23 minute read
In Times of Crisis
S. Ann Johnson
Let me take you with me to a place that even now I can hear and see again so well. To a time when all I can hear are the sounds of spent shells landing on the metal roof above me. A time when all I see are flashes of green light as shots fly past the slanted windows. A time when I hear a wife begging her husband not to dash out into the gunfire to find their seven children, not knowing if all the little ones (including my sister) have had time to run. A time when all I can say is, “Save us, Jesus; save us, Jesus.” A time when I sneak out the back door to see something I was never supposed to see—a valley full of fire with everything burning. I know men are dying and the two armies fired heavy artillery into the night.
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I dress my little sister as a boy, hiding her hair with a handkerchief. I hide my own figure with a baggy t-shirt and prepare for the worst. Imagine us hiding under the bed and covering the ends with a sheet. We play a game of hide and seek that is not a game. How many hours has it been? How many times have we hidden? I realize in my 18- year-old head that no person in the world outside of this place knows what is happening to us. How could they know? How could they know?
The very essence of becoming a missionary/expatriate Christian worker can entail a high degree of physical risk. Yet, the mental health risk is rarely spoken of in Christian circles. Mental health struggles are often dismissed as weakness and a result of inward spiritual struggles. Yet, as Robert Grant points out in his article, “Trauma in Missionary Life”, “Overseas missionaries can be peppered with years of direct experience with an exposure to crime, psychological intimidation, military and terrorist threats, kidnappings, armed coercion, torture, rape and murder. Repeated robberies and home invasions by burglars, soldiers, and terrorists are also not uncommon. Similarly, daily conditions characterized by destitution, oppression, disease, and domestic (as well as street) violence can wear down even the most dedicated of missionaries” (Grant, 1995).
With such physical risks involved in a commitment to overseas service, should it really be so surprising that severe mental health risks could be connected to them? The answer must be no. We need to better understand post-traumatic stress and its effects on families and their interpersonal relationships.
Post-traumatic stress disorder (PTSD) is of crucial importance to me and my family. In October 2002, my family was completely surrounded and caught in the crossfire between battling rebel and governmental forces in northern Cote d’Ivoire. Along with this experience came the very real possibility of death, being taken hostage, and rape. Our electricity and water lines were cut by the rebels. People in leadership on the international school campus where we lived realized we would not survive long without some sort of aid. After leaking the news to the international press, we were finally evacuated by the French military after we had spent a week being confined to our compound. In retrospect, every individual who was there likely experienced some degree of PTSD. Since this experience, I have been curious about its impact. How does this disorder, even in the minimal form that I experienced, affect my relationships? How could it potentially affect my continued work in overseas ministry?
What is Post-traumatic Stress?
Post-traumatic stress stems directly from a trauma experience. This can be defined as a severe life experience that can completely overwhelm a person. Figley, in his book Psychiatric Disorders, defines trauma as “an emotional state of discomfort and stress resulting from memories of an extraordinary, catastrophic experience which shatters the survivor’s sense of invulnerability.” He defines traumatic stress as “a set of conscious and unconscious activities and emotions associated with dealing with the stressors of the catastrophe and its immediate aftermath” (Miller, 1996). He adds that this often is coupled with the problem of not being able to process the event or incorporate it into one's worldview or belief system.
Many researchers believe another type of stress disorder called complex post-traumatic stress disorder is linked with trauma. It stems from continual and repetitious exposure to traumatic events that can span several years. It can be caused by repeated sexual or physical abuse, torture, imprisonment, captivity, and living in dangerous or wartorn countries. Someone working with people who have undergone traumatic events will have to be especially careful they themselves are not adversely affected by this stress. Continual exposure to trauma can lead to “a sense of losing one’s self or identity” (Grant, 1995).
This often occurs in relief workers and missionaries who force themselves not to feel, so that they can continue serving those in need. This is a laudable, normal reaction of the human mind to protect itself. Yet, treatment must be provided for these individuals because long-term exposure to danger and trauma can cause PTSD symptoms.
During a summer internship in rural Pakistan, I experienced, to a small degree, what this kind of regular exposure to dangerous living conditions can feel like. While my experiences there were compounded by my history with post-traumatic stress in Cǒte d’Ivoire, what I experienced in Pakistan was quite normal for anyone entering this kind of environment. Like others, I found my time there difficult. The expatriate Christian worker couple I was living with said that anyone entering Pakistan for their first term could usually only make it for about two months before they needed to leave. The second time, they would only be able to make it about six months and then would need to leave. By the third time, the individual would finally be able to live in the area for about two years before the need to leave arose.
