Woman's Hour - My Best Day, Marina Litvinenko, Cancer testing

Episode Date: September 11, 2019

There's a call for population wide testing for the BRCA gene in the Jewish community, which is at greater risk carrying the gene mutation which is linked to ovarian, breast, prostate and pancreatic cancer. We're joined by Dr Ranjit Manchanda, Consutant Gynaecological Oncologist at Barts NHS Trust who's carried out new research funded by The Eve Appeal, and Caroline Presho who underwent preventative surgery after testing positive for a BRCA gene mutation.Marina Litvinenko on the play about her husband Alexander's death in London and her subsequent fight for an public inquiry. We're also joined by Myanna Buring who takes Marina's part in the play A Very Expensive Poison at the Old Vic Theatre.In the next in our series My Best Day, Alison Fletcher explains why this picture (above) means so much to her. In 1962 an Australian GP, Dr Claire Weekes published a book called Self Help for Your Nerves in which she said she could cure panic, depression, sorrow, agoraphobia and anxiety. The psychiatric establishment dismissed her as under-qualified and populist but her book sold well and is still in print over 50 years later. Judith Hoare, author of The Woman Who Cracked the Anxiety Code tells us about Claire Weekes' treatments, the reaction from her contemporaries and her legacy now.Presented by Jenni Murray Produced by Jane ThurlowInterviewed guest: Ranjit Manchanda Interviewed guest: Caroline Presho Interviewed guest: Marina Litvinenko Interviewed guest: Myanna Buring Interviewed guest: Alison Fletcher Interviewed guest: Judith Hoare

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2, and of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme. Peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, Jenny Murray welcoming you to the podcast for Wednesday the 11th of September. In 2006, Alexander Litvinenko died as a result of being poisoned in a hotel in London. A play at the Old Vic, a very expensive poison, tells the story of the events leading up to his death and his wife's efforts to get justice. I'll be joined by a man of Buring who plays Marina Litvinenko

and by Marina herself. Dr Claire Weeks was an Australian GP who wrote a best-selling book, Self-Help for Your Nerves. The biographer of the woman who cracked the anxiety code is Judith Hoare. And when we asked you to send pictures of you on your best day, hundreds of you got in touch. Today, Alison Fletcher on the day she remembers best. We've known for some time that there's a gene which can cause breast cancer. It's called the BRCA gene and it also has a role in some ovarian, prostate and pancreatic cancers.

We know that if a woman has an immediate relative who has had such a breast cancer, she can be tested and she can then make a decision about whether or not she will have prophylactic treatment. We had not heard before that an entire population could be affected by the gene, but some research among people of Jewish heritage has found they're five times as likely to carry a BRCA mutation and are consequently at greater risk of developing one of the cancers. It's been proposed that everyone in the Jewish community should be offered a test. Caroline Prischow chose to have a double mastectomy when she was found to have the gene. Dr Ranjit Manchanda is a consultant gynaecological oncologist at Barts Health NHS Trust. What are the current guidelines for who can be offered testing and who

can't? So immediate relative could be the person who's got cancer themselves. If you've got cancer yourself, it could include a first degree relative like your sister or your mother. The testing criteria are based on a mathematical probability. So by looking at the family history and the distribution of cancers and the relationship of the relatives If there is a 1 in 10 chance of carrying a faulty gene Then the NHS, and not just the NHS but all international health systems would offer you testing So Caroline, how come you came to be tested? Because I think it was your aunt and not what would be classified as an

immediate relative who had the gene. Yes so I went to my GP because my aunt had been diagnosed with ovarian cancer. Her mother had had pre-menopausal breast cancer and died at 58 and we're of Ashkenazi Jewish descent so she was offered testing when she was diagnosed with ovarian cancer. She urged the family to go for testing, which eventually I did, but I was refused because my GP decided that I probably would not carry a mutation and I should go home and not worry about it. Thankfully, my dad left me the best legacy he could, and he went and got tested in secret. And he died before he went and got tested in secret and he died before

he got the results and when his results came out the consultant who gave the results to our family said that his children should get tested. Did he have prostate cancer which was related? He didn't, no. He just went for testing because his sister was found to carry a mutation and his mother had had breast cancer at 48. Ranjit, how often does the BRCA gene occur in this kind of overall population? So most literature and information suggests that about 1 in 40 individuals in the Ashkenazi Jewish population carry a faulty BRCA gene mutation, which is common to the population. And the general population outside the Ashkenazi Jewish population, it's probably, we now feel it's probably about 1 in 200,

so somewhere between 1 in 200 and 1 in 300. What made you decide, Caroline, that you would opt for surgery? I started off with screening, surveillance. so I had a mammogram and an MRI which is very very stressful and the results came back that I had shadows on both breasts which absolutely terrified me and in my mind I was dead and buried and my children would not grow up with their mother and I went back for an ultrasound and it was found that that was purely due to where I was in my menstrual cycle. And it was at that point that I thought, I can't do this every year.

