[On the "folkloric" psychotherapy to schizophrenic patients--based on phenomenological study].
Psychotherapeutic treatment of schizophrenia is generally considered difficult. One reason for this is that the doctor and patient can easily fall into a relationship of conflict with each other concerning the propriety of "judgments which are morbidly and mistakenly made (K. Jaspers)", referred to as delusions. We carried out close phenomenological structure-analyses of the delusions and of patients' fundamental experiences, based on the premise that a patient with delusions probably has some actual grounding for these in the patient's own concepts, considering the fact that the patient firmly believes these delusions. As a result, we have clarified the following matters from the primary experience of delusions. 1) We found that patients are in a conflicted mental condition which can be considered a collapse of adaptability to "Seken". 2) In this condition of conflict, patients feel guilt relative to "Seken" or feel that they are indebted and should be punished. When patients complained of their primary experience, we were able to persuade them to reserve their judgment of their primary experience, by 3) having each patient listen to the folktale "Torikuyou" in which the "logic of stealing" and the "logic of being stolen", appear in a reciprocal relationship relative to the constitution of crime and punishment, by 4) explaining to each patient about the ambiguity and reciprocity of reality experienced, 5) instead of disputing the propriety of patient's judgment about primary experience, doctor and patient worked together to enable the patient to form a positive understanding of the primary experience. 6) We reduced the patient's psychological conflict relative to primary experience, and were able to defuse and distance the patient's delusions caused by erroneous judgment of primary experience. 7) Regarding the area in which this type of psychotherapeutic approach shows efficacy, we analyzed the concept of "Seken" as a world which can cause conflicts relative to primary experiences. 8) We also analyzed "Giri" as a norm of "Seken" from which patients misconceive that they have deviated, in addition, 9) from the viewpoints of anthropology and cultural anthropology, we analyzed the bases for "Kotowaza (proverbs)" and "Monogatari (folktale)" such as "Torikuyou", which themselves can show psychotherapeutic efficacy. We consider that the psychotherapeutic approach has previously been developed around the concepts of the "individual" and "society", but we made our psychotherapeutic approach from the concept of "Seken" (yononaka = hito: person) that is a structure with deep strata of tradition and culture in Japan, and have reported its concrete development through the presentation of 3 typical cases of schizophrenia with difficulty in adapting to society due to showing the delusion of persecution in their foreground.
Yamada
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T
Juntendo University School of Medicine, Department of Psychiatry.
Yamada
Y
Y
D005260:Female; D005495:Folklore; D006801:Humans; D007564:Japan; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012931:Social Environment