Mental health issues of Maria I of Portugal and her sisters: the contributions of the Willis family to the development of psychiatry

Abstract

Contemporary accounts credit Dr Francis Willis (1718-1807) with facilitating the recovery of King George III from his major episode of acute mania in 1788-9. Subsequently Willis was summoned to Lisbon to advise on the mental health problems of Queen Maria I. This article reports the nature of the illnesses of Maria and her two similarly affected sisters, and uses the program OPCRIT to propose diagnoses of major depressive disorders. The high prevalence of consanguinity and insanity among the Portuguese monarchy and their antecedents probably contributed to their mental health problems. The successive contributions of the Willis family from Thomas Willis (1621-75) to his grand-nephew, Francis Willis (1792-1859), are reviewed; the popular image is somewhat inaccurate and does not highlight their part in the development of psychiatry.

What would be the psychiatric diagnosis of D. Maria I, the “mad queen”?

“…Finally, in December 1788, D. Carlos III of Spain died, who was the father-in-law of Mariana Vitoria and uncle of D. Maria I. It was the sixth death in three years [1][2][3] , Faced with so many losses, the queen began to show symptoms of anxiety: "restlessness, [...] dry mouth, difficulty swallowing, blurred vision, tremors or heat waves," in addition to "body aches" 2 .…”

“…Consequently, she was considered incapable of governing the country and was then replaced in public administration by her son, Prince John VI 2 . In Portugal, she was called "Maria, the pious one", but in Brazil, she became known as "Maria, the madwoman" 3 . Did Maria I suffer from a mental disorder?…”

“…The scientific literature on her clinical case is very restricted 4 . There are no medical records regarding the illness of the Portuguese queen 3 . The available information is based mainly on reports from foreign ambassadors and visitors to Lisbon and a Portuguese foreign minister 1,3 .…”

“…There are no medical records regarding the illness of the Portuguese queen 3 . The available information is based mainly on reports from foreign ambassadors and visitors to Lisbon and a Portuguese foreign minister 1,3 . The Portuguese people, at the time, believed that the queen had been poisoned 2 .…”

‘Details on the Establishment of Doctor Willis, for the Cure of Lunatics’ (1796)

“…As the ‘Details on the Establishment’ illustrated, his reputation was greatly enhanced and the numbers of his patients increased significantly. His acquired fame also brought him a lucrative, prestigious commission to treat Queen Maria I of Portugal, but her mental health problems proved rather more intractable than those of George III in 1788–9 (Peters and Willis, 2013).…”