you are almost there
여호와 나의 목자
그가 나를 푸른 초장에 누이시며 쉴만한 물 가으로 인도하시는도다
내 영혼을 소생시키시고
you are almost there
you are almost there
여호와 나의 목자
그가 나를 푸른 초장에 누이시며 쉴만한 물 가으로 인도하시는도다
내 영혼을 소생시키시고
이제 좀 있으면 30대가 훅 지나고 젊어지지 않을 것이란 생각이 듭니다.
언제까지만 젊을 것 같았는데 요즘에 거울을 보던지 아니면 회사에 들어오는 신입사원들의 얼굴을 보면 제 자신이 나이가 들었다는 것을 느낍니다 ㅎㅎㅎ
하지만 나이가 들어가는 것이 딱히 예상했던 것보다 terrible 하지는 않은 것 같습니다. 물론 잃는 것도 많지만 (어린 외모, 운동신경, 메타볼리즘이라던지, 어렸을 때 사귀었던 친구들이라던지, 어렸을 때 많이 있었던 자유시간등등) …. 그 대신에 얻는 하나의 교환이 이루어지는 것을 느낍니다. 딱히 나쁘지는 않습니다.
약간 욕심은 남아있습니다. ‘젊었을 때처럼 매일매일 뛸거야!’ ’10년전에 했던 것만큼 아령을 들거야!’ 그런 욕심으로 운동을 하고보면 요즘에 몸이 고장이 나는 것을 느낍니다. ㅎㅎㅎ 나이 든 아저씨가 욕심만 많으면 무리해서 몸이 망가지는 현상일지도 모릅니다.
어느정도 내려놓고 … 아니 앞으로도 많은 것을 내려놓고 let go 해야될 것 같습니다. 한동안 내려놓지 못하는 것들이 많았습니다. 모든 것을 완벽하게 하고 나이는 전혀 상관이 없다 라고 생각했지만 그것은 비현실적인 이야기입니다.
남아있는 시간을 잘 써야될텐데 … 라는 생각합니다.
제 9 장
사회적 가치관과 문화 (Culture)의 영향
2019 년 4월, 인도의 텔랑가나 주에서 스무 명의 인도 학생들이 국가고시에서 나쁜 점수를 받아 자살을 한 비극적인 사건이 있었습니다. 15 ‘시리샤’라는 이름의 학생은 십대의 소녀였는데 생물학 시험에서 낮은 점수를 받은 후에, 집에서 부모님이 외출을 하기를 기다렸고 불을 질러 자살 했습니다. 이 사건이 끝난 뒤 조사를 해본 결과 학생들의 시험지에 점수를 매기는 시험 소프트웨어 안에 오류가 있어서 정확한 점수가 계산되지 않았다는 것이 밝혀졌습니다. 정말 끔찍한 비극이자 불운입니다. 경아 누나가 대학교 때 중간고사를 본 후에 낙심하고 자살했던 기억을 상기시켰습니다.
학업 스트레스와 교육 경쟁이 심한 특히 동양의 나라들에서 자살이 더 흔해지고 있습니다. 인도는 한국과 비슷하게 좋은 대학교에 입학하기 위해서는 중고등학교의 성적과 수능의 점수가 필수적이고 명문 대학교의 학력이 장래의 취업률에 강한 영향을 끼칩니다. 아마도 그런 이유 때문에 학생들에게 수능 점수가 생사의 문제처럼 생각되었던 것일 수 있습니다. 동양 문화에 생소한 서양인들은 도대체 왜 학생들이 시험 점수 때문에 그 정도로 스트레스를 받아 자살을 하는지 이해하지 못할 수도 있지만 치열한 경쟁 사회에 익숙한 한국인 여러분들은 어느 정도 이해할 수 있을 것입니다. 이것은 단 한 사람의 탓이 아닙니다. 이것은 사회 전체의 ‘문화’ 때문에 일어나는 현상이라고 생각합니다.
15 Nagaraja, Gali. (2019, April 25). “19 Telangana students commit suicide in a week after ‘goof-ups’ in intermediate exam results; parents blame software firm.” Firstpost, www. firstpost.com/india/19-telangana-students-commit-suicide-in-a-week-after-goof-ups in-intermediate-exam-results-parents-blame-software-firm-6518571.html.
한국을 예로 들어보면 인도보다 더 심각한 상태에 있을 수도 있습니다. 한국의 문화는 지난 50년 동안 엄청난 속도로 발전한 경제 덕분에 거듭 변화하였습니다. 하지만 모두가 아시다시피 지난 20년 동안 놀라울 숫자의 연예인, 정치인 혹은 유명인들이 우울증에 걸려서 자살을 하는 현상이 경제발전과 비슷한 속도로 상승하고 있습니다. 강남에 위치한 서울 카운슬링 센터의 CEO 이자 담당 정신과 의사이신 Chad Ebesutani 씨는 “한국인 사회 안의 청년들에게는 아주 명백하고 커다란 사회적인 압박이 있으며 그 압박은 성공을 해야 된다는 것과 성공의 의미를 둘러싸고 있다 (There’s a very clear societal pressure on South Koreans, especially young adults, based around a really high, unidimensional focus on one definition of success)” 고 언급했습니다. 16 Watkins, James & Ebesutani, Chad. (2018, February 9). “South Korea’s mental health problem — that Koreans don’t admit.” OZY. Retrieved from
위의 사진은 지난 20년간 자살을 통해 목숨을 잃은 연기 배우, 연예인, 뮤지션 등을 포함한 유명인들입니다. 에프엑스의 설리(2019년 사망), 카라의 구하라 (2019년 사망), 샤이니의 종현 (2017년 사망), 여배우 최진실 (2008년 사망) 과 야구선수 조성민 (2013년 사망), 배우 박용하 (2010년 사망), 배우 이은주 (2005년 사망), 배우 정다빈 (2007년 사망), 가수 유니 (2007년 사망), 모델 김다울 (2009년 사망), 그 외에 많은 연예인들이 자살로 생을 마감하였습니다.
