According to Matthew Walker, Professor of neuroscience and psychology at the University of California at Berkeley, “the two most common triggers of chronic insomnia are psychological: emotional concerns, and emotional distress” (Walker 244). In other words, worry and anxiety. The consequences of insomnia or lack of sleep were a health concern in Shakespeare’s England just as they are our contemporary world. Without the benefit of modern science to draw from, Shakespeare, throughout a multitude of plays, draws vivid dramatic connections between poor sleep and psychological torment, with detailed symptoms as relevant today as they were then.
In Henry IV, Part I, Lady Kate Percy addresses her husband, Hotspur, on the eve of a rebellion to overthrow the King, with grave concern about his health. Unbeknownst to her, Hotspur, along with his family and allies, have been plotting this war for weeks. He tells her he’ll be leaving in two hours and she begs him to tell her what’s wrong, asking why he’s been neglecting her for two weeks: “For what offence have I this fortnight been / A banish’d woman from my Harry’s bed? (2.3.40-41). She further elaborates on his strange behavior, “— what is’t that takes from thee / Thy stomach, pleasure and thy golden sleep? (2.3.42-43). Hotspur’s worry has taken his appetite, his libido, and disturbed his sleep. The little and light sleep Hotspur might have gotten, Kate explains to him, is fraught with nightmares of battle and commands to his horse:
Kate then details the physical manifestations of his nightmares: “Thy spirit within thee hath been so at war / And thus hath so bestirr’d thee in thy sleep,/ That beads of sweat have stood upon thy brow —” (2.3.58-60). The ‘war’ Kate refers to within Hotspur is the kind of insomnia inducing stress soldiers suffering from PTSD are likely to exhibit over extended action. Hotspur is Henry Percy’s nickname, earned from his fierceness in battle and impulsiveness of action, he’s a battled tested veteran, with an explosive temper, hence he is said to have a ‘hot spur.’ Having helped Henry IV to power, Hotspur now secretly seeks to overthrow the King. The weight of his decision plagues his sleep, as Kate adds: “And in thy face strange motions have appear’d, / Such as we see when men restrain their breath / On some great sudden hest” (2.3.62-64). She’s describing a man who is gulping for air in his sleep, holding his breath from a sudden command. As Walker explains, patients with PTSD are often war veterans who suffer from recurring nightmares, and that their sleep, especially REM sleep, have been deeply disturbed. In fact, repetitive nightmares reported in PTSD patients was a symptom so reliable that it forms part of the list of features required for a diagnosis of the condition (Walker 212).
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An additional example of ‘disturbed’ sleep where a wife shows concern for her husband’s physical health appears in, Julius Caesar. Brutus is torn whether or not to join a group of conspirators in a plot to murder Caesar. He believes in government and the republic, and although he loves Caesar as a friend, he fears Caesar aspires to power that leads to dictatorship. Having just met with the other plotters in his garden in the dark early morning, Brutus’ wife, Portia, enters, and confronts him about his recent strange behavior. Like Hotspur, Brutus has also chosen not to confide with his wife about his plans. Among other things, she laments his moodiness, brooding, and sighing, adding: “It will not let you eat, nor talk, nor sleep —” (2.1.272). Portia tells him that if he had changed his outward appearance as much as it’s affected his interior life, she wouldn’t be able to recognize him. He tells her that he’s just not well, but she persists: “No, my Brutus; You have some sick offence within your mind —” (2.1.287-288). Without the requisite information from Brutus, nor the medical insight, Portia’s identifying a ‘sick offence’ is her “diagnosis” of Brutus’ behavior, which is a vicious cycle of worry driven sleeplessness. This cycle of sleep deprivation leads to “greater difficulty in deciding upon a course of action in emotionally evocative moral dilemmas, as well as greater willingness to agree with solutions that violate personally held moral beliefs” (Barnes et al.). The weight of Brutus’ ‘moral dilemma’ is the source of his insomnia: take the life of his friend or risk the life of the Roman State. This question is at the heart of the play and arguably makes Brutus the tragic hero of the story.
Often when a character has insomnia and they are aware of the price it extracts on them, they grapple with the cost of leadership and responsibility on their primary need to sleep. This self reflection can be seen in Henry IV Part 2 and Henry V, as mirror images of stress over sleep. In Henry IV Part 2, England is in the middle of a civil war as a strong rebellion continues their struggle to overthrow the crown. The King’s anxiety over the insurrection and the fate of his oldest son has caused him to age prematurely and he’s become seriously ill. The burden of his position is expressed vividly in his long, painful, complaint in the middle of the night in his palace at Westminster. While still working on documents of war, he wonders aloud.
