The Missionary’s Mental Health, II

by James A. Stringham, M.D.

In discussing the mental health of missionaries, we come to the question of why missionaries in need of help often refuse or definitely resist getting help. Others seek help very late. Why? Many factors operate, same of which are reality based; others are not valid.

In discussing the mental health of missionaries, we come to the question of why missionaries in need of help often refuse or definitely resist getting help. Others seek help very late. Why? Many factors operate, same of which are reality based; others are not valid.

1 "I felt it was a choice between my religion and psychiatry." This, or a close variation of it, is the reason why some missionaries hesitate to seek, or actually refuse psychiatric help. Though it is a fact that some psychiatrists are not religious, and there are some who may even recommend things that go against Christ’s teaching, there are psychiatrists who firmly believe in Christ and seek to put their faith into practice in their work. When asked, "How religious are psychiatrists?", a former president of the Aerzean Psychiatric Association said, "I think psychiatrists are as religious as the average person, and more religious than the average scientist." The psychiatrist is committed to helping his patient, as much as any other doctor.

2. Admission of spiritual weakness. This is perhaps one of the most frequent reasons for Christians refusing to seek psychiatric help. "If you pray hard enough," "If you have more faith," "If you spend more time with the Lord," are but three of the many clichés that are used. Individuals know they have faith and feel condemned if they seek psychiatric help. Basically, this is a failure to understand what psychiatry aims to do.

3. Fear of what others will think. This is closely allied to the above. One mission board was reported to have commented, "Heaven forbid that: . . . . . . should come to the point of having a psychiatric evaluation of our candidates." Missionaries have said, "If we have to have psychiatric care, the board will never send us back." There is the fear that "the home or supporting church will be let down" if they seek help for emotional difficulties. One British publication carried an advertisement for a book which listed psychotherapy as a form of "fringe medicine" along with homeopathy, osteopathy, chiropractic, spiritual healing, herbal treatment, and acupuncture. It is easy to understand how such can make people hesitate to go to a psychiatrist. There is a fear also of what friends, families, and fellow missionaries will think.

4. Shame or guilt in connection with psychiatric help. This is how some people feel who come for psychiatric help. At times it is purely morbid guilt. At other times it is an outlet for some deeper, unrecognized, real guilt masked under a false name, i.e., "guilt over going to a psychiatrist" or having emotional problems.

5. Failure or refusal to recognize the emotional nature of the difficulties. This occurs in other people than missionaries too. Many times medical doctors fail to recognize or think of the possibility that the problem is emotional. Long and extensive tests, diagnostic procedures and even treatments are undertaken. These delay the seeking of psychiatric help, and help to fix in the patient’s mind the idea that there is some physical or organic condition.

6. Failure to understand that psychiatrists are doctors just like any other medical person. Many who will go to the doctor with a touch of diarrhea, a temperature, or a stomach ache, feel that emotional problems should be treated with prayer and faith alone. It is just as foolish to think that a person with a serious psychiatric or emotional problem can take care of it only through prayer as it is to think that a person with an acute appendix can take care of it by prayer alone. Without denying that God can and has taken care of all sorts of ills as a result of prayer and faith, it is kidding one’s self to think physical illnesses need a medical doctor, but for emotional illnesses or difficulties one should only pray. It is just as honorable to seek psychiatric help for psychiatric problems as it is to seek medical help for a broken leg. The sooner this is recognized by religious people, the less trouble there will be in the future for people seeking necessary psychiatric help.

7. Unwillingness and inability to face one’s need, and projection of it on to others.There are missionaries and religious people who need psychiatric help. Many do not seek it, and they are at times very vociferous in their blame or condemnation of those who do seek this help. An important factor in some of these individuals is the inward, probably unrecognized need they have for this help. They blame others for seeking help, when they should be blaming themselves for not doing so.

SELECTION OF MISSIONARIES
Following are a few comments in regard to selection of missionaries.

