Maria Dolgopolova: I’d like to add my perspective. We did an entire broadcast on dependencies, where we discussed this family issue in more detail. I think it would be better to address your specific question there. That episode will be aired next week, probably on Tuesday.
But on a more human level, this is about balancing the desire to help with recognizing your own helplessness. If, say, a person has reached a point where they’ve lost their job and are financially dependent on us, that’s one scenario. At that point, they’ve lost a degree of their social functionality, and—while it’s a grim reality—this gives us some leverage. However, if the person is still functioning independently and continues with self-destructive behavior, then, like with other independent adults, there’s little we can do against their will, nor should we.
You can communicate, and as Nastya said, it’s worth trying to engage with the person’s healthy side, but it’s important to vary your approach. Saying the same thing repeatedly won’t work; it’s hard, but I know it’s necessary to find new ways to say it each time. I’ve experienced this with clients, where I needed to convey a simple message: 'I fear for your life; I don’t want to see you dying.' It’s painful to witness a loved one’s decline, but expressing that in 50,000 different ways each time you see them can sometimes have an impact. But it’s challenging, and there’s no guarantee of success.
You also need to accept your own helplessness—acknowledge that while you can be authentic and sincere in expressing your feelings, love, and concerns, even the best words may not halt the other person’s self-destructive behavior. And this holds true not only for alcoholism but for any form of self-destruction, in my opinion.
Of course, having a basic understanding of the issue is valuable. It’s reassuring to know that you’ve explored all the available options, so you can be confident that you’ve tried everything that’s been discovered and tested. If you skip this inner research and don’t affirm, 'I’ve looked into all that exists,' then it might feel too soon to stop trying—not by pushing the other person, but in terms of your own understanding of the issue. I’ve been trained by scientists to value knowledge, both theoretical and practical."
Anastasia Umanskaya: You know, what I’m thinking about? When we were preparing for the broadcast, I even remember you writing in the announcement that we wanted to talk about people who have already been diagnosed. But we’re actually talking more about suspicion and refusal from a close person to get the diagnosis.
Maria Dolgopolova: "Well, to me, it doesn’t matter if a piece of paper has been handed out or not, if someone has been drinking for two months in a row. And the borderline personality disorder, which came up in our discussion, was also relevant."
Anastasia Umanskaya: Alright, alright, but what I want to say is that I think there are stages that relatives of people with mental illness face after a diagnosis. And these stages, let’s say, are more about internal work than external. I’m talking about the fact that at first, we may be in doubt and uncertainty: Is everything okay? Or is there something wrong and help is needed? Is it their character or a disease? What should we do? How should we interact? How can we avoid some outbursts? All of this is part of the initial phase.
But after the diagnosis, the second part begins, and you talk about this actively: the part of informing, informing about the disease, understanding what it is, how to interact with people who have these kinds of conditions. The recommendations will vary depending on the diagnosis—whether it’s a chemical dependency, borderline personality disorder, schizophrenia, or depression. In all these cases, it's important to be somewhat oriented about what your loved one might need, but also to understand what they can do for themselves without your help. Another crucial stage for relatives is the stage of acceptance. The stage of recognizing that I’ve learned what I can, I’ve done everything I can, but this person won’t get better because of what I do. And that’s a very difficult place. And, for me, mental illnesses have a particularly complex aspect, one that perhaps even oncology doesn’t have, at least not in the way it develops, or other chronic conditions. It’s the unpredictability of relapses. And this really affects trust in relationships. This is where relatives struggle the most, because trust is shattered by the illness. Not just something happens to the personality of the sick person, but your trust in them, someone you once trusted, is destroyed. And this is a very difficult reality to accept. I remember how I was often shaken between my daughter’s states, and I still feel shaken at times, when I see that the person is maturing, trying to control themselves, regulate their behavior, and there’s a slight relief, as though this skill has somewhat improved, but then suddenly there’s a setback. And every time, it’s an incredible sense of betrayal if you don’t keep this in your consciousness. This is very difficult work for the family.
