Chicago, Illinois, United States
The death of Cleopatra
For anyone with the temerity to write about Shakespeare, Virginia Woolf has this amusing warning: “Shakespeare is flyblown; a paternal government might well forbid writing about him…one may hazard one’s conjectures privately, make one’s notes in the margin; but, knowing that someone has said it before, or said it better, the zest is gone.”1 So it is at the risk of arousing that paternalistic censor that I dare to write about Shakespeare. My defense is that I write about Shakespeare only as a foil for my main subject, which is the nature of psychiatric practice. I believe that through the study of literature we can gain greater insight into the human condition. By way of illustrating this thesis, I take up the subject of psychiatric diagnosis; in particular, that diagnostic rubric known as “borderline personality disorder” and compare the traits of this disorder to those of Shakespeare’s Cleopatra.
Committees of distinguished psychiatrists labored for many decades to refine the diagnoses that constitute the official nosology of the American Psychiatric Association. From the earliest attempts at classification, resulting in the “Statistical Manual for the Use of Institutions for the Insane” (1917), to the latest of many incarnations of the Diagnostic and Statistical Manual of the APA, much thought and endless debate has preceded each publication. It is from this last document that I derive my definition of “borderline personality disorder.”2
The borderline patient is characterized by a pervasive pattern of instability in relationships, affect, and self-image, as well as marked impulsivity, as represented in at least five of the following nine criteria: (1) Frantic efforts to avoid abandonment, real or imagined, (2) a pattern of unstable and intense relationships, (3) identity disturbance, (4) impulsive, self-damaging behavior (such as promiscuity, substance abuse, recklessness), (5) suicidal behavior, (6) affective instability, (7) chronic feelings of emptiness, (8) inappropriate and uncontrolled anger, and (9) transient paranoia, delusions, or dissociative states. Remember, a patient need only exhibit five of the above symptoms to qualify for the diagnosis of borderline personality disorder.
What took a committee of distinguished psychiatrists decades to define, a single genius accomplished in the space of perhaps a month. I submit that in the character of Cleopatra, Shakespeare created the quintessential borderline. Consider Cleopatra, queen of Egypt, enamored of Antony, who has deserted the Roman triumvirate to attend to his love. In her first speech, act 1, scene one, Cleopatra begs Antony to tell her how much he loves her. She is love hungry, demanding that Antony describe the nature and extent of his love for her. Antony replies that his love knows no bounds. But when Antony receives a message from Rome, telling him that his wife, Fulvia, has died and remanding him home to join Octavius Caesar and Lepidus, Cleopatra flies into a rage. She castigates him as a liar; “thou, the greatest soldier of the world,/ Art turned the greatest liar.” (1.3.47–48) She is so egotistical, that when Antony informs her of his wife’s death, she thinks only of herself, saying, “Now I see, I see,/ In Fulvia’s death, how mine received shall be.” (1.3.77–78) And when Antony protests that he has shown “true evidence to his love” (1.3.89), Cleopatra replies snidely, “So Fulvia told me” (1.3.90), implying that she can not trust him to be faithful, as he has been unfaithful to his wife. Faced with what she deems abandonment by Antony, Cleopatra proclaims her emptiness; “O, my oblivion is a very Antony,/ And I am all forgotten.” (1.3.109–110) Her equilibrium depends upon her perception of Antony’s attitude towards her, “I am quickly ill and well;/So Antony loves.” (1.3.86–87) And when he is away, she obsesses about him. To her handmaiden, Charmian, Cleopatra laments,
Where think’st thou he is now? Stands he, or sits he?
Or does he walk? Or is he on his horse?
O happy horse, to bear the weight of Antony! (1.5.21–25).
Charmian, recognizing her obsession as symptomatic, chastens her, “You think of him too much.” (1.5.7).
In the first act, we are presented with a Cleopatra whose love, when threatened by a perceived abandonment, produces a scathing, sarcastic and enraged attack on the man she has just been extolling as the center of her world. Furthermore, we learn from Antony’s lieutenant, Enobarbus, that she has a long history of suicidal threats and behavior. “Cleopatra, catching but the least noise of this, dies instantly; I have seen her die twenty times upon far poorer moment: I do think there is mettle in death, which commits some loving act upon her”, says Enobarbus; he continues, “…she hath a celerity in dying.” On the subject of Cleopatra’s affective instability, Enobarbus also has something to say: “we cannot call her winds and waters sighs and tears; they are greater storms and tempests than almanacs can report.”
