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Unspeakable: Stories of Survival and Transformation After Trauma
'A wise, deep, nuanced and profoundly moving book.' Siri Hustvedt
'Thoughtful, important and a reminder that hope belongs to everyone.' Christie Watson
The Sunday Times bestselling authors of The Devil You Know return with a life-affirming myth busting exploration of trauma, resilience and healing.
A widow dares not utter her husband's name. A prisoner of war buries the memories of his ordeal. A child hostage is rendered mute. What happens when trauma goes unspoken?
The pioneering psychiatrist and psychotherapist Dr Gwen Adshead invites us to witness her work with patients struggling in the wake of a range of distressing and painful life events. Drawn from over thirty years of clinical practice, Unspeakable illuminates how language - and silence - can dramatically affect the quality of our recovery after disaster. Sometimes the hardest words to say out loud are the very ones to set us free and with Adshead's assistance and extraordinary insight, these courageous people step out of the darkness of shame and fear to discover new possibilities.
This is not a book about trauma, it is about survival. In challenging prevailing misconceptions around trauma and by charting the transformation of patient identities, hearts and minds, Unspeakable makes a powerful case for hope.
'Thoughtful, important and a reminder that hope belongs to everyone.' Christie Watson
The Sunday Times bestselling authors of The Devil You Know return with a life-affirming myth busting exploration of trauma, resilience and healing.
A widow dares not utter her husband's name. A prisoner of war buries the memories of his ordeal. A child hostage is rendered mute. What happens when trauma goes unspoken?
The pioneering psychiatrist and psychotherapist Dr Gwen Adshead invites us to witness her work with patients struggling in the wake of a range of distressing and painful life events. Drawn from over thirty years of clinical practice, Unspeakable illuminates how language - and silence - can dramatically affect the quality of our recovery after disaster. Sometimes the hardest words to say out loud are the very ones to set us free and with Adshead's assistance and extraordinary insight, these courageous people step out of the darkness of shame and fear to discover new possibilities.
This is not a book about trauma, it is about survival. In challenging prevailing misconceptions around trauma and by charting the transformation of patient identities, hearts and minds, Unspeakable makes a powerful case for hope.
- GenresNonfictionPsychology
310 pages, Kindle Edition
Published February 24, 2026
About the author
Gwen Adshead
23 books75 followersDr Gwen Adshead is Visiting Gresham Professor of Psychiatry and currently consultant forensic psychiatrist at Ravenswood House. Prior to this post, she worked at Broadmoor Hospital from 1996, first as Consultant Forensic Psychiatrist, and then as a Consultant in Forensic Psychotherapy. In her role as both a forensic psychiatrist and psychotherapist, Professor Adshead has tried to understand the psychological mechanisms that give rise to violence and life threatening behaviour toward others. She has worked as a member of a therapeutic team whose role is to rehabilitate and offer secure psychiatric care to some of the most vilified and socially rejected members of society.
Professor Adshead qualified in medicine in 1983 and was elected member of the Royal College of Psychiatrists in 1987 before being made a Fellow of the Royal College of Psychiatrists in 2005. She has a Masters’ Degree in medical Law & Ethics; is a qualified member of the Institute of Group Analysis; and holds a Master’s Degree in Mindfulness based Cognitive therapy. In 2013 she was awarded the Jochelson visiting professorship at Yale School of Law & Psychiatry and later that year, was awarded the President’s medal for her work in ethics in mental health. She has over 20 years practice in the NHS and has contributed to the work of the Royal College of Psychiatrists as chair of their Ethics Committee; and she has also contributed to Department of Health policy in relation to abnormal maternal illness behaviour.
Professor Adshead also has particular expertise in the assessment and treatment of doctors whose behaviour has caused them to be in conflict with others. She has set up a group called Mindfulness for Doctors, which aims to build resilience in doctors. Her extensive research interests include abnormal illness behaviour, professional ethics and boundaries in mental health, and attachment theory.
In addition to being a practising clinician, Professor Adshead has authored over 100 academic papers in books and journals. She is a regular guest on radio and television, where she has discussed issues as diverse as criminal mental health and her “Desert Island Discs”. She regularly teaches medical students, psychiatric trainees and presents at conferences nationally and internationally.
