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Hikikomori
a b
Bruce Rosenthal & Donald L. Zimmerman
a
Chatham University, Pittsburgh, Pennsylvania
b
Department of Health Sciences, Towson University,
Towson, North Dakota
Published online: 10 Dec 2014.

To cite this article: Bruce Rosenthal & Donald L. Zimmerman (2012) Hikikomori,
International Journal of Mental Health, 41:4, 82-95

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 International Journal of Mental Health, vol. 41, no. 4, Winter 2012–13, pp. 82–95.
© 2013 M.E. Sharpe, Inc. All rights reserved. Permissions: www.copyright.com
ISSN 0020–7411 (print)/ISSN 1557–9328 (online)
DOI: 10.2753/IMH0020-7411410406

Bruce Rosenthal and Donald L. Zimmerman

Hikikomori
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The Japanese Phenomenon, Policy, and Culture

abstract: Hikikomori (hee-kee-koh-MOH-ree) is a growing social be-

havioral syndrome among Japan’s male adolescents. The main symptom
of hikikomori is for young men to lock themselves away in their rooms
for months, years, or even sometimes decades at a time, with minimal
social contact. While there have been a number of important scholarly
works on the causes, treatments, and consequences of hikikomori, detailed
research of its relation to Japanese health-care policy and its contextual-
izing culture is lacking. In response, this article examines two critical
dimensions of the Japanese phenomenon of hikikomori: (a) the general
conceptual policy model developed by the Japanese Ministry of Health,
Labor, and Welfare for understanding and addressing the hikikomori
phenomenon, and (b) the interplay between current hikikomori policy
and some of the more dominant elements of Japanese culture. On the
basis of this examination, the authors conclude that hikikomori may
be best seen as an example a rational and intentional response to an
otherwise, nonrational, irreconcilable, no-win conflict embedded in a
larger set of cultural changes occurring within Japanese society. If so,
then Japanese policymakers may be best advised to expand their cur-
rent reliance on family therapy and accepted Western psychiatric forms
as treatment options to include a model of free-agency within a global
cultural context.

Bruce Rosenthal, MBA, Ph.D., is program director/chair business programs,

Chatham University, Pittsburgh, Pennsylvania. Donald L. Zimmerman, Ph.D., is
associate professor, Department of Health Sciences, Towson University, Towson,
North Dakota.

82
 Winter 2012–13   83

Hikikomori is a social behavioral syndrome that has appeared more fre-

quently among Japan’s male adolescents over the last twenty years [1, 2].
The main symptom of hikikomori (hee-kee-koh-MOH-ree) is for young
men to lock themselves away in their rooms for months, years, or even
sometimes decades at a time, with minimal social contact (Kondoh N.,
personal communication, January 2010, April 2010) [3].1 Many research-
ers have noted the predominance of men among hikikomori (Kondoh
N., personal communication, January 2010; Hizume M., personal com-
munication, September 2010), yet there is the possibility that men are
simply more visible as hikikomori because they are expected to leave the
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house and set up households of their own in Japan, while the expectation
for women to leave the house is somewhat less.
From the basic question of how many “sufferers” there are to more
complex questions concerning causes and treatments, there is tremen-
dous disagreement about virtually every aspect of the phenomenon. In a
face-to-face household survey conducted in 2002–6 as part of the World
Mental Health Japan epidemiological study, Koyama et al. [4] found
roughly 50 percent of the hikikomori population had a comorbidity with
some kind of psychiatric disorder, and roughly 50 percent were free from
psychiatric disorders, suggesting a variety of causes for the syndrome.
Koyama et al. reported, “A certain proportion of ‘hikikomori’ cases may
be a social and behavioral problem resulting from an interaction between
individuals, family, and society, not a symptom of psychiatric disorder.”
[4, p. 73]. In addition to psychiatric and developmental disorders that
may be at the root of the problem, other researchers reported issues such
as young men reluctant to compete in modern Japanese society and lack
of communication between parents and the children (Sakai M., personal
communication, December 2009) [5].
Part of the problem in identifying, defining, and categorizing hikikomori
is that a vast variety of different individual behaviors are grouped together
under the same term. For example, the concept of hikikomori behavior has
been used to cover behavior ranging from minor personality quirks such
as excessive hand washing or fanatical obsession with a favorite maga-
zine to those who sit in their rooms playing Internet games night and day
to others who simply sit in their rooms and do nothing whatsoever. The
following characterization of hikikomori is based on an amalgamation
of real cases reported by Saitoh Tamaki [5].2 Kenji (a fictional name) is a
Japanese man, 30 years old; during elementary and middle school, he was
normal with no outstanding incidences of any kind. During his first year
 84 international journal of mental health

