I recently discovered this gem of a manga, and I ended up binging through all 262 chapters that are currently available in English. It began in May 2016, and honestly, why hasn’t this been turned into a anime yet? It is the perfect mix of comedy, romance, and slice of life. Come on Kyo-ani, this one is right up your alley. While I could go on about what makes Komi-san Can’t Communicate a must read, that isn’t what you came for. Instead I am actually going to discuss the biology behind one of the characters in Komi-san Can’t Communicate.
Not the character many of you were expecting, I imagine. Most of you were probably expecting Komi herself or Najimi or one of the many interesting characters found in the story. You could write a post or a series of posts on any one of them, but that’s a little too much psychology for my tastes. Instead we are going to talk about Ase Shibuki, and her sweating problem, or hyperhidrosis, which is her defining characteristic.
When we first meet Ase Shibuki in chapter 151 she is complaining about the heat and having to wear a sweater so she doesn’t sweat through her clothes.
You might think that she is just some one who sweats more than others, and perhaps is more susceptible to the heat, and, well, you wouldn’t necessarily be wrong, but we are given more clues as time goes on. Ase Shibuki complains that it doesn’t seem to matter what she does to stop sweating as nothing seems to work. This is backed up by the artwork that visibly shows her sweating all over, especially her face and hands. She is even sweating during the trip they all took to the mountains to snowboard.
This combined with the fact that just about every main character has some sort of quirk to them, leads me to believe that Ase has a condition that is causing her to sweat profusely. In this particular case, hyperhidrosis is what comes to mind.
Hyperhidrosis, or excessive sweating, is a medical condition that is characterized by excess sweat not brought on by heat, exercise or other conditions.
Hyperhidrosis is primarily classified by the extent and location of the excess sweating. In primary hyperhidrosis also known as focal hyperhidrosis, the sweating is found in only one particular part of the body. This particular type of hyperhidrosis typically begins during the teenage years, and is thought to be an autosomal dominant trait. In secondary hyperhidrosis the excess sweating is found all over the body, and usually starts later in life. Additionally, it is typically due to some other underlying conditions such as thyroid and pituitary disorders, tumors, gout, diabetes, and certain medications.
Which type of Hyperhidrosis does Ase have?
Of course, the question on your mind at this point is which specific type of hyperhidrosis Ase suffers from. Unfortunately, there is no easy answer as there are certain pieces of information that are missing, but I think we can make some assumptions to narrow down the list a bit.
First, I think we can safely assume that Ase Shibuki does not have a pituitary condition as she does not show any of the other signs of having one. Additionally, we can safely assume that she does not have a thyroid problem either as she lacks a goiter indicative of hypothyroidism, or bulging eyes indicative of hyperthyroidism. Yes, I realize there are other signs but these are two of the more easily identifiable symptoms. Also, we know she has had hyperhidrosis since at least middle school and she is in high school now, which makes a tumor unlikely as I doubt such a thing would go unnoticed by medical professionals for so long. Lastly, at no point in the manga thus far have we seen Ase Shibuki worry about her blood sugar or exhibit any behaviors that would imply that she has diabetes. She also has all the outward appearances of being a healthy teenage girl, which makes medications unlikely. Thus, we can safely rule out secondary hyperhidrosis.
This leaves us with primary hyperhidrosis, but there are some problems with this as well. For starters, primary hyperhidrosis is typically limited to a single part of the body, and Ase appears to sweat excessively over her entire body. Well, I have an answer to that. When we meet Isagi Kyouko, we learn that she has an almost OCD compulsion about cleanliness. This behavior developed after meeting Ase in middle school, specifically after shaking Ase’s very sweaty hand. Now when we consider that almost every character in Komi-san can’t communicate, an explanation becomes clear.
Ase Shibuki most likely has primary hyperhidrosis localized on her hands, and that this developed in middle school prior to her meeting Isagi. Then when she met Isagi and the girl had such a negative reaction to her, this created the anxiety about her sweating that we see in the manga. Anxiety can cause sweating and it is common for those who have hyperhidrosis to be anxious about their sweating, which then leads to more sweating. And we are shown on multiple occasions that Ase is very self-conscious about her sweating.
What can Ase Shibuki do about her condition beyond wearing the thick clothing that she already does to hide it? Surprisingly, not much, as there is no silver bullet and many of the treatments can have severe side effects. First off, there are a variety of antiperspirant products that Ase is most likely already using but they do nothing to treat the underlying problem. Next there are anticholinergics, which are medications that block acetylcholine, a neurotransmitter. As I discussed in Misaka Mikoto the walking stun gun, neurotransmitters are the substances that nerves release to signal other nerves, muscles, or other body tissues such as sweat glands. And the most common neurotransmitter in the human body is acetylcholine. By blocking acetylcholine, you can block the nervous system from telling sweat glands to release sweat. This is why, while effective, the side effects include dry mouth, urinary retention, constipation, and visual disturbances such as mydriasis (dilation of the pupils) and cycloplegia (lack of ability to focus the eye). This is because the blocking affect of acetylcholine will not be limited to just the sweat glands, impacting other parts of the body. I did read a few reports of individuals finding success with chewing on ice, as the cold temperature lowers the body temperature, which reduces sweating due to being too hot.
There are also injections and surgical procedures that can be done, but again the side effects can be severe. Botox injections can be used to treat excessive sweating in the hands, but the effects wane after 3-9 months and the injections can be quite painful. As for surgeries, the first is sweat gland removal which is usually only done in the case where the excess sweating is originating from the armpit area. The second surgical option is to put a pair of clamps over the sympathetic nerve that runs along the spine compressing it.
Clamping the nerve puts pressure on it which reduces its ability to conduct nerve impulses. This reduction in nerve impulses effectively reduces hyperhidrosis of the hands in 85-95% of patients. However, up to 80% of patients can exhibit compensatory sweating where the sweat production in another area of the body increases. And up to 51% of patients have reported saying that this has made their quality of life worse. Sadly, this not good news for Ase Shibuki, as she doesn’t have many good options to choose from.
Thus, my diagnosis for Ase Shibuki is that she suffers from primary hyperhidrosis, which is focused on her palms. This condition is exacerbated by the anxiety she has about her sweating, which is what is causing the rest of her body to sweat excessively. She most likely inherited this condition from her parents, but that cannot be confirmed at this time. My recommendation would be to use heavy duty antiperspirants, some of which can be used on the hands. Additionally I would recommend she seek professional help for her anxiety. I hope you enjoyed my little foray into Komi-san Can’t communicate, but don’t expect me to dive into the other students anytime soon as I am not a psychologist.