Books: Psychiatrist in the Chair: the Official Biography of Anthony Clare

Anthony Clare (1942–2007) was one of the leading psychiatrists of his generation. I first became aware of him in the 1990s through his popular radio show, In the Psychiatrist’s Chair, in which famous figures submitted to his gentle yet probing questioning and revealed aspects of their lives and personalities that proved fascinating to listeners. However, there was so much more to Clare, the physician who can be credited with demystifying the practice of psychiatry, and who recognised the enormous burden that psychiatric ill-health placed on general practice.

In this informative biography, based on a wealth of public and personal correspondence, publications, and interviews, Brendan Kelly and Muiris Houston swivel the psychiatrist’s chair round to focus on the man behind his achievements.

Born in Dublin, Clare’s early flair as an orator and debater was encouraged by Father Joseph Veale, the Jesuit priest who taught him at Gonzaga College. He went on to study medicine at University College Dublin, where he met his wife Jane.

After graduation he completed an internship in Syracuse, New York, then undertook psychiatry training at St Patrick’s Hospital, Dublin. This led to a registrar post at the Maudsley Hospital, London, in 1970, and in 1983 he was appointed Head of Psychological Medicine at St Bartholomew’s Hospital (Barts), London.

It is the intervening years, however, which interested me most. In 1976, while undertaking a 6-year post in the General Practice Research Unit at the Institute of Psychiatry in London, Clare wrote Psychiatry in Dissent: Controversial Issues in Thought and Practice.¹ This seminal publication was groundbreaking in terms of Clare acknowledging and addressing the diagnostic dilemmas inherent in psychiatric classification, in defending psychiatric practice against its critics, and restoring psychiatry’s credibility in the eyes of the media and general public.

This was one of his most prolific periods, completing an MD thesis titled Psychiatric and Social Aspects of Premenstrual Complaint and co-authoring and editing many publications including Psychosocial Disorders in General Practice, the latter emphasising the centrality of the GP in detecting psychiatric illness.

At a 1982 Oxford conference on mental health attended by GPs, psychiatrists, and other disciplines, including social workers and health visitors, he conducted an exercise in which a GP video consultation of a 44-year-old woman with symptoms of depression and other problems was shown to attendees. Of the 136 participants who responded to three key questions about the video, 70% of the GPs made a tentative or definite diagnosis of depression or anxiety, compared with 58% of psychiatrists; 32% of GPs advocated a ‘reassurance, wait and see’ approach, compared with 22% of psychiatrists; and 15% of GPs disapproved of the way the consultation was handled, compared with 32% of psychiatrists.²

This conference and the resultant book Psychiatry and General Practice, co-edited by Clare and Malcolm Lader, were pivotal in stressing the importance of the consultation in general practice and in highlighting the value of the primary care team.

I read this biography in a circuitous fashion, pausing between chapters to listen again to Clare’s radio programmes, which are still available on Radio 4 Extra.³ His interviews with Maya Angelou, Stephen Fry, Barbara Cartland, Gillian Slovo, RD Laing, and many others are moving, compelling, and a joy to hear. Each episode is a masterclass in consultation technique. Clare sometimes reveals aspects of his own character in these programmes, such as how he makes sense of his own identity, a question addressed admirably in Kelly and Houston’s book.⁴

Clare died of a heart attack at the age of 64. He was first and foremost a family man, married for 40 years and father of seven children. His epitaph, by his wife Jane, records him as ‘a loving and beloved husband, father and grandfather, orator, physician, writer and broadcaster’. These roles are reflected in the photographs in the book, which accompany the detailed text.

His eldest daughter Rachel said, ‘he had a moral compass. He understood shades of grey’,⁴ reminding me that he thought it unhelpful ‘to conceptualise normality and madness as dichotomous and better to see them as points on a continuum’.¹

Professor Sir Simon Wessely, former President of the Royal College of Psychiatrists, described Clare as ‘a kind man, a superb teacher, literary, well-read, and with a sense of humour … [he] was the kind of person you so look forward to meeting’.⁴

I felt a curious sense of loss on finishing this book. How I wish I had met him.

• © British Journal of General Practice 2020