Hannah Barnes’ detailed investigation of what went wrong at the Tavistock Clinic in London under the auspices of the Gender Identity Development Service (GIDS) was a frustrating read. This was not only because of subject material which is, in places, stomach churning, but also because of the author’s approach. Barnes, a BBC journalist, tries to remain impartial in the face of a mountain of facts that she uncovered regarding the wholesale gender transitioning of children at the hands of those in GIDS. The details of what took place at the Tavistock clinic are evidence of medical malpractice on a massive scale, yet Barnes refuses to describe it in those terms.
Barnes bases her neutrality on the view that there is no evidence that practitioners at the Tavistock clinic intended to inflict harm on the children who passed through their doors. Outside of the book, she argued in her interview on Triggernometry that we still “do not know the scale” of the scandal. One child was surely enough, but thousands must provide all the scale needed. Moreover Barnes’ neutrality, which she proclaims with her BBC hat on, would be more convincing if the BBC had displayed a semblance of balance over the reporting of events related to COVID-19.
Barnes’ insistence on using the preferred pronouns of transgender interviewees, even when referring to them pre-transition, is both infuriating and confusing. The investigative chapters have some case study chapters interspersed and, without wishing to make light of her problems by referring to her sex, by the time I read the story of how ‘Jack’ (referred to as ‘he’ by Barnes) had transitioned to a male identity, had tried lesbianism and had also known a few men (she only had ‘top surgery,’ so her vagina was intact), but was identifying as a gay man, I was completely confused about with whom she was sleeping and what sex ‘Jack’ was.
Nevertheless, Time to Think is a meticulous piece of investigative journalism and, perhaps, Barnes could not have conducted the interviews and fact checking had she begun with the view that what was happening in GIDS was an abomination. She is not alone: many consider gender to be only loosely related to biological sex. At some points, the meticulous nature of the work is almost too detailed, written in a who-did-what-and-when format. The time frame of events is confusing in places, and somewhat repetitive. Nevertheless, hardly a chapter passes without some shocking revelation about how GIDS developed and was managed. There was no shortage of management of the clinic, with regular meetings but precious little clinical supervision or opportunities to discuss cases and clinical practice in detail. Few will read Time to Think without realising that something went badly wrong at the Tavistock clinic.
Barnes traces the origins of the clinic geographically, theoretically, and in terms of the key figures involved. The founder was an Italian, Domenico Di Ceglie, who seems a sympathetic character. He appears to have set out with the intention of exploring gender dysphoria in children. At the outset, very few children appeared to suffer, and the intention was to help get to the root of what was causing this. Sessions took place over a very long time during which puberty sometimes occurred and, being a well-known cure for gender dysphoria, the problem often dissipated. However, for a minority it persisted. Only in extreme cases did Di Ceglie recommend the pharmacological intervention that could eventually lead to horrific surgical realignment.
Thus the thin edge of a wedge was created. Early on, Di Ceglie was challenged about this potential by someone who asked if in creating the service he was creating the problem. These words proved to be a doom-laden prophecy. At the last count, over 9000 children may have been seen at the Tavistock clinic since its inception and over 1000 may have been prescribed puberty blockers. These figures are only estimated as, it transpires, accurate records were not kept or are deliberately being withheld, freedom of information requests notwithstanding.
What is certain is that, with the hammer of puberty blockers to hand, every problem presenting at the Tavistock was considered a nail. Thus, a remarkable array of mental health problems—including autism, depression, suicidal ideation, and one case of what sounds like schizophrenia—was treated with puberty blockers. Most children presenting came from disturbed backgrounds involving drug, alcohol, and physical abuse, often involving parents; many had been through their own traumas with drugs and alcohol, sex, and homelessness. Often, they ended up on puberty blockers, moving the children off the analytical couch and on to the next stage as the front line of (mainly junior) psychologists became overwhelmed.
In 2015, when an external consultant was hired to look at problems in the Tavistock clinic, it was discovered that staff considered their workloads to be unsustainable. This led to the hiring of more staff, which merely enabled GIDS to continue recommending even more puberty blockers and putting more young people on the road to transitioning.
While staff had been raising concerns in the mid-2010s, nothing prepared them for what was uncovered in 2019, demonstrating either that they had a remarkable lack of curiosity for what was going on under their noses and little interest in whether it was effective, or that the data were being deliberately withheld. Barnes does not commit herself to a conclusion. A study had been conducted about five years earlier involving 144 children—one as young as eight years old—who were studied over the course of their time on puberty blockers. Only approximately 50 remained in the study but staff were dismayed to find out that being prescribed puberty blockers had not led to any improvement in the problems with which they presented at the clinic. It was then uncovered that following being prescribed puberty blockers—considered a reversible treatment—all of the children remaining in the study had eventually been prescribed cross-sex hormones, which are irreversible.
The extent of research malpractice is staggering. Those responsible for these studies said that causality based on the effect of puberty blocking drugs could not be established: however, they ensured this conclusion by including no control groups. It defies belief as to how the study was approved by a research ethics committee, but it was. The GIDS researchers ‘shopped around’ ethics committees in London until one approved it. Thankfully, that practice has since been stopped.
The initial outcome of revelations about poor practice in the mid-2010s was that nothing had changed; it was, essentially, business as usual at the Tavistock clinic. However, it became apparent that some children were gay and were seeking to transition due to homophobia. There was also increasing pressure to prescribe puberty blockers from Mermaids, an organisation purporting to help ‘gender diverse’ children. This pressure was influencing clinical decisions with one person associated with GIDS declaring, “We were answering to Mermaids.”
In 2017, Dr. David Bell conducted an investigation into GIDS and was “shocked” at what he found. His investigation largely confirmed what has been revealed above, but also pointed to a ‘climate of fear’ among staff who felt unable to challenge what was happening. He was asked not to publish his 54-page report and he became very unpopular at Tavistock. Possibly, this was because he had shown that the clinic was largely dependent on the funding generated by GIDS. It seems that the old adage to ‘follow the money’ may have proved itself once more. Remarkably, even in the face of the manifest problems in GIDS, the response at the Tavistock clinic was a desire to expand the service.
In 2019, due to increasing public and political unease, Tavistock and GIDS staff were questioned in the House of Lords. Revelations about their work there began to appear in the mainstream media and, thereby, to reach the attention of the wider world. This point in Barnes’s narration occurs less than halfway through a book that also includes over 60 pages of notes. To a large extent, the rest is history and is in the public domain. Ordered to close the GIDS service in 2023, the Tavistock clinic has managed to push the deadline back to spring 2024. The service it provides will not cease; instead this will be devolved and scattered across the NHS. Elsewhere, I have described this as a ‘cluster bomb.’ It will actually become harder to identify and monitor these kinds of services. As a result, I fear that the main features of work at the Tavistock clinic will continue, and nothing will change.
Time to Think is, therefore, undoubtedly the most detailed record to date of what took place at the GIDS under the auspices of the Tavistock Clinic. The evidence includes documents in the public domain and interviews with former staff and former patients. Thus, the bare facts are presented in the light of some harrowing personal experiences. That such a situation as the one at the Tavistock Clinic arose is almost beyond belief. This book clearly illustrates that it did and how it happened. As such, for anyone interested in the issues, it is an essential read.
