A letter in response to Bernadette Wren

Bernadette Wren

Dr Bernadette Wren, the former Head of Psychology at the Tavistock and Portman NHS Foundation Trust and Associate Director of the Gender Identity Development Service, defended the Service at great length in London Review of Books (2 December 2021). The LRB has just published (17 December 2021) two devastating critiques by former clinicians at the Tavistock, Kirsty Entwistle and David Bell, which are essential reading. Here is the response of Dr Michael Biggs, Associate Professor of Sociology at the University of Oxford and contributor to Transgender Trend.

Richard Rorty is a favourite philosopher of Bernadette Wren, and her Diary (‘Epistemic Injustice’, London Review of Books, 2 December 2021) brings to mind his definition of truth as ‘what your contemporaries let you get away with saying’.

Wren blames the disarray in her Gender Identity Development Service (GIDS) on the increasing number of referrals starting in 2016. She must know that a whistle-blower, Sue Evans, had already raised concerns over a decade before. The ensuing internal review in 2006 highlighted all the problems that have become familiar: the failure to collect basic data on patients (the unit did not bother to count the number of adolescents subjected to endocrinological intervention); the inability to understand informed consent; and the pressure from patients influenced by lobbying organizations. The review was buried, of course, until the Information Commissioner’s Office forced its release last year.

As Wren notes, the National Institute for Health and Care Evidence found no evidence to justify puberty suppression as a treatment for gender dysphoria. (The drugs have never been licensed for this condition, in the United Kingdom or anywhere else.) What she does not acknowledge is the responsibility of the GIDS for this lack of evidence. For over thirty years it has refused to collect data on long-term outcomes, conveniently losing track of patients when they turn 18. Indeed, it only published the short-term results of its initial experiment with puberty blockers after a protracted campaign by Stephanie Davies Arai and me.

Wren highlights the Care Quality Commission’s 2016 evaluation of the GIDS as ‘good’. She omits its more recent verdict of ‘inadequate’. This time the inspectors actually examined the medical files: ‘None of the records included a clear statement of what the service was assessing. Whilst the criteria for considering referring young people for administration of hormone blockers was set out in the service specification, we saw no reference to this on any patient records.’ Moreover, ‘the records of young people who began medical treatment before January 2020 did not include a record of their capacity, competency and consent.’ Was it a coincidence that clinicians started taking consent from patients exactly when the legal challenge to GIDS was launched in January 2020?

Central to that legal challenge was Keira Bell. Her absence haunts Wren’s Diary, which cites the eponymous legal judgment but never refers to her as an individual person, let alone a woman with the courage to speak honestly about her treatment. Wren continues to deny the harms inflicted on vulnerable patients like Keira Bell—say her name!—by clinicians who pursued what Wren grandiloquently calls a ‘justice project’ rather than practicing evidence-based medicine. As the former Head of Psychology at the Tavistock and Portman NHS Foundation Trust and the Associate Director of the GIDS, she should not be allowed to get away with it.

This Post Has 12 Comments

  1. Denise Harding

    Interesting definition of truth by Rorty. A bit like Pontius Pilate asking Christ “What is truth?” I don’t think he wanted an answer!
    One of my favourite ‘philosophers’ is Mark Twain…..quote attributed to him is “Lies, damn lies and statistics!”

    Thank you to all at Transgender Trend for the work you do.

  2. Saoirse (Twitter)

    Thank you for bringing this to public attention, together with Kathleen Stock and Helen Joyce et al I feel far more informed, albeit terrified, about what is going on behind doors to ofttimes confused and vulnerable young adults.
    Undoubtedly more numbers of individuals with challenges labelled as Trans fuels the socio-political agenda of normalising deviant behaviour. Need to read more about Bernadette Wren and the Keira Bell Judgment.

  3. Peter Jenkins

    Bernadette Wren’s piece (‘Diary: Epistemic injustice’, London Review of Books) has to be taken with a very large pinch of salt. She was a key figure at the Tavistock Gender Identity Development Service, and oversaw the massive shift towards approving consent by children aged as young as 10 for the use of puberty blockers. She claimed (wrongly) that the Memorandum of Understanding on Conversion Therapy represented an ‘industry standard’ of therapy practice, in the form of endorsing a requirement for affirmative therapy. She claimed that it was therefore OK to apply this at the GIDS, despite affirmative therapy lacking any robust evidence base. Wren dresses up her rather thin arguments (and her own managerial responsibility) in flowery post-modernist language, as if rising au dessus de la melee of inter-professional debates, and somehow not actually being directly responsible herself. And yet, as Michael Biggs reminds us, the Care Quality Commission decisively determined that the standards at the GIDS were ‘inadequate’ in 2021, for the very same period while she was in a senior position and for which she should therefore assume managerial responsibility.

