I’ll be brutally honest, I’m no longer shocked by this sort of thing. I personally don’t get it, but I get how it’s their thing.
It took just a few years exposure to the internet of the late 90s and early 00s to open my eyes to the simple psychological truth that the parts of our brain wired up to pass on our genes are some of the most powerful and fascinatingly flexible.
The ample documentation on the development of so many different fetishes all following similar phases from expose through formative experiences to focus and on to full blown fetishisation. It’s the sort of thing that made me consider psychology as a career. The human mind is fascinating.
When I read accounts like this it’s like watching a remake of a classic movie or a cover of a song, there’s always new bits, but you can see the classic parts like landmarks along a trail.
The survey was just 21 people "exclusively contacted in BIID internet forums". How many people who cut off a limb and regretted it would stick around the forum that fed their compulsion to do it?
> How many people who cut off a limb and regretted it would stick around the forum that fed their compulsion to do it?
Maybe many more then you would think. First of all of there are others with regrets they are most likely also found there. Second to warn others. Thirdly to vent.
I agree that the evidence is not the highest quality but i have a hard time imagining a more involved study design that would pass by any ethic board.
I wonder if it's similar to Amazon ratings, where review distributions seem to skew toward people who either love the thing, or hate it? Presumably there's actual research on this. ... Okay here's something about the J-shaped distribution (mostly 5 stars, some 1 stars, little in between) in reviews [1]. (Edit: here's another, more recent summary [2] of polarity in reviews.)
Would we expect the same in something as intimate as amputating pieces of your own body? Hmmm.
Off-topic, but I think the effect is even more pronounced with a binary rating (thumb up/thumb down) vs a 1-5 star rating. I've noticed that really bad or mediocre games will take advantage of the upvote tendency by advertising "90% positive reviews" in an attempt to trick people into thinking they're good.
> Maybe many more then you would think. First of all of there are others with regrets they are most likely also found there. Second to warn others. Thirdly to vent.
And how would you find those posts after they were banned and deleted?
Google tends to cache pages for a long time, banned users usually leave a long trail (and post on sites where they will not get banned) and deleted posts can be resolved by finding and asking the user in question. And usually people with regrets tend to be very, very loud in scenarios like this.
I skimmed the paper and couldn't find where they say they looked for those users and posts that you mention. Maybe I missed it, can you point me to where does it say they make an honest effort to find those people?
I wouldn't say that failing to at least try to look for the less-than-enthusiastic people makes this paper criminally dangerous pseudoscience, but it certainly gives me pause.
> First of all of there are others with regrets they are most likely also found there. Second to warn others. Thirdly to vent.
I don't find that the least bit credible. The proposition forum administrators would tolerate someone "warning others" against the core uniting aspect of their community is not realistic. Generally anyone who questions orthodoxy in such niche communities face vitriol and get banned quickly. Apostates do not hang around religious conversion forums talking about deconversion, gender transition desisters are not welcome on transgender support forums etc.
Then one could surely find multiple occurrences of externally archived but deleted forum post showing just that. You are implicitly asking for proof of absence of such censorship. This is an unreasonable standard.
Preventing motivated people from harassing others on a forum is impossible if anyone can join the forum.
oh, I've run into one. a very unpleasant and mentally unwell person - I think his motivation was purely sexual, and not identity-driven. he creeped me out.
I personally know two, one who used the dry ice method to destroy their legs, and another who achieved paralysis. both are quite happy now, except for the pain and suffering they went through (particularly the person who paralyzed herself, since she caused meningitis which led to horrid nerve pain - but even then, months later, she's happier now that it's done.)
> “The tension that had lined his face was gone. I sensed relief, happiness. David’s leg had plagued him for much of his life. He was free of it, and now he seemed whole.”
This type of ‘cure’ for dysmorphia is not something to be celebrated.
His fixation with amputating his leg started at four years old, it has an admitted sexual element, and now he has a permanent life-altering disability - all this for the want of proper psychological treatment.
The study deals with this though. The people that have BIID do go through psychological treatment, seek therapy, medication etc which don't seem to blunt the issue.
But ultimately the end result seems to be that they will eventually, one way or another, find a way to get the surgery they desire. I don't know what your solution would be in that scenario other than to criminalize it and even then, there's reports of people doing home made amputations by sitting on rail tracks or whatever else you can think of.
And that is....? There is no psychological treatment that cures BIID and the patient here seems very happy. Is it really better and "proper" to give someone treatment that doesn't solve their problem and leaves them upset?
I have BID. I've been in therapy for more than a decade. Therapy has not done anything whatsoever for my dysphoria.
I'm convinced that my overall quality of life would improve if I got the disability I desire. The mental anguish is simply more intense than the consequences of physical limitation. I personally know others who have "gone through with it" and they really are happier now.
What kind of therapy do they attempt? Anything that attempts to integrate the physical body w/ the brain's schematic representation? I'm struck by similarities between BID and phantom limb, and wonder if tx incorporates any of the same strategies.
Also, FWIW, I'm sorry for your condition. It sounds hellish.
my case is kind of special, since I also have a progressive genetic disorder that's led to me being disabled. it affects me in some of the ways that I "want", but not as completely as I'd like, and causes other issues I never wanted at all.
I attempted to integrate like you suggest, shifting my BID towards the direction of my newfound disability. mostly using cognitive reframing, acceptance/commitment therapy, and working at the peripheral issues like imposter syndrome, shame, grief.
I feel much less shame now, and I'm able to use BID as a coping mechanism for my physical condition, but the darned dysphoria is still present.
