Philosophical Ground-Laying for Psychotherapy and Counseling in Korea
Korea Journal : 32-37 (1974.12)
Original Korean Version was published in 1968. (Some part was not translated)


Philosophical Ground-Laying for Psychotherapy and Counseling in Korea

RHEE DONG-SHICK

RHEE DONG-SHICK (Yi Tong-sik) is a clinical professor of psychiatry at Yonsei University and Ewha Womans University and operates a psychiatric clinic in Seoul. His publications include Modern Man and Neurosis(1972), Understanding and Treatment of Neurosis (1974), and Korean Personality and Tao (1974).


Necessity

More than 30 years have passed since the idea of western psychotherapy was first introduced into Korea. In the initial period, however, psychotherapy relied mainly on treatment with persuasion or suggestion or Moritas method of confining the patient to his bed in absolute seclusion. There was one psychiatrist who was analyzed in Japan in the early part of the 1940s; but the interest in psychoanalysis remained mainly in the theoretical aspects, still far from practical application.

Some doctors applied psychoanalysis to practical purposes after the liberation in 1945. It was, however, after the outbreak of the Korean War on June 25, 1950, that Korean psychotherapists could have contact with their American counterparts as army medical officers, absorbing from them American psychiatry which was heavily influenced by psychoanalysis. Short-term courses were offered to train psychiatrists for assignment to army divisions. Army doctors who came to have a great interest in psychotherapy in the course of training went to the United States after discharge from military service for further studies at American civilian hospitals, others undergoing training at U.S. army or naval hospitals either in Korea or in the United States. At present Korean doctors who are studying psychiatry in the United States number many times more than those who are being trained in this field at home.

One salient feature of Korean psychiatry after the liberation, especially after the outbreak of the Korean War, was that it centered heavily on the armed forces, especially on the army, as well as on the United States. Seen from another angle, this means that Korean psychiatry broke away from universities, severing ties with the tradition of Korean psychiatry, and tried to absorb modern theories mainly from the United States rather than evenly from all other countries, an ill-digested absorption at that. In clinical treatment, too, Korean doctors are still far from absorbing the essence of Western psychotherapy.

It was also after the outbreak of the Korean War that counselling was introduced from the United States through courses offered to train counsellors for secondary school in cooperation with psychotherapists and on the basis of what they had learned in America. But these courses were still in a superficial stage. After the establishment of the Student Guidance Research Institute at Seoul National University in 1962, however, a similar organ, though small in size, came into being in other universities in succession and in the municipal government of Seoul. But, except for the one at Seoul National University, the others have not yet attained a high standard in providing counseling. Furthermore, many difficulties are hampering Seoul National University from developing its counseling center to a satisfactory extent although some progress was made, because this is an entirely new field.

Some of Korean psychotherapists held a negative view of Korean culture and Korean people by saying that transference does not take place in Korean patients in psychotherapy, that the ability of psychological understanding is far better in the Japanese than in the Koreans, making it far easier to apply psychotherapy to the former, and that the Koreans are so reticent, whereas the Westerners are freely expressive, that it is difficult to practice psychotherapy among the former. This view, however, is nothing but a manifestation of their defeatism, arising from their failure to cope sufficiently with challenges from the encroachment of Western culture and its follower, Japanese culture.

The view of some Korean psychotherapists, as illustrated above, runs counter to an opinion of American or Japanese psychoanalysts and psychotherapists concerning this question, as well as being hardly convincing in view of what this writer has observed. Frieda Fromm-Reichmann said that although sex was repressed and patients disliked to talk about it in the days of Freud, people in the present-day European or American society talk about it freely, but the fact that their hostility and tenderness are repressed poses a difficulty to psychotherapy. Dr. Masaaki Kato of Japan said that treatment with psychoanalysis is impossible for the Japanese and that Dr. Takeo Doi was perhaps the only Japanese psychiatrist who asserted its possibility. As the Japanese have less disposition to thinking, Dr. Kakeda believed, isolation therapy confining the patient to a solitary room, thereby forcing him to think himself, was the only way of applying psychotherapy to them. Dr. Akihisa Kondo who was trained at an institute of psychoanalysis run by the Horney school said that Dr. Doi was the only Japanese who believed that psychoanalysis is possible for Japanese patients.

Even Doi who believed in the efficacy of psychoanalysis for the Japanese reported that he treated his patient only once a week and he had no patients who had received long-term treatment. Kondo also made the same report. As he interpreted psychoanalysis differently from the manner in which they did in the West, Doi explained, he regarded as psychoanalysis a short-term treatment meeting the patient only once a week. This is entirely different from the type of psychotherapy this writer and other Korean psychiatrists provide for their patients in Korea. Most patients this writer treats are those who require more than three years of treatment on the average during which period he has to meet them two to five times a week. Doi and Kondo are the most authoritative psychoanalysts in Japan, as well as renowned internationally, both having undergone formal training in the United States. In view of these facts, it is apparent which are more pliable to psychotherapy, especially to depth therapy, the Koreans or the Japanese.

