by Hannah Swerling The Sunday Times, posted 28 02 2021
The author was sectioned after a psychotic breakdown fuelled by cannabis and stress. Hannah Swerling hears how he came back from the brink
For three weeks in 2018, Horatio Clare lived an existence far removed from his normal life. A family ski trip to Italy became an espionage thriller where he imagined his fellow travellers were intelligence agents, and sensed conspiracy “waiting like a gun under a coat”. While Clare watched television with his mother and brother, Kylie Minogue appeared on the screen, and he became convinced that he and the pop star were going to get married. At one of his lowest points he drove himself and his car into a Yorkshire reservoir at the bidding of some unknown authority.
As vivid and real as all of this was to Clare, none of it happened. He was having a mental breakdown and experiencing an intense episode of hypomania.
“All I actually did was let the handbrake off and let the car roll down a slope, where it came to rest above a drain,” Clare, 47, tells me from his home in Hebden Bridge, West Yorkshire. “In my mind I was playing some part in a scheme I didn’t understand — hadn’t worked out — but which involved a fake accident and some sort of trail of misdirection which I hoped would finish the whole exhausting nightmare. Delusions often seem to function like an embarrassing parody of an episode of Spooks.”
As a lecturer and writer of books about travel and nature, Clare is used to recounting his epic adventures around the world, but it is his own perilous journey through madness, mania and healing that he documents in his new book, Heavy Light.
He describes his hypomania as an elevated state of excitement, characterised by “flights of fancy, surges of vitality, sleeplessness and irritability. Mildly alarming to friends and family, hypomania brings with it dash, wit and charisma.” The reality is, of course, far less glamorous, and the book sheds light on the darker corners of mental illness, the places sometimes overlooked in the more palatable accounts of mental health, which tend to come with a hashtag.
Before his breakdown, Clare had experienced two other “crises”: one in 2008, at the culmination of a long journey across Africa, and one in 2016, in France. Both involved stress, heat, exhaustion — and cannabis. In France he saw two doctors, who diagnosed cyclothymia, a mild form of bipolar disorder. They told him the condition was manageable with sleep, food, good relationships and a careful avoidance of narcotics and stress. He failed to do this: it was stress, cannabis and an unrelenting work schedule that led to his 2019 breakdown.
Bearing witness to these events were Rebecca, his patient partner of 13 years, their son, then aged five, and Rebecca’s 17-year-old son from a previous relationship, as well as other family and friends, who alternated between conscientious support, despair and helplessness. Finally, in January 2019, Clare was committed to a psychiatric hospital under section 2 of the Mental Health Act.
Today he is healthy, but his memories of the period are still raw. “It was weeks of rock bottom,” he says. “It’s not my own experience that really pains me about that, it’s the effect on my family and friends. Whenever I’m not there, whenever I’m out ranging around somewhere else or I’m locked up, those are the high points for everyone else. They’re not assailed by my lunacy.”
Once sectioned he was prescribed antipsychotic medication. He was reluctant to take it but was told he couldn’t leave unless he did. His book is in part a polemic against what Clare perceives as the overprescription of drugs in a mental healthcare system that sees patients as numbers and doctors as undiscriminating vending machines doling out “life-changing” medication without a second thought.
Clare’s scepticism about medication began in 1995 when, in his third year studying English at York University, he first “hit depression”. He’d been having a lovely time and smoking a lot of cannabis, but then suddenly stopped and came crashing down.
“I remember not knowing what it was,” he says of the episode. “The conversation around depression was in its infancy. I went to the doctor and I’d read about Prozac and I begged for it but the doctor said, ‘I think that would be a terrible idea’. He basically told me that there was no point medicating the symptoms, given the cause was no mystery. I was very lucky to escape it.” Instead, Clare says, he “dragged himself through it” with a move to France, lots of outdoor activity and a good diet — admittedly not a solution that is available to or effective for everyone.
He warned about the underestimated dangers of cannabis in his 2007 memoir, Truant: Notes from the Slippery Slope. “There was a moment back then when I spoke to my friends from university and everyone had been knocked slightly sideways by it,” he says. “The problem is that we still only admit to a misty relationship between cannabis and severe mental illness, but, anecdotally, there’s nothing misty about it at all. We all know that this drug is much more dangerous than the culture gives it credit for.”
