[HN Gopher] Body integrity identity disorder patient satisfactio...
       ___________________________________________________________________
        
       Body integrity identity disorder patient satisfaction after surgery
       (2014) [pdf]
        
       Author : freemint
       Score  : 47 points
       Date   : 2022-07-24 09:55 UTC (13 hours ago)
        
 (HTM) web link (opus.bsz-bw.de)
 (TXT) w3m dump (opus.bsz-bw.de)
        
       | amin wrote:
       | Fascinating. This is about people who have a strong desire to
       | have a their own (perfecly functioning) limb amputated.
       | 
       | It concludes: "None of the patients regretted the surgery and a
       | change for the better was seen in almost all areas of life".
        
         | [deleted]
        
         | lin83 wrote:
         | The survey was just 21 people "exclusively contacted in BIID
         | internet forums". How many people who cut off a limb and
         | regretted it would stick around the forum that fed their
         | compulsion to do it?
        
           | freemint wrote:
           | > How many people who cut off a limb and regretted it would
           | stick around the forum that fed their compulsion to do it?
           | 
           | Maybe many more then you would think. First of all of there
           | are others with regrets they are most likely also found
           | there. Second to warn others. Thirdly to vent.
           | 
           | I agree that the evidence is not the highest quality but i
           | have a hard time imagining a more involved study design that
           | would pass by any ethic board.
        
             | shanusmagnus wrote:
             | I wonder if it's similar to Amazon ratings, where review
             | distributions seem to skew toward people who either love
             | the thing, or hate it? Presumably there's actual research
             | on this. ... Okay here's something about the J-shaped
             | distribution (mostly 5 stars, some 1 stars, little in
             | between) in reviews [1]. (Edit: here's another, more recent
             | summary [2] of polarity in reviews.)
             | 
             | Would we expect the same in something as intimate as
             | amputating pieces of your own body? Hmmm.
             | 
             | [1] https://dl.acm.org/doi/abs/10.1145/1562764.1562800
             | 
             | [2] https://journals.sagepub.com/doi/abs/10.1177/0022243720
             | 94183...
        
               | t-3 wrote:
               | Off-topic, but I think the effect is even more pronounced
               | with a binary rating (thumb up/thumb down) vs a 1-5 star
               | rating. I've noticed that really bad or mediocre games
               | will take advantage of the upvote tendency by advertising
               | "90% positive reviews" in an attempt to trick people into
               | thinking they're good.
        
             | MrPatan wrote:
             | > Maybe many more then you would think. First of all of
             | there are others with regrets they are most likely also
             | found there. Second to warn others. Thirdly to vent.
             | 
             | And how would you find those posts after they were banned
             | and deleted?
        
               | fzeroracer wrote:
               | Google tends to cache pages for a long time, banned users
               | usually leave a long trail (and post on sites where they
               | will not get banned) and deleted posts can be resolved by
               | finding and asking the user in question. And usually
               | people with regrets tend to be very, very loud in
               | scenarios like this.
        
             | lin83 wrote:
             | > First of all of there are others with regrets they are
             | most likely also found there. Second to warn others.
             | Thirdly to vent.
             | 
             | I don't find that the least bit credible. The proposition
             | forum administrators would tolerate someone "warning
             | others" against the core uniting aspect of their community
             | is not realistic. Generally anyone who questions orthodoxy
             | in such niche communities face vitriol and get banned
             | quickly. Apostates do not hang around religious conversion
             | forums talking about deconversion, gender transition
             | desisters are not welcome on transgender support forums
             | etc.
        
               | freemint wrote:
               | Then one could surely find multiple occurrences of
               | externally archived but deleted forum post showing just
               | that. You are implicitly asking for proof of absence of
               | such censorship. This is an unreasonable standard.
               | 
               | Preventing motivated people from harassing others on a
               | forum is impossible if anyone can join the forum.
        
           | throwaway4bid wrote:
           | oh, I've run into one. a very unpleasant and mentally unwell
           | person - I think his motivation was purely sexual, and not
           | identity-driven. he creeped me out.
           | 
           | I personally know two, one who used the dry ice method to
           | destroy their legs, and another who achieved paralysis. both
           | are quite happy now, except for the pain and suffering they
           | went through (particularly the person who paralyzed herself,
           | since she caused meningitis which led to horrid nerve pain -
           | but even then, months later, she's happier now that it's
           | done.)
        
