One of the things I love about blogging, even though I am in my beginning stages and have a very small following, is that I can use my struggles and successes to help others. The following post was so helpful to me, and filled some of my emptiness with understanding, replaced some of my chaos with peace. I have been more honest in my blogs, about what I’m truly experiencing in life. I want someone to stumble across my blog and feel like he or she is more understanding of their situation, their pain. I can only do this by being honest with myself, remaining authentic and transparent through all of this pain I am currently experiencing. The post below is so right-on with one of my lifelong struggles I am working to overcome. I’ve put my personal experience as the Identified Patient in blue text.

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 (drinking at a young age, problems in school, seeking approval in boyfriends) while the rest of the family acts it out in a covert way. Even if the IP tries to act “not sick,” (would have spurts of doing well in school, feeling happy) the family will send messages to “get back where you belong” and set the IP up for failure. (mother’s extreme emotions would control my household, didn’t show gratitude or pride in anything “right” that I did)

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. (I would do the typical teenage rebeling, sometimes acting out of control because inside I felt my life and my sense of security was out of control – I then became the reason for why our home was out of control and was blamed for things going wrong, our mother’s emotions, etc.)

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. (I went to counseling off and on since third grade through high school graduation. When the counselor would suggest that my mother needed therapy or if the counselor suggested things my mother was doing that was the cause of my pain, she would end the session and we would never return to that counselor.)

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. (have felt this all of my life – sick and tired of being sick and tired.) 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. (have never felt truly connected to my family, once in college I really began distancing myself from my mother, simply to survive) IPs tend to gravitate toward other people outside the family system who blame them for everything and keep the focus on them. (string of relationships – friendships and intimate – that allowed me to “act out” my childhood) 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. (no matter what I do – graduating from college, working to support myself, it’s never enough, and my mother among others still pull the same emotional crap even as I pull away. I was hoping it would be a wake-up call that she needs to change or she’ll lose her daughter forever, but she doesn’t.) If you’ve brought it into your relationships, chances are you will not be validated and acknowledged in those adult relationships either. (This is why I am fighting, pushing through therapy. It’s painful to go through, but I want to fill the remainder of my life with healthy, happy relationships.)

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. (Even as a self-sufficient adult out on my own, my mother still talks about me to other family members and who ever is tolerating her at the moment about things I did as a child and teenager.) 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. 🙂

2 thoughts on “The Identified Patient”

  1. Your story is exactly the American as mine. I have read and searched for a while to find someone who is similar to me. I am going through this crazy journey and in the eye of the storm of trying to understand how to deal with my narcissist sister and mother. They will never ever see things differently. They only see what they always have and that in their eyes I am black sheep, the problem. Thankfully I have been awaken to the truth and realized the label given to me is not at all who I truly am. My mother is almost robotic in her reaction to any kind of emotion. To the point it is so very predictable in how she will react to things. I lived a life where my i.p. label was the only identity I had and my family lived inside my head always feeding me with negative thoughts and never being enough. I am in therapy and thriving. I just dont really know what to do with myself at the moment. It is rediscovering myself and its awesome but very extremely lonely too. I have a wonderful husband who is supportive to the core. However it would be nice to connect with someone that can relate to where I am at mentally. It had been a few months since the aha moment of learning I was the ip. Everythinf finally made since. But I have to leave my family behind because they can’t get beyond their own egos and narc. Tendencies. They are like they walked straight out of a phycology text book as far as their denial snd gas lighting and blaming. Never ever apologize. It is like showing a vampire their reflection. It is not there. They are like robots almost on a continuous cycle that thankfully I finally have stepped out of…but now what?

    1. Kristin Mitchener

      I remember when I learned I was the IP. It was validating and sad. At the end of the day, we were failed. In every way. And we are still having to pay for our mothers’ ways. It sucks. It’s not fair. But it’s the reality. To stay healthy I say stay away – distance yourself from people who do not add value to your life, even if that means 100% NC (no contact). I soooo feel for you – I’m sorry you are dealing with this. I, too, have a supportive husband. Remember your vows – you are now one, so don’t go at this alone. Just yesterday a dear friend was telling me I need to open up to my husband more so he can more fully support me. Look to the people who build you up, and let them support you. Remember to care for the little girl who still exists inside of you. To do that, care for yourself and love yourself. To do that, still trying to figure that out. But the fact that you are reading and thinking and commenting tells me that you are strong and you want more for yourself. You will find your way (with your husband beside you). Sending so much peace and love your way!

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