홧병(火病)의 개념에 대한 연구

A Study of the Concept of Hwabyung

Hwabyung(fire disease) is the term which has long been used by lay people in Korea for a clinical disease. This study was conducted in an attempt to define the concept of hwabyung through semistructured interviews with 100 patients complaining of hwabyung who presented at the Department of Psychiatry, Yonsei University Hospital in Seoul. The majority of patients with hwabyung were married women in middle or past middle age and of lower social, economic and educational classes. Any etiologically related factors in family history and past history were not apparent. Hwabyung was found to be a chronic disease with a duration of about 10 years. Many of the patients had received treatment from a number of specialists, herb doctors and even a faith healer and shaman. This was indicative of the fact that they were reluctant to be seen as psychiatric patients but were aware that their illness was of psychogenic origin, suggesting that Korean lay people are already familiar with concept of psychogenic or neurotic disorders. The etiologically related life experiences reported by patients included chronic marital conflict with husband and in-laws, financial loss, poverty, a difficult life, other unfair social suffering and personality characteristics of themselves. These life experiences caused complex emotional reactions characterized by annoyance, mortification, anger and hate. These emotional complexes had been incompletely suppressed as they were of real external origin in the patients’ conscious level. Hwabyung seems to develop as these life experiences，characteristic emotional reactions and related adjustment problems are repeated and accumulate over a long period of time. Hwabyung or hwa seems to be named for a combined state of those incompletely suppressed dynamic emotional reactions and their somatized physical states. These seem to symbolize the nature of fire, from which the term of hwabyung is derived, and the partial suppression of it. Accordingly, in addition to general neurotic symptoms such as anxiety, depressive syndrome, insomnia, indigestion, headache and other physical pains, the symptoms of hwabyung are also characterized by somatic symptoms such as chest oppression, sighs, heat or hot sensations, dry mouth, something pushingup in chest, palpitation, epigastric mass, talkativeness, loss of mind, and an impulsive wish to quickly get out of the house. Diagnostically，depressive, anxiety and somatization disorders were most frequently observed. Many patients had two or more diagnoses. The prognosis seemed to be chronic and poor. The possible relationship between the psychopathology of hwabyung and so called hahn, which is known to be the unique traditional affective expression of Koreans, and the possibility that hwabyung can be a culture-bound syndrome in Korea was discussed