Japan's "gomiso" of Tsugaru region and the "yuta" of Okinawa deeply reflect the prototypical shaman which upon reevaluation is the humankind's oldest of healers. This report focuses attention on both the gomiso and the yuta as well as their clients. With case studies of the "gyoo" (ascetic practices, religious training) practiced under the guidance of gomiso at Mount Iwaki's Akakurasawa as a basis, the psychological meaning held by gyoo is reconsidered from the standpoints of the reformation of personality, the healing function of altered states of consciousness, and the cosmological importance of giving sense to psychosomatic disorders. The keyword in understanding Okinawan shamanism is "kamidaari" (deity curse ; possessedness or shamanistic sickness). Kamidaari which refers to a peculiar psychosomatic disorders comprised of groups of culture-bound syndromes is the means by which yuta's faith healing maintains its efficacy. Thus in order to understand the method by which patients can be more effectively treated, it is of primary necessity to bring a local region's entire health care system well into focus while taking special note of the illness/disease, healing/cureing dichotomies.

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Body Mass Index and HbAlc were measured to determine the relationship between glycemic control, coping styles, life style, and personality traits in 94 patients with non-insulin dependent diabetes mellitus (NIDDM). The coping styles, type A behavior patterns, and psychological status of the NIDDM patients were assessed by the Ways of Coping Checklist (WCCL), the Jenkins Activity Survey (JAS), and the General Health Questionnaire (GHQ). The incidence of problem-focused coping and positive cognitive coping were significantly higher in patients with good glycemic control than in those with poor glycemic control. Female patients showed a significantly higher incidence of self-soothing by eating, and obesity was significantly higher in female patients with poor glycemic control. The incidence of emotion-focused coping was significantly higher in male patients showing good glycemic control. In conclusion, problem focused coping and positive cognitive coping are related to good glycemic control in all NIDDM patients, while self soothing by eating with stress impedes glycemic control in female patients.

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We reported that the level of 17-ketosteroid sulfates (17-KS-S) in urine is related to adaptability to stress in humans. 17-KS-S, differing from 17-OHCS, shows the highest level in young healthy adults, decreases with aging and advancing illness and shows a lowered level under psychosocial stress. Concerning adaptability to stress in relation to meal, 1) In daily life, excess or deficiency of meal due to overload, whether it is psychological or physical, caused a decrease in the value of 17-KS-S, 2) In inpatients, a will to live caused for appetite to increase, accompanied by an increased value of 17-KS-S, suggesting an importance of meal in coping with stress.

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We revised the Japanese brief version of the Short Interpersonal Reactions Inventory (SIRI) which aims at measuring the cancer-prone personality and got standardized data in each sex. The SIRI with some parallel tests were answered by 1, 262 healthy adults. As a result of factor analysis, 33 items were retained and 6 factors consistent with the original scale were extracted (46.2% of total variance). The cancer-prone personality corresponds to the type 1 and type 5. It was indicated that the Japanese brief version of the SIRI could discriminate 6 personality types by comparing standardized scores of 6 subscales. As comparing the mean scores of several parallel tests in 6 personality types, the type 1 was assumed to measure one major trait of cancer-prone personality named 'harmony seeking'and the type 5 was assumed to measure the other major trait named 'rationality/anti emotionality'. It was concluded that a brief questionnaire was developed which can measure personality traits mainly composed of 'harmony seeking'or 'rationality/anti-emotionality'assumed to be profoundly influential to the occurrence of cancer and that its standardized data were obtained.

