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  • Become a psychiatrist

    Become a psychiatrist

    • Choose Psychiatry

      Choose Psychiatry

      • What is psychiatry?
      • How to become a psychiatrist
      • Why choose psychiatry?
      • What next?
      • On a break from training?
      • Choose Psychiatry 2021 video
      • Continuing to choose psychiatry
      • Hear more from the stars of our 2022 film
    • Sixth formers and school students
    • Medical students

      Medical students

      • Becoming a student associate
      • Psychiatry attachments
      • Awards, prizes and bursaries
      • PsychSocs
      • National Student Psychiatry Conference
      • Summer and autumn schools
      • FuturePsych – the student associate magazine
      • The Student Psychiatry Audit and Research Collaborative (SPARC)
    • Foundation doctors

      Foundation doctors

      • Foundation doctor associates
      • Making the most of your psychiatry placement
      • Opportunities for foundation doctors
      • FuturePsych - the associate magazine
    • Help us promote psychiatry

      Help us promote psychiatry

      • How can I help?
      • Ideas to inspire you
      • Resources to help you promote psychiatry
      • RCPsych Recruitment Strategy 2022-2027
    • Choose Psychiatry: Guidance for Medical Schools
    • Supporting Medical Students: Medical Schools
    • Careers past events
    • Choose Psychiatry
      • What is psychiatry?
      • How to become a psychiatrist
      • Why choose psychiatry?
      • What next?
      • On a break from training?
      • Choose Psychiatry 2021 video
      • Continuing to choose psychiatry
      • Hear more from the stars of our 2022 film
    • Sixth formers and school students
    • Medical students
      • Becoming a student associate
      • Psychiatry attachments
      • Awards, prizes and bursaries
      • PsychSocs
      • National Student Psychiatry Conference
      • Summer and autumn schools
      • FuturePsych – the student associate magazine
      • The Student Psychiatry Audit and Research Collaborative (SPARC)
    • Foundation doctors
      • Foundation doctor associates
      • Making the most of your psychiatry placement
      • Opportunities for foundation doctors
      • FuturePsych - the associate magazine
    • Help us promote psychiatry
      • How can I help?
      • Ideas to inspire you
      • Resources to help you promote psychiatry
      • RCPsych Recruitment Strategy 2022-2027
    • Choose Psychiatry: Guidance for Medical Schools
    • Supporting Medical Students: Medical Schools
    • Careers past events
  • Training

    Training

    • Curricula and guidance

      Curricula and guidance

      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty guides
      • Dual Training
    • Your training

      Your training

      • Psychiatric Trainees Committee: supporting you
      • Time out of training
      • Training resources
      • Run-through training
      • Prizes and bursaries for trainees
      • Training less than full time
      • Routes to Registration
      • Cost of Training
      • Leadership and Management Fellow Scheme
      • Understanding Career Choices in Psychiatry
    • Exams

      Exams

      • Can I take an exam?
      • Contact the exams team
      • Preparing for exams
      • Applying for your exam
      • Exam results
      • Special notices
      • Exam FAQs
      • A fair exam
      • Examiners and exam panels recruitment
      • FAQs about applying for exams
      • FAQs about preparing for exams
      • FAQs about the day of the exam
      • FAQs about assessment and results
      • Exams news and updates
    • Neuroscience in training

      Neuroscience in training

      • About the project
      • Neuroscience events
      • Who was on the commission?
      • Neuroscience history
      • Neuroscience resources
      • Multimedia learning
    • Deanery/LETB Hub
    • Medical training initiative (MTI)
    • Undergraduate education forum
    • International Medical Graduates

      International Medical Graduates

      • Shortage Occupation List
    • Quality Assurance in Training
    • Credentialing
    • CPD eLearning
    • Building Capacity in Perinatal Psychiatry

      Building Capacity in Perinatal Psychiatry

      • Perinatal 2023 Masterclass Programme application and process details
      • Perinatal Psychiatry Masterclass for New consultants resources
      • About the Building Capacity Project
      • Perinatal Psychiatry Masterclass for Senior Trainees resources
      • Perinatal Psychiatry Top - up masterclass for consultants resources
      • Perinatal Psychiatry Masterclass for Senior Trainees Jan 2023 resources
    • Dean's annual update
    • Curricula and guidance
      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty guides
      • Dual Training
    • Your training
      • Psychiatric Trainees Committee: supporting you
      • Time out of training
      • Training resources
      • Run-through training
      • Prizes and bursaries for trainees
      • Training less than full time
      • Routes to Registration
      • Cost of Training
      • Leadership and Management Fellow Scheme
      • Understanding Career Choices in Psychiatry
    • Exams
      • Can I take an exam?
      • Contact the exams team
      • Preparing for exams
      • Applying for your exam
      • Exam results
      • Special notices
      • Exam FAQs
      • A fair exam
      • Examiners and exam panels recruitment
      • FAQs about applying for exams
      • FAQs about preparing for exams
      • FAQs about the day of the exam
      • FAQs about assessment and results
      • Exams news and updates
    • Neuroscience in training
      • About the project
      • Neuroscience events
      • Who was on the commission?
      • Neuroscience history
      • Neuroscience resources
      • Multimedia learning
    • Deanery/LETB Hub
    • Medical training initiative (MTI)
    • Undergraduate education forum
    • International Medical Graduates
      • Shortage Occupation List
    • Quality Assurance in Training
    • Credentialing
    • CPD eLearning
    • Building Capacity in Perinatal Psychiatry
      • Perinatal 2023 Masterclass Programme application and process details
      • Perinatal Psychiatry Masterclass for New consultants resources
      • About the Building Capacity Project
      • Perinatal Psychiatry Masterclass for Senior Trainees resources
      • Perinatal Psychiatry Top - up masterclass for consultants resources
      • Perinatal Psychiatry Masterclass for Senior Trainees Jan 2023 resources
    • Dean's annual update
  • Members

