Shakespearean Work and Common Mental Disorders

  

Shakespeare "was not of an age, but for all time! -Ben Jonson

Dr Ruwan M Jayatunge

The eminent English poet and playwright William Shakespeare was a Renaissance dramatist. Shakespeare was unique in the range of his insights into the human mind (Heaton, 2011). Shakespeare knew the “deep psychology” of humanity (Tung, 2007). Therefore he can be considered as one of the grand Renaissance Psychologists.

Shakespeare was one of the great creators of human characters of the 16^th century (Stompe , Ritter   & Friedmann ,2006) and his 37 plays and poetry contain many references of interest for almost all of the medical specialties (Fogan ,1989). Shakespeare had an exclusive ability to grasp the dynamics of the human mind and fathom the dysfunctions of the human psyche. Shakespeare created many characters that appear to be afflicted by psychological and psychiatric disorders.

Shakespeare was very comprehensible in his descriptions of various psychological and psychiatric symptoms. His influence on psychopathology was immeasurable. Many of Shakespeare’s lead characters seem to be having mental disorders and even psychoses.

William Shakespeare’s work confers a wide range of human mental conditions including psychopathology. There are many Shakespearean characters show numerous criteria for mental disorders that has been discussed in DSM 5 (Diagnostic and Statistical Manual of Mental Disorders- a manual   published by the American Psychiatric Association) and the ICD 10 (The International Statistical Classification of Diseases and Related Health Problems classified by the WHO).

Shakespeare wrote about pathological jealousy or morbid jealousy. Shakespeare’s tragedy Othello: The Moor of Venice exemplifies a character that has suggestive features of   pathological jealousy. The play is based on a central character Othello a Moorish general in the Venetian army who is passionately in love with Desdemona the daughter of a Senator. Poisoned by pseudo friends Othello suspects innocent Desdemona and gradually it becomes an overvalued fatal idea. Othello is plagued by morbid jealousy confronts Desdemona, and then kills her.

Jealousy is a complex emotion allied with insecurity, fear, and anxiety. Othello was a romantic as well as an egoistic lover who held a delusional belief that his wife was being unfaithful. Othello made   repeated accusations of infidelity based on insignificant evidence. Othello’s delusional jealousy had strong association with violence that led to the death of his wife. Shakespeare presents Othello’s character in a dramatic way and intensely describes his inner mental conflicts. 

The eponym, Othello syndrome (OS), has its origin in Shakespeare's tragic character. Todd and Dewhurst (1955) described the symptomatology of the Othello syndrome. Othello syndrome is a psychotic disorder characterized by delusion of infidelity or jealousy; it often occurs in the context of medical, psychiatric or neurological disorders (Ciprian et al., 2012). In this syndrome delusions of infidelity predominate.

Shakespeare’s story of King Lear illustrates an aging monarch who is blind to his weaknesses, decides to divide his kingdom amongst his three daughters. The King Lear often stalks his daughter Cordelia who is the loyal and unselfish. Finally Lear was made to abdicate the throne by his two daughters Goneril and Regan.

After the renunciation of the thrown the King Lear was mistreated by two of his daughters and finally driven out in to destitution. His misjudgment of his daughters brings about his downfall. Thus the King Lear   was betrayed by his own flesh and blood and becomes a psychologically fragile man. King Lear’s abnormal behavior, extreme irritability, exhibition of disinhibited thoughts may be the harbinger of psychosis (Somasundaram, 2007). 

Shakespeare’s King Lear, has been a favorite source of clinical observation and diagnosis for psychiatrists for the past two centuries.  Some experts have suggested such entities as mania, senile dementia, delirium, depression, and brief reactive psychosis (Truskinovsky, 2002). The tragic drama of King Lear charts the deteriorating mental health of the main character Lear in five acts. In Act I Lear recognizes his own fragile psychological state ‘O, let me not be mad, not mad, sweet heaven! Keep me in temper; I would not be mad’. These lines, uttered by an elderly man, speak across the centuries and generations. The repetition of the word ‘mad’ evokes the strength of Lear’s anxiety (Richards, 2012).

