Clare, Anthony Ward (1942–2007), psychiatrist and media personality, was born 24 December 1942 in Dublin, the youngest of three children (two girls and a boy) of Bernard Clare, state solicitor with the land registry, and his wife Agnes (née Dunne). Clare recalled his father as a gentle romantic and a fairly straightforward person, whereas his mother was passionate, frustrated, and had an explosive temper. Clare believed that he inherited much of her personality and that his interest in the psyche partly derived from his efforts to understand her.
Early life and education
Clare was educated at Gonzaga College, Dublin – he was particularly good at English and edited the college newspaper – and UCD, where he distinguished himself as a debater known for his wit and verbal fluency; he was auditor of the Literary and Historical Society (1963–4), and won the prestigious Observer Mace debating trophy (with Patrick Cosgrave (qv)). He had decided to study medicine when convalescing in hospital after a teenage accident.
In his youth Clare was a devout catholic; he believed his mother had hoped he might become a priest, and observers often thought there was something priestly about his mannerisms and professional approach. His religious commitment, however, was weakened both by the critical thinking skills inculcated at Gonzaga and by Anglo–American pop culture. Although Clare always respected his Jesuit teachers – he was particularly influenced by Fr Joe Veale (qv), his English teacher, who sought to give his pupils an ideal of service – in the 1960s he published articles criticising restrictions on religious discussion at UCD and attacking Pope Paul VI's 1968 encyclical on birth control. At some point in his twenties Clare abandoned belief in catholicism because he could not believe in a God who intervened at certain points in history but nonetheless permitted random disasters and suffering. In later life Clare described himself as an agnostic.
After graduating from UCD in 1966, Clare married Jane Carmel Hogan, daughter of Gabriel Patrick Sarsfield Hogan (qv); he met her in 1961 in her first year at UCD where she was studying for a BA in English. They had three sons and four daughters; Clare described Jane as his 'rock' on whom he was 'utterly dependent' (Ir. Times, 27 July 2000). They had a strong, sometimes combative personal and intellectual relationship (for example, disagreeing in public print about whether the legalisation of divorce in the Republic of Ireland was desirable).
Clare attributed his decision to specialise in psychiatry to the influence of Norman Moore, professor of psychiatry at TCD; he was also challenged and intrigued as a student by the early work of R. D. Laing (1927–89), notably The divided self (1960), with its emphasis on the patient as a person rather than simply an object of medical intervention. During an internship at St Joseph's psychiatric hospital in Syracuse, NY, USA, in the year after his marriage, Clare came close to a nervous breakdown.
Medical career in Britain
After initial training at St Patrick's Hospital, Dublin, Clare moved to Britain in 1970 as he wished to do research. He and his wife were determined that their children should be Irish rather than British, and initially intended to stay for only a few years. Shortly after his arrival in Britain, Clare wrote an article for the Irish Times contrasting the government-funded British National Health Service with the polarisation between public-patient squalor and private-patient comfort that he had witnessed in Irish hospitals, and criticising the view (widespread among Irish doctors) that the Irish system was less demoralising and more respectful of patients because it expected them to contribute to the cost of their treatment (Ir. Times, 7 January 1971).
Serving as psychiatric registrar (1970–72) and senior registrar (1973–5) at the Maudsley Hospital, London, Clare produced a steady stream of research papers in the British Medical Journal and elsewhere on topics such as alcoholism and premenstrual tension. (In his whole career, Clare published over 100 research papers.) He was awarded an MD for a dissertation on premenstrual tension and an M.Phil. from the University of London for a 1974 dissertation on psychiatric illness in an immigrant Irish population. (His research led him to question the view that the Irish had a particular genetic or socially generated susceptibility to schizophrenia.) Clare was later a patron of the charity Immigrant Counselling and Psychotherapy, working mainly among the Irish community in Britain. In 1980 he received a Ph.D. from UCD for a dissertation on 'The psychiatric and social aspects of premenstrual tension'.
Clare was a researcher (1976–9) and senior lecturer (1980–82) at the Institute of Psychiatry, London, before becoming professor and head of the department of psychopathological medicine at St Bartholomew's hospital (with a weekly round at Hackney hospital to keep in touch with the realities of life at the medical coalface). He found time to campaign for better treatment of trainees, founding the Association of Psychiatrists in Training.