    Members

    • Workforce Wellbeing Hub

      Workforce Wellbeing Hub

      • Psychiatrists' Support Service
      • How the College supports workforce wellbeing
      • Top 10 tips for wellbeing
      • Mentoring and coaching
      • If a patient dies by suicide
      • If a patient commits homicide
    • Supporting your professional development

      Supporting your professional development

      • New consultants (StartWell)
      • Revalidation
      • Assessing and managing risk of patients causing harm
      • Leadership and management
      • Working less than full time
      • Writing clinic letters
    • CPD eLearning
    • Submitting your CPD

      Submitting your CPD

      • Alterations to CPD during coronavirus pandemic
    • Membership

      Membership

      • Members login
      • Receipts
      • Pay Your Subscription
      • Direct Debit
      • Your subscription
      • Grades of membership
      • Benefits of membership
      • Fellowship and other Honours
      • Applying for Fellowship
      • Nominations for Honorary Fellows
      • Nominations for National Honours
    • Your Faculties

      Your Faculties

      • Academic psychiatry
      • Addictions psychiatry
      • Child and adolescent psychiatry
      • Eating disorders psychiatry
      • Forensic Psychiatry Faculty
      • General adult psychiatry
      • Intellectual disability psychiatry faculty
      • Liaison psychiatry faculty
      • Medical psychotherapy faculty
      • Neuropsychiatry faculty
      • Old age psychiatry faculty
      • Perinatal psychiatry faculty
      • Rehabilitation and social psychiatry faculty
      • Faculty job descriptions
    • Specialist and Associate Specialty Doctors

      Specialist and Associate Specialty Doctors

      • A message from the Chair
      • Who are SAS Doctors?
      • How to enter the SAS grade
      • SAS career development
      • SAS doctors resources
      • College SAS training and events
      • Startwell and Staywell
    • Devolved Nations

      Devolved Nations

      • RCPsych in Scotland
      • RCPsych in Wales
      • Coleg Cymraeg
      • RCPsych in Northern Ireland
      • Executive Committee job descriptions
    • English Divisions

      English Divisions

      • Eastern
      • London
      • Northern and Yorkshire
      • North West
      • South Eastern
      • Trent
      • West Midlands
      • South West
      • Executive Committee job descriptions
      • NW and NY mentorship
    • International members
    • Special Interest Groups

      Special Interest Groups

      • How to join a SIG
      • Adolescent forensic psychiatry
      • Arts psychiatry
      • Digital psychiatry
      • Evolutionary psychiatry
      • History of psychiatry
      • Neurodevelopmental psychiatry
      • Occupational psychiatry
      • Philosophy
      • Private and independent practice PIPSIG
      • Rainbow SIG
      • Spirituality and Psychiatry 
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international
      • Women and mental health
    • Committees of Council
    • RCPsych Insight magazine
    • Publications and books
    • Members' eNewsletters
    • Posts for members
    • Public members list
    • Jobs board
    • President's lectures

      President's lectures

      • Declaration of competing interests (President's lectures)
      • List of president's lectures competing interests
      • Past President's lectures
    • Retired members
    • New Members Ceremonies
    • Obituaries

      Obituaries

      • Submit an obituary
      • Remembering Dame Fiona Caldicott
    • 2021 membership survey
    • Mindmasters quiz

