Elizabeth Oldfield speaks with Dr. Gwen Adshead, a renowned forensic psychologist and psychotherapist on the centrality of compassion. 25/09/2024

Kicking off the new season of The Sacred, Elizabeth Oldfield speaks to Dr Gwen Adshead about finding the sacred and the transcendent even in the darkest corners of the human experience. Through her unique lens, she bridges the divide between victim and perpetrator, revealing the common vulnerability and potential for both good and evil that exists within us all.

What is Sacred to you? Gwen Adshead answers 

Elizabeth   

Gwen, I want to kick off with asking you, what are your deep values, or, in my language, what is sacred to you? 

Gwen Adshead   

It’s such an interesting question, and yet such a hard one. I remember reading something quite recently which was attempting to distinguish the sacred from that which is kind of desecrated. And I suppose, when I think about what is sacred to me, I think about those things that mean most to me, but also have, I suppose, a kind of transcendent and eternal aspect to them. Things that I think are kind of bigger than me, bigger than all of us. So, when I think about what’s sacred, I suppose I think particularly about goodness. I suppose I think about the traditional virtues of faith, hope, and love. I suppose I also think about the sacredness of life on Earth and the universe, and something about the eternal qualities of those things. What I’m thinking of in particular is something about is that it’s not that the mundane, the quotidian, kind of no life here on earth is not in itself sacred. I think it is. There’s something sacred about our presence here. But I do think there’s something also about values that are transcendent as well as imminent. So when I go about my daily business, I suppose I look for the sacred in everything because I think that kind of helps me to orientate myself around, particularly the difficult things that one has to deal with.  

Elizabeth   

Could you say a bit more about how that plays out? What does looking for the sacred and everything look like when you’re dealing with deep human suffering and distress and what other people would call evil? 

Gwen Adshead   

Yes. I mean, I think the reason that I kind of approach it in the way that I’ve just been saying is because a long, long time ago, I think perhaps as becoming a doctor, you get in touch with people’s distress. That in a way, as a doctor, you go where the pain is, and you go to where people are struggling. And I think it’s been important to me, and kind of held me – it’s been kind of the ground of where I stand – is to think that we’re all in this together. And that old idea that nothing human is alien to me, which, of course, is that kind of classical thinking, has been really important to me. When I go to approach somebody who’s in pain or who’s exsanguinating or someone who’s done something terrible, or someone who’s kind of really very disturbed, I think, reminding myself of our common humanity, and the common beauty of that humanity is being really important as part of the ground of what I’m going to do that day and how I’m going to interact with that person.  

The ideas in Gwen’s childhood 

Elizabeth  

I’d love to get a sense of how you have become someone who can do the work that you’re doing in the way that you do it. So, could you say a little bit about the big ideas that were around in your childhood, that were in the air as you were growing up? 

Gwen Adshead   

Well, I grew up in New Zealand, and I think that’s important, because New Zealand, then, as now, was kind of a bit ahead of the pack in terms of ecological thinking and of taking the land and the environment very seriously and seeing a kind of interconnectedness between humans and the land they were living on. And that was partly there, also in Maori culture, and also in Australian Aboriginal culture, which I learned a bit about too. So that idea of being profoundly connected to the land and the earth and how we might affect that was kind of there in my childhood. But the other thing that was there in my childhood too, was that both my parents were practicing Christians, so we went to church every Sunday from an early age, from five–years–old. That was my parents’ tradition as well, they’d been raised in that tradition of going to church on Sunday. And I think I was very lucky too to go to a church. It was an Anglican Cathedral in Christchurch, and so I had a very early exposure to Anglican liturgy and ritual with music, and the Book of Common Prayer that goes with that. So that was very much around in my childhood and I think had a big influence on me. So the idea, again, of God being present in the world was very real to me, kind of from an early age. 

I think the last thing that perhaps was also around, and I can’t really tell you how I first heard about it, but I was born in 1960 so in the first 10 or 11 years of my life, what I remember was a kind of beginning of emergence of stories about the Holocaust. And for whatever reason, stories of the Holocaust made a deep impression on me. I suppose I probably read The Diary of a Young Girl by Anne Frank, but I know that I was interested, even then, about how it could be that human beings could do such terrible things to each other, so that was kind of always there in the background of how bad can it be, how badly can it be between beings?  

