The Fight to Save Japan’s Young Shut-Ins
A City Reaches Out to Its Hikikomori Population; Some Stay Inside Their Homes for Years
Academic surveys estimate between 500,000 and two million people in Japan are hikikomori, exhibiting an extreme type of social withdrawal. PHOTO: YUTA ONODA
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Fukuoka, Japan
When the Kimura family moved here from Tokyo, their middle school-aged daughter missed her old friends. Midway into her first year in high school, she stopped going. Between 14 and 19, she barely left the house, and for one year hardly left her room, interacting only with her parents.
Now 33 and recovered, Ms. Kimura says she was “hikikomori.” That’s the name of a type of social withdrawal that can be so severe, people with it don’t leave their houses for years. It’s also what those who suffer from the condition are called.
The puzzling condition is often thought of as a Japanese phenomenon, affecting an estimated 500,000 to two million in Japan, according to projections from academic surveys. Published reports also have described cases in the U.S., Hong Kong and Spain, among other countries.
In Japan, hikikomori has been a household word since the 1990s, with many experts calling it one of the biggest social and health problems plaguing the country. Yet the causes and treatments of the condition—or even whether it’s a mental illness or not—remain poorly understood. And while the Japanese government has poured significant funds into helping hikikomori, treatment success rates remain low.
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The condition illustrates the difficulty of defining mental illness and raises questions about the role society plays in shaping, allowing or even creating problematic behavior. Researchers in Fukuoka have set up an international collaboration to try to answer some of these questions.
Solving the hikikomori riddle has taken on greater urgency in recent years. Sufferers often are men in their 20s and 30s who would be in the workforce but instead are being supported largely by their parents. Government officials worry about who will take responsibility for long-term hikikomori when their parents retire or die.
Fukuoka, a city of 1.5 million 550 miles southwest of Tokyo, about four years ago opened a support center, which the Japanese government requires of every prefecture in the country.
Called Yokayoka, which means, “It’s OK, don’t worry about it,” in the local dialect, the one-room support center is linked to a youth employment facility. The center primarily fields phone calls from hikikomori or, more often, their worried parents. It also offers support groups for hikikomori and their parents. However, only a small number of hikikomori actually show up at the center. Of those, a minority are treated successfully, staffers say.
Takahiro Kato, a professor in the neuropsychiatry department at Kyushu University in Fukuoka, is working with the support center to study hikikomori in a more rigorous and systematic way. Dr. Kato and a team of Japanese and international collaborators that includes Alan Teo, a psychiatry professor at Oregon Health & Science University, want to better define what hikikomori is. They also hope to understand the social and biological underpinnings of the condition to improve treatments.
Professor Kato Takahiro runs a series of diagnostic exams during an interview for hikikomori and depression.PHOTO: DEPARTMENT OF NEUROPSYCHIATRY, KYUSHU UNIVERSITY
People who consider themselves hikikomori exhibit a wide range of symptoms, including depressive, autistic and obsessive-compulsive tendencies. A minority appear addicted to the Internet, says Dr. Kato, a 40-year-old psychiatrist.
Yossy, 31, came for a recent hikikomori support group. He says he didn’t leave his parents’ house for six months after harassment from his boss at his speech therapy internship led him to quit. After that, he did begin to visit friends occasionally and volunteer at a library. But after four years, he still hasn’t held a full-time job.
Hikikomori appears to be a condition distinct from other mental illnesses, Japanese experts say. Only about half of those with the condition would be diagnosed with a disorder in the U.S. psychiatric diagnostic manual commonly known as DSM-5, according to one survey of 4,134 Japanese residents published in Psychiatry Research in 2010. But large-scale survey data on hikikomori remains limited.
Some of the variation is likely due to limited resources in Japan for treating mental health, says Kawano Tooru, head of Fukuoka City Mental Health and Welfare Center. Another factor is that there is often less stigma about hikikomori than mental illnesses considered more severe, like schizophrenia, so more people are willing to call themselves hikikomori, Dr. Kato says.
Dr. Teo, an American fluent in Japanese, has treated several hikikomori-like patients in the U.S. In 2010 he published proposed diagnostic criteria for the condition. It reported that hikikomori’s core feature is social isolation. People should suffer for at least six months and should be unhappy about the isolation before being diagnosed with the condition.
The team in Fukuoka is now working to develop a standardized interview and questionnaire for assessing and diagnosing hikikomori based on some of Dr. Teo’s and others’ work. The researchers hope to support or refute the many sometimes contradictory theories that exist about hikikomori.
Japanese experts point to strict parenting practices and pressure that children feel to succeed as contributing factors. Yet hikikomori often live with their parents, and these parents can be soft in forcing their children to go to school or leave the home. They often bring trays of food to their bedroom doors.
“In western society, it’s difficult to understand this situation,” Dr. Kato says. “Western society parents strongly push [their children] to go out. But in Japan, parents are strongly afraid to push.”
Current thinking is that providing hikikomori with positive social interactions will help them reintegrate with the outside world. Michiko Asami, president of the nonprofit that runs Yokayoka, welcomes each hikikomori with a big smile and tries to initiate a nonjudgmental conversation. Sometimes they sit silently for multiple sessions or won’t look at her. Gradually, some do.
Hidetoshi Ogawa tries to facilitate interaction by having often reticent attendees go around the room and tell a story about something they like to do in a support group that he runs. Once a week he takes the group to a coffee shop or another outside activity to get them used to social interactions again.
The methods to treat hikikomori vary. There is little data to support the effectiveness of any approach. Gradually exposing anxious people to what they fear doing is one commonly used treatment for social anxiety in the U.S.
Even the definition of recovery is vague. Yu-chan, a 27-year-old woman who considers herself no longer hikikomori, is working to hone her computer skills to get a job, which would be her first. She said she was comfortable speaking, but her face immediately flushed a light pink. She trembled slightly during a brief interview when discussing the 14 years where she stayed home because of hurtful words friends said to her when she was 10.
Now, thanks to Ms. Asami’s gentle encouragement, she is able to leave the house, though she still has trouble making friends, she says. (Like Yossy, she agreed to an interview only if she would be referred to by her nickname.)
Others, like Ms. Kimura, appear to respond more fully. She says she had lost confidence in her academic abilities. She grew depressed and couldn’t fathom the idea of being with people. (She asked not to use her first name in an interview.)
Though the idea of going to the hikikomori center terrified her, Ms. Kimura realized she had to change. Otherwise, she says, she would “amount to nothing.”
The warmth of the people at the Yokayoka center inspired her to work hard to interact with others and overcome her anxiety. Now she’s a staff member at the Fukuoka youth employment center connected to the nonprofit that staffs Yokayoka.
“You can’t really take back lost time,” she says to others who are suffering. “Please try to take the first step out.”
— John D’Amico contributed to this article.
Write to Shirley S. Wang at Shirley.Wang@wsj.com
