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The Lost Prince

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7382.229/a (Published 25 January 2003) Cite this as: BMJ 2003;326:229
  1. Iain McClure (imcclure{at}vol.scot.nhs.uk), consultant child and adolescent psychiatrist
  1. Vale of Leven Hospital, Alexandria

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    BBC 1, 19 and 26 January at 8.30 pm

    The distinguished writer Stephen Poliakoff has pulled a royal rabbit out of history's hat for this two part series. He tells the true, but incredible, story of Prince John (1905–19), the youngest son of King George V and Queen Mary, who developed epilepsy and pervasive developmental disorder, and who had a learning disability. Royal embarrassment meant that John's existence and condition were concealed. His case raises fascinating questions. What was the degree of medical and social knowledge 100 years ago regarding neuropsychiatric conditions in children? What have we learnt since?

    When John had his first seizure in 1910, medicine was only just emerging from the dark ages as far as neuropsychiatry was concerned. None of the pervasive developmental disorders, such as Asperger's syndrome (features of which are evident in John's dramatised presentation), had been described (this would take another 40 years). Epilepsy was well known, but relatively unclassified. Assessment was purely by observation and management limited. Effective pharmacological treatment of epilepsy would have to await the advances consequent upon the second world war. Witnessing someone in the throes of a tonic-clonic convulsion was thought to be psychologically damaging for the observer and doctors therefore advised social seclusion of the patient. Knowledge about intelligence and its assessment was only in its infancy.

    Poliakoff presents a painful account, beautifully filmed and scored, of a boy totally at the mercy of medical and social ignorance. Paradoxically, John's high rank, in the stifled world of post-Edwardian royal society, seems to have deprived him further of adequate care. His parents' attachment to him was superficial, their meetings with him brief and infrequent. Only his older brother George (the future Duke of Kent) and his devoted nurse believed in and supported him. Why?

    One can attempt an answer by comparing John's case with that of his second cousin, Tsarevich Alexis (1904–18), whose story Poliakoff interweaves, along with that of his doomed parents and sisters, as a lyrical subplot to the main events. Both boys had potentially life threatening illnesses, but while John was hidden, Alexis's haemophilia became a central concern of the Russian nation. This cannot simply be explained through cultural differences, nor to the fact that Alexis was heir to absolute power. It is mainly because, while the course of all disease is unpredictable, mental disease causes unpredictable behaviour. Beneath this reality lies a set of superstitious beliefs (of demonic possession and so forth) that tether mental disease to the scourge of stigma, which still pertains today.

    Above all, this series is a moving testament to the power of human individuality. It reminds us that difference is a quintessential human strength, which is revealed in the youngest, most apparently incapacitated, in our society. If only we can look for it and value it.

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