of high school, he stopped going to school and began showing a violent

streak at home. When he didn’t like something, he would strike out or
throw things around. Eventually he dropped out of high school, but got
his equivalency through a correspondence course. He became obsessed
with cleanliness in the home and would strike his mother when he saw
something dirty. No longer able to stand the violence, his mother and
then eventually his father left the house and took up residence somewhere
else. The family has been living apart for six years. Kenji is to this day
unemployed; he receives money for living from his parents. He is awake
at night and sleeps during the day; he keeps the doors of the apartment
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locked and only communicates with his parents through written notes.
He has no friends and has no other human relationships. Recently he has
begun to take an interest in music and has expressed a desire for expensive
audio equipment. If he does not receive the exact equipment he wants, he
gets angry. If his parents suggest that he gets what he wants by himself,
he throws a temper tantrum, tries to levy a “fine” against his parents and
threatens them that he will kill them if they don’t get what he wants.
While there have been a number of important scholarly works on the
causes, treatments, and consequences of hikikomori [6], detailed research
that examines hikikomori from the perspective of Japanese health care
policy and its contextualizing culture is lacking.3 In response to this
gap in the literature, this article examines two critical dimensions of the
Japanese phenomenon of hikikomori. These two dimensions are (a) the
general conceptual policy model developed by the Japanese Ministry of
Health, Labor, and Welfare (MHLW) for understanding and addressing the
hikikomori phenomenon, and (b) the interplay between current hikikomori
policy and some of the more dominant elements of Japanese culture.
Public awareness of hikikomori may have begun with, or was at least
heightened by, the publication of Saitoh Tamaki’s [5] book Shakaiteki
Hikikomori in 1998, even though most experts agree that there were prob-
ably scattered cases of hikikomori beginning as early as the 1970s.4 Saitoh
Tamaki is often credited with developing the word hikikomori to describe
these troubled youth, although Kitao Norihiko [7] used the term.
Based on his clinical experience, Saitoh Tamaki [5] sets out his basic
concepts concerning the symptoms and causes of hikikomori in Shakaiteki
Hikikomori. This landmark publication has served as the foundation for
many of the mass media descriptions of the phenomenon in both the West
and Japan. According to Saitoh, the typical hikikomori is a first-born male,
with highly educated and at least middle-class parents, most often with a
 Winter 2012–13   85

nonconcerned father and an oversensitive and highly emotional mother.

While most hikikomori started out as bright, positive children, initial
problems seem to start with a refusal to go to school (futohkoh). Saitoh
saw the family as the key cause and the “cure” of hikikomori through
his description of the breakdown of the relation between the hikikomori
and his family, and the necessity of the family to provide most of the
therapy or support required to reintegrate into society.
Following the publication of Saitoh’s [5] book, other research appeared
and the problem was popularized through television specials such as
“A Million Young People Calling: ‘Hikikomori’” on Nippon TV. The
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general public awareness of hikikomori was significantly increased in

