What Is A Family Symptom Bearer?
In psychology, the term ‘family symptom bearer’ essentially refers to a scapegoat in the family who displays psychiatric problems brought on by the extreme dysfunction, especially with regard to communication, of the family as a whole.
In other words, the family symptom bearer is a kind of conduit through which the psychological problems of the whole family unit are expressed.
It is also suggested that the dysfunctional family of the family symptom bearer is unconsciously motivated to ensure his/her status as the mentally ill member of the family is maintained and that his/her mental illness does not improve…
But why should this be?
One theory is that identifying one family member as ‘the mentally ill one’ detracts attention from the psychological problems of the other family members, of which they may feel ashamed or wish to conceal for other reasons (perhaps wanting to put out the coded message: ‘we’re not the problem, s/he is!’).
“Too much sanity may be madness — and maddest of all: to see life as it is, and not as it should be!”
Often, however, the family symptom bearer is the least psychologically disturbed of the family on many levels and may have the greatest insight into the disturbed family’s extreme dysfunction – making him/her a kind of ‘family truth revealer’, in effect.
The psychiatrist RD Laign suggested that certain family members may have an unconscious need to take on and maintain a caretaker role, due to their own inadequacies, which motivates them (again, on an unconscious level) to prevent the family symptom bearer from recovering. Furthermore, the focus on the family symptom bearer helps to avoid a focus on, and analysis of, the toxic interactions of the family as a whole.
It is also suggested that the family symptom bearer is, in effect, acting out and representing in a tangible manner the whole family’s psychological problems.
The family may frequently deny that the family symptom bearer’s psychiatric problems are a representation and expression of the whole family’s pathological interactions, scapegoat him/her, deem him/her a destructive influence, troublesome and difficult and even exclude him/her from the family, thus evading their own culpability.
The family symptom bearer’s response to the dysfunctional family is, however, unwilled, non-deliberate and unconsciously driven – often, too, s/he is the most sensitive and vulnerable of all the family members.
Frequently, the family symptom bearer has suffered abuse from his/her family and will have unprocessed trauma issues; s/he is also at increased risk of developing problems relating to excessive alcohol and/or drug consumption.
It is important to note that the family symptom bearer’s problems are the RESULT OF WIDER FAMILY PROBLEMS, NOT THE CAUSE OF THEM.
It is therefore vital that the family symptom bearer’s psychiatric difficulties are analyzed in the context of the dysfunctional family dynamics responsible for their genesis ideally by the means, in most cases (if the family is amenable), of intensive family therapy.
DID YOUR DYSFUNCTIONAL FAMILY MAKE YOU THE ‘IDENTIFIED PATIENT’?
‘The person [in the family] who gets diagnosed is part of a wider network of extremely disturbed and disturbing patterns of communication’
BATESON PROJECT :
It has been theorized (originally in the 1950s as part of the Bateson Project, led by Gregory Bateson), 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 onto a family scapegoat.
What Is ‘Projection?
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)
An example of projection would be a very selfish person who constantly accuses others of being selfish and, indeed, sees selfishness in others everywhere she or he looks.
In this way it is a type of blame-shifting – the family displaces 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 she or he is the youngest, most vulnerable, weakest and sensitive member of the family.
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 as 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 the 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 she or 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.’
And, indeed, the anti-psychiatry movement of which R.D. Laing (see above) was a leading part, suggested that, frequently, it was the family of the identified patient who was ‘mad’, and the identified patient the ‘most sane’, having the insight that is lacking in the other family members.
It follows from this that therapy, in cases where an identified patient seems to have been selected, should involve ALL family members.
Indeed, one such therapy, based on the views of Virginia Satir, is called FAMILY SYSTEMS THERAPY and it emphasizes the idea that the identified patient, although having been consciously or unconsciously selected by the family to distract attention from the dysfunction of the family as a whole, may also hold the key to gaining insight into the family’s so-called ‘secret agenda).
