BBC Lucy Worsley Investigates_4of4_Madness of King George
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00:00Winter, 1788.
00:07King George III is hallucinating, violent and abusive.
00:12Out of my sight!
00:15He's losing control of himself and the country.
00:20This is a crisis.
00:22Britain can't have a mentally ill king.
00:27As a last resort, a medical maverick who runs an asylum is summoned.
00:35Can he save the king?
00:43In this series, I'm reinvestigating some of the most dramatic and brutal chapters in British history.
00:52It wasn't just one generation.
00:54It was three generations losing their lives.
00:59These stories are part of our national mythology, harbouring mysteries that have intrigued us for centuries.
01:07It's chilling to think that this could actually be evidence in a murder investigation.
01:13But with the passage of time, we have new ways to unlock their secrets, using scientific advances and a modern perspective.
01:23It's a horrible psychosexual form of torture, isn't it?
01:26Absolutely.
01:28I'm going to uncover forgotten witnesses, re-examine old evidence and follow new clues to get closer to the truth.
01:39It is one of the great British mysteries.
01:42It was one of those moments, I'm afraid, for a historian that makes the hair stand up on the back of your neck.
01:48Oh, wow.
02:00I find George III an intriguing king.
02:04He was conscientious and intellectually curious.
02:11He built this observatory to watch the transit of Venus across the sun in 1769.
02:19He ruled for 60 years, but he was plagued by bouts of mental illness which were barely understood in his lifetime.
02:28The madness of George III has been raked over for centuries by medics and historians.
02:35But I want to look beyond the diagnosis, at the man himself.
02:39And I want to use newly released papers to understand the pressures in his private and public lives that may have brought on his illness.
02:50How did George and Britain deal with having a mentally ill king?
02:56And how did his illness change Britain?
03:06I'd say I know a fair bit about George III, but I don't know nearly enough about his mental health.
03:13And now's the perfect time to take a look at it, because new evidence has come to light.
03:19Just a few years ago, the royal family granted unprecedented access to his personal papers.
03:26This treasure trove of documents is stored at Windsor Castle.
03:31So far, 225,000 documents – that's diaries, letters, and medical notes – have been published online.
03:40But there are still more secrets to be revealed.
03:44I've been here to the Royal Archives before.
03:47But this is the first time I hope to get my hands on documents that will take me behind the scenes into 1788.
03:56I've asked the Royal Archivist to bring out a unique private diary.
04:02It's an eyewitness account of George III's illness as it escalated.
04:10Here we are.
04:11Thank you so much. This is great, thanks.
04:14This is an amazing thing to get to see.
04:16It's the diary of Robert Greville, Journal of His Majesty's Most Serious and Afflicting Illness.
04:24He was one of the king's equerries, which means he spent a lot of time with the king.
04:31And on Sunday the 19th, he wrote,
04:35It's fascinating that he's actually with the king.
04:37This is like a front-line report from the king's bedside.
04:44Here we are.
04:45Thank you so much.
04:59This is like a front-line report from the king's bedside.
05:06What else are we going to learn?
05:10Oh, finally he goes to sleep after having talked for 19 hours without scarce any intermission.
05:20Poor man.
05:22What's happening on November the 24th, we found the king violently agitated and very angry,
05:31but more particularly with Dr Warren, one of the medical advisors.
05:38The king advanced up to him and pushed him.
05:44So Greville's getting pretty upset actually.
05:47He says that the general conduct of the physicians has not been decided or firm.
05:53They simply don't know what to do.
05:55They appear to shrink from responsibility.
06:00Greville says here that a report has been sent to Mr Pitt, the prime minister,
06:05stating that his majesty had passed a quiet night, but that he was entirely deranged.
06:12MUSIC
06:17George had at least five personal doctors, and they were all flummoxed.
06:24In the 1780s, the medical profession still clung to a centuries-old notion about mental illness.
06:33When George fell ill in 1788,
06:36his doctors at first still believed they needed to get this disease out of his body.
06:41They gave him drugs to make him vomit.
06:43They used blisters to draw out what they thought was bad blood from his body.
06:50And they used these little suckers.
06:54Got these off the internet.
06:57I love the way they're actually called little wrigglers.
07:01These are leeches.
07:04Look at them wiggle.
07:07They're just like tiny little monsters.
07:10Ooh, he's sucking the side there.
07:12And the idea was that these would be applied to George's temples,
07:18and that they would suck the madness out of his brain.
07:26The king is bled, blistered and purged.
07:31Nothing works.
07:33But if he doesn't get better soon, his illness could trigger a constitutional crisis.
07:39In 1788, Europe is a tinderbox.
07:44Peter III of Russia has been murdered in a coup,
07:49and in France, the scent of revolution is in the air.
07:55It's a dangerous time to have a mentally ill king.
08:03Investigating the medical mystery of George's condition is not without potential pitfalls.
08:11George's illness wasn't just misunderstood in his own lifetime.
08:15In modern times, another suspect diagnosis has stuck.
08:21This essay was published in the British Medical Journal in 1966.