2000 through wide distribution of news stories of several violent crimes
committed by young people identified as hikikomori. On May 3, 2000, a
boy in Saga prefecture hijacked a bus with a knife holding a six-year-old
girl hostage. After forcing the bus driver to drive for 19 hours the boy
killed a woman and wounded five others. In another incident that came to
light in 2000, an alleged hikikomori named Sato Nobuyuki was arrested
by police after his mother called a physician. Sato had kidnapped a nine-
year-old girl and kept her hostage in his room for almost a decade.
While research evidence strongly suggests that violence among
hikikomori—especially directed at people outside their immediate
families—was the exception rather than the rule, these incidents served
to alert the general public that a problem that had remained hidden for at
least a decade could no longer be ignored. Articles in major newspapers
increased dramatically, from roughly 130 articles in 1999 in the Asahi
shinbun and the Yomiuri shinbun combined (Japan’s two leading news-
papers) to over 650 articles for the combined newspapers in mid-2000
[8]. This first mass introduction by the popular press took on a hysterical
note, which was quickly picked up by the Western press.
As media attention both in Japan and the West increased, the Japanese
MHLW began studying “troubled youth,” concentrating on prefectural-level
Mental Health and Welfare centers for research. The degree to which the
academic and clinical world was taking notice of hikikomori is shown by
the dedication of almost the entire March 2003 volume of the prestigious
journal Clinical Psychiatry to the phenomenon: “Hikikomori: Byohri to
Shindan, Chiryo” (Hikikomori: Pathology, Diagnosis and Treatment).
Concerned with the rising number of youth who were not in educa-
tion, employment, or training (called NEETs), the MHLW originally
addressed hikikomori as primarily a labor issue. By 2000, however,
 86 international journal of mental health

increased pressure from mental health professionals moved the MHLW

to commission Itoh Junichiro of the National Institute of Mental Health,
National Center of Neurology and Psychiatry to undertake research that
would provide guidelines for mental health workers who were increas-
ingly seeing hikikomori patients and their families. In this first set of
guidelines focused on hikikomori (generally referred to by Japanese
researchers simply as “Itoh’s Guidelines”), Itoh [9] did not see hikikomori
as a mental illness in and of itself. Rather, he was the first clinician to
state that hikikomori might have some kind of psychological disorder at
the heart of the withdrawal symptoms. Despite the possible presence of
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psychiatric disorders causing hikikomori, Itoh argued that extensive in-

vestigation into the cause of the withdrawal was not ultimately important.
Gently convincing the hikikomori to reenter society, primarily through
family intervention, was the goal of the guidelines and so analyzing the
trigger of the withdrawal remained secondary for Itoh.
Kondoh’s [10] more detailed analysis during the same period firmly
focused on identifying not only the underlying causes but also on ap-
propriate treatments for hikikomori, which he categorized into three
different groups. The first group consisted of those who suffer from an
underlying psychiatric disorder such as schizophrenia, panic disorders, or
social anxiety. For these cases, Kondoh recommended that the first choice
for dealing with this condition are drugs such as Abilify and Zyprexa
and antidepressants such as SSRIs/SNRIs [selective serotonin reuptake
inhibitors/seretonin norepinephrine reupake inhibitors] and benzodiaz-
epines. The second group consisted of those who have comprehensive
developmental disorders and mental disorders, learning disabilities, low
self-esteem, inability to adjust, victimization delusions, and so on. His
recommended therapy for this group is supportive psychiatric and cogni-
tive behavioral intervention, with drugs as assistant support. The third
group of hikikomori identified by Kondoh is those who have personality
disorders or schizoaffective disorders. For these patients, Kondoh recom-
mended one-on-one psychological therapy or group therapy.
Having defined individual psychiatric issues as a common element
across all three types of hikikomori, Kondoh [10] then explained that
there was a factor within hikikomori that was not psychiatric by stating
that most people achieve independence without the benefit of profes-
sional services even if they have some kind of behavioral or psychiatric
problem. The key variable between those who achieve such independence
and those who suffer hikikomori, according to Kondoh, is the family,
 Winter 2012–13   87

