Fellow British Psychoanalytical Society. Author: Making Room for Madness & Psychoanalytic Thinking in M.H. Settings & Gender Dysphoria: A Therapeutic Approach.
MOURNING THE LOSS OF THE IDEAL SELF: SHORT‐TERM WORK WITH A TRANS PATIENT POST‐TRANSITION - Evans - British Journal of Psychotherapy - Wiley Online Library
Sad day. But
@sueevansprotect
& I always knew this day would come as legal action for damages would be the inevitable consequence of an experimental treatment that lacks an evidence base. Tavistock gender clinic ‘to be sued by 1,000 families’
Journalists interviewing me after my resignation in Feb 2019, often asked why I was the only clinician who would go on record questioned what was going on? Only a few others would speak, all anonymously, until Kirsty Entwistle
@thetimes
@hannahsbee
I resigned as a governor at the
@TaviAndPort
when I realised that serious clinical thought about GIDs was experienced as a threat rather than essential tenant of good clinical practice.
@Hilary_Cass
in her report comments on the closing down of clinical discussion.
Thanks
@HJoyceGender
it’s been disturbing to witness the extent to which, groups & institutions have turned a blind eye to uncomfortable facts. Choosing to ‘shoot the messenger rather than take clinical concerns about an experimental treatment on vulnerable children seriously.
WELL DONE
@KLBfax
,
@cwknews
,
@sueevansprotect
and
@marcuse99903226
- more than anyone, you made this happen. Bye-bye to GIDS, where gender extremists offered quack treatments to distressed kids. Hello research protocols, evidence, multi-disciplinary teams
Thank you
@Hilary_Cass
. Your considered approach has put clinical ethics back at the centre of treatment for these distressed kids. Political ideology has no place in clinical settings. Why has it taken since the 1st report in 2006, to have these serious concerns addressed.
The final Cass report is out. SEGM will analyze this information and will post a summary (which will likely take several days).
The final Cass review is at the link below (the website contains the summary and the full report):
Nine systematic reviews and
Whistleblowers like myself were dismissed as ‘transphobic’ & having no expertise, which as a psychoanalyst with 45 years experience in mental health & having run a dep at
@Tavistock
is odd.
@sajidjavid
getting
@Hilary_Cass
in changed the game.
More evidence of sense prevailing and hopefully the end of the politicized approach to the treatment of kids with gender dysphoria. An approach which has interfered with good medical practice and failed to protect children from unnecessary medical harms
1. Why has it taken so long.
@sueevansprotect
blew the whistle & Dr Taylor wrote a report, which was subsequently buried in 2006. The trust then tried to bury Dr Bells report & reputation in 2018. After a long battle with CEO & chair to take this matter seriously, I resigned.
BREAKING:
#CassReview
@TheCassReview
demolishes the basis for the current model of treating gender-distressed children.
@NHSEngland
has for too long has given vulnerable children harmful treatments for which there was no evidence base.
Letter in the
@guardian
in response to the statement about the closure of GIDs. The politicization of clinical care in this area has been damaging. The
@rcpsych
needs to pay proper attention to
@Hilary_Cass
. It’s responsibility should be towards patient care & clinical evidence.
Affirmation is based on a belief that psychological suffering needs to be removed immediately. But suffering is a signal that something needs attention. MH practitioners have a responsibility to listen & ‘think’ about what this individual is suffering from
I resigned 2019, because serious concerns were being ignored. But the fear of reprisals meant, very few Clinicians were willing to go public.
Freedom to think: the need for thorough assessment and treatment of gender dysphoric children | BJPsych -
Impressive mother & her daughter who desisted from a wish to medically transition. There is no diagnosis of ‘true trans’ in minors. Certainty about the belief that the child was ‘born in the wrong body’ is not evidence that justifies a medical transition.
