無断離院をきっかけに集中内観を導入したヒステリーの1症例

A Case of Hysteria Treated by Naikan Therapy

　【抄録】　視覚異常，聴覚異常，過眠などを呈し，無断離院を繰り返す23歳女性のヒステリー患者に対して集中内観を行った経験を報告する。最後の無断離院の夜，「こんなにたくさんの人に迷惑をかけて私は最低の人間です。」と内省を示した。そこで，集中内観を提案したところ同意を得ることができた。父に対する依存と攻撃が顕著であったため，父に対してのみ内観してもらった。集中内観前後で内観評点は1点から3点まで上昇しており，内観は深まったと思われた。集中内観後にヒステリー症状は消失し無断離院もみられなくなり退院となった。しかし，集中内観後2カ月経過した頃から内省的思考が薄れていった。集中内観から10カ月後，自己の未熟性に対して嫌悪感を抱き，自発的に再び集中内観を受ける。そして前回以上に深い内省的思考を獲得し，生まれて初めて仕事に就くことができた。第1回の集中内観から32カ月後，第2回から22カ月後の社会適応は良好である。

　Naikan therapy, a method of psychotherapy developed out of the asceticism of Mahayana Buddhism in Japan, was introduced into the treatment of hysteria. The patient was a 23-year-old female who presented with hystrionic symptoms of visual disturbance, auditory disturbance and hypersomnia. When she felt displeasure she always ran away from the hospital ward without notice. After she ran away the last time, she expressed regret for troubling so many people and said she felt she was being sinful. Therefore, she agreed to the therapists proposal of five days of intensive Naikan therapy. Generally, patients undergoing Naikan therapy are told to be introspective from morning to night about mercy, service and guilt in relation to the persons closest to them. Since she had expressed ambivalent feelings of dependence and agression toward her father, she was ordered to meditate on her relations with her father. She meditated deeply. On a scale of introspection ranging from -3 to 6 points she was at 1 point at the start of the Naikan therapy and at 3 points at the end. After the Naikan therapy her hystrionic symptoms disappeared and she did not run away from the hospital ward again. Therefore, she was discharged. Her introspection gradually became shallow with time, reaching a low level two months after the Naikan therapy. Ten months after undergoing the Naikan therapy, she felt disgusted with her immaturity and spontaneously requested Naikan therapy again, and received it for seven days intensively. As a result, she arrived at her deepest level of introspection and was soon able to get a job for the first time. Thirty-two months after the first Naikan therapy and 22 months after the second course of therapy, the level of her social adjustment is still good.