OREM — Zach Bullock never opened the dark gray suitcase when he returned home early from his LDS mission to Italy in 2008.
Instead, he stashed the medium-size piece of luggage, "Italia" tag still taped around the handle, at the foot of his boyhood bed in Springville. Then he got a job working Sundays so he could avoid church meetings, where he felt uncomfortable after serving seven months of a two-year mission call.
Bullock completed a degree in social work at Utah Valley University but became fixed on the idea that he needed to complete a master's degree to prove — whether to himself or to others, he wasn't always certain — that he could finish something important.
"I didn't feel normal," said Bullock, now a BYU grad student. "I feel like I failed."
A majority of missionaries who return home earlier than expected may experience feelings of failure, according to a limited UVU study released last month. Experts say the young missionaries for The Church of Jesus Christ of Latter-day Saints are like other men and women 18 to 23 years old who leave home for college, work or the military. Newfound independence comes with unaccustomed stress.
Prospective missionaries need to expect that and prepare for it, and the church recently released a new booklet to help them. Meanwhile, parents and congregations can play an enlightened role in helping early returning missionaries, whom experts say can do more to help themselves, too.
Like a lot of LDS boys, Bullock planned to serve a mission. What he hadn't planned for was his father's death, of stomach cancer, less than two years before he was to leave. His father's last wish was that his son serve a mission.
"I thought I had dealt with his death," Bullock said, "but it turned out I hadn't gotten over it."
Struggling with intensive transitions is normal for young men and women, said Jonathan Sandberg, a licensed marriage and family therapist who has worked regularly with missionaries who returned home early. While a professor at Syracuse University, Sandberg also worked with prospective missionaries and missionaries serving in the New York area. His experience is that missionaries must prepare for change.
"Let's say you are someone who can handle a stress level of seven, and you live your life at a stress level of six by going to your room and listening to your iPod or going to the gym or playing Xbox or whatever you do to handle stress," Sandberg said. "Then you add a new stress or rigor to your life. How many kids have worked a 13-hour day? They get above a level seven, and they don't know how to get back to a six."
"A mission is a stressful environment," said Wendy Ulrich, a psychologist with a unique perspective on missions. First, she returned home weeks early from her mission due to illness. Second, her husband, David Ulrich, was president of the Canada Montreal Mission from 2002 to 2005. For three years, she was much more than a "mission mom." Each "P-day," the preparation day missionaries have for doing laundry and writing letters, Ulrich worked with missionaries who were struggling.
"They work long hours with no breaks or vacations," she said, and have to learn new coping strategies. Most can and do, but sometimes the problem is exacerbated by mental illness.
"Anxiety and depression and obsessive-compulsive disorder are the three main reasons we are seeing people coming home," Sandberg said, "and it's the inability to handle new stressors."
Age can have something to do with that, Ulrich added.
"A lot of these show up at this age because of the combination of a predisposition and the stress of that period of life of emancipating and being on your own and becoming an adult in your own right," she said.
"The same goes," Sandberg said, "for joining the military, for going to college for the first time, for when you first get married."
Nearly three-quarters of those with an anxiety disorder will have their first episode before they turn 22, according to the National Institute of Mental Health. The median age of onset for OCD is 19. It's 20 for agoraphobia, a specific anxiety disorder.
The new UVU study is based on 348 men and women who filled out an Internet questionnaire about returning early from LDS missions. Of those, 36 percent said they came home because of mental health issues, the top reason.
Next on the list was physical problems, at 34 percent.
And 38 percent said stress was a contributing factor to their early return.
This isn't news to LDS Church leaders. Sandberg said the best statement he's seen on this subject was made by late church President Gordon B. Hinckley in a 2003 Worldwide Leadership Training broadcast.
"Good physical and mental health is vital," President Hinckley said. "There are parents who say, ‘If only we can get Johnny on a mission, then the Lord will bless him with health.’ It seems not to work out that way. Rather, whatever ailment or physical or mental shortcoming a missionary has when he comes into the field only becomes aggravated under the stress of the work."
In the same training, President Hinckley said "there must be health and strength, both physical and mental, for the work is demanding, the hours are long, and the stress can be heavy."
