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Eye on Psi Chi: Spring 2016

A National Mental Health Epidemic in South Korea:
What Needs to Change
and Why It Matters


Stacy Ko, MSW, Iowa State University
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"Teacher, I need to diet! I am so fat!” “Teacher, I don’t like my nose; my mom says I should get surgery when I am older, so I can marry a rich husband.” These are just some of the many grievances I heard from my elementary school students during my 3-year stint as an English teacher in South Korea. Hearing young students engage in such painful self-deprecation may signal a sense of alarm to the average American, but hearing these types of statements were par for the course living in Korea, a country where physical appearance is a proxy for success and self-worth in the eyes of others, where external aspects of the self are considered superior to the internal, and where image and reputation play a heavy role in defining status in a competitive society.
As a Korean-American born to immigrant parents in Orange County, California, my time in South Korea was intended to serve as a time of reconnection with my roots and coming to a better understanding of the intergenerational struggles I had endured with my parents growing up as an Asian American teenager in a European American society. While in Korea, I developed a deep sense of cultural understanding of the Korean people and came to respect and admire many of their positive cultural qualities such as their strong work ethic and sense of steadfast loyalty to close others. However, I was also struck by the more despondent sides of Korea that painted a very different picture of the country than the one I had envisioned.
Korea is often considered to be the glamorous, flashy, entertainment capital of Asia with the growing influence of Korean pop stars (“k-pop stars”) and popular actors and actresses spreading throughout the rest of the continent in a movement now known as Hallyu, or Korean wave. This neologism refers to the increasing popularity of South Korean culture since the late 1990s, and is instrumental in defining Korea’s role as a major exporter of popular culture. This growth is also reflected in Korean’s incredible economic development and global integration in the last several decades; the country’s GDP per capita was among that of the poorest countries of Africa and Asia in the 1960s, yet the country now boasts the world’s 12th largest economy with a GDP in the billions (Forbes, 2014). Despite the vast economic revitalization that South Korea has witnessed, there appears to be a wide gap between the glitz and glamor of this financial success and the poor mental health of its citizens that has accompanied this surge in growth.
South Korea has the highest suicide rate in the world among developed nations, at 28.9 per 100,000, and is second in the world exceeded only by Guyana (World Health Organization, 2012). Among the Organization for Economic Cooperation and Development (OECD) countries, Korea also ranks among the highest for divorce, alcohol consumption, and household debt (Cain, 2014). Often, Korean businessmen can be seen passed out on sidewalks or on subways after a night of binge drinking, behavior that is often fueled by a culture where obligatory drinking with higher-ups in the workplace constitutes a mandatory part of working life. The average Korean of drinking age takes 13.7 shots a week—more than any other country in the world, and followed far behind by Russia at 6.3 shots per week (Ferdman & King, 2014).
Additionally, students are part of a cutthroat educational system practically out of the womb where mothers enroll their children in English lessons before they even learn how to walk. This competitive educational culture essentially consumes the lives of Korean youth as students attend after-school academies until midnight as part of their daily routine and are forced to one-up each other for entry into the highly limited amount of prestigious universities in the country. Entry into one of these universities is contingent upon a 9-hour examination, the suneung, which can be seen as a higher stakes, stress-inducing version of the American SAT that will essentially determine one’s fate in life. An unsatisfactory score on the exam has ramifications for life, indicating a failure to attend a top university, a failure to find a suitable job and partner for marriage, and a failure to live up to the expectations of one’s family.
The excessive emphasis placed on body image and appearance by the young Korean population also cannot be understated—Korea is the most diet-conscious of the 13 Asian countries in the OECD, and studies have shown that Korean women place greater importance on appearance and are more critical of their bodies than their U.S. counterparts (Jung & Forbes, 2006; Jung & Lee, 2006). This body image dissatisfaction epidemic manifests in the thousands of plastic surgery clinics scattered throughout the upscale districts of Seoul, where “two-for-one” eye and nose job procedures are akin to getting braces or contact lenses in the United States. Both men and women alike have been known to walk into plastic surgery clinics requesting the facial features of their favorite Korean celebrity as if choosing items off of a restaurant menu. TV shows featuring the before and after experiences of plastic surgery recipients are also extremely popular.
With the slew of personal, cultural, academic, and economic pressures that are endemic to Korean life and have put the country on the top of many “negative” lists, it bears questioning why a country that appears to be on the brink of a national nervous breakdown is so opposed to seeking help. This is even more questionable considering the fact that Koreans are typically quick to adopt Western cultural practices such as smartphones, the use of Facebook®, and cosmetic surgery procedures. Despite this, Koreans appear heavily reluctant to adopt Western psychotherapy practices, and publicly acknowledging personal difficulties and reaching out for assistance is considered extremely taboo. Korean families experience strong feelings of family shame and social stigma associated with mental illness (Shin & Lukens, 2002) that are deeply rooted in their adherence to Confucian values such as stoicism, modesty, and preserving dignity for the family in the face of difficult circumstances. Such cultural values serve to further drive South Koreans into isolation and an inner world of turmoil where maladaptive forms of coping (e.g., alcoholism) may develop in the absence of other socially acceptable responses (Chou et al., 2012; Kim, Wiechelt, & Kim, 2010).
