Backstory to this post: I wrote this post in 2007 and have edited and rerun it about 10 times since – often in response to a client or a reader or listener struggling with being the scapegoat in the family. This one is for my awesome co-mod and anyone else struggling with this. Dance everyone!
Being The Identified Patient
by Susan J. Elliott, J.D., M.Ed.
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. As a person who WAS the IP in my family of origin – the only adopted one in a family of biological children – I can recognize an IP at 20 paces.
Runaway Kids Run Away For a Reason
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. I could see 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 the daughter 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. I honestly thought that she was going to hit me and when she came at me, breath smelling like alcohol, fists at her side, red faced and yelling, as she got about 2 inches from me, I said calmly, “If you hit me, I’m going to hit you back and lay you out.” She backed away but she was very, very angry.
It was not the first time I had been in that situation with a mother who thought I was making a huge mistake and had things all wrong. The last time I was in a situation where a mother wanted to hit me, she had brought the child, a boy of 14, to be evaluated. He had gotten in trouble and run away from home. She brought him to us so that we could lecture him, tell him he was the problem and send him home, duly chastened and frightened into straightening up and flying right.
She wanted me to threaten him with things like jail, boys home, reform school and the like. But after interviewing the kid, something was off. I couldn’t tell exactly what it was, but something was going on with this kid. I wanted the opportunity to speak to him further but the mother was hovering around the outside of the room and he seemed very nervous about it.
I needed more time with the kid, outside of hearing range of his mother. It was the middle of the night and the ER staff was small and the night was busy. I had to wait to speak to the ER doctor who was off doing other things. As I waited I told the mother I wanted to speak to the doctor and have another talk with her son. She went crazy and came at me. Again I told her, you hit me and I’m hitting you back. She was screaming at me in the hallway of the ER. She wanted me to tell the kid to straighten up and send him home.
The mother did not plan on ME, the Former Identified Patient from Hell, to interfere with her plans. The ER staff managed to get her away so I could talk to him alone and the doctor did a second exam (medical clearance for a psych eval is usually very basic). Between my second interview and the doctor’s closer examination, we determined the boy was being abused. He had bruises all over him. He was not going home that night.
Stop the World, I Want To Get Off
And so it is with the dysfunctional family system. These kids were having NORMAL responses to crazy family behavior. i.e. 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.
The P.S. to the first story, with the girl, is that months later I was called to the VA hospital to do a psychological evaluation on someone who was going in for a medical detox. This was a different hospital in a town not very close to where we were in the first situation, so I’m sure that the family was as surprised to me as I was to see them.
The mother, now sober, looked sheepish. The daughter grinned from ear to ear. The father, somewhat coming down from his drunk, was still angry as all get out. He didn’t remember me. Surprise. I did the evaluation, cleared him for detox, and was getting ready to leave when the mother stopped me in the hallway–to thank me. I didn’t lecture her or talk about her codependency but gently suggested she go to Al-anon and to family counseling, if not with her husband, with her daughter. I told her the VA would have them in for family counseling and they needed to focus on the family – I told her that her child was a really good kid. She asked me to have a word with her daughter and when I did, the daughter told me she had been going to Alateen – without her parents’ knowledge – and really liked it and thanked me for not going along with other therapists and her school counselor who had said SHE was the issue. She wanted to go to college and be a counselor. I was happy to have a win for the home team.
I am not blowing my own horn when I say that I have no doubt many other professionals would have handled these two situations differently. I saw it many times. I have no doubt many other professionals would have deemed each of these kids the problem. But my experience as the Identified Patient allowed me to rescue these two kids. And although each mother wanted to take a swing at me, it was worth it (and I am confident I would have decked them if they had).
Being The IP Helps You Get Out From Under
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. I was in therapy due to being abused by my family and then my husband. Most of my acting out – as a child, as a teenager, and as an adult, was a cry for help.
On the Mean Lady Talking podcast , I have recounted, on several episodes, the times my mother beat the hell out of me.The last time she attacked me, my sister pulled her off of me, screaming, “You’re going to KILL her!” and I have no doubt she would have if there was not interference. Like those kids in the ER, I just wanted to run away. I knew what was behind wanting to run away.
I created the GPYB program from my experience as a scapegoat and as someone who grew and learned all about the nuttiness in the alcoholic family system. Being the only non-biological child in my adoptive family, it was EASY to be elected scapegoat. There was no other option for me. I never felt as if I belonged there so it was easy to break away and seek help. It was easy to say, “I NEED HELP.” As a therapist, I was able to use my experience AND my education to help others. I saw many other professionals completely miss the mark. They had been blessed with good, healthy families and had never been to therapy. But that caused a blind spot in them that led to making crucial mistakes as a therapist. If you have a therapist who has never been to therapy, get another therapist!
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.
Do your affirmations the GPYB way. Go to the GPYP workbook  and work on your affirmations, life inventories, parent inventories, boundaries exercises and defense mechanism exercises (IPs have a lot of defense mechanisms!) GPYB is designed for everyone, but especially for the IPs among us. I have your back. Do the program and you will have NO WORRIES!
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” every time 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. 🙂