Why Netflix’s ‘Queen Charlotte’ should come with trigger warnings
A writer with porphyria weighs in on the series' depiction of King George III
With the release of Netflix’s “Queen Charlotte: A Bridgerton Story” on May 4, it seems like everyone’s talking about acute porphyria.
“Queen Charlotte” explores a queen’s role in supporting a king whose mental illness is a nation’s secret. King George III is known for losing the American colonies and being the “mad” king. It’s a shame history defines a person in such a crude way. Nonetheless, King George is believed to have lived with mental illness, at a time when medicine knew next to nothing about treatment.
King George was known to have bouts of psychosis, and historians have long speculated its origin. Some believe it to be arsenic poisoning, while others have suggested bipolar disorder. Acute hepatic porphyria (AHP) is another popular theory, and while discounted by researchers in recent years, it remains embraced by the porphyria community as a form of awareness about the disease.
Why I believe the porphyria theory
I live with AHP, and I understand the impossibility of diagnosing someone posthumously 200 years later. At the same time, I’m partial to the porphyria theory. AHP attacks are characterized by episodes of severe pain and cognitive shifts, both of which King George experiences in the series.
A recent article for PBS NewsHour notes that acute porphyria symptoms can include anxiety, nausea and vomiting, confusion, palpitations, muscle weakness, and brownish urine — all of which I’ve experienced during severe, untreated acute attacks. Some historians believe King George experienced many of these issues as well.
In the series, his illness is a secret kept hidden from all but a small, inner circle. I believe the show does a great job handling this delicate information, even keeping it a secret from viewers at first. It depicts the shame many undiagnosed people with mysterious symptoms feel when told we shouldn’t be feeling the way we do. It takes an average of 15 years for AHP to be diagnosed, plenty of time to hide after years of hearing that nothing is wrong.
Primitive treatment methods and a trigger warning
I’d hate to spoil the show for anyone, but I think Netflix made a mistake in failing to issue a trigger warning for the most challenging part of the series: its depiction of King George’s mental health treatments. I was familiar with the inhumane methods doctors once used to address psychological symptoms, but I still skipped through several scenes.
In late October 2020, I took a pandemic trip to Kansas City, Missouri, to visit a close friend. In the spirit of the spooky season, we wanted to visit haunted places and came across the Glore Psychiatric Museum in nearby St. Joseph. It’s located in a building that once housed the St. Joseph State Lunatic Asylum No. 2, where some disturbing, torturous things took place.
As we pulled the car around the driveway, the beautiful, ornate historic building came into view, looming over the grounds as if it were keeping watch. An eerie feeling descended over me, clutching at my throat and clinging to my shoulders. The museum’s website described replicas of primitive 17th, 18th, and 19th century treatment devices and the awards the museum has won. There was no trigger warning; perhaps it was implied.
Inside, the building still smelled institutional, as if the lost stories of hundreds who once lived there were hanging in the air. Ascending steps to the exhibits, I knew at once that we were about to experience more than we bargained for. Sure enough, we wandered the halls of the former asylum, shuddering to learn about primitive devices and methods doctors once used to “treat” mental illness.
The museum was an impressive collection of stories, medical devices, and a history of mental health treatment. Its exhibits are important and educational, but deeply sad.
I spent part of that morning in reflection, sitting in one of the very rocking chairs that once filled rooms of the institution. In rhythmic motion, I allowed my body to feel the grief of my ancestors, whose porphyria was likely unidentified and mislabeled. I cried for the people, many of them women, who spent their days rocking in this very chair, at a time when our society didn’t have the science or understanding to humanely treat them. I wondered how many had an undetected rare disease like AHP.
In the same way the Glore Psychiatric Museum teaches hard history lessons, “Queen Charlotte” portrays real treatments endured by people living with mental illness in the 18th and 19th centuries. And regardless of King George’s diagnosis, the public discourse ignited by the series has been fascinating.
As people learn more about rare diseases like AHP, I hope to see more characters with chronic illnesses and genetic disorders in the mainstream. Not in hiding or overcome by their disease, but living meaningful lives in spite of it.
Note: Porphyria News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Porphyria News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to porphyria.
About the Author
Simon Leake
I find it hard to understand how it is still taking so long to diagnose the porphyrias. My brother and I were diagnosed, with protoporphyrin blood tests with photosensitive EPP in about 1970. Our family doctor heard something at a conference and contact Dr Hensley the head of biochemistry at Royal Prince Alfred in Sydney. Dr Peter Russell was only a young intern than but is now supervising the Bitipertin trial that I am in.
Maria Wolfram
Hello Simon!
I have been sick from the time I was born.
Only last year, after having my DNA sequenced, the geneticist told me that I had porphyria.
Unfortunately, the hematologist and hepatologist I see, do not rely on my DNA sequencing for diagnosis.
They have ordered a few urine and stool tests, and they all come back negative for porphyria.
Meanwhile, I continue feeling sick without receiving any treatment.
Do you happen to know if the method used for your diagnosis is still being used nowadays?
Thank you!
Best
Maria E.B.Wolfram
Claire Richmond
Hi Maria- Thanks for reading and reaching out. I'm no doctor, so I can only speak from my experience. Because I was in an attack when diagnosed, my urine levels were extremely elevated, and remain so despite treatment. While my stool was also tested, it was the genetic results that confirmed the diagnosis. Truthfully, I don't know if it's possible to be in an acute porphyria attack without detectable ALA/PBG in your stool or urine, that's something with which you'd have to consult your doctor. In the meantime, I wish you some calm and clarity as you continue learning what's going on with your body, the diagnosis journey is incredibly challenging.