Cultural adaptability as an attribute of therapies: The case of morita psychotherapy

Culture, Medicine, and Psychiatry - Morita psychotherapy, a form of therapy developed in Japan some sixty years ago, has survived extensive changes in Japanese society, and is now enjoying...     

Cultural adaptability as an attribute of therapies: The case of morita psychotherapy

Morita psychotherapy, a form of therapy developed in Japan some sixty years ago, has survived extensive changes in Japanese society, and is now enjoying popularity in the United States. This gives us an opportunity to look closely at the concept of cultural fit between an important therapeutic technique and its social milieu, and to speculate about recent changes in American culture that may account for the growing popularity of Moritism. In contrast to Western style `talking therapies' like psychoanalysis, Morita psychotherapy is relatively group-centered, ritualistic, and behavioristic. One would expect to find these features in a Japanese therapy, but their acceptance in America suggests that previously popular Western techniques may not be optimum for handling certain problems of the post-industrial American. McLuhan, Peacock, Douglas, and others have suggested some emerging traits of Western character that might shed some light on this question.     

The indigenization of neurasthenia in Hong Kong

Despite its origin in Western psychiatry, neurasthenia has become a popular concept in Chinese folk medicine, referring to a variety of somatic and psychological symptoms. Review of Chinese medicinal materials and patent medicines shows that neurasthenia is associated more often with somatic symptoms in tonic type medicine and with psychological and psychosomatic symptoms in sedative and tranquilizer type medicine. Popular Chinese books on neurasthenia suggest that causes might be attributed to lifestyle, psychological factors, and health problems. Recommendations on treatment emphasize self-help approaches through changing lifestyle, examining attitudes, tonic care, and relaxation. As a broad term used loosely by professionals and the lay public in Hong Kong, neurasthenia serves the important function of destigmatizing psychiatric disorders. Psychosexual problems may also be conveyed discreetly through somatic presentation. The indigenization of neurasthenia exemplifies how an originally Western concept acquires cultural meaning. Implications of illness conceptualization and the medical paradigm are discussed.     

Neurasthenia as nosological dilemma

While researching concepts of neurasthenia as described by patients and physicians of various backgrounds, it was found that there is a great discrepancy between the two groups. In this study, questionnaires were administered to 70 psychiatric patients, 6 Chinese medicine men, 44 general physicians and 35 neuropsychiatrists, to inquire into the reasons for positive or negative attitudes toward neurasthenia. Half of the clinical patients believed that they were suffering from neurasthenia. Neurasthenia is a predominate term used for various types of distress arising mainly from psychiatric diseases. Chinese medicine men are aware that this term is a medical diagnosis introduced from the West. Through experience they regard neurasthenia as a kind of deficit of nerve. Apparently, the concept of neurasthenia has been integrated into the Chinese medical system, a fact substantiated by its longstanding, nosological use by the public.Younger generation physicians within both general and neuropsychiatric disciplines on the whole reject neurasthenia as a diagnostic term. However, one-third of neuropsychiatrists and 40% of general physicians use this term in their practice in order to improve the treatment of and to establish good communication and rapport with the patients whom they treat. Most of them, however, do not use the term in their formal diagnosis. The concept of the illness, neurasthenia, is historically rooted and today presents a nosological dilemma. It will eventually be transformed conceptually and disappear from the public mind.     

Treating Emotion-Related Disorders in Japanese Traditional Medicine: Language, Patients and Doctors

This paper analyses how the conceptual and therapeutic formation of Japanese traditional medicine (Kampo) has been socially constructed through interactions with popular interpretations of illness. Taking the example of emotion-related disorders, this paper focuses on the changing meaning of constraint (utsu) in Kampo medicine. Utsu was once a name for one of the most frequently cited emotion-related disorders and pathological concerns during the Edo period. With the spread of Western medicine in the Meiji period, neurasthenia replaced utsu as the dominant emotion-related disorder in Japanese society. As a result, post-Meiji doctors developed other conceptual tools and strategies to respond to these new disease categories, innovations that continue to influence contemporary practitioners. I begin this history by focusing on Wada Tōkaku, a Japanese doctor of the Edo period who developed a unique theory and treatment strategy for utsu. Secondly, I examine. Yomuto Kyūshin and Mori Dōhaku, Kampo doctors of the early twentieth century, who privileged neurasthenia over utsu in their medical practice. The paper concludes with a discussion of the flexibility and complexity of Kampo medicine, how its theory and practices have been influenced by cross-cultural changes in medicine and society, while incorporating the popular experience of illness as well.     

