New anthropological questions concerning pathological aspects of the human condition emerge from the hyper connected world. A leading one refers to the experience of derealisation in the Onlife environment. The blurring domain where the real and the digital are melted together, theorized by Floridi (2015), is highly valuable to investigate complex phenomena that are frequently interrelated. It is the case of hikikomori syndrome or severe withdrawal from society that affects adolescents and young adults. After having argued that the hikikomori is a phenomenon of derealisation, the authors suggest that the use of the Internet, within the voluntary isolation of the individuals, is not primarily a digital addiction like PIU or MIU (which may be frequently among the causes of the isolation), but highlights on the effort of filling the void determined by the voluntary detachment from any social activity. This process can be interpreted as a therapeutic approach to self-isolation from the world of life. The authors suggest that this theoretical insight could be highly relevant in psychiatry for grasping nosology and treatment of social isolation, a psychodynamic problem, an emerging issue that needs to be tackled with multiple approaches.
Keywords: Derealisation, Disconnection, On life, Offline, Online, Hikikomori, Internet addiction
Derealisation is the well-known experience of discomfort suffered from the self as a consequence of the loss of contact with the world of life: In a phenomenological perspective, it depends on the lack of relation between the existential poles (I-You, Self-objects). In psychiatry “Depersonalization-derealisation disorder”  refers to the feeling of being detached from the environment; a condition in which the individual perceives himself/herself as an outside observer.
People can make this experience occasionally, in case of traumatic events, stress or when anxiety arises; it can be diagnosed «only if such feelings of detachment frequently recur». Derealisation basically alters the perception or cognitive characterization of external reality  with the consequence of perceiving oneself and the surroundings as strange and unreal .
At first sight, it seems that derealisation only pertains to the ‘real world’ and it cannot be applied to the digital domain that so largely affects everyday life. However, the hyper connected world is going to change the traditional realist frame, if we take into account the Onlife domain . The term Onlife, coined in 2015 by Italian philosopher and Oxford scholar Luciano Floridi  makes references to a region where the real and the virtual are hard to separate. These environments or systems are continually implicated as dynamic units that constantly interact, giving birth to phenomena that are said ‘emergences’ or II type systemic properties .
Within the Onlife region the notion of ‘connection’ grounds any activities linking the real to the digital and vice-versa. No experience of the virtual is ever allowed without a connection with the offline world. Any digital device, a smartphone as well as a computer, should be linked to ‘real life’ for working (the agent, the content). The interrelation between the real and the digital , a basic tool for grasping the very essence of the Onlife domain, is a valuable argument to prove that 1) it is impossible to separate any digital experience from a real one and 2) pathological aspects of the real world interact with the virtual region or 3) aspects of the digital domain can be useful for the therapeutic treatment of diseases that originate in the offline world, as it will be highlighted in this paper.
Hence it makes sense, within the Onlife world, to talk about derealisation, in terms of disconnection (voluntary or compulsory) from the network. Connection, on the other side, can be interpreted as a full experience of the virtual environment. On a metaphysical ground, we move from the realist view of the world of life to an enlarged ontology that embraces the virtual as philosopher Urbani Ulivi holds . In the perspective of psychiatry, any effort to shed light on connection and disconnection might be fruitful to explore derealisation in itself, which is still an underdiagnosed and under-researched phenomenon .
Finally, this theoretical approach is expected to allow a better understanding of several disturbances, related to the Internet addiction but not fully explicable in terms of addictive behaviours, which are currently not included in the diagnostic frame of psychiatry.
BETWEEN THE REAL AND THE DIGITAL: VOID AND SOCIAL ISOLATION
At this point of the paper, we can briefly focus on the phenomenon of void , as a symptom of derealisation, which occurs as a consequence of being dissociated from one’s body, one’s mental processes and from one’s surroundings. Void is the well-known recurrent symptom of several mental diseases like depression, schizophrenia , Narcissistic Personality Disorder , Personality Borderline Disorder  and the Alimentary Behaviour Disturbances , just to quote some of the most relevant pathologies currently diagnosed. Emptiness, on the existential frame of individual life, involves the rupture of the normally expected integration of psychological functions and the social presentation of the self .