많은 한국인들이 이런 문제들이 일어나는 이유가 작은 나라 안에서 일어나는 심한 경쟁률과 성공에 지나치게 집착하는 그 문화 안에서 나온다는 것을 어느 정도 짐작하고 있습니다. 청년들은 사춘기를 갓 지난 시기부터 가장 유명한 학교에 입학하여 가장 유명한 곳에서 취업을 하고 가장 큰 기회를 쟁취해서 부자가 되는 것이 큰 승리라는 가치관을 주위의 환경으로부터 흡수하게 됩니다. 이 메시지는 가족, 친구들, 사회, 영화, 텔레비전이나 인터넷의 미디어를 통해서 반복되고 이 “성공”이라는 단어를 중심으로 하나의 비뚤어진 이미지가 창조됩니다. 그리고 이 “성공”이라는 단어의 이미지 때문에 그 이미지를 완벽하게 충족하지 못하는 사람들은 사회에서 저평가 받습니다. “성공은 X라는 곳에 있는데 너는 훨씬 더 뒤떨어진 Y라는 곳에 있다. 너는 X를 성취하지 않는 한 부족하다”라는 심리를 사회로부터 흡수 받는 것입니다. 하지만 이런 사고방식은 절대 공평하지도 않고 지속 가능하지도 않으며 나라의 모든 시민이 완벽하게 성취하기에 불가능하기까지 합니다. 어느 정도 삶의 기준에서 만족하는 것이 아니라 비현실적으로 높은 성취와 부귀영화에만 집착하기 때문입니다.
우리의 두뇌와 내적 대화는 우리를 둘러싸고 있는 그 나라의 환경과 사회의 흐름에 따라서 크게 영향을 받기 때문에 이런 현상이 일어납니다. 이것은 한국 뿐만이 아니라 일본, 인도, 미국, 그리고 세계 어느 나라에서나 일어나고 있습니다. 그 나라 안의 사람들끼리 공유하는 믿음과 가치관은 우리들의 일상생활을 포위하게 되고 영화, 방송, 광고, 교과서, 소셜 미디어, 대화, 신문, 잡지, 포스터 등을 포함한 다양한 각도에서 매일 우리들에게 쏟아지고 있습니다. 우리는 알지도 못하게 무의식적으로 무엇이 중요하고 무엇이 예쁘고 무엇이 옳고 그릇됐는지를 사회에서 흘러나오는 정보의 흐름 속에서 흡수하게 되는 것입니다. 그리고 이렇게 흘러나오는 사회의 영향 속에 “너는 좋은 시험 점수를 받지 못하면 결국엔 좋은 직업을 가질 수 없고, 좋은 대학교에 가지 않거나 좋은 직업을 갖지 못하면 인생에서 실패자가 된다” 같은 편견을 차츰 흡수하게 되면 당신의 내적 대화가 치명적인 독에 걸리는 것과 비슷합니다. 시험을 망쳐서 자살을 하게 되는 소년 소녀들은 바로 이런 현상을 통해서 사회의 메시지를 흡수하고 자살을 생각하게 된 것이 아닐까라고 추측합니다. 물론 이것은 저의 작은 의견에 불과하지만 논리적으로 생각해봤을 때 그렇게 많은 숫자의 어린 청년들이 왜 시험 점수를 생사의 문제로 생각했을까 라는 점을 계속 질문하다 보면 이런 생각을 하게 됩니다. 한 명의 유별난 케이스나 특정한 상황 때문에 일어난 고립된 자살이 아니라 이렇게 시험 점수 때문에 다수의 사람들이 자살하는 패턴이 한국, 미국, 인도를 포함한 많은 나라에서 일어나고 있는 것을 보면 우리에게 아직 명백하지 않지만 어떤 공통점이 있는 패턴이 일어나고 있는 것이라고 생각합니다.
우리들은 우리 각자 살고 있는 나라의 문화와 환경이 우리의 내적 대화에 얼마나 큰 영향을 끼칠 수 있는지를 깨달아야 합니다. 그렇지 않으면 우리의 정신세계는 사회가 만들어내는 텔레비전, 소셜 미디어, 광고, 영화 등의 강력하고 매혹적인 영향으로 인해서 악화될 수도 있고 우울증에 더 취약해질 수도 있다고 생각합니다. 자기 자신이 살고 있는 나라의 문화와 영향을 객관적으로 분석하는 일이나 어렸을 때부터 배워왔던 모든 가치관을 다시 고려해 보는 일은 결코 쉽지 않습니다. 한국같이 유교사상을 옛날부터 대대로 물려받은 나라에서는 젊은 사람이 나라의 가치관이나 전통적인 문화에 대해서 비판적이기 힘듭니다. 하지만 이렇게 우울증과 자살률의 빈도가 상승하고 있는 위기에는 힘든 과제에 도전해야 될 필요가 있습니다.
사회의 가치관이 문제를 일으킬 수 있다는 가능성을 보여주는 다른 예는 동양인계 미국인 (Asian-American) 인구에서 볼 수 있습니다. 지난 수십 년 동안 재미교포 인구를 포함한 동양인계 미국인 커뮤니티는 “성공” 을 쟁취하기 위해서는 하버드나 예일 같은 아이비리그 대학교에 입학하여 의사 혹은 변호사같이 명예 높은 직업을 얻어야 한다는 고정관념에 둘러싸여 살아왔습니다. 가장 좋은 학교에 들어가 돈을 많이 벌어서 가장 이름있는 직업을 얻고 가장 비싼 자동차를 사서 잘 먹고 잘 사는 것이 “성공”이라고 이곳의 사회는 말해왔습니다. 하지만 이것은 과연 차세대의 아이들과 청년들을 위해서 도움이 되는 조언일까요? 이렇게 제한되어 있는 성공에 대한 가치관은 아이들의 시야를 좁게 만들고 청년들의 시선을 그저 부귀영화를 누리고 다른 사람들 앞에서 뽐내는 삶에 집중하게 합니다. 인내, 사회발전, 도덕, 희생, 봉사, 정신건강 등의 퀄리티들은 전혀 강조되지 않고 그저 학교와 직장의 경쟁에서 승리를 쟁취하는 것만이 가장 중요하다는 얕은 가치관이 아이들의 두뇌 안에 들어옵니다. 이런 가치관을 가지게 되면 어린이들도 경쟁과 성취에만 집착하게 되고 성적이 조금 좋으면 만족하고 조금이라도 뒤처지면 낙심하거나 시기하거나 죽고 싶어하는 그런 극단적인 완벽주의자의 정신상태로 번질 수 있습니다.
