Image: Eric Lafforgue | A North Korean woman bowls at a bowling alley in Pyongyang, Sept. 2008
“Ask a North Korean” is an NK News series featuring interviews with North Korean defectors, most of whom left the DPRK within the last few years.
Readers may submit their questions for defectors by emailing [email protected] and including their first name and city of residence.
Today’s question is from Jack, who asks how North Koreans think about mental health.
Hyun-seung Lee — who comes from an elite North Korean family and defected in 2014 — spoke with NK News about how North Koreans link mental and ideological health, the country’s lack of therapists and its notorious “mental hospitals.”
Lee now resides in the U.S., where he works as a director for One Korea Network and a fellow of North Korean studies at the Global Peace Foundation. He also runs the Pyonghattan YouTube channel with his sister.
Got a question for Hyun-seung? Email it to [email protected] with your name and city. We’ll publish the best ones.
NK News: Does North Korean society emphasize taking care of your mental health?
Lee: Mental health (정신건강) as we understand it in South Korea or the West is an altogether different concept to that of mental health in North Korean society.
In North Korea, the mental (정신) bleeds into the ideological (사상). If somebody has a problem with their mental health, that is seen as analogous to a problem with that person’s ideology.
North Korean society constantly stresses the importance of ideology. That ideology is none other than the revolutionary ideology and spirit that encompasses the party’s monolithic leadership system — the “Juche” Idea — and the “spirit of defending the leader to the death.”
According to North Korean media, if a person’s mind is sick and “rotten,” then that person is ideologically lax and as a result unable to defend North Korea’s socialist system. Any mention of mental health in North Korea implies the sufferer is not revolutionary enough and lacks loyalty to the state.
NK News: How does North Korea deal with mental health issues like depression (우울증)?
Lee: I don’t think I ever heard the term “depression” while I was living in North Korea. If the concept exists, then it’s not something that’s often talked about by citizens, let alone the medical community.
It was when I started watching South Korean dramas and reading South Korean news that I first learned of depression as a medical condition. As I mentioned, if a person is suffering from depression in North Korea, society will judge that as a sickness of the person’s ideology and it will take on a political dimension.
However, it is common in North Korea to see people with sensitive nerves as suffering from hysteria (히스테리) or labeled as insane.
NK News: South Korea has issues with depression, suicide etc. In your experience, do North Koreans have more or less mental health issues than South Koreans?
Lee: In my opinion, North Koreans enjoy better mental health than South Koreans. North Koreans may also suffer from a lot of stress, but they do not easily fall into depression or commit suicide as a result.
No doubt, it’s possible that North Koreans don’t talk about it because they have no concept of depression, and we might be led to think that fewer people have such problems.
But it takes considerable mental fortitude to scrape by in a society without basic freedoms and human rights. In North Korea, it’s viewed as obligatory for party members and citizens to train themselves mentally and ideologically, so ordinary people have no room to think of their own lives in such negative terms.
Suicide is considered an anti-state behavior in North Korea. From the standpoint of the North Korean authorities, the country has become a socialist paradise on earth under the party’s rule.
As a result, suicide is interpreted as a statement of discontent with the policies of the state and the party. People from families in which someone has committed suicide face hurdles gaining employment as a cadre on top of social opprobrium.
NK News: Do they have therapists in North Korea?
Lee: In North Korea they do not have therapists. You won’t find therapists in any North Korean hospital, not even in the special medical facilities catering to the upper elite such as Namsan Hospital and Ponghwa Clinic.
NK News: South Koreas often use the English word “stress” (스트레스). Does North Korea have this word or concept, or a similar one?
Lee: In North Korea, there is no such word or concept as “stress.” Perhaps these days more people are coming to know of stress and depression through South Korean dramas.
You can’t take time off work or go to a resort to recover because of stress or depression. North Korean resorts are mostly open only to mid- to high-level cadres anyway — not the general public.
Most North Koreans rely on alcohol and cigarettes to deal with stress. If somebody’s psychological state becomes particularly severe, they may be treated as a mental patient and sent to a mental hospital (정신병원). That would basically mean the end of that person’s life. From what I know, these people aren’t accorded treatment befitting hospital patients or even human beings.
NK News: While you were in North Korea, did you hear anything about people with serious mental illnesses such as schizophrenia, or about the mental hospitals where they might be sent?
Lee: Yes, I’ve heard of schizophrenia patients in North Korea. There was a trading company director I knew who was forcibly sent to a mental hospital.
A doctor from Pyongyang Medical University once told me about mental hospitals in North Korea. People who suffer from severe mental illnesses such as schizophrenia are sent to them. Each province has one, such as the “No. 49 Hospital;” they are quite notorious among North Korean people.
I also heard about an incident where a family member of a high-ranking cadre was to undergo punishment for corruption. The cadre had that family member stripped from the family registry (호적) and sent to a mental hospital in order to shield themselves from fallout.
The purpose of North Korean mental asylums is to shut away mental patients whose abnormal behavior is considered damaging to North Korean society as well as the country’s image. Recently, however, [I have heard of] cases where people without mental illness have pretended to be insane so that they can avoid harsh punishment from the authorities.
Edited by Bryan Betts
Updated Lee’s biographical information at 10:53 a.m. on Dec. 9, 2021.
Alek Sigley is a PhD student at Stanford University's Modern Thought and Literature program, where he is writing a dissertation on North Korea. From 2018-2019 he studied for a master's degree in contemporary North Korean fiction at Kim Il Sung University's College of Literature. He speaks Mandarin, Korean and Japanese. Follow him on Twitter @AlekSigley.