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In the whizzing development of transgender rights, the issue of what we have the right to do with our own bodies sometimes comes up. Opponents to transgender reassignment surgery often label it as disfiguring, mutilation or simply aesthetic – while those who support it, especially those with gender dysphoria, count it as a need for their mental health.

This topic is not intended to debate over the validity of transgender-based body modifications but rather those of a more extreme nature. Here are some extreme examples to consider.

Body Integrity Identity Disorder – The Desire to Cripple Oneself

Body Integrity Identity Disorder (not to be confused with tumblr-grade "transabled" people) is a rare and relatively newly recognized identity disorder, which is early in research and investigation. The disorder is usually an identity disorder that starts early in life that causes the patient to believe that they are not "born correctly" and must remove a limb in order to feel normal. There are also recorded forms of desires for paralysis, blindness and deafness. As the patient ages, these feelings of discomfort become more and more difficult to manage and impose great psychological stress on the individual. Research seems to suggest that it is indeed a valid identity disorder, however the cause is still elusive.

What is intriguing in these individuals is that the desire to be disabled is so strong, that some people will go as far as to destroy their bodies in order to achieve the form that they desire. Many will go to third world countries to have risky procedures done, while others will take these issues into their own hands. Very rarely, however, a doctor may actually operate on an individual.

This practice is extremely controversial because of the permanent nature of the operation as well as the heavy implications it has on the patient's life, as well as lives around them. Most doctors turn squeamish at the idea of an individual wanting to voluntarily destroy their bodies, and the legal and ethical complications draw doctors away even further. "What if they sue me for malpractice because it didn't turn out after all?"

Another problem is that being disabled puts a large burden on the patient's life as well as those around them. Out of all of the forms, Blind BIID logically has the least effect on those around them since blindness is a condition that doesn't require dependence in most situations outside of transportation or reading, and technology is slowly closing this gap. On the other hand however, those who wish to be wheelchair bound face a myriad of issues, such as the health problems with sitting in a wheelchair all the time, and requiring help from other individuals for essentially the rest of their lives.

Unusually though, about 70% of BIID patients actually feel better after they have transitioned. These individuals feel like a massive burden has been lifted off of their lives and they can finally live the way they were "supposed" to be, while all other therapeutic techniques have little effect on the disorder itself (although it can treat comorbid conditions).

What this raises is a huge ethics issue on how to properly treat these individuals. Since the disorder itself doesn't respond well to treatment in most cases, the progression towards more and more discomfort seems almost impossible to prevent. At the same time however, the act of crippling someone for life is something that cannot be undone and, if done to the wrong person, could end up leaving them even worse than before. However, because BIID can be extremely overwhelming, especially as the patient gets older, it may be safer to offer surgery than to require the patient to cause the damage themselves.

Should patients with BIID have an option to be able to transform their bodies as they see fit, despite the fact that they desire disability?

Cyborgs and Robotic Humans

On another end of the scale is the idea of becoming part mechanical, or a "cyborg" which is the commonly used term. I can't remember the exact term for this movement but some individuals are particularly into unusual body modifications.

Technically, in current day society, there does exist "cyborgs" in a way – those with prosthetic limbs have an artificial limb so that they can function independently. However, a modification to one's body so that they can "enhance" their body as opposed to simply repairing it is quite unusual.

This may share some connections with BIID and BDD (Body Dysmorphic Disorder), but are likely unrelated to an identity disorder. Instead, some individuals want to modify their bodies in a way to make them essentially biological robots.

While less complicated than BIID, where does one safely go about doing this? Should people be allowed to modify their bodies as they see fit for seemingly cosmetic changes?

These are just two examples of how desire for extreme body modification. Should we have full rights to our bodies? Or should some choices not be allowed, for our safety or for the safety of others?

Feel free to add more examples by the way, I'd love to hear about other issues related to the subject.

As far as I understand it, "Body Integrity Identity Disorder" is a disorder bordering on psychosis, and I'd appreciate if you linked to whatever research your referring to so I can read up on it and better understand it. I don't approve of the voluntary removal of limbs, and intentionally crippling yourself should be a crime (and like all crimes if the offender is unsound of mind then they'll be sent to recovery facilities, so I'm not saying we should jail these people), so I think the best course of action is to commit the afflicted until we have more research to better treat this disorder. I guess that sounds intense, and I understand the mental burden that these people must suffer, but allowing people to cripple themselves simply because we can't treat their psychological disorder sounds unethical to me.

