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金光日,元鎬澤 최신의학사 1974 最新醫學 Vol.17 No.1
The authors tried to evaluate the sociocultural and clinical characteristics of discharged cases from a neuropsychiatric ward in a general hospital in Seoul. Materials were collected from all the discharged cases from the neuropsychiatric ward of Kyung Hee University Hospital during the last two years from November 1, 1971 to October 31, 1973. Two hundreds and seventy eight cases (male:160, female:118) were discharged during the above mentioned period. Most of the patients are self-supported for hospitalized treatment. Diagnostic distribution: Forty one percent is schizophrenia: 20.5 per cent, psychoneuroses :20.5 percent, organic cases: 3.24 percent, manic depressive illness: 3.24 percent, senile psychosis: 3.96 percent, alcoholism with delirium tremens and so on. Special attention was given to the high percentage of hysteria (11.86 percent among the total, 22.03 percent among the females), the increasing tendency of senile psychosis, alcoholism, general paresis (1.44 percent) and arteriosclerotic psychosis(2.52 percent). Subgroup of schizophrenia is revealed simple type in 9.65 percent, catatonic type in 3.51 percent, hebephrenic type in 4.39 percent, paranoid type in 44.73 percent, pseudoneurotic type in 6.14 percent, schizoaffective type in 11.40 percent, acute undifferentiated type in 13.16 percent and chronic undifferentiated type in 7.01 percent. Age of the patients:: Mean age and standard deviation are 28.41±9.90(male:28.09±10.18, female: 28.76±9.67) as a whole, 27.42±8.86 (male: 28.14±9. 34, female: 26.19±8.43) in schizophrenia, 30,39±11.29 (male: 27. 88±13. 15, female: 31.45±10.17) in psychoneuroses. Teenagers and the aged over 60 years of age are 16.19 percent and 3.60 percent respectively. Sociocultural status: Educational background of the patients is relatively high: the status is distributed to college in 35.25 percent, high and junior school in 46.75 percent, primary school in 16.18 percent and illiteracy in 1.82 percent. They have religions in 44.57 percent. Schizophrenic patients seem to be married later than other groups. Social class of the familly adapted to the frame of Hollingshead and Redlich is manifested as follows: class I and II is 36.34 percent: class III, 33.45 percent: class I V and V, 30.21 percent. Educational background of head of the family is distributed to college in 44.61 percent, high and junior school in 23.78 percent, primary school in 14.04 per cent and illiteracy in 4. 31 percent. The heads of the family have various religions in 46.01 percent. Rate of parental deprivation before 15 years of age is apparently higher in schizophrenic group than other ones: paternal deprivation seems to be more important than maternal one. Clinical Problems: Seventy five percent of all the disharged cases were admitted to as fresh cases without any previous psychiatric admission. Thirty three percent of total cases, however, has past history of treatment with traditional herb medicine, folk or magical devices, internal medicine and or neurosurgery. The traditional concept of mental illness and mode of treatment which troubled with those of modern medicine are intermingled with the confused channel of seeking medical care in Korea. They were admitted to through various channels: & 28 percent by psychiatrists' referring, 15.84 percent by other physicians' referring, &28 percent transferred from other departments, 6.12 percent by patient's own seeking, and 57.93 percent by family members' own seeking and so on. Mode of treatment in hospital setting is also various and multiple. Pharmacotherapy is the major mode of treatment, i. e. 89.56 percent of all cases and 98.24 percent of the schizophrenic group were treated with pharmacotherapy. Electric shock therapy was applied to 25.17 percent of total cases and to 51.75 percent in the schizophrenics, whereas insulin shock therapy was applied to only one case of schizophrenia. Supportive psychotherapy was applied to 21.58 percent of total cases, to 28.94 percent in schizophrenics and to 33.33 percent in psychoneuroses. On the other hand, intensive psychotherapy was applied to 12.23 percent of total cases, to 10.52 percent in psychoneuroses and to 20.17 percent in schizophrenics, whereas group therapy, to 38.84 percent of total cases, 40.35 percent in psychoneuroses and 59.64 percent in schizophrenics. Family therapy was tried to 10.43 percent of all cases, 14.03 percent and 14.91 percent in psychoneuroses and schizophrenics respectively. Milieu therapy including art therapy, recreation, occupational therapy and other active participation to ward activities was applied to 4&20 percent of all cases and 81.57 percent in schizophrenics. Mean day of hospitalization is 30. 12±37. 17 for all cases, 15. 82±23. 31 for psychoneuroses and 48.59±39.05 for schizophrenics. They were discharged against medical advice in 44.62 percent. Successful follow-up treatment was possible only in 39.21 percent for all cases, 22.45 percent for psychoneuroses and 50 percent for schizophenics inspite of intensive approach and special emphasis to follow-up during hospital staying. Consequently, psychiatric practice in Korea is crucially hampered by poorly socialized medical system and financial difficulty as well as conceptual discrepancy about mental illness between the traditional medicine or the public and the modern medicine. Reasonable delivery system and education for the public are inevitable and necessary for the improvement of psychiatric practice and mental health.
