The tension a person can experience when bereaved by suicide is very real and can take up much internal space in the body and the mind. The mind can turn repeatedly towards the question of why, while the social world can feel altered and the body may experience all manner of challenges from sore shoulders and back pain to upset stomachs and tightness in the throat. The question of why is not one of curiosity as it quite often carries a sense of responsibility within it. People bereaved by suicide can experience this tiring question of ‘why’ alongside feelings of guilt, blame and anger. It is not unusual for people to replay conversations, to reconsider moments that once seemed ordinary and/or to search for something that might have been missed.

In 1969, Elisabeth Kübler-Ross, a Swiss-American psychiatrist, described grief as a process involving five stages, being denial, anger, bargaining, depression and acceptance, in her outstanding book ‘On Death and Dying’. In bereavement following suicide, these can appear in ways that feel somewhat chaotic and difficult to anticipate. Denial may take the form of a disbelief that the death has happened at all or a sense that it does not fit with what was known of the person who is no longer with us. Anger can emerge towards the person who has died, towards others or towards oneself, often intertwined with love and a resulting confusion. Bargaining may be felt in the repeated returning to moments that now carry new meaning alongside thoughts about what might have been different “if only”. Depression, in this context, speaks to the depth of the loss and the absence that follows, rather than our day -to-day understanding of depression. Acceptance is sometimes described as a form of coming to live with the reality of the death, even when it remains painful and incomplete. These stages are not linear or chronologically arranged. She later clarified that these stages were “never meant to help tuck messy emotions into neat packages” in her book ‘On Grief and Grieving’.

In suicide bereavement, this is particularly important. The processes she described do not unfold in order and, although this may be hard to read, they do not conclude. They move in and out of one another, sometimes within the same day or across days, months, years or lifetimes. I often think of any bereavement or loss as being similar to a knot in a beautiful piece of wood. The knot itself is forever there, tight, messy and not going anywhere. However, the beautiful piece of wood, which features the knot, is a result of growing around the knot over time. With the unique type of grief encountered when bereaved by suicide, it is not that the grief ever ends. It is that, as a person continues to experience their own living, they grow around the grief. It will always be painful; anytime you look at a picture or think about a time in the past, the grief can and often will come back, as if it was yesterday that the loss occurred. The ‘Five Stages of Grief’ framework can offer language for experiences that might otherwise feel disorganised but it does not set a path that must be followed.

What remains central is the relationship with the person who has died and the ongoing work of carrying that relationship in a life that has been altered. What does this mean? Well, if our grief was removed or done away with then it would be a dishonour to the person and the relationship we had with them. To feel the grief fully is to honour that person. To weep and feel physical pain at the thought of who that person was and could have been is a testament to the love held for them. It is unfortunate that due to the human condition we cannot experience that love without the potential to experience the grief of loss in some format.

In 1897, Émile Durkheim described suicide in terms of social forces suggesting that levels of connection and regulation within society are key. His work points towards the importance of belonging and social context, without locating responsibility in any one relationship. Edwin S. Shneidman, in his 1993 book ‘Suicide as Psychache’, wrote that “the common stimulus in suicide is unbearable psychological pain”, which he termed ‘psychache’. This idea can sometimes offer a way of understanding suicide as an attempt to escape suffering rather than as a rejection of others or a wish to die. In 2005, Thomas Joiner proposed that suicide emerges when a person experiences both a sense of not belonging and a belief that they are a burden. This is known as the interpersonal theory of suicide. It also suggests that suicidal behaviour is not simply a wish to die, but something that develops over time through exposure and habituation to pain or fear.

Similarly, in 2011, Rory O’Connor developed the Integrated Motivational Volitional model, which distinguishes between the emergence of suicidal thoughts and the transition to action. Within this model, feelings of defeat and entrapment, also interpreted as feeling powerless or helpless in one’s situation, can give rise to suicidal thinking, while factors such as access to means or impulsivity can influence whether a person acts on those thoughts. Again, these ideas do not explain a single death. They offer a language for thinking about how complex and layered these experiences can be.

Apart from theories that can help in understanding, there is often a felt difference in how this loss is held by others. Suicide bereavement is many times influenced by the social responses that follow. Research consistently identifies stigma as a central feature. This can show up in silence, in avoidance or in use of language as people may not know what to say or sometimes they say nothing at all.

If the person who died by suicide was young then there can be a sense that the life that was unfolding has been interrupted in a way that feels difficult to take in. Developmental expectations are disrupted and an imagined future becomes something else entirely, as the absence is not only of the person as they were but of who they were becoming.

There is also the presence of trauma within this kind of grief. Bereavement after suicide can involve intrusive thoughts, images or bodily responses that are not always associated with other forms of loss. The mind can return to the circumstances of the death in ways that feel involuntary which can make restorative rest difficult. It can make everyday life feel less predictable.

At the same time, it is important not to separate suicide bereavement too sharply from other forms of grief. There is a risk that in emphasising difference, the shared human aspects of mourning are lost. Certainly shame and self-blame can be present. However, grief remains grief and love remains present in the loss. Grief theorists have long tried to describe how people live with loss. Accepting the reality of the loss and processing the pain of grief can be the ultimate challenge and these tasks are not steps that are completed in order. They can be returned to repeatedly, especially when the death carries unanswered questions. Meaning making and honouring the person who died by suicide can be deeply challenging but ultimately supportive in living one’s own life. Talking about this and opening up to loved ones is the best way to go about it. Of course, Psychotherapy and Counselling is also an appropriate place to do this if doing it with loved ones feels too much to start with.

For more information on Leo’s services, 

phone: 085 1300573

email: info@leomuckley.com 

web: www.leomuckley.com 

sm: @leomuckleypsychotherapy

“It is a privilege to age….” Phrases like these may make you want to scream. It is not easy being positive about ageing in the face of all that modern society hurls at us over-50s when everything about ageing for women is negative: We are not fertile, not deemed attractive and the physical changes of ageing, such as wrinkles, are deemed ugly, to be erased with serums, injections, or the knife. But the same criticism is not wielded at men; if they have grey hair they are a ‘Silver Fox’ – their wrinkles looked on as distinguished not ugly features.

What we should be asking is Why? Why do women, especially in West Cork, live to such an old age? What is our purpose?

We seem to have an evolutionary mystery here: Why do we live so long beyond the age when we can reproduce? Classic Darwinian theory would predict otherwise, as natural selection favours mutations that increase reproduction and tends to put a cap on survival after reproduction ceases. In fact, almost all female mammals from elephants to squirrels, badgers and meerkats, live only for relatively short periods of time after reproduction ceases.

For human females, a third of our lives will be lived after menopause and only a  handful of mammals do this; orcas, beluga, narwhal and short-fined pilot whales and, according to a recent study, chimpanzees from one population in western Uganda.

The evolutionary purpose of women living 20 or 30 years post reproductive age is that we bring intrinsic value to our society, and I am not talking about being a babysitter on tap for grand kids. I mean sharing our skills, nurturing and teaching others. All of our gleaned wisdoms and skills have value: be it music, art or poetry; it could be crochet or baking, organising and decluttering. Me? I started to write for West Cork People in 2023. I like sharing my knowledge and hope it helps women. As we age, we learn patience, tolerance, acceptance and therefore become better listeners,  better friends and partners.

I say embrace being part of the matriarchy and, dare I say it, embrace your inner crone!

I went to visit my Auntie Breda, age 98, today and wanted to share her insight. She was born, raised, married, had seven children and lived all her life in  the small village of Whitegate in East Cork. She currently is living in Youghal community nursing home. Physically frail but still mentally sharp as a tack, we talked about what it meant to age,  to get old. We talked about dying and we decided we are all dying, because in the end, we all will die – but that is not the point of life.

She felt the important thing is that we enjoy life and I am happy to share my East Cork matriarch’s advice here, salty language and all:  just don’t give a  f#ck what others say or think about you; stop trying to change; just be you.

Women’s physical health:
the facts

• One in two women over the age of 50 will suffer an osteoporotic fracture.

• One in three women, age 75 will die of a heart attack or stroke.

• One in two women over 60 years have high blood pressure and most are unaware. High blood pressure is the lead cause of heart attack and stroke in women if left untreated. The harsh reality with high blood pressure is that you get no symptoms; you feel absolutely fine until you have that stroke or heart attack.

• Women’s cholesterol changes through menopause transition, with total, as well as the bad LDL cholesterol, going up. High LDL is thought to be the strongest predictor of heart disease in women.

