lady macbeth mental illness essay

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Macbeth: Mental Illness in Shakespeare's Play

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Benjamin reiss’ theory of mental illness in macbeth, lady macbeth as a strong character, psychological impact of the duncan's murder on lady macbeth's mental illness.

“Shakespeare believed that madness was ‘disease of the brain’, and could be cured by medical means, aided by judicious care and management, all which he points out as clearly as it could be done by a modern expert.”

“We will proceed no further in this business. He hath honoured me of late and I have bought golden opinions from all sorts of people” (1.7.31).

“What thou art promised. Yet do I fear thy nature; It is too full o’ th’ milk of human kindness, to catch the nearest way: thou wouldst be great, Art not without ambition, but without the illness should attend it.” (1.5.16)

“That made you break this enterprise to me? When you durst do it then you were a man. And to be more than what you were, you would be so much more than a man.” (1.7.55)

“Is this a dagger which I see before me, the handle toward my hand. Come, let me clutch thee” (2.1.44).

“Methought I heard a voice cry, ‘Sleep no more! Macbeth does murder sleep’ — the innocent sleep.” (2.2.35)

“To be thus is nothing, but to be safely thus. Our fears in Banquo, stick deep, and in his royalty of nature reigns that which would be feared.” (3.1.47)

“Upon my head they have placed a fruitless crown and put a barren scepter in my grip, thence to be wrenched with an unlineal hand, no son of mine succeeding.” (3.1.66)

“I have almost forgotten the taste of fears, the time has been my senses would have cooled, to hear a night shriek.” (5.5.9)

• Decker, B. (2019). The portrayal of mental illness in Shakespeare's plays. The Mental Health Clinician, 9(6), 404-408. https://doi.org/10.9740/mhc.2019.11.404
• Evans, R. (2016). Shakespeare's understanding of mental illness. Psychiatry, 79(4), 356-365. https://doi.org/10.1080/00332747.2016.1199469
• Gallagher, M. (2016). A brief exploration of the portrayal of mental illness in Shakespeare's Macbeth. Journal of Humanities and Social Science Research, 1(1), 26-36. https://doi.org/10.11648/j.hssr.20160101.14
• Karkoulian, S., & Johnson, S. K. (2017). Exploring the portrayal of mental illness in Shakespeare's Hamlet and Macbeth. Journal of Psychosocial Nursing and Mental Health Services, 55(7), 40-47. https://doi.org/10.3928/02793695-20170420-03
• Kirschner, S. (2015). The shadow of Macbeth: Shakespearean motifs in Freud's interpretation of obsessional neurosis. American Imago, 72(2), 149-174. https://doi.org/10.1353/aim.2015.0014
• Kliman, B. (2014). Macbeth: From a psychological perspective. In B. Kliman (Ed.), Macbeth: New critical essays (pp. 129-152). Routledge.
• Kramer, E. M., & Callahan, J. L. (2015). The portrayal of mental illness in literature: A review of selected historical and contemporary accounts. Archives of Psychiatric Nursing, 29(2), 104-112. https://doi.org/10.1016/j.apnu.2014.11.004
• Levin, R. (2019). The impact of Shakespeare on the portrayal of mental illness in western culture. Journal of Mental Health, 28(5), 485-489. https://doi.org/10.1080/09638237.2018.1565939
• Lu, M. C. (2018). Macbeth's soliloquies and their relation to mental illness. Journal of Psychological Issues in Organizational Culture, 8(3), 75-84. https://doi.org/10.1002/jpoc.21100
• Uken, A. (2018). Shakespeare and mental health: His impact on psychology and psychiatry. Psychiatric Quarterly, 89(4), 813-822. https://doi.org/10.1007/s11126-018-9567-5

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Lady Macbeth's Night Walking With Dissociative Symptoms Diagnosed by the First Sleep Medicine Record

Marleide da mota gomes.

1 Laboratory of History of Psychiatry, Neurology, and Mental Health, Institute of Psychiatry, Institute of Neurology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Antonio E. Nardi

2 Laboratory of History of Psychiatry, Neurology, and Mental Health, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazilian Academy of Science, National Academy of Medicine, Rio de Janeiro, Brazil

Introduction

William Shakespeare was an innovative play writer prone to capture in his works the knowledge of his time, at the English Renaissance that includes the Elizabethan and early Jacobean Eras (Gomes, 2015 ). Much of Shakespeare's work was assembled at The First Folio (Shakespeare, 1623 ) that is Bard's 35 plays post-mortem collection that is considered one of the most influential books ever published. Lady Macbeth is one of the main characters of the Macbeth Tragedy, wife of the protagonist whom she convinced to kill King Duncan, but she ends up severely plagued by her guilt (Shakespeare, 1988 ).

Many texts of Shakespeare may be considered a lesson of psychopathology (Levin, 2002 ). This is very interesting when it is considered that very little was known in Shakespeare's day about mental disorders as to somnambulism/night walking. The most detailed data could be read in some plays as in The Tragedy of Macbeth (Shakespeare, 1988 ). Night walking could be interpreted at this period as a prophetic or spiritual moment in which the individual was believed to be under the influence of strange or paranormal forces (Kocher, 1954 ; Maraldi, 2019 ). For some it was considered a prophetic or ecstatic state, but for others it was the result of a badly conducted baptism ceremony, consequently, they were often called the ill-baptized (Munro, 1887 ).

Sleep disorders are among the most expressive of Shakespeare's work, regarding medical issues (Riva et al., 2010 ). Probable, it reflects some publications on sleep problems and dreams (Riva et al., 2010 ) that were common in daily discussion in Jacobean England, and night walking was defined as a “serious disorder, a form of melancholy” (Riva et al., 2010 ), and “a great agitation of the brain” (Riva et al., 2010 ). Regarding the sleep problems in general, they were found in several plays, but undoubtedly, the most famous is found in The Tragedy of Macbeth (Act 5, Scene 1/Act 2, Scene 2/Act 3, Scene 2/Act 5, Scene 3) (Shakespeare, 1623 ).

An initial survey made on an edition of the First Folio shows that the word sleep appears 329 times, besides fall which appears 337 times, it is the most found among others that may be related to the neuropsychiatric area, surpassing fit (221 times) and faint (52 times) (Shakespeare, 1623 ).

