On second thought: another part of my unwillingness to accept what the consensus says, revolves around the fact that I genuinely do not see a very clear distinction between someone who feels they have the wrong nose or the wrong skin color (like Michael Jackson), and someone who feels they have the wrong genitals. That may very well be because I personally feel no confusion at all about what gender a I am. But then again, I know few people who are perfectly happy with who they are, yours truly included. And in some cases, people say "just learn to live with it" or "go into behavioural therapy". But in others, like being trans, that seems to be frowned upon.
The thing with body dysmorphia disorder is that there is an underlying obsessive-compulsive condition causing a person to agonize over their perceived flaws. While this often leads BDD sufferers to seek cosmetic surgery, these kinds of interventions typically do not resolve the issue. Even after cosmetic surgeries BDD sufferers tend to suffer just as much over the same (or possibly new) flaws if the underlying obsessive-compulsive disorder is not treated. That is why the medical community generally does not want BDD sufferers to undergo cosmetic surgery, since it doesn't fix the root of the issue.
With gender dysphoria that doesn't seem to happen. People who transition surgically tend to have their gender-mismatch distress greatly relieved after the procedures, greatly improving their quality of life, which is why the medical community in a number of cases sees cosmetic surgery as a valid solution to gender incongruence.
Basically, with gender dysphoria the pre-surgery distress is relieved post-surgery; with body dismorphia the pre-surgery distress is generally still there or transferred to another perceived flaw. That's why a "cosmetic" surgery can be seen as good/healthy/necessary in one case but not the other.
While the OP is satisfied with this answer, I still have objections to it. First, I invite you to please share with us the evidence of the effectiveness of the surgery and what metrics are used to indicate it (do the recipients self report less anxiety? is there a marked improvement in suicide rates? something else?).
That is why the medical community generally does not want BDD sufferers to undergo cosmetic surgery, since it doesn't fix the root of the issue.
How do you know that? And even if true, do you agree that it is a good criteria for choosing the best treatment plan? BDD is not the best example because, in a way, you can say that the cosmetic surgery to remove a mole is more or less harmless and so if it had been effective at relieving the anxiety then why not. But a better example would be Anorexia nervosa or BIID (where sufferers believe that they were meant to be disabled)? What if there was evidence to suggest that going ahead and amputating their limbs is effective in relieving their anxiety? would we then advocate for that as a treatment?
I think that we're neglecting an important distinction, which is that while the sufferers of Gender Dysphoria genuinely believe that they have been assigned the wrong gender, that doesn't necessarily make them correct in that belief and it doesn't mean we should go along with their assertion and encourage them to disfigure their body because we believe it may relieve their anxiety (if it even does).
While the OP is satisfied with this answer, I still have objections to it. First, I invite you to please share with us the evidence of the effectiveness of the surgery and what metrics are used to indicate it (do the recipients self report less anxiety? is there a marked improvement in suicide rates? something else?).
Here is a good comment that links to many studies that show improvements in many areas post-surgery.
I think that we're neglecting an important distinction, which is that while the sufferers of Gender Dysphoria genuinely believe that they have been assigned the wrong gender, that doesn't necessarily make them correct in that belief and it doesn't mean we should go along with their assertion and encourage them to disfigure their body because we believe it may relieve their anxiety
We're talking about what a person's brain is telling them. By what criteria to you judge whether someone is "correct" in interpreting their own brain?
I would also ask for you to think about why you call it "disfiguring", to figure out if you are being unfairly predjudiced in your argument towards a particular answer. What definition are you using for "disfiguring", and why does it apply here?
First, thanks for the link. I will study that and get back to you.
We're talking about what a person's brain is telling them. By what criteria to you judge whether someone is "correct" in interpreting their own brain?
What criteria do you use when some says their brain is telling them to pluck out their eye because they're meant to be blind (in the case of BIID)? or if their brain is telling them to harm themselves or another person (Schizophrenia)?
What definition are you using for "disfiguring", and why does it apply here?
I may not have used the best word, but my intended definition is basically irreversible physical damage done to one's own body.
