Hikikomori: Cultural idiom or present-day expression of the distress engendered by the transition from adolescence to adulthood

Abstract

AimHikikomori is a syndrome involving withdrawal into the home for a duration of more than 6months, identified among Japanese teenagers and young adults. The cultural and sociological approach is central in Japan, where a psychiatric understanding has long been denied. We set out to demonstrate how a psychopathological approach is coherent with the categorization found in the DSM 5, where Hikikomori is described as a cultural idiom, that is to say a present-day expression of distress in the transition to adulthood for certain adolescents, notably in France. MethodologyFrom the very first descriptions of the Hikikomori found in the Japanese scientific literature of the 1980s, we will see how this voluntary confinement syndrome has grown in magnitude and has received special attention from the authorities, which have stressed its cultural aspect. We will discuss how this syndrome is rooted in the Japanese mythology and how it is expressed and described in other cultural contexts, as well as in the French and English-language psychiatric literature. We will finally adopt a psychopathological approach in order to complete our understanding of this behavior among boys at entry into adulthood. ResultsHikikomori existed in other forms in Japan prior to the 1980s, and in France from the mid-1950s, in the so-called “claustration” or confinement syndrome, most often associated with psychotic disturbances. In English-speaking countries, it appears under the name of housebound syndrome, a particular form of agoraphobia for women. It also corresponds to the DSM 5 category “cultural idiom”. This describes an expression of suffering during the transition to adulthood concerning certain teenagers who are confronted to strong social and family demands, leading them to develop massive inhibitions and to suspend the ideals of their Ego so that they are finally driven to seek refuge in passivity. DiscussionWhile the cultural approach is central in the Japanese literature, questions about the existence of comorbidities or about ‘primary’ or ‘secondary’ Hikikomori, point to the value of a psychopathological approach. Despite the refusal to consider Hikikomori as a culture-bound syndrome on account of the presence of similar cases in many other countries, its classification as a cultural idiom can integrate its dual cultural and psychopathological particularities. The role of inhibition, and the confrontation with a demanding and distressing ideal, shape a form of masculinity lapsing into passivity. Subjects seem to actively choose passivity in a kind of a masochistic logic so as to suffer less than if they were actually subjected to it. Thus social withdrawal and confinement in the home could serve as message to those around them, albeit addressed in negative form, an expression of distress linked to the difficulties of the transition from adolescence to adulthood.