In addition to being a magically empowered superhero, Steven Grant, the main character of Marvel’s Moon Knight series, is a man living with dissociative identity disorder, a condition in which someone’s personality and sense of self fragment in response to severe psychological trauma. Moon Knight’s only just begun to explain certain things about its hero, like why Steven — who’s clearly an American — loses significant chunks of time or why he’s putting on such an unconvincing accent while living in England. But all of those details have stood out as some of the more common ways that Moon Knight and other stories like it have typically coded characters as living with DID before delving into what the disorder entails.

As fantastical as Moon Knight — a show about a man who’s chosen by a god to become a mummy-like avatar of moon-themed vengeance — is, it’s clear that Marvel wanted to get its first series about a hero with origins wrapped up in mental illness “right” in some sense. Ahead of Moon Knight’s release, Marvel made a point of noting that a board-certified psychiatrist was brought onto the project as a consultant in order to “help both the actors and the filmmakers understand [DID] and its implications.” Though Moon Knight’s lead director Mohamed Diab has said that the series isn’t an accurate depiction of DID, series creator Jeremy Slater has emphasized that he and the rest of the show’s producing team wanted the show “to be ultimately good and uplifting and have a positive message about mental health.”

At a time when film studios are broadly trying to be more thoughtful about all kinds of on-screen representation, it makes sense that Marvel would take particular care with a show like Moon Knight. But it’s interesting to consider what all “taking care” means when telling thoughtful stories about DID, a disorder whose complicated realities have been eclipsed by sensationalized fiction.

Spoilers for Moon Knight’s first season ahead

Though Moon Knight’s had plenty of time to acknowledge Steven’s DID for what it is, the show only really starts digging into the topic in “Asylum,” the first season’s penultimate episode that finds Steven transported to a metaphysical mental institution. Up until “Asylum” — which itself dances around some of DID’s specifics — Moon Knight has instead relied on a number of stylized tropes associated with the disorder to allude to Steven’s having it. In addition to the gaps in Steven’s memory and people calling him “Marc” for reasons he couldn’t initially understand, he repeatedly caught sight of his reflection moving independently of him, particularly in moments when he was in imminent and supernatural danger.

In the final minutes of Moon Knight’s premiere, as Steven’s being chased down by a spectral jackal creature, it’s only by agreeing to let his reflected self “take control” of “their” body that Steven’s able to tap into his Moon Knight powers to save himself. In almost any other typical cape show, one might reasonably expect Moon Knight to follow up on Steven’s first transformation with an exploration of what his powers are and why he can transform himself into a hooded mummy at will. But one of the ways Moon Knight tries to set itself apart is by revealing early on that, new and unfamiliar as the Moon Knight thing is to Steven, it’s something Marc — one of Steven’s alternate personalities — has been doing for quite some time without Steven’s knowledge.

The idea of having “multiple personalities” has been commonly used in pop culture for years as an outdated term for DID specifically and as a kind of catchall identifier for mental illness. Books like Shirley Jackson’s The Bird’s Nest, Corbett H. Thigpen and Hervey M. Cleckley’s The Three Faces of Eve, and Flora Rheta Schreiber’s Sybil — all of which were adapted into successful films — each told lurid, gripping tales of women whose lives were torn apart by DID. Those early stories helped lay the groundwork for more modern depictions of DID like The United States of Tara, Split, and HBO Max’s Doom Patrol show. But they also played a pivotal role in shaping the public’s perception of what DID is and how it functions, which is a tricky situation given the entertainment industry’s tendency to prioritize drama over nuance and accuracy with sensitive, difficult subject matter.

You can find DID listed in the most recent editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders and the WHO’s International Classification of Diseases. Though DID’s been codified along with all of the other major dissociative disorders like dissociative amnesia and depersonalization-derealization disorder, skepticism about it being real persists.

Marvel Studios

There is no single reason that the psychological and psychiatric communities have not come to enough of a consensus about DID and its components to develop a similar level of understanding of the condition as has been the case with others like schizophrenia. DID’s real-world prevalence comes to mind as an important factor, and for some time, one of the leading theories put forth by skeptics of DID’s existence has been that it’s a primarily North American phenomenon borne out of suggestible individuals taking cues from medical professionals influenced by fictional stories. In recent years, however, more and more clinicians have been re-examining conventional wisdom about DID and arguing that our misunderstandings about it have much more to do with gaps in how professionals are taught to recognize and treat it rather than it being made up.

