More often than people realize, psychological distress is caused by some combination of lack of meaning, lack of social engagement, and lack of spirituality.  These and other existential issues aren't always discussed in Western therapies, but that doesn't make them any less real.

Also not always delved into in Western therapies are the concepts of duality and non-attachment, social service as a means of transcending self-absorption, and the importance of mindfulness, meditation and yoga. We come from a culture that insists that to resolve our mental health problems, we need to focus on them- and ourselves- more. How do I feel? What do I need? What am I missing?

The answers are out there, if we're willing to listen, and looking in the right place. Recently, for me that place has been Eastern Philosophy, including Asia's two more prominent forms of psychotherapy, Morita and Naikan, both of which purport to offer complete psychological cure from fear, psychosomatic pain, perfectionism, anxiety and neurosis.

How do they do this? In the case of Naikan, the resolution of these issues comes from asking and answering three simple questions about the people in your life. These questions are:

what did that person do for me?
what did I do for that person in return?
what trouble and inconvenience did I cause that person?

As you probably noticed, not one of the questions is about ME. Both Naikan and Morita believe that relief from anxiety and malaise comes not from asking "what's in it for me" and "what have I not been given" but rather "what have I not given?"

It would be easy to dismiss Naikan as some Zen, optimistic ideal if it hadn't been proven in a series of studies to be as effective if not more than our own Western psychotherapies. Which means that the roots of our anxiety may in fact be culturally created and empowered. Rather than an innate and inflexible response in all people to a host of life and family circumstances, anxiety may in fact be caused in large part by our conscious preference for self-focus, self-obsession, and self-absorption.

This is a hard pill to swallow- on a number of levels- for us Westerners... one that many people can't or don't want to stomach. The idea that psychological unease can be resolved by an increase in gratitude and a decrease in victimhood is uncomfortable. Neither do Naikan and Morita seem, from our perspective, to take into account the anguish caused by physical and psychological abuse, or to hold the perpetrators conceptually responsible in any way, upping the discomfort level to infuriating...

Still, the next time you take a yoga class, go for a walk or sit before the majesty of the setting sun, consider quieting the litany of thoughts running through your head... your to-do list, your drama, your issues, your pain, and ask... first about your mother, then about your father... next about your siblings, then about your children... then about your friends, your colleagues, and your partner:

what did that person do for me?
what did I do for that person in return?
what trouble and inconvenience did I cause that person?