Psychotherapeutic Aspects of the Martial Arts MARK WEISER, M.D.* ILAN KUTZ, M.D.** SUE JACOBSON KUTZ*** DANIEL WEISER, B.A.*** The legitimacy of the Martial Arts as not merely a set of fighting skills but as therapy is being postulated, based on evidence from the literature, and analysis of the structure of Martial Arts teaching. Moreover, illustrated by a clinical case report, the Martial Arts are proposed bere, forthe firs time, as an adjunct to verbal psychotherapy. Indications and contraindications for patient selection are sug- gested, INTRODUCTION The value of practices that are both alternative and adjunctive to verbal psychotherapy has become apparent over the past 20 years. For example, dance therapy, art therapy, psychodrama, and meditation have all come to be recognized as both therapeutic in their own rights, and capable of enhancing the process of psychotherapy by providing active, physical routes for the discovery and expression of emotions, The Martial Arts (MAs) deserve recognition as worthy of being added to this list of therapeutic practices, as has already been suggested elsewhere, and to the list of supplements to psychotherapy, as is suggested here Formerly viewed by the Western world as“... naught but [a] killing present, anger past, and misery to come, in the course of one who studies these arts," the combat styles called the Martial Arts have come to be appreciated in the West in the last 25 years for their capacity to promote health, both physical and mental. They have come to be seen as inculeating physical and mental relaxation and control of mind and body, which are associated with increase in self-confidence and esteem. The disciplines teach the values of directness and honesty in communication, assertiveness, ability “Psychiatric Resident, Shalvata Mental Health Center, Mailing addeess: Shalvats Mental Health rer, P.O. Box 94, Hod Hasharon, 451000 Isra Director, Consultation Liaison Service, Shah Private Practice 1 Psychiatric Center and Sapir Medical Center. ‘AMERICAN JOURNAL OF PsvcHOTHERAPY, Vol. 49, No. 1, Winter 1995 118 Copyright © 2001. All Rights Reserved.Martial Arts and Psychotherapy to empathize, courage, humility, perseverance, gentleness, respect for oth- crs, responsibility, and self-improvement. As such, they are now understood Tess ac methods of aggression, and more as methods of self-defense, which can he of therapeutic value ‘LrTeraTURE REVIEW ‘The psychological literature on the MAs, which began to appear only in the last 15 years, has in the last four years, proliferated, and “Martial Arts and Psychology” has become an accepted Medical Subject Heading (MESH) term, The literature approaches the MAs as an independent form of therapy, both for normal and mentally disturbed individuals, and it includes studies that examine the therapeutic effects of the physical training and discipline of the MAS, as well as those that point out the processes of MAs training, which are similar to those of verbal psychotherapy. As yet, there are no works that look at the MAs as adjuncts to ongoing psychotherapy. Many studies’ concut that the mental health benefits of MAs training and practice are increased self-esteem and self-confidence, better manage: nent of both feelings of aggression and feelings of vulnerability, and decrease in sleep disturbances and depression. Moreover, training in the MAs benefits relatively healthy people as well as those who are more disturbed.* art of the explanation for some of the psychological benefits of MAs training is the positive influence of physical exercise, a central component of the MAs. Authors”! who studied the effects of walking, running or swimming, found that physical fitness alone can enhance sleep, energy level, tnood, mental performance, and concentration, and decrease tension, stress, anxiety, depression, and hostility While physical fitness may be a central mechanism by which some of the beneficial psychological changes ‘of MAs occur, the confrontation with one’s self and others that is inherent in the MAs has, according to the literature, an additional and enhancing effect,"’ although the benefits of physical training sve more immediate than are those of the MAs. A single session of running or ‘weight lifting is capable of reducing mood disturbance, tension, depression, anger, and confusion, but a single lesson of Karate is not capable of producing such results."* “The learning and mastering of the MAs are a complex and long-term process, which may not only not produce immediate benefit, but may actually increase anxiety before they cause beneficial effects."” Moreover, the benefits from the MAs are manifested slowly, over time, so that those who. have practiced longest show the highest self-esteem.