Next we will scientifically examine the view that Korean culture is authoritarian. Professor Yi Kwang-gyu of Seoul National University asserts that the southern half of the Korean peninsula, at least south of Kyŏnggi Province, was governed by a matriarchy and the influence of patriarchy gradually expanded southward. A matriarchal society is democratic, while a patriarchal society is despotic, according to Professor Yi. On the basis of the democratic culture of matriarchy, he explains, the despotic patriarchal culture was formed on the surface. Compared with the Japanese society, its Korean counterpart is almost devoid of despotism and rather democratic. In other words, the Korean society needed to have more despotic elements, while the Japanese society is too despotic.

Unlike some Korean psychotherapists and most Korean intellectuals, foreigners observe that the Korean people are very emotional like the Spaniards. They say that they feel as if a Korean were a friend of more than 20 years even though he is quite a stranger. They feel no barrier in making friends with a Korean whom they meet for the first time, whereas they feel some barrier before a Chinese or a Japanese. This writer, too, presupposed the notion before he started group therapy that the Koreans are far less expressive, especially so before strangers, than the Westerners and so it might be impossible to glean any meaningful result from group therapy. In fact, however, this writer discovered that though the Westerners are talkative and expressive, their words and expressions often do not flow out of their hearts, whereas the Koreans, though less expressive and less talkative, reveal the bottom of their hearts and the therapy they have undergone proves more effective. It is natural because the most important thing in psychotherapy is not to conceal one's emotion.

In the foregoing paragraph this writer rejected the notion that Korea's traditional culture or the nature of Korean people is unsuitable for or disadvantageous in psychotherapy. On the other hand, some specialists expressed the opinion that Korea has to transplant the Western philosophy of counseling because she does not have her own philosophy of counseling. This, too, is a mistaken notion caused by the lack of full understanding of counseling and psychotherapy. It is also a grave mistake originating from indifference to or disregard of Korea's traditional thought or culture. In fact, the most profound philosophy of counseling or psychotherapy should be found in the Orient, and one is awakened to this truth only after one becomes well versed in Western psychotherapy. Counseling for the upbringing of character is not basically different from psychotherapy.

The purpose of this paper is to correct these mistakes mentioned above and lay the ground for rooting psychotherapy in the Korean tradition. It appears impossible to expect any sound progress in psychotherapy without correcting the mistaken notions.


The Traditional Foundation for Psychotherapy in Korea

(1) Korea's Traditional Medicine and Psychotherapy

Korea's traditional medicine before the introduction of Western medicine had been Oriental medicine. A comparison of Oriental medicine with Western medicine reveals plainly the difference of thought between the East and the West. In the first place whereas Oriental medicine was never ruled by irrationality even though some irrational elements can be found in its tradition, Western medicine underwent a dark age which continued for as long as 16 centuries from the death of Galenos to the 19th century, medicine of the mind ceasing to exist by the 12th century, mental diseases handed over to the care of Inquisition from the realm of medicine and psychiatry, completely giving way to demonology by the close of the 15th century. Witch hunting thrived until the 18th century, burning to death persons stricken with a mental disease. One can never find such brutal and inhumane instances in Oriental history. There was never a time in the history of Oriental medicine when it lost humanism.

Second, the ultimate objective in Oriental medicine has been health, especially mental health. Systematically it recognized that a disease grows out of mind or feelings. The highest aim of Oriental medicine is to prevent diseases by controlling mind. In order to control one's mind one has to cultivate Tao.

In Korea's traditional medicine, as we have seen, it is understood that a disease springs from mind. The basic aim of Oriental medicine has been to prevent diseases and overcome the ailment by controlling mind. In other words, it can be said that Oriental medicine made a start from what Western medicine has arrived at in 2,500 years of its existence since Hippocrates who gave it an aspect of a rational empirical science. The notion of Oriental medicine that its ultimate aim is to prevent diseases by promoting health, especially mental health, is in accord with the ultra-modern theory of Western medicine that organism is under the control of the cerebral cortex or of the neuroendocrinological organization.

