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HEALING THROUGH UNITY

February, 2003

A monthly newsletter dedicated to serving the principles of

physical and spiritual health envisioned in the Baha'i Teachings.

Volume 6, Issue #6

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Contents

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- Borderline Personality Disorder
- The Exchange
- Baha'i Writings on Mental Illness
- Resources for Borderline Personality Disorder
- Conferences
- Fasting
- Question of the Month
- Website
- Purpose of the Newsletter

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BORDERLINE PERSONALITY DISORDER

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By Michael H. Stone "The Fate of Borderline Patients", The Harvard Mental Health Letter, March 1992 (taken from the website: www.recovery-man.com/abusive/bpd.htm.

What is Borderline Personality Disorder (BPD)?

Borderline Personality Disorder is a form of mental illness that is often found in survivors of childhood sexual, physical and emotional abuse. Some abused parties develop BPD and some do not for reasons that are unclear. BPD seems to run in families, but it is not yet known if this is due to genetic or environmental factors. BPD is very common but frequently undiagnosed or misdiagnosed as Bipolar Disorder.

American Psychiatric Association Definition of BPD (Diagnostic and Statistical Manual of Mental Disorders, fourth edition, 1994. Washington, DC: American Psychiatric Association) (My notes are bracketed by parenthesis)

A pervasive pattern of instability of interpersonal relationships, self-image, and affect (mood swings), and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5). (Desperation/rage if they think they are being abandoned, intense feelings of sadness, loss and fear when their partner is away, a need to have access to the partner at all times, inability to allow their partner their own life and friends, a belief that healthy independence in their partner is a threat to them.)

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. (The partner of the person with BPD, friends, coworkers or the person with BPD themselves is seen as wonderful or perfect, or as evil and rotten. People and things are seen as rigidly black and white by people with BPD - there is no normal middle ground.) People with BPD are highly intolerant of / unable to deal with the gray areas in life. This is called "splitting."

3. Identity disturbance: markedly and persistently unstable self-image or sense of self. (Confusion about goals, career, life choices, sexuality or sexual orientation. Persistent questions and discomfort with their perceived role in life. Pervasive issues related to "who am I" and "what is my role in the world". Many people with BPD change careers frequently or enter careers that give them a clearly defined framework and sense of identity, like large corporations or the military. Others fall prey to cults or fundamentalist religions that control all aspects of their life. Fundamentalism can be comforting for people with BPD since the "black and white" nature of these religions give them a framework that fits their world view.)

4. Impulsivity in at least two areas that are potentially self-damaging e.g., uncontrolled spending,  reckless driving, substance abuse, dangerous sexual acts or unsafe sex, binge eating, thrill seeking or risk taking behaviors. 

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. This can be manifested as overt suicide attempts, drug or alcohol abuse, unsafe sexual behavior, or as a pattern of "living dangerously"; this also includes cutting, burning, piercing, and sexual self mutilation. 

6. Affective instability due to a marked reactivity of mood e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days. (People with BPD are intensely moody and volatile emotionally - mood swings and huge shifts occur seemingly "out of nowhere". This is why people with BPD are often misdiagnosed as having Bipolar disorder, and therefore improperly medicated.)

7. Chronic feelings of emptiness. (Generally manifested as sadness, loneliness, isolation, aimlessness, feeling empty without a project or relationship to distract them. People with BPD's low self esteem is often masked by public displays of ego, feelings of superiority or an intense need to control themselves, other people, places and events.) 

8. Inappropriate, intense anger or difficulty controlling anger e.g., frequent displays of temper, uncontrolled anger, violent rages, recurrent physical fights, threats, sexualized expression of anger through violent or abusive sex.

9. Transient, stress-related paranoid ideation or severe dissociative symptoms. (BPD may manifest as a belief that those who love them wish to hurt, control or destroy them. This is especially common in times of stress. Ongoing belief that they are being followed, threatened, observed or are always at risk. BPD's see the world as a dangerous and frightening place and remain constantly on guard, even in safe environments and with safe people.)

