Hwabyung - A culturally-specific ‘diagnosis’

Emotional and mental health concerns are far from the same the world over. Culturally-specific ideas of ‘correct’ behaviour, including the ‘right’ responses to difficulties in life, can produce culturally-specific effects.

That’s the case with ‘hwabyung’, translated as ‘fire sickness’ and unique as a diagnosis to Korea – as a phenomenon, according to one commentator, it is ‘a larger expression of Korean culture and history’.

Korean values 

Korean expectations from life are in direct contrast with Western values of individualism, personal achievement, independence and self-reliance.

Koreans place great stress on the community, on the obligations that family and close associates share to put the common good above any individual need or concern. Any personal grumbles, even serious anxieties in the face of problems, are put aside for the sake of harmony and good relationships within the group. The correct response to troubles is to suppress one’s sadness – to bear it all with stoicism and resignation to the fact that life is hard and heart-breaking at times.

The concept of ‘haan’ which is a deep sadness, not for any actual event, but for the world, for Korea in particular, and for the human condition, is part of this suppression. For many Koreans, haan is a feeling transmitted to successive generations, which upholds powerful traditions and attitudes.

There’s a recognised downside, however. If you have a fine sense of ‘han’, plus years of obeying the cultural rules of denying the bad things that happen to you and people you love, you get sick. And what makes you sick? Hwabyung.

Hwabyung manifests itself in physical ways. The list of accepted symptoms read a lot like a list of Western signs associated with stress, depression, anxiety: various aches and pains, a feeling of pressure on the chest. In addition, someone with hwabyung will also have difficulty getting sufficient sleep, feels tired all the time and reports a strong feeling of hopelessness.

Long-term understanding of the link

Traditional Korean medicine diagnosed this ‘sickness’ long before psychology or psychiatry came on the scene. It was accepted that the body could react painfully strongly to the troubles of the mind, which seek an expression somehow, after possibly many years of being forbidden any sort of outlet.

An excess of ‘fire’ in the individual causes an imbalance in the body. Commonly, troubles are connected to a sense of injustice, of being unfairly treated by a relation, or of being betrayed by the social group, which builds resentment.

To preserve harmony, according to Korean values, this resentment cannot even be articulated, let alone redressed. In studies, Koreans diagnosed with hwabyung have been able to pinpoint precisely why they feel the ‘fire sickness’ and as one reviewer states, ‘Most patients know already that their hwabyung is a psychogenic disorder.’

Traditional treatments

Various ‘therapies’ are traditionally offered to people with hwabyung, by herbal medicine doctors, or perhaps by shamans, and some of them are close to Western-style counselling, or listening.

There are creative strands to the therapy – for example, if someone can trace their feelings to sadness about their lack of education, they may be helped by making cash donation to a school, or by starting a course of learning even in old age.

It may be that as Korea becomes increasingly more Westernised, hwabyung will start to be seen by Koreans themselves as closer to depression or anger, as Western psychiatrists define it.

Image credit: 旧館