John Launer: Gender identity, polemics, and empathyBMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p477 (Published 01 March 2023) Cite this as: BMJ 2023;380:p477
- John Launer, GP educator and writer
Follow John on Twitter @johnlauner
I worked part time for many years at the Tavistock Clinic in London and still hold an honorary post there. The clinic is one of the most prestigious teaching institutions for psychological treatment in the NHS and the world. I’m proud to be associated with it. My role was in primary care education and as a family therapist. I never worked with patients who had gender dysphoria, although I was aware of a small unit there that specialised in helping them. The unit has figured much in the news recently.1
Over my years at the Tavistock I got to know several colleagues who worked in that unit. I heard how the numbers of young people they saw rose exponentially, in line with social awareness of gender dysphoria and public acceptance of it. They often dealt with hostility from patients, families, and pressure groups who believed that the service should offer treatment more readily. Internally, they faced criticism by some clinicians who believed in a more cautious approach involving a much longer assessment.2 I knew and respected people who held passionate positions on both sides of this question.
The stresses on the service continued to increase, and the debate about approaches to treatment eventually erupted in a very public controversy. This was played out with the involvement of the courts, the Care Quality Commission, and the media. It culminated last summer with an interim report from Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, that recommended the closure of the service and its replacement within specialist children’s hospitals.3 This was widely reported in the national press and The BMJ.4
Since then I’ve been concerned to hear, overhear, and read a lot of angry or critical words about the affair. Many comments have been brazenly partisan and ill informed, including false reports that the entire Tavistock Clinic was shutting down. Few people offering their views with vehemence and certainty seem to have read the Cass report itself, which is even handed and nuanced, looking at the wider historical and cultural contexts in which problems have developed.
It is worth trying to understand, as Cass did, the predicaments faced by everyone involved. There were young people who desperately wished to change their gender but found that medical and psychological support in the UK was massively lacking. Some patients underwent gender change but uncovered other psychological conflicts for which support was also deficient. Some clinicians strove to make the best decisions they could in a situation where evidence was thin and the politics noisy. Those who believed in a prolonged therapeutic approach didn’t have adequate resources to offer this either. It’s not clear whether these will be available in the new services.
Cass wrote in her report, “As with many contemporary polarised disagreements, the situation is exacerbated when there is no space to have open, non-judgemental discussions about these differing perspectives.” What we need most now are empathy and dialogue, not polemics and blame.
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.