Oliver had never left the United States when the Mormon church sent him on a mission in Chile in 2002. Eager to serve, the 19-year-old dove into missionary work. But after a few weeks, he began to experience crippling stomach pain. At first, Oliver was embarrassed by his ailment and tried to conceal it. After he lost 30 pounds, he approached the mission president’s wife—who was responsible for granting access to medical care—for help. She instructed him to sprinkle fiber powder on his breakfast and refused to let him seek medical treatment. Over the next few months, he lost 20 more pounds and finally demanded that he speak to a doctor. The doctor prescribed deworming pills. Soon after he took them, Oliver excreted a several-inches-long parasite. His stomach and intestines were irreparably damaged.
There are currently 80,000 Mormon men and women serving on 418 different missions around the world. Most of them will remain healthy throughout their terms, which last two years for men and 18 months for women. Those who get sick or injured, however, may face serious obstacles in obtaining quality health care. The church declined to describe its approach to providing health care to its missionaries and declined to comment at all on this article. But two dozen former missionaries and other sources with knowledge of missionary life, including active church members, recount the same disturbing story: Missionary culture counsels strongly against seeking medical help. Injuries are downplayed. Authority figures block access to care. Psychological disorders are stigmatized.
Young Mormons are endangered by illness or injury every year. And while some may receive adequate medical attention, many do not. The former missionaries I spoke with recounted troubling incidents from each of the past four decades, during missions on multiple continents—most frequently in Central and South America, where about 35 percent of all missions are located. When missionaries who have been denied or discouraged from getting care come home, some leave the church—and some remain often feeling pressure to keep quiet about their experiences. All but one individual mentioned in this article agreed to be interviewed on the condition of anonymity and are referred to by pseudonyms at their request. Those who’ve left Mormonism fear repercussions against their families. Those who are still in the church fear their families may disown them.
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While many people think of missions as the church’s efforts to proselytize and convert non-Mormons, some former missionaries see a different purpose: to solidify Mormons’ commitment to the Church of Jesus Christ of Latter-day Saints at a time when they are at the greatest risk of questioning their faith. All Mormon men are encouraged to embark on their missions at age 18, at the brink of adulthood. Over the next two years, they are required to study Scripture for several hours a day, attend frequent church services—and, of course, proselytize. They are profoundly isolated, barred from calling home except on Christmas and Mother’s Day. They are given no vacation. They are only allowed to email through the church’s own email service, which is widely suspected of being monitored. Their Internet use is restricted, as is their ability to listen to non-Christian music. They are forbidden from engaging in any kind of sexual activity, including masturbation, which is said to be an “introduction to the more serious sins of exhibitionism and the gross sin of homosexuality.”
Missionaries can get lonely. They are frequently placed in far-flung, rural regions of developing countries. Many missionaries have never left the United States when they leave on their missions. Each missionary is paired with a “companion,” with whom he must remain at all times except when using the bathroom. The older of the two serves as the leader of the pair. There is little recourse for a missionary who does not get along with his companion. Women, who comprise about a quarter of all missionaries, follow a similar routine—but they are barred from baptizing converts, a privilege reserved for men. Male missionaries are inducted into the priesthood and become “elders”; female missionaries cannot become priests and remain “sisters.”
You might expect young adults to be terrified to travel to a developing country on their own and spend each day talking to strangers. But few admit to being nervous. That’s because, from childhood, Mormons are taught that missionaries receive special protection through “the spirit,” or the Holy Ghost. According to one former missionary, you can walk into any Mormon church in the country and hear of how a missionary overcame certain death with the help of the spirit. One tale recounts the story of a missionary who was run over by a bus. The wheels of the bus ran over this missionary’s head, the story goes—but he emerged unharmed, protected by the spirit.
Missionaries who do get sick may be reluctant to report any serious problem to an authority figure, in part because they fear getting sent home early, according to most Mormons I spoke to. Every former missionary I spoke with told me that those who leave a mission prematurely are ostracized and stigmatized. They struggle to find a spouse willing to marry them or friends willing to be seen with them. Friends and family presume you weren’t righteous enough to serve—or you just couldn’t hack it. Even missionaries who return home due to serious medical conditions such as cancer are suspect. As one former missionary told me, “You’ll do almost anything to avoid being sent home early.”
