After the Escape: Physical Abuse of Offspring,Posttraumatic Stress Disorder,and the Legacy of Political Violence in the DPRK

Abstract

What is the relationship between victimization by political violence against women in North Korea and later physical abuse of offspring? This article examines the relationships between victimization by political violence, posttraumatic stress disorder (PTSD), alcohol abuse/dependence, and abuse of offspring after arrival in South Korea. A random sample of 204 female North Korean defectors was used to test hypotheses. An oral history conducted with a survivor of North Korean political violence is provided in an appendix to contextualize the results. Analyses established a significant link between previous victimization by political violence and abuse of offspring but not mediation by either PTSD or alcohol abuse/dependence.

Keywords

child abuse political violence torture PTSD alcohol abuse/dependence

My sister-in-law said that it was a crime. “You’re asking to be buried in the State Political Security Department. Fine . . . go with your youngest son. Leave forever. Disappear from this land forever.”

“If I go away, will you be ok, sister-in-law? Won’t it be dangerous for you?”

“It’s fine. Don’t think about me. I will make do somehow. Go.” So I made my preparations in haste and headed up the mountain. That is how it came about.

Most people would not make a decision to leave their home forever lightly. But the decision to leave one’s home, when that home is in the Democratic People’s Republic of Korea (henceforth DPRK or North Korea), is possibly beyond the emotional comprehension of most of us. Defecting from North Korea to go to South Korea is considered treason for which three generations of family members can be legally punished (Byman & Lind, 2010). Hence, in committing the political crime of voting with her feet, Ms Pak is aware that her sister-in-law may have to pay with imprisonment, torture, or even her life.

In the shadow of an eternal media frenzy over nuclear bombs and the quirks of totalitarian fashion, many ordinary North Koreans quietly try to live their lives, first at home, then, in mortal peril in China (from which they will be sent back to North Korea if detected), and finally in the glittering cities of South Korea. Some defectors, in a relatively short period, are able to courageously rebuild their lives and their very identities afresh. Others carry the legacy of terror and anguish in their minds even as their bodies retain the scars and pain of torture. There is good reason for concern that the effects of this suffering will not cease with the parents, but that the children of defectors will suffer the effects of abuse by the state at second hand. A relatively rich and well-developed literature on the children of holocaust survivors suggests as much (L. Baron, Eisman, Scuello, Veyzer, & Lieberman, 1996; Schwartz, Dohrenwend, & Levav, 1994). Using a random sample of 204 female North Korean defectors, this article examines the relationship between violence at the hands of political authorities in North Korea and violence against offspring by North Korean mothers now living in South Korea. We consider as offspring both minor and adult children, which allows for improved statistical power. After testing the relationship between political violence victimization and physical abuse of offspring, the article tests posttraumatic stress disorder (PTSD) and alcohol abuse/dependence as potential mediators that explain the evolution from victim to perpetrator. An in-depth oral history with Ms. Pak, a North Korean defector, is used to contextualize North Korean political violence in an appendix.

Child Abuse in South Korea

Child maltreatment consists of emotional abuse that makes the child feel worthless, neglect that places the child’s safety or psychological well-being in peril, exploitation such as sexual abuse, and physical abuse. This study limits abuse to the use of physical violence against offspring, excluding spanking with an open hand. Physical abuse of children is prevalent among South Koreans. One study found a 19.4% prevalence rate for last-year father-to-child severe physical abuse (Emery, Kim, Song, & Song, 2013). Traditional Korean punishment involves being beaten on the bare calves with a switch, hence a substantial portion (13.49% of Emery et al.’s sample) of the high prevalence comes from the item “beaten with an object.” In a study of university students, 42.2% recalled being physically abused (hit or punched, kicked, beaten with object, shaken, cut or stabbed) at some point during childhood (Lee & Kim, 2011). In a nationally representative study of Korean couples in 2010, 53.5% reported being physically abused by caregivers at some point during childhood (Song, Wenzel, Kim, & Nam, 2015).

As refugees from an oppressive regime, North Koreans are likely to have even higher rates of severe physical abuse. Although it is impossible to obtain representative data from North Korea, in a sample of North Korean youth who had defected, Emery, Lee, and Kang (2015) found that 53% of the youth reported severe abuse by parents at some point during their North Korean childhood. Moreover, child refugees are generally at increased risk for abuse (Euser, Van IJzendoorn, Prinzie, & Bakermans-Kranenburg, 2011). In a sample of refugees from Northern Uganda, Saile, Ertl, Neuner, and Catani (2014) found that PTSD from war experiences, problems with alcohol, childhood experience of abuse, and intimate partner violence (IPV) were risk factors for parents’ self-reported abuse of children. Kim, Choi, and Chae (2012) found that North Korean refugee parents living in South Korea reported higher last-year rates of physical abuse than South Koreans. Among North Korean refugee families, 53% reported minor physical violence against their children in the last year (28% for South Koreans) and 22% reported severe physical abuse (8% for South Koreans). Little research has addressed violence by parents against adult children (Band-Winterstein, 2013).

