Saturday, January 26, 2008

LDS Missionaries and Depression

When I was an LDS missionaries I saw a few missionaries who suffered from mild depression. Depression is defined as mental illness characterized by a profound and persistent feeling of sadness or despair and/or a loss of interest in things that once were pleasurable. Disturbance in sleep, appetite, and mental processes are a common accompaniment. People who suffer may experience crying, low self-esteem and feelings of worthlessness that lead to negative thinking or sleeping too much. Any time the condition exists for over two weeks it is diagnosed as a dysthmic disorder or mild to moderate in nature.

I am not a psychologist so my experience is limited to personal observation. I once worked in a university with a professional clinical psychologist in California who told me that I should be glad I wasn't one since she considered herself messed up and that it took a messed up person like herself to help other messed up people. She used me as her sounding board and would call me when she had personal problems or to discuss her personal life choices. I have paid four counselors for professional advice on relationship issues over a thirty year period who were helpful and reasonably adjusted so I feel for the most part mental health professionals are helpful and have positive advice.

I exhibited signs of mild depression myself while on a mission so I could identify it easily in other missionaries since I displayed similar tendencies. Fortunately for me, I was able to not let it affect me severely and functioned reasonably well. I grew up in a home where both my parents had problems. My father and mother were both diagnosed as being clinically depressed. They both took prescription drugs at one time or another in their lives. Having lived with parents who were both bipolar and depressed made it so I had a up close and personal experience in how to deal with people suffering from it. My mother took medication which helped her overcome the chemical imbalances in her brain. After a couple of years of treatment she went from a condition of pre-senility to being a fully functioning person in her later life. When my mother was first diagnosed they said she would have to be institutionalized which she was for several weeks so her recovery was a miracle.

I noticed the condition acutely in one elder and one sister I served with. Both went through periods where they would question there effectiveness as missionaries and particularly their worth. Neither had committed sexual transgression but they felt an acute sense of worthlessness. Both of them were lifelong members who felt at their lowest when they were not having success on their mission. The questioned their righteousness. Their expectations were so high that when they didn't baptize any one or had periods of limited teaching success they would go into a script where they would repetitively tell anyone around them of their worthlessness. It was hard to listen to such negativity because they repeated it over and over. On occasion they suggested that they were so ineffective that they should be sent home by our mission president. It amazed me that he was so patient with them. It was hard to help them out of their destructive cycle. Every time they seem to get better they would have a self-destructive relapse. It was like a whirlpool that was sucking them down. The more you encouraged them the more they insisted they couldn't be helped.

The sister missionary who suffered from depression received many priesthood blessings from the mission president and her missionary zone and district leaders. I became aware of her problem one day because she couldn't find anyone to give her a blessing so my companion and I helped her out. She told us she was a blessings junkie and if she couldn't get a blessing she wouldn't be able to get out of bed and work. She describe her depression to us in great detail. Drawing on the powers of the Lord helped this missionary for short periods to function sometimes only for a period of days and sometimes longer for weeks. It just depended on whether she success or failure in working with investigators. The suffering person's desire to have a blessing showed that she was working toward overcoming the condition. After her mission I associated with this sister who lived in my student ward and then nearby in Utah. She lived a fully adjusted life and as I tracked her for many years I never witnessed depressive patterns of negativity even when she had children. I think by then Prozac was out which had stabilized her. She was able to take it a short while and lived a normal life without any medication in the end. I think the stress of her mission had a great deal to do with her mild case of depression.

Mission presidents who have missionaries suffering from depression must work closely with them to try to help them break out of the cycle. If after exhausting priesthood channels the missionary remains depressed beyond a few weeks a mission president might try setting up counseling sessions. The mission president first resource is the Missionary Department in Salt Lake City. If missionaries are in United States or Canada they can also be helped through LDS Social Services where a qualified LDS counselor is available to diagnosis whether the condition is serious and requires further treatment.

If after a few sessions with a professional counselor doesn't resolve the missionary's concerns, the mission president can refer the missionary's case to the missionary health department for further determination and final recommendation to the Missionary Committee who decide the missionary's future. Some elders and sisters have been able to complete successful missions with short-term counseling and or medication and others require more intensive help at home that might include hospitalization. When dealing with thousands of missionaries there may be a few cases of clinical depression that exist among them. Missionaries should seek help early and should not be ashamed if they suffer. The mission president's prime concern is his missionaries and their mental health and well being.

If a missionary finds herself/himself with signs of depression they should immediately tell the proper authorities at the MTC so they can get some help rather than wait to go to foreign countries where it will be harder to treat. When a missionary discovers a problem while in the field they need to contact their mission president who will prayerfully and confidentially help them to overcome it using the church's resources. Mission presidents are not mental health professionals so they only have limited ways of helping.

