Missed Diagnoses in History: Story Time: Charles VI and Mary Todd Lincoln

[00:00:00] If you have suicidal thoughts after the grief of a loved one and they are confined to only the desire to join them in the afterlife, that's actually not considered a suicidal risk or a sign of depression. Likewise, if you hear auditory hallucinations and they're just from your dead loved one calling to you or talking to you, that also doesn't necessarily qualify for a psychosis, but it has to be isolated to that.

So take that into account.

Welcome back to How to Be Patient. This is a first, I guess the maiden voyage of Preston doing a solo episode, so thank you all for being here with me today. Margaret is on a break. She is working very hard in fellowship, but will be back later in the season. So while we're sitting around and talking, I figured we could have a little story time.

So I've, I have some interesting stories from history that I thought really highlight some of these psychiatric illnesses that [00:01:00] we probably attributed to, you know, spiritual or magical things back in the day. And the, point that, that fascinates me about all this stuff is the DSM disorders or the things that we've named, like, they've been around forever.

we, we changed the names of them even in the last century. You know, like ADD to ADHD. I think it used to be called minimal brain dysfunction, and then before that it was... I think they called it, like, dysregulation of morals, like the naughty kids in class. So, so even go farther back, we've, talked about this on some of the other episodes that, you know, people are possessed, they're taken over by demons or, there are ghosts around, paranormal activity.

And, a lot of these things have anchors in, medical illness, so that's kinda where we're going today. The first story is gonna lead us to a 12-year-old boy in France who thinks he's made of glass, and the next one is [00:02:00] to a, a widow who develops some very interesting spending habits after a traumatic experience with her husband.

So without any further ado, let's get into it. So the year's 1380 There's a 12-year-old boy who's crowned the King of France. His father, Charles the Wise or Charles V, had just died at 42, and he's leaving the throne to his son, who he's not old enough to, rule yet. And amidst all of this, there's 100 Years War going on with England, or there, there's a war going on with England.

I don't remember if it's the 100 Years War or not. Things are bad and, people are in conflict. The boy, he has four uncles, and all of them are dukes. which I think is a pretty... It's a high-up title. I don't know where it falls under, like count or king or prince but, you know, the, dukes are in charge, they're wealthy, and then they get assigned as regents to take [00:03:00] over, instead of the nephew.

So, Or, instead of the boy himself. So the four uncles are, they're kind of running the show, and one of them, he, pillages the royal treasury and leaves to, Italy to go chase a, crown in a campaign. So he's... So they're spending all this money, they're kind of ruling for him, and the boy who's supposed to be king is, like, watching all this happen, and he develops this kind of like frustration with it, and he really wants to do right by everyone.

So when he grows up watching this, he decides to fire, fire all the advisors as soon as he turns 20 and can inherit the crown. He fires the uncles, who are all the dukes, and says like, "You guys are doing a terrible job. Get out of here." And he brings back his dad's old council, and he wants to make things right again.

So the first order of business for this prince is he negotiates a three-year truce with England, and that's a generational achievement. I mean, [00:04:00] anytime France and England can get along, I think is something that should go down in the history books. But the fact that he was able to do this at 20, it, it's a big deal.

it's something that, you know, the previous royalty weren't able to achieve at all, and th- this guy's coming hot out the gate. he's like the, he's like the Mandami of 1390 France, you know? Ev- everyone was like, "Oh, the... Who's this young guy coming in here? Why is he supporting Arsenal? Oh, look at that."

There's a, treaty between France and England. So, so people love him, and his name is, Charles, so they actually start calling him Charles le Bien Aimé, or Charles the Beloved. So th- this guy is now 24, and he's, really well-liked, and he's done a lot since he came into office. I'm just gonna say office 'cause it sounds easier than the throne.

Everything's going good until there's an assassination attempt. So it's not on the king himself, but he has his friend, Oliver Clisson. He's a constable of France. He's roughly, like, the chief of staff of the army, their [00:05:00] equivalent of that in France at the time. he's a very powerful guy, and, he's, like the secretary of defense but for France in 1380.

And there's a nobleman named, Pierre de Craon, and he ambushes Clisson in a Paris street at night. He stabs him repeatedly and leaves him for dead in an alley, and Clisson barely survives. So, so from our perspective, th- this would be like if somebody tried to assassinate, like, the VP or the SecDef. Y- th- this is a big deal.

