Woman's Hour - Prof Clare McGlynn, Running around Britain, Chronic pain

Episode Date: May 8, 2026

Megan Boxall is a 33-year-old runner who has been running clockwise around the coast of Britain, aiming to complete the equivalent of 200 marathons in 204 days. She began at Sizewell Beach in Suffolk in October and is now just one day away from that same point, having circumvented the whole island. Megan joins Anita Rani to talk about how she is feeling so near to completion.Violent sexual content in the mainstream is reshaping society, according to Clare McGlynn, a Professor of Law at Durham University, whose first book, Exposed, was published yesterday. In Clare’s view, the problem isn’t porn per se – it’s patriarchal porn; Pornographic content that was once niche and difficult to find – including incest, racism and rape - has been normalised and is widely consumed. Clare joins Anita to discuss the harms of extreme pornography.The prevalence of chronic pain is higher among women than men, but for millions of people living with it, the hardest part can be the sense that it is taking over their life. New research from University of Warwick shows how ‘mental defeat’ drives suffering and causes people with chronic pain to withdraw from everyday activities. Anita speaks to Professor Nicole Tang, lead researcher and Fiona, a former nurse who has lived with chronic pain for over 30 years.Samantha Harvey, winner of the 2024 Booker Prize with novel Orbital, has adapted Barbara Pym's 1977 book - Quartet in Autumn - for the stage. This is Harvey’s debut play and it opened last night at the Arcola Theatre in London. Samantha talks to Anita about what drew her to choose Pym’s book, about four lonely 60-something office workers.Presenter: Anita Rani Producer: Rebecca Myatt

Hello, I'm Anita Rani and welcome to Woman's Hour from BBC Radio 4. Good morning and welcome to the programme. Samantha Harvey, you may have read her Booker Prize-winning novel, Orbital. Well, she's written a play which opened last night. Quartet in autumn is based on a Barbara Pym novel from 1977 and it's set in an office. A conversation between four work colleagues. Well, if you were in an office in the 1970s,

maybe you'd like to share some of your office culture stories. Take me back in time, get in touch in the usual way. Professor Claire McGlynn says violent sexual content in the mainstream is reshaping society in her new book exposed. So we will be discussing extreme porn on the program today. And we'll also be talking about chronic pain. We know that millions of people live with it and it's more likely to be women. So can you relate? Has chronic pain been a condition you or someone close to you has had to manage?

Did you struggle to be taken seriously? Seriously, or quite the opposite, finding very good support. Either way, let me know. Get in touch in the usual way. The text number is 84844. You can email the program by going to our website or WhatsApp the program on 0700-100-44. The text number once again, 84844. But first, Megan Boxel is a 33-year-old runner who's been running clockwise around the coast of Britain

aiming to complete the equivalent of 200 marathons in 204 days. I'm tired just saying it. Well, she began at Seiswell Beach in Suffolk in October and is now just one day away from the same point, having circumvented the whole island. And she joins me now. Megan, welcome. When we last spoke to you, you were midway through in February. You were in the Scottish Highlands.

You were more than halfway. Now you are so close to the end. Where are you? and how are you? I'm good. Thank you. Thank you very much for having me back on Women's Hour. Yeah, quite different, quite different scenery right now where I am compared to where I was when I speak to you back in February.

I am now just south of lowest off on a lovely big sandy beach in the sunshine. Yeah, about to run, yeah, run my last, well, proper day and then, yeah, finish tomorrow in size well. I have to say, it looks beautifully sunny where you are. We can see the beach huts behind you. You also look very healthy, glowy, not tired, not exhausted. You've done 200 marathons in 204 days. How much have you got left to run? I've got about 26 miles in total left to run.

Slightly more than that because I'm finishing with the same park run that I started with. So, yeah, the 26 miles plus the 5K park run. Oh, what a lovely way to do it. So your last 5K will be with lots of people. Yeah, and it's the same park run that I started with. So, yeah, closing the loop. Perfect celebration. And last time he told us you were inspired by your uncle when you were 10.

Tell us about him. Why your uncle? Yeah, so he actually walked the coastline of Britain in 2002. He walked anti-clockwise. He went the other way around to me. But he had been diagnosed with young onset Parkinson's disease. And he was walking to raise money and awareness for, yeah, for the condition. And yeah, and it's just stuck in my mind since then

as something that maybe I would follow in his footsteps at some point. And yeah, now I'm nearly there. Now you are nearly there. And it was your own health that prompted you to do this. It was after a bout of bad mental health and an MS diagnosis. So this is actually also about raising money for you as well, isn't it? Yeah, yeah, it is. So I think that when my uncle did his walk,

and although it sparked the dream, I never really had a reason why. and I think for something that's big you kind of need to have a reason why and my reason why is something that I've lent on a lot when it's been tough and yeah for me the reason why was I had a series of quite major setbacks with my mental health in 2024 yeah period of very intense depression and a couple of suicide attempts and in that time I relied on the Samaritans quite heavily they were an amazing support. And then when I decided to, I was feeling a lot better,

I went out for a run in January 2025. And I was running and I just, I felt the fog lift just for a little while. And I thought, oh, this will be my why. I will run around the entire coastline, celebrate Britain as much as I can. And, yeah, and raise money and awareness for the Samaritans. Wonderful. And you're 97 days quicker than the previous woman. So how have you managed to?

