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I'm all for radical morphological freedom, and happen to be libertarian enough to not even be against people without sufficient training or common sense dabbling in the fine arts of cutting things off a human body. If everyone involved consents, why should
Jesusthe UK Government object?Though I would certainly advocate for making that numpty ineligible for welfare of any form, he quite literally lacks a leg to stand on. Welfare should be a safety net, not an opportunity to try bungie-jumping without a cord while expecting it to catch you.
In other words, I demand people get the right to be stupid, even if I find it painful, as long as they avoid imposing externalities on everyone else, or remove that option from them by refusing to give them free money.
Thankfully, the proportion of people willing to go to such lengths solely for the purposes of being a free loader are so tiny they make Lizardman's Constant look like Godzilla, so it's not a particularly pressing matter. But we're not a Full Automated Luxury Space Communism (yet, and the sexuality should be optional), and these idiots should not get to benefit from skimming off the top of other humans earnestly burning their finite lifespans doing productive work. They can sit around and get paid for it when we all have no choice in the matter.
I actually don't know to what extent gender reassignment surgery is covered by the NHS, but at least that sclerotic institution pays lip service to the idea of cost-benefit, if only because it's underfunded. I suspect a proper analysis would rule out gender reassignment via surgery, even for truly hardline or sincere demands, but I haven't done the maths, even using such divorced and clinical figures as QALYs and DALYs.
To me, an ideal outcome would be:
These fools get to perform whatever they like on each other.
The government doesn't throw them in jail, but simply withholds any welfare or further treatment, since the level of pre-meditation and personal desire makes it qualitatively different to say, treating someone who tried to commit suicide because of mental illness.
They figure out how to survive, be it off alms or because lacking a leg doesn't actually kick you out of the workforce, though such a lack of knowledge should make you unemployable in the Knowledge Economy. They probably wouldn't starve to death, not that I would consider that unacceptable.
Mastectomies are difficult enough, I have to clean up after in my day job. Removing the clitoris? Any witch-doctor can do it, and given that female genital mutilation is a thing, do. It's not that hard, and on an unrelated note I had a buddy back in med school who would make cash on the side snipping tips (male) in his living room.
I recently overheard an argument between several Plastic Surgeons and a Psychiatrist where in the surgeons argued that seeking plastic surgery is pathognomonic for body dysmorphia. They asserted that wanting to adjust your own appearance to submit to external (or internal that is informed by external) standards is inherently dysmorphic. It can be relatively harmless in the case of a rhinoplasty, but can be radical as seen here.
I should note that both surgeons seemed very happy to feed the dysmorphia aka Get Paid.
The psychiatrist tried to define what "illness" is and use that angle, but appeared to be on the losing end of the argument.
I haven't thought about this enough to have landed on one side or the other, but I think it is very reasonable to think of this as a sliding scale and a fuzzy one at that.
If we are paying for top and bottom surgery why not this? The conversation on this particular topic is of course very unhealthy, and the people who advocate for dysmorphia treatment are typically allergic to formal analysis and typology on these topics which complicates the matter.
We don't have a good handle of what mental illness and it makes it hard to have a formal judgement as to if this behavior (and others) are okay or not and how to handle them on a legal and financial level.
I stan the psychiatrist here, there are millions of ways in which even the majority of humans wish to "adjust their appearance", from getting haircuts to piercings. Lumping it all together as a manifestation of "body dysmorphia" dilutes it to uselessness, even if you try and restrict it to just those that require surgery. I wager a large fraction of the populace wouldn't say no to free/perceptually safe surgery for even minor cosmetic blemishes, and most don't because of at least the former, as well as general inertia.
I forward the obverse, that I expect a proper cost-analysis that considers DALY and QALY to show that top and bottom surgery don't provide enough benefit to be worth providing, at least as free services through public healthcare systems. I haven't run the numbers myself, nor am I aware of a formal attempt, but that still happens to be my expectation.
Am I against people getting that done, on their own dime? Or surgeons doing them? Not at all. I just don't want general taxpayers, be it through subsidizing the NHS in the UK, or through greater insurance premiums elsewhere, to be the ones footing the bill.
If said hard-nosed analysis did show that the procedure provided net positive QALY (at about the same rate per pound as any normal surgery), then I would accept that as justification for it to be universally available to the dysmorphic. For free (to them, via the NHS or insurance).
Shame said shrink wasn't a Dr. S. A. Sisskind, he'd have rekt them.
But the real one already has excellent essays on the topic, just in case you haven't read these particular ones:
https://slatestarcodex.com/2015/10/07/contra-caplan-on-mental-illness/
https://www.astralcodexten.com/p/contra-kirkegaard-on-evolutionary
While I don't agree with Scott on everything, I lean towards his pragmatic approach here.
"Siskind".
I haven't met Scott in person, so I'm not sure how effective he is in a real-time format, but I should note that this doesn't correlate very well (notice that politicians are typically excellent at quips and real-time debate but uninspired at essay-writing).
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I actually disagree pretty intensely with Scott on most medical adjacent topics (most especially his views on the FDA). I think he's a philosopher and a wise person who happens to work as a physician and not really immersed in the milieu of medicine (likely driven by where he has gotten his training). It's unlikely this impairs his care for the population he chooses to treat, but for the most part he doesn't really act or think like a doctor (granted Psychiatrists often do this).