And it turns out that the person who tried to assassinate him had been working with, John IV, who's the Duke of Brittany. Now, I didn't know. I had to look up what Brittany was. It's a small province in, like, the northwest part of France, which is kind of like its own independent feudal state at the time before they were united.

So i- imagine if the governor of Washington when Wa- if Washington State was, like, kind of its own independent thing, sent a guy to go assassinate the vice [00:06:00] president, and then he, like, ran back to Brittany to seek res- refuge. That's basically what's happening right now. So the king is freaking out about this.

He's like, we need to do something." he's, he takes it personally. He thinks, you know, "I'm next. I'm gonna be assassinated next. They're, gonna be coming for the crown, and they're gonna take all this stuff down." So he actually goes and assembles a force, and he's like, "We're gonna go to Brittany, and we're gonna take these dudes out."

You know, r- like, "G- e- everyone mount the cavalry. We're going to Washington. Whoever, tried to assassinate SecDef, we're, coming for him." But, that's when things start getting kind of weird. So as he's assembling the cavalry, he's, not sleeping. He's really agitated, and he's starting to worry that other people are coming after him.

So he's like, "Who else is gonna... W- where's the assassination attempt coming from?" which at this time seems kind of reasonable because there was literally just an assassination attempt, but he's, like, so on edge that it's kind of distressing other people. [00:07:00] So Now th- it's August of 1390, and the company, they're riding outside of the city of Le Mans in the woods towards Brittany.

And there's a couple different reports about what happened, so we're just gonna go with kind of the more dramatic chronicler version. But a peasant comes out of the woods. he's ragged, maybe had his own issues, and he, basically tries to grab onto the king's horse. Says like, "Charles," you know, "Ride no further, you are betrayed."

And then he gets driven off and goes back up into the woods, but that plants a seed. And now Charles is, mulling over that even more, and he already was on edge. And then maybe a half hour later or a short time later, there's, a knight or a page that's riding behind Charles, and he lets a lance slip, 'cause it's probably heavy to hold these big spears.

S- so the lance falls, and it lands on somebody's helmet or, clinks something, makes a loud [00:08:00] sound. A- and our guy Charles is leading the, pack. He's already jumpy. So, so Charles hears this clink. He turns around and he goes, "We're being attacked. and you all are trying to take me down." And he draws his sword and starts attacking his own guards.

So he yells, actually, this is the quote, "Forward against the traitors. They wish to deliver me to the enemy." So he thinks maybe these, traitors are my own men, that, like, there's a rat or something, and we're going to Brittany, so they were gonna, like, actually, you know, give me up to the enemy when we get there.

He, kills four of them. He t- even attacks his own brother, the, Duke of Orleans, and he was, extremely close with him, so this is all very confusing behavior. These are people that he supposedly trusted before. And then he's finally grabbed by his chamberlain, who pulls him off of his horse, and they subdue him, and they take his sword away, [00:09:00] and he immediately collapses into a coma.

And, this coma lasts four days. They drag... they call off the whole campaign, and they drag him back to the castle. So now he's sitting in the castle 24-year-old Charles, and almost nobody at the court is thinking that this guy's gonna recover. The, court physicians they have around, they've already given up.

The dreaded uncles who are spending all that money, they're, now back in the picture, and they're like, "Guess what? We're gonna be regents again." If you don't know what a regent is, it's basically like someone who has temporary power over the throne without actually being appointed as king themselves.

So it's like if... I think this was in Game of Thrones where, you know, like they, they had the, 10-year-old king and the queen regent, so it's like, "My mom's in charge because I'm not old enough to do it myself." So anyways, they, take over the regency again, and the, they completely dismount the political revolution, and they [00:10:00] fire all of the councilmen that Charles hired because they're like, "He's, dead."

Like, "There's nothing coming to him Until a 92-year-old physician, interesting guy, this is Yama- Guillaume de Harsignyes. I'm really sorry I'm butchering all of these, French names. he's someone from northern France, and I'm just amazed that someone would make it to 92 back then. A- and you ... I always have to remember this, that the average mortality, or the mortality age was, like, in the mid-30s, but that's really heavily offset by so much childhood death.

