Body Dysmorphia (BBC Horizon)

[Emily's Cat]

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]

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]

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]

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]

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]

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.

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]

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]

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]

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]

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.