The main purpose of this paper is to clarify the motive structure of the Japanese youth. This is done by investigating how young people look at themselves (youth's self-image), how the adults look at young people (adult's image of youth) and, further more, how and why these two images differ.Our subjects were chosen from the following four group; 2 youth groups including students and wage earners and 2 adult groups including university staff and managers. Four kinds of questionnaires were made for each of these 4 groups. All four questionnaires had essentially the same content and all subjects were supposed to answer the questions according to their own images of youth. The questionnaire consisted of three parts. Part I investigated youth's motivation to work and their attitudes towards superiors and peers at school or at place of employment. The items in Part II were concerned with the perception of goals in life and in Part III with how often the subjects participated in group activities.The results were as follows : (1) Students feel more urge to study as they go up from freshmen to seniors. The graduate students work most diligently, while many freshmen and sophomores show much less interest in studying. Workers in small-scale businesses are more personally involved in their work than those in the companies of larger size.(2) Generally, wage earners are more sociable than the students. Graduate students feel lonely more often than the undergraduate students.(3) In general, young people today tent to be concerned only with their onw interests.There is no significant difference between wage earners and students in this respect.(4) University staff view their students as generally being undermotivated. In contrast to this, business management tends to see the youths in their employment as being well motivated, a view which is held more strongly in Japanese industries of larger scale. However, while youths in small-scale businesses see themselves as being highly motivated, those in larger companies tend to view themselves as poorly motivated.

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Parent-child relationship appears to play an important role in psychosomatic diseases in adolescence. In this paper our main discussino was concerned with the development of these diseases from the view-point of parent-child relatinoship.In the last five years, 1970-1975,49 adolescent patients, ages ranging from 15 to 19,visited the Psychosomatic Clinic of Nagoya University Hospital, Which was 8.1% of all the patients. These patients were classified into several disease type. For the present study, 31 patients of reactive type were picked up, among whom 20 cases were able to be re-interviewed.(1) The initial symptoms were likely to appear before school examinations, during the examinatinos, in class, and on their way to school. The most important undelying factor was difficulty in adjusting to school life. Past-history reviewing revealed that most of the patients had experienced many troubles during early childhood.(2) Parent-child relationship of these patients were classified into three types; 1) interdependent, 2) independent, and 3) intermediate. Each type had the following characteristics.Interdependent type : In this type most of the patients were immature in thought and behavior for their age. Troubles with school friends served as a trigger for their school maladjustment. Such a condition subsequently resulted in the diseases. Over-protectino of their parents seemed to facilitate the prolongation of their recovery.Indepedent type : The patients behaved as if they were grown-ups in their relationship to parents and doctors. They usually expected to achieve high records at shool. When they recognized that they were not able to live up to their expectations, the diseases and maladjustment appeared.Intermediate type : The patients belonging to this type had more conflicts with their parents than the interdependent and independent types. The conflict emerged from the factitious demand, on the partof their parents, as to selection of school or occupation for their children. It was these conflicts that made the diseases more complicated and the therapy more difficult.(3) From the viewpoint of parent-child relationship, the interdependent type was closely related to the psychosomatic diseases of children, while the independent type to those of adults, However, the intermediate type showed many problems characteristic of adolescence.

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Complicated and delicate states of mind in adolescents, who are well developed physically but are immature mentally, are prone to be influenced by socio-environmental factors. The adolescents are incapable to respond and adapt themselves to these factors. Facing various psychological and metal frustrations, many adolescents are embarassed and don't know what to do with them. These conditions characterize the occurrence and course of pscychosomatic disorders in adolescence and require specific considerations for their treatment. The present report is concerned with the practical problems in the treatment of psychosomatic disorders in adolescence.The ordeal of entrance examinations seems to be inevitable for the adolecents in Japan. Since 1966,the author has been engaged in the health consultation for the 3rd year students of junior and senior high schools and for the students of preparatory schools from the view point of psychosomatic medicine. During this period I dealt with more than 300 students and was strongly impressed by the complexity of mental state in these examinees. I was convinced of the great psychological impact of the entrance examinations and of the significance of psychosomatic approach in order to remove their symptoms. In this context, some cases were presented on the basis of concrete data.Psychosomatic disorders at puberty which need to be take into special consideration are as follows; gastric and duodenal ulcers, irritable colon syndrome, dysorexia nervosa and a persistent complaint of "my body stinks". In relation to these disorders it should be pointed out that depression is not rare at puberty.Finally, the author would like to emphasize an importance of understanding the mental state at puberty, and of establishing a good doctor-patient relationship based on mutual reliance in the treatment of adolescent psychosomatic disorders.

