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Hikikomori: When the ‘safety’ of solitude becomes a prison
https://www.straitstimes.com/opinion/hikikomori-when-the-safety-of-solitude-becomes-a-prison
2024-07-26
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By --- Professor Chong Siow Ann is a senior consultant psychiatrist at the Institute of Mental Health.
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“Why seek out solitude?” asked the writer Pico Iyer. “Only so I can have something happy and different – fresh – to share with my friends. Otherwise I’m just sleepwalking through my days, chit-chatting about nothing. It’s only by stepping away from the world that I recall what I most love in it and how best to give back something rich and real.”
Solitude is that state of grace and silence within which we can reflect, grieve, appreciate, and restore ourselves. In silence, creative ideas are born too.
But solitude can also be darkness and hopelessness – something which came to my mind when I read about 25 young people in Singapore who have been receiving help because they had withdrawn from society, cut off ties with others, and retreated for long periods into the solitude and isolation of their own homes.
“It’s an awful thing, solitary,” wrote Mr John McCain, the Republican senator and two-time contender for the US presidency, of his 5½ years as a prisoner of war in Vietnam – more than two years of it spent in isolation in an approximately 4.5m by 4.5m cell. “It crushes your spirit and weakens your resistance as effectively than any other form of mistreatment.”
Returning former prisoners of war, too, said they found social isolation to be as torturous and agonising as any physical abuse they suffered.
And studies of prisoners in the US penitentiary system found that, after months or years of complete isolation, many “begin to lose the ability to initiate behaviour of any kind – to organise their own lives around activity and purpose”. They were also beset by chronic apathy, lethargy, depression and profound despair.
One of the paradoxes of solitary confinement is that, as desperate as people become for human companionship, the ordeal renders them inept and unfit for social interaction.
A protruding nail
There is another form of extreme solitude that is self-imposed and taken up as a means of hermetic existence.
In his 1998 book Hikikomori: Adolescence without End, Japanese psychologist Tamaki Saito described a condition of extreme social withdrawal and isolation which he called hikikomori, which roughly translates to “a pulling away from society” (this term is now used interchangeably for the condition and its sufferers).
He described individuals – usually young men – who physically isolated themselves in their homes for months to years. Alongside physical isolation, they also remained socially disconnected from everyone, even those within the same household.
The psychologist’s central claim is that hikikomori is a product of certain aspects of Japanese culture exemplified by that famous Japanese saying: “A protruding nail will be hammered down.” Rigid social norms with the emphasis on conformity, high parental expectation, and an overpowering fear of – or revulsion against – shame, make the Japanese more vulnerable to feelings of failure.
And then there is that punishing educational system that was built around highly competitive and rigorous high-school testing, which requires enormous discipline and long arduous study, with an undertow of worry and anxiety. Excellent academic performance is both valorised and the vital first step in a prescribed formula for life success – at least in Japan’s corporate economy.
In an article in The Atlantic magazine, one hikikomori told the interviewer: “As long as I performed well in school, things were okay. But once I started to deviate just a little – they (parents, teachers) went to the extreme and started treating me incredibly coldly.” Close to a third of hikikomori cases in Japan start out as school refusal.
However, what was thought to be a uniquely Japanese condition has since been reported elsewhere. Over the past decades, numerous studies across the globe have observed similar socially reclusive behaviour among individuals in other countries including South Korea, India and the United States.
There are probably commonalities underlying this phenomenon across these different societies: a demanding educational system, high parental expectation, an emphasis on material success, and most crucially, that individual sense of not ever being able to make it and the subsequent utter disillusionment.
Researcher Alan Teo from University of California, San Francisco, believes that American hikikomori comprise a distinct, subset of the people not in education, employment or training (commonly called Neets). In an article in the International Journal of Social Psychiatry, he described a 30-year-old man who had secluded himself for three years.
“During the first and most severe year, he remained within a walk-in closet, ate only ready-to-eat food,” he wrote. “He passed the time surfing the internet and playing video games.”
Many hikikomori are indeed heavy internet and video-game users, but most use the internet passively as a window to the world rather than a means to interact with others – unlike the Japanse hikikomori, who withdraw from the world. An absolute causal link has not yet been shown between hikikomori and digital technology though the ease to shop and entertain oneself without the risk of bruising real-world interactions could exacerbate and maintain social isolation.
The Japanese government has estimated that there are more than a million hikikomori (amounting to 1 per cent of the population) based on two surveys carried out in 2016 and 2019.
A sizeable number of extreme shut-ins would be a harbinger of economic cost for any country. They are not able to work and they are dependent on others – usually their baffled and hapless parents. The Japanese have referred to this as the “80-50 problem”, which is a shorthand for the ages of the hikikomori from earlier days as they transit to middle age (still trapped in their reclusiveness) and as their parents enter their 80s – a tenuous situation which begs the question of how they would support themselves when their parents die.
Can we coax them back?
It’s difficult to gauge just how pervasive – if at all – hikikomori is among us here. No survey has been done, and in my many years of practice, I have encountered only three young men with all the features of hikikomori (and not due to any mental illnesses like schizophrenia or major depression).
Each was triggered by some setback. One experienced academic difficulty while on a scholarship in an Ivy League university, the other was a victim of school bullying, and the third tipped over by the culmination of work stress.
Defensively, they avoided being traumatised again by dropping out of what would have been the expected course set out for them by their parents, society and even their former self. In the main, they were miserable as the initial relief following their self-imposed solitude paled and morphed into abject loneliness. Having withdrawn from society for a long time it became seemingly impossible to re-enter, and they saw their lives to have no meaning or value.
It is tempting to see hikikomori as a form of silent but potent protest against the pervading societal norms and expectations. There, within the four walls of their bedrooms, compartmentalised, literally, from real life, separated from their pasts and their future, they can at least exist without fear of failure or judgment from the outside world.
Hikikomori is currently viewed as a sociocultural mental health phenomenon, rather than a distinct mental illness. And if the factors flagged here do influence such behaviour, it would make sense to address them. If school is where it starts, then the educational system, however competitive, should still be able to find a place for all, without instilling shame. There should also be varied definitions of what constitutes success in life – something other than scoring stellar grades and scaling the professional ladder.
And there is that question of extricating those already entrenched deep in their self-imposed withdrawal.
In Japan, a non-profit organisation called New Start offers “sisters for hire”. The family of hikikomori men would pay for the service of women who, though neither trained in counselling nor psychology, would visit and speak with the housebound hikikomori to draw them out of their isolation and encourage them to live a more normal life.
The South Korean government has offered their young hikikomori from lower-income families a monthly stipend to coax them out of their homes, as well as subsidies for a raft of services, including counselling, cultural activities and even “correction of appearance and scars” – all in the hope of enabling them “to recover their daily lives and reintegrate into society”.
To date, there is no data supporting the efficacy of these two approaches, nor of any other treatment.
The common-sense approach is to use some non-threatening activities to re-engage them and draw them out without arousing their fears. Like those kept long in solitary confinement and stripped of their abilities to interact socially, they need help to rebuild these skills. But the real-world challenge is getting the resources to make all this happen and sustain it over a long duration.
I couldn’t help those three patients of mine – beyond prescribing some medications and referring them to a psychologist. They soon dropped out of treatment and were lost to follow-up. That was years ago, but even now I’m not sure if I would know how to pull them out of their dark holes.
- Professor Chong Siow Ann is a senior consultant psychiatrist at the Institute of Mental Health.
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