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MEDICAL WRITINGS

A Physician's Hamlet

right arrow John F. Burnum, MD

1 March 1997 | Volume 126 Issue 5 | Pages 412-414


As a young man, I thought of Hamlet as a reflective, vibrant fellow student-and sometimes fearless swordsman-tragically victimized by circumstances. Returning to the play these years later, I feel that I must give some answer to a troubling question: Why does my erstwhile hero delay in killing the seemingly guilty Claudius for the murder of Hamlet's father, the former king, when prompt action might have preserved Hamlet's father's dynasty and saved seven of eight persons from death? Given my viewpoint as a physician, my answer comes from thinking about the play as a work that centers on problem solving and moral choice, on Hamlet's agonizing efforts to resolve his suspicion that Claudius is guilty and to decide whether he has the right to kill Claudius in revenge. In his "diagnostic quest," Hamlet must struggle with self-doubt, high risks, political restraints, ambiguous clues, and his own selfish aims-obstacles not unknown to us practitioners.


Hamlet's Controversial Delay
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Many thoughtful minds have long held that Claudius' guilt is obvious and that Hamlet should be held responsible for the tragic consequences of his delay [1-5]. The play opens with Hamlet, Prince of Denmark, grieving over the death of his father and bitterly resentful of Claudius's rapid acquisition of his father's throne and compliant wife; Hamlet's feelings are summed up in the famous phrase "something is rotten in the state of Denmark." Hamlet is soon confronted by his father's ghost, who confirms Hamlet's suspicion that Claudius murdered him and swears the enraged Hamlet to bloody vengeance. But Hamlet disconcertingly turns away from his pledge and lapses into paralyzing introspection.

The litany of proof against Claudius grows as Hamlet catches him and his agents, Rosencrantz and Guildenstern, spying on him and sifting him for what he might know about the venal king. Polonius, the Lord Chamberlain, colludes with Claudius to protect his daughter, Ophelia, from her dalliance with the prince. Isolated and hounded from all sides, Hamlet rejects Ophelia; she later drowns herself.

Wishing to dispel any lingering question in his mind about the king's guilt, Hamlet arranges to have a play presented before the court that mimics the circumstances of his father's death. As Hamlet had anticipated, Claudius panics during the murder scene, a sure sign of guilt. All doubts erased, Hamlet crows to his friend Horatio that he is now set to kill the king-but once again, he strangely does nothing. Later, Claudius confesses his guilt while at prayer.

While berating his mother, Gertrude, for her unseemly second marriage, Hamlet hears a noise behind the arras and, without thought, stabs blindly through, killing Polonius by mistake. While Hamlet is under court arrest, Claudius sends him on a sea voyage to England and secretly arranges to have him executed upon arrival. Taking the scheme as more proof of the king's culpability, Hamlet uncovers the plot and escapes. Upon returning safely to Elsinore, Hamlet, to our astonishment, decides to give up his vendetta with Claudius. Finally, Laertes, furious over the death of his sister, Ophelia, joins the king in a plot to kill Hamlet in a supposedly friendly fencing match. Laertes's rapier is tipped with poison, and a cup of poisoned wine is ready for the unsuspecting, thirsty Hamlet to drink. Claudius's treachery is exposed for all to see. Too late, Hamlet kills Claudius; it seems as if he must have been crazy not to have acted sooner.


Why Hamlet Delayed
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Personal Factors and Political Risks

I cannot absolve Hamlet of all his misadventures. If I think of Hamlet as a problem solver, however, it appears to me that up to the point when he abruptly abandons his mission, his delay is justified. The impediments to Hamlet's inquiry come from within and without; they are inherent in both his character and his circumstances. Internally, Hamlet's initiative is mired down from its inception by his reluctance to confront evil-the king's, his mother's and his own. "The time is out of joint. O cursed spite that ever I was born to set it right!" Disheartened and disillusioned, he scarcely has the will to proceed. "To be or not to be," that is the question.

It has been said that Hamlet's delay is due to some corrosive murky defect of character [2]. Hamlet's dark side cannot be ignored, and yes, his periods of inertial reflection and melancholy compound his delay. But it is also true that both Hamlet's distemper and his delay result from and are appropriate to the dangerous, perplexing, and distasteful task that fate has thrust upon him.

