Identified patient
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Identified patient (IP) is a clinical term often heard in family therapy discussion. It describes one family member in a
dysfunctional family A dysfunctional family is a family in which conflict, misbehavior, and often child neglect or abuse and sometimes even all of the above on the part of individual parents occur continuously and regularly, leading other members to accommodate suc ...
who expresses the family's authentic inner conflicts. Usually, the "designated patient" expresses their unconsciously, unaware they are making overt dysfunctional family dynamics that have been covert and which no one can talk about at home. Occasionally, the identified patient is partly conscious of why and how they have become the focus of concern in the family system. As a family system is dynamic, the overt symptoms of identified patient draw attention away from the "elephants in the living room no one can talk about" which need to be discussed, such as a pending separation or divorce. If covert abuse occurs between family members, the overt symptoms can draw attention away from the perpetrator(s). The identified patient is a kind of diversion and a kind of scapegoat. Often a child, this is "the split-off false carrier of a breakdown in the entire family system," which may be a transgenerational disturbance or
trauma Trauma most often refers to: * Major trauma, in physical medicine, severe physical injury caused by an external source * Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic i ...
.


In organizational management

The term is also used in analyzing dysfunction in businesses where an individual becomes the carrier of a group problem.


Origins and characteristics

The term emerged from the work of the Bateson Project on family
homeostasis In biology, homeostasis (British English, British also homoeostasis) Help:IPA/English, (/hɒmɪə(ʊ)ˈsteɪsɪs/) is the state of steady internal, physics, physical, and chemistry, chemical conditions maintained by organism, living systems. Thi ...
, 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. 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."Dysfunctional family", ''Encyclopedia of Psychology'', April 6, 2001, http://findarticles.com/p/articles/mi_g2699/is_0004/ai_2699000448/ 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.
Virginia Satir Virginia Satir (26 June 1916 – 10 September 1988) was an American author and psychotherapist,http://www.psychologistanywhereanytime.com/famous_psychologist_and_psychologists/psychologist_famous_virginia_satir.htm recognized for her approach to ...
, the wellspring of family systems theory, who knew Bateson, viewed the identified patient as a way of both concealing and revealing a family's secret agendas. 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 – with the ultimate goal of relieving the IP of the broader family feelings they have been carrying. In such circumstances, not only the IP but their siblings as well may end up feeling the benefits.
R. D. Laing Ronald David Laing (7 October 1927 – 23 August 1989), usually cited as R. D. Laing, was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis. Laing's views on the causes and treatment o ...
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." 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, as with the reading of
juvenile delinquency Juvenile delinquency, also known as juvenile offending, is the act of participating in unlawful behavior as a minor or individual younger than the statutory age of majority. In the United States of America, a juvenile delinquent is a person ...
as a coded cry for help by a child on their parents' behalf. There may then be an element of
altruism Altruism is the principle and moral practice of concern for the welfare and/or happiness of other human beings or animals, resulting in a quality of life both material and spiritual. It is a traditional virtue in many cultures and a core as ...
in the IP's behavior – 'playing' sick to prevent worse things happening in the family, such as a total family breakdown.


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 requiring the constant care and attention of the parents. * In '' Dibs in Search of Self'', 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". *
Gregory Bateson Gregory Bateson (9 May 1904 – 4 July 1980) was an English anthropologist, social scientist, linguist, visual anthropologist, semiotician, and cyberneticist whose work intersected that of many other fields. His writings include '' Steps to an ...
considered 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".


Criticism

Extending the original concept of the identified patient, the
anti-psychiatry Anti-psychiatry is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionabl ...
movement went on to argue it is the family who is chiefly mad, rather than the individual the family identifies as 'sick' – positing also that the latter might in fact be the least disturbed member of the family nexus.


Literary and biographical

* In the play ''
The Family Reunion ''The Family Reunion'' is a play by T. S. Eliot. Written mostly in blank verse (though not iambic pentameter), it incorporates elements from Greek drama and mid-twentieth-century detective plays to portray the hero's journey from guilt to red ...
'', T. S. Eliot writes of the protagonist: "It is possible You are the consciousness of your unhappy family, Its bird sent flying through the purgatorial flame". *
Carl Jung Carl Gustav Jung ( ; ; 26 July 1875 – 6 June 1961) was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philo ...
, who viewed individual neurosis as often deriving from whole family or social groups, considered himself a case in point: "I feel very strongly I am under the influence of things or questions left incomplete and unanswered by my parents and grandparents and more distant ancestors...an impersonal
karma Karma (; sa, कर्म}, ; pi, kamma, italic=yes) in Sanskrit means an action, work, or deed, and its effect or consequences. In Indian religions, the term more specifically refers to a principle of cause and effect, often descriptivel ...
within a family, which is passed on from parents to children".C. G. Jung, ''Memories, Dreams, Reflections'' (London 1983) p. 260


See also


References


Further reading

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