Psychosomatic medicine was an area hitherto unharnessed in pediatrics in Japan and neither textbooks nor lectures provided in medical schools covered the subject matter. With a greater specialization in medicine, based on individual organs of the body, pediatrics has also treated the road towards finer analytical process. As a consequence, bacterial infections were well controlled in children and many prophylactic measures for viral diseases were discovered, bringing a drastic change in the constituent of organic disease that are encountered in the pediatrics field.Despite such remarkable strides in pediatrics in responding to organic disturbances, the neglect of teh human factors such as the suffering child and his family remains as an indelible fact. The author has been stressing the importance of the comprehensive and holostic medical approach covering both the mind and the body inclusive of the family, particularly the mother, in achieving the objective in pediatrics.Recently, however, distrubances that require treatment with due regard to the contribution of psychological factors are increasing at a rapid pace. With greater general acceptance of this phenomenon medical insurance on counselling service for certain pediatric disturbances has come to be approved and psychosomatic medicine is attracting greater interest among pediatric specialists as well as the future candidates of the profession.The author felt strongly that pediatric clinicians should all in all consider the (child) patient and his guardian parents, mostly the mother, as single entity in order to carry out a comprehensive and holistic practice founded on the principle of psychosomatic medicine as illustrated in Table 3 in the text. The following pages describe psychosomatic symptoms in children and psychosomatic considerations needed in daily practice as elaborated by specialists of the respective areas.

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It is necessary for the pediatrician to practice psychosomatic approach to his out-patients for the purpose of finding out their psychosomatic disease and neuroses, as well as of investigating physical illness.When we understand what a child is, it is useful that we look a child by metaphor as a ball (sphere) which consists of the disposition (temperament+constitution), upbringing history and environment (Fig. 1). Then if we consider a disease as a cone, the child's situation, when he gets ill, looks like the cone breaking into the ball as Fig. 3. Generally the pediatrician looks at a disease only from the bottom of the cone, but with psychosomatic oprientation, he must look at the cone from every angle through the ball.This theory can be illustrated as follows.1) The pediatrician must take enough time to consult the patient from the standpoint of holistic medicine.2) The pediatrician generally only hears the parent's complaints about his child but must hear and ask the child's own complaints and then analysis the differences between the two.3) Laboratory examinations should be limittd. The pediatrician must attach more importance to imformation which is obtained by questionning.4) There are various methods to approach to the patient with psychosomatic disease or neurosis. So the pediatrician must choose the best method for the patient on the basis of his knowledge and experience of psychosomatic medicine.5) It is not good to place the neurotic patient in the pediatric ward of the hospital.

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The psychological and physical conditions necessary for the onset of infant bronchial asthma is laid down between the ages of 0-6,and the bodily an mental growth, particularly up to the age of three. The strains in development and strains in personality growth have particularly strong influence of the pathogenesis of hte disease. In order to understand the mechanisms of its onset it must be notes that the parent-child relationship in the human being is very much billogical and specific to himself such as manigested in a child who had been raised by wolves taking on the characterisitcs similar to those of wolves, and that the parent of the human being can offer negative parental care.When a child is raised with insufficient mental and bodily activities, psychosomatic condition is established in him which is vulnerable for the onset of asthma.It is probable that the necessary condition for the onset of adult bronchial asthma is laid down during infancy. In this paper, therefore, an examination was conducted regarding the patient's childhood personality characteristics and activities and the attitudes of parents in childhood. It was found that the adults with bronchial asthma in their childhood were clearly introverted in character, defensive, dependent and quiet. The did not play much outdoors but spent much time on their own; and moreover, their parents were characteristically nagging and anxious.