Honestly, I've had a lot of, I've had a lot more support than. So the women who have done it before, I mean, I mean, incredible. And some of the women who have done it before, I have, yeah, so much admiration for them. Yeah, they really paved the way, showed that women can. And I have definitely had more support than they had. And I have no doubt that someone will be able to go quicker than me at some point. But yeah, it's just been a case of I had my agenda. I knew I wanted to run a marathon every day for 200 days and just did it.

Yeah, did it as best I could. Oh, well, we want to hear some of the stories. You've been going at it for so long. And you said, I mentioned there that people have supported you. So tell me about, I don't know, some of the stories about meeting strangers along the way. Have you been, have you slept in people's homes that you've never met before? Give us some insight. Yeah.

No, absolutely. so I don't know the exact number. I will. I work it out at some point after I finish, but I'd say it's around 50 people who, yeah, just put me up. I've had support, like full-time support on the road with drivers helping me with my stuff, people who I know for about half of it,

but the other half was, yeah, strangers putting me up in their homes. How does that happen? Well, I've just been blown away by how much people have wanted to be involved. So I stayed with one person who I knew, and they had a friend down the coast or an in-law down the coast and sort of built a chain. But then also via social media. So when I was in Yorkshire, I had a week that I didn't have any sport. I didn't have any plans.

And I put a post out on social media saying if anyone's available in Yorkshire to help me out. And within 20 minutes, I had seven different places to stay. Friendly people, that's why. Amazing. Doesn't surprise me. And you've also had strangers join you for your runs as well? Yeah, loads and like over 200. Yeah, people who've just come out,

done parts of a day, done a whole day. I had a guy in South Wales who did three whole days. So he ran 140K over three days, having never run a half marathon before. Just was enjoying himself and just wanted to carry on. Have you felt safe? I have, yeah, and it's an interesting question. because, and it's a question I've been asked a few times.

Obviously, a woman running, and I've got a live tracker on me, so anyone can find me at any time. But I've never not felt safe, and I think it's partly because I'm just seeing the best of people at the moment. There's so much good in Britain, and yeah, I'm really, really seeing the best of it. And because of that, I've just felt completely safe. And it's been, yeah, it's been absolutely amazing. Yeah, yeah, no, it's been, it has been amazing. Because you're so close to the end

and I can see the sun is shining, the blue skies behind you, you're beaming. But without wanting to traumatise you too much, can you take us back to when you've really had to dig deep? What have been some of the really testing bits? Yeah, there have been a couple of times that I have really had to dig deep. And I think a lot of that was to do with the weather.

Obviously, running through the winter, it was pretty tough. There were some days that were hard, running into pretty major headwinds and horrible, sometimes snow. rain um and yeah the other times were times that i was on my own and um and yeah there was there was a moment a couple of weeks ago when i was actually i was in hull um and it is i think it's the only time in the two hundred and four days that i i genuinely thought this actually all ends in hull um and yeah and i just my head had gone down i think because by the time i was in hull i was really close like

two weeks away but two weeks of running a marathon every day is still quite a lot of of running and once my head went down my body was then like okay we're done now and I was exhausted and yeah it was it yeah it did take quite a lot to sort of pick myself up with the help of lots of different people sort of reaching out to anyone who would help and yeah and I did carry on kept going and yeah and now now I just feel yeah excited about the finish what have you we're all excited for you it's amazing what an achievement what have you learned about yourself. There's a lot of time to spend on your own, in your own head. Yeah. In your body. In your body. You know. Yeah. Yeah, I have. I've, um, I've learned a lot about

the power of positivity and the power of mind over matter, which is something I kind of, I knew, but I've never felt it quite as strongly as I felt it doing this. I, I set out with a mantra that this was about positivity, about, about shining a light on all that there is, that it's positive in Britain, of which there is so much. And for me, personally, it was to try and shine a light after a period of quite intense darkness. And I just can't believe how much, or the extent to which that being positive helps radiate positivity around me. And that's definitely something that I will try and carry forward for the rest of my life. And it's something that I want to continue once the actual run is finished.

I want to keep trying to shine a light on all that's positive in Britain and hopefully help other people who are struggling with their mental health. Yeah, what a lovely message. Are you going to go back to financial journalism? What's the new focus? When I set out, I was going to 100%. I love my job. But this has just been an amazing experience.

And I feel like there's potentially more I can do in the world to help people who are struggling with their mental health. And I think that's probably where my next step's going to be. Yeah, I'm not sure exactly what it looks like yet. But, yeah, I want to do more to celebrate Britain and be positive and help people who are struggling. Yeah, and you can take your time. Maybe you've earned a rest first.

So what are you planning on doing when you hit Size World Beach? When are you hitting the finish line, you've got tomorrow, is it the day after? Tomorrow? Tomorrow, tomorrow, tomorrow. No, no, so tomorrow I hit the finish line. Yeah, yeah. So, yeah, so tomorrow morning I run the final 10 miles as a group of us running the final 10 miles into size well and then park run. And then we're going to the pub and doing a bit of celebrating and then just putting my feet up, resting. I'm really looking forward to not setting an alarm. Yeah. And then going back through all the memories, I think is the first thing I'm going to do. Yeah, and just try and reflect on what an amazing experience. it's been and write it all down. Yeah, I'm hoping there's a book in there.

So I'm sure there will be. We look forward to it. And yeah, just enjoy yourself tomorrow. I'm buying you a drink tomorrow. Good luck for the last leg. Wonderful. Thank you so much. Thank you, Megan.

Go, go, go. Megan Box all there. And good luck on that final leg. And I must say, if you have heard anything on the program today that affects you, then go to the BBC Actionline website. where there are links to support. A lovely positive message. 84844 is the text number.

