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

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.

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.

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.

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.

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