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PaperclipPerfector  21d ago (text post)   24393 thread views

Culture War Roundup for the week of April 8, 2024

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When discussing pharmaceutical and surgical interventions in the treatment of gender dysphoria, the gender-critical among us often draw parallels with bodily integrity identity disorder. This is a rare psychiatric disorder in which a person experiences profound distress because of the presence of one or more of their limbs, and requests to have these limbs amputated to alleviate said distress (or tries to amputate them themselves). Colloquially, one might say that people with this condition are able-bodied but identify as disabled.

Given that no one thinks that surgical amputation is the correct treatment for this psychiatric disorder, we gender-criticals argued, it follows that surgical intervention is the wrong approach for people with gender dysphoria. If it's wrong to amputate a mentally ill's person's arm just because they say it's causing them distress, how can it be right to do the same for a penis or breast?

Sadly, one man’s modus ponens is another man’s modus tollens, the medical establishment has noted the parallels, and it is coming to a rather different conclusion:

Sensational news from late last week, that doctors amputated two fingers for a 20-year-old patient to alleviate the young man’s mental distress over being able-bodied, contained a buried clue: “He related his condition to gender dysphoria.”

... A 2018 ethics analysis in a Cambridge University Press publication concludes that there is “no logical difference between the conceptual status of BIID and transsexualism”. It goes on to say that, “given that individuals with transsexualism are offered gender reassignment surgery it seems to us that individuals with BIID ought at least to be considered for treatment, including elective amputation in some cases.”

... But what would it mean to accept the amputee identity at scale, the way we have accepted trans rights as a universal humanitarian movement? Drawing exact parallels, we would likely see a total saturation of amputee culture, from amputee story hour to centring amputee voices in DEI training, and doctors warning parents of the very real suicide risks for amputee-identifying children whose parents refuse to accept them as surgically modified cripples or invalids. Advocates would talk of being “assigned able-bodied at birth” to persuade activist teachers and medical associations to adopt the absolutist position that any attempt to talk kids out of amputee surgery amounts to “conversion therapy”.

The journalist Mia Hughes recently asked readers to imagine a society in which amputee advocates enjoyed the same cultural and political victories as trans advocates.

“Imagine there were a sudden 4000% increase in teens identifying as amputees, but we were all forbidden from being concerned. Instead we were supposed to celebrate it,” she posted on X. “Imagine schools teaching children as young as kindergarten that some people have amputee identities, that they get to choose how many limbs they have. Posters promoting body mutilation adorned the walls of many classrooms.”

Nothing specific to add to this* beyond despair. The Anglophone medical establishment appears to be fully ideologically captured. It doesn't matter if the Tavistock is shuttered and there's a rash of lawsuits directed at youth gender clinics in the US: if you're a medic who's internalised (or been made to internalise) the gender ideology worldview, the implications of that worldview and the role of the medical establishment it affirms have far-reaching implications in medical domains unrelated to gender medicine itself. At this point I honestly can't rule out psychiatrists prescribing anorexics appetite suppressants to aid them in achieving their "bodily attainment goals".

*Other than why the fuck are Canadian doctors so keen to help their fellow citizens maim or destroy their bodies??!!

From the article UnHerd cites:

“He hides his fingers, keeps them flexed, leading to impaired dexterity, localized pain, irritability and anger,” Dr. Nadia Nadeau, of the department of psychiatry at Université Laval wrote in the journal Clinical Case Reports. He grew more determined to find a way to get rid of fingers he considered “intrusive, foreign, unwanted.”

“He had contemplated asking a friend to watch over him and be prepared to call emergency services in case his attempt led to a need for resuscitation,” Nadeau wrote.

After undergoing elective amputation, the nightmares and emotional distress immediately stopped, Nadeau said. The post-op pain resolved within a week, there was no “phantom pain” at one month follow-up and, without the two missing fingers, “he was able to pursue the life he envisioned as a complete human being without those two fingers bothering him.”

It’s not the first time amputation has been used as a treatment for BID. In the late 1990s, a surgeon in Scotland amputated one leg above the knee each in two men who’d felt a “desperate” need to be amputees, and who had been turned away by other doctors.

Despite the scandal that erupted, “At the end of the day I have no doubt that what I was doing was the correct thing for those patients,” the surgeon, Dr. Robert Smith, told a press conference.

The fact that there were only two fingers involved in the Quebec case, as opposed to a complete limb, made the decision to proceed easier for the medical team, Nadeau said.

If this now-amputee were me, I'd try to just get over it. Stop taking any action to either sate or resist the discomfort, meditate real hard, just feel it and let it burn out. I think it'd work for me.

But it's a mistake to not understand the other side's perspective. You have a guy who's constantly distressed, whose daily life is significantly impaired, who's begging for help, where many pharmaceutical and therapeutic interventions have failed, and a simple operation will fix his problem permanently. It makes a certain amount of sense, right? This guy's had this problem since he was a child, and it is a doctors' job to fix it, and nothing else is working.

It reminds me of

https://slatestarcodex.com/2014/11/21/the-categories-were-made-for-man-not-man-for-the-categories/

The Hair Dryer Incident was probably the biggest dispute I’ve seen in the mental hospital where I work. Most of the time all the psychiatrists get along and have pretty much the same opinion about important things, but people were at each other’s throats about the Hair Dryer Incident.

Basically, this one obsessive compulsive woman would drive to work every morning and worry she had left the hair dryer on and it was going to burn down her house. So she’d drive back home to check that the hair dryer was off, then drive back to work, then worry that maybe she hadn’t really checked well enough, then drive back, and so on ten or twenty times a day.