Another former missionary, Mike, informed me that he and his friends were hesitant to report injuries because they were terrified the mission president would label them “complainers” or “problem missionaries.” Problem missionaries get less respect and hostile treatment higher up the hierarchy. Halfway through Mike’s mission in West Germany in the late 1980s, his right leg swelled up to the point that he could not lower his pant leg. He refused to see a doctor because he didn’t want his mission president to reprove him. So he continued working 12-hour days proselytizing door to door, suffering through extreme pain for 10 days until the swelling diminished on its own. (He never uncovered the cause of the swelling. Because there are few medical records available for treatments that did not occur, and because Church spokesmen refused to comment on this story, I’ve relied on first-person testimony in recounting many of the incidents here)
I found Mike, along with many of the former missionaries I interviewed for this story, through Sick RMs, a website that gathers the stories of ill and injured missionaries. (RMs are returned missionaries.) “I am now 48 years old,” Mike told me, “and I still have recurring nightmares about being ‘called’ back on a new mission. These nightmares are draining, feverish events that leave me cold, yet sweaty, at the same time. My mission is my deepest regret.”
Clark, a missionary who went to serve in rural Guatemala in the late ’80s, contracted an illness that led his testicles to swell. He wanted to find a doctor, but he was far from any medical facilities. Assistants to the president informed him that the president would be “furious” if he left his area, so he stayed put, contending with crippling testicular pain for a week.
Some missionaries do wish to seek treatment for their ailments. But the hierarchical, bureaucratic structure of missions makes it difficult for them to receive proper care when they need it. Every missionary reports to a district leader, who oversees a handful of companionships. The leader reports to two zone leaders, who oversee about two dozen missionaries. Zone leaders report to two assistants to the mission president, who, naturally, report to the president. A missionary typically speaks directly to the mission president once every few weeks and sends him a weekly email with a status update. This top-down chain of command forces missionaries to go through several authority figures before they speak to anybody who actually has power to help them. Navigating this hierarchy isn’t easy: It opens up missionaries to scorn and reproach and requires them to disclose potentially embarrassing ailments to near-strangers. The process, several sources who dealt with it firsthand informed me, is time-consuming and confusing, rife with delays and detours.
In theory, an area medical authority oversees every “area,” a large geographic space that includes numerous missions. The AMA often consists of a retired doctor and his wife and may be responsible for the health of several thousand missionaries at any given time. The AMA often gives his diagnosis over the phone rather than performing a medical exam. Missionaries are generally denied direct access to the AMA; instead, they must ask the mission president’s wife for permission to speak to him.
All mission presidents must be married, and their wives are typically in charge of missionaries’ health issues. The wives are not required to have any medical training. Yet, in part because they are expected to fill the role of surrogate mother, they are given the power to decide whether a missionary is allowed to see a doctor.
The former missionaries I spoke with provided a variety of explanations for why mission presidents’ wives are resistant to allowing missionaries to see a doctor. Some may assume that missionaries who claim to be sick are just looking for an excuse to shirk their duties. Others may be doubtful that any illness short of a medical catastrophe is serious enough to merit medical attention. Mormonism, as a religion, is not opposed to modern medicine. But mission culture can discourage treatment for anything but the most catastrophic conditions.
Clark, the missionary serving in Guatemala, first discovered just how deep this skepticism toward medical care ran when he came down with a torturous digestive condition. Suffering from constant diarrhea early on in his mission, Clark lost 75 pounds in six months. He then began to experience nighttime asthma so severe that he thought he would suffocate. Although he asked various leaders to help him contact the mission president and his wife for permission to seek care, his pleas went unanswered. Fearing for his life, he took a seven-hour bus to the mission headquarters. The president and his wife were out, and the assistants to the president were horrified: Clark had broken the rules by leaving his mission without permission, and by helping him, they could get in trouble.
Clark demanded that the assistants take him to the hospital, where he learned he had contracted an amoeba that was eating away his intestinal lining as well as roundworms. His stomach and intestines were severely damaged, and he suffers from near-constant gastrointestinal pain today.
Cost doesn’t seem to be a barrier to care. Missionaries foot the bill for many of their own expenses, including medical bills, as well as contributing $400 to the mission each month. Most missionaries remain on their parents’ health insurance for the duration of their missions, and American health insurance companies usually cover emergencies abroad. (The church does not provide its own health care plan.) Moreover, many missionaries live in developing countries where health care is inexpensive. The skepticism emerges from something deeper, as every former missionary I spoke with described it: an ingrained belief that missionaries—who are supposed to be protected by God—could not possibly need the assistance of earthly medical care.