My paper was recognized as one of the top downloads last year! Despite the fact that this thinking is clearly in demand, I've had difficulties getting this work published in some PA journals. Thx
@wileyinresearch
Clinicians must be free to debate & think.
A new peer-reviewed open-access study exposes deep flaws in the Dutch studies that formed the foundation for youth gender transition. These studies should have never been used to launch the practice into mainstream medicine, conclude the authors./1
I agree with Dave Bell, services should go up to 25 &
@Hilary_Cass
young people with GD need holistic care. The narrow preoccupation with ‘gender’, ignoring other factors; comorbidities, trauma, & identity confusion has been disastrous.
@SexMattersOrg
@Transgendertrd
@CanSG_org
‘I literally lost organs:’ Why detransitioned teens regret changing genders via
@nypost
thanks for writing this piece we need more scrutiny and debate about this issue.
Important paper outlining the complexities involved in assessing detransitioners and regret. We have been flying blind, providing medical interventions, that lack an evidence base, for a psychological problem.
@segm_ebm
@Hilary_Cass
Dr Marcus Evans resigned from the Tavistock & Portman NHS Trust over concerns about its gender identity service.
He questions how a child of 11 can consent to treatment that will 'profoundly effect' their physical and psychological well-being.
Read more:
Stephanie Davies-Arai (
@Transgendertrd
) has been raising the alarm about gender ideology and "gender-affirming care" long before it was on most people's radar. We all owe her a debt of gratitude for the work she put in and the resources she created. 🙏
2. After my resignation I was interviewed many times by journalist, who asked if I was conducting a one person vendetta against my old employer. Clinicians, would not go on record, because the atmosphere was so intimidating. This is something
@Hilary_Cass
mentions in her report.
1. Why has it taken so long.
@sueevansprotect
blew the whistle & Dr Taylor wrote a report, which was subsequently buried in 2006. The trust then tried to bury Dr Bells report & reputation in 2018. After a long battle with CEO & chair to take this matter seriously, I resigned.
Feb 2019, Journalists knew there was a serious problem. However, journalistic ethics was replaced by a tendency to tell us what we should think about groupthink. Is the
@Guardian
now back in the game of investigating-reporting the story?
Hats off to fellow
@TaviAndPort
whist-blowing colleagues. Dave Bell,
@sueevansprotect
and Kirsty Entwistle. And the GIDs who spoke to Dave. The Observer view on gender identity services for children | Editorial
Nurses are often the first professional contact for gender confused young people. I recommend this piece as essential reading for nurses. Ex RMN, & HoN at the
@TaviAndPort
for 20 years. The Interim Cass Review and its implications for nursing
@theRCN
Identity development is a changing process influenced by physiological psychological and sociological forces. Affirmation & medicalisation attempt to put a lid on underlying feelings of confusion and turbulence, which are part of this naturally unfolding process.
@Transgendertrd
Finally light is being shone on adult gender clinics and the harms they pose to 17-25-year-olds.
They must be brought into the Cass framework.
At present they offer a fast track to drugs & surgery with little psychological oversight.
Important people with a public profile like
@sharrond62
@jk_rowling
continue to speak out about this issue. We also need clinicians with a public profile to speaks out
@jordanbpeterson
. We need debate & discussion not tyrannical mindless group think.
@TaviAndPort
it’s been a long journey
@sueevansprotect
but
@Hilary_Cass
advocates holistic care for gender confused children. care gender clinic forced to shut over safety fears
@SexMattersOrg
false science associated with this issue was around in the 1980s. But it’s got much worse. The Tavistock own figures, produced for the judicial review, showed the ‘pause for thought’ was a myth, as over 90% of kids that started on PB went on to cross sex hormones
"Cass also said there was a lack of clarity over whether the drugs simply “pause” puberty or if they act as “an initial part of a transition pathway” with most patients “locked in” to changing gender and put onto cross-sex hormones as adults."
