Batman: Jekyll & Hyde #1: A Medical Review
Batman: Jekyll & Hyde #1
Paul Jenkins, writer
Jae Lee, penciler
Batman: Jekyll and Hyde #1 spends half the issue focusing on Harvey Dent, who is better known as the villainous Two-Face. Once a promising District Attorney, Dent had his face scarred with acid thrown by a mobster. As originally written, having half his face horribly scarred drove Dent insane. More current interpretations of the character suggest that Dent always had a darker side and the trauma of the acid burn brought it to the surface.
1. THE DIAGNOSIS OF HARVEY DENT
Arkham Asylum Doctor: Harvey Dent, also known as Two-Face. Paranoid schizophrenic with homicidal tendencies. Secondary diagnosis is a borderline personality disorder, or perhaps multiple personality – we can’t be certain.
Arkham Asylum Doctor: Mister Dent experiences frequent hallucinations as a result of his psychosis. He’s convinced that he shares his body with another person. In effect, he has literally become two people.
It’s no wonder nobody ever gets better at Arkham: the doctors don’t have the slightest idea what they are talking about.
While there are no simple blood tests for mental illness, there are specific diagnostic criteria. The patient is evaluated for the presence or absence of certain symptoms. These symptoms are then used to diagnose the patient. The most commonly used diagnostic reference is the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV TR).
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The DSM-IV TR lists the following characteristic symptoms for Schizophrenia: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
and Paranoid Schizophrenia:
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Harvey Dent does not meet the criteria for Paranoid Schizophrenia (or even Schizophrenia in general). He may be delusional at times (which is certainly up for debate), but he has no hallucinations, disorganized speech, disorganized behavior or negative symptoms.
Similarly, he does not meet the criteria for Borderline Personality Disorder, though he does seem to have some borderline traits.
Multiple Personality Disorder (now known as Dissociative Identity Disorder) fits Dent best. It’s not an exact match, but it’s the closest.
Other thoughts on Harvey Dent’s diagnosis:
- Not every expert is convinced that there is such a thing as Dissociative Identity Disorder.
- It’s interesting that the doctors are not sure that Dent has Multiple Personality Disorder, yet spend two pages talking about his “second personality.”
- In regards to the second quote, the belief that Dent is sharing his body would be a delusion, not a hallucination. It would also be a shared delusion since most of Gotham believes it as well. That’s very unlikely. It’s much more likely that Dent actually has a second personality.
- Based on my reading, I would diagnose Harvey Dent with Dissociative Identity Disorder. His second (mostly dominant) personality has a severe Antisocial Personality Disorder with strong Narcissistic and Histrionic characteristics. He also has Obsessive-Compulsive traits, particularly in regards to the number “2” and his coin. (Though I will happily admit that I am neither a psychiatrist or a psychologist).
2. THE MEDICAL TREATMENT OF HARVEY DENT
Arkham Asylum Doctor #1: Medication?
Doctor #2: Just about every combination we can think of – heavy sedatives to keep his mealtimes manageable…a combination of antipsychotics such as dopamine and antidepressants to relieve the agitation.
Antidepressants, antipsychotics and sedatives are all commonly used in the mentally ill — sometimes we seem to use them too much, sometimes not enough.
The chemical dopamine is a neurotransmitter found in specific areas of the brain. In other words, certain nerve cells release dopamine to communicate with other nerve cells. Research has shown that these dopamine-using cells play a role in schizophrenia.
However, dopamine itself has no use as an antipsychotic medication. There is no way of getting the drug to the brain, let alone to the proper nerve cells. When dopamine is used as a drug, it is used as a cardiac drug to raise the blood pressure in critically ill patients (dopamine has different functions in other parts of the body).
3. BRUCE WAYNE - PARTY ANIMAL
When examining the house of a man who killed his family, Batman finds a prescription bottle from a Dr. Rousse. As Bruce Wayne, he visits the research lab where Rousse works. Pretending to be a party boy, Wayne asks Rousse if he can prescribe him some relaxants such as Valium or Ritalin. Rousse turns him down by pointing out that such prescriptions would be illegal and that he no longer prescribes drugs.
He probably also should have pointed out that Ritalin (methylphenidate) is a stimulant, not a relaxant.
UPDATE (1 June 05):
Several readers have informed me that in the past Two-Face has experienced hallucinations, delusions and disorganized speech — depending on who’s writing him. Some of this is open to interpretation given that most psychological diagnosis is based on subjective criteria. Still, based on those past appearances, a diagnosis of Schizophrenia may not be inappropriate, though I continue to doubt the diagnosis of “Paranoid Schizophrenia.”
I’m still going to stick with my diagnosis, which is based on the more recent and more stable (though no less menacing) Two-Face.
June 1st, 2005 at 8:10 am
Interesting…
Though I feel compelled to chip in, Harvey Dent was shown to have some history of hallucinations once upon a time.
(Actually, I suppose in the context of the story he *believes* himself to have a history of hallucinations, so I guess that could go either/or, if ye wanted…)
June 1st, 2005 at 9:01 am
Doesn’t Dent also suffer from disorganized speech? I mean, depending on who’s writing his lines, Dent does talk to himself or has conversations with Two-Face, abruptly changes subject, sings to himself etc. I’ed certainly have problems having a conversation with him (mind you, that would probably be due to the fact that I would be very preoccupied with not wanting to die).
June 1st, 2005 at 9:22 am
Official Comment
Many of the psychological symptoms are subjective and open to interpretation (especially when many different authors write Two-Face). When Dent is talking to himself, is that a hallucination, delusion or his two personalities “conversing”? I favor the latter, but your mileage may vary.
I’ll stick with my diagnosis(which is based primarily on his appearances over the past 5-6 years), but other interpretations are eually valid (and may be better if they’ve been reading Batman longer).
