Looking at a Beautiful Moon While Immersed in a Lake of Petroleum: Narratives from Italian Individuals with Hikikomori

This study aimed at exploring the hikikomori experience of Italian young adults to detect some psychosocial patterns of hikikomori. A phenomenological analysis was conducted on the narratives of 17 individuals with hikikomori (9 men, 18–39 aged), who posted their stories of social isolation via an online forum. The analysis detected ten themes synthesizing the psychological structure of the participants’ lived experience, which were grouped into three overarching areas respectively dealing with passive identity, early traumatic experiences, and refusal of social participation. Overall, the findings support the psychosocial developmental theory of hikikomori about the reactivation of past insecure attachments and the anxiety associated with novelty and challenge. Limitations, suggestions for future research and clinical implications for individuals with hikikomori and their families are briefly discussed.

it should be noted that the term hikikomori might indicate heterogeneous conditions across different countries (Lee, Lee, Choi, & Choi, 2013;Teo et al., 2015), varying from a symptom of mental disorder to an expression of spirit possession (Loscalzo, Nannicini, & Giannini, 2016;Teo et al., 2015).
In particular, the problem of hikikomori is perceived as quite alarming in the Italian context (Pereira-Sanchez et al., 2019), where a high number of teenagers show similar behaviors (e.g., social anxiety, self-seclusion, school refusal, altered wakefulness-sleep cycle, problematic family relations) to those of their Japanese peers and several social services have started to deal with patients with hikikomori (Loscalzo et al., 2016;Ranieri, 2015). However, the scarce published scientific literature on hikikomori and the limited health professionals' knowledge about the phenomenon, mainly due to the lack of classification systems and intervention guidelines, may still contribute to the underestimation and undertreatment of hikikomori in such a context (Loscalzo et al., 2016).
The present study aims at exploring the hikikomori experience of Italian young adults through a phenomenological analysis of narratives about their social isolation. This may contribute to the qualitative investigation of the phenomenon, because detailed descriptions directly giving voice to people with hikikomori themselves are still rare in the current scholarship (Tajan, 2015b). Indeed, a phenomenological approach is proposed that can consent a better understanding of motivations, perceptions, and expectations around hikikomori, as a debated boundary condition between voluntary lifestyle and mental-health concern, and thus help promote more consistent psychological interventions addressed at such clients. Besides, since hikikomori is a complex phenomenon with multiple causes and undetermined etiology that may overlap with other mental conditions, narrative NARRATIVES FROM ITALIAN INDIVIDUALS WITH HIKIKOMORI 5 represents a powerful strategy for meaning-making and creating a sense of continuity about a condition that may be perceived as a life disruption, like illness or other forms of trauma (Rubinstein, 2016). The experience of hikikomori can be recognized as a subjective condition built through selfnarratives, which may illustrate the sense-making process about the self and one's life story, and the relocation of an individual's place within the family and the social context (Kleinman, 1998). From this perspective, an approach based on personal lived experience allows the formulation of datadriven hypotheses, without assuming a normative and well-defined hikikomori definition or testing specific hypotheses previously assumed by the researcher (Caputo, 2015(Caputo, , 2019a, which is relevant if considering the lack of classification systems allowing a formal diagnosis of hikikomori, especially in the Italian context. Specifically, the present study relies on hikikomori-related written testimonies collected via an online forum, which can serve as a practical data collection method in both social-and healthsciences. Online qualitative research methods are useful to sample minority groups with emotional and mental concerns (Caputo, 2018(Caputo, , 2019b, such as people with hikikomori as "a hidden population, which is, by definition, difficult to encounter, as a result of which whose authentic voices have rarely been heard" (Tajan, 2015b, p. 285). Indeed, this population is hard-to-reach, especially because of the hikikomori's defining feature of social isolation that generally prevents from seeking clinical care and participating in research (Pereira-Sanchez et al., 2019). Besides this, because people with hikikomori spend much of their time in online activity, especially on social media (Liu, Li, Teo, Kato, & Wong, 2018), online forums can be regarded as the favorite space where they can share their experience and potentially seek support from peers and mental health professionals (Pereira-Sanchez et al., 2019). Indeed, the internet can be considered as a rich and complex resource of textual material, because it allows participants to express their deeper feelings and be less inhibited than in a traditional interviewing environment, without relevant differences in the type of reported contents (Wood & Griffiths, 2007).

