「死にたい」と訴える檀家に住職ができること

What kinds of activities can a priest do who has a suicidal person before him?

Jimonkoryu (寺門交流 Temple Exchange) September, 2006 pp 84-93

 What if a lay follower confided in you about fears of suicide? You can’t have nothing to say, and you can’t scold them. Speaking about Buddhism may also have the opposite effect. So what is an abbot to counter with? Let’s learn from activities by priests who have daily contact with the suicidal.

1. The experience of Rev. Yuzen Maeda – Conversational Therapist (精神対話士)

After a funeral, a coffin is about to be put into the pyre when the wife screams out to her dead husband in tears and tries to stop it from being put in the pyre. Meanwhile a small child stands by not knowing the reasons for father’s death. He had committed suicide.

Rev. Maeda recalls, “At the crematorium there is the experience of a strong shock and deep suffering. I know that the suffering of the person who commits suicide exerts incredible pain on the people close to them. I thought I don’t want to have that experience a second time.” Rev. Maeda Yuzen is the 35 year old abbot of Shosan-ji, a Soto Zen temple in Minato-ku, Tokyo.

This story is from last spring of a man who was 35. In the Autumn there was a woman in her mid 50s who committed suicide. These were two people he did funerals for over a period of months. He did not know them well. Maeda has been working to get a private license as a conversational therapist (精神対話士) for the past 5 years, listening to the words of people with anxiety. Regardless of his training, incidents of suicide still arise among his lay followers, so Maeda is not able to stop his regret. He says, “I thought of how I can make the temple more interesting and appealing. When I was thinking about trying to cut down on suicides and mourning families, I learned about the signature campaign.” (see last month’s issue on Lifelink’s signature campaign to develop government policies on suicide prevention).

Rev. Maeda quickly asked for the cooperation of other temples in his area and collected more than 700 signatures. At the same time, he came to some deep thinking about the suicide problem. He recounts, “At any temple, amongst the followers, there are bereaved families from 1 or 2 suicides. But no one talks about it. When I touched on the topic of suicide at another temple, people carefully begin to confide to me. I was surprised to see the great number of people around me who had committed suicide.”

2. A different measure to deal with the suicidal

“One can speak of suicide, but each person who gets stuck in anxiety is different.”

Priests who work on the problem of suicide are unanimous in the above sentiment. In short, there is a method of preventing anxiety for each person.

There are three stages in suicide prevention: 1) prevention, not letting the causes of suicide arise; 2) intervention, getting directly involved when things get dangerous; 3) postvention, taking care of the people left behind after a suicide.

In the last issue, we discussed how often regret occurs among the people left behind and before long they want to follow the person into suicide. In general, it is said that for a single person who commits or tries to commit suicide that at least 5 people nearby have wounds that aren’t healed. In this way, what can be done when followers directly confide their pain?

There is the basic precondition of needing to have the chance for regular contact. One can speak with someone who is clearly gloomy and not genki. One thing is to often create events at the temple. Further, there is the need for visiting followers who live alone, creating time for exchange with members who are not close, and continuing to show interest.

At this time, one must understand the various symptoms of a person who is suicidal (look at the chart on the following page). If there are many signs, there is a high chance of danger, but you also can’t be at all careless if there is only one sign.

When someone confides in you their anxiety, this could be simply one sign. You should simply listen carefully to your partner’s words. After taking in the situation, it’s possible there is a need to recommend receiving mental health treatment. In this case, you can make contact and check to see if the person is receiving their treatment smoothly.

3. The unforgettable response to a sign posted on the front gate

Rev. Maeda wanted to experiment with something. He put up a poster outside the front gate of his temple. In large print is written: “We will listen carefully to what you have to say 「あなたのお話しお聴きします」”; and then in small print below, it says: “Because although it may seem trivial to others, it is a serious problem for you.「他人には些細なことでもあなたにとっては重大な問題ですから。。。」”

He put up the poster 5 years ago and this is what he thinks: “I thought if I don’t show that I will listen to what people say even just through any form, no one will come to the temple even if they are waiting eagerly. So to show my thinking, the first thing I quickly did was to put up the poster.”

