Lessons from Shakespeare

For The Current World

One often hears from students that studying Shakespeare does not attract them and that between problems with understanding the complexities of the language and the dated plots and players, the plays have little relevance to contemporary life. I find that in my professional experience as a geriatric consultant with a masters in ethics, and my role as an ethics consultant and teacher, I often refer to Shakespearean plays and quotes. I find that in the current political atmosphere, especially in the United States and jurisdictions that have a modest or an extreme element of authoritarianism and anti-intellectualism in their cultural construct, there is a lot to be learned from Shakespeare. Once the language is deciphered, the beauty of the language continues to be a marvel to me and many generations of readers and attendees at live performances.

I was lucky. When I was a junior high school and high school student, we studied English literature including at least one of Shakespeare’s plays. I was also fortunate in that from my home in Brooklyn New York, it was possible to take a special bus to and from the Shakespeare festival in Stratford Connecticut and experience one of the plays in a live production. I recall that in junior high school we studied Julius Ceasar, one the bard’s most memorable plays. The Connecticut theatre was built in 1955 and through an act of arson was destroyed by fire in early 2019. Plans for the site and potential for the return of the theatre are still being discussed by the town’s administration with input from the local population state government. It opened with Julius Caesar, and I recall seeing it while in my latter years of junior high school or high school.

I think of the play when I watch the current American political system act out on its new approach to governing and choosing the next president of the United States. I am particularly reminded of Julius Caesar when I hear presidential hopeful and current governor of Florida Ron DiSantis. He embodies in my estimation the famous line from Julius Caesar when Caesar states the following about one of them, he believes is conspiring against him, “Yon Cassius has a lean and hungry look;/He thinks too much. Such men are dangerous.”

Cassius was recognized by Ceasar as being dangerous is one of the plotters in the assassination of Ceasar. After the emperor is assassinated by Brutus, stabbing him, Marc Antony says of Brutus’ act as “the unkindest cut of all”, being done by an apparent dear friend. In my estimation Di Santis embodies many of the attributes described in Julius Caesar by Shakespeare. Critics of the governor remark how poor his interpersonal skills are and how he seems to lake empathy or understanding of the human condition. When he talks about his approach to the southern immigration problem, he posits that he will according to a news story in the Augst 4, 2023 edition of the Guardian that he would” start slitting throats” on his first day in power. Sounds like he would have fit in nicely to a Shakespearean tragedy.

When colleagues or trainees of mine ask for my help in my ethics role to help address a complex family dynamic I often ask them if they have read King Lear. Most have not although some have. I then give them a short synopsis of the tragic dysfunction of the family: again king, three daughters, one of whom is clearly the honest and devoted one. Two daughters along with their husbands look forward to finding ways to disenfranchise the aging king, their father. Through acts of guile and the hubus of their father, Cordelia is disinherited and the king as downsized. His supportive entourage diminished by steps until he is lonely with almost none to support him. At the end in the true tragic sense, Cordelia, and her father die, but his devious daughters also come to an ignominious end. In my role as a medical ethicist and geriatrician I have often been asked to opine on legal cases in which there is a question of inheritance, and the story seems to always be the same in one form or another: the will is challenged by the childe (usually) who expects to be named only to find it is another sibling who unexpectedly the recipient of the proceeds is.

My role is usually trying to determine the mental capacity, by looking back at the evidence to determine whether the will could not have been legally changed when it was because of the likely state of non-capacity. In one case, a lawyer verified a change on a property deed in a person who was hospitalized, clearly delirious and signed of the property transfer in a state of legal incapacity. At the hearing the presiding judge, concurred that the new affidavit could not b valid, that the lawyer had nor acted in accordance with the rules of evidence and the original property transferee would be reinstated. The judge admonished the brother for is unethical behaviour.

The use of alcohol often play an important role in medical practice. There is question that alcohol, when imbibed in other than very moderate amounts can play havoc with one’s brain and liver, and frequently results in behaviours that can be dangerous of even lethal, is statistics from drunken driving fatalities sadly illustrate. Practitioners have learned that information is often insufficient to propel heaving drinkers, often referred to as alcoholics to change their practice and desist from drinking. I recall as a young medical student doing a month at a hospital in Bath in England, during my study days at the Dundee campus of the University of St. Andrews. I was working with a psychiatrist whose interests where schizophrenia and chronic alcohol abuse.

During an afternoon alcohol clinic one of his patients was counselled to enroll in AA to help him break his alcohol dependence. The patient said, “No problem, Doc, I can do this on my own, Believe me.” I call the look on the physician’s face as he scrunched up his eyes and said, “I’m telling you, without you joining AA, you don’t have a hope in hell of getting out of the mess you are in, and losing everything you have.” The patient, dropped his head a bit and said, “OK, I’ll do it if you feel so strongly about it.” The doctor said, “Believe me, I really know about this.” I had a feeling deep inside me, that the reason the physician could speak which such determination was that he had been through this personally. I never had the courage to ask him, but understood from many experiences in life, that if a physician has a personal experience with medical problems or tragedies, the fervor that goes into recommendations is clearly felt.  

The time I spent on the alcohol service reminded me of the wonderful dialogues in Shakespeare’s Macbeth, which I have often used to make a point about the effects of alcohol on human behaviour and performance. In Macbeth,  the Porter states that drinking alcohol provokes “nose painting, sleep, and urine.” He goes on to say that, “it provokes the desire, but it takes away the performance: therefore, much drink may be said to be an equivocator with lechery: it makes him, and it mars him; it sets him on, and it takes him off; it persuades him, and disheartens him; makes him stand to, and not stand to; in conclusion, equivocates him in a sleep, and, giving him the lie, leaves him.”  For physicians who are involved in dealing with patients who are experiencing among other things marital discord, alcohol is frequently identified as one of the culprits. Aggressive activity, especially related to sexual encounters and then disappointment when the alcoholic male experiences, erectile failure.

