We conducted a questionnaire survey in order to study if these was any relationship between one's life habits (drinking and smoking, etc.), life styles and diseases in the middle age. The subjects consisted of patients with digestive ulcer, chronic pancreatitis, hypertension as well as the healthy control.It was found that the patients group had a strong liking for alcohol and smoking. With regard to work patterns, both the patient and the control groups showed over-adaptive tendencies.The healthy group, in particular, had less communication with their family members and spent less time for leisures.It was suspected that that the healthy people might develop serious illnesses if they had increased intake of favorite material as they put on years.

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Owing to a distinguished progress in industrial and technological achievemetn contributed by middle-aged men after the World War II, people in Japan seem to be confronted with a dilemma between seeking for higher economic life and suffering from multifarious distress caused by psychosocial frustrations. Chonsequently depressive state has become prevalent as one of the most popular symptoms in the psychosomatic area for the middle-aged patients.Recently such depressed middle-aged patients with liver function disorder and glucose intolerance are coming to our out-patient clinic. We can put them in a new concept of "Stress-Circular Syndrome" to explain this characteristic illness. Clinical specificity and etiological mechanism of this syndrome were studied retrospectively from bio-psycho-socio and ethical viewpoints.The results of the study revealed that the Stress-Circular Syndrome was consisted of the following four clinical features;(1) the presence of psychosocial stress prior to the onset, (2) three main objective signs which are alcoholic liver dysfuction, nutritional diabetic state and depressiveness, (3) so called "Viscious Circle" in connection with mutual relationships among stress, and symptoms through maladapted behavior of alcohol abuse, (4) specific premorbid personality traits such as perfectionism, meticulousness, rigidity in view, etc.In coping with such patients complaining those symptoms, comprehensive therapeutic approaches were practiced. They are considered to be indispensable in order to break the viscious circle, to correct erroneous view of life and to establish a new life sytle.

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This study reports various diagnostic and therapeutic procedures of climacteric disorders from three points of view, namely, psychological, neurological and endocrinological.1. Psychological aspects;The patients with climacteric disorders (N=76) and climacteric women (N=87) who have not been regularly treated by the doctors were compared on a variety of symptomatic (Subjective Symptoms Questionnaire), and personality (Egogram, MPI) measures.a) Statistical clustering of the climacteric women in terms of the symptoms;The Subjective Symproms Questionnaire was administered which was based on Kupperman menopause compliants and Self-Rating Questionnaire for Depression. The subjects evuluated the severity of their own symptoms, to which factor analysis was applied. Then, factor scores of each subject were calculated and used for clustering the subjects, employing cluster analysis.b) Personality in climacteric disorders;As the results of Egogram test, the climacteridc women with syndrome tended to be too sensitive to other's opinions and behavior, and to repress their anger. The MPI test showed that the climacteric women with syndrome were more introverted and nervous than the healthy.2. Autonomic nervous function;The correlation between the autonomic nervous fuction test and autonomic nervous symptoms have been studied with plethysmography and autonomic nervous symptom score. A significant difference in the plethysmograms of healthy women and vegetative disturbances has been shown in our investigation.3. Endocrinological treatment;At the present time, the administration of an exogeneous estrogen for the treatment of climacteric disorders is generally accepted. However, there have been several reports to show that estrogen will promote carcinogenecity. The author whould like to propose a reactivation method on functionally declinign ovary by approach of induction of ovulation. The author describes a successful case treated by the new method of hormone therapy.Then, the implications of these results are discussed from the psycho-neuro-endocrine standpoints.

