Identified patient
Encyclopedia
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'.
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"' 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'. 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' - 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'.
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. 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'. If therapy or 'the group is successful, not only will the identified patient improve, but his brothers and sisters...will benefit as well'.
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'. 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'. 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'.
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'.
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', 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'.
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"', 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'. 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"'. 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'.
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'.
, 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'.
Dysfunctional family
A dysfunctional family is a family in which conflict, misbehavior, and often abuse on the part of individual members occur continually and regularly, leading other members to accommodate such actions. Children sometimes grow up in such families with the understanding that such an arrangement is...
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'.
Origins and characteristics
The term emerged from the work of the Bateson ProjectBateson Project
The Bateson Project was the name given to a ground-breaking collaboration organized by Gregory Bateson beginning in 1953 which was responsible for some of the most important papers and innovations in communication and psychotherapy in the 1950s and early 1960s. Its members were Gregory Bateson,...
on family homeostasis
Homeostasis
Homeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...
, 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"' and thereby creating the IP. 'Satir
Virginia Satir
Virginia Satir was an American author and psychotherapist, known especially for her approach to family therapy and her work with Systemic Constellations...
...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'. 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' - 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'.
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. 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'. If therapy or 'the group is successful, not only will the identified patient improve, but his brothers and sisters...will benefit as well'.
The concept was taken up by R. D. Laing and his collaborators with respect to the family nexus
Family nexus
The term family nexus was used by the psychiatrist R D Laing to describe a common viewpoint held and reinforced by the majority of family members regarding events in the family and relationships with the world...
, confirming how 'the person who gets diagnosed is part of a wider network of extremely disturbed and disturbing patterns of communication'. 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'. Commensurate with such a view is the reading of juvenile delinquency
Juvenile delinquency
Juvenile delinquency is participation in illegal behavior by minors who fall under a statutory age limit. Most legal systems prescribe specific procedures for dealing with juveniles, such as juvenile detention centers. There are a multitude of different theories on the causes of crime, most if not...
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'.
It has similarly been suggested that 'there's also a core of altruism
Altruism
Altruism is a concern for the welfare of others. It is a traditional virtue in many cultures, and a core aspect of various religious traditions, though the concept of 'others' toward whom concern should be directed can vary among cultures and religions. Altruism is the opposite of...
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'.
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 DibsDibs in Search of SelfDibs in Search of Self is a true story by psychologist and author Virginia Axline. It chronicles a series of play therapy sessions over a period of one year with an emotionally crippled boy who comes from wealthy and highly educated family who, in spite of obvious signs that he is gifted, his...
, an account of a child therapy, Virginia AxlineVirginia AxlineVirginia M. Axline was a psychologist and one of the pioneers in the use of Play Therapy. She wrote the book Dibs In Search Of Self. She was also the author of Play Therapy....
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'. - 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 abuseAbuseAbuse is the improper usage or treatment for a bad purpose, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as: physical or verbal maltreatment, injury, sexual assault, violation, rape, unjust practices; wrongful practice or custom; offense; crime, or otherwise...
from home, by acting outActing outActing out is a psychological term from the parlance of defense mechanisms and self-control, meaning to perform an action in contrast to bearing and managing the impulse to perform it. The acting done is usually anti-social and may take the form of acting on the impulses of an addiction Acting out...
and being "bad." - Gregory BatesonGregory BatesonGregory Bateson was an English anthropologist, social scientist, linguist, visual anthropologist, semiotician and cyberneticist whose work intersected that of many other fields. He had a natural ability to recognize order and pattern in the universe...
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'.
Jung
JungJung
Carl Jung was a Swiss psychiatrist, an influential thinker and the founder of analytical psychology.Jung may also refer to:* Jung * JUNG, Java Universal Network/Graph Framework-See also:...
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', 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
Karma
Karma in Indian religions is the concept of "action" or "deed", understood as that which causes the entire cycle of cause and effect originating in ancient India and treated in Hindu, Jain, Buddhist and Sikh philosophies....
within a family, which is passed on from parents to children'.
Criticism
'The anti-psychiatryAnti-psychiatry
Anti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...
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"', 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'. 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"'. 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'.
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
David Cooper (psychiatrist)
David Graham Cooper was a British psychiatrist, theorist and leader in the anti-psychiatry movement....
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'.
Literary analogues
In The Family ReunionThe Family Reunion
The Family Reunion is a play by T. S. Eliot. Written mostly in blank verse, it incorporates elements from Greek drama and mid-twentieth-century detective plays to portray the hero's journey from guilt to redemption. The play was unsuccessful when first presented in 1939, and was later regarded as...
, 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'.
See also
Further reading
- Patterson, JoEllen (1998). Essential skills in family therapy: from the first interview to termination. The Guilford Press. ISBN 1572303077