The "collage work" was performed by ashmatic children who joined the Asthma Camps to evaluate the self-educational effect of group therapy. Thirty one children (20 boys, 11 girls) joined the camp of 1992, and 30 children (17boys, 13girls) of 1993 and 1994. In this group setting, replacement of another person's attributes was seen, which had never been experienced ("Sugekae") in the collage expressions which had never been experienced in the Sand Play therapy. Such "Sugekae" was mainly shown by junior high school boys whose egograms xhowed significantly higher incidence of type of "Iam NOT OK, you are OK" type than the "I am OK, you are OK" type (p<0.05, z=0.00348) and also than the "I am OK, you are NOT OK" type(p<0.05, z=0.1010), and significantly higher incidence of the "I am NOT OK" group than the "I am OK" group (p<0.05, z=0.0203). The former seemed to have a tendency to replace another person's attributes to oneself ("Sugekae") in there collage works. This seemed to represent negative images against themselves including their physical bodies or supressed conflicts hoping that they could change into some other type of person or that they want to change themselves because of lack of self-confidence. Such introspection, combined with the group dynamics seemed to have led to the expression of "Sugekae".

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To explore the implementation of bereavement care in hospice/palliative care settings in Japan, a self-administered questionnaire was sent to 235 family members of the deceased at one hospice. The survey was conducted in May, 1999, and the recovery rate was 62.6%. Sixty percent of the respondents were female and about half of these widows. Most of the respondents highly evaluated the bereavement care the hospice had provided, consisting of "card-sending (83.6%)", "annual memorial ceremony (72.8%)", and "self-help group for bereavement (63.9%)". Respondents less than 60 year old evaluated self-help group significantly more than those over 60 (p<0.01). Strong needs for "telephone counseling" and "personal counseling" were also recognized, indicating that individually oriented care is an essential part of bereavement care. About 40% of the respondents answered that they had aggravated or newly developed health problems after a death in their family. Their physical health problems included cardiovascular diseases such as ischemic heart diseases and hypertension, gastroenteric diseases such as peptic ulcers and colon polyps, respiratory diseases including asthmas, diabetes mellitus, nephritis, thyroid disorders, rheumatoid arthritis, liver dysfunction and cataracts. They also complained of subjective symptoms such as headache, vertigo, general malaise, appetite loss, change in body weight. As psychiatric health problems, only one case of major depression and one of a specific phobia (riding trains) were reported, while many other complaints included depressive mood, inhibition, anxiety, agitation, insomnia, withdrawal, hallucinations and suicidal idea. About 50% of those who listed "physical" health problems related them to their family member's death. Since the loss of a family member and loved one is a strong stressor for both physical and psychiatric health, risk assessmnt for surviving family members is needed before the death of hospice patients, and appropriate intervention for each individual to prevent future health problems should be implemented. As to the question what their last time with the deceased at the hospice meant to them, many expressed positive feelings. Some respondents mentioned the way the family member dealt with the dying patients and the severity of grief after their death is reolated. For example, "Since our last time with the patient at the hospice was joyful, our grief is less than expected". These results strongly indicate that bereavement care should be started while the patients are still in the process of dying.

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The aim of this study is to investigate the relationship between the coping pattern and mental health after bereavement and to consider maladaptive coping. 123 widow(er)s answered a questionnaire concerning coping with bereavement (Coping with Bereavement Scale) and mental health (General Health Questionnaire Japanese version, 28 items version). As a result of factor analysis with promax rotation, it was revealed that Coping with Bereavement Scale had three main factors : "Life Orientation" (e. g., I thought about my own life from now on), "Avoidance" (e. g., I tried to forget the deceased), and "Retaining Ties (e. g., I talked with the deceased in my heart)". As a result of partial correlation analysis, it was shown that "Avoidance" and "Retaining Ties" had little relationship with mental health. As a result of cluster analysis, the following three patterns of coping with bereavement were emerged : Cluster 1 (low-life-orientation and high-retaining-ties), Cluster 2 (high-life-orientation and high-retaining-times), and Cluster 3 (middle-life-orientation and high-avoidance). These coping patterns were unrelated with age, sex, family structure, and passage of time from loss. Three coping patterns were compared by using one-way analysis of the variance (ANOVA) on mental health, and further post hoc comparisons of significant results were undertaken. The scores of GHQ-28 total and four subscales of Cluster 1 were significantly higher than that both of Cluster 2 and Cluster 3. According to GHQ-28, 93.8% widow(er)s in Cluster 1 was screened as neuroticism. Thus low-life-orientation and high-retaining-ties was considered as maladaptive coping pattern after bereavement. And the implications of these findings for bereavement care were discussed.

