Tag: depression

Depression and My Some Other Day

On September 10, World Suicide Prevention Day, I, like many of you, read the news that Jarrid Wilson had taken his own life. I didn’t know Jarrid, but his death made national news—and reached my computer screen—because he was an associate pastor of a California mega-church and because he and his wife had co-founded Anthem of Hope, “a mental health organization dedicated to amplifying hope for those battling brokenness, depression, anxiety, self-harm, addiction and suicide.”

I didn’t know Jarrid, but I know people like him, people who struggle with depression . . . people like me.

That’s not easy for me to write. I think of myself as a private person. I think of myself as someone who’s in control and even-keeled. But life is too short, sometimes much too short, to keep putting off openness and honesty for some other day.

I am inspired by those whom I’ve seen walk a path of vulnerability. Some are contributors at this site, such as Abby, who writes about her bipolar disorder. Ann discusses her depression in a post on meditation. And Marilyn blogs, “I have never spoken openly about my depression. In fact, this piece is the first piece I’ve ever written about the dark feelings that threatened to consume me.”

This is a first for me, too.

It wasn’t until I returned from the mission field that I was diagnosed with depression, but looking back, I can see that it was present while I was overseas, minus the name. I waited as long as I could to let it become official, based on years of trusting in my own strength and shaking my head at the presumed weakness of others. I remember when my younger self, confronted with someone who told me he had depression, said, “Why does he have to be depressed. Why can’t he just be sad?” I remember seeing a friend’s prescription bottle and smugly thinking, “Not me.”

Since then, I’ve learned that depression is more than sadness, and getting treatment is not a cause for shame. I should have known that long before, but I hadn’t sought out and listened to the right voices.

When Washington Post columnist Michael Gerson revealed his depression in February of this year, he did it from a very visible platform—the Canterbury Pulpit in Washington National Cathedral. In his sermon he tells about being hospitalized just two weeks earlier because of “this insidious chronic disease.” He defines depression as “a malfunction of the instrument we use to determine reality.”

“The brain,” he says, “experiences a chemical imbalance and wraps a narrative around it. So the lack of serotonin in the mind’s alchemy becomes something like ‘Everyone hates me.’ Over time, despair can grow inside you like a tumor.”

Gerson, a former presidential speech writer, is an eloquent wordsmith, and the imagery that he calls up—of a brain disruption clothed in an invented reality—resonates with me. I often wake up in the morning filled with dread, with my mind racing from negative thought to negative thought, searching haphazardly for reasons for the heaviness. And I can always come up with a multitude of reasons.

I have a tendency to forget things, but when it comes to my own shortcomings, missteps, and failures, no matter how long ago, I have a photographic memory. Add to that the stinging words I imagine my friends and coworkers and family members would say to me if they were completely honest, and I’ve found my narrative. Sometimes those dark mornings turn into dark days.

On my darkest days, my faults were all I saw when I looked in the mirror. On my darkest days, the part of my thinking that knew that image wasn’t true was silenced. On my darkest days, I didn’t want to kill myself, but I didn’t want to be alive.

I still have dark days, but it’s been several years since my darkest. I credit the God-given graces of medication, friendship, wise counsel, empathy, and unconditional love. But I can’t say that in the equilibrium of my mind all is now well and forever shall be.

As widely reported in articles about Jarrid Wilson’s death, last month he posted on Instagram: “I’m a Christian who also struggles with depression. This exists, and it’s okay to admit it.”

If only admitting the struggle were a cure-all. It’s not, but it can lead to healing. Admitting the struggle isn’t the whole journey, but it is a step in a necessary direction.

What if I had made that admission while working abroad? What would I have lost? What would I have gained? How would it have affected my family? Would we have shortened our time overseas? Would we have ended up staying longer? I simply don’t know the answers.

Nevertheless, I wish my some other day had come earlier. I wish I could have understood sooner what was going on inside my head and shared it with those around me. I wish I could have, back then, opened the door to let light into my darkness and to be able to speak into the darkness of others, “You’re not alone.”

(Marilyn Gardner, “Depression and the Third Culture Kid,” Communicating across Boundaries, December 27, 2016; Michael Gerson, “February 17, 2019: Sunday Sermon” Washington National Cathedral; Jarrid Wilson, Instagram post, August 17, 2019)

[photo: “Pier,” by Omer Unlu, used under a Creative Commons license]

8 Resources When You Are in the Valley

To those of you who are walking through the Valley of the Shadow of Death, can I just tell you how brave you are?

You might not think of yourself as being brave at the moment, but you are. You are brave to get up day after day and interact with people. You are brave to be honest with yourself (and, at times, us) about how you are.