This belief is especially dangerous in the realm of mental health. The Mormon church does not oppose psychiatry or question the effectiveness of therapy—except when it comes to missionaries. When missionaries experience depression, anxiety, and other psychological disorders, they are sometimes told they are “devoid of the spirit.” The solution for these problems is not therapy but to “forget yourself and go to work.”
Jason, a missionary serving in Brazil, discovered the drawbacks of this strategy at the midpoint of his mission, when the mission president called him in. After making small talk for a few minutes, the president informed Jason that his parents were getting a divorce. He refused to let Jason call his parents, telling him to wait for a letter his mother had sent. (When Jason served in the late ’90s, missionaries were permitted to collect mail only once a month.) God, the president told Jason, will strengthen you if you continue to work hard and follow the mission rules.
Devastated and confused, Jason fell into a cycle of depression and anxiety. Elders counseled him to seek the comforting spirit of the Holy Ghost—to feel the “burning in the bosom” that signals divine peace and calm. It didn’t work. When Jason tried and failed to find the spirit, he felt he wasn’t worthy enough, and God was displeased with his work and attitude. He grew more depressed. Elders counseled him to stop thinking about home. He tried, but he kept wondering about where his younger brothers would live and how his mother would survive with little education or work experience. He convinced himself that Satan had a hold on him and God had abandoned him for his disobedience.
One night, Jason decided he had no reason to live and decided to throw himself off a bridge. At the last second, he balked. But a few weeks later, he had a panic attack in the street and went to the hospital. Doctors took X-rays but found no outward problems. The mission president and his wife told Jason to trust the Lord and work harder. Jason began experiencing constant suicidal thoughts. His work suffered, and zone leaders rebuked him. His fellow missionaries told him that his lack of success proved he wasn’t righteous enough.
At no point did anyone advise Jason to see a therapist or seek psychiatric care. He survived his mission, but he still feels a lingering sense of shame and unworthiness.
Some missionaries are pushed to the mental breaking point by the constant work and strain of the mission itself. Luke, who served in Poland in 2008, was an eager, devout Mormon at the start of his mission. But after a few weeks, the stringent rules of mission life began to wear him down. Luke was required to wake up every day at 6:30 a.m., study the Book of Mormon for two hours, study Polish for another hour, then proselytize for eight hours. For relaxation, he was given half a day off, one day a week. He was punished for the slightest deviation from his schedule. When his work suffered, he was told that his lack of converts signaled a lack of faith. He got trapped in a cycle of remorse: Every time he broke a rule, he was told his actions were the devil’s doing; when he then felt guilty, he was told he was experiencing the pain of God’s disapproval.
The intense pressure of Luke’s guilt pushed him into a depression. He found it difficult to eat. Every time he tried, he threw up. He believed a doctor could not fix the problem—he simply needed to have more faith. But when he returned home to Utah after the mission, he discovered that he had lost his faith completely. The fear of admitting this to his devout mother drove him to vomit more and more, until he started throwing up blood. When he went to the hospital, the doctors discovered seven ulcers in his stomach and small intestine, which had caused internal bleeding. They informed him that his illness was stress-induced by anxiety and depression. After he left the church, his symptoms vanished.
One fairly common mental health issue among missionaries is anxiety over sexual orientation. The church has a fraught relationship with homosexuality, criticizing same-sex relationships as immoral violations of God’s will. And though it has grown more accepting of gay members in recent years, missions are hardly nurturing environment for sexual minorities. At the start of his mission in Singapore in 2011, Casey realized he was gay. Because of the homophobia he witnessed on his mission, he decided to stay in the closet. Concealing his identity sent him into depression. He wrote his mission president repeatedly, describing how miserable he felt at all times, but was never referred to a therapist.
Halfway through Casey’s mission, he was paired with an attractive new companion named Austin. They got along well until, one day, Austin stopped speaking to Casey. A few weeks later, Austin was transferred—and soon afterward, the mission president asked Casey if he “struggled with same-sex attraction.” Casey confessed that he did. The mission president told him his desires weren’t a sin if he didn’t act on them and encouraged him to try to overcome his gay impulses.
Casey later found out from a fellow missionary that Austin had read Casey’s diary and informed his friends, and the president, that Casey was gay. Shortly thereafter, the mission president sent Casey home early, alleging that he had broken the rules by sleeping in and skipping Scripture study. Casey believes he was sent home because of his sexuality. The series of events sent him into an even more crippling depression. He is currently living in his faithful Mormon parents’ basement, attending Brigham Young University. Although he feels the church does not accept him, he fears he cannot leave it. And if he renounces Mormonism, he fears he could be expelled from BYU.
