Have you heard of the phrase ‘moral injury’? Probably not. It is more likely you have if you are American because moral injury is a medical term used in the United States for what we have long called burnout. This occurs when someone becomes chronically exhausted and forms highly negative views about themselves and their performance. They feel emotionally shattered, physically worn down, and don’t want to carry on with the weariness of their work.
Burnout manifests as physical fatigue, but also as despair and hopelessness and convictions about uselessness and failure. People experience fluctuating emotions of depression and anxiety which are associated with a collapse in function, so that work is abandoned and other responsibilities are also forsaken.
Elijah in 1 Kings 19 appears to have suffered something like this, doesn’t he? Contrary to the claims of some interpreters, he did not have a mental illness such as depression or bipolar disorder. He burned out. After years alone and on the run from Ahab and at risk of his life, he finally confronts Ahab and the arrayed masses of false prophets at Carmel. This confrontation culminates in the physically demanding slaughter of hundreds of prophets by his own hand.
Then, just as he might have expected relief at long last from his pressured isolation, and hoped for a revival in Israel, his hopes are dashed as, instead, he is pursued by vindictive Jezebel’s troops. Collapsing in exhaustion and despair, he gives up and wants to die, though not at Jezebel’s hands.
The treatment administered to him by the angel of the Lord is rest and food and sleep. No miracles, nothing special. This is what burnout needs. Rest and recuperation leads to recovery. Following this he was able to continue his planned journey to Horeb to plead against Israel as covenant-breakers (cf. Romans 11:2).
We are told 80 percent of doctors are at high risk of burnout, with many leaving work because of it. I suspect similar figures could be found in any line of work in which long working hours are combined with high degrees of responsibility, and especially in those in which a large proportion of the work involves dealing with other people and their problems.
Gospel ministers clearly fall into such a category. And many ministers experience burnout. They become exhausted, psychosomatically shattered, after periods of heavy pastoral work on top of the regular preaching workload, enduring stresses due to perceived failures, tricky pastoral problems, and often overt or covert opposition. And then there are the indirect stresses of trying to support a wife and children who themselves are impacted by the burdens of church ministry.
In practice people with burnout are often, frequently deliberately, misdiagnosed with ‘depression’ and given antidepressants. I understand the reasons. Depression is an acceptable diagnosis to use for a GP to sign someone off work, and prescribing drugs validates this. This in turn makes it easier for the burnt-out minister to step down from his pastoral responsibilities for a while.
But whether a diagnosis of depression is given or not, the key thing is that the minister, in consultation with his family and elders, acknowledges what the real problem is and what are its causes. Because if these causes are not recognised and dealt with, the burn out will recur, which is no good for anyone.
Like Elijah, the burnt out minister needs rest and recuperation. But if all that is done is giving him ‘a rest’, then the burnout will recur because the root cause has not been dealt with. For we read in 1 Kings 19 that the Lord gave Elijah more than rest and recuperation.
The Lord himself also came to encourage Elijah. In his burnout-driven despair, Elijah believed he was alone as the only faithful prophet: ‘I am the only one left.’ So the Lord came to speak to him. He had been alone for too long without anyone with whom he could share his concerns and unburden his feelings. The Lord agreed with his diagnosis about Israel, reassuring his faithful servant that Israel would be punished as covenant-breakers (vs. 15-17), encouraging him by reminding him he was not alone (v. 18), and providing him with Elisha as a faithful companion to assist him in his work.
Thus the Lord provided the personal support he had been missing, changed Elijah’s working conditions (he would work alone no more), and encouraged him that he was being a faithful servant. A burnt-out minister will need similar support, encouragement, and adjustments to his pattern of work. Then, like Elijah, he won’t burn out again but will be able to serve faithfully for many more years.
The ‘moral injury’ phrase was coined because it was felt the term burnout implied fault in the individual. He chose to work such long hours and to bear such burdens and so why complain? It is his own fault. I don’t like the term, but understand the motivation. He has been injured by ‘the system’. No one is necessarily to blame, it is just that no one has thought about the problem or at least tried to tackle it. The demands of his ministerial work have been too much to bear and if these are not altered then he will burn out again.
How often have you encouraged your minister? I don’t include thanking him for his sermon, good though that is. I mean thanking him for his sacrificial service, acknowledging the good work he does for the church. Have you thought about how you can reduce some of the ministerial load? Have the elders reviewed his work-life balance? Your minister may not have burned out, but the risk is high, and prevention is better than cure.
Alan Thomas is Professor and Consultant in Psychiatry. Elder at Newcastle Reformed Evangelical Church.