The scene of a knife attack in Kawasaki, Japan. The attacker lived as an extreme recluse, known as a hikikomori. Photo / Getty Images
After the stabbing of 17 schoolgirls and two adults at a bus stop near Tokyo last week, a shocked public has been grasping for answers as to what could possibly have driven someone to commit such a horrific act.
Investigators and the news media have zeroed in on the fact that the attacker, who killed himself after the assault, which left two dead, lived as an extreme recluse — or "hikikomori," as the condition is known in Japan.
Then came another grisly crime over the weekend: A retired senior government official fatally stabbed his 44-year-old son, who lived with his parents and had no other social contact. The father, 76, reportedly feared that his son, who had physically abused his mother, might attack others, specifically citing the mass stabbing in Kawasaki, near Tokyo.
Even before these spasms of violence, Japan's hundreds of thousands of hikikomori faced a stigma in a country that has retained a strong taboo against even acknowledging mental illness. Now, psychiatrists and advocates worry that a new wave of fear mongering will leave hikikomori even more vilified and painted falsely as prone to heinous crimes.
While there are extreme recluses in other countries, experts say the condition may be most pronounced in Japan, where a culture that emphasises conformity prompts those who do not fit in to hide away.
Hikikomori are generally defined as adults who hole up in their parents' or other relatives' homes for six months or more, often confined to a single room. They do not work and rarely engage with the outside world, in many cases filling their days with television, the internet and video games. They cannot sustain meaningful relationships, often not even with the parents who physically and financially care for them. Some have lived in this state for years, or even decades.
According to a government survey released in March, there are nearly 1.2 million people who identify as hikikomori — about one in every 60 Japanese ages 15 to 64. But experts say that figure most likely under counts the full scope of the problem.
In the Kawasaki case, local mental health officials told reporters that the attacker, Ryuichi Iwasaki, 51, was a hikikomori who had not worked for "a long period of time." He was living with an aunt and an uncle who officials said did not "want to irritate him much."
Although there have been other high-profile violent crimes involving hikikomori — in which they killed family members, or parents killed adult children who had lived as recluses for years — the correlation is still rare.
"In the past 20 years, the number of hikikomori who have committed a violent crime is only a few — no more than 10 cases, for sure," said Tamaki Saito, a psychiatrist at the University of Tsukuba, about an hour northeast of Tokyo, who is a leading expert on hikikomori. "If we compare that with the general population, I think it's fair to conclude that hikikomori noticeably have no relation to crimes. They are a group with a low crime rate."
Although some studies suggest that hikikomori commit acts of domestic violence at higher rates than the general population, experts say the most pressing problem is that those with the condition, like others in Japan, rarely seek help for their mental health problems. Hikikomori may be affected by schizophrenia, depression or anxiety, or they may be on the autism spectrum.
"The scope of the problem is not things like a stabbing by a person who happens to be hikikomori," said Alan Teo, an associate professor of psychiatry at Oregon Health and Science University in Portland who has researched social withdrawal in Japan. "But more the scope of the problem is in terms of hundreds of thousands of individuals who have been in this protracted state of withdrawal without active engagement in mental health care."
Families are often ashamed to tell anyone that their child is struggling.
"Parents don't disclose the state of their children to outside society," said Tomiko Kushihashi, who runs a local chapter in Hyogo Prefecture, west of Kyoto, of Kazoku Hikikomori Japan, a support group for families of shut-ins. "The entire family is isolated from the society without calling for help."
A looming crisis, experts say, is that a large cohort of hikikomori are getting older, with little indication that they will ever be able to reintegrate into society. Their parents, as they grow older, worry about who will look after these disconnected adults.
According to the government survey, an estimated 613,000 people between ages 40 and 64 identify as hikikomori, outnumbering the 540,000 between age 15 and 39. The vast majority of them are men.
Takahiro A. Kato, a psychiatrist at Kyushu University who researches hikikomori and consults with families, said he was often approached by ageing parents — mostly mothers — who asked how they could continue providing for their grown children. "If I die, what should he do?" the mothers commonly asked, he said.
Advocates have coined the term "8050" to refer to the demographic problem of an increasing number of hikikomori entering their 50s while their parents are entering their 80s.
Psychiatrists still do not know exactly what causes an individual to withdraw into an extreme reclusive state. Some say vulnerable individuals may have been bullied during adolescence, or never learned to cope with anger or the stresses of daily life.
Kato said that Japan's educational system, which emphasises shame in its pursuit of conformity and can undermine personal confidence, may seed reclusive tendencies.
"In the US, a child is encouraged to do things and self-esteem is high," he said. "In Japanese culture and the educational system, children are not encouraged to develop high self-esteem."
Other researchers point to economic factors — hikikomori initially started appearing in large numbers after Japan's property-based bubble burst in the 1990s and many people were put out of work.
Even now that unemployment is low, some recluses may not want to take part in Japan's rigid and hierarchical work culture, where employees are expected to work long hours and promotions are mostly based on seniority rather than performance.
In the public imagination, mothers who spoil their sons are sometimes held to blame, while others point fingers at video game addiction or obsession with cartoons known as manga.
Some researchers say the phenomenon is more prevalent in Japan because the nuclear family is still so central to society and parents are reluctant to kick their children out of the house.
"Because of the way that social welfare works in Japan, it's hard for parents not to take those responsibilities," said Sachiko Horiguchi, an anthropologist at the Tokyo campus of Temple University.
Keeping everything hidden within the home can create a vicious cycle in which both hikikomori and their family members feel trapped.
"With a strong Japanese value of having to take full responsibility for your actions, family issues must be solved within a family," said Natsue Onda, a co-director of Hikikomori UX Kaigi, a group of former and current hikikomori.
Many prefectural governments operate support centers for families of hikikomori, but they are staffed by non specialists. The priority is to help prise hikikomori out of their rooms and get them back to work, a solution that may leave psychological issues unaddressed.
But the more hikikomori are demonised, or at least categorised as damaged or strange, the harder it is for them to be accepted in society or offered a job.
Private services have sprung up to assist families. They can cost thousands of dollars and are not required to provide qualified psychiatric care.
One such service is ReSTART, a company in Tokyo that moves hikikomori out of their parents' homes and into dormitories.
"It's easier said than done," said Shigeru Kusano, a former real estate agent who leads the company. "But to put it bluntly, anybody with the willpower to help others and compassion can do this job."
Written by: Motoko Rich
Photographs by: Ko Sasaki
© 2019 THE NEW YORK TIMES
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