April 16, 1999

The British monarchy has taught us much about psychopathology. The madness of King George, the grief of Queen Victoria and the pseudocyesis of Queen Mary, which is alluded to in the recent movie "Elizabeth" are described in detail in this article.

- Dilip Ramchandani, M.D.
History Notes Editor

By Knight Aldrich, M.D.

Pseuclocyesis, or false pregnancy, still often seen in animals, was a reasonably common condition in humans until the development of modern prenatal care, occurring about once in 25 pregnancies. While improvements in the early diagnosis of pregnancy have dramatically reduced its incidence, pseudocyesis has not been entirely eliminated.

Human pseudocyesis is the ultimate psychosomatic condition: a desperate need for a baby sets off a train of neuroendocrine processes resulting in all the biological signs of pregnancy except a fetus. But not all women desperately wanting a child develop pseudocyesis, so there is more to it than simple wish fulfillment. What more is not clear: pseudocyesis hasn't been studied much, since it is a self-limited condition, and once it is diagnosed, patient, family, and doctor are all too embarrassed or angry about it to want to study it. The biological side of the predisposition is probably related to major depression; the psychological side is likely to include a mother for whom pregnancy had a special significance.

These patients are often unfairly accused of malingering; they are so convinced that they are pregnant that their doctors are frequently misled. One episode is enough; at least in modern times it almost never occurs twice in the same patient. The opportunity for pregnancy is a requisite; it does not occur in virgins, although the delusion of being pregnant, quite a different story from pseudocyesis, may occur in virgins.

The most famous case of pseudocyesis was that of Mary I of England (1516-1558), called "Bloody Mary" because of the slaughter of Protestants that took place in her reign. Actually, Mary was not personally bloodthirsty; she was a homely woman, who was given to depressions when disappointed and whose interests were primarily domestic and religious. For the most part she let her religious advisers determine her government's policies; it was they who instituted the merciless attempt to wipe out Henry VIII's Protestantism.

Henry, Mary's father, had taken over the English Catholic Church when the Pope refused to give him a divorce from Mary's mother, Catherine of Aragon. His main reason for wanting a divorce was Catherine's failure to produce a son. In one of his five subsequent marriages Henry finally got his son, who became Edward VI, and Mary settled into the role of an old-fashioned maiden aunt until she was 38, when Edward died and she became queen. All of a sudden Mary was no longer a confirmed spinster but instead a potential marriage partner much sought after by the crowned heads of Europe, and when Philip of Spain became a suitor, she fell in love with him.

Philip was much like Mary's father. He was a playboy, several years younger than Mary, as Henry had been younger than Catherine, and his interest in Mary, like Henry's in Catherine, was much more political than romantic. Mary convinced herself, however, that it was true love that had led Philip to want to marry her. When, shortly after their marriage, she finally got the message that Philip was only interested in her as the potential mother of a son who would unite their two countries, she at first became depressed, but then the pseudocyesis train of events started up, and she became "pregnant."

Everyone except the Protestants was delighted, and as the months rolled by, hardly anyone suspected that the fetus was more air than heir. Although false pregnancies seldom go to "term," in her case it lasted even longer, as after nine months Mary decided she had miscalculated her delivery date. But eventually came the denouement, which sent Philip off to the continent in a rage, and Mary into a deep depression.

When Philip returned, 18 months later, Mary again became "pregnant," but this time no one took it seriously, and it lasted only two or three months. Again she became depressed; she went into seclusion with one confidante, Jane Dormer, and a short time later she died.

In Mary's case, and perhaps in many cases, pseudocyesis appears to have served as a temporary protection against depression. It did not protect her against her premarital depressions, and it probably, by adding the elements of shame and disappointment, made her subsequent depressions more severe. While mortality in severe depression is usually due to suicide, the cause of Mary's death is not known, and the only account of her death is suspect: it was written by Jane Dormer, her loyal Catholic friend who was about to be married to the Spanish ambassador, and so was unlikely to report anything that might be considered disparaging to Mary.

Mary's attempt to restore Catholicism to England was no more successful than her pregnancies. When she died, her half-sister and successor, Elizabeth the Virgin Queen, promptly restored Protestantism. Elizabeth was the last of the Tudor monarchs, at risk for neither pseudocyesis nor pregnancy.