Bio-psychosocial medicine in disasters—report from Kobe 10 years after the Great Hanshin-Awaji earthquake
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Today, family therapy has developed to one of the important clinical fields
of psychotherapy and family support. The membership of JAFT is
approximately 1100, and one third of them are medical doctors, which is
one of the features of family therapy in Japan.
The clinical feature of family therapy is to understand clinical symptoms in
the context of interaction and/or the belief of family members.
The basic epistemological background has been the systems theory for
these several decades. Recently, new paradigm of clinical practice has
appeared, which is known as postmodern approach in the Western world,
whereas it is called as narrative therapy or narrative approach in Japan.
The concepts and methods of family therapy has been gradually applied in
clinical fields working with families, which, e.g., have child or adolescent
problems, marital problems, problems of mental illness or chronic physical
illness including terminal care, psychosomatic problems, and so on.
The author would like to report about the development and the present
situation of family therapy in Japan as the context of family therapy or
family-based approach in the treatment of psychosomatic problems.
30202The positioning of family therapy in Japanese
It was in the mid-1980s that family therapy began to catch attention in
Japanese psychosomatic medicine. It began with the introduction of family
therapy for eating disorders by Minuchin, S., and also Palazzoli, M.S. It had
a big impact on the psychosomatic field since it was just when they were
groping for a more effective treatment in coping with the increasing number
of patients with eating disorder. Also in Japan, credit goes to Shimosaka,
K., for his original approach towards the families of such patients. In the
1990s, a full-scale practice of family therapy started at the Department of
Psychosomatic Medicine in Kyushu University Hospital by Hayakawa. H.,
Higashi. Y., and Kojima. T, et. al. An effective outcome was seen not only
in eating disorders, but also in various psychosomatic disorders. The most
significant factor of the above practice is the development of a new medical
family therapy model and the techniques based on it.
30203Approach of family therapy for psychosomatic diseases in
Japanpresentation of statistical data and concrete cases of family
therapy for psychosomatic patients and the family
In the United States, it is well known that approach of the family therapy for
eating disorder is practiced by the research of Minuchin, S. et al. In Japan,
the approach is practiced for psychosomatic patients too. The above-
mentioned psychosomatic disease intends not only diseases, such as
psychogenic physical irregularity, in a narrow sense. But psychosomatic
medicine in Japan also includes psychosomatic diseases seen in the field of
terminal care, for example. Primarily, as the basic approach for psychoso-
matic disease, the medicine model and psychotherapy are used together.
And the approach of family therapy is effective especially for the patients of
diseases such as chronic pain and terminal care that are not improved by
general psychosomatic treatments.
The speaker practiced the approach of the family therapy for about
140 patients and families of Somatoform Disorders. In this presentation, the
speaker shows summary of some these cases and research after the illness
and shows characteristics and effectiveness of the family therapy in the
Bio-psychosocial medicine in disastersreport from Kobe 10 years
after the Great Hanshin-Awaji earthquake
30301What can medical assistance do for victims in catastrophes?
Nakayama S, Kozawa S, Ukai T, Ishii N
Introduction: Based on lessons from the Great Hanshin Earthquake, 15
key hospitals for disasters were designated in Hyogo prefecture and have
dispatched their medical teams to affected areas.
Results: In domestic disasters, 13 teams were dispatched in flood in Hyogo
and 10 in Niigata Chuetsu Earthquake in 2004 from key hospitals for
disasters and Red Cross hospitals in Hyogo. In overseas disasters, Kobe
University Medical Team was sent for 921 Chi-Chi Earthquake in Taiwan
in 1999 and Gujarat Earthquake in India in 2001. Hyogo Emergency
Medical Center sent doctors and nurses as members of GO (JMTDR) or
NGO (HuMA) team to help victims of Tsunami disaster in Sri Lanka and
Indonesia in 2004 and 2005. Activities of the teams were fact finding and
advice and clinical activities. Most of serious trauma cases had been
transported before their arrival, and assistance teams could take care of
patients with minor injuries and sickness.
