Missionary Care

Dr. Ronald Koteskey

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Bill was walking down the street near his home when his heart started pounding, it was hard to breathe, his chest tightened, and he had pain in it. He was terrified and thought he was going to die of a heart attack. He went immediately to an urgent treatment center only ten minutes away, but by then he felt much better. Tests there showed no sign of a heart attack or any other physical problem.

He had served in two countries where there were many reasons to be afraid, but he had never felt this kind of fear. How could it be that he had it here back in his peaceful passport country after serving for three years in a job he loved at headquarters? What caused it? Will it happen again? What can he do about it?

What is a panic attack?

A panic attacks occur when, without warning, individuals experience intense fear that occurs suddenly and for no apparent reason. It is one of the most unpleasant, terrifying, and upsetting experiences individuals can have. Although the attack is usually over in a few minutes, it may take people days to fully get over it, and those individuals may fear having another one.

The American Psychological Association notes that “Many people experience occasional panic attacks, and if you have had one or two such attacks, there probably isn’t any reason to worry” (http://www. apa. org/topics/anxiety/panic-disorder. aspx#).

However, people who continue to have them are diagnosed with panic disorder, about 1 in every 75 people. To get some indication of whether you have cause for concern you may want to take the Panic Disorder Severity Scale. A self-report form of that scale is at http://serene. me. uk/tests/pdss. pdf. This is just a screening test, but if you score above ten, it is a good idea to look for professional help.

For some unknown reason, during a panic attack the sympathetic branch of the autonomic nervous system arouses the whole body. Its neurons are interconnected so it arouses glands and smooth muscles all over, including the adrenal glands. Adrenalin (epinephrine) from those glands flows throughout the body through the blood stream. The heart pounds, breathing increases, sweat glands secrete, pupils dilate, etc. All of this unexpected arousal is terrifying. It can occur even while asleep.

What are the symptoms of a panic attack?

As would be expected from what scientists know about the sympathetic nervous system, the symptoms are:

•  Heart palpitations or racing heart
•  Feeling sweaty or having chills
•  Shortness of breath, hyperventilation, or feeling of choking
•  Chest pain or discomfort
•  Dizziness, lightheaded, or feeling faint
•  Nausea or stomachache
•  Trembling or shaking
•  Numbness or tingling in hands and fingers
• Fear of losing control, going insane, or dying

What does the Bible say about panic attacks?

The Bible has several references to panic. Some are about soldiers in battle panicking, deserting, and running away. Others are about people terrified by disease or fire. Still others are about horses fleeing in fear. All of these have someone terrified of a known problem and getting away as fast as possible.

However, the Bible says nothing about panic attacks. Such attacks are internal rather than external.  The persons experiencing them are keenly aware of the feelings of panic but often try not to express those feelings. Most people are embarrassed to show the signs of panic when no “reason” is apparent.

What will panic attacks do to one’s ministry?

 The immediate effects of panic attacks on missionary ministry are obvious. Whether missionaries are teaching, preaching, counseling, or interacting in any other way with people, their effectiveness will decrease when they experience the symptoms above. People interacting with the missionary will wonder what is wrong.

 Later effects, after recovering from the attack, include the following.

•  Avoidance.   The missionary may quit doing anything, including ministry, that may trigger an attack.
•  Anticipatory anxiety.  The missionary may become anxious just thinking about having another attack.
•  Agoraphobia.  Afraid of having an attack when people are around, the missionary may avoid people and crowds, even to the extent of staying home nearly all the time.

How can panic attacks be treated?

• The good news is that most, 70% to 90% of people who have even frequent attacks, find relief. Just knowing about the nervous and hormonal basis of the attacks helps. Here are some things to do.
•  Renew your commitment to God and ask him to help you.
•  Avoid caffeine and other habit forming drugs, especially stimulants.
•  Get a half-hour of aerobic exercise daily.
•  Learn stress management techniques, such as deep breathing.
•  Learn relaxation techniques, such as breathing retraining and positive visualization. 
•  Remind yourself that attacks have a physical basis and decrease irrational thoughts.
•  Gradually increase exposure to situations that have triggered attacks.
•  Consult a physician about the possibility of anti-anxiety or anti-depressant drugs.

How can panic attacks be prevented?

The bad news is that attacks cannot be completely prevented.  Remember that the American Psychological Association said that “Many people experience occasional panic attacks. ”Sometimes the sympathetic branch of the autonomic nervous system just arouses the body.

The good news is that many of the things missionaries can do to treat it also can prevent it.

•  Meditate on God’s word and prayer each day to maintain your relationship with him.
•  Eat a healthy balanced diet while avoiding caffeine and other drugs.
•  Exercise daily and get needed sleep.
•  Minimize over-the-counter supplements and herbal remedies which may contain a variety of chemicals.
•  Avoid stressful situations and manage stress when it does occur. 

Can missionaries with panic attacks lead normal lives?

Of course, the good news is that they can lead normal, productive lives of service. 

Unfortunately, missionaries may feel shame or guilt thinking they lack the faith needed to keep the attacks away.  They self-diagnose the problem as a spiritual one rather than a physical one. Their concern may increase the probability of more attacks.

Missionaries are unlikely to feel guilty if they have diabetes because their pancreas secreting too little insulin. Just as there is no need to feel guilty if the pancreas is not aroused enough by the sympathetic nervous system, there is no need to feel guilty when the sympathetic nervous system and adrenal glands provide too much stimulation to organs all over the body.

Given that things may trigger the sympathetic branch at “random” times when missionaries do not expect it, these missionaries need a plan to calm that system. Here are some suggestions.

•  When you feel one “symptom,” do not let your anxiety about it bring on a full-blown attack. For example, if you notice that your breathing has changed, do not worry about it and bring on a full attack.
•  Learn how to decrease or stop an attack if a full one does occur. Note the ways attacks can be treated above.
•  Avoid triggers if possible, and respond to them immediately if they do occur.
•  Replace negative thoughts, such as “My faith is weak” with realistic, positive ways of viewing attacks.
•  Join or begin a support group so you can share with others facing the same. 

What does the Bible say that would help a panic attack?

The Bible has many promises and passages that help reduce anxiety and increase confidence and comfort. Make a list of verses that are particularly meaningful to you and memorize some of them to recall when a panic attack strikes. Here are some suggestions.

• 1 Peter 5:7. Cast all your anxieties on him, because he cares for you.
• Philippians 4:6. Do not be anxious about anything, but in everything by prayer and supplication…
• John 14:1. Don’t let your hearts be troubled, believe in God. . .

This list could go on and on, but these are passages that speak to me. Develop a list through which the Holy Spirit speaks to you, and then memorize them. God can use his Word to calm you enough to prevent such attacks and help you control them.