金光日 大韓神經精神醫學會 1981 신경정신의학 Vol.20 No.3
Two cases of recurrent unipolar depression with unusually brief attack were reported. The first case, a 39 year-old house wife, revealed a 10 year history of retarded deprssion. Duration of each attack was 12-24 hours in early stage, but 10 minutes to 3 hours recently. Frequently of attack has increased from several times for a month to several times for a day. The second case was a 55 year-old widow who had a 4 year history of agitated depression. Duration of each attack was 2 days, but recently has increased to be 7 or 10 days. Symptom-free interval was 6 months in early phase, however one week recently. The both cases were untreated prior to this psychiatric admission. Tricyclic antidepressant medication resulted in a favorable outcome in both cases. Clinical attention should be given in that these cases with micro-attack of depressive episode would easily be misdiagnosed as dysthymic by rough history taking and observation.
金光日 大韓神經精神醫學會 1981 신경정신의학 Vol.20 No.4
Two cases of hypomanic state induced by therapeutical dose of diazepam were reported for calling physicians' attention to it's possible danger. The hypomanic symptoms appeared 2 or 3 days after initiation of diazepam medication (10 and 15 mg daily respectively), and disappeared one day after discontinuation of the drug by placebo switch. Remedication resulted in reappearance of the hypomanic symptoms. The symptoms were enough to disturb patients' social life, so that discontinuation of the drug was inevitable.
Fluphenazine decanoate의 治療經驗: 安全한 維特治療를 위한 豫備報告
金光日 大韓神經精神醫學會 1979 신경정신의학 Vol.18 No.4
Clinical experience of fluphenazine decanoate therapy was reported with special reference to safety dosage regimen for the successful maintenance therapy. The experiement was conducted by two successive steps; a full dosage regimen during the first half of the period, and a low dosage regimen during the later half. During the initial phase of trial, full estimated doses of fluphenazine decanoate were given to 15 schizophrenic patients (9 acute and 6 chronic cases) who had been treated with oral neuroleptics, for converting oral medication to the depot. Usual dosage was ranged from 0.5cc (12.5 mg) to 2cc (50mg). Akathisia with parkinsonian rigidity was noticed in 13 cases(86.7%) and moderate and severe degrees of the side effects was seen in 12 cases(80.0%). Three cases were uncontrollable by high dose of antiparkinsonian agents and by discontinuation of depot injection. This side effect in one case who had been given 2cc of the depot has persisted over 6 months after the discontinuation. Eighty percent of drop-out rate could be detected in these cases and the main reason was painful distress of the side effects. With the above experience the author gave up such a method of conversion and a new dosage regimen has been tried for the safe use. Oral medication was switched to the depot after acute symptoms subsided and after considerable improvement ensued when the required dose of fluphenazine decanoate was less than 1cc(25mg). Two hours after initial shot of 0.1cc, an additional 0.1 or 0.2cc is given if further dosage is needed with the condition that there is no side effect. When further dosage is required, the remainder is given on the 7th day with careful evaluation