Maria Dolgopolova: "I am so glad to see you, Nastya. You are a dear friend and a trusted colleague. I truly admire the way you presented yourself in those educational programs we attended together. That’s why I was eager to invite you as a guest on my video blog about clinical psychology. And I believe we’ve chosen a very important topic. I'm Maria Dolgopolova, a clinical and analytical psychologist with additional training in gestalt therapy and object relations psychoanalysis. I lead groups, work with clients, and have been running a video blog since 2024. A warm welcome to everyone tuning in today. Nastya, I’d like to pass the word to you. Please share a few words about what you think is important, who you are, and your background."
Anastasia Umanskaya: "Hello everyone. After your impressive credentials, it’s intimidating to speak! I’m not quite as much of a clinical psychologist as you are. My formal education is in psychology, but not specifically in clinical psychology. Clinical work entered my life more through practice. When I was young and full of energy, eager to work, I worked with anything that moved, didn’t move, talked, or came my way, so to speak. As a result, like many novice therapists, I had clients with severe issues, as my rates were low and these clients often struggled to sustain themselves but desperately needed help. I turned to supervisors, took additional courses, and trained in personality disorders. Through this experience, it became clear that I do extensive and effective work in the clinical field. Now, I have 15 years of practice. Currently, about a third of my work involves collaboration with a psychiatrist, providing varying levels of medication support. My foundation is in gestalt therapy; I am a trainer at MIGIP, a supervisor, and I run various training, supervision, and therapeutic groups. I am truly passionate about this work. That’s me, in a nutshell."
Maria Dolgopolova: "Yes, I think it’s also important to explain why we chose this topic and why we consider it significant. We’ll also invite our listeners to ask questions at the beginning, so we can include their concerns in our discussion and make sure we're addressing what’s most relevant to them."
Anastasia Umanskaya: "As for why this topic is significant… In terms of the broader social context, I believe it’s crucial to support not only people suffering from mental disorders but also their families. Often, it’s the close ones who suffer the most from these conditions. On the one hand, they retain their ability to assess reality adequately; on the other hand, they witness their loved one losing that ability. They experience intense emotional reactions and outbursts from their ill relatives. Typically, they are the ones who notice the first signs of the illness, navigating the ambiguity of whether it's a mental health issue, a difficult personality, or something else entirely. In particularly critical situations, these family members may be the ones who prevent suicide attempts or, tragically, deal with the loss of a loved one to suicide. They are in a state of intense concern for their relatives and family, placing them at great emotional risk.
However, our society tends to focus more on helping the person who is unwell. The prevailing social and cultural narrative often suggests that relatives should sacrifice everything on the altar of saving their loved one, possibly neglecting their own lives. We sincerely wish for this not to happen, for the illness not to become a vortex that pulls in more and more people. That’s why we want to discuss how to live when someone close to you is unwell.
"Speaking from personal experience, my daughter has an autism spectrum disorder. Her condition could be described as moderate—she has intact intellectual abilities and speech. It’s not a severe disability; she can function in society, but there are still some peculiarities. This makes things challenging, especially since, to put it bluntly, you wouldn’t immediately realize that she has any condition. Yet, sometimes she does things that would never cross the minds of neurotypical people. This combination—balancing between feeling ashamed because she’s different, feeling sympathy because she can’t help it, and sometimes even resorting to irony because, frankly, it’s hard to cope without it—along with frustration... It’s been a long journey for me to untangle this emotional mix in my life and family, with the help of doctors and various specialists. So, in that sense, I have some personal experience too."
