Strange Case of Dr Jekyll and Mr Hyde, an 1886 novella by Robert Louis Stevenson, made such an impression that today, the term ‘Jekyll and Hyde’ is part of our language. The phrase continues to refer to a person who exhibits markedly different displays of moral character.

Part of Stevenson’s inspiration for the story came from observing mental health patient Louis Vivet, who was one of the first individuals to be labelled with dissociative identity disorder. Termed multiple personality disorder or split personality disorder at the time, Vivet’s diagnosis soon appeared in psychological literature.

The novella has been interpreted as an exploration of the duality of human nature, the internal battle between good and evil, and our tendency to banish dark thoughts and intentions to the unconscious mind, from which they may later manifest in aberrant behaviour.

Now, let’s fast-forward to Robert Bloch’s 1959 suspense thriller Psycho. Who could forget the shower scene in Alfred Hitchcock’s screen adaption of the same name? Antagonist Norman Bates suffered abuse at the hands of his dominant mother, murdered her, and developed dissociative identity disorder. He would talk to himself in his mother’s voice, and wore her clothes when he stabbed hotel guest Mary Crane to death.

Bloch’s writing was inspired by the concept that a monster could live next door, unsuspected, even in a small town. Coincidentally, two years before Psycho was published and unbeknown to Bloch until later, a deranged killer was arrested in a village near his home in Weyauwega, Wisconsin. Ed Gein was found to have been making furniture and clothing from human parts and skin. Medical experts at the time believed he was trying to make a “woman suit” so he could pretend to be his puritanical dead mother. Thomas Harris’s character Jame Gumb, referred to as Buffalo Bill in The Silence of the Lambs, was also influenced by Gein and several other real-life serial killers.

One of the scenes from Silence of the Lambs that has stayed in my mind is the kidnap of Catherine Martin. Gumb used his usual modus operandi. He pretended to be injured and asked for help, a ploy used by Ted Bundy, then knocked his victim out and abducted her.

We met another of Harris’s characters, Hannibal Lecter in Red Dragon, and again in Silence of the Lambs, when Clarice Starling interviewed him during the search for Catherine Martin. Lecter, a forensic psychiatrist and cannibalistic serial killer, commented on Gumb by saying, “Billy was not born a criminal, but made one by years of systematic abuse.”

Lecter’s own development as a serial killer is revealed in Harris’s 2006 publication, Hannibal Rising. Eight-year-old Hannibal endured unspeakable trauma. After his parents had been killed by a German bomber, he and his sister Mischa were held captive by Lithuanian looters.

Mischa was murdered and cannibalized. Hannibal escaped but was rendered temporarily mute by the ordeal, which scarred and haunted him for the rest of his life. Lecter committed to exacting revenge for Mischa, and tracked down and killed her murderers. In Hannibal Rising, Lecter presents as an antihero: although his actions are not morally correct, the reader empathises with his motivation.

My own novels Star-Crossed Lovers and its sequel Death-Marked Love also explore the catastrophic effect of childhood trauma on an individual’s psychological make-up. In the case of Katie Garcia, she is unable to face her devastating reality and a new identity emerges: an alter ego with the capacity to be vengeful and murderous. Her condition is complicated by selective mutism, a traumatic brain injury, and the possibility of post-traumatic stress.

Violence begets violence, but not all victims of assault will become perpetrators. Most won’t. So, when writing her, I had to ask myself, did Katie have a genetic predisposition toward mental illness? Were there existing homicidal tendencies lurking below an innocent exterior?

The 1973 book Sybil, by Flora Rheta Schreiber, focused on the life and treatment of Shirley Ardell Mason for multiple personality disorder, now referred to as dissociative identity disorder (DID). This is considered a pathological, involuntary defence mechanism. Mason’s symptoms before diagnosis included social anxiety, ‘losing time,’ and bouts of depression. Psychoanalyst Cornelia B. Wilbur believed severe childhood abuse precipitated Shirley’s fragmented personality. Sixteen distinct personalities emerged, including a French girl, an artist, a musician, two male selves, a baby, and a teenager called ‘the Blonde’.

The American Psychiatric Association’s DSM-IV (Diagnostic and Statistical Manual, 4th Edition) lists several dissociative disorders. There is not a clear consensus on diagnosis and treatment. In simplified lay terms they include:

  • depersonalisation disorder, which presents as periods of detachment and feeling ‘outside of’ one’s self;
  • dissociative amnesia, a memory disorder characterised by loss of recall for a time ranging from hours to years;
  • dissociative fugue, which results in confusion about identity, usually wandering and unplanned travel, and in some cases assumption of a new identity; and
  • dissociative identity disorder, which was previously known as multiple personality disorder, and presents as a switching between two or more definite personalities, generally with incomplete

Edward Norton played an abused altar boy in the movie Primal Fear, adapted from William Diehl’s 1992 novel of the same name. Throughout the suspense-packed story, we’re led to believe Norton’s character is suffering from DID. In a nice twist at the end, we discover what appears to be the truth—that the villain’s presentation of DID was just a ruse.

Exaggeration or fabrication of mental illness is known in medical terms as malingering, and is often done for motives such as financial compensation, avoiding criminal conviction or gaining sympathy.

The law and the community demand that people pay for their crimes. There is also a general acceptance that mentally ill people should receive appropriate treatment. The ‘not guilty by reason of insanity’ plea acknowledges society’s belief that defendants who are mentally incapable of controlling their behaviour should not be punished.

Debates will continue to rage about leniency, sentencing, and treatment of the criminally insane. In the meantime, books and movies delving into the darkest twists of the human psyche will continue to fascinate us.

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