Author Topic: Body Integrity Identity Disorder  (Read 704 times)

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Offline Hip Nixon

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Body Integrity Identity Disorder
« on: March 22, 2007, 09:26:25 PM »
I recently learned of the mental condition Body Integrity Identity Disorder. People with BIID feel great discomfort with their bodies and believe they should have been born with one or more specific limbs missing.

BIID folk do not consider this desire for stumped limbs to be a preference, they believe they were born in the wrong body and make efforts to "correct" what they see as a mistake from Mother Nature by having healthy limbs amputated.

When I first heard about this mental illness I was blown away by its remarkable similarities to Gender Identity Disorder (Transgenderism); people who believe they were born with the wrong set of genitals.

My hypothesis is that Transgenderism is a mental disorder that should be treated with counseling, not plastic surgery.

The typical transgender story starts during childhood, when the subject says they first felt a desire to act like a member of the opposite sex. This includes (among biological males for this example) interests like wearing dresses or playing with dolls. The subject then tells of repressing these feelings for many years, usually keeping it a secret. Then, often during adulthood, the person decides "enough is enough" and takes steps to have their body cosmetically modified and hormonically doped until they have the outward physical appearances of a woman. After they are "transformed" they are happy in their new body and say their feelings have been confirmed.

The typical BIID story starts in childhood and the subject feels that they shouldn't have certain limbs. They may decide that "on the inside" they are really a double above-the-knee amputee or that their left arm should end in a stump 8 inches from the shoulder joint. All the ones I have read were that specific. They will keep this idea locked inside of them for many years, then at some point in their life decide "enough is enough" and do something about it. This could be simply asking a doctor (such as Dr. Robert Smith of Scotland who was doing elective amputations until he was told to stop by hospital administration), or harming themself in a manner that the limb needs to be amputated. After they are "transformed" they are happy in their new body and say their feelings have been confirmed.

I see this mental disorder as a Rosetta Stone that flawlessly showcases the lack of critical thinking surrounding Transgenderism. Both disorders are feverously defended by the afflicated, who believe they really were born with faulty bodies despite a lack of empirical evidence.

A is C,
A is like B,
therefor B is C.

There was a different thread on Transgenderism in December, which I feel would have been more successful with BIID as a starting point. Unlike that thread's author, I offer no apologies for calling into question a sexual minority lifestyle that has been targeted by bigots. Do aetheists spend their time worrying about being labeled as Godphobic? I do wish to distance myself from those who respond to the issue with blind, hateful knee-jerk reactions, but I do not wish to walk down that road beyond this paragraph.

Labels like "transphobic" distract from the real issue, which is the lack of empirical evidence.

The argument usally relies on appeals to emotions and taking the Transgendered individuals word for it.

I read Dr. Steven Novella's citation of a brain study that are percieved to support the "born in the wrong body" view, formerly known as "God put me in the wrong body." I hate to come off like a pseudoskeptic, but those tests only showed a correlation. Here's a quote:

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"Whether these men were born with a small BSTc which caused them to become transsexuals, or whether these men became transsexuals which then caused them to have a small BSTc, the fact remains that their brains are physically different." -Marc Breedlove


If we do want to base everything on this study. then the first conclusion says that Transgendered people are fooled by their brain into thinking they are a member of the other gender. The second is that the Transgender mindset shrinks the BSTc area of the brain.

The study outright assumes the homosexual women and heterosexual women have the same BSTc because the researchers noted that gay and straight men have the same BSTc size. It states that the researchers very boldly believe other factors are not influential even with the small sample size. This is not a subject I am an expert on so I won't try to argue with them on that.

Another quote from Marc Breedlove reads:

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"For most laymen the idea that experience can alter the structure of the brain may seem unlikely, but for over 30 years neuroscientists have provided demonstrations that this idea is quite correct."

Correct me if I'm wrong, but doesn't that suggest that counseling and therapy could potentially "fix" the BSTc size?

A leap of faith is required to go from having someone believe they were born in the wrong body to saying they ACTUALLY WERE born in the wrong body.

I think it's irrensponcible for a Doctor to be in league with a mental disorder. If someone with a severe hallucinations say they always see the walls of their rooms as drenched in blood, does the hospital dispatch a crew with a bucket of blood and a spray gun?

If we can accept that the mentally ill believe they are historic figures, or mythical creatures, why do we nod our heads when they say they are a member of the opposite sex? The non-mental disorder theory of Transgenderism requires a lot of assumptions about the body and gender.

And extraordinary claims require extrodinary evidence.
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Offline stickman

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Re: Body Integrity Identity Disorder
« Reply #1 on: March 22, 2007, 10:25:51 PM »
Quote from: "Hip Nixon"


My hypothesis is that Transgenderism is a mental disorder that should be treated with counseling, not plastic surgery.


A reasonable hypothesis.  Not one science can presently prove or disprove, as far as I know.

It seems to me that they key thing to be considered is which treatment is more successful.  Have you any evidence to show counseling is more effective than surgery in these cases?

  I've only known one transgendered guy.  I met him as a man, and a year or so later, he began living as a woman.  As I recall, he said that to be eligible for surgery, he had to live as a woman for 3 years, and undergo counselling.  He said that it was really hard to make the decision, and it cost him his marriage, but he never doubted it was the right thing to do.  He seemed really happy as a woman, despite the fact that he was 6'3" and about 220 lbs.  It can't have been easy.
  I lost track of him, and can only assume he went through with the surgery.

