Chapter 1: Executive Summary
Diligent, highly responsible employees are the most vulnerable to mental health breakdowns. This is not a matter of individual weakness, but rather a structural mechanism rooted in a temperament known in psychiatry as the "melancholic type" (Typus melancholicus), which breeds over-adaptation and suppresses one's own distress signals. In fiscal year 2024, the number of workers' compensation decisions for mental disorders exceeded 1,000 for the first time, reaching 1,055 cases (Ministry of Health, Labour and Welfare, 2025). When managers fail to understand this structure and rely solely on conventional checklists, they miss the changes in the employees most at risk. By shifting the quality of everyday observation from "what to look for" to "how to look," it becomes possible to detect the subtle changes in over-adapted individuals.
Chapter 2: Definitions and Current State
2.1 Canonical Definitions
Definition: The melancholic type (Typus melancholicus) is a temperament classification related to depression onset, proposed by psychiatrist Tellenbach. In the refined formulation by Kasahara and Kimura, it is defined as "an other-centered disposition rooted in love of order." Meticulousness manifests across three domains — work, conduct, and conscience — with social norms and moral obligations being highly valued, and an existential orientation centered on "being-for-others" (Sein-für-andere) (Japanese Society of Psychiatry and Neurology).
Definition: Over-adaptation is a state in which a person excessively conforms to the expectations and demands of their environment, to the point where they can no longer recognize their own needs or stress signals. Because over-adapted individuals maintain or even increase work quality as they approach their limits, they appear "normal" or "exemplary" to those around them.
2.2 Typical Scenarios
- A vicious cycle where the inability to "cut corners" even as workload increases leads to ever more work being assigned
- Continuing to answer "I'm fine" without realizing — nor anyone else noticing — that responses have lost their specificity
- Physical symptoms (headaches, stomach pain, insomnia, numbness in hands) emerge progressively, yet are dismissed with "I can't take time off work"
2.3 Manager's Check: Commonly Overlooked Signs
The following are signs specific to over-adapted individuals that rarely appear on standard checklists.
| # | Sign | What to Look For |
|---|---|---|
| 1 | The quality of "I'm fine" has changed | Responses that were once specific have become one-word answers |
| 2 | "Too normal" | While everyone else is busy, one person remains conspicuously calm and composed |
| 3 | Casual conversation and shared lunch breaks have decreased | Work performance is fine, but interpersonal contact has shrunk |
| 4 | Overtime hours haven't changed but output quality has subtly declined | Possible decline in work performance due to mental health issues |
| 5 | Reports physical discomfort but repeatedly says "It's nothing" | Early-stage depression often presents with physical symptoms first |
Chapter 3: Data and Evidence
3.1 Workplace Stress Reality
| Item | Figure | Source |
|---|---|---|
| Percentage of workers experiencing strong stress | 68.3% | (MHLW, 2024) |
| Top stress factor: "Workload" | 43.2% | (MHLW, 2024) |
| 2nd stress factor: "Work mistakes, emergence of responsibility, etc." | 36.2% | (MHLW, 2024) |
| 3rd stress factor: "Quality of work" | 26.4% | (MHLW, 2024) |
3.2 Mental Health-Related Leave and Resignation
| Item | Figure | Source |
|---|---|---|
| Percentage of workplaces with employees on mental health leave or who resigned | 12.8% | (MHLW, 2024) |
| Same figure for workplaces with 1,000+ employees | 91.6% | (MHLW, 2024) |
| Same figure in the information and communications industry | 39.2% (approx. 3x the national average) | (MHLW, 2024) |
| Percentage of workplaces implementing mental health measures | 63.2% (94.3% for workplaces with 50+ employees) | (MHLW, 2024) |
| Most common initiative: "Implementing stress checks" | 65.3% | (MHLW, 2024) |
| Followed by: "Evaluation and improvement of workplace environment" | 54.7% | (MHLW, 2024) |
3.3 Workers' Compensation Status for Mental Disorders
| Item | Figure | Source |
|---|---|---|
