Where is the line between a disorder and else?

And it is examples like you post that demand inconsistency. Each case must be treated as an individual unique case and no one answer fits all.

And so you claim to "know" when you should treat an example as an exception, and yet you cannot define why.How absurd.There is some criteria you're using to decide who is and is not crazy, even if you're only applying it at the individual case level and refusing to be sufficiently introspective to figure out what the actual criteria are.

Bullshit. Utter sophomoric bullshit.What I am saying is that each case is unique and unless a whole lot more information is available I cannot possibly make any ruling.Trying to be consistent without full details is just plain stupid.

So you acknowledge that there are criteria you're using, you simply throw up the defense that "it's too complicated and I don't know enough" as an obfuscation instead of even attempting to explain what those criteria are.It's a hypothetical situation, jar. Ask for any specific details and I;m sure we can collectively fantasize responses. But the fact remains that there is some reason, in the final instance, that will make you say "this person is crazy," or "this person is not crazy."Would you care to share what those reasons might be, and thereby contribute to the thread?

No I don't just 'simply throw up the defense that "it's too complicated and I don't know enough" as an obfuscation instead of even attempting to explain what those criteria are.'I'm saying only a fool would say that consistency is required or desirable.As you say, you can make up any shit example you want.Again, I can't say what would lead to a conclusion of "this person is crazy" or "this person is not crazy" that could be anything but made up bullshit.

How fortunate for any hypothetical patients of yours, then, that you are not in fact a psychiatrist, given that you are apparently incapable of discerning real mental disorder from sane but alien choice beyond the determination of your mercurial and arbitrary gut.Indeed, "made up bullshit" is exactly the way I would describe your approach toward drawing the line between disorder and not-disorder - devoid of thought, containing only what knee-jerk emotional reflex occurs to you in the moment. One would expect that you could interview two individuals who provide identical responses in all ways, and yet you could call one sane, and the other crazy, for no greater reason than that one was interviewed before lunch, and the other after.Such is the foolishness of desiring consistency, that we should seek to avoid identifying the sane as crazy, or the insane as healthy, by establishing clear criteria for determining which is actually which. Certainly your way is better - why bother with diagnosis at all, when one might as well just flip a coin?

See, your response is a great example of foolishness. You are just making shit up when you say 'Indeed, "made up bullshit" is exactly the way I would describe your approach toward drawing the line between disorder and not-disorder - devoid of thought, containing only what knee-jerk emotional reflex occurs to you in the moment.'Then you go on and make up even more bullshit when you say 'One would expect that you could interview two individuals who provide identical responses in all ways, and yet you could call one sane, and the other crazy, for no greater reason than that one was interviewed before lunch, and the other after.'It gets even funnier when you say 'How fortunate for any hypothetical patients of yours, then, that you are not in fact a psychiatrist, given that you are apparently incapable of discerning real mental disorder from sane but alien choice beyond the determination of your mercurial and arbitrary gut.'The reality though is that I have consistently said that I can't trust my gut or consistency or what some other example involved over a decision made on a unique example without far more data.

They might act as you say. Hank Gathers also claimed to feel better and to play basketball better without his heart medication, but he's dead now because of acting on that feeling. He likely would have felt incomplete being alive without any possibility of becoming an NBA player.In any event, BIID is a real treatable disorder whose symptoms are to want to have a limb removed. Came the same thing be said about people who want sex change operations? If not, then the situations are not the same.Edited by NoNukes, : No reason given.

So in this case "harm" meant that it accelerated his own death. Is that how we define "harm?"If so, does removing a limb hasten death, and thereby cause "harm?" Or is there some other definition you're using?Conversely, where does quality of life fit into your considerations? For example, when my grandmother was diagnosed with aggressive terminal cancer, she deliberately made decisions that hastened her own death by selecting hospice care rather than continuing treatment. Does this mean that hospice is a form of "harm" and so her decision should be considered indicative of a mental disorder?If the removal of a limb is considered "harm," how do you consider the quality of life the individual lives? If quality of life could be substantially improved by removing the limb, how does that balance against the "harm" of losing the limb?Mr Gathers chose to play basketball and, as you say, would have likely felt "incomplete" if he were unable to do so. Which would have been the greater "harm" from his perspective? Is the point of view of anyone else particularly relevant, since each person can make their own decisions for themselves? Indeed it can - gender identity dysmorphia is a real treatable disorder whose symptoms are a firm and consistent internal identity as a gender not represented by the patient's physical body, usually coupled with an intense desire to alter the body to bring it into alignment with gender identity. This disorder is treated through the use of hormone therapy in preparation for gender reassignment surgery, which has demonstrated an actual improvement in quality of life for patients who undergo this treatment.If amputation substantially improves the quality of life of a BIID sufferer, can that not be said to be an effective form of treatment, just as gender reassignment surgery? If not, why not?

