So I’ll admit, I’ve recently done an extensive marathon of the series Chicago Med as I was in bed recovering from a bout with you-know-what (yes, it finally got me).
Feelings of this nature are most often the result of trauma that the patient has suffered in their life. What is feeding that feeling that the arm is not part of them? Trauma-trained providers can work with the patient to explore what is going on underneat the feeling. Unnecessary medical surgeries are not the answer.
When I was in my 20s I had certain health issues for which I requested my doctor consider a hysterectomy. I did not want kids for personal reasons and b/c the world was a cess pool. She refused, citing my age and lack of long-term consideration as reasons. I was pissed for awhile, but I'm glad she did not just give in. I did finally have the hysterectomy to correct those issues, but it happened much later after other options were exhausted without resolution. My life in the meantime was not unbearable. I'm glad I didn't have to deal with the results/side effects of hysterectomy when I was younger.
Just because a patient wants some procedure or intervention does not mean physicians are obliged to provide it. And I can’t think of any actual doctor who would for one moment consider amputation of a healthy limb a viable treatment for psychological suffering. There may be a few out there but they are clearly crazy.
There are plenty chronic physical conditions that we live with. We live with pain, some of us lifelong physical pain. There no such thing as "the right to a cure".
If I believe irrationally that taking antibiotics every day for life when I don't have an infection or that chemotherapy would really do me good even though I don't have cancer, no doctor would consider it. Because my belief that I would feel better does not meet the burden of proof of efficacy for treatment.
People often think that they are missing just that one thing to be happy: more money, a house, plumper lips, prettier spouse, you name it. When they get those things, they more often than not remain unhappy.
This is less of an ethical conundrum than people want to believe. If one wants to cut an arm, maybe we can't really stop it, but no, we in general and the medical professionals in particular should not participate in literal insanity.
My father was a neurologist/neurosurgeon in several large urban hospitals. As such, he consulted with many psychiatrists (who are all MD's prior to achieving their Psychiatrist qualification) Dysphoria is a very real condition, as some patients opted to go offshore for the elective surgery. Despite removal of the limb (or other body appendage) many did not get relief. Therapies included medications and behavior modification with no real guarantee of change. It is not a morality issue, but rather an adult issue of choice after reviewing therapeutic options. Back in the 70s, U.S. surgeons would never attempt this surgery. India and Mexico were options. I'm sure Chicago Med is intriguing entertainment, but can it portray the real angst this condition brings to a person's life?
That episode does a brilliant job hitting some key aspects of true dysphoria that most people (including many who should know better) miss, either due to naïveté or on purpose.
- It starts very young. Usually 3-4 years old is when it sets in, and it persists for your entire life. You can attempt to treat it, but there is no known way to remove the feeling from the individual.
- It is EXTREMELY rare. The DSM-5 estimates that it can be as rare as 1 person in 20,000 (0.005%).
A someone who lives with dysphoria, my opinion is that if the dysphoria is legitimate, then there will be no regret later on if the body is augmented to match the desired self. My dysphoria happens to be currently medically impossible, so I can only hope that science gets to a point to allow me to realize my desired self before I die. If my thing was not having an arm, I would have removed it years ago, and since dysphoria lasts forever, I would never miss it.
This brings me to what I believe is the true crux of the issue: distinguishing legitimate dysphoria from things like autism, social contagion, psychosis, childhood imagination, etc. This is why I believe that true dysphoria can only be diagnosed well into adulthood, and only when all other possible conditions are ruled out. When inexperienced or ideologically-driven clinicians make type I errors is when things go tragically wrong down the road, and that's what we're seeing way too much of today.
As someone who suffers with BIID, I have had this for my entire life. I wish a surgeon could cut off my lower legs, I would be willing to pay out of pocket for everything. Surgery, recovery, everything.
Because just like in that episode of Chicago Med, it is absolutely a case of "If I can't get it done surgically, I'll do it myself". I know several other folks with this condition who have attempted, and either succeeded in amputating the limb, or dying during the attempt.
If surgeons can help us, they will absolutely be saving lives. Make us jump through the psychiatric evaluation hoops, meds, therapy. But please give us the surgical option if all else fails.
Here's my take, but it's a bit more on the nose and covers different but adjacent territory:
Your child has gender dysphoria. They have been complaining about this and insisting that they are the opposite sex for some time.
There are two different medical treatments available, and both are equally effective at their stated goal - one allows for a complete transition to the opposite sex with no side effects, the other allows your child to become completely comfortable with their birth sex.
Both treatments are legal, parents can give permission on behalf of their child.
One more dilemma to add... Suppose the patient is indigent & it's decided amputation is the only option. Are taxpayers who may have moral objections obliged to pay the bill?
There was a real-life case of a woman who thought she was supposed to have been born blind. She found a "therapist" who was willing to put drain cleaner in her eyes to be blinded.
