Friday 23 June 2017

Supporting mental illness gets the royal seal of approval

Kate and William. Photo: Chris Weeks/PA Wire
Kate and William. Photo: Chris Weeks/PA Wire

Patricia Casey

If the young Royals in Britain - Harry, William and Kate - wanted to impress us with their openness, then their recent outing on a topic close to their hearts, succeeded. A few weeks ago they donned blue head bands as a mark of their advocacy for mental health awareness. Their promotional video, in aid of Heads Together Campaign, is aiming to reduce the stigma attached to mental illness and to support charities working towards that end. Perhaps they appreciate the internal hardships that people with mental illness experience but also the external stigma and stereotyping that accompanies psychiatric disorder.

Alternatively, they may be keenly aware of the history of mental illness in their ancestors, near and remote. For example, Prince Philip's mother, Princess Alice of Battenberg, was committed to a psychiatric hospital in 1931 having had a nervous breakdown when Philip was 9. His mother's illness was referred to as a "religious crisis" or "religious mania". Others believe it was manic-depression, now known as bipolar disorder. By 1930 she had been diagnosed with schizophrenia. She described having a physical relationship with Jesus. On the advice of Freud her womb was given X-rays to cure her frustrated sexual desired. She later sold her jewels to fund her own religious order The Christian Sisterhood of Martha and Mary in 1949. Philip insisted she return to England during the Greek Coup in 1967 and thereafter she lived in Buckingham Palace, still dressed as a nun until her death in 1969.

More recently there is public knowledge of the mental health problems of Princess Diana, mother of William and Harry. She was an extremely beautiful woman but one who struggled with bulimia nervosa. There has been speculation regarding diagnoses such as personality disorder but posthumous diagnosis is unprofessional without medical records. She was certainly unhappy but whether this amounted to appropriate sadness at the state of her marriage or clinical depression is unclear and not possible to answer in retrospect.

The Royal most commonly known for having severe mental illness and the most studied is King George III (1760-1820), the Monarch under whose reign the Americans fought the War of Independence and won. His illness manifested itself with incoherence, agitation, violence and sexual impropriety. Physical restraint was the favoured method of treatment. When he because ill in the course of the debate on the Regency Bill in 1787/88 it caused a constitutional crisis. In 1811 he was so incapacitated that his son took over his authority until his accession to the throne as George IV in 1820. As the understanding of mental illness became more sophisticated a diagnosis of manic depression was favoured but in the mid-20th century it was believed that he suffered with an inherited condition that could be traced back to Mary Queen of Scots.

Porphyria is a metabolic condition in which porphyrins, essential to the formation of haemoglobin in the blood, builds up due to an enzyme deficiency, causing intermittent symptoms in the nervous system and in the skin. This theory gained widespread acceptance in historical and medical circles. But recently, studies of his medical records suggest that the interpretation of these was flawed and that evidence for porphyria was insubstantial.

Computerised statistical analysis of written material have produced methods by which digitized samples of written and spoken text can be rapidly and reliably categorized. Analyses of samples of spoken language using automated, computer-based methods in schizophrenia have demonstrated the impact of disordered thinking on language use, while others have shown significant differences between the language production of bipolar disorder patients compared to their control counterparts. Different use of language has also been identified in various types of dementia.

Researchers from St. George's Molecular and Clinical Science Research Institute in London (headed by Vassiliki Rentoum) have just published the fruits of such a study in PLOS1 (this is available free online) called, The Acute Mania of King George III: A computational linguistic analysis. The aims of the study were to establish alterations in the King's letters to politicians at the onset of his first manic episode and to establish if these changes were due to illness or other external stressors such as challenging political crises. They also compared language use in the pre- and post-illness phases with the illness phase itself. They found that there was less richness in language during the phases of illness with a paucity of adverbs, which were present before and after the acute illness.

They also found more complex sentence structure with frequent uses of conjunctions and co-ordinates such as "yet", "but" etc during the illness phases. The language during the politically turbulent phases of the King's life differed substantially on these measures from those during the illness phases and from those at different seasons of the year. Applying such sophisticated tools may have clinical relevance in the future.

The younger members of the Royal family have strong historic reasons for supporting mental illness charities working to destigmatise and raise awareness. Mental illness diagnosis has clearly progressed since the lamentable restraining and ultimate stripping of the powers of George III. But it is telling that three centuries later his descendants are now battling to shake off the negativity that it still engenders. It seems there is little cause for optimism.

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