An inside story about eating disorders in South Korea
I was a fixture at all students’ writing contests and didn’t expect to be congratulated with just mundane prizes, but from second grade in high school, I was unable to write. I could write only self-pitying, crappy things, bleak, fragmented poems and, above all, things the judges of student writing contests would dislike for sure. I lost my words and gained weight. Womanhood felt dreadful, because it showered me with an appetite which converted this former hardcore picky eater to a healthy teenager. This appetite led to worsened indigestion and constipation, and a body not-so-skinny-anymore which was frighteningly unfamiliar to me. All these factors were ill-suited for a severely depressed, suicidal, high school girl.
My existence, simply the heavy lump of flesh, was sickening and humiliating to me. The countermeasure I finally arrived at was to dump the food out of my lunchbox in secret every day and to suppress hunger with a bottle of cold barley tea and black coffee from vending machines. At night at home, returning from school where I had to stay all day long, I hastily cooked a fried egg, sprinkled pepper and red pepper powder on it, and ate it slowly with just a little fork. (I didn’t need to eat secretly, because Mom was very happy about that, and she must have been worried at my worsening look.)
Eating disorders were foreign diseases that nobody talked about
At that time, I didn’t know anything about eating disorders. It was the late 1990s. The first small batch of eating disorder clinics had started to open in Seoul several years earlier, thanks to a few young psychiatrists trained in the United Kingdom and Japan. Generally, however, eating disorders were foreign diseases that nobody talked or heard about.
Much later, I heard the story of my friend’s elder sister, a brilliant straight “A” student, who had begun to starve herself, never sitting on a chair even when studying, after some despicable person called her “a big fat ass” at school. Her mother wept as she bathed her daughter who became too weak to do so by herself. Her family might have described this girl as “refusing to eat” but unlikely said “anorexia is killing her.” Her parents decided to let her stay away from her studies for some time and sent her to stay with loving grandparents as a last resort. Slowly, this girl began to make up with herself and recover.
It was the mid-1990s when this girl suffered with her eating disorder. Recently, I found a research article from the Journal of the Korean Radiological Society issued in 1994, describing a 37-year-old woman admitted to hospital with Bartter’s syndrome-like symptoms. But the authors concluded that, for her, more than 20 years of diuretic abuse seemed to have caused the symptoms. The authors stated:
In most of the cases where young female patients who are typically very self-conscious of their appearances show Bartter’s syndrome-like symptoms with normal level of blood pressure and hypokalaemia, the causes often are self-induced vomiting, and diuretic or laxative abuse, but identifying it is complicated because of the patients’ denial.*
So, this woman had struggled with eating disorders secretly, all alone, since the 1970s.
My primary complaint was misunderstood
The new millennium began, and I spent years in the doldrums. My score at the college entrance exam was painfully disappointing; the life at college boiled down to alienation and homesickness. I couldn’t get away with the bad habit of wrist-slashing as a means of dissolving chaotic fear, and eventually I tried to kill myself. I remember the date. It was October 20, 1999. The suicide attempt ended in a farce and, after being released from the Intensive Care Unit (ICU), I instantly developed bulimia. The psychology professor I met for my second psychotherapy session was apparently embarrassed that my primary complaint became my eating disorders while he had geared himself to keep this young girl from trying to kill herself again.
I learned from him how to do Cognitive Behavioural Therapy (CBT), but I was still too young to calm myself in the midst of emotional turmoil just by trying to change my thoughts like Zen masters or ancient Stoics. [What this doctor practised was precisely the Rational Emotive Behaviour Therapy (REBT) developed by Albert Ellis. When I showed him what I had written for a week like a schoolgirl bringing her homework to be checked, he used to say, looking at the discussion part long enough to be a piece of prose, that I wrote “too poetically.” But how can a certain problematic situation and one’s dissecting of it be inscribed in a couple of sentences?]
From ‘client’ to ‘patient’ became a necessity
Bulimic urges conquered my efforts time and time again. The compulsions were reflexive and automatic, a downward spiral. Things unable to do in my capacity kept mounting. After a series of dire failure and humiliation, I had to admit that I’d better get help from psychiatry. There were no more counsellors or clinical psychologists in my vicinity. So, I chose to be a “patient” because I was too exhausted to function as a proper “client.”