Enveloping Mothers,Enveloped Sons: Positions in Chinese Family Therapy

The increasing acceptance and use of psychotherapy in contemporary China powerfully attests to the “psychologization” of Chinese society. Yet attending therapy is only one aspect of psychologization. Analyzing the practice of therapy through case examples illuminates the broader sociocultural context of China’s “psycho-boom.” This includes insight into what I term an expansive-I notion of personhood. This non-singular notion of personhood is a major challenge for Chinese therapists. Therapists’ attempts to resolve clients’ problems by reorienting them according to psychological ideals highlight the multiple, at times contradictory relationships between psychotherapy, the state and families.     

Acceptability of Animal-Assisted Therapy: Attitudes toward AAT,Psychotherapy, and Medication for the Treatment of Child Disruptive Behavioral Problems

Animal-assisted therapies (AATs) are not widely promoted in routine mental healthcare but represent a viable treatment option given positive perceptions of pets and growing evidence that animals provide meaningful contribution to psychological wellbeing. Relatively little is known about the general public's attitude toward AATs, especially in relation to more commonly used alternatives. This study compared the acceptability of four different treatment options (AAT, medication, psychotherapy, and no active treatment) for common externalizing behaviors in children. Parents from a community sample (N = 189) were presented with vignettes describing a child with symptoms of an externalizing behavior disorder and were asked to rate the acceptability of the four different treatment options. Participants rated AAT as a highly acceptable form of treatment and more acceptable than no active treatment and medication. However, AAT was rated as less acceptable than psychotherapy. Experiences with animals (both positive and negative) were unrelated to the acceptability of AAT. These findings suggest that AAT is viewed as a highly acceptable form of treatment for common externalizing behaviors and should be more systematically investigated as a treatment for children's mental health problems.     

Japanese tooth size: past and present

Mesial-distal and buccal-lingual crown measurements were made on male and female samples of recent Japanese teeth from three locations, Fukuoka, Kyoto, and Tokyo, and for Hokkaido Ainu and Koreans. Similar data were collected for prehistoric Middle-to-Late Jomon Japanese and from Yayoi specimens representing the first agriculturalists to appear in Japan. From a tooth-by-tooth comparison of cross-sectional areas, it was shown that the modern Japanese samples did not differ from one part of Japan to another. Korean tooth size also is not significantly different from Japanese, while Ainu have the smallest teeth recorded in Asia. The Yayoi who brought rice to Japan about 300 B.C. came in with teeth that were the same size as Chinese Neolithic teeth. They encountered a resident Jomon population whose teeth were 10% smaller. From tooth size measures alone, it is most economical to suggest that, if the rates of reduction observed elsewhere in the world applied in Japan, the recent Ainu would best be regarded as the direct descendants of the Jomon, while the modern Japanese are the results of in situ reduction from the incoming Yayoi. Other aspects of craniofacial morphology suggest that some Jomon was incorporated by the Yayoi. The modern Japanese, then, while predominantly derived from the Yayoi, would include a Jomon component.     

Attitudes Towards Dogs: A Study of University Students in Japan and the UK

ABSTRACT

The attitudes of 229 (142 females, 87 males) Japanese and 212 (131 females, 81 males) British students towards dogs were measured using a questionnaire comprising 46, seven-point Likert scale items, taking the cultures of both Japan and the UK into consideration. Their responses were separately subjected to Principal Factor Analysis with Varimax Rotation, which suggested seven and five independent sub-scales from the Japanese and British data, respectively. Two of these sub-scales, describing willingness to train and acceptance of dogs as equals, were essentially identical between the two countries. Concern over hygiene, and freedom of access for dogs, were grouped as a single sub-scale in Japan, but split into two sub-scales in the UK. Euthanasia and intolerance of aggression were addressed by two separate sub-scales in Japan but one sub-scale in the UK. Sub-scales relating to stray dogs, and usefulness of dogs, were detectable in the Japanese data but not in the UK. Both Japanese and British women were more likely to consider dogs as their equals, and were less accepting of euthanasia, than men in the same country. The greatest difference between the two countries was in attitudes towards euthanasia, which the British found more acceptable than did the Japanese.     

