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Addiction,
Masculinity, and Medical Professionalism in Horace Saltoun and The
Strange Case of Dr. Jekyll and Mr. Hyde
Susan Zieger
[Work in progress; please do not cite without permission].
Robert Louis Stevenson's 1886 novel, The
Strange Case of Dr. Jekyll and Mr. Hyde is a touchstone of the modern
for literary critics. Its story, of a reclusive researcher of "transcendental
medicine," who falls into the habit of drinking a solution
that physically transforms him into another man for the purpose
of indulging obscure and violent desires, has been widely interpreted
to augur the age of psychoanalysis, with its splitting of the subject
into id, ego, and superego. Stevenson's insight, "that man
is not truly one, but truly two" is often viewed as a proto-modernist
fragmentation of the self. Critics have also filled in the historical
content of this split, claiming, for example, that Hyde's marked
deformity and simian appearance represent fin-de-siècle fears
of degeneration and racial atavism actively decaying civilization;
or, that by embodying degeneracy, Hyde functioned doubly as a metaphor
for a monstrous lower class and a decadent leisure class, thus irritating
middle class readers from both directions; or, that the split between
Jekyll and Hyde conceals the sexual deviance of homoeroticism or
homosexuality, new categories invented by a burgeoning sexology,
with Jekyll's laboratory or "closet" functioning to hide
the love that dare not speak its name.
Hyde, as still other critics have noticed, is such an indeterminate
figure that it is not difficult to build an argument around any
marginalized identity and assign it to him, while Jekyll seems always
to stand for the troubled powers that be. But rather than using
the Jekyll/Hyde split to reflect a social schism, I'd like to consider
the dyad itself and its relation to a marginalized identity that
gets very little historical scrutiny, and yet which was undergoing
rapid development in the 1880s and 1890s, the addict. You might
be surprised to learn that very few histories of addiction exist,
but the truth is that when scholars think about addiction in the
Victorian period, they often apply late twentieth-century therapeutic
concepts such as denial, ritualization, and codependency to nineteenth-century
fictional characters and historical people who never could have
recognized them. In one such study, a scholar uses the clinical
definitions in the DSM-IV to diagnose The Mayor of Casterbridge
with addiction. In another, a scholar uses a clinical vocabulary
on sex addiction from the 1990s to classify Jekyll/Hyde's behavior.
If we accept the premise that addiction is not a transhistorical
phenomenon, we can instead use Stevenson's text to illuminate the
intertwined, unevenly developing discourses of medical professionalism,
masculinity, and addiction in the period itself. At the heart of
this knot of issues was a figure of great fascination, the doctor
who was himself an addict. This doubled figure combines the medical
professional and the object of his study, a person variously categorized
within medical terminology as a "habitual drunkard," "inebriate,"
"morphinomaniac," or "cocainist." These doctors-with-habits
were acutely ironic figures, because their pathological consumption
directly flouted the medical norms that, as professionals, they
were supposed to be enforcing. Jekyll is like one of these doctors;
by experimenting on himself, he comes to embody this merger of medical
researcher with object of study. In this way, he is medicalized
twice: once by virtue of being a medical professional, again by
virtue of deviating from the norms of healthy consumption. This
doubling generates an overdetermined, conflicted masculinity. We
can see this phenomenon by reading The Strange Case through an earlier,
uncannily similar text that also problematizes the relations between
professionalism, masculinity, and pathological consumption - the
bizarre, obscure 1861 novel by Coke Richardson, Horace Saltoun.
By interpreting these texts together, I hope to convince you that
the professionalization of medicine, and the production of its objects
of study, creates a new, hybrid form of masculinity, that of the
habituated doctor. As professional and personal knowledge collide
in this figure, his masculinity becomes stressed and chaotic.
