The Dr Louise Newson Podcast - 177 - Families, relationships and the power of connection with Julia Samuel

Episode Date: November 8, 2022

Human beings are hard wired to adapt to unexpected life events but how do we manage this process alongside our natural need to control? Psychotherapist, Julia Samuel MBE has been interested in this question throughout her 30 year career supporting families with grief and bereavement. Julia founded the charity Child Bereavement UK and has worked extensively with families in the NHS and private sector as well as writing books on grief, family, and change. In this episode, the experts discuss human nature and our response to adverse life events and times of transition. Julia speaks of the importance of love and connection with others and about the impact menopause can have on relationships, family life and work. Julia’s tips for helping your relationship: Be aware of how you’re communicating in your relationship and look at what has changed Try and form a regular habit like going for a walk together to talk and listen to each other and make time to reflect Be aware of your own inner critical voices and turn down the volume on those. Turn up the volume of self-compassionate voices and practice being kinder to yourself Remember connection with others is key throughout our lives For more information about Julia Samuel and her books, visit juliasamuel.co.uk For support and information if you have experienced the loss of a child or care for a grieving child, visit www.childbereavementuk.org

Hello, I'm Dr Louise Newsome and welcome to my podcast. I'm a GP and menopause specialist and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-Bron-Avon. I'm also the founder of the Menopause charity and the menopause support app called Balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based, information and advice about both the perimenopause and the menopause. So today on the podcast, I'm very delighted and honoured to introduce to you, Julia Samuel, who I've known for a little while and very, very inspired by the work that she's done. And it's very common sense work,

actually, but you don't realise until she tells you how common sense and important it is. So, Julia, I'm really keen for you just to talk about what you do and who you are, if that's okay, first off. Well, lovely to be with you. Yes, I'm a psychotherapist. I have been for about 33 years. I worked in the NHS for 25 years, supporting families when a child or a baby died, and find a patron of a charity child bereavement UK.

So for decades, I was focused particularly on grief and bereavement. But the learning from that is about when life events hit us, unexpected life events, which can be from death. It can be from a pandemic, is how we as human beings manage the adaptation process. We are wired to adapt, but we want control. And so it's how we manage that tension for ourselves, for the people connected to us and our lives, and what supports us. So really interesting and important because I am quite a control freak.

I like to be in control. I think a lot of us do actually. Most of us, yeah. Yes, but then when something happens that isn't expected, like you say, as a bereavement or pandemic or anything really that's out of our control, it really plays with our emotions, doesn't it? It completely plays with our emotions. And what will influence it is many aspects.

It's our genetic predisposition, our personality, our history. So how much loss or different. difficulty we've had, the security of our early childhood, what's happening to us at the time. But the biggest single predictor of our outcome at the time of whatever this event is, whether it's a health diagnosis, a loss, we lose our job, our relationship is not working, is the love and the support of others. And also our relationship with ourselves, what I call our shitty committee what we're saying to ourselves about this event because the thing happens outside of us but we could be saying to ourselves well it just shows I'm a failure I'm useless

whereas if we can have a kind of more self-compassionate voice and be kinder to ourselves and not use the event as a stick to beat ourselves with then we have more capacity to manage it and find a way to adapt and change and grow through what is happening to us, rather than try and white-knuckle it and press and have control against it. Yeah, and that's so interesting, isn't it? Because, I mean, as you know, being a doctor is such a privilege, as indeed is your job. And I've met so many people over the years. And a lot of them have had horrendous lives, actually, really horrendous.

And one of the things about being a doctor is you see people that you wouldn't meet otherwise. And, you know, lots of single people. parents who have been emotionally, physically abused by a partner or various partners and struggling to look after their family. And then they turn in line, they say, well, I deserve to be like this. You know, I've been abused before, so therefore I'm going to be in another abusive relationship. And you can see this cycle because there's no one picking them up. And actually, even just as a GP, well, how can you help these people really? But then, often I'd used to obviously listen, but then say to them, but look at how much strength you've got. You've got.

you have six children, you have a part-time job. You know, that in itself deserves a medal. And no one had ever congratulated them just for getting through the day. And I think with life you forget, don't you, actually, that, you know, we're all designed to do different things, but there are some people that just don't get any praise for anything. And it's just everyone works and tries to do their best. But if they've not been set up to feel loved and supported and of value, then it's really difficult, isn't it? It's incredibly difficult.

