It has been theorized (originally in the 1950s) that in many dysfunctional families an individual within the family is, largely unconsciously, assigned the role of the ‘identified patient’.
Essentially, this process comes about as a result of the dysfunctional family projecting (projection is a psychological defence mechanism by which people avoid facing up to their own unwanted feelings, such as aggressive impulses, by displacing and seeing them in others) onto a family scapegoat.
Another example of projection would be a very selfish person who constantly accuses others of being selfish and, indeed, sees selfishness in others everywhere s/he looks; in this way it is a type of blame-shifting – displacing their own psychological difficulties onto one specific family member, who, as a result, becomes the family scapegoat, diverting attention from the rest of the family’s mental and emotional problems.
Often, the identified patient is unconsciously selected as s/he is the most vulnerable, weakest and sensitive member of the family (often the youngest, as in my own case).
If we were made to be the identified patient in our family, our family may have:
– constantly belittled, undermined, ridiculed, humiliated and vindictively teased us
– made us feel inferior and of little or no worth
– made us feel like the family outsider, disconnected from its other members and unacceptable to them, excluded and ‘kept at a distance’
– made us feel that we were an ‘intrinsically bad’ person
– showed little or no interest in us
– labelled us a ‘problem child’ and/or ‘trouble maker, ‘ responsible for all the family’s ills.’
– over-emphasized our faults whilst, simultaneously, ignoring or minimizing our strengths, qualities and accomplishments.
As our family will have a vested interest in continuing to keep us in our role of identified patient (namely to prevent them from having to face up to their own failings and contributions to the family’s dysfunction), they will go to great lengths in order to do so. In fact, if we, the identified patient start to recover, they may be unconsciously driven to prevent this recovery, and thus, by such means, maintain the family’s status quo.
It is likely that, in such families, the identified patient has been psychologically abused by some, or all, other members of the dysfunctional family and that any problematic behaviours s/he does display are, in fact, externalizing behaviours brought on by the family’s mistreatment of him/her.
Indeed, one school of thought has been of the view that in families in which an identified patient has been unconsciously designated, it is not the identified patient who is ‘mad’; on the contrary – it is the other family members. In relation to this view, R.D. Laing put forward the notion that such families suffered from ‘a distorted and disturbing pattern of communications.’
It follows from this that therapy, in cases where an identified patient seems to have been selected, should involve ALL family members.
David Hosier BSc Hons; MSc; PGDE(FAHE).