The Prince Is the Patient: A Shakespearean Tragi-Fantasy of Total Institutional Care

Abstract

In this chapter William Shakespeare’s tragedy Hamlet is reconceived as an allegory of one patient’s countervailing experiences of the total institution. Purposely confined in the secure environment of Denmark’s Elsinore Castle his step-father and institutional senior consultant Claudius unethically, and yet largely successfully, transforms the public perception of Hamlet’s mourning and melancholia over his father into psychoneurosis and violent insanity - his identity from princely protégé to mortified patient. However, Hamlet, whilst appearing to fulfil his diagnosis, actively engages in creative ways to find evidence that will prove that Claudius is his father’s murderer. Nevertheless, the patient’s increasing reluctance to see the world as the state institution sanctions it, gives the powers-that-be even more cause to treat his challenges as a threat to its integrity. Shakespeare’s play exposes the sickness of systems that vest power in a single individual and Hamlet’s case illustrates how unitary approaches to patient care disenfranchise the client whilst tragically disabling the expert service relational. The latter also illustrates how complicated mourning can be experienced as a difficult personal process of intra-psychic transformation. In addition, by playing out the tragic consequences of withholding or intentionally ignoring the real source of a patient’s disease, Hamlet’s case exemplifies the outcomes of labelling, casual diagnoses and inappropriate treatment. Threatened, rendered incompetent, and denied a say in his own healing process, Hamlet’s institutionally inconvenient condition provides him with opportunities for the kind of unsupervised self-analysis and experimentation that ultimately risks his life and those of the community. Hamlet reminds us that when distinctions between the roles of the patient and doctor become blurred and the institution becomes either overly self-protective of itself or focused upon its own projects rather those it serves, its judgement and capacity to ensure that its work is undertaken ethically and sympathetically becomes sadly diminished. Key Words: Doctor-patient relationship, Elizabethan, Erving Goffman, madness, psychoanalysis, Shakespeare’s Hamlet, total institution, tragedy, transpersonal, treatment.