It is difficult to deal with a narcissist when you are a grown, independent, fully functioning adult. The children of narcissists have an especially difficult burden, for they lack the knowledge, power, and resources to deal with their narcissistic parents without becoming their victims. Whether cast into the role of Scapegoat or Golden Child, the Narcissist's Child never truly receives that to which all children are entitled: a parent's unconditional love. Start by reading the 46 memories--it all began there.

Friday, May 23, 2014

The “Identified Patient”

Over and over again I see it written: the scapegoat is troubled, the problem child, the troublemaker, even the household rebel. Psychologists and other writers, from the well-known like John Bradshaw to the most obscure blogger, publish works that make it look like the scapegoat, because of his or her behaviour, might actually deserve both the role and the disdain forced upon him.

My own experience does not bear this out. M. Scott Peck, in his book “People of the Lie,” references the “identified patient.” According to Wikipedia, 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 as a diversion; who is the split-off carrier of the (perhaps transgenerational) family disturbance. 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.

“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. 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.”

That last paragraph strikes a responsive chord in me. I was not only the first person to seek help in my family, I was the only one. NM’s one foray into psychology for me during my childhood—part of a custody battle with my father in which she wanted a psychologist to testify on her behalf—was abruptly cancelled when the therapist was more interested in talking about her than about me. I don’t remember this at all (part of that blank period in my childhood for which I have virtually no memories), but I clearly remember NM citing this as an example of the uselessness of psychology/psychiatry: she took me to a therapist because I was obviously disturbed (I wanted to live with my father, not her) and the therapist was focussing on her instead of me. NM, who had an agenda that had nothing to do with my emotional well-being, took me to that psychologist as the “identified patient” (a person who is taken to therapy by his or her family, as being a problem or having problems), but the therapist saw right through her. We never went back for a second session.

Peck says this child, the identified patient, is the family member who is identified as the source of the family difficulties. And while some of these children are, in fact, acting out, it is usually a problem in family dynamics that is the true source of problem, and if the child is acting out, it is in response to those dynamics. In other words, the child doesn’t really have to be a problem to be designated the scapegoat, although some children become a problem as a result of their being cast into the scapegoat role. Then, they are blamed not only for their acting out behaviours, but for the problems of the entire family system as well.

I read “People of the Lie” long before I had any notion of narcissism and personality disorders. But I was struck with the similarity between the “identified patients” and my self-identification as a scapegoat. I had come across the term in my reading and it immediately resonated within me: my brother, who was always in trouble at school, at home, even in the neighbourhood, was seldom punished for his misdeeds and his lies…often mind-bogglingly transparent…were always accepted as truth. For me, I was blamed and punished for not only my mistakes (which were interpreted as deliberate defiance) but for his misdeeds—his misbehaviour was my fault because I “allowed” him, I didn’t stop him, I was the oldest and he was my responsibility. This is classic scapegoating and, since I was already being blamed for ruining NM’s life by my very existence, it wasn’t much of a leap to lay everything wrong the family at my feet.

In “People of the Lie” Peck describes the parents of a little boy so deeply depressed he was hospitalized. That year for Christmas they had given the boy a .22 rifle, the exact same rifle his older brother had used to commit suicide. When confronted by Peck and the message their “gift” conveyed…that they wanted him to commit suicide, too…the parents became immediately defensive, dug their heels into denial, and refused to entertain the thought. They became angry at Peck, insisting their son was the sick person, not they. Peck defines evil as “militant ignorance” and the behaviour of these people, angrily defensive and unwilling to accept the truth of their actions and the message those actions conveyed to their grieving younger son, exemplify not only their ignorance but their militant defence of it. To remain blameless, to be able to see themselves as good people and good parents, they sacrificed their son, making him the sick one, the identified patient, the one with the problems, and completely absolved themselves of any responsibility for his depression. No, he was the sick one and the doctor needed to focus on him, not on them. They reacted to Peck’s rejection of their son as the “identified patient” in much the same way my NM reacted to that psychologist rejecting me as the same.

