This paper first outlines Morita therapy, followed by a discussion on a Morita-based therapeutic approach to treating somatoform disorders and psychosomatic diseases. Concrete case illustrations are offered. A self-aggravating vicious cycle is formed between sensations and attention among patients with somatoform disorders and psychosomatic diseases, which results in the patients' intensified inner sufferings and further preoccupations with the possibility of getting ill. Therefore, Morita therapists do not focus on the somatic symptoms in their treatment. Instead, patients are encouraged to direct their energy to build or restore a productive life style by doing what they can do or need to do while leaving the symptoms as they are, which in turn lessens their somatic symptomatic preoccupations. However, as psychosomatic diseases are often based on organic disorders, therapists need to examine the nature of symptoms carefully and appropriately explain the pathological states. Additionally, another area of application of this therapy is briefly discussed in terms of improving cancer patients' mental health. Morita therapy is not only a psychological treatment in a narrow sense but also a physical treatment which activates patients' healthy energy by means of physical activities. For this, Morita therapy may be regarded as an integrative psychosomatic treatment.

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In this article, basic concepts of Morita therapy are outlined, and its application to the treatment of somatoform disorder is illustrated through the investigation of cases of outpatient and inpatient. The vicious circle between anxious attention and sensitive feelings causes the fixation of patients' anxiety and their neurotic symptoms. Anxiety and neurotic symptom are considered as the other side of the coin of "Desire for life". In Morita therapy, after having sufficiently listened to patients' complaints about somatic symptoms, therapist treated their anxiety as something natural and encouraged them to step into actions while coping with anxiety. Attention to daily life itself has an effect of shifting a focus from patient's obsession with physical status and of regaining a natural state of physical and psychological being, which leads to the interaction with self as "arugamama (as it is)".

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Among intractable atopic dermatitis patients there are some to whom scratching has become a habit. They often scratch unconsciously, or impulsively, when irritated or trying to escape anxiety. Some patients become psychologically dependent on scratching. They are fixated upon scratching behavior, itching sensation and atopic dermatitis itself, causing a vicious cycle of the fixation (the attention-mediated sensory aggravation effect). I try the Outpatient Morita therapy with these patients, aiming to change their lifestyle and way of thinking, without emphasizing "Don't scratch". Outpatient Morita therapy is a treatment to guide patients to master the attitude of "arugamama". "arugamama" means that patients put aside their symptoms and anxiety (without resorting to scratching), and lead their daily life carrying out what they have to do (self-realization). I guide my patients to practice the attitude of "arugamama", encouraging them to keep a diary or providing them a place where patients can talk to each other about their experiences. As a result, when they become aware of their behaviors and change their way of life, they are often released from the earlier fixation, and become able to accept the reality of their dieases. This could further lead to the acceptance of their own life. Then they often start challenging themselves with courage towards self-realization, resulting in the decrease of their scratching behavior and the recovery of the barrier function of the skin. After that their skin symptoms show remarkable improvement.

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As the pain becomes chronic, patients suffer not only from unpleasant pain sensation, but also their distress is increased until they cannot spend their original meaningful life. It has been reported that various kinds of inefficient treatments are administered repeatedly on the patients, and as a results, the patients have visited several medical facilities in search of better treatment in vain. Taking these facts seriously, the investigative commission on the study of pain was erected by Ministry of Health, Labour and Welfare in 2009. In this review, I introduce the Morita therapy which can be effective for the patients who have lost control of their life and are in profound distress, regardless of existence of structural disorders.

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We have achieved satisfactory treatment results by employing modified Morita therapy for outpatients after many processes of trial and error to seek treatments for oral psychosomatic disorder. In this study, we describe some therapeutic modifications in the treatment of oral psychosomatic disorder. For this condition, it is essential to combine different psychosocial therapies with somatic therapies and medical therapies using psychotropic drugs. These psychosocial therapies include Morita therapy, which was established as a treatment for one of the conditions called Morita Shinkeishitsu, i.e., oral neurosis. Modern oral psychosomatic disorder is similar to this condition. Morita therapy is undoubtedly beneficial for the treatment of this disorder. As we discussed in this study, we will improve the therapy for this purpose while using examples of various other treatment modalities based on our experiences, with suggesting the higher applicability of modified Morita therapy for outpatients of modern oral psychosomatic disorder.

