South Korea’s Mental Health Problem — That Koreans Don’t Admit
WHY YOU SHOULD CARE
The population may be a model of physical health, but that doesn’t mean everything is OK.
By James Watkins
With the highest rates of survival of major cancers and strokes of all developed countries, the ninth-lowest obesity rate in the world and the third-longest expectancy for a healthy life, you could be forgiven for thinking that South Korea is some sort of wellness paradise. It’s all the more remarkable given that less than 30 years ago, medical infrastructure was limited, coverage patchy and outcomes no different from its northern neighbor.
But Korea’s health care revolution hides a dark secret:
South Korea has one of the worst mental health problems in the industrialized world, but Korean people routinely ignore symptoms.
South Korea has far and away the highest suicide rate among the 35 wealthy Organization for Economic Cooperation and Development countries — almost 40 Koreans fall victim to suicide every day, almost 50 percent higher than the second-ranked OECD country, Hungary. Almost 95 percent of Koreans report being stressed, a third of them chronically. According to one study, up to 28 percent of elderly Koreans are depressed, compared with 10 to 15 percent in the U.S.
But, crucially, elderly people in Korea don’t think they are depressed, or at least they don’t want to admit it, with a tiny fraction actually seeking mental health treatment. This is in part because of stigma: 78 percent of elderly Koreans think depression means a person is weak; the same is true for only 6 percent of elderly Americans.
Geopolitical worries with the North are routinely at the bottom of perceived stressors in surveys of South Koreans, below more routine factors such as work, family and culture.
This represents a trend across the spectrum of unreported mental health issues in Korea. In fact, a recent government study found that the vast majority of suicide victims had recently sought medical treatment not for mental health issues, but for physical symptoms such as fatigue, poor concentration, abdominal pain and headaches.
Meanwhile, alcoholism is a huge problem in the country — it has the highest rate of liquor consumption of any country in the world at almost 14 shots per person per week, twice the rate of Russia — and yet alcohol-dependent Americans are four times as likely to seek treatment as alcohol-dependent Koreans, according to one survey. And indeed, despite the country’s problems with mental health, South Korea has the lowest rate of antidepressant use in the OECD.
And while many Americans might report stress when seeing news headlines scroll in from the Korean Peninsula, geopolitical worries with the North are routinely at the bottom of perceived stressors in surveys of South Koreans, below more routine factors such as work, family and culture. There’s a “very clear societal pressure” on Koreans, especially young people, based around a “really high, unidimensional focus on one definition of success,” says Chad Ebesutani, a U.S.-licensed psychologist formerly at the International Psychology & Counseling Center (now at the Seoul Counseling Center), a counseling service in Seoul’s Gangnam district aimed at expats.
From academic pressure on students to get into the country’s three most prestigious universities to professional pressure on job seekers to land a gig at one of a handful of hyperselective chaebol conglomerates, the emphasis on professional success is inescapable for many Koreans. “There’s a lot of [cultural] fear of being different,” says Ebesutani, which can be a breeding ground for insecurity and mental health issues, as well as a reason why most such illnesses go unreported. Ebesutani recalls having a patient in therapy whose parents forced him to quit after finding out he was receiving treatment.
To be sure, rates of mental health issues in the country, including suicide, have been falling in recent years, says Kyooseob Ha, professor of psychiatry at Seoul National University. Ha, who’s also the former president of the Korean Association for Suicide Prevention and a founding director of the Korean National Mental Health Center, points to government survey data showing that, across all age groups, rates of substance abuse, anxiety and mood disorders are not high relative to other OECD countries, and often are lower than in the U.S. And while those government surveys show that “only 20 percent of Koreans seek professional help when depressed,” he says, that’s up from 15 percent five years ago. “The Korean government has realized the importance of mental health and suicide prevention,” says Ha, and has recently created a Department of Suicide Prevention alongside a program to expand mental health centers, with a target to reduce the suicide rate over five years from 26.5 per 100,000 people to 17 (the current suicide rate in Japan).
However, the budget for the new department is just 10.5 billion won ($9.7 million). Meanwhile, Japan allocated more than $170 million for suicide prevention in its 2012 budget. Whether for individuals with mental health issues or for the Korean government, the solution surely starts with acknowledging and understanding the problem.
If you are dealing with suicidal thoughts or know of someone who is, you can receive immediate help by visiting global resources such as iasp.info, or by calling 1-800-273-8255 in the U.S.