It occurs to you that you have been feeling really sad, tired, discouraged about the future, unable to concentrate for some time, and you begin to wonder what is wrong. You just wish you could feel happy and enjoy life again. Certainly committed Christian cross-cultural workers could not be depressed, could they? Wouldn’t God keep them from that? Should you pray? See someone for counsel? See your physician? Will you get better? How long will you feel like this? Let’s consider some of these questions.

The definition of depression changes slightly from time to time, but currently a person must have at least one of the following symptoms most of the day, nearly every day, for two or more weeks to be considered "clinically depressed:"

• Feel sad, depressed, or empty
• Lose interest or pleasure in almost all activities

In addition, the person must have more than three or four of the following nearly every day for the same two or more weeks:

• Great increase or decrease in appetite
• Sleeping much more or less
• Agitation or sluggishness
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Decreased ability to think or decide
• Thoughts of death or suicide

These symptoms must be bad enough to distress you or impair your daily functioning and not be caused by drugs, hormonal imbalance, or other physical problems. If you do not have at least five of these symptoms (including one of the first two), then you do not meet the definition of "clinical" depression. Even if you are not clinically depressed, suggestions in this brochure may be of benefit to you.

Depression is the "common cold" of psychological disorders. About 20 of every 100 women and about 10 of every 100 men experience clinical depression at some time in their lives. Christians sometimes deny that they feel depressed, but many do, as did God’s choice people thousands of years ago. Of course, there is no way we can go back and ask people in the Bible whether or not they have five or more of these symptoms, but let’s look at some things they said about themselves.

• David, king: "How long must I wrestle with my thoughts and every day have sorrow in my heart?.…My life is consumed by anguish and my years by groaning; my strength fails because of my affliction" (Psalm 13:2; 31:10 NIV).
• Job, layman: "Why did I not perish at birth, and die as I came from the womb?….I have no peace, no quietness; I have no rest, but only turmoil" (Job 3:11, 26 NIV).
• Elijah, prophet: "I have had enough, Lord. Take my life; I am no better than my ancestors (1 Kings 19:4 NIV).
• Jonah, cross-cultural worker: "O, Lord, take away my life, for it is better for me to die than to live" (Jonah 4:3 NIV).

Maybe heroes and heroines of the faith in Bible times became depressed, but what about some of our great cross-cultural workers since then? Let us look at what they said:

• A. B. Simpson, founder of the CMA: I fell "into the slough of despond so deep that…work was impossible…I wandered about deeply depressed. All things in life looked dark and withered."
• Adoniram Judson, cross-cultural worker to Burma: "God is to me the Great Unknown. I believe in him, but I find him not."
• Mary Morrison, wife of Robert Morrison (China), who wrote, "My poor afflicted Mary…She walks in darkness and has no light."
• David Brainerd, cross-cultural worker to native Americans: "I live in the most lonely melancholy desert….My soul was weary of life. I longed for death, beyond measure."

Many different things may cause depression. Here are just a few:

• Loss, disappointment, failure, grief
• Unfulfilled expectations, concern about the future
• Negative thinking, success seen as failure
• Medicine side effects, illness, imbalance of hormones or neurotransmitters
• Lack of social support, conflict
• Guilt, unforgiven sin
• Too little light, too much heat

The good news is that although depressed people often feel so bad that it seems hopeless, most people recover from their depressions in a few months to a year or more without professional help. Depressions come, and, usually within months, they go. The bad news is that when people become depressed, the condition may interfere with their work and relationships. Some become so hopeless that they may try to take their own lives before they start to improve. Some types of depression do not get better without treatment; in fact, they can get worse. Other bad news is that about half the people who have depression once have it again.

Many people begin by trying to treat it themselves. Here are some things you might do:

• Replace negative with positive thoughts
• Keep a journal of what you think and feel
• Give yourself affirmations
• Listen to relaxing music
• Get more light or less heat
• Change your normal routine
• Set realistic goals and record reaching them weekly

Also, recent evidence shows that St. John’s Wort, a common plant worldwide, may help relieve mild to moderate depression; it is widely used in Europe. Although it may not grow near you, it is widely available without prescription in pharmacies and wherever over-the-counter medications are sold. People who are seriously depressed and considering suicide should not attempt self-treatment, but seek professional help immediately.

If self-help does not work, the kind of treatment you receive depends on who you see for help.

• Pastor. Cross-cultural workers, like other Christians, often think their feelings of sadness, guilt, and worthlessness have a spiritual basis. Didn’t Jesus come that we might have joy, forgiveness, and life as children of God? Of course he did, and a talk with your pastor for a "spiritual check-up" is a good place to begin. If this spiritual treatment works, fine. But if it does not, then it is good to see a mental health professional.
• Psychiatrist. Depression may have as its cause a chemical imbalance, and psychiatrists tend to emphasize chemical treatment. If your depression is caused by your blood pressure medication, for example, that may need to be changed. If you have an imbalance in the serotonin in your brain, an antidepressant, such as Prozac or Zoloft, may help.
• Psychologist/Counselor. Depression may be caused by your way of thinking about things. Cognitive therapy, which helps you change the way you think about things, is widely used by psychologists and other counselors, and it may help your depression.

We have come to expect instant fixes for any problems we have, and you must be aware that none of these professionals can bring about a cure in a few days. All of these usually take several weeks, but they do often shorten the depression. In addition, your depression may have several causes, so that you need several different kinds of treatment at the same time. You can pray long, but if your depression is a result of your way of thinking or a side effect of a medication you are taking, God may answer your prayer through counseling and/or appropriate medication

There is no sure way to prevent any disorder. People inherit tendencies toward certain disorders, and if depression runs in your family, you are a more likely candidate. However, there are steps you can take that make depression less likely. The most helpful thing you can do is greatly to reduce stress!! Of course, telling cross-cultural workers to avoid stress is like telling them to quit; but fortunately, factors that increase happiness also tend to reduce stress.

Happy people tend to have:

• High self-esteem. Remember that you are created in God’s image.
• Optimism. Change your thinking to see the good in every situation.
• Close friendships (or a satisfying marriage). You are part of the body of Christ
• Meaningful faith and work. You are a part of God’s plan for the redemption of the world.
• Adequate sleep and exercise. Although this seems unrelated, not taking care of yourself physically leads to depression.
• Enjoyable activities. Regularly do "fun" things.

Although depression is common, you can take steps to prevent it and recover from it. You can find joy and hope.

Ronald Koteskey is
Member Care Consultant
New Hope International Ministries

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Mental Health Resources for Cross Cultural Workers
Ron and Bonnie Koteskey, 122 Lowry Lane, Wilmore, Kentucky  40390, USA   Phone: 859-858-3436
ron@crossculturalworkers.com   bonnie@crossculturalworkers.com