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Join Dae Sun Hwang, a first-generation Korean American, and Joo-Young Lee, a child and adolescent psychiatrist. We’ll explore the multifaceted intersection of Korean culture and mental health within the Korean American community. From cultural nuances to familial expectations and societal stigma, we’ll delve into the challenges and opportunities for fostering a healthier community.

Dae Sun Hwang is a first-generation Korean American. Joo-Young Lee is a child and adolescent psychiatrist.

They discuss the KevinMD article, “Beyond K-pop and kimchi: Unraveling the mental health tapestry of Korean Americans.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Dae Sun Hwang and Joo-Young Lee. Dae Sun is a medical scribe, Joo-Young is a child and adolescent psychiatrist, and together they co-wrote the KevinMD article “Beyond K-pop and kimchi: Unraveling the mental health tapestry of Korean Americans.” Dae Sun and Joo-Young, welcome to the show.

Dae Sun Hwang: Thank you for having us.

Joo-Young Lee: Thank you for having us.

Kevin Pho: So I’m going to ask each of you to briefly share your stories and journey, and then we’re going to talk about the article. So Dae Sun, why don’t you quickly go first.

Dae Sun Hwang: Sure. So I’m Korean American. I was born in South Korea, but my family moved to the United States when I was about a year old. So I grew up in the Midwest for most of my life.

And currently I’m working as a medical scribe. What initially inspired me to pursue medicine was my mom’s experience with breast cancer when I was in middle school. Seeing how well her doctors took care of her definitely inspired me, affected my perception of how important of a field medicine was. And so that’s been a big influence on my journey throughout life.

And I’ll be starting medical school in the fall, and definitely looking forward to that next step in the journey.

Kevin Pho: Perfect, and best wishes to you in medical school.

Dae Sun Hwang: Thank you.

Kevin Pho: And Joo-Young, you’re a child and adolescent psychiatrist. Just briefly share your story and journey.

Joo-Young Lee: Yeah, so I’m currently working at Children’s Hospital in Colorado. I was born and raised and studied in South Korea. I was already a board-certified psychiatrist when I decided to come to the United States, and the decision was made because I wanted to learn more about psychoanalytic techniques and theories. I also wanted a better life for my family.

But I had to go through another residency at University of Maryland for this. Thank you, Dr. Aaron Raif, for giving me an interview at the last moment. And afterward I trained at Cambridge Health Alliance, which was a very therapy-heavy program in Massachusetts. And I came here last year with my family. I’m enjoying it ever since.

Kevin Pho: Perfect. Both of you co-wrote a KevinMD article, along with Thomas Park, “Beyond K-pop and kimchi: Unraveling the mental health tapestry of Korean Americans.” So Dae Sun, tell us about this article for those who didn’t get a chance to read it.

Dae Sun Hwang: Yeah, so I worked with Dr. Park, Dr. Lee, and given our shared background as Korean Americans, I think it was an important topic for us. And we wanted to not only provide some background information about our culture and some of the nuances that are unique to our culture, but also being able to understand our community through a mental health lens.

And I think that was important to do because, throughout history, there’s been a lot of stigmatization, I would say, regarding the topic of mental health. And that kind of prevented people from maybe seeking the right care or the appropriate care for their concerns.

But I think that is slowly changing for the better. It seems that the conversation about mental health is slowly becoming more of a public thing, and people are more willing to be open about their challenges. And so I think we wanted to contribute to that, and hopefully through our article we can continue to move the conversation forward in a positive way. And that was kind of the main focus of why we ended up working on this article.

Kevin Pho: So Dae Sun, when you say that mental health is stigmatized in the Korean community, give us some examples of that.

Dae Sun Hwang: So some examples I would say, like, you’re not really allowed to express, from my experience growing up under a Korean household, we didn’t express too much of our emotions. So whether maybe you’re feeling sad, angry, or whatever the case may be, we have a tendency to suppress a lot of those.

