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 unconsciously selected to act out the family's inner conflicts as a diversion; who is the split-off carrier of the (perhaps transgenerational) family disturbance.^[1]

The term is also used in the context of organizational management, in circumstances where an individual becomes the carrier of a group problem.^[2]

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 an excess of painful feelings in a family lead to one member being identified as the cause of all the difficulties - a scapegoating of the IP.^[3]

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, perhaps at the request of the family.^[4] However, while family members will typically express concern over the IP's problems, they may instinctively react to any improvement on the identified patient's part by attempting to reinstate the status quo.^[5]

Virginia Satir viewed the identified patient as a way of both concealing and revealing a family's secret agendas.^[6] Conjoint family therapy stressed accordingly the importance in group therapy of bringing not only the identified patient but the extended family in which their problems arose into the therapy^[7] - with the ultimate goal of relieving the IP of the broader family feelings they have been carrying.^[8] In such circumstances, not only the IP but their siblings as well may end up feeling the benefits.^[9]

R. D. Laing saw the IP as a function of the family nexus: "the person who gets diagnosed is part of a wider network of extremely disturbed and disturbing patterns of communication."^[10] Later formulations suggest that the patient may be an "emissary" of sorts from the family to the wider world, in an implicit familial call for help,^[11] as with the reading of juvenile delinquency as a coded cry for help by a child on his parents' behalf.^[12] There may then be an element of altruism in the IP's behavior - 'playing' sick to prevent worse things happening in the family, such as a total family breakdown.^[13]

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, unconsciously 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 that perhaps the parents, "quite unconsciously...chose to see Dibs as a mental defective rather than as an intensified personification of their own emotional and social inadequacy".^[14]
• 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 sometimes "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".^[15]

Criticism

Extending the original concept of the identified patient, the anti-psychiatry movement went on to argue that it was the family that was mad, rather than the individual the family had identified as `sick'^[16] - positing also that the latter might in fact be the least disturbed member of the family nexus.^[17]

R. D. Laing himself however warned against such idealization of the identified patient.^[18] Family therapists similarly point out that supporting only the identified patient (seen as family scapegoat) merely intensifies the psychological splitting of good and bad already present in the family.^[19]

Literary and biographical

• T. S. Eliot in The Family Reunion says of the protagonist: "It is possible You are the consciousness of your unhappy family, Its bird sent flying through the purgatorial flame".^[20]
• Carl Jung, who viewed the individual neurosis as deriving from the whole familial or social group,^[21] considered himself 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".^[22]

See also

• Rotten kid theorem
• Dysfunctional family
• Fall guy
• Family therapy
• Martti Olavi Siirala
• Münchausen syndrome by proxy
• Narcissistic parents
• Psychological projection
• Role suction
• Sacrificial lamb
• Scapegoating

References

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

Further reading

• Patterson, JoEllen (1998). Essential skills in family therapy: from the first interview to termination. The Guilford Press. ISBN 1-57230-307-7