King Ludwig II of Bavaria, age 18 when he assumed the throne in 1864, was from a family richly endowed with psychotic illness. He became increasingly grandiose, arrogant, and unpredictable in his dealings with his cabinet as he requested enormous funds for building and furnishing vast castles, including the magnificent Neuschwanstein, the model Walt Disney used for his theme parks.
A commission of four psychiatrists, including Dr. Gudden, a professor of psychiatry and one of the early proponents of “no-restraint,” established that Ludwig had “primary insanity” and needed to be removed from office. Initially, the king’s soldiers remained loyal and tended to “overlook” the seriousness of his illness. But when they learned of Ludwig’s sadistic, “preposterous” orders to torture the members of the commission, they became convinced.
The plan was to transport Ludwig to one of his castles, Castle Berg, and create a “one-person mental hospital.” Dr. Gudden would accompany the entourage. Ludwig, prone to suicidal outbursts, seemed calmer once there. Together, Dr. Gudden and Ludwig walked around the castle grounds, which included a scenic path around Lake Starnberg. Suddenly, Ludwig ran toward the lake, and Dr. Gudden ran after him. At least by one historical account, a struggle ensued; Ludwig hit him and held Gudden’s head underwater until he drowned. Ludwig continued farther into the lake until he drowned. He was 40 years old (Alexander, 1954).
This vignette, albeit an extreme example, poignantly highlights certain difficulties of treating a V.I.P.—initial denial and minimizing the seriousness of symptoms by those around him, making exceptions to standard care that would have involved admission to a proper psychiatric hospital, and then implementing a poorly improvised treatment plan that led to disaster—in this case, not only the murder of his psychiatrist but the suicide of the patient.
The first usage of the term V.I.P., according to the Oxford English Dictionary, occurred in the 1930s—a “very........