Participants of the Study
Textual data comprising hikikomori stories were used for the analysis. The stories were retrieved via the public online forum of the Italian Hikikomori Association where people could post and share their experiences of voluntary social withdrawal. All possibly sensitive information was removed. The already existing online forum was part of a website providing information and guidance about support programs addressed to people with hikikomori and their families to face this potential problem condition, with the general aims of raising public awareness about the phenomenon and creating a national network that puts institutions, families, and professionals in contact. No specific inclusion criteria for study participation were used since all the publicly available stories were retrieved and used for the analysis. Overall, the analyzed stories about the hikikomori experience were posted by 17 Italian young adults, both men (n = 9) and women (n = 8), mainly aged between 18 and 39 years. Textual data from the collected stories overall included 15,898 word occurrences (i.e., the total number of graphic forms isolated by means of separators such as blanks and punctuation marks), with a mean of 935 words per story. Concretely, participants were asked to freely provide and share an account of their subjective experience of social isolation as people with hikikomori. All participants gave their written informed consent to be included in the study before posting their stories.

Text Analysis
A phenomenological analysis of hikikomori stories was conducted according to Giorgi's method (Giorgi, 1975(Giorgi, , 1985(Giorgi, , 2009, which consists of a descriptive and explorative cross-case analysis of qualitative data, such as interviews or written texts. The major advantages of this method include the requirement of only a few study participants, the possibility to access individuals' lived experiences, and the good level of ecological validity (Caputo, 2019b). The analysis procedure NARRATIVES FROM ITALIAN INDIVIDUALS WITH HIKIKOMORI 7 consists of a manual (i.e., paper and pencil) coding of text-based qualitative data according to four steps. The first step (from chaos to themes) consists in reading the testimonies several times to get a total impression and identify preliminary themes, i.e. the main issues/matters concerning the participants' hikikomori experience, which need further elaboration with systematic reflection. The second step (from themes to codes) deals with identifying meaning units, intended as text fragments providing any knowledge about the hikikomori experience, and grouping them under the same code headings based on their similar content. This requires an iterative process where code headings can be developed from the initial themes or newly identified from the emerging meaning units. The third step (from code to meaning) implies condensation, through collecting together related code headings, sorting them and abstracting their content into a condensate, intended as an artificial quotation maintaining the original terminology applied by participants. The fourth step (from condensation to descriptions and concepts) refers to transforming the condensates and related concepts into an analytical text accompanied by authentic illustrative quotes. These analytical texts provide descriptions of the related findings and allow a synthesis of the psychological structure of participants' lived experience.

Results
The analysis has detected ten condensates that characterize the narratives of individuals with hikikomori and synthesize the psychological structure of their experiences, which are grouped into three overarching areas respectively dealing with passive identity, early traumatic experiences, and refusal of social participation. Specifically, the first area (passive identity) includes those condensates illustrating a poor sense of agency, expressed through deficient self-perceptions, reduced tendency to manifest anger, and a purposeless vision of the future. Besides, the second area (early traumatic experiences) refers to condensates about shocking and self-threatening events during childhood and adolescence, involving family neglect, school bullying, psychosomatic problems, and the loss of significant others. Then, the third area (refusal of social participation) includes those condensates NARRATIVES FROM ITALIAN INDIVIDUALS WITH HIKIKOMORI 8 expressing a voluntary isolation, mostly related to the low desire for intimacy, the anxiety about facing the world of work, and the overall perception of a corrupted and hostile society. In presenting the condensates referring to each area, some analytical texts illustrate the main related concepts, which are described by directly using the participants' statements.

Passive Identity
Deficient Hikikomori Self. This condensate deals with the hikikomori experience as a deficit condition in ego functioning in terms of vitality, self-determination, and capacity to enjoy positive experiences.
P12, female: "It's like I'm looking at a beautiful moon within a fairytale sky while I'm immersed in a lake of petroleum." P13, male: "Like someone with an amputated leg, I feel like my will was amputated: I can't want anything, I don't even know how to do it." Hikikomori narratives thus suggest issues of reduced self-esteem, revealing an identity shaped around passivity and fragility. P10, male: "I feel like a larva, or rather an empty shell, unable to start a conversation, unable to bond with a person." Suppressed Anger. This condensate highlights the deficient capacity to regulate emotions, especially anger that is regarded as a socially unacceptable emotion, thus leading to suppress potential aggressive reactions. P1, female: "My family situation led me to feel a lot of anger, long compressed and silenced.
Because I did not find understanding, empathy, and respect, I gradually felt that I no longer wanted where participants experience emotional neglect and lack of responsiveness to their own needs, which contributes to rejecting and distancing attachments. P3, male: "Mine continues to be a 'not family' […] They both worked outside Italy, so I seldom had the opportunity to see them except during the few annual festivities." P2, male: "When I tried to take the initiative, I was regularly ignored or silenced with sarcastic jokes, so I convinced myself that talking was useless." As well, marital conflict and parental separation/divorce are frequently reported issues, evoking the perception of the family as an untrustworthy institution. P10, male: "When I was a child, I suffered from asthma due to an allergy and I started taking cortisone that made me fat […] as a result, I had eating problems that led me to anorexia." P4, female: "I suffer from a terrible eating disorder called Binge Eating Disorder. Some people are addicted to drugs and cannot get out of them; I'm addicted to food." The reported complaints contribute to a perceived unhealthy status, which over time requires taking drugs and resorting to healthcare professionals' advice. P5, male: "I had chronic insomnia, which led me to a psychiatrist, so I started taking drugs since I was eighteen years old." Trauma of Loss. This condensate deals with earlier painful life experiences, such as romantic relationship breakup, significant others' death, or loved ones' illness, which may have a role in the onset of social withdrawal: P8, female: "My mother had breast cancer, now she is completely healed, but this event has marked me." This traumatic nucleus, overall concerning issues of separation and loss, seems to negatively affect hope and trust in life and human relationships:

