The Potential of Rinsho Buddhism and Developing Buddhist Chaplaincy in Post 3/11 Japan

by Rev. Hitoshi Jin

Rev. Jin is the Director of the Zenseikyo Foundation & Buddhist Council for Youth and Child Welfare and the Rinbutsuken Institute for Socially Engaged Buddhism as well as a JNEB member. Since the tragic triple disaster in northern Japan on March 11, he has adapted his skills in psycho-spiritual counseling for troubled youth and the suicidal to helping all those in the disaster stricken areas struggling with trauma and grief. Rev. Jin has been making extended visits to the three prefectures Fukushima, Miyagi, and Iwate that were directly hit by the tsunami.

Defining Rinsho Buddhism

Recently in Japan, we have developed the concept of Rinsho Buddhism. The direct English translation of this word rinsho is "clinical" and has with it the image of hospice work for end of life care. However, at our recently formed Rinsho Buddhism institute, we have translated rinsho more loosely as Engaged Buddhism. Thus the name for our institute in English is the Rinbutsuken Institute for Engaged Buddhism (rin refers to rinsho, butsu to Buddhism, and ken to institute). Engaged Buddhism is a modern term first coined by the Vietnamese monk Thich Nhat Hanh during the war there in the 1960s. He sought to describe a type of Buddhism needed at that time where monks do not remain cloistered in their temples, chanting and meditating, but rather come out of the temples to engage in positive action for peace and for the aid of the suffering.

While Engaged Buddhism has been translated into Japanese as "participating in society" Buddhism (shakai sanka bukkyo), the social participation aspect is only half of the equation. The other half is the simultaneous, deep investigation of the inner self. In this way, we might have in addition to Socially Engaged Buddhism, also Spiritually Engaged Buddhism. Dr. A.T. Ariyaratne, the founder of the Buddhist inspired Sarvodaya Shramadana Movement in Sri Lanka, has explained this point as the difference between purna paurusodaya (personality awakening) and vishvodaya (world community awakening). In this way, rinsho has the meaning of engaging in the personal domain as well as the social aspects of the four core causes of suffering (dukkha): birth, aging, sickness, and death.

Developing Trauma Care for Victims of the 3/11 Disaster

The Zenseikyo Foundation & Buddhist Council for Youth and Child Edification is the parent organization for our new Rinbutsuken Institute for Engaged Buddhism. It was established in 1962 with a membership of over 60 denominations from mostly the traditional Japanese Buddhist world. It's purpose has been "to nurture young people in the spirit of Buddhism", and in the early years, we supported temples to establish Sunday schools and children's associations to cultivate young leaders. As times changed, we shifted our work to meet more recent, pressing issues, such as school dropouts and bullying and harassment among the young. We then began engaging in the most intense issues, like hikikomori (shut-ins/social reclusion) and suicide. These are critical issues in which I feel Japanese Buddhists should be involved and which we support our member temples to tackle. Finally, in 2008, we established Rinbutsuken to engage in activities based on the scientific and clinical applications of Buddhist wisdom.

After the catastrophic events of March 11, 2011, Zenseikyo quickly shifted its focus to providing various forms of support to the Tohoku region in Northeast Japan. We first conducted a three week investigation and needs assessment in the region, and then we began providing material aid support amongst our member temples in the hard hit cities of Kesennuma and Ishinomaki in Myagi Prefecture. We also mobilized volunteer priests from our network temples around the country and made created caravans to deliver emergency supplies and cook hot meals.

Looking beyond such material aid, Zenseikyo began doing trauma care with children in the disaster areas. There were children and youngsters living in emergency shelters who had lost family members and had seen shocking sites of death and carnage. They were suffering from insomnia and engaging in acts of violence towards others as expressions of their trauma. So we first supported them by offering physical outlets through places to play and blow off steam. While providing them with a means to play, we also sought to ascertain which children had active trauma problems.

The accumulated problems of living in the shelters - such as little space to play and adults around them also experiencing increasing levels of stress with trying to rebuild their lives and locate missing relatives - often lead to secondary trauma or PTSD (Post Traumatic Stress Disorder). The adults also fell victim to this secondary trauma, which was exacerbated by the particular culture of these Northern Japanese people who have lived for centuries in small, isolated, and intimate communities. As such, they are hesitant to openly express their feelings and needs, especially to outside caregivers and helpers. Thus, from the beginning of May 2011, we entered another field of work to support adults through various forms of entertainment, such as movies, vocal concerts, performances, etc.

