"United States of Tara": Dissociative Identity Disorder (Multiple Personality) on Television - Dissociative Disorders - Tips for Dealing with the Effects of Dissociation

	Mark Dombeck, Ph.D. Essays and Blogs Concerning Mental and Emotional Health
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There's a new television show on Showtime called "United States of Tara" which is about a woman with multiple personalities. My wife and I have watched the first two episodes, and while I didn't expect to like it, I kinda do.

The question of why I'm liking it is relevant. I'm liking it primarily because it is a show that addresses a complicated and misunderstood mental illness - Dissociative Identity Disorder or DID - and it is managing to do this so far without too distorting the depiction of this condition so that it becomes an utter caricature of itself. That is a major accomplishment in my book, as so many shows concerned with mental illness feel exploitive. "United States of Tara" is no "In Treatment", and as it is just getting started, there is still plenty of time for it to degenerate, but so far, so good, I think.

The main character, played by the talented Toni Collette, is a forty-something muralist, wife and mother (of two teenage children) named Tara. Very early on, we see Tara transform into a new character named "T", an impulsive and promiscuous teenage female who goes out on a shopping spree with Tara's credit cards and with Tara's actual teenage daughter in tow. Later still, we meet "Buck" who is a middle aged male redneck sort of stereotype; a hyper-masculine man prone to fist fighting. Finally, we meet "Alice" who is a controlling, Martha Stewart type character.

While watching, I'm ending up pausing the show so as to talk with my wife about how the show's depiction of multiple personality fits with how the actual condition appears in real life, at least with regard to my limited experience treating patients with this condition. For instance, there is a scene where the Alice alter is talking to husband Max (played by John Corbett), informing him about another alter's motives. This is a small detail but a telling one and, in my estimation, an accurate one. Within the architecture of a DID system, alters are not all created equally. Instead, different alters have different levels of knowledge and insight concerning the personality system in which they are embedded and their personal history. Some alters are fully aware of the presence of other alters, may have extensive access to memory, and may even be able to "read the minds" of the other alters. Other alters do not have this privileged access and may be entirely in the dark, knowing only that they frequently experience blackouts. In the United States of Tara, it appears that Alice may be one of these privileged alters, while Tara is not. It would be so easy for the writers to get this sort of thing wrong but they didn't.

Another comment I had was that the few alters who have been introduced feel more or less authentically superficial. I read some criticism somewhere (I can't find it now!) about the show which accused the writers of simply stringing a set of stereotypes together in place of doing actual character development work, but in my experience, many public facing alters (not all but many) really do come across as stereotypes. They are not fully developed people but instead fantasies of people as imagined by a person who needed their stereotyped attributes in order to cope at some time. They can be incredibly one-dimensional, in my experience. Sometimes they have been created to fulfill one purpose and one purpose alone, and that is all they do. There are often more well developed alters in the system as well, but plenty of stereotypes. So that part feels accurate so far.

Alters are frequently specialized, occupying different niches within the life of of the total person in which they exist in much the same way that professions within society have specialized over the course of civilization. So, you tend to see people with DID exhibiting alters who have specialized in specific roles; defensive, executive, economic, social, emotional/vulnerable, sexual, etc. I find the existence of an alter like Buck entirely plausible as an instance of a defensive function. Buck's maleness is not odd or weird though Tara is female; it is a function of the ferocity that Buck needs to bring to his role. Overt aggression is a masculine function in society and so Buck was "born" male. He is adult because he needs to be responsible. He is a redneck because that gives him license to be a loose cannon (e.g., to act out aggressively on impulse). You expect a "redneck" caricature to punch people in the face. It is psychotically weird when viewed from the outside, but the internal logic works just fine.

The alters "T" and "Alice", and also the alter "Tara" (who has not been presented as an alter but who very definitely is an alter) are also reasonably drawn to my eye as well. Tara fulfills social and economic functions. She is the facade that is presented to the world. She has little knowledge of the larger system (she knows it exists but does not have access to the thoughts of the other alters). She exists as a pleasant front behind which the other alters can rest until needed, or hide their vulnerability. She works and therefore brings in money. She is the first alter you meet and the one you think is the primary person (e.g., the original identity which happens to be plagued by these other more partial, more fantastic identities). It's important to keep in mind, however, that in cases of DID, there is no "original" or "primary" person. There is just the alter system, which can only reasonably be thought of in systems or ecological terms. Most people have a unitary experience of self, but people with DID have a true multiplicity.

