--

76 | rs socte.L wrrHDRAwAr, a lrsEess?

no paternal authority. One can only see it as a ps1'chologicaldisease. Where did they come from? They only depend on otherpeople and do not act olr their own. I have never seen any articleson them in France. We have only just arrived at the beginning ofthe problem.

When we put together these opinions, we see that the majority of thecases that I have been cllling "social withdrawal" are classified eitheras "social phobia' or "avoidant pelsonalitv disorder." If we set up thepresupposition that this might be something else, then certainly wemay probably begin to see new possibilities for treatment. Throughthese comparisons with different countries, I came to the conclusionthat the problem of social r'vithdrawal is a multifaceted issue that can-not be explained away as simply a problem of individual pathology'Certainly, if we were to take up individual cases, there is no reasonwe cannot treat them as "social phobia' or "avoidant personality dis-order." Nonetheless, r,vhat makes this problem so diflbrent is that weare not able to complete\' account lbr it with those diagnoses alone'In that sense, the comment from the French psychologist is very irn-portant. In Europe, if people with this severe psychiatric problem donot get treatment and become adults, they will certainly end up on thestreets. The notion that when the withdrawn person is in his or hertwenties and thirties, his or her parents will continue to take care ofhim or her as long as possible-perhaps that is the part of the wholestory, in other words, that kirld of familial relationship and all of theconflict it continually produces, u'hich is the part o{ the story that isuniquely Japanese.

HIKIKOMORI SYSTEMS

Withdrawal Is Not ApathyIn this chapter, I would like to think about why social withdrawalhappens and u,hat its mechanisms are. Why do people 'withdraw"?The reasons certainly are not simple. I myself am not sure I can an-swer the question adequately; however, I do think that it is worth-while to try to move lbrrvard by inquiring into the issue and comingup with different hypotheses.

I would like to emphasize once again that what I have been call-ing 'withdrawal" does not necessarily mean the same thing as apathy.It is true that people who are in social withdrawal might look "in-active" or "idle," but they are not "apathetic." I am sure ofthat,

I have done a fair amount of research on the mechanisms of apa-thy. In general, there are two general patterns having to do with ill-ness :tnd apathy. In the first, patients become apathetic as their illnessdevelops into a chronic state. For instance, it is commonly believedthat when schizophrenia or-depression continues over a long periodof time, the patient loses all sense of initiative; however, in workingwith patients who receive treatment early on, I have rarely seen thepatients become apathetic and listless. One finds many cases of apa-thy and listlessness in patients u,ho have been hospitalized for a longperiod of time in a psychiatric clinic. It is sometimes said that thisapathy comes {iom living for a long period of time in an environmentcut off from society or comes fi:om the side effects of the pharmaceu-ticals being used to treat them. I think that there is a good possibility

I)

177

78 | urntnolroRl SYSTEMS

that this is true. What I am trying to say is that apathy often seemsto be the by-product of hurnan actions and that it is not necessarilythe outcome of the natural progression of illness. That being said, itis also known that certain patients may fall into a state of apathy as aresult o{ mental retardation or brain trauma, and in recent years therehas been a good deal ofattention paid to personality changes broughtabout as the lingering results (or "sequelae," in medical terms) of ex-ternal trauma to the head. It is possible that in cases such as those, apatient might experience a pathological state of apathy.

The other state of apathy is what we might call "learned apathy"This, ofcourse, refers to a kind ofapathy that is neither the result ofa rnental illness nor a problem with the brain; instead, it arises as theresult of some psychological cause' Relatively early on, experimen-tal psychology advanced a number of theories about the mechanismsof apathy. For instance, the following experiment r'l'as conducted' Adog that was kept in a cage was given random, repeated electricalshocks without any warning. At first, the dog showed signs of beingupset, barking and writhing, but it gradually became increasingly"apathetic," showing less and less of a reaction. In ot]rer words, eventhough it was repeatedly receiving unpleasant stimuli, it learned thatit was unable to control them, and that was when the apathy set in'Similar kinds of experiments with human beings have proved that wealso become apathetic in similar situations.

But does that explain the mechanisms of apathy one flnds incases of social withdrawal? Actually, there is a book that explains"withdrawal" and "apathy" from this point of view; however, I thinkthat that model is too oversimplified to be of much use, If anything,I think that model explains only one of the manv different types of"apathy" that do exist. As human beings, we do not want to engagein wasted effort; however, are we always acting with a purpose inmind? The idea of "learned apathy" is not helpful in explaining caseswhere people know that if'they just put forth a little blt of effort theycan achieve good results, but they still loaf around and do not putin the effort. We are contr:idictory creatures who will do things (ornot do things) that we know not to be in our best interests. Peoplein withdrawal are also like this. It is not the case that they do not doanything because they think it will be a waste of time. If anything, it

r-rrKrKoMoRr svsrnus | 79

is beca.use they know that it is in their best interests to do somethingthat they flnd themselves paralyzed. I do not feel that this kind ofsituation can be adequately explained by simply describing the pa-tient as "apathetic."

Withdrawal Cannot Be Explained Simply asIndividual PathologyIn the previous chapter, there was a discussion about student apa-thy. Many researchers have conducted investigations in that subject,including Kasahara Yomishi. Because some people in withdrawal fitthat profile, I rvould like to say a few more words about that here.trirst, it is worth noting that the words student apathy, which we oftenuse in Japanese transliteration (sucltudento apashT), :rre sometimesliterally translated into Japanese as gakusei mukiryokusho (lit. "stu-dent apathy-syndrome") using the same word mukiryoku ("apathy") Ihave been using throughout this section ofthe book. As I stated ear-lier, this affliction cannot be boiled down to simple apathy; instead,I treat it in general terms as meaning that the person does not showany desire {br what their main task should be-in most cases, theirschoolwork. I would like to add that Dr. Inamura Hiroshi did not usethe word ui,thdrawal to describe it, although he frequently used thetransliteration of the Enghsh wordapatltg (apasht).

