July 21

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Media Misrepresentations of Mental Illness: Dissociative Identity Disorder

Posted by on July 21, 2022 in Mental Illness, Movies, neuropsychology, Neuroscience in pop culture, Pop Culture, Science in pop culture | Leave a comment

It’s no secret that watching movies can create lasting impressions on viewers. This is true in cases of medical dramas, where viewers are introduced to rare diseases through interactions with fictional patients seeking help. It is also true of mental health conditions – both in the cases of television and movies, it has become increasingly common to see representations of psychiatric conditions in the media in the past decade. However, characters with mental illness are seldom normal characters carrying on average lives. Mental health remains a stigmatized topic in our society, and the media does not always get things right. Fictional characters with mental illness are often written to be either larger than life or one-dimensional, with their identities often centering on their mental health afflictions. In the worst of these cases, they are villainized in a way that perpetuates negative stereotypes about people with the referenced conditions. Coupled with a widespread lack of professional consulting to achieve proper portrayal of mental illnesses, this phenomenon feeds the mystery and stigma surrounding poorly understood conditions. 

Dissociative Identity Disorder

One movie which received lots of attention for featuring a psychiatric disorder in a protagonist is the 2016 M. Night Shyamalan film Split1. It is probably more fitting to describe this character as an antagonist, as his mental health disorder is the main driving force behind the plot, and the film opens with him kidnapping three teenagers. This character, introduced as Barry, suffers from dissociative identity disorder (DID). This condition is sometimes referred to as multiple personality disorder. Before delving into the movie’s portrayal of DID, it is important to consider what we know about this condition.

The Diagnostic and Statistical Manual 5, a diagnostic tool published through the American Psychiatric Association, defines DID as a disruption of identity characterized by two or more distinct personality states or an experience of possession2. It can essentially be characterized asa condition where someone possesses multiple personalities or identities. In Split, they are referred to as “alters”. These personalities may have different names and mannerisms than the patient’s main identity. Patients who receive a diagnosis of DID often speak about having out of body experiences and lapses in spans of memory, including specific events and people, while presenting different identities3,4,5. However, experiences are heterogeneous – some patients do not experience full separation while presenting each personality, remaining partially aware, while others experience dissociative amnesia and are not cognizant of what other identities experience5. In addition to the characteristics named above, the multiple identities may also have unique names and voices, even genders and ages. DID is often also comorbid with other mental health afflictions such as depression, anxiety, and suicidality3.

Image Credit: Universal Studios.

The underlying cause of DID is alluded to in the film in a series of flashbacks, but never explicitly discussed. However, it would be remiss to ignore that many – seemingly most­ – people with DID have experienced intense childhood trauma. In most cases, this trauma comes in the form of sustained, chronic abuse6. DID has been hypothesized to be a coping mechanism for those who suffer from their traumatic experiences, wherein they are able to push identities to the forefront who are better equipped to handle their traumas and protect parts of themselves which are more vulnerable7. Psychological professionals who work with these patients often focus on working through individuals’ trauma and create methods tailored to each patient that help them employ the strengths of each of their identities so they can function to the best of their ability. This form of tailored psychotherapy has proven to be advantageous for patients who receive treatment, but the road to receiving a diagnosis and therapeutic outlet is not a smooth one. A major obstacle faced by many people with DID is being believed about their condition and receiving their diagnoses. DID has remained highly controversial, with many patients needing to advocate tirelessly for themselves to get medical professionals to believe that their experiences with multiple identities are genuine. Most patients are treated in the mental health system for 7+ years before receiving a diagnosis of DID8.

Split Perceptions of DID

In the movie Split, some aspects of DID are conveyed correctly. It accurately communicates the way patients harbor multiple identities with distinct traits and characteristics, as previously described. Barry is shown several times in sessions with his psychiatrist, who is portrayed as an expert in DID. Prior to the film’s fracture from the truth, the information she conveys is rational and grounded in reality. However, in one scene, the psychiatrist is shown participating in a panel on personality disorders at an international conference. Here, she poses a theory about how fragmentation of DID patients’ consciousness is a “superpower” of sorts, unlocking more of the brain than neurotypical people have access to1. At this point in the movie, the plot begins to cross the bridge from science to pseudoscience and fantasy.  Because DID is so poorly understood by the general public, the assertions made in the film about the abilities of individuals with DID could be interpreted as fact. The way DID patients use their identities to cope with their traumatic experiences is truthful but describing the disorder as a superpower begins to muddy the waters of proper psychiatric care. Although the information being relayed by the ostensibly well-meaning psychiatrist is somewhat grounded in truth, elements of the supernatural are tied in. Therefore, while watching the movie, it may be difficult for the average viewer to discern what is fact and what is untrue. For example, the psychiatrist explains that patients’ different identities may have different medical needs. One of Barry’s alters is diabetic and requires insulin shots, while the others do not. She also tells of a blind woman who had a sighted alter, whose optic nerve somehow regenerated1. I hate to be the bearer of bad news, but no, scientists have not found the solution to nerve regeneration in DID. The debate over whether alters can harbor any different physical traits appears to be highly controversial, with a single citation from 2001 making claims about physical differences between identities that do not appear to be backed by any actual scientific studies9. Altogether, these false and confusing assertions, when blended together alongside benign statements about DID, give viewers the difficult job of separating fact from fiction. This can easily lead to negative misinterpretations that perpetuate the stigma surrounding mental health conditions like DID.