And I think that can lead to a lot of different issues. One thing that we highlighted in the article was the concept of hwabyung, which, you kind of don’t necessarily express your concerns as a mental health issue, but more so a physical symptom. You might feel some sort of a burning in your chest, or somatize, I’m not sure if I’m pronouncing that correctly.

So it’s more of that sort of a manifestation of your concerns, more so than addressing it as, like I said, a mental health challenge. So that’s one example that I would say is related to mental health challenges that arise in Korean Americans.

Kevin Pho: Joo-Young, you were a psychiatrist in Korea, right, before you came to the United States. So tell us about that tension between the stigmatization of mental health disorders and patients coming to you to talk about their mental health disorders. So talk about that.

Joo-Young Lee: So I believe back in Korea, the level of stigma was going down. And when I came here, what surprised me was, I’ve barely been seeing a Korean immigrant population or even Korean Americans in my clinic. So surprisingly, a disproportionately small percentage of Asian Americans are actually coming to the clinic to seek help.

That makes me wonder, like, there is even higher stigma among Asian Americans than Koreans living in Korea. I’m not sure whether that’s a cultural phenomenon or language-based phenomenon. I’m still trying to figure it out.

Kevin Pho: And Joo-Young, when you saw patients come to you for behavioral health issues, what would be some of the typical stories that you would hear from them?

Joo-Young Lee: So what I noticed in clinic is, when Asian Americans end up coming to our clinic, the severity is way, way worse. So I see a lot of psychotic patients, psychotic Asian Americans, severe like catatonic depressive patients. So once they arrive to our clinic, the severity is really strong.

So I think they’re putting it off to the point where they really feel like, oh, this is not a problem of self-discipline. So they seek help when it’s explosive or something’s really, really off.

Kevin Pho: Dae Sun, in your article you talk about the model minority stereotypes that Korean Americans face. How do you think that plays into the mental health challenges faced by the group?

Dae Sun Hwang: I would say that it definitely creates a lot of pressure to always perform at a high level. I think I particularly experienced that when it came to academics.

Asian Americans are typically known for really pushing their children in an academic setting, and to always uphold a very high standard of grades. And I think there’s a fear of disappointing others and dropping below that standard, and that can create a lot of, like I said, pressure. And it can be difficult to cope with that oftentimes, especially for adolescents or children that are growing up in that type of environment.

But hopefully with increasing awareness of mental health issues, that can be alleviated in some way and help people to cope with that in more healthy ways.

Kevin Pho: Did you yourself face some cultural pressure to be silent about potential behavioral health issues?

Dae Sun Hwang: I think that’s true in some ways. I think I would say it was true for me because I was the only Korean American in my school from kindergarten all the way to 12th grade. And so I think not really having a direct contact to relate to prevented me from really having somebody to speak with about these issues.

Although my family, such as my parents or my two other sisters, they probably face similar issues, but I don’t think you’re able to connect with them in the same way that you would with maybe a peer that is experiencing a similar thing.

And so I think just not having a big community of people that are Korean American made it difficult to speak out about the challenges.

Kevin Pho: And Joo-Young, tell us about some of the things that you’re doing in terms of alleviating that mental health stigma among the Korean American population.

Joo-Young Lee: I’m still figuring out what would be the most effective ways, but I believe the PCP’s role is quite important, on how they educate about the importance of mental health, how important it is to get help when it’s deteriorating.

And also, I think through the school system they can reach so many population, that even when parents are not interested in the mental health issue, as if like first generation immigrant, I think school will have a lot of roles to play in putting in some cultural context, talking about stigma, and how it is OK to visit psychiatric consultation, and what they actually do. Because they really don’t, some people don’t really know what we do. They are still in this stereotypical image of the cuckoo’s nest, where you zap the patient. But we’re really caring about not doing harm to patients these days.

So I think those kind of objective knowledge should be spread out there through many routes, I think.

