Monday, June 6, 2011

Notes on Kohlberg’s Stages of Moral Development

I tell you, no virtue can exist without breaking these ten commandments;

Jesus was all virtue, and acted from impulse: not from rules.

William Blake, The Marriage of Heaven and Hell

Is it the case that what we call justice is right because the Gods love it, or do the Gods love it because it is right?

Socrates, in Plato’s Euthyphro

In this paper I want to explore a somewhat reductive sketch [see Table 1, below] of Lawrence Kohlberg’s popular six-stage theory of moral development, this time with reference to literature (chiefly Shakespeare and some Classical Greek texts). I'll proceed stage-by-stage, attempting briefly to say something true and perhaps non-obvious about each one; in so doing, I'm aware that Kohlberg’s actual text is receiving less than the full attention it deserves. These are notes.

Like the other stages, Kohlberg’s “trouble-avoidant obedience and punishment orientation” has been observed in young children and in some adults, so it’s not a fiction. Yet, in its lack of affective color or interiority, the notion of this first stage seems like an artifact of the behaviorist period, when B.F. Skinner regarded human action as the product of unknowable (“black box”) processes in which he claimed to be uninterested. In other words, something about this form of life seems not merely “pre-conventional” but even pre-human because, in its ugly simplicity, it suggests a lone automaton, like a reptile in the desert—not a primate enmeshed in a web of social relationships. For a self without empathy or other forms of identification, the “ superior power” to whom he or she defers might as well be the Sun, a God, or a monster.

John Bowlby’s account of infancy and toddlerhood suggests a far more rich and early exchange of real and imaginary goods including well-wishing, smiles, gestures, and various other affective displays whose function is to stitch together a viable, robust attachment through this process of varied, repeated, mutually attuned exchange. Though Bowlby was ambivalent about Melanie Klein’s work, accepting some of it while bracketing out those claims which struck him as inconsistent with his empirical observations of children, he seems to have agreed with Klein in attributing to young children motivations more complicated (by ambivalence, for example) than behaviorist Learning Theory would admit. Klein saw infants seething with rage and envy, emotions which don’t fit well into a scheme like that of Kohlberg’s first stage, in which a person simply pursues his own advantage and avoids pain by doing only what the more powerful person (the parent) will reward. Bowlby’s diplomatic impatience with Learning Theory turned upon that paradigm’s obtuseness in the face of behaviors more nuanced than its dualistic frame of reference could admit.

In looking for an adult example of this trouble-avoidant “obedience and punishment orientation” in the ancient world, I thought of the surrender of hostages when their captors are threatened with superior force. The motive for their release is not the welfare of the victims, but the fear of reprisal.

The second stage is “naively egoistic orientation,” or “naive egalitarianism, orientation to exchange and reciprocity.” Since it has been argued (e.g., by Gill, 1998) that reciprocity was the heart of ancient Greek ethics until the Socratic Enlightenment, it should be easy to find examples. Among the most famous exchanges in Homer’s Iliad is the swapping of gold armor for bronze armor during a local pause in the Trojan War, when the Greek Diomedes and the Trojan Glaukos discover that their grandfathers were guest and host on some occasion, decades before. Since guest-host friendship (xenia) is hereditary in that culture, these younger men individually agree not to pursue one another in the present battle, and instead, in keeping with the rules of guest-host relationship, they exchange gifts. But this leaves each of the two soldiers temporarily useless to his military superiors, since the rules of xenia seem to trump those of warfare. In a modern army, presumably, other "moral" factors would overwhelm this sacred debt to the grandfathers and their old oaths: deference to military authority in Kohlberg's stage four, and to contract and law in stage five: in other words, Weberian rationalization, the hierarchy of army discipline codified in rule books and Courts Martial.

Though many explanations have been put forward for Glaukos’ strange choice of gift (the poet himself says “Zeus stole away the wits of Glaukos…”), we might be permitted to speculate that the uneven exchange of golden armor worth a hundred oxen for bronze armor worth only nine represents the moment when, even for Glaukos and Diomedes (as for both the German and British armies at the end of their informal “Christmas Truce” of 1914), the grueling monotony of warfare simply resumes. On this tendentious reading, gold for bronze would represent the wasteful trading-away of this fragile, bond-building, Utopian peacetime ethic (xenia) for a destructive wartime ethic of martial heroism amid a world of mere enemies, victims, corpses and slaves.

