Health and Stress
Health from a Christian Perspective
Maintaining Health
Most Important: Love God
Second Most Important: Love Others as Yourself
Third Most Important: Love Yourself
Stress
Coping with Stress
Culture Stress
Change Stress
Separation Stress
Traumatic Stress
Part 1 of Chapter 14 in Dewey’s introductory text is relevant.
(Chapter 14—Stress and Health, in Myers 8th edition is also relevant.)
The previous chapters in this book have been about the major academic areas psychology has studied, such as development, awareness, intellect, motivation, and emotion. This chapter turns to some of the areas to which psychology has been applied, health and stress.
Psychology is the study of behavior and mental processes, and some of the greatest health risks are behaviors. A leading cause of illness and premature death is smoking tobacco, a behavior. Since the 1960s, smoking in the USA has steadily declined for about four decades as psychologists studied why people began smoking, why they did not stop smoking, and how smokers could be helped. This change in behavior has been a major victory in public health as the percentage of smoking adults had been cut in half.
Unfortunately, during this same time, the number of adult Americans who are obese has more than doubled (http://www.medicinenet.com/script/main/art.asp?articlekey=108401). This change is also the result of behaviors, eating more calories while burning fewer of them. Also, unfortunately, the smoking rate apparently stopped dropping in about 2005, and about 20% of adults continue to smoke, causing about 440,000 premature deaths each year (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a3.htm?s_cid=mm5935a3_w). Much remains to be done in changing these harmful behaviors.
Stress is also a major factor in health. Stress makes people more susceptible to disease by compromising the immune system so that they cannot fight off illness. It also increases the probability of such major killers as heart disease and cancer. Many helpful links to items about stress are on (http://www.nlm.nih.gov/medlineplus/stress.html).
Health from a Christian Perspective
Health fits into our Christian perspective as shown in the lower part of Figure 8:1 (Physical….Health). As noted previously, our bodies are similar to those of animals. Research with animals has led to major improvements in both human health and veterinary care.
Figure 8:1 Health from a Christian perspective.
HUMANS
Created . . . . . . . . . . . in the. . . . . . . . . Image of God
Like Animals Like God
Overt Behavior. . . . . . Definition. . . . . .Mental Processes
Understand. . . . . . . . . Goals. . . . . . . . .Make people
Creation like God
Psychoanalysis. . . . . . Systems. . . . . . .Humanistic
Behaviorism Psychology
Experimental . . . . . . .Methods . . . . . . Descriptive
Physical. . . . . . . . . . .The Person . . . . Spiritual
Immaturity. . . . . . . . .Development. . .Maturity
Sensation . . . . . . . . . .Awareness . . . .Perception
(States of Consciousness)
Learning . . . . . . . . . .Intellect . . . . . .Cognition
(Memory)
Biological . . . . . . . .Motivation. . . . .Cognitive
Physiological. . . . . .Emotion. . . . . . .Conscious
Physical . . . . . . . . . Health. . . . . . . .
This chapter primarily includes material about physical health and fitness and coping with stress. The next chapter considers primarily material about mental health.
Maintaining Health
A missionary asked, “What do you do when there are so many things to do, and not enough people to do them, and there’s no way to prioritize because everything’s a priority? This seems like a no-win situation and can lead to quick burnout. Because of such a high level of ministry responsibilities on the field, there’s no time for rest, renewal, or recreation, much less trying to be proactive and keep the body in shape, or to have quality time with the family.” In this one paragraph the missionary has touched on the most important factors relating to maintaining mental and physical health.
The missionary was right in talking about priorities. Some people may say “prioritize your schedule,” but it is much more important to “schedule your priorities.” When individuals prioritize their schedules, they constantly feel under great stress, but they may accomplish little of lasting value. They may become those who are constantly putting out fires, rather than preventing the fires in the first place. Prevention is better than cure.
Most Important: Love God
Jesus was asked this question in Mathew 22 when an expert in the law asked him which commandment was the greatest. Jesus told him to love God with all his heart, soul, and mind. Of course, Jesus was quoting Deuteronomy 5 where Moses had told the people to love God with all their soul, heart, and strength. The command to love God motivationally, emotionally, physically, and cognitively has been around for centuries, and it is still valid today.
Some may say that this command is certainly relevant to spiritual condition, but what does it have to do with mental and physical health? Consider the following quotes from an article by Harold Koenig in the Journal of the American Medical Association in October, 2000. (http://jama.ama-assn.org/cgi/content/full/284/13/1708).
· “More than 850 studies have now examined the relationship between religious involvement and various aspects of mental health. Between two thirds and three quarters of these have found that people experience better mental health and adapt more successfully to stress if they are religious.”
· “An additional 350 studies have examined religious involvement and health. The majority of these have found that religious people are physically healthier, lead healthier lifestyles, and require fewer health services. The magnitude of the possible impact on physical health—particularly survival—may approximate that of abstaining from cigarette smoking, or adding 7 to 14 years to life.”
The best thing for maintaining mental and physical health is to place a relationship with God on the schedule first. This should be time for at least the following:
· Spending time with him
· Talking to him in prayer
· Listening to him through meditating on his Word
· Seeking forgiveness and reconciliation
Like missionaries, Daniel lived and worked in a culture different from the one in which he was reared. With his packed schedule of doing an outstanding job as one of the three top administrators in the nation, one might think that Daniel would not have much time for God. However, his custom was to be on his knees thanking God for what he had done and asking for his help three times a day (Daniel 6).
