Maggie: I want to talk about a friend of mine today. Is that okay?
John: Sure. But are we really talking about a friend?
Maggie: I know I sometimes say we are talking about a “friend” when I really mean me. But this time, it is a friend. And I’m worried about him.
John: What do you want to talk about? And should we give your friend a name? Not his real one, but a different name so we’re not just referring to “the friend.”
Maggie: Let’s call him… Ryan.
John: Ryan it is. Why are you worried about him?
Paying Attention to Our Friends
Maggie: He has always been a bit introverted. Like us. But since the Covid-19 pandemic, he has withdrawn almost completely from everyone. Including his friends.
John: Before I ask a few questions, let me tell you how proud I am of you. You are paying attention to your friend’s behavior, which shows you care. There are so many narcissists that care only about themselves, it is nice to know someone who actually cares about others and does something to help.
Maggie: Thanks. I do care about my friends.
John: So, can you give me a few more facts about Ryan’s behavior? Let’s start with how long you think he has been withdrawn.
Maggie: I started noticing it a lot about five or six months ago, but when I think back, I think he started withdrawing right about the time the Covid virus hit the country.
John: So he has been in the process of withdrawing for about ten months?
Maggie: Yes. But it really accelerated five or six months ago.
John: Okay, so we know the timing. Tell me more about his withdrawal. What makes you think he is withdrawing?
Maggie: Ryan started saying no whenever we asked him to do anything with us, and we’re his best friends. He won’t meet for coffee, go for walks, go hiking, or even take his camera out on a shoot with us.
John: Did you or your friends do something that caused him to cut his ties with you?
Maggie: No no no. That’s not it. He is still friendly when he texts or emails. He just doesn’t want to leave his house.
John: Do you think he is afraid to go certain places, like a park or a coffee shop?
Maggie: Do you mean something like agoraphobia?
John: Yes, something like that.
Maggie: No, I don’t think so. I don’t think it’s the places he is afraid of. I have seen him outside twice in the last month. He was on the greenway walking, but both times it was late at night when no one else was around. When I tried to talk to him, he looked scared. Almost panicked. Like he wanted to escape.
John: Is he afraid of catching the Covid virus?
Maggie: That’s the excuse he uses. And I think it is true, at least to some degree. But it’s more than that. Like I said, he is completely withdrawing from everyone.
John: So its not places he is avoiding, but people?
Maggie: Yeah. That’s what I think. That’s why he stays in his room all day and only goes out if he thinks he won’t run into anyone who will try to talk to him.
John: I think I understand now. You said earlier that he still communicates with his friends, but just through texts and emails.
Maggie: No, that’s not exactly right. At first he did, but not too much anymore. It became less and less over the last several months and none of us have heard from him in two or three months.
John: Has anything traumatic happened to him?
Maggie: I know his boss at work was a real jerk to him. He tried to humiliate Ryan whenever he could. That’s why Ryan quit.
I am worried about him. What do you think is going on?
A Diagnostic Caution
John: I think I might have an idea of what is going on.
Maggie: Really? Tell me.
John: Before we discuss this, we need to have an understanding about the nature of this conversation. Okay?
John: Right, caveats. Neither you nor I are a professionally trained psychologist. While plenty of people engage in amateur diagnoses, we should not do it. No one should.
Maggie: I understand and I agree. I know this woman who claims that God gave her the “gift of counseling.” So she goes around diagnosing everyone she meets and offering her advice. It drives me crazy because her advice is always something like “you should do what I do…” It’s so arrogant.
John: We are not going to do that here. This discussion is simply for information purposes, so we can understand what might be going on and have greater compassion as a result. It is not a diagnosis.
So we are clear on this?
Maggie: Absolutely. But we are also going to talk about what we can do to help him, right?
John: Yes, we will get to that also.
John: There is a psychosocial condition called hikikomori.
Maggie: I’ve heard of it. It’s a Japanese phenomenon.
John: Many of the major studies on hikikomori have taken place in Japan, and a Japanese psychologist—Tamaki Saito—was the first person to bring the term to the field of psychology. But it’s a condition that affects people worldwide.
Maggie: Can you explain it to me in something like a definition? But not a definition like one from the DSM-5. That’s too complicated.
John: I can at least try.
Hikikomori refers to an acute and protracted, social withdrawal. The term applies to both the condition itself and the person doing it, so it gets confusing sometimes. We have to pay attention to how we use the term.
Maggie: Can you give me an example? I think that would help.
John: Sure. A person suffering from hikikomori spends most of her day in her house or apartment, like your friend Ryan. If others live in the same place, she will spend her time in a single room, like a bedroom. She avoids face-to-face social interactions. The longer she suffers from this, the more her interpersonal relationships dwindle, until she has none left.
Maggie: Does the social withdrawal happen all at once, or does it happen over a period of time?