How Gwen experienced God 

Elizabeth  

I’m skipping ahead somewhat, but I have heard you speak about your faith as an adult, but I wonder if it was a kind of continuous thing, or you’re someone who had a dark night of the soul or a crisis of faith before returning to it. 

Gwen Adshead   

Yes, I think my Christian faith, has been very ordinary in that respect. I think that I was raised culturally Christian, and that was a strong attachment for me. Christmas and Easter and festivals and the music of that, that was all very real to me. And I went to a CofE School as well, so we had assembly in the mornings, and the same in secondary school. So cultural Christianity was very real for me, but I think it would be fair to say that it was skin deep and was much more to do with wanting to be a good person, which is, of course, a good thing to aim for! But, as I think is not uncommon in organized religions, I think I had an idea that if I did things, if I turned up at church and I did the kind of basic things, then that would mean that I was a Christian. And I think I really wasn’t a Christian at all. I think it was more about putting on an identity, like an overcoat, but taking it off. And it really wasn’t until I had a pretty miserable decade between age 40 and 50, where my marriage broke down, and all sorts of things went wrong, but mainly the loss of my marriage and illness in the family, and a lot of real pain. I think that was the first time I really experienced intense psychological pain, and I didn’t really know what to do with myself. I was so disturbed. But then God was there. I had such a strong sense of being held, not necessarily soothed or comforted, but held while I was struggling. It was very powerful and hard to articulate more than that, but what that experience did was make me completely rethink everything I had thought before, and I began to think much more about the being rather than the doing if that makes sense? 

Why choose a career in psychiatry? 

Elizabeth 

It really does, and we’ll return to it. Because one of the questions I’ve had reading your work and listening to you is, where does it come from? This ability to hold radical compassion towards people that the rest of society would really rather not have to, not just have compassion for, but engage with in any way. But let’s fill in some of the gaps, because you came back to the UK for boarding school when you were about 11, when did medicine as a career seem like the path that you were going to follow? 

Gwen Adshead   

Oh, that happened very early on. That happened when I was about 7 years old. I was given a book called All About the Human Body, which I still have a copy of because it made such a deep impression on me. And that’s when I first thought about doing medicine. And I had two grandparents who were doctors. And medicine seemed like a popular choice. I mean, my parents, particularly my mother, were happy for me to train as a doctor. So, I really stuck with that idea. I mean, all the way through school, and never really considered anything else. And I. Went off to St Bart’s, one of the London medical schools when I was 18.  

The surprising reason why people practice medicine 

Elizabeth  

In one of your case studies, the sort of composite portraits in The Devil You Know, you talk about David, who’s a GP, who reveals a dark secret about himself, whether he wants to or not, which is one of the reasons it’s so fascinating. But you said, “For some doctors, and I think I may have been one of them once, choosing to study medicine in the first place seemed a way to avoid vulnerability.” Could you say a little bit more about that? 

Gwen Adshead  

Yeah, I do feel this very strongly, I mean, there are many reasons for doing medicine, some more manifest than others, but I think that I was, and perhaps still am, somebody who is uneasy with being vulnerable, uneasy with being dependent on others. And there are a number of reasons for it, if ‘reason’ is the right word. But I think that many societies, and perhaps particularly socio democratic capitalist societies like ours, are very uncomfortable with the idea of vulnerability and dependence. And there are lots of public discourses that very much emphasize autonomy, independence, self–control, self–containment. And the kind of image of us all being sort of billions of billiard balls kind of bouncing off each other, I think that metaphor is still very popular in some ways. You know, it kind of speaks to people that ‘You do you’. It’s very much the kind of language now, ‘You do you, and I’ll do me, and we’ll be independent’. We might bounce off against each other, but we won’t be interrelated. Whereas the reality is completely the opposite. But to be dependent is to be in touch with neediness, to be in touch with vulnerability, but also to be in touch with the uncertainty and the complexity of being connected to others. 