Externally, Hamlet has to move with extreme caution because of the risks involved. "Divinity doth hedge a king," and to precipitously bring down a king, especially one that may be innocent, could wreck the social order [6]. The royal house is "a massy wheel which when it falls each small annexment, petty consequence, attends the boist'rous ruin." The king's guilt had to be proved to the hilt before Hamlet could act.

Uncertainty

Hamlet also delays because he is uncertain of Claudius's guilt. His rankling suspicion of the king is fanned into life by the ghost's testimony that Claudius murdered him. "O my prophetic soul! My uncle?" Hamlet cries. But Hamlet can never be sure that the ghost is not a demon tricking him into acting against an innocent man [7]. Searching for ways to test and strengthen his inferred diagnosis of guilt, Hamlet gives Claudius the play-within-a-play test. Seemingly caught in Hamlet's trap, Claudius panics, but Hamlet does nothing-even on discovering the king off-guard at prayer-giving as an excuse that killing him at prayer would have sent him to heaven. We do not know Hamlet's inner thoughts at this time, but as onlookers we can add that Claudius' behavior, indirect evidence as it is, strengthens the case against him but does not provide proof of guilt definitive enough to warrant killing a king. The king's blenching at the murder scene, for example, could reflect his distress at hearing Hamlet's sinister reference to the murderer in the play as the nephew of the king. The king's confession at prayer is not pertinent to the argument of guilt because neither Hamlet nor anyone else on stage hears it.

We cannot cite the king's probing and spying on Hamlet and his plots to kill him as corroborative signs of guilt, because-as the court thinks-they could just as well be acts of self-defense by the king, whether he is guilty or not. Claudius has every reason to believe that Hamlet is thirsting for his life. For the eavesdropping king to hear, Hamlet tells Ophelia, "I am very proud, revengeful, ambitious. Those that are married already-all but one-shall live." Hamlet's identification of the murderer in the play as the nephew of the king is a chilling parallel for king and court to consider. Hamlet openly tells Rosencrantz the cause of his distemper: "I lack advancement [the throne]." Claudius knows that the blade that killed Polonius was meant for him. A final sign that might confirm the king's guilt occurs during the duel, when Laertes says, "The King's to blame." Not so, however, for Laertes refers to the king's treachery in arranging the match. Hamlet now has sanction to kill the king, but not because the king's guilt in the murder of his father has been established in Hamlet's mind. Only we, the audience, ever know that Claudius is guilty; the grapes of certitude are always suspended just beyond Hamlet's reach ... a situation that provides much of the tension and fascination inherent in the play.

Conflict of Interest

Interlocking with the other impediments to action, Hamlet's fear that his craving for the throne might undermine his right and ability to investigate Claudius's guilt causes Hamlet to delay. More than anything, Hamlet wants the king dead and out of the way: "he that hath kill'd my King and popped in between the election and my hopes." The throne would be his and "the royal bed of Denmark [would no longer] be a couch for luxury and damned incest." Hamlet also wants and needs the king to be guilty in order to justify his own self-serving, rampant ambition.

Aware of his bias and not wanting to give way blindly to his baser nature, Hamlet delays while he tries to determine which course to take. "Prompted to ... revenge by heaven and hell," is he to serve divine justice or an evil personal thirst for power [8]? Can he trust the ghost, or is the ghost a spirit from hell, a demonic projection of his consuming ambition, a devil who "abuses [deceives] ... to damn?" The play's the thing, but if the king's guilt does not come out in one speech, "it is a damned ghost that we have seen, and my imaginations are as foul as Vulcan's stithy."

Transformation

In a surprising about-face, Hamlet returns from his sea voyage spiritually transformed-calm, resigned, and self-assured-for he has decided that it is heaven's prerogative, not his, to determine the guilt and fate of the king. "There's a divinity that shapes our ends, rough-hew them how we will." This vision had been evolving in his mind from the time he killed Polonius ("heaven has pleased it so ...") and was strengthened by his miraculous escape from death on the voyage. Relieved of the burden of decision making, Hamlet now stands aside and peacefully accepts whatever is to come ("There's a special providence in the fall of a sparrow," "what will be will be," "the readiness is all"). He goes to his death bravely in the fencing match with Laertes and in "perfect conscience" kills the king in self defense, not for evil personal gain, nor because he knows that Claudius is guilty, but because the king poisoned his wine and Laertes's foil [9].


