This is a ground breaking book even after all the media coverage about the Tavistock.I think I have written about twenty pieces about the U.K’s main Gender Identity Service but I still finding this an absorbing read and learning things I didn’t know. I am writing this series as I make my way through the book.
I will cover chapters five and 6 in this piece. You can catch up with the series here👇:
The clinic had entered a new era now that Dr Polly Carmichael had taken over the helm. Bernadette Wren also joined during this period as did many new staff as the operations of the clinic expanded. The NHS had commissioned G.I.D.s to provide a national service and referrals were increasing at unprecedented rates. It seems the previous head, Domenico Di Ceglie should have heeded the warning which did, in fact, make him laugh. We are not laughing now.
The picture pained by Barnes, based on her interviews with former Tavistock staff, is of exponential growth in referrals, a complete change in the demographic, and a leadership team seemingly unable to manage the risks for this new client group. Therapeutic work was difficult to schedule and some seem to have embraced the “affirmative” model resulting in more than one account of puberty blockers being offered during the first appointment.
Apart from the time constraints the availability of the medical pathway was changing the nature of the relationship between the clinicians and the children referred to the service. One of them describing a “fundamentalist mindset”.
Newer clinicians relies on the more experienced staff to guide them, in the absence of any formal training. This meant they were all being trained in the “affirmative” model as described by Anna Hutchinson.
Many of the clinicians describe the complexity of the cases they were faced with, including one who had three alternative personalities (known as “alters”) two of them with Australian accents even though the patient had never set foot there. Others had competing mental health conditions and suicidal ideation. Yet for all these patients there was just one treatment pathway, medical intervention to block puberty.
More than one interviewee expressed concern about the influence of lobby groups like Mermaids and GIRES. Rather than resisting this pressure Hutchinson felt that the Tavistock were buckling. The impression given is that phone calls and emails from staff at these organisations were often made to Dr Polly Carmichael.
Hutchinson describes how, originally, she was not too concerned about the use of puberty blockers having assumed /been led to believe, there was a strong evidence base behind their usage. In the next chapter this would change.
This chapter ends with another case study of a gay man with extreme Obsessive Compulsive Disorder that practically kept him housebound. He had been subject to homophobic bullying for many years and now began to question his gender identity. His mother describes how a senior clinician, from the Tavistock, travelled to see him at home and how she reacted to the pressure she felt under, going so far as to describe it as “insane”.
Luckily this gay man escaped the clutches of the Born In The Wrong Body brigade.
In chapter six we meet Matt Bristow, a gay man, who considered himself a “trans ally” and was thrilled to join G.I.Ds. Right off the bat he makes an astute ovservation that so many of the referrals are from traumatic background he wondered if they wanted to reinvent themselves via a new gender identity. Bristow also describes the hostility in some of the therapeutic encounters with patients who resented the assessment period prior to receipt of drug treatment. Patients were also predisposed to be dishonest fearful of being deemed ineligible for treatments.
Those of us with children caught up in this know that our kids are being taught a script on line to dish out to gullible, or complicit, clinicians.
By 2014 the Tavistock had determined that they would lower the age for medical intervention to allow prescriptions for those under twelve. Carmichael referred to this as “stage not age” and announced it in the press.
Carmichael is not being quite accurate in this statement. Further interrogation by the Newsnight Team, which included Barnes, forced an admission that no study had been completed and evaluated at the Tavistock, instead they were relying on the Dutch study. The problem with this was that the Dutch had not experimented on those under the age of 12.
The decision was taken by the senior staff and some staff had misgivings as Natasha Prescott recalls.
While Prescott takes a charitable view of the intentions she does question why the therapeutic aim seemed to be to eradicate any stress or discomfort rather than to teach their patients coping strategies. Other staff members too a more cynical view.
The chapter covers both Mermaids pressure for a reduced age for prescriptions and public statements, by Bernadette Wren, on why GIDs were resisting the pressure. In the end Mermaids got their way.
Barnes questions why NHS England agreed this change in the treatment protocol when no formal evaluation has been published on the ongoing study on these over the age of twelve. She also points out that the Dutch study was not an unalloyed success and even resulted in the death of one of the participants. There had also been a loss to follow up of more than 20%.
This chapter gives a good critique of potential flaws in the way participants were evaluated; in particular the way the patient was assessed for satisfaction with their biological sex, at the outset, and, after surgery, asked if they were satisfied with their target sex. Could the positive results be attributed to this methodology?
All this was taking place against a background of increased rates of referrals, inexperienced staff and a complete inversion of the sexes who were present ing at the Tavistock. From a small number of mainly boys with long standing “gender issues” they were now seeing mainly teenage females who had suddenly emerged as “trans”. This is how one clinician described the waiting room👇. This is what social contagion looks like.
Staff were still under the impression that the puberty blockers being administered were fully reversible. This was despite Carmichael making different public pronouncents for different audiences. She can be found describing PBs as a “pause” for childrens BBC but admitting they are not elsewhere.
This is Carmichael to the guardian.
Against this background the Tavistock was still expanding and doubling its contribution to the NHS trust. They were garnering positive press attention and encouraged to expand its staff, reduce assessment periods, and prescribe to everyone more, and ever younger children. We’re they unchallenged because they were a significant source of revenue?
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