especially the parents. Parental pressure, parental control, and unlimited

parental financial support, in his view, can all serve to prevent the child’s
healthy development through puberty and adolescence, creating vicious
circles of communication breakdown, which made it impossible for the
family to help each other and eventually push the family into withdrawal
from society themselves. In other words, within the wider scope of
people who have some kind of psychiatric disorders, those who become
hikikomori are the ones who also have a dysfunctional relationship with
their parents. As a consequence of his analysis, Kondoh then stressed the
need for family-oriented therapy and believed that, because the family
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is part of the problem, the family must also be considered part of the
solution (Kondoh N., personal communication, April 10, 2003). Since
2003, the MHLW has acknowledged the dual importance of individual
psychological disorders and family dynamics in the underlying etiology
of hikikomori. Based on what can be conceived of as a Venn diagram,
the MHLW framework is viewed as one circle representing cultural or
societal changes in the Japanese family and one circle representing in-
dividual psychiatric/biological factors. In this view, hikikomori are the
people who fall into the area where the two circles overlap, where both
family and psychiatric disorders act as causes.
In the meantime, a small industry concerning hikikomori began
developing in the early 2000s, consisting of clinics, half-way houses
run by nonprofit organizations, parent groups, counseling centers, and
hospitals. Each of these entities, while using a variety of therapies in
various manners, had little hard data that supported the actual treatment
effectiveness of any of their efforts. In 2007, amid increased evidence
that the numbers of hikikomori were increasing, the MHLW initiated an
effort to create a framework for building an evidence-based approach
throughout the hikikomori industry. The first step in this strategy was
to commission a twelve-person panel under the leadership on of Saitoh
Kazuhiko, Director of the Rehabilitation Department of the National
Mental Health and Psychiatric Center in the Kohnodai Hospital.5
The resulting white paper [11] contained the latest and most compre-
hensive data and peer-reviewed analysis available on adolescent hikiko-
mori in Japan and formed the basis of the most recent policy guidelines
issued by the Ministry in 2010 (and distributed to local mental health
authorities) [12]. These current policy guidelines [12] define how the
hikikomori should be approached, spoken to, and treated through a net-
work of supporting institutions, which are prepared to help hikikomori
 88 international journal of mental health

by providing a variety of services ranging from psychiatric therapies and

drugs to communication and vocational skills.6
At the center of such a network, the guidelines [12] place a local
Hikikomori Support Center and assign the center the responsibility of
screening the incoming hikikomori to determine which disorder each
patient has so that he or she may be directed to the proper institution.
Despite the presumptive clinical and academic authority of the white
paper [11] and its resulting policy efforts of the MHLW to develop such
guidelines for its policy, many researchers, including some of the key
authors of the white paper [10], remained concerned over the lack of
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a strong evidential connection between this policy and the hikikomori

syndrome. Indeed, the MHLW’s 2010 guidelines concluded that, although
the best minds in the country have contributed to the wealth of knowl-
edge concerning the syndrome, there is no solid evidence that any of the
methods covered in the policy guidelines will work consistently under
all conditions. “The problem here is that there is no evidence of what
therapy will work in the long run and what won’t” (Sakai M., personal
communication, May 2010).
Above and beyond the lack of an evidential record to connect the
MHLW’s policy with results, a number of additional issues might derail
MHLW’s efforts at building a coherent and effective policy regarding
hikikomori. At the heart of concerns are a number of factors and variables
that may be endemic in the context of Japanese culture and thus outside
the direct control of ministerial policy making. Indeed, this article argues
that new policy analysis should be undertaken that examines hikikomori
as a potential “symptom” of deep changes occurring within Japanese
culture through increased globalization and other challenges to its internal
commitment to its unique national traditions.

The Cultural Context of Hikikomori Policy

A number of researchers and writers have argued that hikikomori is

evidence that Japanese society is collapsing [3]. In this view, traditional
Japanese society is envisioned as a rigid, collectivist social structure
where boys are automatically singled out for the family’s attention and
forced to conform with highly defined cultural protocols and rules as a
prerequisite to personal and professional success.
Such factors as the globalization of commerce, entertainment, the
use of social media, and even the recent Japanese tsunami and nuclear
 Winter 2012–13   89

catastrophe have all had dramatic consequences on the collective moral

power carried in the traditional behavior of the past. In the face of such
monumental social changes, many male adolescents are still facing intense
pressure from their families to continue conforming to traditional Japanese
cultural norms and expectations of appropriate behavior. Such norms are
not only anchored in Japan’s common history of national development,
they are also particularly important to many families that maintain strong
generational memories of their importance in guiding the recreation of
a coherent Japanese society (the Japanese Miracle) in the aftermath of
World War II and its utter national and physical devastation.
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The resulting tension being caused by contradictions between tra-