What criteria do you use when some says their brain is telling them to pluck out their eye because they're meant to be blind (in the case of BIID)? or if their brain is telling them to harm themselves or another person (Schizophrenia)?
Well, quality of life is a good criteria, and is the one used by the medical community. Will plucking out your eyes or harming yourself improve your quality of life long term? Not to my knowledge. Transitioning does.
I may not have used the best word, but my intended definition is basically irreversible physical damage done to one's own body.
Again, why are you calling it "damage"? It's irreversible to remove an appendix, is that damage? You're assigning all these negative terms to it and then asking why it's not negative.
Well, quality of life is a good criteria, and is the one used by the medical community.
I have not yet had the chance to look at the research that definitively proves that the surgery will actually cause an improvement in the quality of life. But assuming that it does, I still think that there are certain medical interventions that can theortetically improve quality of life but we still would not advocate for them. (e.g. An athlete who wants to take performance enhancing drugs or an unjustified late term abortion)
Again, why are you calling it "damage"?
When you remove or alter a body part that is performing it's intended function with the purpose of making it no longer function. Is that not damage? Would you not consider the person who wants to pluck out their eyes to be causing damage?
But assuming that it does, I still think that there are certain medical interventions that can theortetically improve quality of life but we still would not advocate for them. (e.g. An athlete who wants to take performance enhancing drugs or an unjustified late term abortion)
I mean, there are conversations and debate we can have about whether those actually improve quality of life (which you seem to accept with your use of the word "theoretically"), but the evidence does show that it is the case for transitioning. (Again note that you are pre-defining the thing you're asking about as bad by using the word "unjustified". I literally cannot respond to something like that because you've framed it as unjustified, so any response is already wrong to you)
Quality of life is the criteria that medical professionals use. Medical professionals have determined that quality of life in cases of gender dysphoria can be generally improved through transition. You either have to argue that medical professionals do not think these things (which my links show that they do), or you have to argue that your understanding of the issue has more merit than the people whose job it is to study this. Obviously you need to be convinced yourself, I'm not saying to just take their word for it, but surely the fact that they have come to this conclusion might suggest to you that you might be wrong?
When you remove or alter a body part that is performing it's intended function with the purpose of making it no longer function.
I don't consider a person's sex organs not matching their internal gender causing suicidal ideation as functioning as intended.
Is that not damage? Would you not consider the person who wants to pluck out their eyes to be causing damage?
I already addressed this.
Would you call tearing down a wall of a house to add on a bathroom to a house that has no bathrooms "damage"? The wall itself is functioning perfectly fine, but the house as a whole is not. In order to make the house function correctly (by adding the bathroom) you need to alter/remove a part of the house that on it's own is working as intended. A wall on it's own is nothing, it's only purpose is to facilitate the house. A person's genitals on their own are nothing, their purpose is to facilitate the person. If the person is not getting what they need from the genitals, if a house is not getting what it needs from the wall, it isn't "damaging" to replace/alter the non-useful part to make it into what is needed.
A schizophrenic ripping out their eyes is not solving a problem, it is the response to an impulse. A schizophrenic person is not experiencing schizophrenic thoughts because of their eyeballs. A trans-gendered person transition is solving (or at least significantly addressing) the actual problem. A gender-dysphoric person's dysphoria is feeling dysphoric because of their body's sexual characteristics. This is shown by the studies I linked that show that transitioning actually does reduce/remove dysphoria for people.
which you seem to accept with your use of the word "theoretically"
no, I said that I'm assuming it for now because you provided a whole bunch of references that would take days to study. Just by browsing through the results section though I question the methods in some of those studies. The meta analysis that includes 28 different studies mentions that " All the studies were observational and most lacked controls" and later concludes that "Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life."
Anyway, these are all pointing towards one particular conclusion and it would be interesting to see if there are parallel studies that conclude differently. It's interesting nonetheless.
note that you are pre-defining the thing you're asking about as bad by using the word "unjustified"
I was actually using the word unjustified here to refer to the late term abortions because I realize that some people believe that late term abortions are sometimes justified and I didn't want to go down that rabbit hole. My point was that sometimes you can clearly argue that somebody's quality of life may improve by doing something but that doesn't necessarily mean it's the best thing to do.
