The Wisdom of the Symptom Bearer: It’s Always the ‘Crazy’ One Who Knows the Truth


From Medium/Rev. Sheri Heller, LCSW:

“‘The search for a scapegoat is the easiest of all hunting expeditions.’
― Dwight D. Eisenhower

Leila was the target of cruel mockery and disparagement in her large family. She became nonverbal and her eyes glazed over as I prompted her to tell me more about the incessant envy and ridicule. This happened in previous therapy sessions. It was a prelude to her retreating into a spontaneous age regression. Sometimes when we touched on the relentless psychological abuse she endured, the emotional flashbacks would send her down a rabbit hole of dissociation. In her mind, this triggered response further legitimized being stigmatized as the ‘family nut job.’

Leila was the only one in an emotionally and physically violent family system who questioned what was happening. She relentlessly tried to encourage dialogue. This ignited vitriol from her narcissistic parents and troubled siblings who were deeply ensconced in denial and acting out. That she was exceedingly creative and bright exacerbated her plight. She was dehumanized and hated for embodying what others in her family coveted.

Consequently, Leila’s symptoms of anxiety, depression and dissociation got worse. By the time I met with her for a consultation she evidenced signs of complex trauma. Dr. Judith Herman explains in her seminal book Trauma & Recovery that complex trauma refers to a prolonged history of subjection to totalitarian control over an extensive period, which threatens one’s life and arrests the course of normal development by its repetitive intrusion of terror and helplessness into the survivor’s life.

On the surface Leila’s home life looked intact and privileged, even idyllic. Yet behind closed doors was implacable systemic abuse. Character assassination, gaslighting, threats of physical violence and parentification were everyday occurrences, and because Leila couldn’t adequately pretend that all was ‘normal’ she was branded the difficult one.

In psychological parlance, Leila is viewed as the symptom bearer or the identified patient.

The symptom bearer carries the evidence of the familial dysfunction.

This pattern of assigning blame to the one who overtly manifests the family pathology, was glaringly evident when I worked with teens in an alternative high school and drug treatment program. One evening a week the parents would meet to offer each other support and address logistical and clinical concerns with their kids in the program. Unfortunately, this group became a dumping ground where parents disparaged, accused and placed full responsibility on their adolescent child for all their afflictions. Their children were not only expected to shoulder the blame for their own mistakes, but also the mistakes of their parents.

As the treatment coordinator I had the latitude to restructure programming, so one night I announced that the Family modality was being modified. No longer would the weekly group be a place to rail against their children while denying any accountability. Going forward the parents were required to engage in a dynamic group process that would address their personal difficulties from generational patterns of trauma, mood disorders and addictions. Additionally, parents struggling with addictive disorders would be encouraged to participate in the adult component of the treatment program. As to be expected, rather than turn the attention on themselves, many of the parents pulled their kids from the program.

Maintaining the family homeostasis (Bateson Project) or balance, requires the sustainment of specific roles.

When the ecosystem of the family is disrupted by difficulties such as addiction, marital difficulties, or domestic violence, the symptom bearer role is relied upon to shift the attention off of the systemic dysfunction and onto the one designated as ‘sick.’



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  1. Yup…

    Happens a lot between parents and kids. When a parent uses psychiatric intervention as an extension of it – affirming narratives and control – it takes the same insidious dynamic. “No, my mom is confused and abusive” “That’s your mental illness speaking – I’m so sorry your child doesn’t appreciate you, mother. Have some more drugs to make things easier”.

    And when that child really does have psychological issues later in life because of all of this, perhaps seeking treatment or clarity on childhood experiences from a clinician, it just continues. Straightforward trauma, anxiety and other disorders, relationship problems and other “symptoms”, even psychosis in some especially twisted or abusive cases where the “disease” is really a leftover survival mechanism. That “treatment” is likely to be oblivious to this and blame the victim further perpetuates and exacerbates the problem.

    I’ve only twice in my life seen a clinician directly say, “You were treated wrongly, and I’m sorry”. Doing so risks criticizing the clinician and his or her identity. Not that that’s unique here – many professionals are loath to criticize one of their own or the underpinnings of their craft and paycheck. It’s very dangerous. And crazy and anti-scientific and wrong, but it’s understandable.

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  2. This summarizes the process of healing from destructive family dynamics. The only thing I take issue with is saying someone “needs to work with a clinician.” This is NOT true. People can do it themselves as there’s dozens of books on healing from trauma that can do just as good a job if not better, as the “psychotherapeutic” relationship can be just as infantilizing, if not more so.

    Two YouTube videos to jumpstart the self therapy process: “Breaking From Your Parents – – An Overview”, and “Is My Therapist Good Or Not? 12 Questions From A Former Therapist”, both from Daniel Mackler

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  3. How can the “therapeutic relationship” be just as toxic (and even more so) than any other? Because in “therapy”, one actually IS the “identified patient”/symptom bearer, which is not a good feeling at all, and accumulates its own set of “therapeutic” baggage, courtesy your “therapist”.

    So travel light and plan your own itinerary, via self therapy. It’s the safest way to travel!

