Therapists and doctors from the UK: where Tavistock failed

September 3, 2022 • 11:30 am

Here’s a group of physicians and therapists writing in the British Medical Journal about the recent dismantling of London’s Tavistock Gender Identity Service (GIDS). infamous for its pervasive emphasis on “affirmative care” . In practice, such care meant rushing teens (or younger kids) with gender dysphoria into accepting that they’re really members of the other sex and then treating them with puberty blockers, hormones, and surgery so they can transition.  But in some cases straight -up affirmation and subsequent action isn’t the best course, as gender dysphoria might be due to, say, feelings of homosexuality rather than transsexuality.  Or depression. (The controversy over affirmative care involves children, adolescents, and teens; it’s not generally directed at adults capable of making their own considered decisions.

A report on Tavistock’s behavior by Dr. Hilary Cass showed how dysfunctional this treatment was, and ultimately led to Tavistock’s function being farmed out to other clinics. Not only that, but “affirmative care” is to be replaced with “thoughtful and empathic care” (my words): a kind of therapy that first picks apart and analyzes gender dysphoria, and avoids an immediate headlong rush into hormones and surgery. Much of Europe is now going this way, especially in light of the absence of long-term data on the effect of puberty blockers.

As the letter below letter indicates, Tavistock is now about to face a bunch of lawsuits from those who regret the transition through which they were rushed. In fact, as The Independent reports, the lawsuits have already begun. Let this be a lesson to American clinicians, who are still far more willing than their European counterparts to embrace “affirmative care.”  Wrecking people’s lives might not bother these doctors and therapists so much, but in America money (aka the lawsuit) talks.

From The Independent:

The clinic, which is being shut down by NHS England, was criticised by an independent review for the quality of care and services provided to patients, who were predominantly young teenagers expressing an interest in gender transitioning.

Staff, patients and parents have raised concerns that young people using the service were put on the pathway to transitioning too early and before they had been properly assessed.

It is alleged children were “rushed into taking life-altering puberty blockers without adequate consideration or proper diagnosis”, with staff under pressure to adopt an “unquestioning affirmative approach”.

Mass legal action is now being pursued by lawyers against the clinic, named the Gender and Identity Development Service (GIDS), which has treated 19,000 children with gender dysphoria since 1989.

Lawyers at Pogust Goodhead have accused the clinic at the Tavistock and Portman NHS Trust of “failures in their duty of care towards young children and adolescents”.

Head of product liability, Lisa Lunt, said: “While the provision of gender dysphoria treatment for children and young adolescents, where appropriate, is an important service, many have been let down by Tavistock and Portman NHS trust.

“We support the findings of the Cass Review, Interim Report and believe there has been a real level of harm that has been perpetrated towards patients who were rushed into taking life-altering puberty blockers without adequate consideration or proper diagnosis.”

Click the screenshot to read; I’ll put the meat of the letter below:

The origin of poor governance and lack of data collection needs to be openly addressed as GIDS is not unique. Globally, there are significant difficulties in discussing, let alone challenging, the practice of gender clinics, due to the belief systems of those who adhere to gender identity theory – a non-clinical ideological perspective for which there is little to no empirical support. This position requires clinicians to believe that everyone has an innate, subjective gender identity and that individuals whose bodies do not match this should be provided with ‘gender-affirming’ medical interventions regardless of the harms and lack of evidence of benefit (6,7,8). However, a child or adolescent’s sense of gender is part of a complex inner sense of self that can change during the process of development. Medicalising young people on the basis of unsubstantiated theory is unethical: there are many reasons why they might feel dysphoria, disgust, dissociated or ‘cut off’ from their physical bodies, including internalised homophobia, histories of trauma, cognitive difficulties and mental health problems. Each person suffering from such distress requires space and time to understand their feelings.

Offering puberty blockers, cross-sex hormones and radical surgery with the implicit promise of almost magical transformation may cause, and has caused, serious harms. With inadequate follow up by GIDS, no comprehensive long-term observational studies, and no reliable clinical trial data, there is simply no evidence on which to base these interventions (2,6,7,8). It is unsurprising that ‘detransitioners’ (disillusioned people who wish to reverse the effects of ‘treatments’) are coming forward; some may want legal redress and plaintiffs’ firms are seeking them out (9). Without outcome information – let alone understanding how any pre-pubertal child could make a decision to alienate adult functions they cannot understand (like sexual pleasure) – patients and their parents were never in a position to give properly informed consent to uncontrolled experimental interventions (6) clinicians failed to properly describe. These initial cases may herald more as increasing numbers of patients, parents and clinicians question the so-called ‘affirmative model’.