She is the co-editor of several books including Ethical Issues in Forensic Mental Health Research (with Dr Christine Brown); A Matter of Security: The Application of Attachment Theory to Forensic Psychiatry and Psychotherapy (with Professor Friedmann Pffafflin) and Personality disorder: the definitive collection (with Dr Caroline Jacob). Her most recent book, Clinical topics in personality Disorder (co-edited with Dr Jay Sarkar) was awarded first prize in the Psychiatry Section at the BMA Book Awards in 2013.
In her role as Visiting Gresham Professor of Psychiatry, Dr Adshead will present a series of lectures under the title Things of Darkness, based on a quote from The Tempest: ‘These things of darkness, I acknowledge mine’ in the 2014/15 academic year.
Professor Adshead continues her role as Visiting Gresham Professor of Psychiatry with a series of lectures for the 2015/16 academic year entitled Changing Minds.
Professor Adshead qualified in medicine in 1983 and was elected member of the Royal College of Psychiatrists in 1987 before being made a Fellow of the Royal College of Psychiatrists in 2005. She has a Masters’ Degree in medical Law & Ethics; is a qualified member of the Institute of Group Analysis; and holds a Master’s Degree in Mindfulness based Cognitive therapy. In 2013 she was awarded the Jochelson visiting professorship at Yale School of Law & Psychiatry and later that year, was awarded the President’s medal for her work in ethics in mental health. She has over 20 years practice in the NHS and has contributed to the work of the Royal College of Psychiatrists as chair of their Ethics Committee; and she has also contributed to Department of Health policy in relation to abnormal maternal illness behaviour.
Professor Adshead also has particular expertise in the assessment and treatment of doctors whose behaviour has caused them to be in conflict with others. She has set up a group called Mindfulness for Doctors, which aims to build resilience in doctors. Her extensive research interests include abnormal illness behaviour, professional ethics and boundaries in mental health, and attachment theory.
In addition to being a practising clinician, Professor Adshead has authored over 100 academic papers in books and journals. She is a regular guest on radio and television, where she has discussed issues as diverse as criminal mental health and her “Desert Island Discs”. She regularly teaches medical students, psychiatric trainees and presents at conferences nationally and internationally.
She is the co-editor of several books including Ethical Issues in Forensic Mental Health Research (with Dr Christine Brown); A Matter of Security: The Application of Attachment Theory to Forensic Psychiatry and Psychotherapy (with Professor Friedmann Pffafflin) and Personality disorder: the definitive collection (with Dr Caroline Jacob). Her most recent book, Clinical topics in personality Disorder (co-edited with Dr Jay Sarkar) was awarded first prize in the Psychiatry Section at the BMA Book Awards in 2013.
In her role as Visiting Gresham Professor of Psychiatry, Dr Adshead will present a series of lectures under the title Things of Darkness, based on a quote from The Tempest: ‘These things of darkness, I acknowledge mine’ in the 2014/15 academic year.
Professor Adshead continues her role as Visiting Gresham Professor of Psychiatry with a series of lectures for the 2015/16 academic year entitled Changing Minds.
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Displaying 1 - 13 of 13 reviews
March 22, 2026
Fascinating
March 15, 2026
Radio 4's book of the week and I wasn't sure if this would be for me. It was hugely fascinating - each episode taking a different look at trauma and what this does to us, both short term and long term.
March 24, 2026
When I was working on the medical wards (gastroenterology to be precise) my consultant told me off because my discharge letters were akin to ‘reading a short story’.
It was true. Each time a patient was released back into primary care, their GP would receive a neatly-typed narrative arc, with an inciting incident, quite possibly foreshadowing, occasionally a plot twist, and (most importantly) a hero’s journey. Because each patient I saw *was* a short story (to be fair, each patient was an entire novel, but unfortunately I didn’t have an opportunity to listen to the whole book).
As medical students and junior doctors, we are encouraged to gather information. To write patient histories based on clean, tidy statements and in a clean, tidy order. Presenting complaint. History of presenting complaint. Past medical history. Family history. We are taught to gather facts, not listen to stories. Which is a great pity because, whilst facts are obviously deeply important, the truly valuable information always lies hidden elsewhere. Information that will not only help us to diagnose a problem, but to understand how that problem came to be, to resolve it as efficiently and painlessly as we are able, and (if it’s possible) to prevent it from happening again. Equally importantly, if we listen to a patient’s story with compassion and respect (rather than focusing, head down, on a list of signs and symptoms) that patient will feel safe, and heard, and understood. And they will trust us.