P:rul A. Walters, who made the first studies of student apa-thy, saw the causes as linked to a {brmative disorder in "masculineidentification'-in other words, people see themselves as failing "tobe masculine" and hate to fail, so they avoid competitive situations asa form ofself-protection. Kasahara has also noticed that in addition,there are elements that seem to have much in commor with border-line personality disorder, especially anhedonia (feelings of ernptiness)and splitting (extreme opinions and attitudes tor'vard other peopleand things).

If one thinks of "withdrawal" as a kind of "social phobia' or"avoidant personality disorder," then it might be possible to explainthe behavior of certain patients a little more clearly. In other words,the former would explain withdrawal as a kind of f'ear, whereas thelatter would explain it based on a pattern ofbehaviors that recurs over

78 | urntnolroRl SYSTEMS

that this is true. What I am trying to say is that apathy often seemsto be the by-product of hurnan actions and that it is not necessarilythe outcome of the natural progression of illness. That being said, itis also known that certain patients may fall into a state of apathy as aresult o{ mental retardation or brain trauma, and in recent years therehas been a good deal ofattention paid to personality changes broughtabout as the lingering results (or "sequelae," in medical terms) of ex-ternal trauma to the head. It is possible that in cases such as those, apatient might experience a pathological state of apathy.

The other state of apathy is what we might call "learned apathy"This, ofcourse, refers to a kind ofapathy that is neither the result ofa rnental illness nor a problem with the brain; instead, it arises as theresult of some psychological cause' Relatively early on, experimen-tal psychology advanced a number of theories about the mechanismsof apathy. For instance, the following experiment r'l'as conducted' Adog that was kept in a cage was given random, repeated electricalshocks without any warning. At first, the dog showed signs of beingupset, barking and writhing, but it gradually became increasingly"apathetic," showing less and less of a reaction. In ot]rer words, eventhough it was repeatedly receiving unpleasant stimuli, it learned thatit was unable to control them, and that was when the apathy set in'Similar kinds of experiments with human beings have proved that wealso become apathetic in similar situations.

But does that explain the mechanisms of apathy one flnds incases of social withdrawal? Actually, there is a book that explains"withdrawal" and "apathy" from this point of view; however, I thinkthat that model is too oversimplified to be of much use, If anything,I think that model explains only one of the manv different types of"apathy" that do exist. As human beings, we do not want to engagein wasted effort; however, are we always acting with a purpose inmind? The idea of "learned apathy" is not helpful in explaining caseswhere people know that if'they just put forth a little blt of effort theycan achieve good results, but they still loaf around and do not putin the effort. We are contr:idictory creatures who will do things (ornot do things) that we know not to be in our best interests. Peoplein withdrawal are also like this. It is not the case that they do not doanything because they think it will be a waste of time. If anything, it

r-rrKrKoMoRr svsrnus | 79

is beca.use they know that it is in their best interests to do somethingthat they flnd themselves paralyzed. I do not feel that this kind ofsituation can be adequately explained by simply describing the pa-tient as "apathetic."

Withdrawal Cannot Be Explained Simply asIndividual PathologyIn the previous chapter, there was a discussion about student apa-thy. Many researchers have conducted investigations in that subject,including Kasahara Yomishi. Because some people in withdrawal fitthat profile, I rvould like to say a few more words about that here.trirst, it is worth noting that the words student apathy, which we oftenuse in Japanese transliteration (sucltudento apashT), :rre sometimesliterally translated into Japanese as gakusei mukiryokusho (lit. "stu-dent apathy-syndrome") using the same word mukiryoku ("apathy") Ihave been using throughout this section ofthe book. As I stated ear-lier, this affliction cannot be boiled down to simple apathy; instead,I treat it in general terms as meaning that the person does not showany desire {br what their main task should be-in most cases, theirschoolwork. I would like to add that Dr. Inamura Hiroshi did not usethe word ui,thdrawal to describe it, although he frequently used thetransliteration of the Enghsh wordapatltg (apasht).

P:rul A. Walters, who made the first studies of student apa-thy, saw the causes as linked to a {brmative disorder in "masculineidentification'-in other words, people see themselves as failing "tobe masculine" and hate to fail, so they avoid competitive situations asa form ofself-protection. Kasahara has also noticed that in addition,there are elements that seem to have much in commor with border-line personality disorder, especially anhedonia (feelings of ernptiness)and splitting (extreme opinions and attitudes tor'vard other peopleand things).

If one thinks of "withdrawal" as a kind of "social phobia' or"avoidant personality disorder," then it might be possible to explainthe behavior of certain patients a little more clearly. In other words,the former would explain withdrawal as a kind of f'ear, whereas thelatter would explain it based on a pattern ofbehaviors that recurs over

80 | urnrrouoRr SYSTEMS

the course ofthe patient's life. Indeed, these explanations do apply toa certain portion of patients in withdrawal. If we look at the problemthis way, it is possible to explain the pathology of certain withdrawalpatients as having to do with external traumatic experience or as aproblem in developmcnl.

