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No easy task confronts the psychoanalytically trained reviewer of this study of America's last king and 'Psychiatry's most famous
patient', which contains within its pages a spectrum of attributes ranging from medical brilliance to psychiatric bumbling. The latter is all the more remarkable since the work is a product of the same writers who not long ago brought out a sophisticated and informed renewed inquiry into another celebrated psychiatric case: Senatspräsident Daniel Paul Schreber. Still earlier the senior author published a paper on transference that continues to enjoy a high reputation in the psychoanalytic literature. Yet paradoxically it is precisely within the scope of the authors' psychoanalytic expertise as manifested in these two works in particular that the present study falls down.
As chroniclers of medical history they are superb: from the point of view of pathography George III and the Mad Business is an undeniable tour de force. Armed with a long catalogue of painstakingly assembled data, interspersed with plausible hunches, the authors bring forward persuasive evidence that the mental illness of the King was a manifestation, not of a manic-depressive illness, as has been commonly assumed, but of a hereditary metabolic disorder, porphyria. With the taut logic of a well-knit mystery story the drama of the King's recurring ailments is unfolded; point by point the similarities are tracked down between his malady and the known course of acute intermittent porphyria, and finally, in the best tradition of a British thriller, the clincher is provided by a tinted telltale clue—during certain phases of His Majesty's illness, his urine was colored red.
But this engrossing essay is not limited to the illness of King George. As a Mendelian dominant trait whose appearance may be expected in roughly half the offspring of afflicted individuals, evidence of porphyria has been sought by the authors among his ancestors, his collaterals, and his descendants