Can Culture Create Mental Disease? The Rise of “Hikikomori” in the Wake of Economic Downturn in Japan

by Michael Grisafe on November 16, 2012

Young Japanese Businessman

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What happens when a society’s cultural demands can no longer keep pace with the economic reality of the world? Who bears the strain and what happens when the burden becomes too much? A new disorder called “hikikomori” has emerged in Japan over the past ten years which may provide some of the answers.

The word “hikikomori,” literally meaning “pulling in” or “withdrawal,” was first introduced in 1998 by Japanese psychiatrist, Tamaki Saito in his book “Social Withdrawal: A Neverending Adolescence.”1 In this book, Saito defined hikikomori as “those who withdraw entirely from society and stay in their own homes for more than six months, with onset by the latter half of their twenties, and for whom other psychiatric disorders do not better explain the primary causes of this condition.”2

As much as 80% of these individuals are males, and many come from middle-class homes which are able to support them as they barricade themselves in their rooms, shunning friends and family.3 Left alone, some watch television, some surf the Internet, and some simply do nothing but think. There have been reported cases of obsessive compulsive actions amongst these individuals, such as cleaning their rooms over and over, or self-directed acts of harm, such as “cutting”; however many hikikomori seem to lead quiet lives of isolated desperation.

boy at computer

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This imposed isolation has been explained by some sociologists as a direct reaction to the increased globalization and integration of Japan into a Westernized labor market.4 Traditionally, Japanese institutions have favored a very structured transition of youth from high school, to secondary school, to long-term employment. Once a Japanese individual obtained a job, it was thought to be relatively secure and impossible for them to be laid-off. However, those rare individuals who failed to follow this path and immediately obtain a job after graduation from secondary school were considered failures and rarely able to re-enter the labor market at the same level in the future. This contrasts sharply with many Western markets, which are much more socially fluid in accepting labor market reentries and flexible to individuals switching jobs.

However, with increasing globalization the Japanese have had to deal demands of a flexible economy in which companies must adjust their hiring practices to remain competitive with varying needs. The emphasis on loyalty to long-time members of corporations has had disastrous consequences for youth employment in economic downturns. Because older members of corporations are often retained, younger entrants into the labor market are frequently left out in the cold. Many of these unemployed youth are graduates of universities, and are saddled with the feeling of double-failure after following the “correct path” but finding themselves both socially stigmatized and un-hirable in the wake of denied employment.

market crash

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In fact, although 50% of high school graduates go on to complete 4-year universities, up to 20% of them can only find low-paying jobs after graduation.5 This became even worse in 2003 when unemployment in 20-24 year olds rose to 10% and continues to be a problem in our post-2008 society.6

Among this political, social, and cultural backdrop, a growing number of youth known as hikikomori have withdrawn from society and given up on obtaining any means of obtaining the traditional economic and social goals of employment.7

Some sociologists have suggested that these individuals are not rebels in the sense that they are rejecting one ideology and accepting another, but rather individuals defining themselves by rejecting the core values of the Japanese work and social ethic itself. They assert that the hikikomori are the result of these youth comparing themselves to the increasingly unattainable success of their parents. The higher rate of Japanese males classified hikikomori can be seen as a reflection of the intense pressures for career and material success that have been disproportionately placed on them (and have now become largely unrealistic).8 In fact, there is evidence that individuals that come from families with higher levels of education (particularly their father’s education level) have significantly higher chances of developing hikikomori.9

As sociologists and anthropologists continue to debate the social and cultural causes for hikikomori, psychologists have been on the hunt for a common psychological cause that can be used to unite the diagnosis.

The Struggle to Define Hikikomoi as a Disease and Appropriate Treatment

One of the first barriers to treating individuals with hikikomori has been the Japanese struggle to define it clearly as a disorder. Clinicians and researchers still question

whether hikikomori should be classified as a social reaction, a psychological pathology, or a combination of both.10 This struggle can be seen in papers on the subject, which vacillate in their discussion between individual and social-level causes, often locating their suggested remedies somewhere between the two.

