Act anyway#
Week 8. Two traditions that each reject half of what this course has told you.
So far we have assumed two things#
The work happens in your head. And you do it alone.
Before the theory#
You are anxious about starting something. In one line, what do you try to do first?
Almost every answer is a version of the same move. Challenge the thought. Reframe it. Relax. Breathe. Get the anxiety down, and then begin.
Morita disagreed, in 1920#
Shoma Morita (1874–1938) developed his approach in Japan around 1920, for a condition he called shinkeishitsu. Roughly, a nervous and self-scrutinising disposition.
His position was that unpleasant feelings are natural features of having emotions, not malfunctions to be removed. Trying to eliminate them is futile, and it is the thing that keeps you fixated on them.
Accept the feeling as weather. Do what needs doing#
The classical treatment#
| Stage | What it involved |
|---|---|
| 1 | Absolute bed rest, no reading, no talking, no distraction |
| 2 | Light, monotonous work |
| 3 | Heavier, more demanding work |
| 4 | Return to social life and ordinary activity |
Look at stages 1 and 2, then look back at the empty slot.
A parallel, and a warning about it#
A century before anyone measured incubation during undemanding tasks, Morita was prescribing enforced emptiness followed by light monotonous work.
That parallel is mine and it is not evidence of anything. Two traditions arriving at similar practice is interesting, not confirmatory.
The evidence, honestly#
Sugg, Richards and Frost ran a pilot randomised trial of Morita therapy in the UK (2018, BMJ Open). 60 participants, Morita plus usual care against usual care alone.
Enough promise to justify going further. The authors calculated that a full trial would need around 133 people per arm.
A promising pilot, not an established treatment.
Do not let a hundred-year pedigree do the work that data should#
Now the second tradition#
Almost no psychiatrists, for a very large population.
Design the intervention. You have thirty seconds, and you cannot invent clinicians.
The Friendship Bench#
Dixon Chibanda and colleagues (2016, JAMA) trained lay health workers, in practice grandmothers, to deliver six sessions of problem-solving therapy.
Wooden benches outside primary care clinics, in Shona, in local idiom rather than translated clinical language.
Randomised by clinic. Substantially greater reductions in depression and anxiety than usual care, still there at six months.
Three things worth more than the effect size#
- Built for its context, not imported into it. The design started from who was available and what language people actually spiral in.
- The mechanism is another person. Not a technique you apply to yourself.
- It is a bench, outdoors. Zimbabwe put it outside because that is where people would sit down and talk.
What this does to our argument#
The course has treated overthinking as a private mechanical problem with a private mechanical fix.
Morita says the fix is not mechanical. The bench says it is not private.
Neither is in the course’s central claim, and both have at least as much support as it does.
Discussion#
- Morita would say this course’s noticing exercises risk making you more fixated on your own mental states. Is that fair?
- “Act anyway” and “you can always pass” are not obviously compatible. Where is the line?
- If another person is the active ingredient, what is the honest version of advice for someone who does not have that person?