A Glimpse Into the Lives of Japan’s Hermits
“They are tormented in the mind. They want to go out in the world. They want to make friends or lovers, but they can’t.”
—Psychologist Tamaki Saitō
DISCLAIMER: The statements in this article are not meant to criticize Japanese culture but to give context to a complex mental health condition. Disparities and contrasts are mentioned to illustrate the difference between Japanese and other cultures, especially the Western side, and not to imply that one is better than the other.
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So you’re miffed that your government has forced you into social isolation because of the pandemic. You rant and rave about the inconvenience, the loneliness, the separation from family and friends, the curtailment of outside entertainment (especially shopping), education invading your home, and the loss of employment.
But have you ever considered that a large group of isolated people have it worse than you? They live their prolonged social withdrawal in daily torment and depression. Unlike you, they have chosen this lifestyle. Their isolation may be self-imposed but in a way, it is also forced—not by their governments or the medical community—but by their circumstances.
These recluses are found the world over but in Japan, they are known as “hikikomoris.”
What Is a Hikikomori?
The Japanese psychologist Tamaki Saitō coined the term “hikikomori,” a social phenomenon referring to people in extreme isolation who rarely leave their home despite not being physically disabled nor having a practical reason for staying in, such as being pregnant, being a homemaker, or having been diagnosed with a severe mental illness.
Saitō is a Tsukuba University professor, the director of medical services at Sōfūkai Sasaki Hospital in Funabashi, and the author of Hikikomori: Adolescence without End.
The word is part of the phrase “shakaiteki hikikomori” (a transliteration of the English term, social withdrawal). “Hiki” means to pull away into a state or place, or shy away from society as a whole.
Hayakawa, Kato, et al defined hikikomori in their study, “Blood biomarkers of hikikomori [1]” as a severe and prolonged form of pathological social withdrawal syndrome.
The term is flexible. The solo term hikikomori also refers to a person who indulges in the practice. Japan’s Health Ministry refers to hikikomoris as people without psychosis who isolate themselves at home, refuse to participate in society (such as attending school or work), and rarely interact with people (other than family members) for six months or longer.
Many hikikomoris go outside to buy groceries at night (when there are fewer people about). The defining factor of being a hikikomori is not so much the limited space one lives in, but the self-imposed isolation.
A Serious Global Problem
The hikikomori state used to be considered a uniquely Japanese phenomenon. Books like Canadian journalist Michael Zielenziger’s Shutting Out the Sun and articles such as the New York Times’ “Shutting Themselves In” fueled this misconception.
But it is now viewed as an issue with global health implications because of the evidence of hikikomori in epidemiological studies, clinical cases, and media reports worldwide. (Epidemiology is the branch of medicine dealing with the occurrence, spread, and elimination of diseases.)
The problem doesn’t resolve on its own. If hikikomoris don’t get help, they get more distant from society with time. If their parents die and they run out of financial support, they either go on welfare or become destitute and homeless.
The condition is accepted as widespread in South Korea, Taiwan, and China—countries with culturally distinct societies similar to Japan. But incidences of it have also been reported in the USA, UK, Canada, Italy, Spain, Oman, France [2], Ukraine [3], and Australia.
Outside Japan, hikikomoris are stereotyped as young video gamers who spend most of their time and attention riveted to digital screens. James Moore’s article in The Independent UK warns of the danger that the pandemic’s effects may result in an entire generation of shut-ins in Britain, causing them to withdraw from society altogether.
In Italy, Marco Crepaldi, president and founder of Hikikomori Italia, wrote about younger hikikomoris in his book, Hikikomori: I giovani che non escono di casa (young people who do not leave the house). He also set up a website that helps people with the condition and their family members.
Hikikomori Severity Modifiers
Different levels of the hikikomori condition’s impact:
Mild—Hikikomoris occasionally leave their home (two to three days per week).
Moderate—They rarely leave their home (one day per week)
Severe—They rarely leave the bedroom.
Those who leave their home four or more days per week do not meet the criteria for hikikomori.