We would advise that the NHS proactively set up clinical services to support detransitioners, and that the NHS Litigation Authority and Medical Defence Organisations prepare. The government should look closely at materials provided by advocacy groups (such as Stonewall, Mermaids, Gendered Intelligence, and others) that teach children and clinicians (e.g. GPs, nurses, medical students and mental health professionals) gender identity theory as if it is fact, without referencing the concerns and uncertainties in the evidence. Until this is addressed young people will be at increased risk of misinterpreting their complex difficulties as proof they are ‘trans’ and believing there are simple and medical solutions to their distress.

In the future, people will look back at this time and see the treatment of dysphoric youth as not only irrational, but harmful. I still don’t understand why it happened, except that it may have helped people enter a “marginlized” group. Yes, young people themselves have been pushed by their peers to become transsexual (that’s not the only reason, of course), and social media has helped. But adults are supposed to be smarter than this.

h/t: Jez

18 thoughts on “Therapists and doctors from the UK: where Tavistock failed

  1. And yet, uber-woke Canada seems to have passed a law requiring that any doctor or therapist must immediately affirm the self-declared “gender identity” of any teenager, since anything else would amount to “conversion therapy”.

  2. @Coel yes we’re blundering ahead here and pretending not to notice the Tavistock disaster. The federal government has set aside $100M to hire blue-haired gender consultants over the next five years. They will “Embed 2SLGBTQI+ issues in the work of the Government of Canada.” Step one was to rearrange the rainbow alphabet and put the dubious Indigenous “two-spirit” identity up front.

    Whenever you look under the hood, these things always turn out to be make-work projects masquerading as social progress (cf. the Scarborough Charter).

  3. However, a child or adolescent’s sense of gender is part of a complex inner sense of self that can change during the process of development.

    The problem starts at the very top, in the basic premises. Gender Identity Theory rests on the significance of a “sense of gender” which never seems to be clearly defined and can itself change during the process of concept development.

    The usual way to talk about a “gender” different than sex is to equate it with the social constructs of masculine and feminine. But that would mean that girls with traits considered “masculine” (logical, assertive, a preference for blue) and boys with traits considered “feminine” (emotional, nurturing, a preference for pink) can justifiably consider themselves something other than a “real” girl or boy. This obviously just entrenches sexism — yet proponents of Gender Identity Theory claim that it liberates people from sexism. So they reject that meaning as “incomplete.”

    What, then? If “gender” is divorced from both sex and gender-stereotypes, it now bears an an uncanny resemblance to liberal definitions of God: indescribable, without attributes, subjectively experienced, and understood only through the via negativa — we cannot say what it is, only what it is not. Gender is not sex or stereotypes about sex. It’s another thing.

    It’s apparently a vague but incisive Knowingness which defines who you are which is like sex, but not that. And on this basis we allow children to lead the adults into permanently altering their bodies. The major problem at the top doesn’t resolve itself down the pipeline.

    1. Yoh Sastra, you formulate it so well.
      I was just gonna say ‘affirmative care’ is a monster that will be regarded by our successors as just a horrible aberration, but you worked it out in more detail.

      On a side note, I’m completely at a loss why blue is for boys and pink for girls. It appears a American anomaly to me. In Chinese tradition red is male, and blue female. And in Brussels St Pieter’s Hospital aka Hôpital St Pierre (where I worked in a previous life, a Hospital with -at the time- the largest emergency department in Europe) the girls had blue files and the boys pink ones.

    2. Great comment!
      I’ve been thinking of “gender” not quite as God, but as the postmodern post-Freudian soul: we are all born with one, it is vague and indescribeable yet also the most sacred part of us, no one is allowed to question it, it is separate and apart yet also somehow above and more important than our corporeal bodies, it fluctuates constantly depending upon our moods or circumstances yet we all have a True One that is the real eternal source and manifestation of our identity, and it also serves as a moral claim and a truth claim, as in ‘It must be true, I feel it in my soul/gender’….”
      It is all very gnostic and very Platonic.

