Body Dysmorphia (BBC Horizon)

[d4m10n]

Came across this old episode of BBC Horizon today, full video available at the Internet Archive. The episode summary and transcript are available here and the basic gist is that a documentary crew followed around an American woman named Corinne and a middle-aged psychotherapist named Gregg as they sought out a surgical solution to the problem of having two healthy legs.

The consulting psychiatrist is a fellow named Russell Reid^WP, who would go on to get in a spot of bother with the General Medical Council. Reid is careful to point out that these patients are neither delusional nor psychotic:

Quote:

These people are not mentally ill in the sense of having a serious mental illness or psychosis. They're not hearing voices, they're not deluded. It's not as if some force is telling them to have their limb off and they're following their paranoid delusion to do that. If that were the case then they would be psychotic, but they're not like that.

He does call their condition a disorder, however.

It would be fascinating (IMO) to see how these patients have gotten on all these years later.

[theprestige]

He seems to be making what he believes is an important technical distinction, but it is entirely lost on this layman.

[d4m10n]

Originally Posted by theprestige

He seems to be making what he believes is an important technical distinction, but it is entirely lost on this layman.

It is elusive to be sure. I got the sense from the interviews that he'd definitely not recommend amputation if the patient was delusional or psychotic, but he would do so if the disorder was dysmorphic in nature.

Sent from my SM-G996U using Tapatalk

[theprestige]

That sure seems delusional and psychotic to me.

Maybe this is a Crimes of the Future thing? Rational people doing surgery on themselves as a form of transgressive art?

[Planigale]

This is partly a legal issue. The role of the psychiatrist in this instance is not to say whether the leg should be amputated or not, it is to say whether the patient is legally able to consent to the surgery. If delusional e.g. believing that there are insects burrowing under the skin of the leg that will spread if the leg is not removed then they cannot give legal consent. If they are psychotic and a voice has told them they need to amputate their legs because ... then they cannot give consent. If the patient is not psychotic or delusional and has adequate cognitive function then they are competent to make a decision about their body, there is no requirement for that decision too be rational.

However there is no requirement for a surgeon to operate, it might well be illegal.

People can become very fixed on their bodies, hence the existence of cosmetic surgery.

The problem is that treatment of body dysmorphia with drugs or psychotherapy is not very effective (but can be effective for some people), sometimes the easier option seems to be surgery. Time does seem effective most people grow out of body dysmorphia (but not all).

[Darat]

Originally Posted by theprestige

He seems to be making what he believes is an important technical distinction, but it is entirely lost on this layman.

The difference is what lies at the heart of all non-medically required "cosmetic" surgery. The patient may be happy with the outcome, but the surgeon is still causing injury to the patient for no medical or (physical) health reason. Is someone wanting a breast enlargement psychotic or delusional because they feel they will be better in some undefined way with larger breasts? (Indeed we should note that they do not actually get larger breasts all they achieve is a semblance of larger breasts.)

Despite the prevalence of cosmetic surgery and its legal and social acceptability in our societies I do wonder if many people having cosmetic surgery would be better served by it being approached as a mental health issue and dealt with treatment for a mental health issue rather than resorting to irreversible "cosmetic" surgery.

[Carrot Flower King]

Originally Posted by theprestige

He seems to be making what he believes is an important technical distinction, but it is entirely lost on this layman.

It's one which is lost on quite a number of psychiatrists I knew...

[Samson]

Originally Posted by Darat

The difference is what lies at the heart of all non-medically required "cosmetic" surgery. The patient may be happy with the outcome, but the surgeon is still causing injury to the patient for no medical or (physical) health reason. Is someone wanting a breast enlargement psychotic or delusional because they feel they will be better in some undefined way with larger breasts? (Indeed we should note that they do not actually get larger breasts all they achieve is a semblance of larger breasts.)

Despite the prevalence of cosmetic surgery and its legal and social acceptability in our societies I do wonder if many people having cosmetic surgery would be better served by it being approached as a mental health issue and dealt with treatment for a mental health issue rather than resorting to irreversible "cosmetic" surgery.

