Editor’s Note: The language used in the following piece is in reference to the time period in which the events discussed take place.
In my previous blog for Inspire the Mind on “Glass Delusion”, I discussed two royal figures afflicted with mental health issues that in some ways hindered their capacity for performing their royal roles. Further research into the subject of mental health within royal families has unveiled a fascinating find of two more figures with an extraordinary coincidence connecting them.
Both were not only ruling monarchs who fell ill, but they also shared the same doctor. They were Maria I of Portugal and Brazil (1734–1816) and King George III of England (1738–1820).
Francis Willis (1718–1807), a leading physician of his time, travelled across oceans to treat them both
In 1786, the esteemed Maria I of House Braganza, queen of Portugal and later Brazil, was preparing to sign a document reversing legal policies put into place by her predecessor and father, Joseph I. But immediately after she’d put pen to paper and signed her name, a sudden fit of panic, despair, and possibly guilt seized hold of her. She quickly scratched out her signature on the state document and began screeching at the top of her lungs that she was doomed and damned to hell, much to the horror of the courtiers and clerks present. Maria had to be swiftly (and forcefully) escorted back to her private chambers, still screaming and delirious, and this set the precedent for the remainder of her reign.
She really was doomed to follow in the wake of her notorious ancestor, Joanna I of Castile, and not only by being a female heir who’d unexpectedly inherited a crown. Maria would also come to be known as “the Mad” for her mental instability and assumed inability to rule alone. Both women had a son who had to rule in their place.
But what does a court do with a displaced head of state who has lost their mind? Historically, there was only one real course of action; quietly lock them away and seek out doctors who were not only discreet, but experienced.
The doctor, who was summoned to Lisbon in 1792 to take charge of Maria’s case, was one who was uniquely qualified to treat a monarch who had “gone mad,” because he had already treated one.
Francis Willis had been royal physician to King George III, most recognizable to public audiences today as the kooky King who sang solo in Broadway’s Hamilton, a portrayal that while comedic and amusing on stage, wasn’t exactly sympathetic to the real royal’s tragic plight.
Though not featured in the popular musical, Francis Willis would feature in the lives of both Queen Maria and King George as the only available health care provider with the expertise and semi-progressive methods to approach their cases. Unfortunately, Willis never succeeded in fully “curing” either monarch, but he managed at intervals to alleviate their symptoms before the interference and restrictions of political circumstances and general lack of knowledge about mental health crises in the eighteenth century sabotaged their treatments.
When Willis arrived in Portugal and assessed Maria, he had the perception to determine immediately that the Queen’s ailments could be traced to the absence of what we now call “self-care” that accompanied a royal’s lifestyle at the time; Maria was not eating properly, not sleeping well, or enjoying any real privacy or free time in her very public life as a reigning ruler. Just like George III before her, there was no real relief from her duties, but rather counterproductive and physically draining medical procedures administered by her court physicians.
Timothy J. Peters and Clive Willis, who composed a 2013 study of Maria’s I’s predicament for History of Psychiatry, analyzes Francis Willis’s course of treatment as contradictory and, from our current vantage point, modern, at least for the era:
“The nature of [Willis’s] treatments are not specified but presumably were similar to those successfully employed on George III, i.e. stopping regular administration of powerful emetics, purgatives, and other medications, reducing venesection, blistering, and scarification, and adopting his regime of so-called directive psychotherapy and, as necessary, restraint but with adequate nutrition,”
Willis also wanted Maria to receive rest and reprieve, but his ideas frequently clashed with those of Maria’s courtiers and especially her son, who would eventually succeed her as John VI of Portugal. He wanted Maria to travel back to England with him, to be placed entirely under his private care, believing her only chance to heal and recover depended on her renouncing court life completely, just as George III had done. But Portugal wasn’t about to let Willis whisk away their Queen from her native soil. Though no longer able to function as a politician, Maria was still a symbol of Portugal’s might and pride, and in her Kingdom she would remain, even at the cost of her health.
Willis returned to England queen-less in August 1792. He had been Maria I’s doctor for six months.
We now know that Maria was most likely suffering from what is clinically called major depressive disorder (MDD), and Willis’s departure reportedly led to a massive decline in her condition. Compare and contrast those relieving six months to the several years Willis spent with George III, being first called in as a consultant to George’s case in 1788.
Some aspects of Willis’ dubious credentials should be noted. Even in his day, it was frowned upon that he was not a member of the Royal College of Physicians in Great Britain, and he may have practised medicine before being granted his license. But Willis’s episodes of victory with George III — who we now know likely suffered from porphyria and bipolar disorder — seemed to stem from the iron will of the physician’s personality as much as his methods.
Biographer Christopher Hibbert’s George III: A Personal History and biographer Janice Hadlow’s A Royal Experiment both acknowledge and evaluate Willis’s winning strategy: his refusal to show deference to the King, in order to gain full control of his daily routine and activities. He would rule the ruler, so to speak, and enforce restraints and restrictions whenever necessary. This is what the court of Portugal would deny him with Maria. Hadlow describes Willis’s therapy plan as such:
“Willis believed that the king would only improve when he was able to control himself and act calmy; but Willis was convinced measured behavior did not just emerge from within — it could be imposed from without. A patient could be compelled into calmness by the authority of another — especially if the other was himself,” (pg. 387).
According to Hibbert, Willis’ treatment of George III operated on a reward system. The better George behaved, the more pleasures and privileges he enjoyed. The purpose was to motivate and steer George back towards his previous state of independence and freedom: “As Dr. Willis gained more mastery over his patient, he allowed him to do things previously forbidden”. These “previously forbidden” things included George being allowed to shave himself, play with his dog, and receive visits from his beloved wife Queen Charlotte and their daughters. George’s semi-recovery in 1789 is a tribute to the success of this system, though he would later relapse, and in 1811 his son (the future George IV) would replace his ill father as sovereign and assume power as Regent.
Willis did not have access to the medications and facilities that could have been employed to help George today, so he couldn’t work the miracle everyone was hoping for and cure him completely. And he certainly had his contemporary critics. Other physicians of the English court, Dr. Warren and Dr. Reynolds, would attack Willis for mistaking performance for progress: “…although Dr. Willis and his son [his assistant] were admittedly making the king more manageable, they were certainly not curing him,”.
From my own perspective as a historian, I can also see the missing links in Dr. Francis Willis’s practices, and at the same time recognize his noble intentions. He was a pioneer of the mental health care standards we apprehend and expect today. Not a founding father, but a step in the right direction.
Hadlow, Janice (2014). A Royal Experiment: The Private Life of King George III. Henry Holt and Company, LLC.
Hibbert, Christopher (1998). George III: A Personal History. Viking: Penguin Group.
Hilliam, David (2008). Kings, Queens, Bones, and Bastards. The History Press.
Pearce, John M.S (2017). “The Role of Dr. Francis Willis in the Madness of George III.” European Neurology. 78 (3–4), pgs. 196–199.
Peters, Timothy. Willis, Clive (September 2013). “Maria I of Portugal: another royal patient of Francis Willis.” The British Journal of Psychiatry. 203 (3), pg. 167.
Peters, Timothy. Willis, Clive (September 2013). “Mental health issues of Maria I of Portugal and her sisters: the contributions of the Willis family to the development of psychiatry.” History of Psychiatry. 24 (3), pg. 292–307.