Though BPD affects nearly as many people as schizophrenia and bipolar COMBINED; it is greatly  misunderstood by lay people and therapists alike. Few mental health professionals receive enough preparation in school to be effective in treating patients with this disorder. Few clinicians are aware of non-BP issues. People who work in the legal system and other institutions desperately need to be better educated about BPD.

People with BPD often "mask" well - meaning that they present a "I have it all together" face to the world, at work and to their therapists. People with BPD are often very charming, funny and engaging when they are not suicidal or raging. They work hard at covering their tracks; generally only those who are very close to them are aware of the emotional roller coaster going on inside. People with BPD frequently project their issues onto others. ("I don't have a problem - YOU have a problem.") As a result, people with BPD often live lives of misery, remaining undiagnosed or misdiagnosed. (and therefore improperly treated.) Borderline personality disorder is very painful for both the person with BP and the people in their life.

Borderline Personality Disorder is treatable with conventional therapy, geared toward impulse control, anger management and behavior modification, and also responds well to proper medication. Sadly - the overwhelming internal chaos, fear and shame often result in people with BPD refusing treatment. Treatment for BPD is a long term process, but can lead to a much better quality of life for the person with BPD and their partners and families.

Statistics about BPD

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THE EXCHANGE

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The following responses are about dealing with Psychiatric Disabilities/Mental Illness. Because the topic of Borderline Personality Disorder is the focus for this issue, most responses below relate to this topic.

For the past 8 years, I have had the pleasure of working in the mental health field as a social worker, providing services to clients in the Jewish community. Most of my clients suffer from schizophrenia or bipolar disorder. What I have found most useful is allowing my clients to define their own goals and needs, giving them the tools to become self-sufficient, incorporating the use of peer support, and really listening to what they are saying. Many of my clients have a great interest in religion and spirituality. On many occasions, they present me with questions about the Faith that are so well thought out and detailed I often have to do research and get back to them. Many of them are familiar with the Faith before meeting with me. Needless to say, I am kept on my toes. 
- Cynthia Homayun, Ontario, Canada

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All my life, I have been crippled by depression but I always knew it was not the primary illness. That was because when I was not depressed I was still very unhappy with daily life.

When I received the diagnosis of borderline personality disability, I began to read extensively. The connection I made with the symptoms was almost joyful. I no longer was alone, others had these feelings and survived.

Through work with my psychotherapist, I began to integrate these parts which I had so long felt were "wrong" and "bad". I realized that these parts just were, with no judgment. It has been the most important part of my healing. I don't have to struggle with communicating, internally and externally, my thoughts and feelings any longer. I am finally achieving some peace in my life. 
- Anonymous

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In my experience with my girlfriend with BPD, I am aware of 8 of the 9 symptoms (all but #5) as outlined by the American Psychiatric Association Definition of BPD (see above). But I wasn't "really" aware until afterwards, because this "thing" starts to make itself apparent to the uninformed only gradually at first, and I'd never heard of it. It's hard to explain, but in my case I just thought she was "quirky", or to use a male chauvinist description; "high-maintenance." After all, in any kind of seemingly desirable interpersonal relationship, one's natural inclination is to hope for it to be successful. So, when you notice things, little things, you overlook them and pass them off because you're still getting to know this person and don't want to be hasty in your judgment... A BPD (of the "high-functioning" type at  least) can be almost unbelievably charming at times, which makes you seriously doubt any negative signals you think you've been picking up. My BPD girlfriend was the most wonderful person to be with when things were going "well". I couldn't believe how good I felt when I was with her - especially since this was just two years after the death of my wife and I was still grieving hard when we met. But the thing I learned, was that the "good" times were an illusion. This person suffered from the disorder at all times, not just when there was some inexplicable blow-up -- the blow-ups, it was obvious later, were brewing constantly during the good times. This well-developed capability to ingratiate themselves with others I found to be reported by many, and ties in with the "intense" nature of the usually short-lived relationships they form. 

