“Hikikomori,” which translates to “withdrawn,” describes young people with a disorder characterized by extreme social isolation, in which sufferers lock themselves in their bedrooms and refuse to come out, even for years at a time. This disorder afflicts as many as one million Japanese citizens, overwhelmingly men in their 20s and 30s.
Hikikomori typically isolate themselves following a setback, such as failure in school or a bad breakup, that triggers a deep sense of shame. Hikikomori often exhibit symptoms of depression and obsessive-compulsive disorder during periods of withdrawal.
Takahiro Kato, a psychiatrist specializing in hikikomori, explains that the root cause of the condition is cultural, citing “a strong sense of embarrassment and an emotional dependence on the mother” in an interview with ABC News (Australia).
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While a handful of isolated cases of hikikomori have been found in South Korea, Hong Kong, and even Italy, the condition is considered a Japanese phenomenon, a kind of culture-bound syndrome.
A culture-bound syndrome is an affective, behavioral or cognitive disorder unique to a specific culture or group. Various cultural and social factors can contribute to the development of this condition. In the case of hikikomori, one contributor in Japanese society is “sekentei,” a person’s reputation in the community and the pressure to impress others, as explained by BBC News.
This same pressure can lead to a more prolonged period of withdrawal, as the isolation itself compounds the sense of embarrassment, and may delay relatives from seeking treatment for hikikomori.
One similar culture-bound syndrome linked to Japan is “taijin kyofusho,” a condition in which people suffer from extreme social anxiety as a result of often imagined physical shortcomings.
The American Academy of Family Physicians in 2010 reported the case of a 24-year-old graduate student from Japan, who was convinced his body odor offended other students. Despite the fact that no student ever complained of any odor, and the researchers themselves were unable to detect any offensive scent, the student was so anxious about his smell that he barely left his room and fell into depression.
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Not all culture-bound syndromes originate in Japan of course. The book, “The Culture-Bound Syndromes,” by Charles C. Hughes listed nearly 200 folk illnesses upon its publication in 1986. Some of the more unusual conditions identified as culture-bound syndromes include:
Amok: The expression “running amok” comes from the condition of the same name, first introduced to the West in the journals of Captain Cook. Cook described how affected individuals among Malay tribesmen would behave violently, going on homicidal rampages that involved an average of 10 victims. The killer has complete amnesia of the event once it’s over, assuming he or she doesn’t commit suicide or isn’t killed in the process, as is often the case. In addition to Malaysia, this behavior has also been observed in indigenous tribes in the Phillippines, Laos and Papua New Guinea.
Ataque de nervios: Similar to a nervous breakdown, this condition is a panic disorder reported among Latino and Caribbean populations. Symptoms include uncontrollable shouting, crying and aggression. This syndrome is most often caused by family-related stress.
Dhat syndrome: This condition is prevalent in the Indian subcontinent, but has been identified in China, the Americas, Europe and Russia and well. Individuals coping with dhat, described as “semen-loss anxiety,” often show symptoms of sexual dysfunction and loss of virility. Seminal fluid is considered the “elixir of life” in these cultures, so losing it is often linked to fear of irreversible physical damage or even death.
Ghost sickness: This condition is linked with Native American tribes in the American Southwest and Southern Plains and marked by an overwhelming preoccupation with the deceased. Symptoms of this syndrome include weakness, hallucinations, anxiety and feelings of terror.
Koro: This term describes a panic-like anxiety among men that their penises will withdraw into the abdomen and kill them. Symptoms include overwhelming concern about genitalia and fears of impotence or imminent death. This syndrome has been linked to men in China, although the koro phenomenon has manifested in a variety of cultures in Asia and Africa, so there is some debate as to whether koro is a universal condition.
Because so many of these disorders are unique to a specific population, and because there is considerable debate among psychiatry experts about whether these conditions are unique or are simply variations of Western diagnoses, treatment options are limited for those afflicted with culture-bound syndromes.
Undoubtedly when psychiatrists treat a patient for depression or anxiety or other symptoms that manifest as a result of these syndromes, culture is an important consideration for how to approach any potential treatment plan.
Al-Khatib, Talal. 2015. “Bizarre Behaviors From Around the World”. Discovery News. Posted: July 9, 2015. Available online: http://news.discovery.com/human/psychology/bizarre-behaviors-from-around-the-world-150709.htm