How to Stay Sane When Living Abroad

Last summer, I submitted a 47-page thesis exploring the mental health functioning of career medical professionals serving overseas. I spent almost two years gathering articles, reading books, and attending conferences surrounding the topic of cross-cultural adjustment as it related to depression and anxiety among expatriates. This all sounds so academic and professional, huh?

Let me tell you a secret. It was COMPLETELY SELFISH. The only reason I spent so much time researching data and reporting statistics was because I didn’t want to be a statistic.

I’d watched it happen to too many people.

I had friends who had been chewed up and spit out by their experiences on the field. I’d read blogs of disgruntled religious workers who had completely lost hope in God’s design for His body. I’d seen the glazed-over look on the faces of foreign servants who were completely ineffective in their ministries.

I prayed the Lord would spare me from this, but I knew the odds were stacked against me. Cross-cultural adjustment is no joke, and it does crazy things to our minds and our bodies. For those of us in the throws of cultural disequilibrium, I’ve compiled a list of 5 things that I hope will help us all remain sane, serve well, and stay long in our work overseas.


  1. Exercise spiritual discipline.

Expats with a clear vocational call and greater spiritual life satisfaction who regularly practice spiritual disciplines tend to experience greater adjustment to the field. Those with lower levels of spiritual maturity report lower levels of work-related outcomes, little social interaction, and worse relationships with teammates (Kimber, 2012).

This tells me that ministry-related tasks and work responsibilities are not NEARLY as important as protected quiet time for study and meditation. Men AND women need the space to be in the presence of God. And please hear me challenging any man reading this to work extra hard to provide this space for the women on your team, especially those raising small children at home.

  1. Recognize when you’re stressed.

Davis (1969) said “even those intellectually prepared for the new situations facing them experience cultural rub, a nagging irritation which brings on cultural fatigue” (p. 23). People respond to stress with physical symptoms (e.g. headache, stomachache, or diarrhea), psychological symptoms (e.g. anxiety, depression, or difficulty concentrating), and behavioral symptoms (e.g. driving fast, overeating, or excessive spending). I don’t have to tell any of you about these symptoms. Many of us eat, sleep, and breathe them.

I find it most interesting that social support is the single most effective means of dealing with stress. So, invest in online communities like Velvet Ashes, A Life Overseas, and Taking Route. Invest in your physical communities like team and international fellowships. Keep a finger on the pulse of your stress level, and adjust your work load and vacation time as needed. Yes, FOR THE LOVE…TAKE A VACATION. But do come back. 🙂

  1. Focus on your family.

Researchers have reported that there is a strong relationship between a person’s cultural adjustment and his or her marital relationship (Bikos, et al., 2009). In fact, in a study of couples moving overseas, the working spouse reported steadily declining marital satisfaction (in addition to declining mental health functioning) over the course of their first year abroad. Jansohn (2013) and Foyle, et al. (1998) also reported that work-related burnout and premature repatriation play a role in marital breakdown.

Read this: Transitioning abroad DOES affect our marriages. Which affects our children. Which affects our friends and coworkers. We can’t sacrifice our families on the altar of ministry. It’s our families that help us function and thrive overseas. And just another plug: If you are in a family, invite the single workers of your community INTO YOUR FAMILY. Share your marriage…share your children…share your dinners. You will all be blessed by it!

  1. Don’t wait on member care—help yourself.

To date, there has been no psychological test normed for our particular population of religiously motivated expatriates. That means that all of those psych evals you did before moving abroad? Yeah…they may not have actually predicted your cross-cultural adjustment very well. And all of those member care staff? They DO care about your wellness. But the reality is that they aren’t with you on a daily basis to check in on your functioning abroad.

So be your biggest advocate. I don’t mean hole yourself up in your bedroom for weeks at a time with tubs of ice cream and all the seasons of Parenthood. I do mean reach out to someone when you’re feeling a little off. I remember writing an email to our care team last summer saying, “You’re not asking, but I’m telling: I AM NOT OKAY.” That email spurred an immediate response that put me back on track psychologically. It’s perfectly acceptable to fall off the horse, and even more acceptable to tell somebody your lying in a mud puddle of cultural crap. Which leads me to the last point.

