Written by Hyesung Oh, Junior Researcher ’11-12

Neon lights flash. Pedestrians haggle with the occasional street vendor. The scent of 떡볶이 (rice cakes in spicy sauce) and 오뎅 (fish cakes) wafts in the air. Car horns bellow their displeasure at the quotidian gridlock that freezes a winding stream of automobiles. Life courses through Seoul’s veins — from the gaping main roads to the more obscure 가로수길 (commercial back alleys) riddled with neon signs, clubs, bars and 노래방 (karaoke). If the stream of cars is blocked, the stream of people keeps the heart beating.

The gleam of the city compounded with its cacophony produces a visceral musical, familiar and perhaps therapeutic to many. Synesthesia becomes commonplace. To the eyes and ears of those young enough to see this modernized and dynamic Korea as normal, this is home.

But it is not home for all.

Korea has developed more, and more rapidly, than virtually any  country in recent history. In 15 years, Korea’s economy achieved the type of growth that took Japan’s 40 years. [1] Brands such as Samsung, Hyundai and LG have become staple names in international trade. Korea leads the world in Internet access and cellphone usage. There is a strong, machine-like work ethic on display throughout the spectrum of professional life, from offices and universities to mom-and-pop stores.

Yet, throughout the Land of Morning Calm, roaring echoes of those who yearned to be heard, seen and understood reverberate. The dreaded piece of paper ridden with scribbles that may signal each self-inflicted loss of life initiates a chain reaction of reflection, tears and shame in its author’s loved ones.

Korea currently has the highest suicide rate among Organization for Economic Cooperation and Development countries. [2] A scourge once written off as an inevitable consequence of the economic crisis of the late 1990s, the persistently high suicide rate is now begging for investigation. Despite material prosperity, the rate keeps climbing. [3]

Among the silenced echoes, those of the elderly reverberate the loudest. A lethal mix of traditional bias toward stoic suffering, growing poverty and unchecked mental illness have left elderly Koreans most vulnerable to suicidal despair. Koreans aged 60 years and older suffer from the highest rate of suicide. [4]

The Korean education system’s 수능 (Korea’s national college entrance examination) induces incredible existential stress in high school students, making it tempting to heuristically associate the severest rates of suicide with the population toiling for the high-stakes test. However,  young people are 10 times less likely to take their own lives than the  elderly. [5] Why do these false perceptions exist?

At the moment, Korea is a melting pot of the old and the new; the conservative and the progressive; the ill-informed and the well-educated. As its economy continues to strengthen and as Western individualistic values incubate in younger generations, Korea’s traditional foundations are being challenged. Family values are becoming more nuclear and less extended. Mental health and suicide are becoming real issues that people cannot ignore.

Of course, Korean society confers the most influence and power to its eldest members, who, more so than others, consider suicide a symptom of weak character. And as those in power in Korea are quite well-off, the influential elderly may be disconnected from the ramifications of the cultural shift from extended to nuclear families. One manifestation of this disconnect is a dearth of funding for the elderly. The Korean government spent only 1.5 percent of its GDP on social expenditure for the elderly compared to Japan’s 8.6 percent. [6] Only 25.4 percent of Korea’s elderly population (aged 65 years and older) obtained old-age pension services in 2007. [7] Consequently, relative poverty was higher among the elderly compared to the general population in Korea (45.1 percent vs. 14.6 percent). [8] This is bad news for a country whose people traditionally provided for their elders through an extensive extended family network.

Along with societal factors, mental health influences suicide rates as well.  Korean dictionaries and the Korean National Statistics Office, or KNSO, define suicide as an “intentionally self-inflicted” phenomenon. [9] This definition is especially troublesome in the Korean context, as the word “intentional” implies that those who attempt suicide do so with a clear, calculating conscience. It is shown, however, that 60-72 percent of those who attempt suicide in Korea have at least one mental illness [10] and that depression is the main factor driving suicidal ideation in Korea. [11] The KNSO’s definition of suicide perpetuates the culture of viewing suicide as a sustained character problem rather than a problem preventable by intervention, thus worsening stigma against it. [12] Credible, leading members of society have a strong influence over who does or does not get stigmatized, [13] especially in the framework of Asian culture. [14] Unfortunately, as of 2009, there have been no Non-Governmental Organizations, donor organizations or religious organizations that have significantly contributed funding toward mental healthcare services. [15] Suicide prevention efforts require credibility as well as money and materials.