The play about Macbeth was probably written for King James's ancestors and the Stuarts' accession to the English throne in 1603. The King demonstrated curiosity in night walking because he and his mother, “Mary, Queen of Scots, suffered from fits with loss of consciousness and sleep complaints” (Riva et al., 2010 ).

This paper discusses Lady Macbeth's night walking on Shakespeare's report, mainly regarding the relationship between a non-rapid-eye-movement sleep (NREM) and REM parasomnia, and dissociative disorders (DD).

Lady Macbeth's Nightly Ambulatory Behavior

Regarding Bard's works, Shakespeare deeply and unashamed scrutinizes the human behavior and feelings what is masterfully presented employing a scene of a vital physiological phenomenon for the human being that was disrupted. At the Tragedy of Macbeth, several of its characters suffer from sleep problems, usually associated with guilt and punishment, feelings for their sins. This punishment is intense and painfully presented in a kind of sleep laboratory, as it was shown in Lady Macbeth, Act 5, scene 1 (Shakespeare, 1623 ). It can be observed that Lady Macbeth take part as the subject of a first recorded sleep laboratory scene, as her doctor examine her behavior during the night, at the side of the gentlewomen. Act 5, scene 1 of a night walking suggests a vivid NREM-parasomnia or even a DD, all of them probably present in this case. However, firstly we will present some issues regarding sleep phases and eventual intrusion in wakefulness.

Abnormal nocturnal behaviors exhibit various symptoms from simple motor activities to complex and severe behaviors. The illnesses of nocturnal abnormal behaviors include parasomnias, epilepsy, and mental disorders (American Psychiatric Association, 2013 ).

The parasomnia may be those of NREM-related parasomnia, REM-related parasomnia, and other parasomnias according to the International Classification of Sleep Disorders-3 (ICSD-3) (Singh et al., 2018 ).

NREM-related parasomnia is classified as Confusional arousals, Sleepwalking (SW), Sleep terrors, and Sleep-related eating disorder; and REM-related parasomnia are subdivided into REM sleep behavior disorder, Recurrent isolated sleep paralysis, and Nightmare disorder according to ICSD-3 (Singh et al., 2018 ).

Parasomnias are more often seen in children than in the adult population, however, REM Sleep Behavior Disorder can be associated with various neurologic disorders like α-synucleinopathies, Parkinson's disease, and narcolepsy (Singh et al., 2018 ).

This SW disorder can be one of the parasomnias that are a group with abnormal and unpleasant verbal or behavioral motor signs that may appear during sleep or wake-up to sleep transitions ( Figure 1 ).

The sleep phases and their intrusions in wakefulness. (A) Sleep phases and their characteristics in EEG, REM, and NREM sleep; (B) Hypnogram (summary of basic sleep characteristics along time) showing sleep cycles, each with sleep phases (NREM-N1, N2, N3, and REM); C- Intrusions of the sleep phases into wakefulness and their results. Illustration by M. da Mota Gomes.

Each sleep phase has its characteristics, and more commonly vivid dreams occur at the REM sleep phase when there is body paralysis, and fortunately, dream enactment is not possible. However, abnormal patterns may occur due to the intrusion of sleep phases into wakefulness or vice-versa. REM sleep intrusion in the waking state may also explain cataplexy, sleep paralysis, and hypnagogic (wake to sleep) or hypnopompic (sleep to wake) hallucinations, as is mostly seen in narcoleptic patients.

Disrupted sleep may also suppress, at least temporarily the motor-suppressive activity in REM sleep, and consequently promotes REM behavior disorder. In this situation, there is a process of dream enactment that likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. This behavior may be expressed as kicking, punching, yelling, jumping, or aggressive behavior associated to a dream (Singh et al., 2018 ).

The intrusion of REM sleep in wakefulness may also occur at the post-traumatic stress disorder, and other sleep disorders, that share the possibility of body enact dream content and it underlies oneiric experience that can be expressed by dream enactment behavior. Many recent works shed light on this question (Baltzan et al., 2020 ; Barone, 2020 ; Elliott et al., 2020 ; Rocha and Arnulf, 2020 ; Siclari et al., 2020 ).

Posttraumatic stress disorder increases the chances for REM sleep behavior disorder and other parasomnias in people with and without comorbid traumatic brain injury, as in the veterans how is demonstrated in the study by Elliott et al. ( 2020 ).

In contrast to REM sleep behavior disorder, NREM parasomnias have often been related as non-dreaming states, as they may appear from N3 sleep that is one sleep stage with minimal dream recall. However, some data from sleep laboratories show that dreams may also be enacted in NREM parasomnia (Rocha and Arnulf, 2020 ; Siclari et al., 2020 ).

Regarding the confusional arousals, they are episodes of confusion, disorientation, and bizarre behavior immediately after awakening from sleep. As to the night terrors, there is a terrifying scream with severe autonomic symptoms and often motor activity, which might be stereotyped (Hartman et al., 2001 ).

Precisely, SW is a deambulatory movements with decreased levels of consciousness, which may occur during incomplete arousals mainly from slow-wave sleep. Patients act semi- purposefully and usually have poor memory of related events that are less unusual and original than that of REM dreams.

However, may occur an overlap between non-REM parasomnia and REM sleep behavior disorder that is associated with a history of dream-enacting with dream recall. This overlapping represents an apparent boundary confusion between stages of non-REM and REM sleep. Besides, it may occur a rare and severe dissociation between non-REM, REM, and wake states what constitutes agrypnia excitata or status dissociatus , resultant clinically in oneiric behaviors and severe disorganization of normal polysomnographic wake and sleep stage features (Hrozanova et al., 2019 ). Regarding status dissociatus , it can happen in alcohol withdrawal, autoimmune encephalitis, or in synuclein neurodegenerative disorders (Hrozanova et al., 2019 ).

The extreme form of status dissociatus, agrypnia excitata , may occur in alcohol withdrawal, Morvan syndrome, or fatal familial insomnia and other prion diseases (Hrozanova et al., 2019 ).

