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Special Lecture
1st International Congress of Naikan Therapy (2003.10.10～12)

At the Sapporo Ohta hospital we have used Naikan therapy systematically for the last twenty-eight years with successful outcomes in patients with personality disorders or alcohol dependence.
With experience, we have modified our approaches to allow flexible induction into Naikan Therapy and its application to a wide range of disorders and symptoms with effective methods to reduce the resistance of patients to Naikan Therapy induction and its continuation.
In-Hospital Naikan Therapy (IHNT)has evolved based on long experience and data collection should be such that an independent review body can fairly judge the outcomes
The ten points that distinguish In-Hospital Naikan Therapy from usual Naikan therapy.

1. IHNT requires consideration of the ethics of medicine and of labor standards in hospitals and organizations
2. Treatment is provided by a team that includes doctors, nurses, and psychologists, who have themselves experienced Naikan.
3. IHNT has a clear therapeutic plan (Ten step methods) with adequate trained staff to support the patients.
4. Provision of a trained Naikan faculty and several "Naikan"rooms that can be used for different symptoms and disorders.
5. Close observation during Naikan therapy with protection for the patients and a flexible treatment plan capable of change when the patient's condition changes.
6. Accurate treatment progress notes including, staff names, times, room number, the answers to the three questions, occurrence of emotional changes, unexpected changes are recorded.
7. Records of any resistance to Naikan and to induction of Naikan therapy. How the staff dealt with the resistance.
8. Documentation of the seven days of therapy with summaries for medical conferences and statistics.
9. Ability to administer Naikan Therapy to patients with schizophrenia and records of its impact on symptoms.
10. Guidance through daily Naikan for the patient's family, and family Naikan Therapy in Naikan rooms at the end of the seven days.

In-hospital Naikan therapy suggest to us the twelve traumas as therapeutic targets of Schizophrenia

1.External stress and traumas occurring during childhood, prior to the disease onset, and their own internal
stress and traumas. These include
(1) Background trauma: parent's divorce, attempted suicide, death or separation, abuse by the patients, PTSD, alcohol dependence-abuse, school transfer, bullying, and family conflict.
(2) Occasional trauma: personality type before disease onset, coping skills with conflicts with and upsets which may trigger disease, such as examination failure､　broken heart , unemployment, or social withdrawal.
2. Disorders caused by symptoms and the onset of disease. Personal stress and traumas.

(3) Primary trauma: The shock and stress due to disease onset and adverse reaction to delusions and hallucinations.
(4) Secondary trauma: Adverse effects of isolation at work, school, from friends and family caused by bizarre behavior due to delusions and hallucinations.
(5) Tertiary trauma: Development of despair, depression, dishonest behavior, anger and doubt caused by the conflict between acceptance and denial of the disease.
3. Traumas and disorders caused by inappropriate acute psychiatric intervention.

(6) Fourth trauma: Reaction to medical consultation, hospitalization, along with injury to pride and self-denial.
(7) Fifth trauma: Anxiety and shock caused by lack of understanding from families, doctors, and nurses.
(8) Sixth trauma: Anxiety stemming from lack of information on discharge from hospital and absence of a follow up care plan.
4. Traumas caused by chronic and sub-acute medical care.

(9) Seventh trauma: Bullying during hospitalization and inadequate out patient clinic or day care.
(10) Eighth trauma: Adverse reactions to medication such as Parkinsons' disease like symptoms, impotence, and excessive weight gain.
(11) Ninth trauma: Post-onset problems such as prolonged absence from school, leaving school, unemployment or job loss, and social isolation.
(12) Tenth trauma: Anxiety around attending hospital, financial hardships and fear of relapse.
Unfortunately a few patients abandon all hope of recovery, despair, and withdraw from society. Many become uncontrollably angry because of their inability to cope with their symptoms which are pervasive, complex and often multiple. While medication may be effective, the high doses and multiplicity of drugs often causes side-effects of a serious nature.

We appreciate the English language consultation provided by professor Peter M Olley