Being the Identified Patient II

I wrote this post a long time ago and so many of my readers seem to be struggling with this I wanted to rerun it. Dance everyone!

If you cannot get rid of the family skeleton, you may as well make it dance. – George Bernard Shaw

Sometimes we are the family skeleton, the black sheep, the shame of the clan. Many times it’s because the clan is completely nuts. A dysfunctional family needs someone to focus on, someone to blame things on, someone to point to when things go wrong. In clinical settings, we call that person the “identified patient” or IP. It means that in a sick family system, the group has subconsciously elected one person to act out all the family sickness in a very overt way while the rest of the family acts it out in a covert way. Even if the IP tries to act “not sick,” the family will send messages to “get back where you belong” and set the IP up for failure.

Before you know it, the identified patient is acting out AGAIN and the family is shocked (simply SHOCKED! that the person they set up to be the IP is acting like an IP). The IP does the bidding of insanity for the whole family.

It’s not that the identified patient is any sicker than the rest of the family, in fact they probably aren’t, but they are the one through whom the family channels all of its “stuff.” The family dynamic is to keep things status quo, to keep its eyes trained on the IP.

I once went to conduct an emergency evaluation on a 17 year old girl who had not come home all night and was brought to the Emergency Room so that someone could figure out what was wrong with her. I was met by her parents, a father who had obviously been drinking and looked a lot older than he was due to alcoholism and a co-alcoholic, codependent mother who was angry and upset. During the evaluation I knew the kid was the IP in an alcoholic family and that the family was focused on her and her wayward ways and insolent mouth because they could not look at themselves and dad’s alcohol problem and mom’s complicity in it.

They didn’t like it when I explained the problem was not her. I took her aside and suggested she go to Alateen and try to survive the rest of the year with her family. Her mother was furious at me that I was taking the kid’s side.

And so it is with the dysfunctional family system. The daughter’s behavior was actually a pretty normal and healthy response to craziness: ie I want to get out of here and not explain a thing to these people. But the family couldn’t see that and couldn’t see their own sickness which was much worse than any of the kids’ issues.

Usually the one who gets help first in the family is the IP. They get out of the family and find out what is wrong because they are tired of being blamed for everything and everyone. Usually their acting out is a normal response to an abnormal situation and they want help.

It is actually a blessing to be the IP in the family. It keeps you at a distance from the craziness and gives you a chance to get out of it. IPs tend to gravitate toward other people outside the family system who blame them for everything and keep the focus on them. But at some point the IP says, “I have had enough of this.” and move away from that person who is all too familiar (ie like family). Even if you’re not the IP, part of recovery is identifying who you were in the family and how you have carried that role into adulthood. See how your role in the family plays itself out in your current relationship and ask yourself if it’s time for a change.

Being the IP or the one that doesn’t belong can be a blessing. If you’ve never belonged, it’s easy to take a step in another direction. Take refuge in exile. It can be a good thing.

If you’ve been the IP, realize you’re never going to win their approval, so stop trying. You have a role to fill and they’re not going to be happy if you’re not filling it. If you’ve brought it into your relationships, chances are you will not be validated and acknowledged in those adult relationships either.

Stop seeking approval from people who don’t have it to give. Throw off those old messages…get rid of the negative messages from the family…get rid of “get back where you belong” everytime you try to save yourself. It’s okay. As the saying goes, “Explain nothing to nobody.”

You may be the family skeleton…the one they keep under wraps and try to explain away.

You may play a very specific role for them and they are going to be very upset when you step out of that role, but if you are the family skeleton: DANCE. 🙂

This entry was posted in family therapy, hero, identified patient, lost child, recovery, role, scapegoat, triad. Bookmark the permalink.

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