This Eerie Mental Health Condition Has Locked Thousands of Japanese Away From Society


“Hikikomori” is becoming a health crisis.

 

Hayashi Kyoko started becoming a social recluse when her high school principal started talking about university entrance exams on the first day of school.

“The fun high-school life I was looking forward to transformed into nothing more than a period of test preparation,” the Japanese native told the online magazine Nippon.com.

 

“It was a huge shock. I’d sensed before that I didn’t belong in the strictly regimented education system. This feeling manifested itself in physical symptoms, and I stopped going to school.”

And as she grew older she started working a part-time job and, facing pressure from her mother, Kyoko said she “hit her limit” and could no longer face leaving the house or meeting people.

Kyoko wasn’t alone. She had become one of half a million “hikikomori”, a Japanese term referring to people who shut themselves at home and avoid social contact. (The term refers to both the person and the condition.)

Her lowest point was in her mid-twenties, she said: “I spent all my waking hours criticising myself… All I did was get up afternoon, eat, excrete, and breathe. I was like a living corpse. I couldn’t find the tiniest bit of worth in myself. I thought my life was meaningless.

“I had this terrible kind of fury I didn’t know where to direct, and I was always exhausted.”

‘A middle-class malady’

Hayashi Kyoko

The Japanese government officially defines hikikomori as people who haven’t left their homes or interacted with others for at least six months.

 But hikikomori can come in various forms: One person’s condition can be so severe that they lack the energy to leave their sofa to go to the toilet, like one hikikomori who spoke to the website Quartz.

Another could suffer from obsessive compulsive disorders so serious that they shower several hours a day or scrub their shower tiles for hours, such as who spoke to The New York Times.

A third hikikomori said they played video games all day “as if it would tranquilise me.”

Professor Jeff Kingston, an Asian studies professor at Temple University in Tokyo, told Business Insider:

“Sweeping generalisations are always misleading… [But] it seems they are mostly males who exhibit extreme symptoms of social withdrawal who often live at home with parents who take care of them.

“They rarely leave their rooms or their homes, and reportedly live in and limit interactions to the virtual world.

“It is considered a middle class malady because only hikikomori from such backgrounds can rely on the support of their families.”

As of 2015, there were 541,000 hikikomori aged 15-39 in Japan, according to government statistics. There is no data on other age groups, suggesting that the figure is likely to be far larger.

 Some families are also loath to report hikikomori in their households, Kingston said.

Japan announced last Sunday that it would conduct its first nationwide survey of hikikomori among 40-to-59-year-olds later this year, according to the country’s Kyodo news agency.

Previous surveys on the phenomenon were only of 15-to-39-year-olds, as authorities previously believed the condition was limited to young people. The government has since noticed hikikomori grow older and face longer periods of reclusiveness, Kyodo said.

The country now hopes to identify older hikikomori and understand the assistance their families need. As hikikomori grow older and their parents become too elderly to care for them, questions over their fate will become more urgent.

Kingston said: “The survey will provide more accurate information because it hasn’t been done before. I suspect it will provide a basis for improving state policies towards them because it will detail their needs, but the social stigma will persist.”

According to The New York Times, doctors began to observe hikikomori as a social phenomenon around the mid-1980s, when young men exhibited signs of lethargy, refused to communicate, and spent most of their time in their rooms.

There’s no unifying reason why people become hikikomori. Some, like Kyoko, withdraw from society because they feel they don’t know what to do with their lives and can no longer cope with the pressure from people around them.

Others are triggered by events in their lives, like bad grades or heartbreak, the BBC said.

As psychiatrist Sekiguchi Hiroshi wrote on Nippon.com: “Hikikomori feel a deep sense of shame that they cannot work at a job like ordinary people. They think of themselves as worthless and unqualified for happiness. Almost all feel remorse at having betrayed their parents’ expectations.

“At the same time, they are beset by internal conflict between the self that cannot go out into the world and the self that constantly condemns their failure to do so.”

As Tamaki Saito, one of the country’s first and leading researchers in hikikomori, told the BBC: “They are tormented in the mind. They want to go out in the world, they want to make friends or lovers, but they can’t.”

The economic impact of hikikomori

As hikikomori refuse to participate in society, let alone go to work, Japan’s economy also suffers.

Professor Kingston said: “They diminish the size of the workforce, so contribute to a tighter labour market.

“Also, they are not self-sufficient, so when family support dries up due to death or financial problems, they will need to rely on state assistance.”

Japan already faces an aging population and massive labour market shortages. There are about one and a half job vacancies per applicant in Japan, the government reported in September – the highest for more than 40 years.

According to Bloomberg, Japanese Prime Minister Shinzo Abe announced plans in late 2016 to set up counselling centres and have support staff visit hikikomori at home in a bid to boost the country’s flagging workforce.

Whether the policy has worked is unclear, but Kageki Asakura, a dean at Tokyo’s nonprofit Shure University, said it was “putting pressure on hikikomori.”

What are the solutions?

Kyoko, the woman who was house-bound in her twenties, said she “rejoined” society around a decade later.

