Sue Evans was a nurse therapist working at the Tavistock Clinic in London, dealing largely with issues of gender dysphoria in young people. In this piece from Bari Weiss’s Substack (again, subscribe if you read regularly), Evans describes how in the early 2000s the clinic became a place of fulminating “affirmative therapy”, changing its normal procedure of talk therapy to the willy-nilly dispensing of puberty blockers and hormones—all without any thoughtful examination of what was happening. If there was any “social contagion”, it was among the sheeplike employees at Tavistock who jumped aboard a woke juggernaut at the expense the patients’ well being.
Click to read. Because this has already been covered widely, I’m mentioning it for those who haven’t yet read what happened at Tavistock. You are probably aware that after an independent report on the clinic, the NHS has now ordered its closure, with its functions farmed out to several geographically distributed sub-clinics, and with a lesser concentration on “affirmative therapy” and less recommending of drugs to facilitate transsexual changes.
It wasn’t that long after Evans had been working at Tavistock—which I didn’t realize was a clinic specializing largely in talk therapy—before the idea of giving puberty blockers and hormones to gender dysphoric patients swept through the clinic, much to Evans’s dismay, since there was hardly any expertise there in using drugs for gender transitioning.
And then social contagion, stemming from advocacy groups, intensified the pressure to use drugs.
Evans:
The external influence of the advocacy groups increased. Instead of being a clinical, research-focused service where we were learning and developing ideas, it felt like it was a fait accompli that we had to go along with what Mermaids [an advocacy group] and patients wanted—even if we, the mental-health-care professionals, had legitimate questions about the appropriateness of the treatments that patients and patient advocates were demanding.
For example, a weird paradox arose at a conference on transgender health care hosted by Tavistock around 2005: the opening speaker declared that we were no longer supposed to think of gender dysphoria as a mental illness. But we were a mental-health team working at a mental-health facility. What were we supposed to be doing if not treating patients with psychological conditions?
Remember, this was all before the internet took hold of an entire generation of teenagers. There were no online groups dedicated to gender affirmation and coaching kids on what to say to their providers to secure cross-sex hormones. We mostly saw younger boys who believed themselves to be girls from an early age and a few teenagers who felt like they were trapped in the wrong bodies. So, although I felt aware of the gathering force of thinking around the area of gender dysphoria and transgender identity, it was hard to foresee the slow-motion avalanche that would hit over the next two decades.
Yet even what I saw in those years worried me deeply and working on the Gender Identity Development Service started to affect my personal well-being. I would come home with a headache on the days that I worked in the unit, and my heart would beat quickly when I went in the next morning. It felt like every time I raised a concern about us rushing prematurely to prescribe drugs that would have permanent effects on our patients, I’d be met with an eye roll and the unstated “Oh, here she goes again,” or “Can’t she just fit in?”
A concerned Evans went to the clinical director of Tavistock and raised these issues, and this led to an investigation of the clinic—in 2006. Evans didn’t see the results of that investigation until 2019, but it was damning. Sadly, the conclusions were also buried:
It was only in 2019 that I saw the full report when Hannah Barnes, a BBC journalist, obtained it via a Freedom of Information request. It confirmed all the disturbing things I had reported: Our data was poor; it wasn’t being stored properly; and there were not sufficient follow-ups with patients once they left the service—meaning we didn’t know how our patients were faring unless they voluntarily wrote to us.
As we have now learned from more recent whistleblowers, the recommendations in the report were buried, and when any criticism or difficult questions arose in the press, the Tavistock management would repeat the same mantra about how they were “a world-class service.” It’s important to acknowledge that there might have been some staff still struggling to deliver thoughtful, measured care, but the noise around our standards was growing louder.
In the face of an unchanged work milieu, Evans quit her work on gender-dysphoric patients. That’s when an explosion of referrals hit the clinic—mostly biological female adolescents who wanted to transition to the male gender. Later, when one of them—who had been rushed through puberty at 16, went on testosterone at 17, and had a double mastectomy—participated in a lawsuit against the clinic, Evans signed on as a co-claimant. They won, with the ruling that minors under 16 could not give informed consent for puberty blockers (these nearly always lead to hormone injections and full transition). But they lost the appeal.
Then, in September 2021, the government commissioned another report on Tavistock, and this one disbanded the facility, farming out its mission to other clinics and deemphasizing the default use of drugs to transition as well as urging more emphasis on objective but empathic talk therapy as a first line of treatment. This result we all know.
Evans had a rough time of it, but ends on a high note:
I didn’t seek any of this. It has been a pretty stressful few years. When I get a letter from patients or parents from around the world, and they tell me, “Well done, thank you for speaking up, you didn’t give up,” I sometimes get a lump in my throat. It’s been hard to be suspected of being prejudiced when all I wanted was safer clinical practice, more scrutiny and evidence collecting, and improved data storage.
