In an earlier blogpost I wrote about the potential for culture to both create mental illness and label normal illness as mental illness. I thought it would be useful to delve a little bit more into this cultural effect in this blog entry. The phenomenon of Hikikomoris or those who withdraw socially is worthy of further examination.
Andy Furlong talks about the phenomenon in a 2008 article of the Sociological review. The phenomenon presents us with, first of all, an example of a culturally created form of mental illness and, secondly, with an example of normal experience being recolonized by mental ill health.
Normal experience recolonized by mental illness
Looking at the second claim first one can see that the focus on hikikomori as an exclusively psychological phenomenon within a homogeneous group of people. Furlong points out that Hikikomori covers a number of subgroups of people including Otaku and another subgroup characterized as the alternative scene. The first Otaku are seen as ‘nerds’ and ‘geeks’ but they don’t seem to suffer from any recognizable psychiatric condition or peculiar individual psychological malaise. The group forming the alternative scene do not even fit the criteria for Hikikomori but they are still lumped in with the others even though they do leave their homes, form relationships with people and take the freelance work that is the market provides for youths.
When a young person exhibits detachment and lethargy in Japan Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (CFS) are not used as diagnoses. They have a very popular syndrome which they like to call ‘Student Apathy Syndrome’. Perhaps they could add to that a syndrome called ‘I’m sad because my dog is sick syndrome’ or possibly a ‘human condition syndrome.’ The Chinese attitude towards mental health similarly recolonizes normal experience as mental illness. The stigma that is attached to conditions in China definitely adds to the problem. Seeking help from therapists or psychiatrists is a method of last resort coming only after the stage of family, friends and religious healers have been passed. It represents the giving up stage of the family. Additionally the Chinese experience is shaped by the very long periods required and culturally sanctioned by families learning to cope with the difficulties of one of their members.
The Culture in China establishes the individual’s thoughts and feelings as something to be kept within the family. The culture of shame in turn then has created a culture and phenomenon of the somatization of mental difficulties. This is following the pattern of traditional Chinese emotions which sees each of the major emotions as having a corresponding organ which it effects. Tsung-Yi Lin, MD, discussing it says that heart was supposed to be the site of happiness, anger the liver, worry the lung, fear the kidney and desire the spleen.
Cultural creation of psychological problems
It might seem somewhat contradictory to argue that normal experience is being transformed into mental illness and then argue that the culture is creating mental illness. There is psychological difficulty and there is mental illness and I am not trying to suggest otherwise but the creation of this ‘mental illness’ is in large part created by the culture. It is the attitude of mislabelling and mishandling normal psychological difficulty that turns it into mental illness. The exclusively taxonomical approach to the phenomenon is belied by the job market in Japan.
There used to be a system called ‘Jisseki-Kankei’ which involved teachers taking on job placement functions and featured strong links between schools and employers. This system imploded with the recession in the 1990’s. In 1992 1 million job offers were made to Japanese High School Graduates. That number fell to 0.6 million in 1995 and then to 0.2 million in 2003. In a culture that attaches self-esteem to regular jobs and makes no room for second chances it is not surprising that suicides peeks the around March which is the end of the fiscal year and the time when people are let go from their jobs. In terms of the mishandling of the symptom I would give the following example. One approach is for a team of workers to forcibly enter the room of the hikkimoris and scold them for their sloth before removing them to their institution where they would be forced to see the error of their ways.
This, unsurprisingly, does not work. The Japanese public remains sympathetic to these institutions even after one died detainee after being chained to a pillar for four days. Apparently though that’s cool and the public evinced sympathy for the Director because Hikikomori are of course free riding deviants who should be brutally killed. It wouldn’t cross anyone’s mind that perhaps the problem is symptomatic of a wider societal dysfunction perhaps the one that thinks its cool to torture culturally created outcasts as free riders (To death!).
Returning to the Chinese example again one sees a number of culture-bound syndromes described by Tsung-Yi Lin, MD. All of the syndromes he mentions have an important feature in common and that is the somatization of anxiety and fear. To that extent they are culturally created difficulties. There is, for example, Koro which is characterized by panic that the penis will shrink into the abdomen and the person will die.
Then there is frigophobia where patients suffer from an excessive fear and intolerance of cold in terms of temperatures and foods of cold or ‘yin’ nature. Finally, I will mention Shen-k’uei which is characterized by weakness, fatigability, insomnia, anxiety and hypochondria. This of course if not dysphoria in China but of course caused by excessive masturbation, nocturnal emission or intercourse and for this reason is often called sexual neurasthenia. The regressive features within Japanese and Chinese mental health cultures might seem to be easy pickings. One could easily say it’s not that bad in Ireland for example. Yes it is not that bad but it is a bit that bad. While the hikkimori problem is not our problem the issues it raises are issues in Ireland even if less pronounced. The same with the Chinese example we may not have a culture that’s as obsessed with somatization but we still talk in terms of controlling symptoms. We will still conflate symptoms with the illness rather than recognise that everyone has their own unique symbolic world or umwelt. If we were to look at people, and by extension societies, in terms of their symbols we might learn of the great mass of societal dysfunction or insanity.