Abstract
One of the most talked-about social issues in Japan in recent years has been the problem of the nation’s purportedly one million “hidden” youths, known as hikikomori (literally, “the withdrawn”). Most observers agree that the category of hikikomori encompasses a wide range of problems and provocations. The fact that these various dilemmas lead to the shared outcome of shutting oneself away at home is the point of departure here. The article explores the spheres of mental health care, education and family, focusing on the reluctance to highlight underlying psychological dimensions of hikikomori and the desire on the part of schools and families to “mainstream” Japanese children, accommodating as many as possible within standardized public education. Hikikomori can perhaps be seen as a manifestation of Japanese democracy, in which the good society is imagined as cohesive, protective and secure, rather than one in which the individual can freely exercise the right to be different. Schools, families and the sphere of mental health care have focused on producing social inclusion but have discouraged citizens from being labeled as “different”—even when such a distinction might help them. The dearth of facilities and discourse for caring for the mentally ill or learning disabled is, in many respects, the darker side of Japan’s successes. Those who cannot adjust are cared for through the institutions of families, companies and various other spheres that offer spaces to rest and to temporarily “drop out”; however, the expectation is that rest will eventually lead to a re-entry into mainstream society. Often the psychological problem or disability that led to the problem goes unnamed and untreated (hikikomori, psychiatry, special education, youth, family, Japan).
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Notes
At the dining hall of a Tokyo youth support center, a live-in facility for hikikomori youth, I witnessed a teen rinse each bowl and dish with carefully measured amounts of boiled water, before placing his food in the bowls.
Saitō’s (2004) informational book on hikikomori, published with Japan Broadcasting (NHK), takes the question-and-answer format and explores a number of case studies. Most of the cases are young adults who withdraw owing to some setback, the death of a parent or failure in school, rather than chronic emotional or adjustment problems.
The notion of “social hikikomori” has been widely taken up, and Saitō himself disproportionately emphasizes this aspect of normality in his writings. However, many psychiatrists, public health-care workers, school counselors and others simultaneously recognize that some cases of hikikomori involve psychopathology.
Five and six-tenths percent of the total population experienced a severe or moderate disorder in the past 12 months; 2.4% of the total population experienced a severe or moderate form of major depression in the previous 12 months.
The rate of help-seeking is lower at both ends of the spectrum of educational attainment. Those who have not achieved a high-school education may lack awareness or resources to seek help. Those who are highly educated may experience a sense of social stigma or pressure to conceal their problem.
The four survey sites for this study were in Western Japan. None contained a metropolitan city with a population greater than one million. It is possible that a more densely urban center would show higher rates of incidence of self-reported mental illness and more frequent help-seeking.
Among those reporting mood disorders, 25.1% use mental health care of any kind (psychiatrists, nonpsychiatrists, others); 10.2% seek help from general medical practitioners. The comparable rates in the U.S. are 55.5% seeking help from mental health professionals and 47.5% seeking help from general medical practitioner (Naganuma et al. 2007:246). The latter number does not necessarily suggest a lack of awareness of mental health problems but, rather, the way in which internists and primary care physicians, targeted by advertising and awareness campaigns directed at them by pharmaceutical companies, have increasingly encroached on the terrain of psychiatrists by prescribing psychopharmaceuticals.
In his ethnography of aging and the place of the elderly in society, John Traphagan writes that the common perception of senility (“boke,” a Japanese term describing the social remoteness of the elderly, loosely translated as “senility”) “has the potential to be controlled through activity” and that “self-building and effort are fundamental to being a good person…. Indeed, the idea that one may have at least some degree of control over the onset and progression of boke implies both a degree of hope that one can remain a viable social entity and the idea that one should focus one’s attention and effort on doing whatever one can to ensure that this happens” (Traphagan 2003:66).
Susan O. Long (2000:17–21) discusses how common expressions of reconciliation (shikata ga nai, or “it can’t be helped”) allow patients at the end of life to make distinctions between that which they can (and should) control and that which they are comfortable letting go of.
In another essay, Lock (1993b:29) writes that, in contrast with the psychoanalytic paradigm in which the patient aspires to construct his or her own consciousness free of social pressures and constraints, the goal of mental health therapies in Japan more often tends to be reintegrative: “to help a person adjust to a given social situation, however intolerable it may appear.