저는 이 성공의 의미가 완전히 틀렸다고 주장하는 것이 아닙니다. 의사나 변호사와 같은 직업은 현대사회 안에서 꼭 필요한 것이고 이런 직업을 갖기 위해서는 기나긴 세월의 공부와 경쟁과 희생이 필요합니다. 그리고 그렇게 힘든 세월을 거치고 졸업을 하면 좋은 수입을 얻을 수 있기 때문에 부모님들은 그런 많은 혜택을 보고 우리들에게 이런 선택을 강요하십니다. 현대사회에서 독립하려면 좋은 수입은 필수이고 만약에 그렇지 못하면 삶은 궁핍하고 여유가 없고 의존적일 수 있기 때문입니다. 또한 대부분의 부모님 세대는 옛날에 가난을 경험했거나 모국에서나 혹은 타지에서 비참한 경험과 수치를 겪으면서 일해 왔기 때문에 자식들에게는 그나마 더 나은 인생을 살게 하려고 이런 사회적 지위가 높은 직업들을 강요하는 것이라고 믿습니다.
하지만 장래의 아이들과 청년들은 달라져야 합니다. 혹시 사회에서 존경받기 위해서나 높은 수입을 얻기 위해서만 그런 직업들을 얻으려고 노력한다면 저는 그것에 완전히 반대합니다. 열정을 가지고 일생을 의학과 법에 바칠 각오가 된 사람들이 그런 직업에 들어가야지 사람의 생명을 살리고 나라의 법을 지키는 일을 부귀영화를 누리기 위해서만 추구한다는 것이 무슨 말도 안 되는 이야기입니까? 아주 별 볼일 없고 열정 없고 기계적인 의사와 변호사들을 탄생시키는 사고방식입니다. 다른 선택권들이 있다는 것을 아이들로 하여금 깨닫게 하고 스스로 선택하게 인도해 줘야 합니다. 사회에 존재하는 불의를 정정하는 일, 자신의 가장 창의적인 비전을 현실화시키는 일, 불우한 사람들을 돕는 일, 환경을 보호하는 일 등 중요한 일들이 셀 수 없이 많습니다. 하지만 그런 다른 선택들은 전혀 거론되지도 않고 야심 있고 똑똑한 청년들이 그저 돈, 직업의 명예, 혹은 사회적 지위만을 중요시하게 된다면 우리의 장래는 망한 것과 다름없습니다.
미국의 다니엘 핑크 (Daneil Pink), 사이몬 사이넥 (Simon Sinek) 그리고 라지 라구나탄 의사 (Dr. Raj Raghunathan)는 유명한 작가들인데 만족할 수 있는 커리어란 무엇이고 직업에서 진정한 행복을 찾으려면 어떻게 해야 하는지를 깊게 조사한 인물들입니다. 그들의 책에서는 인간은 가장 기초적인 욕구가 만족된 다음에는 직업에서 아래의 요소들을 찾게 된다고 언급한 바 있습니다.
1. 의미 있는 인간관계
2. 자신의 업무능력, 기술, 재능의 발달
3. 직업 안에서 독립적인 선택을 할 수 있는 자유
4. 자신에게 원동력을 주는 의미 있는 회사의 사명/목적
5. 자기가 회사 안에서 도움이 되고 긍정적인 영향을 끼치고 있다고 느끼는 것.
사회적 가치관과 문화에 있어서 또 하나 언급하고 싶은 것은 우리의 자기 정체성 (self-identity)과 자기 개념 (self-concept)이 크게 영향을 받는다는 사실입니다. 2세나 1.5세 아시아계 미국인들은 미국에서 성장할 때 주로 백인이나 흑인들 커뮤니티 속에서 소수민족으로 사는 것이 불가피하기 때문에 어렸을 때 집단 따돌림이나 인종차별을 자주 경험합니다. 그런 일들이 너무 심각해서 트라우마를 겪은 젊은이들은 30대와 40대가 넘은 성인이 되어도 그 상처가 남아서 어렸을 때 놀림 당했던 자신의 동양적 외모를 쉽게 받아들이지 못하게 되는 경우가 있습니다. ‘동양인’이라는 자기 개념 속에서 상처를 받고 고통을 겪는 현상입니다.
그것뿐만 아니라 미국의 텔레비전 미디어와 할리우드의 영화들은 역사적으로 아시아계 미국인들을 덜 떨어진 이미지로 만들어 놓은 원본인 입니다. 지난 10년간 이 문제는 조금씩 개선되어가고 있지만 동양 남자들은 미국의 미디어 속에서 “남성미와 자신감이 떨어지고 리더십 기질이 부족하다”라는 편견이 강하고 동양 여자들은 주로 “이국적인 걸프렌드감” 으로 취급당하기도 합니다. 미국에서 태어나는 아시아계 아이들은 텔레비전 드라마나 영화 속에서 자기와 비슷하게 생긴 동양인 롤 모델을 잘 찾을 수가 없습니다. 요즘은 시대가 달라져서 YouTube 덕분에 방송국이나 텔레비전에 제한될 필요가 전혀 없지만 주류 매체에서는 아직도 이런 면에서 부족합니다. 이렇게 미국을 예로 들어봤지만 한국에서도 분명히 방송이나 텔레비전 드라마들이 대중에게 미치는 보이지 않는 영향이 존재합니다. 작은 예를 들어보자면 드라마에서 흔히 보는 부잣집 주인공의 화려한 집과 옷들이 그렇고 그들의 꾸며진 외모 등도 그렇습니다. 그런 것들을 매일 드라마를 통해 보면서 시청자들은 자기 개념과 자기 정체성에 있어서 어떤 영향을 받는 것일까요? 더 조사할 가치가 있는 질문이라고 봅니다.
