How do we live with Violence?

I had an unusual and powerful experience on Friday.

I went to the Institute of Group Analysis (where I trained as a psychotherapist) for an event to honour the work of Dr Gwen Adshead, a forensic psychiatrist, psychotherapist, and group analyst. She’s best known for her work in secure psychiatric units with people who have committed serious crimes — specifically murder.

She also happens to be the first person with a psychotherapy focus ever invited to deliver the BBC Reith Lectures (2024) — a platform that’s historically been reserved for economists, politicians, philosophers. Until her. Which tells you something about how significant her work has become.

The theme of her talk was violence. But what Gwen really offered was something far more confronting: a space in which to think about violence. To really think. Not just about the act, or the perpetrator, or the horror — but about the human.

She spoke with such steadiness. You could feel, in her presence, the years of sitting with devastating stories: tragedy, trauma, rage, and oblivion. And not just hearing them — absorbing them, metabolising them, staying present to them, again and again. Her presence was calm, dignified, knowledgable and deeply ethical. It made the room feel safe enough to have some kind of encounter with the material under discussion.

Her work takes place at the very edges of human experience — in the places society usually turns away from. In secure forensic hospitals like Broadmoor, where she works with men who are both seriously mentally unwell and responsible for acts that most of us can’t bear to imagine, and the wider prison system. Her work is about creating a space to think, where a person can be both wrong and understood.

To take a life is wrong and cannot be undone, but there is still a story that led a person to that act. There is still the echo of a child within that adult body — a history, a set of conditions, a landscape of neglect or abuse or fragmentation that created the ground for violence to grow. And that does not remove responsibility, but it does allow for meaning.

Gwen spoke not only as a psychiatrist, but as a group analyst committed to dialogue. Group Analysis was developed in the aftermath of the Second World War by S.H. Foulkes, as a way to help deeply traumatised soldiers make some kind of sense of what they had lived through, as victims and perpetrators. Rather than facing their pain alone, they sat together to talk about their experiences, beginning the slow process of metabolising war. Group therapy went on to develop in the newly formed NHS and continues to thrive as a first line treatment for patients with a wide range of mental health struggles, and in the private practice setting exists as a sanctuary for deep relational work and psychic healing. Well held groups have the power to contain and transmute anxiety and depression, as well as the legacies of childhood neglect, violence and abuse. They are a space where we can begin to recognise our unmet needs, develop our ability to hold others in mind and heal the parts of us that never had the chance to grow in relationship.

Gwen highlighted this pro-social approach in her own work: one that refuses to locate disturbance solely in the individual, but instead in their relational context — the absence of care, the rupture of early bonds, the lack of containment, systemic racism, and poverty. The people she works with are not just ill. They are often unparented minds — bodies that were attacked, bodies that never learned safety, and so never learned boundaries. And when there are no boundaries, the mind can become a terrifying, dangerous place. She champions groupwork, not just because of her clinical experience (witnessing offenders in groups develop the capacity to take responsibility for their actions), but because the research demonstrates that group therapy and therapeutic community approaches profoundly reduce recidivism. If you’d like to know more about the process that Gwen moves through with her patients 1:1, her book The Devil you Know is a fascinating, deeply affecting read.

“What did we learn? And are still learning?
That people who kill are not all the same; that they can mourn and be appalled at themselves; that they struggle with shame and guilt.
That group therapy is an essential space to speak, listen and witness; to offer radical empathy.
Radical because it goes to the root of the suffering and then remains, while keeping a respectful distance.
Accepting responsibility for hurt done is essential to risk reduction in the future; and enables better mental health.”
— Dr Gwen Adshead

I found myself sitting in that lecture, listening to Gwen, thinking: this is what true leadership looks like, not authority, not certainty, but the courage to stay close to what is unbearable. The willingness to humanise what most people would rather exile.

In the space for questions after the presentation, someone asked about the parallels between emotionally “killing off” a parent — cutting off contact, deciding they are dead to you — and the act of homicide.

Gwen responded gently but clearly: “When the body is involved, there is finality. There is no return.” It seems obvious, and yet the room went quiet. There’s something about looking directly at the totality of death, and the human who caused it, that alters the atmosphere in a way that’s hard to describe.

Later in the day, we broke into small groups of 8 — part of the group analytic tradition — to sit with what we had heard. These conversations are never easy, and I sense we were grappling with the truth that each and every one of us is capable of being cruel, and how hard it can be to make sense of violence after the fact.

After the small group, we moved into a Large Group. Around fifty of us, sitting in two concentric circles, with no agenda, or panel, just space. There is always a convener, someone to name what’s happening when necessary, but mostly, we are left to speak. Or not.

If you’ve never been part of a large group dialogue, it can feel disorienting. The material of the day echoes into the group dynamic and often gets enacted. Tensions simmer, some people feel powerless, others dominate, and there is no easy resolution. It mirrors society. And if you stay with it, something starts to move. Towards the end, a woman named the frozen moment of the violent act, how it creates a before and after, like a cut into the whole fabric of our world, that can never be undone. This seemed to allow a flicker of deep sadness in the room to move, the ultimate grief for all of the lives lost, damaged, suspended.

I was reminded how rarely we gather like this. Most of us live in an atomised way, unaccustomed to sharing space with others without performance or distraction. We've forgotten how to wait our turn, how to hold complexity, and how to be changed by the presence of other people.

But this is what we need if we want to look at something as difficult as violence.

Not hot takes. Not exile. But dialogue.

And a willingness to acknowledge what lives inside each of us — our own capacities for hatred, aggression, rejection, cruelty. To pretend they are only out there, in someone else, is to divide the human psyche in ways that are equally dangerous. This is why I went; to remind myself and to feel the edges.

So this is a small offering, from one practitioner’s day of listening and learning. And a tribute to the people who keep doing the difficult work — not just the talking cure, but the listening one. The work of turning back toward what we would rather not see.