| Workers' compensation claims for mental disorders | 3,780 cases (up 205 from previous year, 4th consecutive year of increase) | (MHLW, 2025) |
| Workers' compensation decisions for mental disorders | 1,055 cases (up 172 from previous year, 6th consecutive year of increase, first time exceeding 1,000) | (MHLW, 2025) |
| Total claims related to overwork deaths and illnesses | 4,810 cases (up 212 from previous year) | (MHLW, 2025) |
| Of which: deaths/suicides (including attempts) | 159 cases (up 21 from previous year) | (MHLW, 2025) |
| Compensation decisions for suicides (including attempts) among mental disorder cases | 88 cases (up 9 from previous year) | (MHLW, 2025) |
3.4 Workers' Compensation Decisions for Mental Disorders by Age Group
| Age Group | Decisions | Source |
|---|---|---|
| 40–49 | 283 cases (highest) | (MHLW, 2025) |
| 30–39 | 245 cases | (MHLW, 2025) |
| 20–29 | 243 cases | (MHLW, 2025) |
| 50–59 | 225 cases | (JILPT, 2025) |
| Combined 20s–50s | Over 90% of all cases | (JILPT, 2025) |
3.5 Mental Disorders by Industry and Occupation
By industry (top claims):
| Industry | Claims | Decisions | Source |
|---|---|---|---|
| Healthcare and welfare | 983 cases | 270 cases | (MHLW, 2025) |
| Manufacturing | 583 cases | 161 cases | (MHLW, 2025) |
| Wholesale and retail | 545 cases | 120 cases | (MHLW, 2025) |
Industry subcategories (highest):
| Industry (subcategory) | Claims | Decisions | Source |
|---|---|---|---|
| Social insurance, social welfare, and nursing care | 589 cases | 152 cases | (JILPT, 2025) |
| Medical practice | 389 cases | 118 cases | (JILPT, 2025) |
By occupation (top decisions):
| Occupation | Claims | Decisions | Source |
|---|---|---|---|
| Professional and technical workers | 1,030 cases | 300 cases | (MHLW, 2025) |
| Service workers | 556 cases | 182 cases | (MHLW, 2025) |
| Clerical workers | 796 cases | 160 cases | (MHLW, 2025) |
Occupation subcategories (top):
| Occupation (subcategory) | Claims | Decisions | Source |
|---|---|---|---|
| General clerical workers | 577 cases | 97 cases | (JILPT, 2025) |
| Public health nurses, midwives, and nurses | 242 cases | 70 cases | (JILPT, 2025) |
3.6 Events Contributing to Onset of Mental Disorders
| Event | Decisions | Source |
|---|---|---|
| Power harassment | 224 cases | (MHLW, 2025) |
| Major changes in work content or workload | 119 cases | (MHLW, 2025) |
| Serious nuisance behavior (from customers, facility users, etc.) | 108 cases | (MHLW, 2025) |
| Sexual harassment | 105 cases | (JILPT, 2025) |
3.7 Clinical Findings on Melancholic Type and Promotion-Related Depression
| Item | Content | Source |
|---|---|---|
| Core of the melancholic type | Love of order. Keeping everything meticulously organized is the fundamental principle of life | (Japanese Society of Psychiatry and Neurology) |
| Interpersonal characteristics | Being-for-others (Sein-für-andere), valuing social norms and moral obligations | (Japanese Society of Psychiatry and Neurology) |
| Inkludenz (envelopment) | An inescapable contradiction where one cannot abandon meticulousness even as work demands exceed manageable levels | (Japanese Society of Psychiatry and Neurology) |
| Remanenz (residue/remainder) | A vicious cycle where maintaining high work standards generates new tasks, accumulating debt | (Japanese Society of Psychiatry and Neurology) |
| Primary trigger for onset | "The awareness that one has imposed work and tasks upon oneself up to the limits of one's own possibilities" (Mauz) | (Japanese Society of Psychiatry and Neurology) |
| Personality traits in exhaustion depression | Conscientious, meticulous, interpersonally sensitive, perfectionist. Sets high self-demands and constantly imposes new tasks upon oneself | (Japanese Society of Psychiatry and Neurology) |
| Depression recurrence rate | 50% | (Kokoro no Mimi / MHLW) |
| Early physical symptoms of depression | Occipital pain → cold-like symptoms/stomach pain → numbness in both hands, loss of appetite, insomnia (progressive stages) | (Kokoro no Mimi / MHLW) |
| Cognitive impairment | All things are viewed negatively; the common-sense judgment to "take leave and seek treatment" becomes impossible | (Kokoro no Mimi / MHLW) |
3.8 Institutional Framework for Line Care
| Item | Content | Source |
|---|---|---|
| Basis of line care | Managers notice early when subordinates seem "different from usual" | (MHLW, 2015) |
