Woman's Hour - Cervical screening; Addiction in lockdown; Soprano Grace Davidson; Julia Samuel

Episode Date: April 10, 2020

Cervical cancer affects more than 3,000 women a year. Scotland, Wales and Northern Ireland have suspended routine appointments for cervical screening, while services in England are currently mixed. What is the advice for women awaiting appointments, results or referrals during lockdown? Kate Sanger, Head of Public Affairs at Jo's Cervical Cancer Trust, and consultant gynaecologist Dr Christine Ekechi speak to Jenni.Grace Davidson is a British soprano who specialises in the performance and recording of Baroque music. Her purity of tone has attracted many of the leading contemporary composers to write for her, and her voice has also been featured in films such as The Hobbit and Pirates of the Caribbean. Grace is one of the soloists on a new album for Holy Week.We are all currently under pressure, but what if you are dealing with an addiction? According to the charity Action on Addiction, one in three people are addicted to something. How difficult can it be to remain sober or clean in lockdown, and what support can you still access? Jenni talks to Holly Sexton, Substance Misuse Practitioner at We Are With You and Caroline Turriff, a freelance journalist who is 15 years in recovery.Julia Samuel has worked for the last thirty years as a psychotherapist, first for the NHS and then in private practice. Her second book, This Too Shall Pass: Stories of Change, Crisis and Hopeful Beginnings has just been published. She tells Jenni about how people are coping and how to cope in this time of tremendous change.Presenter - Jenni Murray Producer – Sarah Crawley Guest - Kate Sanger Guest - Dr Christine Ekechi Guest - Julia Samuel Guest - Grace Davidson Guest – Holly Sexton Guest – Caroline Turriff

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BBC Sounds. Music, radio, podcasts. Hello, Jenny Murray welcoming you to the Woman's Hour podcast for Friday the 10th of April. Good morning. On Good Friday, as we face an Easter weekend of continued lockdown, how to be hopeful about the future. The psychotherapist Julia Samuel on her book, This Too Shall Pass. It's a tough time, though, for people trying to overcome an addiction, whether it's drugs, gambling, alcohol or even shopping. How difficult is it to remain sober or clean during this period? And what help might there be if you need it?

And music for Holy Week. I'll be joined by the soprano, Grace Davidson. Now, COVID-19 is not the only threat to our health that's creating anxiety. We've become used to the provision of regular checkups for cervical cancer, knowing that it's best to get an early diagnosis and speedy treatment if a test is found to be positive.

But what's the position in the current overstretched NHS? More than 3,000 women every year are affected by cervical cancer and at the moment Scotland, Wales and Northern Ireland have suspended routine screening and services in England are apparently mixed. What's the advice for women waiting for appointments, results or referrals during the lockdown? Well, Kate Sanger is Head of Public Affairs at Joe's Cervical Cancer Trust and Dr Christine Akechi is a Consultant Gynaecologist and speaks for the Royal College.

Christine, how concerned are you that screening is suspended in Scotland, Wales and Northern Ireland, and what's termed mixed in England? Good morning. Well, of course, the first thing to say is that this situation is far from ideal. However, we have to acknowledge that we are in an unprecedented situation. And so any decision that has been taken has been taken with the consideration of keeping primarily our women and our patients safe, and of course, keeping health staff safe.

What Christine does mixed actually mean? In England, the overarching message is that where we can, cervical screening will and should continue. However, the reality is that in some local trusts, very difficult decisions are having to be made with regards to the provision of services. And so what we are finding is that where services can continue, women are being offered their screening. Where there is a pressure in delivering that service, then some appointments will unfortunately have to be delayed. Kate, what sort of concerns are coming to you from women who've contacted the Trust. So we support women across all aspects of cervical health. That's women attending cervical screening, women who've had cell changes,