Because what I am is a nurse. And my job as a nurse is to treat all my patients with respect and an open mind. I try to think about who they are as people, and to relate to their experience and empathize with them. I also believe we need to keep an open and curious clinical mind when something is occurring in society that seems novel or not yet fully understood. It should never be that doctors and nurses are unable to question diagnoses and prescriptions.
If my actions all those years ago have made a contribution, then I am proud. I made the right decision to raise my hand to ask another unwanted question.
There will come a time, I think, when this rush to transition, with its attendant use of “affirmative therapy”, puberty blockers, and hormone treatment, will be seen as a crazy era in medicine and therapy. Of course there are people for whom this kind of transitioning is the right thing to do, but what we often see now is madness, with affirmative therapy being pushed not because we have evidence that it’s the best thing to do for gender dysphoria—we don’t have that evidence—but because it’s ideologically “proper.” If someone suggests that they feel as if they might belong in a marginalized group, the philosophy now seems to be to get them in that group as soon as possible, ignoring other outcomes of dysphoria, like homosexuality.
Other forms of social contagion are sweeping through medical schools in this country. See:
https://www.newsweek.com/dont-impose-dei-med-schools-opinion-1727735 .
An example: “In the Oregon Health and Science University’s “Diversity, Equity, Inclusion and Anti-Racism Strategic Action Plan,” one step reads: “Develop and incorporate DEI, anti-racism and social justice core competencies in performance appraisals of faculty and staff. Include a section in annual performance reviews of staff and faculty on how the employee is contributing to improving DEI, anti-racism and social justice.” “
“There will come a time, I think, when this rush to transition, with its attendant use of “affirmative therapy”, puberty blockers, and hormone treatment, will be seen as a crazy era in medicine and therapy”.
I don’t think that time ‘will’ come, I think that time is right now, at least among most respectable physicians.
What struck me was the following quote: “… the opening speaker declared that we were no longer supposed to think of gender dysphoria as a mental illness.”
If it was not to be regarded as a mental illness, then why should it be treated with medication, surgery or other medical interventions? Or was this meant to imply that gender dysphoria is a physical illness? Presumably not, though I’m not entirely sure.
It reminds me of the conclusion in the 50s and 60s that homosexuality was no longer to be regarded as a mental illness, which led to the medical community no longer trying to “cure” patients, no longer intervening medically, but basically telling them that there was nothing wrong with them.
So why in the case of gender dysphoria would they say the condition is no longer to be regarded as a mental illness, but then proceed with radical medical interventions? Why not just tell them that there’s nothing wrong with them and offer them support instead?
Am I just confused? Am I missing something painfully obvious?
> “Am I missing something painfully obvious?”
Cash. Not just for pills, injections, drug implants, and surgery but for a whole little lucrative cottage industry of physicians, psychotherapists, and lay counsellors all working out of profit-making clinics selling insurance-subsidized affirmation services uncritically to clients who already know what they want.
The bad old days of psychiatrists telling mentally distressed homosexuals that they were mentally ill because of their “disease” were nothing like this. Well-adjusted homosexuals whose only mental health issue was rational fear of being outed and stigmatized stayed out of the clutches of the shrinks. The trans folk today are clamouring to be sold stuff.
What’s different is that we have “made up” the cultural concept that a newborn baby can be assigned the wrong sex at birth and it is consequently trapped in the wrong body until the body is cosmetically changed. This is every bit a piece of culturally-conditioned mythology as the condition called koro, where a Pacific Islander (sorry, African) becomes convinced that his penis is withdrawing into his body and this will lead to his death. I posted a link to an article expounding on this yesterday. Edit: Comment #18 under “New paper purports to refute social contagion . . .”
One could make the argument that something is not an illness or disability, but it requires treatment if it causes pain or distress. Analogy time: childbirth is a natural process, not an illness, and yet it’s really f**king painful, so epidurals (a form of medication) should be available to those who want them. Similarly, you could simultaneously say “Gender dysphoria is not an illness” and “This trans woman is really distressed at having a penis; she needs gender affirmation surgery.”
The trouble is that “there’s nothing wrong with you” can’t mean the same thing to the trans-identified as it means to gay people. They’re very different situations which have been awkwardly linked together by superficial similarities such as both of them involving gender nonconformity and both of them pissing off the Religious Right.
The existence of same-sex attraction is relatively straightforward and was never controversial. The controversy came in how it was explained (“pathological”) or viewed (“immoral.”) If there’s nothing wrong with being sexually and/or romantically attracted to people of the same sex, then all that need happen is for such people to live their lives with their chosen partners. You’re fine = your body & mind are in harmony. Nobody has to change the way their mind works, love yourself as you are.