This is relevant in any branch of medicine, but it’s especially important in psychiatry, where a patient’s story is very often the only information we have, and nurturing that trust and safety is paramount. I wish story-listening was taught to medical students and junior doctors with the same importance as the boundaries of the inguinal canal and how to spot an S-T elevation (and I wish I had the ability to influence this in some way), but until then, what I am able to do is offer you a book recommendation. UNSPEAKABLE by Dr Gwen Adshead and Eileen Horne is the story of situations where severe physical and psychological damage steals away language and identity. Using real-life cases, it explores what happens when trauma goes unspoken about, from the prisoner of war, to the refugee, to the child hostage. What do we do when a patient is unable to tell us their story? As Dr Adshead writes in the introduction, this is a not a book about trauma, it is a book about survival. It’s also deeply moving, incredibly wise and, like the authors’ previous book THE DEVIL YOU KNOW, exquisitely written. Most importantly it highlights the value of stories, both in the telling and in the receiving, because without them, what are we left with … we are all made of stories, and if those stories are smothered or go unheard, how can we ever hope to understand our patients, our loved ones, or ourselves. Even if you have no connection to medicine, you will find this book so very powerful and hugely affecting. If, however, you are a medic, I would go as far as to say books like this are essential reading. Because learning how to listen to stories will not only make your job a whole lot easier, your future patients will thank you for it.
UNSPEAKABLE by Dr Gwen Adshead and Eileen Horne is out now from Faber & Faber. A huge thank you to Sophie Lambert at C&W agency for sending it to me.
It was true. Each time a patient was released back into primary care, their GP would receive a neatly-typed narrative arc, with an inciting incident, quite possibly foreshadowing, occasionally a plot twist, and (most importantly) a hero’s journey. Because each patient I saw *was* a short story (to be fair, each patient was an entire novel, but unfortunately I didn’t have an opportunity to listen to the whole book).
As medical students and junior doctors, we are encouraged to gather information. To write patient histories based on clean, tidy statements and in a clean, tidy order. Presenting complaint. History of presenting complaint. Past medical history. Family history. We are taught to gather facts, not listen to stories. Which is a great pity because, whilst facts are obviously deeply important, the truly valuable information always lies hidden elsewhere. Information that will not only help us to diagnose a problem, but to understand how that problem came to be, to resolve it as efficiently and painlessly as we are able, and (if it’s possible) to prevent it from happening again. Equally importantly, if we listen to a patient’s story with compassion and respect (rather than focusing, head down, on a list of signs and symptoms) that patient will feel safe, and heard, and understood. And they will trust us.
This is relevant in any branch of medicine, but it’s especially important in psychiatry, where a patient’s story is very often the only information we have, and nurturing that trust and safety is paramount. I wish story-listening was taught to medical students and junior doctors with the same importance as the boundaries of the inguinal canal and how to spot an S-T elevation (and I wish I had the ability to influence this in some way), but until then, what I am able to do is offer you a book recommendation. UNSPEAKABLE by Dr Gwen Adshead and Eileen Horne is the story of situations where severe physical and psychological damage steals away language and identity. Using real-life cases, it explores what happens when trauma goes unspoken about, from the prisoner of war, to the refugee, to the child hostage. What do we do when a patient is unable to tell us their story? As Dr Adshead writes in the introduction, this is a not a book about trauma, it is a book about survival. It’s also deeply moving, incredibly wise and, like the authors’ previous book THE DEVIL YOU KNOW, exquisitely written. Most importantly it highlights the value of stories, both in the telling and in the receiving, because without them, what are we left with … we are all made of stories, and if those stories are smothered or go unheard, how can we ever hope to understand our patients, our loved ones, or ourselves. Even if you have no connection to medicine, you will find this book so very powerful and hugely affecting. If, however, you are a medic, I would go as far as to say books like this are essential reading. Because learning how to listen to stories will not only make your job a whole lot easier, your future patients will thank you for it.
