Early-returning missionaries • They encounter guilt and pain when "the best two years" become something far less, but there is help and hope.
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It's what fellow Mormons didn't say that Ryan Freeman found most unnerving.
Freeman had left for his two-year LDS mission to St. Louis in January 2010, full of faith and hope, but returned a few months later suffering severe depression, anxiety and migraine headaches. His mission president was understanding and his family in Springville was supportive. Only a few members made rude comments, but others even once-close friends avoided him.
"People don't know how to talk to you," Freeman says. "There's so much silence."
He felt pressure to "get better" and go back out, he says, so he worked at a Mormon temple and tried to live by mission rules even picking up his guitar or going to a movie made him feel guilty which left the Brigham Young University student in a kind of religious limbo for a year.
Finally, as Freeman was telling his LDS bishop he was ready to return to his full-time mission, the young man broke down, sobbing. This gentle leader helped the would-be missionary see that he still had health issues and that there were other ways he could share and serve his faith.
Not until that moment, he says, did he feel closure.
Freeman, like so many other "early-returning missionaries" (ERMs), continued to be troubled, though, by feelings of failure.
That is no surprise, given the stigma typically associated with coming home before the allotted time. Many Mormons presume any such young person committed some serious sin, broke mission rules, just couldn't cut it or was in some way "unworthy" to wear the badge.
Mormon missions are often described as "the best two years." Many who serve talk about spiritual highs, miracles, faith-building and mind-expanding experiences. Former missionaries rarely detail how tough the work can be, how rigorous, how stressful.
Few enter the mission field anticipating anything but a life-changing, positive experience.
The percentage of young Mormon missionaries who come home early for health reasons has remained fairly consistent about 1.5 percent during the past two decades, according to sources in the church's Missionary Department.
But the number of LDS missionaries has skyrocketed in the past year, thanks to the lower age of service (18 for men, 19 for women), soaring from 58,500 in October 2012 to more than 82,000 today. That means about 1,200 missionaries may find themselves in the "early returnee" category, beset by physical and mental health problems that immobilize them and destroy their plans.
Suddenly, "the best two years" can become the "worst three months."
High-level LDS leaders in Salt Lake City are well aware of the challenges and have created an elaborate system for helping missionaries and their families cope. They just published a candid pamphlet called, "Adjusting to Missionary Life," which lays out some of the challenges young people will face.
They created a team of doctors and psychologists to follow early-returning missionaries' progress at home and to advise parents, families and ward members on how to treat their loved ones.
Several Mormon psychologists and psychiatrists also have begun giving firesides for returning missionaries, as well as studying the effects of early returns and counseling families on how best to help restore their children's confidence.
At the same time, Freeman and his friend, Drew Botcherby, have been sharing their experiences, reaching out to those who feel ashamed and unwelcome. They launched a website, sickrms.com, and solicited stories and responses from 612 missionaries who either came home early or, like Botcherby, faced debilitating health problems on their missions.
"Missions are hard," says Richard Ferre, a psychiatrist who works with the Utah-based faith's Missionary Department. "There are better ways to cope than to hide illness or to presume [those who come home early] lack faith."
Ferre applauds the efforts of Freeman and his group.
Early returnees are no longer voiceless, the psychiatrist says. "That's an incredible step and the only way to take the shame out of it."
The doctors are in • In the 1990s, the LDS Church began to "raise the bar" on missionary standards. That push included better screening to find out if young people might be at risk for physical or mental illness.
It is widely accepted, for example, that several types of mental illness, including schizophrenia and severe obsessive compulsive disorder, often surface in the late teens and early 20s (the age of most full-time Mormon missionaries). Applicants with a history of depression still can go on missions as long as they are stable on medication.
Candidates with limited abilities can serve alternative missions, perhaps an online assignment or gardening on downtown Salt Lake City's Temple Square.
Many young missionaries, though, have no history and show no signs of mental illness until they arrive in their assigned locations and undergo the rigors of missionary life.
Mission presidents' wives are to keep tabs on the health of the young elders and sisters in their charge. They field calls about stomachaches, headaches, flus, colds and broken bones nearly every day. They assess how serious the ailments are and where to turn for help.
