Hanna Barnes is a BBC journalist. After having conducted a thorough investigation of the Tavistock Clinic in London, a centre for gender transition of minorsand after discovering the shortcomings of that service, decided to make it into a book. But it was not at all easy to find a publisher willing to publish it. Not because Barnes' work was not documented and rigorous, but because no publishing house could withstand the probable accusation of transphobia that the publication of the book would entail: apparently in the West today this is the most terrifying thing, it is hard to find someone willing to get into trouble. Eventually a publisher (Swift Press) his book found him. According to The Times, 'Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children' is among the best books to be released in 2023. Also the Financial Times lists it among the books not to be missed this year.
The Sunday Times devoted an extensive report to Barnes' work. Here are some excerpts from the article.
It was not easy for Hannah Barnes to publish her book. As an investigative producer for Newsnight, an analytical journalist and long-time documentary filmmaker, she is used to following intricate stories and this one in particular, she knew better than anyone, was complex. Since 2019 he has been in charge of the Gender Identity Development Service (Gids) based at the Tavistock and Portman NHS Foundation Trust in north London, the only one of its kind for children in England and Wales, and decided to write a book about it. 'I wanted to write a definitive account of what happened because there is a need for it,' he says. Not everyone agreed. "None of the big publishing houses would accept it," they told me. "It is interesting that there were no negative responses to the proposal. They simply said, 'We couldn't convince the younger members of our staff. "
Whatever their objections were, they could not have been about the quality of Barnes' book -Time to ThinkThe Inside Story of the Collapse of the Tavistock's Gender Service for Children- is a thorough and scrupulously non-judgmental account of the collapse of the NHS service, based on hundreds of hours of interviews with former doctors and patients. It also offers a stunning insight into failure: failure of leadership, child protection and the National Health Service (...)
Gids treats children and young people who express confusion - or dysphoria - about their gender identity, meaning they believe their biological sex does not reflect who they are. Since the service was commissioned nationally by the NHS in 2009, it has treated thousands of children helping many of them to access gonadotropin-releasing hormone agonists, known as 'puberty blockers'originally formulated to treat prostate cancer, castrate male sex abusers and is also used to treat endometriosis and fertility problems. The service will close this spring, following a deeply critical report published in February 2022 by Dr Hilary Cass, a highly respected paediatrician who was commissioned to review the service by NHS England. Cass concluded that 'a fundamentally different service model is needed'.
Gids should be an easy story to tell: many people tried to make disclosures for a long time, but Anna Hutchinson, a clinical psychologist who worked at the Tavistock Centre, told Barnes that those who spoke out were 'always rejected in one way or another'.
"It's not really normal for mental health professionals to talk openly to journalists the way they talked to me, and this shows how desperate they were to get the story out." says Barnes. Doctors struggled to be heard just as Barnes later struggled to get his book out; some people prefer censorship to the truth if the latter conflicts with their ideology. Yet, concerns about the service had been in plain sight for yearsIn February 2019, a 54-page report compiled by Dr David Bell, then a consultant psychiatrist at the trust and staff governor, was leaked to the Sunday Times. Dr Bell stated that Gids was providing 'woefully inadequate' care to its patients and that its staff had 'ethical concerns' about some of the practices of the service, how to give access to puberty blockers to 'very disturbed and troubled' children. Gids, he concluded, 'is not fit for purpose'. Many of Bell's concerns had been expressed 13 years earlier in a 2006 report on Gids by Dr David Taylor - then medical director of the trust - which described the long-term effects of puberty blockers as "untested and unstudied"..
"Taylor's recommendations were largely ignored," writes Barnes, and in the decade and a half between Taylor and Bell's reports, Gids reportedly reported more than 1,000 children for blocked puberty, some as young as nine years old. It is impossible to get an exact number because neither the service nor the endocrinologists who prescribe the blockers have been able to provide them to those who have requested them, including Barnes. One figure they have admitted is that between 2014 and 2018, 302 children aged 14 and under were referred for blockers. It is generally accepted now that puberty blockers affect bone density and potentially cognitive and sexual development. "There was everything, everything. But the lessons were not learned,' says Barnes.
Since this story touches on gender identity - one of the most sensitive topics of our time - it was difficult to overcome ideological battles to show the truth. Was the service helping children to become themselves, as its defenders claimed? Or was it pathologising and medicalising unhappy children and adolescentsas claimed by others?
This reflects the partisan way in which people view gender dysphoriaIs it similar to being gay and therefore something to be celebrated? Or is it an expression of self-loathing, like an eating disorder, that requires therapeutic intervention? This has led to the current confusion as to whether the planned ban on conversion therapy should include gender in addition to sexuality. 'Conversion therapy' obviously sounds awful, and politicians across the spectrum - from Crispin Blunt on the right to Nadia Whittome on the left - have been vocal in their support for the inclusion of gender in the bill, which would then suggest that therapy for gender dysphoria is analogous to trying to 'cure' someone of homosexuality.