The government can help by allocating a higher proportion of GDP for national old-age pension services and government-funded nursing home facilities. To combat depression, the government should launch a concerted effort involving scholars, policymakers and community leaders to raise awareness of and weaken stigmas against depression among Koreans.

POSTECH, a prestigious science and technology university in the city of Pohang, can be a model. POSTECH currently has six staff at their student counseling services center, which emphasizes education and awareness, training professors, staff and students to detect early depressive symptoms. The center implemented a Residential Assistant training program focused on detecting and supporting students with mental health issues.

Because of the resulting atmosphere and culture, approximately one-third of undergraduates have visited the center, providing evidence for a de-stigmatization of seeking mental health counseling in the university. The last suicide at POSTECH occurred in 2007, before which the institute had dealt with 38 reported suicides since its 1986 founding. A scaled-up system of surveillance and—most importantly—education would be beneficial to all of Korean society, including the elderly.  Those who suffer from mental illness also deserve more, not less, support from society.

Korea’s elders are a pillar of Korean society that deserves dignity and support. They helped build Korea’s identity and propelled its economic boom. Ultimately, each suicide is a silent failure of society to help its own. Koreans must hear and help the silenced voices, because each such failure is final.

Hyesung Oh is a 2011 Junior Researcher affiliated with the Graduate School of Public Health at Seoul National University.

[1] World Bank. World development indicators 2007. Washington, DC: Author, 2007.

[2] Korea National Statistical Office (KNSO). 2008 Cause of mortality statistics. Daejeon, South Korea: Statistics Korea, 2009.

[3] Kim, Myoung-Hee, Kyunghee Jung-Choi, Hee-Jin Jun, Ichiro Kawachi. “Socioeconomic inequalities in suicidal ideation, parasuicides, and completed suicides in South Korea.” Social Science & Medicine, 70 (2010) : 1254-1261. Print.

[4] Ibid.

[5] There are approximately 110 suicides per 100,000 people among those 60 years old and older, versus 11 per 100,000, 30 per 100,000, and 52 per 100,000 among those 15-24 years old, 25-44 years old, and 45- 59 years old, respectively. Ibid.

[6] Organization for Economic Co-operation and Development (OECD). OECD health data 2009. Paris: Author, 2009a.

[7] National Pension Service. 2007 national statistical yearbook. Seoul: Korea Ministry of Health and Welfare, 2008.

[8] National Pension Service. 2007 national statistical yearbook. Seoul: Korea Ministry of Health and Welfare, 2008.

[9] Nam, Mihee, Dae Seong Heo, Tae Yeon Jun, Min Soo Lee, Maeng Je Cho, Changsu Han, Min Kyung Kim. “Depression, suicide, and Korean society.” Journal of the Korean Medical Association, 54.4 (2011) : 358-361. Print.

[10] Ibid.

[11] Na, Sewon. The effects of social support on suicidal ideation of the middle-aged and elderly. Seoul, South Korea: Seoul National University Graduate School of Public Health, 2011.

[12] Nam, Mihee, Dae Seog Heo, Tae Yeon Jun, Min Soo Lee, Maeng Je Cho, Changsu Han, Min Kyung Kim. “Depression, suicide, and Korean society.” Journal of the Korean Medical Association, 54.4 (2011) : 358-361. Print.

[13] Repper, Julie, Rachel Perkins. Social inclusion and recovery: A model for mental health practice. London: Bailliere Tindall, 2003.

[14] Leong, Frederick T.L., Anna S.L. Lau. “Barriers to providing effective mental health services to Asian Americans.” Mental Health Services Research, 3.4 (2001) : 201-214. Print.

[15] Chun, Chang Bae, Soon Yang Kim, Jun Young Lee, and Sang Yi Lee. “Republic of Korea: Health system review.” Health Systems in Transition, 2.7 (2009) : 1-183. Print.