Shakespeare and Psychiatry: A Personal Meditation

The ancient Greek dramas of Aeschylus, Sophocles, and Euripides gave Western civilization its foundational myths: Prometheus, Oedipus, Antigone, and the Oresteia. Two thousand years passed until Shakespeare arrived and, according to literary critics, achieved something perhaps more important: he “invented the human!”¹ I think of this invention as the secular conception of the human condition. Yes secular! it is a vision of the moral adventure of life constrained by no religious orthodoxy.

Scholars debate whether Shakespeare was Catholic or Protestant. He often draws on both the Old and New Testaments of the Bible and the Book of Common Prayer, but God is missing from his greatest plays. Nonetheless, to paraphrase Simon Russell Beale, the great British actor, to perform in those plays is to experience “redemption and transcendence.” Shakespeare’s understanding of the human condition miraculously transcends his culture, time, and place.

The Rosalind of As You Like It is an empowered woman; Othello, a blackamoor, commands the fleets of Venice; and Shylock, Shakespeare’s Jew, bleeds like a Christian when he is pricked. Even today in our era of cultural diversity, Shakespeare (the dead white male) remains the greatest figure of world literature, performed on every continent, surviving translation. During the recent London Olympics, Shakespeare’s 37 plays were performed by casts from around the world in 37 languages. The Bard’s “vitality seems to be impervious to adaptation.”²

These are the pronouncements of Shakespeare scholars, but they are not alone in these judgments. American psychiatrists have enthused about Shakespeare from the very beginning of their profession. The early issues of the American Journal of Insanity (predecessor of The American Journal of Psychiatry) contain more than a dozen articles on Shakespeare.³ Isaac Ray, a president of the American Psychiatric Association (APA) who pioneered forensic psychiatry in America, thought Shakespeare was essential professional education: “few men [I add women] . . . are so familiar with those adversities of mental character that are in any degree the result of disease, as not to find the spheres of their ideas on this subject somewhat enlarged by the careful study of Shakespeare.”⁴ I emphasize the enthusiasm of Ray and his colleagues, but I agree with medical historians that their psychiatric readings of the Bard were almost totally mistaken.⁵

British psychiatrists, as one might expect, had long been interested in the plays of Shakespeare, and particularly Hamlet. A school of Shakespeare criticism that began in the 18th century looked at the characters in the plays as though they were real people. Physicians, many of them learned in literature as well as the psychiatry of their day, joined the dialogue. The first medical commentator in this tradition was Mark Akenside (1721-1770), a physician and a poet. He was asked about the character of Hamlet. George Steevens (1736-1800), then editing the plays, had questioned Hamlet’s heroic stature, pointing out what he took to be immoral tendencies, eg, his get thee to a nunnery rejection of Ophelia and his sending his schoolmates Rosencrantz and Guildenstern to their death without a pang of conscience.

Akenside made no precise diagnosis, but he thought Hamlet could be forgiven because he “was impaired by his own misfortunes: by the death of his father, the loss of expected sovereignty, and a sense of shame resulting from the hasty and incestuous marriage of his mother.”⁴ Akenside’s compassionate understanding of the Prince of Denmark’s emotional devastation and his perilous personal and political situation was unrivaled by succeeding psychiatric commentators who were so intent on finding a diagnosis for Hamlet that they lifted the character out of context.

Perhaps the most important intervention in Hamlet dramaturgy was made by the physician to George III. The learned Sir Henry Halford (1776-1844) was “lost in astonishment” at Shakespeare’s knowledge of Burton’s Anatomy of Melancholy “so exactly did he portray in Hamlet the symptoms described by Burton.”⁴ Many subsequent productions down through the ages have emphasized Halford’s Burton connection and made Hamlet a “melancholic” figure. It was Winfred Overholser,⁶ an APA president, who pointed out in 1959 that Burton’s Anatomy of Melancholy had not been published until 5 years after Shakespeare’s death and long after Hamlet was written. Actually, Hamlet describes himself as melancholic, but whether Halford got it right or wrong, he stands as an example of the profound influence medical commentators have had on directors and literary critics of Shakespeare.

Having sampled Burton’s Anatomy of Melancholy,⁷ I can only say that it defies modern diagnostic understanding. My guess is that the term “melancholy” might have been the 17th century catch-all equivalent of the 20th century neurosis.