In 1976 he published Psychiatry in dissent, an overview of the basic assumptions and debates of the discipline for students and general readers. This was the first systematic attempt by a professional psychiatrist to address – rather than simply dismiss – the criticisms of the discipline by 'anti-psychiatrists' such as Laing and Thomas Szasz (1920–2012). Clare argued that many of the criticisms made by the anti-psychiatrists were misconceived: e.g., some Laingians suggested simultaneously that mental illness did not exist and that it was universal; Clare accused Szasz of using debating tricks – something to which Clare, as a skilled debater, was particularly sensitive – to support questionable theories such as the views that suicide was always a free decision, the mentally ill were simply playing games, and no condition could be considered a disease unless it was shown to have a biological basis. He maintained that such criticisms lost sight of the genuine suffering caused by mental illness and rested on oversimplified concepts of the diagnostic process, but had nonetheless highlighted many genuine flaws in psychiatric practice (such as the 'warehousing' of patients in institutions). Clare highlighted the tension between psychiatric approaches derived from medical practice (starting with the physical and mental suffering of individual patients) and those derived from social work (highlighting the mental-health effects of social problems, which tended to be downplayed by the medical model and highlighted by anti-psychiatrists). Clare advocated an eclectic pragmatism based on a sensitive and open-minded diagnostic process rooted in concern for the patient, a model that was to be the guiding spirit of his own practice. Many younger psychiatrists subsequently credited the book, and Clare's media work, with inspiring their commitment to the discipline.
Clare's later academic books included: Psychosocial disorders in general practice (1979); Let's talk about me: a critical examination of the new psychotherapies, co-written with Sally Thompson (1981); Social work and primary health care (1982); and Psychiatry and general practice (1982). None had quite the same impact as his first title, partly because they tended to be compiled from pre-published research material rather than conceived as books. Lovelaw (1986) discussed marriage, childbearing and divorce for a general audience.
Journalist and broadcaster: In the psychiatrist's chair
Clare was a compulsive writer; even while working in Ireland, he had been a regular contributor to such publications as the Irish Medical Times, the Irish Times and Hibernia. In Britain his involvement in journalism was driven both by his desire to educate the general public on psychiatry and by the need to provide for his growing family. (Clare later recalled that at the time he was somewhat dismayed by Jane's fertility.) Patrick Cosgrave recruited him to write for the Spectator, and he also became a regular contributor to the social policy magazine New Society. The ability to discuss complex concepts in everyday language in these periodicals brought him to the attention of BBC producers, and when they discovered him to be articulate and verbally fluent he became a regular participant in radio conversation programmes such as Stop the week, Start the week and Midweek. A regular feature on Stop the week, in which he asked prominent high-achievers about their pasts, was the genesis of his best-known media presence. Clare always claimed that his journalism made him a better psychiatrist (possibly by its pressure for clarity). In 1984 he told Maeve Binchy (1940–2012) that when the British Medical Association was asked to comment on psychiatric matters its characteristic response was to give out his phone number (Ir. Times, 31 May 1984).
Clare was particularly associated with the BBC Radio 4 programme In the psychiatrist's chair (1982–2001), in which he interviewed celebrities about their personality traits. Clare sought to get beneath the typical celebrity interview (often geared to promoting the interviewed subject) and to show that the successful might have some of the same darknesses and problems as more apparently ordinary people, but had worked out how to cope with them. Although very popular, the series provoked a certain amount of controversy: Clare was accused of misusing his professional skills and exploiting the subject's and the listener's belief that his training gave him the ability to uncover interviewees' secrets. He replied that the programme format was not comparable to genuine psychiatric treatment, but acknowledged that some interviewees did behave as if they were in a therapeutic situation; he also stated that the title was not chosen by him but by the producer, Michael Ember – Clare would have preferred 'What makes you tick?'. A television series on the same model, Motives (1982), was less successful. (Clare thought that viewers were distracted by paying attention to an interviewee's facial responses, and that the bustle of a television studio disrupted the sense of intimacy between interviewer and subject.) Four books of interview transcripts (with Clare's commentary) were published (1984, 1992, 1995, 1998). An interview in which the comedian Spike Milligan (1918–2002) discussed his chronic depression led Clare and Milligan to co-write Depression and how to survive it (1993). Beyond belief (Channel 4, 1986) was another TV interview series, exploring how people's beliefs affected their actions. Clare was also the first presenter of the BBC Radio 4 series on mental health, All in the mind (1989–98), occasionally hosted the freewheeling Channel 4 discussion programme After dark (1987–91), supplied voiceovers for television documentaries, and was a recurring guest on RTÉ television's Late late show.