Originally Posted by Planigale

This is partly a legal issue. The role of the psychiatrist in this instance is not to say whether the leg should be amputated or not, it is to say whether the patient is legally able to consent to the surgery. If delusional e.g. believing that there are insects burrowing under the skin of the leg that will spread if the leg is not removed then they cannot give legal consent. If they are psychotic and a voice has told them they need to amputate their legs because ... then they cannot give consent. If the patient is not psychotic or delusional and has adequate cognitive function then they are competent to make a decision about their body, there is no requirement for that decision too be rational.

However there is no requirement for a surgeon to operate, it might well be illegal.

People can become very fixed on their bodies, hence the existence of cosmetic surgery.

The problem is that treatment of body dysmorphia with drugs or psychotherapy is not very effective (but can be effective for some people), sometimes the easier option seems to be surgery. Time does seem effective most people grow out of body dysmorphia (but not all).

I like the idea of time being effective as a cure.

Lie down till the urge passes...

[TragicMonkey]

Originally Posted by Darat

The difference is what lies at the heart of all non-medically required "cosmetic" surgery. The patient may be happy with the outcome, but the surgeon is still causing injury to the patient for no medical or (physical) health reason. Is someone wanting a breast enlargement psychotic or delusional because they feel they will be better in some undefined way with larger breasts? (Indeed we should note that they do not actually get larger breasts all they achieve is a semblance of larger breasts.)

Despite the prevalence of cosmetic surgery and its legal and social acceptability in our societies I do wonder if many people having cosmetic surgery would be better served by it being approached as a mental health issue and dealt with treatment for a mental health issue rather than resorting to irreversible "cosmetic" surgery.

Who gets to decide which desires are acceptable and which are not, when it comes to other people's bodies? There are people who regard with horror the notion of women getting their hair cut short. There are people who think tattooing shouldn't be permitted. Where does a line get drawn for acceptable modification, who gets to draw it, and what justification do they need to present to demonstrate why they should be telling other people what to do with their own bodies?

Personally I think people are damn crazy to get breasts added or legs chopped off or grow their fingernails long but they ain't my legs or breasts or nails so it's ain't my business.

[theprestige]

Originally Posted by TragicMonkey

Who gets to decide which desires are acceptable and which are not, when it comes to other people's bodies?

We do, obviously. In consultation with people who have made the study of mental health their profession. That's literally what psychology and psychiatry are for.

You are well educated. You know and espouse the principles of collective self governance. You are reasonably familiar with the scientific study of the human mind and the beneficial insights it brings. This is not a question that should keep coming up.

[bluesjnr]

Originally Posted by theprestige

We do, obviously. In consultation with people who have made the study of mental health their profession. That's literally what psychology and psychiatry are for.

You are well educated. You know and espouse the principles of collective self governance. You are reasonably familiar with the scientific study of the human mind and the beneficial insights it brings. This is not a question that should keep coming up.

Unfortunately, this forum is the very place in which it will come up and run to hundreds of back and forth posts, ultimately ending up with a Right v Left bitchfest.

[Beelzebuddy]

Originally Posted by bluesjnr

Unfortunately, this forum is the very place in which it will come up and run to hundreds of back and forth posts, ultimately ending up with a Right v Left bitchfest.

It doesn't have to end up, it started there. This thread could be merged with the transgender thread in social issues, it's clearly an attempt to relitigate some point about bodily autonomy.

[d4m10n]

Originally Posted by TragicMonkey

Who gets to decide which desires are acceptable and which are not, when it comes to other people's bodies?

In the case of the BBC Horizon episode, there was a specific list of people who needed to approve of the surgery: the consulting psychiatrist, the surgeon, and ultimately the hospital itself.

Originally Posted by Beelzebuddy

This thread could be merged with the transgender thread in social issues, it's clearly an attempt to relitigate some point about bodily autonomy.

Trans issues (which are numerous and sundry) would completely swamp this fairly niche topic.

[TragicMonkey]

Originally Posted by theprestige

This is not a question that should keep coming up.

Oh, sorry. I forgot that you were in charge and had already made the decision.