Second Most Important: Love Others (As Yourself)
When asked what was most important in Matthew 22, Jesus went on to say that the second most important was much like it, to love your neighbor as yourself. Of course, this had also been around for centuries as Jesus was quoting from Leviticus 19. This is especially relevant for missionaries as Jesus emphasized in John 13:34-35, that people will know we are his disciples by how we love each other.
No recent evidence is needed to support this. We have known for years that a social support system is one of the most important factors in maintaining health (http://www.personalityresearch.org/papers/clark.html). This includes a variety of people. The specific persons depend on a person’s situation in life, but probably include some of the following.
· Your spouse
· Your children and teenagers
· Fellow missionaries
· Nationals
· Aging parents
· Etc.
Maintaining mental and physical health means placing relationships with fellow Christians as the second thing on the schedule. This should be time for at least the following:
· Spending time with them
· Talking to them
· Listening to them
· Seeking forgiveness and reconciliation
When faced with a crisis of life and death proportions, Daniel had a long-term relationship with three other expatriates to whom he could turn to ask for urgent prayers. Their prayers were answered (Daniel 2).
Third Most Important: Love Yourself
Jesus said we should love our neighbor as we loved ourselves. Like loving God and loving our neighbor, loving ourselves means at least the following:
· Setting aside some time for yourself
· Thinking correctly about yourself (your self-talk, as a person made in God’s image)
· Generally taking care of God’s temple (our bodies)
God dwelt in the tabernacle, then in the temple, and now dwells in us. The apostle Paul pointed out that our bodies were the temple of the Holy Spirit so we should honor God with our body (1 Corinthians 6:19-20). So the question becomes, how are we doing in taking care of God’s temple? That includes at least the following:
· Eating right. At creation (Genesis 1) God gave us all the seed-bearing plants and fruit trees to eat—that is grains, vegetables and fruits. That is very much like the recommendations of the US Department of Agriculture’s food pyramid (http://www.mypyramid.gov/). After the Fall when we began eating meat, God put a number of restrictions on what kinds of meat and what parts of the animals we could eat. As a college student in a culture very different from home, Daniel questioned the food in the cafeteria. He proposed and conducted an experiment showing that vegetables and water are healthier than rich food and alcohol, an experiment repeated with the same results many times over the centuries (Daniel 1).
· Getting rest. God instituted a day of rest in each week in the Ten Commandments (Exodus 20). This was a day in which no one in the household was to do any work, a day of restoration in each week. Jesus later pointed out that the Sabbath was made for us, not us for the Sabbath (Mark 2). New research points out that sleep (rest) is an essential component of a long and healthy life (http://www.health.harvard.edu/press_releases/importance_of_sleep_and_health). Although two kings had difficulty sleeping (Daniel 2 & 4), there is no indication that Daniel ever had that problem even though his circumstances were far more dangerous than those of either king.
· Exercising regularly. Although not mentioned as much as food and rest, Paul wrote that physical training is of some value (not as valuable as godliness, which is valuable for both this life and the next). When he wrote that, there were not so many “labor saving” devices so that people got sufficient exercise in the tasks of daily living. Today we do not, so it is best for us to schedule exercise in our day. We have to stretch things somewhat to find an example of exercise in the book of Daniel. Although we do not recommend walking in fiery furnaces (Daniel 3), we do recommend walking, running, playing a favorite sport, etc. past the point of perspiration for at least a half hour several times a week (http://www.mayoclinic.com/health/exercise/HQ01676).
Some may wonder what eating, rest, and exercise have to do with mental health. In general psychology the three major categories to help cope with stress:
Six characteristics of happy people are that they tend to have the following:
For further information about specific topics in health psychology click on the following links to parts of Chapter 14 in Dewey’s on-line text.
Stress
From the time they first followed Jesus, Christian workers have faced great stress. Soon after they were called and appointed to ministry, the disciples found their ministry to the crowds so pressing that they did not even have time to eat (Mark 3:20). Nearly a year later, the stress was still so great that they did not have time to eat, and they could not escape the crowds even when they tried (Mark 6:31-33).
Paul, first missionary to the Gentiles, listed some of his stressful situations for us.
· Worked hard, labored, toiled
· Imprisoned repeatedly
· Beaten, lashed, stoned
· Constantly on the move
· Shipwrecked, a night in the sea
· In danger from own countrymen
· Danger in the city, danger in the country
· Danger from “false brothers”
· Went without sleep
· Hungry, thirsty
· Cold, lacked clothing
· Pressure of the concern for the churches
(2 Corinthians 11:23-28)
Stress is a process involving environmental events (stressors), our own reactions to the stress, and the resources we use to cope with the stress. Think of this like the bills received in the mail. Example 1: You have $500 in the bank (resources), and you receive 20 bills totaling $800 due immediately (events), so you panic (high stress reaction). Example 2: You have $5000 in the bank (resources), but you receive 20 bills totaling $800 due immediately (events), but you have little concern (low stress reaction). Note that the stress felt depends both on the events and on resources. So to cope with the stress either decrease the stressful events or increase resources or both.
