Copyright © Susan J. Elliott All Rights Reserved
If you cannot get rid of the family skeleton, you may as well make it dance.~ George Bernard Shaw
The Road to Sanity Starts with Insanity
Sometimes we are the family skeleton, the black sheep, the shame of the clan. Many times it’s because the clan is as dysfunctional as the day is long. If you don’t belong in a family like that, you might come to realize how lucky you are. But many times it’s a rough road from being the family skeleton to being a happy and healthy individual. But you can do it. In fact, being the family skeleton, the black sheep, the shame of the clan, actually gives you a head start.
A dysfunctional family needs someone to focus on, someone to blame things on, someone to point to when things go wrong. In clinical settings, we call that person the “identified patient” or IP. 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.
Rebellious teenagers will decide to buckle down and study and they get picked apart for the slightest transgression. Instead of positive reinforcement, they are met with endless criticism. They throw their hands up and go back to their rebellious ways. It’s hard, as a teen, to realize you’ve been set up to be that way.
Even when the IP tries to “mend their ways,” the family sabotages them either covertly or overtly and before you know it, the identified patient is acting out again and the family is shocked (simply shocked) that the person they set up to be the IP is acting like an IP.
I once went to conduct an emergency evaluation on a 17 year old girl who had not come home all night and was brought to the Emergency Room so that someone could figure out what was wrong with her.
I was met by her parents, a father who had obviously been drinking and looked a lot older than he was due to alcoholism, and a co-alcoholic, codependent mother who was angry and upset. During the evaluation I could tell, almost immediately, that the teen was the IP in an alcoholic family. The family was focused on her and her wayward ways and insolent mouth because they could not look at dad’s alcohol problem and mom’s complicity in it.
The father was teetering on needing medical detox (more about this) and the mother was teetering on needing a stay on a psychiatric ward, but they were hyper-focused on the teenager who didn’t want to stay home at night with them. To me, her running away was more about what was right with her, than what was wrong with her.
I Totally Get You
I lived this scenario in my own life: all eyes had been trained on my acting out when my acting out was a normal symptom of being exposed constantly to craziness in my alcoholic family system.
I spoke to the girl by herself. I took her aside and suggested she go to Alateen and try to survive the rest of the year with her family. Then I had to break the news to her parents that I was not hospitalizing her, wasn’t slapping some serious diagnosis on her, and wasn’t going to buy into this nonsense of theirs.
Of course I didn’t say, “Hey you two are really screwed up and this kid can’t stand it and wants to be as far from you as possible, and – hey – who can blame her?” I made it as vague as I could and said that all teens do some acting out, but she was a very smart and sweet girl and she would be just fine. It was NOT the answer they wanted. They wanted me to throw a butterfly net over her and drag her to the looney bin and leave her there, drooling on herself and babbling in the corner. Yeah…not happening on my watch. I got her to Alateen and therapy. THAT – and not a psych ward – is where she belonged.
Her mother flipped out. She was furious at me that I was taking her daughter’s side. She ran up to me with red-faced fury. As she moved toward me, she looked as if she was going to deck me. I had several parents over the years screaming at me because I refused to saddle a teenager with a psychiatric diagnosis he or she would never get out from under.
When I worked for another agency and another Emergency Room, I had a 16 year old boy named Brandon who was brought in by his mother for his acting out and skipping school and, yes, running away. As I interviewed him, there was something that was really bothering me. His body language was such that he was clearly covering something up.
That’s another issue with the IP. They are taught to not reveal the family secrets because what goes on behind closed doors is our fault anyway. In my case, I thought all of this stuff was normal. I was a foster kid and the Catholic Charities sanctioned my abusive mother as a suitable parent. Not only that, but she had been nominated as “Foster Mother of the Year” TWICE. So who can argue with the mother of the year? Not the rejected, no good child of the year.
Brandon was in obvious distress, and I was not sure why. Normally I’m very intuitive but I was having trouble pinpointing what I was picking up on. He spoke quietly but was, in a sense, bobbing and weaving around the facts. It’s hard to pull out the truth from an IP a lot of times. They have a strong sense of misguided loyalty. Revealing what goes on behind closed doors is like blowing up your whole family with an atom bomb. It just isn’t done.
