Culture, Mental Health, and Theology: A Critical Evaluation of Hwa-Byung in the Diagnostic and Statistical Manual of Mental Disorder (4th Edition) and A Pastoral Theological Revisioning Pubblico

Yoo, Dal Seok (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/bc386j84w?locale=it
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Abstract

This thesis examines the Western definition of mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) from an intercultural perspective, which emphasizes multiple social, cultural, political, and historical analyses necessary for an understanding of human suffering. Clinical case studies of hwa-byung patients provide data for the analysis upon which this study is based. Within this framework, hwa-byung is re-defined not as individual, static, or universal, but as a relational, multiple, and dynamic trauma-related anger disorder. Drawing from cultural and historical phenomena of Korea, this study proposes that it is important to recognize several heterogeneous conditions and qualitative changes in explorations of human suffering. By integrating both emic and etic perspectives, it is proposed that mental health care providers should realize the importance of engaging beyond one's own cultural experience and working through cultural diversity as a source of accurate diagnosis and successful healing. This work explores sak-yim and pu-ri, Korean traditional coping methods for hwa-byung which are complementary. It is argued that in order to cope with the physical pains as well as the emotional and spiritual distresses that result from hwa-byung, it is more effective to combine sak-yim and pu-ri. Through the process of sak-yim (decomposition or fermentation), hwa-byung sufferers can acknowledge the hidden power of emotions, unfold the multiple layers of their issues, restore the relational network with others, and believe in the invisible presence of the Spirit in the intersection of death and life. Pu-ri refers to eventful action for liberation and restoration of wounded body, mind and spirit. In the process of pu-ri, hwa-byung patients may be released from frozen emotions, fragmented trauma memories, unknown fear, internalized false beliefs, and their wounded identity. Utilizing the processes of sak-yim and pu-ri, a new imaginative pastoral approach, which purposes to create a relational and sacred spacefor healing, and establishes multiple access points to the dynamic work of spiritual presence, is proposed.

Table of Contents

LIST OF TABLES. xiii

LIST OF FIGURES. xiii

INTRODUCTION. 1

CHAPTER 1. CLINICAL CASES. 15

Case 1. 15

Case 2. 27

Case 3. 38

Case 4. 48

CHAPTER 2. CRITICAL EVALUTION OF THE DSM-IV DEFINITION AND ASSESSMENT OF HWA-BYUNG. 59

Critical Evaluation of the DSM-IV. 59

Critical Evaluation of Culture-Bound Syndromes (CBS) in the DSM-IV. 65

Critical Evaluation of Cross-Cultural Ability in Post-Traumatic Disorders from the DSM-IV. 77

Critical Evaluation of Hwa-Byung in the DSM-IV. 84

Summary. 105

CHAPTER 3. CULTURAL FACTORS AND IMPILICATIONS FOR DIAGNOSIS OF HWA-BYUNG. 107

Korean Cultural Understanding of Hwa-Byung. 107

Korean Culture-Related Emotions and Hwa-Byung. 118

Clinical Courses and Manifestation of Hwa-Byung. 133

Socio-Cultural and Historical Etiological Factors of Hwa-Byung. 141

Historical Etiological Factors: National Traumas. 155

Summary. 170

CHAPTER 4. PSYCHOLOGICAL AND EXPERIENTIAL UNDERSTANDING OF HWA- BYUNG. 171

Human Subjectivity and Cultural Difference. 171

Human Subjectivity and Trauma. 177

Human Subjectivity, Trauma, and Hermeneutical Aspects. 192

Summary. 198

CHAPTER 5. THEOLOGICAL REFELCTION ON HWA-BYUNG. 200

Theological of Anthropology. 200

Theology of Trauma. 224

Symbolic Expression of Hwa-Byung and its Hermeneutic Impact on Pastoral Care and Counseling. 239

Summary. 252

CHAPTER 6. A NEW IMAGINATIVE PASTORAL APPROACH TO HWA-BYUNG. 253

Introduction of Traditional Coping Methods for Hwa-Byung. 253

Sak-Yim. 253

Pu-Ri. 260

Theological Reflection on Sak-Yim and Pu-Ri. 264

A New Imaginative Pastoral Theology of Healing. 273

Summary. 280

CONCLUSION. 282

APPENDIX. 282

BIBLIOGRAPHY. 288

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