And, actually, what I think is important to mention is that when there is a person with a mental illness in the family, it’s crucial to recognize that the family members are working through grief. And this grief work is typically complicated because the person is still there, they haven’t disappeared, they haven’t gone anywhere. But at the same time, they’re no longer who they were for you. It’s this constant emotional swing between hope that the person will return, the one you loved, and despair because you can’t fully get close to them anymore. They are there, but not really there. And this is a very difficult place, and in this place, I believe that psychotherapeutic help for relatives is extremely necessary.
Listener 1: "Can a mental illness be diagnosed using an MRI, and how accurate is such a diagnosis?"
Anastasia Umanskaya: "This is a very new area of knowledge. There are different studies now, but they are still insufficient for diagnosing mental illnesses through this method. However, for example, it is known which areas of the brain begin to change in cases of prolonged depression, bipolar disorder, or schizophrenia. But these methods are not yet used for diagnosis. At least, that’s what I know. Maybe Maria has more up-to-date information because Maria is someone who always works with new sources."
Maria Dolgopolova: "Well, it seems to me that in comprehensive psychiatric diagnostics, in advanced clinics, all this data on patients is collected. And I can actually share one psychiatric concept. I’ve remembered it. And I apply it. I keep it in my mind, and it really helps me. There is a concept in psychiatry about positive and negative symptomatology. This has nothing to do with positivity or negativity as such. In psychiatry, positive symptoms are those things that a person has, which are not typically present in a healthy person. For example, healthy people do not experience auditory hallucinations, but if someone does, they have positive symptoms. And outbursts of anger, for example, are also considered positive symptoms. A healthy person, conditionally speaking, has fewer of these or doesn’t experience them at all. But with certain deviations, outbursts of anger emerge. So this, too, is a form of positive symptomatology. However, oddly enough, psychiatric and mental illnesses are not primarily dangerous because of positive symptoms. They are dangerous because of negative symptoms, and because of what psychiatry calls the increasing defect. People may say they live with hallucinations or mood swings, and they’ll say, 'What’s the problem? I’m this way, and this works for me. It even enriches me.' Or 'I’m a writer, an artist, and I’m great because of this, so why do you want to take me somewhere for treatment?' But people are encouraged to undergo treatment not to suppress positive symptoms, though. Let’s say a person writes beautiful books or paints amazing pictures due to some extraordinary powers. There’s no problem with that if they are adapted, happy, and their loved ones aren’t going crazy because of it. But people are invited to treatment because these additional positive things, which are not typical, will eventually lead to an increase in negative symptoms. Negative symptoms occur when the person’s brain starts losing the ability to do things that it could do before. For example, in my case, it was very clear in a unit for patients diagnosed with paranoid schizophrenia. It’s the same for schizoaffective disorder and psychotic-level affective disorders. Although these are three different diagnoses—paranoid schizophrenia, affective disorder, and schizoaffective disorder—each may affect different areas of the brain. For example, one person may have everything intact: their thinking patterns, emotional background, and other functions are normal, but they have huge problems with productivity. They are asthenic, with low energy. The disease hit here. Or on the contrary, someone might have good productivity, preserved cognitive functions, and all other abilities, but their mood and emotional sphere may be the most severely affected. And I think that there’s no salvation in a specific diagnostic episode or even in the diagnosis itself—the name written on a medical record. What we need to understand is the weakest part of a person and try either to strengthen that part or save them. But I’m speaking from the perspective of doctors. Relatives, again, cannot save the weakest parts of their adult family members if those family members are not treating themselves. There are limitations. It’s always important to not just focus on the diagnosis but understand the essence of what is happening."
