The world is rapidly shrinking as the result of emerging new technologies but broad cultural gaps between countries still exist and, in my view, have a huge influence on people’s attitudes and way of thinking.

For example, in South Korea, my homeland, emotional coping mechanisms are very different to those in the West. As overseas travel for study and business increasingly takes Koreans to Western countries, including the UK, where ways of behaving and expressing emotions are very different, South Koreans can find themselves emotionally ‘lost’ without the supporting structure of their culture around them.

Take the example of a South Korean student, let’s call him Kim, who has come to the UK to study. He is meeting his university tutor for the first time to discuss his study schedule. Kim is amazed when the tutor goes off to bring them both a cup of tea, and stands up immediately when the tutor comes back into the room. Throughout the meeting Kim nods compliantly, showing his highest respect, even when he disagrees with the tutor’s proposed timescale for his studies, knowing that it will be unworkable for him.

This is a typical example of the behaviour of a young Korean student whose attitude has been strongly influenced by Confucianism. Kim’s dilemma is that, in a different country, his meek behaviour may not work as it does in his own culture, since the tutor may assume that he has completely agreed with all he has said. In Korea, nodding politely doesn’t necessarily imply agreement. Troubles may well occur later when Kim finally cannot cope with his studies and speaks to his Korean friends, who support his view that his tutor never understood him. Kim starts to get worried that he may fail his course and the consequent disappointment of his parents. This anxiety stops him sleeping and he begins to avoid socialising and starts missing classes. These worries lead to him feeling depressed and even suicidal. At this point, he may well turn up as a client in the counselling room.

The suicide rate in South Korea is known to be one of the highest among OECD (Organisation for Economic Co-operation and Development) countries,1 particularly among young people. One of the main causes is academic failure and young people’s fear of being abandoned by their parents as a result.2 This suicide risk is likely to increase when Koreans are exposed to cultural change and are unable to adapt to the new culture effectively. The Korean Government has recently taken initiatives to reduce the suicide rate, including the introduction of local school counselling centres.

Social and cultural expectations

To understand the Korean perspective on life, you have to understand the country’s cultural background. Confucianism is an ethical and philosophical system developed from the teachings of the Chinese philosopher, Confucius, and has had more influence on Korean life than any other religion or philosophy.3 Underpinning Confucianism is a set of principles that define social relationships. The formula for expressing these is called the samgang oryun – the three bonds and the five cardinal relationships. The three bonds are sovereign and subject, parent and child, and husband and wife. The five cardinal relationships are justice between sovereign and subject, closeness between father and son, separation of duties between husband and wife, order between senior and junior, and trust between friends.

There is a strong hierarchy in human relationships, according to Confucianism. In his book Outliers: the story of success,4 Malcolm Gladwell points out the communication difficulties that can arise as a result. On the morning of 5 August 1997, Korean Air flight 801 was descending towards Guam Airport. The pilot was making a visual approach, as the airport’s glidescope was under repair. The first officer was getting anxious about the pilot having no back-up plan, despite the terrible weather. However, he merely hinted but did not say outright that they needed to prepare a back-up plan, because he was hierarchically ‘inferior’ to the main pilot. Even when a warning went off and the main pilot became completely confused, the first officer did not seize control of the plane. This tragedy shows clearly how difficult it is for a Korean person to escape his cultural conditioning, even when his life is in danger.

We-ness5 – that is, the predominance of collectivism in daily life – is another very important concept in Korea. In Korean language ‘I’ or ‘you’ are rarely used because of the lack of importance placed on the individual. Differentiating me from you is not important as we are in the same group. There is no such thing as my car; it is our car, even though I drive the car and use it for the family only at weekends. Revealingly, the Korean symbol for ‘human’ is two sticks leaning against each other. The priority lies not with the individual’s interests but with the interests of the group to which they feel they belong, and anyone attempting to disobey the group’s golden rules is regarded as a ‘traitor’ and removed. In Korea one of the most feared types of bullying is being treated as an outcast and ostracised by friends and peers; in extreme cases, victims who feel they do not belong choose to end their life.