Bentuhua: Culturing Psychotherapy in Postsocialist China

The breathless pace of market reform in China has brought about profound ruptures in socioeconomic structures and increased mental distress in the population. In this context, more middle-class urbanites are turning to nascent psychological counseling to grapple with their problems. This article examines how Chinese psychotherapists attempt to “culture” or indigenize (bentuhua) three imported psychotherapy models in order to fit their clients’ expectations, desires, and sensibilities: the Satir family therapy, cognitive behavioral therapy, and sandplay therapy. It addresses three interrelated questions: What is the role of culture in adopting, translating, and recasting psychotherapy in contemporary China? How is cultural difference understood and mobilized by therapists in the therapeutic encounter? What kind of distinct therapeutic relationship is emerging in postsocialist China? Data presented here are drawn from my semistructured interviews and extensive participant observation at various counseling offices and psychotherapy workshops in the city of Kunming. My ethnographic account suggests that it is through constant dialog, translation, and re-articulation between multiple regimes of knowledge, cultural values, and social practices that a new form of talk therapy with “Chinese characteristics” is emerging. Finally, I reflect upon what this dialogic process of transformation means for psychotherapy as a form of globally circulating knowledge/practice.     

中国人和日本人在人种上的关系——颅骨测量性状的统计分析研究

本研究以北亚、东亚、东南亚和大洋洲一大片区域为背景探索日本人的起源和亲缘关系。结果显示日本旧石器时代港川人、绳文时代和现代人与大约同时期的华南居民有最接近的亲缘关系;从绳文时代到现代日本人的时代变化具有与后者(以及华北居民)相同的趋势。     

Psychological Problems Of Dialogue In Light Of The Ideas Of M. M. Bakhtin And A. A. Ukhtomskii

Comparative examination of the scientific and philosophical ideas of Mikhail Mikhailovich Bakhtin and Aleksei Alekseevich Ukhtomskii is of interest from the standpoint of both the psychological theory of communication and the practice of psychological counseling, psychotherapy, and upbringing. Development of the applied areas of psychology poses the tasks of understanding the particular person and his individual problems and offering psychological assistance in the process of communication. To deal with these questions it is not sufficient to have scientific psychological training, i.e., knowledge of the general laws of personality development and communication; a capacity for personal communication as an aid to resolving human life problems is also necessary.     

Guidelines for the Management of Helicobacter pylori Infection in Japan: 2009 Revised Edition

Background:  Over the past few years, the profile of Helicobacter pylori infection has changed in Japan. In particular, the relationship between H. pylori and gastric cancer has been demonstrated more clearly. Accordingly, the committee of the Japanese Society for Helicobacter Research has revised the guidelines for diagnosis and treatment of H. pylori infection in Japan.
Materials and Methods:  Four meetings of guidelines preparation committee were held from July 2007 to December 2008. In the new guidelines, recommendations for treatment have been classified into five grades according to the Minds Recommendation Grades, while the level of evidence has been classified into six grades. The Japanese national health insurance system was not taken into consideration when preparing these guidelines.
Results:  Helicobacter pylori eradication therapy achieved a Grade A recommendation, being useful for the treatment of gastric or duodenal ulcer, for the treatment and prevention of H. pylori -associated diseases such as gastric cancer, and for inhibiting the spread of H. pylori infection. Levels of evidence were determined for each disease associated with H. pylori infection. For the diagnosis of H. pylori infection, measurement of H. pylori antigen in the feces was added to the tests not requiring biopsy. One week of proton-pump inhibitor-based triple therapy (including amoxicillin and metronidazole) was recommended as second-line therapy after failure of first-line eradication therapy.
Conclusion:  The revised Japanese guidelines for H. pylori are based on scientific evidence and avoid the administrative restraints that applied to earlier versions .     

Y chromosomal DNA variation and the peopling of Japan.

Four loci mapping to the nonrecombining portion of the Y chromosome were genotyped in Japanese populations from Okinawa, the southernmost island of Japan; Shizuoka and Aomori on the main island of Honshu; and a small sample of Taiwanese. The Y Alu polymorphic (YAP) element is present in 42% of the Japanese and absent in the Taiwanese, confirming the irregular distribution of this polymorphism in Asia. Data from the four loci were used to determine genetic distances among populations, construct Y chromosome haplotypes, and estimate the degree of genetic diversity in each population and on different Y chromosome haplotypes. Evolutionary analysis of Y haplotypes suggests that polymorphisms at the YAP (DYS287) and DXYS5Y loci originated a single time, whereas restriction patterns at the DYS1 locus and microsatellite alleles at the DYS19 locus arose more than once. Genetic distance analysis indicated that the Okinawans are differentiated from Japanese living on Honshu. The data support the hypotheses that modern Japanese populations have resulted from distinctive genetic contributions involving the ancient Jomon people and Yayoi immigrants from Korea or mainland China, with Okinawans experiencing the least amount of admixture with the Yayoi. It is suggested that YAP+ chromosomes migrated to Japan with the Jomon people > 10,000 years ago and that a large infusion of YAP- chromosomes entered Japan with the Yayoi migration starting 2,300 years ago. Different degrees of genetic diversity carried by these two ancient chromosomal lineages may be explained by the different life-styles (hunter-gatherer versus agriculturalist). of the migrant groups, the size of the founding populations, and the antiquities of the founding events.     

