Woman's Hour - The Cass Review, Back to Black, Female Psychopath

Episode Date: April 10, 2024

The long awaited Cass Review, published on Wednesday by paediatrician Dr Hilary Cass, calls for gender services for young people to match the standards of other NHS care. Emma Barnett is joined by the former BBC journalist Hannah Barnes, now Associate Editor at The New Statesman and author of Time To Think - the inside story of the collapse of the Tavistock's gender service in children. Alison Owen is the powerhouse British film producer behind the new biopic of Amy Winehouse, Back to Black, released this Friday. In it, the actor Marisa Abela recreates many of Amy’s iconic performances, recordings and her most famous paparazzi moments. Alison joins Emma to discuss why she wanted to make the film, which comes out almost 13 years after Amy’s death.Childlessness not out of choice is a difficult subject to discuss. Those who have experienced it are usually left to grieve and heal alone. Those who have friends and family members wrestling with infertility don’t even know how to talk about it. A new book with 22 personal stories about involuntary childlessness hopes to offer a support group for almost-parents. Emma Barnett talks to the author of ‘No One Talks About This Stuff’ Kat Brown and one of the contributors Rageshri Dhairyawan about their experiences.Do you remember our segment on female psychopaths? We’ll hear from one woman who has been officially diagnosed with the condition. M.E Thomas speaks to Emma about living with psychopathy. Presenter: Emma Barnett Producer: Emma Pearce

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, I'm Emma Barnett and welcome to Woman's Hour from BBC Radio 4. Good morning and welcome to today's programme. You will have seen and heard leading the news bulletins that an NHS commissioned review four years in the making has finally landed and it's damning. The subject, children and gender identity. The verdict, in a nutshell, doctors have been getting it wrong. According to the report's author, the paediatrician

Dr Hilary Cass, there is no good evidence supporting the use of puberty blockers and hormone treatments in children who believe they are transgender. And the treatment of girls has been particularly singled out. Here's Dr Cass talking on the Today programme earlier. There has been a significant change in the population of young people over the last 10 to 15 years. So about 15 years ago, the service was seeing perhaps 50 predominantly birth registered boys in childhood. And over the last 10 years or so it's switched to over 3,000 young people and it's mainly birth-registered girls presenting in early

teens and as you say often with quite complex additional problems. Is this a watershed moment? You will perhaps recall the forced closure of the Tavistock Gender Identity Clinic, which formally wrapped up its operations last month. Another big moment in how we treat young people dealing with what they describe as gender identity issues. We'll get into that and the details of this long-awaited review shortly with a journalist who's been following this story in detail for years. But as we hear about how girls' lives have been affected and how girls have been treated, what is your response? Is this change in direction for NHS England something you welcome or fear? Or perhaps you aren't sure how to respond? It is worth noting that our health

services decision to give children puberty blockers has led the world and has been copied in other countries. And also to note that there will still be private clinics in this country available to those seeking some sort of treatment. You can text the programme with the number 84844 to share your views, your takes, perhaps your experiences of this. Text will be charged your standard message rate on social media at BBC Women's Hour. Email me through the Women's Hour website or send a message to all of us here at Women's Hour via WhatsApp on 03700 100 444. Just watch those data charges as I always say. Also on today's programme a bit of Amy.

A new film of her life Back to Black is set to be released this's a very mixed reviews for those who've already seen it, the critics. I'm going to be joined by the woman whose brainchild it was, Alison Owen, the powerhouse British film producer. We'll hear her take. And as a new anthology is released, filled with stories by women who wanted children but were never able to have them. We will hear from two of those women and also consider the merits of writing difficult things down as a form of deep catharsis. I don't know if you happen to see this study today from Japan, but researchers have found that writing down your reaction to a difficult situation in your life on a piece of paper, then shredding it, scrunching it up into a ball

and chucking it into the bin can relieve some tension, some hard feelings about those negative thoughts, those negative experiences. What is your take? How has writing perhaps played a part in you dealing with something extremely difficult indeed? 84844, the same numbers and ways to get in touch, please, if you feel you can. But first to the long-awaited CAS review as it's become known which says young people have been let down by the UK's gender identity services and that it's mainly those registered girls at birth seeking treatment. In 2009 the NHS's gender identity development service treated 15 adolescent girls. By 2016, that figure increased to 1,071 compared to 426 adolescent boys, an exponential rise. You're also hearing figures there from Dr Cass,

who was the author of this review and the former president of the Royal College of Paediatrics and Child Health. She's raised concerns about other healthcare issues being overlooked in cases where young people are questioning their gender. She says that new referrals should include a screening for conditions such as autism, as well as a mental health assessment. Speaking to LBC this morning, the Prime Minister said the CAS report had shone a spotlight on the issue and that doctors need to exercise

extreme caution when it comes to providing gender services to young people. Is this a moment of progress or concern or somewhere for you in the middle or you aren't sure at all, but you want to learn? Let's learn then from someone who has been looking at this, as I said, for a number of years, the former BBC journalist Hannah Barnes, now associate editor at The New Statesman and author of Time to Think, the inside story of the collapse of the Tavistock's gender service in children. Good morning. Good morning. It's been a long awaited review, the actual final report.