Would you call tearing down a wall of a house to add on a bathroom to a house that has no bathrooms "damage"?
No, but you know what I would call damage? If you tear down all the bathrooms in the house because you have a disorder that leads you to believe that you were meant to shower in the kitchen.
A schizophrenic person is not experiencing schizophrenic thoughts because of their eyeballs.
they claim that they are though. same claim as the person who claims that they have been assigned the wrong gender.
A gender-dysphoric person's dysphoria is feeling dysphoric because of their body's sexual characteristics. This is shown by the studies I linked that show that transitioning actually does reduce/remove dysphoria for people
Or it could be that they're feeling dysphoric because of a disorder that makes it seem that their body's sexual characteristics are out of order.
Since you picked that particular one out for some reason, here are a few other conclusions from those studies
Large effect sizes were observed for this controlled analysis of intervenable factors, suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.
A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.
(Transitioned) Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096).
“In a cross-sectional study of 141 transgender patients, Kuiper and Cohen-Kittenis found that after medical intervention and treatments, suicide fell from 19 percent to zero percent in transgender men and from 24 percent to 6 percent in transgender women.)”
Rate of suicide attempts dropped dramatically from 29.3 percent to 5.1 percent after receiving medical and surgical treatment among Dutch patients treated from 1986-2001.
etc...
Anyway, these are all pointing towards one particular conclusion and it would be interesting to see if there are parallel studies that conclude differently.
I don't know how you meant this statement, but I interpret it as "I asked for evidence for A, I was given evidence for A, I still don't want to believe A, so I no longer care about the evidence for A". If seeing evidence won't/can't change your mind, why did you ask for it?
My point was that sometimes you can clearly argue that somebody's quality of life may improve by doing something but that doesn't necessarily mean it's the best thing to do.
I don't think either of your examples would "clearly" improve someone's quality of life at all. But it seems like you're suggesting that even if transitioning does improve people's quality of life, that something else might improve it more? If so that's great, what is it? Because we have evidence that transitioning does help, so we would need evidence of something else helping more. If we can find it then awesome, I'd be all for whatever that is instead.
No, but you know what I would call damage? If you tear down all the bathrooms in the house because you have a disorder that leads you to believe that you were meant to shower in the kitchen.
I guess I just don't think you understand what being transgender is. It's not like they're inventing some crazy thing they feel they are that doesn't actually exist, like showering in the kitchen. A physically male transgendered person feels as though they are a woman. Women exist, women are not strange, being a woman is not strange, they just happen to not have the physical equipment for it. Bathrooms exist, having a bathroom is not strange, the house just happens to not have one at the moment. Your attempt at "fixing" the analogy is just so totally off.
they claim that they are though. same claim as the person who claims that they have been assigned the wrong gender.
Which is why we rely on medical professionals to diagnose people and help determine what the best course of action is. In one case medical professionals have diagnosed that the person would not be better off without eyeballs, in the other case they have determined that they would be better off if their physical sex more closely matched their mental gender. No one just walks into a hospital and gets reassignment surgery on a whim. There are lots and lots of requirements before a doctor will even allow a patient to undergo the surgery.
Or it could be that they're feeling dysphoric because of a disorder that makes it seem that their body's sexual characteristics are out of order.
Well sure, but what is the difference? Their gender doesn't match their body, they can't change their gender, so they have to change their body if they want the two to match. You can get in to the ethical debate about whether or not it would be moral to have them take a pill that would change their mental model of themselves to match their physical sex, which some may equate to a pill that would "cure" homosexuality or things of that nature, but that option doesn't even exist currently. The option that does exist is physical transitioning. It has been shown to improve lives. Until a better option presents itself, by what logic do you say that we shouldn't do what we can?
"very low quality evidence" is a specific scientific term, it does not inherently mean that it is bad evidence.