I can't live with this anxiety. So I would rather have risk reducing surgery and do it on my terms than have to have surgery after a cancer diagnosis and maybe chemotherapy, radiotherapy. So you had a double mastectomy. Yes. What about your ovaries? I've also had my ovaries and fallopian tubes removed. So that takes you straight into surgical menopause, which I treat with HRT. But doing that, the stress relief outweighs having any symptoms I have. How widely, Ranjit, is this higher occurrence known within the community?

I think there's increasing awareness as genetic testing becomes more common and more applicable across diseases. And there's increasing awareness, but there is still huge restricted access and limited awareness, both amongst the public at large and health professionals. So there's a lot of work to be done to further increase awareness about the BRCA gene. These cancers are largely preventable. And the opportunity to have testing and identify more people at risk, if offered to everyone, will save more lives and in the long term also save more money for the NHS. Why save more money for the NHS? Because the testing is expensive. If you have to have a double mastectomy and have your ovaries and fallopian tubes removed there's cost cost cost involved sorry i don't mean to emphasize but it has to be discussed we've analyzed this

very carefully and we've published three papers on this in peer-reviewed journals where we analyze the cost of testing the cost of treatment the cost of prevention. And scientific literature clearly shows that it is cost-saving for the NHS and you will save more lives. You save more lives because you prevent more cancers and the cost of treating cancers far outweighs the cost of preventive surgery. And also the cost of the test is not expensive. Testing is becoming much, much cheaper and the costs of tests have fallen drastically over the last 10 years. So it's not expensive. Testing is becoming much, much cheaper and the costs of tests have fallen drastically over the last 10 years. So it's not expensive. What have your sister and your half sisters done? So we are four sisters, so two from each marriage. My two half sisters tested negative, so they're okay. They don't need any more testing or screening my full sister also carries a

BRCA2 mutation and she has opted for surveillance so she has an annual mammogram and MRI and currently there's no ovarian screening so she has to rely on knowing her body and looking out for any symptoms that are out of the ordinary I find it very difficult that she does that because obviously I would like her to be as risk-free as possible, but I have to respect that it's her choice. To what extent are you arguing, Ranjit, that the entire Jewish population should be offered the possibility of being tested? Yes, that is what the evidence suggests. So the studies we've done in the North London Jewish population in this country, corroborated and supported by studies that have been undertaken in Canada and in Israel by colleagues, show clearly that we pick up more people at risk and we will be preventing more cancers.

It's a question of offering the opportunity for people to make informed choices as to whether they want to have testing or not. And that's a dynamic process and can change with time. But whichever way you look at it, we will pick up more people at risk and we will therefore be able to prevent far more cancers than we do today. And our study shows that it does lead to at least a reduction in anxiety and there are no detrimental long-term consequences within the study comparing the two strategies of testing.

What's the likelihood of NICE, the National Institute of Health and Care, excellent, what's the likelihood of them accepting that this should be done? I think scientific evidence is out there, and I hope NICE will pick it up, or decision makers will pick it up and move in this direction. There is increasing recognition, I think both nationally and internationally, that this is a way in which we can prevent many more cancers

and is a useful thing to consider. And it's something Caroline herself, we and others are engaged with, both in the UK and with colleagues across other countries to try and move forward. And I'm assuming, because we know it can affect not just breast and ovarian but prostate and pancreatic cancers I'm assuming you're suggesting that men as well as women should be offered the possibility of testing but how might prostate or pancreatic cancers be prevented? So there's very little we can do from a prevention point of view for both prostate or pancreatic cancers. Pancreatic cancers are very difficult to pick up. There is a lot of research ongoing to try and pick them up early,

but that's very much in the research phase and there's nothing that's applicable that's out there that can be implemented. Prostate cancers, again, there are research studies which are looking at screening for prostate cancer and trying to improve outcomes by screening people in that, but it's not yet clinical practice. But we can prevent a lot more breast and ovarian cancer, which have a much higher incidence than the prostate and the pancreatic cancers, and that will save lives. How relieved are you, Caroline, that you had it? Oh, I would do it again in a heartbeat, absolutely.

