The Deseret News is exploring why teens are more anxious than ever and how families and communities can help. This is the latest in a multi-part series.

SALT LAKE CITY —

Nate Clyde lost 18 pounds in the Missionary Training Center.

Suzy Thornock developed an eating disorder a few weeks into her mission.

And Maurice Melligan found himself confronting suicidal thoughts.

From Utah to New Zealand, these young members of The Church of Jesus Christ of Latter-day Saints are just a few of the “early-returned missionaries” who have come home from missions due to mental health challenges that cropped up unexpectedly, or resurfaced during their time “in the field.”

Missionaries, typically ages 18 to 26, are part of an increasingly anxious generation. Diagnoses for anxiety in adolescents are up 17 percent from 10 years ago, nearly 30 percent of today’s kids and teens will meet the criteria for an anxiety disorder at some point, according to the Child Mind Institute, and anxiety is the top concern for incoming college students.

Add these statistics to the already soul-stretching experience of serving for 18 or 24 months away from home, cut off from familiar comforts and facing constant rejection from people who are uninterested in joining a new church — and experts say it’s no wonder many missionaries are having a hard time.

“A mission can be a trigger, and to say it isn’t ... is disingenuous,” said Randy K. Moss, psychologist and principal of Integrated Counseling and Consulting LLC., in Kaysville, Utah, who has worked with adolescents for 30 years, including early-returned missionaries. But, he added, it’s also incorrect to say that missions cause mental illness or that missions are harmful because they are stressful.

As part of a yearlong series on teens and anxiety, the Deseret News talked with mental health experts, former mission presidents, religious scholars and 20 returned missionaries who dealt with mental health challenges while serving — exploring the global problem of anxiety in the unique context of religious service within The Church of Jesus Christ of Latter-day Saints.

Although the doctrine and policies of The Church of Jesus Christ make no distinction between youth who have served missions, come home early or choose to not serve at all, that’s not necessarily true of the church culture.

Nearly all of the early returned missionaries interviewed said their anxiety was amplified by cultural stigmas, like the assumption that missionaries who come home early must be lazy, incompetent or lack faith, plus misunderstandings of mental health challenges in general.

However, young adults who focused on what they learned, rather than what they “achieved” or “didn’t achieve” were more likely to view their mission experiences positively, despite sometimes feeling misunderstood.

Church spokesperson Daniel Woodruff said the church keeps track of the number of missionaries who return home for mental health or other reasons, and while he declined to share this data, said the figures are “significantly lower” than those cited in a recent public survey conducted by religious historian Jana Riess and political scientist Benjamin Knoll.

The survey of more than 1,500 current and former members of the church in the United States found the number of missionaries coming home early is on the rise. More millennials are coming home compared to those in previous generations, the survey results showed.

As of Nov. 6, there were 65,915 full-time missionaries serving around the world, many of whom will never face debilitating anxiety. Yet because anxiety is a growing global issue, the church has developed resources to help, Woodruff said.

The church provides mental health services to missionaries in the Missionary Training Centers, in the field and post-mission, offers training to help mission presidents respond better when a missionary is suffering and sponsors support groups for early-returned missionaries.

This support, along with love and acceptance from family and peers, can help change how young adults view a shortened mission.

“Love the missionary unconditionally,” said Zachary Leifson, a licensed clinical social worker and president of Mission Fortify, a nonprofit group devoted to supporting missionaries. “Let that missionary know that their service was acceptable. It’s really our culture, the Mormon culture, that has created the shame, not the teachings of the gospel.”

Doctrine versus culture

In 1974, former church president Spencer W. Kimball charged every worthy young man to prepare to serve a proselyting mission — a prominent practice in the church since its founding in 1830.

As a child, Josh, who asked that his last name be withheld, remembers singing a song called, “I hope they call me on a mission,” wearing a pretend missionary name tag and receiving quarters from an older man in his ward to “save for his mission.”

