Do you feel like you were (or are) the black sheep in your family? Do you constantly feel misunderstood by your parents or siblings? Does it seem like problems at home were always your fault?
If so, you may have been the identified patient. This is a common term in family therapy, and it describes how the family pinpoints dysfunction and blame onto one person. Unfortunately, the role can persist throughout life and cause serious problems.
Here's what you should know.
Why Do Identified Patients Exist?
Not every family has an identified patient. However, they do tend to be common in more dysfunctional systems. For example, if one of your parents had a mental illness- or if trauma and chaos were constant in the household- someone may have been scapegoated for those problems.
Identified patients "carry" the family's pain. They do this subconsciously by acting out the problems and eventually believing that they genuinely are the issue in the home.
This dynamic maintains a sense of familiar homeostasis for everyone else. The rest of the family can carry on believing that the identified patient is the main problem. As a result, they can avoid looking inward and working to change themselves.
Were You The Identified Patient?
How do you know if you were the scapegoat in the family? Some people just know. They fully remember being bullied or blamed for all the family's dysfunction. They have vivid memories of being ostracized or shamed for who they are.
Other times, families are more covert and insidious in how they shape their dynamics. That said, here are some signs you may have been targeted.
Feeling Detached and Lonely
Most identified patients recognize feeling chronically misunderstood within their families. They often grew up feeling like nobody cared about them (or that people only cared about what they did wrong).
You may feel literally different from other people in your family. For example, if you struggle with addiction and nobody else in your family does, you may feel that trait alienates you. Or, if you had a difficult time in school while the rest of your siblings coasted with excellent grades, you might believe that you're somehow inferior or inadequate.
This loneliness can exacerbate more problems. You might have coped with this feeling by numbing yourself or turning to other destructive coping strategies. You may have also leaned on another support system beyond your immediate family. Unfortunately, these support systems may not have been positive influences.
Feeling Chronically Insecure
It probably comes as no surprise that many identified patients lack a core sense of self. As a result, they might feel uncertain and afraid to take risks. They worry that others won't like them (or that even their friends find them burdensome). They feel like they will fail- no matter how hard they try.
Feeling insecure is painful as a child, and it's just as defeating as an adult. If you struggle with this right now, it may be because you genuinely assumed nobody believed in you. And when people don't believe in you, it's tough to believe in yourself.
It's very possible that you felt like you received unfair treatment at home. For example, maybe your parents were overly strict with you, but they were lenient with your sister. Or, they simply paid more attention to other siblings- while only paying attention to you when you got into trouble.
Either way, you may have internalized that the home is unsafe. Therefore, the world starts to feel unsafe. You may experience immense rage and confusion (without knowing its origin) because of this kind of upbringing. Often, these feelings begin at a young age, long before you can even articulate how they influence you.
Feeling Lost in Relationships
How satisfied do you feel in your current relationships? If you're like most identified patients, you might find it extremely difficult to form secure attachments with others.
Instead, you might present as extremely guarded or aloof. Intimacy may be challenging, as you never know who you can genuinely trust. You might struggle to communicate your needs because you don't believe anyone cares about them.
Or, you may come across as incredibly clingy and devoid of boundaries. This can happen when you feel desperate for connection- you're willing to sacrifice the time and effort it takes to build a relationship for instant intimacy.
How Do You Move On From Your Role?
Families will often maintain having an identified patient throughout generations. This decision isn't conscious- it's simply a diversion tactic. Having someone else "be the problem" abdicates them from inner responsibility and anguish.
Therefore, healing from this role requires awareness and commitment. You need to become aware of how it affects your well-being while also committing to practicing more kindness towards yourself, setting healthy limits, and avoiding future patterns of scapegoating others yourself.
Despite your upbringing, you can feel supported and validated. You can grow from your pain. At The Resurface Group, we are here for you. Contact us today to learn more!