The story of King Lear is a clear narration of old age depression. Depression is the commonest and the most reversible mental health problem in elderly.   Depression is associated with physical illness and disability, life events, social isolation and loneliness. Some experts consider depression as a form of physiological reaction to the old age. King Lear becomes isolated and his negative thoughts consist of worthlessness, hopelessness, guilt, agitation and indecisiveness.

Hendricks (1999) indicates that King Lear's effort to obstruct the marriage of Cordelia in the first scene constitutes a violation of the incest prohibition. Violating the prohibition governing incest and harboring incestuous thoughts and desires, Lear is an incestuous father. This whole psychological complex is named as King Lear Complex- A term for the incestuous libido of a father for his daughter.

Many Shakespearian characters fit to the criteria for Histrionic Personality Disorder. In King Lear Edgar -Gloucester’s older, legitimate son fits in to this description. Edgar plays many different roles and impersonations. His excessive emotionality and attention-seeking creates a void between him and his father. He has a difficulty in emotional intimacy. He is manipulative. Edgar sometimes exaggerates friendships and relationships. His self-dramatization and theatricality is much evident when he plays many different roles like a gullible fool to a mad beggar.

Shakespeare’s psychological drama The Winter's Tale was a story between two friendly kings Leontes, King of Sicilia and Polixenes, the King of   Bohemia. Unexpectedly kings Leontes goes insane and suspects that his pregnant wife Queen Hermione has been having an affair with the king Polixenes. Shakespeare dramatically portrays the king Leontes’s delusional mind which filled with suspicion and conspiracy theory. Shakespeare’s romance The Winter’s Tale recounts a man with a delusional disorder.  

Delusional disorder is a type of mental illness in which the patient has unshakable beliefs in something untrue. These delusions usually involve the misinterpretation of perceptions or experiences. King Leontes had persecutory delusions and he was preoccupied with his delusions that made his life disrupted.

In Shakespeare’s romance, The Tempest is set on a fictional Island. Prospero the Duke of   Milan and his daughter, Miranda have been stranded for twelve years on this fictional Island. Although Prospero was the rightful duke of Milan he was forced to renounce his kingdom by his younger brother Antonio. Prospero is living in exile. Prospero is a scholar and magician manipulating everyone within his reach. Prospero sometimes seems as an autocratic. Prospero is a complex personality shifting between good and bad.   Ambiguity in Prospero’s character testifies Shakespeare’s gifted ability to create different personalities.  Some view this enigmatic protagonist as a surrogate for Shakespeare.

Psychoanalyst Dr Sigmund Freud saw Shakespeare via a psychoanalytic lens and did   psychoanalytic readings of Shakespearian work especially Macbeth and Hamlet. Early Freudian readings of Macbeth focus on the oedipal complex: the father/son struggle between Macbeth and Duncan and the fall of the heroes through a fatal conscience (Favila, 2001). Freud suggested that Macbeth and Lady Macbeth are, in effect, a single personality (Chang Gung, 2012).

Macbeth has been viewed as a play about the oedipal crime of patricide (Krohn, 1986).  Freud called it "blindest fury of destructiveness" (Freud, 1930). Freud elucidated that failure to produce offspring caused striking transformation in Macbeth turning him into a cruel tyrant. The character of Lady Macbeth has often been presented as evil and demonic (Prins, 2001).

Macbeth is more like a dependent personality avoiding responsibility for major life decisions, allowing others to assume that power.  He goes to great lengths to win the approval of others. Lady Macbeth suffers from an irritable self punishing behavior which reminds obsessive-compulsive disorder.  She has obsessive thoughts, ruminations and engages in compulsively actions such as repeated hand washing. Lady Macbeth’s sleepwalking is co morbidly connected with dissociative features.

In 1900 Freud wrote about Hamlet in his book- the Interpretation of Dreams. Freud fully elaborates on the guilt feelings aroused in Hamlet by his incestuous desire for his mother and his wish to displace his father (Chang Gung, 2012). Freud and many of his followers have treated Hamlet as if he were a real person inhibited by the Oedipus complex (Bergmann, 2009).