Political Violence in the DPRK

In 2014, the United Nations published the UN Commission of Inquiry (henceforth COI) on human rights in the DPRK. This comprehensive and exhaustive inquiry found overwhelming evidence of human rights abuses on an unthinkable scale. Item 58 of the COI report states that in the DPRK “torture is an established feature of the interrogation process . . . especially in cases involving political crimes” (United Nations General Assembly Human Rights Council [UNHRC], 2014a, p. 12). The report goes on to state that the inmate population in political prisons has “been gradually eliminated through deliberate starvation, forced labor, executions, torture, rape . . . forced abortion, and infanticide” (UNHRC, 2014a, p. 12) and that hundreds of thousands of political prisoners have lost their lives in these camps. An estimated 20% of refugees from the DPRK have been tortured (Kim, Jeon, & Cho, 2010). The report drew explicit parallels to the crimes of the Nazis specifically (UNHRC, 2014b, p. 344). Political violence against women is particularly egregious. Amnesty International concludes that North Korea “is in a category of its own when it comes to human rights violations” and reports that rape followed by execution is a frequent occurrence in political prisons: “After a night of ‘servicing’ the officials, the women had to die because the secret could not get out. This happens at most of the political prison camps. Prison guard” (Amnesty International, 2014). In the wake of the COI findings, the United Nations demanded immediate access to inspect North Korean prison camps. The findings of the COI were denied by both North Korea and China, and the demand for inspection was rejected.

Life in the North Korean system is precarious enough that no one is immune from human rights violations. However, those who leave the country illegally are subject to particularly horrendous circumstances, because North Korea views illegal border crossing as an “act of treason against the Fatherland” (UNHRC, 2014b, p. 107) and China almost invariably forcibly returns those apprehended within its borders (Margesson, Chanlett-Avery, & Bruno, 2007; Yoon, Park, & Lim, 2014). Hence, any North Korean who leaves without permission, however ordinary or obscure in origins, becomes suddenly and arbitrarily subject to the most draconian punishments of the North Korean state. Hence, the circumstances of North Korean defectors in China might be characterized as “out of the frying pan into the fire” (cf. Emery et al., 2015). The threat of forced repatriation allows human trafficking to flourish and induces PTSD-like symptoms in refugees hiding in China (Chang, Haggard, & Noland, 2008; Margesson et al., 2007).

Research suggests there is reason to believe that political violence suffered in North Korea will be linked to later family violence generally, and child abuse specifically. Saile et al. (2014) found that women’s experience of war-related traumatic events, PTSD symptom severity, and alcohol-related problems were all related to aggressive parenting. Catani (2010) extends the logic of the literature on the intergenerational cycle of domestic violence (Widom, 1989) to violence experienced in war. Although original work examining the “cycle of violence” focused on learning theory (Bandura, 1986) as a mediating mechanism, Catani (2010) notes that PTSD from war violence may be an important mediator. However, she also notes anomalies in the findings. Mothers left behind during the war showed an even larger increase in child maltreatment than the veterans who returned (Rentz et al., 2007).

PTSD and Alcohol Abuse/Dependence as Potential Mediators

The cycle of violence concept in the family violence literature (Widom, 1989) and extensions of the concept to include wartime victimization as a precursor (Saile et al., 2014) support the idea of an empirical link between political violence experienced by defectors and later abuse of their offspring. The mechanisms that explain this link can provide an important point of departure for prevention; hence, empirical support for the model logic is important. A fairly robust research literature suggests that violent victimization can lead to abuse of or dependence on alcohol (Amaro, Fried, Cabral, & Zuckerman, 1990; Devries et al., 2014; Stith, Smith, Penn, Ward, & Tritt, 2004), possibly because victims use alcohol to cope with the emotions engendered by traumatic experiences (self medication; Chilcoat & Breslau, 1998; Jacobsen, Southwick, & Kosten, 2001; Simons, Gaher, Jacobs, Meyer, & Johnson-Jimenez, 2005; Stewart, Pihl, Conrod, & Dongier, 1998). Alcohol abuse/dependence is also strongly associated with child abuse (Emery, Nguyen, & Kim, 2014; Widom & Hiller-Sturmhofel, 2001). There are a number of explanations for why this may be the case. Alcohol may increase disinhibition, disrupt emotional self-regulation, or generate cognitive disorganization or deviance disavowal, thereby engendering child abuse (Miller, Maguin, & Downs, 1997). Put another way, alcohol may be a cause of child abuse because it impairs the judgment of parents who are motivated to abuse, because it interferes with parents’ ability to calm themselves down, or because it causes confusion or allows parents to excuse acts of abuse.

