Hwabyeong

Hwabyeong or Hwabyung is a Korean^[1] somatization disorder, a mental illness which arises when people are unable to confront their anger as a result of conditions which they perceive to be unfair.^[2] Hwabyung is loosely used as the name of the disease, as it is actually more of a name regarding the cause. Hwabyung is known as a culture-bound syndrome.^[3] The word hwabyung is composed of "hwa" meaning "fire", "angry", and "byung" meaning "syndrome" or "illness".^[4] In South Korea, it is also called ulhwabyeong (鬱火病), "depression anger illness". In a survey, 4.1% of the general population in a rural area in Korea were reported as having hwabyung.^[3] Another survey shows that about 35% of Korean employees begin to suffer from this disease at some point.^[5]

Symptoms

Symptoms related to Hwabyeong are "eok-ul" (억울, 抑鬱, [feeling of] unfairness) and "bun" (분, 憤, eruption of anger), (a Korean culture-related sentiment related to social unfairness), external anger, heat sensation, pushing-up in the chest, respiratory stuffiness, going-out, epigastric mass, palpitations, insomnia, headache/pain, dry mouth, anorexia, frightening easily, sighing, sad mood, "han" (a Korean culture-related sad sentiment related to hard life and social unfairness resulting not only from the tragic collective national history, but also from a traumatic personal life), many thoughts, hate, anxiety with agitation, guilty feeling, and much pleading. These symptoms also include depression, anxiety, panic, lumps in the upper chest, or feelings of doom. Patients who are diagnosed may have previously experienced major depressive disorder, dysthymic disorder, anxiety disorders, somatoform disorders, or adjustment disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria.^[6]

Causes

This syndrome is brought on by the suppression and eventual buildup of anger within one's body. Hwabyung is believed to be caused by a build-up of unresolved anger which disturbs the balance of the five bodily elements. If feelings are suppressed for long periods of time, psychosomatic symptoms develop. The triggering cause is external events, particularly intra-familiar stressors, such as spousal infidelity and conflict with in-laws. Because of the cultural emphasis on familial harmony and peace, expressing anger is not acceptable. Therefore, the anger is suppressed and builds on itself over time. The suppressed anger, which turns into hate and despair, is known as han, or "everlasting woe". Once it reaches a pinnacle, it will then manifest into several physical/mental signs such as panic, fatigue, and insomnia among others. Each experience, however similar, is different from others experiencing this illness.

It most often occurs in middle-aged, menopausal women with relatively low socio-economic status. The individuals typically live in traditional families, which stress the value of males while devaluing women. In these families, a woman's virtue is to quietly bear misfortune and unhappiness while maintaining harmony.

Treatment

Western doctors are more likely to diagnose it as a kind of stress or depression. The Diagnostic and Statistical Manual of Mental Disorders currently lists hwabyeong among its culture-bound illnesses. Outside of Korea, informally hwabyeong may be mistaken as a reference to a psychological profile marked by a short temper, or explosive, generally bellicose behavior. To the contrary, hwabyeong is a traditional psychological term used to refer to a condition characterized by passive suffering, is roughly comparable to depression, and is typically associated with older women.^[7] It is important that when diagnosing Hwabyeong, the culture of the patient is well understood. Since Hwabyeong can often be misdiagnosed as depression, the symptoms and culture need to be clearly and thoroughly looked into. Once Hwabyeong has been diagnosed, past treatments need to be reviewed. The treatments for the patient can then be a combination of pharmacological, and therapy-based interventions.

The treatment methods used to combat hwabyung include psychotherapy, drug treatment, family therapy, and community approaches. To be more successful psychiatrists might need to incorporate the teachings from traditional and religious healing methods or the use of han-puri, which is the sentiment of resolving, loosening, unraveling and appeasing negative emotions with positive ones. One example of hann-puri would be a mother who has suffered from poverty, less education, a violent husband, or a harsh mother-in-law, can be solved many years later by the success of her son for which she had endured hardships and sacrifices.^[3]

Popular culture

• A short animation a part of the If You Were Me: Anima Vision, a 2005 South Korean omnibus featuring six short animated films addressing human rights issues in Korea, includes a sketch of a depressed female character who carries a jar (Korean: 병/甁 byeong, a homophone of 병/病 'illness') with a flame (화 hwa) drawn atop it.

References

External links

• Examining Anger in 'Culture-Bound' Syndromes Psychiatric Times
• Health and Health Care Of Korean-American Elders
• Korean Women's Causal Perceptions of Hwabyung
• Hwabyung: the construction of a Korean popular illness among Korean elderly immigrant women in the United States
• Symptoms of Hwabyeong (Korean)
• Sung Kil Min, Shin-Young Suh, Ki-Jun Song (2009). Symptoms to use for Diagnostic Criteria of Hwa-Byung,an Anger Syndrome.Psychiatry Investig. 2009 March; 6(1): 7–12. Published online 2009 March 31.doi: 10.4306/pi.2009.6.1.7
• Hwa-byung: Culture-related Syndrome
• Hwabyung in Korea: Culture and Dynamic Analysis