| Prerequisite for noticing | Maintaining ongoing interest in subordinates and being familiar with their usual behavioral patterns and interpersonal styles | (MHLW, 2015) |
| Scope of medical judgment | Beyond the capacity of managers. This is the responsibility of occupational physicians or equivalent medical professionals | (MHLW, 2015) |
| Legal responsibility of managers | Bear implementation responsibility for the duty of safety consideration (安全配慮義務) | (Kokoro no Mimi / MHLW) |
| Stress check system | Mandatory for workplaces with 50+ employees. Primary prevention is the focus. Managers cannot directly access individual results | (MHLW, 2015) |
| Four-tier care system | Self-care, line care, in-house occupational health staff care, external resource care | (MHLW, 2015) |
3.9 Theoretical Foundations of Stress Models
| Model | Overview | Source |
|---|---|---|
| Job Demand-Control Model | It is important to provide discretion (control) commensurate with job demands (workload and responsibility) | (MHLW, 2015) |
| Effort-Reward Imbalance Model | Stress increases when psychological rewards (recognition, future stability) are insufficient relative to work effort | (MHLW, 2015) |
Chapter 4: Analysis and Implications
Key terms: Melancholic type (Typus melancholicus), over-adaptation, Inkludenz (envelopment), cognitive distortion, learned helplessness, psychological safety, emotional exhaustion, presenteeism, duty of safety consideration (安全配慮義務), line care
Axis A: Mechanism Analysis — Why Do the Most Diligent Employees Break Down?
The Self-Contradiction Born of "Love of Order"
Individuals with a melancholic type temperament are highly valued in the workplace as "model employees." They complete work meticulously, never fail to show consideration for others, and consistently deliver results beyond expectations. The problem is that this very "exemplary nature" becomes the starting point of their collapse.
The mechanism Tellenbach called "Inkludenz" (envelopment) operates in industrial settings as follows: Because they complete work to a high standard, new work comes their way. Because they handle that work just as carefully, even more accumulates. Tellenbach's metaphor — "In digging one's own grave, one digs so deep that one can no longer climb out" — precisely describes this inescapable structure.
A point that is often overlooked: diligent employees are not "prioritizing social adaptation." They feel they are "doing this for themselves" or are "absorbed in their work." Because the boundary between self-actualization and self-depletion is ambiguous, the belief that "I'm fine" persists right up to the breaking point. Based on approximately 25 years of corporate experience and practice as an industrial counselor, it can be said that this "self-perception of being fine" is the most dangerous characteristic of over-adaptation.
Over-Adaptation and the Invisibility of SOS
Over-adapted individuals maintain or even increase their work quality as they approach their limits. This is not "enduring through willpower." In the priority structure of their cognition, "completing what needs to be done" ranks above "physical and mental distress," preventing suffering from reaching the threshold that would trigger behavioral change.
This structure is supported by case evidence. In a case documented on Kokoro no Mimi (MHLW portal), a 31-year-old man who was promoted ahead of all his peers — meticulous and with a strong sense of responsibility — exhibited progressive physical symptoms including occipital pain, stomach pain, and numbness in both hands, yet stubbornly insisted, "I can't take time off work. If I'm going to be a burden, I'd rather resign. I want to handle this on my own" (Kokoro no Mimi / MHLW). Cognitive impairment caused by depression made the common-sense judgment of "rest and seek treatment" impossible.
The SOS is not absent — it manifests as "excellent work performance" or "dismissal of physical complaints." This is why conventional checklists cannot capture it.
Focusing on the "Quality" of Exhaustion
The top workplace stress factors in the Industrial Safety and Health Survey are "workload" at 43.2%, "work mistakes, emergence of responsibility, etc." at 36.2%, and "quality of work" at 26.4% (MHLW, 2024). Diligent employees tend to shoulder all three of these factors alone.