      Mindmasters quiz

      • About the quiz
      • Who won in 2022?
      • The rules of the quiz
      • Sample quiz questions 
    • eLearning Hub
    • Workforce Wellbeing Hub
      • Psychiatrists' Support Service
      • How the College supports workforce wellbeing
      • Top 10 tips for wellbeing
      • Mentoring and coaching
      • If a patient dies by suicide
      • If a patient commits homicide
    • Supporting your professional development
      • New consultants (StartWell)
      • Revalidation
      • Assessing and managing risk of patients causing harm
      • Leadership and management
      • Working less than full time
      • Writing clinic letters
    • CPD eLearning
    • Submitting your CPD
      • Alterations to CPD during coronavirus pandemic
    • Membership
      • Members login
      • Receipts
      • Pay Your Subscription
      • Direct Debit
      • Your subscription
      • Grades of membership
      • Benefits of membership
      • Fellowship and other Honours
      • Applying for Fellowship
      • Nominations for Honorary Fellows
      • Nominations for National Honours
    • Your Faculties
      • Academic psychiatry
      • Addictions psychiatry
      • Child and adolescent psychiatry
      • Eating disorders psychiatry
      • Forensic Psychiatry Faculty
      • General adult psychiatry
      • Intellectual disability psychiatry faculty
      • Liaison psychiatry faculty
      • Medical psychotherapy faculty
      • Neuropsychiatry faculty
      • Old age psychiatry faculty
      • Perinatal psychiatry faculty
      • Rehabilitation and social psychiatry faculty
      • Faculty job descriptions
    • Specialist and Associate Specialty Doctors
      • A message from the Chair
      • Who are SAS Doctors?
      • How to enter the SAS grade
      • SAS career development
      • SAS doctors resources
      • College SAS training and events
      • Startwell and Staywell
    • Devolved Nations
      • RCPsych in Scotland
      • RCPsych in Wales
      • Coleg Cymraeg
      • RCPsych in Northern Ireland
      • Executive Committee job descriptions
    • English Divisions
      • Eastern
      • London
      • Northern and Yorkshire
      • North West
      • South Eastern
      • Trent
      • West Midlands
      • South West
      • Executive Committee job descriptions
      • NW and NY mentorship
    • International members
    • Special Interest Groups
      • How to join a SIG
      • Adolescent forensic psychiatry
      • Arts psychiatry
      • Digital psychiatry
      • Evolutionary psychiatry
      • History of psychiatry
      • Neurodevelopmental psychiatry
      • Occupational psychiatry
      • Philosophy
      • Private and independent practice PIPSIG
      • Rainbow SIG
      • Spirituality and Psychiatry 
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international
      • Women and mental health
    • Committees of Council
    • RCPsych Insight magazine
    • Publications and books
    • Members' eNewsletters
    • Posts for members
    • Public members list
    • Jobs board
    • President's lectures
      • Declaration of competing interests (President's lectures)
      • List of president's lectures competing interests
      • Past President's lectures
    • Retired members
    • New Members Ceremonies
    • Obituaries
      • Submit an obituary
      • Remembering Dame Fiona Caldicott
    • 2021 membership survey
    • Mindmasters quiz
      • About the quiz
      • Who won in 2022?
      • The rules of the quiz
      • Sample quiz questions 
    • eLearning Hub
  • Events

    Events

    • Conferences and training events

      Conferences and training events

      • Register your interest - CESR in Psychiatry Training
      • MHA Section 12 and Approved Clinician Training
      • Register your interest - Present State Examination Course 2022
      • Subscribe to receive the Events eNews
      • Register your interest - ICD-11 events
      • RCPsych Certificated Courses
      • Grand Rounds
    • International Congress 2022

      International Congress 2022

      • Congress 2022 FAQs
      • Congress Webinar Package
      • Poster Presentations 2022
      • Exhibition Opportunities 2022
      • Your guide to Congress
      • IC22 Keynote speakers
      • Programme
      • Speaker information
      • Travel and accommodation guidance 
      • Social and Fringe Events
      • #RCPsychIC
      • Rapid Fire and Poster Prize Winners
    • International Congress 2023

      International Congress 2023

      • Register your interest - Congress 2023 exhibitors
      • Travel and accommodation guidance 
      • Registration
      • Congress 2023 FAQs
      • Poster Presentations 2023
      • Social Media
    • In-house training

      In-house training

      • In house training: working with us
      • Health of Nation Outcome Scales
      • Competing interests
    • Events held by other organisations
    • Free webinars

      Free webinars

      • Free webinars for members
    • Recruitment events
    • Claiming Expenses
    • Terms and conditions
    • Speaker guidance for online events
    • Conferences and training events
      • Register your interest - CESR in Psychiatry Training
      • MHA Section 12 and Approved Clinician Training
      • Register your interest - Present State Examination Course 2022
      • Subscribe to receive the Events eNews
      • Register your interest - ICD-11 events
      • RCPsych Certificated Courses
      • Grand Rounds
    • International Congress 2022
      • Congress 2022 FAQs
      • Congress Webinar Package
      • Poster Presentations 2022
      • Exhibition Opportunities 2022
      • Your guide to Congress
      • IC22 Keynote speakers
      • Programme
      • Speaker information
      • Travel and accommodation guidance 
      • Social and Fringe Events
      • #RCPsychIC
      • Rapid Fire and Poster Prize Winners
    • International Congress 2023
      • Register your interest - Congress 2023 exhibitors
      • Travel and accommodation guidance 
      • Registration
      • Congress 2023 FAQs
      • Poster Presentations 2023
      • Social Media
    • In-house training
      • In house training: working with us
      • Health of Nation Outcome Scales
      • Competing interests
    • Events held by other organisations
    • Free webinars
      • Free webinars for members
    • Recruitment events
    • Claiming Expenses
    • Terms and conditions
    • Speaker guidance for online events
  • Improving care