Yet after two years of college, the fact that Josh was 20 — two years past the eligible age for male missionary service — became conspicuous in his social circle at church. While he had a strong desire to help others and connect with God, for reasons he can’t explain, a “lump of dread” formed in his stomach every time he thought about leaving for two years.

Despite hesitations, and with the encouragement of friends and church mentors, Josh submitted his mission “papers.”

In the Provo Missionary Training Center, the “dark feelings” Josh had suppressed turned into “absurd misery.” After nine weeks of getting four hours of sleep a night, Josh was too exhausted to push back when a doctor told him he needed to go home.

The first night back he cried for hours.

The next day, he and his family went into the mountains where he alternated between hiking and weeping.

“They weren’t mad at me, they were shocked,” he said of his family. “They saw me in so much pain and they had no idea where it came from. Three months prior, everybody looked at me like I was on a road to success, and now I was a damaged object to be kind and compassionate to.”

That was more than a year ago, and Josh, now 21, considers himself about 40 percent recovered from his mission experience. He dislikes clinical labels like anxiety disorder or mental illness, and instead is focused on finding meaning in his struggle.

“The pain that people experience is not shameful, it is purifying,” he said, adding he wants people to stop seeing missionaries who come home early as somehow “lesser” or broken.

In a 2016 video promoting a Face to Face event for young adults, Elder Jeffrey R. Holland, member of the Quorum of the Twelve Apostles, said missions are missions, no matter the length, and that serving for 18 months for young women and two years for young men is somewhat of a “modern invention.”

In 1837, early church apostle Heber C. Kimball served a famous mission to Great Britain that lasted only 8 months, while other missions in the church’s history lasted four or five years.

“When someone asks you if you served a mission, you say ‘yes,’” said Elder Holland. “You do not need to follow that up with, ‘but it was only four months.’ Say ‘yes,’ you served a mission and be proud of the time you spent.”

The mission call itself reads, “It is anticipated that you will serve for …” — a phrase some missionaries find comforting when they are unable to serve for the traditional time frame, said Destiny Yarbro, who interviewed and surveyed hundreds of missionaries for her book, “Home Early ... Now What? How to Navigate Coming Home Early From a Mission.”

Melligan, 28, served for three weeks in Holland before he told his mission president he was going home.

He’d been waking up each day to a “dark cloud,” and then feelings of panic would set in, followed by suicidal thoughts.

Once home, and having recognized his struggles as anxiety, he felt prompted to Google “service mission,” and came across an opportunity to serve as a young church-service missionary.

He worked with religious leaders and chose to serve a 6-month mission with church public affairs from May to November of 2015, working as a reporter for the then-Mormon Newsroom and traveling between his native New Zealand, Australia and Papua New Guinea.

“I realized that everything that I felt about myself — that I was a failure, that I lost out on blessings — was a huge lie,” Melligan said. “The service mission helped to restore my confidence in how I thought about myself.”

Young church-service missionaries can either be called on a service mission initially, or reassigned if they’ve come home early from a traditional proselyting mission.

After a missionary’s case is reviewed by the Church Missionary Department, missionaries and their parents talk to their stake president to determine the best course of action, said Woodruff.

And because young church-service missionaries usually live at home and serve locally — with church operations, approved nonprofit community organizations or in stake service assignments — they are able to receive needed care for physical or mental challenges, he said.

“Whether a young adult serves a proselyting mission or a young church-service mission,” the church’s website reads, “both are acceptable offerings to the Lord.”

Facing anxiety

As proselyting missionaries, young adults are asked to leave behind friends, family, hobbies and even their first names as they adjust to a new environment, rigorous schedule and often a foreign language.

Mindful of these daunting requests, the church released a new set of pre-mission interview questions in 2017 for leaders to help young people identify and report mental health challenges before they find themselves in the “pressure cooker setting of a mission,” as clinical psychologist Rulon Gibson, put it.

