It can be argued that modern humans, in their estrangement from nature, often seek to challenge, conquer, and control nature, essentially living in opposition to it (Fujita 1986; Morton 2017). ‘Nature’ here does not refer only to an isolated notion of the natural world as distinct from humans, but more broadly to the reality of all phenomena, encompassing both the environment and human nature (Fujita 1986; Morita 1998). Morita Therapy seeks to redress this ultimately self-defeating imbalance, by moving patients from an unnatural, inauthentic state to a natural, authentic state in which they live in harmony with the natural world, accepting the body and mind’s natural reactions to life rather than resisting the inevitable cycles and fluctuations of (human) nature (Kitanishi 2005; Morita 1998).
All phenomena, including those of the mind and body, are constantly in flux: as humans are always interacting with their environments, their thoughts and emotions shift accordingly (Fujita 1986; Morita 1998; Ogawa 2007). Thus, all emotions are natural, integral, legitimate, and unavoidable experiences conceptualized only as pleasant or unpleasant (desired or undesired) but not as positive or negative (Minami 2013; Reynolds 1976). Indeed, these responses are functional: the mind and emotions shift in order to adapt to situations; ultimately, anxiety and pain are necessary for survival (Fujita 1986; Kora 1995; Morita 1998). As such, all emotions allow life to flow in a balanced way, as long as they are not intellectually judged as either ‘positive’ or ‘negative’ (Kondo 1975).
Analogous to the natural world, these responses cannot be controlled or manipulated by will (Ogawa 2007). Instead, Morita noted that all emotions will naturally dissipate, if left to do so (‘the law of emotion’) (Kora 1995; Morita 1998). According to Morita, as emotions cannot be controlled, people are not considered responsible for them; conversely, behaviour is considered controllable, and people responsible for taking the action which needs to be taken, regardless of accompanying emotions (Morita 1998; Ogawa 2007).
Arugamama (literally, ‘as it is’) means to accept things as they are: to concede to phenomenological reality and obey nature (Morita 1998; Ogawa 2007; Reynolds 1976). This is not an intellectually-induced state of acceptance, but an embodied, empirical, intuitive state in which one is immersed in action, has no awareness of the self as set apart from nature, and thus no self-consciousness and resulting difficulties (Kitanishi 2005; LeVine 1998). As such, the authentic experience of the self is accepted as such without judgement or resistance (Ishiyama 2011; Kora 1995). This empowers people to adapt to life with spontaneity and flexibility, taking necessary action whilst allowing the natural ebb and flow of thoughts and emotions (Kora 1995; Ogawa 2007).
Desire for Life
This concept refers to a natural and fundamental appetite for self-improvement and self-actualisation, comparable to the humanistic notion of a life-propelling inner force: an innate, purposive drive to strive and preserve life (Fujita 1986; Kondo 1975; Kora 1995; Morita 1998). This inherent intelligence and energy strives for the optimal health which results when the body, mind, and emotions are allowed to flow naturally (Ogawa 2007). Thus, Morita therapists do not teach patients how to live meaningful lives, but rather help them to remove the obstacles to their intuitive desire to do so.
With desire for life comes an inevitable fear of death: desire and fear are two sides of the same coin (Minami 2013; Morita 1998). For example, a desire to be accepted by others may manifest in feelings of social anxiety. Therefore, the stronger one’s desire towards self-fulfilment, the more likely one is to experience self-concern and disappointment (Ogawa 2013). Thus, desire both propels one to live, and causes suffering, due to the discrepancy between the ideal (desired state) and the realities of life (Kitanishi 2005; Morita 1998; Ogawa 2007). Suffering, therefore, does not indicate a deficit, but an excess: a key concept in counteracting feelings of inadequacy (Kitanishi 2005; Morita 1998; Reynolds 1976).
As suffering is considered a natural phenomenon originating from desire for life, problems stem not from suffering itself but from a fixation on and resistance to suffering (Fujita 1986; Morita 1998; Ogawa 2013). Thus, it is the lack of naturalness, the distortion of the arugamama attitude, which is believed to cause difficulties (Fujita 1986). This is conceptualized as a misdirection of desire for life; a squandering of energy through futile efforts to eliminate unpleasant thoughts and emotions (Kora 1995; Ogawa 2007).
The Vicious Cycle
Two self-defeating components, Toraware and Hakarai, are conceptualized as producing a vicious cycle which exacerbates suffering (henceforth referred to as ‘the vicious cycle’) (Morita 1998). Toraware (mental preoccupation with symptoms) is characterized by: attentional fixation on symptoms, resulting in rumination and sensitivity to symptoms and perpetuating a cycle of increased distress and fixation (Morita 1998; Ogawa 2013); and the contradiction between ideal and real: a perceived discrepancy between how things should be and how they are (expressed in a perfectionist, unrealistic, judgemental, and dogmatic worldview and/or self-image), which leads to a conditional acceptance of experiences, the self, and the world, and to the labelling of thoughts and emotions as positive or negative, rather than experiencing them only as they are (Kora 1995; Minami 2013).