If I'm reading this right: one of the subjects (#18) is 27 years old now, and had a "friend" perform an amputation on him in 2008...when he was about 13. Yikes.
Ive read stories from people with BIID and in many ways it's similar to gender dysphoria. The way they feel it, all the things around it, fantasies, dreams, etc.
Gender affirming surgeries have success rate of 95%+. No surprise that BIID people have no regrets after all.
This type of "treatment" is an utter failure and surrender of the fields of psychology, psychiatry, and neurology.
The way we used to think was - a sex change surgery used to only be performed because we could not fix the mental problem (patient being unhappy with their body). Now the whole script has flipped and we are talking about how a "transwoman has always been a women" and a "transman has always been a man", which is the newest version of "if theory conflicts with the facts, so much the worse for the facts".
Now we actually ponder cutting off people's arms and legs, which is so incredibly bizarre.
Not to mention how this opens a huge pandora's box of "recognising" "transabled" people, "transracial" people (see Oli London, Rachel Dolezal, or Martina Big) as, for the lack of a better word - "healthy".
As a bisexual dude I suspect a lot of that has to do with the stigma around "conversion therapies", but I worry that term suffered from some really heavy "scope" creep.
> type of "treatment" is an utter failure and surrender of the fields of psychology and psychiatry
I, too, have an emotional response. But let’s be scientific. If the counselling shows middling success, and the amputation 90%+, why do our feelings, as third parties, overrule the person whose body it is?
I don't say this should be forbidden for consenting adults. I am saying that it should not be sold as "the treatment" but as "we don't have anything better for now, we are working on it, if you can't wait, you can do it".
Not really - we now create stable identities from what is essentially a form of mental illness. We no longer say that someone suffers from "body dysmorphia", instead we say that they were "assigned the wrong body at birth". It's similar to those deaf parents of deaf children who are against giving them a cochlear implant lest they lose their "deaf culture".
The problem with that is the same as we would get if we decided that the way to treat anorexia is by allowing the patients to starve themselves to death. They would die thin and happy, but I don't think many people would agree with it being the "preferred solution to that problem".
You're comparing apples and oranges though. We know that anorexia can generally be treated with cognitive therapy and help restore people to a healthy and comfortable body weight. Those same treatments fail when applied to people with BIID. And they way they cause harm is different as well, since failing to treat anorexia results in starvation. While refusing to treat BIID results in people taking dangerous risks to amputate themselves.
I don't see much of an actual solution to these issues in your arguments other than some hand waving about politics as some sort of root cause.
I fail to see the parallel. Anorexia as "starving themselves to death" is not a stable identity, it is an identity in decline with ongoing suffering and temporary highs.
Should taking of legs be the first treatment option? No.
Should people get therapy, medication and other treatment? Yes.
Should those treatments be refined and improved, sufferers of BIID experimented on to improve treatments? Yes.
If society is unable to come up with a treatment that works for years should society deny sufferers this radical treatment forever? No. That is imposing the majority world view on a minority when the difference in world view poses no harm. Yes, society would need to address potential cognito hazards/memes and make sure there are no people doing this for economic incentives or other mental illnesses for which treatments exists.
If society would let people get the treatment, that would not be capitulation. That would be acknowledging that while society has interest in being able to treat that, that interest can not forever outweigh the benefits the radical operation has for the sufferer. Capitulation would be if society stops trying to find a treatment besides radical operation and handed operations out without scrutiny.
One way to do that would be to look at outcomes of patients who have received the therapy to see if they feel their needs are met, like this study did.
> we are now creating stable identities from what is essentially a form of mental illness
Defining mental illness is imprecise. We’ve gotten it horribly wrong before, from diagnosing intelligent women as hysterics to gay men and women as deviants. We also have a long, failed history of well-meant prohibition.
If we’re seeing preliminary evidence that a surgery makes miserable people happy, I say we follow the lead without prejudice. Maybe we find these peoples’ bodies are picking up on precancerous signs? (Airball.) Probably, we don’t. But my peers’ botox has visibly reduced their faces’ expressiveness; is that mental illness?
Out of all of our emotions, I trust my sense of social disgust least. The world in which it evolved is no more. If I can’t find reason beyond discomfort to question someone’s decisions about themselves, I broadly tend towards letting them be.
All things you write - looks like you getting you data from conservative media. "assigned the wrong body at birth" - even in trans community considered huge simplification and wrong narrative. It's used only to explain the feeling to people who knows nothing about the issue.
Gender dysphoria - yes, people suffer form it. Transition is the way to lower this suffering. That's the 'cochlear implant' equivalent from your example.
> looks like you getting you data from conservative media
Not OP. But this seems unfair. Not only does the language surround trans persons vary from decade to decade, city to city, it’s also—understandably—guarded.
Someone far from knowing “nothing about the issue,” and moreover, wishes to learn more, could innocuously use language that is offensive in some circles but tolerated—even encouraged—in others.
And transition is not "the cochlear implant", the implant would be "an implant that makes you not dysphoric". Transition is "learning how to live as a deaf person".
That NHS data collection recommendation says nothing about "wrong body", though. They're trying to elicit accurate information about something potentially medically relevant (assigned biological sex). Their concern is that if you ask a trans person simply "male or female" you'll get an answer that either reflects the gender someone is living in, or the sex on their birth certificate. The former is useless if you're trying to assess the risk of chromosomal disorders, the latter if you're trying to work out how to politely address them.
This is what repression looks like. Before coming out, while you try to live as you assigned gender - that's living as a deaf person, pretty literally as derealization and depersonalization are kind of 'deafining'. As with deaf kid - you fix the body, not the mind, so with gender dysphoria you fix the body first.