Trauma is “psychological injury caused by some extreme emotional assault” (Reber & Reber, 2001). PTSD is by definition related to psychologically traumatic experiences like political violence (American Psychiatric Association [APA], 2013). PTSD is characterized by hyperarousal, intrusion, and constriction (Horowitz, 1986). PTSD may be associated with later perpetration of abuse because of traumatic identification with the perpetrator (Frankel, 2002), by increasing the parenting burden on the nontraumatized parent (Dekel & Goldblatt, 2008), by increasing parental hostility and insensitivity (Van Ee, Kleber, & Mooren, 2012), or by reducing positive parenting (Gewirtz, Polusny, DeGarmo, Khalysis, & Erbes, 2010). Many studies have linked parent PTSD to child abuse empirically (cf. Black, Heyman, & Smith Slep, 2001; Gewirtz et al., 2010; Van Ee et al., 2012), but not all studies have done this (Berlin, Appleyard, & Dodge, 2011; Pears & Capaldi, 2001). Based on the literature discussed, we formulated three hypotheses:

Hypothesis 1: Victimization by political violence in North Korea will be positively associated with physical abuse of offspring in South Korea.

Hypothesis 2: The relationship between political violence and physical abuse of offspring will be mediated by alcohol abuse/dependence.

Hypothesis 3: The relationship between political violence and physical abuse of offspring will be mediated by PTSD.

A community’s collective efficacy (a combination of neighborhood solidarity and informal social control) has been frequently used to study community effects on homicide (Sampson, Raudenbush, & Earls, 1997), and child maltreatment (Guterman, Lee, Taylor, & Rathouz, 2009; Molnar, Buka, Brennan, Holton, & Earls, 2003; Yonas et al., 2010). Because North Koreans living in South Korea tend to live together in communities, we decided to control for collective efficacy in our models. Models also controlled for how long the respondent has been in South Korea, respondent’s age, current income, and religious affiliation. Whether the respondent was a member of the ruling communist party in North Korea (formally the Worker’s Party of Korea) is used as a measure of previous social status in the North.

Method

Data

Quantitative

Random sampling of North Koreans residing in South Korea is somewhat complicated by security concerns. Representatives of the government of the DPRK can use knowledge of a defector’s residence in the South to intimidate and punish family members who remain in the North and, occasionally, directly threaten high-profile defectors. Hence, the South Korean government keeps confidential the locations where North Koreans are housed. It would similarly be unwise to publish all of the details of our sampling procedure. Generally, however, North Koreans residing in the South are for the most part provided housing together in clusters. We first used simple random sampling to obtain 5 administrative clusters in the greater Seoul area. Within each cluster we randomly sampled buildings (invariably large or small apartment buildings) and within each building we attempted to interview one female representative from each North Korean refugee household. When more than one female representative from the same household was available, respondents were selected by most recent birthday.

Unlike most South Koreans, North Koreans living in Seoul all know their North Korean neighbors. Hence, once one resident in a particular building had agreed to participate, that resident was able to introduce the study team to all of the other North Korean residents in the same building. Anecdotally, North Korean refugees are thought to be difficult to interview, in part because of a relatively high study burden on the population, but also because they have very good reasons for mistrusting people. However, using incentives of 20,000 KRW (17.41 USD), we were able to obtain a reasonable response rate (76.7 %). Details of the qualitative interview procedure are provided in the appendix.

Training

All quantitative and qualitative interviews were conducted by the second author. Two days of training on sampling, obtaining informed consent, respondent safety, and the survey instrument were provided by the first author. This training was supplemented with material to raise awareness about the difficulties faced by and unique security concerns of North Korean refugees. Prior to conducting quantitative interviews, the second author had to pass a written exam and certification interview. Oral informed consent was obtained from the sample of 204 refugee women to better protect their security via anonymity.

Measures

Severe abuse

Five items were used from the parent–child Conflict Tactics Scale (CTS; Straus & Hamby, 1997) to capture very severe abuse of offspring. These were as follows: (a) beat him/her up, (b) grabbed him/her around the neck and choked him/her, (c) burned or scalded him/her on purpose, (d) punched or kicked, and (e) beat with a hard object like a belt, stick, or whip on some part of the body that was not the buttocks. Internal reliability for these five items was good (Cronbach’s α = .95). These items were collapsed into a single dichotomous outcome indicating whether there had been any severe abuse of the offspring since arrival in South Korea. Given the relatively small sample, using the entire time since arrival allowed for better statistical sensitivity than in the past-year measures.