Forming the core of the notion that one should overcome diseases by holding one's mind upright, it seems, is Taoist or Buddhist thought, although it cannot be denied that such a notion had existed before Taoism and Buddhism. Before the birth of Western medicine there had been a technique of psychotherapy peculiar to Oriental medicine. For example, this writer was told a story by a Son of my patient some time ago. First told by his father, the story was as follows: About one hundred years ago, a young man was married to a daughter of a wealthy family. An orphan, he underwent various hardships. On the night of his wedding, he suddenly grew pale, unable to eat and speak. A man who had studied on Kŭmgang-san mountain was visiting the village. He was consulted. He sent to the house where the wedding was a group of women who were noted for their wailing. They wept sadly, and the young man instantly recovered. In view of present-day psychotherapy, it can be said that the man from Kŭmgang-san mountain must have grasped and analyzed the mind of the groom in this way: At the peak of happiness, the young man was overwhelmed by his memory of his sorrowful oppressed past, so much so that he could not even burst into wailing. The women were asked to weep in behalf of him to give vent to his sorrow. This can be considered a psychoanalytic treatment with a perfect understanding of the patient. A similar treatment is employed by some therapists even today; but in no instance are third persons employed as in the above case. Mostly patients are given some stimulation or told to make some action in order to find out the their hidden mind.

(2) Buddhism, Especially Sŏn Buddhism, and Psychotherapy

The religions original to the Orient are Confucianism, Buddhism, and Taoism. One common point among them is that they all are aimed primarily at building up noble character and controlling one's mind. Especially Buddhism, seen from the standpoint of psychiatrists, is nothing but psychotherapy. Especially Sŏn( Zen in Japanese) Buddhism is striving to attain the highest aim of psychotherapy. It is rather natural that Karen Horney, Erich Fromm, and many other noted Western psychoanalysts have a deep interest in Sŏn Buddhism and are practicing it. This is an inevitable phenomenon because the ultimate objective of psychotherapy is self-realization or a return to real self which is the highest aim of Sŏn Buddhism.

Sakyamuni taught as a means of realizing the truth. Shin calls for an observation of one's body, including the movements of its all parts, in order to under stand it correctly as one's self. su means selftraining to reach the stage where one becomes aware of the feeling of being indifferent of pain or pleasure caused to one's body or mind. Sim means correct understanding of all forms of mind such as greediness, sincerity, etc. Bŏp indicates a process of self-awakening to the existence of five obstacles to attainment of true human nature: greediness, insincerity, stupidity, indecisiveness, and doubtfulness. After undergoing this process of self-training, the Buddha preached, one can clearly recognize all phenomena and identify oneself with them. To say that one clearly recognizes phenomena arising in one's mind and body which one has not recognized before is the same as an effort in psychoanalysis to become conscious of what has been unconscious. Psychotherapists let their patients possess their feelings as their own.

Sŏn Buddhism tries to convey the truth without the intermediary of language by pointing directly to the nature of man. The truth cannot be explained with words but it can be conveyed only "from mind to mind." By looking at one's true nature one can be enlightened. This is similar to the process of psychotherapy. "Communication" or "nonverbal communication" is a term employed in psychotherapy. Psychiatrists believe that facial expression, voice, attitude, action, attire, and behavior are more expressive than words, revealing one's true mind more clearly. Therefore it is generally recognized that communication in depth can be achieved by nonverbal means. Psychotherapy is possible more through communication between minds than with words.

Another point showing coincidence between psychotherapy and practice of Sŏn is that a patient or a novice must expose his mind to the psychotherapist or the guiding monk. It is an absolute requirement for a patient to disclose all of his mind before his therapist if he is to be cured of his mental illness. The patient can be saved only when he penetrates into his own mind and realizes that all sufferings are caused by his illusion. When a monk reaches this state of mind in his Sŏn practice, he can be regarded as having arrived at a stage of seeing the nature of things and being enlightened. It is said in psychotherapy and counseling that such terms as relation and the essence of matter cannot be grasped with concepts. What cannot be converted into concepts cannot be expressed with letters. The Sŏn master must point directly to the essence of human nature if he is to awaken his disciples. By penetrating into one's own mind a patient can be cured and a Buddhist follower enlightened.

There is no difference between psychotherapy and Sŏn Buddhism as long as both try to eliminate illusion and lead men to a clear grasp of reality. However, both are unable to reach a thorough stage. This writer believes that whereas psychotherapy tries mainly to eliminate illusions that arise in personal problems, Sŏn Buddhism aims at connecting individuals directly with reality. There are, generally speaking, three veils which lie between men and reality and obscure their view of reality. They are organism, culture, and personal experiences. Psychoanalysis or psychotherapy can remove the veil of personal experiences, but neither can remove the veil of organism and culture. On the contrary, Sŏn Buddhism regards it as its ultimate aim to transcend personal experiences, culture, and organism.

