As one of the most secluded nations on earth, it is no surprise that many aspects of North Korean life remain a mystery to outsiders. However, the lack of psychiatric help for mental health in North Korea is well documented and corroborated by defectors. According to a 2014 South Korean study published in the National Library of Medicine, 76.3% of North Korean defectors suffered from mental illnesses that typically went untreated in their homeland. As opposed to the Western view of mental health as a health problem that should be treated by medical professionals, North Korean society sees mental health issues as a byproduct of the individual’s lack of support for the nation’s “revolutionary” ideology.

5 Facts About Mental Health in North Korea

1. A medical problem misdiagnosed as political. Among both elites and those in poverty, mental health conditions in North Korea tend to go untreated and there are no counselors and psychotherapists. Instead of clinically treating mental health in North Korea with counseling, compatriots view those who have mental health issues as dissidents who are disloyal to North Korean ideology. As a result of this stigmatization, mental health is a very taboo topic in North Korean society.
2. Number 49 Hospitals. Although North Korea does not utilize psychiatry or counseling to treat mental illness, those deemed mentally ill are placed in “Number 49 Hospitals” upon their family’s request. These facilities practice antiquated techniques such as insulin-coma therapy, where staff members inject “subjects” with high doses of insulin in order to create a coma-like state that lasts for days. The stigmas surrounding “49” inhabitants also cause North Korean society to brand these individuals as outcasts. As a result of this, families with relatives in “49” facilities often lose sociopolitical status due to stigmas.
3. Defector’s Trauma. According to Dankook University professor Jin-Won Noh and National Medical Center psychiatrist So Hee Lee’s October 2020 study “Trauma History and Mental Health of North Korean Defectors,” only 5% of adult North Korean defectors did not have exposure to trauma when in North Korea. Out of the 95% who dealt with traumatic events in the North, the most common types of trauma stemmed from witnessing government executions, enduring starvation, starvation-related deaths of family and friends, witnessing extreme physical assaults and “escaping arrest following defection.” North Korean defectors also struggle with assimilating into South Korean society due to cultural and linguistic differences.
4. Long-Term Effects of the Arduous March. North Korea’s famine in the 1990s caused catastrophic death tolls, with millions of citizens dying from hunger. The international aid given to North Koreans during the Arduous March also directly undermined the North Korean government’s claims of self-reliance and complete isolation. However, its effects on mental health are long-term, with these traumatic experiences linked to drug addiction and mental illness among North Koreans. For example, Lee Kwan-Hyung, a researcher from the Seoul-based Database Center for North Korean Human Rights, estimated that 30% of North Koreans used drugs as of 2016, with methamphetamine and opioids the most common. Due to its appetite-suppressing properties, methamphetamine usage spiked during North Korea’s 1990s famine.
5. Malnourishment’s effect on the brain. Between 2018 and 2020, 42% of North Koreans experienced malnourishment. This extreme food insecurity also has extremely damaging effects on mental health and brain development. For example, malnourishment is linked to mental health issues such as depression, anxiety and concentration difficulties.
6. Organizations that Aim to Help. Due to its isolationist nature, organizations outside of North Korea cannot provide mental health counseling to North Korean citizens living in North Korea. However, there are groups such as Crossing Borders that give assistance to North Korean defectors that cross into China. Although Crossing Borders is a faith-based group, they also perform secular duties such as providing medical support, shelter, counseling and safety for refugees at risk of trafficking or abuse.

Looking Ahead

North Korea’s failure to properly diagnose and treat mental illnesses with psychiatric care has caused the problem to fester over time. Historical traumas dating back to the nation’s strict rule and history of famine have made the problem endemic in North Korean society. However, other issues connected to mental health in North Korea, such as stigmatization of those in need of help, are not necessarily unique to North Korean society, with similar problems occurring in Western countries as well.

– Salvatore Brancato
Photo: Flickr