And if you actually make it into adulthood, a lot of people did actually live to pretty ripe old age, and it wasn't uncommon for, you know, otherwise, like, healthy people to make it into their 60s, 70s. This is the first one in the '90s that I've read in a, really old text, so shout out to this guy. maybe he [00:11:00] was taking his creatine.

So this guy lives in northern France. He's not a court physician, but he does have a doctorate from the University of Paris. He did some med school, maybe the equivalent of a, residency in Italy back in the day. He's done a lot of work around Egypt and Syria collecting medical manuscripts. I feel like this is important because, at the time, the Middle East was actually way ahead of, Europe as far as, medical treatment goes.

They were ... I think even at that point, they were using opium as, like, anesthetic and a mild sedative. They were performing, you know, basic versions of cataract surgery. So if, Guillaume is actually leaving France and getting some information, from Egypt and Syria, he, might actually be cooking with his ideas.

So he comes back. He's, built this reputation treating plague patients in Picardy, which I think is in Italy, and he's [00:12:00] renowned. He's, like, the guy, which is what I'm getting to. Th- this guy has studied around, and he comes up, and he sees the king, and he's treat- he tries to treat him, with his humors, and he diagnoses him with, torbel.

So torbel, I guess, is agitation or a weakness of the head, and he says that he's taken too much from the moisture of his mother and believes that it's because his mom, Joan of Bourbon, had her own documented episode of madness after one of her childbirths So she had a post-childbirth madness, and he, they think that humor, that moistral humor came from the mom and descended into Charles.

So the doctor in 1392 used humoral theory. He documented the family history, so good job. And then [00:13:00] he actually got him out of the coma. Like, everyone was amazed that he even recovered. So the court actually requested, Iame to stay on as the, court physician, and he was like, "Nah, dude, I'm so done with this.

I'm 92. All of you guys are freaking out over this 24-year-old who went mad and, s- like attacked you all in the woods, and I got him to wake up, so just, like, let me go." And so they, paid him a lot, and then he just kinda said peace. And they were trying to get him to come back, but he's not going to.

So Charles kind of comes back into this temporary level of stability, and he rules again kind of normally, and then he goes into these other periods of, madness again. And this goes on for about 10 or so years, where it just keeps getting worse, and episodes start happening more and [00:14:00] more frequently.

And then 1405, so 13 years after, he develops this delusion around glass. So a little thing about glass is it, was a relatively new invention at the time, and it was So it's hot technology. Not a lot of people have access to it, and also it's like the concept is it's brittle. You know, it's like made from stone, but it's not stone because you can see through it.

so the thought of it like kind of being this like immaterial or, you know, getting into people's veins or becoming a part of their body was not unheard of. I think Charles was one of the first documented to have delusions of glass, but actually he's not the only one. So he starts to believe consistently now, not just in episodes, that his body is made entirely of glass.

He refuses to let anyone touch him. He has these iron rods sewn onto his clothing so that if he falls, he's not gonna shatter because of the, glass body that he's in. And then he would refuse to move for days at a [00:15:00] time because no one can break the glass. So we went from like these small episodes to now just j- he's completely impaired.

So now, once th- once he's frozen, I guess, you know, he's figuratively and liter- literally acting like glass. France starts losing in their war. They're taking on Henry V. So 10 years after the glass delusions start, Henry's, army in England come do- comes down, they crush the French army in 1420. So they have the Treaty of, Troyes where Charles manages to pull out of his glass delusion for a little bit and is able to sign away the French throne to Henry V, and he disinherits his own son People dis- people disagree over, like, how lucid he was when he signed over the throne to Henry V, but it, I think [00:16:00] that's how it's gonna be documented because they don't wanna say that he didn't have capacity, right?

And then Charles ultimately dies in 1422. His son eventually retakes the country, but only after a peasant girl from Lorraine named Joan, shows up claiming God told her to. So I, don't know. She might have an interesting story arc later, but we'll, get into that in a different episode. So in conclusion, e- everyone at the time acknowledged that Charles VI was mad, but they thought he had, humid vapors, moisture from his mom that was causing this madness.

they tried bleeding, they tried purging, they tried prayer, exorcism, and none of it worked. Some of it might have helped. Maybe it helped him wake up from the coma, but nobody really knows. And at the end of the day, he lost the war, he gave up his throne, and he lost his family. [00:17:00] So that is the story of Charles VI, the king with the delusions of glass.

