In the event of a catastrophe, victims show symptoms of psychosomatic disorders due to the following various factors : traumatic stress caused by disaster itself, grief caused by experience of loss due to disaster, and stress caused by the change of living environment thereafter. The needs for “psychosomatic medical support” are high in all phases of disaster. In the acute phase, we care for physical symptoms and physical disorders of victims from a psychosomatic standpoint. In the chronic phase, the needs of mental health care will be revealed, but we will give medical care along with mental health care. During the reconstruction period, we care for victims who have suffered from physical symptoms due to long-term stress and loss. For the coming disaster, we psychosomatic experts need preparations as well.

We need to pay special attention to the medical assistance to the Great East Japan Earthquake. This may be associated with the temperature, custom and culture of Tohoku people who are reticent and enduring. Although there are differences to some degree, the trauma and loss that many victims experienced have a significant impact upon mental and physical conditions. Many of them will recover by natural healing power, but in some people their conditions may be extended or become severe due to trauma, bereavement and other secondary factors. The problem is that some will develop mental diseases such as depression and post-operative disorder, but quite a few victims must have developed physical diseases due to various physiological function diseases and exacerbated their chronic disease due to stress association with the earthquake. Although many victims of Tohoku who have a strong tendency to suppression will be aware of a vague feeing of unwellness caused by disaster, it is predicted that they appear as psychosomatic diseases which are difficult for them to recognize as their own feelings and body sensations. Many physicians or psychiatrists will find it difficult to realize the pathogenesis of such psychosomatic disease. Needless to say, it is extremely important to notice the existence of disorders and to approach them from both physical and mental viewpoints. For the medical assistance to the reconstruction of the Great East japan Earthquake, we have high expectations for the work of the department of psychosomatic medicine.

Municipalities of the disaster stricken area bear a great burden of responsibilities for conducting immediate rescue and a long-term relief activity to the sufferers. At the Great Hanshin-Awaji Earthquake 1995, many public officials themselves fell victims to the disaster, while relief workers concerned were obliged to be engaged in providing quick and sufficient services. Psychosomatic care is required in proportion to the growth of the long-term physical and mental afflictions along with built-up stress. In light of sufferers’ mind right after the disaster, it is natural that perception of each community or individual be widely different, which has been varying further occasionally in the course of recovery process as time goes by. Since then, Kobe City workers visited many different disaster areas including the Great East Japan Earthquake 2011 so as to back up the governmental supporters concerned. Through those activities, it came out to be clear that different items of issues arose out of a disaster depending on its type, scale, environmental view point, cultural and social back ground of each stricken area. Relievers also are influenced by occasions and dealings related to the disaster. Since the situation in its entirety as well as individual conditions varies quite often, it can be said practical psychosomatic care is significantly necessary for both victims and relievers.

In case of large scale disasters, the mother has to provide special care for her children. This article described psychosomatic symptoms and distinctive experiences in the disaster for mother and children. Mothers’ psychosomatic stability and relaxing made her children healthy and stable. The most effective care for mother is the daily life support for foods, clothes and the shelter. We should establish the psychosomatic support system widely including non-affected areas. Psychosomatic care support system needs to continue for a long period after the disaster.

Earthquakes lead to several psychiatric or psychosomatic diseases (PSD), such as post-traumatic stress disorder (PTSD), depression, and functional constipation, among survivors. Kumamoto experienced an earthquake in 2016 that was registered 7.3 on the Richter scale ; the earthquake claimed the lives of approximately 130 people. I had the experience of treating my patients before and after the earthquake in my psychosomatic clinic in Kumamoto. I present several case reports of patients showing typical and atypical episodes following the disaster. In addition, I studied PTSD or depressive symptoms in patients with PSD using a screening questionnaire for disaster mental health (SQD). The prevalence of PTSD and depression among patients with PSD was significantly higher than that among control subjects. Logistic regression analysis revealed that PTSD was significantly associated with female sex, diagnosis of PSD, and the amount of earthquake-related damage to the subject’s house. However, depression had only two significant risk factors : female sex and diagnosis of PSD. It is suggested that although PTSD is induced as a direct impact of the disaster, depression following the earthquake is influenced by individual psychosocial factors. When we treat patients after a disaster, we should take care of not only the direct, but also the indirect impacts of the earthquake on the human mind.

Food allergy presents a variety of symptoms, which may be difficult to improve unless psychological factors are considered in combination with apparent somatoform conditions. We report a case of severe and prolonged food allergy for which only the somatoform symptoms had been examined. The patient was a woman in her 40’s. Before we examined her, she had developed various somatoform symptoms and disabilities. Finally, she has much improved by psychosomatic intervention. The patient had developed rash, abdominal distention, weakness of limbs, emotional instability, and hallucination following ingestion of some specific food items. She had been experiencing these symptoms for two years and visited several clinics, where she was diagnosed as having food allergy. She was advised to avoid all cereal grains and fruits; however, her symptoms had persisted. When she visited the allergy department at our hospital for detailed examination, she fell down from weakness of limbs, which resulted in her emergency hospitalization. Physical and clinical examinations revealed that while she had antibodies against several specific food-driven antigens, there were no detectable factors contributing to other symptoms such as neuropsychiatric abnormalities. We suspected that she had somatoform symptoms and started behavioral therapies using restriction of movement, provided guidance for coping with emotional instability and its physical response, and trained her for assertion. These treatments enabled her to control the somatoform symptoms by herself, improved food allergy, and recovered well enough to reintegrate into the society. This case implicates that food allergy patients with multifaceted symptoms may be more effectively treated if the presence of stressor and the existence of somatoform disorder are recognized early enough through psychosomatic intervention.

The patient was a 78-year-old woman. Her chief complaints were dysgeusia, anorexia, weight loss, pigmentation on her hands and alopecia. She noticed dysgeusia symptoms after the insertion of artificial teeth. Because she had no abnormal dental findings, she was referred to the psychosomatic department of our hospital with consideration for her history of depression. The gastrointestinal endoscopy showed esophageal cancer in the early stage and gastrointestinal polyposis of which histological findings showed hyperplastic epithelium, edematous stroma and inflammatory cell infiltration. The colonoscopy also showed polyposis from the ascending colon through to the descending colon. These findings lead to the diagnosis of Cronkhite-Canada syndrome. She was treated with mesalazine and prednisolone accompanied by supportive psychotherapy to relieve her stress, and then recovered. Along with dysgeusia and anorexia, ectodermal disorders including skin abnormalities are often reported as the first symptoms of Cronkhite-Canada syndrome for which patients receive a medical check-up. Moreover, its development is sometimes related to psychological and/or physical stressors. In conclusion, we report a case of Cronkhite-Canada syndrome under strong psychological stress where the chief complaint was dysgeusia.