How one U-M researcher is raising global awareness of the hikikomori phenomenon
Mr. H didn’t leave his apartment for three years. For the first year, he sequestered himself in a walk-in closet. A housemate supplied him with junk food, and he passed the time surfing the internet and playing video games. And while Mr. H. said disdain for society drove him to seclusion, it was also a source of distress. One day, the 30-year-old reached out to psychiatrist Alan Teo, M.D.
In 2009, Teo, a Robert Wood Johnson Foundation Clinical Scholar at the U-M, was the first physician to publish a review in English medical literature of hikikomori, a phenomenon of severe social withdrawal gaining prevalence among young adults in Japan; government estimates place the number of hikikomori in the island nation around 700,000 — more than the population of Seattle, Washington. Mr. H. had come across Teo’s work and sought his help reentering society.
This chance encounter led this year to the publication of a report about Mr. H., who became the first documented case of hikikomori in the Americas. Others have been reported in Spain, Italy, Oman and Korea.
Factors in Japanese society and family structure are often highlighted as major contributors to the disorder, but whether it’s unique to the Japanese culture is not merely an academic question, says Teo. “It’s clearly most prevalent in Japan, but there’s growing evidence that hikikomori exist all over the world,” he adds, noting that social isolation can be as deadly as smoking or excessive alcohol consumption. In May, Teo participated in a symposium at the Japanese Society of Psychiatry and Neurology’s 108th annual meeting that explored the international nature of the disorder.
Becoming a recluse is nothing new, but it’s a question of prevalence and degree, says Teo. “We’re not pathologizing or creating illnesses,” he says. “These are people who are no longer able to function in their daily lives, and who are extremely troubled by their isolation and loneliness. Everyone goes through periods of relative withdrawal, but for these individuals it becomes a way of life.” A 2010 epidemiologic study found that one out of every 100 Japanese adults between the ages of 20 and 49 reported experiencing a hikikomori episode — defined as withdrawal lasting at least six months — with about half of them showing no indication of additional mental health conditions.
Some scientists hypothesize that the isolating effects of modern technology may be driving the phenomenon, at least in part. “Researchers in Korea have found a link between hikikomori and Internet addiction, which the national government is already treating as a significant public health problem,” says Teo.
Internet addiction is just one of the areas Teo and colleagues from India, Japan and Korea are examining in an ongoing study that will for the first time analyze the disorder cross-culturally.
By raising awareness about hikikomori, Teo hopes people like Mr. H. may be able to get help earlier. “The data indicate that people don’t come in for treatment until they have been suffering for a year or more,” he says. “It’s like if a person waits until they’re 300 pounds before they try to lose weight; it’s going to be really hard to get back to a healthy state. We need the public to keep an eye out for their loved ones and friends, so that they’re able to recognize a problem before months or years have gone by.” —IAN DEMSKY