       | jasonhansel wrote:
       | If I'm reading this right: one of the subjects (#18) is 27 years
       | old now, and had a "friend" perform an amputation on him in
       | 2008...when he was about 13. Yikes.
        
         | throwaway89201 wrote:
         | No, it's a 2014 study. So he was 21.
        
       | freemint wrote:
       | Trigger warning: Contains references to voluntary disfigurement
       | and mental health.
        
         | political12345 wrote:
        
       | recuter wrote:
       | 3.2. Erotic Component
       | 
       | Several, but not all subjects wrote they feel an erotic component
       | as e.g.:
       | 
       | "In puberty there came an additional sexual component of about
       | 50% weight."; "In addition the stump is erotic.";
       | 
       | "When my first wife suffered from an osteo-sarcoma and lost her
       | left leg, my life was perfect. The stump became part of our
       | sexual satisfaction.";
       | 
       | "There is an aesthetic sexual complex, in addition I find the
       | kind of walking very erotic.";
       | 
       | "The otherness, the stump stimulated me. Pretending always
       | resulted in masturbation"
        
         | techdragon wrote:
         | I'll be brutally honest, I'm no longer shocked by this sort of
         | thing. I personally don't get it, but I get how it's their
         | thing.
         | 
         | It took just a few years exposure to the internet of the late
         | 90s and early 00s to open my eyes to the simple psychological
         | truth that the parts of our brain wired up to pass on our genes
         | are some of the most powerful and fascinatingly flexible.
         | 
         | The ample documentation on the development of so many different
         | fetishes all following similar phases from expose through
         | formative experiences to focus and on to full blown
         | fetishisation. It's the sort of thing that made me consider
         | psychology as a career. The human mind is fascinating.
         | 
         | When I read accounts like this it's like watching a remake of a
         | classic movie or a cover of a song, there's always new bits,
         | but you can see the classic parts like landmarks along a trail.
        
           | recuter wrote:
           | > I personally don't get it, but I get how it's their thing.
           | 
           | There is really nothing to get, some people just sexually
           | identify as pirates and won't feel complete without the
           | necessary body modifications. I knew I wanted to be one at
           | five years old for example.
           | 
           | Without the life saving surgery bestowing unto me a peg leg,
           | hook arm, and glass eyeball I'd be a very sad panda. From now
           | on you must refer to me as 'Yaaaaar', 'Matey' or 'Ahoy'.
           | 
           | I hope Treasure Island becomes mandatory viewing in
           | kindergarden along with puffy shirt sensitivity training so
           | other privateers won't have to endure the same pain as I did.
           | Your own children might be destined for the high seas and you
           | must not hold them back.
           | 
           | (I couldn't resist this most obvious of jokes)
        
       | poszlem wrote:
       | This type of "treatment" is an utter failure and surrender of the
       | fields of psychology, psychiatry, and neurology. The way we used
       | to think was - a sex change surgery used to only be performed
       | because we could not fix the mental problem (patient being
       | unhappy with their body). Now the whole script has flipped and we
       | are talking about how a "transwoman has always been a women" and
       | a "transman has always been a man", which is the newest version
       | of "if theory conflicts with the facts, so much the worse for the
       | facts". Now we actually ponder cutting off people's arms and
       | legs, which is so incredibly bizarre.
       | 
       | Not to mention how this opens a huge pandora's box of
       | "recognising" "transabled" people, "transracial" people (see Oli
       | London, Rachel Dolezal, or Martina Big) as, for the lack of a
       | better word - "healthy".
       | 
       | As a bisexual dude I suspect a lot of that has to do with the
       | stigma around "conversion therapies", but I worry that term
       | suffered from some really heavy "scope" creep.
        
         | treffer wrote:
         | I skipped right to the conclusion, as I wanted to see what the
         | document says, and it kicks of with "where no other treatment
         | exists", and to prevent self-inflicted amputations. Plus it
         | acknowledges that these people potentially need help _now_,
         | before we find better solutions in the other fields.
         | 
         | I can highly recommend to give the conclusion section a read. I
         | think the authors are well aware of these issues, to the point
         | that this scoping (no other treatment available right now /
         | other options exhausted + person needs help right now) makes me
         | slightly supportive.
        