1. Doctor-addicts
The nineteenth century represented a shift
from an older, aristocratic form of medicine, in which doctors were
essentially servants, to a modern one, in which they diagnosed and
instructed their patients. Under the eighteenth-century patronage
system, unique aspects of the individual, such as life history and
temperament, required customized care; after the revolution in Paris
medicine around 1800, these elements were subordinated to a set
of norms applicable to everyone. Before Paris medicine, wealthy
clients furnished the doctor with the story of their injury or illness
and any other factors they deemed relevant, and helped determine
the treatment in a dialogue with him. But in the nineteenth century,
physicians reversed this power dynamic, soliciting only the information
they wanted, and comparing it with other patients' to produce a
norm or standard by which they could apply treatment to bodies rather
than individuals. Debates over physician-caused habituations were
a key moment in this reversal. As a defense against the accusation
that physicians' carelessness caused patients to develop alcohol
and morphine habits, writers such as F. E. Anstie countered that
the patients themselves were merely blaming their doctors to cover
up their own pre-existing depraved conditions. This counter-critique
was aimed specifically at upper-class women, who appeared to have
developed raging habituations in attempts to follow the latest fashion.
Medical writers bolstered their own public image by characterizing
rich female patients as lying, depraved pleasure-seekers, and contrasting
them to heroic, slandered doctors. Doctors declared that only medical
professionals could determine and administer dosages of hypodermic
morphine or alcohol to their patients. Doctors thus began to institute
norms of consumption that supplanted self-medication based on different
individual responses. Nascent formulations of addiction therefore
serve as superb examples of the nineteenth-century medical institutional
domination of individual acts of consumption. Since morphine and
alcohol dependencies were marked by self-medication rather than
doctor-supervised medication, proto-addictions such as morphinomania,
alcoholism, and inebriety could be viewed as the crux of this shift.
This state of affairs meant that patients could no longer treat
their own ailments. Everyone needed a doctor's insight into the
standard structure and function of the typical human body. But what
about doctors themselves? Did their knowledge allow them to treat
themselves? From the late 1850s, doctors had great access to new
opium alkaloids and the cheap hypodermic technology with which to
inject them. The pages of The Lancet in the 1870s and 1880s are
sprinkled with stories of doctors, chemists, doctor's wives, and
medical students - people expected to know better - overdosing on
morphine and laudanum. These stories would appear to strike a blow
to medical authority. If a doctor could not properly dose himself,
how could he safely care for his patients? The poetic justice of
physician-caused or "iatrogenic" habituations was not
lost on Dr. Henry Obersteiner, who wrote in the neuroscience journal
Brain that "If medical men are charged - and it is to be feared,
justly - with the propagation of [morphinism], owing to their carelessly,
or for mere convenience' sake, leaving morphia and subcutaneous
syringe with the patient, it may be regarded as their punishment
that the demon morphinism finds among them his favorite victims."
The point is not merely that a handful of habitués made the
medical profession look bad, but that they indicated the awkwardness
of an emergent medical authority. The figure of the doctor-addict
was a tear in the ongoing separation of the subjects and objects
of knowledge, and another wrinkle in the supposedly smooth rise
of the medical profession to cultural power. The self-experimentation
of Romantic-era dilettantes and investigators such as Humphry Davy
was no longer an option for professional scientists in the Victorian
period. Knowledge was not to be gained by submission to powerful
forces, but to be itself forcibly extracted from nature. In a period
that characterized the will by its forcefulness or "power,"
the production of proper knowledge amounted to a kind of flexing
of the will; only illegitimate knowledge resulted from the will's
weak turning in upon itself. A good physician could not be both
the bearer of such scientific knowledge and the keeper of knowledge
derived from a habituation - a certain kind of personal, untransmissable,
illegitimate knowledge born in moments of powerlessness. These forms
of knowing were differently gendered; so their combination in a
single figure makes for significant gender trouble.
2. The texts
The figure of Henry Jekyll dramatizes this
dilemma about knowledge, because his private metamorphosis into
Hyde emerges through professional exchanges between men.
First, there is the professional service that the lawyer Utterson
performs for Jekyll, the vetting of Jekyll's drafted will, which
will leave everything to Hyde. This exchange exacerbates Utterson's
suspicions about Jekyll's relationship to Hyde, fueling the mystery.