Many came into the country with their children. Talking with one’s family about these kinds of reactions to living in a dangerous area for long periods of time is essential. It helps prevent burnout and emotional problems after extended exposure. Care for third-culture kids must include discussions about how repetitious exposure to stress can impact children’s development and what can be done to address this reality.
Symptoms and Characteristics
Post-traumatic stress sufferers often feel powerless, helpless and unable to gain control over their lives. They are unable to talk to others about the symptoms they are dealing with and find it impossible to explain what they have seen and heard. Usually an “intrusive phase” occurs directly after the trauma and lasts six to eight weeks. During this time, victims of trauma experience a high degree of emotional numbness. They often have flashbacks, sleep disturbances, nightmares, startled responses (often to loud sounds), panic and anxiety attacks, depression, irresolvable stress, social isolation, and problems concentrating (Grant, 1995).
More long-term symptoms occur as well. Victims of trauma re-experience the event persistently throughout their lifetime. Symptoms fade, but do not vanish entirely. Individuals try to avoid situations that will cause recurring feelings associated with the specific trauma. This can include avoiding watching specific films, fireworks or any activity related to the trauma. Many people with PTSD have difficulty tolerating noise and experience continuous symptoms of increased tension, anxiety, and irritability (Carson, 1998).
Noise disturbance is one of the most recurring aspects of post-traumatic stress disorder I deal with on a continual basis. I have always loved fireworks, yet I was caught off guard when I realized I can no longer enjoy fireworks as I once did. One Christmas I went with friends to see the lighting of Chicago’s Michigan Avenue. Unfortunately, I had forgotten that fireworks are set off from a barge in the Chicago River. I was quickly reminded of this when they exploded 30 feet from where I was standing. My body quickly took me to the ground. I started shaking and weeping uncontrollably, which continued for about an hour.
It is during such times that I most vividly see what I experienced in Africa. I feel I must use the opportunity to remember it clearly. Otherwise, I will forget what reality is like every day for people who must live in war, people the world has forgotten or never knew existed. These feelings have some benefits because of the focus of my life on helping people. But I now realize that my remembering also is due to survivor guilt, another symptom of posttraumatic stress disorder.
Survivor Guilt
Sometimes I purposely watch movies that trigger memories of the traumatic events I experienced. Watching the movie Hotel Rwanda was a difficult but validating experience for me. I had never allowed myself to realize how guilty I felt in leaving Cǒte d’Ivoire. Once we reached safety, I was greatly relieved. Yet, I had never understood what it was that made me feel I was still missing something. When I watched the section of Hotel Rwanda that portrayed the guilt some foreigners had when they were evacuating, I saw that their bus, a Peugeot, was exactly what we had used.
When I heard the reaction of the Africans to their being abandoned, I became incredibly nauseous and began weeping. I allowed myself to feel what had been the real trial in driving out of that country. It was not just fear, but guilt. I felt guilty for being white and could not understand why my skin color and my nationality dictated my ability to flee and my certainty of survival. What I experienced is exactly what Roger Grant describes in his article: “Being reared in relatively privileged backgrounds, able to flee overwhelming situations of poverty and violence at a moment’s notice, often leads to self-recriminations and self-inflicted deprivations” (Grant, 1995).
Survivor guilt has enormous consequences in interpersonal relationships between missionaries. Individuals withdraw from each other, thinking they are the only one feeling guilty for surviving. Guilt is difficult to explain to people and is rarely talked about. I have rarely talked about the guilt I felt. It is difficult and was never brought up in my community post-evacuation. This lack of understanding among expatriate Christian workers, who have endured a similar trauma, can be paralyzing to their interpersonal relationships. While everyone is celebrating their return to their passport countries, the traumatized missionaries often find it difficult to celebrate with them. They inwardly mourn those they left behind. This strains relationships with extended family who cannot understand why their precious relatives are not happier to be alive. They tend to completely avoid the subject of survivor guilt with people at home. Missionaries fear being misunderstood or that their audience will be apathetic about the situation. Many times, expatriate Christian workers who experience survivor guilt have no idea of their feelings unless they are unearthed in counseling and related experiences or through films.
