- Kenneth W Heaton, retired reader in medicine
- Correspondence to: K W Heaton
- Accepted 21 November 2006
Objectives To determine how often Shakespeare's characters faint, fit, or die from extreme emotion; to assess Shakespeare's uniqueness in this regard; and to examine the plausibility of these dramatised events.
Design Line by line search through modern editions of these late 16th and early 17th century works for accounts of characters fainting, fitting, or dying while under strong emotion and for no other apparent reason.
Data sources All 39 canonical plays by Shakespeare and his three long narrative poems; 18 similar works by seven of Shakespeare's best known contemporaries.
Results 10 deaths from strong emotion are recorded by Shakespeare (three occur on stage); all are due to grief, typically at the loss of a loved one. All but two of the deaths are in the playwright's late works. Some deaths are sudden. Another 29 emotion induced deaths are mentioned as possible, but the likelihood of some can be challenged. Transient loss of consciousness is staged or reported in 18 cases (sounding like epilepsy in two) and near fainting in a further 13. Extreme joy is sometimes depicted as a factor in these events. Emotional death and fainting also occur occasionally in works by Shakespeare's contemporaries.
Conclusions These dramatic phenomena are part of the early modern belief system but are also plausible by modern understanding of physiology and disease. They teach us not to underestimate the power of the emotions to disturb bodily functions.
The diseases mentioned in William Shakespeare's works have been much discussed,1 2 3 4 5 but another category of bodily change of medical interest seems to have escaped comment—the symptoms and signs induced by strong emotion in his characters. My interest in this topic was aroused when, studying Hamlet, I was struck by the violence of the hero's reaction to his encounter with his father's ghost on the battlements of Elsinore. Hamlet's anguished words, “Hold, hold, my heart, and you, my sinews, grow not instant old, but bear me stiffly up” (1.5.94; act, scene, line in Norton Shakespeare6), seem to suggest that his heart was palpitating and his knees were buckling. The symptoms suggest a near-syncopal attack or, conceivably, a paroxysmal tachycardia causing a drop in cardiac output. Continuing my studies of Shakespeare's plays and poems, I came across similar episodes, often involving actual loss of consciousness, and even several cases of sudden death, all occasioned by strong emotion. This prompted me to search systematically for bodily changes induced by emotion in the characters created by Shakespeare in his plays and long narrative poems. To put the findings in context, I examined in the same way some works by other playwrights active in the first half of Shakespeare's career.
Using a modern, annotated edition of the complete works of William Shakespeare,6 plus a monograph of Edward III,7 I read over a 20 month period every line of the 39 canonical plays and the three narrative poems—Venus and Adonis, The Rape of Lucrece, and A Lover's Complaint—mostly in chronological order, and systematically recorded every mention of a physical symptom or sign occurring in a character who was clearly experiencing strong emotion. Elsewhere, I have dubbed these phenomena “flags of feeling.”8 They cover many systems of the body and, between them, attest to the playwright's acute awareness of the way the human body responds to emotion. Here I report the most dramatic of Shakespeare's flags of feeling: faints, fits, and death.
For context, I made a similar study of 18 works by playwrights active before 1600 (that is, contemporaries of Shakespeare who were least likely to show his influence). These were Christopher Marlowe (his six extant plays and the narrative poem Hero and Leander), John Lyly (Endymion, Gallathea, and Midas), Robert Greene (Friar Bacon and Friar Bungay and James the Fourth), John Marston (Antonio and Mellida and Antonio's Revenge), Thomas Lodge (The Wounds of Civil War and the prose romance Rosalynd), Thomas Dekker (The Shoemaker's Holiday), and Thomas Kyd (The Spanish Tragedy).
I searched in the chief sources of four plays for any mention of the deaths or faints featured in that play: for King Lear, the anonymous 1590 play The True Chronicle History of King Leir and his Three Daughters; for Antony and Cleopatra, Thomas North's translation of Plutarch's Life of Marcus Antonius; for Julius Caesar, Plutarch's Life of Julius Caesar; and for As You Like It, Thomas Lodge's Rosalynd.
In identifying the characters' emotions and their causes, I relied on a close reading of the text, informed by a Darwinian approach to the nature and nomenclature of emotion.9 10 I resolved obscurities in Shakespeare's texts by reference to other editions of his works (Arden, Oxford, New Cambridge) and to a compendium of Shakespeare's unfamiliar and misleading words.11
Among several hundred flags of feeling in the works of Shakespeare, I discovered 10 instances of non-violent death in characters who, as far as one can judge, were not physically ill but were under severe emotional stress (table 1⇓). They are a varied group, including women and men, a child, and a very old person. The one common factor is their emotional state—extreme grief. At least four of the deaths (those in King Lear and Antony and Cleopatra) are sudden, and three of them occur on stage. None of them is mentioned in the plays' chief sources.
