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Do people undergo experimental heart surgery because they don't like how their heart looks?
If there was an experimental heart surgery which changed the color of a patients heart from vaguely red to bright pink, I wouldn't support people doing it. I definitely wouldn't support impressionable teenagers who read about this on the internet doing it.
Oh, then you'll love the whole question of "people who want to be amputees" piggybacking off the trans movement, which in turn piggybacked off the gay rights movement. Welcome to the transableism community, and BIID (Body Integrity Identity Disorder).
One large reason this whole topic is a giant steaming mess is the over-reaction to "it's all personal autonomy, my body my choice, medical gatekeeping" push for absolute liberty on the part of the person seeking such radical changes. "It's not mental illness, it's my life!"
Except then that becomes the rationale for the craziness to seep in as well. If it's fine to seek radical surgery to change your body to fit with your mental model of what it should be like, why not people who feel deeply distressed by having an arm or a leg they want removed?
We need to get back to a common sense model, but unhappily nobody can agree what common sense looks like at this date. The success of having homosexuality removed as mental illness from the DSM meant that now all kinds of what can be described as 'alternate sexualities/orientations' cannot be called mental illness, and so the worst fringe cases get free rein. If we had the courage to say "no, this is insanity and not simply an unconventional lifestyle choice" we might cut the Gordian knot.
Your last paragraph doesn't follow from the rest of your post - indeed, it seems at odds with it. The transableism guys are claiming they deserve accommodation because their wacky desire is a mental condition isomorphic to gender dysphoria. The problem very much isn't that we've become unwilling to call these things mental illness! I say that neither should be classified as mental illness. Gender reassignment should be classified as elective plastic surgery, not treatment for an illness. This is what a principled stance for personal autonomy should yield, and cuts through all the bullshitting about suicide risks.
The model of transsexuals is exactly that. It’s medical, social and even political accommodation to a reality that exists only in a person’s brain. There is nothing physical about being a transsexual. If no biological or social intervention happens, a trans woman will develop into a man from the baby boy he was born as. A trans abled person is in exactly that position of wanting society and especially the medical establishment to not only accept them, but work to make the vision of themselves a reality in the real world.
My question is with so many of these issues — where and how do you stop the creeping of the concept into more related concepts? If we accept transgender, and force everyone to play along and force doctors to do surgery and insurance companies to cover it, why not trans-canines who want a tail, why not the trans-abled who want the doctor to cut off their legs? Why not allow for transracial people to live as their desired race?
I think a good working model of mental illness must naturally include deviation from observed reality, and the best option for treatment shouter accepting the reality that exists. I am not a Korean in a white American body. I can have all the surgery and act as Korean as I want. I’m still not Korean. And if I persist in that delusion then the problem lies between my ears, not with the reality that made me German American.
Why not indeed? I don't think you understood my position, which is happy with neither the mainstream trans or anti-trans positions. I'm a transhumanist, I have libertarian leanings on at least this particular issue, and I do in fact consider it a grown man's right to get an artificial tail if he wants, just as much as artificial breasts or a nose piercing. Or some sort of melanin injection that changes your skin color, if it existed. Bodily autonomy means bodily autonomy. I fully bite that bullet.
However, treating all these things as personal desires should also logically mean that we stop medicalizing them. I think it's disingenuous of the trans movement that they simultaneously go for the bodily-autonomy line, which I respect, and want to keep "gender dysphoria" classified as a mental illness. You really can't have both. Wanting-sex-reassigment-surgery should not be classified as a mental illness any more than wanting-a-tattoo-really-bad. (You could certainly find biological women with self-image issues who were suicidal before getting cosmetic plastic surgery, but that doesn't make the surgery a medical intervention then, just an expense she has decided on of her own free will in pursuit of her happiness. We shouldn't treat the matter any differently if it's a biological man who elects to get the same procedure.)
There is, of course, a separate conversation about whether someone who makes himself disabled on purpose should get the same unemployment benefits etc. as someone who lost an arm by accident. But if a millionaire wants to cripple himself at his own expense, and can demonstrate that he's making that choice of his own free will after careful consideration, rather than in a fit of psychosis - then I don't see why that should be a crime. Hella weird, but it's not my business.