08:25It's by a couple of psychiatrists, McAlpine and Hunter.
08:29They looked at George's medical records and argued that he had a rare genetic blood disorder called porphyria.
08:38This idea really stuck, notably in the stage play by Alan Bennett.
08:44When this was turned into a film, there was actually a caption on screen suggesting that George had porphyria.
08:50But historians have been divided about this, and now there's a rival diagnosis.
09:00I'm meeting an eminent psychiatrist who led a recent review of the Mental Health Act in England and Wales.
09:08He's also been examining the papers from the Royal Archives.
09:13Can the new evidence settle the question of what was wrong with George, once and for all?
09:21Simon, how do you feel about diagnosing dead people? There are some concerns here, aren't there?
09:27Oh, yeah, very much so. In medicine in general and psychiatry, it's a very dangerous thing to do.
09:32The only reason that we can do this with George is because the documentation is so extraordinary.
09:37Why do you think that porphyria was so warmly welcomed as a theory in the 1960s?
09:43McAlpine and Hunter were, it now turns out, ardent monarchists,
09:48and they wanted really to remove the taint, the stigma of mental illness from the royal family.
09:54And porphyria did run in the royal houses of Europe, by the way, it just didn't affect George.
09:59But they wanted to kind of help the Queen out by taking away the taint of mental illness.
10:05What was really the King's condition, do you think?
10:09The best evidence we have from George is the observations of his behaviour.
10:13We've had for some time now what we call diagnostic criteria,
10:16and in which you can fill in a computer programme, and that will then tell you what is the most likely diagnosis.
10:22So you have your computer programme, and you can put George into it and see what comes out?
10:27You can indeed.
10:28Employment, King.
10:31Residence, Windsor Castle, grandiosity, a bit difficult in a King to diagnose that, actually.
10:36Excessive self-reproach, he was a great one for beating himself up.
10:40Poor sleep, very, very common, reduced need for sleep, reduced appetite.
10:45He's having hallucinations.
10:47Yes, there we are, he's having some hallucinations, which is common in very severe mania.
10:51There were times when he had to be restrained, for example, because there was also a lot of violence and things like that.
10:57And so now they've ticked what the diagnosis is,
11:00and it comes up as the most probable diagnosis is what we now call bipolar disorder.
11:06Not a concept they had.
11:08At the time? No, not at all.
11:10Any doctor reading that now, it would just shout bipolar at you, it really would.
11:15I'm convinced, but can you tell me what causes it?
11:20I wish I knew. I don't. Nobody knows.
11:23What we do know is there's very compelling evidence that what we call life events,
11:28so major traumas in your life, bereavement or being a victim of crime or, you know, divorcing, something like that,
11:37it doesn't cause bipolar disorder, but what it does do, it will then trigger an episode and you'll have a full-blown illness.
11:43So it's sensitive to what's going on in our environment.
11:47Is there a particular life stage at which people generally start to experience it for the first time?
11:52Yes, it usually starts in younger people, so the peak age is somewhere between 20 and 30.
11:58So if George had it, we could expect perhaps to see some evidence of this in his 20s.
12:05He had an episode in 1765. It's unclear what it was and the records, as I understand it, simply have never been found.
12:18This earlier episode in 1765 is intriguing.
12:24George was 50 when he had his first documented bout of illness in 1788,
12:30but if bipolar disorder usually strikes between 20 and 30, were there earlier signs?
12:41Here's George in his coronation robes in 1760.
12:46He was just 22. Doesn't he look young, but full of confidence.
12:53It was only a few years after this, in 1765, that we get this mysterious incident of illness,
13:00when he disappeared from public life for a while.
13:04And there are now quite a few historians who are suggesting that this was perhaps his first experience of the mental illness
13:11that would come back with a vengeance in 1788.
13:16There are tantalising clues that the royal family was covering something up.
13:24The daughter of the king's hairdresser, Charlotte Papandick, wrote later,
13:29it was Her Majesty the Queen's wish to prevent the public from discovering the nature of the king's illness.
13:38But this is all gossip, not fact.
13:41I can't find any doctor's notes in the Georgian papers, but there is this.
13:46Now here's a really fascinating nugget of information from 1765.
13:53George has called in his ministers to a meeting, and he tells them he wants to make plans for a regency.
14:02He wants to make provision for the administration of government
14:08in case of a minority which God prevent.
14:12So that means, should George die or become incapacitated,
14:18and if his children weren't old enough to take over, what would happen?
14:22He wanted his wife or his mother to step in as monarch.
14:27Now, this could be a complete coincidence, but the timing suggests to me,
14:35otherwise, perhaps this year, George realised that there was something seriously wrong with him,
14:42something that might stop him from doing his job as king.
14:51If the trail runs cold here, let's leave the younger George,
14:55and move forward to 1788, and George's first official bout of illness.
15:02If episodes of bipolar disorder can be triggered by traumatic events or extreme stress,
15:10what was happening in George's personal life in the run-up to 1888?
15:16There's something at the Royal Academy I want to see.
