Author | Hannah Barnes |
---|---|
Audio read by | Hannah Barnes |
Language | English |
Subject | Transgender health care |
Publisher | Swift Press |
Publication date | 23 February 2023 |
Publication place | United Kingdom |
Media type | Hardcover Ebook Audiobook |
Pages | 464 |
ISBN | 9781800751118 |
OCLC | 1356002081 |
Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children is a 2023 nonfiction book by BBC Newsnight investigative journalist Hannah Barnes. The book is about the NHS Gender Identity Development Service (GIDS) based at the Tavistock and Portman NHS Foundation Trust. [1] [2] Barnes said, "I wanted to write a definitive record of what happened [at GIDS] because there needs to be one." [3]
Time to Think received positive reviews from critics, who commended Barnes's journalism.
The book is centred around more than 100 hours of interviews Barnes conducted with close to 60 former clinicians who worked at GIDS. All but two of the interviews were taken before the decision was made to close GIDS.
Time to Think traces the history of GIDS from its foundation in 1989, covering the evolving nature of their services, the usage of puberty blockers, the influence of charities and support groups Mermaids, GIRES (Gender Identity Research and Education Society), and Gendered Intelligence, and the limited collaboration with CAMHS.
It traces various reports made by clinicians raising concerns: the David Taylor review (2005), David Bell report (2018), Dinesh Sinha's GIDS review (2019), Helen Roberts report (2021), and Hilary Cass review (2022).
The history is interspersed with accounts of seven young people who were treated by the service: Ellie (1994), Phoebe (2009), Jack (2011), Alex, Hannah, Jacob, and Harriet.
Domenico Di Ceglie set up the Gender Identity Development Clinic for children and adolescents within the Department of Child Psychiatry at St George's Hospital in September 1989. In 1994 the clinic moved to the Portman Clinic and became part of the Tavistock and Portman NHS Foundation Trust. At the beginning the work was largely therapy-based [ clarification needed ]. Di Ceglie said of the outcomes at the time, around 5% "commit themselves to a change of gender" and 60% to 70% grew up homosexual. [4] : ch. 1 In 2000 there was a retrospective audit led by David Freeman, looking at the records of 124 patients the service had seen since opening. The audit found that a majority of patients did not go on to transition, and that they could not predict which patients would be which. The audit showed it was very rare (2.5% of the sample) for young people referred to GIDS to have no associated problems. 70% had more than 5 "associated features". Common problems were associated with relationships, family, and mood. [4] : ch. 1
Barnes sent the book proposal to 22 publishers. Several publishers praised the proposal, but declined to publish it; one of them on the basis that it was too controversial. On 13 April 2021, the independent publisher Swift Press made Barnes an offer. [5]
Barnes's book has generally received praise. Camilla Cavendish of the Financial Times described it as a "meticulously researched, sensitive and cautionary chronicle" and a "powerful and disturbing book" that reminded them of other NHS scandals. [6] Rachel Cooke, writing in The Observer called her work "scrupulous and fair-minded" and, with regard to GIDS, "far more disturbing than anything I've read before". Cooke says the account is of a "medical scandal" and "isn't a culture war story", concluding: "This is what journalism is for." [7] Paul Cullen, of The Irish Times calls the book "forensic and sombre" and "scrupulously non-judgemental". [8] Cordelia Fine describes the book as an "exhaustively researched account" of "a textbook organizational scandal". Fine notes that Barnes "repeatedly relays clinicians' support for young people's access to a medical pathway [and] offers no grist for prejudice-fuelled mills." Fine explains what she regards as "[s]ocially just medicine" and says "Barnes's book is replete with examples of how far short the gender service fell from this ideal." [9]
Katy Hayes of the Irish Independent called the book "meticulously academic, thoroughly footnoted and referenced", though it is "a dense, clotted read". Hayes notes that interviews were "almost exclusively" with former GIDS employees who "dissented" from the direction the leadership took. Therefore, while "Barnes has her well-argued position, and the questions she raises are legitimate", "the result makes the book feel very one-sided. All the clinicians talk about how they harmed children. There is very little mention of how any clinician might have ever helped anyone." Hayes complains that the "book occasionally slides into innuendo" (such as about funding), which Hayes says is "a pity, because they make Barnes sound biased", and that "the overall tone of the book is so hostile that it is likely to become another weapon in the unfortunately loud and bitter war over this subject." [10]
Will Lloyd of the New Statesman called it "as scrupulous as journalism can be" and noted "[t]hough pundits will use it as fuel for columns, Time to Think is no anti-trans polemic". [11] Hannah Milton of BJGP Life explains that Barnes's approach to writing the book was "very rigorous" and that Barnes "comes across as a compassionate writer" who was objective, "fair and balanced". However, reading the "fastidiously documented" book was "heavy going at times" and ultimately "doesn't give any answers about how a gender service should be run". [12] Suzanne Moore from The Daily Telegraph called it "well-researched" and notes that "Barnes is not coming at this from an ideological viewpoint." [13] Janice Turner of The Times said it was a "sober, rhetoric-free and meticulously researched" account. [14]
Year | Award | Category | Result | Ref |
---|---|---|---|---|
2023 | Orwell Prize | Political Writing | Shortlisted | [15] [16] |
2023 | Baillie Gifford Prize | Shortlisted | [17] [18] |
Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder.