This is not to say that the identified patient is not suffering, does not need some kind of therapeutic intervention. Most likely s/he does. But critical is the understanding that the reasons the IP needs help is not because s/he is the centre of the family dysfunction. Often the child singled out as the scapegoat is the most emotionally healthy, most cognitively aware, most fundamentally balanced member of the household. The child may act out to draw attention to the family in a subconscious hope of getting help…or the child may be so successfully subdued that s/he simply goes along, not making waves, either biding her time until she can escape or becoming so imbued with the family mythology that she buys into it and accepts that she is at fault, even though she cannot figure out how. The identified patient has been damaged by the dysfunctional family system, but she is not the only damaged person and she is not the cause of the dysfunction.

Is it possible to have a dysfunctional person inside a functional family? I believe it is, using my NM and her FOO as an example, but I think it is rare. Perfectly normal families can have a family member who is substantially different from the rest of them. We are not blank slates upon which our parents write: if we were, all of us ACoNs would be the same and we are not. We each bring a unique personality and set of traits with us when we come into the world and it may well be that there is something in our particular make up that strikes a negative note in our NMs and causes them to single us out as the scapegoat.

Identified patient is a psychological term that, in my mind, equates to scapegoat. A dysfunctional family needs someone to focus on, someoneto blame things on, someone to point to when things go wrong… It means that in a sick family system, the group has subconsciously elected one person to act out all the family sickness in a very overt way while the rest of the family acts it out in a covert way. Even if the IP tries to act “not sick,” the family will send messages to “get back where you belong” and set the IP up for failure.” How much does this sound like the family dynamics surrounding the scapegoat?

“It’s not that the identified patient is any sicker than the rest of the family, in fact they probably aren’t, but they are the one through whom the family channels all of its “stuff.” The family dynamic is to keep things status quo, to keep its eyes trained on the IP.” Have you tried going NC—or even LC—only to find members of your family going out of their way to suck you back into the drama? That isn’t because they love you and miss you (as they may well say) but because they need you to be there to take the blame, to be the negative focus, to be the disappointing one against whom they can all compare themselves and come away superior.

Some of us disappear from the family scene and we don’t get hoovered. This is the function of the “ignoring types,” the family dynamic that treats you like you are invisible until something is needed from you. In such situations “…the identified patient, or IP, is viewed as a troubled individual or, in extreme cases, as someone with whom the family would be better offwithout.”You are still the IP or scapegoat, but in this case, the family had decided that your absence makes them whole as they can continue to find ways to blame you even at a distance.

“Usually the one who gets help first in the family is the IP. They get out of the family and find out what is wrong because they are tired of being blamed for everything and everyone. Usually their acting out is a normal response to an abnormal situation and they want help.” Some of us seek therapy, others of us seek self-help through books, websites, on-line groups, journaling. Some of us don’t seek help at all and just escape the FOO but continue to replicate our dysfunctional emotional relationships with others, seeking to “get it right” this time…the next time. And some of us just get out and withdraw, licking our wounds and living in a cocoon of hurt.

But we all want that hurting to stop. “…part of recovery is identifying who you were in the family and how you have carried that role into adulthood. See how your role in the family plays itself out in your current relationship and ask yourself if it’s time for a change.

“Being the IP or the one that doesn’t belong can be a [hidden] blessing. If you’ve never belonged, it’s easy to take a step in another direction. Take refuge in exile. It can be a good thing.

“If you’ve been the IP, realize you’re never going to win their approval, so stop trying. You have a role to fill and they’re not going to be happy if you’re not filling it. If you’ve brought it into your relationships, chances are you will not be validated and acknowledged in those adult relationships either.

“Stop seeking approval from people who don’t have it to give. Throw off those old messages…get rid of the negative messages from the family…get rid of “get back where you belong” everytime you try to save yourself.”

