Kathryn Mannix - Is mortality a threat or a catalyst?

Mortality: Threat or Catalyst? A Conversation with Dr. Kathryn Mannix

In this episode of The Examined Life, Kenny Primrose is in conversation with writer, speaker, and retired palliative care physician Dr. Kathryn Mannix about whether mortality is experienced as a threat or a catalyst for living. Mannix describes how early fear and resentment of death drew her to caring for dying patients, what she observed as medical abandonment, and how nurses taught her that the most important thing at the bedside is “how you are.” She argues that modern culture has lost “death literacy,” fueling fears shaped by Hollywood depictions and that talking about death through storytelling helps people to understand ordinary dying and what to expect. The discussion covers loss of control, end-of-life “audits,” regret as a processed, safer place than rage or shame, emotional literacy, and companionship that makes space for distress. Mannix suggests accepting finitude can clarify values and cultivate gratitude.

00:00 Mortality As Catalyst

01:27 Meet Dr Mannix

04:01 Threat Or Catalyst

04:32 Learning To Be Present

11:22 Magical Thinking Fears

16:56 What Dying Looks Like

23:11 End Of Life Audit

27:38 Rethinking Regret

32:25 Regrets and Joys

34:05 Regret as Wisdom

35:01 Emotional Literacy Work

38:35 Guilt Shame Reframing

40:50 Self Compassion Voices

43:33 Holding Space Culture

48:52 Telling the Story

51:22 End of Life Audit

53:28 Death Catalyst Gratitude

58:59 Closing Reflections

Relevant Links:

https://www.kathrynmannix.com/

www.examined-life.com

https://thisexaminedlife.substack.com/

Transcript

Mortality As A Wake-Up Call

Kenny Primrose 1:27

Dr. Catherine Mannix, it's such a pleasure to have you join me on the Examined Life podcast.

Kathryn Mannix 2:32

No, I'm delighted to be with you, and thank you very much for inviting me.

Kenny Primrose 2:37

I couldn't think of a better person to do series on death, dying of grief and loss. You have spent a long career in palliative care, and since taking retirement, you've written a couple of books, what with the end in mind and listened, which I think are fantastic, and so do many, many people, really helpful. So you're on a bit of a mission to change the culture, change the way we approach and think about and behave around death and dying. And as you know, the kind of theme of the podcast is to try and get interviews to distill some of their wisdom and insight into a question it would be helpful to be asking ourselves. So with that in mind, Catherine, I wonder, is there a question that kind of bubbles up for you when you think this is going to be a helpful lever-to-pool or thing to think about?

Kathryn Mannix 3:28

Thank you. So I wish I could just have said yes, because I've been thinking about this so long that there should be, you know, it should be distilled to a fine point. But I started off with some really quite waffly questions, big, clumsy, clunky. But it's been really good to try and think it down and distill it. And the question I've come down to is do we see our mortality as a threat or as a catalyst?

Kenny Primrose 4:00

What a great question. I wonder where we should begin with it. So I mean, perhaps with yourself, Catherine. Mortality for you, do you see it as a a threat or a catalyst? And has that has that changed over the course of your career?

Kathryn Mannix 4:20

Yes, it has. And over the course of my lifetime, I think, not just the course of my career, I've long suspected that we gravitate towards or completely shun and look away from things that trouble us. And I suspect that I've gravitated towards looking after dying humans because to start off with I was resentful of death and fearful of death. And it's a little bit like learning to sleep in the dark and deal with the fact that there might be a witch under the bed and there are definitely monsters behind the curtains. You know, you've been a brave girl and showing them that you're not frightened of them anymore, they have the power. So I think maybe my early fascination with the patients I was looking after who were dying was partly to do with how abjectly unhappy I felt that these people were reaching the end of their life. It was very much about what was their experience for them and noticing the tendency of medical abandonment. So I was a medical student on a ward where many patients died because it was a ward that looked after people, adults with leukemias. And so one of the markers of my three decades in medicine, or four decades counting medical school, is how transformed outcomes have been for adult leukemias and adult hematological malignancies in that time. But I met people who had been well last week and who were going to be dead next month. Such a short illness, so overwhelming. And I noticed that the doctors tiptoed past those beds and didn't interfere. And the nurses were the people who were going in and out of the room. And this is my first clinical ward and my first understanding that doctors didn't do the job I thought I had been training to do. They did things to patients, they didn't work with patients. The nurses did that. So I had a bit of a crisis that I might have actually chosen the wrong career, which went on for several very tearful weeks. And the nurses were fantastic in saying you can come in and be with us and be alongside. You don't have to be, you don't have to be that doctor. You don't have to behave that way. You could behave this way. And so they taught me that when you go into a room where a person is dying, the most important thing is not what you do, but how you are. So they taught me how to be. So once I could be less uncomfortable in that room, or or be comfortable with my own powerlessness in that room, then I was able to start to think about what do we need to do to enable doctors to be better at the bedsides of dying people. And then the next catalyst was having, you know, worked first of all in oncology and then changed tack to come into palliative care. Then realized that part of the reason that doctors are struggling to have conversations with dying people about dying is because people don't know about dying anymore. That that's over the second half of the 20th century people lost familiarity with dying. So we're no longer talking to people about something they understood, which my elderly patients, when I was first qualified, did. Now we don't meet anybody who's familiar with dying. And so how do we have those conversations? So um has it has it been a threat or a catalyst? I think it was a threat, but it's absolutely the fact of human mortality has been a catalyst for changing the way I want to approach the bedsides of dying people. And the fact of my own mortality has made me realise that here we are, this is now, this is it. And however good or bad or in between this moment is, it's unique, it's not going to come again. And that makes the joyous so important because it's transient, but it also makes the terrible more bearable because it's transient.