Having been down this long and winding path with more folks than I ever imagined when I first put my foot on foreign shores, I’ve gathered some resources and offer them here — not to fix you, but to walk with you.

1. To those not in the valley — The biggest “resource” we can offer to our sisters is prayer and our presence. If you are aware of someone who is in the valley, write her name on a piece of paper and place it where you’ll remember to pray for her. As you cook, fold laundry, commute, brush your teeth, let’s pray for one another. 

2. At times our thinking can get out of whack when we are depressed — and it becomes so automatic, we don’t even notice it. Scripture reminds us over and over how important our thoughts are because out of them flow our feeling and reactions/responses. (This isn’t meant to shame you and say, “Hey, get your thoughts right!” It’s meant to give you some context :))

Automatic Negative Thoughts (ANTS) help us to figure out where we might need to change how we think/talk to ourselves. Give someone you trust — spouse, good friend — permission to point out what they hear or read (if in emails) from you. You might be using “all” or catastrophizing in ways you didn’t realize. We can’t change or pray about things we’re not aware of.

3. If it is available, you might want to go to the doctor and have a check up to be sure nothing else is going on. When you are in the Valley of the Shadow of Death that probably sounds too overwhelming to navigate. Can you have a friend be your advocate and figure out the steps for you? Or set up an appointment? Sometimes medicine is easier to get in a foreign country –if the doctor thinks your blood chemistry may have gotten out of balance a bit of medicine can be a resource. And medicine alone isn’t going to solve the problem — find a confidant (friend, counselor) to help you untangle and sort out some of what is going on in your head, heart, and soul. God is in the business of restoration, though not always quickly.

4. Just needing a place to start, I like this one: Coping with depression. They offer small practical steps.

5. The Anxiety Centre comes highly recommended by a trusted friend who has used their services in remote areas of the world and had truly life changing results. There’s lots to look at for free, but then membership is required for access to all their stuff.  Memberships can be monthly, semi-annual or annual (and of course, the longer the membership, the cheaper put month it is.)  I think it’s reasonable and worth it!  If you have sessions with one of their coaches, you’ll be free access to the full website for the duration of your counseling time.  The counselor costs are reasonable, too.  They can meet with you by skype or other methods.

They not only deal with anxiety disorders, but have info on OCD, PTSD, panic attacks, and other related issues.  Even though there isn’t a special section on it, in the body of their main info, they have some helpful tips for depression, and they’ve noted a connection between anxiety and depression.

6. If you or a loved one (spouse, child, or friend) will be traveling while walking this path, this is a helpful list.

7. Advanced Global Coaching –-they are trained to know when someone would benefit from coaching and when they need to look into professional counseling. Sometimes, valley times are not full-blown depression, but seasons of confusion and lack of clarity as to the next step(s). AGC is a place that can help sort out which path you’re on. I know several people who work for them and everyone we’ve encountered has been top notch.

7. Another coaching resource is: Coaching Mission International. Coaching for missionaries is very reasonable. For more info, check out the Bridges program.

8. These two articles are by people with personal experience with depression. All the way down is by Parker Palmer and The Spiritual Dimension of Depression is by Elissa Elliott. A book from “the front lines” is Henri Nouwen’s The Inner Voice of Love: A Journey Through Anguish to Freedom.

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I don’t mean to overwhelm you with resources, this is more of a starting point. What other resources have you heard of or found to be helpful?

We here at A Life Overseas are not “professionals,” but we are professional carers! Thank you for enhancing our community by offering a piece of yourself.

A version of this first appeared on Velvet Ashes

Failing at Fatherhood (how moving abroad ruined my parenting)

I sat on the floor, weeping.

I was two whole days into living abroad, and I was already losing it.

Those tears portended more, and in our first year overseas, the thing that knocked me down the most, the thing that discouraged and distracted and depressed me the most, was the sense that I was failing at fatherhood.

I loved being a dad. It was a very core part of my identity, and something I really cherished. Moving to Cambodia, I had expected cross-cultural stress. I had expected transition tension and unmet expectations. I had even expected conflict with other missionaries and nationals. But I never thought I’d feel like my identity as a father was being shredded up and burned in the furnace of a cross-cultural move. That was a surprise.

Have you ever felt that? Like living abroad was changing your parenting in a not-so-positive way?

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We moved overseas when our boys were six and seven and our girls were one and three.

I suppose my fathering style could have been characterized as, um, B I G. I loved playing with our kids in wide open spaces, throwing things, kicking things, climbing things. We played loud and we took up a lot of space, and that’s how we liked it.

