[A case of depression with avoidance tendency showing successful reinstatement at work]

Recently, it has been suggested that depressive patients with avoidance tendency are increasing in number. They are inclined to become depressed under specific stressful circumstances, for example, in their workplace. They also show such features as being able to enjoy private activities, to show an almost normal vegetative function, and to blame others or circumstances, etc. Although their symptoms are mild in general, they tend to be prolonged and make it difficult for the patients to return to work. In this article, we report a male middle manager who presented mild depression with avoidance tendency. We tried to reduce his excessive workload, and, at the same time, to keep him going to work. As a result, the rhythm of his daily activities became stable, and work reinstatement was successful. Matussek says that the self has two aspects: the 'private self' and the 'official self'. For depressive patients, the private self is more important, but in public, they tend to do what others want them to. Such behavior with the public self conflicting against the private self makes them exhausted. This is common to the avoidance type of depression, and a typical major depression. The main difference between them is that the orderliness which patients show their behavior, that is, the basic character of the public self, is weak in the former and strong in the latter. In therapy for the avoidance type of depression, it is necessary to both reduce the excessive workload of patients and help them to continually relate to their workplaces, considering the degree of orderliness of their personality.