Some stressors (events) are always present in the background, such as noise, heat, insects, poverty, discrimination, minority status, and we are not even aware of them. Other stressors are the almost daily irritating hassles of life, such as traffic jams, waiting in lines, fender benders, struggling with language in new situations, loneliness, computers down, difficult co-workers, and bureaucracy (http://www.nlm.nih.gov/medlineplus/stress.html). People feel the strain whenever these occur. Still other stressors are major life changes experienced by nearly everyone at some time, such as death of a family member, moving to a new church or field of service, serious illness or accident, and divorce of close friends (or yourself). People struggle with them when they happen. Finally, some Christian workers experience life-threatening stressors, such as assault, tornadoes, deadly diseases, earthquakes, evacuation, floods, or war. The effects of these traumas can be long lasting.
Even positive things, such as marriage, the birth of a child, and promotion can be stressful. They require change or adaptation and draw on a person’s resources.
Some people react to stress with physical symptoms, such as headache, stomachache, diarrhea, and so forth. Other people react with psychological symptoms such as anxiety, difficulty concentrating, depression, and so forth. Still others react with behavioral symptoms such as driving too fast, picking fights, overeating, going on spending sprees, and so forth. Stress can affect many areas of our lives.
Coping with Stress
Remember that coping with the stress demands either a decrease in the stressful events or an increase in resources for coping with the stress or both.
· Changing the time you do things may decrease the stressors. Shopping at a different time may decrease the traffic jams, result in fewer lines at the market, and make a fender bender less likely.
· Stress is cumulative, so try to space out stressful events rather than clumping them together. For example, if you have to deal with a difficult co-worker, do not schedule the meeting right after a shopping trip that is likely to involve long lines and traffic jams.
· Background stressors may sometimes be decreased with things at hand. If noise is constantly draining away your energy, listening to soothing music through a set of headphones may eliminate that source of stress.
· Anticipating and preparing for stressful situations serves to inoculate you against the stress reactions. If you are in a situation that may call for an evacuation, develop a plan for knowing the time to evacuate, evacuation routes, and alternative means of evacuation. If kidnapping is likely, take steps to avoid it, and learn how to act if kidnapped.
· God is our major resource for coping with stress. Do not neglect reading God’s Word because the Holy Spirit often illuminates passages of Scripture relative to the stressful situation you are in. Search the Scripture for what God has already said about your situation.
· Pray for yourself in stressful times. Prayers of intercession for others are wonderful, but at times you need prayers of petition for yourself. Christian workers who spend much time in intercession need not feel guilty for petitioning God for their own needs.
· Meditate after you have asked God for direction. Listen for the answer. Sometimes the Spirit uses a memorized passage of Scripture, a word from a fellow Christian, or an event that occurs in your life to direct your coping efforts.
· Ask others to pray for you. These may range from unspoken requests to detailed explanations. Ask people to commit to pray for you by name during specific days or specific times of great stress.
· Research shows that social support is the single most important human means of increasing resources to combat stress. The fellowship of believers in Christ is an invaluable source of strength for the most difficult stresses you face.
· Use your problem-solving skills to help reduce your stress. Read about the stressful area in your life. Talk with others who have experienced the same types of stress. Brainstorm solutions yourself, comb books for ideas, and ask others for possible solutions. Select a potential solution, try it out, and evaluate whether or not it works; then adjust it if necessary or try a new solution. Repeat the process as often as necessary.
· Take time for a healthy diversion. You may need time to cool off a while or recharge before trying to cope any more. You may need a time to rest in addition to your Sabbath each week. Spend some time on reading, listening to music, enjoying a hobby, playing a favorite sport, or doing other things that you enjoy.
· On the other hand, don’t procrastinate. Procrastinating can also cause increased stress, so set reasonable deadlines for yourself to complete your personal and professional responsibilities.
· Get some exercise. God gave us reactions to stress that prepare us for flight or fight. Running, swimming, walking rapidly, or playing active sports are analogous to flight.
· Take time for adequate rest and relaxation. Remember that God made the Sabbath for us as humans, and be sure you take that day of rest, relaxation, and restoration each week, whether it is on Sunday or another day of the week.
· Sleep is a major coping resource for dealing with stress. Take time to sleep, and if you are having difficulty sleeping, learn about ways to get better sleep.
· Monitor self-talk. Be sure you have helpful thoughts so that you are an encouraging “coach” to yourself. A mean, cruel, discouraging coach may say something like, “That is really a dumb idea. It’ll never work. There’s no point even trying it.” A caring, hopeful, encouraging coach would say, “I can do all things through Christ who strengthens me.”
· Pour out your soul. Express your thoughts and/or feelings in any of several ways. These include journaling, writing letters to friends, praying, composing poems or songs, singing songs or reading Psalms that reflect your thoughts or feelings.
· Use relaxation techniques of stretching and/or breathing, and/or imagining one of your favorite places as described in our anxiety brochure.
· Learn how to appropriately say, “No,” to reduce lower priority demands on your time. God’s people can appropriately refuse the requests of others. At times Jesus himself dismissed the crowd and went off by himself to pray, and he even often withdrew for prayer when people came to hear and be healed (Matthew 14:22-23, Luke 5:15-16). He chose to say, “No,” to one kind of request to meet a higher priority.
· Delegate some of the responsibility to someone else, such as Jesus did when he sent out the disciples (Matthew 10).
· Ask for what you need from others. Jesus told his followers to ask, seek, and knock to get things they needed (Matthew 7). Asking for help from others may be a blessing to them. Sacrifices on their part may be spiritually helpful to them.