Another way in which professional exchange conceals and reveals
secret knowledge is through Dr. Lanyon's professional dispute with
Jekyll. Lanyon had dismissed Jekyll's foray into "transcendental
medicine"; he is appropriately punished when he accepts Hyde's
offer to watch his transformation back into Jekyll: "[I]f you
shall so prefer to choose, a new province of knowledge and new avenues
to fame and power shall be laid open to you
." (79). Yet
this revelation - emphatically designated by Hyde as being "under
the seal of our profession" (80) -- is so mind-blowing that
Lanyon withers and dies. Third, the very form of The Strange Case
of Dr. Jekyll and Mr. Hyde is that of both the legal and the medical
dossier: a collection of papers by different authorities bearing
on the same topic. The reader is thus invited to try on the role
of the professional expert, sifting through pieces of evidence to
reconstruct the narrative. Stephen Arata argues that "the novel
turns the discourses centering on degeneration, atavism, and criminality
back on the professional classes that produced them, linking gentlemanliness
and bourgeois virtue to various forms of depravity
. [J]ekyll
and Hyde is a consummate critique of the professional men who formed
the bulk of its readership." Nicholas Daly has made a similar
argument with respect to Bram Stoker's Dracula - that the anxiety
surrounding the vampire "produce[s] as both necessary and natural
a modern form of professional, male, homosocial combination - the
team of experts." These critics underscore professionalism's
status as the exchange of knowledge between men. And indeed, the
relative absence of women from the novel forces masculinity to develop
through itself, without any easily identifiable opposite. Under
this pressure, The Strange Case produces a masculinity riven by
paradox: Jekyll's apparently feminine lack of self-mastery combines
with Hyde's excessively masculine fullness of self. At first, Utterson
imagines Hyde to be Jekyll's illegitimate son, "the ghost of
some old sin, the cancer of some concealed disgrace" (41);
this thesis holds up, albeit not in the way Utterson imagines. That
is, not in relation to an illicit relationship with a woman, but
in an even more illegitimate, involuted relationship to himself.
Perhaps Jekyll's bizarre fate results from an errant, inwardly directed
professionalism. The effect is a masculinity in chaos, divided against
itself and overdetermined.
Horace Saltoun also produces the same chaotic masculinity through
professional exchanges and disclosures of private secrets; the secret
here similarly involves an unnatural relationship to the self. Just
as Utterson functions as Jekyll's friend and the story's primary
narrator, so the narrator Paul functions as Horace's friend and
chronicler. The story begins with Horace and Paul having just passed
their medical exams. Horace confesses to Paul that he suffers from
alcoholism, and over the years, Paul recounts Horace's ups and downs,
which include a spree in the notorious Seven Dials area after rejection
by a coquettish lover; details of his worsening condition, which
jeopardizes his career; a return to sobriety and marriage to the
stoic Margaret; and final descent into delirium and near homicide
as he attempts to strangle Margaret with seaweed from the shore
of his north Wales summer home. Through it all, Paul keeps Horace's
secret, and in return Horace lends him the money to purchase his
practice. Like JH, HS 's formal structure is the story of a story;
the revelation of the secret story is conditioned by professional
exchanges. Horace continues to advance professionally because Paul
refuses to let his secret "ooze out." Horace's alcoholism,
like Jekyll's odd habit, becomes the symbol of professional secrecy.
Both The Strange Case and Horace Saltoun thus create a new kind
of professional masculinity that is already doubled, because it
is both unique and corporate, individual and bound to a brotherhood
united in esoteric knowledge. The primacy of this social relation
runs counter to reproductive heterosexuality. For example, Paul
frets over Horace's plan to marry, because he is likely to spread
his dipsomania to his children. Yet the alternative would be limited
to the affective bonds with his male students. Richardson raises
these two issues together, having Horace argue that his wife-to-be,
Margaret, would exert more influence over their children, and that
his exclusion from marriage makes him susceptible to the affection
of his students:
[S]cience and experience support us in the
idea that the mother has in general more influence than the father
on the cerebral development of her child. Margaret has such a perfect
organization, such a calm fine temper, it would be impossible to
conceive of her failing to influence all near her.'
I reflected. I didn't like to advise, and I told him so.
'Why, Paul, it's enough to make a man go mad of himself, or take
brandy indefinitely, to be so isolated as I am: I could shed tears
sometimes when those rough scampish fellows show the personal affection
to me which they often do.' (434)
In this way, Horace attempts to salvage a space within reproductive
heterosexuality for himself, by diminishing the role of patrilineal
biological inheritance. Yet Paul, the objective narrator, disagrees.
