Back home: distress in re-entering cross-cultural missionary workers and the development of a theoretical framework for clinical management.

A high proportion of cross cultural aid workers and missionaries who may also be involved in aid work are known to suffer from significant psychological distress on re-entry. In the Australian primary health care system, Australian general practitioners are most often the first point of contact for those with psychological distress. There is, however, little acknowledgement or understanding in the medical literature of the distress of this particular group in Australian society and their management in the general practice setting. This thesis addresses these issues with an analysis of the experiences of 15 returned adult Australian missionaries. The thesis presents an analysis of evidence and builds theory using predominantly qualitative methods. Firstly, I comprehensively explore the evidence for the nature of the distress suffered by these re-entering missionaries. Through analysis of their accounts of their day-to-day lived experience during the interactive transition of their re-entry, I demonstrate the importance of their loss and grief, particularly their disenfranchised grief, as part of their psychological distress. I describe a new type of disenfranchised grief: self-absorbed disenfranchised grief. Some missionaries appeared to have less distress than others, which has led me to categorise two groups of re-entrants, the resilient and fragile. Further exploration of these missionaries’ psychological distress led me to focus on the nature of their resilience. I demonstrate the psychological, social and spiritual constructs which increase resilience in this group in the context of multiple losses and grief as well as the role of their identity disparities. I also demonstrate a link between resilience and identity disparities. Secondly, the results of this thesis together with the existing theoretical models for loss and grief enable me to build an evidence-based theoretical framework to address psychological distress during re-entry. I show how the Dual Process Model, which addresses loss and grief after bereavement, may be modified to address loss and grief during re-entry based on the findings of this study. Within this framework I also demonstrate the facilitators and barriers that affect the missionaries' psychological distress during re-entry. I offer this model as a framework for dealing with missionaries' psychological distress during re-entry in the clinical setting.Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 201