Is it as expected? Tell us what you can take so far. I think it is as expected because we've known this for a long time we've known about the exponential increase in referrals and particularly in girls we've known about the shift in presentation from largely pre-pubescent birth registered boys to adolescent birth registered girls who are contending with all these other difficulties that dr Cass has said. We've known that the evidence base is very weak. And I think for those who have followed it for many years, there's no surprises in there, but it's quite shocking to see it laid out in such devastating and comprehensive detail. And for the Prime Minister to say a spotlight has been shone,

well, yes, but it's been shining in the background for a long time and really we probably should have acted along before this let's come to that but the the idea that it's still shocking even for those who who have followed this there will be those who have not uh it's right at the top of the news agenda across all papers websites radio stations today um if they just hear what we've been doing for children hasn't had the evidence, hasn't been right, what would you say to those people who don't understand how we got to this place? Well, it's difficult to comprehensively explain how and why we got to this place. But essentially, what happened was quite remarkable and Dr Cass explains it but

we had a medical intervention puberty blockers the colloquial term for them that at the beginning appeared to be helpful for a very very small group of very distressed children who had had this distress about their gender identity from childhood. And this started in the Netherlands. And the idea was if you met quite stringent conditions and in a very small number of people, this might help ease that distress. And the idea was that it would give that young person time to think about what they wanted to do while the body not developing in a way that was causing more distress. Now, that all made sense on paper, but there wasn't

very much data. So, what JIDS, the Gender Identity Development Service, set out to do was to say, well, this sounds promising, but we don't really know much, so we'll do our own study. Now, it wasn't designed very well, but okay. They did their own study. But then the remarkable thing was that in 2014, without any data back from that study, they simply rolled out the early blocking of puberty for gender distressed children as routine practice. And, you know, they did that under the guidance or the oversight of NHS England and that's quite extraordinary that and then perhaps even more extraordinary is that a year later two years later for sure the service had some results back from that that cohort there were only 44 children on it and they'd all by this point been on puberty blockers for a year and those data showed that actually they hadn't replicated the findings of the Dutch study at all. And in fact, these children weren't doing any better.

In fact, some of them, their mental health was deteriorating and they were feeling worse. At that point, something should have changed because that's what evidence-based medicine is. When the evidence changes, when something you thought was true is not then practice should change and it didn't and I guess that was the starting point for a sizable number of staff working in the service saying what are we doing and it wasn't just people getting worse. There was also this really explosion of the myth of time to think because it appeared to be the case that rather than providing time to think, it was actually cementing. It appeared to be. We don't know for sure because of the way the studies were designed, but it appeared to be cementing that gender identity because practically all of the children that went on the blocker then went on to the next stage of medical transition. So didn't give time?

No. They didn't appear to, no. And that's repeated today. And the big other element, if you like, of this is moving away from a medicalised approach. You know, it could have been puberty, it could have been something else, to a more what's being described as a holistic treatment pathway. I'm thinking of some parents this morning who may be listening

who are thinking, what do I do now? What does that mean? A holistic pathway? Yes. Well, it's saying we're going to treat the young person in front of us as a full young person, because what has happened in the past is that, and some of this is not JIDS' fault at all, but everything was seen down this lens of gender identity. Because the idea was that JIDS would look at that aspect of a person's life, and then the child would have any other difficulties assessed by Child and Adolescent Mental Health Services, CAMHS. But that didn't happen. CAMHS were absolutely stretched beyond capacity. And actually, there was this real fear of dealing with someone with this magic word gender.

And some of the clinicians I've spoken to say well it it was like a cloak of mystery this word gender gets and everyone is scared and thinks that oh they're the experts they'll do it and actually frankly for some cam services it was a way of getting children off their books because they couldn't have them so i mean in the last year nearly 40 000 um young people have experienced a weight of over two years yeah it's appalling to be seen by child and adolescent service nearly 1 million young people, according to the latest figures, were referred there. Just to give a scale of the demand.

Not of this issue, but of all support. And this is one of the things that Dr Cass raises today, that it's a much bigger issue of a crisis in young people's mental health. And that's not to say that identifying as trans is a mental health issue, but it not to say that identifying as trans is a mental health issue, but it needs to be seen in this broader picture. Is that how some people may take that today, though, that identifying as trans is a mental health issue? They may do.

They may do. But I don't think... Because, you know, concerns about autism and mental health have both been brought up. But I think that's just what the evidence shows us. I mean, sadly, the data we have on the children, both seen and referred and not seen who are lingering on a waiting list, is really poor because because JIDS didn't collect it properly. And that that's also underlying. I mean, it's been woefully inadequate. And but but what we do know is that the vast majority of those children, as well as their gender-related distress, had other difficulties, depression, anxiety, eating disorders. They're all overrepresented, as the researchers attached to the CAST team have said. Autism, you know, a 2% prevalence in the general population, 35%, not quite an autism diagnosis, but displaying moderate to severe autistic traits in those referred to JIDS. Now, these are observations, they're measurable.

