Two traditions that break this course's assumptions. A Japanese therapy that refuses to treat feelings as problems to solve, and a Zimbabwean intervention built on the idea that other people close your loops
26 April 2027
Where. Outdoors, venue posted by the Friday before. Opens with the ten-minute detox.
Everything so far has assumed the work happens in your head and that you do it alone. Today, two traditions that each reject one half of that. Both have real evidence, which is why they are a lecture rather than an aside.
Morita says stop waiting to feel better#
Shoma Morita (1874–1938) developed his approach in Japan around 1920, for a condition he called shinkeishitsu. Roughly, a nervous, self-scrutinising disposition that will sound extremely familiar to this room.
His central move is the one worth the lecture. Western approaches to anxiety overwhelmingly aim to reduce the unpleasant feeling. Challenge the thought, reframe it, relax, breathe, get the anxiety down, and then act. Morita’s position is that unpleasant feelings are natural features of having emotions, not malfunctions to be removed, and that trying to eliminate them is both futile and the thing that keeps you fixated on them. You accept the feeling as weather, and you do what needs doing regardless.
The classical treatment was residential and had four stages.
| 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 |
Notice stage 1 and stage 2 in particular, then look back at the empty slot and the sandwich. 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. But it is hard to un-notice.
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. It showed enough promise to justify going further, and the authors calculated that a full trial would need around 133 people per arm. So it is a promising pilot, not an established treatment. Do not let anyone tell you it is proven, and do not let the hundred-year pedigree do the work that data should.
What survives regardless of the trial results is the principle, which costs nothing to test on yourself. The next time you are waiting to feel calm enough to start, notice that you are waiting, and start anyway.
The Friendship Bench, where other people close your loops#
The strongest evidence on this syllabus for a culturally-rooted intervention comes from Zimbabwe.
Dixon Chibanda and colleagues (2016, JAMA) built a programme around a problem the country had in stark terms. Almost no psychiatrists for a very large population. So the intervention was designed from what was actually available. Lay health workers, in practice grandmothers, chosen for being trusted and rooted in their communities, were trained to deliver six sessions of problem-solving therapy, sitting on wooden benches outside primary care clinics, in Shona, using local idiom rather than translated clinical language.
The trial randomised by clinic and compared it against usual care. The bench groups showed substantially greater reductions in depression and anxiety symptoms, and the effect was still there at six months.
Three things about that are worth more than the effect size.
It was built for its context rather than imported into it. The design started from who was available and what language people actually spiral in. Compare that with a practice compressed into a graphic and exported, the subject of week 4.
The mechanism is another person. Not a technique you apply to yourself. Every effective exit in How you stopped involved ending something, and a startling number involved telling someone. The bench takes that seriously as the active ingredient rather than as scaffolding.
It is a bench, outdoors. This course holds its lectures outdoors on partly-decorative grounds and one Californian study. Zimbabwe put the intervention outside because that is where people would sit down and talk.
What this does to the course’s argument#
Both of today’s traditions poke a hole in the framing you have been given, and I would rather name the holes than paper over them.
The course has treated overthinking as a private mechanical problem with a private mechanical fix. Morita says the fix is not mechanical. You stop negotiating with the feeling and get on with your day. The Friendship Bench says it is not private. The loop closes when someone trusted is sitting next to you. Neither of those is in the course’s central claim, and both have at least as much support as it does.
Discussion#
- Morita would say most of 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?
- Both interventions today came out of severe resource constraints, no psychiatrists and no pharmacology. Does constraint produce better design, or do we just notice it more when it does?
Teaching team
- Idris Fenn, tutor