Stage three in our sketch bears several different descriptors, this one being central: “Conformity to stereotypical images of majority or natural role behavior.” This might be the best fit for explaining why, in a famous scene in Iliad VI, the Trojan hero Hektor insists that his son Astyanax must grow up to be a warrior like himself, even amid a world of disastrous siege warfare, raiding, and piracy. This makes some rational sense, to be sure, since a violent world requires of each society a class of defenders capable of violence. But the Iliad of Homer, like Virgil’s Aeneid or Shakespeare’s Coriolanus, is striking for its characters’ poverty of imagination on just this point. Traumatized and deeply conditioned by warfare, they simply cannot imagine a radical break from this way of doing things. Among the major impediments to the invention of more stable peacetime institutions is precisely this warrior identity, which prescriptively and descriptively frames almost all esteemed male role behaviors in terms of force, deriding the alternatives as failures of this one prestige-bearing role behavior: fighting. The theme is a common and persistent one; several other Shakespearean dramas seem driven by exasperation at the way we squander the best possibilities in life by our slavish allegiance to role behaviors that tend to create the conditions for their own necessity: the tragedies of Titus Andronicus, Macbeth, and Hamlet all show male soldiers whose love in other roles (father, husband, king) is ultimately vitiated by the depredations of their own patriotic violence. In Coriolanus, the hero’s mother (Volumnia) has so completely internalized Roman martial mores that she raises her son to be little more than a murder machine. When he tries to break away from Rome, he is trying to break away from this mother and from the soldiering identity she has fed him since infancy. The pathos lies in his inability to make this escape, even amid his impressive new capacity to fantasize about it: “There is a world elsewhere.”

Stage four seems to be the best fit for—indeed, the very home ground of—one tragic hero in particular, the Creon of Sophocles’ tragic drama Antigone, one of the three Theban plays. Early in his short reign, King Creon forbids the burial of Antigone’s brother Polyneices because he had fought on the wrong side of the recent civil war over the throne of Thebes. While Antigone argues that religious “eternal law” and familial piety require her to bury her brother in spite of the King’s command, Creon himself argues that civic law (i.e., his own royal decree) is simply more important that any countervailing obligation because without consistent obedience to such law, the entire society may unravel: “But whomever the city appoints must be obeyed, / In each detail, whether just or utterly opposed to justice… There is no evil worse than anarchy. / This it is, that causes states to perish, / Makes houses desolate, / Disperses spear-men, routing their alliance; / But obedience to command / Saves the bodies of the fortunate many. / Therefore such rules must be defended / As are handed down…” (Sophocles, trans. J. Hecht, 2004). The modern rationale for a separation of civilian authority from military authority lies here, since it affords a possible corrective to the military’s characteristic ethical blindness as to the desirability of the ends that it pursues with such impressive discipline. If military thinking can sometimes transcend the tactical and achieve the broader vision we call strategic, it still cannot go so far as to win through to the wider vista of culture, where civil society chooses among alternative goals using non-military resources (e.g. the fine arts, such as theater and literature; the medical arts and sciences, such as psychoanalysis and other therapies oriented to the reduction of harm; and the political art, including the dialectics of factional struggle through semi-rational deliberation in the popular assembly and the courts).

With the fifth stage we enter the level of “post-conventional, self-accepted moral principles.” The appeal of this phrase is its implied transcendence of the power relations that defined the earlier phases; no longer is the subject toadying to authorities he might secretly despise. “Contractual, legalistic orientation” marks a developmental achievement because, despite the similarity to stage four, there has been a shift of emphasis away from roles (which can be limited to a particular situation or micro-society) and toward contracts and statutes (which at least aspire to a sort of universal status that dignifies them—or would seem to do so, as long as we are under the influence of 18th century Enlightenment figures, especially Kant). But in actual experience, a person might well give an account of his or her motivations for a given ethical choice that drew upon several different Kohlbergian stages in the same self-report, just as an analyst or analysand might give several overlapping interpretations of the same dream, or a spectator at a play might feel both pity for a dying villain and a vicarious sense of triumph over the same character’s destructive ambitions. This matter of overdetermination—the copresence of multiple reasons for a choice (or multiple causes for an event)—need not prevent ethicists like Kohlberg from teasing-out the tangled threads of motivation, so long as we are under no illusions that the stages are discreet, invariant, or unidirectional in their unfolding.

Examples of this fifth stage might include Socrates’ decision, detailed in Plato’s Crito, to remain in prison and face certain death rather than flout the law by slipping past the guards with the bribe his friends were ready to provide. Instead, the old philosopher cites his reverence for the law. But this is odd, because in the somewhat earlier dialogue (earlier both in its composition and in its setting within the larger story arc of Plato’s Socrates) the Euthyphro, we are shown this same Socrates chastising young master Euthyphro for uncritically enforcing a civic law without regard for the details of the case. In other words, by insisting upon his own execution in the Crito, Socrates is running roughshod over the mitigating circumstances that he cited with such conviction in the Apology. We might be permitted to wonder whether he is making himself a martyr in deliberate spite of the Athenian jury that condemned him, as if to bite the great sleepy horse of the polis one last time with his gadfly mouth that seems to say, “you are wrong about me; I obey the law, even a foolish law, and even at my own peril.” Such a person would not really, or not only, be acting out of respect for legal writ, though he claims to do so; he would also be exposing the limits of that orientation to justice, as Dr. King did in the Birmingham Jail.