In the psychiatrist's chair unintentionally played into the popular image of psychiatrists as practitioners of Freudian psychoanalysis; in fact, Clare publicly denounced Freudian analysis as a self-sealing, quasi-religious subculture, and Freud himself as a prophet masquerading as a scientist. Clare preferred cognitive behavioural therapy, which seeks to improve patients' ability to function by teaching them to keep negative trains of thought from becoming self-reinforcing. This may have reflected his own need for control; despite his compulsive public activity, his personality was (to use a favourite expression of his) extremely well guarded, and in private he displayed both eager, spontaneous playfulness and a certain irascibility.
Return to Ireland
Clare returned to Ireland as medical director of St Patrick's Hospital (1989–2000), and professor (1989–2000) and adjunct professor (2001–07) of clinical psychiatry at TCD; he founded the Dublin University psychiatric rotational training programme for doctors in training. He remained involved with the London media and medical worlds, and was chairman of the prince of Wales's advisory group on disability (1989–97). Clare declared that he had 'come home because it is home' (Ir. Times, 12 December 1988).
Soon after returning, Clare conducted a series of interviews on RTÉ, The Irish in mind, which was widely criticised. In 1993 he was an unsuccessful candidate for Seanad Éireann from the NUI constituency, polling 7.22 per cent of first preferences and eliminated in sixth position on the tenth count. Friends thought Clare had been somewhat naïve about Irish politics, and that his setbacks were due to a resentful perception in certain quarters that he saw himself as a superior being coming over from England to solve all Ireland's problems.
Clare then decided that political involvement would interfere with his other work, though he took a prominent role in the 'right to remarry' campaign during the 1995 constitutional referendum on divorce, while arguing simultaneously that couples with underage children should be strongly discouraged from divorcing. (He also outspokenly supported the legalisation of abortion in certain circumstances in the aftermath of the 'X case' (1992), arguing that the 'right to life' should be defined as covering mental as well as physical life; however, he supported the unsuccessful 2002 constitutional amendment to limit the impact of the X decision, arguing that allowing abortion on psychiatric grounds would corrupt the medical profession. Critics of his views detected a strong ambivalence, even an underlying and not fully acknowledged conservatism.)
As medical director of St Patrick's Hospital, Clare oversaw the development of clinics dealing with chronic fatigue and eating disorders. He was particularly proud of his role in securing additional research grants for trainee psychiatrists and in reshaping the physical environment of the institution to make it less forbidding. In 2000 he stepped down to work at St Edmundsbury Hospital, Lucan, Co. Dublin, an acute psychiatric unit affiliated to St Patrick's. The decision was associated with a late-middle-age personal crisis, partly in response to his parents' deaths. This emotional upheaval is reflected in his last book, On men: masculinity in crisis (2000) – accompanied by a radio series of the same title – which argued that men needed to examine their sense of identity in the wake of the decline of patriarchy, and that the male sex was being pathologised in ways resembling past negative stereotypes of women.
Clare concluded that his continuing hyperactivity was harming his personal relationships. From about 2002 he bowed out of his media commitments – even refusing to write book reviews – to focus on family life and medical work, spending more time with his wife at their holiday homes in Kerry and Sardinia. He became reclusive, still seeing patients but having relatively little contact with friends; as an outward sign of this change, he grew a beard. In 2003 Clare and his wife became directors of Plan Ireland, a charity seeking to improve the lives of children in underdeveloped countries. He planned to retire finally from medicine at the end of 2007; earlier that year, he accepted an honorary fellowship of the Royal College of Psychiatrists. While returning with his wife from a holiday in Sardinia, Clare died suddenly of heart failure on a stopover in Paris on 28 October 2007.
Although some medical critics dismissed Clare as a 'pop psychiatrist', and some advocates of the view that mental illness was a construct of social injustice dismissed him as practising 'old-style voodoo establishment psychiatry' (Noel Browne (qv), Ir. Times, 28 September 1989), he was generally regarded as a polymath of great gifts who did much to expand academic knowledge and public understanding of his subject, and whose work both with individual patients and as an administrator contributed greatly to the relief of individual human misery.