  It's surely not something anyone should rush into, but I don't see anything wrong with it.  Anyone have any figures on the percentage of people who get the surgery and regret it?
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Offline SkepThickHeaded

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Re: Body Integrity Identity Disorder
« Reply #2 on: March 23, 2007, 01:03:00 AM »
Quote from: "Hip Nixon"

My hypothesis is that Transgenderism is a mental disorder that should be treated with counseling, not plastic surgery.


My gut instinct is that is a correct statement.  

As a result of living in a very gay city (gay as in accepting of alternative lifestyles, not gay as in lame) and peripheral involvement in the music scene which is even gayer, I know a LOT of people who run the gamut of gay, trans(vestite, sexual, gender).  So I've actually had the "sit down and talk over beers" with people who are literally uncomfortable in their own skin, and say things like "I hate my penis" and "I'd cut it off if I weren't a coward".  

It's not the kind of conversation that reminds you of someone who needed a cyst removed, it's the kind that makes you think the person is in serious need of major mental health support, not a guy with a scalpel.

The intellectual side of me demands that people be allowed to do whatever they want to their own body, there really can't be any more sacrosanct form of freedom.  At the same time though, I'm pretty sure that a doctor who cuts off healthy sex organs probably shouldn't be calling what he does "medicine".
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Offline IRON MAN

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Re: Body Integrity Identity Disorder
« Reply #3 on: March 23, 2007, 07:17:48 AM »
Quote from: "Hip Nixon"
... There was a different thread on Transgenderism in December, which I feel would have been more successful with BIID as a starting point.


I assume you are talking about this thread:  http://www.skepchick.org/skepticsguide/viewtopic.php?t=893

I of course am aware of BIID, but I felt the debate is potentially tangental enough without bringing that up too, which is also why I felt I had to preempt arguments about gay rights, the right to do with your body as you choose, etc.  I've been down this road many times before.  Don't say I didn't warn you ...

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Unlike that thread's author, I offer no apologies for calling into question a sexual minority lifestyle that has been targeted by bigots ...


My ego is a minor point in the context of this discussion, so I wont make an ongoing issue out of this, but I will say that I disagree with that characterisation.  And I don't think "apologising for calling into question" is exactly a phrase many people here would associate with me.  You might need to read it again.
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Offline Hip Nixon

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Body Integrity Identity Disorder
« Reply #4 on: March 23, 2007, 09:55:32 AM »
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My ego is a minor point in the context of this discussion, so I wont make an ongoing issue out of this, but I will say that I disagree with that characterisation. And I don't think "apologising for calling into question" is exactly a phrase many people here would associate with me. You might need to read it again.


I apoligize for coming off that bluntly. I believe you intention was to protect yourself from ad hominems about being motivated by prejudice, not an apology for your beliefs. I was trying to be concise with my wording and not dwell on that issue for too long. Again, I apoligize for my clumsy wording.

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It seems to me that they key thing to be considered is which treatment is more successful. Have you any evidence to show counseling is more effective than surgery in these cases?


If my hypothesis is correct, and this is a mental disorder and not a case of the body being the wrong gender for the brain, then I see surgery as a "cheat" to get out of therapy.

I do agree with most rights people have over their own bodies, however this is different. Let me explain with an example.

There are men who are uncomfortable with their own homosexuality that seek sex change operations to live the life of heterosexual women. See http://www.transkids.us/ for their perspective, which is often silenced by the "born in the wrong body" crowd. I feel these people, being in a rational state of mind, should have the right to change their bodies as they see fit.

If my hypothesis is correct, then Transgender folk are not in a rational state of mind. If someone with schizophrenia asked a doctor to put out their eyes so the devil can't use them as a spyglass into the earth, it would be wrong to "go along with the disease."

If someone with delusions about their body wants to be mutilated (through a so-called sex change or amputation) isn't it also wrong to go along with that disease?

I have found no evidence that counseling is more successful. I could try to chalk it up to not being used as a treatment enough, but thats useless conjecture. Assuming the success rate is dismal in comparison, isn't it a more appropiate form of treatment?

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I've been down this road many times before. Don't say I didn't warn you ...


I've been down this road too. I was an op/ed columnist in college and I had a few articles (and responces) on the issue. I can post them if this thread can handle the volume of information.

From one of those responces, I was corrected in my false impression that sex-change patients are screened to see if they have the disorder. Instead, they are screened to see if they can handle the treatment. Here's a quote

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The Harry Benjamin International Gender Dysphoria Association - http://www.hbigda.org/ - an internationally recognized group of professionals who create and maintain the standards of care for persons with Gender Identity Disorder define transsexualism as having three distinct criteria: The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment; The persistent presence of transsexual identity for at least two years; and the uniqueness of the disorder is not a symptom of another mental disorder or a chromosomal abnormality. It should be noted that there are other types of GID, but these are beyond the scope of this discussion.
To qualify as a mental disorder, a behavioral pattern must result in a significant adaptive disadvantage to the person or cause personal mental suffering. GID does both of these things. Though it is not directly life-threatening, denying treatment or insurance coverage to persons working through this disorder would be comparable to withholding similar assistance from persons with anything from bipolar disorder to suicidal depression. It is estimated that GID appears in less than 0.25 percent of the population. Providing needed medical treatments to a population of that size simply does not compare to the scores of fraudulent insurance claims which occur every year.

 

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