Sunday, April 26, 2009

What healthy might look like

Yesterday I wound up discussing Body Integrity Identity Disorder with Matteo and Johan Mau, the peculiar "psychological feeling that one would be happier living life as an amputee", which is "usually, if not always accompanied by the desire to amputate one or more healthy limbs in order to enact that desire."

According to wikipedia "The exact causes for BIID are unknown. However, some experts have put forward theories as to why some people suffer from this illness. One theory states that a child, upon seeing an amputee, may imprint his or her psyche, and the child adopts this body image as an "ideal". Another popular theory suggests that a child who feels unloved may believe that becoming an amputee will attract the sympathy and love he or she needs. The biological theory is that BIID is a neuro-psychological condition in which there is an anomaly in the cerebral cortex relating to the limbs; cf. Proprioception. If the condition was neurological, it could be conceptualized as a congenital form of somatoparaphrenia, a condition that often follows a stroke afflicting the parietal lobe. Since the right side of the inferior-parietal lobule, which is directly related with proprioception, is significantly smaller in men than women, a malfunction of this area could potentially explain not only why men are much more likely to have BIID, but also why the requests for amputations are most often of the left-side limbs (the right side of the brain controls the left side of the body and vice versa)."

Matteo and Johan Mau weren't advocates of the biological theory and thus both found Body Integrity Identity Disorder to be the symptom of a mental disorder, and thus not something that should ever be treated surgically.

From there, their opinions diverted a little, I guess, insofar that Johan Mau accentuated that accommodating the amputation of someone suffering from BIID should never be at the expense of society at large, whereas Matteo accentuated that society at large has a responsibility to meddle when someone suffers from a disorder that may put their own life at danger.

Feel free to correct me guys, if you find that I am not doing your arguments or stories justice, but this is what I remember most clearly from our late night talk:

Matteo brought up the example of a man in the UK who ate nothing but French fries, couldn't imagine eating anything else, and eventually died from malnutrition. This, he found, bore similarities to the Body Integrity Identity Disorder: It's non-sensible to treat something physically healthy, thus it must be the symptom of something else, which in turn ought to be treated as a mental disorder with or against the will of the person suffering from it. (Again, feel free to correct me, if I got it wrong.)

Johan, who just like Matteo, is a Political Science student, was more focused on the expenses associated with the treatment and care of the members of a society. Society, he found, should be committed to ensuring its members a dignified life, and having one of your limbs cut off when there is nothing wrong with it, is pure excess, and is not the responsibility of society, the State, whatever to deal with. (Once more, do feel free to chip in and correct me.)

Me, I realize, when it comes to such issues, I'm torn between being quite a Liberalist and quite a Socialist. Although I'm not crazy about this juxtaposition in the first place, I found this little snippet from Wikipedia quite useful:

The basic ideological difference between liberalism and social democracy lies in the role of the State in relation to the individual. Liberals value liberty, rights, freedoms, and private property as fundamental to individual happiness, and regard democracy as an instrument to maintain a society where each individual enjoys the greatest amount of liberty possible (subject to the Harm Principle*). Hence, democracy and parliamentarianism are mere political systems which legitimize themselves only through the amount of liberty they promote, and are not valued per se. While the state does have an important role in ensuring positive liberty, liberals tend to trust that individuals are usually capable in deciding their own affairs, and generally do not need deliberate steering towards happiness.

Social democracy, on the other hand, has its roots in socialism (especially in democratic socialism), and typically favours a more community-based view. While social democrats also value individual liberty, they do not believe that real liberty can be achieved for the majority without transforming the nature of the state itself. Having rejected the revolutionary approach of Marxism, and choosing to further their goals through the democratic process, social democrats nevertheless retain a strong skepticism for capitalism, which they believe needs to be regulated or managed for the greater good. This focus on the greater good may, potentially, make social democrats more ready to step in and steer society in a direction that is deemed to be more equitable.

*The harm principle is articulated most clearly in John Stuart Mill's On Liberty, though it is also articulated in John Locke's Second Treatise of Government and in the work of Wilhelm von Humboldt, to whom Mill is obliged and discusses at length. Conversely, Mill concludes that government should not forcibly prevent people from engaging in victimless crimes such as personal drug usage.

The Offence principle relates to the Harm principle, in that both postulate a moral or legal ground for enshrining an actor's behaviour. Whereas the Harm principle refers to the interests of "the other" (the victim), affected by the actor's conduct, the Offence principle refers to the moral standings/feelings of society. Do we want to prevent people taking drugs to protect them (against themselves), or because it is disruptive towards society and hurting the moral feeling of others?

What it all comes down to, I guess, is that a) I find that people should have the liberty and right to determine and pursue what makes them happy as long as this pursuit does not pose a direct harm or threat to the happiness of other people, and b) that society should ensure these rights by supporting the people who are not in a position to do so by their own means. In other words, if someone really finds that having a limb less will make them happy, then who am I to judge if that's right or wrong. So by all means, go ahead, and if you can't pay for it yourself, then we should all at least consider chipping in to make it happen.

You know, I'm not saying we should simply pay for it no questions asked, but hey, let's at least critically assess whether the person in question has given it proper thought as to why life will be more with less.

I realize this may sound naive, because of course we must establish some criteria for what may be considered the characteristics of a dignified life. And I suppose this is were I become, first and foremost, a humanist, understood in a modern sense of the word, as someone willing to discuss and modify what are thought to be the values, capacities of and worth of the human being at a given point in time. These things, as history has shown us over and over again, are ever changing. As I said to Matteo last night, homosexuality was also considered a symptom, and a treatable one at that, back in the day.

What I really wish for, I suppose, is that I can be part of a generation and a society that is willing to make the concept of normality more encompassing. I support homosexuality, gay marriage, gay parents, transsexuals, and grown-ups who get a kick out of dressing up like babies, just like I hope that had I lived in a different time and place I would have supported the right of black people riding in the front of the bus and going to University. You get my drift, I hope.

When I read about BIID on Wikipedia, one of the things that struck me most, was that it said that people suffering from the condition recognizes that their desire to have a limb cut off is "strange and unnatural". That they feel "alone in having these thoughts, and don't believe anyone could ever understand their urges. They may try to injure themselves to require the amputation of that limb. They generally are ashamed of their thoughts and try to hide them from others, including therapists and health care professionals."

And it reminded me of this thought-provoking quote I once came across which went something along the lines of "healing processes often being mistaken for the symptom of a problem".

And I truly wonder if so many of the things that we consider to be challenges to normality or rationality or whatever category you wish to employ, are really just indications of other normalities and rationalities in the process of healing themselves. That it's a really healthy sign. That they are, please excuse the cheesiness, making their voices heard.

I'm not saying I want to amputate any of my limbs or anything. I'm just saying I relate. To whatever it is they might be trying to heal.

p.s. This little piece of writing is not necessarily to be interpreted as an argument. I'm just thinking out loud, and of course you're welcome to point out any inconsistencies in my thinking. In fact, I welcome them.

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