The famous Henry Maudsley (1835-1918), for whom the London hospital is named, had a deep literary understanding of Hamlet but, in my view, thoroughly distorted by his classist English ideas about family heritage represented as the clinical wisdom of psychiatry. He dissected Hamlet’s character as derived from his poor family heritage, including a “taint from his mother” (Queen Gertrude) who, in Maudsley’s reading, was either in on the killing of her husband, the King, “or was just as bad.” And, Maudsley opined, Hamlet was the “nephew of the bloody bawdy villain,” the fratricidal Claudius. His conclusion, “dissimulation is Hamlet’s inherited disposition.”⁴

Maudsley is an example of what I take to be an unfortunate tradition. Instead of learning from Shakespeare’s understanding of the human condition, psychiatrists began to apply what they thought was the science of psychiatry to dissect and diagnose his characters. Or as Isaac Ray and his colleagues did, they found their diagnostic categories and nosological theories confirmed by Shakespeare. The Variorum edition of Hamlet catalogs a centuries-long psychiatric debate: “Is Hamlet’s insanity real or feigned?”⁴ That debate continues today in mock trials about which I shall have more to say.

Sigmund Freud was never very interested in Kraepelinian diagnoses or legal definitions of insanity. He launched the practice of psychoanalyzing Shakespeare’s characters with his observations on Hamlet in the Interpretation of Dreams.⁸ We are told by Peter Gay⁹ (Freud’s biographer) that when Freud was 8, he was already reading Shakespeare and reciting in near perfect English some of the famous lines. There are quotes from Shakespeare scattered throughout the collected works, and in perhaps his most important insight, Freud recognized Shakespeare’s Hamlet in Sophocles’ Oedipus and formulated the Oedipus complex-the cornerstone of psychoanalysis and of his personal self-analysis.

Kurt Eissler¹⁰ one of Freud’s most loyal adherents (and the author of his own erudite study of Hamlet) believed that Freud got more of his ideas from Shakespeare than from his patients. That seems to me entirely believable. In my own retrospective judgment, once one gets past the Interpretation of Dreams and the Three Contributions to the Theory of Sex, it is fair to say that Shakespeare saw more deeply and broadly into the human condition than Freud.

Nonetheless, Freud’s Oedipus complex dominated productions of Hamlet in the second half of the 20th century as the Anatomy of Melancholy had before then. Laurence Olivier, in planning his Hamlet performance, famously consulted with Ernest Jones,¹¹ Freud’s acolyte and biographer, who had expanded Freud’s insights into a book about the Danish Prince. Under Jones’ tutelage, the scene in which Hamlet finally accuses his mother (“As bad, good mother as kill a King and marry with his brother,” Act III, Scene IV, Line 27-28) takes place during an eroticized wrestling match in Queen Gertrude’s bed. Olivier’s 1948 film version of Hamlet, emphasizing the mother-son sexual attraction, earned him Academy Awards for Best Picture and Best Actor. In 1990, Zefirelli directed Mel Gibson in an even more explicitly Oedipal version of the play. But, although that blatant emphasis is gone from recent productions, Freud’s ghost still haunts the castles of Elsinore on stage and screen. Sex has become an explicit part of the plot, graphically depicted in Ophelia’s madness. And during rehearsals and workshops in preparation for Hamlet, it is not uncommon for directors and performers to explore the unconscious of the characters (and their own), often with the help of psychoanalysts.

Freudian interpretations of Shakespeare, although now on the wane, also flourished in the groves of academe during the second half of the 20th century. Many of the leading scholars in Shakespeare criticism relied either on Freud himself or on Lacan as a framework for their interpretations.¹ Lacan’s interpretation of Hamlet is, as one might expect, recondite and abstruse but strays very far from the text and into Lacan’s own phallocentric imagination and theory of desire.

Although no contemporary psychiatrist or psychiatric theory plays a dominant role in Hamlet dramaturgy, Justice Anthony Kennedy of the Supreme Court created a prominent public role for psychiatrists in his mock trial of Hamlet. First staged at the Supreme Court in 1996 to raise money for the Shakespeare Company of the District of Columbia, it has had 3 iterations in other venues in which I participated as 1 of the 2 expert witnesses. Justice Kennedy resurrected the debate cataloged in the Variorum edition of Hamlet: is Hamlet’s insanity real or feigned?

