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Why is mental health treatment sluggish in Korea?
  • By Marian Chu
  • Published 2018.01.12 17:37
  • Updated 2018.01.18 16:47
  • comments 0

Shock rippled through Korea when Jong-hyun, a talented, prolific K-pop star from SHINee, committed suicide in December, shedding light on mental health on not just the entertainment industry but in Korea as a whole.

Dr. Noh Gyu-shik, a well-known psychiatrist who authored several books on child psychology and appeared on several broadcasts as a special lecturer, sat down with Korea Biomedical Review Thursday to discuss depression and mental health treatment in Korea.

Dr. Noh Gyu-shik talks about depression and mental health treatment in the country in an interview with Korea Biomedical Review Thursday.

Question: What is depression?

Answer: Depression is a problem related to emotion. People may begin to have suicidal thoughts after experiencing a loss of drive, joy, good moods, sleep, or appetite. These are typical symptoms often alleviated with treatment. If for some reason treatment is not adequately received, however, it could lead to suicide.

Q: Are there any characteristics of Korean culture or modern culture that contribute to depression?

A: Korea is a highly civilized society riddled with intense competition and high expectations of the individual. The stress originating from these factors sometimes lead to depression.

Authoritarian thoughts where students must sacrifice their youth to get into college and the individuals must sacrifice [themselves] for their job, and their family still exist in our society. All these add up to a culture wherein personal freedom, choice and personality are not respected.

The economy is also getting worse, and unemployment is rising. The first thing affected by these changes are often the prevalence of mental illness. A declining economy increases the incidence and re-hospitalization rate of not only depression but also other psychiatric diseases such as schizophrenia. So whether mental disorders increase will also depend on which way our economy swings.

Q: Can you compare the level of mental health treatment in Korea to that of other countries?

A: As far as accessibility goes, our country provides better access [to mental health treatment] than other countries such as the U.S. because anyone can see a doctor relatively easily. Likewise, anyone can go to a mental health clinic. The nation is outstanding regarding accessibility.

Quality-wise, it’s difficult to say. For medical technology, it may be better to import it or learn about it from abroad. But for mental health, it’s essential to understand an individual’s psychological and cultural background. Korean doctors probably do a better job of treating Korean patients because they are more likely to follow the patient’s stories or situation.

Korean psychiatrists are also starting to publish their papers in well-known international journals and magazines. As there are lots of opportunities to get training abroad, we face no problems in keeping up with overseas trends. I can confidently say that the quality of psychiatric treatment here is excellent.

A characteristic particular to our country’s insurance system is the treatment at large university hospitals and local clinics. It is difficult to get “long-term treatment” or lengthy consultations for one patient, at a university hospital. University hospitals mainly use drug therapy. On the contrary, local clinics are more likely to provide psychiatric interviews that last from 30 minutes to an hour.

Q: Are patients able to access mental health treatment in Korea, financially and culturally?

A. Regarding economic cost, treatment revolving around medication costs around 10,000 won ($9.40) per visit. It’s pretty cheap. Insurance does not cover long-interview treatments, which last about an hour, or cognitive behavioral therapy. Treatment costs for these types of treatment differ [depending on the hospital], but as far as I know, the price is similar to the U.S.

Culturally, there is more prejudice against seeing a psychiatrist in our country compared to the West. The perception [that those going to psychiatrics] have a “weak will,” “weak heart” or are “completely insane” still exists. But that perception is growing weaker. I can say with confidence that young people come to see me without fear or prejudice.

Q: What are some reasons for the stronger prejudice against mental health treatment here?

A: I think the high barrier to getting mental health treatment here has a lot to do with our Confucian culture that emphasizes individual will, spiritual strength, and self-discipline. One of the most respected historical figures in our country, Admiral Yi Sun-shin, is well known for saying, “Those who seek death shall live. Those who seek life shall die.” Buddhism from the Silla Dynasty also has a proverbial saying, “Il-che-yu-sim-jo” that roughly translates into “everything comes from the mind.” These thoughts are embedded in our culture.

Q: Do you think the stigma around getting mental help is improving?

A: I think people are more open to mental health treatment now because there’s too much stress. People are reaching a limitation in dealing with it by themselves.

In the past, people went to a psychiatrist as a last resort after trying everything else. Nowadays people get treatment before their symptoms get worse. Some people go to get help even if they don’t have a significant problem.

From my experience in the field, celebrities coming out and saying that they have panic disorders, or even committing suicide (although far from ideal), contributing to lowering the social barrier to getting treatment. When celebrities talk about their experience with mental health treatment and pathologies, it has a positive impact on reducing the threshold for getting treatment. People think, “Oh, even people like that have that condition. It’s not just me.”

So even though the social barrier needs to get lower still, progress is being made.

Q: I’ve heard many Koreans are reluctant to use psychiatric medications. Is this true?

A: Resistance to drug therapy is not a problem found only in Korea. We see issues of drug compliance abroad as well, but, as I said before, Koreans have a strong cultural conviction that they can control their mind with their will. Against this backdrop, people sometimes are afraid of being “controlled” by medication. Some also believe that taking prescription indicates a terrible mental state. The black-and-white view is that non-medication treatment is okay, while drug treatment means it's a severe problem. This is one reason why people refuse medication, from personal experience.

Q: Are there any other barriers to treatment?

A: Most people worry about leaving a record-trail that may be detrimental to them later on. Whether it’s getting a job or getting into university, people are afraid of facing discrimination [due to treatment records].

Others also are hesitant to visit doctors or receive treatment because they may get rejected when buying [private] insurance. These are the most common concerns people voice when visiting a psychiatric office.

But treatment records are kept under a confidentiality agreement. The Health Insurance Review and Assessment Service (HIRA) stores treatment data, but they cannot leak it to external parties, at least in principle.

Insurance companies likewise are not allowed to discriminate against [people who have gained treatment]. Patient confidentiality is already installed systematically. But trust in the system doesn’t exist yet, I guess.

If we become a society that adheres to these rules, then these concerns are automatically alleviated. But it won’t be if public trust is broken or not gained.

Q: Do you have any advice for people hesitant about treatment?

A: I want to emphasize that no drug can control a person’s mind. Instead, medication can help you live the life you wish to live. If you believe it’s necessary, and a professional recommends it, following the recommendation can help you take charge of one’s life.

Q: Is there a particular type of depression associated with only Koreans?

A: Psychiatric recognizes a culture-bound disorder that manifests as depressive symptoms in Koreans called “hwatbyeong.” Hwatbyeong is an overlap of depression and anxiety that include cardiovascular symptoms of heart attack and chest tightness. The phenomenon, prevalent among married middle-aged women, is known to arise from severe conflicts between the mother-in-law and daughter-in-law and from a wife having to obey her husband at all times. The Confucian environment probably contributes to the hwatbyeong.

Nowadays, young people rarely exhibit these characteristics, indicating a change in social structure. Mother-in-laws are not as scary as they were before. Women are more self-assertive now, which increasingly dilutes these cultural factors.


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