For the discussion group in April/May 2023 we read Hannah Barnes’ recent book Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children.
We started the discussion with an overview of the history of GIDS from Libby Brooks’ Guardian article to remind ourselves of the GIDS timeline of events. We then then discussed different aspects that may have contributed to GIDS getting away with doing often substandard work for so long – like the amount of money that GIDS brought in, lack of willingness to change (perspective) and listen, homophobic attitudes amongst some staff members etc.
Alfie was particularly struck by the fracturing of the services. On the one hand the disconnect between CAMHS and GIDS, where the former assumed that GIDS would do therapeutic work, which of course they did not. On the other hand, the fast-tracking of the older adolescents, which were quickly referred onto adult services by GIDS. Once at adult services, the assumption was that GIDS had done proper in-depth assessments and the young patients simply and easily continued down the medical route.
David pointed out that there was a distinct lack of communication and lack of record keeping, something that seems to occur regularly when there are scandals involving the NHS, especially if there are multiple teams and/or outside organisations involved.
It was interesting that as readers, we had come to different concepts of what GIDS did exactly, which seemed similar to the differing points of views and experiences of clinicians at GIDS. Robbie felt that the book made it really clear that GIDS’ job was assessing whether the children were meeting the criteria to enable referral to the endocrinology team for puberty blockers, whilst some of us felt that this was not as clear at the start of the service.
Alfie rightly pointed out that any service for children and young people with gender distress should work from a holistic approach with multiple options for help and support, including medical and therapeutic support therapeutic route. Robbie agreed, but felt felt that there only really was one pathway, which Björn agreed with. He was particularly struck by the fact that the medical pathway seemed very well thought out in terms of number of sessions, referrals if blockers were deemed appropriate etc. However, the therapeutic side of things did not seem to have been given as much thought at all. The book included very little detail about what would happen if children would not choose the medical interventions. Would they get therapy and if so what kind (psychodynamic, psychoanalytic, CBT etc)? Would they be referred to CAMHS or back to the referrer? Would they be dropped after 6 sessions to work it out alone?
We were all shocked by how experimental the treatment was. GIDS was using a drug that was used for precocious puberty, chemical castration or prostate cancer off-label to block children’s puberty, often for long periods of time. We were of course aware that there is often experimentation with new drugs or treatments, for instance for people who are given experimental drugs to treat a certain type of cancer. However, David rightfully pointed out that there is a difference between offering an experimental drug in a fairly certain life or death scenario and providing it for gender dysphoria. Adding to that Alfie said that in cases where terminally ill patients were being given a potentially life lengthening or saving drug, that this would usually be part of a study, which is not what happened at GIDS.
In terms of the staff at GIDS it was clear that there were definitely quite a few ideological differences between those who worked there. From someone being berated for saying they did not have a gender identity, incidences of homophobia and even someone being able they need not apply for a post if they thought sex was immutable. Having differences of opinion is in itself not a problem of course, but being unable to discuss these, especially when providing medical care for vulnerable children is.
In terms of the book, there was a feeling that Barnes adapted a BBC-like neutral stance for her book. That is not to say that she did not take any risks. GIDS and some of its employees do not come off particularly well and Barnes definitely put her head above the parapet when deciding to write this book, in a similar way to the whistleblowers who raised concerns initially and spoke to her for the book. Barnes is a journalist and it seems that at the end of the day, she seemed to feel that her job was’t to pass judgment, but to bring to light what happened at GIDS. Barnes did this well considering the complexity of what happened at GIDS over a period spanning decades, with many events and bearing in mind that the people who worked at GIDS over the years had very different perspectives, experiences and memories of what it was like.
At the end of the session we discussed the need for a deeper understanding of where this is coming from. Some of us were especially surprised by the high levels of homophobia reported throughout the book and that this seems to still be such a big issue in this day and age. We also discussed the need to understand why there was such an increase in girls identifying as trans when boys used to be the majority. We discussed the link between girls’ physical development and the rape culture in which this happens – where men and boys objectify, harass and sexually abuse them. We also briefly touched on young girls and boys undergoing invasive medical treatment, whilst older men like Eddie Izzard, simply change the way they present outwardly.