And then we moved to a concrete box with bars on the windows in an urban capital of a developing country. No grass. No yard. No large spaces.

For me, the shift from wide open spaces to urban jungle was rough. I had to adjust, but first I got depressed. Often, it’d happen on a Saturday; I’d wake up just wanting to go outside and throw a football with my kids.

And with the clarity of thought that overwhelms at times like this, I felt like I had moved from a garden to a prison. A prison that was 95 degrees and thick with humidity!

I had traded acres of green for walls of grey. En Gedi for Sheol.

I watched my kids hang from metal bars on windows when they used to hang from giant limbs on oaks. They were happy, but I was dying.

I missed being able to step outside and kick a soccer ball. I missed our fire pit on cold autumn nights. I missed our porch swing. I missed our yard. I missed the way I used to father.

But thank God the story doesn’t end there, with a depressed dad missing what once was. No, the story definitely doesn’t end there…

 

The Dawn
Slowly, I began to realize a few things. First, I still needed to play with my kids, and second, I could still play with my kids. That sounds silly, I know, but in the haze of transition, this realization wasn’t a given.

I knew things had changed; I knew I had lost some stuff. I needed to grieve that loss well and figure out how to adjust and bend and change too. Basically, what I needed was some creativity, a little bit-o-crazy, and the willingness to spend cash.

And so it began.

I penciled in a “man trip” to a national park an hour outside of the city. I took the boys and we hiked and wrestled and joked and ate junk food. It was glorious.

I was invited to speak in Beijing. The boys tagged along (thanks in part to the honorarium), and we walked Tiananmen Square and the Great Wall. We ate at McDonald’s. A lot. The younger one navigated the subway system, and “a clear day” took on a whole new meaning.

I took the girls on a staycation. We got a hotel outside of town, stayed up late, and swam a lot. Of course, we also ate junk food. (Don’t tell mom.)

We started Nerf wars, using multiple levels of our row house, with intense battles taking place over the “eagle’s nest” position on the top floor. Best vantage point and all.

I bought a ping-pong table and crammed it in a corner. One side has two feet of clearance, so we use the walls and ceilings as extensions of the table. That table provides lots of “play time” that my kids enjoy and I need. Does that sound weird? It’s true. I need to play with my kids.

Rainy season hit our town, flooding the streets up to our knees. I yelled at the kids to get on the moto and we plowed through the water, making a giant wake with our urban jet ski. Neighbors laughed at the crazy white guy with three little kids screeching with delight in monsoon rains.  In America, we’d find a snow-filled parking lot and drift in our van. Here, we find a flooded street and pretend we’re on a lake! Same Same (but different).

We play “air hockey” on the tile floors, using wooden blocks as pucks and plastic cups as the hand-held hitter things. We use Lego men to play table football. We put a badminton set on the flat roof, supposing that a birdie falling from forty feet would do less damage than a volleyball.

We rent a soccer field for $7/hour to throw a Frisbee or a football. I don’t feel guilty spending the money. In America, we didn’t have to rent the park.

We go “cliff jumping” at the Olympic Stadium pool. My six-year-old actually chipped her tooth jumping from the five meter platform. I was so proud of her. (Don’t tell grandma.)

My youngest daughter loves motorcycles. She wraps her little five-year-old fingers around the handlebar and yells “Faster, Papa! Faster!”

We have disco lights in the bathroom. Long story.

 

Practically Speaking
So, here’s what helped me through this particular parenting crisis. Maybe these will help you too.

1. Be Creative. Early on in transition, creativity is very hard to come by. You’re exhausted and on the edge already. So ask around. Ask other parents, “What do you do for family time here? Where?” Just remember, what works for one family might not work for your family. That’s OK. Find the things that work for your family, and then do those things. Boldly.

2. Be Crazy. The Cambodians think we’re crazy, and maybe they’re right. Maybe I am crazy, but I’m also not depressed. Are you willing to look a bit weird? (Wait, you’re a missionary, what am I saying?!) But seriously, are you? Your survival might depend on it.

3. Spend Cash. If you need to spend some money to share a fun experience with your family, spend it. And don’t feel guilty about it. Now, if you feel like God doesn’t want you to spend it, then don’t. But if you’re afraid of spending money because of what your donors might think, that’s a pretty good reason to go ahead and spend it. Don’t let your kids grow up thinking that the most important question when discussing a family activity is, “What will our supporters think?” That question has killed many missionaries, and their children.

 

One Day
My kids still make fun of me for crying in those early days. Thing is, I don’t think they realize I was crying for them; I thought I had lost them. I thought I had lost me. One day they’ll know.

One day they’ll grow up and read this, and when they do, I hope they know how very much I loved being their dad.