         | [deleted]
        
         | JumpCrisscross wrote:
         | > _type of "treatment" is an utter failure and surrender of the
         | fields of psychology and psychiatry_
         | 
         | I, too, have an emotional response. But let's be scientific. If
         | the counselling shows middling success, and the amputation
         | 90%+, why do our feelings, as third parties, overrule the
         | person whose body it is?
        
           | Teever wrote:
           | Well in many countries with socialized medicine it's society
           | paying for the procedure, and in many countries with a social
           | safety net it will be society paying the disability payments
           | for someone who has compulsively had their legs cut off or
           | their eyes blinded with acid.
           | 
           | Let's run with your idea, if a vast majority of people felt
           | compelled to do these things would society be better off?
        
           | poszlem wrote:
           | I don't say this should be forbidden for consenting adults. I
           | am saying that it should not be sold as "the treatment" but
           | as "we don't have anything better for now, we are working on
           | it, if you can't wait, you can do it".
        
             | bastawhiz wrote:
             | > it should not be sold as "the treatment" but as "we don't
             | have anything better for now, we are working on it, if you
             | can't wait, you can do it"
             | 
             | It's not sold as the treatment.
             | 
             | And to your comparison to trans folks, top and bottom
             | surgery is not easy to access (and getting harder by the
             | day!). Talk to any trans person and ask them all the things
             | they needed to do and go through to prove to their doctors
             | that they're trans enough. Besides there not being another
             | option, gender affirming surgery works! The patients are
             | largely satisfied with their outcomes! Why do we need to
             | complicate this with suggesting how they _should_ feel or
             | think?
             | 
             | But moreover, who the fuck cares? I had gynocomastea
             | surgery (after years of bodybuilding) and all I had to do
             | was sign a form. Women can elect to get breast augmentation
             | with no evaluation. Why should a trans person have to prove
             | that they deserve a cosmetic surgery that anyone else can
             | get--so long as the outcome is gender conforming? I can get
             | anything I want tattooed on my face today, but someone else
             | can't get their chest flattened for months because...some
             | lab coats don't think they deserve it enough?
        
             | JumpCrisscross wrote:
             | > _it should not be sold as "the treatment" but as "we
             | don't have anything better for now, we are working on it,
             | if you can't wait, you can do it"_
             | 
             | Isn't this true of all treatments? It's the best we've got.
             | It seems to work. It has downsides. We're looking for
             | better options.
             | 
             | We start with the least invasive option. But we don't stop
             | midway because something better might one day turn up.
        
               | poszlem wrote:
               | Not really - we now create stable identities from what is
               | essentially a form of mental illness. We no longer say
               | that someone suffers from "body dysmorphia", instead we
               | say that they were "assigned the wrong body at birth".
               | It's similar to those deaf parents of deaf children who
               | are against giving them a cochlear implant lest they lose
               | their "deaf culture".
        
               | freemint wrote:
               | > We now create stable identities from what is
               | essentially a form of mental illness.
               | 
               | Yes. And? A stable identity is preferable for the
               | sufferers. Can you explain the problem with that?
        
               | poszlem wrote:
               | The problem with that is the same as we would get if we
               | decided that the way to treat anorexia is by allowing the
               | patients to starve themselves to death. They would die
               | thin and happy, but I don't think many people would agree
               | with it being the "preferred solution to that problem".
        
               | fzeroracer wrote:
               | You're comparing apples and oranges though. We know that
               | anorexia can generally be treated with cognitive therapy
               | and help restore people to a healthy and comfortable body
               | weight. Those same treatments fail when applied to people
               | with BIID. And they way they cause harm is different as
               | well, since failing to treat anorexia results in
               | starvation. While refusing to treat BIID results in
               | people taking dangerous risks to amputate themselves.
               | 
               | I don't see much of an actual solution to these issues in
               | your arguments other than some hand waving about politics
               | as some sort of root cause.
        
