Sunday, December 12, 2010

Suicide Risk and Prevention in South Korea – Glory Song

BEHIND THE PRISTINE VENEER

In the past ten years, South Korea has seen major economic and cultural advancements. Not only has its technological and automobile industries become giants in the global economy, even its cultural export, consisting of music, dramas, movies, fashion, and impeccable looking celebrities, have now garnered worldwide followings and have become household names across all of Asia. Historically a deeply traditional society founded on rigid hierarchy and a strong sense of unification, the influx of wealth and Western ideals have transformed the nation into a hub for consumerism and pursuit of higher living. The ritzy avenues of Seoul, with its fashion billboards, endless stores and countless plastic surgery centers attest to the shift in societal ideals to a glorification of what is glamorous, luxurious, and beautiful.

However, behind Korean National Tourism’s best effort to portray the nation as the junction where rich tradition meets modernity, lie deep-seated social problems of increased senses of alienation and pervasively unaddressed psychological anxieties that serve as direct consequences of a nation that has not confronted the mental illness and social vices brought about by their rapidly transforming society that is leaving so many of its people alone and behind.

A UNIQUE PHENOMENON

In 2006, South Korea surpassed Japan in having the highest suicide rate among the 30 Organization for Economic Cooperation and Development (OECD) nations that include the United States and large parts of Europe (1). In 2009, suicide made up 6.2 percent of the total number of deaths in Korea and ranks as the 4th leading cause of death in the country, behind common pathological conditions of cancer, cerebrovascular diseases and cardiovascular ailments such as stroke (2). The National Statistical Office (NSO) reported 26.1 suicides per 100,000 people in Korea for 2005. The corresponding figure for the United States was 10.2 (3).

Perhaps a phenomenon that has been unique to South Korea is the overwhelming number of heavily publicized suicides by public figures, including those of former president Roh Moo-hyun, millionaire Samsung heiress Lee Yoon-hyung, and a string of entertainers such as singer U;Nee, supermodel Daul Kim, and most recently, Park Yong-ha, who had been a frontrunner in the “Korean Wave” cultural export movement (4). Due to widely available media outlets, a large subscription to entertainment by the public, and the homogeneity of the population, Korean public figures have an unusually close dynamic with the general public, and everything from their outfit to their personal life to their past history is constantly monitored and a potential subject of scrutiny by the people.

Since popular actress Lee Eun-joo’s suicide in 2005, a consistent trend of copycat suicides have followed in the two months after the announcement of a public figure suicide. Statistics report that the number of people who commit suicide within two months after the death of a celebrity was distinctly higher than those in other months in a given year. The numbers were 2,568 for actress Lee Eun-joo in February, 2005; 2,330 for U;Nee in January, 2007; and 2,876 for actor Ahn Jae-hwan in September, 2008 (5).

Such phenomenon in which people mimic the suicide method they observe has come to be known as “The Werther Effect” (6) and has contributed greatly to Korea’s sharply increasing suicide rate. Yet it is only within the last two years that the national government has really made a centralized effort to launch a campaign in response to this growing social tragedy.

TACKLING THE SURFACE

In late 2008, 10 government ministries and offices came together to develop a blueprint for a national anti-suicide campaign (7). The long-term goal focuses on strengthening the social and economic safety net for those in the low-income brackets and the aged, but in the meantime, the government has also established a series of short-term measures. These measures target what are considered the two main perpetrators for enabling suicide among the population: 1) the media responsible for disseminating news of celebrity deaths to the public and 2) the accessibility of suicidal means to the individual.

In an effort to limit the sensationalism surrounding celebrity death, the Ministry of Health and Welfare has requested that media companies 1) refrain from printing celebrity suicides as headlines and 2) refrain from describing the specific means or situation of the death and interviewing family members of the deceased (6). In efforts to close off access to various means of suicide to the common people, the Ministry of Land, Transport and Maritime Affairs have plans to set up more screen doors at subway stations to prevent people from committing suicide by jumping in front of trains and the Ministry of Food, Agriculture, Forestry and Fisheries have plans to regulate purchases of poison pesticides in an attempt to cut off access to the abuse of such supplies (8).

While it remains to be seen whether these preliminary strategies will make any impact in reducing the rate of suicide, there are certain flaws in these rationale that raises concern as to their efficacy. This paper will highlight three critiques of the Korean government’s anti-suicide intervention strategies and provide alternative suggestions that address each of the three shortcomings.