    Peter Jenkins

  4. charles lewis

    I recall Wren’s address to members of the medico-legal society two or three years ago. I started to groan (aloud) when she coyly informed us that of late it had been discovered that there were more than two genders etc etc. She was whisked away at the end by the chairman so that I had to pursue her to get a response (which I did not get). She is not, however, the only mad creature at the Tavvy (the sane ones have left).

    1. Colin+Day

      There are only two sexes, but there might be many genders.

      1. Triplet

        There are as many genders as we decide there are. It is a linguistic construct. With that said, the traditional gender binary of male/female has a lot of practical benefits: one, it reflects the biological reality of sex; two, it is robust enough to accommodate possibilities such as a ‘feminine man’ or a ‘masculine woman’, meaning it allows a large amount of diversity in the behavioural and physiological presentation of males and females without pressuring them to mutilate their bodies.

        What are the practical benefits of detaching gender from sex? Two mains ones that I’m aware of: ideological reinforcement of the psychedelic techno-post-modernism which lies at the heart of our alienation from the natural world – and consequently drives our destruction of it. That, and big money for Big Pharma, through the creation of lifelong patients.

  5. G.P. Joyce

    ‘and so it continued both day and night …… ‘
    Why does this supposedly Conservative Govt. care not one whit about the ruination of young minds
    and bodies?
    Good interview today on ‘RTNews’ about this mania in Wales.

  6. Michael Biggs has done excellent work which has exposed the neglect, by the UK mental health establishment, of this area. He highlights Bernadette Wren’s omissions, but not entirely fairly.

    ‘Wren blames the disarray in her Gender Identity Development Service (GIDS) on the increasing number of referrals starting in 2016’ is not correct. In fact it is David Bell who emphasises that ‘enormous pressure’ in his letter.

    Wren outlines multiple causes of the problems affecting the service. Centrally, the founder of GIDS ‘had trained as a psychoanalytic psychotherapist and was therefore a Tavistock insider’, so that ‘its base at the heart of British psychoanalytic training and treatment set GIDS apart from equivalent services from the beginning.’

    The hyping of claims by Freud and his psychoanalytic successors to provide ‘treatment’, and their stifling of scrutiny and criticism, have been well documented, albeit often decades too late for those ‘analysands’ who suffered financially, and sometimes worse: https://www.nybooks.com/articles/1993/11/18/the-unknown-freud/

    Biggs describes Sue Evans as ‘a whistle-blower’. She is a psychoanalytic psychotherapist married to psychoanalyst Marcus Evans. According to their website, he has had a private practice since 1995, and they now work together. David Bell is often described as a psychiatrist in the media, but he is also a psychoanalyst, and a former president of the British Psychoanalytical Society. Wren’s criticism of Bell as adopting a ‘wounding tone’, and putting forward ‘half truths’, is supported by the criticism of him by Tavistock child safeguarding lead Sonia Appleby, who disagreed with the tone and attacking nature of Bell’s leaked report (as summarised by the judge in Appleby’s successful employment tribunal claim [p.54] https://drive.google.com/file/d/1JNpwp5aDrVwAe1VcG6vSxqVRouO1bdZ_/view ).

    Wren also writes that ‘until the mid 2000s, when an LGBT group was established by staff and trainees, many at the Tavistock found it hard to speak openly about their same-sex sexuality’. David Bell does not deny this persistence of psychoanalytic dogma (at a time when Marcus Evans appears to have been in a senior management role at the trust), well after the doctrine of homosexuality as pathological was officially discontinued by the BPA.

    Campaigners for biomedical interventions in gender dysphoric children and adults are deeply suspicious of psychoanalysts. With good reason, in my opinion. In time, Bernadette Wren may be seen as having guided GIDS away from ‘Freudianity’, as well as resisting poorly tested drugs and surgery reasonably well, given the intense lobbying from Mermaids and others.

