Professor Anthony Clare - Four Books

Professor Anthony Clare

I have always had a particularly deep interest in psychology, psychotherapy and psychiatry, mainly inspired by my having been diagnosed with clinical depression of the unipolar variety exactly 27 years ago this month.  That diagnosis coincided with my having to recuperate in a psychiatric hospital for seven weeks.  Thankfully, in the interim, I have never had to reacquaint myself with the interior of any such institution, as my experience of the psychiatric service was thankfully a good one.  Needless to say, such is not the experience of many sufferers of mental illness.  I have read many books over the years in the areas enumerated above, but one amazing Irish psychiatrist, scholar, humanitarian and brilliant communicator and populariser of his profession stands out for me, and that is Anthony Ward Clare.

Professor Anthony Clare (1942 – 2007) was an Irish psychiatrist and a presenter of radio and television programmes. He presented the ground-breaking radio series In the Psychiatrist's Chair, an interview and discussion show on the guest’s philosophy and psychology of life, which aired on BBC Radio 4 between the years 1982 and 2001.  You can access recordings of these interviews here: Psychiatrist's Chair  Over the course of the programme, Clare spoke with hundreds of well-known figures, ranging from Spike Milligan to Anthony Hopkins, Barbara Cartland to Joanna Lumley. A judicious selection of those interviews was also published in three volumes by Chatto & Windus. Clare held an M.Phil. and doctorate (M.D.) in psychiatry and was a fellow of the Royal College of Psychiatrists.  He did most of his training in England. 

In today’s post, I wish to review some four books by, or about, Dr Anthony Clare: (i) His most scholarly book, Psychiatry in Dissent: Controversial Issues in Thought and Practice, written when he was only 34 years of age, Second Edition, 1980, Routledge; (ii) Depression and How to Survive It, which he co-authored with Spike Milligan, Arrow Books, Random House, 1994; (iii) In the Psychiatrist’s Chair III, Chatto & Windus, 1998; (iv) Psychiatrist in the Chair: The Official Biography of Anthony Clare, Brendan Kelly and Muiris Houston, Merrion Press, Newbridge, 2020.

Psychiatry in Dissent (1976)

Described at the time by the English psychiatrist and widely-published author Anthony Storr as “the best modern survey of psychiatry as it is at present practised in Britain,” this book still rates highly today in the history of psychiatry as Clare argued eruditely that the way forward for his medical specialty could only be through the rigorous evaluation of new theories and treatments, along with a truly eclectic and open-minded approach to the understanding and management of mental illness.

Psychiatry in Dissent was a ground-breaking and prescient book when it was published by describing in as broad and as comprehensive a way as possible the controversial topics of mental illness, a deep analysis of schizophrenia, an insightful discussion of the notion of responsibility, the various physical treatments available in psychiatry, including the controversial use of Electroconvulsive Therapy, and indeed the then position of mental health within the medical health services.  All the while the author goes to pains in seeking to explicate the scientific underpinning of his whole endeavour. 

As this is more of a textbook for students of psychiatry and a reference book for those of us interested in mental health and its preservation, I will confine myself to reviewing one chapter only in this classic evaluation of the then state of psychiatry in 1976, with an expanded and updated edition in 1980.  The chapter that grabbed my attention is “The Concept of Mental Illness” (p. 1 – 37) as it is the broadest and most essential concept, and one that will be of most use to the general reader.  I also found the chapter on diagnostics exceptional, and I will leave it to those with a deeper interest in psychiatry to search out the book themselves and read it.

Clare’s first chapter is an attempt at a definition of what a mental illness actually is in the first place.  Indeed, he points out that there have been attempts to abolish the concept altogether.  He further indicates that the various descriptions of the psychiatric/psychotherapeutic endeavour in use give a good indication of differences in approach and theory espoused by each.  For instance, the use of the term “patient” obviously implies a medical model, while the use of the term “client” refers to a counselling approach, while the historical use of “deviant” would refer to a criminological perspective.  Clare then proceeds to give a very clear account of the “anti-psychiatric” movement, namely that spearheaded by the psychiatrist Dr Thomas Szasz.  In 1976, Clare saw this as demonstrating to the public “the apparent ideological chaos within psychiatry.” (p. 3)

