“Raze out the written troubles of the brain” Macbeth 5,3

[First published in the Royal College of Psychiatrists London Division Newsletter, June 2009
http://www.rcpsych.ac.uk/pdf/royal%20col%20of%20psy%20iss9%20final.pdf ]

Who needs patients, when there’s a wealth of educational psychopathology being performed in the West End?

It won’t have escaped the attention of psychiatrists in the capital with an interest in performing arts that the National Theatre’s autumn season last year had at its core a revival of Sophicles’ Oedipus Rex. Jonathan Kent directed a new translation by Frank McGuinness with Ralph Feinnes as the king, fumbling blindly in search for the truth of his origins. As the stage revolve in the Olivier rotated imperceptibly a palpable tension was created among the audience as we waited for the tragedy to reach its inevitable conclusion.

Later in the season Every Good Boy Deserves Favour (by Tom Stoppard and André Previn), also on the Olivier Stage, demonstrated the dilemma for a psychiatrist between determining what is a thought content abnormality (the delusional belief that one is an orchestral conductor) and what is a thought crime (“Your opinions are your symptoms... your disease is dissent”). At the Almeida in Islington, Juliet Stevenson will be playing a successful musician in consultation with her psychiatrist, played by Henry Goodman, in a revival Duet for One, by Tom Kempinski this spring.

However, even theatregoers who don’t choose to seek out such apparently relevant productions may find themselves nevertheless confronted with compelling psychodrama. From December, also at the National, the Chicago based Steppenwolf Company presented August: Osage County, trailing awards and plaudits from its continuing Broadway run. Tracy Letts’ August is an exhausting and hilarious three-hour black comedy in which the audience is invited to observe a Midwestern family reunite in the aftermath of the disappearance of their father. Here, vile, tragic, Violet Weston, a drug addled matriach, decides over a funeral supper that it is “just time we had some truths told ‘round here’s all” and in so doing repels all around her and invites them to “stick that knife of judgement in me, go ahead, but make no mistake… When nothing is left, when everything is gone and disappeared, I’ll be here. Who’s stronger now, you son-of-a-bitch?!”.

Even avoiding straight theatre, for a psychiatrist, won’t guarantee escape from Axis I and Axis II disorders. At the Royal Opera in the Autumn, Strauss’ Elektra left audiences stunned at Klytaemnestra’s blood curdling cackles, hearing that her son is dead and can no longer assist his sister in seeking revenge for the murder of her beloved father. In the spring, in Korngold’s Die Tote Stadt, we see a young man haunted in grief for his late wife Maria. Elsewhere, at the Hackney Empire, the English Touring Opera are in rehearsals for Janacek’s, Kat’a Kabanova, with sexuality, shame and suicide set to a stormy score.

Among recently opened musicals, Spring Awakening at the Hammersmith Lyric, is a show which adds rock music inner monologues to illustrate Frank Wedekind’s once banned play about teenage sexual urges in an oppressive and uninformative upbringing. Sunset Boulevard, Andrew Lloyd Webber’s stage musical adaptation of the classic movie, might be said to depict a woman with many Cluster B traits and, tipped soon to transfer from Broadway, is a highly lauded revival of Gypsy, in which a Mama Rose disastrously projects all her own aspirations into her daughters.

So I have given a list of examples of plays, operas and musicals that might form an eclectic cultural agenda for a London psychiatric trainee this year, but how might these be perceived as a syllabus or source of clinical inspiration? Perhaps as a series of case studies, and of, admittedly fictional, recreations of more complex dynamics and systems than doctors usually see in a consulting room or A&E cubicle.

In his book Scenes of Madness, Professor Derek Russell Davis concludes that through theatre, there is much we can discover about psychiatric illness and practice, notably that plays offer the playgoer, as an observer, the chance to put behaviour “into a context of events, circumstances and their connections”. We also learn that “intervention from outside by a mediator” especially one with subjective, intuitive, understanding can help the characters gain resolution. This intuitive understanding is gained, “when the playgoer sees the meaning in the behaviour through empathy with the person afflicted”.

In the theatre we’re also free to express and explore counter-transference, whether as a gasp, cry, tut or tsk, or to laugh in a way which would have the PALS office pursuing us were we do to so in the workplace. There’s also the added insight into the intrapsychic world of stage characters in the form of soliloquies, arias and solos, which might allow us to speculate similarly as to the conscious and unconscious motivations of our own patients.

I’m not sure MRCPsych examiners will be posing questions on Hamlet (Donmar West End, Wyndhams, from June), King Lear (Young Vic, Feb – Mar), or Blanche DuBois (Streetcar Named Desire, Donmar Warehouse, from July) but I’ll be in the audience hoping for both entertainment and insight for my own practice.