From spotlight - Winter 2019 - self-care for the carer
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First, let's blow a myth. Christians can and do get depressed and they can and do suffer from mental health conditions. Many great Christians, including Martin Luther, Charles Spurgeon, John Newton and Mother Theresa battled bouts of depression and/or anxiety. If you are or have struggled with mental illness, you're in good company!
Moreover, Christian healthcare workers seem particularly vulnerable to burnout. This vulnerability stems from three seemingly good things: character, commitment and the Christian climate. Let me explain:
Most nurses and midwives have caring and giving personalities. We are usually capable and motivated people with very full lives and a strong sense of responsibility. The demands are not just at work but often in our families and our churches too. Part of the problem is that we are often other people centred and often bad at self-care. We're so busy giving out and serving others (frequently while under pressure) that we rarely stop, to take stock and to care for ourselves.
There's a sense as a Christian that we are to live a life of service and embrace suffering like Christ did. We follow a Saviour whose obedience led to crucifixion, so it would be wrong to want a stress-free life, wouldn't it? Aren't we supposed to 'go the extra mile' at work and always be the last one to leave the ward at the end of a nursing shift? But, as we read below, God has made our bodies to need rest and time to refuel, so we require ongoing wisdom as to when it's right to sacrificially serve and when it's right to say 'no'.
Then there's the stigma of admitting to mental illness. Will Van de Hart, Pastoral Chaplain at Holy Trinity Brompton church in London calls the lack of conversation and acceptance of mental health issues in the church 'the elephant in the pew'. (1)
In society, there is a climate of shame and silence over mental illness (though this is beginning to improve) but the stigma is compounded for Christians if we believe that by suffering from mental illness we have offended God or are expressing a lack of faith.
what is clinical depression? (2)
These are the common features of clinical depression that one would look for in seeking to establish a diagnosis:
Two weeks or more experiencing symptoms 1 or 2, plus at least four of the other symptoms (3-9) for most or all of the time.
1 Feeling low and down nearly all the time
2. No interests or pleasure in anything
3. Unable to sleep properly
4. Loss of weight (sometimes gain in weight)
5. Agitated or very slowed down
6. No energy, tired all the time
7. Feeling worthless or guilty
8. Unable to concentrate
9. Recurrent thoughts of death or suicide
As Christian healthcare professionals, all of us must take responsibility for creating a culture that is rich in God's grace. A culture where we patiently walk alongside each other and support each other without judgment. A culture where we remember that we live in the 'now' and the 'not yet' of God's restorative kingdom. Our journey this side of heaven as a Christian nurse or midwife may be up and down. But with fellowship, prayer, biblical wisdom, practical help and support, and when needed, medical help, things will improve.
Many of us may not have clinical depression, but we may suffer from stress, anxiety or depression for shorter periods, often in response to specific stress factors or chronic workplace challenges. Even though much of this is a normal human response, God wants us to flourish in life and in the vocation to which he has called us. We will better serve others in the long-term if we look after and are kinder to ourselves. So, how can we improve our mental health and well-being?
Will van de Hart likens the way our bodies operate to that of an engine. Every engine is dependent upon oil, air, fuel and its battery. (3)
1. get enough rest
The oil of the mind is the neurotransmitter serotonin which typically depletes in times of high stress and exhaustion. I mentioned earlier the self-giving nature of most Christians called to healthcare, who feel the added compulsion to give sacrificially when they read words like the apostle Paul's in Romans 12:1 'Therefore, I urge you, brothers and sisters, in view of God's mercy, to offer your bodies as a living sacrifice, holy and pleasing to God…'
However, there's a difference between godly sacrifice and needless burnout. A 'living sacrifice' might be better expressed as a 'sustainable sacrifice' - the sort of self-giving that enables us to go on day-by-day for the long run while having wisdom to prioritise rest.
Replenishment often comes in times of rest and contentment. Where possible, try to keep a regular sleep pattern and enhance falling to sleep by planning for a 'non-screen unwind' period before bed.
2. give yourself a break
Air keeps the engine cool. We need clear air to gain perspective and clarity. When did you last have a holiday, or some time off just for yourself? Even Jesus, at the height of his healing ministry, would regularly take time off by himself to go and pray (Luke 5:16). Sabbath rest is ordained by God as essential to our well-being. We all need time, as Rob Parsons puts it, for 'kicking the leaves' - time for quiet reflection and with no other purpose than being able to unwind. (4) Try and find activities or friendships that are life-giving to you and then make sure you intentionally include time for these. You are important enough to invest in yourself!
3. good physical & spiritual food
Fuel represents good food for the body and good spiritual nourishment for the soul. God has made us holistic beings, and so how we care for our body and spirit also affects our minds. Exercise and healthy food helps us recharge, boosts our immune system and helps us keep well - all reducing stress levels. I realise it's hard to sometimes drink enough, never mind eat on a busy shift! But remember that your ongoing health is important, so grab that cup of tea or cereal bar when opportunity arises and don't feel guilty!
As Christians, we have an additional resource (fuel) to call on - the Lord Jesus Christ. Pray before, during and after a long shift, giving to God the pressures and anxieties of your work and ask for the Holy Spirit's help to show love and care to your patients and colleagues. Invite God's presence into all you do; refocus on what really matters; not just on the immediate pressures you face and ask him to help you cope with the load.
4. get connected with other Christians and with God
To recharge our battery, it helps to stay in fellowship with others. The tendency when depressed is to withdraw from others and hibernate in isolation, but it's exactly at this time that we need other's support and encouragement. Even if you have just one or two trusted friends who you can talk to when you're struggling, they can keep an eye out, pray or simply hang out with you. Foster precious relationships in the good times, so they are there ready at any low points.
Let's be honest, we don't always feel plugged into God and the power of the Holy Spirit. But even if we feel rubbish, it's crucial to keep up our personal times with the Lord, turning to him daily whether we feel him close or not. The truth is, he is with us however we feel, his love and his Spirit will seep through our tired hearts and minds and bring comfort and resourcing, so we can keep serving.
When I'm feeling low, I love turning to the Psalms where King David and the other psalmists really knew the release of a good lament to God! Psalms 74, 80 and 90 are favourites of mine for this, and help turn suffering and pain into intercession. I equally meditate on the Lord's words of hope and encouragement from Scripture (e.g. God is our refuge and strength, an ever-present help in trouble (Psalm 46:1,3) or 'Do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand' (Isaiah 41:10)).
Carving out time to spend in prayer and in Scripture with Jesus will help bring healing, restoration and encouragement to our frazzled minds and spirits.
Serving others as nurses and midwives is a privilege and it's good to be diligent in our caring. But let's be mindful of our own limitations and our need for God. The mystery is that God puts his treasure in us, weak and fragile vessels that easily crack, so that the glory might go to him. (5)
Pippa Peppiatt is CMF Head of Nursing
1. Van de Hart W, Waller R. The Worry Book. London: IVP 2011
2. Diagnostic and statistical manual of mental disorders, 4th edition. American Psychiatric Association. Washington DC. 1994:327
3. Van de Hart W. Op Cit
4. Parsons R. The Heart of Success. London: Hodder & Stoughton, 2002
5. 2 Corinthians 4:7