Despite the fact that the Katz* family didn't 'believe in therapy' I wound up seeing Kay when the situation was totally desperate.
It is standard in family therapy to utilize genogram analysis for three generations, and that seems to be necessary to fully understand where Kay was coming from.
Kay's father, Kevin, was the only child of two Holocaust survivors. Despite the fact that Kevin's father was missing a thumb and forefinger, his mother had a nervous tic, and neither parent had any relatives, the war was never spoken of in Kevin's home, even when the father or mother lit a Yahrtzeit candle to commemorate the deaths of one of numerous siblings who had died during it.
Kevin had an accident as a young child, and his face was disfigured, but the topic was never broached, not by Kevin, not by his parents, not by his wife. To this day, Kay does not know what happened to her father to cause such scarring.
Kay's mom, Kadisha, was born to a heavy-drinking father and passive mother in the hills of Kentucky, as unusual as that was for Jews of the day. Kadisha was the first-born, followed by a boy, and then a girl. After the youngest sister, Kadisha's father told the children that his wife needed to be hospitalized for a postpartum depression.
Kay's maternal grandmother never left the psychiatric hospital, and Kadisha and her two siblings were mostly raised by a maternal aunt--and Kadisha herself--as their father became progressively less engaged with his children, finally leaving the family for good when Kadisha was 12.
Kadisha left home and came north at 16, supporting herself by doing nails and hair. At 17 she enrolled in a history class, just for kicks, at the local community college, where she met Kevin, doing his pre-reqs for the business degree he claimed later he had always wanted, and they married--an odd couple for sure--when she was 18 and he 19, pregnant with a child--another secret never to be told.
Both parents dropped out of school to scramble, with a baby on the way. Kevin became a traveling salesman, peddling mathematics textbooks, while Kadisha returned to doing nails, and then, as one baby after another arrived, became of necessity a full-time mom.
Kevin was on the road all the time when the kids were younger, and boasted to all and sundry that he had never changed a diaper or given a bottle. Raising kids, he maintained, was a woman's job, and, due to his explosive temper, the kids son learned to steer clear of their father.
Kadisha was pretty docile and could put up with most of the treatment she got, but at times she could lose her patience and fought back, mostly by refusing to speak to Kevin.
Then Kevin and Kadisha used the kids to speak to each other.
"Tell your father, " Kadisha would order Kay, "that I'm sick of his treatment and if he doesn't like this dinner he can just go find himself someone else to cook it for him."
"And you can just tell your mother," Kevin informed Kay, "that she's lucky she's got a man as solid an straight as me-let HER walk and see what else she can find out there, especially when she heads out towing 5 kids."
Sometimes using the kids as go-betweens went on so long that the parents actually forgot why they weren't talking to each other, and conversation deteriorated to, "Tell your mother to pass the green beans." Finally they just petered out, and eventually started talking to each other again. Apologies were never forthcoming-the whole procedure just got tiring.
Kay later told me the kids always half believed their father would walk out at any time. He could be scary an verbally violent to the kids, so their mother and the children banded together in a pact of secrecy-you just didn't tell Kevin anything important, no matter what. It was hard to tell how he would respond, so it was easier to tell him nothing, and the children's reported lives were a tissues of secrecy an lies, vis--vis their father.
And then the children began to reach adolescence, with Kay at the forefront.
The kids were actually all "good kids." They basically did well in school, they more or less succeeded socially, they were respectful. They didn't reflect in any way the dysfunction that pervaded their home, until Kay reached her senior year of high school, and the gloves came off.
Kevin enforced a strict curfew, which Kay circumvented by sneaking out the window. She lost her 'drippy old friends,' as she called them, and found some new ones that I wouldn't call drippy--but wouldn't have much positive to say about either. There was drinking, pot, sexual activity. Having grown up in a traditional Jewish home, Kay was pushing the boundaries of anything acceptable.
When Kay was suspended from school for showing up stoned, Kadisha brought her to me to ask for help, trying to elicit from me a promise that I wouldn't tell Kevin about treatment.
And Kay shared a few things in therapy, but she obviously didn't want help. She was on a bad track--and--and here's the point this all comes to--her siblings flourished. They continued to perform well both socially and academically, and worked jobs outside.
Because, you see, Kay was theidentified patient. Kay served, in a most self-sacrificing way, as the 'sick person' in the family, thereby acting out the family's dysfunction, and allowing the rest of the family to succeed.
Soon a boy she knew--peripherally, but still--died of a drug overdose, and I recommended an inpatient drug rehab program for Kay--partially to treat her growing chemical dependence, and partially to remove her from the family system that was bringing about her downfall.
But her parents were resistant, as family members so often are when the identified patient truly has a chance of healing.
And Kay, perfecting her identified patient role, has continued her downhill spiral--all the while granting her four siblings freedom from acting out the family dysfunction.
They owe her a debt of gratitude, as do all family members with identified patients in them--but is gratitude enough to save Kay?
Don't let yourself play the identified patient role--it isn't worth your life.
*All names and identifying details have been changed.
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