||January 8th-23rd, 2010
■Friday; January 8th, 2010: left BKK at 23:00
I thought to myself, what and why I am doing this, took off for 2 weeks to see something I felt connected with.
■Saturday; January 9th, 2010
Arrive at Narita Airport, terminal one at 6:45 am. We took JR Narita Express train directly to Shinjuku station, Y3470 each person. We got off at Shinjuku station and tried to find Keio line train. We were off the way for about 30 mins, but finally found out the Keio line station. We took a semi-express train to Chofu. We got off at Chofu and got on a taxi to Jikei Dansan Hospital, around 11:00 am. Dr.Rieko Shioji picked us up at the inf. desk and took us to the Morita center, showed us around the campus and took us to Shirakaba dormitory. Dr.Kei Nakamura, the Director of the Center for Morita Therapy, took us for lunch at the cafeteria with Rieko. A bowl of noodle costed Y360, however it tasted and smelled pretty good. We got some rest at the dorm and got out back to Shinjuku around 4 pm. We got back to the dorm around 10 pm. Dipping in an onsen at the dorm was really refreshing and good for the leg strain. We supposed to see Dr. Nakamura at 1 pm tomorrow to join the univ. martial club New Year ceremony. The dorm has a kitchen and free laundry.
■Monday; January 11th, 2010
National Holiday to celebrate becoming 20 years old! Hospital is closed. We took a train to Kamakura, Y1970 round trip, around 1 hr by train from Shinjuku. Kamakura used to be a capital of ancient Japan, so there were many old temples. We visited Zen temple of Kenjoji,..., Daibutsu(big Buddha), Hasedera(thousand hands Kanon) and the ....shrines. Got back to the dorm around 8pm, went right in the onsen.
■Tuesday; January 12th, 2010
We started visiting Morita center at 9am. We met Dr.Nakamura briefly, then Yuko(clinical psychologist) gave us an introduction to Morita therapy.
Morita therapy(MT) developed around 1920 by Shoma Morita, MD to treat shinkeishitsu; anxiety disorders(social phobia, ocd, panic, agoraphobia, GAD, somatoform d/o and later depression). Its concept is when there is an anxiety; there is a desire for leading a good life behind it. For example, a teacher who was tremoring and blushing in front of students. If she does not have a desire to be a good teacher, she would not care about her performance. However, once she had an anxiety, she became obsessive with the symptoms to the point that she too preoccupied with her symptoms more to what should do it life normally. The more she desired to do good, the more she became anxious. In MT, removal of symptom is not the goal, but to change in attitude and accepting them, and goes on with routine daily life. The therapist said to the pt `` You are not weak, but you have a strong wish to be good``. The concept is to help the pt to be able to know what they want and direct their lives according to their wishes. ``MT gives time and space, but not direction, for the patient``. Taijin-kyofu-sho (anthrophobia: phobia of interpersonal relationship) responded pretty well to MT.
Classical MT started with 3-4 months residential admission: 1st absolute bed rest for a week, 2nd light work period, 3rd regular work , and 4th preparing to go home. I shall give you some example, after a week of bed rest usually pt will become bored to death and want to do something. MT said that boredom is healthy, because it shows that patient still have a motivation to do things, otherwise he will not get bored!!!! Very humanistic, indeed. Seemed to me that here they focus more with pt`s life than just a symptom approach, pretty holistic approach.
Yuko took us around the hospital, a university hospital. There are 10 psychiatrists in the dept. The inpatient unit is a 20-bed unit. The pictures of unit staff are including Ben, Maru and Coro, 3 dogs and a rabbit. Three main inpatient groups were 1. Plant group, 2. Animal group, and 3.Daily life group. Patients grow a kitchen garden and learn to take care of plants, look after animals, and maintain their routine daily chores. The outpatient unit is small with about 10 rooms. Overall, the ward looks very home-like, the outpatient unit looks easy going. We watched a MT VDO in the afternoon and played ping pong with the pts in the unit in the evening.
