Shakespearean work and common mental disorders

Dr Ruwan M Jayatunge M.D.

William Shakespeare

The eminent English poet and playwright William Shakespeare created many characters that appear to be afflicted by psychological and psychiatric disorders. Shakespeare had an exclusive ability to grasp the dynamics of the human mind and fathom the dysfunctions of the human psyche. Indeed Shakespeare was very comprehensible in his descriptions of various psychological and psychiatric symptoms. Shakespeare's influence on psychopathology was immeasurable. Many of Shakespeare's lead characters seem to be having mental disorders and even psychoses.

Mental conditions

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 is discussed in DSM 4(Diagnostic and Statistical Manual of Mental Disorders, a manual published by the American Psychiatric Association that covers all mental health disorders for both children and adults) and the ICD 10 (The International Statistical Classification of Diseases and Related Health Problems classified by the WHO)

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 overwhelmed 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.

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 misjudgement 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.

The story of King Lear is a clear narration of old age depression.

Physical illness

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.

Many Shakespearian characters fit to the criteria for Histrionic Personality Disorder. In King Lear Edgar the Gloucester's loyal son and heir fits to this description. Histrionic Personality Disorder is a condition characterized by excessive emotionality and attention-seeking. They need to be the centre of attention all the time, Individuals with this disorder may have difficulty achieving emotional intimacy in romantic relationships.

They may seek to control their partner through emotional manipulation or seductiveness on one level, whereas displaying a marked dependency on them at another level. Histrionics also tend to exaggerate friendships and relationships, believing that everyone loves them.

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.

The Tempest

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. Shakespeare's tragedy Macbeth is another example of a play that contains a character with personality disorder. 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 behaviour which reminds obsessive-compulsive disorder. She has obsessive thoughts and engages in compulsively actions such as repeated hand washing.

Lady Macbeth's sleepwalking is co morbidly connected with dissociative features.

In the Shakespearian tragedy Hamlet, Prince of Denmark, 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.

Complex characters

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.

In Twelfth Night one of the main characters, Olivia is totally withdraws from society to mourn the death of her brother. She rejects romance and deviates from worldly pleasures. Her self punishing and self-denial behaviour 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.

Alcohol consumption

Macbeth consulting the prophesy

Alcohol dependence is classified under the Substance Related Disorders in DSM4. Shakespeare's history plays Henry IV and Henry V recounts Alcohol Dependence which is often a progressive and fatal disease. 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.

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.

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.

Shakespeare knew about the effects of syphilis and refers to the illness as pox in his plays. Shakespeare especially in Measure gaudily describes syphilitic symptoms for Measure, Love's Labour's Lost, The Life of Timon of Athens, and some of his poems. During the Shakespearean days diseases were considered as punishment for sinful behaviour.

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.

Cultural icon

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 behaviour in an aesthetic form. Perhaps Shakespeare qualifies to earn the title Medieval Psychoanalyst.