Maybe it's just me, but fixing identities scares me much more than fixing the body. There was studies in which trans people were asked if they would want to be consent with their assigned sex (i.e. trans woman to be happy as a man) - most don't. After transition almost none would agree to change it for 'no dysphoria, assigned sex at birth'. 'Fixing' such people sounds like a very cruel and scary idea.
But sometimes deafness is the result of defects in the structure of the ear and sometimes it's the result of defects in the auditory nerve, or other structures in the brain.
In some instances we provide a prosthetic that overcomes the defects of the ear, like a traditional hearing aid, or surgery that corrects those defects, and in others we augment the person with a cochlear implant that bypasses the issue with the nerve. We don't yet have the ability to directly modify the brain with surgery or implants for deafness but I'm sure that we would if we could.
It's interesting that we're talking about deafness because there are many instances of deaf people with heredity causes for their deafness opposed to testing their children with new, effective treatments like cochlear implants because they view it as impinging on their deaf culture.
I think that there are many parallels between this and the developing trans culture which will result in trans people being resistant to more effective, less invasive treatments to cure them of their affliction.
Why do certain maladies develop strong identity politics while others don't? There isn't a diabetic identity, or a halitosis community, so why these ones?
I guess my problem with your view of 'transness' is that you view it as illness or dysfunction. And it's not that. Turning transwoman to a man is equivalent of turning man to opposite gender in a bad case of gynecomastia. That's not the mind that is a problem, I hope you understand my point.
Dysphoria goes deeper than just bodily dysmorphia, it's about how you see yourself, not only your body. So changing my mind to make me something I'm not (a man) sounds like a horror - some kind of upgraded lobotomy. That's much more invasive than any surgery.
And it's not about culture, it's about understanding that people identities is not a part that you can/should fix.
And speaking about data and science, there is pretty clear evidence that trans people who receive proper care (hormones) and accepted by society live normal happy life as the rest of the people.
> it should not be sold as "the treatment" but as "we don't have anything better for now, we are working on it, if you can't wait, you can do it"
It's not sold as the treatment.
And to your comparison to trans folks, top and bottom surgery is not easy to access (and getting harder by the day!). Talk to any trans person and ask them all the things they needed to do and go through to prove to their doctors that they're trans enough. Besides there not being another option, gender affirming surgery works! The patients are largely satisfied with their outcomes! Why do we need to complicate this with suggesting how they should feel or think?
But moreover, who the fuck cares? I had gynocomastea surgery (after years of bodybuilding) and all I had to do was sign a form. Women can elect to get breast augmentation with no evaluation. Why should a trans person have to prove that they deserve a cosmetic surgery that anyone else can get—so long as the outcome is gender conforming? I can get anything I want tattooed on my face today, but someone else can't get their chest flattened for months because...some lab coats don't think they deserve it enough?
Well in many countries with socialized medicine it's society paying for the procedure, and in many countries with a social safety net it will be society paying the disability payments for someone who has compulsively had their legs cut off or their eyes blinded with acid.
Let's run with your idea, if a vast majority of people felt compelled to do these things would society be better off?
The visceral discomfort you feel about having a surgery to change your body, how uncomfortable and wrong that feels, and how unhappy you would be if someone did that to you?
The feeling that you're having, is gender dysphoria. That's what trans people feel all the time, every single fucking minute of their lives, every time they look down getting a painful reminder that their body isn't Right; until they fix it - which is a capital-C Cure. Problem solved, forever.
That sounds pretty fucking great to me. Why wouldn't you let people live how they want to?
Here's a thought experiment. What if we had a simple, effective, and side-effect free pharmacutical treatment for BIID? what if someone could take a cheap pill every morning and they suddenly felt fine with their leg that they would otherwise be compelled to cut off?
This would obviously be better than hobbling someone with crutches or a wheel chair and a disability cheque, better for society abd the individual too.
Now what if a doctor decided one day to test this treatment on someone with gender dysphoria and lo and behold it worked just as well for them? The patient suddenly felt great about their body, great about their appearance and they stopped obsessing about changing it with risky and painful surgeries.
This cheap and effective pharmacuticial treatment would instantly become a first line treatment for gender dysphoria, right?
That sounds pretty fucking great to me. Why wouldn't you want people to live their life how they were born to?
I guess because they feel that they feel like they born to be their preferred gender. The idea that there will be a treatment that will make me feel like a gender I'm not sounds pretty f-cking terrible to me.
Try this experiment on yourself and think that there is a treatment to make you think you are woman/man. How's it make you feel? And together with that, reflect on what exactly make you be a man/woman - your body or your psyche.
There is a lot parallels between gender dysphoria and BIID, but GD is bit more than just 'this is not my body'.
Why don't we expand your thought experiment? What if said pill also cured homosexuality? If it made bisexual people straight? This treatment would instantly become highly valued for all sorts of religious groups and families. And if they're perfectly happy after the treatment, what's the problem? Why don't you want people to live as 'nature' intends?
What your arguing for in your thought experiment is, effectively, treatment designed to radically change someone's sense of identity without side effects. It's a thought experiment that falls apart once you expand it to other things that were once commonly thought of as mental illness.
It's simple. Being bisexual or homosexual doesn't intrinsically cause any physical or mental anguish for people in that state.
People with BIID and Gender dysphoria will kill themselves if they don't receive treatment, and will otherwise ha e poor life outcomes due to the adjacent side effects like depression and self harm that comes.
