Monday, 1 August 2011

Hikikomori: the birth of a psychiatric condition?

A friend of mine* sent me this link a few days back. Hikikomori is a Japanese term describing when people withdraw from social life, seek isolation and refuse to leave their house for a period of 6 months or more. Digging deeper, there are some very interesting perspectives on this 'condition' (if I can call it that) and in particular, the culturally-based explanations put forward for hikikomori based on Japanese society and its history celebrating the nobility of solitude.

I don't quite know if I understand or believe such cultural and historical explanations for all cases of such enforced solitude. It's a little bit like saying that everyone who commits suicide in Japan is doing so as part of an honourable death; a simplistic and one dimensional view which takes no account of other factors like depression, which although socially-mediated is not necessarily a 'social illness'.

Back to hikikomori, I was quite astounded by the figures being put around estimating prevalence of the condition: 1.2% over a lifetime. That's 1.2% of people in Japan aged between 20-49 years old, isolating themselves for 6 months or longer. I have to admit some ignorance with the intricacies of Japanese society so please excuse my surprise with the figures reported. Although originally thought to be a condition only present in Japan, the emerging data seems to suggest that such symptoms are present in various countries and cultures worldwide - at least according to the psychiatrists questioned in that study.

There are also proposals that hikikomori should formally enter the realms of psychiatry, with this paper suggesting potential diagnostic criteria for possible inclusion in DSM V on the basis that the presentation of some cases do not meet criteria for other DSM defined conditions. I don't want to enter this debate at this time but certainly it strikes me that hikikomori might show more than a passing connection to a few other conditions including some characteristics potentially present in some autism spectrum cases.

I would like to raise one last point on hikikomori in relation to my recent post on the autism figures in South Korea. Whilst I stress that I am not suggesting any connection not least because of the age difference, I do wonder to what extent the SK study reporting 1 in 38 children having an autism spectrum condition might overlap with the hikikomori group given the 'cultural' overlap between SK and Japan. Is the psychological and behavioural profile of autism, high-functioning autism in particular in childhood, similar, the same or different from that of hikikomori? If similar, what does this tell us about the SK figures and would they be replicated in Japan?

For those of you who are perhaps interested in reading more about this, perhaps take a look at this book at your local library (not an endorsement by the way).

* Many thanks to Suzanne for her emails about hikikomori.