°7? 19 Copyright © 2001. All Rights Reserved.AMERICAN JOURNAL OF PSYCHOTHERAPY Explanations in the literature of the basis for the psychic benefits of the MAS focus on the provision of physical activity and group experience, the Positive role model of the instructor, and the emphasis in MAs training on values such as respect, humility, responsibility, perseverance, and honor, These attitudes and values become a model for the student, which can then be generalized to many arenas of living, 42525 The management of aggression is seen as a prime example of MAs learning that is applicable to many areas of life. In MAS training, with its emphasis on the defensive, rather than aggressive use of the techniques, one must learn the containment of aggression and mastery of the fear of being attacked, so that potential attack is faced without the “contamination” of thoughts or feelings. This mastery can then be applied to coping with attacks other than physical—from the early, primal fears raised in the past by parents or significant others, to current dificult or embarrassing situations, Not only does the literature describe the therapeutic relevance of the MAs, in some papers*>*2627 it explicitly notes the parallels between the goals and methods of the MAs and verbal psychotherapy, in that both are disciplines for gaining understanding into one’s character, as well as into the forces at work in the world around one, with the aim of growth toward a new and stronger way of being with one’s self and in the world, “Analogies between the experience of the MAS and that of psychotherapy include the exposure to insights into the self through timing—the correct timing of a sparring block or the correct timing of an interpretation —and the importance of space. As physical and psychological space grow nearer, strategies for coping with increasing levels of vulnerability and intimacy must change. Both MAs students and psychotherapy clients learn to understand and deal with resistance, their own and others’, to manage both evasion and confrontation, and to cope with both aggression and vulnerability These papers even sce some methods embedded in the MAs as didactic metaphors for training or improving the skills of psychotherapists, For example, the MAs teach the technique of “extending” a challenger’s movement slightly after it has reached its natural end, similar to encouraging 4 patient or client to intentionally exaggerate his/her symptoms, for instance, to feel even more depressed.2” This exaggeration, “throws the patient off balance,” helping him to shift the direction of his energy. In another example, the attitude of constant, but not forced, concentration required by the MAs, and the free-floating attention required of the psychoanalyst are seen as parallel. Similarly, the MAs tension management through the paradox of “doing nothing,” of actively waiting, is seen as comparable to the active waiting required of a psychoanalyst with his patient 2° 120 Copyright © 2001. All Rights Reserved.Martial Arts and Psychotherapy In sum, the available psychological literature about the MAs emphatically concludes that they produce therapeutic effects on patients and therapists alike, through their simultaneous physical, interpersonal, and intrapsychic focuses. SHOTOKAN KARATE AS AN EXAMPLE OF A MARTIAL ART There are many forms of MAs, some that use weapons, such as Kendo (swordsmanship) and Japanese archery, and others that teach unarmed combat, such as Karate, Judo, Kung-fu, and Aikido. There is a continuum in the MAs from the soft, “internal” styles, which emphasize philosophy and meditation, to hard, “external” styles, which emphasize competition and Combat, A classical martial art with elements of both the internal and external, Shotokan Karate is centrally positioned on this continuum, and will be explained in some detail, in order to illustrate the therapeutic elements in the MAs. Shotokan Karate originated 1400 years ago when Daruma, the founder of Zen Buddhism, left western India for China to teach Buddhism, Daruma’s teachings were both spiritual and physical, and he is quoted as saying, “Although the way of Buddha is preached for the soul, the body and soul are inseparable,” Daruma developed a training system ‘to develop your physical strength enough to enable yourselves to attain the essence of the way of Buddha,” and with the fusion of this system with Kempo (Chinese boxing), Shotokan Karate spread to other parts of China, Okinawa, and later, to Japan. Practice of Shotokan Karate is divided into three elements: (1) Kihon, meaning “basic,” and referring to basic blocks, punches, and kicks; (2) Kata, meaning “form,” and referring to a sequence of blocks and attacks