Identified Patient

I am planning to use my blog for the next four weeks to explain some concepts in Bowen’s family systems theory (FST) – concepts we will not cover in this sermon/growth group series. This week let’s think about the identified patient.

FST assumes that while there are individuals in a family, they are all part of one family’s emotional system. At times the system can be healthy, and at other times the entire system has too much anxiety or pressure in the system. Think about your family connections during Covid, in the lead-up to Christmas, or when someone has a major illness or incident that impacts everyone else.

We all respond in different ways. Some of us become more responsible and work even harder. Some of us become more emotionally alert, and check in on everyone – are you OK? Despite this, there remains excessive anxiety in the system, and that anxiety needs an outlet.

At such times, what often happens is one person becomes the identified patient. They may call out that things are broken. Or they may act out. It often looks like one child has gone feral.

This annoys others in the family no end. This is the last thing we need now! We are quick to name this child as the problem child, or the black sheep. Perhaps we believe they are attention-seeking.

FST suggests this is an unhelpful diagnosis. Tensions in the family are not the result of the identified patient. To suggest so is to make the identified patient a scapegoat. Everyone else in the family might feel better blaming the troublemaker, but nothing is fixed.

FST proposes it is more helpful to think of a problem system, not a problem person. There are unresolved problems in the family system. The problem exists more so between family members than just in one of them. Isaac and Rebecca’s family is very much like this.