Hikikomori Diagnostic Criteria
In the absence of standardized diagnostic criteria for being a hikikomori, Takahiro Kato, Shigenobu Kanba, and Alan Teo, in their study, “Defining pathological social withdrawal [4],” proposed these:
Marked social isolation at home—the condition’s central and defining characteristic
Continuous social isolation of six months minimum (Three months is classified as “pre‐hikikomori.” In Korea, this duration is the minimum.)
Significant anguish or functional impairment connected to the isolation
Notes on criteria:
Kato and colleagues removed the previous criterion of “avoidance of relationships and social situations” because, in their interviews assessing people for the hikikomori condition, many of the interviewees said they have minimal social interaction and meaningful social relationships but don’t avoid social interaction.
This lack of avoidance is one of the primary differences between hikikomori and social anxiety disorder.
On criterion #3: In the earlier stages of their condition, hikikomoris are content in their social withdrawal because they are relieved at being able to escape the agonizing realities of life outside the home. However, as their isolation gets prolonged, most become distressed and lonely.
The team also developed a standardized interview and questionnaire for assessing and diagnosing hikikomoris. With these and the criteria, they hope to support or refute the many contradictory theories on the condition.
When Does Hikikomori Begin?
The hikikomori condition typically sets in during adolescence or early adulthood. In the early 1990s, the average age was 15; now it’s 32. The Japanese Ministry of Health, Labor, and Welfare’s 2009 survey backs this figure (32.6).
But many hikikomoris are middle-aged. A 2019 study by the Japanese government found that the country now has more hikikomori aged 40 to 64 than those aged 15 to 39. Elderly individuals and homemakers who meet the above criteria may also be considered hikikomoris.
Often, Japanese hikikomoris start as “futōkō” (aka “tōkōkyohi,” an older term), meaning truants or youth who refuse to attend school.
Accompanying Symptoms
These vary among patients, but those recorded include:
autism
paranoia
heated outbursts
mental or emotional anguish
depression
childish behavior
obsessive-compulsive tendencies
lowered or loss of self-esteem
internet/gaming addiction (minority)
suicidal thoughts
Inclined toward violence to themselves (self-harming) but not to others. Sample behaviors are smashing dishes and punching walls but rarely hurting family members living with them.
Exclusions to the Condition
Even if many hikikomoris prefer to play video games, coast the internet, or read comics than interacting with others, psychologists emphasize that their condition is not caused by laziness.
No other extreme physical or mental conditions, such as disabilities, being bedridden, or harboring a psychological illness, is the primary reason for the withdrawal.
YouTuber Scott Ackerman, himself a depressive living in Japan, suggests that “a clear set case of society as a whole is the cause and concern” of the hikikomori state. He has interviewed numerous shut-ins and hikikomori experts for his channel “Unrested.”
What Do Hikikomoris Do all Day?
Nippon’s 2019 report revealed that the number of hikikomoris who surfed the internet or played computer games was lower than non-recluses. Contrary to the stereotype of hikikomoris living in a virtual world, the study showed that they generally do very little.
Typical Reasons People Become Hikikomoris
According to the 2019 government survey, the most common reason (29.1%) for people becoming hikikomoris was due to job loss or resignation. Other reasons given were retirement, dysfunctional personal relationships, illness, and inability to fit in the workplace.
Other causes documented by experts:
bullying
school phobia
nerd phobia
homophobia
low self-esteem
social ineptitude
perfectionist ideals from authority figures
very high parental expectation
busy, absent, undemonstrative parents
abusive parents
family members who are enablers
restrictive, rule-bound society
colossal societal pressure
adolescent peer pressure, which compels them to be easily swayed by public opinion or the majority vote
toxic work environment
mental health disorders like agoraphobia and clinical depression
These external factors exacerbate the problem:
Two major issues are the absence of a clear definition of the condition and disagreement on the diagnostic criteria.
The stigma on mental health issues
The unwillingness on both sides (parents and children) to seek help because of shame. It takes three to five years before people ask for help. By then, the problem has escalated to unmanageable proportions. The most extreme case was someone in isolation for 26 years.
Enablers (mostly parents/guardians)
The financial aspect
Refusal to connect the disorder to a mental health issue—there is less stigma with being a hikikomori than a mentally ill person.
Social media—comparison with others, particularly celebrities
Exposure to video game technologies and the internet. Enough research supports this, such as TaeYoung Choi’s report. This study from the Catholic University of Daegu psychiatrist and researcher proves that technology can intensify antisocial dispositions, aggravating the plight of hikikomoris.