In my opinion, if a spouse suffers from BPD, in one sense "fulfilling" the promise of the "fortress for well-being" is almost as unlikely as a double amputee re - growing his limbs. Generally a BPD lacks the basic capability to feel responsible for his/her actions - they've simply never developed that far emotionally, although they usually are haunted by a chronic sense of unworthiness because of it - despite this they "project" all negativity onto those closest to them ("others" are the source of all their problems), because grappling with the emotional turmoil (for them) of a truly intimate/spiritual relationship is just too much - again due to their lack of "normal" emotional maturation. The process of "projecting" can take on some truly mind-bending forms, leaving the non-BPD partner questioning their own culpability in the whole mess. 

In my relationship with my girlfriend, more than once I was accused of either using violence, or making this person fearful for her safety because I "was in a bad mood", when all that had happened is that I had not concurred with something she had said. That's all it takes sometimes for a BPD to start "acting out" Also, it was very typical for her to not remember things. I was told on one occasion by my girlfriend that terrible things had happened to her when she was little - -later on she denied any knowledge of such events or of having said anything to me about it.

I was so traumatized by my whole experience with this that I kept searching for an explanation and finally stumbled across the clinical description of BPD online at a mental heath site. It intrigued me though the language used was not really clear to a layman. Upon further investigation - following links to simpler explanations of what the clinical language meant, it sounded like I was reading transcripts of my time spent with my girlfriend. It was like a light being turned on in a dark cellar.

BDP people suffer terribly (as do those close to them), and what's really sad is that what they suffer from is part of their normal state of being, the basic structure of their personality. Some people say that love is the answer, but, as Baha'u'llah says in Hidden Words, Arabic #5: "Love me that I may love thee. If thou lovest me not, My love can in no wise reach thee." The thing to remember, as one "recovered" BPD has written, is that when a BPD says "I love you", he/she doesn't mean the same thing that the rest of us mean. They tend to find after a while what I'll call the generally accepted concept of "love", an attempt to manipulate them...they start to feel "suffocated" by an intimate relationship, and that's when they push the "loved one" away. You get the very real sense of having been pushed out and walled off from them - when all you've done is to show the tenderness, consideration, your own love. Knowing how to deal with - or reciprocate - that love is a either a skill a BPD doesn't have or has to a severely limited degree, and so it becomes difficult or almost impossible for our love to reach them. I really believe that in this life there is little that can be done.

I think that it is for future Baha'i healthcare professionals, investigating and acting in the light of the Divine Teachings to find a way to adequately deal with this, because just good intentions and saying lots of prayers isn't going to be enough for those that already are suffering. And whatever the causes of it are, they will largely be eliminated as the Teachings become more widely integrated into the lives of the generality of humankind. "The well-being of mankind, its peace and security, are unattainable unless and until its unity is firmly established." (Gleanings from the Writings of Baha'u'llah, p. 286)
- Anonymous

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BAHA'I WRITINGS ON MENTAL ILLNESS

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It is not easy to be burdened with long years of mental illness such as you describe. And plainly you have sought aid from many persons of scientific and non-scientific training backgrounds, apparently to little avail over the years of your prolonged illness. Possibly you should consider, if it is feasible, consulting the best specialists in a medical centre in one of the major cities, where the most advanced diagnosis and treatment can be obtained. The science of the mind, of normality and of the disabilities from which it may suffer, is in its relative infancy, but much may be possible to aid you to minimize your suffering and make possible an active life. The last ten years in the therapy of mental disorders has seen important advances from which you may well benefit. 

Your discovery of the Faith, of its healing Writings and its great purposes for the individual and for all mankind, have indeed brought to you a powerful force toward a healthy life which will sustain you on a higher level, whatever your ailment may be. The best results for the healing process are to combine the spiritual with the physical, for it should be possible for you to overcome your illness through the combined and sustained power of prayer and of determined effort. (From a letter written on behalf of the Universal House of Justice to an individual believer, July 23, 1984, Lights of Guidance, pp. 283-284)

