Transgender + 'Body Integrity Dysphoria' = the Next Frontier of 'the Science™' (and Sanity)
A 'case study' by psychiatrist Erich Kasten tells the horrifying story of a man who tricked everybody around him to accede to his mental illness--it's yet another revolutionary push
Editorial prelim: Substack claims this post is ‘too long for email’.
If you wish to find out ‘more™’ about what frontiers ‘the Science™’ has been pushing as of late, you might find the below two postings also of interest:
More pertinent to today’s posting is perhaps the below piece:
As per the second of these links, while the above posting tells the story of something gone wrong without intent, today’s piece is about…something else entirely.
Well, before reading on, be advised that the below ‘study’ by ‘the Science™’ is—beyond sick, evil, and then some. You be the judge.
Emphases [and snark] mine.
What Happens When ‘Transgender Medice™’ (sic) Meets (Another) Severe Mental Illness?
To get an answer, we’ll look at the recent paper entitled ‘Case study about a patient suffering from body integrity dysphoria and gender dysphoria’ by one Erich Kasten, a runs a Practice for Psychotherapy & Neuropsychology Am Krautacker 25, Travemünde near Lübeck, Germany.
Abstract
Among the phenomena that arise from a discrepancy between the external appearance of the body and the mental body image, there are two important ones: gender dysphoria (GD; transgender), which denotes people who have problems with their gender identity, and body integrity dysphoria (BID), which refers to people who have an intact body but mentally feel the need to change it in a way that may even cause disability, for example, an amputation. This single case report deals with the fate of a person who has both. This article describes a male-to-female transgender individual who managed to have her feet amputated, but was later arrested by police on charges of extreme pornography. The description shows that the suffering associated with BID can be so severe that extreme attempts at resolution are made. This case report also shows the lack of understanding in our society in dealing with the people affected. The article also shows that there seems to be a connection between the two different changes in body image gender dysphoria (GD) and body identity dysphoria (BID).
Did you catch this? This is a ‘study™’ about ‘a male-to-female transgender individual who managed to have her feet amputated, but was later arrested by police on charges of extreme pornography’. If these notions don’t catch your attention, I don’t know what would.
This article aims to show that the suffering of a person whose external body does not correspond to their mental body image can be so strong that drastic measures are resorted. Similar to suicide prevention, necessary steps should be taken in our society to prevent the people affected from taking such dangerous measures [like, say, jailing the surgeons who cut off that poor person’s legs; and jailing those psychiatrists who prescribed synthetic hormones? Let’s see if anything related to the endocrine system is actually noted below…]. This article also shows that there seems to be a connection, which has so far been little described and not really explained, between the two different identity disorders, namely, gender dysphoria (GD) and body integrity dysphoria (BID) [like, mental illness galore?]. Recent studies suggest that both disorders may be caused by changes in neural networks of body image [huhum, could, say, synthetic hormones affect ‘changes in neural networks’?].
I have so many questions here already, but we shall defer until we learned ‘more’ about the case.
Some people are also dissatisfied with their skin color and would like to belong to a different race of people [would that mean that ‘race’ is biological? Is this why you can be ‘transgender™’ but not ‘transracial’ (whatever that means)?]. In the case of body dysmorphic disorders (BDD), dissatisfaction with the appearance of certain body parts can even reach pathological levels [remember this does not apply to gender dysphoria] There are two phenomena…GD (former: gender identity disorder, transgender, transidentity, transsexualism) and BID (former: body integrity identity disorder, xenophilia, apotemnophilia, amputee identity disorder). Both of these disorders involve a discrepancy between the external body and the mental body image, but they have clear differences. The biological basis for GD has already been better researched, and it was found to have social influences, for example, through upbringing in childhood or experiences in adolescence [hence the gigantic potential for abuse and grooming]…it is striking that both begin at an early stage of development [which is why drag queens seek to talk to pre-K and kindergarten children] and both groups experience a great deal of suffering due to the incongruity [because their twisted perception doesn’t align with, well, reality]. The latter applies to many anomalies of the body…There are also parallels to the altered body image of Anorexia nervosa or to BDD [both involve massive elements of social contagion]. The single case report presented here describes such an example. In particular, it shows the considerable suffering of people who have such an identity disorder. However, what is more appalling is the ignorance with which our society treats those affected.
