Who Trolled Amber? - The Tavistock - Episode 4: The enemy within

Episode Date: September 18, 2023

The internal divisions at GIDS and the wider Tavistock centre spill out into the open. Whistleblowers are publicly critical of GIDS. One accuses the service of fast tracking young people onto puberty blockers after just one meeting with clinicians. The senior leadership team at GIDS desperately tries to hold the team together. Meanwhile the numbers on the waiting list tick up and up. Listen to the full series today. For the premium Tortoise listening experience, curated by our journalists, download the free Tortoise audio app. For early and ad-free access to all our investigative series and daily and weekly shows, subscribe to Tortoise+ on Apple Podcasts.If you’d like to further support slow journalism and help us build a different kind of newsroom, do consider donating to Tortoise at tortoisemedia.com/support-us. Your contributions allow us to investigate, campaign and explore, and to build a newsroom that is responsible and sustainable. Hosted on Acast. See acast.com/privacy for more information.

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along the dual carriageway and up into the more suburban parts on the outskirts of the town. And a very pretty street with lots of tiled houses with orange roofs and cypress trees. I can see a fig tree and some flowers. And we're just trying to work out which one is Kirsty's house. I think we're down here. The Kirsty I'm looking for in a small town in northern Portugal

is Dr Kirsty Entwistle. Hey, it's the house with the sunflowers. She's a clinical psychologist who works at the Gender Identity Development Service at the Tavistock. Hello. Hi. Hi, Kirsty. Hi, how are you? Really nice to meet you. Good, how are you? Shoes up? No, no, don't worry about it. Definitely, yeah. Pretty garden.

It's like a riot of colour out there. Yeah. Kirsty's home is spacious and immaculate. The artwork on her walls is all her doing. Her passion is painting and her job is a therapist. She has the air of someone who is trying to work out the world in real time, who is always questioning and trying to understand what she sees. She joined JIDS in 2017, but she stayed for only a year. JIDS was the first time I'd ever heard about gender identity. Never heard about it before. And that's what I was just saying, like, what is it? Where has this come from? How come it's, like, such a big thing now? And then that's how I ended up in this meeting where I got called transphobic.

Kirsty's part of a new wave of clinicians at the Tavistock recruited to try and meet the soaring demand for its services. She's excited, but she's also, to use her own words, very green about the work at JIDS. And she's immediately thrown into the sharp end of the debate about trans healthcare. On day one, she's called transphobic by a colleague. She's hit a raw nerve at the heart of the row about whether it's right to medicalise young people with gender dysphoria.

The Gender Identity Development Service is divided. The wider Tavistock is divided and it's all about to spill out into the open. Kirsty Entwistle becomes one of the whistleblowers. I'm Polly Curtis. From Tortoise, this is The Tavistock. Episode four, The Enemy Within. It's my first job, like working professionally with children, and it was probably one of the most disturbing experiences of my life. And in some ways it is related to kind of what happened at GIDS.

Kirsty has a backstory. When she left university, her first job was in a children's home in Rochdale. The young person that I was working with, a girl who was only 12, kept running away from the house and not coming back for several weeks. And, you know, when she came back, we'd find out that she had been like having sex with men and was in a really bad physical state. This is 2003. And what is witnessing first-hand is the early days of what was to become the Rochdale grooming scandal. When the police would bring her back they would say they can't press charges against the men because the girl was like an unreliable witness and kept changing the story so couldn't

go anywhere. The police when when they bring her back, aren't telling Kirsty and the other staff that this is happening to other kids in Rochdale. She's no idea it isn't an isolated case, that it's systemic and will be later exposed as a major grooming scandal. This girl would kick and scream and bite and spit at you and attack you to try to get out of the house and run away.

And it didn't make any sense to me why a 12-year-old girl would attack you when you're trying to stop her from doing something that was harmful to herself. Because when she came back, she would always be incredibly distressed about what had happened. That young girl's confused reactions make Kirsty want to study psychology and the experience stays with her. It was one of the first things that came to my mind when I started at GIDS, you know, hearing stories and these are the minority stories of kids like self-harming or, you know, even on their faces or saying they're going to hurt themselves if they can't get on puberty blockers because that made me think about, well, I know that kids will harm themselves

to access something that is actually harmful to them. I know that just because a young person kicks and screams and tries to pull the house down, it doesn't mean that what they want is the right thing for them. When she arrives at JIDS, she's never heard of gender identity, but that doesn't seem to matter when she's recruited. Did they question you on your belief and understanding of what being trans is? Not as far as I remember.