We are gonna take a quick break, and when we come back, let's talk about what we actually think was going on psychiatrically with him

What do y'all think was actually wrong with him? Like, what's on your differential if we were to be the court physician coming in to diagnose him? Second to-- Like, let's pause like we're in Dora. What do you think the diagnosis is? Okay, let me tell you what I'm thinking a-and what a lot of people have come to the conclusion of.

He almost certainly has schizophrenia, but, some would argue maybe schizoaffective disorder, and let's kind of go back and look at the clues. So his mom had after-birth madness or po-postpartum psychosis. That greatly increases, the [00:18:00] risk of inheriting schizophrenia, but it's still not huge. So if two parents that both have schizophrenia have a kid, the odds of that kid developing schizophrenia is only 15%.

So it's not as likely. Bipolar, however, is really inheritable. Bipolar is, like, as inheritable as height. So whether or not the moisture definitely came from the mom, like, it, it increases risk, but it's not, like, guaranteed to be genetic. The, other thing to, to remember is that schizophrenia is often like a two-hit system.

So if you're genetically predisposed to it, you have to have some kind of environmental factor that exacerbates it. So if you have two twins, when we do twin studies with schizophrenia and one twin develops schizophrenia, the other twin only develops it, like, 60 to 70% of the time. And I, say only like that, yeah, that's still really high odds.

But for someone who has the same exact genetic makeup to [00:19:00] develop schizophrenia that you cannot based on your life circumstances, that, that, makes a big difference. So He was 24 when he had his first episode of madness. that puts us right in the range for a first break psychosis. But it could have been a manic episode, but I think it's unlikely because his primary symptom was paranoia, and like he thought that people were out to get him and out to murder him.

Some of it I think was, you know, well-founded or logical paranoia, but then it started developing into delusional paranoia, especially when he started to believe that his own men were going to attack him, and then he acted on that. So if I was the psychiatrist at the time, I think we would be getting ready to, you know, file an order of protective custody for this guy 'cause he, he might be a danger to himself or others since he thinks that his own guards are trying to usurp him and he's literally attacking them and we're, seeing that happen in real time.

But this is interesting. He, goes into a [00:20:00] coma, and that doesn't really make sense to me. If you have a psychotic break and you go straight into a coma, what... Like what could that be? I, was wondering like is this an autoimmune encephalitis that's happening? Does he have some other like cond- underlying condition going on?

But I think most likely it's catatonia. He-- I, I... That... I mean, I didn't see him and I can't examine him, but the pattern that I see clinically is someone, they, develop a, psychosis. their mind is completely hyperactive, because they, you know, there's an extreme inciting event, and then that psychosis decompensates into catatonia, and then catatonia can spontaneously resolve.

So that might have been what happened. The other thing that I'm like just thinking about right now is... So, so the treatment of catatonia is with benzodiazepines, right? it's, actually from hyperactivity of the brain that kind of shuts down your ability [00:21:00] to move your arms and legs. And so we tr- we treat it with these benzos that they target these GABA receptors, which would be the same thing, as like wine or alcohol.

So, so I wonder if, the doctor comes in and he's trying to treat the humors and he's like, "Have some of this wine, it will help you." You know, like, get him some beer to, to cure the humors or something. That, that may actually be, a viable treatment for his catatonia to help him come out of the, the, comatose, state.

Now, a-as far as the rest of, his progression goes, he has these intermittent lucid states, so he may still be suffering from psychosis or delusions. I don't really know. I don't have a ton of details about what was going on. So that would make him still have criteria for schizo- schizoaffective or schizophrenia at least.

But then he has these ups and downs where he, g- he goes into these frenzies. [00:22:00] I didn't describe a lot of that in the story, but there are times where he, you know, would go into a frenzy and they'd try to have a whole festival or party to, calm him down. The other thing that's interesting that we also...

