Fearful that my difficult child has become the Identified Patient


I fear that my difficult child has become the "Identified Patient" aka the scapegoat for ALL of the dysfunction, fighting and turmoil that is going on his father's home and for some of the problems in mine as well.

difficult child came to live with me full-time over a month ago because of the problems at his dad's house, the stepmother being at the end of her rope, the deterioration of his relationship with his easy child older sister.
This has been such a painful time.

Last night I came across the concept of the "Identified Patient" and the more I read the more sick to my stomach I became. Is this what we have done to our son?

It seems like a "what came first, the chicken or the egg?" type of situation. difficult child has been difficult/challenging/different since infancy. He was on baby Zantac and special formulas for "colic" within a few weeks after birth. Hence, ten years of dealing with one challenge or another with him and wouldn't it be natural to fall into the trap of blaming him for all of the families problems? I think so. I certainly blamed him for being the last straw in my failing marriage. But just because it is an easy trap to fall into, it is still just as damaging. I am pretty sure that is what is going on at his dad's house now.

difficult child finally has a great team of p-doctor and new t-doctor working together. I will ask them these questions at this week's appointment. Why the heck haven't they brought this up?

Have any of you felt this way before? Is/was your difficult child the "Identified Patient" for your family's dysfunction? And if so, how did you fix that?


Wiped Out

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I don't think husband and I have, however, I do think easy child/difficult child thinks difficult child is too blame for everything even when he isn't.


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I also think my easy child/difficult child blames difficult child for all the family issues.

On the other side I can honestly say that in my family I was the "Identified Patient."

I remember when my mother first started getting sick and we went to family counseling together. I was pregnant and 19 and miserable. Basically living with a friends family because moms mental health and drama was too much to deal with on top of a pregnancy. Anyway the therapist would sit us all down in the room and blame me for everything. I felt like the lowest of the low. I refused to go back after a few appointments and that made me even worse.

About 8 years later that same therapist apologized to me. I think everyone thought because my graduation from highschool, drop out of college, and teen pregnancy all happened around the same time my mom got mentally ill that it was my fault. 20+ years later it is pretty dang clear that it wasn't me it was her mental issues.

Not that I didn't share some of the blame for the stress but I wasn't the disease I was just a stressor for the disease.


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Mental illness is a brain disorder, not something your child gives you. You can suffer stress, but if you really lose touch with reality, it has nothing to do with anyone but your own DNA.

I was the black sheep, as I call it. We never went to counseling as a family. I'm glad. I know everyone would have pointed a finger at me and knowing me I would have refused to have gone back after bawling like a baby. Psychology is theory and the more they know, the more scientists are putting these theories out of business. Not that long ago (in my early years) autism was considered a mental illness (a form of severe schizophrenia) that happened because a child had a "refrigerator mother." Forty years later we know Autism Spectrum Disorders (ASD) is a neurological problem, not a form of schziophrenia caused by ANY kind of mother. And we also know that schizophrenia is a hereditary brain disease, not caused by life but by genes.

You had nothing to do with mom's mental illness and I'm sorry you had to go through hearing that you caused your mother's problems.
I brought up my concern that my difficult child has become the "Identified Patient" at his p-doctor/t-doctor appointment yesterday. They both just nodded and listened. This is pretty much their initial reaction to almost any hot button question I ask. We had a lot of important stuff to cover yesterday. Still, I would have liked an opinion from them. When p-doctor stepped out of the room for a minute I asked the t-doctor what we do to correct the situation, if in fact, difficult child has become the Identified Patient (at least somewhat) and she replied, "The first step is identifying it." That's as much as I got from either of them.

His dad couldn't make the appointment yesterday but is supposed to be at the next one in two weeks. I will bring it up again at that time. It is important to me that if this is happening we do "identify it." If the entire family system is broken, focusing exclusively on "fixing" difficult child is only going to make things worse in my opinion.


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When I was growing up, my younger brother, who later was diagnosed as schizophrenic was what we used to call the scapegoat in a dysfunctional family. He didn't look quite as much alike as the rest of us did plus he was already on the path of mental illness and clearly, aside from me, he was the most sensitive as well. But being a boy, that wasn't as comfortable for everyone to deal with, hence, he was singled out. I used to have nightmares about him being locked in a tiny dwelling in the middle of a wheat field and I would spend the night running to get him out of there..........even as child myself, I knew what was happening to him was wrong.

I think in highly dysfunctional or highly charged family systems, it is not uncommon for those in the family to concentrate on the one who is the most vulnerable and make them the problem. Years ago, that "problem child" would be the focus of all of the scrutiny and therapy while the system itself thrived. It is more common now for the entire family to be asked to attend therapy, because it is more widely known that it is the system which is broken, not only one of it's members.

In your case it appears that getting your son out of that system was necessary and timely. However, your ex and his wife are likely cemented in to their prevailing view that your son is "the problem" not their failing system, so they may not be open to any changes in that thinking or the dynamic.

You may end up being the only one who not only identifies it, but is actually willing to do anything about it. I don't know your son, but perhaps explaining this to him in terms that he can understand, without being negative about his father and stepmother, but as a human trait that when people are scared and don't know what to do, they often blame someone else. He likely already feels blamed so identifying it with him may bring him some relief and acknowledge his feelings. Fixing it is a whole other issue, you only have the power to change it within your own system, but you might open the door with him to bring the truth of the situation in and let that, at least for now, be enough.


