SEOUL, Korea, March 7, 2008 -- An hour of weekly laughter was good enough for Jung-Oak Lee, 64, to fight off depression that coincided with two years of chemotherapy to treat her colon cancer.
Every Friday afternoon, she travels almost two hours to join about 100 other cancer patients and families in a packed hallway of Seoul National University Hospital, one of Korea's largest, to learn how to guffaw.
"It was awkward at first. Yes, smiling is a good thing, but you know, I'm a little conservative. I sometimes still think laughing out loud is a bit low class," she said.
In a country of Confucian tradition where solemnity is considered noble and jocularity the opposite, Koreans are usually taught to keep their emotions inward.
As the old Korean saying goes, men are not to cry more than thrice in their lifetime -- at birth, at loss of sovereignty of his country and at parent's death. And for a household to prosper, women's laughter should not be heard outside the fence of her home.
"The social culture is changing now, though. Laughing is considered positive, but many people still don't know how to let it out," said Lim-Sun Lee, a nurse and laughter therapist leading the session. "But all it takes is four sessions. After that, they start cracking up."
The hourlong session is a mixture of dancing, lectures, sharing jokes and show-and-tell confessions.
"Today, we're going to learn the penguin dance," Lee shouts, "so waddle around and stomp your feet to the music!" Mimicking and giggling, the groups of all ages from a 6-year-old to senior citizens wave their arms.
Most cancer patients have some period of mental depression and laughing has a significant therapeutic value, according to Lee.
Studies have shown that effects of laughter on the body start with blood vessels expanding, which stimulates circulation. After laughing, blood sugar levels drop and the action helps promote comfortable sleep. It also boosts the level of serotonin that provides calming actions in the brain and body, and the level of dopamine linked with feelings of happiness and pleasure.
If laughter is somewhat unnatural to the Korean older generation, another treatment for depression is singing therapy. Doctors say similar effects such as improved circulation and increased antibodies stem from singing out loud.
With karaoke rooms and bars on almost every street corner, singing is the most common form of entertainment when friends and family gather in Korea. Upscale taxis and buses carry karaoke systems for passengers to enjoy en route. Company and college orientations often involve newcomers singing in front of the group. TV stations carry regular programs such as "Challenge 1,000 Songs," where candidates compete to finish a randomly selected song with perfect lyrics. Community centers offer singing classes where mostly housewives beyond middle ages sign up.
"Korean people sing when they are happy, and they sing when they are sad. It's an easier way to express themselves than to talk or laugh too much, especially for women who grew up in a conservative background," said Young-Ju Son, a singsong star guru with 19 years of teaching experience.
She hops between three to four community centers every day to teach housewives the art of singing and expression.
At the community town club on the outskirts of Seoul, about 90 women learn an old popular Korean song "Men Irritates Women" to a computerized band and Korean drums beat to the rhythm by teaching assistants.
Son urges her students to cry out their husbands' or sons' names whenever "men" come up in the lyrics.
For some, these classes are a stress management tool. For others who suffer from depression, singing can be a healing process.
Son says about half of her students have suffered at least mild depression. Of them, a third have been diagnosed with what's known here as "housewife holiday syndrome," one of the most common forms of depression in which women fall into, before and after, national holidays.
Confucian tradition holds that only housewives are to bear the burden of catering big family gatherings during the holiday season, whereas men are expected to socialize with relatives while staying away from the kitchen.
Media health campaigns preceding holidays now warn housewives to keep their backs straight while cooking pancakes for hours, and remind men to take a break while playing card games. Women may show depression symptoms such as change of appetite, back and knee pain and feeling restless.
In-Soon Oh, 47, was one of them. "I used to close every curtain in the house midmorning after my family goes to work or school. I would just sit in dark or sleep until it's time to prepare dinner. After everyone goes to bed, I would find myself driving around the neighborhood."
She says her husband cheated on her with her next-door neighbor friend. But 27 years into her marriage, she still lives with and nurses her in-laws.
"One day, I just swallowed 90 sleeping pills," she said. After surviving the suicide attempt and hospitalized treatment for severe depression, she began singing therapy at a friend's suggestion. "I was like a cheerleader in my class when I was a girl," she proudly said with a grin.
"When I started singing, it all came back. Singing made me feel confident as a person, not just as a wife or mother." Oh is now taking an advanced course to be a certified singing lecturer, which also includes musical skills to beat the Korean drum.