This makes Horace's pathos even more apparent, as he is left to
articulate the combination of dipsomania, insanity, and melancholy
that his prohibition from marriage and procreation induces. Crucially,
in the grammar of the passage, it is not only this prohibition,
but the display of affection from his students that makes Horace
want to cry. In his capacity as teacher, Horace plays the feminine
role of tearfully receiving displays of affection that his excessively
masculine ("rough scampish") young men proffer. A similar
gesture of ambivalence is made earlier when Horace and Paul are
discussing his loneliness and his love for the coquettish Cecile
Otway, who ultimately rejects him. Then, Horace explains his loneliness
similarly:
I tell you it is the knowledge that as I
pace these weary, crowded, seething streets, if I were to fall down
dead I should be carried to the nearest hospital, and no moan would
be made - none would own me, unless one of my own lads got hold
of me-" (245).
In this scenario, the homosocial bonds of
the medical brotherhood substitute for the heterosexual ideal. Horace's
image of his lifeless body being discovered by one of his own students
is an erotic fantasy that derives its frisson from the overlap of
individual and institutional relations. The fantasized moans are
the sound of a prohibited homosexual intimacy rearticulated as the
more acceptable lament of grief. In this way, the story pits professional
homosocial and domestic heterosexual life against each other.
This tension is articulated most pointedly in the narrative fulcrum,
in which Horace attempts to murder Margaret. Having nursed Margaret
back to health after her confinement, a procedure that involved
the administration of stimulants to her for weeks, Horace is especially
susceptible to an outbreak, which occurs after he hears news of
his sister's death from a drunken accident. Nevertheless, he expresses
a determination to return to the lecture room, a plan to which Margaret
reasonably objects. He disappears, and Paul later finds him along
the beach, a vision of deeply complicated masculinity:
He was entirely naked, with the exception
of a chaplet of black seaweed on his head, and a twisted rope made
out of the root part of the same material, coiled round his neck,
waist, and loins, and terminating in a fantastic knot which fell
to his knee, his feet were cut and stained, and a thin streak of
blood was visible from a cut on his forehead, from which it trickled
slowly down his face. He was shouting, blaspheming, and gesticulating,
and tearing the seaweed violently from the rocks, and hurling it
by great handfuls into the sea. (443)
The image of Horace naked, adorned with slimy
weeds, bleeding and shouting, fulfills earlier physiognomic hints
of atavism in the same way that descriptions of an apelike Hyde
do. Horace's extraordinary seaweed outfit seems both a feminine
accessory and a baroquely phallic display. A chaplet, also known
as a garland or wreath, has classical Greek connotations of majesty
and masculine beauty, obviously invoked ironically here. The blood
trickling down his forehead emphasizes Horace's lost physical integrity,
as he loses his intellect and merges with his environment, the sea.
The full disclosure of Horace's alcoholic insanity thus transforms
him into an atavistic and ambiguously gendered creature, a kind
of furious merman. Shortly after this description, Horace attempts
to strangle Margaret with the seaweed, an act that finally resolves
his conflict by violently excluding the feminine.
To conclude: while The Strange Case depicts deep division as an
element of human nature, Horace Saltoun depicts it as a symptom
of alcoholism. But both use professional, male homosociality as
the narrative context of the peculiarly self-centered, violent conditions
they represent. In its nascent forms, addiction disturbed gender
and sexuality because the addictive substance or pathological behavior
replaced normal social affections and activities. Secondly, as medicine
was professionalized, so too was masculinity was forced to change.
Because self-medication was no longer possible, men and women were
thrown into relation with professionals or experts who claimed to
know more about them than they knew about themselves. In the late
nineteenth and early twentieth century, addiction was the foremost
example of this lack of self-knowledge, for the addict was the last
to recognize the devastating division in his or her own self. If
as recent critics have argued, the professional expert increasingly
appears as a fictional hero who fights irrational, monstrous forces,
in Horace Saltoun we see that dyad fused into a single figure. His
masculinity becomes the casualty of the contending forces of self-knowledge
and professional knowledge.
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