s observations without the interference of self. This is more complex than meets
the eye; for instance, Freud’s ‘defense mechanisms’ might be seen as a patterned set of
‘illusion-making strategies’ (LeVine, 2000), which from a Zen perspective, do not
necessarily derive from the unconscious per se.

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Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

one. It is (not natural) for mind and body to move in different directions or the
mind to move when the body is quiet…when (one) works, work itself works; when
(one) does zazen, zazen itself meditates. This is what the text means by “movement
and stillness are not separated. Taking meals, one eats neither too much nor too
little; sleeping neither too briefly nor too long…’Not to have any consciousness of
good or evil outwardly is called Za; not to move from seeing self-nature inwardly
is called Zen.’ (Yamada, How to Practice Zen, Institute for Zen Studies in Kyoto,
p. 3-8)

I note that in a personal conversation with Akihisa Kondo, he stated that ‘Suzuki
told me that the reclining state has more enlightenment potential than the sitting state in
Zen because the person is in a still and vulnerable state, and that Morita’s use of an
isolation, bedrest stage is essential to its Zen power...particularly when
mind=body=spirit.’ (Notes from personal conversations with Kondo, 1992). Thus, there
is a spirit infusion that is part of still-movement in Zen. Note here that by ‘spirit’, I do not
mean ‘spiritual’ as there are no religious attachments in Zen; rather spirit is the essence of
life’s forces, akin to a Shinto16 interpretation. In the same way the art of tea and Zen are
one; the art of sword and Zen are one. You must train yourself for this oneness in your
work in the garden…” (Yamada, p. 9-10). In Morita’s therapy, the realisation of self-
nature occurs when one is engaged with Nature, as in plant and animal care, and by
noticing and responding to the changing sky during the course of the day.

Contemporary use of Morita therapy and case examples

Today, the classical treatment is applied in public and private hospitals in Japan,
as well as in a home environment by this author in rural Australia. Though Morita
therapy has been written about in the United States, Europe and Australia, application of

16
Shinto literally means, ‘the way of the gods’. It is a Japanese indigenous perception and
trusted belief, and there is no founder or sacred text like the bible or sutras. It is not
monotheistic and has no absolutes (such as absolute wrong or right). Shinto gods are
called kami and sacred spirits take the animated form of rock, rain, rice, river, tree,
mountain, wind and so on. It is an optimistic system as there is no inherent evil; and
humans can become kami after death. Shinto rituals are performed to call on kami for
protection.

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Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

treatment outside Asia has been sparse.17 The following case sketches are taken from my
practice of Morita therapy in Victoria, Australia.

Case of Raol

In one case in 1999, Raol was a first generation Australian gay man from
Southern Europe. The four-stage treatment was given over the course of three
weeks. He came to therapy with unresolved childhood abuse and long-term patterns
of binge eating. Raol was ambivalent as to whether he was going to stay or leave
the first stage of isolation rest because he said it was ‘boring’. I asked him to endure
his ambivalence about staying or leaving and to see what happened. He soon
became sad and asked me to come to his room; this was day five of the first stage of
therapy. He began to sob and wanted to speak of his emotional experience. I asked
him to ‘just cry’. He cried for almost an hour. I sat quietly next to his bed and then I
left the room after his breathing was normal. I told him he could take a cool shower
and asked my assistant to change his bedding while he bathed.

When he moved to stage two, he wrote in his diary about his personal history
related to childhood sexual abuse in ways that asked me to be his witness; I wrote
something simple and profound in the margins of his diary. The next morning I had
an assistant teach him how to do a woodcarving. He became engaged in this
activity and eventually his urge to have a witness to his past experience subsided. A
turning point for him occurred when he woke to the sound of a parrot outside his
window. He wrote the following in his diary: I was restless all night and then the
parrot called strongly outside my window in the morning; it was a real wake-up
call for me. I realised that my past was mis-placed. I could feel safe again in bed.
His past became more background than foreground over time. He later said he was
able to experience pure grief without his mind interfering, and that he could still
stay active in the garden when he felt confused. (His former pattern was to stay
home from work or let his bills collect when he felt discomfort – which created
more stress over time). In stage three, he was able to become more descriptive in
his garden journal, and that coincided with his fuller engagement with the physical
and social environment.

