Mental Health, Therapy, and Psychopathology: Busting Some Myths

Elizabeth Zelvin

As an experienced psychotherapist, I frequently wince over errors on issues of mental health, mental illness, and related topics. The mystery community is well aware of some of these. For example, everybody seems to know that everything about the CSI TV shows is wrong. Crime scene and forensic scientists don’t interview witnesses or confront suspects. DNA results come back from the lab in months, not hours—except, of course, when the case has global high priority, as we saw following recent events in Pakistan. But some myths are extremely persistent. Giving life to them in fiction perpetuates them further.

Here are some of my pet peeves:

Myth: If you want therapy to deal with, say, relationship or family issues, you need a psychiatrist or psychologist. Reality: More “talk therapy” is done by clinical social workers (like me) than by psychiatrists and psychologists. Psychiatrists can prescribe psychotropic medications and get patients admitted to hospitals, so a competent therapist would refer a patient with severe symptoms of anxiety, depression, or a thought disorder to a psychiatrist for evaluation. But once they’re stable, the talk therapy could continue.
Psychologists are trained to evaluate a patient or client’s cognitive and emotional functioning, so they might be called in for psychological assessment testing.

Myth: “Multiple personalities” are rare but can pop up anywhere; a variant: they don’t exist or are somehow invented or induced by the therapist. Reality: The current correct term is “dissociative identity disorder.” It’s fairly common, and it develops as a response to severe sexual abuse in childhood. An ordinary therapist treating a client with DID would be well advised to read some of the very good books on the subject and seek supervision with a clinician experienced in such cases. The therapist needs to guard against being fascinated by the different “personalities,” while engaging as many of them as possible in the treatment. The goals are co-consciousness and, eventually, integration. The biggest challenge is when a client experiences an abreaction—a flashback, like those of military veterans with post-traumatic stress disorder, in this case to the experience of being sexually abused as a young child.

Myth: Accusations of sexual abuse, especially when memories have been repressed but recovered, are often lies or delusions. Reality: Wrong, wrong, wrong. As the Catholic Church recently admitted, the sexual abuse of children is an all too common phenomenon. Repression of memories is a psychological defense mechanism—a survival skill—as is the dissociation mentioned above. Most sexually abused children are not lying, just as most raped women are not lying. I believe that emphasizing the exceptions has a deeply damaging effect on societal beliefs and therefore on the ability of the abused and raped to achieve both emotional health and justice.

Myth: Psychopathic serial killers can have normal relationships and can be appealed to. Reality: A forensic psychologist who worked on the cases of some of the most infamous serial killers put it best: “Dexter doesn’t exist.” There are no magic words a victim can say to change the killer’s mind.

Myth: Alcoholics can go in and out of alcoholism and can eventually drink normally. That proves they don’t really have a problem. Reality: Alcoholism is a progressive illness, and somewhere between alcohol abuse and alcohol dependence is a point of no return. The compulsive drinking is just the tip of the iceberg; emotional, social, and behavioral issues are part of the picture, as are negativity, hopelessness, and despair.

Myth: Schizophrenia is the same as multiple personality and can be used as a synonym for ambivalence or mixed feelings. Reality: Schizophrenia is a thought disorder that is biochemical and to some extent genetic in origin. Symptoms include auditory hallucinations and thoughts and beliefs that depart from reality in various ways.

Myth: People who talk to themselves in the street must be schizophrenic. Reality: Sometimes schizophrenics talk back to their hallucinations, but some of the folks you hear cursing and making inappropriate remarks in public have Tourette’s Syndrome, an entirely different disorder. And even more of them are just talking on their cell phones.