The only negatives that being bisexual and homosexual have come from external sources as you state.
In other words bisexual and homsexuao people are in a state of homeostasis while people with BIID and Gender dysphoria are not.
I mean as a bisexual male, I can definitely state I've had my fair share of mental anguish over having a thing for men in the past so I don't exactly buy your post about being in 'homeostasis' as you've described. That feels more like post-hoc rationalization for a terrible thought experiment than anything else. Especially since people that suffer from gender dysphoria tend to have worse outcomes due to external sources and lack of validation, much like what would happen to severely repressed gay people in religious communities.
And to further play the devils advocate there were plenty of people at the time that believed gay people were a blight on society for multiple reasons. Hence why conversion camps were a thing.
but is the source of the mental anguish that you've experienced internal or external?
Like if you were born in a society where religious zealots who espoused bisexual bigotry just didnt exist, toxic masculinity wasnt a thing and there was a bunch of bisexual representation in media would you have had that anguish? very unlikely.
People with gender dysphoria face the same negative external influences as you do, arguably worse (lets be real, much much worse) but if it would be removed and they lived in a world without it they would still be discontent with their state, to the point of depression which would result in a poor quality of life and for many suicide.
Thats the hallmark of the disorder. thats what gender dysphoria is.
Lets do another thought experiment, what if we lived in a society where gender reassignment surgery was impossible. like lets ssay we just didnt have the advancements in surgical techniques necessary, but we had much better pharamcuticals. If surgery was impossible, but giving someone a pill like I described in the first thiufht experiment was possible that would be the morally correct thing to do as opposed to doing nothing, right?
To address your final thought experiment: In a vacuum? Maybe. But there's a simple and easy response to your second thought experiment that completely blows it apart, and that's lobotomies.
Lobotomies were used as a cure for all kinds of different things. If you knew something was a problem and lobotomy was the only thing that seemed to cure it, is it morally correct to do so as opposed to doing nothing? That's why these simplistic thought experiments are bad because there are examples of what happens when you take it to their logical (and often sadly real) conclusion.
Is your issue with lobotomies is that they are a crude, irreversible surgery that doesn't always work?
Now you understand the reticence towards gender reassignment surgery and why someone would be looking for much lower risk pharmaceutical treatments for gender dysphoria, which is exactly what we ended up doing with brain disorders?
It's worth noting that we still do brain surgery on people, and that we're even moving towards using implants to modulate how the brain functions, as opposed to the crude technique of severing parts their brain with rods jammed into their noses or holes drilled into their heads.
I have a feeling that we'll look back on this time when we cut off penises and inverted them into crude vagina like canals, jammed silicon bags full of salt water into chests and pumped people full of hormones as barbaric as the lobotomy era.
They're things that we do out of convenience because they're the best that we have, not because it's what we want to do.
> treatment designed to radically change someone's sense of identity without side effects
To what extent is "sense of identity" innate, and to what extent is it culturally shaped?
For example, "homosexuality" and "heterosexuality" were not something common before the late 19th century. While people still engage in sexual acts with the same and/or opposite sex, such acts did not play a role in their identity.
This is evident as far back as ancient Rome.[0]
> Homosexuality in ancient Rome often differs markedly from the contemporary West. Latin lacks words that would precisely translate "homosexual" and "heterosexual". The primary dichotomy of ancient Roman sexuality was active/dominant/masculine and passive/submissive/feminine.
To the ancient Romans, sexual acts with someone of the same sex wasn't viewed like we do today. They wouldn't have spoken about themselves as "gay" or "straight." Rather, they would have spoken about themselves as "dominant" or "submissive."
This concept runs counter to the way we think about sexual identity today, but it demonstrates that there is far more nurture in the mix than we often like to admit.
And, please note, this is not a judgment on people who identify as homosexual or heterosexual. It is also not a claim that we can "change" someone's orientation. It's simply pointing out that sexual identity is not necessarily something which is purely innate (nature). This is something we tend to take for granted and without much thought in contemporary Western society.
The base reality ("I am only sexually attracted to other men") has existed since time immemorial, the cultural conditions for expressing that reality change as the ages change.
This is no different to now, it was only in 2007 that Mahmoud Ahmadinejad claimed there were no gays in Iran. In various nations you can survey the populace and find wildly varying amounts of homosexuality, all correlating closely with LGBT acceptance. Even now I have muslim friends who are gay and openly tell me that they intend on suppressing their desires for their entire life so as to provide a family and not disappoint their parents.
> The base reality ("I am only sexually attracted to other men") has existed since time immemorial, the cultural conditions for expressing that reality change as the ages change.
Would your answer to the original question then be that the "sense of identity" is the result of or predominately from nurture? That is, one who sees as "gay" or "straight" sees themselves as such because of culture? Or to put it in a more generic manner, culture determines identity?
Culture determines your publicly expressed outward identity, I have no doubt that people have assumed a gay/trans/etc identity privately for far longer than we've had terms or tolerance for them.
Some of the most common observations by our very small trans elderly is that they "found a way to describe" or "finally found the words" for who they are, ie the identity was always there but no terms to identify with.
I think by and large it's nature (fraternal birth order effect, twin studies etc) modulated to the extreme by societal rejection. You dont see gay men in the streets of countries where homosexuality earns the death penalty, you instead see extremely depressed "straight" men :)
That is what we do for people with anxiety disorder. They often resist treatment, are finally persuaded to try it, and almost all are afterward regretful that they did not get treatment years earlier.
> That sounds pretty fucking great to me. Why wouldn't you want people to live their life how they were born to?