               | freemint wrote:
               | I fail to see the parallel. Anorexia as "starving
               | themselves to death" is not a stable identity, it is an
               | identity in decline with ongoing suffering and temporary
               | highs.
               | 
               | Should taking of legs be the first treatment option? No.
               | 
               | Should people get therapy, medication and other
               | treatment? Yes.
               | 
               | Should those treatments be refined and improved,
               | sufferers of BIID experimented on to improve treatments?
               | Yes.
               | 
               | If society is unable to come up with a treatment that
               | works for years should society deny sufferers this
               | radical treatment forever? No. That is imposing the
               | majority world view on a minority when the difference in
               | world view poses no harm. Yes, society would need to
               | address potential cognito hazards/memes and make sure
               | there are no people doing this for economic incentives or
               | other mental illnesses for which treatments exists.
               | 
               | If society would let people get the treatment, that would
               | not be capitulation. That would be acknowledging that
               | while society has interest in being able to treat that,
               | that interest can not forever outweigh the benefits the
               | radical operation has for the sufferer. Capitulation
               | would be if society stops trying to find a treatment
               | besides radical operation and handed operations out
               | without scrutiny.
        
               | freebreakfast wrote:
               | How does one distinguish between a stable identity and an
               | identity in decline?
        
               | JumpCrisscross wrote:
               | > _we are now creating stable identities from what is
               | essentially a form of mental illness_
               | 
               | Defining mental illness is imprecise. We've gotten it
               | horribly wrong before, from diagnosing intelligent women
               | as hysterics to gay men and women as deviants. We also
               | have a long, failed history of well-meant prohibition.
               | 
               | If we're seeing preliminary evidence that a surgery makes
               | miserable people happy, I say we follow the lead without
               | prejudice. Maybe we find these peoples' bodies are
               | picking up on precancerous signs? (Airball.) Probably, we
               | don't. But my peers' botox has visibly reduced their
               | faces' expressiveness; is that mental illness?
               | 
               | Out of all of our emotions, I trust my sense of social
               | disgust least. The world in which it evolved is no more.
               | If I can't find reason beyond discomfort to question
               | someone's decisions about themselves, I broadly tend
               | towards letting them be.
               | 
               | (Side note: appreciate the discussion.)
        
               | [deleted]
        
               | curious-im wrote:
               | All things you write - looks like you getting you data
               | from conservative media. "assigned the wrong body at
               | birth" - even in trans community considered huge
               | simplification and wrong narrative. It's used only to
               | explain the feeling to people who knows nothing about the
               | issue.
               | 
               | Gender dysphoria - yes, people suffer form it. Transition
               | is the way to lower this suffering. That's the 'cochlear
               | implant' equivalent from your example.
        
               | JumpCrisscross wrote:
               | > _looks like you getting you data from conservative
               | media_
               | 
               | Not OP. But this seems unfair. Not only does the language
               | surround trans persons vary from decade to decade, city
               | to city, it's also--understandably--guarded.
               | 
               | Someone far from knowing "nothing about the issue," and
               | moreover, wishes to learn more, could innocuously use
               | language that is offensive in some circles but tolerated
               | --even encouraged--in others.
        
               | curious-im wrote:
               | > "learning how to live as a deaf person"
               | 
               | This is what repression looks like. Before coming out,
               | while you try to live as you assigned gender - that's
               | living as a deaf person, pretty literally as
               | derealization and depersonalization are kind of
               | 'deafining'. As with deaf kid - you fix the body, not the
               | mind, so with gender dysphoria you fix the body first.
               | 
               | Maybe it's just me, but fixing identities scares me much
               | more than fixing the body. There was studies in which
               | trans people were asked if they would want to be consent
               | with their assigned sex (i.e. trans woman to be happy as
               | a man) - most don't. After transition almost none would
               | agree to change it for 'no dysphoria, assigned sex at
               | birth'. 'Fixing' such people sounds like a very cruel and
               | scary idea.
        
               | Teever wrote:
               | But sometimes deafness is the result of defects in the
               | structure of the ear and sometimes it's the result of
               | defects in the auditory nerve, or other structures in the
               | brain.
               | 
               | In some instances we provide a prosthetic that overcomes
               | the defects of the ear, like a traditional hearing aid,
               | or surgery that corrects those defects, and in others we
               | augment the person with a cochlear implant that bypasses
               | the issue with the nerve. We don't yet have the ability
               | to directly modify the brain with surgery or implants for
               | deafness but I'm sure that we would if we could.
               | 
               | It's interesting that we're talking about deafness
               | because there are many instances of deaf people with
               | heredity causes for their deafness opposed to testing
               | their children with new, effective treatments like
               | cochlear implants because they view it as impinging on
               | their deaf culture.
               | 
               | I think that there are many parallels between this and
               | the developing trans culture which will result in trans
               | people being resistant to more effective, less invasive
               | treatments to cure them of their affliction.
               | 
               | Why do certain maladies develop strong identity politics
               | while others don't? There isn't a diabetic identity, or a
               | halitosis community, so why these ones?
        
