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The Collation

When the Body is Ill, The Mind Suffers: Shakespeare's Unravelling of Women’s Hysteria and Madness in the Elizabethan Era

A half-finished portrait of a woman whose face is upturned in what looks like suffering.
A half-finished portrait of a woman whose face is upturned in what looks like suffering.

During my research fellowship with the Folger Institute, my investigation has undertaken an exploration into a highly under-represented aspect of mental health and has focused on lived-in experiences of mental illness in Shakespearian England. What did it mean not only to treat mental illness but also create art and write about these experiences? There have been dominant answers to this question throughout literary studies, which have traditionally emphasized the focus of “illness” and reinforced the notion that people were too un-fit to function.

This study instead considers specifically women’s experiences of mental illness from the point of view of an embodied experience, one that takes a dualistic approach to understand both the physical and psychological within the civil society of the time. It looks at the individual living with mental health difficulties such as Despair and Eating Disorders through the lens of “otherness” and seeks to examine their experiences within larger social contexts of the period. This blog is to give a brief insight into some of the work through lived-in experiences and their representations. These historic shortcomings provide us with contextual scope for deeper understanding of these fallacies and engage with the influence that the creative voices had in perpetuating these narratives.

Historic Overview

In the early Tudor era of England, the common belief was that there were five main types of mental health illnesses. First there was Melancholia, which referred to depression and apathy, and Mania which many associated with violent action. Second, were more ‘medical based’ mental abnormalities such as erratic behaviors caused by fevers: Delirium and Phrenitis, which was inflammation of the brain. The last mental illness was Amentia, which was the lack or complete loss of mental abilities.1

In this era, there was a strong influence of the Greek physician Hippocrates’ theory of the four humors. He noted that these physical qualities—blood, yellow bile, black bile, and phlegm—had influence on the body and its emotions. All of these were caused by either ‘scientific’ or ‘magical-demonological’ origins such an abundance of black bile in the body, which is one of these four humors, or demonic possession. Mental illness was caused when the bile flooded the brain which resulted in evil ‘humors’. Similarly, demonic possession was associated with ‘lunacy’ which required exorcisms to eradicate evil spirits.2 The most prevalent illness was melancholy. It was believed that women were more prone to this illness than men.3 It was a sign of their belief in the mental and physical inferiority of women. Regardless mental illness did persist across all regions and all socio-economic classes.


When we examine the female experience of mental illness in Elizabethan Era, the most visibly apparent experience of ill-health is hysteria. Hysteria was understood as individuals having emotionally charged behavior that was excessive and out of control. Hysteria was undoubtedly the first mental disorder attributable to women. Freud fermented this notion decades later as he considered it to be an exclusively female disease.4

Women were supposedly more vulnerable to mental disorders, because they were weak and easily influenced and because they were somehow guilty. Medical experts at the time argued that hysteria, “mother-fits” or “frenzy of the womb,” was caused by influxes of menstruation or “corruption of a woman’s seed”. This term often referred to many sexual related onsets such as lack of sexual activity, sexual repression, or even too much sexual desire.5 Hysteria and most mental disorders in women were highly misunderstood with individual moral-biases and filled with prejudice in both diagnosis and treatment.6

If we examine two of Shakespeare’s most famous tragedies, Hamlet and Macbeth, the plots portray the downfall of their female characters Ophelia and Lady Macbeth from sanity to suicide. These women’s stories provide glimpses into the demise of their mental state based on this historical context. In Hamlet, the sweet and innocent Ophelia states her interest in the young man to her family, who forbade her from pursuing her desire. Mendelson and Crawford outline how this could have been the initial start of Ophelia’s hysteria as such disturbances in love affairs could have been considered a trigger and provoked these “mother-fits”.7

Furthermore, her sudden loss of contact could certainly be considered a disturbance in Ophelia’s life. The loss of her father and several other events could have contributed to her demise; however, Hamlet’s impact was the most substantial cause of her spiral into madness. Hamlet’s madness was perhaps a breaking point for Ophelia and caused her to develop an “erotic melancholia”.8 This diagnosis may be an understatement for Ophelia’s mental health struggles, nevertheless it provided a basis for her later behavior. Neely describes her actions throughout the narrative to become more “restlessness, agitation, shifts of direction … and show that madness is exhibited by the body as well as in speech”.9 Ophelia’s behavior was closely linked to that of her male counterparts in the play. When their security and comfort crumbled, so did she. The reliance on males for such stability is problematic and her psychosis was discredited and not acknowledged leading to a spiral downfall.

Similarly, Lady Macbeth’s story was gendered. Her suffering always made this discourse visibly apparent. The first instance that reaffirms this claim was when Macbeth had a manic episode after the murder of Banquo in Act III, and she asks him, “Are you a man?” (III.iv.70) which insinuates that only a woman would behave in such a way. Then she states to him that his behavior was “quite unmanned in folly” (III.iv.88). This accusation reasserts the notion that Macbeth’s reaction to his mental illness is feminine, as folly is predominately a female trait. As Lady Macbeth descends into her own madness, the doctor, when examining her situation stated:

Not so sick, my lord
As she is troubled with thick-coming fancies
That keep her from her rest (V.iii.46-48).

