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Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children Hardcover – 23 Feb. 2023

4.8 4.8 out of 5 stars 424 ratings

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SHORTLISTED FOR THE BAILLIE GIFFORD PRIZE FOR NON-FICTION

SHORTLISTED FOR THE ORWELL PRIZE FOR POLITICAL WRITING

'This is what journalism is for' - Observer

Time to Think goes behind the headlines to reveal the truth about the NHS’s flagship gender service for children.

The Tavistock's Gender Identity Development Service (GIDS) was set up initially to provide talking therapies to young people who were questioning their gender identity.

But in the last decade GIDS referred around two thousand children, some as young as nine years old, for medication to block their puberty. In the same period, the number of referrals exploded and the profile of the patients changed: from largely pre-pubescent boys to mostly adolescent girls, who were often contending with other difficulties. Was there enough clinical evidence to justify such profound medical interventions?

This urgent, scrupulous and dramatic book explains how GIDS has been the site of a serious medical scandal, in which ideological concerns took priority over clinical practice.It is a disturbing and gripping parable for our times.

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From the Publisher

Shortlisted for the Baillie Gifford
'Raw, honest and moving' - Emily Maitlis
About Hannah Barnes
Times and Financial Times Best Books of 2023

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Review

‘An exemplary and detailed analysis of a place whose doctors, Barnes writes, most commonly describe it as “mad”... Powerful’ - Financial Times

‘A deeply reported, scrupulously non-judgmental account of the collapse of the NHS service, based on hundreds of hours of interviews with former clinicians and patients. It is also a jaw-dropping insight into failure: failure of leadership, of child safeguarding and of the NHS’ - Sunday Times

‘This book is a testament to the moral courage of Hutchinson and colleagues who sought to expose the chaos and insanity they saw while practising by stealth the in-depth therapy they believed young people deserved … And Hannah Barnes has honoured them with her dogged, irreproachable yet gripping account’ - The Times

'This incredibly important book shows that we still don’t know how many children were damaged for life. I want every institution and every politician who pontificates about gender to read this book and ask what happened to all those lost girls and boys – and why they were complicit’ - Daily Telegraph

‘At times, the world Barnes describes feels like some dystopian novel. But it isn’t, of course. It really happened, and she has worked bravely and unstintingly to expose it. This is what journalism is for’ - Observer

‘The question Barnes puts at the centre of this book is “Are we hurting children?" What follows is an extraordinarily sensitive and important piece of work that exposes the huge price some of our young have had to pay for a system that was simply not rigorous enough in asking that question. Time to Think – which explores the rapid rise and phenomenal growth of the GIDS clinic at the Tavistock – is essential reading for anyone who wants to understand how safeguarding concerns got lost, despite the best intentions of practically all those involved.

'The testimonies in the book are raw, honest and moving. More than that they are a vital piece of evidence that shows – without prejudice – where things went right, where things went wrong and, remarkably, the thousands of cases of young people where we still don’t know' Emily Maitlis

'Time to Think shows what happens when the exponents of an ideology, so certain of its righteousness, capture a field of medicine, silencing critics, refusing even to collect follow-up data on whether its treatments actually work' - The Times Best Books of 2023 So Far

‘A powerful investigation … The interviews with staff and children ― some who have happily transitioned and some who have not ― show how complex the issues are. Not a comfortable read but meticulous and thought-provoking’ - Camilla Cavendish, Financial Times, Best Summer Books of 2023

'Meticulous and scrupulously researched book on Gids’ downfall' - Lucy Mangan, Guardian

'Truly illluminating ... a work of diligent, intellectually fearless reportage into the Tavistock Centre’s child gender identity development service' - Sunday Times, Best Books of Summer

'A brilliant book written in a very thoughtful way about the failures of the Tavistock clinic' - Wes Streeting

About the Author

Hannah Barnes spent fifteen years at the BBC specialising in analytical and investigative journalism, most recently as Investigations Producer for BBC Newsnight. Hannah is now an Associate Editor and Writer at the New Statesman.

Product details

  • Publisher ‏ : ‎ Swift Press (23 Feb. 2023)
  • Language ‏ : ‎ English
  • Hardcover ‏ : ‎ 464 pages
  • ISBN-10 ‏ : ‎ 1800751117
  • ISBN-13 ‏ : ‎ 978-1800751118
  • Dimensions ‏ : ‎ 16 x 3.5 x 24 cm
  • Customer reviews:
    4.8 4.8 out of 5 stars 424 ratings

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Hannah Barnes
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Hannah Barnes is an Associate Editor and Writer at the New Statesman. Prior to that she spent 15 years at the BBC specialising in analytical and investigative journalism on both television and radio. She has produced and reported a variety of Radio 4's best known long-form shows and been a daily editor of the Today programme. She was later Investigations Producer for BBC Newsnight. Her book, Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children, is a Sunday Times Bestseller and was shortlisted for Orwell Prize for Political Writing and Baillie Gifford Prize for Non-Fiction.