We went to OK store to buy something to cook. We made rice, fried been sprout, and raw octopus as our dinner. Sea food here is pretty cheap. Of course I went into the onsen at the dorm for an hour to heat up my right feet. It seems to help with my plantar fasciitis.
■Wednesday; January 13th, 2010
Dr.Tateno gave us a private lecture in applying MT for OCD. I learned some new words aphephobia: fear of touching, atelophobia: fear of imperfection. He presented a case of a publishing manager who irresistibly compulsive checking the author`s name of the book he about to printed out. OK, the good desire behind is to make a perfect, faultless book. He used to make a mistake, we all do, MT said. MT encourage him to keep doing the work not quitting, ``Let recall the experience that you let your anxiety drain away, leaving it as it is, and keep on create a new book.`` To accept anxiety as it is, and examine what he wants in life: he want to be a good publisher, so print a book then, why worry!!!!
We went to a pt group meeting in the unit. The patient reported about plants, animal, and their routine. Every night before going to bed every patient has to write a diary. Not focus only on symptom, but their life as a whole in a day!
We attended a staff meeting for 2 hours in the afternoon.
We cooked rice, fried fish, fried veg. We did the laundry. Again 1.5 hours in an onsen
■Thursday; January 14th, 2010
We got two private lectures in the morning, Applying MT to Panic and GAD by Dr.Yano, and Applying MT to SAD by Dr. Shioji. We learned more about the Taijin Kyofu-sho (phobia for interpersonal relationship). Couple of new terms; jiko-shu-kyofu: afraid of other smell one’s body odor, kaishoku-kyofu: afraid to eat with others (one patient of mine in Thailand had this symptom). The main concept is the patients believe that particular sensation or emotion is an evidence of a morbid abnormality, then they try to resist that feeling, so it keeps coming back(sounds like obsessional thought but in the social performing context. We learned from 2 cases of patients of SAD, the conclusion of the case was for her to accept her weakness and unacceptable emotion and finally change to attitude of accepting her symptoms. At the end the patient was angry toward the absence of her therapist without informing her, I love the interpretation; “her anger was an expression of her desire to rely on the therapist, although this was an emotion she had forbid herself. Her reluctance to reveal her weaknesses developed into social phobia or fear of shame in front of others”. Lovely, and very humanistic interpretation, this won my heart!! Seeing the good desire behind her symptoms.
We watched another VDO; Tokiwadai. It’s about MT treatment in another hospital, very home-based kind of therapy. We had an hour discussion with Dr.Tateno in the afternoon. He is very kind and very patient to explain and gave us some practical points about MT.
■Friday; January 15th, 2010
We got off with free hours in the morning. We watched a VDO on `Hakkenkai`: a MT group support run by patients. In the evening, we got 2 lectures from Drs.Kawakami and Tanii regarding the use of medication in MT. They now pretty much combine psychopharm and MT. They like to use Abilify(6&12mg) for OCD here.
■Sat and Sun; January 16th and 17th, 2010
We went to Hakone area for the weekend. It`s about 1.5 hours away from Tokyo by train. The train system here is very well structured and regimental. It’s too easy to navigate. We do not really have to ask anybody to go around in Japan. On the train, there is LCD screen tell you where is the next Station, of course, in English. We went to onsens in Hakone, seeing Mt.Fuji and the Ashi lake. The bus and local train system in Hakone are as good as in Tokyo. It snowed for an inch on Saturday. Hakone is a mountainous area. We went to see the hot spring for black egg at Owakudani. We stayed in Ryokan at night. We got back to Tokyo around20:30. I was tired and felt down a little bit. We had to present ppt in the staff meeting tomorrow regarding the Dept of Psychiatry Siriraj Hosp.
■Monday; January 18th, 2010
I started off with OPD with Dr.Nakamura. He started at 8 and finished at 13:30. The patients are very gentle and respectful to the doctor. They bowed before they sat down, stepped back and bowed before leaving the room, especially older patients were very well-manner. Dr.Nakamura were very kind, he tried to explain every case briefly to me. After the clinic, he took me for lunch at the cafeteria.