There is enough evidence suggesting that, in the digital age, the reduction in face-to-face communication contributes to the decline of interpersonal skills, lessening the ability to socialize confidently in public.
On the flip side, it also offers solutions, like providing a remote platform by which to communicate, saving hikikomoris from the anguish of physical and eye-to-eye contact.
Even though technology is not the only reason for the perpetuation of the hikikomori lifestyle, digital communication has made the issue harder to solve by giving hikikomoris an excuse to isolate more.
Statistics
The problem came into public discussion in the late 1990s (mostly due to Saitō’s 1998 book) but it has existed long before that.
In 2016, the Japanese Cabinet Office estimated the number of hikikomoris aged 15 to 39 as 541,000 based on a 2015 nationwide survey. Over 35% of them were in isolation for seven years or longer. Unrecorded then were hikikomoris 40 years old and older.
❊ Gender Inequality
The Japanese Cabinet Office’s 2018 report showed that male hikikomoris outnumber females in a ratio of 4:1, with 76.6% aged 40 to 64. The condition is more common in men because of immense pressure to succeed in academics and careers.
It is more prevalent among the well-educated upper and middle classes because parents can afford to support their reclusive offspring.
Kyoko Hayashi, an active member of hikikomori support groups, says women hikikomoris aren’t properly documented because society views them as either domestic workers or homemakers. Their depression is not apparent. Thus, female sufferers are hidden.
The reality is, it’s not just a male issue.
Females and the LGBTQ+ community suffer from it too but the Japanese are either not aware of this fact or don’t recognize its presence.
❊ Squabbling Statistic Gatherers
In 2018, Saitō said the number of cases in Japan was “more than 1 million, 20% of male adolescents in Japan, or 1% of the country’s total population.”
Pundits accused him of playing up the statistics to make himself more famous and presenting the problem as more serious than it is. He later admitted in his autobiography that his earlier quoted numbers were not factually based but justified them with his motivation to bring attention to the problem.
However, it turns out Saitō was right. In 2019, the Japanese Cabinet Office conducted a survey that revealed 613,000 hikikomoris aged 40 to 64, with the overall estimated headcount (aged 15 to 64) as 1.15 million.
During a press conference at the Foreign Press Center, Japan that same year, Saitō referred to that survey, claiming the authorities may be undercounting the number of recluses and suggested it could be more like 2 million, which “could eventually top 10 million.”
The different (and conflicting) statistics are confusing because they are the result of the government’s estimated guesses since not all cases are reported. Reasons for not reporting include stigma, “haji” (cultural shame), and “sekentei” (social appearance)—sensitivity about one’s reputation and the pressure to conform to social norms.
Yasuhiro Yamazoe, a recovering hikikomori, says that haji is an important concept in Japan and many like him perceive it to be “more painful than dying.”
Some say the government makes up or assigns terms to whitewash and downplay societal problems.
In Korea, their psychiatrists estimate 300,000 hikikomoris, often linked to online gaming addiction. Saitō says Italy estimates 100,000 cases.
History of the Condition
After World War II, Japan had a few robust economic decades. The concept of the “salaryman” surfaced, with its secure job position and financial assurance that often lasted a lifetime.
This development ended with the bursting of the bubble economy in the late 1980s and early 1990s, which led to a long economic recession called the “lost decade” or “lost score.” This changed the work culture and negatively affected the spirit of the people.
Lifetime employment gave way to part-time jobs. This is known as the “employment ice age.” A whole generation is faced with short-term ones for the first time. Part-timers, temps, or contract workers now make up almost 40% of the workforce compared to about 20% in the 1980s.
This adversely impacted the outlook of people of employment age and caused a rift between generations. Until now, many parents cannot understand why their (sufficiently educated) adult children have difficulty finding work and are now reliant on them. But many recluses contend that the economy is responsible for their dependent lifestyle; they did not choose it.
The hikikomori condition has become a societal and economic problem because Japan now has a shrinking workforce. It needs more young workers to a greater extent than most countries. It has difficulty meeting this need because of low immigration levels, extremely low birth rates (921,000 births versus 1.37 million deaths in 2018), and a huge aging population.