There are commonly reported trigger factors for SW/non-REM parasomnia that include sleep deprivation and stress (Bargiotas et al., 2017 ), as happened with Lady Macbeth. SW is usual in school children and rare in adults, and it may be trigger by genetic features, neurological, psychiatric factors, but its diagnosis is based on anamnesis, and video-polysomnography may be needed to exclude some similar disorders. Indeed, the identification of SW episodes is deeply reliant on the behavior being detected by others or the sleepwalker questioning it because of injuries or other manifestations when he/she awake. Treatment of SW needs the recognition of etiological factors, means for the sleep environment to become safer, and the use of sedative drugs, if necessary.

“Gentlewoman: Since his majesty went into the field, I have seen her rise from her bed, throw her night-gown upon her, unlock her closet, take forth paper, fold it, write upon't, read it, afterwards seal it, and again return to bed; yet all this while in a most fast sleep.”

“Gentlewoman: Neither to you nor any one; having no witness to confirm my speech. Enter LADY MACBETH, with a taper. Lo you, here she comes! This is her very guise; and, upon my life, fast asleep. Observe her; stand close.”

“Doctor: You see, her eyes are open. Gentlewoman: Ay, but their sense is shut.” “LADY MACBETH: Wash your hands, put on your nightgown; look not so pale. …I tell you yet again, Banquo's buried; he cannot come out on's grave.” (Shakespeare, 1623 )

When Lady MacBeth's physician gave his impression about her sleep problem to his husband, Macbeth recognized the psychogenic aspects underneath the night walking and the possible way to treat it.

Indeed, the NREM-related parasomnias have many differential diagnoses, including REM sleep behavior disorder, sleep-related epilepsy, sleep-related DD, alcohol-and drug-related behavioral signs and symptoms during sleep, obstructive sleep apnea, and psychogenic events or malingering (Hartman et al., 2001 ). Naturally, a significant psychosocial antecedent, as occurred with Lady Macbeth raises a possible diagnosis of a DD and post-traumatic stress disorder with dream enactment behavior.

The dissociative experiences, such as those occurring in DD, may also be comorbid with episodes of SW, but occurring in some moments during which the individual remains awake (Hartman et al., 2001 ). In the Statistical Manual of Diagnosis of Mental Disorders−5th Edition (American Psychiatric Association, 2013 ), a dissociative symptom is related to the deterioration of the consciousness, such as recalls of memory, self, and local orientation.

Karatas et al. ( 2017 ), determined that a portion of the patients with parasomnia also had dissociative disorders, with dissociative amnesia at 33.3%, dissociative evasion at 13.3%, and dissociative disorder that cannot be otherwise named at 53.4%, there was also sexual or physical abuse and neglect.

One more association between dissociative symptoms and sleep is raised when it is known that sleep hygiene may be very useful to the treatment or prevention of dissociative symptoms (Maraldi, 2019 ). It is a diagnostic challenge, as the principal differential diagnosis of Lady Macbeth's is between a vivid SW and a DD, not exclusively.

Lady Macbeth's scene portrays deambulatory behavior, SW that may suggest somnambulism, plus a dissociative disorder or even dissociatus status less probably post-traumatic stress disorder with dream enactment behavior.

Lady Macbeth presents a nocturnal dissociative episode with an altered state of consciousness, in which traumatic memories return, as a possible manifestation of post-traumatic stress disorder. However, in this case, the main question raised is whether we are facing the diagnosis of DD itself or a case of NREM-related parasomnias, particularly a vivid SW, combined with dissociative symptoms. The main trick point to this differential study is based on the level of consciousness. This favored our choice for the first option, vivid SW, as the Gentlewoman says: “Gentlewoman: Ay, but their sense is shut” that we can assume that the patient is asleep, and if she were awake, this would be a case of DD.

However, the vivid, complicated, lengthy night-walking in adults is not common in patients with SW. However, psychiatric comorbidities are found in patients with SW, mainly depression, as shown in 25% of the adult-onset SW by Bargiotas et al. ( 2017 ). Besides, commonly informed aetiological factors for SW comprise sleep deprivation and anxiety (Bargiotas et al., 2017 ).

Regarding Lady Macbeth, she had a paradox between her awake state of indomitable strong power, at the side of the sleeping one. This side was pressed by the shadows and the suggestions of the night favored by the liberty of conscience what yield and throw off forever the mask of the right person that she had worn so long (Munro, 1887 ). Regarding the dissociative disorder, they are frequent in the general population (Maraldi, 2019 ), with about one-third of individuals reporting at least one dissociative symptom during their stressful moments. The etiology of dissociation has been psychologically linked to childhood trauma, but even the trauma feature points to the need of considering cognitive, psychopathological, and sociocultural features, other than the trauma itself in a comprehensive model of dissociative symptoms (Maraldi, 2019 ). Besides, there is an increasing amount of data lightening the complex association between dissociation and anomalous sleep disorders such as recurrent nightmares, vivid and bizarre dreams, sleep paralysis, hypnagogic/hypnopompic imagery, and narcolepsy symptoms (Maraldi, 2019 ).

Concerning just the dream, it has been considered an interesting feature for dissociative disorders such as absorption/ imaginative involvement and multiple identity states (Crisp, 1996 ). Besides, it is frequent to consider the concrete and psychological theme of a person's dreams as a predictor of dissociative tendencies and conversion symptoms (Levin, 2002 ; Maraldi, 2019 ). Also, highly dissociative patients usually describe more vivid dreams and other unusual sleep experiences. However, Lady Macbeth's SW behavior is not favorable to REM sleep disorder and eventually linked dream enactment behavior as eyes open usually are not found in this condition as mentioned in the scene: “Doctor: You see, her eyes are open.” Besides the eyes usually closed, in REM sleep disorder, the patients are not aware of their environment, and they can't get far from their bed as Lady Macbeth did.

About 16–25% of adult sleepwalkers have comorbidity with depressive or bipolar disorders, as mentioned by Hrozanova et al. ( 2019 ), as seems to be the case of Lady Macbeth, which led her to suicide. Anyway, it is worth to recognize that dissociation disorder is a potential differential diagnosis for NREM parasomnias. This discrimination is a challenge and makes this an area of complex study. However, we can hypothesize that Lady Macbeth suffered from dissociative amnesia (AD) as well as depression (American Psychiatric Association, 2013 ). This disorder involves the temporary loss of recall memory which can be voluntary or involuntary and can result from stressful moments, with severe and disturbing emotions such as those that affected Lady Macbeth.

