On the Couch: Stefan Salvatore

Ah, sweet younger brother Stefan is on the couch today. If you missed Damon's analysis from Monday click here.

Stefan captured the hearts of many a female with his battling-his-inner-vampire-demons persona and incredible love for Elena....as his voice over said in the opening credits..."I had to know her."

Stefan was born in 1847, seven years after his brother, in Mystic Falls. In the glimpses of his human life before he was turned into a vampire (in 1864, when he was 17), it is apparent that Stefan was the "good" son. He lived by a code of ethics and morals, and valued honor, duty, justice, and responsibility.

As a vampire, those traits remained...which is often negatively referred to as his "humanity." When we first meet Stefan, he's sort of an herbivore vampire in that he only feeds off animals (just go with the imperfect metaphor). This makes him physically weaker than other vampires who feed off humans straight from the vein. Stefan has a strong regard for human life, yet he's been known to go on "binges" where he essentially loses touch with his humanity and compassion and kills people right and left. This is his "Ripper" persona.

I know you probably think I'm about to diagnose Stefan as Dissociative Identity Disorder (formerly called Multiple Personality Disorder). I'm not. I think there is plenty of proof that Stefan and Ripper Stefan are the same person. Yes, he does suffer blackouts wherein he violently dismembers his victims only to reassemble them (perhaps in remorse?) when he comes to. This pattern is how Damon recognizes Stefan's path away from Mystic Falls and is able to track him down.

But he's still integrated as one vampire. I think it's most evident when he calls Elena as the Ripper but doesn't say anything. She tells him she still loves him and isn't going to give up on him, and it's clear he's miserable away from her, having to be forced to be the Ripper. And he saved Klaus in the first place to keep his brother alive...all kinds of internal angst, but not internal dissociation from his real self. He laments all the kills he made as the Ripper. They grieve him and haunt him. He calls himself a monster--and hates that side of himself.

That said, Stefan does have a problem. Since human blood isn't a substance the Diagnostic and Statistical Manual of Mental Disorders would recognize, we're going to have to be creative. The term drug can refer to any non-food chemical substance or preparation administered for the purpose of correcting or weakening a disease process (therapeutic drug) or for pleasure (recreational drug). Human blood for Stefan fits the bill.

I'd diagnose Stefan with a really severe case of substance dependence with an unknown substance (just a technicality in our world), with physiological dependence. Here's the criteria (Stefan's in red):

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) tolerance, as defined by either of the following: 

 (a) a need for markedly increased amounts of the substance to achieve Intoxication or desired effect (I think he gets pretty high from just a sip.)
 (b) markedly diminished effect with continued use of the same amount of the substance 

(2) Withdrawal, as manifested by either of the following: 

(a) the characteristic withdrawal syndrome for the substance (It's clear Stefan wants blood when his face goes all veiny.)
(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms (Rabbit blood, anyone?)

(3) the substance is often taken in larger amounts or over a longer period than was intended (Stefan had a disturbingly long list of names in the closet of his Ripper persona.)

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use (A few accidental drainings because he couldn't stop.)

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects (Stefan scoped out the locales that would give him better access to folk and less chance a Missing Persons Report would be filed. Slick, Stefan.)

(6) important social, occupational, or recreational activities are given up or reduced because of substance use (Gave up his entire life for this last binge, including his romantic relationship.)

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

Stefan's had at least three staged interventions from his friends: two from Lexi (in 1864 after his first binge and then again in 1922 after his binge with Klaus), and then the latest binge from season 3 when he agrees to be the Ripper again to preoccupy Klaus and keep him away from Mystic Falls and Elena. (Note: Stefan willingly agrees to the deal out of compassion for his love.) Even dispassionate brother Damon knows Stefan's got a problem.

Stefan's coming into at least a partial remission, as he seems to be able to hold his head above water for extended periods of time after receiving some help. But he needs to get into a Bloodaholics Anonymous program and stick with it.

Let's Analyze: Do you think Stefan is the same person/persona as Ripper Stefan? Why or why not?