    3. Yes!
      And to the “reasons why they might feel dysphoria” listed in the paper, I’d add social media-transported ideas of beauty plus the ever more silly sex stereotypes that children get bombarded with from earliest infancy. In Germany, if you want to buy school supplies for children, a product range that used to have nothing at all to do with sex or gender when I was a child, you now have to choose between stuff decorated in pink with princesses and unicorns or in blue with pirates, excavators or medieval dragon slayers.

  4. You’ve nailed it, Sastra. The “vague but incisive Knowingness” of gender identity theory is analogous to the Faith of religions. Come to think, the rest of Progressive
    “theory” is much the same. No wonder its communicants work to impose their entire theology on everyone, via theocratic measures like DEI fealty statements

    1. Canada has also committed “to promote and continue strengthening the rights of 2SLGBTQI+ communities in Canada and abroad.” Watch your back, Scandinavian terfs.

  5. Sastra’s comment above really nails it, and underscores the importance of well-defined terms and pushing back when ideologues attempt to co-opt or redefine language. If gender theorists refuse to define gender in any quantifiable way that does not rest on subjective feelings, then they should not expect to be taken seriously. So tragic to think about how many young kids are making life altering decisions based on feelings that may have nothing to do with gender dysphoria.

  6. It’s good that “gender affirmative” care is being revisited and phased out in favor of “let’s take some time to think this all over and decide if it’s really where I want to go” care. It’s unfortunate that lawsuits are part of the mix, but such suits will have the effect of ending this reckless practice more quickly—there’s nothing like legal action to focus a medical administrator’s attention. It will be interesting to hear what comes of these lawsuits. It’ll be hard to disentangle whether the providers inappropriately pushed patients into unwanted procedures or whether they were simply complying with patient wishes.

    1. That’s an interesting essay.

      The “Definitional Expansion Hypothesis” points out that the same conceptual fuzziness found in the usage of the term “gender” also applies to “transgender” — which now includes cross-dressers and the Gender Nonconforming

      All these institutions are saying the same thing: if your expression or behavior is different from what is “typically associated” with your sex based on “traditional expectations,” you are transgender. This is literally equating common gender nonconformity (i.e. masculine females, feminine males, and androgynous people of either sex) with transgenderism.

      You don’t even need Social Contagion to explain the rise in trans-identification if 10 year olds are convinced that any deviance from GI Joe and Barbie means they’re transgender. And in need of “gender-affirming care.”

      That definition creep might also explain some of the hostility towards people who are skeptical about elements of modern transgender doctrine, since by definition such critics are now considered skeptical of anyone and everyone who doesn’t conform to what a religious conservative might expect.

  7. We see brave “terfs” standing up not just for themselves, but for all natal females. To be honest, I’d like to see gay men get a bit more involved in pointing out imaginary nonsense when they see it. Some say they are getting too comfortable with their respectability, their legalised marriage and wide societal acceptance. Some self-declared authority (was it the SPLC or the ACLU?) took male homosexuality off their list of marginalised groups as they were claimed to face no oppression any more. And yet they have a real interest in seeing youngsters who will grow up to be gay be allowed to do so, instead of being told they must take hormones and have their genitals mutilated so they can be wonderful rainbow-coloured unicorns instead of boring gays. I know the boys are outnumbered by the unfortunate girls who enjoy being love-bombed when they declare themselves non-binary, but all the same….society will be a bit less interesting one day when we can turn to each other and ask ‘Do you remember when we had gays?’
    The vast majority of us are not taken in by this silliness, and only keep quiet for fear of being labelled. Talking of which, a laughable article in the National Post a few days ago pointed out that 85% of Canadians do not add their pronouns to e-mails, and that this means they need more guidance from academics and policymakers! Link:
    I believe the policymakers need more guidance from the public in this case!

  8. I’ve worked with kids for decades. I was a kid who didn’t fit the traditional role model and I went through a lot because of that, so I do empathize with these young people. But my perspective has always that boys and girls can feel, think, and behave independentaly of sexual steryotypes and stupid role models while still being boys and girls. A lot of educators, parents, and others took this position during the ’70s and ’80s, but it fell by the wayside during the Reagan years – one of many lousy things that happened then. I am heartened to hear about how many in Europe are questioning the current ideology, maybe we can get back to some kind of humane sanity in the way we relate to kiddos..

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