Body Dysmorphia (BBC Horizon)

[Puppycow]

Originally Posted by 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.

Amen to that.

This is what I was thinking.

Is it our business as a society to tell others what they can and cannot do with their own bodies? My inclination is to say no. But, we also live in a society where disabled people can receive special welfare benefits. If having your legs amputated means that you are now dependent on others to provide for you, then it is our business after all what other people do with their own bodies.

Likewise if you say the taxpayer or legally mandated insurance coverage should provide for "gender-affirming" surgeries and treatments (hormones, etc.) that can add up to hundreds of thousands of dollars.

It becomes my business when you demand that I pay for the consequences. (Or for the cost of transition.)

I'm not against any of these things, I just don't want to be forced to pay for it.

[bluesjnr]

Originally Posted by 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.

You know my uncle?

[TragicMonkey]

Originally Posted by Puppycow

Amen to that.

This is what I was thinking.

Is it our business as a society to tell others what they can and cannot do with their own bodies? My inclination is to say no. But, we also live in a society where disabled people can receive special welfare benefits. If having your legs amputated means that you are now dependent on others to provide for you, then it is our business after all what other people do with their own bodies.

Likewise if you say the taxpayer or legally mandated insurance coverage should provide for "gender-affirming" surgeries and treatments (hormones, etc.) that can add up to hundreds of thousands of dollars.

It becomes my business when you demand that I pay for the consequences. (Or for the cost of transition.)

I'm not against any of these things, I just don't want to be forced to pay for it.

If your concern is public expense then why stop there? Poor people having babies is a public expense. Disabled people are an expense. The elderly are an expense. Do you think those groups are worthy of public expenditure? Should they be denied any benefits? Or perhaps it would be cheaper if those groups just weren't around, eh?

[TragicMonkey]

Originally Posted by The Atheist

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.

It would be "worse" because you personally value your genitals more than your leg? Does it work the other way for people who value their leg more than their genitals?

[casebro]

Originally Posted by Skeptic Ginger

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

Okay, lets use transsexuals as a model. Evidenced by their HUGE suicide rate, they are not made happy by the changes. Corrinne wouldn't be either.

Corrinne should be required to spend a few day with a double amputee to see what a PITA it is to have a disability. All I've got is arthritis and heart probs, Thank FSM I am not in a wheel chair.

[Lplus]

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?

Crazy in both cases, but you asked when society should step in and I gave you and answer.

Originally Posted by TragicMonkey

If your concern is public expense then why stop there? Poor people having babies is a public expense. Disabled people are an expense. The elderly are an expense. Do you think those groups are worthy of public expenditure? Should they be denied any benefits? Or perhaps it would be cheaper if those groups just weren't around, eh?

Yes they are worthy of the expense because none of them are crazy.

[casebro]

Originally Posted by TragicMonkey

If your concern is public expense then why stop there? Poor people having babies is a public expense. Disabled people are an expense. The elderly are an expense. Do you think those groups are worthy of public expenditure? Should they be denied any benefits? Or perhaps it would be cheaper if those groups just weren't around, eh?

But Corrine and Trans cause those costs willingly. Your examples do not.

[TragicMonkey]

Originally Posted by casebro

But Corrine and Trans cause those costs willingly. Your examples do not.

Then the missing element is a moral one: to access help one must be judged worthy. Voluntary amputation? Unworthy. Involuntary amputation? Worthy...but what if that injury was the result of a foolish or bad action? Mindy lost her leg in a car accident. Is she worthy of help? But what if she was driving carelessly and caused the accident? Worthy? What if she was drunk at the time? Unworthy?

By introducing the element of judgment you require the existence of judges. Let panels be created to assess the moral worth of each person's claim to public expenditure, and they receive according to their moral worthiness rather than their physical needs!

I realize people get mad at the notion that someone's unfairly getting something but I think the rush to fix that problem leads to much worse ones.

[TragicMonkey]

Originally Posted by Lplus

Yes they are worthy of the expense because none of them are crazy.

The mentally ill don't deserve help?

