Naikan and Alcohl Dependence
A Case Study

Haruo Kubo(not his real name)was born in Miyazaki Prefecture,graduated from middle school,and got a job in a bicycle shop,where he worked for about four years.
Thereafter he enlisted in the Self-Defense Forces and was posted in Fukuoka Prefecture.
Just about every night he would go drinking with the same group of friends to relieve the stress of the day's training.
One evening in the second year after he enlisted,he drank a great deal and was late for curfew.
He got into a quarrel with the guard at the gate,deserted on the spot,and returned to his home town.
After that,he failed to keep a steady job.
He continued to drink heavily and to move back and forth between Fukuoka and his home town,constantly changing employment.

In 1963 Mr.Kubo married,but his drinking only increased.
He resumed a life of going back and forth between Fukuoka and his home town,continuing this for about ten years until finaly he and his wife were divorced.
Mr.Kubo took custody of their two children,but soon thereafter his older daughter died of acute pneumonia and then his younger daughter died from an accident with a floor heater.
Mr.kubo's state of mind became increasingly distraught and he began to drink as much as 1.8 liters a day of shochu(a low-grade distilled alcoholic beverage with high alcohol content).

Unable to watch this,his family became so concerned that lthey placed him in a psychiatric hospital.
He was first hospitalized in 1970,but as soon as he was released he immediately began to drink again,gradually becoming abusive and physically violent.
He was subsequently hospitalized six times.
Soon after being released from the hospital again in 1976,he went to Fukuoka to work,but resumed daily drinking,until finally he caused an incident in which another person was injured.
He was sentenced to three months in prison and was placed on parole after his release,but-unable to stop drinking-he drank even more than before,stopped working altogether,and became more violent.
He was taken into police custody many times.
One day Mr.Kubo's family brought him to our hospital.
They gave me a letter from the director of the psychiatric hospital in their home town in which the following remarks were made:

This patient has been hospitalized numerous times in the past,twice in this hospital.
This last time,he was admitted on an emergency basis on Oct.1,1978,with chronic alcoholism and hypertension.
He had been drinking steadily for the previous two to three days and became violent,shattering all the glass in his house and breaking up the furniture.
Apparently,he has recently undergone an increasingly severe personality change;his attitude is entirely self-centered and Indifferent,lacking in empathy for others or in any restraint.
It seems impossible to treat him using the usual kind of instructions and explanations.
I am sending him to you thinking that you might try giving him the Naikan therapy that you do there.

We were concerned about taking such a troublesome patient but admitted Mr.Kubo to our hospital on October 13,1978.
The diagnoses entered on Mr.Kubo's chart at his initial examination were alcohol dependency,alcoholic myocardosis,alcoholic hepatitis,and diabetes.

When he first entered the hospital,he would say things like, "It was my idea to come to this hospital to quit drinking.
I don't care if it takes two or three years!"
But by the third month of his hospitalization,he insistently requested a furlough from the hospital.
We urged him to persevere for a while longer,until after he had experienced Naikan,but he would not listen,saying,"No,I won't drink,absolutely"

So we reluctantly gave him permission for a furlough of four days and three nights.
He did not come back to the hospital on the day of his scheduled return.
Finally,on the eighth day,Mr.Kubo was taken into police custody and,very drunk,was escorted back to the hospital by a patrolman.
After that he seemed to be uncomfortable relating to the other patients and the nurses,and he kept to himself for some time.
Eventually he settled down again,and at that point we decided to introduce him to Naikan therapy.
Mr.Kubo vowed sincerely to try very hard.

The Effects of Naikan

It appeared that Mr.Kubo's motivation for agreeing to do Naikan was his desire to be discharged from the hospital as soon as possible.
However,by the third or fourth day it was obvious that he had forgotten all about discharge and was engrossed in the Naikan.
The primary reason for Mr.Kubo's involvement in Naikan appeared to be his discovery of the love that his parents had for him as indicated by his "Naikan Self-Reflection " journal.

I was astonished at how many ways I had caused trouble for my mother and how many things she had done for me.
When I realized how throughout my thirty-six years,my mother had looked after me with so much caring and tenderness-in spite of my self-centeredness-I sat there in that screened-in enclosure and wept.
And I believe that my father,too,has always regarded me with a generous heart.

If a person lacks the self-awareness that he is alcohol-dependent,he will not develop a desire for treatment,nor will he rearlly try to stop drinking.
It was when he reflected on his past behavior toward his wife and children that Mr.Kubo became fully aware of his own illness.

About my wife-I married at age 21 and we had two children,but my wife finally gave up on me because of the way I was when l drank and because of my thoughtlessness.
Unfortunately-also because of my thoughtlessness-my older daughter died of illness and my younger daughter died in an accident and I broke up with my wife.
I really wish I could see my wife now and apologize to her sincerely.

Righting the wrongs of the past means first of all to stop drinking.
However,if sobriety is something forced upon a person by others(family or therapist),it cannot be maintained.
Unless there is a voluntary,self-willed resolution to quit drinking,continued sobriety is impossible.

When I realized that my parents had cared enough to send lelters and packages to me every month to me,with my history of eight hospitalizations and my criminal record,a good for nothing who had every reason to be disowned altogether I said to myself,Well,it's still not too lale.
While Dad is still living,while Mom is still in good health,Ireally want to repay my debt to them by becoming sober.
And I began to realize that I was developing the resolve to carry through on that.

If a person reflects deeply on how many people he has troubled through his use of alcohol,the desire arises to make amends to those people-even in 1/10,000th part.
He comes to understand that building better relationships with those people will contribute to his own happiness as well as to theirs.
However,he also comes to the painful understanding that establishing better human relationships is like building castles in the sand unless he continues to be sober.
Mr.Kubo came to a decision.

I wonder if I ever really thought about other people before.
I think this is the first time that I looked back on my thirty-six years and realized what a wretched fool I was,how self-centered I was-causing so much trouble for my parents and always lying to my brothers and sisters and other people.
What I realized during this Naikan intensive was first of all my own selfishness and how mired I was in thoughtlessness toward others and in my own selfhatred.
In living my life from here on out,I vow earnestly to remain sober and to persevere on a straight patht in life,never forgetting my indebtedness to my parents or the thoughtfulness of my wife and my siblings,those things that I realized during my Naikan intensive.
I am resolved to take good care of myself and to live from now on with a sence of my indebtedness toward my parents and my brothers and sisters and toward others.

Mr.Kubo left the hospital with this resolve and even now continues to do daily Nani.


In order to quit drling,it is not enough merely to make a firm resolve.
One must possess the psychologicals strength to continue implementing that resolve.
Since Naikan therapy is a comparatively restrictive mode of treatment,it may be conjectured that a fair amount of endurance and psychological strength is cultivated merely by going through the treatment itself.
And it would seem that the energy to reform on one's own those things that one has discovered by carefully Iooking at the self on one's own,without receiving any preachy criticism from others,that energy in fact becomes the strength to remain sober.

I asked myself,What does it mean to live as a human being?
What is llfe?
And the answer seemed to come to me.
Simply put,I realized that life,to be a human being,meant from now on,so long as I am alive,so long as I have life,to be strict with myself,not to be defeated by mysel.
I am resolved to live out the remainder of my life without ever forgetting this feeling.

With these reflections as his grounding,and continuing to do his daily Naikan,Mr.Kubo maintains sobriety and-to the amazement of his family and others around him-continues to live a meaningful life.

Constructive Living Quarterly(Spring 1994 VOL.2 NO.1)
Naikan and Alcohol Dependence A Case Study