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 (タイトル・クレジット表記 日/英)

 «修復のモニュメント「ドア」»
 渡辺 篤
 2016–2020年
 写真：井上圭佑
© Atsushi Watanabe 2020

 MONUMENT OF RECOVERY “The Door”

Atsushi Watanabe
Photo by Keisuke Inoue
© Atsushi Watanabe 2020
 Mental Health and Social
Withdrawal in Contemporary Japan

This book examines the phenomenon of social withdrawal in Japan, which

ranges from school nonattendance to extreme forms of isolation and confine-
ment, known as hikikomori. Based on extensive original research, including
interview research with a range of practitioners involved in dealing with the
phenomenon, the book outlines how hikikomori expresses itself, how it is
treated and dealt with, and how it has been perceived and regarded in Japan
over time. The author, a clinical psychologist with extensive experience of prac-
tice, argues that the phenomenon although socially unacceptable is not homog-
enous and can be viewed not as a mental disorder, but as an idiom of distress,
a passive and effective way of resisting the many great pressures of Japanese
schooling and society more widely.

Nicolas Tajan is a program-specific associate professor in the Graduate School

of Human and Environmental Studies at Kyoto University, Japan.

BK-TandF-TAJAN_9780815365747-200257-FM.indd 1 09/11/20 1:29 PM

 Japan Anthropology Workshop Series
Series editor:
Joy Hendry, Oxford Brookes University

Editorial Board:
Pamela Asquith, University of Alberta
Eyal Ben Ari, Kinneret Academic College, Sea of Galilee
Christoph Brumann, Max Planck Institute for Social Anthropology, Munich
Henry Johnson, Otago University
Hirochika Nakamaki, the Suita City Museum

Founder Member of the Editorial Board:

Jan van Bremen, University of Leiden

The Japanese Family

Touch, Intimacy and Feeling
Diana Tahhan

Happiness and the Good Life in Japan

Edited by Wolfram Manzenreiter and Barbara Holthus

Religion in Japanese Daily Life

David C. Lewis

Escaping Japan
Reflections on Estrangement and Exile in the Twenty-First Century
Edited by Blai Guarné and Paul Hansen

Women Managers in Neoliberal Japan

Gender, Precarious Labour and Everyday Lives
Swee-Lin Ho

Global Coffee and Cultural Change in Modern Japan

Helena Grinshpun

Inside a Japanese Sharehouse

Caitlin Meagher

Mental Health and Social Withdrawal in Contemporary Japan

Nicolas Tajan

For a full list of available titles please visit: www.routledge.com/Japan-

Anthropology-Workshop-Series/book-series/SE0627

BK-TandF-TAJAN_9780815365747-200257-FM.indd 2 09/11/20 1:29 PM

 Mental Health and Social
Withdrawal in Contemporary
Japan
Beyond the Hikikomori Spectrum

Nicolas Tajan

BK-TandF-TAJAN_9780815365747-200257-FM.indd 3 09/11/20 1:29 PM

 First published 2021
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
52 Vanderbilt Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa
business
© 2021 Nicolas Tajan
The right of Nicolas Tajan to be identified as author of this work has
been asserted by him in accordance with Sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
The Open Access version of this book, available at www.taylorfrancis.com,
has been made available under a Creative Commons Attribution-Non
Commercial-No Derivatives 4.0 license.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalog record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record has been requested for this book

ISBN: 978-0-8153-6574-7 (hbk)

ISBN: 978-1-351-26080-0 (ebk)

Typeset in Times New Roman

by KnowledgeWorks Global Ltd.

BK-TandF-TAJAN_9780815365747-200257-FM.indd 4 09/11/20 1:29 PM

 Contents

Prefacevi
Acknowledgementsviii
Introduction: Step aside, intersections, minor roadsxi

