He appears in real anguish (4)
I believe the answer is:
alan
'he' is the definition.
(I've seen this before)
'in real anguish' is the wordplay.
'in' indicates the answer is hidden within the clue.
'ALAN' is hidden within 'real anguish'.
'appears' acts as a link.
(Other definitions for alan that I've seen before include "- Bennett, English actor, dramatist, writer" , "- Ayckbourn, English playwright" , "- Bennett, English dramatist, author" , "English name" , "Boy" .)