Clare carefully describes the evolution of the term “disease” and even quotes a felicitous term from the French philosopher Michel Foucault, namely the “medical gaze.”  Now this “gaze” itself has evolved from simply external observation to an elaborate internal observation today. There then follows an account of the development of microscopes and other complex medical equipment at the time of writing (1976 – 1980). One of the consequences of viewing a disease as “a lesion” (physical defect) has been “the tendency among some psychiatrists to ground mental phenomena…. on a foundation of …. biochemistry and pathology.” (p. 6) He then asserts that there has been a growth in “the naïve belief that psychic disease is brain disease.” (p. 7) In other words, a reductionism of the psychic world to that of the physical or material one solely.  Clare, being ever that comprehensive and broadminded scholar, contends that the ideal for the psychiatric profession is “an ideal unity of soma-psychic reality.”  In short, therefore, in the treatment of patients, there should be an approach from the opposite but complementary perspectives of medicine and its associated physical sciences (somatic approach) and that of psychology and its associated behavioural sciences (the psychic approach).  Over the course of the chapter, Clare outlines many of the contentious and fuzzy definitions, if not in some cases a total lack of definition of mental health, even quoting the Rosenham Study (1973) that the diagnostic process in psychiatry was useless as “we cannot distinguish the sane from the insane in psychiatric hospitals.” (quoted, p. 14) I cannot say that I have understood all the cases and theories, Clare describes in this chapter. Still, I certainly grasp the goal of his arguments, namely that mental illness is a complex reality indeed, and one that has to be approached from as broad a perspective as possible.  I learned also, indeed, that ill health is the general state of poor health, while disease is a specific, diagnosed abnormal condition with recognisable signs and symptoms, often having a biological or physiological cause. For example, a person can have a disease without feeling ill (e.g., having undiagnosed high blood pressure), but the subjective experience of symptoms like pain, fatigue, or weakness is what constitutes ill-health.  Both the medical model (what he calls the somatic approach) and the psychological/psychotherapeutic one (what he calls the psychic model) are both needed to tackle the complexity of the human personality.  In all of this, Clare acknowledges that the social context of the client also plays a considerable role. 

I was also inspired by his assertion of a continuous spectrum between Madness/Insanity on the one hand and Soundness of Mind/Sanity on the other.  He gives a brief sketch of this broadly held view from British psychiatrist John Connolly who in 1830 attacked those medical men who sought “a strong and definable boundary between sanity and insanity”, and more recently Dr Ronald Laing, who stated that the ascription of “madness” to patients was “a gross travesty.”  Seeing mental health as a fight between opposite poles without a complex spectrum in between is a gross oversimplification.  These are my words, not Clare’s.  His preferred expression for this mistaken approach is “dichotomising.”  “It is probably a mistake to conceptualise normality and madness as dichotomous…. Rather, they are best thought of as opposite ends of a continuum, a continuum on which most of us find ourselves positioned in that grey and shady area between the two opposing poles.” (p. 32)  

Depression and How to Survive It (1994)

I bought this book the year after I was diagnosed with clinical depression (thankfully, depression of the unipolar variety only) and found it to be a riveting and absorbing read.  Having interviewed Spike Milligan for his popular radio programme In the Psychiatrist’s Chair in 1982, Clare was amazed at Milligan’s clear account of his forty years with bipolar depression (commonly known as manic depression).  Some years later, Professor Clare realised that he had found a most suitable candidate who would help him illuminate and describe the mysterious nature of mental illness, which he had comprehensively explored descriptively and scientifically in our first-named book above.  In the case of this book, he was to investigate the mysterious and sometimes terrifying illness that is clinical depression.  This is obviously a book for the general reader, which is crammed on the one hand with information, clear definitions and on the other with an account of the existential experiences of bipolar depression by a very articulate sufferer, the comedian, author and entertainer Spike Milligan. Clare outlined some basic statistics like the following: in 1994, the U.K., with a population of around 58 million, had about 4 million sufferers from depression, that is 1 in every 15 people when rounded up decimally.  Today’s figure given on Google for the U.K. is 7.5% or 7.5 per 100, which, according to my calculations, is 1.125 in every 15, just a little more than Clare reported.  Again, the professor supports an eclectic and comprehensive team approach to the treatment of depression: (i) physical drugs and ECT, (ii) psychological, which includes psychotherapy of various approaches, especially CBT and (iii) the social developmental approach that includes courses on personal development and decision making, and occupational therapy and so on (see p. 5). 