So I think you're right, life is random. You know, this idea that good things happen to good people and bad things happen to bad people, we kind of know that there are so many unpredictable random things. And some people continuously have terrible things. And often good people have bad things. And what supports them is, of course, that first attachment relationship. You know, what I call your kind of emotional. template that you carry around with you. And that is telling you, if it's secure, that I am

worthy of love, I am good enough, and I can trust, and the world is a good, kind place, and I can kind of manage the waves as it hits me. And you can have a kind of spectrum of really very secure and, you know, very fragile. And also that can be influenced by different domains that you can have a secure attachment with some types of things and people and not others. So it's not kind of black and white. And I think there's something like menopause in the area that you're working in, that will very much influence how we respond. But also as human beings, we have to remember we are wired evolutionally with a negative bias. So we're wired to look for danger.

So if you have a compound of a difficult childhood and a lot of bad things happen to you, then you get menopause and other things happen to you. It feeds into the story you tell yourself about yourself and your life. And the story you tell yourself is the person you become. So when you as the GP or me as the therapist can add another sort of stream to what you're saying to yourself, which rebalances it, which is more positive, which acknowledges what they are doing and what they have done and really kind of lets them know that that is remarkable given their circumstances, that opens a portal that reshapes the story. for themselves. And then they can begin to have this movement between negative and positive. None of us are going to be positive all the time and it wouldn't be helpful.

But it's this capacity to be flexible and adaptive and support ourselves through difficult things so that we feel bad when they're hit by the storm. But all of us can have, and I would hope, develop a kind of toolbox of mechanisms of mechanisms and behaviours that help us rebalance. We can't do it in the peak of the crisis because we're too hyper. But, you know, emotions only last 90 seconds. It's the story we tell ourselves that gets us locked in the rumination of them. And so if we let them pass, then we can begin to think, well, engage our brain because we're not in the sort of sympathetic part of our brain, what's going on? What does this mean? What do I need? And what do I need to do? And if we kind of

slow down and breathe, then we're accessing much more data. When we stay in a panic and hyper, we only know how to attack or run or shut down. And that's when really bad decisions happen. Yeah, especially the shutdown. And it's very interesting. When I started, working so much in the menopause several years ago now, I was very naive and I hadn't realized how much impact the menopause can have on relationships. And it's only because I've obviously seen and spoken to thousands of women now. And this is this common theme where they tell me that they love their partner, but actually their relationships fall in apart. And sometimes it's because they've slept in spare bedrooms because they've been too hot,

they can't keep the duvet on. So very simple physical things that are changing and they'll bodies. But more often it's because they feel irritable, they feel short-tempered, they just can't think properly. And then other practical things, like they're so tired, they can't be bothered to cook. And they were usually the person that cooked the meal in the evening. So the husband would come home from work and say, well, what's for supper or nothing? I haven't bothered. I've been sitting on the sofa because I feel so awful. And then it sort of, this wedge starts and their relationship just goes. But they never want their partner to leave them, but then they don't enjoy being with their partner.

And their poor partners, if they come and with the patient, will tell me how this isn't the person I married. And then there's all this internalisation because the woman's saying, but I deserve to be feeling like this because I've put on weight. I'm really tired. I'm very interested. What I can see. It's all my fault.

And so she's internalising. The partner's just thinking, what do I do? And you can see their relationships going. And there's no surprise that, you know, divorces are at the peak in the late 40s. women, but it's how you can explain that and turn it into something where they can grow from it together and improve their relationship because they're both desperately sad people. It's not like a session in Relate where they hate each other. They actually want to be back together, but things have changed and they're just out of control. I think that's right. And I mean,

I wrote a case study about that in This Two Shall Pass is that a woman who had been very attractive, very positive. She was thrown into this vortex from menopause, which she didn't realize was menopause until she went to the doctor where she had very hot flushes. She said, I had white nights of sleeplessness. And, you know, if you're not sleeping, you're hit by this cascade of symptoms, you're not your best self. You're not your loving, kind self that wants to go to say in Bruce and cook supper. And in some ways, it's a design. fault as human beings, that when we're suffering, we become difficult and intractable and not easy to have relationship with. When we're suffering, having relationship is the thing that we need

most. There's some awful thing that when you're happy and well and calm, people are drawn towards you, and the reverse is also true. So what I do with couples, because the communication shuts down and people become, they blame, and there's very simple kind of objective beliefs that then inform their relationship. She doesn't love me anymore. She can't be bothered. I'm bad. I'm ugly.

