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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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