The alter "T" exists to to rebel and break rules. Why this function should be needed in the ecological system of a person living with DID isn't made clear in the show, so I will try to help make it more clear. In my experience, there is always a rebellious aspect to the DID alter system, which forms as a normal reaction to the difficult conditions that caused the system to come into existence in the first place. Namely, there generally isn't any DID without substantive child abuse having taken place first. So, you have a situation where dissociation becomes a coping strategy that a young child uses in order to cope with sometimes horrific abuse. I don't know if abuse is always required to be present in order for DID to form; I only know that in the examples of DID that I've known intimately, it has been present or at least claimed to have occurred. So - one or more alters come into existence that hold abuse memories and pain, often cast as children or actual infants, and then in response to the pain that these pain-holding alters contain and encapsulate, come into being the duty-bound defenders, like Buck, and also the rebellious rejecters, like "T" who cannot stand to be controlled or duty-bound and who instead act out in hedonistic and self-destructive ways. Buck is a angry reaction to abuse designed to keep it from reoccurring, where T is a more primitive rejection of abusive control (and hence her younger age). These same dynamics get acted out with some frequency by non-multiple abuse victims as well, but in an integrated and owned fashion, without the need to have new "selves" take on new roles.

Another nice aspect of "T" is the suggestion that she is promiscuous. In my experience with a sexually abused female DID patient, some alters were promiscuous. This seems to me in part a function of how sexual abuse can shape women's (and men's) self-concepts. The abuser makes you into a sexual object, and then you start to see yourself as a sexual object. So you start offering yourself as a sexual object to the others around you. This dynamic also happens to abuse victims who are not DID, but when it happens within a DID alter system, it often gets encapsulated as an alter.

What is blatantly and oddly missing from United States of Tara, then, is the abuse history, and the alters which carry and contain the abuse memories and emotional pain that alters like Buck and T would seem to imply. To my mind, Buck and T and Alice don't make sense without some other pain-containing, probably very young alter(s) in relation to which they are essentially reactions. I have a few thoughts about why the writers have not presented us with this pain-containing aspect of the alter system. Possibly, they are just getting started, and it is possible that they will do so in later episodes. Alternatively, they are sensitive to the fact that the introduction of the abuse theme and the need to depict the abuse-containing alters (who might cry uncontrollably and mutely rock in the corner of the room or act in an infantile manner) would introduce a profoundly sad tone to the show's comedic energy which might turn off viewers. I hope it is the former rather than the latter.

There are a few conceits or mistakes that the show is promoting. There is this idea that the alters are now coming out because "Tara has gone off of her medications"; that they were under control before but now she is off her medications as a part of some kind of integration push, possibly therapeutic (although we have not yet been introduced to any therapist or psychiatrist). To suggest that medication could successfully control or suppress an alter system in a patient with DID is not terribly plausible. The main dynamic in DID is dissociation. Dissociation is a psychological phenomena (occurring at the level of attention and memory) more than it is neurological (occuring due to brain damage of some sort). DID is a coping style, learned very early on before the consolidation of normal unitary adult identity has taken place in people who are (usually) abused, and also who have a talent (possibly biologically based) for dissociation. Dissociation is not schizophrenia (where voices are are auditory hallucinations that do typically respond to anti-psychotic medication) in any way shape or form. DID does produce a truly psychotic-acting individual, but this is a different form of psychotic than the paranoid psychotic we think of due to schizophrenia, and produced by a different mechanism.

Another potential conceit is that the family household depicted in United States of Tara is fairly functional and organized. In reality, DID is a serious condition that is generally associated with a lot of behavioral chaos and a more disorganized family life. It is certainly possible that a DID family could hold itself together as well as the family depicted in the show, but it does seem more unlikely to be that way (to me) than not. Those individuals I've worked with have far more chaotic and troubled home lives than anything I've seen depicted here.

United States of Tara is produced and broadcast by Showtime, a premium network, and thus it will not be easily viewable by many readers in the short term. Until DVDs or iTunes/Amazon downloads are available, You can, if you like, visit the Showtime website and watch the first episode online.

I know from long online experience that there are many people out there who might read this who themselves live with DID, or with a family member who has DID. It's apparently not anywhere near as rare as we had previously thought (or maybe the Internet has just helped many different people find each other who would have been isolated otherwise). In the spirit of finding each other, I'd really appreciate it if those of you who have first hand knowledge of DID could leave a comment below, helping to flesh out what it is like to have DID; how the alter systems tend to be set up and how they function. There are a lot of mistaken beliefs out there about DID, and still many people who think they are alone in dealing with this complicated issue. Your observations can thus be of substantial help and comfort to future readers.

We've just posted a Wise Counsel Interview with Dr. John Kihlstrom , who is a professor of psychology at UC Berkeley, and a well known research clinical psychologist in the field of hypnosis and dissociation. I encourage anyone who is interested in the topic of dissociation to listen to that interview as it is eye opening.