I thought the last tweet was going to be my last, but I just burst into tears. The
#CassReview
may be a watershed moment, but it comes too late for detransitioners who've written me heartbreaking letters of regret. Today's not a triumph, it's the laying bare of a tragedy. 7/7
Taken a long time, many articles, interviews documentaries a judicial review & now a book. But finally this issue is where it needs to be
@hannahsbee
Group of clinicians at Tavistock raised ‘serious concerns’ over functioning via
@YouTube
@sueevansprotect
Social media is a monster we don’t know how to manage as it gives air time to people, who attack measured thought and judgment as if it was prejudice. Thoughtlessness leaves us all vulnerable to damaging actions, particularly the most vulnerable.
It was an honour to speak with whistle blowing psychotherapist
@sueevansprotect
& her husband, the former Tavi governor
@marcuse99903226
for the latest in a series exploring what led to the Cass Review. We talk about what life was like at GIDS.
The Tavistock scandal shows the dangers of groupthink. Maintained in order to avoid the hatred unleashed when someone has the courage to say ‘I want to examine what’s going on, hear and see things for myself’.
@KemiBadenoch
@thetimes
‘If only I were a boy …’: Psychotherapeutic Explorations of Transgender in Children and Adolescents thanks
@SEGMtweets
for making it possible to have this paper open access.
No, this is no April Fool's. The House of Horrors was shut down, but it was very real, &
@marcuse99903226
worked there. Watch in 1st reply - pls like & share.
Under psychological pressure individuals often developed fixed beliefs. These beliefs attempt to bind together a individuals fragile sense of self. MH practitioners need to be free to explore what’s going on for the individual. Who is this person what are the struggling with.
@ProfLAppleby
the whole area has been awash with unhelpful and damaging false claims. Parents are often frightened of a drastic split with their child or even worse suicide. These threats can inhibit parents and prevent essential dialogue and critical thinking.
We need to see an end to that line about choosing a living daughter or dead son.
It is not based on evidence.
May add to distress in young people & mislead worried parents.
Deeply insensitive to 200 families/yr to whom the suicide of a teenager is more than a slogan.
@MForstater
over the last 2 years
@sueevansprotect
and I have run many events for Psychotherapy & Counselling groups interested in thinking about this GD. However, as Hilary_Cass says in her report clinicians often say they feel intimidated & wary of exploring in the usual way.
Thx
@jo_bartosch
. As I've said before, there were so many essential links leading to
@Hilary_Cass
, but it was so critical informed journalists were prepared to risk the wrath of the mob & row against the cultural tide, to protect children.
@sueevansprotect
Our clinical institutions have been keeping a low profile, exchanging a quiet life at the expense of medical ethics & the turbulence accompanying critical thought. Amongst many other issues, it's essential to understand the failure of medical authority in the area.
@JamesEsses
🚨Breaking🚨
Along with over 130 politicians, clinicians, lawyers, social workers, detransitioners, academics and campaigners, I have written to
@RishiSunak
, demanding a Public Inquiry into the infiltration of gender ideology and the harming of children.
Please read and share.
"Once your decision making is based on a pre-existing belief structure, you’re not in a clinical environment."
An essential listen. Marcus Evans
@marcuse99903226
discusses with
@triggerpod
what went on at the Tavistock and why he resigned as governor.
Clinicians need good governance, research, curiosity, child safeguarding, discussion & debate.
@TaviAndPort
has been burying the extent of the trans charities influence. The ideological tails wagging the clinical dog.
@Transgendertrd
Your
@thetimes
article filled
@sueevansprotect
& I with renewed sadness & anger. This is a medical scandal that’s caused much harm
@KLBfax
. In our view, the courage to front the JR changed the game & brought in
@Hilary_Cass
. Your brave actions have saved many more kids from harm.
'The whole history of the Tavistock was to do the opposite, it’s to look at the person as a whole rather than getting fixed on gender.'
Former Governor at Tavistock NHS Trust Marcus Evans and
@skysarahjane
discuss gender identity services.