Magical Thinking And Fear Of Death Talk

Kenny Primrose 9:05

Thank you for sharing your own story there, Catherine. That's that's a really helpful comment. As you say, the transience of joy means it has to be savored, but the transience of pain is something that you can endure knowing that it is also transient. The idea of it being a threat, I approach this conversation and the other conversations I've had about death with the same kind of sense of threat, I think, that you talked about. You know, there's a line from Carl Jung that I will poorly paraphrase. He says something like, the cave you most fear to go in is the one where the that holds the treasure you seek. And I've spent a lot of my life kind of avoiding thinking about death. You know, it's come to visit me in in horrible guises, you know, the the the loss of a mother, an uncle, a sister-in-law, and uh I've buried it and have kind of run away from it or have tried to reframe it because it's it's very uncomfortable and it feels like a threat, a threat that might overwhelm if I allow it to. So leaning into it through having conversations like this, I'm hoping can begin to turn it from a threat into a catalyst. But there's something kind of I think superstitious almost in our fear of talking about death. You know, if I talk about it now, I I worry that is it am I tempting fate? Is something terrible going to happen to someone I love? And you know, I wonder if you could tell me a little bit about the the sense of threat or the fears people have when you begin to approach the subject of death. And fascinating that you include other doctors in this who kind of swerve the bedsides of people who are dying when, as you say, you thought that was the job.

Kathryn Mannix 11:08

Yeah, it's it's a really interesting thing. So so I've I've been a cognitive behavioural psychotherapist as part of my career journey, and it was one of the most fascinating things to be able to do to apply this science and art or a very evidence-based psychotherapy, all the evidence in the early days coming from psychiatric practice, and apply it to people who are not psychiatrically unwell, but who may be emotionally disturbed and overwhelmed by the experience that they're having with their physical illness and the approach of their death. So, one of the concepts we have in cognitive therapy, CBT, is the concept of magical thinking, which is exactly what you're describing. And it's a very powerful force in small children. They they believe that they can cause things to happen. But they also therefore believe that they have caused things to happen. So when bad things happen in children's lives, if they relate them to an episode of their own behavior that they feel that might have been responsible, you know, I was really, really angry with Granny when she did so and so, or she said such and such, or she didn't. And then Granny got sick and died, and it's all my fault I made that happen. So we develop magical thinking very early in life, and then we we grow through it, but we don't always grow past it. So we, for example, don't buy baby goods during a pregnancy, just in case. As though, in some way, if I buy the pram in the sales, because I can save a lot of money doing it that way, but it's too early, I will in some way prejudice pregnancy. So we do it in lots of different ways. Oh, I can't think about it in case in case it doesn't happen. If the more I think about it, the more it might not turn out to be the way I want, getting into my dream job, being able to take a holiday of a lifetime, something like that. So we do it about anything that's emotionally charged. We don't only do it about dying, but we definitely do do it about dying. That in some way to talk about it will make it manifest. And there are, of course, people who believe in manifesting. I don't share their belief, by the way, do think that that's magical thinking. But I also, as a cognitive behavior therapist, recognize that if we do think about things in order to be able to expedite them or avoid them, that will change our behaviors. It will change the way we notice cues and the way we respond to them. So we may feel as though we're manifesting, but actually all we're doing is encouraging ourselves to perhaps take risks that we didn't take before or avoid risks that previously we would have felt quite safe about. So does our thinking affect what happens to us? In some ways, it does. But I don't think talking about dying will make us die sooner, but it might make us start to notice that I'm not as strong this Christmas as I was last Christmas. And before I had this conversation, I wasn't thinking about that. When I'm talking to people about that, though, I say, so how about the action of buying a lottery ticket and then talking about winning? Does that make you win the lottery? And they laugh. And we know that talking about sex won't make people pregnant, right? So there are really good examples of silly magical thinking that we can use to just ponder the power of magical thinking in a funny way, because something that makes you laugh and makes you think stops you from backing away and not being able to bear thinking about it. So I use a lot of humour in talking to people about fear because it helps them then to gradually creep towards the thing that they are fearful of talking about. Their illness progressing, their cancer relapsing, their parent, their child, themselves dying. And we get there slowly and by degrees.

