Hwa-Byung among older Koreans

The culture-based syndrome I chose to research was Hwa-Byung, which is caused by the suppression of anger over a long period of time (even some cases up to 30+ years). Hwa-Byung is most commonly found in first generation older immigrant Korean women. These women come to the US for many different reasons such as following their children or spouse (especially if they married at a young age), trying to start over in a new country, or to find work. This move affects their financial stability and many lack medical resources and face language barriers after the move. These stresses and other triggers, such as unpleasant family situations (like a death in the family, spouse abuse or infidelity, or other family arguments), can eventually lead to Hwa-Byung. This syndrome often goes without a diagnosis because it is considered shameful or embarrassing to have it in the older generation of Korean culture.  The symptoms include both psychological and somatic aspects. The psychological aspects include depression, irritability, paranoid feelings,  and others while some somatic aspects are headaches, shortness of breath, tachycardia, blurred vision, lumps in the throat or chest, shortness of breath, and others. Hwa-Byung can be mistaken for depression because it shares a lot of the same symptoms like indigestions, palpitations, sweating, body aches, hot flashes, etc. Hwa-Byung is most commonly diagnosed by asking the patient a series of questions, such as what their symptoms are and how do they affect their daily lives, also by determining if they are currently experiencing any common stresses or trigger as mentioned earlier. It is treated by both pharmacological and non-pharmacological methods. Some methods including medication are anti-depressants, anti anxiety drugs, anti psychotic drugs, beta-blockers to treat palpitations and/or heat sensations, and other drugs. Other non-medication related methods include psychotherapy, relaxation techniques, social skill development, and others.

Choi, Myunghan and Hye‐A Yeom. 2011. “Identifying and Treating the culture‐bound Syndrome of Hwa-Byung among Older Korean Immigrant Women: Recommendations for Practitioners.” Journal of the American Academy of Nurse Practitioners23 (5): 226-232. doi:http://dx.doi.org/10.1111/j.1745-7599.2011.00607.x. http://ezproxy.msu.edu/login?url=http://search.proquest.com/docview/884681417?accountid=12598.


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  1. Laceey Ruble says:

    Based on class materials, I see culture as a form of social communication. One’s culture influences a person’s identity by shaping thought and behavior through learning. It is through learning social patterns, ways to behave, think, and present oneself that culture influences people on an individual level. Taking into consideration this definition of culture and other environmental factors, I believe Hwa-Byung should be regarded as a culture bound syndrome. According to the definition of culture bound syndrome, an illness must be recurrent, locality-based, and associated with culture. Hwa-Byung fits these criteria because it is seen among older immigrant Korean women. Even though Hwa-Byung shares certain similarities with other psychological disorders in the DSM, I would say that is it a unique illness. I think it is advantageous to think of Hwa-Byung in this way, because there are cultural, psychological, and physiological factors that need to be addressed in order for treatment to be successful. For example, in Korea it is seen as indecent to express anger in many ways. Their culture places a special emphasis on familial coexistence. When women from Korea come to an unfamiliar environment, experience poverty, among other family pressures – specific anger and stress can build up from individual situations (probably, more than the typical American would bottle-up). This is why the Korean immigrant experience is unique. These people come from a different culture and react to anger, stress, and depression in a different fashion. Therefore, Hwa-Byung should be addressed as a culture bound syndrome in order for treatment to take into consideration how Korean culture has influenced its development. In Hannah’s summary of Hwa-Byung, a Western ethnomedical approach is taken. Treatment uses therapeutic and medicinal approaches. After reading a little more about Hwa-Byung on Wikipedia, it says that Koreans regard the illness as “a build-up of unresolved anger which disturbs the balance of the five bodily elements.” This idea is a long-shot from the biomedical system used in Western culture. I think is it important to understand how this illness is explained within the traditional Korean ethnomedical system, because how an individual views an illness can influence how successful certain treatments will be.

    Wikipedia. Hwabyeong. Accessed July 17, 2014. http://en.wikipedia.org/wiki/Hwabyeong.

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