Yes, you might fail. You might even fail repeatedly in your efforts to get away, to resist being sucked back into the drama by empty promises and your own broken heart. But if you don’t keep resisting you will get absorbed back into the drama and become nothing more than a broken gear in their dysfunctional machine. They aren’t going to change –there is too much in it for them to keep you in your assigned role—and nobody is going to rescue you. To escape and have your own life, a life of fulfilment and devoid of their drama, you have to shrug off the role they have imposed on you. You have to do it yourself. 

You have to be your own hero.


  1. another great post, Violet. Hope you're well. CS

  2. Last time I spoke to my NGC younger brother, he said, "I just want the old mulderfan back." I replied, "She's gone, but if you go to Walmart you can probably pick up a new doormat for under $10."

  3. It's like you wrote this for me! So glad I found this blog.

  4. Hi Violet, I've found your blog to be very helpful and informative as I've been trying to recover from childhood trauma/traumatic grief. This post really resonated with me. I recently said to someone, "Not wanting to be around my family isn't a sign that I'm trying to isolate myself, it just means I'm mentally healthy!"

  5. Wow. I see so many kindred here. I feel a little less alone.

  6. Thankyou for your insightful post. It has taken me years of therapy to feel safe enough to look at the dynamics of my family. I have just been diagnosed with PTSD as a results of growing up in an extremely dysfunctional family in which out of 6 siblings I am the only one saying that the family was/is dysfunctional. I have been ostracized for my views. I am the proverbial IP. My family even had a meeting in which they wanted to drag me to a psychiatrist because they dont want `to get what I have`and I thought that was love!

    I am waiting to start trauma therapy and I hope this time this will help.I am totally isolated from my family who stand aside in bewilderment wondering what is `wrong with you`.I also believed that it was me with the issues as they said. What a relief to realize that I became the way I became BECAUSE of the family issues. In a way I have been sacrificed for the `good` of the family and I went along with it until now. I am now coming to a screeching halt! No more scapegoat, no more sacrificial lamb, no more IP. JUST NO MORE!

  7. For years I have known that I was/still am (part time) IP. I was always the one in trouble for my younger sisters mistakes. Now there is just me and my sister and we have grown older but she contimually trys to maintain and reinstate me as the scapegoat. Mostly I am able to resist but some times I become tired and have to leave to recharge. I do not believe that things will ever change, my sister will continue to live by the same script. I am a Psych nurse and have worked with disfunctional families fore many years so have a good understanding that for things to change my sister must make a huge effort to understand the role the family designated foe me and that will be very difficult. In NZ we have a saying "Kia Kaha" which means "have courage" I say Kia Kaha to all of you.

  8. Wow..At 15 I was "hospitalized" for an "adjustment disorder" when my dysfunctional family was out of control..and it only got better. I became a psych RN (of course!) and stayed AWAY for over 2 decades. And I DID get the treatment no one else got, the insight to see, "yes, they are pointing their fingers of craziness onto ME.." Unfortunately, a very serious illness brought me back here and (surprise again!) the 2 sibs that never really made it "out" are FURIOUS. The lies, the slander, the gaslighting (middle-aged and sad..) are more sociopathic than anything (u speak of "better off without u." In my family, I believe the rage of my very existence makes that literal. And even as a senior citizen, mom, a bright woman with all of this ablaze in her eyes, cannot see her son who has done the unspeakable at the rage of the return of his sister (me: but mom, I have CANCER...) Everyone in too much narcissistic haze to see, well, ME, a person, with feelings..not a kickball. I write all this to say, thanks for the reminders. You cannot change them. They cannot give what they don't have. And being an RN doesn't fix your family. You do have to be your own hero. Sometimes over and over. All that said, hard as it is to be the IP, I'd much rather be me. Thanks and best to all.