    Improving care

    • College Centre for Quality Improvement (CCQI)

      College Centre for Quality Improvement (CCQI)

      • What we do in the CCQI
      • Quality Networks and Accreditation
      • National Clinical Audits
      • Multi-source feedback
      • CCQI resources
      • CCQI Who we are
      • Research and evaluation
      • CCQI news
    • Campaigning for better mental health policy

      Campaigning for better mental health policy

      • Five Year Forward View
      • Integrated care and mental health
      • Children and young people's mental health Green Paper
      • Cross-government mental health and wellbeing plan 
      • RCPsych in Parliament
      • Join our Research Panel
      • College Reports
      • Position Statements
      • Process for College publications
      • Other policy areas
      • Mental Health Watch
      • COVID-19: Guidance for clinicians
      • Reforming The Mental Health Act
      • Don't overlook mental health campaign
      • The Mental Health Policy Group (MHPG)
    • Planning the psychiatric workforce

      Planning the psychiatric workforce

      • About workforce
      • Job planning and recruitment
      • Our workforce census
      • Campaigning for the mental health workforce of the future
      • Workforce strategy
      • Job description approval process
    • Public Mental Health Implementation Centre

      Public Mental Health Implementation Centre

      • Our partners and first partnership activity 
      • How to work with the Public Mental Health Implementation Centre
      • Who's involved in the Public Mental Health Implementation Centre?
      • Aims and objectives
      • Reports
      • About public mental health
      • PMHIC Parliamentary Launch 
    • National Collaborating Centre for Mental Health

      National Collaborating Centre for Mental Health

      • About NCCMH and our work
      • Clinical guideline development
      • Competence frameworks
      • Quality improvement programmes
      • Reports and research
      • Service design and development
      • Work with us
    • Physician Associates

      Physician Associates

      • About Physician Associates
      • Employing Physician Associates
      • Becoming a Physician Associate
      • Support for Physician Associates
      • Physician Associates network
      • The Competence Framework for Physician Associates in Mental Health
    • Invited Review Service
    • Public Health and its role in mental heath
    • Sustainability and mental health

      Sustainability and mental health

      • In your community
      • In your practice
      • In your trust
      • Nature matters
      • Sustainability scholars
      • About sustainability in mental health care
      • Sustainability resources
      • College position on sustainability
      • Attending COP26
    • Using quality improvement
    • College Centre for Quality Improvement (CCQI)
      • What we do in the CCQI
      • Quality Networks and Accreditation
      • National Clinical Audits
      • Multi-source feedback
      • CCQI resources
      • CCQI Who we are
      • Research and evaluation
      • CCQI news
    • Campaigning for better mental health policy
      • Five Year Forward View
      • Integrated care and mental health
      • Children and young people's mental health Green Paper
      • Cross-government mental health and wellbeing plan 
      • RCPsych in Parliament
      • Join our Research Panel
      • College Reports
      • Position Statements
      • Process for College publications
      • Other policy areas
      • Mental Health Watch
      • COVID-19: Guidance for clinicians
      • Reforming The Mental Health Act
      • Don't overlook mental health campaign
      • The Mental Health Policy Group (MHPG)
    • Planning the psychiatric workforce
      • About workforce
      • Job planning and recruitment
      • Our workforce census
      • Campaigning for the mental health workforce of the future
      • Workforce strategy
      • Job description approval process
    • Public Mental Health Implementation Centre
      • Our partners and first partnership activity 
      • How to work with the Public Mental Health Implementation Centre
      • Who's involved in the Public Mental Health Implementation Centre?
      • Aims and objectives
      • Reports
      • About public mental health
      • PMHIC Parliamentary Launch 
    • National Collaborating Centre for Mental Health
      • About NCCMH and our work
      • Clinical guideline development
      • Competence frameworks
      • Quality improvement programmes
      • Reports and research
      • Service design and development
      • Work with us
    • Physician Associates
      • About Physician Associates
      • Employing Physician Associates
      • Becoming a Physician Associate
      • Support for Physician Associates
      • Physician Associates network
      • The Competence Framework for Physician Associates in Mental Health
    • Invited Review Service
    • Public Health and its role in mental heath
    • Sustainability and mental health
      • In your community
      • In your practice
      • In your trust
      • Nature matters
      • Sustainability scholars
      • About sustainability in mental health care
      • Sustainability resources
      • College position on sustainability
      • Attending COP26
    • Using quality improvement
  • Mental health