Talk about throwing out the proverbial baby (those who suffer from such mental illnesses) with the bathwater (i.e., everybody else is at fault).
The entire paper is fully Open Access, which means it’s available online in its entirety; it’s why I’m skipping the part in which both illnesses are described in some detail and focus on the ‘body identity disorder’ (i.e., the desire to cut off one’s own body parts):
Since 2022, the disorder has been included in the ICD-11 and the DSM-5, and is named BID. A very small number of people with intact bodies feel [sic] the need to have a disability. The exact etiology of this disorder is unknown. A multi-causality of genetic, neurological, and psychological influencing factors is assumed to be at play, in which those affected have the intense feeling [sic] that a part of the body does not belong to them. People with BID can feel and move the corresponding limb, but they cannot feel it as part of their mental body image. The disorder usually causes severe psychological distress. As a result, many people try to amputate the particular body part, while others are forced [by whom?] to use an assistive device (e.g., wheelchair) because they do not feel that the body part belongs to them…[line break added]
The condition usually develops in childhood or early adolescence and often represents a perceived [sic] need that extends across the patient’s entire lifespan. The predominant focus of this desire for disability is the amputation of a limb. However, it may also involve a loss of sensory capabilities, such as blindness, deafness, or paralysis. A person with BID does not perceive the body part that is in the focus of the dysphoria as belonging to the rest of the body; some people with BID even describe a feeling of being ‘overcomplete’. Ho and co-authors found that pain perception was lower in the undesired than in the other leg. The urge for a disability may be so intense that those affected try to achieve a visual approximation of their desired body image (e.g., binding an undesired part of the body, using crutches, or a wheelchair). People with BID call these behaviors pretending. Dissatisfaction with the body can increase to the extent that they go to radical methods, such as freezing limb tissue in dry ice, triggering infection, or amputating by placing the limb on railway tracks. [I’ll spare you the links here…]
We’ll shift gears now to enquire about why would people do so?
Since 2020, studies using functional magnet resonance images (fMRI) techniques have showed altered connections of the motoric-sensory networks in the brain. According to studies by Saetta and co-authors, the right superior parietal lobule was less functionally connected to the rest of the brain. In addition, this area of the brain and the left premotor cortex were atrophic. The extent of the atrophy correlated positively with the strength of the desire for amputation. According to an article by Chakraborty et al., treatment methods such as medications and psychotherapy were ineffective…
The suffering caused by BID is incomprehensible to the unbiased observer. For a healthy person with an intact body, it is inconceivable that someone would voluntarily want to have an amputation of a limb or even a paraplegia. The following case report describes the fate of a person affected and makes it clear how much these people suffer from the incongruence between their external body and their internal mental image of their body.
Case Presentation
The case report presented here describes a patient who was affected by transgender dysphoria and changed from male-to-female gender. Furthermore, she was affected by BID and felt the need for amputation of both legs approximately 20 cm below the knees. No medical or psychotherapeutic therapies were sought; she was too embarrassed to express this need to a doctor or therapist. She was very aware of the counterarguments; she knew that she would probably no longer be able to do her job with a double amputation. Before the operation, she was afraid that an amputation could result in death and injuries that were not planned. Still, she has a fear of embarrassment if someone finds out the truth [so, that poor person lied to several medical professionals]. On the other hand, she sees an emphasis on the pro arguments, such as that she no longer has to constantly ponder the need for amputation and that she is not constantly aware of having a pair of unwanted feet attached to her legs. She sees these as ‘false meat’. To say it right here: Since the amputation, she feels free and enjoys the appearance of her own body and is proud of having successfully mastered this challenge. The patient contacted me after the amputation had already been completed. So, there was no therapy, nor was there any recommendation for or against the dry ice method she used to get rid of her feet.
And then there’s the following segment about Mr. Kasten’s ‘clinical findings’ (but note that he just explained that ‘there was no therapy’.
Before the amputation, she constantly had to keep her need for the disability as a secret, which laid heavy on her, and the mental pressure caused by BID robbed her the joy in life. The mental pressure caused by the need for a disability made her completely desperate and reduced her concentration and working performance…
In the questionnaire according to Garbos et al.…answers were made retrospective [sic].
