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Dr. Gwen Adshead
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Mia Sorrenti
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? In this episode, we return for part two of our recent live event with forensic psychiatrist and psychotherapist Dr. Gwen Adshead. Adshead joined us recently at the Kiln Theatre to discuss how we understand and overcome trauma. Drawing on three decades of clinical experience, Adshead explores how traumatic events shape, shape, identity, and through case studies, she makes the case that alongside post traumatic stress is also the possibility of post traumatic growth. She was in conversation with palliative care doctor, author and broadcaster Rachel Clark. If you haven't heard part one, we recommend jumping back an episode to get up to speed. Now let's return to the conversation live at the Kiln Theatre.
Rachel Clark
In exactly the same way that a surgeon, when they're conducting an operation, quite literally with their scalpel, has the power of life and death with this individual. It's very clear that sometimes in the conversations you have with your patients, you have an enormous responsibility bearing down on you. You have the potential for enabling somebody to live with their trauma, to redefine their trauma, their sense of themselves in a way that enables them to live their life, but also the jeopardy of saying or doing the wrong thing that might make things worse. And that is a daunting responsibility. What drew you to this work?
Dr. Gwen Adshead
Gwen well, I'm a physician and doctors go where the pain is and I trained as a psychiatrist because I was interested in psychological pain as much as physical pain. Although, of course, when I started in psychiatry, I didn't really know what my path would be. And I was very interested in the stories that people had to tell, but I was also quite interested and how bad it could be. But I think, as you say, the work of healing does involve being with people who are at their most vulnerable. And it is true that you have to proceed carefully when people are at their most vulnerable. And one of the things that's become very clear in the trauma research field over the last 30 or 40 years is that idea of digging things out. It's all got to be got out and brought to light. Is actually has turned out not to be quite as true as all that, or not as crudely as that. That, yes, there may well be things that have to come to light. But I don't know how many archaeologists are in the audience today, But I understand from archaeologists that archaeology begins with very soft brushing away at the surface. It doesn't mean going in with a digger. It means brushing away on the surface. So you see what is there to be explored so you don't make a deep cut where you shouldn't. And there is a wonderful quote from our earliest psychologist, possibly better known as a playwright, who says, and when we have our naked frailties hid that suffer in exposure, we'll question this most bloody piece of work to know it further. And the point about that is that you have to hide those. The frailties have to be taken care of. And it's my responsibility as a psychiatrist and a psychotherapist to make sure that people don't kind of expose themselves too much too soon. And controlling the time, or rather conducting the time perhaps, is an important part of the work, but also just not making assumptions that you know what the worst thing is, because again, people will come with a story of trauma. And again, it's very easy to assume that you know what the worst thing is, but actually it's different for everybody, and you have to make space to ask. It's very unwise to assume that you know what the worst thing is about a traumatic event.
Rachel Clark
You are a doctor who is also a writer, and you say in this book that you're passionately interested in words and how we generate the stories of our lives. Do you think that writing has made you better at your clinical job? And has your clinical job made you better at being a writer? Because maybe somehow in their core, they're the same enterprise?
Dr. Gwen Adshead
Yes, I think that's true. I think they are a similar enterprise because words are all. We have to communicate what we're thinking, but especially to communicate what we're feeling. And we are social animals. We have to engage with other people, but we also have a story of ourselves that we tell ourselves, but we have a story of ourselves that we tell other people. And we need words to be able to do that. And the posh term for not being able to put your feelings into words is alexithymia. And that concept of alexithymia presupposes that we all have to learn to lexithyme. We all have to learn how to put our feelings into words. And that's something that, for most of us, grows during our childhood and adolescence and continues. We're always working on finding the language, I think, for experience. But many people who've experienced a lot of childhood trauma, in particular, may struggle to find words. So in my work, I often meet a lot of people who find themselves struggling for words, lost for words, as they say. And so helping people find the words has been an important part of my role as a therapist. But of course, that means making essays and mistakes and sometimes getting it wrong, sometimes speaking clunkily, and then being able to talk about why that isn't landing, why is that the wrong word, what's a better word? And being ready to make a new venture, even if it turns out to be a failure. And T.S. eliot refers to this as a raid on the inarticulate. And he thinks that poetry is a rage on the inarticulate. And so the idea that poetry has something in common with therapy because it brings into being something that wasn't there before. And in therapy, people often have, as I was saying earlier on, perhaps have a new thought or a new appraisal, a new perspective, something that wasn't there before. And then that idea that listening carefully to how people speak as well as the content of what they say has helped me, I think, become much more interested then in how we might do that as a writer. And, of course, doing that with Eileen. Our drafts go back and forth many, many times, and we talk about the words that we use. Why this word here, why that word there? So I think they are intertwined, the clinical work for the finding of words and the writing.
