Throughout his life, George III suffered from several periods of severe mental illness. Prior to 1810, he had overcome these episodes and enjoyed extended moments of lucidity that allowed him to remain as the acting monarch. However, after the death of his favourite daughter, he descended into a psychotic depression from which he didn’t recover. From this moment until his death in 1820, George’s son, the Prince Regent, ruled the United Kingdom of Great Britain and Ireland in his stead.
Despite being born several months prematurely, George exhibited no signs of mental illness during his childhood or adolescence. The first indication of any mental instability was a retrospective diagnosis of subclinical depression when the king was 27. The first widely documented bout of mental illness occurred in 1788 when he was 50. On the instructions of his physician, George spent a season in Cheltenham to convalesce from a previous illness, most likely gall stones. During his time in the spa town, the George displayed apparent signs of hypomania. His health deteriorated significantly during the autumn and following spring due to a serious psychotic illness which almost resulted in the implementation of a regency act. He recovered from this episode and endeavoured to avoid unnecessary mental fatigue by relying increasingly on his prime minister, William Pitt the Younger.
George III would suffer from two further bouts of mental illness in 1801 and 1804 which have been diagnosed as being episodes of bipolar disorder. Despite recovering from both episodes and experiencing significant periods of lucidity, by 1810, George III had succumbed permanently to his illness and spent the rest of his life in worsening health.
One possible reason given for his lapse into permanent mental instability was the death of his youngest and favourite daughter, Princess Amelia. Medical reports state that the his “melancholy was beyond description.” It became apparent that the he was in no fit state to conduct the affairs of state, and as such, the Regency Act of 1811 was passed allowing George, Prince of Wales, to discharge royal functions on behalf of his father. This period, which lasted from 1811 until 1820, became known as the Regency.
While matters of state were being conducted by the heir apparent, George’s personal care was overseen by his wife, Queen Charlotte. As his health began to rapidly deteriorate, the Charlotte gathered together a council of trusted and discreet statesmen led by the Archbishop of Canterbury, Charles Manners-Sutton, to oversee every aspect of the king’s daily medical needs. Manners-Sutton and his wife were both royal favourites with the king personally intervening in Manners-Sutton’s translation to Canterbury after Pitt’s failed attempt to appoint his former tutor, Bishop Pretyman-Tomline, to the position. He was key in managing the complex relations between Queen Charlotte and the court physicians, whom the queen distrusted.
The council received daily reports from the sick room assessing his state of mind and the likelihood of a recovery. The Manners-Sutton papers at Lambeth Palace Library contain 3075 separate reports and offer an intimate insight into George III’s mental health during the final decade of his life. They contain distressing accounts of his psychotic episodes in which he believed that he was immortal, could raise the dead and that England south of the Humber was sinking into the sea. He would often become agitated and violent, requiring the use of opiates and a straightjacket to sedate him. By the time of his death, George had become blind and almost totally deaf. His final medical report includes a footnote by Manners-Sutton, “His Majesty expired at 32 minutes past 8 o’clock p.m., January 29th . C. Cantuar.” These papers have since been used in several retrospective diagnosis. One such diagnosis was for porphyria, a group of liver disorders which can affect, amongst other things, the nervous system. This particular diagnosis made its way into the closing credits of the film The Madness of King George but has since been disputed in several studies, most notably in research conducted by St. George’s, University of London which concluded that George’s illness was almost certainly mental and not physical.