Now the next item is about pornography. Violent sexual content in the mainstream is reshaping society, according to my next guest, Claire McGlynn, a professor of law at Durham University whose first book exposed has just been published. In it, Claire lays out how extreme content, once niche and difficult to find,

is now freely accessible on platforms and viewed by millions every day. Examples of this include incest, racism and rape. And she says content like this has been normalized and is widely consumed via websites and social media. Well, in this interview, we will be discussing some of this content in a frank and detailed way. I am joined now by Professor Claire McGlynn. Welcome.

Hello, good morning. Good morning. Now, the last time, Claire, you were on Woman's Hour, was 2007, and you were talking about porn there. So 19 years later, you've turned your academic work into a book. Why? I want to contribute to public debate about this issue and get my research out into the world. So, yeah, I've been doing research on pornography for about 20 years now, including with fellow academics Fiona Vera Gray.

And, yeah, I want to help shape debate because we need to talk more about some of this material. I know it's difficult conversation, but that's what we definitely. I need to do. What's changed in 20 years? Well, you know, it's interesting, like a good academic, I have my notes here from 20 years ago. Oh, you kept them. I've kept them. Yeah, absolutely. And what's interesting reading back, I write, because we were talking then about some horrific extreme pornography that we were only just beginning to realize was easily, freely available on the internet. And I've written down that this is not mainstream bog standard porn, but 20 years later, it is. It's.

It's everywhere and it's freely and easily accessible. In the book, you make pains to say that porn per se is not the problem. It's patriarchal porn. So why is it important to differentiate and explain? So pornography takes all shapes and forms and sizes and there's some niche material, there's pay-per-view material, you know, there's ethical, feminist types of porn. But my focus is on these mainstream pornography sites, the very large platforms that are easily, accessible and viewed by millions every day. So that's my target. But I'm calling it patriarchal porn because the reality is these sites are about men's interests and men's pleasure. It is not

about women's sexual pleasure at all. And it's also about men exercising power over women and men dominating women. And women basically agreeing and accepting and being seen to like anything and everything. And so that's the patriarchal nature of it. So I really just hope that term will help people understand in a way what's out there. I mean, it's something we talk about in various ways on the programme, but we're now going to your research and the overview and what you've discovered. How much of this extreme porn is being selected because it's a choice and it's what someone's thing is, if you like,

and how much is being pushed out and driven to people? Oh, I think a lot of this is about the algorithms of these large platforms driving more extreme material to us. So just like we've seen with social media, we know that the social media companies want to give us the more extreme content, the more polarising content, because that's what engages us.

And it's the same with the porn platforms. They want to feed us the more extreme, brutal, boundary pushing, you know, horrific content, because unfortunately that's what engages many of us, and it keeps us coming back and it keeps us interested. So that's what you're, shifted also in 20 years. 15 years ago, you know, the platforms,

you know, it might have been what you would choose to search for because you had to search for a lot of this content. Now it's what's being promoted to people. So, and we know that from some of the research we've done. We've analysed the landing pages like the shop front of these large platforms. And we've seen that some of that material is sexually violent. That's what they're pushing to us. And so that's what tells us about,

what's happening and about regulation really. In the beginning of your book, you say something really simple that really made me sit up and pay attention, which was remember when there was a time when the Playboy's centrefold was shocking. And now things have moved on so far beyond that. So what did you find?

So there, I hesitate because some of it is challenging. And it was challenging for me, even though I'd been investigating pornography for a lot of the, well, for many years, some of the material I did find really disturbing and would weigh on my mind for many. So, for example, some of the incest material. So this is material. I'm not talking about just terms like stepmom or daddy.

I'm talking about where it's depicting sexual activity between family members, so like daddy and daughter. And this material, it's not just that it's kind of gross and offensive, what it does is it reproduces the ways in which this abuse is carried out. So you've got older men creeping into young girls' bedrooms. You've got it labelled about sex education. You've got it labelled as our little secret. The men are saying I was led on or the mother's unavailable.

So I go to the daughter. You know, it's like free propaganda for these abusers. I'm very shocking to hear as well. Another one of the subjects that you cover in the book and that I mentioned in the open is racism and pornography. Not much talked about. Absolutely not. So although we're having more of a conversation now about pornography,

the racist element of it seems to still be going under the radar. And again, to emphasise this is mainstream pornography, what you see on the very easily accessible websites. Race is a category, you know, women, black and minority women are labelled in that way. The pornography against black women is often more aggressive.

The black men are portrayed in a really aggressive way. They're three times more likely to be in videos of visible aggression. So it's kind of an undercurrent though that's rarely talked about but it's just insidious

and I think it seeps then into our lives. Well that exactly what we're going to say when my mind went, which is, you know, these sort of really terrible, terrible porn narratives that you're talking about. What is the impact on society and individuals? Well, you see, I think some of these messages, like I say, they kind of seep into society. We almost don't notice that they're there. But with millions viewing them, it has to be having an impact. You know, that's what the whole PR and advertising industries do. They repeatedly tell us something so that eventually we just think about it's normal, we go and buy it and we purchase

it, whatever. And that's what's happening in pornography. And it's also to do with people talk about what's called sexual scripts. We learn about sex from pornography. What's normal? What do we want to do? What do we want to try out? And so we're looking at the pornography as that kind of guide or sex education. And we take it on board and then we go and act it out. So it's, yeah, and that's how it then has that impact on society. When you talk about the links between porn and harmful behaviour, you say that there are clear parallels with the tobacco industry and now climate change. What do you mean by that?