위에서 언급한 모든 일들을 하루아침에 바꾼다는 것은 불가능하지만 제가 강조하고 싶은 점은 우리를 둘러싸고 있는 사회와 문화는 개인에게 도움이 되지 않을 뿐만 아니라 오히려 해를 끼칠 수도 있다는 것입니다. 그리고 사회의 가치관이 뭐라고 하던 텔레비전 속의 광고가 뭐라고 언급하던 우리는 우리의 각자 마음속에서 건강하고 강한 내적 대화를 만들어내야 하는 개인적 책임이 있습니다. 다른 사람들이 뭐라고 하던 당신이 독특하고 매력적이고 소중하다는 신념을 잃지 않게 노력해야 합니다. 물론 이건 쉽지 않습니다. 우리는 한 나라의 국민으로서나 한 회사의 일원으로서 그 조직의 울타리 안에 존재하기 위해서 압박과 영향을 받습니다. 하지만 명심하셔야 될 것은 우리의 사회적 가치관을 지배하는 “지배층”에 있는 정치인들이나 매스 미디어의 리더들, 오피니언 리더들, 혹은 소셜 미디어 인플루언서들은 당신과 저 같은 평범한 사람들의 정신 건강 따위는 별로 개의치 않는다는 것입니다. 그러니 자기가 자리 잡고 있는 사회의 가치관을 깨닫고 이해하는 것은 중요하지만 그 모든 것을 흡수하지 않는 것이 더 건강하다고 생각합니다. 미국의 인구 절반이 동양인 남자가 남성미와 자신감이 부족하다고 믿는다고 해도 진짜로 동양인 남자들이 자기 자신에게 문제가 있다고 믿으면 안 되는 것처럼 말입니다.
마무리하기 전에 한국적인 문화의 장점들을 더 강조하고 싶습니다. 제가 지금까지 언급한 바로는 한국적인 사상 안에 정신건강에 해로운 부분들이 있어 비판적으로 이야기했던 것은 사실이지만 그렇다고 해서 모든 것이 나쁜 것은 아닙니다. 한국은 기나긴 세월의 투쟁을 이겨온 깊은 역사와 철학, 문화적 재산, 재능, 기술, 용기, 예술성 등을 겸비한 엄청난 가능성의 나라임이 틀림없고 오늘날 온 세계가 한국이라는 나라에 열광하고 있습니다. 장래에 대한민국을 발전시키려면 이런 장점들을 잊지 않으며 자부심을 가지되 현대사회 안에서 문제를 일으키고 있는 새로운 요소들은 무엇인가를 정확히 파악하여 외면하거나 부정하지 않고 확실히 직시하는 것이 필요하다고 믿습니다.
마지막으로 2019년에 보도된 세계 각국의 자살률을 정리합니다. 각 나라에 따라 기후, 정치적 혹은 경제적 상황 등이 너무나 다르기 때문에 이 자살률의 통계가 문화적인 요인 때문에 만 일어나는 것이라 판단할 수 없습니다. 그 방대한 이유들 하나하나를 모두 이해하는 것은 이 책에서 다 다루는 것은 불가능하지만 반드시 장래에는 인류가 이 진실을 파해쳐 나가야 한다고 생각합니다.
다른 나라들에 비해 가장 낮은 자살률을 보이고 있는 나라들은 아래와 같습니다:
반대로 가장 높은 자살률을 보이고 있는 나라들은 아래와 같습니다:
(출처: 2019년 World Population Review 뉴스)
When it comes to accurately defining the causes of major depression, many questions still remain unanswered today. While researching this topic, I had the chance to interview Dr. Chad Ebesutani, a leading clinical psychologist with a Ph.D. from UCLA and founder and director of the Seoul Counseling Center in South Korea. Following are excerpts from our conversation.
Dr. Ebesutani: “If I were to grade the current level of mental health treatment for depression in the world, I would give it a C. We have figured some things out, but definitely in need of improvement. I’m not satisfied with the current state of things at all. There’s so much we can do and I know we can do more. I don’t want to blame psychologists—as I understand the challenge of treating complex things—but we have yet to really understand what works [for depression] and how to communicate what works to others.
At the end of the day, I believe that effectively treating depression involves starting with looking at what the individual can do first. In this way, everyone can be part of the solution. Otherwise, it really is a downward spiral—you start feeling down, you don’t do anything, you feel even more down so you don’t meet anybody. It’s hard to pick yourself up after that [spiral].”
Dr. Ebesutani states that depression is a multifaceted problem that often cannot be addressed by medication alone, but needs more of an integrated, comprehensive approach. He also sees the need to integrate “cognitive behavior psychotherapy” (which is more of a science and technique-oriented) with the warmer and more emotionally-oriented “client-centered” approaches.
Dr. Ebesutani’s opinions rang true to my own experiences as well. Most people did not challenge the over-simplistic explanation from Katie’s psychiatrist that he wasn’t exactly sure what had led to Katie’s suicidal depression. After all, Katie had been going through weekly therapy sessions and prescribed antidepressant medication by the clinic. When I started experiencing depression myself in college and showed up at the university health clinic in desperation, I also got a sense of what Katie might have experienced. I felt like a nameless object in a factory queue that just needed another quick-and-easy fix so that I could make room for the next person in line. I waited my turn in a quiet lobby with other grim-looking students and then received a 45-minute conversational evaluation in a private room where I was told to talk about my biggest problems to a complete stranger who told me she was a social worker. After I was done trying to poorly articulate my internal struggles and rumination to this person in 45 minutes, she simply told me that I should be prescribed SSRI medication and come back next week if things don’t improve by then. To be honest, it was an incredibly discouraging and disappointing experience.
Fast-forward to today, we still have yet to see any noticeable paradigm shifts for diagnosing or curing depression. One of the reasons I wrote this book is to bring more awareness to the fact that things are clearly not working very well with the status quo. If the current system of psychiatry and psychotherapy were enough to handle this global, multifacted problem, we wouldn’t be seeing the continuing rise of depression and suicide rates today. I am not saying that we should discontinue trusting in psychiatrists altogether; we can all benefit immensely from their expertise and experience. To be honest, they all have an incredibly tough job. When you compare psychology to “observable” sciences like chemistry, biology or physics, we must remember that we still have no reliable way to see into the “black box” of the brain and deduce which thought patterns are exactly leading to which neural activity. No objective tests or measurable metrics are currently available for doctors to deterministically “test” for depression, like we can test blood samples, urine samples or heart rate for detecting various diseases. This may be one of the biggest reasons psychology continues to rely on subjective patient feedback and conversational evaluations. Psychologists ask questions to their patients and check to see if they fit the criteria for depression outlined in a book called the DSM, Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.