Would you have been able to answer those questions at that stage? I don't think so. What she's expecting is all the traditions of a Freudian approach to psychoanalysis. Exploratory talking therapy that seeks to discover the unconscious drivers of a person's feelings and behaviours. That's what she's trained for and why she wants to work for the Tavi. But on her first day, what she sees tells her that's not what happens at JIDS. I was in the kitchen on my first day just trying to kind of get to know people and get to know my colleagues and told the joke and it was about Freud's sexual,

psychosexual development theory. And the colleague that I was speaking to was really offended by that and, you know, said that she thought it was load of, I can't remember whether she said crap or rubbish, but was clearly really dismissive and was very confusing to, you know, be at the Tavistock and for somebody to be so dismissive of Freud, like it really confused me. Soon after, she's in a meeting with a couple of colleagues and she asks what she thinks is an innocent question about the nature of being trans. I was just kind of speaking out loud and it was not with any bad intent. You know, I was just wondering if gender is so core to people's

sense of personhood, how come it wasn't put into the Big Five measure? Now the Big Five is a psychology measure that dates from the 1960s. It's still used to help understand personality. The five measures are neuroticism, openness, conscientiousness, extroversion, and agreeableness. Kirstie is wondering aloud why gender identity isn't a sixth. The other thing that I said is, I don't feel like I have a gender identity. I'm just female. I don't feel like a woman a gender identity I'm just female like I don't I don't feel like a woman I just am female and then my colleague said I think you're transphobic I think this you know what you're saying is transphobic and I was just really shocked like oh my god like I've never I don't think I'd ever heard that word before, but I knew it was really bad and it felt like being called racist.

And I was just like, in panic. Oh God, what have I done? What have I said? I need to get out of this room. This feels really scary. Clinicians at JIDS work in pairs so they can discuss and reflect on each of their cases. And Kirsty has to work with the woman she says called her transphobic. Things were tense after that. Kirsty tells me a story about one of the clients they see together. It was a young person, I think he was 15, who was born female but identified as a boy

and came with their mum. And this was a kid who was really, really struggling, had been horribly bullied, really nasty, homophobic bullying, and was not doing very well at all, was very depressed and really struggling. After a few sessions, Kirsty feels her colleague is starting to think about a referral to the endocrine clinic, where puberty blockers are prescribed. but she doesn't agree with this. I ended up in an argument with my

colleague and I was saying you know this young person just doesn't want to be a girl really hates being a girl is really distressed about being a girl. There's nothing in, you know, what they're saying that, you know, shows that they would benefit from medical transition. And my colleague said, oh, he hates his periods. And I was like, everybody hates their periods. Like, it's really unusual to like having a period, you know? And then the other thing that we argued about was that the young person apparently had quite an intense interest in Thomas the Tank Engine as a child. Kirsty believes her colleague was saying

that an interest in typical boy toys was enough to meet a criteria for gender dysphoria. That is just, like, completely unacceptable, an interest in Thomas the Tank Engine being used as clinical evidence. for gender dysphoria. That is just completely unacceptable and interesting. Thomas's Hank engine being used as clinical evidence, you just can't get on board with that. The more I talk to Kirsty, the more I realise what a big gulf exists between what she believes

and what I've been hearing from Polly Carmichael. I accept and believe that there are individuals who identify in a gender that does not match their physical body and I accept that is a phenomenon. Kirstie has moved quite quickly from knowing very little about gender identity to questioning the nature of being trans. Is it fair to say you don't believe people can be trans? I think that people transition and they undergo medical transition and they can, you know, live good lives and they're happy and live fulfilled lives that

definitely happens so then those people are definitely trans um but i just personally haven't encountered anybody that i thought that this is like an innate condition that you know that they were born with the brain of the opposite sex or um you know they were born in the wrong body i just haven't personally encountered anybody that I think this is like an innate biological condition. I think it's more complicated than that. Kirsty struggles to fit in at the Tavistock. She eventually decides she's got to quit for her own well-being.

She leaves her job without a fuss and moves to Portugal with her boyfriend. They get a dog and she spends the first few weeks pacing the local pathways, trying to process what she's seen. This forest, there was an old train line that's been made into a path. So just walking up and down there. Were you in a very bad place? up and down there.