LDS leaders have divided the world into regions, each with a full-time medical missionary (a trained physician) and a full-time mental health professional. These health missionaries then assemble a network of doctors and clinics, which they have personally visited and evaluated.
A hospital in Ethiopia, for example, may well be as qualified as Intermountain Healthcare to provide antibiotic treatment or recognize the symptoms of malaria.
There are no blanket rules about when to send a missionary home for a health crisis, explains Gregory Schwitzer, a general authority and physician who oversees missionary health. For some, it might be appropriate to say, "Just buck up," but to others that would be terribly insensitive.
Every case is different, save for missionaries who express suicidal thoughts.
"We can't deal with it in the field," Schwitzer says. "We have to send them home. That's an absolute."
Still, many problems can be resolved where the missionaries are serving appendicitis, for example, or a case of dengue fever while others can best be handled at home.
Leaders have to determine what the impact of depression, for example, will be on the missionary's ability to work (every day starts at 6:30 a.m. goes until 10:30 p.m.), on the relationship with an assigned "companion" (the pairs are together 24-7) and on the whole group (there are about 200 missionaries in each of the 405 Mormon missions around the world).
No decision is made lightly or by ecclesiastical fiat, Schwitzer says. A mission president and his wife consult with the area medical or mental health adviser, then with the missionary's LDS stake president and bishop, and, of course, the missionary's parents.
Schwitzer gets about seven to eight emergency calls every week, he says. He has a team of physicians and consultants in Utah who take calls day and night.
Once the decision is made to send a missionary home, the church's Returned Missionary Support System kicks into gear, he says. Some 60 to 70 physicians, capable of dealing with physical and mental health challenges, are on call to help the missionaries deal with their problems and re-enter home life.
"We want to make sure they are going into the hands of a stake president and family who are supportive," Schwitzer says. "We do what we can to educate and rely on local leadership."
Though LDS leaders recognize the inherent feelings of failure an early returnee might experience, they emphasize that no service no matter how short-lived is any less valued or valuable.
These are our sons and daughters, Schwitzer says. They are us.
Preaching peace, finding peace • Late LDS Church President Gordon B. Hinckley once said that new converts need three things a friend, a responsibility and nurturing in "the good word of God."
Mormon psychologist Wendy Ulrich, who served on the church's subcommittee that wrote the "Adjusting to Missionary Life" pamphlet, argues early returnees have the same needs.
Ulrich also believes it is essential for these missionaries and their parents to have a story maybe just a one-sentence answer to tell at church the first week.
"If he or she will stand up in some kind of Sunday meeting and say, 'I am home and I really need your support,' from then on people will deal with you," says Ulrich, who served with her mission-president husband, David, in Montreal. "If they don't know what's up, they don't know what to say."
In addition, she says, it is helpful for returning missionaries to have adult mentors beyond their parents in their Mormon ward, or congregation.
Even so, the question of whether to return to their full-time mission can keep these kids from fully coping or moving on.
"These losses are particularly difficult because there isn't a sense of finality," Ulrich says. "You don't know whether to hold out hope or shut it off. You don't want to close that door prematurely, but it is tough to live with ambiguity."
Eventually, she says, these young Mormons have to find new roles and make peace with coming home early. They have to decide whether to view their time as a missionary as "a big blot on their lives as Latter-day Saints or as just a blip on the road."
It's hard to imagine that a determined sister missionary such as McKenzie Giles could lose her confidence, but she did.
She was called to the Adriatic North LDS Mission in summer 2012 and assigned to serve in Sarajevo. The Bosnian capital was beautiful, she loved her companions, and life was great until she started suffering headaches, blurry vision and nausea.
Giles saw several doctors in Bosnia, but none could pinpoint the cause. After some weeks, the mission president and his wife moved her to the mission home in Zagreb, Croatia.
They consulted with the LDS area physician in Germany, who spoke to local doctors, she says, some of whom thought it was simply a case of homesickness. They also had daily conversations with her parents in Pleasant Grove. She had endless blood tests, none of which explained her unusual symptoms.
One night, everything escalated, Giles says. "I couldn't get out of bed. I was really discouraged. The mission president gave me a [healing] blessing and told me I would get well, but not necessarily in the mission field."
After the prayer, he said it would probably be best if she were treated in the U.S.
She knew it was time to go home.