The church emphasized emotional and mental preparation alongside spiritual readiness before 2002, when church leaders first called for "raising the bar" on mission qualifications. Since then, they have developed new resources.
The missionary preparation student manual, published in 2005 and available in its entirety online at lds.org, includes a chapter on physical and emotional preparation. It also includes counsel that missions are not for everyone. In a 2003 general conference talk, Elder Richard G. Scott of the Quorum of the Twelve Apostles said young men and women who have suffered from depression, anxiety, or obsessive-compulsive behavior can be called on missions but may need to prepare by seeking professional treatment and medication.
LDS Family Services offers mission prescreening, said Sandberg, now a BYU professor.
"Their job is to help prepare people, so when this happens in the mission field they have been asked, 'What are you going to do?' They help them write down a plan: 'I'm going to talk to the mission president. I'm going to do these relaxation exercises.' Most just need a plan."
Others are redirected to different types of service.
Sandberg's advice echoed that of Elder Jeffrey R. Holland of the LDS Church's Quorum of Twelve Apostles, who announced his own past struggle with clinical depression during a general conference talk in October.
"These afflictions are some of the realities of mortal life, and there should be no more shame in acknowledging them then in acknowledging a battle with high blood pressure or the sudden appearance of a malignant tumor," Elder Holland said.
He provided a list of more than 20 suggestions for working with depression, including remaining faithful, seeking spiritual help, watching for stress indicators, making adjustments and seeking professional help when necessary.
More recently, the church has started to provide freshly called missionaries with videos to watch before they leave that include advice on emotional preparation.
Then several months ago, the church released a new booklet, "Adjusting to Missionary Life." It is provided to missionaries before they leave, and many report being asked to complete an online course while at a missionary training center. The resource includes a self-assessment that allows the missionary to determine where he or she fits on a color spectrum of stress — green, yellow, orange or red.
In a letter home that family posted on an open blog, the president of the church's India New Delhi Mission said he and his wife took the evaluation and found they both were in the yellow range. The manual said it is normal to spend some time in that range.
"So we are working to use some of the very techniques we teach the missionaries," President David Berrett wrote.
Missionaries are expected to use the booklet's self-assessment tool regularly. When they identify something they are having difficulty with, say, staying organized or feeling anxious or inadequate, the assessment points them to a section of the booklet with specific tools and suggestions.
Missionaries must develop new resources, like spiritual and interpersonal skills, Ulrich said.
"That's when we grow the most. Missions are great. We learn to rely on the Lord, on ourselves."
Bullock developed the idea for the UVU study with professor Kristine Doty, who had two children return home early from missions. When Bullock realized that 73 percent of those who filled out the questionnaire said they had experienced feelings of failure, too, he felt relief.
"Now I didn't feel alone," he said.
Ulrich wasn't surprised by the finding.
"Only about half of people who start college finish college," she said. "The vast majority of missionaries do complete the mission at a time of life when people often start projects and do not finish them, because of their commitment to the Lord and the church. That can compound the sense of failure for those who don't.
"But many of the reasons for coming home should not include a sense of failure. Most of the missionaries who come home early do so for physical or mental health reasons, because they can't tolerate them."
But the UVU study found that missionaries who came home for physical or mental health reasons had increased feelings of failure, though not if they felt well-received by their congregations. Many do not.
Elder Holland addressed that generally in his talk: "Broken minds can be healed just the way broken bones and broken hearts are healed. While God is at work making those repairs, the rest of us can help by being merciful, nonjudgmental and kind."
Asked about the UVU study, LDS Church spokesman Cody Craynor said: "It is our hope that all church members and visitors to our local congregations will be warmly received and feel the love and support of our faith communities. This extends to elders and sisters returning home and adjusting to life after their missions regardless of the duration of their service or personal circumstances."
Sandberg turned to a parable.
"On a basic doctrinal level, people need to be Christians," he said. "(The Good Samaritan) didn't look at the man in the road and say, 'You shouldn't have come down this road,' or, 'Of course it's someone like you.' We need to be less judgmental, more accepting and more warm."