               | curious-im wrote:
               | I guess my problem with your view of 'transness' is that
               | you view it as illness or dysfunction. And it's not that.
               | Turning transwoman to a man is equivalent of turning man
               | to opposite gender in a bad case of gynecomastia. That's
               | not the mind that is a problem, I hope you understand my
               | point.
               | 
               | Dysphoria goes deeper than just bodily dysmorphia, it's
               | about how you see yourself, not only your body. So
               | changing my mind to make me something I'm not (a man)
               | sounds like a horror - some kind of upgraded lobotomy.
               | That's much more invasive than any surgery. And it's not
               | about culture, it's about understanding that people
               | identities is not a part that you can/should fix.
               | 
               | And speaking about data and science, there is pretty
               | clear evidence that trans people who receive proper care
               | (hormones) and accepted by society live normal happy life
               | as the rest of the people.
        
               | Teever wrote:
               | Well... it is an illness and dysfunction.
               | 
               | That's why people are treated by medical experts for it.
               | 
               | We're merely discussing the best form of treatment.
        
               | poszlem wrote:
               | I am sorry, but no, that's not coming from the
               | conservative media.
               | 
               | See for example "sex assigned at birth" https://service-
               | manual.nhs.uk/content/inclusive-content/sex-... as an
               | example from a mainstream medical institution, the
               | British National Health Service.
               | 
               | And transition is not "the cochlear implant", the implant
               | would be "an implant that makes you not dysphoric".
               | Transition is "learning how to live as a deaf person".
        
               | pmyteh wrote:
               | That NHS data collection recommendation says nothing
               | about "wrong body", though. They're trying to elicit
               | accurate information about something potentially
               | medically relevant (assigned biological sex). Their
               | concern is that if you ask a trans person simply "male or
               | female" you'll get an answer that either reflects the
               | gender someone is living in, or the sex on their birth
               | certificate. The former is useless if you're trying to
               | assess the risk of chromosomal disorders, the latter if
               | you're trying to work out how to politely address them.
        
         | anaisbetts wrote:
         | The visceral discomfort you feel about having a surgery to
         | change your body, how uncomfortable and wrong that feels, and
         | how unhappy you would be if someone did that to you?
         | 
         | The feeling that you're having, is _gender dysphoria_. That 's
         | what trans people feel _all the time_ , every single fucking
         | minute of their lives, every time they look down getting a
         | painful reminder that their body isn't Right; until they fix it
         | - which is a capital-C Cure. Problem solved, forever.
         | 
         | That sounds pretty fucking great to me. Why wouldn't you let
         | people live how they want to?
        
           | NewEntryHN wrote:
           | OP doesn't question the issue nor the necessity to fix it. He
           | questions the solution.
        
           | Teever wrote:
           | Here's a thought experiment. What if we had a simple,
           | effective, and side-effect free pharmacutical treatment for
           | BIID? what if someone could take a cheap pill every morning
           | and they suddenly felt fine with their leg that they would
           | otherwise be compelled to cut off?
           | 
           | This would obviously be better than hobbling someone with
           | crutches or a wheel chair and a disability cheque, better for
           | society abd the individual too.
           | 
           | Now what if a doctor decided one day to test this treatment
           | on someone with gender dysphoria and lo and behold it worked
           | just as well for them? The patient suddenly felt great about
           | their body, great about their appearance and they stopped
           | obsessing about changing it with risky and painful surgeries.
           | 
           | This cheap and effective pharmacuticial treatment would
           | instantly become a first line treatment for gender dysphoria,
           | right?
           | 
           | That sounds pretty fucking great to me. Why wouldn't you want
           | people to live their life how they were born to?
        
             | curious-im wrote:
             | I guess because they feel that they feel like they born to
             | be their preferred gender. The idea that there will be a
             | treatment that will make me feel like a gender I'm not
             | sounds pretty f-cking terrible to me.
             | 
             | Try this experiment on yourself and think that there is a
             | treatment to make you think you are woman/man. How's it
             | make you feel? And together with that, reflect on what
             | exactly make you be a man/woman - your body or your psyche.
             | 
             | There is a lot parallels between gender dysphoria and BIID,
             | but GD is bit more than just 'this is not my body'.
        