    Mental health

    • Problems and disorders

      Problems and disorders

      • ADHD in adults
      • Alcohol and depression
      • Alcohol and older people
      • Anorexia and bulimia
      • Anxiety and generalised anxiety disorder (GAD)
      • Anxiety, panic and phobias
      • Bereavement
      • Bipolar disorder
      • Cannabis
      • Catatonia
      • Club drugs
      • Coping after a traumatic event
      • Debt and mental health
      • Delirium
      • Depression
      • Depression in older adults
      • Feeling overwhelmed
      • Gambling disorder
      • Heroin dependence
      • Hoarding
      • Learning disabilities
      • Medically unexplained symptoms
      • Memory problems and dementia
      • Obsessive-compulsive disorder (OCD)
      • Perinatal OCD
      • Perinatal OCD for carers
      • Personality disorder
      • Physical illness
      • Postnatal depression
      • Postnatal depression key facts
      • Postnatal depression: information for carers
      • Postpartum psychosis
      • Postpartum Psychosis in Carers
      • Post-traumatic stress disorder (PTSD) 
      • Schizoaffective disorder
      • Schizophrenia
      • Seasonal Affective Disorder (SAD)
      • Self-harm
      • Shyness and social phobia
      • Sleeping well
      • Avoidant/restrictive food intake disorder (ARFID)
      • Cocaine dependence
    • Support, care and treatment

      Support, care and treatment

      • Alzheimers drug treatments
      • Antidepressants
      • Antipsychotics
      • Antipsychotics in pregnancy
      • Being sectioned
      • Benzodiazepines
      • Children's social services and safeguarding
      • Cognitive Behavioural Therapy (CBT)
      • Complementary and alternative medicines: herbal remedies
      • Complementary and alternative medicines: physical treatments
      • Depot medication
      • Deprivation of Liberty Safeguards
      • Electroconvulsive therapy (ECT)
      • Guide to mental health tribunals
      • Liaison psychiatry services
      • Lithium in pregnancy and breastfeeding
      • Mental capacity and the law
      • Mental health in pregnancy
      • Mental health rehabilitation services
      • Mental health services and teams in the community
      • Mother and baby units (MBUs)
      • Neuromodulation
      • Perinatal mental health services: what are they?
      • Planning a pregnancy
      • Psychotherapies and psychological treatments
      • Social prescribing
      • Spirituality and mental health
      • Stopping antidepressants
      • Valproate in women and girls who could get pregnant
      • What to expect of your psychiatrist in the UK
      • COVID-19: Medication for mental health
      • COVID-19: Remote consultations
      • COVID-19: Going to hospital for a physical illness or injury
      • COVID-19: Eating disorders
      • COVID-19: Perinatal care
      • Hypnosis and hypnotherapy
      • Benefits, financial support and debt advice
      • Caring for someone with a mental illness
    • Young people's mental health
    • Translations

      Translations

      • Arabic عربى
      • Bengali বাঙালি
      • Bulgarian български
      • Chinese 中文
      • French Français
      • German Deutsch
      • Greek Ελληνική γλώσσα
      • Gujurati ગુજરાતી
      • Hindi हिंदीहिंदी
      • Italian italiano
      • Japanese 日本語
      • Lithuanian Lietuvių kalba
      • Pashto پښتو
      • Persian (Farsi) فارسی
      • Polish Polski
      • Punjabi ਪੰਜਾਬੀ
      • Romanian Română
      • Russian Pусский
      • Somali
      • Spanish Español
      • Turkish
      • Tamil தமிழ்
      • Urdu اردو
      • Welsh Cymraeg
      • Sindhi سنڌي
      • Ukrainian украї́нська
      • Swahili Kiswahili
    • Mental health and psychiatry FAQs
    • Order mental health leaflets
    • About our mental health information
    • Disclaimer about our mental health information
    • Choosing Wisely - a national campaign
    • BSL translations
    • MindEd – free mental health eLearning
    • Order mental health packs for schools