I spent over 2 hours talking to him (a long evaluation) and as he talked, so softly with a flat affect, I was wondering if he was on the autism spectrum (much less about autism was known then but I was picking up on something and had worked with autistic children when I was learning diagnostic testing.) But I didn’t want to jump to that conclusion since I had just learned about it and didn’t want it to influence what was happening with Brandon. When all you have is a hammer, everything looks like a nail. I needed to get this “right.”
Still, it bothered me that I couldn’t put my finger on it. I went to speak to the ER doc about the medical clearance. Before Psych Services evaluates, the patient needs to be cleared medically by the ER staff. It’s usually a very brief and surface evaluation, especially when it’s a very healthy 16 year old boy. He had been cleared almost immediately upon admission.
Revisiting the Physical
I went to the doctor and asked if he could revisit the physical. The doctor walked into the exam room and asked the boy to take off everything but his boxers and put on a gown. The boy went into a full-blown panic and tried to bolt out of the room. Security was called.
Now we have a situation and the mother is losing it in the waiting room, insisting that we hand over the kid RIGHT THEN AND THERE otherwise she was calling the police. It was getting weirder and weirder. I was in the 13th hour of a 12 hour shift, and I was exhausted. But my spidey senses were on high alert. What the hell is going on here?
A security guard went to the waiting room and brought the mother to a smaller room where we typically counseled family members of someone who had passed away or was in very critical condition.
Another security guard went to the exam room where Brandon was hyperventilating to beat the band (don’t ask me what that phrase means, but it fit). I stood outside the exam room waiting for the physical to be concluded. When the doctor came out, he was furious. He pulled me into the doctors’ lounge and said, “This kid has bruises all over him. He says it’s from playing sports, but I doubt it. CPS and the police have been called. He’s in severe distress. I need you to sit and talk to him until they get here.”
Getting IPs to Give It Up Is Like Pulling Teeth
I went into the exam room and lowered the lights as it was glaring and stark and not conducive to authentic conversation, which is what we needed to have. Brandon was clearly distressed by the uncovering of the coverup. As a formerly abused child, I knew exactly where this kid was coming from. The trouble everyone was about to get into was going to be his fault. He knew it, and I knew it.
Sitting on the exam table with tears flowing down his face, I felt so awful for him. I took his hand and stared into his eyes and I said, “Brandon, listen to me…you did not do anything wrong here.” He was shaking his head. I said, “No one has the right to put their hands on you like this.” He denied anyone had put their hands on him. He was sticking with the sports story. I relayed to him how I had lied to the ER doctor when pressed about my black eye that my ex-husband had given me. The doctor knew and I knew and he knew I knew, but I would not give it up. The doctor was so frustrated with me. This was the last physical fight we had before the marriage ended. But I was not ready to announce to anyone that I had been putting up with abuse all these years, and I was convinced it was all my fault anyway.
I said, “Brandon, I understand how you’re feeling, but we are here to help you, not to hurt you. You’ve been hurt enough.” On that note he fell apart completely, wailing and choking on deep, gut-level sobs. I just sat with him, holding his hand, until he let it out. Then he fell back on the exam table, closed his eyes and went – almost immediately – to sleep. It was almost 10 a.m. and we had been there all night.
I peered outside the door where a security guard was stationed. I said to him, “I’m going to check in with mom and I’ll be right back in case he wakes up.”
She was shaking and holding her stomach and her legs were bobbing up and down. I had no idea if she was a fellow victim or a perpetrator or an enabler of someone else who was an abuser. I asked the guard to let us have 5 minutes. He went outside. I explained to her – as best I could, where we were in this situation. I didn’t imply it was her fault, or I was accusing her of anything. Again, I had no idea what role she played.
She had been sitting down and I was standing up. She leapt out of the chair and came at me with a face full of fury and as she got close to me, raised her fist…screaming about how dare I suggest that anyone abused her child!
She was about 5 inches taller and about 50 lbs heavier than me. But, I stared at her and said, calmly, “I suggest you put your fist down. Because if you hit me, I’m going to hit you back.” Assaulting a clinician who suspects you of child abuse is not a great idea. She backed away but held onto her anger. It was bubbling over.