Kenny Primrose 15:45

It's really helpful. I can feel the irrationality of this way of thinking in me. You mentioned that kind of feeling impotent is part of part of approaching death, right? Where it's where we lose agency by degrees or dramatically or whatever. And I think when we lose agency in life, that's when we reach for sometimes kind of magical thinking, that kind of thing, because it gives us some sense of purchase, some sense of control. But I wonder if part of the threat when we don't want to face our mortality is just this fact that we are not in control and there are things that we cannot control. How much of that kind of surfaces when you're you know approaching the bedside of the dying or the family of the dying?

Kathryn Mannix 16:35

Yes, that's definitely a feature, and it and it's it's got several different chapters, I suppose. So, first of all, people are very afraid of what they haven't seen and don't know. So they're afraid of the process of dying because they we don't know that we don't know. We get information from wherever we can, and we turn that into what we're expecting. So many people who've never been alongside a dying person expect a Hollywood style dying or a soap opera style dying. And of course, they are dramas, and therefore they are dramatic. And I was really cross for a very long time about the atrocious inaccuracy of dying in our sc on our screens, and and how awful, difficult, outlandish dying turns out to be on screens. And I was talking to that about talking about that with Carrie Ad Lloyd, who's yeah, you you know Carrie Ad for a I just listened to your episode the other day, actually.

Kenny Primrose 17:47

It was uh it was a lovely conversation.