FAMILY SYSTEMS THEORY AND THE FAMILY SCAPEGOAT
FAMILY SYSTEMS THEORY :
FAMILY SYSTEMS THEORY was developed by the American psychiatrist, Murray Bowen (1913-1990). The theory proposes that :
a) The family acts as a highly complex system
b) This system is made up of family members who are emotionally intertwined
c) The ‘units’ of the system (i.e. the emotionally intertwined family members) interact in highly complex ways
d) Family members, through emotional interaction, affect each other’s thoughts, behaviours and emotional states (though are often unaware of the degree to which this process is taking place)
e) Some family members are more emotionally interconnected than others, but all are emotionally interconnected to some extent.
THE EFFECTS OF ANXIETY PERMEATING THE FAMILY SYSTEM :
When one or more of the family members become anxious, the anxiety becomes ‘contagious’ and ‘infects’ other members of the family. As the level of anxiety increases, so, too, do the emotional interactions between family members become correspondingly, increasingly stressful.
Eventually, a particular family member (the most sensitive and vulnerable) starts to absorb the majority of the anxiety produced by the family system which puts this person at risk of developing various forms of mental illness including depression and anxiety disorders. In this way, this individual acts as a kind of ‘container’ or ‘vessel’ into which the lion’s share of the stress and anxiety generated by the entire family system is poured; this process, in turn, can result in him/her becoming the ‘family symptom bearer’ / ‘family scapegoat’ / ‘family black sheep’ (see related article recommendations below).
I provide an example of how this can play out below :
Let’s take a hypothetical family consisting of four members: mother, father, oldest son (age 16), and youngest son (age 14). Now, let’s imagine the following scenario :
The family functions relatively well until the parental marriage comes under strain. The stress and anxiety generated by this marital friction permeates the whole family.
In response to the increased anxiety in the family home, the father spends much more time at the office, becoming a workaholic; the mother, to distract herself and bolster her self-esteem and self-image, throws herself into charity work and religious activities; the oldest brother cuts off from the family, spending his time in his bedroom listening to music or doing homework (when he is not bullying his younger brother); the youngest son responds by getting drunk, taking drugs, getting into fights and becoming involved in petty crime.
The family then identify the youngest son as being at the root of the family problems and decide they should all attend family therapy sessions.
However, the family therapist points out that the youngest son is NOT, in fact, the source of the family’s problems, and that therapy can only work if all family members face up to their own specific problems.
However, the father, mother and older brother do not wish to entertain the idea that they might have anything to do with the way in which the family has become dysfunctional, insisting, instead, that it is the youngest son who needs to be ‘fixed’, certainly not any of them!
Having made their feelings on the matter abundantly clear, the family then terminates the family therapy. Permanently.
Because the family is still convinced that the youngest son is, as it were, ‘the root of all evil’, the family pack him off to a psychiatric hospital for a couple of months.
Due to the fact that the youngest son is now away from the malign influence of the family atmosphere (rather than due to any treatment the hospital attempts to provide proactively) the youngest son’s psychological condition improves considerably. Eventually, therefore, his family (magnanimously, in their own grossly distorted and self-serving view) grant him permission to return home.
However, when the son does return home because the other family members have failed to acknowledge, let alone address, their own issues, the youngest son’s psychological condition deteriorates again and things go from bad to worse…
In other words, it is the system as a whole that needs to be ‘repaired’, not just one part of it (i.e. the family member displaying the most inconvenient, and least socially acceptable, symptoms / psychological defenses).
Bateson, G., Jackson, D., Haley, J., & Weakland, J. (1956). Toward a theory of schizophrenia. Behavioral Science, 1,
Bowen, Murray (1966), “The Use of Family Theory in Clinical Practice”, Family Therapy in Clinical Practice (reprint ed.), Lanham, MD: Rowman & Littlefield (published 2004), pp. 147–181, ISBN 0-87668-761-3
Bowen, Murray (1974), “Toward the Differentiation of Self in One’s Family of origin”, Family Therapy in Clinical Practice (reprint ed.), Lanham, MD: Rowman & Littlefield (published 2004), pp. 529–547, ISBN 0-87668-761-3
R. D. Laing, The Politics of Experience (Penguin 1984)
David Hosier BSc Hons; MSc; PGDE(FAHE).
Holder of MSc and post graduate teaching diploma in psychology. Highly experienced in education. Founder of childhoodtraumarecovery.com. Survivor of severe childhood trauma.