Maria Dolgopolova: "Wow, you’ve shared so much and with such detail that I almost have nothing to add. But there’s one angle I’d like to highlight, based on what I’ve encountered in my practice. It’s such a delicate, nuanced, and case-specific boundary when we’re dealing with someone who is unwell, especially when it comes to mental health issues. On one hand, there’s clearly a need to support them, because leaving them entirely to their own devices can lead to obvious destructive consequences. The type of destruction varies depending on the disorder, but any reasonable person can see that letting them go entirely unassisted isn’t an option. On the other hand, if we step in too much, we can easily create a codependent situation—much like with alcoholics—where the person doesn’t fully experience the consequences of their behavior because those around them have formed a protective circle that alters their environment. As a result, they become insulated from the impact of their actions. And, as we know, this only serves to prolong the illness, creating a cozy shell for the person to remain ill, while those around them bear the strain. Finding that fine line—how to help without overstepping and exacerbating the situation—is always an intriguing, meaningful, and crucial challenge, in my opinion."
Anastasia Umanskaya: "I completely agree with you. It’s such an individual story for every family and group of people who form this circle of support. Honestly, it’s hard to imagine that we could come up with one-size-fits-all recommendations here. Rather, we can touch on some key points, markers to consider, to help each person in the system find their place.
You know, something else occurred to me as you were talking. I should also mention that I’m a family psychologist—unfortunately or fortunately—so I have some understanding of how family systems work. We can perhaps approach this topic from that perspective as well."
Maria Dolgopolova: "Yes, I understand. Let’s hear from those who have joined us. If you have any questions, please share them now so we can incorporate them into our discussion."
Anastasia Umanskaya: "I’ll be jotting down questions, just in case."
Listener 1: "Hello! I attended your ‘Fear of Death’ group. Do you remember?
Maria Dolgopolova: "Yes, I remember."
Listener 1: "So, you know my situation with my daughter. I also have a daughter, and now I hear that you have one too. And I can’t figure out if it’s a mental illness or just a bad character. She keeps telling me, ‘You’re the only one who’s sick here, you’re the only one who’s sick.’ I was recently diagnosed with cancer, and she believes she’s perfectly healthy, but her behavior is very odd. What should I do? Should I leave her alone or constantly try to help? She absolutely refuses to see any doctors. She says she sees subtle realms, feels things intensely, and mixes historical events with personal stories, involving herself in these narratives. Sometimes, she tells me all about it, connecting the dots in her mind. How should I handle this? Are there urgent steps I need to take? Because she’s incredibly stubborn and refuses any treatment, consultation, or help. She thinks she knows everything herself. That’s my story, and I hope to get some advice. Thank you!"
Maria Dolgopolova: "Nastya, shall we give a brief response?"
Anastasia Umanskaya: "Yes, I think it’s important to start by trying to establish a dialogue with your daughter. I didn’t quite catch how old she is, but from what you’ve shared, it seems like she’s an adult."
Maria Dolgopolova: "Yes, she’s over 30."
Anastasia Umanskaya: "It seems, then, that before talking to her about your worries or suggesting seeing a doctor, it might be beneficial to engage with her on her own terms—specifically about her stories and fantasies. Try to understand where she’s getting this information and how she’s weaving it together. For example, we need to figure out whether she’s immersing herself in some sort of role-playing game where blending historical events with her own character is just part of the game. That wouldn’t necessarily indicate a mental health issue. However, if she truly believes this is part of her life mission or reality, then it could be more concerning.
But right now, we don’t fully understand the context. What I do pick up on, though, is that her stubbornness signals to me that she’s currently not ready to accept help from professionals. It sounds like she has a rigid boundary in place, which makes it difficult to even suggest any kind of assistance.
You mentioned that she says, ‘You’re the sick one, not me.’ I’m guessing that she hears from you, directly or indirectly, that you think something’s wrong with her. For now, I would suggest refraining from such comments, to soften that hard boundary she’s put up. Establishing trust and connection is the first step. Only after that can you gently suggest, perhaps from a place of concern for your own well-being, something like, ‘I’m worried; could you do this for me, for my peace of mind? Could we consult someone together?’
