I had the privilege of seeing Hamlet last night at Shakespeare in the Park. I say the privilege because the production was as usual excellent. For those of you who don't know, it is a New York tradition for the Public Theater to host plays by Shakespeare -- usually two -- over the summer free to the public. The production attract competent and relatively famous actors. This year, they decided to do Hamlet which they apparently haven't done for more than 30 years when Sam Waterston played the lead. Sam Waterston is back as Polonius. Michael Stuhlbarg plays the lead, and Lauren Ambrose -- the woman from Six Feet Under -- plays an exquisite Ophelia. The scenery and directing is excellent. Actually my only complaint was that Laertes was a bit over the top, but that is to be expected: Hamlet did kill his father.

Anyway, while watching, I remembered the absolute wealth of science and particularly neuroscience related lines in Shakespeare. Take Hamlet in Act III, Sc. IV as he confronts his mother:

Ham. Assume a virtue, if you have it not. 180
That monster, custom, who all sense doth eat,
Of habits devil, is angel yet in this,
That to the use of actions fair and good
He likewise gives a frock or livery, 184
That aptly is put on. Refrain to-night;
And that shall lend a kind of easiness
To the next abstinence: the next more easy;
For use almost can change the stamp of nature, 188
And master ev'n the devil or throw him out
With wondrous potency.

A perfect description of habit learning if I ever heard one and good advice for anyone attempting to amend their own vices.

This one in Act. V Sc. II made me think even more. Hamlet attempts to make amends with Laertes before they fight with rapiers:

Ham. Give me your pardon, sir; I've done you wrong;
But pardon 't, as you are a gentleman.
This presence knows, 152
And you must needs have heard, how I am punish'd
With sore distraction. What I have done,
That might your nature, honour and exception
Roughly awake, I here proclaim was madness. 156
Was't Hamlet wrong'd Laertes? Never Hamlet:
If Hamlet from himself be ta'en away,
And when he's not himself does wrong Laertes,
Then Hamlet does it not; Hamlet denies it. 160
Who does it then? His madness. If 't be so,
Hamlet is of the faction that is wrong'd;
His madness is poor Hamlet's enemy.
Sir, in this audience, 164
Let my disclaiming from a purpos'd evil
Free me so far in your most generous thoughts,
That I have shot mine arrow o'er the house,
And hurt my brother.

This is the essential problem of agency in psychiatry. On the one hand, we label those with mental illness as dis-eased -- separated from normal. Their acts are not their own. We recognize that there is such as a thing as criminal insanity. On the other hand, how do we respond to the middle cases? Cases of mental "illness" in which the patient clearly has something wrong with them but is not completely devoid of sanity abound: consider depression or bipolar disorder. There are lucid moments. Where do they end and the disease begins? And if they do something wrong, was it the disease or was it them or was it both?

Hamlet abdicates responsibility for killing Polonius and pushes that responsibility on madness, but we know that this is a half-truth. He wasn't entirely mad; it could have very well been Claudius behind the arras. I think this passage really gets at the ambiguity of assigning agency in mental illness. It also gets to the problem of Hamlet. Hamlet accomplishes his revenge, but he also drags several innocents down with him. He breaks Ophelia, kills Polonius, and drives Laertes to treachery. Is he culpable for these acts? Does the fact that he was wronged excuse them?

Interestingly, there is another passage that deals with this issue: the ambiguity about whether Ophelia's death was suicide or an accident. Here is Act V, Sc. I:

Laer. What ceremony else?
First Priest. Her obsequies have been as far enlarg'd 104
As we have warrantise: her death was doubtful,
And, but that great command o'ersways the order,
She should in ground unsanctified have lodg'd
Till the last trumpet; for charitable prayers, 108
Shards, flints, and pebbles should be thrown on her;
Yet here she is allow'd her virgin crants,
Her maiden strewments, and the bringing home
Of bell and burial. 112
Laer. Must there no more be done?
First Priest. No more be done:
We should profane the service of the dead,
To sing a requiem, and such rest to her 116
As to peace-parted souls.

Given the Christian obsession with distinguishing suicide from accidental death -- so as better to stamp one's grave as hell- or heaven-bound, I suppose...I have never really understood why the priest thought this was his job -- establishing agency is equally important.

So here's the weekend challenge for the more literary among you. I am looking for quotes from Shakespeare with direct reference to science or medicine. Any play will do. Try to avoid those passage dealing with the human condition; we've all heard plenty of those. Feel free to add in the comments any interpretive discussions you feel those passages require.

Cheerio and have fun!