Clare is quick to dismiss myths about depression, myths which state that it is a mild disorder, that it is not life-threatening and that it is untreatable.  In fact, he underlines that it is the very opposite of each of these myths.  He quotes the Pulitzer Prize-winning novelist, William Styron, a sufferer from this disease like Milligan: “It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode.”  Clare continues by stating that “during the time it took to write this book, Spike Milligan suffered a severe attack of depression…. For over a year, he remained depressed and anxious, lacking motivation…. This episode was particularly resistant to various forms of treatment – hospitalisation, drugs, ECT, reassurance and counselling.” (p. 6).  I read these insights from the doctor and the patient with both interest and sympathy as a counterargument to Dr Tony Bates in Breaking the Heart Open in my last review.  No one book or no one doctor, like no one human being or approach, has all the answers.  A learned man I once knew always quoted the saying, often attributed variously to Thomas Aquinas or Friedrich Nietzsche in different forms, which goes: “Beware the man who has only read one book.” This saying means that this person may have a very narrow viewpoint and an inability or unwillingness to understand different perspectives.  So, it warns us against people with a single, narrow view of the world.  In fairness, any good scholar will take into account opposing viewpoints, too, to sharpen his understanding and the nuances of his own approach.

This book is an excellent handbook for the sufferer of depression and for any family members of that patient.  Chapter one gives an extensive and full case history and a comprehensive account of the presenting problem of manic depression of the patient named Spike Milligan.  It also presents the existential situation of the suffering patient, which allows Clare to substantiate his theoretical and clinical findings. His psychiatric report includes personal history, family history, school and occupational history, psychosexual history, medical history, psychiatric history, personality, behaviour, speech, mood, thought content and so on.  Under the heading of perception, Clare informs the reader that the patient is clearly in touch with reality; that is, the patient shows no psychotic symptoms.  This is an important point as psychosis refers to a loss of connection with everyday reality.  Such can happen in the manic phase of bipolar disorder, but not usually in the depressed phase. (p. 15) This first chapter also gives a clearly documented account of the experience of Mr Milligan: “I have got so low that I have asked to be hospitalised and for deep narcosis [sleep].  I cannot stand being awake.  The pain is too much.  I have had thoughts of suicide…. Something has happened to me – the vital spark has stopped burning….” (p. 15)

Seriously depressed individuals report an overall deadening or flattening of sensations.  All five senses become distorted for the worse.  For example, food becomes tasteless, sounds may become magnified and intrusive (both of which I experienced myself, but for a short time only, thankfully).  Milligan found that colours actually drained from everyday life, leaving him in a very grey and depressing world indeed.  He describes a “terrible emptiness,” and when an episode of depression suddenly hits him, “it is like a light switch.  I feel suddenly turned off” (p. 16 – 17).  Again, with Spike Milligan, I also experienced, though thankfully for only a few weeks ever, “the most distressing feature of depression, the complete evaporation of feelings.” (p. 19) Overall, one can only have the deepest of sympathy for the mental pain experienced for so long by Mr Milligan and his sustained feeling of brittleness in an apparently wholly uncaring world.

There is so much useful information in this book that I could go on far too long in singing its praises.  Already, I have exceeded the normal length of my usual reviews. Chapter two describes depression from as broad a perspective as possible, with a clear and readily understood diagram on the continuum of possible moods that range from severe mania at one side of the curve to severe depression at the other.  Clare explains what moods are and how they change, the symptoms of depression (both polar and bipolar) in detail, and how a depressive episode can be described as a slowing down of the energy of the patient or agent, while a manic one can be described as a speeding up of that energy. He explains clearly the difference between a hallucination and a delusion, which I found insightful.  A hallucination is a sensory perception in the absence of an external stimulus to the sense organs.  Delusions are where the patient or agent becomes convinced that others are trying to harm them, damage their reputation or even kill them.  There are chapters on the causes of depression (quite scientific but worth the effort of understanding) and a very instructive one on the treatment of depression, which is very comprehensive.  The latter chapter is widely eclectic: it ranges from discussing the various types of psychotherapeutic interventions to psychiatric treatment with various drugs, mainly antidepressants and the controversial ECT.  Clare finishes the book with a useful chapter on how to cope and provides a comprehensive reading list.  In short, this is an instructive and useful read, a treasure trove for anyone recently diagnosed with clinical depression or for their close family members.