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To investigate the mental states of terminal cancer patients with pain, we carried out tree drawing tests on 115 admitted patients in the pain clinic of Chiba university hospital and examined the relationship between the result of tree drawing tests and the background factors of those patiens such as sex, age, suffering periods and pain duration as well as the results of the Sentence Completion Test (SCT). The terminal patients tend to draw immature, unsteady, weak, unstable and normal-sized tree with regular or thin truncks and do not add based lines. It means that they feel strong uneasiness and are afraid of their critical situations. Viewed in the light of age, the patients in the prime of life drew poor and unstable trees leaning to the left, while the younger generation drew solid trees, double stroke trunks and patients of advanced age drew weak and unsteady trees and one stroke trunks. Patients who have been in pain for a shorter period trend to draw straight trees leaning to the left and those who have been in pain for a longer period draw crooked trees leaning to the right. Trees drawn by the patients who consider their situations deeply and feel hopeless but still keep struggling against their deisease to come up to their families expectations are unsteady, unnatural and immature and add base line. The pessimistic patients who only consider their disease negatively draw unnatural and immature trees and are not add base lines. Neutral patients who consider their siuations composedly and desire to set out on a journey or to put their assets in order draw mature and solid trees but most of them do not add base lines. Seeing that the feelings of the terminal cancer patients are reflected on their tree drawings as stated above, the tree drawing test is an effective way to known how we should meet the needs of those patients.

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This hospital has conducted Home Oxygen Therapy (hereafter referred to as HOT) on 64 cases (including 26 deaths and two cancellations) since May 1993. A surver was made by mail on the current 36 HOT patients to appraise the previously unexamined conditions, particularly in relation to the effectiveness of therapy and psychological burdens. Twenty seven patients (75%) (20 men and 7 women with an average age of 74.5) responded. The results showed that HOT contributed to improvement in appetite and sleep. Twenty-nine patients (80%) were able to manage their own oxygen equipment. However, improvement in breathing was limited only to 8 patients (22%), and no improvement was found in social activities such as going out (eg. thier movement became slow, apologizing profusely to taxi drivers and others, etc.). Other manifest problems included paying for electricity, psychological burdens of living alone on a pension, worries about cold weather, having oxygen tubes all over the room, which are characteristic of the life of the old age.

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We report a case of a 59-year old woman who is one of the victims of the Great Hanshin-Awaji Earthquake of January 1995. The house in which she was living alone was completely destroyed by the earthquake and she moved into a temporary dwelling. She had been treated for her diabetes mellitus and chronic hepatitis at our hospital as an outpatient. In October 1996, she was hospitalized because of exacerbation of her diabetes mellitus and liver function. This was due to changes in her life style and psychological stress by the earthquake disaster. While in the hospital, she showed some problems with treatment as she got into trouble with the staff members and other inpatients. The patient was therefore referred to the department of psychosomatic medicine for "consultation liaison". It was found that the patient had had traumas due to stress from the earthquake disaster. For recovery from these, a stable therapeutic relation and living environment were indispensable. This meant "establishment of safety"for the patient. Then, psychosomatic care including patient education proved to be effective. The patient's clinical courses of diabetes mellitus and chronic hepatitis showed psychosomatic correlations with her mental condition. Therefore, a psychosomatic approach from the mental and physical standpoint is considered to be significant for the patients who are the victims of disasters seeking for others' support with chief complaints of somatic diseases and symptoms.

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The patient is a 55-year old electrical engineer. He began to have an insommia since a highway road was built near his house where trucks go along even late at night. Two years before the first visit to our department, he felt insomnia and had an uncomfortable sensation as "ear rings a strange sound". The laryngologist he visited could hardly understand his complaint of ear's symptom. He showed no abnormal sign by a routine laryngological examination including audiometer and X-ray. He was referred to our department suspected to have delusion about his own hearing. At first, we medicated him a hypnotic to get enough sleeping time. In due course, he was suspected to be suffering from infrasound health damage. Therefore, we advised him to keep a sleeping diary and wear an activity monitor to elucidate a relationship between his insomnia and the sound. His insomnia showed DSPS (delayed sleep phase syndrome) due to something related to infrasounds at midnight. In addition, there was a relationship between his sleeping time and his daytime condition of the next day. We should be cautious when we see an insomnia patient who might have infrasound health damage.

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