      Order mental health packs for schools

      • Order form for mental health factsheets for young people
    • Audio resources
    • Veterans' mental health
    • Suicide resources
    • Problems and disorders
      • ADHD in adults
      • Alcohol and depression
      • Alcohol and older people
      • Anorexia and bulimia
      • Anxiety and generalised anxiety disorder (GAD)
      • Anxiety, panic and phobias
      • Bereavement
      • Bipolar disorder
      • Cannabis
      • Catatonia
      • Club drugs
      • Coping after a traumatic event
      • Debt and mental health
      • Delirium
      • Depression
      • Depression in older adults
      • Feeling overwhelmed
      • Gambling disorder
      • Heroin dependence
      • Hoarding
      • Learning disabilities
      • Medically unexplained symptoms
      • Memory problems and dementia
      • Obsessive-compulsive disorder (OCD)
      • Perinatal OCD
      • Perinatal OCD for carers
      • Personality disorder
      • Physical illness
      • Postnatal depression
      • Postnatal depression key facts
      • Postnatal depression: information for carers
      • Postpartum psychosis
      • Postpartum Psychosis in Carers
      • Post-traumatic stress disorder (PTSD) 
      • Schizoaffective disorder
      • Schizophrenia
      • Seasonal Affective Disorder (SAD)
      • Self-harm
      • Shyness and social phobia
      • Sleeping well
      • Avoidant/restrictive food intake disorder (ARFID)
      • Cocaine dependence
    • Support, care and treatment
      • Alzheimers drug treatments
      • Antidepressants
      • Antipsychotics
      • Antipsychotics in pregnancy
      • Being sectioned
      • Benzodiazepines
      • Children's social services and safeguarding
      • Cognitive Behavioural Therapy (CBT)
      • Complementary and alternative medicines: herbal remedies
      • Complementary and alternative medicines: physical treatments
      • Depot medication
      • Deprivation of Liberty Safeguards
      • Electroconvulsive therapy (ECT)
      • Guide to mental health tribunals
      • Liaison psychiatry services
      • Lithium in pregnancy and breastfeeding
      • Mental capacity and the law
      • Mental health in pregnancy
      • Mental health rehabilitation services
      • Mental health services and teams in the community
      • Mother and baby units (MBUs)
      • Neuromodulation
      • Perinatal mental health services: what are they?
      • Planning a pregnancy
      • Psychotherapies and psychological treatments
      • Social prescribing
      • Spirituality and mental health
      • Stopping antidepressants
      • Valproate in women and girls who could get pregnant
      • What to expect of your psychiatrist in the UK
      • COVID-19: Medication for mental health
      • COVID-19: Remote consultations
      • COVID-19: Going to hospital for a physical illness or injury
      • COVID-19: Eating disorders
      • COVID-19: Perinatal care
      • Hypnosis and hypnotherapy
      • Benefits, financial support and debt advice
      • Caring for someone with a mental illness
    • Young people's mental health
    • Translations
      • Arabic عربى
      • Bengali বাঙালি
      • Bulgarian български
      • Chinese 中文
      • French Français
      • German Deutsch
      • Greek Ελληνική γλώσσα
      • Gujurati ગુજરાતી
      • Hindi हिंदीहिंदी
      • Italian italiano
      • Japanese 日本語
      • Lithuanian Lietuvių kalba
      • Pashto پښتو
      • Persian (Farsi) فارسی
      • Polish Polski
      • Punjabi ਪੰਜਾਬੀ
      • Romanian Română
      • Russian Pусский
      • Somali
      • Spanish Español
      • Turkish
      • Tamil தமிழ்
      • Urdu اردو
      • Welsh Cymraeg
      • Sindhi سنڌي
      • Ukrainian украї́нська
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Yume Nikki: insights into social isolation through playing a video game

Cultural blog, Gaming the mind

29 July, 2020

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Content warning: please note this article describes the plot of Yume Nikki and contains references to suicide

These past three months have been challenging for many. Members of the public have had to experience a period of self-isolation in order to protect themselves and others from becoming unwell with Covid-19. Speaking as a junior doctor, not being able to physically see my family has been difficult, though I do consider myself fortunate to have maintained social interaction through my clinical work.

Over the last few weeks I have found my sleep regularly interrupted by nightmares, most of which revolve around the loss of loved ones; from speaking to colleagues it would seem that I am not alone in this. Between the disturbing dreams and the weeks spent in my bedroom, I was reminded of an indie game I first played over a decade ago called Yume Nikki (Japanese for ‘Dream Diary’), a game many speculate is about a girl who is ‘Hikikomori’: a Japanese term used by mental health professionals to refer to individuals experiencing prolonged social isolation in their own home, along with significant functional impairment or distress.

While Hikikomori has not been mentioned in any international diagnostic manuals for mental health, it has been the subject of a growing amount of clinical research around the world, sparked by concerns about its increasing prevalence in the Japanese population.

Isolation

Isolation is a major theme of the 2004 cult-classic Yume Nikki. Upon starting the game, players find themselves isolated within a single apartment room and balcony, as protagonist Madotsuki (‘windowed’) will shake her head in refusal upon any of the player’s attempts to interact with the front door.

Madotsuki is unable to leave her bedroom. Many players suspect that this is because she is ‘Hikikomori’

The dreams of Madotsuki

Exploration of Madotsuki’s room reveals little to do beyond playing a simple and repetitive mini game on a retro game console, interacting with a television which displays no channels, or saving progress in a diary. Given the lack of enjoyable options to pass the time, perhaps it is no surprise that going to bed offers an appealing alternative, which is when Madotsuki begins to dream. Each dream begins in Madotsuki’s apartment, which appears similar to its waking world equivalent, aside from one important aspect: Madotsuki is able to leave through the front door.

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The dream nexus offers Madotsuki numerous paths behind many doors, though most ultimately loop back to this location

Leaving the dream apartment brings players to an eerie nexus with a circle of a dozen uniquely-decorated doors, each leading to a different ‘world’. These locations are all interconnected but remain distinct from each other, with designs ranging from a minimalistic field of snow with interspersed trees, to a phantasmagorical space where the walls are covered in zippers, legs and arms. Regardless, the atmosphere throughout is one of unease and confusion.