I'm fat now. He's not going to love me. All of those things. So what communication can do, and people can do this on their own, one of the ways is a mechanism where you take 10 minutes each to say what's happening, I am feeling this. And the other person just listens. The power of just being heard and the person isn't rehearsing what they're going to say to prove you wrong is amazingly potent. But if they're with me, they hear each other. And what they hear is the emotion

and the motivation and the complexity of what the behaviour you can't always know, no, not going and cooking, all of those things, sleeping in separate rooms. And when you understand fully what's going on in the other person, you then ignite your feelings for them because you have empathy. You go, oh, it's not because she's an old cow or whatever. you know, there's all this going on. And then you can slowly build the bridges of connection and understanding and kindness. And then you can reinvigorate the relationship.

And even just walking and talking together, I think often getting outside, being in nature, not eyeballing each other, and each taking it in turns, how the week has been, what's been difficult. and if you're menopausal, the symptoms that you're struggling with and what that does for you can really help a relationship. And also the children in the relationship. Well, that's the thing. It's not just the partner, is it? Of course, it's the immediate relationship, but also the wider family as well, actually. And, you know, I think, you know, it's so important because all our relationships can influence what we think. But as you say, you know, the family

is the only relationship that we cannot leave. And some people actually do. I speak to a lot of people who have just disconnected from their family and that's really sad. They do, but they're still in them. Yes, I know. They dream about them, they think about them, they're part of them. So they use a lot of energy to cut them off, but they can never really leave them psychologically. Yeah, that's really powerful actually, isn't it? Because people think it's an easy option just to ignore maybe a parent in a relationship or a sibling.

I mean, for some people, that is the only option they have, but it is never for free. No. It's very interesting, and I hadn't actually also understood the power, it sounds very silly now, because I talk about it's a lot, but the power of hormones in our brains and, you know, the changes that can occur. And, you know, as you know, I see there's a lot of women who are misdiagnosed with anxiety, depression, mood disorders, often given antidepressants, and we know it's their hormones. hormonal changes and it can be very difficult to tease out sometimes and a lot of women really

internalize things and worry and over worry and ruminate a lot and this repetitive behavior often say to the patients gosh it must be exhausting to be in your brain how do you have time to do anything else and and they're like prisoners in their minds so it's really just having tools to empty your brain sometimes can be really important aren't they even if you're not menopausal of course of course. I mean, the connection between menopause and your brain is really underestimating. You know, there's higher rates of suicide, particularly with undiagnosed menopause. But also, if you have a pre-existing diagnosis like schizophrenia or bipolar disorder, your hormones, as you know, influence your brain and how you think. And so you have much more difficulty. And those

symptoms of your illness will be stronger. So I mean, those are particularly vulnerable groups. And as human beings, at all stages and phases of our life, what we seek is homeostasis, is regulation so that we can go up in response to a demand and we have the capacity to wind down and that we can have calm, feel safe in our minds, safe in our bodies, safe around our kitchen table. When we get big surges of hormones that act like the threat system in our brain, that we go into fight, flight or freeze, we go into the sympathetic and we get locked in the sympathetic. So then the world looks like it's on fire. There's another fire alarm going off in our heads. And then, as I said before, that affects all of our actions and the ways that we think.

and so someone waving at you can feel like it's an attack because you interpret their behaviours and tone of voice and what's happening to you through the mindset of I am in danger. Which is so interesting actually doing it, because this is just teenagers as well, isn't it? Definitely. And I mean, I've got... Hormones again, I mean, this is a different transition.

But it totally is. When I was perimenopausal, my middle daughter was starting on her hormonal journey and you're absolutely right there were some days where I could tell her something and it'd be fine other days I would say the same thing and it would have been the rudest the most horrible and I learnt with time actually just to listen to her and not retort and then she'd often storm off and then quite often would write me a note to say sorry which I thought was very good but then at other times she'd be fine and I think you're right and looking back it's also obvious isn't it of course it was her hormones she was trying to be a bigger person than she thought that

she actually was and thought it would be useful to be so rude. But her body was in this state of hyper alert. So it didn't matter even if I gave her 20 quid, she would still hate me. You know, it was one of those. And you can see now it's exactly the same with these perimenopausal or ages. So the poor partner or family member who's on the receiving end, if you don't understand what's happening, you are going to take it as a very personal criticism, aren't you? And it does, it is personal. And you have to have a third brain that's saying, to you, it's okay, calm down. She doesn't hate you. You haven't done it wrong, you know, so that you can have a way of kind of calming yourself down when you're hurt. I think this idea

that we're not going to be upset isn't helpful because of our feelings erupt far quicker than our thoughts to make sense of them. But also, you know, for a teenager, part of what they're doing developmentally is separating an individual into becoming independent. that they're not so attached with you. And so, of course, someone who's menopausal, you need to look at the context of their life, too, in that they may have teenagers who are screaming at them or teenagers that are leaving home.