The National Institute of Population and Social Security Research has projected Japan’s population to drop from 127 million to just 51 million by 2115 if current trends continue.
The Emergence of Unfair Stereotypes
Jeff Kingston validates the above situation in his book, Japan’s Quiet Transformation: Social Change and Civil Society in the 21st Century. He says older generations look down on younger ones with temporary jobs. They call them “freeters,” a combination of the word “freelance” and the German term “arbeiter” (worker).
Freeters are stereotyped like hikikomoris: lazy, slackers, problematic, parasitic, dangerous, and preconditioned to be criminals. Saitō said this is not true according to statistics—with a few exceptions.
The term hikikomori has also been used interchangeably with the UK term NEET (not in education, employment, or training). Freeters, NEETs, and hikikomoris became interconnected terms, as Saitō explained in his book.
Separately, sociologist Masahiro Yamada conceived the term “parasite singles” in 1997 to refer to the country’s unmarried adults mooching off their parents.
Psychological Explanations
Moore claims that hikikomori shares characteristics with schizophrenia, internet addiction, or prodromal psychosis, common comorbid (accompanying) diseases. (Prodromal psychosis is the early stage before a full-scale psychotic episode. Symptoms develop slowly and can be misinterpreted as normal behavior, especially in teenagers.)
However, most hikikomori cases do not typically coexist with a mental disorder.
❊ Proposed Hikikomori Equivalents
~ Avoidant personality disorder—Hayakawa and colleagues discovered that it is the most common disease found alongside the hikikomori condition.
~ Agoraphobia—an irrational or extreme fear of open, crowded, or hard-to-escape places; or the dread of leaving home. Some clinicians have drawn parallels with this disorder, but many hikikomoris are not afraid to go out. They simply refuse to do so.
~ Anthropophobia—the fear of people is another theory on the equivalent of hikikomori. The National Institute of Mental Health does not use the term but refers to it as “social anxiety disorder” on its website. Some experts say it is the same as sociophobia (aka social phobia), the fear of social gatherings.
The difference is that the sociophobic is comfortable in an anonymous social setting (like a crowd of strangers), while the anthropophobic is anxious in all types of social environments.
The extremely anthropophobic has difficulty dealing with one person at a time, even somebody close to him. He may prefer to communicate only remotely.
~ Bamen Kanmoku—Many hikikomoris have this anxiety disorder in which a person normally capable of speech cannot speak in particular situations or to specific people. Most people in Japan, even teachers, counselors, or doctors, don’t recognize it. Instead, they often ignore it or mistake it for something else.
It is similar to alexithymia, the inability to recognize or describe one’s emotions.
Sayo Irie has written about Bamen Kanmoku in her book as she has suffered from it for a long time. She claims that some with this condition cannot even say thank you or sorry. Despite this, they refuse to communicate and won’t explain themselves.
So they are often mistaken to be rude, arrogant, selfish, stubborn, or uneducated. As a result, they are often teased or bullied. Some teachers mistake Bamen Kanmoku for misbehavior (students disliking teachers), so they punish students suffering from it.
~ Internet gaming disorder (IGD)—Younger hikikomoris are stereotyped as online gaming and internet addicts. Online video gaming is now widely associated with addictive behavior. That’s why since 2013, it has been included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Section III.
The American Psychiatric Association (APA) suggested the inclusion in DSM-5 as a temporary (conditional) disorder because mental health experts are still debating on specific issues that need further clinical research (such as the time spent playing games), along with caffeine use disorder.
In 2018, the World Health Organization (WHO) included gaming disorder (GD) as a mental disorder (6C51) in the International Classification of Diseases, 11th revision (ICD-11).
Note that the APA did not include internet-based gambling in the diagnostic criteria for IGD because it is already included in the diagnostic criteria for gambling disorder.
Socioeconomic Explanations
❊ Implications on Employment
In the typical Japanese life cycle, the transition from high school to college is quite harsh. Plus, there isn’t much time to relax between the competitive educational system and work—with few exceptions, like a prep year for a university exam.
A gap in the résumé leads to monumental problems obtaining employment. One wrong move can lead to an abyss of despair. Since many hikikomoris spend years without jobs, they have minimal chances of getting hired.