The relief is amazing. Caroline Prescio and Dr Ranjit Manchanda, thank you both very much indeed for being with us. Now, in 2006, Alexander Litvinenko, a young Russian detective who'd moved to the UK with his wife and son and become a British citizen, died after he'd been poisoned with polonium-210 in a hotel in central London. His story is told in a play which opened last week at the Old Vic Theatre.

It's called A Very Expensive Poison and traces his history and that of his wife Marina in Moscow and then as they settle here. It also follows Marina's efforts to get a public inquiry into her husband's death. The conclusion was that the Russian FSB secret service had most probably authorized the killing with the approval of Vladimir Putin. Well, I'm joined by Mayanna Buring, who plays Marina, and by Marina Litvinenko. Marina, how happy were you to have your story made into a play? First of all, it's absolutely amazing to have my story on a stage.

I can't say I've never believed it, but I never have even idea how it might be made. But what I saw, and I saw this play already three times, and I would say I can have a conclusion. I think it's amazing. First of all, it's my life story and my love story. It's done so well. Thank you to Mayanna and Tom. Tom, who plays your husband, of course. Tom, who plays my husband. And it's most important for me. But, of course, all this story

for what happened in London in 2006 brought in a certain way and so interesting, and it's attracted different people from different levels and different ages. And when I saw these people in theatre, when they discussed about this, I realised it was all right to bring the story to stage. It's a tough story, Marjana.

How did you prepare to play Marina, knowing she may well be sitting in the audience watching you do it? Well very early on it was very clear to all of us and definitely to me that what we were not doing was a documentary. Lucy had done an extraordinary, Lucy Prebble absolutely who is extraordinary and she had also done an extraordinary amount of research and what she had captured was the sort of madness of of of the event and and the times but also um the true the emotional truth of it and and with that in mind it gave me a freedom to let go of this idea that I was going to do it you know a sort of stage physical replica of you, Marina. And instead, I just needed to follow Lucy's work and Lucy's words

and find the emotional truth in all of the beats that she had written. It's all there on the page. And by doing that, we would achieve what we all wanted to achieve, which was to get this story out there, to remind people of it or to educate people about it again, and also to help people to feel this emotional madness. Marina, it is at times incredibly moving. I mean, we open with that awful famous picture of your husband lying in bed in hospital and the impact it all had on you.

And then at times there's almost pantomime in the comedy, where the audience goes from feeling they want to be in tears to just howling with laughter at some of the amusing things. How do you cope with the fact that it swings from tragedy to comedy? 100% I agree. It would be what already was mentioned, dog drama. It would be not right. And people might be not attracted to watch it.

They would decide, we read about this. It was a lot of publication, documentaries. And how it was done, it's amazing because it's so entertaining. It's so unusual. It's the music. It's the dancing. I have no idea, again, what I would like to say.

I have no idea how it might be made so perfectly. And, of course, when I received the question, who's going to play you, I have no, again, idea who it might be. Of course, when I received the question, who's going to play you? I have no idea who it might be. But when I saw Mayanna first time, from the very beginning, I realized it's exactly me, even without seeing her on the stage. There you are. She approves of you, so that's all right. But from the actor's point of view,

you know, these moments in the play when it's very funny, the hapless assassins who, you know, seem to be a couple of complete idiots, the portrayal of Putin, a frightening and dangerous thing. How easy is it for you as actors to switch from anguish to humour? Again, you just play the emotions in the moment. And I think that think that's what again Lucy Prebble does really brilliantly she juxtaposes this place where she allows you to laugh

and this place where she reminds you of the horror and those are constantly in tension with each other throughout the play so it's very deliberate and in a way I feel that the horror is more effective because just prior to it, you've been belly laughing. Marina, there's a mention in the play of Anna Politkovskaya, who I interviewed on Woman's Hour. She was a journalist who opposed Putin.

She was shot a month, I think, before your husband died. And I wondered how much her death inspired you to fight for justice. Anna Politkovskaya was an amazing woman. And she was an important person in the life of my husband. I could call them friends. And I saw her a few times. And her death for Sasha was devastating. And he pointed Putin as a person who killed Anna Politkovskaya. He said it in a frontline club. And I believed if Sasha would be alive, he'd be able to investigate this case. He would try to find who behind this crime.