I, like I've seen progress, is how, like things get worse when you don't treat them, and then you develop a fixed delusion that doesn't come back. So when you're in a psychotic state, you're experiencing a lot of excitatory inflammation because y- your brain's like just firing all the time in the wrong places, but it's still firing, and then the nerves start to get frayed a little bit.

So as that fraying happens, the brain starts to atrophy, systems decompensate, delusions become more fixed, symptoms get worse. So it actually makes a lot of sense that about 10 years after his first break, he then develops completely unremitting fixed delusions that his body's made of glass [00:23:00] This one's interesting to me.

I wanted to say it's like most similar to like a Cotard delusion, but a Cotard delusion is a belief that you're dead, and he's believing that he's made of some other kind of material that's not his own body. So my thought is that th-this kind of belief that he's made of glass, it, might be like some kind of derealization or depersonalization that he's interpreting through the lens of his psychosis.

He's having this, like, feeling like his body's not his own, but he's come to the conclusion that it must be glass because he's in this persistent, psychotic state. So if I was the doctor back then, I wouldn't have humid vapors or bleeding on this. We, would say schizoaffective disorder, bipolar type, and then I would go out to the mines and I would say, "Are we mining lithium [00:24:00] out here?

Is there, any way I can crack some of these rocks and, like, break them under, you know, like a mortar and pestle and feed them to the king? It'll help stabilize his mood, believe it or not." They'd be like, "Oh, Preston, where'd you learn this stuff?" And I'm like... I'd be like, "Don't worry, I'm from the future," you know.

And also, where's your helldole tree growing? Because I need to go harvest from that too." Bada bing, bada boom. You know, actually, if I, was doing that, I bet you maybe king would have stabilized, then they wouldn't have signed over the throne to Henry V. Sorry, England, you know. but that's what happens when you don't have adequate medical care.

You lose the Hundred Years' War. I don't think I have too much else to say about that, but it is, it's an interesting case. And, I'll be thinking, I'll be thinking more about this glass delusion stuff. I'll ask my patients too, if they ever think they're made of glass. May just be something to do with the [00:25:00] new, technology also.

So people think that, you know, there's cameras inside them. People think that AI can read their minds. Like delusions, the, reference points don't change, but the content does. You still think you're being followed, but, by whom? That-that's dependent on the cultural context. So yeah, interesting case.

Okay. Well, we are gonna take a quick break, and when we come back, we're gonna talk about Mary Ann Todd, the widow.

Welcome back. And we are now moving to May 19th, 1875 with the story of Mary Ann Todd So the setting is in Chicago. A 56-year-old woman is sitting in her ho- hotel suite at the Grand Pacific when she hears a knock on the [00:26:00] door. A police officer and a deputy come in, and they inform her that she's required to come to court immediately.

She's been charged with insanity. There are 17 witnesses already there. They've already testified against her. There's no loyal- lawyer to advocate for her, and the trial's gonna take place this afternoon, or the sentencing more or less, and if she does not come voluntarily, she'll be taken by force. She's the widow of Abraham Lincoln.

Bum, Let's get into how this happened. So little bit of backstory. Mary Todd, she's born in 1818 in Lexington, Kentucky. She's grows up in this wealthy slaveholding family. She's educated very well, especially for a woman of her era. She, speaks French. She's politically, inclined, and she's always been telling her friends that she would marry a president one day, and they all kind of scoff at her, and they say, "Oh, [00:27:00] that's, y- you're not gonna marry the president," you know?

"Women can't even be president. Why do you think you'd marry one? Well, I guess that's how you'd get in the White House is by marrying one, but it's not gonna be you, Mary Ann." That's what they said probably. I wasn't there. So she finds this guy, Abraham, tall, charming man, and she marries him in 1842, and her family really disapproves.

They're like, "That Lincoln boy, he's poor and lowborn. There's nothing good coming out of that." And together they have four sons, and they say, "You know what? Screw you, Mom and Dad, and our wealthy slaveholding family back in Kentucky. I'm, going with this guy because he seems honest." And that's what she did.

But then some pretty negative stuff starts to happen bef- before there's this whole war thing. So in 1850, Eddie dies at the age of three. [00:28:00] Mary gets really depressed, and she doesn't leave her bed for weeks. In 1862, Willie, her, other son, dies of ty- typhoid at age 11. And this is 1862, so now Lincoln's, he's, won the election.

