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How Tavistock Came Tumbling Down

By Sue Evans | Common Sense | August 4, 2022

I joined the Tavistock Clinic in North London as a clinical nurse therapist in 2003. Back then, Tavistock was prestigious—known all over the world for its professional seminars and specialized psychological treatments for mental-health patients. Before I ever worked there, I would attend lectures and training workshops to hear from renowned psychoanalysts, who were considered some of the best in the field.

A lot can change in a decade.

Last week, the National Health Service ordered that the gender youth clinic at Tavistock to shut its doors by next spring. And I am part of the reason why.

The story of what happened at Tavistock is the story of how a small group of whistleblowers—doctors, nurses, parents and patients, together with the help of journalists and reporters—were able to relentlessly expose activist-driven medicine that they knew was irresponsible. It’s also an object lesson for others who are deeply concerned about a one-size-fit-all approach to transgender healthcare and wonder what they should do about it.

I was delighted when I started working at Tavistock back in the early 2000s. My role as senior clinical lecturer was to devise and deliver training courses for mental-health staff. Shortly after I joined, I took on another part-time role working with children and adolescents in what was called the Gender Identity Development Service.

There were, as I recall, seven of us on the team back then. We would have clinical meetings each week in which we would discuss our referrals and caseloads. Back then we had fewer than 100 referrals per year in the entire country and they were mostly biological boys.

Sometime during my first few weeks we were discussing a newly referred patient, a 16-year-old boy with a complex history, who felt he had been born in the wrong body. My colleague took on the case. Four months later, the boy’s name came up again in the meeting, and my colleague announced that she was recommending him for puberty blockers (gonadotropin-releasing hormone agonists), which are used to suppress the further development of secondary-sex characteristics like breast tissue in females or facial hair in males. Puberty blockers are almost always followed by cross-sex hormones (testosterone or estrogen).

Usually, when new patients arrived at the service, they would come in for an hour or so once a month for the first few months. So I was surprised to hear that my coworker was recommending drugs when, in my view, no meaningful understanding of his internal world could have been reached. I knew from my experience in working with adolescents that any diagnostic assessment arrived at after such a short time span would have been superficial.

It’s worth pointing out that Tavistock specialized in therapy—talking through problems with patients—and that we did not generally prescribe drugs. For that reason, I had expected the same approach when it came to treating children and teens with gender dysphoria. But it seemed that, even back then, certain staff didn’t hesitate to recommend puberty blockers—even for vulnerable kids contending with anxiety, autism, internalized homophobia or other challenges.

I had also noticed that senior clinicians in the service would regularly meet with Mermaids, a transgender patient-advocacy group. At the time, various patient-advocacy groups were springing up alongside mental-health services so that patients would have a voice in the examination room. At first, I viewed all of this as an overdue development. But as time progressed, it seemed clear that groups like Mermaids were exerting influence over doctors and clinicians in the service—sometimes dictating the expectations of care for our patients.

One small anecdote: I was once instructed by a superior to rewrite a letter I’d written to a male patient’s referring doctor—making sure to use the patient’s chosen, female name and new pronouns. I understood the sensitivities around this subject, but I pointed out that using a female name and female pronouns might be confusing to the clinical team, since we had been talking about a male child with gender dysphoria..

I was informed that failure to use the right name and pronouns might result in problems or even litigation for me and the gender clinic at Tavistock.

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 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?”

There were a few colleagues who shared my views. One colleague, Dr. Az Hakeem, would also speak up at team meetings. But for the most part I felt alone, and I felt very anxious about some of the children who had been referred for body-altering medications. I began to feel as though I might be part of something unethical. I tried to take on only children who were legally too young to commence the blockers, which would allow me more time to do long-term therapeutic work while avoiding the dilemma of the fact I worked in a so-called “gateway service” to medicalization.

I spoke a lot to my husband, Marcus, who is a psychoanalyst and who was by now a senior member of staff in the Adult Department of Tavistock. He suggested I go to the clinical director at theTavistock, which I did. She listened and took my concerns seriously. I later learned that she reached out to Dr. David Taylor, the Medical Director of the Trust, who was asked to launch an investigation into the work of the gender clinic. That was issued in 2006.

I do not remember being shown the report then, and don’t recall any in depth discussion about the contents of it or how the recommendations would be implemented. The only change that I remember was that a senior staff member from the more general Adolescent Department began overseeing our work. That oversight petered out when this staff member retired.

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.

I had tried hard to help the Gender Identity Development Service from the inside, but it felt like I was swimming against a stronger and stronger tide. I didn’t want to be part of something that felt wrong, and I knew that each time I spoke up I was being cast in a darker shadow of suspicion by my colleagues.

