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The "Madness" of King George III

Britain's longest-reigning male monarch suffered from recurrent bouts of a mysterious illness.

portrait of king george III
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  • Photo Credit: Wikipedia

The reign of King George III started over 250 years ago, but there’s no way you haven’t heard of him. He’s infamous for a number of occurrences during his lifetime, and you’ve probably seen his recent representation in popular culture, whether you recognize him as the mad husband of Queen Charlotte in her Bridgerton spinoff, or portrayed by Jonathan Groff as the tyrant king in Hamilton. You probably know at least two of the following three facts: 

  1. He was the “Mad King”
  2. He lost the American Colonies
  3. He’s responsible for the Regency period

But what’s the full picture? Or at least the fuller picture? Let’s start by first gathering the facts in order, then we’ll look at his symptoms, and examine how those facts and symptoms have been analyzed to diagnosis his infamous illness(es).

Frankly, because King George III was born two months prematurely, no one was confident he would live very long, let alone to adulthood. Although he was difficult to educate because of suggested slower mental development, he did finally learn to read at age 11, and he was one of the only monarchs of that era to study science—specifically astronomy.

When George III was 12 years old, his father died from a lung injury. That’s when George III became the heir apparent. It was another 10 years before his grandfather King George II died, and in 1761, when George III was 22 years old, he became King of Britain and Ireland.

On September 8 of that year, when he was 23, George III married Charlotte of Mecklenburg-Strelitz (who was just 17 years old). His coronation took place two weeks later.

By most accounts, George and Charlotte were happily married, and unlike many monarchs, George took no mistresses. Over the course of their marriage, George and Charlotte had 15 children together.

During George III’s reign, Britain had a constitutional monarchy, meaning it was ruled by a cabinet. The cabinet that George III inherited had started the Seven Years’ War, a global conflict fought with France and Spain in Europe, and the French and Native Americans in North America. They were in unprecedented debt because of said conflict.

Regarding the Stamp Act and the petitions sent by three American colonies, although the House of Commons rejected them all, the King himself favored modifying the act rather than enforcing or repealing it. When his hand was forced, he actually supported repeal.

portrait of King George III with Queen Charlotte and their six eldest children
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  • King George III with Queen Charlotte and their six eldest children, by Johan Zoffany, 1770.

    Photo Credit: Wikipedia

When the American Revolution broke out, he did regret that decision, thinking that capitulation was the first step toward revolution. In 1776, the American Declaration of Independence declared King George III the “tyrant” who was “unfit to be the ruler of free people.”

Historical scholarship has since overturned these unfavorable readings of the King. It seems that in England itself, he remained popular among his subjects after the war—of course, Americans were no longer counted among those subjects by then, so that must have factored in as well.

Beginning in 1788, although possibly even as early as 1765, the King suffered from recurrent episodes of an illness that mystified his contemporaries and caused him to be labeled mad. His symptoms included: abdominal pain, seizures during which his attendants had to restrain or sit on him, and blue urine. He also spoke and wrote in long, wild sentences. One observer wrote that he spoke until “he was exhausted, and, the moment he could recover his breath, [begin] again, while the foam ran out of his mouth.” Later hair analysis confirmed that he also had high amounts of arsenic in his system.

By 1811, he was so ill that he could no longer rule. His eldest son stepped in as Prince Regent, and ruled until King George III's death in 1820.

People still beg the question, what exactly was King George’s ailment? 

The short answer is, we don’t know exactly. But there are several theories.

In the 1960s, Drs. Ida Macalpine and Richard Hunter presented the idea that the king had acute porphyria, which is caused by a buildup of chemicals. Some symptoms of acute porphyria are anxiety, hallucinations, severe pain, nausea and vomiting, palpitations, high blood pressure, muscle weakness, red or brown urine, and blindness. So, some of those symptoms align with what King George reportedly experienced…but also, contemporary historians are not super confident that we can trust those records. And they’ve all but ruled out porphyria recently, even though this was considered his most likely diagnosis for decades.

Dr. Timothy Peters, an expert in porphyria, reviewed Macalpine and Hunter's studies and found them very selective in the symptoms they chose to report. He suggested that one reason why this diagnosis stuck so long despite many holes in its evidence could be that maybe a metabolic disorder was easier to process than a mental health diagnosis…particularly when a monarch was concerned.

Recently, a team at the University of London presented the idea that King George III simply had a severe mental illness. The nonstop speech and writing that observers noted in the king is similar to the manic phase of bipolar disorder. Dr. Peter Garrard and Dr Vassiliki Renoumi analyzed the king’s use of language and discovered that when he was experiencing periods of illness, his sentences could be as long as 400 words. He also often repeated himself, and his vocabulary became more complex. This level of loquacity, along with convulsions, could be symptoms of the harmful euphoria of manic depression.

It makes sense, too, that 19th century physicians would not have made this diagnosis, since it didn’t exist yet. Even in the 1960s when Macalpine and Hunter were revisiting the king’s maladies, people didn’t yet put much stock in psychology.

Besides, the most famous symptom of porphyria, the blue urine, could very well have a different source. King George III’s medical records show that a medicine he was given regularly, called gentian, may turn urine blue. So one of his most famous symptoms could have actually been caused by his medicine, not the illness itself.

On the other hand, what about that arsenic? When his hair was tested in 2005, there were high levels of arsenic present. Arsenic may have been given to King George III as a medicine, as well…and some of his symptoms could have been caused as a side effect of the arsenic, like abdominal pain and vomiting.

A study in 2010 indicates that his chronic mania may have gradually evolved into dementia, which necessitated the regency of his son. The same study reveals that King George’s blindness later in life was due to bilateral cataracts, and they reexamined his progressive deafness as reported by his attending physicians, too.

So, although we don’t have definitive diagnoses for the maladies King George III suffered some two and a half centuries ago, new scholarship has all but ruled out the most popular, porphyria; and it points to a combination of other illnesses and treatments that may complete the portrait of his reported symptoms.