In America,
In Asia, and
Anywhere else in
This whole wide world.

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Resources for Parenting Abroad

3 Ways to Care for the Heart of Your Third Culture Kid

To the Parents of Third Culture Kids

One Down, Three to Go

Five Longings of a TCK’s Heart

 –

Have you ever felt this? Like living abroad was changing your parenting in a not-so-positive way?

How did you deal with it? How are you dealing with it?

What would you add to the “Practically Speaking” section? It doesn’t have to start with a C (but extra points if it does).

Worthless

I feel worthless.

The feeling rises and crests like an impending wave barreling towards the surface of my heart. And with each wave of worthlessness comes an intense weariness of soul, a near drowning.

The breakers seem to rise from nowhere. I can’t predict them, and that makes me mad. They’re not tied to whether my work or ministry is going well or faltering. They don’t seem to be related to whether or not folks approve of (or agree with) me. They just come. And break.

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I wonder if I’m alone. Am I?

I don’t know enough of this language.
I’ll never know enough of this language.

I don’t know what I’m doing.
I have fewer skills than I thought I had.
I have fewer skills than they think I have.
I wonder when they’ll find out.

I haven’t accomplished what I came here to do.
I’ll never accomplish what I came here to do.
What did I come here to do?

This country doesn’t need me.
There are a lot of workers here already.
What can I do?

My passport country doesn’t need me.
There are a lot of workers there already.
I have nothing to offer.
I am worthless.

And the waves of worthlessness crash. And then I crash.

Do you know the feeling? I wonder how many of us know the feeling. I wonder how many of us have drowned in this feeling.

So now, I want to speak to the drowning ones, those gulping for air under the waves. To you, and to myself, I say “Remember your God who descends.”

“I love the Lord because He hears my voice and my prayer for mercy.
Because He bends down to listen, I will pray as long as I have breath.” 
Psalm 116:1-2

Allow these truths to wash over your soul:

God not only hears your prayer, He hears your voice. He hears you, not just some list of words strung together in the form of adoration or petition or whatever. He is near enough to hear your voice, and loving enough to care.

He descends. He bends down to listen, to hear you. He’s not a distant, aloof dad who requires his children to “speak up and for goodness sake enunciate.” He bends down to love you. This is your God.

He is not a God hidden away in a Holy Place, high on a hill. He is not sulking behind a giant curtain in a Temple, coldly demanding allegiance “or else.” He is a God who takes that Temple curtain, that holiness, and wraps it around His own flesh and blood and bones and joins you. And wonder of wonders, He wraps you up in His holiness, covering your worthlessness, calling you worthy.

Worthy of His affection.

Worthy of His love.

Even worthy of His dance.

So if you find yourself drowning in worthlessness, remember. Remember the King who descends. Remember the Father who sings. Remember that He loved you before you even accomplished breathing.

So let go my soul and trust in Him
The waves and wind still know His name
It is well with my soul.

More thoughts from the dark:
Demon & Divine

“I Can’t Trust Anyone” | Lies We Believe

The last two months we’ve been exploring the ideas in Timothy Sanford’s book “I Have to be Perfect” (and other Parsonage Heresies). I hope this series is as healing for you as it has been for me.

So far, we’ve given ourselves permission to say “and” in The Little Word That Frees Us. Then we began to exchange our “shoulds” for “coulds” in “I’m Not Supposed to Have Needs” | Lies We Believe. If you’re new to the conversation, you might want to go back and read those first two sections.

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“I’m different”

Before we dive into this lie, I need to clarify something. Sanford, himself an MK, says this belief has nothing to do with the legitimate “differentness” of being an MK and having a blended-culture worldview. That’s the TCK part of being an MK, and is a different discussion.

Rather, the belief that “I’m different” comes from being treated differently. It comes from living under different expectations and being required to abide by different rules. Sanford says this is not imaginary: though church members try to deny it, they often do judge PKs and MKs differently. People apply standards to them that they don’t apply to “regular” people. Likewise, we ministers and missionaries often apply standards to ourselves that we wouldn’t think of applying to non-ministry people.

We need to pause here and acknowledge the truth inside the lie: adults and children in ministry contexts do have different experiences, and those experiences can be quite exotic. More travel, more exposure to other cultures, more opportunities to attend events and meet well-known Christian leaders.

Other times our experiences are darker. We (along with our children) see the underbelly of church and missionary culture. We know all about problem people and problem finances. We know who is “against us,” and at times we even know who is responsible for eliminating our positions and reducing our influence, all in the name of Christ. These are the secrets we must keep and the burdens we must bear — and that too, makes us feel different.