For more information about stress, see the many links at http://www.medicinenet.com/stress/article.htm.
Also click on the following links to parts of Chapter 14 in Dewey’s on-line text.
Culture Stress
Missionaries often feel tired, anxious, discouraged, isolated, angry, and homesick but cannot think of any reason why they should feel that way. They have been on the field for several years, but these feelings always seem to be there, increasing and decreasing. They wonder what could be causing them. It could be culture stress. They might say, “I know about culture shock, but what is culture stress?” What is the difference between culture stress and culture shock? What causes culture stress?” What are its effects? What can be done about it? Can it be prevented? Here are answers to some of these questions.
What is culture stress? Culture stress is the stress that occurs when people change to a different way of living in a new culture. It is what they experience as they move beyond understanding the culture to making it their own so that they accept the customs, becoming comfortable and at home with them. If they are trying to become a real part of the culture, to become bicultural, they are likely to experience culture stress as they assimilate some of the conventions to the point that they feel natural.
Of course, some who live in a “missionary ghetto” may experience little culture stress. Early modern missionaries often lived in compounds, which were physically identifiable as missionary ghettoes. Today, even though some missionaries live physically in a national community, they have primarily relationships with other missionaries. A missionary subculture may develop which becomes focused on itself and preoccupied with group concerns so that the missionaries experience little culture stress. Those trying to become an integral part of the national community are the ones who experience the greatest culture stress.
How is culture stress different from culture shock? As culture shock was originally defined (honeymoon, crisis, recovery, adjustment), culture stress was considered to be a part of it. However, the word “shock” connotes something sudden and short-lived. Thus, many people today think of culture shock as the crisis stage (confusion, disorientation, and lack of control) and the recovery stage (language and cultural cues more familiar). These stages begin when the new missionary leaves the enthusiastic, exciting, optimistic tourist mode, usually beginning in a few weeks, worsening for about six months, and basically ending within a year or two.
Culture stress is the adjustment stage in which people accept the new environment, adopting new ways of thinking and doing things so that they feel like they belong to the new culture. This takes years, and some missionaries never complete it. This may go on and on.
What causes culture stress? Many factors enter into the amount of culture stress one feels while living in another culture. Here are some of the major ones.
· Involvement. The more you become personally involved in the culture, the more culture stress you may feel. The tourist, the business person or someone from the diplomatic corps not committed to being the incarnation of Christ in that culture, may feel little culture stress.
· Values. The greater the differences in values between your home culture and your host culture, the greater the stress. Values of cleanliness, responsibility, and use of time may cause stress for years. Cultures may appear similar on the surface but have broad differences in deeper values.
· Communication. Learning the meanings of words and rules of grammar are only a small part of being able to communicate effectively. The whole way of thinking, the common knowledge base, and the use of non-verbals are necessary and come only with great familiarity with the culture.
· Temperament. The greater the difference in your personality and the average personality in the culture, the greater the stress. A reserved person may find it difficult to feel at home where most people are outgoing extroverts. An extrovert may never feel at ease in a reserved culture.
· Entry and re-entry. Most missionaries, unlike immigrants, live in two cultures and may never feel fully at home in either. Every few years they change their place of residence, never fully adapting to the culture they are in at the time.
· Children. The more your children internalize the values of your host culture and the more you realize that they will be quite different from you, the more stress you may feel.
· Multinational teams. Although effectiveness of the ministry may increase, working together in your mission with people from cultures other than your host culture often adds to the culture stress.
What are the results of culture stress? Many of the results of culture stress are the same as those of any other stress.
· Feelings of anxiety, confusion, disorientation, uncertainty, insecurity, and helplessness
· Fatigue, tiredness, lack of motivation, lethargy, lack of joy
· Illness (stress suppresses the immune system), concern about germs, fear of what might be in the food
· Disappointment, lack of fulfillment, discouragement, feeling hurt, feeling inadequate, feeling “out of it”
· Anger, irritability, contempt for the host culture, resentment (perhaps toward God), feelings of superiority or inferiority
· Rejection of the host culture, the mission board, even of God.
· Homesickness
· Etc.
Some people seem to believe that they can adapt to anything, even continual stress, without it hurting them. It just does not work that way. In the 1930s, stress researcher Hans Selye put rats under many different kinds of stress. He kept some in a refrigerator, others in an oven, made some swim for hours a day, injected others with chemicals, others with bacteria, etc. The results were almost always the same. The rats went through the same cycle. First was the alarm reaction in which resources were mobilized. Then came the resistance stage in which it seemed like an adequate adjustment had been made. But if the stressor was intense enough or long enough, sooner or later the stage of exhaustion occurred when the resources were depleted, and the rats collapsed. If the stressor continued, they died. Many have seen people who seemed to be making an adequate adjustment suddenly break down. Uninterrupted stress of enough intensity leads to exhaustion sooner or later in most individuals.
What can be done about culture stress? Much can be done to decrease culture stress and make it manageable.
· Recognition. Realize that culture stress is inevitable for those attempting to become at home in a host culture, and look at what factors cause you the most stress.
· Acceptance. Admit that the host culture is a valid way of life, a means of bringing Christ to the people who live in it.
· Communication. Beware of isolating yourself from everyone in your home culture, those with whom you can relax and be yourself, those with whom you can talk.
