Have you ever heard of hikikomori? Literally: "pulling inward."

First described by Japanese psychiatrist Tamaki Saito in 1998 — and for decades assumed to be a uniquely Japanese problem. 

It isn't.

A 2025 meta-analysis of 19 studies and 58,000+ participants found cases across Europe, North America, and beyond. US estimates put prevalence around 2–3%. Roughly 1 in 40 Americans.

We support autistic children. We abandon autistic adults. 

In our latest Child Psychiatry Report, Mary Baker-Ericzen, research professor at San Diego State University and clinical psychologist at the Intricate Mind Institute, asks clinicians to consider a different question at every visit: Is this patient building the skills they'll need when the system stops showing up for them?

Autism doesn't protect against suicide. It hides it. 

It's easy to treat xerostomia as a nuisance, low on the priority list when you're managing psychosis or depression. But left unaddressed, it quietly does real damage.

A German medication beat paroxetine for anxiety. Its approved in 20 countries. Most U.S. clinicians have never heard of it. 

Depression distorts memory. Measurement restores it. 

In December 2025, Flow did in fact receive FDA Approval, based on data from the Empower trial. Before that, it had been marketed under FDA clearance—a lower evidentiary bar. That correction matters—and it sharpens the question many subscribers have been asking me: How much does FDA approval tell us about real‑world effectiveness?

Psychodynamic therapy isn’t outdated.
It’s evolving. Grounded in evidence.