メランコリー型の意義再考―症例を通して

Reconsidering the Significance of Typus Melancholicus: A case study

抄録

　メランコリー型（Tellenbach H）は本邦において典型的なうつ病の病前性格として重視されてきたが，近年は回避的，自己愛的，あるいは軽躁的要素が混じたうつ病群の増加とともにその位置が相対的なものになりつつある。しかし，非メランコリー型に見えるうつ病にもメランコリー型と共通する要素が見いだされることは少なくない。本稿では，症例の検討を通じてメランコリー型を構成する要素を再検討し，多様化するうつ病を統一的に理解する視点を探ってみたい。メランコリー型は秩序志向性を基本的な特徴とするが，その底には環境の変化に対する脆弱性と対象との一体化願望が存在する。これらの特徴には，循環性格（Kretschmer E）の素因が関与していると考えられる。

　In Japan, Typus melancholicus (Tellenbach H) is regarded as a typical premorbid personality trait of depression. Recently, its significance appears to be decreasing with an increase in other types of depression with characteristics such as avoidance, narcissism, and occasional hypomania-like episodes；however, these non-melancholic types of depression have some features in common with Typus melancholicus. This may help in understanding various types of depression in a comprehensive manner.

　In this case study, we reexamined the fundamental features of Typus melancholicus in order to identify the features that might occur to a greater or lesser extent in the non-melancholic types of depression. We found that vulnerability to changes in circumstances and imaginary unification with objects, (e.g. intimate persons, jobs, and one's own bodies as the basis of activities) as well as the orderliness, which is one of the main characteristics of Typus melancholicus, were also observed in the non-melancholic types of depression；the first 2 factors may be involved in cyclothymia (Kretschmer E).