With the Olympic Games and coronavirus numbers escalating Japan has been in our attention. A lesser-known Japanese phenomenon is that of hikikomori, (derived from the verb hiki “to withdraw” and komori “to be inside”) a term to describe young people who become extremely withdrawn and socially isolated, devised by Japanese psychiatrist Professor Tamaki Saito in 1998. It is a phenomenon defined by a refusal to go to school or work for at least 6 months, largely remaining at home and becoming totally socially disconnected. With 1.2% of the population affected, this has become a significant social and mental health issue which has also been identified in other countries including Australia, Bangladesh, Iran, India, Japan, South Korea, Taiwan, Thailand, and the USA.
Unlike other conditions which are firmly located in the DSM-V as psychiatric conditions, hikikomori exists ‘in the murky territory between psychiatric disorder and social ill, it’s polysemous nature has made it ripe for public discussion and policy decisions. Etiological explanations range from individual psychopathology to dysfunctional family relations, and from a lack of employment opportunities for youth to societal pressure to succeed in a narrowly prescribed path.’ The debate has ranged from the suggestion that it is a manifestation of as yet undiagnosed schizophrenia to a trenchant criticism of Japanese culture and family, including the suggestion that ’a function of hikikomori was a response to traumatic events such as emotional neglect from family members, a lack of parent-child communication, or an inability to express oneself to one’s parents’. Unsurprisingly this has created a debate about treatment with those favouring sociological explanations which frame the behaviour as a legitimate life choice recommending a ‘wait and see’ response while an individual medical explanation emphasises early intervention and treatment.
This phenomenon is particularly interesting in the debate it generates and the way this exposes the insubstantiality of diagnosis in our field. It raises the question of how many diagnostic categories we unthinkingly embrace are, like hikikomori, a fascinating combination of social, medical, and sociomedical factors, each of which require a considered and respectful response.
Ellen B. Rubinstein and Rae V. Sakakibar Diagnosing hikikomori social withdrawal in contemporary Japan Medicine Anthropology Theory 2020-06-16, Vol.7 (2), p.58-81