Then he received something unbelievable from nearby. When gathering for a memorial service with others monks from the same sect, another abbot rebuked him and said, “It is not natural for the temple to listen to the anxiety of people. Why did you deliberately put up that sign on your front gate?”

Rev. Maeda forgetting himself had this counter argument: “When I didn’t have that sign up, no one who needed counseling ever came. As soon as I put it up, such people increased. If you look at the reality, the poster and even more the putting up of it, of course there was a need to make the appeal “I will listen to you”. Isn’t there the perception that the gap between normal folk and us priests is deepening? In this case there not a single priest who can deny what Rev. Maeda’s saying.

The result of Rev. Maeda putting up his poster has been huge. One after another people who had no connection to the temple came to visit. At the busiest, more than 10 people per month visit. The core has been people who work in a 2 km radius of the temple.

“It is said that the temple gate (sanmon) is built as a wall to keep regular people out. But I feel that if they understand that they “will be listened to carefully”, many people will come to the temple.”

Rev. Maeda has counseled about 30 suicidal people so far. He has also made preparations to receive people any time with a 24 hour phone service. One time a phone call came in the middle of the night by a person in a fix who said, “I’m gonna kill myself now.” Maeda devoted then next two hours to intimately listening to him. The result, by remaining in intimate contact, was that by the next morning he came to express his thanks at the temple.

4. What are the qualifications for becoming a conversational therapist (精神対話士)?

However, there is a sense that Rev. Maeda needs something to guide himself in these activities. He is in the process of obtaining certification as a conversational therapist from the Mental Care Association. A conversational therapist works to support a person facing anxiety to regain their life power through continual listening. This is different from mental medical care or clinical psychology.

The Mental Care Association (メンタルケア協会) in Minato-ku, Tokyo was created in 1993 as a private organization of doctors from Keio University Medical Faculty. Nationwide there are more than 600 of these therapists. Besides doctors and nurses, there are also teachers.

In order to get certified, you have to take 15 lectures in basic curriculum and 7 practice curriculum sessions and also submit two papers. Then you can be certified after an individual interview on your paper and a group interview. Not everyone can do this. The success rate for those getting national certification as clinical psychologists is about 70%, while for these conversational therapists, it’s 10-15%, quite tough.

The cost for studying is 25,000 yen/month. There are four periods for counseling with one time running about 80 minutes. The honorarium for one time is 4,000 to 6,250 yen. In counseling two people you can make about 30,000 yen a month. Amidst the many demands of getting qualified, Rev. Maeda is also counseling a a man who is a “shut-in” (hikikomori).

Rev. Maeda explains his role this way: “For example, in dealing with a schizophrenic, there is no manual for how to use this method or this medication. Personally, I have to take his personality and make friends with his conflict. I also must show to him that I will remain close for anything he needs. You have to be on the lookout for any arising of the loss of security between two people. If there is not this security, whatever treatment you do will have no meaning. I think this making connection with people is the most important skill. “

Of course to become a conversational therapist, you need to have basic studies in psychology, and human and family theory. As well as this learned knowledge, he says the most important this is to be determined to create intimacy. “For a person who is in the life crisis of whether to live or die, they will perceive, ‘What does this person think of me?’” This is the true for the chronically anxious and those holding lots of suffering. People’s emotions have become very sensitive. In this case, there can be insight into how to really end one’s own suffering. Therefore you need to be determined. If you need to know about techniques and medications as well, you have to study really hard. While holding some uncertainty, it’s important to communicate intimacy to the person.”

5. The practice of Abbot Toshihide Hakamata – Education Chairperson

Akita Prefecture holds the dishonorable distinction of having the highest suicide rate in the country for 11 years running. For the last 10 years or more Abbot Toshihide Hakamata of (47) of Gesso-ji, a  Soto Zen temple in Fujisato-cho has been working on this problem. In the previous month’s article, we introduced Rev. Hakamata who has received a lot of attention in the media as the Educational Chairperson in this village where recently there was the well-publicized murder of two primary school students by a deranged mother.