Henry’s thoughts, fueled by insomnia, weave through the torment toward their final lucid conclusion, a simple breathless insight: “Uneasy lies the head that wears a crown” (3.1.31). Anxiety and worry are normal, and when in proportion can lead to improved behavioral attention, acute awareness and problem solving, which certainly has been the case for King Henry. Too much of it can turn clinical and turn up in the body, as it does for Henry with his insomnia, and in turn, his failing health and ultimate death. “Insomnia patients [cannot] disengage from a pattern of altering, worrisome, ruminative brain activity” (Walker 245). As a matter of clarification, the difference between sleep deprivation and insomnia is this: [being sleep deprived is having adequate ability to sleep but giving oneself an inadequate opportunity to sleep, and insomnia is suffering from an inadequate ability to generate sleep despite giving oneself the adequate opportunity to get sleep] (Walker 240-241). “Did Shakespeare himself suffer from insomnia?…These are unanswerable questions and unhelpful questions” (Hall 32). Indeed, speculative, but there’s no denying Shakespeare’s insight into the human condition went beyond dramatic license. It is highly plausible that Henry’s death came from acute insomnia. In fact, Walker has an entire chapter in his book called, “Sleep Disorders and Death Caused by No Sleep.” Certainly, a chill ran down my spine when I read the title, and the content was no less comforting. In it, Walker states, “Few other areas of medicine offer a more disturbing or astonishing array of disorders than those concerning sleep” (237). This is clearly drawn in Henry’s despairing: “O sleep, O gentle sleep” (3.1.5).
An interesting correlation within a recent contemporary study holds a striking possible link between medieval Humorism and Henry’s death. Although, obviously anecdotal, since we’re dealing with a fictional character and there wasn’t a postmortem scripted into the play, there is, however, a consistent documenting of Henry’s insomnia and weakening physical state: “But health, alack, with youthful wings is flown / From this bare withered trunk” (4.3.388-389). The medieval system of medicine is based on the four “humors,” and their corresponding four temperaments. The humors were: black bile, yellow bile, phlegm, and blood. These body fluids always needed to be in balance, and any disturbance of this balance, which included environmental factors and one’s mental faculties, might lead to illness and death. Walker highlights a research study done by the University of Chicago where they attempted to answer a fairly basic question, “Is sleep necessary for life?” (257). By preventing rats to sleep for extended periods, they discovered [rats would die after fifteen days, on average] (257). Briefly, there were a few factors at play: a shift in metabolic rates, [mammals and humans live in a very narrow temperature range, any extreme variation puts them on a thermal cliff]. The rat’s metabolic system collapsed as did their immune system. The results were ghastly: externally, there was weight loss, sores, “decrepitude that resembled accelerated aging” (259), and internally, there was “a landscape of physiological distress” (259). The final outcome was septicemia, a toxic and systemic bacterial infection. It was bacteria from the rat’s own gut [bile], “one that an otherwise healthy immune system would have easily quelled when fortified with sleep” (259). That ‘fortification’ is precisely what Henry desperately craved: “O gentle sleep, Nature’s soft nurse” (3.1.5-6).
Perhaps insomnia runs in families; if not, they certainly are occupational hazards of Kings in Shakespeare’s plays, as we again see in Henry V. While disguised as a commoner, King Henry sits alone in camp the night before the Battle of Agincourt, and like his father before him, laments the weight of responsibilities on his young shoulders: “What infinite heart’s-ease / Must kings neglect, that private men enjoy!” (4.1.244-245). Henry states that he would trade all royal ceremony for the peaceful sleep of a slave: “Who with a body fill’d and vacant mind / Gets him to rest, cramm’d with distressful bread; / Never sees horrid night, the child of hell” (4.1.278-280). This long speech is a view into Henry’s psyche, and the anxiety he struggles with the duties to care for and protect his subjects, who luckily live without any such concerns: “What watch the king keeps to maintain the peace, / Whose hours the peasant best advantages” (292-293). This “vulnerability” Henry displays might just be a symptom of anxiety and lack of sleep feeding on itself. As a dramatic device, it’s well validated by a sleep deprivation study by the Norwegian Naval Academy on its officers. In it they concluded that [transformational leadership and transactional leadership decreased from the rested to sleep-deprived condition, whereas passive-avoidant leadership overall increased from the rested to sleep deprived condition]. (Olsen et al. 683). Perhaps what Henry needs is just a good night’s sleep to wrest his worries away.
