韓國 都市 社會에 있어서의 히스테리의 臨床的 及 人類學的 硏究

A Clincical and Anthropological Study of Hysteria in Korean Urban Society

In view of the suggestions that classical hysteria is decreasing in incidence in urban Western society, and that the pattern of symptomatology changes with the cultural milieu, the author considered that a study of his current experience in Seoul, Korea would be of some general interest. The records of 50 in-patients diagnosed and discharged as hysteria at the Seoul National Univercity Hospital Department of Psychiatry between the periods from 1958 to 1963 were studied. Among the 50 hysteria patients, 42 were diagnosed as conversion reaction and 8 dissociative reaction. Of the 50 patients, several of them were re-admitted and discharged and the total number of discharges of the 50 patients counted in were 56. This is 5.44% of the 1,030 dischargs from 1958 to 1963. Thus, hysteria was found to be relatively frequently diagnosed among its in-patients in Korea in comparison to the findings, for instance, of the Johns Hopkins’ which revealed the cases of hysteria to be 1.84% of the 2,873 patients discharged between 1945 and 1960 and 2.14% of 2,661 patients discharged from 1913 to 1920. About one-half of our conversion patients had classical hysterical symptoms in terms of “loss of function” and “hystero-epilepsy” and only in 2 of the 42 conversion patients the predominant symptom was pain alone. Thus, in Korea, the “classical” symptoms are the most common expression of the illness at the present time and this makes a contrast to the urban Western society whose reported most common and persistent complaint is pain. The patient appeals for help with pain whereas the patient with loss of function or hystero-epilepsy need not to do so since the symptoms speak for themselves. This variation of clinical reaction may have some bearing in the cultural difference with the suggestion that loss of face is the basic important factor to Koreans. All of the 50 patients studied were female and a significantly greater propertion of them were either the oldest or the oldest girl in the family than would have been expected by chance alone. This is another interesting point of Korean hysteria patients in contrast to the Western patients of who many were found to have occupied the position of the youngest child, or the youngest child of one sex in the family. In Korean cultural milieu where the female are emancipated only on legal level and their sex more strictly inhibited than male, a mother is expected to give a birth to a first son. A mother too wants a fiirst son not only for her emotional satisfaction in him but because it is only as a mother of a first son or sons that she gains status in an Oriental extended family system. When the first born is a girl, the infant naturally suffers from overt and covert affectional deprivaton. The postulation is that such experience as a little girl and growing up in this cultural milieu gives rise to a shifting role and difficulties in role stabilization in her later life. Including the foregoing impressions, above all, our attention should be directed to the fact that hysteria is very frequently diagnosed in Seoul, Korea. Some anthropologists and psychiatrists have classified cultures as “shame” and “guilt” cultures. It is also suggested that in the Orient, where the threat of loss of face in all its myriad ramifications is so central as a sanction, some of them concluded that the sense of guilt or sin is practically absent. The reasoning is that to exhibit anxiety meant a loss of face to the Orientals, whereas classical hysterical symptoms such as loss of function or hystero-epilepsy were face-saving. Quite keen observations as they are, they, including the suggestion such as Orientals “superb oral hold on life,” do not solve the fundamental and important philosophical di