12th Greek Australian Legal and Medical Conference
Samos, Greece 2009

KING LEAR - A study of the early onset of Alzheimer's Disease

The Hon. Austin Asche A.C., Q.C.

The pattern of tragedy.

The great theme of Shakespearian tragedy is the destruction of a basically good human being by some innate fault of character. This is elementary,because the opposite, that is, destruction of a bad person cannot be a tragedy. The interest then lies elsewhere in the way in which evil entraps itself. "Richard III" is the prime example. At his very first entrance he proclaims himself as "determined to be a villain" and proves it throughout the play. The fascination lies in his magnificently outrageous villainy, and his final defeat. There is nothing tragic in this triumph of good over evil. Tragedy lies in the triumph of evil over good.

Shakespeare was profoundly aware of this, and has even given us the recipe.

"So oft it chances in particular men
That, for some vicious mole ofnature in them,
... ... these men,
Carrying, Isay, thestamp ofonedefect,
Being nature's livery or fortune's star,
Their virtues else, -be they as pure as grace,
As infinite as man may undergo,
Shall in the general censure take corruption
From that particular fault."
(Hamlet)

Thus, Macbeth - a decent man - is destroyed by "vaulting ambition"; the noble Othello, by jealousy; and the brave Coriolanus, by pride. "Julius Caesar" gives us two, possibly three characters, undermined by excess of virtue, pride or jealousy. Brutus, the main character, (despite the title), falls because he believes too much in an ideal his fellow conspirators do not share; Caesar, because he has come to believe he is invincible; and Cassius, very much the lesser in nobility to the other two, nevertheless succumbs to a jealously unworthy of the man he could have been.

"Romeo and Juliet" may seem different as a tragedy more of circumstance than character, -"star crossed lovers"; but, even here, the impetuosity ofthe two leading protagonists contributes to their doom.

"The stamp of one defect" undermines the potential for goodness and greatness; and the individual and the world suffers.

The exception is "King Lear".

No "vicious mole of nature".

The opening scenes introduce us to a petulant, aging man, behaving erratically, stupidly and irrationally. He is dividing his kingdom to give one third to each of his three daughters; but takes away the share of his youngest daughter, Cordelia, and furiously banishes her, because she refuses to indulge him with the effusive and hypocritical praise employed by her elder sisters. But there is no suggestion that this outburst of eccentricity is merely the culmination ofsome basic flaw always present in his character. On the contrary, there is convincing evidence that, before the events which the play relates, he had been a noble, wise, monarch, revered and loved. The evidence is overwhelming because it comes from the three most honourable and honest members of his household, who have known and revered him all their lives.

Call, as first witness, the Earl of Kent, who immediately protests after Lear so furiously rejects Cordelia. Kent is astounded precisely because this is not the king he has known and loved.

"Royal Lear,
Whom I have ever honour'd as my king,
Loved as my father, as my master follow'd,
As my great patron thought of in my prayers"

Lear cuts him off -

"The bow is bent and drawn, make from the shaft."

But Kent persists. He is speaking out plainly in the face of obvious injustice, though he feels the sadness at having to contradict his master and friend.

"Let it fall rather, though the fork invade
The region of my heart: be Kent unmannerly
When Lear is mad".

In the later exchanges he fixes upon the only explanation he can think of. The noble Lear' s "hideous rashness" can only be explained by some serious illness.

"Kill thy physician, and the fee bestow
Upon the foul disease".

Kent's reward for his frankness is the sentence ofoutlawry. He has five days to leave the kingdom, and can be killed if he remains in it thereafter.

Kent does not leave, but, in disguise, comes back to serve the king in secret.

Our second witness is the Earl of Gloster. He, too, is an honourable man, though somewhat too naive and credulous. Thus he accepts, without questioning, the lies told by his elder son Edmund about the supposed disloyalty of his younger son Edgar. Persuaded that Edgar plans to murder him, he reacts by ordering Edgar's death, forcing Edgar to nee in
the guise ofthe madman "Tom O Bedlam".

