What caused the madness of King George?

King George III reigned from 1760 to 1820 during which time he lost one empire and set about getting another. The United States won its independence but British rule extended into what is now Canada as well as the Indian sub-continent and other parts of the world. France under Napoleon was defeated. And the industrial revolution made Britain the economic powerhouse of the world. So – a mixed report card but on balance positive. However – for the king himself – his reign was marred by periods of madness.

Nobody doubts that from 1788, King George experienced episodes of mania. He would talk incessantly until he began to foam at the mouth. On one occasion, he planted a beef steak in the ground firmly believing it would grow into some kind of beef tree. And he tried to shake hands with an oak tree believing it was the King of Prussia. More worryingly, King George tried repeatedly to climb the very high Great Pagoda in Kew gardens. This and other odd behaviour led to him being physically restrained – which was an unprecedented way to treat a monarch.

Diagnosing mental illness properly is frankly something we still struggle with today. Must declare a personal interest at this point as my mother was on the medical staff at an asylum in the 1960s and 1970s. So, psychiatry has always fascinated me. My mother’s hospital pioneered a concept known as the ‘therapeutic community‘ where patients were involved to a degree in the running of the institution. King George was also subjected to a treatment regime that was fairly new – even revolutionary.

DISCOVER: Was George III really a tyrant?

Francis Willis and the Moral Treatment approach

The doctor who treated George III – Francis Willis – is remembered by most people for putting poor George in a straitjacket and humiliating him. However, although not without fault, he was a great deal more sympathetic to patients than was the norm in that era. Willis was already 70 years old when he began treating the king and had run an asylum in Lincolnshire with some recorded success.

Some of the snobbery directed at Willis by the court physicians – who had failed to tackle’s the king’s insanity – has percolated down to us today. There’s a perception that Willis was a barely qualified charlatan making it all up as he went along. This is hugely unfair. Willis may not have been a Fellow of the Royal College of Physicians and his approach involved a degree of experimentation but his approach was as scientific as anybody else – arguably more so.

Willis adopted a regime based on good manners. King George had to behave himself. If he didn’t, he’d be treated like a naughty child. He would then have to earn the right to see other people or have a knife and fork at the table by being good. This infantilised the king but was based on an idea Willis developed that mental illness was caused in part by over-stimulation. This was called the ‘Moral Treatment’ where outright brutality was replaced by a stern paternalism and would eventually earn Willis a handsome government pension in his retirement.

Some of his other treatments though were more questionable and based on the dubious idea – that persists into our own times – of ridding the body of “toxins”. This was done by applying purgatives, blistering the skin and administering arsenic. The latter led to dangerous levels of arsenic being registered in the king’s hair after he’d died. It could also have triggered the medical condition that many have argued caused his madness: porphyria.

The argument over Porphyria as a cause of the madness of King George

Porphyria refers to a group of disorders that involve a build up of porphyrin in your body. Now I don’t want to get too technical here but basically, this can lead to physical symptoms such as vomiting, skin disorders and palpitations but also psychological symptoms including confusion, paranoia and hallucinations. If it was true that porphyria was the cause of madness then the finger of blame could be partly directed at Willis – at least for later outbreaks of insanity – and that would undermine entirely his diagnosis and approach.

Since the 1960s and the work of two psychiatrists – mother and son team Ida Macalpine and Richard Hunter – porphyria has been widely accepted as the cause of King George’s madness. Like many scientists they had an underlying theory to prove. In their case, it was a rejection of Freudian psychoanalysis in favour of biological psychiatry. The king wasn’t mentally ill in the accepted sense but essentially experiencing a form of physical poisoning that sent him round the twist.

The Macalpine/Hunter view gained the ascendancy pretty quickly. Willis was made to look like a total fool. But in recent years, their view has been challenged. The rival opinion is that the king had four or five episodes of bipolar disorder. That it really was mental illness pure and simple.

Macalpine and Hunter did analyse the contemporary medical reports. They showed that the king suffered jaundice, abdominals pains, discoloured urine and other physical symptoms ahead of each incidence of insanity. The colour of his urine was very noteworthy and to them pointed to porphyria. In the 1990s theatrical play The Madness of King George – later a movie – the monarch’s blue urine before his 1811 burst of madness is one of the key dramatic moments.

But the opponents of the porphyria diagnosis point out that the king’s urine wasn’t always blue before a period of irregular conduct. Ahead of his 1811 madness, there were six recorded observations of clear urine and the king had also been prescribed extract of gentian that would have turned his urine violet.

There is, of course, a good reason to hope that Macalpine and Hunter were right and that this is to remove the stigma that bipolar disorder – which is hereditary – might be a recurring feature in the British Royal Family. Better to believe for political reasons that the origin of King George’s madness was biological rather than psychiatric. We don’t want to start thinking there’s something unstable about those Hanoverians.

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