• A high BMI, over 30, increases a woman’s risk of heart attack threefold. 

Menopause transition results in weight gain, on average 7kg according to studies, but in reality it is more. That weight sits around the belly, known as central obesity and is incredibly difficult to shift. The combination of central obesity and lipid changes is called metabolic syndrome and is associated with  higher risk of developing diabetes.

Women over 60 increasingly experience urinary symptoms of frequency, passing urine many times in the day, nocturia; getting up at night to pee, discomfort when you wee like a cystitis feeling and recurrent urinary tract infections (UTIs) are common in the over-70s. Incontinence is sometimes thought to be the inevitable companion of ageing and we will all end up in pads by the age of 80. Not true: UTIs and incontinence in our old age are preventable!  

While the medical conditions mentioned above are related to falling oestrogen levels through menopause, they are not inevitable. So what can we do to stay healthy into our 80s? Well, prevention is better than cure!

Cardiovascular disease
(CVD)  prevention

Hypertension or high blood pressure, diabetes and heart disease are prevalent in women over 60. Diabetes, heart disease and stroke, however, are all preventable.

Regular aerobic exercise, a healthy low fat, Mediterranean diet, not smoking,  moderate drinking, weight loss, keeping BMI under 30 will all result in a massive reduction in your risk of having a heart attack or stroke or becoming diabetic.

See your GP once a year for blood pressure, cholesterol and HbA1C. The HbA1C test picks up pre-diabetes. If diabetes is caught at this stage and you make changes to diet, increase exercise even if you don’t loose weight, you will stop yourself becoming diabetic. Once diabetes is diagnosed you have a one in three risk of heart attack or stroke in the next 10 years so you want to catch that bugger early. 

If you are found to have even slightly raised blood pressure, you take a once a day tablet. If your pressure is kept low, the high blood pressure effects on the heart, kidney and brain simply does not happen and you prevent your heart attack, heart failure, atrial fibrillation, stroke and kidney failure.  

If cholesterol and LDL are raised, a once a day statin tablet has been shown in studies to result in a 50 per cent reduction in your risk of heart attack or stroke over the next 10 years. Even if your cholesterol is not raised, this benefit is seen.

The female heart

Most studies looking at heart disease or trials developing cardiac drugs have been done using male participants. Female coronary heart disease (CHD) is different to male; we tend to have issues with our small coronary arteries; men tend to block off their big arteries. Symptoms can be completely different between the sexes.

Women tend not to get classic chest pain when exercising that men present with; there can be pervasive fatigue; you might feel breathless or lightheaded when you exercise or just feel you don’t have the energy to get out for a walk. Symptoms can be triggered by worry or stress rather than exercise,  so can be put down to psychological chest pains rather than cardiac symptoms resulting in delayed diagnosis. 

Don’t ignore symptoms,  see your GP: if you are diagnosed with CHD before you have that heart attack you prevent damage to a section of heart muscle. This part will  not move properly after a heart attack resulting in a weak heart pump, a condition called heart failure. Yes, once diagnosed with CHD, you need to take a few tablets every day but surely that is better than being dead or very breathless and unable to exercise or walk.

Osteoporosis and falls prevention: calcium and vitamin D, exercise and weight training

We need a minimum 1000 units Vit D per day and this is impossible to get in our food plus we live in the wrong country; 80 per cent of people in Ireland are vitamin D deficient because of lack of sunshine.

We need 1200mg calcium per day. Use this calculator (www.osteoporosis.foundation/educational-hub/topic/calcium-calculator) to work out if you are eating enough and if not your GP can prescribe a combination calcium plus Vitamin D tablet.

Walking helps muscle and bone strength and West Cork women are big walkers. But weight training is also really important. I am not talking about massive dumbbells and hours in the gym; most gyms throughout West Cork are running women-only weight training sessions. A session involves using very low weights in a repetitive way, 10 to 20 movements in each set, to build up different muscle groups. This results in better core strength and balance, prevents falls and will increase your bone density.  

Studies have shown that you get benefits from what they call exercise snacking; just doing a 10 to 15 minute session several times per week. Once you know what exercises to do, get yourself a set of weights and you can do them at home. 

Oestrogen therapy for the over 70s

Vaginal oestrogen is safe and, in my opinion, essential for all women over 60. Systemic HRT,  not so much. 

Systemic HRT means using oestrogen as a tablet or through the skin as patch, gel or spray, which is absorbed into your bloodstream and acts all around the body.

Evidence from recent studies and Cochrane analysis suggests that systemic HRT started under the age of 60 or within 10 years of the last menstrual period is associated with a reduction in atherosclerosis progression, coronary heart disease, CHD,  and death from all cardiovascular causes as well as all cause mortality. More recent evidence points to greater CVD benefits by starting within six years of last period.  

Four to five years systemic HRT use is associated with almost halving of risk of osteoporotic hip fracture by the age of 65. 

However, studies have repeatedly failed to show any benefit for CVD or osteoporosis prevention when systemic HRT is started for the first time in women over the age of 60. There is also some evidence that doing so might lead to slightly increased risks of heart attack or stroke.  Studies showing that, however, did include women aged 69 to 75, who inherently have a higher risk of CVD.

In short, as a menopause doctor, do I ever start systemic HRT for the first time in a woman over 70?  No, because of the lack of evidence for benefit.

However, if a 70-year-old patient already using systemic HRT for many years wants to continue, that is a different situation. The issue here is that prolonged HRT use for greater than five to 10 years,  is linked with slightly increased risk of breast cancer. 

Genitourinary Syndrome of Menopause (GSM) 

GSM is the term used to describe the effects that oestrogen deficiency has on three areas: genital skin, the vagina and the urinary tract.

Local oestrogen therapy is not just about sexy time; many women assume because they are not sexually active, or they are, but do not experience discomfort, that there is no need to use vaginal oestrogen. Not true!

The urinary symptoms so common in women over 70 are caused by oestrogen deficiency. Using vaginal oestrogen will usually completely cure the symptoms.

Local oestrogen therapy can be a cream or pessary. Cream can be applied to skin of external genital area and also inserted inside the vagina with an applicator. Cream is preferable if there is any soreness burning, itching of skin of genital area.

Think of it like filling an empty tank; if you are 70, your bits have not had any oestrogen for 20-plus years; you will need to use it daily for four weeks, then two to three times per week.

Skin symptoms usually resolve quickly in a week or two. For urinary symptoms of dashing to the loo, leaking if you cannot get there fast enough, getting up at night to pee, leaking when you sneeze and discomfort when peeing and UTIs, it tends to take longer before you see a benefit; sometimes a few months,  so stick with it.

Studies have shown that long term use of vaginal oestrogen is associated with reduced risk of incontinence and recurrent UTIs in our old age.

Is local oestrogen therapy safe? Yes, even if you have had breast cancer in the past.

Studies looking at vaginal oestrogen use in women with a history of breast cancer have not shown any increase in cancer recurrence or in mortality.

Studies of women using vaginal oestrogen long term have showed it is not significantly absorbed as their blood oestrogen levels remain very low.

You will find more information on GSM in the British Menopause Society Women’s Health information leaflet accessible on www.thebms.org.uk.

If you have symptoms suggestive of GSM, please see your GP. If needed, your GP can refer you to be seen at the gynaecology clinic in Bantry.“I

t is a privilege to age….” Phrases like these may make you want to scream. It is not easy being positive about ageing in the face of all that modern society hurls at us over-50s when everything about ageing for women is negative: We are not fertile, not deemed attractive and the physical changes of ageing, such as wrinkles, are deemed ugly, to be erased with serums, injections, or the knife. But the same criticism is not wielded at men; if they have grey hair they are a ‘Silver Fox’ – their wrinkles looked on as distinguished not ugly features.

What we should be asking is Why? Why do women, especially in West Cork, live to such an old age? What is our purpose?

We seem to have an evolutionary mystery here: Why do we live so long beyond the age when we can reproduce? Classic Darwinian theory would predict otherwise, as natural selection favours mutations that increase reproduction and tends to put a cap on survival after reproduction ceases. In fact, almost all female mammals from elephants to squirrels, badgers and meerkats, live only for relatively short periods of time after reproduction ceases.

For human females, a third of our lives will be lived after menopause and only a  handful of mammals do this; orcas, beluga, narwhal and short-fined pilot whales and, according to a recent study, chimpanzees from one population in western Uganda.

