The introductory chapter of It’s Madness is full of arresting statistics and stories. Since 2014 South Korea has had the highest suicide rate in the world – at 29.1 people per 100 000 of the population it was more than double the OECD average of 12.5. Barely 15% of South Koreans who have a formal mental health diagnosis seek treatment for it, while the government woefully underspends on mental health. Western treatments such as psychotherapy have so far failed to gain traction, and hi-tech innovations like the interactive suicide prevention panels on Mapo Bridge in Seoul (a famous suicide spot) seem so far not to be working: in the first year or so after their installation in 2012, the number of suicides actually quadrupled. The messages chosen for the panels – including ‘The most shining moment of your life is yet to come’ – suggest a society with a long road ahead of it in discerning real causes and solutions for its mental health crisis.
Having thus laid out the problem, following up with a succinct survey of psychiatric and anthropological debates about conceptualising mental illness – which goes a long to making this book accessible for people new to the area – the author, Theodore Jun Yoo, introduces us to the task he has set himself. He seeks to trace the process by which Korean society’s understanding of madness has developed: the layering of newer approaches on top of old to form a palimpsest, where the traditional has ‘constantly bled through the more modern layers’ (pp. 10–11).
It is a helpful image, to which for the most part the structure of the book is faithful. We begin in Chapter 1 (‘Forms of Madness’) with accounts of how distress and aberrant behaviour, of the sort understood by contemporary biomedicine as mental illness, has been approached in the context of ‘Korean shamanistic practices’ and traditional Chinese and Korean medicine.
From Chapter 2 (‘Madness is …’) we move to the early years of clinical psychiatry in Korea, discovering a complex conversation opening up between pre-existing Korean approaches and Japanese and Western psychiatry, the latter making its way into Korea via German-influenced Japanese professionals and ideas and also via medical missionaries from Australia and elsewhere. We begin to get a feel for how the Japanese colonial administration regarded questions of mental health and illness. Early on there was relatively humane treatment for predominantly Japanese ex-pat patients early on, with innovations in Japan such as occupational therapy quickly making their way to Korea – not least via the work in Seoul of Suitsu Shinji, a former student of Japan’s ‘father of psychiatry’, Kure Shūzō. Later this shifted to the increasing referral by police of Koreans deemed to have behavioural problems of one sort or another. The Korean press at the time believed the authorities to be operating a distinction between the threatening and non-threatening mentally ill – one of our first hints in Korea of the interweaving of (mental) health with security concerns seen in other colonised parts of the world in the late nineteenth and early twentieth centuries. Meanwhile, colonial promises to build large-scale facilities for the mentally ill went mostly unfulfilled – as they did in colonial India during the same interwar years.
Later on in Chapter 2 we meet a fascinating character: an Australian psychiatrist and Christian missionary by the name of Charles Inglis McLaren, who, in an important turn away from what one missionary called the usual ‘cannonade of prayer’ directed at the afflicted by missionaries and volunteers, seems to have been trying to pioneer a fusion of spiritual, physical and psychotherapeutic care for his patients at Severance Medical College and Hospital. He was ahead of his time here, both in terms of the scope of Christian medical mission and the blending of religious/spiritual ideas and techniques with those of avowedly secular therapeutic modalities like psychoanalysis (which McLaren studied briefly in Vienna).
People, thought McLaren, must be delivered from their pasts. Some of his resulting work amounted to a psychodynamic take on moral therapy (the latter with a long pedigree in various parts of Europe), in which the ministry of Jesus was found to have surprising resonance for the lives of the mentally ill. As McLaren put it:
His [Jesus’] teachings about sex, money, the family, fear, economics, and the other problems, which constantly appear and reappear in a psycho-neurological clinic, are strangely apposite, constructive and vital. (p. 61)
For a monograph that is relatively short – its main text running to just 153 pages – it is a shame that more was not made of McLaren’s innovations here, probing further what the author calls ‘spiritualized psychotherapy’ in one place (p. 62) and ‘spiritual psychoanalysis’ in another (p. 75). Perhaps the available source material did not allow it, but there is a sense here, as elsewhere in the book, that important stories and pieces of data have been picked out but not as fully probed for their significance as they might have been. There is always room for more contextual information too. Although we hear about McLaren and his work, there is very little on the broader social and cultural backdrop to Christianity in Korea during these years: there is only a rather vague speculation that McLaren’s ‘approach to mental illness through a spiritual framework may have influenced Korea’s new Christian communities’. At the very least, this is fertile ground for further study.
Chapter 3 (A Touch of Madness: The Cultural Politics of Emotion) offers a look at mental illness via ‘literary and legal representations of the emotions’. Rich in its detail on everyday distress and its purported causes, the chapter suffers occasionally from conflating – or at least not distinguishing with sufficient care between – writers who were making distinctly political connections between colonialism and distress, and later commentators keen to read such connections back into their work. A groundbreaking film called Arirang (1926), which dealt with mental illness, offers promising analytical territory, though while the author’s own comments are enlightening there is little sense given of how the film was received at the time – despite it being ‘perhaps the single most discussed film of its day’ (p. 106).
Chapter 4 (Madness as a Social Epidemic) is more successful, utilising newspaper material to trace the medicalisation and criminalisation of mental illness, together with what seems to have been a rich journalistic line in connecting distress with ills of the age: too much modernisation harming men, too much traditionalism harming women. The mixture of biological, psychosocial and seasonal aetiologies discussed in the press is fascinating, as is the spectacle of police officers ‘diagnosing’ the causes of suicides when they are called out to investigate – neurasthenia seems to have been a common conclusion reached. And yet there does not seem to have been much discussion about solutions. The colonial authorities apparently regarded a rising suicide rate in Korea as proof that their modernisation project was gaining traction, while the press called for greater investment in infrastructure without – it seems – building (or perhaps being allowed by the censors to build) a coherent political or moral case for changing the circumstances that gave rise to so much distress.
In a book that breaks much new ground – mental health in colonial Korea never before having been subjected to close analysis of this sort – it is perhaps churlish to be disappointed that the Conclusion confines itself largely to a short summary of points previously made, and that there is no epilogue joining the reader up once again with the South Korean present. Yoo has undoubtedly given us much food for thought here, and it is to be hoped that other researchers will be inspired to pursue some of the leads he has uncovered.