The exclusion of other psychological and psychiatric disorders was carried out using the symptom check list (SCL-90-R). A more detailed personal examination was not possible. The patient lives in a distant country and ultimately wishes to remain anonymous. Here, the change in psychological symptoms is interesting. The presence of disorders before and after amputation was examined using SCL-90-S (Franke)…the severity of almost all symptoms is significantly reduced after successful amputation. The alignment of the external body with the mental body image has obviously helped the psyche to stabilize and symptoms to become weaker.
Remember, all of this is based on a symptom check list. That’s it.
The—to me—sickest parts follow a bunch of figures (that I’ve skipped).
The patient kindly made the effort to write down her story. It is not only exciting [sic] to read about what she did but also how the authorities reacted and how much discrimination these people can face:
I am now 48 years old. From a young age, I have had a dislike of my body. I was born as a boy, and as child, I liked to play with “Transformer” toys, and I was fascinated by the way that they could change form. From about the age of 7 years, I was starting to feel that I would prefer to have been born as a girl. I had many more female friends than male, but I was still a stereotypical boy—playing sports and playing with toys for boys.
It must have been around 9 years old when I saw a double leg amputee at the beach shuffling across the sand. I cannot remember whether he was an above knee or below knee amputee, but I found it fascinating and I can still remember it vividly today. I kept on thinking about it.
Just after starting secondary school, I remember getting teased by my friends for being infatuated with a girl in the year above me. In fact, I was not in love with her—I wanted to be her. Everything about her appealed to me—her clothes, her hair, etc. At this point, I really started to question my gender [but, apparently, not his or her sanity]. I would go to bed at night hoping that I would be transformed into this girl, but there was something else that was bothering me. I had felt that my feet felt “weird” my entire life. Their appearance did not distress me, but they did not really feel as if they had the same “value” as the rest of me. They felt surplus to my body. It was as if my body ended in the middle of my shins, and then, I had these stilts projecting beyond that point. I really didn’t understand it.
At about the age of twelve, I watched the film “Robocop” [so, Hollywood had a part in this story, too]. I was fascinated by the thought of losing an unwanted limb yet preserving function with a mechanical device. I remember thinking that it wouldn’t be bad to replace these feet that were bothering me with plastic and metal feet that wouldn’t be so disgusting. I started to think that I would rather look down and see nothing or obviously artificial feet (that were obviously not part of me) than look down and see “permanent meat stilts” that were permanently attached.
I then had a bit of an epiphany—what if I was a woman with no feet. This immediately felt right. Everything about this thought fitted with my ideal image for myself. I did, however, know that these thoughts were strange, and I thought I could never share them. I cross-dressed in private for years and drew lots of pictures of how I saw my ideal self. I became increasingly frustrated with my feet and hated cutting my toenails, etc.
In my late adolescence, I began to explore my gender a bit. It was still secret, but I attended a few clubs dressed as a woman. It was with the advent of the internet that I began to understand things a bit more. I suddenly found a community of trans friends, and I also started to find information about amputees. Initially, the internet only really provided information about amputee fetishism. I think I do have an attraction to female amputees to some degree, but my core desire was to be a female amputee. It was frustrating that I could not explore this, and back in the mid-to-late nineties, the amputee “scene” was mostly about devotees.
I concentrated on my academic work and graduated from university. I had a girlfriend (who I told about my gender issues on our third date) who is now my wife. I couldn’t bring myself to tell her about the feet situation. I eventually had children. All of this time, I cross-dressed in private and dreamt about getting rid of my feet. Over the years, the literature online started to mention body dysmorphia, and the term BIID came into existence. I read everything I could about it as it seemed to describe my situation perfectly. I was also fascinated by the overlap with gender nonconformity.
Over all of these years, my thoughts about getting rid of my feet would wax and wane. But overall, the feelings were occupying more and more of my headspace. I felt as if a lot of my “processing power” was being used to control or suppress these thoughts. I was constantly trying to distract myself by working harder and harder at my job.
In about 2007, I decided I could no longer carry on. I could control the gender issue to some degree by cross-dressing, but I couldn’t do anything about the feet situation (pretending didn’t work for me because I knew I was pretending). I tried to think of ways to ablate my feet. I wondered about lying on a railway track, but was worried about dying in the process. I couldn’t think of a way to engineer an accident to achieve my goal. I did, however, read online about using dry ice. I bought some dry ice and tried, but I could not tolerate the pain and abandoned the attempt. This left me with some blistering and superficial necrosis on my feet. I got really depressed and thought that I would be stuck forever.