might be needing treatment and women living with and beyond cancer. And an increasing number of our inquiries at the moment are obviously based around the virus. And this includes women who are scared or confused about whether to attend screening or not they're up there they've had appointments cancelled or postponed sorry for cervical screening or for treatment and then there's also women who are living with cancer who obviously have a really heightened anxiety at this difficult time who might be facing change to their treatment or to their care and as many of us are staying at home, lots of people are having to maybe shield or self-isolate. There's increased anxiety. So all of the people coming to us, there's sort of increased anxiety at this time. And there's also lots of

people who are experiencing symptoms or potential symptoms who are really unsure of what to do at this point, because there's a lot of confusion around. What sort of advice have you been able to offer those who are clearly anxious? The most important thing to remember is that all decisions are being taken right now to keep you safest. The NHS across the UK is working really, really hard behind the scenes to make decisions that are right for their patients and where appointments or procedures are delayed or postponed that is because the decision has been made that it is in your best interest to delay that doesn't mean that

it isn't going to be any less anxiety inducing so do look for support do speak to your healthcare team do speak to us we've got a helpline've got a forum, we've got lots and lots of information about coronavirus. But also remember that your GP is still there. So if you are experiencing symptoms or if you have concerns about your healthcare, then your GP is there. They might be offering you a phone appointment or a virtual appointment, but they are still there. They still want to hear you. And if you are experiencing symptoms, then it's really, really important that you do go and get it checked out. Christine, it's always been emphasised that screening is there. We must take it up. The sooner we get the results, the sooner we get the treatment, the better the chances of survival with cervical cancer. How worried do you expect women to be about not being screened now

or maybe waiting for results of a smear? Well the first thing is to acknowledge the anxiety that any woman who finds herself in this situation would feel but we have to remember that the cervical screening program is such an excellent program in detecting the pre-cancerous cells. That is to say that if a woman has a test and is returned with a result that suggests an abnormality, in essence what it is saying is that we have potentially detected pre-cancerous cells that if we did nothing over a long period of time, we're talking over a number of years, may progress to cancer. So the reason why the message remains that cervical screening is important and women should engage with the cervical screening program is that we wish to

be able to detect these pre-cancerous changes before they ever evolve to cancer. Now in this current situation that we are in we have to then acknowledge that there may have to be a postponement or delay to some women or for some women who may require a cervical screen. In reality a delay of a few months will not significantly increase the risk of women developing cervical cancer. So what advice specifically would you give to a woman who's recently been diagnosed with HPV, the human papillomavirus, which we know is significant in cervical cancer, or has had an abnormal smear result but hasn't been given a follow-up appointment what did she do? Well the first thing to say is that whilst we will always endeavor to return the results for screening tests as quickly as possible in this current situation we may find that there is a

delay to the return of some of these results. I have to remind women that for the vast majority of women their results will be returned as normal. However for the small proportion of women that for the vast majority of women, their results will be returned as normal. However, for the small proportion of women that may have an abnormal screening results, there then is a triage with regards to those results. So for some women who have been detected or found to have high risk HPV and abnormal changes to the cells. In most areas, they will still be invited for colposcopy. That is essentially where we take a more detailed look at the cervix. For others where they have been found to have abnormal changes but their colposcopy appointment is deferred, I would want to reassure women as much as possible that once the acute stage of this pandemic is over, women will be invited for their colposcopy appointments when it is absolutely safe to do so and as soon as we can do so.

Kate, I know that you know of women who have symptoms but don't want to bother their GP. What do you say to them? I would say pick up the phone and call your GP. Your GP is there, they are still working and they want to look after you and they will advise you what the best course of action is. We're hearing from lots of women at the moment through our support services who are saying they feel bad bothering their GP and they recognise that the strain that the NHS is under and that's completely true however you are not bothering your GP if you have your have symptoms or any other health concern do call your GP or give us a call and we can talk you through the best course of action and Christine what are the symptoms for which women should definitely seek advice?

Absolutely. So for any woman who has noticed abnormal bleeding, a change to her menstrual cycle, in particular, bleeding after having sex, bleeding after the menopause, which is absolutely abnormal, unexplained pelvic pain, bleeding in between periods, and in some occasions, increased vaginal discharge.