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"In the Baha'i Teachings it is made quite clear that when one is ill, one should seek the best available medical advice. This naturally leaves a person free to choose what they consider good in medical opinion. If you and ...'s mother feel that she is improving under the care of your own doctor, and...is willing to wait and be patient and see if she goes on making progress, there can surely be no objection to her doing this. There are a great many as you know mental diseases and troubles at present, and the one thing Baha'is must not do is take defeatist attitude toward them. The power in the Faith is such that it can sustain us on a much higher level in spite of whatever our ailments might be, than other people are who denied it. This however does not mean that we should ignore medical opinion and treatment. On the contrary, we should do our best to procure the opinion of specialists and competent doctors. (From a letter written on behalf of Shoghi Effendi to an individual believer, January 12, 1967. Lights of Guidance, p. 284)

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RESOURCES ON BORDERLINE PERSONALITY DISORDER

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WEBSITES

http://www.mhnet.org/poc/center_index.php?id=8

http://www.mhnet.org/poc/view_doc.php?type=doc&id=517&cn=8

http://www.recovery-man.com/abusive/bpd.htm

http://www.mhsanctuary.com/borderline/anon.htm

http://www.bpdresources.com/

http://www.soulselfhelp.on.ca/bspeak.html

BOOKS

"Stop Walking on Eggshells, Taking your life back when someone you care about has Borderline  Personality Disorder", by Randi Kreger and Paul T. Mason

"I Hate You - Don't Leave Me" by Jerold J. Kreisman, MD & Hal Straus

The books are available at places like Amazon.com if you can't find them in a local bookstore.

"Some Guidance for Spiritual Assemblies Related to Mental Illness and Its Treatment" by Mary K. Radpour, Images International Publisher, 5010 Austin Road, Chattanooga, TN 37343 U.S.A., www.images-international.com , images@chattanooga.net

ASSOCIATION OF BAHA'I MENTAL HEALTH PROFESSIONALS

In August 2000, the National Spiritual Assembly of the United States approved the incorporation of the newly formed Association of Baha'i Mental Health Professionals. Membership in the Association is not limited to psychotherapists but all those who have an interest in mental health and its treatment. It welcomes educators, psychologists, nurses, physicians, counsellors, administrators of programs for the developmentally disabled and chronically mentally ill, substance abuse counsellors, vocational counsellors, volunteers in service to the mentally ill, and anyone who has an interest in a fuller understanding of the application of the Baha'i teachings to matters of mental health. Visit the website of Association of Baha'i Mental Health Professionals - www.bamhp.org.

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CONFERENCES

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BAHA'I MEDICAL ASSOCIATION CONFERENCE

The Baha'i Medical Association of Canada will be holding its annual conference on April 11, 12 and 13, 2003 at the Toronto Baha'i Centre. The theme is "Moral Education and Health" and will feature the work of Dr. Farzin Davachi, Dr. Brian O'Toole in HIV/AIDS prevention, and Counsellor Dr. David Smith. Dr. Gopi Menon will speak on the proposed health project near the Baha'i temple in Uganda.

Roundtable discussions, poster presentations, and a gala dinner make the Baha'i Medical Association Conference 2003 a unique opportunity for Baha'i physicians and health care professionals to get to know each other, network, share goals, and develop plans of action. 

Registration forms can be completed online at www.bahaimedicalassociation.ca .

Email conference@bahaimedicalassociation.ca for more information. The conference is open to individuals of all backgrounds.

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HEALTH CONFERENCE AT DESERT ROSE BAHA'I INSTITUTE

Our theme this year is "Choosing Happiness, Our Health Depends On It." Psychologist, teacher, counselor and author are among the adjectives that describe our keynote speaker Dr. Homayoun Mahmoudi. He will be our opening speaker on Friday at 3:15 P.M. so be sure to come early!

Presenters include Katherine Christensen, Mary-Lela Gilbert, Louise E. Ingraham, Barbara Nakai, Dr. Joel Orona, Dr. Hannah Rishel, and Dr. Robert Waters who will present diverse subjects such as: "How our emotions affect our health", "Nutrition and addiction", "Enhancing our life through the joy of music", "Unbusying - Finding Balance When the World's Equilibrium Hath Been Upset", "Community Prosperity through Spiritual Health" and much more. We will offer an opportunity for Pilates exercise to tone our bodies. A special treat will include performing artists Steve and Makhosuzanna Fletcher, delighting us with music, dance, and stories. Mrs. Marguerite Sears will share with us her insights on happiness.

