Mental Illness

I beseech God to obtain prosperity unto thee in this world, to confer favour upon thee in His Supreme Kingdom, and to heal thee from the illness which has befallen thee for some hidden reason which no one knows save God.

Madness, incurable otherwise, can be cured through prayer.

Spiritual feelings have a surprising effect on healing nervous ailments.

The worst enemies of the Cause are in the Cause and mention the name of God. We need not fear the enemies on the outside for such can be easily dealt with. But the enemies who call themselves friends and who persistently violate every fundamental law of love and unity, are difficult to be dealt with in this day, for the mercy of God is still great. But ere long this merciful door will be closed and such enemies will be attacked with a madness.

With the love of God all sciences are accepted and beloved, but without it, are fruitless; nay, rather the cause of insanity.

As regards the question about a person who is mentally ill attending the Feasts, anybody who is well enough mentally to attend a Bahá’í Feast and understand what it is all about is certainly well enough to be a voting member. Only people who are very seriously deranged mentally and confined to institutions or under constant supervision should be deprived of their voting rights.

But in this world such illness is truly a heavy burden to bear!

In the Bahá’í 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 Bahá’ís must not do is take a 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 who are denied it.

It is a great pity that as yet so little is really known of the mind, its workings and the illnesses that afflict it; no doubt, as the world becomes more spiritually minded and scientists understand the true nature of man, more humane and permanent cures for mental diseases will be found.

It is the responsibility of Bahá’í Assemblies to decide when individual interests should be subordinated to those affecting the collective welfare of the community. But, as already stated, the interest of the individual should always be safeguarded within certain limits, and provided they do not seriously affect the welfare of the group as a whole.

It is very hard to be subject to any illness, particularly a mental one. However, we must always remember these illnesses have nothing to do with our spirit or our inner relation to God.

Let us hope in the meantime scientists will find better and permanent cures for the mentally afflicted.

Regarding persons whose condition has not been defined by the civil authorities after medical diagnosis, the Assembly on the spot must investigate every case that arises and, after consultation with experts, deliver its verdict. Such a verdict, however, should, in important cases, be preceded by consultation with the NSA. No doubt, the power of prayer is very great, yet consultation with experts is enjoined by Bahá’u’lláh. Should these experts believe that an abnormal case exists, the withholding of voting rights is justified.

Regarding the interpretation of mental unfitness, this is not the same as being physically incapacitated. By the latter is meant a condition much more serious than any temperamental deficiency or disinclination to conform to the principle of majority rule. Only in rare cases when a person is actually unbalanced, and is admittedly proved to be so, should the right of membership be denied him. The greatest care and restraint should be exercised in this matter.

That there should be, however, certain individuals, who, by reason of some serious deficiency, physical or mental, would be incapacitated to contract marriage and enjoy the blessings of an enduring and successful marital life, is only too evident, but these constitute only a very small section of humanity, and are therefore merely an exception, and their condition cannot possibly invalidate what an all-wise and loving Providence has decreed to be the normal way to a fruitful and constructive social existence. The exact conditions and circumstances under which such incapacitated individuals should be advised or even prevented perhaps from entering into any sort of marital existence have not been specified in the Bahá’í Writings, but will have to be defined later on by the Universal House of Justice. In the meantime, those believers who consider themselves as falling into the above category would do well, before taking any final decision themselves, to consult medical experts, who are both conscientious and competent, and to abide by their recommendation.

The Guardian, much as his heart goes out to you in your fear and suffering, Cannot tell you whether electric shock treatments should or should not be used, as this is a purely medical question, and there is no reference to such details in our Scriptures. The best scientists must pass upon such methods, not laymen.

There are a great many as you know mental diseases and troubles at present, and the one thing Bahá’ís must not do is take a 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 who are denied it.

There is nothing in our teachings about Freud and his method. Psychiatric treatment in general is no doubt an important contribution to medicine, but we must believe it is still a growing rather than a perfected science. As Bahá’u’lláh has urged us to avail ourselves of the help of good physicians Bahá’ís are certainly not only free to turn to psychiatry for assistance but should, when advisable, do so. This does not mean psychiatrists are always wise or always right, it means we are free to avail ourselves of the best medicine has to offer us.

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.