❊ Cultural Implications
In Japan, adult children dependent on parents are common and accepted. The Japanese Ministry of Internal Affairs and Communications’ 2015 survey revealed that 3.08 million unmarried people aged 35 to 44 are living with their parents.
The Nishi Fumihiko (the Statistical Research and Training Institute) states the number as nearly 50% of unmarried Japanese aged 20 to 34.
Why Japan’s singles prefer to stay unmarried and live with their parents:
No affordable residential options
Lack of financial security
Conservative expectations of society (especially on women)
Why is hikikomori not a pertinent problem in developing countries?
Saitō cited Italy and Spain in his book as the two leading European countries where children live with their parents the longest, with cohabitation rates surpassing 70%. The same cultural element is found in Japan and South Korea.
In contrast, their North American and European counterparts are encouraged to be independent after high school.
In countries where the dependent behavior is accepted and normalized (such as Japan, South Korea, and Italy), the hikikomori problem is more prevalent.
How does one explain, then, that despite the accepted practice of adults living with parents in many countries in Southeast Asia, the Subcontinent, and Latin America, hikikomori is rarely a problem?
Examples are three countries in the WHO’s 2021 list of the 10 nations with the lowest suicide rates in the world: the Philippines (2.2 out of every 100,000 residents), Venezuela, and Honduras (both 2.1). These are based on 2019 stats.
Perhaps most parents in these countries cannot tolerate and sustain their kids depending on them indefinitely because of poverty. Whereas many families in the aforementioned industrialized countries—that have a majority middle class and a smaller gap between the rich and the poor—can indulge their kids’ dependent lifestyles.
In the Philippines, like in Japan, they place tremendous importance on education but for different reasons. All Filipino parents in the lowest-income sector look at education as a sure way out of destitution. It also serves as a great socioeconomic equalizer. A dirt-poor person who somehow obtains higher education is seen as an equal by people financially better off than him.
Wealthy Filipinos educate their children to maintain socioeconomic status. Most want their kids to carry on their businesses, continue the same professions, and marry within their circles. This is why a lot of them pressure their kids to attend their alma maters, typically Ivy League universities.
Whereas in Japan, education is valued across economic strata because it usually leads to a permanent job with stellar benefits. However, this was true only with previous generations and is a rarity in current Japan.
Education in Japan also provides assured inclusion in the community and approval from society. Having a good education also means they are following the norms and dictates of society and government. It is an expectation of and from everyone.
Granted, there are also Filipino shut-ins who may get depressed and socially withdrawn because they find it difficult to fit in or conform to society. However, out of economic necessity, they are compelled to find creative ways to solve problems and get out of their dire circumstances.
In developing countries where the majority of the population live on or below the poverty line, wherever destitution rules, the compulsion to survive against all odds trumps being a hikikomori. In that sense, impoverishment is a very effective coercer in improving one’s lot in life.
❊ The 80-50 Phenomenon
Many hikikomoris from the early 1990s are now in their 50s, yet are still financially dependent on their parents who are in their 80s. They are what the media call the “the 80-50 problem.”
As their parents retire or pass on, these aging hikikomoris won’t be able to take care of themselves financially because they have spent too much time as recluses—rendering them vulnerable to poverty.
Some fortunate hikikomoris with wealthy parents have trust funds set up for them so that even after their parents die, they are left with enough to live on. However, they are susceptible to another social evil: swindlers who used to prey on seniors have now discovered the reclusive demographic as new victims.
❊ Criminal Implications
Many regard social withdrawal as a cause of criminal behavior because of cases like the Niigata kidnapping and captivity of a young girl (1990-2000) and the Kawasaki mass-stabbing (May 2019).
Saitō disagrees, stating that social withdrawal and crime have an extremely minimal connection. He reiterates that mental illness is not the main cause of the hikikomori condition. The shut-ins involved in the above incidents had serious psychological disorders, which do not fit the Health Ministry’s definition.
Saitō emphasized that hikikomori is more of a state than an illness and that those in this condition rarely engage in criminal activity. He views hikikomori as decent people simply mired in troublesome situations.
❊ Implications of Living in a Conformist Society
Japan is often seen as a wealthy, disciplined, perfect society where the locals have a high work ethic, crime is absent, no one is homeless, and everyone is happy.
