As humankind becomes a single global ecological system, the biopsychosocial approach to health, we believe, offers great advantages (for illness, disease, stress, growth, aging, the family, poverty, violence, environment). Effectively we integrate information from a polypolarity of dimensions and conceive a formulation central to the basic problem to be answered, and particularly to those of human survival. The strategies employed relate how the human person receives, analyzes, processed and responds to constant streams of change in internal and external environments, while endeavoring to maintain Allness and Wholeness. This we have described. The biopsychosocial concept recognizes the fundamental laws of science, obeyed the laws of matter and motion, recognizes the role of entropy, functions within concepts of time and space, and is characterized by a unity of forces served by organazation through an integrated biologos within an information universe. In our contemporary thinking it is the profundity of the transfer questions-how to integrate diverse disciplines, -that concerans us. Our work to date argues that when information energy systems and human interofective systems interact, that outcome may have critical significance for good health, quality of life, and human survival (desease illness, stress, wars, conflict, adverse human behavior, denial of human and ethical social rights, conduct and so forth). At the personal level we have approached the experimental field through health communications and education for health emphasizing the critical nature of integration, the role of the parasympathetic way for survival, and the concept of the biologos as the most natural understanding of wholistic being.

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A concrete treatment method is described for comprehensive approach in patients with asthma, a representative psychosomatic disease. A protocol of 5 steps was followed, in method was used in the patients with asthma which was refractory to conventional medication, the success rate was the same as, or better than, that in cases of general asthma. Two cases are described and precious results are discussed. This treatment led to a reduction of asthmatic symptoms and also to a decrease in other complications and a marked improvement in quality of life (QOL). In treatment for psychosomatic disease, it is necessary to have a different paradigm for unconventional treatment.

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Home Oxygen Therapy (HOT) is an indispensable therapeutic means to the patients with chronic respiratory failure, such as chronic pulmonary emphysema, post tuberculosis, lung fibrosis, etc. Recently, home care has been regarded so important that HOT has been applied to the patients with chronic respiratory failure for the purpose improving QOL for them. Now in Japan (1990), HOT is practiced for about 15,000 patients with chronic respiratory failures. These patients are getting considerable benefit, not only in improving shortness of breath, but also in developing ADL. Inspite of introducing this therapy, however, the majority of HOT patients have many handicaps as respiratory cripple and are exposed against much stress in both psychological and somatic respects. As a part of holistic approach to the HOT patients, we have performed the following trials. I) The survey of psychosocial respects of the HOT patients, using : (1) comprehensive psychosomatic questionnaire for the patients with long term oxygen therapy (Egashira, Agoo 1986), (2) self rating questionnaire of depression, (3) questionnaire C of the research team of Japanese Ministry of Health and Welfare, (4) and others. The results of this survey revealed that the patients have many problems in psychosomatic respects which consist of dependency, pessimism for prognosis, frustration, in another, a trend of depression, and decrease of social role functioning in reinstatement and human relationship. II) Reginal approach including (1) staff meeting for HOT practice (Kyushu Respiratory Care Conference) (2) formation of a club for HOT patients and its communication program in our hospital.

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Psychosomatic medicine is often referred to as the core of holistic medicine and a psychosomatic approach (PSA) plays a major role in the holistic approach to various circulatory disorders. However, there are questions as to "to what disorder", "by whom" and "what kind of" approaches should be applied. In order to answer these questions, the author tried to classify the patients in terms of the indication of PSA. Two-hundred and fifty-one outpatients with cardiovascular symptoms who have visited the Department of Psychosomatic Medicine in Tohoku University Hospital from 1987 to 1989 were classfied into the following groups. A. Cases with psychosomatic problems 1. Psychological factors affecting the diseases 2. The diseases affecting psychological states 3. Cardiac symptoms without specific diseases B. Cases with coexisting somatic and psychological problems C. Cases without psychosomatic problems Group A (n=157) needed certain PSA which should be carried out by psychosomaticists. Group B (n=77) needed either a liaison-psychiatric approach by both internists and psychiatrists or PSA by psychosomaticists. Group C (n=17) did not particularly needPSA but needed somatic approach by internists. Various approaches such as brief psychotherapy, autogenic traning, transactional analysis, behavior modification and pharmacotherapy were applied to the group A according to the subgrouping. In this study, 93% of the patients definitely or relatively needed PSA because of the specialty of our department. Although the rate may be low, there also seem to be some patients who need PSA in other institutes specializing circulatory diseases. It was thought necessary, from the standpoint of holistic medicine, to determine the indication of PSA as well as the diagnoses.

