In this review article, the author attempted to draw a comprehensive picture and research problems of depressive disorders from the view point of cultural psychiatry.
@ES Occurrence :
@EN Rarity of depression has, with several exception, been reported from many non - Western countries. This rarity has conventionally been attributed to the poorly differentiated personality with vague superego and traditional lack of original
sin.
However, very careful evaluation of research details such as diagnostic criteria, concepts and fashions, source of data, depth of evaluation, researchers' orientaiton to cultural pattern of emotional expression and interculturl bias of the
researchers
is necessary for the correct cross-cultural comparison.
In Korea, many previous studies reported low occurrence of depression. Only 0.02% of the population in 20 agricultural and costal fishing villages suffered from affective disorders, whereas 5 - 7 % of all neuropsychiatric inpatients were found to
have
affective disorders. This was prematurely attributed to the fact that there is no guilt in korean tranditional cultural context, However, the validity of the data is rather doubtful because a depressed person is not traditionally regarded as a
patient
in Korea. The possibility that such cases were overlooked in field surveys can not be excluded. Recently, most Korean psychiatrists were led to believe that depressive cases were increasing. One out patient clinic reported that 23% of its new
psychiatric patients were diagnosed as depressive. It was also reported that the admission rate of affective disorders in one neuropsychiatric ward had increased from 5% to 15% during the last 10 years. It is questionable whether this change in
patient
population is due to a real increase of patient or to an increase in the number of people who seek psychiatric help. Changes in deagnostic fashion too, have no doubt contributed to this increase. Meanwhile the recent industrialization of society,
the
trend toward smaller nuclear families and the collapse of the traditional supportive milieu of depressed people have led to both a real increase in the number of depressive cases and to an increase in the number of people visiting psychiatric
units.
On the others, recent nation - wide epidemiological survey using DIS-III reported that life - time prevalences are 2.22% in major depression and 2.3% in dysthymic disorder, which are less prevalent comparing with those of St. Louis, New Haven and
Los
Angeles. But, depressive tendency of general population was, using CES -D, proved as higher in Korea than in Western countries. Depression score was 15.6 in Korea, whereas 7.96 -9.25 in the United States. It is also questionable whether due to a
real
increase of the cases or to a different research methodology.
@ES Clinical Manifestations :
@EN A Lack of guilt, rare suicidal tendency, confusional episode and somatic expression of depressive feeling have been considered to be characteristic feature of non - Western depressives, even though there are considerable contradictory
findings.
Repeated evaluation suggests that some findings are true and others are from research artifects or from cultural bias. Some of them are estimated to be chronologically changed. These manifestations were variously and plausibly explained in terms
of
culture and personality.
Strong somatization with a lack of guilt and suicidal idea had been reported in Korea.
The tendency toward expressing depressive feeling in somatic descomforts is more prominent in Korea than in Western countries. Somatization seems to be a core traditional defense mechanism used in coping with internal and external stresses. It
can
be
attributed to several contexts ; the concept of illness of traditional herb medicine in which emotional problems are projected unto the soma, and the milieu of the large family where outward expressions of emotion are discouraged, and the
traditional
way of conducting interpersonal relation in which emotional outbursts are suppressed.
The lack of guilt and suicidal ideation in Korean depressives has been interpreted as being the result of a lack of Christian cultural values. However, this conventional interpretation has been criticized recently by several researchers. Careful
studies
of depressive symptomatology suggest that guilt and suicide are apparent among depressed Koreans as well as among Western sub jects, Previous reports that guilt and suicidal idea are rare are now felt to considerble methodological errors. The
first
mistake was that the researchers evaluated symptoms so superficially that they were unable to elicit deep-seated guilt and suicidal idea ; they collected their materials from only the chief complaints of the patients. The second is that they
defined
guilt in a strict Christian sense, that is, the vertical sense of guilt, stemming from man's relation to God, as in Western societies, But it is also possible to conceptualize guilt in a horizontal sense as to his ancenstors, family and neighbors
in
cord with Oriental concepts. When we define guilt in a Christian terms, it rarely appears in Korean depressives, but when we define it in Oriental terms, guilt is crucial in Korean depressives as it is in their Western counterparts. When this
broad
definition of guilt is applied, the incidence of guilt is estimated to be same in Korean and Western depressives.
Regarding the suicidal idea, it is also from problems of evaluation. Superficial and less intensive evaluation frequently fails in detect of suicidal idea in Korea. Most Korean depressives are not likely to express suicidal idea, which conceals
under
the somatic complaints. For the evaluation fo suicidal idea even guilt, good doctor-patient relation and skillfull evaluation are essential. Recent studies suggest higher suicidal idea among Korean depressives than among Western counterpart.
Special
attention has been paid to the research finding that suicidal rate was high as 45 per 100, 000 population in a small island in Korea. Previous low suicidal rate was attributed to the peole's sttitude toward suicide that they ususally tried hide
it.
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