[Darat]

Originally Posted by TragicMonkey

Who gets to decide which desires are acceptable and which are not, when it comes to other people's bodies? There are people who regard with horror the notion of women getting their hair cut short. There are people who think tattooing shouldn't be permitted. Where does a line get drawn for acceptable modification, who gets to draw it, and what justification do they need to present to demonstrate why they should be telling other people what to do with their own bodies?

Personally I think people are damn crazy to get breasts added or legs chopped off or grow their fingernails long but they ain't my legs or breasts or nails so it's ain't my business.

I'm all for body autonomy - so if you are into body modification good for you, I'm not in principle against people doing anything they want to themselves.

As a society we do have gate keepers in place and when we start to move to body modification by surgery the one we have in place is medical professionals. If you are contemplating a procedure that requires a medical professional then it's entered the world where society has decided it has a say in what can happen, we regulate them, we set ethical tests and so on.

At that point I don't think it is inappropriate for society to say "OK, in principle you can have your healthy leg removed but before we allow someone to do that to you, there will be a medical assessment of your requirement".

And I would like to think that medical assessment isn't only "they can physically survive a general anaesthetic and they should be able to survive the physical trauma of such a procedure", an assessment of their mental health should also happen.

We still segregate mental and physical health, any health assessment should be taking into account physical and mental health. So like we would say "Sorry you have COPD so we can't remove your leg because you are not healthy enough" we should be able to say "Sorry you have a mental health issue so we can't remove your leg because you are not healthy enough".

There seems to be a lot - I know anecdotal - of stories of people who have a "cosmetic" operation to only find out having the larger breasts hasn't made them feel happier/better.

Of course all that is predicated on us having good, accessible healthcare systems with proper funding for anaesthetists and psychiatrists.

[ahhell]

Originally Posted by Planigale

This is partly a legal issue. The role of the psychiatrist in this instance is not to say whether the leg should be amputated or not, it is to say whether the patient is legally able to consent to the surgery. If delusional e.g. believing that there are insects burrowing under the skin of the leg that will spread if the leg is not removed then they cannot give legal consent. If they are psychotic and a voice has told them they need to amputate their legs because ... then they cannot give consent. If the patient is not psychotic or delusional and has adequate cognitive function then they are competent to make a decision about their body, there is no requirement for that decision too be rational.

However there is no requirement for a surgeon to operate, it might well be illegal.

People can become very fixed on their bodies, hence the existence of cosmetic surgery.

The problem is that treatment of body dysmorphia with drugs or psychotherapy is not very effective (but can be effective for some people), sometimes the easier option seems to be surgery. Time does seem effective most people grow out of body dysmorphia (but not all).

Originally, plastic surgery was developed fix real problems. Restore the appearance of burn victims and give women who had had mastectomies breasts. The surgeons then realized there was a cosmetic market and sold the notion that the proceeds from elective surgeries would help fund the surgeries for those who actually need it.

Originally Posted by Darat

The difference is what lies at the heart of all non-medically required "cosmetic" surgery. The patient may be happy with the outcome, but the surgeon is still causing injury to the patient for no medical or (physical) health reason. Is someone wanting a breast enlargement psychotic or delusional because they feel they will be better in some undefined way with larger breasts? (Indeed we should note that they do not actually get larger breasts all they achieve is a semblance of larger breasts.)

Despite the prevalence of cosmetic surgery and its legal and social acceptability in our societies I do wonder if many people having cosmetic surgery would be better served by it being approached as a mental health issue and dealt with treatment for a mental health issue rather than resorting to irreversible "cosmetic" surgery.

I think at least in the US the relationship to cosmetic surgery is a bit more ambivalent. I don't know many people that would judge a women with an A cup for going up to a B or C. I don't know anyone that wouldn't look a bit askance at someone going from a C to a D or even bigger. Get rid of that bad scare or benign mole on your face, nobody cares. Have your perfectly nice but not perfect nose shaved or not quite puffy enough lips pumped up, most folks I know will judge a bit.

Anyrate, as to the OP, that's long been a thought experiment for the more Trans skeptical folks.

[casebro]

To me, wanting a healthy leg removed is a perfect example of crazy. She IS psychotic on some level.

