Psychosomatic medicine originated in Germany, and today all German universities have departments of psychosomatic medicine. Spreading beyond Europe, psychosomatic medicine was widely adopted in the United States, where it developed mainly in conjunction with liaison psychiatry, basic research, and behavioral medicine. Japan adopted many of the psychosomatic medicine practices prevalent in the United States, but the direction it chose is similar to that of Germany. Since 2005, the number of members in the Japanese Psychosomatic Medicine Association has declined. This decline may reflect the growth in opportunities to study standard psychosomatic medicine without being affiliated with any university’s psychosomatic department.

I have been engaged in clinical and research work in psychosomatic medicine focusing on three main themes : 1) research on the effects of low nutritional status on the body and mind, 2) education on effective psychotherapy for eating disorders, and 3) activities to promote medical cooperation and consultation by telephone and e-mail for patients with eating disorders and their families. Although good results have been observed, challenges remain in securing specialized treatment facilities and providing adequate treatment for the pathological aspects of the diseases. In recent years, advances in medical science have led to significant improvements in the treatment outcomes for cancer, infectious diseases, diabetes, and collagen diseases. However, stress-related diseases, including eating disorders, suffer greatly from a lack of established treatment regimens, which has led to distress for patients and their families. These stress-related diseases are difficult to resolve with pharmacotherapy alone. Therefore, it is important to integrate psychosomatic medicine into the treatment to achieve better results.

In 1962, Yujiro Ikemi wrote that psychosomatic medicine aims to reorient medicine by incorporating psychology into medical care. In 1982, Hitoshi Ishikawa wrote that modern medicine was reaching its limits and self-regulated medicine should take the place of medicine that controlled others. Sixty years later, psychosomatic medicine has developed widely in various medical specialties, including chronic pain, cancer, palliative medicine, and primary care, but its role has also diminished in some medical fields. Based on the question of whether the original point is still alive today, we will consider the unexplored medical fields that psychosomatic medicine should be introduced into in the future.

It is no exaggeration that the concept of psychosomatic medicine and its perspective on patient care has now widely penetrated all aspects of medicine. Today, the relationship between psychosocial stress and physical illness is commonly treated in departments other than psychosomatic medicine. One could argue that the concept of psychosomatic medicine has changed from being innovative when it first emerged to being universal. While the appeal of such medicine should remain the same today, it seems important to change and develop its appeal in accordance with the times. We conducted a questionnaire survey of psychosomatic physicians to determine whether the definition and concept of psychosomatic disorders should remain the same, and what is needed for the future. Many agreed that the current status of psychosomatic disorders is acceptable while many stated that a strategy for creating and communicating a new appeal is needed for the future.

I hoped to participate in the practice of psychosomatic medicine because I strongly felt psychosomatic medicine remained uncultivated in the wild land. For young men, psychosomatic medicine appeared to be an eligible entrance into the new unknown world. Soon after graduation, I enrolled for a course in psychosomatic medicine and learned how to treat patients with eating disorders from Dr. Ken Fukamachi. In my resident course at Kyushu University, I struggled to treat patients with psychosomatic diseases. At Nagato Memorial Hospital, psychosomatic diseases were treated in patients with severe silicosis. In postgraduate school, I majored in psychoneuroimmunology ; for the detection of subtle expression of brain cytokines under conditions of psychological stress, I developed a highly sensitive detection system using PCR. At the National Institutes of Health, I studied brain neurotransmitter function using molecular biological techniques. After I returned to Japan, I treated patients with focal dystonia using biofeedback systems, participated in the management of the ward and the organization of the psychosomatic division of Kyushu University Hospital, and experienced real issues in the practice of psychosomatic medicine. At Fukuoka Dental College, I pursue the treatment of psychosomatic patients in the local community and treat patients with oral psychosomatic diseases in collaboration with the dental sections. In this article, I review whether my original aim was realized or not considering over 30 years of trail.

As a physician specializing in psychosomatic medicine, I have devoted over 35 years of my life to their field since graduating from medical school. Reflecting on my training and research, I would like to summarize my achievements, future challenges, and the message I hope to convey to young physicians. I find great satisfaction in practicing psychosomatic medicine, as it is a real pleasure to be able to enjoy the joy of “people can change” together with my patient. I sincerely hope that more young people will have the opportunity to experience the thrill of this field.

From 1990 to 1991, Saku Central Hospital, my employer, sent me to enroll as a research student at the Department of Psychosomatic Medicine in Kyushu University. Saku Central Hospital is known for its practice of community medicine.

Since returning to the hospital, I have been providing medical treatment in the department of psychosomatic medicine and psychiatry and also fulfilling hospital management responsibilities. In this article, I look back at what I learned at Kyushu University and discuss some of the ideas of Toshikazu Wakatsuki, who introduced community medicine at Saku Central Hospital. I would like to express my personal opinions on community medicine and psychosomatic medicine. I believe that medical care is essentially psychosomatic medicine. As specialization progresses, an understanding of psychosomatic medicine, which unbiasedly examines both physical and mental aspects, should be adopted in all clinical departments. Community medicine captures the patient’s condition from a broader perspective that includes their family, their life, and the community they live in. In the wake of a major turning point in human history, medical professionals must pursue expertise in diagnosing and treating diseases, while simultaneously looking at health and diseases from a broader social perspective.

Background : Although somatic symptom disorder (SSD) is generally considered an incurable condition with poor prognosis, few studies have investigated its treatment outcomes. Therefore, this study aimed to investigate the treatment outcomes in patients with SSD after one year in our outpatient setting.

Methods : In this retrospective study, the medical records of 35 outpatients (26 women ; mean age=54.5 years) with SSD specified as persistent (duration ≥ 6 months), who visited our department between April 2018 and March 2019 were examined for treatment outcomes.

Results : Of these patients, 16 (48.5%) showed improvement in symptoms, five (15.2%) were refractory to the treatment, and 16 (45.7%) discontinued the treatment.

Conclusion : SSD is not a disease with poor treatment outcomes as previously considered. In the treatment of SSD, however, a psychiatrist (or a psychosomatic physician) alone may not always be able to provide sufficient treatment. We believe that in the future, a collaborative approach with psychotherapists to develop treatments for SSD would be warranted.