I suppose we all might have different ideas of the degree to which we are allowed to intervene in people's lives, especially when they're afflicted with psychological disorders or psychoses (I want to stress the disorder part, because I'm totally cool with trans people getting sex reassignment as I don't consider that a disorder, nor does the surgery leave the patient crippled when done correctly). Do you let an anorexic person starve themselves? The answer should be no, but forcing someone to eat is paramount to torture (the practice was common in madhouses and is still performed in Guantanamo Bay). I think we have a responsibility to prevent people from harming themselves, especially when such harm is motivated by psychological disorder and ill mental health, but I have no idea how that doesn't violate some kind of freedom (the 'right to their body' as you put it).

I apologize. I was busy at the time when I wrote this, and I can't re-edit my post due to time constraints. I didn't think of linking the articles. Here are some articles. It should be noted that these are very early in research and should NOT be considered conclusive:

The Role of Specific Experiences in Childhood and Youth in the Development of Body Integrity Identity Disorder (BIID)
Body Integrity Identity Disorder and Gender Dysphoria: A Pilot Study to Investigate Similarities and Differences
Effects of Psychotherapy on Patients Suffering from Body Integrity Identity Disorder (BIID)
Body Integrity Identity Disorder and Mancophilia: Similarities and Differences
Body Integrity Identity Disorder (BIID): How Satisfied are Successful Wannabes

A leading researcher in the condition outlines his research here (in German). Sorry, most English sources are not that great.

The disorder is mainly treated as a psychosis because of this lack of research and non full understanding of the disorder, in addition to a lack of knowledge within therapist circles. This treatment may change as more evidence is unearthed – the disorder still needs more research to understand what methods are effective.

The major issue with throwing these individuals into prison is that it's very clear that these individuals are, at least in some way, psychologically suffering. It may be your view that they are criminals for wanting to hurt themselves but regardless, the individuals themselves are suffering and people who are suffering who do not pose a threat to others should not be treated as criminals. The origins of this suffering may be purely psychological or have other means (the current standing theory is that early life experiences, sexual desires and a neurological defect are found in many individuals with the condition) but regardless these people are suffering. In most cases these individuals only pose a threat to themselves, so it's more likely that they need psychiatric help than penal punishment. Another issue with throwing them into prison is the fact that most patients do seem to improve after their surgery.

Another issue with the disorder though is that other disorders can manifest themselves in a similar way. For example, in most cases of BIID, the desire for amputation or disability is consistent, but in some cases it changes. It's possible that the term is an umbrella term and these cases with "switching" may be purely psychological. Some other studies have been done to suggest that some cases of BPD can also appear to be BIID – the major difference is that the onset is sudden instead of being gradual over a person's development. (I'll find the article later)

I think the greatest difference between an anorexic person and someone with an identity disorder is that an anorexic person does not identify as a skinny person and their health problems are due to a perpetual cycle spiraling inward as opposed to an identity issue. It's true that it is similar to Body Dysmorphic Disorder, where people attempt to continually modify their bodies because they don't think it's "right" but it's still not really an identity disorder.

In my personal opinion I do believe that body modification should be a last resort to individuals who have been known to try to hurt themselves to achieve amputation. At this point, these people have shown that they are so distressed by their condition that it is safer to simply operate on them in a sterile environment rather than risk them getting infections from more informal means.

Will edit later if I find more sources

I'm on the "really don't care what you do to yourself" side of all this. We got rid of loony bins so now we have to deal with the loonies among us demanding loony things.

If you want to fuck up your eyesight or amputate a limb, by all means, sign some paperwork releasing the hospital and doctor from future liability. I'm all for the right to euthanasia too, go die, who honestly cares? As long as you can pay for it without a govt subsidy, go wild.

^ that mostly applies to the sick people tho, wanting to be a cyborg is a goal worth achieving. I'm so ready for some Matrix style insert-chip-learn-anything kind of deal. That's the future right there.