And sorry, I have thought about mental illness is, just not this body dysmorphia claim (and I can see how the way I wrote that would make that unclear).
In any case, I think if the surgeons had split off signaling from "dysmorphia" it would be easier to agree with them. A piercing or a tattoo is trying to say or express something, even if the latter is "permanent." An adjustment of your body to what you feel like you need to be seems naively dysmorphic. One example thrown out was "if an OnlyFans creator wants a boob job to make more money is that dysmorphia" and it was asserted yes, and I think you are right that greatly erodes whatever dysmorphia is supposed to mean, but still I'm willing to go with "eh, mild end of the scale."
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Isn't something like nullification a pretty solid indicator of mental illness? FWIW I agree that we should give more sympathy/pity to people who attempt suicide, but I have a hard time identifying the difference.
Maybe the usually higher level of pre-meditation and planning plays a role, but I'd still sympathize more with someone who planned a suicide attempt over months than someone who planned and received a nullification over the course of a day or two.
I can certainly discriminate between different types of mental illness, and have no qualms about doing so.
A BPD art-hoe and a depressed incel are both self-destructive, for no "fault" of their own (as popularly conceived as ethereal metadata not grounded in material properties), but one is far more destructive towards others.
A depressed person often doesn't want to be depressed. Or they feel terrible about being a burden, most of them aren't overdosing on paracetamol to get on welfare when their liver fails (presuming that doesn't kill them). In the UK, they are lucky to have the NHS around to save their ass for free (and me, eventually, though I charge for my services), but they do not undergo dangerous, crippling procedures to indulge a fetish and expect other taxpayers to clean up after them. The closest are the people into self-harm, and razer cuts and burns are nowhere near as expensive to treat, presuming they don't grow out of it.
Many would prefer not to be saved. We insist on saving them. I have mixed feelings on the matter, including extending to euthanasia: suffice to say that if rules and regulations didn't tie my hands, I would let a lot more people who didn't want to live on philosophical grounds kill themselves (presuming it wasn't just pure depression, or at least a form of depression that can be cured/managed to provide an acceptable QOL). Alas, the law and my medical licensing bodies disagree, and I care more about my paycheck than my principles here.
On the other hand, our friend Nullius Maximus here? While I have no way to prove it, I think he was mentally competent to gauge the consequences of his actions, and would likely have not gone through with it if he was left with the burden of fending for himself. And if he had, he wouldn't be newsworthy, just another crazy who killed himself for dubious reasons. Here, his craziness can be presumed to be sly.
That is far worse, as far as I'm concerned. I endorse his ability to do as he pleases. I do not endorse shielding him from the consequences of his actions.
And to be clear it is the BPD art chick causing harm to people around her and the incel silently seething but not hurting anyone.
I would hope that was obvious, but I suppose it's worth clarifying in case someone came away thinking I was making the opposite argument.
Understood. Which is why I'm pointing out that the opposite is actually true. Incels are (to within round off error) harmless. BPD art chicks are very harmful to the unfortunate people drawn into their social sphere.
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I suppose men are more predisposed to criminality, but neither is likely to be harmful to others.
The amount of damage a typical incel can cause is far more bounded than what a reasonably attractive woman with borderline personality disorder can inflict. The overwhelming majority of incels don't go around shooting up schools, they sulk and argue on 4chan. People with BPD are corrosive to the psyche, uncovered flames that draw moths for miles.
You're (were?) a regular on the RSP subreddit, I'm sure you can imagine all the examples you like.
I’m not sure it’s a particularly good argument for the harmlessness of the incels that they congregate on 4chan, one of the most culturally influential websites on the planet, molding the headspaces of countless young men all over the world (some young women as well).
One of the precise risk factors of the incel subculture is that exposure to it seems to convince numerous temporarily virginal 17-year olds (or even younger types) that it’s over, women will only have sex with them if they’re a chiseled sociopathic gigachad, nothing they do can matter since they’re [short/fat/not rich/weak-chinned/Asian/etc], best not even try.
The gynosupremacists/femcels hang out on Twitter. I only see one of those two sites in the news constantly, so I believe the one I continue to hear claimed as a legitimate source by the vast majority of world media is taken a lot more seriously.
And then it is this core demographic that forms the backbone of the education-managerial complex as well as a significant chunk of state bureaucracies. The angry women are, in aggregate, much, much more dangerous than the angry men.
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On a per capita basis? The average incel, be it on 4chan or elsewhere, is largely harmless.
And 4chan has all kinds of mentally ill people, from the humble incel, to schizos, to
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AFAICT, the only reason people look down on their argument is that it denigrates higher status people than them in doing so (ie, women). Remove that and you get a bog standard feminist argument that men shouldn't seek validation from women through sex.
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I thought the implication was that the art-hoe was more dangerous to others. I picture the depressed incel not leaving the basement; the BPD, out keying cars over imagined slights.
That is indeed what I'm getting at. Anyone who disagrees hasn't met enough depressed incels or women with BPD. I have the dubious fortune of knowing plenty of both.
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