These sorts of psychiatric explanations can be used in certaincases to understand the withdrawn state; however, that does not nec-essarily mean that it is possible to cure the withdrawn state throughpsychoanalysis. I say this because it is difficult to carry out psycho-analysis with socially withdrawn patients who do not necessarily wantto be treated in the first place. Moreover, it is difficult to understandthe whole problem if one views social withdrawal only as a questionof individual pathology. The family and society are deeply implicatedin the problem as well, so it only makes sense that psychoanalyticanalysis, which as a fundamental rule takes the individual patient asits principal subject, will not be able to deal with the problem entirelyon its own.

As long as one attempts to account for the problem of social with-drawal as grounded solely in the pathology of one individual patient,the way we understand it, as well as any therapeutic measures wetake, will only be superficial. But there is an even more fundamentalproblem that precedes that. If we treat withdrawal as an individualproblem, then we shut down any communication with the familiesof the patients, saying, "If the withdrawn person himself or herselfdoesnt come to see me, there's nothing I can do." Social withdrawalinevitably involves the family, too, even in those cases where a with-drawal arises as the result of an individual, psychological problem.The involvement of the family only makes the problem worse, andthe pathology grows deeper. But that is not all. The social pathologyat work in our country ends up reflected in it as r'vell.

As I hinted in the section in the plevious chapter about inter-national comparisons, social withdrawal is not something that is seenonly in Japan. Nonetheless, the cases of withdrawal we do see herein Japan proceed along a unique path. The peculiarities ofthat pathreflect the cultural and social situation in our nation. For that reason,the problem of "social withdrawal" goes well beyond just being aproblem of individual pathology; it should be given serious consid-

Hrr(rKoMoRr svsruus I B1

eration in the fields of social psychiatry and public health. l1lat way,the issue of withdrawal will not be examined only through psychi-atric methods that treat the individual; it will take on a greater sig-nificance as scholars conduct casework and therapeutic interventionsinvolving entire families. In this book, as I think about measures tocope with the situation, I also want to emphasize that is importantto think abotlhow to carru out ffictiae therapeu.tic intensenti,onsrather than just how to treat the individual most affected.

Vicious Circles in Relationships with OthersAs I mentioned before, the very act of withdrar,ving from society isitself traumatic. In other words, the longer the period of withdrawaland the more serious the isolation, the more likely it is that the patientwill fall into a vicious circle that will only make the withdrawal worse.In ordinary diseases within the body, when individuals grow sick,their bodies will react naturally with various therapeutic measures,including immune responses, and if those work, individuals begin torecuperate from the sickness. In the case ofwithdrawal, however, theunhealthy state has the function of making the situation even worseand even prolonging it. Why is thatP

The first reason has to do the fact that there are multiple causesfor "social withdrawal." As Nakai Hisao, a professor emeritus fromKobe University, once noted, psychiatric ailments that arise becauseof simple psychological reasons typically get better by proceedingalong a simple path of development. Conversely, ailments that pro-ceed along long, complicated paths usually do not have a single cause;instead, they are caused by a combination of multiple different {'ac-tors, and this often impedes atter-r-rpts at treatment. F-or instance, itseems the reason the trauma of being bullied lasts for so long has todo with the fact that the bullying itself usually continued over a longperiod of time, and as a result the trauma developed in complicatedways. The chain of events that leads a person to withdraw from soci-ety is certainly not simple. I say more about this later, but I believethe emotional situation for many people in withdrawal is usually soknotty and confused that it is not even effective to think about causeand effect; however, because the situation is so knotty, the patient

80 | urnrrouoRr SYSTEMS

the course ofthe patient's life. Indeed, these explanations do apply toa certain portion of patients in withdrawal. If we look at the problemthis way, it is possible to explain the pathology of certain withdrawalpatients as having to do with external traumatic experience or as aproblem in developmcnl.

These sorts of psychiatric explanations can be used in certaincases to understand the withdrawn state; however, that does not nec-essarily mean that it is possible to cure the withdrawn state throughpsychoanalysis. I say this because it is difficult to carry out psycho-analysis with socially withdrawn patients who do not necessarily wantto be treated in the first place. Moreover, it is difficult to understandthe whole problem if one views social withdrawal only as a questionof individual pathology. The family and society are deeply implicatedin the problem as well, so it only makes sense that psychoanalyticanalysis, which as a fundamental rule takes the individual patient asits principal subject, will not be able to deal with the problem entirelyon its own.

As long as one attempts to account for the problem of social with-drawal as grounded solely in the pathology of one individual patient,the way we understand it, as well as any therapeutic measures wetake, will only be superficial. But there is an even more fundamentalproblem that precedes that. If we treat withdrawal as an individualproblem, then we shut down any communication with the familiesof the patients, saying, "If the withdrawn person himself or herselfdoesnt come to see me, there's nothing I can do." Social withdrawalinevitably involves the family, too, even in those cases where a with-drawal arises as the result of an individual, psychological problem.The involvement of the family only makes the problem worse, andthe pathology grows deeper. But that is not all. The social pathologyat work in our country ends up reflected in it as r'vell.

As I hinted in the section in the plevious chapter about inter-national comparisons, social withdrawal is not something that is seenonly in Japan. Nonetheless, the cases of withdrawal we do see herein Japan proceed along a unique path. The peculiarities ofthat pathreflect the cultural and social situation in our nation. For that reason,the problem of "social withdrawal" goes well beyond just being aproblem of individual pathology; it should be given serious consid-

Hrr(rKoMoRr svsruus I B1

eration in the fields of social psychiatry and public health. l1lat way,the issue of withdrawal will not be examined only through psychi-atric methods that treat the individual; it will take on a greater sig-nificance as scholars conduct casework and therapeutic interventionsinvolving entire families. In this book, as I think about measures tocope with the situation, I also want to emphasize that is importantto think abotlhow to carru out ffictiae therapeu.tic intensenti,onsrather than just how to treat the individual most affected.