Before his breakdown Clare had experienced two other ‘crises’
Despite these convictions, Clare continued to smoke it until his most recent breakdown. “Of the many things I regret and feel ashamed of, that is one of the greatest,” he says. “If I had learnt the lesson that I preach, I don’t think I would have been in the position that I hurled myself into. It was awful because I thought, ‘I can get away with this. Just a little bit of mania, just a little bit of hyperspeed might help.’ So I attempted to use it, but, of course, it uses you. It’s taken me a long time to be safe around it. I have absolutely no need, interest or desire for it now.”
Clare took the medication: two doses of quetiapine, which “threw a blanket over the D2 receptors” in his brain. That, and being taken away from his daily stresses, recreational drugs and alcohol, allowed him to emerge from his hypomania. “Being given that space was a wonderful gift,” he says.
Yet as he came to his senses, the prospect of more long-term medication became a bitter pill. He was given aripiprazole, another antipsychotic, which is supposed to have fewer side effects, but he felt woozy and cut off. “My conviction was that I didn’t need it,” Clare says. “First I halved the dose then cast it aside, and that puts you in a position of being non-compliant and also puts your poor family in a terrible position, because the simple narrative that there’s a terrible imbalance in the brain that can be remedied with a pill is incredibly reassuring. The fact that it has no scientific basis doesn’t cut any ice, understandably, with someone who’s worried that you’re going to go crazy. So I did what a lot of people do, which is lie about taking it.”
As he continued his recovery during lockdown last year, Clare reluctantly admitted to Rebecca that he had stopped taking the medication. “She could see I’d been well for months but I felt a terrible coward,” he says. “A lot of people who take medication are braver than I am. You have to try and make the best judgment for you.”
Clare is an advocate of talking therapy, as opposed to medication. In hospital he identified in himself and his fellow patients a powerful desire to talk. As he writes in the book: “This need was so great in one [patient] that he broke down in tears at the impossibility of the enormous task of explaining himself and giving a full account of all that he had done. The need is particularly urgent in a hospital, where you know you are, must be, to some extent, mad. You want to make your story known in order to reconstruct and reclaim the thread of yourself.” For Clare the fact that readily available talking therapy comes with a price tag is the hardest line in the story. “It’s unfortunate the poor are overwhelmingly in the hands of an industrial psychiatry, whereas the wealthy can afford psychotherapy,” he says.
In a tragic example of what happens when mental illness is left untreated, in 2011 Clare’s half-sister, Janey, killed herself. “She was two days away from going to see a doctor — she had an appointment,” he says. “She was obviously manic and in the absolute throes of it and she was unlucky, but I was away and, I don’t know — had she come to the doctor and had the doctor done the right thing, with any luck, she’d have been sectioned and helped. Whether or not that would have meant medication is impossible to know, but what happened to her doesn’t strike me as mysterious. It strikes me as terrible.”
While his father “suffered depressions”, Clare resists the idea of a family tendency towards mental illness, writing in the book that no gene has been identified for bipolar disorder. However, his psychiatrists still saw it as a “big ticked box when I said one family member had been depressed and another had killed herself”. Clare believes their suffering was circumstantial — his father endured abuse from his own mother, estrangement from his own father and a long series of failed relationships, while Clare’s half-sister was traumatised by her parents’ divorce, used drugs heavily and spent long periods in poverty and isolation.
Clare’s idealism about “de-prescription” and a more holistic, tailored approach to mental illness is admirable, but one has to wonder how realistic it is in our underresourced NHS. “We won’t get what we want unless we’re clear about what we don’t,” he maintains optimistically. “An ideal system would involve a huge amount of conversation and talk and access to clinical psychotherapy, and work back from there. The theory is all clear. The next stage is implementation. We need politicians of vision. People are growing up in a landscape of greater understanding and hopefully greater openness.”
Today Clare has a routine in place that helps to keep him healthy, taking vitamin D and omega-3, being “really serious” about his diet and ensuring he is getting enough sleep. He is also driven by a sense of purpose to remove the stigma around mental health breakdowns. “You can be sectioned — it’s OK,” he says. “It did feel like a branch snapping but it doesn’t have to be the end of you. In fact, it can be a new beginning.”
An extract from Heavy Light, by Horatio Clare
I am still sitting in the car in the lay-by a few hundred metres below the dam.
“I want confirmation,” I say to the radio. “You want me to run this car off the road?”
The programme is a profile of someone whose name I missed but I recognise the voice of the speaker. It is the elderly academic we met when we were skiing, the Liverpudlian talent spotter and agent runner for MI6.
“Oh yes, he was incredibly brave,” he says.
I take my seatbelt off, engage first gear and let the clutch up ever so slowly. The car begins to roll. Its course will take it over rough but flat ground to the lip. There is nothing beyond the edge there but a steep drop. The car is moving well now. I open the door and roll out. I stand and watch the tail lights disappear. The noise changes, there are rattles and thumps, fading now, then a resonant crash.