Justice Kennedy concocted a scenario that narrowed the question as appropriate in law. He posited that all of the characters who died in the final scene by poisoning-Queen Gertrude, King Claudius, Laertes, and Hamlet-had all miraculously recovered. Only Polonius whom Hamlet had stabbed in Act IIi, Scene IV was dead. Hamlet was charged with the murder of Polonius, and the only question to be decided at trial was whether Hamlet was sane or insane at the time of that crime. The only witnesses were to be 2 psychiatrists.

The American Law institute’s formulation of the insanity defense would apply. The basis of the psychiatric testimony was to be any statement in the text of the Folger edition of the play.¹² The expert for the defense was a leading forensic psychiatrist with experience in many trials. I was the witness for the prosecution, and although I have been a Professor of Law and Psychiatry at Harvard for more than 4 decades, I had no experience as a forensic psychiatrist. My former student and friend Joel Klein, then a lawyer in the Clinton White House, convinced me to participate. He knew that I taught Hamlet in my law and literature seminar, and he understood my principled objections to forensic psychiatry.¹³ I was quite convinced that Hamlet had no serious mental disorder. And Joel Klein assured me I would testify only for the state whose lawyers would argue that Hamlet was not insane. Preparation for the trial at the Supreme Court caused me to dig deeper into the play and the literature of Hamlet criticism-a great intellectual pleasure!

Two famous lawyers met with me before the trial to work out a strategy. They were superb in their craft but not steeped in the study of Hamlet. My first task was to convince them we believed in ghosts. Or at least that the guards of the watch, Bernardo and Marcellus, and Hamlet’s friend Horatio had all seen the ghost of Hamlet’s father before Hamlet had and thus this was not a textbook hallucination.

My understanding of Hamlet was most influenced by a single defining performance. In 1989, Derek Jacobi directed then 27-year-old Kenneth Branagh in a brilliant Hamlet staged on the grounds of what is supposed to be the actual Elsinore Castle in Denmark. The bare-bones outdoor production bore no resemblance to the inward-looking Oedipal or melancholic versions of the play. The eerie appearance of the ghost on the battlements of the castle to begin the first act left no doubt that this was a supernatural phenomenon, not Hamlet’s hallucination. King Claudius was a Machiavellian usurper who kept his nephew under surveillance, ready to dispatch or poison him as he had his father.

Branagh’s vibrant youthfulness changed the emotional tone of every interchange. His prince was passionate, impetuous, defiant, struggling to control his emotions, barely able to contain his outbursts of resentment and contempt. Indeed, he was a brilliant young student of philosophy, not a man of action, caught up in a moral and political predicament and feigning madness only when watched by Claudius’s subalterns. My opinion of Hamlet was much like that of Akenside in the 18th century. Hamlet was a troubled man in a difficult situation who “put on an antic disposition” just as he had said he would in Act I. I thought of his psychiatric problems as a complicated grief reaction and testified that he was not insane when he killed Polonius.

The forensic expert’s opinion was based on DSM and the Folger text of Hamlet,¹² both of which he seemed to have committed to memory. He concluded that Hamlet suffered from rapid cycling bipolar disorder, and he retrieved from the text exact quotes that met DSM criteria and substantiated his view that Hamlet was insane. The jury, which included Justice Ruth Bader Ginsburg, found Hamlet sane. I am told that forensic experts reviewing the testimony from their professional perspective considered that result inexplicable.

Since the entire trial was broadcast by C-SPAN and is still available online, any reader who is truly curious can examine the record.¹⁴ I am confident that the defense expert is a better forensic psychiatrist than I and a more experienced clinician. But a forensic psychiatrist who fits Hamlet into a DSM category and pronounces him insane has in my opinion cut pieces out of the greatest portrait of a character in the greatest play ever written.

I have revisited the trial of Hamlet in a class I teach with Professor Alan Dershowitz-Justice and Morality in the Plays of Shakespeare. Again in a mock trial, I testified that Hamlet was sane. On this occasion, however, I saw the basis for my testimony in a completely different light than I had in the several previous public trials. Hamlet has 7 soliloquies in which he shares his innermost thoughts and feelings with the audience. It suddenly occurred to me that those soliloquies were as good or better than the information I or any other psychiatrist could obtain in prolonged anamnestic interviews. The soliloquies reveal the kind of insight, judgment, and reality testing we do not expect from patients with serious mental disorders. My friend, Fuller Torrey,¹⁵ likes to use the term “anosognosia,” suggesting a neural mechanism for the cardinal symptom of serious mental disorder. Whatever term psychiatrists use to indicate lack of insight, it clearly does not describe the Hamlet of the soliloquies.