Species diversity of insects in Japan: Their origins and diversification processes

Japan is considered a global hot spot of biodiversity. With regard to species diversity, insects are no exception. To date, more than 32,000 insect species have been identified in Japan, while around 100,000 species of insects are estimated to inhabit this country. In this paper, we outline background factors having contributed to diversification of Japanese insects. Of course, the high degree of Japanese insect diversity is the result of many complex factors. In addition to the humid Asian monsoon climate and the extensive latitudinal gradient of habitats, the extremely complex geological history has contributed as an important factor to generate and maintain the high species diversity and endemism. In particular, the independent origins of northeastern and southwestern Japan from the Eurasian continent have greatly contributed to the diverse composition of Japanese insect fauna. To highlight the importance of this process, we introduce some case studies and previously published papers focusing on several insect groups with low dispersal ability. Those cases indicate that the geological history of Japan has played an important role in the differentiation of Japanese insect species. Besides such geological factors, climatic and ecological factors in combination have contributed to the formation of Japanese insect fauna in complicated ways and produced its particularly high degree of biodiversity. The knowledge compiled here will provide useful information for future studies aiming to understand more deeply the processes of speciation and faunal formation of Japanese insects.     

Phylogeography of Japanese horse chestnut (<Emphasis Type="Italic">Aesculus turbinata</Emphasis>) in the Japanese Archipelago based on chloroplast DNA haplotypes

Japanese horse chestnut (Aesculus turbinata: Hippocastanaceae) is one of the typical woody plants that grow in temperate riparian forests in the Japanese Archipelago. To analyze the phylogeography of this plant in the Japanese Archipelago, we determined cpDNA haplotypes for 337 samples from 55 populations covering the entire distribution range. Based on 1,313 bp of two spacers, we determined ten haplotypes that are distinguished from adjacent haplotypes by one or two steps. Most of the populations had a single haplotype, suggesting low diversity. Spatial analysis of molecular variance suggested three obvious phylogeographic structures in western Japan, where Japanese horse chestnut is scattered and isolated in mountainous areas. Conversely, no clear phylogeographic structure was observed from the northern to the southern limit of this species, including eastern Japan, where this plant is more common. Rare and private haplotypes were also found in southwestern Japan, where Japanese horse chestnuts are distributed sparsely. These findings imply that western Japan might have maintained a relatively large habitat for A. turbinata during the Quaternary climatic oscillations, while northerly regions could not.     

A network meta‐analysis of the effects of psychotherapies,pharmacotherapies and their combination in the treatment of adult depression

No network meta‐analysis has examined the relative effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression, while this is a very important clinical issue. We conducted systematic searches in bibliographical databases to identify randomized trials in which a psychotherapy and a pharmacotherapy for the acute or long‐term treatment of depression were compared with each other, or in which the combination of a psychotherapy and a pharmacotherapy was compared with either one alone. The main outcome was treatment response (50% improvement between baseline and endpoint). Remission and acceptability (defined as study drop‐out for any reason) were also examined. Possible moderators that were assessed included chronic and treatment‐resistant depression and baseline severity of depression. Data were pooled as relative risk (RR) using a random‐effects model. A total of 101 studies with 11,910 patients were included. Depression in most studies was moderate to severe. In the network meta‐analysis, combined treatment was more effective than psychotherapy alone (RR=1.27; 95% CI: 1.14‐1.39) and pharmacotherapy alone (RR=1.25; 95% CI: 1.14‐1.37) in achieving response at the end of treatment. No significant difference was found between psychotherapy alone and pharmacotherapy alone (RR=0.99; 95% CI: 0.92‐1.08). Similar results were found for remission. Combined treatment (RR=1.23; 95% CI: 1.05‐1.45) and psychotherapy alone (RR=1.17; 95% CI: 1.02‐1.32) were more acceptable than pharmacotherapy. Results were similar for chronic and treatment‐resistant depression. The combination of psychotherapy and pharmacotherapy seems to be the best choice for patients with moderate depression. More research is needed on long‐term effects of treatments (including cost‐effectiveness), on the impact of specific pharmacological and non‐pharmacological approaches, and on the effects in specific populations of patients.     