The evolutionary purpose of women living 20 or 30 years post reproductive age is that we bring intrinsic value to our society, and I am not talking about being a babysitter on tap for grand kids. I mean sharing our skills, nurturing and teaching others. All of our gleaned wisdoms and skills have value: be it music, art or poetry; it could be crochet or baking, organising and decluttering. Me? I started to write for West Cork People in 2023. I like sharing my knowledge and hope it helps women. As we age, we learn patience, tolerance, acceptance and therefore become better listeners,  better friends and partners.

I say embrace being part of the matriarchy and, dare I say it, embrace your inner crone!

I went to visit my Auntie Breda, age 98, today and wanted to share her insight. She was born, raised, married, had seven children and lived all her life in  the small village of Whitegate in East Cork. She currently is living in Youghal community nursing home. Physically frail but still mentally sharp as a tack, we talked about what it meant to age,  to get old. We talked about dying and we decided we are all dying, because in the end, we all will die – but that is not the point of life.

She felt the important thing is that we enjoy life and I am happy to share my East Cork matriarch’s advice here, salty language and all:  just don’t give a  f#ck what others say or think about you; stop trying to change; just be you.

Women’s physical health:
the facts

• One in two women over the age of 50 will suffer an osteoporotic fracture.

• One in three women, age 75 will die of a heart attack or stroke.

• One in two women over 60 years have high blood pressure and most are unaware. High blood pressure is the lead cause of heart attack and stroke in women if left untreated. The harsh reality with high blood pressure is that you get no symptoms; you feel absolutely fine until you have that stroke or heart attack.

• Women’s cholesterol changes through menopause transition, with total, as well as the bad LDL cholesterol, going up. High LDL is thought to be the strongest predictor of heart disease in women.

• A high BMI, over 30, increases a woman’s risk of heart attack threefold. 

Menopause transition results in weight gain, on average 7kg according to studies, but in reality it is more. That weight sits around the belly, known as central obesity and is incredibly difficult to shift. The combination of central obesity and lipid changes is called metabolic syndrome and is associated with  higher risk of developing diabetes.

Women over 60 increasingly experience urinary symptoms of frequency, passing urine many times in the day, nocturia; getting up at night to pee, discomfort when you wee like a cystitis feeling and recurrent urinary tract infections (UTIs) are common in the over-70s. Incontinence is sometimes thought to be the inevitable companion of ageing and we will all end up in pads by the age of 80. Not true: UTIs and incontinence in our old age are preventable!  

While the medical conditions mentioned above are related to falling oestrogen levels through menopause, they are not inevitable. So what can we do to stay healthy into our 80s? Well, prevention is better than cure!

Cardiovascular disease
(CVD)  prevention

Hypertension or high blood pressure, diabetes and heart disease are prevalent in women over 60. Diabetes, heart disease and stroke, however, are all preventable.

Regular aerobic exercise, a healthy low fat, Mediterranean diet, not smoking,  moderate drinking, weight loss, keeping BMI under 30 will all result in a massive reduction in your risk of having a heart attack or stroke or becoming diabetic.

See your GP once a year for blood pressure, cholesterol and HbA1C. The HbA1C test picks up pre-diabetes. If diabetes is caught at this stage and you make changes to diet, increase exercise even if you don’t loose weight, you will stop yourself becoming diabetic. Once diabetes is diagnosed you have a one in three risk of heart attack or stroke in the next 10 years so you want to catch that bugger early. 

If you are found to have even slightly raised blood pressure, you take a once a day tablet. If your pressure is kept low, the high blood pressure effects on the heart, kidney and brain simply does not happen and you prevent your heart attack, heart failure, atrial fibrillation, stroke and kidney failure.  

If cholesterol and LDL are raised, a once a day statin tablet has been shown in studies to result in a 50 per cent reduction in your risk of heart attack or stroke over the next 10 years. Even if your cholesterol is not raised, this benefit is seen.

The female heart

Most studies looking at heart disease or trials developing cardiac drugs have been done using male participants. Female coronary heart disease (CHD) is different to male; we tend to have issues with our small coronary arteries; men tend to block off their big arteries. Symptoms can be completely different between the sexes.

Women tend not to get classic chest pain when exercising that men present with; there can be pervasive fatigue; you might feel breathless or lightheaded when you exercise or just feel you don’t have the energy to get out for a walk. Symptoms can be triggered by worry or stress rather than exercise,  so can be put down to psychological chest pains rather than cardiac symptoms resulting in delayed diagnosis. 

Don’t ignore symptoms,  see your GP: if you are diagnosed with CHD before you have that heart attack you prevent damage to a section of heart muscle. This part will  not move properly after a heart attack resulting in a weak heart pump, a condition called heart failure. Yes, once diagnosed with CHD, you need to take a few tablets every day but surely that is better than being dead or very breathless and unable to exercise or walk.

Osteoporosis and falls prevention: calcium and vitamin D, exercise and weight training

We need a minimum 1000 units Vit D per day and this is impossible to get in our food plus we live in the wrong country; 80 per cent of people in Ireland are vitamin D deficient because of lack of sunshine.

We need 1200mg calcium per day. Use this calculator (www.osteoporosis.foundation/educational-hub/topic/calcium-calculator) to work out if you are eating enough and if not your GP can prescribe a combination calcium plus Vitamin D tablet.

Walking helps muscle and bone strength and West Cork women are big walkers. But weight training is also really important. I am not talking about massive dumbbells and hours in the gym; most gyms throughout West Cork are running women-only weight training sessions. A session involves using very low weights in a repetitive way, 10 to 20 movements in each set, to build up different muscle groups. This results in better core strength and balance, prevents falls and will increase your bone density.  

Studies have shown that you get benefits from what they call exercise snacking; just doing a 10 to 15 minute session several times per week. Once you know what exercises to do, get yourself a set of weights and you can do them at home. 

Oestrogen therapy for the over 70s

Vaginal oestrogen is safe and, in my opinion, essential for all women over 60. Systemic HRT,  not so much. 

Systemic HRT means using oestrogen as a tablet or through the skin as patch, gel or spray, which is absorbed into your bloodstream and acts all around the body.

Evidence from recent studies and Cochrane analysis suggests that systemic HRT started under the age of 60 or within 10 years of the last menstrual period is associated with a reduction in atherosclerosis progression, coronary heart disease, CHD,  and death from all cardiovascular causes as well as all cause mortality. More recent evidence points to greater CVD benefits by starting within six years of last period.  

Four to five years systemic HRT use is associated with almost halving of risk of osteoporotic hip fracture by the age of 65. 

However, studies have repeatedly failed to show any benefit for CVD or osteoporosis prevention when systemic HRT is started for the first time in women over the age of 60. There is also some evidence that doing so might lead to slightly increased risks of heart attack or stroke.  Studies showing that, however, did include women aged 69 to 75, who inherently have a higher risk of CVD.

In short, as a menopause doctor, do I ever start systemic HRT for the first time in a woman over 70?  No, because of the lack of evidence for benefit.

However, if a 70-year-old patient already using systemic HRT for many years wants to continue, that is a different situation. The issue here is that prolonged HRT use for greater than five to 10 years,  is linked with slightly increased risk of breast cancer. 

Genitourinary Syndrome of Menopause (GSM) 

GSM is the term used to describe the effects that oestrogen deficiency has on three areas: genital skin, the vagina and the urinary tract.

Local oestrogen therapy is not just about sexy time; many women assume because they are not sexually active, or they are, but do not experience discomfort, that there is no need to use vaginal oestrogen. Not true!

The urinary symptoms so common in women over 70 are caused by oestrogen deficiency. Using vaginal oestrogen will usually completely cure the symptoms.

Local oestrogen therapy can be a cream or pessary. Cream can be applied to skin of external genital area and also inserted inside the vagina with an applicator. Cream is preferable if there is any soreness burning, itching of skin of genital area.

Think of it like filling an empty tank; if you are 70, your bits have not had any oestrogen for 20-plus years; you will need to use it daily for four weeks, then two to three times per week.

Skin symptoms usually resolve quickly in a week or two. For urinary symptoms of dashing to the loo, leaking if you cannot get there fast enough, getting up at night to pee, leaking when you sneeze and discomfort when peeing and UTIs, it tends to take longer before you see a benefit; sometimes a few months,  so stick with it.

Studies have shown that long term use of vaginal oestrogen is associated with reduced risk of incontinence and recurrent UTIs in our old age.