Despite all this, I now consider my certitude about Hamlet an example of hubris. A mock trial it now seems to me is an invitation to narrow one’s perspective both on Shakespeare and on Hamlet. I recognized my failings in another defining performance of Hamlet. This one starring Michael Sheen and directed by Ian Rickson at the Young Vic in London. It was the first Shakespeare play Rickson had directed and his intentionally radical interpretation went against everything I believed. Denmark was a secure psychiatric hospital, Claudius was the nefarious superintendent, Polonius was a bumbling psychiatrist, and Hamlet was a disturbed mental patient. In the ghost scene, Hamlet lies down on the floor and out of his mouth comes the sepulchral voice of his dead father. Rickson had gone back to the psychological Hamlet, this time inspired by RD Laing¹⁶ and The Politics of the Family.

And Rickson’s idea of what is “rotten in the state of Denmark” is inspired by the 1975 film One Flew Over the Cuckoo’s Nest. Hamlet is being tormented under the aegis of psychiatry. Sheen and Rickson spent months brainstorming about the play, opting to abandon the “revenge Hamlet” and creating a new family dynamic conception. Their Hamlet hates his dead father but is locked in grief and projects his hatred onto his Uncle Claudius. They brought in psychoanalysts to help them think through all of the characters and their dynamic interactions.

It is tempting to simply dismiss this Young Vic version of Hamlet as aberrant, and many critics did. And I was certainly inclined to do the same. The production both attacked my understanding of the play and made psychiatry the evil force of oppression. But Sheen was brilliant as a mad Hamlet, and the soliloquies took on a new and different meaning. It was a stunning performance. This 21st century Hamlet demonstrated, once again, that there is no ultimate truth of the matter in Shakespeare. Hamlet says of Yorick, “A man of infinite jest.” Perhaps we can say of Shakespeare, a man of infinite human understanding and empathy.

References:

References

1. Garber M. Profiling Shakespeare. New York: Routledge; 2008.

2. Berman R. The Shakespeare industry. Sewanee Rev. Fall 1976;84:657-668.

3. Reiss B. Bardolatry in bedlam: Shakespeare, psychiatry, and cultural authority in nineteenth-century America. ELH. 2005;72(4):769-797.

4. Furness HH, ed. Hamlet: The New Variorum Edition. New York: Dover Publications; 2000.

5. Edgar II. Amariah Brigham, isaac Ray and Shakespeare. Utica, NY: State Hospitals Press; 1961.

6. Overholser W. Shakespeare’s psychiatry-and after. Shakespeare Q. 1959;10(3):335-352. http://www.jstor.org/discover/10.2307/2866854?uid=3739832&uid=2&uid=4&uid=3739256&sid=21101579500523. Accessed January 25, 2013.

7. Burton R. The Anatomy of Melancholy. 1621. http://danassays.wordpress.com/encyclopedia-of-the-essay/the-anatomy-of-melancholy-by-robert-burton-1621. Accessed January 25, 2013.

8. Freud S. The Interpretation of Dreams. http://www.hermetics.org/pdf/Sigmund_Freud_-_The_Interpretation_of_Dreams.pdf. Accessed January 25, 2013.

9. Gay P. Freud: A Life for Our Time. New York: WW Norton; 1998.

10. Eissler KR. Discourse on Hamlet and Hamlet: A Psychoanalytic Inquiry. New York: international Universities Press; 1971.

11. Jones E. Hamlet and Oedipus. Garden City, NY: Doubleday; 1949.

12. Shakespeare W. Hamlet (Folger edition). New York: Washington Square Press; 1992.

13. Stone AA. The ethical boundaries of forensic psychiatry: a view from the ivory tower. Bull Am Acad Psychiatry Law. 1984;12:209-219.

14. C-SPAN Video Library. Trial of Hamlet. March 17, 1994. http://www.c-spanvideo.org/program/55363-1. Accessed January 25, 2013.

15. Torrey EF. The insanity Offense: How America’s Failure to Treat the Seriously Mentally Ill Endangers Its Citizens. New York: WW Norton & Company, Inc; 2012.

16. Laing RD. The Politics of the Family. New York: Vintage Books; 1969.