A Glimpse into North Korea's Psychiatric Care System

Abstract

Few –if any-countries in the world are poorer, more totalitarian and, foremost, isolated than North Korea. The impact of this situation on the country's psychiatric care system is expected to be huge. Literature review on Pub-Med, Scopus and Google. Up to date, there are no studies on this topic from North Korea. Information comes only from North Korean defectors in South Korea, therefore caution is required. Anxiety disorders and depression seem to receive no specialized psychiatric treatment in North Korea. These disorders are ascribed to a malfunctioning autonomous nervous system and are commonly treated by neurologists. In 2012, according to WHO, 9,790 suicides have taken place in North Korea, a country of 22.5 million. Suicide appears to be viewed as an act of ‘treason’ against the state rather than a symptom of severe psychopathology. Patients with psychotic disorders are usually hospitalized in remote mental institutions called ‘number 49 prevention posts’ –after North Korea's cabinet decision No.49 on mental health-, under appalling conditions. The patients themselves are called ‘number 49 subjects’. Insulin-coma therapy seems to be still implemented in such places. Counseling and psychotherapy are apparently non-existent. Methamphetamine –used during the ‘Arduous March’ of the mid-90's for suppressing appetite-is the main substance of abuse. The low status of the specialty, the remote location and the terrible state of the mental institutions discourage the best medical students from becoming psychiatrists. Based on the available data, North Korea's psychiatric care system seems to suffer from very serious structural deficiencies.