ditional family expectations and the new cultural realities of a global,
post-recession society has led some researchers to see hikikomori as an
effort to reconcile two competing sets of behavioral expectations. Indeed,
the stark differences between the expectations of young Japanese and
those who came before them has prompted some to see these differences
not merely as a stage in adolescent development but as a historic clash
over the very future of Japan itself [13–15]. Indeed, in personal com-
munication, many mental health personnel who work on a daily basis
with hikikomori have stressed that although there are those who suffer
from some kind of psychiatric or developmental disorder, there are many
who do not (Junko Niimura, personal communication, December 11,
2011; Tetsushi Tsujimoto, personal communication, December 13, 2011;
Naoya Shiraishi, personal communication, December 4, 2011; Yoshihiko
Fujimoto, personal communication, November 2011). These interviewees
stress issues such as pressure in school, lack of acceptance of differences
in Japanese society, change in the nature of work in Japan, frustration and
disappointment in lack of opportunities in recession-plagued Japan, or
the hikikomori’s disappointment with their lack of immediate success.
One difference between the current generation of Japanese adolescents
and their parents is that the current generation appears to be excessively
narcissistic with a concomitant reluctance to form attachments or even
simple efforts at communication (Sakurai, cited in [14]). While such
behavior does not necessarily qualify as hikikomori, this tendency to
create what Sakurai [16] called a closed “community of me” is reflec-
tive of a generation of “internal privacy and external caution.” Sugimoto
[17, p. 78] argued, “These young people are inclined to draw a line of
autonomy and isolation around themselves and are sensitive to the intru-
sion of outsiders into their personal lives.”
 90 international journal of mental health

While the numerical scope of such behavior is currently unknown, it

may be safe to assume that as Japanese culture continues to change at
least some young Japanese youth have responded by actively seeking
out a very self-centered, safe, and private world. If so, hikikomori may
carry with it a corresponding role definition and a related set of expected
hikikomori-type behaviors. In this sense, becoming a hikikomori—or at
least exhibiting some hikikomori behaviors—may offer a young person
an appealing role definition, a meaningful personal narrative, and perhaps
a chosen path out of confusion and stress.
While it is not unreasonable to assume that there might be “good”
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reasons why more and more youth are hiding away their “selves” in the
role of hikikomori, there are many examples where young men in other
life environments with similar expressions of angst, growing pains, and
social malaise have chosen the opposite path and directly engaged with
the perceived source of their confusion. For example, the creative arts,
social change movements, and even street gangs can all be seen as clear
cases in which young individuals (albeit, not necessarily Japanese) have
apparently chosen to engage actively with others to express their collective
frustration, anger, and desire to change the world to be more consistent
with their individual expectations of what they would like it to be.7
Our emphasis here on some form of active agency theory [18] may,
however, be placing too much emphasis on individual “choice” in the
etiological composition of hikikomori. Certainly there are those hikiko-
mori with preexisting psychological disorders who may be predisposed
to withdrawal precisely because their ability to actively choose a course
of behavior and personal narrative are inherently contained by their men-
tal limitations. However, as pointed out in a number of research reports
[2, 10], a meaningful number—and, perhaps, majority—of those who
appear to be hikikomori do not have a serious debilitating disorder such
as schizophrenia. Rather, as we suggest here, they may be “acting” that
way on purpose because extreme withdrawal from social intercourse may
make perfect sense as a defensive response to the collapse of traditional
cultural expectations all around them.8