Isolated

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In May 2010, the Japanese government funded a research group that attempted to succinctly classify and create guidelines for the assessment and treatment of the disorder. The group’s finalized definition, however, retains much of the confusion that facilitated the need for the investigation itself, leaving the disorder in a limbo without a true etiological context. The group defined hikikomori as follows:

“A phenomenon in which persons become recluses in their own homes, avoiding various social situations (e.g. attending school, working, having social interactions outside of the home etc.) for at least six months. They may go out without any social contact with others. In principle, hikikomori is considered a non-psychotic condition distinguished from social withdrawal due to positive or negative symptoms of schizophrenia. However, there is a possibility of underlying prodromal schizophrenia.”11

In the wake of this definition, a survey conducted as a part of the WHO Mental Health Initiative showed that of 4,134 Japanese respondents, 1.2% reported having experienced hikikomori. In addition, a study conducted by the Japanese government in 2010 reported that 236,000 hikikomori existed in Japan.12

However, these results are based on the definition of hikikomori cited above, which may be unequally recognized in the medical and psychological community. In a recent online survey of psychiatrists, pediatricians, psychologists, nurses, and medical students in Japan, there was disagreement on what actually constitutes the characteristics of hikikomori.13 Many disagreed on details for diagnosis, such as the time away from society required for pathology and how to define isolation. Some medical professionals believed that hikikomori can be more accurately diagnosed by a simple diagnosis of schizophrenia, developmental disorders, stress related disorders, and others psychopathologies.

Alone

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Yet, despite this disagreement in the details of the diagnosis, nearly all of the groups showed some level of agreement that that hikikomori should be considered a disorder which is characterized by youth shutting themselves away in a room away from society.

This seems to mirror the general sentiment espoused by the Japanese when discussing hikikomori: “We know something is wrong, and our youth are shutting themselves away, but we don’t know exactly why, and we don’t know what to do to keep it from spreading.”

This topic has grown increasingly urgent in Japan as the so-called “first-generation” of hikikomori who have been living with their parents for the past 20 years approaches 40. Many worry not only for the fate of these aging hikikomori, but the social and economic consequences for Japan as the hikikomori’s parents retire and pass away. As their parents die off, Japan may be faced with the very real problem of integrating a large population of socially disengaged and unskilled individuals into society. This makes the hikikomori both a personal problem and a potential national disease.

As Japan searches for solutions to this pressing public health concern, a new global economy in conflict with millennium-old cultural traditions continues to loom as the backdrop for generation of youth abandoned to ennui.

Watch the trailer for  “Tobira no Muko,” or “Left Handed,” a film about a young boy who drops out of school and becomes a hikikomori (ignore the advertisements at the end).

1Tateno, M., Park, T. W., Kato, T. a, Umene-Nakano, W., & Saito, T. (2012). Hikikomori as a possible clinical term in psychiatry: a questionnaire survey. BMC psychiatry, 12(1), 169. doi:10.1186/1471-244X-12-169
2Ibid.
3Jones, Maggie. (2006, January 15). Shutting Themselves In. The New York Times. Retrieved from http://www.nytimes.com/2006/01/15/magazine/15japanese.html?pagewanted=all&_r=0
4Toivonen, T., Norasakkunkit, V., & Uchida, Y. (2011). Unable to conform, unwilling to rebel? Youth, culture, and motivation in globalizing Japan. Frontiers in psychology, 2(September), 207. doi:10.3389/fpsyg.2011.00207
5Ibid.
6Ibid.
7Ibid.
8Jones, Maggie. (2006, January 15). Shutting Themselves In. The New York Times. Retrieved from http://www.nytimes.com/2006/01/15/magazine/15japanese.html?pagewanted=all&_r=0
9Umeda, M., & Kawakami, N. (2012). Association of childhood family environments with the risk of social withdrawal (’hikikomori’) in the community population in Japan. Psychiatry and clinical neurosciences, 66(2), 121–9. doi:10.1111/j.1440-1819.2011.02292.x
10Toivonen, T., Norasakkunkit, V., & Uchida, Y. (2011). Unable to conform, unwilling to rebel? Youth, culture, and motivation in globalizing Japan. Frontiers in psychology, 2(September), 207. doi:10.3389/fpsyg.2011.00207
11Tateno, M., Park, T. W., Kato, T. a, Umene-Nakano, W., & Saito, T. (2012). Hikikomori as a possible clinical term in psychiatry: a questionnaire survey. BMC psychiatry, 12(1), 169. doi:10.1186/1471-244X-12-169
12Ibid.
13ibid.
14Jones, Maggie. (2006, January 15). Shutting Themselves In. The New York Times. Retrieved from http://www.nytimes.com/2006/01/15/magazine/15japanese.html?pagewanted=all&_r=0