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Holistic medicine means undertaking biopsychosocioethical medical approaches and giving supports to patients. Type A behavior pattern is a well known risk factor for coronary heart disease (CHD), consisting of components such as time-urgency, harddrivingness, competitiveness and hostility. By understanding the behavior pattern of patients, several benefits can be obtained by holistic approaches and supports to CHD patients. 1) The first of all, to know the behavior pattern of patients is to gain new information about risk factors for CHD. Many evidences have been shown clinically and experimentally which prove the relationship between CHD and the type A behavior pattern. 2) Secondly, to know the behavior pattern is to have a keyword which tells psychosomatically the whole state of patient. The behavior pattern is associated with and constructed of many personal (constitutional hereditary disposition and personality) and environmental (psychosocial stress, occupational position, social demand and nationality) factors. So understanding the behavior pattern is very useful for understanding whole characteristics of patient. 3) Thirdly, understanding behavior pattern helps to have a standpoint which points out social pathogenecity for CHD. This social pathogenecity induces the type A behavior pattern which is believed as the way to make economic success or to become an excellent administrator. Clinically type A patients seemed to have many harmful tendencies for CHD in their daily lives. For example, they make a vicious circle between excessive involvement in job and emotional stress due to job, then they become tired and exhausted. They often have wrong overconfidence, lack of self-awareness of being ill, and of proper self-control to prevent heart attack. Concerning these harmful characteristics of type A, a case of recurrent MI was demostrated. This administrator, 53 years of age, fell with acute myocardial infarction and was admitted to hospital and came back to job. Thereafter he could not modify his typical type A behavior pattern. He was involved more and more in his job, until he fell due to his recurrent attack. Type A modification is apparently necessary to prevent recurrent MI. So both beharioral couselling to patient and social education to his environmental surroudings are necessary to modify patient's type A behavior pattern. These efforts may be considered as a final approach of holistic medicine to CHD patient.

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One handred and thirteen patients who were admitted to our department for organic and functional disorders of digestive system over the past four years were studied. A multidisciplinary approach was applied to them including the evaluation and treatment of the digestive diseases. Each patient was evaluated from the point of view of organic, functional and psychiatric disorders. A psychiatric assessment, related to the onset and clinical course of digestive disease, was established for each patient. The following factors should be taken into account for the treatment of degestive diseases, besed on our study : In many cases of digestive diseases, depression was considered to be strongly related to the onset, as well as, the clinical course of the diseases. Complaint of abdominal pain should be recognized and accepted. When diagnosis and treatment are difficult and confused, the possibility of a factitious disorder should be considered.

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According to the recent increase in needs for rehabilitation medicine, the author as a physiatrist has been faced more and more with varieties of diseases. Among them, impairments of neurological origin are given much weight. In our department of rehabilitation medicine, patients with neurological impairment account for 20% of all the newly admitted patients. Cerebrovascular diseases are most common. As a matter of common knowledge, rehabilitation medicine aims at "holistic medicine" which includes the approach for not only physical disability but also psychosocial problem accompanied with "mourning work". Moreover, this ideal is to be realized through the care of medical team which consists of many kinds of staff. Thus, such a problem as an unreasonable psychological conflict within staff members or a distortion of team organization sometimes arises to interfere with our comprehensive rehabilitation program. In order to cope more adequately with the psychosocial problems as well as physical ones and to consider what the team management for the patient should be, we have held a liaison conference for four years. It is held weekly amang rehabilitation staff members (including a physiatrist, a physical therapist, an occupational therapist, a speech therapist, nurses and a medical social worker) and a liaison psychiatrist. In the conference, we discuss psychological or behavioral problems of patients caused by psychosocial conflicts or mourning work, negative counter-transference of therapist to patient and problems of interpersonal relationship among patient, family and therapist. From April in 1986 to March in 1990,more than 40 cases were presented to the liaison conference. Results obtained through questionnaires to our staffs proved the conference to be effective in the rehabilitation setting (1) to promote a better understanding for psychological problems, (2) to consider interpersonal relationship between staff and patient, saff and staff, patient and family, staff and family, and (3) to make clear the role of each staff in team management.