Along the way she almost killed herself, saw a psychiatrist, and started talking to other hikikomori. After turning 40, she also started managing hikikomori self-help groups in Yokohama, where she lives.

Other volunteer groups, such as New Start, try to get hikikomori to go to community centres, get work experience, and socialise.

New Start runs a “Rental Sister” programme, where volunteers visit hikikomori’s houses and chat to them from the other side of their bedroom door to try to get them out, reported freelance photographer Maika Elan, who visited a New Start centre in Chiba-shi, a city near Tokyo, in 2016.

It usually takes a “rental sister” one to two years to coax hikikomori out their bedrooms, Elan said.

Other hikikomori set up a newspaper to shed light on the country’s recluses.

Established in November 2016, the Hikikomori Shimbun (“shimbun” is Japanese for “newspaper”) discusses the phenomenon around the country and hopes to serve as a link between hikikomori and the outside world, according to Japan’s Asahi Shimbun.

Professor Kingston said: “One can only hope that more access to various therapies and public health campaigns to destigmatise the phenomenon will encourage more to seek help, find it, and learn to manage their symptoms so that they can lead more productive and fulfilling lives.”

The World Health Organization Identifies Gaming Disorder as a Mental Health Condition


Gaming Disorder

In 2018, the World Health Organization plans to add “gaming disorder” – characterized by a pattern of persistent or recurrent gaming behavior – to its list of mental health conditions.

According to the beta draft site, the WHO’s 11th International Classification of Diseases (ICD) defines a number of diseases, disorders, injuries and other related health conditions, which are listed in a comprehensive, hierarchical fashion. It enables the sharing of health information between countries and facilitates the analysis of “health information for evidence-based decision-making.” The previous version of the ICD was approved in 1990 by the 43rd World Health Assembly. The current draft that lists “gaming disorder,” is not final, nor does it list prevention or treatment options. The beta draft site, updated daily, is also not approved by the WHO.

The WHO’s impending beta draft for the next ICD classifies gaming disorder as a pattern of behavior with “impaired control over gaming,” in terms of its frequency, intensity, duration, and the capacity to quit. The disorder falls under the parent category of “Disorders due to addictive behaviors,” and is characterized by giving increased priority to gaming over other daily activities.

Applying to both online and offline video gaming, the condition is also defined by the “continuation or escalation of gaming despite the occurrence of negative consequences.” In order to be diagnosed, these behaviors must be evident over a period of at least 12 months, according to the draft.

A Matter of Contention

“The WHO designation is now generally in line with the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5)’s description of internet gaming disorder (IGD),” Nancy Petry, a professor of medicine at the University of Connecticut Health Center, told Futurism. The main difference though, Petry said, is that the DSM-5 didn’t consider the data sufficient to classify IGD as a unique mental health condition. Rather, it’s categorized under “conditions for further study.”

The WHO’s decision highlights a schism among psychologists: some think the new designation is a welcome one, but others don’t see enough evidence to justify it.

Alexander Blaszczynski, a professor of clinical psychology at the University of Sydney, Australia told Futurism he is concerned about “the absence of clear diagnostic criteria determining what constitutes a gaming disorder, and the validity of applying existing addiction criteria to a behavior.” He noted that there is a range of behaviors now being identified as addictions — everything from salsa dancing, to smartphones, to in vitro fertilization. “At what point does an activity transform from an entertainment to a disorder?” he said.

The controversy ultimately reflects some deeper philosophical debates that have dogged most areas of medicine for many years, Ronald Pies, a clinical professor of psychiatry at Tufts University School of Medicine, told Futurism. “What should or should not count as “disease” or “disorder”? Do we require physiological, biochemical, or neurological “markers” of a putative disease entity in order to validate it, or is it sufficient to document substantial impairment and dysfunction in activities of daily living, responsibilities, etc., as the WHO criteria emphasize?”

Chris Ferguson, a professor of psychology at Stetson University in Florida told Futurism that he does not support the WHO’s designation. “Basically I don’t think the research is there yet to support this as a diagnosis and there is considerable risk of harm due to a “junk diagnosis.”

He said research suggests what we’re calling “gaming disorder” isn’t really a solitary diagnosis. Ferguson said some people certainly overdo gaming, as others may “overdo” or develop addictions to myriad other activities like shopping, exercise, and sex. “But the data we have suggests that usually individuals have a preexisting mental health condition like depression or anxiety first, then use these activities as coping mechanisms.”

Pies said he shared many of Ferguson’s concerns, saying he was “more skeptical than not” of the designation. “While some recent neurophysiological studies suggest that IGD may be a discrete disorder, there is still no scientific consensus on this point. It is unclear whether IGD is truly a “stand alone” condition; whether it is mostly explained by other underlying conditions, such as anxious or depressive disorders; or whether it is merely a subtype of so-called “behavioral addictions”, which are themselves sources of scientific controversy,” Pies said.

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Others, like Douglas Gentile, a psychology professor at Iowa State University, see this as a big step in the right direction. Gentile compared where we are with gaming “addiction” as “similar to where we were with alcoholism in the 1960s.” At that time, alcoholism was considered a moral failing — people thought ‘it’s your own damn fault,’” he told Futurism. “It took another 30 years for people to agree that a medical model for alcoholism makes sense and now people can get the help they need.”