Political violence

The measure of political violence was created to roughly follow the revised CTS items used to measure IPV (Straus, Hamby, Boney-McCoy, & Sugarman, 1996). Participants were asked (yes/no) whether authorities in North Korea had ever (a) slapped them; (b) hit them with an object; (c) done something to them so they needed to see a doctor; (d) punched or kicked them; (e) burned them; (f) threatened them with a knife or gun; (g) used a knife or gun on them; (h) done something so that they had difficulty walking, pain, or bruises the next day; (i) thrown or knocked them down; (j) grabbed them around the neck or shoved them; (k) choked them; (l) forced them to have sex; and (m) forced them to perform sexual acts. The Kuder-Richardson coefficient was .93, indicating good internal consistency. The CTS approach for political violence was developed for two reasons. First, because the CTS was used to measure physical abuse of offspring, it was already a familiar format, and second, using a similar format places a lower burden on respondents.

Alcohol abuse/dependence

Ewing’s (1984) four-item Cut down, Annoyed, Guilty, Eye-Opener (CAGE) measure was used to capture alcohol abuse/dependence. Castells and Furianetto (2005) found the CAGE to have good sensitivity and specificity for alcohol dependence (Castells & Furianetto, 2005). The four yes or no items were as follows: (a) In the past 3 months, have you ever felt you should cut down on your drinking? (b) In the past 3 months, have people annoyed or criticized you by criticizing your drinking? (c) In the past 3 months, have you ever felt bad or guilty about your drinking? and (d) In the past 3 months, have you ever had an alcoholic drink first thing in the morning? This scale had acceptable reliability (Kuder-Richardson’s coefficient = .73). The count of total items endorsed was combined into a scale. Normally, endorsement of a single item on the scale is interpreted as an indicator of alcohol abuse; endorsement of two or more items is interpreted as an indicator of dependence.

PTSD

The Korean version of the Impact Event Scale–Revised (IES-R-K; Nam, Kwon, & Kwon, 2010; Weiss & Marmar, 1997) was used to measure PTSD. The IES-R is a 22-item scale with subscales for hyperarousal, intrusion, and avoidance. The introduction to the IES-R reads, “Below is a list of difficulties people sometimes have after stressful life events. Please read each item and then indicate how distressing each difficulty has been for you during the past 7 days” (Weiss & Marmar, 1997). Possible responses are (0) not at all, (1) a little bit, (2) moderately, (3) quite a bit, and (4) extremely. Hyperarousal items include things such as “I was jumpy and easily startled”; intrusion items include things such as “any reminder brought back feelings about it”; and avoidance items include things such as “I avoided letting myself get upset when I thought about it or was reminded of it” (Weiss & Marmar, 1997). The Korean version of the scale contains a fourth subscale that captures sleep disturbances, emotional numbing, and dissociative symptoms. Screeplot analysis of the principal components of the items strongly indicates the appropriateness of a single construct (an elbow of nearly 90 degrees after the first component). A score of 17 or lower is considered no PTSD, a score between 18 and 24 is considered partial PTSD, and a score of 25 or higher is considered fully diagnostic of PTSD. Internal reliability was good (Cronbach’s α = .96).

Perceived collective efficacy

Two scales were used to measure collective efficacy: neighborhood solidarity and neighborhood informal social control (Sampson et al., 1997). Solidarity was measured by agreement with five items: (a) this is a close-knit neighborhood; (b) if your family has an important problem, people around here care; (c) people in this neighborhood can be trusted; (d) people around here are willing to help their neighbors; and (e) people in this neighborhood share the same values (Cronbach’s α = .89). Informal social control was measured with five items: You could count on your neighbors to do something about it if (a) children were skipping school and hanging around outside, (b) children were showing disrespect to an adult, (c) there was a fight in front of your house/apartment, (d) someone was spraying graffiti on nearby buildings, and (e) the city had decided to close the fire station closest to your apartment (Cronbach’s α = .85). These items were combined into scales ranging from 1-5 such that the score for each individual was the average across all five items.

Control variables

We controlled for religion (Christian, no religion, or some other religion), age, current income, and previous Korean Worker’s Party membership.