Feelings of this nature are most often the result of trauma that the patient has suffered in their life. What is feeding that feeling that the arm is not part of them? Trauma-trained providers can work with the patient to explore what is going on underneat the feeling. Unnecessary medical surgeries are not the answer.
When I was in my 20s I had certain health issues for which I requested my doctor consider a hysterectomy. I did not want kids for personal reasons and b/c the world was a cess pool. She refused, citing my age and lack of long-term consideration as reasons. I was pissed for awhile, but I'm glad she did not just give in. I did finally have the hysterectomy to correct those issues, but it happened much later after other options were exhausted without resolution. My life in the meantime was not unbearable. I'm glad I didn't have to deal with the results/side effects of hysterectomy when I was younger.
Just because a patient wants some procedure or intervention does not mean physicians are obliged to provide it. And I can’t think of any actual doctor who would for one moment consider amputation of a healthy limb a viable treatment for psychological suffering. There may be a few out there but they are clearly crazy.
There is something underlying any desire.
There are plenty chronic physical conditions that we live with. We live with pain, some of us lifelong physical pain. There no such thing as "the right to a cure".
If I believe irrationally that taking antibiotics every day for life when I don't have an infection or that chemotherapy would really do me good even though I don't have cancer, no doctor would consider it. Because my belief that I would feel better does not meet the burden of proof of efficacy for treatment.
People often think that they are missing just that one thing to be happy: more money, a house, plumper lips, prettier spouse, you name it. When they get those things, they more often than not remain unhappy.
This is less of an ethical conundrum than people want to believe. If one wants to cut an arm, maybe we can't really stop it, but no, we in general and the medical professionals in particular should not participate in literal insanity.
My father was a neurologist/neurosurgeon in several large urban hospitals. As such, he consulted with many psychiatrists (who are all MD's prior to achieving their Psychiatrist qualification) Dysphoria is a very real condition, as some patients opted to go offshore for the elective surgery. Despite removal of the limb (or other body appendage) many did not get relief. Therapies included medications and behavior modification with no real guarantee of change. It is not a morality issue, but rather an adult issue of choice after reviewing therapeutic options. Back in the 70s, U.S. surgeons would never attempt this surgery. India and Mexico were options. I'm sure Chicago Med is intriguing entertainment, but can it portray the real angst this condition brings to a person's life?
That episode does a brilliant job hitting some key aspects of true dysphoria that most people (including many who should know better) miss, either due to naïveté or on purpose.
- It starts very young. Usually 3-4 years old is when it sets in, and it persists for your entire life. You can attempt to treat it, but there is no known way to remove the feeling from the individual.
- It is EXTREMELY rare. The DSM-5 estimates that it can be as rare as 1 person in 20,000 (0.005%).
A someone who lives with dysphoria, my opinion is that if the dysphoria is legitimate, then there will be no regret later on if the body is augmented to match the desired self. My dysphoria happens to be currently medically impossible, so I can only hope that science gets to a point to allow me to realize my desired self before I die. If my thing was not having an arm, I would have removed it years ago, and since dysphoria lasts forever, I would never miss it.
This brings me to what I believe is the true crux of the issue: distinguishing legitimate dysphoria from things like autism, social contagion, psychosis, childhood imagination, etc. This is why I believe that true dysphoria can only be diagnosed well into adulthood, and only when all other possible conditions are ruled out. When inexperienced or ideologically-driven clinicians make type I errors is when things go tragically wrong down the road, and that's what we're seeing way too much of today.
As someone who suffers with BIID, I have had this for my entire life. I wish a surgeon could cut off my lower legs, I would be willing to pay out of pocket for everything. Surgery, recovery, everything.
Because just like in that episode of Chicago Med, it is absolutely a case of "If I can't get it done surgically, I'll do it myself". I know several other folks with this condition who have attempted, and either succeeded in amputating the limb, or dying during the attempt.
If surgeons can help us, they will absolutely be saving lives. Make us jump through the psychiatric evaluation hoops, meds, therapy. But please give us the surgical option if all else fails.
Really like this one.
Here's my take, but it's a bit more on the nose and covers different but adjacent territory:
Your child has gender dysphoria. They have been complaining about this and insisting that they are the opposite sex for some time.
There are two different medical treatments available, and both are equally effective at their stated goal - one allows for a complete transition to the opposite sex with no side effects, the other allows your child to become completely comfortable with their birth sex.
Both treatments are legal, parents can give permission on behalf of their child.
Which one do you choose?
One more dilemma to add... Suppose the patient is indigent & it's decided amputation is the only option. Are taxpayers who may have moral objections obliged to pay the bill?
There was a real-life case of a woman who thought she was supposed to have been born blind. She found a "therapist" who was willing to put drain cleaner in her eyes to be blinded.
Not a moral dilemma. Continue pursuit of help without harm.