June 1st, 2005 at 10:34 am
Diagnosis -
Isn’t Paranoid Schizophrenia exactly what Harvy has? A “preoccupation” with delusions (other, coin, two) but none of the other symptoms of schizophrenia? (Though why they insist on calling it “schizophrenia” much less muddy the waters with “paranoid” continues to astound me.)
I personally believe in MPD, and believe that it is exactly what Harvey has. I mean, he was created to embody exactly that disorder. But for those that don’t believe in the disorder, PS would seem to be a pretty good fit. (Though ineptly handled, the claim that they don’t know what Harvey has might be an attempt to show that the staff is not united in a belief in MPD as a diagnosis.)
Spot on on the APD, Narcissisim, and Histrionic too. Too bad people - and not just comics writers - seem to feel that mental disorders are singular and mutually exclusive.
Party -
Bruice obviously confused the nature of the drugs to further his image as an incompetant playboy. The doctor was naturally tired of trying to explain to fine points of psychopharmacology to idiots just looking to get high, and let it slide. (This is why we need more footnotes: “Of course kids, we all know that Ritalin is an upper. Batman is just pretnding! - Ed.”)
June 1st, 2005 at 11:17 am
Official Comment
David,
You’re right about the Ritalin. That mistake can easily be explained away on Bruce’s playboy persona, and I meant to add a line to that effect to the original. I’m not so much correcting a mistake as explaining a misconception.
June 1st, 2005 at 6:28 pm
Not only is Ritalin a stimulant, but it works via dopamine, so it would likely exacerbate schizophrenic symptoms.
But it is often thought of as a sedative, especially by people who think kids are being sedated with it.
I heard a public radio show which was anti-ritalin, and at one point they used a Foo Fighters song to illustrate how Ritalin abuse had entered pop culture. They focused on the lines “ritalin is easy, ritalin is good”. But later lyrics suggest that this was intended as “ritalin is an easy way to deal with your kid” not “ritalin is easy to get for abuse”. The following line mentions “even the ones who watered down the daughter”, suggesting the band was using the common idea of ritalin as a personality-draining sedative.
June 2nd, 2005 at 7:54 am
Speaking as a counselor/trained psychologist, I would agree on diagnosing Two-Face as dissociative: not only for past evidence, but his whole decision making process is based on flipping a two-headed coin and letting “it” decide, rather than taking responsibility for his own moral choices.
(With paranoid schizophrenia, my only issue with Dent would be his relative lack of overt symptoms. Sure, he was scarred, but his behavior is a lot more controlled than, say, the Joker’s). He also seems very highly functional for a schizophrenic, but I could see histrionic/antisocial/narcissistic traits.
Sometimes, though, I think writers find buzzwords on the Net and plug them in to sound intelligence (e.g., “dopamine”, “Ritalin”). I know that, with ADHD kids, Ritalin theoretically makes brain activity more “regular”, whereas in non-ADHD, it acts as a stimulant.
June 2nd, 2005 at 1:22 pm
In the instances when I’ve read comics in which he appeared, Dent has always come across more pissed-off than insane…but that’s just a lay opinion! :)
June 2nd, 2005 at 4:23 pm
I am so glad I checked here first.
I just sat down and read #1 and #2 today, and being a psychiatric nurse in the UK, I did wonder how bizarrely different US psychiatry might be ;-)
The “dopamine” references lept out at me straight away, as did the spurious differential diagnoses.
I can see a doctor saying that sedatives make meal times better, but try feeding someone who is sedated !
It’s a bit of a stretch to interpret Harvey Dent’s “conversations” with his other self as hallucinations, because he has indicated that the voice is talking to him in the second person. Usually schizophrenia is accompanied by third person voices or “others” taking about the subject.
(This next bit may be a spoiler, but I don’t know how to hide it. Please delete if necessary:)
The story seems to be heading towards Harvey’s brother somehow being enacted by Harvey’s voice, and “Two Face” is often derogatory about Harvey - more in keeping with a dissociative reaction to a traumatic event (or two if the acid attack is to be joined by some childhood event).
(Spoiler ends!)
“In effect, he has literally become two people.” UGH!
I favour the dissociative disorder diagnosis (isn’t it a more severe version of Bruce Wayne’s ?) and the use of schizophrenia here just seems to be the classical lay-person’s misuse of the term. However, it is worth considering that paranoid psychoses can include delusions of grandeur, which the Two-Face side of Dent’s personality has in bucket-loads.
Just to strip Paul Jenkins’ psychiatrist of any remaining credibility, there is a good case for a form of bi-polar affective disorder linked to the dissociative symptoms. When on a low, Harvey is in control, when manic* he “becomes” Two Face.
(*These days everyone knows that “manic-depressive” does not mean “very depressed”, don’t they ?)
The biggest flaw in this version of Arkham Asylum is the suggestion that “shock therapy” might be used to “isolate the secondary personality”. As far as I am aware, ECT is predominantly used these days for severely depressed cases. The “Cuckoo’s Nest” stereotype of it being used punitively has long been discredited, although that’s not to say that it does not happen. ECT might be used to allay an episode of mania (but that was not one of the so-called doctor’s diagnoses, was it.)
The idea of ECT being used to separate dissociative personalities is unfounded, since it would be more likely to remove the secondary personality all together.
June 3rd, 2005 at 11:51 pm
Official Comment
Excellent points Ade, you hit the nail right on the head.
If I remember correctly, Jenkins is actually from the UK (Wales, actually) so he’s one of yours…
June 4th, 2005 at 5:47 am
Yes, Jenkins was a south Londoner, but he’s obviously never been in Bedlam ;-)
Some of our best writers used to be psychiatric nurses (Moore, Delano?)
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