We ended on a discussion about whether we felt it was ever OK to give puberty blockers & hormones to children and young people. It was difficult to come to a clear answer on this, but by and large we felt that there may occasionally be circumstances in which this was warranted. However, these circumstances would be rare. When questions like this come up, it’s easy to go into ‘utopia’ mode by saying that ideally everybody could wear and like what they wanted without having to change their body to fit societal expectations.
Unfortunately this is not the reality of this time. Medical treatments are out there and even though there isn’t the scientific evidence to back the treatment up, it has taken root in our society and is seen by many a solution for gender dysphoria. At the moment it feels unavoidable that some children and young people will choose this, despite the information the collapse of GIDS has brought to light. To some degree we need to live with this reality, but we should not let that stop us from investing in less invasive approaches, more research and more discussion about what is going on and what we can do to support and help these young people lead happier lives with as little medical intervention as possible.
To finish the evening off, we discussed the question “How does the content of the book relate to what MACS does in terms of anti-sexist work?“.
In some ways this question was easy to answer – saying that people are born in the wrong body based on their behaviours, what they like, how they like to dress is saying “there is no problem with sexist stereotypes, the problem lies with the body and that is what needs to change” which fits into MACS’ remit of being anti-sexist / challenging sexism. In terms of how the book relates to what MACS does in practice, it seemed much harder and we couldn’t really formulate a clear answer. Perhaps it relates best through our support of single-sex spaces, women’s rights, same sex-attraction and safeguarding. Whilst these may not seem related at first glance, there does seem to be an important connection. In a climate that is so hostile that some people feel being trans is preferable to being same-sex attracted for instance, supporting organisations and individuals that promote gay and lesbian rights feels like an important message.
A few days after the meeting David attended a launch event for the book featuring the author and two of the whistleblowers, Anna Hutchinson and Dr David Bell. Bell was especially good on how the scandal reflected the influence of misogyny in society, and also made the point that adult gender services are even more “captured” than GIDS. He gave the example of a woman with obvious mental health issues, who wanted to transition and was planning to kill herself after the operation, thinking she would live on as a man. In spite of this she was considered by her gender clinic to be a suitable case for gender reassignment.
We started the discussion with an overview of the history of GIDS from Libby Brooks’ Guardian article to remind ourselves of the GIDS timeline of events. We then then discussed different aspects that may have contributed to GIDS getting away with doing often substandard work for so long – like the amount of money that GIDS brought in, lack of willingness to change (perspective) and listen, homophobic attitudes amongst some staff members etc.
Alfie was particularly struck by the fracturing of the services. On the one hand the disconnect between CAMHS and GIDS, where the former assumed that GIDS would do therapeutic work, which of course they did not. On the other hand, the fast-tracking of the older adolescents, which were quickly referred onto adult services by GIDS. Once at adult services, the assumption was that GIDS had done proper in-depth assessments and the young patients simply and easily continued down the medical route.
David pointed out that there was a distinct lack of communication and lack of record keeping, something that seems to occur regularly when there are scandals involving the NHS, especially if there are multiple teams and/or outside organisations involved.
It was interesting that as readers, we had come to different concepts of what GIDS did exactly, which seemed similar to the differing points of views and experiences of clinicians at GIDS. Robbie felt that the book made it really clear that GIDS’ job was assessing whether the children were meeting the criteria to enable referral to the endocrinology team for puberty blockers, whilst some of us felt that this was not as clear at the start of the service.
Alfie rightly pointed out that any service for children and young people with gender distress should work from a holistic approach with multiple options for help and support, including medical and therapeutic support therapeutic route. Robbie agreed, but felt felt that there only really was one pathway, which Björn agreed with. He was particularly struck by the fact that the medical pathway seemed very well thought out in terms of number of sessions, referrals if blockers were deemed appropriate etc. However, the therapeutic side of things did not seem to have been given as much thought at all. The book included very little detail about what would happen if children would not choose the medical interventions. Would they get therapy and if so what kind (psychodynamic, psychoanalytic, CBT etc)? Would they be referred to CAMHS or back to the referrer? Would they be dropped after 6 sessions to work it out alone?
