I don't know what happened! Everything was going great. We'd been out at dinner with our friends Jack and Jean. We said goodnight at the restaurant and were walking back to the car when Tom's mood seemed to change suddenly. It was a sudden mood swing, not subtle at all. The jocular man who had been filled with hilarity while optimistically toasting our future at dinner was suddenly sullen and mean. His cutting observations about my appearance, criticism of my conversation at dinner, calling me stupid… I felt like he was going to whirl around and hit me! His very presence had become unbearable! Simply being in the same space as this man was causing me great distress. I was afraid – afraid of what was about to happen… I do not understand! How could this otherwise loving man suddenly show himself to me as such a monster? Mind you, this is not the first time he's transformed like this, but it's been so long. I thought he'd gotten over it! I swear, he has a real Jekyll and Hyde personality. It's horrible!
Does Tom suffer from 'Jekyll and Hyde Syndrome' – or does Tom simply have anger issues – or are Tom's problems much, much more profound? From the short extract and limited information above, we really can't say for sure what has caused Tom such distress. We can only say that something is wrong – something is not right to cause said behavior, and according to Tom's wife, he's not just "having another bad day." Why did Tom's wife describe his mood swing as akin to Tom being a 'Jekyll and Hyde?' What is the perception of this label that it is applied freely to almost any situation we can't quite explain that involves shifts in mood or behavior?
There is no such specific diagnosis called 'Jekyll and Hyde Syndrome' in the DSM-V, but having found its way into the common jargon, it is interesting to consider if there was such a thing, what would it indeed be? An analysis of Dr. Henry Jekyll's symptoms is quite revealing (and there are many), especially when we ask ourselves if they align with the author's generally accepted original intent.
Long intrigued with the interplay of good and evil as reflected in the human personality, in 1886, Robert Louis Stevenson published his gothic novella "The Strange Case of Dr. Jekyll and Mr. Hyde." The book sold an estimated 40,000 copies in its first six months after release, perhaps due more to the perceived decay of the Victorian moral standards of the 19th century than the artistic value of the work on its own merits.
Rather than expound on the Jungian expression of shadow and persona or jump right into a debate over the nuances of what constitutes certain mental illnesses, let us simply stop and take stock of what so-called Jekyll and Hyde syndrome is and is not and consider things, one at a time.
What does it mean if we say that someone is a "Jekyll and Hyde?" Before launching into a possible answer to that question, let me first say that it's probably not what you think – nor are the slew of internet references a reliable source for understanding what it might be. While there are experts such as Peter Demuth (2021), whom I admire greatly for his explanation of the Jungian archetype, and Beverly Engel (2007), whose work provides relevant examples and identifiers of Jekyll and Hyde behavior in others and oneself, there is generally a sense of disagreement in the literature as to what definitively constitutes someone as having a 'Jekyll and Hyde' personality. The label gets thrown around quite carelessly, and it is somewhat bothersome to me! Perhaps we can attribute that, at least in part, to the passage of time and the 130-plus years since the story's initial publication. Or perhaps not. It is not as simple as most people who misuse the label believe, yet not so complex that it takes a degree in Jungian Psychology to understand.
Who is Dr. Henry Jekyll and Mr. Edward Hyde?
Dr. Henry Jekyll is a gentleman. A fine, upstanding, Victorian gentleman of wealth and social status. Driven by science, he is a desperately unhappy man with deeply repressed sexual and violent urges. Fearing he will surrender the earned wages of his life should the truth become known, Jekyll's internal struggles with benevolence and malevolence become unbearable as he desperately seeks relief for his dark and ravenous passions.
After reading (and thoroughly enjoying) the story, most people fail to recognize that there is no Mr. Hyde. Edward Hyde is not a separate character nor dissociated personality (we'll get to that soon). To suggest that Mr. Hyde is an alter ego is only accurate to the extent that an alter ego may represent the opposite side of a personality. In this case, Mr. Hyde is not the opposite side of Dr. Henry Jekyll as he exists; he is unique unto himself, said to be grotesquely ill-shapen and significantly younger than Henry Jekyll, thus subject to the follies and forgiveness of youth.