In the interview Kihlstrom talks about whether there is always abuse or trauma involved in cases of dissociative disorder, and in his very educated opinion, based on a lot of careful research he and others have done, the answer is no. Trauma is not associated with dissociation, or at least not with the key feature of dissociation which is amnesia (memory loss). And if you think about it, that makes some sense. After all PTSD, which is the prototypical post trauma response is usually characterized by the inability to forget trauma; not so much by a disposition to repress knowledge that it happened. Kihlstrom isn't saying that abuse doesn't occur in such cases, but that abuse doesn't cause the dissociation to occur.

This is a complicated area and one that is hard to study, but when quality research is available to illuminate an issue, you are somewhat foolish to not take it seriously. So - I wish to change my above essay in light of what I've learned today (although I won't actually do that). The show will apparently work fine without any linking of a past abuse with Tara's present day DID, even though it is now clear that that is in fact the direction they are going in.

Mark Dombeck, Ph.D. is Director of Mental Help Net (a public service of CenterSite.Net - a provider of website and internet services and educational content to employee assistance and behavioral health organizations), and a licensed Psychologist in the state of Ohio (License #5698).

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Dr. Kihlstrom - and your editor's note - kittyspud singleton - Jan 23rd 2010

I wouldn't write off your opinions on DID just yet based on this fellows arguments.

"Using prospective methodology, Dr. Kihlstrom started with traumatized patients who were not previously dissociative and followed them over time to see if some of these patients went on to develop amnesia for their traumas. When this did not happen he interpreted this to suggest that trauma probably was not causing dissociative symptoms like amnesia to occur. Similar lines of reasoning and experiment also supported this interpretation."

I find this methodology suspect at best. What did he define as trauma? How old were his subjects? Did he induce the trauma himself to insure a proper scientific controls? Was it with patients who endured prolonged trauma? Did he have subjects who were DID included in his long term study? Where these folks treated during the time that he was studying them?

"Kihlstrom's view, such trauma history is more likely incidental than causal so far as dissociation is concerned. The true cause of dissociative disorders remains unknown, in his view."

If we cannot look back at a child's history to determine their current mental crisis, then what is he proposing that we look for? If a toe is injured, do we not ask what caused this toe to be injured so we can properly repair it, or do we just look at the injury in the current state and treat the symptom while ignoring underlying causes which could cause repeated boughts of the same condition?

I'm also questioning his assumptions on dissociation. He seems to be focusing on amnesia - the 2nd lowest on the spectrum and making assumptions for the others along the spectrum.

I have dissociative Identity disorder. I have seen one episode of United States of Tara. It makes me LIVID. First off, MEDICATION DOES NOT TREAT DISOCIATIVE IDENTITY DISORDER. Years of therapy/Abreactive work do. MPD is a "HIDDEN DISORDER". ANd the majority of "INSIDE FAMILY" of all multiples are CHILDREN. And yet this show doesn't show any children- just sex crazed teens, vietnam vets....RIDICULOUS.

What a mockery. I have had to stay in the closet because of the ignorance of this disorder, and now thanks to this show- I have to stay in the closet. I am a survivor of abuse. This disorder is not a joke. I don't run to my closet and put on outfits and talk in accents.

As a therapist working with a DID client, with no host, it is helpful to me to read the comment from the individual who has none, either. My client is very troubled by the constant switching in order to avoid executive functions, which create chaos and confusion for her. Have others had any success "forming a committee" as a means of sharing the activities of daily living? Thanks for your help.

I live in Australia and we do not have the show here as yet but I will be interested to see it!I have been diagnosed with DID after years of treatment for different diagnoses. I am very fearful of any of my family or friends finding out, but I am also very fearful of voices telling me that they are going to hurt me and another part of me and regularly telling me to kill myself because I am hopeless and serve no purpose.One part of me died when I was 12 years old(he was 10 at the time) and this has upset me and caused severe depression at times.Now my therapist insists that he is not dead - that he is inside somewhere. Can anybody relate to this? I am confused and frightened and would appreciate any help about this situation and how to deal with it.Cheers,MAK

In case someone stumbles across this post not having seen the latest episode, they have disclosed that the abuse occurred by Tara being raped in boarding school. Clearly, her parent's are no winners either. Thanks for the post - it was extremely helpful!

"They are not fully developed people but instead fantasies of people as imagined by a person who needed their stereotyped attributes in order to cope at some time. They can be incredibly one-dimensional, in my experience. Sometimes they have been created to fulfill one purpose and one purpose alone, and that is all they do. There are often more well developed alters in the system as well, but plenty of stereotypes. So that part feels accurate so far."

I'm a female member of a male system. Yes, I'm kind and sensitive and I like knitting, so at first glance you could assume that I was a stereotype. But I am just as varied and adaptive of an individual in my own right as any singleton. I find the phrase "alter" offensive and obnoxious. I've been in system all 19 years of the body's life. It's not like I was "created" because there was some role I needed to fill.

