david bell has never worked in gender clinics. tavistock where he worked has a gender clinic, but also has a community clinic, a drug and alcohol clinic etc and they are distinct from each other. he worked at tavistock but where he worked in it matters. itâs like saying that someone who works at disneyland has inside knowledge on how they run the animation studio or vice versa. it just isnât true and doesnât make sense. same company, completely different areas.
I'll answer this because I think you're sending it in good faith, but I think this is an absurd bone to pick, and that it's one you're picking to give yourself sufficient reason to discredit the very real concerns being raised by people who have been very close to this work. It isn't even a bone you're picking with Bell himself, which could at least be a point of actual discussion. It's a bone with how I passingly characterized his account of widespread medical experimentation (the use of medicine that is not yet shown by data to be effective at treating the condition for which it is being used) on gender nonconforming children who have an unusually high incidence among them of other mental health problems. To draw a parallel, this is like if I said in a passing comment that the restaurant where I work had started serving Campbell's chicken noodle soup as miso soup and someone chimed in, "Ahhhhh but you work behind the bar and not in the kitchen!" Except instead of soup we're talking about the possibility that barely pubescent children are regularly being set by professionals on a path to treating a psychological problem (a problem they're often prevented by trained clinicians from even understanding as a form of emotional distress rather than as a statement of objective identity reality within them) with lifelong medical intervention that will impact sexual and reproductive decisions they cannot (according to at least one apparently generally well regarded judge in the UK) even conceptually understand, without first making attempts to do literally anything else to work on the underlying emotional distress itself.
It's a serious accusation. I understand if your impulse is to flinch from it because it was mine- it seems absurd!!!- but either take issue with the accusation itself or don't, investigate it or write it off immediately as nonsense, but don't disrespect either myself or yourself by taking issue with how I presented his work in a comment I took fewer than 10 seconds to write. You genuinely owe more to yourself. Maybe you don't like my telling- fine, you don't have to take it at face value. You can read it in The Observer here, or read the first reporting on his findings in The Guardian here.
The point isn't that David Bell is some gender expert and in fact in my personal estimation his opinion on the matter is leant significant credence by the fact that he's not someone who's spent 100,000 hours in trainings about gender identity at his workplace. The point isn't even that David Bell broadly has good opinions on the treatment of psychological problems with medical interventions. The point is that David Bell worked at the institution for 25 years, during which he oversaw important and large chunks of their functions and came to hold major responsibilities in that institution, and that after GIDS clinicians themselves kept bringing their concerns to him he felt obligated to ring several alarm bells about it in 2018- to use your comparison to companies, this is actually much more like someone in the accounting office of a corporate restaurant chain seeing a lot of holes in their restaurants' books and ringing alarms. Mind you, David Bell was not the first person to make similar complaints about the work being done on children experiencing gender dysphoria- Sue Evans WAS a psychotherapist working in GIDS directly who began to have similar reservations in the early to mid 2000s, with particular concern about the speed at which children were being funneled into hormonal treatment. The fact that Bell was not the first to make the claim does not make the claim true or false, but if Bell's distance from the GIDS service itself provides you buffer that allows you not to look further then I'm providing you with Sue Evans' case because it strips that distance. You may notice in the Guardian piece that parents are noted as being concerned with what they claim was a lack of the complex psychological evaluation of people aged 17 to 25 that, they believed, GIDS would use to evaluate children. Sue Evans was not even happy with the care these parents are saying they wish their late adolescents were getting.
If you want to argue that David Bell made the whole thing up, that's one thing. If you want to argue that Sue and husband Marcus Evans, both of whom are now retired sort-of whistleblowers, are simply making some fuss to drum up sales on their new evil conversion therapy manual on psychotherapy for gender dysphoria, and that listening to them is dangerous because they hold the position that transition isn't the best choice for everyone dealing with gender dysphoria (which, as the concept becomes familiar to more people and registers to them as a legible way to talk about their distress, will itself necessarily become more common) then that's one thing. If you want to simply argue that it's bigoted for Bell not to approach the topic of medical intervention itself as one solely of identity rather than as a medical intervention offered for a problem, then that's one thing. Those are assertions that we could discuss. But to sit here and pick this minute bone tells me that you clicked that link and you saw something that bothered you, and that when it bothered you you typed this up and thought it would put the whole thing to bed for you. But I'll bet it didn't work and I really hope it doesn't, and that you investigate the claim further, and when you do that we can discuss evidence for and against the claim and if you come to think it's mostly bogus we can discuss that, but I'm not going to allow a conversation about funneling children into medical intervention as identity support to be derailed into a discussion about which office David Bell worked in. Let's focus in on a few of the things I found when I went to investigate this claim, largely presented by people who think they're getting on the right side of a civil rights movement by advocating for these practices.