Rachel Clark
Thank you. In just a moment, we'll open up this discussion to the audience. But one final question from me, Gwen. There's a book you mentioned several times in Unspeakable, and you encourage readers of your book to also read this one, and it's CS Lewis's A Grief Observed. What is it about that book, why do you encourage people to consider reading that book in particular?
Dr. Gwen Adshead
Well, C.S. lewis, or Jack Lewis, as he was known, was a rather extraordinary polymathic man, and he was an extremely psychologically minded individual. He has extraordinary psychological insights. And if you haven't come across this book, it's his account of how he felt after his wife died. And he wrote it actually under a pseudonym to begin with, but it begins with the sentence, no one ever told me that grief felt so much like fear. And it goes on from there. And it's very honest, it's very open. But what it is is a very thoughtful man trying to. Trying to make sense of how is he going to live with these feelings? What does life look like now that he no longer has his wife to be with and to talk to? And he knew it was coming. They both knew it was coming. But nevertheless, her knowing didn't change the fact that when she died, he was bereft. And, of course, the word bereft comes from the Anglo Saxon for something being stolen or robbed from you. And so I think, coming back to the question you asked me at the beginning, there is something about trauma that I think has within it some kinds of trauma, at least about a kind of robbery, something being stolen from you and the grief that kind of goes with that.
Rachel Clark
Thank you so much. Over to you. Now, in the audience, there are two roving microphones. So first of all, chap in the white top in the middle, the hardest person to get to in the whole theatre with a microphone. Please
Dr. Gwen Adshead
just be right close to it like that.
Audience Member 1
Thanks. Thanks, Gwen. And Rachel, it was great. I'm gonna be a bit greedy with my questions. So the first one is, Gwen, you've really beautifully brought together Shakespeare, Eliot and your own professional experience. Psychotherapy is obviously a very modern institution, but this is an internal part of the human condition, trauma. Could you talk a bit about what your sense is of, like, how people might have done this in different times, different cultures, different places that didn't have our modern structure of psychotherapy. And I suppose a second related question is you also made a very interesting comment at the start about how there are multiple different ways of engaging with trauma. You were obviously a trained psychotherapist. I think in your Reith lectures you talk a bit about mindfulness. I just wondered if you could touch on some of the other ways that you think people can do this. You know, mindfulness obviously is one, but I'm thinking potentially of psychoanalysis and how those, you know, appropriate in some cases or Not. Or just. If you could just say a bit about how you think about those different methods.
Dr. Gwen Adshead
Thanks. You do know we have to go home at some point?
Rachel Clark
Yes. You have two minutes.