The Importance of Grieving
Adding to the stress and trauma problem of expatriate Christian workers is the individualistic spirit that most tend to have. People think they can handle stress on their own and refuse to lean on their friends and co-workers. Robert Grant echoes this reality in his book on member care: “Part of the difficulty of treating missionaries is that they have been trained to be tough and not to let certain feelings affect them. Frequently, considerable emotional and physical pain are repressed or offered up to God. In the case of some traumatic injuries, these attitudes can have life-threatening consequences” (Grant, 1995).
Many missionaries, so overwhelmed by the amount of work and by the pressure of the task they are to accomplish, feel guilty if they stop to deal with personal mental health issues. Also, a good deal of pressure on them stems from the fact that they are their being supported financially by friends and relatives back home. They often feel they must use their time on the field wisely and not waste one moment.
This kind of stress is incredibly unhealthy, especially when added to the post-traumatic stress that can be caused by other external factors. If struggles are not dealt with properly, many expatriate Christian workers are faced with three options: head home, accept an administrative position, or endure incessant psychosomatic problems. “The effects of trauma, if left untreated, can result in a variety of psychological, physical, and interpersonal impairments that can last a lifetime” (Grant, 1995). Loss of friends, coworkers, homes, and ministries is a normal occurrence in missionary life. Yet, there is an emphasis in the mission’s community on the need to be “tough” which contributes to a lack of dealing with true grief and loss.
While individuals might be able to press on for a time, not addressing the problem will eventually paralyze their ability to give of themselves to others and can lead to burnout. This type of self-sufficiency is an incredible hindrance to healthy relationships among expatriate Christian workers. They can feel ministry and trauma recovery are constantly competing for their time. I have experienced this as an adult on the field. On occasions, our family has had to make time for counseling so that we can continue in our work in a healthy way. I have made make it a priority to champion mental health care for other missionaries and promote selfcare in any way I can.
Effects on Relationships
Post-traumatic stress can have many negative effects on individuals and communication. Expatriate Christian workers often try to hide from each other how they are really coping with the effects of traumatic stress. Those struggling to deal with the trauma fear being seen by their peers as “weak” and unfit to continue the work. “Peer pressure amongst missionaries is a powerful force” (Grant, p. 79). Relationships among fellow missionaries and missionary couples will continue to disintegrate because survivors often use poor coping mechanisms to hide their pain. This is often seen in the form of addictions which individuals use to gain control over their situation and release the internal pressure they often struggle with. These addictions can range from alcoholism to workaholism, all of which severely affect the mission’s community.
Trauma victims often have a difficult time relating to other people after a crisis. They feel people will not understand what they have experienced. This leads to unfair judgments of people who may genuinely want to understand what the individual has seen and heard. People often begin closing themselves off from relationships in an attempt to protect themselves from further hurt.
“Many times this self-imposed distancing and coldness in relationships alternates with what psychologists call enmeshment, relationships that are so close and constricting that the people involved in them don’t know where one individual leaves off and the other begins” (Porterfield, p. 33). Those who have survived trauma together often become like brothers and sisters who withdraw and alienate others. They see them as too “naïve” or “inexperienced” to understand what they have been through. This kind of superiority after experiencing a traumatic event is a sad reality in many mission circles.
Yet, many positive effects of experiencing a trauma are often overlooked and I feel must be mentioned. When one’s life is threatened, all outside issues become completely meaningless. Relationships in a community become the key to survival. These relationships are forged in steel and result because of negative, nonjudgmental attitudes and, in turn, complete acceptance. For my high school senior class, this meant a complete destruction of all cliques. Relationships became deep and focused on what really matters in life. All triviality was demolished.
Charles Davis explains this well in his account of the trauma he endured in Congo. “Fellowship deepens when pain is shared” (Bayly, 1966). After my experiences in Côte d’Ivoire, my class became my family overnight. My school became my home. I felt my class and our school family as a whole were like a giant family. We had all experienced the same trauma, and there was an unspoken closeness surrounding the entire community.
There is also a great deal of intrapersonal benefit in seeing the hand of God protecting His people in such unquestionable ways. Experiencing a trauma can be a catalyst for spiritual renewal and can deepen an individual’s faith. I would never wish away the experiences I had in Côte d’Ivoire. They have shaped me into who I am and have rooted me in God and a life of service. Trauma forces us to lean solely on God.
