Medical emergency that rocked the Middleton home

James Middleton has laid his struggles bare in his memoir Meet Ella: The Dog Who Saved My Life.
James, 37, is best known as the brother of the Princess of Wales, Kate Middleton. He’s also become an outspoken mental health advocate.
In his book, the dog breeder gives a rare glimpse into life on the periphery of the British royal family and it is fascinating.
Here’s everything we’ve learned from James’ memoir, which is currently available via e-books, with the paper version due out in Australia later this year.
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Prince George was the first grandchild for the Middleton family, and his entry into the world in 2013 was equal parts historic and dramatic.
James recalls his nephew’s birth and the drama that unfolded in the lead up, discussing sister Kate’s acute morning sickness for “the whole of her pregnancy”.
He said their mother Carole was “looking after her while William was away working as a search and rescue pilot” inside Bucklebury Manor, the Middletons’ family home.
“As the day of the baby’s arrival drew closer, the activity ramped up a notch at Bucklebury,” he writes.
“A stream of visitors came and went.”
It was early one evening, two weeks before the then-Duchess of Cambridge was due, that James received a call from his mum saying there had been an accident.
His beloved dog Ella had given birth to a litter of dogs and pup Zulu, who was also in the car with his mum, had become stuck in a gate and injured.
Between a fire crew, James’ dad Michael and James’s crowbar, they freed Zulu and rushed to the vet for urgent treatment.
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The dog eventually recovered.
James later learned Zulu had bitten his mother while in distress, saying he felt “guilt” over this as his mum had enough to worry about with “Catherine, who wasn’t fully aware of what had happened.”
Catherine gave birth to Prince George and she and William then “packed up their home at Kensington Palace and set off for Anglesey with Lupo in tow.”
Lupo was the black English cocker spaniel James had given the couple, and who has since died.
James writes: “Their life together in their seaside cottage with George seemed idyllic, and I remember thinking: ’I can’t wait to meet someone and have my own family.'”
James and sister Pippa Middleton were late for a birthday party in Kate’s honour, which James explains wouldn’t normally have mattered too much, except it was being hosted by Queen Elizabeth.
“Pippa and I were late for Catherine’s birthday party, which in the normal run of things wouldn’t have mattered too much, but this time the Queen had kindly offered to host the teatime gathering at Sandringham, so it was crucial we arrived on time,” he recalls.
Pippa and James had arrived on an overnight flight from France and were “bleary-eyed and sleepless.”
They drove to the Middleton home from the airport but traffic was terrible, leaving them little time to get ready and leave.
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“I was hopping into my shoes and tucking in my shirt as I raced along the corridor,” he recalls in the book.
“Then I bounded downstairs two at a time and into the room where everyone was assembled for tea, almost running smack into Her Majesty.
“She and Prince Philip had just got up to leave just as I blundered in with Pippa behind me,” he continues.
James had been rehearsing how to greet the Queen during the drive. He knew to say “Your Majesty” for the Queen and “Your Royal Highness” for Prince Philip.
In his panic he mixed them both up, addressing the Queen as “Your Royal Majesty.”
“I heard snorts of laughter and looked past the Queen to see everyone in the room stifling giggles.”
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The Queen was lovely, greeting him warmly and smiled, urging him to have something to eat. The pair had quickly bonded over their love of dogs.
”Whenever we visited Sandringham, the Queen, being a dog lover herself, welcomed Ella, and one year after Christmas, Tilly and Zulu came too,” he writes.
“Her Majesty was always concerned about their well-being.”
James was fortunate enough to spend time with the Queen before her death in 2022 at the age of 96.
He recalls doing a jigsaw puzzle with her one Christmas and the Queen deftly putting the complicated picture together a few pieces at a time while he struggled to match them up.
“It was the sort of activity I’d have enjoyed doing with my own grandparents, all four of whom had died in the space of three years when I was a teenager,” he writes.
“So in a way, I felt the Queen was filling a granny-sized void in my life.”
He said engaging in “this everyday pleasure” was “elevated” by the “extraordinary company” he was in.
“It still feels surreal, the fact that I was there with the Queen: I look back on it with amazement,” he writes.
“She frequently put down five pieces to my one, deft-fingered while I was inept, scanning the board with practised eyes, not even stopping when people came to talk to her, but still chatted as she slotted in the pieces.”
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Once they were finished with the puzzle, it was the Queen who suggested they check on Ella.
He recalls the Queen giving him “modest” but carefully wrapped gifts. That year she gave him a pair of socks and he gave her “a card with a photo of Ella on it and a few jars of my own honey”, produced from his bees.
That year they also discussed beekeeping and Her Majesty knew the work it took to care for the bees and produce enough honey, something he loves to do.
It wasn’t until James was in treatment for his mental health struggles that he was diagnosed with ADD (Attention Deficit Disorder). He also discovered after years of struggling in school that he is dyslexic.
“A bit of me wonders if the undiagnosed ADD was a trigger for my clinical depression,” he writes.
“In everything from relationships to work I have felt like a square peg in a round hole. That’s why I spiralled into negativity, why I approached everything with a profound sense of my own inadequacies.”
He reflects on his school reports, which urged him to apply himself.
“It’s true. I loved chemistry. I found it fascinating. But my mind had to go on that circuitous journey to get the answer that everyone else found immediately,” he writes.
“It was as if my brain was wired differently.”
This “dogged” him throughout school, university and into adult life.
The joint diagnoses of ADD and clinical depression “explains such a lot about me,” he writes.
A combination of traditional therapy and Cognitive Behavioural Therapy (CBT) helped James eventually turn a corner.
His doctor also gave him the book The Gift of Adult ADD: How to Transform your Challenges and Build on Your Strengths by Lara Honos-Webb.
When told to highlight the parts that applied to him, James found it all did.
“It is as if the entire thing has been written just for me,” he writes.
“A window into my complex mind. It all applies to me.”
He buys copies for his family to read and soon enough he feels the “first chink of light.”
“Looking back on my childhood and adolescence now, it all starts to make sense.”
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James was moved by his family’s willingness to help him in any way he needed when he entered treatment for depression. This included family therapy.
It was a few months into his treatment that his then doctor suggested his family be included in his treatment.
“So we start with my parents,” he writes.
“I begin to open up to them, to tell them about the therapy, the problems that began early in my boyhood. They attend two sessions with me but remain bewildered, full of questions I cannot answer.”
He says his parents were left feeling “regret” that they didn’t know how he felt.
“I tell them not to reproach themselves,” he writes. “When I was at school, there was no one to diagnose ADD, no resources; scant awareness of it. How could they have known.”
When his sisters Kate and Pippa arrived, he says they understood “straight away.
“They come to a session with me, and the fact that they are here, wanting to help me, makes me burst into tears.”
“Catherine has already done a lot of work through her mental health initiative Heads Together, and she asks Dr Pereira some pertinent questions,” he writes.
“She understands so much. I’m overwhelmed. I feel such gratitude and admiration for her, for her knowledge and compassion.”
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