15:22By 1783, George had 15 children.
15:27The older ones, particularly the Prince of Wales,
15:31were causing him all sorts of trouble with their overspending and their womanising,
15:36but he really doted on the two littlest boys.
15:43Tragically, George's toddler, two-year-old Alfred, died suddenly.
15:50Then eight months later, four-year-old Octavius died too.
15:56Infant death was common, so you might think parents were used to dealing with this kind of loss.
16:10This is such a poignant image.
16:17It's an engraved copy of a painting George had done
16:23to commemorate his two lost little boys.
16:27This is Prince Alfred, who died first, and he's in heaven already,
16:32and he's welcoming in his brother, Prince Octavius.
16:37And Octavius dies, and this angel's here to look after them both.
16:42George had the original of this on the wall of his bedchamber,
16:46so that when he woke up in the morning, the first thing he'd see were his lost sons.
16:54That alone, I think, speaks volumes about what this loss meant to him.
17:01It seems to me that this could have been a trigger for his breakdown in 1788.
17:07But to prove it, I need a window into George's mind.
17:17George's mind is a window into his past.
17:23I need a window into George's mind.
17:35You might think that's impossible.
17:38But I've come to Kew Gardens, the playground of Octavius and Alfred,
17:43to meet a professor who's doing something unique.
17:47He's examining George's hallucinations and delusions.
17:52How do you know what the King's delusions were?
17:55Well, we have very few direct records of what the King says,
18:00but we do have what the pages of the attendants who were looking after the King
18:04when he was asleep, or in the night, told the doctors the next morning.
18:10From those, you get these often very brief references
18:13to things that he essentially believed, or imagined,
18:17but which, when you put them all together, it's quite a substantial body of material
18:21that just lets you see inside the King's mind, really.
18:24And do you think you can see evidence of specific trauma,
18:28bad things that happened to him in his life,
18:30that you see sort of being processed through these delusions?
18:33Well, there are particular incidents relating to his children.
18:38He was a very devoted father.
18:40And when they were lost at different phases of his life,
18:44they then reappear to him in his delusions,
18:48in really very moving ways, actually.
18:51What sort of delusions is he having about his lost children?
18:54There's a very particularly moving incident
18:56that takes place on Christmas Eve, 1788.
18:59So this particular night, what the King records
19:03is thinking that the pillow of his bed is Octavius.
19:08Oh! Who's come back.
19:10It's awfully sad. It's all then described here.
19:13It says he had the pillow in the bed with him,
19:16which he called Prince Octavius,
19:20who he said was to be newborn this day.
19:24The reason this is so upsetting is because you just have the image
19:27of him holding the pillow like it was the baby.
19:31That's the recurring trope, actually, for the King,
19:34because when his daughter Amelia dies from TB, after she's dead,
19:38he begins to imagine having conversations with her
19:41and that she's had holes drilled in her coffin
19:45and, in fact, survived burial
19:47and has come back to talk to him after that.
19:49That's a very strange delusion,
19:52which, again, echoes this earlier incident with Octavius.
19:55The fact that this comes up in his delusions,
19:58not only in this illness but in his later illness too,
20:01suggests that that's the trigger.
20:03Alfred, do you feel that this research is giving you
20:06a really extraordinary insight into the mind of a king?
20:10There's a sense in which one of the things that's happening to him
20:13in his illness is he becomes disinhibited
20:15and will actually perhaps articulate things
20:17that he otherwise has been suppressing or repressing in his mind.
20:21And, in a way, it's his illness,
20:23it's his so-called madness that allows us to know him.
20:26Absolutely. We don't get to those bits of his mind otherwise.
20:37I've been left feeling really sad
20:40about what Arthur had to say about George's love for his children
20:45and his grief for their loss.
20:48It's easy to forget that he wasn't just a king,
20:51he was also a human being.
20:58The death of these children was not marked by formal court mourning.
21:04They were considered too young.
21:06So George doesn't have this as a way to help him process his loss.
21:12He represses his grief.
21:15And it clearly festers, bursting out during episodes of mania.
21:26It's clear to me there's concrete evidence of personal trauma,
21:30which could have triggered a bipolar episode.
21:34But I also want to look at the political pressures on George too.
21:38I know this was a tricky time to lead a country.
21:42George was staring down the barrel of a new world order.
21:48An account of the rise and progress of the late Tumults.
21:53Dead bodies in the streets of London.
21:56This is serious stuff.
22:01Newspaper headlines from the 1780s reveal a time of huge turmoil.
22:11George decided to grant some new rights to Catholics.
22:16It seemed like a generous and liberal thing to do,
22:19but it went horribly wrong.
22:22There were anti-Catholic riots and sectarian violence on the street.
22:27This newspaper article here describes a Roman Catholic chapel being set fire to.
22:33What they call the mob are out on the streets.
22:37They're waving revolutionary flags, actually.
22:41Things are on the brink of enormous trouble.
22:46The 1780s weren't just an age of reason, but an age of revolution.
22:51And it wasn't just Britain that was on the brink.