Rev. Hakamata first had the chance to get involved in this issue in 1992 from the vihara activities of his own same sect. Vihara (which means “temple” in Sanskrit) is a Buddhist basis for providing facilities for palliative care in Japan. “I first learned about the present situation of suicide in Akita from a seminar held at the Akita University Department of Medicine’s Forensic Medicine Classroom at which Prof. Naofumi Yoshioka spoke. In 1995, I again started to study the issue after participating in a meeting chaired by Prof. Yoshioka called “Thinking about Depression in Akita”.

So in 2000 he organized a meeting called “Thinking about Our Hearts and Lives” at which twenty-eight people attended, including monks of his own denomination, housewives, health professionals and public health officials, and members of the social welfare organization and district welfare officers. At this meeting, public health officials from all over the area gave lectures on health but also learned from listening to local residents. Rev. Hakamata has been part of this group that has held such meetings, lectures and activities in other cities and towns in the region.

He notes, “People who want to commit suicide at the time of doing so find themselves all alone. The power to stop this is needed from the community. Just from a small thing can come the chance of becoming anxious. As so we should give a hand when these small anxieties arise. Then, when you overcome some problem, you must experience some happiness you could have never imagined.”

6. The Wall of Privacy with Danka?

Rev. Hakamata has presided over the funerals of two lay members who committed suicide. “It’s sure that there is no temple that hasn’t had to do some funerals for suicides. In this way, Buddhists have a connection with the suicide problem. But it seems no one understands how to listen to the voices of the bereaved families. It’s difficult to get involved in people’s problems which are seen as individual ones especially suicide, because you are not supposed to invade the privacy of others.”

In this way, Rev. Hakamata developed one activity in his community in 2003 establishing a “salon” or cafe called Yottetamore. Renting facilities at the village city hall and holding meetings every Wednesday afternoon, the purpose has been to provide a place where anyone can freely get together to talk. In this way, Rev. Hakamata has taken the first measure to reduce suicide and connect it to the rebirth of community. He says, “Whoever comes here will find someone who will listen to them carefully. Everyone knows that once a week at this place there will be someone that will surely give them some mental support.”

Rev. Hakamata has also gotten his sect office to get involved. The Akita Soto-shu Youth Division has for the last two years done memorial services honoring those who have killed themselves and created prayer gatherings for the bereaved families of such people. At this year’s gathering in March, Rev. Hakamata gave the sermon. “This is an important chance to listen to the real feelings of the bereaved families. There are many people participating who were close to a person who committed suicides some years ago. So shouldn’t each sect office create such an activity soon?”

As already mentioned, the residents of Fujisato-cho developed a mutual fear and anxiety after the murder of the two school kids. Rev. Hakamata’s salon and suicide prevention measures have not fallen into just an intermittent thing. “The pain of this event is felt strongly. In the countryside as well, human relationships have become fractured. For example, farm work is no longer done cooperatively. Each family works in a different company. Children have become few. In these households, children aren’t disciplined. The real meaning is that there is no connection across generations. In this way I thought that the key to create connection in the community did not need experts but rather getting people together to do something to stop suicide.”

Now Rev. Hakamata has become swamped in his local work. In this way it seems that it’s not possible to do what in the last issue Rev. Shinohara proposed, which is for priests from all regions working on suicide to gather and create a network..

7. The practice of Abbot Jotetsu Nemoto on the Net

Q: Please tell me concretely the reason for wanting to die.

A: Totally exhausted. I want to more slowly rest.

Q: Please tell me from up to now how have you come to a resolution while continuing to live?

A: I tried to commit suicide before. When I awoke in the hospital, I saw my dad crying in the bed next to me. After that, I haven’t tried. No matter what I won’t die. I’m scared to die. I don’t know how to. Whenever I go up to the roof of my apartment, I get scared and can’t jump. So there’s nothing to do but keep living.

The person responding in this mail exchange is a 29 year old woman, married with no children. At present she’s involved in social welfare work at a nursing home. Diagnosed with schizophrenia, she had the experience of returning to consciousness in a hospital after attempting suicide.