People have an inherent, fundamental Right to their own body, to mold it into the image that they choose. If they want to take your magic pill? They have every Right to, good on 'em. But if they want their body to be a certain way, they have that Right too.
Maybe, maybe. If they're willing to foot the bill and if nobody has to be coerced into performing the surgery. Oh, and they sign a "no regrets, tough shit" contract.
Right now the NHS is dealing with a "Why didn't anyone stop me? All I got was positive support!" situation from someone who is detransing.
I skipped right to the conclusion, as I wanted to see what the document says, and it kicks of with "where no other treatment exists", and to prevent self-inflicted amputations. Plus it acknowledges that these people potentially need help _now_, before we find better solutions in the other fields.
I can highly recommend to give the conclusion section a read. I think the authors are well aware of these issues, to the point that this scoping (no other treatment available right now / other options exhausted + person needs help right now) makes me slightly supportive.
It's extremely hard to imagine a meager disability benefit (if any) outweighs the surgery and recover and then living without the limb indefinitely. If you were really in it for the money, would you then hang out on a forum talking about the surgery and not the money? Why would you have a whole arm or leg removed when you could simply have a hand or some fingers removed?
Even if they were eligible for the disability, the implication that this isn't a real disorder ignores almost every aspect of its reality.
There's a story from Oliver Sacks (Maybe in TMWMHWFAH [1]) where a
patient wakes up after a head trauma or stroke and screams at his leg
- "Get rid of it! Cut it off". IIRC, the dysphoria was acute or
somehow treated, so that might suggest there's a good prognosis with
neurological intervention.
That actually wasn't BID, it was another condition called somatoparaphrenia. They might be linked, but no treatment short of surgery for BID has ever demonstrated efficacy.
I have this condition (Body Integrity Dysphoria), along with a fairly intense physical disability that I did not choose (genetic disorder), and along with being trans, so I can answer any questions you'd like to ask.
I became aware of my BID at age 6. I specifically want paralysis, which is ironic now that I'm showing neurological symptoms from the genetic condition. There is a sexual component for me, but it's not my main motivation, and the sexual aspect has reduced as the pure dysphoria intensifies.
The physical dysphoria is fairly similar to the gender dysphoria I've experienced, but the social aspects, identity and tradeoffs are completely different.
I've tried antidepressants, therapy including traditional psychoanalysis, IFS, CBT, ACT, etc. Nothing has put a dent in the dysphoria, only helped me move on despite it. I know two people who've successfully achieved their disability, and they're much happier now. I would if I were not so terrified of the risks of DIY.
I am aware that hypnosis can be used to induce temporary paralysis in targeted body regions. Have you experimented with that and does it offer a temporary reprieve from at least one of your sources of disphoria?
I've done psychedelics before, but never with the idea of treating BID, and I've never noticed changes in my BID from psychedelics. I've been waiting for psychedelic psychotherapy to be legalized so I can make a good effort at it with a therapist.
as for hypnosis and temporary paralysis, that's interesting as well. I've never been hypnotized, but I'd certainly give it a shot. I have induced numbness temporarily by stretching my spinal cord - I have a spinal defect from my genetic disorder, so bending forward yanks where it's snagged. it's extremely painful, though.
I've also never used antipsychotics, though I know they've been tried unsuccessfully in others.
There is a thriving scene of content creators on reddit which create hypnosis content without any oversight. They produce "canned" recordings or scripts to be recorded and share them freely or patreon supported. I wouldn't expect them to work immediately as "building rapport" and "opening up to the idea" are important for the power of suggestions to grow. Getting in touch with people and having sessions over text, voice or video might also be an option if the .mp3 files just do not do the trick or more custom experiences are wanted.
Hypnosis with an hypnotherapist might also be an option, although i am unsure they wouldn't try to treat you into accepting your body as is first. YMMV. You could also try both.
https://old.reddit.com/r/hypnofair and https://old reddit.com/r/erotichypnosis have a lot of NSFW content but are more popular then the SFW https://old.reddit.com/r/recreationalhypnosis because of course it's the internet. Browsing around there are definitely some files which involve immobilisation but they seem to be targeting people into bondage or being drugged. Looking at those tags is a fascinating rabbit hole of what people are into.
I need to know everything about the neuroscience behind disphoria, and other kinds of somatosensory disorders. Feel free to spam me, or at Gmail if you prefer.
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[ 2.4 ms ] story [ 152 ms ] threadSeveral, but not all subjects wrote they feel an erotic component as e.g.:
“In puberty there came an additional sexual component of about 50% weight.”; “In addition the stump is erotic.”;
“When my first wife suffered from an osteo-sarcoma and lost her left leg, my life was perfect. The stump became part of our sexual satisfaction.”;
“There is an aesthetic sexual complex, in addition I find the kind of walking very erotic.”;
“The otherness, the stump stimulated me. Pretending always resulted in masturbation”
It took just a few years exposure to the internet of the late 90s and early 00s to open my eyes to the simple psychological truth that the parts of our brain wired up to pass on our genes are some of the most powerful and fascinatingly flexible.
The ample documentation on the development of so many different fetishes all following similar phases from expose through formative experiences to focus and on to full blown fetishisation. It’s the sort of thing that made me consider psychology as a career. The human mind is fascinating.
When I read accounts like this it’s like watching a remake of a classic movie or a cover of a song, there’s always new bits, but you can see the classic parts like landmarks along a trail.
It concludes: “None of the patients regretted the surgery and a change for the better was seen in almost all areas of life”.
Maybe many more then you would think. First of all of there are others with regrets they are most likely also found there. Second to warn others. Thirdly to vent.
