In order to examine the present situation and ideal way with regard to occupational mental health, we have conducted the following two surveys. 1) In order to examine the relationship between the following total scores and stress level, we have surveyed 1,586 workers (normal group) and 101 patients with occupational maladjustment syndrome (maladjustment syndrome group) by using the method for stress assessment of worker. This survey consisted of 65 stressor questionnaires based on the social readjustment rating scale by Holmes, including 18 new questionnaires in the occupational environment. The subject group judged their experiences during the past year by the self-rating method with scoring from 0 to 100 (marriage=50). The scores of the stressors experienced during the year were summed up. The average score of the maladjustment syndrome group was 882,in contrast to 382 in the normal group. The percentage of more than 600 was 75.2% in the maladjustment syndrome group in comparison with that of 21.1% in the normal group. As the results, we found that the scores above 600 were among the indicators to find the one's level of adjustment and stress. We considered that the scores more than 600 indicate a high stress level. It was found that 21.1% of the normal group was under the high stress level. Next, we analyzed the frequencies of the high stress level with χ^2-test based on sex, age, occupation and work position. The stress levels at the ages over thirty were higher than twenties. Section heads and leaders were under greater stress than the employees. 2) From the investigation of about 10,000 company employees, we found that the workers who received tranquilizers rose from 6.4% in 1963 to l2% in 1987. The 74% of tranquilizers medicated people in 1987 had stress-related diseases. At the same company in 1963,the percentage of treatment with tranquilizers was almost the same between the younger (below 29 years) and the ages of over 30. In 1987,the percentage of the younger age group decreased to 2% from 5.8% in 1963,while the percentage in the older age group (over 40 years) showed the increase to 27.9% from 6% in 1963,a 4.6-fold increase compared with the figure in 1963. From the above-mentioned results, we considered that it is important for us not only to treat the patients with mental disorders but also to cope with the workers with the higher stress level of occupational mental health to prevent the stress-related diseases.

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Recently, Mental Health in places of work seems to include not only health care for mental disorders but also prevention of and coping with stress related diseases. There are, however, many difficult practical problems in this field. We have developed a stress checklist 86 (SCL-86) and stress management programs for occupational health. We have also performed a shortterm health promotion seminar at a hot spring resort. I would like to discuss practical stress management and a holistic approach to mental health at work. 1) Developement of a stress checklist 86 (SCL-86) : This questionnaire is designed to evaluate the stress tolerance of an individual as a system, according to measurement of both 'psychosocial stressor' and 'stress reaction'. In the comparative study of Cornell Medial Index (CMI), the Profile of Mood States (POMS) and SCL-86 test batteries, it is concluded that the SCL-86 has a good criterion-related valididy and that this questionnaire is a useful new tool for measurement of an individual's ability to tolerate stress. 2) Stress management programs for occupational health : We have performed stress management programs for occupational health, which include an educational approach to health care, relaxation techniques such as Autogenic Training and increased self-awareness of stress using the SCL-86. The majority of the participants in these programs have reported that they have a good chance to become more aware of their stressful situations and their responses to stress. 3) Short-term health promotion seminar at a hot spring resort : This program includes dietary control, exercise, spa bathing, relaxation training and health counseling. Although the term of these health promotion programs was limited to 5-6 days, there was significant improvement of physical and mental conditions and subsequent improvement of life style. Therefore, it is concluded that these health promotion programs at a hot spring resort are useful for prevention of stress related diseases and health promotion. From the experinces of these stress management programs, I would like to emphasize that our holistic approach is valuable for mental health in occupational site.

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1) The author as a psychosomatist practices mental health care with views of positive activity (active function) and standby activity (standby function) at the hospital and the health management center of one group enterprise. 2) Positive activity mostly means an edification movement for mental health demanded (requested) by the enterprise. The enterprise could appeal to employees its attitudes : mental health (mental aspect) is as important as physical health (physical aspect). Accordingly, it becomes valuable opportunities to modify (correct) the bias against treating mental issues. 3) Standby activity includes both medical examination and treatment for outpatients and health consultation. However, the deeply rooted bias that outbreak of mental problems relates to evaluations for individuals interferes voluntary consultation in the present situation. Therefore, it is necessary for employees in the work place (office) to accumulate experiences "how to accept such an psychologically unhealthy member" by cases in close contact with doctors (office doctors), so that they are helped not to be puzzled by an immediate bias (immediate prejudice). 4) In order to effectively execute (practice) medical examination and treatment for outpatients and health consultation as standby activity, and to make environmental adjustment, doctors need (a doctor needs) to fully grasp the working environment in collaboration with staffs and colleagues who have direct relations with a client in the office.

