Queen Charlotte (and ‘the mad king’): where lived experience is more important than diagnosis – Psychiatry in television

Queen Charlotte: A Bridgerton Story, a 2023 Netflix series inspired by the lives of King George III and Queen Charlotte, tells the story of a blossoming romance tainted by George's severe bouts of mental illness and distressing treatments.

The mystery surrounding the cause of King George III's illness has long intrigued historians and psychiatrists. Perhaps most famously, in the 1960s, psychiatrists Macalpine and Hunter¹ suggested porphyria (a rare hereditary blood disorder) as the ‘royal malady’, despite limited empirical support. This diagnosis gained widespread acceptance, influencing portrayals such as Alan Bennett's play The Madness of King George, later adapted into a multi-award-winning film. Bennett's depiction focuses on physical symptoms, with the king suffering from bouts of severe abdominal pain, tachycardia, and ‘blue water’ alongside his ‘madness’.

The porphyria hypothesis, heavily influenced by the antipsychiatry movement of the time, has since been discredited and has yielded to the current theory that George lived with bipolar disorder. Supported by biographical accounts and medical notes, this theory stands as a more substantiated perspective. Nevertheless, numerous individuals have contested the idea of retrospective diagnosis, arguing that it is impossible to definitively ascertain George's exact ailment. With this in mind, Netflix takes a different approach by intentionally avoiding any focus on a definitive diagnosis. Instead, the narrative centres on an enthralling love story, exploring how George's illness intersects with his romance with Charlotte. Told through Charlotte's eyes, the story elicits empathy for her sadness, frustration, and confusion as she grapples with George's behaviour. It offers profound insights into the impact of mental illness, and highlights how important loving, supportive relationships are for the well-being of patients with severe mental illness.

Empathy is also evoked towards George as we get to know his kind and loving personality between episodes of illness, and his fears around relapse. This is crucial for destigmatising mental illness, given that media portrayals significantly shape public perceptions of psychiatry. Other portrayals of George III, such as the Broadway musical Hamilton, which crudely jests and plays into the ‘mad king’ stereotype, or Bennett's play, which depicts George as violent and hypersexual, perpetuate harmful stereotypes that can lead to discrimination and prevent individuals accessing treatment. In contrast, Netflix provides a more human portrayal of the nuanced and complex impacts of mental illness. This sympathetic depiction therefore educates the public about the lived experience of severe mental illness, for both patients and their families. George's diagnosis, though interesting, is secondary; the series prompts reflection on the challenges faced by George and Charlotte in a time when mental illness was even more perplexing and misunderstood than it is today.

Though Netflix's portrayal of a significant case in British psychiatric history aims primarily to entertain, it holds great importance in diminishing stigma by showing that the lived experience of those suffering with mental illness is far more important than fixation on a diagnosis. ‘What matters madness when true love flourishes?’²