However, the severity of stress cannot be measured by "quantity" alone. As the Job Demand-Control Model demonstrates, when discretion is not commensurate with job demands, stress increases even for the same number of working hours (MHLW, 2015). When a diligent employee is promoted to a managerial position, the nature of their work shifts from their forte — hands-on work — to unfamiliar coordination tasks, and the mechanism of exhaustion accelerates rapidly. Monitoring working hours alone cannot capture this change.
Axis B: Institutional and Environmental Analysis — Why Are Existing Systems Insufficient?
The Paradox of Line Care
The MHLW line care guidelines take as their basis the detection of subordinates who seem "different from usual" (MHLW, 2015). The approach focuses on deviations in behavioral patterns such as increased tardiness, reduced conversation, and unkempt appearance.
This framework is effective in many cases, but it is structurally ill-suited for over-adapted individuals. Because the "usual behavior" of over-adapted individuals is itself built on excessive conformity to expectations, they appear even more composed as they approach their breaking point. The inability to find something "different from usual" is not a failing of managerial competence, but rather a structural misalignment between the design assumptions of line care and the characteristics of over-adaptation.
Limitations of the Stress Check System
The stress check system focuses on primary prevention (proactive risk reduction) (MHLW, 2015), but managers cannot directly access individual results. Although the system for identifying high-stress individuals and providing interview guidance is institutionalized, over-adapted individuals tend to underestimate their own stress and mark "no problem" on the check sheets. The self-care function that the system assumes — "workers become aware of their own stress" — is precisely what is undermined by over-adaptation.
The percentage of workplaces implementing mental health measures has reached 63.2%, with 94.3% among those with 50 or more employees (MHLW, 2024), and the most common initiative — stress check implementation — stands at 65.3%. Despite this, the fact that workers' compensation decisions for mental disorders have increased for six consecutive years reveals a gap between the existence of systems and their actual effectiveness.
Risk to Managers Themselves
Workers' compensation decisions for mental disorders peak in the 40–49 age group at 283 cases (MHLW, 2025). This means the managerial generation itself sits in the highest-risk bracket. The managers trying to protect their subordinates are themselves in need of protection.
Managers bear implementation responsibility for the duty of safety consideration (安全配慮義務) (Kokoro no Mimi / MHLW) and are responsible for assessing subordinate conditions, providing consultation, and improving the workplace environment. However, as the Effort-Reward Imbalance Model indicates, when the psychological rewards for this responsibility (recognition, visibility of outcomes) are insufficient, managers themselves enter a stressful state (MHLW, 2015). The paradox emerges that when mental health measures are added as "yet another obligation" for managers, it may actually increase their burden.
Axis C: Impact Analysis — What Happens If Left Unaddressed?
The Surge in Workers' Compensation Reveals Structural Problems
Workers' compensation decisions for mental disorders reached 1,055 in fiscal year 2024, exceeding 1,000 for the first time and marking the sixth consecutive year of increase (MHLW, 2025). Claims also rose to 3,780, the fourth consecutive annual increase. Compensation decisions for suicides (including attempts) stood at 88 cases.
By industry, "healthcare and welfare" stands out with 983 claims and 270 decisions (MHLW, 2025). In subcategories, "social insurance, social welfare, and nursing care" leads with 589 claims and 152 decisions, followed by "general clerical workers" with 577 claims and 97 decisions (JILPT, 2025). These are occupations where "diligent, considerate individuals" are heavily represented, and which show high affinity with the melancholic type temperament.
Decline in Work Performance Due to Mental Health Issues — The Reversal of Cause and Effect
An often-overlooked impact is that mental health issues cause a decline in work performance, which in turn results in extended overtime (Kokoro no Mimi / MHLW). Because the cause-and-effect relationship is reversed, managers perceive the situation as "they're slow" or "they're inefficient," and provide performance guidance rather than the support that is actually needed. This misidentification further worsens the situation.
Depression Recurrence Risk and Long-Term Organizational Impact
The recurrence rate for depression is 50% (Kokoro no Mimi / MHLW). In the case of the aforementioned 31-year-old man, impatience led to a premature first return-to-work decision, which resulted in relapse. For organizations, this means that a single sick-leave response is insufficient — a long-term framework encompassing return-to-work support and relapse prevention is necessary. Returning employees carry various anxieties: "How do people at work see me now?" "Can I readjust to the workplace?" "Will my illness come back?" When managers receive these feelings, it has the effect of easing tension across the entire workplace (Kokoro no Mimi / MHLW).