    1. Michael Biggs

      I’m not competent to wade into a dispute over Freudian theory, but I must refute any insinuation that the whistleblowers at the Tavistock are motivated by homophobia. The Taylor report in 2006 had already recognised the overlap between homosexuality and cross-gender behaviour and identity: “In a proportion of cases, the [gender] identity disorder shades into … same-sex sexual preferences.” The implication, of course, is that many children with gender dysphoria (as we would now call it) would naturally grow into gay or lesbian adults—and that this normal course of development would be thwarted by diagnosing them as ‘transgender’ and subjecting them to experimental endocrinological treatments.

      Several of the clinicians who have left the GIDS in recent years—while Dr Wren was Associate Director—are gay or lesbian, and one of their major concerns was the collusion of clinicians with homophobic parents. In their evidence to Sonia Appleby’s employments tribunal, Matt Bristow and Anastasis Spiliadis specifically mentioned the impression fostered by the GIDS that it was much better to be a ‘straight’ transgender person than a merely ‘cis’ gay or lesbian . For example, a transgender speaker invited by the GIDS to address families spoke of their great relief at not being a gay man. When lesbian and gay staff complained to the management of the GIDS, they were ignored.
      For more information, see ‘Tavistock gender clinic “converting’ gay children”, Sunday Times, 20 June 2021; https://www.thetimes.co.uk/article/tavistock-gender-clinic-converting-gay-children-tz8cs77p3

      Although David Bell can speak for himself, my impression is that his intervention was moved less by his theoretical commitment to Freudianism and more by hearing the testimony of many whistleblowing clinicians including Bristow and Spiliadis, who came to him only because the management of the GIDS—including the associate director, Dr Wren—consistently ignored their concerns.

    2. Marcus Evans

      I’m used to slurs on my character as part of the argument surrounding this debate. It’s just part of the attempt to throw mud so that the clinical concerns are ignored. I was a manager at the Tavistock but had no part in the management of GIDs. As Michael pointed out. It was Dr Bell that raised concerns about the issue of internal homophobia as one of the factors influencing children’s wish to transition. This was a concerned raised by GIDs staff and reported to Dr Bell. As manager of the Adult and adolescent I had to deal with complaints about the service. I took the view that one always took complaints seriously as they tell you something about your service . I resigned as governor from board of governors (a voluntary position I held after retirement) because I did not believe the trust took issues raised in Dr Bells report seriously.

      As Michael Biggs points out. The alarming issue is that the GIDs service failed to follow up patients seen by the service. No data collected.

      As a manager in the trust I collected outcome measures on patients treated by the service and would routinely produce reports. Data on diagnosis, outcome of treatment, age, etc . This goes for every other clinical service provided by the trust. It’s good clinical governance to collect data as it tells you, who you are treating and the effectiveness of the treatment you provide. The downside of treatment and how you may improve the service . This is all part of good clinical governance.

      The absence of data for this service (as well as the absence of high quality long term outcome studies) is symptomatic of the politicisation of this clinical issue. It is scandalous that no short or long term was collected for this experimental treatment, which has long term implications for vulnerable children and their families.

      The need for good data has nothing to do with psychoanalysis. It’s to do with good clinical
      Practice. We learn by scrutinising our practice.

  7. Dyketagnan

    Alongside Bell and Entwhistle’s letters, LRB published a response by Wren. Most of it was whining that she didn’t like Bell or Entwhistle’s TONE and they were being MEAN about the other staff. She didn’t address a single substantive point from their letters but did make an interesting admission:

    “The bigger picture, however, is that of the cohort of children and adolescents discharged from GIDS in 2019-20, only 16 per cent had been referred to the endocrinology team. Of those, just over half (all of them over sixteen) went on to cross-sex hormones with GIDS – less than 9 per cent. The others did not start hormone treatment, or they aged out or stopped. Some of these patients may go on to receive the treatment as adults.“

    How many aged out and received treatment as adults? How many actually stopped? Wren wants to reassure people that not all these kids go into hormones without actually saying that this means that not every kid who is referred to the clinic is actually in need of transition. Because this would imply affirmation-only is wrong.

    And where are these results published? Are we meant to take her assertion on faith?

    GIDS’ responses raise more questions than answers.

  8. Karen

    When a child says they are the opposite sex, why are they being referred to this insane place that promotes mutilation?
    Surely GPS were taught biology in medical school. They know that people are either male or female.
    Where are the psychiatric institutions that used to deal with these issues? Closed.

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