The person who was putting the questions to her isRev. Jotetsu Nemoto, the 34 year old abbot of Daizen-ji, a Rinzai Zen Myoshin-ji subsect temple in Gifu Prefecture. Rev. Nemoto has assembled a “community group” on the internet called “Those Who Want to Die”. Suicidal people who don’t want to be by themselves with this on their minds talk here about things from daily living to death. This is a space on the internet where they can talk amongst themselves. They make plans to actually meet and talk sometimes.

Rev. Nemoto explains the purpose of the activity as: “It’s not about counseling and becoming a leader for the suicidal. Rather, it’s about providing support so that while helping eachother as friends/comrades, they can pray to find their own resolution.”

Rev. Nemoto established this group two years ago and since the beginning it’s built up to the scale of over 400 people. However, because this site became well known for its sensitive discussions about suicide, he’s had to take it down. From now he plans to re-establish the group in a way which doesn’t advertise about suicide. At present the members are about 70.

8. Young people who can speak through e-mail

Before beginning this activity, Rev. Nemoto had the opportunity to become close to suicide. “When I was in junior and senior high, two friends committed suicide. From that time I’ve held some burden or debt about what I can do about this.”

Rev. Nemoto was born in Tokyo and after quitting a university in the city [Keio University], he began working in a company. But after developing an interest in sitting meditation (zazen), he ordained at 25. After living as a young monk in a Tokyo Rinzai temple, he deepened his practice by entering Shogen Junior College (which specializes in Zen studies).

After four years of living in a monastic setting, Rev. Nemoto was surprised just after returning back into the world. Since the time of his school friends’ suicides, the number of suicides all over Japan had increased and he felt, “Nothing’s changed.” Rev. Nemoto began to visit the homepages created by young people who had a connection to suicide and wrote comments. “The counseling activities for the suicidal done by other people on the internet often take the form of sermoning from above, and I had doubts that was making any progress.”, he recounts.

In establishing the aforementioned group, Rev. Nemoto just jumped into counseling individual mails. He says, “People who have confided their anxiety to someone comparatively get better naturally. The danger is the people who begin to think, ‘How can I kill myself?’”

However, unlike using a telephone, what can be done when someone confides their anxiety about suicide through an e-mail in which one cannot create intimacy? He notes, “Concerning intimacy of partnership, one can say sending a mail is roughly equivalent to speaking. E-mail is the chief means of speaking. But it doesn’t involve any specialized words. It’s just exchanging the usual discussion of everyday life. Within this, it’s possible to come to a resolution of the problem together. The thing I can do at this time is to create the basis for shared intimacy or being a partner. They may tell me the details of their illness or medication, which I listen to, and share their anxiety about it closely. In this way, they may come to think ‘Man, why have I been wanting to die?’, and then they can say they can move forward. After such an exchange, if Buddhism can play a role that’s great.” Rev. Nemoto emphasizes that whether it’s on the telephone or on e-mail the important thing is to share in their anxiety.

9. “Wanting to die by overdose”

Now we want to return to Nemoto’s discussions with the 29 year old woman. She had one close friend, who was a 23 year old male student at Buddhism University (Bukkyo Daigaku) in Kyoto. He also suffered from schizophrenia. The two met on the internet and as they held a mutual interest in Buddhism, the created a sensitive correspondence. However, in September of last year he committed suicide. After his suicide, she wrote a message to him on her blog.

Nemoto continues to think of how to keep good contact with her as she thinks about suicide and the feeling of the difficulty of living. Still not sure, he continues his discussion with her through e-mail.

In the previous chart is the record of the conversation between the two. In this conversation, she expresses her desire to die by overdose. Over a period of two days from May 16-18, she told of her suicide plan to overdose by taking a large dosage of prescription medicine. When the ambulance came quickly, she was fortunately saved from the brink of death, but today her very unstable situation continues.

