Obituary: Professor Anthony Clare
Psychiatrist who probed the minds of public figures on the BBC Radio 4 show 'In the Psychiatrist's Chair'
Anthony Ward Clare, psychiatrist and broadcaster: born Dublin 24 December 1942.
Psychiatric Registrar, Maudsley Hospital, London 1970-72, Senior Registrar 1973-75; research worker, General Practice Research Unit, Institute of Psychiatry 1976-79, Senior Lecturer 1980-82; presenter, In the Psychiatrist's Chair 1982-2001; Professor and Head of the Department of Psychological Medicine, St Bartholomew's Hospital Medical College 1983-88; presenter, All in the Mind 1988-98; consultant psychiatrist, St Patrick's Hospital, Dublin 1989-2007, medical director 1989-2000; Clinical Professor of Psychiatry, Trinity College, Dublin 1989-2000, Adjunct Professor 2001-07; presenter, Men in Crisis 2000; married 1966 Jane Hogan (three sons, four daughters); died Paris 29 October 2007.
The voice of psychiatry to millions in the British Isles, Anthony Clare was best known for his BBC Radio 4 show In the Psychiatrist's Chair, which ran between 1982 and 2001. His interviews with public figures spawned three books of the same name.
He once said that his fascination with the successful was driven by a desire to know how they "survive things that would break some of my patients" and concluded that "when all is lost, they have a talent. They would sacrifice almost everything for a talent."
Although the programme was sometimes accused of prying, Clare countered that "no one has ever complained about being abused on it". His interviewees were well aware of what was in store, he said. "The word psychiatric tells you that what will be talked about will be things like feelings, regrets, memories, emotions, drives. It helps to shift the talk away from all that usual showbiz stuff."
Clare's first major publication had been the 1976 book Psychiatry in Dissent: controversial issues in thought and practice. "Brilliant, timely, well informed and extremely well written," was how the psychiatrist Anthony Storr described the book. Clare said many things that are as valuable today as they were then. In his introduction he asserted that: "Nothing does more to obstruct the progress of psychiatry and obscure its way forward than the readiness to adopt as established truth the frills, the fads, and the fancies of passing intellectual fashion."
"Every diagnosis in general medicine and in psychiatry," he wrote, "is a hypothesis to be tested and refined . . . The clinician, at his best, is a superb observer and organiser of clinical data, and these skills, which have been overshadowed in general medicine by technological achievements, retain their primacy and their force in the everyday practice of psychiatry."
His two chapters on "schizophrenia" are still worth reading now for anyone trying to understand what it is and how it comes about. In an admirable spirit of open inquiry, Clare sympathetically presented views on the matter that he disagreed with. His own view, which still holds true, is that
the validity of the claims on behalf of a causal role for disordered family relationships or abnormal brain functioning or faulty genes, or other possible "aetiological factors" . . . can only be tested if there is some prior agreement as to what clinically constitutes the disorder in the first place.
He also wrote:
It is still not clear whether schizophrenia constitutes a single disorder with a single cause manifesting itself in a variety of ways or whether it is an "umbrella" term which includes several conditions with different causes and deceptively similar clinical manifestations.
He wrote the book at a time when challenges to psychiatry from within the field by R.D. Laing and Thomas Szasz, among others, were influencing professionals and the wider culture. Clare presented their views respectfully and discussed them critically. Clearly he disagreed with the main thrusts of their theses, but his tone was amiable and pleasant, never harsh or strident.
Years later, in 1996, in an introduction to an interview with Laing in the first collection of In the Psychiatrist's Chair, Clare wrote, "We are still too close to R.D. Laing's death to be able fully to assess the ultimate worth and impact of his views. His was a powerful voice in the movement to demystify mental illness and he undoubtedly contributed to the process whereby psychiatry moved out of the large, isolated, grim mental hospitals into acute units attached to general hospitals and into the community . . . He influenced a whole generation of young men and women in their choice of psychiatry as a career." Clare once attributed his own choice of career to Laing's influence.
