Korean culture has been capturing the attention of a worldwide audience in large part thanks to success on multiple platforms, whether it be a binge-worthy TV show such as Squid Game, award-winning films like Parasite, or even world-class goals from the beloved Hotspurs team captain, Son Heung Min. Celebrating Korean culture jumps beyond the screen and into a pair of headphones thanks to the global fandom of K-pop or even into the aisles of Trader Joe’s–people’s cravings for foods like kimbap, kimchi, and Korean barbeque. As first/second-generation Korean immigrants, we are thrilled to have a part of our culture become increasingly visible globally. This cultural presence has played a significant role in shaping the identity and experiences of Korean Americans. However, beneath the surface of these cultural celebrations lies a complexity involving mental health, an aspect that is often overlooked but is integral to understanding the Korean American experience.
Korean Americans are the fifth largest sub-Asian group in the United States. Among Asian American groups, Korean Americans have one of the highest rates of depression. However, only a small fraction of Korean Americans utilized mental health services. Clinicians have the opportunity to screen for mental health conditions, but they also need to consider cultural and social factors with Korean Americans.
Grasping the cultural nuances of distress is critical for clinicians to provide comprehensive and empathetic mental health care to Korean-American individuals. The phrase culture-bound syndrome refers to recurring, locality-specific patterns of abnormal behavior and distressing experiences that may or may not be associated with a specific DSM-5 diagnostic category. People refer to many of these patterns as “illnesses,” or at least ailments, and most have regional names. There is a Korean cultural concept of distress known as “Hwa-byung (화병),” which translates to “anger syndrome,” and it constitutes suppressed anger and/or sadness manifesting as vague somatic symptoms, particularly around the chest area. Therefore, clinicians should be cognizant of unique depression-related expressions that carry a somatizing quality at the surface level: “My guts are exploding (속터진다),” “feels stuck (답답하다),” “my chest is burning (열불난다).”
Many Korean Americans have a strong sense of pride in their heritage. The rising global popularity of Korean cultural exports has led to a greater acceptance and celebration of Korean identity in America. However, this cultural pride may put social pressure on its individual constituents to succeed and uphold the high standards set by their community and family. The “model minority” stereotype that has long been projected onto Asian Americans often places additional burdens on Korean Americans, as they are expected to excel academically and professionally. Additionally, needing to reconcile the identity as an object of hate in the face of the COVID-19 pandemic has complicated Korean Americans’ consolidation of their sense of self.
Family is an integral part of the Korean culture. While there is a strong sense of familial support and loyalty, there is also an expectation to conform to traditional Confucian values and to prioritize family over individual needs. In this cultural backdrop, success may be reduced to an obligatory “face-saving” for the family. This can create a challenging dynamic for those who wish to pursue paths different from their family’s expectations, making an environment prone to developing false selves and spitefulness among young individuals. These can contribute to mental health issues if not adequately addressed.
For first-generation Korean immigrants, the challenges of adapting to a new culture, language barriers, and the loss of a support system back home can take a significant toll on mental health. In addition, the striking difference in medical systems between South Korea and the United States can be quite enigmatic to navigate–given how many emails or calls they need to exchange in their second language, even to enroll in an insurance plan. While their descendants are more likely to be culturally assimilated, they still face identity conflicts and a lower sense of belonging to either culture. Korean American immigrants are not only distanced geographically and culturally from Korea; they now find themselves stereotyped as perpetual foreigners due to their status as minorities within a predominantly caucasian Anglo-Saxon society. Some Korean immigrants project onto their offspring their fantasy that linguistic and ethnic disparities could be removed through total cultural assimilation, encouraging a total embrace of the “white” culture.
Furthermore, the interaction between these generations–authoritarian parents and autonomy-aspiring children–can easily create a hostile familial environment. Unique family dynamics emerge when second-generation Korean children act as cultural ambassadors or teachers within the family, upending the traditional Confucian value that parents are the educators of their children.
There has been a stigma attached to mental health issues within Korean culture as they are often seen as a sign of weakness or matters that should be dealt with privately. This stigma among Korean Americans can persist even after immigration, preventing people from seeking care and disclosing their mental health issues. Fortunately, a growing cultural shift in mental health is propelled by a wave of advocates, influencers, and increased awareness. The conversation around mental health is starting to find its way into the public eye as people like Nick Cho, the “Korean Dad” on TikTok, and celebrated Korean psychiatrist Dr. Oh Eun-Young are making it more accessible and relatable.
The mental health of Korean Americans is a multifaceted issue intertwined with cultural pride, familial expectations, and societal stigma. As the visibility of Korean culture continues to rise in America, it is crucial to think about its nuanced psychiatric repercussions on the population to better support the mental health struggles of Korean Americans. Recognizing the unique challenges they face, encouraging open conversations about mental health, and providing culturally sensitive resources are vital steps toward fostering a healthier community for Korean Americans.
Acknowledgment: We thank Yesie Yoon, MD for the comments and edits.
Dae Sun Hwang is a first-generation Korean American. Thomas Pak is a psychiatry resident. Joo-Young Lee is a child and adolescent psychiatrist.