We were all shocked by how experimental the treatment was. GIDS was using a drug that was used for precocious puberty, chemical castration or prostate cancer off-label to block children’s puberty, often for long periods of time. We were of course aware that there is often experimentation with new drugs or treatments, for instance for people who are given experimental drugs to treat a certain type of cancer. However, David rightfully pointed out that there is a difference between offering an experimental drug in a fairly certain life or death scenario and providing it for gender dysphoria. Adding to that Alfie said that in cases where terminally ill patients were being given a potentially life lengthening or saving drug, that this would usually be part of a study, which is not what happened at GIDS.
In terms of the staff at GIDS it was clear that there were definitely quite a few ideological differences between those who worked there. From someone being berated for saying they did not have a gender identity, incidences of homophobia and even someone being able they need not apply for a post if they thought sex was immutable. Having differences of opinion is in itself not a problem of course, but being unable to discuss these, especially when providing medical care for vulnerable children is.
In terms of the book, there was a feeling that Barnes adapted a BBC-like neutral stance for her book. That is not to say that she did not take any risks. GIDS and some of its employees do not come off particularly well and Barnes definitely put her head above the parapet when deciding to write this book, in a similar way to the whistleblowers who raised concerns initially and spoke to her for the book. Barnes is a journalist and it seems that at the end of the day, she seemed to feel that her job was’t to pass judgment, but to bring to light what happened at GIDS. Barnes did this well considering the complexity of what happened at GIDS over a period spanning decades, with many events and bearing in mind that the people who worked at GIDS over the years had very different perspectives, experiences and memories of what it was like.
At the end of the session we discussed the need for a deeper understanding of where this is coming from. Some of us were especially surprised by the high levels of homophobia reported throughout the book and that this seems to still be such a big issue in this day and age. We also discussed the need to understand why there was such an increase in girls identifying as trans when boys used to be the majority. We discussed the link between girls’ physical development and the rape culture in which this happens – where men and boys objectify, harass and sexually abuse them. We also briefly touched on young girls and boys undergoing invasive medical treatment, whilst older men like Eddie Izzard, simply change the way they present outwardly.
We ended on a discussion about whether we felt it was ever OK to give puberty blockers & hormones to children and young people. It was difficult to come to a clear answer on this, but by and large we felt that there may occasionally be circumstances in which this was warranted. However, these circumstances would be rare. When questions like this come up, it’s easy to go into ‘utopia’ mode by saying that ideally everybody could wear and like what they wanted without having to change their body to fit societal expectations.
Unfortunately this is not the reality of this time. Medical treatments are out there and even though there isn’t the scientific evidence to back the treatment up, it has taken root in our society and is seen by many a solution for gender dysphoria. At the moment it feels unavoidable that some children and young people will choose this, despite the information the collapse of GIDS has brought to light. To some degree we need to live with this reality, but we should not let that stop us from investing in less invasive approaches, more research and more discussion about what is going on and what we can do to support and help these young people lead happier lives with as little medical intervention as possible.
To finish the evening off, we discussed the question “How does the content of the book relate to what MACS does in terms of anti-sexist work?“.
In some ways this question was easy to answer – saying that people are born in the wrong body based on their behaviours, what they like, how they like to dress is saying “there is no problem with sexist stereotypes, the problem lies with the body and that is what needs to change” which fits into MACS’ remit of being anti-sexist / challenging sexism. In terms of how the book relates to what MACS does in practice, it seemed much harder and we couldn’t really formulate a clear answer. Perhaps it relates best through our support of single-sex spaces, women’s rights, same sex-attraction and safeguarding. Whilst these may not seem related at first glance, there does seem to be an important connection. In a climate that is so hostile that some people feel being trans is preferable to being same-sex attracted for instance, supporting organisations and individuals that promote gay and lesbian rights feels like an important message.
A few days after the meeting David attended a launch event for the book featuring the author and two of the whistleblowers, Anna Hutchinson and Dr David Bell. Bell was especially good on how the scandal reflected the influence of misogyny in society, and also made the point that adult gender services are even more “captured” than GIDS. He gave the example of a woman with obvious mental health issues, who wanted to transition and was planning to kill herself after the operation, thinking she would live on as a man. In spite of this she was considered by her gender clinic to be a suitable case for gender reassignment.
