The National Health Service (NHS) has announced an “independent review” of the Gender Identity Development Services (GIDS) for children and young people at the Tavistock and Portman NHS Foundation Trust. Hilary Cass, OBE, former president of the Royal College of Paediatrics and Child Health, has been appointed as chair. The announcement was ushered in with supportive quotes from: Professor Helen Stokes-Lampard, Chair of the Royal College of General Practitioners; Dr Michael Brady, the Government’s National Adviser for LGBT Health. Separately, the Care Quality Commission (CQC) (the alleged independent regulator of health and social care in England) will carry out an inspection of the GIDS in the autumn working closely with the Cass professionals. Those of us who have been aware of deep problems at the heart of the GIDS initially breathed a sigh of relief at the promise of an ideology-free and politically independent review. However, before the review has even been carried out, I argue its independence is already severely compromised.
The GIDS has taken a specific affirmative approach to children’s self-declared gender that is broadly in line with the concept of “gender identity” derived from queer theory and espoused by trans lobby groups such as Stonewall, Mermaids and Gendered Intelligence. Dr Bernadette Wren, the recently retired clinical psychologist lead at the GIDS, and Dr Polly Carmichael, its current Director, have helped sculpt a model which affirms a boy or girl’s internal conviction of having been “born in the wrong body”. This model is now hegemonic and replaces a more traditional psycho-social analysis of gender dysphoria. This latter seeks the causes of the child’s body dysphoria, or his or her wish to identify with the opposite sex. Affirming gender identity is championed by the GIDS as well as by lobby groups as a victory for social justice, for gender diversity, and for children’s freedom from oppressive gender norms. Adopting a psycho-social approach to gender identity is now branded as transphobic conversion therapy, equivalent to gay conversion therapy.
In 2015 a memorandum of understanding forbidding trans conversion therapy was drawn up by a small group of trans activist psychologists and ratified in 2017 by the board of the UK Council for Psychotherapists (UKCP). The vast majority of UKCP members had no input into that decision and many remain unaware of it to this day. The Royal College of General Practitioners (RCGP), of which the GIDS reviewer Helen Stokes-Lampard is the Chair, is a signatory to the memorandum. The RCGP states: “Conversion Therapy is…therapy that assumes certain sexual orientations or gender identities are inferior to others and seeks to change or suppress them on that basis […]” Anyone accessing therapeutic help should be able to do so without fear of judgement or the threat of being pressured to change a fundamental aspect of who they are. Stokes-Lampard declares her personal commitment to the memorandum and her allegiance to its social justice model: “Being…trans is not a disease, it is not a mental illness and it doesn’t need a cure. Any proclamations to the contrary risk causing harm to our … trans patients’ physical and mental health and wellbeing, as well as perpetuating discrimination in society.” In contrast, many GIDS clinicians are critical of the affirmative approach and have contrary but equally impassioned social justice concerns. Dissent and conflict between clinicians about the affirmation approach are central to the demise in which the GIDS finds itself, with some clinicians resigning, an issue which the print media, in particular the Times, has increasingly exposed. Young children given puberty blockers nearly all go on to cross-sex hormones and this practice is the start of a pathway, not a pause to take stock, which leads to infertility, reduced sexual function, and, for young women, mastectomies, hysterectomies and oophorectomies (removal of the ovaries).
Keira Bell, a 23-year-old woman, is currently taking legal action against the GIDS. She relays the emotional and psychological problems she suffered as a child, including a traumatic childhood, and says she should have been challenged more by medical staff over her decision to transition to a male as a teenager. She was given puberty blockers without adequate assessment or psychological work and, even though she fiercely fought for medical intervention, in reality, she claims she was too immature to give consent to medical intervention.
A number of young women are now detransitioning and have set up an organisation The Detransition Advocacy Network to “support those who desist from gender transition, and to lobby institutions for the de-stigmatisation of detransition and expansion of detransitioners' healthcare and legal options.” It was launched in Manchester in 2019 where a panel of detransitioners argued the clinical injunction to affirm rather than question gender identity is equivalent to being compelled to affirm an anorexic child who sincerely believes she is grossly fat. Moreover, affirmation can be a form of gay conversion therapy, with young lesbians led to believe they are male in a female body rather than young women who are same-sex attracted.
Dr Anna Hutchinson and Dr Melissa Midgen have years of experience working at the ‘coal-face’ of the GIDS. They argue that children presenting in ever greater numbers at the GIDS, the majority of whom are girls, suffer from a constellation of psychological, familial and social problems such as child sexual abuse, bullying, low self-esteem, rigid stereotypes of femininity, shame about being same-sex attracted and autism. The conflation of gay conversion therapy with an alleged attempt to convert “transchildren” is utterly simplistic and confuses sexuality with gender. Children currently somatise distress about their sexed bodies through the queer narrative it is possible to be ‘assigned’ the wrong sex at birth. Truth claim to “authentic” trans identity saturates the social media that young people imbibe where adopting a trans identity has a certain cultural cache. Simplistically understanding “transgender” as a real, empirically verifiable condition and interpreting the young person’s distress as the consequence of social stigma can be tantamount to further abuse by clinicians, as Keira Bell and other de-transitioners powerfully argue.
