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Wednesday, February 19, 2014

Book Review: "What Missionaries Need to Know about Burnout and Depression," Esther Schubert, Olive Branch Publications, 1993.



Review:
What Missionaries Need to Know about Burnout and Depression is a very helpful short book on the causes and available helps for people facing depression or burnout. Esther Schubert has for more than ten years had extensive experience in counseling missionaries and their children, both on the field and in their homeland. She herself is a child of missionary parents, and lived in various countries in Asia throughout childhood and high school. She travels to mission fields several times a year for the mission of psychiatry in the missionary community. Her book is a must have for people in cross-cultural ministry as well as for the missionary community.
-M. L. Codman-Wilson, Ph. D., 2/19/2014
Excerpts
Burnout
“Burnout: “a fuel shortage where one continues to burn the candle at both ends but has run out of the necessary fuel…Burnout (and eventually depression for me) was a condition born of good intentions. I fell prey to it for consciously unselfish reasons, though I believe I was unconsciously driven to reach perfection in my career, as a wife, as a mother and as a Christian. I pushed myself far too hard, far too long and I failed to acknowledge my own limitations” (Esther Schubert, What Missionaries Need to Know about Burnout and Depression, Olive Branch Publications, 1993, pp.1-2).

“Burnout can occur at any time during missionary service, but first term missionaries may be the most vulnerable. Statistics suggest that about 15% of first term missionaries bail out. Many of them have faced the exhaustion of fundraising before coming to the field. Culture shock often peaks at 8 months into the first term. Language study may seem to be an unending, unsuccessful effort. The time frame of burnout is approximately 2-3 years into a new experience” (p. 4).

But burnout is not only a missionary liability. “Roy Oswald in his article on clergy burnout identifies the following 16 symptoms:
1. “The tendency to feel negative or cynical about parishioners
2. Loss of enthusiasm for job
3. Lowered emotional investment in work
4. Fatigue and irritability
5. Cynical and sarcastic humor
6. Increased withdrawal from parishioners
7. Increased rigidity in dealing with parishioners
8. Feelings of isolation and lack of support
9. Frustration in accomplishing tasks
10. Increased feeling of sadness
11. Physical ailments
12. Lowered enjoyments of legitimate sexual activity with one’s spouse
13. Tendency to blame others for problems
14. Tendency to feel guilty much of the time
15. Feeling of “just hanging on” until retirement
16. Sense of emptiness and depletion” (p. 3).

“Burnout can occur from 2 sources:
          1. The first is a ‘system generated burnout’ due to untenable organizational mission policies, inadequate supervisory personal, inadequate time off, unrealistic expectations of the mission board.
          2. The individual traits of the person involved:
·         Perfectionists who live with shoulds, oughts and the need to be in control may run on nervous energy and burn out quickly
·         Workaholics are often driven to live up to their or other’s unrealistic expectations
·         Oldest children in a family who need to achieve control
·         Goal oriented missionaries who are often frustrated in cultures in which these frames are less important than people skills
·         Other-oriented people’s need to be liked or admired. They are very sensitive to criticism and may drive themselves to avoid it.
·         Unresolved negative emotions such as bitterness (or anger) are sources. Bitterness may occur due to unmet needs, personal loss or sinful attitudes” (p. 5).

“Friest says that people in burnout sometimes feel like Garrison Keillor’s Catholic church in rural Minnesota – Our lady of Perpetual Responsibility. (How about that for a missionary wife’s job description!) Under the right circumstances, this style – some people call it the “messiah complex” – produces a condition that he calls “compassion-fatigue” (p. 6).

“Type-A missionaries display many of the characteristics of people prone to heart disease. Sehnert lists ten of these characteristics:
1. Tendency to “over plan”
2. Multiple thoughts and actions
3. Need to win
4. Desire for recognition
5. Always feeling guilty
6. Impatient with delays or interruptions
7. Over-extended
8. Sense of time urgency
9. Excessive competitive drive
10. “Work-aholism”
Type-B missionaries, those who are addicted to helping, tend to manifest another set of characteristics. According to Tubesing, they demonstrate the following behavior traits:
1. A willingness always to give emotional support but seldom to ask or expect it from others
2. A feeling of selfishness when not responding to other people’s needs
3. Excessive concern not to hurt other people’s feelings
4. Determination to get a job done, no matter what the cost to oneself
5. A desire to avoid conflict
6. A tendency to say “yes” too much and too often
7. A feeling that one “ought” to be able to help everyone
8. Sometimes, a sense of getting one’s own needs met by helping others” (pp. 6-7).