of side effects. The above dosage regimen has been tried to 30 schizophrenic patients (21 convalescent and 9 chronic cases). Sixty seven percent was given less than 0.3cc(7.5mg) and only two cases needed 1cc. Fourty three percent could be reduced in their dosage during maintenance. Intervals of injection were 14 days in 10 percent, 18 days in 3.3 percent, 21 days in 69.7 percent and 28 days in 20 percent. The intervals could be extended in 20 percent of the cases and was constant in 76.7 percent. Side effects were noticed in 33.3 percent, but mostly mild and subjective. Only 3 cases(10%) manifested moderate degree of akathisia with parkinsonian rigidity, akathisia with dystonia and hand tremor respectively that required concomitant medication of antiparkinsonian agents. The other cases could be easily managed by dosage reduction of the next shot. Drop-out rate was only 10 percent (3cases). According to the author's experience, high dosage regimen seems to be troublesome both for the patient and for the physician due to high frequency of side effects especially extrapyramidal symptoms, even in the case of converting oral medication to fluphenazine decanoate. Initial very low dosage with gradual increase up to 1cc of the depot could be recommanded as a safe dosage regimen even for the maintenance therapy.
정신분열병 환각의 횡문화적 연구 : 상해와 서울의 비교 A Transcultural Study
金光日,長良棟,陸明康,朴康奎,朴容千,金大虎 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.5
연구목적 : 정신분열병의 환각이 문화사회의 특성에 따라 어떤 차이가 나는지를 확인하고 그 의미를 문화정신의 학적 견지에서 고찰해보고자 이 연구를 시행하였다. 방 법 : Shanghai와 서울의 정신분열병 환자를 대상으로 환각의 형태, 내용, 주제 등에 관한 비교문화적인 조사연구를 하였다. Shanghai Mental Health Center, 국립서울정신병원, 한양대학교병원에 입원하고 있는 환자중 DSM-Ⅳ 진단기준으로 정신분열병의 진단이 확정된 환자 가운데 입원한지 1개월에서 6개월 이내인 환자를 대상으로 사전에 성별, 연령, 교육연한, 발병기간 임상아형, 등 5개 변인을 통제하여 조사대상을 선정하였다. 조사대상이 된 환자는 396명(Shanghai 182명, 서울 214명)이었다. 이중 환각이 확인된 환자 231명(Shanghai101명, 서울 130명)을 최종 연구대상으로 하였다. 결 과 : 환각의 형태에서는 양 집단 차이가 없었으나 환각의 내용이 양 집단에서 차이를 보였다. 즉 Shanghai에서는 정치적인 내용이, 서울에서는 초자연적/종교적 내용이 많았다. 결 론 : 환각의 주제나 내용은 망상과 긴밀하게 연관이 되어 있다는 점, 그리고 사회문화적 상황의 영향을 다분히 받고 있음을 알 수 있었다. Objective : The types, contents and major themes of schizophrenic hallucinations in Shanghai and Seoul were compared for evaluating cultural differences and connotation. Methods : Among the schizophrenic inpatients of Shanghai Mental Health Center in Shanghai and National Seoul Mental Hospital and Hanyang University Hospital in Seoul, 396 cases(182 cases in Shanghai, 214 cases in Seoul) were selected by two ways: a) five staged stratified random sampling of sex, age, education, clinical subtype and onset year, b) cases who have admitted for one to six months in their last admission. Among them, 231 cases(55.39% in Shanghai, 60.83% in Seoul) confirmed to have hallucinations were the final subjects of study. Results : Frequencies in types of hallucination were not different between the two groups. However, contents and major themes were different: Political themes and related contents were dominant in Shanghai cases, and supernatural and religious themes and related contents were dominant in Seoul cases. Conclusion : It was concluded that contents and themes of hallucinations were closely related to the delusional contents and themes, and such patterns were considerably influenced by so-ciocultural characteristics.
