Annual Meeting

October 10-13, 2002

Pasadena, California


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[Work in progress; please do not cite without permission].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 Critics have also filled in the historical content of this split, claiming, for example, that Hyde's marked deformity and simian appearance represent fin-de-siècle fears of degeneration and racial atavism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.