Preventing and Treating School Refusal and Severe Social Withdrawal

I first heard about ‘hikikomori’ on a visit to Japan 25 years ago. It was a new term then, used to describe severe and prolonged school refusal in teenagers, sometimes evolving into complete social withdrawal. The person’s life would become confined to a bedroom, with no friends and minimal contact even with family. In extreme cases, the hikikomori would remain isolated for years or even decades.

The problem has grown worse over time. There may now be more than a million hikikomori in Japan, many of whom are in their 20s, 30s, or 40s. The government wonders what will happen in coming decades as their parents age and begin to die. Who will care for this army of hermits completely unable and unwilling to care for themselves?

Hikikomori was originally regarded as a phenomenon peculiar to Japanese culture — perhaps related to its perfectionistic expectations, shyness, easy embarrassment, inhibition, parental indulgence, school bullying, wealth, and increasingly constrained job and marital prospects.

But the shut-in phenomenon has since gone global, increasingly reported also in South Korea, the United States, Oman, Spain, Italy, and France.

A major driver is the spread of internet gaming which can provide someone with an appealing alternate reality and a 24/7 international network of virtual friends — a more compelling and controlled social world than the rough and tumble rejections that occur in everyday life.

On a recent visit to Sweden, I discovered increasing concern about an identical set of behaviors (locally called ‘home-sitting’) and an excellent program to prevent and treat it, directed by Ia Sundberg Lax and her colleagues in Magelungen Utveckling.

She writes:

“School refusal can be the first step toward a complete and lifelong alienation from society- causing personal and family suffering, health problems, unemployment, and large social welfare expenses. The economic costs can be more than one million —> Read More