1 School nonattendance created the need for clinical

psychologists1

2 The resistance to students’ psychological care 32

3 Is social withdrawal a mental disorder? 59

4 Mental health surveys on hikikomori88

5 NPO support toward hikikomori youths 117

6 Hikikomori subjects’ narratives 151

7 Beyond the hikikomori spectrum 186

8 Conclusions: Social isolation, biopower, and the

end of the clinic 219

Index 243

BK-TandF-TAJAN_9780815365747-200257-FM.indd 5 09/11/20 1:29 PM

 Preface

“Hikikomori phenomenon, far from being homogeneous, begins to appear

as it really is: the history of a myriad of singular subjects who, despite them-
selves, draw attention to their absence while making social renunciation an
idiom that is deeply subjective and eminently social.” This quotation encap-
sulates some of the central issues of this fascinating and important work.
Nicolas Tajan is not an anthropologist but a clinical psychologist who was
brought by his topic of inquiry to act and proceed in his research more
and more like an anthropologist. As the above mentioned sentence indi-
cates hikikomori is not a psychiatric category – showing this is one of the
central aims of the book – the term refers to “the history of myriad singu-
lar subjects” rather than to an ailment with clear characteristic traits. The
point is not merely that this failure at being a homogeneous set of indi-
viduals or psychological characteristics reflects the difference between the
method of the psychiatrist, who sees instances of particular diseases and
categorizes them as depression or bipolar disorder, and that of the anthro-
pologist, who seeks to encounter others as they are in their diversity, rather
than to categorize them. The point rather is that the reason why hikikomori
escapes psychiatric categorization is neither because these categories do not
constitute knowledge nor because it is true that all medical categories sub-
sume under a single term myriad singular subjects, but because hikikomori
fails to become an object of psychiatric knowledge. It is not a mental disease
but a psychosocial phenomenon.
The hikikomori does not ask anything from the psychiatrist, or the
medical profession in general, or from any others in particular actually:
hiding, shut in a room in a house that he or she rarely leaves. There is a
paradox here in viewing these persons as “patients”. How do you meet
someone who does not want to meet anyone? What if you succeed, is the
person you met a hikikomori or not hikikomori anymore? This desire for
isolation and loneliness, which Tajan describes as an “idiom of distress,”
is eminently social and challenges the health professions. Here are persons
who do not ask for help, do not come forward with their complaints, and
therefore are only made into “patients” by others. Which happens only some-
times, when they are not hidden from view by the family from (and within)

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 Preface vii
which they are hiding. In either case, they do not seek help, for whatever
reason they have renounced asking.
The clinic has always been about responding to the patient’s demand, even
if in many cases, this meant reinterpreting it in a different way. Medical and
psychiatric categories are tools that help the specialist endowed with knowl-
edge, called upon because of that knowledge, to respond to the patient’s
demands. Hence the need for a different method and approach when the
person’s way to ‘address’ others is silence, isolation, social renunciation; one
that is not, or at least that is less, predicated on a hierarchical relation of
knowledge and thus closer to that of anthropologists. Clinical psycholo-
gists interested in hikikomori have to do fieldwork. They cannot remain in
their office waiting for the patients to come. They must go to them. This
profoundly changes the relationship and indicates that these individuals in
distress are not like those who can be analyzed, and disciplined through the
use of psychiatric categories. In what ways are they different? This is what
this book describes with finesse and attention and tries to interpret in a
larger social and historical context.
The hikikomori phenomenon, according to Tajan, makes visible an ongo-
ing process of social transformations of which it is part. One that is par-
ticularly visible in Japan, but that is also present in many places across the
world. It concerns the place of medical professions in contemporary post-
modern societies, the way individuals attempt to make themselves into sub-
jects, their refusal of current mental health practices, and it questions the
place and role of anthropological knowledge in this changing world.