If we think we’re different, however, we may keep ourselves from pursuing deep relationships. We may push people away and close our hearts to them. We may become lonely and even depressed. Alternatively, we may slide from believing we’re “different” into believing we’re “better.” We may like our positions of influence and authority: they boost our ego and pad our sense of pride. Although it’s uncomfortable to admit sometimes, we are a tribe who likes to set ourselves not merely apart, but also above.

Neither of these reactions is right or healthy. We may lead very different-looking lives, but we bear the same image of God. We may shoulder different responsibilities, but we share the same human need for unconditional love and acceptance. I don’t believe God’s desire for those in ministry is any different than for anyone else. I believe He wants all of us to experience authentic, life-giving community. But if we believe we’re different, we may cut ourselves off from the fellowship we so desperately need. If we believe we’re different, we may deprive ourselves of the deep relationships our souls crave.

We need to delete the “missionaries are better” mindset from our vocabularies. We need to stop isolating and elevating people in ministry and start embracing each other as equals, no matter which labels we personally claim. We need to take responsibility for the pedestals we’ve placed certain people on – even if we placed ourselves on those pedestals.

We need to level our hierarchies. Missionaries sin, ministers sin, and our children sin — just the same as everyone else. We all need a Savior. Honesty, openness, and acceptance are for all members of the Body. They’re for the ones preaching from the pulpits, and for the ones sitting on the back row. They’re for the ones sending monthly newsletters across the ocean, and for the ones sending monthly checks in the mail. They’re for everyone.

 

“I can’t trust anyone”

“I can’t trust anyone” closely follows “I’m different.” Many of the same experiences that lead us to believe we’re different also lead us to believe we can’t trust anyone, and it can be hard to tease out the differences.

At first glance, “I can’t trust anyone” might not seem like a lie. If church people have let us down, if they’ve mercilessly judged our struggles, if they’ve betrayed our confidences and broadcast our private stories to the world, this statement might seem true. And we might have decided we’re better off on our own. We might have decided we don’t need anyone after all.

Truth be told, I had trouble writing this section. Unlike some of the other lies in this series, I don’t have significant personal experience with this one. I’ve certainly considered myself “different,” and at times “better,” but I haven’t personally struggled with trusting people. I’ve always had a small circle of people I could trust, and I have a feeling this is because I didn’t grow up in a ministry home.

My story is not everyone’s story, however, and I’ve spoken with enough pastor’s kids and pastor’s kids’ spouses to know this trust issue is a big deal. It plays out in loneliness, arrogance, and a lack of close relationships.

While I’ve generally had safe people in my life, I know this much is true: some people cannot be trusted. Some people are not safe. There is truth inside this lie. Sometimes unsafe people in the Church hurt us deeply. Sometimes religious people wound us so severely that it almost seems irreparable, and we decide never to trust church people again.

While it is most definitely true that some people can’t be trusted, it is also true that some people can be trusted. Trustworthy people may be hard to find, but they do exist. And without that elusive trust, we can’t have meaningful relationships. When we choose not to trust people, we cut ourselves off from the relationships that can buoy us in times of trouble. When we tuck our weaknesses away where no one can find them or use them against us, we may think we are safe, but in reality we are alone.

If there truly is “neither Jew nor Gentile, neither slave nor free, nor is there male and female, for you are all one in Christ Jesus,” then perhaps there should be no pastor or member either, no missionary or sender. Not that there aren’t differing roles and responsibilities in the Church – because there are — but that we are all one in Christ, and all equal in His Church. So let’s accept each other’s weaknesses and respect each other’s stories. Let’s push back against the prevailing church culture that ranks us over and under each other, and love each other as equals.

I’m not saying we can’t be friends with people who’ve had similar life experiences. Those people instinctively understand us, and they can be a refuge for us. What I am saying is that we can be friends with people outside our circles, too. Others in the body of Christ can love us well, too. There are people “outside the tribe” who can accept our entire story, with all its complications and paradoxes. And we can love them in all their glorious complexity, too. Reaching out to people who aren’t exactly like us is what the Church was designed for.

 

“I can ruin my parents’ ministry“

Of all the lies listed in the Parsonage Heresies book, this one strikes me as the most tragic. It tells children they make their parents credible – or not. It tells children they prove their parents’ worth – or not. It tells children their behavior makes an adult’s ministry successful — or destroys it.

This lie places the burden of an adult’s employment squarely on the shoulders of a child. This is unfair in any profession, and completely out of place among God’s people. Children — loved by God, sought by God, cared for by God — should never feel the pressure to ensure their parents’ wage-earning ability.

