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- [00:01]
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Mia Sorrenti
Terms and conditions apply welcome to Intelligence Squared, where great minds meet. I'm producer Mia Sorrenti. What does trauma do to our sense of self and how can we begin to rebuild after it? Today's episode is part one of our recent live event with forensic psychiatrist and psychotherapist Dr. Gwen Adshead. Adzhead joined us at Kiln Tutor to discuss how we understand and overcome trauma. Drawing on three decades of clinical experience, Anthead explores how traumatic events shape identity, how silence can deepen suffering, and how language can become a path to recovery. Through case studies, she makes the case that alongside post traumatic stress, there's also the possibility of post traumatic growth. Let's join our host now, Rachel Clark live at the Kiln Theatre.
- [01:50]
Rachel Clark
Thank you Ginny, and thank you Intelligence Squared for hosting this event tonight in the fabulous Kiln Theatre, which has the best seats. If you're vertically challenged, as I am, they're very comfortable. I am delighted to be interviewing Dr. Gwen Adshead this evening about her new book. It is genuinely fabulous and I highly, highly recommend buying it if you haven't already. Gwen is somebody who has over three decades of experience in forensic psychiatry and psychotherapy. Many of you will have read her first book, the Devil youl Know, which was widely acclaimed when it was published in 2021 and was a remarkably hopeful book, I think in the sense that instead of shying away from and condemning some of the most dark, extreme excesses of human behavior, the violent crimes that we're capable of, it sought to understand and delve into what typically we shy away from, and rightly after the publication of that book, Gwen received the accolade from the BBC of being invited to give the wreath lectures in 2024. Again, they're on BBC sounds hugely recommend them if you haven't listened to them already. But we are going to be talking this evening about her latest book, published this Thursday, called Unspeakable. And it focuses on a later part of Gwen professional career. So not her work in forensic psychiatry and psychotherapy in Broadmoor, but in trauma psychotherapy with non offenders in a highly regarded NHS trauma clinic at the Maudsley Hospital here in London. And what we will do is we will talk for about 45 minutes, making sure there's a good, good 20, 25 minutes for questions from all of you. So do please store up your questions. I want to try and get as many in as possible. But I thought I would start, if I may, Gwen, by asking you to explain to us all why you decided to write your next book about this particular topic. So the subtitle of this book is Survival and Transformation After Trauma. What is it about that topic that so fascinates you?
- [04:49]
Dr. Gwen Adshead
Well, I started working in the field of trauma many, many years ago. As Rachel said, I worked in one of the first trauma clinics at the Maudsley Hospital and also one at the Middlesex Hospital. And what I learned from speaking to people who'd survived trauma was just that really, that if they were speaking to me, they had survived. But the question was at what cost? What had it cost them to survive this far and what was the quality of their survival and it that way, that further away, Okay, I knew at this, see, I need help, so be patient. So what I was learning from talking to people who'd survived a whole range of different experiences. Sometimes experiences in childhood, sometimes experiences in adulthood, sometimes experiences that had happened a very long time ago, sometimes experiences that were still ongoing. And what I was learning from the people I was listening to was how complex trauma is as a concept. And so in the Devil youl Know, Eileen and I had tried to share with readers something about the complexity of the concept of violence, which is a concept that all of us are interested in, that all of us have ideas about. And in the same way I think everybody is interested in trauma, I think it's a complex concept that we often use, sometimes in a less than thoughtful way way. And so what we wanted to do in this book was invite people to think about trauma in a more nuanced kind of a way. And to do that the only way possible, which is by listening to the stories and the voices of people who survived and how they have managed to transform their lives after trauma.
- [07:00]
Rachel Clark
Thank you. And before we get into the extraordinary personal cases that make up this book, just as in your first, could I ask you to expand a little bit on your definition and perhaps an nhs a medical definition of trauma. Because I know, as the mother, as of a teenage girl, for instance, that trauma is sometimes used to denote the fact that, oh my God, today was so traumatic I forgot my PE kit. Clearly not necessarily the same as everybody's experiences of trauma. So what exactly is trauma, first and foremost?
