It is clear that patients and family members actually desire the amelioration of symptoms and cure. However, until now, there have been no major discoveries regarding the causes and definitive treatment of mental disorders and the progress of research is necessary. To produce results, it is necessary not only for researchers but also for patients and family members to cooperate in order to do large-scale investigations, and cooperation cannot be realized without trust. Therefore, it is the authors' opinion that the following two points are necessary to maintain trust.
 The first is the reconsideration of the physician-patient relationship. It is not in the laboratory but in clinical practice where the patient constructs a relationship of trust with the physician. Rather than concerning about the patients' agreement at case reports as a "cumbersome ethical restraint" or "being contrary to academic freedom," it should ideally be a valuable opportunity for a doctor and a patient to establish a relationship of trust through the explanation for obtaining agreement. The Japanese Society of Psychiatry and Neurology has created the most stringent criteria as compared with other academic societies with regard to agreement, although the reasons for the strictness should be understood.
 The second is to reflect the opinions of patients and family members in the planning and implementation phases of research. The question that is raised is whether involving patients and family members from the stage of research planning change the future of medical care. Should such a perspective be involved in the process of research?
 In the present article, I shall mainly discuss the necessity of the patients' agreement at case reports where patients and family members come into the closest contact with research. Moreover, as a result of recent developments in research on patients, ethics are necessary not only in "research performed by researchers" but also in "research by patients on patients themselves," and debate from the perspective of patient-family member relationships is also needed. To create a reliable study, I shall consider what is necessary with regard to ethics while taking into account the experience of the authors as patients and family members.
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