“How did you go bankrupt?” a character is asked in Hemingway’s novel The Sun Also Rises. “Two ways,” he replies. “Gradually, then suddenly.” So it is with medical scandals, too. Disquiet builds and eventually, suddenly – often when someone goes to the press – a reckoning falls.
The Clinic traces the rise and fall of the Tavistock Clinic’s Gender Identity Development Service (Gids) for children. It was founded in 1989, primarily to provide talking therapy for young people suffering from a recently identified phenomenon called gender dysphoria – the feeling that there was a mismatch between the sex they were born and the sex (or gender – the conflation of the terms goes in many ways to the heart of the problem) they should have been.
In 2004, the “Dutch protocol” was created, which used puberty blockers on dysphoric children to “press pause” (though the phrase gives a misleadingly optimistic spin on just how reversible their immediate effects are, with the long-term effects being unclear) on their development and, it was said, buy them time to think. Avoiding puberty also makes it easier to transition later on if desired. Under pressure from trans activists and charities such as Mermaids, a support group for parents of trans-identifying children, the Tavistock adopted the protocol and began to supply puberty blockers to patients. Demand for them rocketed – even more so in 2009 when, under new medical director Dr Polly Carmichael, under-16s became eligible for prescriptions. A number of Tavistock staff became increasingly concerned about the level and type of care the children were receiving from a clinic they felt was both overwhelmed by the volume of cases and increasingly under the sway of a viewpoint which says that anything other than gender-affirming care amounts to the transphobic prolongation of mental suffering for patients. Sue Evans, a former nurse there, notes that children with comorbidities – behavioural difficulties, ADHD, autistic traits, or who had suffered physical or sexual abuse – had those underlying issues “pushed to one side” in favour of the medicalised pathway inaugurated by blockers that could and – it was later found, in 98% of cases did – lead to cross-sex hormones, followed by surgical alteration.
It wasn’t until a damning judicial review (overturned on appeal, where it was found that judges had gone beyond their remit) in 2020 and the production of the highly critical Cass Report two years later that Gids was, effectively, shut down.
The programme interviews a patient from each side of the equation: Libby, a trans girl, says going on puberty blockers has been nothing but a positive experience and is anxious about Gids’ closure affecting the continued treatment needed. Jasmine, a girl who took puberty blockers, testosterone and had a double mastectomy in pursuit of becoming a man says now that what she needed after a traumatic childhood was help and someone “to take an interest in me outside my gender. But Gids just spoke to me as a trans person.”
At just an hour long, The Clinic can do little but scratch the surface of the multitudinous complexities of this heartbreaking (whatever “side” you’re on) subject. Especially for anyone who has read Newsnight journalist Hannah Barnes’ meticulous and scrupulously researched book on Gids’ downfall, Time to Think, it will feel frustratingly broad. The inclusion of an uninterrogated Susie Green, the former CEO of Mermaids and a divisive figure even before the organisation became embroiled in a series of controversies, will raise some eyebrows.
But The Clinic delineates the factions and lays out the basic questions admirably, clearly and unsensationally. What do you do, it asks, when your child comes to you and says firmly and consistently that they were born in the wrong body? Can parents know best? Should passionate advocacy trump clinical expertise and the traditional, careful seeking after accurate diagnoses, however unpalatable? How do you evaluate the comparative dangers of various forms of non-intervention in a new and developing field?
There are other questions floating around in the ether that never quite crystallised during the programme but – if we take the existence of this documentary and Channel 4’s recent The Gender Wars as a sign that parts of the omerta round this increasingly vexed issue are beginning to break down – perhaps they will be asked in future programmes. There are wider, perhaps more abstract principles at work here, such as what happens when discussion – especially in a medical context, especially among professionals – is always framed as dissent. When every other kind of mental or physical health protocol and treatment is subject to constant rigorous scrutiny, debate and amendment in the face of new research, what makes transness a special case? On and on we could go and, hopefully, will. There is so much still to listen to and to learn.
The Clinic aired on ITV1 and is available on ITVX.
