[This article is available in audio format on the Pondering Purple podcast.]
I wish my parents had read an article like this one before I was born into the world of missions. But there was little awareness about mental health—especially juvenile mental health—in the Christian world of the 60s, 70s and even 80s. In some cases, there was actual push-back against psychological intervention and treatment, because so many believed that a strong faith should be enough, both for prevention and for a cure.
I was depressed nearly as far back as I can remember. It’s visible in a faded portrait taken when I was about six and evident in some of the poems I wrote as soon as I was able to spell. My first public poetry reading was at the age of ten, when, to the consternation of the adult poets in the room, I proudly recited the piece I’d written about the graphic massacre of a baby seal. If ever there was a red flag… (I’ve detailed my struggle with depression in more detail here.)
My parents never knew how deep and chronic my despair was. They didn’t suspect that a six-year-old could be depressed. Nor did they know what signs to look for under my sometimes-bubbly behavior. The despondence ebbed and flowed throughout my early years and into my adulthood. I wonder, looking back, how different my inner life might have been had someone known what mental illness was and what to look for when I was growing up.
Over the past few decades, a deeper understanding of mental illness—its prevalence and causes—has grown. We know so much more about its origins, manifestations and treatments now. We also know how common it is. In the United States, it is estimated that 17% of youths aged 6 to 17 will develop a mental health disorder. It would be foolish to assume that the world of missions is exempt from such a concerning statistic, considering the exacerbating factors that abound in it.
A doctor in the small German town where I used to live once asked what we were doing at the MK school that was causing such anxiety and depression in our small community. He was treating so many of us for those disorders that he had serious questions as to the health of our work ethic and lifestyle. Rightfully so. I believe that some of the factors that can either cause emotional distress or aggravate existing forms of mental illness may occur in greater numbers and more intensely in the missionary community. They have been keenly—sometimes damagingly—felt by many MKs who grow up, as one put it, “in a fishbowl on the back burner.”
Here’s an incomplete list of just some of those exacerbating factors:
• Frequency of transition
• Pressure to perform
• Feelings of personal/moral failure
• Lack of transparency
• Absence of authentic relationship
• Perception of being different
• Unexpressed/unresolved conflict
• Cultural alienation
• Linguistic barriers
• Neglect from caretakers
• Lack of emotional protection
• Lack of permission to express anger, sadness or other forms of distress
• Feeling misunderstood
• Spiritual warfare
• Unexpressed guilt
The ACEs diagnostic tool (Adverse Childhood Experiences) adds another set of factors to the tally. These might include sexual abuse and other forms of trauma that can also occur while growing up in ministry: witnessing or being victims of natural disasters, epidemics, conflict, threat of harm and more. It is estimated that 1 in 6 Americans will score 4 or higher on the test. (See this helpful overview.) Yet at a recent MK conference, 76% of the MKs who took the test had a score of 4 or more—the most potentially harmful category of results.
“Toxic stress from ACEs can change brain development and affect how the body responds to stress. ACEs are linked to chronic health problems, mental illness, and substance misuse. […]” (Source)
Though the participating MKs were eager to take the test and discuss their scores over the next several days, they were less enthusiastic about talking more vulnerably in terms of long-term emotional fallout, mental challenges and suffering. That’s true to form. In my nearly thirty years of ministry to MKs, I’ve learned that those who experienced something that felt like mental illness as children never told their caregivers about the hardships they were enduring. Imagine the emotional erosion so many of them experienced from shouldering the accumulation of so much unspoken suffering…
Yet help cannot be sought unless the torment is made known.
• Not wanting to burden their parents. “They’re so busy and stressed already…”
• Not wanting to appear weak or needy. “I’m an MK. I should be resilient.”
• Not wanting to be disloyal. “God called my family—how can I say it’s hurting me?”
• Not wanting to demonstrate insufficient faith. “It would go away if my prayers were strong enough.”
• Fear that there will be no help. “This is just who I am. Nobody and nothing can help me.”
