Moving abroad is a wonderful privilege filled with blessings. Those of us who grew up internationally are able to experience the richness of the world in a way which we couldn’t have otherwise. In short, it is great. Yet there is a price to pay. Life is often filled with death, loss, and grief to an unprecedented level. This pain takes its toll on the human body, often in the form of mental illnesses.
It is difficult to pin down what causes mental illnesses. Both genetic and environmental factors are at play. However, there are some situations where mental illnesses become easier to spot. Think high-stress situations such as dealing with pressure to get visas sorted whilst trying to find a school for kids. Or potentially dealing with cycles of loss as you say goodbye to good friends, not knowing when you will see them again. Or wrestling with questions of identity as re-entry into your passport country becomes painful. Any of these sound familiar?
This is particularly challenging for TCK’s. Whilst these challenges can wipe anyone off their feet, dealing with these difficult circumstances during your developmental years can be devastating to your mental health. In the years where humans’ brains are primed to learn about identity, culture, and belonging, we are pulled from one place to the next in painful upheavals. Whilst it does vary from TCK to TCK, the general trend is one of dealing with far greater stress and grief than your average child.
It then comes as no surprise that mental health is a bigger problem among TCKs than the global trend. Whilst data is notoriously difficult to obtain (turns out being all over the world makes it hard to collect data!), there is a connection between cross-cultural living and struggling with a mental health disorder. When this happens during one’s developmental years the issue is magnified.
Unfortunately, mental illnesses are not taken as seriously as they should on the mission field. For example, depression is the leading cause of disability in the world and seems to go hand in hand with missions work. Despite this, most missionaries don’t have an extensive knowledge of the issue. I have many MK friends who struggle with depression, anxiety, bipolar, or other mental health problems (I, myself, am ill with a suspected somatization disorder). Missions is messy and painful work, contributing to mental illnesses in MKs.
The severity of these illnesses varies, but they cannot be ignored. I would not be surprised if many of you reading this know of someone who has tried to, or has, committed suicide. I went to an MK school in Kenya (RVA), which I loved. Yet, every year multiple people struggled with mental illnesses. I am not writing this to reflect badly on my school. Whilst the school is far from perfect, mental illnesses are part and parcel of missions work. Suicide is a terrible consequence of mental illnesses, but not the only one. The destruction they cause is pervasive and casts a menacing shadow over every area of our lives. It is a topic nobody seems to consider until the situation is already devastating.
One of the curiosities of mental illnesses is that they tend to show up later in life for us. The trauma the we carry around as TCKs usually manifests itself through mental illnesses once we are adults. The counselor Lois Bushong says that most TCKs tend to only start going to counseling once they are in their 30’s.  I am not yet in my thirties, but already, increasing numbers of my classmates report having mental health issues, almost exclusively struggling from unresolved trauma or grief on the mission field. Being a TCK does not stop when we become adults; both the blessings and the curses will follow us forever.
This is not a TCK-specific problem. Many cross-cultural adults report bouts of depression after transitioning culturally. This is often the case when people return to their passports culture.
The reality is that anyone who lives a stressful lifestyle, moves a lot, has had to say lots of goodbyes to friends, places and languages, struggles with questions of identity or belonging during their formative years will be more prone to mental illnesses. Obviously, missionaries (including MKs) fit right into these categories. It is something that we will have to deal with, whether we want to or not. I can guarantee that every missionary knows someone who has a mental health problem. They might not be aware of it because of the painful and secretive nature of these illnesses, but they affect almost all missionary families.
To their credit, mission organizations are ahead of the game in member care. They are the best international groups in this regard. However, with mental illnesses we still have a long way to go.
Here are some thoughts on how we can fight mental illnesses: they can only be fought as a team. Given that we are all one family under God, it is something we should all care about.
1. Have a well-rounded theology of suffering. We should not expect a comfortable life as Christians, but rather the opposite. We live a broken world in desperate need of God’s grace. There should be a constant dialogue around suffering, both its inevitability and how to rejoice in it (think Colossians 1:24 or James 1:2). Without this understanding we will grow inconsolably despondent in tough times. For a brilliant book on this check out The Call to Joy and Pain by Ajith Fernando.
2. We need to be proactive in conversations about mental illnesses. This is not a topic we should only learn about when we encounter its consequences. It needs to be part of all healthy discussions about being a cross-cultural missionary. If you have kids, it is crucial to bring them up discussing them. Not only do they have a decent chance of being ill in the future, but they will also play a key role in supporting other TCK friends who are likely to struggle with mental illnesses.
3. We need to have a proper understanding of mental illnesses as medical issues. Missionaries cannot go onto the field thinking that mental illnesses are spiritual failings or defects. This attitude will crush them, their children, or their friends when they encounter mental illnesses (regrettably this is still common). Whilst suffering from a mental illness is tough spiritually, medically speaking it is as physical as breaking a leg (although it’s more complicated because our brains are inspiringly complex). If you trust a doctor to fix a broken bone, please trust doctors as they tell you that mental health is physical too. (I can provide a plethora of evidence for anyone interested.) Like any problem, proper education on the topic will allow us to be supported and get the help we need quicker.
4. Pray for all those suffering from mental illnesses. It is a terrible burden and cannot be carried alone. Feel free to get in touch with any questions. Please keep this conversation going.
 Bushong, Lois. Belonging Everywhere and Nowhere: Insights into Counseling the Globally Mobile. (Indianapolis: Mango Tree Intercultural Studies, 2013), page 47.
Aneurin Howorth grew up up in East Africa as an MK. Both his parents are British, but he has an American accent from time spent at Rift Valley Academy. Aneurin is passionate about mental health and the relationship it has to living internationally. He believes we need more discussion around these topics and blogs about both at https://noggybloggy.com/. He is currently studying for a Master of Science in the psychology of mental health at the University of Edinburgh in Scotland. You can contact him here or on his personal blog.