In the Psychiatrist’s Chair III, 1998

Without a doubt, Anthony Clare was the best-known psychiatrist of his generation. His BBC Radio 4 show, “In the Psychiatrist's Chair,” which ran from 1982 to 2001, brought him international fame and changed the nature of broadcast interviews forever. Famous interviewees included Stephen Fry, Anthony Hopkins, Spike Milligan, Maya Angelou and Uri Geller.  Some thirty interviews are at present made available online at the BBC webpage, though I notice that the interview with Jimmy Saville has not been uploaded yet. All of his interviewees yielded much private information about themselves to Clare's inimitable, gentle, yet probing style.  The interview with Saville is not in the volume of selected interviews I have at my disposal, but I remember reading it somewhere online, and I found that the interviewee was exceedingly evasive, as one would expect from the then undiscovered sexual predator.

In short, the transcripts of the interviews in Volume three, the only one of the three books I have, make for very interesting and stimulating reading.  One learns about the gentle, authentic and probing style of an expert listener and astute interviewer, and one receives no little insight into a psychiatrist’s mind.  If you are interested in what makes the interviewee tick, this is the book for you, or better still, listen to the recordings at the above link.  You will not be disappointed.  The interviewees in my chosen volume include war correspondent Martin Bell, academic Sir Kenneth Dover, actor Stephen Fry, and the classical violinists Nigel Kennedy and Yehudi Menuhin.

The war correspondent Martin Bell, a man of his time, shows a dispassionate "stiff upper lip attitude" to revealing his feelings about how shocking the effects of war have had on him.  That response, of course, may also be the result of his training as an objective journalist: “I’m paid to be a witness.  I’m not paid to tell people what to think or feel.” (p. 17) Interestingly, given the current situation in Gaza, Bell stresses the point that it was his contact with genocide that had the most profound impression on him: “One of my great heroes is Eli Wiesel…. One of the points he makes is that the culpability not only lies with the hatred that makes it [genocide] happen, but with the indifference that lets it happen. (p. 16 -17).  Again, the following statement from Bell is enlightening: “I don’t like emotion out of control… In television a lot of the time I just shut up because the pictures are so powerful and the sounds that go with them.  I call it the art of writing silence.” (p. 18) Or again, one can feel how incongruous, disturbing, and confounding would be the experience of a returning war correspondent or soldier from the stress of battle when they encounter the minor concerns of home, be it how the winner of the National Lottery can cope with life after a major win, or a disputed right of way over a field in a rural location.  As a result, Bell often asks himself the question: Which one is the real world?  Interesting, also, that while he does not deny shell shock or PTSD, he has always refused debriefing, counselling or therapy.  He prefers, he tells us, “to talk it out among ourselves.”  He admits that such an approach is denounced as “blokedom” and is not liked at all. 

The late politician Tony Benn’s interview is uplifting in its positivity towards life and the possibility of changing the world for the better.  Back in the early 1990s, here is this politician’s diagnosis of the political situation: “Things are still shifting to the right because fear is a great instrument of popular control and if you can frighten people, they’ll do what you tell them.  I try to give people confidence in themselves.”  His discussion on the relationship between Church and State is illuminating, and he criticises the established church strongly for its patriarchal and hierarchical language.  His views on the Church and its place within society and culture are interesting, while he seems to dismiss mysticism as evasion of active involvement to improve the conditions of our fellow human beings.  I will finish with Tony Benn’s insight into leadership which derives from the Chinese philosopher Lao-tzu: “As to the best leaders, the people do not notice their existence, the next best the people honour and praise, the next best the people hate, the next best the people fear but when the best leader’s work is done, the people say, we did it ourselves.” (p. 55) All of the interviewees share considerable knowledge and wisdom with the reader, or better still with the listener.  You probably will not readily find this book or its two predecessors, so the online originals will most definitely be the better option.  I wish you good listening. 