One of my friends who graduated in psychology from Stanford University and is now a professor at BYU told me that in his opinion the way to overcome mental illness was as simple as living the gospel. He used the serpent on the pole as an example of how simple it was, all the children of Israel needed to do was look and live. He acknowledge that there are many people who suffer severe depression who need drugs to equalize the chemical imbalance in their brains but for the most part those suffering from mild to moderate depression could overcome their condition by living the gospel fully and placing their faith in the Lord who can lift any burden. I can see some validity to his assertion however I must lack faith because I have had a hard time breaking bad cycles without real effort.

I decided to see if I could find the LDS Church's position on depression.
Many people have debated whether a young man or woman should go home early from their mission for depression. I think that missionaries should resolve the problem before ever going. But if they have a problem they should work it out in the MTC or with their mission president when in the field. Going home should be a last resort. It should only be done if the missionary needs intensive help and treatment that will take more than a few hours a month. Even having said this I recognize that out of 50,000 people there will be a small percentage who need help that lasts many hours or days. Such people should be treated with respect and dignity. They should not be treated as failures. Diseases of the mind are just as debilitating as diseases of the body. Blame should not be assigned.

Dr. Donald B. Doty, Chairman of the Missionary Health Service, said: "Physical and mental preparation should begin at least two years before a full-time mission. . . .

Preventive measures are also essential for young adults who are preparing to serve missions. Today about 3 percent of missionaries have their missions shortened by either physical or mental health problems. Losing 3 out of 100 missionaries may not seem like very many. But to the individual and his or her family, it is very significant.

For more than a year, I have served in a calling where I observe the health problems missionaries encounter. Based on my experiences in this assignment, I would offer the following information to help young people who are preparing to become missionaries reduce the likelihood of developing these health problems.

Fortunately, many of the health problems that missionaries encounter are preventable with proper preparation. Elder David A. Bednar of the Quorum of the Twelve Apostles stated, “The single most important thing you can do to prepare for a call to serve is to become a missionary long before you go on a mission.”

I recommend that health preparation begin at least two years in advance of the anticipated missionary service. Those who wait to prepare until the last minute or until after they have received the call to serve may not be ready and may even have their missions delayed.

Physical health preparation usually includes a routine office consultation with a medical doctor and a dentist. In some cases, mental health preparation may require evaluation by a mental health professional. . . .

When prospective missionaries prepare themselves well in advance of submitting their recommendation applications, they can identify and resolve health problems, improve their physical strength, and be better mentally and emotionally prepared to withstand the rigorous life required of missionaries. They will then be much more likely to complete a successful mission free of significant health problems.

Unfortunately, some missionaries unpredictably become ill or injured while serving. More than 50 health-care professionals are serving as full-time missionaries throughout the world, with 200 additional volunteers serving at Church headquarters—all in support of missionary health. Speaking for this small army of health-care professionals, we will be there to help any missionary who becomes ill or injured. And we pray every day that our missionaries will remain healthy and safe from harm as they serve the Lord and His children."

In 2007, Dr. Doty further states: "All people have moments of sadness, anxiety, and discouragement. This is normal, especially at times of loss and grief. However, any emotional difficulty that interferes with normal daily functioning needs to be dealt with before missionary service begins.

Any unresolved sins can affect both the mental and physical health of individuals. These should be resolved through full repentance as potential missionaries meet with their bishops before receiving a call. But once this is done, there still may be other conditions needing treatment.

Mood disorders. Those who suffer from chronic or recurring feelings of depression, sadness, anxiety, or fear should be evaluated by a doctor or mental health counselor. Mood swings, especially when they involve temper and anger, should also be evaluated. Treatment, including counseling or medication or both, often reduces or relieves mood disorders, making missionary service possible.

Abnormal thought patterns. Excessive worry and guilt can seriously impair a missionary’s ability to serve. Perfectionism, which is a consuming need to be perfect, can also become a crippling mental health issue. Recurring painful thoughts and repetitive behaviors such as excessive hand washing are signs of obsessive-compulsive thought disorder. Counseling with a doctor or mental health professional can often effectively treat these abnormal thought patterns.

Learning disorders. Because the ability to learn and teach is the essence of missionary work, learning problems such as attention deficit disorder (ADD) can impair missionary success. However, evaluation and treatment of learning disorders may improve learning ability considerably. Some learning disorders may not be compatible with missionary life. Parents and prospective missionaries should prayerfully counsel with their bishop and professionals on the viability of serving a full-time proselyting mission.