Analytic Issues

Because refugees had been in South Korea for different lengths of time, a Cox proportional hazard model was used to test the hypotheses. The cluster design of the sample requires corrections for clustering in the standard errors of linear models; hence, dummy variables for four out of the five clusters in the data were included in the model. Models were tested using Stata11. Model diagnostics were run using linear probability and ordinary (linear probability) regression models controlling for number of years in South Korea to allow the model to be thoroughly vetted. The largest variance inflation factors were 2.64 (respondent identifies as Christian), and Ramsay’s Reset test did not suggest evidence of linearity problems (F = 1.88, df = 3, 141, p = .14). An important consideration is whether to control for whether the respondent’s offspring is a minor (less than 18 years old) at the time of the interview. Minority status does not change the findings when it is controlled and is not significantly associated with severe abuse in South Korea (χ² = .50, df = 1, p = .48). Missing responses for the variable, however, cause the number of analyzable cases to drop from 159 to 107. For this reason, we have chosen to leave it out of the analyses.

Results

PTSD symptoms were common in our sample. Although 6.4% of the sample had a score of zero (no PTSD symptoms) on the IES-R, 63.2% of the sample had a score of 25 or higher, meeting the criteria for full PTSD. The sample mean was 32. Our findings suggest that more than six out of every 10 defectors may meet the diagnostic criteria for PTSD. A total of 32.8% of the sample had scores of 40 or higher, suggesting severe PTSD symptoms.

Some of these symptoms are likely attributable to political violence, but since 21% of the sample reported some victimization at the hands of North Korean authorities, the preponderance of PTSD in the sample cannot be attributed to that. The breakdown of violence was as follows for the whole sample: slapped by an authority, 12.3%; hit with an object, 12.7%; needed to see a doctor, 7.4%; punched or kicked, 12.3%; bitten, 3.4%; burned, 5.4%; threatened with a knife or gun, 6.9%; attacked with a knife or gun, 4.9%; had a bruise or other injury the next day, 10.8%; knocked down, 5.9%; beaten up, 6.4%; pushed or shoved, 7.8%; choked, 3.9%; forced to have sex, 3.9%; and forced sexual acts, 2.0%.

Those who reported any violence by North Korean authorities tended to report a lot of it. Among the 43 people who reported any such violence, reports were as follows: slapped by an authority, 58.1%; hit with an object, 60.5%; needed to see a doctor, 34.9%; punched or kicked, 58.1%; bitten, 16.3%; burned, 25.6%; threatened with a knife or gun, 32.6%; attacked with a knife or gun, 23.2%; had a bruise or other injury the next day, 51.2%; knocked down, 27.9%; beaten up, 30.2%; pushed or shoved, 37.2%; choked, 18.6%; forced to have sex, 18.6%; and forced sexual acts, 9.3%. On the whole, these findings suggest that political violence is underreported by the refugee population. Unlike IPV statistics in which a larger percentage of the sample tends to endorse minor violence items only and a smaller percentage endorses severe (cf. Emery et al., 2013), only 2% of the sample said that North Korean authorities had inflicted minor violence only (slapped or pushed, grabbed or shoved), whereas 19% endorsed severe violence. This makes it seem likely that almost all of those who endorsed the political violence questions were torture victims, and those who had suffered more minor forms of violence simply did not remember or bother to check the scale.¹ A 19% torture rate in the sample does not differ significantly from the 20% torture rate estimated by Kim et al. (2010; Z = .37, p = .75).

One of the central concerns of this article is whether the horrendous victimization endured by survivors of political violence makes them more likely to perpetrate violence against their own children. The rate of severe abusive violence toward a child since arrival in South Korea was 24.5% of the 159 respondents who have lived with their children for at least some of the time since arrival in South Korea. The breakdown among the five items was as follows: (a) beat him/her up, 15.7%; (b) grabbed him/her around the neck and choked him/her, 15.6%; (c) burned or scalded him/her on purpose, 15.5%; (d) punched or kicked, 20%; and (e) beat with a hard object like a belt, stick, or whip on some part of the body that was not the buttocks, 23.4%.

A bivariate Cox proportional hazard model suggests that reporting any victimization by political authorities is associated with 2.44 times higher odds of reporting perpetration of severe abuse of one’s offspring (χ² = 5.66, df = 1, p < .05). PTSD does have a significant bivariate relationship with victimization by political violence in the DPRK (t = 2.1, df = 202, p < .05), but does not have a relationship with severe abuse of offspring (χ² = .88, df = 1, p = .35).

