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.

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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.

lunatic asylum

Inside a British lunatic asylum

One building dominated the horizon near where I grew up in north east London. It had the distinctive, squat, red-brick water tower common to the Victorian era British lunatic asylum. This was Claybury Hospital, a vast complex covering 290 acres for treating the mentally ill of east London and the Essex suburbs.

Both my parents were on the medical staff at Claybury in the 1960s and in fact, it’s where they met – in the cafeteria. However, my father decided psychiatry wasn’t his bag and changed careers but my mother was there until the asylum closed in the late 1980s. Despite all the criticism and misinformation levelled at psychiatric hospitals, as well as the fear they inspired, she loved the work.

To go inside a lunatic asylum

As a child, I got a privileged look at life in an asylum. And it fascinated me. Every weekend, I’d accompany my father in the car to pick up my mother as she came off her Saturday and Sunday shifts. As with many psychiatric hospitals, the grounds were idyllic. Beautifully landscaped with pristine lawns, chestnut trees, a large willow, an eighteenth century manor house incorporated into the hospital, tennis courts and two big old churches – Anglican and Catholic.

As children, my sister and I would go and practice our serve on the tennis court, which I think was for staff, while outside the wire fence, patients would walk around in their dressing gowns in what could often look like a mildly zombified state. I assumed this is what they meant by a “chemical straitjacket”. Quite frequently, patients would wander out of the main gates and into the local town and then be returned by police officers or locals.

It’s hard to convey the scale of Claybury. But it was like a self-contained village even generating its own electricity up to 1929. The hospital was a combination of closed, semi-closed and open wards. There was therefore a large cohort of permanently resident patients for whom Claybury put on a detailed calendar of social and sports activity. In 1964, a Social and Recreational Centre was opened that put on dances with a small orchestra providing the music.

From lunatic asylum to therapeutic community

In the 1960s, the hospital pioneered what was called the ‘therapeutic community’ approach to its 2,000 patients. Patients and staff collaborated on day-to-day functions. And former patients were employed to work with nurses on the domestic chores to keep the wards clean and functioning. This was termed the “Claybury revolution” and not all staff, used to a more authoritarian regime, liked the new way. But it was mandated by two charismatic and reforming managers at Claybury – Denis Martin and John Pippard.

They wanted to break with the old stereotypes of the Victorian asylum. Decisions on treatment would be made through democratic discussion and, as far as was possible, patients were encouraged to take responsibility for their own behaviour. The therapeutic community approach at Claybury become an international talking point in mental health circles.

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I was always taken by the personal relationship that my mother had with patients at the asylum. She would bring their artwork and even cookery home to share. I’ll be honest, as a child I was reticent to eat the cakes made at Claybury. I remember blurting out: “What if they put a razor blade in there?” Seriously ignorant comment. And I’d get a telling off for saying such a thing. When a patient passed away, my mother was genuinely upset. There were strong bonds between some of the patients and medical staff.

Controversial treatments

In terms of the controversial aspects of Claybury – one can’t ignore the use of lobotomies for a period. My mother was present at one and the nurse next to her fainted during the procedure. This awful operation was thankfully discontinued but not before it had ruined many lives. What still continues to this day is the use of electroconvulsive therapy (ECT). That is sending an electric current through the brain, normally to address severe depression.

I’m always amazed at the number of people who think ECT doesn’t happen anymore. It very much does. But way more sparingly than fifty years ago. I once asked my mother how ECT worked and she told me that a consultant had once summed it up to her: “We have now idea what it does but it seems to do the job”. In other words, ECT is based purely on the empirically observed, surface results without much idea of what it’s doing beneath the surface.

Contrary to what many people think, it’s performed under general anaesthetic – though in the old days that was not always the case. Having sadly lost a friend to depression (he jumped off a motorway bridge head first), I realise that for some people any cure is grabbed at when all else has failed. My mother recalled being on ‘suicide watch’ at Claybury when a patient in bed during the night tore a button off his pyjama bottoms, split it in half, and managed to slash his wrists. My mother told me this to illustrate how suicidal feelings can overwhelm some poor souls.