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Top reviews from United Kingdom

  • Reviewed in the United Kingdom on 11 April 2024
    It's a disturbing bit of journalism focused on facts and evidence from senior staff swept up in the GIDS story. I found it gripping and value the clear writing. Do read this if you care about troubled health services and the young people who used them. This is a real story about real people in a difficult area of care, set apart by its cool analysis from the fevered and partisan public debate on trans issues.
    7 people found this helpful
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  • Reviewed in the United Kingdom on 2 January 2024
    This is a scrupulously researched account of what went wrong at the Tavistock/GIDS, and a fair-minded explanation of some of the reasons why what happened did happen. There are no bad actors in this story (made up of several stories); pretty much everyone is well intentioned. It's just that sometimes people seeking to help others end up harming them -- particularly, in medicine, when, as here, there is very little evidence base to act upon, and medics are placed under various forms of social and political pressure. (Things can also go wrong, of course, when there is too little social and political oversight.)

    Barnes is very clear about her sources (clear about who they are when they have given permission; clear about how she is using sources that wanted to remain anonymous; and clear about when she is offering up her opinion). Barnes also knows that she has to be scrupulous, to avoid being dismissed -- on grounds of being transphobic, or otherwise. In fact, this is not a book that comes over as being prejudiced; and all the main voices quoted are clearly happy to support trans clients.

    It's been stated that 20 publishers rejected this book; it's hard to see why they would do that, unless out of fear to be seen in some way as insensitive. The one reasonable objection to the book is that, because it is factually scrupulous, certain sections are not an entertaining read. (The use of interspersed chapters giving personal case histories mitigates this.) But given the clear importance of the issues under discussion, it would seem hard to justifying rejecting the typescript on that ground. Credit is also due, then, to Swift publishers, without whom this book may not have seen the light of day. (Their editor, though, might have picked up on the difference between 'who' and 'whom'.) Credit is also due to Newsnight and the BBC, where Barnes did her original work.

    Those wanting to look at the earlier history of gender, and its place within medicine, might look at the earlier chapters of Helen Joyce's 'Trans'. (The book, though, is mainly about 'transactivism'.)
    15 people found this helpful
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  • Reviewed in the United Kingdom on 6 August 2024
    This both informs of the facts and educates you about a complex issue.
    2 people found this helpful
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  • Reviewed in the United Kingdom on 25 March 2023
    You know you’re working for a dysfunctional organisation when it exhibits all or some of the following behaviours;

    Ignoring reasonable challenge, or gaslighting those who practise it;

    Cultivating a family culture which puts the organisation above criticism;

    Writing of minutes before the meeting, or after the meeting but with important issues fudged or left out altogether;

    Indiscriminate over-ride of long-standing governance processes;

    Refusal to wait for the outcome of studies before embarking on objectively risky courses of action;

    Dismissal of concerns on the basis of “lack of evidence” whilst ignoring or suppressing whatever evidence exists;

    Caving-in to extreme unrepresentative pressure groups;

    Paternalistic “we know best” attitudes;

    The emergence of “unwritten but mandated” behavioural codes;

    The abandonment of objectively necessary process improvements on obviously bogus grounds, principally that they are “all too difficult.”

    All of these “10 Deadly Sins” were hard-baked into the culture of the now closed Gender Identity Development Service (GIDS) that was part of the Tavistock health trust, and are covered extensively in Hannah Barnes’s book TIME TO THINK.

    It is hardly surprising, and another organisational “red flag,” that several of the main actors in this sorry tale refused to be interviewed by Barnes for the book, but within this limitation, Barnes gives a very good account of the rise and fall of the service, albeit one that is a little long-winded in parts.

    But for those who are predisposed to believe that any criticism of any gender identity service is inherently transphobic, the book is more balanced than one might expect. It relates the story of one patient who is very happy with her trans status and thought so highly of the organisation’s work that she sat on its recruitment panels.

    It’s very nice to see the story of the dysfunctional GIDS service coming out when it is still contemporary news, rather than years after the event, as has so often been the case with organisational scandals of the past. That said, it took no fewer than five reports, the earliest one dating back to 2005, for the day-to-day reality of GIDS to be acknowledged, and the most recent ones (2020-vintage) made the same criticisms as were made in the first.