Is local oestrogen therapy safe? Yes, even if you have had breast cancer in the past.

Studies looking at vaginal oestrogen use in women with a history of breast cancer have not shown any increase in cancer recurrence or in mortality.

Studies of women using vaginal oestrogen long term have showed it is not significantly absorbed as their blood oestrogen levels remain very low.

You will find more information on GSM in the British Menopause Society Women’s Health information leaflet accessible on www.thebms.org.uk.

If you have symptoms suggestive of GSM, please see your GP. If needed, your GP can refer you to be seen at the gynaecology clinic in Bantry.

Patrick has spent over 20 years working in this area through the Food for the Brain Foundation, an online Charity that has now assessed the cognitive health of nearly half a million people. What’s emerging from that work is quite striking: the story we are being told about dementia may be missing the bigger picture.

Rather than focusing solely on amyloid plaques, Patrick argues that factors like high homocysteine levels, poor blood sugar control, and lifestyle habits are far more powerful predictors of brain decline. He also asserts that dementia should not be viewed as an unavoidable consequence of getting older, but rather as a preventable disease in many instances. 

In fact, he suggests that up to 73 per cent of cases could be avoided by modifying our diets and lifestyles. 

That’s a hopeful message. If you want to read more, there’s SO much information on foodforthebrain.org – but here’s some things you can add into your diet this week to start making a difference. 

Feed your brain with
omega-3 fats

The message is simple: our brains are built from fat – around 60 per cent of it. But not just any fat, but specifically omega-3 fatty acids like DHA.

This is where traditional diets come in. Patrick spoke about how our ancestors evolved along coastlines, eating seafood – mussels, seaweed, small fish like sardines and mackerel – which helped grow the large, complex brains we have today. Yet many of us now eat little to no fish.

The shift is simple: aim for two to three servings of oily fish a week – sardines, mackerel, herring. Tinned is perfectly fine, but look for Irish brands that fish as sustainably as possible like Shines Seafood. 

If that’s not realistic, a good-quality omega-3 supplement (rich in DHA) is one of the most important additions you can make. Also, walnuts, flax, chia seeds and leafy greens can also help support your omega 3 levels. 

Lower homocysteine
with B vitamins

If there was one concept that really landed during Patrick’s talk, it was homocysteine. Patrick describes it as a “toxic amino acid” that damages both brain cells and arteries. When levels rise, memory tends to decline – and when levels fall, memory improves.

The key to keeping it in check? B vitamins – particularly B6, B12 and folate. These are found in leafy greens, whole foods, and also in good-quality B-complex supplements. But here’s the important bit: B vitamins don’t work properly without adequate levels of omega-3 – so the two go hand in hand.

If you would like to test your Homocysteine levels, you can order the home blood test kit from foodforthebrain.org. This can help you to know if you need to add in more B Vitamins. 

Balance your blood sugar

Another strong theme from Patrick’s talk was blood sugar.

“Sugar kills brain cells,” he said bluntly – and while that may sound dramatic, the connection between high blood glucose and cognitive decline is increasingly well-established.

A diet high in refined carbohydrates and sugar can push us towards insulin resistance and pre-diabetes – both of which are strongly linked to dementia risk.

The goal isn’t perfection, but stability: Cut back on sugar and ultra-processed carbs; include protein and healthy fats with all meals; and eat your veg first – this slows down glucose absorption.

Eat colour, plants and protective compounds

Beyond fats and balanced blood sugar levels, our brains thrive on antioxidants and plant compounds.

Berries – especially blueberries – are rich in anthocyanins, which can cross the blood-brain barrier and help protect brain cells from ageing and damage. Leafy greens bring folate and vitamin C, while foods like dark chocolate, green tea and turmeric add further protective benefits.

Curcumin (from turmeric), for example, has been shown to support levels of brain-derived neurotrophic factor (BDNF) – a compound involved in learning and memory.

Use targeted supplements to support your brain

I like to top up with supplements as I don’t always manage my diet perfectly. Here’s what I’m taking regularly: Omega-3 (high DHA) – essential for brain structure and mood (and so many other things!); B-complex vitamins – to regulate homocysteine (also good for energy, hormones…); Alpha-lipoic acid (ALA) – this is worth reading up on, it’s very protective of the brain; Vitamin D – we all know Vit D crucial for mood and cognitive health, especially in Ireland; Magnesium – to support our nervous systems, and also good for our brain health.

My goal for the next decade is to really focus on my brain health. The more I read and learn, the more I realise there’s so much we can do. Exercise, regular socialising, good sleep, and perhaps cutting down, or even cutting out, alcohol all come up again and again in the research on protecting our brains.

What I found most reassuring about Patrick Holford’s approach is how ‘wholistic’ it is “If we get our diet and lifestyle right for our brain, they’ll also be right for our body,” he said, and that really resonates with me. Even small changes like the ones above can make a meaningful difference to our brain health, while also supporting our overall wellbeing.

I also like the fact that if you log on to the Food for the Brain Foundation website, you can do a free cognitive test to assess your risk, and then order a homocysteine test for more insight. It feels empowering to have tools like this, small ways of keeping an eye on things and taking action early.

Good luck and let me know if you have any natural health questions I can help with! 

To answer these questions, we need to start by looking at the nervous system itself. The nervous system consists of the central nervous system comprising the brain and spinal cord and the peripheral nervous system, which is a network of nerves that connects the brain and spinal cord to the limbs and organs. This vast system of nerves, approximately 45 miles long if we were to lay it out, is responsible for 100 per cent of our body functions. It is the body’s communication and control network. The nervous system detects the information in our environment, processes it and then sends signals throughout the system that co-ordinate movement, sensation, and bodily functions. It is always listening to the inner environment of the body and detecting the external environment, and it is the nervous system that determines our movement patterns. How we move through the world and indeed how we perceive it, is down to our nervous system.

Our sciatic nerve, which emerges from the spine, is the longest and thickest nerve in the body. It runs from the lower spine through the buttocks and down the back of both legs, terminating at the foot. It enervates the leg and carries the motor signals to the muscles, resulting in our being able to move our legs.

Just like our joints and our fascia, our nerves require movement to stay healthy. Nerve cells, interestingly, are known to be the most excitable cells in the body. They both love and require novelty to be healthy. From a movement perspective this means multi-directional movement is essential. Not only does multi-directional movement excite the nerve cells in the peripheral system, it also lights up the brain, as synaptic activity or signal transmission keeps the brain alert and firing in response to the inner and outer environment. Quite literally, without movement our brains become dull. And we need regular movement in many directions in order to support blood flow and drainage for the nerves. This is an especially important factor in sciatica prevention.

So how can we distinguish the pseudo from the real sciatica?

Real sciatica results from nerve compression in the spine. This can be as a result of injury to the back, herniation of the disc, known colloquially as a ‘slipped disc’ or stenosis. Such impingement upon the discs causes shooting, burning electric pain down the leg with the pain manifesting below the knee as the sciatic nerve doesn’t supply so much sensory function in the thigh. Sciatica usually resolves in four to six weeks, and pain relief may be needed. Pain is often, though not always, worsened by actions such as coughing, sitting, or placing load on the spine. Major red flags for sciatica are if pain runs down both legs, weakness or numbness develops down both legs or there is a loss of continence in either bladder or bowel. These are the symptoms of cauda equina, a rare but serious medical condition whereby the nerves at the base of the spine are severely compressed. It requires immediate surgical intervention to prevent loss of motor function or paralysis.

Pseudo sciatica is a milder creature and manifests more as neural tension and restriction. One sure sign of this type of sciatica is that symptoms will change depending on the limb positioning. For instance, if you pull your foot up towards you, which automatically shortens and tightens the sciatic nerve, you’ll feel an uncomfortable pulling sensation. This condition typically occurs with muscle stiffness or limited movement, but motor function remains intact. Poor hip mobility can also create symptoms of fake sciatica as tight or weak buttock muscles can impinge upon the nerve causing a literal pain in the butt. This condition may cause persistent discomfort, but it does not radiate pain to the lower extremities. Nerves enjoy movement but dislike strain. The brain responds defensively to stretching of major nerves, such as the sciatic nerve, due to their heightened sensitivity. This can result in ‘stuckness’ which can look like stiff ankles, tight hamstrings, hips and lower back. 