Over the next few years, I distracted myself with my family and work, but was getting more and more depressed. I spent more and more time online in transgender forums, and eventually I discovered some BIID forums. Some of the members of these forums were clearly quite mentally unwell [how informative to learn that s/he noticed others being ‘mentally unwell’, but I suppose in his or her case, s/he felt it was different], but I did find a few people who seemed to have a genuine and deep need to change their bodies.
I continued to think too much about things. As the levels of stress would increase in work, I would find myself not being able to think of anything else but changing my body. I started to wonder again about amputation. I suffered a bicycle accident (I got hit by a car) and damaged my superficial peroneal nerve on the right. I then stood on a Weaver fish and ended up with a midfoot infection requiring admission to hospital. Not only were these feet not really part of me, they were causing me pain and massive inconvenience!
Through discussion with “realized wannabes,” I found out that the pain of dry ice could be mitigated by numbing the limbs with iced water first. I was very skeptical about this. In 2019, I decided to try again. I cooled my feet with iced water and then managed to freeze them in dry ice. It took around 6 hours. I had guessed about a 50–50 chance of dying or achieving a successful outcome. I was so frustrated that these odds were acceptable [no more concerns about mental issues].
I stayed at home and went to bed with frozen feet. I don’t remember much after this, but I woke up in hospital. Everyone assumed that I had sepsis. I was very confused and couldn’t believe that I had done this to myself. I started to doubt what I had done. I wondered if I had imagined it as everyone was saying I was septic. It felt unreal. I chose not to disclose this. Eventually, I underwent surgery and achieved bilateral below knee amputations. It was amazing. The relief was incredible. Everything looked and felt right. I was so much happier and also nobody had questioned my sanity! I was worried that I was going to be locked in a mental health facility, but no one noticed. I underwent prosthetic rehabilitation, and everything was amazing.
I understood that my BIID and gender issues were related, but it was not that I was seeking genital amputation [but getting rid of his or her feet below the knees was a-o.k.]. I went back to work. Life was brilliant. I continued to cross-dress and decided that I would probably perform a transition to female when my children had left home (my wife was against my gender transition but OK with me cross-dressing in private).
All was fine. I absolutely did not regret the amputations. I developed an interest in sport. I started going to a gym. People told me that I seemed happier and more confident. I was proud of myself for doing it and glad it worked. It was a 100% success. I would honestly say that it was the most successful therapy in the world. No other procedure gives a 100% cure like my amputations did for me.
I was arrested by the police. During the investigation of another member of the BIID online community, they discovered that I had seen videos of an extreme pornographic nature and that I had arranged my own amputations. I was therefore investigated for possession of extreme pornography and insurance fraud [both of these things are odd; there’s no more information given].
All I can say with confidence is that although I regret that I fell under the suspicion of the law, I absolutely do not regret losing my feet. I feel [once more] as if my mental bandwidth has increased as I no longer am constantly distressed by that part of my body. It is as if lubricant has been applied to my cognition, thus freeing it up. It is difficult to describe. Had I not achieved that, then I am certain that I wouldn’t be here anymore [no emotional blackmail here, eh?]. The benefit of being “discovered” is that I am now addressing my gender issues and have started feminizing hormone therapy [all is well, isn’t it?]. I am out to my friends as a transwoman.
I understand why the police had to investigate me [do you?], but it is now feeling [again] like harassment [really?]. They seem to think that this is all a fetish and that there is a sordid cause for all of this. Hopefully, I will be able to convince them otherwise.
At this point, the study shifts to citing the psychological report requested by the court investigating the issue:
[The accused person] … agreed to an informal admission to XXX-ward following suicidal feelings [true or false?] following questioning by the police, as his is under investigation for being in possession “of extreme pornographic image/images portraying act likely to result in the serious injury to person’s private parts” from 2010 to 2021 [more lies, apparently]. He reported the process of the interview traumatic [what isn’t these days?]…On admission [the accused person] reported that <. He knew what he could do to end his life. He reported being “surprisingly ingenious” with regard to ways of ending his life and was concerned he could act quickly. He was scared that he knows he is capable of harming himself significantly (in reference to his feet) and that he can deal with pain. Through his work he is desensitized to harmful acts…He was struggling with feelings that he has lost everything, feels extremely guilty and, has damaged his family and will lose his job. He feels he has hated himself for a long time, his physical body and his personality. [...] Currently the “successful” part of [the accused persons] life is under threat and potentially the “shameful” part of his life becoming public leading to feelings of being unable to cope and leading to thoughts of ending his life.