I said, “If I thought that someone was abusing my child, I would be adamant about finding out who, what and where and protecting my child. Why are you angry that we want to keep him safe?” She was yelling about false accusations and misunderstandings and all kinds of things. I was not going to get through to her and I suspected, now, that she was the perpetrator.
I left the room as the police and CPS got there. A social worker from the hospital and a mental health counselor from CPS were gathered. Brandon was awake and when I said goodbye to him, I gave him my card and said, “If you need anything, give me a call.” I checked in with his case worker periodically and my understanding was that he was placed with relatives after this and was doing well.
Become Awake and Aware
As for the girl above, a few months later I was called to the VA hospital to do a psych eval on someone who was being admitted for a medical detox. I walked in and – to my surprise – it was mom and dad. All 3 of us looked surprised at the same time. Fancy meeting you here.
The mother looked at me sheepishly. Her demeanor had changed. She was not the same person who had jumped up and down with me when her daughter was in the ER. The dad was in awful shape. I was concerned, as was the medical staff, that his liver was destroyed.
I kept the evaluation short and cleared him for detox. When they were moving him to his room, I gently inquired if there was something I could do for her or her family. I didn’t want to push her as I wasn’t sure where she was at, but she had an entirely different look than the last time I saw her. Gone was the aggression and the edge. Now, in only a few short months, she looked as if she had been dragged through fire and brimstone and mud and locusts and frogs and hail and boils and hurricanes and tornados and floods and volcanoes and earthquakes and rabid dogs and rabid rabbits and killer bees. She looked thoroughly defeated by all of this. She’d lost her aggressiveness and also her denial. She had the hollowed out look of someone hitting her codependent bottom.
She was surrendering to the truth. It’s a hard place, but not as hard as staying sick. She asked how to handle this. I said, “There will be family meetings here. They will work with you as he transitions back home. If you don’t have a therapist, please get one. If you haven’t gone to Alanon, please go. But, above all else, take care of you and your daughter.”
She thanked me. I said to her, “Go home and get some sleep. Your husband will be well taken care of here and you need to take care of yourself.” She nodded and we parted ways.
Teens As Targeted IPs
So many parents—very dysfunctional parents—paraded teenagers through the ER trying to get a “diagnosis” for a child who was elected to be the IP and who didn’t deserve a “diagnosis.” Many other clinicians would have saddled her with some diagnosis and continued the parents’ painting of a very wrong picture. This just adds to the child’s suffering, and I wouldn’t hear of it in this case (and many others I saw over the years.)
And so it is with the dysfunctional family system. Many times a teen will act this feeling out: I want to get out of here and not explain a thing to these people.
But the family can’t see that and can’t see their own sickness, which was much worse than any of the child’s issues. When my adoptive brother announced he was gay at 16, my codependent mother took him to a psychiatrist because this would just kill my alcoholic father. It was she and my father who needed a psychiatrist. Not my brother. But away he went. When he told the psychiatrist whatever he wanted to hear, they released him as “cured of homosexuality.” But he was soon back in a same sex relationship…which my mother called a “phase” he was going through. He’s been in that phase for 45 years now; with the same partner for more than 25 of those years. I don’t know when the phase would be ending. Perhaps the nursing home.
My brother wasn’t the IP because he wasn’t crazy enough, and he was their biological child. But mostly he wasn’t the IP because they couldn’t complain about him being gay because it was too humiliating to them. With me, they could shout from the rooftops what was wrong with me and it wasn’t their fault because – it was my in my genes which they had no responsibility for. So I was “Tag, you’re it!” And I remained “it” until the day I walked out of that family and never looked back.
The Role of the IP
The IP does the bidding of insanity for the whole family, acting out a lot of dysfunction. Or the IP tries to get away…is often a run-away…because running away is a sane response to insanity. It is so unfortunate that so many therapists and clinicians miss the boat and label the IP as something that he or she is not. The IP issue is not taught in most graduate programs. But IPs who run away are exhibiting an incredibly SANE response to an INSANE situation. Those who buy into the insanity huddle together, fingers pointed everywhere but to themselves.