The close association between sleep disorders and dissociation is a poor explored subject that could open many hypothesis or etiological factors to dissociative syndromes from childhood trauma and to feelings (Kocher, 1954 ). Also, sleep disorders such as sleep paralysis and bizarre dreams have given rise to various interpretations from popular and paranormal beliefs, such as stories of alien abductions and the presence of strange and feared creatures during the night (Kocher, 1954 ; Maraldi, 2019 ). Indeed, SW may be an interesting tool for understanding the differences and similarities among beliefs about sleep-related phenomena in different cultures (Kocher, 1954 ; Hartman et al., 2001 ).

“MACBETH: Cure her of that. Canst thou not minister to a mind diseased, Pluck from the memory a rooted sorrow, Raze out the written troubles of the brain And with some sweet oblivious antidote Cleanse the stuff'd bosom of that perilous stuff Which weighs upon the heart? (Act 5, Scene 3)“ (Shakespeare, 1623 )

Regarding the memory of the events, sleepwalkers usually have poor memory of SW events that are less unusual and original than REM dreams. Naturally, the self-reports and clinical observations have their bias on at least partial awareness of the event by the individual or being told about his/her SW by someone who has observed it, as the physician of Lady Macbeth. The use of light by Lady Macbeth ( Figure 2 ) could also be considered another dissociative sign for a careful psychopathologist. However, the relationship between the mentation and full-blown episodes of SW and night terror may be higher than is currently thought. Some observations may point that dissociation is not explicitly associate with similar sleep disorders, but to the quality of sleep and insomnia symptoms, as we observe in Lady Macbeth. Besides, dissociation was also shown to be associated with a series of non-pathological anomalous sleep experiences, such as lucid dreaming and out-of-body experiences (Maraldi, 2019 ). Also, dissociative experiences seem to be associated with nightmares and waking dreams, but it is not correlated with “concious dreaming,” thereby suggesting that dissociation may be related to those sleep disturbances that are hard to manage.

The Sleepwalking of Lady Macbeth by Johann Heinrich Füssli (1781–1784) (Musée du Louvre). Free domain.

However, the dissociation prevalence during anomalous sleep experiences is mostly unknown, either for general or clinical populations (Maraldi, 2019 ), but Hartman et al. ( 2001 ) considers a great association between parasomnia and dissociative disorders. Lady Macbeth's physician and his assistant, the Gentlewoman, used the clinical observation and detailed anamnesis, in this way, we could consider this scene as the first laboratory session described in the literature (Kocher, 1954 ). Regarding Lady Macbeth's experience, it is full of guilty and severe depression that leads her to sleep disturbance, and in the end, the character commits suicide. The underlying mood disturbances may have worked as a trigger for the SW and a final resolution of a sublime ambitious character. However, we can assume that we are not dealing with a simple non-REM parasomnia, but it can be a more complex one due to the imbrication of different phases of sleep as occurs in the dissociatus state. Besides, this non-REM / REM parasomnia can be bi-directionally related to dissociative phenomena (Crisp, 1996 ).

In short, William Shakespeare was a playwright who innovated the theater and analyzed human behavior in a creative, seductive, and shameless way. The Bard addressed medical issues steeped in human emotions, including the sleep disorders of his tormented characters. In the play, The Tragedy of Macbeth, the night walk of Lady Macbeth is analyzed through the words of her doctor and Gentlewoman. This scene can be considered the first record of sleep medicine described in the literature. The identification of episodes of night walks depends deeply on the behavior witnessed by other people. The diagnostic option regarding this event concerns a parasomnia associated with dissociative symptoms. Thus, it is possible to suggest that the traumatized Lady Macbeth had a dissociatus status resulting from the overlap of non-REM / REM sleep parasomnia and dissociative symptoms. These due to her anguish and/or her deep disturbing silent feelings.

Author Contributions

Both authors planned the project together, read the references, discussed and planned the article, wrote the manuscript, agreed, and approved with its final version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

Thanks all the staff from the Laboratory of History of Psychiatry, Neurology and Mental Health from the Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil.

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Guest Essay: “A mind diseased”: Examining the evolution of madness using Shakespeare’s Macbeth by Sarah Ahmed

INTRODUCTION

Over the years, our understanding of what it means to be mad has evolved. Ancient civilisations held the belief that madness was as a result of spiritual possession; the Enlightenment’s concept of rationality remade madness into an external manifestation of internal grief; in the last century we have started to develop biological theories of mental health as we begin to understand more about how the brain works on a synaptic level.[1] It has even been suggested by prolific writers such as Szasz and Foucault that madness is not a disease at all but rather “a cultural construct, sustained by a grid of administrative and medico-psychiatric practices”.[1 (p.3)] It follows that as our understanding of madness has developed, so too have our readings and interpretations of madness in literature as we apply new theories of illness to fictional characters (perhaps in an attempt to empathise more strongly). Bossler said that “Shakespeare’s characters have always been a fertile field for the application of psychological principles”[2 (p.436)] and Shakespeare’s graphic descriptors of a “mind diseased”[3 (5.3.41)] have leant Macbeth to continuous reinterpretation.

In many readings of Macbeth the play has been approached using a particular literary theory or frame of reference. For example, Freud and his followers have analysed the play using the lens of psychoanalysm,[4] prion-based theories of madness have been applied to the text[5] and some have suggested that Macbeth’s madness is a result of battle fatigue.[2] Alternatively the play has been analysed using an approach more in line with New Historic theories of interpretation by considering the historical and social context of the time: the humoral theory of health[6, 7] has been applied to the play and the characters’ dramatic evolutions have been examined from a religious[8] or gendered perspective.[6] Each interpretation presents a new way of understanding old characters and each will be explored below as we examine how our understanding of madness has evolved and argue that if a frame of reference is important to our understanding of Macbeth , a deeper appreciation might be achieved by considering the notion of madness from the perspective of the Elizabethans.

