Mental Health and Missions: Dealing with a Hidden Problem
Written by Ryan Currie
STATEMENT
Missionary life can be mentally and emotionally demanding, often leading to depression, anxiety, loneliness, and burnout. Mental health should be approached with confidence in God’s Word, hope in God’s work, and openness with God’s people. The primary way to prevent and address mental health challenges is through the ordinary means of grace and intentional discipleship within a local church. Sending churches, mission agencies, and, at times, medical professionals can also offer support through counseling and care, especially when there is no healthy field church. Sometimes, leaving the field (for a season or permanently) may be necessary. Sending churches should be ready to receive and care for missionaries returning from the field. Mental health challenges should always be addressed with compassion and discernment.
Introduction
“Give us this day our daily water,” I prayed as I took in the beauty of my surroundings. Once you got past the humidity and mosquitoes, it was actually quite lovely. As I looked out, the green of the West African bush met the blue sky.
The sun hit the opening of a dark and dried-up water cistern. Access to water is a matter of life and death in this region. When the cistern dries up, the community faces a crisis. My family was a part of this community for a season. I watched as a man prepared to enter the cistern to dig for more water. He wiped the sweat from his brow and checked the rope tied around his waist, then handed the rope to his helpers and entered the mouth of the cistern. It was a dangerous business. He had no way of knowing if the walls would cave in on him. This pit might become his grave. Still, he descended into the darkness.
While there are countless joys and rewards in the life of a missionary, missions work often feels like a descent into a deep and dark pit. William Carey (1761–1834), known as the father of modern missions, once described the unknowns of missions as full of risk. For Carey, preparing and planning for missions was like “deliberating about the importance of penetrating into a deep mine, which had never before been explored.”[1] When he set out into the unknown to proclaim the gospel to the unreached, he looked at those sending him and said, “I will go into the mouth of the pit if you hold the ropes.”
Like most missionaries, Carey expected the exploration of this deep mine to be fraught with dangers. One of the dangers that Carey did not expect, however, was how penetrating this mine came at the cost of his wife’s mental health.
Missions and Mental and Emotional Health
New missionaries expect difficult things like culture shock, limited resources, some opposition, and even persecution. It’s what they signed up for. But many are surprised by how mentally and emotionally demanding missions is. Missionaries often struggle with depression, anxiety, loneliness, and burnout. These struggles can surprise both the missionary and their supporters because they trust that they are doing God’s will and He will accomplish his work through them. There is an assumption that God will give resources to protect the missionary from experiencing things like depression, anxiety, and loneliness.
The missionary who returns to their home country after a few years overseas may sound quite different than when they were first casting their mission vision. There is a temptation for missionaries to put their best foot forward when they meet sending churches and partners in ministry. Those who struggle with mental and emotional health begin to fear that if they express what they are experiencing, they will be pulled from the field, or support will dry up. Shame eats away at missionaries who struggle with these things because they think they are failures. The thought can creep in that they are an imposter. They can buy into the lie that they would not feel this way if they were faithful missionaries and trusted God.
The reality is that missionaries are everyday people who struggle with the same things that everyone else does. Missionaries are not unshakable heroes of the faith. They are ordinary people with ordinary struggles. Stress takes a toll on anyone, and missionaries often live with high-stress levels.
Mental health should not be a taboo topic in missions. Those considering missions should count the cost and expect to battle mental and emotional challenges. At the same time, these challenges should not discourage people from going into missions. Missionary struggles with mental health are not uncommon and should be approached with confidence in God’s word, hope in God’s work, and openness with God’s people.
The Pit of Depression, Anxiety, and Loneliness
Some of the most distressing scenes in Scripture tell the story of isolation and hopelessness when a believer is stuck in a cistern or pit. For example, it doesn’t take much imagination to feel Joseph’s hopelessness as his brothers abandoned him. “They took him and threw him into a pit. The pit was empty, and there was no water in it” (Genesis 37:24). Jeremiah was thrown into a cistern and sunk into the mud (Jeremiah 38:6). The experience of depression can feel like you are descending into a bottomless and dark pit.
When people experience stress, trials, and isolation, it is normal to experience some level of depression. Missionaries are no exception. The darkness can be overwhelming, as it must have been for Joseph and Jeremiah. When ministering in difficult places, it is common to experience crises. Sometimes, in missionary life, it doesn’t matter how strongly the “holders” back home grip the rope. You may face circumstances where you feel like darkness is your closest friend and are completely alone (Psalm 88:19). You are far from family and everything you know and love. Furthermore, cultural and language gaps between those you live with can create a constant feeling of distance.
The Carey Family: Missions and Mental Health
Even our missionary heroes from history struggled with mental and emotional health. We cannot look at these missionaries with rose-colored glasses and ignore the severe depression of Adoniram Judson and the insanity of Dorothy Carey.
Let’s look a little more closely at the example of William and Dorothy Carey. William Carey is rightly celebrated for his moral clarity and vision, which inspired a global movement of missions. But the move overseas broke his wife, Dorothy, emotionally and mentally. At first, Carey set out for India alone, but he eventually convinced his wife and her sister to join him. Dorothy’s initial unwillingness to go to India turned into resentment and depression as the difficulties and trials of mission life compounded. The Carey family initially lived near poverty. “I am in a strange land. No Christian friend, a large family, and nothing to supply their wants,” William wrote at one point.[2] When their 5-year-old son, Peter, died from dysentery, Dorothy’s grief turned to despair and eventual insanity. William and others wrote of her insanity. She was finally confined to her room after patterns of verbally and physically attacking Carey.
