COVID Threatens
to Bring a Wave
of Hikikomori
to America
We should work to protect others from falling
into long-term social withdrawalI
n 2014 a vibrant and well-traveled patient I will
call Alice, whom I (Berman) was treating for bipo-
lar disorder, began refusing to leave her home
after a prolonged course of physical rehabilitation
for a spinal injury. None of the usual diagnoses—
depression, anxiety or agoraphobia—explained her
withdrawal, which continued after medications
stabilized her mood. Patients with these conditions
typically maintain a desire to be with others, but
Alice had shut out the world.
Recalling a 2010 paper by colleagues from the
University of California, San Francisco, I suspected
that Alice was experiencing hikikomori, a syndrome
of extreme social isolation originally found in Japan
that described primarily young men who confined
themselves at home rather than attend school or
go to work. The study proposed diagnostic criteriaCarol W. Berman is a psychiatrist and author in New York City. She is a clinical assistant
professor of psychiatry at New York University’s Grossman School of Medicine and maintains
a private practice. Berman’s M.D. is from N.Y.U. Her latest book is Taming the Negative Introject.
She is also a playwright with credits that include Under the Dragon.
Xi Chen is a medical student at the University of Rochester and a graduate student in
Columbia University’s Writing Program. He is writing a book about homebound Americans.Anita Anand/Getty ImagesOPINION