  1. Reverse the stigma against mental health issues.

In 1970, Stringham wrote, “It is just as foolish to think that a person with a serious psychiatric or emotional problem can take care of it only through prayer as it is to think that a person with an acute appendix can take care of it by prayer alone…It is just as honorable to seek psychiatric help for psychiatric problems as it is to seek medical help for a broken leg. The sooner this is recognized by religious people, the less trouble there will be in the future for people seeking necessary psychiatric help” (p.1).

Before his time, much? It seems we can still learn so much from this statement 45 years after it was written. We aren’t superhuman. We aren’t untouchable. Living overseas turns us inside out and exposes all of our junk. And that sometimes requires some professional help as we work through what we’re learning and how we’re changing. You aren’t alone. We’ve all been there. Welcome to the party! We’re a pretty fun, screwed up crowd. Especially when we’re mentally healthy.


If you have questions about the articles cited here, I’d be happy to email them to you. If you’re struggling to find the grace to buy the can of Dr. Pepper at the import store, this is me telling you to go buy the case. Stockpile Dr. Pepper if you need to…you will have more bad days.

Those of us who have answered the call to move overseas are few and far between. We don’t have the manpower to supply backup when we neglect our spiritual and physical needs. I pray we can all lean more into our spiritual Provider as we welcome the physical community He gives us. Sanity for all, my friends!


  1. B May 31, 2015

    This is brilliant.

  2. Denise June 1, 2015

    I loved this article so much. Thank you for sharing your research with us in such a concise applicable way. Great reminder that spending time in the Word is so important. Also, I can not confirm or deny that I have ever holed myself up watching season upon season of Parenthood. Sharing this today on Taking Route’s social media.

    1. Lauren Pinkston June 1, 2015

      Thanks, Denise. Parenthood lovers, unite! We appreciate Taking Route so much–thanks for sharing resources!

  3. Patty Stallings June 1, 2015

    Spot on, Lauren!  Thank you for investing your time and energy in researching and now in sharing.  There’s so much here I want to shout “Amen” to!  🙂

    1. Lauren Pinkston June 1, 2015

      That means so much coming from you, Patty. Have I said that before? I value your feedback…you rock at what you do!

      1. Patty Stallings June 4, 2015

        Mutual Admiration Society.  🙂

  4. Casey June 1, 2015

    Lauren, Another great post! Coming from someone who has experienced mental illness as an expat for the past 7 years, I love these practical tips to help prevent struggle. They are solid truth. Would you consider adding one more point to your list? Mental illness is spiritual, physical, biological, and emotional. Even with perfect execution of these steps and more, you still may become mentally ill. I have spent years arguing with myself about what we could have done differently. I have beaten myself up over what we failed to do. After spending a lot of time in counseling, I see we only made minor mistakes… but I’ve still suffered severely. The guilt associated with mental illness over what we did or did not do correctly in the prevention of it is painful. Knowing others are looking at our lives and measuring up how they are going to do better or did better hurts. Sometimes, mental illness is out of our hands. I know you are in NO WAY judgmental – your sweet spirit blessed me during a time you could have easily judged me. I just wanted to make this comment in the hopes someone else in a similar position to myself might be able to shake off that sense of failure, the feeling of “this is all my fault some way or another.” Love you, girl, and love your heart for others!

    1. Lauren Pinkston June 1, 2015

      This is wonderful, Casey. Thank you so much for sharing your story here. I hope everybody will click on the link to your blog and read your posts about your journey. So much richness there. You’re absolutely right–even if we do everything ‘right,’ we may still experience mental illness. I appreciate your transparency so much, and your willingness to welcome people in! You are wonderful and I love you. : )

      1. T June 2, 2015

        Where is Casey’s blog?


    2. karen June 2, 2015

      Casey, I really appreciate you saying this and hope you’ll tune in tomorrow when I talk a little more about mental illness. Lauren, thanks for the post and practical insight! I’d love to read your thesis.

  5. Elizabeth June 1, 2015

    Love this Lauren! So very practical. And is this based on the research for your thesis and related to the interview you gave Amy Young? Just curious, because we may be contacting you more about your research sometime in the near future. 🙂

    #3, my husband and I have been pretty good at. We’ve always tried, even in America, to make sure our family doesn’t suffer from our ministry and that we do fun family things together. We were forced into that habit because he worked 60 hours a week, and we HAD to be intentional. Even here, we have to fight for the time; it’s still hard to make it happen. And we still sometimes skip it and have to regroup. It’s just that it’s been a part of our lives from the beginning.