📺 Sky 501
Did an interview for the
@TheLancet
in 2019. The interviewer said the editors had spoken to the journal lawyers & in 15 years working for the journal, he’d never known an issue cause so much. Medical institutions journals tend to steer clear of this issue.
@hannahsbee
@thetimes
Journalists interviewing me after my resignation in Feb 2019, often asked why I was the only clinician who would go on record questioned what was going on? Only a few others would speak, all anonymously, until Kirsty Entwistle
@thetimes
@hannahsbee
@francisjfoster
@KonstantinKisin
@triggerpod
importantly this issue needed to opened up for debate and discussion. The publics knowledge of the issue has come a long way since this interview in 2021.
1.
@segm_ebm
This makes perfect sense when operating in a clinical environment that applies the principles of good medical practice. However, this was not the case in GIDs the culture had become politicised. Red flags were continuously ignored because they challenged the ideology
Last week, England shut down the world’s largest pediatric gender clinic at the Tavistock (GIDS). Investigative journalist Hannah Barnes shares 7 lessons for the rest of the world at
@segm_ebm
NYC conference.
Lesson 1: When new evidence emerges, be prepared to change direction.
@STILLTish
I first met
@cwknews
as a panel member at a House of Lords event called First Do No Harm in 2019 & Stephanie presented with such knowledge and insight. It was a pivotal meeting as it led to the JR.
@SexMattersOrg
when I resigned, I was contacted by journalists saying clinicians were concerned but intimidated and wouldn’t speak up.
Freedom to think: the need for thorough assessment and treatment of gender dysphoric children | BJPsych
@marcuse99903226
resigned after an internal report by Dr David Bell warned that the GIDS service "as it now functions is not fit for purpose & children’s ends are being met in a woeful, inadequate manner & some will live on with the damaging consequences"
The tick box approach to psychiatry & diagnostic spread, encourages people to believe they have a condition that requires psych medication rather than understanding & thought. Psychiatric assessment should be wholistic and in depth.
The approach based on
@sueevansprotect
and my experience of treating kids & parents. The book outlines a model for understanding the unconscious individual and familial dynamics that may be influential the presentations of GD.
@ThePosieParker
that was a crucial meeting as it bought together clinicians academics parents from both sides of the pond. Crucially the plan to take a judicial review was hatched in the pub. The judgement threw a spotlight on GIDs & the medicalisation of children.
@Hilary_Cass
Way back in May 2019
#LetWomenSpeak
(aka Standing for Women) hosted a talk at the House of Lords about the harm of puberty blockers and other dangerous medical practices inflicted on children.
All MPs, Lords and Ladies were invited. Only
@Tanni_GT
had the guts to turn up.
Couldn’t agree more;
@hjoycegender
, the two sides' argument was used to dismiss the Whistleblowers from the start. But we are talking different languages; one side
is the language of political ideology, while the other is based on medical ethics, safeguarding & clinical evidence
I'm glad that the bullying of anyone who tries to say anything factual on gender-related stuff is finally being talked about. But this article still frames the situation as "both sides", which it isn't. Take the cancelled conference it describes 1/5
Very important paper examining problems in the current treatment approaches to trans identified kids.
@Hilary_Cass
outlined the weak evidence and the tendency to shut down clinical discussion. We need better long term evidence, treatment and care.
@SEGMtweets
@sueevansprotect
Thanks
@helerina
. When you’ve be in MH as long as we have you know the difference between good practice & bad.
@sueevansprotect
was disturbed by her experience at Gids in 2005. Then I was disturbed by the Tavistock attempts to bury legitimate concerns raised in Bells report.
Your
@thetimes
article filled
@sueevansprotect
& I with renewed sadness & anger. This is a medical scandal that’s caused much harm
@KLBfax
In our view, the courage to front the JR changed the game & brought in
@Hilary_Cass
. Your brave actions have saved many more kids from harm.