But many clinicians argue that the inclusion of gender would potentially criminalise psychotherapists who explore with their patients the reason for their confusion (...)
How come the only NHS clinic for children with gender dysphoria did not realise what it was doing? or has it continued to do so? Thanks to Barnes and his book, we now know the answers to these questions and many more.
Gids was founded in 1989 by Domenico Di Ceglie, an Italian child psychiatrist. Its aim was to create a place where young people could talk about their gender identity with 'non-judgmental acceptance'. Puberty blockers were available for 16-year-olds who wanted to 'pause time' before committing - or not - to gender change surgery (...) In the early 2000s, those working within Gids noticed that some gender activist groups - such as Mermaidswhich supports 'gender-diverse' children and their families - were exerting a 'surprising' influence on Gidsespecially with regard to encouraging the prescription of puberty blockers. Barnes writes in his book that Sue Evans, a nurse working at the Gids at the time, asked a senior manager so that Gids could not focus only on verbal therapy and not administer body-altering drugs. According to her and another doctor, writes Barnes, the senior manager replied: 'It is because we have this treatment here that people come.
Around the year 2000, the trust asked Di Ceglie to draw up a report on who his patients were. The results were surprising. Most of the Gids patients were boys with an average age of 11 years. More than 25% of them had spent time in therapy, 38% came from families with mental health problems and 42% had lost at least one parent, either through separation or death. Most had other problems such as anxiety and trauma from physical abuse; almost a quarter had a history of self-harm. No conclusions were drawn and Gids continued to treat gender dysphoria as a cause rather than a symptom of adolescent distress.
It was a gender identity clinic in the Netherlands that came up with the idea of giving blockers to children under 16 in the late 1990sand in doing so provided Gids with the justification it needed. The Dutch clinic claimed that 12-year-olds could be treated with blockers if they had suffered from gender dysphoria for some time, were psychologically stable and lived in a supportive environment. This was known as the 'Dutch protocol'. Pressure groups and some gender specialists encouraged the clinic to follow suit.
Dr. Polly Carmichael took over as director of the Gids in 2009 and, in 2011, the service undertook an 'early intervention study' to examine the effect of blockers on 16-year-oldsbecause so little was known about their impact on children. Instead of waiting for the results of the study, Gids removed all age limits on blockers in 2014, allowing children as young as nine years old to access them. At the same time the requests were increasing dramaticallywhich meant that doctors had less time to assess patients before helping them access blockers. In 2009 Gids had 97 requests. In 2020 there were 2,500, with another 4,600 on the waiting list, and doctors were desperately overloaded. "As the numbers seeking Gids' help exploded around 2015, there was increasing pressure to exceed them. In some cases this meant shorter and less thorough assessments.
Doctors saw increasingly mentally ill children, including those who identified not only as a different gender but also as different nationalities and ethnicities"Usually East Asian, Japanese, Korean, that sort of thing," says Dr Matt Bristow, a former Gids clinician. But this was seen by the Gids as irrelevant for their gender identity problems. Even the past stories of sexual abuse have been ignored"In the case of a girl abused by a male, I think one question to ask is whether there is any relationship between identifying as male and feeling safe," says Bristow. But, the doctors point out, any concerns raised with their superiors always got the same answer: that the children should be referred to blockers unless they specifically said they did not want them. And few guys have said that.
Then there was the number of autistic and same-sex attracted children who attended the clinic claiming to be transgender. It is estimated that less than 2% of children in the UK have an autism spectrum disorder; at the Gids, however, more than one third of their referents had moderate to severe autistic traits. "Some staff members feared they would find themselves unnecessarily treating autistic children," Barnes writes.
There were similar fears about gay children. Doctors recall multiple cases of young people who had been homophobically bullied at school or at home, and then identified themselves as trans. According to the clinician Anastassis Spiliadis 'in many cases' a family says: 'Thank God my child is trans and not gay or lesbian'. The girls said: "When I hear the word 'lesbian' I cringe" and the boys talked to doctors about their disgust at being attracted to other boys. When in 2012 Gids asked the teenagers who had approached the service news regarding their sexuality, over 90% of females and 80% of males stated that they were attracted to the same sex or bisexual. Bristow came to believe that Gids was performing 'conversion therapy for gay children' and there was a grisly joke in the team that 'they would no longer be gay at the rate Gids was going'. When gay doctors like Bristow expressed their concerns to the managers, they said it was implied that they were not objective because they were gay and therefore 'too involved'.
What if becoming trans is - for some people - a way to convert from being gay? If a boy is attracted to other boys but is ashamed of it, then a potential way around the problem is to identify as a girl and then insist that he is heterosexual. This possibility complicates the government's plan - which has all-party support - to include gender along with sexuality in the bill to ban conversion therapy, since allowing a young person to change gender is sometimes itself a form of conversion therapy (...)
The relationship between the sexes was changing considerably. When Di Ceglie started his gender clinic, the vast majority of his patients were boys with an average age of 11 years and many had been suffering from gender distress for a long time. But as early as 2019-20, girls outnumbered boys at the Gids by six to one in certain age groups, particularly between the ages of 12 and 14, and most had not suffered from gender dysphoria until after the onset of puberty (...)