And what about bloating? If the stomach feels bloated, is that a symptom? It may be, but in reality, bloating could be a sign of many other conditions which are not serious. And the overarching message would be that if you have any concerns then do seek advice through the standard channels which would be in the current situation calling and speaking to the GP. I would just want to reiterate what Kate has said that people should seek advice from their GP. If you're not able, of course, now to see them physically, you can do so by speaking to them over the phone. And Kate, just one final point. How concerned are you people at the Trust about what may be a backlog of smear tests after the lockdown is over well clearly there's going to be a big job after lockdown is over to get everyone who has overdue a smear test back into the program and get them screened and and we will be supporting the nhs and public health england uh across the uk um to get as many women in back

into the program and a lot of that will be ensuring that women understand the importance of clinical screening that they feel confident in going to their GP and comfortable with going to their GP, and that they understand how to make that test a little bit easier. Because there are still lots and lots of barriers to going for cervical screening. The virus is another barrier. But by working hard, we hope to get back to normal cervical screening as soon as possible. Kate Sanger and Dr. Christine Aggeti, thank you very much indeed for being with us. And if you are worrying about what we've been discussing, do let us know. If you have problems, we'd like to hear from you.

Now, we know the country's cultural life has been put somewhat on hold at the moment as we can't go to the theatre, a concert or a cinema but of course there's a big effort to make plays, films and music available often online. On Sunday there'll be a BBC4 concert on television at seven o'clock called Culture in Quarantine. The performers will be singing as a virtual choir, having recorded their parts in isolation but appearing on screen together. Then there's a new album for Holy Week, including Couperin's Le Son de Ténèbre, and Grace Davidson is the soloist. ORGAN PLAYS Et et Crescissus est a feriasse omnes Gregorius. Satsang with Mooji Om esti con... Om esti con... ...Eges. Grace, your voice is so beautiful.

It's one of those that gives me goosebumps. It's beautiful. Now, traditionally, the couperin there is sung, I think, on the Wednesday of Holy Week. Today, obviously, is Good Friday. Why is it meant for the Wednesday? Well, that's a good question. I'm not entirely sure why it's meant for the Wednesday. It was first performed on the Wednesday in the year 1714 when it was written by Francois Couperin and it was used with each piece that was sung I believe they extinguished the candles in the setting of the church and the

Abbey where it was performed. It is the most gloriously beautiful music and I fell in love with it about 15 years ago when I first performed it in St Paul's Cathedral. Now you're also part of the concert on the record the consort on the record for Gualdo's Tenebrae Responsories that's a really difficult one to pronounce why is that piece suitable for Maundy Thursday do you know that? The Jez Waldo, the text was written for the Maundy Thursday. So the other half of my album, which I shared with Tenebrae and Nigel Short, is the responsories for Maundy Thursday

by the Italian Renaissance composer Carlo Jez Waldo. So they are hugely contrasting to the beauty and smooth, melismatic lines of the Kufra. So it seemed like a fitting alternative on the disc. Now, I know you grew up with a grand piano in the hallway, but not a musical family. How did you become involved with music? I sang endlessly as a small child, I'm told, and I was taken to see the musical Cats in the West End when I was three years old. And apparently I stood on my theatre seat and sang along to the entire show, and my mother had to clap her hand over my mouth and press me back down into my chair. chair so you could say I got rather involved with music early on and I was lucky enough to be

encouraged to learn the violin and the piano which we were homing for another family but it was really the singing by the age of 15 that I knew I loved and the direction that I wanted to go into. I was very inspired by Emma Kirkby and her recordings of Renaissance and Brock music. And yet you went on to train as a chef. Why? I did for a year. I did a chef's course. I think at that stage in my life I'd left school, but I didn't know whether I would qualify for a place at the Royal Academy