Another often forgotten characteristic of chronic alcohol abuse is the negative effects on the neurological system, especially the brain and the peripheral nerves. When I rotated through the Veteran’s Administration Hospital in Boston during my American internship, I saw relatively young patients with peripheral nervous disease caused by Beri Beri, due to severe vitamin B1 deficiency often an accompaniment of severe alcohol abuse. A colleague of mine, an expert in neurophysiology, while working in northern Ontario reviewed many patients diagnosed with Alzheimer’s dementia, who he was certain had in fact, alcoholic induced dementia. It was hard to differentiate with the diagnostic tools available, but the history was much more indicative of an alcohol causation than the usual gradually progressive course of Alzheimer’s dementia. I was asked to see a patient who was referred because of a gait disturbance and falls. He had seen several previous physicians who I presume failed to obtain his alcoholic history: as a high-level CEO he almost daily had lunch which included at least two shots of whisky and a half or more bottle of wine as well as wine with his evening meal. I clearly had a cerebellar ataxia which. A scan of his cerebellar region revealed marked atrophy. When I explained what I thought was the problem he said, “I only drank the best of whisky, Scottish single malt and the finest wines, usually imported.” He had been doing this for decades and never discussed it and as it seems failed to reveal it to the physicians that examined him. He agreed to stop drinking but was left with cerebellar ataxia for the rest of his life.

Sex and all its manifestations from love to lust is an important of the human condition and as would be expected is explored in many ways by Shakespeare. The bard’s description of how sex workers and non-marital sex partners are often viewed is expressed eloquently in King Lear, Thou rascal beadle, hold thy bloody hand!”
Why dost thou lash that whore? Strip thine own back;
Thou hotly lust'st to use her in that kind
For which thou whipp'st her. The usurer hangs the cozener.
Through tatter'd clothes small vices do appear;
Robes and furr'd gowns hide all.

In Macbeth, Malcom says to Macduff while speaking about Macbeth,

“But there's no bottom, none,
In my voluptuousness: your wives, your daughters,
Your matrons and your maids, could not fill up
The cistern of my lust.”

From Troilus and Cressida, Cressida says to Troilus,

“They say all lovers swear more performance than they
are able and yet reserve an ability that they never
perform, vowing more than the perfection of ten and
discharging less than the tenth part of one.”

During my military service in the Israeli service, a young lieutenant came to my office complaining of a discharge from his penis. When I informed him after microscopic examination of the discharged material, that he had gonorrhea, his initial response was, “That slut” to describe the participating young female soldier from another base with whom he had extramarital sex because as he said, “my pregnant wife will not satisfy me, and I couldn’t stand it any more.” Interesting and perhaps characteristic was that his first reaction was put the onus on this young soldier, lower in rank than he was, rather than looking into his own actions.

Family discord goes back as recorded history and is found in even the earliest texts. Many contemporary novels have as part of their core plot line, family strife. Tolstoy’s famous opening in his novel Anne Karenina captures it all, “All happy families are alike; each unhappy family is unhappy in its own way.” Nothing embodies family feud’s more dramatically and vividly as that between the in Romeo and Juliet. As clearly characterized by an on-line summary, “Capulet and Montague are the heads of two feuding families in William Shakespeare's famous tragedy Romeo and Juliet. Their blood feud brings about the deaths of the title characters when Juliet (the daughter of Capulet) and Romeo (the son of Montague) fall in love.

In Homer’s epic poem, the Iliad, the Trojan War which is the subject of the poem was precipitated by Paris, son of the Trojan King, and Helen, wife of the Greek king Menelaus escaped together to try. This marital offence resulted in a long lasting war, with many dead, which when it ended, resulted in Troy falling to the Greeks and Helen returning with her husband Menelaus to their home.

In Shakespeare’s Othello, “Iago is furious about being overlooked for promotion and plots to take revenge against his General, Othello, the Moor of Venice. Iago manipulates Othello into believing his wife Desdemona is unfaithful, stirring Othello's jealousy. Much like a tragic hero, Othello has fallen from the great heights of being a loving husband, an excellent warrior and a respected general. He allows jealousy and mistrust to get the best of him, which causes him to kill his wife and then himself, making him fallen.” This theme has been repeated from time immemorial and is often the core of many novels throughout the history of literature. Jealousy, as is known very well by lawyers, psychotherapists, and writers, is often the basis of couples’ dissolution, break-up of marriage, violent acts and numerous movies and plays. In George Elliot’s Middlemarch, the so-called hand from the grave allows the dead jealous Mr. Casaubon to continue to exert control over the options open to Dorothea, and the locus of that control is her property to prevent his widow from following her true love, but threatening to impoverish her should she follow through with her relationship with her true love Lydgate.

 As a physician it is important to go well beyond the standard clinical practice to recognize the person beneath the patient. It is often necessary to bring into the conversation the experiences of the physician beyond purely clinical comparisons to reach the patient. In my exploration of their life experiences, hobbies and travels I try and find areas of congruence. If they are from another country or culture, I try to draw on my own extensive travel experience to make a connection outside of the clinical realm. I often say I know a few words in many languages and a lot of words in few. Being able to greet the patient in their own language or wish them health in that language as the leave the office goes a long way in closing the gap between patient and doctor, to persona with some illnesses and doctor. It is important, satisfying, often full of humour and stories and I believe enhances the therapeutic alliance.