Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) results from an incident that involves actual or threatened death or serious injury. A minister may never experience PTSD, but he or she will almost certainly see it numerous times within the church membership and greater community. As the minister tries to help those with PTSD, the minister will suffer the normal stress from those actions. PTSD results from experiences such as:

  • Severe auto accidents¾now tied with armed robbery as the leading cause of death for missionaries worldwide
  • Armed robbery—especially common throughout Latin America, Africa, Eurasia, and Eastern Europe
  • Physical assault
  • Rape
  • Car-jacking—especially common throughout Latin America, Africa, Eurasia, and Eastern Europe
  • Kidnapping—common in Latin America and Africa
  • Civil war and insurrection—almost a norm in much of Africa
  • Natural disasters
  • Expulsion—always a problem in sensitive countries, but now increasingly common even in Western Europe
  • Witnessing any of the above

When any of these crises threaten death or physical injury, or when an individual witnesses death or physical injury, PTSD grows into a significant possibility. Many missionaries assume that they remain resistant to PTSD as long as they avoid the above experiences. However, they usually overlook that witnessing any of the above incidents makes them susceptible and remains the most overlooked and most frequent source of PTSD for missionaries. Witnessing these events in your congregation can also lead to PTSD.

Witnessing or experiencing any single above event, by itself, can easily induce Post Traumatic Stress Disorder (PTSD). The Diagnostic Statistic Manual IV indicates that PTSD results whenever a victim experiences the following:

  1. Actual or threatened death or serious injury, or witnessing death or physical injury
  2. The individual’s response includes intense fear, helplessness, or horror
  3. And the individual experiences the following symptoms for at least one month:
    1. Persistent re-experiencing of the traumatic event
    2. Persistent avoidance of stimuli associated with the traumatic event
    3. And persistent symptoms of arousal such as sleeplessness, anxiety, hyper-vigilance, or increased levels of energy
  4. And the symptoms cause distress in work and social functioning.

For condition 3.a. above, the event can be re-experienced through intrusive memories, recurrent nightmares, or flashbacks. Flashbacks occur when the individual relives and behaves as though the event is happening all over again.

For condition 3.b. above, the individual feels intense distress when exposed to cues that symbolize the event. For instance, a firecracker is mistaken for a gunshot. So the individual usually tries to avoid thoughts, feelings, or conversations about the event. The individual especially tries to avoid places or people associated with the event.

PTSD is associated with increased rates for depression, panic disorder, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Agoraphobia (fear of going outside), Social Phobia and Bipolar Disorder. The victim often feels intense guilt over surviving the traumatic event.

How susceptible am I to PTSD?

The lifetime incidence of PTSD in the U.S.A. is 8%. Thus, almost every minister will find numerous PTSD victims within their community. For missionaries, however, the incidence remains 4-10 times higher, depending on the country in which they live. Twenty percent of women develop PTSD after a traumatic event. Thirty percent of Vietnam combat veterans and 50% of POWs develop PTSD. Other than witnessing any of the above incidents, the most common source of missionary PTSD remains a serious auto accident or armed robbery. Regardless the incident, repeated exposure to any the above incidents increases the vulnerability to PTSD from a later incident. So by the third incident, the individual grows four times more likely to suffer from PTSD. And so in some countries, almost all missionaries and many other ministers eventually experience PTSD, usually after repeated exposure to multiple incidents. Their colleagues sometimes wonder why a seemingly relatively minor incident suddenly results in major problems, when all along, the minister gradually grew increasingly vulnerable to PTSD. The analogy of “the final straw that broke the camel’s back” applies to ministers more than many realize. However, with PTSD each successive straw (incident) weighs twice as much as the former.

PTSD often begins immediately after exposure to an incident, but sometimes emerges as much as 30 years later. A Vietnam veteran friend of mine suddenly experienced disabling symptoms over 30 years after leaving Vietnam. The Harvard Mental Health Letter describes it:

Victims are often edgy, irritable, easily startled, and constantly on guard: the Vietnam veteran always sits with his back to the wall; the rape victim watches for potential rapists everywhere. Victims sleep poorly; they are agitated and find it difficult to concentrate. This group of symptoms is often described as hyperalertness or hyperarousal.