14:30 -16:00 meeting with patients. The patients gave a weekly report regarding the animal, plant, and daily life groups.
We gave a presentation of our dept at 16:00 with around 12 staff here. They asked us some questions and were very impressed with the well structure of both our undergrad and postgrad system.
In the evening I went off by myself to Jiyuguoka area. Walk alone in an artistic well design area made me feel much better. Here is not downtown, so there were not as many people. A lot of homemade bakery stores, housing-furniture stores (very cute and artistic). I felt like I was in Montmartre in France. Very cute, it made me feel better about Tokyo. I always feel uncomfortable with materialistic, shopping oriented kind of big city.
■Tuesday; January 19th, 2010
We joined the patients for work. We helped them in the animal group. They cleaned pigeons cages, made food for 12 pigeons, gave medicine to the sick pigeons. Took dogs for a walk, made food for rabbit. One of the dogs had an end stage liver problem and close to die, he is 12 y/o. Junji, an intern, told us that he and the patients felt very sad. He saw the dog since was a medical student here.
We had another lecture in applying MT to depressive patient. They saw depressive pts that they had too good desire for life, so they had struggles in life. They emphasized the concept of arugamara(being oneself as he is), and yojo(recovery). ``Do what should be done, irrespective of your mood. However accept your feeling and to things appropriate for the condition`` Arugamara!!!
In the evening we went to Kichijoji, the residential area for new generation of Tokyo. It felt more like live here than in Tokyo. Art shops, music on the street, bakery stores. Very lively, indeed. Not that far from where we stay, Kokuryo, just 30 mins by train. The interns at the dorm told me that Kichijoji and Jiyugaoka are where rich people stay in Tokyo. That`s why it looked very lively, but very down to earth though.
■Wednesday; January 20th, 2010
I had free morning. I wrote some more of my drug school survey article. Torr had an OPD with Dr.Nakamura. We had lunch together and attended a staff meeting.
■Thursday; January 21st, 2010
We joined the plant group with the patients in the morning. We went out and helped the patients in the garden. It’s nice to see how each patient managed to work and interacted in group. Junji helped us with English explanation.
We had a discussion hour with Dr.Tateno in the afternoon. We went to Akiba to have dinner with Hiro and Luke. We stopped by Shibuya to have a “Lost in Translation” moment in the crowd. We had Korean style BBQ. Talking with Hiro and Luke made me feel a whole lot better at working at Siriraj. They seemed to very understanding the workload, the obstacle and the burden of doing research in the University Hospital. I told them regarding my early retirement plan that I bought a piece of land next to the beach in southern Thailand. May be it just for my security of be able to escape if I want to!!! The dinner was good. They seemed to be drained from a long work. Luke dropped us at the Shinjuku station, very kind of him.
■Friday; January 22nd, 2010
Here come, the last day. We stopped by to say bye to everyone at MT center. Time does fly, 2 weeks. I am kind homesick a little bit. We had a farewell session with Dr. Nakamura in the afternoon. I like his style and manner a lot. He looked very kind and gentle.
We went to buy some sweets and things for our friends and family from the OK and Ito. We went to Shimokitazawa in the evening. I prefer Jiyuguoka to Shimo. A lot of CD stores there though.
■Saturday; January 23rd, 2010
I went back home from KIX. The flight back to Bangkok took 6 hours. Being away for 2 weeks, made me look back at living in Bangkok differently. Well, I am glad I went to Jikei Hospital. I think it was somehow untraditional for staff to leave for 2 weeks to visit other hospitals, well why I have to do the same as others, be myself. Knowing one own self is probably the most precious thing I can think of. I am glad that Kristipong went with me. There are a lot more to learn and see on this beautiful planet. We both agreed the thing we most impressed on this trip is the staff at the Jikei Hospital. Their hospitality, their kindness, their friendliness are very uplifting.
||Nantawat Sitdhiraksa, MD
February 4th, 2010