Sokun Tsushimoto: Caring for body and soul

With his shaven head, straight back and deep, calming voice, Sokun Tsushimoto, a newly qualified physician who started practicing at a Tokyo clinic in April, clearly betrays evidence of his long and rich life experience.

Until he set out on his eight-year study/training path toward becoming a medical doctor in 2000, Tsushimoto practiced in an altogether different field — that of Zen Buddhism — in which he had held one of the highest positions in the Rinzai School, one of Japan’s two major schools along with the Soto School.

Although he no longer belongs to any Buddhist group, nor has any official status as a monk, the 54-year-old native of Ehime Prefecture in Shikoku still says that he is a priest who also happens to be a physician — not the other way around.

And while Japan has a number of Christian, Buddhist and Shintoist doctors, what separates Tsushimoto from the rest is that he was a high-ranking priest who has spent most of his life being trained in, thinking about, studying and teaching on matters of life and death.

Tsushimoto, born a son of a temple priest in the city of Yawatahama, says that, like many others in similar circumstances, he was drawn by the “gravity” of his family lineage to inherit that profession — just as most Buddhist priests in Japan inherit their jobs, except for a few “outsiders,” who feel personally and powerfully drawn to the priesthood.

So, after studying philosophy at Kyoto University, Tsushimoto trained at Tenryuji Temple in Kyoto for more than 10 years, becoming superintendent priest in 1993 at one of 14 Rinzai School groups at age 38.

Already on a fast track, he could have continued his career from there as an elite monk — but he didn’t.

Frustrated by his lack of medical knowledge when he tried to help people negotiate the unavoidable process of dying — and faced with contradictions of organized religion, which is often more interested in fundraising and adhering to doctrines than in solving people’s real-life needs — he decided to become a doctor so he could look after people in both body and soul.

Over the following six years, Tsushimoto studied at Teikyo University in Tokyo with classmates almost half his age, eventually passing the national exam to become a licensed medical doctor. After that, he had to complete a two-year residency training before qualifying to be a practicing physician. He now works three days a week at Kuramae Internal Medicine Clinic in Tokyo’s Taito Ward.

Tsushimoto, who is married and has two school-age daughters, recently sat down for an interview with The Japan Times, to talk about his time as a trainee monk, his reasons for turning to medicine as a career and much more. The following is an excerpt from that four-hour interview.

As the son of a Buddhist head priest, did you have any reservations about following your family’s profession?

Most children born in temples don’t want to become monks. It’s just a matter of how far away you can get from the gravity (of the family tradition). Some struggle in other parts of society and return to the religious community. But as far as I know, only a handful actively set out to inherit a priesthood.

So you think that people generally become monks because they regard it as their fate?

Yes. Most of them come to terms with that reality. . . . I don’t think it’s so bad to explore many opportunities outside temples and then, accepting your fate, to return to life at the temple. Even if they were pulled back by gravity, they’ve still had a good life experience outside.

What was it like for you?

I was also pulled back (laughs). I have one foot in the religious field, the other in medicine. I’m happy with the way it is.

You studied philosophy at Kyoto University. What was it like there?

I majored in religious studies there in the department of philosophy. I studied a variety of things — Western philosophy, Chinese classical philosophy and Indian philosophy. That was in my late teens and early 20s, so my interests were diverse.

What did you focus on in particular?

I was interested in views of life and death, and especially in new religions. I did some fieldwork as I thought the best way to learn about them was to go and feel the live energy of those groups. One that I visited had elements of shamanism and another promoted the idea that the world is coming to an end but God will save us. They had grand, mythical views of the world. I found them appealing, and realized that such views could be easily aligned with political energy — almost like the energy Hitler used to have with his unique view of the world. In wartime Japan, we had a religious group called Omoto-kyo with a unique view and set of values, but it was disbanded in a government crackdown.

Omoto-kyo?

Yes. It was founded by a man named Onisaburo Deguchi, who people referred to as Wanisaburo Deguchi. He probably had supernatural powers from the time he was little. One of his followers was a man named Wasaburo Asano, an English literature scholar who was influenced by British spiritualism that had come to Japan in the Meiji Era (1868-1912), and he mixed that with the Shinto preached by Deguchi. Asano contributed to the birth of many other “new religion” groups in Japan.