Among other notable interviewees from that first series of In the Psychiatrist's Chair were the Wimbledon champion Arthur Ashe, the comedian Ken Dodd, the crime writer P.D. James, the director Derek Jarman, the agony aunt Claire Rayner and the television personality Jimmy Savile. Later interviewees included the American psychologist Kay Redfield Jamison, the ex-cabinet minister Cecil Parkinson (who revealed that he regretted the unhappiness he caused to others), the comedian Bob Monkhouse (who said that his mother had not spoken to him for years), the television personality Esther Rantzen (who admitted to insecurity about her looks), and the politician Paddy Ashdown (who spoke about his father's death), among many others. One subject who stood up to Clare's questions was the cricketer Geoffrey Boycott, until Clare eventually asked: "Why did you agree to do the programme?" Boycott replied, "Because my publisher said it would sell my book."
Clare was a persistent critic of Sigmund Freud and of psychoanalysis, though his criticisms were not new. He regarded Freud as "a religious prophet speaking in a secular language". In a 1985 two-part newspaper essay about psychoanalysis, he remarked on the fact that "patients selected for psychoanalysis are very much healthier and more socially capable than patients treated otherwise". He referred to a study that pointed out that more than half the patients in psychoanalysis in the United States were either themselves practising psychiatrists or psychologists, or were their wives, husbands or children. He said about psychoanalysis that "the overwhelming majority of reported cases involve patients suffering minor degrees of psychiatric ill-health or people who are not patients at all. This high degree of selectivity has largely been ignored by psychoanalysts and their supporters."
Clare commented that in psychoanalysis, "the allegedly 'free' communications of the patient are strongly influenced by the values and expectations of the analyst". He continued:
The smallest expressions on the analyst's face have been shown to act as significant cues. In addition, as Freud himself admitted, the memories of patients are "shaped" so as to conform to psychoanalytical theory. If the patient disputes that analyst's explanations, he is demonstrating the well-known defence-mechanism of "resistance". If he accepts, he is confirming the validity of the basis of psychoanalysis.
Clare first came to public prominence on Radio 4's Stop the Week programme in the 1970s. He hosted a feature on the show in which he interviewed various high-achievers about their past; when one of his patients complained that his subjects seemed too perfect, Clare decided to delve deeper and In the Psychiatrist's Chair came about.
Among Clare's other books were Depression and How to Survive It (1993, co-written with the comedian Spike Milligan), and On Men: masculinity in crisis (2000). He said about men that "there's nothing more irresponsible than the untethered man". He regarded his own parenting skills as "good enough", but said that his "family had to put up with quite a lot". He spent years working hard to gain his professional credentials and said that he consoled himself, when he looked at his eldest children, that they had survived "despite" him rather than because of him.
He was born in Dublin on Christmas Eve 1942, the youngest of three children and the only son of Bernard, a state solicitor, and his wife, Mary. Anthony was a Jesuit pupil and altar boy committed to the Catholic Church. Beginning in the 1960s this belief slowly disappeared, and he later, in a 2001 interview, came to call himself an agnostic. "I can't really believe in a god that can suddenly and haphazardly intervene during one moment in history, causing air crashes, genocide and famine," he said, though he admitted to missing "the theatricality of the Catholic Church".
He was educated by Jesuits at Gonzaga College and then was a student at University College, Dublin, from where he got his medical degree in 1966. After training in psychiatry in St Patrick's Hospital in Dublin, he moved to the Institute of Psychiatry and the Bethlem Royal and Maudsley Hospital in London.
In 1966 he married Jane Hogan, whom he met while she was studying for an MA in medieval English. They had three sons and four daughters over the course of about 18 years. The family returned to Ireland in 1988 where Anthony Clare became medical director of St Patrick's Hospital and Clinical Professor of Psychiatry at Trinity College, Dublin.
In 1993 the Clare family was traumatised when, on a summer's day, two young men broke into their home armed with a pool cue, a machete and a hockey stick. They took rings from Jane's fingers and a necklace from her neck before tying her to a chair. They locked one of the Clare daughters, as well as Clare's secretary and her daughter, into a wardrobe. The secretary jumped to her death from a bridge four days later. Clare himself had gone past the house at the time without realising what was happening. He later described his wife as a "formidably capable woman" and said that, had he been there, he "would have made matters worse".
After two terms as medical director at St Patrick's Hospital, Anthony Clare moved to St Edmondsbury Hospital in Lucan, Co Dublin, a unit of St Patrick's. At the time of his death, he had been due to retire.