We are currently runnning a triumvirate-myself, Baki and Gaspard. Although we may have came from the same soul originally, we are each whole people in our own right. We prefer the expression Mulitiplicity. There isn't a single person in my system who was created- with the exception of Rob.

However, I will acknowledge that members of multiple systems do sometimes take on specific roles of their own accord, or may be pressured into filling a specific function in the systems collective life. To give some examples from our experience: Gaspard is a fusion of two previous system members, Edward and Charlie. Charlie was a flamboyant sex addict. This was not a role that he enjoyed filling, but he thought that he had no other way for his existance to be acknowledged.

Editor's Note: It was not my intention to offend, so please accept my apologies if something I have expressed here feels offensive. Regarding my expression of the stereotyped nature of some alters (a term for which I do not have a better term) , in my experience, some alters I interacted with were shallow and seemingly single purpose, while others were more integrated and more like a "whole" person. I expect there is variability in how complex and "whole" a given alter/partial becomes based on roles they may take on and on time spent conscious, either directly or vicariously.

One thing that is clear to me from my direct experience is that how someone with DID sees themselves from within looking outward can be very different than how they are perceived from the outside by society. Society does not recognize multiplicity. The ability to take responsibility is a good area to illustrate what I mean. I had a patient who would act out in outrageous and sometimes illegal ways which ended up being abusive to her children, but upon examination, the outrageous actions were undertaken by alters within her system which rejected their role as a part of the larger system. From the inside there was an uncoperative society with some irresponsible, self-destructive members. From the outside she was simplyacting abusively, and upon further examination, psychotically, and she ended up being committed to a psychatric facility for a time. The law perceived her as a single negligent and temporarily incompetent individual, whereas from inside, her society contained responsible elements and irresponsible elements who could not agree; some very responsible and others not so much. It's impossible to rate the quality and complexity and "wholeness" of a "self" from the outside looking in, I think. But in an important way, someone looking at a system from the outside is going to see "parts", because the singleton self case is the vast majority of cases, and a system stands out for being different in contrast. It may feel insulting to be thought of as a part when you feel like a whole, but that is how it appears to be from a social point of view looking in.

I'd disagree that they haven't referenced an abuse history. It's been subtle, but there were comments that made me think there is definitely a back story (like Tara's sister asking why Tara would just take verbal abuse from people in her town, "Just like when we were kids.")

I'm also curious about the absence of child parts, but at the same time, my system can go for extended periods with only a few parts active, and there aren't always child parts active. More than that, there have been times when other parts do their best to keep child parts from coming out, as a way of maintaining safety. My younger parts are more likely to come out when things are fairly secure in my life, and that doesn't seem to be the case right now for Tara.

What's more, I don't spend a lot of time, outside of therapy, talking about my abuse history. People who have known me a long time are aware of it, but it's not the focus of my current relationships. In the 3rd episode, we saw a few minutes of Tara with her therapist, and they were talking about what is currently going on in Tara's life. I find this fairly accurate, since at least half of my time in therapy is spent working on my present-day relationships rather than just focused on the past. While the past impacts what we talk about, much of our focus is on improving what is in my life right now.

I should add that, with therapy, many of my younger parts have gone from uncontrollable crying to working through the developmental tasks of more normal children. So someone who encounters the ones who are secure enough to emerge around someone other than my therapist are as likely to see a happy, excited child as to see someone who is still trapped in the experience of being abused.

And I think my therapist's experience of my parts is very different from anyone else's. Parts come out in therapy when they are dealing with challenges. They come out to cope with memories, or to learn how to adjust to living in the present rather than being trapped in the past. So they are more likely to come to my therapist when they are upset, needing to cry, feeling traumatized by a memory, and so forth. In my day to day life, there is much less crying and curling up in a corner, and a lot more just living my life.

I agree that it's odd that the show keeps referring to how Tara's meds (Halcion, I think) kept the parts from emerging. On the other hand, I know of people who have found combinations of medications that do seem to suppress switching, so it's not completely unbelievable to me.

As for Tara's functionality... My household (I live with my partner) is no less stable or functional than the households of my friends, and is significantly more stable than the households of many people I know with abuse histories. Most of the people I know in person who are multiple also have pretty stable lives; many of them have partners and children, and they are able to keep satisfying jobs, even while coping with their multiplicity.

I do agree with your perception that Tara is a part, just like anyone else in the system. I'm biased, though, having spent my life in a system with no "host." So there has always been a level of shared ownership of my life. But there are quite a few parts in my system who can sympathize with Tara's comment at the beginning of the second episode, that having parts is like hosting a kegger in your brain, only you're passed out and miss the whole thing, getting stuck with nothing but the cleanup.

I'm interested to see where the show will go, and looking forward to more development of the story. So far, so good, in my mind.