["Shuuchaku" in various types of manic-depressive patients].
Shimoda's concept of "statothymia" consists of the hypothesis on the characteristic of the emotionality of manic-depressive patients (Shuuchaku-temperament) and the typological description of their personality (Shuuchaku-personality). According to him their emotion, when it has once arisen in relation to something, hardly diminishes. This characteristic constitutes a neurophysiological basis of the disease. The persons, who have this characteristic of emotionality, are quite reliable persons in society, who make every effort to accomplish their obligation, to take responsibility. But at the same time under the overloading situation they are not able to get out of the persistent involvement in work and consequently fall into depressive or manic phases. Although this concept is even today relevant to the core group of mood disorder, it has also some limitations. There are lots of cases in which overwork does not precipitate the manifestation of the disease. The loss of an important person and the change in surroundings are classically well known precipitating situations of melancholic phases. Nowadays such cases are also found, in which failure to acquire a desirable social environment or a romantic partner precipitates the outbreak of the disease. Furthermore such patients of younger generation categorized into "soft bipolar spectrum" defined by Akiskal are far from socially reliable persons, rather maladjusted. Shuuchaku-personality or Typus melancholicus, which is almost equivalent of it, constitutes only one of the various types of patients, together with such types as manic type, avoidant-dependent type and "soft bipolar" type. This article aims at, not only by following Shimoda's concept but also by taking the ordinary meaning of the Japanese word "Shuuchaku" into consideration, presenting a new formulation applicable to various types of the patients of mood disorder. The Japanese word "Shuuchaku" orginally means "sticking to" or "preoccupied with" a certain object, surrounding, or ideal. We consider that in manic-depressive patients the self, which has once been strongly connected with such objects or ideals hardly retreats into past and sticks to the present self. This formulation is not only in accordance with Shimoda's hypothesis on the characteristic of emotionality but also it reveals how the problem of object relation and that of temporality are interconnected with each other in manic depressive patients. One of the prominent features of the melancholic symptoms is that patients have the feeling of irrevocability. This indicates in return that in their premelancholic phase they live rather in revocable time. This revocable time is, from our view, the time in which the past self does not completely retreat and always sticks to the present self. In the patients of Typus melancholicus, since the self, which has well been settled in a stable surrounding, always sticks to the present self, the present self continues to avoid an irrevocable change. At the same time since the self, which has not completely taken responsibility, sticks to the present self and drives it to achieve more preciseness in taking responsibility, the order of their surrounding is maintained before it is irrevocably disintegrated. However overloading and unexpected changes in their surrounding could undermine their revocable time and lead them to the outbreak of the disease. In contrast the patients of manic type are not able to settle down in a stable surrounding, rather they often develop conflict with it. In them the self, which could have acquired a desirable condition but has not, sticks to the present self and drives it to seek more ideal conditions outside of the surrounding already given to them. In them the failure to acquire a new desirable condition could precipitate the disease. Furthermore their life course could be close to that of "soft bipolar" patients, when it becomes unstable through the conflict and the disillusion with their surrounding and the consequent withdrawal from real social life.
Tsuda
Hitoshi
H
Tokyo University, Faculty of Medicine, Department of Psychiatry.
Hori
Arinobu
A
D001714:Bipolar Disorder / Q000145:classification / Q000209:etiology / Q000523:psychology*; D004644:Emotions; D006801:Humans; D013694:Temperament