In Netflix’s *Queen Charlotte: A Bridgerton Story*, King George suffers from a mysterious mental illness that causes episodes of confusion, agitation, and erratic behavior. The show portrays these episodes as sudden breaks from reality, with George talking rapidly, becoming disoriented, and eventually being subjected to brutal treatments by his doctors. While the series never names a specific diagnosis, it draws heavily from the real medical history of King George III, a history that has been debated by doctors and historians for over two centuries.
What the Show Gets Right
The series depicts George’s illness as episodic, meaning he cycles between periods of clarity and periods of severe mental disturbance. That matches the historical record closely. The real King George III experienced at least four, possibly five, distinct episodes of mental illness during his reign. During his worst crisis in 1788, royal attendants noted that “His Majesty had become more peevish than he used to be and is agitated and talking incessantly and incoherently.” His condition deteriorated until he was restrained in a straitjacket, his legs tied, and his body secured across the chest.
The show also accurately portrays the isolation George endured. Historically, he was cut off from contact with people, partly driven by political maneuvering from his son and allies who wanted to establish a regency. One well-known story describes the King addressing a tree as though it were the King of Prussia, prompting his physicians to tie him to his bed until he calmed down. The show captures this tragic dynamic: a man who, in his lucid moments, understands what is happening to him and dreads the loss of control.
The Porphyria Theory
For decades, the most popular explanation for George’s illness was porphyria, a rare blood disorder that interferes with how the body produces a component of red blood cells. In the 1960s, two psychiatrists (a mother-and-son team named Macalpine and Hunter) published papers arguing that George suffered from acute intermittent porphyria, later revised to a milder variant called variegate porphyria. They pointed to symptoms in the historical record: muscular weakness, blindness, vocal hoarseness, abdominal pain, jaundice, and discolored urine.
The urine detail became especially famous. A single sample from January 1811 reportedly had a bluish tint, which playwright Alan Bennett dramatized memorably in *The Madness of George III*. But that evidence is weaker than it appears. In the six weeks before that blue urine sample, physicians recorded the King’s urine as pale, clear, yellow, and normal on six separate occasions. And three days before the blue sample appeared, George had started a new medication, an herbal extract that could have caused the discoloration on its own.
This porphyria theory is what *Queen Charlotte* loosely draws on when it hints at a physical rather than purely mental cause for George’s suffering.
Why Most Experts Now Disagree
A thorough re-examination of George III’s extensive medical records has shown that Macalpine and Hunter were highly selective in which symptoms they reported and how they interpreted them. When researchers reviewed the full record, including caretakers’ diaries, the pattern that emerged looked far more consistent with recurring episodes of acute mania, part of what would today be classified as bipolar disorder.
Computational analysis of George’s own letters supports this. Researchers used machine learning to compare letters written during his healthy periods with those written during episodes of illness. The language patterns during his episodes, including reduced vocabulary variety and other structural changes, matched features seen in the speech and writing of modern patients experiencing acute mania.
One additional twist: analysis of strands of George’s hair revealed high concentrations of arsenic. Arsenic interferes with the same metabolic pathways that porphyria affects, which means his doctors may have inadvertently worsened his symptoms through the medications they gave him. The arsenic didn’t cause his illness, but it likely made his episodes more severe and prolonged than they would have been otherwise.
How George Was Treated
The treatments shown in *Queen Charlotte* are not exaggerated. In the 18th century, mental illness was poorly understood, and the methods used on the King were considered standard care. He was physically restrained with straitjackets and straps. His doctors applied blistering agents to his skin, a practice based on the theory that creating painful welts could draw illness out of the body. He was isolated from his family for extended periods. Dr. Francis Willis, a clergyman turned physician who specialized in treating mental patients, took charge of the King’s care and employed these coercive techniques with the full support of Parliament.
The show uses these historical treatments to powerful dramatic effect, particularly in scenes where Charlotte witnesses or learns about what is being done to her husband. The real Queen Charlotte was similarly kept at a distance during George’s worst periods, and the political dimension was real: if the King could not govern, power would pass to his son as regent, which is exactly what happened permanently in 1811.
George’s Final Years
The real King George III’s last major episode began around 1810 and never fully resolved. By 1811, Parliament established a formal regency, and his son governed in his place for the remaining nine years of his life. George spent those years largely confined and out of public view, blind and increasingly deaf. He died in 1820 at age 81. The show ends well before this point, focusing on the earlier years of George and Charlotte’s marriage when recovery between episodes still seemed possible.
What makes the portrayal in *Queen Charlotte* resonate is the tension between George’s intelligence and warmth during his clear periods and the devastating unpredictability of his relapses. Whether his condition was bipolar disorder, porphyria worsened by arsenic-laced medicine, or some combination, the emotional reality the show captures is grounded in a genuinely tragic historical story.