Paul Dumouchel

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 Acknowledgements

Before beginning this book, I had the privilege of completing my Ph.D. in

psychopathology at the University of Toulouse in 2014 under the exceptional
supervision of Marie-Jean Sauret and Pierre-Henri Castel. In France, most
of those who are interested in Lacanian psychoanalysis know Marie-Jean
Sauret for his unique style that combines kindness, humor, firmness, and a
sincere involvement in political matters. It is still a surprise for both of us
that his legacy continues in Japan where I work now as an associate profes-
sor and a psychoanalyst. And, I honestly do not have enough words to say
how privileged I feel to have met one of the most prolific thinkers in con-
temporary France: Pierre-Henri Castel. Since our first contact in September
2009, I owe him the freedom I took to allow myself to adopt an approach
that is at the crossroads of Lacanian psychoanalysis, clinical psychopathol-
ogy, history of psychiatry, and the anthropology of mental health.
I would also like to express my gratitude to Tsuiki Kosuke for allowing me
to work from April of 2011 to March of 2017 in the Institute for Research in
Humanities at Kyoto University. He was also immensely helpful in answering
my questions about the Japanese language, culture, history, and society.
I am very thankful for all the people from the NPOs supporting hikikomori
and nīto who agreed to welcome me and answer my questions, in particular the
members of the NPO M. and the NPOs of the G. and H. prefectures, namely,
Messrs. Arai, Nomura, Yamamoto, Murata, Sano, Wada, and Taniguchi, as
well as Ueyama Kazuki, with whom I spoke at length. Within the profession-
als of H. prefecture supporting young truants and their parents, Ms. Otsuka,
Mr. Sakurai, and Dr. Matsuda graciously contributed toward helping me
better understand the Japanese health and medico-social fields. I would also
like to thank Prof. Kubo along with Misaki and her parents.
For the rereadings and the remarks concerning the early versions of my
work, I would like to thank Sophie Moulard, Aline Henninger, Natacha
Vellut, Rodrigo Drozak, Philippe Lavergne, Jeanne Gaillard, Marc-Henri
Deroche, and Miwaki Yasuo. Regarding the verification of kanji, romaniza-
tions, and their remarks on translations, I would like to thank Ueo Masamichi,
Nobutomo Kenji, Horikawa Satoshi, Fukuda Daisuke, Yamaguchi Takeshi,
Inoue Haruko, and Isomura Dai. For the last versions, my gratitude goes

BK-TandF-TAJAN_9780815365747-200257-FM.indd 8 09/11/20 1:29 PM

 Acknowledgements ix
to Eyal Ben Ari, Hamasaki Yukiko, Nancy Pionnié-Dax, Shiozawa Meiko,
James Coates; Ichida Yoshihiko, Koizumi Yoshiyuki, Hirose Jun, Ohji
Kenta, and members of the Foucauldian Studies Research Seminar (Kyoto
University, Institute for Research in Humanities); and Paul Dumouchel,
Matsumoto Takuya, and Joan Jastram.
I thank my parents Monique and Jean-Jacques Tajan, and my wife Maiko
Tajan, along with the rest of my family for all of their support.
Finally, I would like to thank the following institutions for granting me
the funding that enabled me to carry out this research:

Japan Foundation [2010]

The Japanese Society for the Promotion of Science (JSPS) [Post-Doctoral
Fellowship (short-term) for North American and European Researchers,
through a Nominative Authority (CNRS), 2012]
Canon Foundation in Europe [Canon Foundation in Europe Fellowship,
2014]
The Japanese Society for the Promotion of Science (JSPS) [Post-Doctoral
Fellowship (standard) for North American and European Researchers,
2015]

This work was supported by JSPS KAKENHI Grant Numbers 19K12975,

18H00999, and 18KK0068. Any opinions, findings, and conclusions or
recommendations expressed in this material are those of the author and
do not necessarily reflect the views of the author’s organization, JSPS
or MEXT.
All information that could reveal the identities of the people that have
been questioned has been changed, and the names of the associations in
which I have investigated have been anonymized, with the exception of
Mr. Ueyama’s testimony and various information available on the Internet
(e.g., the testimonies Mr. Maruyama and Ms. Hayashi, Newstart, and KHJ
websites).
Some portions of the current book have been published in their earlier
versions in French, Japanese, or English publications listed here.

Tajan, Nicolas. 2015a. “Adolescents’ School Non-Attendance and the Spread of

Psychological Counselling in Japan.” Asia Pacific Journal of Counselling and
Psychotherapy 6 (1/2): 58–69.
Tajan, Nicolas. 2015b. “Social Withdrawal and Psychiatry: A Comprehensive
Review of Hikikomori.” Neuropsychiatrie de l’Enfance et de l’Adolescence 63 (5):
324–331.
Tajan, Nicolas. 2015c. “Japanese Post-Modern Social Renouncers: An Exploratory
Study of the Narratives of Hikikomori Subjects.” Subjectivity 8: 283–304.
Tajan, Nicolas. 2017a. Génération hikikomori. Paris: L’Harmattan (Collection
Japon).
Tajan, Nicolas. 2017b. “Traumatic Dimensions of Hikikomori: A Foucauldian Note.”
Asian Journal of Psychiatry 27: 121–122.