Case notes on Tam and modified Morita therapy

17
To date, I am the only clinician to use the four-stage residential treatment as designed by
Morita in an English-speaking country. Much of Morita’s theory has been transferred for use in
outpatient counselling in North America and Australia, and some claim that it fits nicely within a
cognitive-behavioural framework. However, I contend that Zen is often misunderstood in
cognitive-oriented treatments, which could actually strengthen attachments to dualistic thinking
and emotional outcomes. Following, a process would minimise the power of paradox and visceral
experience derived from Morita’s four-stage treatment.

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Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

In another case (2005), I recommended Morita therapy to Tam, a 37-year old,

university educated, social worker who identified as heterosexual, agnostic, married
with one child, and third generation Australian from Scottish descent. Tam came to
my outpatient practice initially, and presented with anxiety, cumulative trauma
since childhood, and feelings of isolation despite having social skills and a network
of friends. He had seen a hypnotherapist and cognitive therapist in the past with
temporary relief. His main concern was his use of adult pornography because his
wife discovered his use and described it as ‘sick’ behaviour. He was worried about
the impact his ‘secret’ use may have on his relationship over time. Initially, I saw
him for 10 one-hour weekly sessions and then suggested Morita therapy. I modified
Morita’s 4-stage therapy to an eight-day treatment while keeping the legitimacy of
the four stages. The treatment consisted of the following: three days of silent-rest;
two days of light work and diary writing; two days of heavy work, art and diary
writing; and one day of social activity. In our first session, Tam said he felt ‘drunk’
when he used Internet pornographic material. I was aware of the risk of dissociation
embedded in his use, particularly since his pornography use sat in a context of early
childhood abandonment, and sexual seduction by his mother when he was an early
adolescent. Also, his father had abused alcohol in much of Tam’s childhood – and
there was either verbal shouting or silence between the parents. He did not have a
close relationship with his older brother until recently, following their mother’s
death. His wife’s character was similar to his mother and father’s combined
characters. He described feeling abandoned and invaded simultaneously by his
wife (and gave similar descriptions of his childhood experiences).
With the backdrop of this history, his pornography use made sense to me
clinically; in fact he said it gave him a sense of predictability. Morita therapy
assisted in de-shaming Tam around his pornography use, and in reducing his
experience of betrayal by his wife and parents, as well as thinking he was betraying
his wife.18 Because Morita therapy is experiential in scope, it does not aim to
interpret or polarise behaviours as either good or bad. Tam said he felt relieved that
I was not going to focus on changing those behaviours or impulses as the goal of
treatment. Morita’s theory does not align with addictive theories on pornography
use, or devise goals for total abstinence. Initially, I encouraged Tam to simply
observe the rise and fall of his impulses, and his relationships to place, other and
self. His internet use occurred often in a small room in his home any time of day;
the place felt ‘like a secret’ and his time in the room increased when he intuited his

18
During my clinical fieldwork in Asia and Australia, I observe a chain of responses to
severe trauma -- wherein a person experiences Confusion, Betrayal and Shame
simultaneously (CBS Complex) (LeVine, 2007, International Morita Therapy Congress,
Vancouver, Canada). When this complex is present, I often observe obsessive behaviours,
and the person often states that they cannot sleep due to obsessional thinking; I often see
links between this CBS chain and suicide risk. Morita therapy decreases a person’s over
focus on this baffling and overwhelming complex of experience, while also disentangling
her or him from a morality-based review of history, which reduces shame.

20
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

wife’s demands and simultaneous rejection of him. In many ways he was

oversensitive to his wife’s moods. His anticipated fears of her emotional outbursts
became clearer to him as therapy progressed. For Tam, pornographic material was
‘simple and reliable’ when compared to the dynamics he entered in his love
relationships with women. In particular, he had been selecting romantic partners
who were intrusive emotionally (akin to his mother), yet absent and dismissive
(akin to his father) – a context that reinforced his solo Internet use in an enclosed
small room.
Morita did not regard insight as the goal for treatment or as an incentive for
change, however, insight happens often during the phases of treatment; it is more
than an intellectual understanding but rather that which Morita called Taitoku (or
whole body understanding). Morita therapy gave Tam the experience of a safe
place from which to stay engaged in the physical and social environments even
when his impulses to use pornography were present. While working in the garden,
he became engaged in learning how to prune plants, and how to bonsai seedlings.
These types of activities gave him the experience of broadening his peripheral
activity outside the Internet room. The therapeutic environment provided a rich
contrast of experiences from which to make future decisions for his wellbeing.
Herein lies strength in Morita therapy wherein the therapeutic milieu provides a
reliable relationship alongside the therapist-patient interaction.