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The pathoplastic mechanism of anorexia nervosa has been explained from somatic, psychodynamic, psychopsysiological and other specific points of view. However, a comprehensive approach is important to understand this mechanism, particularly in connection with clinical practice.The author reviewed 56 patients who had been examined or treated as anorexia nervosa at our department during the years from 1965 to 1974 and fulfilled the criteria which we devised for the present study, with particular attention to clinical phenomena, family backgroud, personality development as well as bodily experiences.The results were as follws : 1) A certain hypothalamic dysfunction, which could not always be attributed to starvation, was indicated in some patients.2) It was thought that in most patients the mother-child relationship and family background were unsuitable to their psychosomatic development from early infancy through leter periods.3) It was recognized that most patients had had some disturbances in interaction with the outer world since infancy. These disturbances manifested themselves particularly in the forms of disturbed object relationship and poor autonomy in eating behavior and/or body weight regulation. On the other hand, characteristic adaptive efforts, such as controlling their own body and bodily function, clinging to certain norms and complying with the outer world, were observed to have been developed, to compensate for these disturbances.4) Our observations elucidated that their bodily experiences were fillied with infantile anxiety, that is, anxiety about disintegration of their own personality as well as about impending loss of the object world.On the basis of these observations, a following hypothetic interpretatino of the pathoplastic mechanism in anorexia nervosa was assumed : With the advent of adolescence when instinctual drives are heightened, the adaptive efforts of anorectic patients become insufficient, inducing the fortified efforts to compensate for themselves as a defense mechanism. As the result, there is decreased interaction with the outer world, which may bring about a certain abnormality in somatic basis of integrating homeostasis. This abnomality, in turn, is supposed to reactivate infantile anxiety concerning bodily experiences and consequently intensify the same defense mechanism. At this point, a psychosomatic structure is thought to be formulated as a vicious circle.

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The author presented a case of psychogenic amenorrhea and a case of psycogenic dysmenorrhea, both of which were diagnosed as psychosomatic disorders in adolescence, in order to show the criteria of diagnosis for these disorders.In the past 4 years, the author saw 197 cases of gynecological disorders in puberty, of whom 58 cases were psychosomatic.Hormonal examinations on the hypothalamus-pituitary function in these cases reveals that although the negative feedback working inhibitively on the hormonal stimulatino has been completed, the positive feedback mechanism responding even to a very small amount of stimulation has not yet been matured in adolescent girls.The author thinks that the immature functino of the hormonal center in the hypothalamus and the instable function of the autonomic nervous system observable in puberty women are the factors playing an important role in the development of adolescent psychosomatic disorders.According to the therapeutic results obtained by the author, 44.8% were effective, 46.6% ineffective and 8.6% drop-outs in terms of psychotherapy.However, Hungertherapy, which the author designed to treat these ineffective cases, produced good results with 88.9% of effective and 11.1% of ineffective cases.

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Recently pubescent psychosomatic disorders are on the increase. Those patients find it difficult to study hard at school due to their subjective complaints of various somatic symptoms, for example, generalized weakness, fatigue, headache, abdominal pain, muscle pain, palpitation and so on.In our clinic, about 9% of the total beds are occupied by those patients. During the past 7 years, 65 such cases (45 females, 20 males) received psychosomatic treatment.Their ages ranged from 11 to 22 years old, mostly being in the senior high school period. Various diagnoses had been given to those patients at other medical services before they came to our clinic including, for example, irritable colon syndrome, atypical anorexia nervosa, tension headache, arm shoulder syndrome, lumbago and so forth. From the psychosomatic standing point , these diagnoses failed to see the essential nature of the disease. Actually, those young people have been led to maladjusted social life due to their overly protected upbringing at home and in school. As a result, they have doveloped immature personality.Our treatment began with correcting their life pattern by means of basic social training. Next, behavior therapy, mainly operant conditioning, was conducted using a complete selfreflectino method. Finally, the treatment ended with a specific 10-day fasting therapy that was originated by our research group.This psychosomatic approach was successful in 85% of the 65 cases. These students are now enjoying their school life.

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A 32 year old man was admitted to our hospital for the purpose of cardiac examination. His occupation was a conductor of a labor union in his company. He complained of cardiac attacks which mainly included the feeling of tightness in the chest.Although resting ECG records showed normal findings, delta waves with short P-R interval were demonstrated by a stress interview. Bundle branch block with short P-R interval also appeared during the attacks.He was diagnosed as WPW syndrome which was precipitated by emotional stress in relation to his occupatino such as conflicts between the labor union and employer at the time of financial crisis.

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