CRITIQUE 1: OVERSIMPLIFICATION OF THE SOCIAL COGNITIVE THEORY

Social cognitive theory posits that individuals learn by watching what others do and that behavior change is affected by environmental influences, personal factors, and attributes of the behavior itself (9). Furthermore, self-efficacy, or the belief a person has in his or her capability to perform the behavior, is central to the individual performing the behavior. However, within a societal set-up like South Korea, environmental influence and social pressure play a formidable role in the coercion of individual behavior.

While the social cognitive theory as it stands may be valid in a Western society where individualism and self-reliance are upheld, its component make-up become less balanced in traditional Asian societies that strongly value homogeneity and conformity to a set of social expectations. In South Korea, environmental influence is so extensive that it spills over to influence personal belief and even the ideation of self-efficacy.

The fundamental assumption underlying the effort to restrict public exposure to celebrity deaths is that individuals imitate what they see and thus conversely, if individuals are shielded from such exposure, they will be less likely to imitate. While it seems the Ministry of Health grasps, to a certain extent, how powerful the entertainment industry is in influencing public opinion, it does not understand just how deeply its citizens are drawn into the lives of these glorified entertainers.

Efforts to limit public exposure are impractical in two ways: 1) it is simply not feasible to control all channels of information that reach citizens on a daily basis and 2) the level of response to a celebrity suicide is not so much determined by the choiceness of words in its reporting or whether it makes it to the front page, but by how well-known and well-loved that individual was prior to his or her death.

Indeed, according to monitoring by the Korean Association for Suicide Prevention , among 343 articles in 10 major newspapers and 113 reports by four major broadcasters, 60.1 percent failed to follow the guidelines (6). Furthermore, even if all media outlets did refrain from overt reporting, the news of their death can still travel via blogs, forums, chatrooms, unofficial news sites, word of mouth, etc. Ultimately, it’s the shock and perceived gravity of the loss, and not the degree of its exposure, that triggers individuals to follow suit.

CRITIQUE 2: MISUNDERSTANDING OF “SELF-EFFICACY”

The rationale behind the government’s effort to censor the ways in which individuals can achieve suicide is understandable – after all, with fewer viable means of committing suicide, it would seem that less people would choose to do so. In this way, the government may believe they are undermining the perceived self-efficacy of individuals and deterring them from committing such an act. However, what they may not realize is that for an individual to witness the death of a well-known public figure may provide the strongest support that he or she can take action and ownership of their life and end it. While the government believes that the availability of resources is what limits or enables the perceived ability of someone to make a choice, the very reality of someone well-known actually committing suicide is infinitely more powerful of an instigator. Thus, expending resources to limit certain means out of an almost infinite number of possibilities may prove futile as a buttress against the impact of real death.

In another way, limiting access also may prove too late of an intervention in preventing suicide. In one study performed in Korea looking at clinical characteristics of depressed patients, researchers found that of 1183 participants they recruited, 21.4% had a history of suicide attempts (10). This means that individuals who are attempting suicide may have a long history of suicide ideation and even unsuccessfully acting on it. When one contrasts a few mere subway screens to the years of ideation and depression that may have taken root in an individual, it is easy to see why such prevention efforts may be limited in their efficacy.

CRITIQUE #3: NOT IDENTIFYING THE ROOT OF THE PROBLEM

Finally, one can argue that asking the media to refrain from reporting may actually aggrevate the problem by conveying the message that suicide is not a serious issue that needs to be addressed. At the root of the phenomenon is not simply that individuals simply mimic what they see celebrities do, but rather, that long withstanding pressures and anxieties pressing in from all sides has driven them to a point where seeing someone else acting out the thought that had been plaguing their own minds for so long only serves as the trigger that catapults them from contemplation to action.

Studies have found that since the 1997-1998 East Asian Financial Crisis that yielded 19.9 suicides per 100,000 people, numbers have consistently been high and on the rise (11). One study found that suicide rate was clearly related to the unemployment rate and also a result of the widening rich-poor gap and social polarization that also resulted from the financial crisis (12). Additionally, studies found that while the absolute increase in suicide rates are attributed to older individuals over 45, the proportional increase in rate was most prominent among younger people (13), an indication that the problem has expanded to society at large and individuals across all age groups have been increasingly feeling the burden to take their life as an escape from environmental pressures.