Here's a video from 7 years ago of Johanna Olson-Kennedy, a doctor who was then working specifically with children at a children's hospital in LA, talking about the natural puberty of their bodies as "the wrong puberty" and positing puberty hormone blockers as the way to allow children to have the puberty that "corresponds to their brain," and making the argument that gender dysphoria isn't even a mental health issue at all. Absolute best case scenario, the concept of a medical professional telling a child that the natural and healthy process their body is going to embark on soon is WRONG would be shocking in any other context, especially when told to, as she claims, especially vulnerable children. She makes no mention of the fact that this intervention is one that allegedly is a treatment for the psychological distress called gender dysphoria and seems hostile even to that framing- in particular she seems very much to be advocating for making medical decisions based not on treatment of a problem but on identity crystallization and affirmation, conflating gender dysphoria (a form of psychological distress) and gender identity (a particular concept which some people, but not all, and frankly not most people feel is central to whether they are a man or a woman, or at least to describing what kind of person they want to be).
Here's the same doctor advocating for children to be able to get double mastectomies at 13 because they rarely regret it, implying that patients should get double mastectomies before they've been on testosterone for too long because testosterone can exacerbate the "mismatch" between one's overall look and one's chest, and implying that it is common for nipple sensation loss after double mastectomies to be temporary. Any doctor who works regularly with dysphoric people SHOULD know that we have a tendency to displace the distress- that many people take hormones and then think their face is too sexed or their hands or their hips or their whatever- so to hear her discuss perceived mismatch and relief at the removal of breasts as the way to fix it is alarming, because those of us who experience this problem know that usually the anxiety shifts and finds another point of focus, since the problem is not the fact that we have breasts. This doctor strikes me as functionally invoking the obsessive component so common in gender dysphoric people as proof that the treatment is working. At 11:19, a woman asks, "I'm a psychologist who works with trans youth and when I endorse them for surgery through the insurance companies, they want- there's a part of the form that says, 'I have discussed the complications or the problems with these procedures,' and just ethically, what am I supposed to say to them?" To be clear, this sounds like a mental health care professional who is entrusted with providing care for gender dysphoric people raising an ethical objection to the informed part of informed consent. Olson-Kennedy bizarrely frames this as a matter of transgender healthcare being designed to make cisgender people comfortable, laments that sometimes insurance companies "need" that to "feel okay about somebody else's body" as though these companies have feelings (another instance of what a lot of the people here share, a propensity to talk about absolute nonsense like corporations having feelings and the expectation that the audience will accept it as fact and move on) about what's best for individuals, and claims that it's unusual to need to inform patients of treatment risks in mental health care as though that would be a good thing if true for most patients, but says that mentioning nipple sensation loss and "dog ears" while also mentioning that patients rarely regret surgery should suffice. She then goes on to compare double mastectomies to choosing a college, to say that "if you want breasts later in life you can go and get them," to mock the concerns parents might have for their child's ability to even make future reproductive decisions as selfish fuss about grandchildren, and even to suggest that clinicians help arm-twist mothers into supporting their children's mastectomies by having them wear binders for a while to experience that discomfort since obviously it's the alternative to removing a teenagers breasts before that teen can even legally consent to sex, let alone sign a legally binding contract. She laughs at people who think "you can make" someone transgender, while being an advocate for puberty blockers despite the fact that almost all children who get on them will eventually be moved onto cross sex hormones.
This is where I am going to have to address what I'm sure is a new bone you'd like to pick. But, you may say, that video is posted by a group that clearly opposes pediatric transition outright! That seems to be true! You can agree or disagree with that position, but the video itself doesn't show Olson-Kennedy's words chopped and screwed or heavily minced, it shows her making her own case. I'm loading this because I'm sure that the overall bent of the channel is going to have a very ouchy impact on that nerve which you've trained yourself to look away when touched. If your curiosity or your own sense that you kind of have to look into the massive allegation here, drives you to look at more, you'll find things like
This video in which Diane Ehrensaft, developmental and clinical psychologist in the San Francisco Bay Area and the Director of Mental Health and founding member of the Child and Adolescent Gender Center run through UCSF, suggests in her care guidelines that clinicians should "help the child discover the gender position that feels most authentic" and "fortify the child's gender resilience" as though that means absolutely anything at all and is evidence supported medical guidance rather than a lot of massive ideological propositions about gender rolled into her ideal treatment model. She later refers to a child by saying that they "fully transitioned from male to female" between 3rd and 4th grade, chuckling as she says they were "post transition" at the age of 9. Obviously she's not referring to any surgical or likely even hormonal interventions, but it is striking to hear. In particular her point that one should fortify the child's gender resilience makes me deeply uncomfortable, because what I think she would say is that she means affirming the child in who they say they are, but I think that she means deepening the roots of the child's apparently coping mechanism of gender dysphoria. This is especially troubling to hear from a psychologist who should understand that children can only make claims using the concepts they have formed, such that a child who says their stomach hurts when they go to school is not lying about distress or even the symptom itself, but is using the language they have available to say, "I'm anxious!"