22:54The King of France had faced an assassination attempt,
22:58and the American War of Independence was coming to a head.
23:02Here's Cornwallis, defeated at Yorktown, doing the Walk of Shame.
23:07They're taking down the British flag,
23:10and they're putting up the American flag in its place.
23:14So George would have hoped to have added to his empire,
23:20but instead he must have felt that he had effectively lost America.
23:30These crises coincided with the start of the mass news era.
23:35George had nowhere to hide. He was exposed.
23:42And I found an extraordinary letter,
23:45which suggests George was afraid he was failing.
23:50Now, this is just the most fascinating document from the Royal Archives of 1782.
23:58It's a letter that George III has drafted,
24:03saying that he's going to hand in his resignation.
24:07I am therefore resolved to resign my crown.
24:14Extraordinary! No king had abdicated for a thousand years.
24:19And just think of the huge stink that there was
24:22when Edward VIII abdicated in the 20th century,
24:25at a point when the monarchy was much less politically significant
24:29than it was here in the 18th century.
24:32George has clearly agonised over his decision.
24:36There's all sorts of crossings out and underlinings in his letter.
24:41And there's a real sense of alienation here and disillusionment.
24:47Now, he never actually sent his letter of resignation to Parliament,
24:52but it shows the mind of a king in turmoil.
24:58George is under extreme pressure
25:02to make monarchy work in this new era.
25:06He must devolve, or perish.
25:11George styled himself as a new, slightly more accessible kind of a king.
25:17His line was that he was going to listen to people's grievances,
25:21and respond to them.
25:23Now, ordinary working people didn't have the vote,
25:26but they could make political points through giving the king petitions.
25:31They were able to take their problems straight to the top.
25:36Crowds gathered at the gates of St. James's Palace,
25:40waving their petitions, begging the king for help.
25:44And in August, St. James's Palace,
25:48begging the king for help.
25:50And in August, 1786, something happened,
25:54that I think must have increased the pressure on his already vulnerable mind.
26:00As it says in the newspaper,
26:02his Majesty was stepping out of his post chariot
26:06at the garden entrance to St. James's, just over there,
26:10when the attack was made upon his life.
26:15The woman, by whom the desperate attempt was made,
26:18had been observed waiting for the king's arrival for some time.
26:31The woman advanced from the crowd,
26:34and presented a paper folded in the form of a petition.
26:38When the woman aimed a blow with a knife at his Majesty's breast.
26:44A knife cut the king's waistcoat.
26:50A woman was immediately taken into custody,
26:53and on examination, appears to be insane.
27:00I'm fascinated by this assassination attempt,
27:04when a mentally ill woman, and a soon-to-be mentally ill king,
27:09came face to face.
27:12Who was she? And how did George react?
27:17This is a woman called Margaret Nicholson.
27:20She's a 36-year-old spinster and needlewoman.
27:25And she felt that something needed to be done to improve her life.
27:29So she petitions the king.
27:31So she's writing him letters, saying,
27:34Dear King, I want you to do this for me.
27:37Yeah, well, you know, if only it was that clear.
27:39What sort of things?
27:41Here's one of Margaret's petitions.
27:43She thought she was due a property settlement of some sort.
27:47She thought she was due a decent marriage,
27:49possibly to the king himself,
27:51if only he'd rid himself of his ghastly foreign wife.
27:53Do you think that she was suffering from some sort of mental health issue?
27:57Well, that's an interesting question.
27:59She petitions the king something like 20 times,
28:03just between April and August of 1786, by her own testimony.
28:08On the 2nd of August, 1786, she's clearly had enough,
28:12so she turns up one more time.
28:14The king gets down out of his carriage.
28:16She's ushered towards the king.
28:18I expect they've all seen her before, they know who she is.
28:21And she's got her little piece of paper again,
28:23but the piece of paper this time conceals a dagger.
28:25Yeah.
28:26And then immediately, and this is the interesting thing, I think,
28:29he immediately says,
28:32The poor woman is mad. Do not hurt her.
28:36And I know he said that straight away,
28:38because just about two hours later,
28:41one of the young pages who'd been attending the king testifies,
28:45these were the words the king used.
28:48Do you think that when he gave this compassionate reaction
28:52towards Margaret Nicholson, don't hurt her,
28:55do you think that he saw a fellow sufferer?
28:58He immediately identifies what's wrong with her,
29:00so even whether or not, yeah, it's a little bit close to home for him,
29:05where he recognises a fellow sufferer,
29:08the incident provoked a huge public conversation
29:11in the newspaper press and elsewhere
29:13about whether or not Margaret Nicholson was mad,
29:16because if she's going to be put before a law court,
29:20it's going to have to be on a charge of high treason.
29:27George's words, do not hurt her, became iconic.
29:32They were in newspapers, in prints.
29:35It was wonderful PR for the king.
29:38His compassion towards Margaret brought mental illness into the open.
29:43But what happened to her?
29:46Was she treated kindly, as he'd asked?
29:50There's no evidence of a public trial,
29:52but there is a folder in the National Archives with her name on it.