I take off my clothes, retaining only my boots. I want to shed, to help them lay their false trail, or whatever it is they want with this faked car accident. It’s almost over. I follow the car’s track to the lip and down.
Miraculously, the vehicle has come to rest like a bridge across an overflow drain from the dam. The car is just longer than the concrete channel is wide, so it sits resting on its bumpers a few feet above the shallow channel of water in the bottom of the drain. I climb up into the driver’s seat. The car is well built, a Toyota, and it seems unharmed. The lights are still on. The engine has cut out. The radio still plays.
“He was a hero,” the voice is saying. “He really gave it everything. He got a bash in the face, broke his nose, and he just played on.”
Of course. They want me to complete the staging of this accident. Right then. I kick violently against the windscreen above the steering wheel, roughly where my head might have struck had the airbag failed. It takes a lot of kicks to make it star and crack. Now I take one of my son’s boxing gloves. To complete the illusion — which must be crucial to the negotiations or they would never ask it so explicitly of me — I must sustain injuries. I punch myself hard in the centre of my face, and again, until I hear my nose click. That’s enough. F*** them if it’s not enough. I trudge back up to the road.
There is a moon behind cloud, no stars. Although I am only wearing my boots it is not that cold. Too cold to stand around, though. I start jogging back along the road towards Hebden. Surely they will pick me up soon. They won’t want to leave me out here like this, I hope.
Thank goodness! There. A great big white camper van. How kind of them, how clever — the perfect camouflage. The passenger door opens. I climb in. Immediately there are shouts. “Someone’s just got in! Who are you? Get out!”
There are two women inside, and children. I jump out, terrified. “Get the hell out! Go away!”
Confused and frightened I circle it — surely they are here for me? Isn’t it time I met someone behind all this, someone who can tell me my part is over, that I have done well, that I can go home and sleep? Isn’t it time someone in authority sat down with Rebecca and me and said it is all over? Haven’t we earned the right to have each other back and be with our little boy?
The camper van starts its engine and lurches at me, chasing me out of the way.
Flee. Run the other way this time, towards the reservoir and the moors.
Keep your spirits up. Don’t be shaken. Don’t be scared. There is a light up ahead, a farm.
The curtains are open. Soft stair light falls into a dim front room. It looks lovely. How to attract attention? Am I supposed to attract attention or am I supposed to let myself in? Difficult, being naked. Easy to give the wrong impression ...
Around the side of the house there is a yard. Suddenly the night blazes white, security lights flood on with a roar of barking dogs. At least half a dozen dogs are lined up in cages next to a parked Land Rover, going berserk. I am not going to wait for someone to press a button and release them. They will start with the most vulnerable bits. I jump at the Land Rover and scramble up to its roof. Now lights come on in the house. The door opens and a man comes out.
He is a young man, fit-looking and perhaps slightly military, like a gamekeeper.
“What the f*** are you doing on there?”
“I think I’m in need of assistance.”
“Get off there. Get down.” I do. “I just need help,” I say.
He shuts the door. He looks irritated and incredulous. Not in on it, then. I jog off down the road again, heading back towards Hebden once more.
Not long afterwards a police car appears.
“What’s going on?” one of the officers asks. It is a surprising opening. Aren’t they supposed to know? If they do not know I should not tell them. I guess all this needs to be deniable. I need a cover story until I can see their senior officers, the security service or the special forces — whoever is party to what is really happening. I will know them immediately.
“I’m not really sure. I think someone left some drugs in my flat and I was driving and I think I just came up on acid. I crashed my car.”
“Where’s the car?”
“It’s over there — it went over the ledge over there.”
“Are you hurt?”
“I had a bang on the head but I’m fine.”
“You better get in.”
The back seat of that police car is the warmest, softest, most lovely place. The officers cast about with their torches.
“Hey, I’ve found his clothes over here!”
They bring them; jeans, a jumper and shirt, boxers. “You better put them on. Bet you’re glad we found those.”
It was a remark they made more than once. They were good-humoured. I told them I was very grateful.
“There’s a vehicle down there!” another officer calls. A second police car turns up. After various exchanges and a conversation over the radio it is established that I can be taken in. I am told I am being arrested on suspicion of driving under the influence. I nod contentedly. I am blissfully tired and calm. I think I sleep.
Extracted from Heavy Light by Horatio Clare, published by Chatto & Windus on Thursday at £16.99 © Horatio Clare 2021
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