Although young men purportedly count for the vast majority of hikikomori cases, this may be because their presence in the home is more likely to be pathologized than a young woman’s (because it is associated with a failure to earn a wage). In the support groups and facilities I have observed I have found a number of adult women who remain at home, often helping with basic household tasks, caring for aging grandparents or managing the budget. Many of them have escaped even the label of “hikikomori.”
One hears stories from foreigners who visit a Japanese home and find a socially retired figure quietly sitting in the back room or kitchen. Nothing is said, yet the family member has clearly ceased to function socially. Families may shelter the depressed, particularly women. It is not syntactically clear here whether the women are doing the sheltering or whether they are the depressed.
Lois Peak’s ethnography of social control at a Japanese daycare center shows how from the earliest stage of child socialization, the thrust of education is to minimize difference by continually encouraging students to reintegrate. Peak shows that teachers surround and smother rebellion not through discipline and punishment but, rather, through redirection, gentle cajoling and empathy. Peak (1989) writes that students who resist integration with the daily structure of the school find themselves “boxing with an army of friendly shadows.”
A range of curricula for all subjects is nationally prescribed, including suggested lesson plans. Although middle-class (and upper-class) children can buy extra education, which increases their chances of success, the crucial ideological premise undergirding the standardized exam system is the presumption of a level playing field. For most public-school students, school becomes hypercompetitive at the close of compulsory education, as students begin to prepare for high-school entrance exams. High schools vary radically in quality and ambition (see Rohlen 1983:11–42), and thus students are eventually sorted in ways that closely shape their future careers and class status.
Public-school students now take the Sanford-Binet Intelligence Scale at the time of entry into a school, but the test is considered very general, differentiating only those students who are markedly disabled or delayed. Results are not shared with parents, and parents have the right to refuse to submit their child to the test.
The importance of Peak’s point with respect to the question of special education was clarified for me in a paper by Colin Pfeiffer (2008).
Karen Nakamura’s (2006:7, 28–29, 88–89) discussion of deafness in Japan and the resistance to signing among prewar deaf citizens who felt it was marginalizing (and also the attempt to mimic verbal language in Japanese signing) is a fascinating exploration of the trade-offs of such mainstreaming of the disabled.
The Ministry of Education shows that elementary schools across Japan have a total of 311 special classrooms for children with language disabilities (classrooms where children spend the whole day). The number for middle schools is 27. For cognitive disabilities the number is 12,465 for elementary schools and 6131 for middle schools (Monbukagakushō 2006:41).
LeTendre reports, in a preliminary study of special education in Japan from the late 1980s, that he observed a special-education classroom that included one child with Down syndrome, one with epilepsy and another who appeared to be “extremely nervous and shy.” Several others seemed to have developmental delays that affected their language and learning abilities (LeTendre and Shimizu 1999:6).
Some scholars have noted that the system of early detection and referral is highly developed in Japan (LeTendre and Shimizu 1999; Peak 1989; Hendry 1986 [cited in LeTendre and Shimizu 1999:6]). And yet such detection, occurring in the early years of kindergarten and elementary school or before, through health-care services or childcare providers, is probably most effective in discovering major disabilities, including blindness, deafness, retardation and so forth. More subtle problems, such as autism spectrum disorders or learning disabilities, can cause major social maladjustment in a context in which everyone is expected to keep apace and to share closely woven social values. These more subtle problems, even when discovered by teachers or other care providers, are often met with the desire on the part of parents to continue with mainstream education and to refrain from treating the child any differently than others.
More intensive classrooms, still located in normal schools, exist for more intensive problems, such as retardation and severe chronic illnesses that affect the capacity to learn and function, as well as other disabilities. And in Tokyo six specialized schools, or yōgo gakkō, exist for severely retarded or disabled children, where the facilities are fantastic, teacher-student ratios are low and the teachers are highly trained.