Kathryn Mannix 17:48

Yeah, so she she is so for listeners who who who don't know her, she's she's uh an actress, she's a comedian, she's a writer, and she was bereaved of her own dad when she was about 16. And she says, you know, I've spent almost all of my life in the Dead Dad's Club and nobody wants to talk about it. So she's done this wonderful podcast that talks mainly to people who use humour for a living. So that was an interesting thing because clearly I'm not a famous comic actress, writer, producer, but she has spoken to a couple of other people who've kind of got expertise. But it what I love her podcast because she's doing exactly that thing we've just been talking about, holding up the lens of, oh, we're going to talk about this, but we're gonna do it in a funny way so that you can bear it. It contains the tension. Anyway, I'm whinging on to Carriad about terrible death. And she said to me, But it's you know, that it's not about the death, is it? How do you mean it's not about the death? Well, in dramas, death is a plot device. Actually, how the dying happens doesn't really matter. The writer is writing how characters who would not normally be in a challenging situation or who would not normally be alongside each other can be brought together by this event, which happens to be the death of a different character. They're not writing about the death, they are writing what happens to other characters around the death. It was kind of a light body. But I still think we need better deaths in drama. And Coronation Street did do a fantastic one a few years ago for which they won prizes, which was a young mum dying from cancer. And on the night that she actually died, my phone was pinging, pinging, pinging. Um, people saying, Did you write this? Did you write this? Because they wrote a really authentic dying. And of course, no, I didn't write it, but the script writers did talk to the palliative care team in one of the Manchester hospitals near where they do their recording. And it turns out that when you're describing ordinary dying, it doesn't matter who you talk to, who's the witness, the witness is going to describe the same thing. So it was maybe quite good kind of triangulation for I am saying this, and then those days was a bit of a lone voice, but many more voices are now coming on board. So that's very useful. So people don't know what to expect, and so they expect something extraordinary. And so being able to describe the ordinary process of dying, which is what the book with the end in mind is all about, really, is it's only stories about people who are doing their living during that last part of their lives when they happen also to be dying, and it includes some very close-up and personal accounts of them doing that dying. And it seemed to me that holding people safe in a story where they really wanted to know what happens to these people, where they really care about these people helps them to stay present. And that's why I do storytelling, and that's why I give enough surrounding story that you've met the person and you've got some emotional investment in this person as you then walk with me through the story of what's happened. So not knowing what to expect is a huge difficulty to people, and explaining ordinary dying is a huge relief to people, and that restores for them some of that sense that you're talking about of their lost control, not because they can control the process as it's happening, but at least now they know what to expect, and they've got a sense of phases and stages and almost predictability. So going back to pregnancy again, they they've got the kind of mind map of doing dying that women and their birth partners get given when they go to anti-natal classes about pregnancy and giving birth. What are the phases? What are the stages? And how. How will we support you each step of the way of that? Because you won't have a lot of control. Your body will do this for you. It knows how to give birth, it knows how to die, but we recognize it and we will be companions for you, and we will do the best that we can to reduce any discomfort that it causes. And of course, giving birth causes astronomically more discomfort than dying causes. And maybe that's another important thing to say. Process of dying is not a process of discomfort. You'll die of something, and that might be uncomfortable. But it won't be more uncomfortable on the day that you're dying than it was any of the other days. And we usually know how to manage whatever your discomfort is. So we'll keep doing that then. Whether it's, you know, pain or breathlessness or nausea or itch. But many, many people at the end of their lives don't have any symptoms apart from just being very tired and gradually losing consciousness. But then the other loss of control, I guess, is the existential thing of well, if I'm dead, what am I? Who am I? Where am I? Am I at all? And I've got nothing to give you at that point. I don't know the answer to that. But I know how to hold a safe space where you can turn over the rocks if you like and look at what's underneath them. What is your best hope? What is your worst dread? What is your guiding force or set of principles? And something that we see people doing all the time at the end of their lives is a kind of end-of-life audit of how have I matched up to the things that I think are the most important. And that might be, you know, being a really good environmentalist and doing my recycling properly, or going litter picking on a beach, or it might be more overtly political, you know, if I've been a good enough communist, conservative, liberal, whatever, it might be adherence to one of the great faiths and you know, how faithful a Jew have I been, how much have I paid witness and lived a Christ-like life for Christians? All sorts of different principles that guide people, often strands of them rather than a single thing. And helping people to do their audit and then helping them not to over-criticize themselves. Because at the point where people are looking back, they may have a tendency to look at their faults and to underexpose themselves to their strength and their achievements. And again, as cognitive therapists, I I have a name for that. It's called selective abstraction. It's like opening a filing cabinet with all your memories in it. That on the day when your mood is low, the memories where the tabs stick up on the files are the sad, difficult, traumatic things that have happened. And on days when, you know, those days when the sun shines and every traffic light is green. On those days, you open that drawer and all the tabs that sit up are the joys and blessings in your life. And actually all the files are true, but we selectively notice different ones according to the way we're feeling by mood at the time. So helping people to look at the whole filing system and then think about how to forgive themselves for the times when they didn't step up in a way that they now regret.

Kenny Primrose 25:47

That's really helpful. I'd like to ask a little bit more about that in a second, but if I can just kind of review a bit of what I think you said. So we we've kind of lost death literacy. People die in hospital, not at home anymore. Most of us have not been with someone who's dying. So we we've lost the sense of the process. And when we don't talk about it and we kind of swerve conversations about it, that that sense of threat grows. And so one way that you manage that is by saying that this is what to expect. I find your conversation with Carriad Lloyd really helpful when I think you talked about what you do when a family wants to know how long has someone got left to live. You would say, Well, I can't, I can't tell you how long they've got left to live, but I can tell you what to expect when they don't have long. Right? Here are your kind of tell signs. I find that really helpful. In fact, I would have found that really helpful, I think, if someone had said it to me previously when I've I've been in that kind of situation. So we talk, I mean, I think a little bit about, you know, Harry Potter not talking about Voldemort and that the threat of Voldemort just grows the more he's he who shall not be named. It's a bit the way we talk about death and dying. We try and suppress it and avoid it, and it becomes more menacing, more something to be feared. So making the unspeakable speakable is part of the process of like defanging the threat in a sense. Although you don't have more control, you know what to expect, and your comparison to pregnancy is is really helpful. But your idea of an end-of-life audit that you're helping people kind of review the files as they look back, brought to mind Bronny Ware's work on the five regrets of the dying. And I was wondering whether those resonated. And there's a sense in which lots of people have received her book as a catalyst for life, I think.