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The period of childhood is a process of development. Psychosomatic reactions which appear in the childhood may vary from one period of development to another from the immature type to the mature type. Therefore, children's psychosomatic disease should be considered as floating and unfixed in nature. Cases of anorexia were analyzed from this point of view. In comparison with anorexia nervosa (AN) environmental and social factors seemed to be affecting more directly the onset of this disorder. The isokation among their friends and the difficulty of adaptation to school which resulted in school refusal were often seen among these children. As the disorder progressed, children became inactive and depressive. In contrast with AN, it was easy to let these children have a will to become healthly and the recovery could be seen within a few months if an adequate treatment was given. They tended to be nervous, introbersive, methodical, dependent, perfectionistic, and usually regarded as "good children." A strong symbiotic union was seen in mother-child relationship. The group of children who has these distinctive features described above may be classified as a new disease entity, named "Eating refusal", a pre-reaction of AN

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In pediatrics, we see the need for comprehensive and developmental medicine where the needs of the physical, mental and emotional being are treated as one and not separatd entities.We also notice that children are more influenced by physical and environmental factors than personal factors as shown in the adult. So pediatricians usually have interests and been involved in the field of prevention and consultation through health care clinics, well-baby clinics, child guidance clinics, institutes of handicapped children, school doctors, etc., and now pediatrician's works are expanding into the educational field. In Japan, pediatric psychosomatic medicine has not yet been fully developed as it should have.There are several reasons for this, which I would like to explain. First, the child develops with age, but is still immature compared to teh adult. Psychosomatic diseases in the narrow sense are associated with the fixation of symptoms in certain organs, but in the young, fixed disorders are only infrequently encountered, Second, research techniques specialized in pediatric psychosomatic medicine have not yet been developed. Third, psychosomatic clinics for children are not very well paid for in Japan. Fourth, we don't have teams of specialists organized to treat children from the psychosomatic view point in Japan. Lastly, some people say that pediatricians don't have the necessity of psychosomatic medicine because pediatricians usually maintain the idea of comprehensive medicine, and spend much time to the guidance of rearing and caring methods for children. I partialy agree with this opinion; hawever, I believe the psychosomatic approach in pediatrics is necessary to achieve healthy and happy lives for children, and to prevent psychosomatic disease in the adult. Therefore, we have organized the regular meetings in Japanese pediatric association to discuss and research in the practice of psychosomatic medicine.In conclusion, I would like to consider what we can contribute to comprehensive medicine as a pediatrician.1) Prophylaxis of diseases of adults.2) Research of the course of fixation and erpresentation of psychosomatic diseases.3) Comprehensive pediatrics will make children healthy and happy, and promote their healthy and happy life in the future.4) Comprehensive pediatrics are needed to give guidance to parents, and also to help teachers by giving advice on comprehensive education. These are essential roles of pediatricians.

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1) We devised a new equilibrium test termed "Equilibrium test for neurotic vertigo". In this test, a subject who shows development or increase in vertigo and ataxia after an injection of adrenaline is stimulated by hearing suggestive words, such as [I am going to give you an injection of adrenaline], after which physiological saline solution is injected subcutaneously as a placebo. The resulting changes in eye and body equilibrium function are examined by various equilibrium tests and compared with those induced adrenaline itself.2) This test showed in vertiginous patients with cranio-cervical injury two reactions of Type A and Type B. In Type A, placebo results in development ofr increase in ataxia, and the ataxia thus induced tends be similar to that induced by adrenaline. In Type B, saline solution has no significant effect on eye and body equilibrim.3) With reference to the results of our animal experiments and patients with cranio-cervical injury, we postulate that Type A is induced in the following manner; abnormal excitation of the temporal cortex, which is brought about by psychological stress, affets the hippocampus, particularly its adrenergic component through the neural linkage between the two parts of the brain mentioned above. Thus, over-stimulation of adrenergic component of the latter brain is induced, resulting in development or increase of disequilibrium of the eyes and body. This, of course, leads to teh appearance or increase of vertigo in patients with Type A.4) Type A is considered to be of psychosomatic origin, since this type of ataxia has the following characteristics : i) In patients with Type A, the patterns of ataxia by the above mentioned equilibrium test are specifically correlated with the locus of lesions in the equilibrium system. ii) In these patients, there is an alteration in types of ataxia in the course of treatment and moreover, this alteration appears in relation to psychological factors. iii) Type A is frequently observed in patients in a hysterical state of traumatic neurosis, whereas this type of ataxia is never seen in other types of mental diorders, such as neurosis and masked depression.5) With reference to the results of our animal experiments and patients with cranio-cervical injury, we postulate that the cerebellum, albeit not a primary neural element in production of vertigo of psychosomatic origin-nevertheless affects the adrenergic component related to the hippocampus, thus enhancing development of vertigo of this type.