Eating disorders. Because people can use food to comfort themselves and relieve feelings of depression or anxiety, eating can become an addiction leading to obesity. On the other hand, social pressure to be lean or even underweight can lead to anorexia nervosa or bulimia, both of which create serious health risks. These disorders will not resolve themselves during a mission. Because they are so difficult to treat, they may not be compatible with missionary service.

Homesickness. While mild homesickness is a normal part of the mission experience, leaving parents and siblings can cause anxiety so intense that it interferes with the ability to sleep or eat. Rapid weight loss is common among missionaries with severe separation anxiety. To prevent these problems, prospective missionaries should become comfortable being away from home. Extended camping trips or living in a dormitory at school can reveal any tendency for severe separation anxiety. Those who do have problems functioning when they are away from home should seek treatment from a doctor or mental health professional.

Social skills. Missionary work involves meeting and conversing with people of all ages and speaking before groups. Prospective missionaries should become comfortable talking to older people. They should practice being respectful and courteous, using proper table manners, and observing other social courtesies. Missionaries are also required to approach strangers and strike up a conversation. Therefore, prospective missionaries should learn to be comfortable in initiating contact and conversing with people outside their normal circle of family and friends. They should also be aware of cultural differences in the world.

Employment. Missionary work is just that, work. There is nothing easy about missionary work, so young people should develop the ability to work reliably. A regular job teaches such habits as getting to work on time, not missing work unnecessarily, doing assigned tasks well, looking for more work when the assigned task is completed, and not going home early. A job also helps young people understand the value of money. Where possible, prospective missionaries should plan to pay as much of the cost of the mission as possible, rather than depending on parents or donations from others. Helping pay for their own missions will help prospective missionaries learn to live within the stringent missionary allowance.

During the course of preparing to serve, prospective missionaries may discover serious physical or emotional issues. Prospective missionaries and their parents should be completely candid in disclosing all health issues and medications on the missionary recommendation application.

Unfortunately, some health problems can present insurmountable obstacles to serving full-time proselytizing missions. The First Presidency has stated: “There are worthy individuals who desire to serve but do not qualify for the physical, mental, or emotional challenges of a mission. We ask stake presidents and bishops to express love and appreciation to these individuals and to honorably excuse them from full-time missionary labors.”2 In such cases, service missions can be a great blessing, allowing individuals to live at home and receive appropriate medical care while growing and maturing in the service of the Lord. Parents, bishops, and stake presidents can help in encouraging and arranging appropriate opportunities."

In 2004 S. Brent Scharman, Manager of Evaluation and Training for LDS Social Services said: "President Hinckley has stated that a missionary needs to have good physical and mental health, because any “ailment or physical or mental shortcoming a missionary has when he comes into the field only becomes aggravated under the stress of the work.”

Depression is the most common emotional problem experienced by missionaries. Most periods of depression pass with time, problem solving, and prayer. President Boyd K. Packer has said:

“There is in the mission field the tendency to be discouraged. Sometimes a missionary will tell me, ‘I have had just a miserable day. Everything has gone wrong, and I am discouraged. It just isn’t going to go right. I feel very depressed.’’ . . .

“Learn that there must be ups and downs in your life. You can find that explained to you in the doctrine: ‘For it must needs be, that there is an opposition in all things’ … (2 Ne. 2:11). That is part of life!”

Discouragement comes to all missionaries at one time or another. It is not the same thing as depression. Individuals who are prone to serious states of depression and who have previously required counseling and medication should consult with their leaders prior to submitting an application for missionary service. The application must include an honest history. If medication has been prescribed, it should be continued while serving.

In many areas of the world, LDS Family Services is available to help families and leaders learn to differentiate between everyday ups and downs and clinical depression. Your bishop or branch president can help you contact the nearest LDS Family Services office. For more information, see the Web site http:\

Mission presidents report that some missionaries experience difficulty because they have set unrealistic standards for themselves. Elder Cecil O. Samuelson of the Seventy said in a talk to missionaries: “Interestingly, often those who struggle the most with issues of perfectionism are among the most talented missionaries and people. They are often ones who have been excellent students and have been model children and outstanding young people. Frequently, they have looked forward to being missionaries, are well prepared, and come with the expectation that they will do everything to be successful. For some, they become so obsessed or consumed with their every thought, action and response, that they may become far too extreme in their own perceptions of what is expected of them.”

When young people develop realistic expectations for themselves and learn that perfection is a lifetime process, they will be better able to enjoy their experience in the mission field."

