(Image: Angus Greig)
Epilepsy, psychiatric breakdown, sleep disorders 鈥� for all the crudity of 16th-century healthcare, Shakespeare鈥檚 observations still inspire doctors today
EPILEPSY, psychiatric breakdown, sleep disorders鈥� For all the crudity of 16th-century healthcare, there鈥檚 a surprising amount of modern medical detail in Shakespeare鈥檚 plays. The behaviours of some of his characters often bear a striking resemblance to how today鈥檚 doctors describe a range of neurological disorders, and his observations continue to inspire centuries after his death.
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One of those inspired was . 鈥淭he poets and philosophers before me discovered the unconscious,鈥� Freud once said, which the literary critic Harold Bloom of Yale University thinks refers to Shakespeare. Indeed, Bloom contends that what we think of as the Freudian map of the mind is in fact Shakespeare鈥檚.
Freud鈥檚 interest in Shakespeare may have crystallised while he attended lectures by another medical pioneer, Jean-Martin Charcot. Charcot is known as the father of neurology, and his theories on neurosis and hysteria led . He often used Shakespeare to illustrate the detailed observations of behaviour and character traits that are needed for diagnosis.
That鈥檚 a lesson many neurologists still appreciate. 鈥淭he art of medicine is strikingly similar to storytelling,鈥� says neurologist Brandy Matthews at the Indiana University School of Medicine in Indianapolis. 鈥淣o matter how amazing the technology that supports clinicians, nothing trumps a careful history and physical examination.鈥�
Following in Charcot鈥檚 footsteps, some neurologists, including Matthews, still use Shakespeare in their classes. They have also . It might be easy to mistake creative licence for medical observation, but the rich detail of the descriptions suggest that some of the symptoms might have been inspired by real-life encounters. 鈥� then a notorious mental institution best known by its nickname, Bedlam.
Of course, no one is saying that his dramas should be read as medical reports, but these observations may have helped bring his characters so vividly to life.
Bloom has gone as far as to say that Shakespeare 鈥渋nvented鈥� the human. By this he means that while all the various character traits that are in Shakespeare existed before, few before Shakespeare had written them down in such detail, inspiring later generations to be more reflective when considering their own behaviours. Whether you agree with Bloom or not, Shakespeare鈥檚 influence on the medical understanding of the mind seems undeniable. Read on for the case notes of his most famous characters.
1. Name: The Macbeths
Description: Privileged, married, middle-aged Scottish couple
Supporting quotes: His: 鈥淭hen comes my fit again.鈥� Hers: 鈥淥ut, damned spot! Out, I say!鈥�
Macbeth reports hallucinations including a dagger floating in front of him and voices telling that he would sleep no more. As well as these symptoms he has impaired cognitive function, involuntary movements, insomnia and psychiatric breakdown. He had been in contact with a cauldron containing a possible source of infectious misshapen proteins known as prions, which would support a diagnosis of variant Creutzfeldt-Jakob disease (Clinical Infectious Diseases, vol 42, p 299).
Lady Macbeth is a different matter. She is able to get up and write a letter 鈥渁ll this while in the most fast asleep鈥�. This is classic parasomnia, a condition whereby behaviours can be exhibited while asleep. She also has a form of obsessive-compulsive disorder, washing her hands for up to 15 minutes at a time in an attempt to remove an imagined stain: 鈥淲hat, will these hands ne鈥檈r be clean?鈥� Handwashing is known to ease emotional stress.
2. Name: King Lear
Description: Elderly statesman and father
Supporting quote: 鈥淲here am I? 鈥 am a very foolish, fond old man.鈥�
King Lear, at over 80 years old, has lived far beyond the average life expectancy. His , a sign of Parkinson鈥檚 disease. He veers from psychosis, in which he doesn鈥檛 know his own daughter (鈥測ou are a spirit鈥�), to moments of clarity when he recognises her (鈥淚 think this lady to be my child Cordelia鈥�). The king even appears to believe himself dead (鈥淵ou do wrong to take me out o鈥� the grave鈥�) 鈥� an assertion seen in a disorder known as Cotard鈥檚 syndrome. Taken as a whole, his , a form of dementia associated with Parkinson鈥檚.
鈥淵ou do me wrong to take me out o鈥� the grave鈥�
鈥淟ear鈥檚 fluctuating lucidity, poor decision-making and suspiciousness could all make sense in the light of that diagnosis,鈥� says Adam Zeman, a cognitive neurologist at the University of Exeter in the UK.