However, there’s so much more we can do right now as individuals and a collective community to improve our understanding of depression and the general level of treatment at large, instead of chalking everything up to an unexplainable “chemical imbalance in the brain” that only doctors and prescription medicine can solve. In fact, many professional psychiatrists, psychologists and pharmaceutical companies today may be just as confused as the rest of us about the underlying causes of clinical depression. Dr. Daniel Carlat, a renowned clinical professor of psychiatry at Tufts University School of Medicine, covered this very topic in his 2010 book, Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis. Dr. Carlat emphasizes that the current psychiatric community places undue emphasis on psychopharmacology (the study of the use of medications in treating mental disorders) while convincing ourselves that we now have cures for mental illnesses “when in fact we know so little about the underlying neurobiology of their causes that our treatments are often a series of trials and errors. ”
It’s not all bad news, however. Cognitive Behavioral Therapy or CBT has proven to be very effective and promising for treating depression in the psychotherapy community. CBT is intriguing because it focuses on how your thoughts and feelings lead to behavioral patterns, and teaches you to notice and change your negative habitual patterns by challenging your own thoughts, similar to what we discussed in the first section. As disappointed as I was in Katie’s campus psychiatrist, I do still have a lot of hope and respect for doctors and therapists out there who genuinely care about their patients, continue to create groundbreaking research and are skilled in different forms of therapy such as CBT. Based on my experiences, I can definitely say with confidence that not all psychiatrists, psychologists and psychotherapists are “created equal.” Some are better than others, by a mile. Some are absolutely terrible and care more about money than their patients.
Furthermore, researchers and academics are constantly improving their understanding of clinical depression all over the world. For example, in 2015, the PNAS scientific journal published that meditating, exercising and spending time in nature are highly effective in preventing rumination and overactivity in the brain. According to the study, participants who went on a 90-min walk through nature reported lower levels of rumination and showed reduced neural activity in an area of the brain linked to risk of mental illness compared with those who walked through an urban environment. Studies also show that maintaining a nutrient-rich diet, journaling about emotions, engaging in art/music therapy, exposing yourself daily to sunlight and spending time to bond with others all help in fighting depression by helping you regain a balanced level of neurotransmitters such as dopamine, serotonin and oxytocin. As much as I want to expand on every single one of those important findings, there’s already plenty of great literature out there on each of those topics so I encourage you to read them (some of them are below). If I were to highlight three topics in particular, it would be nutrition, physical exercise and social support. Speaking as someone who’s experienced and recovered from major depression before, understanding and improving those three aspects were major game changers for my own recovery.
Here’s a short list of great books that I most recommend on the topic of defeating depression, handling rumination and understanding our brain:
Although we are still currently unable to pinpoint the exact causes of depression today, if we were to integrate the efforts of experienced healthcare professionals and researchers with our own individual efforts, depression may be more effectively understood and treated all over the world. As it stands now, there’s no denying that there’s so much more we need to discover about how depression works.
The following is the rest of my interview with Dr. Ebesutani. We talked about the impact of culture, history and economics on the depression and suicide epidemic in South Korea.
Terry: “Dr. Ebesutani, what do you think about South Korea’s unique relationship with depression today?”
Dr. Ebesutani: “There seems to be two worlds trying to integrate. New Korea & Old Korea. Parents & Children. East & West. Modern & Traditional. They are trying to integrate and they don’t know how. And I believe this is causing a lot of pain in Korea, as there is a lack of understanding of each other leading to social conflict.
Another factor affecting depression in Korea, I think, is that society is still built upon rigid structures, hierarchies and order. While these things do have their merit and can help societies, such as helping to stabilize systems, I believe they are hard on individuals. In rigid systems, you often need to give up choice and your desire to pursue what is individually meaningful to you. There’s pros and cons with that. But I do believe that overly rigid hierarchies, order, and structures can harm individuals.
The third factor that I see affecting depression in Korea are, ironically, the close-knit relationships here. Koreans value connecting with each other and Korea is a very close-knit society. Koreans worry a lot about each other. And they genuinely care about each other. The general Korean mindset seems to be: “I genuinely care about you. We are connected and I need to take care of you.” For example, there’s frequent mixing of money, helping each other financially through family, relatives and friends. People also make comments to each other on personal matters, mostly out of concern. While this can be positive, I do see the negative side effects of being too closely intertwined in relationships. Things get messy, and people get hurt. There’s a lot of unwanted intrusion into peoples’ lives.”
Terry: “What do you think about the impact of South Korean parent-child relationships on their mental health?”
Dr. Ebesutani: “This is a complicated and difficult question to answer. My opinion is this. When Koreans recovered from the IMF crisis, they sacrificed their individual desires and pooled money and efforts together to keep the country alive. It’s definitely related to the Korean culture—if you want to do something great, you need others and sacrifice yourself to do something as a group. Korea has proven that. Koreans are willing to sacrifice themselves for their family and their country like they did for IMF, and parents do the same for their children. Some influences include Confucianism, and the ideas of group harmony over individual desires.
I work with lots of international Korean students who studied abroad and have become westernized. They definitely do not see the same world as their parents. Korean parents tend to have high standards and also want their children to try hard to live a better life than their own because they had to make many hard sacrifices in the past. So they force their children to live a “better” life that they think they should live.
Children are thus often criticized and rarely praised, disciplining them often in order to keep their children achieving more and more, which leads to long-term stress, anger and frustration in their relationships. Korean children become angry at their parents and the world. The parents’ perspective is that they are sacrificing so much for their children and their family so their children should sacrifice to meet their demands as well to be able to live a better life. But that generational integration is not happening very well. We need to find ways to better support that.”
I sincerely thank Dr. Ebesutani again for his gracious support. I was deeply moved by his willingness to accept my request for an interview out of his busy schedule and his words of encouragement for me to continue writing this book.
The way your mind operates is largely conditioned by your past experiences as a child, when your brain was the most susceptible to influence and soaking up ideas like a sponge. A habit you developed at 7 years old can stay with you even at 30 years old. Having a near-death experience in a swimming pool when you are a kid can traumatize you for life and make you avoid water as a full-grown adult. That’s why looking back at the influences you received from your parents (and other authority figures in your childhood environment) may be crucial to understanding your current mentality. They impacted your brain and your mind’s stories in a major way through childhood conditioning.