The wife’s reaction was described as follows:
As far as [my wife] goes, she doesn’t want to write anything herself. [My wife] did not know about my self-amputation until the police started asking about dry ice and if there was anything suspicious about my “illness” [see what I mean about the mental problems?] whilst I was being questioned at the police station. She then put the pieces together and asked me about it when I returned and I confessed everything. She was also under the impression that it was sepsis (she was visiting her parents when I did it). She was remarkably understanding when I explained it but was obviously upset. She was angry that I had never told her about these thoughts prior to the freezing. It took her a while to understand (she did some research herself online which helped). She does see it as a “mental illness” [how would she come up with that?] and I think the fact that all the psychiatrists and psychologists I have seen have said that I am otherwise sane has helped her. She can see that it was something I needed to do.
[My wife] is however less understanding about the gender transition. She sees herself a bit as a “trans-widow” and that I have betrayed her. Unlike the BID, which previously I didn’t think she would understand or accept, I told her about my gender issues early in our relationship (over 20 years ago). At that point I was a crossdresser and wanted to transition, but was able to suppress this. I promised her that if we stayed together then I would never transition. She tolerated my exploration of femininity as long as I did it in private when she wasn’t around. As my gender feelings got stronger, it became difficult for me to suppress it. So, by beginning to express my feminine side she felt that I was breaking a promise to her. Our relationship was never a highly physical one (we do have 2 children), as she became aware of my need to transition, I moved out of the marital bed to the spare bedroom.
We don’t really discuss things anymore. We remain friends, but there is an artificial calm where things go unsaid. Mostly we remain together for the children. I have no need to get another partner and have no interest in sex. I remain attracted to women, but I can live platonically. I feel very guilty that I have denied [my wife] her male partner [care to count the number of ‘I’?] She does not seem to want to find another relationship—but we are still working things out. It is hard to make plans currently as I really don’t know what is going to happen to me [well, aren’t you somehow involved in this?]. We are trying to keep things as “normal” as possible for the children.
The children do not know about my legs. My main fear is around people finding out about my legs and the effect that will have on my family. I hope that my family isn’t ridiculed for having a “freak” like me around. I am worried not for myself but for them. My [wife] has always been sensitive to status and image and she is petrified of what people will say and think. She fears going from being the wife of a respected and outwardly normal [person] to the partner of a public ally [sic] humiliated weirdo.
From the ‘Discussion’ Section
Individual case studies naturally have little evidential value for the entire population of those affected, but they are particularly widespread in medicine when they describe, for example, special features in the course of a disease. The description of an individual patient can serve to justify hypotheses for research on larger populations of those affected.
The case report shows how strong the social stigmatization is that a person with identity disorders encounters [so far, that’s kinda always been this way]. Ultimately, the authorities cannot be blamed for the fact that the police know nothing about differential diagnosis in such a special field. In both groups with problems with the body identity, there are neighboring disorders that border on paraphilias. Transvestism can be a transitional phase to GD, but it is often also a paraphilia in which people find it erotic to dress and wear makeup like members of the opposite sex. People with mancophilia (i.e., “deformation fetishism”) look for disabled partners, but they rarely want to be disabled themselves. However, there is definitely an area of overlap between BID and mancophilia. In 2018, Aner and co-authors showed that those affected by BID rated amputees as significantly more attractive and erotic than those not affected. Without wanting to excuse the drastic actions of the police, there is still a lot of uncertainty in research about where the limits are [remember, this is Mr. Kasten talking about police enforcing the law].