Kohlberg’s sixth stage of moral development, the last one in which he seems to have had full theoretical confidence (though he speculated on a seventh), is here called a “morality of individual principles of conscience.” The descriptor “individual” pulls a lot of weight here, since upon it depends the difference between a potentially slavish allegiance to principles outside the self, or internalized from without, on the one hand, and on the other, an integrated sense of the good as the resultant of one’s accumulated ethical experience, the moral know-how of a life with other people under the shared constraints of scarcity and historical contingency. Adherence to principle will not suffice as the pinnacle of human development, since principles are rarely as universal as they appear, and emergent circumstances (such as technological change, qualitative shifts in either the supply or the demand for a given scarce resource, etc.) can open new and undefended flanks on the periphery of their application. The trouble with principle is that regardless of its origin—in the trenches of experience, or in the mind of a revered charismatic figure or in Heaven—it is not intrinsic to the self. What is intrinsic to the self? Decency of impulse. Consider Blake’s striking remark that introduced this paper: “Jesus was all virtue, and acted from impulse: not from rules.”

If Melanie Klein is correct, and infants harbor bitterly destructive feelings as well as the consequent remorse, guilt, and yearning to make reparation, then we ought not mourn for childhood as an innocent era of lost goodness. Instead we can feel rich with adulthood’s vast opportunities to cultivate moral goodness in the self by performing symbolic actions of reparation. Given what we know about the natural world that produced us, with its predation, dominance hierarchies, and general ruthlessness in the face of scarcity, we can expect our species to resemble the others in its aggressive disposition. But like the bonobo chimpanzees, or like certain baboon troops that have lost their dominant members, we can also cultivate alternative arrangements that conduce to cooperation and conflict resolution. In that group endeavor, and in its individual counterpart (the effort to master aggressive impulses and even replace them with pre-cognitive, affective dispositions toward altruism, empathy, and repair), “principle” is perhaps best regarded as the crucial but temporary scaffolding without which the ethical self cannot be constructed. But the ethical self is not these mere principles, be they external or internalized, any more than the person is his or her outward armor or internal skeleton.

CODA: Luther

In this connection, consider the epochal figure of Martin Luther, grand architect of the Protestant Reformation, spiritual ancestor of American culture. He thought himself a second Paul, amplifying and renewing the Apostle’s message that the cold mortmain of The Law had been superseded by the free gift of Christ’s love. In that vein, Luther wrote a million pages of brilliant if repetitive prose commentaries on Paul’s Letters to the Romans, the Galatians, and so on. Luther’s point—his theological life’s work—was to supersede the legalism of the Catholic Church as he thought Jesus of Nazareth had superseded the legalism of the Judaism of his day, replacing it with warm, inner feeling. But this, Luther did not do. As he threw a thousand years of (often draconian) jurisprudence in the trash, he forgot just what it was that he wanted as its superior substitute. When Luther drove away the mere “outer man” of “works” and restored the primacy of “the inner man,” what he was exalting was not decency of impulse, not a better reason for doing the right thing. Luther had little or no interest in just what people did or did not do, and was only concerned with what people believed. I will never forget my shock and horror twenty years ago, on first reading this passage from Luther’s great, mad essay “On Christian Liberty”:

...[S]ince faith alone justifies, it is clear that the inner man cannot be justified, freed, or saved by any outer work or action at all, and that these works, whatever their character, have nothing to do with this inner man. On the other hand, only ungodliness and unbelief of heart, and no outer work, make him guilty and a damnable servant of sin. (56)

As the man is, whether believer or unbeliever, so also is his work — good if it was done in faith, wicked if it was done in unbelief. (70)

On this scheme, you can perform any apparently heinous action you wish, from mayhem to genocide, and still bask in the rosy glow of a good conscience, with an eventual reward in Elysium’s eternal bliss, so long as you were persuaded, through the duration of your bloody spree, that the propositions of Protestant Christianity—including a few counter-intuitive whoppers involving a pregnant virgin, a reanimated corpse three days in the grave, and some water that turned into Cabernet—are factual propositions. Conversely, if you spend your threescore & ten years helping the poor and the weak, defying the wicked and the mighty, and generally brightening the world with your good cheer, patience, and charity, after death you will still burn in eternal torment without hope of redemption, for the sole reason that you remained unpersuaded of those same exotic propositions about the pregnant virgin, the resurrected itinerant exorcist, and so on. This sort of thing is what made Schopenhauer remark of a similar book, “I could not find a single valuable idea in it.”