Vicious Circles in Relationships with OthersAs I mentioned before, the very act of withdrar,ving from society isitself traumatic. In other words, the longer the period of withdrawaland the more serious the isolation, the more likely it is that the patientwill fall into a vicious circle that will only make the withdrawal worse.In ordinary diseases within the body, when individuals grow sick,their bodies will react naturally with various therapeutic measures,including immune responses, and if those work, individuals begin torecuperate from the sickness. In the case ofwithdrawal, however, theunhealthy state has the function of making the situation even worseand even prolonging it. Why is thatP

The first reason has to do the fact that there are multiple causesfor "social withdrawal." As Nakai Hisao, a professor emeritus fromKobe University, once noted, psychiatric ailments that arise becauseof simple psychological reasons typically get better by proceedingalong a simple path of development. Conversely, ailments that pro-ceed along long, complicated paths usually do not have a single cause;instead, they are caused by a combination of multiple different {'ac-tors, and this often impedes atter-r-rpts at treatment. F-or instance, itseems the reason the trauma of being bullied lasts for so long has todo with the fact that the bullying itself usually continued over a longperiod of time, and as a result the trauma developed in complicatedways. The chain of events that leads a person to withdraw from soci-ety is certainly not simple. I say more about this later, but I believethe emotional situation for many people in withdrawal is usually soknotty and confused that it is not even effective to think about causeand effect; however, because the situation is so knotty, the patient

82 | nrnrnonroRr sYSTEMS

falls into a vicious circle, and that only makes the situ:rtion that muchmore unclear. I try to explain what I mean in a slightly easier wayusing schematics.

When one looks closely at the probleln of soci:rl withdr:awal, onesees it has to do with problems in relating to other people. I wouldlike to try thinking about the multiple causes for withdrawal by di-viding them into three areras, bzrsed on who is involved. The threealenas are (1) the individual, (2) the family, and (3) society in general.

I suspect that with withdrar.val, there is some kind of viciouscircle going ot in each o{'these t}rree arenas, and tl-rat is the reasonthat the withdrawn state ends up prolonged over a long period oftime. To a greater or lesser degree, these vicious circles can occurwith almost all mental illnesses. What is so conspicuous about with-drawal, however, is that these three arenas have a tendency to affecteach other negatively and shut one another down.

With other mental illnesses, it is often the case that even whenpeople {bll into a vicious circle at the individual level, the {bmily workswith them and helps them break free from the problem. Even whenthe family has unhealthy dynamics that make it hard to escape avicious circle, it is sometimes possible for individuals to make contactwith society and fbrm interpersonal relationships that will help themsolve the problem. It is not uncommon that through temporary hos-pitalization, the patient gets away from the family, undergoes treat-ment, and becomes better. It is often the case, however, that patientsr,vho have recovered fr-om withdrawal during hospitalizatioli go homeand slip back into their old patterns of behavior:. The reason simplyhas to do with the fact that the family fails to treat them in a way thatercourages their mental well-being.

For people in a state of withdrawal, the routes between the "in-dividual and family" and the "individual and society" are completelyshut down. As a result, the only thread of hope lies in getting thefamily to cooperate. In reality, it is often the case that treatment thatinvolves earning the understanding and cooper:rtion of the family canallow the person to recover. In most cases, however, there is a viciouscircle at wor* in the relationship with the family, and the situationjust gets worse and worse.

Unfbrtunately, the more these vicious circles go wrong, the more

r{rKrKoMoRr svsrolrs I B5likely they are to stabilize, almost as if they were functioning as asingle, independent system. And once these begin to {unction as astabilized system, then it becomes drfficult to stop the cycres throughsmall doses of treatment.

I call these vicious circles "hikikomori systems," and I believethe fund:rmental principle for any kind of treatment involves think-ing about how to disengage those systems. of course, the ideas that Iam presenting are only one possible hypothesis, and I might be goingtoo {'ar by simplifying the reasons for withdrawal this much; nonethe-less, I believe that thinking about withdrawal as a system is signifi-cant precisely because it is so simple and straightforward. At the veryleast, it becomes easier to explain the various different situations ofpeople in withdrawal through this model, and I believe it will proveeffective in helping us devise better plans {br treatment.

The Three Systems of Individual, Family, and SocietyIn Figure 1, I have provided two diagrams of what I call a "healthysystem" and a "hikikomori system." In a healthy system, all three sys_tems have a point of contact and are working. By point of contact, Imean to say that there is an open and functioning channel of commu_nication. The individrral is communicating with his or her family inthe course ofeveryday existence, and they continue their lives, eachaffecting one another. The individ,al also communicates with societyin places such as the school and in the workplace, and through them,society af{bcts him or her. Through their lives and activities in variousarenas, the family also has an open route of communication with so-ciety, and the fan'iily and the surrounding society affect one another.Of course, this is an idealized model, and in real life, cornmunicationdoes not always go smoothly. In most cases, however, they do not losetheir 'point of contact" entirely-in other words, they clo not findthemselves in situations where all channels for communication arecut off completely.

In the hikikomori system, howevel the points of contact havebeen cut off from one another and no longer function. Now somereaders may find themselves thinking, "No, that can't be. The indi_vidual talks to his or her family frequently, and the family has plenty

82 | nrnrnonroRr sYSTEMS

falls into a vicious circle, and that only makes the situ:rtion that muchmore unclear. I try to explain what I mean in a slightly easier wayusing schematics.