One of the new questions reads, “Do you currently have or have you ever had any physical, mental, or emotional condition that would make it difficult for you to maintain a normal missionary schedule, which requires that you work for 12–15 hours a day, including studying for 2–4 hours a day, walking or biking for up to 8–10 hours a day, and so forth?”

This rigorous schedule begins at one of the church’s 14 Missionary Training Centers, where missionaries spend two to nine weeks preparing before being sent around the globe.

They’re up at 6:30 a.m., in bed at 10:30 p.m., with language study, proselyting instruction, compulsory exercise and gospel devotionals in between. There’s very little downtime.

While there, each missionary gets a copy of the church’s “Adjusting to Missionary Life” booklet, to help them recognize and cope with stress.

Yet, stress and anxiety are not inherently bad things, said Jonathan Abramowitz, a clinical psychologist and professor of psychology and neuroscience at the University of North Carolina, Chapel Hill.

Those feelings are the body’s built-in alarm system, which responds to perceived threats by releasing adrenaline to help the body to “fight, flee or freeze.”

With anxiety disorders, the brain overestimates the perceived threat and becomes stuck on high alert, inflating normal stressors to the point of impeding clear thinking and normal functioning, he said.

“When we can’t make all the anxiety go away — because we can’t — we need to teach people how to be better at having anxiety,” Abramowitz said.

Nate Clyde, now 20, thought he was pretty good at handling his anxiety when he left for the Provo Missionary Training Center in July 2017.

He’d been taking anti-anxiety medication since elementary school and had learned how to handle starting a new school year and the daily stress of tests and homework.

It wasn’t perfectionism, but changes of environment that “freaked him out” the most, as well as the fear of throwing up.

When Clyde submitted his mission papers, they were likely “flagged,” then reviewed by a team of volunteer mental health experts, like Gibson. Two screeners independently review each application and make a recommendation about the individual’s readiness for missionary service.

Past mental health problems rarely affect a missionary’s eligibility, said Gibson, as screeners focus on current functionality, meaning full disclosure of ongoing symptoms is paramount.

Clyde was experiencing no major symptoms when he submitted his papers, which is probably why his application was approved, Gibson said.

Yet even those with zero history of mental health problems may experience challenges for the first time on a mission because early adulthood is precisely the time when mental illnesses are most likely to manifest, said Gibson, who in his former calling as a mental health authority was responsible for the psychological needs of all the missionaries serving in Japan, Korea, and Micronesia Guam from 2010 to 2012.

For Clyde, the transition to missionary life was more dramatic than anything he had ever experienced. His coping skills failed him. He couldn’t eat because of his fear of throwing up, and ended up losing 18 pounds in four weeks before returning home.

“One day, I was so proud of myself for eating five Fruit Loops,” he said. “I had no strength. I couldn't move or focus.”

Internalizing grace

When mental illness crops up in a religious setting, it can lead to feelings of “failing God,” or “not being good enough.”

“When I got home, I totally felt like I blew it,” said author Yarbro, whose own physical and mental health problems sent her home early from Hungary nine years ago.

“I felt so ashamed, so embarrassed that I couldn’t ‘cut it.’ Some things that were said in the mission, I internalized and believed that I must not have had enough faith, or I did something wrong and that’s why I was home.”

She later realized that was the “achievement culture” talking, and it forced her to grapple with the idea of God’s grace in a new way.

Daniel Judd, a BYU professor and former mission president in West Africa, said young missionaries would often confess microscopic or even made-up “sins,” worried that they weren’t good enough, and that their hard work wasn’t earning them the promised results.

Their fears reminded him of the story of Martin Luther, the young Protestant reformer.

During Luther’s first year in the seminary, his excitement slowly gave way to anxiety, depression and obsessive-compulsive confession.

So the young student worked harder, prayed more, studied longer and got up earlier. Yet the more he did that, the worse his mental health became, said Judd, associate dean of the religious education department at BYU and a Ph.D. in counseling psychology.

Finally, as Luther read through the New Testament — Galatians, Romans, Ephesians — he discovered the grace of God, which Judd believes not only transformed his life, but set the stage for the reformation itself.