BK-TandF-TAJAN_9780815365747-200257-FM.indd 9 09/11/20 1:29 PM

 x Acknowledgements
Tajan, Nicolas, Yukiko Hamasaki, and Nancy Pionnié-Dax. 2017. “Hikikomori: The
Japanese Cabinet Office’s 2016 Survey of Acute Social Withdrawal.” The Asia-Pacific
Journal 15 (1): 1–11.
Tajan Nicolas, and Meiko Shiozawa. 2020. “Hikikomori wo saikōsuru – kaigai,
tokuni furansu no jirei 「ひきこもり」を再考する―海外、特にフランスの事例”
(Rethinking Hikikomori – Examples from France and Abroad), Kyōku to Igaku
教育と医学. 3/4: 54–61.

BK-TandF-TAJAN_9780815365747-200257-FM.indd 10 09/11/20 1:29 PM

 Introduction
Step aside, intersections,
minor roads

“Trust the author you are studying. But what does it mean to ‘trust an
author’? It means the same thing as groping, proceeding with a kind of
groping. Before you fully understand the problems someone poses (…) you
have to silence the voices of objection at all costs. The voices of objection are
those which would say too quickly: ‘Oh, but look here, there is something
wrong’. And to trust the author is to say, let’s not talk too quickly (…) you
have to let him speak.”
Gilles Deleuze Cours sur Michel Foucault October 22, 1985

Defining hikikomori
Shakaiteki hikikomori designates a phenomenon of social withdrawal and
the individuals concerned, i.e., shut-ins. Shakaiteki means “social” and the
word hikikomori is composed of hiku (to pull, draw, retreat) and komoru (to
shut oneself up, stay inside). Hikikomori has long been difficult to define;
however, recently, a consensus appears to have been reached among psy-
chiatrists. “Hikikomori is a form of pathological social withdrawal or social
isolation whose essential feature is physical isolation in one’s home. The
person must meet the following criteria: a) marked social isolation in one’s
home; b) duration of continuous social isolation of at least 6 months; c) sig-
nificant functional impairment or distress associated with the social isola-
tion” (Kato, Kanba, and Teo 2020: 117).
This consensus represents marked progress from previous definitions.
However, I have some reservations about the statement that it is a “patho-
logical” form or that it must require “significant functional impairment
or distress associated with the social isolation.” It is not a criticism of
colleagues, who I appreciate as individuals and scholars. It is simply that
psychiatrists determine pathologies and are trained to treat what they
call “disorders.” I must say that I myself am passionate about the history
of psychiatry and the way in which psychiatrists create psychiatric cat­
egories. I also find the new formulation of Kato, Kanba, and Teo (2020)
interesting: “Individuals who occasionally leave their home (2–3 days/week),
rarely leave their home (1 day/week or less), or rarely leave a single room