The worlds are vast and labyrinthine, replete with unsettling, otherworldly imagery, and accompanied by a haunting soundtrack. Abstract symbols that may or may not mean something are sprinkled throughout the worlds alongside random occurrences such as a ghost face with a 1-in-64 chance of appearing every time a certain light switch is flipped.

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A faceless Madotsuki encounters the random face in the dark ‘Uboa’, named by fans for the scream they often elicit

Indeed, unlike most games that assure the player how the game “should” be played, Yume Nikki stands out with a sheer absence of dialogue throughout. Players find themselves cast suddenly into a strange and unfamiliar dream world, with nothing but their own speculations for company. Anxiety and disorientation are inevitable as one wanders this illogical realm, feelings arguably not dissimilar to those brought about by prolonged isolation.

The mystery in the game

Even the game’s elusive creator “Kikiyama”, who has kept their true identity a mystery, has remained doggedly silent on the validity of the many fan theories and interpretations of what Yume Nikki means. Some fans have questioned whether or not Kikiyama is Hikikomori and if Kikiyama drew upon their own personal experience of isolation when making this game.

4

Psychedelic backdrops float past, giving the impression of an ever-changing dreamscape

The surreal characters that populate the game world do nothing to allay the player’s unease. Wandering around aimlessly without hints to their origin or motive, these creatures either ignore Madotsuki upon her attempts to interact with them, or turn towards her and make incomprehensible noises. Even in the one instance when she comes across a party of beaked humanoids who appear to be having a good time at a picnic accompanied by cheerful music, Madotsuki is able only to watch from a distance, due to plants blocking her approach.

Some wonder if these events are symbolic of Madotsuki’s real-life predicaments – in this case, perhaps representative of her deliberate social exclusion by unsympathetic individuals. Given that these avian adversaries may also chase Madotsuki and attempt to trap her in enclosed spaces in certain dream areas, one wonders if she may be a victim of bullying. Research about Hikikomori has suggested that intense social pressures brought about by adverse experiences like bullying can contribute to the isolation of such individuals (Teo et al., 2015), with a significantly increased risk of dropping out of education (Yong & Nomura, 2019).

5

Madotsuki watches the party from afar, her path obstructed by twisted vegetation

Dream world and effects

Madotsuki may make use of various “effects” within the game. Found only after painstaking exploration of the dream worlds, these effects can change Madotsuki’s appearance or behaviour in various ways, some quite bizarre. This is another puzzling aspect of the game, as players are left wondering the significance of, say, being able to light Madotsuki up in bright neon colours, or having her play a flute.

Some players speculate as to whether transformational effects, such as the ability to “fatten” Madotsuki, or change her into a faceless ghost, may hint at underlying disturbed body image, or issues with self-esteem. Comorbidity of hikikomori with other mental illness is particularly common (Tan et al., 2020).

6

The bicycle effect aids in exploration of the dreamscape and harks back to Japanese roleplaying games of old

Perhaps more unsettling is the “knife” effect, which, when equipped, will cause many characters to flee Madotsuki, whilst immobile characters start shuffling around in a seemingly panicked manner. Players may, if they choose, attack these characters with the knife and even kill them to obtain coins. These coins can be used to increase player health at vending machines, but there is no reason to do this, as much like in a dream it is not actually possible to get hurt.

The game gives no overt sign of whether you are doing the “right” thing or not and players are kept ruminating as to the meaning of their actions and their possible consequences. In fact, one does not need to use the knife at all when completing Yume Nikki. Regardless of their meaning, much like the game’s environments, these effects are confusing and unsettling.

7

Watchful eyes sprawled throughout certain areas evoke a sense of paranoia, whilst outstretched arms almost seem to suggest a feeling of helplessness

The player reaches the game’s ending by collecting all 24 effects. Regardless of how the player chooses to play the game, the end is always the same: Madotsuki wakes from her dream and is now able to interact with a set of stairs which have appeared on her balcony, which she then climbs before jumping over the edge, seemingly to her death.

The ending

This ending is devastating and comes as a shock to many players who may have developed an appreciation for the silent protagonist. As abrupt and upsetting as the ending may be, it does, intentionally or not, reflect that individuals who are Hikikomori are vulnerable in that they are more likely to have risk factors for suicide (Yong & Nomura, 2019). Some fans argue whether this death occurs in the waking world or is just another dream, which may indicate their difficulty in accepting such an upsetting outcome.

8

Descending deeper into the dream, imagery becomes visibly more disconcerting. It is hard not to feel concerned for Madotsuki

The overall picture Yume Nikki paints is extremely bleak: a young girl stuck in her room, unable to access support, with nothing but a dream world for company that turns increasingly hostile towards her, and yet conquering the dream leads only to her apparent demise.

Whilst Madotsuki’s self-imposed confinement is believed to be indicative of her status as Hikikomori, it is important to note that Hikikomori has a strict set of diagnostic criteria in Japan (Kato et al., 2020) – including a minimum duration of 6 months and associated functional impairment - and it is debatable whether Madotsuki’s presentation meets these.