So in many areas, like medicine and climate change are good examples. We act on the basis of like a probability. Is it more likely than not that, you know, this pollution going down a river is going to impact on us? We might, you know, of course it's more likely than not. And I think in pornography it's much the same. We have to see, you know, is it more likely than not that the society we're living in with high levels of violence against women and girls, for example, it's more likely that we're living in that world because of this violent material in mainstream porn? So I'm not saying that a man watches a violent video and then the next day goes out and acts and say, you know, sexually assaults someone. But I am saying that the messages that are sent mean it's more likely.

than not that we're living in a world with high levels of that violence that's often not taken seriously. And if young men are seeing it and it's their first introduction to it and it's extreme and it's violence and then so on some level it's normalized. And it's that it's the numbers when you say millions. You know, it's not just a small amount of people. This is millions of people. There is legislation though, isn't there? I mean, it's been a criminal offence to possess rape porn since 2015. And on the 29th of April this year, the new Crime and Policing Act,

became law and it criminalises depictions of pornographic images of strangulation or suffocation as well as pornography which depicts incest and some forms of step incest. So what else needs attention? What are the next steps? Well, yeah, we've made

some great strides in the last couple of years. Largely thanks to the work of members of the House of Lords like Baroness Burton who's really pushed this agenda. So we have the basis now, the grounding of legislations. What we really need now is to see that enforced. Because although you mention the offence around rape pornography,

we've not yet seen that enforced in relation, following the Online Safety Act. So we've got it. Yeah, the grounds there, we just need the law enforced now. Yeah, because possession of pornography debicting adults, role-playing as children, carries a maximum sentence of three years. So are you wonder where all the prison sentences are? Well, yeah, I mean, that's true. but I mean, I guess the target of this legislation is actually the platforms.

Because under the Online Safety Act, now that these are criminal offences, those platforms have to prevent us seeing this material and remove it swiftly. So if these laws that you've described are enforced, it actually could have a transformative impact on what we're seeing online and what, as you say, young people are accessing online. What of the pawn companies said to you? So, you know, I've had a few discussions with them. And some are better than others.

You know, one of the interesting things is that some of the largest porn platforms, they do actually have some controls over what you can search for, unlike a platform like X, for example, which has a minimal content control. I actually find some of the material on X more horrific and more horrifying than on some of the mainstream porn sites. There have been some successes, for example, the Advertising Standards Authority. What have they done? So the Advertising Standards Authority have guidance around objectifying content, around gender roles. And they've given quite a few strong rulings recently about some of the portrayals of women in advertising

and including the portrayals of incest in some adverts. They've been really firm on that. So I think they're a really good example of what can be done by a real. regulator, you know, we can make a difference. I think that's a key message amongst some of the grimness here. We can make a difference. Things can change. It does not have to be this way. We just need to all come together and say we really want this change. Let's make it happen. I must say we did ask X for a response, but they haven't got back to us yet.

Let's talk about a new law covering intimate intrusions. This is something you talk about as in the book. What would that be? So a lot of my other work, and it intersects with pornography, is around image-based abuse. So when people are taking or sharing intimate images without consent. But what I've experienced, again, over the last number of years, is every time, if you like, there's a form of abuse that comes up, that technology is used to abuse women. We have one new law that fits that category. So we have a law on sharing intimate images.

We then have a law on upskirting. have a law on cyber flashing. And it deals, those laws are all great. I mean, I've worked, you know, to help introduce many of those laws. But it just deals with a category at a time. The idea of intimate intrusions is try to get a law which is future-proofed. So protects women from the ways in which, you know, technology is going to be used in the future. So, for example, there's a lot of discussion and on the BBC yesterday about smart glasses,

now being used to harass women. And we're probably going to need legislation to deal with that particular instance. And in the meantime, they'll have thought of something else will have come up. So the idea of intimate intrusions, and the Ministry of Justice is looking at this again. The government has said they're going to look at this whole area again,

which is really positive. And that's my suggestion for a broader law that's future-proof. So we don't have to keep coming back to ask for a law because the crucial part about that is it requires survival, to come and speak. And we shouldn't have to rely on survivors all the time to have to bring their trauma to us before we'll act. So apart from strengthening regulation,

what about criminal sanctions? So there are criminal sanctions for possessing some of these forms of pornography. And that's important, but for me it is about the platforms is what we need to absolutely focus on. And the other aspect I'd want to focus on is public education. So for example, I think,

around strangulation, we really need a national campaign around that to really get across the harms of sexual strangulation because, you know, in essence, the study is coming out from MRI scans and blood tests. So it's giving women brain damage. It's like being repeatedly concussed. But in rugby, we know about that problem. So you can make an informed choice and we're doing something about it. But in this area, I just don't think people realize just how risky it is to their long-term health, women particularly, because they're the ones mostly being strangled. So a public education campaign on that would be brilliant. You touched on it earlier, but I wonder what kind of personal toll all of this has had on you. At times, viewing some of this material, especially some of the stuff involving depictions of very young girls, which is on these platforms.

It's lawful is when someone's 18, but they're depicted as a really young girl. Some of that materials is, well, it's horrific to view, but it's horrific. The reality is it's horrific, knowing that very little is being done about it until now. I mean, I have a great support network, and I work with organisations like Not Your Porn

and the End Violence Against Women and Girls Coalition, and refuge, you know, there's so many out there that give me the support as well to carry on doing this work. So you will continue. Oh, yeah, I'll be continuing. As I say, we can make a difference. So yes, I'll be trying to play my part. Professor Claire McGlynn, thank you so much for speaking to us.