文化變遷에 따른 精神疾患 槪念 및 治療法에 관한 見解調査
金光日,元鎬澤,李正浩,申榮宇,金允姬,朴宗學,崔圭珙,洪性彦 大韓神經精神醫學會 1975 신경정신의학 Vol.14 No.4
Opinion about the cause and desirable way of treatment of mental illnesses, psychoses and epilepsy, were collected from 379 rural peoples and 201 peoples in Seoul city by individual informal interviews. Purposefully, the interview were limited to old people over 50 year of age who were resident in the rural areas with traditional way of life, and to the relatively civilized peoples who had been resident in Seoul for the past ten years. The results from the two sources were compared and discussed from the point view of acculturation. It was obvious that the concepts in cause and treatment of mental illnesses was shifted from the primitive orientation to the modern one. Shamanistic and primitive medicinal concepts were almost neglected in Seoul sample, whereas the two concepts were definetely high as 53.2% for psychoses, 88.3% for epilepsy in rural sample. Seoul sample unexpectedly revealed high psychological orientation to the causs of psychoses and even to the cause of epilepsy as 88.5% and 17.6% each. On the other, rural sample manifested the psychological orientation to the cause psychoses and epilepsy as 46.8% and 3.4% respectively. Way of treatment was also evidently changed; supernatural and primitive medicinal treatments for the mental illnesses were scarcely adviced by Seoul people, whereas the two treatments were adviced by the rural people in 44.5% and 18.6% each for the psychoses, and 4.4% and 63.4% for the epilepsy. Folkpsychological way of treatment for the psychoses was 61.7% in Seoul, 20.0% in the rural area. Even for the epilepsy, this psychological treatment was 22.2% in Seoul, 2.5% in rural area. Opinion about the efficacy of modern medicine in the treatment of mental illnesses was still negative. Favorable result of modern medical approach for the psychoses could be expected only in 28.6% of Seoul sample, 8.9% of rural sample. That of modern medical approach for the epilepsy could be only in 36.4% of Seoul sample and 10.5% of rural sample. Seoul sample responded to the psychoses as "curable" in 59.3%, but rural sample did in 20.2%. For the prognosis of epilepsy, Seoul sample responded as "curable" in 27.4% and rural sample only in 3.0%. It was impressed that the concept and way of treatment of mental illnesses were apparently changing from the primitive to the civilized by acculturation process. Two kinds of problem would be suggested. One is a discrepancy between concept and real attitude. Seoul people are interestingly enough to have desirable conceptual change of mental illnesses, while they frequently practice shamanistic and primitive medicinal approaches. By such reason, it would be likely that the conceptual acculturation would be the initial step to change, and attitudinal acculturation would be clearly later. The attitudinal acculturation is still intermingled with primitive and modern approaches. Another problem is poor expectation to modern medicine in the treatment of mental illnesses. Prognositc view is also not so favorable as expected, even the Seoul sample is more favorable than the rural is. Furthermore, they, both Seoul and rural peoples, have various kinds of psychological or folkpsychological causes and treatment. This tendency is more prevalent in Seoul. These patterns easily suggest a difficulty of secondary prevention in Korea.