    And #4, I haven’t had a problem with (so far). The way our org is structured, no one regularly checks up on me. Instead, I contact the member care person for help when I need it — something I have no trouble doing! I think it goes back to my high school chemistry classes, when I was surrounded by boys and just had to get over the fear of speaking up and asking questions. Not being bashful in asking for help has been really good for me, and I’m always helped by talking it out with and asking for resources from my member care person.

    But #1 and #2, wow, I’ve needed help on. Actually, I really believe in #1! I just can’t let that time slip is all. It’s too easy to let it slip. But #2, man, I am really bad at!! My husband tells me this every time I have a breakdown in sanity. Every time. Because I’m always so surprised at myself. He says, you need to learn your warning signs so you take a break BEFORE you’re maxed out and want to escape for days at a time. But I have real difficulty doing this. I never know until AFTER I’ve lost all my reserves, and I’m not quite sure why this is. I go along and I’m feeling fine and I’m stretched “but it’s ok” and then suddenly BAM! Something that doesn’t seem like a big enough deal to topple a person, topples me. I can see clearly looking back WHY I lost it, but I can’t quite see it while I’m IN it. My husband is a much better self-monitor than I am, and paces himself accordingly, but clearly I am terrible at it!

    It usually has to do with having too much social interaction. (I’m an introvert.) I am very careful about what we plan for our family, but sometimes too many things come up, things that we really need to attend (birthday parties, going away parties, etc etc, important life events) and I usually feel just fine at the event itself. I enjoy the people, and I enjoy the interaction, and I enjoy the event. It’s only later, when I lose it, that I realize that I AM NOT OK. Additionally I often have to skip my exercise routine to attend social events, and I really need my endorphins!

    So anyway, I feel like I can implement, or at least have a plan for implementing #1, #3, #4, and #5 (I’ve always been upfront about my need for counseling and have never thought it wrong for Christians to take prescription meds for psych issues), but I am really at a loss for #2. Even with my attempts to prevent these little meltdowns, I still find myself unaware of my true emotional and mental status until it’s too late. And then, of course, I can and do take a break. I would just prefer to take the break first and avoid the melting down. I should (Oops! I said “should.” That’s supposed to be a no-no!) know this about myself by now, but I don’t seem to be able to predict these things very well.

    1. Lauren Pinkston June 1, 2015

      Hey Elizabeth! This is just a snippet from my thesis, and my interview with Amy was based on one of my comprehensive exams. So, two separate papers. But I’ve read and written lots about these topics for the last few years. I don’t know why it has taken me so long to write it up for the blogging community!

      The quiet time? This is hard. Especially with littles in the house. But the self-monitoring is a learned skill I think. Your words reminded me so much of something my husband might say, so I just looked over and asked him, “Do you feel like you can monitor your own stress level well, or is it often too late before you realize you’re stressed?” His response? “I think you can identify it much earlier than I can.”

      I don’t know if Jonathan is usually this person for you, but this is where having a spouse/good friend on the field is so valuable. They can tell us when we’re a little off our game, and be the whistle-blower for our need of a timeout.

      I think people (spouses included) will be much more willing to share warning signs with us if we have already opened the door for warning signs to be shared. I am writing this to the whole Velvet Ashes audience, so please don’t feel like I am targeting your marriage. WE NEED TO BE TEACHABLE in our life overseas, and this includes being guided into healthy behaviors. If you haven’t already, open a dialogue with someone you know and trust and ask them to share with you when they see warning signs of stress and burnout you may not yet see in yourself. We need all the loving, godly help we can get!

      1. Elizabeth June 2, 2015

        That’s great advice Lauren 🙂 I think, as I’ve reflected on this some more, that I need to be paying closer attention to my behaviors instead of my feelings. My feelings gauge is apparently Full or Empty, with no Half Tank or Quarter Tank to warn me. (My husband can’t really tell either — but he is ALWAYS very good about giving me the space and time when I express a need, which unfortunately, as I’ve discussed, is often at a time when my stability is already crumbling.) Perhaps my gauge has a lag of some sort!