Here's a BBC Newsnight episode that details several relevant parts of the issue, given the context that in 2014 GIDS received NHS approval to begin giving puberty blockers to children as young as 11 years old despite the pronounced lack of evidence of what they'd do to things like brain development and bone development and despite the fact that a poorly designed study it (GIDS) built to address those questions had only just begun. The policy change came after the number of children referred to GIDS shot from 97 in 2009/10 to 969 in 2015/16 to 2,590 on 2018/19, and in 2015/16 that included one three year old and three four year olds.
You're trying to change the point for the sake of your own comfort, and I won't let you and I genuinely think you deserve better than trying to make yourself comfortable with something that makes you uncomfortable. Here are my conclusions: I took a peek and I got a view at what strikes me very clearly as a medical scandal, and one that upsets me particularly as someone who experiences gender dysphoria and finds it disturbing to see a doctor who's in charge of a children's gender clinic saying nonsense about gender resilience about children in a state of emotional distress, or telling children that their natural and healthy puberty can be "wrong" puberty. At its core, these interventions only make sense if you believe that a female child is can be a boy who is LITERALLY stuck in the "wrong" body and that therefore all your interventions on the body are actually addressing the problem, the "wrong" element. If, on the other hand, you think these individuals are suffering from a set of very complex forms of emotional distress, sometimes in reaction to gender itself and sometimes just happening to utilize as a vehicle for the distress a major framework that children get very early in their development (the distinction between male and female is one of a few concepts children start to reliably understand quite early, and therefore it is reasonable even in children who are not gender nonconforming that one of the first ways they might be able to vocalize their distress is through that concept) then this looks like medical professionals telling children there's something wrong with their bodies when there factually is not and COULD not be, and suggesting making interventions on a body that's literally not the problem. For a child to tell you they were born in the wrong body is one thing- it is metaphorical language the child is using to express a real desire or real distress- but for a doctor to tell a child they could be born in the wrong body, as though any of us were SUPPOSED to be born anything let alone the other sex, that's irresponsible toying with people who don't yet understand even the basic frameworks at play here and therefore can't even understand that they're being medicalized on the basis of ideology and not on the basis of medicine.
To be very clear, it's one thing for adults to be making hopefully informed decision. Obviously I don't believe it is possible to actually change sexes, but adults who have a clear understanding of that concept and of what they are actually doing by pursuing transition (which is changing things about their body that cause them emotional distress and doing so in a way that will facilitate other people seeing them the way they want to be seen) can look at the pros and cons of transition as medical intervention and decide how they weigh things like finding clothing easily and sexual satisfaction. That's one set of questions to consider. It's another to be messing around with children's core concepts by telling them that their bodies could even POSSIBLY be "wrong" before they've reached the age, around 7 for most children, when they can even developmentally grasp the concept of sex constancy- that people who are female, for instance, are female all the time even if you put them in "male" clothing. These doctors are talking about identity affirmation and how children know who they are because gender identity because they've read the books and done the work you bigot! None of them are asking what condition they're treating, whether the treatment works reliably, or what working even means. They also seem shocked that a child who's in such severe distress that they've even landed at GIDS to begin with would not just find their way out of gender dysphoria in a couple of years while in therapy at clinics that encourage them to see their emotional distress as indicating an essential component of their baseline identity, and that their distress might only grow as their peers all develop and they remain literally incapable of developing more emotional tools to cope with the distress they're experiencing because a doctor paused their brain development on purpose due to favoring cosmetic changes that allow children a better opportunity to be visually perceived as the opposite sex over all of the risks associated with blockers. So maybe you look at all of this and see absolutely nothing, but I looked and I see something, so I'm going to say something. I hope that if you see something, you begin to find yourself able to say something as well, at least in the context of safe private relationships where you should be able to discuss ideas on their own merits without being interpreted in the least charitable light possible.