“His story is our story,” Judd said, noting that this destructive pattern is what many missionaries and members of The Church of Jesus Christ fall into — trying to earn perfection and missing the entire point of Jesus Christ’s teachings.

Embracing this concept doesn’t just make for good sunday school discussions — it affects a person’s physiology.

Judd recently published a study on grace, legalism and mental health, showing that Latter-day Saint BYU students who trusted in their own “good works” reported fewer experiences with God’s grace, and because of that, poorer mental health.

And the reverse was true as well — students who reported experiencing and trusting in God’s grace in their lives reported less anxiety, depression and shame.

“Legalism — this obsession with doing, being exactly obedient — it seems to … block our ability to experience grace,” Judd said.

In addition to misunderstanding grace, some missionaries “have a very unrealistic understanding of success,” said Gibson. He worked with missionaries who believed in the “sin model,” a cultural — not doctrinal — belief that a lack of convert baptisms or even feelings of discouragement are due to insufficient prayer, scripture study or faith.

Legalism — this obsession with doing, being exactly obedient — it seems to … block our ability to experience grace. – Daniel Judd, a BYU professor and former mission president in West Africa

Missionaries may believe such fallacies because of unintentionally harmful ideas propagated by mission leaders, who preach that exact obedience to mission rules will directly result in baptisms, or that any personal struggle can be overcome with increased diligence to gospel teachings alone, several returned missionaries said.

“There’s no one mission president that does everything right,” said Judd.

While serving as a stake president, Judd would often get calls from mission presidents asking about missionaries from his area.

“Sometimes I was very grateful for the sensitivity of that mission president, and other times I would be thinking, ‘oh, I wish that mission president could see this missionary through my eyes, or the Lord’s eyes ... and be a little more sensitive to his or her concerns,'" Judd said. “'Treat them more as a person and not as a worker.’ ”

Mission presidents come from a variety of backgrounds and professions — they may come from a military background where there’s a focus on discipline or from a business management background where there’s a focus on numerical results, said Gibson.

But instead of emphasizing numbers of baptisms, referrals or lessons taught, the church’s handbook for missionaries, “Preach My Gospel”, teaches that success is achieved when a missionary "feels the spirit,” in other words, when a missionary feels loved and led by God, Gibson said.

Because no one is perfect, he said, missionaries and mission presidents who recognize that they will regularly make mistakes, and that others will too, will have an easier time adjusting to missionary life — and be more gentle on themselves as well.

Getting Help

Suzy Thornock, now 20, was two months into her mission in Scotland last year when she found herself unable to get out of the car.

After she and her companion arrived at a location where they planned to proselyte and said a prayer, as was routine, Thornock’s companion started bundling up for the snow-coated highlands in her knee-length, fur-lined coat. But Thornock couldn’t move. What if she couldn’t say the right things? What if people rejected her?

Her companion urged her out of the car, but Thornock refused, then broke down in tears, sick to her stomach.

At that point, Thornock had been bulimic for several weeks. Throwing up had become her way to deal with the overwhelming stress that she was failing to live up to the “perfect missionary ideal.”

Soon after her experience in the car, Thornock realized she needed help overcoming her anxiety and bulimia. In her journal, she wrote down three steps: 1) pray about it; 2) e-mail her mother on the next preparation day; 3) tell the mission president’s wife.

The mission president’s wife helped Thornock get set up with the area mental health authority in Germany, who listened to Thornock’s problems and gave her advice over Skype.

The church connects missionaries to counseling services and even assists them in getting prescription medications, if needed.

But while the church has resources for missionaries who are struggling, they are limited, according to Gibson. “Our goal is not to involve missionaries in extended counseling and therapy while they are serving,” he said. “That's better done at home.” For missionaries who would recover better with the support of their families in a familiar environment, the church will purchase a next-day plane ticket home for them — no matter the cost.