    1. Absolutely. Unable to see me through their narcissistic haze. yup.

  9. I was given the book, 'People of the Lie' many years ago. I was already aware of my designation in the family constellation and was deeply involved in searching for answers about myself and my life up to that point. It never ceases to amaze me how those in my life; family members and friends, both refused to accept that I was anything other than the role ascribed to me in their own minds. I came to realize that I was better off starting my own network of friends and creating a family other than the one I was born into; after trying to establish myself as an individual, to no avail. I now enjoy a life unfettered by the constant struggle and energy drain that it took to fight a losing battle. I'm free to express myself, create myself, explore myself; without the added pressures of trying to remain safe with those who have no interest in my safety and constant reminders of how I 'used to be'.

  10. Thank you for this blog...after many yrs "out" of the madness, I am home with a chronic illness..even at almost 50 y/o, this is a hard place, the "ip" place...thanks for speaking everything I feel. I do a lot of writing. Right now, nice to read and be a part of something
    That I never knew was bigger (or as sad ...or as strong..) as me. Blessings....

    1. I have a chronic illness, too. Has anyone done research on IPs and which diseases they have later in life?

    2. Being chronically ill for decades now, drove me back to that dysfunctional home in an effort to not become homeless for yet a 3rd time. Now I know what a horrible mistake that was and am in a fight for my life, trying to create an escape plan from the abuse.

      I think you likely have something there, about the connection to chronic illness. I think we are just on the very edge of comprehending the incredible threat that longterm STRESS is to our physical and mental health.

      Thanks for the validations in this blog. It's good to be reminded that it's not MY's a natural response to this MUCH crazy!

  11. I have tried to publish at least 10 times, but am being domestically abused and hacked (the extreme of being the hated IP) and can write nothing...or am highly censored. My faith keeps me going. Just wanted to THANK YOU for helping me and sooooo many for not feeling so alone. You are brave, and an overcomer and should be so, so proud.

  12. This article really resonated with me. I have been on NC with my siblings since Christmas eve when my four siblings raged at me. My one sibling told me she wished I was dead. Only because I told them I thought it was time to consider a nursing home for our mother. Long story short, she went to the nursing the next day due to serious congestive heart failure. My sister messaged me just last week and asked to be a friend on Facebook again since I had taken her off since going NC. Yup. I fell for it. Right after I friended her she posted an article that basically put me right back to the horror I felt at Xmas eve. I now believe my therapist "don't get sucked back in, they will not change."'

  13. Sage advice...don't get sucked back into their solar system. The rules will never change and you will always be the IP. I recently got sucked back in and was hurt and shamed within an hour after my sister made the "nice invite to be friends on FB again. She merely used social media to put me in my place and shame me. While my recovery time is getting shorter, it is still hard for me to believe my family can be so evil, as Peck talks about.

  14. My birthday is in a few days. I'm getting sick, biting my tongue, having all sorts of unexplainable pains, and trouble breathing. I know it's coming. The excused ambush to deliver the cheap, thoughtless purchase she got because she thought it would make a good gift for "somebody" or the castoff item she replaced with something she liked better in the several times over recycled gift bag so she can shove her way in my front door and take notes for the next call she makes to CPS in an attempt to steal my kids. The annual call from my father (they divorced in 1976) with inappropriate, assaultive questions, rude criticism about anything he can latch onto, and, of course, derogatory comments about Her that are more a go at me than anything else. Is it so much to ask to be left alone?

  15. For a narcissist, yes it is too much to ask because it thwarts what they want and what they want is what drives them.

    Do yourself a favour and don't answer the door when she comes. Put in a peephole if you have to in order to see who is there, but don't answer the door. If you don't open the door, she can't push her way in.

    My mother succeeded in stealing my kids through her lies, she even got the rest of the family to support her so that I didn't even know if they were dead or alive for eight years. Don't leave yourself open to that--don't open the door when she comes calling.

  16. The only way is NC to break the cycle of insanity that you keep trying and failing to fix because they like you being there to pacify, comfort, and console them and also be the sick one to distract from their sickness. It's because you have a heart that feels and cares and they don't.


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