Conclusion and Final Thoughts

Hikikomori is a complex condition that requires much more than one-

dimensional responses to fully explain and understand. Despite this
complexity, the Japanese government’s current approach seems to prefer
 Winter 2012–13   91

a rather simple focus on well-accepted Western psychiatric forms and

individual rehabilitation within the context of the family.
We believe that one of the main limitations of the government’s strategy
is the assumption that the traditional family is able to act as an effective
therapeutic agent. Recent changes in Japan may have reduced the family’s
ability to intervene into adolescent behavior patterns in any meaningful
and effective way. In the face of such changes, many male adolescents
may, in fact, be trying to resolve conflict between traditional and emerging
behavioral expectations through extreme forms of personal separation, self-
absorption, and narcissism. That is, while there may be a strong desire of
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the adolescent to meet the traditional expectations of his primary family,

the adolescent’s daily experience with a changing (and increasingly global)
world may be presenting a direct and visceral challenge to the unques-
tioned moral authority of the traditional Japanese family. If so, in some
cases hikikomori may be best seen as a rational and intentional response
to an otherwise, nonrational, irreconcilable, no-win conflict embedded in
a larger set of cultural changes occurring within Japanese society.
If at least some of the hikikomori phenomenon can be understand as
a personal and purposive response to conflicting demands on behavior in
times of dramatic social change, it may be useful to compare hikikomori
with how adolescents have responded to rapid cultural change in other
circumstances of time and place. For example, several researchers and
providers have pointed out that hikikomori and anorexia have certain
similarities and may possibly reflect aspects of that particular culture
and time (Arai S., personal communication, February 2010; Kondoh N.,
personal communication, April 2010) [19]. According to Brumberg [19],
anorexia in the 1920s and then again in the 1960s took on a very cultur-
ally oriented meaning where an extremely thin body became something
more than just an aberrant body-type within the world of fashion. For
some, being anorexic, although terribly and literally self-destructive,
was a purposive choice to become a living cultural statement that spoke
against and rejected the matronly figures, manners, and morals of the
overly fed, decaying bourgeois culture of the previous generation.
Of note here is that while Brumberg [19] viewed anorexic behavior
as a personally destructive choice of young women, she still saw it as
focused and goal-directed behavior. That is, it was behavior that had
both meaning and purpose in contrast to the prevailing cultural milieu.
In the case of the hikikomori, however, it is precisely the lack of focus
and goal-directed goals that appears to define much of the behavior of
 92 international journal of mental health

the hikikomori. This notion raises the possibility that hikikomori may,
in some cases, be the result of an effort to reconcile two equally com-
pelling yet directly contradictory sets of behavioral demands and role
expectations. Rather than choosing one or the other courses of action, the
hikikomori may reflect a third option: choosing not to choose between
the two available sets of culturally defined role expectations.
If this postulation is reasonable, then it is sensible to suggest that the
personal experience of hikikomori over time may be precisely focused on
the search for a synthetic reconciliation of the two (or more) competing be-
havioral demands. As such, this search may be viewed as a legitimate effort
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to develop a set of new role definitions that better reflect ongoing changes in
the Japanese culture and society. For example, one of the relatively constant
components of postwar Japan has been the culturally anchored pressures
placed on young middle-class Japanese boys to excel in their university
entrance examinations. The preparation for these examinations can be
enveloped within a smothering family environment that leaves very little
room for a child’s private space. In this context, just as the anorexic became
a living rejection of bourgeois manners and morals, hikikomori may be, in
part, rejecting the very group-centered society and fanatical success orien-
tation that has been emphasized by the family as a direct expression of the
family’s status and identity. However, competing with such straight-forward
rebellion against the family may also be an equally compelling culturally
embedded logic to honor the family above all else, even if that means turn-
ing away from acknowledging the ongoing changes in Japanese culture
that are directly opposed to the traditional centrality of the family.
It is also interesting to note that young women may also end up in a
hikikomori lifestyle as a consequence of confronting the potential of self-
determination offered by a world of global possibilities while simultane-
ously facing the family’s expectations of becoming a traditional Japanese
wife and mother. For both young men and women, then, the unwillingness
to choose between two conflicting yet equally compelling roles may, in
this view, lead to the behavioral paralysis of hikikomori. However, in
contrast to current Japanese policy that primarily views hikikomori as a
kind of psychiatric disorder occurring among adolescents with dysfunc-
tional relationship with their parents, we propose that, at least in some
cases, hikikomori may be better seen as a very cogent and clear choice to
not engage in one or the other sets of conflicting behavioral expectations.
In short, rather than view hikikomori as a disease that is rooted in family
problems, we suggest that it may reflect purposeful inaction.
 Winter 2012–13   93