Giles flew back to Utah on Jan. 17, 2013, exactly six months after starting her 18-month mission.
Her parents were loving and understanding, Giles says. Her mother had explained her health problems on her daughter's missionary blog, so her ward members were well aware. Her father, a marriage and family therapist, insisted on talking about it, did not let his daughter withdraw from the family or friends or forget about the good times she had on her mission.
Giles continued to see doctors without success for a couple of months until, finally, one discovered parasites in her blood. She was treated with medication and supplements. Soon, the symptoms began disappearing.
But her feelings of inadequacy didn't.
"It really hurt to think I couldn't complete something I had wanted to do my whole life," she says. "I felt it was my fault."
Every time, she opened her Mormon scriptures, Giles says, she would see passages she had underlined as a missionary, and it would make her weep. She avoided telling anyone she served a mission. She wondered if she would ever be herself again.
The turning point came when she met another early returnee at the doctor's office. They talked about their common feelings. Her new friend invited Giles to hang out, to attend the LDS Institute of Religion, or just talk.
"She was able to say she was an RM with joy," Giles says. "Now I can be that person for others."
And she finds them all around.
'Heartbreaking' stories • When Utah Valley University psychology professor Kris Doty witnessed firsthand the pain of early returnees in those around her, she launched a study to try to understand the experience in a wider context.
Doty, a Mormon and head of UVU's behavioral science department, enlisted the help of several students and conducted in-depth interviews with a dozen early returnees. The researchers then surveyed 348 such missionaries 81 percent male, 19 percent female.
They found that the largest chunk (39 percent) came home early for personal reasons. Nearly as many (36 percent) return for mental health issues and 34 percent for physical reasons. About a quarter (23 percent) had "unresolved transgression" or disobeyed mission rules.
More than half (58 percent) felt they were treated poorly or indifferently by fellow ward members and nearly a third said they encountered similar chilly receptions from family and friends. A whopping 73 percent of all respondents reported feelings of failure.
"That was heartbreaking," Doty says.
Roughly two-thirds fell uncomfortable in social settings, less than half felt confident saying they were returned missionaries, and 40 percent felt pressure to go back out. Some reported not unpacking their suitcases for months.
The interviews also produced sad stories.
"The mission president phoned my stake president, and I had to call my parents. I called my mom at work and she just started crying," one returnee said. "I told my dad, and he tells me he's failed me as a father. I won't be able to come home. There won't be a bed for me there."
Doty heard about other insensitive comments from well-meaning but misguided members.
One LDS leader put his arm around a young man who had come home with mental health problems and said, "I don't care what you've done, I still love you," implying the missionary had somehow messed up.
At a recent homecoming for an early returnee, the bishop stood before the congregation and said: "We are so happy to have her home, but the family could use your prayers."
These comments, Doty says, are made without malice but reveal so much cultural pressure and false assumptions.
Even those who come home for simple homesickness, disobedience or disbelief deserve to be embraced, she says. "This is supposed to be a gospel of love, right?"
That's how Freeman sees it, too.
"It takes a lot of courage to go out on a mission and face rejection," he says. "But it also takes a lot of courage to come home early and face a similar rejection."
Especially when the wounding words and actions come from fellow members, friends, even family.
Freeman wants to help missionaries feel pleased about what they did whether they stayed a week, a month or the full two years.
Suggestions for helping young Mormons before and after their missions
• Talk to young people and families about the stresses, not just the joys of missions.
• Teach coping skills to missionaries, including when they face health challenges.
• Provide better training for mission presidents and their wives in dealing with mental illness.
• Urge family members not to focus on the amount of time served, but on the benefits and lessons learned while on the mission.
• Develop sensitivity workshops for local LDS leaders about early-return missionaries.
• Present firesides for all returned missionaries, including those who came home early, about how to transition to post-mission life.
• Let early returnees decide for themselves if they want to go back to their missions.
• Recognize that mental illness is as real as a broken leg and not a missionary's fault.
• Encourage early returnees to speak to their congregation about their mission if they desire.
• Offer alternate ways of serving that are as valued as a full-time mission,
• Work to remove the stigma of returning early.
• Train ward councils to establish a welcoming and accepting ward environment.
Sources: Interviews with missionaries and therapists