Hospital-based Naikan therapy for patients with schizophrenia.

Kouhei Ohta MD. Ph.D. Sapporo Ohta Hospital

1st International Congress of Naikan Therapy (2003.10.10〜12)

Hospital-based Naikan therapy (HBNT) is an in-hospital medical service developed in our hospital over the last 30 years. In the system doctors and staff cooperate and can adapt to changes in the patients condition making it suitable for patients with severe psychological symptoms such as schizophrenics.

I. The differences between HBNT and conventional Naikan method.
    1. HBNT pathways include clear schedules and staff assignments. Most of the doctors and staff have experienced Naikan.
    2. Full patient records are kept and include dates, room number, theme of Naikan, the patient's responses and condition, and emotional expressions by the patient.
    3. Medical staff must be flexible and affirmative for patients who lack insight into their disease and eventually be able to cope with psychotic patients.
II. HBNT suggest to us schizophrenic symptoms and consist of accumulating complex and multiple posttraumatic stress disorders (PTSD) of the following four groups.
Traumas 1: occurring during childhood prior to disease onset.
Traumas 2: caused by symptoms and disease onset.
Traumas 3: caused by inappropriate acute psychiatric intervention.
Traumas 4: caused by inappropriate sub-acute and chronic medical care.

Reality testing including HBNT effectively cures each PTSD.

III. A case of adolescent non-school attendance with auditory hallucination.
    1. History: She was an ordinary student. In the eighth grade, she was rebuked by her teacher for playing on the roof of a building. She developed depression and insomnia and attended a psychiatric hospital and was diagnosed as having an anxiety disorder, but failed to respond to medications. She was discussing her problems with a friend who shared the discussion with other classmates. Thereafter, she dropped out of school and developed self-injury behavior and some psychotic symptoms
    2. Hospitalization: She related that her schoolteacher told her she did not need to attend school and should have died with the first interview. When small, a stranger tried to abduct her. Now, recalling that event she is frightened of all men, including her father, and is unable to use public transport. She sometimes cuts her wrists unconsciously. She had already attended two other hospitals with auditory hallucinations and possible psychotic symptoms tending to worsen.
    3. HBNT: From the first day, she showed obvious emotion as she tearfully recollected what she had received from her mother. Mostly female therapists interviewed her and encouraged her by praising her efforts in HBNT. She stated that she was absent from school "because I just didn't want to wake up or little things like that". She underwent familial Naikan with her parents. Her mother apologized to her because she had not praised her enough and her father apologized for his stubbornness. She and her parents met the school principle and indicated she would return to school. After attending school for three days from the hospital, she was discharged after a total hospitalization of eighteen days.
    4. Discussion: Factors in her school truancy were the rebuke by the teacher and her friends ridicule. These may have triggered her delusion of persecution, auditory hallucinations, and depression eventually leading to social withdrawal and self-injury.
HBNT demonstrates that formation and development of both healthy and pathological cognition really resembles the structure of Fractals and Self-Similar. We deeply sympathize with Mandala and sandplay technique studied by C.G.Jung (1875-1961)

I appreciate the English language consultation provided by professor Peter M Olley.