Of course, people without medical education might suspect that a person who wants to have a body part amputated is “insane.” The scientific literature is full of descriptions of self-amputation among schizophrenics [gee, I wonder why medical professionals would think that…] However, there are serious differences here. Most important is that schizophrenics only have the urge to amputate during an acute attack, whereas BID sufferers carry this wish with them from a very young age throughout their lives. In addition, there are other parts of the body: people with BID have the need for paralysis or amputation of a leg. Schizophrenics are more likely to want to amputate their genitals, eyes, or a hand, for example, out of the delusion that this hand is tempting them to do evil or that their eyes are showing them things that make them sin. In people with BID, the reason is much more the incongruence between the external body and the mental body image. Schizophrenics do not report these kinds of feelings. Blom et al. wrote that “BIID patients are not psychotic and are mentally competent to oversee the consequences of an elective amputation.” [please don’t go down that particular rabbit hole when it comes to pre-/post-hoc justifications]
Another interesting point is that there seem to be parallels between GD and BID. As already mentioned, many sufferers show both. For instance, Vaseckova and co-authors presented a case of a 24-year-old female-to-male transgender. The patient described a deep-rooted feeling that this hand was not a part of his body. As early as 2016, Robles pointed out that transgender identity should be removed from the list of mental disorders. A neuronal lesion probably does not play the only role; psychological and social factors also are important. However, incorrectly connected networks for body image in the brain may form the basis. The introduction already pointed out that such faulty neural networks have been well researched for GD, and initial studies have been carried out for BID. It is possible that both are congenital defects in neural circuits that form a basis and can then manifest themselves in childhood and adolescence. It cannot be ruled out that both identity disorders use common networks, which could explain the frequent co-occurrence of BID with GD.
BID raises a lot of ethical questions [and then some]. As early as 2009, Müller [44] argued whether amputation in BID can be ethically justified [I’m unsure whether or not I wish to read that paper…I kept the link just in case you want to it] and suggested that those affected should rather wait until psychotherapeutic or other methods are available to help them. So far, however, there is only one example in the literature of a person with BID being cured by psychotherapy [20]. On the other hand, for transgender people, there are—in addition to the surgical solution—a lot of effective psychotherapeutic treatment options. On the other hand, Chakraborty and co-authors wrote that medical and psychotherapeutic techniques to heal BID were mostly ineffective; in contrast, amputation seems to cure the desire totally [52]. Nadeau presented a single case report, wherein a 20-year-old male sought elective amputation after other treatments proved unsuccessful. Despite [sic] ethical concerns, the decision for surgery was based on the patient’s sustained desire and potential risks of self-harm [again, isn’t that (emotional) blackmail? We need to talk about the involved surgeons, too, I suspect]. Following amputation, the patient experienced immediate relief, emotional distress subsiding, and improved functionality.
The desire to mutilate one’s own intact body massively violates common aesthetic and ethical ideas, at least in Western culture [huhum, what would that mean?]. This is also reflected in the legal situation. Doctors are obliged to maintain or establish physical health and integrity and this means a medical-ethical debacle with regard to BID [I can see an unhealthy industry in the making, with jurisdictions offering such ‘services’ to Westerners in, say, Southeast Asia]. An amputation, even at the request of the person affected, is a bodily harm and is subject to criminal law in most countries.
Ultimately, those affected often struggle for several decades with the question of whether or not they should really have the amputation. Almost all of them are rational enough to know the disadvantages of a disability [no comment]…in many countries people with GD have the option of having legal surgery in a hospital, this is not the case for people with BID. An operation abroad is basically illegal; it must be covered up with a lot of lies and costs well over $20,000 (per leg) [I don’t know about other body parts]. As the suffering increases, the poorer people are left with only drastic do-it-yourself methods [ah, let’s throw in classism].
If you made it so far, here’s the main beef Mr. Kasten appears to have:
The Hippocratic Oath obligates doctors to help the sick. However, most doctors focus on organic diseases. The ethical problem here only [sic] arises from the fact that they are being asked to amputate a healthy leg purely for psychological reasons. In other words, they are mutilating a person who is—from a pure medical point of view—essentially healthy. The question of ethics is resolved, however, when one also takes psychological suffering into account.