But this is a long process, and there’s no guarantee it will work. However, from what I understand, her stubbornness and the boundaries she’s set—whether to protect her possibly fictional or even unhealthy world—are not something you can simply push through or ignore. You cannot force an adult, especially one in our country, to seek psychiatric help unless they voluntarily agree to it or are deemed a danger to themselves or others. Based on your story, it doesn’t seem like your daughter fits into either category.
Maria Dolgopolova: "Well, that’s a different country, and I don’t know its laws. No, no, it’s not Russia.
But I can actually respond to that question a bit differently — more as an addition to what you’re saying, Nastya, rather than a contradiction. This brought up a personal story for me, about my mother. My mother has been a well-known psychotherapist for quite a long time, perhaps even on a global scale, one could say. More than 25 years ago, she became very interested in my father’s strong personality traits. It was clear that my father was comfortable with his distinctive personality and didn’t experience any issues or discomfort because of it. If there were any issues, they were felt mostly by other people, not by him.
So, my mother went to a well-known clinician of that time to share what was important to her, simply speaking from her own experience of what she was dealing with in her life. She wanted to understand, so to speak, the scale of the problem for herself.
In fact, this is also a life journey, and a very significant part of it because it’s not just about trying to save another person or providing them with assistance. What’s crucial is to understand how to behave constructively towards yourself and the other person by recognizing what exactly we are dealing with. Once we have an understanding of the situation, regardless of whether the other person acknowledges it or not, we can choose a course of action that is most constructive for the situation. In this sense, we don’t even have to rely on the support of our relatives; rather, we can do this work for ourselves, thereby supporting ourselves and choosing a constructive way forward."
Anastasia Umanskaya: "Yes, I agree."
Listener 1: "I’ll keep listening."
Maria Dolgopolova: "Alright, thank you. Are there any more questions?"
Listener 2: "Yes, I have questions. Hello. My son, who is 18 years old, has been diagnosed with Borderline Personality Disorder, emotionally unstable type. He was recently also diagnosed with Bipolar Disorder. I have two questions. The first question is: where is the line between when someone is genuinely unable to engage with society — something you may have touched upon earlier, though I came in late — and when it becomes convenient for them to let healthier family members handle things for them? In other words, where does manipulation start, and how do you find that balance?
The second question is about dealing with aggressive outbursts and sudden switches. It’s reached a point where the rest of us — myself or the younger children — are afraid to talk to him because we never know which comment might trigger a reaction. As a psychologist myself, I try to acknowledge his feelings, saying things like, ‘Yes, you’re angry right now,’ but none of my approaches seem to work; they only seem to irritate him further. So, what can we, his family, do? How can we manage and balance this?
As for treatment, he’s very inconsistent — one moment he’s willing, the next he’s not; sometimes he takes his medication, other times he suddenly stops. This, I suppose, aligns with the diagnosis. Thank you."
Anastasia Umanskaya: "How long ago was the diagnosis made?"
Listener 2: "The Bipolar Disorder diagnosis was given just about a month and a half ago, but I’m not entirely sure if I fully accept it yet because I have some doubts. He’s quite intelligent, reads a lot, and initially self-diagnosed, saying, ‘I see all the symptoms of Bipolar Disorder in myself.’ He even considered taking a break from university — perhaps that was part of the reason for bringing it up, as he’s only seen a specialist once. So, there are some doubts, but overall, the symptoms seem to fit. The Borderline diagnosis was given back in November of last year."
Anastasia Umanskaya: "On what basis did you initially consult a doctor for a diagnosis?"
Listener 2: "He asked for it himself. Yes, he asked. As I understand it, there were some auditory hallucinations. During the first appointment, the doctor… Back then, he was still a minor. The doctor said that the symptoms were too scattered and it was hard to attribute them to a single condition, so they leaned towards a Borderline Personality Disorder diagnosis. We found another doctor. A year later, my son requested help again and started attending appointments on his own, as he was already of legal age by then. A different diagnosis was given."
Anastasia Umanskaya: "So, he stopped therapy, and no single doctor has observed him over the long term."