· Escape. You need daily, weekly, and annual respites. God made the Sabbath for people, so be sure you keep it. Reading, music, hikes, worship (not leading it), and vacations are necessary.
· Identity. Know who you are and what you will allow to be changed about you. Acculturation inherently involves changes in your personality, so determine the unchangeables.
· Activity. Since stress prepares you for fight or flight, and as a missionary you can probably do neither, you must have some physical activity to use that energy. Sports, an exercise plan, and active games with family or friends can reduce stress.
· Befriend a national family. Get close to a national family just for fun, not to learn or evangelize. Learn how to have fun in that culture.
Can culture stress be prevented? The answer to this is simple and short. No! Stress in general cannot be prevented because we all experience it in life. Trying to become at home in another culture is always a challenging venture.
However, like other stress, it can be managed, decreased to a level with which you can live; stress without distress. The factors that help missionaries cope with stress are summarized in the three enduring things mentioned by Paul at the end of 1 Corinthians 13.
· Faith. In addition to faith in God, faith in yourself as a person created in God’s image and called into his service will help you cope.
· Hope. Rather than feeling helpless, having not only the hope of eternity with God, but also hope in your future, knowing that he has good plans for you, will help you cope.
· Love. Finally, having both God’s love and the love of his people to give you support in the stressful situations you face daily, will help you cope.
Stress is a part of life, and everyone learns how to manage it or suffers the consequences. Remember that not everyone can become at home in two cultures, and it typically takes a very long time for those who do it successfully.
Change Stress
Jonah faced change in his life when God told him to become the first cross-cultural missionary by going east and confronting Nineveh (Jonah 1). Jonah went west. When he finally obeyed, the people in Nineveh responded to his message and repented. However, rather than rejoicing, Jonah became disillusioned and angry because of God’s grace and compassion for a despised people group. Though succeeding outwardly, he failed inwardly.
At the beginning of his second term of missionary service (Acts 15) Paul suggested to Barnabas that they go back and visit people where they had been before to see how everyone was doing. However, as recorded in the verses immediately following that, Paul wound up going with Silas (rather than Barnabas), going to Macedonia (rather than to Asia), and meeting new people (rather than visit people they had seen before). Paul adapted to the changes and became a successful missionary, both inwardly and outwardly.
Know that change happens. Even if life seems to be predictable and stable at the present time, sooner or later missionaries will probably have to cope with such changes as Paul did in Acts 15-16. Someone has said that the only thing that does not change is change itself. This has been true of cross-cultural missionaries from the beginning. Some people thrive on change and seek it out, but others dread change and struggle through it when it comes. Most people want enough change to keep life interesting, but not so much as to make them uneasy.
What can one do to get through those inevitable changes that happen in life? Of course, change itself is not the problem; the problem is in how we deal with it when it happens. Here are some ways to cope.
Anchor to a point of stability. The Bible is clear that our point of stability is in God himself.
· I the Lord do not change… (Malachi 3:6).
· He will never leave you or forsake you (Deuteronomy 31:6).
· Jesus Christ is the same yesterday, today and forever (Hebrews 13:8).
· I am the alpha and Omega, the First and the Last, the Beginning and the End (Revelation 22:13).
To successfully adapt to change, we must keep our commitment to God up-to-date. Without this secure anchor, we may become like Jonah rather than like Paul.
Expect emotions. When people face change, and emotions of all kinds come flooding in, they may say, “I don’t understand why this has affected me so much.” One moment they are laughing, and the next they are crying because they are normal. Nearly every emotion occurs during change. Here are some of the most common, illustrated in Paul’s life as he experienced great change at the end of his third term.
· Uncertainty about the future may result in fear, worry, anxiety, apprehension, dread, self-doubt, or panic. Paul said he was going to Jerusalem, not knowing what would happen to him there (Acts 20:22).
· Being forced to change may result in stress, anger, frustration, or hostility. Paul felt compelled by the Spirit (Acts 20:22).
· Looking at what you are losing may result in sadness, depression, despondency, or despair. Paul wept as he was about to leave (Acts 20:36).
· Considering new opportunities may result in joy, elation, or happiness. Paul said he looked forward to finishing the course and completing his task (Acts 20:24).
Note that Paul acknowledged his emotions, and this allowed him to cope and continue with his work. These emotions may overlap, or some find themselves on a pendulum swinging back and forth between them. We need to acknowledge and express emotions as we hold on to our anchor. Trying to build a dam to hold them inside may result in the dam bursting and the emotions spilling out.
Take time to grieve. Losses are real. It is all right (even necessary) to do all the things Paul and the elders from Ephesus did as they departed from friends in Acts 20:37-38.
· Wept
· Embraced
· Kissed
· Grieved
Coming to terms with losses and adjusting to change takes time. Trying to rush through without getting closure on what missionaries are leaving will make it hard to enter their new roles.
Swim with the current. When individuals feel like they are being swept along in a torrent of change, they should swim with the current as long as it is not taking them away from the work God called them to do. If a person is called to put God’s word into the language of the people, he may insist on using a quill pen and parchment to make copies of it (or even a Gutenberg press or even moveable type). However, learning to use the computer will make work more effective.
We have proverbs expressing this.
· When the wind blows, don’t build windbreaks; build windmills.
· If life gives you lemons, make lemonade.
· When the river flows, don’t just build a dam; put in a hydroelectric generator.