Another therapeutic method that is the special domain of Buddhist priests is performing funerals and memorial services for the deceased. In the wake of the disaster, there was such a large number of dead bodies coupled with crippled facilities for cremation and burial that local priests - many of whom were victims themselves - could not meet the demands for funeral services. Volunteer priests from all over the country came to the region to help with these services. They have continued, now more than a year after the disaster, to offer special services for the deceased spirits and for the extended care of the bereaved.

In order to better develop our staff and volunteers for this therapeutic work, we held four workshops from April to May, 2011 on the topic, "Introduction to Trauma Care at the Time of Disasters" in Tokyo, Saitama, and Kyoto. In the definition of health made by the World Health Organization (WHO), there are 4 aspects, one of which is spiritual health, an area we feel is particularly suited for religious professionals to assist with and support. Our workshop included a 4-hour program consisting of a lecture on disaster trauma care, orientation to deep listening volunteer work, a workshop on attitudinal healing, and a presentation on how to perform memorial services for the deceased. Among the 170 persons who attended these workshops, we were able to enlist 50 as staff to provide psycho-spiritual and religious care. They were dispatched at the beginning of May through July for 2-3 days every other week, visiting 4-5 shelters at a time.

As the summer came, we created a Temple Summer School for children from nearby the Fukushima nuclear facilities where their ability to play outside is restricted. We took them by bus to safe areas where they could experience freedom outdoors amidst nature. Staff for this event included volunteers from the Tokyo area, volunteers involved in kindergartens and day care centers, and members of the Soto Zen Young Priests Association.

By September, all the emergency shelters were being closed, and those who could still not return home or find other housing were moved into temporary housing units. The temporary housing units can hardly be called houses. They are tiny rooms with no space to accept visitors. The compounds of such units of 50 or more contain one common building for meetings but very little space for people to use freely. As the cool weather and winter returned, the problem of the isolation of these remaining victims became a concern. According to an investigation by Japan's public television network, NHK, by the end of September, ten people had died from the effects of isolation or from suicide. After their initial relief to survive the disaster, many victims have been faced with the despair of trying to rebuild their livelihoods and their communities.

Since 1998, Japan has had a suicide rate of over 30,000/year, and although numerous NGOs have been created to tackle this issue and work on prevention, the numbers have remained above 30,000. With the dislocations of the 3/11 disasters, these numbers do not look to decrease in the coming year or two. This is why more than ever I feel we need religious professionals to get involved in this work.

To face this problem of suicide and death by isolation for the middle aged and elderly, Zenseikyo began in September 2011 to run herb tea cafe events in the temporary housing units. Either in the common community room or outdoors, we provided a space for people to gather to strengthen relationships among themselves and also to talk to our volunteers about their concerns. These were modeled loosely on the "Zen tea ceremonies" that the Soto Zen Youth Association established during previous disasters in other parts of Japan for supporting those living in temporary housing. At our tea parties, we use western herb teas that have medicinal and calming properties to support the well being of those people.

Using Rinsho Buddhism to Move from Trauma Care to Spiritual Care

There are various needs for fundamental wisdom in the trauma care of disaster victims. First of all, we may ask what is trauma, specifically psychological trauma? It can be said to be "a mental injury sustained by a great impact or shock which to a certain extent cannot be treated". The common characteristics which cause trauma can be identified as: 1) an event that was impossible to predict (such as an earthquake or tsunami); 2) an experience that is a life and death matter; 3) a feeling of absolutely no power or control in the face of the event. Further, trauma can be also triggered by something happening to someone close to oneself or by witnessing trauma as it occurs to someone else. There is the chance of trauma happening even for people who have watched such events on television, much less experienced them directly.

Trauma itself can be explained as "the psychological state of an interruption or breach of trust between one's own self and the world outside". In other words, there is the feeling of loss about the possibility of daily living, experienced as "something is wrong". Concretely, this manifests in the loss of self-confidence to do something by oneself and the sense of betrayal by the world around oneself, which had sustained oneself up to that point. This loss of trusts leads to anxiety, such as "What is going to happen now?" and "Am I going to be OK?" as well as the arising of despair, such as "It's totally impossible now." and "It's impossible that things will get better."

Especially in the case of trauma caused by a disaster, it is easy for the feeling to arise, "I have been totally abandoned here amidst this very dangerous world". Further, in the event of the loss of a loved one related to trauma, in addition to normal grief, there are the continuing experiences of "invasive memory" as well as thoughts like, "Couldn't they have avoided death?" and "What has finally come of them?"

In terms of responding to trauma, firstly, there is the attempt to remedy the situation in which the experience that has caused the trauma is re-experienced. Concretely, there is remedying the occurrence of flashbacks and the critical self-examination and strong psychological pain that is connected with events that trigger recollection of the experience such as dreams and "invasive memory".

Secondly, there is remedying the problem of denial and paralysis. Concretely, we must not forget the importance of the experience by running away from it and becoming mindless by entertaining oneself constantly.

