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Body Dysmorphia (BBC Horizon)

d4m10n

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d4m10n
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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 ReidWP, 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:
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.
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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.
 
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theprestige said:
He seems to be making what he believes is an important technical distinction, but it is entirely lost on this layman.
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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.

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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?
 
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).
 
theprestige said:
He seems to be making what he believes is an important technical distinction, but it is entirely lost on this layman.
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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.
 
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Darat said:
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.
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Planigale said:
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).
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I like the idea of time being effective as a cure.

Lie down till the urge passes...
 
Darat said:
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.
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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.
 
TragicMonkey said:
Who gets to decide which desires are acceptable and which are not, when it comes to other people's bodies?
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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.
 
theprestige said:
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.
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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.
 
bluesjnr said:
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.
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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.
 
TragicMonkey said:
Who gets to decide which desires are acceptable and which are not, when it comes to other people's bodies?
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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.

Beelzebuddy said:
This thread could be merged with the transgender thread in social issues, it's clearly an attempt to relitigate some point about bodily autonomy.
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Trans issues (which are numerous and sundry) would completely swamp this fairly niche topic.
 
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TragicMonkey said:
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.
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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.
 
Planigale said:
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).
Click to expand...
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.

Darat said:
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.
Click to expand...
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.
 
To me, wanting a healthy leg removed is a perfect example of crazy. She IS psychotic on some level.
 
casebro said:
To me, wanting a healthy leg removed is a perfect example of crazy. She IS psychotic on some level.
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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.
 
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Darat said:
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.
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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?
 
TragicMonkey said:
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?
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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.
 
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