Literary psychiatric observation and diagnosis through the ages: King Lear revisited

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Date: Mar. 2002
From: Southern Medical Journal(Vol. 95, Issue 3)
Publisher: Southern Medical Association
Document Type: Article
Length: 7,184 words

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ABSTRACT: Shakespeare's plays, and in particular King Lear, have been a favorite source of clinical observation and diagnosis for psychiatrists for the past two centuries. Most authors agree that the description of Lear's mental symptoms is remarkably consistent and close to life. This article summarizes previous attempts to diagnose the mental illness of King Lear, featuring, among others, such entities as mania, senile dementia, delirium, depression, and brief reactive psychosis, and offers a new diagnosis according to the modern diagnostic criteria, namely, bipolar I disorder, most recent episode manic, severe with psychotic features.

THE INTEREST of professional psychiatrists in the descriptions of insanity from Shakespeare's plays goes back in time 200 years or more. In England in 1795, Ferriar (1) recommended "Aretaeus . . . Shakespeare and Richardson" to "those who would gain a knowledge of the symptoms of madness from books." Bucknill (2) maintained in 1859 that "abnormal conditions of mind had attracted Shakespeare's diligent observation, and had been his favorite study," stating also that "on no other subject . . . has he written with such mighty power." In America, such prominent psychiatrists of the 19th century as Brigham, Ray, and Kellogg published articles and books on the diagnosis of mental diseases from the works of Shakespeare. All these authors, reviewing Shakespeare's insane characters, paid particular attention to the madness of King Lear.

In the 20th century, the play King Lear served as inspiration for numerous psychiatrists, psychoanalysts, psychologists, and gerontologists. Lear was used as a clinical case, an object of psychoanalysis, and a psychosocial model. The psychiatric diagnoses assigned to him show a remarkable variety. However, there seems to have been little communication between the authors who wrote on this subject. A review that would summarize the existing diagnostic ideas and a diagnosis in accordance with the most recent criteria are therefore in order.

Various reasons for the remarkable accuracy of Shakespeare's psychiatric descriptions have been proposed. Some authors, such as Kellogg, (3) attribute this accuracy to poetic inspiration; others, to his tremendous capacity for observation of life and for extrapolating the noticed facts to numberless ordinary and extraordinary situations, to synthesize an unmistakable "clinical picture" that would remain true to life throughout the entire existence of the characters on the pages of his plays. According to Bucknill, (2) "the peculiarities of a certain character being observed, the great mind that contains all possibilities within itself, imagines the act of mental transmigration, and combining the knowledge of others with the knowledge of self, every variety of character possible in nature would become possible in conception and delineation." Ray (4) stated that "Shakespeare, from a single trait of mental disease he did observe, was enabled to infer the existence of many others that he did not observe." The sa me author maintained that, contrary to the metaphysicians, who looked at the mind "in the abstract," Shakespeare looked at it "in the concrete," the logical result being the undisputed superiority of his descriptions. Along the same lines, Andreasen (5)...

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Gale Document Number: GALE|A84306312