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Twenty one primiparas and 31 multiparas were investigated for their psycho-physical condition during the early puerperal period. The puerperal patients filled out a questionnaire that was composed of 20 questions regarding State-Trate Anxiety by Spielberger, C. D., 10 questions regarding maternity blues by Pitt B. and 30 questions regarding physical condition by division into work physiology and psychology ; Institute for Science of Labor in Japan, Starting from the day after delivery to the last day of hospitalization. Additionally, three questions regarding physical pain, such as the after-pains, perineal pain following episiotomy, and breast pain due to engorgement, were also filled out. All of patients had a vaginal delivery of a healthy, full-term infant, and received postpartum nursing care in the clinic. They also had a routine episiotomy and suture removal on the fourth day postpartum. They were given prescriptions for anti-biotics, an ergonovine and anti-phlogistics for four days. The after-pains decreased rapidly, but the perineal pain did not decrease in primiparas especially, while the breast pain increased gradually until the second day postpartum in multiparas and third day in primiparas, decreasing thereafter. The multiparas frequently complained of fatigue more than primiparas for three days after birth. The level of complaint was regarded as being slight to moderate in multiparas. The primiparas generally held a higher score for anxiety than multiparas. There are some correlations among their anxiety and depression ratings, fatigue domain II and total fatigue numbers. The depression was related to fatigue domain I, domain II, the total fatigue numbers and anxiety. However, they were correlated with fatigue domain I, and total fatigue numbers in multiparas. The multiparas held a higher score for anxiety, depression, fatigue domain I, III and total fatigue numbers when they became conscious of two more regions of physical pain than one region or zero. This study may have had some problems with the questions on the questionnaire, and the method of evaluating physical pain.

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There are reports regarding the patients with bulimia nervosa in whom due to continuous vomiting, chronic regurgitaion of acid gastric contents erodes and demineralizes their teeth. This study included an investigation of oral manifestations of the patients with bulimia nervosa, and a questionnaire on oral hygiene and eating disorder presented to them. The subjects consisted of 12 patients with bulimia nervosa (25±7 years old ; 1 male and 11 females) who were under the care of Dr.Yasuda at the Department of Psychosomatic Medicine, Kita-Kyushu Municipal Medical Center. The following results were obtained : 1) Hyperesthesia and toothache were noted in half of the subjects. The average number of decayed, missing and filled teeth (DMFT) in the subjects was 45.5 ± 21.6. This is 4.4 higher than the number of DMFT described in a report on the survey of dental diseases by the Medical Affairs Bureau, Ministry of Health and Welfare of Japan in 1993. White spots on maxillary anterior teeth region were noticed in 2 subjects, and parotid gland swelling was seen in one subject. 2) Nine subjects (75%) were conscious of an increase in decayed tooth count after contracting eating disorder, 5 subjects (42%) were anxious about acid eroshio of teeth and 5 subjects (42%) were conscious of acid erosion of teeth. Eight subjects (67%) were under the care of dentists, but only 2 subjects (17%) were pointed out to have a change in oral state. Five subjects (42%) were anxious about the care of the dentists in charge. Seven subjects (58%) were reluctant to tell their dentists about eating disorder and 9 subjects (75%) expected dentists to be informed of eating disorder. 3) The average number of DMFT found in the grope with vomiting for 4 years of less (n=8) was close to the number described in the report on the survey of dental diseases by the Medical Affairs Bureau, Ministry of Health and Welfare of Japan in 1993, but the average number of DMFT found in the groupe with vomiting for more 4 years (n=4) was 15.9 higher than that of the report. The number of DMFT found in the grope with vomiting for 4 years or less was lower than the number found in the groupe with vomiting for more 4 years, but no significant oral manifestations of acid erosion of the teeth were found. A relationship between vomiting and erosion was not found either. The reply to the questionnaire that they were reluctant to tell dentists about eating disorder suggested the patients' mental states of desiring to make a secret of eating disorder. Although only few subjects were pointed out by dentists to have a change in oral state, dentists play an important role in diagnosing the disorder. It is important that both medical doctors and dentists notice this problem and its treatment.

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We treated a 24-year-old woman with irritable bowel syndrome whose physical symptoms decreased after joining a psychodrama group. Here we describe the treatment process and discuss the therapeutic factors related to this case. The psychodrama group comprised 5 clients exhibiting a psychosomatic disorder or neurosis 2 therapists. A total of 10 psychodrama sessions were held every other week. Our client with irritable bowel syndrome was not aware of and could not express much emotion ; she talked only of her physical symptoms in individual psychotherapy sessions. She had a tendency toward alexithymia. After joining the psychodrama group, she becacme aware of her social adjustment style (that is, she realized that she was not self-assertive, and she adjusted her opinion and behavior to fit the expectations of those around her, putting herself under a lot of stress). Little by little she verbalized her feelings and wishes. She resigned from her job, to which she felt she had adapted herself too much, and her physical symptoms decreased subsequently. We believe the psychodrama factors of "fantasy and playfulness", "concreteness and action", and "being away from oneself" were effective in this case, enabling the client to recognize and express her feelings and wishes.

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