So, a Zombie, a Transsexual, and an Anorexic walk into a —
If the next word were “bar” it would look like the set-up for some really insensitive joke. But what comes next isn’t “bar”, It’s “psychiatrist’s office”, and what first looked like a rude quip suddenly becomes an ethical dilemma.
I wasn’t kidding about the zombie, either.
There is a “zombie disease” in which a fracture develops between one’s daily life, and how one understands himself. Although normal routines — eating, drinking, sleeping etc — may continue, the subject believes himself to have died. Some exotic interpretation of events is used to explain away the apparent conflict between ongoing physical existence and the belief that they are dead. It’s called Cotard’s Syndrome. Esme Wang, for instance, suffered from it for 2 months.
There’s the transsexual, who — with the support of Psychologists, insists that surgical or hormonal intervention is required to set things right for the belief that one is in the “wrong body”, so to speak.
There’s the Anorexic where the subject sees an overweight person in the mirror, and will take dangerous steps to lose weight — sometimes ending up in hospital.
You could round out the list with Body Dysmorphic Disorder where Jewel Shuping claims to have had a shrink pour drain cleaner on her eyes to blind her, at her request, because she always wanted to be blind.
The question I offer the reader is this: by what overarching standard shall we decide how to react to these various conditions. In one sense, they are all the same situation, showcasing someone who’s understanding of reality is sharply at odds with the consensus of casual observers.
Here’s how this plays out. Since each situation is one where the perception of reality as experienced by the subject is in conflict with the observation of reality by everyone else, upon whose model should we base professional counsel?
It doesn’t take careful observation to see that the reaction to some of these situations is mutually exclusive.
For example: In Cotard’s Syndrome, the body is (I believe) healthy. Formal treatment, to such degree as it was offered, must then focus on the patient’s perception of reality, by whatever method is deemed most appropriate.
This is different from the treatment offered in Anorexia, which has both physical and psychological components. Each of these would require treatment. Treating one to the exclusion of the other will fail. (As attested in this woman’s remarkable account of recovery.)
When the perception in conflict takes another form, we respond differently. For people who perceive a conflict between their physical body, and the gender with which they identify, the perception is affirmed, and (some) medical doctors line up to hormonally or surgically alter the body of that person.
Said differently: physical reality is altered to align with the subject’s perception. This response is smiled upon as an example of how we have become more Progressive, Tolerant, Compassionate, etc.
Those smiles are quickly replaced with outrage in another “transformative” story: Jewel Schuping.
Like the transsexual, she believed fervently that there was a disconnect between the way her body ought to be, and the way it actually was. Like the transsexual, she sought counsel from mental health professionals. Like the transsexual, she was assured of the validity of her feelings, and was offered a means to physically alter the body that it could match those feelings.
The report says the shrink helped her procure numbing drops, and then actually poured bleach into her eyes at her request.
My first response to that last story (perhaps yours, as well) was why is that shrink not in prison?
But my follow-up question went a little deeper: how different is Jewel from the transsexual?
We don’t have one overarching standard by which we approach all these scenarios.
When there is a self-perception that is at odds with reality, we have several options: approach the subject as delusional, and in need of psychological treatment (as we would with the “zombie” disease); treat both body and mind as in need of treatment (as with Anorexia); or alter the body, to appease the mind.
In the last category, you have maiming (Jewel), or hormone treatment and surgery. Would we feel less horrified if he didn’t just dump bleach on her eyes? Suppose her eyes were surgically removed in a proper hospital setting and replaced with pretty glass ones? Would we feel better about it?
Since there are so very many disorders that can distort perception, even self-perception, could someone please explain what scientific basis gives us different responses to similar problems? Why do we chafe at mutilation, but cheer gender reassignment? Why do we intervene to help the anorexic live more successfully in her natural body, but take the precise opposite approach with a transsexual?
I understand the pressures to do so that stem from social activism, and political expediency, but do not see what either of these have to do with medical science itself.
Especially in light of the fact that surgery for transsexuals has such a poor success rate in helping them resolve their crisis. (A major study even supports the opposite conclusion.)
If surgery doesn’t actually provide the help they seek, can someone please explain how we are truly being “compassionate” by offering to radically alter someone to facilitate what in any other non-sexual context would be described as a delusion?