You must always remember, no matter how much you or your others may be afflicted with mental troubles and the crushing environment of these State Institutions, that your spirit is healthy, near to our Beloved, and will in the next world enjoy a happy and normal state of soul.

. . . despite the many mental diseases and troubles of the present day, the power in the Faith is such that it can sustain Bahá’ís, whatever their ailments may be, on a much higher level than is given to others who are denied its healing grace.

It is also quite permissible for a National Spiritual Assembly to debar an individual believer from serving on a Local Spiritual Assembly without removing his or her voting rights and they may also debar a believer from attending the consultative part of a Nineteen Day Feast. You may also debar a believer from voting in elections without imposing all the other administrative sanctions involved in administrative expulsion.

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.

Limited sanctions (i.e., restrictions on one’s eligibility to serve on institutions or participate in community events) are usually imposed in cases where the individual disrupts the unity of the community, or is mentally unfit and unable to exercise judgment or behave responsibly. The Universal House of Justice has clearly indicated that a National Spiritual Assembly may debar an individual from serving on a Local Spiritual Assembly without removing his administrative rights.

Mental illness is not spiritual, although its effects may indeed hinder and be a burden in one's striving toward spiritual progress. In a letter written on behalf of the Guardian to a believer there is this further passage: "Such hindrances (i.e. illness and outer difficulties), no matter how severe and insuperable they may at first seem, can and should be effectively overcome through the combined and sustained power of prayer and of determined and continued effort." "That effort can include the counsel of wise and experienced physicians, including psychiatrists. Working for the Faith, serving others who may need you, and giving of yourself can aid you in your struggle to overcome your sufferings. One helpful activity is, of course, striving to teach the Cause in spite of personal feelings of shortcomings, thus allowing the healing words of the Cause flood your mind with their grace and positive power.

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 made possible an active life. The last ten years in the therapy of mental disorders has seen important advances from which you may well benefit.

The statement that 'only the spiritually ill experience psychiatric disorders' is entirely without foundation.

The withdrawal of administrative rights from a person who is suffering from a mental illness is not a sanction, but merely a recognition of the fact that the believer's condition renders him incapable of exercising those rights. From this you will see that the mental incapacity must be very serious for this step to be taken, and would normally be dependent upon a certification of insanity by medical authorities or confinement in a mental hospital. Again, depending upon the kind of mental illness, such suspension of voting rights may or may not involve non-receipt of Bahá’í newsletters, inability to attend Nineteen Day Feasts, etc.

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.

An awareness of appropriate personal boundaries may elude individuals with personality disorders and, depending on the characteristics and degree of the disorder, behaviors may range from extremes of aggressive intrusiveness to extremes of anxious and fearful withdrawal. Both require guidance concerning inappropriate behaviors and, in cases of intrusiveness, sometimes stronger measures.

As with many health conditions, mental disorders fall on a continuum from so mild as to be almost undetectable to very severe. The degree to which a particular individual’s conduct may be affected varies accordingly and may improve or worsen over time, depending on many factors. Some individuals may suffer from more than one mental disorder or a complicating general medical condition at the same time.

Assemblies are encouraged to seek advice from local mental health professionals, including social service agencies, and qualified non-profit organizations concerning specific situations and to draw upon these resources in deciding upon any course of action.

Assemblies may wish to encourage family members of a person with a mental disorder, if they haven't done so already, to find out as much as they can about the disorder as well as medical conditions that may be associated with it, and get help for themselves, even if the person with the disorder doesn't seek treatment. Family members can encourage the person with the disorder to inquire about education and counseling, but pressuring or trying to force the person to get help may be counter-productive.

At any time, the Assembly may wish to seek professional advice for dealing with a believer who has been diagnosed with, or appears to suffer from, a personality disorder.

Because the symptoms of PTSD and other trauma reactions can impact how a trauma survivor feels and acts, traumatic experiences that happen to one member of a family affect everyone else in the family. When trauma reactions are severe and go on for some time without treatment, they can cause major problems for the person and his or her family. Sometimes, in response to overwhelming trauma, individuals resort to substance abuse, which can complicate or exacerbate the problems.

Furthermore, persons with mental disorders may have difficulties with substance abuse, which further disrupts brain chemistry and affects behavior.