[TragicMonkey]

I really dislike the concept of adding a moral evaluation to people's illnesses. Lung cancer patients frequently get treated shabbily if they were smokers, and then when people find out they got it from another cause they're suddenly nicer about it. Because they don't "deserve" lung cancer as much as smokers do. Happens with other illnesses and ailments, too: HIV from a transfusion is morally worthier than from sex, which is morally worthier than from contaminated needles. Unless the needle was a hospital mistake and not recreational drugs. My father's cancer was caused by smoking but because it wasn't lung cancer people assumed it wasn't and were nice to him.

I'd rather have illnesses and ailments treated with no regard to morally evaluating the patient and deciding how much they deserved their suffering. Even if it costs the public money.

[Lplus]

Originally Posted by TragicMonkey

The mentally ill don't deserve help?

You didn't include the mentally ill in your list. Still, in their case I think any money should be spent curing them in the short term rather than a long term commitment to the result of pandering to their crazy.

[Skeptic Ginger]

Originally Posted by casebro

Okay, lets use transsexuals as a model. Evidenced by their HUGE suicide rate, they are not made happy by the changes. Corrinne wouldn't be either.

You lack a citation and evidence genital surgery is the only relevant variable.

[casebro]

Originally Posted by Skeptic Ginger

You lack a citation and evidence genital surgery is the only relevant variable.

I bet even YOU could google <lgbt + suicide> (or any single letter) and find that their extremely high suicide rate is common knowledge.

They blame their high suicide rate on the way society treats them, nobody wants to blame their 'craziness' that is part of their syndrome.

Okay, I'll accept that it is not a choice. But it is a mental abberation at heart. Caused by genetics of brain chemistry. EVERYBODY wants mutual friction of mucous membranes. The choice of whose is mental. (emotional is a sub-set of mental)

[casebro]

They do still lock people away for "..being a danger to themselves or others."? Corrine, anybody?

You would slam-dunk her craziness if she was merely a 'cutter'.

[thines]

This is an interesting thread. There is an excellent book on disorders of "the self" which includes a chapter on a fellow who wanted his leg amputated because he didn't like it, people who believe they are dead and other interesting such beliefs. It's Ananthaswamy's (2015) "The Man Who Wasn't There".

[arthwollipot]

In discussions like this it's important to remember that psychosis has a strict definition. It's an inability to distinguish between what is real and what is not, so things that are only imagined become real. This is not what is going on with body dysmorphia. Dysmorphia is this body is not mine and can lead to people self-harming to get rid of it. I know such a person.

[Skeptic Ginger]

Originally Posted by casebro

I bet even YOU could google <lgbt + suicide> (or any single letter) and find that their extremely high suicide rate is common knowledge.

They blame their high suicide rate on the way society treats them, nobody wants to blame their 'craziness' that is part of their syndrome.

Okay, I'll accept that it is not a choice. But it is a mental abberation at heart. Caused by genetics of brain chemistry. EVERYBODY wants mutual friction of mucous membranes. The choice of whose is mental. (emotional is a sub-set of mental)

I think you missed my point. Of course there is a high rate of suicide among transgendered persons.

But where's the evidence gender reassignment surgery increases the suicide rate?

[Emily's Cat]

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.

Great post

There are so many complexities to the brain, and I don't know all of the terms. I know a few... but sometimes the boundaries seem fuzzy to me. For example, I have a neurological disorder - I'm epileptic. Sometimes my brain doesn't do the physical things it's supposed to do (or more appropriately, does too many physical things that it isn't supposed to do). My spouse, on the other hand, has a neurofunctional disorder - they're ADHD. Their brain does the physical things correctly, but doesn't respond or engage the elements it's supposed to. Even though there's nothing physically disordered in their brain, their executive function doesn't work correctly. My sister has a psychological disorder - they are bipolar. Everything physically functions correctly, and the responses from each brain area is appropriate, but the emotional regulation of those areas is out of whack.

It gets really confusing though. I don't really understand the distinctions between them, and I believe some conditions have changed categories over time.

[Emily's Cat]

Originally Posted by TragicMonkey

"Reasonable people" also thought slavery and marital rape were perfectly sensible, and that interracial marriage and public education were not sensible.