Chapter 5: Recommended Actions
Phase 1: Initial Response — Change the Quality of Everyday Observation
For the individual:
- If physical symptoms (headaches, stomach pain, insomnia, numbness) persist for more than two weeks, consider visiting a psychosomatic medicine clinic rather than an internal medicine doctor
- Recognize that the thought "I can't take time off work" may itself be a sign of cognitive impairment
For managers:
- Pay attention not only to "different from usual" but also to "too normal"
- Observe the quality of responses to "Are you doing okay?" (presence or absence of specificity)
- Watch for changes outside of work duties, such as decreased casual conversation or eating lunch alone
Phase 2: Consultation and Intervention — Response Based on Relationship
For managers:
- If a subordinate is resistant to consulting a professional, say "Let me go talk to someone on your behalf," and consult the occupational physician yourself (Kokoro no Mimi / MHLW)
- Prioritize listening to their feelings fully over giving advice (Kokoro no Mimi / MHLW)
For HR:
- Address the formalization of stress checks by implementing them in conjunction with workplace environment improvement (54.7% implementation rate)
- Build a system that integrates all four tiers of mental health care (self-care, line care, in-house occupational health staff, external resources)
Example Phrases for Consultation
- When the individual contacts a helpline: "I feel like my ability to concentrate has declined compared to before. Could I talk to someone about this?"
- When a manager reaches out to a subordinate: "I've been thinking about you lately — has anything interesting happened at work?" (A question that touches on how the person is feeling, rather than task progress)
Chapter 6: Resource Guide
Public Helplines
| Service | Contact | Hours |
|---|---|---|
| Workers' "Kokoro no Mimi" Telephone Counseling (Ministry of Health, Labour and Welfare) | 0120-565-455 | Weekdays 17:00–22:00, Weekends 10:00–16:00 |
| Yorisoi Hotline | 0120-279-338 | Available 24 hours |
Resources for Employers
- Occupational Health Support Centers (Sanpo Centers): Provide consultation on occupational physician selection and workplace environment improvement
- Kokoro no Mimi: A portal site by the Ministry of Health, Labour and Welfare. Offers free tools including line care e-learning (15 minutes) and workplace stress self-check
Chapter 7: Conclusion
Mental health breakdowns among diligent, responsible employees are not a matter of individual vulnerability, but a structural problem arising from the interaction between the melancholic type temperament and workplace environments. Now that workers' compensation decisions for mental disorders have increased for six consecutive years and exceeded 1,000 for the first time, the line care framework must shift from a "checklist-based" approach to "relationship-based everyday observation." What is asked of managers is not a change in "what to look for," but in "how to look." The first step to take is this: tomorrow morning, ask the subordinate you rely on most — not about their work, but about how they're feeling — with a simple question like, "How have you been doing lately?"
Chapter 8: Frequently Asked Questions (FAQ)
Q1: Why are diligent employees more vulnerable to mental breakdown?
It relates to a temperament known as the melancholic type (Typus melancholicus). Individuals who value order, exist for the sake of others, and cannot lower their work standards become trapped in a self-contradiction (Inkludenz) as workload increases beyond manageable levels. Furthermore, over-adaptation renders them unable to recognize their own distress signals, deepening the problem (Japanese Society of Psychiatry and Neurology).
Q2: Are checklists insufficient?
Conventional line care is based on noticing subordinates who seem "different from usual," but over-adapted individuals appear even more composed as they approach their breaking point. Because "different from usual" cannot be seen, checklists alone are insufficient. It is necessary to pay attention within everyday relationships to changes in the quality of "I'm fine" and decreases in casual conversation.
Q3: Is a manager's failure to notice a subordinate's mental distress a matter of competence?
It is not a matter of competence. The cause is the structural paradox that over-adapted individuals actually "appear more capable." Additionally, managers themselves are in the age group (40–49) with the highest number of workers' compensation decisions for mental disorders (MHLW, 2025), and often lack the capacity themselves.
Q4: What is the first thing a manager should do?