        But I’ve been realizing some things even this week about my habits. For example, I often let my kids tag along with me in whatever I’m doing. Getting ready for church? My girls watch me. Exercising? My girls follow along. I used to think this was no big deal. They’re not doing anything wrong. But life here is so stimulating. Too many senses stimulated at once. Smells, heat, sounds. I’m especially overstimulated by sounds. With construction next door, just adding regular kid conversation can overwhelm me.

        So instead of letting them be with me for 15 minutes here and 30 minutes there, I recently decided to do those things alone. The sound level would just get too high. In effect, I nullifying my efforts to produce endorphins through exercise, because I was allowing too much sound input. So I think what I need to do is pay attention to my boundaries. Am I enforcing a strict boundary for myself? Giving myself a little breathing space? Again, it’s not because my kids are bad or even behaving badly; they’re not. They’re just loud! Which is very normal!

        Anyway, what I’m trying to say here is that until I can figure out how to monitor my inside self better, I’m going to be paying more careful attention to those few things I can do on my own behind closed doors. I was amazed how much better my Sunday started out this week when I told my kids I was putting my makeup on alone, and turned on my worship music while I did it. So nice!

        And yes — about the interview. I’m so interested in all those factors you listed. Need more details for what they mean and how they impact adjustment! 🙂

        1. T June 2, 2015

          Oh, the sounds!  They exhaust me!! (and I live in a very quiet neighborhood!!!, but I’m from Kansas, and from small towns where it is very quiet all the time!!! and the only people who yell at each other outside didn’t live in my neighborhood.)  Here there are people yelling at each other alllll the time.  Not always angry yelling, just yelling.  And lots of construction.  eeek!

          1. Elizabeth June 2, 2015

            LOL, T, glad to know I’m not the only one overwhelmed by sounds! I’m from Kansas City, MO, so close to Kansas, and I also spent a few years of my childhood in Junction City/Fort Riley, so it was fun to read about this connection. 🙂

      2. MaDonna June 4, 2015

        Thanks Lauren! Yes, I do think Uwe sees it coming before I do. We were able to talk a bit about it this week, which led to some good conversations. Yeah for conversations about marriage and building each other up and not about “the plan….the ministry…etc.” Don’t misunderstand, those are important, but sometimes they override other areas…probably because we are both a little on the driven side.

        Elizabeth, I’m a sound person, too. I realized it this morning as my daughter was asking 20 questions about anything and everything…I just wanted time and quiet to process what was going on in my own head. I’ve been trying to get up really early to have some alone time – not that I’m a saint, by no means, but selfishly to have a half hour where NO one interrupts my thoughts with some question or need or construction. I liked your idea of boundary – that maybe the conversation starter tonight when the kids go to bed. 😉

  6. MaDonna June 1, 2015

    Thanks Lauren! Great research – which I’m sure you have so much more you could have shared, but this was GREAT. I’d have to say that #2 is my biggest issue. I think I’m kind of like Elizabeth, I just don’t know what my signs are. I let it all build up and then, well, it just gets ugly… either in my relationships or my health. I know parenting a child with special needs has brought on some of it – I love my daughter, so please don’t misunderstand me – but somedays are really tough. I’ve learned that I need time to unplug and get recharged. My husband is great in that he sees that I need this as well. We try to plan an afternoon away every few weeks when it is possible. He sends me away on retreats with other ladies, and we are trying to schedule me a time to retreat without others.

    But, I had a meltdown last week – but I’ve not been exercising, stresses have been higher, and I’ve not had any breaks. I really appreciate your list, as it gives some practical ideas. I don’t have the option of member care, but there are people I know who could be that for me if I would just ask. So, thanks again!

    1. Lauren Pinkston June 1, 2015

      Good for you for processing all of this, Madonna. I think that talking through our stresses is HUGE when it comes to knowing how to address them. I wrote some ideas about #2 in response to Elizabeth’s comment, so I hope those help. But I’m so thankful that your husband is support of your need to get away and recharge!  And it’s great that you’ve got this happening on a regular basis. I’ll be honest, I’m 100% extrovert and high energy. But I need time to unplug and recharge on a weekly basis. It’s okay to care for ourselves…and it’s MORE than okay, really. So happy that our community is finally starting to normalize this. : )

  7. Ashley Felder June 1, 2015

    Love! First, I have to say that I’ll count my blessings again today as our org provides amazing member care. (Shout out to you, Patty!) They even visit us face-to-face to see how we’re doing. Amazing. I won’t take it for granted. But it’s true–they can’t see our day-to-day and they’ll only know what we tell them.