And remember Anya as a very determined person and doing incredible stuff, helping people in Chechnya. Even when she was in danger and was asking to move from Russia, she said, I can't. Okay, I can't write my articles being in Europe or in America, but how about these people? And it's every time thinking about people and what you can do to help people.

It was important for me too. How difficult though was it for you to get the public inquiry? There's an extract of Theresa May in the play when she was Home Secretary. What was it she actually said to you when you were trying to get your public inquiry? First of all, of course, it was not easy because it took a quite long time. But then I was not thinking about this, is it difficult or not,

because I didn't know how long it will take. I just knew we need to achieve a result. If it's not possible to do in this direction, we will take another one. If we need to go to inquest, it's one thing, or we're going to public inquiry. And every time when I had some kind of destruction, I couldn't believe why. I don't do nothing wrong. I do this for this country. I do this for Russia. And of course, when they received this rejection of public inquiry from Home Secretary, who was Theresa May at this time, I couldn't understand why. And everything that was saying why, I didn't feel it's true.

She said it was not in the public interest, I think. And even it would cost a lot of money. It was just a the public interest, I think. And even it would be cost a lot of money. It was just a question why it's just so important to all of us to understand why these two countries as Russia and United Kingdom can't be together. The play, as I think I've suggested in my questioning, is openly critical of the Russian assassins, the probable approval of President Putin. And I wondered for both of you, how much does being involved in this make you fear for your own safety? Well, I mean, from my point of view, it was very clear that compared to so many people like you, like Sasha, like Ben Emerson, like so many people involved in this case, like Anna, the fear that I experienced is nothing in comparison to these

incredibly brave individuals who are out there on the front line fighting all the time. But the fact that as soon as I read this, it was a story I wanted to be a part of. It felt important. And I feel it's more dangerous to be afraid of telling these sorts of stories. I think that's for me where the danger lies. Marina, what about you? I absolutely agree. I would say even silence is not protection anymore. You have to say the truth and you need to say this aloud. And I can't say I don't like this question about safeties. I think you have to live your life. You need to live your life with your friends, with your family, and just not to be afraid.

Marina Litvinenko, Miana Bering, thank you both very much indeed for being with us. And I saw the play on Thursday and I was gripped throughout. Thank you both. much indeed for being with us and i saw the play on thursday and i was gripped throughout thank you both thank you now still to come in today's program the woman who cracked the anxiety code a biography of dr claire weeks whose book published in 1962 was self-help for your nerves and the serial episode three of black water and by the way you may have missed jane's conversation with the women's aid about je Geoffrey Boycott's knighthood. And on Monday, a phone-in about your feelings about Brexit.

If you've missed live programmes, you can always catch up by downloading the BBC Sounds app. Now, a few weeks ago, we asked you to get in touch and send us a picture that somehow captured you at your best. Not just looking your best, but feeling your best. Hundreds of you got in touch with pictures of your best day, and we'll be running as many of your stories as we can over the next two weeks. You can see the photos we're talking about on Twitter, Instagram and on the Woman's Hour website.

Today, Alison Fletcher told Laura Thomas about how she came to a political protest relatively late in life. This is a picture of me taken by a passerby outside the House of Commons last October when I went down and joined in a demonstration of women who'd met at protest about the fact that their pension ages had risen and they didn't know about it. Tell me what this situation means for you personally, if you would. Well, I thought when I started work that I would retire at 60 because that had been the case for women since World War Two. I have now looked back and if it was to change, you would have thought it would be quite a big thing and it would be debated. So I was shocked when I found out personally that instead of retiring at 60 in 2021 I've had seven years added so I've got to work to

67 which for some of my schoolmates who left at 16 would mean 51 years of working you never know now if if you'll live long enough and have the health to enjoy it. But this photo, we ask for your best day, and I'm sensing that even though this issue is a vexed issue, something that has caused problems and sadness and anger and frustration, I can hear all of those things in what you're telling me, there is a sense that this day was a good day, that there was something't know what was going to happen I just rolled up in London and walked through the centre of London from a small town right up to Parliament Square and I could hear the noises I approached and there were hundreds of women on the green outside

the House of Commons and they were talking and chanting, and I just joined in, and I met people there who felt like me, and they'd come, some of them, all the way down from Newcastle. Some of them had just come from London and said they'd heard about the demonstration on Twitter, and I didn't even really know what Twitter was, but I later joined that and managed to talk to more that day but it took up a momentum of its own and we spilled onto the road in front of Parliament

and we ended up sitting in the middle of the road stopping the traffic and we actually felt like we had our voice heard because we were so frustrated at being ignored. It made me feel quite empowered. I also felt quite privileged that I could do such a demonstration in a country like Britain that allows peaceful demonstrations, as should be the case in all democracies. But as we know, in a lot of countries around the world, in France and Hong Kong, you have to fear the police.