FRAMES OF REFERENCE

By simply using a literary approach it is clear both Macbeth and Lady Macbeth undergo dramatic evolutions over the course of the play, be this into madness or something else. Macbeth, who is initially seen to cower beneath his wife’s ambition, “grows ever more frightening…as he becomes the nothing he projects”; conversely, Lady Macbeth implodes and withdraws from society.[9 (p522)]

Macbeth’s decline begins almost immediately following the couple’s decision to take the crown – the great warrior Macbeth is seen to be anxious about the proposed murder, saying “If it were done when ‘tis done, then ‘twere well/It were done quickly”.[3 (1.7.1-2)] Even before the murder his worries manifest themselves as hallucinations when he sees the now famous “dagger of the mind”,[3 (2.1.38)] which first appears clean before being doused with “gouts of blood”.[3 (2.1.46)] His deterioration progresses when he returns to the stage after murdering the King and claims auditory hallucinations, hearing “a voice cry, ‘Sleep no more:/Macbeth does murder sleep”’.[3 (2.2.38-39)] In saying this Macbeth becomes almost premonitory (like the Weird Sisters) as he does indeed suffer sleep disturbances later on, a “symptom” which is often quoted in discussions of his madness.

Lady Macbeth’s fall is more measured and gradual – whilst Macbeth is hearing noises she admonishes him as she would “shame/ To wear a heart so white”.[3 (2.2.67-68)] Here the colour white has connotations not only of innocence and purity but of cowardice; it evokes the white feathers of World War One which were given to the men refusing to enlist. Most of Lady Macbeth’s dramatic evolution occurs off-stage as is typified by the change in her mode of speech. In the banquet scene of Act3 Scene 4 Lady Macbeth’s gravitas and assurance is obvious in how she address the nobles in verse:

Think of this, good peers,

But as a thing of custom. ‘Tis no other,

Only it spoils the pleasure of the time.[3 (3.4.96-98)]

She is the very embodiment of regality. This is contrasted against Act 5 where she speaks only in prose. In Shakespeare’s plays prose was often reserved for the lower classes, or for conversations between characters who are knew each other well, such as Rosalind and Celia in As You Like It. [10] It was also used in the speech of characters who were mad or feigning insanity, as verse was apparently “too regular and orderly for expressing madness”.[10] As such Hamlet, Ophelia and King Lear all speak in prose at some point in their respective plays.

The (d)evolutions of Macbeth and his wife have also been subject to particular frames of reference. A psychoanalytic reading would suggest that Macbeth’s madness is due to a “psychic catastrophe”,[4 (p. 1483)] which is a direct result of his murder of the King. In this reading the King acted not only as Macbeth’s Superego, but that of the whole country, representing “the unifying power which bound the warrior’s destructiveness and directed it towards external enemies in order to preserve stability in the kingdom”.[4 (p.1488)] This goes some way to explaining why Macbeth is so affected by this particular killing as the King was not only his head of state but the means through which “Belladonna’s bridegroom”[3 (1.2.54)] could funnel his inner destructive nature. Conversely, the witches represent a “malignant regression to primitive states of mind”[4 (p.1484] and the other extreme of Macbeth’s psychic spectrum. In taking heed of their premonitions Macbeth turns towards his Id; in returning to them for help and validation Macbeth gives in to his base nature.

A Freudian reading doesn’t label Macbeth’s behaviour with a diagnosis but instead strives to understand why the Thane behaves the way he does. A Freudian would believe that Shakespeare merely described behaviour which he had observed in mankind but never had a frame of reference to explain what he saw; Freud’s theory provides this context.[4] The ease with which some of Shakespeare’s plays lend themselves to a Freudian interpretation has been used as evidence for this view with the most famous example being Hamlet and its connection to the Oedipus story. This idea that Shakespeare described human nature accurately but was missing the terminology to explain what he saw has been used repeatedly in various literary theories and evokes Lawrence Olivier’s famous proclamation that Shakespeare was, or is, “the nearest thing in incarnation to the eye of God.”

More recent theories of madness, which have originated as our understanding of both biology and psychology has developed, have also been applied to Macbeth . One such theory is that Macbeth suffered from Creutzfeldt-Jakob disease (CJD), or another similar prion disease.[5] The paper which proposed this theory was published in the Clinical Infectious Diseases Journal, highlighting how a person’s background can be used to form the frames of reference they use in their interpretation not only of the scientific world but of literature. It is important to note that the authors of the paper admit that Shakespeare may not have intended Macbeth’s dramatic evolution to mirror the natural history of a prion disease; similar to advocates of psychoanalysm they believe the playwright showed “an uncannily prescient understanding of prion disease transmission via exposure to neural tissues”[5 (p.299)]but lacked the context to explain it. The variety of human and animal offal present in the witches’ brew is considered the possible source of transmission.[5]

In creating their theory that Macbeth may have suffered from CJD the authors look beyond the usual symptoms of traditional madness – sleep disturbances and hallucinations – and find quotative evidence for more specific indicators of prion disease such as “neurological and cognitive deterioration”[5 (p299)] as well as “myoclonus and involuntary movements”.[5 (p.301)] However in most of the examples found it is possible to take what Shakespeare wrote and interpret it as a metaphor. For example, evidence for myoclonus is found in the following quote:

Take any shape but that, and my firm nerves

Shall never tremble. Or be alive again,

And dare me to the desert with thy sword;

If trembling I inhabit then, protest me

The baby of a girl.[3 (3.4.102-103)]

It may be that Shakespeare intended the reader to take the above literally and imagine Macbeth trembling; conversely it is just as likely that he meant it as a metaphor and Macbeth trembles in fear of the Ghost – even today we use similar expressions. After all, Shakespeare was foremost a poet. The following quote has also been attributed to myoclonus: “Then comes my fit again. I had else been perfect”.[3 (3.4.20)] It is similarly ambiguous as there is nothing in the script to suggest that Macbeth has an actual fit; it is more likely to metaphorically psychological in nature.