DID and “evil alters”: a 21st century take on a classic trope

Image Credit: The Verge.

Interestingly, Split’s decision to portray a DID patient with perplexing and morally ambiguous personalities is not an isolated instance. Robert Louis Stevenson popularized the concept of the evil alter ego in his classic novella, The Strange Case of Dr Jekyll and Mr. Hyde, originally published in 188610. In modern times, despite carrying on this trope through the lens of DID, other series have proven that elements of fantasy and action do not have to come at the expense of people with DID. In the new Marvel series Moon Knight (caution, this section contains spoilers), protagonist Steven Grant is introduced as an odd but endearing museum employee with an inclination to wander in his sleep, waking up in strange places with no memory of how he got there. As the series continues, Steven discovers that he is losing significant amounts of time, and it becomes clear that his physical body is carrying on during these periods that he cannot remember. Eventually Steven makes contact with Marc Spector, another personality who lives in his body who turns out to be a fearless mercenary11. The two communicate by speaking to one another in their reflections, which has been described as a metaphor for internal communication between alters12. Moon Knight got several things right about DID – it puts an important spotlight on the trauma that acted as an underlying cause of the condition, shedding light on the protagonist’s vulnerable psychological state. It also acknowledges an interesting phenomenon, which is the fact that Steven is unaware that he is one of at least two personalities, while Marc is aware of their condition. This speaks to the experience of many real people with DID, who experience varying degrees of cognizance4. While this series’ portrayal of DID is more sensitive and realistic than in Split, it is still far from perfect. The same trope is employed as in Split – a person with DID harbors a violent alter, and chaos ensues. This element of the plot reinforces the stereotype that those who struggle with their mental health are prone to violence and instability.

In Split, the experience of living with DID is portrayed with a great degree of creative freedom. In another fracture from reality (spoiler alert), Barry ultimately transforms into a superhuman form dubbed “The Beast” that consumes two of the teenage girls he kidnapped earlier in the film, a sacrifice planned by some of Barry’s alters. While having a character with DID scale sheer walls on his fingertips and devour a human sacrifice might be shocking entertainment, these exaggerations may cause people to fear those with DID, who are simply people who have suffered, coping with their trauma in a rare and complex manner. The violence Barry is capable of is simply another exaggeration of this film. By highlighting him as a disturbed and violent figure, the film ensures that one of the only characters in pop culture to be shown with DID is a monster. However, this could not be further from the truth. Studies have shown that people with DID are unlikely to be violent, and are statistically more likely to be a victim of crime than a perpetrator4,13.

In this film, the intersection between reality and pseudoscience comes at the expense of real patients with DID. Though Barry’s transformation into “The Beast” is clearly science fiction, the violent escalation we see Barry undergo throughout the movie is damaging for those with DID who must already surmount societal hurdles to lead normal lives. Stereotypes of instability plague those who struggle with mental health, from depression and anxiety to personality disorders, contributing to difficulty and fear surrounding discussions of mental health. Barry’s perceived instability during his descent into violence, orchestrated by his evil alters, feeds into the stigma surrounding people with mental illness. People who struggle with mental health are often perceived as mercurial and erratic regardless of their capability to lead normal lives and maintain steady jobs and relationships. This has major implications in the culture surrounding this topic, particularly in environments such as school and work, leading to broad impacts on adolescents and adults alike. Although we have come a long way in understanding and breaking down the stigma surrounding mental health by the year 2022, there is still a lot of work to be done.

Repercussions of irresponsible portrayal of mental illness

Image Credit: Universal Studios.