- [07:48]
Dr. Gwen Adshead
And that's. It is a complex question, I think. And there is a medical definition in terms of formal diagnoses, which is about witnessing or surviving events that cause significant physical injury or threat to life. And there was an old definition which was about events outside usual human experience. And although I'm glad that kind of definition is gone because it raises very odd questions about what on earth is a usual human and a usual human experience, nevertheless, it was trying to capture.
- [08:25]
Rachel Clark
Do you think that's a 70 kilogram white male?
- [08:29]
Dr. Gwen Adshead
Well, I suppose it was capturing what your teenage daughter was talking about, which is that we, all of us sometimes feel intense frustration or anxiety or a sense of catastrophe. Something bad is going to happen and we don't like those feelings and so we resist them and we want to share them with people, we want to tell people about them. But in my experience, what I've been learning is that experiences that are traumatic are ones that change your identity. Now, they may change your identity slowly over time, or they may change your identity suddenly with no warning, so that the person that you thought you were and the way that you relate to other people suddenly becomes very different. And so survivors of those kinds of trauma are battling with the loss of a previous identity as well as the challenges of a new identity. So, but again, although it works best if you like that idea of a change of identity, well, in your world, Rachel, of course, you meet people whose identity as a well person is suddenly taken away from them when they hear that they have a life threatening illness and things are not the same again. But I think it's different when people are experiencing trauma that happens over a number of years and particularly if they're experiencing trauma when they're forming their identities as children and young people. So you can see now already just what a complex, what a complex concept it is and how it really is important, I think, that we take time to dig deep into what we mean by trauma and don't just settle for something which feels sometimes a little bit more superficial. The kind of hashtag trauma and traumatalk a time, a 10 second reel of trauma, without really understanding what it's meant to the person who survived.
- [10:36]
Rachel Clark
So your time working with people who have experienced trauma is obviously people whose lives have been disrupted in such a way that they require NHS intervention. So presumably in order to have reached you, their lives have been affected quite significantly, is that right?
- [11:06]
Dr. Gwen Adshead
I think that's right. And I also think that there's something there about people identifying themselves as needing help. And one of the real challenges, I think, for trauma survival is, is that people often know that they're struggling but find it very difficult to find the words. And one of the reasons that we call this book Unspeakable is because there is something about the traumatic experience that sometimes silences people so that they become speechless. They're not able to articulate how they're feeling. And so that makes it difficult for them to come and seek help. So for every person who comes to seek help, we're aware, I think, that there are lots of people who don't seek help and who perhaps need help to articulate what they've been through and what they're going through. And you're just making me think of somebody I've seen recently who went through a terrible experience, which I won't go into because it's a live issue. But what was very striking to me was that he said to me, I'm doing a report on him. And he said that I was really the first person he had talked to about this. Now, that wasn't completely true because of course he had told his lawyers something about what had happened, but there was something about the way that we were speaking that he felt was a qualitatively different kind of experience in which he had just. Because I wasn't asking very many questions, I think because I was just listening and saying and then, and then, and. And I think what people really need is that kind of space to think and to be listened to. And that's one of the other themes in the book too, is the anxieties that I have that we don't have enough spaces for people to come to talk about their experiences of trauma and the kind of person that they feel they are now and who they'd like to be.
- [13:11]
Rachel Clark
You have a beautiful quote which I've noted down at the start of the book, which speaks to exactly that. There's no manual for how to live after trauma, but language and the Capacity to think new thoughts about oneself is a vital part of recovery. Is that something of the essence of what you're trying to do when you see these patients?
- [13:37]
Dr. Gwen Adshead
It's the essence, I think, of what we do with any kind of psychological therapy, I think. But I think one of the things that therapy can do, and it doesn't really matter what kind of therapy it is, but therapy usually provides people with a space to think about what's going on in their minds and how they're relating to themselves and other people and perhaps take up a slightly different position in relationship to those thoughts or feelings. Not discarding them, not denying them, not dismissing them, just taking up a slightly different position, looking at them in a slightly different way. And the moment you do that, it's possible to have a new thought. And once you have a new thought, you can't unthink those thoughts. And they often a new thought will help you take up, have a new appraisal of what you've been through and perhaps see possibilities for how you live now that weren't clear before. But you need that time and you need that space with someone who's going to be listening.
- [14:43]
Rachel Clark
Yes. And perhaps in our very fast lived world, any spaces where you feel as though someone is really listening to you, really attending to you and giving you the full focus of themselves in this moment are very few and far between.