or one of the music colleges. So it was a sort of alternative career plan. And I loved cooking, so it was a sort of alternative career plan and I loved cooking so it was it wasn't a hardship but luckily it hasn't gone to waste the training I cook every day now so it's it's there still with me. But you did make it to the Royal Academy of Music and really did rather well didn't you? Well, I hope so. I'm not sure I'm really an institution person. I think that my musical life really began once I'd left, actually, if I'm honest. Meeting and making relationships with other colleagues and musicians

and all the repertoire that I've learned over the years has been my journey and that's what's made me who I am now. You are of course known mainly for Baroque music how did you choose your speciality? I think because I learned the violin as a child I was very attracted to the Baroque music the vocal lines in Baroque music are incredibly instrumental. And there seemed to be a really sort of understanding link there for me. I also sing, I have a kind of strange combination of repertoire that I sing these days, because I've traveled the world singing Baroque music, but I also work in the film industry. And I sing these days because I've travelled the world singing Baroque music, but I also work in the film industry and I sing on many soundtracks on films and commercials.

Just to mention The Hobbit and Pirates of the Caribbean. How did you come to be involved in those two? Well, it's an extraordinary thing. I think the voice that I use and the voice I have seems to fit these two categories, the Baroque and the film. But I use different skills and discipline when I'm performing live or when I'm in a studio. For the film repertoire, I'm required to come along and add a sort of smooth colour or a mood to a scene. I'm not necessarily required to convey text or tell a story as I may do when I'm performing live in a Matthew Passion in the concert or in a church. So I mean it's been a wonderful thing for me to have a film and work in studios because I'm a mum and I travel a lot. Being able to pop into London and do this is a brilliant thing for me. How does it actually work in the studio then? You're the music that's going with a particular

scene. Are you watching the scene as you sing or not? Interesting question. Sometimes we are, but I think they tend not to because people get rather distracted and start watching the film, especially if it's a big feature film they want to see what's going on um so normally we are given headphones and we sing to a click track uh and we we just have uh in one ear we can hear some of the orchestra playing perhaps or whatever the backing is and we sing along with that Did I just hear a dog taking part in the background? Oh, I do have a dog, but I hope, I think he's in the garden. He's been instructed to stay well away from the kitchen for now. It's all right. I rather like it when people are at home and their dogs are barking

and their children are making a noise in the background. Yes, well, it's become the new way of communicating, hasn't it? But what impact is the lockdown having on a freelance musician? Well, the current situation has had a colossal impact, actually, on musicians and my friends and my colleagues. We're all suffering, rather. I mean, the rug has completely been pulled from under our feet. And unfortunately, we can't just go back to work

after the lockdown is lifted whenever that might be our performances have now been cancelled well into the future because it's so unknown and to make things more worrying promoters festivals agents record companies that they're all unable to negotiate for the future as everything is in in limbo so it's a real worry and um and it's tough emotionally too, because I'm so sad not to have been able to take part in all the wonderful things I was due to do this Easter, and Easter being the most predominant time of my year, really,

with the repertoire that I sing. I know you're involved in the Culture in Quarantine virtual choir on BBC4 on Sunday. How easy was that to work, where everybody was recording their own bit separately and then it's put together online? Well, it was interesting. It's a challenge. It's not something I've ever done before. We all sent in our individual lines and these amazing filmmakers and engineers

will be required to stitch us together into a big jigsaw puzzle. I'm intrigued to see how it turns out. I'm sure it'll be wonderful, but I don't know that it can quite replace live music. But everyone's having to be so inventive with the ways that they come up to sort of communicate with music now. And it's going to be a very challenging few months ahead and we'll see how it pans out. Well, look after that beautiful voice of yours. And that, of course, is on BBC4 on television at seven o'clock on Sunday.

That's Culture in Quarantine. And Grace Davidson, thank you so much for being with us this morning. Now still to come in today's programme, This Too Shall Pass. The psychotherapist Julia Samuel's book is about change, crisis and hopeful beginnings. How does she think we can manage this particular period of change? And the serial, of course, episode five of George Eliot's The Mill on the Floss. I think we all know there are terrible temptations when you're stuck at home all day, every day.