And it's not to say that, and this was a classic debate, it's not to say that having other difficulties causes a trans identity. You know, some would argue that that trans identity and not being affirmed and not being respected for who you are triggers those other things. So I don't think you actually need to make a judgment on which way the arrow is going in terms of causality. Yeah, it's how you treat. Let's listen to Dr. Cass from that interview with the Today Programme's Justin Webb because he asked Dr Cass what would happen to the children who've been told there is now no chance of accessing puberty blockers? In the first instance NHS England has put some additional resource in to support local services to at least be doing an initial assessment. Is it enough do you think? It's not about the money, it's about the workforce and a huge part of this is we have got to help clinicians from all backgrounds realise that they

do have the transferable skills to see these young people and I know there are massive waiting lists for mental health in general but this particular group of people has been disadvantaged compared to other similarly distressed young people. The point being, I suppose, as well, that the things that will be offered might not include or might be an effort to avoid the kind of things that would change a person's body forever. Yes, there is going to be a small number of young people for whom a medical pathway is the right pathway. And in many ways, the more we can address the wider problems for some of those young people who are not going to go on a medical pathway, the easier it will be for us to ensure that those who are going to need a medical pathway get onto that

specialist track sooner rather than later. What does that mean, a medical pathway? Well, it's talking about the different stages of medically transitioning. So the first step of that has always been puberty blockers, but they're taken out now effectively, they're not going to be prescribed. So it'll hormones so masculinizing so testosterone for birth registered females or feminizing estrogen for for birth registered uh males um and i think i think what she's saying here and i think i know i know there'll be many in the trans community who are very angry today, but better evidence based compassionate care that is catered to the individual is going to benefit everyone. Both those who who do end up transitioning and it's just make it a safer process. And for those for whom that won't be the right answer.

And we know it hasn't been for some. Yeah. And also to say, I mean, there's Dr. Aidan Kelly, a clinical psychologist specialising in this and just trying to help somebody, a young person, may also still feel that they haven't got anywhere to turn right now. Dr Aidan Kelly, no doubt has the interests of young people at heart, but his income relies on helping young people medically transition.'s the director of a of a private gender clinic so which still exists which i mentioned in my yeah so you know he's he's entitled to his review i mean my understanding is that every systematic review of using puberty blockers to treat gender distressed kids both by nice these ones, which have also fed into the CAS review in Sweden, in Finland, and Norway have used those reviews, they've all come to the same conclusion,

which is the certainty of using puberty blockers in this context, all the evidence is a very low certainty as to its clinical effectiveness and its safety. So I think it's quite questionable and you know Dr Kelly worked at JIDS for five years the model has been roundly criticized the service has been shut down it was rated inadequate I think I would go with the opinion of Dr Cass. He's of course not not here to to respond directly to that but but has responded to this so just wanted to give the chance for you having looked at this across the piece, to respond for those who are reading in perhaps more detail. Just finally, is this a moment, do you think?

I know there's been moments, but do you think it's a moment where we will now see a drop in the number of girls, for instance, talking on Women's Hour, being perhaps referred in this way or how that comes to be when we see those numbers? I'm not sure about the numbers. I think, I hope it will be a turning point. And I think the fact that it's on the front pages of most national newspapers from The Guardian right through to The Telegraph and The Mail shows you that this is not a culture war, a political story. It's about healthcare. It's about how we best care for a group of very distressed and often vulnerable children and young people who've been so badly let down. And I think it looks like there's a realization going on across society that we've really messed up here we've really let down these people and if those with the right skill set are prepared to work in this area as as Dr Cass sets out and hopes then yes maybe we will see those

referrals go down because maybe it's just part of growing up and gender identity won't be seen as this separate thing that needs to be addressed separately. But just just, you know, the to and fro of growing up and being a teenager and going through puberty. Some very interesting messages to that effect, which I'll come to. Hannah Barnes thank you. A statement here from NHS England who contacted a spokesperson says NHS England is very grateful to Dr Cass and her team for their comprehensive work on this important review over the past four years. The NHS has made significant progress towards establishing a fundamentally different gender service for children and young people in line with earlier advice by Dr Cass and following extensive public consultation and engagement by stopping the routine use of puberty suppressing

hormones and opening the first of up to eight new regional centres delivering a different model of care. We will set out a full implementation plan following careful consideration of this final report and its recommendations and the NHS is also bringing forward a systemic review of adult gender services and has written to local NHS leaders to ask them to pause offering first appointments at adult gender clinics to young people below their 18th birthday. Important to read that out in full. Some messages coming in. There's one here, for instance, that said, as a child, I thought I should have been born a boy. I prayed every night I would wake up a boy. At puberty, I realised that wasn't going to happen and accepted who I was. I'm very happy I didn't have social media to influence me. For me, that would have been the wrong choice.

Dr. Cuss talks about the influence of social media on young people today in that report. Another one, my 13-year-old daughter, now trans son, wants to take puberty blockers. He's wanted to be a boy since age 10. He has ADHD, has been assessed for autism, but not enough characteristics have been found. He has mental health issues, depression, his undercams, but has not been seen. We always have told him that taking puberty blockers is an adult decision, so he can make that choice when he is an adult. Plus, we know very little about long-term issues. I'm not sure what his future holds in terms of his identity, An anonymous message there. Thank you very much for feeling like you could get in touch on that. I'll come back to more of your messages on that and other things we're discussing in today's programme in short order. But now in a new film out this week, seen by some as controversial,

it is the brainchild of my next guest, Alison Owen, the powerhouse British film producer. The actor Marissa Abella plays Amy and recreates many of her iconic performances, music recordings and also some of those more infamous paparazzi moments. It doesn't depict her tragic death at 27 from alcohol poisoning, but we do see her decline from addiction. Good morning, Alison.