Table 1. Because this essay focuses on Lawrence Kohlberg’s theory of moral development, but without the ambition to treat it in depth, I’ve made use of the following one-page summary of his theory, excerpted unmodified (except typographically) from an academic website at Haverford College: Only this element of my essay is thus excerpted; the rest is original, unless otherwise cited.

Kohlberg’s Moral Stages

Kohlberg’s theory specifies six stages of moral development, arranged in three levels.

Level I: Preconventional/Premoral

Moral values reside in external, quasi-physical events, or in bad acts. The child is responsive to rules and evaluative labels, but views them in terms of pleasant or unpleasant consequences of actions, or in terms of the physical power of those who impose the rules.

Stage 1: Obedience and punishment orientation

  • Egocentric deference to superior power or prestige, or a trouble-avoiding set.
  • Objective responsibility.

Stage 2: Naively egoistic orientation

  • Right action is that which is instrumental in satisfying the self’s needs and occasionally others’.
  • Relativism of values to each actor’s needs and perspectives.
  • Naive egalitarianism, orientation to exchange and reciprocity.

Level II: Conventional/Role Conformity

Moral values reside in performing the right role, in maintaining the conventional order and expectancies of others as a value in its own right.

Stage 3: Good-boy/good-girl orientation

  • Orientation to approval, to pleasing and helping others.
  • Conformity to stereotypical images of majority or natural role behavior.
  • Action is evaluated in terms of intentions.

Stage 4: Authority and social-order-maintaining orientation

  • Orientation to “doing duty” and to showing respect for authority and maintaining the given social order or its own sake.
  • Regard for earned expectations of others.
  • Differentiates actions out of a sense of obligation to rules from actions for generally “nice” or natural motives.

Level III: Postconventional/Self-Accepted Moral Principles

Morality is defined in terms of conformity to shared standards, rights, or duties apart from supporting authority. The standards conformed to are internal, and action-decisions are based on an inner process of thought and judgment concerning right and wrong.

Stage 5: Contractual/legalistic orientation

  • Norms of right and wrong are defined in terms of laws or institutionalized rules which seem to have a rational basis.
  • When conflict arises between individual needs and law or contract, though sympathetic to the former, the individual believes the latter must prevail because of its greater functional rationality for society, the majority will and welfare.

Stage 6: The morality of individual principles of conscience

  • Orientation not only toward existing social rules, but also toward the conscience as a directing agent, mutual trust and respect, and principles of moral choice involving logical universalities and consistency.
  • Action is controlled by internalized ideals that exert a pressure to act accordingly regardless of the reactions of others in the immediate environment.
  • If one acts otherwise, self-condemnation and guilt result.

Friday, June 3, 2011

Hamlet: A Mental Health Treatment Report on Denmark's Sweet Prince

I've been neglecting the blog a bit this year, partly because I'm trying to become a psychotherapist. Most of my time is absorbed in taking classes and writing papers. The last time I did an advanced degree, I eventually tried to revise my seminar papers for publication, and placed quite a few of them in academic journals over the years; I hope to do the same for some of these, too. Some of the material is about my own conflicts or limitations, which is writing I'm reluctant to disclose, lest it alienate anybody whom I might otherwise perhaps be able to help. But other recent papers seem to me appropriate, thoughtful enough, and maybe even interesting, so I am thinking of posting some. This is the first one I'll try here; please comment if you feel like it.

(Speculative) Mental Health Treatment Report

“…while the patient lives it through as something real and actual…”

--Freud, “Recollection, Repetition, and Working Through”


This MHTR assesses the protagonist of Shakespeare’s tragedy Hamlet, Prince of Denmark. Quotations from the play are cited with Roman numerals indicating act and scene, respectively (thus “II, iv” means Act Two, Scene Four). Temporality is a vexing issue here, since the character is killed in the drama’s ending, and since he experiences many marked changes of state as the action transpires. An MHTR is based on interviews; it’s an extrapolation from the patient’s own reporting, supplemented by the clinician’s observations and a handful of gross situational facts such as divorce, job loss, arrest, toxicology results, and so on. By contrast, our knowledge of Prince Hamlet is based on a text whose generic conventions include the theater’s “fourth wall,” an illusory barrier between the spectators (or the reader) and the delimited world internal to the text. For the purposes of this assignment, then, I am assuming a different play, identical to Shakespeare’s except that toward the end of Act Five, when Hamlet and Horatio are through talking with the Gravedigger but have not yet arrived at Elsinore for the duel with Laertes, the Prince excuses himself from Horatio’s company and enters a windowless shack by the side of the road, whose green weathervane wails on its hinges in the wind. Having heard this sound before in my dreams, I hear the creaking, squeaking swinging noise again now, as I wake to find myself apparently dwelling in this same shack, and practicing psychotherapy in it: beside my chair is a long couch, onto which a man of about 28 has just sat down, wringing his hands and rather fiercely staring at me.