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  4. I was the sicky in my family, the scapegoat, the one who ruined nearly everything within the family dynamic. I would not study. This was jammed down my throat daily, hourly, continuously and it was the greatest horror any family as wonderful as mine could suffer.
    Especially when issues that created tension surfaced, they focused on how I destroyed their peace of mind, their lifelong goals, their reason for living, everything they tried to achieve. My parent’s Ivy League educations, (my uncle played football with RFK as my dad paid his way through school, after he paid his own way through Harvard when JFK attended) were referenced frequently to prove what could be achieved with hard work, unlike yours truly. He resented Joe pulling up in his limo to drop John off) the financial sacrifices they made every day to send me to the finest schools money could buy, the ways they went about living lives of drudgery because I spoiled everything by not becoming a scholar and preparing for the presidency, the way they worked night and day and on weekends from dawn until past dusk to beautify the mansion we lived in, to save the expense of paying others–it was and had to remain The Most Beautiful Estate locally, statewide and nationally, but only if I worked harder to manicure their lawns, plant shrubbery, build rock gardens, clear the lower level to prepare it for development of exquisite landscaping, build the bath house for that secluded part of our property, paint the house which was a year round task including the inside with their porches and kitchens and solarium, trimming out the massive picture windows, fixing leaks, installing the custom made awnings, building and caring for the patios, the fountains, indoors and outdoors, thoroughly cleaning and keeping in perfect order their garages, until 8 or 9pm and it was time for them to consume massive amounts of Dewars Scotch, every night. Then, back up at the crack if dawn after drinking til midnight, or 1am, 2am, or 3am until dad passed out playing the organ.
    The books I wouldn’t read, the educational t.v. programing I wouldn’t watch, wasting my time listening to rock and roll when I was supposed to be appreciating and studying the great operas and the great composers.
    For a few moments after working exhaustively all weekend on one of their endless projects, dad would acknowledge his pleasure with my efforts. Then, it was back to being the cause of the fighting, the tension, the screaming and howling and hatred and accusations and slamming doors among my siblings, picking up my sister who hid in a corner of the living room behind the drapes, shaking and whimpering, having been beaten by mother, to drive her to a place of safety for the night. And it was my fault. It always came back to that, to me, for destroying my family, because I refused to learn. I was not going to be president of Exxon, a U.S. Senator and then the President unless I reformed and studied 18 hours a day when I wasn’t working around their palace. Time was running out for me to position myself for greatness.
    I know about being the designated rotten, despicable, horrible, evil, disgusting GDSOB. My parents sacrificed everything so that I could study and prepare and bolt through the ranks after Harvard, MVP football player and Rhodes Scholar.

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    • It sounds very much like your parents were emotionally abusive, simply because you didn’t fit their expectations of you. I consider that horrible on their part, and I empathize with having to put up with that kind of horrible behavior. I would be very angry and disappointed by them, but I’d imagine I might always feel somewhat like I could “never be good enough” to satisfy them. Their behavior was cruel!

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      • And when they read Driven by Hallowell, a Harvard graduate and double blessed (ADHD and dyslexia) M.D. , they were silent. Mother actually said, “I’m sorry you struggled so.” Dad, the drunken, successful, narcissist noted he had some of the symptoms, never acknowledging the hell I lived in. Yes, he certainly had some of the symptoms but he was a genius and highly, highly, highly organized, disciplined, and determined, like the British Colonel played by Alec Guinness in The Bridge on the River Kwai, who was imprisoned in a dog house and would not give in after weeks of deprivation–that was my old man– and then designed and built a glorious bridge against all odds, that was my father.

        I was merely the God Damned, son of a bitch, lazy, good for nothing slob. Every day.
        They had no idea, not the slightest hint, how badly I wanted to learn. How desperately I longed to please my dad. How broken hearted I was. They were absolutely consumed with their passionate bitterness over my pathetic lack of interest

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        • To explain better the impetus behind these things, realize that Dad thought and believed strongly that he should have been president. JFK got in because he was talented, but mostly because he came from wealth. (Dad was well aware of his ways with the ladies which was common knowledge at the time on the campus.) Dad came from extreme poverty and waited on tables at Harvard and on JFK, to help to pay his way through school. He believed he was smarter, funnier, more powerful, more capable, a better athlete, more articulate, more charismatic and had better ideas on how to run the country than Kennedy and that he deserved the presidency. That contributed to the reasons he put pressure on me to perform. Growing up, I was given everything he didn’t have. So, I was without excuse. I would, I must, I had to become president. Very much like Joe groomed Joe Jr. to reach the top. Senior blamed his inability to become president in part because of his Irish heritage. Jr. died of course, so Jack was expected to fulfil dad’s dreams.

          So, for me, there were No excuses, We had the money to give me all those opportunities dad never had.

          “Meanwhile back in the year one
          When you belonged to no one
          You didn’t stand a chance, son
          If your pants were undone
          ‘Cause you were bred, for humanity
          And sold to society
          One day you’ll wake up, in the present day
          A million generations removed from expectations
          Of being who you really want to be
          Skating away, skating away, skating away
          On the thin ice of the new day”

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