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Koreans and suicide Winston Chung MD, MS, Child and Adolescent Psychiatry

Faculty

In the wake of former President Roh's suicide last week, we all might benefit from

taking a long, hard look at a concerning epidemic of Koreans' taking their own lives.

Data indicates that South Korea is the suicide capital of the industrialized world. But

this is not just a problem in South Korea. While working on the Asian Focus Inpatient

Psychiatry Unit at San Francisco General Hospital, another worker once told me that the

patients whom he feared were most likely to actually complete suicide while on the unit

were Korean, and that this was based on precedent.

As a Korean-American psychiatrist who is affected by Roh's suicide and has struggled

with many of the issues mentioned below at both a personal and professional level, Ican't help but organize some thoughts on what factors might be involved:

Some Koreans may have a biological predisposition for emotional reactivity and

passionate extremes or obsession. Before one judges this, it should be pointed out that

this is not necessarily a bad thing. Emotional reactivity or passion can lead to great

artists, musicians, or businessmen. The fact that a Korean has been drafted in every

major professional sporting league in the United States may also be a result of

competitive fire or passion. But all too often the emotion that gets triggered is anger,

and this anger, whether turned inward or outward, often leads to destructive behavior.

The emotional reactivity may also predispose one to depression, anxiety, substance

abuse, bipolar disorder and cluster B personality disorder, all of which I believe are

under-diagnosed in the Korean community in the United States as well as Korea.

There are two significant and related psychological factors which may contribute to this

problem, the attitude of pride and the defense mechanism of denial. Extreme pride in

one who might be predisposed to emotional reactivity, however, may lead to

maladaptive narcissism and a Machiavellian attitude toward success, achievement,

prestige and outward appearances. It is this dynamic and resulting competitiveness

which may be related to the rash of adolescent suicides around the high school exit

exam each year in South Korea.

Suicide may be a consequence of pride when pride is hurt, leaving a wake of shame ornarcissistic injury. In a "shame society" such as Korea, shame is such a painful

emotional burden that it may trigger a suicide and many take action to avoid shame

and save face. It is the drive to save face that can drive the defense mechanism of

denial. Denial may serve a purpose in minimizing shame in the moment and promoting

harmony, but it often leads to much worse suffering later and it also decreases the

probability that the one who suffers will seek treatment for emotional wounds. The

pride-shame-denial cycle adds to the stigma for individuals seeking mental health

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treatment. In Korea, one of the most common, culture-bound syndromes is known as

Hwa Byung, which often presents as a multitude of physical symptoms that are rooted

in depression or anxiety. Because of the stigma and denial of mental illness, it is much

more culturally acceptable to acknowledge physical symptoms, while continuing to deny

painful psychological wounds. But one can only deny festering emotions for so long

before they explode in some form of destructive behavior.

Two related social phenomenon that may be particularly relevant to the Korean suicide

problem are patriarchy and Evangelical Christianity. Patriarchy is rooted in the influence

of Confucian hierarchical philosophy and plays a significant role in promoting harmony

in the structure of family and society, but this hierarchy is causing problems in modern

society. When the man is allowed to bully and do whatever he wants regardless of the

effect on the family, this is likely to incite fear, anger or resentment. Since Korean

patriarchy does not allow for women or the young to express their dissent or anger, the

anger is often turned inward and this is a classic dynamic of suicide (see Korean

actresses who have killed themselves in the past three years). The patriarchy also putspressure on the patriarch to be perfect and makes him less likely to be able to tolerate

his own fallibility.

It is from the wounds of patriarchy that many Korean young people and women seek

healing in the form of Evangelical Christianity. Christianity has been an extremely

positive force in helping Koreans get through many tribulations and the Korean Church

is the foundation for Korean socializing and fellowship. It is ironic, however, that religion

may actually reinforce the patriarchal values and masochism that are the causes of

suffering. Korean pastors might encourage the suffering wife to bear her cross as Jesus

did and receive all benefits in the afterlife. But aside from the doctrines of Christianity, it

is the tendency to polarize the cognitions of followers that may have the greatestimpact. For instance, Evangelical preachers will often say that there is only one true

way in life, or one's actions are either for God or against God, and it is this polarized,

absolute, black and white thinking that is often the root of suffering and depression and

may make one more likely to choose an absolute solution to what is seen as an

absolute problem. The belief in an absolute, one way of solving problems may make

one neglect another way - may be helpful.

It is the dialectical concept of tolerating two opposing points of view that may be

important in helping Koreans to deal with these difficulties. Similar to the point of view

that both spiritual and mental health are important, not one or the other; individuals

who are predisposed to emotional reactivity and black-and-white thinking will benefitfrom trying to be able to tolerate two opposing points of view and open up to new

possibilities, including prioritizing mental health. If President Roh could have reconciled

the idea that he could still be a good person, husband, father, president AND someone

who makes mistake; or that a strong person can ALSO seek mental health treatment,

his needless death may have been avoided. I just hope my own father might be able to

tolerate the idea of being a good person who can also make mistakes before it is too

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late. By Winston Chung

Jason disagrees with the religious reference in this article. Further, he believes that four

aspects of Korean culture image, networking, status and competition bring about

tremendous stress.