In a similar fashion, Macbeth’s dramatic evolution has been attributed to a diagnosis of battle fatigue.[2] Similar to explaining Macbeth’s madness as CJD, or even in examining it through the lens of psychoanalysm, the theory’s creator admits that although Shakespeare may not have set out to describe a case of battle fatigue, “the only thing new about [attributing a diagnosis of battle fatigue] is its name. Human nature remains the same”.[2 (p436)] Again it is interesting to note that the author of this paper is a military veteran.

The symptoms of battle fatigue are similar to those of traditional madness and CJD – “obsession of anxiety, jumpiness and inability to sleep”;[2 (p.437) however Macbeth has also been exposed to all the causes of battle fatigue.[2] The ceaseless toil of first the war and then the murder, combined with Macbeth’s powerful imagination, tips the balance of sanity towards dominant thoughts of blood and war.[2]Macbeth’s subsequent murders are explained as him returning to the place where he has known most success – the battlefield – in an attempt to cure himself of his malady; he tries to find peace by doing what he does best, except now he “enjoyed killing others too much to kill himself”.[2 (p437)]

IS IT ENOUGH?

In each of the above theories Macbeth is interpreted using a particular frame of thought; as was particularly prominent with the CJD and battle fatigue examples the frames of reference were drawn from the author’s life experiences. It is interesting to note that in each of the above readings it was claimed that Shakespeare merely described human nature (admittedly with some finesse and precision); what each new theory brings is context based on new interpretations of madness. Applying contemporary theories of (psychological) illness to diagnose literary characters is a phenomenon which is not just limited to Macbeth, or even to Shakespeare’s work: Winnie the Pooh’s Pooh and Piglet have been diagnosed with ADHD and General Anxiety Disorder respectively;[11] it has been suggested that Darcy may place on the Autistic Spectrum.[12] It is possible that our current biological theories will one day be disproved and appear outdated to future generations, and highly probable that as we develop new theories of madness these too will be applied to fictional characters, and we will have new ways of interpreting the actions of the Thane and his Lady.

However it is also probable that Shakespeare intentionally modelled his characters around Elizabethan notions of madness; unfortunately we can never know what Shakespeare meant when he described “a mind diseased”.[3 (5.3.41)] However by accepting that Shakespeare was an accurate portrayer of human nature we can begin to understand what Elizabethans thought about madness by examining the play in its historical and social context. Braunmuller agreed by saying that critical “claims are often false to the play’s complex relation with the social and political circumstances in which it was first written and first performed”.[3 (p.1)]Knowing more about these circumstances could be hugely useful, not only in giving readers a deeper understanding of the play but in showing us how mental illness was viewed in the 1500s/1600s. It is in this vein which we will continue.

HISTORICAL AND SOCIAL CONTEXT

Medicine, health and the medical professions feature heavily in Shakespeare’s plays and those of his contemporaries,[13] and “it has long been recognized that England in the period from 1580 to 1640 was fascinated with madness”.[6 (p.316)] However it has been suggested that Shakespeare’s knowledge is greater than that of a regular Elizabethan.[14] The reasons for this stretch beyond the scope of this essay but it can be assumed that Shakespeare knew about current theories of health and illness. It was during the Elizabethan era that madness started to become medicalised and was seen as humoral in nature; it was also associated with gender and religion. Each of these viewpoints have been used to interpret Shakespeare’s work.

Humoral theory stated that melancholy, now known as depression, was caused by an excess of black bile, the humor associated with winter and dryness. This resulted in a combination of “passivity, unsociability, fury, stupidity, paranoia, lust, anger, mania, but especially sorrow and fear”.[6 (p.319)] Most of these, in varying combinations, are seen in Macbeth and Lady Macbeth after they decide to kill the King. The use of humoral metaphors has been explored extensively in Shakespeare; in Macbeth it is especially with relation to Lady Macbeth and her ambitious nature.[7]

Despite more “scientific” theories it was also around this time that madness began to become gendered – although the frame of reference may have shifted from religion to reason, women were still seen as weak, second class citizens.[6] Melancholy in its purest form was associated with “the upper class, the literate, the masculine”.[6 (p. 319)] Conversely women were thought to suffer from melancholy’s sister, hysteria.[6] This idiosyncrasy can be clearly seen in Shakespeare’s Hamlet where Hamlet’s (possibly feigned) madness is always seen to be quite noble in nature – he is never anything less than the distressed Prince of Denmark – whereas Ophelia’s is seen almost to be “beautiful, sweet, lovable, pathetic”.[6 (p. 322)]

This gendered madness can also be seen in Lady Macbeth’s descent, which holds many similarities with Ophelia’s madness. Like Ophelia, Lady Macbeth speaks in riddles and without apprehension of her surroundings; both repeat key phrases in their deliriums with Lady Macbeth meditating on all the blood her and her husband have spilt; both return to the stage in their mad stage in the second half of the play after a prolonged absence; both their lives end in apparent suicides. The women of the play become “cultural scapegoats”[6 (p. 328)] as Lady Macbeth’s sex automatically acquaints her with the “so withered and so wild”[3 (1.3.38)] Weird Sisters. Conversely we sympathise with Macbeth, seeing him “not as the victim of a revengeful God, but as a victim of Macbeth himself”.[8 (p. xxii)] This is because Macbeth’s madness and feverish passion is seen as manly – at the start of the play even the strong Lady Macbeth expresses a desire to be “unsex[ed]”,[3 (1.5.39)] to possess the cruelty associated with ambition which her husband seemingly possesses.

The role of religion also plays an important part in the play. Although the theories of Enlightenment had started to permeate into society, religion and God still strongly influenced the way in which people interpreted their world. With this in mind it is possible to see the dramatic evolutions of Macbeth and his wife as religious punishments given due to breaches in their God-given consciences. It has been suggested that “the external phenomena associated with conscience manifest themselves more clearly in Macbeth and his wife than in any other of Shakespeare’s dramatic personages”.[8 (p. ix)] Madness aside, there are many Christian references throughout Macbeth . Lady Macbeth advises her husband to “look like th’innocent flower,/But be a serpent under’t”[3 (1.5.63-64)] in a reference to the story of Adam and Eve in the Garden of Eden. By counselling her husband to be a serpent she equates murder with its patron, the Devil. In preparation for the murder Macbeth reassures himself that Duncan’s ‘virtues/Will plead like angels”.[3 (1.7.18-19)] Lennox wishes that “a swift blessing/May soon return to this our suffering country”,[3 (4.1.48-49)] suggesting that holy salvation is needed to save Scotland from Macbeth’s unholy crimes. The fact that the Doctor advises Lady Macbeth “more needs…the divine than the physician”[3 (5.1.64)] has been used as evidence to suggest that “Shakespeare wanted us to view her condition as the result of remorse, as the outcome of her guilty conscience”.[8 (p. 15)] However this statement can be viewed in one of two ways – either the Doctor is aware that Lady Macbeth has committed unholy crimes and so needs spiritual retribution more than a medical solution; it could also suggest that the Doctor believes all cases of somnambulism to be spiritual in nature and so recommends a divine solution.