See, that was easy to solve. There’s some justification added, though, which I cannot omit here:
Cosmetic surgeons operate on women’s breasts that are too large or too small because of the psychological suffering; liposuction is performed on obesity because people suffer from being fat and misshapen, noses and ears are straightened according to the patient’s wishes, lips can be plumped up, and wrinkles smoothed out…The ethical dilemma with BID relates to the fact that a disability is being created due to the operation; which is not the case with cosmetic surgery or gender reassignment. In response, those affected say that they do not feel disabled after an amputation; on the contrary, they feel “complete” without the leg; their amputated appearance corresponds to the mental image they have of themselves in their brains. It should also be taken into account that some prostheses are now so good that “disabled people” can perform better than people with their own legs. In 2008, the athlete Oscar Pistorius was excluded from the Olympic Games in Peking because his prostheses gave him an advantage [another case study, eh?].
Nevertheless, there are still several ethical problems. After gender reassignment surgery, transgender people have the desired body, but many have problems with their jobs and cannot find a partner [perhaps a state-run trans partner app would solve that problem?]…Although previous studies have not found a common mental disorder for those affected by BID, the question of deeper psychological problems remains an unresolved issue…
A story like the one told here should no longer happen [agreed, but then again, a broken clock is also correctly telling the time twice a day]. Those affected need the help of our society, not persecution by the police [s/he isn’t ‘persecuted’ for being mentally ill; s/he’s investigated for extreme pornography and insurance fraud—if s/he’s otherwise sane, there’s no problem understanding, as well as accepting, the consequences of breaking these laws]]. In this sense, Loriga proposed that “the autonomy of the patient cannot be disqualified by default based on the amputation request, despite its oddity, and that any skepticism demonstrated by the physicians is based on a false preconception of ill will or ignorance, which results in a blaming attitude towards the requesting person”.
And then, of course, there’s the issue of ‘blame’, of course awarded ‘by society’ for what is—well, what is this person suffering from? Mental illness appears a given, but I’d add a good dose of narcissism and the desire to live among the rest of society while not abiding by their shared rules, conceptions, and codes, moral and otherwise.
This means, in effect, that this person—and Mr. Kasten as his or her ‘enabler’—wish to take all the benefits of modern life while considering themselves above everybody else.
Bottom Lines
This might sound very harsh, but keep in mind that the person who does so considers himself or herself a member of a kind of vanguard, if you like, or someone who’s chosen a path of action that is very different from everybody else, and who wishes that all others around him (or her) to change.
Just take in a few more lines from the ‘conclusions’ by Mr. Kasten:
This single case report supports the assumption that both GD and BID have a similar basis [as far as hypotheses go, it’s technically o.k.]. This article proves that the suffering of people with BID can be extreme [also—especially—in terms of their abuse of the people around them, from their partners to hospital staff to everybody else]. Although in many countries it is possible to change gender surgically, there is still no solution in sight for those affected by BID [which is what ‘papers’ like this one push for]. On the contrary, these people are often discriminated against and stigmatized because the idea of having a healthy body part amputated does not fit into the mind of the average citizen [it’s your problem if you cannot see this]. Neither GD nor BID is likely to be a mental disorder in the true sense of the word [so, if it’s physiological, then also, logically, the ‘transgender™’ thing is—wait for it—biological?]. The introduction already pointed out that neural bases can be supposed [on the basis of one (!) case study]. Further research is needed in these aspects [of course, for the grift to continue, it must be].
So, if, at this point, you ask yourself: who is Erich Kasten? Well, here’s his private website (in German) and he is a self-identifying ‘neuro-psychiatrist’ who one (1977-83) studied psychiatry at the U of Kiel, followed by opening a private practice and the obtainment of a Ph.D. (1993). Six years later he received the Habilitation (1999) and, following a quite active academic career in various places, was made a full professor of neuro-psychiatry at the U of Applied Sciences (Fachhochschule) Hamburg (2013-23). His research focus includes ‘Extreme Forms of Body Modification’ and ‘Body Integrity Identity Disorder’ (BIID), and in the latter context, this is what you could read:
It is also questionable whether a doctor, if he learns of a patient’s wish for an amputation, must arrange for the patient to be forcibly hospitalised in a psychiatric clinic in order to protect himself? Since BIID sufferers are not classified as mentally ill by the majority of experts and the wish is not to be regarded as a suicide attempt, forced hospitalisation is unlikely to do justice to the situation of those affected.
