Cave Syndrome: Viral and Social Toxins, and the Inner Life

The Japanese Sun Goddess, Amaterasu, hid in a cave until she was convinced by others she could leave

Source: Adobe stock image by matiasdelcarmine, licensed by Ravi Chandra

Cave syndrome is being defined as a persistent unwillingness to leave the relative safety and security of the home to risk COVID infection or re-infection as the pandemic abates. Psychiatrist Alan Teo, in Scientific American, likens it to the Japanese hikikomori (or shut-in) syndrome, in which an extreme form of agoraphobia takes hold and individuals isolate for six months or longer. This is a useful analogy that might help us understand how toxins in our social and physical environment trigger tendencies to cut oneself off from society—and might offer some solutions as well.

Shut-in syndrome occurs in many cultures, and may be becoming more prevalent as technology makes it more viable to live in isolation or near-isolation. Michael Zeilinger wrote about hikikomori in his 2009 book Shutting Out The Sun: How Japan Created Its Own Lost Generation. Zeilinger describes individuals who keep to their rooms for years or decades at a time, usually depending on family to meet their basic needs. Most or all of these individuals had experienced severe childhood bullying, with resultant fear, social anxiety, shame, and other emotions of disconnection from the social milieu, including low self-worth. With concerted and focused mental health efforts, Zeilinger described how some hikikomori were rehabilitated back into society—but this required the special attention of professionals and concerned community members. I assume, but am not sure, that others eventually come out of isolation on their own as well. But there are cases of people who have died in isolation. Social isolation itself also has deleterious effects on mental and physical health, especially on those who are most vulnerable, including, in the U.S., immigrants, minorities, LGBT individuals, and elders.

Resignation syndrome is an even more pronounced psychological withdrawal and was the subject of the Oscar-nominated short documentary Life Overtakes Me by John Haptas and Kristine Samuelson. Resignation syndrome is described in traumatized refugee children who seem to be having a severe survival brain “freeze” response to overwhelming trauma, or who some speculate may be subconsciously taking on the martyr role to help their families. Susan Brink reported for NPR:

“The Swedish word uppgivenhetssyndrom sounds like what it is: a syndrome in which kids have given up on life. That's what several hundred children and adolescents have done — literally checked out of the world for months or years. They go to bed and don't get up. They're unable to move, eat, drink, speak or respond. All of the victims of the disorder, sometimes called resignation syndrome, have been youngsters seeking asylum after a traumatic migration, mostly from former Soviet and Yugoslav states. And all of them live in Sweden.”

These unfortunate children have been treated with generous TLC (tender loving care) by family members and other caregivers. This might facilitate, at the neurobiological level, a sense of safety and trust, allowing them to return to conscious awareness and interaction.

A psychological correlate is involution, in which thoughts and feelings are turned inward after meeting some kind of interpersonal barrier or setback, leading to rumination, isolation, and social withdrawal.

For Asian Americans, the nation’s atmosphere contains risks of not just COVID, but the palpable risks of being targeted by violence in an atmosphere of anti-Asian sentiment amplified by aggressive political rhetoric blaming China for the virus. Moreover, economic hardship and general distress also create anxiety, which is likely bound or overridden by scapegoating Asians and Asian Americans.

Asian American parents have been less willing to send their children back to in-person schooling, partly out of fears of facing racist abuse. (Balingit M, Natanson H, Chen Y. As schools reopen, Asian American students are missing from classrooms. (Washington Post, March 4, 2021.)

Seemingly, not a day has gone by recently without new reports of violent incidents against Asian Americans. Asian women attacked with a hammer in Hell’s Kitchen by another woman demanding that they take off their masks. Two older Asian American women slashed by a man with a knife at a San Francisco bus stop. An Asian American man pushing his toddler in a stroller, pushed to the ground and punched by another man. On a far lesser scale that reminded me of the aggression that Black men face on a daily basis, I’ve been yelled at by White men twice for wearing a Black Lives Matter T-shirt, once in San Francisco, and another time in the East Bay town of Livermore. (Far more often, though, I’ve been met with support and affirmation for wearing the T-shirt. The times are, hopefully, changing.)

Those who have been traumatized or who fear violence, as well as those who fear infection, have understandable reasons to be isolative, or to be highly cautious about venturing outside into an uncertain environment. This is a psychic burden that must be consciously addressed by individuals, media, health systems, communities, and politicians. In many ways, the traumatized and anxious are important bellwethers of our society. Their presence raises the questions, “How well are we looking out for one another?" “How well can any of us look out for ourselves?” and “How can we better care for those most vulnerable to infection or violence?”

Certainly, making the physical environment more certain will help a great deal. The risk of COVID infection will decrease only as more people become vaccinated and the viral risks around the world abate. We can look out for each other by following CDC and local public health department guidelines, using our common sense and empathy, getting vaccinated, and wearing masks as appropriate.

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The risk of violence will only abate if we amplify social cohesion and work diligently at reducing the causes of violence. There is an active media campaign that is amplifying awareness about Asian American identity and issues, but I’m not sure how we reach those who are most disconnected or unreceptive to media messages. The long-term solution must lie in promoting non-violent ways to deal with intra- and inter-personal distress and conflict throughout the pipeline that produces violent outcomes, and also promoting cultural education, awareness, and literacy across the lifespan.

There are real toxins in our social and physical environment. Minimizing dangers is ignorant and foolhardy. Maximizing dangers might verge on paranoia, but each individual must decide for themselves how they wish to hold perceived dangers.

I believe there is a middle path. We must inform ourselves about the risks and benefits of our social and physical environment. We must develop the quality of our supportive relationships. And we must develop our inner lives to meet the challenges of isolation, disconnection, and relationship itself. We must reach out to those in need. And we must continue to be brave in service to others, because society needs our bravery.

As I wrote in a previous post:

“For this Buddhist psychiatrist, the true Self is that which responds creatively to adversity and suffering—and every day of survival, growth, relatedness, expression, affirmation, self-acceptance and self-compassion can be a victory for the true Self.”

I wish you well in cultivating your own sense of trust, safety, and social connection as we continue on in the pandemic. If you’re feeling very anxious or anguished, reach out for support on available hotlines. No one gets through life alone, but life has some very lonely moments indeed.

(c) 2021 Ravi Chandra, M.D., D.F.A.P.A.

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