“The longer you don’t go out, the harder it becomes”

So­cial iso­la­tion is a grow­ing health prob­lem.” This is from the 2014 study, Hikiko­mori in Spain. Since then, the men­tal health spe­cial­ists who did the study have pub­lished two more, the most re­cent last year. They analysed a good num­ber of se­vere cases of iso­la­tion in Cat­alo­nia for a year. Hikiko­mori, they say, is a psy­chopatho­log­i­cal and so­ci­o­log­i­cal phe­nom­e­non in which peo­ple, es­pe­cially young peo­ple, with­draw com­pletely from so­ci­ety for a pe­riod of at least six months.

This re­search was based on the cases of 200 peo­ple. One pro­fes­sional who took part was psy­chi­a­trist David Córcoles, from the In­sti­tute of Neu­ropsy­chi­a­try and Ad­dic­tions at Hos­pi­tal del Mar. “There are peo­ple whose con­di­tion has wors­ened with the pan­demic, such as pa­tients with anx­i­ety dis­or­ders, ob­ses­sive-com­pul­sive dis­or­der, and ago­ra­pho­bia.” In the case of ago­ra­pho­bia, he adds: “An extra ef­fort is needed, be­cause if you al­ready didn’t want to go out, you have just been handed a jus­ti­fi­ca­tion for stay­ing at home. And an im­por­tant fact is that we know the longer you go with­out leav­ing home, the harder it is to do so.” It can be hard to de­tect hikiko­mori if the peo­ple around you do not see it first. “We have pa­tients who have not left home for 20 years. And one, for 35. He hasn’t left the house for any rea­son,” says Córcoles.

There are two types of hikiko­mori, pri­mary and sec­ondary. “In the pri­mary there’s no pathol­ogy and iso­la­tion is the only symp­tom. Sec­ondary hikiko­mori is caused by a men­tal ill­ness.”

It is not hard to fall foul of the syn­drome. Imag­ine a per­son with de­pres­sion who only wants to stay in bed. They stop going out, and can con­tinue not going out if there is no one around to help. “It ful­fils the cri­te­ria of sec­ondary hikiko­mori. De­pres­sion leads to con­fin­ing one­self. The im­por­tance of peo­ple in the en­vi­ron­ment to de­tect these cases is clear,” says Córcoles, who nev­er­the­less adds: “Of our 200 pa­tients, we were un­able to visit 36; their fam­i­lies did not want us to. It’s hard.”

The av­er­age per­son stud­ied was around 40, with an av­er­age iso­la­tion time of three and a half years. “We found that the longer it went on, the harder it was to change the be­hav­iour. The more se­ri­ous cases jus­ti­fied in­vol­un­tary hos­pi­tal­i­sa­tion. What seems con­tra­dic­tory, how­ever, is these peo­ple ended up bet­ter off than those whose sit­u­a­tion had not been so se­ri­ous.”

“Every­one likes being able to de­cide not to go out. Yet it’s an­other thing when you shut your­self up at home and the day comes when you have to go out but can’t. You do not de­cide freely. Some­thing is de­cid­ing for you,” adds the psy­chi­a­trist.

It is hard to imag­ine any­one in this sit­u­a­tion hav­ing fam­ily re­spon­si­bil­i­ties. “Some do, but not many. It might be okay if you just have a part­ner. I re­mem­ber one case where the per­son af­fected hadn’t been out for 20 years due to ago­ra­pho­bia and didn’t want any treat­ment. And they had a part­ner and a daugh­ter,” he says.

With many suf­fer­ers un­no­ticed and a lack of pub­lic men­tal health pro­fes­sion­als, hikiko­mori is un­der­diag­nosed. “Hikiko­mori syn­drome is a case of hid­den suf­fer­ing. We must also keep in mind that they are peo­ple who do not cause trou­ble, on the con­trary. These cases are in­vis­i­ble.” In their stud­ies, the re­search team noted: “The preva­lence and mag­ni­tude of iso­la­tion have prob­a­bly been un­der­es­ti­mated due to the lack of spe­cific com­mu­nity men­tal health ser­vices that can de­tect and treat these peo­ple at home.”

Some 60% had a fam­ily his­tory of men­tal dis­or­ders, with 45% among close fam­ily. In 56% of cases, the mother had a his­tory of emo­tional dis­or­ders. It is often the fam­ily that de­tects the prob­lem, but fam­ily can also be part of the prob­lem. The qual­ity of fam­ily re­la­tion­ships, whether the fam­ily is dys­func­tional, whether there has been emo­tional ne­glect or abuse, are very im­por­tant.

Re­gard­ing fam­ily dys­func­tion in re­la­tion to hikiko­mori in Japan, the re­search talks about the con­cept of amae, a Japan­ese term that refers to the in­dul­gent de­pen­dence of chil­dren on par­ents. To this type of in­fan­til­i­sa­tion should be added an un­de­mand­ing up­bring­ing, lead­ing to young peo­ple with lit­tle mo­ti­va­tion and de­pen­dent on the com­forts of the fam­ily home. This can be ap­plied to many cases of hikiko­mori in Japan, but also to other so­ci­eties, like our own.