The conference will be starting on Feb. 7th at 2:00 P.M. for registration and ending on Sunday, Feb. 9th following consultation at 3:00 P.M. The registration fee for all three days which includes 6 meals is $70 for adults and $54 for children 4-14. For more information or to register for BCHH 2003, please email drbi@cgmailbox.com. Desert Rose Baha'i Institute, Inc., 5688 Tweedy Road, Eloy, AZ 85231-9611 (520) 466-7961

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FASTING

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During the Baha'i month of Loftiness which begins March 2nd, Baha'is 15 years of age and older fast from sunrise to sunset for nineteen days. Exempted from the Fast are children under 15, those who are ill, over 70, traveling, pregnant or nursing women, women in their courses or those doing heavy labour. The Fast ends at sunset March 20, Naw-Ruz (Baha'i New Year).

"These are the days of the Fast. Blessed is the one who through the heat generated by the Fast increaseth his love, and who, with joy and radiance, ariseth to perform worthy deeds. Verily, He guideth whomsoever He willeth to the straight path." (Baha'u'llah, The Importance of Obligatory Prayer and Fasting, by the Research Department of the Universal House of Justice, p. 7)

"Verily, I say, fasting is the supreme remedy and the most great healing for the disease of self and passion." (Baha'u'llah, ibid, p. 8)

"Well is it with you, as you have followed the Law of God and arisen to observe the Fast during these blessed days, for this physical fast is a symbol of the spiritual fast. This Fast leadeth to the cleansing of the soul from all selfish desires, the acquisition of spiritual attributes, attraction to the breezes of the All-Merciful, and enkindlement with the fire of divine love." ('Abdu'l-Baha, ibid, p. 22)

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QUESTION OF THE MONTH

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The focus for the upcoming issues will be on how to improve accessibility in the Baha'i and surrounding communities for persons with disabilities, illnesses and diseases of various kinds. This may include removing physical barriers, changing our attitudes and providing relevant support or available technology to ensure that everyone is a part of community life. Working together to provide basic information and accommodations as well as typical solutions will hopefully enable those struggling with a disability or illness to be involved in the community. After all, we all have disabilities/struggles of various forms. This information may also apply to the workplace. We will continue this consultative process.

Some of the disabilities/illnesses we will consult about are (if there are others missing, please let us know):

  1. Hearing Impairment
  2. Visual Impairment
  3. Mobility/Physical disability
  4. Learning Disabilities /Attention Deficit Disorder
  5. Developmental Disabilities
  6. Brain Injuries
  7. Physical Illnesses such as cancer, arthritis, heart condition, back impairment, Alzheimer's, etc.
  8. Psychiatric Disabilities/Mental Illness
  9. Emotional

For the February issue, we will focus on dealing with our emotions. How does being aware of our emotions affect our health and well-being? What are some practical ways to recognize our feelings/emotions?

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WEB SITE

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You can visit the website, obtain back issues and the Healing Through Unity

Course at: http://www.healingthroughunity.org.

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PURPOSE OF THE NEWSLETTER

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"Healing Through Unity" is published for the purpose of sharing thoughts, comments and experiences on how the teachings of the Baha'i Faith are being applied to physical and spiritual health. Other than the quoted Holy Writings, the material in this newsletter represents the thoughts and opinions of the writers and has no authority. You are free to copy articles, provided you indicate the source of the article. There are 10 issues per year; it is not published during July and August. The newsletter is produced in Ontario, Canada. 

Please send your stories, comments, suggestions or "Question for the Month" ideas to Frances Mezei by e-mail: fmezei@sentex.net.

PLEASE NOTE:

Many thanks to all of you who send such wonderful contributions for "Healing Through Unity" Newsletter. The decision to select and edit material submitted for publication is determined by the editor.

If you have a change of e-mail address, please inform me with your old and new email addresses. To cancel the subscription, please send message to: fmezei@sentex.net

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