Reasonable people can sometimes agree on things we now view as horrific... Therefore, let's toss the reasonable people out and listen to the unreasonable ones? Doesn't seem like a great approach to me.

Originally Posted by TragicMonkey

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.

But it *is* the basis for ethical judgement, and is a cornerstone of legal and regulatory standards. You might disagree with it, but in actuality, that's how it's done. A very large portion of law relies on either a "reasonable person" or a "prudent person" standard for situations where judgement is involved. The entire realm of negligence is based on "reasonable person" standards.

[Emily's Cat]

Originally Posted by The Atheist

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.

I can understand that your feelings fall that way, and it makes sense. But from a "third party" perspective... genital alterations of adults doesn't present a burden on anybody else.

Personally, I still end up thinking that vaginoplasty has too many risks that occur too often, and shouldn't be done at all. There are so many complications with infection and pain that it seems medically unsound to me. Phalloplasties also have risks of infection at the donor site, as well as scarring, and the whole lack of any sort of functionality... but those complications don't endanger the life of the person as much as vaginoplasty does. Mastectomy and breast implants have very little medical risk, my only hesitation on those is the age of the patient. But by and large, mastectomy and breast implants don't carry any higher medical risk than nose jobs or calf implants.

[Emily's Cat]

Originally Posted by TragicMonkey

If your concern is public expense then why stop there? Poor people having babies is a public expense. Disabled people are an expense. The elderly are an expense. Do you think those groups are worthy of public expenditure? Should they be denied any benefits? Or perhaps it would be cheaper if those groups just weren't around, eh?

What is your position, TM? You've got a lot of "just asking questions" going on, but you're not making an argument. Additionally, you're expanding the concept in relatively absurd ways. I honestly don't know what you're driving at.

[Emily's Cat]

Originally Posted by TragicMonkey

Then the missing element is a moral one: to access help one must be judged worthy. Voluntary amputation? Unworthy. Involuntary amputation? Worthy...but what if that injury was the result of a foolish or bad action? Mindy lost her leg in a car accident. Is she worthy of help? But what if she was driving carelessly and caused the accident? Worthy? What if she was drunk at the time? Unworthy?

By introducing the element of judgment you require the existence of judges. Let panels be created to assess the moral worth of each person's claim to public expenditure, and they receive according to their moral worthiness rather than their physical needs!

I realize people get mad at the notion that someone's unfairly getting something but I think the rush to fix that problem leads to much worse ones.

Not at all. There's no judgement of worth involved. It's a question of agency and volition.

A person who is either born disabled, or becomes disabled through accident, had no agency in their disability. At the very worst, we might argue that they displayed recklessness with respect to their own welfare if they acquired a disability by doing something dumb.

But that's not the case under discussion with respect to body dysmorphia. This is a case of someone who is physically healthy making an intentional decision to become unhealthy. It's not a lack of foresight, it's not reckless disregard for a potential outcome - it's intentionally seeking the outcome.

[Emily's Cat]

Originally Posted by TragicMonkey

I really dislike the concept of adding a moral evaluation to people's illnesses. Lung cancer patients frequently get treated shabbily if they were smokers, and then when people find out they got it from another cause they're suddenly nicer about it. Because they don't "deserve" lung cancer as much as smokers do. Happens with other illnesses and ailments, too: HIV from a transfusion is morally worthier than from sex, which is morally worthier than from contaminated needles. Unless the needle was a hospital mistake and not recreational drugs. My father's cancer was caused by smoking but because it wasn't lung cancer people assumed it wasn't and were nice to him.

I'd rather have illnesses and ailments treated with no regard to morally evaluating the patient and deciding how much they deserved their suffering. Even if it costs the public money.

I swear, it's like you have no understanding of the role of agency.

[Emily's Cat]

Originally Posted by arthwollipot

In discussions like this it's important to remember that psychosis has a strict definition. It's an inability to distinguish between what is real and what is not, so things that are only imagined become real. This is not what is going on with body dysmorphia. Dysmorphia is this body is not mine and can lead to people self-harming to get rid of it. I know such a person.

That's what gets it classified as a delusion, rather than a hallucination.