In such environments, it is extremely difficult for individuals to express themselves for fear of challenging the group’s authority, which would risk their membership. A common example is drinking after work. Work colleagues regularly meet for a drink in a restaurant after work. If you do not drink or turn up, you are regarded as someone who spoils good team spirit. More importantly, you must not refuse a drink offered by your boss because this would be considered highly offensive; it would adversely affect your reputation in your company and go against you in your performance report.

Han – a Korean emotion

An old Korean folk song tells the story of a woman who has been abandoned by her lover. After she is abandoned she wishes her lover a sore foot – a passive form of aggression, rather than expressing her anger and actively challenging his leaving. The woman’s emotion, which so many Koreans connect with, is known as Han.

Han is an emotion that most Koreans would regard as being unique and differentiated from Western culture. ‘It is a feeling of unresolved resentment against injustice suffered, a sense of helplessness because of the overwhelming odds against one, a feeling of acute pain in one’s guts and bowels, making the whole body writhe and squirm, and an obstinate urge to take revenge and to right the wrong – all these combined.’6 Historically, Koreans have been in Han-provoking situations for a long time. They have suffered at the hands of foreign invaders and experienced excruciating poverty. In the face of perceived international indifference, the total accumulated Han in Korea is enormous.

Typically, Han is evoked in situations where some injustice has been done to oneself. This injustice could be inflicted by a foreign power, on employees by their employers, on citizens by their government, on a daughter-in-law by her mother-in-law, on a wife by her husband, on a poor person by his rich neighbour – Han is anything that is perpetrated on a person/group and is permanently imprinted in their psyche as injustice. This specific emotional coping style not only protects Koreans from experiencing the negative effects of chronic stress, it has also built the character of Korean people, both nationally and individually.7

In extreme cases, those who are unable to accept their Han take their own life as a way of showing their anger and discontent. Others often develop a culture-bound syndrome known as Hwa Byung – a type of somatisation disorder that occurs when people are unable to confront their anger as a result of unfair conditions.8 The repressed emotions manifest as physical symptoms, which are acceptable to talk about in Korea, while the culturally ‘unacceptable’ underlying emotions remain safely hidden. Therefore ‘digesting’ one’s suppressed anger is vital to a person’s survival in Korean society.

Sometimes, however, those suppressed emotions are released; for example, Koreans believe misbehaviour caused by drinking is an acceptable way of venting their anger.

Hwa Byung can be illustrated by the case of H, a married woman in her 40s, who has been working in a local market as a cleaner. She is the main breadwinner as her husband is an alcoholic who often becomes violent towards her, yet she has not been able to divorce him because she fears her two children would be subject to social ostracisation if they did not have a father. H has anxiety attacks, usually a couple of weeks prior to the festive season when she goes to her parents-in-law, where she is always reprimanded by her mother-in-law for not being able to cook or clean well. H has recently developed chest pain and headaches for which no medical cause has been found. One of the characteristics of H’s Hwa Byung is complete denial of her extreme anger towards her husband and her frustration about her situation. These emotions have been transformed into physical symptoms, which now attack H herself. The rest remains in the form of Han in H’s mind, which she is conscious of and which is safely accepted by her culture, both internally and externally.

H’s Han may be resolved many years later by the success of her children, for whom she has endured hardships and sacrifices, since children often become the vehicle through which mothers cope with their Han.9 In East Asia children are expected to feel indebted toward their parents for all the devotion, indulgence, sacrifice and love that they have received from them.10 It is not unusual for Korean young people to feel guilty if they fail exams, thinking they have let their mother down and that therefore she will not be able to resolve her Han. In fact, there is a study suggesting that Korean students with guilty feelings achieve more academically.11 When guilty feelings become too severe, however, young Koreans may get angry with their parents, feeling they have expected too much of them and put them under a lot of pressure. This hatred towards their parents may cause them to self-harm or sometimes even to take their own life as a way of retaliating by destroying their body, which their parents are trying to take control of.