And I think I was very avoidant of that. I think, at a very practical level, because I was largely looking after myself from an early age, being vulnerable was kind of something that I didn’t want. And I think that quite a number of people go into medicine in order to locate their neediness and vulnerability in somebody else and look after it there. And I think I may well have been one of those people, and that doesn’t have to be a bad thing, so long as you don’t denigrate vulnerability and neediness in others. And I think there can be sometimes a tendency in medicine, not always, a tiny bit of denigration of the vulnerable status. And that’s in a much wider context of hierarchical statuses, where being powerful and independent is better than being vulnerable. Which is, of course, why the message Christianity has always been so radical, because it talks about foolishness and weakness, and things going wrong, and writing in the dust, and people who are not wanted being invited in, and the person who’s identified as a criminal turns out to be someone who is infused with a much greater love and power than ever anticipated by anybody, that’s an extraordinary story.  

What led you to Broadmoor Psychiatric hospital? 

Elizabeth  

It really is. I hadn’t made the link between this criminality of Jesus and your work. But I’d love to know, reading about your career, there’s this training as a doctor and specializing in psychiatry and getting interested in medical–legal reporting, making judgments for the courts. And your book taught me that the word ‘forensic’ just means associated with the law. And then training in psychotherapy, adding all these strings to your bow, and eventually ending up in this extraordinary position that you write about in the book of doing talking therapy with patients in Broadmoor, which UK listeners will know. But for people otherwhere in the world, is the high security hospital for violent offenders with significant mental health issues. I’m probably mangling all the language, forgive me, but the shorthand works. What was the thread that you’re pulling on that got you from training as a doctor to sitting opposite a serial killer or a child rapist in Broadmoor trying to help them understand their crimes? 

Gwen Adshead   

Well, I think of it as a golden cord rather than a single thread, because I think there were a number of threads. But I think the first thread was something about the potential for each of us to do something terrible or to get into an evil state of mind. And that was something that my father really taught me, not judging other people, that, a) just not making judgments and assumptions about people, but b) especially not judging people, because who knows whether you might have done something just as bad in similar circumstances. And in fact, more than that, who’s to say, for example, that uncharitably refusing to help somebody who’s in need yesterday is not, in its own way, just as bad as killing and decapitating someone when you’re mentally ill. And the person with mental illness has some excuse in that they’re mentally ill, I have no excuse for being uncharitable yesterday, except that I was feeling a bit lazy!  

So that’s one of the threads, is not seeing a great necessarily, seeing a huge difference between me and these other people, except perhaps a question of degree, and, of course, the question of my privilege. You know, if you go into mental health, you meet people who are often grossly deprived of all sorts of things that many of us take for granted. Then if you go into forensic mental health, the vast majority of people in the meet will have been raised in poverty, lucky to have gotten to school, stayed in school, lucky to have friends, lucky to have a partner. Often, they have appalling relationships with parents, if they have any at all, and the kind of, eking out an existence on benefits, and petty crime, and addiction problems. So, you get exposed to the different ends of the world. And I think that that awareness of poverty and its claims upon us was kind of part of that, that those of us who have [privilege], have a duty to go and share what we’ve got. 

I was always interested in justice and judgement. I mean, it started with the philosophy of it, but because I was interested in how courts could decide whether mental illness could alter your responsibility or not, it’s a very profound philosophical question. But of course, the Christian message that I’ve been grown up with was a) certainly not to judge and b) that forgiveness was available to everybody. So, if that forgiveness was available to everybody, was the gospel message, then I was certainly not going to be in a position to reject or treat badly those whom the gospel said would be welcome in the Kingdom of Heaven. And, in the Matthew 25 chapter, it was all written out as clear as day. “When I was in prison, you visited me. When did I see you in prison? When you went to see prisoners, you went to see me.” So those three things, not judging, realizing that my capacity for sinfulness and cruelty was just the same as theirs, it was just on a different scale. It was a tune played on a piccolo, as opposed to the full orchestra version, but it might not be that different in kind or nature. And then something about not judging and trying to contribute to justice. And then that third thing about not rejecting those who God was not rejecting, if the law was not rejecting them, then I was in no position to reject them either.  