We immediately emphasize that not all cases of hikikomori can be

best explained through reference to purposeful inaction. Some still re-
quire a disease-based diagnosis and treatment. With that said, however,
we also can envision that at least some of those adopting the lifestyle of
hikikomori may be doing so on purpose.
Our use of the construct of purposeful inaction does not imply that
such internal decision making is foundationally rational, made through a
free and clear choice, or even necessarily informed with anything but the
most rudimentary self-awareness. Rather, our focus on purposeful inac-
tion is best understand in the context of the naturally occurring, internal
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life space directly experienced and used by the adolescent hikikomori to

make sense of their everyday life. From that perspective—the perspec-
tive of the adolescent—whether the decision to “do nothing” is right or
wrong is not important; it is simply a necessary action that must be taken
to avoid the potential consequences of actively engaging in the conflict
between Japan’s traditional past and its unknown global future
We fully recognize that viewing hikikomori as a choice not to choose
in a contradictory cultural context is highly speculative and best viewed as
a hypothesis deserving of further research rather than a final conclusion.
We hope, however, that this culturally based hypothesis of purposeful
inaction is sufficiently suggestive to Japanese policy makers that im-
portant new questions can be raised about how the profound changes
taking place in the larger Japanese society and culture may be affecting
the real-life choices being made by individual adolescents currently
defined as hikikomori. Indeed, we believe that increased interest in the
potentially legitimate logic for choosing not to choose (i.e., purposeful
inaction) among adolescents significantly expands the options for those
charged with developing public health hikikomori policy.
Rather than just looking for faults in family dynamics, underlying
psychiatric disorders, and new and better pharmaceutical interventions,
there may be benefit in expanding the range of policy potions through a
better understanding of the natural logic being used by youth to engage
actively in nonaction in the face of a variety of compelling, contradictory,
yet equally demanding sets of cultural demands and expectations.  

Notes

1. Original translations of Japanese source materials, including transcribed con-

versations with principles were conducted by the primary author. These translations
were based on his 12 years of professional work in Japan. Key elements of these
 94 international journal of mental health

translations were verified by the original author/speaker and further reviewed by a

bilingual native speaker. All Japanese names are listed as the Japanese would; that
is, family name first and given name second.
2. Recall that all Japanese names are listed as the Japanese would; that is, family
name first and given name second. Thus Saitoh is his family name, and Tamaki is
his first name. Saitoh Tamaki is the Head of Treatment Department in the Sohfukai
Sasaki Hospital. He is not to be confused with the editor of the MHLW-sponsored
white paper, Dr. Saitoh Kazuhiko.
3. We take culture here in a wide and intentionally inclusionary sense follow-
ing Tylor’s [20, p. 1] foundational definition: “Culture or civilization, taken in its
wide ethnographic sense, is that complex whole which includes knowledge, belief,
art, morals, law, custom and any other capabilities and habits acquired by man as
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a member of society.”
4. School refusal (tokokyohi or futohkoh in Japanese)—young people refusing
to attend school—appeared in Japan in the early 1980s.
5. The remaining members of the panel consisted of psychiatrists and research-
ers selected from various geographical areas of Japan who had direct experience
working within Mental Health and Welfare centers and National Psychiatric and
Mental Health centers.
6. Out of the three support dimensions listed in the guidelines [9], two are cen-
tered on the family, signifying how central the family is regarded as a causal factor
in the syndrome as Kondoh [8] suggested.
7. While it is clear that such iconic public personas of individual isolation as James
Dean, Marlon Brando, and Kurt Cobain are all rooted in the American experience,
we use them to exemplify the difference between active and focused efforts to engage
others about the experience of alienation and isolation to others versus the hikikomori’s
complete lack of effort to communicate anything at all about their internal lives.
8. Indeed, while unlikely, it is not inconceivable that some hikikomori may be
reflecting a premature but nonetheless similar conclusion as Prince Hamlet’s mys-
terious and multilayered ending asserts that “the rest is silence.”

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