Parapraxis is a slip of the tongue, thought to reveal a repressed motive. Parapraxes in the psychopathology of everyday life are "mistakes" that reveal the workings of the unconscious (Mahon   (2000). Shakespeare has placed a parapraxis in Hamlet's mouth in the soliloquy in Act I. Hamlet says, "But two months dead, nay not so much not two." The slip attributed to Hamlet is of course no slip at all when seen as an aesthetic contrivance of the bard's to suggest the tension between warring aspects of Hamlet's psychology (Mahon, 1998).

Shakespeare made Hamlet's character in an enigmatic way and Hamlet has become one of the complex characters of Shakespeare. Hamlet was emotionally plagued when he revealed his mother’s adulterous relationship with Claudius, Hamlet’s uncle. He was devastated over the father’s assassination. Hatred towards Claudius, Hamlet's uncle and new stepfather who murdered his father made him to seek retaliation. Freud's psychoanalytic profile of Hamlet’s character suggests that Hamlet had an unnatural love for his mother Gertrude the Queen of Denmark. This very idea coincides with the fact that his inability to love Ophelia.

Ophelia goes insane and drowns herself when Hamlet rejected her love. This resembles a typical form of acute stress disorder. According to the DSM, "The essential feature of Acute Stress Disorder is the development of characteristic anxiety, dissociative, and other symptoms that occurs within 1 month after exposure to an extreme traumatic stressor. Ophelia responded to Hamlet’s rejection event with strong feelings of fear and helplessness. It was an emotionally painful, distressful event for her. Ophelia’s   reduced sense of surroundings, depersonalization and increased state of anxiety well pronounced in the act.

Freud finds that in The Merchant of Venice the choice a woman (Portia) has to make between three suitors is inverted (as in the logic of a dream) into the choice a man makes between three caskets, that is, three women. He examines the situation in which Bassanio is forced to choose between three caskets to win Portia, and, as if analyzing a dream, associates the caskets with “symbols of what is essential in woman, and therefore of a woman herself” (Sigmund Freud-  The Theme of the Three Caskets , 1913). Freud assumes this motif of “a man’s choice between three women” must be indicative of some universal human problem; it must be an archetypal representation of something that lies deep within the human psyche -collective consciousness (Chang Gung, 1912).

Shakespeare’s world was a white-centered Christendom (Tung, 2008). Carla Della Gatta states that the Merchant of Venice has been labeled Shakespeare’s most controversial play because of the problematic character of Shylock.  More has been written about Shylock than any other Shakespearean character except Hamlet. The Jew of Shakespeare's "Shylock" reflects the 16th century bias of Shakespeare- Jew as stereotype persona (Muslin, 1990).

Shakespeare uses such words as 'mad' and 'madness' more often in Twelfth Night   than in any of his other plays; therefore it is a reasonable assumption that he was interested in madness when he wrote it.  Shakespeare's view of madness seems to be singularly at odds with platitudinous Renaissance concepts of it as a matter of the four humours. Madness, like any disease, is the result of a disordered state of the four fluids in human bodies which were called humours (Daalder, 1997).

Shakespeare first depicts "madness" in Titus Andronicus which was thought to be Shakespeare's first tragedy, but Titus is faking madness, in other words he is malingering. Malingering is a condition not attributable to a mental disorder. Malingering is defined as the intentional production of false or grossly exaggerated physical or psychological symptoms in order to gain some external incentive (American Psychiatric Association, 2000).

Grieving Shakespearean characters exhibit many somatic symptoms and signs and a wide range of psychosomatic illnesses (Heaton, 2012). The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition (Garralda, 2010). 

The word “somatization” was coined, curiously enough, by the mistranslation of a German word used by the psychoanalyst Wilhelm Stekel in the 1920s (Marin & Carron, 2002). Somatization has been described as the translation of emotions into somatic problems or complaints.