against imaginary opponents, superficially similar to a dance; and (3) Kumite, or sparring with an actual opponent. Tn Kihon, the basic movements, much emphasis is placed on the “oneness” of each motion. The entire body must move as a unified whole. For example, in a forward punch, the whole body, legs, hips, torso, and arms must move simultaneously. During the entire motion, it is very important that only the muscles necessary to hold the body up or move it be tensed, while the rest of the body is relaxed, until the moment of “focus,” the end point of the movement, at which the muscles ofthe striking arm or leg tense for impact with an imaginary opponent. At the moment of impact, the entire being, both physical and mental, is focused, concentrated, and completely immersed in the motion. ‘There are many Katas, different patterned combinations of blocks and 121 Copyright © 2001. All Rights Reserved.AMERICAN JOURNAL OF PSYCHOTHERAPY attacks, which take 1 or 2 minutes to complete. Each pattern is practiced thousands of times, until there is no conscious thought of technique, thus making the practice a “meditation in motion” or “moving Zen,” as Karate has been named The Kumite, or sparring with an actual opponent, is a kind of nonverbal communication, demanding the overcoming of fear from both participants, so that each can be sensitive to the clues of the other. The attacker and defender face each other and must maintain eye contact throughout the interaction. The attacker seeks the defendant’s moment of weakness and decides that he/she is going to strike at a certain point, use all his/her strength and ability, and not be intimidated by his/her opponent, who may be perceived as more powerful and frightening. The defender also must overcome his/her fear, so he/she can anticipate the impending attack, in order to preempt it Overcoming the fear of being hurt, especially when facing a strong ‘opponent, is not easy. The avoidance of pain is an instinctual behavior, with obvious adaptive benefits. However, fear can be paralyzing, preventing the practitioner from moving correctly, and it can destroy the calm that enables him/her to discern the subtle signs of an impending attack and thereby defend him/herself. Overcoming fear in Karate, interestingly enough, is based on acceptance of the potentiality of getting hit and feeling pain, Only when one has accepted such a possibility, can one loosen up, move correctly, see the opponent, not one’s own fear, and properly fight In addition to coping with fear, establishing the proper distance or space between opponents, called the “ma,” is important for the practice of Karate and the other MAs. One must learn to know one’s own strengths and weaknesses, which determine the distance from the other at which one feels comfortable, and to overcome one’s difficulties, so that appropriate distance can be maintained. Too much distance, and there is no contact between opponents. Too much closeness to the adversary, one will not have enough time to defend oneself when attacked. The optimal distance is not pre-set, but is dynamic, changing with each pair of opponents, and within any one confrontation, as each opponent maneuvers, attempting to penetrate the other's “ma” and thus gain an advantageous position from which to attack ‘THE MAs As THERAPY. Though there are parallels between the goals, and some of the methods, of the MAs and psychotherapy, the MAs achieve these goals through a physical, as opposed to a verbal, route. The efficacy of a physical approach is attributable to the physical basis of all experience. As Piaget 28 among othe! 122 Copyright © 2001. All Rights Reserved.Martial Arts and Psychotherapy has shown, cognitive and emotional development is initially primarily in the sensory-motor, or physical, mode. The infant learns primarily through the visual, tactile, and kinesthetic sensory pathways, which are later integrated into higher cognitions. Stem? points out that this physical mode of experiencing is present throughout life, and the capability of what he calls “transmodal perception,” means that such physical learning is automatically translated to cognitive and emotional spheres. "The physical leaning through the nonverbal exercises of the MAs can directly improve mental health. It fosters recognition of the integration of mind and body, teaches practitioners to relax, to focus, to communicate, to persevere, and to be self-aware and self-accepting, while still striving for improvement. In addition, it emphasizes minimizing fear and anger in order to maximize focus and concentration. In short, as does successful psycho- therapy, proper practice of the MAs training heightens feelings of harmony and control, and thus of