When I have a headache, the symptom is that my head hurts. But the actual problem is usually somewhere else: my back or my feet, generally.

Similarly, a member of a family (family meaning any emotionally connected group) may show symptoms of depression, eating disorders, sexual acting-out, rage, paranoia, anxiety, alcoholism, drug abuse, and chronic physical illnesses.

However, in many cases those are just symptoms. The sickness is somewhere else. It may be in one person, it may be multiple people, or it may be that the family structure itself is just sick, even though no specific person is sick.

I will use the most extreme example to start: a father who is sexually abusing his children.

The father won’t show symptoms unless somebody starts to heal. Until then, he will seem to have it all together.

Who will show the most extreme symptoms? The victims will show symptoms, obviously, but the most severe symptoms will be shown by those in the family who take emotional responsibility for their father’s actions, whether they are victims or not. Those trying to protect the father, or the family’s reputation, even if it’s just on an internal level, will suffer the most pain, and they will transmit that pain to their loved ones.

Next, a much less extreme and very common example. The father and mother are emotionally abusive to each other. The children watch. So now instead of one predator we have two abusers. In such a family the children will show more severe symptoms than the parents.

The parents may show symptoms of, for example, depression or alcoholism. The children though, will suffer from pathological depression, eating disorders, extreme drug abuse, sexual acting out and/or bizarre chronic physical illnesses. The severity of the symptoms will depend on the extent to which the children feel responsible for their parent’s behavior.

This cannot be overstated. The children’s emotional feeling of responsibility for their parent’s relationship determines the severity of the children’s symptoms.

The third example is a family where no one is clearly abusive but the family structure is sick, characterized by incessant conflict, poorly maintained boundaries, communication breakdowns, and a lot of people doing things they hate doing. This is disturbingly common in organizations like churches, non-profits, and businesses that lack healthy competition. These toxic families are marked by total “stuck-ness”. The family always seems incapable of moving forward, and everyone feels anxious, frustrated, or burned out.

And the least healthy, most dependent member of the family controls the family.

How? Their dependence requires everyone else’s attention and makes growth impossible. The family is engaged in constant crisis management. Everyone is very empathetic and no one sets effective boundaries. And of course, everyone gets to treat the least healthy family member as the scapegoat.

Romantic relationships often end up here. Crappy co-dependent relationships have an inherent stability because both partners agree to put up with each other’s mess. In return they don’t have to be alone, and they don’t have to deal with the pain of growth.

And growth always hurts. Setting boundaries always causes short-term pain. Real healing always hurts at first. That’s why it’s so important to distinguish the symptoms from the sickness. When you start to heal, the symptoms often get WORSE at first!

Now when the symptoms are bad enough, sometimes they have to be dealt with directly, just like I had to take an anesthetic when I got my wisdom teeth pulled. Sometimes pain-killers are necessary.

But if you are suffering from symptoms you will eventually have to deal with the family sickness that creates and sustains those symptoms. And unfortunately, that will often lead to temper tantrums from members of the family who are comfortable with you being the scapegoat, the victim, the clueless “leader”, the super-achieving golden child, or (worst of all) the “empath”.

Never forget that other people’s temper tantrums are not your responsibility. At all. Your responsibilities are your own words, actions and habits, your direct relationships to your own dreams, values and goals, and your direct relationships to other people. That’s it.