• Fear that putting it into words might make it worse. “Now that it’s out there, it feels even more real.”
And so, they suffer.
Before moving on to suggestions for parents to implement, may I share with you the words of some of the teen and adult MKs I spoke with for this article? This is what they wrote as they looked back on their mental health struggles.
Nightmares began at 7 that involved me not being able to do some specific tasks and so the entire population of earth died because of me. Over and over again. My panic attacks started in 10th grade boarding school, but I thought I was having heart attacks and for months thought I would die there with no way to get help.
Christians and especially missionaries were supposed to “buck up” and be strong. If you had issues with anger or sadness, wasn’t that a sign of weakness?
No one ever talked about grief or loss, about feeling isolated. It was also well known that if you talked to someone about your feelings, it could blow back on your parents. So, when I was sexually assaulted, I spoke to no one, because it might affect “the work.” That’s not healthy and negatively affected my relationship with God for years.
Both my parents had a nervous breakdown while on the field because the stresses were so great and their pleas for help went unattended. Of course, we children suffered because of my parents’ emotions and actions during that difficult time.
Many other MKs loved boarding school and thrived, but it was very difficult for me. I would get physically sick and throw up the whole way and it felt to me like the world was ending at every goodbye. It was sheer misery for me.
When my best friend drowned senior year, the staff had us gather on the beach, hold hands and sing ‘Let’s just praise the Lord.’ Later I started laughing hysterically. Didn’t sleep for ten days.
My “stuttering” was from severe anxiety and panic attacks directly related to my parents’ “career.” My doctor correlated this to me at the age of 38, although it started at the age of 6. He was shocked they never took me to a doctor for it. Jesus and [their work] was more important than the fact their lifestyle made their son sick.
We were to be seen and not heard. Our needs didn’t matter. The “mission” or “ministry” came before family because it got lumped in wrongly with “god.”
My brother and I were in a vehicle with someone who died. No one offered to take us home. We were left to go downtown and get a cab to go to our own hometown.
What can we do?
Each one of these suggestions is merely a starting point. It will need to be considered and fleshed out—by individuals, whole families and entire communities—if we’re going to clearly see what needs to change in order to recognize mental illness, name it, address it and bring rescue to those who suffer. If we can begin the healing by implementing the following practices, there’s a chance that “growing up MK” will become so much healthier—something that can be wholly celebrated without the unbearable burdens that sometimes come with the undeniable blessings.
1. Create a family culture and vocabulary in which every member’s sadness, stress, fear, lethargy, dread and impulses to harm oneself or others can be openly discussed.
This needs to begin as early as communication is possible and be reinforced by regular, honest conversations. (Family “Yays and yucks” sessions at least once a week can be helpful with young children. Contact me if you’d like to know more about those.)
2. Be mindful of the words you use within earshot of children.
MKs are predisposed to seeing perceived weakness as insufficient faith. Make sure your words don’t paint emotional challenges or mental illness as failure or sin. And be intentional about speaking in terms of hope and help for healing.
3. Because so many MKs seek to protect their parents (and their ministry) by their silence or by putting on expected behaviors, pay attention.
Regularly (re-gu-lar-ly) and lovingly scan for signs of distress or mental illness. See this chart for a place to start. The ACEs quiz might be helpful to evaluate your child’s toxic stress too.
4. De-stigmatize the life-saving and mental-health-enhancing practice of seeing counselors, psychologists and psychiatrists.
Make sure your kids know that seeking clinical help beyond counseling can be legitimate and good too. Medicine is not a copout. Get them help as soon as you suspect there’s a problem—without making them feel that they’re being a burden. And seek help yourself if you need it, so they’ll see how normal and helpful it is.
5. Plan regular family and individual debriefs, run by people outside your ministry spheres, particularly (but not only) after traumatic events.
Make these a priority. Don’t wait two years until your next home assignment if you’re seeing concerning behaviors now or have just been through something you know might impact a child’s mental wellness. Invest and sacrifice if necessary in order to ensure your children’s health.
