Published next week by Chatto & Windus, Horatio Clare's 'Heavy Light: A Journey Through Madness, Mania and Healing' investigates how we understand and treat acute crises of mental health. Sue Brooks reviews.

I have to admit I could not read this extraordinarily powerful book in the conventional way. 'It aims to be a straightforward story' the author says, but within a few pages I am deep in dangerous waters, heart pounding and if anyone had been observing, probably twitching like mad. I had to start again from a different direction; working backwards, following Horatio’s footprints, just as he did in gathering the material, and reaching the point where the idea of the book was clear.

'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 seek to discover if there are alternatives to a lifetime of pills.'

The events take place between December 2018 and the beginning of lockdown in 2020. As on previous occasions when stressed by work commitments and Seasonal Affective Disorder and using cannabis and alcohol recklessly, Horatio is approaching a breakdown. The Val di Fassa in the Ladin Alps on a family ski holiday becomes a crucible 'for a madman to act out his fantasies, unknown and mostly unobserved.' He seems to have total recall — 'madness of this kind,' he writes, 'is like a sunrise of the self, a flood of light banishing the shadows of the relative, of perspective. The sun is rising fast, strobing the world with new colours until it glows in hyperreality.' Who would not wish to know such moments? What writer could resist?

The cost to Horatio’s partner, Rebecca, and their two children is terrible. Somehow they return home. The mania continues in and around Hebden Bridge and Horatio’s childhood home near Abergavenny. On one occasion when he can no longer cope, he sets the car on a downward slope into a reservoir and sits inside with the windows open. It is so real, so utterly compelling, I'm unaware of holding my breath until I reach the end of the paragraph and the shock of the words 'I am still sitting in the car in the lay-by.'

The fantasies increase in intensity to the point where it is not safe for him to live in Hebden Bridge. 'The next day, at last, they come.' Horatio Clare needs to be detained under Section 2 of the Mental Health Act 1983. He is taken to an inpatient ward at Wakefield Hospital.

The next three weeks form the backbone of the story. His diary is riveting: each of his fellow inpatients so real and full-bodied in the telling of their own stories, and crucially, the role cannabis has played in all of them. Horatio shows himself to be a great listener with an inexhaustible capacity for friendship. He realises quickly that there is no way out except 'through a pill bottle, the contents of which are as mysterious to the doctors as they are to us'. He agrees to the one he believes has the least side effects — aripiprozale — vowing that he will reduce the dose as soon as he can. He is lucky. He becomes a Voluntary Patient (Section 17) and is discharged on Day 23, rather than the 28 days of Section 2. On his first unaccompanied walk as a Voluntary Patient, he visits the Hepworth Gallery — 'the calm in which the pictures exist and their beauty, which seems to speak in a language of silences and feelings, sways over me like music.' When he leaves to return to the ward at the appointed hour, he uses the word 'healing' for the first time. Art therapy suddenly has meaning.

In Part 11 Horatio begins the research which he hopes will lead to greater understanding of 'the lessons my Odyssey may have to teach', chiefly around the pill bottle and alternative treatments. Rebecca is fearful of another manic episode and insists he must take the pills because he has a chemical imbalance in the brain. Horatio intuitively feels this to be untrue. He believes he has never felt high or shown signs of hypomania without using cannabis. It has been a pattern since his early twenties and can surely be changed without chemicals. Secretly he has reduced the dose of aripiprazole and is well on the way to not using it at all.

He is fortunate in being able to interview Dr Peter Macrae, a psychiatrist who counters the view that mental illness starts with chemical imbalances in the brain. He is the first doctor in Horatio's experience who has listened and not dismissed the idea of a predisposition to cannabis psychosis. 'We have no useful tests...all our treatment is based on presentation...and by trial and error based on side effects.' Dr Macrae prefers to work with patients on their individual circumstances using social activities as a prescription rather than drugs.

This leads to the book by Robert Whitaker Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise in Mental Illness in America and a conference where Robert is giving an address. The movement for rethinking the standard textbook for psychiatry (The Diagnostic and Statistical Manual of Mental Disorders) has been growing for some time and many of its practitioners are at the conference, including the person who, 'of all those I have interviewed, impresses me the most' — Yasmin Ishaq, the leader of Open Dialogue, a branch of therapy pioneered in Finland and becoming established in the UK. Using the skills of systemic and family therapy, Yasmin and her team work with the patient, the family and professionals to explore recovery without using drugs. The results have been spectacular.

Alongside the research, Horatio is committed to personal therapy with a practitioner of EMDR (Eye Movement Desensitisation and Reprocessing), a treatment which has helped many people suffering from traumatic stress. Sometimes they spend several sessions working on one particular episode from childhood, gradually reducing its power to affect his behaviour. He makes no claim that it is better than any other of the many therapeutic models; only that it worked incredibly well for him.

By the end of the summer, with no manic episodes, a regular flow of work and more time living with the family, Horatio tells the truth about the pills. Rebecca is angry, but it doesn't shake her commitment to the story in which she has been the key player. The book is dedicated to her. They discuss his discoveries from the research, and talk through the sessions with the therapist — there is no limit to Rebecca's willingness to listen — and also they have a lot of fun, together and as a family.

Wonderful things happen. They return to Val di Fassa on the anniversary of the first trip and have a great time. He revisits the ward at Wakefield and offers Creative Writing sessions. Horatio and three other inpatients write a poem together — 'Everman's Day on the Ward'.

He has come through a whole year and told the story. It is a superb and shining achievement, therapeutic for Horatio and informative and inspirational beyond measure for those who read it. Heavy Light is an odyssey for our times, full of hope in an uncertain future. If you feel faint-hearted at the beginning, as I did, please persevere. It will be a life-changing experience.

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'Heavy Light' is published this coming Thursday. Order your copy here.

Tagged as: Horatio Clare

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