Thirdly, there is the problem of hyper arousal. Concretely, this expresses itself in insomnia and the inability to concentrate as well as being short tempered and easily shocked. In the case of children, it can be accompanied by over sleeping.

When conspicuous obstacles continue to cause a hindrance for more than a month and PTSD arises, there is the need for support from psychological professionals. The main causes in the shift to PTSD are: the inability to support others close to one, a high level of daily life stress, and the depth of trauma. Alcoholism, depression, and suicide are not uncommon in these cases, which were well documented in the Great Hanshin Earthquake Disaster of 1995.

There can be a great gap between individuals in how they experience and deal with trauma. Based on different mental and physical constitutions, the care giver should puts aside evaluations, because there is the possibility of repeating the trauma in the person; for example, if the caregiver uses phrases like, "It's so sad"; "There are others with worse experiences"; "Please also do your best for those who died." If the victim internalizes the experience and trauma as their own personal matter, they can become very isolated. Especially for those who have lost a loved one, they may feel, "It would have been better for me to die too." - which is something we have heard in our work in this disaster. Rather, the caregiver must become intimate with the victim's feeling, and by repeating this process of intimate interaction, gradually find a treatment that fits the victim.

For Buddhist priests in Japan, the first opportunity to connect with people, especially those traumatized by loss and death, is at funerals and memorial services. It has been heartening to learn directly from many of the victims in the disaster areas of their positive feelings towards Buddhist priests and their activities at this time through comments like, "Just listening to the voice of the Buddhist priests chanting saved me."

Buddhist priests, however, need to take this opportunity to go deeper into an intimate interaction rooted in active listening. In terms of Buddhist practice, this is related to the four practices of the bodhisattva (shi-shoho) in relating to people. The fourth such practice (samanarthata, doji) is especially important as it refers to working together by putting oneself on the same level as others and participating alongside them in activities. This can be further explained as putting oneself in the place of others and listening deeply without getting caught in one's own view. The idea is to listen as Kannon Bodhisattva would. However, it is not usual for religious professionals to have received training in such deep listening, and especially for Buddhist priests, this can be a high hurdle to get over.

A third practice beyond traditional memorial rituals and then active listening is to encourage self-respect. Victims may have to learn to not compare themselves to others no matter what the situation and to think of the preciousness of their own existence. This idea is based on the story of the Buddha who is said to have announced shortly after his birth, "I alone am the honored one in the heavens and on earth."

A fourth practice is to encourage an awareness of the connection of oneself to all sentient life in the universe. It is important to support the victim to reconfirm life, which is born from the connection to all the myriad forms, and to reconfirm the connection between oneself and one's family, friends, acquaintances, and nature.

A fifth practice is to encourage re-building karmic connections to those who have died. One can become aware of a connection to those who have died within oneself. However, it takes great power to heal trauma and grief. This involves connecting to a new identity by learning to live every day and developing the great fundamental power to move on from the past.

A final important topic in this process from psychological trauma care to existential, spiritual care is the issue of death itself. In the disaster areas, we sometimes have been asked the question from those who lost loved ones, "What happens after death?"; and "Where does the spirit go to?" The answer may differ depending on one's faith or religion. However, it is important to habitually consider the problem of the afterlife and the problem of death. Responses may differ but my hope is that religious professionals will not balk or hesitate when asked these questions.

If religious professionals do not hesitate to take on these issues, victims will not lose the trust of others and the world outside. Especially for those who have lost loved ones, I think it can be a principal case for the establishing of a new individual identity. I think this is one major potential of Rinsho Buddhism.

Systematizing Rinsho Buddhism through a Clinical Pastoral Education Program

The experiences of supporting the traumatized in Northeast Japan after the events of 3/11 have made clear the need for much more highly trained Buddhist priests. The large majority of the engagement of Buddhist priests since the disaster has been on the most basic level of performing funerals and memorial services. As explained above, some priests have tried to work beyond these confines by setting up tea parties and cafes for interacting with victims in the shelters and temporary housing. However, when traumatized people shift into the deeper psychological issues of PTSD, most Buddhist priests do not have the training to engage with them. Beyond the 3/11 disaster, there are the chronic psychological problems of Japanese society - outlined earlier such as suicide and general individual isolation - which urgently need the engagement of qualified religious professionals.