Are the cigarettes you hid away when you gave up still there? Is it okay to have a glass of wine before the sun goes over the yardarm? Is it okay to have a glass of wine before the sun goes over the yardarm is it okay to have a go at poker online or maybe spend the morning shopping from your sofa how much greater must these enticements be if you've suffered from an addiction in the past whether it be drugs alcohol gambling nicotine or even shopping well the charity on Addiction reckons one in three of us are addicted to something. So how difficult is it to stick with your resolve to quit at a time like this? And what help is there if you're finding it hard?

Well, Caroline is a freelance journalist who's been in recovery for 15 years. Holly Sexton is a substance misuse practitioner with We Are With You. Holly, what makes people particularly vulnerable to relapse at this time? Hello. So I think it's obviously a really difficult time for a lot of people. And I think it's often said that the opposite of addiction is an abstinence. The opposite of addiction is connection. So naturally, when people who are struggling to fight addiction, you know, to anything are being isolated, it could be really destructive to their strength. Although we know it's kind of the right thing to do for the country right now, being away from support networks that have sometimes taken a lot of motivation and hope to create an access could be really harmful to anyone with problematic drug or alcohol use. Caroline let me just ask Caroline

how hard are you finding the lockdown Caroline? Well I mean the whole structure of my life has pretty much collapsed because of the lockdown I mean I am 15 years clean. I've been going to mainly women-only recovery meetings several times a week for 15 years. And many of the women, like me, have very traumatic childhoods. And the level of bonding and identification you get in those meetings is incredibly intense. I'm an only child. But going to these women's recovery meetings is like being in a room with 20 of the sisters you've never had. And, you know, they're very tactile meetings.

I'm single, you know, I only touch people when I hug my friends or hug someone or hold their hand or stroke their arm if they're crying at a meeting and you know all that's been taken away. Caroline it was announced yesterday that pharmacists may be allowed to hand out some very strong medicines without a prescription during this period including the heroin substitute methadone. What do you make of such a relaxing of the rules, given the experiences that you've had? Well, obviously, all opiate substitution medications,

like methadone and Subutex, can be abused. And obviously, we are seeing a big rise in addictive behaviours because of the lockdown. I mean, alcohol sales have increased significantly. There are reports that, you know, people are engaging more in online gambling. So there is a danger that people could abuse those opiate substitutes. But I think on balance, it's probably safer that they have access to them rather than running short, because if they run short of methadone or opiate painkillers,

they could result to possibly buying heroin from street dealers or getting opiate painkillers online, which is much more dangerous because you can actually get more than enough to kill yourself online with almost no regulation now the holly when drug and alcohol services can't offer the kind of face-to-face help that caroline has described how important it is for her to go to meetings and be with other people. How high is the risk that people will relapse when they don't have those meetings that they need to go to? Well, I think obviously I really hear what Caroline's saying. And I, you know, I see that within clients who are sort of struggling in this situation at the moment. And I think that, you know, there's obviously a real struggle with people being isolated at home and that's something that we're

as a charity and a service really trying to kind of create ways or think of ways to try and support them through this time and I think you know in that situation it's it's almost even more important that those you know group supports Caroline's accessing find a way to still provide some form of service to the people that are in that situation at home. So I think for me, now is even more an important time to have that group support still running online so that anyone that's vulnerable right now and struggling still knows that we're open and that we're providing that support. So are you talking about Zoom or FaceTime, those kind of things?

