학술논문
북한이탈주민의 건강과 질병에 대한 문화적 접근 / A Cultural Approach to the Health and Illness of North Korean Defectors
Document Type
Dissertation/ Thesis
Author
Source
Subject
Language
Korean
Abstract
본 연구의 목적은 북한이탈주민의 건강과 질병에 대해 문화적으로 접근해 그 맥락에 대한 이해를 돕는 것이다. 남한과 다른 북한의 의료문화를 파악해 남한 의료 현장에서 빈번하게 발생하는 오해의 배경을 이해하는 것을 구체적인 목표로 잡았다. 연구자는 약 500명의 외래 환자, 약 180명의 입원 환자를 진료하며 참여관찰을 하였고 그 중 의과와 한의과에서 모두 진료를 받은 경험이 있는 15명을 대상으로 면접을 실시하여 북한이탈주민의 건강과 질병에 대한 그들의 내재적, 주관적인 이해(理解)를 알고자 하였다. 지금까지 살펴본 북한이탈주민의 건강과 질병에 대한 문화적 배경을 종합해 다음과 같은 결론을 도출할 수 있다. 첫째, 북한이탈주민은 외상사건을 많이 경험하였기 때문에 정신건강이 좋지않을 수밖에 없는 배경이 있음에도 불구하고 이들의 정신적 고통을 정신질환으로 치환하며 정신의학으로 해결하는 단순한 구도에서 벗어나 개인의 맥락을 고려해 다양한 스펙트럼으로 개별화된 대응이 필요하다. 둘째, 북한에서 사용하는 건강과 질병에 대한 개념이 서양의학의 지식과 맞지 않아 북한이탈주민이 호소하는 신체 증상과 질병행동이 신체화 증상, 건강염려증 등의 정신질환으로 오해를 받기도 하지만 그 배경에 잠재된 의료 개념의 상이성, 이들의 신체 건강이 악화될 수밖에 없었던 실재적인 배경, 의사소통의 어려움 등을 고려해야 한다. 셋째, 남한의 의료인은 북한이탈주민의 신체적, 정신적 고통을 자신의 문화로판단하여 갖는 편견이 있는데, 북한이탈주민의 건강과 질병에 대한 맥락을 이해하며 편견을 극복하고 문화적 역량을 갖추는 것이 중요하다. 우리 사회에는 북한이탈주민이 정신질환에 취약하다는 담론이 형성되어 있는데 이상에서 논한 북한이탈주민의 건강과 질병에 대한 문화적인 이해를 통해 이 담론이 단순하게 적용될 수 없음을 반증하고자 한다. 또한 본 연구는 북한이탈주민의 특수성을 이해하고 이들의 질병을 있는 그대로 바라보는 데 기여하는 초석이 될 것이다.
This research investigates the issues of health and illness among North Korean defectors in a cultural approach. More precisely, this dissertation aims to look into medical culture in North Korea and its political and cultural background, which frequently misleads South Korean doctors in examining North Korean defectors. The researcher as a medical doctor observed approximately 500 outpatients and 100 inpatients over four years, and interviewed with 15 patients, as a part of ethnographic research, who had the experiences of being treated in both Western and Traditional Korean medication. The interviewees were selected for finding out whether North Korean defectors were fully aware of their health conditions and illness. Their different cultural background behind the health and illness of North Korean defector leads this research to the conclusion as follows: First, it is necessary to carefully consider the background of individual patients, and apply tailored medical treatment to each case accordingly. Each patience has its own cultural context behind her/his symptom that should not be simplified into a particular disease especially for those like North Korean defectors who had gone through such a traumatic times. Given this tendency of North Korean defectors, it is not appropriate to simply diagnose the defectors suffering psychological trauma with mental disorders and provide them with psychiatric treatment. Second, the medical terms and their meanings used in North Korea are often different from those used in Western medical system in South Korea, which leads South Korean doctors to misdiagnose the defectors with simple mental disorders such as somatization and hypochondriasis. South Korean doctors often show prejudice against North Korean defectors as they tend to deploy a lens of South Korean culture to examine physical and psychological pains of the defectors. Therefore, when doctors in the South examine North Korean defectors, they should take into account several points such as the differences of medical terms between the North and the South, cultural background directly affecting the defectors’ health, and difficulties in communication between people in the two Koreas. Third, it is imperative for doctors in the South to recognize background and context behind North Korean defectors‘ health conditions and illness, to dispel their prejudice, and to build up their capability to understand cultural differences. It is commonly understood that North Korean defectors are vulnerable to mental disorders. This research, however, shows that this assumption cannot be always valid by critically adopting cultural perspective on the health and diseases of the defectors. Therefore, it has to be argued that understanding the distinctive situations and contexts of North Korean defectors in the process of medical treatment is vital for appropriately examining their illness and health.
This research investigates the issues of health and illness among North Korean defectors in a cultural approach. More precisely, this dissertation aims to look into medical culture in North Korea and its political and cultural background, which frequently misleads South Korean doctors in examining North Korean defectors. The researcher as a medical doctor observed approximately 500 outpatients and 100 inpatients over four years, and interviewed with 15 patients, as a part of ethnographic research, who had the experiences of being treated in both Western and Traditional Korean medication. The interviewees were selected for finding out whether North Korean defectors were fully aware of their health conditions and illness. Their different cultural background behind the health and illness of North Korean defector leads this research to the conclusion as follows: First, it is necessary to carefully consider the background of individual patients, and apply tailored medical treatment to each case accordingly. Each patience has its own cultural context behind her/his symptom that should not be simplified into a particular disease especially for those like North Korean defectors who had gone through such a traumatic times. Given this tendency of North Korean defectors, it is not appropriate to simply diagnose the defectors suffering psychological trauma with mental disorders and provide them with psychiatric treatment. Second, the medical terms and their meanings used in North Korea are often different from those used in Western medical system in South Korea, which leads South Korean doctors to misdiagnose the defectors with simple mental disorders such as somatization and hypochondriasis. South Korean doctors often show prejudice against North Korean defectors as they tend to deploy a lens of South Korean culture to examine physical and psychological pains of the defectors. Therefore, when doctors in the South examine North Korean defectors, they should take into account several points such as the differences of medical terms between the North and the South, cultural background directly affecting the defectors’ health, and difficulties in communication between people in the two Koreas. Third, it is imperative for doctors in the South to recognize background and context behind North Korean defectors‘ health conditions and illness, to dispel their prejudice, and to build up their capability to understand cultural differences. It is commonly understood that North Korean defectors are vulnerable to mental disorders. This research, however, shows that this assumption cannot be always valid by critically adopting cultural perspective on the health and diseases of the defectors. Therefore, it has to be argued that understanding the distinctive situations and contexts of North Korean defectors in the process of medical treatment is vital for appropriately examining their illness and health.