Dr. Gwen Adshead
Your second question in particular is a big challenge. So just going to think about that for a bit. I mean, as you rightly say, the provision of safe spaces, as it were, with people called therapists to talk about psychological pain may be it has a modern form, I agree, but of course confession is a kind of old form of something similar. And the idea that one of the ways to discover who you are after something terrible has happened, that one of the ways you do that is to reach out to another person and talk to them about it, I think is ancient. I mean, one of the many complexities about trauma and trauma, psychiatry and the history of trauma, it's dominated of course in the ancient world by military trauma. And so there are many accounts of the psychological distress that men in battle fear and experience. And Shakespeare in One, Henry 4 has a wonderful account of Hotspur suffering from post battle stress and his wife describing that. So I think that we've always known that traumatic experiences can leave people with a range of different kinds of distress. And traditionally the way that people have dealt with that is to go and find somebody to talk to about it and someone who will listen. And I guess what is new, particularly in the last hundred years or so, is a plethora of interventions that invite us to think about our mind in different ways. And you've mentioned too psychoanalysis, which really is comparatively new. Mindfulness meditation, of course is ancient and in its original form. And the practice of letting go of painful thoughts is 2000 BC from the Pali canon. And I find that very hopeful, you see, because it makes me think that this is part of the human condition. Part of the human condition is to experience suffering and pain and having to make sense of disastrous experiences that change you. And it's very few of us who won't experience things like this. So there are lots of different ways to approach it. And you can practice trying to engage with your pain, look at it in the eye and kind of show compassion towards your pain. You can attend to the physical experiences of your pain. Lots of people very interested, of course, in the mind because of course the brain is part of the body. So psychological and psychosomatic experiences can be very effective. For some people it's quite individual. And this is one of the other problems, I think, is that there's been a conflation between, you know, if you experience trauma, then you must have ptsd, which is not the case. And then there are various treatments for ptsd, but, you know, and it's all still very live. You may or may not know that there's a lot of interest in giving people small amounts of psychedelics to see if that will change their painful memories. There's things like emdr, eye movement desensitization therapy, which is about again, really, it's again about looking at your pain in a different way. So they have quite all these different therapies and interventions actually have quite a lot in common. I mean, the one thing they have in common, the first thing they have in common, is that they're an invitation not to avoid. But that not avoiding doesn't necessarily mean kind of having it rammed in your face. We have no evidence that it helps at all. But what that means is that somehow developing a kind of intervention that allows people to work at the pace that they can work at. So there was a nice study published in the Journal of the American Medical association last year sometime, which showed that written exposure therapy was no better than antidepressants for some kind of anxiety. But it was no better, but it was no worse. And it seems to me that written exposure therapy is much more likely to have the kind of effects in terms of how you see yourself and other people than antidepressants will. I don't have anything against antidepressants. Taken them myself. Jolly useful, but I think sometimes we need to have different kinds. We might need lots of different kinds of intervention. And then the real question, you can see why I warned you about going home, because the real question is, what order do we do these things in? And is that the same for everybody? And we just simply don't have that kind of data. We just don't have it. So the work tends to be broken up between kind of the military sector and then a bit about the violent sector, then a bit about people who are in transport accidents, because different people have very different outcomes.
Rachel Clark
Thank you. Other questions. The lady in the very dark top, possibly black.
Audience Member 2
Thank you so much. This has been really interesting. Being from the States, there's a lot of diagnoses that get thrown out. And even here, you know, it's widely talked about. I mean, people talk about adhd, ocd, autism. We throw out a lot of things around. There's complex PTSD versus ptsd, I guess I was just curious to hear from you your thoughts on, like, these diagnoses, and also how they might differ depending on who the patient is. I'm aware there's Like a tendency for men to get diagnosed with complex ptsd, whereas women tend to get borderline personality disorder. And so, yeah, I was just curious about your thoughts on diagnoses and where they sit within your practice and perhaps
Rachel Clark
the fact that diagnoses have been politicized in the UK and the States in recent years.
Dr. Gwen Adshead
I mean, diagnosis as a medical tool is about a working hypothesis, it's not about a box. And I think one of the most dispiriting things of the last 10 years has been the use of diagnoses as a kind of box to put people in. And I was privileged to work with Jacob Dunn who wrote he went to prison after killing a man by accident. But he wrote a wonderful book called Right from Wrong that the wonderful James Graham then made into a play called Punch, which is absolutely amazing and if you ever get a chance to see it, it's very, it's an astounding play. But the reason I'm mentioning Jacob is because, and I don't think he'd mind my saying is he got a diagnosis of ADHD when he was at school and he felt that it didn't help him at all. In fact, it was an attempt to explain his difficulties in learning coming from a good place. But in fact what he felt was, well, that's me done, I've got this, there's nothing I can do about it. I might as well just give up. And he did, he did give up. He dropped out of school and got into trouble. And that's where this kind of stories starts. And I think that we all have a duty not to use diagnoses in a way that cause people more problems. And if you're using diagnosis in a way that puts somebody in a box that sets up an argument, then that's not what a diagnosis has ever been used for. A diagnosis has always been about a working hypothesis. And actually as a psychotherapist I don't use diagnosis very much. I start from a kind of problem based definition which is in which I don't decide what the problem is. The person in front of me tells me what the problem is. But I mean, but diagnoses also get weaponized in legal cases and that can be a problem. Although the people who devised the DSM 5 and the ICD 11 did always point out that you should not be using these things in courtrooms, but they do get used in courtrooms. So I think, but most of all, I think that sometimes we can use language, the language of diagnosis to distract ourselves. And it's almost as if it shuts down a conversation instead of opening something up. So you know, when I hear somebody say, well, I've got this, I want to know what does that mean for you? What does that what's the impact on your life? What's the impact on who you are? Is it great? Is it small? And what, if anything, do you need help with? This is a particular issue, of course, for people who are living with disabilities who need help with all sorts of things, but not necessarily with the living with the disability. So again, this is a huge topic.