Gloster was not present when Lear renounced Cordelia, and he is more puzzled and distressed than angry when he first hears the news.

"Kent banished thus! And France in choler parted!
And the king gone tonight! Subscribed his power!"

He is under some form of allegiance to the Duke of Cornwall, (now Regan's husband), whom he admires and trusts.

"The noble duke my master,
My worthy arch and patron, comes tonight".

So, when Cornwall subjects Kent, now disguised as a gentleman serving Lear, to the indignity of being put in the stocks, (ostensibly for assaulting the odious courtier Oswald, but really because of Kent's continuing loyalty to Lear), Gloster "beseeches" him not to do so, but does not object further. He contents himself with explaining to Kent that,

"tis the Duke' s pleasure,
Whose disposition, all the world well knows,
Will not be rubb'd nor stopp'd".
And he tells Kent,
"I' ll entreat for thee."

So far he still remains loyal to Cornwall, though troubled by his "patron's" behaviour.

"The Duke's to blame in this; 'twill be ill taken".

Slowly, however, he realises that there is evil about. When Lear is pitilessly expelled into the storm, Gloster finds shelter for him, and, finally realising that "his daughters seek his death", he secretly arranges Lear's escape. When his merciful action is discovered he is seized and bound. Even now he cannot believe that he will be ill treated.

"What means your graces? - Good my friends consider
You are my guests: do me no foul play, friends".

To no avail; and we have here one of the great horror scenes in Shakespeare, when Gloster' s eyes are plucked out by Cornwall ("out vile jelly"), with the gloating encouragement of Goneril and Regan; and he, too, is thrust into the darkness.

(Those who think Shakespeare is mild, compared to modem horror films, should reflect on this scene, and read "Titus Andronicus")

We must treat the witness Gloster with more care than Kent, whose honesty is so plainly evidenced by his frankness and courage. It is not Gloster's honesty that is in question, but his naivety. If he can be so clearly deceived by Edmund, if he can, at least at first, excuse Cornwall's malevolent conduct and words towards Kent as a regrettable show of bad temper in a man he otherwise admires, can we accept him as a witness of truth when he speaks of Lear in terms of respect and loyalty? Could Lear have cozen'd him all these years, as Cornwall seems to have done, masking villainy sufficiently to deceive a naturally trusting nature?

The answer lies partly in the character of Lear himself. Even in his ravings there is nothing to suggest that Lear has played false with any man. But the greater answer is in Gloster's final decision to support Lear. This is made at a time when the anti-Lear forces are so plainly in the ascendant that any "sensible" man would rally to their cause. Nothing, at this point, suggests that they are not going to prevail. The "prudent' course would be to go along with them, even at the expense of a few indignities. Gloster would keep his estate and his Earldom, and might even be rewarded for a public support, important to conspirators seeking respectability. That, at least, is what Gloster would have thought at the time. We know, ofcourse, that Edmund would soon have disposed of him, but Gloster does not know this, and believes that Edmund is his loyal son who has saved him from the dreadful disloyalty of a younger son who has plotted his death.

Gloster does not take the easy solution. When he finally realises that he is in the presence of evil, he does what he knows he has to do, knowing that he faces great danger in doing it.

"If I die for it, as no less threatened me, the king, my oid master must be relieved".

He pays a ghastly price for this, but it shows that his love of the king is far deeper than any dissembling on the king's part could have engendered over many years.

We can accept him as a witness of truth when he indicates clearly that this "madness" of his old master is recent and contrary to anything that has gone before.

Finally we have the most important and convincing witness of all. What an awful job it would be to have to cross-examine Cordelia! These obviously truthful witnesses are a nightmare to opposing counsel. Perhaps one could ask why she could not be more "diplomatic". Certainly her answer to Lear, when he invites her to follow her sisters' example of fulsome and hypocritical recital of their adoration for him, is pretty blunt.