The
@Hilary_Cass
report means clinicians and services will have to proceed with the appropriate clinical rigor in assessment and caution that has been missing thus far. A treatment that lacks an evidence base but has serious consequences for children’s development.
#firstdonoharm
Sad day. But
@sueevansprotect
& I always knew this day would come as legal action for damages would be the inevitable consequence of an experimental treatment that lacks an evidence base. Tavistock gender clinic ‘to be sued by 1,000 families’
RT this paper in 2020 led to a record number of downloads.
@jk_rowling
, involvement & passion have been essential in taking the argument from ingroup to broader public. Freedom to think: need for thorough assessment & treatment of GD | BJPsych Bulletin
@hannahsbee
@sueevansprotect
& I kept thinking institutions couldn't keep disregarding publicised concerns about harm & lack of evidence in the treatment of vulnerable kids. The failure of medical authority in the NHS forced the need for a judicial review & then
@Hilary_Cass
@sueevansprotect
@marcuse99903226
Well, they certainly didn’t want to release it… I remember finally reading it and just being shocked how similar all the concerns you raised were to those being voiced a decade later. What a missed opportunity.
The Cass Effect As demonstrated by this article,
@Quillette
has covered this important issue from the start-prepared to row against the cultural tide and challenge groupthink. We need more room for complex critical thought about difficult areas.
@genspect
no simplistic ‘one size fits all’ clinical group but clusters of presentation & everyone is individual. Some rely more on the excitement of occupying a female identity (AGP) & spaces, others not so much. We need more clinical thought and room for nuance.
@Genspect
@HJoyceGender
@HJoyceGender
says when she's sympathetic about trans boys, someone always says "they're AGPs!" She asks the panel: why do you think there's so much resistance to the idea that there's a novel presentation of trans for teen boys like there is for teen girls? Good question. 13/
Planned legislation will interfere with practitioners or parents role in protecting against possible harm. Exploration is not to force a prejudiced view on the child but to understand the forces contributing towards the belief in medical transition as the only solution.
@Jebadoo2
Under psychological pressure individuals often developed fixed beliefs. These beliefs attempt to bind together a individuals fragile sense of self. MH practitioners need to be free to explore what’s going on for the individual. Who is this person what are the struggling with.
The political capture of medical and psychological institutions, leaves children vulnerable to iatrogenic harms from a medical treatment that lacks an evidence base. The failure of medical authority forced
@sueevansprotect
and mother A had to turn to the JR.
@rcpsych
@Hilary_Cass
6. Ever week since 2019,
@sueevansprotect
& I receive two letters a week from parents desperately worried about their child. Families are torn apart, and kids may go on to regret medical treatment. Where have the medical authorities been
@NHSEngland
@rcpsych
@CareQualityComm
5. Then thank goodness, the government realised something was seriously wrong & sent in
@Hilary_Cass
and some of us the could see the light at the end of a long tunnel. I can’t believe this day has arrived sanity has been restored.
@SexMattersOrg
3. It was always evident to
@sueevansprotect
Dave myself
@Doctor_Az_
others in the trust & 10 clinicians from GIDs that reported to Dave that this was a reckless experimental treatment. But the judicial review put GIDs under public scrutiny & in my view, this was a game changer.
2. After my resignation I was interviewed many times by journalist, who asked if I was conducting a one person vendetta against my old employer. Clinicians, would not go on record, because the atmosphere was so intimidating. This is something
@Hilary_Cass
mentions in her report.
There’s no ‘one size fits all’ model for understanding GD & while a psychoanalytic approach is not always appropriate, the model can provide insights into unconscious motives. Therapist need to see the individual behind the presenting issue.
@genspect
@RichMcHugh
politicization & false science that surrounds this issue has interfered with much needed clinical understanding. Short term fixes to psychological disturbance often have hidden long term costs. We need more open debate & thought & less ideologically driven assumptions