The Ministry of Education has been working to reform its special education agenda, which it has now relabeled as “special encouragement” (tokubetsu shien). The Ministry is aware that children who need special education are often not getting it and appear to be attempting to accommodate the recognized need for special education with the social ideal of educating all children together. It now advocates that more children commute to these specialized classrooms and has prescribed internal structures and procedures for identifying troubled children. (Although few schools seem to have the resources or knowledge to closely abide by these prescriptions.) At the same time it mandates that all children who attend special schools for the disabled (yōgo gakkō) and those who commute to special schools must also have an affiliation with a regular classroom (tsūjō gakkyū), even if they only attend this classroom for sports day or special activities. The agenda seems conflicted, and the Ministry’s embrace of the contemporary American trend toward “inclusive” special education (meant, in the U.S. context, to redress the years of segregation in special education in American schools and overreliance on remedial and vocational forms of schooling for the mentally and physically disabled) is especially confusing, given that the flaw of Japanese education thus far has been “inclusion” to the point of denial and intolerance.
In a “step classroom” (suteppu gakkyū) that I observed in one elementary school, for school-refusal children, 2 h of attendance every day counts as a full day in a regular classroom.
The recently published memoir of a self-reflective day laborer in Tokyo, Ōyama Shirō, which won the Kaikō Takeshi prize for literature, occasionally offers the reader a hint as to how the author came to find himself in the position of living alone and working for an hourly wage in one of the few slums of Tokyo. It is a lifestyle that the author clearly indicates that he chose, after realizing that he would “never be able to survive in the world of ordinary adults … to go out into society and find a job, to marry a woman and raise a family….” In the conclusion of the book Ōyama (2005) mentions a cousin on his mother’s side with whom he felt close as a child (and who looked like him), who was institutionalized in his twenties and who remains confined. “I never made any direct inquiries but I can surmise that he was institutionalized for depression,” the author writes (112–113). Ōyama recalls that he looked like his cousin and identified with him as a boy. He chooses the shantytown of the day laborers as space where he can obtain a measure of stability, self-sufficiency and calm, avoiding middle-class social life and the potential of being diagnosed with a major mental disorder. To interpret Ōyama’s musings as conclusive evidence that it was depression that drove him from mainstream social life would be speculative; nor do we know whether other disenfranchised laborers share this trajectory (though Ōyama’s own story and others indicate a prevalence of alcoholism and gambling). Nonetheless, for Ōyama, the underworld of the day jobs and temporary housing quite clearly provided a haven in a society where few such alternatives exist—and the consequences for dropping out entirely can be grave.
Joao Biehl (2005) has talked about “zones of abandonment” in Brazil: spaces not on the map, in which residents appear to lack social identity—and yet spaces which speak powerfully to the social consequences of mainstream social structure (2–3). In Japan one might argue that “zones of abandonment” are not spheres of impoverishment or neglect but, rather, liminal spheres in which, for a variety of reasons, citizens who cannot accommodate the highly ordered, middle-class social life can retreat to be cared for, while at the same time sacrificing the opportunity to grow, transform and participate in society.
In a study of urbanization in Japan during Japan’s era of rapid economic growth, Edward Norbeck (1978) wrote, in his historical ethnography of a Japanese rural village in Okayama Prefecture, Takashima:
Opportunities for social-emotional affiliation with other human beings are still abundantly available in the family and, much more than in the past, elsewhere in Japanese society. It is noteworthy that psychiatry as private practice has almost no development in Japan, although psychiatrists are well represented in hospitals treating neurosis and psychosis and, as scientific representatives of modern medicine…. A large part of the roles of psychiatry as it operates in the U.S. is met in Japan by ties with one’s associates of daily life—family members, unrelated confidantes, co-members of the numerous social groups and the world of industry and commerce, and, for part of the nation, by membership in intimate subgroups of the new religious sects. (342)
Admissions to hospitals for “social reasons” (shakai-teki nyūin) is not uncommon—for example, admitting a patient who is dysfunctional from alcoholism, but does not fit within the medical framework of treatable disorders, or even admitting the family member of a dysfunctional or abusive individual. As such, hospitals often fill the void in care for amorphous psychological problems and needs. One close acquaintance, a middle-aged man who was depressed and had stopped working, grew disheveled and periodically abusive; his wife could no longer care for him. Under the care of a psychiatrist, he was admitted to a hospital for two months over the summer where there happened to be a bed—a hospital which specialized in care for the elderly. Clearly the intention of the stay was a manner of “rest cure”—a place to relax, to relieve the family and, perhaps, to self-reflect—but not a form of targeted psychiatric intervention.