Those with sufficient financial resources end up looking for a doctor in a third world country and then use the excuse of an accident. Others do it themselves. One patient shot himself in the knee to force the doctors to perform the amputation; others used home-made mini-guillotines, chainsaws or deliberately induced infections. David Openshaw, a 29-year-old Australian, placed his right foot in dry ice for six hours until the tissue died and doctors had to amputate the leg below the knee. In a television interview, he publicly declared that he was now happier than ever before. Some scientists now believe that as long as there is no other treatment option, surgical amputation in hospital is ultimately the lesser of two evils.
Johannes wrote the following sentences that are worth discussing: ‘Everyone must know for themselves what is best for them, just as it is self-evident and otherwise accepted in other areas of life. Incidentally, in order to assert the right to self-determination and free will, it is my life and my body and ultimately only I have control over it."
For those who wish to go deeper down that rabbit-hole, there are further references for papers and publications.
If Mr. Kasten would support other infringements of bodily autonomy, such as mandatory vaccination, cannot be determined right now.
The main issue here, it seems to me, is that ‘papers’ like these are nothing short of revolutionary in the true sense of the term.
While I consider the presented case study a very much extreme form of mental illness, I’m wary of the proposed ‘solutions’: even if one considers the (shitty) argument of amputation without need or indication to be the lesser of two evils, if one needs others to become accomplices in these shenanigans, it’s no longer an issue of ‘personal’ (sic) autonomy or sovereignty.
My liberty ends where your’s begins (and vice versa). If a severely mentally ill person lies to those around him, first responders, doctors, and others, he or she makes them their accomplices under the pretence of false statements, lies of omissions, or cold-blooded, calculating schemes.
This is wrong, both in terms of implicating others against their will (and thus adding a fundamentally coercive aspect never considered by Mr. Kasten) and by subordinating the others’ conscience, morals, and professional standards to one’s whims or figments of imagination.
Yes, being locked in a mental institution, typically sedated, isn’t a ‘good alternative’, and there would also be coercive aspects to be considered here; still, that route appears—still—way more sensible in light of the invoked principle ‘it’s all about me’.
I don’t have any idea how to resolve this issue, though, but I do think it’s worth pointing out that society cannot—and, possibly, also shouldn’t—accede to each and every desire of any individual however harmless or inconsequential it may be. The slippery slope to what Mr. Kasten presented is clear, and its implications are horrible already (think of the castration and mutilation meted out by so-called ‘gender transition™’).
I suspect that it’s a bit too late to put that particular genie back into the proverbial bottle though—at least under the circumstances of post-modern Western society: with borderline pathological individualism running rampant, aided and abetted by spineless and corrupt politicos (who, e.g., enable ‘gender reassignment surgery™’) and celebrated by devilish special interests (‘Pride Month™’), acceding to the demands of individuals like the person described above is the next logical (sic) step.
I suspect ‘post-natal abortion’, the normalisation of techno-fetishism (‘Transhumanism™’)—that is, augmentation of biology with synthetic stuff and/or technological gimmicks—, and the abolition of most remaining moral and other barriers on the ‘free™’ exercise of all kinds of sick and depraved ‘practices’ to follow-suit. Take a look at this, for instance:
In the end, the question Man must ponder appears simple: would he, like in the ancient Greek myth of Icarus, attempt, once more, to beat the Creator and thus fall to the Lord of Darkness?
Or would Man return to the arguably much harder path of atonement and repentance?
This is what must arise if [Normal] is abolished in favour of "everything is on a spectrum", and if [Rights] are made into something existing externally from the human mind/perception; Rights made into some kind of deity to be worshipped and obeyed no matter any real consequence.
If there's a normal to diverge from, we can then adjudicate the divergence as being a threat and a danger, or not, and act accordingly.
If rights are tied to demonstrated ability and observed behaviour (i.e. if they are conditional rather than universal and automatic or even autonomous), then we can strip away or restore said rights based on someone's behaviour.
Sometime between the 1960s and 1970s and the reports of the frankly often abhorrent conditions in many asylums and institutions, to present day, there was a change-over from too much in one direction, to too much in the opposite. If you have ever tried to walk on a suspended rope, you know that the more you try to compensate, the more you swing the other way, until you fall off.
In this case, we have to "fall off" in order to correct, and accept that the cost will be tens of thousands, perhaps hundreds of thousands or even millions of lives ruined one way or another, simply because [Normal] was removed and unearned [Rights] were made omnipotent.