self-confidence and self-esteem ‘The parallel to psychotherapy is furthered when one considers the “dojo,” or place where the MAs are taught. The “dojo” can be a school, gym, home, outdoor area, or any place where a group can practice, but it is marked as separate from the outside world of “ordinary life” by the wearing of a white “gi,” the traditional MAs uniform. This uniform indicates that material wealth, achievements, and titles are left outside, as these cannot assist in the struggle against one’s self and others. As is true in the psychotherapeutic setting, however, the problems that arise for the practtio- nets in the dojo are similar to those they have in the outside world. Their character flaws are exposed, they learn about themselves, face their prob- lems, and try to change Similarly, the Zen-oriented method of teaching in the MAs parallels methods of psychotherapy, especially with relatively healthy people. The Zen teacher does not answer the student’s question, but returns it to him/her, helping him/her find the answer within him/herself. As with therapy, the process can be painful and frustrating, but provides an opportunity for prowth, in particular for people whose problems are “neurotic” —that is, ‘who suffer from feelings of inadequacy, low self-esteem ot poor body-image, depression, and anxiety. Interestingly, people who express high levels of aggression, such as those who have difficulties with limit-setting, like juvenile delinquents, as well as people who have difficulty identifying and expressing theit aggression, such as timid or shy people, can all benefit from the aggression-contsol gained in MAs practice. While the MAs can be insight-promoting for healthier subjects, because of their physicality, they may also be appropriate for more disturbed 123 Copyright © 2001. All Rights Reserved.AMERICAN JOURNAL OF PSYCHOTHERAPY populations, such as the chronically mentally ill. The repetitive, fixed exercises can be organizing, whereas the chaotic thoughts and behaviors of such patients restrict their ability to utilize a verbal mode. ‘These patients Fequire constant supervision while training, to anticipate and prevent psychotic relapse and violent outbursts. A knowledgeable teacher can be both a respected authority figure for these patients and a close observer of patients” status The MAs as therapy are contraindicated for persons who are likely to lose control and use the techniques learned inappropriately, such as sociopaths, people suffering from impulse-control disorders, and ‘alcoholies and drug addicts, who are actively drinking and abusing drugs. To quote two relevant axioms: “All Aikido arts are secret in nature and are not to be taught to rogues who will use them for evil purposes,” and “He who puts a sword in the hands of a crazy man is crazy himself.” ‘THE MAS As SUPPLEMENT TO VERBAL PSYCHOTHERAPY That the practice of the MAs can be a form of psychotherapy has been argued in the literature and analyzed here, That they can also supplement other, more verbal, forms of psychotherapy is hereby proposed, As Kutz, Borysenko, and Benson,*® demonstrated with regard to the practice of Mindfulness Meditation, MAs practice exposes problems, which, once observed, can be worked on in psychotherapy. Because the context and experience of MAs is so different from daily life, difficulties in relating to one’s body, in coping with fear, and in regulating interpersonal distance, for examples, are revealed to the patients in a highlighted, tangible manner. They can then profitably examine them through the cognitive-verbal mode of psychotherapy. In addition, with patients’ knowledge and consent, psychotherapists can make a formal alliance with psychologically aware MAs instructors, of which there is an increasing number (who can be found at MAs training centers or through word of mouth), with whom the therapist could meet periodically to discuss patients’ progress. The following case illustrates the positive effect of MAs in an ongoing psychotherapy. Case 1 M., a 20-year-old man, came to therapy because of feelings of depres- sion, existential confusion, a sense of social inadequacy, and repeated difficulties in forming a relationship with women, During his first year of therapy he described a childhood history of unhappiness, fear of his unempathic, despotic father, and distance from his mother. He also raised the suspicion of having been sexually molested but did not have any memory 124 Copyright © 2001. All Rights Reserved.Martial Arts and Psychotherapy traces to support that feeling, His intense feelings, at times bordering on the psychotic, of isolation and confusion, were accompanied by suicidal ideation and one undecisive suicide attempt. During