In the psychotic experience of the void, as psychiatrist and phenomenologist Binswanger noticed (1960; 1956) , a loss of intentionality also occurs, limiting the capacity to look at the objects and the other entities different from the Self. If we move from offline to online domain, we notice that several experiences of the void are deeply related to the virtual world. Within this particular existential domain, the void is strictly related to social isolation.
Young people are primarily affected by disturbances linked to the overuse of the digital devices, like the Pathological Use of the Internet (PIU) or the Maladaptive Use of the Internet (MIU). Anxiety, depressive states, substance use, disorientation and a deficiency in relational and emotional competences are reported as effects of the high exposure to the web and the social domains . Although there is wide consensus among scholars that «pathological Internet use (…) seems to increase» and «several authors have reported a significant co-morbidity of PIU and mental and psychosomatic disorders» (OECD, 2018) , nevertheless the PIU does not appear within the DSM 5, despite the introduction of a specific digital-related disturbance (Internet Gaming Disorder) .
A huge number of investigations underline the pathological Internet use among adolescents in Europe, with a higher prevalence of PIU among males and females reported higher MIU , however, scientific evidences are still insufficient to establish diagnostic criteria. Nevertheless, there is a large agreement that compulsive use of the Internet is the result of maladaptive cognitions about the self and the world, along with behaviours that increase and reinforce them . Scholarly investigations about this topic seem to suggest the high risk of derealisation linked with the pathological or at least problematic  Internet use, a particular trait that makes these disturbances a distinct diagnostic category respect the domain of the addictive behaviours in which they are generally included.
A relevant reported consequence of being engulfed with the virtual world is the difficulty to blend with the others in a social environment, outside the digital frame, since a very early age, as it been recently reported . The reason we make direct reference to the Internet addiction  is due to the fact that scholars have recently argued a relation between those disturbances and the surge of a complex social-anthropological-behavioural disease known as the hikikomori syndrome, which can be seen as a case history of void in the Onlife domain.
In the next paragraph, we seek to underline that the discomfort of void provided by the social withdrawal (offline) seems to be compensated by the connection with the web (online).
FILLING THE VOID BETWEEN THE REAL AND THE DIGITAL: THE HIKIKOMORI SYNDROME
With the Japanese term hikikomori (staying indoors) scholars refer to the social withdrawal that affects adolescents and young adults up to 40, a phenomenon emerged in Japan in the 1990s, although the very first description dates 1978 . The hikikomori persons  cut almost all ties with the ordinary existence in real life; they avoid any social contact and generally stop going to school or university, spending almost all their time at home for weeks, even for years, without leaving their room. Parents feel unable to cope with a behaviour, of which the origin is hardly related to a major prodromal event. As noted before, the digital overexposure has clearly proved to be linked with the surge of the disturbance: especially as Tateno et al.  concluded that the subject at high risk of hikikomori on H-25 (the 25-Item Hikikomori Questionnaire)  had longer internet usage time.
As Kato and colleagues suggest: Bio psychological, cultural and environmental factors are all listed as probable causes of hikikomori  in Japan as well as in other countries where the syndrome was described. Western sociologists put forward that it is a transitory phenomenon due to social reasons . Empirical studies  assume that the majority of hikikomori persons present some kind of psychiatric disorders. Teo and Gaw make a prudential distinction between cases oh hikikomori related to Axis I or II disorder  and the others, arguing that only the very severe syndrome belong primarily to the first group. Worth noting that the Japanese Ministry of Health, Labour and Welfare, within the 5 diagnostic criteria established for highlighting on hikikomori is oriented to exclude schizophrenia, mental retardation or mental disorders .
Why is the hikikomori’s phenomenology so interesting for the present investigation concerning the experience of void in the Onlife domain?