John: Over a period of time. At first, a person may just appear unhappy. But over time she gradually becomes more and more insecure, quiet, and withdrawn. She eventually loses her friends and even stops talking to her family, until she is truly all alone.
Maggie: That sounds like torture.
John: Yeah, it is torture. Can you imagine the loneliness?
Maggie: What does she do all day?
John: Hikikomori usually spend their time on computers, playing video games, watching television, or reading. Anything they can do in isolation and by themselves, in order to avoid people who might criticize them or make them feel worthless.
Maggie: Are they afraid to go outside?
John: No, like your friend Ryan, they go out, but only when they think they won’t be noticed or recognized by someone. So they usually go out late at night, or they go to a different town, or they go to a restaurant that is unfamiliar to people who may know them. It is people they are trying to avoid, not places.
Maggie: It sounds like they become hermits.
John: Yes, that is exactly the case. But terms like hermit, recluse, loner, and outsider are derogatory terms meant to minimize the people suffering from hikikomori, social anxiety, avoidant personality, and other psychosocial disorders. So let’s not use those terms.
Maggie: I’m sorry. I didn’t know. I didn’t mean to minimize anyone.
John: I know you didn’t. But most people who use derogatory terms like these do so to make themselves feel powerful. Remember our discussion of ressentiment?
Maggie: I remember. And I’ll try to be more aware of the affect of my words on people.
I think I have a general idea of what hikikomori looks like now. Can you tell me a bit more about the symptoms? What do psychologists look for?
Symptoms/Criteria of Hikikomori
John: Hikikomori is relatively new as far as diagnostics go. So the literature is a bit all over the board when discussing the symptoms for diagnosis. But it generally agrees on the following:
- Hikikomori spend most of their time at home, almost all day every day.
- They consistently avoid social situations like school and work and church.
- They consistently avoid social relationships with friends and family.
- Their social withdrawal interferes with their occupation, schooling, social activities, and relationships.
- They withdraw for a period of six months or more.
- The social withdrawal is not due to another mental disorder, such as depression, avoidant personality disorder, and social anxiety, and it doesn’t have a physical cause.
Do these make sense to you?
Maggie: Yes. I think so. But what causes hikikomori?
Hikikomori and Causation
John: Some of this is speculation because the research is not complete. But I think these causes are based on good judgment.
Maggie: I get that.
John: Overwhelmed by circumstances:
Some scholars think that hikikomori occurs in response to feelings of being overwhelmed by circumstances.
Maggie: I don’t understand.
John: Think about the time and events we are currently living in. With Covid, the quarantine, a volatile job market, the social upheaval, and the hatefulness displayed during the election cycle, it would be easy to get overwhelmed. And some have become overwhelmed, leading them to simply withdraw and hide.
Maggie: So they are just hunkering down and weathering a crisis?
John: It’s more than that. The hikikomori avoid social interactions as a way of avoiding further pain and stress. They truly believe they are doing the only thing they can do to protect themselves.
Maggie: Can you give me an example? A hypothetical?
John: Let’s do a thought experiment.
Maggie: Okay. I like these.
John: Imagine this scenario, which is a true fact pattern I recently heard about.
Because of the Covid quarantine, many employees are working from home. This has left some employees feeling isolated and alone, even though they are having daily contact with their co-workers.
Maggie: I have heard this same thing from students at my school.
John: It’s a pretty common feeling these days. Now insert yourself into this fact pattern, which is about an employee named Maggie:
Maggie works hard everyday, including extra hours in the evenings and on weekends. Her immediate supervisor has an inner circle and he tries hard to promote those employees in this circle. But Maggie has never been part of the supervisor’s favorites, and often feels separated from the team as a result. And the supervisor intentionally gives Maggie assignments outside of the unit or work that she must do by herself. As a result, she rarely works with actual unit members, causing her to feel even more separated from the team. The supervisor also takes insulting shots at Maggie during unit meetings, doing so while hiding behind a cloak of “that’s-just-the-way-I-am.” He doesn’t do it often, but just enough to guarantee that Maggie feels humiliated and lives with a fear of being terminated.
Maggie: The supervisor sounds like a jackass.
John: Good description. Are you in the scene?
John: Tell me how you feel.
Maggie: Angry. Like I want to escape and never see the supervisor again. And frustrated.
John: What about your co-workers? How do you feel about them?
Maggie: Embarrassed and humiliated. It’s hard to be around them, as a result.
Oh oh oh, I get it. I am isolating already.
John: Yes, exactly. And you can imagine how Maggie’s feelings of isolation and separation can take on an enhanced liveliness during the quarantine, when she is not even able to have hallway conversations with her co-workers.
This scenario could easily lead her to separate from her supervisor and co-workers as a defense mechanism to prevent further harassment, abuse, and stress. If this continues for any length of time, the feelings of separation and isolation could cause hikikomori.
Maggie: Why doesn’t she just quit her job?
