There may also be less hi-tech ways to exploit hikikomori’s relationship with technology. Shinichiro Matsuguma, a PhD student at Keio University School of Medicine in Tokyo who specializes in positive psychology, has set up a non-profit to rehabilitate hikikomori called the Strength Association. He’s provided coaching to 32 patients using principles from positive psychology, which focuses on strengths rather than flaws. The majority of his clients play videogames so this typically involves discussing playing styles and motivations to identify strengths like teamwork, strategy or leadership.

"Many people, even their parents, see hikikomori as not doing anything,” he says. "But from my perspective, they're developing their strengths through the video games. And I always tell them while you're playing video games you are developing strengths that can be applicable to different life domains."

Establishing these strengths improves self-esteem, he says, but can also guide patients on the best path to re-entering society. The approach has yet to be scientifically evaluated, but he says almost 80% have taken a first step towards reintegration like going back to school, university or vocational training.

Remote counselling

Experts agree though that there's no substitute for direct social contact and intensive therapy. Yoko Honda, a clinical psychiatrist who manages the Fukuoka City Mental Health and Welfare Centre, says the national government has been pushing them to use social media to provide remote counselling to hikikomori, but they’ve resisted.

“Just one tweet is not enough for expressing our anxiety or emotions,” she says, though she agrees it might be useful for reaching new patients.

Asides from psychotherapy and medication to treat any underlying psychiatric disorders, a central plank of their strategy is family training to fix dysfunctional home environments. The Yokayoka Room also provides a safe haven for those on the path to recovery to meet others like them and relearn atrophied social skills. But she says the varied nature of cases makes treating them tough.

“We hope to give tailormade support to all these hikikomori,” she says. “But we always need a lot of labour, a lot of time.”

That’s something Malagon-Amor found in her 12-month study of Barcelona’s hikikomori. Those who received more intensive therapy either at home or in hospital reacted best. Less intensive outpatient services were linked to higher abandonment of treatment and often worsening isolation. “They're very fragile patients,” she says.

Whether or not the West should be gearing up for a tsunami of such patients is still unclear. But social isolation can be a feature of other conditions, from depression to PTSD, so Malagon-Amor thinks the West can learn a lot from the Japanese experience.

And regardless of the scale of the phenomenon, Teo hopes hikikomori research will broaden our understanding of the importance of social connections to our mental and physical health.

“When I talk to parents of someone with hikikomori it's very clear to me that the social isolation is causing huge negative impacts – it ripples through the individual, to their family, to others,” he says.

“So that social impairment, problems with social connections, we haven't paid enough attention to that in medicine. And I think now with hikikomori, with more attention to loneliness we are finally starting to look at these issues as health issues. And that's good.”

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