his second year of therapy, M. joined a Shotokan Karate club, and began practicing regularly, “in order to increase self-confidence.” Soon after beginning the Kata, dance-like routines, he reported feeling more centered and confident, and attributed this good feeling to the harmonious motion and mental concentration he felt during and after the Kata exercises. When the Kumite, the sparting with a real opponent began, M.’s level of anxiety increased markedly. In his therapy, he described his feelings, when facing his opponent, as ones of intimidation, dread, and humiliation, followed by numbness and depersonalization; “It is as if I don’t exist anymore.” These emotions were particularly aroused when he was hit or overcome by the sparring partner. Explored in therapy, these feelings led to the unfolding of screen memories with painful details of his repeated sexual abuse by his neighbor, who, he later discovered, was also his mother’s lover. Ms sense, familiar to him since childhood, of utter helplessness and despair, of having no one to turn to, was repeated in the dojo with every Kumite, and explored within subsequent therapy sessions, linking his sense of dissociation and depersonalization to the intense rage he felt within him when facing the threat of the other. (Later in therapy, he dared admit that the close physical contact was also associated with some homosexual ideation, which was exciting, as much as horrifying for him.) The rage was accompanied by infantile magical thinking. M. felt he could not only kill, but devout ot pulverize his opponent. Such feelings terrified and paralyzed the patient to the degree that he considered stopping his Karate training, but with exploration, they were gradually modulated. For M., the physical experiences at the Karate school had a dual, complementary effect of increasing his self-confidence and arousing fear- some emotions. Aided by the greater confidence he felt, he could translate the difficult emotions into a verbal mode and bring them to therapy, thus enabling some working through and integration of these traumatic exper ences, Although this therapy was not smooth, it would have been slower and more arduous without his experiences in the MAs arena As they did for M., the MAs may usefully foster verbal psychotherapy for psychosomatic and alexithymic patients. Described by Nemiah and Sif. neos,}! and by Sifneos,® such patients deny feelings and have difficulties verbalizing about those affects they do feel. The MAs arouse feelings that, because of their intensity, are hard to deny or suppress. And, because the 125 Copyright © 2001. All Rights Reserved.AMERICAN JOURNAL OF PSYCHOTHERAPY feelings are expressed physically, they are easier for nonverbal patients to identify, then translate into words, and address in psychotherapy. In addition to being combined well with verbal psychotherapy, the MAs could be combined with group therapy. A good dojo has some elements of a therapeutic group: the participants interact with one another, brave difficul- ties together, and foster in each other experiences of growth and change. With a MAs teacher who is part of the group or, more ideally, is also a trained group therapy leader, the elements of MAs practice could be combined with verbal group psychotherapy, by discussing at the end of each MAs session the feclings which were aroused in the ‘dance’ and sparring exercises CONCLUSION With evidence from the literature and analysis of the structure of MAs teaching, the legitimacy of the MAs, as not merely a set of fighting skills, but as therapy, has been argued. Moreover, with the illustration of a clinical case report, the MAs has been suggested as a potential supplement to verbal psycho- therapy. It is the authors’ hope that future clinical and research data will further illuminate the connection between verbal psychotherapy and the MAs, SUMMARY Formerly understood by Western thought as only a set of fighting skills, the Martial Arts (MAs) have come to be seen, in the psychological literature about the MAs, as a comprehensive approach to both physical and mental health. The MAs enhance self-esteem through the provision of physical activity and group experience, and the teaching of relaxation, concentration, assertiveness, and directness and honesty in communication. Thus, they are understood to be a legitimate form of therapy, for both “neurotic” and some chronically mentally ill patients cis proposed in this paper, that the MAs can also be a useful supplement to verbal psychotherapy, as they foster and expose feelings through a physical modality, which can then be observed and analyzed in the modality of verbal psychotherapy. 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