UNSPEAKABLE by Dr Gwen Adshead and Eileen Horne is out now from Faber & Faber. A huge thank you to Sophie Lambert at C&W agency for sending it to me.
Review of advance copy received from Netgalley
Thoughtful, informative, compassionate ‘from the psychiatrist’s chair’ narrative 4.5 raised
Because I work, professionally, with people with complex mental health challenges, and especially, with PTSD, I am always interested in books like this, even though my modality is a different one. There is, with good explorations and accounts of the therapeutic relationship and the witnessed journey – which this absolutely is, much to teach others, like me, on how to refine their own work.
What stands out so strongly here is that Dr Adshead takes an individual approach with her clients, a narrative one, which allows the personal story to be told, heard, witnessed, and that her guidance is both gentle, measured and offered to THIS person, THIS session, rather than being something of formulaic method.
She does not eschew the employment of other methods, as needed, whether that is support through pharmaceuticals or techniques. What stands out though, is story, the client’s story, individual meaning.
This is also supported by Adshead’s out steeping in literature, which, after all, is also about the journey and story of individuals. A subtle and truthful writer will manage both to create the unique individual character, AND there will be resonance which links into the reader’s understanding, and the ‘lessons’ of felt archetypes.
Her approach which also explores ‘what is arising here for ME?’ (the therapist) is also one which I find valuable to consider, as, often, in a deep and authentic session some kind of energy field, some kind of quality of experience and felt sense, happens for the practitioner in a session. It may be that what arises is the therapist’s, it may be the client’s, it may be the space between, the resonance, but the practitioner will find this can be useful to observe.
She takes her own journey through (disguised, details changed, and portmanteau) through her decades of work, in many different kinds of practice, especially within large organisations, from her time as a new trainee right through to semi-retirement and the holding of the space of supervision for other practitioners, and indeed with those entering into training themselves.
Thoroughly recommended, including to those who have no professional involvement, but are generally curious about the whole variety of human experience, and, particularly, in journeys out of our human suffering into something more integrated
Gratefully received as an ARC from the publisher, via NetGalley
Because I work, professionally, with people with complex mental health challenges, and especially, with PTSD, I am always interested in books like this, even though my modality is a different one. There is, with good explorations and accounts of the therapeutic relationship and the witnessed journey – which this absolutely is, much to teach others, like me, on how to refine their own work.
What stands out so strongly here is that Dr Adshead takes an individual approach with her clients, a narrative one, which allows the personal story to be told, heard, witnessed, and that her guidance is both gentle, measured and offered to THIS person, THIS session, rather than being something of formulaic method.
She does not eschew the employment of other methods, as needed, whether that is support through pharmaceuticals or techniques. What stands out though, is story, the client’s story, individual meaning.
This is also supported by Adshead’s out steeping in literature, which, after all, is also about the journey and story of individuals. A subtle and truthful writer will manage both to create the unique individual character, AND there will be resonance which links into the reader’s understanding, and the ‘lessons’ of felt archetypes.
Her approach which also explores ‘what is arising here for ME?’ (the therapist) is also one which I find valuable to consider, as, often, in a deep and authentic session some kind of energy field, some kind of quality of experience and felt sense, happens for the practitioner in a session. It may be that what arises is the therapist’s, it may be the client’s, it may be the space between, the resonance, but the practitioner will find this can be useful to observe.
She takes her own journey through (disguised, details changed, and portmanteau) through her decades of work, in many different kinds of practice, especially within large organisations, from her time as a new trainee right through to semi-retirement and the holding of the space of supervision for other practitioners, and indeed with those entering into training themselves.
Thoroughly recommended, including to those who have no professional involvement, but are generally curious about the whole variety of human experience, and, particularly, in journeys out of our human suffering into something more integrated
Gratefully received as an ARC from the publisher, via NetGalley
February 24, 2026
This book was so worth reading. Dr Gwen Adshead, in her role as a forensic psychotherapist and also a trained psychiatrist, writes of eight patients she has met over a few decades of her work. Each has experienced trauma and reading their stories is helpful to understand how people can be affected by the actions of others and also a salutary lesson in how our own actions can have far reaching negative consequences on others if we behave badly or simply thoughtlessly. Dr Adshead has anonymised her subjects and their stories to protect them but the book is extremely readable to the lay person with a minimum of medical technical terms.