Of course, isolation can be a positive experience for some, but it is difficult to imagine how being left with only your own thoughts for company for such a long period of time can remain a positive experience. While research on the subjective experience of Hikikomori has yet to occur, it could perhaps be argued that the distress that the player is forced to experience through the game can feel particularly reminiscent of the struggles of the Hikikomori condition – from the endless ruminating thoughts about unanswered questions, to the perception of a cheerless, hostile world.

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Violent scenes hint at potential traumatic events in Madotsuki’s past

While Hikikomori was initially thought of as culture-bound to Japan, emerging evidence of cases from other cultures suggest otherwise (Kato et al., 2019). Unfortunately, Hikikomori can face significant stigma due to negative perceptions of their condition (Pereira-Sanchez et al., 2019), which can be a further barrier to help-seeking for their treatable mental health conditions.

Understanding empathy

Games such as Yume Nikki could play a crucial role in increasing players’ understanding and empathy for Hikikomori by helping them experience, first-hand, the horrors of isolation. In fact, one study assessing individuals playing Yume Nikki found that players showed an increased understanding of Hikikomori alongside a desire to learn more about it, but only after reading articles on the game’s fan website cataloguing discussions by fans that explicitly consider the link between the game and Hikikomori (Bommarito & Dunlap, 2014).

It was remarkable how this was the case even when the game itself left a less significant impression on the players, leading the authors to conclude that experiences are meant to be shared and considered in a collaborative environment, in which the perspectives of others are to be built upon or contended with additional experiences.

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The cheery melody of the flute offers some respite in an otherwise oppressive world

During this ongoing period of self-isolation, some of us at Gaming the Mind have found our own little ways to cope. Playing online games together and organising virtual group film watching sessions have both been good ways to stave off feelings of loneliness, and individual mindfulness exercises have personally been a great help in my day-to-day activities. It is important to remember that loneliness, isolation and Hikikomori are all similar yet distinct phenomena.

One can be objectively isolated without the subjective feeling of loneliness, and not all who are isolated would meet full diagnostic criteria for Hikikomori (Kato et al., 2020). Social isolation has itself been identified as a threat to mental (Coyle & Dugan, 2012) and physical health in older adults (Klinenberg, 2016), and both loneliness and social isolation are contributors to all-cause mortality in adults more generally (Holt-Lunstad et al., 2015).

Whilst the true mystery of Yume Nikki and the developer’s identity may remain unsolved for years to come, perhaps the game and this recent period of enforced self-isolation, as well as the discussion that they generate, can offer us a window into the experience of Hikikomori, or at the very least make us all that bit more empathetic to its profound impact.

Authored By Dr. Hamilton Morrin (Foundation Doctor, Guy’s and St Thomas’ NHS Foundation Trust). Supervised by Dr. Marcus PJ Tan (CAMHS SpR, SLaM NHS Trust).

References

Bommarito C, Dunlap K. Dream lucidity: Yume Nikki and learning the empathy dreamscape. International Journal of Gaming and Computer-Mediated Simulations. 2014;6:35-49. 10.4018/ijgcms.2014070103.

Coyle CE, Dugan E. Social isolation, loneliness and health among older adults. Journal of Aging and Health. 2012;24:1346–1363.

Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227-237.

Kato TA, Kanba S, Teo AR. Hikikomori : Multidimensional understanding, assessment, and future international perspectives. Psych Clin Neurosci. 2019;73(18):427-440.

Kato TA, Kanba S, Teo AR. Defining pathological social withdrawal: proposed diagnostic criteria for hikikomori. World Psychiatry. 2020;19(1):116-117.

Klinenberg E. Social Isolation, Loneliness, and Living Alone: Identifying the Risks for Public Health. American Journal of Public Health. 2016;106(5):786–787.

Pereira-Sanchez V, Alvarez-Mon MA, Asunsolo del Barco A, Alvarez-Mon M, Teo A. Exploring the Extent of the Hikikomori Phenomenon on Twitter: Mixed Methods Study of Western Language Tweets. J Med Internet Res. 2019;21(5):e14167. DOI: 10.2196/14167

Tan MPJ, Lee WL, Kato TA. International experience of hikikomori (prolonged social withdrawal) and its relevance to psychiatric research. Brit J Psych International. 2020. Published online: https://doi.org/10.1192/bji.2020.20

Teo AR, Fetters MD, Stufflebam K, Tateno M, Balhara Y, Choi TY, Kanba S, Mathews CA, Kato TA. Identification of the Hikikomori Syndrome of Social Withdrawal: Psychosocial Features and Treatment Preferences in Four Countries. Int J Soc Psychiatry. 2015;61(1):64-72.

Yong R, Nomura K. Hikikomori Is Most Associated With Interpersonal Relationships, Followed by Suicide Risks: A Secondary Analysis of a National Cross-Sectional Study. Front Psychiatry. 2019. https://doi.org/10.3389/fpsyt.2019.00247

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