And the book Exposed came out yesterday. And we have a couple of statements, one from the government, saying violent pornography is dangerous. Those who post or promote it are contributing to a culture of abuse that has no place in our society. We have taken strong action to tackle this. It's now criminal to possess or publish vile forms of harmful pornography that depict incest, adults' role playing as children or strangulation suffocation.

We've also stepped up expectations on platforms by making all of these priority offences. This is a bold and progressive change to the law cracking down on pornography, which risks normalising horrific crimes on mainstreaming harmful activity. And an off-com spokesperson said, tackling the shocking and disproportionate harm that women and girls face online is one of our highest priorities. For more than two decades, the porn industry has been unregulated and unaccountable, and while significant progress is being made,

we know there's more to do. Under the Online Safety Act, platforms must assess and mitigate the risk of people in the UK encountering illegal extreme pornography. Companies that don't comply should expect to face enforcement action. We've launched investigations into more than 80 porn sites and issued more than £3 million in fines for non-compliance. Once again, Professor Claire McGlynn, thank you.

Thank you. 84844 is the text number. Now, on Monday, We broadcast a special edition of the program about how to have difficult conversations. We all have to have them at some point in our lives, whether at work, at home or with friends and family. So why do we often find it so difficult to have that chat? Here's the psychotherapist and international conflict mediator, Gabrielle Rifkind. I think partly because we've all had experiences where conversations have gone wrong.

And also maybe we've even seen in our own family where there's been conflict. And we haven't seen it resolved. we've seen it actually get worse. But I think one of the reasons it is so difficult to have these conversations is we have in our minds, at the end of it, we need to agree. Now, I wanted to throw this idea upside down and say, what would it look like if we started a conversation right at the beginning by acknowledging that we might not end up agreeing,

that we don't have to pull people over the back, barricade, they don't have to think like us, and that we might, just in a spirit of curiosity, whether, you know, it's someone who's different religion, different politics, thinks profoundly differently to you, maybe someone your family who annoys you, what happens if you open your mind and say, I want to learn how they think and also end up landing in a space where you might not agree? Could that be fine? We often think with the difficult conversation that there has to be a resolution of sorts, but perhaps we're framing the resolution in the wrong way?

I think that is part of the problem because people have different histories, different backgrounds, different traumas, different scripts in their head. And in fact, I kind of learnt this from my work in the International Conflict Resolution that if you assume people are going to end up agreeing, you're going to be actually paralysed. And disappointed. Frustrated, and it might well end going back to war. So it's big stakes.

But even in everyday conversations, that you might actually land in the territory, well, you still don't agree, but you did understand each other's point of view. And that can actually be a huge relief. Gabrielle, Rifkind, talking to Nula, and you can hear that program in full by going to BBC Sounds

and searching. for the Woman's Hour episode on Monday the 4th of May. Now, for millions of people living with chronic pain, the hardest part isn't always the chronic pain itself. It's the sense that it's taking over their life. According to an NHS health survey for England from a few years ago, women experienced the condition more than men. And now new research from the University of Warwick shows how

what they refer to as mental defeat drives suffering and causes people with chronic pain to withdraw from everyday action. activities. To discuss this, I'm joined by Nicole Tang, Professor of Clinical and Health Psychology at Warwick University and director of the Warwick Sleep and Pain Lab, who was the lead on this research, and by Fiona, a former nurse who has lived with chronic pain for more than three decades and is a staff member with pain concern, a charity that offers information and support to those living with the condition. And if you'd like to get in touch and share your experience, then please feel free to do so. Remember, you can remain anonymous. The text number is 8484.

for Fiona Nicole, welcome to Woman's Hour. Nicole, I'm going to come to you first. I think we should start by clarifying what we mean when we use the phrase chronic pain. How is that established? What is it? Well, good morning. Thanks for having me. So let's start with pain. I think most people know what it feels like to have pain. It is an unpleasant experience.

Even though you can't see it, you don't have a machine to measure it, but you know it when you get it, like when you have a paper cut accidentally, or when you bang your shin onto something hard, you know that you've got the pain. So typically, when the pain lasts for longer than it should, when it doesn't go away, say more than three months or six months, then it will be considered as chronic pain. And your research focused on women and men,

but we know women are more likely to experience chronic pain. Why is that? Yeah, so there are a number of different reasons, and it's quite complicated. to understand why that is the case. I think a couple of things. First of all, we have different anatomies, we have different biological makeup, we have different nervous system, genetics, and hormones play a very big role as well too. And so women who have experienced period pain, pregnancy, childbirth, they know that hormones can be really powerful. And that's why a lot of the time,

women may be reporting more pain, more pain experiences and greater impact of the pain on how they function during the day-to-day life. And I mean, chronic pain affects around 20% of people and it's widely recognised as not just a physical condition. You talk about what you described as mental defeat associated with it. What do you mean by that? Yes, it is a concept that we're trying to apply to the study of chronic pain, try to help us to understand the deeper impact of pain on a person's sense of self and identity. To be honest, it's really difficult to live with chronic pain 24-7. It interrupts everything. Everything you do, how you feel about yourself, how you feel about other people. So it's really hard to do the things that you normally do.