Discussion: Prompt medical assistance must be provided in disasters,
taking account of the fact that lack of information is one of the
inevitabilities of catastrophe. Physical treatment was the first priority of
disaster medical management. At the same time, mental supportive care,
which could be given not only by specialists but also by any member of the
teams, looked essential; even victims had difficulties to communicate
Conclusion: Rapid dispatch of assistance teams is the most important as
well as well timed withdrawal. Any team must be more conscious of its
potential to reduce psychological and mental stress of the victims in
30302Participation for disaster relief as a psychiatrist
Fujii S, Kato H
When arguing about the relationship between psychiatry and disaster, we
need to consider two of the same sort but different viewpoints: disaster
psychiatry (medical treatment) and mental health care (psychological
support). When the great Hanshin-Awaji earthquake hit the Kobe area in
January 1995, psychiatric first aid stations and emergency services were
provided for about 3 months against the rapidly increased treatment needs.
Subsequently, 5 months after the strike, the Center for Mental Health Care
was established because of its devastating damage and enormous sufferings.
The center provided psychological support based on the existing local
community health care system, especially for the residents in the temporary
and the permanent housing, until March 2000. With growing general
interests and needs in mental health care, the center reopened in April 2004
as Hyogo Institute for Traumatic Stress, equipped with facilities for
training, study, and a clinic, targeting not only for disaster survivors but also
for victims from crimes and accidents.
Thus, the experience of this huge earthquake urged us to think more about
mental health and to start related programs in the very early stage after
disaster strikes in Japan. Under such conditions, we experienced
unexpected flood by typhoon in Hyogo prefecture, the Niigata Chuetsu
Earthquake in Japan, and finally the Sumatra Earthquake and the Indian
Ocean Tsunami Disaster internationally, all within this 1 year. In the
symposium, we are going to report slightly different ways of participation
as psychiatrists in each disaster, to exchange opinions in medical field and
for the better future cooperation.
30303The experience as a psychosomatic physician in the disaster
Murakami N, Ozasa Y, Muramatsu S
The Department of Psychosomatic Internal Medicine in Kobe Red Cross
Hospital was founded in 1996 for the purpose of treating psychosomatic
and psychological problems in patients from the Great Hanshin-Awaji
(Kobe) earthquake on January 17, 1995.
A disaster causes compound stressors. A disaster breeds physical, psycho-
logical, and social distress because of disease, injury, death of family,
homelessness, job loss, and loss of community. Such compound stressors
have a bad effect on body and mind of victims for a long duration.
For example, according to our research on 82 diabetes outpatients in 1996,
those who had suffered from the Great Hanshin-Awaji Earthquake were
Symposium abstracts / Journal of Psychosomatic Research 58 (2005) S7S29S8
more apt to have worse cases of diabetes. Diabetes represents one of the
psychosomatic diseases. Multiple factors such as diet, exercise, compliance
and coping for illnesses were related to this result.
According to other researches on outpatients of psychosomatic internal
medicine in 2000 and 2005, about 40% of the patients thought that there
was still a correlation between the illnesses and the disaster 10 years after
the earthquake. In fact, some patients came to consult us about their
physical and psychological distress for the very first time.
In our opinion, the victims should be provided physical, psychological, social
and spiritual care over a long period after a disaster. We must provide a
network among the various specialists in case of an event of a disaster.
Brainbody interactions: real daily phenomena of
30401Theory of emotional awareness and brain
processing of emotion
Negative affect that is not experienced or expressed may be the most
pathogenic response to environmental stress. The purpose of this paper is to
provide a way of understanding this phenomenon from a psychological and
physiological perspective. A cognitive developmental model of emotional
awareness will be presented that holds that the ability to become consciously
aware of ones own feelings is a cognitive skill that goes through a
developmental process similar to that which Piaget described for other
cognitive functions. The developmental process consists of the transition
from unconscious (implicit) to conscious (explicit) processing, with explicit
emotional processing having a modulatory effect on implicit processes. A
parallel hierarchical model of the neural substrates of emotional experience
will be presented next supported by recent neuroimaging work. It will be
argued that the neural substrates of implicit and explicit emotional processes
are distinct. The neural substrates of implicit aspects of emotion and three
distinguishable aspects of explicit emotional processing will be presented:
background feelings, focal attention to feelings, and reflective awareness of
feelings. The conscious processing of affective states requires the partic-
ipation of structures that subserve attention andmental representation that are
not unique to emotion. The domain general (i.e., not specific to emotion)
function of these structures may help to explain the vast individual
differences that are observed clinically in the ability that people have to
monitor and report their own emotions. The implications of this psycho-
biological model for behavioral medicine research will be presented.
