Psychiatry in Former Socialist Countries: Implications for North Korean Psychiatry

Abstract

Very little information is available regarding psychiatry in North Korea, which is based on the legacy of Soviet psychiatry. This paper reviews the characteristics of psychiatry in former socialist countries and discusses its implications for North Korean psychiatry. Under socialism, psychiatric disorders were attributed primarily to neurophysiologic or neurobiological origins. Psychosocial or psychodynamic etiology was denied or distorted in line with the political ideology of the Communist Party. Psychiatry was primarily concerned with psychotic disorders, and this diagnostic category was sometimes applied based on political considerations. Neurotic disorders were ignored by psychiatry or were regarded as the remnants of capitalism. Several neurotic disorders characterized by high levels of somatization were considered to be neurological or physical in nature. The majority of "mental patients" were institutionalized for a long periods in large-scale psychiatric hospitals. Treatment of psychiatric disorders depended largely on a few outdated biological therapies. In former socialist countries, psychodynamic psychotherapy was not common, and psychiatric patients were likely to experience social stigma. According to North Korean doctors living in South Korea, North Korean psychiatry is heavily influenced by the aforementioned traditions of psychiatry. During the post-socialist transition, the suicide rate in many of these countries dramatically increased. Given such mental health crises in post-socialist transitional societies, the field of psychiatry may face major challenges in a future unified Korea.

Insomnia in North Korean Refugees: Association with Depression and Post-Traumatic Stress Symptoms

“… 14 15 Furthermore, refugees usually come from countries where the concept of psychiatric disorders is unfamiliar or stigmatized, as is the case in North Korea. 4 Some items of questionnaires describing more abstract theme may be misunderstood by North Korean refugees. Some item of CES-D regarding social isolation or comparison with others may reflect the reality of prejudice commonly experienced by North Korean refugees.…”

“…North Korean refugees have commonly experienced traumatic events such as torture, violence, rape, human trafficking, imprisonment, and witnessing death by public execution, starvation, or shooting. 3 4 Before settling in South Korea, most North Korean refugees have felt extreme insecurity about the fear of arrest and deportation back to North Korea. Even after their arrival in South Korea, they often experience diminished socioeconomic status, culture shock, prejudice, and financial difficulties.…”

The Effect of Traumatic Experiences and Psychiatric Symptoms on the Life Satisfaction of North Korean Refugees

“…With an increasing number of North Korean defectors entering South Korea, helping them to adapt successfully to South Korean society has become a major challenge for the South Korean government. Like most refugees, North Korean refugees have undergone traumatic experiences such as starvation, torture, physical and sexual violence, separation from or death of family members, human trafficking, arrest, deportation, imprisonment and witness to public execution [16][17][18] . The political humiliation of human rights is also a serious problem in North Korea.…”

Effects of Psychiatric Symptoms on Attention in North Korean Refugees

“…Furthermore, North Korean refugees have commonly experienced various traumatic events before settlement in South Korea, in addition to various economic and cultural difficulties after settlement. 11 12 13 As a consequence, North Korean refugees are at high risk for psychiatric symptoms, 14 15 16 17 which are closely related to cognitive dysfunction. Therefore, although attention and cognitive function are essential for North Korean refugees to successfully adapt to their new South Korean environment, they may be more vulnerable to attention deficits or other types of cognitive dysfunction.…”