And so when you are not fulfilling your normal roles, it feels like you are not the person that you were anymore. And so the pain has taken over. It dominates every aspect of your life. And so that is what we call mental defeat. So it is essentially a mindset, a mental state that we thought could help us to capture that tough feeling that lots of people in pain would feel. Fiona, I'm going to bring you in here. Welcome. You've lived with chronic, you've lived with chronic pain for 30 years since the birth of your first child. Can you explain briefly what you've had to deal with? Hi, Anita. Lovely to meet you. Yeah, so it was the birth of my first daughter and it's not her fault, I have to say. She was quite a big baby and I had a stretch injury on the nerve, pedendal nerve, which is the nerve that

feeds their genitals in men and women. And so that was like the first time I became aware of it 35 years ago. And it sort of on and off caused a few issues, but it wasn't too bad. I could live with it. And I just thought, oh, that's part of having given birth. It's also known as cyclist syndrome. So that might mean a bit more to people. You know, when you ride a bike and you get numb in your saddle region. And that's something that I did as well.

I was a cyclist. And I was very keen on a lot of squat movements, going to do aerobics and all those things which I now realize were a risk factor in entrapping the nerve. I also had pelvic floor repair with some mesh, and that's when it became really difficult to manage. And then finally, in 2012, I think it was, it became irretractable. And just like Nicole was saying, the signs of mental defeat were definitely there.

It just completely took over my life. And it's one of those things. that we can't see it. No. It's only the person who's dealing with it. They're suffering and it must be so lonely because and because we can't see it, you're like, how do we understand? But can you describe the kind of pain that you were dealing with?

Oh, it was, I'll describe it. It's visceral how I say it is like having your genitals grated with a cheese grater and then having vinegar put on it. That was at its worst. burning, stabbing, it's unpredictable as well, so you'd never know when it's going to happen, you know. Yeah. It's, yeah, it's horrendous.

That sounds so horrendous. Extreme, extremely painful. Were you taken seriously straight away when you went to discuss it? What was the reaction? I think that, I think because I'm an ex-n nurse, so I could get my point across more easily, you know. So in that respect, yes, the GP did. take it serious and was very supportive. But because you can't see it. Because it's such,

it's quite a rare thing that I had. It was really hard to actually get it diagnosed. I saw four different pain specialists, one of whom said, oh, you've got a mental health diagnosis, which I have. So therefore, you're more at risk of getting chronic pain. And he just sort of dismissed it like that. And said, oh, well, you can live a full full life with chronic pain. I thought, well, how? I can't even sit down without being in extreme pain, you know. So, and eventually I did have a nerve pot which confirmed it. And I had decompression surgery in France in 2014, which was a life-changing, really. So that was life-changing 2014.

But up until that point, what kind of impact did it have on your life? And do you recognise what Nicole was talking about and affecting your mood? Absolutely. I do because it's, it's all pervasive. You know, it's there all the time. You can't think about anything else. You can't concentrate on anything else. Your life just shrinks.

You're unable to do the things that you would normally do. It's difficult to talk about. And this condition is really difficult because it's so embarrassing. People who say, oh, how's you back? Oh, no, it's not that. It's not really something that you want to talk about, you know. It is really, really tough. So how do you cope?

What got you through it? What got me through it? I met my husband. After my surgery, I was still in pain. So that was a brilliant thing. That was something not related to the pain. I learned how to do mindfulness at the local Buddhist centers, mindfulness for health course, which was brilliant,

even that I thought at the time or this won't help, but it really did. Just having brilliant family and friends who were so supportive and never gave up on me. And I know I'm so lucky because so many people in this position have not got that support, and it must be really, really hard. reaching out to peer support online, finding two women with the same condition, and then having a purpose, working for pain concern, delivering pain education sessions with other people who've got chronic pain, making a difference to people with pain,

and also being on the helpline as well. Yeah, we're getting messages in, so I'm going to read some out to both of you, and then Nicole, and get your reactions, actually. So someone's saying, thank you for covering this subject on long-term chronic pain. I have a condition called atypical facial pain, left-hand side of face nerve, right-hand side, migraine. It's taken nine years to get to be understood how the pain affects my day-to-day life, as I am never out of pain.

It varies in severity, but when, at its worst, it confines you to bed. It's the internal loneliness of the condition. I have an amazing family and good friends. I do all the self-support medication, but it's always the future that you worry about. will I manage as I get older? Yes, you're agreeing. What would you think to that, Fiona? What would you say?

I honestly, I said that I, when I saw that consultant, I actually said to him, what if, when I'm an old person and I'm sat in a chair and I can't tell anyone that I'm in pain, what will I do then? And he didn't have an answer, but this is very common to people with chronic pain. It's that catastrophizing about the future. And this is something that they do and nobody can be blamed for doing that. It's really tough.

And Nicole, so I mean, I guess this comes back to what you were talking about, the mental defeat. What can the consequences of that be? Yeah, so I completely understand what was being described by the listener. It's such a lonely place. You're in your own dark corner fighting the pain all the time. And so I guess through the concept of mental defeat, we are trying to bring the person back to the consultation so that the doctor is not just seeing

the symptom or the pain as a disease that they're trying to treat, but it's the person and how they experience the pain. So from our own research, what we have found is that if people are feeling a strong sense of mental defeat, they're more likely to focus the attention that they have on the pain itself. This is almost like when you go to the dentist office to do a dental procedure. You focus on the procedure and the pain that you feel rather than watching a telly. And so you have that pain amplified in your brain and it's sending even more pain signal to you. So it intensify the suffering. And so that is one not so good thing that come out. If you are having a strong sense of mental defeat, it can also make you catastrophize like what

