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      Was King Ludwig II of Bavaria misdiagnosed by Gudden and his colleagues?

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          Abstract

          In 1886, Bernhard von Gudden and three other expert psychiatrists diagnosed the Bavarian King Ludwig II with “paranoia (madness),” a diagnosis that the Bavarian government used to justify removing Ludwig from power. Although Ludwig was not evaluated in detail by the psychiatrists, in their opinion, sworn eyewitness accounts and general knowledge about Ludwig’s behavior provided sufficient grounds for the diagnosis. Ludwig was a great admirer of the musician, Richard Wagner, and shared some of his ideas of an idealistic society. At first, he identified with Wagner’s opera heroes, and he became Wagner’s patron sponsor for life. However, he grew increasingly interested in an absolutist state, envisioning himself as a monarch with a role similar to that of Louis XIV. His multiple building projects, for which he incurred much debt, his conviction that he was descended from the Bourbons through baptism, his increasingly abnormal behavior, and his hallucinations together formed the basis for the psychiatrists’ diagnosis. Although not mentioned in the expert opinion, Ludwig’s homophilic behavior—a scandal at the time—was probably also an important reason for his removal from office. A review of the psychiatric knowledge and societal philosophy of the time indicates that the psychiatrists were correct with their diagnosis in their time.

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          [Ludwig II of Bavaria - the "fairy tale king": his last years from a psychiatric point of view].

          Ludwig II of Bavaria (Germany) entered the political stage at the age of 18, following the premature death of his father Maximilian II in 1864. At that time, Ludwig was a very handsome, slender young man; he was enthusiastic and had a pronounced taste for fine arts and music, and was admired by the people as a "fairy tale king". However, already during the first years of his reign, he displayed traits that fulfilled the ICD-10 criteria for schizotypal disorder together with a combined cluster B personality disorder. They became even more pronounced over time. Towards the end of his life, Ludwig developed "imperial madness", a typical pattern of behavioural excesses including craving for power, splendour, construction, unrestrained spending, excessive eating and sexual exploitation, revenge with a tendency for cruelty, and an inclination for theatrical and sometimes irrational acts. This complex syndrome is usually manifested in excessively egocentric rulers who have almost unlimited power or, in the case of Ludwig II, an overwhelming desire to possess it. His imperial madness was possibly contributed to by an orbitofrontal brain syndrome. One conjecture is that this condition reflected a neurodegenerative process; another is that a primary deficit, initiated by brain damage following a severe bout of meningitis during Ludwig's babyhood, played a role. In this case, functional compensation by other brain areas may have eventually been counteracted by chronic substance abuse in his thirties. The monarch's life ended tragically when he was 40 by which time he had become adipose and had lost most of his teeth; meanwhile, he was placed under tutelage, dismissed and detained. Before his death by drowning in Lake Starnberg (suicide? attempted escape??), Ludwig apparently killed his psychiatrist, Bernhard von Gudden, who carelessly served as his sole attendant. Yet Ludwig's image as the beautiful fairy tale king is still alive in the hearts of successive generations of Bavarians and in the fascination demonstrated by the masses of tourists from throughout the world who visit (against his formerly declared wishes) his "dream castles".
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            [Bernhard von Gudden on the occasion of the 125th anniversary of his death].

            Bernhard von Gudden died 125 years ago together with King Ludwig II of Bavaria, his royal patient. The prominence of the "Fairy Tale King", the circumstances surrounding the deprivation of his power and his psychiatric internment as well as the establishment of Luitpold's reign and above all the catastrophic ending of the Bavarian royal drama still outshine Gudden's importance for the scientific development of the new subject of Nervenheilkunde (psychiatry and neurology), particularly Bernhard von Gudden's importance and integrity as a physician. Not only was he a much sought-after academic teacher, but he was also a patient-focused advocate of the principle of no restraint. As director of mental institutions, Gudden gave vital impulses for the improvement of mental health treatment. For 14 years he treated Prince Otto, the mentally ill brother of Ludwig II. Gudden rendered an expert opinion together with three other Bavarian psychiatrists resulting in Ludwig's legal incapacitation. Concerning the justification for the King's ousting there have been very different and controversial arguments from the constitutional and psychiatric point of view even in recent times. There is, however, a growing conviction that Ludwig II was incapable of reigning, the deprivation of his power followed the path prescribed by the constitution, and Gudden and his colleagues carried out a reviewing procedure considered valid by today's standards and appropriate under the circumstances. The royal disaster ending with the patient's and reviewer's death, however, has to be attributed to a misjudgement by Gudden that is based on the role diffusion between reviewer and treating physician.
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              [Was the expert medical opinion rendered by B. von Gudden regarding King Ludwig II of Bavaria correct?].

              Even today the deaths of King Ludwig II of Bavaria and the Munich-based psychiatrist Bernhard von Gudden on 13 June 1886 remain something of a mystery. In his psychiatric expertise von Gudden had rated Ludwig as insane and incapable of governing. Ludwig was placed under tutelage, deposed and interned under the supervision of guards. After the catastrophe witnesses and the press were silenced by strict censorship under threat of heavy penalties. Even today obstacles to free information still exist, aiding and abetting the birth of legends and the preservation of leading traditional views. We report on the results of a 5-year research project conducted at the Heidelberg Academy of Sciences and Humanities and based on information derived from private and public archives in Germany and abroad. Reference is made to comparable analyses. Neither von Gudden's expertise nor Ludwig's behaviour provide reliable cues to his alleged insanity. The reasons and motives behind the king's deposition are discussed. Apart from von Gudden's tragic death, this was not a singular case of a psychiatric expertise commissioned in the monarchist culture of the nineteenth and the early twentieth century.
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                Author and article information

                Contributors
                rsteinberg@t-online.de
                Peter.Falkai@med.uni-muenchen.de
                Journal
                Eur Arch Psychiatry Clin Neurosci
                Eur Arch Psychiatry Clin Neurosci
                European Archives of Psychiatry and Clinical Neuroscience
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0940-1334
                1433-8491
                21 July 2020
                21 July 2020
                2021
                : 271
                : 4
                : 799-807
                Affiliations
                GRID grid.5252.0, ISNI 0000 0004 1936 973X, Klinik für Psychiatrie Und Psychotherapie, , Ludwig-Maximilians-Universität, ; Nussbaumstr. 7, 80336 Munich, Germany
                Article
                1161
                10.1007/s00406-020-01161-8
                8119274
                32696275
                ee4e8f6b-b42f-4f13-bd38-99a69ee17a9e
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 14 April 2020
                : 29 May 2020
                Categories
                Original Paper
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                © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                Neurosciences
                bernhard von gudden,ludwig ii,diagnosis,paranoia (madness),expert opinion
                Neurosciences
                bernhard von gudden, ludwig ii, diagnosis, paranoia (madness), expert opinion

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