29:57Margaret's case went right to the top.
30:00It was the Privy Council, the king's advisers, who decided her fate.
30:06Oh, yes!
30:11Look at all of this!
30:13So it's clear that they've done a pretty thorough job.
30:17They've examined Margaret herself.
30:21She has...
30:23Oh, she said here that she never meant to kill the king...
30:28..but just wanted to get his attention.
30:32And they've also talked to her brother.
30:36He says that she came to London 20 years ago
30:40and that she'd worked as a housemaid.
30:46But she'd been sacked from that job and she had been ill.
30:53He says that she's been breaking out into fits of laughter in the night.
31:00And the brother also says this. It's extraordinary!
31:03He says that reading Milton's Paradise Lost,
31:08and such high-styled books,
31:11had contributed to turn her brain.
31:15That's such an 18th-century thing, isn't it?
31:18Reading fancy books can make a woman mad.
31:25So what are the Privy Council going to do?
31:27What she'd done, an assassination attempt, was treason.
31:32She could have faced the death penalty.
31:34But they didn't go down that route.
31:37So instead, they turned to the Vagrancy Act.
31:41And they used that to have her shut up in Bethlem,
31:47better known as Bedlam.
31:49This is Georgian England's most notorious madhouse.
31:54They get her assessed by one of the doctors from Bedlam.
31:59This is Dr John Munro, and he says that never in his life
32:05had he seen a person more disordered.
32:09But that's really quite a strong statement, isn't it,
32:12from the man who runs England's most notorious madhouse,
32:14that he'd never seen a madder person than Margaret.
32:18Makes you wonder if he's overstating the case,
32:21so that they can all, with good conscience, lock her up.
32:30And she's not the only one.
32:36In November 1788,
32:38George succumbs to all the political and personal pressure,
32:42and becomes seriously ill.
32:46After weeks of failed treatment,
32:48his doctors take an unprecedented step and lock him up.
32:54Not in Bedlam, of course, but in Kew Palace.
33:00The king's eldest son senses an opportunity to seize power.
33:06He tells everyone his father is unfit to rule, and calls for a regency.
33:12Daily bulletins are tied to the gates of Kew Palace,
33:16but they are heavily censored, and don't explicitly mention madness.
33:22Speculation runs rife.
33:29So here we have two infamous so-called mad people,
33:34a seamstress and a king,
33:36tied together by this assassination attempt.
33:39I'm so intrigued.
33:41And it was the same with the public back then.
33:43They couldn't get enough of the story.
33:48These are just a small snapshot
33:50of the many, many different images that were being produced.
33:54A lot of the facts were few and far between,
33:56and a lot of embellishment was going on.
33:58So here we have Margaret in Bedlam.
34:01Oh, my goodness, is that her there?
34:03That's supposed to be her.
34:05Oh, wow.
34:06This image is kind of extraordinary.
34:08It shows this violent, strange, terrifying figure.
34:11She's clutching straw.
34:13Straw was used as bedding in an asylum.
34:16She's kind of involved with these two figures,
34:19two of the leading revolutionaries of the day.
34:21So here we've got rational masculinity, and here she is looking...
34:25Wow.
34:26Is this the archetype of the mad woman, having crazy hair?
34:29Exactly, kind of Medusa style.
34:31Clearly, people are making money out of Margaret Nicholson.
34:35Was there a real market for this?
34:37Absolutely.
34:38Waxworks were being made, people would pay to see waxworks,
34:42and her lodgings were described as being besieged.
34:45One I always find particularly fascinating
34:47is the obsession around the knife.
34:50Very quickly, it became common for enterprising innkeepers
34:55to announce that they had the original knife,
34:58and some of them didn't have the knife,
35:00but they had a fork, which was the partner.
35:02I particularly love the idea of,
35:04come to my pub where you will see the fork that went with the knife
35:07that might have belonged to Margaret Nicholson.
35:09Absolutely, absolutely.
35:11When the king himself became ill,
35:14how was he treated by this sort of media of the 18th century?
35:19I think one of the really striking and surprising things
35:23is that there was very little cultural treatment of the king.
35:28So one of the very few images we have of the king when he went mad
35:32is this one, Filial Piety,
35:34and it shows the king looking perhaps ill,
35:38but none of the kind of typical iconography
35:41about madness is being applied to him.
35:43On the left-hand side, we have the Prince of Wales,
35:46who's sort of obviously drunk.
35:48We've got the kind of political backdrop
35:50of the Regency crisis in 1788.
35:53I suppose here what's really going on
35:55is that they're using the situation
35:57to make the Prince of Wales look bad.
35:59Exactly.
36:00The madness of the king is being downplayed.
36:02I think it's a bit of a no-go area.
36:06A mentally ill king is simply unmentionable,
36:10so the press feeds the frenzy with Margaret instead.
36:16She even becomes the star attraction at Bethlehem,
36:20and the upper classes come to ogle at the mentally ill.
36:26A mad king is extraordinary,
36:28but if I want to understand mental illness at the time,
36:32I need to investigate Margaret's story too.