Unfortunately running away doesn’t always solve the problem. Many times the IP doesn’t have tools to function in a healthy, sane universe so even though they are trying to escape the family of origin because they know, at a core level that something is really wrong, dysfunction is what they know so they gravitate toward new dysfunctional people. The untreated IP’s comfort zone is discomfort, disloyalty and being blamed for whatever ills or bad luck befalls the family. The pressure is enormous and they just want to GO…far, far away. They don’t think outside the box…they just want to get outside the box.
For many IPs, they run from their primary family relationship but gravitate toward those who still treat them like the IP they were groomed to be. They can find themselves in abusive relationships with narcissists, sociopaths, gaslighters…It can be a rough road for the IP on their way to the bottom…to finally getting the help they need.
If you were the IP, please don’t judge yourself for not knowing or for taking so long to get help.
You didn’t know that you didn’t know.
You are not your fault.
IPs are groomed to play a starring role in the screwed up family dysfunction. The fact that you are getting help – uncovering the secrets and lies – and not sitting in a corner drooling on yourself is a testimony to your ego strength and fortitude. That will come in very handy as you heal and go forward.
The people I have met in over 25 years of being a therapist are usually the IP in their family of origin who have spent many adult years chasing withholding individuals. The IP is subconsciously looking for approval they wouldn’t get in a million years. But eventually the pain gets bad enough that they give up and get help. It is not unusual for the person presenting in therapy to be an IP who is sick and tired of being sick and tired. They have known, all their lives, that something is wrong and it’s not with them, but they have been blamed for so long by so many until they’ve had enough.
The IP escapes, but without a support system and new knowledge in place, IPs tend to gravitate toward other people outside the family system who blame them for everything and keep the focus on them. But at some point the IP says, “I have had enough of this.” and move away from that person who is all too familiar (i.e. like family). Even if you’re not the IP, 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 or past relationship and ask yourself if it’s time for a change.
Exile as a Blessing and a Boon
It actually can be a benefit to be the IP in the family or in a relationship. Dr. Clarissa Pinkola Estes calls it “exile as boon.” Meaning that if you don’t belong to or with certain people who have very big issues, it can be a very good thing. It can be to your great benefit to be the black sheep, the identified patient, the outsider. Embrace it. It’s easier to step away from people who never thought you belonged anyway. Own your outsider status and get the hell away from lunatics.
It’s time to realize you will never get their approval in a million years. It’s time to give you your own approval. Give yourself credit for surviving all these difficult people all these years. Give yourself credit for getting some insight. Give yourself credit for getting this far with so many odds (and odd people) stacked against you.
Learn to embrace your outsiderness. If you’ve never belonged, it’s easy to take a step in another direction. It’s easy to throw off the need for approval from people who would never give it and do exactly what you want to do. Take refuge in exile. It can be a good thing. Set your own course and stop trying to fit in with people who don’t want you to fit in. Stop trying to please others and learn to please yourself. A few years ago I bought myself this keychain as the very proud black sheep of my Irish families. Thank goodness I’m not like you looney toons. I embrace my outsider status. Being on the inside would be a great deal of hell.
Time To Let You Be You – And Dance the Heck Out of It!
If you’ve been the IP in your family of origin and realize you’ve been chasing the same kind of person as an adult, stop and realize you’re never going to win their approval, so stop trying. Stop gravitating toward others who withhold approval. A withholding boyfriend or girlfriend. A withholding boss. Withholding friends. Give yourself approval and know that you matter and you count.
You’ve survived the dysfunctional family, the dysfunctional partner, the dysfunctional boss. You’re a survivor and you don’t need anyone’s approval.
Throw off those old messages…get rid of the negative messages from the family…get rid of “get back where you belong” every time you try to save yourself. It’s okay. As the saying goes, “Explain nothing to nobody.” You’re entitled to be happy. You really are. No one has the right to take that away from you.
You may be the family skeleton…the one they keep under wraps and try to explain away.
You may play a very specific role for them and they are going to be very upset when you step out of that role, but if you are the family skeleton: DANCE!!!!
Copyright © Susan J. Elliott, J.D., M.Ed.
All Rights Reserved No Duplication is Allowed Without Explicit Permission of the Author
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