The illness that dare not speak its name

For the last five years, members of the Korean Association of Neuropsychiatric Practitioners have been debating whether to remove the word mental from all areas of their field, including titles used in university hospitals and private clinics where psychiatry is usually practiced in so-called “mental health departments.”
The reason is simple. The doctors are worried that the word creates a cultural bias that hinders patients who need help, thus causing more suicides. Korea’s suicide rate has doubled since 2000. In 2005, 12,047 Koreans took their own lives and 12.7 per cent of people in their 40s say they have felt suicidal impulses. Suicide now kills more Koreans than car accidents or high blood pressure.
In a survey hosted by the Association, nine out of 10 adults replied that they would “hesitate” before sending their children to a psychiatrist. Over 80 percent said that psychiatric patients were the victims of social bias and disadvantages at work.
The association’s bulletin board recently received a posting from a patient who suffers from schizophrenia. He said that the Korean name for the disease, which translates as “split mental state,” should be changed because it “seriously distorts the actual symptoms of the illness, causing sufferers to be debased and abused in our society.”
In 2002 Min Seong-gil, a psychiatry professor at Yonsei University, released a survey that tested the level of bias against schizophrenia in Korea.
He reported that 96.6 percent of Korean psychiatrists admitted that they feel “distress” when they tell a patient about the illness because they “sense disapproval of the condition and the social stigma that comes with the name.”
Seventy percent of doctors said they “seriously considered” acceding to patients’ requests that they change the name of their illness on medical documents, because the condition can cause social disadvantages. And the problems are not reserved for those with schizophrenia.
“For a long time mental disorders in Korea have carried a social stigma and psychiatrists try to reserve the phrase mental illness for more serious disorders like dementia,” explained Lee Sang-min, a spokesman for the Korean Association of Neuropsychiatric Practitioners. “Most patients who visit private clinics are suffering from neuroses or chronic symptoms like depression. For them the phrase creates a wall and gives them a false impression of psychiatric treatment.”
It’s not just a question of names. Experts say that mental disorders are regarded as a cultural taboo because, traditionally, Koreans have believed that mental disorders are caused by demonic possession. The superstition still prevails in some rural areas where people often put more faith in shamans than in anti-depressants.
In Yeoncheon Community’s Mental Health Center doctors hold monthly sessions for their patients’ families to try and make sure they don’t hire shamans to perform an exorcism or seek other treatments besides the medical care that patients receive from the center.
The regional gap in medical awareness has also exacerbated the problem.
“The level of awareness is definitely higher in bigger cities,” says Baik Sang-bin, a psychiatrist at Gangneung Asan Hospital, who worked at Yonsei Severance Hospital in Seoul before he relocated. “Here I see a lot more patients dragged in by their families, whereas in Seoul there were more patients who voluntarily sought help.”
Whatever the cause, the public’s hesitation to visit psychiatrists has recently led to some devastating revelations about the deteriorating condition of the nation’s mental health.
Aside from the rising number of unauthorized mental clinics across the nation, the suicide rate in South Korea is now the highest among the members of the Organization for Economic Cooperation and Development and has been for two years. The international press has taken to calling Korea “the suicide republic.” A series of celebrity suicides in recent months has led to a growing concern that the country needs urgent help to overcome taboos about many aspects of mental health.
“There is a wealth of false information about depression and anti-depressants among Korean patients and that’s causing enormous problems,” says Dr. Lee, who is also a psychiatrist at Yonsei Feel Clinic. “Often you see the families of patients encouraging their relatives to stop taking prescription medications after a few weeks because they fear social bias. That ends up aggravating the patients’ symptoms.”
It might help if those with depression realized that the government has taken major precautions to protect the privacy of patients with psychiatric disorders.
For example, Dr. Baik said that the Korea Transportation Safety Authority was denied access in 2002 to a list of patients who had received psychiatric treatment. They made their request to the Ministry of Health and Welfare. It was denied because the ministry ruled access would be an intrusion of the patients’ medical privacy. The transportation authority wanted the information to assist its monitoring of bus drivers and subway traffic controllers working in public transportation.
There are some grounds for optimism. Many doctors say that increased social awareness is making people more open-minded.
“Four years ago doctors would spend a minimum of 30 minutes explaining what depression is,” says Song Hyeong-seok, a psychiatrist at Maum-to-Maum (heart to heart), a clinic in Ilsan. “Now, by the time a patient seeks help they already know what their problem is. They are just waiting for proper treatment.”
Many psychiatrists now have Web sites with photographs of their clinics including their waiting rooms and consulting suites. Their lobbies have been made to look more like hotels to fight the public’s negative stereotype of mental hospitals.
At the national level the government recently announced that they would expand the number of state-run psychiatric community centers from 105 to 230 by the year 2010. Online counseling has also become an option along with hotlines and counseling centers that are more accessible to the public and offer more anonymity.
“There is often an immense fear among people in stressful circumstances, and they don’t want to tell a stranger their problems face-to face, whether their fears are financial, emotional or social,” says Ha Sang-hun, a director of Lifeline, a telephone counselling service. “But the fact is we need far more support for alternative counseling centers. Korean society changes so fast and there are more individuals who feel an emptiness in their life and difficulties in coping with the changing values within their families and society. It would help so many people just to know that their problems are being taken seriously.”
Meanwhile the Korean Association of Neuropsychiatric Practitioners has set up a committee to develop alternative names to replace those currently used. They include “Mind Therapy,” “Mental Stress Science” and “Medicine of Mind and Body.” Once the name is set it needs approval from the Ministry of Health and Welfare before it can be put into effect.
“Overall there seems to be a lack of training about how to control anger in our society that’s either cultural or biological,” says Dr. Baik. “The element of anger is quite deep in many Koreans. We seem to be more easily drawn to extreme scenarios. Our anger builds faster and more spontaneously than among other ethnic groups. It might have to do with the conditions of modern society, which are unstable.”

By Park Soo-mee Staff Writer [myfeast@joongang.co.kr]