If individuals with mental disorders are repeatedly writing letters or making phone calls to the Assembly, it may wish to appoint a liaison with a capacity to listen to interact with the individual. It may be helpful to assist people to clarify and focus their thinking by asking, “Why are you telling me that?” It is also possible to politely interrupt a flow of monologue that is unproductive.

If need for a therapist is indicated, the Assembly may wish to suggest that the person get a referral from his or her primary physician, if they do not already have someone they are seeing or would like to see. If the individual’s behavior seems to be so extreme that immediate assistance is required, the Assembly or its liaison may wish to contact a mental health crisis intervention unit or the police, as seems appropriate to the situation.

If the Assembly becomes aware of a problem that might be an indicator of mental illness or other disorder it should avoid suggesting that there might be a mental problem, as it is not qualified to make such a determination. Depending on the circumstances, it may wish to suggest that the person undergo a medical evaluation through his or her primary care physician or other health care practitioner.

If the family wishes, the Assembly may wish to provide a mentor to assist it with consultation. In addition, a task force could serve as a liaison with the Assembly and direct the individuals concerned to proper human resources and professionals for assistance. They may also provide guidance based on the Writings, depending on the case.

If the person’s problems are affecting the community, the Assembly may wish to establish clear boundaries regarding his or her behavior in relation to itself, the community and, if necessary, to particular individuals within the community, with explicit consequences for violating the boundaries. If that approach is used: Care should be taken to establish boundaries that are reasonable and consequences that are appropriate. If possible, this should be done in consultation and cooperation with the individual involved.

In cases of mental disorders, the Assembly should make its decisions first in consideration of the benefit and welfare of the whole community and then in finding resources for the individual.

Mental incapacity may include such conditions as accidental brain injury, Alzheimer’s Disease, dementias associated with aging and other intellectual disabilities, and mental retardation. Limitations on the administrative rights of mentally incapacitated individuals may be conferred in some cases and is intended not as a sanction but as a relief of the responsibility to vote or undertake other administrative duties.

Once consequences are specified, if the predetermined boundaries are violated, the Assembly must act to impose the consequences. If need for a therapist is indicated, the Assembly may wish to suggest that the person get a referral from his or her primary physician, if they do not already have someone they are seeing or would like to see. If the individual’s behavior seems to be so extreme that immediate assistance is required, the Assembly or its liaison may wish to contact a mental health crisis intervention unit or the police, as seems appropriate to the situation.

Personality disorders differ from personality change in their timing and the mode of their appearance. They are disturbances in character development that may interfere with proper functioning in personal, social and work relationships. Some specific disorders tend to improve over time and respond to treatment while others may not. As with other health conditions, personality disorders vary in degree of severity and people with milder degrees of disorder may function reasonably well in most situations.

Post-traumatic stress disorder or PTSD can afflict persons of any age, gender or background. Those most at risk are victims or witnesses of abuse, molestation, assault or attempted assault, rape, torture, natural disasters, severe accidents, or terrorism, persons who have lived in areas of prolonged conflict or persecution (including members of minority populations in the United States), prisoners or former prisoners, persons who have been in combat, and those whose jobs bring them into contact with life-threatening situations or their aftermath.

Prior to making a decision about how to actively shepherd someone with a personality disorder, the Assembly will wish to evaluate the person’s willingness to attempt to undertake responsibility for life’s demands and the process of spiritual transformation. In some cases the person may refuse to take constructive action on his or her own behalf. In such cases, the Assembly may be wise to limit its involvement until it sees evidence of willingness to actively engage in the process of transformation.

Problems of personality disorder may be complicated by medical conditions, substance abuse and/or mental illness.

The Assembly may find it helpful to put the boundaries and consequences for violating them in the form of a written contract at the time of the agreement so that both the individual and the Assembly will have a copy. If possible, the actual wording should be agreed upon by both the individual and the Assembly. This will help to reduce confusion and minimize individual differences of perception in recalling what was decided when referring to the agreement in the future.

Unusual or sudden changes in thinking or behavior that cause problems may signal a mental or physical health change. Anyone who undergoes a personality change that results in unaccustomed problematic behavior should be encouraged to seek medical evaluation.

[W]e would ... emphasize the ideal of rehabilitation within the family as well as in the community. Family members should be trained, where possible, to help provide the support and encouragement that the disabled person requires to surmount his impairment.