For example, in Asian cultures, filial piety or being respectful and obedient towards elders is the main virtue that parents teach their children. Not that there’s anything inherently wrong with filial piety, but the darker side of this cultural norm comes to the fore when the elders start abusing their power to shame children into “proper” conduct. Pressure, punishment and guilt trips are the emotional tools often used by Asian parents to sculpt high-performing, over-achieving sons and daughters. Their lessons usually go along the lines of “Bring honor to your family through obedience and excellence. If you fail, you will bring dishonor. If you disobey, you will be punished. Succeeding is the only way to make us happy.” We are not talking treats for getting an A+ on an exam; it’s physical punishment over scoring anything less than an A or being grounded for months if you get caught hanging out with your boyfriend instead of studying.
Back in the 90s, I remember being in some after-school program in Seoul where a Korean teacher in her early 30s literally beat my hands with the hard end of a wooden broom to discipline me whenever I incorrectly answered my math problems. Although hitting students is no longer allowed in South Korea, that’s just one example of an Asian culture that expects children to fear rules and elders to ingrain blind obedience toward authority in children. “You answered this algebra problem wrong? How could you be so stupid? Here’s some pain to make sure you don’t get it wrong again. I’m hitting you for your own good.” How thoughtful.
I never questioned such Asian values growing up because I had internalized them as the “normal way” of living. Until my 20s, I seldom challenged my elders or parents and thought that obeying them and making them happy was always the “right” thing to do. Now that I’ve spent the last 20 years in the U.S., I feel very differently about those beliefs. It’s up to us to apply our learned thought patterns to situations only if they are relevant, and then discard them when they are not. It took me a very long time to break out of that traditional mold and to be able to look at my elders and parents objectively. You need to determine who and what they are, and especially, what their limitations are.
I’m not saying that you should always disobey your parents and elders either. Of course there’s several situations where it’s best to follow their advice. However, sooner or later, you must learn how to do your own thinking. And when you do become a mature adult capable of making your own decisions, your parents who’ve raised you and led your decisions when you were a child are no longer the right people to continue forcing you in a certain direction. Like a pair of children’s shoes that no longer fit you because you’ve outgrown them, the childhood conditioning and rules set by your parents when you were just a kid need to be discarded as well. If our goal is to live a satisfying life as mature adults capable of making our own decisions, we cannot allow our parents or elders to order us around without questioning them—especially when the rules they have been asking you to blindly obey are based on their own personal limitations, biases and the imperfect childhood conditioning they inherited themselves. Then we would just be repeating the cycle. Somebody has to notice such cycles and stop them from repeating.
The irony is that parents will continue to try to tell you what to do and how to live your life because they will always see their little baby when they look at you, often in the genuine belief that they know better than you. Your job as an independent adult is to filter their advice. The helpful advice stay. Ignore the rest. And it’s up to you to decide which is which. No more blind obedience or listening to them more than you listen to yourself. Look at them objectively. Is there a chance that their advice and comments are coming from their own inherited ideas of what’s right and wrong?
Another example of what Asian cultures need to address is our story about how success is limited to a few prestigious professions based on social status and money. That is essentially a story fabricated by the previous generations and relayed to us through our parents and grandparents. And it’s completely understandable. The very first generations of Asian immigrants had almost zero career options in America and other countries abroad, except for manual labor or businesses like restaurants, laundromats and nail salons. Of course they wanted better lives for their children, and we cannot blame them for that. A life of stable income with a respected job title and high level of education is very different compared to a painful life of poverty with a job where nobody treats you with respect. Many of my Korean uncles and aunts suffered through that lower-class life and made sure to remind me often to learn from their hardship and study hard.
But the world is changing faster today than ever before. There are new occupations now that have more responsibility and future potential than the traditional paths that were held sacred before. There’s entrepreneurs, artists and innovators who are creating extraordinary value for the people around them while being completely unbound by a job title. In this age of rapid change and innovation, the best blueprint for success may not be the one that was fixed 50 years ago by our parents and grandparents. We are the ones who must adapt to and steer the world. We have to change it, so we can make it better than the world in which our parents lived before, not succeed solely based on their old rules.
I’m not advocating that you quit med school, law school, graduate program or whatever career path you are actively involved in. If it’s a path that motivates you to live a purpose-driven life, then by all means, go study what inspires you and throw yourself 100% into your profession. I am advocating however that the decision to choose your life path come from you, and you only. And if that decision turns out to be a bad fit for you, then you have every right and responsibility to change your course at any point in your life. Granted, you must give enough time to a chosen career path before you make a major switch; otherwise you will be wasting time and money jumping back and forth between different paths, never deciding on anything in particular. But limiting yourself to a few career choices, just because of your parents’ wishes, I feel is completely illogical. You must choose for yourself and find out for yourself what is best for you.
I do want to emphasize one thing: Our parents are not the problem. That’s not what I’m trying to say. I owe so much to both my parents. My mother is a strong single mother who raised my sister and me as the sole breadwinner of the family in a foreign country. We do have to recognize that our parents are not perfect, but we must still love, forgive and respect them. They did their best with whatever they knew and had at the time. Challenging the mindset of our community and developing a healthy mindset has less to do with disobeying our parents and more to do with identifying and fighting for what’s best for everyone. Be aware that faulty stories can seep into your mind through your childhood influences from your parents and family members, but do not blame them needlessly. Now that we recognize those influences as adults, it’s time to let go of past issues and move toward a better direction together.
If you are currently a college or high school student who’s grown up with the traditional Asian mindset and are afraid of challenging your parents, I urge you to start learning how to think for yourself. It doesn’t mean disobey your parents every chance you get, but it does mean you start developing your own internal compass for how you want to navigate your own life. At the end of the day, if you let anybody else including your parents dictate your life, the one who will suffer the most, if they turn out to be wrong, is you. If you do not start this process of thinking for yourself early on, then you may end up as a full-grown adult who’s completely directionless while still toiling away in the same hamster wheel set up by your parents who may no longer be alive. By taking control of your own life decisions, you can start learning today how to be more responsible. It’s scary but liberating at the same time. If you are wrong, it’s on you. And if you are right, that’s on you as well.
Rather than just blindly assuming that your parents are the best equipped to make your career decisions, start by choosing your own major and classes. Rely on mentors and peers around you to gather the most accurate information; I even encourage you to find different mentors for different reasons. For example, find a mentor you can rely on for career advice, and then find another mentor for relationship advice. The possibilities are endless if you keep your eyes open. Base your decisions on facts, latest information and your personal strengths and then be ready to experiment and change course if something doesn’t feel like the right fit. When it comes to choosing a career path, research what kind of topics you are naturally curious about learning, what kind of problems you are naturally good at solving, what kind of mentors you would like to learn from and what kind of projects inspire you.