Although this statement upset me more than any other lie in this book, I don’t have actual experience with it — probably because I didn’t grow up in a ministry home. But I can imagine it doesn’t feel like a lie. I can imagine having social, emotional, or educational difficulties and being afraid to express them, because taking care of those issues might take my family off the field.

While I’ve never met any parents who held their children responsible for their ministry career, adult PKs and MKs probably have painful stories to back up this belief, and for those stories, I am truly sorry. Whether this pressure came from within your family or externally from church members, or some deadly combination of the two, I am so, so sorry. That’s a heavy burden to carry.

I’d also like to consider the corollary of “I can ruin my parents’ ministry”: “I can ruin my husband’s ministry.” I am much more familiar with this fear. I didn’t originally want to move overseas, but I thought if I refused to go, I’d ruin my husband’s missionary dreams. I am not the only wife who’s ever felt this. Kay Bruner writes in As Soon as I Fell, “All through our training, I had heard how important it was for the wife to ‘be involved in the project.’ People said that if the wife wasn’t involved in the project, the whole thing would go down in flames. I didn’t want to be the reason our project failed.”

That’s a lot of pressure, and I’ve spoken with other wives who feel the same way. We’re afraid we can ruin everything for our husbands. Sometimes that idea is even planted by well-meaning organizations and leaders. Sometimes it comes from inside us. And honestly, I don’t know what to do about this issue.

I don’t even think this pressure is relegated to children and spouses. I think as adults in missions, we fear that our own sin or poor choices might cause us to fail, so we silence our own struggles. Other times we have medical issues that need tending, and we’re faced with the choice to hide or deny them, or to seek help off the field if needed.

To be honest, I’m not sure how to separate the truth from the untruth in these beliefs. I’m not sure how we as the Body of Christ can deconstruct these harmful lies. I hope and pray this pressure to perform for the sake of your parents or spouse is becoming a relic of the past, but I have a feeling this is something we need to talk about more. I don’t have many answers here. I would love it if you shared your hard-won wisdom and experiences in the comments.

 

Have you ever felt different, alone, or unable to trust anyone?

Where have you found safe community? What does safe community look like for you?

What can we do to facilitate safer environments in the Church, and specifically for people in missions and ministry?

Have you ever felt you could destroy your parents’ or spouse’s or even your own ministry career? How can we address this pressure in a healthy, God-honoring way?

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Part 1: The Little Word That Frees Us

Part 2: “I’m Not Supposed to Have Needs“

Part 4: “God is Disappointed With Me“

Part 5: A Conversation with Timothy Sanford

photo credit

When You Need Help Abroad: Finding A Good Counselor When You Live Overseas

One of the first questions people often ask me when they learn that I’m a psychologist is, “are you practicing?” They are invariably disappointed when I tell them “no, I’m still busy with our young children, and I’m trying to start a business on the side.” Here, like many other places I’ve lived abroad, there is a shortage of trained mental health professionals who are well equipped to help the expatriate population.

And, boy, a significant chunk of the expatriate population needs some helping.

That’s not surprising, really.

Moving abroad pushes you out of all sorts of comfort zones. Pretty much everything in life – from grocery shopping to figuring out the point of life – gets more complicated. The level of challenge in your life goes way up, right when you lose a lot of your normal support and coping mechanisms.

Yes, this can be a recipe for great personal growth. It is also, often, a recipe for great personal struggle and pain.

Coping with sudden and extreme change gets exhausting. Living far from family and friends gets lonely. Witnessing the impact of your choices on your family members – particularly your children – can breed guilt and insecurity right alongside gratitude. Having the familiar social and cultural scaffolding of your life ripped away can force you to confront core identity questions around yourself, privilege, meaning, purpose, and the existence and nature of God. The pathways to answering these questions often lead through dark valleys.

I would guess that those who live overseas entertain a higher chance of experiencing significant mental health problems, marital challenges, or substance abuse issues than those who remain on home soil. I’ve seen numerous marriages hit the rocks and other important personal and team relationships become hopelessly mired in miscommunications and conflict. I’ve seen people skid into alcohol and porn addictions. I’ve seen parents feel guilty and helpless as they watch their children implode (or explode). I’ve frequently seen more people who cannot shake anxiety, grief, bone-deep exhaustion, or the grey, soul-sucking fog of depression.

When these things happen (and they happen more often than you might think) expatriates can find it very difficult to get help.

There are all sorts of reasons why this is so, but one of those reasons is a shortage of qualified mental health professionals who themselves live abroad. So today, we’re going to talk about how to find some help when you find yourself struggling with a dark, difficult chapter in your story.

