Scapegoating the Identified Patient

It’s not uncommon for people to take on, or be assigned “roles” in groups such as at work, in class, or within a family. Perhaps you have a reputation for being the “overachiever” at work, the “class clown” in school, or the “golden child” at home. 

Sometimes labels like this can shed a positive light on someone, and sometimes they can be incredibly negative. Regardless, continuously labeling someone can limit them and blind people from seeing individuals as they truly are.  

Labels Can Be Damaging 

Positive or negative, labels can be harmful, affect our sense of self, and hold us back or limit us to be only one thing.

Positive Isn’t Always Positive

Positive labels may impress an extreme amount of pressure for an individual to act a certain way or perform at a certain level. Think about terms like the “golden child.” All of this pressure can be extremely stressful, especially as a child. Or, this positive label can box someone into being just that one characteristic, when they really are so much more and have so much to offer. 

Negative Labels

Negative labels can be discouraging and detrimental to a person’s identity and overall confidence. Perhaps this looks like “the lazy, video-game playing son” or “the loud one” in school. Negative labels can also limit a person into being that one thing and fail to acknowledge every other attribute they likely have.

If someone is negatively labeled and constantly reminded of that label, they are likely to respond in one of two ways:

1. The individual will work tirelessly to be perfect in every way possible, searching for love, pride, and acknowledgement from others (parents) that they will not likely get.
2. The individual recognizes nothing they do (good or bad) changes the image others have of them, so they embrace the label and begin acting in a way that earns said label. 
   

One such negative label, or role, sometimes seen within a family unit is the Identified Patient (IP). The IP is a family member who is unofficially chosen as the bearer of all symptoms related to an entire family’s dysfunction. The blame for any problems, mistakes, or chaos within the whole family system is thrust upon this individual. 

The ‘Identified Patient’ is the clinical term for the blacksheep of the family. This person is made to fill the scapegoat role, the symptom bearer, the troublemaker or the problem child. The family member that is rejected, shamed, and blamed.‍

Family System Theory

Every family is unique with unique make-ups, dynamics, habits, traditions, etc. Family systems theory looks at the family as a social system with its own power structure, ways of communicating, roles, characteristics, and rules. 

Rather than considering the family to be made up of individuals independently of each other, family systems theory looks at family as an interconnected system where each individual's behavior influences others behavior. 

One person’s behavior is directly (or indirectly) perpetuated by the behavior of other individuals within the family. The response from family members can either encourage change, or continue to maintain the family norms.  

Individual functioning within a family systems model is determined by many factors within the system, including their given role and the expectations that come with that. The IP is typically labeled in early childhood and used as the scapegoat for dysfunction within the whole family. 

The term “blacksheep” means a person is ostracized to some degree in a group. They don’t fit in for whatever arbitrary reason the group decides. In terms of family systems theory, being the blacksheep means that a person’s role in the family evolved to be the scapegoat.

Family Scapegoat Syndrome

An individual assigned as the family “symptom bearer” is used as a scapegoat for anger, wrongdoing, or trouble within the family. Rather than parents and siblings taking a look at their own role in any issues, they deflect and blame it on the IP of the family. 

This is family scapegoat syndrome—collectively and unconsciously, family members decide who is the blacksheep of the family, and what that looks like for the functioning of the system.

There is typically no predictable logic or reason an individual is dubbed as the IP. Some arbitrary reasons one might be chosen as the IP are:

• Birth order
• Gender
• Appearance 
• Biological relations vs Step vs Adopted 
• Intellect 
• Athleticism 
• Mental health 
• Physical health 
• Sexual orientation
• Personality traits 
  

All of these factors have the potential to play a role in identifying an IP in a dysfunctional family and all of these factors are not under anyone’s control. 

Think of the classic movie Cinderella, the stepmother and stepsisters blamed Cinderella for everything, no matter who made the mistake or what the problem was. She didn’t fit in and was chosen to be culpable and abused for the dysfunction of the whole family due to circumstances that were out of her control.‍

How Someone Becomes the Blacksheep of the Family

The dynamic within a family with an IP and how that person (usually a child) is treated can vary greatly. The treatment of the IP is likely correlated with the level of dysfunction present within the family system.