Silence, free roaming, and toreware

In both cases, strategic silence and use of paradox were essential to the therapy
outcomes. With Raol, I sat silently near him when he cried. The power of secure silence
coincides with the paradoxical impact that stillness exerts. The therapist is silent yet
unassuming when visiting the patient in the first stage. Thus the patient experiences a
reassurance that is not dependent on words. Also, the prone position maintained in Stage
One fosters fleeting states of vulnerability in the patient. I have noted how a person tends
to recall earlier history during the first stage, while trying to engage the therapist in a life
review, (though some patients think that the culture of psychotherapy requires one to do
so). I observe how social isolation generates a kind of free roaming into one’s past.
However because the therapist does not engage the patient, her or his past associations
run a natural course, and self-indulgence decreases. The therapist needs to be aware of
traumatic history in the patient as this free-roaming phase may aggravate post-trauma
responses that require further assessment and/or treatment. However, most of my patients

21
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

have reported that the safe environment contained their fears during this first stage of
treatment (LeVine, 2000).
In Morita therapy, elongated silence in the first stage leaves the patient open to roam
freely in thoughts, feelings and imaginings without any interpretation by the therapist.

The patient lies silent in all the stirrings and perseveres – to see how it all turns out.
It is the isolation experience of treatment, not the facilitation by the therapist that
prompts something akin to insight. In many ways, free association may be less
censored in isolation rest because the patient struggles only with his or her personal
taboos about the content of what surfaces, whereas in analysis, the patient may
withhold content because of his or her concern about the analyst’s impression. In
Morita’s isolation-rest phase of treatment, there is no one to impress and therefore
no one by whom to be distracted. Although the analyst might say that the content
of what surfaces in the presence of the therapist is important, the Morita therapist
would view his or her presence as a distraction from the social isolation that serves
as an important paradox for the treatment. The isolation serves eventually to
promote interpersonal relationships (LeVine, 1994, p. 156).

One value of the isolation, silent stage of treatment is that the person is given time to
indulge in self until the self’s conflicts is no longer interesting. In talking therapies, the
person may indulge in past history during a session and then be expected to leave the
session and return to activity. Morita therapy facilitates a setting from which a patient
decreases attachment to destructive people, situations, and objects. In this way, akin to
Kondo’s notion of elastic mind (1953, p. 34), the person experiences the healthy elasticity
of mind, body and spirit. Any exaggerated attachment (over or under attachment)
interferes with healthy elasticity. So often in people who have experienced cumulative
trauma, their attachments to destructive situations and people can enter a loop of
repetition akin to tokaware.19
One outcome measure for Morita’s treatment comes from documenting a shift in the
patient’s exchange patterns with the therapist (Kondo, 1961, and personal conversations
during supervision in the 1990s). Thus the therapist can record exaggerated patterns of
behaviour (such as when a patient wants the therapist to acknowledge her/his progress all
the time), alongside changes in diary themes. Progress is often overtly observed after the

19
According to Morita, tokaware occurs when one is trapped in a loop of anxiety.
Morita’s therapy is designed to dismantle this cycle and to generate a middle-path of
attachment wherein one is neither too attached nor detached.

22
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

second stage when the patient engages equally in a relationship with the self, natural
environment, and the social environment.

Influence of international politics on mental health environments

Since the time of my first administration of Morita therapy in the early 1990s in
Australia, the use of Morita’s treatment in English-speaking contexts has taken three
directions: classical residential 4-stage therapy, classical therapy with a modified
isolation-rest stage, and counselling-based outpatient care. Morita’s theory has been
adopted into counselling practices in the United States and Canada, and incorporated into
some academic counselling curricula20. Scholars and practitioners have worked to
preserve the philosophical core of Morita’s therapy. Sometimes, Morita-based concepts
(as a theoretical orientation to counselling) are presented alongside other modalities of
treatment, such as Cognitive Behavioural therapy.
Despite such growth, Morita therapy sits in a larger international arena of mental
health policies, with some socio-political factors inhibiting its global development. For
example, inpatient psychiatric units in the USA, Australia, New Zealand and the United
Kingdom have institutionalised a culture of treatment that is often urban-based and rarely
considers the impact that physical environments have on staff and patients. In addition,
cookbook frameworks that use cognitive-behavioural and meditative methods seem to be
increasing.21 In fact, most inpatient psychiatric hospital units would regard patients’