They're in the White House. So she's established herself as the First Lady, but she can't even ... She's so devastated again for a long period that she can't even attend the funeral. She stops engaging with the public, and she starts hosting seances in the Red Room to try to get in contact with her dead child.

Side note If in the DSM, if you have suicidal thoughts after the grief of a loved one and they are confined to only the desire to join them in the afterlife, that's actually not considered a suicidal risk or a sign of depression Likewise, if you hear auditory [00:29:00] hallucinations and they're just from your dead loved one calling to you or talking to you, that also doesn't necessarily qualify for a psychosis, but it has to be isolated to that.

So take that in count. Take that into account if you weren't already thinking about it. So she's hosting these seances. She's trying to reach the other side to talk to him. Lincoln attended at least one of these seances. During the war, she's publicly accused of being a Confederate spy. She's put under a lot of pressure.

Her brothers from that rich slave-owning family in Kentucky, they're fighting for the South, and some of them are ultimately killed in combat. So it's been a stressful time for her. She's getting a lot of flack in the political press. her-- a lot-- her-- two of her sons have died, and the war finally ends, and it's now April 14th, 1865, and her husband are trying to go to Ford's Theatre to, you know, [00:30:00] celebrate or enjoy the evening.

So she, she's holding her husband's hand, and John Wilkes Booth walks into the theater and, shoots him in the back of the head with a .44 caliber Deringer from a distance of about four feet. So she's splattered with all of his blood and brain tissue, and she goes into this, screaming state and doesn't stop for several hours.

So She's, like, you know, taken to the hospital, and they're, trying to calm her down, but, she's having a lot of trouble stabilizing. and then kind of finally returns to somewhat of a normal state. Then, about six years later, there's another loss in her family. Tad, which was her last surviving young child, dies at 18 of a pleurisy-like illness.

I ha- I had to look up pleurisy, all these, like, old weird, medical things. [00:31:00] It's just like, it's probably a pneumonia or, like, a pleural effusion. Like anything... So, you know, like, as you know, the pleura is the tissue in between, your lungs and your rib cage, so some kind of infection there. So he probably had the equivalent of a, pneumonia, wasn't breathing very well, and then eventually died.

But, it's at 18, so he was, like, almost, he almost made it. He was like, "Oh man, only a couple more years, and then I could Develop the delusions that I have glass in my body, but, oh, the pleurisy got me first. So that was a mill time joke. Also, no pun intended there either. she now has buried three of her four children and also her husband.

Her son Robert's the only one left. and Robert is a, he's a well-established, lawyer in Chicago. So between 1872 and 1875, that's when she really starts to decompensate. First of all, [00:32:00] I'm kind of amazed that she's gone through this much trauma and hasn't fully decompensated yet. obviously, there's like a couple depressive episodes, you know, between like 1850 when, like when her kid dies and when she, you know, goes into what they probably described as a hysteria, after her husband was shot.

But the fact she's holding it together is really impressive. So around 1872, she's, living in these hotels in Chicago, and she develops these compulsive shopping patterns. She will go, to the whole garment district and buy like 300 pairs of gloves. She'll buy multiple expensive watches in single trips.

She buys drapes for houses that she doesn't even own because she lives in a hotel room. She tells acquaintances that she's destitute, but then she's also spending thousands of dollars. Turns out she, she racked up about $27,000 of debt in that period. So $27,000 in [00:33:00] 1865-- sorry, 1872 worth today. Let's see.

So that, that's the equivalent of about $760,000 in debt in these, like, strange compulsive shopping habits. She's also, spending the entire night pacing the hotel halls. She has this decreased need for sleep, and then she also starts to believe that people are trying to poison her. The city, she believes the city removed her bones during the night, that her husband's voice is speaking to her, and that she's having stuff crawling all over her.

she then, is carrying around $57,000 in government bonds, and she sews them to her petticoat, like on the inside of, them 'cause she doesn't trust them to be anywhere else. And, that I think-- I mean, if [00:34:00] $26,000 is like 700,000, like this, is like probably $1.5 million worth of bonds that she's just like holding onto herself, which I mean, I know she's not in the, best mental state, but Mary, you know, like sell some of those bonds, you could pay off all that watch debt and the gloves that she got.

she probably has not seen it that way, obviously. So things are getting pretty bad. Family members are starting to notice, friends are noticing. The son finally, starts to act. So Robert Lincoln hires Leonard Swett. he's an old friend of Abraham, and they quietly prepare to essentially take away her rights.