Were you in a very bad place? Yeah, I think so. A very strange place, very odd, like being so isolated. Just really wrestling with my conscience and really, I don't know, at a loss. Kirsty's haunted by her interactions with families at JIDS and feels she's failed them. She hasn't got the internet installed yet,

so she stops off on her walks at a local shopping centre and scrolls through social media, watching the row about trans healthcare escalate. She's sat in that shopping centre when she comes across an article on the Mail Online by a Tavistock whistleblower called Marcus Evans. And it just blew my mind because it was like, oh my God, somebody else thought this. It wasn't just me.

I wasn't the only one who felt like what was happening was wrong. Kirsty watches from Portugal as the internal battle at the Tavi starts to burst into the open. In November 2018, a man called David Bell pens an internal whistleblower report. He's one of the most senior staff members at the wider Tavistock and he also sits on the governing body. And his report is devastating.

You know, there's a sort of myth to think that the service was ever completely harmonious and everybody thought the same. As the internal divisions pour out into the open, Bernadette Wren, the senior JIDS clinician, is desperately trying to hold the team together. So the idea of people being in very different camps offends me. I almost won't accept it. I think there must be a way in which we can see what it is that people are so unhappy about here and to try

and address it in a way that doesn't mean that people are going to fall out. But after David Bell... It absolutely became impossible to do that. Bernadette is floored by the Bell Report's accusations, including that children were being fast-tracked to puberty blockers after only one meeting. But it was the finality with which it was delivered with no notice to the JIDS leadership that really hurt.

It was the tone. I don't just mean tone. It was the absolute condemnatory language which shocked me so much. And I don't want to overplay the emotionality of that although I experienced it in a very emotional way but the the absence of any possibility of discussion or kind of bids for any further sort of mutual understanding or actually respect for a different view. With the Bell Report, Bernadette was out of tactics. I felt I tried to keep a bridge open

and I think that that chance was swept away really with the Bell report because it was so quickly leaked, as these things so often are. It then became the way of understanding how the service was and it became kind of quite a fixed image. And we were kind of stuck with it then as a characterisation of what the service had been like. Any attempt to describe some of those relationships or those attempts to manage it with a bit more nuance have been lost.

One feels almost foolish now trying to describe it in that way. Ten clinicians had spoken to David Bell, but they weren't identified. Some still worked there. I can only imagine how that bred suspicion between team members and poisoned the atmosphere. The trust within the team was lost. if it wasn't something so contentious and something so significant and important, you could say, well, they're in the wrong job because they don't want to do the thing that the clinic is set up to do. Of course we don't say that because we're not claiming such comprehensive knowledge. We're still saying we're at the frontier of knowledge. So maybe those people who don't entirely like the spec are bringing something to the team.

Maybe we should hear what they're saying. Polycar Michael is less accommodating. Ultimately, if you have a fundamental problem with the way in which care is offered to this group of young people by the service, then whilst one can hear some concerns, one doesn't necessarily accommodate them. I'm loathe to make an analogy in some ways because it brings in other things but it's sort of like working in a centre that offers abortions where you don't believe that abortions are right.

The Tavistock is now dealing with the enemy within. David Bell's report had a galvanising effect on other whistleblowers. Eight months later, Kirstie publishes an open letter to Polly Carmichael. She writes, Jid's clinicians tell children and families that puberty blockers are fully reversible. But the reality is no one knows what the impacts are on children's brains. So how is it possible to make this claim? At the heart of this rail, there's a fundamental clash.

It's between those who believe gender dysphoria is a pathology, something inherently wrong to be explored and questioned, and those who believe it's an identity, something that's innate. There's echoes of this falling out in the Tavi's recent past. In 2021, the British Psychoanalytic Council issued a formal statement of regret over its historic pathologising of what it means to be gay. Bernadette recalls that for a long time, people at the Tavistock didn't feel safe to come out as gay. Clearly, the Tavistock and psychoanalysis, as other bodies of expert psychological knowledge, including psychology itself, of which I am a professional member, had some very, very oppressive ideas about sexuality not that long ago.

The definition of pathologise is to regard or treat as psychologically abnormal. It presumes something needs to be fixed. Twenty years ago, the debate at the TAVI was about whether being gay is a pathology. There's a hint of history repeating itself in the row about how to treat children with gender dysphoria now. Acast powers the world's best podcasts. Here's a show that we recommend. Hi, I'm Una Chaplin, and I'm the host of a new podcast called Hollywood Exiles. It tells the story of how my grandfather,

Charlie Chaplin, and many others were caught up in a campaign to root out communism in Hollywood. It's a story of glamour and scandal and political intrigue and a battle for the soul of the nation. Hollywood Exiles, from CBC Podcasts and the BBC World Service.