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Psychological characteristics of eight groups of chronic patients (N=240) were examined by factor analysis. The diseases studied consisted of cancer, chronic nephritis, chronic hepatitis, diabetes mellitus, rheumatoid arthritis, atopic dermatitis, unidentified clinical syndrome, and habitual constipation. Thirty subjects from each of the eight groups were randomly selected from the in- and out-patients at our clinic. A total of thirty-one variables : Thirty scales from the two psychological tests (the Yatabe-Guilford Personality Inventory and the Cornell Medical Index-Health Questionnaire) given to the subjects mainly on their first visits to us plus the period from the outbreak of their diseases to the time of the tests were factor-analyzed by the principal factor method.The analysis revealed five factors. Factor 1,with a factor contribution rate of 62.2%, was supposed to be related to emotional instability and somatic complaints; Factor 2 was related to extroversion; Factor 3,impulsiveness; Factor 4,thinking extroversion; and Factor 5,period of contraction. However, it appeared to be justifiable to tentatively not consider Factors 4 and 5,both because they showed a low rate of factor contribution and because few variables had high loading for these factors.Furthermore, factor scores were calculated for each patient for each of the five principal dimensions. An examination of the eight diseases on the basis of these factors suggested as follows : (1) Of all the patients, those with unidentified clinical syndrome were more likely to be high in emotional instability and somatic complaints, while those with cancer were least likely(Factor 1); (2) Those with atopic dermatitis, although low in activity adn social extroversion (Factor 2), showed a marked trend toward aggression and impulsivess (Factor 3); and (3)Conversely, those with rheumatoid arthritis were suspected to be the lowest in aggression and impulsiveness among the patients.

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片頭痛および筋収縮性頭痛の心身医学的特性を明らかにする目的で, 心理的側面, ストレスに対する反応性, 自律神経機能の側面から検討を行った。 さらに精神生理学的治療手段としてのBiofeedback療法を施行し, その有用性および心理的因子との関係につき調査した。 心理テストとして, Manifest Anxienty Scale(MAS), Self-rating Questionnaire for Depression(SRQ-D), Maudsley Personality Inventory(MPI), Egogram Check List(ECL), Yatabe-Guilford Personality Test(YG test)を施行した。 ストレスに対する反応性を, Mirror Drawing Test(MDT)を用いて, task performanceを検査し, 状況不安としてとらえた。 自律神経機能検査法にはMicrovibration(MV)を採用した。1) 片頭痛に比し筋収縮性頭痛では, MAS, SRQ-D, MPIのN項目で有意に高値を示した。両疾患群とも低不安群のエゴグラムは, ほぼ同様のパターンを示し, NP-dominant FC<AC型であった。 高不安群のエゴグラムは両者に違いがみられ, 片頭痛ではCPが高く, 筋収縮性頭痛ではACが高値を示した。 自律神経機能に問題を有すると考えられた症例は, 両疾患群とも約60%を占め, 差は認められなかった。 状況不安としてのMDTに異常を示したものは, 片頭痛に比し筋収縮性頭痛に有意に多く, 73.7%であった。2) Biofeedback療法の有効率は, 片頭痛に対する皮膚温フィードバック法では84.2%に有効であり, 筋収縮性頭痛に対するEMGフィードバック法では70.3%であった。 biofeedback有効例および無効例の心理的側面を比較検討すると, YG testで外向性格のもの, MASでは低不安のもので有効率が高かった。 抑うつ尺度では高度抑うつ群で最も有効率が低かったが, 有効群, 無効群の間に有意差は認められなかった。これらのことから, 片頭痛および筋収縮性頭痛では, 自我状態や自律神経機能の面で共通する点が多いことが示唆された。 一方, 不安, 抑うつの傾向やストレス状況下におけるtesk performanceに相違が認められ, これらの因子が, 両疾患の精神生理学的および症候学的特徴の形成に関与していることが想定された。 さらにbiofeedback療法の有効性を確認するとともに, その治療過程に心理的因子が関与していることが示唆された。 近年, 両疾患の精神生理学的な類似性が論議されているが, 総合的な立場から比較検討した報告は少なく, 今後さらに精神生理学的研究をはじめとし, 治療学的側面も含めた幅広い研究が必要なものと考えられた。

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