First do no harm: reflections on gender dysphoria in children and young people (video)

Thursday 24th November, 6.00pm.

Topic: First do no harm: reflections on gender dysphoria in children and young people

Speaker: Dr David Bell

Between 2009 and 2019 the referral rate to the Tavistock Gender Identity Disorder Service (GIDS) increased from about 90 per year to about 2700. In 2018, in his role as Clinical and Academic Staff Representative on the Council of Governors, Dr Bell describes how he was approached by a large number of GIDS staff who raised very serious concerns about the quality of the assessment procedures, the lack of attention to consent and the atmosphere of intimidation directed to any staff who expressed concerns. Dr Bell did not work in the service and does not work with children or adolescents.

These meetings formed the basis of a critical report submitted to the Trust which was subsequently widely discussed in the press. This, along with similar concerns raised by parents, other colleagues and organisations led to rising public concern about GIDS. This resulted in a Judicial Review and finally to the decision by NHS England, following the Cass Review, to close the service. The Cass Review recommended that rather than providing a single specialist GIDS, patients would be better served by a number (~8) of regional services with a “broad clinical perspective” linked to multidisciplinary teams and specialist paediatric departments. Given the requirement to stabilise current service provision for existing patients, two new “early adopter services” have been established, one of which will be at the South London and Maudsley NHS Foundation Trust.

Over the last four years Dr Bell has been involved in thinking about the current debate over gender dysphoria in children and adolescents, trying to maintain a thoughtful and psychoanalytic perspective in a contested and politicised climate. In this talk he presents his views and concerns, offering some suggestions as to what may underlie the large increase in the number of children and young people seeking transition. He also discusses what he considers to be a peculiar state of thinking, or rather non-thinking, that has come to dominate discussions of gender identity disorders. The view presented here is his own.

The topic of gender identity is controversial and already has an academic literature which is too large to signpost here. A perspective on clinical approaches and practice is offered by the Cass Report.


Dr David Bell is a Psychoanalyst and Consultant Psychiatrist (retiring from his consultant post in 2021). He worked at the Tavistock for more than 25 years, and developed and led the Fitzjohn’s Unit, a service for the most complex and severe adult cases referred to the Trust. He is a past President of the British Psychoanalytical Society. He lectures and publishes on a wide range of subjects including the work of Freud, Klein, Bion and the understanding of severe psychological disorder. Books include: Reason and Passion, Psychoanalysis and Culture: a Kleinian Perspective, Living on the Border, Turning the Tide (on the work of the Fitzjohn’s Unit), and Paranoia. He is one of the UK’s leading psychiatric experts in asylum and immigration.

Leave a Reply

Your email address will not be published. Required fields are marked *