Disorders and Treatment
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As promised in my last post, here is a rundown of dysfunctional family systems roles other than the previously described spoiler.
1. The savior: In this scenario, a parent has suppressed his or her ambition to excel at some endeavor in order to satisfy cultural mandates, leading the child to act out the parent's forbidden ambition. The savior role often leads to chronic depression in the patient playing the role. For example, a woman from a traditional culture who has been exposed to female professionals in the United States might secretly wish to become a doctor. She can admit such a wish to neither herself nor anyone else, for fear of being disowned by her traditional relatives who expect her to be nothing more than a wife and mother.
Because parents often live vicariously through identification with their children, the woman might push her son or possibly even a daughter to become a doctor. This child becomes the parent’s savior. Whether the mother’s “stage mother” behavior initially produces a conflict in the child depends on whether or not that child had a natural inclination to become a doctor. However, even if the child were so inclined, a conflict will develop as the child gets closer to the goal. If the son or daughter succeeds in getting through medical school, the mother may, for example, become depressed.
The reason that the mother becomes depressed is that the child’s success reminds her that she herself was not able to do what she had really wanted to do all along. When she reacts negatively to the child, she is in reality covertly thinking about her own disappointment. From the perspective of the child, however, it can easily look as if the mother never really wanted him or her to become a doctor in the first place. The child becomes depressed because success becomes equated with a sense of helplessness and futility over keeping the parent stable.
2. The avenger: The avenger acts out a parent’s forbidden anger and hostility. This often leads the avenger to develop antisocial traits. For example, a father who is angry at his own employer but who was expected by his own Depression-era parents to keep his nose to the grindstone may react with not-so-hidden glee when his son creates havoc for the son's boss at the son’s place of employment. If the son keeps it up, however, father then feels obligated to be critical, for two reasons. First, he was taught that such flagrant self-expression is wrong in employment contexts. Second, he really does not want to see his son lose his job.
3. The defective: This role often leads to somatization or chronic psychological impairment. It is often seen in families with traditional gender role conflicts. The parents may or may not be conflicted over the role of parent per se, but feel useless when they are no longer needed in their capacity as traditional family caretakers. Children of course grow up, and the empty nest approaches. During this period, the parents may have fantasies about being free from family obligations and indulging in their more individualistic tendencies. Unfortunately, they feel useless and vaguely guilty if they do indulge them.
The child of such parents fears becoming independent for fear the parents might develop a pathological empty nest syndrome. He or she responds by failing to become self-sufficient. So that the parents do not blame themselves for the child’s lack of independence, or feel as though they had been inadequate parents, the child blames this inability to take care of himself or herself on some physical or psychological disorder.
The actual disorder may or may not be present, and if present, may or may not be exaggerated. Often it is unclear whether or not the child is purposely exaggerating his or her apparent disability. This way, depending on whether the parent is feeling guilty or angry at a given time, the child can assuage one polarity and feed into the other. He or she attempts to regulate exactly how much of each their parents’ are experiencing, in order to provide maximum stability.
Diseases that were traditionally thought to be "psychosomatic" are usually the ones used by a defective in need of a physical impairment. That is because they can be easily faked. One can wheeze even when one is not having an asthma attack, or have a pseudo-seizure when not having a real seizure.
4. The go-between: In this situation, the child is triangulated into a conflictual parental marriage. One or both parents may use the child as a confidant to complain about the other parent. Sometimes the parent may even subconsicously induce the child to act as a sort of surrogate spouse - providing to that parent what the real spouse is not providing. In the latter scenario, if the parent-child relationship has any sexual overtones, the child may exhibit histrionic traits. Sometimes, adult go-betweens are “on call” to settle marital disputes. Mother might come over and say to a grown daughter, “Go tell your father to do such and such; he won’t do it if I ask him but he will for you.” If the daughter complies, the mother may become jealous of her child’s relationship with the father.
5. Little man: This scenario is a variant of the savior role that leads to narcissistic issues. It is usually seen in males but may occur in a slightly different form with females. Gender role conflicts once again are the main culprit. In this situation, a woman who may have been taught as a child to be dependent on men and defer to men for most major decisions marries a man who is inadequate in some way. She may describe him as “never there for me.” He may be a poor provider due to a general unwillingness to work hard or may even desert the family altogether.
The woman then turns to her son to take care of her in all the ways his father did not. However, the son fails in this role for two reasons. One, he may be too young and simply lack the capabilities to look after her; he probably needs his mother to take care of him. Second, the mother resents his attempts at looking after her and subverts them. The reason for this is that she really is not - nor does she really want to be - as dependent as she may appear to be. The more the son tries to meet her needs, the more the mother emasculates him.
A male with narcissistic personality disorder may marry a female with BPD. Such a union is a common couple type seen in marital therapy and is an excellent example of a marital quid pro quo. The female with BPD is almost a prototype of a woman who seems to be in dire need of someone who will take care of her, but who spoils any attempt by anyone to do so. The relationship of the narcissistic male with his mother is thusly re-created in an even more extreme form within the marital relationship.
6. Monster. These people become seemingly horrific people within the family through such reprehensible behavior as severe child abuse. Everyone loves to hate these people. They may even brag about their misdeeds so that other people are fooled into thinking they are actually proud of them and therefore hate them all the more. This role can serve various purposes, such as to take the heat off parents who were themselves playing the monster role.
The monster is in effect saying, “It was OK that you abused me because look how awful I am. I clearly deserved whatever it was you dished out. In fact, I even do the exact same things you did.” Such people rarely come to therapy, so I have mostly learned about this role indirectly when my patients have to deal with parents who played the role. I believe it is central in cases in which abused children become abusive parents themselves.
These are the major role types, but there are also supporting roles such as the circuit breaker, who distracts two warring family members just when their arguments are about to escalate into violence. There is also the switchboard, who relays messages between other family members who are playing the major roles and their parents when the two parties are not speaking directly to one another.
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