             | anaisbetts wrote:
             | > That sounds pretty fucking great to me. Why wouldn't you
             | want people to live their life how they were born to?
             | 
             | People have an inherent, fundamental Right to their own
             | body, to mold it into the image that _they_ choose. If they
             | want to take your magic pill? They have every Right to,
             | good on  'em. But if they want their body to be a certain
             | way, they have that Right too.
        
               | at_a_remove wrote:
               | Maybe, maybe. If they're willing to foot the bill and if
               | nobody has to be coerced into performing the surgery. Oh,
               | and they sign a "no regrets, tough shit" contract.
               | 
               | Right now the NHS is dealing with a "Why didn't anyone
               | stop me? All I got was positive support!" situation from
               | someone who is detransing.
        
             | fzeroracer wrote:
             | Why don't we expand your thought experiment? What if said
             | pill also cured homosexuality? If it made bisexual people
             | straight? This treatment would instantly become highly
             | valued for all sorts of religious groups and families. And
             | if they're perfectly happy after the treatment, what's the
             | problem? Why don't you want people to live as 'nature'
             | intends?
             | 
             | What your arguing for in your thought experiment is,
             | effectively, treatment designed to radically change
             | someone's sense of identity without side effects. It's a
             | thought experiment that falls apart once you expand it to
             | other things that were once commonly thought of as mental
             | illness.
        
               | Teever wrote:
               | It's simple. Being bisexual or homosexual doesn't
               | intrinsically cause any physical or mental anguish for
               | people in that state.
               | 
               | People with BIID and Gender dysphoria will kill
               | themselves if they don't receive treatment, and will
               | otherwise ha e poor life outcomes due to the adjacent
               | side effects like depression and self harm that comes.
               | 
               | The only negatives that being bisexual and homosexual
               | have come from external sources as you state.
               | 
               | In other words bisexual and homsexuao people are in a
               | state of homeostasis while people with BIID and Gender
               | dysphoria are not.
        
               | fzeroracer wrote:
               | I mean as a bisexual male, I can definitely state I've
               | had my fair share of mental anguish over having a thing
               | for men in the past so I don't exactly buy your post
               | about being in 'homeostasis' as you've described. That
               | feels more like post-hoc rationalization for a terrible
               | thought experiment than anything else. Especially since
               | people that suffer from gender dysphoria tend to have
               | worse outcomes due to external sources and lack of
               | validation, much like what would happen to severely
               | repressed gay people in religious communities.
               | 
               | And to further play the devils advocate there were plenty
               | of people at the time that believed gay people were a
               | blight on society for multiple reasons. Hence why
               | conversion camps were a thing.
        
               | Teever wrote:
               | but is the source of the mental anguish that you've
               | experienced internal or external?
               | 
               | Like if you were born in a society where religious
               | zealots who espoused bisexual bigotry just didnt exist,
               | toxic masculinity wasnt a thing and there was a bunch of
               | bisexual representation in media would you have had that
               | anguish? very unlikely.
               | 
               | People with gender dysphoria face the same negative
               | external influences as you do, arguably worse (lets be
               | real, much much worse) but if it would be removed and
               | they lived in a world without it they would still be
               | discontent with their state, to the point of depression
               | which would result in a poor quality of life and for many
               | suicide.
               | 
               | Thats the hallmark of the disorder. thats what gender
               | dysphoria is.
               | 
               | Lets do another thought experiment, what if we lived in a
               | society where gender reassignment surgery was impossible.
               | like lets ssay we just didnt have the advancements in
               | surgical techniques necessary, but we had much better
               | pharamcuticals. If surgery was impossible, but giving
               | someone a pill like I described in the first thiufht
               | experiment was possible that would be the morally correct
               | thing to do as opposed to doing nothing, right?
        
               | fzeroracer wrote:
               | To address your final thought experiment: In a vacuum?
               | Maybe. But there's a simple and easy response to your
               | second thought experiment that completely blows it apart,
               | and that's lobotomies.
               | 
               | Lobotomies were used as a cure for all kinds of different
               | things. If you knew something was a problem and lobotomy
               | was the only thing that seemed to cure it, is it morally
               | correct to do so as opposed to doing nothing? That's why
               | these simplistic thought experiments are bad because
               | there are examples of what happens when you take it to
               | their logical (and often sadly real) conclusion.
        
