COMMENTARY

Raising Psychiatry Up 'From Depths of the Asylums'

Alison M. Heru, MD

December 15, 2020

In "Psychiatrist in the Chair," authors Brendan Kelly and Muiris Houston tell the story of a fellow Irishman, Anthony Clare, MD, who brought intelligence and eloquence to psychiatry. They tell a well-measured, well-referenced story of Anthony Clare's personal and professional life. They capture his eloquence, wit, charm, and success in psychiatry as well as alluding to Clare's self-reported "some kind of Irish darkness."

Dr Anthony Clare

In 1983, I was a young Scottish psychiatrist entering a fusty profession. Suddenly, there was Anthony Clare on the BBC! In "In the Psychiatrist's Chair," Clare interviewed celebrities. In addition to describing his Irish darkness, Brendan Kelly, MD, PhD and Muiris Houston, MD, FRCGP, both of whom are affiliated with Trinity College Dublin, note that Clare said: "I'm better at destroying systems than I am at putting them together — I do rather look for people to interview who will not live up to the prediction; there's an element of destructiveness that's still in me."

I still listen to his talks on YouTube. His delicate probing questioning of B.F. Skinner, PhD, is one of my favorites, as he expertly and in an ever-so-friendly manner, teases out Skinner's views of his upbringing and tags them to his behavorialism. It is this skill as an interviewer that captured us; can psychiatrists really be this clever? Yes, we can. All of the young and hopeful psychiatrists could see a future.

Clare raised psychiatry up from the depths of the asylums. He showed that a psychiatrist can be kind, charming, and sophisticated – handsome and helpful, not the ghouls of old movies. He did what needed to be done to psychiatry at that time: He set us on a footing that was not scary to the public. His vision for psychiatry was to improve services to those in need, reduce stigma, and show the public that there is a continuum between health and illness. He also took on the push for diagnoses, which he felt separated the normal from the abnormal, us from them.

He wrote his seminal work 10 years after graduating from the University College of Dublin. "Psychiatry in Dissent: Controversial Issues in Thought and Practice" was published in 1976, and is still considered one of the most influential texts in psychiatry. Clare "legitimized psychiatry not only in the eyes of the public but in the eyes of psychiatrists too," the authors wrote.

He did not support psychoanalysis and eschewed the rigor attached to the learning of new psychotherapies. He took renowned experts to task, but in ever such an elegant way. He successfully took on Hans Eysenck, PhD, I think because Eysenck insulted the intelligence of the Irish. He had a measured response to the anti-psychiatrists Thomas Szasz, MD, and R.D. Laing, MD, incorporating their ideas into his view of psychiatry. Clare was a social psychiatrist who highlighted the role of poverty and lack of access to mental health services. He stated that psychiatry was a "shambles, a mess and at a very primitive level."

I enjoyed learning about his fight to make the membership exam for entrance into the Royal College of Psychiatry worthy of its name. Clare helped found the Association of Psychiatrists in Training (APIT) and wrote eloquently about the difference between training and indoctrination, which he described as having people fit a predetermined paradigm of how psychiatry should be constructed and practiced, versus education, which he defined as forming the mind.

He highlighted the lack of good training facilities, and teaching staff in many parts of the United Kingdom. When Clare studied candidates in Edinburgh, he found that 70% had no child, forensic, or intellectual disability training. By the time I did my training there, I was able to get experience in all three subspecialties. He opposed the granting of automatic membership to current consultants, many of whom he considered to be "dunderheads." I can attest to that!

In the later phase of his life, Clare likened his self-punishing regime at the height of his hyperproductive fame to an addiction — a fix, with its risk/reward, pain/pleasure kick. He identified fear as being an unacknowledged presence in most of his life. There are vague hints from Clare's friends and colleagues that something drove him back to Ireland from a successful life in London.

Although his wife was described as being fully supportive of him, her words on his tombstone indicate something: What they indicate you can decide. She called him "a loving husband, father and grandfather, orator, physician, writer and broadcaster." No mention was made of his being one of the greatest psychiatrists of his generation.

In 2000, he wrote "On Men: Masculinity in Crisis," about men and the patriarchy, and highlighted the concept of "performance-based self-worth" in men. He stated: "What is the point of an awful lot of what I do. I'm in my 50s. I think one should be spending a good deal of your time doing things you want to do...and what is that? I want to see much more of my family and friends. I want to continue making a contribution, but how can I best do that?...I am contaminated by patriarchy; there is no man who isn't. There is hope for men only if they 'acknowledge the end of patriarchal power and participate in the discussion of how the post-patriarchal age is to be negotiated."

He opined whether it is still the case that, if men do not reevaluate their roles, they will soon be entirely irrelevant as social beings. The value of men is less in income generation but more in cultivating involvement, awareness, consistency, and caring, he stated.

As always with famous and talented people, we are interested not only in their professional gifts to us but in their personal journeys, and the authors, Kelly and Houston have given us this rich profile of one of my lifelong heroes, Anthony Clare. Anthony Clare makes you feel good about being a psychiatrist, and that is such an important gift.

Heru is professor of psychiatry at the University of Colorado at Denver, Aurora. She is editor of "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013). She has no conflicts of interest.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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