Dissociative Identity Disorder and the Media: Ethical Questions

I had an experience recently that I thought I’d write about. These days I often receive requests from various media sources wanting to interview me about something trauma related. Terrific, I typically think! Another type of opportunity to raise awareness and educate. Of course I am well aware that not all media is created equal; to the best of my ability I want to participate in ways that destigmatize and demystify mental health issues.

Recently I received one such request, a sort of fact finding, information gathering mission, from an organization purporting to be planning to make a documentary about dissociative identity disorder (DID).  The stated goal was to present a more realistic view as compared to the over the top portrayals we are used to seeing. The call cited my writing on this topic, particularly my article United States of Tara Controversy where I address concerns about sensationalism of DID by the media.

Sounds good, right?

Unfortunately, it quickly became clear that what was really wanted was for me to serve up access to a DID client or clients who could perform on cue, perhaps with the therapist present to facilitate the process. How disappointing! This just sounds like more of the same. I’ve previously written about the negative impact of depicting only the “Tara” or “Sybil” extremes of DID as the norm. This experience also got me thinking about what, in my clinical opinion, is wrong with therapists participating in such endeavors. (In case you were wondering, I declined to participate any further).

A situation like this brings up issues for me related to confidentiality, dual relationships and the potential for exploitation of the client. Whose needs are being given priority in this situation? When I have seen shows like this in the past I have felt very ill at ease. I have wondered how the therapy was compromised by this extra-therapy activity and what the motives of the therapist were. His/her own fame? Increasing awareness and education? The best interests of this particular client?

And what of the therapy relationship? It is of course illegal and unethical for therapists to violate confidentiality, so in no way would I introduce a client to a documentary maker without their consent. But wouldn’t even raising this as a possibility alter the therapy relationship? Would a client feel compelled to say yes to please the therapist? Honored to be asked? Is it really possible to give informed consent when it may be difficult to anticipate exactly how such an activity might impact you and help or hinder your ongoing healing?

As a psychologist I agree to operate within my profession’s code of ethics. This involves engaging in a thoughtful, decision-making process, weighing whether extra-therapy activities constitute a dual relationship, and if so is there potential for harm? An excerpt from the American Psychological Association‘s Ethical Principles of Psychologists and Code of Conduct states:

A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.

Would taking part in a documentary with a client be reasonably expected to do any of the above? Too likely for my comfort!

In closing, I share with you the opinion of the International Society for Study of Dissociation. They have included a section specifically addressing “Publications and Interactions with the Media” in their Guidelines for Treating Dissociative Identity Disorder in Adults:

The media and the public have a long fascination with DID, going back to the 19th century. Also, when doing a story, media reporters commonly want an individual to be the focus of the “human interest” aspect of the story. Thus, clinicians working with DID may find themselves targeted by the media asking to do a story on DID, usually with the request that the clinician provide a patient to be the story’s focus. In all interactions with the media concerning DID, the therapist’s primary responsibility remains the welfare of his/her patients. Thus, the therapist must maintain the highest ethical and legal standards of  confidentiality with respect to clinical material. Appearances by patients in public settings with or without their therapists, especially when patients are encouraged to demonstrate DID
phenomena such as switching, may consciously or unconsciously exploit the patient and can interfere with ongoing therapy. Therefore, it is generally not appropriate for a therapist actively to encourage patients to “go public” with their condition or history. Patients who ignore this advice rarely have a positive experience and often wind up feeling violated and traumatized.

My gut reaction to not get involved was immediate. This was exactly the sort of media representation of any mental health issue that I want to see us move away from. I am glad there are resources like those I’ve quoted from above to help clinicians make informed choices when the decision does not seem clear.

Kathleen Young, Psy.D.

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18 Responses to Dissociative Identity Disorder and the Media: Ethical Questions

  1. Merrick Dean says:

    Good call Kathe, very good call..

  2. Jeanette says:

    As a person with DID and involved in very intense post trauma therapy, I have been troubled also by most of the media’s intrusion into the lives of DID patients, I can’t think of anything I’ve seen so far that didn’t leave me feeling that the client had just been exploited, and that even I had been exploited just by having the same disorder. I can’t imagine a competent therapist even thinking about subjecting their client to this, there is no control over what is going to happen, nor what the outcome will be once it hits the editing room.

    I’m happy to see you speaking out about this kind of thing. I get so twisted up inside when I see this stuff going on, it doesn’t do those of us who have the disorder any service, it smacks of ‘freak show’ and that is so hurtful. I can’t imagine anyone who has the disorder wanting to be seen in this way. Trying to maintain the appearance of being normal seems more the priority for those of us who suffer with this.

    Thank you for writing about this and expressing a compassionate perspective. 🙂

    • Thanks for your response, Jeanette. It sounds like we have similar reactions to these media portrayals of DID. It is disturbing, seeing how the media uses something that is painful to many as a source of entertainment!
      One way I wanted to write this was as a way of standing apart from others in my profession who do participate. It is not how we all operate!

      • Jeanette says:

        It is very encouraging to know that there are therapists who understand the complexity and the pain involved in DID, and who would never compromise their clients healing process.

        From what I can tell, it’s very hard to find therapists who even have experience in working with this disorder, and I’m so thrilled to have found one that I am working with amazingly well, and it warms my heart when you do a post on occasion about DID, I can feel your compassion for survivors and that is uplifting for me. 🙂

  3. I loved the phrase (perform on command) because that’s always been my pet peeve with therapist or those who do evaluations. If they don’t see a switch soon enough they seem to doubt dissociation which always baffles me. Good article today.