    I, too, need to get better at recognizing my stress. Recently I’ve been seeing a chiropractor…at foreign fellowship…laying out on the tables we gather at…with everyone watching. Awkward, but my neck needs it. He told me last time that I carry my stress in my neck and shoulders. I had never thought about it. Then, the other night, when my 2 boys were while I was cooking dinner, I felt it. The pain was crawling up my neck. Thankfully, my intuitive hubby picked up my other non-verbal cues (and harsh tone with the boys) and took them outside until bedtime. That’s all I needed…an hour to re-adjust my thoughts and heart.

    Thanks for this post!!

    1. Lauren Pinkston June 1, 2015

      I LOVE to hear about good care! And I can only imagine what a dream it must be to have Patty as your caregiver. Rejoicing in this with you!

      I love the image of you laid out on the tables at international fellowship. We have to take what we can get! Glad you’re making progress in recognizing your stress and again…a big “Yahoo!” to supportive husbands! My mind is now turning towards thoughts for a post on how to monitor our stress levels… ; )

    2. Patty Stallings June 4, 2015

      Awww, thanks, Ashley.  I loved being with you this week!

  8. Sarah June 1, 2015

    Hi, Lauren! As an MK the whole time I was growing up, I’ve enjoyed several of your blogs, but would be really interested in reading the articles you cited in this one, as well. Could I get the reference information from you? Thanks so much!

  9. Lauren Pinkston June 1, 2015

    Sure thing, Sarah. Can you shoot me an email at LMPINKSTON at GMAIL.COM? I’ll send it your way!

  10. Danielle Wheeler June 1, 2015

    Lauren, I LOVE the rich resource that you are.  I love that you take your academic mind and do the hard work and then turn around and make it real and available to everyone.  Thank you, thank you.

    1. Lauren Pinkston June 7, 2015

      Thank you for giving me space, Danielle. This is a blessing to me.

  11. Jennifer Ott June 1, 2015

    Thank you for such accessible, comprehensive recommendations.  We are packing up to move to Zambia (helping start a medical clinic), and the whole journey has been stressful.  I don’t ask for help…ever, volunteer for everything, and grunt through.  I think I need to print this list out and read it frequently!

    1. Lauren Pinkston June 7, 2015

      Jennifer, I’m going to go ahead and place you in a category of resilient people! As I was writing my thesis, I was talking to my husband (a family practice MD) about the population of medical professionals serving abroad. As we considered the number of people who aspire to earn medical degrees, actually make it to graduation, and then take all of their training to move overseas, we decided these are unique persons. 🙂

  12. Kim June 5, 2015

    Wish that I had read this five years ago before we boarded the plane! I had no idea what we were in for or how HARD life was going to be for me physically, spiritually and emotionally. I thought panic attacks (new for me) were a sign of spiritual weakness, that I simply didn’t have enough faith or enough love for my new home country. I trudged along for two years trying to keep it all together until our first trip home, where it became clear I was not okay.

    We unfortunately had no help from our former sending agency and over here counseling is not really a thing yet, so there weren’t many options. If it had not been for mentors from back home I’m not sure I would have made it and our marriage certainly would not have. When I look back now I can’t believe how I didn’t practice self-care or even fully grasp that I needed to. There were so many things I just simply didn’t know, questions I didn’t know to ask or who to even ask. And now, looking back at things I thought were just weaknesses in me, I see were actually more normal than I realized. Obviously too much to write in the comments section, but all that to say, I loved your article and think what VA is doing is so helpful to women like us who often feel so misunderstood and struggle in silence.

    1. Lauren Pinkston June 7, 2015

      This is tragic and beautiful, Kim. I’m so thankful that you had mentors during that time to walk with you. I believe in member care and organizational support and all of that stuff, but I REALLY believe in mentors that you know and trust. This is a WIN, WIN, WIN for anybody, anywhere. We have to have social support. It’s the single-most important factor in keeping people mentally healthy…and now I’m wishing I had mentioned this here. Another day!

