Anastasia Umanskaya: "I would start from the latter point you highlighted, Maria. It seems to me that trying to negotiate in a situation where our participant clearly states there are no predictable warning signs is where she is getting trapped. It’s the trap of believing that it’s always possible to reach an agreement.
Maybe if you recognize certain signs, such as when your son is in an unstable state, which you might gauge by your own level of fear, it might be better to avoid contact altogether rather than trying to negotiate. Because the type of aggression you’re describing… Aggression can manifest in many forms. There’s verbal aggression, like a raised voice or unpleasant language. But what you’re describing is physical aggression, which is actually dangerous. A broken table or a door knocked down — those could easily result in debris flying towards you or your children.
I think when we talk about trying to reach an agreement with a person in such a state, we lose sight of the safety of those attempting to negotiate. And especially if I’m hearing correctly, there are younger children involved as well. So, it’s actually good news that he lives separately now. I’m tempted to joke, let him break his own furniture. But honestly, it doesn’t matter what the diagnosis is. Neither Bipolar Disorder (BD) nor Borderline Personality Disorder (BPD) inherently involves that level of aggression. Yes, someone with BPD may struggle to control their emotions. But until he is ready for consistent therapy and training in emotional regulation, there’s not much you can do except to learn how to avoid those sharp edges and minimize contact during such episodes.
Prioritize your own safety and the safety of the other children. The level of aggression here is simply too high."
Maria Dolgopolova: "You know, I think we're really seeing two opposing values here that seem to push us toward doing opposite things. On one hand, there's the value you've just highlighted: we have ourselves, younger children, and someone who behaves in an unsafe way. The fact that he's living separately is a relief — something to be grateful for, since the safety of the greatest number of family members is a priority.
At the same time, there's this other narrative that I want to try to convey. It’s something I sense without clear words, but I'll try to articulate it because it’s crucial and ties into the theme of our discussion. I've worked extensively with people diagnosed with various conditions, including endogenous psychoses, hallucinations, and borderline personality disorder. From that experience, I've learned that working with such cases often involves navigating a fine line between a genuine desire to understand and a willingness to help — step by step, slowly and carefully. For example, if there's self-harm, it’s important to explore how it came into a person's life, what purpose or need it fulfills. Or if there are outbursts of aggression, we need to look at what might be driving that accumulation of anger inside.
That's why, in this discussion, I specifically asked about the age when these behaviors started. Sometimes parents can observe that from an early age, the child was filled with aggression, fears, or inconsistencies. Perhaps other family members tried to connect emotionally, but the child seemed to push everyone away. What lies behind that behavior?
On the other hand, sometimes it's difficult to pinpoint whether something was always present or whether it emerged suddenly during a turning point. Problems can become noticeable and clear only at a certain stage. For instance, a person may grow up seemingly fine, but at 16, they suddenly experience severe chronic depression. Before that, they managed to keep it together; they didn't show signs of depression, and neither they nor their parents were aware of it.
This, of course, leads us down a different path, one that involves exploring how much we can truly understand another person and their processes — while ensuring that our own safety remains intact. When I work with clinical cases, I always ask myself two questions: how can I help this client? And secondly, am I doing so safely? Could this client potentially harm me outside of therapy? Or could I end up getting so entangled in their worldview that I put myself in significant danger, not as a therapist but as a person?
There's a big difference between managing negative transference within the therapeutic container and dealing with things that may spill over beyond therapy. And regarding the latter, I've made a clear decision for myself: some contacts need to be ended, one way or another, whether quickly or over time. It’s not about being a hero or not; it’s about setting boundaries to protect oneself.
And, of course, whether we are therapists or family members of such people, the question of continuing to help should only be pursued in constructive ways. We shouldn't chase after them against their will, trying to cure them beyond what they are ready for. Here, it is vital to cling to our own sense of helplessness, because we cannot drag people out of illness into health using our own resources. That would create a fake sense of health, which would be short-lived. We would become enslaved to maintaining this illusion, even though true health isn’t there."
Anastasia Umanskaya: "I have a small addition to what you're saying. It’s very true in the context of therapy, but family members are in a very different position than therapists. For one, they don’t have the fundamental contract that we have with our clients. In therapy, our contract is precisely about providing help. Essentially, the client brings the healthy part of themselves to address the unhealthy part. It’s with that healthy part that we establish a contract, agreeing on the frequency of sessions and defining the nature of our relationship. Only with this healthy side can we work on the unhealthy aspects.
However, family members don’t have that agreement. This person hasn’t given them permission to collaborate with their healthy side to address the unhealthy one. And when it’s a child, they often still expect a continuation of mothering: ‘Here’s my unhealthy part, and mom, please nurture and cradle it.’
