Multiple issues with character’s identity struggles

“The United States of Tara”

“Revolution” episode, Showtime, Feb. 15, 10 p.m.

The premise

Tara Gregson (Toni Collette) is a hard-working wife and mother of two in Overland Park, Kan. She paints room murals, juggling her family and career while suffering from dissociative identity disorder. She decides to take a break from medication but continue psychotherapy. Off medication, her alternate personalities reemerge: wild and flirty pot-smoking teenager “T”; ‘50s housewife Alice; and male, motorcycle-driving, gun-loving war vet Buck. Her sister often expresses doubt about the validity of Tara’s disorder.

In this episode, one of Tara’s murals has been damaged, and Tara and husband Max (John Corbett) are trying to figure out if one of her other personalities is to blame. Tara describes her other personalities as being “in another room in my head that I’m not privy to. I can kind of click with it.” This time, there had been no click signaling a change in personality.

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The medical questions

What is dissociative identity disorder and can it be faked? Is the condition treatable with medication or can it be managed by therapy alone? Do the alternate personalities emerge at times of stress or off medication? Are the personalities as different from one another as in Tara’s case? Is her description of different rooms in her head and “something clicking” when she goes from one personality to the next believable?

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The reality

Dissociative identity disorder (formerly known as multiple personality disorder) can result when a child with an unstable identity is subject to severe emotional trauma over an extended period of time, says Dr. Richard P. Kluft, a clinical professor of psychiatry at Temple University and a psychiatric consultant to “The United States of Tara.” The child eventually creates a new personality with which to hide from memories and from his or her real identity.

Kluft says that the disorder can be faked but that doing so for an extended period is difficult. But Dr. Richard Van Dyck, a dissociative-identity expert and emeritus professor of psychiatry at VU University Medical Center in Amsterdam, says that it’s difficult to “differentiate true dissociative cases from simulated cases.”

Not all psychiatric experts believe that the disorder exists, says Dr. Jess P. Shatkin, director of education and training at the NYU Child Study Center. “During my career, I’ve only seen one convincing case,” he says, “and even then I think that some of the 17 identified ‘personalities’ were fabricated.”

In the real world, medication does not have a direct impact on the switching of the personalities, says Kluft, though it can be useful in treating underlying anxiety and depression that can increase the chances of a dissociation.

Alternate personalities are more likely to emerge in times of stress, but medication withdrawal is more likely to cause unstable behavior than direct changes in personalities, Van Dyck says.

Psychotherapy is the primary approach to treating the disorder, as the show depicts. Van Dyck adds that opinions vary on the best therapeutic approach -- whether to stabilize the current crisis or to explore past traumas that led to the problem in the first place. Tara appears to be receiving a combination of both approaches.

Research on dissociative identity disorder indicates that alternate personalities vary widely and may cross gender lines. Van Dyck finds this aspect of the show believable, but Shatkin disagrees, pointing out that most people who suffer from the disorder (if it exists) would be more mildly affected than Tara.

As the show’s consultant, Kluft admits that the personalities on the series are exaggerated for the sake of drama and therefore somewhat unrealistic.

Personalities may have a varying level of awareness of each other, so the show’s portrayal of the shift from one personality to another is fairly believable. Tara’s description of rooms of the brain as homes for the alternate personalities is a commonly used metaphor.

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marc@doctorsiegel.com.