I am reading this at in chunks so I do the review justice. This one will cover chapters 7 & 8. You can read the rest of the series at the link below. Do buy the book. My review is no substitute and it is an important historical record. Also order it at your Library.

TIME TO THINK: Hannah Barnes

Chapter 7 is aptly titles The Bombshell as there are growing numbers of staff expressing concerns, a huge surge in referrals and staff are failing to meet targets over waiting times.

The decision was taken to invite an external consultant to review G.I.Ds and, for a brief point, it looked as though significant change was on the horizon. For some staff this change couldn’t come soon enough as one commented.

The consultant, Dr Femi Nzegwu, made her recommendations which included reviewing the criteria for referrals, a minimum standard for report writing and even a temporary cessation of the service.

Anna Hutchinson shared her recollections of this time.

According to Hutchinson it was Polly Carmichael who ended the discussion about closure, in her view all it required was “brave leadership”.

There is no evidence that NHS England were ever told of the report, certainly the chief executive of the NHS Trust, where GIDs was based, not: He had to find out from the media.

Meanwhile, in 2016/17, when the report was commissioned, referrals were still increasing and the staff doubles from 40 to 80 and still they could not keep up. The criteria was not tightened up and there were multiple agencies able to refer children.

At around this time the first reported outcomes of the Tavistock experiment with puberty blockers started to emerge. The preliminary findings showed a mismatch between positive reports by the patients which were not borne out by the psychological testing. Amazingly there was no improvement of the Gender Dysphoria or the self-harm. Subjects also had higher degrees of suicide ideation.

Despite this no halt was called to the live experiment which included 162 children by 2016. Carmichael actually argued that this progression rate might mean that some children who would have benefited may have missed out! Though she did conceded it was possible that the puberty blockers influenced the trajectory for these kids. Almost as if going through a natural puberty helped resolve bodily rejection.

There was more. The researchers revealed that near a 100% of the children had progressed to cross-sex hormones. Only one stoped treatment citing issues with bone density development. For some clinicians this was a wake up call.

Hutchinson sounds absolutely horrified by what the clinic was doing to some of the more vulnerable children in our society. A horror I share.

For natal boys there is another consequence. One of the arguments for blocking puberty had been the prevention of the development of secondary sexual characteristics would avoid unnecessary surgery in the future. For males, however, the stunting of their male genitalia actually increased the likelihood they would have to undergo an even riskier type of surgery. The Tavistock staff knew that one of the boys in the Dutch study had died following complications of this type of surgery. We know also, from Marci Bowers, a “trans-identified” man and a surgeon, that these children will likely grow up and be not only sterile but inorgasmic. It shocks me everyday that we are still doing this.

Some of the clinicians describe how there practice changed after this research but the clinic itself issued no directive and did not change practice. One of the clinicians drafted a leaflet, to be shared with patients and their families, warning about the issue with future genital surgery. The leaflet needed approval from Carmichael who did not respond to the requests; a decision described as unethical by one 👇 clinician.

The reluctance to commit this to paper invites speculation as to Carmichael’s motives. This was one suggestion.

Chapter Eight.

This chapter covers the fallout for the staff and how some began to modify their practice in line with the new information. Stress levels were high and staff were offloading to one another but the service itself had not reviewed its treatment protocols. Discussions across GIDs, were they occurred were described as polarising.

This chapter also covers what seems to be the dysfunctional relationship with CAMHS (Childhood and Adolescent Mental Health Services). It appeared that the impact of economic policy “austerity” had placed intolerable pressure on CAMHS who were referring to GIDs partly to relieve pressure on their service. It was not that these children did not express unhappiness with their sexed body they did, but they often had co-morbid mental health issues which were left untreated by a referral to GIDs.

A further difficulty was that it was ideologically driven lobby groups, like Mermaids, who stepped in to provide support to parents and children. Mermaids , as we know, believed in the idea someone could be born in the wrong body and pushed the idea that if you did not medicalise these kids they would commit suicide. There involvement would, inevitably, drive up referrals and make existing referrals anxious for the medical pathway.

Matters were not helped by the number of agencies able to refer children to GIDs.

The feeling I am left with is a service spinning out of control and a leadership team unable to take the hard decisions and, at the heart of this problem, children bing irreversibly damaged.

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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👇:

TIME TO THINK: Hannah Barnes

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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