Dissociative Identity Disorder is termed as such, deviating from its former name of Multiple Personality Disorder, because rather than having several different identities inhabit one body, the disorder is understood to encompass one multi-faceted personality with parts that are not yet "functioning together in a smooth, coordinated and flexible way” (Boon et al, 2011)". In my opinion this was portrayed accurately by Sally Field as we see personalities ranging from the calm and collected Vicky to the infantile Ruthie surface in varying situations. Indeed, these "personalities" are autonomous and identify themselves as distinct from Sybil, sometimes in terms of age and even gender, which is consistent with real life accounts of this disorder. To the film's credit, they also managed to capture the cause of the disorder quite accurately as DID is almost exclusively caused by repeated childhood trauma, as seen by Sybil's mother's horrific abuse of her daughter. In the absence of appropriate parental support, much like the way Sybil's father refused to even acknowledge his wife's abusive behaviour, the dissociative identities arise as a method of coping with the trauma. As we saw in the film, this was not a lifestyle choice for Sybil, despite her singular attempt to convince Dr Wilbur that their sessions together were nothing more than a staged act. The contemporary explanation for DID is that the individual personality is "experienced in a disconnected way via separate 'parts' or 'alters'" due to an inability to reconcile the various aspects of personality, memory, identity, behaviour, and feelings (Spring, 2012). Going by this, one could postulate that the "identity" of Vicky is a projection of Sybil's ideal self, whereby she is sophisticated and dignified where Sybil is not. Mary, the identity that arose after the death of Sybil's grandmother, could be a way for Sybil to keep the memory of her grandmother alive, as the latter was possibly the only person who Sybil felt loved her. Even Dr Wilbur mentioned that Sybil's different "personalities" were there to protect her and take action when she herself could not.
According to the DSM-V, the criteria for an individual to be diagnosed with DID (Tracy, 2016) includes:
1. Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to and thinking about the environment and self.
2. Amnesia must occur, defined as gaps in the recall of everyday events, important personal information and/or traumatic events.
3. The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
4. The disturbance is not part of normal cultural or religious practices.
5. The symptoms are not due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).
Based on the events that transpired in the film, it is safe to conclude that the portrayal of Sybil as a woman afflicted with DID as she clearly meets the first three criteria. It is also assumed that her condition was not a result of religious practices or a certain substance. Indeed, we see marked impairment in Sybil's daily functioning as her dissociative episodes caused her to lose her job, which understandably results in distress.
However, the movie also depicted several ethical violations in terms of the client-therapist relationship, which I believe no qualified mental health practitioner should ever commit in real life. Dr Wilbur adopted a psychodynamic approach in order to uncover the root of Sybil's disorder, although some recommend that therapy involve cognitive behavioral therapy (CBT) instead (Gillig, 2009). In spite of this, the real issue lies with Dr Wilbur's conduct as a psychiatrist. Even though she is warned by her colleague not to become emotionally attached to Sybil, we can almost see a personal investment as she continues to treat Sybil. Additionally, we see her commit a breach of confidentiality by informing Richard about Sybil's disorder when Marcia attempted to kill herself. As a mental health professional, safeguarding a client's information is of utmost importance considering the level of trust established during sessions and the stigma surrounding mental health problems that still pervade society. Understandably, the situation warranted drastic measures in order to ensure Sybil's safety, but one cannot help but wonder if Richard and Sybil's relationship would have turned out differently had she found the right time to tell him about her disorder on her own terms. Other than that, a mental health professional should only provide services within the boundaries of their own competence (APA, n.d.), but we see Dr Wilbur struggle to decide on a course of action when Sybil regresses into Ruthie. She took a step in the right direction by contacting a colleague for help, but the problem resolved itself when Sybil resurfaced, but did nothing to address the problem of Dr Wilbur's professional capabilities in dealing with some of Sybil's more challenging alters.
Ultimately, I think the film did its best to portray DID in a realistic light whilst remaining within the realm of good story-telling. As a psychologist, however, some of Dr Wilbur's actions were questionable at best, and I would not condone them in a professional setting as it could impact a client's recovery.
References
American Psychological Association. (n.d.). Ethical Principles of Psychologists and Code of Conduct. Retrieved from http://www.apa.org/ethics/code/
Boon, S., Steele, K., & van der Hart, O. (2011). Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists. Retrieved from https://books.google.com.my/books?id=raGhAQAAQBAJ&printsec=frontcover#v=onepage&q&f=false
Gillig, P. M. (2009). Dissociative Identity Disorder: A Controversial Diagnosis. Psychiatry (Edgmont), 6(3), 24–29.
Tracy, N. (2016). Dissociative Identity Disorder (DID) DSM-V criteria. Retrieved from http://www.healthyplace.com/abuse/dissociative-identity-disorder/dissociative-identity-disorder-did-dsm-5-criteria/
No comments:
Post a Comment