20
Such training is offered predominantly by Ishu Ishiyama at the University of British Columbia
who holds Morita weekend trainings, and by Brian Ogawa at Washburn University, Kansas
(Ogawa, 1988) who has incorporated Morita therapy into the counselling curriculum, and has
taken a core of graduate students to Japan for Morita therapy field study (personal
correspondence, 2006).
21
The increase in these programmed approaches to psychotherapy seems to coincide with the
increase in funding that is attached to ‘evidence-based’ research. Though viability and reliability
of treatments for patients is a worthy and ethical goal, much has been translated into particular
quantifiable methods and measures for funding purposes. To date, the bulk of these therapeutic
programs place the pathology in the individual, which forecloses a more contextual orientation to
mental health and wellbeing. Having said this, this author contends that ‘evidence’ can be
generated on treatments that reduce symptoms as well as extend the scope of ‘quality of life’. One
challenge is to better measure an increase in responsive engagement with self, other, time, and
place – which seems probable given preliminary pilot outcomes from Morita therapy by this

23
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

caring relationships with vegetation, birds or animals as falling outside the goals of
patient (indoor) care.
By contrast, in regions where people’s relationships to seasonal activities are
embedded in agricultural life (as in rice planting and harvest rituals throughout Asia),
Morita therapy is more readily embraced as a viable treatment. For example, Dr Didier
Bertrand is the director of the Laos PDR branch of AFESIP (Acting for Women in
Distressing Situations),22 an organisation that assists girls who have been sex trafficked in
Asia. He recognises the need for a ‘progressive treatment’ for children and young adults
suffering from layer-upon-layer of traumatic experience. He and I are in discussion about
ways to provide safe and nurturing ‘places’ for residential therapy, with art, play and
outdoor therapeutic methods of treatment akin to Morita’s therapy.23 To date, standards
set for international mental health development (supported often by the World Health
Organization) prioritise numbers of ‘inpatient’ beds as evidence of such development;
such a criterion diminishes the potential for designing psychiatric centres that re-place
(rather than displace) patients in their natural environments.
As a way of preserving the core of Morita’s practice, I apply the classical 4-stage
treatment in my small residential practice in Victoria for English-speaking people who
suffer from trauma experiences, and excessive anxiety. My practice involves supervision
for health professionals who want to train in Morita’s classical theory and practice before
translating it into outpatient use. I surmise that if this treatment were not continued

author. Discussions on outcome studies for Morita therapy in hospitals outside Japan that
incorporate (and triage) quantitative, qualitative and phenomenological methods are underway
with this author and Professor David Richards from the University of York, UK.
22
AFESIP was developed by Somaly Mam who published a book (‘The Road of Lost Innocence,
Virago, 2007) about her own experience of so-called recovery from the stench of sexual torture. I
write ‘so-called recovery’ because Somaly’s autobiography is evidence of the on-going, haunting
nature of horror. (She states, ‘Consulting a psychologist isn’t enough. I did that. I’ve tried a great
many things. But the past is inscribed on my body now.’) Therapy which tries to change thoughts
and emotions within the individual is naively placed. Mam’s story is evidence of complex
sociopolitical and environmental disorder and she points to the disorder outside the self, and ways
that her whole body has been contaminated and hurt -- forever. Morita therapy does not try to
change this fact by attaching to a particular kind of ‘recovery’.
23
Similarly, Dr J Bhoomikumar (Director of Chey Chumneas child mental health centre
in Takhmau, Cambodia) is aware of the impact an environment has on health care; he has
assisted the construction of gardens, open play and sitting areas, and traditional Khmer
houses in which children and their families can rest together when a child needs care.

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Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

outside Japan as a clinical inpatient practice, the classical foundation would lose its
essence via verbal and pharmaceutical approaches to treatment. Of course, I am still
uncertain how the isolation stage can be simulated in outpatient care, but I am certain that
the isolation-rest stage is essential to the successful progression of the other stages.
Overall, I am engaged in the process of conservation of this structured therapeutic
system, particularly as it becomes popular outside Japan.