The term somatoform disorders (SDs) was first introduced in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) in 1980 (APA). The new DSM-5 Somatic Symptom Disorder (SSD) emphasizes the importance of psychological processes related to somatic symptoms in patients with somatoform disorders (Herzog et al., 2015). In King Lear, Hamlet, Henry VI, Richard III etc.  Shakespeare presents characters with possible symptoms of somatoform disorder.

Epilepsy has been portrayed in literary works of Shakespeare. Epilepsy and the "falling sickness" are mentioned three times in Shakespeare, in Julius Caesar, Othello and figuratively in King Lear (Breuer, 2002). Cazan (2014) surmised that William Shakespeare recognized brain damage, particularly epilepsy, as depriving the individual of self-control. For instance after killing Desdemona Othello goes in to an acute stress reaction filled with emotional agitation. Following overwhelming emotional condition Othello has a seizure. Researchers believe that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. 

In Twelfth Night one of the main characters, Olivia is totally withdraws from society to mourn the death of her brother Sebastian. She rejects romance and deviates from worldly pleasures. Olivia’s self punishing and self-denial behavior is strongly connected with her mood.  Shakespeare’s elaboration on Olivia’s mental state is closer to a person diagnosed with Adjustment Disorder. After the major stressful life event she often experiences feelings of depression and anxiety. Olivia has disturbance of conduct and acts out inappropriately.

Shoaib (2014) indicates Electra complex in Shakespeare’s Twelfth Night. He further explains that both Olivia and Viola in Twelfth Night have an unconscious desire to possess the father figures represented by their brothers. The two girls are possessed by an acute desire to replace and imitate their mothers by first idealizing the father-figures, and then by replacing the wish for their own fathers (or the father-figures) with the wish to emulate their mothers by possessing an ideal father, and having a child.

The four plays in the Henry VI-Richard III sequence well illustrate Shakespeare's recognition of hereditary influences upon the human condition. The weak-willed Henry VI is markedly different from his father, grandfather, and son who were all valiant, warlike, and brave (Hook, 1987). There is a high degree of clinical accuracy in Henry IV’s and Henry V’s addictions. In Henry IV and Henry V the subjects are craving for alcohol and unable to reduce or stop alcohol consumption and physiological dependence is well pronounced. Shakespeare writes on Alcohol dependence in a melodramatic manner.

Shakespeare had a rudimentary insight about Posttraumatic stress disorder. Posttraumatic stress disorder (PTSD) is a debilitating anxiety disorder characterized by re-experiencing, hyperarousal and avoidance symptoms. On a larger scale, in Henry IV, Part 1 (2.3.86) Shakespeare has given an account of what could be called post-traumatic stress disorder (PTSD), four centuries before the condition was formulated, and years before the word stress acquired its present usage. The Lady Percy is inquiring about the King’s nightmares. He is psychologically overwhelmed.  Adding up in “A Midsummer Night’s Dream (5.1.21) Theseus (The heroic duke of Athens engaged to Hippolyta) gives an example of how raised anxiety can distort the accuracy of perception (Bennet, 2011).

Richard III is a historical play by William Shakespeare.  Richard had previously been described as Shakespeare's first major character and his second most substantial, after Hamlet; in terms of the number of lines he was given (Tulloch, 2009). King Richard III's reign lasted a mere 25 months, yet he is undoubtedly one of the most notorious monarchs in English history (Tulloch, 2009). Richard III comes to power through a series of horrible acts, killing off his enemies, his kinsmen, his wife and most of his supporters. Shakespeare had dramatized the actual historical events to describe Richard as a pure, self-professed villain of monstrous proportions.

Richard III experiences nightmares could be as a result of Sleep Disorder. During rapid eye movement (REM) sleep vivid dreaming is most common. In nightmares the subject wakes abruptly from the fourth stage of sleep (deep sleep), with waking usually accompanied by gasping, moaning, or screaming. Night terrors are often triggered by emotional conflict. Hence Shakespeare gives a detail account of a Sleep Disorder which was evident in Richard III.

The source of the evil character of Richard III is somewhat ambiguous. It seems most likely that in the first three plays of the sequence Shakespeare intended Richard's villainousness to be perceived as innate, caused by the same forces of nature that produced Richard's deformities (Hook, 1987). Aird and McIntosh (1978) hypothesized that Shakespeare's Richard III suffered from Ellis-Van Creveld syndrome which is an inherited disorder of bone growth that results dwarfism.