Kathryn Mannix 27:49

Yes, they did. They did. In fact, I was given her book as a gift by her publisher when I was in discussion for the publishing right, the with the end in mind. So that was that was lovely because I met her editor, who was talking about what a what a wonderful person she is, as well as the brilliant book that she'd written. So that was a lovely thing. And it's made me think, think well, working at the bedsides of dying people has made me think. And Bronny's book about regrets, and then lots of other people's discourse on regrets, has made me think a lot about regret. And I think that I take a slightly different view from many of them, which is that I think regret gets a bad rap. You know, we try to live a life without regrets. Well, frankly, if you get to the end of your life with no regrets, you probably knock never got out of your box. And even then, so then that could even be the biggest regret of all, couldn't it? I think that life is full of opportunities for getting things right, getting things wrong, or somewhere in the middle. And because they are always decision points and choice points, we will always wonder what would have happened if we'd done the other thing instead of the thing that we did, and we can never know. So you could reach the end of your life only looking back and yearning for the path not taken and regretting that. But something that I've noticed at the end of life is that although people are looking back and they're saying, Oh, well, I I really wish that, this, and oh, it would have been better if that. So it's not only regret, and I think that's really important, there's a small number of people who are still stuck in the place of devastation of difficult life events. Either bad choices that they made, or just terrible stuff that landed in their way, or awful choices that people who were very close to them made, and they got caught up in the in the wreckage from that, and they are still out at sea storming, filled with fury and rage and blame if they're spitting it outwards, or filled with uh self-hate and guilt and shame if they're holding it inwards, at the edge of life, unable to open the filing drawer and see the joys, only able to see these devastating, difficult, dreadful things. And meeting those few people has made me realize that actually almost everybody has had things as difficult in their lives as the fights that those lost people are still fighting. But almost nobody is still fighting them. So what's everybody else done then? And I've been really curious about that because I realize that whether you have psychotherapy or not, the whole of life is about processing our experience to make sense of it, to be able to use the difficult things as stepping stones and guide and turning points in order to make the most of what is available to us in this temporary life. And when they felt the strong feelings and finished the rage and fury and blame, or process the guilt and shame and self-disgust, they reach a quieter place. They'll always wish those difficult things hadn't happened. But the quieter place, I think, is regret. And regret is the safe place we get to when we've done the work of processing the things that have otherwise have the potential to harm us. So I think we should all reach the end of life with regrets, and that those regrets should be the processed scars of the difficult things that happened that we will always wish had not happened, but over which we have no control, or maybe part of the problem is it was our control, and we chose badly and we behaved in a way that wasn't in accord with our ideals. But we get to the other end, maybe a bit battered and held together by the scars of those bad experiences, but also able to open the drawer and say, despite those bad experiences, look at the joys, look at the blessings, look at what it's been worth to have been alive. So I think that trying to live a life of no regret is not a productive way of looking at it. How do we process harms so that they become acceptable regrets?

Kenny Primrose 33:19

It's a really interesting, slightly counterintuitive line that regret is a safe place, but I guess what you're saying is that it allows us to feel the full range of emotions, to not ruminate on shame or rage or whatever, but allow it to kind of settle in us. I I read a book last year by Daniel Pink on regret, and he he did a huge survey on regret. Have you read it? Yes, I have a wonderful Yeah, it stayed with me. You know, he talks about four categories, I think, of regret, and he says each regret reveals a need and yields a lesson. It's something like that. Is there a a sense then if we can if we don't talk about death, if we swerve it or avoid it, like I've done lots of times in my life, then do we avoid the wisdom that exists in contemplating our affinitude or mortality?

