Interlude

Dear Dr. Jiménez

In response to your inquiry, I am happy to elaborate on our previous telephone discussion. I apologize for my poor English and it is easier for me to express my thoughts via email.

As you are aware, I have been working with a number of individuals for several years who exhibit similar behavior as what you described.

In Japan, there has been a recent surge in cases like this where there is a disassociation with social norms and expectations. This has happened in the past and seems to be almost a cyclical phenomenon, but the media has latched onto recent trends and have promoted certain terms and diagnoses, which is an unhelpful situation if you ask me.

The “Don Quixote Syndrome” that you described is known here as ”chūnibyou”, roughly translated, it means middle school sickness. An invented media term that has been applied to certain behaviors similar to those you have described to me.

A “chūnibyou” is meant to be an adolescent, usually male, usually socially awkward, who has an obsession with fantasy subcultures. More commonly known as ”otaku”, a somewhat derogatory term for animation and comic book fans, a chūnibyou is even more obsessed with specific aspects of their fantasy obsessions. While otaku are somewhat ostracized due to a perceived lack of social skills and strange hobbies, those identified as chūnibyou may exhibit behavior that is considered suspect and potentially dangerous as they behave as if their fantasies are real.

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The obsession with magic powers, superman abilities, and other worlds is the common link which made me think of this parallel to your situation. There have been very rare cases in Japan when violent acts were committed by such individuals, garnering the public disapproval of any who exhibit these types of predilections.

My approach, which I suggest you consider, is to do what you can to help your patient remove himself as much as possible from the influence of all things that reinforce the delusions held by the individual. Encourage them to avoid fantasy media and focus on real-world concerns. In cases such as this, self-actualization can present a larger danger for stable mental health. I recommend traditional employment, exercise, meditation, and as a last resort, medication.

Again, I apologize for my poor language skills. If you are planning to attend the conference in Boston this October, I will be speaking there, and would be happy to discuss your case in more detail in person.

Best regards,

Nozomi Torako, M.D., Ph.D.

Teikai University, Kyoto, Japan

June 1, 2011