After graduating from university, you went into Zen training at Tenryuji Temple in Kyoto. I understand the monks’ morning training starts at 4 a.m. Is that correct?

It depends. On some days, I used to get up at 3:30, and at 4:30 on other days. About three days a month, when we finished a weeklong ceremony, I was given a break and would be able to sleep until 6.

When did you normally go to bed?

We would finish training under the supervision of a training monk at around 10:30 p.m. Then it was time for everyone to go outside individually, taking a zabuton (floor cushion) with them, and find their own favorite place to meditate. I was expected to meditate for at least an hour, but some motivated ones would continue for two hours. When I was in a good condition, I would continue sitting outside until 4 a.m. when the temple bell rang and it was time to start the morning session all over again.

Isn’t it hard to live like that all year round with hardly any time to sleep?

Sometimes you are sleeping while meditating — and that is a pleasure. You might not be sleeping continuously, but you sleep here and there. When you meditate, you sit in the same place for four or five hours, so you can’t maintain your concentration the whole time. After a small doze, you are refreshed and gain the energy to concentrate again.

After that, at the age of 38, you were appointed as a superintendent priest of the Buttsuji group, one of 14 subgroups of the Rinzai School of Buddhism, and were thus invited to be based in the group’s head temple in Hiroshima Prefecture. What was life there like?

The experience changes depending on where you go. My temple was in the countryside, but even within that small organization there were factions and there was political infighting. To some people I was welcome, but to others I wasn’t.

Were you elected to be a superintendent priest?

No. People from the temple invited me to head the temple. However, the fundamental problem with the temple was that it was in the countryside and people were narrow-minded. So they were wary of accepting an outsider, even though they knew they had to change the temple and hadn’t the knowhow to do it.

What was it they had to change?

Fundamentally, religion is not suited to organization. When you look at the origin of religion, you see that Buddha and Jesus Christ were individuals, around whom groups of followers were created.

When religious groups are formed, a range of secular principles are also born. That’s because the groups have a need to maintain themselves, as well as to expand and propagate their ideas. Then money becomes an issue and groups develop political feuds with other religious groups. Under such circumstances, pure religious beliefs often run counter to organizational needs.

As a result, monks end up discussing budgets, the amount of donations they need to collect and how to achieve their targets by doing this and that. . . . It’s almost like a business.

Another thing is, religion does not change. Sutras from 2,000 years ago are often used as the basis of values or how to behave, and monks try hard to put a contemporary spin on them to make them relevant to today’s society. But even if you tweak the sutras to fit modern needs, there is a limit. Sutras weren’t written with concepts such as brain death and organ transplants in mind. However, monks today are also affected by the scientific pragmatism of the 21st century, so it is extremely difficult to mix those (contemporary) views with the traditional mind sets of their religious groups.

Shortly after you entered medical school in 2000, determined to become a doctor, you were effectively forced to resign from the Buttsuji Temple and lost your official status as a monk. Why did you feel you had to do that, when pursuing a religious calling alone could have been worthy and challenging course?

There are two reasons. Buddhist priests are often criticized for showing only up at funerals and not responding to social needs, and they are all very well aware of the criticisms, but don’t know what to do. So it has been a big theme for Buddhism how to help people through the process of sho ro byo shi (being born, aging, becoming ill and dying). But when they wear their robes, people look at them as something ominous. Monks are not even welcome in hospitals. But sho ro byo shi are most often happening in hospitals — with many people dying there. The essence of sho ro byo shi is concentrated at hospitals, yet we can’t even freely go in.

What do you mean that you can’t go in?

In the West, Christian ministers and sisters have no problem reaching patients inside hospitals. It’s the same for some Christian hospitals in Japan. But in Buddhism, because you have to renounce the world to become a monk, monks have been somewhat insulated from the rest of society.

Of course, if you look back in history, there are many priests who went out and helped the public. But under the Tokugawa Shognate (1603-1867), the danka parishioner system started, whereby people were made to belong to temples to prevent them from converting to Christianity. Once a family became a danka member of a temple, their descendants belonged to the same temple semi-permanently, assuring temples their sources of income without having to aggressively look for them. So temples got lazy. The danka system is one reason why Buddhism became corrupt in this country, I think.

