Objectives
In Japan today it is believed that there are a million young adults who refuse to work and who avoid social contact. This phenomenon, known as “hikikomori” (social withdrawal), has become a serious socio-psychological problem throughout the country. However, there has been little psychopathological consideration of this phenomenon, and no detailed discussion of diagnosis. In this article, we investigate the phenomenon from a psychiatric perspective by introducing the concept of “primary hikikomori” and examining its relationship to recent changes in Japanese society.
Methods
We reviewed several studies concerning the epidemiology and psychopathology of hikikomori. As psychiatrists, we have considerable experience treating hikikomori youth (referred to simply as hikikomori) in individual therapy, group therapy, family therapy and family group therapy sessions. Based on this experience, we present a typical case of “primary hikikomori” and identify its psychological features. We also analyze hikikomori from a socio-cultural perspective. The observations made herein are based on this first-hand clinical experience as well as careful consideration of a number of other psychiatric and sociological reports concerning hikikomori.
Results
Firstly, a typical case of hikikomori is presented. Secondly, we identified the psychological features of “primary hikikomori”, or hikikomori with no obvious mental disorder, as follows: 1) display a tendency to avoid competitive settings; 2) cherish an “ideal image” based on the expectations of others; 3) are unable to make a fresh start from their current situation; and 4) have parents who continue to invest in their child’s ideal image. We assert that “primary hikikomori” is a new manifestation of the conflict prevalent among contemporary Japanese youth. Thirdly, we discuss possible contributing factors to the phenomenon from three viewpoints: 1) changes in the socio-cultural constellation; 2) changes in communication; 3) changes in the labour system and examined the implications of such widespread change.
Conclusions
We believe that it is necessary to consider the possibility that the hikikomori phenomenon, which emerged in Japan in the 1990s, might be the first sign of a larger disturbance within present-day society in general. Moreover, the pathology of societies giving rise to this hikikomori phenomenon ought to be examined.