In his study of hikikomori as a social problem, Saitō Tamaki points out that “independence” (jiritsu) is a considerably more complicated issue than simply severing social or economic dependence. For Japanese youths, historically, independence has begun with leaving the house to establish a separate residence but culminated in the care of aging parents (Saitō 2003:106, 109). Students do not typically leave home when they begin college, for example, at 18.
Munakata (1986:372) notes that previously, before public mental health care and welfare facilities came into existence, mental patients were often “left alone in a cold, dark room of the house or in a barn.”
For a thoughtful and wide-ranging discussion of the emphasis on family care as an antidote to modern society, see Lawrence Cohen’s (1998) No Aging in India, especially his section on “Gerontology as Cultural Critique” (103–106).
She had spoken earlier, warning a younger woman that working full-time could limit her emotional availability to her child (jibun no naka no yōyū ga dekite inai).
She remarked, “Just like when you hide in your house until a storm passes and it is safe to come out, I think that retreating (hikkomu) is a very natural and healthy thing to do.”
For an excellent discussion of how psychiatrists must wrestle with these kinds of decisions, and the epistemological stakes in relying on medicine over other forms of therapy, see Tanya Luhrmann’s Of Two Minds (1999), specifically, on medication (204–212, 234–238).
Vickery analyzes the popular television drama PsychoDoctor, its pedagogical approach to discussing mental illness and the treatment of mental illness as something even those in the mainstream (successful salarymen, housewives, etc.) may suffer from.
Applbaum’s (2006) analysis of global drug marketing and the making of biomedical universalism in marketing antidepressants in Japan focuses on the erasure of cultural particularities by shifting the emphasis from health-care providers to patients as consumers who should exercise “free choice” (100–101).
In contrast, the sales figure for 2001 in the United States, Paxil’s first year in Japan, was $1.8 billion (Landers 2002).
Breslau’s (2004) analysis of the expansion of the psychiatric diagnosis of posttraumatic stress disorder (PTSD) to wide-ranging areas that suffer from political upheaval or natural disaster is relevant to considering the future of depression in Japan. Breslau reveals the “extension of the range” of the kinds of problems that can fall into this category and the advocates for the category who accompany humanitarian interventions. He suggests that the role of the ethnographer is to continue to think through and beyond imposed categories, “to make sense of local expressive forms relating to historical traumas and individual biographies…” (123).
A private organization that reaches out to teachers and counselors.
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Acknowledgments
Ideas in this article were presented at the annual meetings of the American Association of Anthropology on two panels, “Critical Therapeutics” (2006) and “The Social in the Individual: Approaches to Mental Illness, Suicide, and Suffering in Japan” (2007). The panels generated a good deal of exchange, and I would particularly like to thank the discussants for offering valuable comments: Tanya Luhrmann and Andrew Lakoff (2006) and Susan Long and John Traphagan (2007). The other members of the panels, Rebecca Lester, Joshua Breslau, Chikako Ozawa-de Silva, Ken Vickery, Junko Kitanaka and Karen Nakamura, have been—and continue to be—important interlocutors. I am indebted to colleagues and mentors in the mental health-care sector in Tokyo who facilitated my observation of support groups and counseling sessions and who shared their knowledge: Nishida Chikako, Fukazawa Satoko, Hayakawa Kazuko and Tamura Misao. Saitō Satoru has been an important mentor and interlocutor from the psychiatric standpoint. Noguchi Yūji provided valuable input from the perspective of medical sociology. Kathleen Pike and Emi Doi, both clinicians, offered valuable exchanges on the state of mental health care and the social construction of psychological issues in Japan. Research for this article was supported by an Abe Fellowship, funded by the Social Science Research Council, a Japan Foundation Short-Term Research Fellowship, and by the Princeton University Committee on Research in the Humanities and Social Sciences.
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Borovoy, A. Japan’s Hidden Youths: Mainstreaming the Emotionally Distressed in Japan. Cult Med Psychiatry 32, 552–576 (2008). https://doi.org/10.1007/s11013-008-9106-2
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DOI: https://doi.org/10.1007/s11013-008-9106-2