- [15:05]
Dr. Gwen Adshead
Well, it does feel as though there's a kind of conveyor belt approach to medicine in general and particularly, I'm afraid to say, in mental health care. And the problem about that is that with any long term condition, if you're living with a long term condition of any sort, whether it's physical or mental, you have a relationship with your problems, but you need to build a relationship with the people who are going to help you. And we have good evidence that if you have enduring relationships with healthcare professionals, that tends to have better outcomes. And the worry that we have, very strong worry that I was talking about with the president of the Royal College of Psychiatrists only yesterday, the real worry we have is that mental health care professionals are not getting that time and not atonement. You can have 20 minutes for a follow up appointment, you can have half an hour for an assessment, half an hour for an assessment with a new person who you've never seen before, half an hour. And that is really scary. And those decisions are not being made by clinicians, they're being made by people who are running our healthcare services and have a kind of vision of what a good service looks like, that's very far from what the clinicians think and indeed, what the experts by experience think.
- [16:38]
Rachel Clark
Yeah, yeah. And my equivalent of that is 10 minutes to break the news to someone that they have terminal cancer. 10 minutes onto the next one. It's amazing. Anyway, let's talk about the case studies that make up this book. An extraordinarily powerful array of characters and stories which are really indelibly stamped on my mind after reading this book. Could you talk a little bit, Gwen, about how you chose your characters and how you built them? Because as with any doctor who is writing a book about their work, you're. You have to try to find a way of reflecting authentically your expertise while protecting patient confidentiality.
- [17:31]
Dr. Gwen Adshead
Yes. So, again, that's absolutely right, Rachel. And I'm very blessed to be working with a creative writer, Eileen Horn. She's a professional storyteller, and she and I, between us, have developed a kind of a real interest and fascination in creating composites that are based on clinical realities. So the clinical aspects are all real, but there are no actual people. They're not actual cases, and they couldn't possibly be, partly because of confidentiality, but also because people's personal stories are not. Are not my property to give away and share with others, but justice for the devil, you know? In each of the trauma stories, there's a kind of key message that Eileen and I were keen to try and develop. So in the first one, which is about a prisoner of war, we're really exploring the issue of how do memories apparently disappear from your mind but then come back later? How could that. How could that be? So that's a story about a man who has memories that he didn't have before in older age. And then we wanted to explore stories of people who had fled war zones. We wanted to explore the stories of people who'd experienced a kind of violence, kind of unusual kinds of violence. We wanted to talk about people who experience racism and racist assaults. We wanted to talk about people who experienced childhood trauma, the kind of chronic childhood trauma that I see such a lot of in my forensic work, but also in lots of other places. And we also wanted to talk about a health care professional who has an experience of trauma that has an impact on their lives. So we wanted to try and have a range of adults. They're all adults, partly because I don't work with children, so I don't have that expertise. So they're all adults, but they're a mixture of ages and sexes and heritage and different kinds of experience. But what they have in common is something about the extent to which their experiences have affected who they think they are as people, their identities as people, and also something about speechlessness that each and every one of them has a story to tell about. Finding it hard to speak.
- [20:17]
Rachel Clark
Thank you. And it feels very fitting to talk about one of the stories you've just alluded to today of all days. It's the fourth anniversary of the invasion of Ukraine. We saw the biggest refugee crisis in four years ago. And one of your characters is Nadia, a refugee from an earlier conflict. I wonder if you could just talk us through this case to give a flavor of the book as a whole.
