King Lear
by William Shakespeare
The tragedy King Lear was originally drafted by William Shakespeare in 1605.
The main plot revolves around the 80 year-old widowed King Lear, who intends to pass on the cares and responsibility of monarchy to his three daughters.
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As other plays by Shakespeare, King Lear has been a favourite source of clinical observations and diagnoses for psychiatrists for the past two centuries. Indeed, when examining Shakespeare’s characters from a psychiatric / neuroscientific perspective, King Lear is one of the most interesting ones. Throughout the plot, signs of King Lear’s “mental illness” are revealed.
Some literary analyses attribute his symptoms to schizophrenia or depression. However, it seems like above all, Lear’s symptoms fit with dementia.
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Dementia is a broad umbrella term, which describes a range of progressive neurological disorders that include a set of symptoms such as memory loss and difficulties with thinking, problem-solving or language, and may also include changes in mood or behaviour. These changes are caused when the brain is damaged by diseases, such as Alzheimer’s disease or a series of strokes.
We watch Lear as he goes through the steps of dementia, beginning with his daughters acknowledging that something changed in their father’s behaviour:
REGAN:
'Tis the infirmity of his age: yet he hath ever
but slenderly known himself.
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GONERIL:
The best and soundest of his time hath been but
rash; then must we look to receive from his age,
not alone the imperfections of long-engraffed
condition, but therewithal the unruly waywardness
that infirm and choleric years bring with them.
As Lear loses his sense of “self”:
KING LEAR:
Doth any here know me? This is not Lear:
Doth Lear walk thus? speak thus? Where are his eyes?
Either his notion weakens, his discernings
Are lethargied--Ha! waking? 'tis not so.
Who is it that can tell me who I am?
And witness his own realisation that something is wrong:
KING LEAR:
O, let me not be mad, not mad, sweet heaven
Keep me in temper: I would not be mad!
There are many different types of dementia and some people may present with a combination of types. King Lear’s symptoms mostly fit with Dementia with Lewy bodies (DLB), which is the second most common diagnosis of dementia after Alzheimer disease.
Lewy bodies are abnormal clusters of protein called alpha-synuclein. In normal conditions, this protein is essential for normal development of cognitive functions. However, in DLB it mutates to form little clusters inside brain cells and disrupt their function.
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More specifically, scientists believe that in DLB, Lewy bodies disturb certain brain cells that produce two important neurotransmitters ,which are chemicals that act as messengers between brain cells. The first neurotransmitter is called acetylcholine, and is important for memory and learning. The second neurotransmitter is called dopamine, and is important for behaviour, cognition, movement, motivation, sleep, and mood.
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King Lear exhibits cognitive and motor impairments, irrational thinking, sudden mood changes, paranoia, hallucinations, delusions, and inability to recognize people he knows.
Here are just a few examples:
KING LEAR:
Arraign her first; 'tis Goneril. I here take my
oath before this honourable assembly, she kicked the poor king her father.
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Fool:
Come hither, mistress. Is your name Goneril?
KING LEAR:
She cannot deny it.
Fool:
Cry you mercy, I took you for a joint-stool.
KING LEAR:
Pray, do not mock me:
I am a very foolish fond 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;
For, as I am a man, I think this lady
To be my child Cordelia.
KING LEAR:
O, let me not be mad, not mad, sweet heaven
Keep me in temper: I would not be mad!
No doubt that Shakespeare’s detailed and deep observations of human behaviours allowed him to realistically capture the main features of dementia, and to impose them on Lear’s character. Or as Simon Callow put it: “Shakespeare wrote all there is that we need to know about dementia in King Lear”.
A) The large pink Circle is a Lewy Body within a Brain Cell. (B) The brown section to the left of the Lewy Body is normal brain pigmentation. (C) The nucleus, the cell's control center is to the far left of the cell. source: U.S. Department of Health & Human Services
Schematic drawing of a Lewy body