Managing both the real and fake

With real sciatica, once the episode has passed it is crucial to begin to strengthen the core to support the lower vertebrae and take pressure off discs and nerves especially where there has been a herniation. In the case of stenosis, learning how to move the spine with awareness is crucial. While there is no guarantee that you will not be revisited by sciatica, recovering confidence to move safely is vital. Remember nerve cells thrive on novelty and movement. Because the brain will ‘guard’ tight nerves we can end up limiting our movements to avoid pain and lose so much more in our capacity to experience the world. We must proceed gently but with confidence. 

For both, stretching the nerve should be replaced by gliding the nerve. Gentle flexion and extension of the foot (pulling the foot up towards you and then pointing it away, exhaling as you pull towards and inhaling as you point away) is a simple way to start. Avoid doing too much at first, as it can be exhausting and may worsen symptoms. If you experience a flare up, wait for it to subside before continuing.

I would like to recommend a lovely modality called nerve brushing. Stand and place both hands on the abdomen and begin to brush down as though you are brushing crumbs off your clothing. Proceed your legs to your feet then brush down the chest and arms and head. Keep your touch light. Once you have brushed down the body return to the abdomen and proceed to brush in an upward direction through the whole body as before. This has the effect of lightly stimulating and relaxing the nerves and disarming the alarm system in the brain and makes stretching and gliding gentler so you can restore your sciatic nerve to health.

Cosmeticorexia is an emerging psychological pattern defined by an intense and persistent preoccupation with physical appearance, often driven by unrealistic beauty standards and amplified by constant exposure to curated digital imagery. While interest in appearance and self-care is a natural part of human behaviour, cosmeticorexia moves beyond this into a space where appearance becomes central to identity and self-worth. It is not simply about wanting to look good; it is about feeling that one must look a certain way to feel acceptable, valued, or even safe within social environments. In this sense, cosmeticorexia reflects a deeper internal struggle rather than a surface-level concern.

We increasingly observe that individuals caught in this pattern respond not to how they actually look, but to how they believe they should look. This distinction is important because it highlights the role of perception rather than reality. The internal experience is often characterised by dissatisfaction, comparison, and a constant sense of falling short. Even when changes are made, whether through grooming routines, cosmetic products, or aesthetic procedures, the relief tends to be temporary. A new perceived flaw quickly replaces the previous one, creating a cycle that is difficult to interrupt. The pursuit becomes endless, not because the desired outcome is physically unattainable, but because the internal standard keeps shifting.

At a psychological level, cosmeticorexia is closely linked to feelings of inadequacy, fear of judgement, and a fragile sense of self. The focus on appearance becomes a way of managing these feelings, offering a temporary sense of control. When life feels uncertain or emotionally overwhelming, the body can become a project – something to fix, refine, or perfect. However, this sense of control is often misleading. The more attention directed towards appearance, the more sensitive and critical the individual becomes, leading to increased dissatisfaction rather than resolution. What begins as an attempt to feel better can gradually turn into a source of distress in itself.

The role of social media in reinforcing cosmeticorexia cannot be overstated. We are now exposed to an unprecedented volume of images that present highly edited, filtered, and curated versions of reality. These images are often perceived as normal, even though they are far removed from everyday human experience. As individuals scroll through these representations, comparison becomes almost automatic. The mind begins to measure itself against an ideal that is not only unrealistic but constantly evolving. In this environment, appearance is not just observed; it is evaluated, ranked, and publicly validated. The number of likes, comments, and shares can become a proxy for worth, further embedding the belief that how one looks determines how one is valued.

Over time, this creates a powerful feedback loop. Exposure to idealised images leads to internal comparison, which generates dissatisfaction. This dissatisfaction then drives attempts to improve appearance, which may result in short-term validation. However, this validation is rarely stable, and the individual soon returns to a state of self-criticism. Each cycle reinforces the underlying belief that something is not quite right and needs to be fixed. The individual becomes increasingly focused on perceived flaws, often magnifying them beyond their actual significance.

Behaviourally, cosmeticorexia may present in a number of ways. Individuals may spend excessive amounts of time examining their appearance, taking photos, or adjusting specific features. Daily routines can become dominated by grooming, skincare, or makeup rituals, sometimes to the point where they interfere with other aspects of life. There may also be a growing reliance on cosmetic procedures or consultations, accompanied by extensive research into ways of altering or enhancing appearance. Emotionally, self-esteem becomes closely tied to how one looks on a given day. A minor imperfection can have a disproportionate impact on mood, leading to anxiety, frustration, or withdrawal from social situations.

Cosmeticorexia also shares common ground with other psychological conditions. It overlaps significantly with body dysmorphic tendencies, where individuals fixate on perceived flaws that may not be noticeable to others. It can also intersect with disordered eating patterns, particularly when body image becomes central to identity and control. In some cases, obsessive-compulsive features may emerge, with repetitive checking or corrective behaviours becoming difficult to resist. These connections highlight that cosmeticorexia is not a superficial concern but a complex and multifaceted issue that sits within a broader psychological context.

One of the most significant underlying themes in cosmeticorexia is the relationship between appearance and identity. Instead of developing a sense of self based on values, experiences, and relationships, identity becomes increasingly tied to how one is perceived externally. The question shifts from “Who am I?” to “How do I look?” This shift can create a fragile sense of self, as it relies heavily on external feedback and is vulnerable to change. If appearance becomes the primary source of validation, any perceived imperfection can feel like a threat to one’s overall sense of worth.

Teenagers are particularly vulnerable to this pattern, as they are in a stage of life where identity is still forming. Peer relationships and social acceptance carry significant weight, and the desire to belong can intensify the focus on appearance. When combined with exposure to idealised images and the pressure to present oneself in a certain way, cosmeticorexia can develop as an attempt to navigate these challenges. What may begin as curiosity about beauty or self-expression can gradually evolve into a more rigid and critical relationship with one’s appearance.

The long-term impact of cosmeticorexia can be profound. Emotionally, individuals may experience ongoing dissatisfaction, anxiety, and a diminished sense of self-worth. Behaviourally, significant time and financial resources may be directed towards maintaining or altering appearance, sometimes at the expense of other areas of life. Relationships can also be affected, as the focus on appearance may interfere with authentic connection. When self-worth is externally driven, it can become difficult to engage in relationships from a place of confidence and stability.

Addressing cosmeticorexia requires a shift in focus from external appearance to internal experience. This involves recognising that the urge to fix or change appearance is often linked to underlying emotions rather than actual physical flaws. Developing awareness of these emotional drivers can create space for a different response, one that does not immediately involve action or correction. It also involves challenging the patterns of comparison that are so deeply ingrained, particularly in digital environments. Reducing exposure to unrealistic content and questioning the assumptions it creates can help to weaken its influence over time.

Ultimately, cosmeticorexia reflects a broader cultural emphasis on appearance as a measure of value. It invites us to consider how identity is shaped and what we prioritise as a society. When appearance becomes the dominant lens through which we view ourselves and others, we risk losing sight of the qualities that make us fully human. Moving beyond this requires a rebalancing, where appearance is recognised as just one aspect of identity rather than its foundation. In doing so, we create the possibility for a more stable and authentic sense of self, one that is not dependent on constant adjustment or approval.

Now indoors with the door and windows wide open, I can still feel a gentle sea breeze brushing against my face and arms and circulating my little home here. My feet are bare, toes touching the ground and heels resting against the legs of the chair. All is well in this moment, this perfect moment of awareness, appreciation, and of living life fully. I love the simplicity of soaking it all in, this intentional taking in the good and savouring it. I take time to feel my body against all the surfaces, the ground, the chair, my elbows on the table or armrest, fingers touching the keyboard, and I repeatedly sense into the moment, almost exaggerating this momentary awareness of being present in this body, with no pressure, nothing to do, nowhere to go. Resting in the embrace of nature and this amazing natural world.  

And maybe because this dry, calm, sunny weather has been so rare this year, it seems extra precious and, I’m sure like most people, I want it to stay. We naturally want these good times to last, however, by the time it took me to move indoors, because the sun was cooling, I had received news of the deaths of two people I knew. A stark reminder that life is so unpredictable and can change in the blink of an eye. All the more reason for us to value our lives and the people and places we hold dear.  I pause and intentionally think of these affected families and a feeling inside of me stirs. Their grief resonates with me, and I feel deep discomfort and a sense of deep compassion for them.  

Compassion-based mindfulness encourages qualities like empathy, inclusion, solidarity and having the ability, as well as making the choice, to step into someone else’s shoes and offer compassion.