Good morning. Thank you for being here. You were the driving force, I understand, behind this project. Why did you want to do it? I don't know that I described myself as the driving force. I certainly initiated it, but our amazing director, Sam Taylor-Johnson, was the driving force who found the language and the aesthetic for it. But why did you want to to do this in the first place whatever drew you to it?

Funnily enough as a film producer I came to it more as an Amy Winehouse fan than as a film producer I you know I adore Amy's music and to my mind she's sort of the greatest musical artist of the 21st century so far. And it felt to me that she was in danger of having her legacy become one of the tragic death rather than her extraordinary genius and talent. That happens to a lot of female icons. She was sort of unwittingly joining the pantheon of Marilyn Monroe, Janis Joplin, Judy Garland. And so I wanted to give her back some agency

and ownership of her legacy. I mean, I was looking through your work and you seem that you gravitate towards, not only, but to telling stories of women unsung in some ways or defined in different ways. For me personally, I adored Sylvia with Gwyneth Paltrow which you were you were behind as well talking of course Sylvia Plath it was it was a wonderful film to be able to see and think about

her differently thank you so much I love that movie like one of my own children and that it was very underrated I think it for various reasons largely political ones it got a bit sidelined but I'm glad to hear it's got a fan in you. Well, I think in those who know, they know. I always think that when you've seen something that perhaps others should see or maybe haven't yet. But some will question, as big fans of Amy Winehouse, did we need this film? Do we need this sort of creation again? There are those who also worry about perhaps not hearing her voice in it because actually there was a decision made there for the actor to learn how to sing like Amy Winehouse.

What do you say to those fans? I would say come and see the film and make your own mind up. I think Sam has just done a terrific job with the film. I couldn't be happier with it. We had a standing ovation, which is really unusual at the premiere for a movie. People come out of it incredibly moved. And I would urge people to go and make their own minds up. I think there was a need for the reason I stated previously,

that the legacy was in danger of becoming one of tragedy rather than triumph. And I think we've very much made the decision to see the film from Amy's own eyes, from her own perspective uh she had a lot of opinions about her in her in her life it was like a you know the trope of the goldfish in the fishbowl and that continued in death with everybody having something to say and trying to analyze why did she die could have stopped could have been stopped whose fault was it and this is a chance for amy to have her say actually for her to uh to tell the story from the inside out rather than the outside in and we made the film by looking very much at her

her lyrics and her early notebooks and writings of Amy's so that we felt that we could really inhabit her persona and what she what she felt about her life as it developed we've got a clip uh from the film let's let's have a listen to Amy Winehouse, played by Marissa, talking to her nan, played by Leslie Manville, talking about meeting a new man. Blue eyes. There's a moment when we just looked at each other. You know, no words needed. We just melted into each other you know no words needed we just melted into each other no embarrassment

just felt so warm yeah what'd you say his name was Blake right. Blake. Jewish? Didn't ask, but no. Well, how do you know? He had loads of tattoos. Well, so have you. I do love that.

There's a lot of comedy in this film. Yeah. There is. And Amy's Jewishness is a big part of, was a big part of her identity and is there woven in. I think I've had similar conversations with my grandpa when asking if one of my boyfriends was Jewish or not.

Straight in, I can relate to that part. But in terms of the portrayal of Blake Fielder, civil or Blake Fielder these days, I understand, who many rightly or wrongly blame in part or perhaps in full for her downfall. I understand that, was it you or someone else from the film met up with him before? Yeah, I met with Blake and Jack, who played him, met up with him. And, yeah, I was really impressed by Blake and I wasn't necessarily expecting to be. I found him really direct and really honest

about his relationship with Amy. And this is somebody who's had his whole... This is a guy who's in his early 20s who was with Amy, I don't know, 18 months, two years, and has had his whole life defined by that. And he's handled it, actually, with a lot of grace because he hasn't sold memoirs or done any of those things. He has tried to get on with his life and when i met with blake he was he had tried to avoid meeting me first up you know so it was a sort of the first of

of a few failed attempts um he came in the room and he was just immediately very direct and looked me in the eyes and he said i know i can't change anything about this film and I've got no influence on it. And I accept that. I just want you to know one thing. And I said, what's that, Blake? And he was slightly trembling as he said it. And he looked me in the eyes and he said, I loved Amy then and I love her now. And it was really moving. And I was really affected by that. And when Sam and I went to meet Janice, who's Amy's mum, and asked her about Blake, we were still sort of putting together the version of Blake.

And Sam asked Janice, you know, what did you think of Blake? Did you like him? And she said, I didn't like or dislike him. Obviously, I've got some bad feelings towards him because of what happened. But she said, you know, my daughter died when she was 27 and she really loved that boy. And I'm really glad that she had one big love in her life while she was here. And that really touched us as well. And that kind of gave us permission to portray Blake as Amy saw him, not as everybody else saw him, not as some scuzzy junkie that was portrayed, but as the person that she fell in love with which for her was a kind of combination of you know marlon brando meets joe strummer that's who that's the romantic uh sexy guy that

she fell in love with so that's who we put on screen i suppose what gets debated is biopics and the perspective and the ability to get to some truth you know blake has said in recent years he feels guilt because he gave heroin to Amy for the first time and in your version Amy tries heroin after they split up for the first time. Some have already reacted who have seen the film and some friends have already spoken