Hakarai encapsulates futile attempts to control or remove these otherwise natural experiences, which maintain attention on and further aggravate them, impeding the mind and body’s capacity to dissipate them according to their natural course (Minami 2013). These efforts may be made cognitively, such as wilful attempts to suppress emotion, or behaviourally, such as activities undertaken to escape emotion (Nakamura et al., 2010).
The overarching objective of Morita Therapy is to cultivate arugamama by removing the distortion of this attitude caused by the vicious cycle (Fujita 1986; Morita 1998; Nakamura et al. 2010). The process is also intended to restore, and foreground attention on, desire for life: through building tolerance and acceptance of suffering, patients shift from being directed by this to being directed by the desires underlying it, re-channelling their energy into purposeful action which fulfils such desires (Fujita 1986; Reynolds 1976). Patients’ conduct therefore becomes dictated by external reality rather than internal states; patients move from being self-oriented to being reality-oriented (Kora 1995; Krech 2014).
When patients reduce engagement in the vicious cycle and shift attention to everyday life, symptoms naturally reduce as a by-product of more meaningful and constructive living (Kora 1995; Nakamura et al. 2010; Ogawa 2013). However, the purpose of Morita Therapy is not to eliminate suffering or symptoms: given Morita’s mechanisms of psychopathology, such attempts are counter-productive (Minami 2013). Thus, in contrast to Cognitive Behavioural Therapy (CBT) (Beck 2011) and Behavioural Activation (BA) (Lewinsohn et al. 1976), Morita Therapy does not seek to reduce symptoms through imparting techniques or modifying thought and/or behavioural patterns. Indeed, whilst other approaches all intervene in the experience of symptoms in some form (challenging thoughts; scheduling activities; meditation; cognitive reappraisal), the Morita Therapy method is specifically non-intervention in symptoms (or nature) (Minami 2013). Any attempts to intervene are considered part of the vicious cycle (‘Hakarai’) (Minami 2013), thus differentiating Morita’s vicious cycle from comparable conceptualisations in other treatments.
Overall, Morita therapists help patients to re-establish contact with nature, cultivating an allowance of their own authentic human nature with its natural ebb and flow of emotion. More specifically, therapists facilitate patients’ understanding of the vicious cycle, capacity to be with symptoms, and engagement in purposeful action (Minami 2013).
Illustrating their non-interventional stance, therapists implement Fumon (selective non-response, or strategic inattention) in response to patients’ expression of complaints, to shift patients’ attention away from symptoms and towards purposeful action (Nakamura et al. 2010). Thus, therapists do not dwell on patients’ symptoms, nor attempt to elucidate reasons for suffering, beyond stressing the naturalness of all emotions, explaining how the vicious cycle operates for the individual, and highlighting specific desires underlying fears (Nakamura et al. 2010; Ogawa 2013). Nonetheless, in outpatient treatment therapists do initially enquire into a patient’s symptoms sufficiently to elicit how they engage in the vicious cycle; for example, therapists may respond to a patient’s description of experiencing symptoms by asking where their attention is at that time (to ascertain attentional fixation) and what they do at such times (to ascertain ‘Hakarai’) (Nakamura et al. 2010).
Traditionally, Morita Therapy begins with bed rest, taking a restorative approach to allow natural healing (Kitanishi 2005; Minami 2013; Morita 1998). Thus, therapists ask patients to ‘be with’ unpleasant thoughts and emotions without attempting to fight or control them, for anything between multiple thirty minute periods (in some outpatient settings) to approximately 1 week (inpatient settings) (LeVine 1993; Morita 1998).
By thus eliminating external stimuli and the need to confront suffering, the vicious cycle is thought to be broken: patients experience the ebb and flow of thoughts and emotions running their natural course (Fujita 1986; Kora 1995; Morita 1998). Paradoxically, rest is understood to begin the process of diminishing self-centredness with increased self-focus: patients eventually reach a state of ennui and begin to redirect their attention from introversion (self-preoccupation and fixation on symptoms) to extroversion (ecological awareness and purposeful behaviour) (LeVine 1993; Morita 1998; Ogawa 2013; Reynolds 1976). Accordingly, the patient’s spontaneous desire to do, motivated by desire for life, is heightened, at which stage patients move onto action-taking (Kora 1995; Morita 1998).
Following rest, therapists facilitate patients’ movement through three stages of action-taking: (1) light monotonous activities; (2) purposeful activities; (3) social reintegration (Morita 1998; Ogawa 2013). Over the stages, patients’ spontaneity and engagement with others, objects, and nature are increased (LeVine 1998). Patients move onto the next stage according to their readiness to undertake more demanding activities, engagement in nature and action versus engagement in the vicious cycle, and awareness of the natural ebb and flow of thoughts and emotions (Minami 2013; Morita 1998).