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Companies deal with the mental health of employees because they need to invigorate the atmosphere of work places and preclude the decline of work forces. At present, there is a growing recognition of the need for mental health. What has aggravated this need is the fact that given the introduction of office automation, challenges of new undertakings, transfers unaccompanied by families, and other attendant family problems, individual employees are now under unprecedented levels of pressure, both mentally and physically. It is also a fact that resulting stresses are mounting, irrespective of the age, status or intensity level of stress. Resistance to stress varies from person to person, and there certainly is no universal cure. As the purpose of businesses is to seek profits, and as employees are part of this endeavor, it is the responsibility of companies to do everything possible to enhance individual employees' ability to adjust themselves to their work environment. For the question of mental health, therefore, our company's basic policy is to cover all employees and, gathering as much information as possible about individuals, deal with it in the process of overall personnel management. Necessarily, therefore, managers/supervisors should not only be responsible for mass management but also always place emphasis on supervising individuals, while giving due consideration to the varied backgrounds of individuals. In other words, one way of dealing with mental health is for managers/supervisors to act as the key persons for enhancing mental health in their respective places of work. Managers/supervisors must, first of all, see to it that their own mental health is good and then work out an organizational setup whereby persons needing attention are duly referred to the health care staffmembers for appropriate attention and care and also work out education/training programs for these staffmembers. Considering the growing complexity of the nature and substance of work, work environment, etc., the issue of mental health in business will be a permanent one. Our intention is to continue to increase our knowledge and information concerning mental health in our effort to find appropriate ways to deal with this problem.

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Family caregivers of their demented relatives at home experience psychological and physical stress. We have assumed a theoretical model concerning the relationship between caregivers' burden as cognitive appraisal and their stress as its impact. This model was investigated in a gerontopsychiatric epidemiological survey in Tokyo metropolis including 5,040 randomly selected persons aged 65 years and over residing in the community. Subjects of this study was 63 primary caregivers who were taking care of their demented relatives at the survey. These caregivers consisted of 5 males and 58 females, and the mean age was 59.7 years. The aged persons under care by these caregivers were diagnosed as dementia by psychiatrists. They were composed of 27 males and 36 females, with the mean age of 81.2 years. Three scales were administered to 63 caregivers. The Caregiver's Burden Scale was used in order to assess the burden of caregivers at home multidimensionally. psychological and physical stress symptoms that these caregivers experienced were assessed by the psychological Stress Response Scale and the Physical Response Scale (short version). The findings disclosed that psychological and physical stress symptoms were most likely resulted from three dimensions of burden ; dealing with dementia symptoms, worry about future, and interpersonal difficulties, and that burden as a psychological factor induced physical manifestations as well as psychological symptoms. These results suggest that both psychosomatic and psychological interventions are necessary to decrease caregivers' psychological and physical stress symptoms.