to the papers say he's been shown as a lovable rogue, sort of how you're describing that as opposed to the person who gave her heroin. I hadn't actually read that he'd given her heroin for the first time. the person who gave her heroin i think i hadn't actually read that he'd given her heroin for the first time i know he gave her heroin because they shared it together and lots of people gave her heroin and having been around addiction an enormous amount myself i my perspective is definitely that there's only one uh villain in the world of addiction and

that's addiction itself you know you everyone has their own agency everyone makes their own choices and nobody can force that on you you know sometimes you meet parents who say you know well I don't like that person because they gave them weed in California and you're like well if they didn't get weed in California from one person they'd get it from another if you want drugs and you're drawn to to that lifestyle you will find it and i don't think you can blame anyone any one person i suppose it comes back to the idea of amy and her agency maybe that's what you're talking to there but but for those who may feel uncomfortable with the portrayal of blake in this way that i'm explaining even though it's not just about who gave who drugs yeah what do you say to them because he as some friends have said to papers today,

you know, he wasn't some sort of Disney prince to them. He was a big part of her downfall. Yeah, I mean, and we portray that honestly in the film. You see, there's, in fact, there's been other reviews that have said that Blake is vilified too much in our film. So it all depends on your perspective. I mean, we do see, do see Blake sharing drugs with her. We see him getting back to get her together again

because he thinks there might be money there. He's no Disney prince. He's portrayed by a sexy actor, yes, but he's no Disney prince in terms of his actions. So I think it's absolutely fair that we show Blake from Amy's point of view because we want to show Amy as a smart, sensitive, romantic woman, which she was, she wouldn't have been with somebody if they were

a total using idiot. So give her some agency, give her some credit for her own choices. And I do sometimes suspect the whiff of misogyny here because you go to see a documentary or you read versions of Jimi Hendrix and Jim Morrison. Nobody's ever saying, you know, oh, was it Jimi Hendrix's dad or girlfriend's fault? No, they give him the integrity of his own decisions and in his own life. Let's give that to Amy as well. But I suppose people, men or women can be led, you know, and there are those questions that people have. And it's interesting to hear when you've created something, when you've been involved in creating something,

where you draw lines and how you decide how to portray things. And I think that's the opportunity when talking to you that if you, most people won't have seen the film yet, you can have that in your mind when you go and see it and hear about how decisions are made. Yeah, I think that's right. And it's a tightrope. So at every point, when you're walking that tightrope and making a movie, you ask yourself the right questions or the tough questions.

And as I said, we wanted to show Blake as the person that Amy fell in love with, but we also didn't want to exonerate him of any culpability, which we haven't done either. So we have shown him sharing drugs with her, giving her drugs as a honeymoon present. We have shown him consulting with his drug dealing mate about whether he should get back together again because she's just had a number one album and there'll be some money there. So we do do that. But we asked ourselves every single line, every single scene. We would ask ourselves the question of whether it felt truthful, whether Amy would approve. I mean, Amy was our northern star the whole time.

She was the lodestone. Did you know her? Yeah, I met her a couple of times. I wouldn't claim to know her well at all. But I certainly imbibed her vibrant, truthful, honest, authentic personality. So I think that was certainly a lens that we used to analyse every single thing that we did along the way and continued to do, even in the release,

even with guest lists at the premiere, we were going, would Amy want that person there? Would Amy want that person photographed on the red carpet? It's a really distinct prism through which to see everything. And it's really helpful. Well, people adore Anne Adored. So they feel very strongly about it. And I'm sure many will want to see Back to Black.

It's in cinemas from this Friday. All the best with it. Thank you for talking to us and also giving us the opportunity to play some Amy Winehouse this morning on the programme. Great to have you on the programme. Thank you. Thank you so much Emma. Messages also still coming in, getting in touch with all sorts this morning and the ideas of some of our conversations coming through and perhaps you also have some views on what you just heard regarding Amy Winehouse and legacy

and how we kind of get to that place of how we tell stories and how we talk, which in some ways leads me on to our next discussion and how we share our experiences and pain, which, of course, Amy Winehouse was known for writing a lot about. A new anthology with 22 personal stories about involuntary childlessness hopes to become a support group for those that the lead author describes as almost parents. The book is aptly called No One Talks About This Stuff and is compiled by the journalist Kat Brown, who herself, despite years of trying and very much wanting to become a mother, has been unable to have children. Kat has just joined me in the studio. Good morning. Hi, Emma. Thank you for having us. And also joining me Rageshra Daryawan, Rageshra, excuse me, a sexual health doctor who has also not been able to

conceive and become a parent despite undergoing four rounds of IVF and several medical procedures. Thank you for joining us as well. Thank you Emma. Kat, to come to you first, you have brought together these stories. Why did you want to do that, first of all? A baby popped out at the end like a candy bar. And I just didn't have anything. It was just unexplained infertility. And my way of dealing with it was to send a slightly panicky tweet asking for any kind words that people had. But understandably, lots of people don't do that because, you know, they keep their nervous breakdowns private. But as a journalist and as somebody who has just always found comfort in the stories of others, I really wanted to create that for other people. And also just I'm in recovery as well and have been for a reasonably long time.

And that whole thing of listening to the similarities, not the differences in somebody's story. Recovery. Yes. So I'm sober from booze. Not crispy M&M's, sadly, but, you know, one step at a time. It's just so people are with you and where you are, I suppose it's important to understand. Because for you as well, Kat, you do share your story in this book as one of the women. And those you describe, I think, beautifully as almost parents. And what did that mean to you to be able to write that?