Psychiatrist in the Chair: The Official Biography of Anthony Clare, 2020

This is a painstakingly well-researched biography written by Brendan Kelly, Professor of Psychiatry at Trinity College Dublin and Muiris Houston, Adjunct Professor of Narrative Medicine at Trinity and a long-standing medical writer and health strategist.  It is unsurprising, then, that the endnotes run to some thirty pages and are meticulously detailed.  They also append an equally detailed chronology of Professor Clare’s life as well as a bibliography of books authored solely by him, books co-edited by him, book chapters from his pen and an exhaustive list of articles written for both the Medical Press and Popular Press. This bibliography runs to some twenty pages.  On top of all that, there is a fine index.  What makes this a wonderful biography is that his wife and children were interviewed, and this gives the book a solid grounding that allows us to acquaint ourselves with the real family man that he was as well as the academic and public persona which we encountered in the media.  

What comes across to the reader is the amazing energy of Professor Clare from his earliest days at school.  He was always highly gifted verbally as well as intellectually.  He wrote for his school magazine at the Jesuit-run Gonzaga College, where he also participated in debates as well as acting in many plays.  He learned much, which he was later to put into practice in his life, from the formative influence of his teacher and life-long mentor, Fr Joseph Veale, SJ: an intense engagement with public debate, profound curiosity about human nature, coupled with an endless desire to understand and help others.  Most of all, Veale’s greatest gift to the young Clare was an undying love for words, both spoken and written. At university, he acquitted himself at the top of his class academically as well as involving himself wholeheartedly in debating with the University College Dublin, Literary and Historical Society, with which he went on to win the Observer Mace Trophy in 1964, accompanied by fellow debater and lifelong friend Patrick Cosgrave. 

His wife Jane, whom he met at college, revealed that Clare had a strained relationship with his mother, who “wound him up, in every sense of the word, and set him off to prove his worth to her and thus to himself.   She so injected the instability and conditionality of her approval into his core that he was condemned to a life of performance-generated self-esteem.” (p. 24).

Clare chose psychiatry as it was arguably the most verbal of the specialities.  His daughter, Rachel, concurs: “Dad was drawn to psychiatry because it involves personal narrative, and with Freud, storytelling.” (p. 18) In London during his early training in psychiatry, he became chairman of APIT or the Association of Psychiatrists in Training and achieved much for the rights of young doctors entering the profession.  In this, he showed his courage to stand up for what he believed was right, even if it meant challenging authority.  Also, he was gifted insofar as he could voice his strongly-held disagreements in relatively good humour.  He had learnt much from Fr. Veale: one stuck to the argument and never attacked the person.  In other words, “argumentum ad hominem” could never be entertained in good debate.

Again, Clare was to write a lot for the prestigious medical journal the Lancet, and even as early as 1972, it was remarkable for someone at such an early stage in his training to have been published in such a prestigious journal.

In all of this, the reader will pick up how driven Professor Clare was throughout his whole life.  In short, he was a workaholic.  Indeed, in his later life, he was to liken his self-punishing regime to an addiction, a fix, with its risk/reward, pain/pleasure kick.  He even identified fear as being an unacknowledged presence in his life. He lived his life in a constant rush, always writing and publishing, doing research for his radio and television programmes while at the same time holding down a job as director of the prestigious psychiatric hospital St. Patrick’s, Dublin.  His friend Ruth Dudley Edwards recalled that “Tony was always the star of things, but he did live very much on his nerves.” (p. 47).  He was also a great provider for his family, she further stated, and worked prodigiously to provide his seven children with private schooling.  Another friend, Robin Murray, remarked: “Tony was always late because he was doing so many things.  He was always rushing around from one thing to another.” (p. 48)

While there is so much about psychiatry and the insightful and ground-breaking contributions Dr Clare made to the growth of his profession and to the ongoing care of psychiatric patients in this book, further commentary here is not needed into so rich and productive a life.  Anyway, I have perhaps written a little too much here on my obsession with mental health.  In conclusion, Dr Clare’s many plans were cut tragically short when he died suddenly of a heart attack in Paris, on the 28^th of October 2007 at the age of 64, as he and his wife Jane were travelling home from Sardinia.  His daughter Rachel lovingly observed that “Dad was a terrible coward about medical interventions…. He was a bit hypochondriacal …. Illness happened to other people…. He was too tough on himself physically, living in the way he did, on adrenaline.” (p. 199).  In a sense, it is encouraging for us lesser mortals, if not somewhat sad, to note that even our heroes have their personal fears and failings.  Thus, died tragically young a psychiatrist who did more than anyone of his generation to improve the public understanding of psychiatry.