Find it wherever you get your podcasts. ACAST helps creators launch, grow, and monetize their podcasts everywhere. ACAST.com As these debates were raging inside the Tavistock, Steph Preston has become a patient at JIDS. They weren't aware of the row at the time, but they certainly felt its effects. Throughout my time there, from that first appointment

all the way through to being referred to the adult clinic, I had five different clinicians. And with each new clinician, they're not getting closer to what they want, the blocker. With each new person they meet, there's another layer of exploration of their identity. I just remember being so frustrated and there were numerous sessions where I'd leave and I'd cry. I would cry to my mum outside to have a stock and then I'd cry when I got home and I'd feel so emotionally exhausted

that I'd just sleep for the afternoon or I'd have a really intense headache and it just felt like no progress was being made because they were very much hung up on, are you sure? It felt very much like a blocker to me making progress. Steph sensed the different approaches of different clinicians through the questions they asked and it very much felt to me at least like there was this question of are you really sure you're not just gay and I remember the male clinician who was a gay male and was open about that said well there are drag queens because I

started watching RuPaul's Drag Race of course by this point and so he said of course there are drag queens and there are very effeminate gay men and there are effeminate bitch men and are you kind of sure that you aren't just gay? Others spent longer asking about their mental health. I've struggled with various mental health issues, anxiety being one of them, depression being another. I was also a very angry child, and with certain clinicians it was touched on way too much, and it felt almost like they were digging into the mental health

and sidelining the gender identity kind of questions and and whack did you feel like some were more much more supportive and empathetic less questioning yeah there were a couple who I definitely remember as just letting me talk and letting me explain how I feel. But it was never, it was never a kind of, are you really sure you're trans moment with some of them? Compared to, say, one of the first two clinicians who was saying quite outright, are you sure? Are you sure you're not just a gay man or an effeminate man? I've done the work. I've gotten to this point. I've waited the 10 months on the wait list. I've gone through the counselling. I have taken the time to do my research. Do you honestly think I would be here if I wasn't trans?

Do you honestly think I would have waited the year from coming out to my first appointment if I wasn't trans? Would I really be going through all of this effort? And it felt like a slap in the face at times. During the same period, Sandra accompanies her child to the clinic. Sandra tells me she spends each session silently pleading for the clinicians to dig deeper, ask more questions, to unpick her child's ideas about their identity. She wants them to probe what's really causing her child's dysphoria. I've had hoped that the Tavistock would discuss all this with her, but they're very affirming, and they start by assuming that the child is trans.

Does it get very volatile? Does it get angry? Yeah, well, she'll have a sort of tantrum and, you know, she thinks it's completely unreasonable of me to see her as a girl. It is heartbreaking, actually. Yeah, I'm so sorry. I'm sorry. I can see the pain in her eyes. She's heartbroken about this split in her family and desperately lonely in the position it leaves her in. She's very beautiful. I think she thinks she's fat and ugly, but she's not.

And she almost makes herself look, now because she's got very, very short hair, she wears baggy black clothes, you know, they all do. I know from talking to other mums, they all wear exactly the same clothes. She looks like, you know, she possibly is a lesbian, a butch lesbian, you know, and I just pray one day she does realise that's what she is. I don't know. Sandra feels that the path to puberty blockers is all but inevitable. She's playing for time. blockers is all but inevitable. She's playing for time. And her period started in fact just after the first meeting there. We went out and bought everything she needed and I let her take a day or so off school because it was so traumatic for her. So I feel slightly awkward asking this

question. It feels intrusive but was she, as her body began to develop, was she binding? She wanted a binder and I was very against it because of the dangers. I agreed to let her have one as long as it wasn't too tight and I'd sort of surreptitiously made sure that it wasn't too tight. I'd sort of stretched it and sort of yanked it a bit too. I don't know if you've seen them. They're rigid at the front. They're sort of stretchy material, but the front panel is like thick canvas with no stretching in it at all. So they would be very damaging to the breast tissue if they're tight. So I'd make sure

that it wasn't. In fact, I've cut the tight bits away from the seams. So it's now no tighter than a sports bra. While Steph is frustrated by the lack of progress, Sandra is trying to slow things down and hoping her child will grow out of it. I felt she had to go through puberty because it's, well, you know, the body, you know, she needs to go through puberty because it's an essential part of maturing into an adult. Everybody knows that now.