36:36MUSIC CONTINUES
36:47These two statues are the very last surviving bits
36:51of the Bethlehem hospital where Margaret was incarcerated.
36:56It was demolished in 1815.
36:58They represent the different types of madness
37:02that people believed existed in the 18th century.
37:05This one is melancholy madness.
37:09He's calm and still.
37:11And this one is raving madness.
37:15He's trying to burst out of his chains.
37:20These two were over the entrance when Margaret arrived.
37:24Not exactly a warm welcome.
37:28In the 1780s,
37:30doctors still thought they could treat people with mental illness
37:33by purging it from the body.
37:35I'm hoping that Bethlehem's archivist
37:38can help me uncover the details of Margaret's treatment.
37:42We actually have her admission record here,
37:44which would have been created when she first came in to the hospital.
37:49And we can see Margaret's name.
37:52Margaret Nicholson, there she is.
37:54Do you know how they would have diagnosed her?
37:57What sort of illness they thought she had?
37:59The hospital would have been split into male and female wings
38:03and it would have been split into melancholics and ravers.
38:07And where do you think she fitted into that?
38:10I mean, I think generally she's described as quite a quiet,
38:13withdrawn patient, I think, a lot of the time.
38:17So I'd be surprised if she was moved apart from the melancholy patients.
38:22These categories are not super subtle, are they?
38:25No, they really aren't.
38:27And what were the conditions like in the hospital?
38:30They were probably not very good.
38:32So people were bled,
38:34people were given medication that would make them vomit
38:37or purge themselves in other ways.
38:41It was known round about this sort of time
38:44there's a new strain of thought that's saying this isn't working,
38:47but Bethlehem is still persisting in this.
38:50So is there some information about what happened next to Margaret?
38:54Does she appear again?
38:56Yes, so we will see her again in the incurable admission register.
39:00So the incurable ward would have been the long-stay section of Bethlehem.
39:05You say that, but the name, it's...
39:08It's very depressing thought, isn't it?
39:10It is, yes. You know, these are people who are...
39:13A long stay. ..probably lifers by this point.
39:16It says,
39:17''Emotions made that Margaret Nicholson be no longer confined in her cell by a chain.''
39:22Oh!
39:25So what year is this?
39:27This is 1791, so this is four years.
39:30So she's been in chains for four years?
39:33She is regularly clapped in irons.
39:36Goodness me. I'm thinking what this means.
39:38Does this mean that the hospital committee have decided
39:41that she's so peaceful and not hurting herself
39:44that they don't need to bother doing that sort of thing?
39:46Yes, yes. But what is also interesting in this
39:49is the implication that she is well enough to be unchained.
39:54But she is still in the incurable wing.
39:56And that might be because she's this special patient.
40:00What she did received national attention.
40:03Therefore, the bar for her recovery is higher than it is for anybody else.
40:08It also perhaps implies that the hospital has been told not to release her.
40:12Not to release her. In any circumstance.
40:15Of? You.
40:17She has been, if you like, disposed of by the state.
40:24It's pretty clear that at Bethlehem,
40:26they were still committed to doing things the old way.
40:29Patients in cells. Chains.
40:32And it's rather devastating to think of Margaret being written off almost
40:38with that word, incurable.
40:53I found these old lantern slides in the archives.
40:57This one is of Dr Thomas Munro.
41:01It was his father who incarcerated Margaret.
41:04And Thomas takes over Bethlehem from 1792.
41:08Asylums like his were a law unto themselves.
41:12Bethlehem hadn't updated its treatment plan in 100 years.
41:17But there was a new school of thought
41:20that mental illness was an illness of the brain
41:23that needed to be treated in its own way.
41:28Some of these new ideas were to be found in this book.
41:31It's the first proper book about madness as a mental illness.
41:37It's called A Treatise On Madness by Dr William Batty.
41:42This was really radical stuff.
41:47And he suggested that it was wrong to chain up mentally ill people.
41:52Nor was he in favour of shock treatments,
41:55things like making people vomit.
41:58Instead, he proposed quiet and fresh air and exercise,
42:03which sounds extraordinarily modern, doesn't it?
42:07That's what people are still recommended to do to this day.
42:11Batty's book was published in 1758,
42:14so that's 30 years before the king got ill.
42:18But it was George's illness and Margaret's too
42:22that raised the profile of his work.
42:25It went mainstream and people started to implement it.
42:31So while Margaret was written off as incurable,
42:35did these new ideas reach George?
42:39In winter 1788, George is delusional,
42:44aggressive, sleepless, and time is running out.
42:49A regency bill has been prepared.
42:53If the king is not better in three months, his son will take over.
42:59In December 1788, the royal family make a bold decision.
43:04They summon a man called Francis Willis,
43:07who runs a madhouse in rural Lincolnshire, to come here to Kew.
43:15Private madhouses begin to spring up from the 1750s onwards
43:20as new treatments are introduced.
43:23Willis is one of a band of so-called mad doctors,
43:27or, to you and me, early psychiatrists.
