Mental Illness as Plot Twist – Ethics in Fiction

Y’all… I have a love-hate relationship with the thriller genre. Soooo many of these books seem to fall under the cookie cutter “white woman with a dark past, a drinking problem, and a terrible husband who turns out not to be what he seems” plot without much new to offer. But once in a blue moon, I’ll find a book like The Silent Patient that kind of blows me away and keeps me coming back to the genre. (This is only marginally related to the topic at hand, but if you haven’t read The Silent Patient, please do. It has a major character in a mental hospital and managed to do so without feeling exploitative towards those with mental illness.)

This post was prompted by a thriller I recently read which will remain unnamed, because it’s impossible to discuss the issue at hand without delving into huge spoiler territory. The book was an advance reader copy, and I’d hate to throw the whole plot out into the world before the book is even released, but if the subject matter is something you know you want to avoid, I’ll happily email you the title. (Send me a message at

But really, I could be talking about any number of books or movies and the point would remain the same; writers seem to really love using dissociative identity disorder for cheap thrills.

Definition via

MV5BZTJiNGM2NjItNDRiYy00ZjY0LTgwNTItZDBmZGRlODQ4YThkL2ltYWdlXkEyXkFqcGdeQXVyMjY5ODI4NDk@._V1_.jpgThe trope of the evil alter-ego in someone with DID is heavily used in horror/thrillers, seemingly without any regard for the fact that real people suffer from these disorders and the associations formed through fiction carry through to the public’s view of them in real life. We see this trope popping up in movies like Split, Psycho, and in countless books, like Before She Knew Him (Peter Swanson) and (albeit with a sci-fi twist) The Strange Case of Dr. Jekyll and Mr. Hyde. It’s easy to see where the trope comes from; there is an intrinsic horror in the thought of large gaps in memory where we aren’t fully in control of our own actions. But fiction delving into DID routinely focuses on the prospect of harm to others as opposed to the ways the person with the disorder suffers. This, despite the fact that the evidence shows that people with DID are no more likely than the general population to be violent. In fact, those who suffer from mental illnesses are more likely to be the victims of violent crime than the general population.

The book that prompted this post made an effort to turn this trope on its head. The main character suffers from DID and is unaware of it. Her husband has been manipulating her for his own purposes, using one of her alters to get rid of inconvenient mistresses. While he is portrayed as the true villain and puppet-master, the book still hinges on the assumption that DID is linked to a proclivity for violence. The first murder was not committed at the husband’s request, and this was what made him realize he could use her disorder to his own advantage. The book ends with an afterward about mental health awareness and a desire for writers to do better by those who suffer from things like DID. It’s a nice sentiment, but it seems the author herself missed the mark in this case.

Thanks for reading, friends! Please feel free to share your thoughts on this topic in the comments, or tell me about one trope you want to see die in 2020!


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8 thoughts on “Mental Illness as Plot Twist – Ethics in Fiction”

    1. I was a psych major as well, so I think that’s part of why this is one of my big pet peeves. I also have a friend with DID, and I can’t look at stories like that without thinking about the mental impact on people like her. Things like anxiety, depression, etc., are often shown soooo inaccurately, but it doesn’t usually have the kind of malice that books featuring DID do. Most of the DID plot lines seem to amount to, “people with this are half evil and may decide to kill you at any moment.” Like… come on. Even if it weren’t hurtful towards the very real people who have that disorder, it still seems like lazy writing.

      Liked by 1 person

  1. Ugh. I really do wish mental illness was portrayed better in media period. Some books hit on it well, but I’ve noticed that the majority of them just don’t do well. I also wish people would stop writing books set in mental health hospitals altogether. Especially if they’ve never been in one themselves. I was in one for a couple weeks as a teenager, and I have not read a single book that has gotten it right, unfortunately. This is why I’ve been avoiding The Silent Patient, but I may give it a shot based on how you enjoyed it.

    Liked by 1 person

    1. I think The Silent Patient never bothered me the way books like this do because, while the setting is a mental hospital, it doesn’t fall into that super gross “crazy people are scary!!!” trope to build cheap tension. There is violence in the book, but it becomes clear that the violence in the plot was never a product of mental illness. I can’t speak specifically to the accuracy of the hospital setting because I have no first hand experience there, but just as someone with an educational background in psychology and who is sensitive to gross depictions of mental illness because of my own struggles, I was able to enjoy the book.

      Liked by 1 person

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