They gather 17 witnesses. They subpoena the hotel staff, watch and glove salesmen or clothing salesmen, physicians, and they don't tell Mary about any of this stuff. And then [00:35:00] on May 19th, 1875, they start a trial, and they appointed this counsel, Isaac Arnold, who they gave him the case that morning.

They-- He doesn't get to... He doesn't cross-examine very well, and he doesn't call any witnesses. And they bring her from that hotel room down to the trial, where they basically accuse her of being insane. The jury deliberates in 10 minutes. They find her guilty, and they commit her to Bellevue Place in Batavia, Illinois, which is a private asylum about 40 miles west of Chicago.

But it doesn't end there. That night, Mary goes to multiple Chicago pharmacies trying to buy laudanum. She tells one pharmacist that she needs it for a swelling on her shoulder. He recognizes what she's doing, tips off her doctors. They substitute camphor water for laudanum. She drinks it and is fine. What an interesting [00:36:00] way to address a suicide attempt.

And I don't know what laudanum is. Let's look. So laudanum is a potent alcohol-based opium-containing, compound. Okay, so she basically, she wants to overdose on opiates. that's what she... Oh, laudanum. I wonder if that's where Dilaudid comes from. Probably. So I would never do that if my patient was suicidal, be like, "Oh, let's just swap it out and let her do it."

Like, "Oh, you know, this guy, he's gonna kill himself. He's got the g- the gun and the bullets right here," and I'm like, "Just swap them for blanks." And then he, like, fires the gun and is fine. We're like, "Oh, yeah, that's a safety plan right there." I mean, but-- A- and what's wild is they're already committing her against her will.

They sent her to this asylum, and then they let her go out. Like, can we make up our mind about where we want to land on [00:37:00] giving these people rights? Like, if you're determining that Mary is undeniably insane, then why'd you turn her out to the, street where she can go to the pharmacy and ask for laudanum?

Like, like if you're gonna say someone doesn't have capacity to make decisions on their own or competency, then, they'll, like, make decisions for them. I don't know. I- interesting, move by the doctors there. So she ends up in Bellevue, where she actually gets considerable freedom. She gets carriage rides, correspondences.

She gets visitors. One of her friends, Myra, Myra Bradwell, she visits her and is hanging out in Bellevue, maybe going on some of these carriage rides too, and becomes convinced that she's no longer acutely ill or was never ill as she was charged. this friend Bradwell leaks the story to The Chicago Times.

The paper runs a sympathetic series and, makes a whole story of it, and now the son, Robert, is publicly [00:38:00] embarrassed and feels bad about doing this whole trial. Like, "Oh, hey, Mom, sorry I told everyone that you were insane and got you locked up." Too bad it only took until the Chicago Times wrote a whole news story about it for me to actually like double back on this.

Like, was Robert not visiting her either? What the hell, man? Like your mom's lost three kids and her husband, you can't go visit her in, at Bellevue? It's 40 miles away. You know, make the trip. Anyways, th- they put a lot of pressure on Robert and then they... He gets her released back into her sister's care in September of 1875.

In June of 1876, they have a second sanity trial and she's declared sane, and she spends her last couple years estranged from Robert. Most of the time is in Europe. Then she returns to her sister's home in Springfield, Illinois to spend her, elder years. She dies in 1882 at the age of 63. [00:39:00] So what do y'all think was going on?

Let's pause while you think of the diagnosis. So the one coming in here for me is it's pretty strong bipolar I. So

I think we teased earlier is these like pretty severe depressive episodes that she has. It's hard to, differentiate between, like, complicated grief, adjustment disorder, and depression sometimes. But, I think that if you're at the point where you're not leaving bed for weeks, that's... I mean, I wasn't there, but looking back, that's gonna be pretty close to a qualifying diagnosis of, a major depressive episode, and it seems like she probably had several of those.