Epilogue
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From my perspective as a diagnostician, I find that Hamlet-for the greater part-justifiably delays in indicting Claudius because he resents having to abandon his halcyon student days for an engagement with evil, because awesome risks are involved in questioning the divine authority of a king, because he is uncertain about the king's guilt, and because he is concerned that his jealousy and passion for the throne cause him to judge Claudius unfairly. If he were to kill Claudius out of hate, Hamlet would himself be damned. I have difficulty, however, with Hamlet's eventual abdication of his mission and his shifting of the responsibility for the king's fate to providence. In practice and in life, we problem solvers do not have the option of disengagement. We are obligated to make decisions, no matter how dangerous and problematic, and we must do so with full knowledge and with proper control of our conflicts of interest.

I thus have mixed feelings toward Hamlet. Professionally, I approve of his delay but question his right to abandon his undertaking. However, on a personal level (his misadventures not withstanding), after all these years, he still has my sympathies-who can resist his salt-and-pepper sensitivity and panache? Furthermore, we physicians have much in common with Hamlet: onerous thankless assignments, political restraints on our decisions, uncertainty and danger at every turn, the pitfalls of wresting decisions from ambiguous information, and the need to adjust our actions to allow for consequences. Ambition and envy lash us toward fame and fortune, to become chiefs ourselves-the old king must die, as we will in our time. Thus we, too, are familiar with self-serving bias.

From the romanticized Hamlet of my youth I have fashioned Hamlet the beleaguered diagnostician-decision maker. In searching for the definitive meaning of Hamlet, I have looked into the play as a mirror held up to nature and have found over time my mutable, evolving self. As we change, what we make of the world around us changes. Indeed, fast entering my old king days, I have intimations of a budding identification with Claudius. Heaven forfend that I am led to turn this "smiling, damned villain" into a hero.

Rest well sweet prince.

Though hosts of scholars till the meaning of thy words,

Thy mystery never dies.

Each proclaims the answer's found,

But each in chains's perspective bound.


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Tuscaloosa, AL 35401
Requests for Reprints: John F. Burnum, MD, 400-C Bryant Drive E, Tuscaloosa, AL 35401.


References
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1. Wilson JD. What Happens in Hamlet. Cambridge, UK: Cambridge Univ Pr; 1956:200-1.

2. Bynum WF, Neve M. Hamlet on the couch. In: Bynum WF, Porter R, Shepherd M, eds. The Anatomy of Madness: Essays in the History of Psychiatry. New York: Tavistock Publications; 1985:289-304.

3. Levin H. Interrogation, doubt, irony: thesis, antithesis, synthesis. In: Bevington D, ed. Twentieth Century Interpretations of Hamlet: A Collection of Critical Essays. Englewood Cliffs, NJ: Prentice-Hall; 1968:73.

4. Braddy H. Hamlet's Wounded Name. 2d ed. Amsterdam: Rodopi NV; 1974:1-5.

5. Gottschalk P. The Meanings of Hamlet. Modes of Literary Interpretation since Bradley. Albuquerque, NM: Univ of New Mexico Pr; 1972:25.

6. Wilson JD. What Happens in Hamlet. Cambridge, UK: Cambridge Univ Pr; 1956:49.

7. Gottschalk P. The Meanings of Hamlet. Modes of Literary Interpretation since Bradley. Albuquerque, NM: Univ of New Mexico Pr; 1972:142-8.

8. Shakespeare W. The Tragedy of Hamlet Prince of Denmark. Boston: Ginn; 1939:204.

9. Bertram J. The theme. In: Bevington D, ed. Twentieth Century Interpretations of Hamlet: A Collection of Critical Essays. Englewood Cliffs, NJ: Prentice-Hall; 1968:93-103.



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