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We examined 152 cases with climacteric syndrome in our clinic. The average age was 48.5±4.2. We classified the subjects into four types : somatic, psychosomatic, neurotic and depressive by interviews and a psychological test (CMI). Several kinds of therapy were applied to the patients. Conjugated estrogen and dihydroergotamin mesylate were used mainly for the somatic type women. Minor tranquilizers and psychotherapies were used for the psychosomatic or neurotic types, and antidepressant were used for the depressive type women.The menopausal period was classified into three stages : premenopausal (I) in which there is still a regular menstrual cycle, the premenopausal (II) which is judged to occur within 2 years after menopause, the postmenopausal which occurs 2 years or more after menopause, and the postoperative in which the women had undergone a hysterectomy and/or bilateral oophorectomy.We also measured the serum level of luteinizing hormone (LH), follicular stimulating hormone (FSH) and estradiol (E_2) by radioimmunoassay. The t test and qui square were used to compare many factors.Results : 1) The psychosomatic and neurotic types appeared more frequently than the somatic type in the premenopausal (I) women, while the somatic type was observed more frequenly than all other types in the postmenopausal women.2) Treatment was less effective in postoperative women than in premenopausal (I) and premenopausal (II) ones.3) Treatment led to excellent results in the somatic type, 92.1%, and the depressive type, 80%. But effectiveness was rether low in the psychosomatic and neurotic types, 65% and 63%, respectively.4) LH and FSH levels decreased and E_2 increased when treated by conjugated estrogen, while treatment by a minor tranquilizer did not alter the hormone levels at all.Our clinical experience showed that correct diagnosis and selection of appropriate therapy for patients with climacteric syndrome can be achieved by intervewing such patients for at least 30 min. and then classifying them into the most fitting types.

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In our practice, the highest incidence of psychosomatic diseases is seen in the middle-aged (climacteric) patients as compared to those in the other periods of life. These patients manifest a variety of symptoms and we often experience many difficulties in treating them. No identical cases have been observed. Therefore, it is not an efficient way to deal with these patients individually. In order to improve such a situation, we attempted to make a practical classification of these patients in order to improve our treatment.The present paper describes the results obtained.1) Subjects : Our subjects consisted of the patients who were ween in our hospital during the past 15 years, whose chief complaint was vertigo. They were all referred to us under a diagnosis of psychosomatic disease or its suspicion because of the intractability of the symptoms observed. The onset age ranged from 45 to 55 years. Only documented cases were included as the subjects of this study. As a result, a total of 206 cases (28 males and 178 females) constituted our subjects.2) Methods : In order to find if there were any common features, the chief psychogenic factors responsible for manifestation of vertigo were classified largely into two groups; that is 1) the somatic treatment related group and 2) the social problem group. These two groups were further divided into some subgroups.3) Results : In the somatic treatment related group in which iatrogenic factors were also taken into consideration, the treatment consisted chiefly of somatic therapy and administration of psychotropic drugs in addition to psychotherapy which was given when so indicated. As a result, the remission rate was about 73% (72 out of 98 cases).As to the treatment for the social problem group, persuasive psychotherapy for various troubles was the chief treatment choice. In addition, various other therapies including getting cooperation of persons related to the patients and administration of psychotropic drugs were performed. The remission rate obtained in this group was about 66% (71 out of 108 cases).In sime cases, the traditional Chinese therapy was also applied, which was often effective if the symptom could be grasted accurately.

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Estrogenic changes in the life cycle of the women are influenced during puberty, pregnancy and partum periods as well as in the climacteric period, and also develop psychosomatic or psychogenic disturbances.According to H. Deutsch, a psychosomatic viewpoint of menopause is based on the loss of feeling of feminity in women, and also found in hysterectomized and castrated women.Also senility, anxiety and fear of death, changes in the family pattern due to separation or living together caused by employment after graduation or marriage of sons and daughters, an increase of divorce due to disillusionment and dissatisfaction with the husband, fear of pregnancy and reduction of reproductive fuction etc. seem to bring forth anxiety and conflict which are accompanied with many stubborn symptoms. Most of these aspects are closely related to the personality of the individual and facilitate the necessity of a psychosomatic approach.In this study, CMI, YG test, SCT and counselling were done with 48 cases of climacteric syndrome and the following results were obtained. Three out of 9 climacteric women had guilt feelings toward their husbands, which was more as compared to 6 cases who had quiet feelings toward their children.Twenty cases (42%) had climacteric symptoms with normal menstruation, which may mean that climacteric symptoms are also found before menopause. Also the age of the climacteric period has advanced due to the late menopause, changing one's life cycle.With regard to one's life history, a negative image of fatherhood was seen more often than that of motherhood in these maladjusted women.Social changes in the post-war era have been influencing climacteric women; however, the stable cultural patterns established in the family, environment, religioin and personal history, etc.do not cause these problems. It is necessary, on the part of doctors, to give more considerations to psychosocial factors of the climacteric women.