Perhaps this conflict between religion and science is indicative of Shakespeare’s own, confused beliefs. It is not impossible that he realised that “by constructing a language through which madness can be represented, the popular theatre facilitated the circulation of the discourse; by italicizing the language of madness, it encouraged its interrogation and transformation”.[6 (p. 338)] Especially true in the Elizabethan age this is particularly poignant today; theatre provides us with a way of interpreting health and disease – it allows us to be privy to people’s perceptions of illness and influences how the public view a certain disease.

THE EVOLUTION OF MADNESS: A CONCLUSION

As we develop new ways of understanding health and disease we have returned to old texts to apply our knowledge. This is especially true with regards to psychological illness, and Shakespeare’s work is often subjected to these new readings. You can chart the evolution of madness through critical interpretations of Macbeth ; the same applies for readings of depression in Hamlet or dementia in King Lear . On one hand it is interesting to consider why we do this – scientifically speaking quotes from Shakespeare do not count very highly on the ladder of evidence based medicine. I like to think it’s a question of human nature and empathy. We can be so affected by the actions of a fictional character that we are moved to tears or laughter; characters become real to us and we want to know why they behave the way they do, both to satisfy our human curiosity and to perhaps explain why we are so emotionally affected by fiction.

It is also interesting that many of the theories we have explored use the same quotes as evidence; one line can be interpreted in many different ways. Most of the authors considered have admitted this – human nature remains constant and we simply assign different labels to it. Perhaps madness has not evolved at all, but rather as a society we have outgrown one way of thinking and are eager to make our mark on the world by creating another; where better to find reassurance that what we believe is correct but in the great fictional works that define our society?

And what did Shakespeare mean when he described “a mind diseased”? Whilst every new reading brings something profound to a seminal work perhaps it is only by considering the historical and social context that we can fully appreciate what it was that the Bard was trying to convey. As much as we – as readers, critics, health care professionals – would like to diagnose his characters we should always remember that perhaps Shakespeare was simply being a writer and creating characters who would give good performances, characters which would appeal to the public’s expectations. Madness, like beauty is in the eye of the beholder: “in the drama, as in the culture outside it, madness is diagnosed by those who observe it”.[6 (p. 321)] Ultimately, readings and contexts aside, how we view a work of art is an inherently personal experience, influenced as much by our own lives as by society; perhaps it is enough that we feel something, rather than feel nothing at all.

• Porter R. Madness: A Brief History. Oxford: Oxford University Press; 2002
• Bossler R. Was Macbeth a Victim of Battle Fatigue? College English 1947; 8 (8): 436-438
• Shakespeare W. Braunmuller AR, editor. Macbeth. Cambridge: Cambridge University Press; 2008
• Tarantelli CB. “Till destruction sicken”: The catastrophe of mind in Macbeth. Int J Psychoanal 2010; 91: 1483-1501
• Norton SA, Paris RM, Wonderlich KJ. “Strange things I have in head”: Evidence of Prion Disease in Shakespeare’s Macbeth. Clin Infect Dis 2006; 42: 299-302
• Neely CT. “Documents in Madness”: Reading Madness and Gender in Shakespeare’s Tragedies and Early Modern Culture. Shakespeare Quarterly 1991; 42 (3): 315-338
• Fahey CJ [Internet]. Altogether governed by humours: The four ancient temperaments in Shakespeare. Graduate Theses and Dissertations 2008. URL: http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=1229&context=etd [Accessed July 2014]
• Toppen WH. Conscience in Shakespeare’s Macbeth. Groningen: JB Wolters; 1962
• Bloom H. Shakespeare: The Invention of the Human. London: Fourth Estate; 1998
• Schwartz DB [Internet]. Shakespearean Verse and Prose. Last Edited 2005. URL: http://cla.calpoly.edu/~dschwart/engl339/verseprose.html [Accessed 4th June 2013]
• Shea SE, Gordon K, Hawkins A, Kawchuk J, Smith D. Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A.Milne. CMAJ 2000; 163 (12): 1557-1559
• Bottomer PF. So Odd a Mixture: Along the Autistic Spectrum in ‘Pride and Prejudice’. London: Jessica Kingsley Publishers; 2007
• Spurgeon C. Shakespeare’s Imagery and what it tell us. Cambridge: Cambridge University Press; 2005
• Davis FM. Shakespeare’s Medical Knowledge: How Did He Acquire It? The Oxfordian 2000; 3: 45-58

Other sources:

Barroll JL. Artificial Persons: The Formation of Character in the Tragedies of Shakespeare. South Carolina: University of South Carolina Press; 1974

Bradley AC. Shakespearean Tragedy: Lectures on Hamlet, Othello, King Lear, Macbeth. 3rd Edition. London: Macmillan Press; 1992

Sarah Ahmed is a final year medical student at the University of Birmingham, UK

A version of this article will be presented at the 7 th Global Conference – Madness: Probing the Boundaries at Mansfield College, Oxford ( 5 th- 9 th  September 2014).

Correspondence to:  [email protected]

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The Role of Mental Illness in Macbeth

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Macbeth's mental decline, portrayal of mental illness, impact on the plot.