Charles Davis speaks of a morning after his hostage experience. “Usually I’m pretty sure of myself. That morning I wasn’t sure of anything except that the Lord was the only reason I was there, still alive” (Bayly, 1966). Our lives become refocused in the aftermath of difficult times. Our faith is enriched after understanding the true depth to which we can truly trust our God. Davis’ friend Assani sums this up well. “After these times of suffering, I have a stronger desire to serve God than ever before. My heart is surging with much more joy than before this time of sorrow” (Bayly, 1966). Similarly, the trauma I experienced in Côte d’Ivoire has helped me become aware of the trauma happening daily all over the world. I have been given a gift I can use to feel the pain of others, and I will forever be grateful to God for that.
Quick Response
“Without treatment, the most damaging aspects of trauma can stay underground indefinitely. When this becomes the case, tremendous cost to physical, emotional, and spiritual health, as well as to interpersonal relationships and vocation, can be the results” (Grant, 1995). It is wise for any victim of traumatic stress to take an adequate amount of time away from the situation to rest both physically and mentally.
Supportive therapy is also extremely important to a person’s recovery. Treatment immediately following the event is a crucial part of recovering from severe stress reactions. Individuals who were treated immediately after trauma had a 60% rate of improvement, while those without immediate treatment showed only a 26% rate of improvement (Grant, 1995). One of the most important methods of helping trauma victims is to allow them to be together. When victims of trauma are together, they are able to bond and understand each other better than any counselor. Group relationships in safe environments after an experience of trauma can greatly decrease the intensity of post-traumatic symptoms.
I can vouch for the effectiveness of immediate treatment for a group. Our organization brought everyone from our group back to the home office in the U.S. where counselors immediately began conducting sessions with both adults and children. As an 18-year-old, I benefited from both. It was so healing to hear adults processing and validating the experience together.
I’ll never forget the moment a flag snapped in the wind outside the window where our children’s counseling session was taking place. Every child hit the floor. Our counselor’s face was a mixture of surprise and concern. Then all the kids began laughing. There was a camaraderie that helped us process the events in Africa.
While we were at the home office, people from churches in the city donated clothes and suitcases because we had left Africa with only the clothes on our backs. Other classmates did not get the same kind of immediate response from their organization. Many of them shared with me their continued struggle in processing their experiences and some were angry.
A Family Response
Intimate relationships within the family unit and with close friends are key to understanding and relieving tensions caused by post-traumatic stress. Individuals must allow and illicit many times the story of what happened so that he or she can process it as they speak. In doing so, healing is taking place within the person’s mind. They realize someone cares about them and about what happened to them and within the friendship threatened by a traumatic event. “Repetitive talking about the experience and constantly reliving it in fantasies or nightmares may serve as built-in repair mechanisms to help a person adjust to the traumatic event” (Carson, 1998). Regular debriefing allows an individual to be continuously processing what has happened. PTSD does not heal completely, it fades. Thus, the process of healing should not be stopped. Ongoing support groups should be formed, both in the passport country and on the field to deal specifically with these issues in a preventative matter. “Without ongoing support, crisis intervention rather than preventative care becomes the pattern, and many in the field risk becoming more and more emotionally numb” (Grant, 1995).
A crisis management team plays an important role in handling a crisis situation, but it is an area where crucial mistakes can be made. I attended a crisis conference in Thailand, and the man running it had been the chief negotiator for his agency in a hostage crisis. I was shocked to learn he had no prior experience or crisis training. This was also true of the rest of the members of the team, which had been hastily thrown together. In addition, the organization had no policies, mate-rials, or preparation for a hostage situation. This lack of preparedness negatively affected their ability to function as a team and accomplish the task. Splits developed within the team and stresses emerged that affected their relationships with family and friends.
While many organizations are well prepared for a crisis, many others are not. Since these situations are inevitable, agencies can’t wait to prepare for a crisis until it happens. At that point it is too late. Each agency should already have policies and a team in place long before any crisis occurs. These policies should be regularly reviewed and updated. The team members should have specific training in crisis management, and their roles and responsibilities clearly defined in advance. In addition, the organization should know what outside help and resources are available (such as Crisis Consulting International) to provide training, review policies, evaluate risk, negotiate, etc.