In 1986 President Ezra Taft Benson gave a First Presidency message about depression. He said "To lift our spirits and send us on our way rejoicing, the devil’s designs of despair, discouragement, depression, and despondency can be defeated in a dozen ways, namely: repentance, prayer, service, work, health, reading, blessings, fasting, friends, music, endurance, and goals." Each point is discussed with ways of overcoming symptoms of depression.

In 2007 David S. Baxter Overcoming Feelings of Inadequacy wrote there are five things to overcoming inadequacy: You're Better Than You Think You Are, Serve Others, Ignore the Devil's Decision, Replenish Spiritual Reserves, and Draw Near to the Savior. "we can serve others. President Benson taught, “To press on in noble endeavors, even while surrounded by a cloud of depression, will eventually bring you out on top into the sunshine.”

There is something about service that brings about a marvelous change in how we think and feel about ourselves. As we stretch our souls in service, we begin to forget our own challenges, and we are blessed with good feelings—even joy.

President Spencer W. Kimball (1895–1985) taught this concept most powerfully: “The more we serve our fellowmen in appropriate ways, the more substance there is to our souls. We become more significant individuals. … Indeed, it is easier to ‘find’ ourselves because there is so much more of us to find!”

The experience of Ammon and his missionary brethren is illustrative. While engaged in their missionary labors, they experienced discouragement and despondency; yet they were determined to press on. Ammon records, “Now when our hearts were depressed, and we were about to turn back, behold, the Lord comforted us, and said: Go amongst thy brethren, the Lamanites, and bear with patience thine afflictions, and I will give unto you success” (Alma 26:27).

There follows an inspiring record of their devotion to the cause. They “traveled from house to house” and taught in streets, homes, temples, synagogues—everywhere they went. It was not easy service. It was arduous and beset with difficulties, and it required that they give their very best. Ammon speaks of severe persecution that must have caused them to stretch every sinew (see Alma 26:28–30).

Despite it all, and in sharp contrast to their original feelings of despondency, Ammon concludes his witness with this ringing declaration:

“Now have we not reason to rejoice? Yea, I say unto you, there never were men that had so great reason to rejoice as we, since the world began; yea, and my joy is carried away, even unto boasting in my God; for he has all power, all wisdom, and all understanding; he comprehendeth all things, and he is a merciful Being, even unto salvation, to those who will repent and believe on his name.

“Now if this is boasting, even so will I boast; for this is my life and my light, my joy and my salvation, and my redemption from everlasting wo” (Alma 26:35–36).

Ammon describes in the space of eight verses how they had progressed from despondency to joy. What made the difference? He and his brethren simply went to work. They devoted themselves to the great cause of preaching the gospel and testifying of the redemptive power of the Savior. As a result, they rose above their circumstances; in doing so, they found themselves. They knew the source of light and joy, and their joy was multiplied when they helped so many others to be saved “from everlasting wo.”

So it can be for us as we lose ourselves in the service of others."

Let us remember the advice of President Ezra Taft Benson in overcoming depression: "Let your minds be filled with the goal of being like the Lord, and you will crowd out depressing thoughts as you anxiously seek to know him and do his will. “Let this mind be in you,” said Paul. (Philip. 2:5.) “Look unto me in every thought,” said Jesus. (D&C 6:36.) And what will follow if we do? “Thou wilt keep him in perfect peace, whose mind is stayed on thee.” (Isa. 26:3.)

“Salvation,” said the Prophet Joseph Smith, “is nothing more nor less than to triumph over all our enemies and put them under our feet.” (Teachings, p. 297.) We can rise above the enemies of despair, depression, discouragement, and despondency by remembering that God provides righteous alternatives, some of which I have mentioned. As it states in the Bible, “There hath no temptation taken you but such as is common to man: but God is faithful, who will not suffer you to be tempted above that ye are able; but will with the temptation also make a way to escape, that ye may be able to bear it.” (1 Cor. 10:13.)

In 1985 President Hinckley gave ways to overcoming discouragement:

"I remember interviewing a discouraged missionary. He was having trouble with a language which was not his own. He had lost the spirit of his work and wanted to go home. He was one of 180 missionaries in that mission.

I told him that if he were to go home he would break faith with his 179 companions. Every one of them was his friend. Every one of them would pray for him, fast for him, and do almost anything else to help him. They would work with him. They would teach him. They would get on their knees with him. They would help him to learn the language and be successful because they loved him.

I am happy to report that he accepted my assurance that all of the other missionaries were his friends. They rallied around him, not to embarrass him, but to strengthen him. The terrible feeling of loneliness left him. He came to realize that he was part of a winning team. He became successful, a leader, and he has been a leader ever since. That's what each of us must do for one another.