I agree that the evidence is not the highest quality but i have a hard time imagining a more involved study design that would pass by any ethic board.
Would we expect the same in something as intimate as amputating pieces of your own body? Hmmm.
[1] https://dl.acm.org/doi/abs/10.1145/1562764.1562800
[2] https://journals.sagepub.com/doi/abs/10.1177/002224372094183...
And how would you find those posts after they were banned and deleted?
I wouldn't say that failing to at least try to look for the less-than-enthusiastic people makes this paper criminally dangerous pseudoscience, but it certainly gives me pause.
I don't find that the least bit credible. The proposition forum administrators would tolerate someone "warning others" against the core uniting aspect of their community is not realistic. Generally anyone who questions orthodoxy in such niche communities face vitriol and get banned quickly. Apostates do not hang around religious conversion forums talking about deconversion, gender transition desisters are not welcome on transgender support forums etc.
Preventing motivated people from harassing others on a forum is impossible if anyone can join the forum.
I personally know two, one who used the dry ice method to destroy their legs, and another who achieved paralysis. both are quite happy now, except for the pain and suffering they went through (particularly the person who paralyzed herself, since she caused meningitis which led to horrid nerve pain - but even then, months later, she's happier now that it's done.)
This type of ‘cure’ for dysmorphia is not something to be celebrated.
But ultimately the end result seems to be that they will eventually, one way or another, find a way to get the surgery they desire. I don't know what your solution would be in that scenario other than to criminalize it and even then, there's reports of people doing home made amputations by sitting on rail tracks or whatever else you can think of.
And that is....? There is no psychological treatment that cures BIID and the patient here seems very happy. Is it really better and "proper" to give someone treatment that doesn't solve their problem and leaves them upset?
I'm convinced that my overall quality of life would improve if I got the disability I desire. The mental anguish is simply more intense than the consequences of physical limitation. I personally know others who have "gone through with it" and they really are happier now.
Also, FWIW, I'm sorry for your condition. It sounds hellish.
my case is kind of special, since I also have a progressive genetic disorder that's led to me being disabled. it affects me in some of the ways that I "want", but not as completely as I'd like, and causes other issues I never wanted at all.
I attempted to integrate like you suggest, shifting my BID towards the direction of my newfound disability. mostly using cognitive reframing, acceptance/commitment therapy, and working at the peripheral issues like imposter syndrome, shame, grief.
I feel much less shame now, and I'm able to use BID as a coping mechanism for my physical condition, but the darned dysphoria is still present.
Gender affirming surgeries have success rate of 95%+. No surprise that BIID people have no regrets after all.
Not to mention how this opens a huge pandora's box of "recognising" "transabled" people, "transracial" people (see Oli London, Rachel Dolezal, or Martina Big) as, for the lack of a better word - "healthy".
As a bisexual dude I suspect a lot of that has to do with the stigma around "conversion therapies", but I worry that term suffered from some really heavy "scope" creep.
I, too, have an emotional response. But let’s be scientific. If the counselling shows middling success, and the amputation 90%+, why do our feelings, as third parties, overrule the person whose body it is?
Isn’t this true of all treatments? It’s the best we’ve got. It seems to work. It has downsides. We’re looking for better options.
We start with the least invasive option. But we don’t stop midway because something better might one day turn up.
Yes. And? A stable identity is preferable for the sufferers. Can you explain the problem with that?
I don't see much of an actual solution to these issues in your arguments other than some hand waving about politics as some sort of root cause.
Should taking of legs be the first treatment option? No.
Should people get therapy, medication and other treatment? Yes.
Should those treatments be refined and improved, sufferers of BIID experimented on to improve treatments? Yes.
If society is unable to come up with a treatment that works for years should society deny sufferers this radical treatment forever? No. That is imposing the majority world view on a minority when the difference in world view poses no harm. Yes, society would need to address potential cognito hazards/memes and make sure there are no people doing this for economic incentives or other mental illnesses for which treatments exists.
If society would let people get the treatment, that would not be capitulation. That would be acknowledging that while society has interest in being able to treat that, that interest can not forever outweigh the benefits the radical operation has for the sufferer. Capitulation would be if society stops trying to find a treatment besides radical operation and handed operations out without scrutiny.
Defining mental illness is imprecise. We’ve gotten it horribly wrong before, from diagnosing intelligent women as hysterics to gay men and women as deviants. We also have a long, failed history of well-meant prohibition.
If we’re seeing preliminary evidence that a surgery makes miserable people happy, I say we follow the lead without prejudice. Maybe we find these peoples’ bodies are picking up on precancerous signs? (Airball.) Probably, we don’t. But my peers’ botox has visibly reduced their faces’ expressiveness; is that mental illness?
Out of all of our emotions, I trust my sense of social disgust least. The world in which it evolved is no more. If I can’t find reason beyond discomfort to question someone’s decisions about themselves, I broadly tend towards letting them be.
(Side note: appreciate the discussion.)
Gender dysphoria - yes, people suffer form it. Transition is the way to lower this suffering. That's the 'cochlear implant' equivalent from your example.
Not OP. But this seems unfair. Not only does the language surround trans persons vary from decade to decade, city to city, it’s also—understandably—guarded.
Someone far from knowing “nothing about the issue,” and moreover, wishes to learn more, could innocuously use language that is offensive in some circles but tolerated—even encouraged—in others.
See for example "sex assigned at birth" https://service-manual.nhs.uk/content/inclusive-content/sex-... as an example from a mainstream medical institution, the British National Health Service.
