Questions We Should Be Asking
What questions do churches and mission agencies need to be asking about the mental health and mental health struggles of the missionaries they support and send out to other countries and cultures? This is a question that I have often pondered in my member care role at OMF as I talk to missionaries every week.
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I lived in Asia for over 25 years, much of that time as one who struggled with mental health concerns. I still have mental health issues. I cringe as I write that: “mental health issues.” It seems like a lot of language surrounding mental health perpetuates negative stereotypes. But I’d rather say I have “issues” than say I still have mental health problems or a mental illness!
Learning to Talk About the Pain
Most of us seem to be like children when we try to talk about our mental health. Corinne Gnepf describes how children want to talk when they are struggling emotionally, but they “are not able to because they have not developed the language skills and vocabulary yet to share about their experiences and feelings.” Adults use play therapy with children to help them express in play “what they cannot verbalize because their words are not adequate.”
But, how do we help missionaries express mental health concerns when their words are not adequate? Actually, Gnepf suggests that most adults with mental health issues “had adverse childhood experiences that were never adequately addressed.”
Maybe it is easier to talk about questions and statements that are not helpful. Here are 5 questions not to ask, and why:
1. “Do you think God wants you to be taking anti-depressant medication?” This question suggests you know God’s desires for the other person. If you’re truly seeking a theological explanation, approach the topic sensitively within an intentional conversation.
2. “Should you go back if life there is so hard?” “Should” statements don’t encourage vulnerability. This question oversimplifies the issue without seeking to understand the missionary’s perspective.
3. “Are you depressed?” While this is not necessarily a bad question, it can make a person feel even worse about themselves if it is asked outside of relationship.
4. “If so many missionaries are depressed, why won’t they talk to me, their missions pastor?” If you are the person in a position to give or pull support talking about these struggles can be challenging.
5. “Should we send out a missionary with mental health problems? We are not a hospital here.” Again, this question does not communicate sympathy, empathy or encourage vulnerability.
Even though one in five Americans struggle with a mental disorder in any given year, and half of all Americans have such disorders at some time in their lives, the stigma remains. The National Alliance on Mental Illness (NAMI) has produced helpful infographics on mental health struggles in America.
This mental health stigma is especially true for missionaries, many of whom live in environments that appear designed to surface unresolved issues.
A mental health ministries newsletter says, “Stigma is toxic to mental health because it creates an environment of shame, fear and silence that prevents many people from seeking help and treatment. The perception of mental illness won’t change unless we act to change it.”
What Churches and Friends Can Do to Help Missionaries Face Mental Health Challenges
1. Be aware that maintaining mental health is a growing problem for missionaries. I think it has always been a problem but now we are talking about it! I am now more surprised when missionaries have never had mental health struggles than when they do.
It’s challenging to obtain current data about the mental health of missionaries, but the statistics we do have seem to support current trends.
The book Too Valuable to Lose (1997) shares findings from a ReMAP study (the Reducing Missionary Attrition Project) conducted by the Mission Commission of the World Evangelical Fellowship (WEF). Among those surveyed, problems related to mental and/or physical health were the fourth most common reason that missionaries stopped serving.
Others have made similar observations. In a recent workshop I conducted, a medical doctor admitted that at least 50 percent of the missionaries he sees have been treated for depression.
Psychologist and missionary, Lisa McKay writes, “I would guess that those who live overseas entertain a higher chance of experiencing significant mental health problems, marital challenges, or substance abuse issues than those who remain on home soil.” In addition to depression, missionary mental health concerns can include burnout, exhaustion, anxiety, grief and PTSD resulting from trauma.
2. Offer a safe place, sufficient time and a listening ear to help your missionary friend process what is going on. Craig Thompson, a former missionary in Taiwan, describes how not everyone can offer the right environment and culture that is necessary for an honest and vulnerable debrief to take place. If that is the case for you or your church, there are excellent independent member-care individuals and organizations.
Two years ago, after 30 years as missionaries, my wife and I attended a week-long debrief. It helped us identify deeply rooted, painful words and pictures and bring them to the cross. Actually, we have used art therapy to debrief groups of missionaries, helping them to discover in pictures what could not be expressed in words.
3. Create a care policy at your church that make funds available for missionaries needing mental health assistance. Communicating such a policy to missionaries helps to dispel some of the stigma of mental health struggles.
My wife and I have benefitted on many occasions by seeing counselors paid for by our church. Friends may want to offer financial help to missionaries when their churches are unable to do so. We are grateful that OMF’s Mental Health Fund is available for returning missionaries who need to cover counseling costs or attend needed debriefing events.
4. Be honest about your own mental health struggles. Sharing your own journey with depression, anxiety or other mental health concerns may create a safe place for missionaries to talk. You may be surprised at the conversations you will have if you can open the door and step aside. As you share and care, “those who are weak and lame will not fall but become strong”
David and his wife Doris have served with OMF for over 30 years, and spent the first 26 of those years in the Philippines. David is an avid tennis player and enjoys exploring new places with Doris. They are passionate about training others to teach adults and to care for missionaries.
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