Paul wrote to the Romans, "We then that are strong ought to bear the infirmities of the weak." And then he added these significant words, "And not to please ourselves" (Romans 15:1). There is a sad tendency in our world today for persons to cut one another down. Did you ever realize that it does not take very much in the way of brainpower to make remarks that may wound another? Try the opposite of that. Try handing out compliments."

Elder L. Tom Perry in his recent 2007 Conference Address "Raising the Bar" said: "You must recognize that missionary service is emotionally demanding. Your support system is going to be withdrawn from you as you leave home and go out into the world. Many of the ways you use now to cope with emotional stress—like hanging out with friends, going off by yourself, playing video games, or listening to music—are not allowed by the rules of missionary conduct. There will be days of rejection and disappointment. Learn now about your emotional limits, and learn how to control your emotions under the circumstances you will face as a missionary. By doing this, you raise the bar to greater heights and, in effect, fortify yourself against emotional challenges during your missionary service."

I wonder if there others who have overcame depression on a mission. How did you do it? Please share your experiences so others can have the courage to be healed.


J. Stapley said...

I am convinced that mild depression can be influenced by Satanic forces.

I think you need to be very, very careful here. My personal area of research is in the development of the Mormon liturgy and specifically Mormon healing. The early Saints frequently associated satanic forces with sickness and death.
With the modernization of medicine, this perspective was generally shed from the body of the Church. I don't want to say that the early Saints were mistaken, as they often witnessed great miracles; however, there is no question that our mortality rates now are much, much better. Consequently, when you attribute Satanic forces to mild depression, I wonder if you would be also willing to attribute Satanic forces to the flu or other sickness?

Dr. B said...

That is a good point. I have revised my blog accordingly.

Anonymous said...

I am offended with you saying mild to moderate depression can be overcome by living the gospel. Not true that is like saying Cancer can be overcome by living the gospel, depression is a mental illness just like any other illness and needs medical attention

Anonymous said...

I have suffered from anxiety for 5 years. I live the gospel, I pay my tithing and I have a temple recommend. My anxiety is not due to a satanic force nor is anyone else's. It is what it is...a chemical imbalance and with the correct, low dose meds, I am functioning normally.

Anonymous said...

I suffer from seasonal affective disorder, which severely inhibits my ability to function normally during the autumn/winter months. I received a call to a place with even less daylight than where I currently live.

What should I do?

Dr. B said...

Contact missionary department 800-453-3860 Monday through Friday explain ask advice.

Anonymous said...

When I went into the Missionary Training Center before my mission to Japan, I soon fell into a deep depression. I was able to struggle through and make it to Japan, but once there again felt depressed. Things would get better and worse, but as time went on, I settled in.

My mission president considered me a "problem elder," and was not sympathetic. He contacted my parents, and there was talk of sending me home. Luckily, I was allowed to stay, and finished my two years.

Since my mission, I continue to struggle with depression from time to time. It's just a part of me. Medication has not helped. Therapy has helped, though it has been far from a magic bullet to slay the depression.

I hope that people can respond to depressed missionaries with love rather than punishment. My mission was filled with competitiveness. Hours were carefully tracked, as were meetings, baptismal challenges, and other numbers. Depressed or otherwise challenged elders brought down the numbers, and heard about it. That did not help.

While I was not an ideal missionary, and not an ideal companion, I grew a lot on my mission. It was good for me, and I think good for the Church.

In my opinion, depression has little to do with whether one is living the gospel. So tolerance and love seem the best way for both the sufferer and those around him or her when a missionary suffers depression.

Anonymous said...

I have a son who has been in the mission field for almost 2 weeks and has had very negative opinion of himself that seems to be taking over everything he thinks, says, and does. I will seek help for him, as I can tell that his "mindset" is not allowing him a chance to get out of the "hole"," as he describes.

Dr. B said...

Contact missionary department 800-453-3860 Monday through Friday explain ask advice.

Sheila Hunter said...

We are ft prosylyting missionaries and love it! We notice in our weekly mtgs some elders who need a boost:) we have tried to help them by: feeding them:) sharing beautiful spiritual advice and thoughts with them, acknowledging their feelings, letting them know they are not alone, my husband is am MD and I'm a chemist so we tell all missionaries: carry an energy bar, water get good sleep etc blood sugar affects psychological state. Most of all: it is the Lord's work and time. I myself am an over achiever and want everyone to be baptized next week ;) but I realize patience and humility, and especially love are the keys to successful missionary work. Thank you for your site!:)