Stressed and Depressed, Koreans Avoid Therapy

By MARK McDONALD JULY 6, 2011 New York Times

SEOUL It can sometimes feel as if South Korea, overworked, overstressed and ever
anxious, is on the verge of a national nervous breakdown, with a rising divorce rate,
students who feel suffocated by academic pressures, a suicide rate among the highest
in the world and a macho corporate culture that still encourages blackout drinking
sessions after work.

More than 30 South Koreans kill themselves every day, and the suicides of
entertainers, politicians, athletes and business leaders have become almost
commonplace. The recent suicides of four students and a professor at Koreas leading
university shocked the nation, and in recent weeks a TV baseball announcer, two
professional soccer players, a university president and the former lead singer in a
popular boy band killed themselves.

And yet Koreans while almost obsessively embracing Western innovations ranging
from smartphones to the Internet to cosmetic surgery have largely resisted
Western psychotherapy for their growing anxieties, depression and stress. Talk-
therapy modalities with psychiatrists, psychologists and other types of trained
counselors are only slowly being accepted, according to mental health experts here.

Talking openly about emotional problems is still taboo, said Dr. Kim Hyong-soo, a
psychologist and professor at Chosun University in Kwangju.

With depression, the inclination for Koreans is to just bear with it and get over it,
he said. If someone goes to a psychoanalyst, they know theyll be stigmatized for the
rest of their life. So they dont go.

Mental health experts said many troubled South Koreans seek help from private
psychiatric clinics (and pay their bills in cash) so their government-insurance records
do not carry the stigma of a Code F, signifying someone who has received
reimbursement for such care.

Even when Koreans do seek out counseling, the learning curve can be steep.

A prominent psychiatrist with a practice in Seoul, Jin-seng Park, said it was not
uncommon for some new patients to come to his office, talk over a problem for 40
minutes and then be shocked when theyre presented with a bill.

Theyll say, I have to pay? Just for talking? I can do that for free with my friend or
my pastor, said Dr. Park.

Patients also balk, he said, at the idea of spending more than a couple sessions on
talk therapy. Instead, most patients simply ask for, and expect, medication, said Dr.
Park, whose Web site advises that nearly all of the medications used in the U.S. are
available here, too. So dont worry about getting those medications in Korea.

About a third of his patients come for counseling, Dr. Park said, and the rest rely on
medication.
Koreans are getting more comfortable with Western psychotherapy, but this is
limited to the highly educated and those familiar with Western ways, said Dr. Oh
Kyung-ja, a Harvard-trained professor of clinical psychology at Yonsei University in
Seoul.

Meanwhile, the suicide rate in South Korea is nothing short of alarming, nearly three
times higher than in the United States. The rate here doubled in the decade between
1999 and 2009. Suicide pacts among strangers who meet online is a growing
phenomenon. Suicides by drinking pesticides, hanging or jumping from tall
buildings are the most common.

We have seen a rapid increase in depression, and Id say 80 to 90 percent of our

suicides are byproducts of depression, said Dr. Kim. Government mental health
clinics have proved effective in helping with basic family or marital problems, he
said, but theyre not getting at depression.

That issue is still very closed. We still conceal it.

South Korean society has traditionally been underpinned by Buddhist and Confucian
values, which emphasize diligence, stoicism and modesty. Individual concerns are
secondary. Preserving dignity, or face, especially for the family, is paramount.

Some experts trace South Koreas emotional malaise to the decline of these
traditional values and the rise of the country as a modern industrial power, starting
in the 1980s. South Korea, once even poorer than woeful North Korea, now boasts
the worlds 13th-largest economy.

As the society became more oriented toward materialism, people started to compare
themselves, said Dr. Park. Theres a lot of competition now, even starting in
childhood, and the goals of life have moved. We have a saying, If one cousin buys
land, the other cousin gets a stomachache.

With Confucian values on the wane, Koreans use a variety of ways short of
prescribed medications to wick off the stresses of the hectic pace of urban life.
Consulting shamans, outdoor exercise like golf and hiking, alcohol, organized
religion, the Internet and travel are common outlets now.

More Koreans see fortunetellers than psychiatrists, said Dr. Yoon Dae-hyun, a
psychiatrist at Seoul National University Hospital and an official with the Korean
Association for Suicide Prevention. Our biggest competitors are fortunetellers and
room salons. They certainly make more money than us.

Koreans are trying to find their own package, their own set of remedies and
theyre doing this very intensely, of course, said Dr. Oh, the Yonsei professor. They
are desperately searching for things to do to divert themselves from stress. They just
dont have a good model.