Reviewed by Peter Reason
It was on a family skiing holiday that Horatio Clare finally went mad. This was the culmination of a period of high activity and stress, coupled with misuse of cannabis and alcohol: feelings of optimism and energy, sleeplessness and overwork that had developed into mania. At first, this was accompanied by ‘wit and charisma’, only mildly alarming to family and friends. But in the airport, he begins to play a game, a game that as he plays it becomes all too real: ‘Just imagine, imagine being part of some great and secret scheme’: the signs are everywhere, in the way that man touches his hat, the young woman’s raised hand, the military looking man… He is sure he is part of something exciting and concealed, a global movement of the elect.
The first half of the book gives a detailed and gripping account of this mania as it amplifies through the holiday and afterwards. It is a quite extraordinary account, so deeply engaging I found it difficult to put the book down. Clare has several brushes with the mental health professionals, but—middle class, articulate, believable—each time he is able to sidestep their concerns and the evidence offered by his increasingly concerned family and friends. Eventually, after deliberately crashing his car—on instructions from ‘authority’ via the radio—leaving it balanced across a drainway on the moor, he is picked up, naked, by the police, and sectioned under Section 2 of the Mental Health Act.
Part One of the book concludes with chapters detailing his nineteen days in a locked ward in Wakefield Mental Hospital. At this point the book, mercifully, slows down somewhat, as if we readers can join Clare in coming down from the mania. Nevertheless, he continues to provide the reader with a meticulous account of his responses to the hospital and to the anti-psychotic drug treatment he receives, alongside acute and sympathetic observations of the nursing and psychiatric staff, and his fellow patients. The time in hospital is a mixture of anxiety, boredom and recovery. Clare has no doubt that the drugs work in the short term, even though he realizes soon enough that the psychiatric profession has no real idea how they work. By the time he is discharged he is both grateful for the kindness and care he has received and sceptical about the bipolar diagnosis and prospect of staying on drugs for the long-term—Aripiprazole for one or two years, lithium longer term.
It is at this point, he tells us, that the idea for the shape of this book takes place: ‘By writing it all down, I will attack the taboos around psychosis and sectioning. I will explore and celebrate the role of friends, family, strangers and professionals who helped us. I will follow a line through the layers of treatment and authority to which I was subject… I will find out what choices are available to people like me after we are released from hospital… I will seek to discover if there are alternatives to a lifetime on pills’. In Part Two the pace of the book slows yet again as Clare continues his personal story ‘in search of healing’, placing it alongside an exploration of the history of treatment, anti-psychotic drug therapy, psychotherapy, radical psychiatry, and alternative treatments.
The personal story includes his relationship with his partner Rebecca, a central protagonist to whom the book is dedicated. The distress she experiences through Clare’s psychosis—not just from Clare’s behaviour but from the failure of the health system to respond to her concerns—her love and her fierce protection of her family are evident page by page. It would be unjust not to salute her contribution to the story. Yet this is not without conflict: having been on the receiving end of much of Clare’s madness and relieved that he is now stable under the drug regime, she is insistent he continue to take the medication. Clare is equally insistent that he will not, as he is carefully (a psychiatrist might disagree) reducing and then stopping taking Aripiprazole. He deceives Rebecca about this (and he acknowledges his history of deception), so this reader held his metaphorical breath through the second half of the book in anticipation of her response when his deception is finally revealed.
Clare’s researches lead to a consideration of ‘another way’ through madness as he draws together what he has learned about rethinking psychiatric services. While he is uncomfortable with the view that there is a conspiracy between pharmaceutical companies and psychiatrists, he is convinced there is no evidence-based brain theory to support the long-term use of antipsychotic drugs—although he is sure they have their place in managing high levels of distress. In contrast, he shows there is good evidence that there are forms of psychotherapy and of processes such as ‘open dialogue’ that work as alternatives. And he comes to a sudden realization that the issue is not about cure but of healing: ‘In writing this book, there were moments when I could not bear to look too long at things I did. The hells I and Rebecca and our children went through I will carry with me. And although this is a hopeful story of progress into healing, I can make no claim that my shadows are banished; it will not necessarily be all right in the end. I shall have to wait and see’.
He is well aware that white, articulate middle-class patients such as himself are likely to be privileged in their treatment. Yet he is sure he has ‘dodged a hail of chemical bullets’. It was wrong that he was not listened to, wrong that no second psychiatric opinion was available; it was luck and professional positioning that enabled him to find diverse opinions from radical psychiatrists and other mental health professionals; and good fortune that his middle class status allowed him to spend £60.00 an hour on psychotherapy (he also points out that the £2,000 he spent on therapy was far less than his previous expenditure on cannabis and alcohol).
This book raises important issues that merit much debate about how the provision of mental health care, articulating the perspective of a ‘patient’ or user of services and drawing together perspectives and voices that deserve more attention. It also is an invaluable source of insight for those of us who, as laypersons, may be confronted by friends and loved ones who are going through a breakdown; and indeed, for those who have experienced such a breakdown. Clare gives us a narrative and a language for talking about these experiences. (I noticed my own struggle around the choice of ‘breakdown’ in my previous sentence; I find Clare’s willingness to use the word ‘mad’ in the title and in the text is a great relief.) From my own experience of trying to support a university student through a manic phase, and also arranging care for a friend who was delusional for a while, Clare’s account rings with authenticity. We can see directly the distress Rebecca feels at his behaviour, and also the immense frustration of getting him properly cared for.
Strange though it may seem for a book dealing with such weighty matters, this book is a ‘page turner’, certainly in the first half. I recently participated in an online seminar with Clare organized by the creative writing organisation Arvon. He began by offering us a quote from George Orwell emphasizing the duty of the writer to their reader to write with clarity. He absolutely lives up to his own advice: this is an extraordinary book, not just for the story, but for the excellence of the writing.
I should leave the last word to Clare, who tells us of the struggle he had with the writing: ‘There were moments when I could not bear to look too long at things I did.’ But he believes he has, with much help, learned how to manage his natural highs and low, and particular avoid behaviour that amplifies them.
‘We count our blessings… go to sleep peacefully and wake up hopeful.’
Peter Reason is a writer who links the tradition of travel and nature writing with the ecological predicament of our time. He writes regularly for Resurgence & Ecologist, and has contributed to EarthLines, GreenSpirit, Zoomorphic, LossLit, The Island Review, and The Clearing. He has written two books of ecological pilgrimage, In Search of Grace (Earth Books, 2017)and Spindrift (Jessica Kingsley, 2014). With artist Sarah Gillespie he published On Presence: Essays | Drawings in 2019, following this in January 2021 with On Sentience: Essays | Drawings, both available directly from the author/artist. Find Peter at peterreason.net, and on Twitter @peterreason.
Horatio Clare, Heavy Light (Chatto & Windus, 2021). 978-1784743529, 348pp., hardback.
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