(3) Confucianism, Taoism, Ch'ŏndo-gyo, and Psychotherapy

Though less thoroughly than Buddhism, Confucianism and Taoism lay the greatest stress on the cultivation of mind to ennoble personality. One thing common to confucianism, Buddhism, Taoism, and Tonghak thought is that man is endowned with the attribute of God, which is quite different from Christian thought. The most outspoken expression in this regard can be found in Tonghak thought that man is heaven. In the process of undergoing the Reformation, existentialism, psychoanalysis, and psychotherapy, Western thought has gradually been liberating man from God; it is asserted in existentialism and psychoanalysis that man should return to his original self and it is taught in psychoanalysis that self-salvation is possible through self-awakening.

Those parts of Oriental thought which are most closely linked to psychotherapy are as follows: First, it is said in Tashueh (Great Learning) that mental health can be maintained only when one keeps sincerity, never deceives self, and remains discreet. Sincerity mentioned here is common to "congruence" or "genuineness" of Rogers, " ruthless honesty" of Horney, and Jung's emphasis of genuineness on the part of psychotherapists. Sincerity is the basis of psychotherapy, and no success can be expected in psychotherapy without it.

Second, it is said in Chungyong (The Golden Mean) that to follow nature is called Tao (Way, Truth). The state of harmony can be achieved when matters become devoid of collision. When one's mind enters the stage of harmony, he can see matters as they actually are. This can be thought of as another description of the Buddhist concept of mind free from attachment to certain things.

In view of the fact that the Oriental religions emphasize sincerity, they are in accord with psychotherapy.

Laotzu emphasized "no striving," which is important not only in psychotherapy but in other departments of medicine, politics, and education. Primum non nocere is emphasized in Western medicine. Those who are going to help others should bear it in mind that the persons to be helped should be encouraged to attain self-growth and self-development. Nothing should be done to them except eliminating obstacles which may be detrimental to achieving the above. The practices should be avoided that a teacher, a physician, or a politician forces his pupil, his patient, or his people to follow his advice which, though he may believe in its benefit, is, in fact, harmful. At best, he oppresses him and does harm to him.


Conclusion and Prospect

As we have seen, the traditional culture of the Orient, including Korea, regards it as the supreme objective to realize the truth. Confucianism, Buddhism, and Taoism are all primarily concerned with mind; and the Tonghak tenet that man is an incarnation of Heaven is shared commonly by the three Oriental religions. Western psychotherapy was born only 2,500 years after the start of medicine. It appears that Western thought began to pay an attention to the Oriental Tao (Way or Truth) in this century. This means that the Oriental thought set itself free from the concept of God personified 2,500 years ago. Based on the notion that man and God are one and the same, the Orientals considered it the highest ideal to become a buddha, a sage, or a Taoist immortal.

In view of the fact that Western psychotherapy attaches importance to the relation between the therapist and his patient and the former's character and sincerity, it can be said that the Orient excels the West in the philosophy of psychotherapy, setting forth its ultimate objective as early as 2,500 years ago. Especially Confucius valued human relations most and all Oriental religions hold in common that they all lay stress on character and sincerity. Even though commitment is emphasized in analysis of existence, the Western commitment is far from reaching the height of the Confucian commitment exhorting to attain gentlemanship even by sacrificing oneself, or of the Buddhist commitment stressing self-sacrifice for salvation of the masses. Tao is believed to be able to lead man to the state of a buddha, a sage, or a spirit Western thought has not reached this height. The state of being awakened to Tao provides man the zenith of mental health.

It was long ago that the crisis of Western civilization was talked about, and many intellectuals predicted its downfall. But only a few prescriptions have been offered. Toynbee placed his expectation on the reform of Christianity, while Lewis Mumford saw that the only means of saving Western civilization can be found in self-examination, self-understanding, and self-control. These indicate nothing but Tao of the Orient. Elements which contributed to undermining Western civilization are the disappearance of God as the spiritual pillar and the loss of man's subjectivity (Chuch'esŏng: ) due to his subjugation to organization and machinery. There is no remedy for the crisis-ridden Western civilization other than recovery of human integrity. Tao helps man preserve his independence, and therefore Western civilization can overcome the crisis only by absorbing Tao. The modernization of the West can be achieved by absorbing the Tao of the Orient on the basis of its science and technology, while the Orient can modernize itself by absorbing the science and technology of the West on the basis of its Tao.

By realizing that the essence of our traditional culture constitutes the philosophy of psychotherapy, Korean psychotherapy should strive to lead its Western counterpart by absorbing the Western technique. Korean intellectuals are called on to integrate the Oriental and Western thought and make a contribution to the development of world culture by reviving the thought of such eminent Korean thinkers as Wŏnhyo and HŏChun.
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Ten-Oxen-Pictures illustrate the process of purification of mind. Pictures of this site are Ten-Oxen-Pictures of Songgwangsa Temple.