“Somnambulism refers to sleep disorders that involve some sort of movement. It encompasses conditions such as: sleepwalking, sleep talking, sleep eating, sleep texting, sleep sex, and, very rarely, sleep homicide” (Walker 238). — Enter the Macbeths. There are a multitude of thematic motifs that inhabit Macbeth, and certainly ‘sleep’ is one of them. In keeping with the topic at hand, I’ll continue to filter ‘sleep’ through the lens of symptoms and causes of insomnia, avoiding lyrical and metaphorical associations with the word. The Macbeths have plunged their world into chaos through a series of ruthless murders in their ambitious drive toward the throne of Scotland. As the body counts rise, so do their sleepless nights. Shakespeare introduces the concept of sleep as a deeply vital function to the characters when one of the Witches weaponizes sleep against a woman’s husband: “I’ll drain him dry as hay. / Sleep shall neither night nor day / Hang upon his penthouse lid” (1.3.20-22). Later, having encountered these same witches with Macbeth, Banquo, has wrestled with their vision of the future regarding the future of the throne. He shares his insomnia with his son Fleance in Macbeth’s castle.
Although prophesied by Witches, Banquo’s paranoia driven insomnia is as real as contemporary science confirms. Recent medical research [highlights that aside from anxiety, another potential consequence of insomnia, is the feeling that others are deliberately trying to harm us] (Science Daily). “Clinical experience indicates that there is a vicious cycle: insomnia makes us anxious and fearful, and these feelings make it harder for us to sleep” (Ibid).
Macbeth describes how sleep eases worries, alleviates the aches of physical work, lessens anxiety, and nourishes the body and mind like food. Sleep seems to be meaningful to Macbeth, though he’ll never rest peacefully without nightmares after Duncan’s death. At a banquet for the new King and Queen, Macbeth finds Banquo’s ghost sitting in his chair. Invisible to the rest of the company, Macbeth speaks to the ghost. Lady Macbeth addresses it as insomnia by persuading him to put the deaths out of his mind: “You lack the season of all natures, sleep” (3.4.173). Finally, it is Lady Macbeth who most famously captures the physical and mental cost associated with severe anxiety and insomnia. Her guilt having wrestled her mind away, she has now been reduced to sleepwalking, desperately trying to wash away an invisible bloodstain: “Out, damned spot, out, I say!” (5.1.37). The Doctor and Gentlewoman are astonished at her descent into madness, as the Doctor proclaims: “This disease is beyond my practice. / Yet I have known those which have walked in their sleep, who have died holily in their beds” (5.1.62-65). The Doctor’s ineffectualness in this case is in keeping with the lack of knowledge associated with sleep. Neither the physical causes nor the effects of sleep were well understood, and that contributed to the sense of fear and anxiety that surrounded sleep in Elizabethan and Jacobean England. One could characterize Lady Macbeth’s behavior as delirium, which a recent study stated was a commonly encountered in intensive care units: “Sleep in these patients is characterized by sleep fragmentation, an increase in light sleep, and a decrease of both slow wave sleep and rapid eye movement sleep” (Ramos et al. 781). There are numerous chemical imbalances that transpire, of course the Doctor wouldn’t have a clue, and ironically, four hundred years later “these phenomena are not yet well understood” (Ibid).
As the play approaches its closing sequences, Macbeth enters Dunsinane with the Doctor and attendants as he readies for battle with the approaching English army. Macbeth asks the Doctor about his wife’s condition: “Not so sick, my lord, / As she is troubled with thick-coming fancies / That keep her from her rest” (5.3.46-48). With a battle approaching his doorstep and his mad wife sleep walking, Macbeth desperately demands a remedy.
Four hundred years later, a great deal more is known about the biological need for sleep, but not a whole lot more. A myriad of data certainly exists regarding chemical synthesis within the brain during sleep, or the imbalances that occur during sleep depravation and insomnia. Shakespeare, lacking any of the science we have today, managed to accurately capture the symptoms of insomnia, driven mainly through the psychological turmoil of his characters. His detailed depictions of powerful figures unable to sleep bridge the centuries between the Elizabethan world and our own world through careful insight. For instance, anecdotally, many American presidents have been insomniacs: Bill Clinton was a self professed ‘functioning insomniac’, and Abraham Lincoln was a chronic insomniac. In his plays, Shakespeare offers us brilliant dramatic insight into the cost Nature extracts from humans when they disregard their sleep mandate, one [that evolution spent 3,400,000 years perfecting in service of life-support functions] (Walker 340). Within that context of time, four centuries is a mere blip in our common humanity. To quote a French saying, “plus ça change, plus c’est la même chose.” — “The more things change, the more they stay the same.”