When one looks closely at the probleln of soci:rl withdr:awal, onesees it has to do with problems in relating to other people. I wouldlike to try thinking about the multiple causes for withdrawal by di-viding them into three areras, bzrsed on who is involved. The threealenas are (1) the individual, (2) the family, and (3) society in general.

I suspect that with withdrar.val, there is some kind of viciouscircle going ot in each o{'these t}rree arenas, and tl-rat is the reasonthat the withdrawn state ends up prolonged over a long period oftime. To a greater or lesser degree, these vicious circles can occurwith almost all mental illnesses. What is so conspicuous about with-drawal, however, is that these three arenas have a tendency to affecteach other negatively and shut one another down.

With other mental illnesses, it is often the case that even whenpeople {bll into a vicious circle at the individual level, the {bmily workswith them and helps them break free from the problem. Even whenthe family has unhealthy dynamics that make it hard to escape avicious circle, it is sometimes possible for individuals to make contactwith society and fbrm interpersonal relationships that will help themsolve the problem. It is not uncommon that through temporary hos-pitalization, the patient gets away from the family, undergoes treat-ment, and becomes better. It is often the case, however, that patientsr,vho have recovered fr-om withdrawal during hospitalizatioli go homeand slip back into their old patterns of behavior:. The reason simplyhas to do with the fact that the family fails to treat them in a way thatercourages their mental well-being.

For people in a state of withdrawal, the routes between the "in-dividual and family" and the "individual and society" are completelyshut down. As a result, the only thread of hope lies in getting thefamily to cooperate. In reality, it is often the case that treatment thatinvolves earning the understanding and cooper:rtion of the family canallow the person to recover. In most cases, however, there is a viciouscircle at wor* in the relationship with the family, and the situationjust gets worse and worse.

Unfbrtunately, the more these vicious circles go wrong, the more

r{rKrKoMoRr svsrolrs I B5likely they are to stabilize, almost as if they were functioning as asingle, independent system. And once these begin to {unction as astabilized system, then it becomes drfficult to stop the cycres throughsmall doses of treatment.

I call these vicious circles "hikikomori systems," and I believethe fund:rmental principle for any kind of treatment involves think-ing about how to disengage those systems. of course, the ideas that Iam presenting are only one possible hypothesis, and I might be goingtoo {'ar by simplifying the reasons for withdrawal this much; nonethe-less, I believe that thinking about withdrawal as a system is signifi-cant precisely because it is so simple and straightforward. At the veryleast, it becomes easier to explain the various different situations ofpeople in withdrawal through this model, and I believe it will proveeffective in helping us devise better plans {br treatment.

The Three Systems of Individual, Family, and SocietyIn Figure 1, I have provided two diagrams of what I call a "healthysystem" and a "hikikomori system." In a healthy system, all three sys_tems have a point of contact and are working. By point of contact, Imean to say that there is an open and functioning channel of commu_nication. The individrral is communicating with his or her family inthe course ofeveryday existence, and they continue their lives, eachaffecting one another. The individ,al also communicates with societyin places such as the school and in the workplace, and through them,society af{bcts him or her. Through their lives and activities in variousarenas, the family also has an open route of communication with so-ciety, and the fan'iily and the surrounding society affect one another.Of course, this is an idealized model, and in real life, cornmunicationdoes not always go smoothly. In most cases, however, they do not losetheir 'point of contact" entirely-in other words, they clo not findthemselves in situations where all channels for communication arecut off completely.

In the hikikomori system, howevel the points of contact havebeen cut off from one another and no longer function. Now somereaders may find themselves thinking, "No, that can't be. The indi_vidual talks to his or her family frequently, and the family has plenty

84 | urnrnolroRr sysrEMS

Model of a Healthy SystemThe circles represent the boundariesofthe three systems, and the placervhere the circles overlap indicates thecommunication between the three. Thethree systems are all in contact with oneanother and are Iunctioning together,but they are each able to maintain theirown boundaries.

Model of the Hikikomori SystemThe systems are not in contact with oneanolher anrl are nof moving in urrisun.Power operates on each layer of thesystem, but for the inner systems thatpower is perceived as stress, and thatstress simply prolongs the vicious cycle.

Figre 1. Aheahhtl sllstem and ahikikomori sAstem.

of contact with the outside society through work, school, and so forth.Isn't what is missing the connection between the individual and thesurrounding society?" The question that I would ask in return is this:does the 'point of contact" involve real communication? If there werereal communication between the individual and the family, then thatwould just make the situation all the more difficult.

For real communication to be possible, it cannot be a one-waystreet, where one of the two parties is just talking to the other. Recip-rocation is an essential element of communication. Communication isrrot real communication if the individual does not listen to what hisor her family has to say and just delivers an unbroken litany of his or

HIKIKOMORI SYSTEMS J 85

her own complaints. It is surprisingly easy to overlook this point. Thepoint is that "simple conversation" and "communication' are quitedifferent things.

For the remainder of this chapter, I explain how the hikikomorisystem functions in each ofthe three arenas.

The Inability to Accept the Intervention of OthersLet's start with what the hikikomori system means for the individual,

As I have explained previously, the person who is in a state ofsocial withdrawal typically feels a strong sense of conflict. As I havealready shown, this conflict frequently leads to a variety ofpsycho-logical symptoms. From those symptoms, it is possible to fall into avicious circle. A fear ofothers, obsessive-compulsive disorder, and de-lusions of persecution all make it that much harder for the individualto participate in society. To make matters worse, the majority of thesesymptoms will not get better without participating in society or re-ceiving some sort of treatment. The worst misfortune to befall peoplein withdrawal is that even though their symptoms are progressivelygetting worse, they find themselves in situations where they feel theneed to withdraw even further.