John: Again, think about the circumstances. Quarantining keeps her home and good jobs are hard to get in this failing economy. The result is that employees are staying put despite terrible working conditions.
Maggie: So hikikomori is a defense mechanism against overwhelming and abusive circumstances?
John: Exactly right. And this is just one isolated fact pattern. There are a thousand other examples in many different contexts other than work, like school, church, and social clubs.
Maggie: I think I understand. Given his boss’s treatment of him, something like this could be what pushed Ryan into isolation. What’s another cause?
John: Posttraumatic Stress:
Posttraumatic stress is often associated with soldiers coming home from war. But many events can cause it.
Maggie: Like what?
John: Any sort of abuse can cause posttraumatic stress, and this includes both physical and mental abuse. Abused children, for example, often exhibit signs of PTSD. And abused wives. I know several high school students that suffered extreme bullying who now exhibit symptoms, and it also occurs as a result of bullying in the workplace.
Maggie: How about cancer? Can things like extreme sickness cause post-traumatic stress?
John: Absolutely. Any trauma can cause PTSD.
Maggie: How does this lead to hikikomori?
John: Trauma sometimes causes a victim to want to escape any scenario that could further victimize the person. Students who are bullied avoid school; employees who are bullied avoid work; and you get the point. The easiest thing to do is to stay in a safe zone, which is often a home or a room.
Maggie: And if a person does that for too long, it becomes a pattern she can’t break.
John: You got this.
Maggie: Any other causes I should be aware of?
John: Many other causes:
There are a lot of causes, such as fear of failing to meet family or societal expectations, and failing at school or in the job market. Some mental health disorders also turn into hikikomori.
Maggie: Like what?
John: Social anxiety disorder sometimes causes hikikomori when the fear of meeting others grows so large that the person refuses to leave her house.
Maggie: So hiding out because of Covid-19 is not hikikomori?
John: No. Just because a person is trying to protect herself through separation doesn’t mean she suffers from hikikomori. But it could turn into hikikomori if she lets her fear run away with her.
Hikikomori occurs when a stressor agent becomes so great that the person pulls out of all her social (work, school, play) relationships to avoid the stressor. Like we said above, the victim of prolonged bullying may seek to isolate to prevent further abuse. And a person who was consistently humiliated may seek to avoid further social interactions as a way of avoiding further humiliation.
Maggie: I get it.
Two Clarifying Points
John: We need to discuss and clarify two last points.
Maggie: What’s that?
John: First, a person can be in a pre-hikikomori state, where she is just beginning to isolate or her isolation has only been going on for a few months. But this is a vulnerable time because the longer a person isolates the easier it is to continue to do so. After several months of isolation, it becomes difficult to return to a normal path of life with schedules and goals and social interactions, which leads to further depression and seclusion.
Maggie: So its important to identify this stage in our friends and take steps to help?
John: I love the way you are thinking.
Maggie: What is the second point?
John: Hikikomori has exploded as a result of the online lifestyle. It is easy for a person to isolate when she can chat online, order food in, and entertain herself through gaming.
Maggie: What about online friends?
John: I’m not sure what you’re asking?
Maggie: Do hikikomori have online friends?
John: Yes, that is often the case. But online friends cannot take the place of face-to-face interaction. A person needs actual interpersonal relationships to be psychologically healthy and online friends do not provide this.
Intervening and Helping
Maggie: What can we do to help Ryan and others like him?
John: The first step is to pay attention to the people around you, which you have already done by paying attention to Ryan.
Many people, including our friends and colleagues, are interested in themselves only, and as a result they are blind to the obvious signs of mental health decline in the people around them. Let’s not be like this.
Maggie: What is the second step?
John: The second step is to seek advice from a third party who may be able to assist you, which you have also done by bringing the problem here to discuss.
Maggie: And the third step?
John: The third step is to continue to be a good friend. Reach out to Ryan, text him, offer to bring him food, and offer to assist him. Don’t ignore him or give up on him. Just be there for him.
Maggie: What if he ignores me?
John: Be persistent. Don’t give up on him. That is sometimes the best we can do.
Maggie: Okay. And next?
John: The fourth step is to be a good listener if Ryan wants to talk about his mental health. But just listen. Don’t judge and don’t offer advice. Just be supportive.
And if you get a chance, suggest that Ryan get professional help from a psychologist. That is the fifth step. You can even offer to help him find a therapist.
Maggie: That sounds smart. Anything else?
John: Yes, there is one last thing. You should encourage Ryan’s other friends to reach out to him. With the support of all his friends, I think Ryan has a good chance of coming out of this.
Maggie: So this really comes down to two points: be a good friend and help Ryan get some professional help?
John: You are so smart. Hopefully our friends and colleagues will take your words of advice to heart.
Maggie: Thanks for talking about this with me.
John: You’re welcome. And I hope Ryan gets the help he needs. He’s lucky to have you as a friend.