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Mild depression can be considered as one of the representative disorders among the middle aged in Japan today. However, this disorder is not neurotic depression in the usual sense of the term, but rather belongs to a mild type of endogenous depression of the monopolar type.When occurred in the middle age, it is characterized by lack of exernal inhibition and easily overlooded by other people. Therefore we are suggesting that this depression be called "endogenous, not-psychotic depression." This disorder is frequently found particularly in the urban areas.Generally speaking, an outstanding charateristic of endogenous depression in Japan is that there is a considerable degree of unanimity as to its premorbid personality in many patients.Above all, the melancholy-syntonic personality (Tellenback) is often observed in the monopolar type of depression. The author summarized the charateristics of this disorder as 1) obsessive concern for orderliness, 2) ability to maintain smooth relationship with other and 3) identification with the tradition-honored value system. These are, however, the characteristics of the middle age and not of adolescence. This deserves attention when we deal with psychosomatic disorders of the middle age.Why is it that this diagnostic prerequisite is not so important in western countries while it is in Japan? It may be related to the socio-cultural conditions of Japan. That is, under these conditions, the individual is considered a good person when he does not assert himself and always needs to be assured by the value of other people, particularly by the value cherished by the society which consists of undistinguished average people. At any rate, it is useful to pay attention to the premorbid personality when we diagnose psychosomatic disorders of the middle age.

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In order to study psychosomatic problems in geriatric medicine, data were gathered on outpatients who had presented themselves for treatment over the past ten years at the University of Tokyo.For a statistical comparison. the following factors were obtained from a personal/medical history card and the therapist who had treated the patient : 1. Age and sex 2. Diagnosis 3. Referral source 4. Duration of therapy 5. Rsults of psychological testing 6. Patient's mental state 7. Theerapy methodology 8. Prognosis The findings were summarized as follows : a. 3.57 percent of the outpatients studied were 65 years of age or older.b. Diagnostic composition of patients studied were : (1) 35% psychosomatic disease(2) 30% depressive state and depression(3) 18% neurosis with 74% hypochondriasis These findings were essentially the same as those of other researchers and established theory.c. Rank order of psychosomatic disorder prevalence : (1) Hypertension(2)Insomnia(3) Writer's cramp(4) NCA(5) Asthma(6) Headached. The majority of outpatients were referred from internal medicine.e. Many outpatients experienced only short therapeutic gains from treatment, but a "good" prognosis (therapeutic gain of a period in excess of 1 year) was obtained in 77% of the outpatients studied.f. No differences were found between elderly males and outpatients in general in CMI data, but the YG test revealed more E-types among the elderly males.g. Treatment recerved by the patients studied was as follows : (1) 100% of the patients received brief psychotherapy.(2) 76% of the patients received drug therapy.(3) 33% of the patients received autogenic training.h. In drug therapy, the following were prescribed : (1) 50% of the patients received minor tranquilizers.(2) 50% of hte patients received antidepressants.(3) 30% of the patients received hypnotics.