Also, as I explained earlier, the very fact that a person is in awithdrawn state inflicts more psychological damage. Physically, theperson might begin to stay up nights and sleep during the day, or heor she might develop insomnia, and those things just spur on the re-versal even further. In this way, the withdrawn state is rather like anaddiction. I say this because with addictions, there are various viciouscircles that operate as a single system, and these just make the addic-tion that much worse. For instance, alcoholics often feel extremelyguilty about their drinking. Still, even though they feel guilty-or toput it more precisely, because they feel so guilty-they end up drink-ing all the more and sink deeper into the quagmire. It is rather like thestory of the drunkard in Antoine de Saint-Exup6ryk book The LittlePrince. The Little Prince asks the drunkard why he drinks, and heresponds that he drinks because he is ashamed. When asked why heis so ashamed, he says that he is ashamed that he drinks. Pathologicalbehaviors give rise to new conflict, and that merely strengthens the

IrL-

84 | urnrnolroRr sysrEMS

Model of a Healthy SystemThe circles represent the boundariesofthe three systems, and the placervhere the circles overlap indicates thecommunication between the three. Thethree systems are all in contact with oneanother and are Iunctioning together,but they are each able to maintain theirown boundaries.

Model of the Hikikomori SystemThe systems are not in contact with oneanolher anrl are nof moving in urrisun.Power operates on each layer of thesystem, but for the inner systems thatpower is perceived as stress, and thatstress simply prolongs the vicious cycle.

Figre 1. Aheahhtl sllstem and ahikikomori sAstem.

of contact with the outside society through work, school, and so forth.Isn't what is missing the connection between the individual and thesurrounding society?" The question that I would ask in return is this:does the 'point of contact" involve real communication? If there werereal communication between the individual and the family, then thatwould just make the situation all the more difficult.

For real communication to be possible, it cannot be a one-waystreet, where one of the two parties is just talking to the other. Recip-rocation is an essential element of communication. Communication isrrot real communication if the individual does not listen to what hisor her family has to say and just delivers an unbroken litany of his or

HIKIKOMORI SYSTEMS J 85

her own complaints. It is surprisingly easy to overlook this point. Thepoint is that "simple conversation" and "communication' are quitedifferent things.

For the remainder of this chapter, I explain how the hikikomorisystem functions in each ofthe three arenas.

The Inability to Accept the Intervention of OthersLet's start with what the hikikomori system means for the individual,

As I have explained previously, the person who is in a state ofsocial withdrawal typically feels a strong sense of conflict. As I havealready shown, this conflict frequently leads to a variety ofpsycho-logical symptoms. From those symptoms, it is possible to fall into avicious circle. A fear ofothers, obsessive-compulsive disorder, and de-lusions of persecution all make it that much harder for the individualto participate in society. To make matters worse, the majority of thesesymptoms will not get better without participating in society or re-ceiving some sort of treatment. The worst misfortune to befall peoplein withdrawal is that even though their symptoms are progressivelygetting worse, they find themselves in situations where they feel theneed to withdraw even further.

Also, as I explained earlier, the very fact that a person is in awithdrawn state inflicts more psychological damage. Physically, theperson might begin to stay up nights and sleep during the day, or heor she might develop insomnia, and those things just spur on the re-versal even further. In this way, the withdrawn state is rather like anaddiction. I say this because with addictions, there are various viciouscircles that operate as a single system, and these just make the addic-tion that much worse. For instance, alcoholics often feel extremelyguilty about their drinking. Still, even though they feel guilty-or toput it more precisely, because they feel so guilty-they end up drink-ing all the more and sink deeper into the quagmire. It is rather like thestory of the drunkard in Antoine de Saint-Exup6ryk book The LittlePrince. The Little Prince asks the drunkard why he drinks, and heresponds that he drinks because he is ashamed. When asked why heis so ashamed, he says that he is ashamed that he drinks. Pathologicalbehaviors give rise to new conflict, and that merely strengthens the

IrL-

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behaviors-it is this particular process that is a characteristic of ad-dictive behavior. One sees a similar kind of vicious circle in the be-havior of people in withdrawal. Individuals see their withdrawal asthe "behavior of a loser," and this makes their feelings of self-hatredall the worse, leading to a deeper withdrawal-a vicious circle.

In ordinary circumstances, relationships with the family andother people are what stop the cycle from getting worse. These days,most people believe it is almost meaningless for an alcoholic to tryto stop drinking on his own. Gregory Bateson has said that tryingto do so is like trying to lift yourselfup in the air by pulling on yourown shoestrings. The most common treatment for addiction today isto enlist the help and guidance of the family while having the addictparticipate in a self-help group. In other words, it is important to havethe family and other people participate in the process. If the source ofthe vicious circle is oneself, then it is absolutely necessary to let othersintervene and proceed to treatment.

We can apply this httle bit of common sense to the treatment ofpeople in social withdrawal, too. The reason people cannot extractthemselves from their state of withdrawal is that they hate this kindof intervention from other people more than anything. On the otherhand, however, people who have steeled themselves and made uptheir mind that they are going to accept the help of others are able toreturn to society, almost without exception. I have observed this inworking with patients, so I knorv that it is not possible to deal withwithdrawal if we try to deal with it only from the standpoint of indi-vidual pathology.