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When you’re trying to find a counselor locally, ask around

If you’re looking for a psychologist or counselor, start by asking others in town about the options. You don’t have to go into details, just ask if anyone knows of any psychologist, counselors, or social workers living in town.

You might want to start with your embassy. Talk to the doctor on staff at the embassy clinic, if there is one. Ask them whether they know of any psychologists or counselors practicing locally and, if not, what they recommend when people contact them asking for mental health or family counseling referrals.

If you live near an international school, you can approach them for information, too. The international schools may know of skilled expats in town, especially those who work with children.

You can also ask other expatriates, particularly doctors, nurses, midwives, doulas, and pastors.

Search online

world magnifyingWhen you live anywhere outside the major city centers, word of mouth is your best bet when it comes to finding mental health professionals who live nearby. However, you might get lucky with an internet search. Here are three things to try…

Check out International Therapists Directory. It provides an online global listing of professional mental health therapists who are familiar with the TCK and international expatriate experiences.

Use Google. I’m in Laos, so I would try searches like “mental health Laos” “mental health Vientiane” “psychologist Laos” “counselor Laos” “family therapy Laos” etc and see what comes up. I’d also search LinkedIn with those same search phrases.

When it comes to choosing a counselor, be picky

Don’t work with someone just because they live nearby. Yes, there are some benefits to sitting down with someone face to face, but a significant proportion of the mental health professionals I’ve met abroad are… well… to be honest… strange.

Be picky. You will be far better off talking to someone you trust and like via Skype than sitting with someone locally who isn’t qualified or able to help you.

Selecting a counselor is an important and individual process. Remember that a counselor who works well with one person may not be the best choice for another person. Also, when you live overseas, it can be helpful if your counselor has lived abroad themselves or has previous experience working with expatriates.

When you’re considering working with someone, you might want to let the counselor know you’re thinking of making an appointment and ask if they have a couple of minutes to talk with you before you make a decision.

Don’t use this time to explain at length why you want to make an appointment. Instead, ask some questions that can help you get a better feel for this counselor and whether you feel comfortable talking to him/her.

Here are some questions you could ask:

  • Can you tell me a bit more about your training and experience? Are you a licensed mental health professional?
  • Can you tell me a bit more about your general approach to counseling?
  • What do you enjoy about counseling?
  • If you feel comfortable naming the issue that you want to work on in general terms (e.g., “issues related to humanitarian field work,” “child-rearing problems,” “marital issues”), you might ask, “How much experience do you have working with people with this concern?”
  • How long (over time) do you generally like to see clients?
  • Can you tell me more about your fee structure/how you handle billing? (Either on the phone or in your first meeting, the counselor should provide information about procedural matters – fees, meeting times, availability, confidentiality, etc.).

When you meet with a counselor, ask yourself whether this is a person with whom you feel comfortable talking. You may need to talk with the counselor more than once to know the answer to that question. Do you feel the counselor is listening to you? Does the counselor treat you with respect? Does the counselor respond to your questions constructively?

If you can’t find someone local who you like and trust, find someone back home and work with them using Skype, Facetime, or other video-chat options. Nowadays, many counselors are happy to take on long-distance clients.

Find and read resources online

Articles, online training modules, and podcasts are not an adequate substitute for talking to someone, but they can help along the way. Here are a couple of websites that you might find useful.

The Headington Institute: Provides psychological and spiritual support services for aid and development personnel worldwide. Check out their free online training center covering topics related to resilience, stress, trauma, relationships, spirituality and more.

Member Care Associates: Provides and develops supportive resources for workers and sending groups within the mission/humanitarian sectors. Click on their Articles/Books tab to find a long list of resources for those on the mission field. Click here to read about their latest book in the Member Care series.

The American Psychological Associations Online Help Center: This is a good source for general articles and tips sheets about health, emotional wellness, families, relationships, and children.

Please chime in and add to this list!
Feel free to ask questions, share your experiences, or add useful links.

Carrying Water

Today’s guest post comes from Tamara White, former domestic missionary, current international consultant and therapist.

Tamara White Carrying WaterWhen I was in Haiti, high up in a mountain village, I was greeted every morning by a little girl who carried water for her family. The container was as big as her torso, perched perfectly on her sweet head. It seemed too heavy for such a tiny girl and I mentioned this to the pastor’s wife. ‘Yes,’ she said, ‘we’d like for everyone to have accessible water but really, it’s good for the children to carry water. It is the least of their battles.’ She, of course, was right. I was there to teach about PTSD but during my stay I was informed about their battles for education, gender equality, food insecurity, and opportunity.