- [20:51]
Dr. Gwen Adshead
Yes. So Nadir is based on the many people that I saw when I was working at these two trauma clinics, both at the Maudsley and at the Middlesex. So, as Rachel was saying, in the 90s, the former Yugoslavia broke up and there was a great internal struggle and people, neighbors murdered each other. It was most extraordinary destruction of a culture and a country. Great, great suffering and people terrified, people fleeing. And quite large numbers of people fled from the Forum, former Yugoslavia, to come to England. And some of them, not all of them, but some of them, sought help in the trauma clinic at the Middlesex. Now, one of the wonderful things that I had experience working at the Middlesex was the trauma clinic that I worked in had a children's section, in fact, more accurately, a child and family section. So this story really begins with a colleague coming to me to say that he's working with a little boy from the former Yugoslavia, from Sarajevo, who can't speak, who's not speaking. He's three years old. He came to England when he was probably about one, and he's not speaking. And the child therapist who's working with him is very worried about his mother. The child therapist is trying to work out why this little boy can't speak. And the child therapist begins to wonder whether something is going on for his mother. And he notices that the mother is crying a great deal. So he asks me to see her, to see if I can spend time with her and help to understand what might be going on for her and whether by me helping her to say something of what's going on for her that may help us understand what her little boy, Besim, is struggling, how he might be struggling to speak. And what emerges in my work with her is that she was widowed not long before she fled Sarajevo. Her husband and the father of her newly born baby was killed in a bomb. He went out to get bread and never came back. And she can't say his name. What she's struggling with is grief. And what she's talking to me about is the feeling that if she articulates her grief, she will explode, that there'll just be nothing of her and she'll explode. And then who will be there for Baseem?
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Dr. Gwen Adshead
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- [26:59]
Rachel Clark
There is a beautiful passage in the book about the moment in which she confronts this. Would you be happy to read it for us, please?
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Dr. Gwen Adshead
Certainly. So I've just explained that Nadia has
- [27:16]
Narrator/Reader (possibly a voice actor reading excerpts)
been talking to me about how she
- [27:17]
Dr. Gwen Adshead
fears that she will explode if she says her husband's name.
- [27:26]
Narrator/Reader (possibly a voice actor reading excerpts)
This may sound illogical, but from a psychotherapist's point of view, her emotional rationale was faultless. Nadia feared disintegrating under the weight of the painful emotions she had held in check all this time. This was the first sign of a connection between her son's muteness and her fear about speaking about her husband or even uttering his name. I said something to that effect, and she looked stricken. Do I hurt Basim for not speaking? If I die, then I hurt him much more. I assured her I understood her concern.
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Dr. Gwen Adshead
It sounds very hard.
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Narrator/Reader (possibly a voice actor reading excerpts)
You fear you will.
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Dr. Gwen Adshead
I searched for the right words, perhaps
- [28:20]
Narrator/Reader (possibly a voice actor reading excerpts)
let something terrible out. There was a silence. Then Nadia whispered, what can I do? Far from certain myself, I offered, could you try safe in here with me to say Basim's father's name? Nadia shook her head vehemently, and silence fell again. We must have sat there for several minutes, our heads bent as if in some shared prayer. Then she made a noise like a grunt or a cough. I saw that those sad dark eyes were wet for the first time, and she was trembling, evidently on the edge of letting go. At last she made another noise, a hiccup, becoming some sort of word. Ivan, Then, drawing out the two syllables. As if surfacing from a long time underwater. She gasped for air, her face contorted, and I thought that surely she would weep now. Yet she didn't. I let myself repeat his name aloud. Yvonne. I was honoring her effort and contemplating with sorrow this young man who would never grow old, the father that Basim would never know unless his name was spoken. Nadia made a movement, her eyes going to the wall clock. There was a little time before the end of our session, and I had to make sure that she was all right to leave after this important disclosure. Is there anything you need right now, Nadia?
- [30:19]
Dr. Gwen Adshead
How about some water?
- [30:21]
Narrator/Reader (possibly a voice actor reading excerpts)
She declined, but then took the offered glass. Nadia, you've taken such a risk today and been very brave. It's nearly time for us to stop, and I need to know if you're okay with going home now. Is there anything you want to say? She shook her head. I thought about her words, her fear that she would explode. Are you in pain? She gave the slightest nod. I knew better than to move or ask for more, and waited. Eventually she sighed, reaching round to fumble for her coat on the back of her chair. I feel shocked, I think. But I feel something also. I can't say a small correction. No, I mean a connection to him. But I cannot do more today. She pushed herself to her feet and I stood with her in the small space, eye to eye. I understand. But I'd like you to call me tomorrow to tell me how you are. Will you do that for me? I think it's essential for you and for Basim. And is it okay if I tell Owen about our session today? Okay. Tell Owen and I will call. She ducked her head and all but ran away. Watching her go, I wished she had more support at home. This session had been huge for her. I thought of Ivan again, and all the grieving war widows whose men vanish, their names inscribed on silent monuments.
