The author presented a 50-year old woman with severe hepatic and renal disorders who was psychosomatically treated, and reviewed its clinical course from the viewpoint of salutogenesis. Since she began working as a nurse at the age of 18, she developed a disordered eating behavior and alcoholism because of much stress at her workplace. She got married when she was 29 years old and lived with her parents-in-law who complained much and tended to get angry with her attitude at home. Her personality is characterized by compulsiveness, clinging and inflexibility. Psychological tests revealed the patient's dependency and depression. Whenever she is negatively criticized, she feels guilty, depressed and desperate, refusing therapeutic intervention, and finally falls into self-abandoned behavior such as heavy drinking. During the first three admissions, hepatic coma recurred and renal anemia was aggravated. As she indulged in wrist-cutting, psychosomatic approaches were applied to the patient preferably under ambulatory situations. The treatment included drip infusions (against hepatic insufficiency), medication (antidepressant, anxiolytics) supportive psychotherapy, and autogenic training. The patient's renal failure worsened and hemodialysis was started. Since then her symptoms have been improving, she returned to her workplace and her relationship with her parents-in-law has also been improved. From the viewpoint of salutogenesis, which was developed by Aaron Antonovsky, three factors are supposed to have contributed to the improvement in this case. (1) The therapeutical environment where the autor tried to keep consistent support and safety. As a result, a reliable doctor-patient relationship was achieved and the patient could accept her own disease and distance herself from it. This is an equivalent of the sense of comprehensibility and manageability. (2) The patient's experience as a nurse facilitated her acceptance of the treatment. Her correct understanding of the disease promoted her compliance with the treatment. This corresponds to the sense of manageability. (3) The patient's character also played an important role, that is, her strong feeling of responsibility changed her attitude towards her parents-in-law even though her basic personality is not altered. This is the sense of meaningfulness. In conclusion, the author would like to suggest the relationship between the three factors of the sense of coherence and major three Japanese traditions, namely, Shintoism, Buddhism, and Confucianism. Each combination of two traditions might correspond to one of the three components of the sense of coherence. The combination of Shintoism and Buddhism constructs comprehensibility, that is, our perception of the nature in Shintoism and interpretation of the life in Buddhism play an important role in understanding and explaining the order of the world where we are living. The combination of Buddhism and Confucianism makes manageability, that is, the respect for the life in Buddhism and ideal social relationship shown in Confucianism are essential elements forming our behaviors in social life. And finally the combination of Confucianisms and Shintoisms corresponds to meaningfulness.

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This study investigated the relationships between stress responses and hardiness which consists of positive thinking and sense of control. Results revealed significant correlations between positive thinking and stress responses I the high positive thinking led to show lower stress responses. Sense of control was related to four of stress responses, such as depression, anger, emotional confusion and withdrawal. Those of high sense of control were less likely to show these stress responses than those of low sense of control. These results suggest that both high positive thinking and sense of control reduce stress responses. Thus increasing hardiness by cognitive techniques might be efficacious against stress responses.

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Associations between perceived social support and immune systems were examined. Immunological assessments (T cell count, B cell count, NK cell count) and psychological assessment (stress coping inventory ; SCI) were administered to 98 male employees with written informed consent. Partial correlation coefficient controlled for age and smoking between social support and immune functions revealed that there were weak but significant correlations between perceived social support and NK cell counts (CD 3^-CD 16^+, CD 3^-CD 56^+) (r = 0.25-0.26 : p<0.05). These findings might imply that perceived social support augments natural immunity.

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Im this study a relationship between physical condition and mental health of elderly persons was examined in two areas, Kitanakagusuku Village and Kudakajima Island, where are known for longevity and traditional ceremony in Okinawa. The subjects consisted of 173 elderly persons (75 male, 98 female), aged 65-100 years, living in Kitanakagusuku Village and 77 (24 male, 53 female), aged 65-92 years, living in Kudakajima Island. A structured interview survey on state of physical conditions and mental health concerning subjective well-being was conducted. Subjective well-being was measured by the Revised Philadelphia Geriatric Center (PGC) Morale Scale and the Life Satisfaction Index Koyano (LSI-K), and physical condition was measured by subjective healthiness and Index of Competence (ADL : activities of daily living). Multiple regression analysis according to age and sex was separately examined on the related factors of subjective healthiness, PGC Morale Scale (PGC-M. S) and LSI-K. Multiple regression analysis showed that the related factors of subjective healthiness were as follows ; for Kitanakagusuku Village, PGC-M. Score and education, for Kudakajima Island, ADL, sex, LSI-K score and spending money. And also multiple regression analysis showed that the related factors of subjective well-being such as PGC-M. S, LSI-K were subjective healthiness and ADL. From the results of multiple regression analysis, it can be said that subjective well-being strongly affected subjective healthiness and ADL. There is a correlationship between mental health and physical condition. This study indicates that a good mental health of high level such as the elevatation of subjective well-being promotes a good somatic condition of health.