Stage one involves light repetitive tasks (usually using the hands) which absorb patients’ attention, engage their senses, stimulate their desire for life, and engage them in nature where possible (Minami 2013; Morita 1998). For example, patients may engage in knitting, tending to pets, and light gardening. Stage two involves purposeful and necessary tasks which are more challenging and practical (using whole body movements), cultivating patients’ capacity to undertake such activities in the presence of symptoms (‘anxious action-taking’) (Minami 2013; Morita 1998). The nature of these activities depends on what is required of patients in their environment, and may include cleaning, larger gardening projects and more strenuous exercise. Stage three involves applying Morita Therapy principles to more social tasks and larger life events, and may involve resuming or changing employment, or re-establishing interpersonal relationships (Minami 2013; Morita 1998).
In facilitating action-taking, therapists encourage patients to follow their curiosity and desires, and “ ‘jump into doing’ what is immediate and necessary” within their environment (Ogawa 2013) (p.64). In contrast to BA and CBT, whilst therapists can collaboratively identify tasks with patients which fulfil the criteria for each stage, they are not directive in activity scheduling and/or prior goal discrimination. Instead, action-taking comes about naturally and spontaneously through the inherent purposefulness of desire for life: patients are driven by self-actualising desires and tackling necessary tasks in the moment, rather than their tolerance built up through habituation and/or meeting pre-determined goals (which are avoided in Morita Therapy) (Ogawa 2007). Furthermore, the success of action-taking is not assessed in terms of its impact on symptoms: living a purposeful life in spite of symptoms is the success (Fujita 1986). Thus, action-taking is not a means to an end, but is the end itself.
Through immersion in action and shifting of attention to the external environment, patients continue to experience how thoughts and emotions naturally ebb and flow if left alone (Fujita 1986). Indeed, it is understood that patients’ attentional fixation on their symptoms is dissipated (Morita 1998) and they move beyond conscious processing of the self: they “forget anxious thoughts and feelings and become one with action” (Ishiyama 1986) (p.379). Morita Therapy thus minimises the subjective self, inducing a ‘mindless’ state in which one is fully absorbed in the present moment (Morita 1998; Ogawa 2013). This contrasts mindfulness-based approaches, which may be seen to magnify the subjective self: increasing self-awareness in order to shift subjective experiences (potentially increasing self-focus and a fixation on emotional experience from the Morita Therapy perspective).
During therapy, patients complete daily diary entries about their experiences of the day, on which therapists comment (Kora 1995; LeVine 1998). In their comments, as in outpatient therapy sessions, therapists recognise patients’ symptoms as natural experiences (often using natural world metaphors, such as comparing the uncontrollable nature of fluctuations in mood to those in the weather); point out attempts to fight or control inevitable emotions, and contradictions between ideal and real; reframe unpleasant thoughts and emotions as desires; and reinforce patients’ awareness of the external environment, and engagement in action and nature (Minami 2013; Nakamura et al. 2010). Therapists maintain the Fumon stance and thus, unlike in a typical BA or CBT diary, do not analyse the links between action and symptoms, nor the impact of action on mood. For example, a therapist may respond to a patient’s description of going for a walk outside and resulting improvement in mood with the following comments: “You have engaged in purposeful activity and picked up on the natural ebb and flow of emotions here. What did you notice outside?”.
The aim of Morita Therapy is not for patients to receive persuasive counselling, but to incorporate persuasive experiences, which are considered to bring a deeper level of insight than intellectual learning (LeVine 1993; Morita 1998; Ogawa 2013). Whilst approaches which emphasize specific techniques and rational understanding of emotions may be seen to intellectualize emotions, Morita Therapy thus de-intellectualizes emotions, holding that it is the very application of the intellect to emotions which perpetuates the vicious cycle through misinterpretation and over-analysis (Iwata 2019).
Through a process akin to experiential re-education, Morita Therapy patients organically discover the transient nature of emotions, and their ability to tolerate them (Fujita 1986; Morita 1998). As such, they develop intuitive, empirically-based, and embodied understandings of natural rhythms, and the futility of resisting them: “the quality of non-resistance” (Krech 2014) (p. 39). They thus move towards arugamama; a state in which patients accept and live in harmony with nature, including their authentic human nature.
Thus, although other approaches such as Mindfulness-Based Cognitive Therapy (MBCT) (Segal et al. 2002) and Acceptance and Commitment Therapy (ACT) (Hayes et al. 1999) also cultivate acceptance, by combining mindfulness with Cognitive Therapy (MBCT) or following a linear process (ACT), the nature of ‘acceptance’ differs. In Morita Therapy, acceptance has a uniquely active, spontaneous, and paradoxical quality: it cannot be brought about through cognitively reappraising symptoms, only through direct behavioural experience and bodily engagement with nature (Fujita 1986; Morita 1998; Ogawa 2013; Watts 1961).
Morita Therapy is thus qualitatively different to established Western approaches. Whilst other approaches may appear comparable in aim (e.g. acceptance) and certain processes (e.g. action-taking), they miss the phenomenological essence of Morita Therapy: a reorientation in nature through behavioural experience alone, and with that an embodied (de-intellectualized) acceptance of thoughts and emotions as natural phenomena (Tseng 2005).