[Darat]

Originally Posted by casebro

To me, wanting a healthy leg removed is a perfect example of crazy. She IS psychotic on some level.

Psychotic has a specific meaning and the reports indicate he wasn’t(is?), however he was/is mentally unwell.

The question for me would be - if we have tried to address his health issue with other treatments and they have failed should we allow him to have his leg removed? I think the only way to answer that is to make a judgement call i.e. whether the removal of the leg would cure him or not. If we don’t think it would cure him then we shouldn’t allow it.

[TragicMonkey]

Originally Posted by Darat

Psychotic has a specific meaning and the reports indicate he wasn’t(is?), however he was/is mentally unwell.

The question for me would be - if we have tried to address his health issue with other treatments and they have failed should we allow him to have his leg removed? I think the only way to answer that is to make a judgement call i.e. whether the removal of the leg would cure him or not. If we don’t think it would cure him then we shouldn’t allow it.

You're assuming this is a question of disease, a failing in the health that ought to be cured. What if it's just a desire? People want different things, and most people would define happiness as being able to fulfill their desires. Who gets to decide what desires are just desires, and what desires are just symptoms of disease? My grandma desired to wear purple velour tracksuits with shiny gold sneakers and carry a tiger-patterned cane: was she suffering from a disease like dementia, a psychological disorder in which she believed she was a stereotypical pimp, or merely afflicted with peculiar taste in fashion? And yes, I know that's much less extreme than wanting to lop off a healthy limb; my point here is that from the outside how can we tell for someone else? Where does their desire to do as they will with themselves become someone else's business to judge and interfere?

[Lplus]

Originally Posted by TragicMonkey

You're assuming this is a question of disease, a failing in the health that ought to be cured. What if it's just a desire? People want different things, and most people would define happiness as being able to fulfill their desires. Who gets to decide what desires are just desires, and what desires are just symptoms of disease? My grandma desired to wear purple velour tracksuits with shiny gold sneakers and carry a tiger-patterned cane: was she suffering from a disease like dementia, a psychological disorder in which she believed she was a stereotypical pimp, or merely afflicted with peculiar taste in fashion? And yes, I know that's much less extreme than wanting to lop off a healthy limb; my point here is that from the outside how can we tell for someone else? Where does their desire to do as they will with themselves become someone else's business to judge and interfere?

Where they will need support from society to manage their lives without the appendage in question.

Someone wants an ear removed? Meh, ok I guess;

Someone wants both legs removed? (extreme example) No.

[TragicMonkey]

Originally Posted by Lplus

Where they will need support from society to manage their lives without the appendage in question.

Someone wants an ear removed? Meh, ok I guess;

Someone wants both legs removed? (extreme example) No.

The degree of "support from society" one needs varies with one's personal wealth. Oprah could easily afford to hire platoons of servants to run her errands or indeed carry her about on a palanquin wherever she desires. Would that make the desire to amputate her own legs sane for her, but crazy in a poorer person?

[Emily's Cat]

Originally Posted by Planigale

This is partly a legal issue. The role of the psychiatrist in this instance is not to say whether the leg should be amputated or not, it is to say whether the patient is legally able to consent to the surgery. If delusional e.g. believing that there are insects burrowing under the skin of the leg that will spread if the leg is not removed then they cannot give legal consent. If they are psychotic and a voice has told them they need to amputate their legs because ... then they cannot give consent. If the patient is not psychotic or delusional and has adequate cognitive function then they are competent to make a decision about their body, there is no requirement for that decision too be rational.

However there is no requirement for a surgeon to operate, it might well be illegal.

People can become very fixed on their bodies, hence the existence of cosmetic surgery.

The problem is that treatment of body dysmorphia with drugs or psychotherapy is not very effective (but can be effective for some people), sometimes the easier option seems to be surgery. Time does seem effective most people grow out of body dysmorphia (but not all).

Hmm... I'm not sold on that view of what constitutes a delusion. A delusion is a false belief, whereas a hallucination is a false perception. I would tend to think that believing that one's healthy body parts should not be there would qualify as a false belief.