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There is no doubting the asylum system was flawed and you wouldn’t re-invent it. However, nobody believes that we spend anywhere near enough on mental health or that ‘care in the community’ and the closure of the asylums was driven as much be cost saving as a desire for better therapies. And sadly, there is a high representation of mentally ill people in another institution these days: prisons.

Claybury – or the ‘loony bin’ as my schoolmates used to term it – is now a luxury housing estate. The wards of the one-time lunatic asylum are now bedrooms and dining rooms. One of the Victorian churches has a swimming pool in what was previously the nave. I own one of the pews, which I took with the vicar’s permission before the hospital gates closed for the last time. And the patients and staff are ghostly memories.

Maddest rulers in history

Who were the maddest rulers in history? We’ve not been short of a few in my lifetime. Though some have been insane but wily while others had become incapacitated through mental illness. Colonel Gaddafi is a good example of insane but wily. While poor old Boris Yeltsin seemed increasingly unstable in his last years.

Dynastic systems breed the maddest rulers

When you have a political system where somebody inherits the top job, you’re not always assured of the best person for the role. That’s especially the case when the new king or queen is completely insane. Yet that’s exactly what has happened many times in history when the mad have taken over.

Charles VI of France (1368 to 1422) believed he was made of glass and wore protective clothes to prevent his body being shattered. Think what happens to the Night King in Game of Thrones and you get the idea. In one incident while out hunting, Charles was convinced he was under attack and killed four of his own retainers before being restrained.

The reign of Charles VI was very long because he took power when he was very young. And there seems to be a connection between assuming the throne in infancy and coming under tremendous mental strain. Think about it. You have had no preparation for absolute power and when things go wrong, it comes as an overwhelming shock.

Maddest rulers: Henry VI and his fits of deep depression

So, child monarchs don’t tend to have happy reigns. Henry III, Richard II and Henry VI in England are good examples of this. Henry VI suffered what looks like fits of depression that made him completely unable to rule for periods of time. Stress seems to have rendered him like a rabbit in headlights – he froze while his advisers around him panicked.

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Juana La Loca (literally Joanna the Mad) was Queen of Castille, part of modern Spain, in the early 16th century. This was when Spanish power around the world was reaching its height with colonies in the Americas, across Europe and Asia. But Juana was way too mad to be allowed to rule any of that so she was “secluded” (locked away) in a castle.

Maddest rulers from the bible and ancient Rome

The biblical monarch of Babylon Nebuchadnezzar exhibited symptoms of a disorder known as boanthropy where an individual believes they might be a cow! Now it’s hard to know if this was propaganda used against him or the truth. But the condition certainly exists.

The Roman Empire threw up an extraordinary number of mentally unstable emperors almost from the start. The second emperor, Tiberius, retreated to the island of Capri where he reportedly tortured people in some pretty horribly ways.

He was then succeeded by Caligula whose madness is disputed by some historians but accepted by most. One of his oddest acts was to announce the appointment of a new consul, which turned out to be a horse called Incitatus.

In the 6th century CE, the Byzantine Empire was ruled by Justin II. A chronicler called John of Ephesus described how he was possessed by an evil angel that made him impersonate animals!

For suddenly it destroyed his reason, and his mind was agitated and darkened, and his body given over both to secret and open tortures and cruel agonies, so that he even uttered the cries of various animals, and barked like a dog, and bleated like a goat; and then he would mew like a cat, and then again crow like a cock: and many such things were done by him, contrary to human reason, being the workings of the prince of darkness…

Ecclesiastical History – John of Ephesus – Book 3

The only way to calm Justin down was to have organ music played all day and night, which must have driven his courtiers round the bend. He also had to be pulled through the palace in what’s described as a throne but I think a baby cart would present a truer picture.

And then no blog post on mad monarchs could leave out the maddest of them all – King George III. The king of England who lost America and his mind. Experts are still debating what the nature of his disorder was and views seem to change every year.

But the poor man was completely incapacitated for periods and would do things like greeting trees and shaking their branches as if they were human. You will all be familiar with the famous stage play and movie on this life story.