    • Hi Jacki! Thanks for commenting.

      You are making a point that addresses one of my concerns about these sorts of media portrayals: folks think all DID looks like that and doubt their own experience or (in the case of clinicians) miss seeing the more subtle variations.

  4. Nice to meet everyone 🙂

    I’d love to take interviews as someone who is living with DID and purposefully not integrating. However, if they expect us to switch and put on a show for them they have another thing coming. I’m very out-of-the-closet about my diagnosis, and I use it as a strength (most people go “OH, that explains how you….” [fill in the blank: are so creative, are so logical, are so talented in so many things, etc.]). However we’ve crafted a ubiquitous mask we wear for the world, and it’s not coming off for the camera. 🙂

    I can explain why we won’t outwardly shift for the camera, and I can explain why we have a mask in the first place. Our DID developed mainly as a defense mechanism, so it developed right alongside a safety mechanism to “not get caught” switching: our mask was developed to keep people — INCLUDING OURSELVES — from detecting our shifts. People sometimes ask me “who I am” at any given moment. Most of the time we’d be hard pressed to know, but we always dodge the question because it’s usually not the questioner’s business “who we are” at any given moment. Sometimes we are fully aware of who we are, sometimes it’s like someone saying “What are you thinking?” and the thought just dives away from you never to be recovered.

    All that said, it’s 100% up to each person & system what they are comfortable with. If someone wants to switch for the camera, more health to them. I had a hard time force-switching for my own video (on YouTube just find The Crisses) that I filmed to talk to people who weren’t co-aware in my head. I can’t see myself force-switching just for some journalist or so that someone can get good ratings on a show. I posted my video several years later as an act of authenticity and in the hopes that it might help other multiples. If they want footage of someone “switching”, it’s on YouTube. 😛 🙂

    The Crisses

    • Hi Rev Criss and welcome! 🙂

      I really appreciate your input. Thanks also for introducing me to your site which I look forward to perusing more fully.

      • That’s my “Work site” — I’m (we’re? Darn English.) the founder of http://kinhost.org which is a big resource of by-multiples-for-multiples (and those who love them) information. Also have our own separate site http://crisses.org — haven’t gotten around to removing all our personal stuff from kinhost.org yet. Very nice to make your acquaintance.

        Oh, I also ran across a new conference going on in February — “Infinite Mind” — in Florida for persons with DID. I’m not affiliated, but it looked really interesting in case anyone here is interested.

  5. Kathy, Really good for you. Your attention to boundaries and ethics and welfare of patients is exemplary. DID patients are just one group that tends to be exploited. Thank you for not going there. Your thoughtful approach is one that instills confidence. I do think others do media who have good intentions, but end up in not such a good place. Last year I seem to recall that Discovery Health did a special on DID (it was part of their “odd disorders week” or something like that). Colin Ross was the main therapist on the DID show. I was kind of appalled at how the show went. I saw it as exploitative. The problem is that the real day-to-day picture of DID is not so media sexy. This is why people who write about it in the way you do, and I do, and many others do, are so important.

    • Your comment means a lot to me, Paul. Thank you.

      Good point about intentions! I know of several clinicians I think highly of who got involved with the media with good intentions and learned hard lessons about how those things can turn out. But that was back in the 80s. By now we’ve seen so many examples of exploitative media coverage of mental health issues it makes good sense to be wary.

      Blogging and social media are so powerful; they give folks the opportunity to tell their stories in their own way, and to paint real pictures of the variety of types of survivors and paths to healing. I have long admired your blogging voice, Paul, as a valuable resource for clinicians and survivors alike.

  6. kiyacat says:

    I think it would be hugely conflicting to be asked to participate in a show… i was even asked to be in a book (and I admit I didn’t know why I was saying yes… to please?) and I am glad the book never even got started. I would think it would be especially dangerous with multiples because the host may agree (or another adult part) and then in filming, another who did not consent, or child alters are there and it is just SO NOT OK. I do think it would change the relationship – there would always be that doubt – did we just get used? were we sold out? am i really safe with this therapist? am i only a show to the therapist? There might be withdrawal or resentment later or a total rupture.
    I hope you also gave them a piece of your mind about turning DID into entertainment for the masses. It is a tricky line to walk; sensationalism or education. Now if say Discovery Channel wanted to have a play actor learn what our lives are like and then reproduce the “humdrum everyday-ness” of it as an educational film so that therapists and loved ones could better catch the signs of stress and switching, I could see that as useful – but not utilizing an acutal patient and their therapist.

    • Hi kiyacat-

      Oh, another good point about the complexity of informed consent when dealing with multiplicity!

      I did indeed describe what I see as problematic about a therapist engaging with their client in such an endeavor, as well as my hope that this not be another “dog and pony show” approach to such a serious topic.

      Could it be done differently/educationally? Sure! Do I think I as a therapist should serve as a conduit to my clients? Absolutely not. But I think I made that clear already, huh? 🙂

  7. Lothlorien says:

    You made a good call. I cringed when I read they wanted a client who could be prompted to switch on cue! That is manipulation and most definitely exploits the client. You are also right in the consent area. Many clients would be torn by their desire to “help” or go along with the therapist or not–it could cloud their ability to know what they truly want for themselves.

    I have been diagnosed DID, although I am approaching integration and my T says my experience is more in line with DDNOS these days. I appreciate you sharing this issue on your blog.


  8. marlee says:

    I am so desperate to be able to get therapy right now I think I would do it if someone could help me get treatment. My insurance has limited me to 20 appointments a year and I’m going through some intense stuff and it’s just not enough. I hate to have to go in the hospital again. 😦

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