Objectives : We argue for a key concept in "Narrative-Based Medicine" through detailed analysis of interactions in illness narratives. The purpose of this research is to illustrate that practical knowledge based on a patient's lived experience of illness has significant meanings and functions for medical treatments that advocate a holistic medical care. Subjects and method : Subjects of this research are 5 patients placed in the 3^<rd> stage of Four-stage model (1^<st> report). This research adopted the qualitative research method from an anthropological point of view, because it was necessary to mention the influence of a researcher upon subjects. An anthropological research for narrative analysis can deal with interactions among patients, a doctor and a researcher as academic agenda. Results : We examined illness narratives for clarification of a key concept in "Narrative-Based Medicine". It was clarified that illness narratives as "witness" were proving the truth of their illness experience. We found there are 3 aspects on dynamics of witness (Fig. 1); (1) illness narratives as witness of subjects in the 3^<rd> stage, (2) a medical doctor as a witness person for their illness narratives, (3) a researcher or a family member as a second witness person. We found that each interaction among these 3 aspects could be considered indispensable conditions in order to conduct medical treatments based on the dynamics of witness. Significance of illness narratives as witness lies in that subjects will be able to live together with chronic illness through interactions among these 3 aspects. Conclusion : In analysis of illness narratives in this research, it was clarified that the dynamics of witness in the above mentioned 3 aspects could generate medical phenomenon that encouraged patients to live together with chronic illness. We regarded the dynamics of witness as one of the key concepts of "Narrative-Based Medicine". Hence we named this medical phenomenon "Witness-Based Medicine".

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Objective : High prevalence of irritable bowel syndrome (IBS) in patients with panic disorder (PD) has been reported. PD has a lot in common with IBS on the viewpoints of symptomatology, pharmacotherapy and the brain-gut axis theory. However, precise characteristics of PD patients with IBS are not well understood. Therefore, the purpose of this study is to investigate the clinical characteristics of PD patients with IBS. Method : The participants of this study were 150 PD outpatients (37 males and 113 females, mean age was 33.7±9.5 years old), who met DSM-IVcriteria. PD patients completed Rome II Modular Questionnaire (RMQ), Scale of PD symptoms, and Beck Depression Inventory (BDI). Results : The prevalence of IBS who met Rome II criteria was 36.0% of all participants. The onset of IBS preceded in 38.9%, the onset of PD preceded in 29.6%, and the simultaneous onset was found in 14.8%. The PD patients with IBS (PD[+]/IBS[+]) had significantly higher prevalence of agoraphobia and depression than those without IBS (PD[+]/IBS[-]). PD[+]/IBS[+] was apt to have higher frequency of anticipatory anxiety than PD[+]/IBS[-]. Furthermore, as compared among PD[+]/IBS[+] with agoraphobia (IBS[+]/AP[+]), PD[+]/IBS[+] without agoraphobia (IBS[+]/AP[-]), PD[+]/IBS[-] with agoraphobia (IBS[-]/AP[+]), and PD[+]/IBS[-] without AP (IBS[-]/AP[-]), IBS[+]/AP[+] and IBS[-]/AP[+] had significantly higher degree and frequency of anticipatory anxiety and depression than IBS[-]/AP[-]. Conclusion : High frequency of anticipatory anxiety and depression of PD[+]/IBS[+] may be associated with agoraphobia. However, there was no significant difference between IBS[+]/AP[+] and IBS[+]/AP[-], and between IBS[-]/AP[+] and IBS[+]/AP[-]. Therefore, we should not disregard the relationship between IBS and high score of anticipatory anxiety and depression. Further studies on relationship between IBS and agoraphobia may be required in larger sample.

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Objective : The purpose of this study is to determine the degree of influence that "subjective physical problems" and "future time perspective" affect "negative anxiety", and to compare standardized coefficients of these two paths in a multiple indicator models of the covariance structure analysis among the young, the middle-aged, and the elderly. The multiple indicator models in this research were consisted of two unobservable exogenous variables called "future time perspective" and "subjective physical problems", and a latent endogenous variable called "negative anxiety". Subjects and method : In total 179 young, 180 middle-aged, and 160 elderly people were served as subjects. They were asked to give rating to 18 items of the Experiential Time Perspective Scale (Shirai, 1994) and additional 4 items. An exploratory factor analysis of these responses revealed that 5 items had high loading on one of 4 abstracted factors, which was named "future time perspective". Three items of 5, which had a higher value of factor loading more than. 5 for each of 3 groups (the young, the middle-aged and the elderly), were adopted as observable endogenous variables for a latent exogenous variable "future time perspective". Another unobservable exogenous variable named "subjective physical problems" included two observable endogenous variables. One is "physical condition" being judged by a question for general health condition. The other one is called "subjective symptoms" shown according to the number of checked items of the ten physical problems. Also all the subjects evaluated 25 items of Yamamoto's Anxiety Scale (Yamamoto, 1992). Through these responses, an exploratory factor analysis showed that 13 items had high loading on one of 2 abstracted factors, which was named "negative anxiety". Three items of 13, which had a higher value of factor loading than. 7 for all of 3 groups, were adopted as observable endogeneous variables for a latent endogeneous variable "negative anxiety". Results and conclusion : Through a simultaneous analysis of multiple population, the results showed that the standardized coefficients indicating degrees of influence of "subjective physical problems" on "negative anxiety" were almost same as about. 4 in all three groups (the young, middle age, and the elderly), while those of "future time perspective" on "negative anxiety" were -0.36 with statistical significance in the group of the middle-aged, but not significant in the group of the young and the group of the elderly. These results suggest that "subjective physical problems" would produce "negative anxiety" at similar proportion in any life cycle, while "future time perspective" could influence the decrease of negative anxiety only in the group of the middle-aged because the middle-aged people could predict their future in accordance with their present ecomonic and social situations.

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Despite that fact that few societies are impervious to traumatic events leading to death and bereavement, there is paucity of studies pertaining to the societal-specific reactions to loss considering that grief reaction tend to be marked with psychosomatic problems. Societal-specific reactions could shed light on what constitutes culture-specific or culture-reactive idioms of distress. This paper considers whether grief process and task of grief emanating from Euro-American thanatological literature has heuristic counterpart to grief reaction observed in different parts of the world. The present exploratory process of qualitative enquiry considers how the family in Oman narrated their perceptions, beliefs, and practice of their dead relatives. After sudden death, carrying out funeral customs and ritualistic grieving practices for the deceased may appear to indicate an acceptance of the loss in traditional Omani society. In actuality, however, the family begins to be preoccupied with the idea that the deceased is somewhat still alive. Instead, the relative of dead equate the fate of deceased with ensorcerement and zombification. Present qualitative enquiry suggests that in the traditional Omani society, such preoccupation with ensorcerement and zombification is likely to have brought hope, reduced stress of sudden death and facilitated a long but easy transition through bereavement. This is interpreted as culturally sanctioned reactions to loss that appear to constitute explanatory models that entail negation of loss without indication of pathological sequel. Within context of similar reaction from Japan and Haiti, it appears that although death is universal phenomenon, reaction to it differs from culture to culture. It is concluded that cross-cultural study on coping with traumatic events would likely to pave the way for further research and the appreciation of the diversity of human experiences. Such undertaking is relevant in this age of globalization and acculturation where psychosomatic problems are becoming a global challenge.

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