Elizabeth   

I have to confess, we share an agent! And Sophie handed me your book very early on in our conversations, and it sat on my chair for a long time because I thought that book will be too dark for me to read. Ridiculously low tolerance for particularly children in distress. I’m working on it, but I don’t have a high tolerance of trauma. 

Gwen Adshead  

No, I hear you! I was the same.  

Why backstory is important when speaking to offenders 

Elizabeth   

But it’s not dark, which is a very strange thing to say about stories of people who have committed the acts that we as a society hold to be most atrocious. And it’s not dark, because you tell the stories of these people, your patients, and their lives that have led up to these disasters with such tenderness and empathy and compassion that the reader cannot help but end up understanding it. And there’s a tension in that, because everything you’re saying, and I share your faith so, and hopefully most of the time, in theory, I’m where you are. But it is an offensive thing. It sounds offensive to a lot of people and to the kind of dominant ways we think about crime and victims and perpetrators and good and evil. To spend as much attention and empathy and curiosity and in your case, professional time and energy, understanding the people who have caused such harm to those elsewhere. And yes, I very much agree with you that it’s a necessary journey for us to go on. And I didn’t want to go on it! I didn’t want to be asked to have compassion for these people. You must get that response a lot. What’s your way that you hold that? 

Gwen Adshead   

Yes, you’re quite right, it is a response I get a lot. Well, not a lot, but it is undoubtedly true that many people, before they read the book, assumed, not unreasonably, that it was going to be a kind of true crime book with lots of lingering on human suffering and, what I can only describe as salacious excitement at other people’s cruelty. And I was very keen, as I think you can probably imagine, to communicate how much the work is not like that. Because so much of the work is tragic. This is particularly true in a place like Broadmoor, where people have committed acts of violence, usually in very disturbed states of mind. And so when they recover some kind of mental health, the realization of what they’ve done is often unbearable and very distressing, particularly for people who’ve killed family members but also because they realize that by doing what they’ve done, they kind of kill off all the kind of connections that make for a very enjoyable and happy human life. They are people who are in the most desperate kind of state. And I think, one of the values that’s driven me here, is that concept that, and I can’t remember who’s most famous for having said it, lots of different people have said it in different ways, but the idea that the way we treat the worst of us is a guarantee for how we treat the best of us. That if we’re treating the worst of us with dignity and respect and compassion, then that will probably guarantee that the best of us will get it too. But if we create a group of people who we say are not worthy of any human attention or compassion or respect, then that is a very dangerous precedent to set, because it may look very obvious that this group of people here that we call nasty people X, that it’s all right to kick them about and treat them as dirt and hate them and denigrate them and be very excited about how good you are in comparison to them. But history tells us that it’s very unwise to allow a denigrated group to emerge as legitimate victims. And countries and societies have paid very heavily for that, and we’re still paying. We’re all still paying for what happened in 1930s Germany.  

And finally, my other thought is that I just refuse to subscribe to the idea that there’s not enough compassion to go around. You know, compassion for perpetrators of violence doesn’t mean that I don’t have compassion for victims of their violence or other kinds of trauma. There’s enough compassion to go around. Not only that, but there’s also enough care to go around. It’s all about priorities. I think there’s no reason why victims of violence and trauma shouldn’t have good quality therapy and treatment. And it’s ludicrous that we don’t provide proper interventions for victims of childhood trauma and adult trauma. It really is bizarre that those services exist, only to some extent, for people who’ve been who have been violent, when mentally ill. But trying to get disturbed children therapy is almost impossible. And, I won’t be around to see it, but I’m cautiously hopeful that in another couple of hundred years, they’ll look back on us as we look back on medieval times. You know, who are these people? They put men on the moon. They did replacement knees, they did replacement hearts and lungs, they could even make three–dimensional things with a computer, but they couldn’t take mental health seriously at all.  