Multiaxial Diagnosis Form

Diagnostic code DSM-IV-TR name

Axis I:

296.89 Bipolar II Disorder, With Rapid Cycling (Provisional Diagnosis)

296.64 Bipolar I Disorder, Most Recent Episode Mixed,

Severe With Psychotic Features (R/O)

Axis II: Personality Disorders and Mental Retardation

Diagnostic code DSM-IV-TR name

_________________ No diagnosis on Axis II

Axis III: General Medical Conditions

ICD-9-CM code ICD-9-CM name

_________________ No diagnosis on Axis III

Axis IV: Psychosocial and Environmental Problems

Problems with primary support group

The patient’s father died less than six months ago. Two months later, the patient’s widowed mother married the brother of her late husband. The patient is experiencing the grief of father-loss (which Freud called “the most important event, the most poignant loss, of a man’s life”), intensified by several factors involving his primary support group: an unusually strong identification with his late father (they share the same name), together with unresolved guilt over what seem like robust but unconscious Oedipal feelings of rivalry with his father, now dead; hatred of his uncle; and feelings of isolation and betrayal deriving from his mother’s “o’er hasty marriage” (her words) to this same uncle. Instead of joining Hamlet in his mourning, she apparently has thrown herself into a new life with her late husband’s younger brother, the new King. The patient was deeply hurt by the “wicked speed” with which she remarried: “But two months dead!” (I, ii). The patient’s firm belief that his uncle/stepfather murdered his father has made it impossible for him to adjust to his new family configuration (“A little more than kin, and less than kind.” I, ii).

Problems related to the social environment

Though the patient has one close friend (Horatio), most people at court perceive their career prospects and social lives as strongly dependent on a quick and thorough switch of allegiance, away from the dead man and onto his successor, regardless of any disparity in their relative merits as kings or human beings. But the patient, as the dead man’s loving son and heir apparent, finds himself incapable of any such adjustment. Perhaps this speaks for his integrity and self-knowledge; it also isolates and makes him vulnerable.

Educational problems

Already a very learned man, Hamlet hopes to continue his studies. But his uncle, who has recently become the focus of intense feelings of rage, helplessness, and resentment, has prevented this: “For your intent / In going back to school in Wittenberg, / It is most retrograde to our desire…” (I, ii). Lately he derides both his reading (“words, words, words…” II, ii) and his writing (“I have not art to reckon my groans” II, ii).

Occupational problems

The patient is a prince, raised to expect that he would succeed his royal father to the throne of Denmark. In recent months, however, his uncle has been crowned in his stead. Somewhat naïve about other vocations, the patient cannot seem to imagine himself as anything but the Prince he was, or the King he had expected to become. Though briefly exiled to England, he returned to Denmark in an effort to carry out what he regards as the will of his father’s spirit. Like Shakespeare’s Coriolanus, he may say “There is a world elsewhere,” but unfinished business calls him back home.

Housing problems

The patient reports disgust with his uncle on a broad range of issues which include the latter’s alcoholism, often manifest in boisterous late-night drinking binges held in the large residence they share (I, iv). Though the castle of Elsinore is capacious, Hamlet does live under the same roof as the King and Queen, which may be exacerbating his horror at the thought of their sexual relationship. He became visibly distraught as he vividly speculated on the subject with somewhat eroticized disgust: “Nay, but to live / In the rank sweat of an enseamèd bed, / Stewed in corruption, honeying and making love / Over the nasty sty…” (III, iv).

Economic problems


Problems with access to health care services

Although the patient has inherited considerable wealth and social position (“to the manor born”), the healthcare available to him is severely constrained by his temporal position in the continuum of history. Wilfred Bion once cited the moment in Shakespeare’s Macbeth when the Scottish King learns that the Doctor cannot help his mad Queen, and responds in disappointment: “Canst thou not minister to a mind diseased?” Bion supplied a fitting answer: “Well, not at the moment, but in four hundred years, come along again and we’ll see what we can do.”[i]