There is a fine line that must remain between exaggerated science fiction horror movies and demonizing what we do not understand. However, I do not want to condemn fiction- there is nothing wrong with movies about superheroes, intergalactic adventures, or anthropomorphized animals. When viewers know they are watching a work of fiction, stretching features of the world we understand, artistic creativity can be appreciated and explored. Alternatively, when people with psychiatric struggles are depicted as evil in ways that conflate mental illness and science fiction, it is almost exclusively damaging. This is the case in Split. Director M. Night Shyamalan is a master of mysteries and plot twists, but in this film, the basis for his antagonist was in extremely poor taste. By choosing a mental illness that is so poorly understood, Shyamalan was able to blur the lines between truth and reality in what I am sure was a calculated design – but in doing so, he had no regard for the patients with DID who would be caught in the crossfire. Additionally, it became known that the actor behind Barry did not meet with any DID patients in preparation for his role, perhaps alluding to the fact that the character was not designed as a realistic portrayal. In recent years, platforms such as Netflix and Hulu have begun to screen content warnings and disclaimers before their original movies and series. A well-known case where content warnings were implemented was in 2018 when Netflix inserted a warning video before their show 13 Reasons Why, which was centered around a case of an adolescent suicide and contained depictions of traumatic events such as sexual assault and self-harm14. This amendment followed an outburst of protests brought on by concerned viewers and a staggering 28.6% increase in youth suicide (ages 10-17) in the month following the show’s release15,16. This statistic alone is enough to leave anyone with a pit in their stomach, and was seemingly the direct result of showrunners adamantly disobeying experts’ guidelines on how to approach such sensitive and traumatic themes. Altogether, it is evident that the way mental health is portrayed in the media has an incredibly clear effect on viewers, and irresponsible handling of such topics can have devastating consequences.

In 2016, perhaps this type of precaution could have saved Split from criticism over blurring fact and fiction. By asserting that the movie contained exaggerated portrayals of mentally ill characters or labeling itself more firmly as science fiction (rather than leaving its superhuman transformation as a plot twist), Split may have been able to separate Barry from the vulnerable population of people living with DID who found themselves villainized in this film.

Featured illustration by Gracia Lam.

Citations

  1. Shyamalan, M. Night (Director). (2016). Split. Universal Pictures.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  3. National Alliance on Mental Illness. (n.d.). Dissociative Disorders. Retrieved July 8, 2022, from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Dissociative-Disorders
  4. Dissociative identity disorder (DID). (2022, February 20). Retrieved July 12, 2022, from https://www.sane.org/information-and-resources/facts-and-guides/dissociative-identity-disorder#references
  5. Şar, V., Dorahy, M. J., & Krüger, C. (2017). Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective. Psychology research and behavior management, 10, 137. 
  6. Brand, B., & Pasko, D. (2017). Split is based on myths about Dissociative Identity disorder. PsycCRITIQUES, 62(18). doi:10.1037/a0040801
  7. Nedelman, M. (2017, January 23). What Shyamalan’s ‘split’ gets wrong about dissociative identity disorder. Retrieved July 8, 2022, from https://www.cnn.com/2017/01/23/health/shyamalan-split-movie-dissociative-identity-disorder/index.html
  8. Brand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2016). Separating fact from fiction: An empirical examination of six myths about Dissociative Identity disorder. Harvard Review of Psychiatry, 24(4), 257-270. doi:10.1097/hrp.0000000000000100
  9. Haddock, D. B. (2001). The Dissociative Identity Disorder Sourcebook. New York, NY: McGraw Hill.
  10. Stevenson, R. L. (2012). Dr Jekyll and Mr Hyde. Penguin Classics.
  11. Cameron, P. (Executive Producer). (2022). Moon Knight [TV series]. Marvel Studios.
  12. Vinney, C. (2022, May 10). Mind in the media: What Moon Knight gets right about dissociative identity disorder. Retrieved July 12, 2022, from https://www.verywellmind.com/what-moon-knight-gets-right-about-dissociative-identity-disorder-5248670#:~:text=Rosenbaum%2C%20MD%20explains%2C%20when%20the,in%20the%20comics%2C%20with%20early
  13. Webermann, A. R., & Brand, B. L. (2017). Mental illness and violent behavior: The role of Dissociation. Borderline Personality Disorder and Emotion Dysregulation, 4(1). doi:10.1186/s40479-017-0053-9
  14. Libbey, P. (2018, March 22). Netflix adds a warning video to ’13 reasons why’. The New York Times. Retrieved July 8, 2022, from https://www.nytimes.com/2018/03/22/arts/television/netflix-warning-video-13-reasons-why.html
  15. Bridge, J. A., Greenhouse, J. B., Ruch, D., Stevens, J., Ackerman, J., Sheftall, A. H., Horowitz, L. M., Kelleher, K. J., & Campo, J. V. (2020). Association Between the Release of Netflix’s 13 Reasons Why and Suicide Rates in the United States: An Interrupted Time Series Analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 59(2), 236–243. https://doi.org/10.1016/j.jaac.2019.04.020
  16. Cole, C. (2019, April 29). Release of “13 reasons why” associated with increase in youth suicide rates. Retrieved July 8, 2022, from https://www.nih.gov/news-events/news-releases/release-13-reasons-why-associated-increase-youth-suicide-rates