And transition is not "the cochlear implant", the implant would be "an implant that makes you not dysphoric". Transition is "learning how to live as a deaf person".
This is what repression looks like. Before coming out, while you try to live as you assigned gender - that's living as a deaf person, pretty literally as derealization and depersonalization are kind of 'deafining'. As with deaf kid - you fix the body, not the mind, so with gender dysphoria you fix the body first.
Maybe it's just me, but fixing identities scares me much more than fixing the body. There was studies in which trans people were asked if they would want to be consent with their assigned sex (i.e. trans woman to be happy as a man) - most don't. After transition almost none would agree to change it for 'no dysphoria, assigned sex at birth'. 'Fixing' such people sounds like a very cruel and scary idea.
In some instances we provide a prosthetic that overcomes the defects of the ear, like a traditional hearing aid, or surgery that corrects those defects, and in others we augment the person with a cochlear implant that bypasses the issue with the nerve. We don't yet have the ability to directly modify the brain with surgery or implants for deafness but I'm sure that we would if we could.
It's interesting that we're talking about deafness because there are many instances of deaf people with heredity causes for their deafness opposed to testing their children with new, effective treatments like cochlear implants because they view it as impinging on their deaf culture.
I think that there are many parallels between this and the developing trans culture which will result in trans people being resistant to more effective, less invasive treatments to cure them of their affliction.
Why do certain maladies develop strong identity politics while others don't? There isn't a diabetic identity, or a halitosis community, so why these ones?
Dysphoria goes deeper than just bodily dysmorphia, it's about how you see yourself, not only your body. So changing my mind to make me something I'm not (a man) sounds like a horror - some kind of upgraded lobotomy. That's much more invasive than any surgery. And it's not about culture, it's about understanding that people identities is not a part that you can/should fix.
And speaking about data and science, there is pretty clear evidence that trans people who receive proper care (hormones) and accepted by society live normal happy life as the rest of the people.
That's why people are treated by medical experts for it.
We're merely discussing the best form of treatment.
It's not sold as the treatment.
And to your comparison to trans folks, top and bottom surgery is not easy to access (and getting harder by the day!). Talk to any trans person and ask them all the things they needed to do and go through to prove to their doctors that they're trans enough. Besides there not being another option, gender affirming surgery works! The patients are largely satisfied with their outcomes! Why do we need to complicate this with suggesting how they should feel or think?
But moreover, who the fuck cares? I had gynocomastea surgery (after years of bodybuilding) and all I had to do was sign a form. Women can elect to get breast augmentation with no evaluation. Why should a trans person have to prove that they deserve a cosmetic surgery that anyone else can get—so long as the outcome is gender conforming? I can get anything I want tattooed on my face today, but someone else can't get their chest flattened for months because...some lab coats don't think they deserve it enough?
Let's run with your idea, if a vast majority of people felt compelled to do these things would society be better off?
The feeling that you're having, is gender dysphoria. That's what trans people feel all the time, every single fucking minute of their lives, every time they look down getting a painful reminder that their body isn't Right; until they fix it - which is a capital-C Cure. Problem solved, forever.
That sounds pretty fucking great to me. Why wouldn't you let people live how they want to?
This would obviously be better than hobbling someone with crutches or a wheel chair and a disability cheque, better for society abd the individual too.
Now what if a doctor decided one day to test this treatment on someone with gender dysphoria and lo and behold it worked just as well for them? The patient suddenly felt great about their body, great about their appearance and they stopped obsessing about changing it with risky and painful surgeries.
This cheap and effective pharmacuticial treatment would instantly become a first line treatment for gender dysphoria, right?
That sounds pretty fucking great to me. Why wouldn't you want people to live their life how they were born to?
Try this experiment on yourself and think that there is a treatment to make you think you are woman/man. How's it make you feel? And together with that, reflect on what exactly make you be a man/woman - your body or your psyche.
There is a lot parallels between gender dysphoria and BIID, but GD is bit more than just 'this is not my body'.
What your arguing for in your thought experiment is, effectively, treatment designed to radically change someone's sense of identity without side effects. It's a thought experiment that falls apart once you expand it to other things that were once commonly thought of as mental illness.
People with BIID and Gender dysphoria will kill themselves if they don't receive treatment, and will otherwise ha e poor life outcomes due to the adjacent side effects like depression and self harm that comes.
The only negatives that being bisexual and homosexual have come from external sources as you state.
In other words bisexual and homsexuao people are in a state of homeostasis while people with BIID and Gender dysphoria are not.
And to further play the devils advocate there were plenty of people at the time that believed gay people were a blight on society for multiple reasons. Hence why conversion camps were a thing.
Like if you were born in a society where religious zealots who espoused bisexual bigotry just didnt exist, toxic masculinity wasnt a thing and there was a bunch of bisexual representation in media would you have had that anguish? very unlikely.
People with gender dysphoria face the same negative external influences as you do, arguably worse (lets be real, much much worse) but if it would be removed and they lived in a world without it they would still be discontent with their state, to the point of depression which would result in a poor quality of life and for many suicide.
Thats the hallmark of the disorder. thats what gender dysphoria is.
Lets do another thought experiment, what if we lived in a society where gender reassignment surgery was impossible. like lets ssay we just didnt have the advancements in surgical techniques necessary, but we had much better pharamcuticals. If surgery was impossible, but giving someone a pill like I described in the first thiufht experiment was possible that would be the morally correct thing to do as opposed to doing nothing, right?