金光日,南正鉉 大韓神經精神醫學會 1978 신경정신의학 Vol.17 No.1
Clinical characeristics of married female psychiatric patients whose trouble could be attributed to an undesirable mother-in-law/daughter-in-law relation have been analysed in this article for the purpose of understanding it's psychopathological manifestation and the psychotherapeutic process. Materials were obtained from the clinical records of 113 married women (99 daughters-in-law and 14 mothers-in-law) who had admitted to the psychiatric ward of Hanyang University Hospital during the past two years from August 1, 1975 to July 30, 1977. Three cases of divorcee and widow and 29 cases of neurological diseases or brain syndromes were not included in this study. Three criteria were applied for sample selection: the cases selected were a) those whose mother-in-law/daughter-in-law conflict was a main theme or target of emotional discharge, b) those in whom the same conflict was related to the developement of mental symptoms and c)those in whom the conflict gave influence on symptom aggravation. Subject group consisted of 32 daughters-in-law and 6 mothers-in-law with overt mother-in-law/daughter-in-law conflict, whereas control group consisted of 67 daughters-in-law and 8 mothers-in-law without the conlict. Among 99 daughters-in-law and 14 mothers-in-law, mental conflicts of 32 cases (34%) of daughter-in-low and 6 cases (43%) of mother-in-law could be attributed to a frictional mother-in-law/daughter-in-law relation. The subject group of daughter-in-law was younger in age than the control, and the subject group of mother-in-law was older in age than the control. Educational level was higher in both subject groups than in both controls. No significant differences of social class, characteristics of early parental relations including early bereavement, and present family structure in terms of nuclear/ large family could be found between the subjects and the controls. Neuroses and borderline cases were predominant and schizophrenia and depression were rare in the subject groups. Their mother-in-law/ daughter-in-law conflicts were mostly manifested by somatic symptoms rather than by acting outs. In psychotherapeutic process, the first stage was characterized by abreaction or ventilation by which symptomatic relief was successful. The second stage was to recognize the meaning of symptoms in terms of daughter-in-law/mother-in-low conflict. The third was to recognize the conflict as her own personality problem. The fourth was to accept the traditional value of respecting the elder. In traditional patriarchal family, it is so hard to carry out women's duties as a daughter-in-law, as a wife and as a mother. And the daughter-in-law and mother-in-low easily become rivals against each other to win the stronger status in the family. Frustration of the daughter-in-law in the past, however, could be successfully suppressedby Confucianistic ethic of respecting the elders. Nowadays, this ethical pressure is so weak that their frustration is liable to manifest emotional conflict without much suppression. Furthermore, they are ambivalent between the traditional and modern values. In such a context, mother-in-law/daughter-in-law relation inevitably becomes worse and provokes early individual conflicts resulting in a frequent family trouble. Understanding and acceptance of traditional value and way of life would be an easier access to solution of the confilct.
金光日,元鎬澤 大韓神經精神醫學會 1972 신경정신의학 Vol.11 No.2
The authors evaluated the folk concept and the way of treatment of mental illness among korean old peoples in the rural areas with materials from the field survey. The materials were collected from the individual informal interviews with 379 rural peoples over 50 years of age. The area sampling is designed to include all of 9 administrative districts in South Korea, and to be two villages in each one, for the nation-wide survey. The results were as follows. A) Concept of Mental Illness The concept of mental illness was so intermingled with various conceptual frames that clear-cut classification was difficult. Therefore, the following classification is not from the definite conceptual demarcation but from the impressive findings. a) Supernatural or primitive concept: This concept was estimated to be 35.6 percent for the psychoses, and 26.8 percent for the epilepsy among all answers. As a supernatual or primitive concept, 59.4 percent was classified into the spirit intrusion, 21.3 percent into the violation of taboo. 9.7 percent into the soul-loss, 0.8 percent into the disease sorcery and the object intrusion respectively for the psychoses. For the epilepsy, 63.7 percent was classified into the violation of taboo. 16.7 percent into the soul-loss, 15.7 percent into the spirit intrusion. There was no evidence of disease sorcery for the epilepsy. Most supernatural illness were considered to be influenced by the shamanistic orientaion. The spirit intrusion and the violation of taboo were the prominent concept in the cause of mental illness as well as the general pattern of Korean shamanism. The object intrusion and the diseae sorcery were not so significant as those of shamanism. The supernatural being the patient possessed by, is mainly ancestral gods, spirit of the dead, evil spirits and other gods. They believe that some of possessed persons destined for shamans but can be qualified as shaman after intensive training and recovery form illness through initiation rite. They distinguish the evil supernatural being from the good one. Only person who possessed by the good heing is believed as a future shaman. The meaning of violation of taboo was not so typical. Even there were such