‘Be kind, everyone you meet is fighting a hard battle.’ Plato

That was my mantra as I dove into inner-city ministry twenty years earlier. There were fun battles. Walking through a foot of snow to the latest ‘hole in a wall’ food haunt with friends. Teaching the Sunday School lesson from on top of the classroom table with some nice hip hop moves for ‘Moses’ and, my favorite – being ornery late at night and blaring Luciano Pavarotti into my Tupac driven neighborhood. And, there were dark battles. Perplexing injustice and violence, exhausting vigilance for safety, and the loneliness of pouring myself into others when I was still becoming whoever ‘I’ was. But there was something even more destructive that was leaving my soul ragged and orphaned. Depression and anxiety.

I attended small groups with other twenty somethings living in the city. I probably looked like I connected but internally, I felt void and unmoved always feeling like I was looking in. In staff and community meetings I was robust in debate but would give a big sigh as I crawled into bed feeling a mere shadow of my former self. The only time I truly felt myself was when I sang. I’ve always sang and performed but during those years, I loved worship because I felt alive, like my inner and outer being had finally merged for those few moments.

I remember helping some friends from the Jesus People apartment out of their car. We were talking about simple things. Familiar things. I was ‘spirited’ in my share of the conversation. As the wife gathered her belongings from the back seat her husband looked at me over the top of the car and said, ‘you know, Tam, it is okay to be angry.’ Me, a sweet Kansas girl happy to serve and eager to go that extra mile, angry? Shortly after that conversation one of the young women in our ministry told me, matter of factly, that I was just ‘not real.’ No one had ever said something like that to me. I was the one people sought out not dismissed.

Those two interchanges were simple, almost benign, but enough observation to slice into my façade. I was angry. And, I was submerged, not real and not accessible. I didn’t have a clue what that meant or how to deal with it so I did what any reasonable person would do and had a breakdown and left. It would not be the last time I would slowly, imperceptibly, fade away, and fall apart.

That was before I made frenemies with my nemesis. Before the devastating symptoms there are alarming whispers and I’ve learned to lean in and listen but, mostly, I’ve learned to care for myself. To those who are also the prey of depression and anxiety, this may mirror your own effort to be present instead of being submerged and fighting to breathe. Often and sadly, as a leader, or missionary, or, ‘person of repute’ as my mother would say – you do not get to be depressed or anxious. Which means you are a fool or crazy or, the very worst – needy.

After numerous battles fought, with some won but many lost, I decided that my truest offering might be to merge my 20 years of experience in ministry with the artful ministry of the soul – counseling. I know from experience that the demands of ministry, particularly in impoverished and vulnerable communities, can ‘out-crisis’ my crisis any day leaving me to silently fade and flat line. In combination, I know how vapid and confusing it can be, when faced with the challenge of serving in communities with a prevalence of trauma and consequential mental health decay, all while trying to honor culture and expressed felt needs. But my offer to you would be through my new mantra:

“Living well and beautifully and justly is ALL one thing.” Socrates

When I am not congruent in mind, body and soul, when I do not indulge in beauty and creating beauty, then justice seeking is really a mirage of intention. The Gospel tells me that I am free to float to the top, to engage, to wonder aloud about all these pains and to live in kindness because my battle matters too.

After becoming acquainted with the battles of the people in that mountain village in Haiti, what was it then that unnerved me about that tiny, little girl carrying water on her head every day? Quite simply, it was because it said, ‘I am in need.’ It was Christ, at high noon, asking for a cup from the shamed woman at the well. I get to share a cup of water with Christ when I admit, ‘I am in need.’ And when we all gather at the well, the water just might turn to wine. It’s most often not our choice what we get to carry in life, whether it is water or depression or injustice. The real battle is to be present, flatfooted and standing in our space in this world. I don’t allow my battles to remove me from my life anymore. I carry them, on my head if I have to, so I can live well and beautifully and justly. And that is kindness.

What hidden battles do you carry? What would it cost you to carry them on your head for all to see?

Tamara White, MA, NCC – Ministry: www.zoeroots.com  Practice: www.zoecounsel.com

Tamara WhiteTamara has over 20 years experience in urban, international, and diverse populations serving complex situations of individuals, teens and families in crisis. She founded and directed two nonprofit organizations in Chicago and Denver serving homeless families, teens, gang members and single mothers, with a focus on addictions, attachment, trauma and life skills.   An undergrad student of theology, organizational development, and communications she holds a Masters in Counseling Psychology. Her areas of expertise are trauma and PTSD, addictions, pre/post adoption, therapeutic parenting and attachment, grief and loss and, of course, depression and anxiety. Tamara is a single, adoptive mother who resides in Colorado with her children who amuse her, pets who shed, and friends who make her laugh.