Editor’s Note: While a mission is a deeply rewarding experience, it can also be stressful. L. Marlene Payne, M.D., has written a new book, “Mission Possible: A Guide to Mental Health for LDS Missionaries and their Mission Presidents, Parents, Bishops and Therapists.” Click here to learn more

I have had the privilege of serving as a psychiatrist for forty years.  They were years when psychiatrists did both medications and therapy, so I knew my patients more intimately than I knew my friends.  During thirty-five of those years, I often took care of missionaries who needed psychiatric help in the Washington, DC, North and South missions.  It was interesting to see the variety of personalities in the missionaries I met, and I learned that the Lord needs many kinds of missionaries to teach the many kinds of people that walk the earth.

One of my favorite stories was shared by Matt Schults.  “I was sent to Switzerland where I served for six months.  I was transferred to Germany and thus had to apply to their government for permission to stay there.  This was usually a routine matter, but I was stunned when the mission office lost my papers, something that had never happened before. The time limit had expired by six days, and in spite of lawyers’ efforts, my papers were stamped “Deported.”  The first presidency of the Church confirmed that I needed to return to the United States.  I had to leave the next morning.

[dfads params='groups=2870&limit=1&orderby=random']

I packed all night and got to the airport at 4 AM.  I was very calm and felt that this was what I was supposed to do.  I was on my way to Wisconsin to finish my mission, but as the long flight droned on, I hit a low point.  I was exhausted and began to doubt why this was happening.  I went to the bathroom at the back of the plane, passing the empty stewardess chair.  When I emerged a few moments later, a man was sitting there reading.  He looked up at me and said, ‘Are you coming or going?’  I looked puzzled, so he continued.  ‘From you mission. You are going to Wisconsin.  The Lord needs you there, and because you are obedient, you will find your purpose there.’  He rose and walked to the front of the plane.  It was the last I saw of him, but his words of comfort hung in the air like a blessing.

After four months in Wisconsin I became a zone leader.  My companion and I had taught a conference and were ready to leave, but I felt prompted to go to the bathroom.  Forget it!  I didn’t have to go.  The prompting came again.  It was annoying.  I really didn’t have to go.  It came the third time, strongly, so I went back into the building to find the bathroom.

When I entered, I found a missionary curled up in the fetal position sobbing.  I lifted him up, put my arm around him, and began to comfort him.  The missionary cried, “It’s too hard. I can’t do it.”  We went to a room and sat down.  The missionary continued to sob, pouring out his anxiety and discouragement.  He then lifted his head and looked at me for the first time.  He glanced heavenward and began to laugh and then to cry again. What was going on here?  The missionary cried out, “It was you!”  “What do you mean?” I asked.

The missionary revealed that he had been called to serve the Hmong (Southeast Asian) population in Wisconsin.  It was a tonal language, very difficult, and he was told that it would take him about eighteen months to learn it.  During his thirteen weeks in the MTC, his anxiety became very severe, and he developed panic attacks stemming from his fear that he would not be able to learn the language.  He decided on his last day in the MTC that he would go home.

That night he had a dream.  He was in Wisconsin and had been on his mission for a while. In the dream he was very discouraged and felt he should go home.  A young man came, put his arm around him, and comforted him. He had a prosthetic eye with a pupil that did not dilate or constrict.  It was the same eye that he saw when he lifted his head to look into my eyes.  I had had an accident as a child and had lost an eye, replacing it with a prosthetic eye.  The missionary had begun to laugh, he said, “Because God knows me and loves me.”  He stayed on his mission, became proficient in the language, and went on to train others and be a very successful missionary.  I realized that Heavenly Father had recalled me from Europe to help this missionary because I could be identified as the elder he saw in his dream.