(In Korea, clinical psychologists themselves are aware, or self-conscious, of being deemed as second-class citizens in the mental health realm. They can treat people like their fellow psychiatrists, but their single session would cost patients five to seven times more than that of the psychiatrists because the National Health Insurance Service (NHIS) covers only “medical” costs.)
So, the years of the different follies and tragicomedies began. I had three choices; it was clear cut because only three clinics specialised in eating disorder treatment in Seoul, the first batch, as I mentioned. At that time, I was already a shy fan of the quirky day hospital regulars who were very talkative on an open message board of the website belonging to one of the clinics, sneaking a peek every day at what was happening at the message board which never had a peaceful day. However, I couldn’t easily choose that clinic. It looked almost impossible for me to mingle with them as a newcomer. So instead, I chose an outpatient clinic which had the most bureaucratic and coldest looking website.
‘Come here and sit next to your mother,’ the psychiatrist said
That outpatient clinic was in a cool, glass-walled building at the roadside of Gangnam. The psychiatrist who owned the practice was an orthodox disciple of the Maudsley model and had just opened the first-in-nation inpatient clinic only for eating disorder patients. The clinic was located at a neighbourhood about 20 minutes away by taxi. It was late November 2001.
This was my second visit and this time I was with Mom who travelled from another city to see me, meet the psychiatrist, and pay the fee I probably couldn’t afford alone. It was a cold winter evening, early snow fell outside, and when the office door opened, I could see the psychiatrist’s solemn face and Mom looking back at me. “Come here and sit next to your mother,” he said.
I wrote this story in my memoir, Swallowing Practice, published in August 2021 in Korea. For a long time, I didn’t think I could possibly be a published author. I wrote short stories out of those unforgettable, traumatically engraved memories of mine and submitted them to competitive literary contests. However, only the winners got an opportunity to put their names on the registry of legitimate literary circles in Korea, and I experienced rejection all the time. (My narrative mentor who taught me how to write the truest truth, how to choose the most honest and exact words, and who was an avid reader of Byron Katie, Nietzsche, Borges, and Buddhist scriptures, tried to cheer me up, saying, “The papers and magazines must have wanted some bright and hopeful novels unlike your depressing stories. But you already have fans in my writing class, do you remember? Your time will surely come.”)
There are many more stories to tell
My memoir is an assortment of the rejected stories plus fresh chapters I wrote anew years after. I wanted to put it out into the world as quickly as possible and forget about that. I signed the contract with the publisher, whose enthusiastic, novice editor willingly helped me finish the book and did not request me to change anything.
I know now that there are many more stories to tell. I wrote things and conversed with others in English on the early day pro-ana forums – these forums were in English, because there were none in Korea yet. I was curious who the ‘pro-ana’s were and what they were talking about, so I searched and found a few appealing to me. I remember only two now: anafriends and blue dragonfly. This was at a time when the press was starting to provide coverage about such sites and there were interviews with the teenage sysops under the threat of police investigation. And now? Here, pre-teen girls preoccupied with reducing their bodies to nothing, are seeking pro-ana friends on social networks.
I find that many people, especially young women in South Korea, misunderstand that ‘pro-ana’ literally means ‘anorexia’. ‘프로아나(peu-ro-ah-nah)’ overshadowed ‘거식증(geo-sihk-jeung, anorexia)’, so to speak. They see ‘pro-ana’-claiming social network accounts where the owners pursue extreme dieting, so that leads to general misunderstanding, I suppose.
Story-sharing is one way to give hope to others
The first and only inpatient clinic for people with eating disorders in South Korea was short-lived regrettably, and the only day hospital has also been dissolved. Much younger patients and increased numbers of male patients are seeking therapy. Many more women are suffering than 20 years ago. There are many people with eating disorders in Seoul, and I eagerly want to do what I can do to resist this collapse.
Sharing my story is one way to do this.
Yang et al. A Case of Pseudo-Bartter Syndrome. Journal of the Korean Radiological Society, 31(4), 1994: pp.727-729.