Somatoform Disorder or Culture-Bound Syndrome: Manifestation & Symptom Expression of Han in Koreans
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One of the ongoing controversies about the relationship between culture and psychopathology has to do with the long-reported tendency of Asian psychiatric patients to primarily manifest and express psychological distress with somatic symptoms. Cultural differences in symptom expression have been the focus of studies on somatization. “Somatization is a term originally tied to a psychodynamic theory of illness causation in which psychological conflict was transformed or transduced into bodily distress” (Kirmayer & Young, 1998). Young & He (2002) imply that the absence of organic findings to explain patients’ reported symptoms suggest the possibility of a somatoform disorder. However, the common complaints usually do not satisfy the stringent DSM-IV-TR criteria for somatization disorder and can be categorized more closely to undifferentiated somatoform disorders. The most common theories propose that the low rate of reporting psychological problems and high rate of overemphasizing bodily symptoms among Asians compared to other ethnic groups may reflect cultural rather than cognitive preferences (Lin & Cheung, 1999; Chun, Eastman, Wang, & Sue, 1998).
This is most evident in studies of various culture-specific syndromes such as the two Korean folk syndromes listed in the Diagnostic and Statistical Manual of Mental Health Disorders (American Psychiatric Association [APA], 2000): hwa-byung and shin-byung. Hwa-byung is literally translated into English as “anger syndrome” and attributed to the suppression of anger, disappointment, grudges, and unfulfilled expectations and the symptoms include insomnia, fatigue, panic, fear of impending death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations, generalized aches and pains, and...
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...that this view of somatization as a mark of psychological primitivism can be used against the patients by disqualifying and invalidating their somatic symptoms and expressions of distress.
I recognize that issues that are relevant to the mental health of any cultural or ethnic group is multidimensional and complex. Despite the impossibility of generalizing any individual’s experience over that of another, I believe han is undeniably embedded in the deepest alcoves of the Korean psyche and soul which shapes and operates on so many levels—from the largest and highest historical-national level to the personal innermost-mindset of a Korean individual. In this brief and space-limited paper, I selectively reviewed research findings that were most relevant for further exploring the meaning of somatization and expression of han by Koreans in the field of psychopathology.