I found myself highlighting some sections to read again in the future as they resonated with me for one reason or another. One such highlight was that when people say they are 'fine' sometimes a psychologists will interpret that as an acronym for 'feeling inside not expressed'.
I was also concerned that I might find the book too traumatic myself to read given it deals with some fairly heavy subjects such as the holocaust, child abuse, tragic accidents and being a child hostage on a plane. However, I did not find it too traumatic all which is a testament to the good writing and the clear, sensitive, personal way in which Dr Adshead deals with all of her clients which is impressive. Her final case highlights the need for a therapist to have their own supervisor/therapist to share the burden of some of the difficult things they hear about in their consultations.. A very well written and helpful book on a challenging subject.
With thanks to NetGalley and Faber and Faber Ltd for a free copy of this book in exchange for an honest review.
I found myself highlighting some sections to read again in the future as they resonated with me for one reason or another. One such highlight was that when people say they are 'fine' sometimes a psychologists will interpret that as an acronym for 'feeling inside not expressed'.
I was also concerned that I might find the book too traumatic myself to read given it deals with some fairly heavy subjects such as the holocaust, child abuse, tragic accidents and being a child hostage on a plane. However, I did not find it too traumatic all which is a testament to the good writing and the clear, sensitive, personal way in which Dr Adshead deals with all of her clients which is impressive. Her final case highlights the need for a therapist to have their own supervisor/therapist to share the burden of some of the difficult things they hear about in their consultations.. A very well written and helpful book on a challenging subject.
With thanks to NetGalley and Faber and Faber Ltd for a free copy of this book in exchange for an honest review.
Review of advance copy received from Netgalley
Having both a personal and professional interest in the subject of trauma therapy I was delighted to receive an advanced reader copy of 'Unspeakable' and am grateful to the publishers and NetGalley for the opportunity to review this excellent account .
The authors present case study work in a very sensitive way offering great insight into the profound effects of different traumatic experiences and how these can impact at different times and in different ways throughout a persons' different life stages. The power of the therapeutic relationship underpins all the work the authors present, offering a refreshing change to the medical model of formulation and medication.
The ways in which transference and counter-transference play out in therapeutic relationships were highlighted and the importance of clinical supervision and personal reflection were presented as key factors in successful work with clients.
The book is not loaded with medical jargon making it accessible to a wide audience. I was struck by the warmth I felt towards the authors as they worked with deep care and concern for their clients, offering hope that with the correct therapeutic conditions, healing from the most profound trauma is a possibility. An acknowledgement of the decimation of the current mental health services offered in the NHS was acknowledged bringing an important realism to the current situation.
The authors present case study work in a very sensitive way offering great insight into the profound effects of different traumatic experiences and how these can impact at different times and in different ways throughout a persons' different life stages. The power of the therapeutic relationship underpins all the work the authors present, offering a refreshing change to the medical model of formulation and medication.
The ways in which transference and counter-transference play out in therapeutic relationships were highlighted and the importance of clinical supervision and personal reflection were presented as key factors in successful work with clients.
The book is not loaded with medical jargon making it accessible to a wide audience. I was struck by the warmth I felt towards the authors as they worked with deep care and concern for their clients, offering hope that with the correct therapeutic conditions, healing from the most profound trauma is a possibility. An acknowledgement of the decimation of the current mental health services offered in the NHS was acknowledged bringing an important realism to the current situation.
Review of advance copy received from Publisher
Trauma studies and their intersection with literature are not only of great personal interest to me, but I think that reading about trauma from psychological perspectives is important in terms of navigating life and the people around us. “Unspeakable” features everyday people whose traumas arise in often unpredictable ways, and this book allows insight into these moments from the lens of a mental health professional who is very honest about these encounters.
Books like “Unspeakable,” which are accessible and not too theory-dense, serve as extremely valuable entry points to the trauma studies field. This book centers on a psychotherapist’s experiences with specific individuals, and the chapters are organized as such. From the oft-studied war veteran to her experiences with other mental health professionals working through their own traumas, this book provides an interesting survey of how trauma shows up in the everyday.