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There is a book called The Normal One that talks about this. In my case I have 4 kids, the oldest two being twins. One twin (the boy) is my difficult child. A school counsellour alerted me to the book because she worried about the burden on his twin sister of being "the normal one". It was quite illuminating.
difficult child was definitely a lightening rod in the family. I could be in a bad mood and mad at everyone but keeping a lid on it till he walked in the room and did or said something then I would lose it. It is partly because he could never read social cues...my other kids would disappear or deescalate, he would walk right in and make things worse. The other kids used to even say "can't you see that mom is getting mad? stop it!" but he couldn't.
This is not in any way blaming him, it is just observing the (sad) interaction.
Good that you can see it. Try reading the book.
Thanks for the suggestion Echolette. I am not sure I get how you mean it will help with my difficult child being the Identified Patient??? Although obviously I haven't had time to read the entire book yet, I have read a few excerpts and review of the book that you recommended and it appears to be directed at helping the easy child sibling.

Recently, the stepmother has worked hard to convince easy child that difficult child has totally ruined her life, is bad, to be avoided as much as possible, spied on, tattled on, and created a huge divide between the kids that didn't exist before. I am trying to find ways to take the entire focus off of difficult child being "bad", see the system as a whole, and most importantly mend their relationship. Does this book address those concerns?

I get that easy child may have had to bear the "burden" of being the normal sibling but with the current family dynamics her needs and burdens are being over-addressed to the point where it is causing more damage to their sibling relationship.


I hope everything gets better for you and your family. Its hard to balance everything with good or great outcomes. When stress levels rise, and the more people involved, it does take a lot out of everybody and the blame gets put out even more so on difficult child. I understand about the focus on difficult child, sorta the same situation here. Wish I had good advice for you, just keep talking with them and gently guiding them as you already are. That book sounds interesting, my next one I will get. Good luck at the next appointment, hopefully they will be more helpful for you.
Thank you Confused. It is hard to balance everything and most of our situations are so complex that even the professionals are challenged by them. Yeah, better for my family would be nice. Thanks again. I wish you the same.

Over all of the years of difficulty and all of the fears I have had regarding difficult child never once had I even thought of the concept of him being the "Identified Patient" until I read about it the other night. I learned about this in a book I am reading about suicide called, "Waking Up Alive."
After I became aware of this "Identified Patient concept, I wanted to find out from the p-doctor and t-doctor how common this phenomena is with our difficult child children. I would assume that it is pretty common or at least they are at high risk of this depending on the family dynamics. I wanted to find out if they think that this may be going on in our situation. How to avoid it and how to correct it. All I got was, "The first step is identifying it."

So yes, I do hope that I get more help at the next appointment. His father is supposed to be there so maybe having both of us in the same room will facilitate the discussion about this. I plan to pose all of those questions to them again. Thanks for wishing me luck with that. I'm going to need it.


Your welcome. I was thinking about my situation and what your saying. I do believe it can effect our difficult child more than we might think. I know I was so stressed after 5 years plus of how bad my sons issues were, I did argue back. The medications have helped which we have to get him back on ( coughing with a nebulizer so mixed medications bad idea) and for our house, we cant really correct whats been done, just to change how we deal with things and try to get our difficult child to change with us. I tell my kids, ok, we all made mistakes and I didnt know how to handle it, ha.. we still are learning how to handle it! But, the more and more we encourage their good behavior and start all our kids, even ourselves in new activities maybe that will help? Then, they can see that they each have a new great out look on life. Volunteering if thats even possible would be a great help. I know Im nervous for my son to work with the animals and people because he does get mad out of nowhere and he cant always hold back...he starts next week ( hes never hurt an animal but still)

I know its harder for them when families are not on the same page too. Again...like mine. But, like I tell my kids we are all different for a reason, some people can handle things better than others. They are oversensitive at times and I just try to build up their self esteem. Look into life coaches/ positive people who do this for a living, Im sure there are some out there. I am sure you have already been encouraging them :) Its hard! Keep us updated and hugs!


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My difficult child's history is partly similar to yours. He too was difficult from day one. It started with a colic that went on and on and new issues, new battles, new challenges just kept coming. We were warned about this phenomenon first time when we were in parenting therapy when he was five or six. They didn't call it 'identified patient', but that was what we were warned about. We tried to avoid it, but like in everything else in parenting, our success were short and our failures common. So it has been ongoing problem all that time. still is.

It is so very easy to blame squeaking wheel for every bump in the road. And it does have huge negative influence both the black sheep but also 'white sheep.' While my easy child is a good kid, compassionate, loving, tries to be fair and all that, the misplaced feelings of superiority are not attractive features. Neither are entitled tantrums or moral outrage, when live happens and 'the black sheep's' strengths start to show and he occasionally outshines the 'white sheep.'

Sibling issues when one kid is a difficult child can be really difficult. It is so very difficult, or more truthfully, impossible to keep the situation fair to all kids. And also so very easy to blame the problem kid for actual adult issues.

Unfortunately in your situation it may be incredibly difficult, or impossible to make your ex and his wife to see their part in this. And it coming from you will likely not help at all. Maybe it would be wiser for you not to talk with them about this issue but rather try to get the therapists to address it?