The reality is, it has numerous problems like most countries, including lack of regular employment and the difficult return to the labor force after having been forced to resign to care for aging parents. But some are unique to its society, such as the constant rise in the population’s average age and the dearth of respect for individualism.
Modern norms still follow principles from World War II, which advocate militaristic ideals, especially on following rules without question. Society dictates most aspects of life, from one’s behavior to parenting to mode of dress.
It is a conformist society where the populace is urged to be like everyone else. That is why being different is frowned upon. People are compelled not to stand out. This is surprising in a nation that has given the world the artistic genius of Hayao Miyazaki and Akira Kurosawa.
It is also a collectivist society—one which follows the principle of giving a group priority over each individual in it. So one is always expected to sacrifice his needs for the benefit of many.
Most, if not all, hikikomoris feel it is an onerous society to live in. To succeed in an environment with perfectionist ideals, one has to walk between the dichotomized paths of:
honne—our true selves; the face we show in the company of loved ones and comfortable surroundings
...and
tatemae—an “outside face” we have to wear like a mask to hide our real feelings so we can deal with people and duties every day
The upkeep/pretense of the tatemae is very stressful for many people and almost impossible for most hikikomoris to execute.
Saitō explains that locals view those not useful to their family or society as having no value. When hikikomoris are not able to heed the government’s call to be actively engaged, they feel worthless and cornered. At the same time, many parents feel the condition is their fault.
What Clinicians are Arguing About
The physiological process of hikikomori is not clear. The condition has not been officially classified as a disease in psychiatry. Some clinicians are still unwilling to call it a syndrome, even though scientists have already referred to it as such, like in Hayakawa and colleagues’ “Blood biomarkers” study.
This is because, according to Emmanuel Stip’s Internet Addiction, Hikikomori Syndrome, and the Prodromal Phase of Psychosis [5]—the first published hikikomori-related report from Canada—clinicians are still debating whether this condition is a culture-specific reaction to societal change in Japan or an emerging psychiatric disorder also existing in other countries.
Another area of contention is whether hikikomori should be diagnosed if another psychiatric disorder is responsible for the symptoms.
Some experts suggest that the term “secondary hikikomori” should be used if multiple conditions are present to partially explain the syndrome. Without an “intercurrent psychiatric diagnosis,” meaning no other psychological disorders exist, the term “primary hikikomori” should be used.
Treatment
It’s difficult to help people who don’t or won’t seek help. Nevertheless, psychotherapy is the common treatment, although there is no universally accepted effective therapy yet.
However, the Japanese government, NGOs, local organizations, charities, religious institutions, private businesses, and former hikikomoris have set up solutions, such as rehabilitation centers, hotlines, support groups, and safe meeting venues.
NPO Panorama representative Masahiro Ishii, whose organization offers hikikomori support, confirms that steps have been carried out to solve the problem.
✓ Existing Solutions
Disciplinarian (tough love) or militaristic approaches—include hiring companies like Hikidashi-Gyōsha that force recluses out of their rooms and into rehabilitation centers (with the parent’s permission).
This has detrimental effects, such as captured hikikomoris en route to rehab jumping off moving trucks then getting killed on the highways. (That was an actual event reported by Japanese YouTuber Nobita [6] in 2020.)
Hire a professional “hikikomori persuader”—Takeshi Oshikawa, aka “The Convincer,” claims to be the only individual in Japan who peacefully persuades shut-ins (and the mentally ill) to seek help or attend rehab.
Peer support—Many former hikikomoris share their personal stories and urge fellow sufferers to seek professional help. Ex-hikikomori Ryosuke Hoshino says, “We need to make seeking counseling common and accepted.”
NPOs—An example of a nonprofit organization dedicated to helping shut-ins and their families is Kazoku Hikikomori Japan, run by psychiatrist Masakazu Nakagaito.
Halfway houses—Newstart is an example. It has a community center, a restaurant, and cafes, where residents interact with the community through work experience and social activities, such as country walks, seminars, trips, and concerts. It made headlines in 2004 when its staff took a group of hikikomoris on the Shikoku 88-temple pilgrimage.
