TheNewYorkTimes

StressedandDepressed,KoreansAvoid
Therapy
ByMARKMcDONALD
Published:July6,2011

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 actively 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 13thlargest 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.
Christian pastoral counseling can be a support for some patients, said Dr. Park, who
has tutored ministers on therapeutic techniques, although he cautioned that this was no
substitute for professional therapy. Pastors try to treat patients themselves, he said,
and this can have serious and dangerous complications, even deaths.
Consulting a shaman is still common among many Koreans, usually when they come
down with the blues, the odd illness or a run of bad luck. Indeed, shamanism has made
something of a comeback in South Korea in recent years, with an estimated 300,000
shamans ministering to clients.
Many shamans, known as mudang, even operate sophisticated Web sites these days
(complete with online fortunetelling), even as they continue to strangle chickens, walk
barefoot on razor blades and commune with dead relatives whose spirits reside in trees,
chimneys or woodland creatures.
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.

Room salons are after-work clubs frequented by hard-drinking businessmen who select
from a bevy of personal hostesses who ply them with expensive drinks and listen to their
problems over the course of an evening.
Yu Jeong is a fortuneteller at Daily Motion, a cafe in Seoul that features 15-minute
readings (and a free waffle) with the purchase of a coffee.
Psychiatrists treat patients like patients, so the people dont tell them every bad thing,
she said. Young people come in here and tell me everything, even the things they wont
tell their parents.
Young people in South Korea are certainly unhappy, even chronically so, in part
because of ferocious academic pressures that begin early on. A recent survey here
found that young Koreans for the third straight year were the unhappiest
youngsters in a subset of Organization for Economic Cooperation and Development
countries.
Ms. Yu said she counsels about 50 people a day, usually couples or small groups of
friends who are seeking advice on romance, marriage or changing jobs.
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.