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Psychotherapist’s Dilemma: A “Split” Point of View

Ayushi Ladha

Pop culture and psychology have a tumultuous history of not aligning with each other. Every other movie depicting a mainstream psychological phenomenon depicts a varying ratio of accurate and inaccurate portrayals of various mental health conditions as well as aspects. However, some psychological thrillers force us to reckon the possible real-life implications of what is often portrayed as fiction.

The movie Split is a work by M. Night Shyamalan (2016) which has taken several creative liberties in creating a chilling, if quite hyperbolized, portrayal of the rare dissociative identity disorder (DID). While the movie has faced its fair share of criticism for its violent portrayal of DID (Split: Why Mental Health Experts Are Critical of the Movie, 2017), the movie, alongside several other similar plots, raises the much more hidden question of the approaches that psychotherapists undertake while diagnosing and attempting to treat the extremities of rare and currently clinically uncurable mental disorders like dissociative identity disorders. This begs to question the vagueness that persists regarding where to draw the line between professionalism versus the best interests of the person undergoing the disorder. It also indicates towards the blurred boundaries of a therapist’s personal intervention versus the decision towards institutionalization.

Split is the story of Kevin, a character diagnosed with DID with 23 personalities known and discovered by his psychotherapist, Dr Karen Fletcher, during his therapy sessions (Shyamalan, 2016). While the movie focuses on an undiscovered and dangerous 24th identity, certain approaches by Dr Fletcher showcase the dilemma of “working hours” and the difficult boundaries of professionalism a psychotherapist faces. Kevin, as different personalities, tends to email Dr Fletcher at odd times of the day as well as the night to schedule extra sessions or urgent, immediate sessions, which Dr Fletcher obliges to (Shyamalan, 2016, 0:11:01, 0:38:12, 0:54:20, 1:10:40). While the aspect of different personalities emailing Dr Fletcher might be contested, the scenario unfolds a very real portrayal of psychotherapy as a profession being a choice between regular, scheduled therapy sessions or being present for a client undergoing a highly unpremeditated disorder. One’s own psychotherapist understands one’s case the best after multiple sessions of diagnosis and research, which creates for a difficult situation when the client undergoes serious disorders due to constant need for attention and diagnosis. The boundaries between such professionalism versus the client’s best interests are yet not clear, and neither is there a clear choice when it comes to the unpremeditated and often unprecedented possibilities of danger for a person undergoing a serious mental disorder.

Another hazy area of decision-making in psychotherapy for a disorder like the DID as portrayed in Split is the choice between personal intervention from psychotherapists versus institutionalizing the client or putting them under constant care. Kevin does not seem to have any guardians or kin. The only person aware of his disorder appears to be Dr Fletcher, who was also using her sessions with him to conduct research on DID and its manifestations as a factor of biological changes in the human body (Shyamalan, 2016, 0:35:49). While the science behind her claims seemed to be under study, by the end of the movie, it becomes consistently evident that Kevin could have been either institutionalized of under constant care due to his dangerous actions. However, Kevin seems to be a fully functional, self-sustained individual with a house of his own and living a broadly normal life as viewed by Dr Fletcher, thus making it difficult to diagnose the severity of his case. Before the movie climax, however, Dr Fletcher suspects the severity of Kevin’s disorder to be far worse and takes it upon herself to visit Kevin (Shyamalan, 2016, 1:11:26). In doing so, Dr Fletcher puts her life at risk and realizes the illegal, horrendous kidnapping and containment of three teenage girls done by Kevin as one of his personalities (Shyamalan, 2016, 1:19:02). Dr Fletcher loses her life while trying to save the girls (Shyamalan, 2016, 1:28:56). For a client undergoing a severe mental disorder with dangerous implications and no guardian or family members, their psychotherapist providing institutionalization or involuntary constant care is widely unheard of, and vague regarding the guidelines on doing the same. The same incident also raises the question of whether a psychotherapist should heed to personal intervention outside of professional capacities in case of perceived danger on a professional level as compared to an ethical level, thus confounding the boundaries needed to be drawn between client and therapist as part of the therapy and treatment process.

While severe and rare disorders themselves pose as a primary dilemma concerned with treatment methods varying from case to case, a secondary dilemma which has its own set of vagueness is on the psychotherapist’s end: how and when to establish boundaries in cases which are extremely involving. Immersing into a case is extremely crucial to analyse the best methods and approaches of treatment, yet, drawing a line on what constitutes as part and parcel of the treatment process versus what constitutes as measures to be taken in extreme cases is crucial as well. While close monitoring and watchlists for those in danger of severe actions and consequences is one way to go, in cases which might even vaguely resemble the circumstances as seen in Split might possibly need a different approach altogether, one that currently seems to be extremely difficult to quantify or specify. A part of the same is being informed and aware of the actual severity of the disorder, yet, a larger part is settling the blurred boundaries on what should constitute as part of the psychotherapist’s treatment process and what should the methods be to approach these boundaries to achieve a common ground between the client’s best interests as well as the therapist’s professional foundation.

 

Works Cited

Healthline. 2017. Split: Why Mental Health Experts Are Critical of the Movie.

https://www.healthline.com/health-news/movie-split-harms-people-with-dissociative-identity-disorder [Accessed 10 October 2022].

Night Shyamalan, M. (Director). (2016). Split [Film]. Universal Pictures. Amazon Prime:

https://www.primevideo.com

 

 


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