But in fact, I found that the policemen who came over to us, as we demonstrated, were friendly. And to be honest, I thought they probably agreed that we should give the MPs a hard time. Did you make friends? Yes I kept in touch with some people and the lady who took the picture I joined Twitter and kept in touch with her and I spoke to other people who there's quite a community now on Facebook and on the internet of women all across and I feel like we are friends we're

sister in arms and I'm doing it for my sister as well who's a bit younger but in reality we're doing it for all women and probably a lot of men too who don't want to have their pension age increased either. And it sounds like the the energy and the spirit of that day has been something that you've carried with you since yes certainly it gave me a boost I felt like I'd actually done something and I feel like I might be part of history because there was a statue there of Emily Pankhurst and I think the history there was of the suffragettes and the suffragists and I know that their struggle took years. It took a long time for the women to get the vote

and I think it might be a long time for people to see that this change was wrong too. But as long as we win in the end, whether it's for us or the next generation of women and men, I think it was worth doing. And I'm very pleased that I could actually do something practical and get the message out there. Alison Fletcher was talking to Laura Thomas. In 1962, an Australian GP, Dr Claire Weeks, published a book, Self-Help for Your Nerves,

in which she said she could cure panic, depression, sorrow, agoraphobia and anxiety. The book became a bestseller and it's still in print, but she was rather poo-pooed by the psychiatric establishment who dismissed her as not being qualified for this kind of work. She was interviewed on Pebble Mill in 1983 and spoke about how a housewife might manage depression. Take a housewife who stands at her window and at dusk she's looking out.

She has had bouts of depression before and there's just something about the dusk, the falling leaves, perhaps a distant church bell, something that just strikes a note inside her and she feels her heart as she thinks go woof and you know that little clutching hand on the on the tummy and she thinks no not one of my bouts again oh she becomes immediately apprehensive and afraid because she knows what they're like she knows what it's like to go through a bout of depression and now this is where she does the wrong thing. She starts to rush here and rush there to try and get rid of it. She'll rush to the supermarket. And when she's finished, she'll think, now, has it gone?

Am I any better? Has it gone? And, of course, the best way to remember something is to try so hard to forget it. And, of course, the family will say, oh, Mum, get yourself up out of this one. You know, do something about this one. She's been doing it perhaps for days, mum, get yourself up out of this one. You know, do something about this one. She's been doing it perhaps for days, trying to get herself out of it. And the more she tries, the deeper she gets into it. Now, that is a perfect example of how not to manage a bout of depression. Dr. Claire Weeks.

Now, Judith Hoare is the author of The Woman Who Cracked the Anxiety Code. Judith, why were you interested in writing Week's biography? Well, Jenny, in my 20s, I was working in Parliament House in Canberra covering federal politics, and I'd moved there from Sydney. It was really a hothouse. It was stressful deadlines. I was very young. And then I got a bout of illness, a problem with one of the, funnily enough, one of the early contraceptive devices, very flawed. And I ended up in hospital and I got very run down, went back to work. And I think the combination of the new job, the stress, the pressure, and I got heart palpitations, rather as Claire did when she

was young and under stress. And they worried me. I went to a cardiologist. There was nothing wrong with my heart, but they were unceasing. And as a result of that, I became more and more alarmed by my own body, which I felt was quite out of my control. And perhaps there was something wrong with me and I didn't understand what it was. A friend of my mother's had lent her a book by Claire Weeks and she passed it on to me and all of a sudden these really bewildering feelings in my mind and body were explained and when I read them as a journalist I thought who is this woman who can explain what seems to me to be so distressing and baffling so simply. Now we heard we heard her say, oh, come on, snap out of it,