"This body is not mine" is qualitatively different from "I perceive little ants all over me"... but both are still false.

The person experiencing the falseness could still use some compassion though. It's a question of what actions are most compassionate in the long run, versus the short term.

[Emily's Cat]

Originally Posted by Skeptic Ginger

I think you missed my point. Of course there is a high rate of suicide among transgendered persons.

But where's the evidence gender reassignment surgery increases the suicide rate?

I'm not sure about increasing it, but there is evidence that it does not decrease the rate. It seems that there is a short term alleviation of distress, a temporary reprieve. But given that the surgery cannot actually address the underlying issue, it doesn't really fix the problem.

Surgery can give a superficial appearance of being the opposite sex, but it does not actually turn a person into a member of the opposite sex. A female with a phalloplasty and a mastectomy remains a female, and no amount of surgery can make them functionally male. A male with a vaginoplasty and breast implants, even with facial feminization and tracheal shaving, remains male. The modernest of modern medicine cannot make them into a female.

The very best that can be accomplished is a surface-level facsimile of the opposite sex, and if they're very lucky, that facsimile is enough to fool other people who aren't interested in procreation. At the end of the day, however, passing remains cosmetic, and the core of the person is not changed. It is enough for some people to live their lives with less distress, but there have been several studies now that show that on average, the suicide rate and the rate of distress over the long term remains about the same as it was prior to surgical intervention.

[d4m10n]

Originally Posted by Emily's Cat

That's what gets it classified as a delusion, rather than a hallucination.

The consulting psychiatrist took care to point out that the condition was not classified as a delusion, in his view.

Quote:

DR. RUSSELL REID (Consultant Psychiatrist): Certainly when I first heard of people wanting amputations it seemed bizarre in the extreme but then I thought well, I see transsexuals and transsexuals want healthy parts of their body removed in order to adjust to their idealised body image and so I think that was the connection for me. I saw that people wanted to have their limbs off with equally as much degree of obsession and need and urgency and it was a powerful emotion.

I think in that sense it's a psychological obsession. 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.

[Chanakya]

Seems like a cut and dried to me.

Completely, completely whack idea that I have difficulty even wrapping my head around. That, without a shadow of a doubt. (So much so that, if I had more time --- or, let's be honest, if I were less lazy --- I'd click around a bit myself to make sure this sort of thing isn't a gag that's somehow gotten traction online.)

But, like Tragic Monkey very rightly says, not my limb, or whatever other body part. Therefore not my business. Should proper psychological evaluation establish that this isn't some weird offshoot of depression of some such, that might be treated in the usual way; or that this isn't a passing fancy that the dude (or dudette) will regret the very next day (that is, ensure they understand and fully embrace the full implications of what they're considering); and further that they're mentally sound: then it's no one's business but their own what they do with their body parts, and indeed with the lives. Keep it, don't keep it, their call.

Should doctors assist them in doing this? I don't see why not. No doctor should be compelled to, obviously; but no doctor should be stopped from doing that either, either by law, or by weirdo vigilantes that are obsessed with wanting to run other people's lives and affairs.

I'm completely with TM on this one. (Assuming this isn't a gag, this weird business!)



eta: Okay, right, it comes back to me. I have actually heard of this thing before. And what's more heard of it right here in this forum. A while back, and I've no recollection of which thread it was --- could be the transgender thread I suppose, that seems the most likely candidate.

[d4m10n]

Originally Posted by Chanakya

Should proper psychological evaluation establish that this isn't some weird offshoot of depression of some such, that might be treated in the usual way; or that this isn't a passing fancy that the dude (or dudette) will regret the very next day (that is, ensure they understand and fully embrace the full implications of what they're considering); and further that they're mentally sound: then it's no one's business but their own what they do with their body parts, and indeed with the lives.

Assuming an individual is independently wealthy and has enough income to arrange for all the additional assistance they will need after removing both legs above the knee, the highlighted bit makes perfect sense. Otherwise, they will have to rely on family, friends, neighbors, and/or government assistance significantly more than they did when fully ambulatory.

