The person [in the family] who gets diagnosed is part of a wider network of extremely disturbed and disturbing patterns of communication’

R.D. Laing




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 defense 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 / ignored us / treated us dismissively
  • labeled us as a ‘problem child’ and/or ‘trouble maker, ‘ responsible for all the family’s ills’ and its external locus of control
  • over-emphasized our faults whilst, simultaneously, ignoring or minimizing our strengths, qualities, and accomplishments
  • blamed us not only for our own problems (that have arisen due to family dysfunction and are therefore symptoms of this dysfunction) but for the problems and mistakes of the entire family. In this way, parents seek to exempt themselves from all responsibility or accountability.
  • made us the receptacle of all the family’s unconscious, shared failings
  • made us the target of all the family’s malice In relation to being treated with malice by other family members, you may wish to read my article on sadistic mothers
  • made us feel stigmatized
  • stonewalled us if we tried to make other family members aware of the reality of the family’s dysfunction as a whole
  • frozen us out and ostracized us
  • made us function as ‘black sheep of the family and the scapegoat so as to exonerate and remove the onus of responsibility from themselves
  • because other family members have a vested interest in our remaining emotionally distressed and ‘ill’ they reinforce this signs of this state by only showing positive affect (which may take on the form of infantilizing care) when we are ‘broken’ and ‘sick’. Any attempt to diverge from this designated role is not tolerated and is likely to be deliberately undermined for fear that it will interfere with the family homeostasis
  • made to feel isolated and alone and to suffer from ‘traumatized loneliness‘ which, in turn, reinforces feelings of shame
  • made us feel marginalized, disenfranchised and alienated
  • made us the recipient of mockery, scorn, contempt, disdain, and derision

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 behaviors she or he does display are, in fact, externalizing behaviors 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).


David Hosier BSc Hons; MSc; PGDE(FAHE).