Yeah, definitely. So I know obviously they're not quite the same as being sat in person, but something that's really positive that we've found is that people who previously, you know, you said to them, would you be up for a group, would say no, no way. People are being a lot more open to the idea of connecting to those online groups and considering, you know, from the comfort of their home, online groups and considering you know from the

comfort of their home you know they can turn off their camera if they don't want to visually be seen and it's giving people the confidence to join groups if they maybe were too anxious to before and we hope that when the service is open in person for those groups again people will feel more confident about you know joining in person and that will help their recovery grow even further. But Caroline, if people are struggling, how hard is it to admit to yourself that you need to ask for help? Well, it's very difficult to ask for help. I mean, at the height of my addiction, I was using cocaine 22 hours a day. I was drink and drug driving every day, crashing my car. I was bulimic. I was told every time I made myself sick, which was multiple times a day, I was, you know, I could have a fatal heart attack or stroke. And, you know, that didn't make me ask for help. I was told I would be dead in three months. That didn't make me ask for help it's very very difficult you know I had to be forcibly removed from the situation I was in by my family and put in rehab I would probably never have asked for help it's incredibly difficult when you're in a self-destructive spiral of addiction

to ask for help because you start to think that you want to die you know and that you know the fact that you're risking your life every day is a good thing because you're oh caroline i think we've lost you temporarily holly um from from your experience when you're dealing with women a lot i know there seems to be evidence that women find it particularly difficult to ask for help why might that be hello holly apologies i think my mic just uh disconnected briefly i missed that last bit i'm so sorry for that okay i think i heard the end of the question though was it about kind of you know women in treatment there seems to be evidence that women particularly find it difficult to ask for help. Why might that be?

Yeah, so I think that's something that we obviously see. I mean, so men in services make up sort of 73% of the treatment population. So I think coming into kind of services can be quite daunting for women, especially, you know, if they've got children or they're worried about you know how that might be perceived by others and there's definitely you know a link between domestic abuse and trauma and female substance use and you know obviously we see that with male male clients as well but the link is definitely stronger with with females and so coming into that environment and where they may face people who, you know, they know through their trauma or that sort of thing can make it really,

really difficult to come in and ask for that help. And that's why we have things like, you know, women's groups and why if someone does come in and ask for some support, they can choose to have a female key worker so that we try and encourage women you know this is a safe space for you even if even if that getting through that threshold is really really difficult we try and make sure that the service that they receive you know they they let go of those kind of insecurities and fears and that we're really supportive to them. Holly there may be families and friends who are spotting that something is going wrong. I mean, there may be people who live with somebody who's a recovering addict or they may see them on Zoom or whatever if they're having meetings.

And they may be saying, look, you need to do something about this. You're slipping back. How should family or friends approach an addiction I think you know this is something we people ring us up and ask a lot about and it's really really difficult to have that conversation because often you know not always but often the person you're wanting to speak to about it might not want to speak to you about it so I think for anyone that is out there you know concerned about families and friends go on our website because we've got some really really useful information about how to have those difficult conversations with people you know how to look out for when is the right time to speak

to them and when they're kind of maybe going to be more open to that conversation and Caroline I think we have you back now so can I just put this point to you as well how helpful can family or friends be how should they approach you if they think you're in trouble I think that family and friends can help to an extent but they don't really understand the extremes of drug addiction or what would happen if you relapsed I think family and friends need to direct people who they think have an addiction towards people who understand that addiction. So maybe, you know, charities like We Are With You, or, you know, they could phone the NA or AA helpline or the government's drug service, talk to Frank. I think, you know, they need to, people with a problem need to be directed towards other people who've had a problem or understand that problem.

And that's the best thing that family and friends can do, because it is not possible, really, for somebody who has no professional understanding of addiction or no personal understanding of addiction to really understand the lengths that people will go to get drugs. The fact that they will risk their lives multiple times a day to get drugs is very difficult for family or friends to understand. But other people who've been through that addiction, you know, this is why I find, you know, the women's recovery meetings so incredibly powerful because, you know, there's such massive identification you know people understand exactly where you're coming from caroline what you've been caroline

i'm going to have to stop you there thank you very much indeed for being with us holly sexton thank you too of course alcoholics anonymous narcotics anonymous are the things caroline was referring to and we will put details of organisations that might be helpful on the Women's Hour website. That'll probably be a little bit later in the day. And if you have trouble like this, again, let us know. You can email us. You can tweet us. You know how to get in touch with us. Now, I can't think of a title to a new book that is more aptly timed.

