This study examines how mental health is defined, experienced, and governed under North Korea’s authoritarian system. Drawing on in-depth interviews with six women who received psychiatric treatment before defection, it reconstructs how ideology and institu-tional control shaped perceptions of illness and care. Findings show that psychological distress was moralized as weakness or ideological deviation, discouraging formal treat-ment and reinforcing surveillance. Participants described fear of exposure, avoidance of hospitals, and reliance on informal healing, with enduring stigma symbolized by the 49-ho psychiatric label. Overall, the analysis reveals that mental illness in the DPRK functions less as a medical condition than as a disciplinary mechanism that intertwines morality, medicine, and political power.
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