Swimming upstream may simply exhaust a swimmer while going with the flow may accomplish his purpose. Stubborn rigidity may be defeating while flexibility may get missionaries through the torrent. The only time not to harness the energy of the current is if it is carrying them away from what God has called them to do. In this case, they may have to swim across the current and get out of the water.
Find friends. Pride makes some people try to cope alone, a most difficult thing to do. Sharing with other people is a great help. Bravery may mean having the courage to ask for help when needed. Here are some people who can swim with you or throw you a life jacket.
· People who have been through the change you are facing. They may have helpful suggestions to cope or mentor you through those changes.
· Your family (missionary, church, and biological) cares, so someone in that family will listen to you and help.
· Close friends whom you trust deeply will allow you to express your fears and frustrations, and they may offer ways to cope.
· Member care people in your organization can help you function through its changes.
· Pastors or counselors with no connection to your organization can bring an outside objectivity not found within your agency. When facing new dangers in Jerusalem, Paul called on the elders of the Ephesian Church (Acts 20:17).
Focus on the good. Every change has both good and bad in it. Those in ministry may be leaving friends, but they will also make new friends. They may have to leave a task they know well, but they will also learn to do something new. Focus on good new things.
All of us have the choice of looking back at what we are leaving or looking ahead to where we are going. Paul wanted to finish the course, to complete the task. Keeping attention on God’s call keeps us moving in the right direction. Concentrating on him and his goodness as our point of stability, we can navigate change. Remember that every glass that is half empty is also half full. Optimists may make as many mistakes as pessimists, but they have a lot more fun getting where they are going.
Take one step at a time. When missionaries begin to feel overwhelmed by the size of the change, they need to break the experience up into smaller parts. It may seem hopeless to walk across the continent, but many people have done it, always one step at a time.
The new assignment may be to begin a school in a village that has never had one. While we all went to school, starting one may be a task that seems hopeless. Take it step by step.
· Find a place to meet.
· Select a curriculum.
· Hire some teachers.
· Etc.
Take care of yourself. During change some people forget to care for themselves. They need to care of themselves in every way, spiritually, socially, physically.
· Have a daily devotional time.
· Spend time daily with spouse and family.
· Schedule time with other missionaries.
· Eat good healthy meals.
· Exercise several times a week.
· Get rest by keeping a Sabbath.
Remember that it will end. Every stream or river ends at a lake, sea, or ocean sooner or later. Likewise, every torrent of change comes to an end, and then people will experience feelings of stability and normalcy again. Keeping this in mind is a deterrent to feeling helplessly swept along in the current.
When people move to a new position in a different city, they may ask how long it will be before it really feels like home. Although some people make it sooner, it takes a full year for many to adapt to the change. It may not feel like home until missionaries have gone through every season, every holiday, etc.
Separation Stress
Whenever people in ministry are separated, disagreements are likely to occur. The most famous case is probably when Thomas refused to believe what the other disciples told him about Jesus’ resurrection (John 20). Of course, the same was true of other disciples as well (Mark 16, Luke 24).
This has especially been true relative to missions. Even after Peter became convinced about the Gospel being for the Gentiles and witnessed them receiving the Holy Spirit (Acts 10), the other early Christians not there at the time were critical of his actions (Acts 11). A major crisis arose in the early church after Paul and Barnabas returned from their first term of missionary service and had not required the Gentile Christians to be circumcised (Acts 15).
These disagreements and misunderstandings still occur today among missionaries in general but may be especially difficult for husbands and wives experiencing separations related to their missionary ministry. In these days of air travel, absences of a few days or a few weeks are very common, as are even longer absences. This is true not only on the field but perhaps even more so when on home assignment. One spouse or the other may be gone nearly every weekend or several weeks at a time raising support. Although these absences may be more frequent today, the reactions of individuals to them have not changed. What are some of the difficulties that may occur? What can be done to minimize these difficulties?
It always happens when you are gone. For the spouse left at home, it seems like that is the time crises are most likely to occur. A pipe breaks. The car will not start. The computer locks up and will not reboot. The kids get sick. The teacher wants to talk to a parent about a problem at school. The list goes on and on. Whether such things happen more frequently when a spouse is gone or not, they at least seem to. Here are a few steps one can take to cope with this situation.
· Develop a “practical” support group. Make a list of people you can call on to help with the car, the computer, illness, and other problems.
· Use whatever means of communication you have available to contact your spouse. E-mail can usually bring a response in a few hours. A cell phone can often get an immediate response.
· Ask older missionaries who have lived in the same area for suggestions on how they coped with such situations.
· Lower your expectations. Rather than trying to fix everything, let something go.
I need your stability. Marriage is about sharing life, and today that is more possible than ever before. When one spouse feels the need to discuss a situation with the other, the sooner they can do that, the better. When both spouses share in the decision, both have responsibility for the outcome. With our varied means of communication one can contact a spouse virtually anywhere within a few hours, and the traveling spouse should make that possible. Do not hesitate to spend whatever money is necessary to communicate. Here are a few ways that can be done.
· Cell phones. Do not turn them off unless absolutely necessary for an agreed on length of time. When you do, return the call as soon as possible.
· E-mail. Check your e-mail on an agreed-on schedule and reply immediately.
· Fax. Leave word with whoever receives your fax messages to get them to you as soon as possible and reply immediately.