Death as a possible consequence of extreme emotion is mentioned in the dialogue on 29 occasions (see extra table on bmj.com). Grief predominates again, but Shakespeare's characters believe other emotions besides grief to be potentially fatal: fear on two occasions, both in early works; anger on two occasions, both in late works; and even joy on two occasions, also in late works. The cause of this destructive joy is, in both instances, the recovery by an ageing father of a lost daughter, believed dead.
Table 2⇓ shows the 18 occasions on which a Shakespearean character transiently loses consciousness while under extreme emotion. The incident is most often described—in a stage direction—as a character falling to the ground, with rapid recovery (seven occasions). The word “swooning” is used in six instances, “fainting” in five, and “trance” in two. In five cases, the onlookers at first think the person collapsing has died, but usually the episode is made light of, and twice it is dismissed as “womanish.” In the case of King Henry IV, the faint begins with dimmed vision and giddiness, consistent with simple syncope (but, unlike all the other characters, he had been ill for a long time). With Julius Caesar and Othello, the illness seems to be epilepsy: Julius Caesar is said to foam at the mouth and to be prone to “the falling sickness,” an old name for epilepsy; with Othello, epilepsy is confidently diagnosed by another character (Iago).
Emotion is explicitly blamed for the faint in six cases; with Gloucester in King Lear it seems to be the expectation of death. The responsible emotions vary—grief is the most common (table 2⇑), but positive emotions are present in the list (joy and excitement).
Rosalind's spectacular faint on seeing Orlando's bloody napkin in As You Like It does not occur in the source work. Julius Caesar's epileptic fit on being offered the royal crown of Rome is not to be found in Plutarch's Life of Julius Caesar.
Near-fainting is described or mentioned on 13 occasions. The causes are again varied: fear (three cases); shame (three); grief (three); and anger, joy, excitement, and sexual desire (one case each). Facial pallor is described in one case (Love's Labour's Lost 5.2.392); in another, people close to others who are fainting are said to change colour (The Winter's Tale 5.2.80).
Among the 18 works by Shakespeare's contemporaries, I found one actual death and seven imagined deaths from emotion. These are mostly from grief but also from fear and anger and, in two cases, from excessive joy (in Endymion and Antonio's Revenge). I also found three actual faints and one imagined one: two from grief and two from sexual desire (those in Endymion and Hero and Leander).
This study has revealed a remarkable propensity for Shakespearean characters to die or faint, or to speak of these things as likely to happen, as a result of extreme emotion (or passion as it was called then). All but two of the 10 actual deaths, and all three of the staged deaths, occur in plays written towards the end of the playwright's life. Late plays are the only ones in which a major character dies in this way, and the play containing the most talk of death from emotion is Shakespeare's last but one solo work (Cymbeline). All this might prompt the speculation that, in his later years, Shakespeare was already contemplating his own demise, even though he was still in his 40s (he died at the age of 52, for unknown reasons).
Besides actual deaths, Shakespeare's characters often speak of dying from strong emotion as a possibility, even a probability. Did Shakespeare himself believe that people die as a result of intense emotion, especially grief? The speaker in Sonnet 45 clearly does so: “My life . . . Sinks down to death, oppressed with melancholy;” but a poem's speaker does not necessarily represent the poet himself. In the person of Rosalind, Shakespeare mocks the idea that a man can die of unrequited love: “The poor world is almost six thousand years old, and in all this time there was not any man died in his own person . . . in a love cause” (As You Like It 4.1.81). Some of the claims of likely death in the table on bmj.com should be taken with a pinch of salt as poetic hyperbole or the fumes of an overheated romantic brain, but many cannot be so easily dismissed. Sometimes with Shakespeare, grief becomes fatal only when it is intensified by shock or horror, as in the experience of Lear.
The joy of Pericles and Cymbeline on recovering their daughters is so intense that they fear it might kill them. Shakespeare himself had two daughters, whose health must have caused him deep concern after his only son Hamnet died at the age of 11 in 1596. Elsewhere, an excitable young man (Troilus) is portrayed as being so anxious about his first love assignment that he fears dying through excess of pleasure. However, in Elizabethan slang, dying could mean orgasm. Christopher Marlowe is quite explicit that his fully aroused heroine faints at the entrance of her lover (Hero and Leander Sestiad 2.2).