If a subordinate is resistant to consulting a professional, say "Let me go talk to someone on your behalf," and consult a professional yourself as a manager (Kokoro no Mimi / MHLW). What matters most is the willingness to listen fully to their feelings, rather than giving advice.
Q5: Does depression recur?
The recurrence rate for depression is 50% (Kokoro no Mimi / MHLW). Rushing the return-to-work decision increases recurrence risk. Return to work should be considered only when the following criteria are met: the individual subjectively feels almost back to their normal state, nearly all symptoms have improved, and they have a genuine desire to work — not driven by impatience.
Chapter 9: Sources and References
Government Publications
- Ministry of Health, Labour and Welfare, "Overview of Results of the 2024 Survey on Industrial Safety and Health (Actual Conditions Survey)" (厚生労働省「令和6年 労働安全衛生調査（実態調査）結果の概況」) https://www.mhlw.go.jp/toukei/list/dl/r06-46-50_gaikyo.pdf
- Ministry of Health, Labour and Welfare, "Workers' Compensation Status for Overwork-Related Deaths and Illnesses, Fiscal Year 2024" (厚生労働省「令和6年度 過労死等の労災補償状況」) https://www.mhlw.go.jp/stf/newpage_59039.html
- Ministry of Health, Labour and Welfare, "Content of Initiatives for Line Care" (厚生労働省「ラインによるケアとしての取組み内容」) https://www.mhlw.go.jp/file/06-Seisakujouhou-11300000-Roudoukijunkyokuanzeneiseibu/0000153867.pdf
- Ministry of Health, Labour and Welfare, "Stress Check System Implementation Manual" (厚生労働省「ストレスチェック制度 実施マニュアル」, 2015) https://www.mhlw.go.jp/bunya/roudoukijun/anzeneisei12/pdf/150507-1.pdf
- Kokoro no Mimi (Ministry of Health, Labour and Welfare), "Line Care e-Learning Materials" (こころの耳「ラインによるケア eラーニング教材」) https://kokoro.mhlw.go.jp/linecare/data/e-learning.pdf
- Kokoro no Mimi (Ministry of Health, Labour and Welfare), "A Case of Promotion-Related Depression Due to a Meticulous and Highly Responsible Personality That Made It Difficult to Delegate Work" (こころの耳「几帳面で責任感が強い性格から仕事を部下に任せきれず昇進うつ病を発症した事例」) https://kokoro.mhlw.go.jp/case/681/
- Kokoro no Mimi (Ministry of Health, Labour and Welfare), "Consideration for Subordinates and Colleagues: Are You Paying Attention?" (こころの耳「部下・同僚への配慮：気配りしてますか -上司・同僚の方へ-」) https://kokoro.mhlw.go.jp/attentive/atv004/
Academic Papers
- Japanese Society of Psychiatry and Neurology, "Revisiting Tellenbach's Melancholia Theory" (日本精神神経学会誌「Tellenbachのメランコリー論再説」) https://journal.jspn.or.jp/jspn/openpdf/1150070711.pdf
Research Reports
- Japan Institute for Labour Policy and Training (JILPT), "Workers' Compensation Decisions for Mental Disorders Increase for the 6th Consecutive Year" (労働政策研究・研修機構「精神障害の労災支給決定件数が6年連続の増加」, 2025) https://www.jil.go.jp/kokunai/blt/backnumber/2025/08_09/kokunai_01.html
Chapter 10: Related Content and Author Information
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About the Reset Method
The "structure that prevents people running at full speed from stopping" addressed in this briefing note is also a core theme of the Reset Method. The Reset Method takes as its guiding philosophy: "It's okay to stop. If you start walking again, even one step can change the future." It is an approach that reframes stopping not as weakness, but as a wise choice.
Author Profile
Kazuhiko Ehara
Certified Industrial Counselor (Japan Industrial Counselors Association). Director, Kazuna Research Institute. Regular member of the Japanese Association of Brief Psychotherapy.
After approximately 25 years working at an IT company, he became independent. In his 20s, he experienced over 200 hours of overtime per month, and was himself a firsthand example of "numbness to pain." Drawing on his experience of witnessing workplace mental health issues from the inside as a corporate employee, combined with his expertise in brief coaching grounded in SFBT (Solution-Focused Brief Therapy), he provides information on mental health to managers and HR professionals.