Hwa-byung is a shortened form of the Korean term ulhwa-byung. It can develop in people who endure unfair treatment for a long time without being able to push back. When someone repeatedly suppresses feelings of injustice with no one to confide in, that emotional pain can emerge as physical symptoms.
Hwa-byung is known as a condition closely tied to Korea's cultural background. An attitude of swallowing anger rather than showing it, and a culture that has long regarded bearing emotions as a virtue, are seen as contributing factors. Korean expressions such as "a knot forming in the chest," "harboring deep-seated grief" and "rage welling up" reflect this sentiment.
After hwa-byung among Koreans became known abroad, it became the subject of several studies. In 1994, it was introduced in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, as a syndrome related to Korean culture. The English name was a direct transliteration of the Korean pronunciation: "Hwa-byung."
The main symptom of hwa-byung is a heavy, oppressive feeling in the chest or the upper abdomen just below the breastbone. Some patients experience pain or a sense that they cannot breathe properly. A feeling of heat is especially common. Patients often describe it as a burning sensation, as if a fire were blazing in the chest.
Many patients visit multiple hospitals over this discomfort in the chest and upper abdomen. Even after undergoing cardiac tests, endoscopies and other examinations, they are told nothing clearly abnormal has been found. In some cases, symptoms persist and they eventually turn to a psychiatric department. Still, when chest pain or shortness of breath appears, it should not be assumed to be hwa-byung from the outset; other physical illnesses must first be ruled out.
Hwa-byung often goes unnoticed for a long time. Emotions accumulate little by little, the way clothes grow damp in a drizzle, before symptoms appear. When symptoms finally surface in earnest, there may be no major stress at that moment. That makes it difficult to connect chest and upper abdominal pain or burning to emotional pain experienced in the past.
Suppressed emotions do not all resolve on their own with the passage of time. Feelings can remain even while a person tries not to recall distressing events. Hwa-byung is common among middle-aged and older adults, and its symptoms can emerge at the same time as menopause.
Treatment can involve medication and counseling. Medication can improve physical symptoms and insomnia, though the response to treatment and the time required differ from person to person. Rather than stopping medication at will once symptoms improve, it is important to decide the duration and method of treatment in consultation with medical staff. A process of examining long-accumulated emotions and stress factors together is also needed.
In daily life, practicing how to express suppressed emotions safely can help. One approach is to talk about what happened in the past or write down the feelings from that time. It can take the form of talking to oneself or a conversation, or be written like a diary. What matters is looking back at one's own feelings, which have gone unaddressed.
Keeping a "past journal" to sort through earlier events is another method. It involves calmly writing down what happened and what felt unjust. At first, writing about events from long ago may feel unfamiliar. But once people start writing, memories and emotions from that time can return so vividly that they surprise themselves.
Group therapy, in which people share stories with others who have had similar experiences, is another option. Unlike individual counseling, it combines hearing about others' experiences with opening up about one's own. Learning that they are not alone in such suffering can bring comfort. Some patients say the burning feeling in the chest gradually subsides as the sessions continue.
Conversation and writing are not the only ways to express emotions. Moving the body or immersing oneself in a hobby can also help relieve tension and shift one's mood. It is worth looking for an activity one can enjoy, from exercise such as aerobics to singing, playing an instrument or crafts.
What matters is not trying to bear every emotion alone. Instead, people can find a method of expression that suits them, such as confiding in someone they trust or keeping a journal. Using exercise and hobbies to shift emotions is another option. If symptoms persist or interfere with daily life, it is best to seek professional care.
Family members and those around the patient also have an important role. When someone talks about their pain, it should be heard fully and met with empathy, rather than brushed aside or answered with advice to endure it. If an environment is created in which emotions can be expressed instead of suppressed, the number of people suffering from hwa-byung could fall as well.
