In tonight's post, I would like to say that I am faithfully reproducing the opinions of my learned psychiatrist friend Dr C.R. Etin – but I'm not. The following short treatise is a satire, a little like the essay A Modest Proposal, written by Jonathan Swift in 1729, in which Swift argued that the famine then gripping Ireland could be eased by the poor selling their children as food to the rich. The ideas and even the language of tonight's essay is exactly the same as those in the previous post "Representations of Madness in Shakespeare" but the tone and intention is different, a little more focussed I hope. Sometimes a kick in the head is the only way to wake a person up. I actually tried to get this published in my local newspaper but obviously it doesn't belong to the right genre.
I turn you over now to my learned friend Dr Etin.
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Representations of Mental Illness in Shakespeare
Who can deny the incredible progress psychiatry has made since the nineteenth century in the identification, classification, description, and treatment of the mentally ill? Milestones include the discovery of dementia praecox by Pick and Kraepelin in the 1890s, the discovery of autism, in its modern sense, by Asperger in 1938, and the first publication of the Diagnostic and Statistical Manual of Mental Disorders in 1952. Today psychiatrists have at their disposal a comprehensive and sophisticated taxonomy of human kinds that greatly facilitates the diagnoses and care of those whose deviations from the norm cause themselves and others social distress. It is truly a wonderful time to practice psychiatry.
Of course, it would be absurd to suggest that mental illness was invented by the medical profession; although in previous eras, perceptive observers lacked the vocabulary educated professionals today possess, a vocabulary which enables us to describe and catalogue the various mental disorders found among patients today, these disorders must have been present even in the Elizabethan and Jacobean periods, the eras on which I shall focus. It is my contention that the playwright William Shakespeare, himself a perceptive observer, recognised these disorders among members of his own community and wrote about them in many of his plays. In this article I shall consider the ways Shakespeare represented mental illness in four of his major works: King Lear, Macbeth, Othello, and Hamlet.
I shall begin with King Lear. It is not the purpose of this article to provide a comprehensive synopsis of each of these plays but, when considering King Lear, it is necessary to provide some idea of the plot. At the beginning of the play, Lear, the rule of Britain, decides, somewhat capriciously, to divide his kingdom between his three daughters. Dissatisfied with his youngest daughter’s reply to the question, “Which of you shall say doth love us most,” he deprives her of her inheritance and apportions his realm between his two older daughters. Lear seems to believe that he can retain “the name and all th’ addition to a king” and delegate “the sway/ Revenue, execution of the rest” to his sons-in-law. He also seeks with “reservation of an hundred knights” to alternate his stay between the two daughters’ homes. After his daughters whittle away his retinue to nothing after a month and bicker about who will put him up, he cries “I shall go mad!” and charges into the heath accompanied only by his loyal friends, the Fool, Gloucester, and Kent.
In the next several acts, Shakespeare provides a virtuoso depiction of a psychotic episode. There can be no doubt that Lear displays an abnormal state of mind. He exhibits signs of both persecutory delusions and delusions of reference, seeming to believe the thunderstorm he encounters is allied with his daughters and telling the elements, “yet I call you servile ministers/ That will with two pernicious daughters join/ Your high-engendered battles ‘gainst a head/ So old and white as this” and telling an itinerant schizophrenic he encounters “Didst thou give all to thy daughters? And art thou come to this?” Later, Lear addresses people who are not physically present, suggesting either visual or auditory hallucinations. He also shows all the symptoms of pronounced thought disorder, at times making him difficult to understand.
This could lead us to the conclusion that in King Lear Shakespeare is presenting us with a depiction of schizophrenia. The problem with this interpretation is that schizophrenia typically manifests itself in late adolescence or early adulthood, and Lear is an old man. Could we suppose that Lear has suffered repeated psychotic episodes all his life and that Shakespeare is only dramatising the last? Such a reading is contraindicated by the fact that when Lear informs his court of his intention to divide his realm between his daughters, his friend Kent sees it as atypical, surprising behaviour, behaviour he has not exhibited previously. A more fitting diagnosis would be, in my opinion, dementia; Lear’s decision to divide his kingdom could be seen as an early warning sign. Shakespeare probably knew elderly people with this condition and, inspired by his concern for these poor individuals, wrote this play to raise awareness of it. At its heart, King Lear is a compassionate portrayal of an elderly dementia sufferer.
The eponymous protagonist of Macbeth also quite evidently shows signs of an abnormal state of mind. Macbeth hallucinates twice, the first time when passing surreptitiously towards Duncan’s bedroom with the intention of killing him, the second time when he sees the ghost of Banquo during a formal dinner, an apparition none of the other guests can see. I’ll quote a little known passage that describes the first hallucination.
Is this a dagger which I see before me,
The handle towards my hand? Come, let me clutch thee:
I have thee not, and yet I see thee still.
Art thou not, fatal vision, sensible
To feeling as to sign? or art thou but
A dagger of the mind, a false creation,
Proceeding from the heat-oppressed brain?