Jay Bowlyle November 16, 2012 at 3:54 pm

“As much as 80% of these individuals are males, and many come from middle-class homes which are able to support them as they barricade themselves in their rooms, shunning friends and family…..One of the first barriers to treating individuals with hikikomori has been the Japanese struggle to define it clearly as a disorder.” Interesting article but i can’t sympathize with so called “Hikikomori.” This sounds like a rich people’s problems. This is like trying to explain to a malnourished kid somewhere around the world that there is a disease called anorexia! I’m always fascinated by Japanese culture but I am not shocked.

Michael Grisafe November 16, 2012 at 4:41 pm

Hi Jay,

On one hand “hikikomori” manifests itself in only the rich and middle class who can afford to support their agoraphobic children, however, social classes can be dynamic, so that it is more accurately described as a broader human problem. Just as obsessive compulsive disorder is more prevalent in Western societies among middle class individuals, it doesn’t make the disease any less dire or the emotions people feel any less real or important than those suffering from other psychological diseases more prevalent in poorer populations. However, whether one buys into this reasoning or not is less relevant than how this disorder has the potential to affect the population economically and socially as these individuals are forced to emerge into society when their parents pass away. This makes hikikomori a potentially disastrous national issue which extends beyond social class.

dogsnoseknows November 18, 2012 at 11:43 am

Very interesting, well researched example of cultural conditions/pressures linked to mental disease.

Wonder how many examples could be found in our own culture these days? Pathological tribalism, aka hyper-partisanship, would be a timely topic.

Michael Grisafe November 18, 2012 at 11:53 am

Thanks! I wish I had thought of framing hyper-partisanship as a cultural disorder a couple weeks ago! It would have been spot-on!

Ginny Kendall November 19, 2012 at 10:23 am

Has there been an attempt by medical/psychiatric professionals to talk directly to these young people about what they feel and why they are behaving this way? Whether you sympathize with hikikomori or not, it will obviously have an impact on Japan in the future. Part of me says, “yes, they are acting like spoiled, privileged kids,” but the social implications make it worthy of further study and possible resolution.
I am concerned by the sight of young people in the U.S., sitting together at a restaurant table or other public place, texting instead of talking with one another. This is a variation of anti-social behavior with far less impact than hikikomori, but it might also be classified as a cultural disorder.
Thanks for this post. it was informative and provided just enough information to introduce the subject.

Michael Grisafe November 19, 2012 at 10:49 am

Hi Ginny,

There have been many attempts to reach out to these youth, but the reasons the hikikomori give for their isolation seem to vary. Some articulate it as a result of pressures in their life, others feel that it is a way to cope with depression, others are afraid of interacting with people in society, while the vast majority simply say nothing at all. Those that do go for treatment have sometimes been diagnosed with Obsessive Compulsive Disorders, Depression, Post Traumatic Stress Disorder (PTSD), depression, social anxiety, and others, which begs the question of whether these mental problems are causing the shut-in behavior, vice-versa, or if a third confounding cause (like culture itself) is to blame.