Maria Dolgopolova: "Until they're 50"
Anastasia Umanskaya: "Yes, up until they’re 50 or even 60 years old. The saying goes: a bad mother is one who won’t feed her son until his retirement. But that’s not really the issue; the real point is that we’re dealing with a very different type of alliance. There’s a huge difference between an adult child bringing their troubled side to their mother versus bringing it to a therapist. A therapist, though they may be perceived as a mother figure, actually has more rights — the right to invite awareness, the right to implement therapeutic interventions, to give recommendations, and even to set conditions for psychiatric treatment. Family members, however, don’t have these rights.
The attachment relationship that relatives have is a very important and powerful tool, but it’s crucial to know how to use it correctly. From what I gathered, our listener is a psychologist herself. And this is just my imagination, which may not be entirely accurate, but I suspect that trying to apply psychological skills in such situations can actually worsen the contact rather than improve it. The reason? It may overshadow the possibility of simply being a mother. Because yes, at 18, someone is legally an adult, but they’re often still far from being truly grown up. Sometimes they just need a mother.
Maria Dolgopolova: "You know, speaking of family members, not therapy, I’d like to emphasize something. When people have children, they often hold this optimistic belief — and I've seen it in my work and even in my own thoughts — that we’ll have a wonderful relationship with our kids. We'll bring out the best in each other, and everything will turn out like the most touching stories about attachment. The grown-up child will embrace us and say, 'Mom, I’m so happy you gave birth to me, and now I’m a happy, fulfilled person.' But real life has a way of intervening in these idealized visions.
One common issue, which I've discussed with clients, friends, and even older generations like my mother’s, is that separation is far from a poetic process. It’s messy and painful. Neither the parent nor the child experiences anything euphorically pleasant in that process."
Anastasia Umanskaya: "I completely agree with you.
Maria Dolgopolova: If… in addition, the child has a mental disorder, this dark side of separation gets amplified tenfold, becoming even more difficult and unpleasant. But still, separation is something that needs to happen, or else we end up with a child who is still dependent on their mother even into retirement age. Yes, there are mental disorders so severe that someone might indeed need lifelong care, but such extreme cases of total incapacity due to illness are rare.
Anastasia Umanskaya: "Absolutely. And I think when I talk about someone needing a mother, I’m really referring to a kind of dual message here. On one hand, there's the part that rebels, sometimes in very harmful ways, and on the other hand, there’s a healthy fragment that genuinely wants to separate and mature. In this sense, it’s not so different from psychotherapy, where we can only engage with the part that’s willing to connect.
Needing a mother doesn’t mean taking the child into your arms when they’re throwing furniture around. It’s more about recognizing who you are to this person — are you their mother or their therapist? These are fundamentally different roles.
Maria Dolgopolova: Absolutely, very different reactions should be there
Anastasia Umanskaya: "And related to that, let’s get more specific — there was a question about manipulation that I’ve been holding onto. I want to suggest a simple, everyday tool to test this. You don’t even need psychological training or, God forbid, psychiatric knowledge. Respond to manipulation with manipulation and observe the results. If the person is truly capable of self-control, they will adjust their behavior in response to a reduction in financial support, for instance. It’s a straightforward approach: ‘I find this behavior unacceptable,’ and then observe the short-term outcome. If they respond with behavioral changes, then whether it's manipulation or not — and I don’t particularly like that term — it shows they have the ability to control their actions if sufficiently motivated.
It’s a different question, which we could explore further another time, about how long that self-control can be sustained. Sometimes, a person can hold it together for a while, but then the illness takes over again. But when it comes to testing which behaviors are manipulative and which are symptoms of a disorder, allow yourself to experiment a bit."
Maria Dolgopolova: "I agree, but it’s still a delicate line. When I worked in a ward for patients with endogenous psychoses, my more experienced colleagues taught me a lot. There’s this saying — and specifically, I worked with patients with paranoid schizophrenia, so they were often deeply lost in psychosis, completely believing in their hallucinations with no critical awareness whatsoever. Yet, we discussed an interesting point: throughout the history of psychiatry, there’s never been a case where, if a psychiatric facility caught on fire, these seemingly detached-from-reality individuals couldn't pull themselves together and evacuate. In those moments, all conversations with gods or demons would instantly stop, and they would act to save themselves. Even those who seemed utterly incapacitated in normal circumstances were always able to handle this basic survival task. So, it’s very complex."
Anastasia Umanskaya: "But wait a minute, cutting financial support in half and starting a fire to make someone pull themselves together seem like very different actions to me."
Maria Dolgopolova: "Of course. But even limiting material support is also very life-altering in this context. A person can temporarily gain some control over their mental disorder. As you said, it might last for a short time — maybe a year, I think. But eventually, the disorder will take over again because, ultimately, it’s pushing from within."
