1. The "depression of success" data
| Profession | Suicide rate (vs general) | Source |
|---|---|---|
| Physicians | ×2.0 (men), ×2.3 (women) | Korean Medical Association 2022; Schernhammer 2004 meta-analysis |
| Legal professionals (lawyers, judges, prosecutors) | ×1.5–2.0 | Korean Bar Association 2021 |
| CEOs / executives | ×1.5–2.0 | Korea Labor Institute 2022 |
| University professors | ×1.8 | University Faculty Union 2020 |
| Finance / securities | ×1.7 | Financial Supervisory Service 2022 |
| Famous entertainers | ×3–5 | National Center for Mental Health 2020 |
This is the clinical counter-evidence to the "success = happiness" myth.
2. 4 features of "high-functioning depression"
① Perfectionism + achievement addiction
As covered in #218 (perfectionism), socially-prescribed perfectionism is a strong predictor of depression and suicide. Successful people "succeeded" through perfectionism, but the cost is chronic depression.
② Learning "help = weakness"
Physicians: "How can the helper need help?" CEOs: "If the leader is weak, the company collapses." Lawyers: "If you crumble in front of a client, you lose trust." The control / competence demands of professional identity block self-care.
③ Fear of professional threat
| Profession | Threat |
|---|---|
| Physician | Medical Service Act §8 disqualification includes mental illness (rarely applied in practice — but fear) |
| Lawyer | Attorneys Act §5 disqualification (similar) |
| Civil servant / teacher | State Public Officials Act §33 disqualification |
| CEO / executive | Shareholder / board perception of "leadership instability" |
| Soldier / police | Concerns about firearms / promotion |
Actual disqualification is limited to "severe / work-incapacitating" cases — common depression / anxiety don't affect licenses. But fear delays treatment.
④ Family / workplace denial
"You're doing well — why?", "With your salary there's no reason to be unhappy", "You have to set an example for the kids". The better external evaluation, the more your complaint is received as "incomprehensible".
3. The difficulty of clinical diagnosis
Limits of measurement tools
- PHQ-9: "appetite / sleep / concentration / work" items are answered as "I'm handling it", producing low scores
- The "death / suicide" item must be assessed separately
- MADRS, HAM-D and other clinician-rated tools also depend on self-report
Clinical clues
- Absence of "this is enough" satisfaction
- Sudden helplessness after vacation / retirement
- Depression flares outside work hours (evenings, weekends, dawn)
- Rising alcohol / drug use
- "Without me, the company / patients / family would be better" thoughts
- Obsession with expensive insurance / body checkups
4. 5 keys to treatment
Step 1: separate from professional identity
"I am a physician / CEO / lawyer" → "I am a human who plays the 'role' of physician / CEO / lawyer". Subtle but decisive. Recover self-worth as a human, not a role.
Step 2: confidential channels
- "Professional-only" clinics rather than general psychiatry (some in Seoul Gangnam, Yeouido, Samseong)
- Korean Medical Association EAP, Bar EAP
- Overseas telehealth (Lyra Health, BetterHelp — no Korean medical record)
- Anonymous self-help groups (Physician Support Line — US)
Step 3: medication + psychotherapy
- SSRIs, SNRIs (pick those with less effect on work performance)
- CBT, ACT (acceptance and commitment therapy) — physicians and CEOs are ACT-friendly
- EMDR (with comorbid trauma)
- Weekly 50 min, 6 months – 2 years
Step 4: peer support
- Confidential groups with same-profession peers (physician groups, CEO masterminds)
- Overseas examples: Physicians Anonymous, Doctors4Doctors
- Korea: some university hospitals have started peer-support programs
Step 5: family / spouse education
- Learn the denial pattern ("you're doing well, why?")
- Understand the danger of high-functioning depression (suicide risk ↑)
- Learn this person's SOS signals (tone, behavior, social media)
- Assess the family member's own mental health (spouse depression often comorbid)
5. Profession-specific risks
Physicians
- Drug access → suicide means ↑ and lethality ↑
- Long hours, sleep deprivation, accumulated patient deaths
- Fear of medical errors / lawsuits
- Women physicians, surgery, psychiatry, anesthesia at higher risk
Legal profession
- Adversarial environment (trials)
- Vicarious trauma from client trauma (domestic-violence / child-abuse cases)
- Post-bar young-lawyer burnout
CEOs / executives
- Isolation (loneliness at the top)
- Decision pressure, accountability for failure
- Suicidal ideation rises during company crisis
Professors / researchers
- Impostor syndrome, research failure
- Responsibility burden over graduate-student depression (#213)
6. Korean resources
- KMA Member Assistance Program (anonymous counseling for physicians and medical staff)
- Korean Bar Association Mental Care Center (opened 2022)
- Korea Executives Counseling Center (CEOs / executives)
- Some university-hospital professional clinics: SNU, Samsung, Asan, etc.
- Overseas telehealth: BetterHelp, Talkspace (no Korean record)
- 1577-0199 / 1393: suicide crisis
7. The "leader's" responsibility — employee mental health
If you have high-functioning depression but demand "toughness" from subordinates, depression becomes company culture. When leaders get their own mental-health treatment and (selectively) share that experience, subordinates' treatment-seeking rises 40–60% (Bell et al., 2022). The leader's self-care = the organization's mental-health infrastructure.