This story is one of my favorites because it indicates the love and the attention to detail that Heaven bestows on missionaries.  Another story that echoes this theme was told by J.D. Payne.  He served in the Italy, Rome mission and prayed throughout that he could help to bring a family into the Church.  Twice he and his companion had taught a family who accepted the Gospel and agreed to be baptized.  Each time, as they were filling the baptismal font, the family contacted them and said that they had changed their minds and wanted nothing further to do with the Church.  We went to Rome to pick up J.D. at the end of his mission.  He came down to Rome from Pescara by bus, and on the bus he met a man who became interested in the Church.  Since J.D. was leaving, he passed his name to the elders who took his place.

The following year my son asked if he could return to Rome over spring break.  Excited to see the members and some old investigators, he went to his last city first.  When he arrived in Church on Sunday, they announced the confirmation of a family that had been baptized the previous evening.  As they put their hands on the father’s head, J.D. realized that he knew the man. It was the man he had met on the bus, the last invite of his entire mission, being confirmed a member of the Church–and his entire family with him.  After the meeting J.D. walked up to him.  The man looked at him a moment, and then his face lit up.  “You!” he said with a surprised joyfulness.  “You!” J.D. said back to him, equally surprised, equally joyful.  “Thank you,” the man whispered, as they embraced.  “No, thank YOU,” J.D. returned.  I looked for you my entire mission.”

An interesting and honest reflection about his mission was offered by Vance Mellen:

“The mission was one thousand times more intense than what a person will feel during normal spiritual experiences.  I am lucky to have a spiritual experience once a week in my current life, but I had them far more intensely every single day, often ten times a day or more…Despite being with a companion that might be great or miserable, I often felt very lonely and unable to connect.  There were many times when I wanted to love an investigator that I was teaching, but deep down inside, I could hardly stand them.  Maybe they were lazy or just seemed too much of a ‘loser‘ to make it into the Church.  I had to constantly battle against such judgmental and impatient thoughts.

“Little by little, over the first year of my mission I learned to feel and follow the Spirit.  Most of my spiritual experiences were measured and small accomplishments wherein I learned what the Spirit really was, and what it was trying to tell me. These quiet kind of spiritual experiences, the daily grind, were the most valuable to me.  This is how I leaned the most.  I also learned from bad experiences: bad companions, bad missionaries, unwilling members, lousy investigators, lack of support from ward mission leaders–all of these bad experiences humbled me and forced me to pray and build a friendship with Christ, who surely went through much of the same in His ministry.

“I learned patience.  I learned to love and support even the most troublesome people. I learned to work things out; I learned when to call the mission president and when to put my foot down.  Through these highs and lows on a mission I was whipped back and forth like a sapling in a Kansas tornado.”

I treated hundreds of missionaries and witnessed their wonderful spiritual growth.  Only a handful of them went home early because of their psychiatric difficulties; the rest were able to finish their missions.  When I retired, I set up a relationship among the mission presidents, Missionary Medical in Salt Lake City, and the new psychiatrist who assumed care of many of my patients.  Half a year later I asked the wife of the DC South Mission President how that was faring.  She told me that it had fallen apart because of a technicality in the financial arrangement between Missionary Medical and the new psychiatrist.  I asked who was caring for the missionaries with emotional difficulties, and her response was chilling:  “We are sending them home.”  I immediately called Missionary Medical and resolved the problem; the new psychiatrist is now treating missionaries.

That spurred me to write my book “Mission Possible,” presenting a summary of my work with missionaries.  The central point of the book is that it is possible and important to medically treat those with psychiatric difficulties on their missions, and that in doing so they have the opportunity for great spiritual growth.

Many came for help at the beginning of their missions, so I was able to see their progress not only emotionally and psychologically, but spiritually as well.  I learned that missionaries grew in many ways.  They thought less about themselves and more about their investigators as time went on.  They developed a love and empathy for those they taught.  They deepened their ability to communicate and work through problems with their companions.  They learned the immense value of bending their will to fit the yoke of obedience.  They could see in the lives of their investigators that while we all have our free agency there are consequences to our choices.  Most of them learned to rely on the Lord and receive counsel and direction from the Holy Ghost.  They developed deeper testimonies, stronger faith, and often more humility.