Another concern of this article is the role played by alcohol abuse/dependence. Among the respondents in the sample, 49% appear to be at risk for alcohol abuse (endorsed at least one item on the CAGE) and 32.8% appear to be at risk for alcohol dependence (endorsed at least two items on the cage). Victimization by political violence in the DPRK was significantly associated with 2.03 times higher odds of incrementing up one item on the CAGE measure of alcohol abuse/dependence (χ² = 4.87, df = 1, p < .05); a one-unit increase on the PTSD scale was associated with 1.02 times higher odds of incrementing up one CAGE item (χ² = 12.08, df = 1, p < .001). However, the CAGE measure was not significantly associated with higher odds of severe abuse of offspring (χ² = .37, df = 1, p = .54).

The mean monthly income of respondents in the sample was 237,000 KRW ($206.58 USD), but this did not have a bivariate relationship with severe abuse of offspring (χ² = .07, df = 1, p = .79). The mean age of the respondents was 57 years old; older respondents had marginally higher odds of reporting perpetration of severe abuse (odds ratio [OR] = 1.02, χ² = .309, df = 1, p = .08). Fully 60% of the sample identified as Christian (Catholic or Protestant), 29% identified as having no religion, 2% identified as Buddhist, and 8.9% identified as something else. Christians were almost entirely Protestant (the sample had three Catholics). Compared with the Buddhist/Other category, both Christians and those with no religion had lower odds of reporting severe abuse of offspring. However, this finding was only significant for those with no religion (OR = .25, χ² = 4.98, df = 1, p < .05). Mean neighborhood solidarity in the sample was 14.5; mean response on the informal social control subscale of collective efficacy was 10.1. Neighborhood solidarity was not significantly associated with severe abuse (χ² = 1.42, df = 1, p = .23), but neighborhood informal social control was associated with marginally higher odds of severe abuse (OR = 1.07, χ² = 2.76, df = 1, p < .10). Among the respondents, 15.8% had been Worker’s Party members; this was not associated with severe abuse (χ² = .01, df = 1, p = .92).

Table 1 shows the results of the Cox proportional hazard models. Mediation requires that the proposed mediators be significantly related with both the independent variable and the outcome (R. Baron & Kenny, 1986). Because PTSD and CAGE scores indicating alcohol abuse/dependence are not significantly related to severe abuse of offspring, tests for mediation are not appropriate. However, we show the full model both with and without these two variables, so the reader can judge for her/himself. Model 1 shows that reporting victimization by political violence in North Korea is associated with 3.16 (p < .05) times higher odds of reporting severe abuse of offspring, holding other variables in the model constant. A one unit increase in perceived informal social control in the neighborhood was marginally associated with 1.08 times higher odds of reporting severe abuse of offspring (p < .10). Having no religion was associated with .27 times lower odds of reporting severe abuse of offspring (p < .05). Model 2 shows the model when PTSD symptoms and alcohol abuse/dependence are controlled. The controls do not alter the findings; indeed, the OR for political violence showed a slight increase (OR = 3.27, p < .05). A mediation model implies that the OR should have become smaller (closer to one) when the controls were introduced.

Table 1.

Severe Abuse of Offspring: Cox Proportional Hazard Models. (N = 153).

Variable	Model 1			Model 2
Variable	β	SE β	OR	β	SE β	OR
Any political violence	1.15	0.43	3.16**	1.19	0.46	3.27*
Neighborhood solidarity	−0.004	0.05	0.996	−0.02	0.05	0.98
Neighborhood informal social control	0.08	0.05	1.08†	0.09	0.05	1.09†
R’s income (in 10,000 KRW units)	0.003	0.01	1.003	0.004	0.01	1.004
R’s age	0.02	0.01	1.02	0.02	0.02	1.02
Christian	−0.43	0.49	0.65	−0.41	0.48	0.67
No religion	−1.30	0.66	0.27*	−1.34	0.67	0.26*
Korean Worker’s Party	−0.23	0.54	0.80	−0.26	0.55	0.77
PTSD (IES-R-K)				−0.01	0.01	0.99
Alcohol abuse/dependence				0.15	0.15	1.16

Note. Inferences shown are from likelihood-ratio tests, not WALD statistics. OR = odds ratio; PTSD = posttraumatic stress disorder; IES-R-K = Korean version of the Impact Event Scale–Revised.

†

p < .05 *p < .05. **p < .01. ***p < .001.