They may have aging parents. In a context of a world that sees aging is something that we have to be anti-aging, rather than embracing, that we have this kind of hyper devotion to youth and beauty where someone at, you know, midlife is losing their fertility. So there's a big developmental transition where part of their identity has been their sexuality. And of course, you continue to have sex and more so

if you take HRT. But you're a lure, you kind of consents when you walk down the street, you're invisible. I mean, I remember walking down the street with my teenage daughters and realizing that I literally no longer existed or the builders didn't care about my day anymore. Not that they cared that much before. But you know, it's, you notice. But you're right, this invisibility because there are so many people, as you know, around 10% of men and pools of women give up their jobs because of their brain fog, their memory problems, their anxiety.

And we just recently did a survey of NHS employees and 48% had considered leaving their jobs. And a lot of people aren't going for promotion. They're going part-time. But they're not going part-time because they want to spend the rest of it in the gym or gardening or with their children or grandchildren, they're doing it because they cannot cope with their jobs. So they are making themselves invisible, actually, from society. And they're not contributing to society. And there are this lost generation of women. And we always talk about

the gender pay gap and we need more women on boards. Well, yes, we do, but we need more functioning women, full stop. You know, it's absolutely barbaric that the minority of us are able to receive treatment, which is evidence-based. And I feel it's this sort of down. And I feel it's this sort of downward cycle almost and a lot of people, in fact, I was talking to somebody yesterday. It was a man. I'd never met him before. It was just a meeting about something. And I said, I don't know if you know much about me or the menopause. And he said, well, I know enough really. I've got three sisters and I've watched them go through it. My mother had a terrible time and I'm just starting to support my wife through it. I thought, well, you don't have to actually. It is a preventable, we're not

preventable, but it's a treatable condition that people don't have to suffer. But it was almost like, that's just the way it is. And I think if you're resigned to that, you just think, goodness, me, that's really impacting him, actually. He's, he sort of, his shoulders went down as he was thinking about what he was going to have to endure almost with his wife. And it's not awful. It really is awful. And, you know, one of the big things is that the menopause should be, like having our period, should be discussed multi-generationally with all the gender. that it's part of the conversation and so that it's normalized and that it's normalized that you can have choices about what you do, whether you choose to take HRT or whether you don't,

but that you have the information so that you make an informed choice. And, you know, some of the research that I found for my book was, interestingly, women who had multiple roles who were working actually managed that transition of their life better because they had purpose and meaning and structure that supported them and that women who had given up work to look after their children did less well. And so your research adds into that that they may be in the job which would support them, but then because the effect of their memory and how that hits their confidence and their competence and their sense of agency, they then kind of retreat as we do, you know, with fight or flight, you either freeze or.

and you retreat, or you kind of blow up. So, not blow up, but you lose your temper. So the kind of big message I think you and I completely aligned in is that we need to be informed and have information, that we will be influenced by our own subjective personality type and history and our family and our context and what's happening to us at the time. You can't ignore the other circumstances of your life.

You can't just take H.R.T. and think everything is going to go away. No. But what we need to recognize is that we have agency about how we manage ourselves and how we choose to manage ourselves, that we have a sort of toolbox, that we take exercise, that we do something that calms us down, whether that's meditation or breathing regime or yoga, that we actively choose things that give, have joy in our life. what we eat, how we sleep, you know, all the kind of pillars of regulation. And that builds a stability in us that enables us to weather the storms as they come through our body.

And hopefully while the HRT regulates our hormonal body. And then we are in a better place to manage it. But we're not in control of it. Yes. So that we can do a lot that supports us. But the thing that is the biggest influence is the love and connection to others. and that love is strong medicine. And, you know, menopause can break a relationship.

And I've seen couples, you know, they're falling on the rocks of the menopause because they haven't been able to communicate and work it through together. But actually the thing that will help couples most is love. And love is not a soft skill. You know, often it's talked about as this easy thing. Love is hard because we, where you love most, you hate most. Those couples you talked about, they didn't react because they were indifferent. Indifference is the opposite of love, not hate, you know, so that we need to

learn about how we manage ourselves, love in action moving forward, being able to step back, to slow down, to communicate, to be physical with love, but sometimes not, you know, It's very complicated and the better we understand ourselves. And also our family system and the story we have as a culture, are we a family that can talk about these things, that can allow difference, that can allow conflict? Or do we have a barrier? No, no, no, we can't talk about this.