      So glad you’re in a better place now. It’s good to read your thoughts as you re-process this period in your life…your story will be used to His glory over and over again!

  13. Ellie June 5, 2015

    Thanks Lauren for this. Particularly point 4 and 5 – you gave me the shove to write a much needed email about something this week! And for the quote about stockpiling Dr Pepper – made me laugh. I don’t subscribe to that particular “vice” but I will translate the concept 🙂

    1. Lauren Pinkston June 7, 2015

      That’s wonderful news, Ellie. We are typically comfortable with the beauty of Jesus being seen in our weakness, but I think He can shine in our strength and health, too. : )

  14. Karen June 7, 2015

    This is great. I love number 5. Having been diagnosed with major depression many years before I came to Cambodia, I had learned to live with the fact that I needed medication to stay sane. It is a chemical imbalance, just as diabetes is, and I had to accept that. I thank God He has helped me to do that. For many years I thought I could never be an overseas worker as I didn’t have perfect health, and especially perfect mental health, and I’m still not sure any sending organisation would accept me, but God gave me an opportunity to serve Him in Cambodia, with a safety net, for six months. Eight and a half years later I’m still here, albeit in a different position, but still doing what I believe He called me to do. It hasn’t always been easy, and there have been meltdowns, and other challenges along the way, but in His strength I can continue to serve here in Cambodia.
    Number 1 is a big challenge for me, with school starting at 7.30am, but I’ve made a point of keeping a Bible & devotional booklet on my desk at school, and it’s a priority for me to get to school early enough for even five minutes with Him.
    Number 2 is also important. As a full-time teacher, and part-time student, it’s sometimes easy to get overloaded, so I’m learning to be careful about number 2. A mini-vacation is sometimes all it takes to get back on track.
    I can see how number 3 would be important if I had a family, and as a teacher I’ve seen the impact on kids who have come second or even third to ministry. As a single, it’s harder. I don’t have a spouse to share stuff with. I thank God for the friends He has provided me along the journey who are only a text message away.
    Which brings me to number 4. As an older single Christian (think 50+), on a teaching contract without the benefit of a sending organisation, the whole member care issue is a challenge, especially since I’m teaching in a secular school. I thank God for those in the International Church community, and in my previous Christian school (where my journey to Cambodia started), as well as a supportive psychiatrist in Australia, all of whom have provided “member care” for me at different times. I think the important thing, which is what you are saying, is to know when to reach out for help, preferably before we get to meltdown stage, so that we can stay sane.

    Great article. Thank you.

  15. Cecily July 10, 2015

    Lauren, thanks for your article 🙂

    Are you familiar with member care resources for overseas workers who have no member care? My organization at home provides nothing, and I have no member care here on the field.  I have found some resources online, but I have no idea about the quality of the resources.  If you know something other than just a website address, I would be happy to receive some recommendations.

    1. Lauren Pinkston July 12, 2015


      Sorry it took me a few days, but I’ve dug up some resources for you!

      My family was trained by, and they have lots of resources on the library tab on “M” Care.

      There’s also, which offered care to overseas workers who don’t have a board or care team – looks exactly like what you’re searching for!

      I also learned about and it looks very encouraging. It directs you to another page with ebooks and good resources for our line of work.

      Lastly, my care professional referred me to this blog post and the resources at the bottom: Hope this is helpful!

      All my best.

      1. Cecily July 13, 2015

        Thank you so much, Lauren, for taking the time to give such a helpful response to my inquiry!  I am sure I will find something to help me.  Bless you!  Cecily

        1. Amy Young July 13, 2015

          I’d just echo what Lauren has said … if you haven’t checked out the M care website, there are tons and tons of books! And if you (or anyone else!) lives in a country that’s sensitive to the M word, he’s translated all of his books into M safe vocab and they can be found here

  16. Martha July 27, 2016

    Thanks for what you have written here and in your other article on Being Stressed. Can you tell me more about Jansohn (2013). I was trying to look up more about what he said re: overseas workers stress levels. Has he written books or articles that would be helpful? I work in member care. Thanks for any help you can give me about this.

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