Han in the UK

Jisu was a 19-year-old girl who came to the UK from Korea four years ago to study at boarding school, and had recently started a course at art college. Jisu’s college mentor noticed her academic performance was lagging behind and she kept missing deadlines. Jisu admitted she was struggling to attend classes and revealed that she was having suicidal thoughts. Her mentor advised her to seek professional help.

During the first session of psychotherapy, Jisu reported difficulty in thinking or feeling anything except a constant wish to take her own life. Interestingly, this didn’t make her anxious and she often dwelled on thoughts of how she would do it. When she shared her suicidal fantasies with her friends, they were shocked by how extreme they were and by how little she seemed to value her life.

Jisu’s father was a successful businessman who, when drunk, often became violent towards his wife, Jisu and her sister. Jisu revealed her hatred towards her father, yet did not feel sympathetic towards her mother, who she believed had failed to protect both her and her sister. Since coming to the UK, Jisu had worked hard to get a place at art college. However, after she started college, she began to struggle to keep up with deadlines and lost confidence in her ability as she felt ‘discriminated against’ and ‘neglected’ by her tutors. She was unable to share her frustration with her mentor as she was worried that it would negatively affect her grades.

What drew my attention was that Jisu felt relieved after she got into art college but felt lost soon afterwards. It sounded as if she had worked hard to earn her parents’ approval and love. She became disappointed when she saw her younger sister now getting more parental attention as she prepared for her ‘A’ levels. As her dream of regaining her parents’ love was shattered, her frustration and anger built up, before she turned the anger towards herself. She felt compelled to abandon her parents by killing herself, which mirrored the abandonment she felt from her parents. Jisu spoke of her confusion about the different culture she encountered when she first came to the UK. She had felt isolated, had no one to talk to, had difficulty speaking English and could not tell anyone she did not like her school in the UK and wanted to go back to Korea because she knew how much her parents were sacrificing for her studies.

Jisu had become very self-critical of her academic failure, which was projected onto her mentor, whom she also regarded as being neglectful and unprotective of her, just like her mother. Jisu identified her mentor with her mother, whom she felt abandoned by and angry with.

Regular psychotherapy with me revealed her longing for her mother. Jisu was able to talk about her guilt at failing to rescue her mother, whom she came to see as a victim. Jisu became angry when she realised that parents who were violent towards their children could be charged with a criminal offence and jailed in the UK. Being away from her father also made it possible for her to reflect on what he had done to her and her family. This provoked intense anger towards him and raised a dilemma because she was financially dependent on him for her studies.


We-ness and Confucianism both contribute to Koreans’ strong obedience to authority and unconditional loyalty. Han is a Korean way of coping with intense anger and dealing with the emotions evoked when a person has no power to challenge an injustice. It encompasses various forms of self-punishment and strong negative feelings about oneself. When a Korean is exposed to a different culture, she has to re-evaluate her previous experiences in a new framework, which often provokes extreme anger and guilt. It also causes a strong resistance, which therapists often fail to understand if they are culturally unaware. This means it is important for therapists working with Koreans to bear in mind their strong wish to be heard but also their feeling that they cannot reach out for help. This poses enormous challenges when working with clients who have moved from one culture to another, especially if they are still establishing their identity in the course of their psychological development or have not accomplished this, for whatever reason. It is important therefore to be vigilant for signs of trauma resulting from cultural relocation.

Dr Ieehyok Woo originally qualified as a neuropsychiatrist in South Korea and currently works as a consultant child and adolescent psychiatrist in the NHS. He also sees Korean students and adults in private practice both as a psychiatrist and for psychotherapy. 


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