by Shaun DMello on  February 11, 2015 at 4:46 PM Health In Focus
Hikikomori Population; People Who Stay Indoors for Years
Hikikomori is a form of severe social withdrawal, not unlike social anxiety disorder. The term was coined in Japan to describe an extreme form of social anxiety disorder that had become increasingly prevalent in the past decade.

In the Japanese context this is also a socio-cultural phenomenon, which is why the term 'hikikomori' was applied to describe the condition. Quite literally 'hikikomori' means 'withdrawal'. Japanese psychiatrist, Tamaki Saito was the first to use the term to describe this condition. While people fitting the description of hikikomori may have existed in the past in other parts of Southeast Asia, it has only emerged as a bigger social problem in Japan in recent decades.

Individuals with a history of mental illness and psychological disorders like social withdrawal syndrome, obsessive compulsive personality disorder, chronic depression, autism, internet addiction and post-traumatic stress disorder are more likely to develop a severe social anxiety disorder or hikikomori.

What are the Signs of Hikikomori?

Individuals identified with 'Hikikomori', are socially, often been described as modern day hermits and recluses. However, in most cases it is more than a social or lifestyle choice. It is an indication of a sociological or psychological problem. The condition is most prevalent amongst young men between 20 and 30 years of age, but it can affect women as well. In this condition, the afflicted will display certain behavioral traits:
  • Mild social withdrawal with decreased interaction, social interaction and a loss of friends will be the first sign.
  • The affected individual will most likely appear to be unhappy and suffer from depression.
  • The person will be extremely shy and insecure, socially awkward, and will have difficulty communicating and sharing feelings.
  • This is followed by more extreme social withdrawal, which isn't hard to miss.
  • The affected person will hide away in his/her room in complete social isolation.
  • They will refuse to leave their room for months or even years.
  • There is almost no contact with friends and even with family members living in the same house.
  • The only activities that the affected will indulge in will include watching television or using a computer to surf the internet or playing games.

What Causes Hikikomori?

It is hard to pinpoint any specific causes for the condition, as experts are still undecided over its classification as a sociological, behavioral or psychological problem. This raises many questions, such as 'is it a unique phenomenon in Japan?', 'why is it so prevalent in Japan?' and 'why the sudden rise in this phenomenon?' The answers to these questions will actually help give us some insights into the causes of Hikikomori.

Cultural Issues

To begin with, the problem is not unique to Japan, but it is most widespread in Japan. This is due to Japan's unique culture and societal structure. While almost all cultures do emphasize conformity and subject individuals to a certain amount of pressure to perform within certain parameters, the pressure to perform is a lot higher in the Japanese culture. The Japanese society is also unforgiving and most people traditionally would not get a second chance to find their place in society. Young men are prepped to perform and graduate from school or college to pursue a career and get married. This has been the traditional Japanese ideal of success and there is no slacking of time between adolescence or schooling and career life. Not finding a job and beginning work as soon as you graduate is seen as shameful in such a scenario. This puts a great deal of stress on youngsters and results in many wanting to turn their backs on society and the world at large.

Family Structure

While in most cultures this would probably result in a temporary slump, in the Japanese culture there are no second chances and adults who fail to get jobs or lose their jobs are regarded as losers and misfits unworthy of second chances. Most teenagers and young adults therefore withdraw and become introverts, seeing as there is no way out. Unfortunately, Japanese parenting is indulgent and this makes it even easier for young adults to withdraw completely. Parents do not take charge and are generally not forceful: instead, they wait on their kids. This means that a parent will rarely seek outside help or force their child to get help; they will make sure that their children have all that they need to survive with meals and other provisions while the child stays holed up. Moreover, Japan has an affluent middleclass structure in which parents support children indefinitely without too many financial constraints. This obviously compounds the problem.

Economic Issues

The problem has magnified in recent years, because the poor economic climate in the past decade has aggravated and worsened social conditions, making it a lot harder for young graduates and working professionals to find viable employment. In the meantime, social attitudes and prejudices have remained unchanged making it extremely difficult for youngsters to cope with the social, peer, family and financial pressure.

Treating Hikikomori

Treating Hikikomori can be pretty complicated as it is a condition we still don't fully understand and one that we can't even agree upon. This said, there are certain basic approaches that can help. Adolescence is a tough time in the modern world, especially when growing in a highly competitive environment with limited opportunities. Many psychological disorders that affect social behavior develop during this time when teenagers come under increasing pressure to mature into adults with careers overnight. Hikikomori however doesn't develop overnight and the high rates of comorbidity with depression and other mental illnesses are illuminating.

This suggests that hikikomori develops as a symptom of other untreated mental health issues or causes other mental health issues, depending on whether hikikomori is to be regarded as a unique disorder. Either way, symptoms of depression and obsessive-compulsive behavior are often associated with the condition. If such behaviors are observed before there is complete social withdrawal, parents or other family members should immediately seek help.

Once the individual actually develops hikikomori or goes into complete social withdrawal, there is a rapid loss of socialization skills. The person loses all self-confidence and is filled with a phobia of any social interaction. This makes reintegration a lot tougher as the person needs to relearn their social skills. As time progresses the condition becomes worse and therefore it becomes a lot harder for the family to help break the patient out of the isolation. As is the case with most health conditions and probably more so in the case of hikikomori, early detection and treatment can make a huge difference.

To address the growing problem, the condition needs to be treated with a social and psychological approach.

Psychological Approach

The warning signs of hikikomori should be treated as behavioral or mental disorder. Parents need to seek help by getting the youngsters to either visit a clinic or hospital for counseling, observation and in some cases drug therapy if necessary. If the individual is unwilling to leave the house and does not co-operate, then parents need to seek help from support groups and counselors.

Social Approach

In this approach, the patient is not admitted into a hospital or a clinic but is instead relocated to a communal or shared living environment where he/she learns to reintegrate into social groups. This involves socialization techniques with group activities and interaction with other patients who are in various stages of recovery from the same condition. This works in a manner similar to support groups and counseling as it provides the patient with like-minded individuals who have endured similar experiences and at the same time it is conducted within a structured and supervised setting.

Other novel methods being used in the treatment and rehabilitation of hikikomori are -
  • Support groups and halfway houses like New Start try to get the hikikomori patients to a place where they can seek external help. Young women who work or volunteer for the organization will visit the house and try to strike conversations with the patient. To cause minimal discomfort, which would be counterproductive, the woman will only communicate from the other side of the closed door. The main aim is to reassure and befriend the patient before coaxing him out of isolation.
  • There are also videos that help the individual to get reacquainted with social skills necessary for communication, while still remaining in isolation. This helps the individual better prepare for reintegration in society, but it cannot be relied on alone.
  • Cognitive-behavioral therapies that use counseling and talking may also be effective and can be particularly helpful when dealing with depression or anxiety.
The problem of hikikomori doesn't just affect the person who has withdrawn, it also puts an incredible strain on the family. Families are advised to seek help from support groups and therapists not just to learn about techniques to help the affected individual but also to learn about strategies to cope with responsibility of caring for a hikikomori patient.

Source: Medindia

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