Identified patient

Identified patient, or "IP", is a term used in a clinical setting to describe the person in a dysfunctional family who has been subconsciously selected to act out the family's inner conflicts in order to keep attention focused on an element that lies outside of the core conflict - who is 'often the split-off carrier of a breakdown in the entire family system...transgenerational'.^[1]

Origins and characteristics

The term emerged from the work of the Bateson Project on family homeostasis, as a way of identifying a largely unconscious pattern of behavior whereby 'if the painful feelings among the family members increase past a certain point...they may pick on one family member and blame him or her for all the discomfort..."scapegoating"'^[2] and thereby creating the IP. 'Satir...saw the identified patient as manifesting an outward sign of the intrapsychic and interpersonal problems within the family system...preserving - while paradoxically revealing - the family's secrets, agendas, and processes'.^[3] Conjoint family therapy stressed accordingly the importance in group therapy that 'the "identified patient", and all the other members of his family attend - his parents and his brothers and sisters, and his uncles and aunts and his grandparents too'^[4] - on the grounds that 'it's hard to treat the scapegoat unless the whole family can be persuaded to take back the bad feelings that he's carrying'.^[5]

The identified patient - also called the "symptom-bearer" or "presenting problem" - may display unexplainable emotional or physical symptoms, and is often the first person to seek help, often at the request of the family.^[6] However, while family members will typically express concern over the IP's problems, 'at the first hint of a change in the status quo, including the temporary relief of symptoms in the identified patient, they will instinctively react in some way to stabilize the pattern that has worked for them in the past'.^[7] If therapy or 'the group is successful, not only will the identified patient improve, but his brothers and sisters...will benefit as well'.^[8]

The concept was taken up by R. D. Laing and his collaborators with respect to the family nexus, confirming how 'the person who gets diagnosed is part of a wider network of extremely disturbed and disturbing patterns of communication'.^[9] Later formulations suggest that 'the patient may usefully be viewed as a sort of "emissary"...to the outside world, whose implicit task is to find help for others in the family'.^[10] Commensurate with such a view is the reading of juvenile delinquency wherein 'frank misbehaviour...should be perceived as a cry for help by the child on behalf of his parents': the delinquent IP can be seen 'as the individual personification of themes relating to the repeated loss of, and repeated mourning for, the good authority...in his family'.^[11]

It has similarly been suggested that 'there's also a core of altruism and self-sacrifice in the scapegoat's behaviour...the "sick one" senses that playing their scapegoat role is often preventing even worse things happening, like the destruction of the marriage and break-up of the family'.^[12]

Examples

• In a family where the parents need to assert themselves as powerful figures and caretakers, often due to their own insecurities, they may designate one or more of their children as being inadequate, subconsciously assigning to the child the role of someone who cannot cope by themselves. For example, the child may exhibit some irrational problem that requires the constant care and attention of the parents.
• In Dibs, an account of a child therapy, Virginia Axline considered with respect to the parents that 'perhaps, quite unconsciously, they chose to see Dibs as a mental defective rather than as an intensified personification of their own emotional and social inadequacy'.^[13]
• A child may be regarded as a bully and a troublemaker in school and labeled a "problem child," when he may in fact be expressing conflicts and problems, such as abuse from home, by acting out and being "bad."
• Gregory Bateson considered that in some instances 'the identified patient sacrifices himself to maintain the sacred illusion that what the parent says makes sense', and that 'the identified patient exhibits behavior which is almost a caricature of that loss of identity which is characteristic of all the family members'.^[14]

Jung

Jung independently concluded that a neurosis 'comes from the totality of a man's life...from his psychic experience within the family or even his social group',^[15] and saw himself as something of a case in point: 'I feel very strongly that I am under the influence of things or questions which were left incomplete and unanswered by my parents and grandparents and more distant ancestors...an impersonal karma within a family, which is passed on from parents to children'.^[16]

Criticism

'The anti-psychiatry movement of the Sixties...proposed the theory that it was families that were mad rather than simply the individuals who were scapegoated by them as the "sick member"',^[17] thereby extending the original boundaries of the IP concept. 'From this position, it was a short hop, given the ethos of the Sixties, to doubting the normality of normality itself...the mad were the super-sane'.^[18] Laing might insist overtly that it is 'not necessarily the case that the person who is "out of formation" is more "on course" than the formation. There is no need to idealize someone just because he is labelled "out of formation"'.^[19] In practice, however, he and his followers tended to claim that 'more often than not, a person diagnosed as "mentally ill" is the emotional scapegoat for the turmoil in his or her family or associates, and may, in fact, be the "sanest" member of this group...the least disturbed member of the entire group'.^[20]

Later and perhaps soberer family therapists would insist by contrast that 'you mustn't take anyone's side....That's why I believe the ideas of R. D. Laing and Cooper have done a lot of harm. It's natural, from an emotional point of view, to side with the scapegoat, but...it doesn't work. Supporting only the scapegoat makes the rest of the family less secure, more paranoid, even less able to "own" their bad feelings'.^[21]

Literary analogues

In The Family Reunion, the protagonist is told, 'It is possible You are the consciousness of your unhappy family, Its bird sent flying through the purgatorial flame', and comes to see his life as 'a dream Dreamt through me by the minds of others'.^[22]

See also

• Dysfunctional family
• Family therapy
• Martti Olavi Siirala
• Münchausen syndrome by proxy
• Narcissistic parents
• Psychological projection
• Scapegoating

References

1. ^ Peter L. Rudnytsky, Reading Psychoanalysis (2002) p. 44
2. ^ Robin Skynner/John Cleese, Families and how to survive them (London 19940 p. 103
3. ^ Sara E. Cooper, The Ties that Bind (2004) p. 17
4. ^ Eric Berne, A Layman's Guide to Psychiatry and Psychoanalysis (Penguin 1976) p. 295
5. ^ Skynner/Cleese, Families p. 104
6. ^ "Dysfunctional family", Encyclopedia of Psychology, April 6th, 2001, http://findarticles.com/p/articles/mi_g2699/is_0004/ai_2699000448/
7. ^ Cooper, p. 17
8. ^ Berne, p. 295
9. ^ R. D. Laing, The Politics of Experience (Penguin 1984) p. 94
10. ^ S. H. Buckman/A. S. Gurman, Theory and Practice of Brief Therapy (2002) p. 93
11. ^ T. Pitt-Aikens/A. T. Ellis, Loss of the Good Authority (London 1989) p. 89, p. 118, and p. 185-6
12. ^ Robin Skynner/John Cleese, Life and how to survive it (London 1994) p. 38
13. ^ Virginia Axline, Dib:; In Search of Self (Penguin 1975) p. 80
14. ^ Gregory Bateson, Steps to an Ecology of Mind (1972) p. 237 and p. 243
15. ^ Quoted in David Sedgwick, Introduction to Jungian Psychotherapy (London 2006) p. 63
16. ^ C. G. Jung, Memories, Dreams, Reflections (London 1983) p. 260
17. ^ Jenny Diski, The Sixties (London 2009) p. 126
18. ^ Diski, p. 126-8
19. ^ Laing, p. 98
20. ^ Mary Barnes and Joseph Berke, Mary Barnes 9Penguin 1974) p. 84 and p. 91
21. ^ Robin Skynner/John Cleese, Families and how to survive them (London 1994) p. 106
22. ^ T. S. Eliot, The Complete Poems and Plays (London 1985) p. 333

Further reading

• Patterson, JoEllen (1998). Essential skills in family therapy: from the first interview to termination‎. The Guilford Press. ISBN 1572303077