Back in the 1970s, people in Britain were mystified by the enthusiasm of Americans – especially New Yorkers – for shrinks. Since then, the vogue for therapy has spread and advice from non-experts on surviving divorce, bereavement and bankruptcy is now commonplace and not always insightful. By contrast, Gwen Adshead, a psychiatrist who has specialised in trauma, is invariably rewarding.
Her previous book, The Devil You Know (2021), on the minds of violent criminals, was written with Eileen Horne, a former drama producer – as is Unspeakable. I wasn’t entirely sure why Adshead needed a collaborator here, being so obviously well-read. There are references to Homer, Shakespeare, Dante, Keats and Yeats, along with C.S. Lewis, T.S. Eliot, Italo Calvino, Primo Levi, Pat Barker, James Baldwin and Ernest Hemingway. If they all came through Horne, perhaps we should be told. But if you are curious about people’s stressors, Adshead proves a compassionate and perceptive guide to body language in all its forms.
She is astute at explaining thought processes and discussing decisions. She acknowledges that digging up traumatic memories can be harmful. For example, there’s little to be gained in analysing why a patient’s parent might have been abusive, she says; the important thing is to help the patient understand their distress and navigate life in such a way that they are not consumed by their experiences.
Of course, if the patient is the violent parent, it’s vital they understand the reasons for their actions. Adshead has worked with many offenders in prison, trying to help them recognise why they turned to criminality and how those factors can be alleviated so that they don’t repeat the offence. She points out that people respond to psychological trauma in many different ways, often depending on whether they have supportive, loving relationships.
The case histories encompass patients from all backgrounds. One of the most memorable sufferers is Tom, an elderly man who has nightmares and screams in his sleep. He had once been held in a Japanese prisoner-of-war camp. Adshead gently probes his experiences and discovers what has triggered his memories. But I couldn’t help wondering whether he might also be suffering from dementia with Lewy bodies, which causes acting out dreams in REM sleep, often with thrashing about and terrified screaming, as well as cognitive problems, such as not finishing sentences, and Parkinsonian ones, such as illegible writing – all of which were noted in Tom. Admittedly, he improved after many sessions with Adshead, but sometimes there are multiple pathologies present.
There isn’t room to discuss even a fraction of the cases, drawn from decades of clinical practice, but Adshead’s thought processes and methods make for fascinating reading.
Comments