Dr. Simone Reinders is a senior research associate at the King’s College London psychology department’s Centre for Affective Disorders, where her work has focused on using brain imaging to identify structural biomarkers of the brain common in people with DID and post-traumatic stress disorder. When we spoke with Reinders, she pointed to her own research into the disorder’s biological correlates, or physiological origins, as an example of how the clinical research community’s thinking about DID in particular has shifted in recent years.

“We have also shown that some of these biological correlates are associated with early childhood trauma,” Reinders said. “There has been a lot of skepticism around DID — that it can be enacted. But different studies have shown that people simulating DID are not able to enact all of the characteristics of DID.”

Marvel Studios

In 2012, Reinders published a study seeking to determine whether DID could be attributed to “fantasy proneness, suggestibility, suggestion, and role-playing” by studying different test groups of people instructed to inhabit two distinct identity states. Of the study’s 29 subjects, 11 were patients with DID, 10 were controls who were highly prone to fantasizing, and eight controls who were not prone to fantasizing. Each of the study’s participants was observed listening to taped recordings of autobiographical memories after being instructed to inhabit either a neutral identity state or a trauma-related identity state. Along with brain imaging data, Reinders’ study also monitored subjects’ blood pressure, heart rate, and heart rate variability and found that when listening to their personal trauma scripts, people with DID exhibited higher subcortical activity and nervous system activation than controls.

“My paper in 2012 showed that blood flow patterns in the brain in individuals with DID cannot be simulated by healthy controls simulating DID,” Reinders said. “It’s also important to note that an independent follow-up research by the team led by Dr. Yolanda Schlumpf at the University of Zurich found similar results that DID cannot be simulated by controls.”

“My paper in 2012 showed that blood flow patterns in the brain in individuals with DID cannot be simulated by healthy controls simulating DID,” Reinders said. “It’s also important to note that an independent follow-up research by the team led by Dr. Yolanda Schlumpf at the University of Zurich found similar results that DID cannot be simulated by controls.”

Using arterial spin labeling — an MRI imaging technique that tracks the flow of cerebral blood — Schlumpf’s 2014 research found that perfusion patterns differed drastically between people diagnosed with DID and actors who were instructed to shift between the “Emotional Part” of themselves and the “Apparently Normal Part.” While work like Reinders’ and Schlumpf’s suggests that the medical community could continue to develop a sharper understanding of dissociative disorders, Reinders noted that one of the biggest issues plaguing the field is a lack of people with the proper training to understand it.

“At least here in the UK, there are no university courses on DID,” Reinders said. “So, inexperience and unfamiliarity with how to diagnose somebody with DID can be aspects that a therapist is facing simply because the disorder’s never been offered to them in their path of training.”

Marvel Studios

In a recent interview with Mindful Things — McLean Hospital’s podcast focused on combating the stigma surrounding mental health treatment — Dr. Milissa Kaufman, head of McClean’s Dissociative Disorders and Trauma Research Program, explained that a helpful way of beginning to understand DID is by contextualizing it with post-traumatic stress disorder. Because DID often stems from trauma experienced in a person’s childhood, those with the disorder also typically suffer from PTSD, which has a far more well-defined set of symptoms.

“There are intrusions of traumatic memory, there’s avoidance of salient reminders, there are negative alterations in cognitions and in mood, and there are alterations in arousal and reactivity,” Kaufman said. “Importantly, not only do all folks with DID have PTSD, but they also have a very specific kind called the dissociative subtype of PTSD.”

What Kaufman was describing is how, in addition to all of the typical symptoms of PTSD, those living with DID also have histories of coping with specific traumatic events by displacing and compartmentalizing their experiences of them. Though the general concepts of trauma and dissociation loom large in people’s minds, Kaufman noted intense depersonalization — detachment from one’s sense of self or body — and derealization — detachment from one’s surroundings — as the specific symptoms necessary along with PTSD to make accurate DID diagnoses.

In the buildup to “Asylum,” Moon Knight gestured towards the severity of Steven’s condition and his own personal traumas by introducing important aspects of Marc’s life, like his wife Layla El-Faouly (May Calamawy). Steven’s having no recollection of being married to Layla or involved in the mysterious situation that led to her father’s death made for somewhat interesting television. But those details’ larger purpose was to set “Asylum” up for a number of significant reveals — chief among them being that Marc, rather than Steven, was the original personality who first developed DID as a young boy.

