MEDICAL MATTERS:Shakespeare identified a very modern condition
SHAKESPEARE WAS a master at portraying profound emotional upset in the physical symptoms of his characters, a recent analysis of his works claims.
Kenneth Heaton, a medical doctor and published author on the Bard’s oeuvre, analysed 42 of Shakespeare’s major works and 46 of those of his contemporaries, looking for evidence of psychosomatic symptoms.
He found that Shakespeare’s portrayal of symptoms such as dizziness/faintness, and blunted or heightened sensitivity to touch and pain in characters expressing profound emotions, was significantly more common than in works by other authors of the time.
Vertigo, giddiness or dizziness is expressed by five male characters in The Taming of the Shrew, Romeo and Juliet, Henry VI part 1, Cymbeline and Troilus and Cressida. And there are at least 11 instances of breathlessness associated with extreme emotion in Two Gentlemen of Verona and Troilus and Cressida, and in the poems The Rape of Lucrece and Venus and Adonis, compared with just two in the works of other writers.
Meanwhile, fatigue and weariness as a result of grief or distress is a familiar sensation among Shakespeare’s characters, most notably in Hamlet, The Merchant of Venice, As You Like It, Richard II and Henry IV part 2.
Dr Heaton concludes that his data shows that Shakespeare “was an exceptionally body-conscious writer”, suggesting that the technique was used to make his characters seem more human, to engender greater empathy, and to raise the emotional temperature of his plays and poems.
I wonder what Shakespeare would have made of post-traumatic stress disorder (PTSD)? First recognised as a diagnosable psychiatric disorder in the 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), its very existence continues to attract debate, with several experts arguing that culturally determined, understandable emotions to traumatic events are being pathologised. The Vietnam War was a major trigger in recognising the condition, although military doctors in the first World War described a similar constellation of symptoms as shell-shock.
More recently PTSD has been recognised as one of the sequelae of civil disasters and in victims of rape. Our knowledge of the neurobiology of PTSD has been helped by advances in neuro-imaging and neurophysiology. An almond-shaped structure in the brain called the amygdala receives information about external stimuli which in turn triggers emotional responses including our “fight or flight” response. Other areas of the brain – the hippocampus and medial prefrontal cortex – influence the response of the amygdala in determining the final fear response.
A current theory is that post-traumatic stress disorder represents a failure of medial prefrontal and anterior cingulate networks to regulate the activity of the amygdala, which results in hyper-reactivity to threat. This in turn causes a spike in stress hormones in the body; it has been suggested that this initial surge of chemicals may be associated with the consolidation of traumatic memories.
But an uneasiness around the diagnosis persists. DSM-IV has an extensive checklist approach to the diagnosis, leading some sceptics to suggest that those interested in pursuing compensation for psychological upset use these items to spin a story for examining psychiatrists. Then there are social, cultural and political aspects of the surge in PTSD diagnoses to consider.
The new vulnerability of men allied with a compensation culture undermines a more traditional military heroism; to what extent this has contributed to the 200,000 or so US troops who have returned from Iraq and Afghanistan with a diagnosis of PTSD remains to be seen.
What about PTSD treatment? Unsurprisingly, given the shifting cultural and diagnostic sands, this too has been somewhat controversial. Psychological treatments such as trauma focused cognitive behavioural therapy (CBT) and eye movement desensitisation are the first-line treatments.
Anti-depressants may be helpful in those with a secondary depression. And who knows – in the future perhaps some bibliotherapy in the form of well-chosen plays by Shakespeare may help PTSD sufferers.