Where it might get a bit trickier is when a person acknowledges that the body part is there, is natural to be there, is supposed to be there... but dislikes the body part and wants to remove it for some reason. "I know these are my legs, and there's nothing physically wrong with them, but I hate them and my life will be better if I cut them off" may not technically qualify as a psychiatric disorder... but it seems as if it would certainly be a behavioral disorder.

Having an irrational and harmful emotional response (and attendant behaviors and actions) is still a category of mental health disorders.

[Emily's Cat]

Originally Posted by Darat

The difference is what lies at the heart of all non-medically required "cosmetic" surgery. The patient may be happy with the outcome, but the surgeon is still causing injury to the patient for no medical or (physical) health reason. Is someone wanting a breast enlargement psychotic or delusional because they feel they will be better in some undefined way with larger breasts? (Indeed we should note that they do not actually get larger breasts all they achieve is a semblance of larger breasts.)

Despite the prevalence of cosmetic surgery and its legal and social acceptability in our societies I do wonder if many people having cosmetic surgery would be better served by it being approached as a mental health issue and dealt with treatment for a mental health issue rather than resorting to irreversible "cosmetic" surgery.

I generally agree with your take on this. I might consider an argument that purely cosmetic surgery, while it may not "fix" anything, also doesn't directly cause harm - with the caveat of people "addicted" to cosmetic surgery. I mean, getting a boob job doesn't generally cause medical problems or inhibit the ability to go about one's life in a relatively normal fashion. Getting a "leg job", however, definitely causes harm and hardship.

[Emily's Cat]

Originally Posted by TragicMonkey

Who gets to decide which desires are acceptable and which are not, when it comes to other people's bodies?

Rational, prudent people who can reasonably foresee whether the desired modification will cause *harm* to the person seeking the modification.

The concept of a "reasonable person" interpretation is commonplace and highly effective. It's employed throughout a multitude of legal and regulatory standards.

[Emily's Cat]

Originally Posted by TragicMonkey

You're assuming this is a question of disease, a failing in the health that ought to be cured. What if it's just a desire? People want different things, and most people would define happiness as being able to fulfill their desires. Who gets to decide what desires are just desires, and what desires are just symptoms of disease? My grandma desired to wear purple velour tracksuits with shiny gold sneakers and carry a tiger-patterned cane: was she suffering from a disease like dementia, a psychological disorder in which she believed she was a stereotypical pimp, or merely afflicted with peculiar taste in fashion? And yes, I know that's much less extreme than wanting to lop off a healthy limb; my point here is that from the outside how can we tell for someone else? Where does their desire to do as they will with themselves become someone else's business to judge and interfere?

At the point where their desire to do as they will with themselves confers an obligation for accommodation or support on other people.

Your grandparent's fashion choices don't result in any obligation (aside from perhaps having to control one's facial expressions while viewing the outfit). Having one's legs lopped off confers an obligation on other people to help support that person, to provide accommodations as a disabled individual, to help with accessibility, financial assistance, medical assistance, conveyance, etc. It's not a choice being made solely for themselves - it's a choice that affects everyone else around them. At the very minimum, the person who has decided to remove their legs will need a wheelchair, alterations to their home to accommodate their leglessness, alterations to their vehicle or access to transportation services provided by others... and those things are all being paid for by the public - either through direct taxation in the case of countries with universal health care, or through higher premiums for countries with private insurance. Either way, their desire is not theirs alone.

[Emily's Cat]

Originally Posted by TragicMonkey

The degree of "support from society" one needs varies with one's personal wealth. Oprah could easily afford to hire platoons of servants to run her errands or indeed carry her about on a palanquin wherever she desires. Would that make the desire to amputate her own legs sane for her, but crazy in a poorer person?

Nah. It's still crazy. But it's a crazy that doesn't affect anyone else.

[theprestige]

Some people just want society to be a perfect system of formal logic, where all questions of propriety resolve to simple absolute binary propositions.

If breast enlargement is fine for some people, it must be fine for everyone. Society cannot possibly evaluate mental health on a case by case basis, and make allowances in some cases but not in others. If we let Evel Knievel indulge his death wish, we cannot possibly prohibit Legless McCrazypants from following her own dream of self-harm.