One additional layer to the problem is that families often do not take their children for treatment or help of any kind because of the social shame it would bring to them. That means that means that a large portion of these hikikomori simply live in isolation without help or guidance for years. Check out one of the articles I cited from Maggie Jones at the New York Times for some of the interventions that organizations in Japan are trying: http://www.nytimes.com/2006/01/15/magazine/15japanese.html?pagewanted=all&_r=0 .

Thanks for reading, and I’m glad you liked this introduction to a very complicated topic. As you stated, although the article is confined to the phenomenon in Japan, there may be many asocial aspects of the problem that are manifesting themselves in countries like the US.

Angela November 21, 2012 at 3:51 pm

I think dismissing this as a class or Japanese issue diverts from the situation that many youths in many countries feel that they have little to look forward to in life: university debt, no jobs, no healthcare etc. In this light the values that societies propagate (valuing certain kinds of success, sexual norms or standards of material wealth) appear unattainable and increasingly meaningless. Apathy has many faces, which includes the ignoring of political realities, various forms of anti-social behaviour or suicides. In addition, psychological support has acquired a reputation for trying to re-enforce individual normative behaviour instead of tackling the collective root of the problem, so it is frequently avoided by disenchanted people.

jp November 28, 2012 at 11:54 am

my group is making a thesis about hikikomori and we, also, related it to being an alternative culture. i’ve read a lot of posts about the phenomenon and they vary on reasons why people become hikikomori. however, the common denominator is that after they return to the society, they don’t exactly know why they became hikikomori, that’s why i think it’s hard to really know the reason behind hikikomori, no one verifies the hypotheses of experts regarding the reason behind the phenomenon. anyway, thanks for posting this, it’s very informative.

Tressella January 17, 2013 at 8:42 pm

Could Hikikimori be diametrically opposed to narcissism? Could it be personified by Echo, the antithesis of Narcissus? Will narcissism be omitted from the DSM as it reaches a saturation point? Will narcissism’s antithesis continue to proliferate as well? Or is this merely some sort of (d)evolution or intrinsic population homeostasis such as lemmings into the sea or teens running amok with guns in elementary schools?

Yuichi Hattori April 9, 2013 at 1:08 pm

My name is Yuichi Hattori. I am a Japanese psychologist in private practice treating hikikomori clients from 2001. There are two types of hikikomoris: classic hikikomori and covert hikikomori, the latter I call “functional hikikomori.” According to my clinical experiences in the past 12 years, both types of hikikomoris have a history of attachment trauma with their mothers. (all biological mothers due to the absence of divorce in the families) When rejected emotionally by a mother, a young child hides his original self for protection, and creates a false self to adapt to the dysfunctional mother. The child grows to an adult who neither trust nor show his his true identity to people. When the conflicts between pretending and hiding the true identify become unbearable, he would retreat into extreme degrees of isolation and confinement. This phenomenon is observed commonly across my hikikomori clients. Hikikomori begins from dysfunctional mother-child relationships, which are influenced by the society that values group harmony and compliance over individual freedom. The syndrome began surfacing when Japan achieved economic success while the mothers with traditional values were unprepared to satisfy the children’s needs for love, individual freedom, and self-actualization. Hence, many hikikomoris find no place in Japan, feeling captive in the affluent but culturally oppressive society.

I wrote in English “A case study of 35 hikikomori clients,” which was co-published in Journal of Trauma Practice, Vol. 4. No. 3/4, 2005, pp. 181-201; and Trauma and Dissociation in a Cross-Cultural Perspective, The Haworth Maltreatment & Trauma Press. The paper is available online at http://jtp.haworthpress.com.

Juhainah May 19, 2013 at 9:06 am

I am enlightened with what you shared. I’m looking forward to reading your case study. However, I have a question. What’s the difference between classic hikikomori and covert hikikomori?

www.oneaccessinternet.com May 9, 2013 at 8:14 am

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Dymo May 29, 2013 at 12:25 am

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Michael June 1, 2013 at 10:35 pm

Has anyone studied hikikomori who’ve gone abroad (presumably with the emotional and financial help of their parents)? Does the new environment with different rules knock them out of their funk?

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