In conclusion: constructing therapeutic environments across cultures

Morita did not categorise anxiety or depression as mental disorders per se, and
from this orientation, he designed his therapy so that the patient moves from an unnatural
state to a natural state, rather than moving from an abnormal to normal state. Morita
therapy is not ‘psycho’therapy as such; rather it is a sequenced therapy that breaks down
the human tendency to categorise thoughts and emotions as irrational, undesirable, or
desirable.
Drawing on Zen, the first stage of therapy is designed to purposefully disengage
the person from dialogue and creative stimulation. By enduring this starkness, one is
thrust back into the human core that engages in (and is engaged by) Nature.
Paradoxically, by denying stimulation in the first stage, the patient gets bored with her or
his symptoms and begins to experience the environment with all the senses – which
returns the person to the natural cycles of a diurnal mammal. Also, the austere yet
predictable and safe setting allows the person to experience a non-chaotic external
environment so that internal emotional chaos subsides.
For practitioners socialised outside Japan, Morita therapy is challenging because
the therapist is required to suspend any desire to be the central change agent. In this way,
the therapist relinquishes power to the 4-staged progression of treatment. Accordingly,
the therapist is trained to observe minute behavioural changes in patients that are
idiosyncratic or culturally relevant -- without verbal exchange. In most forms of
psychotherapy, verbal exchange is encouraged, if not a pre-requisite, and the therapist
assesses the content of that exchange. In Morita therapy, however, the tone of the
patient’s silence is assessed across the 4-stages. For instance, behaviours that indicate a
curious silence over an agitated silence are cues that the patient is ready to move from

25
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

stage one to stage two.

Because this treatment returns a patient to the ‘ordinary’, it has tremendous
capacity to be applied across cultures and places. Culture and geography may change
from place to place, but ecological processes remains the same. This is the strength in
applying Morita therapy in Japan, Europe, SE Asia, or Australia. However, the reality is
that evidence-based research on the reliability of therapies is important for the global
promotion of Morita therapy. By combining qualitative and quantitative methods that are
as sensitive to extrinsic change as intrinsic change, Morita therapy may show itself as a
quality of life enhancer.
I have found Morita therapy invaluable for people who suffer from cumulative
trauma. In particular, Morita therapy re-orients them to the difference between ‘natural
(Nature-based) change as a secure base’ – and destructive change induced by humans as
an insecure base. The patient learns to read and respond to contexts with clearer
discernment – and this shift in response patterns can be measured.
Having said all this, the therapist is responsible for maintaining a particular kind of
silence within him or herself. Kondo believed that the progress of the patient depended on
the ‘uncluttered’ stillness of the therapist. Also, patients with traumatic histories are
attuned to safe or unsafe situations, and their progress is strengthened when the
therapist’s presence is secure and responsive. Overall, a secure-silence becomes the
context from which patients experience the natural rise and fall of symptoms/emotions
(akin to the larger ecology). Silence is a shift in the patient’s former behavioural patterns,
and it becomes a shift in relational exchanges as well. This, too, can be measured.
It seems to me that the capacity of patients to endure Morita’s methods is less the
issue than the capacity of therapists to construct therapeutic environments that allow
patients’ worries to run their natural course. Therapists who train in Morita therapy are
often aware of the ‘meaning’ underlying psychological symptoms, but rather than
interpret symptoms as objects to be eradicated, they provide a safe place for symptoms to
rise and fall. Paradoxically, in this way patients give up their desire for symptom
annihilation, while having a rest from such pressures. If patients gain insight into the

26
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

origins of their symptoms, though welcomed, it is merely a bi-product of Morita’s

treatment.24
For me, maintaining the classical integrity of the treatment during its international
development is a bit like improvisational theatre, wherein the performer returns to the
core premise throughout the performance in order to retain the original threads of
meaning.

24
Kora (1968) notes that “…nature is not (hu)man-centered….and anxiety is inseparable from human
existence.” (p. 318).

27
Book chapter (in French). In Indigenous Therapies in Medical Anthropology. Remi
Bordes (Ed). Aux Lieux d'Etre.

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