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George III's Illness and Misdiagnosis

George III's madness is well known but historians believe there that is a more accurate prognosis than the previously accepted porpyhria.

George III in 1762. Portrait by Allan Ramsay (1713-1784)

George III in 1762. Portrait by Allan Ramsay (1713-1784)

King George's Mental Strain

King George III was born on the 4th of June 1738 and ascended to the thrones of Britain and Hanover on the 25th of October 1760. When he died on the 29th of January 1820, his mind had long wandered into a surreal world in which he could converse with his dead children. He was also blind.

He has been remembered as the mad king. This image was reinforced in the Alan Bennett play (1991) and film (1994) The Madness of King George. Many people mistakenly believe that his first episode of mental illness occurred after he lost America. It was earlier, 1765. His mental strain was caused by domestic and global troubles including the skyrocketing national debt, tension in the American colonies, and the Seven Years War in Europe. He had three Prime Ministers (Pelham-Thomas, Stuart, and Grenville) during the first five years of his reign and the blame for the turnover was broadly attributed to George’s tendency to interfere in political matters.

Contingency Plans

John Stuart, 3rd Earl of Bute (1713-1792) was George III’s former tutor and mentor. He served as his Prime Minister between 1762 and his resignation in April 1763. With George’s mother, Princess Augusta of Wales (1719-1772), he tried to conceal the king’s symptoms of fatigue, depression, and forgetfulness from George’s wife Queen Charlotte (1744-1818). This episode was not as violent as his later ones and it was easier to disguise. Charlotte and the public remained unaware of his suffering.

Parliament made discreet plans in case George III did not recover his equilibrium or if he passed away unexpectedly. His heir George, Prince of Wales (1762-1830) was under three years old so a regency was prearranged, without Charlotte’s knowledge, so that she could rule until the younger George was of an age to reign in his own right. A speech was drafted on the 24th of April 1765 and filed. It informed the public that the king was incapacitated and that to maintain continuity George had appointed a regent. This speech wasn’t used because the king recovered his health.

Mental Health Collapse

In the summer of 1788, George III traveled to the spa town of Cheltenham in Gloucestershire to drink its healing waters after complaining of feeling unwell. The waters did not improve his physical health and by that autumn his mind was under severe attack. The royal family and government were unable to deny the decline in his health so they confirmed to the public that George III was unwell. He was isolated at Kew Palace and only saw his doctors. Queen Charlotte and their daughters took rooms above him but they could not visit him which distressed him and the ladies.

George III was treated in ways that today we consider inhumane or pointless. Repeated emetics and blood lettings, cold baths, and mustard applied to abscesses offered little comfort. His “expert” doctors might have simply hoped for the best when they peddled their remedies.

A bust of Dr. Francis Willis (1718-1807). He was George III's primary physician during his 1788-1789 illness

A bust of Dr. Francis Willis (1718-1807). He was George III's primary physician during his 1788-1789 illness

Rethink the Diagnosis

The “Madness of King George” might have been caused by porphyria. This has long been the popular diagnosis but recent studies have presented a stronger diagnosis, that the king had bipolar disorder, not porphyria.

At St George’s, University of London Dr. Peter Garrard and Dr. Vassiliki Rentoumi studied the king’s illness and handwritten documents closely. In 2013 they determined that George’s sentences when he was ill, written and in speech, ran on and were repetitious. Some were over four hundred words long. He also used a wider and more colorful vocabulary than when he was in good health. We know from records that George III could talk for hours and foamed at the mouth when seized by his illness. These symptoms suggested bipolar disorder to them.

Garrard and Rentoumi noted that the porphyria diagnosis was less harmful to the image of the great House of Hanover than the stigma of admitting mental illness. Time hasn’t changed attitudes greatly and so porphyria has been clung to as an explanation.

Famously, the king’s urine was said to be purple. There is an alternative cause put forward by the doctors and historian Dr. Lucy Worsley which gets overlooked. George’s medication contained the plant gentian which has deep blue flowers. Still used today, the flowers have the side effect of changing the color of urine to blue-purple.

A 2005 analysis of a lock of George’s hair revealed traces of arsenic. Today we consider it a dangerous poison but it was widely used in medicine, cosmetics, and domestic and industrial situations for hundreds of years. Over time the arsenic must have adversely impacted his physical and mental health.

Sir Thomas Lawrence's (1769-1830) 1789 portrait of Queen Charlotte

Sir Thomas Lawrence's (1769-1830) 1789 portrait of Queen Charlotte

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George III's Recovery, Lapses and Final Episode

By 1789, George, Prince of Wales was keen to take the throne for himself and hold the full powers of a monarch. Parliament decided to award him only limited powers. Queen Charlotte was given control of the king’s person, the royal family, and the court. She was afraid of the constitutional implications of the situation and about what her erratic husband might do to her. As a result, her hair turned white from stress.

On one occasion the king saw Prince George and flew into a rage throwing his eldest son against a wall. The queen refused to allow the prince further access to his father for fear of distress.

George III’s health returned just as the Regency Bill 1789 was being finalized. Prince George believed that the physicians were incorrect. He demanded an audience with the king. This was permitted and the younger George was forced to concede that he could not stop his father from returning to his rightful place. On the 23rd of April 1790, there was a thanksgiving service for George III’s recovery.

He suffered relapses in 1801 and 1804 but these did not lead to a regency. It was after the death of George III’s favorite daughter Amelia on 2nd November 1810 that his mind broke down and could not be repaired. When Queen Charlotte died in November 1818 the king was totally oblivious to the loss.

George, Prince of Wales eventually got his wish to rule. He became the Prince Regent in February 1811 and ascended the throne as King George IV on 29th January 1820.

Dr. Lucy Worsley: Fit To Rule (Go to 37:45 for George III)


Hadlow, Janice. (2015). The Strangest Family. Harper Collins


BBC News. "What was the truth about the madness of George III?":

Professor Peter Garrard:

Vassiliki Rentoumi:

The Royal Family:

Historic Royal Palaces:

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

© 2021 Joanne Hayle

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