In the middle of my mission, I had two very sick companions one after the other. With both companions, their health was so bad that we slowly spent more and more time in the apartment until they were eventually sent home. It was a challenging experience for me in both cases as I focused my energies entirely on supporting them in this frustrating circumstance. After the second one went home, I was assigned an extremely energetic and capable companion. I missed my previous companions, but was relieved to have the pressure taken off so I could focus on missionary work again. However, soon after I got this new companion, I spiraled into depression. Frankly, I was exhausted and had been holding myself together for a long time in order to support my sick companions. Also, in my new situation I felt like I wasn’t useful any more. I had had a really important role and was very needed, and suddenly I didn’t feel as needed anymore (people who care for an ailing family member often experience similar reactions when their roles shift). What was also surprising was that it took me several months to get out of the depression. I remember waking up every day and standing in the shower feeling no energy or motivation to do what I needed to do that day. I became numb, and felt like I was just suffering through the days until I could go home. Sometimes, I got so fed up with the depression that I would try to fight my way out of it, but it felt like trying to climb out of a muddy hole. It took an enormous amount of effort and the more I fought to get out, the further I slipped down into the hole. I talked to the mission president about my feelings to some extent, but I don’t think it went much beyond the fact that I was struggling. I don’t think the word “depression” even came up in our conversations. Luckily, my new companion was very supportive and understanding of me and after several months of being together, I felt myself coming out of the depression.
Because of that experience, I have thought a lot about the missionary experience and mental health. The following list includes two situations that I directly observed as a missionary as well as an experience of a close friend.
1-My first sick companion and I spent a couple of days in the mission home right before she went home. At the same time an elder was being sent home who had suddenly started exhibiting very unusual behavior. When he started the mission he was doing well. However, over the last week or so he had become very manic (he talked very quickly, had a ton of energy, rarely slept, and often had new ideas about how to do things that were not practical). For example, he had decided that a good way to be able to talk to more people would be to stick his head out of the car window all of the time (with his bike helmet on) and talk to them as they drove by or waited at stoplights. I observed some of this manic behavior while we were in the mission home together. For example, he stayed up all night organizing things in the house into a categorization system that didn’t make sense to the rest of us. The mission president’s wife told me that when they informed his family, the family was not surprised as they had a history of this type of mental health issues in their family.
2-My mission trainer showed symptoms of bi-polar disorder. She was very happy and energetic one moment and would lash out at me over little things the next moment. She was extremely controlling and it was very difficult to predict her changes in mood. She had originally started her mission in the states but got sent home for a couple of months before she was reassigned to my mission. We were together for 6 weeks and then she was assigned a new companion. She got sent home from her mission soon after she got the new companion.
3-My friend was assigned to work with a sister who was struggling with anorexia. Over their first couple of days together, the companion only ate one piece of bread and talked all day about calories and body image. My friend prayed a lot to know how to help her and was inspired to say and do certain things. Slowly over the companionship, this missionary started eating again and was able to complete her mission.
Often we think that people with tendencies toward mental illnesses would develop mental health problems regardless of their circumstances. The vast majority of times this is not the case as environmental circumstances can trigger or exacerbate mental health problems and can also impact how they are dealt with. One of the biggest triggers of mental health problems is stress, and missions can in many ways be a very stressful experiences (which I go into in more detail below). In addition to being inherently stressful, I believe that characteristics of the current missionary program increase the likelihood that someone would develop a mental health problem. Additionally, I believe that characteristics of the current missionary program decrease the likelihood that missionaries would seek and receive appropriate and timely treatment. This is also expanded upon in more detail below.
I think church leaders recognize that missions can be stressful and difficult experiences and have made an effort to address mental health concerns before missionaries get to the field. For example, current missionary applications ask questions about mental health and require that missionaries resolve mental health issues before submitting their papers. However, it is likely that many individuals either show no forms of a mental health problem or have had those problem resolved before the mission only to experience some form of mental health problem during their missionary service. It is impossible to know what percentage of missionaries struggle with mental health issues without conducting a study. However, based on my experiences I would hypothesize that there are unique aspects of the missionary experience that raise the likelihood that an individual would struggle with a mental health issue. These are listed below:
1-Missionary life can be very stressful for a variety of reasons. These can include living in a different country and speaking a different language and working long hours. Also, missionaries can place a lot of pressure on themselves and each other if they are not reaching certain goals or getting certain results. In many cases the missionary’s personal worthiness or spirituality is questioned when the missionary is not getting the desired results. Furthermore, missionaries often set goals that are dependent on the choices of others. Thus, missionaries can become frustrated when they work really hard and yet are unable to reach their goals.