Fiona was saying. Think more negatively about yourself and about your future and about how you relate to other people. So all in all, that will help shut you away from the world. Instead of drawing on social support, you know, keep yourself in a lonely place. It also, you know, stop you from doing things that you enjoy. So it totally just lower your quality of life. And Nicol, and we talk about this often on Women's Hour, which is, you know, how women, it's really hard,

but we really have to advocate for ourselves in medical settings because often we're dismissed, not believed, not listened to. So a bit about pain management and how women manage it differently because of those things or have to manage it differently. It's really unfortunate that women feel dismissed in the medical setting and they have to really push themselves to, you know, advocate for pain treatment. There has been studies showing that women are given less painkillers when they are presenting in the A&E department with same symptoms, same level of severity. And so that is really unfortunate. And we would like to see that there were more training to help doctors and medical professional

to understand that women experience pain differently. And so in terms of management, I would have to say that actually, women seems to be managing it slightly better than male counterparts and, you know, other genders. They seem to be more in touch with their emotions, which is actually a good thing because they look after themselves, they tune into how they feel. and like what Fiona has done for herself she is drawing on her support network and I think that is super important

and Fiona I think it's really important that you give some advice to people listening we've got messages coming in from people who may be in a similar situation to you what would you say to them I'd say if you can share how you're feeling with someone and a lot of people can't do that find a trusted helpline look at the British Pain Society

to have a list of websites, trusted websites that can give support. Tell your story if you can. Ring a helpline. That's often the first point really. And just, yeah, and don't give up. I think that's really good advice. I'm just going to read out this last message because it relates to what you've just said. I can relate to chronic pain.

I've had psoritic arthritis since 23. It's all consuming and impacts your mood. So trying to manage a busy job, motherhood and just life has been at times horrendous. but I have used the acceptance method to manage it. I decided to own my condition and just deal with it quietly. Many colleagues and friends don't even know I have this condition and now largely under control. Having a positive outlook and avoiding self-pity was my saviour.

I always think there are people worse off than me, so just finding joy in everything. Finding joy good, but also maybe, as Fiona said, do talk to people. Yeah. Find your network. Reach out, find your network, find a peer support network, anything, just don't hold it all in.

up you can. It's really tough. Thank you both of you. Nicole and Fiona for speaking to us this morning. And I must say we don't have a response from the Department of Health on this. But if you have been affected by anything, you may have heard in that discussion. You can go to the BBC Actionline website where you'll find links to support. And if you have a medical issue, then, of course, your first port of call should be your GP. 84844.

Now, a new play, Quartet in Autumn, opened last night at the Arcola Theatre. in East London. It's based on a novel written in 1977 by Barbara Pym and was adapted for the stage by Samantha Harvey, who won the Booker Prize, as you will know, for Orbital in 2024. In the play, we see four

lonely 60-somethings, colleagues in an office navigate their uneventful days whilst dealing with their impending retirement. Samantha, welcome to Woman's Hour. Morning, Anita. The morning after the night before, you just opened. Congratulations.

How was opening night? I think it was good. I laughed in all the right places. That's good. It's a good start. It seemed to go down well. It's really interesting, you know, being in rehearsals and we or there are things that we respond to, obviously. You know, things that we find moving, things that we find funny.

But you have no idea how it's going to translate to an audience. And I'm told from night to night it's different. You know, it might be completely different tonight. But last night, it was lovely. It felt really warm. I think people responded to the characters. Yeah, it felt, I think, like a success. Well, no, I'm sure it was.

I mean, what an experience for you having written it and then having to watch it and people respond to it. For those listening who don't know, Barbara Pymne's quarter of autumn, can you tell us the story a little bit? Yeah, I mean, it's very simple and you've more or less described it anyhow, but it is a novel set, which it was published in 77 and it's set in the mid to late 70s, in London, in an office. There's four characters, two men, two women.

And they are, the two women are facing retirement. The two men are a few years off. They're all in their 60s. And it's really about this kind of tentative relationship they make with one another and their ability, but largely in. ability to connect. And the two women are about to retire and there's this anxiety about what will happen to them when they do. You know, even though their relationships with one another are not, are rather transactional

and not close, they all would kind of like them to be closer than they are. And the prospect of retirement is terrifying. What then? You know, it's very much a play about loneliness and a book about loneliness, but it's very funny book. It's brilliantly comedic and Pim's dialogue is bright and sharp and wonderful and so it's very

in that sense it was quite easy to adapt for the stage. It was published in 1977. It was shortlisted for the book of prize. So how were the women of the 70s in Barbara Pim's work living different lives to women today? It's interesting because a lot of

Pim, Pim had a long career. She wrote a lot of novels in the 50s. And then she had 16 years of being unpublished because her publisher felt that her work was just outdated and it wasn't speaking to 1960s Britain. She wrote in the 50s a lot about women's lives but largely the isolation of women, women either living alone and unmarried or women who were married and frankly bored. You know, the shut out of the world of work with not very many prospects. All of her novels are funny. I mean, I don't mean to make them seem dour.

They're not at all. They're very funny. But they are about the limitations women face. And in some ways, Quartet was written after that 16-year period, and it was her first published novel after that, that kind of wilderness period. In some ways, it's less about women's lives than her others because it's sort of about the lives of these four characters,

the two women and the two men. And all of them are suffering equally. from a social invalidation, I guess, and a worry about a changing world. Am I right in saying that she was sort of politically conservative, a committed a member of the Anglican Church, but was she progressive for her generation? I think she was quite progressive.

