Epistemic injustice *title edited by MNHQ*

[NutellaEllaElla]

Bernadette Wren, Consultant Clinical Psychologist formerly of GIDS has written this piece. I've briefly scanned it and hope to read it in more detail when I'm not on my phone. I could be wrong but at first glance I think she is trying to tread a line. I did notice the phrase "assigned female at birth" but am trying to engage fairly with her intentions rather than pick at words. Anyway, perhaps it will be of interest to some on here. I feel sorry for the staff, what a hot potato.

Diary: Epidemic Injustice

It also meant not evading the fact that trans, non-binary and queer people have been (and often still are) dismissed as knowledge holders within healthcare systems; that they are subject to ‘epistemic injustice’, since society as a whole lacks an adequate interpretative framework to understand their experiences

This^ stood out to me. I don't understand the relevance of someone's identity when accessing medicine?

There are pressures arising from the widening scope of medicine in the service of identity and well-being, and from biomedical technologies that enable novel adaptations of the body, as well as those arising from new societal demands for special rights or protections, and from the dethroning of traditional experts (this has come with a greater than ever demand for mental health support).

I'm slightly concerned that the dethroning of traditional experts means no longer relying on science or evidence based treatments...

All these issues have been thrust into the spotlight by the refusal of trans-identifying youth to accept the limits of the society into which they were born.

What limits? The reality that you cannot change sex?

This piece seems to be very disingenuous - as someone pointed out above it's all very "it's everyone else's fault" without of course any suggestion that GIDS might be doing anything wrong, or that there is any issue with the "queering" of medicine.

Shitting themselves about Cass, probably

As regards this “For years, we had relied on local CAMHS teams to screen and support young people with psychosocial difficulties before referring them to GIDS, and to keep that support in place while we attended to gender concerns. But in 2016, NHS England commissioners ruled that GPs, schools and social workers could refer patients to the service directly. More problematic still, many local CAMHS teams, overstretched and understaffed, withdrew support for these children, reasoning that a well-funded highly specialist service like GIDS should be able to cope.” this is what a former patient has to say.
twitter.com/MediocreDruid/status/1462435765145714692

“All these issues have been thrust into the spotlight by the refusal of trans-identifying youth to accept the limits of the society into which they were born“

As I think another poster has already pointed out, all her previous apparent neutrality is cancelled imo by this summing up.

It as though it is being implied that the limits are arbitrary coming from a repressive society and that the trans identifying youths are right to oppose them. When the actual limits that are facing them could be those arising from myriad difficulties in their lives, in which case the limits will not be lessened but increased by their transition.

Also, I question that these issues are being thrust into the spotlight by the trans youths themselves. I think they are being thrust into the spotlight by American academics, doctors practising trans surgeries, algorithms from the internet, and social contagion.

Proper bullshit, basically.

It was not me gov, it was all the other big boys that done it.

There’s a long letter from David Bell responding to Wren’s article in the new edition, also from former GIDS clinician Kirsty Entwhistle, and a response from Wren.

Bell’s letter covers in detail the “climate of intimidation” at GIDS, co-morbidities in the patient group, detransitioners etc

Wren says their tone is “wounding and dismaying”. The only substantive point she addresses though is the number of young people going onto cross sex hormones, which Bell puts at 98%.
“It is true that in one published study of a small, highly selective group of young people with severe and long-standing gender dysphoria persisting into adolescence, 98 per cent of those who started on puberty blockers proceeded to cross-sex hormones at sixteen. The bigger picture, however, is that of the cohort of children and adolescents discharged fromGIDSin 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 withGIDS– 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.”

Transgender Trend published this letter from the superb Dr Michael Biggs:
www.transgendertrend.com/letter-bernadette-wren/:

I make no apologies for repeating the last 2 damning paragraphs:

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.

Thank you for updating the thread, your link doesn't appear to be working. I'll try again for you
Response by Dr. Biggs

and i'll add another link
responses by Dr Entwistle and Dr Bell

Thanks for the links - I couldn’t work out how to do it.

Bell's letter is so clear and careful, and Wren’s response just seems like rhetoric. E.g. when she talks about “uninflected proselytising, expressed in an antagonistic idiom” when Bell’s writing seems the exact opposite of that.

One thing that jumped out at me was her claim that critics like Bell and Entwhistle have “no regard for the welfare of the existing GIDS team, many of whom are lesbian, gay or queer.” What does the sexuality of the clinicians have to do with whether critics can question the treatment given to children?

(In her original article she also mentions an “LGBT group was established by staff and trainees” and having listened to the Nolan podcasts, and the role of these kinds of networks within the BBC etc, I’m finding that suggestive.)