Hwa-Byung in Korean immigrants

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

This Post Has 1 Comment

  1. Nick Flaga says:

    Hi Dan, really interesting post.
    Culture is the result of a group of people, united by region, age, ethnicity, or social factors, that demonstrate similar behaviors and beliefs.
    From my interpretation of culture bound syndromes, I believe Hwa-Byung meets the requirements. The common behavior of South Korean women to suppress their feelings of anger and frustration instead of expressing their discontent is correlated with cultural views on proper behavior and demeanors of Korean women. One could also assume that Hwa-Byung is the result of individual personalities and preferences on how to deal with certain issues. However, the culture we are raised in and live in certainly transform our personalities and reactions to various situations.
    The disadvantage of Hwa-Byung being a culture bound syndrome is the diminishing realization that we ultimately control our own actions and reactions to certain situations. Korean women, on an individual level, should be apply to see the disadvantages of suppressing emotions, and make a personal choice to voice their feelings and opinions in a respectful manner.
    The advantage of Hwa-Byung being a culture bound syndrome is the realization that, in general the way Korean women deal with their emotions through suppression is having harmful effects on their health. By seeing a correlation from these symptoms to Korean culture we are able to provide distinction to healthy behaviors that could in turn be adopted by Korean women and in turn alter their cultural behaviors.

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