Or we always have to be fine. Yeah, it's so important because I, as you know, I met my husband many years ago when I was 18. And so we've got a very stable relationship. There's nothing that he doesn't know about me or vice versa. And we're very, very open. But when I sometimes talk to patients, especially if they haven't had an intimate relationship for many years,

and so what did your partner think about this? Oh, well, we don't talk. I just nipped to bed early and I hope I'm asleep by the time he comes up and switches off the telly or I'll make an excuse of a headache. But they never talk about it. And think, goodness me, I can't imagine being in a relationship where we can't even talk about the most intimate thing

that you're doing with your partner, let alone anything else. And I think women who have this internalisation where they feel that they're a burden and they don't want to burden with others actually makes it worse for others. I think it's surprising how people want to be burdened because if you explain how you're feeling,

it's a start of a really great conversation then, isn't it? A lot of that comes from shame, that sense of that awful toxicity that sort of coats someone on the inside that if I'm fully seen for who I am, there's something about me that's wrong with me, you know, and that I need to hide. So I can't be open. I can't say what I'm feeling or what I fear or look at my flabby tummy or because I don't believe in myself that it's okay. And it brings me up with sort of this sense of shame and that there's something wrong with me.

And I think one of the things that we need to look at, which, you know, my last book, Every Family has a story, is the transgenerational pattern. that we learn about what to believe and what we can talk about and what's okay and what isn't okay from our parents and they learned it from the generations before them. And that these patterns of responses and ways of coping with ourselves and life are passed down from generation to generation. And one of the things is, you know, in the generation that feels the pain of the difficulty, if that isn't process and dealt with in that generation, it gets passed down. down to the next generation until someone's prepared to feel the pain. And that would be true

with something like the menopause, because you would have seen your mum. I mean, my mom, I mean, she's dead now and I really love my mom, but she did not deal well with the menopause. Let me just say. And it was pre-HRT, just about pre-H-R-T. Yes, it was definitely pre-HRT. And she was bonkers, basically. And none of us had the least idea what was going on. And so where we are lucky now in the way that she wasn't, she didn't have stabilising coping mechanisms, she didn't have information about menopause, and HRT wasn't available to her.

So she had very little. And what's amazing for my generation, and I'm 63, and certainly all the women younger than me, is that we do have it available. What, as you're saying, is really devastating is that it isn't available to everybody for many reasons and some of it is bias. Yes.

Well, I had an email last night from someone from Argentina to say she'd learned so much. She was translating some of my work into Spanish, but she said we can't get H.RT over here. We're not allowed it. No one will prescribe it. We're all suffering. You just think, goodness me, it's a worldwide problem.

It really is. But women are waking up to it. There's a lot we need to do. But I think this has been a fabulous conversation because we all have got so much to learn about ourselves. And we have to really think, and I think everything that you've said is just so true for everybody, whether you're male, female, whether you're menopausal or not. There's something that we can all learn and improve. And so I'm very grateful for your time, Julia. It's a pleasure.

It's lovely talking to you. So just three tips before I finish, if that's okay. So people who might be struggling with their relationship, what three things are you? do you think would be the first steps really in the right direction of trying to help themselves and their partner? I mean, I think the first step is awareness because you can kind of sleepwalk into a terrible relationship, but actually there were lots of signs before. So kind of be aware of how you're communicating, what's changed. And I do think as a couple, walking and talking is a really good therapy being outside moving your body not eyeballing each other and kind of naming of what you're

aware of or what you're worried about is incredibly useful and then doing something that intentionally is calming and feels like a treat like going to have a pizza or you know going to a pub and having a drink afterwards or whatever it is so that you you do the thing of walking together and talking and listening and with that you can have space in between where you don't have to talk where you can begin to process what's being said and you can reflect and be more thoughtful and moving your body shifts you so you're more balanced, you're more able to take in information. So I think awareness is really good, the habit of regularly having a kind of check in with each other and maybe doing that through walking and talking or however you might do it. And I think the third one

is being aware of your critical voices and what I call your shitty committee and trying to turn the volume down on them and turn up the volume on self-compassion. Because our relationship with others is what defines the quality of our lives, but it starts with the relationship with ourselves. So if we're kinder to ourselves, we then are more available and able to have relationships with others. And so, you know, I think the big thing is connection and that we do want when we're suffering, but actually all through life, our life should be paved with connection and love of people.

Very, very important. Lots to think about and it's been fantastic. So thank you ever so much, Julia. And it's been wonderful. Thank you. Thank you, Louise. For more information about the perimenopause and menopause, please visit my website, balance, hyphen, menopause.

or you can download the free balance app which is available to download from the app store or from google play