this is not the way to deal with depression. What did she say was the way to deal with anxiety and depression? Well, she was a scientist and she had, as a result, and a doctor, she understood very much, from a scientist's point of view as well as a doctor, the fight or flight reflex, which is instinctive to all of us. We can't control that. If a stone drops from the sky or something like that,

or a tiger runs at you, you can't control your response. So what she knew was that when you get into that situation where you have very inappropriate panic responses when there's no tiger or no terrifying situation, that you must just go with that terror. You can't fight it because the instinct is to fight it. The instinct is to run away. It's called fight or flight. But there are occasions for people with high anxiety where there is really no threat and they're a bit overwhelmed by that fear that they've got because it was fear she knew that was driving it. She has a series of words which she

said you should follow, kind of mantra. What are those words? Yes, just simple six words designed to calm the nervous system, to deregulate it as it were. They were face, accept, float and let time pass. All of which are fairly self-explanatory. Possibly float was the most difficult concept. People today might try and say it was equivalent to mindfulness. It's just a bit of release, just yield entirely is what she said to the feelings. You must let those feelings run their course for if you don't, you perpetuate the vicious circle. It's by fighting the fear, which is so instinctive in people, that perpetuates the fear. What she would say is you have had first fear and then you add second fear to first and you're in a vicious circle before you know it.

So you must yield to it. Now, she was absolutely convinced that she had the cure, that cure was possible. What evidence did she have that it was possible? Look, the evidence was in the huge, grateful hordes of individuals, first in her practice in medicine, where she would explain to them very simply the way in which the nervous system worked. She wasn't a great believer in delving into the past. I mean, people had problems and yes, they should be addressed, but what they were worried about was the all-consuming feelings

of fear that they had now, and that had to be addressed. But she learned from being a doctor that she was offering something special to people. They got better. Once their situation was explained to them, once the simple medical, the way the nervous system functions and the way to calm it down, as it were, is explained to them, they have a small toolkit where they can take charge and that those black areas become less terrifying. Then when she published the book,

it was a bestseller. The first book sold, I think about 600 copies were printed and they sold within three hours. Why was the psychiatric establishment so opposed to her and just poo-pooed her ideas? I think she was an outsider. It was like a silo. If you weren't a trained psychiatrist and they'd studied Freudian psychology, she might have been a scientist and a GP, had a scholarly background, but she was not a psychiatrist.

She was an outsider. She had a zoological background. Well, not only that, she had a doctorate of science. So she'd reached the very top. She'd got a Rockefeller scholarship to London to study evolution in lizards. She was working at the absolute top of the tree and had an international reputation in that field and then became a doctor. But that wasn't good enough.

She wasn't a psychiatrist. And also, here she is writing books called Self-Help. Well, they thought that was just nothing more than grandma's advice and they didn't see that beyond the simplicity of this book lay a depth of understanding of evolution, of the body and of the mind and of the interconnection of all of that. She understood that so clearly, but she was also perhaps being just an older woman standing up there in front of those audiences probably didn't help much in those days either, but she was really an outsider who wrote self-help.

To what extent was she one of the first self-help book writers? Look, I can't be definitive about that, but I'm pretty sure looking back on it, she was around the time of Dale Carnegie's book, How to Make Friends and Influence People. So she was, you'd have to say, one of the very early people. And she did say she had two choices. With a scholarly background, she could have written a scholarly research paper, but she said she could see the need was so great that she should go directly to the people, and she wrote a little manual for people who needed help right now. Not an appointment with a couch in a week's time, but something that would help them in that desperate state people can get into.

The understanding of mental illness and the words used to describe it are very different now from what they would have been in the early 60s. Where is she different and where is she the same as what we might hear now? Well, I think she identified fear was at the centre of her analysis. If I can go back a bit in time, fear, I think a lot of scholars and medical people at the early part of the 20th century in World War I realised how important fear was in deranging people's sense of their own comfort and themselves. But you had Freud and psychoanalysis and early childhood experiences and sex. So that sort of went off onto the mind area. I think she brought it back to the body.