Growing up, perhaps your family, or a family you knew, had one kid that was known as the problem child, the troublemaker. Oftentimes, people look at a child independently and see “acting out” as simply misbehaving.

Some families may blame and emotionally, mentally or physically abuse the IP, others will attempt to “fix” the IP.

What Scapegoating Looks Like

When families seek therapy, the IP is usually the individual that is considered the source of the problem, or problems, that brought them there. The family seeks therapy in order to “fix” that individual. Rather than looking for flaws within the whole family system, the identified patient is seen as the source of all the issues.

A scapegoating parent may think:

“if only my son would stop getting into fights at school” 

“if only my daughter didn’t suffer from anxiety” 

“if only my kid didn’t with his grades in school” 

"If" this wasn't the case, our family would no longer have any problems and everything would be okay. 

What these other family members fail to do is look at the role they may be playing in a child’s misbehavior and struggles. What is the actual cause? A kid’s behavioral or mental health problems often disguise larger issues within the family.

Lasting Effects 

While the IP label originates in childhood, it can stay with someone well into adulthood. Years of being “the reason” for dysfunctional family dynamics, the family scapegoat, the person that needs “fixing” can have a serious effect on someone. 

That individual will inevitably internalize those comments and the feelings that come along with them. They may believe they really are the problem. They may feel lonely, unsupported, and unworthy. 

Dysfunctional Adult Relationships 

These feelings and beliefs, even when not true, can drive people into other dysfunctional behaviors, relationships and environments. Because of their upbringing, dysfunctional behavior is normalized and can be difficult for them to spot. Or, they may not believe they are worthy of anything better, so they accept less in friendship, work relationships, and romantic relationships. 

Anxious Relationship Style

They may work relentlessly for love and approval from the people that put the negative label on them in the first place. No matter how hard they work and what success they have, this love and approval may be something those people can’t or are not willing to give. 

Harmful Behavior

After internalizing those negative beliefs about themselves, an IP may begin to self-sabotage, neglect their needs, engage in reckless behavior, or even self-harm.  

When you’ve been told negative things about yourself all your life, you tend to believe them, and when you believe them, you begin to question yourself, your worth, and your judgment.

Overcoming the Role of the Family Scapegoat

The good news is that, while it may not always be easy, you don’t have to be labeled as the IP forever. You can’t choose the family you are born into, or how they treat you. But you can choose what kind of treatment you accept for yourself and who you allow in your life from this day forward. 

Individual and Family Therapy

Therapy is a helpful intervention to help individuals learn and continue to reaffirm that they were never the problem. Sometimes individuals will know or learn this, yet there are still times those old thoughts and feelings are triggered. Therapy and healthy relationships can help support individuals weather the storm when those feelings and beliefs are dug up.

If caught while still young, family therapy can help too. Sessions as a family can help the scapegoated child heal from the damage of being designated as the IP. These sessions also have the potential to educate family members on how their own behavior affects others and help repair relationships.

Take Care Of Yourself First

Drawing boundaries is another important step in distancing yourself from the role of the IP. This can be a difficult step and people may push back and make you question your judgment, but it is important to stick to your boundaries. These boundaries should be in place with old relationships, family, and any new relationships that may develop. 

Sometimes, people don’t take well to individuals learning to take care of themselves and only accepting healthy energy in return. Some cases may require individuals to go no-contact or limit time spent with particular people. This is up to the individual if they feel it is a necessary part of healing. 

It is always good to have high hopes and low expectations, so you are prepared to properly take care of yourself—with or without the support of other people.

‍You Are Not Alone 

Unfortunately, families outsourcing their dysfunction onto one individual is not particularly uncommon. Whether conscious or not, this is how some families strategically evade their own mistakes and feelings. If you feel like you never fit in, like you couldn’t do anything right, or like you’re the blacksheep of your family, you don’t have to feel this way forever.

There is so much more to you than a label you have been given to carry. You can escape that fate and have a life you are proud of, and others are proud of too. 

Sequoia Behavioral Health has evidence-based treatment programs and a caring staff to help you break through whatever box you were put in. We can assist you in finding your true, authentic self and begin to live a happier, healthier life. Call at 480-690-9304 or schedule a time to chat about how we can help you break the cycle and get to a place you want to be.