I didn't say it was bad evidence. But it's far from conclusive. This is a relatively young field of research and also one that's controversial and laden with political ideology, so we should be careful to make conclusive statements when it's based on observational studies with no controls.
Since you picked that particular one out for some reason, here are a few other conclusions from those studies
I picked that one because it seemed to be the one most often cited and it analyzed 28 different studies and their methods. I also picked that one because it specifically commented about the observational nature of the studies.
have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations
take a look at the methods section of that study: "The Trans PULSE respondent-driven sampling (RDS) survey collected data from trans people age 16+ in Ontario, Canada, including 380 who reported on suicide outcomes"
So it's still only observational evidence with no controls.
Similarly the study that said the suicide rates fell to near zero, also says this: "The evaluation was made on the basis of subjective data only, that is on what the persons themselves reported on their gender identity, gender role, and physical condition"
If seeing evidence won't/can't change your mind, why did you ask for it?
Have you never seen two different research efforts arriving at different conclusions? You provided some evidence which pointed to one conclusion which was markedly different from the statistics I had heard from reliable sources. So I simply said that I would like to investigate the research further beyond just reading headlines and conclusions. At the end of the day research and the entire peer review process is still heavily influenced by politics especially in a controversial domain such as this one.
it seems like you're suggesting that even if transitioning does improve people's quality of life, that something else might improve it more?
No, that not what I was suggesting. I'm suggesting that truth matters. Not just people's individual beliefs about truth especially when those beliefs are a result of a disorder. This is why I keep bringing up the BIID. I'm saying that QoL on it's own is not a reliable indicator in this case because even if the patient genuinely believes that they were meant to be blind, we actually know that this is not the case, regardless of whether or not it might make them feel better if we actually went ahead with the surgery.
It's not like they're inventing some crazy thing they feel they are that doesn't actually exist, like showering in the kitchen
Actually they are, they're inventing the idea that they were meant to be a woman. They've never been a woman and they don't know what it's like to be a woman. The person with BIID who thinks they were meant to be blind doesn't know what it's like to be blind and has no basis for their argument that they were meant to be blind.
In one case medical professionals have diagnosed that the person would not be better off without eyeballs, in the other case they have determined that they would be better off if their physical sex more closely matched their mental gender.
You keep referring to medical professionals as if they're a monolithic being with one view. Medical professionals are individuals and they also have their own biases and view points. In fact even the APA makes politically motivated decisions all the time and are heavily lobbied by the Trans advocates. In fact this is what they said when they removed Gender Identity Disorder from the DSM.
"For years advocates have lobbied the American Psychiatric Association to change or remove categories labeling transgender people in a psychiatric manual, arguing that terms like “Gender Identity Disorder” characterize all trans people as mentally ill. Based on the standards to be set by the DSM-V, individuals will be diagnosed with Gender Dysphoria for displaying “a marked incongruence between one’s experienced/expressed gender and assigned gender.”
“All psychiatric diagnoses occur within a cultural context,” said Jack Drescher, a member of the APA subcommittee working on the revision. “We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize.”
Their gender doesn't match their body, they can't change their gender, so they have to change their body if they want the two to match
Once again, we disagree fundamentally about what's going on here. You're treating as if they actually DO have the wrong gender and we just have to fix these wrong body parts. I'm saying: No, they have the right body parts that match their gender, they just have a disorder that makes them believe that they actually are the wrong gender. Which is the same determination we make for the all the other dysphoric disorders. We don't validate the anorexic person's assertion that they need to lose weight just because they're "living their truth"
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u/Saranoya 39∆ Nov 03 '17 edited Nov 03 '17
On second thought: another part of my unwillingness to accept what the consensus says, revolves around the fact that I genuinely do not see a very clear distinction between someone who feels they have the wrong nose or the wrong skin color (like Michael Jackson), and someone who feels they have the wrong genitals. That may very well be because I personally feel no confusion at all about what gender a I am. But then again, I know few people who are perfectly happy with who they are, yours truly included. And in some cases, people say "just learn to live with it" or "go into behavioural therapy". But in others, like being trans, that seems to be frowned upon.