In the hikikomori syndrome, two different dynamics of void could be noted, a dysfunctional one, offline, and a therapeutic one, online. On one side, the young person takes voluntary the distance from the world of life, isolating from the social community in order to engage in online gaming  or surfing in the web. The consequences of the Internet overuse are those that typically affect subjects with mental diseases: loss of motivations, alienations, depressive state, and a low care of themselves. Because of these psychotic-like symptoms, adolescents suffering from the hikikomori syndrome are frequently diagnosed with depression or latent schizophrenia; in some cases, psychiatric treatment is required, in other case, it is not. As Stip and colleagues note: The exact place of hikikomori in psychiatric nosology has yet to be determined .
We suggest that hikikomori can be interpreted as a (transitory) phenomenon of derealisation where void is experienced as a consequence of the voluntary closure to the world of life. The lack of contact with the ‘real’ world, accompanied by the loss of temporal frame, is compensated with the immersive approach to the digital environment. Young people affected by hikikomori, in fact, are withdrawn into their room but they spend most of their time coping with Pc and digital devices. This trait is common to the cases reported in the literature, where adolescents are described to be absorbed in PC games and Internet» or «surfing the Internet, chatting on online bulletin boards (…) and playing video games .
The digital world counterbalances the loss of reality filling the gap – social, relational, educational, relational, and motivational – that the hikikomori’s phenomenology brings into the surface. Offline and online are melted together, in the hikikomori, in the same way as it happens in the Onlife domain, that’s why The growing interconnectedness of offline and onlife worlds could also offer ways to ease hikikomori back into everyday life . Far from being a pathological trait, this interrelation recalls the typical operation of filling the void in the ‘real’ world, which is aimed at recovering something that has been lost. As Tateno, Kato, Skoukaukas and Guerrero reported , a patient affected by the syndrome started going out, leaving his room, after downloading Nintendo’s smartphone game Pokémon Go.
Strictly dependent on the idea of absence, the concept of horror vacui - the Latin formula for the fear of the void refers to the urge/necessity to fill an empty space with all kind of details . Although it originally referred to the domain of art, the horror vacui provides a better understanding of void as a consequence of derealisation, because it reveals the connection between the human subjects and their being-in-the-world. Filling the void could be interpreted as an existential strategy to overcome anguish. In Was ist die metaphysic? (1929) German philosopher Martin Heidegger assumed that anguish is the feeling of absence. In the digital domain filling the void belongs to the operation of cutting and paste , in which also consists of the peculiar power of the digital, as Floridi theorized .
An «under-diagnosed and under-researched phenomenon», derealisation is a crucial key for understanding several disturbances that affect individuals when they lose any contact with the environment and make the experience of the void. The increasing role of the digital in our lives suggests shedding lights on the virtual side of this existential discomfort. There are phenomena that can be understood only within the frame of the Onlife domain, where offline/real and online/virtual are melted together. It is the case of the severe social withdrawal among adolescents or young adults that - the authors argue – can be interpreted as a case of voluntary derealisation.
Differently from the pathological emptiness, which follows to anxiety or traumatic experiences or mental diseases, in hikikomori void does not overcome the individual. It is frequently reported that the self-isolated subjects fill the emptiness through the Internet, spending a huge part of the time surfing or gaming or using social networks. They seem to repeat the strategy of filling the void, a process that exists in the real world in order to manage anxiety or panic. In brief, we could say that connection (online) may be the cure for derealisation (offline), which is often caused by addictive Internet behaviours. We should not be amazed by this vicious/virtuous circle: the Onlife domain is characterized by a constant interaction of the real and the virtual. No surprise that adolescent or young adults, who are the main consumers/actors of this melted environment, are so exposed to the risks that belong to it. What emerges within the hikikomori dynamics is the therapeutic potential of the Onlife world, whose power has not yet been explored. This dynamic, very common in the hikikomori syndrome could clarify why these social withdrawals very often do not give rise to psychotic-like symptoms.