And what were you happy to say about that experience? Well, whether it was me or other people or the people, I opened the book to a sort of open submissions eventually to try and get as broad a draw of people's experiences as possible. It was just really important to make sure that people had gone through therapy and a real significant form of healing before they wrote this down so that they weren't raw. in any kind of way. They are so wild and so violent that if you're then writing your story down and then having to go through the really mundane aspects of being edited going, oh, could you lose that semicolon? That's it's just not what you want. So this like putting this book

together, it wasn't so much necessarily part of my healing journey, but it was very important for me, for anybody, whether they are parents who have lost a child or people who've never had the opportunity to become a parent or all of these myriad ways that our own life experiences intersect with fertility, infertility, that we just had that opportunity to share and hopefully for people to be able to see their own, that violent feeling, but also that hope, that recovery in people's stories that they so kindly shared. You talk in the book, I've written down some of the lines that I will remember. You talk about one point where you think you might be pregnant, the longer I wait, the more

I hope. You also talk about thinking you would win in this. And then there's this line where you you just say when it hasn't worked again I just want to be a mummy yeah it's really bloody hard isn't it and anybody listening if you're going through this now if you have been through this whether it was 50 years ago or last week I just want to give you the biggest hug because there's a wonderful phrase called disenfranchised grief, like a grief that isn't recognised by society. And again, whether it's like people will recognise something as if there is a physical evidence of this. And I had a hip replacement a couple of years ago, which was actually weirdly very healing for me in the infertility sense, because

I literally had a pair of crutches, there was physical evidence of what was, you know, wrong with me, if you liked. Whereas after the IVF, after trying to conceive for so long, I'd been very aware of my body to a horrendous extent for years, but there was no evidence of it, no evidence of the timelines in which my husband and I would have been parents. And, you know, we have animals, we have lovely nieces and nephews. There will always be children in our lives.

And we've also got incredibly kind friends and family. But, you know, we're on that timeline. And I think people really, really need to grieve properly for that other timeline as well, because otherwise it just gets stuffed down inside of you. Which, again, is why reading about all of these incredibly challenging feelings in a fairly open way. And I've put a trigger index as well, because, you know, some people, understandably, will not want

to read about certain experiences just yet, and might want to read about them down the line, but just being able to sort of share and... Well's a there's a range of as you would expect but there really is a big range of of experiences that can come together around this um around this experience this reality uh ragashree let me bring you in at this point you you have contributed uh an essay um and you you say after uh you have the diagnosis of endometriosis you then were told you wouldn't be able to conceive naturally. Yeah, that's right. So I was actually diagnosed with endometriosis whilst I was trying to get pregnant and was trying to work out why I couldn't get pregnant.

So for me, when we had our cycles of IVF and they failed, and again, like Kat said, it was a complete shock to me that they didn't work. I thought if you just kept trying at some point, you would get pregnant. So it was really shocking. But in a way for me, it almost felt like a definite stop. Like I knew I was definitely not going to get pregnant naturally. So this was my time to really start to grieve and to get over it. And I was, I think, very keen to move on once the fertility treatment failed

to kind of move on with my life. And there will be those, if I can just pause on that for a moment, because you have four rounds, I believe, from your essay, and then you don't carry on. If you don't mind me asking, was that a decision you and your husband came to, that we would do this number, or how did you know how to stop or when to stop? I think we were very lucky to live in an area where we got three rounds of IVF on the NHS,

so we knew that we would go for that. And then after that, our consultant said, there's actually, you know, this one treatment that we didn't try. So we thought, OK, we will pay to have this extra treatment and if it doesn't work, then we will stop. But we also had access to fertility counselling together, which really helped with that. And why did you want to write about this? Why did you want to share with a greater number of people?

So Kat put the call out for writers a few years ago. And actually, I thought this was something that I didn't want to write about. It felt very personal. And I thought I'd moved on. I'd done my grief work and did all the things to try and get over it but um a few years ago I took some time out from work to study and being less busy and having kind of more mental headspace I noticed I'd started to feel very sad about this again so the timing of Kat's call out was actually really um was really timely because I thought

you know I did want to write about it and And through writing this essay, it came up with lots of feelings that I hadn't thought about for a long time and made me realise I hadn't completely healed. There were still things I needed to do. And also you talk about maybe this will always be unfinished in some ways, that there will be different times where you feel differently about the fact that, you know, you wanted and tried to have a child and weren't able to? Yeah, absolutely. I think, you know, it's something that will always be there. It's always going to be part of me. And I think I was so keen to move on that, you know, I almost forgot myself that I really wanted to be a mum and I didn't let other people know that. And I

think that's actually really important to show that, you know, I did want to be a mum, but it didn't happen for me. So, you know, I did want to be a mum, but it didn't happen for me. So, you know, with friends and things going through their different parts of life, you know, I've got a lot of friends who are parents now, and they will become grandparents. And I'm sure, you know, some of these feelings will resurface again then. But I think being aware of it, letting myself, you know, heal through that is going to be really important. You do actually talk about a family member, I think a party in your essay who said you know shouldn't you be now cracking on and trying to have a child and you you talk very well i think and you write very well rather about because there was nothing to show or an ability to to say easily what had happened then they could

say that and you have to take it in some ways. Yeah I think I almost felt like we'd been too discreet about our fertility treatment we didn't tell many people and this happened about I think six years after we'd stopped trying so I really felt like you know everyone knew that we had tried and it hadn't worked and most people were being you know very sensitive so I was really shocked when they said that to me because it's almost like they didn't know and I thought you know you, we haven't told enough people we haven't made it clear that we really wanted to have a child and it didn't work out for us

