Hwa-Byung a Culture-Bound Syndrome

Anger Syndrome

Jennifer Williams

Anthropology 3315
Dr. Guy Prouty
October 8. 2014

A culture-bound syndrome is an illness that is distinctly found among a specific culture or

geographical area. An example of a culture-bound syndrome is Hwa-Byung. Hwa-Byung is a
culture-bound syndrome that is specific to Korean culture. The illness derives its name from
Hwa meaning fire and Byung meaning disease. Its also known as Wool-Hwa-Bung or Anger
Syndrome in Western culture. According to theories of traditional Oriental medicine, fire is one
of the five universal elements. If its found to be excessive in the body, this fire element is
believed to disturb the balance of bodily elements resulting in disease (Somers,
psychiatrytimes.com). Hwa-Byung is considered a culture-bound syndrome because it manifests
predominantly in women of Korean heritage when they suppress anger, frustration, hate,
animosity, and other negative feelings toward their family or significant others (Choi and Yeom,
wiley.com).
Hwa-Byung is seen predominately in 4.1%- 11.9% of women of Korean heritage when
they suppress anger, frustration, hate animosity, and other negative feelings towards their family
or significant other. If these feelings are suppressed for a long period of time then psychosomatic
symptoms begin such as depression, anxiety, panic, lumps in the upper chest or palpitations
(Choi and Yeom, wiley.com). The most common source of this syndrome is unfair social
situations, which were typically and most commonly related to the violence of husbands and
mother-in-laws toward housewives. Many Koreans with Hwa-Byung feel that they are the
victims of chronic unfair social aggression, which is related to the traditional culture of the
patriarchal Korean social system and the fatalism and collectivism of Koreans (Kil Min,
nih.gov).
Hwa-Byung seems to begin with anger and it develops into a syndrome thats
complicated with its suppression, accumulation and partial behavioral expression. Hwa-Byung

can very commonly be confused with depression, however there have been studies that compared
patients suffering with depression to Hwa-Byung and there were many symptoms that differ
from depression. Those symptoms included feelings of unfairness, subjective anger, external
anger, heat sensation, pushing-up in the chest, dry mouth and sighing (Kil Min, koreamed.org).
Also a symptom known as Hahn, a unique emotion among the Korean people signifies a unique,
depression-like affective state that results from chronic suppression and frustration (Jackson,
ebscohost.com).One critical detail that differentiates depression from Hwa-Byung is individuals
do not tend to show suicidal tendencies. Doctors may rule out Hwa-Byung if a patient has
suicidal attempts. Another point to make is that Korean patients tend to self-diagnose themselves
with Hwa-Byung but will not admit that they are depressed. This is important because it helps a
doctor differentiate and diagnose the patient.
There has only been a little research on Hwa-Byung, however a study using infrared
thermographic imaging report that the temperature on the body of Hwa-Byung patients was the
highest in the anterior middle chest and the difference in temperature was biggest between the
upper and lower back (Kil Min, nih.gov).
Various treatments have been suggested for this culture-bound syndrome. The target
treatment is reducing anger. Hwa-Byung has traditionally been managed with psycho-social
treatments. They include talking or pleading, dialogue, debriefing of traumatic experiences and
sometime obtaining revenge. Koreans have developed many cultural or folk methods for helping
patients with Hwa-Byung. A mask-dance, madang-theater, pansori, folk songs or meditation have
been practiced. Traditional herb physicians have prescribed herb medicine or acupuncture thats
given at certain designated points. Shaman rituals have been used and are currently being used.
Korean psychiatrists recommend combined psychotherapy and drug therapy for anger reduction

and general medical treatment for somatic symptoms. Much of the information on biological and
neurochemical nature of anger has been compiled but the information for treatment of anger
problems is not sufficient. There have not been any systematic clinical trials for the drug
treatment of Hwa-Byung. Most Korean psychiatrists recommend the combined use of
antidepressants and antianxiety drugs (Kil Min, nih.gov).
There are some management strategies to approaching Hwa-Byung and its symptoms that
allow the patient to cope with the illness. An integrated holistic approach is essential for treating
patients with Hwa-Byung. If an older Korean immigrant woman is suspected of having HwaByung, a thorough exploration of the types and effects of treatments that the patient previously
received needs to be conducted. Anger suppressed for over ten years is the core component of
Hwa-Byung and treatment should be managed in a constructive way. This can be achieved by a
combination of both pharmacological and non-pharmacological interventions (Choi and Yeom,
wiley.com).
A pharmacological approach is usually focused on symptom-specific treatment and
includes modification of a variety of mood dysfunctions related to Hwa-Byung, such as
aggression, anxiety, and depression. These include anti-aggressive agents, antipsychotic drugs,
antidepressants, antianxiety drugs, or a combination. Determining pharmacological approaches
can be individualized depending on the history of treatment, the course of improvement, and
reactions to medications. A combination of non-pharmacological interventions is essential for
managing Hwa-Byung effectively. Suggested approaches, include psychotherapy, cognitivebehavioral interventions, relaxation techniques, and social skills development (Choi and Yeom,
wiley.com).

Anger exists in people of all cultures. It is not a characteristic that is specific to one
culture or geographical area. Hwa-Byung is an anger syndrome that is specific to Korean women
because of their culture and how they are perceived in their society. Every culture could
potentially have its own version of Hwa-Byung. In Western society there are women and men
who experience similar conflicts within society and cope differently than those in other cultures
would. Western medicine has many ways to diagnose anger and well as many ways to treat it
psychologically and medicinally. No matter what culture we live in, its wrong for society to
burden a person to a point of causing a culture-bound syndrome called Hwa-Byung.

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