Also, the Buddhist robe has come to be associated with death. When I go to a hospital wearing a robe, people look at me coldly. We are never welcomed, and people even ask us, “Has somebody died?” If we tell them that we are trying to console the sick or pass on the teachings of Buddha, we may well be told that we are completely out of place.

So I thought, “Well, then, why don’t I go in there wearing a white robe, as a doctor?” That was one, simplistic line of thinking behind it.

There was another reason for me to seek medicine as my profession, and that was that monks look at people’s souls and minds, whereas doctors look at people’s bodies. I think human beings are made up of both body and soul. So if you want to look at someone holistically, you need to be able to look at both. Monks don’t know how to look at humans physically, regarding it as something only material. But when people feel pain, it’s because they are damaged physically. You need to know how to look at the physical side of humans, or you cannot talk about life and death. I’m not saying every monk should become a doctor . . . and of course that’s just not possible. But a few of us could, and should.

My other reason for turning to medicine was personal, and that had to do with my own father’s death, which turned my idea of death upside down. Before that, I was unnecessarily afraid of death and regarded it as something to shun. But I realized that death is a process, and that it affects not only the dying person but also his or her family and others. I saw it for what it is, and that impacted me very much.

How did you finance your medical studies?

My old Buddhist shisho (master) paid the admission fee for me because I had not planned out the financial part of my studies, and so after I passed the entrance exam I started to scramble for funds. After exhausting all options, I went to my shisho to ask for help. I had almost given up going to the school, to tell you the truth, but many other high-ranking priests also helped me financially by submitting their works of calligraphy. My supporters would hold an exhibition twice a year — one in Tokyo and one in Kyoto — and proceeds from sales of the works would be given to me so I could pay my tuition. I have also raised some money by making speeches and writing short essays. Then some others helped me through donations.

Did you get financial help from danka families you served in Hiroshima?

No. They rather protested my move. Most of those who support me today got to know me through articles about me that have appeared in the media.

I also understand that you became ill and took some rest during your hospital residency training. When was that?

That was three years ago. It’s a bit complicated. I had my residency training at a Tokyo hospital. It was tough physically, but more than that I didn’t get along with my immediate supervisor. The way it works is that a first-year residency trainee is taught by a second-year trainee, who is taught by a junior doctor.

Teaching is also learning, so it’s supposed to work. But it can lead to a situation where an immature person is being taught by another immature person. These are people in their mid-20s who have no life experience but are exceptionally smart. They may be conceited because everyone suddenly starts calling them sensei (learned person), and when you have someone like that above you it can be tough. I wasn’t obsessed with the fact that I was way older than them, or what I was doing before, and I didn’t mind having a young supervisor. But I just found my particular supervisor hard to cope with, which doubled and tripled my fatigue.

And I had studied for six years with no rest at all, so I decided to take a break for about 10 months, and I started my two-year residency all over again the following year. That time, I did my residency at a hospital affiliated with Teikyo University in Tokyo. However, the demands for physical stamina remain a big challenge for me.

When you took some time off, did you ever regret your decision to change your career after the age of 40?

No. But things were not easier at the Teikyo University hospital. For one thing, most people did not shown consideration for my physical stamina or my age. That’s understandable, as I used to be tough on old or retired people who sought religious training. I think I was more accommodating than others, but I was also tough on them, adopting an attitude of “If you are not up to the challenge, just leave.”

Professor-level doctors were a lot more accommodating, because they were generally in my age group and they also thought they couldn’t work as hard as the young ones.

The second time around, my supervising doctor was also much younger than me, but he was nicer than the first one.

Was residency hard physically?

Yes. Doctors would make their daily ward rounds at 7:30 a.m., which meant I had to be at the hospital at least 30 minutes before to check the conditions of patients from the night before. At night, I couldn’t finish work until after midnight. I barely made the last train. I hardly had time for lunch. That lasted for months. I lost quite a bit of weight and I think I looked pretty depressed. And then as the health of the patients I saw deteriorated, I wavered, too. It added to my stress.

Have any particular patients left a deep impression on you?

That would be my first experience of being present at a patient’s deathbed. He wasn’t so old . . . a few years older than me.