Discussion

The results illustrate the prevalence and severity of political violence victimization and PTSD among North Korean refugee women. Of the entire sample, 21% reported some political violence victimization; 19% reported severe violence. This was significantly related to abuse of offspring. The small percentage of people reporting minor violence only is unusual in studies of violence. For example, in survey studies of IPV, the number of people reporting severe violence is usually less than half of the number of people reporting minor violence (cf. Emery et al., 2013; McDonald, Jouriles, Ramisetty-Mikler, Caetano, & Green, 2006; Straus & Gelles, 1990), and this also usually holds true for minor versus severe child abuse (Afifi, Brownridge, Cox, & Sareen, 2006; Straus & Gelles, 1990). The fact that only a tiny fraction of the sample reported minor political violence only, while a much larger proportion reported severe political violence forces us to draw at least one of two conclusions: (a) political violence against those who will later defect, when it occurs, is highly likely to be severe, or (b) those who elect to report political violence on the survey are disproportionately more likely to have suffered severe violence. The first conclusion would be true if (a) political violence in North Korea is overwhelmingly likely to be severe rather than minor, or (b) victims of severe political violence are disproportionately more likely to later defect than victims of minor political violence. The second conclusion would be true if (c) victims of severe political violence were more motivated (e.g., by anger) to report the violence. As of May 2015, there are 19,711 female defectors living in South Korea (Ministry of Unification [MOU], 2015). To the extent that our survey is representative of that population, this suggests a minimum of 4,139 of them have suffered some political violence by North Korean authorities and 3,745 of them have suffered severe political violence/been tortured. For nearly one in every five of these victims, the violence at the hands of authorities included sexual assault. This is probably an underestimate.

The extremely high percentage of North Korean refugees with PTSD (63.2%) suggests that the defection process itself is traumatic. Indeed, some defectors report that it is common to resolve to commit suicide if one is intercepted by authorities in China. (Specifically, this information comes from a second, as yet unpublished qualitative interview.) PTSD does not occur in all people as a response to traumatic events, and further, only roughly one third of the proportion of those with PTSD report victimization by political violence. This is to say that illegally crossing borders with the knowledge that they could be shot by border guards, along with living with the possibility of being forcibly repatriated, tortured, and possibly killed, for weeks, months, or years, may be enough to cause PTSD in some of the defector population. The prevalence of PTSD in the sample suggests that more than 12,400 of the female defectors in South Korea may have PTSD; the 32.8% with scores of 40 or higher on the IES-R-K suggests that more than 6,400 female defectors in South Korea may have severe PTSD.

The bivariate results suggest that the high rate of PTSD among refugees puts them at high risk for alcohol abuse/dependence. Results from the CAGE suggest that more than 9,600 female defectors (49%) may be at risk for alcohol abuse and more than 6,400 (32.8%) may be at risk for alcohol dependence. However, neither PTSD nor alcohol abuse dependence were related to severe violence against offspring in any of the analyses.

Political Violence Related to Abuse of Offspring, But Not via PTSD or Alcohol

Of the three hypotheses, only the first hypothesis was supported by the model. Among women cohabiting with their children, 24.5% reported some severe violence against their children since arriving in South Korea. However, this percentage cannot yet be used to produce population estimates because it is not known what percentage of the female defector population resides with their children. Consistent with Hypothesis 1, victimization by political violence was significantly and positively associated with higher odds of perpetrating severe violence against one’s children after entering South Korea. This is consistent with the proposal that the cycle of violence (Widom, 1989) can cross from a sociopolitical context to a family context (Catani, 2010). However, the proposed mechanisms for that transmission, PTSD and alcohol dependence/abuse (Black et al., 2001; Catani, 2010; Saile et al., 2014; Van Ee et al., 2012), do not appear to hold for this sample.

It is possible that the relatively small sample prevented the discovery of a significant mediated relationship; indeed, the effect size of the CAGE was not trivial. However, it is also possible that we do not find PTSD to be a mediator because, in fact, it is not. Other studies testing for mediation between victimization and later perpetration have also failed to find significant relationships (cf. Berlin et al., 2011; Cohen, Hien, & Batchelder, 2008). The psychological disorganization caused by PTSD may be more likely to result in neglect than physical abuse. Another important study in fact found that PTSD was associated with less child abuse when the parent had been abused as a child (Pears & Capaldi, 2001). This last study suggests that the effect of a parent’s PTSD on child abuse may be in opposite directions depending on the presence or absence of some third factor. If that moderating (R. Baron & Kenny, 1986) factor remains unknown and hence uncontrolled for, the bidirectional effects of PTSD will tend to cancel each other out. It is this last possibility that should be cause for concern and must be explored in future research. Another potential mechanism explaining the relationship between political violence and perpetration of violence against one’s children is IPV (Catani, 2010). Given that this study adds to the ambiguity of previous findings on PTSD, serious and comprehensive conceptual work is warranted before further empirical study of the link between PTSD and abuse of offspring.

Perceived Neighborhood Informal Social Control: Not What We Would Expect?

