King George III of England and Queen Maria I of Portugal: bipolar disorder and prince regents as common features of their reigns

Abstract Humanity is sporadically subjected to leaders with deviant behavior, ego problems, or psychiatric disorders, potentially leading to social instability. Bipolar disorder is not common in all populations, but, coincidentally, studies suggest that it affected two sovereigns that were contemporaries, King George III of England, who died 201 years ago, and Queen Maria I of Portugal, who died 205 years ago. They lived during a time when Europe was in turmoil with the French Revolution and Napoleonic Wars, which also coincided with the rise of psychiatry. Both monarchs were forced to have prince regents rule in their place, due to their emotional decline, and they shared the same medical consultant, Francis Willis.


Introduction
The mental health of some unusual monarchs, prime ministers, presidents, and political leaders in general has been questioned, and others were unmistakably mentally ill, potentially threatening their nations' stability. 1 Indeed, insanity and politics are often intertwined. 2 As with the general population, much of the insanity in political leaders is influenced by genetics, which is most tragic when these leaders occupy hereditary political positions.
Thus, when monarchs develop a mental illness, several steps are needed to remove them from power.
We discuss two such late 18th-century/early 19th- In the late 18th and early 19th centuries, it was not possible to make proper psychiatric diagnoses and treat sidelined sovereigns during their own lifetimes.
Both the monarchs discussed here have been assumed to have suffered from bipolar disorder (BPD). They also shared the same attending physician, Francis Willis. 3 This article raises questions concerning the two monarchs' mental symptoms and the impact of their physician's immersion in the medical knowledge of the time. These issues belonged to an age of turmoil in Europe.

Impacts of the psychological process on the legal and political scene
Monarchs turn their daily exercise into a grand dramatization, in a balancing act of power through their titles, medals, and privileges. As gifts bearing the leader's image, these monarchic rituals help foster reverence and extend the monarchs' own personalities, hovering high over their subjects' heads. 4 In a monarchy, if psychological instability arises within the court, the natural substitution within the family hierarchy begins to be articulated. Even if the probable succession favors an older child, court dealings may always happen. The American colonies gained independence during his reign, which also witnessed the French Revolution and the Napoleonic Wars, which finally ended with Napoleon's defeat. 5 England was shaken by King George's erratic behavior. Macalpine & Hunter (1969), apud Pearce,3 state that the king suffered from porphyria, a metabolic disease that can affect the central nervous system. These findings were widely covered by the English press, but the main diagnostic hypothesis today would be bipolar disorder. 3 During George III's illness, the Prince of Wales was regularly sent letters by his father's physicians, reporting on his habits and behaviors. There are several reports of the king's illness. It was noted in 1788 that "His Majesty had become more peevish than he used to be and is agitated and talking incessantly and incoherently." Later that month, on December 20, the king's condition worsened still further, because "H.M became so ungovernable that recourse was had to the strait waistcoat: His legs were tied, & he was secured down across his Breast, & in this melancholy situation he was, when I came to make my morning Enquiries." 6 When the king was stricken by "madness" in the summer of 1788, his condition worsened, and he was finally removed from power after a major mental crisis.
To control variations in the king's behavior, physician Francis Willis was summoned to treat his disorder. As his doctors were unable to explain the king's illness, false stories about his condition spread. 7 George III was excluded from contact with the people, due to an alleged plot by his son and allies, pressured by a populace with a supposedly insane ruler who was unfit to rule. The impact of a "crazy" ruler, plus the opposition led by Pombal (with whose ideas and actions the queen disagreed) was extremely relevant. She was classified as "crazy" but was probably depressed due to several deaths in the family and that of her friend and confessor Friar Inácio. 13 The queen was highly popular, and her demise and removal from power must have had a significant impact on her subjects, with whom she had interacted a great deal.
Maria I's mood swings may explain why, having subjected the Marquis de Pombal to an inquiry to investigate his alleged illicit enrichment and excesses  Worthy of note is the high degree of consanguinity of the Portuguese royal lineage, which resulted in marked family incidence of mental illness.
In conclusion, with regard to concerns of State, monarchies have an appropriate hierarchy to respond and adjust when the sitting monarch displays mental incompetency, as occurred with George III and Maria I.

Disclosure
No conflicts of interest declared concerning the publication of this article.