4 days after her attempted suicide on May 22, Rev. Nemoto was able to meet her in Tokyo. He talks about the condition of that time: “She’d become very gaunt and goggle eyed. We went to places that she and her male friend had gone. When we finished we talked about getting together next time to chant the Heart Sutra (hannya shin-gyo). I’m still having exchanges with her now but I don’t know how much longer she’ll live.” said Rev. Nemoto not hiding his uncertainty.

Rev. Nemoto gave a presentation on this half-year process at a meeting for young monks and nuns called Bozu Be Ambitious held at Seisho-ji, a Soto Zen temple in Minato-ku in Tokyo. There were more than 20 monks and nuns who participated in his presentation. Some participants expressed their concern for Rev. Nemoto and his counseling work as follows: ”There’s a limit to how far you can continue with counseling with just a kind attitude.”; “You can’t just do this by yourself. You need some kind of organization.”

Rev. Nemoto recounts, “I listened to the very concerned words of the participants. Afterwards, we prayed for the recovery of the suicidal, and chanted the chants of each sect for 30 seconds each. For everyone it was a moving to feel together the connection to the suicide problem.”

Transcript of Rev. Nemoto’s e-mail correspondence with the suicidal Ms. A

10:24 pm, April 30, 2006

Rev. Nemoto: “Please tell me concretely why, even though someone listens to you, you cannot explain in words so that they can understand when the only thing you feel is that “it’s hard to live”?

Ms. A: I can’t come out with the right words ….[skip]…. I wonder why it’s difficult to live. But it’s just that way that I can’t live. This energy is very strong. I have no hopes. I feel empty. I feel burdened. That kind of feeling. Even looking at society, I see no salvation, just killing each other and cheating each other. There’s just the burden of living. I’m tired. It would be enjoyable to sleep and die.

12:12 am May 2^nd

Rev. Nemoto: Please tell me concretely what’s the number one thing that recently gets you down?

Ms. A: The depression is really harsh, so I’ve taken a break from work. As it’s been 3 years since I started, I don’t care so much. Yeah, it seems the depression, and no understanding comes. It’s Integration Dysfunction Syndrome, something like that I can’t say. ….[skip]…. Petty things like the suicide of the housewife of the architect connected to the falsifying of earthquake proof buildings, a brush with the rejected entrance into a university of a child of the founder of Aum Shinri-kyo. There’s no vitality left.

Rev. Nemoto: From various things, like humans, living things, the sun, water, we receive power by which we grow. In the end, it’s all ashes. In this way, I think there’s some obligation to return the favor. Completely. …[skip]

Ms. A: Does that mean returning the favor without dying? It seems it’s not possible (laughter). On the contrary, it’s more like revenge (laughter). But based on that idea, it’s better to go ahead and die for society (laughter).

8:34 pm May 16

Rev. Nemoto: Can you tell me about your family?

Ms. A: “Mother and child”. My mother would say, ‘Your younger brother is cuter than you.’ Gradually 10 years later, I left home. The husband, worked, as a realtor. My connection to him was (laughter) … I don’t know. Friends? It seems no one could understand me and my deal. They don’t know anything about what I do on the internet. It seems they don’t want to know.

Two days after on May 18, Ms. A attempted suicide by taking a large dosage of prescription medicine but fortunately she was saved from the brink of death..

CONCLUSION

Truthfully, many young priests are deeply concerned about the suicide problem and there is not a small number of people who are not connected to it. We have shown that right now out in the field many priests are offering proposals. Assistant Abbots who have time should make a network in order to grapple with this problem.

For example, there should be sharing of information of the lists of the houses of lay followers from each temple where old people live in solitude and people who are worrisome so that priests who have time can make regular rounds to visit them. Buddhists should listen carefully to proposals and effective measures against suicide which they can perform.

In these last two issues we have introduced 7 priests with a connection to the suicide problem. It seems we have run out of Buddhists who know how to perceive the suffering of others who think, “I want to die”. People like this stay in a temple waiting to be asked for help. On the other hand, monks and nuns should go out in society and try to stop the suffering of people who have anxiety. The thing needed is the determination to keep getting together with people who need counseling. These 7 monks embody this way.