When not experiencing the above symptoms, the victims often experience numbing. Numbing includes a desire to avoid feelings, thoughts and situations that remind them of the incident, or a loss of emotions altogether. The victim notes that they cease to feel that anything matters. They feel cut-off from other individuals. Their feelings seem unnatural because they feel numbed to almost everything around them.

While adults often experience nightmares about the incident, children experience more generalized nightmares about monsters and demons. Instead of reliving an event, they re-enact it in their day-dreams and play. They tend to complain of all sorts of aches and pains, talk like a baby again, and some resort to wetting their pants like a toddler.

How does PTSD affect the children of ministers?

Childhood PTSD seems to induce borderline personality disorder in the adult years. The symptoms of a borderline personality include instability in mood, thinking, behavior, interpersonal relationships, and self-image. Borderline personalities are difficult to live with. Their friends and relatives note that the borderline personality presents unreasonable demands, provocative behavior, tantrums, hypochondriacal complaints, and suicide threats. These individuals seem chronically disagreeable, short tempered, and easily offended. Friends often feel dismayed that these individuals who seem so insensitive toward others can respond with hypersensitivity to anything that affects themselves. These individuals almost always experience multiple divorces and seem particularly susceptible to alcohol abuse. Without doubt, many adult children of ministers and missionaries suffer as lifelong borderline personality as adults due to their untreated childhood PTSD.

What should I do about PTSD?

First, realize that much hope exists. Two years after their release, I (Nathan) debriefed a group of POWs. All suffered from PTSD as a result of intense torture by the Taliban. After the intervention, all reported an immediate cessation of nightmares. Twelve recovered fully from other symptoms within a year and all recovered fully within two years. Similarly, a missionary contacted us who suffered from PTSD including daily nightmares for nearly two years after an incident of physical assault and battery. After the intervention, she reported an immediate total cessation of nightmares, and within one year she reported a total cessation of all other symptoms.

Thus, intervention works. Please reject the notion that you simply need to work through it. Without intervention, PTSD almost always destroys work effectiveness and all relationships with family and coworkers. In as little as two or three hours, someone can lead the victim through a process that usually helps considerably. Sometimes the process requires repeated interventions, but the process works. Almost no one needs to suffer from chronic PTSD.

Second, note that PTSD occurs as a normal result of an abnormal event. Since the victim feels abnormal, they and their colleagues often assume that the victim is abnormal. They are wrong. The victim’s bodily response (with PTSD) remains a normal response to an abnormal event. When you see a missionary or other minister who seems to act abnormally, instead of blaming them, ask yourself, “What event has this person experienced that stimulates them to act this way?” Almost always, their behavior follows as a normal result of a very abnormal event. We invite you to avoid blaming yourself and fellow ministers for something that seems almost inevitable in many countries. Let’s normalize PTSD. Blame the abnormal event, not the victim.

PTSD remains a normal experience for many ministers and even some of their parishioners and members of their community. However, great hope remains with intervention.

Hope remains

In A Psalm in Your Heart (125) Dr. George Wood addresses the appropriate response to stressful events like those that affected King David (see Psalm 31). He relates a narrative between Wayne Kraiss and an elderly woman about her bedridden childhood.

When I was a little girl in Germany, one day I asked my mother what it means that “all things work together for good.” My mother was baking a cake and, without directly answering my question, she handed me a spoonful of baking soda. It tasted awful. Finally, I asked her what she was doing and she responded that she was answering my question. “Amelia, my mother said, “I don’t want you to ever forget that all things taken by themselves are not always pleasant. But when they are mixed together and fired in the oven, you love the results.”

Dr. George Wood ends with the following prayer:

Lord, I don’t like the taste of a bitter experience but I trust you with the outcome. Forgive me for thinking the ingredient was your final product. With David, I confess, “How great is your goodness which you have stored up for [me].”

What if I suffer from burnout, depression, or PTSD?

If like Brian, you suffer from clinical depression or PTSD, don’t despair. For many ministers, these normal vocational hazards result from responding to a sinful society and a fallen world.

This websiite never offers therapy. This website provides prevention and resilience skills. If you presently suffer from depression or PTSD, please see a psychologist or physician right away. Both depression and PTSD remain highly treatable.

© 2013 Nathan Davis

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