Whatever the truth about Richard, Shakespeare suggests a premature breech delivery and a painful labour. At birth the child had a tooth or teeth, and perhaps the posterior hairline was low, while the appearance of a toad suggests a short neck and prominent eyes. Later the child grew up to have a withered arm, a hunchback, raised shoulder, and legs of unequal length (Rhodes,    ‎1977).  His deformity caused an immense psychological pain and it was reflected in violence and frustration. Shakespeare exceptionally narrates the inner psychological conflicts of Richard III.

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The tragedies of William Shakespeare make frequent use of suicide, some accomplished and some merely contemplated (Kirkland, 1999). Suicide is the act of intentionally causing one's own death. Shakespeare’s Romeo and Juliet that was written around 1595 recount youth suicide. Shakespeare knew the psycho social impacts of suicide.

William Shakespeare profoundly wrote about violence. He knew the mental health effects of violence. Violence is behavior that is used to intimidate and assert control over an individual and includes physical, sexual and emotional abuse. William Shakespeare’s Titus Andronicus features violence such as cannibalism and rape.

Shakespeare artistically described ASC or altered state of consciousness. In Pericles, Prince of Athens an altered state of consciousness that mimic death is described in the In the Act III, Scene II when Cerimon opens Thaisa’s coffin. An altered state of consciousness, (ASC) is a specific condition which is significantly different from a normal waking beta wave state. An altered state of consciousness can occur under the oxygen deprivation. Some view hypnosis as an altered state of consciousness. Dietrich (2003) states that altered states of consciousness are due to transient prefrontal deregulation.

Shakespeare knew about the effects of syphilis and refers to the illness as pox in his plays. Syphilitic symptoms are gaudily described by Shakespeare especially in Measure for Measure, Love’s Labour’s Lost, The Life of Timon of Athens, and some of his poems. In Shakespeare's play King Lear the word 'epileptic can be detected. Textual analysis of the lines following the use of 'epileptic' suggests that it is actually a reference to the pock-marks of syphilis, endemic in Elizabethan England, and is not actually a reference to epilepsy itself (Betts & Betts, 1998).

Syphilis is a sexually transmitted disease caused by Treponema pallidum. Syphilitic infection can cause complications such as Neurosyphilis which has physical and psychological manifestations (notably psychiatric abnormalities) with marked personality changes. Patients with Neurosyphilis may have dementia memory loss, depression, mania and many other features.

Ross (2005) speculated that Shakespeare's obsessive interest in syphilis, his clinically exact knowledge of its manifestations, the final poems of the sonnets, and contemporary gossip all suggest that he was infected with "the infinite malady." The psychological impact of venereal disease may explain the misogyny and revulsion from sex so prominent in the writings of Shakespeare's tragic period. He made an atypical premise that Shakespeare's late-life decrease in artistic production, tremor, social withdrawal, and alopecia were due to mercury poisoning from syphilis treatment. 

Shakespeare knew the physical and psychological dysfunctions associated with the aging process. Aging is the progressive accumulation of changes with time that are associated with or responsible for the ever-increasing susceptibility to disease and death which accompanies advancing age (Harman, 1981).Shakespeare viewed the aging process as disabling and old age as a time when individuals lost some abilities to function, particularly when it came to mental capacity and physical mobility (Covey, 2000).

Shakespeare's final play, The Two Noble Kinsmen, contains profound psychological insights   (Mahon, 2001). It is an adaptation of Chaucer's Knight's Tale. It discusses love, rivalry, jealousy, unresolved mental conflicts and insanity.

William Shakespeare is the best known author in history and he is regarded as a cultural icon. Shakespeare was a true genius who made a remarkable analysis on human psyche. His observations were quite unique and he presented his literary characters so naturally expressing their inner mental conflicts and behavior in an aesthetic form. Perhaps Shakespeare qualifies to earn the title Medieval Psychoanalyst.

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