Consider the words of the apostle Jeffrey R. Holland: “So how do you best respond when mental or emotional challenges confront you or those you love?…If things continue to be debilitating, seek the advice of reputable people with certified training, professional skills, and good values.  Be honest with them about your history and your struggles.  Prayerfully and responsibly consider the counsel they give and the solutions they prescribe. If you had appendicitis, God would expect you to seek a priesthood blessing and get the best medical care available.  So too with emotional disorders.  Our Father in Heaven expects us to use all of the marvelous gifts He has provided in this glorious dispensation.”

One of the mission presidents with whom I spoke shared that some families had children, ready for missions, who were being treated for major psychiatric illnesses like bipolar disorder.  When they filled out the missionary application they did not list the illness or its necessary medications.  They felt that it would stigmatize their child or lessen the chance that they would be sent to a more exotic overseas mission.

Others felt that since their child was doing the Lord’s work, he wouldn’t need any care because the Lord would look after him.  The mission president described the suffering that one young man experienced when he had a bipolar episode triggered by the stress of the mission.  I recalled counsel given in the early days of the Church when the Saints were gathering from Europe to Zion:  “The Lord helps those who help themselves.”

The Lord also helps missionaries through their wonderful mission presidents.  One president, President Ed Scholz remarked that it was one of his priorities to keep missionaries for the full time of their service.  He sent home only three missionaries out of three hundred over his three years as a mission president.  His goal was to keep them there and prepare them for leadership roles in the church after their return home.

He also felt that is was important for them to stay because they had been through the temple and had made a commitment.  With that came sacrifice.  He noted that the mission president’s handbook said nothing about baptisms but rather talked about keeping the missionaries strong in the Church and preparing them for leadership.  He said that growth on a mission comes from converting oneself, from understanding the Gospel.  A few of his missionaries left the Church after they returned home, but most remained faithful and strong.  Some became outstanding Church leaders.

As I looked back over my work with missionaries, I identified seven conditions which were common causes of distress: bipolar disorder, depression, anxiety disorders, obsessive-compulsive disorder, attention deficit hyperactivity disorder, body dysmorphic disorder, and Asperger’s syndrome.

