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Assimilation of Western Psychotherapy in Asia - The Korean Case - |
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※ Read at the 2nd Pacific Congress of Psychiatry, Manilla, May 1981.
Assimilation of Western Psychotherapy in Asia - The Korean Case -
Dong-Shick Rhee, M.D.
Dongbook Neuropsychiatric Clinic, Seoul.
Since the introduction of Western Psychotherapy to Asia, especially that of Western psychoanalysis, the idea has been prevalent that Western psychoanalytic principle, theory and technique can not be applied to Asian patients. This has been the case in India, Japan and many other countries in Asia. The initial enthusiasm for psychoanalysis started with the American military occupation of South Korea in 1945. This enthusiasm grew during Korean War, which necessitated the cooperation of U.S. military psychiatrists and Korean Army psychiatrists. It came to a peak about 1957 when those psychiatrists who were trained by both Korean and American psychiatrists during Korean War and went to U.S. for further training after their discharge from the Army, began returning home. In the course of their psychotherapeutic practice 1956 to 1970, those American-trained psychiatrists in Korea started to complain about the difficulty or impossibility of applying Western psychoanalysis and psychotherapy to Korean patients. Korean culture and personality were blamed. In this paper I will describe the process of assimilation Western psychotherapy in Korea chronologically and thematically, so that one can see how the difficulties were overcome and solved. This will also show how the difficulties other Asian therapists encountered can be solved.
PREWAR PERIOD
Korean medicine had developed on the same lines as Chinese medicine since ancient times until the arrival of American missionary doctors and the Japanese invasion about 90 years ago. With the introduction of Western medicine by American missionary and the Japanese, traditional psychotherapeutic principles and insights were abolished because Western medicine was materialistic and elementaristic and did not have any insight into psychodynamic or psychosomatic principle which is the essence of Korean and Chinese medicine. Under the Japanese occupation in the early 1920's, the concepts of Western psychoanalysis and psychotherapy were introduced. One psychiatrist attempted "psychoanalytic treatment of a case of hysteria." Persuasion, suggestive therapy and Morita therapy were also practiced. One Korean psychiatrist had psychoanalytic training in Japan in the early 1940's. However, in general no systematic psychoanalytic or psychoanalytically oriented psychotherapy was practiced in Korea.
POSTWAR PERIOD
The American occupation of South Korea in 1945 gave the Korean psychiatrists the chance to have contact with the American military psychiatrists and consultants and American psychiatric literature. This contact came to a peak when the Korean War broke out in 1950. During the Korean War, Korean Army psychiatrists and American military psychiatrists joined to train division psychiatrists in the Korean Army. In 1953 I treated a case of psychogenic headache successfully. This case was reported in a medical journal in 1960. Many of these division psychiatrists went to the United States to have full training. Around 1957 these American-trained psychiatrists began to return to Korea and started to have positions in medical schools. They taught dynamic psychiatry and psychotherapy, and practiced psychotherapy. In 1957 a Freud symposium was held for the general public and drew a big audience. In 1962 and in 1963 symposia on psychotherapy were held. The trend towards dynamic psychiatry became overwhelming after the Korean War form 1951 to 1969. Since in every symposium the participants only talked about theory and did not present their practical experiences, we had another symposium on psychotherapy titled "Symposium on Psychotherapy experienced in Korea" in 1966. Still we could not make the participants bring out their experiences gained from their actual psychotherapeutic practice. In 1964, the fact that therapist's psychodynamics were being projected unto patients was pointed out by K.S. Han at the annual meeting of the Korean Neuropsychiatric Association. In 1966 the therapist's personality as the crucial factor in psychotherapy was introduced by me as the topic of discussion. On the other hand, American counseling was introduced into Korean educational circles around 1956 on the initiative of U.S. Educational Commission in Korea. In 1962 the first Students Guidance Center with an American advisor was established at Seoul University and a one year internship program was established to train counselors. This was continued until K.S. Kim and Rhee left the Center in 1972.
Enthusiasm for dynamic psychiatry and psychoanalysis lasted until between 1966 to 1969, when many of American-trained psychiatrists started to find it difficult to practice psychotherapy in Korea. The causes of the difficulty were enumerated. The financial capacity of Korean patients, Korean culture and personality were blamed. Korean patients were too authoritarian, poor in emotional expression and less psychologically minded than American or Japanese patients. One American-trained educational counseling professor proposed to import Western counseling philosophy in 1967 at the annual meeting of the Korean Counselors' Association because he thought there was no such thing in Korean culture. One professor of psychiatry complained that Korean patients do not have transference because of the authoritarian character of Korean culture and personality.