This too shall pass. Stories of Change, Crisis and Hopeful Beginnings was published just before the lockdown began. Its author is the psychotherapist Julia Samuel, who, of course, joins us from home. Julia, how are you coping with this change and crisis? I think I'm the same as everybody else. It comes in waves, doesn't it? Sometimes I think, oh, I'm doing really well and I'm really kind of winning here or I'm balancing. And then other times I get furious about the smallest things. So then I have to listen to my own medicine, which sometimes you

sort of forget in your back pocket when you're cross with your husband for not putting stuff in the dishwasher. What is your medicine on that particular question? How do we avoid losing it with members of the family when you're all locked up together? I think the first thing is to kind of realise that we all are finding this difficult. And so, you know, if you're not learning Chinese and playing the violin to give yourself a break, but also that we will have tensions, but also to slow down. And I think one of the things that families can do is have a kind of Cobra meeting together and just check in and say to each other, I'm finding this difficult and this so that you're making transparent what is actually being played out over the dishwasher or, you know, chopping up the carrots or whatever, so that you're more open with each other and honest. Why are we generally ill-equipped to deal with change, especially a change of this magnitude? I think most of us have a problematic

relationship with change, even if it's change that we choose. But I think, and also particularly in the 21st century, I think we have a kind of false sense of our control. So when now we are being completely controlled by a pandemic, we kind of hit a wall. I think people have sort of thought, if I think my way around it, if I will my way around it, can I recondo my feelings to be tidy? And then recognize fundamentally that they are powerless powerless and the thing to do is to have

you know to have the sort of serenity prayer to accept the things you cannot change change the things you can and have the wisdom to know the difference which obviously links to the addiction person you're talking to before what's the best way then to look after ourselves? I think the first is in fact just in your question is that we do need to take care of ourselves that we can't things we do to block change often do us harm so to support ourselves in it to be self-compassionate, kind to ourselves, connected to other people. I think that really matters, even if it is on screens.

I think we need that more than anything else, and it is the predictor of helping us manage best is when we feel close to other people. Exercise, as sort of unglamorous as it is, even if it's on your 12-minute app or with Joe Wicks on the telly, it reduces the cortisol in your body, which sets you on high alert. So it reduces that hormone and gives you oxytocin, which calms you. And if you do a breathing exercise after that, you know, you don't have to find your inner chi chi but just breathe in for seven and out for 11 again that's a very good combination of exercising and breathing so what you want to do when your system goes on high alert is to do the behaviors that calm you intentionally do things that comfort

you listen to grace davidson or a playlist or plant a bulb. But intentionally doing it helps you. And then, funny enough, altruism, like the response to the NHS, helping other people helps you feel better about yourself. And I think it gives you a sense of agency when you feel so powerless. And it has the side benefit of improving your immune system. And what about this cultivating hope? I mean, Hopeful Begin beginnings is part of your book. How do you make yourself feel hopeful? This too shall pass.

Yes. I mean, I think you can't have hope when you're in the midst of the crisis, because that is a kind of false hope. And it's a kind of thin optimism, which doesn't work. So hope, as you're coming through the other side of the crisis, it isn't just an emotion, although that helps. It's how we think that we have a capacity to set realistic goals, how to achieve them. And then that gives us self-belief. And so it's a very intentional attitude. And it is hope that is the alchemy that turns a life around. So you may have a tiny flicker now, but, you know,

hearing everyone on your program today, people have seeped into every aspect of people's life. So it's a little light at the end of the tunnel but as it passes and the wave crashes then to do things that ignite their own hope i know you're now working with medical staff at an nhs hospital what sort of help do they need and how can you help them in some way I mean they so I give psychological support I think what helps them is the permission to that what they're feeling is normal in the same for us at home and they may have particular difficulties and challenges so to talk them through and I think the main things by them talking amongst

each other they each realize that they're not the only one with a worry or finding it difficult and they kind of realize that what they are feeling is normal too and it supports them it's connecting because most of the time in the NHS you're all on on and being active and doing things so just sitting down having sort of 40 minutes to connect, I think helps build their resilience as a team. And teamwork makes an enormous difference. How are your clients finding things when you can't see them face to face? It's a huge range.