Kevin Pho: And Joo-Young, give us an example of something that you’ve done, or something that you’ve heard, to alleviate that stigma and really move that needle to talking about behavioral health issues more openly among Korean Americans.

Joo-Young Lee: So I just graduated, and I’m actually just having some time to create some other stuff other than seeing patients. So I am involved in creating some YouTube videos on normalizing the mental health concerns.

Also, I’m thinking of constructing some local parent training groups, so that I can reach out to the parents directly about common mental health concerns and how we can effectively overcome.

So I think doctors definitely have roles outside the clinics, where you can permeate through the community and target a bigger population.

Kevin Pho: Do you anticipate, or have you seen, some cultural inertia when it comes to alleviating that mental health stigma?

Joo-Young Lee: Actually, not that much. I think overall, even the older population is starting to embrace the importance of mental health.

For example, a big example, my father really didn’t like me pursuing psychiatry when I chose to do it, but he’s now really open, he’s talking to me about how important mental health is right now. And I really appreciate that, and I view that as a kind of a bigger inertia towards embracing mental health even in the older population.

And like we mentioned in the article, there are a lot of celebrity mental health figures in Korea now, propagating and normalizing these behaviors. And I really thank those TV personalities for propagating the correct knowledge.

Kevin Pho: So as a primary care physician myself, are there any specific questions that I could ask Korean patients in the exam room that may uncover potential behavioral health issues?

Joo-Young Lee: Yeah, so the biggest issue that’s quite often hidden is social isolation among this society. So I would ask more about their friendship and their family, their support system in general.

And also, Koreans, when asked if they need an interpreter in the clinic room, they often say no. But still, if the patient’s language, if English is not their primary language, I would still have an interpreter ready. Because once you have an interpreter ready, the kind of fabric changes, and it gives them comfort, it gives them validation to speak in their mother tongue, and they’ll start to speak about something they wouldn’t have spoken without an interpreter.

Because, like we said in the article, the cultural expression, how they describe mental health, is very different. There’s no one-to-one correlation in language, Korean to English. So I think with a professional interpreter in the room, things will change, and I think physicians will have better, reliable information from patients.

Kevin Pho: We’re talking to Dae Sun Hwang and Joo-Young Lee. Dae Sun is a medical scribe and pre-medical student, Joo-Young is a child and adolescent psychiatrist, and together they co-wrote the KevinMD article “Beyond K-pop and kimchi: Unraveling the mental health tapestry of Korean Americans.” Now I’m going to ask each of you just your take-home messages to the KevinMD audience. Dae Sun, why don’t you go first.

Dae Sun Hwang: Yeah, so I’ll just relate it to my recent acceptance to medical school, because that’s still fresh in my mind.

I would say that definitely holds true, like the classic advice of working hard, having confidence and belief. But also I definitely recognize the importance of having somebody like a mentor, or somebody that’s more experienced or more knowledgeable about the path that I’m taking.

And so I would encourage anybody that is going through a similar situation, if they do have a resource such as somebody that is more knowledgeable, definitely reach out to them. And I think that can provide a lot of clarity in their journey and make it a lot more efficient. And yeah, I found it very beneficial, so I would encourage others to do the same.

Kevin Pho: Joo-Young, and we’ll end off with your take-home messages to the KevinMD audience.

Joo-Young Lee: Yeah, so I think two things.

So one, physicians would benefit so much if you start the initial encounter with asking about social correlates, like support system, work, their interest. It just makes a way more relaxing environment, so I think that’ll be really important.

Also, stick to open-ended questions in the clinic. It’s so important. That’s what I learned throughout my training, the curbing down the urge to ask closed-ended questions to end the encounter early. But I found that open-ended questions just open up so much from the patient, and I think it’ll benefit the accuracy down the road.

Kevin Pho: Dae Sun and Joo-Young, thank you so much for sharing your stories, time, and insight, and thanks again for coming on the show.

Dae Sun Hwang: All right, thank you.

Joo-Young Lee: Thank you. Thank you, Dr. Kevin Pho.