Ultimately, neither the Werther effect nor Social Cognitive Theory can fully explain the depth of this prevalent suicide phenomenon in South Korea nor provide an adequate solution out. What is necessary is a return to unity and a collective effort to raise the morale of everyone from peasants to millionaires, and to instill hope that alternative methods of dealing with life’s uncertainties and anxieties are better options than ending one’s life.

SOLUTIONS IN RESPONSE

MAKING THE MOST OF CELEBRITY INFLUENCE

While the consequence brought on by a celebrity death can be categorized under “unintended media effects ” that stem from Social Cognitive Theory (14), South Korea can take advantage of the massive popularity of celebrities and the uniquely intimate dynamic between public figures and the public to launch an anti-suicide television show or education series. The underlying assumption of Social Cognitive Theory is that individuals mimic behavior they see in others. As a result, mere 30 second advertisements or empty, cheery words may have little effect. However, should well-loved and respected public figures partake in a documentary or television show that brings together the reality of individual struggles and shows how these individuals deal with them or help others address them, this may substantially provide examples of solutions or encouragement that viewers are not alone in their problems and as a result, restore a sense of unity and promotes greater openness in confrontation and discussion of such problems.

Another way of bringing about positive and “intended media effects” is to take advantage of social media outlets and make a push for positive blogs and anti-suicide pieces. Studies have shown that a reliable preliminary indicator for suicide attempt is the posting of some “final words” on the individual’s blog or homepage. In a country like South Korea where such a large proportion of the population have ready access to the internet, online communication has over the years come to replace in-person interaction, especially among many of the younger generation. The internet provides an anonymous, removed setting on which one has the freedom to express anything on their mind – and many times have served as breeding ground for malicious remarks and bullying. Many times, celebrity’s personal pages are the most consistently followed. If there can be a campaign launched where celebrities agree to post encouraging messages or sharing of their struggles onto these sites, these entries can serve as a platform for greater dialogue among individuals young and old who read them.

INTERVENE EARLY AND APPROPRIATELY

As discussed earlier, one of the shortcomings of attempting to set-up subway screens and pesticide purchase monitoring is that the financial resource could instead be used for more early intervention that more directly target the root of suicide attempts. Instead of money spent that poses as physical barriers to a behavior, money should instead be allocated for the creation of a community in which individuals can mutually entrust and encourage, as supported by the Social Support Theory (14). The Theory posits how networking and interacting help individuals cope with stressful events.

Erecting screen doors on subways and denying individuals of poison will only more glaringly put them face to face with their suicide ideation and negatively represent government’s role in addressing the problem. Instead, if support groups can be created, either through local religious groups or grassroot groups that will take individuals from their isolation and plug them into a community that builds long-term relationships and support, this will minimize feelings of alienation and other ideations that pushes one to take extreme measures. It also provides a system of accountability and mutual monitoring for warning signs of potential harmful behavior.

GETTING TO THE ROOT OF THE PROBLEM

Finally, no single campaign with slogans or visuals can provide a long-term solution, because it doesn’t address the root cause of why individuals undergo depression and eventually spiral into suicide ideation instead of recovering from their condition. The first step to bringing suicide rates down is to truly understand what factors are involved that has made them rise. The societal stresses placed on men differ from that on women, and the anxieties that plague the youth lies in great contrast to those that demoralize the old. Only when these factors are identified and explored can they then be addressed with hope of being resolved.

For youths in South Korea today, life can be both suffocating and strenuous. On one hand, there is immense academic and parental pressure to perform in school and to excel, because the reality is there is a limited number of jobs and opportunities domestically. On the other hand, the allure of the glamour and ease that comes from the media’s portrayal of celebrity life draws hundreds of thousands youths each year to try out for talent agencies, each with hopes of being a part of the next international-hit boy band or girl group. For young girls, the issue of self-image is particularly hurtful, as societal pressure dictates very clearly a very narrow standard of beautiful, and a single fold in the eyelid could be the determinant of whether or not you are hired. Growing up in such a stifling and psychologically tumultuous environment, and many times devoid of open dialogue with parents, youths often find they have no true guidance or support. In a study that examined the main risk factors in relation to suicidal ideation among high school girls and boys, it found that for males, all behavioral variables (i.e. smoking, drinking) were predictive of suicidal ideation while for females, sexual orientation and bullying were predictive factors (15). Such results reflect the need for greater parental intervention and school education that covers such heavily stigmatized topics as divorce and sexual health.