Listener 2: "No, he’s not ready to maintain consistent contact with doctors even now. So, should I still be consulting doctors on his behalf? After all, he’s an adult now and quite independent — this part is unclear for me."
Anastasia Umanskaya: "And does he live with you because he’s studying, and you’re supporting him financially?"
Listener 2: "No, he lives on his own. Another reason for seeking help was self-harm. That was the main reason. He lives separately, and I see him a few times a week."
Anastasia Umanskaya: "And what role do you play in his life?"
Listener 2: "I provide financial support."
Anastasia Umanskaya: "No, no, no, that’s not the question. I’m repeating your question to confirm if I understand it correctly."
Maria Dolgopolova: "I’d also like to clarify something. In this situation, about five or ten years ago, was there anything that concerned you about your son’s development? At what age did you, as a mother, start noticing any concerning behaviors, whether it was aggression or other troubling symptoms?"
Listener 2: "Yes, there were aggressive outbursts. He’s been quite short-tempered throughout his life. I think since he was about 11 or 12, he would periodically see a psychologist. The psychologist didn’t see any grounds for psychiatric intervention. There are, let’s say, certain genetic traits in his personality."
Anastasia Umanskaya: "Do you have other short-tempered people in your family?"
Listener 2: "Yes, his father."
Anastasia Umanskaya: "And does his father live with him?"
Listener 2: "No, he lived with him until he was 7 years old. The patterns were certainly set back then. I attributed some of my son’s behaviors to that."
Anastasia Umanskaya: "Could you also share a bit more about how his teenage years went?"
Listener 2: "It was difficult. He ran away from home a few times. We were living with a stepfather who was a former military man and tried to impose strict discipline. Boundaries and rules were always hard for him to accept. Arguing and rebelling is probably normal for a teenager, but whenever there was pressure, he would leave home — it happened two or three times."
Anastasia Umanskaya: "Well, of course, it’s hard to diagnose via conversation alone. But for me, there isn’t enough information to confidently conclude Bipolar Disorder (BPD). Definitely not enough. Ideally, though it’s rarely feasible, it would be beneficial if the same doctor could see your son roughly every 2-3 months over the course of a year."
Listener 2: "I completely agree."
Anastasia Umanskaya: "Only then can we talk about a reliable diagnosis."
Listener 2: "But forcing him to go is unrealistic. Forcing him is both wrong and impossible, and convincing him… Well, he agreed to see a different doctor, but he won’t go back to the previous one."
Anastasia Umanskaya: "You mentioned that the children are scared, and you are scared too..."
Listener 2: "Yes, the last incident happened just a few days ago. He broke down a door, smashed several tables... The issue is that we never know which phrase will trigger such an intense reaction. And the question here is: how to handle this, how to establish some kind of agreement?"
Maria Dolgopolova: "I’d like to provide some context here. The situation is indeed serious and complex, and to make significant progress, it would require gathering more data, understanding the broader context, and so on. That’s work that could take at least 50 minutes to dive into deeply, but we can’t do that right now. However, I believe that our participant has highlighted two typical issues present in many similar situations.
One of those issues is distinguishing between manipulation and a genuine cry for help. For instance, with self-harm, we often encounter cases where a teenager might cut themselves to draw attention, seek help, bring a parent back, or perhaps try to stop them from seeing a new partner. It’s a cry for help, but where is the line between manipulation and a plea for assistance? In almost every case we look at, this aspect will likely be present, and it’s an important distinction to make.
The second issue raised was how not to fear people with mental disorders. For example, when it comes to sudden outbursts of anger, these individuals may act in very unpredictable ways. As a result, other family members, recalling family dynamics, start to adjust their own behavior in response. But is this a constructive process? And how can we navigate it? We definitely won’t be able to fully analyze this specific case today, though it’s valuable and worth further exploration, both by our participant and with the help of professional communities. However, we should try to stick to some general guidelines here, I believe."