Kathryn Mannix 34:43

Yeah, I think that's the thing that turns it into a catalyst rather than a regret, isn't it? If there's only male and there are limited opportunities to act, to experience, to love, to nurture, to make sense, then knowing that it's limited helps us to think, well, I I want to have achieved that thing, I want to have experienced that thing, I want to have set that thing at rest, I want to have set myself free from this difficulty, whatever it is. But just waiting often isn't enough. And so there is that expression, isn't there, doing the work, which does mean sitting in the space where we feel the discomfort of strong, unpleasant emotions. And I guess it's the it's learning emotional literacy. So parents help children to regulate themselves when they are fearful, when they are sad, when they are outraged. And they do big emotions, don't they? Watching children doing emotions is really instructive because actually we have the same emotions as adults. We've just learned to socially polish them so that we don't lie on the floor in boots and drum our heels as one of our like three-year-olds did once upon a time. But we can feel like, can't we? So being able to fully experience our own distress. And I know you've talked to BJ about about grief and grieving, and I'm really looking forward to listening to that. Grief cuts through many of these things. The loss of the hoped-for thing, the loss of the beloved thing or person. And until we've gone through that kind of dark night of the soul of the reality of the loss, we can't start to come out the other side of it living alongside the loss. So, in my storm metaphor, that will be, you know, if you're out in the sea of emotions, you might have lost your mast or you might have a huge hole in the side of your boat because of that loss. But it will become one of the repairs that keeps you afloat, that allows you to get to your safe harbor of regret at the other end of your life. Or hopefully earlier than that, by recognizing early that with finite, why store up all that difficult work for the last bit of life? Why not do it as you go along? But it's hard to sit in difficult emotions. You're fortunate if you have parents who've taught you to experience your emotions and regulate it so you can bear to be there and process what's going on. You're fortunate if you have a dear friend or a life partner who co-regulates with you so that you can bear to sit in your distress for a period of time and work out what's going on in there for you. Because again, cognitive therapy asks people to revisit their distress in order to pick out what they were thinking about and how true the thoughts actually were that were driving their distress. So when you do a bad thing and then you feel, oh, I'm um, I I feel guilty or I feel ashamed. So guilt would be about the thing that I did, and shame would be about being the sort of person who could do that sort of thing. So shame is a personal judgment. To be able to sit with somebody therapeutically or just in kindness and love because you're part of their circle, and say, Okay, so tell explain to me what's going through your mind. And what's going through your mind is I am the worst person in the world, and that's the most terrible thing to have done. And nobody could ever be my friend again if they knew this about me. And being able to then say, now hang on, it wasn't a good thing, and you didn't behave in a way that you value the worst person in the world, nobody would be your friend again, and you start to kind of pull the thought back towards not these kind of tsunami waves of emotion with the thoughts that go with them, but back to sea level of okay, let's let's just try and put this into a context now and find where you actually are. Yeah, I did a thing that I'm not proud of. I've got a horrible sinking feeling in my gut. I definitely do need to go and own up to that and apologize, don't I? And now you're in this karma place where the thoughts are in proportion. And funnily enough, as you get the thoughts into proportion, the emotions also regulate into proportion as well. So doing the work is a really important thing in helping us, not just at the end of our lives, but as we're doing life.

Kenny Primrose 40:11

So it's I mean, the word that's coming to mind is equanimity, but it's not kind of resigned acceptance, is it? This is kind of I guess deep work to resolve a conflicted inner life that will allow you to live in light of your values in a way that's you don't need to wait until the end of life to do, right?

Kathryn Mannix 40:36

That's absolutely right. And so we we we judge ourselves, most of us judge ourselves more harshly than we would judge anybody else. And so sometimes this piece of work is about introducing us to ourselves. So, Kenny, I'd like you to meet Kenny. And Kenny feels really bad about this. Tell him, Kenny, tell him, tell him what you did and how bad you feel. So, Kenny, I'd like you now to give Kenny an appraisal of that. And I'd like you to talk to Kenny as though he's a friend of yours. Because we don't speak to ourselves as though we are our friends, we speak to ourselves as though we are sensorial parents or judgmental teachers or disciplinary God. And actually none of the great faith teaches about that disciplinary God only. And we somehow need to find the loving version of the judge who's able to say, Yeah, not your best moment. And yet look at all your virtues, look at all the things that are good about you. I'm so proud of you for recognizing that this is not your best moment. Now, what are you going to do about it? Because it isn't always the bad thing or the difficult circumstance or the moment of despair that's the worst thing. It's whether or not we avoid it, deny it, run away from it, or whether we say, Yeah, this is this is not good. And what I do with it now is the thing that's going to be the thing I look back on.

Kenny Primrose 42:29

It's helpful to think about those different voices, the kind of critical parent, or the petulant or anxious child, or the sense of shame, and actually try to, yeah, as you say, step back and say that that's not the whole story here. I mean, the avoidance of doing this kind of inner work is easy because it feels like there's a kind of societal avoidance, a kind of conspiracy of our culture to not dwell with these hard things, to not allow them to be processed. Which is presumably part of the reason you wrote this book, listen, to create those spaces for people to do a bit of that work. I wonder if you could say a little bit more about how we might create spaces in our own life, but maybe also culturally in our schools or places of worship or whatever.

How To Sit With Distress

Kathryn Mannix 43:21

Yeah, it's it's it's an interesting thing, isn't it? That we've got a kind of culture of kindness.