typical ones as the violation of sex taboo and delivery taboo, most of violation of taboos were rather attributed to the fault of their ancestors or heavenly punishment than their own individual responsibilty. Even if the case of heavenly punishment, it was considered not because of his fault but because of the fault of his ancestor or other things. The cause of epilepsy was so mostly attributed to the heavenly punishment that the epilepsy was believed as an incurable disease. b) Somatic or natural concept: This concept was estimated to be 17.6 percent for the psychoses, and 61.5 percent for the epilepsy. There were some considerably scientific concepts on the mental illness. For example, heredity, head injury, physical weakness, nutritional insufficiency, and emigration of parasite into the brain were indicated as some causes of mental illness, even though the concept of brain syndrome and that of psychoses were confused each other. But most prominent concept categorized as physical or natural cause of mental illness was that mental illness was attributed to some functional disturbance of liver, heart, lung, kidney, spleen and other internal organs. Such a concept is probably influenced by traditional concept of mental illness in the herb medicine. This folk concept which revealed a higher projective tendency of psychological problems into the inner organs has been possibly contributed to the dominant tendnency of somatization in korean patients. Untill now, the herb doctors diagnose the psychoses and the epilepsy as some disease of heart, liver, kidney, gall bladder and so on. c) Folk psyhological concept; This concept was estimated to be 46.8 percent for the psychoses, and 3.4 percent for the epilepsy. This folk psychological concept was closely related to the modern psychological concept of mental illness. Most of them are to be, however, influenced by the traditional wisdom of people. The cause of psychoses in the folk psychological concept did apparently indicate the emotional frustrations which had experienced through all individual life situations. For example, love deprivation in early childhood, maltreatment by parents. love sickness, dissapointment in love, sexual frustration, economic troubles and other environmental stresses were pointed as cause of mental illness. B) The way of folk-treatment of mental illness a) Supernatural treatment; The supernatural treatment was estimated to be 44.5 percent for the psychoses, and 4.4 percent for the epilepsy. The most of supernatural treatments were principally shamanistic in nature, even if there were some buddhistic, taoistic or christian faith healings. The shamanistic rites, magical spells, method of beating patient with a mulberry bough, and method of giving shock to the patient by various ways were common shamanistic way of treatment, which expel the evil spirits the patient possessed by. b) Primitive medicines; The method of treatment with the primitive medicines was estimated to be 18.6 percent for the psychoses, and 63.4 percent for the epilepsy. The treatments in herb medicine. such as acupuncture, moxibustion, and tonics were sometimes choice of approach. And various parts of many animals were believed as effective drugs in the treatment of mental illness. These animals had some meanings of magical power and partly of nutritional supply. c) Folk-psychological approach; This kind of treatment was estimated to be 20 percent for the psychoses, and 2.5 percent for the epilepsy. The cultivation, emotional equilibrium milleu therapy, deep understanding by parents, and to promote the wishfulfillment were the main way of approaches. Much interest was shown in some ideas that the crazy could be healthy by marriage or sexual intercourse. d) Other folk-treatment; This method was estimated to be 6.2 percent for the psychoses, and 1.5 percent for the epilepsy. The main principle of this kind of treatment was to expel the energy from the patients for promoting tranquility. C) Prognostic Outlook Their opinion about the prognosis of psychoses and epilepsy was generally pessimistic. Nineteen percent of them answered "incurable" for the psychoses, 70.6 percent for the epilepsy, and 20.2 percent answered "curable" for the psychoses, 3 percent for the epilepsy. The other peoples answered "slight symptomatic improvement is possible". One of the important points of discussion on the above results is the cultural channel of somatization in Korean patients. The traditional concept of illness is to be classified as two man streams: one is shamanistic influence and another is the orientation of herb medicine. The shamanism has played the main role in the formation of personality and cultural characteristics in Korea since ancient time. The essence of shamanistic recognition is so called projective system. In shamanistic society, the problems of human being are not recognized as their own problem. All problems are attributed to the supernatural causes. Consequently, there is not only vague responsibility in the causation of psychological illness but also poor responsibility in individual problems and historical participation. On the other hand, disease concept in the traditional herb medicine expresses significantly somatic projection even for the neuroses, psychoses and epilepsy. Every organ has it's specific symbolic meaning in the conceptual frame of herb medicine. For example, kidney is believed as a center of energy so that depressive illness is attributed to the functional disturbance of kidney. Such a frame of interpretation of illness in the herb medicine has possibly contributed to the higher tendency of somatic projection of korean mental patients.