Shakespeare creates a Cleopatra who demonstrates affective instability, identity disturbances, a hunger for proclamations of love, feelings of emptiness at the prospect of being abandoned, an intense and unstable relationship with Antony, an extensive history of suicidal behavior, and uncontrolled anger in a frantic attempt to avoid being abandoned by the latest of her many lovers. Shakespeare’s Cleopatra is the quintessential borderline personality. Further evidence for this depiction of the Queen of the Nile comes in Act II, when a messenger arrives from Rome to inform Cleopatra that the widowed Antony has been married to Caesar’s sister, Octavia, in order to cement the political and military alliance between the two men. Before the messenger can even speak, Cleopatra assumes the worst, fearing that he bears news of Antony’s death; “Antonio’s dead! If thou say so, villain, Thou kill’st thy mistress.” (2.5.32–33) This anxiety, so extreme, demonstrating her feeling that she would be unable to exist in a world without Antony, is emblematic of the borderline. Learning that Antony is alive and well, Cleopatra offers the messenger gold; but subsequently, when informed that Antony has married Octavia, she flies into a rage and beats the messenger, sending him away. In act 3, Cleopatra recalls the now frightened messenger and questions him relentlessly about Octavia. How old is she, how tall, what is her coloration, what is the nature of her speech, and so on. Finally, when she is satisfied that Octavia is no match for her beauty and not a competitor for Antony’s love, she repents her previous behavior and again rewards the messenger with gold. Such emotional lability, shifting rapidly from fear to ecstasy to rage, and then contrition, is characteristic of the borderline.
Throughout the play, Cleopatra idealizes Antony, calling him “demi-Atlas of this earth” and “My man of men.” But as is typical with the borderline, those they idealize can instantly lose favor and come crashing down from their pedestals. Cleopatra’s ambivalence is clearly on display after she learns of Antony’s marriage. She says to her favorite courtier, “Let him forever go – let him not, Charmian.” (2.5.143); then she proceeds to compare him to both a Gorgon, the hideous mythological creature, the very sight of whom causes death, and to Mars, the heroic Roman god of war. But her idealization is so intense, her dependence on Antony so great, that when he dies, her world becomes empty and she seeks death in order to join him and be liberated from her “desolation.” Her encomium to the dead Antony reflects not only her idealization, but the beauty of Shakespeare’s poetry:
I dreamt there was an emperor Antony.
O, such another sleep, that I might see
But such another man. …
His face was as the heavens, and therein stuck
A sun and moon, which kept their course and lighted
The little O, the earth. …
His legs bestrid the ocean, his reared arm
Crested the world. His voice was propertied
As all the tunèd spheres. (5.2. 93–95, 97–100, 102–104)
How is it that Shakespeare could so accurately portray the borderline personality 350 years before it was first described by Robert Knight in 1953?3 Perhaps this is not so surprising or unusual, for Freud gave priority to the great writers in understanding the human mind. Freud wrote, “creative writers are valuable allies and their evidence is to be prized highly, for they are apt to know a whole host of things between heaven and earth of which our philosophy has yet let us dream. In their knowledge of the mind they are far in advance of us everyday people, for they draw upon sources which have not yet opened to science.”4 Compared with the two-dimensional, phenomenological depiction of the borderline of official nosology, Shakespeare’s Cleopatra is a vibrant, colorful, poetic creation, bringing to life the qualities that are too often lacking in psychiatric case histories.
It is for this reason, that when teaching residents and students of psychiatry, I advised them to read fiction. What better way to learn about vengefulness and delusional jealousy than to read Othello. To understand a guilt that is so great that it gnaws at the soul, one may read classics such as Crime and Punishment, Poe’s The Tell-Tale Heart, and Death and the Dervish by Meša Selimovic. The effects of shame and guilt on character can be discovered in Madame Bovary; and what better way to comprehend how addiction can destroy an entire family than by reading O’Neill’s Long Day’s Journey into Night. Would you know what delirium feels like? You can find a powerful description of this experience in Hunger by Knut Hamsun, or an amusing one in Evelyn Waugh’s The Ordeal of Gilbert Pinfold. The poetry of Emily Dickenson provides powerful insights into the emotions evoked in contemplating death and lost love. Nor can we neglect classic Greek literature, for let’s not forget that Freud derived the name of one of his greatest discoveries from a play of Sophocles. The list is endless and the possibilities limitless for understanding human psychology through literature. Those who labor to make psychiatry solely a scientific practice are not only on the wrong track, they are missing out on the beauty of the discipline. Celebrate psychiatry as an art that is informed by science, for in what other field of medicine can you read the classics of literature and say that you are simply “keeping up in your field”?
Note: All quotes are taken from the Folger Shakespeare Library edition of Antony and Cleopatra, edited by B. A. Mowat and P. Werstine, Simon and Schuster Paperbacks, NY, 2010.
- Woolf, Virginia; On Being Ill, Paris Press, Ashfield, Massachusetts, 2012.
- Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association Press, Arlington, Virginia, 1994.
- Knight, R. P.; “Borderline States”, Bulletin of the Menninger Clinic, 1953.
- Freud, S.(1907); “Delusions and Dreams in Jensen’s Gradiva”, The Standard Edition of the Complete Psychological Works, IX, Random House and the Hogarth Press, London, 1995.
JONATHAN D. LEWIS, MD, now mostly retired from the private practice of psychiatry, formerly served as clinical assistant professor of psychiatry at the University of Illinois School of Medicine from 1977–1992. Subsequently he specialized in the treatment of refugees as Medical Director of Asian Human Services of Chicago, and consultant to the Chicago Health Outreach Refugee Mental Health Clinic of the Heartland Alliance, the Marjorie Kovler Center for the Treatment of Survivors of Torture, and in private practice.