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Lady Macbeth's Mental Illness Analysis Essay Sample

Macbeth, written by William Shakespeare, is an English playwright based on the concepts of deception, treason, and the lust for power. The main character, Macbeth, goes on an exhausting journey of moral dilemmas, such as murder, to become the king of Scotland. However, it is not necessarily true that Macbeth was the sole perpetrator of these crimes, considering Lady Macbeth, his wife, was the true manipulator. She shamed Macbeth for not wanting to do it to begin with, making Macbeth look as if he is the weak one. Ironically, he is the one having second thoughts about assassinating King Duncan, when in reality, Lady Macbeth is demanding him to do so. Women are considered to be traditionally frail and dainty, and they are not expected to be aggressive. The ideology of women being incapable of committing a heinous crime has been entrenched in our society through historical events of feminine hysteria. In this instance, Lady Macbeth becomes a “supporting character”, and her descent into madness is not taken nearly as seriously as Macbeth’s. She is left with the pressure of having murdered innocent people, and not even being acknowledged for it, up until the point of committing suicide. In William Shakespeare’s Macbeth, the hypersexuality and feminization of Lady Macbeth is contrasted with the masculinity of Macbeth, providing an idiosyncratic experience of her further descent into madness.

One of the main reasons for the exaggeration of women and their psychological decline is caused by the historical context of their hysteria. In the Elizabethan era, any women who were considered non-conformative or peculiar were considered witches. Then, during the Renaissance period, it was a popular belief that madness and uncanny evil was created by supernatural forces. As the sixteenth century continued, some of these ideas proved to be untrue. However, the majority of these stereotypes remained, and still affect our society today. In William Shakespeare and the Representation of Female Madness, Maria Isabel Barbudo believes that, “Association of madness with femininity existed prior to the 19th century, but it was in the Victorian era that women were more likely to be incarcerated in asylums, and ‘mad women’ came to dominate representations of madness.” Many women felt it was necessary to be in accordance with the rest of society. Anyone who was seen as an outlier, such as being queer, having a mental illness, or other differences, was shamed and not treated equally to the rest of society. Due to her anxiety of being an outcast, Lady Macbeth plays into these stereotypes, therefore disproving her own circumstances. This can be found when Lady Macbeth pleads for spirits to “unsex” her, and strip her of everything that makes her a woman (Macbeth I.V.47-50). Lady Macbeth wants to destroy her feminine characteristics, therefore giving her an opportunity to be seen as cruel and unusual without being questioned for it. However, this is paradoxical, because Lady Macbeth was far more fearless than Macbeth ever was.

Macbeth is treated as masculine and “ruthless”, majorly due to him being a man, while he was in fact “weaker” than Lady Macbeth. Macbeth, realistically, would not have been able to murder King Duncan do it without his wife. During the entirety of the play, Macbeth was hesitating as to whether or not he should kill him. Then, Lady Macbeth steps forward and scolds him, insulting him and calling him a coward, and as a result, he finally agrees. It is very evident that Macbeth is not as strong as he claims to be:

Madness enacts through the psychopathic behavior of the two main characters—Lady Macbeth and Macbeth himself. With her eyes fixed on the crown, she justifies Macbeth’s claim to it and devises ways to acquire it. [...] She instigates Macbeth into murdering Duncan to realize his long cherished dream of becoming the king. However, once Duncan is heinously murdered, both of them begin to show signs of madness. (Bali)

Lady Macbeth is equally as dedicated to becoming the queen as Macbeth. However, due to the lack of female representation of wickedness, it seems as if she is the issue. It takes an experienced level of coercion to manipulate someone into murdering one who is beloved and worshipped. Lady Macbeth manipulated Macbeth into killing Duncan, however, the rest of his descent into madness was based upon his own decisions (Vince.) As it has been proven, Lady Macbeth is more than capable of being able to murder someone on her own. However, she uses methodical and critical thinking in order to have Macbeth do it for her. The argument that women do not have the capability of being diabolical is unreasonable. The only rationale behind this concept is caused by the stereotypes of women and their “vulnerability.”

Women are often categorized as delicate and fragile, and are not expected to be dastardly or evil. If it were even suggested that a woman could potentially have a mental disorder, it would be automatically assumed that she would be quiet about her struggles. Her feelings would be portrayed through “silence and poetry” (Barbudo), whereas men would more likely have aggressive behavior. This can be conveyed through the contrast between Macbeth and Lady Macbeth. When Macbeth is described, he is portrayed as an ambitious and brave warrior who leads the Scottish troops into battle. Although Lady Macbeth can be conveyed as ambitious, her feminity overweighs the majority of her unique characteristics, since she is hypersexualized to an extent. In Mechanics of Madness in Hamlet, Macbeth and King Lear, Shweta Bali claims that “While Macbeth suffers from insomnia, Lady Macbeth starts sleepwalking. With growing signs of insanity, she appears less as an awful instigator of murder and more as a piteous, helpless woman.” This quote provides context behind the institutionalization of women and their descent into madness. When a male character, such as Macbeth, has psychological problems, it is seen as typical. However, when a woman endures the same obstacle, she is treated in an entirely different manner. These social patterns can cause uncertainty for women, and make them feel as if they are inferior to men.

Due to the historical context of women and psychopathy, women are seen as more dainty and soft-spoken than men. This is ironic because, in reality, there are thousands of women who could disprove this theory, Lady Macbeth included. Since Lady Macbeth was the manipulator in the play, Macbeth could not have murdered without her, therefore making her a strong contribution to the plot. When Macbeth was written, women were more susceptible to being admitted into an asylum, considering they were believed to be a witch, or supernaturally inclined. A feminist uprising has subsequently occurred, and there is more demand for women’s rights than ever. Women have been fighting this battle for hundreds of years, and although it does not compare to the thousands of lives that have ended due to mental illness, such as Lady Macbeth’s, it is still considered a new beginning for humanity. Lady Macbeth is treated as if she is inferior to Macbeth, and Shakespeare uses stereotypical strategies to portray her as if she is not capable of murder. Women and their psychological needs have been silenced due to the belief that women are gentle and loving, rather than evil or iniquitous. Even Shakespeare himself wrote, “Why then, alas, do I put up that womanly defence, to say I have done no harm?” (Macbeth IV.II 85-87) Furthermore, considering Macbeth is living in a time in which conveying women in a negative manner is somewhat appropriate, it is truly no surprise that women are considered “less than” men in modern-day society.

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