· Even if there is no “emergency,” communicate on an agreed schedule.
What about the children? Children, like spouses, have various reactions to a parent being gone. They may become angry, lonely, moody, disobedient, withdrawn, and so forth. Here are some ways to cope with these.
· Communicate I. The traveling parent can talk by phone personally, e-mail a message to each child, or add a special message to a fax.
· Communicate II. The parent at home can encourage communication with the children by asking, sharing, and being vulnerable.
· Discipline must be administered immediately, not when the absent parent returns. If possible, spouses should communicate before it is given.
I get so angry. The spouse left at home may become angry at the traveling spouse or angry at God. One may feel abandoned, that the absent spouse is gone because she or he really wants to be. Even if agreed to beforehand, one may feel anger at God for calling the spouse away. Such feelings must be faced, and so must thoughts about the absent spouse. Talk with others about them, beginning with the object of your anger. If necessary, with permission, talk with selected others.
· With the spouse
· With God
· With a support group
· With a counselor
We seem to have less and less in common. Of course, separated marriage partners do. People involved in different activities become concerned about different issues and develop different interests. A strong marriage requires common interests, and that will require intentionally maintaining these.
· Openly discuss with each other what is happening and what interests you want to nurture together.
· Choose interests that you value in your marriage.
· Choose friends that you each value, people with whom you are both comfortable and have similar interests.
I get so lonely. Of course. Both partners are alone, so both are likely to be lonely. To combat this, intentionally plan how to combat the loneliness.
· Tell each other about your loneliness.
· Find activities that help decrease the loneliness. For some it may be watching a video, for others having friends in, and for still others, reading a book.
· Both journal about your feelings of loneliness while apart, and then share your journals with each other when together.
· Communicate frequently via e-mail and telephone.
I can’t believe I’m attracted to ____. Although being attracted to someone other than your spouse takes many people by surprise the first time it happens, it is very common. This attraction may be either sexual or emotional. As one song put it, “When I’m not near the girl (guy) I love, I love the girl (guy) I’m near.” Typically we come to like the people we interact with most, which is usually our spouse. If a person feels vulnerable in this area, he/she is. Individuals who do not feel vulnerable may be even more vulnerable than those who do feel it. Such attraction must not be tolerated in any way.
· Be honest with yourself about it.
· Be honest with God about it.
· Find an accountability partner (or group) of the same gender to call you regularly to ask for a report.
It’s so good to have you home, so why are we arguing now? Separated couples have been looking forward to being together for several days or weeks, and now they find themselves in an argument. What is the problem? Remember that both are probably physically and emotionally exhausted from all the things we have discussed. The spouse who stayed at home has been carrying the load usually carried by two people. The spouse who traveled is tired from work, travel, and perhaps jet lag and intestinal disturbances from getting some of the flora and/or fauna from the local water.
· Both need to realize what the situation is.
· Both need to be especially patient with each other.
· If disagreements begin, it is best to shelve discussion until both have time to get rested, perhaps taking turns covering for each other while the other rests.
· Celebrate your reunion (when you are rested) in some special way.
We need to talk. Missionaries, of all people, should know the importance of debriefing. They consider it routine when they reenter their passport country, and it is the same for any transition. Coming home from a few days or weeks is also a reentry, and both marriage partners need the chance to debrief this minor transition. Again, communication is of greatest importance, so debrief each other.
· Look at your journals, and tell each other everything about your separation.
· Consider how this fits in to your life story together.
· Decide what changes this may imply for your lives together in the future.
· Make specific plans for how you will cope with separation next time.
Traumatic Stress
Some may look at this heading and say, “I’ve experienced some traumatic things as a missionary, but what in the world are PTSD and CISD? Does trauma affect children like it does adults? What happens to those who help the traumatized? Is there anything we can do to help prevent serious problems following trauma?
What is trauma? People who respond with intense fear, helplessness or horror when they are confronted with something that involves the threat of death or serious injury to themselves or others experience trauma. This may be something people actually experienced themselves or something they witnessed.
Although this can happen to anyone anywhere in the world in the form of accident, assault, rape, etc., missionaries in some cultures are more likely to have such experiences, and less likely to have someone who knows how to help them at the most crucial time. Missionaries are often more likely to experience conflicts, such as guerilla warfare, coups, and evacuations. They may also be more likely to live where natural disasters, such as typhoons, earthquakes, and volcanic eruptions, occur frequently. They may also live through epidemics, such as cholera, typhoid, or malaria. Terrorism, kidnapping, and being held hostage are more common in mission settings. If missionaries do not experience the trauma firsthand, they often witness it in national friends.
What is PTSD? Although nearly everyone living through such events has some symptoms for a week or two, some have much longer-lasting minor symptoms that do not interfere with their lives. However, some experiencing severe trauma develop Posttraumatic Stress Disorder (PTSD), and their symptoms are:
· Re-experiencing the traumatic event in the form of having recurring images or thoughts, or distressing dreams, feeling as if the event is happening again, and reacting physiologically to stimuli associated with the event or similar to the event
· Avoiding things associated with the trauma, such as conversations, activities, places, people or feeling detached from others, unable to experience emotions, and unable to remember significant parts of the trauma
· Experiencing symptoms of increased arousal, such as being easily startled, unable to sleep, irritable or angry, and having difficulty concentrating
These symptoms may occur immediately or be delayed for months or years. They may last for a few months or for many years. PTSD has been called combat fatigue and shell shock when found among the military in combat (http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml).
