So what is BIID? From an article in the Atlantic Monthly:
Folks with BIID are folks who want to have healthy limbs chopped off so that their external self can match their internal, idealized self. Some of these folks actually go through with it, cutting of one or more limbs. Although people with BIDD are rare, the condition – at least anecdotally – appears to be becoming more common.
The Atlantic author brings up an interesting question: Does the existence of a diagnosis and treatment (in this case, amputating a limb or limbs) for a condition increase the prevalence of the condition in society?
But it is possible to imagine another story: that our cultural and historical conditions have not just revealed transsexuals but created them. That is, once “transsexual” and “gender-identity disorder” and “sex-reassignment surgery” became common linguistic currency, more people began conceptualizing and interpreting their experience in these terms. They began to make sense of their lives in a way that hadn’t been available to them before, and to some degree they actually became the kinds of people described by these terms.
I don’t want to take a stand on whether either of these accounts is right. It may be that neither is. It may be that there are elements of truth in both. But let us suppose that there is some truth to the idea that sex-reassignment surgery and diagnoses of gender-identity disorder have helped to create the growing number of cases we are seeing. Would this mean that there is no biological basis for gender-identity disorder? No. Would it mean that the term is a sham? Again, no. Would it mean that these people are faking their dissatisfaction with their sex? No. What it would mean is that certain social and structural conditions — diagnostic categories, medical clinics, reimbursement schedules, a common language to describe the experience, and, recently, a large body of academic work and transgender activism — have made this way of interpreting an experience not only possible but more likely.
So the existence of sex reassignment surgery – and of an increasingly active and visible transsexual community – may be increasing the number of people who genuinely and sincerely need to have their sex changed. And a similar dynamic, ten or twenty years from now, may lead to a huge increase in the numbers of people who go to doctors and ask for a limb or two (or four) to be removed.
As blueheron points out, for those of us who are supportive of sex-change operations for transsexuals, it can be hard to find a reason to oppose amputations for folks with BIID:
1) Visceral horror and a conviction that anyone who wanted to have their limbs amputated was sick and needed immediate psychological help
2) A somewhat uncomfortable understanding of how closely this phenomena paralleled other people’s questions about gender identity.
3) An awareness that my beliefs about personal choice and responsibility means that by my own morals, these people should have access to the surgeries they want.
That’s pretty much where I stand. The Atlantic article quotes a young woman who plans to have both of her arms cut off. That horrifies me, and yet – assuming she is sane – I cannot see a justifiable reason to not allow her to control her own body. Subjectively, I am horrified by the idea of someone choosing to be crippled; but I realize other people are just as horrified by the idea of someone choosing to change sex. My horror is my own problem, not the problem of someone with BIID.
Objectively I don’t think a life lived without arms is any less important, or potentially any less fulfilling, than a life with arms. So if someone feels they need to have a doctor remove their arms to obtain happiness, on what grounds could I disagree?
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