"Nothing, my lord".

But when she proceeds to a rational explanation, onc cannot dispute the logic.

"Good my lord,
You have begot me, bred me, lov'd me; I
Return those duties back as are right fit,
Obey you, love you, and most honour you.
Why have my sisters husbands if they say
They love you all? Haply, when I shall wed,
The lord whose hand must take my plight shall carry
Half my love with him, half my care and duty:
Sure I shall never marry like my sisters,
To love my father all".

This sensible reply merely infuriates Lear, from whom all sense has fled, and assures her disinheritance and expulsion.

Far from becoming embittered and rancorous against her father after this treatment, she proves the one true and loving daughter; and dies for it.

She loves her father deeply because he has always been a good and loving father to her. Clearly he has not shown any conduct to her in the past that she could stigmatize as harsh or unjust. Thus she accepts unhesitatingly that his change in personality is not due to earlier defects becoming more emphasised, but clearly to some obscure illness. When re-united to him, her first thoughts are how to have him cured. Of the physician she asks

"What can man's wisdom
In the restoring his bereaved sense?"

And the physician gives her hope.

"There is means, madam;
Our foster-nurse of nature is repose
The which he lacks; that to provoke in him
Are many simples operative, whose power
Will close the eye of anguish".

(In other words, rest, and appropriate drugs. A philosophy as commendable then as it is now, though today the pharmacopeia may be more extensive).

So, the evidence of three plainly honest and unimpeachable witnesses the three most noble characters of those who know Lear, establish, beyond doubt, that the behaviour of Lear, when we first encounter him, is totally uncharacteristic ofthe man he has been. Had he been, in earlier life, the arrogant fool he now appears to be, he could not have inspired the selfless loyalty ofthese three decent folk. The blunt, plain speaking Kent would have left him years ago, Gloster would not have risked his life for one he would regard as a tyrant, and Cordelia would have no reason to honour and fight for a father whose conduct would have shamed her.

These three are all of one mind. There is no "vicious mole of nature" in Lear, nothing in his past conduct to explain the present; and they can only conclude that some unwilled and invincible power has overtaken him, which they call, by the generalised term, "madness".

A modem diagnosis may be more specific.

Alzheimer's Disease.

An affliction, generally of old age, though it may sometimes strike earlier, is now categorized as "Alzheirners Disease". Symptoms are gradual loss of memory, gradual disorientation and disinhibition, culminating in a withdrawal from ordinary existence where the patient becomes a shell, functioning physically but not cognitively, and requiring permanent care. In the final stages patients seem emotionally unaware of any embarrassment or pain their condition may cause others, but, at the onset, they may still have moments of self-realisation that they have done or said something distressing or hurtful to those nearest to them. These times must be very painful to bear, particularly if they can not understand why they have acted in such a fashion.

The tragic fact is that such symptoms can and do occur in persons who have led good, productive and decent lives, with no previous history of eccentric behaviour. The change is greatly distressing to friends and relatives who must bear the brunt of undeserved abuse, or the anxiety of tracing the sufferer who has wandered off to some unknown destination.

Modem treatment can explain and alleviate, but cannot, as yet, cure. But, at least, one can now understand.

"Tout comprendre c'est tout pardonner".

In suggesting, therefore, that King Lear shows typical signs of early Alzheimer's, Iam not, ofcourse, claiming any miraculous foreknowledge in Shakespeare. That would be as fooli sh as maintaining that he anticipated psychiatry by portraying Lady Macbeth's sleepwalking and distracted dreams as if he knew of some precursor to modern thought. In fact, the doctor who observes the lady says frankly, "This disease is beyond my practice"; which is exactly what you would expect him to say in those times. (Just as the "madness' of King George III could not be more specifically described in the eighteenth century, but would have to wait two hundred years to be recognised as porphyria).

What Shakespeare can do, -as the acute observer that he was, -is give us a pattern of symptoms, from his own observations and rational imagination, which we, with later knowledge, can now recognise and categorise.