Whether she was awake or sleepwalking, the doctor is dismissive about her sickness and sees her to be troubled by “fancies.” This word choice here is important as it reaffirms an idea of feminine foolishness since the term typically denotes unrealistic belief. The doctor asserts to Lady Macbeth that she must use willpower as a form of mental cure and that it requires no medical intervention as it is all in her head. One point to examine closely is that the doctor utilizes the pronoun: “himself.” The doctor further iterates that:

Therein the patient
Must minister to himself (V.iii.56-57).

He is expounding the notion that she must use willpower to remedy herself. It is important to note in this quote that the doctor is speaking directly to Lady Macbeth but uses the male pronoun to refer to a patient’s need to take control of their own health. Perhaps this pronoun alludes to a belief that only men could have the power to cure themselves. Unfortunately, Lady Macbeth dies following this conversation, which further emphasizes her womanly weakness to illness.

The insight from Shakespeare’s portrayal adhered to the medical understanding of illness. Ophelia’s and Lady Macbeth’s representations of their illness illustrate a lack of understanding through the poor representations of the depths of a disease. There was a failure to communicate and portray differentiation between physical, verbal, and mental expressions of madness. These representations illustrated how there was a common societal perception that there was no separation between body and mind.10 This notion is reinforced through Hodgkin’s description of mental illness as a “single system” and taken as merely women’s behavior and not acknowledged as a person’s struggles.11

King Claudius stated “poor Ophelia” after her death, noting that Ophelia:

Divided from herself and her fair judgment,
Without the which we are pictures or mere beasts (IV.v.82–83).

Notably, King Claudius here separates Ophelia as a person from her gender. He has made her actions appear nonhuman and almost barbaric as her soul was separated from her body with her actions based purely on raw emotion. Shakespeare enlightens an animal-esque treatment of Ophelia’s behavior which consequently has the audience not seeing her as a human being suffering from a debilitating disease and trying to escape from her pain. Instead, the spectators get a glimpse into the life of a silly girl “suffering physically and mentally the pangs of rejected love”.12 Ophelia’s mental ill-health was visually reduced and dismissible as her behavior was lovable and pathetic. This notion was apparent through the Elizabethan Era as women were often thought to react more emotionally to their inner struggles than men. This could have been due to the social expectation that men should not show their feelings, or that their behavior was more rational than a women’s.13 Nevertheless, this treatment of women’s mental health was perpetuated throughout centuries.

A half-finished portrait of a woman whose face is upturned in what looks like suffering.

Charles LeBrun, Portrait of the Marquise de Brinvilliers. Drawing. 1676. Musée du Louvre.

Drawing briefly on the Portrait de la marquise de Brinvillier, which depicted the famous poisoner beheaded in Place de Grève on July 16, 1676, this study focused on the instability and hysteria of the woman, and Le Brun applied this frenzy and panic to her expressions. Her eyes are distant and incredibly fearful. Her body appears tight and compressed with frozen stiffness. The physical expressions illustrate the sharp pain that manifested pain in the mind and body.

An engraving of a woman collapsing back into the arms of a man while a crowd watches

Callot, Jacques. A Possessed Woman. Engraving on paper for Scelta d’alcuni miracoli e grazie della santissima nunziata di Firenze. London: British Museum, 1611-1619.

In Jacques Callot’s Exorcism of a Possessed Woman, this work depicts the sporadic behavior of a woman having a hysteric fit about to receive an exorcism. The “propagandist emotionalism” of this piece was utilized to further spread the miracles of the Annunciata.14 This aided and reinforced the reputation of the church and cemented the future of the belief in religious faith to address mental illness.15 There are difficulties in this portrayal as women’s behaviors were taken as emotionally driven throughout their lives so the balance between sanity and abnormality is not distinct.

An engraving of a woman holding a book and looking over her shoulder at an angel and people in heaven over a sinking ship.

Spierre, Francois, St Teresa’s Vision of the 40 Jesuit Martyrs, engraving, 1660.

Drawing upon Spierre Francois’ St Teresa’s Vision of the 40 Jesuit Martyrs, this piece illustrates St. Teresa amid a divine revelation. The fine lines are blurred as the same sporadic behavior is depicted as an act of divine ecstasy. What characterized her experiences and that of the women who were receiving the exorcisms is the commonality of a lack of bodily control. Whereas one woman is being punished for mental instability, the other is achieving the assertion that her heightened vision was linked with these hysteria-type symptoms.16 Perhaps Ophelia, St. Teresa, and Lady Macbeth allude to the notions that a women’s body is not her own. While many women are punished for their wild and hysteria related behavior, if it serves the needs of men, the church or the state then it can be validated. Whether it be a sign of affirmation of a man’s intentions or solidifying the faith’s propaganda, it is deemed acceptable. However, if it is not aligned, then a woman is punished accordingly.