But while we can make choices every moment of our lives about how we live them, we really have no control over events that happen every day. So, there is something about noticing and relishing the good moments while accepting their impermanent nature and being able to sit with and accept the difficult moments too, instead of resisting them. Having the knowledge that a day going so smoothly and perfectly can be instantly interrupted can help us to be very grateful for those moments in the sun and our leisure time, simply because nothing stays the same for too long.  

Nature can be so reassuring amid all that’s happening within us and around us. It is a constant in our lives and yet always in a state of flux and flow. The amazing, heroic swallows are back and that fills so many of us with joy. To sit and watch them swooping and circling, imagining all they went through to get back here is truly awe-inducing. Perhaps our everyday mindfulness practices this month can be to garner moments of comfort from simply sitting listening to the birds or quietly watching the swallows. Can we put our phones and the news aside for a small while and feel the life that is bursting forth at this time of year? This poem ‘Allow’ by Danna Faulds is a nice one to contemplate.

‘There is no controlling life. / Try corralling a lightning bolt, / containing a tornado. Dam a

stream and it will create a new / channel. Resist, and the tide / will sweep you off your feet.

Allow, and grace will carry / you to higher ground. The only / safety lies in letting it all in – / the wild / and the weak; fear, / fantasies, failures and success. / When loss rips off the doors of / the heart, or / sadness veils your / vision with despair, practice / becomes simply bearing the truth. / In the choice to / let go of your / known way of being, the whole / world is revealed to your new eyes.’

Mindfulness in May

Drop-in mindfulness hour at CECAS, Myross Wood, Leap on Tuesday mornings 10-11am, May 12, 19 and 26. €12. 

Beginners, returners and newcomers are always welcome.
For more information: phone: 087 2700572 or email:
susanoreganmindfulness@gmail.com 

FB: susanoreganmindfulness. www.mindhaven.ie

I thought it might be helpful to reflect on my experience of working with these new groups and how we can apply our practice to daily life in everyday ways, by ‘catching’ ourselves in the moments that make up our lives. Over eight wonderful weekly sessions together we practiced mindfulness meditation and explored our thoughts, feelings, emotions and sensory experiences. We reflected honestly and shared our experiences openly. We felt our feelings, laughed, cried and discovered our common humanity, realising that we were all much more similar than different. We practiced some mindful eating and mindful movement. We learned that our minds are busy, but by practicing meditation, they will gradually begin to settle.  

Alongside our growing awareness of ourselves and others, we practiced gratitude, self-compassion and loving kindness for ourselves and all living beings. We discovered that, even though taking our time and moving slowly, we still covered a lot of ground. By examining our habits in terms of which were nourishing or depleting us, we all committed to paying more attention to how we were spending our time. I was struck, and very often moved, by everyday examples that people shared of what they had been noticing between one week and the next. Often, on the face of it, little things, but I see them as ‘little big things’, or even huge things, because, once brought into awareness, they invite potential change, growth, softening.

Some of the benefits that participants shared were so rich and impactful. Examples include, stopping to have breakfast quietly, sitting eating meals slowly and tasting the food, driving slower, improved sleep, enjoying time on holidays better, noticing that we have a choice if we ‘catch’ ourselves in the moment. This ‘catching the moment’ can work in two ways, catching ourselves about to react to a situation, in our usual, habitual way or catching a special moment in our lives and really savouring that moment, as if ‘banking’ it, making a deposit in our long-term memory for our future.  

One example of a habit noticed that perhaps we can all identify with, was of feeling annoyance, even intolerance towards, slow drivers or slow-moving vehicles. Habitually, our response might be to get too close to the offending vehicle, to feel a build-up of impatience, frustration, anger as we wait to overtake. But bringing mindfulness to the situation and noticing or catching the moment of annoyance as it arises can bring an awareness of choice. Hang on, we have a choice here. We can either get highly stressed which takes a toll on our wellbeing or we can simply take our time and wait behind the lorry or tractor until we can find a safe place to pass, then breathe, feel our hands on the wheel and overtake without hardly any stress at all.

Conversely, a striking example of a participant catching themselves in a ‘good’ moment, was someone who was about to go sea swimming off a rock but was finding it impossible to get in.  Because of the tide, she would have to wait or go to a different beach. Instead of rushing off to another spot, she had the realisation in her own mind that, hang on, “This is a moment in my life”.  So, with this awareness, she chose to stay on that rock until the tide changed and had her swim.

Reassured, affirmed and encouraged by this generous group sharing, I was repeatedly reminded that mindfulness meditation really matters, it has meaning and long-lasting impact on people’s everyday lives. Mindfulness meditation can be this grounding, steadying, joyful, lifeforce, providing us with skills we can all learn to help us on our life’s journey.  Skills that, once the foundation has been laid, require consistent practice to grow and strengthen, both formally, through meditation, and informally, through how we live our everyday lives. It is pure privilege to be a conduit of these practical yet life-changing skills and practices, and something that I will be forever grateful for. The simple, yet profound, quote from writer Annie Dillard seems fitting here. “How we spend our days is, of course, how we spend our lives.”

Mindfulness in April

Drop-in mindfulness hour at CECAS, Myross Wood, Leap on Tuesday mornings 10-11am, April 14, and 2h. €12.  Beginners, returners and newcomers are always welcome.

A free three-week compassion-based mindfulness programme for family carers will run at Mossie’s in Adrigole, Beara beginning Thursday April 23, 12-3pm.

For more information: phone: 087 2700572 or email: susanoreganmindfulness@gmail.com 
www.mindhaven.ie

Suffering is part of the human condition. We cannot know joy without sorrow. To be self-compassionate, according to Neff, is to move from over-identifying with our suffering to being mindful of it. What does this mean in practice? It means that we recognise our unique suffering and we notice it rather than falling fully into it and identifying with it as the only thing we are experiencing. She writes that the next step towards self-compassion is to move from the experience of isolation in our suffering to common humanity. This is to recognise that every human on this planet is just that, a human. That we all have humanity in common. When we can recognise this fact, then we can also know that every human suffers. This can open a new aspect of suffering that can alleviate the sense of isolation we can feel. It is easy to think “I’m all alone in this suffering” yet by recognising common humanity we can move out of that isolation.

The last step according to Neff is to move from self-hate or self-criticism to self-kindness. In practice, this is very much about being kind to one’s Self. This does not mean that we become egotistical or display narcissistic traits. If you think of the person you are closest to, that might be a friend, family member or partner, I can hazard a guess that you would go to the moon and back and move mountains for that person if they shared their suffering with you. You would do everything in your power to alleviate their suffering. Self-kindness is about turning that move to alleviate a person’s suffering on oneself. To become one’s own best friend instead of one’s own worst enemy. What is important here is not simply the presence of kindness but the stance of openness to one’s experience. This is not about correcting or fixing something. It is about allowing an experience to be held without immediate judgment. In practice, this often runs counter to how many have learned to relate to themselves, particularly those who carry histories of shame or trauma. Intentionally creating self-compassion doesn’t stop suffering, rather it means you can have the skill of not making your own suffering worse.

Christopher Germer, an American clinical psychologist who has co-authored books with Neff, writes how the apparent simplicity of self-compassion can obscure its difficulty. In my work, I often notice that for many clients, especially those who are actively suicidal or deeply self-critical, offering kindness inwardly can feel unfamiliar or even unsafe. In this sense, self-compassion is not a skill to be learned. Rather, it is often through the experience of being met with compassion by another, in this case a therapist, that a person can take what is offered and turn it inwards. This is where the work of Paul Gilbert, a British clinical psychologist and founder of Compassion Focused Therapy, becomes particularly relevant. Gilbert situates compassion within an evolutionary framework, describing how human beings have developed multiple affect regulation systems.

He suggests that “compassion is a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it”. This definition places emphasis on sensitivity rather than positivity and acknowledges that turning toward suffering requires capacity. Often that capacity is not easily accessible to everyone. For individuals who have spent much of their lives in threat-based states, the idea of responding to themselves with care can activate fear rather than relief as they would have experienced their needs and wants as leading to danger once upon a time. Gilbert’s work invites a more nuanced understanding of the challenges to practicing self-compassion and explains why it can be protective to not practice it if shame, trauma, suicidality and/or abuse are part of one’s experience.