- [32:32]
Rachel Clark
There is an extraordinary amount of empathy in that passage, and it makes me imagine how very lucky your patients are to have you as their therapist. That piece beautifully encapsulates someone making that transition from an experience that was literally unspeakable, literally rendering her young son Vasim unspeakable, unable to speak into uttering the vital word for the first time, and I imagine everyone in this room would like to be the kind of person who knows what to say when a friend, a relative, anyone they come across is traumatized. We hear that something traumatic has happened in their childhood, in their adulthood. We want to say the right thing, do the right thing, and very, very often that might make things unspeakable for us because we don't know what the right words are. So how did you, in that moment, unlock that vital expression of her, her dead husband's name? And what is your advice to people who don't have your training but who want to be empathetic and supportive with anyone they care about who has suffered trauma?
- [34:17]
Dr. Gwen Adshead
Well, I suppose my first thought is that although this story is ostensibly about a refugee, and given the various stories and accounts of refugees that we've all heard over the last 10 years, I thought it was perhaps important to have a story about someone who'd fled a war torn country and all the struggles that go with that. But at the heart of this story is a traumatic bereavement, which is the commonest kind of trauma that most of us will ever experience. We will probably all experience bereavement in a long and I hope a happy life. There will be the sadness of loss of people that we love. And when that happens suddenly and without warning, that is the kind of bereavement that is particularly distressing. And you know, I've tried to be a learning therapist. I think one of the things about being any kind of helper and it doesn't matter whether you're professional or not, it's kind of being open minded about what helps and listening to what is important for this person. And one of the things that we know from general research in psychology is that reassurance doesn't help people. And that's really clear. So in a way that's nice and easy. So now we know you don't say, well, it's going to be fine, it will all be fine. So you don't say that. But the other thing that I'm learning, have learned, still learning, is something about the importance of being honest, I think something about truthfulness. Truthfulness to the fact that sometimes it's impossible to find the right words. And I don't always know what to say for the best. But what I try to do is work out what this person is struggling with most at this very moment. So often that's what I'll say is what is the worst thing for you right now? And of course, it may be many things. If any of you who've spoken to a grieving friend or been in grief yourself, the worst thing is often a very odd thing. You know, well, who's going to go to the dry cleaners now? Who's going to do the weeding? Or more commonly, I don't know anything about the bank statements I don't know anything about the tax. These kind of things are really often bizarre, kind of very mundane things that then hit you with a terrible poignancy. And in this case, this is just a woman who can't say a name, but her fear has transmitted itself to her son. He's a smart little boy and he knows his mum is frightened of something, is frightened of some kind of sound. So he is carefully not making a sound until she's ready. And I saw this happen many times with very skilled child psychotherapists helping children to speak, but helping their parents to speak was part of it. So I was learning, I think, not to worry too much about not knowing and actually sometimes to say to people, I wish I knew what to say to take your pain away. Or even just, I wish I could take your pain away. But just offering sometimes to say, I'm going to keep you company while you walk with this is something that people say has been helpful. And on this last point about bereavement, and I'm confident, though there are many people in this audience who will know this experience that often when you lose somebody you love, it's very painful for them not to be mentioned again. But here, in this particular case, Nadia is really struggling with whether she can do that or not, that the, that the strength that she needed to make her way to a new country and find some kind of employment and deal with the home office and all of that stuff. She kept all her pain at bay and I think she felt she would be overwhelmed. But of course, once she was able to name him, actually some kind of grieving, more healthy grieving, could start and then she could talk about, about missing him and about what she loved about him, what she liked about him and how. And she saw. The other problem was that she saw Ivan's face and her little boy's face and that was one of the other things that she found rendered her speechless. When I'm thinking of the many Nadias I've seen, that's kind of often what they say. I see my husband's face and then I'm speechless with grief again.
- [39:21]
Mia Sorrenti
Thanks for listening to Intelligence Squared. This episode was produced by Ginny Hooker and it was edited by Mark Roberts. For ad free episodes and full month recordings, you can become a member at intelligencesquared.com forward/membership. And to join us at future live events, you can head over to intelligencesquared.com forward/attend to see our full events program. You've been listening to Intelligence Squared. Thanks for joining us.
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