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This study attempted to examine the psychological factors of Type A Behavior Pattern (TABP), and the relations between TABP and traditional coronary risk factors, and also TABP and occupational level in Japanese males. The behavior patterns were evaluated by JAS (Jenkins Activity Survey : form C) and the psychological factors by CMI (Cornell Medical Index) in 593 males who underwent regular health check-ups. The relationship between JAS standard scores and coronary risk factors (obesity index, blood pressure, serum cholesterol, triglycerides, HDL-cholesterol, serum glucose, serum uric acid and smoking habit), the psychological points of CMI, and occupational level were analized. The results are that 1) The mean value of the serum cholesterol level was significantly (p< 0.05) higher in JAS Type A cases than Type B. 2) The type A score was proportionally correlated with cholesterol (r=O.121,P<0.01) and triglycerides (r=0.084,P<0.05) values. The factor S score was correlated with obesity index (r=0.096,p<0.05) and uric acid (r=0.099,p<0.05), but inversely correlated with HDL-cholesterol (r=0.083,p<0.05) values. The factor J score was correlated with obesity index (r=0.087,p<0.05) and uric acid (r=0.130,p<0.01) values. 3) The mean value of the type A score of 10 to 20/day cigarette smoking group was significantly higher than either non-smoked (p<0.01) or former-smoked group (p<0.05). The mean value of the factor J score of non-smoked group was significantly lower than the other three groups of formersmoked, 10 to 20/day smoking and more than 20/day smoking. 4) The type A score was correlated with factors of both irritability (r=0.123,p<0.01) and anger (r=0.220,p<0.001) in CMI. The factor S score was correlated with factors of anxiety (r=0.125,p<0.001), irritability (r=0.224,p<0.001) and anger (r=0.341,p<0.001). 5) The mean values of the type A (p<0.0001) and factor J (p<0.001) scores of managerial level were significantly higher than non-managerial level. The results of this study indicate that the TABP has psychological factors of both anger and irritability in spite of those weak relations, and also suggest that there are relations between TABP and serum fatty levels, obesity and uric acid. These metabolic disorders may come from eating or smoking habits or the working stress as a manager in the TABP of Japanese males.

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Psychosomatic problems surrounding renal transplantation were discussed through observing the psychological process of a case with alexithymia during hemodialysis (HD) therapy prior to transplantation. The patient was a male of 42 years of age. During the early stage of HD initiation, he was comparatively positive in adapting to the new environment including HD therapy. As the HD therapy continued, the patient eventually became alexithymic. We assumed that the manifestation of alexithymia was related to his denial of a serious traumatic experience during his early childhood. Furthermore, it was indicated from the psychoanalytical standpoint that his deficient self-management associated with alexithymia was derived from the strong defense mechanism. In treatment, we made efforts to understand empathetically his view of the problems and to establish a common treatment goat between patient and therapist. We then made detailed plans to solve his problems and carried them out in the way which was acceptable to him. Moreover, stimulations were given to bring to the surface his anxiety and hypochondriasis which were repressed by the defense mechanism. This approach was effective enough to improve alexithymia and lack of self-regulation. It became possible for the patient to perform smooth post-transplant physical management. This treatment result indicated that alexithymia is reversible, suggesting the necessity to consider the indication of renal transplantation based on psychosomatic findings including alexithymic manifestation. For this reason, we consider this case report quite valuable for reference in future consultation-liaison psychiatry.

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In our medical department at a middle-sized hospital with a large number of patients (340 beds, 808.9 outpatients per day in 1989), time spent for each patient is limited. This condition is unsatisfactory for comprehensive medical care. In the present study, neurotic patients who visited our department were examined in order to clarify the important points to be noted in practicing comprehensive medical care in general medical field.The subjects were 75 patients who were diagnosed as neurosis by the department of psychiatry after they visited the medical department for January 1985 to December 1989. They comprised 25 men and 50 women, with the mean age of 46.4±19.4 years. They complained of various physical symptoms including general malaise, anorexia, headache, palpitation, dyspnea, abdominal pain, disturbed defecation and chest pain. On the other hand, main mental symptoms included insomnia, anxiety, depression and irritation. In particular, insomnia was an important 22 clue to understand the patient's mental state. Physical diseases such as hypertension, diabetes, chronic pancreatitis, bronchial asthma, chronic hepatic disorder, peptic ulcer and pulmonary emphysema were found in 30 of 75 patients. Of these 30 patients, 21 exhibited a correlation among symptoms of the physical disease, psychic symptoms and psychogenic factors. The main mental factors were problems, involved in the family, arising from the composition of family members who are living together, problems related to occupation, anxiety about illness and death or disease of relatives. It is concluded that the following three points should be noted in practicing comprehensive medicine in a primary care : to make a good doctor-patient relationship through careful interview and full, close physical examination, to examine the presence or absence of insomnia and to pay special attention to the composition of family members living with the patient.

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