In this case, Mr. Hyde is nothing more than an immoral mask for the respectable Dr. Jekyll to don, therefore eliminating the incriminations of guilt, shame, blame, and damage to his otherwise good name. Mr. Hyde, the hideous, violent, monster-like, uncouth, younger, and less developed version of Henry Jekyll, is absolutely the intended result of Jekyll's experiments. He is not an accident. His excuse to live life as "a hideous creature without compassion or remorse." More than simply the desired pursuit of immorality, Hyde is necessary – his relief.
Of Note
There are two story elements worthy of noting that offer insight into why many people – perhaps most people – fail to recognize that Mr. Hyde does not exist as an independent person. These are also important when considering how the descriptor 'Jekyll and Hyde' has entered our vernacular. Saying that someone has a 'Jekyll and Hyde' personality to describe frequent mood swings or even a dissociative disorder (we'll get to that) does a disservice to Stevenson's novella and the client whose condition it labels.
The first point worthy of note is that Stevenson does not reveal that Jekyll and Hyde are the same being until about two-thirds of the way through the story. He intentionally leads the reader into the realm of magic potions and their supposed ability to create life – however despicable and unworthy. To the untrained eye, the second is a little more difficult to see; that is, it is essential to note that at no time is Dr. Jekyll unaware of the deeds of Mr. Hyde. While eventually, he is no longer conscious nor controlling of the transformation, at no time is he unaware of his monstrous acts while masquerading as Edward Hyde and living off the wealth of Henry Jekyll.
So, what is 'Jekyll and Hyde' then?
What Jekyll and Hyde Syndrome Is Not
Perhaps due in part to the way the reader is led through the story, there are some misconceptions about what this condition is and what it is not. By process of elimination, let us consider what it is not. First, I propose that Jekyll and Hyde syndrome is not dissociative identity disorder (DID). The range of DID markers is broad but includes identity confusion, identity alteration, and amnesia as specific characteristics. Yes, there are allied forms of dissociative disorder without amnesia (dissociative disorder not otherwise specified – DDNOS, DSM-IV). However, research shows that while DID and DDNOS patients exhibit good self-reflective capacities and cognitive insight, the dissociative symptoms of DID and DDNOS appear qualitatively different (Annegret & Carsten, 2017; Dorahy et al., 2014).
A diagnosis of DDNOS is often applied when the client exhibits some dissociative symptoms or there is a lack of information to determine that the client fully meets the criteria for any of the existing dissociative disorders. The classic characteristics of identity alteration and amnesia define DID in the DSM-V. Still, the client may present with multiple covert dissociative (flashbacks, hallucinations) and non-dissociative (affective instability) symptoms, which may obscure the condition's true nature (Scroppo et al., 1998).
Understandably, those suffering from DID might present with an initial diagnosis of schizophrenia, but the person with schizophrenia cannot likely be confused with a Jekyll and Hyde personality. On the other hand, clients who present with classic schizophrenia disorder may also exhibit some symptoms of DID (Ross, 2004). Still, Jekyll and Hyde syndrome should not be confused with schizophrenia either.
Schizophrenia is a cognitive disorder afflicting a person's perceived reality and how they interact with what they believe is happening around them. The hallmark symptoms of schizophrenia are psychosis, such as auditory hallucinations (hearing and interacting with voices, disorganized speech), and delusions (rigid false beliefs and disorganized or catatonic behaviors). Also, impairment of cognitive functioning and a perceived outward flat emotional response with no loss of inner emotional experience and short- and long-term memory deficit (forgetfulness) of those diagnosed with schizophrenia may also be present as symptoms (Aghevli et al., 2003; Kring et al., 1993). This is important to note as both Henry Jekyll and Edward Hyde have outward emotional responses to their situations, surroundings, and deeds.
Drug abuse may trigger symptoms of schizophrenia in people who are susceptible to mental illness. (This is a common presentation among the street population with whom I work.) The danger becomes a failure to recognize comorbidity in the context of meth use as a cause of persistent psychotic syndrome (Callaghan et al., 2012; Grelotti et al., 2010), suggesting meth psychosis and schizophrenia as the same disorder on a continuum of pathology (Wearne & Cornish, 2018). Evidence suggests that while distinctly different, there is divergence in the behavioral, biological, and cognitive markers of the two disorders (Wearne & Cornish, 2018). While schizophrenia is a proposed dissociative subtype of DID, no study has found DID without multiple non-dissociative comorbid psychopathologies, with lability and suicidal ideation among the most frequent (as cited in Dorahy et al., 2014, p. 405).