I mean, some of my clients who were most kind of depressed and very low there's something about this that matches what they're feeling and they actually feel a sense of relief that you know that the outside world is feeling what they're feeling like so they don't feel so at odds with the world um and i think everyone has a kind of default mode coping mechanism when they're challenged by change. So people who were anxious before, the volume is turned up, they feel more anxious. I mean, no one is finding it easy, although it is by no means the same for everybody. I mean, there are people like you've talked about and those with financial difficulties, you find it much more difficult or in volatile, violent relationships. Julia Samuel, thank you very much indeed for joining us this morning.

And I will just repeat the title of your extremely tightly book. This too shall pass and it will, won't it? It will. I was talking to Julia Samuel. Now, we had lots of response to the discussion about addiction and a number of you got in touch to stress that you were still attending meetings online. Kath emailed to say there are active AA meetings all over the world. I'm caring for an elderly relative in Ireland,

but very much in contact with AA meetings in Stockport. There's great sobriety and people ready to support and welcome newcomers. I'm supporting someone after relapse. It is very positive. Change is possible and strength in female sobriety is available. Your article was too negative. Yes, it is hard, but there is hope, support and change is possible. An AA member added, lots of Alcoholics Anonymous meetings are being held on Zoom. Contact your local AA by phone and they will supply links. And someone who didn't want us to give a name said, Thank you for your piece on addiction.

I'm currently supporting one of my children, and I'm getting tremendous support from an organisation called Props. They support the carers, but the job of giving advice to our loved ones is the job of professionals. They're still supporting their clients by phone, even though face-to-face meetings are not allowed at this time. Sue added on twitter not to minimize other addictions but you didn't mention food addiction in these times of isolation mixed with anxiety i'm finding it very hard to contain my food addiction and lucy also on twitter said ironically my son who is addicted to crack and heroin, is safe right now in detox.

You wouldn't believe what a relief it is to know that he's safe. And lots of you loved hearing the soprano Grace Davidson just as much as I did. You wanted us to remind you of her name. And Julia asked, this morning on the programme, Grace Davidson sang a piece of music for Easter Holy Week. Please, could you give me the name of the piece of music, or the name of the album on which Grace sings this? Well, the album is by Tenebrae Choir, and it's called Couperin's Leçon de Ténèbre. And the full title, and here I go, is Couperin's Leçon de Ténèbre

and Gaisoil de Ténèbre Responsories for Monday, Thursday by Ténèbre. Gosh, I managed to get it all out. Now do join me tomorrow for Weekend Woman's Hour when we'll be discussing how best to share responsibility for children if you and your partner are separated, and what to

expect if you're pregnant during the pandemic and maybe about to give birth. That's tomorrow afternoon, Saturday at 4 o'clock. That's all I've got for you today. Bye-bye. Hi, I'm Catherine Bell-Hart. And I'm Catherine Bowhart. And I'm Sarah Keyworth.

We're comedians separately and a couple together, and we're the host of You'll Do, the podcast that gives you a little insight into perfectly imperfect love. Yeah, forget nights in with this one and hashtag couples goals. We want to know the whys and hows of sticking with the people we love

and asking a few of the questions that are meant to help us develop intimacy. So why not give it a listen and subscribe to You'll Do on BBC Sounds. I'm Sarah Treleaven and for over a year I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started like warning everybody. Every doula that I know. It was somebody out there who's faking pregnancies. I started like warning everybody. Every doula that I know. It was fake.

No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story, settle in. Available now.