1. A careful psychiatric evaluation. This is important. It is admittedly hard at times to obtain information from a person who may be aware that it will prejudice his chances of appointment. The psychiatric evaluation should be done early in the process. Missionaries do not always give the correct answers to questions. One missionary, when asked why she did not tell her difficulty with parents said, "I didn’t want to go into all of that." She completely covered it up. Another couple given some psychological tests just before they were due to sail merely gave what they thought were acceptable answers, and covered up underlying psychological information. A long series of questions like the Cornell Questionnaire sent out along with the application forms would be valuable. This questionnaire has 195 questions with "Yes" and "No" answers to various questions about mental and physical health.

Another suggestion is that in the outline of their life history there should be specific instructions to write out about other family members and their relationship to them. This can be very valuable. This may be difficult to elicit. Some suggestion such as this may help. "Please tell us about your family. Tell about the members and of your life together; little interesting things which give a picture of your life together as a family." In the answers and from reading between the lines, there may be leads to broken relationships. For instance, if only one parent is mentioned, but both are living, the failure to mention that parent may be significant. The life story may give some leads that a psychiatric evaluation may be able to bring out things which at the time of the psychiatric interview might otherwise be suppressed.

2. Psychosomatic and polysurgery persons. A careful scrutiny of the medical and surgical history can be very important. It is not always easy to spot a psychosomatic person. However, in the Cornell Questionnaire such persons will have an above average number of "Yes" answers in regard to various physical complaints. These can be followed up and evaluated. A person who has had more than two operations, regardless of what the diagnosis has been, needs careful consideration. It may be that surgery was necessary, but a careful obtaining of the details and circumstances may uncover a neurotic pattern. Psychosomatic persons often jump at the opportunity of another operation, even if they have been advised to go slowly.

3. Interpersonal relationships. Broken relationships, particularly if they are with family members, pose an additional hazard when one is sent to the foreign field. Just how to obtain this information may be difficult. Having a careful interview with the candidate, taking into consideration his life history, may uncover such things. Psychological tests may also give an indication of difficulty in the area of personal relations. Frequently missionaries with emotional problems have people at home they hate, feel bitter toward, or can’t forgive. If such things are uncovered before appointment, and dealt with, much sorrow and heartache may be avoided.

4. The past. Here is another area which if explored may uncover buried seeds of future psychiatric problems. As strange as it may seem, even missionaries may carry around real guilts, or have things repressed they do not realize are there. How to get at these is a problem. One missionary said, "If I had been asked, `Is there anything you have never told anyone else?’, I would have had to lie and say `No’ or I would have revealed its existence." A lot depends on the person conducting the evaluation, but it might be an experience which if dealt with before going would save much trouble later.

5. Attitude toward sex. For married or single persons, the idea that sex is evil, bad, and that any sexual feelings are bad is very likely to give emotional trouble on the field. How much recent trends have done away with such attitudes is difficult to say. The attitude that "anything is okay in sex" is just as much a source of trouble as "anything about sex is bad." It is a help in evaluation to know what the person’s attitude is.

6. The individual’s personal spiritual life. A person going into full-time religious work who is having no regular time for daily devotions is carrying a mental health hazard with him. Saying one’s prayers for five minutes night and morning is not having a daily devotional life that is effective, although it is better than nothing. Failure to have such a devotional life is one of the very common weaknesses of both missionaries and ministers. The idea that "all my life is for God and all my work is for him" does not take the place of daily individual time with God. Hence, to learn the nature and reality of the candidate’s personal spiritual life can be very important. A strong, meaningful spiritual life is a positive asset.

7. An optimistic outlook toward life. A person with such an attitude toward life and people is going to make a better adjustment living overseas. Strange as it may seem, often the difference is in the way one looks at things, getting the proper perspective or attitude. The old story goes that the optimist says the glass is half full while the pessimist says it is half empty. In taking pictures one sees this also. A picture taken of a group or a landscape with the light in the correct direction will be clear and bright. The same picture taken against the light may be foggy, unclear, and displeasing to look at. This is important. An optimistic attitude is an integral part of good adjustment overseas. Further, a person who is habitually pessimistic should stay at home.

