Advanced Search

The American Journal of Psychiatry, VOL. 157, No. 3

Letter to the Editor | March 01, 2000

Dr. Jekyll and Mr. Hyde: A Primer on Substance Dependence

ERIC LEWIN ALTSCHULER, M.D., PH.D.; DANIEL WRIGHT, PH.D.

Am J Psychiatry 2000;157:484-484. 10.1176/appi.ajp.157.3.484

Article

References

text A A A

To the Editor: We suggest that Robert Louis Stevenson’s classic Dr. Jekyll and Mr. Hyde is a useful primer for patients, their families, and physicians on substance dependence.

The traditional diagnosis given the afflicted doctor is dual or multiple personality disorder. Indeed, not just in common usage, but in the scientific literature (1), the names "Jekyll" and "Hyde" have become synonymous with a "split" personality. However, given the extreme rarity of multiple personality disorder, especially in a man (2), compared with the high frequency of a diagnosis of substance dependence, the ubiquitous association of Hyde with Jekyll’s ingestion of his homemade potion, and the evidence given in the following, we believe that Jekyll’s disordered personality and suffering can be explained by substance dependence.

DSM-IV requires that three of seven criteria be met in a 1-year period for a diagnosis of substance dependence. Jekyll meets six of these (criteria 1, 2, and 4–7).

Criterion 1: tolerance (3, p. 90): Jekyll needs to double or triple the amount used.

Criterion 2: withdrawal (p. 92).

Criterion 4: persistent desire or unsuccessful efforts to cut down or control substance abuse (pp. 91–92). For 2 months Jekyll abstains from his potion, but then he can abstain no longer.

Criterion 5: much time spent recovering from the drug’s effect (p. 100). Jekyll notes that it takes increasingly long for Hyde to wear off.

Criterion 6: important social activities reduced because of substance use. As Hyde, Jekyll refuses to see friends (see, for instance, p. 41).

Criterion 7: substance use continues despite a physical problem that might be exacerbated by drug use. Jekyll notes that he is risking death by using larger quantities of the substance (p. 90). Jekyll’s statement "I swear to God I will never set eyes on him [Hyde] again. I bind my honour to you that I am done with him [Hyde] in this world" (p. 34) is poignantly reminiscent of vain oaths of abstinence made by those suffering from substance dependence problems.

What was Jekyll’s drug of dependence? While alcohol is and was the most common drug of abuse, and Stevenson himself was known to have used alcohol, for a number of reasons we think it was not Jekyll’s drug of choice. First, Jekyll twice mentions alcohol by way of comparison to his potion (pp. 82, 92), with the implication that his potion is not merely ethanol. As well, the cardinal symptom associated with taking the potion—the vivid perception that Hyde is smaller than Jekyll—does not seem consistent with alcohol dependence. Other drugs that Stevenson was known to have used are hashish and opium (4, 5), but use of neither of these drugs would be consistent with Hyde appearing to be smaller than Jekyll. As well, the often marked activity of Hyde, including the murder of Sir Danvers Carew, would not be consistent with opium dependence.

Cocaine was available when Dr. Jekyll and Mr. Hyde was written, but, if anything, cocaine might have make Hyde feel larger than Jekyll, not smaller. Hallucinogenic drugs can cause a change in body image perception. Although LSD would not be synthesized until the 1900s, Stevenson might have tried naturally occurring hallucinogens such as mushrooms. Or perhaps Stevenson or one of his associates synthesized, accidentally, a hallucinogen in the course of attempting to find a drug to treat Stevenson’s tuberculosis. To leave room for readers’ imaginations, Stevenson may have deliberately left the identity of the drug somewhat vague.

Regardless of whether the drug can be identified, the DSM-IV criteria for dependence can be met interestingly and usefully in this case, independently of identification of the specific substance. Because Stevenson’s novella is short (about 100 pages) and inexpensive (less than $5.00), it can be easily obtained and read. We hope Dr. Jekyll and Mr. Hyde is a useful aid to physicians, patients, and their families in better understanding and treating the common and often serious disease of substance dependence.

References

Ezekowitz RA: Genetic heterogeneity of mannose-binding proteins: the Jekyll and Hyde of innate immunity? Am J Hum Genet 1998; 62:6–9

Hocke V, Schmidtke A: "Multiple personality disorder" in childhood and adolescence. Z Kinder Jugendpsychiatr Psychother 1998; 26:273–284[PubMed]

Stevenson RL: Dr. Jekyll and Mr. Hyde (1886). New York, Bantam Books, 1981

Pope-Hennessy J: Robert Louis Stevenson. London, Jonathan Cape, 1994, p 50

Elwin M: The Strange Case of Robert Louis Stevenson. London, Macdonald, 1950, p 79

Ezekowitz RA: Genetic heterogeneity of mannose-binding proteins: the Jekyll and Hyde of innate immunity? Am J Hum Genet 1998; 62:6–9

Hocke V, Schmidtke A: "Multiple personality disorder" in childhood and adolescence. Z Kinder Jugendpsychiatr Psychother 1998; 26:273–284[PubMed]

Stevenson RL: Dr. Jekyll and Mr. Hyde (1886). New York, Bantam Books, 1981

Pope-Hennessy J: Robert Louis Stevenson. London, Jonathan Cape, 1994, p 50

Elwin M: The Strange Case of Robert Louis Stevenson. London, Macdonald, 1950, p 79

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.

Submit a Comments

Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of JBJS editorial staff.

* = Required Field

Comment Author(s)*(if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Comment Title*

Comment*

Cancel

Print
E-mail

Recipient(s) will receive an email with a link (good for 72 hours) to 'Dr. Jekyll and Mr. Hyde: A Primer on Substance Dependence' and do not need to have American Journal of Psychiatry account to access the content.
Your Name:*
Example: John Doe

Email Address:* CC Me:
Enter your valid email address. Example: jdoe@example.com

Recipient's Email Address:*
Separate multiple email address with semi-colons (up to 5).

Subject:* 's American Journal of Psychiatry: 'Dr. Jekyll and Mr. Hyde: A Primer on Substance Dependence'
Subject for your email.

Message:
(Optional, message will truncate at 1000 characters)

Processing your request... Please Wait...

Copyright © in the material you requested is held by The American Psychiatric Association (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that you are requesting the material solely for personal, non-commercial use, and that it is subject to The American Psychiatric Association's Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The American Psychiatric Association's Privacy Policy for further information.

Copyright © American Psychiatric Association. All rights reserved.
Share
Get Citation

ERIC LEWIN ALTSCHULER, DANIEL WRIGHT; Dr. Jekyll and Mr. Hyde: A Primer on Substance Dependence. American Journal of Psychiatry. 2000 Mar;157(3):484-484.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

Copyright © American Psychiatric Association. All rights reserved.
Reprints