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PTSD and looking after the survivors'Imagine seeing your parents shot right in front of your eyes': Psychiatrist Kim Moon Doo
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승인 2012.04.09  15:25:37
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As of 2011, approximately 14,000 people were officially recognized by the government as victims of the 4.3 massacre, while over 30,000 were registered as family members who lost loved ones during this seven-year seven-month period from 1948 to 1954 known as 4.3 in Korea.

Every year on April 3, a Jeju 4.3 massacre commemoration ceremony is held to remember and honor those who lost their lives and share the sorrow felt by family members.

However, what about those who lived through and survived the Jeju 4.3 massacre? Most of the survivors are now in their late 60s or older, and still vividly remember what happened. With the 4.3 Special Act, only 175 people were recognized as disabled due to the massacre. Fewer than a hundred are still alive. Yet, the Jeju government census shows that there are over 30,000 people 70 years of age or older living on the island who possibly experienced the massacre.

“Two out of three people who survived the 4.3 massacre can be diagnosed with Post-Traumatic Stress Disorder (PTSD) after 60 some years,” says Associate Professor of Psychiatry Kim Moon Doo at Jeju National University.

In 2008, a survey was conducted to demonstrate mental status of those survivors. The survey was distributed to 134 Jeju 4.3 disabled persons. Only 70 finished surveys were returned and analyzed.

The survey contained questions to measure the participant’s overall mental health. Measures included Activities of Daily Living Scale, social support measures, Center for Epidemiologic Studies Depression Scale, Rosenberg Self-Esteem Scale, Post-Traumatic Stress Disorder Symptom Scale-Interview (PPS-I) along with Impact of Event Scale. The average age of the participants was 78.1. The sample was 59.1 percent male and 40.9 percent female with 66.7 percent having graduated from elementary school, while 33.3 percent did not receive any formal education.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV - TR) states that individuals may suffer from PTSD after “(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and (2) the person’s response involved intense fear, helplessness, or horror.”

According to Kim, when a person experiences trauma, a part of their brain becomes slightly damaged. Each time a person dreams or encounters similar stimulus, the damage worsens.

“Imagine a breakup with a loved one. It is like experiencing that hurtful breakup over and over, but the only difference is 4.3 trauma is worse,” Kim explained.

According to Kim, early detection and treatment are most important. However, due to the fact that most survivors were left untreated, they currently suffer from chronic PTSD, which is very hard to fully recover from. Also, untreated PTSD patients are at a higher risk of becoming depressed.

PPS-I measures the severity of PTSD symptoms. When an individual scores between 15 to 19 on the scale, counseling is advised. When the score is between 20 to 29, the patient is considered to suffer from mild PTSD and treatment is required. And those who score over 30 are diagnosed with severe PTSD.

The survey showed that 68.6 percent of Jeju 4.3 disabled persons scored over 15 on the PPS-I scale, and 34.3 percent scored over 20.

Compared to a similar study conducted by Jeonnam University Professor Oh Soo Sung on survivors of the Gwangju 5.18 pro-democracy movement that showed 44.6 percent scored higher than 15 on the scale, psychological damage done to Jeju islanders is considerably more severe.

When one is diagnosed with PTSD or major depression, one cannot perform everyday tasks. This can be due to a lack of motivation, hypervigilance, irritability, or outbursts of anger. Unfortunately, most survivors were not aware of either the term PTSD or its concept. Only 14 percent of participants had previously received psychiatric treatment or counseling.

PTSD patients tend to re-experience the trauma through (1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions (2) recurrent distressing dreams of the event (3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated) (4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event (5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event [DSM IV - TR].

“Imagine seeing your parents being shot right in front of your eyes,” said Kim. “These kinds of psychological trauma that the 4.3 survivors went through, no one can imagine except for themselves.”

In addition to reliving the trauma over and over, a major symptom of PTSD is feeling nervous all the time. Due to this symptom, said Kim, many 4.3 survivors became alcoholics or depressed.

In the same survey, 82.4 percent of participants often or always felt depressed during the past year. Analysis showed that the prevalence of minor depression among the sample is 54.3 percent, while that for major depression is 35.7 percent.

“Being apologized to is fundamental for the healing process,” Kim emphasized. Especially because only 30.2 percent of the sample believe that they are being constantly supported emotionally, while 69.8 percent does not.

“The government apologized once, however, I don’t feel the support from the government, rather I feel betrayed by the government,” Kim Chul, president of the Jeju 4.3 Survivors Disabled Association, told The Weekly.

As a professional psychiatrist working at Jeju National University Hospital, Kim Moon Doo only sees 4.3 survivors from “time to time, not often.” Some of the 4.3 survivors still feel a need to hide their experience because they are scared of damaging their family’s reputation.

“At this moment, treatment should focus on letting the patients openly talk about what they had experienced, and give them support both emotionally and financially,” the professor said.

The professor emphasized the need for a trauma center on Jeju for survivors and family members along with offering the victims financial support. Since September 2011, the provincial government offers financial support to survivors and the families of the April 3 Massacre. However, the amount of support is trivial. The survivors receive 80,000 won (US$71) per month, while family members receive 30,000 won a month.
ⓒ Jeju Weekly 2009 (
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