What is CISD? Critical Incident Stress Debriefing (CISD) is a method of helping prevent PTSD from developing in someone who has experienced trauma. CISD is a structured group meeting ideally conducted by a trained professional between 24 and 72 hours after the crisis. A day is needed for the shock and numbness to wear off and for the people to rest and attend to immediate needs. After three days people begin to “seal off” emotionally and distance themselves from the trauma. Unfortunately, with airline scheduling problems, needed visas, lack of funds, etc., trained professionals may not be available within 72 hours, so those present but not directly involved in the crisis may want to deal with trying to prevent PTSD. Here are the outlines of a CISD which usually takes two or three hours (http://www.icisf.org/).
· Introduction. Explain the purpose of CISD, discuss what will and will not be held confidential, make sure that only those directly involved in the crisis are present and that all directly involved are present, give opportunity for questions, and have prayer together. (If some do not want to participate, point out to them that they may not need help, but they may be helpful to others in the group.)
· History. If the people involved know each other well, this step may be omitted. However, if they are not part of an already established group, having each one briefly give a personal testimony, family history, personal background (education, work, marriage, children, happiest times, most stressful times, strengths, and weaknesses) may be helpful.
· Facts. Ask each member of the group to tell about what happened and what his or her role was. This may include anything from watching helplessly as someone died to pulling people from the wreckage and saving their lives.
· Thoughts. Ask members of the group to give the first thought they remember after they stopped behaving automatically. It may be something as simple as worrying about a pet or as complex as wondering what would happen to their child if they died.
· Reactions. Ask each person to talk at a more emotional level about his or her experience, perhaps by asking, “What was the worst part of it for you?”
· Symptoms. Ask members to describe any symptoms they experienced during and after the event, such as disturbed sleep, lack of appetite, or poor concentration.
· Spiritual struggles. Experiencing trauma may impact members’ faith in God or concept of God. Indicate that it is safe to report questions about God. You may want to pray with them, even repeat some of the Psalms of David as he questioned God.
· Education. Summarize the meeting and note that their symptoms are normal for anyone who has experienced severe stress; then give them some techniques to help reduce stress. Tell briefly about PTSD and note that common reactions to trauma are feelings of anger, anxiety, denial, depression, guilt, grief, tension, and gastrointestinal problems.
· Referral. Finally, encourage participants who experience continuing problems to see a mental health professional for CISM (Critical Incident Stress Management), because you have just given first aid, not full treatment.
What about children and trauma? Children are also affected by trauma and need care much like adults. Parents, teachers, pastors, and friends of the family may be most helpful to children.
· The presence of supportive loving adults is the greatest need of traumatized children. Children find the greatest comfort in knowing that they will not be left alone, that someone will be there for them whenever needed.
· Children need to be given enough information to comfort them but not so many details that it increases the trauma. Always tell children the truth; covering up the facts leads to distrust later on.
· Like adults, children need to be able to process what has happened to them with other children their own age. Also like adults, they need a facilitator present—a supportive, loving adult.
The general health of the family influences how severely the trauma will affect the child. Children from dysfunctional families are much more vulnerable to the effects of traumatic situations.
Does debriefing affect the helpers? Yes. The debriefers must be debriefed. Leading a debriefing is an emotionally draining experience, and anyone doing it is very likely to experience the very symptoms they have heard others describe. They need some way to process what they have been through themselves, again within 24-72 hours. If not, the debriefers may well experience compassion fatigue and become cynical or emotionally “walled-off” themselves.
This does not need to be another full CISD but may be an informal way to talk through what has happened to them. They should have people praying for them. They should not schedule other emotionally demanding events after the debriefing so that they will have time themselves to debrief. If possible, the debriefers should work in pairs so that they can get together later and debrief each other.
What can we do to prevent trauma? Agencies should have contingency plans for potentially traumatizing situations. Decisions should already be made on such questions as to whether or not ransom will be paid, who will go to help people in traumatic situations, who will speak for the mission during crisis times, and so forth.
Missionaries should know how to act to minimize danger. For example, they should know where flash floods are likely to occur, and avoid those roads when they see clouds in the mountains. Or tagging luggage: “Dr. Jonathan Q. Smith, PhD, Executive Director, Important Mission International" is a much more inviting target for hostage takers than is “John Smith, 123 The Lane.”
Each person should know what to do if a potentially dangerous situation occurs. For example, what do you do if an earthquake occurs? Running from a brick building is not wise. What do you do if you are taken hostage? Those early minutes of captivity are some of the most dangerous, and resistance in the face of overwhelming odds may result in becoming a corpse.
We live in a fallen world, and trauma cannot always be avoided. However, by using the best resources that we have available and the spiritual resources that God supplies, we can emerge from the situation only scarred to some extent, but not total casualties.
For many good links to more information about trauma go to http://www.trauma-pages.com/.
Conclusion
Psychology is not only the science of behavior and mental processes but also is the application of that science to real problems people face. This chapter showed how psychology has been applied to help people improve their general physical health and how it has been applied to help people cope with stress in their lives.
Missionaries have stressful lives for many reasons, not least of which is living in a “foreign” culture. Some of this stress is just the everyday hassle to get things done, but some of it is because of political turmoil and safety issues of living in unstable host cultures.