The doctrine that has built up around people distressed over their sex, however, is complicated, controversial, and cultural, involving sweeping changes and adjustments in science (“all people are born with a gender identity which may not match their sex assigned at birth;” “sex is a spectrum;”) epistemology (“the only way to know if anyone is a boy/man or girl/woman is to ask them;”” the inner sense of knowing gender cannot be described nor does it contain elements”) and relationships (“someone’s gender is more important than their sex in almost every case;””we have a moral obligation to believe this and work to establish it.”)
So “there’s nothing wrong with you” can mean “you’re trans and society must adjust itself. Since the unenlightened won’t accept your True Self unless you look the part, you understandably feel a burning need to look the part. We can help with hormones & surgery.” You’re fine the way you are = You are your mind & you’re right that your body doesn’t fit your mind. Let’s change the body.
Because if “you’re fine the way you are” means “your body & mind go together so learn to love yourself as is” — that’s transphobic.
With reference to comment #3, there was a school of thought in the 60s that nothing should be regarded as a mental illness. The movement was called “anti-psychiatry” by one of its founders,
Dr. David Cooper, about whom Wiki informs us as follows.
“Cooper believed that madness and psychosis are the manifestation of a disparity between one’s own ‘true’ identity and our social identity (the identity others give us and we internalise). Cooper’s ultimate solution was through revolution. …He coordinated the Congress on the Dialectics of Liberation, held in London at The Roundhouse in Chalk Farm from 15 July to 30 July 1967. Participants included R. D. Laing, Paul Goodman, Allen Ginsberg, Herbert Marcuse and the Black Panthers’ Stokely Carmichael.[4] Jean-Paul Sartre was scheduled to appear but cancelled at the last moment.”
[I suppose Jean-Paul Sartre cancelled because of uncertainty over whether the Congress, or for that matter he himself, actually existed. I am sometimes subject to this ambivalence myself.] I wonder whether our current activists, in their social contagion to normalize and in fact celebrate gender dysphoria, are aware of their antecedents in the anti-psychiatry movement.
Right, and adding the notorious Michel Foucault’s Madness and Civilization: A History of Insanity in the Age of Reason !
I learned about this story from your side. Thank you for the interesting post! I hope that the tide is turning, or at least beginning to.
Yes, really shocking that the Tavistock clinic got away with that nonsense for so long. Dr David Bell also blew the whistle on what was going on but got sidelined. His interview for the Nolan Investigates podcast series is well worth a listen (but skip the annoying banter in the first minute or so): https://www.bbc.co.uk/programmes/p09yk7dh
If Dr Bell is a transphobe then I’m a banana!
(The whole series is excellent, if you have the time.)
Well, perhaps you are a banana inside who was born in the wrong species, I mean kingdom.
Sonia Appleby, a child safeguarding expert, was another Tavistock whistle-blower whose warnings went unheard. This period will be recorded in medical history as a shameful one in which legitimate concerns were ignored because of an ideologically driven agenda.
D’oh, forgot the link: https://www.theguardian.com/society/2021/sep/04/gender-identity-clinic-whistleblower-wins-damages
The medical genesis of this stupidity might be the case of David Reimer under the care of psychiatrist John Money. Due to a failed circumcision and under the theory of supreme gender/sex malleability (because it is socially constructed after all, hence malleable) – sex reassigned at near birth became the experiment – with his twin brother being the control! An extremely sad tale of un-science and the birth of a gender ideology (??).
https://embryo.asu.edu/pages/david-reimer-and-john-money-gender-reassignment-controversy-johnjoan-case
Everything about this subject is shockingly revelatory.
Even as a parent, you might read about this subject, feel empathy for the families involved, but take comfort in the belief that it would not happen to you, because you would never consent to your kid being given unproven drugs and therapies. Besides which, your kid is a normal and happy boy or girl.
It is a revelation when you learn that your consent is not required, nor is there any requirement that you be informed at all. Quite the opposite, really. Most of us recognize that any time an authority figure wants to keep their interactions with someone’s kids a secret, further investigation is warranted.
“Recklessly” is a key word used in the subject article. Normal rules about drug safety, parental consent, any normal safeguards, are just ignored in favor of affirmation.
I visualize the mental side of child rearing as sort of a firmware/software issue. Parents have a mental list of expected dangers that their child would likely face. They update the child’s firmware so that programs like “drug experimentation” or “getting in the white van with the stranger” will not run. I have written before that communism does not work on my kids, because they learned about it not from a teacher with a nose ring, but from a grandfather who spent years as a political prisoner in China.
Anyway, it is hard to shield your kids from threats that you do not anticipate.
I hope that is changing. Parents are surely learning about this, and can teach their child to let them know if a teacher or other adult tries to sell trans ideology to them, in the same way that they know to tell if a teacher pulls down their pants and touches them in a private place.
