Hikikomori: The Silent Epidemic of Social Withdrawal

I recently came across the Japanese term Hikikomori, which means withdrawal and specifically refers to an extreme avoidance of social contact. This phenomenon was brought to the attention of the Japanese public by psychiatrist Saito Tamaki MD after the publication of his book, “Hikikomori, Adolescence without End,” which describes this social withdrawal phenomenon in a sector of the Japanese population.

The Hikikomori phenomenon is characterized by individuals becoming more reclusive and socially isolated, often not leaving their homes or bedrooms. Many suffer from guilt and shame, stemming from the ambivalence between societal expectations and their own needs.

In Japan, the number of reported Hikikomori cases is estimated to be around 700,000 to 1 million. There has also been an increase in these isolative behaviors among youth in other Asian and Western countries. In Japan, the focus on cultural conformity and the value placed on following the school-work pathway have led to strong negative reactions from families and society towards those who deviate from these expectations. Sociologist Teppei Sekimizu notes that these individuals are frequently confronted with questions like, “Why can’t you just continue attending school or work?” and “Why won’t you just move out of your parents’ home?” These rhetorical questions and societal pressures about compliance and conformity have led to significant family conflicts and stress.

Juan Villoro, a Mexican writer, notes that since at least the 1960s, the expectation for adolescents in most Western countries has typically been to look forward to leaving their homes. However, we now see more youth and emerging adults turning inward, towards their bedrooms.

Hikikomori is triggered by many factors. Although a large percentage might suffer from underlying mental illnesses like social anxiety, panic disorder, obsessive-compulsive disorder, autistic spectrum disorder, and depressive disorders, it is important to note that Hikikomori itself is not a mental disorder. Instead, it is a phenomenon impacted by many factors that lead to a final pathway of social withdrawal and isolation.

In my clinical experience over the last 30 years as a child and adolescent psychiatrist, I have observed certain behaviors during development that are possibly inherent in modern life and affect some children and adolescents. An example is the increased prevalence of addictions to video games, digital technology, and social media. Many youths find it hard to separate from their digital devices, making it difficult to participate in and engage in other social activities with family and peers, including having trouble leaving their bedrooms. This can lead to significant isolation.

Another contributing factor, I believe, was the recent COVID pandemic, which initially required staying at home with virtual schooling. Although most children were excited to return to school, some children, adolescents, and their parents continued to have hesitation and fear of returning to onsite activities even after the end of the pandemic, preferring the “safe” home environment.

Let me exemplify this point with a composite case frequently seen in my clinical practice:

A 12-year-old female with a history of trauma, depression, and low self-esteem, who lived in a conflictive home environment for several years, presented with a reluctance to socialize and return to school. She exhibited an obsessive tendency to always wear a mask and dark glasses as protective gear, which also served as additional barriers from others, including her family. It took several years and treatment before she was able to break from these barriers and fears and become less uncomfortable interacting with others.

Although there is no specific cause for this growing phenomenon of social isolation, there is evidence of a growing tendency to isolate, especially among youth. Most recently, the US Surgeon General Dr. V. Murthy issued a national advisory on social isolation and loneliness, which is pertinent to this conversation. I refer to my previous blog on this topic: Addressing Loneliness and Social Isolation: Tips from a Child Psychiatrist

In Japan, there has been wider recognition of Hikikomori and its implications for individuals, families, and society. This has helped address the stigma and barriers associated with this problem, especially by reframing the traditional school-work pathway seen by most members of society as the only option for becoming fully integrated citizens.

Arthur Frank, a sociologist and survivor of cancer and myocardial infarction, utilizes the concept of “narrative wreckage” to help reframe traumatic stories of suffering into a restorative narrative, “redrawing the map and finding new destinations and recovery.” In Japan, day centers have opened to provide a space for individuals suffering from Hikikomori to share their stories in a supportive environment. At the same time, families can better understand and support their loved ones. This has helped reduce the climate of anger and hostility and led to a more empathetic approach to assist them in integrating back into society.

In conclusion, I believe that the Japanese phenomenon of Hikikomori provides us with a framework to help understand the increasing prevalence of social withdrawal and isolation in our world. It assists us in identifying early triggers, stressors, and compulsive behaviors that reinforce social withdrawal, as well as those who suffer from mental disorders that promote this isolation. Having a better understanding of these complex behaviors can enhance our approach to providing evidence-based treatments and support.

References:

1. Frank A. The wounded storyteller.

2. Teppei Sekimizu. A Sociology of Hikikomori.

3. Saito Tomaki. Hikikomori, Adolescence without End.

4. Juan Villoro. No soy un Robot.

5. Daniel Gutierrez. Addressing loneliness and Social Isolation. ShrinkBox blog.