For Thornock, they did both. Shortly after the Skype counseling session, Thornock was honorably released and returned home where she was able to overcome her eating disorder. Today, she is continuing her education at Brigham Young University and pursuing a career in nursing.

Finding meaning

For many early-returned missionaries, coming home brings relief but also new challenges. Settling into old routines and reuniting with friends or family members can be stressful, especially if those people have difficulty understanding or accepting what the missionary has been through.

When Marissa Folland, now 20, came home early from her mission to Portland, Oregon, a friend told her he was “calling her bluff,” — in essence, accusing her of lying about why she was home. Though hurt by his comment, she chose to ignore it. She knew she hadn’t broken any rules, nor would she have lied about something so serious.

Eventually, as her friend saw what she was going through and “realized how real it was for me,” she said his attitude changed.

“The healing process of anxiety and depression or any difficult or traumatic experience takes time,” said Folland who’s been home for just over a year. “Be patient with yourself and those around you who are trying to help.”

While no missionary leaves on their mission planning to come home early, many of those who did come home unexpectedly told the Deseret News they were still grateful for the experience and what it taught them.

“It’s really surprising to me how much I’ve changed since my mission,” said Jon Batman, 20, who served in Argentina in the summer of 2016. Once a shy, young man, he now considers himself more of an “extrovert” who “loves talking to people and hearing their stories.”

In his 9 1/2 weeks out, Batman said he grew closer to God, which he believes is the ultimate reason for going on a mission.

After he came home, he also found purpose in becoming a mentor for other early-returned missionaries through a church-sponsored support group.

“The group really helped,” he said. “It showed that there were people experiencing the exact same thing as you, and you’re not alone in this.”

Though the journey to find healing is personal, family support can make the process easier, said Leifson, with Mission Fortify. Missionaries who came home to angry or disappointed parents often struggle for much longer, he said.

When Brenna Poggemann, now 21, came home from her mission in Portland, Oregon, in the summer of 2016, her dad brought his laptop into her bedroom and worked by her side for a week, while she slept and recovered. He and Poggemann’s mom didn’t try to “fix” her, but made sure she ate well and got exercise by taking her on daily bike rides.

“My parents were genuinely trying to find out what was best for me,” said Poggemann. “Sure, they didn’t quite understand exactly what I was going through, but they didn’t let that get in the way of treating me correctly, finding out what I needed, and being sympathetic.”

The best help may come as members of the church abandon the idea that those who haven’t served missions are somehow less capable than those who have, said Moss.

“We need to talk about missions ... as a possible developmental milestone,” he said, “not the crowning aspect of our lives.”

For Clyde, his mission has definitely been a life-changing experience — though not quite in the way he expected.

Recently, he started taking a new medication, which is helping a lot, and after a year at Weber State, he’s moving out of his parents' house to live with a best friend in Orem and attend Utah Valley University.

He still believes in the doctrine taught by the church, but has a hard time at Sunday meetings, especially when people talk about missions.

“I have days where I feel like such a loser, and I ask, ‘why did God let this happen?’”

He doesn’t blame anyone for his difficult mission experience, but wishes he’d heard different counsel when he was preparing to go.

“If you know you have anxiety, don't treat it lightly,” Clyde said. “Prayerfully consider a mission and talk to people. Don't let people tell you ‘you can do it.’ Really find out for yourself. People say ‘with God all things are possible.’ I don't know how to explain that scripture. But there are people who can't do it for certain reasons.”

Church leaders also recognize that within the diverse population of the church, individuals have different talents and abilities as well as capacities for service.

“No one has encouraged missionaries to go out and to stay out on their mission more than I,” said Elder Holland. “But listen … there are reasons that people can't serve a mission. There are reasons that people can't go on a mission in the first place. We know that. We understand that.”

“I say commendation to you, and the love of the Lord to you, and the blessings of the church to you for trying to go, for wanting to go,” he said. “I want you to take the appropriate dignity that you deserve from that and to know that the Lord loves you and the Church loves you.”