Anastasia Umanskaya: "Yes. I think it would be appropriate to share a case from practice here. I have a client in therapy with whom we’ve been working for many years. His mother developed schizophrenia after giving birth to him, some time later. And this is a beautiful story about finding the weak spots and compensating for them. They stayed together, the parents, and the father, essentially, spent his whole life compensating for the mother’s illness. Now, the mother functions as a healthy person, receiving therapy and supportive injections to maintain remission. It’s some new modern medication. And, essentially, the father spent his whole life compensating, which unfortunately didn’t protect the children from the severe trauma related to this issue. But this, in a sense, is a good outcome, when relatives were able to compensate for the sick, deteriorating part of the personality, without destroying the healthy part too much. For example, the mother always took great care of the father, creating a cozy home environment. That part still exists, and it hasn’t been destroyed by the illness. And that may have allowed the couple to stay together. Accordingly, the son has been going to therapy for many years, including because it is very difficult to build long-term relationships. Well, actually, this is the trust issue we were talking about. If trust is destroyed in parent-child relationships early in a child’s development, when the main adult gets ill, it can severely affect the child. This is why it’s so important to understand what the weak part is and how we can support that part. They still won’t become a healthy person, but some part of their life can be preserved."
Maria Dolgopolova: "Yes. Do we have any more questions from the listeners? I’ve got the impression that every time we gave someone a chance to speak, people did, so… If there’s anything left..."
Listener 1: "You were just talking about positive and negative symptomatology. How long can this go on by itself if, for example, there are no medications involved?"
Anastasia Umanskaya: Well, there’s a well-known fact that if a mental illness isn’t treated, it destroys brain structures. And, of course, the longer it remains untreated, the more widespread the damage becomes. Does it lead to the end of life? Not by itself. It leads to a deterioration in quality of life, yes. The other thing is, if a person with a mental illness falls into deep depression, for example, they might commit suicide or experience a severe affective crisis. So, although it’s a bit of a dangerous phrasing, the direct threat to life isn’t posed by the illness itself, but by secondary risks—people may take actions under the influence of their illness that threaten their health and life.
For example, I have a story from my clients. This wasn’t someone I worked with directly, but they shared it with me. One client’s sister developed a mental disorder, and schizophrenia was later diagnosed, but it wasn’t confirmed until the end when she had already passed away. During the course of her schizophrenia, cancer was discovered. But when cancer was diagnosed, the family still didn’t know she was mentally unstable and that her decisions couldn’t be trusted. She refused treatment and died from cancer. Yes, she died from cancer. Why? Because of schizophrenia? Yes. Did schizophrenia kill her? No. It was the cancer that killed her. This combination is complex and risky.
So, answering your question about how long it can last… I would ask, how long for what? For irreversibility? All processes will become irreversible over time. The question is…
Listener 1: "How deeply can the brain be damaged?"
Anastasia Umanskaya: "The longer it lasts, the deeper the damage. Unfortunately, it really depends on the specific illness, because different illnesses have different intensities of damage."
Listener 1: "One year, three, five, ten?"
Anastasia Umanskaya: "Who knows? It really depends on the baseline strength of the brain's functions, the severity of the illness, and the speed of progression. It’s similar to somatic medicine—like with gastritis, for example. A person can live with it for many years without even knowing they have it, and it might develop slowly without causing significant harm..."
Maria Dolgopolova: "Listen, I can add from the perspective of psychiatry, as we discussed in the clinic. In this case, MRI is not a useless diagnostic tool because, over time, especially when looking at a five-year period, it’s usually… I mean, for example, if we look at a classic case of an endogenous disorder, schizophrenia, they all progress at different rates when untreated. Some forms of schizophrenia progress very slowly. If schizophrenia were to kill someone, it would take 200 years. In this case, even if a person doesn’t treat it, they will likely live to be 100 and die from another illness."
Anastasia Umanskaya: "From old age."
Maria Dolgopolova: "More precisely, from some common disease. Right. In some cases, the course of the illness can be different, and a person can die from brain damage caused by the illness itself. That does happen."
Anastasia Umanskaya: "I see, I didn’t know this aspect. Well, I suppose it’s because, in private practice, I mostly deal with slow-progressing diseases, while the more intense cases usually end up in the hospital."
Maria Dolgopolova: "If not for my experience in clinic, I wouldn’t have this information either. Well, it looks like we have... Yes, please."
Listener: Finally, I don't quite understand. Can a mental illness be diagnosed through an MRI, and how accurate would such a diagnosis be?"
