|Illustration: Raymond Limantara|
By Faris Mokhtar
In Singapore, private psychologists and psychiatrists say they see up to five cases a year of hikikomori, although there are no official statistics.
12 July, 2019
SINGAPORE — She was 27 and suffering from depression in 2015. Instead of seeking help, Jane (not her real name) decided to shut herself off from the outside world, spending most of her time alone at home.
For more than two years she lived like a hermit. On some days, she would listen to music, watch videos, play the guitar or read. But there were days when her mind slipped into an abyss.
“I couldn’t do anything other than compulsively overthink and self-harm,” she said, declining to elaborate.
She became reclusive when she decided to shut down her café, which she opened after graduating from university with a degree in advertising.
Asked whether something had triggered her to become a recluse, she replied: “It just naturally happened and I never thought I needed a reason for that because staying alone in my own world was just so much better than anything else.”
During the time she lived in isolation, Jane – who is now 31 and requested anonymity – largely relied on her savings. Grocery shopping was done online. When ill, she turned to home medication.
It was only recently that she was told by a psychologist that her situation was a case of hikikomori – a term coined by Japanese psychiatrist Tamaki Saito to describe adolescents or adults who withdraw from society, isolating and confining themselves to the walls of their homes for six months or longer.
In Singapore, however, it remains unclear as to how many individuals have the condition. The Institute of Mental Health has not seen any cases of hikikomori and there are no published local studies on the issue.
That does not mean there are no cases at all. Social workers and private psychologists and psychiatrists told TODAY that they see up to five cases a year, with most of them teens and young adults aged between 10 and 39.
But the number of people experiencing hikikomori could be bigger. It’s just that they go largely unreported because they are not coming forward to seek help, said social workers and psychologists.
Primarily, it’s because they refuse to make contact with professionals offering help either due to denial or the stigma attached. There is also a fear of meeting others aside from family.
As a result, parents too are at a loss as to whether they should seek help and how to go about doing it. The lack of intervention though could only make matters worse.
Ms Cindy Ng, the director of professional standards at Methodist Welfare Services, said: “It is like a downward spiral where the youth sinks deeper and deeper with time. The more isolated the youth is, the more fearful he is of interacting with others.”
A LACK OF AWARENESS
Unlike in countries such as Japan and South Korea, there is a lack of in-depth studies on the issue in Singapore or figures on how many are socially withdrawn.
In Japan, a government survey in 2015 showed there were an estimated 541,000 people – or 1.57 per cent of the population – aged between 15 and 39 affected by hikikomori.
A South Korean study in 2005 showed that there were 33,000 youths who were socially withdrawn. Experts in Hong Kong estimate that there could be 140,000 young people experiencing hikikomori there.
Psychiatrists and psychologists told TODAY that hikikomori is not a psychiatric diagnosis per se. Dr Marcus Tan, a consultant psychiatrist at Nobel Psychological Wellness Clinic, which is part of Healthway Medical Group, said: “At best it is but a descriptor of a set of behavioural characteristics.”
Mr Praveen Nair, a psychologist at Raven Counselling and Consultancy, said that there are underlying mental illnesses that could lead to individuals experiencing hikikomori. They include depression, agoraphobia or anxiety disorder as well as obsessive-compulsive disorder.
Dr Tan pointed out that hikikomori could also have cultural and social underpinnings – a reason that youths are susceptible to it.
Apart from having to juggle exacting academic standards, he pointed out that they are also in the midst of forging self-identity and making the transition to adulthood, where they are expected to take on responsibilities and meet expectations that “are starkly different from what they are used to”.
[This makes it sound like the hikikomori is in the pupae stage... except they don't emerge from their chrysalis.]
He added: “Stress is certainly a risk factor for social withdrawal.”
Ms Ng said that the lack of thorough understanding of the issue could lead some to perceive it as a mental health condition. Better awareness, she added, could reduce stigma and facilitate access to mental health services at an earlier age.
HIDDEN FROM VIEW
Individuals affected by hikikomori typically have poor social relationships – at home and in school or at work – and prefer to keep communication to a minimum, even with their family members.
They seldom leave their homes, which means some have left their education and jobs prematurely, and are almost always preoccupied at home with computer games, watching television or sleep.
Social workers as well as psychologists and psychiatrists who have overseen such cases said they were referred to them either by schools or other clinicians. Only a handful of parents reached out for assistance.
Mr Nair recounted a case of a young adult who was 29 when he was referred to him by another clinician in 2016. The man worked for two to three years before he decided to leave his job and live in isolation for the next four years.