The Standards of Care for the Health of Transgender and Gender Diverse People (SOC) is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social, hormonal, or surgical transition. It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist – especially outside the United States – the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people.
Great Ormond Street Hospital is a children's hospital located in the Bloomsbury area of the London Borough of Camden, and a part of Great Ormond Street Hospital for Children NHS Foundation Trust.
The Tavistock Institute of Human Relations is a British not-for-profit social science organisation, working with challenging issues for the public good: providing practical help for people and organisations to learn, lead, change and innovate, especially in difficult times.
The Tavistock and Portman NHS Foundation Trust is a specialist mental health trust based in north London. The Trust specialises in talking therapies. The education and training department caters for 2,000 students a year from the United Kingdom and abroad. The Trust is based at the Tavistock Centre in Swiss Cottage. The founding organisation was the Tavistock Institute of Medical Psychology founded in 1920 by Hugh Crichton-Miller.
Evelina London Children's Hospital is a specialist NHS hospital in London. It is administratively a part of Guy's and St Thomas' NHS Foundation Trust and provides teaching hospital facilities for London South Bank University and King's College London School of Medicine. Formerly housed at Guy's Hospital in Southwark, it moved to a new building alongside St Thomas' Hospital in Lambeth on 31 October 2005.
Gillick competence is a term originating in England and Wales and is used in medical law to decide whether a child is able to consent to their own medical treatment, without the need for parental permission or knowledge.
Kenneth J. Zucker is an American-Canadian psychologist and sexologist. He was named editor-in-chief of Archives of Sexual Behavior in 2001. He was psychologist-in-chief at Toronto's Centre for Addiction and Mental Health (CAMH) and head of its Gender Identity Service until December 2015. Zucker is a professor in the departments of psychiatry and psychology at the University of Toronto.
Puberty blockers are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens and estrogens. Puberty blockers are used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity. The same drugs are also used to treat other conditions, such as precocious puberty in young children and some hormone-sensitive cancers in adults.
Psychoanalytic infant observation is a distinct empirical case study method in psychoanalytic and psychotherapy training which was developed at the Tavistock Clinic in London by child psychoanalyst Esther Bick. In 1948 she collaborated with John Bowlby to develop the approach as part of psychotherapy training. It has since become an essential feature of pre-clinical training in child and adult psychotherapy, psychoanalysis and related fields throughout the Western world.
Hilary Dawn Cass is a British paediatrician known as chair of the British Academy of Childhood Disability, for establishing the Rett Clinic for children with the Rett syndrome neurodevelopmental disorder, for developing palliative care for children, as well as for leading the Cass Review completed in 2024. In the 2024 Dissolution Honours, Cass was nominated for a life peerage as a crossbencher.
Transgender rights in the United Kingdom have varied significantly over time, with transgender Britons facing many issues not experienced by non-trans individuals. These include various laws and public attitudes in regards to identity documents, as well as anti-discrimination measures used by or pertaining to transgender people, in the areas of employment, education, housing and social services, amongst others.
Mermaids is a British charity and advocacy organisation that supports gender variant and transgender youth. It also provides inclusion and diversity training. Mermaids was founded in 1995 by a group of parents of gender nonconforming children and became a charitable incorporated organisation in 2015.
A gender identity clinic is a type of specialist clinic providing services relating to transgender health care.
The Gender Identity Development Service (GIDS) was a nationally operated health clinic in the United Kingdom that specialised in working with children with gender identity issues, including gender dysphoria.The service closed on 28 March 2024 after serious concerns were repeatedly raised over a number of years by several independent NHS whistleblowers.
Laverne Antrobus is a British child psychologist. She trained at the Tavistock and Portman NHS Foundation Trust in the 1990s. Throughout the 2000s and 2010s, Antrobus has hosted documentaries and appeared as an expert on the BBC and Channel 5.
Bell v Tavistock was a case before the Court of Appeal on the question of whether puberty blockers could be prescribed to under-16s with gender dysphoria. The Court of Appeal said that "it was for clinicians rather than the court to decide on competence" to consent to receive puberty blockers.
Current research indicates that autistic people have higher rates of LGBT identities and feelings than the general population. A variety of explanations for this have been proposed, such as prenatal hormonal exposure, which has been linked with sexual orientation, gender dysphoria and autism. Alternatively, autistic people may be less reliant on social norms and thus are more open about their orientation or gender identity. A narrative review published in 2016 stated that while various hypotheses have been proposed for an association between autism and gender dysphoria, they lack strong evidence.
Genspect is an international group founded in June 2021 by psychotherapist Stella O'Malley that has been described as gender-critical. Genspect opposes gender-affirming care, as well as social and medical transition for transgender people. Genspect opposes allowing transgender people under 25 years old to transition, and opposes laws that would ban conversion therapy on the basis of gender identity. Genspect also endorses the unproven concept of rapid-onset gender dysphoria (ROGD), which proposes a subclass of gender dysphoria caused by peer influence and social contagion. ROGD has been rejected by major medical organisations due to its lack of evidence and likelihood to cause harm by stigmatizing gender-affirming care.
The Independent Review of Gender Identity Services for Children and Young People was commissioned in 2020 by NHS England and NHS Improvement and led by Hilary Cass, a retired consultant paediatrician and the former president of the Royal College of Paediatrics and Child Health. It dealt with gender services for children and young people, including those with gender dysphoria and those identifying as transgender.