On account of the radical progression of the technology of medicine and informational technology, medical educators need new method for training medical students properly. There are two main variants, one is the problem based leaning (PBL) and the other is for medical human sciences. PBL-tutorial is the educational method for training the student to obtain the ability to manage the medical problems by themselves. On the other hand, medical human sciences are the way to understand the patients as a human being with physical or mental problems, not as a disease itself. There still remain many problems to teach the latter to the medical student. We need a good professor who is a proper educator and how to supply the educator continuously. We surely know that the psychosomatist is the one of the best educators on this field and also the department of psychosomatic medicine is the only one supplier of continuous educators at least in Japan. We have to show the superiority in the existence of the department of psychosomatic medicine in medical education to teach the human science in the future.

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In medical schools without the department of psychosomatic medicine, the department of psychiatry plays the central role in the undergraduate education of psychosomatic medicine. Psychosomatic medicine in a broad sense is a clinical approach which aims to see every patient of any disease from not only physical aspects but also psychosocial aspects. It is not different from psychiatric approach, although psychiatry mainly deals with mental illnesses while psychosomatic medicine mainly deals with somatic diseases. In Tokushima University, the department of psychiatry assumes responsibility in lectures on medical psychology and general psychiatry as well as clinical clerkship of psychiatry. From now on, what is emphasized more in medical education is clinical clerkship. In order to reach a U. S. standard, each medical school tries to extend the period of clinical training. The education of psychosomatic medicine also needs to consider this trend. Introducing the case of Tokushima University, significance of the undergraduate education of psychiatry and psychosomatic medicine is considered.

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To practice psychosomatic medicine in general practice, we have found that the recognition of psychosomatic medicine is still not sufficient. While our task is to promote enlightenment of psychosomatic medicine, it is required to enhance the psychosomatic medicine on post- and undergraduate education. However, even though we increase the conventional lecture hours, it would end in simple cramming of knowledge and it has been difficult to reach the learning goal of psychosomatic medicine, which includes ethic education, manner education and reliable doctor-patient relationship. Further, as a result of the categorical lectures, it has been difficult to deepen the understanding of psychosomatic medicine containing various factors. In the future, it will be important to develop new the curriculum of psychosomatic medicine based on the outcome by cooperating several courses.

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In modern medical care, with its growing emphasis on holistic medicine and professionalism, the needs in areas such as the physician-patient relationship and narrative medicine, areas in which psychosomatic medicine excels, have intensified. At Toho University we have established lectures on Comprehensive Medicine that run throughout the school year, as a course covering topics such as breaking bad news to patients and psycho-oncology. Psychosomatic medicine can be called an area in which it is possible not only to provide education within a "psychosomatic medicine" framework but also to play various roles as part of the medical education. Offered during students' fourth year, these structured lectures on psychosomatic medicine utilize a PBL tutorial format. Clinical training is given in the fifth year. While clinical training can be said to occupy the critical position of serving as a bridge between structured lectures and postgraduate clinical training, it also entails the difficulty of having to address the needs of both learning methodologies within a limited time period. Consequently we have introduced narrative medicine's approach of using a "parallel chart" as one means of deepening students' reflections. This paper introduces psychosomatic medicine training at Toho University.

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Objectives and Subjects : Recently, many cases of middle-aged women with eating disorder have been reported. This study aims to clarify the relations among nurtured experiences from infancy, the internal working mode (mental representation) and the trend of eating disorders in 369 middle-aged women (aged between 30 and 59 years old) by use of questionnaires. Results : A fearful-avoidant type of eating disorder tendency was higher than other types when classified from the internal working model. Also, unstable part of the internal working model affected the eating disorder tendency. The nurturing experience was correlated to the inner working model, but it was uncorrelated to the eating disorder tendency. Conclusion : These results suggest that the characteristics middle-aged women had acquired during their growth process produce the differences in eating disorder tendency.

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Background : The introduction of highly active antiretroviral therapy (HAART) in 1995 has drastically decreased both the incidence and number of deaths due to AIDS among HIV-infected patients. HIV has now become a chronic disease for which long-term control is possible, and as a result mental illness among HIV-infected patients has now become an issue. However, no consistent guidelines for the psychological support of HIV patients have yet emerged. Methods : In order to compare the features of mental illness between HIV-infected patients and healthy controls, we conducted various psychological tests (CES-D, STAI, TCI-125, Rosenberg test) on 13 HIV-infected outpatients at the Department of Infectious Diseases and Infection Control at Tokyo Jikei University Hospital (all registrants were male ; median age 38.5±6.0 years) and 21 age/sex-matched healthy male controls (median age 36.6±5.5 years). We also investigated psychological stress in the HIV group using questionnaires. This study was conducted from July 2009 to August 2012. Results & Discussion : The psychological tests and questionnaires revealed that HIV-infected patients were significantly more affected by "depression" and "anxiety" than were healthy controls. On the other hand, the level of "self-esteem" in the two groups was almost the same. However, the levels of "reward dependence" and "self directedness" in TCI-125 were lower in HIV-infected patients than in healthy controls. HIV-infected patients suffer stress not only because of the disease itself but also due to social features such as concerns about social prejudice and a sense of isolation. Therefore, in addition to the high-risk period just after diagnosis of HIV infection, and at the point when AIDS is developed, careful long-term observation of stress in such patients is needed in order to restrain both suicidal ideation and actual suicidal action, as well as management of their HIV burden. Only 20% of HIV-infected patients reveal their condition to their families, and 30% state that they have no-one to rely on for emotional support. This situation suggests that society is not yet ready to accept HIV patients. Unfortunately in Japan, some people are still under the impression that AIDS is frightening disease that can be easily transmitted from one person to another and is directly linked to death. In this situation, HIV-infected patients will become more and more isolated and lose their sense of trust in others. I think that in order to improve the social acceptance of HIV-infected patients, dissemination of correct knowledge and information about HIV to the general public is vital.

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A patient who is shy and timid, has a tendency to isolate himself since childhood. In fact, he has lived alone in a city. Due to Social Anxiety Disorder (SAD) , he had showed signs of adjustment disorders with social withdrawal at work. His sick leave had been extended for a long period of time. We proposed Cognitive Behavioral Therapy as the method to use for intervention. We asked the patient to keep a record of his home assignments every day. We also asked him to document his anxiety attacks. Moreover, we asked him to describe the anxiety episodes and to indicate the emotion and the time he experienced. Gradually his anxiety and tension had improved. Unfortunately, the disaster on March 11, 2011 triggered a regression of his SAD. Devoid of any food at home, he expressed hesitation to go out of his house and buy essential basic necessities. Even if he didn't have any information as to whether his parents were alive, he continued to withdraw from social contact. Three weeks later he was able to receive information that all of his family members survived. It was only after two months since the disaster when he visited his family. He had witnessed the disaster himself, which became a turning point for him. Thus, he gained the will to move on. He decided to come out of his shell and finally joined a volunteer group that took care of cleaning up the debris left by the earthquake devastation. To our surprise, this he did voluntarily. After getting back to the city, he joined the program "Return to Work". This program aimed to train people who had long been on sick leave due to inability to make proper adaptation to their working environment. From emotional instability he changed positivity. Almost all of his symptoms were gone and after ten months since the disaster, he finally could return to work. Almost two years have passed since he had gone back to work. He has never applied for any leave of absence nor has his disorder relapsed during this period. There were very few reports of specific therapeutic methods for recovery from social withdrawal. Most of the cases are still unknown. We make a report on a fully recovered rare case here that we had ever experienced.

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