The doctors knew that their patients were not like those in the Dutch protocol. Those patients had been subjected to screeningThey had been suffering from gender dysphoria since childhood and were psychologically stable, with no other mental health problems. "Gids on the other hand - according to almost all the doctors I spoke to - referred to people under the age of 16 for puberty blockers who did not meet these conditions," Barnes writes. Most of the children between the ages of 11 and 15 who came to the clinic between 2010 and 2013 were on blockers. The doctors tried to reassure themselves by saying that the blockers were only giving their patients time to think about what they wanted by relieving their anxiety. But in 2016, the Gids research team presented the initial results of its early intervention studywhich examined the effect of prescribing blockers to children under 16 years of age: although the children said they were 'very satisfied' with their treatment, their mental health and gender-related distress have remained the same or worsened. E each of them had switched to sex hormones cross-sexsynthetic testosterone for female births, oestrogen for male births. Instead of giving them time to think, the blockers seemed to put them on the road to surgery. The doctors were concerned that the service had abandoned NHS best practice. They repeatedly raised the issue with Carmichael and the executive team, but nothing changed. In just six months in 2018, 11 people working at Gids left for ethical reasons. The people who spokesuch as David Bell and Sonia Appleby, the child protection officer for the Tavistock Trust, claim to have been bullied or dismissed (...)
Everything the informants tried to say was confirmed. A 2020 inspection by the Care Quality Commission of the Gids rated the service 'inadequate'. and pointed out that some evaluations for puberty blockers consisted of only 'two or three sessions' and that some staff members 'did not feel able to raise concerns without fear of reprisal'. Around the same time, former Gids patient Keira Bell initiated a judicial review against the trustarguing that at 16 she was too young to understand the repercussions of being put on blockers and that she bitterly regretted her transition (...)
So what really happened at the Gids? And why did nobody stop it? Barnes' book suggests multiple credible factors. Outside activist groups, such as Mermaids and Gendered Intelligence, came to exert undue influence on the service and complained if they felt things were not being done their way. For example, Gendered Intelligence complained to Carmichael, the director of Gids, when a doctor dared to publicly express the opinion that not all children with gender dysphoria would become transgender. In 2016, an expert in gender reassignment surgery warned Gids that subjecting boys to puberty blockers made it harder for them to undergo surgery as adults because their penises had not developed enough for surgeons to construct female genitalia. Instead, surgeons had to use 'segments of the intestine' to create a 'neo-vagina'. But senior managers refused the doctors' requests to write this in a leaflet for patients and families. In the book Hutchinson is said to have said: 'I could be wrong, but I think Polly [Carmichael] was afraid to write things down in case they got into the hands of Mermaids' (...)
Money is suspected to have been another problem. When Gids joined the Tavistock Trust it was a secondary service, it wasn't even in the main building. But in 2020-21, gender services accounted for about a quarter of the revenue of the trust (...)
"It is really surprising how few people were willing to question Gids. As one doctor told me, since it was gender there was this 'veil of mystery'. There was a feeling of 'Oh, it's about gender, so we can't ask the same questions that we would ask any other part of the NHS'. For example: is it safe? Where is the evidence? Where is the data?
And then there was the external culture. The failure of basic safeguarding at the Gids seems to have accelerated from 2014 onwards, at the same time as there was a push for transgender rights. Stonewall, having helped secure equal marriage for gays had now turned its attention to the rights of trans people (...) TV networks also played their part (...)
David Bell suggests that the Tavistock Trust protected the Gids "because they saw it as a way of showing that we were not grumpy old conservatives; that we were ahead of the game and in the vanguard'. The fact that the Tavistock clinic was briefly, in the 1930s, a place where homosexual men were brought to be 'cured' probably also played a role in the embrace of gender ideology by the trustas if it were atonement for a wrong past.
According to the suggestions of Dr. Cass, Gids will close this spring and be replaced by regional centres, where young people will be seen by doctors with more specialities (...) It seems incredible that such a disaster happened. How could an NHS service medicalise so many autistic and same-sex attracted young people, unhappy teenage girls and children who simply felt uncomfortable with male or female role models, with so little knowledge of the causes of their discomfort or the effects of medicine? And how did Carmichael, still director of Gids, not suffer any repercussions, while those who tried to report claimed they were bullied and fired? On the other hand, it is a miracle that the information is now available. For too long too many people have turned a blind eye to the problems arising from gender ideology, including health care for children with gender dysphoria - because they have focused on trying to be on the right side of history and refused to look at the obvious wrongs.
Barnes knows that some people will be angry with her for writing the book. But she also knows that she had to write it. "Even among the doctors working on the front lines of this problem, there is no consensus on the best way to care for these children. There has to be a debate that has to get out of the clinic and into society because this is not just about trans people. It is much more than that. It is about children."
Translation by Marina Terragni
Original article here