Hwa-Byung is a culture bound syndrome found in four to twelve percent of women with South Korean heritage. Literally the terms means “anger disease” and is so named because when elderly women of Korean culture suppress anger, frustration, hate, or other negative feelings for a very long period (thirty to forty years), psychosomatic symptoms appear such as depression, anxiety, panic lumps in the upper chest, palpitations and “feelings of impending doom”. These symptoms are maintained even after the women have immigrated to the United States. Patients with this illness most often identify it themselves and tell their family, although they usually do not seek medical attention because in South Korea mental distress is seen as shameful. Western doctors often overlook the illness anyway because of language barriers, or treat it generally as depression. Patients suppress the stress voluntarily or subliminally to “maintain family harmony” and eventually it accumulates until it becomes Hwa-Byung at which point anger is often taken out on the family anyway. Like depression, Hwa-Byung can lead to chronic indigestion. However, the unique factor is that those with Hwa-Byung identify it themselves and are often ashamed of having it, are submissive and hide negative feelings and have no suicidal tendencies.
Since the patients studied are Korean women immigrants to the United States, the treatment is Western based. This includes a combination of mood-altering pharmaceuticals that is unique to the patient and usually includes an anti-depressant. However, holistic approaches are also identified as helpful treatment such as therapy, relaxation techniques, and social-skills building; “a community-based, culturally tailored nursing intervention is particularly effective when treating Hwa-Byung”. Finally, it has been found that a healthy relationship between the treating doctor and the patient’s family which includes mutual trust is important in treatment and sustainability of treatment. Again, because these patients are immigrants and treated in the U.S. they are in the professional sector of healthcare – a physician coordinating with a psychotherapist.
Choi, Myunghan and Hye-A Yeom. “Identifying and treating the culture-bound syndrome Hwa-Byung among older Korean immigrant women: Recommendations for practitioners.” Journal of the American Academy of Nurse Practitioners 23 (2011): 226-232. Accessed July 19, 2013, http://onlinelibrary.wiley.com.proxy1.cl.msu.edu/doi/10.1111/j.1745-7599.2011.00607.x/full