Unfortunately, there are many barriers both internally and externally to developing such qualified religious professionals to work as chaplains in a variety of fields. Externally, the Japanese medical and psychological systems are somewhat out of date and do not recognize the importance or role of spiritual and religious support for patients, while depending on purely medical interventions and pharmacology. Further, society at large has lost interest and trust in most religious professionals, especially Buddhist priests. It is usually only the desperate, who have tried many other methods, that eventually turn to religious professionals as a final resort. There are, however, certain communities, like the ones in the disaster areas of Northeast Japan, that remain relatively committed and connected to their local temples and priests. Finally, Japanese Buddhist institutions have been struggling for the past century to adapt to modern society. The training systems for their priests have little practical training for engaging in intimate, personal matters with lay people, ironically even about religious and spiritual matters.

This is where the potential of Clinical Pastoral Education (CPE) lies. CPE was originally developed in the United States in the 1920s among Christian ministers to confront very similar issues as mentioned above - specifically the major failing in religious education to train ministers in active listening. CPE was transmitted to Japan through the seminaries of Christian universities and the graduates or chaplains who work in their affiliated hospitals. However, Christian institutions are still a very small minority in Japan, which is dominated by a vast and eclectic world of Buddhist-related religious institutions. Through the influence of progressive Christians promoting CPE, some Buddhists have also sought to develop various kinds of training programs in counseling, hospice care, and other therapeutic skills over the past decade. While these programs have had difficulty sustaining themselves, there is an increasing awareness and interest in the training and development of Buddhist priests in the variety of counseling skills to which Clinical Pastoral Education can be applied.

Zenseikyo's long time experience in working with traumatized children and then its activities supporting the victims of the 3/11 disaster has led us to commit full time to the work of cultivating Buddhist chaplains, or what we prefer to call rinsho-bukkyo-shi, which can be translated as "Buddhist clinicians" or even "engaged Buddhists". While we hope to attract fully ordained Buddhist priests to the program, we are also making registration open to lay Buddhists from various backgrounds.

As Zenseikyo is an ecumenical organization, we have wide networks of religious professionals, not just Buddhists, whom we are recruiting to support us in developing this work; for example Sister Yoshiko Takagi, Director of the Sophia University Institute of Grief Care, and Rev. Yozo Taniyama, a Jodo Shin Pure Land Buddhist priest from the newly created Practical Religious Studies Department in the Graduate School of Tohoku University in Sendai, a region hard hit by the tsunami. Zenseikyo also has strong international ties, and we have been consulting with Rev. Julie Hanada, a Jodo Shin priest and certified CPE trainer at Harbor View Medical Center in Seattle, Washington; Rev. Joan Halifax, a Soto Zen priest and founder of the Upaya Buddhist Chaplaincy Program in New Mexico; and Ven. Huimin Bhikshu, co-founder of the Association of Clinical Buddhist Studies and monastic training program at the National Taiwan University Hospital's Palliative Care Unit and Hospice. Through these on going consultations, we are developing a systematic Buddhist chaplain training program based on the best practices of innovative foreign programs, while seeking to develop a particular model that fits indigenous Japanese Buddhist culture and society.

In short, we will begin our three-level training program in the spring of 2013 as follows:

・Level One (View): A 12-part lecture series consisting of 20-30 hours of instruction co-hosted by the Buddhist affiliated Taisho University in Tokyo in the Spring of 2013. This lecture series will introduce participants to the fundamental concepts of Rinsho Buddhism, socially engaged Buddhism, and chaplaincy. Assembling experts from a variety of fields, it will also expose students to practical work in the related fields of terminal care, suicide, youth problems like bullying and shut-ins (hikikomori), criminal behavior and reform, poverty, community decline, and, of course, disaster related trauma. This program will be a required preliminary for students-in-training while also being open to the public.

・Level Two (Practice): Beginning in the Autumn of 2013, a series of advanced workshop seminars for only students-in-training covering a total of 30 hours of instruction. Fields of training will cover: deep listening skills, Attitudinal Healing, role-play, counseling, cognitive and behavioral therapy, interpersonal psychotherapy, etc.

・Level Three (Residency): Upon the completion of the two above learning modules, students-in-training will begin a 100 hour residency with one of the many organizations in our network; for example Buddhist organizations working on suicide prevention and supporting the homeless; non-profit organizations working on issues presented in the Level One lectures; and other public or private organizations like hospitals and hospices open to using religious professionals. Finally, as the program progresses, we envision constructing a center where students can study that also functions as a counseling center where students can learn and practice directly with qualified caregivers and patients.

There is still an incredible amount of work to be done to accomplish our ultimate goal of developing a national system of highly trained, certified Buddhist clinicians. Such a process is years in the making, yet the Great Eastern Japan Earthquake and Tsunami Disaster as well as the Fukushima nuclear incident have provided a critical opportunity for Japanese society to shift paradigms and re-root itself in more sustainable, Buddhist inspired values. In this way, I think there is much we Buddhists can and should contribute much to the relief of those living with great trauma and grief.