金光日 大韓神經精神醫學會 1972 신경정신의학 Vol.11 No.4
"Sin-byung" is a culture-bound depersonalization syndrome known as an initiation disease in Korean shamanistic society. Traditionally, the person who has suffered from "sin-byung" is believed to be destined for a shaman. Symptomatology of this initiation disease is so varied as case by case that it is sometimes difficult to present all of the symptoms. Even though there are some variations in symptomatology, the following typical symptomatic model is possibly formulated. Prodromal phase is characterized as long-existing hysterical or psychosomatic symptoms such as anorexia, weakness, insomnia, indigestion and/or functional paralysis of extremities. Frequently, they are inevitably to be bedridden for a prolonged period, with symptom of cloudy consciousness. Occassionally, these prodromal symptoms are precipitated by some chronic physical illnesses. In some cases with acute onset, the prodromal phase is not a necessary process, so they enter directly into the following phase. Duration of the prodromal phase is variable, from several weeks to twenty years. The following is a depersonalization aphase. In this phase, the prodromal symptoms are more aggravated. Hallucinatory experiences, dreams of revelation or prophecy, confusion, with/or psychomotor excitement are common additional symptoms. Suggestion that they must become a shaman is revealed in the form of hallucination, dream or intuition. But the basic nature of this phase is to be said as a depersonalization phenomenon. Some cases are really possessed by supernatural beings, mainly ancestral spirits, whereas other cases are simply depersonalized. Both states, possession and simple depersonlization are, however, believed as "possessed" in Korean shamanistic society. There is no evidence of animal possession. Traditional shamanistic approach to "sin-byung" is an initiation ceremony. It is a shamanistic concept that "sin-byung" can be cured only after becoming a shaman through the initiation ceremony and recurs promptly after rejecting shamanistic performance. Psychiatric diagnosis on "sin-byung" can be different according to the cases and the phases. Diagnosis in the initial phase is applicable to hysteria or psychosomatic disorders, while in the depersonalization phase, hysteric psychosis or schizophrenia is usually diagnosed. Prognosis is relatively favorable because of rapid recovery, when treated medically. But they recur usually due to possible unresolved shamanistic complex. Four cases of typical "sin-byung" were presented with detail individual analyses from the psychoanalytic view point, for the purpose of evaluating their psychodynamic meaning. Results of the study are summarized as follows: a) Active motivation of escaping from the painful reality to the fantastic world is unconsciously underlined. b)"sin-byung" is understood as a culturally approved channel for expressing inner hostility and managing other persons. c) Referring to the concept of "transient regression in the service of ego" they search for infantile wishfulfillment in the regressed state of "sin-byung". The possession reveals a symbolic meaning of marriage to gods in the patients' unconsciousnesses. And they identify their parents with shamans, ancestors and gods, the patient possessed by, so they realize their infantile wishes, such as dependency need toward parents and incest desire, in relation to the supernatural beings. They compensate their inferiority by way of special contact with the supernatural beings. Consequently, "sin-byung" can be understood not only as a psychopathological manifestation in that they project their longstanding inner conflicts unto the shamanistic complex, but also as a manifestation of unconscious trial for resolving their conflicts by way of projection unto the shamanistic value system.