Kirsty Entwistle, an ex-GIDS clinician has dared to speak out publicly, lambasting Carmichael’s management of the GIDS, pointing to accusations of transphobia and charges of conversion therapy if a clinician questions a child’s self-diagnosis. She also writes about the GIDS unethical association with the trans lobby group Mermaids. Susie Green, the CEO of Mermaids, took her 16-year-old son to have his genitals surgically removed in Thailand when he identified as a girl. She has been a vociferous and influential campaigner ever since that “gender identity” is inborn, even though she has no medical or other qualifications to back this assertion. Green argues that the GIDS woefully lags behind the USA where speedier services and even earlier medical intervention abounds for “transchildren.” She asserts that that “the whole process at the GIDS loses the voice of the young people and that they need more autonomy”. Mermaids has had a disproportionate effect on the political landscape, providing workshops for organisations such as the police about the range of gender identities: There is a spectrum ranging from GI Joe and Barbie at furthest ends. Mermaids thus regurgitates, in the guise of gender fluidity and gender authenticity, a succession of norms and stereotypes.
A documentary by BBC Newsnight exposes that staff concerns about children’s welfare are shut down when clinicians insist that some are referred onto a gender transitioning pathway too quickly. They reported worries that Sarah Davidson, a member of the GIDS leadership team who is an adherent of queer theory and enthusiastic advocate for the work of the children’s trans affirmative lobby group Gendered Intelligence, would sometimes refer children for treatment after only one or two appointments. They insisted: "Absolutely it should never happen because this is a pathway that will lead to huge, huge changes for this young person, potentially, infertility." The checks and balances put in place in any institution to regulate a system ‘gone rogue’ have not been functioning at the GIDS, indeed they have taken on a certain pathology and macabre irony all of their own. In a turn of events worthy of a soap opera, Sonia Appleby, the named professional for safeguarding children and the Safeguarding Children Lead at the Tavistock is also whistleblowing, claiming that the GIDS has misused its own procedures to besmirch her for taking whistle-blowing clinicians’ concerns seriously. She claims there has been an unwritten but mandated directive from GIDS Director Carmichael and the management team to prevent clinicians’ safeguarding concerns from now coming to her attention!
This contextual background brings me back to the fulsome assurance that the review of the GIDS, made necessary by the mounting criticism of the affirmative approach, will be independent.
In a mind-bending twist with regard to alleged neutrality, the CQC is a subscriber of Stonewall’s diversity scheme (as are most government departments). Stonewall’s affirmative stance insists that men who identify as women (even if only through the perfunctory act of cross-dressing) ARE women if they say they are, and that women who find this objectionable should just “get over it.” In the past five years, Stonewall has championed changes to the law in two main areas: The abolition of single sex exemptions in the Equality Act 2010; Reform of the Gender Recognition Act (GRA) 2004 to allow men, through a simple bureaucratic process, to be recorded on their birth certificates as female thus giving men legal entitlement to enter all single-sex spaces and areas of life designated for women. A grassroots movement of resistance sprang up where women have been the David to the mighty Stonewall Goliath. In fighting to retain women’s sex-based rights (and suffering utter vilification for doing so, including by Stonewall) the government has performed a U-turn and will not reform the GRA.
The CQC has tied itself to a social justice model of self-identified gender as defined by Stonewall, despite the latter’s partisan view of human rights. Indeed the Commission boasts that it is recognised by Stonewall for its commitment to trans equality: “We are pleased to have progressed and been named in Stonewall's top 100. This outcome reflects a sustained programme of work and continued activity around the LGBT agenda by our network and senior leadership within the Commission.” By choosing Brady as a spokesman in their announcement of the review, and showcasing his views, the NHS reveals its own bias. Brady’s hope that the welfare of children will be placed at the heart of the review is uncontroversial and laudable. However, his model of child welfare requires analysis. Welfare includes not only those children “experiencing gender dysphoria” but also those children who are “trans or non-binary”. He thus accepts the assertions of lobby groups that “trans” is an empirically objective condition outside of social context rather than, as an independent reviewer, interrogating the concept of “the trans or non-binary” child for the grounds of its veracity.
Brady’s views are in line with the very ideological approach and social justice politics that has brought the GIDS to its current demise. He can be found at twitter @drmbrady confirming his gender self-identity as male by informing his personal pronouns are “he/ him”. A quick perusal of his twitter feed reveals a commitment to the trans affirmation model.
A few examples will suffice. Brady allies himself with Mermaids as a reasonable, moderate and balanced organisation:
He advises children to seek support from Mermaids:
He assures members of the trans community that he understands their plight, sending hearts to let them know he stands with them in their oppression, providing links for individuals needing support to Mermaids, Gendered Intelligence and other trans affirmative organisations including the private clinic of suspended Helen Webberley @GenderGP:
In conclusion, the CQC has not only effectively become an executive arm of Stonewall, oblivious to its own institutional capture, the two spokespeople chosen by the NHS both share, to a greater or lesser extent, the very concepts, ideological commitments and social justice values of the GIDS model of care that has instigated the need for a review in the first place. The claim to neutrality can only be maintained if the Cass review actively includes professional in-put from the growing number of doctors severely troubled by the affirmative model: the unverifiable truth claims about gender identity based on queer theory; the conflation of conversion therapy with in-depth exploration of the child’s psychological condition; the physical harms of medical intervention which can turn children and young people into medical patients for life.
Committed women and men will continue to argue that “transitioning” children is an appalling moral dereliction of our adult duty of care and protection. Sooner or later society will not countenance the sterilisation of children and young people under a rainbow flag of “social progress.” I predict the affirmation model of the GIDS will eventually be abandoned and the Mermaids Empire dismantled brick by brick. I suspect those who have ever supported it will slink away, as with other previous national scandals of child harm, hoping no-one will ever remember their association with it. For the sake of our children and grandchildren, let’s hope so.