I'm also just thinking through, Kat if you were with someone at an event or a party a family member or friend and they said something like, oh, do you want children? and then you were able to say, being less discreet which perhaps what this book may help people do um we did want them we did try and um it didn't happen for a whole range of reasons if you were able to say that I suppose what would you say to people who would then think

I don't know what to say back I mean actually since it happened I have just stopped being discreet about it at all and I mean obviously unless it's somebody who so evidently wouldn't want or be able to hear reality. And it's just a surface question, if you like, like, how are you? But I ended up having the most amazing conversations with people who invariably would be extremely generous and frank about their own experiences because it's, you know, lots of people go through this, it's just not spoken about unless you are a celebrity, which is, again, one of the major reasons I wanted to do this book, and why I crowdfunded it through Unbound, because I didn't just want it to be, you know, essentially famous white women who get to have their experiences spoken about and legitimized. I wanted this variety of it,

partly because that then helps people find themselves. But what I would say is that there is no perfect answer as to what to say. And I have been extremely quiet or useless when my own friends have been through miscarriage or horrendous incidences themselves because we're not equipped with the perfect what to say guidebook all I can say is that the things that have helped me most is when my friends have taken me off to a quiz or been kind or sent some really amazing eyeliner through the post or sent a card or just shown in some way that I matter and that I matter in whatever is going on with my life and in their lives. And whatever happens, I will always have a part in theirs

as when, you know, I sort of put myself back together or help back together and can take that part of it. And for that, that's friendship. And I am incredibly grateful for that always. Rageshree, Kat, thank you so much for coming and talking. It's a whole other thing to talk as opposed to write. I recognise both are big asks, but the book is called No One Talks About This Stuff,

edited and compiled by Kat Brown. Thank you so very much indeed. Thank you. For all you do. Absolutely. We are moving on to talk about something uh completely different but there are some messages just coming in here about writing and the power of it um diana says i didn't destroy a piece of paper with my anger on it i mentioned

this japanese study earlier i wrote a novel which is a love letter wrapped in rage. This has proved to be very cathartic. I shall shortly be 79. So it's never too late to be able to do that, I think is Diana's message. Never too late indeed. And when I was doing a PGCE, I was treated very badly by the teacher who was supposed to be my mentor. I ended up failing to complete the training in a big part because he made me a nervous wreck. I never told him what I thought of his behaviour when I left and it rankled for years until I wrote an email telling him exactly what I thought of him.

I didn't send it, but it was such a relief to get it all out. It's never troubled me since. There you go. The power of writing. Something my next guest may also be able to relate to. You may remember a segment, though, that we did back at the start of March on female psychopaths. Dr Clive Boddy from Anglia Ruskin University told us about his research into the unique traits

of women psychopaths in the workplace, and the clinical psychologist Estelle Moore gave us a medical perspective on the condition. Today I'm joined by a woman who calls herself a psychopath, and in fact, when tested by a woman who calls herself a psychopath and in fact when tested by a university expert in Texas she scored 99% under the criteria. Jamie or Emmy Thomas as she's known online uses both her blog and book Confessions of a Sociopath to raise awareness of the condition and speak about what her life is like. Jamie good morning. Good morning. Thank you for being here.

Should we go back to the beginning? Because you say you knew early on, even as a child, that perhaps you were different. Yes, I think that I knew that I was different. But I think for a long time, I just thought maybe I was very smart. And I thought I'm Mormon. So I thought that's very quirky. I mean, you tend to kind of like stick out as being a Mormon or something, you have unique religious beliefs and unique religious, you know, protocol or whatever. And I so I had five siblings, so six kids in the family, and we were all musical, and it was a little Von Trappy. And it was, you know, it was definitely different than my peers.

But it took probably until kind of college when I realized I don't really have normal relationships with people. And what does that mean? Because I also believe there's a story of you watching television with your father when you were younger and you learn about empathy. Yes. Yeah. So I was watching TV. There was some, you know, sad story. It was, you know, some child in Africa or something. And I made a joke about it. And my dad was like, have you no empathy? And I still remember that, you know, I was very young. I was like seven or eight. And I remember and I said, I don't know what is empathy. And he kind of gave me an explanation. And then I thought, maybe I don't. That's the actual answer I gave him. Maybe I don't. And he kind of didn't follow up with it, I guess. And so I still have that memory. But it wasn't like anybody really followed up with me about any of it. I don't know if it's because my parents had six kids. And so, you know, how much attention can you pay any one child?