Re-entering the Mission Field with PTSD
It is possible for a missionary to return to the field after experiencing PTSD— but it is especially important for people to face their fears. My family returned to Africa only three weeks after evacuating from Côte d’Ivoire. While this might seem like too short a period of time, our organization handled things well by providing counseling for both children and adults. A reality that heightened our stress at home was being around people who could never understand our experiences. We were also being interviewed by newspapers and radio stations repetitively. Going home to Alaska was the last thing I wanted to do at that point. Returning to Dakar, Senegal, where we were surrounded by a loving mission’s community who understood our trauma, was the most healing thing we could have done.
My summer in Pakistan was a type of “trial run” for me in re-entering a hostile environment on the mission field. One time when we were visiting Islamabad, Pakistan’s capital, immensely loud noises (sounding like gunshots) started to go off nearby. I immediately hit the ground and army crawled my way over to the window only to discover a large group of men standing outside our house. My mind instantly went into survival mode. I knew in my head that it must be a wedding, but my body could not acknowledge the fact. Even after making it downstairs and talking to my teammates who assured me it was a wedding, I continued to weep in the shower. I allowed all my forgotten feelings resurface and all the images to refill my mind.
While these symptoms of PTSD may sound severe, they did not significantly affect my ability to minister and teach in Pakistan. This was because even as I was experiencing them, I knew what was happening in my body. I allowed them to pass and told other people, whom I had previously prepared, what was happening. Their support and understanding strengthened our relationships and allowed me to feel affirmed even through those experiences.
Now, after 11 years of serving on the field as an adult in Asia and North Africa, I know that returning to the field after facing trauma as a TCK is possible. I have had to humble myself to ask for help from counselors and teammates along the way. I have had to be open with my husband about the struggles I might face and do face overseas when I deal with fear and anxiety. There have been times I have had to choose to be honest about how situations overseas are affecting me differently than they would other people.
I have used my childhood experience of trauma overseas for good in my mission community. I have encouraged other organizations to prepare for traumatic and crisis situations: to have crisis teams, evacuation insurance, funds and emergency services available for their members. I have been open about the importance of counseling check-ins for myself and encouraged other missionaries in my community and on my team to do the same.
In this time of facing a global pandemic while living overseas with my children in areas with less than ideal medical care, I can turn to my good Father and lay my fears at his feet. “The good news is that the worst events are survivable. Only when traumatized people isolate themselves is surviving difficult. But when the pain, fears, and inner rage are shared with others who have suffered similar fates, the victim can begin to see that their responses are normal. With time, understanding, acceptance,…trauma can be survived, and the person can move on with hope” (Hicks, 1983). With God’s help, hope can be found in trauma and relationships can be healed.
S. Ann Johnson
S. Ann Johnson is a third-culture kid (TCK) and an Alaskan. She is mother to two current little TCKs. She works in international education and has been working in Asia and Africa as an adult for the last 13 years. She lived as a child and teenager in both Cote d’Ivoire and Senegal and taught TCKs at Dakar Academy in Senegal. She has an M.A. in Intercultural Studies from Wheaton College.
Reference Works
Bayly, Joseph T. (1966). Congo Crisis: Charles and Muriel Davis Relive an Era of During Weeks of Imprisonment in Stanleyville,
Carson, Robert C., Butcher, James N. and Mineka, Susan. (1998). Abnormal Psychology and Modern Life. Addison-Wesley Education Publishers.
Grant, Robert. (Jan 1995). Trauma in Missionary Life: An International Review, Vol XXIII (No 1).
Hicks, Robert. (1993). Failure to Scream. Thomas Nelson Publishers.
Jacob, Mel. (1983). Post-Traumatic Stress Disorder: Facing Futility In and After Vietnam. Currents in Theology and Psychology. Vol. 10.
Meisenhelder, Janice Bell. (2004). Responses of Clergy to 9/11: Post-Traumatic Stress, Coping, and Religious Outcomes. Journal for the Scientific Study of Religion. Vol 43.
Miller, Thomas W. (1996) “An Update on Post-traumatic Stress Disorder”. The Hatherleigh Guide to Psychiatric Disorders. Hatherleigh Press.
Porterfield, Kay Marie. (1996). Straight Talk About Post-Traumatic Stress Disorder. Facts on File.
Rogers, Dalene Fuller. (2002) Pastoral Care for Post-Taumatic Stress Disorder: Healing the Shattered Soul. Haworth Pastoral Press.