[d4m10n]

Originally Posted by Lplus

Someone wants both legs removed? (extreme example) No.

This was actually what Corinne was asking for: double amputation, well above the knee. I think it's fair to say she would need significant support from society to manage without them, at least at first.

[Elaedith]

Originally Posted by d4m10n

It is elusive to be sure. I got the sense from the interviews that he'd definitely not recommend amputation if the patient was delusional or psychotic, but he would do so if the disorder was dysmorphic in nature.

Sent from my SM-G996U using Tapatalk

I'm not sure why the distinction is unclear?

The term disorder is often used to refer to a condition that causes distress or functional impairment or harm to others, and therefore may require diagnosis and treatment or accommodation. It is not synonymous with 'mental illness', and a large number of conditions classified as psychological disorders would not appropriately be described that way (e.g. autistic spectrum disorders). As we know from discussion elsewhere, the DSM defines numerous conditions that are only considered disorders if they cause distress/impairment/ or harm to others. Psychotic disorders are a subset of disorders that involve symptoms like hallucinations and delusions or disorganised thought, that could impair judgement.

There has been interest in the possibility that body integrity dysphoria involves some sort of inversion of the process involved in phantom limbs (where somebody is missing a limb and feels that it's still there). In the case of phantom limbs, the generally favoured (although still controversial) explanation is neurological - that each part of the body is 'mapped' onto a region of the sensory cortex, and the part of the brain devoted to mapping stimulation from the missing limb, receiving no sensory input, starts responding to stimulation in adjacent regions, which is misinterpreted as coming from the 'phantom'.

If the reverse is true, some parts of the body not being properly 'mapped' might lead to the sensation that a limb is not part of the body because the brain doesn't properly process sensory input from that part.

There seems to be some recent research along these lines, although the explanation is more complex and relates the issue to altered connectivity in larger scale networks.

[d4m10n]

Originally Posted by Elaedith

The term disorder is often used to refer to a condition that causes distress or functional impairment or harm to others, and therefore may require diagnosis and treatment or accommodation.

This is one of those unusual cases where patients are hoping to trade off psychological distress for functional impairment.

ETA: Thanks for the link.

[Elaedith]

Originally Posted by d4m10n

This is one of those unusual cases where patients are hoping to trade off psychological distress for functional impairment.

ETA: Thanks for the link.

Yes, good point. But if the person already feels impaired, it might come down to a perception of which form of impairment they think is worse.

Making somebody disabled is obviously not an outcome that would normally be an acceptable goal of a medical procedure.

[novaphile]

Originally Posted by Elaedith

I'm not sure why the distinction is unclear?

The term disorder is often used to refer to a condition that causes distress or functional impairment or harm to others, and therefore may require diagnosis and treatment or accommodation. It is not synonymous with 'mental illness', and a large number of conditions classified as psychological disorders would not appropriately be described that way (e.g. autistic spectrum disorders). As we know from discussion elsewhere, the DSM defines numerous conditions that are only considered disorders if they cause distress/impairment/ or harm to others. Psychotic disorders are a subset of disorders that involve symptoms like hallucinations and delusions or disorganised thought, that could impair judgement.

There has been interest in the possibility that body integrity dysphoria involves some sort of inversion of the process involved in phantom limbs (where somebody is missing a limb and feels that it's still there). In the case of phantom limbs, the generally favoured (although still controversial) explanation is neurological - that each part of the body is 'mapped' onto a region of the sensory cortex, and the part of the brain devoted to mapping stimulation from the missing limb, receiving no sensory input, starts responding to stimulation in adjacent regions, which is misinterpreted as coming from the 'phantom'.

If the reverse is true, some parts of the body not being properly 'mapped' might lead to the sensation that a limb is not part of the body because the brain doesn't properly process sensory input from that part.

There seems to be some recent research along these lines, although the explanation is more complex and relates the issue to altered connectivity in larger scale networks.

If I recall correctly, some of Oliver Sach's patients were people who developed this condition after a brain injury. That supports what you're saying.