Maria Dolgopolova: "It should be a comprehensive diagnosis, not relying on just one method. It must involve a battery of tests—both bio-physiological and content-related, including classic psychiatric interviews, clinical assessments, etc. Then, based on the combination of all the data, you can make quite accurate conclusions and predictions."
Anastasia Umanskaya: "But I think here, Olga, remembering your question, I remember that your daughter doesn’t want to seek help. Finding the right method to lure her into treatment, so to speak, in order to figure out what’s going on with her, I’m afraid that won’t work. This is the place we’ve talked about a lot with Maria during this broadcast—when you start taking on a function that is no longer under your control. Because even if you do one test, that information will be insufficient. Those tests should be ordered and interpreted by a doctor. And if I remember your case correctly, your daughter isn’t ready to seek help yet. So, it’s very unfortunate. But in this case, CT or MRI isn’t so important. What matters is that she seeks help, and then the doctor can collect the necessary methods. Yes, it’s about helplessness and powerlessness. There’s a lot to this topic."
Maria Dolgopolova: "I think we have about five minutes left, and we can dedicate them to any aspect. If listeners want to provide feedback, that would be valuable to us as well."
Anastasia Umanskaya: "Yes, I’d be interested in hearing that."
We were thanked for the material by a few people. We were also asked if Maria Dolgopolova, myself, and I would be launching a psychodynamic group for people whose relatives have mental illnesses.
Anastasia Umanskaya: "I’ll make a tragic joke here—I run into my own powerlessness when it comes to time. Unfortunately, all my dreams don’t fit into my schedule. And, in this sense, such a group is something I feel is very important, but at the same time, it never feels like an urgent priority. So, personally, I don’t even have it in my project plans at the moment... I think these groups could be very supportive on the one hand, but they also have the potential to be draining. It’s a contentious question, much like with a group for people with depression. Will we all sink together, or will we rise together? A group made up of people who all have loved ones suffering from mental illness has, for me, a very dangerous potential for becoming a sinking ship. But maybe Maria has something to say about it?"
Maria Dolgopolova: "Listen, I’ve been thinking exactly the same thing. I lead psychodynamic groups right now, and they’re not thematic groups. They’re not for people with depression, nor for people with relatives with mental illnesses, or for those dealing with addiction issues. But, when it comes to this topic—relatives and loved ones with mental disorders—almost every group I’ve gathered, I’d say about 50% of the participants have been in that situation. And from my experience, 50% with this topic is the optimal number to avoid the group turning into a sinking ship. It allows people to dive into different topics, and, of course, I still lead each participant’s request separately. I keep their specific situation in mind and think about how to structure the group process so that everyone’s issues develop together. But it’s definitely easier for me to do this in a mixed group rather than gathering all the people with depression or all the people with cancer, or worse, all those with troubled relatives suffering from chemical dependencies or mental disorders in one place. This mixed approach works more effectively for me, though, of course, thematic groups are possible if someone is prepared for them. But that’s probably not something I would do."
Anastasia Umanskaya: "I think you could definitely send people to any of Maria’s groups, and it would be perfectly fine. Honestly, I think the only thing that matters is that the leader is well-prepared for the group process. In this sense, I fully support Maria and her groups. I think it’s a great opportunity to recommend them."
Maria Dolgopolova: "Well, thank you, Anastasia. Thanks to the participants as well. I think we’ve covered what we could in the time we had."
Anastasia Umanskaya: "Yes, I hope it was clear, and I’d like to use this opportunity to joke: Come to our clinical conference at MIGIP. Both of us will be there. Maria will present something interesting, I’ll present something as well. There will be many other fascinating speakers, and it will be online. If people are interested in the topic of clinical practice, they might find it useful. It will take place in December. Information is available on the institute's website."
Maria Dolgopolova: "It will be a great event. I highly recommend it."
Anastasia Umanskaya: "Yes, indeed. Well then,"
Maria Dolgopolova: "Let’s wrap up. Until next time."
Anastasia Umanskaya: "Goodbye, goodbye."
Maria Dolgopolova: "Goodbye to everyone!"