BK-TandF-TAJAN_9780815365747-200257-Intro.indd 11 09/11/20 1:29 PM

 xii Introduction
may be characterized as mild, moderate or severe, respectively,” (p. 117)
while those who leave their room 4 or more days a week are excluded from
the hikikomori category. In addition to their recognition that hikikomori
co-occurs with other mental disorders, their contribution is an important
step compared to previous works. That being said, my approach is very
different because I am questioning the very fact that hikikomori is a pathol-
ogy, including the modalities of assessing the impairment or distress of
the persons concerned. More precisely, I question the basic assumptions
of psychiatric categories from a standpoint where the history and anthro-
pology of mental health, clinical psychopathology, and Lacanian psy-
choanalysis intersect. This point of view features in Japanese academic
categories as “intellectual history” (shisō shi): I address the very notion
of loneliness while simultaneously combining theories and methods of the
history and anthropology of mental health, clinical psychopathology, and
Lacanian psychoanalysis.
This book is about social withdrawal (from school nonattendance to
acute social withdrawal called hikikomori) and psychological clinics in
contemporary Japan. The volume builds on my ethnographic research on
mental health practices in contemporary Japan (Tajan 2014, 2015a-c; Tajan
and Shiozawa 2020), and its perspectives encompass aspects related to the
meaning and experience of distress, illness, mental health, and support;
the cultural, historical, clinical, and linguistic context of support practices
and access to care; and the cultural influences on individual’s and the pop-
ulation’s mental health and expression of distress. Overall, the book aims
at contributing to anthropological inquiry while making arguments rele-
vant to the interdisciplinary study of subjectivity. More precisely, my goal
is to stimulate the development of important theory, methods, and debates
in the anthropology of mental health and to explore the links with neigh-
boring fields in the humanities, social sciences, and mental health–related
disciplines.
This study is an investigation of a hidden population, which is, by defi-
nition, difficult to encounter, and as a result authentic voices have rarely
been heard. Philological, clinical, and ethnographic methods have been
used. The philological methodology is crucial here because the study
of texts (and interviews) in their original language (Japanese) ensures
that the translation does not mislead the reader and that it respects the
subjects’ points of view. The clinical methodology is widely used in med-
icine and psychology, and originated from being at a patient’s bedside,
observing their symptoms. Given my training as a clinical psychologist
and my psychoanalytical clinical practice, I conducted and interpreted
sources and interviews with a clinical perspective and sensibility, using
ethnographic methods. I used ethnographic methods and techniques
such as participant observation and field interviews, which are often
employed in cultural anthropology, when collecting the narratives of
hikikomori subjects.

BK-TandF-TAJAN_9780815365747-200257-Intro.indd 12 09/11/20 1:29 PM

 Introduction xiii
Anthropology matters for clinicians
I am not an anthropologist, yet I thought of this work as a volume that
would follow on from Encounters with Aging by Lock (1995) and Depression
in Japan by Kitanaka (2012). To me, these two books are required reading
for anyone interested in mental health issues in contemporary Japan.
As I write this introduction and finalize this book in Spring 2020, our
societies are experiencing unprecedented confinement due to the COVID-
19 epidemic. I have been a program-specific associate professor at Kyoto
University since February 2019, where Associate Professor Matsumoto
Takuya and I contribute to the Laboratory of Psychopathology and
Psychoanalysis and its Kyoto University International Mental Health
Seminar. I also officiate as vice president of the International Mental
Health Professionals Japan.
I am not a lover of Japan, but I like living here in Kyoto and its sur-
roundings and suspect that I will stay here for a long time, maybe forever.
It is perhaps the only place in the world that allows me to be immersed in
three languages – Japanese, English, and French – on a daily basis, and it
truly contributes to very simple feelings of happiness. However, a decade
ago, I was far from imagining the direction my life would take. At the time,
around 2009, I was in the Bordeaux area, where I worked full time in a
guidance center offering psychotherapy to children, adolescents, and their
families. I do not want to hide anything here: I loved my job; the team was
amazing; and we were able to successfully support a number of children and
families in distress.
To tell the truth, as soon as I finished my master’s degree in psychology in
2005, I wanted to enroll in a Ph.D. program, but I also had a deep desire to
invest myself in clinical practice, which for me continues to be, even today
and hopefully for a long time, an invaluable source of teachings. Around
2009, I decided that it was time to embark on a Ph.D. At the same time, I
wanted to live a year abroad, an opportunity I did not have before. Japan
had started to interest me, though very gradually in recent years: its food,
gardens, language, culture, and arts. Also, there was Jacques Lacan’s idea
that the Japanese were unanalyzable (Lacan 2005: 126), which intrigued me.
I planned my first trip to Japan in the summer of 2009, during which I had
the opportunity to meet several psychoanalysts and psychiatrists, to whom I
asked a simple question: currently, what is the most important issue in youth
mental health? Their response was unanimous: hikikomori and the increase
in autism and developmental disorders. Back in France, I had written a pro-
ject on these themes, accepted a few months later by the Japan Foundation.
During my Ph.D., I had to narrow the spectrum of my research to the study
of hikikomori, but my interest in autism has remained alive and is one of the
topics in my current research pipeline.
Since April of 2011, I have lived continuously in Kyoto, Japan. Here, I met
my future wife, did my Ph.D. and postdoctoral research, got married, had

BK-TandF-TAJAN_9780815365747-200257-Intro.indd 13 09/11/20 1:29 PM

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