Traumatic Brain Injury and the Identified Patient – Part 1

Hi, and welcome back to Second Chance to Live. I am sorry I have not been writing more recently. I have been preoccupied with taking care of some other business for Second Chance to Live. Although I have been distracted, I now believe I have clarity. I want to share a concept with you that I learned through studying Family Systems Theory. The information has enriched my life tremendously. First of all let me say that I do not believe there is any added value in pointing my finger in anyone’s direction. As an adult I am responsible to and for my decisions my choices and myself. What I have learned through my recovery process has empowered and continues to empower my ability to pursue my unique creativity.

In families where there is conflict, secrets or unresolved emotional pain different members of a nuclear family are assigned or assume different roles with in the family system. These roles are a way to contain the displaced sadness. Please read my post, Displaced Sadness. One of these roles is the scapegoat or the identified patient. The identified patient with in the family system absorbs the dis-ease within the family. The identified patient becomes the focus and the distraction. The identified patient or the scapegoat invariably has to carry the shame of the dis-ease within the family. Please read my post, Whose Shame are You Carrying? Shame is different than guilt in that guilt can be resolved through making an amends, whereas shame is a being wound. The individual who experiences shame does not believe that they make mistakes, but instead that they are a mistake.

In the process of carrying the family’s shame, the individual is unknowingly shackled to the shame created by the unspoken conflict, secret or unresolved emotional pain. The identified patient is led to believe that they are the reason for the conflict with in the family. Consequently, the identified patient develops a sense of responsibility for the conflict and in the process is led to believe that there is something inherently wrong with them. In response the identified patient may act out the conflict through anti-social behavior or attempt to do more or be more to resolve the conflict. Grandiosity manifests through an overdeveloped sense of responsibility. Because the identified patient or scapegoat believes they are the reason for the family conflict debilitating shame keeps them trapped in the role.

Overcompensation becomes a way of life for the identified patient as they attempt to resolve the conflict.

In my experience, I was placed in the role of an identified patient at a very early age. In the process I embraced an overdeveloped sense of responsibility in my attempt to be more and do more. Instead of being, I became a doing. I believed that if I was more than, then I could avoid my inherent sense of shame for not being enough or doing enough. I also believed that if other people were irritable, restless or discontent I had to somehow make them “OK” so we could be “OK” so that I could be “OK” with myself. In my attempt to anticipate what was expected of me I spent considerable time people pleasing, approval seeking and mind reading. None of these strategies proved to be effective, but only reinforced my sense of inadequacy and self-contempt. Nevertheless, I still strove to be perfect in my attempt to resolve the family conflict. Self-loathing distracted and perpetuated my grandiose sense of responsibility.

As I have mentioned previous posts, I was in a motor vehicle accident in 1967 at the age of 10. I sustained an open skull fracture with right frontal lobe damage, a severe brain contusion with brain stem involvement. Denial of my injury became a familiar component within my family because I was able to teach myself (with the encouragement of my Mom) how to walk, talk, read, write and speak in complete sentences. Although I acquired a real disability, the invisible nature of my traumatic brain injury placed my disability in an all too familiar mindset — if we can not see the disability, no disability exists. Nevertheless, the impact of my traumatic brain injury presented me with cognitive / psyche / social deficits and limitations. My previously assigned role as an identified patient in the process took on a new meaning. Please read Part 2 .

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