Sources of Ministry Stress:
          1. “Separations, rootlessness, transitions…Missionary kids at the time of reentry are ‘invisible internationals,’ they are strangers caught between two worlds. Their allegiances are many and none and they mostly have difficulty knowing where ‘home’ is.”
          2. Cultural stresses – in adjustment
          3. Physical stresses – health, hygiene, climate, danger
          4. Spiritual warfare
          5. Interpersonal relationship – “Dorothy Gish lists the inability to confront as the most frequent stressor encountered by missionary personnel. Pre-field psychological testing listing the MMPI suggests that a significant number of missionary applicants have a high need for affection which makes it difficult for them to confront colleagues, missionary or national. Many of these missionaries also utilize denial or repression as defense mechanisms and have limited capacity for insight as conflicts develop.
          6. Administrative and organizational issues
          7. Emotional bruising and old baggage, caused by overly severe or dysfunctional families, early loss or rejection. Trauma in earlier life will be reactivated after a stressful life event…In many cases this is manifested in the exaggerated response to a seemingly insignificant event, but one which symbolizes earlier traumatic losses
8. False guilt placed on or by others who label a depressive attitude sin” (pp. 11, 14, 18, 21).

Depression
“Depression is a biochemical illness which often makes the pain of living more terrible than dying…Crisis intervention for depression addresses three issues:
          1. Immediate prevention of suicide
          2. Gradual relief of severe emotional pain
          3. Prevention or amelioration of further depressive episodes” (p. 22).

“There is both endogenous depression and exogenous depression. Endogenous is depression with a biochemical base…Chemicals in the body and brain have been deleted resulting in serious emotional disturbance…Statistics tell us that if victims of unipolar or bipolar depression are not treated, there is a 15-25% chance they will eventually commit suicide” (pp. 22-25).

“In exogenous depression, no meds are needed. Usually the passage of time, support systems and counseling are adequate…Exogenous depression is a reaction to real or perceived loss of a loved one, place, possession, pride, self-esteem, job or status. It is caused by acute external stress” (pp. 22-24).

Prevention
“Burnout and some cases of depression may be prevented by the following:
1. Learning to “off load” emotionally. This requires being in touch with one’s own feelings, keeping short accounts (not allowing grudges and frustrations to build up in personal relationships), and dealing with issues as they occur
2. Learning to say “no” when one is asked to do more than is reasonable
3. Being alert to desperate feelings and understanding the emotional implications of those feelings. It may help to consider a worst-case scenario in an effort to defuse the subliminal unconscious fears. This helps the individual confront the “what if” and to acknowledge the adequacy of God's grace
4. Eating a regular balanced diet
5. Making time for meaningful relationships and fellowship, keeping the capacity for laughter. Remember “A merry heart doeth good like a medicine.”
6. Exercise. Missionaries need to schedule time to exercise on a regular basis, understanding that exercise releases body chemicals called endorphins which lift the mood and help in depression prevention
7. Devotional life. Our devotional life compensates for the fact that many spiritual goals are nebulous. It provides us with the encouragement and sense of God’s presence in the good times as well as the difficult ones
8. Paying attention to sleep needs and remembering that God is more interested in us than in our work. David A. Seamands once commented that we are not “God’s cosmic pets.” If we abuse our bodies and minds, they will eventually wear out
9. Maintaining a commitment to the “law of the Sabbath.” All of creation is geared to one day of rest per week. God set the example at creation and Jesus continued that in Mark 6:31 when He said “Let us get away from the crowds and rest.” The consequences of not observing the Sabbath are catastrophic whether for the individual, the mission, the nation, or a profession” (pp. 50-51). 

“When we as missionaries begin to see others in terms of what they can do, not who they are, we deface humanity and damage the missionary community. God’s order is grace first (relationship) and work second (even His). When we reserve God’s order we get into trouble” (p. 51).