Don’t be discouraged because you can’t seem to figure out everything on your own right away. You are not supposed to. Take your time, learn from trial and error and experiment again and again while asking for mentorship from others. You will get to where you want to be in small steps. Trust the process and work patiently on figuring out your unique self-potential.
(Above is a venn diagram of a model to find your career “happy place.” It highlights the intersection of the three overlapping circles: the problems and needs of the world, things that inspire and empower you (i.e., your passions and inspirations), and your skill sets (i.e. your personal talents). This was created by Scott McGregor, one of my professional mentors from Cisco Systems in North Carolina)
I also don’t recommend you blindly follow the “follow your passion” advice, which is often misunderstood by people who think that following their passion allows them to do whatever they want without thinking about the consequences, like impulsively setting up a dessert shop in a town that’s already saturated with dessert options, or trying to make a living as an exotic dancer in a town that could care less about exotic dancing. You wanting to do what makes you happy is important, but you must be willing to put in the effort necessary to ensure that you are providing something valuable to the people around you and endure the consequences when things don’t turn out to be as rosy as you initially imagined. In business terms, you must achieve the right “product-market fit” with the world around you. Whatever service, product or value you want to offer to the world to make an impact, you must gauge its potential by how well you will be able to serve the people in that community as well as how much demand it will generate. A better advice in my opinion may be “follow your passion responsibly under a few conditions.” We might want to encourage the next generation to follow their passions and pursue what they are inspired by as long as (and this caveat is crucial) they also satisfy certain criteria similar to below:
Lastly, I want to mention that a degree from an Ivy League university is not always synonymous with lifelong success, like Asian parents often believe. In fact, in his book David and Goliath, Malcolm Gladwell specifically mentions the dangers of the “small fish in a big pond” scenario where being in an environment full of people seemingly more accomplished than yourself can actually make you less motivated to try your best due to relative deprivation and feelings of inferiority. We have more than enough examples in history where a person from humble origins ended up becoming the best, most highly regarded leader of his or her respective discipline, even though they didn’t have the most prestigious academic background (Abraham Lincoln, Thomas Edison, Albert Einstein and Steve Jobs come to mind). The typical Asian parents’ focus on an Ivy League education is overhyped and disproportionate compared to their lack of focus in teaching children how to think independently and outside the box—the very qualities that are essential for future leadership, creativity and imagination. And it was Albert Einstein who said, “the true sign of intelligence is not knowledge but imagination.”
[Excerpt from book Diaries of My Older Sister]
In this section, we cover the myriad of factors that may be the origin of our mind’s stories and obsessive rumination. We may need to dig deeper into the intersection of neuroscience, biology, psychology, cultural influences, childhood experiences and more.
The human brain is an incredible tool for performing all kinds of complex activities, such as planning for the future, remembering the past, playing a musical instrument, painting, dancing, catching a football in the touchdown zone and a million more. But human evolution seems to have failed in preparing us for when our brain starts malfunctioning from all this complexity, for example, in the form of ruminating or obsessive thinking. Rumination may essentially be a disease of the overactive mind. In this case, our most advanced asset, the brain, is harming us instead of helping us in our daily lives.
Studies show that genes and family history are strong predictors of depression. Some of us may be born with a genetic predisposition that puts us at a higher risk for major depression later in life. There’s a twofold to threefold increase in lifetime risk of developing major depression among first-degree relatives or anyone with a sibling or parent with depression. I can attest to this through my own family history; not only did my sister and I experience major depression, but so did many relatives from both my mother’s and father’s side of the family. We cannot deny the significance of genetic “cards we are dealt” at birth when it comes to the risk of developing depression.
However, that doesn’t mean that we should label depression as a result of some genetic defect or a random malfunctioning of the brain that we have no control over. My belief is that a large percentage of individuals who experience major depression or suicidal ideation in recent times are not born with a fundamental defect in their neurochemistry that causes depression with no apparent reason at all. Granted, this is difficult to prove because depression is another case of the “Nature versus Nurture,” “Chicken or the egg” debate. How can we be sure if depression is resulting from the direct experiences of a person’s life or from their fixed genetic destiny? Was the person’s brain impacted by some external event that ended up causing depression or was the person innately born with the risk of developing depression? Although more conclusive studies are needed, it may be safe to assume that there’s a complex interdependence between genes and environment. There may be a specific subcategory of depression where genes play a part in making us more susceptible to depression, and then the actual experiences during a person’s life may trigger that susceptibility, causing symptoms of major depression to surface as a result.
Then again, not all cases of depression or suicidal ideation may follow this pattern. Even if the surface-level symptoms are the same across two different patients of depression (such as a loss of interest in daily activities, a change in eating or sleeping patterns, fatigue, a lack of motivation, difficulty concentrating, etc.), a clear distinction has to be made between Patient A who may have recently suffered the loss of her entire family in a car accident, and Patient B who has no history of trauma or recent loss but instead has been suffering from years of obsessive rumination. It may not be far-fetched to say that a major portion of depression in recent times fits into this latter category. Some of us might have always carried the “dormant potential” for depression in our lives, and that potential may become awakened as a result of some stressful life event that we face. This is also why I believe that people who suffer from depression should not be judged as “weak” or “deficient.” There may be a complicated mix of factors at play that may or may not trigger a person to fall into a depressed state that has nothing to do with the person’s mental strength or fortitude. I think these reasons are what makes depression so confusing and difficult to understand or prevent. The actual trigger of depression for one group of people might be due to one similar set of reasons, but for some people, it might due to completely different, unrelated reasons.
For the subset of depression that I referred to as the “dormant potential” category, in which I include myself and Katie, it might be possible that some of us are naturally born with an abnormally high sensitivity to certain triggers that could lead to an overactivity of the brain. Some people simply knock this off as an “over-sensitive personality”; I personally compare this condition to allergies. Like a person whose physical immune system reacts hyper-sensitively to pollen or other allergens, a person born with a rumination-prone brain might be suffering from an over-sensitive mental reaction system that manifests itself in the form of obsessive, repetitive thoughts in response to stressful emotions, social situations or life events. And those stressful thought patterns may sound very much like the different examples we covered in the first section: self-loathing, regret, comparison, catastrophizing, self-judgment, labeling and more.
