King George III, a figure immortalized in Netflix’s “Queen Charlotte,” Broadway’s “Hamilton,” and the film “The Madness of King George,” remains a subject of intense historical and medical curiosity. Despite his long reign of nearly 60 years, he is often remembered for the loss of America and, perhaps more intriguingly, for the periodic bouts of severe illness and erratic behavior that plagued his later years, ultimately leading to his inability to rule for the last decade of his life. The question of King George Iii Diagnosis has captivated historians and medical professionals for centuries.
While some modern diagnosticians have retrospectively proposed a physical, genetic, liver-based disease as the root cause of his ailments, this widely publicized theory has faced considerable skepticism. The most prominent theory, suggesting that King George III suffered from acute porphyria, a genetic condition affecting hemoglobin production, was advanced in the mid-1960s by the mother-son psychiatric team of Drs. Ida Macalpine and Richard Hunter. Their conclusion stemmed from an extensive study of over 100 volumes of King George III’s medical records, acknowledging the historical differences in medical understanding compared to modern concepts of illness and disease. Their findings were subsequently published in respected medical journals and their book, “George III and the Mad-Business,” further solidified their argument.
Acute porphyria is characterized by a wide array of distressing symptoms, including anxiety, hallucinations, intense pain, nausea, vomiting, rapid heartbeat, high blood pressure, numbness, muscle weakness, discolored urine (red or brown), and even blindness. King George III undeniably experienced a number of these symptoms. He was known to suffer from severe abdominal pain and seizures, requiring physical restraint by his attendants during episodes. His urine was noted to be blue, likely due to gentian violet, a medication he was prescribed, though not the characteristic brown or red associated with porphyria. In his final years, he endured blindness from cataracts and possible deafness, further complicating his condition. Research suggests these physical ailments may have exacerbated his psychiatric state.
However, the porphyria diagnosis, despite gaining significant traction in medical and historical circles, was not without its detractors. Soon after Macalpine and Hunter’s publications, numerous experts in biochemistry and metabolic disorders voiced strong disagreements. Despite this expert dissent, the porphyria theory became widely accepted, permeating medical literature, historical accounts, and popular culture. Even as late as 1982, the porphyria diagnosis was supported in medical education settings.
More recently, a team of researchers from St George’s, University of London, presented a compelling counter-argument. They proposed that King George III’s “madness” was not porphyria but rather a manifestation of severe mental illness, specifically bipolar disorder. Researchers Peter Garrard and Vassiliki Rentoumi meticulously analyzed the king’s handwritten letters, focusing on his linguistic patterns during periods of illness and wellness. Their findings revealed a striking difference in sentence structure. During episodes of illness, King George III composed extraordinarily long, rambling sentences, sometimes reaching up to 400 words, filled with creative but often nonsensical content.
This pattern of verbose and pressured speech is a well-recognized characteristic of the manic phase of bipolar disorder in modern psychiatry. The manic phase, marked by euphoria and hyperactivity, is often followed by a depressive phase, characterized by profound sadness and low energy. Historical accounts from the late 18th century corroborate the bipolar theory. Witnesses described King George III’s behavior during his episodes as incessant talking, sometimes to the point of exhaustion and foaming at the mouth, mirroring descriptions of mania.
Further complicating the King George III diagnosis, a 2005 hair analysis revealed elevated levels of arsenic. Arsenic, a known neurotoxin, can induce mental health issues and neurological problems. Intriguingly, arsenic was a common medicinal substance during that era, raising the possibility that King George III might have been prescribed arsenic-containing medications for his attacks, potentially exacerbating his condition. Reports highlighted the potential impact of arsenic on his mental state.
British porphyria expert Dr. Timothy Peters re-examined Macalpine and Hunter’s archival research and concluded that their interpretation of King George III’s symptoms was selectively biased. His review suggested that the porphyria diagnosis was no longer tenable and required revision. Peters posited that attributing the king’s condition to a metabolic disorder rather than mental illness might have been more palatable during a time when mental health was heavily stigmatized and rarely discussed openly.
King George III’s recurrent illnesses necessitated periods of seclusion at Kew Palace, away from public scrutiny and the pressures of daily governance. Each withdrawal from London triggered a constitutional crisis, raising critical questions about who would govern England in his absence. Following a national debate in 1788 regarding the potential regency of his son, the Prince of Wales, King George III’s declining health ultimately led Parliament to officially appoint George IV as Prince Regent in 1811.
Despite the enduring fascination with his periods of illness, it is important to remember that King George III was also regarded as a just and reasonable monarch during his periods of wellness. He possessed a strong intellectual curiosity and a love for books. Notably, he was the first British monarch to study science. This contrasts sharply with the popular image of a debilitated and foolish king often portrayed in fiction.
In conclusion, the definitive King George III diagnosis remains elusive. The porphyria versus bipolar disorder debate underscores the inherent challenges in diagnosing historical figures who lived centuries ago, particularly without the benefit of modern medical examinations and physical evidence. The enduring popularity of the porphyria theory highlights how easily a plausible retrospective diagnosis, once established, can become entrenched in popular historical narratives, even when lacking definitive proof. While respecting the contributions of all researchers engaged in the King George III diagnosis debate, it is crucial to acknowledge the inherent limitations of retrospective diagnoses and the ongoing uncertainty surrounding the true nature of his illness.