Kenny Primrose 43:27

And somehow by being kind to people, we should be stopping them from feeling bad. And I don't quite know where that script came from. But anybody who's tried to tell somebody else a difficult time they're going through has had the experience of the other person saying, Oh, poor you, but never mind, better days are coming. This will one day all be behind you. There will be other opportunities. Distract, defend. Close down, don't be in that sad space in front of me. And and in in listen, one of the stories that that I tell is of meeting one of my classmates bumping into a in in the medical school. And she was distressed and and weeping. And I was oh, don't cry. It's whatever it is, it's all going to be it's going to be okay. And then she just looked up at me and said, Well, my mum's died. I can't make that right. There's nothing I can do that's going to make that right. And what's even worse is this girl is continents away from her family. And this is the 1970s. It's going to be so difficult and complicated to get back into the bosom of her family. And communication is really difficult. And the mum had been sick and she didn't know. And I have just tried to use reassurance and kindness to make her be better when actually the appropriate thing for her is to be utterly, utterly distraught. And I can do nothing other than be there if that's going to be helpful for her. She might even haven't forfelled not want me there. You know, it might be that she needs to be in a room on her own with her thoughts and a box of tissues, and me providing cups of coffee through the door because she doesn't want anybody to see her in that state. She's in charge. It's her journey. And we are the companions and the best companions. Accompany people in the way that the person prefers to be accompanied rather than deciding how we're going to do it. And that requires a humility that we're not always very good at. And it also requires an ability to be alongside somebody who's really distressed and recognize how distressed they are and not try to fix it. And we are progressively more and more fixers in society because we've got better and better machines and chemicals that fix things. We don't have to stay miserable. We can pop a pill, we can drink alcohol, we don't have to stay perplexed, we can ask a search engine, we can get AI to write the difficult letter for us. And actually, there are ways of not having to be in the place that's difficult because we can divert into problem solving it rather than leaning into it and experiencing it and allowing it to be difficult until we reach the place where we understand that yes, this is, you know, probably for that lovely woman, the most difficult thing that had ever happened to her in her life. And she was able to tolerate it, and she was able to walk into town to find a travel agent to book a flight to get to Nigeria, and she was bereft, and she was functioning, and we need to see that we're never just one thing. And so we can be better companions to distressed people, and when we are distressed people, we can be distressed people who are still our whole selves experiencing this thing. We're not weak to be distressed, we're whole to be distressed. There's a sense of deficiency, isn't there? I remember when my mother died, I was 21, and I tried to reframe it. I tried to say, you know, I'm just I'm just glad that, you know, she was my mum for 21 years. And and there was no, it was like a wall, there was no space for negative emotion. And that was in some sense applauded. You know, people said that showing strength of character. I don't I remember it was at a funeral saying bye to people, and I was weepy, and someone just said, chin up. And that was yeah, I know, I mean, poor, poor choice of words, even if you're gonna convey that sentiment. But it was it it kind of framed the way that I did deal with it. So I dealt with I think pain by not dealing with it, by distracting myself and trying to reframe, which is sometimes a strategy that gets you through short term, but ultimately would it be fair to say it detaches us from ourselves?

Kathryn Mannix 48:38

I think that's a very fair comment. And I think that we are progressively as a society going two ways that so there's a group of people who are becoming more in touch with the idea that these deep emotions matter, and making the emotional space to do that work is really important. So using psychotherapy is becoming less of a shameful thing, or some people just write to themselves, you know, they use journals and they sit down. And one one of the things about experiencing really difficult situations is working out how to navigate. And sometimes we work out where we are by telling the story. And if you get shut down when you try to tell the story, you never say it aloud. You never get to have that kind of conversation where, in telling it aloud, you're not just telling it to the person who's listening to you, you're telling it to yourself. And you start to be able to sequence things in different ways, where you write it in a journal, you write it in a diary. And so you get to that point, and I bet you've had this experience. I know I've had it lots of times. You're telling a story to somebody, and this happened, and then that happened, and then this person said, then I wondered about, and then I tried this. Oh no, hang on. No, no, that didn't happen then. That happened before that thing two things ago that I just told you. Oh, okay, oh, so that's why that person responded like that, because that happened often. Oh, and in saying it out loud or writing it down, we allow ourselves now to see each of the stepping stones in the round and work out how we ended up taking this particular path because of the other things that were happening at the same time, or the responses of other people to the same difficult event dealing with, or whatever it is. So saying it aloud, being in the difficult space and recognizing it helps us to understand it. And then there's this other path, which is oh, she's so brave, she's so strong, oh, he's he's really got his chin up. Which is we either we're not acknowledging that that person has got difficult things to deal with, or we really kind of hope that they're not going to involve us in dealing with them. Thank you. And do those people get an opportunity to do their work? Sometimes they do, sometimes they don't, but many times meeting people towards the end of life, because that was my job, you find that things resurface that were never dealt with at the time that they were sharp and raw and difficult, and somehow they got wrapped up and bundled around with busyness and distraction and other things. And now, here at the end of life, where there isn't a way of escaping them, they turn up in the audit and they're still as raw as they were because the work wasn't done.