The Carey family’s example is admittedly extreme. They faced levels of stress that most missionaries today rarely face. While Dorothy Carey’s struggle with mental health was more intense than most, it highlights the reality that mental health must be discussed and considered in missions. All too often, we rightly look to William Carey as the visionary leader of a missions movement but ignore the severe mental health challenges he and Dorothy faced. Her situation was tragic, and the response to her mental struggles could have been much better. As all of us are, they were imperfect missionaries. Their example demonstrates that missions and mental health challenges can go side by side.
This isn’t just a problem in the past. It is present today. A missionary friend of mine shared this story:
I’d been on the field for a long time when my mental health fell apart. I began to experience day after day of intense anxiety with no apparent cause—all I could think about was how terribly anxious I felt. Episodes of deep depression followed where life felt so dark and gloomy that I wondered how in the world I could go on. This continued off and on for close to 5 years. There was seemingly no relief, and believe me, I tried everything. Some of our supporting churches thought we should return to the States, where I could have better medical and counseling resources. Still, my husband and I decided to stay, mainly because our field church cared for us so well through their prayers, concern, and acts of service. Gradually, my distress went away and has never recurred. Still, I worried about the stigma of being a missionary and struggling with mental illness.
In light of the reality of mental and emotional challenges in missions, what is the path forward for missionaries and their local churches?
1. Confidence and Hope in God
Mental health issues, anxiety, depression, and loneliness paint a bleak picture, but it is not the end of the story. The missionary can set out with deep confidence and hope in God. For the missionary battling mental and emotional health challenges, there is hope, and they are not alone. The ultimate remedy to the darkness of depression and anxiety is the light of Christ and his all-powerful presence.
A great irony of mission work is that when you feel the most alone, at that moment, you are the least alone. Jesus is with you in the pit. Jesus is not only with us to the end of the age; he is with us in our darkest and most helpless moments. He is with us in our regrets. He is with us when we think we have counted the cost but find out we are not as strong as we thought. Just as Jesus stood by Daniel’s three friends in the fiery furnace, so also Jesus is with you in the most distressing circumstances you face as a missionary.
Missions work can, at moments, feel like a pit as depression clouds your vision. But God is giving you more of himself in the moment you feel yourself sinking into the mud (Jeremiah 38:6). For a thirsty community to receive the gift of water, someone must do the hard and dangerous work of descending into the dark unknown. The risk must be taken.
God meets you at that risk. God does not shield the missionary from experiencing these challenges, but he does sustain you through them. His strength is made perfect in your weakness (2 Cor. 12:8–10). He is the all-powerful rope holder. More than that, he is the one who descends with you into the pit and shows himself to you in radiant brightness in the middle of the darkness. His presence holds you and guarantees your labor will not be in vain. The work is for a purpose. God’s glory will cover the earth as water covers the seas.
2. Openness with God’s People
God meets people, and his presence is most clearly felt through the ordinary means of grace. The missionary may be tempted to hide these challenges, but God has designed them to be faced with other believers in a church community. The missionary who experiences anxiety and depression has a crucial choice to make: will you rely on your own strength, or will you humble yourself and be vulnerable enough to invite others into your struggles?
The primary way to prevent and address mental health challenges is through intentional discipleship and mutual encouragement within a local church. The leadership and members of the local field church are the first places where the missionary should be vulnerable and seek help. Missionaries live in a variety of contexts all around the world. For example, my family has lived in three different locations, and the context ( including the health of the local field church) has varied dramatically in each of these. Some missionaries will be a part of a healthy local church; others may be church planting in a frontier location; and others may be seeking to influence a local church towards biblical health. However, in each of these situations, the missionary should first rely on the resources in their local church, no matter how few they seem.
In some cases, especially in frontier contexts or where there is not a healthy field church, the sending church and agency will be especially helpful in supporting the missionary family in their mental and emotional health struggles. Sending churches and mission agencies can offer support through counseling. They can also help the missionary discern when, how, and to whom they can reach out for professional medical help. Sending churches can advocate for needed rest and care. Sometimes, leaving the field (for a season or permanently) may be necessary. But this should not be the default reaction. Sending churches and agencies should be careful to invite vulnerability and openness without quickly assuming that a missionary needs to leave the field. Mental health challenges should always be addressed with compassion and discernment. Sending churches should be ready to receive and care for missionaries returning from the field, including helping them with practical needs, such as housing and transportation. Finally, if a missionary needs to come off the field (for a season or permanently), a church and agency should ensure that they keep “holding the rope” with love and wisdom as they help them transition back to their home country.
Conclusion
Corrie ten Boom, no stranger to suffering, once said, “There is no pit so deep, that God’s love is not deeper still; with Jesus, even in our darkest moments, the best remains and the very best is yet to be.” No matter what mental or emotional challenges the missionary encounters, the love of God is deep enough to sustain the missionary. These challenges can become a pathway to see more profound glory and beauty. They also become an opportunity to lean on the local church and invite others into our lives.
God will bring streams of water to dry lands. He does this through the work of missionaries who trust him no matter what they face as they descend into dark and unknown mines.
Footnotes:
[1] John Piper, Andrew Fuller: Holy Faith, Worthy Gospel, World Mission. (Wheaton: Crossway, 2016), 21.
[2] Mark Galli and Ted Olsen, 131 Christians Everyone Should Know, (Nashville: Christianity Today), 245.