Gentile doesn’t think our culture is ready to accept the medical model of video gaming, and still sees it as a moral failing — mostly by the children’s parents. “We have lots of people who could be helped, but aren’t being helped. If you walk into a doctor or psychiatrist’s office, they either won’t treat it or you have to pay out of pocket.”

Ferguson isn’t sure “why the WHO is so obsessed with gaming when a wide range of behaviors can be overdone.” Given that other potential addictions, like food or sex, have as much research as gaming, it seems likely that the WHO’s kneejerk reaction comes from a broader moral panic over video games and technology, he said.

But Gentile counters that the WHO’s acknowledgement that video gaming could be a problem “puts truth back on the table,” Gentile said. “We need to treat games with more respect. We play them because we want to be affected, but then say they have no effects.”

Access Is a Predictor Of Addiction

As our video game experience expands with virtual reality (VR) and augmented reality (AR), the argument gets even murkier. “One thing that we do know about addictions, generally, is that the number one predictor [for] if you’re going to become an addict is access,” said Gentile. “If you can’t get drugs, you can’t become addicted to them. Now that we’ve made gaming this ubiquitous — on phones, with gaming tech and VR tech in-house — we’ve made access open to everyone.”

Gentile isn’t certain that VR games are more addicting than their traditional counterparts. “We don’t know if greater immersion makes the games more addictive. To say that VR will be more addictive is making the argument that seeing things in three dimensions is more addictive than seeing them in two.” But he added that we don’t have the scientific evidence to support that.

Scientists do tend to agree on one thing: that the designation will ensure researchers pay more attention to the problems that can arise from excessive gaming. “It is important that people with this condition receive help, and that research progresses in a manner consistent with state of the art science applied toward other mental health conditions,” said UCONN’s Nancy Petry.

Moreover, the WHO designation could help those diagnosed with video gaming disorder in another way: if they’re able to access treatment, it could be covered by insurance. However, Ronald Pies warned that “social goods” of this sort do not amount to a scientific justification for a disease category, and even among supporters of the diagnosis, there is no consensus regarding what the effective “treatment” would be.

‘Gaming Disorder’ May Get Classified as a Mental Health Condition – Here’s What That Means


How much Mario is too much?

There’s a certain point at which a hobby can become too much.

The World Health Organisation is considering adding “gaming disorder” to the list of mental health conditions in its next update of the International Classification of Diseases (ICD), according to a beta draft of the document.

 

The 11th version of the ICD is not yet set, but the addition would be a recognition that a pastime can become problematic if it leads to a form of addictive behaviour.

Specifically, the draft’s language states that gaming behaviour could be a disorder if it meets three characteristics: if a person loses control over their gaming habits, if they start to prioritise gaming over many other interests or activities, and if they continue playing despite clear negative consequences.

This would add gaming to a list of other behaviours that can become problematic if people lose control over them, including gambling and disorders related to the use of substances like alcohol, marijuana, caffeine, or nicotine.

Gaming covers any activity from playing Two Dots on your iPhone to sitting down in front of a custom-built gaming PC for hours.

Putting that category of activities on the list would give doctors and mental health professionals a way to officially diagnose someone with the condition.

But to be clear, this doesn’t mean that all gaming is addictive or could lead to a disorder. It’s only if the behaviour is severe enough “to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning,” according to the draft.

In other words, it has to be intense enough to harm personal relationships or interfere with school or work.

The psychology of games

The psychological community has been debating whether gaming is addictive enough to be described as a disorder for some time.

So far, the American Psychiatric Association has declined to classify gaming addiction as a disorder but has said it merits further research.

Part of the problem is how to distinguish between simply spending a lot of time playing games and actual addictive behaviour.

Scientists need to “establish a clear-cut distinction between someone who may use games excessively but non-problematically and someone who is experiencing significant impairment in their daily lives as a consequence of their excessive gaming,” a group of researchers from Nottingham Trent University in the UK wrote in a paper published last summer in the Journal of Addictive Behaviour.

There are plenty of stories about individuals whose gaming behaviour has become problematic – people have gotten so caught up in online games that they have ruined relationships and lost jobs.

Compulsive gaming and problematic substance use can also go hand in hand.

But problematic gaming may also serve as a dysfunctional coping mechanism for some, according to the Nottingham Trent researchers.

Someone who is struggling with depression or anxiety may turn to gaming or abuse substances like alcohol as a way to relieve those symptoms.

Benefits and harms

Figuring out the degree to which playing games is harmful (or helpful) is all about context, according to Bruce Lee, an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health.

Lee wrote in a column for Forbes that gaming habits can also be psychologically beneficial.

On the positive side, research has shown that game playing can relieve stress, improve problem-solving abilities, and enhance traits like eye-hand coordination.

Technologies that we think of as for gaming, like virtual reality, can also be used in psychological therapy.

Yet people can struggle to find a healthy balance with gaming.

Researchers are still trying to understand the activity’s risks and effects, since it has only recently become such a common pastime – 63 percent of US households contain at least one “frequent gamer,” a trait that didn’t exist a couple of generations ago.