What I am trying to say is this. Even though there might be sev-eral, different aspects involved in the individual sickness that startedthe whole process of withdrawal, as long as those reasons are psycho-genic in nature, once people enter into an extended period of socialwithdrawal, they will end up continuing down that path and stay ina state of withdrawal that they cannot escape from on their own. Aslong as they are in that situation, the best plan of action is not to con-tinue to be preoccupied with the beginning of the illness and keeptrying to diagnose what went wrong early on. More important thantrying to figure out what caused it is realizing the phenomenon of "so-

Hrr(rKoMoRr svsrolrs I 87cial withdrawal" represents an entire system, and one must providetreatment and guidance with that in mind.

Lack of CommunicationNext, let's look at the "family system" (see Figure 2). The family mem_bers who surround the person in withdrawal are also caught up in avicious circle. First, the individual goes into withdrawal, and as theperiod of withdrawal grows longer, anxiety and irritation grow withinthe family. In their anxiety, the fan'iily gives the individual variouskinds of stimulation, hoping to get him or her to change his or herbehavior somehow. Frequently, this "stimulation' involves deliveringspeeches based on sound advice, or sometimes, it involves little morethan yelling at the individual to get up and go. This stimulation, how_ever, does nothing but add pressure and stress to the individual anddoes not help him or her become more active. If anything, the morestimulation he or she receives, the more likely he or she is to sinkdeeper into a withdrawn state. This then just makes the family thatmuch more anxious and irritable, and they repeat the stimulation,although half-aware that it is not going to do any good.

As I have made clear already, the thing that causes these viciouscircles to form is a "lack of communication." The one-way stimuli thefamily gives to the individual cannot be considered real communica-tion precisely because it is so one-sided. The family's words do notreach the person in withdrawal at all. All that happens is that the f'am_ily's anxiety, dissatrlsfaction, and irritation drive the individual into acorner.

In the behavior of withdrawn individuals, there is some sort ofhidden message. That much is certain. If the family can grasp exactlywhat that message is at an early stage, that alone can sometimes beenough to help put the individual on the path to recovery. Even incases when the individual has been in withdrawal {br a long period oftime, it is possible for the family to prevent the vicious circle from get-ting worse by sympathizing with the individual and understandingwhere he or she is coming from. Listening for messages, understandingwhile sympathizing-these things are what make deep, meaning{ul

86 | nrnrnouoRr sysrEMS

behaviors-it is this particular process that is a characteristic of ad-dictive behavior. One sees a similar kind of vicious circle in the be-havior of people in withdrawal. Individuals see their withdrawal asthe "behavior of a loser," and this makes their feelings of self-hatredall the worse, leading to a deeper withdrawal-a vicious circle.

In ordinary circumstances, relationships with the family andother people are what stop the cycle from getting worse. These days,most people believe it is almost meaningless for an alcoholic to tryto stop drinking on his own. Gregory Bateson has said that tryingto do so is like trying to lift yourselfup in the air by pulling on yourown shoestrings. The most common treatment for addiction today isto enlist the help and guidance of the family while having the addictparticipate in a self-help group. In other words, it is important to havethe family and other people participate in the process. If the source ofthe vicious circle is oneself, then it is absolutely necessary to let othersintervene and proceed to treatment.

We can apply this httle bit of common sense to the treatment ofpeople in social withdrawal, too. The reason people cannot extractthemselves from their state of withdrawal is that they hate this kindof intervention from other people more than anything. On the otherhand, however, people who have steeled themselves and made uptheir mind that they are going to accept the help of others are able toreturn to society, almost without exception. I have observed this inworking with patients, so I knorv that it is not possible to deal withwithdrawal if we try to deal with it only from the standpoint of indi-vidual pathology.

What I am trying to say is this. Even though there might be sev-eral, different aspects involved in the individual sickness that startedthe whole process of withdrawal, as long as those reasons are psycho-genic in nature, once people enter into an extended period of socialwithdrawal, they will end up continuing down that path and stay ina state of withdrawal that they cannot escape from on their own. Aslong as they are in that situation, the best plan of action is not to con-tinue to be preoccupied with the beginning of the illness and keeptrying to diagnose what went wrong early on. More important thantrying to figure out what caused it is realizing the phenomenon of "so-

Hrr(rKoMoRr svsrolrs I 87cial withdrawal" represents an entire system, and one must providetreatment and guidance with that in mind.

Lack of CommunicationNext, let's look at the "family system" (see Figure 2). The family mem_bers who surround the person in withdrawal are also caught up in avicious circle. First, the individual goes into withdrawal, and as theperiod of withdrawal grows longer, anxiety and irritation grow withinthe family. In their anxiety, the fan'iily gives the individual variouskinds of stimulation, hoping to get him or her to change his or herbehavior somehow. Frequently, this "stimulation' involves deliveringspeeches based on sound advice, or sometimes, it involves little morethan yelling at the individual to get up and go. This stimulation, how_ever, does nothing but add pressure and stress to the individual anddoes not help him or her become more active. If anything, the morestimulation he or she receives, the more likely he or she is to sinkdeeper into a withdrawn state. This then just makes the family thatmuch more anxious and irritable, and they repeat the stimulation,although half-aware that it is not going to do any good.

As I have made clear already, the thing that causes these viciouscircles to form is a "lack of communication." The one-way stimuli thefamily gives to the individual cannot be considered real communica-tion precisely because it is so one-sided. The family's words do notreach the person in withdrawal at all. All that happens is that the f'am_ily's anxiety, dissatrlsfaction, and irritation drive the individual into acorner.