Problems related to interaction with the legal system/crime

Rather like a corporate whistleblower or a political dissident (Alford, 2001), Hamlet is caught between the law of the organization to which he belongs, and a higher ethical imperative which that law has apparently compromised. The patient reports overhearing his uncle remarking on this very matter: “In the corrupted currents of this world / Offence’s gilded hand may shove by justice, / And oft ‘tis seen the wicked prize itself / Buys out the law…” (III, iii). Hamlet has no “problems related to interaction with the legal system” because Elizabethan law (see III, i; IV, iii; V, i) was still a fluid thing, not really a “system,” nor has he the benefit of legal recourse against his royal uncle, for the same reason that a successful revenge would likely go unpunished: at the top of any society, successful violence tends to remain above the law. In the words of Shakespeare’s contemporary, John Harrington: “Treason doth never prosper… for if it prosper, none dare call it treason.” A person of the 21st Century could not be in Hamlet’s situation, which presupposes a hereditary monarchy in Northern Europe; but anyone who felt Hamlet’s rage for a new stepfather and believed that the Ghost of his father was demanding that he murder him would, of course, be a danger to himself and to others, a homicide risk and a likely candidate for 51/50 involuntary hospitalization.[ii]

Other psychosocial and environmental problems

The patient’s girlfriend was enlisted by her father to spy on the patient. He found out about this, took it quite personally, and abruptly ended their relationship, directing a tirade of verbal abuse at her and at himself (III, i).

Axis V: Global Assessment of Functioning Scale Score: 20 Time Frame: recent weeks, since the Coronation of King Claudius. The GAFS is difficult to apply here, for reasons explained above and below. In general, the patient maintains meaningful relationships and shows keen intellect, but he also shows signs of being a danger to himself and to others.


The patient reports several depressive symptoms, including anhedonia: “I have of late—but wherefore I know not—lost all my mirth, forgone all custom of exercises” (II, ii); suicidal ideation: “O that this too too solid flesh would melt… Or that the Everlasting had not fix'd / His canon 'gainst self-slaughter!” (I, ii), “To be, or not to be” (I, iii); as well as anxiety-related insomnia: “Sir, in my heart there was a kind of fighting / That would not let me sleep.” (V, ii). He also reports a highly disturbing command hallucination: “Revenge his foul and most unnatural murder.” (I, v).


The patient explains that he has recently had experiences whose ethos he associates with madness—“an antic disposition”—and that although he initiated most of these as deliberate performances of a feigned madness, as each episode progressed, it became impossible for him to distinguish with full confidence between this mere malingering and a real insanity that deeply frightened him. Factitious disorder (300) is ruled out, since there is an environmental reason “to put an antic disposition on” (I, v), namely to frustrate his uncle’s efforts to control his response to the crisis at court.

His girlfriend reports an instance of Hamlet’s crazy behavior: “Lord Hamlet, with his doublet all unbraced, / No hat upon his head, his stockings fouled, / Ungartered, and down-gyvèd to his ankle; / Pale as his shirt, his knees knocking each other, / And with a look so piteous in purport / As if he had been loosed out of hell / To speak of horrors…” (II, i). This was malingering. Yet perhaps its form expresses elements of the patient’s experience, as if his outer clothing were expressive (albeit inadequately) of his inner spirit, just as it is seen to be in the earlier “inky cloak” scene (I, ii). There, the element of the clothes that matched the spirit was their mourning blackness; here, it is their disarray. Like the acting of the Player who weeps for Hecuba (II, ii), but unlike the lies of a killer (one who might say something like “The harlot's cheek, beautied with plastering art, / Is not more ugly to the thing that helps it / Than is my deed to my most painted word.” III, i), Hamlet’s antic disposition is a dissembling in the service of the truth.


The patient is unsure of his precise age but presents as about 28, a Danish male of royal background who currently has no employment, gainful or otherwise. He did not seem unkempt, as he had in Ophelia’s description above (“his doublet all unbraced…”), but seemed reinvested in his appearance, with buttons and laces all done up correctly, and, perhaps importantly, a white shirt among black garments instead of all black. He began the interview seeking advice about his girlfriend’s recent symptoms of acute mental distress. When we turned to the patient’s own experience, he was extremely guarded at first. Unsatisfied with the confidentiality clauses in the intake forms he had signed, he made me swear by his sword, “Never to speak of this that you have heard.” (I, v). That done, the patient disclosed his suspicions that his father may have been killed by the younger brother who survives him—the patient’s uncle, who now enjoys his mother’s bed as well as the throne. These suspicions were, in the patient’s view, confirmed (“O, my prophetic soul!”) by a recent encounter with a speaking apparition that claimed to be his father’s spirit, and which proceeded to elaborate a vivid account of exactly how the uncle murdered the father (I, v). The patient commands an impressive interpersonal sensitivity. He noted my silent skepticism about the Ghost and responded: “There are more things in heaven and earth… Than are dreamt of in your philosophy.” (I, v). For good or ill, our “philosophy,” broadly construed, is the only tool we have in hand, and it militates very strongly for the proposition that there is no Ghost outside the patient’s mind. In a separate interview, the patient’s mother reports an episode in which Hamlet, in her own presence, claimed to hear and see this same Ghost, while she had no such experience (III, iv). Yet this is complicated by the reports of others in the patient’s circle: Bernardo, Marcellus, and Horatio (I, i; I, iv; I, v), each reported seeing the same apparition, watching it together, first without Hamlet and then with him. Shared Psychotic Disorder (297.3) is ruled out, since four people saw the Ghost simultaneously, three of whom show no other mental disturbance.