Private venues—like cafés or meeting rooms where recluses can socialize in a safe environment
In-patient rehabilitation centers—where hikikomoris are taught how to reintegrate into society. An example is Yoshida Masashi’s independence support facility, MIRAI, which follows the boarding system.
MIRAI’s programs include counseling and teaching wards work skills by giving them responsibilities within the center, doing charity work, or volunteering at their partner farm in the Katori district. The center’s fee is US$2,800 for the first month. The car pickup charge is excluded and depends on the distance. Within Tokyo, it’s between $460 and $930. Beyond, it’s around $1,400.
The “fake family industry”—includes “rent-a-sister/brother” programs. These are offered by private businesses that rent out actors to provide company and conversation to all lonely people, not just hikikomoris. The service has expanded to include rentals of entire families (including grandparents) and girl/boyfriends.
School counseling—Psychiatrist Jiro Ito says they have started appointing school counselors in some cities but students seldom go to them. “Going to counseling/therapy is often seen negatively in Japan.”
Support groups for family members—Journalist Ishikawa Kiyoshi, author of Dokyumento: Chōki hikikomori no genba kara (Long-Term Recluses: A Documentary Report from the Front Lines), conducts monthly classes for family members, individual discussions with hikikomoris, arranged gatherings for the youth, even trips to other Asian countries.
Reach-out programs—NPO Panorama staffers seek out hikikomoris using online marketing and advertising. After which, they do person-to-person communication and support.
Home visitations—Kiyoshi makes 800 house calls a year, and in 2017 completed more than 10,000.
Milieu therapy (changing the physical environment)—includes day programs and residential programs like alternative schools outside the rigid traditional education system called “free schools.” However, they don’t provide students standard accepted credentials.
A “loneliness minister”—Japan recently appointed one, emulating Britain’s initiative
Tools for dealing with social anxiety and withdrawal—these include a video that teaches very shy people how to make eye contact by staring at actors, and virtual companions or holograms that provide company to lonely individuals.
Publications—Hikipos is a magazine that features the experiences and lives of hikikomoris. Its editor-in-chief is journalist Morito Ishizaki, an ex-recluse himself.
✓ Other Proposed Solutions
Shunsuke Nonaka and Motohiro Sakai, in their study, ”Psychological Factors Associated with Social Withdrawal (Hikikomori),” recommended these treatment approaches:
Public awareness
Early detection and intervention
Comprehensive psychiatric evaluation
Instrumental support (teaching patients self-compassion and stress-coping skills)
Behavioral disengagement
Family involvement is essential because relatives are vital sources of patient information.
For pure (primary) hikikomoris: formulate a working theory for the cause of their isolation and target their treatments to what distresses them the most. Ask patients what their goals are and work with those. Find out what motivates them to get better.
Treat underlying psychiatric conditions with psychotherapies like cognitive-behavioral therapy.
Home visitation (also being done in Korea)
Skills training, like vocational skills and social cognition (eye contact, emotional interpretation)
Clinical trials
✓ Experimental Treatments
Oregon Health and Science University psychiatric professor Alan Teo, one of the scientists who proposed the above diagnostic criteria for hikikomori, suggests these experimental treatments for the hikikomori condition:
telepsychiatry—remote consultation and treatment
oxytocin—a hormone studied in schizophrenia related to social cognition and behavior
muscle relaxant medications—used in recent clinical trials on Fragile X syndrome, autism, and substance use disorders
How to Solve the Social Worker Shortage
Former recluses are lobbying for societal and governmental change, such as more assistance for hikikomori support workers because there is a huge shortage. Social workers like Ishii, who has been in this field for 20 years, are rare. Most quit because of the job’s difficulty.
Unfortunately, hikikomori support staff cannot exactly measure the success of their work because they cannot show clear evidence that what they do is effective. This is a big hurdle and makes it difficult to get sponsors.
But they have been able to help some who were suffering from depression and PTSD to get medical assistance. Ishii claims the success rate is approximately 30 to 40%. After counseling, hikikomori attitudes and behaviors have become positive.
❊ Proposals for change:
Ishii wants to increase recognition specifically for hikikomori support workers. “We need to raise the status of this industry,” he urges, “and give workers fair salaries. This will lead to better hikikomori support.” Recluse workers get only 1/3 of the salary of public workers.