From the aesthetic experience to severe mental illness, filling the void means to replace a loss of reality with content, an object, in order to repair what has been detached: hallucinations in schizophrenic patients, for example, restore a certain interpersonal relationship that has been lost. If we accept this premise, we can set on a secure ground the possibility that the digital traces a possible therapeutic pathway for hikikomori as well as for several social isolation phenomena which are increasing  in the Onlife age.
1. APA (2013) Diagnostial manual of mental disorders: DSM-V, Washington DC: American Psychiatric Association. Derealisation-depersonalization Disorder corresponds to: Code 300.6 (F48.1).
2. Psychology Today (2019) Depersonalization/Derealization Disorder. Available online at: https://www.psychologytoday.com/intl/conditions/depersonalizationderealization-disorder
3. American Psychological Association (2007) APA Dictionary of Psychology.
4. Fisogni P (2019) Void in onlife age, aspects of derealization and disconnections. ARC J Psychiatr 4: 27-35.
5. Floridi L (2015) The onlife manifesto being human in a hyper connected era. Heidelberg, New York, Dordrecht, London: Springer.
6. Minati G (2019) On some open issues in systemics. Systemic of Incompleteness and Quasi-Systems. Springer: Chams, pp: 343-351.
7. Urbani Ulivi L (2019) First steps towards a systemic ontology. Systemics of incompleteness and quasi-systems, Chams: Springer, pp: 57-75.
8. Michal M, Adler J, Zwerenz R, Wiltink J, Reiner I, et al. (2016) A case series of 22 patients with depersonalization-derealisation syndrome. BMC Psychiatry 16: 203.
9. Epstein M (1989) Forms of emptiness: Psychodynamic, meditative and clinical perspectives. JTP 21: 61-71.
10. Lysaker PH, Lysaker JT (2010) Schizophrenia and alterations in self-experience: A comparison of 6 perspectives. Schizophr Bull 36: 331-340.
11. Kernberg O (1975) Borderline conditions and pathological Narcissism. New York: Aronson.
12. Elsner D, Broadbear JH, Rao S (2017) What is the clinical significance of chronic emptiness in Borderline Personality Disorder? Australas Psychiatry 26: 88-91.
13. Null G, Bernikow L (2001) The Food-Mood Body Connection. Nutrition-Based Environmental Approaches in Mental Health and Physical Wellbeing. NY, London, Sydney, Toronto: Seven Stories Press.
14. Kirmayer LJ (1994) Pacing the Void: Social and Cultural Dimensions of Dissociation. In D. Spiegel editor: Dissociation: Culture, Mind, and Body, American Psychiatric Association. Washington: American Psychiatric Press, pp: 91-122.
15. Binswanger L (1960) Phänomenologische Studien. Pfüllingen: Verlag G. Neske; Binswanger L. Drei Formen Missglückten Daseins. Verstiegenheit, Verschrobenheit, Manieriertheit, Tübingen: De Gruyter Incorporated.
16. Mencacci C, Migliarese G (2018) When everything changes: Psychic health in adolescence. Pisa: Pacini.
17. OECD (2018) Children & Young People’s Mental Health in the Digital Age. Paris: OECD Publishing, pp: 124-125.
18. Pabasari G (2017) Internet Addiction Disorder, Child and Adolescent Mental Health. SPi Global, Zagreb.
19. Durkee T, Kaess M, Carli V, Parzer P, Wasserman C, et al. (2012) Prevalence of pathological internet use among adolescents in Europe: Demographic and social factors. Addiction 107: 2210-2222.
20. Durkee T, Carli V, Floderus B, Wasserman C, Sarchiapone M, et al. (2016) Pathological Internet Use and Risk-Behaviors among European Adolescents. Int J Environ Res Public Health 13: E294.
21. Díaz-Aguado MJ, Martín-Babarro J, Falcón L (2018) Problematic Internet use, maladaptive future time perspective and school context. Psicothema 30: 195-200.
