Principle 1 of Family Systems: The Identified Patient

what is wrong with him (us)?

Often a family will name one of its members as the “black sheep.” A church will pick a person or a group in the congregation and label him or them as “the problem.” If we could only fix “the problem” or if we could convert the “black sheep,” the family or church would be okay.

The concept of family systems: if a situation is chronic – if the symptoms are recurring or of long duration – it’s not the “fault” of one person. It is because the family “likes it that way.” The family likes it the way it is more than being willing to endure the pain and effort it would take to change it.

Edwin Friedman, in the first chapter of his book, Generation to Generation (© 1985 The Guilford Press), explained the concept of the identified patient. The family member with the obvious symptom is not to be seen as the “sick one” but as the one in whom the family’s stress or pathology has surfaced. Physicians don’t assume the part of a human organism in pain, or failing to act properly, is necessarily the cause of its own distress. Problems in any organ may relate to excessive over functioning, under functioning, or dis-functioning of another. By keeping the focus on one of its members, the family, personal or congregational, can deny the very issues that contributed to making one of its members symptomatic, even if it ultimately harms the entire family.

A doctor doesn’t suggest someone who comes to him with yellow skin call the Avon lady. He’ll probably start by looking at the liver. Although the skin is yellow, it didn’t begin in the skin.

My father had bypass surgery in 1981. In February 1998, he was having pains in his jaw. He asked my wife, “Gail, do you think the pain in my jaw could have anything to do with my heart?”. She assured him that was a distinct possibility. He called his doctor on Monday. Tuesday he had an angiogram. Wednesday he had his second bypass surgery. He had a pain in his jaw. He didn’t need to see a dentist. It was heart disease.

Often when I’m consulting with congregations, the identified patient is “leadership.” Brothers tell me, “Our problem is a lack of effective leadership.” I ask how long this has been an issue. Usually, it’s been an issue for years. It’s my observation a church has the leaders it wants. It has leaders it’s trained, prayed for, encouraged, and tolerated. It’s late to be concerned about the quality of leadership two weeks before time to appoint shepherds or deacons. A series of sermons from 1 Timothy 3 and Titus 1 won’t make up for years of neglect in making disciples of Jesus.

Paul describes how the body is connected and how members affect each other in 1 Corinthians 12:26, “And if one member suffers, all the members suffer with it; or if one member is honored, all the members rejoice with it” (NKJV). We rarely have an individual problem of long duration. It’s a family problem. If we fail to recognize this, we may fix “the problem” (identified patient) but if the family doesn’t change, the symptoms will resurface in the same patient or another because forces that contributed to “the problem” are still there.

Do you know of a congregation that’s fired most of its preachers? Who selects preachers? Who interacts with preachers, encourages preachers, and discourages preachers? Are they consistently choosing bad preachers? Who did that? Do they select good preachers and good preachers become bad after they arrive? Will you solve the problem by choosing another bad preacher or a good preacher who will be micro-managed or ignored and criticized until he leaves?

We need to ask the same questions about all leadership. Who selects leaders? Who encourages elders and deacons in their work? Does the group approve or say nothing when unqualified men are considered? Do many in the congregation begin to criticize and question motives of anyone appointed to leadership? How long has it been since many people or the group expressed sincere, specific, and sustained appreciation to the leaders, individually and as a group?

I heard Ira North say, “We put a man in an ice house and cuss him for not sweating.”

If a church has a leadership deficiency, I wonder why they like it that way?

In his book, Healthy Congregations (Copyright © 1996 The Alban Institute, Inc.), Peter Steinke gives two quotes about this principle:

  • “It is more important to know what sort of patient has the disease than what sort of disease the patient has.” –Sir William Osler (page 23).
  • “The healthy society, like the healthy body, is not the one that has taken the most medicine. It is the one in which the internal health building force is in the best shape.” –Peter Senge (page 101).

When “the problem” has been in a church, family, business, or softball team for years, a good question for the group, “I wonder why we like it that way and would we be willing to endure the pain to change it (us)?”.

How have you dealt with “the problem” (identified patient) in your group?
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5 thoughts on “Principle 1 of Family Systems: The Identified Patient

  1. Jerrie,
    An excellent article, thank you. As some people get older they don’t want to go to the doctor because they are not willing to change or see if their illness can be dealt within a positive way. I think congregations that have been unhealthy for a long time find it easier to stay as they are because it has “always been that way”. Change is not something to be feared as long as we control it in a positive way.

  2. Excellent article, Jerry. Family systems is a huge and overlooked part of church dynamics. Keep up your great work. You are sowing wonderful seeds of wisdom in your senior years. I am sitting at your feet and learning a lot.

  3. Very good article! The problem is not always what is seen at first glance. There is often something else causing the problem. There is often a Black sheep of the Group. BUT THAT BLACK SHEEP MAYBE THE ONE WHO HAS THE BEST SOLUTION to the real cause of the problem. we need to examine ourselves and all sides before proceeding. To often the problem is my/our way or you can hit the highway. It is not what is the best way, it is my way.