I see thee yet, in form as palpable
As this which now I draw.
Thou marshall’st me the way that was going,
And such an instrument I was to use!
Mine eyes are made the fools o’th’other senses,
Or else worth all the rest: I see thee still;
And on thy blade and dudgeon gouts of blood,
Which was not so before. There’s no such thing:
It is the bloody business which informs
Thus to mine eyes…
If there was doubt about Lear’s diagnosis, there can be none about Macbeth’s. Visual hallucinations are a first-rank symptom of schizophrenia and the fact that Macbeth considers the possibility he is hallucinating here, that the dagger might be the product of “a heat-oppressed brain”, strongly suggests he has hallucinated before. Macbeth is, evidently, schizophrenic. We can feel reassured that this diagnosis is correct by considering the speech he delivers after being informed of Lady Macbeth’s suicide. We would expect Macbeth to exhibit signs of grief or guilt but in the “Tomorrow and tomorrow and tomorrow” soliloquy, he shows an inappropriate emotional response, indeed signs of ‘blunted affect’. This of course is one of the negative symptoms of schizophrenia. Just as Macbeth is a portrayal of a schizophrenic, Lady Macbeth, with her compulsive hand-washing, is obviously a depiction of someone suffering from OCD.
Through Othello, Shakespeare again dramatises a figure with an abnormal state of mind. After he is persuaded by Iago of Desdemona’s infidelity, he delivers a speech characterised by paraphrasia or ‘word-salad’ before falling on the floor in a fit. When approaching Desdemona’s bedroom with the intent of smothering her with a pillow, his “Put out the light” soliloquy displays strong evidence of depersonalisation. However, Othello does not display any other symptoms of psychosis and so a diagnosis other than schizophrenia is called for. In the later part of the play, he seems to think Iago all good and Desdemona all bad – this ‘splitting’ suggests Borderline Personality Disorder. If we consider the fact that he is taken in by Iago’s deception, although it should be obvious that Iago is duplicitous, we might alternatively consider Autistic Spectrum Disorder. Autists of course have impairments with respect to social interaction, with ‘theory of mind’, and Othello’s inability to ‘read’ Iago suggests precisely that condition.
Finally, we might consider the most famous ‘madman’ in Shakespeare’s corpus – Hamlet. After Hamlet converses with the ghost of his father, he tells his friend Horatio that he shall “think meet/ To put an antic disposition on”. He thereafter shows a conspicuous lack of self care, presenting himself to Ophelia “with his doublet all unbraced/ No hat upon his head, his stockings fouled./ Ungart’re and down-gyved to his ankle/ Pale as his shirt, his knees knocking each other, And with a look so piteous in purport/ As if he had been loosed out of hell/ To speak of horrors”. He presents with delusions, telling Polonius, the Secretary of State, “I know thee well – thou art a fishmonger.” We have circumstantial evidence that he experiences both suicidal ideation and aboulia. He describes man as a “quintessence of dust” to his friends and says “man delights not me, no, nor woman either”, strongly suggesting anhedonia. Moreover he shows only limited insight into his condition, appearing to believe his mental health is weather-dependent, at one point telling Rosencratz and Guildenstern “I am but mad north-north-west; when the wind is southerly, I know a hawk from a handsaw.”
If Hamlet, like Macbeth, is a depiction of schizophrenia, it is also a trenchant critique of attitudes towards the mentally ill in Shakespeare’s day. Polonius appears to believe that Hamlet’s illness results from his strong feelings towards Polonius’s daughter Ophelia; Shakespeare is obviously satirising the idea, widespread in his own time but today discredited, that mental illnesses have causes, that a person goes mad for a reason. Shakespeare is also dramatising the inhumane treatment of the mentally ill in Shakespeare’s time. After Hamlet kills Polonius, he is sent to England ostensibly for a rest but (unbeknownst to him) bearing instructions that he be executed. If Hamlet had become ill in the world we live in today, he would be treated much more compassionately of course. He would be committed to a secure ward at a mental hospital and treated with suitably high dosages of an appropriate anti-psychotic, such as Rispiridone and Clozapine, and, for the safety of the public, never released.
It may appear odd to seek to find the mental disorders Shakespeare represents in his work but the attempt is not so far removed from modern psychiatric practice. In 2007, the New Zealand Psychiatric Journal published an article posthumously diagnosing Janet Frame with Autistic Spectrum Disorder, presumably based on a deep and thorough reading of her many novels, short stories and poems as well as her autobiographies. Shakespeare must often have observed that those around him were mentally disordered; in fact the deep intention evidently underlying his whole oeuvre was surely to raise awareness among his contemporaries of the problem of mental illness in the society in which he lived. Shakespeare was truly a genius. We can have no doubt that, if he were alive today, Shakespeare, with his penetrating understanding of human nature, would have become a psychiatrist rather than a playwright!