These issues are not outside our realm of knowledge or exposure in the United States—a simple Internet search of any of the aforementioned phenomena brings up dozens of popular newspaper and magazine articles on the state of mental health in South Korea. Popular headlines from The New York Times and The Global Post read, “Stressed and Depressed, Koreans Avoid Therapy” and “Why South Koreans Are Killing Themselves in Droves” (Cain, 2014; McDonald, 2011). Additionally, a growing Korean-American population in the United States faces many of the same issues and barriers to seeking help, serving to bring these issues closer to home. Similar to Koreans living abroad, this population espouses the suppression of individual emotions for the sake of the collective group with disclosure of mental anguish or pain coming at a high cost. Turning to mental health professionals only comes as a last resort with most Korean Americans preferring to turn to more informal social networks such as family, friends, and the church community for help.
So what does this mean for the psychology community in the United States? As a country where psychology as a discipline is arguably one of the most well-developed worldwide, we hold a professional responsibility to educate ourselves about the mental health concerns that occupy other parts of the world, and to then actively engage with these issues in a relevant way. We must foster international connections and academic exchange with researchers abroad, engaging in multicultural research endeavors and outreach that seek to cultivate awareness among the populace and develop means of increasing access to mental health care in culturally informed ways. International connections abroad can then be further harnessed to facilitate public policy change and stigma-reducing efforts within Korean governing bodies, thus beginning to alter the structure of how Korean mental health issues are conceptualized by the people on a broader level. However, it is only when we are armed with a careful, thorough cultural knowledge that we will be able to  use our profession in culturally competent, practically meaningful ways.
Although South Korea has endured years of hardship in the realm of mental health that is vastly at odds with its burgeoning economic success, I am hopeful that we will be able to have an active role in affecting change within education, research, and practice in a country that is, quite fortuitously, open to Western ideals and collaboration. Researchers in the United States might take steps to address the growing mental health concerns in Korea by engaging in research around social stigma and mental illness, as well as developing psychoeducation interventions that might be adapted for use with Korean populations to lessen the stigma associated with help-seeking. Mental health professionals who work in metropolitan areas with high numbers of Korean clients might seek additional multicultural competence training to learn ways that mental health issues can be reframed in culturally acceptable ways that reduce barriers to help-seeking (e.g., highlighting biological aspects of mental illness that may constitute a more acceptable reason to seek help). These steps taken by mental health professionals might serve to foster more positive associations with help-seeking, separating it from personal or familial shame. It is no longer congruent with the helping nature of our profession to stand on the sidelines and watch an entire country suffer before our eyes—our profession demands a responsibility that we care, that we initiate, and that we persist in our efforts to stimulate change.
References
Cain, G. (2014, March 15). Why South Koreans are killing themselves in droves. Global Post. Retrieved from http://www.salon.com/2014/03/15/why_is_suicide_so_popular_in_south_korea_partner/
Chou, S. P., Lee, H. K., Cho, M. J., Park, J. I., Dawson, D. A., & Grant, B. F. (2012). Alcohol use disorders, nicotine dependence, and co-occurring mood and anxiety disorders in the United States and South Korea—A cross-national comparison. Alcoholism: Clinical and Experimental Research, 36, 654–-662. doi:10.1111/j.1530-0277.2011.01639.x
Ferdman, R. A., & King, R. (2014, February 2). South Koreans drink twice as much liquor as Russians and more than four times as much as Americans. Quartz. Retrieved from http://qz.com/171191/southkoreans-drink-twice-as-much-liquor-as-russians-and-more-than-four-times-as-much-as-americans/
Forbes Best Countries for Business: South Korea. (2014, December). Retrieved from http://www.forbes.com/places/south-korea/
Jung, J., & Forbes, G. B. (2007). Body dissatisfaction and disordered eating among college women in China, South Korea, and the United States: Contrasting predictions from sociocultural and feminist theories. Psychology of Women Quarterly, 31, 381–393. doi:10.1111/j.1471-6402.2007.00387.x
Jung, J., & Lee, S. (2006). Cross-cultural comparisons of appearance self-schema, body image, self-esteem, and dieting behavior between Korean and U.S. women. Family and Consumer Sciences Research Journal, 34, 350–365. doi:10.1177/1077727X06286419
Kim, W., Wiechelt, S. A., & Kim, S. (2010). The evolution of drinking motivations among Korean women with alcohol dependence. Health Care for Women International, 31, 327–344. doi:10.1080/07399330903215627
McDonald, M. (2011, July 6). Stressed and depressed, Koreans avoid therapy. The New York Times. Retrieved from http://www.nytimes.com/2011/07/07/world/asia/07iht-psych07.html?_r=0
Shin, S. K., & Lukens, E. P. (2002). Effects of psychoeducation for Korean Americans with chronic mental illness. Psychiatric Services, 53, 1125–1131.
World Health Organization. (2012). Global health observatory data repository suicide rates: Data by country. Retrieved from http://apps.who.int/gho/data/node.main.MHSUICIDE?lang=en

Stacy Ko, MSW, is a second-year, Korean-American doctoral student in the counseling psychology program at Iowa State University. Born and raised in Southern California, Ko received her BA in psychology and communication studies, and her master of social work from the University of California, Los Angeles. In between her undergraduate and master’s education, she spent time living and working in South Korea as an English teacher where she gained an interest in mental health issues specific to the Korean population. Her current research interests in perfectionism and body image concerns affecting the South Korean college student population will take her to Korea this spring, where she will conduct a study as part of an international research endeavor in Seoul. Ko hopes to combine research, clinical, and teaching work upon graduating from her PhD program. In her free time, she enjoys yoga, cooking, watching documentaries, and engaging in other forms of self-care.

Copyright 2016 (Volume 20, Issue 3) by Psi Chi, the International Honor Society in Psychology


 
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