Yours Toothfully by Dr Chan Joon Yee

They adulterated their milk. A few creative folks out there adulterated their ads.

Laurentia Tan won 2 Equestrian bronze medals at the Paralympics. Swimmer Yip Pin Xiu won a Paralympic gold medal and rewrote two world records. They are both Singaporeans!

When both women arrived home, Minister for Community Development, Youth and Sports, Dr Vivian Balakrishnan announced at the airport that swimmer Yip Pin Xiu and equestrian dressage rider Laurentia Tan will be conferred the Meritorious Service Medal and Public Service Medal, respectively. How nice.

But days before that, we were only aware that Pin Xiu will receive just 10 per cent of the $1 million that an able-bodied athlete will receive for an individual gold medal at the Olympics. Many Singaporeans, including our lovely NMP Eunice Olsen, have questioned our government over this disparity or inequality if you will.

“The cash awards given to the Olympians are not government-funded but from the private sector and Singapore Totalisator Board and they have had this scheme for several years,” said Mr Teo Ser Luck.

Frankly, that was quite a piece of news to me. I’ve always thought that our government was the one funding the Olympic monetary awards. At least the COE and ERP collections would be put to good use. But no, our government does not contribute. And if there were no contributions from the private sector at all, our disabled but full-blooded Singaporean athetes will get … a big pat on the back from the government.

But part of the fault really lies with Singaporean supporters like us. How many of us watched Laurentia’s event? How many of us watched Yip Pin Xiu in action? In fact, many of us only took interest in the 2 ladies after we’ve heard that they’ve won. And Pin Xiu won a gold medal for goodness sake. We skipped the anticipation stage and went straight to celebration. Even without all the fanfare and initial support, the 2 ladies went on to do us proud. We ought to feel ashamed of ourselves - especially the folks who give all kinds of excuses to deny them the same monetary rewatds that our foreign talent received.

Borderline personality disorder (BPD) is a serious mental illness characterised by pervasive instability in moods, interpersonal relationships, self-image, and behaviour. The majority of affected individuals show signs of BPD in early adulthoood. Some appear to be affected in childhood. It has been estimated that 2% of the population in the UK is affected by BPD. Richard J. Corelli claims that up to 14% of the American population is affected, the prevalence in young women being about 3 times higher than in men.

There are some similarities between a person with bipolar disorder and someone with BPD. There are similar maniac and depressive mood swings. However, in bipolar disorder, the patient without medication remains in a maniac or depressive mood for weeks or months.

In contrast, the person with BPD automatically snaps out of it within a couple of days. In other words, they turn from threatening and quarrelsome to a kind and loving person very quickly, seemingly unaware of the damage they have just done. This leaves the target of their attacks confused and perplexed, unable to adjust to these swings in a way that will satisfy the BPD. This may result in another bout of aggression. The BPD may realise but somehow just cannot accept that normal people do not have these mood swings and take time to recover from their insults.

In a sense, people with BPD, if not observed closely, can appear quite normal. In fact, if the first impression is good, some people may find them exceedingly friendly upon first encounter. If subsequent dealings are pleasant and superficial, the BPD may never exhibit signs of aggression. This may delay the identification of the problem. How would you identify, avoid or accommodate a BPD? From my own personal encounters with BPD individuals, I have identified the following signs.

1. Impulsive Aggression
A person with BPD is impulsive and aggressive. This has to do with extreme sensitivity. One doctor likened it to a burn victim with gust of wind passing over his wounds. The person with BPD can feel extreme pain upon the mildest criticism or objection and reacts with completely disproportionate anger and aggression.

2. Extreme Sensitivity
These people are extremely sensitive to rejections and abandonment - or what they perceive as abandonment. A trip taken without them can be perceived as abandonment even when it is they who decide not to tag along. Lonely because of uncontrolled emotions, the BPD may feel that the whole world is against her. Her mind is flooded with positive or negative thoughts at different times of the day. She cries a lot. She rejoices a lot. She loves a lot. She hates a lot.

3. Extreme Insensitivity
When a BPD attacks, she attacks with extremely insensitive remarks. Even though a BPD needs others to be kind to her, she can have no qualms about being unkind to others over the most petty issues. As one BPD said: “My revenge will be 10 times more painful for you than what you have done for me”. BPD people say and do such things without any awareness of the consequences. They can be nice and friendly one moment, cruel and mean the next. It’s as if their emotions are controlled by a switch nobody can access.

4. Uncompromising/Controlling
Not all BPD individuals are like this, but some can be very bossy and uncompromising. They may want to control everything and everyone around them. They may spend hours at the supermarket looking for the perfect buy or refuse to buy a item because of a tiny scratch on it. While they are control freaks, they also feel inferior and insecure. They may envy others, feel worthless, yet try to project an air of superiority.

5. Black/White World
In my opinion, this is perhaps the most diagnostic sign of BPD. A person with BPD is often overly emotional and easily fascinated by something or someone who appears pleasant at first sight. When they meet someone who gives them a good impression, they will adore or even idolise that person. However, the slightest conflict will turn the relationship upside down. The BPD person will love or hate 100%. There is no middle path. When they see their best friend talking to someone they dislike, they will ditch that best friend.

6. Extreme Mood Swings
To a BPD, an angel can become a devil in an instant. A good idea can become a bad idea with absolutely no redeeming features because of a tiny flaw. People dealing with BPD people will be dealing with rapid and unfathomable changes of plans which only they can initiate but not others.

7. Self Mutilation/Suicide Threats
People with BPD may resort to binge eating, drugs, long hours in bed or self mutilation (cutting oneself with a knife) to relieve stress. To fight feelings of abandonment and to seek attention, the BPD may threaten family members with abandonment or suicide.

BPD used to be treated as a psychological problem that resulted from childhood trauma. Recent studies reveal that genetics play an important role in BPD. An identical twin of someone with BPD has a 35% chance of developing BPD. Let’s see. Identical genetic makeup and only a 35% chance of getting the same disorder? Somehow, that doesn’t sound right to me. Researchers now believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults.

Treatment? Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilising drugs that are known to enhance the activity of GABA, the brain’s major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioural interventions and medications, but it seems that BPD cannot be managed with precision and predictability like diabetes or high blood pressure. I wonder if TCM techniques like acupuncture can help.

Judging from the responses from men whose wives have BPD, the outlook seems pretty grim. Significant improvements have been reported, but no remedy seems to last. Most of the successfully treated cases have relapsed when the individuals tries to interact with mainstream society again.