I applaud any effort to shine a light on the inner workings of the trans/industrial complex. It has grown to the problem it is largely because people generally have no idea what the extent of the danger is, and especially the fact that normal and healthy kids are at risk.
The medical professionals who are complicit in what is essentially needless and destructive interventions against children should be litigated against relentlessly, for the rest of their lives. I personally would be happy with much more severe penalties, but we are civilized people.
Some of the treatments for gender dysphoria are irreversible and life-altering. Even non-surgical interventions can evoke permanent changes. Many of the patients, being minors, have their whole lives ahead of them—lives that can be ruined through haste.
I’m glad that there is still some sanity around this matter. Maybe closure of this clinic will send a message to others. It’s OK to slow down and make dead certain that your patients really do want and need the interventions they are asking for. With a fast-growing cancer, time is of the essence. With gender dysphoria, a little bit of time for reflection and consultation should be part of the medical protocol. Advocates, too, should call for the same if they are true advocates for the people they claim to represent.
And if children and adolescents meet time for exploration, reflection, and consultation with claims that they’d rather die because other people aren’t agreeing with them, one would hope mental health professionals wouldn’t decide that the proper thing to do is give them what they want, and now. Advocating exploration, reflection, and consultation are not signs of having a phobia.
Indeed.
The one thing no one seems to be mentioning in all this is the parallels with Repressed Memory Therapy, a movement that held the ‘one true cure’ for female mental issues was for the person under treatment to accept they had been sexually assaulted by close male relatives.
Families were broken up, people put on trial and all on the basis of ‘evidence’ that was produced though leading questioning.
And it had long term consequences, one of the key planks of RMT was to convince ‘Victims’ that they were in fact ‘Surviors’, ideas that bought forth terrible fruit in the form of the ‘Dear Colleague’ letter.
I actually had been thinking the same thing. Also the Satanic panic in the ’80s.
While England has slowed down, the Biden administration recently asserted that gender affirmation is “trauma-informed care.” California is at the top of the list where state legislators have introduced a bill that would allow any child to come to California to medically transition without parental knowledge or consent.
This ‘trans-madness’ is the greatest gift to the Alt-right in the US one can imagine, especially -but far from solely- in the field of education.
After the SC decision to strike down Roe vs Wade, the Democrats have (had?) a fighting chance to prevent an extreme rightwing take-over of both Houses, which appeared to be on the books before the SC decision.
I hope that this ‘trans-madness’ will not lead to the Democrats snatching defeat from the jaws of victory once again.
I hate to admit it, but in the ‘trans’ context, the despicable De Santis sounds much better than many a Democrat.
Hell, even the deplorable Josh Hawley looked reasonable when he said men can’t get pregnant and the liberal law professor told him that this belief “denied trans people exist” and “opened them up to violence” and suicide.
The inability to come up with a clear definition of “woman” — all the hemming and hawing, the hand waving and introduction of nuance and congenital disorders — is ONLY prompted by a desire to affirm transgender doctrine. Scientists didn’t previously define women by “gender” and cultures never argued that a woman wasn’t a woman if she didn’t conform, they only charged her with being wicked or sick. The Tavistock clinic didn’t start out with the understanding that children who didn’t like being the sex they were weren’t boys & girls, but girls & boys.
By treating the transgender issue as if it makes as strong a case in science, reason, and ethics as gay rights, the Democrats are shooting themselves in the foot. “Why are you aligning with THEM and THEIR GOALS?” they constantly ask liberal critics of Genderism. “Why are YOU?” we can reply.
One of the many odd things about the whole Tavistock Clinic saga is that it was not, and never had been, a centre which dealt with transgender issues.
For adults, there was a referral by local psychiatrist to a London hospital which had the specialist centre for the country, and this might lead to a two year period in which the patient had to live as a member of the sex to which they aspired. Hormone treatment was supervised by the patient’s local hospital. It was only after this period that any surgical intervention would even be considered.
From the start it seem odd that a psychiatric clinic would embark on medical treatment with potentially lifelong effects, and often when the contact period with a child in distress was so short, only a handful of sessions. That is, a much shorter period of assessment & with less follow up than with adults.
The argument against children being able to self diagnose either a psychological or physical condition is based upon their stage of maturity a d comprehension. My 17 yo stepson has decided on 8 professional fields in a year. He sprayed a school bathroom stall with chocolate syrup because it would be funny, but cannot explain how it would be funny. He patiently explained to me how boys were actually girls first, and penises were overgrown clitorises, which was basic biology. He also thinks 16 year olds should have the right to vote. But, he should be able to decide if he should get hormone blockers and radically invasive surgeries.
In “Crazy People” there is a scene about which of the clinic patients would want to be an ad man…or a fire engine. Watch it. It sums up the entire debate, concisely.