    In trying to be both comprehensive and balanced, TIME TO THINK becomes a bit long-winded and over-detailed in parts. For this reason it gets four stars rather than five from me. However, this is still a very good mark. Any student of organisational behavioural theory should read it.
    38 people found this helpful
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Top reviews from other countries

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  • Amazon Customer
    5.0 out of 5 stars Livre sur une clinique du genre
    Reviewed in Canada on 4 August 2023
    Excellent pour pour comprendre l’idéologie du genre dans ses dérives
  • missmuffintop
    5.0 out of 5 stars Institutional Failure
    Reviewed in the United States on 1 March 2023
    Exhaustively researched and cogently written, this book is interesting enough on its own as a portrait of profound institutional failure. If you've ever worked in an unethical organization, you'll recognize a lot of familiar territory: an opaque mission, nonexistent metrics, suppression of any information deemed negative, branding of people who speak up as troublemakers or simply not cut out for the work (and purging them), the halo effect, and a siege mentality. I'm reminded of the quote from All the President's Men: "The truth is, these are not very bright guys, and things got out of hand." I'm of course referring to so-called leadership at GIDS, and not the brave whistleblowers whose accounts form the basis of this book.

    What's most troubling to me is that, just as countries like the United Kingdom, Finland, and Sweden have taken a hard look at the evidence in favor of puberty blockers and the gender affirmative model and found it sorely lacking, the United States is doubling down on an even more lax, esoteric model. These concerns cannot be dismissed out of hand as transphobia. Dr. Marci Bowers and Dr. Erica Anderson, experts in their field and trans women themselves, have voiced concerns about this. There are many areas of medicine where there is a lack of agreement and no single, definitive answer around how best to address the source of a patient's distress. What is so unique about gender dysphoria that it precludes any discussion or debate around the best way to treat it?
  • Ostrogoth
    5.0 out of 5 stars Umfangreiche Darstellung der Entwicklungen um den Gender Identity Service der Tavistockklinik
    Reviewed in Germany on 15 December 2024
    In Großbritannien hat sich der Wind gegenüber frühen Geschlechtsangleichungen von Kindern und Jugendlichen vollkommen gedreht. Seit 2024 sind sogar Pubertätsblocker, also Medikamente zur Unterdrückung der biologisch angelegten Pubertät, verboten. Nutzen und Risiken dieser Medikamente sind zu wenig erforscht und daher ist die Behandlung von Minderjährigen mit Geschlechtsdysphorie damit hochgradig experimentiell.

    Dem voraus gingen jahrelange Warnungen von Whistleblowern, die in der ehemals einzigen Ambulanz für Kinder und Jugendliche mit Geschlechtsdysphorie tätig waren, sowie ein Aufsehen erregender Prozess der ehemaligen Patientin und Detransitioniererin Keira Bell. Danach beauftragte der Betreiber der Klinik mit der umstrittenen Genderambulanz, der NHS eine unabhängige Untersuchung. Diese wurde von Hilary Cass durchgeführt und ging als Cass Review in die Geschichte ein. Die Ergebnisse waren schockierend und führten dazu, dass die Genderambulanz schließen musste.

    Die Journalistin Hannah Barnes hat ein Buch vorgelegt, mit dem sie die Geschichte dieser Genderambulanz von ihrem Anfang bis zu ihrem Ende erzählt. Hierbei stützt sie sich auch auf vielfältige persönliche Erfahrungsberichte ehemaliger Patienten/Patientinnen und deren Eltern sowie Ärztinnen und Ärzten.

    Entstanden ist ein sehr lesenswertes, weil differenziertes Buch mit tiefen Einblicken, was auch in Deutschland für alle Menschen Pflichtlektüre sein sollte, die verstehen wollen, wieso der Behandlungsansatz mit Pubertätsblockern ein umstrittener ist und wieso Großbritannien die Kehrtwende vollzogen hat.
  • SL
    5.0 out of 5 stars Livre essentiel sur les abérrations du problème transgenre
    Reviewed in France on 23 June 2023
    Ce livre décrit en détail (avec des répétitions nécessaires pour pouvoir retenir une histoire si compliquée) les abérrations de la clinique principale anglaise qui s'occupait du 'problème transgenre' parmi les enfants et les adolescents. Il montre clairement l'aveuglement de beaucoup des 'experts' médicaux, et illustre très bien le proverbe que 'le chemin vers l'enfer est pavé de bonnes intentions'. En voulant aider des personnes très jeunes et leurs familles (et en participant à un champ de médicine neuf et donc attirant, et même lucratif), beaucoup du personnel de la Tavistock Clinic a pris le risque de gâcher l'avenir de leurs patient(e)s, en leur donnant des bétabloquants et des traitements hormunaux dont les effets ne sont toujours pas connus à long terme, sur base d'un minimum d'évidence et sans prendre les précautions les plus élémentaires. Que la France, la Belgique et le Canada en prenne bien note, car les mêmes maux sévissent chez nous, chez vous aussi.
  • M Eklund
    5.0 out of 5 stars Important!
    Reviewed in the Netherlands on 12 May 2023
    This should be obligatory reading for anyone supporting gender ideology.