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You have four healthy limbs. You feel really, really sad about that and believe you should only have three. Yes, that is mental illness, every bit as much as if you believed your neighbours were breaking into your house to smear shit on the kitchen walls.
You have healthy external and internal sexual characteristics. You feel really, really sad about that and want to undergo surgery to change what can be changed to those of the opposite sex. The only difference I see is that so far we have agreed to go along with the latter and not the former, as yet, though I wonder how long that distinction will hold. Somebody is going to do "limb reassignment surgery" (and apparently already has), there will be a movement and activism, there will be "studies show that after getting the amputation suicidality goes down and self-reported happiness goes up", there will be "what harm does it do? besides, it doesn't affect you anyway" and the rest of it.
Mental health is a part of medicine. The treatments we have in this area are less effective, less evidence-based, even controversial but part of current medicine nevertheless.
Some issues are clearly related to biologic disorders like autism or schizophrenia. Sometimes we are not even sure what it is.
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You're a biological woman. You have healthy but pretty small breasts. You feel really, really sad about that and want to undergo surgery to make them larger. Is that mental illness?
I don't think desires should be pathologized, except in extremely rare cases. My belief is that legal adults should be able to get whatever elective surgery they damn well want, so long as they demonstrate informed, lasting consent. If it's kosher for a cis woman to get breast enhancements if she sees fit, I see no reason why the same right shouldn't apply to a biological male. Contrariwise, if we recognize that a woman who gets plastic surgery (or her ears carved to look pointy, or whatever non-gendered body modification) is just exercising her rights as a free individual, not responding to some all-important mental illness which it would obviously make her suicidal to deny - then the current classification of "gender dysphoria" as a mental illness becomes obviously nonsensical. It becomes a cheap and dirty hack to convince people to support transition, in minors and others, Because Psychiatrists Say So Suicide Risk Suicide Risk Suicide Risk Do You Want Their Deaths On Your Conscience. I think that is the great lie of the trans movement, and while I understand how they got there, I would like them to get rid of it and revert to a principled stance of "people can do what they want".
If you think that in order to be attractive you need Giant Bazongas, and guys really do expect women to be waifs with Giant Bazongas or else they're not pretty enough, then maybe not strictly mental illness but something has gone wrong with social attitudes and expectations diverging wildly from reality. And people addicted to plastic surgery do exist, and I would have no problem calling that mental illness.
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No real dog in the rest of this fight but I should point out that some of the plastic surgeons I've met believe that ANY desire for their services is fundamentally body dysmorphia (and therefore mental illness).
Even things as simple as nose jobs.
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I really don't think that's enough for them. If it was just about body modification, then appeals to autonomy would be fine and a sensible position. But they want more than that. They want the right to do want they want, and make everyone else approve of it. They seek self validation from external sources and are sad at not getting it. Hence the moral blackmail.
I agree! See "while I understand how they got there, I would like them to get rid of it and revert to a principled stance". I have more common ground with the pro- than anti-trans movement at the end of the day, but I am very happy to criticize the current Standard Trans Message, which has been optimized for winning PR battles, not for truth.
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I'd be a tad bit concerned if my heart was, for example, a shade of blue. I'm not quite sure how I'd find out in the normal course of things, but it can happen, and represents a rather concerning situation.
Note that I'm objecting to the standards being used by the person I was replying to. I'm not a fan of gender reassignment surgery, or hormones, or putting on a dress.
I'm actually kind of surprised by that. As a transhumanist, I would've thought you were all in support of gender reassignment surgery (since it fits in nicely with the idea of breaking out of the limitations of the meat body one was born with). Can you expand on your thinking there?
