Dr Kathryn Mannix worked as a palliative care doctor for thirty years. She wants us all to be better informed and less afraid about dying and death so that we can be each other’s companions in life’s challenging times. Her first book With the End in Mind was a Sunday Times best-seller and was The Times’ Thought Book of the Year.’
Her second book, Listen: How to Find the Words for Tender Conversations, was recently published by Harper Collins. FRANK’s Editor in Chief Melanie Sykes talked to her about her deep understanding of life and death.
What drives you to write? Would you say it is a calling to help people heal themselves and help others?
Dr Kathryn Mannix: When I wrote my first book, With the End in Mind, I didn’t see myself as a writer so much as a person with a lot of experience in dying and death. I kept coming across sick people and their families who knew death was approaching, but they had no idea what to expect. They were terrified because all their ideas came from TV deaths and newspaper headlines.
I know dying very intimately. The process of dying, much like the process of giving birth, is fairly predictable. I know from long experience that dying people can live comfortably even as dying advances, as long as any symptoms of their illness are well-managed. The dying person isn’t aware of a gradual loss of consciousness at the end of life. The unfamiliar breathing patterns of a deeply unconscious person can upset families, who might mistake them for distress.
The first book was simply a way of communicating with anybody who will die one day, to say “Hey! This is what happens! It’s understandable, manageable, describable.”
“You can accompany your dear people while they are dying. You can observe and understand the process. And the more you understand it, the less you will fear it.”
Then the avalanche of readers’ letters started. People wanted to know how to talk to their families and friends about illness, dying, death and grief. There are many subjects that we struggle to talk about right through life. My palliative care and cognitive therapist perspectives gave me a lot to say about those tender, poignant and awkward-feeling conversations. So that’s how ‘Listen‘ was born.
What are the key messages of Listen and whom would you like to read it?
Dr Kathryn Mannix: ‘Listen’ is a book for anyone who has ever felt ‘I don’t know what to say or ‘I’m scared if I mention this, then I might make things worse.’ I suspect that’s almost all of us.
The key to holding safe, deep, emotional conversations isn’t what we say, it’s how we listen.
Instead of rushing in to reassure someone distressed or to offer ways to ‘fix’ their difficult situation, we encourage them to mull it over aloud – to tell us the whole story.
The book suggests how to do that, from the way we invite someone to talk to us, to ways to stop ourselves from interrupting to solve one aspect of their situation or offer ‘fixes,’ and how to help the person to tell the whole story, even parts of it they may have overlooked, or that feel too difficult to say aloud.
Since reading it, I have been very mindful of how I approach situations and I have learned more and more not to steam in with solutions but to hear the person out. What is the magic behind the distressed person being heard by another?
Dr Kathryn Mannix: Being listened to is very powerful. It allows the person to take the time to tell their story aloud, in all its difficult detail. As they are telling it to us, they also hear it themselves. When a problem is stuck in someone’s head, it swirls around without making any progress. As they say it out loud, they start to make new sense of it.
Telling another person about upsetting things helps to move past all the emotions to get to the details. A listener who accepts those emotions and says ‘I’m sorry this is so tough for you’ creates a space for exploring their sadness or fear, anger or guilt. That’s not an easy thing to do – we want to help them feel better, so we feel an urge to reassure them. But holding back, letting them continue to describe their inner experience, is a far more helpful response. In the end, if it is ‘fixable,’ we should enable them to do that. Our role is supporting, not fixing.
Were you always an empathetic person? How did it manifest when you were a child?
Dr Kathryn Mannix: I’ve always had an intuition about people’s emotions. I’m intrigued by what makes people’ tick’ and by how much goes on underneath the surface of people’s lives. Since I was young, I’ve found people in trouble often tell me their woes, from family and friends to strangers on public transport. It wasn’t until I trained as a Cognitive Behavioural Therapist that I discovered that this natural curiosity, and the willingness to sit alongside people in deep distress, was a skill with a name. CBT (Cognitive Behaviour Therapy) gave me a structure for sharing my intuitions back with people, and it encouraged me to use curiosity to help them understand themselves better. It fits my philosophy of supporting other people to be the solvers of their own difficulties.
Some people are born with the ability to communicate truths and want to help people. Can people without that natural inclination learn this skill?
Dr Kathryn Mannix: Humans are hard-wired for connection. It’s how we’ve survived as a species. Some people are more natural listeners than others, but everyone can learn to be a better listener. It’s harder in some circumstances than others. Parents struggle to watch a child in distress without trying to ‘fix’ things. Giving someone really bad news is always a dreadful task. Yet, we can make even the hardest conversations less traumatic by learning how to be listeners and companions in distress.
How early should we be taught about helping others and how to navigate difficult conversations? Should we be teaching this in schools?
Dr Kathryn Mannix: We can learn to listen to others from a very early age. Some primary schools use ‘circle time.’ Pupils sit in a circle and take turns speaking while everyone else listens to what they say without interrupting or judging them. They are supported to say what matters to them. They learn to listen properly to one another and that they have a right to be listened to.
Older children can learn ‘peer mediation’ skills – how to help other pupils to discuss their differences with curiosity, listen to understand each other better, and agree on a resolution. Imagine if new employees brought those skills to their places of work!
In Western society we are great at celebrating but not so good at handling grief and loss. Is this cultural?
Dr Kathryn Mannix: Funerals were once an opportunity to lament and mourn – those are strong, important, yet difficult emotions. Gradually funerals are changing to ‘celebrations of a life’ and although some tears are allowed, the emphasis has shifted. Perhaps we are drifting towards this as we lose our understanding of death and mortality. We need both and we have to stop anaesthetising ourselves from sorrow – it’s part of life.
How is the writing process for you? What is your pattern around it? Is it an enjoyable experience?
Dr Kathryn Mannix: I love the process of writing. I come from a family of storytellers, and we have always used stories to talk about the important things in life. When I’m writing, I imagine I am chatting with someone. In my head, the reader and I are sitting side by side, watching the story unfold together.
Often the story is bursting to get out. I have to sit down and write before I can get on with my day. Sometimes I refer to reflections I wrote after working with specific patients and families. I originally wrote them to work through my understanding, but those notes have helped me base the books on real situations, even though the details are changed to protect confidentiality.
When I come back to edit, that’s when I start my ‘conversation’ with the reader. ‘What can we observe here? What does that tell us about ourselves? What can we learn?’ We’re learning together, in a lifelong process of curiosity and discovery.