Those familiar with trauma theory might find this book a bit surface level, but it is very readable and I enjoyed it for that reason. Some of the case studies did seem to wrap up a bit too ‘neatly’ in my opinion, but in the interest of providing polished vignettes of her patients, I can also understand why this was the case.
Thank you so much @faber for the proof copy!
Books like “Unspeakable,” which are accessible and not too theory-dense, serve as extremely valuable entry points to the trauma studies field. This book centers on a psychotherapist’s experiences with specific individuals, and the chapters are organized as such. From the oft-studied war veteran to her experiences with other mental health professionals working through their own traumas, this book provides an interesting survey of how trauma shows up in the everyday.
Those familiar with trauma theory might find this book a bit surface level, but it is very readable and I enjoyed it for that reason. Some of the case studies did seem to wrap up a bit too ‘neatly’ in my opinion, but in the interest of providing polished vignettes of her patients, I can also understand why this was the case.
Thank you so much @faber for the proof copy!
Review of advance copy received from Netgalley
Before I started reading this book, I was slightly concerned that I might be burnt‑out on non‑fiction and needed a lighter subject. However, the book immediately took hold of me, and I was invested and intrigued by every patient’s story, Dr Adshead’s analysis, and the way she conversed with each person so sensitively and carefully.
Trauma is a tough subject that may be difficult for most readers, but if you are interested in psychiatry and the value of therapy (and, in this case, getting it back into the NHS’s budget), this is a fascinating and ultimately mostly heart‑warming read. Although the book uses stories of real people, they are anonymised, and I thought it was done very respectfully. You may, of course, wish to skim the subject of each chapter quickly to decide whether you feel comfortable reading about each patient’s specific experiences.
Thank you to Faber for providing this book for review consideration via NetGalley. All opinions are my own.
Trauma is a tough subject that may be difficult for most readers, but if you are interested in psychiatry and the value of therapy (and, in this case, getting it back into the NHS’s budget), this is a fascinating and ultimately mostly heart‑warming read. Although the book uses stories of real people, they are anonymised, and I thought it was done very respectfully. You may, of course, wish to skim the subject of each chapter quickly to decide whether you feel comfortable reading about each patient’s specific experiences.
Thank you to Faber for providing this book for review consideration via NetGalley. All opinions are my own.
March 1, 2026
I'm probably the wrong person to have reviewed this book, so I didn't enjoy it. I've been through a lot of personal trauma in my life. Not least being diagnosed with a terminal disease two years ago, but before that, a plane crash, a drowning, a brush with a child with suspected cancer, two dead parents. So I'm always looking for some insight, and this wasn't it. For me.
The Coda was the most interesting part of the book for me.
The notion of silence resonated with me after a big accident (a plane crash in my case), but I also wanted to get some insight into why I've also experienced euphoria after near death events, but that wasn't even mentioned. Maybe just me.
The Coda was the most interesting part of the book for me.
The notion of silence resonated with me after a big accident (a plane crash in my case), but I also wanted to get some insight into why I've also experienced euphoria after near death events, but that wasn't even mentioned. Maybe just me.
April 17, 2026
4.5 rounded up (5 stars to the first half)
I enjoyed this compassionate exploration of PTSD with vignettes from people with different experiences. I felt the ones nearer the start of the book especially were written so as to have relatable elements for any reader. I think I would have liked more breadth of experience included, I sort of felt like the ones chosen represent the ideas of causes of PTSD that are already known about and the survivors are seen as the 'good' kind of survivors and I would have liked the authors to be a bit braver in this respect.
I enjoyed this compassionate exploration of PTSD with vignettes from people with different experiences. I felt the ones nearer the start of the book especially were written so as to have relatable elements for any reader. I think I would have liked more breadth of experience included, I sort of felt like the ones chosen represent the ideas of causes of PTSD that are already known about and the survivors are seen as the 'good' kind of survivors and I would have liked the authors to be a bit braver in this respect.
March 28, 2026
3.5* I am in the middle about this one, my mum recommended it to me after hearing about it on radio 4. personally I prefer more science based instead of stories, I think that it would be more effective if the questions were in the chapters.
March 4, 2026
Really interesting read; it was great to hear the author speak about her book in Blackwells whilst I was reading!
March 31, 2026
Good but I prefer other books of similar style
Displaying 1 - 13 of 13 reviews