Sudden non-violent death does occur in young people as well as older ones. Sometimes a cause is not found at autopsy, but recently a group of diseases has been identified that are believed to explain 30-40% of sudden deaths in young adults. These “ion channelopathies” affect the electrical functioning of a structurally normal heart. One of them, long QT syndrome, can cause sudden death “when a person is startled or suddenly awoken from sleep,” and catecholaminergic polymorphic ventricular tachycardia is liable to occur “while the person is exerting themselves or suffering emotional stress.”12 Extreme emotion can also lead to sudden death in people with subclinical cardiomyopathy or ischaemic heart disease, probably because of a ventricular arrhythmia caused by an outpouring of catecholamines. Such an outpouring can certainly lead to heart failure from myocardial stunning, even in people with apparently normal hearts.13
Knowing none of this, Shakespeare realised that extreme emotion can have powerful, indeed dangerous, effects on the human body. In this respect he was not unique. In Greek mythology, which pervades early modern writings, extreme emotion could lead not only to madness but also to a physical transformation (or metamorphosis), which, arguably, is akin to death. The fatal effects of too much joy, as well as too much fear, were described by the 10th century Arab physician, Haly Abbas.14 These effects must have been familiar to Elizabethan dramatists because, in Antonio's Revenge of about 1601, Andrugio is mendaciously reported as dying from the “vast delights of his large sudden joys.”14 In the play, these supposed joys follow a period of extreme anxiety, a mixture of positive and negative emotions that was considered especially dangerous. A similar mixture kills Gloucester in King Lear, where “his flawed heart—alack, too weak the conflict to support!—'twixt two extremes of passion, joy and grief, burst smilingly” (5.3.309). Lear himself dies in a state of alternating despair and hope for the life of his beloved Cordelia.
Some of Shakespeare's deaths were not sudden. Leontes attributes the fatal illness of his son Mamillius to shame at the “dishonour” of his mother, but the royal servant is surely nearer the truth when he speaks of the child's fear for the fate of his unjustly imprisoned mother (3.2.144). In the other delayed deaths, the grief is explicit. Its cause is always the loss of a loved one and this loss is occasioned by rejection, banishment, imprisonment, and disappearance, as well as by bereavement.
Modern research has proved that mortality is increased among recently bereaved people.15 Whether emotional upset or the stresses of life without the loved one matters more is debated; Shakespeare seems to have had no doubt on this score. For example, a doubly bereaved father “took such sorrow that he quit being” (Cymbeline 1.1.38). Psychologists speak of the broken heart hypothesis, and bereaved people are indeed especially liable to a cardiac death.15 One argument for the broken heart hypothesis is the increased incidence of suicide after bereavement and here, again, Shakespeare has something to contribute, in the reported fates of Lady Macbeth and Lady Constance (table 1⇑).
Shakespeare recorded fainting under strong emotion on 18 occasions. Nowadays called vasovagal syncope, this often causes myoclonic jerks, easily misdiagnosed as epilepsy.16 Emotional fainting is quite common, and its mechanisms are familiar—vagal bradycardia and hypotension from peripheral vasodilatation. However, swooning in public still evokes wonder, if not alarm. In the theatre, a character “fainting” on the stage is an effective way of raising the emotional temperature. In Greene's James the Fourth, the Queen of Scotland faints at the news of her husband's likely death, crying “Help, now help, a sudden qualm assails my heart.” In Marston's Antonio's Revenge, the Duchess of Genoa swoons when she hears that, contrary to what she had just been told, her missing husband is dead (another case of contrary emotions in dangerously quick succession). In the same play, the heroine Mellida swoons at the (false) news of her beloved Antonio being drowned and fails to recover consciousness; this was the one actual death from emotion that I came across in the works by Shakespeare's contemporaries.
Shakespeare had no hesitation in going for dramatic effect by adding a death, a fit, or a faint to a play when this was absent from his source material, even with overtly historical plays such as Julius Caesar and Antony and Cleopatra. He may even have been more prone to include such “flags of feeling” in his work than other writers of his day, but this survey can do no more than hint at this.
Does Shakespeare, with his unique insights into the human condition,17 have a message for today's doctors? I think he does: never underestimate the power of the emotions to disturb bodily functions.
What is already known on this topic
Many medical allusions occur in the works of Shakespeare
Shakespeare's works are full of strong emotions
What this paper adds
Strong emotions sometimes have dramatic physical effects on Shakespeare's characters, including fainting, fitting, and sudden death
These emotions can be positive ones, including joy and sexual desire
Shakespeare reminds us that emotion can drastically change bodily functions
An extra table is on bmj.com
Competing interests: None declared.