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

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 every day 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”.

The appointed symptom bearer is the repository of unconscious collective familial defects and cruelty and functions as an external locus of control. Rather than recognizing a multiplicity of egregious concerns within the family, the symptom bearer is focused on as the primary cause of difficulties. Essentially the symptom bearer is scapegoated so as to take the onus off other family members. They are the proverbial ‘black sheep’ of the family.

The suffering of the symptom bearer runs deep. Being ‘loved’ becomes coupled with remaining crippled, as any deviation from the role of the sick one has been met with acrimony. As a result, traumatic loneliness plagues the symptom bearer.They feel ashamed of their perceived defects and culpability in relational dynamics. The shame reinforces feelings of marginalization and stigma.

Should the symptom bearer find the courage and fortitude to embark on recovery they will have to deal with the repercussions of upsetting the family homeostasis. Any attempts the symptom bearer makes to reclaim his worth and self-respect will be met with sabotage. Sometimes the sabotage may be stealth and take the form of infantilizing caregiving. Or it could be more overtly brutal and take the form of stonewalling, mockery, ostracism and belittling condemnation.

The symptom bearer who manages to liberate himself from the ravages of these annihilating dynamics will need to work with a clinician that takes a family systems approach. He will be challenged to dismantle an indoctrination in which the guilt of the family has become internalized as inherent ‘badness’. He will need to affirm that what he embodied for the family was a testimony to his instinctual awareness of the collective dysfunction.

Ultimately he will also have to find the courage to walk away from those who refuse to honor his right to be characterized with dignity and respect. When he embodies the conviction to refuse to take on the projections of those refusing to take personal responsibility for their own defects, he has reclaimed the source of his power; his ability to experience a healthy love of self.

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As a survivor (and thriver) of complex trauma and a seasoned therapist specializing in treating complex trauma, narcissistic abuse syndrome and addictions, I am intent on creating content that affords informative insight, hope and healing from psychological disorders. I aim for my creative content to assist readers with tapping into the resiliency of the human condition while recognizing the countless challenges of being human.

New York City, NY

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