[Chanakya]

Originally Posted by d4m10n

Assuming an individual is independently wealthy and has enough income to arrange for all the additional assistance they will need after removing both legs above the knee, the highlighted bit makes perfect sense. Otherwise, they will have to rely on family, friends, neighbors, and/or government assistance significantly more than they did when fully ambulatory.

Actually the very thought of someone actually doing something like that --- and the thought comes graphically to mind, as I read your post and type out my response --- kind of makes my stomach turn, an actual (if very slight, because completely impersonal) vertiginous, nauseated reaction. ..........But, once again, someone else's body part, then their call, not mine; and my reaction is compeletely irrelevant. (And no doubt the reaction is partly because one isn't used to this sort of thing. Should people come out and start doing it, then no doubt the rest of us will get used to it without feeling queasy every time we hear of something like this.)

You're right, such a person naturally becomes more dependent on others, provided their own income isn't enough to compensate for it, and maybe to an extent even if they're wealthy enough. But, while that's a fair point, and a point that a candidate for this sort of thing needs to very carefully understand and consider and evaluate before pulling the plug, but I'm not sure how it's relevant to anything beyond that. Their friends are family are well within their rights to not want to put themselves out to accommodate this sort of thing; and equally within their rights to want to reach out and provide assistance. Their business, their call. I agree, this ...person, can't demand of family and friends that they help them, they haven't that right, I don't think.

That state though? I don't know. While this person wouldn't have any rights per se over their family, IMV --- unless they were legally dependent on them for some reason --- but the state, well, I really don't know. On one hand, I agree, they shouldn't have any right to make demands on me and my pocket directly. On the other hand, one of the functions of the state is to step in to provide assistance that is warranted, and that individual taxpayers may not necessarily be willing to provide. So is this "warranted"? I don't know! The question of whether the state should actually provide any assistance in this kind of a case is ...well, something that is debatable, with things to be said on both sides of the issue.


----

Ah, right, edit window's still open, good. You know what, I've made up my mind. That is, had I been asked to vote on this issue, on whether the state should support body-dysmorphs (don't know if that term's actually used, but whatever), well then I'd have not voted at all, back when I wrote that comment, because I was undecided, totally undecided. But I've made up my mind now, and the answer's a Yes. The state should, indeed, support these dysmorphs. I mean, not necessarily go out and offer them support that no one else gets, no; but any support, any assistance, than disabled folks generally get, these dysmorph-disabled people also should be eligible for, that's my considered view now, and that's how I'd vote, if it came to that. (Open to changing my mind, given new facts and better arguments, as always; but as things stand I'm pretty sure how I feel about this now.)

[deadrose]

In some ways it's a sad subject for me, because I got to be friends with one of the poster boys for body dysmorphia, Stalking Cat.

He was a really nice, sweet guy. But his transformations made him seriously unemployable, and if he got any sort of disability or welfare support, it was the usual unsurviveable amount. Having to depend on others' kindness eventually took its toll,
he tried moving to a cheaper area in the middle of nowhere, but he had no friends or support system there, and he eventually killed himself.

[Chanakya]

Originally Posted by deadrose

In some ways it's a sad subject for me, because I got to be friends with one of the poster boys for body dysmorphia, Stalking Cat.

He was a really nice, sweet guy. But his transformations made him seriously unemployable, and if he got any sort of disability or welfare support, it was the usual unsurviveable amount. Having to depend on others' kindness eventually took its toll,
he tried moving to a cheaper area in the middle of nowhere, but he had no friends or support system there, and he eventually killed himself.

****. That's ...such pity, such a ****.

If dysmorphia's an ailment, then it's such a pity he received no treatment and guidance and support. And if dysmorphia is a thing --- as I suspect it is --- then it is such a pity it is so little understood, and that he received so little support, and had to live and die alone and unsupported like that.

The world has troubles enough already, I know, but still, this is one area that definitely needs work. To study and understand this thing properly, and also to devise ways to support those afflicted.

[d4m10n]

Originally Posted by Chanakya

If dysmorphia's an ailment, then it's such a pity he received no treatment and guidance and support.

It strains credulity to suppose there is no ailment involved here; the only questions are those of its nature, etiology, and treatment.