Discussion
The aim of the present study was to explore some common themes about the subjective experience of social isolation of people with hikikomori, through a phenomenological analysis of their stories.
The first interesting result refers to the image of a deficient hikikomori self, overall featured by a fragile and passive identity, as also found in previous research studies (De Luca, 2017;Ranieri, 2015). This suggests that hikikomori may be conceived as an idiom of distress involving a depressed, addicted or traumatized self and as a form of socially regulated expression of complaint (Tajan, 2015b). Indeed, although hikikomori is viewed as a voluntary behavior to some extent, a significant degree of emotional distress and impaired personal functioning emerges from the direct voices of participants, confirming its problematic nature also in the Italian context (Loscalzo et al., 2016). This

NARRATIVES FROM ITALIAN INDIVIDUALS WITH HIKIKOMORI
14 passivity is intertwined with reduced emotion regulation capacity, especially concerning anger that tends to be suppressed and indirectly expressed through covert behaviors. In this regard, recent research has shown that people with hikikomori have higher passive-aggressive traits if compared with controls, thus expressing anger in more indirect ways (Katsuki et al., 2019). According to Tajan (2015b), hikikomori can be described as a passive struggle in terms of a silent form of resistance inside the home and outside social institutions. Social isolation may thus represent a subtle form of aggressiveness that is expressed through rejecting and keeping others at a distance. This is also supported by Ogawa (2012), who affirmed that such passive-aggressive dynamics, mainly due to insufficient maternal containing in childhood, sustains the withdrawal and nourishes pathological narcissism over time. Besides, the hypothesis of a passive-aggressive style seems consistent with other features, such as an ineffective self-assertion, a negativistic attitude, and a resistance to demands for adequate performance, as found in the present study. Pessimism about the future and disillusionment with life shaping hikikomori stories could thus be better understood in the light of an attack (at the symbolic level) to goodness and value of human existence, and not as a mere expression of depressive mood. Indeed, denying life meaning may make the inability to seek pleasure more tolerable (Suwa & Suzuki, 2013) and justify one's behavior as a way to actively choose passivity rather than undergo it (De Luca, 2017), thus allowing participants' to unconsciously avoid guilt feelings related to their inhibition.
Besides, a history of aversive or traumatic experiences characterizing the hikikomori condition are derived from the present study, similar to what was found in other countries (Teo et al., 2015). Almost all hikikomori life stories report peer rejection/bullying during school age (Hattori, 2006), considered as one of the main traumatic triggers of social withdrawal (Tajan, 2015b(Tajan, , 2017, leading to school phobia and education dropout over time (Ranieri, 2015). Another key issue refers to family relations, which are described as lacking exchange, empathy, and responsiveness, with emotional neglect as causing a sense of abandonment (Hattori, 2006;Ranieri, 2015). As well, the reported concerns about the parental couple (e.g., marital conflict, separation, divorce) in hikikomori narratives seem to suggest a breakdown of the family identity, within a socio-cultural perspective looking at hikikomori as related to the lack of social support structures and to the increasing weakening of institutions (Allison, 2013). Indeed, hikikomori life stories are characterized by traumatic experiences concerning separation and loss of significant others and by psychosomatic complaints involving body image distress since childhood and early adolescence. Given the impact of attachment distress on affect-centered mentalization and the relevance of the frustrating experiences of loss and separation for the onset of psychosomatic symptoms (Herrmann et al., 2018), a failed mourning process due to an unresolved loss can be hypothesized. Within a psychosomatic frame (Aisenstein & Rappoport de Aisemberg, 2010), the potential reduced mentalization of loss/separation episodes reported by participants (e.g., romantic relationship breakup, significant others' death, or loved ones' illness) may have generated a form of death anxiety, which is avoided by repressing aggressive impulses and projecting narcissistic libido onto the body, thus resulting in psychosomatic distress. As well, such traumatic experiences may have caused helplessness and impaired ego-functioningin terms of self-determination and effective adaptation to the environment -thus lessening the participants' capacity to repair through vital and hopeful investment on life (Goldstein, 2001). Indeed, one of the main features of hikikomori is the profound lack of confidence in life, accompanied by the feeling of being unsafe or unprotected when relating to others and the outside world (Hattori, 2006).