The mindfulness component of self-compassion draws heavily on the work of Jon Kabat-Zinn, who introduced mindfulness into Western clinical contexts through Mindfulness-Based Stress Reduction. He describes mindfulness as “paying attention in a particular way, on purpose, in the present moment, and non-judgmentally”. Within self-compassion, this quality of attention allows one to notice suffering without becoming overwhelmed by it or pushing it away. It creates a kind of internal space, or capacity, where experience can be witnessed. Without this, attempts at self-kindness can become entangled with avoidance or self-criticism.

Research on self-compassion has found how it functions psychologically, that it is associated with greater emotional resilience, not because it removes distress, but because it changes how distress is processed. Research in 2007 found that “self-compassionate people appear to be more willing to acknowledge and accept negative aspects of themselves”. This willingness is clinically significant, as it is often the avoidance of internal experience that maintains suffering. Self-compassion, in this sense, is not about feeling better, rather it is about being able to feel without becoming defined by what is felt. An existential perspective, it has also been explored in research and situates self-compassion within a broader engagement with suffering and meaning. Research in 2016 found that “the healing power of self-compassion lies in its ability to transform suffering into a meaningful human experience”. This framing moves away from symptoms and notes that suffering is not something to be eliminated but something to be understood and held within the context of a making meaning of one’s life.

The roots of these ideas can be traced back to Buddhist psychology, where compassion is considered a fundamental orientation toward suffering. The teachings associated with the Dalai Lama often emphasise that compassion involves recognition of shared humanity. As he writes, “if you want others to be happy, practice compassion; if you want to be happy, practice compassion”. While simple, this reflects an understanding that the boundaries we draw between self and other are often more permeable than they appear.

Across these perspectives, there is a consistent theme of self-relating. This has implications for how things work in therapy and how people can change by attending therapy. Many therapy approaches focus on modifying thoughts or behaviours, which can be effective but may leave underlying relational patterns intact. Self-compassion, by contrast, speaks to the way a person meets themselves in moments of difficulty. It is less about what is thought and more about how those thoughts are held. People who experience persistent self-criticism or shame are often not lacking in insight. They may already understand the origins of their distress or recognise the distortions in their thinking. What is often absent is a sense of internal safety. 

This is why the relational context matters. Self-compassion is often first encountered interpersonally, through the experience of being understood and not judged. Over time, a person can begin to internalise the experience. The therapist’s stance becomes a kind of model that can be followed, not in a prescriptive sense, rather as a lived experience of another way of being. There is also a need to be cautious about how self-compassion is framed culturally. In some contexts, it can be misunderstood as self-indulgence or weakness. Neff addresses this directly, noting that “self-compassion is not a way of judging oneself positively, self-compassion is a way of relating to oneself kindly”. This distinction matters, particularly for individuals who have been misled to believe that their worth is contingent on performance or achievement.

Self-compassion is not a technique to be applied forcefully. It involves turning toward what is difficult, recognising it as part of being human and responding with care for one’s Self. For many, this is not an intuitive process. It requires time, safety and often the presence of another. Whether therapy is focused on addressing a person’s challenges cognitively, relationally or somatically, to name a few ways, the question of how a person relates to themselves remains central. Self-compassion offers one way of engaging with that question as an ongoing practice of meeting oneself, again and again, in the midst of experience. A powerful stance to take in a world that is currently so polarising and harmful to so many. Self-compassion is gentle and courageous thing to engage in and therapy can be a safe place in which to practice.

For more information on Leo’s services, phone: 085 1300573, email: info@leomuckley.com.  www.leomuckley.com, social media: @leomuckleypsychotherapy.

In a world governed by an unwritten code of behaviour and appropriation, it can feel, as an autistic person, permanently unsafe. Unsafe to be yourself. You find yourself asking: Am I getting it right? Replaying conversations and interactions, wondering if you’ve offended someone, then breathing a sigh of relief when you see them again and they don’t seem unhappy with you. But even then, doubt creeps in. Maybe they’re just pretending.

This is a familiar place for many neurodivergent people who have learned, from a young age, to wear a mask. To suppress their natural way of being because they’ve been told, directly and indirectly, that it isn’t acceptable. I’ve spoken often about these unseen systems, the structures that shape how we operate as a society. But who created them? And why are we expected to fit into one or two narrow, binary ways of thinking and behaving?

As an autistic person, I can see how hard I’ve worked to be malleable, to become what I thought others wanted me to be. I learned to people-please, to avoid confrontation, to stay below the radar. Being quiet, compliant, even docile felt safer. In recent years, with a deeper understanding of my neurodivergence, I’ve realised I don’t need to bend myself to maintain relationships with people who only accept me on their terms. In fact, I’ve come to recognise the hollowness of relationships built on control and subtle manipulation.

Over the years, I’ve been fortunate to find a small number of friends who accept me as I am, and whom I accept as they are: human, generous, and imperfect. Around these people, I don’t feel judged, and I don’t judge them. That doesn’t mean we always agree. We don’t. We disagree, we fall out, but we’re willing to talk, to repair what’s been misunderstood. We don’t take disagreement as a personal attack. We can say hard things, and we can hear them, because we remain open to the possibility that we might be wrong.

This, to me, is the great value of friendships among neurodivergent people. There is a shared directness, an honesty. What we say and how we behave tends to reflect what we genuinely think and feel. If I ask a friend something, I trust I’ll get a truthful answer. Sometimes that truth is uncomfortable, but the safety it creates far outweighs the discomfort. There is no need to perform, no need to pretend. And that is a profound gift, especially in a world where I have, at times, believed relationships were genuine only to discover, painfully, that I had misread them.

By contrast, relationships shaped by mixed signals can be deeply confusing. When someone appears warm and engaged in person but withdraws or excludes you elsewhere, it creates a disorienting contradiction. As a neurodivergent person, I find it far easier to accept that someone simply doesn’t like me. That’s okay. It’s not possible to like everyone. What’s difficult is the pretence.

We don’t need to be unkind, but we also don’t need to perform connection where it doesn’t exist. We can be honest, compassionately. The idea that we’re meant to be friends with everyone is both exhausting and untrue. We won’t connect with everyone, and that’s natural. It doesn’t prevent coexistence. It doesn’t rule out the possibility that, over time, circumstances might change and connection might grow. Difference is not a deficit; it is simply difference.

Real relationships involve friction. Disagreement is not the problem. How we navigate it is what reveals our humanity. Do we retreat into silence, blame, or gossip? Or do we step into honesty, expressing how we feel while remaining open to perspectives that differ from our own?

For me, real relationships are places where I can finally relax, where I can show up as myself and feel accepted. I don’t have to shrink or edit who I am. My friends feel the same, and that mutual freedom is a gift.

Perhaps, as humans, we might pause the next time we are tempted to silence, ridicule, or dismiss someone, and ask ourselves: why does this feel acceptable? If we are to become truly capable of collaboration, we need to embrace honesty. We don’t have to like everyone, but we can still relate with respect. Real friendships will include friction and, at times, hurt, but it is in how we repair those moments that our humanity is most clearly revealed.

The pelvic floor is a complex and vital group of muscles, ligaments, and connective tissues that stretch across the base of the pelvis, supporting the bladder, uterus, and bowel. For women, the health and strength of the pelvic floor are crucial throughout life — from puberty through pregnancy, childbirth, and menopause. Maintaining a healthy pelvic floor is essential not only for physical wellbeing but also for emotional health, confidence, and overall quality of life.

One of the primary roles of the pelvic floor is to provide structural support to the pelvic organs. These muscles act like a hammock or sling, keeping the bladder, uterus, and rectum in their correct positions. When the pelvic floor is weakened — due to factors such as pregnancy, childbirth, aging, or hormonal changes — women may experience pelvic organ prolapse, where one or more of these organs descend and press against the vaginal walls. This can cause discomfort, pressure, or even pain, significantly affecting daily life and mobility. A strong functioning pelvic floor helps prevent prolapse and supports long-term pelvic health.

Another key function of the pelvic floor is maintaining continence. The muscles control the opening and closing of the urethra and anus, allowing for proper bladder and bowel control. Weakness in these muscles can lead to urinary incontinence, a common but often under-discussed issue among women. This can occur as stress incontinence — leaking during coughing, sneezing, or exercising — or urge incontinence, where there is a sudden, intense need to urinate. Strengthening the pelvic floor through targeted acupuncture has been shown to reduce or even eliminate these symptoms, restoring confidence and comfort in daily life. Perhaps most surprising incontinence affects many young female athletes and acupuncture can be a valuable tool to improve their bladder health.