In the behavior of withdrawn individuals, there is some sort ofhidden message. That much is certain. If the family can grasp exactlywhat that message is at an early stage, that alone can sometimes beenough to help put the individual on the path to recovery. Even incases when the individual has been in withdrawal {br a long period oftime, it is possible for the family to prevent the vicious circle from get-ting worse by sympathizing with the individual and understandingwhere he or she is coming from. Listening for messages, understandingwhile sympathizing-these things are what make deep, meaning{ul

l88 | Hr K rKoMoRt SYSTEMS

Fi.gre 2. Vicious circles for the hikikomori.

communication possible for the first time within the family. It is onlythis kind of deep communication that has the ability to stop the vi-cious cycles in the family from getting worse.

The Disconnect between the Family Systemand the Social SystemThen what about the "social system"P I mentioned earlier that in thehikikomori system, the three systems of individual, family, and soci-ety are all detached from one another. You might think to yourself,"But doesn't the family at least have some point of connection tosociety through the workplace or other institutions?"

I should probably clarify a bit further and say that when I em-phasize that there is a disconnect between the three systems, I meanto say that they have lost a point of connection when it comes to theproblem of the withdrawn person. Yes, even families who are ex-

HTKTKOMORT SVSronaS I Bg

tremely forward-thinking and participate actively in society tend tobe closeJipped when it comes to talking about their own child beingin a withdrawn state. Families worry about what people will thlnkand try to hide it, or sometimes they try to figure out some way tosolve the problem on their own without consulting with anyone.Psychologists have often found that in the course of individual de-velopment, the tendency to "keep to oneself" significantly slows apersonk ability to solve adolescent problems. What I would like toemphasize here is that the disconnect between the family system andthe surrounding social system is exactly the same sort of"keeping tooneself" that inhibits progress toward solving the problem. In a cer-tain sense, it is no exaggeration to say that the family is also in a stateof social withdrawal.

It is this tendency to keep to oneself that causes a disconnectbetween the "family system" and the "social system." Even thoughthere is a separation between the two, it frequently happens thatthe family falls into a vicious cycle of its own. The family tries tostay independent and avoid the opinions of others, but at the sametime, they lose the opportunity to seek out treatment or counselingbecause that would mean getting other people involved. That simplyreinforces the tendency to keep to themselves. It seems to me thatthe tendency to "keep to oneself" on the part ofthe parents is char-acteristically Japanese. Instead of the 'American-style" withdrawal inwhich everyone, including the family, avoids society altogether, thefamily continues to desire a connection with society-or perhaps it isbecause they want a connection all the more that they end up keepingto themselves. Because this setup prolongs conflict, it simply strength-ens the hikikomori system.

That being said, how can we help the hikikomori system beginto function in a healthier manner? I explain that in detail in the nexthalfofthe book, which is dedicated to practical advice.

'l'reatment and counselingPressure from society

Anxiety and irritation ofthe individrral

Pressure to go outsideor to do work

Anxiety and irritation ofthe {iimily

Treatment and counseling

l88 | Hr K rKoMoRt SYSTEMS

Fi.gre 2. Vicious circles for the hikikomori.

communication possible for the first time within the family. It is onlythis kind of deep communication that has the ability to stop the vi-cious cycles in the family from getting worse.

The Disconnect between the Family Systemand the Social SystemThen what about the "social system"P I mentioned earlier that in thehikikomori system, the three systems of individual, family, and soci-ety are all detached from one another. You might think to yourself,"But doesn't the family at least have some point of connection tosociety through the workplace or other institutions?"

I should probably clarify a bit further and say that when I em-phasize that there is a disconnect between the three systems, I meanto say that they have lost a point of connection when it comes to theproblem of the withdrawn person. Yes, even families who are ex-

HTKTKOMORT SVSronaS I Bg

tremely forward-thinking and participate actively in society tend tobe closeJipped when it comes to talking about their own child beingin a withdrawn state. Families worry about what people will thlnkand try to hide it, or sometimes they try to figure out some way tosolve the problem on their own without consulting with anyone.Psychologists have often found that in the course of individual de-velopment, the tendency to "keep to oneself" significantly slows apersonk ability to solve adolescent problems. What I would like toemphasize here is that the disconnect between the family system andthe surrounding social system is exactly the same sort of"keeping tooneself" that inhibits progress toward solving the problem. In a cer-tain sense, it is no exaggeration to say that the family is also in a stateof social withdrawal.

It is this tendency to keep to oneself that causes a disconnectbetween the "family system" and the "social system." Even thoughthere is a separation between the two, it frequently happens thatthe family falls into a vicious cycle of its own. The family tries tostay independent and avoid the opinions of others, but at the sametime, they lose the opportunity to seek out treatment or counselingbecause that would mean getting other people involved. That simplyreinforces the tendency to keep to themselves. It seems to me thatthe tendency to "keep to oneself" on the part ofthe parents is char-acteristically Japanese. Instead of the 'American-style" withdrawal inwhich everyone, including the family, avoids society altogether, thefamily continues to desire a connection with society-or perhaps it isbecause they want a connection all the more that they end up keepingto themselves. Because this setup prolongs conflict, it simply strength-ens the hikikomori system.

That being said, how can we help the hikikomori system beginto function in a healthier manner? I explain that in detail in the nexthalfofthe book, which is dedicated to practical advice.

'l'reatment and counselingPressure from society

Anxiety and irritation ofthe individrral

Pressure to go outsideor to do work

Anxiety and irritation ofthe {iimily

Treatment and counseling