You have to be the adult. You are the parent. I wouldn't let her get behind the wheel of a car or sit there with a bottle of whiskey all night long because she's too young. Because these things are dangerous and too risky. So why are they allowed to diagnose themselves at this age? They're children. We all go through these phases when we're teenagers, goths, emos, all the rest of it, punks, you know, it's a form of rebellion, isn't it? But most people grow out of it. So she's determined to get it. And I've got to try and stop it.

I need to understand how the Tavistock clinicians judge whether a young person is ready for puberty blockers or not. It's a difficult question to ask. In effect, I'm asking about how they judge whether a teenager's identity is settled or not, whether they will always identify as trans. I ask Polly Carmichael. When you get to the point of making this critical decision with such big impacts for them, such unknown impacts. I don't know how you make that decision. And you've said you can't be sure, you've said you can't be certain. I don't hear that you're trying to understand, you know,

the central question, which is, is this person really trans or not? And, you know, it's such a difficult question to even ask. But ultimately, is that not what you're trying to find out? Well, I wouldn't be asking anyone if they were really trans or not, because people identify in many ways and many people don't necessarily identify as trans. Aren't you really trying to understand with this person whether they truly want to transition and in the context of everything you've said around the social factors involved in this aren't you trying to ask that question ultimately so our service could be described as affirmative insofar as we respect young people's identification at at any one time and we accept that you know that that is how they feel so I think I would start from you know an acceptance

that there are individuals who for the course of their life will continue to identify in a particular way and so are there also individuals who won't? Absolutely. So how do you know, in your work with that individual, how do you know the difference between the two if you're making a decision to refer for puberty blockers? It is very much a case-by-case presentation. presentation you are making a prediction based on everything you've heard and the whole exploratory process that i've heard from your patients yeah happens um you're making a prediction about the course of their future and therefore so we're making a prediction about the sense of self the gender identity and that that is something that is going to persist, that that is not going to change and is going to continue into adulthood. As Polly describes this process of detective work, of trying to work out if someone's

identity is fixed, there's that word again, affirmative. Polly uses it to describe the service that the TAVI offers. That doesn't mean that we are assuming that is how they will always feel. It doesn't mean that that won't change and develop over time. It doesn't mean they're inevitably going to go to the endocrine clinic so I think you know a lot gets attached to a word. It certainly does even within the service its meaning seems to vary after Polly tells me about the affirmative approach her colleague at the Leeds clinic James tells me something different. So we know that the service takes an affirmative approach, controversial words, raising your eyebrows. I wouldn't agree with that. You

wouldn't agree with that? No, I think it's much more complex, much more nuanced than that. And I think one of the myths that GIDS takes is a sort of affirmative, non-exploratory approach. And I would say that my approach is to be respectful. I suppose I affirm that this is what this young person might be feeling at this particular time about their gender identity and maybe has done for quite a while but that certainly does not then sort of lead me to necessarily sort of say okay that's how it is. My job is to explore that and to make judgments. So similar to Polly and yet subtly different. Outside in the wider world, Jid's affirmative approach is used pejoratively by critics

to imply an unthinking acceptance of a child's gender identity. Even that word, affirmative, is like the black gold dress again, seemingly the same thing but perceived as different by different people. But by now, the reality is the service is slipping further and further away from affirming anything. Because referrals are ratcheting up and up, the waiting list is growing and the clinic is struggling to keep up. And outside the Tavistock, the culture war is erupting.

Coming up in episode five, the Tavistock Clinic's fate hangs in the balance. Everyone I asked for help told me that I was a bigot, that I'm a risk to my child, and that my child was likely to, was at risk of suicide. And what did that do to you? Well, you think, is it true? The service isn't about fixing someone. It's about people go to gets around their gender dysphoria and providing support for that. It has not been our experience that people have kind of missed glaring other context because they're so focused on the gender dysphoria.

It's definitely a boogeyman kind of argument. And he said, well, that's all very interesting, but we are not going to speak to you. It's a cult. It's a cult attitude. You're either with us or against us. If you say anything critical, we won't talk to you. Additional production by Immy Harper The executive producer is Jasper Corbett The Tavistock is a Tortoise production Thank you. you