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The subjects consisted of 50 elderly people (14 males, 36 females), aged 65-96 years old living in the Kudakajima Island of Okinawa where there still exists the traditional religious praying customs and events. Analysis according to age and sex was examined on the related factors of Philadelfia Geriatric Center (PGC) Morale Scale, Life Satisfaction Index K (LSI-K), subjective healthiness, WHO/QOL 26-revised, ADL, "S" -scale (the existential ego-state of Self) and physical index s-IgA, free MHPG in saliva. The average score of subjective healthiness showed high level both of males and females and furthermore, to keep in high level such as 4.23±0.96 (65-74 years), 4.12±0.86(75 years over), however no significant difference in ages. Concerning subjective healthiness, a significant positive correlation was found among LSI-K, PCG morale scale and WHO/QOL 26. Even those in their 60's, 70's, 80's, 90's, the s-IgA concentration in saliva continued to show high level without reduction. And multiple regression analysis showed that the s-IgA concentration in saliva significancy was affected by independent activities in daily life which belong to the low rank of ADL index (p<0.05), and "S" -scale score, environmental domain which belong to the low rank of WHO/QOL 26 were revealed related tendency (p<0.10). After the traditional religious praying ceremony, MHPG-level in saliva showed lower level tendency in female who had experienced these holy customs (p<0.10). As the results of the above findings, it is suggested that improvement of mental health performes a very important role of health promotion such as the immune system , and also traditional religious customs exert a better influence on elder people for their mind and body in Kudakajima Island of Okinawa.

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The purpose of this research was to examine the local elderly people's mental health and its relating factors based on the local characteristics of Okinawa. At first, the factors relevant to self-esteem were examined for the elderly peoples aged 65 years and over residing in the Tairagawa area of Gushikawa city located in the central part of Okinawa. As a result, good health and economic conditions, life satisfaction, and subjective well-being all showed significantly high self-esteem scores for both males and females. Moreover, self-esteem scores were significantly higher for those who were depended upon in the community during traditional events or local festivals. The factors relevant to self-efficacy were examined for 162 residents '65 years or older aged in Nakagusuku village, located in central part of Okinawa. Self-efficacy showed a significant positive correlation with subjective well-being and the social role of daily activities. In an analysis by gender, self-efficacy showed a significant positive correlation with the participation in local traditional events and festivals for males. In females, it showed a significant positive correlation with economic conditions. When examined the relation to depressive tendencies, the Center for Epidemiological Studies Depression Scale (CES-D) was used to evaluate 610 peoples aged 80 years and over in Nakagusuku village. The CES-D score showed a significantly low value for those with high rates of interaction with neighbors (to include family), high levels of physical independence and subjective well-being, lower levels of health anxiety, and higher levels healthy consciousness. The CES-D score showed a significant negative correlation with the self-esteem score, the extent of subjective daily life and interest in society, and the degree of social participation. It can be derived from the above results, that the mental health of elderly people is related to various factors such as physical and psychological health conditions and social roles and activities. In addition, the possibility of traditional Okinawan events and festivals influencing an elderly people's QOL (quality of life) is also suggested.

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In Japan, the boundary between Psychosomatic Medicine and Psychiatry is not clear. At Kyushu University Hospital, we have a separate department for each field. To try and clarify the boundary between these two departments, I investigated the patients who were sent from one of the two departments to the other. In one previous year, 32 patients were sent from the department of psychosomatic medicine to the department of psychiatry. Among these patients almost all kinds of psychiatric illnesses could be found, therefore, physicians of psychosomatic medicine are required to have sufficient knowledge to distinguish the major types of psychiatric illnesses. On the other hand, only a few patients were sent from the department of psychiatry to the department of psychosomatic medicine. Most of them were patients who had some somatic symptoms, but no abnormal findings were identified during the routine physical examination and laboratory tests carried out by the departments of internal medicine, surgery and so on. However, many of these patients improved after being diagnosed and treated by physicians of the department of psychosomatic medicine. As a result, the ability of the physicians who belong to the department of psychosomatic medicine regarding the diagnosis and treatment of functional somatic diseases should be regarded more highly than it is at present. I therefore believe the final and most important aim of psychosomatic medicine should be to provide the best possible treatments for patients with somatic disease, and not to compete with the department of psychiatry to get more patients.

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Bereavement service is one of the significant services in hospice/palliative care units (PCUs). The aim of this national survey of bereavement services in Japanese hospice/PCUs is to comprehend the actual state of the support systems available for the bereaved. We sent a self-administered questionnaire to all 97 government-approved hospice/PCUs in November of 2001. Eighty-seven responses were returned (response rate 89.7%). Results showed that 76 institutions (87%) recognized great or at least some desire of bereaved persons for bereavement services. Seventy-three institutions (84%) assumed that all bereaved families should be recipients of bereaved services, and 60% of them attempted to assist other family members as well as the primary caregiver. In 38 institutions (44%), bereavement services were performed in off-duty hours and with no financial reimbursement. Twenty-six institutions (30%) had provided no training for the support services for the bereaved. Only 1 (1%) institutions undertook risk assessment by written form. Forty-nine institutions (56%) had no integrated support services from mental health practitioners. More than half indicated that "insufficient training", "lack of organizational support", "lack of sufficient staff time", and "lack of personnel" were the most difficult obstacles encountered in the delivery of bereavement services. In conclusion, we clarified multiple problems of support systems for the bereaved in Japanese hospice/PCUs and recognized the need to solutions throughout these institutions.

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