For missionaries struggling with psychological or physical ailments, there is one spiritual comfort. If you do die on a mission, your death is glorified, because it means God chose you to serve as a missionary in the spirit world. Only the finest missionaries are chosen for this honor, since those in the spirit world are most in need of conversion. One former missionary told me that the funeral of a friend who died on a mission was a bittersweet affair. His parents were sad to lose their son but happy to know that God found him worthy of preaching in the afterlife.
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Several Mormons injured on their missions are currently working with attorneys to bring negligence suits against the elders who denied them access to medical treatment. These lawsuits are in their early stages, and none of the parties involved are speaking to the press. Those with knowledge of the lawsuits, however, believe the church is aware of their existence. And though deliberations of church policy are conducted in private, several sources told me that church leadership may soon create new rules to give missionaries easier access to medical care.
Most Mormons understand that medical care in developing countries will be lacking in comparison with Western treatment. But not many seem to view lack of proper health care as an ingrained or systemic problem in the church. Zach Power, a Sunday school president in Orem, Utah, who served in Australia from 2007 to 2009, told me that he had heard “horror stories” about medical problems—but faced no crises himself. Several of his fellow missionaries struggled with depression and were eventually sent home, but he believes they received adequate care and compassionate treatment. “Most of my concern would be for people who go to South America and contract some sort of disease that stays with them for the rest of their lives,” Power told me. “But these are the risks you take when doing any sort of humanitarian work.”
Power has a point: The majority of serious medical issues I learned about occurred on missions in developing countries, especially mission-heavy Central and South America. I spoke with several Mormons who served, or whose family members served, in the United States; they reported no problems.
The ex-Mormon missionaries I spoke to agreed that, among American Mormons, there is no widespread knowledge that at least some missionaries lack access to good care. Most of my sources were also skeptical that a few lawsuits would make a difference. Only an avalanche of legal action, they said, would force the church to make a change. That’s an unlikely scenario: Among devout Mormons, suing the church is seen as suing God, and any missionary who dared to bring a case runs the risk of losing the support of his friends and family.
Some missionaries are more optimistic that change could come from inside the church. Drew Botcherby created Sick RMs, the website for ill and injured missionaries, in part to bring greater attention to the problem. Botcherby describes the site as “an open community discussion about missionary health issues,” and its testimonies are notably uncritical of the church; participants describe their struggles and constructively offer potential solutions. While serving on a mission in Brazil in 2011, Botcherby himself contracted dengue fever. After losing 16 pounds and much of his hair, he asked to go to the hospital—and was denied permission. Two weeks later, Botcherby had lost 15 more pounds and could hardly move. He made his companion take him to the hospital, where he received emergency treatment.
When the mission president discovered what happened, he screamed at Botcherby and informed him that if he went to the hospital again, he’d be sent home. At that point, Botcherby was still so ill that he could hardly talk or move. He considers himself lucky. He says several of his fellow missionaries with equally serious conditions were denied access to treatment for months.
Botcherby doesn’t betray any bitterness about his experience—and while he quit the church as soon as he received his BYU diploma, many contributors to Sick RMs remain tithing churchgoers. He explained to me that it’s difficult to get former missionaries to share their struggles unless they can be presented in a positive light. Sick RMs isn’t pitched as an attack on the church but rather an effort to help reform it. If the website did criticize the church, it would probably be ignored within the community. Devout Mormons, Botcherby told me, generally assume that any report of a church misstep must be untrue.
It’s easy to take all these horror stories as evidence that the church will never change its ways. But from my conversations with nearly two dozen former missionaries, I’m cautiously optimistic that—if enough former missionaries speak out about their experiences—the church could be approaching a turning point. Mormons have no theological objection to medical care, including psychological treatment. The roadblock to proper health care for missionaries isn’t primarily about money, education, or belief. It’s about culture. A missionary culture that demands the subordination of personal health to the success of the mission will always put Mormons needlessly at risk.
Changing that culture will require more than just easier access to doctors—though certainly every missionary should be able to get direct, immediate access to a physician. To address the root of the problem, the church will have to grapple with serious questions about how much sacrifice it demands of its missionaries and how willing it is to see them as individuals rather than instruments of the religion. That won’t be an easy process. But it’ll be necessary if the church wants future generations of Mormons to complete their missions with enthusiasm for their religion—and not deep resentment over how profoundly it wounded them.