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With the elderly representing 9.8% of the population as of 1982,Japan can be considered to have entered the age of oldage. The graying of the nation has been bringing about sweeping changes in various aspects of society. For one thing, the number of the elderly living alone increased by 3.0% from 1971 to 1977. Whereas the number of the elderly living with their families decreased by 7.6%. The lifestyle is affected by these changes in the social structure.On the other hand, mental function in the elderly becomes diminished with aging. As a result, both reserve capacity and adaptability are lower in the elderly than in the young. The elderly are said to be liable to develop stress-induced disease because of diminished ability to cope with physical, psychosomatic and social stress. Although the elderly are more prone to psychosomatic disorder than the young for the reasons given above, this disease seems to have hardly been investigated from the standpoint of its relationship to the changes in the social structure.In the present study elderly persons with psychosomatic disorders and those without anything abnormal were compared in relation to their environmental conditions and changes in the social structure with a view to clarifying factors predisposing to psychosomatic disorders and types of the disease.The subjects of this study consisted of 107 elderly persons without physical disorders admitted to an old-age home, and of them 11 (10.3%) had complaints. The old-age home inmates (living 4 to 5 to a room) changed roommates every month. As a result of this change in the living environment the number of inmates with complaints increased to 14 (13.0%). When 78 anemic elderly inmates with physical disorders also changed roommates similarly, the number of inmates with complaints increased by 6.6%. In short, the frequency of psychosomatic disorders was higher with diseased elderly inmates than with healthy ones, when they had a change in their living environment.The effects of the changing social structure on the lifestyle of the elderly were determined in terms of personality, activities of daily living, objective of living, and CMI in three groups;elderly persons living alone, those living with their spouses adn those living with their families.The elderly living alone were generally characterized by an inactive lifestyle, distorted personality seclusion from society, loss of the objective of living, and significantly low CMI, as compared with other two groups. Further, a larger number of the elderly living alone had psychosomatic disorders of the dependent and depressive or the elusive type.These findings suggest that the phenemenon of physical and mental aging lowers the reserve capacity and adaptability of the elderly, so that they lose balance, both mentally and physically.Further, the changes in lifestyle and environment arising from the changing social struture seem to facilitate the development of psychosomatic disorders in the elderly living alone.

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Depression in the old age has a greater frequency and is considered as an imoprtant disorder in the field of psychosomatic medicine. The authors studied senile depression with regard to epidemilogical, biological and psychological aspects.1) In an epidemiological survey, the authors made investigations using a self-rating questionnaire for depression (SRQ-D) in psychosomatic clinics, homes for the aged, clinics of general practitioners and old peoples homes (Total 1,063 caess).High SRQ-D scores were observed in 24% of the subjects in the psychosomatic clinics, moderate and high SRQ-D score groups occupying 54% of all. The differences of SRQ-D scores between the psychosomatic clinics and the homes for the aged, between psychosomatic clinics and the clinics of general practitioners, between psychosomatic clinics and the old peoples homes were statistically significant at p<0.01 level.High SRQ-D scores in the homes for the aged, the clinics of general practitioner and the old peopes homes revealed 7-11%, moderate and high score were found in 16-25%. All the differences were not statistically significant.2) The cortisol levels by dexamethasone supperession test (DST) were analysed in 10 senile depressive inpatients. As a result, DST showed 3 non-suppression and 7 suppression cases. The cortisol after dexamethesone administerd was over 10μg/dl in the cases of non-supression.3) With regard to psychological aspects, we reported 3 cases of object loss in the old. Case 1 is a 66-year-old male with senile depression. He retired due to the age ristriction, which made him recognize his life changed and feel sadnes. Case 2 is a 61-year-old female with depressive state. She felt sorrow of parting with her children because of their marriage and lost pleasure of eating as she had to diet herself for Diabetes Mellitus. Case 3 is a 70-year-old female with depressive pseudodementia. She lost her role of house work such as takign care of her grandichildren. These 3 cases indicated that their experiences of object loss in the old age induced depression and hopelessness.An epidemiological study suggested that latent depression was present in 10-20% of the old people who were staying home, et al. DST, when used for the old aged, appeared to induce a similar response as it was used for the younger and middle ages. It was suggested that DST was an important indicator to judge the severity of depression and responsiveness of antidepressants. Psychologically, the aged experience a lot of bio-psycho-social loss. Their mourning work for object loss requires a multi-dimensional approach. It is appropriate to treat the aged people at institutions where psychosomatic medicine is practiced.