So in 2007, I quit.

After I left the gender clinic, I continued to work in other departments at Tavistock. I continued my clinical lecturing and practiced psychoanalytic psychotherapy. Life was satisfying and busy, and I tried to put the experience out of my mind.

But it became increasingly impossible to ignore.

In the past decade, there has been an explosion in referral numbers to the gender clinic at the Tavistock—over 3,000 in 2019—and the service came under mounting pressure to get through the long waiting lists. This resulted in even more children getting fast-tracked and put on blockers if they expressed a wish for them.

The profile of the patients changed significantly, too. Many were adolescent girls who had never exhibited signs of gender dysphoria. Often, their feelings of wanting to be a boy developed along with their breasts, or when they got their period. They were horrified by their bodies, and they wanted control over the changes taking place in them.

Between then and now, there were more whistleblowers, like Dr. David Bell, a psychiatrist and psychoanalyst at Tavistock, who issued yet another report on the service in 2018 that raised a lot of the same concerns that I had raised back in 2005.  Sonia Appleby, whose job title was Safeguarding Children Lead, spoke out in November 2019, claiming that she was being blocked from doing her job by management. By then, the political pressure, the institutional capture, and the influence of social media had become much more intense, and about 40 people were working on the youth gender care team. Shortly after Dave’s report came out, my husband Marcus resigned from the Tavistock Board.

His resignation gained national publicity, and Marcus was invited to present at a 2019 House of Lords meeting, which I attended with him. A representative of the Tavistock Trust who was also at the meeting read a statement claiming that no one was being rushed through treatment, that Tavistock was a best-in-class facility. This was my second Damascene moment. I raised my hand to speak. “Look, that is not correct,” I said. “I worked there. And I saw that children were being pushed to transition very quickly.”

After that meeting, a group of us met, and we learned that a mother of a girl with autism and gender dysphoria was seeking support as a claimant in a judicial review of Tavistock’s practice of giving puberty blockers to minors. (Adults who transition are also prescribed blockers prior to starting on cross-sex hormones.) She had contacted a lawyer and he arranged a meeting with several of us who had attended the House of Lords meeting. The mother was worried about her daughter’s referral to the Gender Identity Development Service, as she did not feel that her daughter would be able to fully understand the ramifications of the treatment and give informed consent to it. She needed to remain anonymous and, therefore, needed a co-claimant who could afford to go public. Dave was still at Tavistock and was being threatened by the administration there. My husband had his hands full with his own patients. I did not relish the idea of sticking my neck out, but I knew I had to get back into the ring. By now, the whistleblowers’ reports felt grave. I signed onto the suit.

Almost no one in the U.K. wanted to get involved, so I set about finding expert witnesses in the United States, Australia and Scandinavia. Gradually, we put together statements and evidence to support our claim that children could not give fully informed consent to an experimental treatment with lifelong, as yet unknown consequences. I found, among many others, Kiera Bell through a journalist, and I was immediately taken by her story.

Keira is a young woman who went on puberty blockers at 16, testosterone at 17, and then had a double mastectomy—only to realize, at 21, that she wasn’t, in fact, a man trapped in a woman’s body. She argued that, as a minor, she hadn’t been able to consent in any meaningful way to the treatment. Eventually, she became a co-claimant in the case against Tavistock.

In December 2020, we won. The court ruled that minors under 16 could not give informed consent to having their puberty blocked. The ruling came as a great relief. I thought, Finally, people will have to pay attention and examine the evidence base for treatment of childhood gender dysphoria.

It’s hard to deal with the feeling of being hated. I’m aware how contentious this area is, and while I was only ever trying to do my best for our young patients, there was a loud group of people who would only hear my concerns as transphobia or bigotry or that I was a proponent of conversion therapy. The win felt like such a victory—not just legally, but culturally. It felt like an honest conversation was finally beginning to happen.

But then, in September 2021, we lost on appeal. It was awful—deflating.

The only thing that softened the blow was the fact that the government commissioned yet another report into Tavistock. And the results were devastating. It vindicated everything we had been saying for years.

But this time, the NHS decided they were going to do something about it. On July 28, the NHS announced that Tavistock Gender Identity Development Service would be closed and that, from now on, regional clinics would handle cases of transgender kids. I was blown away. I still can hardly believe it. The aim is that the new services should be more holistic, taking into consideration the whole child, and adopt better clinical standards according to the new report’s findings.

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.

Sue and Marcus Evans run a private psychotherapy practice in London. They are the authors of “Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults,” which you can buy here. 

August 11, 2022 - Posted by aletho | Book Review, Science and Pseudo-Science, Timeless or most popular | Human rights, UK