43:31Let me introduce you to Dr Francis Willis.
43:35I'm calling him Dr Willis,
43:37but I do know that his contemporaries
43:40might not have agreed with me in doing that
43:43because they didn't yet have the idea of a doctor
43:46and they didn't know what a doctor was.
43:49Members of the Royal College of Physicians, for example,
43:52would have said, no, he's just the keeper of a madhouse,
43:55we don't count him as one of us.
43:58So, I think it's quite an exciting decision
44:01that the royal family have called him in.
44:04It's a sign of how desperate they were, I think.
44:08He's a maverick.
44:11This is a make-or-break moment,
44:15for him and for his nascent profession.
44:19There's no higher-profile patient than this.
44:23What on earth is he going to do?
44:30Willis is a man of many talents,
44:33but he's also a man of few words.
44:36What is he going to do?
44:44George was treated by Willis here at Kew.
44:48The king's tin bath still survives.
44:52This source is key to what happened to him.
44:56It's a diary by Francis Willis and his son.
45:00And they start off explaining
45:02what the previous doctors had given the king.
45:05These really powerful sedatives.
45:08Here he's been prescribed 30 drops of laudanum.
45:13Now, that is opium dissolved in alcohol.
45:17It's not a sustainable strategy.
45:19It's not going to make him better.
45:21It might even get him addicted.
45:24It's kind of like prescribing the king heroin.
45:31Willis decides to put a stop to this
45:34and he radically reduces the dosage.
45:38He also makes a bold decision
45:41to treat George just as he would any other patient in his asylum
45:46and bend the king to his will.
45:54Oh, wow!
45:56I've got a straitjacket for you.
45:59My goodness! What?
46:01It keeps on giving.
46:03What is with these arms? They're so long.
46:06How does it work? Here's the back.
46:09It buttons up the back, so you put your arms in like that
46:12and it's done up.
46:14And why are the sleeves so immensely long?
46:17So you put your arms in there and then you hug yourself
46:21and then you get tied round the back.
46:24So it forces you to go like this to give yourself a hug.
46:28Yes. Once you've no longer got the use of your hands,
46:32the fight-and-fight mode is turned off
46:35so that it could then support you to calm yourself down.
46:40I was expecting something barbaric,
46:43something that was to do with restraint.
46:46Compared to the manacles, which was what people were using before,
46:50this is really soft. Oh, this is a big step forward.
46:53Certainly when I first looked at this,
46:55I had the same feelings as yourself.
46:58It's really scary, the idea of it being, you know, tied up, really,
47:03but this is a treatment and most illnesses,
47:06you know, most treatments are scary.
47:09Let me show you some of the ways
47:11in which Dr Willis used the straitjacket.
47:14Well, he doesn't actually call it a straitjacket.
47:17The strait waistcoat was taken off from His Majesty
47:21that morning yesterday,
47:23but was put on again soon after 2 o'clock
47:27and was not taken off till 9 this morning.
47:31Goodness me.
47:32So he was kept in his strait waistcoat
47:35for the whole of this particular night.
47:38Nowadays we use drugs and that's a chemical restraint. Yeah.
47:42Sometimes that's not appropriate either
47:45because it's just treating the symptom,
47:47it's not allowing your brain to rebalance and sort itself out.
47:51That's really interesting that you're using the word
47:54to not rebalance the brain.
47:57That's the language that Francis Willis used in the 18th century.
48:02Now, even if Francis Willis had the best intentions in the world,
48:08I do feel sorry for the poor king
48:11because it says here,
48:13they beat me like a madman.
48:17The king doesn't escape the brutal remedies
48:21of purges and ice-cold baths.
48:24But there were also new ideas at play.
48:28Willis is clearly picking up
48:30on the progressive approach of William Batty.
48:34While Margaret in Bethlehem is chained and left to rot,
48:38Willis is encouraging George at Kew to take the air.
48:44And even though George does try to scale the giant pagoda,
48:48a 50-metre structure,
48:50Willis is confident his strategy is having some success.
48:57If you leave it untreated,
48:59an episode of mania can last between days or months.
49:03And to this day, doctors don't really know why they come to an end.
49:07But, on the 20th,
49:09they really know why they come to an end.
49:12But, on the 26th of February, 1789,
49:15a bulletin appeared on the gates of Kew Palace.
49:19Three months after he'd arrived,
49:21Dr Willis was able to announce
49:23the entire cessation of His Majesty's illness.
49:32It could be that the king's bipolar episode
49:35has simply run its course.
49:38But it does appear that the king's been restored to health by Dr Willis.
49:44And not a moment too soon,
49:47the Regency Bill is only days away.
49:51After months of political uncertainty,
49:54George is ready once again to be king.
50:08On St George's Day,
50:10there was a huge celebration of the king's recovery,
50:14here at St Paul's Cathedral.
50:18Now, the Archbishop of Canterbury
50:21recommended that George himself shouldn't attend.
50:25He thought the excitement might bring on a relapse.
50:28But George had other ideas.
50:30He said, no, I'm going.