Then, the findings highlight that social withdrawal may result from the refusal of social participation, in line with the definition of hikikomori as a voluntary lifestyle of isolation (Uchida & Norasakkunkit, 2015). A low proneness to establish close social contacts and intimate relationships has been previously explained as depending on an ideal self-image originating in the desires of others rather than in one's own desire (Suwa & Suzuki, 2013). This seems intertwined with the perception of a corrupted and hostile society, as well as with the difficulty of integrating oneself into the labor force, supporting the definition of people with hikikomori as post-modern social renouncers (Tajan, 2015). In this regard, the high perceived pressures of the school to work transition and the demands of a competitive society progressively lead to developing inhibitions, seeking refuge in passivity, and relying on avoidance-based strategies (De Luca, 2017;Kato et al., 2018;Tajan, 2015b). Consistently, people with hikikomori consciously refuse to adopt the mainstream normative cultural values, as well as the standards of a post-industrialized and globalized society (Uchida & Norasakkunkit, 2015). In this sense, hikikomori appears as a phenomenon strongly intertwined with other public concerns in the aging society, such as the problem of young people not in full-time education, employment, or training (NEET), also in Italy (Tajan, 2015a).
In summary, some study limitations should be taken into account, such as the small number of participants and the convenience nature of the sample, preventing the generalization of the results to the entire Italian hikikomori population, which could be instead characterized by higher variability.
Besides, because hikikomori narratives were collected via an online forum, it should be acknowledged that a potential self-selection bias of participants could exist, including individuals with emotional distress or stronger need for support about their hikikomori condition. Therefore, given its qualitative and exploratory nature, the present study provides only some clues regarding the subjective experience of people with hikikomori that need further investigation. However, to our knowledge, it represents the first phenomenological study on hikikomori experience in the Italian context, providing evidence of several patterns similar to those characterizing social withdrawal in other countries, thus confirming the cross-national nature of this phenomenon (Ranieri, 2015). In this regard, some similarities between the Japanese and Italian cultures have been found, which may lead to the reduced autonomy of individuals, thus explaining the increasing spread of social withdrawal among Italian young people. For instance, such cultures are both characterized by a familistic society grounded on overprotective parenting (Aguglia, Signorelli, Pollicino, Arcidiacono, & Petralia, 2010;Ricci, 2014) and a strong financial dependence on families of origin (Spinello, Piotti, & Comazzi, 2015), with a very high number of solitary non-employed persons living with their families (Genda, 2019).
Besides this, the added value of the present study is to deepen and extend the phenomenology of hikikomori from direct testimonies, thus providing useful insights for future research development and clinical intervention in the field. Overall, the three identified aspects of hikikomori referring to passive identity, early traumatic experiences, and refusal of social participation may contribute to the understanding of social withdrawal behavior, so to promote more consistent interventions for people with hikikomori and their families in clinical practice. Self-imposed confinement can be described as a passive struggle against social pressures and resistance to outside world (Tajan, 2015b), probably triggered by a history of complex traumas experienced during childhood and adolescence, comprising school bullying, parental emotional neglect, and personal distress (Hattori, 2006;Tajan, 2017).
Indeed, such threatening events could enhance self-defectiveness and reduce sense of agency, overall leading to feelings of mistrust towards others and society as well as of anxiety to explore. From such a perspective, our results seem consistent with the psychosocial developmental theory of hikikomori (Krieg & Dickie, 2013;Li & Wong, 2015), stating that the individual's social interactions may be blocked due to the reactivation of past insecure attachments and the anxiety associated with novelty and challenge. Therefore, early adverse events (e.g., bullying, loss/separation, illness) should be carefully considered as potential emotional triggers of a hikikomori condition over time. As well, secure environments and support structures should be promoted as protective factors to help clients with hikikomori face school and work transitions, so to favor their autonomy and self-efficacy.