Anastasia Umanskaya: "Well, based on what we heard from the listener, I still think it's closer to borderline personality disorder than bipolar disorder (BPD). The reality is that, when it comes to family members, you’re not going to cure the person. You won’t even teach them to control their behavior. What you can do is test how you’ll deal with certain manifestations. Can they control their behavior or not? In the end, such a person needs to work on learning how to manage their affects. And that’s work that family members won’t be able to do. What family members can do is show, in some way, that under certain factors or limitations, the person can pull themselves together for a while, but eventually, they’ll regress. But maybe in this process, the person will start to develop an interest in managing their states. If a connection is made — the realization that regulating their emotions leads to something beneficial in life and society, while not regulating results in deprivation — then we might start seeing some change. Unfortunately, we can only influence from the outside in this way."
Maria Dolgopolova: "Well, here’s my rather grim thought: if the family could have taught the person to regulate themselves, that would have been done before the age of 18. If something went wrong — whether the family couldn’t provide it, or the child couldn’t accept it, or simply couldn’t accept it from his family — it’s often too late after that. At that point, it’s about the person making an adult choice: will they learn to regulate themselves or not?"
Anastasia Umanskaya: "Yes, and I still think it’s incredibly important to point out that healthy family members of someone with a mental illness bear responsibility for the distance they choose to maintain. This is the key point I want to make. Often, people fall into the trap of thinking that because their loved one is ill, they must care for them, devote their life to caring for them, or take on more responsibility than they do for other loved ones, whether that’s other children or family members. And this 'must' is often shaped by society’s expectations. I strongly support those dealing with mental illness in their families to figure out the distance they need to maintain — one that allows them to care without depleting themselves or losing their own life. The famous airplane rule: first, put on your own mask before helping your child — this applies to family members of people with mental illnesses too. If you’re drained by pretending that your loved one is healthy for society's sake, or if you're fighting for them to behave as though they were healthy, or to get them to recover when no treatment exists, you will inevitably burn out."
Maria Dolgopolova: "It sounds like you’re touching on the theme of shame. Because sometimes, I would even say that family systems — though I’m not a family therapist, it seems to me this applies to family systems — try to cover up. There's a lot of shame involved if the broader society finds out there’s someone sick in the family. People are willing to go to great lengths to hide it, creating the illusion of a picture-perfect family where everyone is healthy. Because, in their minds, it feels like an accusation — that it’s their fault, that they are somehow inferior, which is why they have this 'bad' person who is sick. And so, the family plays along, saying, 'Let’s give everything we have, but somehow make it look like we’re still the perfect, healthy family.' But this is a dangerous game. It’s a very dangerous position, where, without a doubt, the sick person doesn’t get any better."
Anastasia Umanskaya: "Yes, I completely agree. In this game, the loser is already clear: it will be you, and the winner will be the illness. It’s best not to even start playing."
Maria Dolgopolova: "Yes, and not even the sick person will win."
Anastasia Umanskaya: "Exactly, the sick person won’t win. They will become the victim of these games. Because, if we pretend everything is fine, we’re not allowing them to adapt within their own capabilities. That’s a very important point. Yes, Let’s hear if there are more questions from anyone.
Listener 3: "Yes, hello again! Could we discuss dependencies within the scope of the stated topic?"
Maria Dolgopolova: "Yes, we can."
Anastasia Umanskaya: "If Masha says we can, then we can."
Listener 3: "Alright, well, it’s a fairly standard case of progressive female alcoholism, where we reject all help, including psychiatry and psychotherapy."
Anastasia Umanskaya: "Who’s rejecting it?"
Listener 3: "The mother. So, when she comes out of a drinking binge, a new problem emerges: 'I drink if I want to, I don’t drink if I don’t want to.' She believes she has control, saying 'I can drink if I want, or not drink if I don’t want to, but if I do drink, it lasts two months, followed by a hangover, and then I just sleep it off,' but still, she thinks 'I have control.' As her son, what can I do in this situation to help? Thank you."
Anastasia Umanskaya: "Help with what, exactly?"
Listener 3: "Help with fighting the disease, though she doesn’t ask for help herself."
Anastasia Umanskaya: "Then, in what way does she need help?"
Listener 3: "Good question. It’s more us, the people around her, who need help. Those around the person who is ill."
Anastasia Umanskaya: "With what, specifically?"
Listener 3: "We would like to do something about this disease. We really would."
Anastasia Umanskaya: "This is exactly the trap that Masha and I talk about often: trying to help someone who doesn’t ask for help and believes they’re in control. It’s a bit like placing yourself above them, thinking, 'they’re ill, and I’m here to restore their health.' But it won’t work if the person is an adult, capable, and fully aware of their own choices.
Alcoholism has a complex aspect: those suffering from chemical dependency often live in a split state. When sober, they aren’t emotionally connected to the part of them that drives them to drink, and when intoxicated, they’re not connected to the part that values sobriety. A family member can’t bridge this gap; it’s complex psychotherapeutic work. So the only thing you can do, as with the previous case, is connect with her healthy side and express how it affects you when she chooses to drink, asking for her support on your behalf. Then be prepared to accept a refusal if that’s the answer.
And again, as Masha and I always say, you have to come to terms with your own helplessness. Asking for help implies both a 'yes' and a 'no'.