Setting aside that Steven / Marc’s traumatic trip down memory lane comes by way of an anthropomorphic hippo goddess, “Asylum” is mindful and considerate as it details how Marc’s family was torn apart by grief following the accidental death of his younger brother, Randall (Claudio Fabian Contreras). In flashbacks, “Asylum” shows you how young Marc (Carlos Sanchez) and his brother were close growing up and spent their afternoons pretending to be Dr. Steven Grant and his companion, Rosser, two British characters from the fictional Tomb Buster film. It’s during one of the boys’ routine excursions to a cave by their childhood home when Randall drowns, and while Marc immediately blames himself for his brother’s death, their mother, Wendy (Fernanda Andrade), takes it upon herself to never let Marc forget what happened.

Moon Knight purposefully cuts away from depicting the lifetime of physical abuse Wendy heaped on her surviving son as she grieved the one she lost. What it does spotlight, though, is how Steven first began stepping in for Marc as a means of dealing with his mother’s rage and beatings.

Much like its emphasis on Marc / Steven’s auditory hallucinations, Moon Knight’s introduction of the circumstances that caused his psyche to fragment does gel with some aspects of DID that have been borne out through clinical study. But one concern the researchers we spoke with noted is how, even as they attempt to portray the disorder accurately, shows like Moon Knight run some risk of glamorizing DID and misinforming the general public about it simply by turning it into entertainment.

Marvel Studios

Dr. Igor Pietkiewicz is a psychotherapist and assistant professor at SWPS University in Poland, where he teaches about cultural psychology and heads up the school’s Research Centre for Trauma & Dissociation. In his own research, Pietkewicz has reasoned that a lack of clear diagnosing guidelines for DID is one of the more significant factors contributing to instances of false positive diagnoses and the general way in which DID comes to be misunderstood as a rare, exotic condition. When we recently spoke with Pietkewicz, he echoed Dr. Reinders’ belief about European psychiatric programs doing a lackluster job of training future clinicians and characterized DID as a “disease of hiddenness” due to sufferers tending to want to hide their symptoms.

“People who really have DID have been severely traumatized and usually try to hide or minimize their symptoms to pretend they don’t exist because they are terrifying for them,” Pietkiewicz said. “Take a core symptom like amnesia. You’re talking to me now, but imagine suddenly finding yourself in a supermarket with no idea how you got there or who put things in your cart. It would be terrifying because you’d think your mind was playing bizarre tricks on you.”

Something both Dr. Reinders and Dr. Pietkiewicz emphasized is that, as alarming as DID’s symptoms can be to people with it, the core trauma that first led to the disorder — often sexual and at the hands of a caregiver — is far more devastating and not something to make light of. In addition to sensational DID stories having the potential to be disrespectful, Pietkiewicz said, they also have the power to inspire people to misidentify themselves as DID sufferers, making it that much more difficult for professionals to connect with people who legitimately need their help.

“I think Hollywood has to be very careful about DID and giving people the idea they might have it,” Pietkiewicz said. “Especially teaching them about the core symptoms and subtleties.”

Moon Knight’s far from being the most salacious depiction of DID Hollywood’s ever produced. When you compare it to Iron Fist’s spin on Typhoid Mary — an American army soldier who develops DID as an adult after being captured in Sokovia — it’s a marked step-up for the MCU just by virtue of framing Steven as a troubled man rather than a dangerous villain. But Moon Knight, like so many other stories about DID, is meant to be an exciting story of triumph where the challenges Steven faces push him to become an extraordinary superhuman. Ultimately, that may be the best that these sorts of shows can do. But it’s important to acknowledge the potential consequences that can come from mining these narratives for storytelling’s sake over and over again.

Reinders has not seen Moon Knight. But she expressed that, in her view, fictionalizing DID for entertainment at all is ethically inappropriate. Though Reinders is sympathetic to filmmakers’ need to earn a living, she pointed out how, in the grand scheme of things, these sorts of fictional stories can end up negatively affecting researchers like her whose work depends on public funding.

“Because DID is so prone to skepticism, it has been really hard for me to get funding for my research,” Reinders said. “But this research and training are very important. Training for therapists and developing more expertise costs time, and it costs money.“