So if, as Bullock said, "Missionaries who felt their ward members received them better upon returning home had decreased feelings of failure," and "were less likely to experience a period of activity," how can congregations help early returning missionaries feel comfortable?
Ulrich said church members often don't know what to say because they don't know the circumstances. Too many assume the missionary did something wrong, though the UVU study found that only 12 percent came home because of an unresolved transgression that if confessed would have kept them from mission service in the first place, and just 11 percent were sent home for disobedience to mission rules.
Many find it easier to avoid the situation. She suggested saying: "I'm so glad to see you. I'm sorry things didn't work out the way you expected."
"It's really, really helpful to kids that people will talk to them," she said. "When a member of the military who was wounded or ill comes home, we treat them with a hero's welcome. Sometimes a missionary comes home and we don't treat them as well, even though they served well for the time they served, sometimes at great personal cost."
Missionaries who return early can take responsibility for their reception, too. She suggested they stand up in Relief Society or elders quorum and say: "For whatever reason, the mission didn't work out the way I intended. I'm home now. I love the Lord and I'm looking forward to what I'm doing next."
"That allows people to move forward," she said.
Ulrich also said early returning missionaries should seek therapy and find a mentor, someone not a parent, to meet with weekly about their plans and goals.
"I was ill on my mission and came home several weeks early," Ulrich said. "If I have one regret for myself, it's that I let myself get bogged down with this too long, thinking that it somehow was my fault that I got sick. That's easy for people with a bit of a perfectionist streak."
UVU's Doty, the professor who led the study, said parents struggle with guilt, grief and loss when a missionary son or daughter returns early.
"I can tell you how true that is," she said. "I am the mother of early returning missionaries. I can tell you of emotions and the struggle we feel, and you wonder, 'What did I do, what did I not do?' It had nothing to do with anything that I said or did. It was just circumstances.
"If I could turn back the clock or say or do anything differently with my early returning missionaries, I would pretty much give up my retirement for that, because I pretty much said some things that were kinda stupid. I did some things that were kinda stupid, all in the effort to get them back out (on their mission again), not really listening to what they needed."
Ulrich said Doty's experience is normal.
"This can be as hard on parents," she said, "and they feel a sense of failure. They assume that once their child is on a mission, everything will go right in their lives. It's hard for parents as well to get the encouragement and support they need. They don't want their kids to feel their parents are disappointed in them."
Sandberg said parents of early returning missionaries should get help. Then they need to push forward.
Doty said parents should start by making sure their child gets a full needs assessment done by a professional, one who listens to the returned missionary's needs and desires.
"We have to get past our own issues with this, because it's not about us, it's about our sons and our daughters. We've got to get past this 'It's all about me' phase and move on to 'What do they need, what can we do to help them and how can we help make their adjustment more comfortable?'
"We can do a lot to model for our children learning from a situation and not getting stuck in self-recrimination," she said. "God gives us the grace and power we need to overcome challenges and get on with our lives."
Bullock slipped into the room near the end of a family party one Thursday in October after presenting the findings of the UVU study, but the dark gray suitcase wasn't at the foot of his boyhood bed.
Five years after leaving it there, he finally was ready to open it.
Still, he was embarrassed — a successful graduate student on track to complete his studies in April, a man with a wife and two young children — to ask his mother where the luggage was.
In storage, she said, in the basement.
He had trouble finding it on a waist-high shelf until, finally, he saw the tag: "Italia."
He pulled the suitcase down and set it in the middle of the basement floor. He unzipped it. He opened the lid. He stared inside for what seemed like minutes.
"It was kind of overwhelming," he said. "I was kind of speechless. In that moment I realized I can move on from this. It doesn't have to be a bad memory."
He started to remove his things and place them on the floor around him. His favorite scriptures he'd had his whole life. The glasses he hadn't been able to find for years. Four hundred photos. His passport. Suits. Ties. Shoes.
Exhausted by two children under age 2, his wife, Teresa, was ready to go home until she found her husband on the floor in the basement, saw how excited he was.
"I figured that needed to be taken care of first," she said.
"I opened the suitcase," he said, "and it became one of the best days of my life, getting my scriptures back and reading my journal about all the great experiences I'd tried to bury."