Although the informal social control scale of the collective efficacy measure (Sampson et al., 1997) was marginally associated with abuse of offspring, the direction was opposite to that hypothesized. This finding joins a growing number of ambiguous findings with respect to collective efficacy and violence within the family. Much of this research finds not only no relationships between the collective efficacy measure of informal social control (cf. Molnar et al., 2003), but significant relationships opposite in direction to those predicted (cf. Emery, Wu, & Tsolmon, 2015).

Emery, Trung, and Wu (2015) argue that the ambiguity in findings for relationships between family violence and the collective efficacy measure of informal social control occurs because of heterogeneity between neighborhoods. Nontraditional neighborhoods, they claim, see violence within the family as crime; hence, the informal social control of street crime and disorder by neighbors will be negatively correlated with family violence. Traditional neighborhoods, on the other hand, view family violence as a form of social control. Hence, the collective efficacy informal social control will be positively associated with family violence in such neighborhoods. Emery et al. (2015) recommend obviating the problem by asking directly about informal social control of child maltreatment using a scale they developed (informal social control of child maltreatment [ISC-CM]). Further research using multiple measures should further examine the relationship between community characteristics and violence against offspring in the defector community.

Effects of Religion

The sample had a very high percentage of Christians (60%). This is fully twice as high as the percentage of South Koreans who are Christian (29.2%; Moon, 2011). Although this number may appear to be stunningly high for defectors from a country whose official ideology is that religion is the opiate of the masses, it is less surprising for those familiar with the workings of the underground railroad that evacuates North Koreans from China. So many of the activists who operate the underground railroad are Christian missionaries (cf. Peters, 2015) that North Korean defectors are often instructed to “look for a building with a cross” (Kim, 2015; p. 221) to get help upon arrival in China. Needless to say, selflessly risking your freedom and possibly your life to help the defenseless is likely to impress those whom you help. Although the coefficients for both Christians and those selecting “no religion” were negative with respect to severe violence against offspring, only no religion was significantly associated with less violence. This somewhat intriguing finding requires more research.

Limitations

This study is cross-sectional, nonexperimental, and hence noncausal, and subject to reporting biases. There is no comparison sample of men. The sample size was relatively small; hence, null findings for Hypotheses 2 and 3 may have occurred because of a lack of statistical power. The small sample size also necessitated an outcome measure that combines both adult and minor children as offspring. Hence, the study cannot be seen as a study of child abuse so much as of family violence. On the other hand, given minor children are likely to have less exposure to (time in) South Korea, they may have a smaller effect on the results. And indeed, as discussed in the analytic issues section, whether the child was a minor was not significant and had no effect on the results. Our results can only be generalized to the defector population in the greater Seoul area, and represent a first study requiring replication. It is possible that selection bias, in the form of a willingness to talk about and endorse violence, explains the relationship found between political violence and violence against offspring. It is also possible that in some cases mothers are suffering from abuse by adult children. Finally, it is important to note that the defector population is a highly selected one, and cannot be used to generalize to the larger population in North Korea.

Conclusion

Although many populations have suffered from severe violence and trauma, as Ms. Pak’s experiences make clear (see Appendix), the blend of totalitarian control with its omnipresent threat of severe violence and execution, the terrifying ordeal of escaping the state, and the potential culture shock of those exposed to decades of misinformation renders the experiences of North Korean defectors unique in the world. It is vitally important to understand how to assist and empower this population, both for its own sake and to better understand the future needs of Northerners in a reunified Korean state. This article has provided concrete illustration of the prevalence of political violence. It shows that the defector population is severely affected by PTSD, alcohol abuse/dependence, and abuse of offspring. Abuse of offspring is linked to victimization by political violence, but that link is not explained by PTSD or alcohol abuse/dependence. Substantial conceptual work around PTSD, political violence, and family violence is much needed, as is rigorous research if we are to better understand and help one of the most oppressed populations on the planet.

Footnotes

Appendix

Acknowledgements

We thank IsraAid for supporting the training of the research team and the participation of Dr. Lieblich and Jennifer McCann for translation of the oral history.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: We gratefully acknowledge the support of an SSRC grant (890-2013-0043) from the Canadian government.

Notes

Author Biographies

Clifton R. Emery is an associate professor in Social Work and Social Administration at the University of Hong Kong. Previously, he was an associate professor of Social Welfare and associate director of the Yonsei Institute for North Korea Studies at Yonsei University in Seoul.

Jieun Yoo is a doctoral student at Yonsei University in Seoul. Her research focuses on the well-being of North Korean refugees.

Amia Lieblich is a professor emeritus at Hebrew University and a professor at the Academic College of Tel Aviv. She is a prominent expert in narrative studies in the field of psychology.

Randall Hansen is a political scientist and historian at the University of Toronto. His research focuses on migration, citizenship, and refugees.

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