22. Fernandes B, Rodrigues Maia B & Ponte HM (2019) Internet addiction or problematic internet use? Which term should be used? Psicologia 30.
23. Tateno M, Teo AR, Ukai W, Kanazawa J, Katsuki R, et al. (2019) Internet addiction, smartphone addiction, and hikikomori trait in japanese young adult: social isolation and social network. Front Psychiatry 10: 455.
24. Shaw M, Black DW (2008) Internet addiction: Definition, assessment, epidemiology and clinical management. CNS Drugs 22: 353-365.
25. Kasahara Y (1978) Taikyaku shinkeishou withdrawl neurosis to iu shinkategorii no teishou (Proposal for a new category of withdrawal neurosis). In: Nakai H, Yamanaka Y, editors. Shishunki no seishinbyouri to chiryou (Psychopatology and treatment in the adolescent). Tokyo: Iwasaki Gakujutsu Shuppan, pp: 287-319.
26. Hikikomori (2020) Available online at: https://en.wikipedia.org/wiki/Hikikomori
27. Tateno M, Teo AR, Ukai W, Kanazawa J, Katsuki R, et al. (2019) Internet addiction, smartphone addiction, and hikikomori trait in japanese young adult: social isolation and social network. Front Psychiatry 10: 455.
28. Fisogni P, Fisogni A (2020).
29. Kato TA, Tateno M, Shinfuku N, Fujisawa D, Teo AR, et al. (2012) Does the ‘hikikomori’ syndrome of social withdrawal exist outside Japan? A preliminary international investigation. Soc Psychiatry Psychiatr Epidemiol 47: 1061-1075.
30. Furlong A (2008) The Japanese hikikomori phenomenon: Acute social withdrawal among young people. Sociol Rev 56: 309-325.
31. Malagón-Amor Á, Martín-López LM, Córcoles D, González A, Bellsola M, et al. (2018) A 12-month study of the hikikomori syndrome of social withdrawal: Clinical characterization and different subtypes proposal. Psychiatry Res 270: 1039-1046.
32. Teo AR & Gaw AC (2010) Hikikomori, a Japanese Culture-Bound Syndrome of Social Withdrawal?: A proposal for DSM-5. J Nerv Ment Dis 198: 444-449.
33. Stip E, Thibalt A, Beauchamp-Chatel A, Kisely S (2016) Internet addiction, hikikomori syndrome, and the prodromal phase of psychosis. Front Psychiatry.
34. Teo AR (2010) A new form of social withdrawal in Japan: A review of Hihikomori. Int J Soc Psychiatry 56: 178-185.
35. Gent E (2019) Social isolation is often blamed on technology, but could it be part of solution? BBC Future.
36. Tateno M, Skoukaukas N, Kato TA, Teo AR, Guerrero APS (2016) New game software (Pokémon Go) may help youth with severe social withdrawal, hikikomori. Psychiatry Res 246: 848-849.
37. Mortelmans D (2005) Visualizing Emptiness. Visual Anthropology 18: 19-46.
38. Fisogni P (2019) Void in onlife age, aspects of de-realization and disconnection. ARC J Psychiatry 4: 27-35.
39. Floridi L (2017) Infraethics–On the condition of possibility of morality. Philos & Technol 30: 391-394.
40. Silić A, Vukojević J, Čulo I, Falak H (2019) Hikikomori silent epidemic: A case study. RIPPPO 22: 317-322.
- Journal of Blood Transfusions and Diseases (ISSN:2641-4023)
- Chemotherapy Research Journal (ISSN:2642-0236)
- Archive of Obstetrics Gynecology and Reproductive Medicine (ISSN:2640-2297)
- Journal of Cancer Science and Treatment (ISSN:2641-7472)
- International Journal of Diabetes (ISSN: 2644-3031)
- Journal of Ageing and Restorative Medicine (ISSN:2637-7403)
- Journal of Oral Health and Dentistry (ISSN:2638-499X)