You're in luck, because just a day or so ago I went into a lengthy explanation of why I'm not an advocate of gender reassignment surgery, and why transhumanism is as distinct from trans ideology as cats are from dogs:
https://www.themotte.org/post/1794/culture-war-roundup-for-the-week/311661?context=8#context
As one tanshumanist to another, my problem with this is that it seems like a very limited view of transhumanism. What I'm rooting for here is a future where I get to be some sort of shapeshifting consciousness which only occasionally reverts to humanoid form for old time's sake; not just "a 6'9" muscular 420 IQ uber-mensch". And if we get that, surely, surely you see that only joyless luddites would keep objecting to calling someone who's manifesting as a clearly-feminine angelic metaverse hologram "she", just because she doesn't have any biological female characteristics. (Because, you know, she wouldn't have any biological characteristics anymore.) Gendered language would only be based on presentation. And if Utopia involves calling people "she" even if they have no XX chromosomes if that's how they present themselves, it seems clearly morally correct to me that we should call a female-presenting person "she" even stuck as we are in flesh bodies that occasionally have spurious XY chromosomes.
I only used the example of a 6'9 genius for illustrative purposes (and it's an upgrade over my current build), I want to be a posthuman information entity running on a Matrioshka brain as much as you do. I'm pretty sure I've already said that.
We're not yet at that posthuman state. People currently have certain physical and biological traits that they're unable to change even if they desperately want to change them. That's the whole thrust of my argument. Will I call someone "she" even they're not biologically female? Why not, it's not a big deal for me. Will I say that they're indistinguishable from a normal woman? No, because that's not true.
A large fraction of trans advocates make demands far more significant than merely calling people by different names or different pronouns. I personally don't care at all what toilets they use, or if they want to enter women's sports, but plenty of people do, and that's a far bigger ask.
Ah, all fair then. I think we're basically on the same page.
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Trans women want to be called "she" because they would like to be biological women and forcing people to call them "she" is as close to that as they can get, barring operations. Your hypothetical hologram person doesn't want to be called "she" for this reason (because if they did, they would actually transform into a biological woman).
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Gotcha. So it's not that you're opposed to those things per se, but that you're opposed to pretending like they are reaching the goal (when in fact they aren't).
That's a good summary. If there was a pill that magically turned you into the opposite gender, what business of mine is it if people take them or not? If there were people claiming to have that pill, convincing other people that worked, and resisting evidence to the contrary, then I'm against poor epistemics on principle, and I'm also a psychiatrist (in training).
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https://www.themotte.org/post/1794/culture-war-roundup-for-the-week/311661?context=8#context
TL;DR we aren’t there yet, but once we are, he’s not going to complain.
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I'm lost in the analogy now. What?
I was being literal, sufficiently bad cyanotic heart disease can literally make your heart blue. You'd have more pressing concerns at that point other than the color.
Didn’t think about that! (That said I’ve not seen basically anything about early developmental disorders since medical school)
Would be rather odd for it to suddenly happen to an adult though
Depends on how generous you want to be with "late cyanosis", but my understanding is that something like an Ebstein's anomaly or PAPVAR can rarely present in adulthood with any asymptomatic childhood and adolescence.
Same dawg, same. Hoping none of that nonsense comes up in my line of work.
Point taken.(Is PAPVR a cyanotic disease...? I don't think it is.)
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I'm pretty sure he's referring to a heart attack, and I'm guessing the analogy refers to that "not liking how something looks" can reflect a more serious underlying cause than pure aesthetic distaste.
No one, and I mean absolutely no one, among trans activists believes there is an underlying issue with a trans person's endocrine system, genitals, or breasts. If for no other reason, then because it could be used for diagnosis and gatekeeping.
With all the caveats of our discussion a couple days back…I really don’t think this is true? If only because androgen insensitivities and intersex conditions make a really secure motte. They more or less defuse the “is it a choice/contagious?” step of the argument.
See also the confusion over whether Imane Khelif was an icon of trans resistance.
The thing is, if they really believed this, than the motte is all that there should be. No one outside of a DSD condition should even be considered for a gender dysphoria diagnosis. Like I said in the other comment, I don't think even truscum would let that fly.
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I don't think that's true. The truscum/tucute divide exists, and it wouldn't surprise me if the former regained power in this new environment.
I don't think even the truscum believe the issue is with the endocrine system, genitals, or the organs constituting secondary sex characteristics. Maybe they'd go for brain differences or something.
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