One reason for that was because he did not enjoy the routine of work, said Mr Nair.
Describing the case as “extreme”, Mr Nair said that when he visited the man at his house, he still had dead pets such as fish and a hamster in his room. He could not bring himself to dispose of them, the psychologist added.
Supported by his parents, he has the financial means to live in isolation, but Mr Nair said that doing so has cost him certain basic human interaction skills.
“He often avoided eye contact, mumbled softly when he spoke and constantly folded his arms whenever he moved.”
Mr Nair said that he tried to counsel the man for a few months but he decided to stop attending the sessions.
CHALLENGING TO PROVIDE HELP
Seeing through the help required is also a challenge for those offering it. Ms Ng said: “When our social workers visit their homes, they ignore them and sometimes lock themselves in the rooms.”
Senior social worker Paul Tan from Methodist Welfare Services – which oversees three family service centres – experienced just that.
He recalled handling a case involving a 14-year-old secondary student who had a “poor prognosis”.
The teen had not been going to school for about a year when his school referred the case to Methodist Welfare Services. He eventually withdrew from his studies.
The school reported that the boy had displayed self-harm behaviour whenever he felt pressured to return to school. He had also threatened to hurt his family members when under duress.
Mr Tan said: “The family situation was difficult, highly conflictual and tense.”
On his first visit, the boy refused to even open his bedroom door. “His mum opened the door and I could see him just lying on the bed, playing with his phone,” Mr Tan said.
He paid three to four more visits, but each time, Mr Tan was stonewalled. The social worker even tried writing letters to the boy. There was no response.
In the end, the case was closed as not much help could be given.
[Can't blame the social worker. If you have 100 cases and 99 of them respond to you and seem to really want your help, and there there is one case which doesn't even want you there, doesn't respond, and you make no headway, no progress, wouldn't you rather return to the 99 cases that urgently NEED you, or at least respond to your attempts to help?]
Parents too are left helpless. Ms Renjala Balachandran, the head of SINDA Family Service Centre which sees two to four hikikomori cases per year, said that in the cases that her centre has dealt with, the fathers would "cope" by working long hours.
The mothers were left to handle the situations with little or no support.
Still, there are parents who tried, but felt defeated.
Mr Tan said that they also live in fear and apprehension, worried their children might hurt themselves if they are pushed too much.
And that has happened in some cases Mr Tan has to oversee.
Some cut themselves, others turned aggressive towards their family members, hurling things at them. There are also those who threatened to attempt suicide if they are forced to go out of their homes.
Ms Ng, who said that Methodist Welfare Services sees up to five cases of hikikomori a year, noted that the current ecosystem of help does not facilitate mandatory referral for treatment. “Often we are unable to proceed with intervention,” she added.
BECOMING MORE SOCIABLE
Dr Tan, who has seen 10 to 15 cases during his 20 years in practice, said that about half of his patients regularly come in for sessions – once to twice a month. There are two to three patients who stopped their sessions with him.
For individuals with hikikomori, recovery “is slow as a tremendous amount of time is usually required to engage these individuals and have them be less reclusive”.
He added: “At present, an effective clinical approach and strategy of treatment remains lacking. At my clinic, apart from spending time trying to engage these individuals, I employ a combination of psychotherapy and pharmacotherapy to help manage the anxiety they experience and reframe the fears they have.”
For Mr Nair, who has come across 10 to 20 cases since he started practising in 2004, said there have been instances of improvements in behaviour.
But most practitioners, he said, prefer to follow the maxim used in the treatment of addictions, whereby the client is informed that there is no “magic cure” and each day is a process of positive change that the client needs to be aware of.
“As such, it is hard to say that a case is considered cured. This keeps clients constantly vigilant and aware that every day is part of a process,” he added.
In Jane’s case, she has become more sociable and is now studying for a second degree in psychology at a private university.
There were challenges, of course, to lead a life of normalcy. And the biggest obstacle – herself.
“Socialising looks natural and easy for most people but I just can’t. So I feel really rubbish because I can’t do what people easily do even if I try so hard.”
Exercising at home was a turning point for her, Jane said. It changed “my body and my lifestyle, and most importantly my mindset”, she added.
Nevertheless, coming out of her shell remains a work in progress. She declined to do a face-to-face interview for this article, preferring to respond through emails facilitated by Mr Nair, who is also her lecturer.
“It may seem like I’m doing fine today but it’s still challenging. It’s tough but I think it’s all about the mindset. I know exactly that I need the practice, so I push myself very hard even if it’s tough.”