Was he in his 50s?

Yes. But he looked like a really old man. He had an incurable disease and started to have difficulty speaking. He asked me once why he had to suffer from such a condition, though part of him had accepted the fact that he had an incurable illness that would lead to his death. But even then, when he had difficulty breathing, he couldn’t help but wonder how much more he would have to suffer, and how he could be relieved from his pain.

After my first attempt at residency training, I had my workload reduced a little bit, so I had fewer patients to look after. That meant I had quite a lot of time to care for that patient. I was in charge of adjusting his medical ventilator (to help him breathe). It was a futile process, in a way, because his condition was only going to get worse. He lost the ability to speak so we started communicating by writing memos. He would occasionally manage a whisper, but his voice was inaudible due to the noise from the vital-signs monitor.

How long were you with him?

It was less than a month. Since I could not be at my father’s deathbed, it was the first time I — either as a doctor or as a person — witnessed someone’s death. I was worried, too. On the other hand, the nurses were so used to seeing people’s deaths, and were so methodical about their way of dealing with patients, that I found it disturbing and irritating.

What do you think you did for that person? Did you say something to assist him?

No, not in words. When he asked me, “How long will this pain last?” I couldn’t tell him how long. Neither did I feel it was right to say, “You’re going to die soon, so that’s when you will stop feeling this pain.” And he knew that himself. When he asked me why, he was asking something else. He was asking me about the pain of existence, and that is a question with no answer. Maybe he was looking for something spiritual, and all I could do was be with him. He would also shake my hand, and I was grateful that he wanted me to be there at the very end. You don’t have to be prepared to do or say something in situations like that. Words might or might not be necessary. The most fundamental thing is to be around, and to listen to the breathing of the person.

You have said that you find institutionalized religion contradictory. But health care is also institutionalized. Isn’t it difficult to deliver ideal health care in today’s circumstances?

Yes, it’s difficult. The bigger a medical institution is, the more hierarchical it gets. More people work as a team of care providers, then there are times when they are not able to accommodate the needs of each individual patient. But in a clinic-type setting, and if you go and visit a patient’s home, you can provide the most natural care for the patient. Big general hospitals have their uses — for acute illnesses especially. But I see hope rather more in home-based medicine, where a doctor/nurse team can deal one-on-one with a patient, especially in end-of-life care.

Japan is infamous for having one of the highest suicide rates in the world. The government has started taking action, but the religious community, especially the Buddhist community, has long been criticized for doing little to mitigate the problem. What can be done about this?

Some activist monks have been volunteering as counselors for Inochi no Denwa (Lifeline) and other telephone-counseling services. And there are others who exchange letters with those who have tried committing suicide or are contemplating it. But in truth, they are a minority. Also, temples as organizations have been inflexible.

I think there are economic reasons behind some suicides, so that should be dealt with as part of social security. And those who are suffering from depression should be medically treated, I think. But religious practitioners should delve into more fundamental questions, such as why it’s wrong to commit suicide, and why it’s wrong to kill people.

The revised Organ Transplant Law was just recently passed, and I was asked to make comments by several media organizations. My view is that religious practitioners should talk more about fundamental things, like what life is, what death is — not so much about whether they agree with Plan A or Plan B.

My stance is that we don’t even know what death is exactly, so we can’t define death. I know that many people are waiting desperately to get an organ transplant and they are running out of time. But apart from that, I feel that we should look harder at the process of death. Science alone cannot do that, because we can’t scientifically determine what happens after someone’s death. Near-death experiences are also just impressions of those who have experienced them. We should look squarely at these issues from interdisciplinary points of view — utilizing the expertise of people in brain science, medicine, religion and psychology.

But are people on the verge of killing themselves or in terrible pain likely to listen to calls for deep thinking on the meaning of life and death?

Probably not. People who are in pain should have their pain relieved (through medication), then they can start thinking about these things. People who want to kill themselves won’t listen to big ideas. But ultimately, people themselves must come to terms with issues of life and death.

You say you call yourself a priest more than than a doctor, citing your longer career as the former. Will you still be saying that in the future when you will have become a veteran doctor?

Yes. For me, this is a medical development of religion. If I start my next life as a doctor, it would be the other way around. (smiles)