Yeah, I mean, she does, she, the Anglican Church was the centre of her life, and writing was the centre of her life, I would say in literature. So in some sense, Yes, she was conservative, but she was very interested in people and not so much in issues, I think. I mean, I might be misrepresenting her, but my feeling of having read her work and sort of looked at Quartet very deeply is that she's interested in people and in all the different situations in which they find themselves. So she's not judging about that.

She's a mocking of her characters. She doesn't satirize them. There's this very kind of open-hearted, open-minded approach to them. She writes, you know, in a glass of blessings, one of her novels she writes about the protagonist falls in love with a gay man. She doesn't realize he's gay. She's this kind of wonderful, charismatic, beautiful young man who she falls in love with him doesn't understand why he doesn't love her back, you know. We've all been there. We've all been there.

Absolutely, more than once. So I think she was writing about homosexuality in the 1950s. Nobody else was redoing that, you know, but she wasn't, there was nothing kind of judgmental or salacious or anything about it. She was just simply observing these people. And you're an award-winning novelist with a Booker Prize on Dea Beltz. What made you want to take on the challenge of writing a play? Well, I actually wrote this play several years ago.

Ah. In 2022, I had a year-long sabbatical from my teaching job. And I thought, I was just finishing Orbital. And I thought, I just want to try something new. I'd love to try a play. It's sort of the turning the process of writing inside out, especially for a novelist like me, who relies very heavily on character, inner landscapes,

an interiority. And I thought, well, you can't really do that in a play, not to the same degree as in a novel. So it would be kind of fun to try to do something different, you know, to challenge myself. So, and then I read, I just read Quartet, I think, and it seemed very stage ready in some ways. There was kind of beautiful, funny, wonderful book that hasn't been adapted for anything, for TV, stage, anything. So I just gave it a go in a completely amateurish way, had no idea what I was doing, never imagined it would be made.

Here we are. I think we should hear a clip. Well, that was a very respectable lunch. Yes, nice bit of place, that. You've barely touched your salad, Marcia, not to your liking. There was nothing at all wrong with it. Not really the weather for salads. I thought you'd be a salad enthusiast, Lettie.

You've put on a bit of weight, haven't you, since retirement? No harm in it, though. Some elderly people do enjoy their food. Better that than giving up eating altogether. Of course, older people really don't need much. Warmth is the more important thing. How was the chicken forestier, Lettie? It was quite delicious.

vegetables and that. I suppose that's what foresty air means, things from the forest. Though you don't often find vegetables in a forest. Very good, funny, but also the way that the men are talking to the women. I mean, I was going to say, has it drastically changed since the 70s? I don't know. I mean, we talk about it more. How did it make you feel when you were reading these sorts of interactions in Pym's novel? You were taken back to a bygone era? Well, yeah, there's certainly sexism in the play, in the novel, I should say, and in the play.

In some ways, the two male characters do kind of lightly bully the two female characters. There's this also kind of protectiveness of them, but they're all just living very much in their kind of gender norms, the things that they're told to say and think and feel. but I think it's less a book about gender than you might imagine. You know, again, I really don't think Pym was writing about issues. I think she was writing about people. She's so interested in people. And there's a gentleness that she extends to all of her characters.

And there's, you know, I think all of the comedy and the melancholy of the book, which are both very, very much its drivers. come from this gap between what the characters think and what they say to one another and the inability to communicate. And I think a lot of this, the patronising behaviour of the men towards the women is in part because they don't know how to relate to women. They want to be less alone. They want to connect, just as the women want to connect with them and with each other,

but they just don't know how. And how many issues within the play are still alive today? I'm thinking of the cost of living and loneliness, as you've just mentioned. Yeah, quite a lot. I mean, I don't think that in order for something to live well, for something that was written in the past, to live well in the present, it has to resonate and has to be relevant. But I do think there are things about Quartet that do really resonate.

And it struck me when I was reading in 2021 or whenever it was. You know, there's a great sort of anguish about globalisation. and immigration and race and the sense of change and how that threatens one's own way of life. The cost of living and austerity is a big theme in it. In the book, the characters kind of mither about the fact that Britain's just joined the EEC and what that will mean and there's a great suspicion of the French. And it's, you know, a lot of these things are relevant, but also we're kind of at the end of that cycle. Well, they'll just have to come and see it.

So experience it. Samantha Harvey, thank you so much for joining us. And what a brilliant use of the word mither. And a quarter in autumn opened last night at the Arcola Theatre. And it runs for five weeks until a quartet, sorry, a quartet in autumn. And it runs for five weeks until the 13th of June. Join me tomorrow for weekend, Woman's Hour. That's all for today's Woman's Hour.

Join us again next time. Hi there, I'm Dilly Carter, and this is everything you need to know about my new podcast. Sort your life out, unpacked. I interview a different celebrity every episode. They bring me in three items from their home that reveal them most about them, and we unpack the stories behind those items. And I give you a few tips and tricks along the way. Some of the guests that I'm going to be interviewing are TV presenters like Lorraine Kelly,

reality stars like Harry Cotona, podcast royalty like Elizabeth Day, and of course our very own Stacey Solomon. Oh, and let's not forget some incredibly funny comedians like Phil Wang and Eddie Caddy. I think, as with everything to sort your life out based, you are going to get so much motivation, inspiration and ideas for your own home. Sort Your Life Out unpacked presented by me, Diddy Carter. You can watch us on Eyeplayer and listen on BBC Sounds.