The Complicated Madness Of King George III

“Mental illness is in the eye of the beholder.” —Prot, in K-Pax (1995)

In A Nutshell

King George III might have been a mad king, but he was mourned when he finally passed away after a decade living in isolation. It’s long been thought that he was suffering from manic-depression, but it was put forward in the 1960s that he might have had a genetic condition called porphyria. The disease causes attacks of severe pain and hallucinations, and those attacks are usually triggered by anything from sun exposure to alcohol. That something that might have been the trigger for the king has been found—the massive levels of arsenic that doctors were pumping into the troubled regent in an attempt to cure him.

The Whole Bushel

The madness of England’s King George III was the stuff of legend, so much so that it’s often difficult to see past the stories and the madness to the person languishing underneath. In truth, his illness was much more than just mistaking inanimate objects for old friends; there were times when he was perfectly rational in between bouts of insanity, and he knew that he was going mad. In 1788, after what would be one of many periods of insanity, he remarked to his son that he knew that he was going mad and wished that he would die before losing his mind completely.

In spite of being known as the king who drove away the American colonies, King George III oversaw other great English victories. It was the beginning of the Industrial Revolution, it was the start of steam power, it was a time of colonial expansion and the end of the Seven Years’ War. He had the support of the people, and even throughout his illness, his public held vigils and prayed for him to get well.

He did, for a time, usually when the doctors stopped treating him. And that was the first clue as to just what was really wrong with him.

His mental state was frightening. There were times when he would talk so much and so quickly that he would begin to foam at the mouth, needing to be restrained. He went through violent phases, one particularly bad one was directed at his son, who would later succeed him a full decade before his death. And there were times when he thought that he was already dead, and he would have conversations with relatives that had long since passed on and with the angels he believed surrounded him in heaven.

It’s been proposed that he was the victim of a genetic disease called porphyria, which is a condition that results in the accumulation of a substance called heme in the body. One form, called cutaneous porphyria, causes mainly skin conditions like the development of blisters and itching. The other, acute porphyria, happens—as in George III—in attacks that typically last a few days to a couple of weeks.

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The symptoms of acute porphyria match the physical symptoms that are often overlooked as having gone along with the regent’s much more popularized mental state. He also suffered from blinding headaches, stomach pains that left him immobile, and swelling of his feet. That’s along with the mental symptoms of the disease, like hallucinations and paranoia.

This early diagnosis, first postured in 1968, took the place of the old idea that the king had been suffering from a manic-depressive psychosis. A look at the genetics of his descendants has shown that many of them carry the gene that causes porphyria, and the overwhelming majority of people who have it—about 90 percent—never develop any symptoms whatsoever.

So why was the regent so devastatingly ill?

Now, it’s thought that the problem was largely because of his doctors. Attacks of acute porphyria can be triggered by a number of things, from fasting to prolonged exposure to the Sun. And it certainly could have been triggered by the massive amounts of arsenic that were found in strands of his hair that were subjected to testing. The arsenic, commonly used in such things as wig powders, was also given to him as a component of several of his medicines, including emetic tartar and James’ powders. The arsenic found in his hair was more than 300 times the levels that would be considered toxic.

There are still others that dispute the porphyria theory, as there is no way to definitively determine whether or not the monarch had the gene for the disease, as attempts at DNA analysis have failed. And even today, it can be difficult to tell the difference between porphyria and psychosis. But given that the king recovered when the doctors stopped trying to make him better, it’s a telling sign that perhaps the madness of King George III wasn’t a mental illness after all.

Show Me The Proof

BBC News: King George III: Mad or misunderstood?
Mayo Clinic: Porphyria
Colonial Williamsburg: The Poisoning of King George III

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