2-Because most missionaries are between the ages of 19 and 22, there is a reduced likelihood that they will recognize a potential mental health issue in themselves or other missionaries. Furthermore, while some mission presidents and their wives might recognize a potential problem, missionaries have limited day to day contact or interaction with the mission leaders. Additionally, most mission presidents and their wives have limited training in recognizing mental health issues, and thus might not be able to recognize the signs of a problem. In some cases, the reaction of the mission president can even make the situation worse (I have heard of cases of mission presidents that didn’t believe that depression was anything more than a lack of faith and effort).
3-Most missionaries have limited access to mental health professionals. If a problem was recognized, they may or may not be able to see a counselor who would be able to appropriately diagnose and treat the problem because of where they are living. Furthermore, because missionaries move around often, it would be difficult for a missionary to visit a mental health professional for more than a limited amount of time.
4-Missions involve a high expectation to conform to a rigid lifestyle that offers very little flexibility for individual needs and differences. Furthermore, missionaries have little freedom to engage in behaviors that may improve their mental health. For example, many counselors will encourage their patients to use family members and friends as support systems. Missionaries literally have this support system stripped away as their ability to talk to family and friends is very limited. Also, counselors will encourage individuals to engage in stress-reducing activities that can help them cope with high stress situations. These types of activities can vary from individual to individual, but can include things like playing musical instruments and listening to music, exercising, and other forms of relaxation. While missionaries can engage in some of these activities in a limited way, they have very little down-time in which to cope with the stress they often face.
5-Missionaries are required to be with their companions 24 hours a day, 7 days a week. Being with the same person all of the time can be difficult in the best circumstances and can be incredibly stressful in the worst circumstances. We all interact with people that we have a hard time getting along with, but we are usually afforded some time away from those people to decompress. Additionally, missionaries can be reluctant to express concerns about their ability to get along with their companion as it is often characterized as having a lack of faith or not putting in enough effort.
In my mind, the current missionary program limits individuals from serving who could actually gain a lot from the experience. Furthermore, it unnecessarily raises the risk that an individual would develop a mental health problem during their mission, and reduces the likelihood that they will seek treatment. Given that there is often a good deal of pressure to serve a mission (for young men and sometimes for young women) and a lot of social pressure to not return home early, I worry that a lot of missionaries decide to tough out their situation instead of seeking adequate care for their mental health. I worry that in many cases this will unnecessarily worsen the mental health of the individual as well as impact other missionaries and potentially ward members or investigators. Furthermore, mental health issues that develop or are exacerbated during the missionary experience can continue to impact individuals long after they return home.
I think there are several practical changes that could improve the situation for missionaries. They include:
1-Providing training to mission presidents about recognizing potential mental health problems and how to address them. Teach missionaries in the MTC about how to deal with the stress of the mission, about symptoms of different mental health problems, and what to do if they or their companion experience those symptoms. Emphasize that mental health issues are not a result of a lack of personal worthiness or a lack of desire to be a good missionary.
2-Provide a safe space for missionaries to address concerns about mental health issues as well as resources to address the issues when they arise. For example, missionaries could be encouraged to raise concerns about these issues during the interviews that they have with their mission president. Where possible, the mission president should establish a working relationship with mental health clinics within the mission boundaries that they could refer missionaries to. In areas where mental health resources are limited, senior missionaries could be called who have professional mental health training. Their role could involve treating missionaries who are struggling and educating all of the missionaries about mental health issues.
3-Build more flexibility into the missionary schedule. Allow more time for missionaries to de-stress by engaging in activities appropriate for their calling and situation.
4-Missionaries should be given a safe space to express concerns about the companionship to their mission president. Where possible, missionaries should be given some alone time or time to work with other companions so they are not with the same person all of the time.
Overall, I am really grateful for my missionary service and glad I went. I learned how to talk to literally anyone and came to know and love people in a wide variety of personal circumstances. As a church, we should be focusing on how to increase these positive benefits of missionary service while decrease the risks. We should be focusing on how to expand these opportunities to a wider variety of people by making changes to the current approach to mental health issues.
What do you think? Did you experience mental health issues during your mission or observe these issues in others? How do you think the missionary program could be improved to contribute to better mental health of the missionaries?