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Dr. Gwen Adshead
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Rachel Clark
There is a question over there that from the person in the red scarf.
Dr. Gwen Adshead
I would like to know if you have come across patients who were so unable to speak that you considered alternative therapies to talking therapies, which were the ones that you considered and you would recommend? Thank you. Yes. And certainly in my, in my work in the hospital, where a lot of the people I work with, because of childhood adversity and deprivation, struggle with language. And so we use a lot of the creative therapies to help people find their voice. And occupational therapies can be hugely helpful too. But that's of course, in a very particular context. In the outpatient setting, I think it's much harder. But of course, if somebody's come to you as a therapist, and if what they're struggling with is that they're unable to speak, maybe you just need to stay with that. You see. I mean, in my inpatients, in the inpatient setting where I'm working, then we feel like we do need to try and help people find their voice if we can. But I think if I'm seeing somebody, I do very, very little private practice, but I do sometimes do extended assessments to help People kind of work out what kind of therapy they might be interested in and if they can't speak, then I let them not speak. I mean that silence might be very important. And actually letting the silence be can be enabling for people. And of course sometimes people can write and getting people to write things down, if they don't want to speak, they don't have to. But if they've come this far to see me, then there's something, there's a question there in the interpersonal space. And I think your question is a really nice one because I think for me it raises a very powerful question for those of us who work as therapists or carers, which is about sometimes the being is more important than the doing. Sometimes it's important just to sit there and not do anything and see what the other person wants to do next so that we don't take control too much. It's easy to take control, particularly if we feel uncomfortable with the silence. But I don't want to be doctrinaire about this and of course I can't be doctrinaire about this. But the kind of general answer to the question is sometimes the creative therapies can be an excellent way to help people find their voice. No question about it. And I've been very blessed and enriched to learn from drama therapists, but especially from arts and music therapists who do amazing work.
Rachel Clark
Yeah. In palliative care too. Yeah. Gen people in glasses. You've been waiting a long time to ask your question. Your time has come.
Audience Member 3
Thank you for indulging me in consultation. How much attention to pay to physiology and if you do pay attention to people's physiology, how does that guide the questions you ask to elicit the client's story?
Dr. Gwen Adshead
Well, I will ask the ordinary questions about kind of appetite and sleep and general physical well being. It depends a little bit on the context. Context. But I always explore people's physical health with them and I also, I always ask them about how much, whether they do any. What their relationship is really like with their bodies. Because that's something that is often will tell you something very important. I mean, I can't. I don't have a particular thing that I'm looking for.
Audience Member 3
I was thinking about the work of people like Milton Erickson who could assess at a deep level people's physical reactions to things. And that would probably guide a set of questions to elicit maybe the story.
Dr. Gwen Adshead
Yes, I suppose I try not to come in with a set of questions too much. I mean, I usually start by saying where does this story start. And so I try to try and get a sense of what it is that's bringing them to see me today because the question is always, why now? Why are you here now? And then I'm kind of interested in whether something has changed and is that part of why they're here now? I guess I kind of wait to see whether things will emerge. I do always ask about childhood fear because I think that exposure to childhood fear has a very potent impact on people's reactions to their relationship with their bodies, but also with their minds and with other people. So I always ask people about fear experiences and I do ask people about whether who they went to, if they were upset when they were little. I try and get some sense of how they've coped with how they usually cope with stress. And I try and ask questions about people's early attachments because I do think the early attachments have a very profound effect on all sorts of aspects of people's minds and brains as they're growing up. But I also always ask about positive things. I always ask about strengths. I always ask about what people are interested in, what people like doing. And because I think that that's also, of course, really important. But it's hard to say in advance because I don't necessarily always ask the same questions in the same order because you don't know quite. It depends what people say back to me, if you see what I mean.