               | Teever wrote:
               | Is your issue with lobotomies is that they are a crude,
               | irreversible surgery that doesn't always work?
               | 
               | Now you understand the reticence towards gender
               | reassignment surgery and why someone would be looking for
               | much lower risk pharmaceutical treatments for gender
               | dysphoria, which is exactly what we ended up doing with
               | brain disorders?
               | 
               | It's worth noting that we still do brain surgery on
               | people, and that we're even moving towards using implants
               | to modulate how the brain functions, as opposed to the
               | crude technique of severing parts their brain with rods
               | jammed into their noses or holes drilled into their
               | heads.
               | 
               | I have a feeling that we'll look back on this time when
               | we cut off penises and inverted them into crude vagina
               | like canals, jammed silicon bags full of salt water into
               | chests and pumped people full of hormones as barbaric as
               | the lobotomy era.
               | 
               | They're things that we do out of convenience because
               | they're the best that we have, not because it's what we
               | want to do.
        
               | anaisbetts wrote:
               | > It's simple. Being bisexual or homosexual doesn't
               | intrinsically cause any physical or mental anguish for
               | people in that state.
               | 
               | I'm pretty sure this is 100% false. If in doubt, ask your
               | local Catholic priest about it.
        
               | freebreakfast wrote:
               | > treatment designed to radically change someone's sense
               | of identity without side effects
               | 
               | To what extent is "sense of identity" innate, and to what
               | extent is it culturally shaped?
               | 
               | For example, "homosexuality" and "heterosexuality" were
               | not something common before the late 19th century. While
               | people still engage in sexual acts with the same and/or
               | opposite sex, such acts did not play a role in their
               | identity.
               | 
               | This is evident as far back as ancient Rome.[0]
               | 
               | > Homosexuality in ancient Rome often differs markedly
               | from the contemporary West. Latin lacks words that would
               | precisely translate "homosexual" and "heterosexual". The
               | primary dichotomy of ancient Roman sexuality was
               | active/dominant/masculine and
               | passive/submissive/feminine.
               | 
               | To the ancient Romans, sexual acts with someone of the
               | same sex wasn't viewed like we do today. They wouldn't
               | have spoken about themselves as "gay" or "straight."
               | Rather, they would have spoken about themselves as
               | "dominant" or "submissive."
               | 
               | This concept runs counter to the way we think about
               | sexual identity today, but it demonstrates that there is
               | far more nurture in the mix than we often like to admit.
               | 
               | And, please note, this is not a judgment on people who
               | identify as homosexual or heterosexual. It is also not a
               | claim that we can "change" someone's orientation. It's
               | simply pointing out that sexual identity is not
               | necessarily something which is purely innate (nature).
               | This is something we tend to take for granted and without
               | much thought in contemporary Western society.
               | 
               | 0. https://en.wikipedia.org/wiki/Homosexuality_in_ancient
               | _Rome
        
             | ncmncm wrote:
             | That is what we do for people with anxiety disorder. They
             | often resist treatment, are finally persuaded to try it,
             | and almost all are afterward regretful that they did not
             | get treatment years earlier.
        
       | at_a_remove wrote:
       | I wonder if these folks are then eligible for disability. This
       | never seems to be addressed in any of the breathless articles
       | around this phenomenon.
        
         | bastawhiz wrote:
         | It's extremely hard to imagine a meager disability benefit (if
         | any) outweighs the surgery and recover and then living without
         | the limb indefinitely. If you were really in it for the money,
         | would you then hang out on a forum talking about the surgery
         | and not the money? Why would you have a whole arm or leg
         | removed when you could simply have a hand or some fingers
         | removed?
         | 
         | Even if they were eligible for the disability, the implication
         | that this isn't a real disorder ignores almost every aspect of
         | its reality.
        
           | ncmncm wrote:
           | Thinking of the healed leper in "Life of Brian".
        
       | nonrandomstring wrote:
       | There's a story from Oliver Sacks (Maybe in TMWMHWFAH [1]) where
       | a patient wakes up after a head trauma or stroke and screams at
       | his leg - "Get rid of it! Cut it off". IIRC, the dysphoria was
       | acute or somehow treated, so that might suggest there's a good
       | prognosis with neurological intervention.
       | 
       | [1] "The Man Who Mistook Hos Wife For A Hat"
       | https://en.wikipedia.org/wiki/The_Man_Who_Mistook_His_Wife_f...
        