When a woman had a mental health illness, it was not seen as someone suffering from a disease. Through the characters and artwork discussed we can see how problematic this representation was and the effects had it had throughout civil society. As characters such as Ophelia and Lady Macbeth illustrated, Hysteria was incredibly gendered and subsequently was not adequately treated. Often it was seen as manic depression or demonic possession, but not cared for. What the past teaches us is that these antiquated understandings of lived-in experiences of mental illness are incredibly problematic. Through examining these historic shortcomings, we can learn from their fallacies. We can strive to focus on patient-oriented treatment models for recovery and enforce the notion that mental illnesses are not a method for alienation, but a reminder that we all suffer.

  1. See Hanson, Marilee. 2015. Tudor England Mental Illness Types & Facts, English History.
  2. See Sceats, Amelia. G. 2016. Rationality and reality: perspectives of mental illness in Tudor England, 1485- 1603. Master’s thesis, University of Huddersfield. and Suzuki, Mihoko. 1992. See Gender, Class, and the Social Order in Late Elizabethan Drama. Theatre Journal, 44(1), 31–45.
  3. See Suzuki, Mihoko. 1992. Gender, Class, and the Social Order in Late Elizabethan Drama. Theatre Journal, 44(1), 31–45.
  4. See Tasca, Cecilia, Rapetti Mariangela, Carta Mauro Giovanni, and Fadda Bianca. 2012. Women and hysteria in the history of mental health. Clinical practice and epidemiology in mental health: CP & EMH, 8, 110–119.
  5. See Scull, Andrew. 2015. Madness in Civilization. Princeton: Princeton UP, Print.
  6. See Angermeyer MC, Holzinger A, Carta MG, Schomerus G. 2011. Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. Br J Psychiatry; 199:367–72.
  7. See Mendelson, Sarah., Crawford Patricia. 1998. Women in Early Modern England 1550-1720. Oxford: Clarendon. Print. Page 24.
  8. See Camden, Carroll. 1964. On Ophelia’s Madness. Shakespeare Quarterly 15.2: 247–255. Web. Page 245.
  9. See Neely, Carole Thomas. 1991. ‘Documents in Madness’: Reading Madness and Gender in Shakespeare’s Tragedies and Early Modern Culture. Shakespeare Quarterly 42.3: 315–338. Web.
  10. See Neely, Carole Thomas. 1991. ‘Documents in Madness’: Reading Madness and Gender in Shakespeare’s Tragedies and Early Modern Culture. Shakespeare Quarterly 42.3: 315–338. Web.
  11. See Hodgkin, Katherine. 2010. Women, Madness and Sin in Early Modern England: The Autobiographical Writings of Dionys Fitzherbert. Farnham: Ashgate. Print.
  12. See Camden, Carroll. 1964. On Ophelia’s Madness. Shakespeare Quarterly 15.2: 247–255. Web. Page 225.
  13. See Neely, Carole Thomas. 1991. ‘Documents in Madness’: Reading Madness and Gender in Shakespeare’s Tragedies and Early Modern Culture. Shakespeare Quarterly 42.3: 315–338. Web. Page 322.
  14. See Caldwell, Dorigen. 2006. Re-Viewing Counter-Reformation Art [Review of The Papacy and the Art of Reform in Sixteenth-Century Rome: Gregory XIII’s Tower of the Winds in the Vatican, by N. Courtright]. Oxford Art Journal, 29(1), 139–142.
  15. See Sauerländer Willibald. 2014. The Catholic Rubens: Saints and Martyrs, 1st ed. (Los Angeles: Getty Research Institute), 79.
  16. See Caldwell, Dorigen. 2006. Re-Viewing Counter-Reformation Art [Review of The Papacy and the Art of Reform in Sixteenth-Century Rome: Gregory XIII’s Tower of the Winds in the Vatican, by N. Courtright]. Oxford Art Journal, 29(1), 139–142.


An impressive survey of the subject by Alexandria Zlatar, with many helpful endnotes. Thanks, indeed, Alexandria, and also “Collation” for hosting the piece. Yes, the case of Ophelia
is a dramatic, theatrical instance of the ‘endgame’ for female hysteria & depression: suicide.
Other cases of depression, expressed in varying (discreet) ways, are Ann Finch and, as I suggested in “The Book of Hester” (online), Hester Pulter. But wait! Also interesting is the example of some early women writers who heroically faced-down considerable tragedy in their personal lives, yet did not give way to debilitating grief & melancholy — Anne Bradstreet, Katherine Philips, et al. Their solace was Faith, the continuity of family & marriage, and the creative process of writing. All, quite noble, dignified, inspiring. And such personal strength! This is a serious, important subject; we are just beginning to sort it out from such a distance.
– Maureen E. Mulvihill
Princeton Research Forum, NJ.
Submitted August 9, 2022.

Maureen E. Mulvihill, Princeton Research Forum, NJ. — August 9, 2022