Writing Heavy Light, the story of my breakdown and healing, worked for me in the same way that Burton’s Anatomy seems to have done for him. You research, arrange and explore what happened to you. By talking through your experiences in an intimate dialogue with the reader — a generous, forgiving, interested figure in my conception, and slightly more time-pressed than Burton’s seems to have been, given Anatomy runs to over 1300 pages in paperback — you find a kind of harmony with them, and with your condition.
Investigating options for my treatment and researching the many ways in which we have conceived of the mind’s distempers was engrossing and often shocking. Recovery rates from breakdown were as good as ours in the early twentieth century, when it was accepted you could have a nervous collapse and then get better.
Psychiatry accepts that things went badly awry in the early 1960s, with the chemical imbalance theory, which held that distress came from a deficiency or excess, not in the humours, but in our brains. Psychotropic chemical solutions were mass-prescribed. The problem, as the sublimely melancholy Blackadder of the trenches said of the alliance system preceding the First World War, was that the theory was bollocks.
Happily, we are moving towards a Burtonian conception of mental distress which gives equal roles to the mind, body and spirit in the restoration of wellbeing. If you are suffering, we now know, you need time off work, a support group of family and friends, exercise, the guidance of a physician who may or may not prescribe medication, an acceptance that we all suffer sometimes, as well as the help and perspective offered by the arts, nature and creativity.
This was Burton’s original prescription, and we now share it. Researching Heavy Light, I found a widespread and growing conviction, shared by psychiatrists and psychologists, that holistic treatment — what the President of the Royal College of Psychiatrists, Dr Adrian James, refers to as “the biopsychosocial approach” — is the most hopeful way through what Burton would have seen as a worldwide crisis of melancholy.
All of us know someone who suffers. This may partly be due to the pandemic, which forced introspection on to so many, and partly because we talk about it, with a frankness that the internet has surely multiplied. I found that Burton’s conviction that what ails you ails you alone, in a specific and personal way, was vital to my recovery. Taking control of the language was crucial.
“How would you have treated me when I was in the grip of delusions?” I asked Yasmin Ishaq, a leading NHS practitioner in Open Dialogue, a progressive treatment for psychosis and schizophrenia which achieves dramatic results through talk and support, with a minimal role for medication.
“We normalise them,” she told me. “I would have said, ‘This is an absolutely understandable reaction to what has happened to you.’” Open Dialogue understands delusions as a kind of emergency language, a way of making sense of a world the sufferer can no longer bear.
Still, I was haunted by the fear that despite a long and robust recovery, I might not ever quite come back from what had happened to me. But then came a quietly amazing thing. “It’s not about curing, it’s about healing,” Yasmin Ishaq said.
It was so simple and yet it was an epiphany. In Burton’s terms, I was given permission to think about my path as an ongoing rebalancing — of humours, in his conception; of body and mind, of work and life, of rest and relationships, in ours.
Discussing melancholy and acute traumatic crisis with Mary Ann Lund and the psychiatrist Ahmed Hankir on Radio 4 last week, I used the term breakdown. The astonishing Hankir, an award-winning clinician who has performed his stigma-busting show The Wounded Healer to 75,000 people in 13 countries, queried the term. He experienced his crisis, he said, as a breakthrough.
And this is why I rather love the idea of Burton’s melancholy. It accepts a universe of different experiences and reactions, a universe as vast as humans are various. In his Ode on the subject, John Keats saw “veiled melancholy’s sovran shrine” as omnipresent – in his case, even in the “temple of delight”. Burton’s expanse of melancholy, he suggests, if only in tints and splashes, is part of all of us.
Horatio Clare’s Heavy Light: A Journey Through Madness, Mania and Healing is published by Chatto & Windus.
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