Target Patient

In a group or family dynamic, there is often what clinicians call a “target patient.”    This is the person who seems to most disturb the group dynamic, and so is identified as the source of problems within the unit.   Other terms for them might be “black sheep” or “scapegoat.”

The target patient isn’t the one who is causing the dysfunction in the group, but rather they are the one who is revealing it through their behaviours or words.   For example, mother may demand a regime of compliance to a somewhat dysfunctional norm, and the target patient may point out the costs of that compliance, which results in the rest of the group trying to silence them, trying to remove their standing to speak, or to directing social pressure to try and make them compliant with group norms, whatever those norms may be.

It will come as no surprise to anyone who knows me that I was quickly identified as the official shit-disturber in my family.   Was I the one who was causing the shit?  No.   But I was certainly the one who was stirring it up rather than letting it lie.   The Emperor may have no clothes, but it’s pointing that fact out that is often seen as the problem, not the Emperor’s demands for denial.

What did this mean for me?   Because I was selected as the target patient, I was also selected as the target healer.   My challenge was to get beyond the family dynamic so the sickness could stop with me.

That’s a challenging path, being the one who turns the other cheek.   Others act out their own fear and denial, trying to push my buttons and make me complicit in their game, but my obligation was not to let them drag me in, to stay centred and cool, not manipulated.

I know how to manipulate, but, like Penn & Teller, I had to learn to use that talent to educate rather than to baffle and control.    This meant un-wiring and examining the emotional triggers my family placed in me, understanding them well enough to come back and not be wazzled.

As I took care of my parents for their last decade of life, which including working with my sister and brother (or my sister-in-law’s husband, as I took to calling him), these learned skilled were taxed beyond the limits, at enormous cost to me.   As the target patient, the one who revealed the dysfunction in the family, I had to turn myself into the target healer, taking all those twists and smoothing them out using my own limited time and energy.

A friend of my sister is in a dark place, and not for the first time.  She stopped responding to my sister, and my sister found that frustrating.

“I tried to figure out what I had done wrong, why I was left hurt and angry,” she told me.

“Why you felt hurt and angry,” I suggested to her.  “Those are your feelings.  There is no indication that your friend wanted to hurt you.”

“Yes, but whenever someone is distant with me, I immediately start to worry about what I have done wrong,” she said.

“You had a passive-aggressive mother who wanted attention and control,” I suggested, “so she taught all her kids to be hypervigilent to her expression, to immediately try to satisfy her before she started making things worse.”

“Yeah,” my sister answered.  “My friend just dropped out for her reasons, but I immediately assumed it was about something I did wrong.”

“Well, better than our brother,” I noted.  “He got so habituated to that experience that he married a woman who always demands her feelings come first, and always makes him feel he has done something wrong and needs to work more to satisfy and satiate her.”   I admit, that when my parents were both dying and my brother would tell me that the highest priority had to be his wife’s happiness, I found that difficult.

I was the target patient, and that meant I had to be the target healer for my family.

And while it was admirable I took up that duty and did my excellence to do that job, I’m really feeling the cost of holding and processing the sickness for an entire family, rather than finding my own health and exuberance.

Oh, well.