And then on the flip side, these, manic spending habits, so, you know, impulsivity, decreased need for sleep, and [00:40:00] paranoia, so, so it'd be mania with psychotic features. and then probably increased goal-directed activity. So I imagine she w- probably felt like she was on a mission. she's buying curtains for a house that she doesn't need.

She, probably maybe had plans of buying a house, and then she has to furnish it and all this stuff she's doing. But it's, all just, nonsensical. But then if she returns to this sane state, so, so the difference between her and Charles VI is that she returns to, like, a normal state or a normal level in between.

Even when she's hanging out in Bellevue, she's, like, pretty cogent, whereas Charles has these exacerbations, but he never quite back, quite comes back to the old Charles. He still thinks his skin's made of glass even when he's not staying up all night having this, wild episode. What's fascinating about this is that it's, an interesting case in forensic [00:41:00] psychiatry.

So we essentially took away this person's rights without any due process, and she was stuck in an asylum for years. And the fact that she was such a high-profile person and that a news story would be willing to run a case or run a series on it is probably why she was released. But a lot of lesser-known people weren't afforded that luxury.

You know, many wives were committed to asylums and spent the rest of their lives there, even if they had intermittent bipolar episodes, but were otherwise, like, sane and able to be contributing members of society in between. So this, is a, I think, like, a pretty bad application of the law, and it's, interesting to see how, both the...

I guess the medical practice was clunky back then, but so was, so were also the, [00:42:00] kind of the, ethical and legal proceedings that we had. And the only thing that, that doesn't change about this entire story is that there's some shitty son who's a lawyer that's just gonna railroad all your care I'm just kidding.

No offense to lawyers, but really, like, man, some people, they- their kids just have it out for them. And I guess I would, like, initially wanna give Robert the benefit of the doubt when he's, like, trying to get her committed because she is doing a lot of dangerous stuff. But then he never followed up and saw that she was getting better and it took him until, you know, the world was basically calling him out for just trying to get his mom locked up.

So, so I think how he responds after that kind of ultimately gives away his intentions. Well, th- this has been fun. Thanks for coming along with me to, read these stories. I don't, know. This is, like, usually the part where I talk to [00:43:00] myself or we, chat with Ro- Margaret a little bit. Yeah, Preston, this is the part where I talk to you.

That was me pretending to be Margaret. But I don't know. Is it-- it's just a time for us to hang out and reflect on some interesting stories of the past. for those of you that join that Patreon or, liked the message on Patreon, we're gonna be sending out the T-shirts pretty soon. I was able to talk with Dr.

Sine. He has them in your s- in your size, so I think we're getting a Prozac XL and a Wellbutrin large. So, look out for those in your inbox. And outside of that, I don't think I have any other, big announcements. let us know how you think the show was, if you like these stories, or if you just like listening to me do solo stuff.

If you don't want me to just yap the whole time, maybe I'll take y'all on a hike or something. I don't know how reasonable it is to do that for a podcast. anyways, if you do wanna see more of me or [00:44:00] anyone on the Human Content podcast family, we're on Instagram and TikTok at humancontentpods or howtobeapatientpod.com.

If you wanna send us a voice note, feel free to, to drop a line there. I'm at presro on TikTok or at itspresro on Instagram and YouTube. Margaret, who is not here, she's at badarteveryday on TikTok, Instagram, and Substack. Thanks again for your listening. I'm your host, Preston Roche. Our executive producers are me, Preston Roche, Mara Duncan, Will Flanary, Kristin Flanary, Aron Korney, Rob Goldman, and Shahnti Brooke.

Our editor and engineer is Jason Portizo. Our music is by Omer Ben-Zvi. To learn more about our program disclaimer and ethics policy, submission verification and licensing terms, and our HIPAA release terms, go to howtobeapatientpod.com or reach out to us at howtobeapatient@human-content.com with any questions or concerns.

How to Be a Patient is a Human Content production.[00:45:00] 

Thank you for watching. If you wanna see more of us or if you wanna see... This is Lilac. She's my cat. She's gonna be waving her hand at one of the floating boxes, which will lead to more episodes. Lilac, point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They pr- they probably exist for real.

But in the meantime, I'm just gonna pet Lilac, and then I'm gonna go dance in the [00:46:00] background