This doesn't sound like Henry Jekyll; he was having too good of a time as Edward Hyde! Yes, he took drugs – the potion! But he recalls everything, however grotesque and repulsive the memory.
So, What Is It Then?
Many reviewers have said that Stevenson's novella was the first to deal with what was once colloquially known as split or multiple personality disorder: a diagnosed mental disorder that describes a client who presents with two or more distinct and relatively enduring personality states. After its emergence as a more defined condition in the late 1960s (as hysterical neurosis, dissociative type), DID did not enter the common dialect until the release of the DSM-IV in 1994. Not only a name change to better reflect the complex nature and our growing knowledge of the condition – and I am not sure accurately, also adopted as a descriptor of split personality disorder. Inclusive of the specific criterion of amnesia to the current diagnosis of multiple personality disorder (Tracy, 2022). This delineation provides an essential distinction between the concepts of split personality and diagnosed DID.
In reflection, our understanding of split personality disorder – and subsequently DID – has long since surpassed and outgrown Dr. Henry Jekyll's original symptoms and perhaps, Robert Louis Stevenson's original intent.
If, as I am claiming, Jekyll and Hyde syndrome is not DID, and it is not schizophrenia, could it be misconstrued as manic-depressive psychosis or bipolar disorder? What is it then? A study in dualism? A primer on substance abuse? I hope you'll visit this very personal discussion over the next few weeks as I explore further the truly strange case – and fascinating tale – of Dr. Jekyll and Mr. Hyde.
I invite you to please leave your thoughts in the comment section below.
REFERENCES
Aghevli, M. A., Blanchard, J. J., & Horan, W. P. (2003). The Expression and Experience of Emotion in Schizophrenia: A Study of Social Interactions. Journal of Abnormal Psychology, 119, 261-270.
Annegret, E.-H., & Carsten, S. (2017). Dissoziative Bewusstseinsstörungen : Grundlagen, Klinik, Therapie (Vol. 2. Auflage). Stuttgart, Germany: Schattauer.
Callaghan, R., Cunningham, J., Allebeck, P., Arenovich, T., Sajeev, G., & Remington, G. (2012). Methamphetamine use and schizophrenia: a population-based cohort study in California. American Journal of Psychiatry, 169, 389-396. doi:10.1176/appi.ajp.2011.10070937
Demuth, P. (Producer). (2021, May 15). Dr. Jekyll and Mr. Hyde: The Interplay Between Persona and Shadow. [Multimedia Presentation] Retrieved from https://jungchicago.org/
Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., . . . Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian and New Zealand Journal of Psychiatry, 48(5), 402-417. doi:10.1177/0004867414527523
Engel, B. (2007). The Jekyll and Hyde Syndrome: What to Do If Someone in Your Life Has a Dual Personality - or If You Do. Hoboken, NJ: John Wiley & Sons, Inc.
Grelotti, D., Kanayama, G., & Pope, H. (2010). Remission of persistent methamphetamine-induced psychosis after electroconvulsive therapy: presentation of a case and review of the literature. American Journal of Psychiatry, 167, 17-23. doi:10.1176/appi.ajp.2009.08111695
Kring, A. M., Kerr, S. L., Smith, D. A., & Neale, J. M. (1993). Flat Affect in Schizophrenia does not Reflect Diminished Subjective Experience of Emotion. Journal of Abnormal Psychology, 102(4), 507-517.
Ross, C. A. (2004). Schizophrenia: Innovations in Diagnosis and Treatment. Birmingham, NY: Haworth Press.
Scroppo, J. C., Drob, S. L., Weinberger, J. L., & Eagle, P. (1998). Identifying dissociative identity disorder: A self-report and projective study. Journal of Abnormal Psychology, 107(2), 272-284. doi:10.1037/0021-843X.107.2.272
Tracy, N. (2022, January 12). The Amazing History of Dissociative Identity Disorder (DID). Retrieved from https://www.healthyplace.com/
Wearne, T. A., & Cornish, J. L. (2018). A Comparison of Methamphetamine-Induced Psychosis and Schizophrenia: A Review of Positive, Negative, and Cognitive Symptomatology. Frontiers in Psychiatry, 9. doi:10.3389/fpsyt.2018.00491