I'm thinking of a patient who kept falling out of bed, because they kept pushing their own leg out of bed, as they perceived that leg to be an alien, dead thing, that shouldn't be there.

[Skeptic Ginger]

I cannot imagine any surgeon willing to amputate a good leg because a person was bothered by it. Sorry for not reading through the thread, I'm sure my comment ignores a number of facts.

This is a psych problem, not a physical problem. And it is in no way equivalent to tattoos, ear piercings or a tummy tuck.

Sorry, carry on.

[The Atheist]

By all means cut off your legs and arms as you desire.

But don't expect to receive a single cent of welfare money if you're then unable to work.

I don't see much difference removing a leg or a foreskin - one's just a bit bigger, and at least the person cutting their leg off consents to it. I haven't seen any babies consenting to having their penises cosmetically changed.

[TragicMonkey]

Originally Posted by Emily's Cat

Rational, prudent people who can reasonably foresee whether the desired modification will cause *harm* to the person seeking the modification.

The concept of a "reasonable person" interpretation is commonplace and highly effective. It's employed throughout a multitude of legal and regulatory standards.

"Reasonable people" also thought slavery and marital rape were perfectly sensible, and that interracial marriage and public education were not sensible. Blind assumption that most people agree on what is reasonable, and that they are right, is not a secure basis for legal or regulatory standards. It's certainly not a good basis for ethical judgment.

[Orphia Nay]

Originally Posted by casebro

To me, wanting a healthy leg removed is a perfect example of crazy. She IS psychotic on some level.

I think she's more delusional than psychotic.

Having said that, I can't explain why this is different to wanting to change your sex, even though I think it is different.

[Skeptic Ginger]

Originally Posted by Orphia Nay

I think she's more delusional than psychotic.

Having said that, I can't explain why this is different to wanting to change your sex, even though I think it is different.

For one a sex change operation doesn't remove a limb. For two transgender is a well known diagnosis with standards of care.

There is no standard of care that removing a limb is a treatment for anything except physical reasons like massive trauma or gangrene, something like that.

[Planigale]

Originally Posted by novaphile

If I recall correctly, some of Oliver Sach's patients were people who developed this condition after a brain injury. That supports what you're saying.

I'm thinking of a patient who kept falling out of bed, because they kept pushing their own leg out of bed, as they perceived that leg to be an alien, dead thing, that shouldn't be there.

This is quite a common phenomenon following a non-dominant hemisphere stroke (ie usually one causing weakness of the left side of the body). It is called an attention deficit disorder. The way it is commonly demonstrated is lifting the paralysed left arm across and holding it on the right side (there may be an associated left visual field deficit) and asking whose hand it is, the patient fails to recognise their own hand.

ETA there is no sensory loss in the left arm in general, it is a perceptual problem not a sensory problem.

[Darat]

Originally Posted by TragicMonkey

You're assuming this is a question of disease, a failing in the health that ought to be cured. What if it's just a desire? People want different things, and most people would define happiness as being able to fulfill their desires. Who gets to decide what desires are just desires, and what desires are just symptoms of disease? My grandma desired to wear purple velour tracksuits with shiny gold sneakers and carry a tiger-patterned cane: was she suffering from a disease like dementia, a psychological disorder in which she believed she was a stereotypical pimp, or merely afflicted with peculiar taste in fashion? And yes, I know that's much less extreme than wanting to lop off a healthy limb; my point here is that from the outside how can we tell for someone else? Where does their desire to do as they will with themselves become someone else's business to judge and interfere?

Thought I'd been clear about this, I'll try again using your terms. As long as the health assessment comes back OK then he should be allowed to make a decision based on his desires.

If the health assessment doesn't come back OK for instance he has COPD and has little chance of surviving the amputation then his desire alone wouldn't be enough.

[The Atheist]

Originally Posted by Orphia Nay

I think she's more delusional than psychotic.

Having said that, I can't explain why this is different to wanting to change your sex, even though I think it is different.

I've been asking that exact question for five years in the Trans thread.

Personally, I'd rather lose a leg than my boy bits, so if anything, genital removal is worse.