The patient has recently become obsessed with the hypothesis that his uncle murdered his father. He is overwhelmed by the feeling that he is personally obligated to avenge that murder by murdering his uncle in turn. As a mandated reporter I reached for a telephone, intending to alert the police, but the voice on the other end was Dogberry, the clownish constable from Much Ado About Nothing, who seemed to gape and sputter at the sheer enormity of the situation as I described it. He let me know, in his idiom full of fake verbal sophistication and earnest virtue, that his scope of competence and scope of licensure (“office” was his word for it) could by no means extend to the restraint of a Prince, much less the arrest of a King, and he hung up on me.


Under Axis V “educational problems” were discussed. Despite his love of learning, the patient reports a new contempt for his studies, which seem trivial compared with the crisis of his father’s murder and its consequences—especially the patient’s obsessive but ambivalent yearning for revenge: “Yea, from the table of my memory / I’ll wipe away all trivial fond records, / All saws of books, all forms, all pressures past / That youth and observation copied there…” (I, v). Yet this image of erasing false knowledge from his mental notebook is followed immediately by a counter-image of writing down something new, in a painful moment of what Bion might call “learning from experience”: “My tables! Meet it is I set it down / That one may smile, and smile, and be a villain.” This is just one recent iteration of an ever-repeated discovery, that human beings are capable of amazing levels of evil which they seek to cover with equally amazing levels of deceit. Treatment should honor the painful learning in that lesson, while pointing up its incompleteness: secret betrayals, false shows of love, and deeply personal loss are not the whole story of human life, and need not be the whole story of Hamlet’s life, if he can learn more.


One Horatio, sometime scholar at the University of Wittenberg, the patient’s best friend.


The patient is a strange man with a high degree of achieved individuality. Since he often remarks on the perceived emptiness and consequent interchangeability of the people around him (especially courtiers, e.g., Rosencrantz, Guildenstern, Osrick), treatment will have to include respect for individuation and idiosyncrasy. Prince Hamlet also finds himself at or near the uttermost pinnacle of the society to which he belongs—a rare state of affairs which would frustrate any effort to pathologize his grandiosity as mania or even hypomania (this complicates the distinction between Bipolar I and Bipolar II in Hamlet’s case, as does his command hallucination, which speaks for Bipolar I, whereas the rest of the patient’s functioning seems much less mentally disturbed than the hallucination would suggest). In rank he is a prince; in nature and achievement he’s what Shakespeare elsewhere (Henry the Fifth, II, ii) called “the full-fraught man.” Envisioning a good therapy outcome for him is challenging, because he has come to associate change with loss, and grief with integrity. His uncle and his mother have already made bad-faith efforts to rush his mourning (I, ii), so he will need plenty of time to grieve for his father.

The main obstacle to the patient’s happiness seems to be his hateful feelings for his uncle. Yet these feelings are rooted in very real deeds. It would be crazy-making for a therapist to go after Hamlet’s symptoms—the anhedonia, suicidal ideation, and the intermittent psychotic breaks including visual-auditory homicidal command hallucinations—without respecting the concrete facts to whose vexing presence they represent a partly effective, partly self-destructive response.

This uncle represents to the patient his own defeat, and his father’s murder—but also, the victory of a worldview so deeply cynical as to cast the value of existence into doubt. In our interview, Hamlet quoted the Chorus from Sophocles’ Oedipus the Tyrant as they comment on a successful regicide: “if such acts are respected, why should I join in the dance and worship”?

One possible outcome is that the patient will accept the duel proposed to him recently by Laertes, and then allow the violence of the duel to break out of its conventional confines and kill King Claudius. But this uncontained violence might well destroy the patient, his mother, Laertes—in short, all concerned (as in fact happens in V, ii, the final scene of the play). In such a case, treatment goals are alternative futures in which violence is successfully contained, sublimated, or diverted onto objects deemed appropriate for its absorption. If Hamlet can gain the throne without killing his uncle, he can lawfully dispose of him. Treatment might direct the patient’s attention to the practical means at his disposal, in ways conducive to reality-testing. As Jones (1910/1949) has shown, Laertes turns the Danish people against Claudius quite easily, and “Where Laertes succeeded, it is not likely that Hamlet, the darling of the people, would have failed.” Yet this has not occurred to him, so far.