8. Philosophy or way of meeting difficulties. Some of the things we run into which we dislike or don’t think good can be changed. The person who has the attitude that difficulties and problems are challenges to be faced will have an easier adjustment. If a person believes that most of these difficulties have an answer, and he refuses to give up without making sure, he will have a better chance of successful adjustment. On the other hand, it is equally important that a proper attitude be had toward difficulties that cannot be changed. The acceptance of the inevitable with good grace, as well as acceptance of difficulties that have not yet been changed, is important. This is particularly important for a Westerner going to the East. The pace is slower. Judged by our standards there is less efficiency; time may mean little. Though Kipling was referring to the Orient when he wrote this, it might be helpful to anyone going abroad to memorize the following:

Oh, it is not good for the Christian’s health To hustle the Aryan brown. For the Aryan smiles, And the Christian riles, It weareth the Christian down. The end of the fight: A tombstone white, With the name of the late deceased, An epitaph drear A fool lies here Who tried to hustle the East.

9. Emotional maturity. This is another important asset for successful missionary adjustment. This article is not the place to discuss in full what emotional maturity is. It includes the ability to stick to a thing until it is finished, to work together with people in harmony, to see things objectively, to accept frustration and delay with good grace. It includes the ability to work together with others in a team. Emotional maturity differs from perfection. Emotionally mature people may have times when they get upset or act immature in certain specific situations. This is to be differentiated from real immaturity. All of us are subject to periods of temporary emotional immaturity.

MAINTAINING MENTAL HEALTH
Now, for some suggestions in regard to maintaining the mental health of missionaries.

1. General health measures. Those things that are considered to be good physical hygiene measures are also good mental health measures. They are important.

a. Adequate rest and sleep. The amount of rest and sleep persons need differs from individual to individual. A bit of study and keeping track of the time spent in rest and sleep will enable a given individual to know how much he needs to function efficiently. Some need 45, some 50, some 60 hours of sleep a week. It has been stated that Edison got three or four hours a night. Having learned what is needed, the schedule should be set to get that amount, deleting other things in order to bring that about.

b. Regular exercise. This is good for both physical and mental health. It improves the whole general body tone, circulation, and helps to keep the cobwebs from accumulating. If the exercise happens to be walking, which has been described as one of the best and most easily available, it may let you explore outside your own little area of work. However, the only way to get regular exercise is to make no exceptions except in extreme emergencies. Even when traveling a great deal, this is possible. While waiting for a plane, a half hour walk can be taken at the airport if you make yourself do it. Exercise, to be effective, needs to be continuous for at least 25 to 30 minutes. In your daily routine you may walk three to four miles around the home, office or institution in which you work. This is not the kind of exercise needed for health! It is not usually continuous enough to stimulate the circulation adequately and for a long enough period so that the heart can develop a reserve. Regular exercise may help a person with arthritic tendencies, keeping them more mobile.

c. Getting away from the work for a while. This again is important. Whether it is getting away by taking a vacation or by some recreation, it is essential. Vacations or holidays are important. A person who takes a regular vacation, leaving the work for a period, will stay healthier. Weekends do not constitute an adequate vacation. Depending on the nature of the work, if it takes you a week to get ready for a vacation because of the work load, and a week to catch up on return, certainly less than three to four weeks of vacation is too short.

Recreation and hobbies are another way of getting away from the work. The goal is to get your mind absorbed in something else. Reading, even some mystery stories, can be very helpful. Novels, articles of interest and books on subjects of your interest are good. Writing, painting, music, photography, handwork, domestic arts, a work shop, and countless other forms of hobbies, including games and sports, can serve this purpose.