Lobotomies were used as a cure for all kinds of different things. If you knew something was a problem and lobotomy was the only thing that seemed to cure it, is it morally correct to do so as opposed to doing nothing? That's why these simplistic thought experiments are bad because there are examples of what happens when you take it to their logical (and often sadly real) conclusion.
Now you understand the reticence towards gender reassignment surgery and why someone would be looking for much lower risk pharmaceutical treatments for gender dysphoria, which is exactly what we ended up doing with brain disorders?
It's worth noting that we still do brain surgery on people, and that we're even moving towards using implants to modulate how the brain functions, as opposed to the crude technique of severing parts their brain with rods jammed into their noses or holes drilled into their heads.
I have a feeling that we'll look back on this time when we cut off penises and inverted them into crude vagina like canals, jammed silicon bags full of salt water into chests and pumped people full of hormones as barbaric as the lobotomy era.
They're things that we do out of convenience because they're the best that we have, not because it's what we want to do.
I'm pretty sure this is 100% false. If in doubt, ask your local Catholic priest about it.
To what extent is "sense of identity" innate, and to what extent is it culturally shaped?
For example, "homosexuality" and "heterosexuality" were not something common before the late 19th century. While people still engage in sexual acts with the same and/or opposite sex, such acts did not play a role in their identity.
This is evident as far back as ancient Rome.[0]
> Homosexuality in ancient Rome often differs markedly from the contemporary West. Latin lacks words that would precisely translate "homosexual" and "heterosexual". The primary dichotomy of ancient Roman sexuality was active/dominant/masculine and passive/submissive/feminine.
To the ancient Romans, sexual acts with someone of the same sex wasn't viewed like we do today. They wouldn't have spoken about themselves as "gay" or "straight." Rather, they would have spoken about themselves as "dominant" or "submissive."
This concept runs counter to the way we think about sexual identity today, but it demonstrates that there is far more nurture in the mix than we often like to admit.
And, please note, this is not a judgment on people who identify as homosexual or heterosexual. It is also not a claim that we can "change" someone's orientation. It's simply pointing out that sexual identity is not necessarily something which is purely innate (nature). This is something we tend to take for granted and without much thought in contemporary Western society.
0. https://en.wikipedia.org/wiki/Homosexuality_in_ancient_Rome
This is no different to now, it was only in 2007 that Mahmoud Ahmadinejad claimed there were no gays in Iran. In various nations you can survey the populace and find wildly varying amounts of homosexuality, all correlating closely with LGBT acceptance. Even now I have muslim friends who are gay and openly tell me that they intend on suppressing their desires for their entire life so as to provide a family and not disappoint their parents.
Would your answer to the original question then be that the "sense of identity" is the result of or predominately from nurture? That is, one who sees as "gay" or "straight" sees themselves as such because of culture? Or to put it in a more generic manner, culture determines identity?
Some of the most common observations by our very small trans elderly is that they "found a way to describe" or "finally found the words" for who they are, ie the identity was always there but no terms to identify with.
I think by and large it's nature (fraternal birth order effect, twin studies etc) modulated to the extreme by societal rejection. You dont see gay men in the streets of countries where homosexuality earns the death penalty, you instead see extremely depressed "straight" men :)
People have an inherent, fundamental Right to their own body, to mold it into the image that they choose. If they want to take your magic pill? They have every Right to, good on 'em. But if they want their body to be a certain way, they have that Right too.
Right now the NHS is dealing with a "Why didn't anyone stop me? All I got was positive support!" situation from someone who is detransing.
I can highly recommend to give the conclusion section a read. I think the authors are well aware of these issues, to the point that this scoping (no other treatment available right now / other options exhausted + person needs help right now) makes me slightly supportive.
Even if they were eligible for the disability, the implication that this isn't a real disorder ignores almost every aspect of its reality.
Additionally, maybe this is a disorder where the current solution is really crappy.
I just want to know if they go on disability after. It's a question. Trying to distract from it is ... odd.
[1] "The Man Who Mistook Hos Wife For A Hat" https://en.wikipedia.org/wiki/The_Man_Who_Mistook_His_Wife_f...
I became aware of my BID at age 6. I specifically want paralysis, which is ironic now that I'm showing neurological symptoms from the genetic condition. There is a sexual component for me, but it's not my main motivation, and the sexual aspect has reduced as the pure dysphoria intensifies.
The physical dysphoria is fairly similar to the gender dysphoria I've experienced, but the social aspects, identity and tradeoffs are completely different.
I've tried antidepressants, therapy including traditional psychoanalysis, IFS, CBT, ACT, etc. Nothing has put a dent in the dysphoria, only helped me move on despite it. I know two people who've successfully achieved their disability, and they're much happier now. I would if I were not so terrified of the risks of DIY.
as for hypnosis and temporary paralysis, that's interesting as well. I've never been hypnotized, but I'd certainly give it a shot. I have induced numbness temporarily by stretching my spinal cord - I have a spinal defect from my genetic disorder, so bending forward yanks where it's snagged. it's extremely painful, though.
I've also never used antipsychotics, though I know they've been tried unsuccessfully in others.
Hypnosis with an hypnotherapist might also be an option, although i am unsure they wouldn't try to treat you into accepting your body as is first. YMMV. You could also try both.
https://old.reddit.com/r/hypnofair and https://old reddit.com/r/erotichypnosis have a lot of NSFW content but are more popular then the SFW https://old.reddit.com/r/recreationalhypnosis because of course it's the internet. Browsing around there are definitely some files which involve immobilisation but they seem to be targeting people into bondage or being drugged. Looking at those tags is a fascinating rabbit hole of what people are into.