And what about though, when it came to putting empathy, I suppose, in practice, when it came to making friends, having social bonds? Well, you know, I think that, you know, children can be quite unempathetic sometimes. They can be quite empathetic too. But I think that often, you know, I seem to kind of relate to some of the behavior of children. I feel like psychopaths are somewhat childlike. And so, you know, like pushing people, I mean, you know, there's just kind of a testing of boundaries, I think personal boundaries, themselves and their peers that happens, you know, especially, you know, during puberty, especially I found amongst teenage girls, there's a lot of kind of cattiness and a lot of kind of mean girl type behavior that can kind of happen. So I think that I didn't consider myself invested in those types of trying to vie for the top. But I also didn't think of myself as being quite outside the norm. You know, I think during that whole puberty period, when everybody's trying

to find themselves, everybody kind of does stuff that they may be later are ashamed of. What made you think you might be a psychopath? And what made you look into it properly? I think the thing that made me think I might be a psychopath is I kind of never learned to care about other people the way that I saw other people, you know, care about each other, you know, that empathy thing. You know, when I was in university, I had thought to myself, okay, I'm going to start prioritizing relationships, because I never had before. And I thought that college is supposed to be the time in which you make these lifelong friendships. And so I thought, this is what I'm going to do, I'm going to maximize my college experience. So I wanted to be a good friend. And I just

failed so badly at it. And I think that's what surprised me is that I was just pretty bad at it. I didn't seem to be able to intuit people's emotional needs. I didn't really have the patience for listening to them. I thought crying, you know, when somebody cried, I thought of it as a manipulation tactic. Usually, did you ever cry? If I cried, it was probably out of frustration, anger at that time. Again, I suppose someone listening to this who thinks there are those or maybe them, I've not been able to make friends, but there's a line isn't there between that and other reasons potentially, and then what you came to think of as a need to look into psychopathy? Well, yeah, I think, I mean, there may be many reasons why people don't make friends. I think the lack of

connection is the thing that I was lacking. And some people, you know, it just takes you have to find the right person to be able to connect. And I thought that too, you know, through university through law school, I thought, I'll be able to connect eventually to people and it just never really did happen. And you went on to practice law. Yes. How was that? How has this affected you in your work? So I think that in a lot of ways, it was a great choice for a profession for me, because when you're trying to convince people, especially when you're doing litigation, like I started out in, everything is manipulative. Everything's storytelling. Everything's trying to get people to see your client's viewpoint, you know, like in a he said, she said situation. You want them to side with you. And so you're thinking about what's going on in the minds of the jurors. You're thinking, you are going to try to spin things as well as you can within the rules of the law.

You do this test that I mentioned and you clear it in the sense of you hit 99%. What makes, give us a sense of what gets you that diagnosis? What sort of traits? You've talked about a lack of empathy. There must be other elements. So I would think my personal experience is I think of my experience of psychopathy is that it feels like a lack of a sense of self or very weak sense of self. And so things that would kind of characterize that some of the behaviors that you might see, or some of the things that I experienced are a disconnect to my own emotions. You know, since I don't really

see myself as being, you know, a specific, you know, I have a very weak sense of identity. I don't, you know, I know that what my shoe size is, and my favorite color, but that's kind of it. People ask me questions about myself. You know, it's, it's like a puzzler. I really have to stop and think. I don't naturally have, you know, ready-made self-expression or, you know, my favorite thing to do on the weekends is to paint or to, you know, to do these different things. I really have to come at it kind of like an anthropologist studying my own behavior. What about rage and ability to control that if you don't have that feeling for yourself or for others?

The word psychopath is often used in a very negative way, of course, as people will be familiar with it. It could be used in links to criminality. It can be links in a way that when you describe someone as possibly the worst you could. What would you say to that about that side of things? So I think without kind of a good awareness of my own self, my emotions come to me decontextualized. It doesn't seem like I'm even sometimes aware of them. I'm still experiencing them. It's almost like, though, like the sounds on but the

TV screens off a little bit, there's just kind of a disconnect there. And so I can be angry and not kind of realize it until the anger has maybe spiraled. So I do experience rage in those instances. And it surprises even me, you know, I think, why am I acting this way? Why? I have to ask you that I've got very little time. Why did you go public about being a psychopath? So I think that the problem with psychopaths in society is largely that there's a lack of understanding. And so psychopaths aren't allowed to just say, hey, I struggle with empathy, because then they are, you know, fired from their job, or, you know, they get divorced or whatever, people aren't comfortable having psychopaths in their lives. And so the psychopaths have to mask, they have to pretend they have to hide. And those behaviors make people even more afraid, because now you know that there's psychopaths, you know, in this building that are probably lying to you, and you worry about them. And you worry, hey, are they trying to manipulate me?

And the answer is yes, but they're mostly doing it self-defensively because if they come out about it, then they're going to get these negative consequences. But if people can kind of accept psychopaths the way that they've come to accept, you know, many other types of people, you know. Yes. We're going to have to leave there, but that's the case answered. Jamie or Emmy Thomas's People May Know Online. Thank you. Thank you for your company. I there, but that's the case answered. Jamie or Emmy Thomas, as people may know you online. Thank you. Thank you for your company. I'll be back with you tomorrow at 10. That's all for today's Woman's Hour.

Thank you so much for your time. Join us again for the next one. I'm Helena Bonham Carter, and for BBC Radio 4, this is History's Secret Heroes, a new series of rarely heard tales from World War II. None of them knew that she'd lived this double life. They had no idea that she was Britain's top female codebreaker. We'll hear of daring risk-takers.

What she was offering to do was to ski in over the high Carpathian Mountains in minus 40 degrees. Of course it was dangerous, but danger was his friend. Helping people was his blood. Subscribe to History's Secret Heroes on BBC Sounds. I'm Sarah Treleaven, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies.

I started, like, warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby.

It's a long story, settle in. Available now.