The manic depression of George III

You may well have seen the 1993 Alan Bennett play ‘The madness of George III’ or the following year’s film adaptation, ‘The madness of King George’. (The name change was apparently because Hollywood moguls thought that the “III” would lead moviegoers to assume that the film was a second sequel to ‘The madness of George’.)

A major premise of the play and film was that George III’s condition was due to the inherited metabolic disease porphyria, but recent research suggests that this long-standing belief is nonsense and that George’s main problem was actually dipolar disorder.

It was back in the mid-1960s that Ira Macalpine and her son Richard Hunter, both psychiatrists and amateur historians, published several papers and a best-selling book arguing that George III suffered from acute intermittent porphyria, a diagnosis they later amended to the milder but rarer variegate porphyria. Despite criticism by porphyria experts, their claims were widely accepted by historians.

Now, more than 50 years later, psychiatrist Timothy Peters, of Birmingham University, and Dr David Wilkinson, an expert on the life and times of George III, have re-examined the evidence and found that Macalpine and Hunter were highly selective in reporting the signs and symptoms of the king’s illness, attributing them to porphyria when there were far more plausible explanations.

For example, an episode of hoarseness was ascribed by the king’s doctors to a head cold, from which he recovered in a few days. But Macalpine and Hunter claimed that the hoarseness was a feature of porphyria, even though such symptoms in acute porphyria would often be terminal and even today would take 12 to 18 months to resolve.

Equally spurious as symptoms of porphyria are six episodes of “discoloured urine”, which feature in Bennett’s play. In reality, a single report of blue urine followed six reports of normal urine during the previous six weeks. Peters and Wilkinson suggest that the prescription of extract of gentian as a digestive stimulant three days earlier may offer an explanation for the discoloration.

The Macalpine and Hunter theory is further weakened by the fact that, if George III had inherited porphyria, then half of his 15 offspring and eight siblings should also have had the porphyric gene.

Even though the disease would not have been triggered in all of them, at least a couple might have been expected to show symptoms. But medical historians have failed to find any evidence of porphyria in George’s ancestors or in the descendants of his extended family.