Recovering hikikomori Ogatake started a place targeted at LGBTQ+ hikikomoris and kids who refuse to attend school. Some of Ogatake’s clients who recovered now offer support to fellow hikikomoris. He says this may alleviate the social worker shortage.
Final Thoughts
While medical and government authorities in Japan are still vacillating on whether to address the hikikomori problem on a moral basis, its future adverse economic impact looms ahead. The world’s second-largest economy (after Germany) will soon be faced with more elderly people and fewer younger ones taking up the jobs vacated by their parents.
Once their parents become debilitated or die, middle-aged hikikomoris left behind without their parents’ pension funds or who run out of money will be forced to depend on the social welfare system next, which, even now, is already overburdened with the elderly population.
The aged will run out of people to take care of them if the potential caregivers are holed out in their homes, unwittingly contributing to the shrinking workforce.
Whether moral or economic, the situation has to be dealt with immediately, not just for the sake of the hikikomoris but for the entire country.
In other countries not having this economic dilemma, their authorities have a moral and social obligation to take care of their psychologically aggrieved populace. One simply cannot ignore this urgency, especially the fact that many hikikomoris have a tendency to self-harm and are suicidal.
It is time to stop turning a blind eye on the glaring white elephant!
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Expat Scribe is the author of the psychological techno-thriller, “The Invisible Cyber Bully: What it’s like to be watched 24/7.”
The novel tackles the surreptitious bullying and illegal surveillance, DNA-extraction, psychological torture of, and experimentation on ordinary citizens by law enforcers, scientific laboratories, various “hidden” associations, and global authorities. Some chapters discuss the garden-variety bully from schools and neighborhoods. The book also features a primer on how to fight cyber bullying.
“The Invisible Cyber Bully“ is available on Amazon worldwide in ebook and print edition. For a list of bookstores in other countries that stock this book, click here.
Footnotes:
[1] Hayakawa, Kato, et al. “Blood biomarkers of Hikikomori, a severe social withdrawal syndrome”. Scientific Reports. 2018.
[2] Chauliac et al. “Characteristics of socially withdrawn youth in France: A retrospective study”. International Journal of Social Psychiatry. 2017.
[3] Iryna Frankova. “Does Hikikomori Exist in Ukraine?” European Psychiatry. 2020.
[4] Takahiro Kato, Shigenobu Kanba, and Alan Teo. “Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori”. World Psychiatry. 2020
[5] Emmanuel Stip. “Internet Addiction, Hikikomori Syndrome, and the Prodromal Phase of Psychosis.” Frontiers in Psychiatry. 2016.
Sources:
Takahiro Kato, Shigenobu Kanba, and Alan Teo. “Hikikomori: experience in Japan and international relevance. World Psychiatry. 2018.
Shunsuke Nonaka and Motohiro Sakai. “Psychological Factors Associated with Social Withdrawal (Hikikomori)”. Psychiatry Investigation. 2021.
Drew Ambrose and Aun Qi Koh, documentary filmmakers. 101 East Japan: The Age of Social Withdrawal
Nasution, Effendy, and Amin. “Internet Gaming Disorder (IGD): A Case Report of Social Anxiety”. 2019.
ICD-11 for Mortality and Morbidity Statistics (May 2021 version): 6C51 Gaming disorder
Seminar by Psychiatrist Alan Teo on Hikikomori at the University of Michigan Center for Japanese Studies: Modern-Day Hermits—The Story of Hikikomori in Japan and Beyond
Photo Credits:
Sad card—PDPics
CCTV cameras—Arvin Keynes
Homeless—Jon Tyson
No place like home—Anastasiia Chepinska
Man with smartphone—Sayan Ghosh
Frightened boy—Sippakorn Yamkasikorn
Woman by window—Anthony Tran
Contrasting feet—Ayesh Rathnayake
Woman behind blinds—Tetiana Shyshkina
Gamer wearing VR helmetErik Mclean
Bedroom silhouette—Ewan Yap
Gamer on couch wearing VR helmet—Erik Mclean
Parchment mask—Cottonbro
Blue silhouette—Redd
Thumbnail—Anton Maksimov Juvnsky
Such an enlightening article! Hope you post more of these.🤓