Rachel Clark
How incredibly refreshing to spend an hour talking about and striving for complexity in understanding all the rich and diversity of human experience and not putting individuals into boxes and neat diagnostic labels. This has been an incredibly interesting hour. Thank you so much. I'd like to say to you, first of all, Gwen, Absolutely brilliant. Thank you. Gwen will be signing copies of her book now out in the foyer and it is a beautiful and wonderfully interesting book. I'd like to say thank you to the fabulous Kiln Theatre, to Intelligence Squared for hosting this wonderful event and to all of you for coming and for asking such superb questions. It's been an absolutely wonderful evening. Thank you so much.
Dr. Gwen Adshead
Foreign.
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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Date: March 25, 2026
Host: Rachel Clark (with Dr Gwen Adshead)
Venue: Live at the Kiln Theatre
Producer: Mia Sorrenti
This episode is part two of a live discussion with forensic psychiatrist and psychotherapist Dr. Gwen Adshead, focusing on trauma, its impact on the sense of self, and the journey toward recovery and growth. Dr. Adshead draws on her extensive clinical experience and literary knowledge to explore how individuals cope with trauma and the unique importance of language, narrative, and attentive therapy in healing. The conversation also covers the applicability of various therapeutic approaches and the pitfalls of overreliance on diagnostic labels.
“Archaeology begins with very soft brushing away at the surface. It doesn’t mean going in with a digger… You see what is there to be explored so you don’t make a deep cut where you shouldn’t.” (03:44)
“It’s very unwise to assume you know what the worst thing is about a traumatic event.” (05:29)
“Poetry has something in common with therapy because it brings into being something that wasn’t there before.” (08:08)
“There is something about trauma…some kinds of trauma at least about a kind of robbery, something being stolen from you and the grief that goes with that.” (10:48)
“The one thing they have in common…the first thing they have in common is that they’re an invitation not to avoid.” (17:10)
“One of the most dispiriting things of the last 10 years has been the use of diagnoses as a kind of box to put people in.” (19:42)
“Sometimes the being is more important than the doing…letting the silence be can be enabling for people.” (27:04)
“I always ask about positive things. I always ask about strengths.” (31:40)
On Trauma and Therapy:
“You have to make space to ask. It’s very unwise to assume you know what the worst thing is about a traumatic event.”
— Dr. Gwen Adshead (05:29)
On the Common Ground Between Writing and Therapy:
“Poetry has something in common with therapy because it brings into being something that wasn’t there before.”
— Dr. Gwen Adshead (08:08)
On Grief and Loss:
“There is something about trauma…some kinds of trauma at least about a kind of robbery, something being stolen from you and the grief that goes with that.”
— Dr. Gwen Adshead (10:48)
On Diagnostic Labels:
“Diagnosis as a medical tool is about a working hypothesis, it’s not about a box.”
— Dr. Gwen Adshead (19:42)
On the Limits and Power of Silence in Therapy:
“Sometimes the being is more important than the doing…letting the silence be can be enabling for people.”
— Dr. Gwen Adshead (27:04)
Through wisdom, humility, and literary references, Dr. Adshead advocates for nuanced, compassionate, and flexible approaches in trauma therapy. She resists reductionist answers, values narrative, and centers the lived experience of the individual over rigid diagnoses or predetermined protocols. The discussion is empathetic, layered with metaphor and cultural reflection, and rooted in practical clinical wisdom.
This episode provides rich insights into the evolving understanding of trauma, emphasizing the need for gentle, individualized interventions, the healing power of narrative, and the importance of openness to multiple therapeutic approaches. Dr. Adshead’s stance on diagnostic humility and the value of silence and creativity in healing offers a nuanced, humane perspective for clinicians and lay listeners alike.