The pelvic floor also plays a significant role in sexual health. These muscles are involved in arousal, orgasm, and overall sexual function. When the pelvic floor is strong and flexible, it can enhance sexual sensation and satisfaction. Conversely, when the muscles are weak or overly tight, women may experience pain during intercourse or reduced sensitivity. Acupuncture can relax tight muscles and reset and activate muscles that are not working. To contribute to a more fulfilling sexual experience and improved intimacy.

Pregnancy and childbirth place unique demands on the pelvic floor. During pregnancy, the growing uterus exerts increased pressure on these muscles, while hormonal changes make the tissues more elastic in preparation for birth. Vaginal delivery can stretch or even damage the pelvic floor, leading to weakness or dysfunction postpartum. Acupuncture postpartum aids recovery. Especially after surgery to reduce the risk of incontinence, promote healing and increasing the chances of a vaginal birth after a caesarean.

As women age, the pelvic floor can become more vulnerable, as oestrogen levels decline during menopause and muscles naturally weaken and the tissues lose elasticity. In conclusion the pelvic floor is a cornerstone of women’s health at every age. Influencing core stability, continence, sexual function and overall wellbeing. Despite its importance, it is often overlooked or discussed only after problems arise.

Education, awareness and regular pelvic floor acupuncture can empower women to develop a strong core, maintain bladder and bowel control, support pelvic organs and improve overall pelvic stability and strength. Enhancing function, confidence, comfort, and quality of life.

Amanda Roe is an acupuncturist and clinical hypnotherapist, who specialises in women’s health. She offers a range of therapies including acupuncture for pelvic floor dysfunction, pain and fertility. She combines this with clinical hypnotherapy to help people suffering with trauma, fears, phobias and eating disorders. For more information or to book a consultation visit www.roehealth.ie or call/text Amanda on: 087 6331898.

Understanding these patterns can help people recognise what their body is experiencing and choose more effective ways to manage it. Managing and eliminating symptoms can be key to better, longer-term health — and increasingly, identifying underlying food intolerances is becoming an important part of that process.

Food intolerance testing offers a simple and accessible way to uncover hidden dietary triggers that may be contributing to poor stool quality, sluggish bowel function, or irritation in the digestive tract. By identifying and reducing these triggers, many people can support more regular, comfortable bowel movements.

One of the most common forms of constipation occurs when the colon slows down. In this situation, stool moves through the large intestine more slowly than normal, resulting in fewer bowel movements and a persistent feeling that the body is ‘backed up’.

People experiencing this type often report bloating, abdominal heaviness, and the sense that the bowel never fully empties. They may still pass stool, but the process feels slow and incomplete. Over time, this can contribute to low energy and inefficient nutrient absorption, as the digestive system itself becomes sluggish.

Lifestyle factors frequently play a role. Diets low in fibre, insufficient fluid intake, lack of physical activity, and changes in routine — such as desk work, travel, or disrupted schedules — can all slow the movement of the colon. Certain medications can also contribute.

Simple adjustments are often recommended first: increasing dietary fibre, drinking more water, and maintaining regular physical activity. Even something as simple as daily walking can help stimulate the bowel’s natural contractions.

However, when these changes are not enough, food intolerance testing can provide an additional layer of insight. Certain foods — even those considered ‘healthy’ — may slow digestion or contribute to bloating and inflammation in sensitive individuals. By identifying and temporarily removing these triggers, the bowel may begin to function more efficiently, helping restore a more natural rhythm.

Another pattern develops when stool remains in the colon long enough for too much water to be absorbed. The result is hard, dry stool that can be painful to pass.

People with this type often notice small, pellet-like bowel movements and significant straining. The dryness can irritate the lining of the rectum, sometimes causing small tears known as fissures.

Dehydration is a common contributing factor. Diets very low in fibre, certain medications, and ageing can also make the bowel more likely to produce dry stool.

Treatment generally focuses on restoring moisture and softness to the stool. Increasing fluid intake and consuming fibre-rich foods that retain water — such as oats, seeds, fruits, and vegetables — can help improve consistency. In some cases, healthcare providers may recommend stool-softening support.

Food intolerance testing can also play a valuable role here. Some intolerances may contribute to low-grade inflammation in the gut, which can disrupt normal fluid balance and stool formation. By identifying foods that may be irritating the digestive lining, individuals can make targeted dietary adjustments that support better hydration within the stool and reduce discomfort during bowel movements.

A third pattern occurs when the bowel does not generate strong enough contractions to push stool out effectively. In these cases, stool may reach the rectum but still be difficult to pass.

People often describe feeling the urge to go but being unable to do so without significant straining. Some report a sensation of blockage or pressure.

This pattern can sometimes be related to problems with the coordination of pelvic floor muscles, which are responsible for helping the body expel stool. Nerve-related issues or long-standing constipation can also reduce the bowel’s natural responsiveness.

In these situations, a medical evaluation may be helpful. Some patients benefit from specialised pelvic floor therapy or treatments designed to stimulate bowel activity.

Occasional constipation is common and usually only temporary. However, advice should be sought if symptoms persist for several weeks, if there is blood in the stool, unexplained weight loss, severe abdominal pain, or a sudden change in bowel habits. These symptoms may signal conditions that require further investigation.

Constipation is not always the same problem and by understanding whether the issue is slow movement, dryness, or difficulty pushing stool out, individuals and healthcare providers can take more targeted steps toward relief.

Incorporating food intolerance testing into this process offers a practical and easy way to personalise that approach. Rather than relying on trial and error, testing can help identify specific dietary triggers that may be affecting stool consistency, bowel rhythm, and overall digestive comfort.

By combining lifestyle improvements with targeted dietary insights, many people can achieve more regular, comfortable bowel function — supporting not just digestive health, but overall wellbeing.

If any of the symptoms above are affecting you, get in contact with Michelle Ryan on 087 6704930 or email bwellhive.ie to book a consultation or food intolerance test, and understand what could get your bowel working better to function at optimum.

Energy-based treatments have come a long way, and the options available today can address everything from sun damage and pigmentation to texture, fine lines, redness, and scarring. A life lived outdoors in this part of the world, as much as we love it, does leave its marks — and treatments like IPL, laser resurfacing, and microneedling have become the most effective ways to address those changes without surgery or significant downtime.

IPL, or Intense Pulsed Light, is one of the most versatile of these. It uses broad-spectrum light to lift pigmentation — the brown patches and spots that accumulate from years of sun exposure — as well as tackling redness and broken capillaries. In the days after treatment, the skin can look a little flushed and pigmented spots may darken briefly before they clear, which is completely normal and a sign the treatment is doing its job. It’s also precisely why you want cloud cover and short days on your side while you recover.

For those dealing with more significant concerns — deeper lines, acne scarring, sun-damaged texture — Erbium YAG laser resurfacing is worth knowing about. It works by precisely removing the outer layers of skin, prompting a fresher, smoother surface to regenerate in its place. The results can be quite remarkable, but recovery takes a week and sun avoidance during that time isn’t optional, it’s essential. That makes this treatment one of the most time-sensitive in terms of when in the year to schedule it.

Microneedling works on a different principle entirely, rather than light or heat, it uses very fine needles to create tiny, controlled injuries in the skin, which triggers the body’s own healing response and a meaningful boost in collagen production. It’s particularly well suited to improving skin texture, softening fine lines, reducing pore size, and helping with scarring, and it tends to suit a broader range of skin types than laser treatments do. Most people need a course of sessions a few weeks apart, so starting now means you can complete that course comfortably before the height of summer.

Whatever you choose, or even if you choose nothing at all, there’s one thing that matters more than any treatment: daily SPF. Not just on holiday, not just when the sun is out. Every single day. The UV index in Ireland is lower than in southern Europe, but it is never zero, and the slow accumulation of daily UV exposure is responsible for the majority of skin ageing. For those who form pigmentation you must also think about High Energy Visible Light (screens and overhead lights) and for this reason should be wearing a mineral SPF; mineral SPFs are also good for those with more sensitive skin. And finally a wide-brimmed hat, as unfashionable as it might feel, remains one of the most effective things you can put between your skin and the sun. The weather around here is so unpredictable I carry a roll up one in my handbag in case I get caught out sitting outside Bushes in Baltimore on what started as a grey day and ended with a tropical sunset!

So if you have started thinking about treatments for your skin now is a great time to start.