It's true that those crazy Japanese can make a game from anything. And while the obscure premise and gameplay behind Mikie is pretty damned surreal, the scenario was something that was very prevalent in Japanese pop-culture, and goes a long way to explaining how this weird game might have come to be.
High school students make up the bulk of characters in Japanese youth-orientated entertainment, from TV through comics to videogames. When we look at 95% of manga and anime, not to mention games like Nekketsu Kouha: Kunio Kun (better known as Renegade round these here parts), the prevalence of this format is unmistakably. Mikie, quite clearly, was an attempt to epitomise American high school high jinks in a form that Japanese arcade goers would accept.
Mall life and sports had their place, but not in a way that tied with school life in the Far East, so an alternative method of crafting a blonde haired, renegade teen heart throb had to be found. To this end, the star of the show, Mikie, had to shirk his lessons and recover hearts from under the chairs of his fellow students; piecing together a letter from his strange girlfriend. The teacher was something of a task master and utterly intolerant of an unseated pupil - chasing down poor, lovelorn Mikie and beating him to the floor (which was acceptable in 1984).
In return, Mikie isn't adverse to hoofing his teacher in the nuts or dropping a Glasgow kiss on him when that elusive love letter is within his juvenile reach. A toned down version (where Mikie no longer dies from teacher abuse, and isn't required to headbutt glass jars) was more commonly found on this side of the ocean. The surreal world of Mikie never quite achieved the pop culture fandom so many high school teen soap dramadies attain in the Land of the Rising Sun, but the game lives on in the rebellious nature of lovesick kids the world over.