Shakespeare may not have seen actual examples of Lear's behaviour,or that of Lady MacBeth, though we would be unwise to conclude that he did not. He certainly had plenty of opportunity to observe eccentric and violent conduct. London, after all, was full of people behaving strangely enough to be confined to Bedlam, or imprisoned like poor Malvolio: and he would certainly have seen enough to glean his basic material, and let his imagination do the rest.

Kipling, in a splendid, insightful poem, speculates on how Shakespeare might have found some of his characters. For instance:

"How at Bankside, a boy drowning kittens,
Winced at the business, whereupon his sister,
(Lady Macbeth aged seven), thrust 'em under,
Sombrely scornful".

Shakespeare builds up Lear's character as a good man who suddenly becomes inconsistent. Nothing strange in this. Karl Jung tells us,"How can anyone live without inconsistency?" It is only when the inconsistency merges into erratic and irrational behaviour, accompanied by petulance and arrogance, that Shakespeare' s audience would have concluded that Lear was going mad; and we might conclude that symptoms of early Alzheimer were beginning to appear.

It is not only in his treatment of Cordelia that we see this. There are other signs of serious lack of judgment and uncharacteristic acts.

Clouded Judgment

Returning to the first scene of the play, we find Lear announcing that he is going to retire. He explains this in terms that would be understood by anyone after years of executive responsibility, feeling less able or less willing to cope with the duties entailed. Lear sounds eminently sensible, here, -though a little morbid.

"'tis our fixed intent
To shake all cares and business from our age,
Conferring them on younger strengths, while we
Unburdened crawl towards death".

This is more or less what countless top executives say on retirement, though they are less likely to talk about crawling towards death, but rather to speak about golf, gardening and travelling.

But our suspicions should be aroused by the lack of restraint with which Lear does it. He gives everything away, dividing his kingdom, (like Gaul), into three parts, then two, after Cordelia's intransigence, and leaving himself nothing but his hundred knights, whose upkeep, he confidently expects, will be met by these oh-so-grateful daughters.

Now, neither in this age nor in Shakespeare's, has it been normal for a retiree to give up all his assets. Shakespeare himself retired to the best house in Stratford, and certainly did not put it in his wife's or children's name before his death; nor would anyone have expected him to do so. There is something unduly extravagant in Lear's behaviour, something erratic and impetuous, such as a person losing his grip on reality might do.

Furthermore, what Lear wants in return is lavish and fulsome praise. Goneril and Regan lay it on thick and don't mean a word of it. Cordelia loses through honesty. Judgment is clouded.

Goneril and Regan, having gained what they wanted, turn on him, treat him contemptuously, and conspire to strip him ofhis hundred knights.

(One can feel a certain sympathy for the two ugly sisters about this. It's going to be difficult to run an orderly household with a hundred old drunks carousing loudly about the place. But they solemnly agreed to the terms.)

Lear reacts like spoilt child. Goneril, who first starts the cutting down business, is reviled as a "degenerate bastard ', and he will get Regan to punish her. Regan is a good girl.

"When she shall hear of this of thee, with her nails,
She'll flay thy wolfish visage".

But Regan dumps him. She is worse than Goneril. Very well, back to Goneril, She will, at least, let him keep fifty knights. But, of course, she won't. Finally, he realises that he is at the mercy of both of them. He will have no followers and be treated as a supplicant dependent on their whim.

Like a spoilt child, he rages, curses, and beats the air with futile threats.

"I will have such revenges on you both,
That all the world shall -I will do such things,
What they are yet I know not: but they shall be
The terrors of the earth".

Here is a man, previously in full control of himself, now reverting to whatShakespeare,inanotherplay,hascalled the first of the seven ages of man, that is, the infant, "mewling and puking". In an adult this may be a sign of something more ominous approaching, a quick descent into the " last scene ofall", that is, "second childishness and mere oblivion", which is a pretty fair description of the final stages of Alzheimer's.