The public figures who have died in recent years suffered from depression brought on by a variety of psychological burdens. Former president Roh hung himself following a number of high-profile corruption investigations. Actor Park Yong-ha had a terminally ill father and felt financially burdened despite his many sources of incomes. Singer U;Nee committed suicide reportedly as a result of work pressure and depression over her overly-sexualized public image. Actress Jang ja-yeon left a suicide note listing in detail all the sexual favors and forced services she was forced by her entertainment agency to perform in order to secure roles and advance her career (16). These few individuals’ rationale for taking their own lives highlights a vast array of deeply entrenched problems with Korea’s society as a whole – from corruption to sexual assault, work pressure to financial paranoia.

FINAL THOUGHTS

The suicide epidemic that has overtaken a South Korea that gleams so brightly from the outside illustrates the complexity and challenge of public health intervention. On the surface, the mortality figures may not seem so shocking – a high profile death here and there, with most of the suicides going unreported or publicized. However, a closer look at the few cases that do get more deeply investigated unveils a multitude of societal problems that is undermining the mental health of an entire nation. Difficulties, challenges, environmental pressures will always exist, especially within emerging nations like those of East Asia where old conservatism and new openness have created a life that is at once bustling with life and locomotion but at the same time, eating away at long withstanding lifestyles grounded in peace and simplicity. While people are sacrificing their time and their health for the pursuit of a larger house, greater purchasing power, and improved social standing, it is twined with irony that in the process of gaining what is disposable, they are disposing of what cannot be regained.

WORK CITED

1. Society at a Glance 2009: OECD Social Indicators, Organization for Economic Cooperation and Development.

2. “South Korea has top suicide rate among OECD Countries.” Seoul, September 18, 2006. Yonhap News.

3. “Suicide in South Korea Case of Too Little, Too Late.” Seoul, February 3, 2007. OhmyNews Korea.

4. “South Korea’s Suicide Problem.” July 21, 2010. The Wall Street Journal.

5. “Copycat Suicides Serious.” Seoul, October 4, 2010. The Korea Times.

6. Phillips, David P. “The Influence of Suggestion on Suicide: Substantive and Theoretical Implications of the Werther Effect.” American Sociological Review. 1074, Vol. 39 (June): 340 – 54.

7. “S. Korean Religious Groups Join Anti-Suicide Campaign.” Seoul, March 25, 2010. Arab Times.

8. “Anti-Suicide Measures Due.” Seoul, August 31, 2008. The Korea Times.

9. Bandura, Albert. “Social Cognitive Theory: An Agentic Perspective.” Asian Journal of Social Psychology. Volume 2, Issue 1, pages 21-41, April 1999.

10. Park, Min-hyeon, et al. “Clinical Characteristics of Depressed Patients With a History of Suicide Attempts: Results from the CRESCEND Study in South Korea.” Journal of Nervous & Mental Disease. October 2010, Volume 198, Issue 10. Pp 748 – 754.

11. Inoue, Ken, et al. “Relationships between suicide and three economic factors in South Korea. Elsevier – Legal Medicine 12 (2010). 100 – 101.

12. Kim, Myoung-hee, et al. “Socioeconomic inequalities in suicidal ideation, parasuicides, and completed suicides in South Korea.” Social Science & Medicine. Volume 70, Issue 8, April 2010, Pages 1254-1261.

13. Kwon, Jin-won, et al. “ A Closer look at the increase in suicide rates in South Korea from 1986 – 2005.” BMC Public Health. 2009. 9:72.

14. Frank, Pajares, et al. “Social Cognitive Theory and Media Effects.” The SAGE Handbook of Media Processes and Effects. Los Angeles: SAGE, 2009. 283-97.

15. Park, Hyun Sook. “Predictors of Suicidal Ideation Among High School Students by Gender in South Korea.” Journal of School Health. Volume 76, Issue 5, 2006.

16. “Jang ja yeon’s suicide stirs up Storm in South Korea.” December 9, 2010. The Huffington Post.

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1 Comments:

At December 12, 2010 at 5:02 PM , Anonymous Marshall Couper said...

What an interesting article. In particular the sections on intervening early and getting to the root of the problem. In Australia, we've recently launched an early intervention (assessment) tool to the public where the results go to their practitioner. There is a reluctance for many people to speak about their mental health with their practitioner and the Mind Screen is changing that. If you are able to put me in touch with someone in South Korea who could fund the development of a South Korean version we could make a real difference to the South Korean suicide rate. Marshall Couper, CEO, Global Mind Screen Group Pty Ltd.

 

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