I answered these questions in a paper "The philosophical Ground Laying of Counseling and Psychotherapy in Korea" in 1968 and in another subsequent paper "Research on Psychotherapy of Korea" in 1970. It was pointed out that Korean therapists' difficulty in treating Korean patients should be attributed to the Korean therapists themselves rather than Korean patients or culture and personality of Koreans. That is, poor, incomplete understanding and digestion of Western psychoanalysis or psychotherapy. I urged the Korean therapists to examine themselves rather than blame patients, culture and personality of Korea in general. It was also shown that Korean traditional medicine is based upon the Tao which is the ultimate form of psychotherapy and philosophy of psychotherapy. I also urged the Korean therapists study and understand Korean culture and personality without preconception. The humanistic, natural and communicative character of Korean culture and personality was pointed out explained that the Tao actually means self examination, self understanding, self control, self discipline and purification of oneself. In other words, the Tao means liberation from neurotic conflict, maturity or mental health. It is also relationships, communication, harmony, integration. It is reality, perception and practice rather than concept, conception and theory. It is also commitment, the spirit of Bodhisattva.
At the beginning of assimilation Western psychotherapy in Korea, psychotherapy was considered as verbal exchange. But this erroneous understanding was clarified after repeated discussions, in the late 1960's. In the 1950's, the concept of the unconscious was assimilated first. Since 1964 the importance and meaning of the personality of the therapist, transference and countertransference have been brought into the focus of the discussions. The most common cause of the difficulty in treating Korean patients was inability on the part of the therapist in communicating to the patient, both verbally and nonverbally, in terms that the patient could understand in his own culture. Therapists who have learned psychotherapeutic skills and methods in one culture such as U.S.A. must learn over again how to communicate with these skills and methods in another culture such as Korea. For example a therapist communicate one thing to a patient by using the patient's first name in the U.S.. The same therapist would communicate something completely different by using a patient's first name in Korea. The therapist must communicate with the patient in terms that the patient knows and understands.
In 1967 a movement to have organized activity for learning and studying psychotherapy was attempted but failed because of the counter pressure from some of the professors of psychiatry. This initial movement culminated in the formation of the Psychotherapy Case Study Group in 1974, which became the nucleus of the Korean Academy of Psychotherapists. Within this group, the theory and practice were firmly rooted by having monthly case conferences throughout the year without interruption, 4 symposia a year on important topics in psychotherapy and bi-weekly group supervision, Many of the members are having personal psychotherapy as well. In 1978 a new circle for the study of Jungian psychology was formed around 2 Jungian analysts trained in Zuerich. The Korean Academy of Psychotherapists joined the International Federation for Medical Psychotherapy in 1976.
In 1979 the spring meeting of the Korean Neuropsychiatric Association had as its theme "Psychiatry in Korea Today". The subtitles were: Korean Culture and Psychiatry, Culture and Mental Disorders in Korea and Psychotherapy in Korea and showed the common denominators between the Western way of psychotherapy and the Eastern way, the Tao. I also showed the differences between them. The point was also made that Western psychoanalysis and psychotherapy are heading towards the Tao which is the ultimate form of psychotherapy.
In 1965 a number of intellectuals and psychotherapists formed a small group for th study of Buddhism which is still active. We have been reading sutras and practicing Zen, meeting every Tuesday evening except for vacation period. We also studied Confucianism, Laotzu and Chuangizu. The initial reaction of the Korean intellectual, psychiatric and psychological circles to the revival of traditional Tao was mostly negative. However, through repeated clarifications, by showing the elements common to the Western and the Eastern psychotherapies and also by pointing out the tendency to ignore the tradition as the mechanism of identification with the aggressor, that is, the West, this negative reaction is subsiding.
CONCLUSION AND PROSPECT
In Korea we have discovered the firm ground on which Western and Eastern psychotherapy can be based. After absorbing the essence of Western psychoanalysis and psychotherapy, we can place psychotherapy on a higher level. This conclusion leads to another conclusion that the Western therapists should practice the Tao and the Eastern therapists while understanding Western psychoanalysis and psychotherapy more thoroughly should practice the Tao and not ignoring it. |
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