Kenny Primrose 51:45

Do most people at the very end manage to let go of those things, albeit just with yeah, yeah.

Kathryn Mannix 51:52

Most people will be able to describe, um, yeah, though, oh, do you know what? The the worst thing that I've ever done is, and at the time, oh I found it really difficult to live with myself. Every now and again it's flashed up on my mind. I still can't believe I was the kind of person who could do that. I wish I hadn't. I wish it had been different. And I've done this and that, and the other I've supported this charity, or I've done that work, or I've impressed this message on my children, or you know, all kinds of lifelong mitigating responses to that action that I wish I hadn't chosen. And so they're able to say, Yeah, there's that thing, and it was awful. I so wish I hadn't done it. And here's all the ways it's impacted me. Here's the burden it's given me, all almost in a penitential way, even for people who don't live guided by faith where penitence is an important part of it. It's interesting you still see people saying, Yeah, I I I kind of done my penance in in these ways, and I feel like I've leveled out the balance in the audit.

Kenny Primrose 53:04

There's there's a real sense of emotional regulation, I think, that can come through confession, right? In a sense, I guess be it secular or religious, the it's it loses its power. I I I wonder, Catherine, I want to be cognizant of your time, but if I can just return to this question of whether death is a threat or a catalyst. So it's a threat when it's avoided, it's a threat because we fear it enough that we try not to talk about it or think about it or whatever. And it can be a catalyst. Maybe you can fill in the blanks here, but to a deeper life, to a more connected life, to a life in tune with what we actually really value, would that be what you're thinking when you say it can be a catalyst?

Kathryn Mannix 53:49

Yeah, I think that recognizing our finitude, recognizing our impermanence makes every moment count. And so everybody who's been longing for their holiday, and then they've got their five days, seven days, ten days in the place they've wanted to be has experienced the kind of pointy end of this, haven't they? Every moment is precious. Every day I get up and I open the curtain and I look on a view that I wouldn't normally see, or I'm with people who are precious to me, who I know I'm not going to see again for a very long time. Or I'm experiencing weather that I never get at home. I've got friends who are cross-country skiing in Norway at the moment, and I've got other friends who are somewhere where it's sunny and beautiful, and and every moment of that is precious. And my friends out in the snow are marveling at the reflection of the sky on the snow, they're marveling at the texture of the snow and the weird, squeaky noises that it makes when they're snowshoeing across it, they're not just in a snowscape, all of their senses are involved in being here now in that way. And when we see people who are really highly emotionally transcendentally evolved, when we meet elders and very wise people, and elders may not be very old, but they are they've worked out what matters, but they have a sense of being, a groundedness in them now that is the thing that we notice about them. That that is the thing that makes them elders, and some people take a lifetime to get to that, and some people learn it early in life through great hardship or through being recognized despite their own sense of unworthiness. Richard Raw talks about this really, really beautifully.

Kenny Primrose 56:01

Second half of life stuff.

Kathryn Mannix 56:02

Second half of life stuff that happens for some people very early. And never to others, and some people, yeah, just you know, they are they don't get there, and I meet them at the end of their lives offended. Offended that they're dying. So the catalyst is this is it, and you can embrace it and use it and say love it, and there are parts of it that we don't love, aren't there? But we can value them, I think. Maybe that's the word that we value them, or we can just kind of anesthetize ourselves because it's a threat rather than a catalyst. And then that like going to a beetra on a team's holiday, then the whole time so drunk that you don't make the most of really being there, and then have very little to remember about it when you get back home again. Sadly, I've never had that experience, but I have something once. Um yes, the idea that it's a threat makes us want to distance ourselves from even thinking about it. The idea that it's a catalyst helps us to know that the really important thing about catalyst in chemistry is that the catalyst changes the reaction, but the catalyst itself is not changed. Right? So death will continue to be on the horizon. We aren't going to make a change in our lives that makes us immortal. What we're going to do is make a change in our lives that allows us some of the time, because we'll never perfect it, to be the best and most aware versions of ourselves that we can be. That then allows us to be grateful at the end of every day and looking back at the end of periods of time and looking back at the end of a lifetime to have been alive at all. So I think gratitude is the treasure, maybe, that the catalyst of certainty of dying gifts to us.

Kenny Primrose 58:27

That's really helpful, Catherine, and and and a really beautiful place to end. Thank you so much for joining me for a conversation today. I I've, you know, you give me loads to think about myself and all of our listeners too.

Kathryn Mannix 58:42

Thanks, Kenny, and thank you for inviting me. It'd be lovely to talk to you.