50:32My lord, he said to the Archbishop of Canterbury,
50:35I have twice read over the evidence of the physicians on my case,
50:40and if I can stand that, I can stand anything.
50:44Thousands lined the route to St Paul's,
50:47and medals were struck to commemorate the occasion.
50:51And here is one of them.
50:55They're not actually that hard to find,
50:57because so many of them were made.
50:59This one came off eBay.
51:02And on one side we've got George's little face.
51:05There he is, looking alive and well.
51:08And on the back, the exciting story of what's happened.
51:13It says, lost to Britannia's hope,
51:17but to her prayers restored.
51:21Having a mentally fragile king
51:24appears not to have destabilised the nation.
51:28If anything, it humanised him
51:31and the lives of his people.
51:34The irony is that King George III
51:37was virtually the only monarch left standing in Europe
51:41by the end of the 18th century.
51:44But the story doesn't end there.
51:47There's another medal.
51:51Dr Willis had his own medals struck.
51:55He paid for these himself.
51:57These are different grades.
51:59This is the cheaper copper version,
52:02and this is the deluxe shiny tin model.
52:07You've got a picture of Dr Willis on the front,
52:10and on the back it says,
52:12Britain's rejoice, your king's restored.
52:16The message is, I'm Dr Willis, why you restored him?
52:20It's the most fantastic bit of self-promotion.
52:24A bit like an advert, really,
52:26something you might almost call a psychiatrist.
52:29And I think the significance is
52:33that this profession of psychiatry
52:36is coming out of the shadows.
52:38It's getting respectable.
52:40This is its moment of triumph, if you like,
52:43captured in tin.
52:50George may be restored to health,
52:53but Margaret gets no medal and no redemption.
52:59It would be 25 years before the government
53:02started to concern itself
53:04with the horrific conditions inside public asylums.
53:10During that time, the king did relapse in 1801 and 1804.
53:15He convalesced for a while in the home of a friend,
53:19an MP named George Rose.
53:24Witnessing George's illness helped galvanise Rose,
53:28and in 1815 he led a select committee
53:31charged with investigating Bethlehem.
53:36These are the minutes of this parliamentary committee
53:40that's looking into the better regulation of madhouses in England.
53:46They're calling all sorts of witnesses to give evidence
53:51and very dark pictures being painted of existing conditions.
53:58This part's really distressing.
54:01We've got a witness who's seen unfortunate women
54:05locked up in their cells,
54:07naked and chained on straw,
54:12with just one blanket for a covering.
54:16Now, George Rose clearly suspects that there have been male keepers
54:20looking after female patients,
54:23which is inappropriate.
54:25Power could have been abused here.
54:27And he's really going after Dr Munro,
54:30who's in charge of the Bethlehem hospital.
54:32Dr Munro says,
54:34In Bethlehem, the restraint is by chains.
54:36There is no such thing as chains in my private mental hospital.
54:41And he's asked about this. Why? Why the difference in standard?
54:45And Dr Munro says,
54:47Well, it's because chains are fit only for pauper lunatics.
54:52Isn't that shocking?
54:54He says,
54:55If a gentleman was put in irons, he would not like it.
54:59Too right!
55:01I don't think Dr Munro realised
55:03how much he was going to damn himself by this statement.
55:06It caused a scandal.
55:08He was offended by this idea of a double standard for rich and for poor.
55:12The fallout of this was so bad that Dr Munro had to resign.
55:20This committee exposed the sexual abuse,
55:24an excessive restraint that had been rife for decades.
55:28It was a watershed moment.
55:30A process of reform had begun.
55:34Fearing further censure,
55:36both of them started keeping individual patient notes.
55:43Now, these books are from after 1815,
55:47when they had to keep fuller records.
55:50So I'm really hoping these might shed some more light on Margaret.
56:00Because of the king's illness and the reform that followed,
56:05we can now at least find her in the records.
56:12Oh, and look at this.
56:14It's progress reports in 1816, 1817, 1819.
56:22By this time, she's been in the hospital for nearly 30 years.
56:29It says here she's now in an advanced stage of her life
56:36and is perfectly deaf.
56:38She's decent in her appearance and quiet and civil in her demeanour.
56:46Sounds to me like she's better.
56:50And then the records stop.
56:53It's really fantastic to get a glimpse of a real person here.
56:59And she doesn't seem like either a criminal or a patient any more.
57:05She's just a quiet old lady.
57:08Do you know what? I've got a little tear in my eye.
57:12MUSIC PLAYS
57:20Reform really came too late for Margaret Nicholson.
57:24She was incarcerated in Bethlehem for 42 years
57:28and died on 14th May 1828.
57:34George III was suffering from chronic mania and dementia
57:38when he died on 29th January 1820.
57:44This encounter between George and Margaret happened at...
57:50In fact, it fed into this key moment of change
57:54for the science of psychiatry
57:57and for the reform of psychiatric asylums.
58:02There's still so much more to learn
58:04about the complexities of mental illness.
58:07But this was the starting point.
58:37MUSIC FADES