I would like to mention that I detest the commonly used “chemical imbalance in the brain” explanation of depression. Yes, there may be a neurochemical imbalance in people who are showing symptoms of depression, but the real question is, why did that imbalance arise in the first place? Because depending on the particular individual, the answer to that question may vary greatly even if the symptom cluster and affected neurotransmitter levels might look similar. And unless we answer that question of why, we will always end up treating the brain as a black box that we are unable to crack, while resorting to surface-level solutions that treat the symptoms alone.
Like we discussed before, the imbalance might have been caused by a laundry list of different reasons, perhaps something biological or over time by some other external factors. A doctor saying that a person is depressed because of a chemical imbalance in the brain is almost like a car mechanic telling you that your car is broken because there is something wrong with the engine, and then not telling you anything else. Okay, can anybody tell us how and why the car engine ended up that way so that we can prevent the car from breaking down again, so that we are not at the complete mercy of this random disaster? If the answer is no, then it puts more responsibility back on us. We don’t have to give up all our power and potential as individuals to try to understand what might have gone wrong with our own brains. And then we can work together to find the why instead of jumping at band-aid solutions.
Articles published by the Harvard Health Publishing of the Harvard Medical School echo the sentiments that “the onset of depression is more complex than a brain chemical imbalance” and “[that] figure of speech doesn’t capture how complex the disease is.” Research suggests that rather, “there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. […] Several of these forces interact to bring on depression.”  So if depression turns out to be much more complex than just a biological complication, like many of us suspect, how can we do a better job of discovering the true causes behind the curtain? Is the existing system that heavily relies on medication going to help us discover the root causes of this issue, or are we just sweeping much bigger issues under the rug?
I would like to emphasize that I do not claim to understand all the different subsets or variations of depression. I assume that this is a very specific type of depression that I’ve been focusing on throughout this book, the type that Katie and I experienced. For example, all the mindfulness tips or cognitive behavioral tips in the world may not be able to help a person who was born with a severe neurochemical imbalance that only medication can address or has experienced a physical trauma to the brain that’s dramatically altered his physiology. Every individual’s explanation for depression may be different in that way, and therefore, we cannot rely on a single, static answer for every episode of depression (although general patterns may exist depending on the cause). That is why Dr. Daniel Amen, a renowned author of the book Change Your Brain, Change Your Life, talks about the importance of using visual neuroimaging techniques and brain scans to see and pinpoint what kind of electrical activity might be actually occurring inside a depressed person’s brain instead of trying to guess their psychological condition through conversational evaluations. He makes the valid point that undiagnosed brain injuries or physiological issues inside the brain can lead to symptoms of mental illnesses, and using these visual means can help us rule out “biological” factors that might be causing psychological problems, and recognize general patterns within the brain. Generally speaking, any advanced technology that allows us to unravel the black box of the human brain by giving us additional qualitative or quantitative data points may help us significantly improve our understanding and diagnosis of depression.
All in all, I strongly disagree with the school of thought that it is some “faulty gene” that causes depression or the fault of some weak character. Instead, the answer may be far more complicated. For example, studies indicate a possible correlation between high creativity (as well as IQ) and elevated risk for mood disorders and depression, hinting that the brain’s capacity for depression and creativity may be linked. This is not a surprising hypothesis, considering that some of the brilliant minds in history, such as Vincent Van Gogh, John Nash, Abraham Lincoln, Beethoven, Kafka and Freud, were presumed to have suffered from mental illnesses. My belief (shared by many others) is that the same parts of the brain that cause excessive rumination are also closely linked to the areas responsible for creativity, memory, empathy, focus and problem-solving. And it may be up to us to channel our brain’s focus toward the right direction so that we are able to use it for constructive creativity and empathy rather than self-destructive rumination. Yes, the downside of a depression-prone brain is a high sensitivity to stressful stimuli that can tip you into mental suffering. However, we can learn to embrace the sensitivities of our brain totally, and understand how to coexist with them.
A dear friend was diagnosed with cancer today.
I guess it’s not uncommon but quite a shock that people my age are now having to think of such health issues. We felt so invincible in our 20s.
I pray for their recovery and happiness.
COVID-19 seems almost over, fingers crossed.
I wonder how different it will be post this pandemic.
Some excitement. Some nervousness. Some hope.
Strong body makes a strong mind. Must work on training every part of my body more diligently.
Don’t be afraid of failure. Not failure, but low aim, is the crime. In great attempts, it is glorious even to fail – Bruce Lee.
臣亮言(신량언) “신 제갈량은 말씀 올리건대, … 親賢臣(친현신) 遠小人(원소인). 어진 신하를 가까이 하고, 소인을 멀리하는
그것은 욕심을 버린다는 일인것 같다.
죽을때는 육체도 재물도 친구도 데려가지 못한다. 애인도 데려가지 못한다.
죽을때는 영혼에 묻힌 너의 향기만이 너를 동반한다.
너의 선행. 너의 희생. 너의 가르침. 너의 사랑. 너의 따뜻함. 너의 신앙.
영혼은 죽을때 이 인생의 기록과 함꼐한다.
내 영혼을 깨끗하게 하기위해서
나의 인생을 예술가같이 아름답게 그려내려야 한다.
하루하루. As best as it can be with every stroke of every day.
굴곡이 있어도. 슬픔이 있어도. 절망이 있어도. 그것을 통해서 강해지고. 그것을 통해서 성장한다.
인생은 아름답다. 주님의 창조물이다.
나는 주님께서 주신 목적을 이룰때까지 포기하지 않는다.
진실, 창조, 자유.
다음세대에 주고 우리세대는 죽는 것이다.
그것이 바로 인생의 목적이다.
자기 잘낫다고 젊은 이들이나 약한 이들을 학대하거나 조종해서 자기밥과 돈만 챙기고 있는 이기적인 이들은 다음세상에서 반드시 저주를 받을 것이다. 주님께서 심판하실 것이다.
나 내 평생 주님께 바치고 다음 세상에서 주님의 얼굴을 마주보며 말할 것이다.
최선을 다했습니다, 주님.
about 30 hours in. feeling a little lightheaded but good. it must be normal.
i feel grateful that i can do this.
We can do all things through God who gives us strength