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Dementia is one of the most common clinical symptoms among aged persons. According to the reports by Hasegawa et al. and Karasawa et al., approximate eight percent of the aged with the ages of 65 years and over are afflicted with some mental illnesses and about a half of them are suffering from demented state.In today's medicine, dementia refers only to deterioration of the mental function due to organic deseases of the cerebral hemisphere. However, the relationship between dementia and brain status has not been consistently observed. Few studies on dementia have paid attention to the somatic, psychological or social background of the subjects, although these socio-psychosomatic factors are known to influence intellectual function as well as certain variables such as the EEG. Especially at early stages of dementia, many of early symptoms of dementia differ little either quantitatively or qualitatively from those that occur in normal, healthy individuals who are exhausted, anxious or subject to severe environmental pressures.The intellectural deterioration commonly seen among aged persons undoubtedly is closely related to the structural and functional impairment of the brain. With a given brain impairment some individuals follow a pattern of simple and gradual intellectual deterioration and are without any significant complication. They are able to maintain a relatively active life and makes a reasonably good adjustment in the community. In contrast, many others deteriorate rapidly and present a variety of complications-depression, regression, agitation, paranoid symptoms. The differences between these two groups are very likely the result of the differences in their physical health, socio-economic status, environment and personality.Therefore, Wang points out that dementia as a clinical syndrome can be viewed as a socio-psycho-somatic disorder. Although brain impairment is an obligatory factor in most cases of intellectural deterioration, many socio-psychological factors also play an important contributory role. These factors may aggravate the behavioral manifestations of intellectual deterioration.They may also accelerate the decline of physical health, which, in turn, may affect the brain as well as the socio-psychological condition of the individual. Frequently all these factors interact with each other and form a vicious cycle that leads to further deterioration. The interaction of these social, psychological and somatic factors often becomes the most important determinant of hte course and outcome of dementia. Early recognition and correction of these factors may help prevent the development of complications and slow down the progression deterioration.This paper describes, a definition and causal diseases of dementia, clinical characteristics of of dementia in the aged, clinical symptoms which should be differentiated from demented state, factors which influence the clinical course and outcome of dementia, and psychotherapeutic approach for the aged with dementia. It also emphasises psychosomaitc aspects of dementia in the aged.

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We have conducted a research on a mental-physical correlation of cancer patients and their way of facing death through psychoanalysis, sand play, dream analysis and group image therapy.Results of the research are summarized as follows.(1) Treatment for cancer patients, especially for the aged, can be too late because of their family situations caused by such factors as unclear family and lack of close parent-child relationship. Patients' personality and their will to individualization also relate to this issue.(2) We examined personality characteristics of cancer patients from the view points of their childhood experiences and object deprivation experiences in their life. Their personality characteristics were introverted, hard-working, well regulated and sociable. They were able to amintain good relationships with others. However, they were not very good at finding how to spend their time for their own leisure.(3) Japanese aged cancer patients show depression rather than anger in their process of facing death. However, in their dreams, Japanese patients showed more anger than depression in comparison with European and American patients. The importance of being touched especially for "depressive" aged cancer patients need to be stressed.(4) It became clear through dream analysis of dying cancer patients that they usually tried to integrate their life during the short term of facing death. Problems of masculinity-feminity and the aged are discussed as the main themes of this integration.(5) We also report how cance patients discussed cancer and treatment in group image therapy in connection with the problem of anouncing cancer to the patients. They could educate and encourge their spiritual development with each other no matter how their cancer situations changed. They supported and consoled each other in order to accept death. These matters are reported along with case presentations.Aged cancer patients' mental characteristics in their process of facing death are also reported.

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