That would be an example of harm, and apparently an example which you are willing to accept. But, no, that's not a definition. I could well have used an example of a manic person not taking their medication.For me personally, I don't have any problem weighing the benefits of what turned out to be a few weeks of college basketball over a human life, and finding the balance favoring life. Neither did Gather's family, which ended up suing LMU. Edited by NoNukes, : No reason given.

And yet Mr Gather could have refused to take his medication regardless of what his family or LMU or his doctors or anyone else in the world thought.The question is not "how would you make this decision." Obviously you and I had different value hierarchies than Mr Gather did; he valued his sport over even his own life.Relatively sane people make similar decisions all the time - many intelligent people smoke, for example. My uncle made that decision in full awareness of likely outcomes, and now he lies in hospice care with terminal lung cancer, in the final days of his life, about to leave his bipolar wife and autistic son without their primary caregiver...and yet we would not say that his decision to smoke was borne of mental illness.I would certainly prefer that my uncle had made a different decision, just as Mr Gather's family, I'm sure, wishes desperately that their son had made a different decision.But the line between disorder and an incredible personal choice (in the literal sense - a choice one cannot understand or comprehend) is not drawn by identifying what we would choose. Down that road lies classifying all minority positions as mental illness.So tie this all back to the topic: If a man suffers from BIID and loathes his left arm and wishes it removed, is he crazy? Should amputation be considered a viable treatment, or should it not be an option at all? How do the concepts of "harm," life expectancy, self-harming choices, personal choice, self-determination, and quality of life align in such a case?I'd like to make clear that, despite my vehement replies to jar, my own position is not at all set; I lean in one direction only because I can empathize with a desire not to have my choices regarding my own body made for me by anyone else, even if those choices are harmful (my diet certainly demonstrates that I'm not considerate of "harm" to myself in that respect). I'm tending toward a definition of "harm" as the denial of value fulfillment - values such as body integrity, avoiding pain, retaining property, general health, longevity, and so on - where individuals of similar intelligence may arrive at different value hierarchies than my own and which I may have great difficulty understanding or empathizing with. I'm participating in this discussion in large part as a way to externalize my own thoughts on the matter and expose myself to multiple points of view so that I can determine what my position should actually be.

Roger. Are you trying to question whether or nor a man who wants to cut his arm off is sane? But regardless of the slipery slope, whether or not you're sane does have a definition.The lines may get blurred in some cases, but we can get the jist of it... And I doubt the patient has a good feel for that.In my opinion, that's where the definition of sanity comes into play. Its only a viable treatment when all the other options have failed. Maybe they don't, maybe the results are inconsistant. But, the line between disorder and an incredible personal choice does lie between what we think we should choose. How could it be any other way? We can't enter their mind and determine if they're sane. We have to relate.And there lies the crux of whether or not its a "disorder". Its about rationality. We have to rely on out own intuition for that, we cannot rely on their's. They're the ones in question. That gets into drug addiction, and I think we could count that as a form of induced insanity.

I don't just fear. I've already been like black folks in this regard.A number of years ago, I met this young man. At the time, he had just come back from a 6 year tour in Iraq and was just trying to find his place in the gay community. I went over and introduced myself to him and we began to see each other. Then we started dating. Then I asked him to move in with me and he agreed.Well, he started telling me that the reason he joined the army was because he didn't know where his place was here back home. He thought he was gay. Well, it turned out that by having a relationship with me he was getting closer to what he was, but not quite. He started dressing in women's clothing and wearing makeup. So, here I was watching my partner transition into the opposite sex. Let just say I wasn't very tolerant.See how that works? Despite the fact that I had been prejudiced against by society at large for all my life, I was just as intolerant of my partner's "condition" (for lack of a better word). Obviously, I still have a lot of feelings for him/her even though we haven't seen each other for years and I'm with someone else now. What about people that are transgendered? They honest to god believe they were born into the wrong body. I used to believe they needed to be treated. After all, the male sex organ on these people were perfectly healthy organs. How was that different than a healthy arm or leg?My turn around with regard to transgendered people have made me question everything.Edited by yenmor, : No reason given.

I'm not sure what your point is here. What you describe is almost certainly what did happen. LMU, in my opinion, would have been completely justified to tell Gathers that he was off the team if he did not take his meds.In the case of BIID, yes the patient might well chew his own leg off, badger style. But what we are asking about is whether it would be ethical to refuse to amputate his leg rather than to try to give him psychiatric treatment. I can readily distinguish between such treatment, which apparently has some success, and gay conversion treatment which is a non-medical treatment.

This isn't quite the same as simply comparing being gay to BIID. Doesn't sound like mere prejudice driving your disapproval, but perhaps your partner could not tell much difference.