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This study was done to investigate how important the psychosomatic approach is to diabetic patients with various associated disorders. Some of the associated medical problems of diabetic patients in this study were severe complications, depression, eating disorders, personality disorders, nervous vomiting, alcoholism, neurosis, alexithymia, and workaholic syndrome, etc. The subjects consisted of 53 diabetics, 10 males and 43 females (average age : 43yr, ranging from 19 yr to 72yr) who had been admitted to our ward. Among the 53 subjects, there were 35 cases with associated medical problems (group I) and 18 ordinary cases (group II). The results of psychological tests at the time of admission and therapeutic results at the time of discharge were as follows : 1) Of the 53 patients observed in group I, 69% showed neurotic tendencies by the CMI (III, IV) significantly more than group II. 2) In group I, 56% of the patients had high scores (>50 points) by SDS, 36% were of the unstable type (B and E) by the YG test and 59% showed a low percentage of GCR in the PF study. These patients tend to have numerous comparisons to those in group II. 3) Seventy-three percent of the patients in group I and 83% of the patients in group II 3) Seventy-three percent of the patients in group I and 83% of the patients in group II showed good control at the time of discharge. In conclusion, 26 cases (73%) with associated medical problems who came to our hospital for treatment of diabetes mellitus were able to control themselves after treatment with the psychosomatic approach. Of these patients, 15 (43%) subsequently continued to remain under control during a follow-up period from 1 to 3 yrs. It is important to improve our efforts in treatment of diabetic patients associated medical problems.

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The central nervous system is important in coordinating behavioral and autonomic control of homeostasis in response to outer and inner environmental changes. Multiplex neuronal networks of efferent and afferent autonomic nerves, plus various neuronal structures contribute to integration of information to control feeding behavior as well as visceral functions. Chemosensitive neurons in the lateral hypothalamic area (LHA) that receive and respond to humoral information, such as blood-borne chemicals and hormones, have been identified in this area. The information received here by the chemosensitive neurons themselves, or through afferent neuronal connection from the brain stem or viscera is further integrated by communication between the hypothalamus and the association cortices. The LHA also regulates autonomic nerve projections to visceral organs such as the liver, pancress and gastrointestinal tract through the efferent path to the autonomic preganglionic neurons in the brain stem and the spinal cord. Intracerebroventricular administration of 2-deoxy-D-glucose (2-DG) induced feeding behavior, hyperglycemia, and excitation and inhibition of LHA neuronal activity which indicates involvement of LHA chemosensitive neurons in the control of feeding behavior. Direct application of 2-DG into the LHA increased adrenal sympathetic nerve activity and decreased sympathetic nerve activity to the brown adipose tissue (BAT). This indicates that glucoprivation induced by 2-DG affects LHA neuronal activity, and some of the signals received by chemosensitive neurons are reflected in the control of behavior, while others are projected to the autonomic nervous system. Excitatory effects on adrenal nerves promote catecholamine secretion and hyperglycemia. Inhibitory effects on BAT sympathetic nerves suppress thermogenesis and energy expenditure in this tissue. All of these responses are considered to be necesary for the maintenance of the homeostasis in response to a challenge of the central nervous system. From this view point, disturbance of feeding behavior in obese patients is considered to be a result of abnormality in the transduction of information that simultaneously controls behavior and visceral functions. These patients have unbalance and dissociation of communication between the association cortices, the hypothalamus and peripheral metabolism. Consequently, higher functions such as memory and motivation in cortical neurons, and external information received by them strongly effect their feeding behavior. Behavioral disorder in obese patients can impair peripheral metabolism, and the resultant incorrect humoral information can further disturb behavioral control. One of the most important factors in the treatment of obesity is escape from this vicious cycle of information transduction. To accomplish that, it is necessary to input appropriate information produced by sensory signals into patients themselves. Their neuronal systems must be conditioned to detect the difference between correct and incorrect information, and reflect this ability in behavioral control. Finally, the recovery of physiological control is expected as an object of treatment.

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