The human desire to create a villain 

Elizabeth   

Yes it feels like that to me. And I listened to a few of your interviews with people getting really angry with you, or at least being very combative with you. And I was trying to understand it to myself, and I think it is that sense that we only have so much compassion. And we’ve obviously developed these categories, particularly now, where there is the category of victim and there is the category of perpetrator, and they are hermetically sealed. One of the things your book does is it really shows how that’s not true. You can be both, and many people are both. And I think this sense of I’m not the same. You know, I can even feel it in myself as you say that. My uncharitableness to the person on the street who asked for help is not dissimilar, and the desire to say that’s not the same, that there is such a thing as evil and evil people and they need punishing, that we can take revenge on people that have hurt us, seems to me to be bubbling up again as a story that we are telling as a society that externalizing evil into the other, rather than acknowledging it as a deep condition of the human heart and a temptation that we’re all prone to. Is it more live or am I just hearing it more loudly? What do you think? 

Gwen Adshead   

It’s such an interesting question. I suspect that it has always been there. I think that the wish to ‘other’ somebody and locate badness and somebody else, and then enjoy attacking them because of it has been there throughout human history. I think it’s there and in John 8, with the story of the adulterous woman, you know, these men are so excited about the prospect of stoning her to death! And then it all kind of fades away. And there’s just a woman and Jesus and a writing in the dust that we know not what, and the letting go and don’t do it anymore. And I don’t condemn you but go and do something different. And I think the very strong wish to make yourself feel better by making somebody else feel bad, that is part of the human condition in terms of our capacity for evil. Thomas Aquinas said we have a disposition both to evil and to goodness. And I think our disposition to evil often starts from the idea that I’ll make myself feel good by making somebody else look bad and I think that has to be resisted.  

Now, of course, you don’t need religious discourse to make this real or valid, but I think it is interesting that across human history, it has been religious and theological discourses or discourses of spirituality that have invited us to examine our own hearts before we go judging other people’s, and that’s very important. Interestingly, you could almost argue that it’s important evolutionary wise, because we need to live in groups. We are group animals by biology, if you like to talk that kind of talk. There are quite a lot of evolutionary thinkers in psychology and psychiatry, and I have some sympathy with the idea that we are kind of a primate, like gorillas and chimpanzees. We are group animals. We have to live in groups. We have to be mindful of other people’s minds, and we have to be able to also ride a boundary between our own minds and the minds of others. And you talk about this beautifully in your book, actually, about the negotiation of boundaries and rules.  

When a group of people come to live together, there has to be negotiation, and that negotiation is not always comfortable, and negotiating conflict, and negotiating the negative feelings that go with conflicts and disagreements, and jealousies, and anger, and deprivation – all that kind of human stuff that’s about taking our own minds seriously, but also the minds of others. And they all have to be real. And the worry that I have about saying those people over there are terrible, and we over here are great, is that it’s not very real. It’s not reality based. There was a marvelous example of this on the radio the other week. Somebody did an article about the recent horrible riots, and they were a BBC reporter who’d gone down to cover the riots and some of the rioters saw them and said, “Oh, they’re from the BBC. That means they’re pedophile scum!” You know, it’s the worst thing you could possibly say to anybody, these very ordinary journalists, are “pedophile scum”. It’s a meaningless offense, but it’s meant to say, we hate you people. But it’s not very realistic, it’s not like they have done anything except come and do what they’re meant to be doing. But there’s so there’s something a bit mad about that, truthfully, and I use that word advisably… 

Elizabeth   

Yes, you’re probably qualified to use it! 

Gwen Adshead   

Yeah, madness is about a failure of reality testing and reason. You know, reason, and reality, and truth are, are crucial here. You can delude yourself.  

The role of spirituality and values in psychiatry 

Elizabeth   

This is making me think, because my impression of the mental health world in general, perhaps medicine in particular, is pretty secular. How unusual are you as such a senior psychiatrist and psychotherapist to be so open and drawing publicly, even personally, on your faith? Is it less secular than I think it is? Because I can imagine people saying that faith itself is a delusion. 

