There are many medical references in Shakespeare, whose writings begin late in the sixteenth century. At the time there were many theories of medicine. One of the most respected was that of the four humours: blood, choler (yellow bile), phlegm, and melancholy (black bile).

…or if that surly spirit, melancholy

had baked thy blood and made it heavy-thick

which else runs tickling up and down the veins…

King John III iv

Falstaff

Sir John Falstaff is one of great witty characters of the English stage:

‘ A man can no more separate age and covetousness than a’ can part young limbs and lechery; but the gout galls one and the pox pinches the other, and so both degrees prevent my curses. Boy!

…

I can get no remedy against this consumption of the purse; borrowing only lingers and lingers it out, but the disease is incurable… A pox of this gout! or, a gout of this pox! for the one or the other plays the rogue with my great toe. ‘T is no matter if I do halt; I have the wars for my colour, and my pension shall seem the more reasonable. A good wit will make use of anything; I will turn disease to commodity.’

King Henry IV Part II I ii

Madness

Many of Shakespeare’s plays involve madness, be it individual, group, or societal. In ‘King Lear’ the madness of the King jeopardises the state, whilst in ‘Macbeth’ the madness of the society threatens individuals. War is seen as a form of madness, as is love. In ‘Romeo and Juliet’, passion drives the protagonists to their deaths. That Shakespeare could regard love as a form of madness is evident from his sonnet CXLVII:

‘Past cure I am, now reason is past care,

And frantic mad with evermore unrest;

My thoughts and my discourse as Madmen’s are…’

The question of what is and what is not insanity, and whether indeed it even exists, is succinctly put by Polonius in ‘Hamlet’, in one of Shakespeare’s most famous lines:

‘Though this be madness, yet there is method in ‘t.’ (II ii)

Another case of interest, that again raises the question of the nature of madness, its cause and effect, is the reaction of Lady Macbeth to the murderous self she has become. Her illness, we are to believe, is genuine, because the doctor is called. She is troubled by haunting dreams that are directly related to her guilt, and practices obsessional nocturnal hand-washing. It is quite astonishing to me that Sigmund Freud doesn’t mention this when discussing ‘Macbeth’ in his masterpiece ‘The Interpretation of Dreams’. Certainly he would have had more to say about it than the doctor in the play, who seems perplexed, but accurately observes that

‘More needs she the divine than the physician.’ (V i)

King Lear

The case of King Lear is our special focus. Shakespeare offers us a perfectly accurate description of an elderly man, suffering from the middle stages of Alzheimer’s dementia. Lear, we are told, is ‘four score’ years old, and Alzheimer’s affects approximately 35% of the population at this age. Shakespeare, as usual, is to be admired for his perceptiveness: octogenarians would have been uncommon in a time when the average survival was about 45 years for men. Everything we learn about Lear fits the diagnosis perfectly. His irrationality and forgetfulness interspersed with periods of painful awareness of his state, his bursts of rage and tearfulness attesting to a crippling emotional lability, and his tendency to become lost even among his companions of many years are all typical of the disease.

Lear is reduced to a guard of a hundred, nay fifty, nay twenty-five knights, by the secret connivance of his daughters Regan and Goneril. Addressing Goneril, Lear says…

‘ I prithee daughter, do not make me mad:

I will not trouble thee, my child; farewell.

We’ll no more meet, no more see one another;

But yet thou art my flesh, my blood, my daughter;

Or rather a disease that’s in my flesh,

Which I must needs call mine: thou art a boil,

A plague-sore, an embossed carbuncle,

In my corrupted blood.

(…)

You Heavens, give me that patience, patience I need!

You see me here, you Gods, a poor old man,

As full of grief as age; wretched in both!

If it be you that stirs these daughters’ hearts

against their father, fool me not so much

to bear it tamely; touch me with noble anger,

and let not women’s weapons, water-drops,

stain my man’s cheeks! No, you unnatural hags,

I will have such revenges on you both

that all the world shall- I will do such tings,

what they are yet I know not, but they shall be

the terrors of the earth. You think I’ll weep;

No, I’ll not weep;

I have full cause of weeping, but this heart

shall break into a hundred thousand flaws

or ere I’ll weep. O fool! I shall go mad.’ (II iv)

At the end of this climatic and painful speech, Lear addresses an important character in the play, the king’s fool. Shakespeare’s fool is a traditional one: he gambols about the place and gets away with salacious puns and malicious gossip thanks to a lively intelligence and cunning that ensures his precarious survival at court. Lear’s fool is a devoted servant of the King:

Kent: Who’s there?

Fool: Marry, here’s grace and a codpiece; that’s a wise man and a fool. (III ii)

The fool treads the line as finely as possible, and much good humour can be derived from this. Shakespeare provokes his audience via the medium of the fool to examine madness in the world of the play. Not only are the other characters under inspection, so too is the theatre itself. What is madness and what is acting?

The Duke of Gloucester has another theory about the problems of the kingdom:

Gloucester: These late eclipses of the sun and moon

portend no good to us;… Love

cools, friendship falls off, brothers divide: in cities,

mutinies; in countries, discord; in palaces, treason…

(goes on to talk about predictions)…

Edmund: This is the excellent foppery of the world,

that, when we are sick in fortune, often the surfeit

of our own behaviour, we make guilty of our

disasters the sun, the moon, and the stars; as if

we were villains on necessity, fools by heavenly

compulsion, knaves thieves and treachers by

spherical predomination; drunkards liars and

adulterers by an enforced obedience to planetary

influence;… (I ii)

Edmund, the scheming son, in his false letter, is clear about the diagnosis:

(Gloucester reads)‘This policy and reverence of age

makes the world bitter to best of our times; keeps

our fortunes from us till our oldness cannot relish

them. I begin to find an idle and fond bondage in

the oppression of aged tyranny, who sways, not as it

hath power, but as it is suffered. Come to me, that

of this I may speak more. If our father would sleep

till I waked him, you should enjoy half his revenue

for ever, and live the beloved of your brother, Edgar’ (I ii)

In Act VI Scene vi there is a long scene with Lear berating everyone as treacherous. The king is fantastically dressed in flowers: ‘Oh thou side-piercing sight’, says Edgar, his good son, who later has an aside: ‘O! Matter and impertinency mix’d; reason in madness.’

Finally, in Scene vii, Cordelia, Kent, and a doctor attend to the king:

Lear: Pray, do not mock me:

I am a very fond, foolish old man,

fourscore and upward, not an hour more nor less;

and, to deal plainly,

I fear I am not in my perfect mind.

Methinks I should know you and know this man;

Yet I am doubtful: for I am mainly ignorant

what place this is, and all the skill I have

remembers not these garments; Nor I know not

where I did lodge last night. Do not laugh at me;…

…Am I in France?

Kent: In your own kingdom, sir.

In the end Lear is condemned to live on, and power remains with him, Kent, and Edgar...these are about the only survivors…the Fool and Cordelia die, along with Edmund, Goneril and Regan.

Consider: Have you met any patients whose mental illness is debateable? Have a look at the Thomas Szasz’s book: he was a New York psychiatrist who founded the ‘anti-psychiatry’ movement.

Are there any modern states with leaders whose behaviour may be considered abnormal, and who are adversely affecting the health of their citizens?

References and further reading

Szasz T S (1974) The Myth of Mental Illness Harper and Row pp 238-49

Freud S (1985) The Interpretation of Dreams Pelican p368

updated: 22/03/2010