2. Specific suggestions in regard to mental health.
a. Someone with whom you can regularly communicate your inner thoughts. For married couples the most natural person would be the spouse. If communication with one’s spouse is not possible, then help is needed right there. Communication and sharing can be improved even after a quarter of a century of married life.

For single people the problem may be harder but is still possible to solve. Not as ideal, but still helpful, is having a friend with whom one can keep in contact through writing. Being able to talk over one’s thoughts, feelings and reactions with another human being is very important. It may take great effort, but if one is convinced of its importance, it can be worked out. In many instances where this has not been possible the individuals have had problems of sharing, and may never have had any close friends anyway. It is possible to have close friends of the same sex without homosexual activity. The latter is definitely to be avoided, some of the modern trends notwithstanding.

b. Habitually facing and trying to deal with problems and frustrations. Writing down the problems, each one on a separate sheet, writing down thoughts about them and possible solutions is helpful. This, and returning to them periodically, jotting down new ideas and thoughts as they come is an amazing way of getting help and insights. Pray about them and write down thoughts as they come to you. Dr. John K. Williams in his excellent book, The Knack of Using Your Subconscious Mind (Prentice Hall) has many suggestions to help in this. The attitude should be taken toward one’s problems that they can be solved, that there is a way.

c. Keeping alive mentally and growing. There are several ways to do this. Keep in touch with what is happening in the world through written news media. Listening to the radio is inadequate; television is the same. These two media can help keep you in touch with events, but do not give the perspective that written media do. A weekly newsmagazine is a help. Keep informed of what is going on in other parts of the world.

It is unnecessary to agree with everything that is written. It stimulates the mind to think about these things and disagree with them. In addition to material of general or wide information, if one’s work is such that there are special journals, one should subscribe to some of them and glance through them, reading some of the articles. One will stagnate in one’s work if this isn’t done. It is said that at the present rate of change, half life of medical knowledge is ten years. That means that if nothing new is learned in the medical subject in ten years, half of what was learned is out of date. The mind must keep growing or it will die. When we stop growing mentally we are half dead. For some, studying new subjects can be a means of growth. A person may study astronomy for no other reason than to learn about it for his own information and interest.

d. Psychiatric evaluation or consultation. In the mental health field this is an important area. It is possible to have a psychiatric evaluation in much the same way that a person has an annual physical examination. This does not say, "I have a psychiatric problem," but just "I want a check up." In this way things may be discovered and recommendations made before they become serious. Worry, anxiety, depressions, frustrations, and fears do not automatically mean one is a psychiatric "case." However, if any of these, to mention only a few, seriously interfere with one’s daily activities, or are prolonged, it is wise to seek help.

e. An active and meaningful spiritual life. From what has been said, it should be obvious that this is an important help to one’s mental health. Although people who are deeply spiritual may need psychiatric help, nevertheless a deep spiritual life is a definite mental health asset. This includes daily prayer, meditation, Bible reading. Weekly spiritual food is about as adequate as eating our regular food once a week.

Such suggestions regarding keeping mentally healthy will greatly add to a person’s understanding of himself, his problems, goals, and result in an enhanced opportunity to continue living a healthy, productive life.

RESPONSIBILITY OF SENDING AGENCIES
In the whole area of mental health, the agencies and sending boards have more responsibility than they now recognize. They are responsible not only for selection, but also for providing leadership in the spiritual realm. This is not always recognized. One of the most important areas where help is needed is in this whole question of human relationships. Most boards may be "aware that it is a problem" in many places, but do not see that there is a responsibility they have to do something about it. It is accepted.

For instance, just recently a patient said, "In this mission station where I was there were two families who were at odds with one another. I didn’t dare go into either house, as they would have thought I was taking sides with that family."

When the boards take active responsibility for tackling this psychological-spiritual problem, they will be opening the way to better mental health, not only for the missionaries, but for the Christian church and the world. The answer is in Christ; help is needed in implementing it.

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