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Objective : We conducted a survey examining mothers with eating disorders and their offspring at the National Hospital Organization, Kurihama Medical and Addiction Center. The first report of results from this survey was entitled, "Comparative study of marriage, pregnancy, delivery, and child care between Japanese women with and those without eating disorders". The present report is the second report and concerned with the somatic, psychological, and behavioral disorders of children whose mothers have eating disorders. This report is the first survey conducted in Japan of children whose mothers have eating disorders. Methods : The subjects were 30 children from 20 mothers with eating disorders and 36 children from 20 mothers without eating disorders. The mothers of the children in both groups underwent semi-structured interviews conducted by the authors regarding their children's developmental problems. The semi-structured interview form was prepared for the survey and included 42 items to clarify the health problems of the children. Results: During their infancy, the children of the mothers with eating disorders had significantly more developmental difficulties, such as an abnormal birth, developmental retardation, and hospitalization for illnesses, than the children of mothers without eating disorders (47.6% vs. 16.7%). The subjects had significantly more episodes of enuresis (42.9% vs. 10.0%) and experiences of being abused than the control group (26.7% vs. 0%). Among the children of the mothers with eating disorders, children whose mothers had smoked during pregnancy had lower birth weights than the children whose mothers had not smoked. Furthermore, the children whose mothers had experienced postnatal depression had more experiences of being abused than the children whose mothers did not experience postnatal depression. One girl had brain damage whose mother had fallen severe binge eating and self-induced vomiting during her pregnancy. Conclusion : This study shows that children whose mothers have eating disorders require careful, long-term support.

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Objective : The purpose of this study was to investigate the actual symptoms of patients with eating disorders, and elucidate which symptoms distressed families the most, as well as how they coped with them. Method : We presented a questionnaire regarding 17 symptoms of eating disorders in a group meeting to support families. The selected symptoms were 1) an unbalanced diet, 2) insufficient dietary intake, 3) overeating, 4) to persist with a peculiar dietary habit, 5) to compel their family to eat large amounts of food, 6) to watch and control the family meals, 7) to compel the family to keep his/her company in daily life, 8) to go intentionally a long way, 9) unable to keep still and being hyperactive all day, 10) to resist changing their own lifestyle, 11) to create conflict within the family, 12) unable to go out alone, 13) unable to work (unable to go to school) , 14) destructive, violent behavior or abusive words, 15) money troubles such as shoplifting or wasteful extravagance in spending, 16) wrist cutting or suicide attempts, 17) addictions. We questioned whether any of the 17 symptoms listed above existed within the family. When the symptom did exist, seriousness was evaluated on a scale of 11 degrees (from 0 to 10 points). We further asked the families to describe effective coping mechanisms for improvement, together with ineffective ones in their experience. We received answers from 31 families. Results : More than 50% of the patients have the following 5 symptoms. They were 4) to persist with a peculiar dietary habit, 6) to watch and control the family meals, 7) to compel the family to keep his/her company in daily life, 9) unable to keep still and being hyperactive all day and 10) to resist changing their own lifestyle. Among the aforesaid symptoms, the median degree of seriousness was greater than 6 points in items 4), 9) and 10). The described coping mechanisms were varied and even identical coping mechanisms were evaluated differently from family to family. Conclusions : The symptoms which distress the families of patients with eating disorders are associated not only with diet and hyperactivity but also compulsive behavior. It was considered an effective support mechanism for the families to discuss how to cope with these troublesome symptoms within the group meeting to support families of patients with eating disorders.

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