  1. Bipolar disorder is a mood disorder that includes periodically elevated and depressed moods.  Type 1 includes manic symptoms, implying that the sufferer can be out of touch with reality, and Type 2 includes hypomanic symptoms, implying no flight beyond the bounds of sanity.  This disorder requires constant oversight since episodes may be triggered by stress, lack of sleep, and the seasons of the year.  With careful treatment and a firm therapeutic alliance, bipolar disorder can be successfully stabilized.
  2. Depression is also a mood disorder.  The symptoms of depression are basically the same as  those in depressive episodes of bipolar disorder without the manic or hypomanic phase.  This is the most common cause of illness worldwide and affects one in every three or four people across the lifespan.  People feel so bad when they are depressed that it becomes very hard to sustain the work of a mission, but this illness is very treatable with both psychotherapy and medication.  I told my missionaries that when they overcame the depression, they would enjoy their missions, and they did.
  3. Anxiety disorders include generalized anxiety disorder, panic attacks, phobias, and posttraumatic stress disorder. The missionary discussed in this chapter had generalized anxiety disorder, and it made his missionary efforts painful.  Patients have questioned which is worse, anxiety or depression, and many have pointed to anxiety. In this chapter I shared a treatment approach for GAD that included elements of therapy, medication, and behavioral techniques.
  4. Obsessive Compulsive Disorder is characterized by obsessions (intrusive thoughts) and compulsions (behaviors that one feels compelled to perform) and is often accompanied by intense anxiety. This drives the obsessions and compulsions in an effort to lessen the anxiety.  The obsessions and compulsions can be very odd.  This condition is so hard for missionaries because many are trying to be perfect, and the OCD exaggerates and intensifies this beyond endurance.  The condition is treatable with behavioral therapy; at times it is so severe that medication is also required.
  5. Attention Deficit Hyperactivity Disorder has two parts:  hyperactivity and inattentiveness.  In a nutshell. hyperactivity means that the person has high energy, is on the go, feels restless, gets bored easily, and does things impulsively like interrupting others before they have finished their sentences.  Inattentiveness means that the person cannot pay attention unless the subject genuinely interests him, makes careless mistakes, loses things, and is disorganized.  Missionaries with ADHD cannot concentrate on their scriptures, have trouble paying attention in discussions with investigators, get bored in meetings, are disorganized, and often annoy their non-ADHD companions.  Many missionaries with ADHD are never diagnosed or treated and still serve successful missions, but they can do a better job and are more successful if they treat their ADHD.  This is done with medications and therapy.
  6. Body dysmorphic disorder is a condition in which people are very critical of some aspect of their appearance, especially hair, nose, or face.  It causes great self-consciousness and is often accompanied by depression.  It can make a mission a very uncomfortable experience, but it can be very helpful to have support and treatment through the course of the mission.
  7. Asperger’s syndrome is not an illness, but its presence can have a profound impact on serving a mission.  Those with this condition have significant gifts.  They often have areas of special interest about which they know a great deal, and their pleasure in sharing their knowledge can make them wonderful teachers.  Their heightened sensory sensitivities can develop into fine gifts. Their difficulty lies in social relationships.  They may lack empathy or be awkward, missing social cues and not knowing how to manage the give and take of relationships.  They often have trouble with companions, may be shy or have strong tempers.  These missionaries can really benefit from a strong, supportive relationship with a therapist who can model appropriate social contact.  They may also require medication for treatment of depression, temper management, and symptoms of ADHD and OCD which are usually present with Asperger’s syndrome.

The reason for describing the diagnosis and treatment for these various conditions in missionaries is to illustrate the central point that these disorders can be identified and stabilized.  This gives missionaries the opportunity to continue their missions rather than coming home early, often a source of lifelong shame and guilt.  I treated several missionaries who had to come home early.

Their problems were overwhelming and they could not function on their missions.  When a missionary comes home early, he or she needs to be met with kindness, thoughtfulness, and support from members of his ward.  There is no room for jokes, criticism, or gossip.  Those in the ward can help the returned missionary to heal by treating him like a normal person and including him in activities.

One missionary who was sent home early was treated with great kindness by his ward members. When he came to church that first Sunday, members of the ward said only, ‘We’re glad you’re home.  It’s good to see you.‘  The stake president told his parents to call him as soon as he got home even if it was very late, because he wanted to meet with the returning elder.  He continued to meet with him frequently.

The Bishop also supported him with several interviews conducted with unconditional acceptance.  He was asked to help with service projects, taken out to breakfast, and invited to go on splits with the missionaries.  A member of the ward arranged for him to get a job.  This elder was able to move on much more successfully.

In the midst of my work I had an amazing spiritual experience which has sustained and strengthened me for the past thirty years.  It gave me an exquisite knowledge of the love the Heavenly Father has for us, a love which cannot be conveyed in words.

I wish everyone had access to the love our Father feels for us.  What a difference this would make in this angry, suffering, sad world.  His love is a magnet that draws our souls to Heaven.  Once one has tasted of this love, there is no more disposition to do evil, but to do good continually.

Missionary work is the way this message is spread among His children, another reason that it is so important to support missionaries, to help them complete their missions.  It is true that missionaries are “whipped back and forth like a sapling in a Kansas tornado,” but these challenges do make them stronger in faith, patience and love.  I am sure that Father in Heaven and His Son especially love them for their willing sacrifice.”