It’s a pretty typical case of obsessive-compulsive disorder, but it was really interfering with her life. She worked some high-powered job – I think a lawyer – and she was constantly late to everything because of this driving back and forth, to the point where her career was in a downspin and she thought she would have to quit and go on disability. She wasn’t able to go out with friends, she wasn’t even able to go to restaurants because she would keep fretting she left the hair dryer on at home and have to rush back. She’d seen countless psychiatrists, psychologists, and counselors, she’d done all sorts of therapy, she’d taken every medication in the book, and none of them had helped.

So she came to my hospital and was seen by a colleague of mine, who told her “Hey, have you thought about just bringing the hair dryer with you?”

And it worked.

She would be driving to work in the morning, and she’d start worrying she’d left the hair dryer on and it was going to burn down her house, and so she’d look at the seat next to her, and there would be the hair dryer, right there. And she only had the one hair dryer, which was now accounted for. So she would let out a sigh of relief and keep driving to work.

And approximately half the psychiatrists at my hospital thought this was absolutely scandalous, and This Is Not How One Treats Obsessive Compulsive Disorder, and what if it got out to the broader psychiatric community that instead of giving all of these high-tech medications and sophisticated therapies we were just telling people to put their hair dryers on the front seat of their car?

But I think the guy deserved a medal. Here’s someone who was totally untreatable by the normal methods, with a debilitating condition, and a drop-dead simple intervention that nobody else had thought of gave her her life back. If one day I open up my own psychiatric practice, I am half-seriously considering using a picture of a hair dryer as the logo, just to let everyone know where I stand on this issue.

Amputating a few fingers is somewhat more invasive than putting a hairdryer in your car. But it's the same principle, right?

That's from the categories are made for man, which Zack's spent a lot of time disagreeing with because, yes, it was about trans people and how to treat them. I didn't even remember that was why Scott told that story until I looked it up again today.

And, it's a good analogy, because this is what it feels like for a medical professional dealing with trans patients. You have adults who beg for hormone treatments, claim to be and appear to be in severe distress due to lacking them, and do indeed appear to improve after taking them. This is what it should look like! There are issues with kids, issues with surgery, but none of those undermine the obvious case for accepting trans people and treating them with hormones - it seems to make them happier and better. Again, yeah, edge cases, but the trans people I know are not perpetually depressed psychological wrecks like you'd expect from rw twitter memes, they're generally normal and happy.

Claiming otherwise requires some sophisticated reasoning, like one that claims happiness or sexual satisfaction are of little value themselves, and only matter when done for in line with a greater purpose - in this case, marriage and having children. And since trans individuals imitate the appearance of sexuality without the fertility backing it, it's bad. I agree with something like that.

Nothing specific to add to this* beyond despair. The Anglophone medical establishment appears to be fully ideologically captured

If A is evidence for B, B should be evidence for A, yes? "One man’s modus ponens is another man’s modus tollens?" If we took this case being a novel case of unnecessary amputation as evidence that trans ideology has thoroughly captured the medical system, or something like that, and then we observe that this isn't novel - I think we should doubt the reasoning that led to the claim of ideological capture.

edit: here is the paper about the case.

Amputating a few fingers is somewhat more invasive than putting a hairdryer in your car. But it's the same principle, right?

I don't see how placing a hairdryer in your car violates Primum non nocere.

It amazes me to think that I once found Scott's argument in "the categories were made for man" persuasive. Rationalists are all about defining words in ways which "cleave reality at the joints", and yet Scott apparently thinks that "anyone who claims membership in this category" is a better definition of "woman" than "adult human female".

do indeed appear to improve after taking them

Well, some and some. From my understanding, having read Jesse Singal's deep dives into this issue, the evidence base is a lot more mixed than trans activists would have us believe.

If A is evidence for B, B should be evidence for A, yes? "One man’s modus ponens is another man’s modus tollens?" If we took this case being a novel case of unnecessary amputation as evidence that trans ideology has thoroughly captured the medical system, or something like that, and then we observe that this isn't novel - I think we should doubt the reasoning that led to the claim of ideological capture.

If you have examples of cases of bodily integrity disorder being treated with amputation prior to the modern trans activist movement, I would love to see them. Or perhaps I should say - what gives me pause is not that amputations for sufferers of bodily integrity disorder are being carried out, but that they're being carried out using precisely the same reasoning that "gender-affirming care" providers use to justify removing breasts and penises.

I don't see how placing a hairdryer in your car violates Primum non nocere.

They did try, first, doing no harm - "attempts at “non-invasive” relief, including cognitive behavioural therapy, Prozac-like antidepressants and exposure therapy".

Well, some and some. From my understanding, having read Jesse Singal's deep dives into this issue, the evidence base is a lot more mixed than trans activists would have us believe.

My recollection of the deep dives is mostly that the scientific evidence isn't strong either way, but both from my recollection of those studies and from anecdotes, most adults who go on hormones are happy about that, and even most adults who eventually stop taking hormones are happy about the fact they took hormones. There's clearly a large core group MtFs who are very committed to being trans and seem to (not necessarily counterfactually, just before and after) be happier as a result.

If you have examples of cases of bodily integrity disorder being treated with amputation prior to the modern trans activist movement, I would love to see them

I mean, the leg amputated in the 1990s I quoted above. I'm not claiming it has no relationship to trans activism, just that "The Anglophone medical establishment appears to be fully ideologically captured" isn't a justified conclusion from this particular amputation and a single paper connecting BID to transgender people.

most adults who go on hormones are happy about that,

Going on hormones and then believing that hormones are bad for you seems like it would be unlikely because of the sunk cost fallacy.

I agree that's a reasonable factor but it doesn't seem like a significant one. I'd be more amenable to an argument of the form "people can adapt to anything, and it's just not bad enough to override the confused desires that led them there", but they do not at all seem to be in the state of "would regret it but see as sunk cost", that feels very different.

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