To emphasise the change in Lear, let us consider how the old Lear (call him Lear I) would have reacted to his daughters' treachery. We can easily extrapolate from the clues we already have.

As a wise, prudent monarch, he would have retained some control, even if he gave away ostensible power. For, as a wise, prudent monarch, and no matter how much he loved and trusted his daughters, he would clearly have understood the danger to his kingdom ofgiving absolute rule into untrained hands He was a good king. For the sake of his subjects, he would need to have power to intervene to correct the errors of inexperience, or any tendency towards tyrannical behaviour.

Assume, however, that somehow he lost this control, perhaps by a palace revolution, or a sudden capture ofhis person when he was off guard. By reason of this unexpected calamity he finds himself virtually imprisoned by his daughters. Would Lear I have behaved in the hysterical manner of Lear 2? Certainly not. He would have kept his dignity, bided his time, sown discord between the sisters, (easy to do with this pair), noted that the citizens were getting restive under the arrogance and stupidity of their new rulers, and, ultimately recovered his power. No doubt he would then be met with grovelling apologies by two frightened ladies assuring him that they "didn't mean it" and had been led astray by wicked advisers.

All this is clear enough by what we know of Lear 1; and emphasises that Lear I could only have turned into Lear 2 by some disease of mind.

This is not rewriting Shakespeare. Obviously he knew that these things can happen. It is part of his vast observation of human nature. He could not do more than call it madness. We can take it a little further by recognising the symptoms he so graphically describes as something consistent with a disease that may change a decent, rational person into someone sadly different.

None of this makes the tragedy of "King Lear" any less of a tragedy. If anything, it makes it more so. We see a noble man of noble mind struggling against forces he cannot control, and which leave him devastated; just as those suffering from the early onset of Alzheimer's retain moments of self-realisation which leave them mortified by what they have done. Lear has exactly this sort of agony.

"Pray do not mock me:
I am a very foolish fond old man,
Fourscore and upward, not an hour more nor less:
And to deal plainly,
I fear I am not in my perfect mind".

The love and care ofCordelia gives him some respite; but, when he and Cordelia are captured by Edmund and the daughters, (both now contending viciously for Edmund's favours), his contrition is even greater and sadder. To Cordelia he cries:

"When thou dost ask my blessing I'll kneel down
And ask of thee forgiveness".

But something of the old fire has returned:
"He that parts us shall bring a brand from Heaven,
And fire us hence like foxes. Wipe thine eyes:
The good years shall devour them flesh and fell,
Ere they shall make us weep. We'll see 'em starve first".

Here is something of the old Lear, brave and strong enough to attempt the rescue of Cordelia; too late.

"I killed the slave that was a'hanging thee",

With the body of Cordelia in his arms he can only mourn in the saddest of the great sad passages of the play; some of the most moving ever written.

"I might have saved her; now she 's gone for ever! Cordelia,
Cordelia! Stay a little".

And later:

"thou'It come no more,
Never, never, never, never, never; -''.

The Majesty of the Play

The play is acknowledged, -and deservedly acknowledged, -as one of the greatest tragedies of all time. It is permeated with some of the finest lines the Great Master ever wrote.

I have not dwelt on the majesty and magnificence of the language, for my theme has been to a different drum. You may reject the argument entirely, for obviously the play stands securely in its own power. But it may add yet another dimension to reflect that, while this, in any interpretation, is the story of a heroic figure struck down by something unknown, inexplicable and pitiless, it may also depict similar tragedies of our own time; and we may the better understand.

Shakespeare would leave it ultimately to fate against which even the gods can only watch and pity.

"Upon such sacrifices my Cordelia
The gods themselves throw incense".

If Shakespeare, from his boundless observation of the human condition, reflects on inexorable fare, can we recognise something equally remorseless, and still mysterious, but of which we may now have some glimmerings of knowledge, and even hope?