In an apartment in Seoul, South Korea, Lee So-yeon wakes in the night, thankful that everything she’s just seen is in the distant past.
She dreams of her former life in North Korea, of swimming the icy waters of the Tumen River, of being captured by traffickers in northern China and subjected to a new set of horrors. She dreams of a failed suicide attempt, of being bound and thrown back into the river unconscious, of the North Korean soldiers who dragged her body from the Tumen, keeping her alive but condemning her to 13 days of starvation and physical brutalization in one of the country’s prisons. She dreams of being stripped naked there and forced to lie on a bed with four other women as a guard examined her bodily cavities, keeping the same unsterilized gloves on to search all five women. She dreams of the darkness of her cell, punctuated by smells of her own excrement and compares it to the black of being kicked unconscious by guards.
But she also dreams of release—getting out of prison, swimming the Tumen again, and taking a boat to Seoul, beginning the resettlement process in 2008, two years after her first escape attempt. She dreams of the day when, for the first time, a doctor told her that the nightmares and flashbacks were symptoms of post-traumatic stress disorder, a condition many defectors face, and the hopelessness and despondency that hung over her waking life were symptoms of depression. Unlike what she was taught growing up, other North Koreans experienced these conditions too, and in Seoul, she could talk about them without fear of being sent to an institution few ever leave.
For resettlement and medical professionals working with North Korean migrants like Lee, a major step in providing effective mental health interventions is convincing defectors that the issues they face are diagnosable and treatable. While defectors are generally aware that mental health exists, they know little to nothing about specific conditions, the prevalence of mental health issues, and treatment strategies.
Defectors show high rates of psychological trauma. It can be caused by everything ranging from starvation or abuse to fearing capture after resettlement or retribution taken out on loved ones left behind. Despite the suffering, research shows that North Korean migrants are frequently averse to even basic mental health help.