'Hikikomori' disorder could complicate Japan quake recovery
As the crisis due to the radiation leak, earthquakes, and tsunami in Japan deepens and the problems with displacement of Japanese citizens increases, the psychiatric phenomenon in Japan known as “hikikomori” could cause a unique concern for the country’ s relief and restoration efforts.
In the early 1990s, this extreme form of social withdrawal was identified in Japan, where young people would seclude themselves in their homes for months or even years at a time. Researchers initially estimated over a million people in Japan had been experiencing this withdrawal, leading to the phrase in the media “ the missing million.”
“Hikikomori” commonly have symptoms of depression, anxiety, and unusual sleep patterns. Japan’ s Ministry of Health, Labor and Welfare created a definition of “hikikomori” that included the following:
1. The person does not take part in society and remains at home.
2. The person does not take part in or have interest in going to school or work.
3. The person does not have any close relationships other than with family.
4. The withdrawal is not a symptom of a psychotic disorder.
5. These symptoms persist for at least six months.
This definition includes complete home isolation, however for the most part, psychiatrists and researchers I spoke with in Japan typically used a more broad conception of isolation to include people who can leave their home but are not gainfully employed or have any close relationships.
“Hikikomori” I met in Japan would often stay awake all night using the Internet, playing computer games, or watching TV and sleep throughout the day. Patients would use social media to communicate, but did not engage in a great deal of face-to-face interactions with others. When I saw patients who were “hikikomori,” they usually only sought help when they were unable to maintain their isolation, either because their parents were ill or passed away or the family finances changed and they could no longer afford to support the isolated family member.
“Hikikomori” has almost exclusively been identified in Japan, although some researchers believe it is a worldwide phenomenon. The recent crises in Japan could result in many “hikikomori” asking for help for the first time, this in addition to the undoubtedly tens of thousands of people already at high risk of trauma related psychiatric disorders due to trauma resulting from the death, medical illness, loss of housing and forcible displacement caused by the tsunami, radiation leak in Fukushima Prefecture, and the recent earthquakes.
The change in the job market has been a factor often pointed to as a cause of “hikikomori.” Before 1990, it was generally understood that a person in Japan would complete school, interview once with one company, then stay with that same company until retirement. After the stock market crash in 1990, this situation changed dramatically.
Lifetime employment at one company is no longer guaranteed, young people interview at several organizations and do not secure employment immediately after graduation. The issue that occurs is that many young people are reacting as if this is cause for shame and guilt and if the family has the means, these feelings can lead to people becoming “hikikomori” or exacerbate more mild forms of social isolation.
New psychiatric disorders are not quickly acknowledged by the psychiatric community. Often there is a great deal of skepticism, especially if there is a lack of a robust body of clinical research as is the case with “hikikomori.” However, people suffered for generations before disorders like post-partum depression and seasonal affective disorder were formally recognized by psychiatric organizations.
Whether it is called extreme social isolation or “hikikomori,” this phenomenon, in my opinion, will be a very relevant variable in any sustained outreach or relief effort for the Japanese people in the coming months and years. It is likely that there will be an incredibly high need for psychiatric services in the aftermath of the earthquakes, tsunami, and radiation leak due to “hikikomori.”
Paul Ballas is a practicing child psychiatrist in the Philadelphia area and serves as a medical adviser and writer of pro-social, pro-health and educational video games for children and adults. He won a travel fellowship to Japan through the Noguchi Medical Research Institute and Thomas Jefferson University Hospital, during which he saw patients in the Osaka City Hospital system.