30402Neurovisceral integration, emotions, and health
A comprehensive model of emotions and health must attempt to account for
the complex mix of cognitive, affective, behavioral, and physiological
concomitants of normal and pathological affective states and dispositions,
and how these might impact upon health. We present the outlines of a
model that integrates some of these components into a functional and
structural network that may help to guide us in our understanding of
emotion and health. Functionally, this network involves autonomic
regulation, affective regulation, and cognitive regulation. Structurally, this
network includes reciprocal, inhibitory circuits between prefrontal cortex
and subcortical evolutionarily primitive motivational structures that can be
indexed by rhythmic activity of the cardiovascular system. We will briefly
review some of the work that we have done to uncover the functional
aspects of this reciprocal, inhibitory circuit with respect to autonomic,
affective, and cognitive regulation. We will emphasize the relationships
among autonomic, affective, and cognitive regulation in organism health
and propose a group of underlying physiological systems that serve to
integrate these functions in the service of self regulation and adaptability of
the organism. We will attempt to place this network in the context of
dynamical system models that involve feedback and feedforward circuits,
with special attention to negative feedback mechanisms and inhibitory
processes. Importantly, we will show that the negative behavioral states and
dispositions associated with a relative autonomic imbalance toward
sympathetic dominance represent a disinhibition of positive feedback
circuits that are normally under tonic inhibitory control.
30403Braingut interactions and emotion
Clarifying functional module of the brain in response to visceral stimulation
is one of keys to understand the mechanism of emotion because the brain is
thought to form primitive emotion by integration of interoceptional signal.
Antonio Damasio has suggested that when we think about the potential
consequences of a behavior, the memory of our emotional state (visceral
experiences) in similar circumstances may provide useful information for
evaluating the behavior. Therefore, research on gut feeling is important not
only for clarifying pathegenesis of irritable bowel syndrome (IBS) but also
for understanding the mechanism of emotion. In studies of positron emission
tomography (PET) with injection of H2[15O], colonic distention pressure
dependently induced visceral perception, and anxiety, which significantly
correlated with activation of specific regions of the brain including the
prefrontal, anterior cingulate, parietal cortices, insula, pons, and the
cerebellum. Specific triphasic cerebral evoked potential of N1, P1, and N2
was obtained with the rectal electrical stimulation. Colonic distention
induced a significant decrease in the alpha power and a significant increase in
the beta power of electroencephalogram (EEG). Some molecules which
modifies braingut interactions were identified. They were at least cortico-
tropin releasing hpormone, histamine, and serotonin. These data suggest that
the functional module of the brain in response to the visceral perception is
present. Besides, the abnormal consequence of stimulation evoked arousal
and emotion may relate to pathophysiology of IBS. Further research on
braingut interactions will provide clinically useful information and basic
knowledge of psychosomatic medicine.
30404Brainbody interactions as the psychosomatic pathway to
Deter HC, Richter S, Buchholz K, Rudat M, Weber C
Introduction: Salt-sensitive normotensive men (SS) are an interesting model
for studying the development of essential hypertension (EH). These
participants exhibit also an enhanced pressor (BP) and heart rate (HR) response
to mental stress. The high stress-induced HR and BP acceleration is also a EH
risk factor and may result from sympathetic activation or vagal withdrawal.
This seems interesting to study brain cardiovascular interactions.
Methods: To understand the importance of autonomic dysbalance for the
increased stress responsiveness, we studied cardiovascular reactivity to mental
challenge in 17 SS healthy Caucasian male and 56 SR control participants.
Salt sensitivity was determined by a 2-week dietary protocol (20 vs...