Gwen Adshead   

Well, yes, and no. I think that undoubtedly, there’s a spectrum, Elizabeth, I think that’s the reality. And you know as well as I do, that within the sciences generally, there’s a spectrum of beliefs. And many scientists have had very strong faith systems of different kinds in supporting them in their work. And I think that medicine in general and psychiatry in particular is no different. So, we have a spectrum of spiritual thinking and faiths within the practice of psychiatry, we have a spirituality special interest group. Is it either the biggest or the second biggest special interest group in the college, and I think that is because you can’t practice psychiatry without thinking about values. Well, you can’t practice medicine without thinking about values. And I’m thinking now of the work of a wonderful colleague called Professor Bill Fulford, who’s a moral philosopher as well as a wonderful psychiatrist. He wrote a marvelous book about facts and values and values–based thinking in medicine and especially in psychiatry, and the importance of having good quality facts, but also an understanding of people’s values. And that is particularly live in mental health, because in order to understand a person who seems very disordered in front of you, like how you started with me, you need to understand something about their values and their belief systems and who they’ve been in their lives in order to understand how they’ve come to be before you either, you know, grossly depressed or wild of eye and listening to voices or having run amuck and disembowel 3 people in Swindon or whatever it happens to be, doesn’t have to be Swindon by the way! But that person, before you meet them, they’ve had their own lives, and their own values, and their own story to tell of relationships and life. And as a psychiatrist, you’re going to need to know something about that if you’re going to really get to understand them and help them to change their minds for the better.  

How to be radically compassionate 

Elizabeth   

Yes, I’m thinking you must have some of the radical compassion, the radical curiosity and care that it takes to sit close with some of these people. Ian in the book, who is a child sex offender and take both yourself and the reader on a journey whereby the tragic end of his life I was devastated by requires something right? It requires some moral framework, some commitment to hold you in relationship with people that commit these radical acts of harm to other people. To sort of pull it back to the realm of what most listeners will have to deal with in their lives, which is more kind of ordinary difference, more people they disagree with, that they are tempted to reject for reasons of different tribe, or different worldview, or whatever it is. Maybe criminals, maybe people who’ve committed acts of violence or less. What helps you hold that posture? What helps you stay committed to their full humanity, even though you might think they need to be restrained, or be involved in the justice system, or whatever the equivalents are, and listeners’ examples that they’re holding in their heads. 

Gwen Adshead   

Yes, and I just want to start my answer by saying it’s really important to me what you’ve just said, which is there’s nothing about offering a kind of compassionate and therapeutic listening and attention to the realities of what people have done. None of that is an alternative to the ordinary processes of justice in terms of people being found guilty. And none of what I’ve been thinking about and writing about for the last decade or so is about excusing people. Nor indeed do I think that people shouldn’t be offended or outraged when they hear about something terrible happening. I mean, I’m an ordinary person when I hear about the terrible events in Southport, I feel that in my heart, like anybody else. I feel a sense of outrage but most of all, I feel massive distress on behalf of, yes, the families, but also the young man who did that, and his family too, and the terrible journey that faces them, as well as the families of the children who were killed and the other people who had to witness that. This is a kind of disaster of such massive proportions. It’s kind of cataclysmic, it’s cosmic, and it kind of disturbs the order of the universe. And I think what sustains me is a belief in the goodness and order of the universe, that goodness exists as much as evil does. And that we absolutely have to hold on to that and it’s a duty to be hopeful. 

Faith, hope and love, these three, these are duties. They’re not simply a kind of lovely ornament of life, they’re a duty. They’re a way of relating to the world, so that relating to goodness is really important, growing that capacity for goodness, and noticing when you’re kind of drifting into a mean state of mind, is really important. So, what sustains me is that belief that cultivating goodness is as real and as important as the evil that happens in the world. Actually, I worry that we don’t pay enough attention to goodness, that every single act of terrible human evil is reported in enormous depth. Although, having said that, the news cycle moves on very swiftly. And I know how many of us are holding in our prayers for those families have those little girls right now, those families in unspeakable pain. And you can only do that if you also believe that goodness, truth, and beauty exist in an ultimate form, which is ultimately as real as anything that humans can do, if not realer, if not bigger. 

Elizabeth   

Dr Gwen Adshead, thank you so much for speaking to me on The Sacred. 

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