Recently there has been more interest in the topics of bereavement and grief care after the loss of a family member in Japan. Because the infant and child mortality is at very low rate and caused suddenly in many cases, parents are unprepared to deal with the loss of a child. The grief of bereaved parents is particulary severe, complicated, and long lasting. In this article, we described the importance of grief care and how to help the family after the death of a child. To help grieving parents, we must deal with unique issues and the impacts after the loss of a child. The areas include : effects of family system, issues with surviving sibling, psychosomatic problems, as well as psychological grief response. Before any intervention, it is important that we assess the factors influencing the grief reaction, the degree of resolution of the grief, and the reason for failure to complete the mourning work. When grief care is useful support, the mourning process is facilitated and some psychosocial problems are decreased. We also discussed clinical implications for caregivers and directions for the future studies of bereavement.

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Male climacterium is complicated by various factors. It needs multi-dimensional evaluation including bio-psycho-social factors. It has been recently pointed out that the decrease in free-testosterone secretion is found in male climacterium. In this connection, important psychological factors affecting the male middle age include mood disorders, mid-life crisis latent alcoholic dependence and daily sleep disturbance. Main social factors can be changes in the quality of work procedures and increased quantities of work contents, changes in the husband-and-wife relationships, children's growth and independence, and decline of parental influence (generativity crisis). Ethically a change in the philosophical value is important. Clinical evaluation of the middle age is useful from the stand point of life cycle. Being workaholic is one of the common coping styles which are selected by the middle aged persons. But workaholic coping is also a vulnerable defense which fails easily, and behavior modification becomes necessary for the workaholics. It should be suggested that workaholism is closely connected with the money-centered community value which had given support to the economic growth of Japan. There were many cases of office refusals in the men of 40's as well as those of 20's according to the investigation conducted by the psychosomatic clinic of Toho University. The lifestyle-related diseases found in the middle age such as obesity, alcoholic liver disease, hypercholesterolemia were often closely related to psychological and sociological problems. Improvements in the bad habits were difficult to achieve in the case of alcohol drinking and over eating by the clinical intervention for the company employees at the mental health office. In general, the lifestyle-related diseases of the middle age could not be modified easily. Therefore countermeasures need to be taken to enhance restructuring of the psycho-social values and the social support systems.

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Recently, andropause has been highlighted in the media. Actually, our impression is that middle or old aged men who suffer from erectile dysfunction, depression, instability and general fatigue etc. are increasing. Lately, we have established a special outpatient department based on the idea that these clinical symptoms are caused by aging change. We would like to review the actual situation of andropause. In this study, the results of the screening tests for the patients including HADS and IIEF 5 are also reported.

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Recently, many middle-aged men complaine of the symptoms like menopause, such as sweating, flushing, headache and so on. In Japan, the suicide ratio of middle-aged men has been increasing. In the field of psychosomatic medicine, the background of those symptoms seems to be depression or anxiety. In the field of urology, the decrease of androgen might induce those symptoms. Furthermore, sildenafil citrate, a therapeutic medication for erectile dysfunction (ED), is available. In this situation, the author opened a male menopause clinic for middle aged men with ED, cardiovascular disease and psychosomatic complaints in April 2001. The author report the experience and characteristics regarding this male menopause clinic.

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The author explained the technical terms regarding male climacteric, and also explained male climacteric disorder and male climacteric depression. Before making a diagnosis of male climacteric, we must exclude male depression because both of them can present similar symptoms. In the reports by psychiatrists, the serum testosterone levels of the patients are not measured, and the reports by urologists are not male climacteric depressions but male climacteric disorders. Therefore, we cannot conclude definitely if male climacteric depression is truly present or not. If present, it is "symptomatic psychosis" in terms of psychiatric nosology. In the end, the author described the relations between male depression and sexual dysfunction.

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We investigated 56 employees in an apparel company who developed mental disorders. The number of employees of this company is 948. There were 24 depression patients, 15 anxiety disorder patients, and 1 schizophrenic patient. Thirty-one of 40 female patients (77.5%) were between 25 and 34 years old. The main cause for their mental disorders seems to be related to marriage problems. We assumed that the precipitating factor of young women's illness was their difficulties in private life. As to chief complaints, 30 patients had mental symptoms and 24 had physical symptoms. Their objective signs included 'being absent from or late for work (21.2%)' 'emotional instability (13.6%)' 'decreased efficiency (9.1%)' and 'inappropriate use of E-mail (6.1%)'. Some admitted sending impolite mails. Others persistently sent mails to the same person. They sent mails at midnight and early in the morning. On the other hand, many patients did not admit objective signs (45.5%). The risk that creative workers like designers and pattern makers develop mental disease seems to be high. In some cases, mental diseases occurred in relation to specific brands.

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