She brought back how important it is, those terrible feelings that fear brings. It's not just a feeling in your head you're frightened. It's a whole body feeling. Your heart races, you worry, you can't breathe. People get all sorts of different terrible dissonant symphonies of physical responses. I think people now understand how that body-mind connection is so important now in a way that got derailed through the 20th century when everyone focused on the mind. What would she have made then of mindfulness, which is very popular now, and cognitive behavioural treatment? I don't think she's easily categorized. I think she would say that the rational mind can't do battle with these feelings. So the people who were saying

thinking positive thoughts and reframing things, I don't think she would have thought that was terribly useful for people in a state of high panic or phobic or obsessive people, people really distressed because the rational brain can't overcome the wash of feeling. They have to go with the wash of feeling. So she might have understood mindfulness because in a sense that's got an acceptance notion. She would have understood a return to the body, which the neuroscientists now have more. And I think people more understand that getting the body into a state of peace is very important and the mind often can't do that just by itself. So I think she'd have that in common. What she probably wouldn't

like about today is people chop anxiety up into lots of different categories. I think in the latest manual there's something like 24. You've got all these different disorders, anxiety, social anxiety disorder and so on, and people are put in these categories. She wouldn't have liked that. She was what's called a lumper, not a splitter. She saw fear generically as behind most anxiety. She's not talking about psychotic people or people with psychotic illness.

It's just the general run of nervous illness. I was talking to Judith Hall. We had a lot of response from you on the breast cancer gene question. Caroline said, my mother died of breast cancer at 47. I have no other living relatives and I've been refused testing for the BRCA2 gene, basically as I don't have enough relatives. No opportunity for the preventative care discussed for me. Why? Someone else said you are talking about immediate relatives but do you realise there are significant numbers of people like me who were adopted and don't know who their relatives are. We just

aren't acknowledged by the NHS. The number of forms I've filled in where they ask for family history but never have an I don't know box. It's a form of discrimination perhaps. Even doing modern DNA ancestry testing doesn't always reveal relatives unless they're signed up on the same site and it's very expensive to go on multiple sites. Please can I remain anonymous? But Dr Simon Piper said, I'm a retired GP, just for fun. I had my DNA analysed. It showed that I'm BRCA negative. I was delighted to convey this information to my two daughters. If you have £120, he said, you can access this information without the barriers of the nhs and kate said i'm listening with interest to your episode of the section about the braca gene

please could you stress that the gene can be passed on via male members of the family my sister and i were treated because our grandma and her twin sister both had ovarian cancer my sister has the braca one gene and I don't. Sadly they tested my dad too late as he was already in his last weeks of life with prostate cancer and he also carried the gene. Pushing to get tested could save your life so it's well worth going to your GP if there's a line of these cancers in your family. We also had a lot of response to our conversation about Dr. Claire Weeks. Camilla Gitter-Hughes said, How interesting that this woman was advocating to allow rather than avoid,

a touchstone of mindfulness for women in the 1960s. Kiri Thomas said, So incredible to hear about Dr. Weeks on the 1960s. Kiri Thomas said, So incredible to hear about Dr Weeks on the programme today. Her book helped me so much during my very anxious 20s. So simple, yet effective. Loved her ideas and still do. Lizzie said, When I was in my early 20s living in London,

I began to suffer from panic attacks and anxiety. It was horrendous and I had no idea what to do. I went home to my parents and shut myself in my room for a few days. My mother realised what was happening and gave me a copy of Self-Help for Your Nerves and it was amazing. I have managed my anxiety well for more than 30 years due to it and have lent the book to others on many occasions. The best book ever. And then Vicky texted, Face, accept, float, time will pass.

I'm sitting in the bath reciting this and feeling loads better, thanks. I will check out the doctor and the biography. Not depression, but definitely some anxiety at times. Now do join me tomorrow when I'll be talking to Wad Al-Khatib, who's documented her life on camera through five years of uprising in Aleppo in Syria. She was surrounded by conflict, violence, death and cruelty, but she fell in love, got married and had a baby daughter. She captures incredible stories of loss, laughter and survival in her film Summer, which has been receiving rave reviews. And I'll also be discussing Susan Sontag with the author of a new biography,

Benjamin Moser. That's all tomorrow. Join me if you can. Two minutes past ten. Bye-bye. Russell Cain here, and I'm here to tell you about Evil Genius, the BBC Radio 4 podcast, where we take icons from history and then decimate them by slinging mud.

Think you know everything about Einstein? You don't. He was a woman hater. You probably think you know about Amy Winehouse, that she was a victim. She had a pretty dark side, and we're not shy about exploring it. Evil genius. We take people from history and a panel of three fellow jesters have to vote at the end of the show.

No ifs, no buts, no grey areas, evil or genius. Plus hilarious banter as well. So head to BBC Sounds now and hit subscribe. 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.