In recent years, psychiatrists in Japan have increasingly participated in palliative care teams. In this study, reasons why psychiatrists face difficulties when treating dying patients and their family members are discussed and some solutions are suggested. With respect to diagnosis, psychiatrists often hesitate to follow a normal psychological process in an effort to adhere to their specialty and do not consider subjective components in a patient's statement in the objective methodology of psychiatric diagnosis. In addition, many psychiatrists are unfamiliar with denial in the terminal phase or the desire for hastened death and are puzzled by how the psychic phenomena of dying patients are indistinguishable from physical symptoms. Family members of dying patients may hesitate to seek psychological treatment because they feel guilty about receiving such care. Moreover, recent changes in the diagnostic criteria of depression due to grief may be confusing to psychiatrists. From a therapeutic perspective, difficulties in diagnoses directly lead to therapeutic predicaments, and depression in the terminal phase is difficult to treat because antidepressant medications are not effective. To overcome such difficulties, I suggest that psychiatrists should also carefully consider patients' physical symptoms, reinforce categorical diagnoses with a subjective understanding, and deepen their understanding of spiritual pains.
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