         | throwaway4bid wrote:
         | That actually wasn't BID, it was another condition called
         | somatoparaphrenia. They might be linked, but no treatment short
         | of surgery for BID has ever demonstrated efficacy.
        
       | drummer wrote:
        
       | curious-im wrote:
       | Ive read stories from people with BIID and in many ways it's
       | similar to gender dysphoria. The way they feel it, all the things
       | around it, fantasies, dreams, etc.
       | 
       | Gender affirming surgeries have success rate of 95%+. No surprise
       | that BIID people have no regrets after all.
        
       | bradwood wrote:
       | Since when was "wannabes" a medical/academic term?
        
         | throwaway4bid wrote:
         | "wannabe" was the in-group term used inside the BID community,
         | back in the '00s. It's fallen out of favor as a pejorative
         | lately.
        
       | throwaway4bid wrote:
       | I have this condition (Body Integrity Dysphoria), along with a
       | fairly intense physical disability that I did not choose (genetic
       | disorder), and along with being trans, so I can answer any
       | questions you'd like to ask.
       | 
       | I became aware of my BID at age 6. I specifically want paralysis,
       | which is ironic now that I'm showing neurological symptoms from
       | the genetic condition. There is a sexual component for me, but
       | it's not my main motivation, and the sexual aspect has reduced as
       | the pure dysphoria intensifies.
       | 
       | The physical dysphoria is fairly similar to the gender dysphoria
       | I've experienced, but the social aspects, identity and tradeoffs
       | are completely different.
       | 
       | I've tried antidepressants, therapy including traditional
       | psychoanalysis, IFS, CBT, ACT, etc. Nothing has put a dent in the
       | dysphoria, only helped me move on despite it. I know two people
       | who've successfully achieved their disability, and they're much
       | happier now. I would if I were not so terrified of the risks of
       | DIY.
        
         | shrubble wrote:
         | Was treatment with pimozide ever attempted?
        
         | freemint wrote:
         | I am aware that hypnosis can be used to induce temporary
         | paralysis in targeted body regions. Have you experimented with
         | that and does it offer a temporary reprieve from at least one
         | of your sources of disphoria?
        
       | mgsk wrote:
       | There's a great long-form article about this:
       | https://medium.com/matter/8476df17bddf
        
         | shanusmagnus wrote:
         | Ugh, that's heart-wrenching. Curious, did you know about this
         | phenomenon already, and thus remember the article? Or did you
         | find it just now?
        
         | implements wrote:
         | > "The tension that had lined his face was gone. I sensed
         | relief, happiness. David's leg had plagued him for much of his
         | life. He was free of it, and now he seemed whole."
         | 
         | This type of 'cure' for dysmorphia is _not_ something to be
         | celebrated.
        
           | GavinMcG wrote:
           | ...why not? Italicizing "not" isn't much of an argument.
        
             | implements wrote:
             | His fixation with amputating his leg started at four years
             | old, it has an admitted sexual element, and now he has a
             | permanent life-altering disability - all this for the want
             | of proper psychological treatment.
        
               | fzeroracer wrote:
               | The study deals with this though. The people that have
               | BIID do go through psychological treatment, seek therapy,
               | medication etc which don't seem to blunt the issue.
               | 
               | But ultimately the end result seems to be that they will
               | eventually, one way or another, find a way to get the
               | surgery they desire. I don't know what your solution
               | would be in that scenario other than to criminalize it
               | and even then, there's reports of people doing home made
               | amputations by sitting on rail tracks or whatever else
               | you can think of.
        
               | throwaway4bid wrote:
               | I have BID. I've been in therapy for more than a decade.
               | Therapy has not done anything whatsoever for my
               | dysphoria.
               | 
               | I'm convinced that my overall quality of life would
               | improve if I got the disability I desire. The mental
               | anguish is simply more intense than the consequences of
               | physical limitation. I personally know others who have
               | "gone through with it" and they really are happier now.
        
               | bastawhiz wrote:
               | > proper psychological treatment
               | 
               | And that is....? There is no psychological treatment that
               | cures BIID and the patient here seems very happy. Is it
               | really better and "proper" to give someone treatment that
               | doesn't solve their problem and leaves them upset?
        
               | filoleg wrote:
               | I think the main idea of a proper psychological treatment
               | is that it wont "leave them upset".
        
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