Differentials of Yayoi immigration to Japanas derived from dental metrics

A major influx of new people, today termed Yayoi, migrated from the East Asian continent into the Japanese archipelago during the Aeneolithic and Protohistoric periods and interbred with the preexisting Jomon people. This study classifies ancient and more modern Japanese into natives or immigrants using discriminant analysis based on dental measurements in order to reconstruct the initial impact of the immigrants and the temporal and geographical differentials of mixture with the preexisting people. The results suggest that the earliest immigrants diffused into central Japan, including the Kanto region. The proportion of immigrant origin in the protohistoric Kofun was less in eastern Japan (72%) as compared to western Japan (81%-90%). The proportion of the immigrants in the Kanto District decreased during the medieval period (63%) and increased again in the early modern Edo and later modern times (75%), which might indicate that the gene flow still was occurring from west to east even in these times. Assuming the estimated proportions of either group reflect the intermixture ratio, the recent Japanese people may be regarded as hybrid of the native and immigrant groups with the following approximate ratios: 1:3 for the Kanto Japanese, 2:3 for the Ryukyu Islanders and 7:3 for the Hokkaido Ainu. These estimations support the "dual structure model" formed by Hanihara (1991) for explaining the population history of Japan.     

Work Content and Serious Mental Illness among Middle-Aged Men: Results from a 6-Year Longitudinal Study in Japan

Objective

The present study aimed to determine prospective associations between work content after a working life of more than 20 years and serious mental illness among Japanese men aged 50 to 59 years, using a nationwide population-based survey.

Methods

Data were extracted from a national longitudinal survey of middle-aged and elderly persons previously conducted by the Ministry of Health, Labour and Welfare in Japan. We analyzed data across 10 work content categories for Japanese men who had been working in the same job type or industry for over 20 years. As part pf the survey, participants completed the Kessler (K)6 scale each year to determine their level of psychological distress (with scores ≥13 indicating serious mental illness). Cox discrete time proposal hazard regression analysis was used to examine potential associations between work content and serious mental illness from 2005 to 2010. Further adjustments were made for other sociodemographic characteristics and lifestyle factors.

Results

The current study involved a total of 11,942 participants with a mean (± standard deviation [SD]) of follow-up was 3.4 (± 2.0) years, during which time 892 participants (7.5%) had been classified as having a new-onset serious mental illness. Men who had worked in service jobs and in manufacturing jobs at baseline were more likely to develop serious mental illness than those in managerial jobs (hazard ratio 1.37, 1.30, 95% confidence intervals 1.04–1.80, 1.02–1.65) after adjustment for confounding variables.

Conclusion

These findings suggest that Japanese men aged 50 to 59 years who have worked in service and manufacturing jobs after a working life of over 20 years have an increased risk of serious mental illness during follow-up. Identifying the most at-risk work content category after a working life of over 20 years would be an essential part of providing more effective interventions for psychological distress among Japanese men in this age group.     

Occurrence of the endangered species Nitellopsis obtusa (Charales,Charophyceae) in western Japan and the genetic differences within and among Japanese populations

Nitellopsis obtusa (Charales, Charophyceae) are widely distributed from Europe to Asia; however, this species has been recorded in only the five lakes in central Honshu in Japan. This species was thought to be extinct in Japan, but was rediscovered in limited areas of Lake Kawaguchi in central Honshu. More recently, we discovered more Japanese populations of N. obtusa in Lake Biwa in western Honshu, and it became clear that the species had a broader distribution in Japan than originally believed. In addition, although only male or female thalli have been collected at each lake, both male and female thalli were found from Lake Biwa. This is the first report of a potentially sexual population of N. obtusa in Japan. The DNA sequences of three chloroplast DNA markers, including both coding and non‐coding regions, were identical in all specimens from Lake Kawaguchi and Lake Nojiri (Central Honshu), and differed from those of Lake Biwa and German specimens. Although Japanese and German specimens were genetically similar, Japanese specimens displayed considerable genetic diversity according to locality.