Professional ethics precludes any recommendation to proceed with the revenge-command of the Ghost, yet the patient is implacably haunted by this same command. Treatment avenues that depend solely upon renunciation of ambition are therefore not likely to succeed, since their exemplars—e.g., Gilgamesh, Buddha, Pope Celestine V—were not, like Hamlet, haunted by guilt over unperformed vengeance. Instead it may be best either to help the patient to reassess his options for a putsch on the rabble-rousing model of Laertes (rather than on the assassination model of Claudius); or to marshal a legal proceeding, perhaps backed by foreign assistance from Fortinbras of Norway (who also has reason to want Claudius exposed and deposed). Whatever road the patient chooses through his practical problems, treatment goals should include a fortifying of the patient’s self-love, again through reality-testing, this time focused on the love tendered to him by Ophelia, by Horatio, and by the people.

As for his mother, it makes plenty of sense for the patient to be angry about the speed of her remarriage as well as her choice of second husband. Hamlet wrote the lines he gave to the Player-Queen: “Both here and hence pursue me lasting strife, / If, once a widow, ever I be wife.” But this ideal of postmortem monogamy is a recipe for despair, and there are well precedented alternatives available to the family. The work of mourning for his father will have to include a mourning for the marriage that was ended by his death; a new emotional life for Hamlet is linked with his eventual allowance of a new erotic life for his mother. It will also be essential to attenuate or reframe the patient’s identification with his late father, a difficult prospect which time may help bring about.


Aspects of the patient’s typical mental functioning suggest intermittent hypomania, including non-pathological flight of ideas and insomnia. But his killing of Polonius—which I knew about from the text, not any disclosure by the patient—proves that he is a real danger to Claudius at the least, and perhaps even to others besides him. The deaths of Rosencrantz and Guildenstern (like that of Polonius, arguably) seem more like casualties of that distasteful “craft of intelligence” which defines so much of life at Court, than a personal act of violence. Hamlet did them no direct violence, and they were about the business of having him executed when he surreptitiously made unofficial but legitimate use of his late father’s signet ring to switch their instructions. The risk of suicide seems low, especially now that the lessons of the graveyard have been learned: that life ends soon enough anyhow, and that the vanity of human wishes frees us to live more playfully than we might otherwise dare.

Hamlet’s royal station is a source of both meaning and danger, opportunity and onus. He cannot, as some Americans have been known to do, reinvent himself as some other kind of man, lighting out for the territory to spin a new identity out of nothing. What he has inherited is too big for that. Yet there may be a way of making it smaller; in fact (as I’ve written elsewhere), this shrinkage may be what Hamlet has achieved in his recent observations: of the actor who weeps “for nothing,” of Fortinbras who fights “even for an eggshell,” and of the graveyard, where Emperors and peasants are alike turned into mulch. A personal dilemma that had seemed to great to master is gradually reduced to “the fall of a sparrow” by comparison to the cosmos at large. That is easily said, but Hamlet seems to be doing it: “learning from experience,” as they cannot whose lives are already scripted.


Alford, C.F. (2001) Whistleblowers: Broken Lives and Organizational Power. Ithaca: Cornell U.P.

Hecht, J. “Tragedy, Hamlet, and Luther,” Forschungen zur Frühen Neuzeit, Goethe University, Frankfurt-am-

Main, 2002.

Weber, M. (1904-05/1992). The Protestant Ethic and the Spirit of Capitalism. trans. Parsons. London: Routledge.

[ii] As a highly specialized rhetorical genre, the MHTR serves the well-being of the patient (since it represents an earnest effort to come to grips with the nature of his or her pain and predicament, the better to formulate a course of treatment) and the convenience of a surrounding world of highly regulated professionals. Whatever its merits and limitations, the MHTR (and the DSM which it aims to apply) epitomize the “rationalization” process whose eventual result Max Weber described as an “iron cage” for the human spirit. Yet this cage of modernity is simply “where” we live, and adaptation to it is a never-ending project. I suppose the patient’s experience of his or her life gets connected to the clinician, who is connected to the DSM-IV (TR), which connects him or her to the profession and to the legal system, and so on. To use a metaphor from the body, most of these links are the connective tissue of rationalized procedure; some are perhaps more nutritive, striving to supply personal human interaction as an artery supplies oxygen or a vein takes away carbon dioxide.