Breasts And Limbs

Dreher reads a hell of a lot into a two-sentence post from yesterday linking to his post about trangender people and those who want to have limbs amputated for non-medical reasons:

I get sick of this kind of juvenile fusspot response whenever anyone tries to discuss the moral aspects of issues having to do with sexuality. You know, the "How dare you compare [thing I approve of] to [thing you disapprove of]!?!" As if how dare you were any sort of argument. It was clear to anyone who took the trouble to read my post that it was someone here on the Templeton fellowship who raised the question in a discussion about transgenderism, the body and personal autonomy. And it's a perfectly legitimate question, because it raises issues of the lines society draws around the individual's ability to alter his or her body.

Forgive the jerking knee. But when a transgender person encounters someone from the Templeton Foundation, there's a reason for it to jerk. There is a genuine issue here, I shouldn't have been so snitty, and a Dish reader, who approves sex changes and amputations helps out:

I work as a psychotherapist on the Transgender Clinical team at a prominent GLBT health center. I think Dreher raises a very good point about these folks who have issues with their limbs and matters of autonomy.

I saw a very compelling documentary about these people and the one doctorsomewhere in Europewho actually provided the surgery they so desperately believed they needed.  The establishment eventually shut him down for providing this care but before they did, he operated on a number of patients and my sense was this surgeon wasn’t a quack.  He followed a very similar protocol as we do in assessing transgendered individuals before approving hormone treatment or surgery, making sure there wasn’t some other significant mental illness that made the treatment contraindicated.  The people with these limb issues were “normal” in every respect, with no evidence of mental illness, except for this profound dysphoria regarding their limb.  These patients simply knew that they would receive relief once the limb was gone, and sure enough, they were much happier afterwards.

Who knows why this happens to people.  These phenomena simply aren’t understood and I don’t know if they ever will beat least not in our lifetime.  I have all sorts of metaphysical explanations that I’ll keep to myself, but in the mean time, isn’t it only right to help these people?

You write that these people want to have their limbs amputated “needlessly” but who gets to define “need”?  I assume that you meant to suggest that these limbs are otherwise healthy and fully functioning, but the same can be said for trans men who want to have their female breasts removed or trans women who want to have their male genitals removed.

I share all this because I’m what’s called a “gate keeper”.  Trans clients need letters from people like me to start hormone therapy or to have surgery, and trust me; it’s not a fun position to be in.  My desire is always to help and I don’t enjoy having this kind of power over people’s lives.  No health care provider wants to play “gender police".   I’ve often commented amongst my colleagues about the similarities between these two populations and about how to make these decisions that so significantly change people's bodies and lives.  As our team has evolved over the years, we’ve struggled with countless cases in making the decision to approve someone for treatment.  What the field in general is coming to is a place where we assess that the patient is not otherwise mentally ill and that they are fully competent to make this decision for themselves.  I don’t think we can do much more than that.  I think that same determination should be made with limb dysphorics.