6. Don’t assume that your children’s emotions and faith will be strong enough to withstand what yours can.
I can’t emphasize this enough! Children simply do not have the resilience and fortitude we sometimes expect of them. (In my experience, that vaunted “resilience” we assign to young MKs is too often simply lack of permission or vocabulary to speak of hard things.) If children and teens have been exposed to something adults find “troubling, scary or destabilizing,” their young hearts and minds will feel it as “terrifying, horrifying and traumatizing.” And if there’s already underlying mental illness there, it could cause a sudden downward spiral that requires immediate attention.
7. Speak about Jesus/God as someone who understands grief, who suffered, whose heart breaks for their broken places, who knows how helpless they feel and who longs to bring resources into their lives that will help them to heal.
Reassure them that he is not ashamed of their depression, anxiety, OCD, or any other form of mental suffering. He is with them and for them. Make sure you don’t use mature-believer-talk with your hurting children. They might not have the spiritual savvy to hear “God allowed this” or “everything that happens to us is sifted through his hands” in the way you intend it to be heard. Please make sure you don’t use words that make God the perpetrator of their pain. (More on that here.)
8. Sometimes the best answer to a child’s mental illness or suffering will be rescuing him/her from a context that is toxic and damaging—even if it isn’t so for the rest of the family. There is no greater demonstration of your child’s importance to you and to God than the sacrifice it might take to get her away from the source of her pain and provide her the help she deserves. (An article on this topic is here.)
Again—mental illness is no less prevalent on the mission field than it is elsewhere. Some of the professionals I spoke with for this article actually suspect that it might be more common among children raised in a highly demanding context and without a singular cultural identity.
Remember: MKs are experts at “protecting” our parents from the acid that is eating away at our sense of stability, worth and safety. They don’t want to add to their caregivers’ stress or make them worry, therefore will not easily bring up the distress they’re living with. It’s up to the adults who love them to create contexts, relationships and practices that allow for full disclosure. I spent most of my life telling myself that I could power my way out of the depression and anxiety haunting me. I couldn’t. And the years I spent neither speaking of them nor seeking help for them eroded my wellness in ways I’m still measuring today.
I realize there is no way that a single article could exhaustively unpack this topic. Please consider this merely a discussion starter—a primer. I encourage you to process it with others in your community and within your own family. To establish new practices that will contribute to the overall health of all involved, particularly the children whose pain too often goes unspoken, unnoticed and unhelped.
We all—as a people committed to helping and serving others in the name of the Lord—need to make sure no child’s wellbeing gets overlooked in our zeal to reach the ends of the earth.
Please use the comments space below to add your recommendations of reading/listening resources that might be helpful.
I’ll close with more quotes from young and adult MKs. Their words matter. Their experiences matter. What they wish their parents, adults of influence and community members had done differently matters.
I wish my parents had realized the importance of rest when I was a child. I feel like I never saw my dad because he was a workaholic, and we didn’t have family vacations hardly ever.
I wish the stigmas could be erased. Even now. I wish my mission had offered/insisted on grief counseling when my sister drowned. My Dad (who saw her found three days later) and my oldest brother never really recovered. My Mom and I had our struggles in dealing with it over the years, but it took a harder toll on my Dad and my brother.
I wish anyone had had a clue about autism and non-military PTSD.
I wish I wish my parents had been better equipped to know what depression and anxiety might look like. At least 3 out of 4 of us kids struggled with one or the other.
“I wish someone had told me…”
…that legitimate mental health care is a good thing.
…that missionary attrition (leaving the field) was not a personal failure or source of shame.
…that all of us needed psychological care after being in a war.
…that trauma affects everyone differently. Complex trauma can cause even physical problems.
…that depression and anxiety are not sins. Psychologists are not evil.
…that mental and emotional health matter just as much as spiritual health. That there is immeasurable strength in safely acknowledging how we are doing mentally and emotionally, first as parents, then as kids. Being safely seen, heard, and known without judgement is foundational to functioning beyond mere survival on the mission field.
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