3. Name: Sir John Falstaff
Description: Alcoholic, overweight old man
Supporting quote: 鈥淚f sack and sugar be a fault, God help the wicked.鈥�
He may be sweet and kind, but Falstaff is also plump, addicted to sack (sherry) and suffers nightly from a treatable sleep disorder. The evidence comes from a report of Peto, a companion of Falstaff, who was asked to fetch him. 鈥淔alstaff!鈥� he scoffed, 鈥淔ast asleep behind the arras, and snorting like a horse.鈥� Prince Hal replied, 鈥淗ark, how hard he fetches breath.鈥�
In people who are overweight, there may be constriction on the airways, and this narrowing can lead to sleep apnoea, the commonest form of sleep-disorder breathing. Falstaff may be a comic character, but sleep apnoea is not a trivial condition: .
4. Name: Othello
Description: High-ranking military man of African descent
Supporting quote: Desdemona says to Othello: 鈥淎nd yet I fear you; for you鈥檙e fatal then when your eyes roll so.鈥�
Othello is a brave, honourable soldier, a man of free and open nature. But he is also a man prone to seizures that are associated with violence. Some transformation. 鈥淢y lord is fallen into an epilepsy,鈥� says Iago. 鈥淭he lethargy must have its quiet course, if not he foams at the mouth, and by and by breaks out to savage madness.鈥� Othello鈥檚 tragedy is complete when, during a seizure, he strangles his wife to death.
Evidence for a link between epilepsy and violence undertaken during seizures has been debated for centuries. A review of court cases from 1880 to 2013 found 178 occasions when epilepsy was used as a defence for murder. 鈥溾�� (Neuropsychiatric Disease and Treatment, vol 9, p 667).
David Tennant as Hamlet in 2008 (Image: Robbie Jack/Corbis)
5. Name: Hamlet
Description: Danish prince, aimless graduate
Supporting quote: 鈥淢an delights not me 鈥� no, nor woman neither.鈥�
Recently bereaved Hamlet, a graduate around 30 years old, thinks life isn鈥檛 worth living, saying 鈥淚 do not set my life at a pin鈥檚 fee鈥�. He is melancholic and impulsive, accidentally killing his girlfriend鈥檚 father. Most of all he swings between moods superbly high and desperately low. He can be tender to his girlfriend, Ophelia, but then cruel (鈥淕et thee to a nunnery: why wouldst thou be a breeder of sinners?鈥�) and almost violent. His wit and insight is second to none but can manifest in extreme talkativeness and an inability to assess danger. He is also indecisive.
Under the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, 鈥� an assessment that makes sense to Farah Karim-Cooper, a scholar at Shakespeare鈥檚 Globe theatre in London. 鈥淵ou can see evidence of his mood swings and rage in his chamber with his mother, and in his exchanges with Ophelia,鈥� she says.
6. Name: Coriolanus
Description: Blood-thirsty army general, disastrous politician
Supporting quote: 鈥淒espising, for you, the city, thus I turn my back: There is a world elsewhere.鈥�
Coriolanus is a classic case of how brilliance in one field, soldiering, doesn鈥檛 necessarily translate to another, politics. 鈥淢any productions emphasise Coriolanus鈥檚 inability to understand the politics of the real world and the necessity of custom even when you think it鈥檚 pointless,鈥� says Erin Sullivan of the Shakespeare Institute in Stratford, UK.
Coriolanus has an extreme lack of social aptitude, and a lack of empathy: he is 鈥渁 kind of nothing鈥�. It could be argued, too, that he has a desire for routine, a desire that is frustrated when he is exiled. 鈥淭hey are trying to thrust him out into the crowd, they want him to make nice and he just doesn鈥檛 want to do it,鈥� says Karim-Cooper. 鈥淭hat鈥檚 often attributed to his pride and sense of social superiority, but perhaps you could read it as a slightly autistic trait.鈥�
But maybe that illustrates how we bring our own cultural and scientific baggage to the Bard. No doubt in 100 years there will be different interpretations again. Perhaps that, more than anything, shows the richness of Shakespeare鈥檚 plays.
Read more: 鈥�Shakespeare: Poet, playwright, scientist?鈥�
This article appeared in print under the headline 鈥淭he Bard will see you now鈥�
