7 ms·

What is your definition of healthy? Should people born with a cleft palate be forced to leave it alone? What about people with breathing problems due to their

What is your definition of healthy? Should people born with a cleft palate be forced to leave it alone? What about people with breathing problems due to their anatomy? If a kid has teeth grow in improperly and start causing jaw problems, should they be prohibited from having their wisdom teeth removed or teeth realigned with braces? Should tonsil removal be prohibited? If a woman has severe back pain due to oversized breasts, should it be prohibited to get a reduction surgery even if it improves quality of life? Should vasectomies be prohibited if a person with testes wants to be able to have sex with their partner without the risk of pregnancy? Should it be prohibited to medically disable "healthy" body parts as well? As an alternative to vasectomies you can use drugs to similarly disable that body part, in many cases effectively forever. Should that be illegal too? What about anti-androgens like Spironolactone - used on-label for multiple different purposes - should we ban those since they are also used for MtF HRT? Birth control also is functionally disabling healthy parts of the body. Why does a problem "happening in the mind" somehow mean that no treatment can occur outside of the mind? Do you think mood stabilizers and antipsychotics should be banned because we're treating an "in the mind" problem with physical, body-altering interventions?

Breefield 4y ago
Thank you.
jononomo 4y ago
[flagged]
- kevingadd 4y ago
  [removed]
  - 1123581321 4y ago
    Your first comment was better. This is a discussion about public health so of course people can contribute to it, and take an interest on behalf of the affected. And he does not seem at all upset.
    - kevingadd 4y ago
      [flagged]
      - 1123581321 4y ago
        That wasn’t at all necessary, but I appreciate it (and I also note and appreciate the sarcastic meaning here.)
      - allarm 4y ago
        > mentally diseased The mentioned commenter didn’t say it though.
- amanaplanacanal 4y ago
  My understanding is that transitioning is the best treatment we have. If you know of some other treatment the psychiatric community is unaware of, I’m sure we would all like to hear it.
  - deleted 4y ago
    [deleted]
  - justsomehnguy 4y ago
    Yes, [a successful] transitioning [in an accepting society] is the best treatment we have. Until that things differ and people suffer.
  - jononomo 4y ago
    [flagged]
    - nscalf 4y ago
      Oof this isn’t even close to being proven to the point of being a reasonable recommendation. How about you wait 10 years and see if that’s real science. Dietary science is hard.
      - mikrotikker 4y ago
        How about we just try it for a month or 3 and see what happens? Its very low impact.
        klyrs 4y ago
        No, "try every low-impact crackpot theory on the internet for 3 months before seeking a well-established treatment" is not a reasonable suggestion for any condition.
  - at-w 4y ago
    It would seem that the massive increase in young people opting for these procedures would lead to fundamental differences in the population that undergoes them. Assuming your understanding is based on long-term studies done before this massive increase occurred, the effects they found are likely to differ in this now fundamentally different population. Given that the currently skyrocketing rates are largely a phenomenon of the past 5 years, that assumption is almost certainly true. As one example of such differences that we know of for certain, the ratio of patients seeking these procedures who are male vs. female has shifted massively from before the past 5 years. Even ignoring all the observed differences, the simple fact that it was once much harder to access treatment would mean those observed in older studies would be more motivated or certain of their condition, on average, than patients undergoing treatment today. In the same period, hospitals saw an influx of patients of the same age who believed they had symptoms of Tourettes (https://www.wsj.com/articles/teen-girls-are-developing-tics-doctors-say-tiktok-could-be-a-factor-11634389201 https://www.wsj.com/articles/teen-girls-are-developing-tics-...). Johns Hopkins estimated this included up to 20% of their pediatric patients, compared to 2-3% just 2 years earlier. Much like the rise in transgender minors, this was strongly concentrated in young females with other mental health issues who had been exposed to "Tourettes content" on social media. This is despite Tourettes being about 3x more common in males prior to the recent explosion in cases. There are clearly people who genuinely benefit from surgical/hormonal treatments for gender dysphoria. In any case, adults without major psychiatric issues have the right to most hormonal and/or cosmetic procedures should they wish to get them. It's still worrying how vehemently many activists oppose any questioning of such a massive rise in minors seeking life-altering treatments and implicitly or explicitly promising vulnerable kids that such treatments are the solution for their problems.
- gdavisson 4y ago
  First, why do you consider it to be a problem in the mind, rather than the body? It seems to me that, fundamentally, gender dysphoria is a mismatch between the mind and the body. Declaring the body to be correct and the mind wrong seems arbitrary (as would declaring the mind to be right and the body wrong). It's not really a question of right and wrong, it's the mismatch that's the problem. Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving-hormone-treatment-see-improvements-to-their-mental-health https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example). Note that not all transgender people experience gender dysphoria. Some are fine with the bodies they were born with, and for them gender reassignment would be unnecessary and irrelevant. Also, note that this is different from treatment for e.g. anorexia nervosa. If someone with anorexia loses weight, it doesn't help; they'll continue to see themselves as overweight. Treatment for anorexia has to focus on the patient's mind. Helping them lose weight would make their outcome worse, not better, which is why it's not done. Scott Alexander gives an interesting analogy to a case from the mental hospital where he works here: https://slatestarcodex.com/2014/11/21/the-categories-were-made-for-man-not-man-for-the-categories/ https://slatestarcodex.com/2014/11/21/the-categories-were-ma.... A woman with OCD was constantly worrying that she'd left her hair dryer on, and was having to drive home 10-20 times a day to check whether it was really off, or was on and going to burn the house down. Nothing they'd tried worked, until someone suggested she take the hair dryer with her. That effectively solved the problem for her, because she could always just look over at the dryer, see that it was unplugged, and go about her business. But caused a huge controversy among the psychiatrists between those who thought "This Is Not How One Treats Obsessive Compulsive Disorder" vs those who just said "it worked". I'm with the "do what works" crowd.
  - jononomo 4y ago
    There is no empirical way to verify if someone is actually transgender. In fact, there really is no theoretical way that a person could even be transgender unless one accepts the idea of a non-material soul that is somehow gendered. Whether someone is a male or a female is simply a question of biological definitions of observed reality, just as whether an animal is a dog or a cat is simply a question of biological definitions and observed reality. A man who thinks he is a woman is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition. This is not to say we should not have compassion for people who believe they are transgender and try to help them.
- howinteresting 4y ago
  This is just completely untethered from science and reality. The standard of discussion is shockingly low here.
  - kelseyfrog 4y ago
    It's obvious if you've been through a CSci program. Math, Physics, EE, and CSci are real science and Psychology and Sociology aren't. That means that topics that fall under Psychology and Sociology domains are inherently invalid and rather than retreating to a position of simply unknowing, "hard science" types feel justified in framing their personal experience as reality, science, nature, and fact[1]. I don't blame the tendency; we all want to believe what we're doing is important, but when it involves stubborn indignation, it's a maladaptive behavior. 1. To the point where these words end up being sensitive and specific to identifying the group.
    - howinteresting 4y ago
      I'm primarily talking about medical science (including clinical psychology) here, not "psychology" in general. You can certainly make the argument that medical science isn't as "hard" as physics, but clearly medicine generally works. You can also make the argument that gender-affirming care doesn't have RCTs behind it, but there's no way to have an RCT that (a) isn't immediately unblinded because the physical effects of HRT are obvious within days, and/or (b) isn't a gross human rights violation. So we rely on supposedly (but not actually) "low-quality" observational studies instead. For example: https://medicine.yale.edu/lgbtqi/research/gender-affirming-care/ https://medicine.yale.edu/lgbtqi/research/gender-affirming-c...
  - iaml 4y ago
    [flagged]
    - the_only_law 4y ago
      Well, this isn’t particularly new, so yeah it might be time to pack up.
- nitwit005 4y ago
  We're there an actual such treatment, people might take it, but it doesn't exist. Therapy can help with a surprising number of issues, but it isn't magic.
- dang 4y ago
  Low-information flamewar comments are not welcome here. You've been doing it repeatedly and we ban such accounts, so please stop. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
xupybd 4y ago
As a though experiment I've thought a lot about the black alien project. Specifically the removal of his fingers. I'm not sure I know where to stand. Should he be free to do what he wants? Should doctors be required to avoid removing healthy fingers ( I don't think they were doctors but I've altered the situation for my thought experiment)? My conclusion is I have no idea how to even approach it. I'd be interested in others thoughts. I like this topic as it's less politically charged but explores similar ethics.
bruiseralmighty 4y ago
There will never be a clear cut definition of health, but most people can innately tell what a well regulated body looks like for their culture. For instance, most Americans know they're fat or obese and that this is not good for their long term health outlooks and will have detrimental affects on other aspects of their lives. Some may choose to be okay with this, but very few sincerely argue that being fat is 'healthy'. Most will try to lose weight (excess fat) at some point in their lives. Sometimes we remove body parts that are no longer well functioning within an understood ordering of the body. Inflamed tonsils can be removed, large wisdom teeth pulled, even ovaries can be discarded if they're found to be hosting cancers, but all of these are examples of organ dysfunction. We know what is regular, non-painful, and non-disruptive about the human body because many human beings spend a lot of time in that state and most begin life in that state before transitioning to a disordered state. When that transition happens, medical science seeks an explanation for the dysfunction: how did these tonsils become inflamed?, why do wisdom teeth crowd the mouth?, how did this woman's ovaries come to carry so much cancer? We look for the cause of a dysfunction in order to treat it. If instead we remove the well functioning breasts of a 15 year old, or replace a healthy penis because a patient informs us that they abhor their member, or prescribe a blocker for an otherwise well regulated puberty, then we have inverted the entire thrust of centuries of medical understanding. We are taking a healthy body and searching for a malady that we have been told must be there. Once there is no longer a discernment between the regular and the dysfunctional for a human body then an explosion of maladies abounds all begging for treatment. If enlarged breasts are causing spinal issues then perhaps they should be reduced in order to correct those issues. But why not removal? We remove enlarged tonsils, why not enlarged breasts? Surely the removal of them would also correct any spine issues. In fact, it may even be ethically easier as the doctor and patient do not have to contemplate a correct breast size. But of course it is unlikely the patient or doctor ever considered the wholesale removal of the breasts in these cases because both approached the question with an idea already in mind of what a healthy human body would look like despite they're not having any precise agreement on the topic beforehand. And in fact, we should question the ethics of both vasectomies and birth control. In 2023 these treatments are mostly, though not entirely, considered mostly in the pursuit of carefree pleasure and fun. Why should either be condoned? We condemn being fat on entirely the same terms. Often Americans are fat because they eat too often and always in excess due to eating feeling good. If one doesn't praise obesity, then what ought they find desirable about self-imposed sterility? Of course what compounds these ethical concerns is that in these cases the subjects are children. On the whole this takes the acts from merely questionable or wrong-headed to monstrous.
deleted 4y ago
[deleted]

Breefield 4y ago

Thank you.

jononomo 4y ago

[flagged]

kevingadd 4y ago
[removed]
- 1123581321 4y ago
  Your first comment was better. This is a discussion about public health so of course people can contribute to it, and take an interest on behalf of the affected. And he does not seem at all upset.
  - kevingadd 4y ago
    [flagged]
    - 1123581321 4y ago
      That wasn’t at all necessary, but I appreciate it (and I also note and appreciate the sarcastic meaning here.)
    - allarm 4y ago
      > mentally diseased The mentioned commenter didn’t say it though.
amanaplanacanal 4y ago
My understanding is that transitioning is the best treatment we have. If you know of some other treatment the psychiatric community is unaware of, I’m sure we would all like to hear it.
- deleted 4y ago
  [deleted]
- justsomehnguy 4y ago
  Yes, [a successful] transitioning [in an accepting society] is the best treatment we have. Until that things differ and people suffer.
- jononomo 4y ago
  [flagged]
  - nscalf 4y ago
    Oof this isn’t even close to being proven to the point of being a reasonable recommendation. How about you wait 10 years and see if that’s real science. Dietary science is hard.
    - mikrotikker 4y ago
      How about we just try it for a month or 3 and see what happens? Its very low impact.
      - klyrs 4y ago
        No, "try every low-impact crackpot theory on the internet for 3 months before seeking a well-established treatment" is not a reasonable suggestion for any condition.
- at-w 4y ago
  It would seem that the massive increase in young people opting for these procedures would lead to fundamental differences in the population that undergoes them. Assuming your understanding is based on long-term studies done before this massive increase occurred, the effects they found are likely to differ in this now fundamentally different population. Given that the currently skyrocketing rates are largely a phenomenon of the past 5 years, that assumption is almost certainly true. As one example of such differences that we know of for certain, the ratio of patients seeking these procedures who are male vs. female has shifted massively from before the past 5 years. Even ignoring all the observed differences, the simple fact that it was once much harder to access treatment would mean those observed in older studies would be more motivated or certain of their condition, on average, than patients undergoing treatment today. In the same period, hospitals saw an influx of patients of the same age who believed they had symptoms of Tourettes (https://www.wsj.com/articles/teen-girls-are-developing-tics-doctors-say-tiktok-could-be-a-factor-11634389201 https://www.wsj.com/articles/teen-girls-are-developing-tics-...). Johns Hopkins estimated this included up to 20% of their pediatric patients, compared to 2-3% just 2 years earlier. Much like the rise in transgender minors, this was strongly concentrated in young females with other mental health issues who had been exposed to "Tourettes content" on social media. This is despite Tourettes being about 3x more common in males prior to the recent explosion in cases. There are clearly people who genuinely benefit from surgical/hormonal treatments for gender dysphoria. In any case, adults without major psychiatric issues have the right to most hormonal and/or cosmetic procedures should they wish to get them. It's still worrying how vehemently many activists oppose any questioning of such a massive rise in minors seeking life-altering treatments and implicitly or explicitly promising vulnerable kids that such treatments are the solution for their problems.
gdavisson 4y ago
First, why do you consider it to be a problem in the mind, rather than the body? It seems to me that, fundamentally, gender dysphoria is a mismatch between the mind and the body. Declaring the body to be correct and the mind wrong seems arbitrary (as would declaring the mind to be right and the body wrong). It's not really a question of right and wrong, it's the mismatch that's the problem. Second, I don't know of any treatments for gender dysphoria (in trans people, not people with other conditions that've been misdiagnosed) that "fix" the mind and actually work. Gender reassignment, on the other hand, works, in the sense that it improves peoples' lives (see https://www.scimex.org/newsfeed/transgender-teens-receiving-hormone-treatment-see-improvements-to-their-mental-health https://www.scimex.org/newsfeed/transgender-teens-receiving-... for example). Note that not all transgender people experience gender dysphoria. Some are fine with the bodies they were born with, and for them gender reassignment would be unnecessary and irrelevant. Also, note that this is different from treatment for e.g. anorexia nervosa. If someone with anorexia loses weight, it doesn't help; they'll continue to see themselves as overweight. Treatment for anorexia has to focus on the patient's mind. Helping them lose weight would make their outcome worse, not better, which is why it's not done. Scott Alexander gives an interesting analogy to a case from the mental hospital where he works here: https://slatestarcodex.com/2014/11/21/the-categories-were-made-for-man-not-man-for-the-categories/ https://slatestarcodex.com/2014/11/21/the-categories-were-ma.... A woman with OCD was constantly worrying that she'd left her hair dryer on, and was having to drive home 10-20 times a day to check whether it was really off, or was on and going to burn the house down. Nothing they'd tried worked, until someone suggested she take the hair dryer with her. That effectively solved the problem for her, because she could always just look over at the dryer, see that it was unplugged, and go about her business. But caused a huge controversy among the psychiatrists between those who thought "This Is Not How One Treats Obsessive Compulsive Disorder" vs those who just said "it worked". I'm with the "do what works" crowd.
- jononomo 4y ago
  There is no empirical way to verify if someone is actually transgender. In fact, there really is no theoretical way that a person could even be transgender unless one accepts the idea of a non-material soul that is somehow gendered. Whether someone is a male or a female is simply a question of biological definitions of observed reality, just as whether an animal is a dog or a cat is simply a question of biological definitions and observed reality. A man who thinks he is a woman is simply mistaken by definition, just as a man who thinks he is a dog or a cat is mistaken by definition. This is not to say we should not have compassion for people who believe they are transgender and try to help them.
howinteresting 4y ago
This is just completely untethered from science and reality. The standard of discussion is shockingly low here.
- kelseyfrog 4y ago
  It's obvious if you've been through a CSci program. Math, Physics, EE, and CSci are real science and Psychology and Sociology aren't. That means that topics that fall under Psychology and Sociology domains are inherently invalid and rather than retreating to a position of simply unknowing, "hard science" types feel justified in framing their personal experience as reality, science, nature, and fact[1]. I don't blame the tendency; we all want to believe what we're doing is important, but when it involves stubborn indignation, it's a maladaptive behavior. 1. To the point where these words end up being sensitive and specific to identifying the group.
  - howinteresting 4y ago
    I'm primarily talking about medical science (including clinical psychology) here, not "psychology" in general. You can certainly make the argument that medical science isn't as "hard" as physics, but clearly medicine generally works. You can also make the argument that gender-affirming care doesn't have RCTs behind it, but there's no way to have an RCT that (a) isn't immediately unblinded because the physical effects of HRT are obvious within days, and/or (b) isn't a gross human rights violation. So we rely on supposedly (but not actually) "low-quality" observational studies instead. For example: https://medicine.yale.edu/lgbtqi/research/gender-affirming-care/ https://medicine.yale.edu/lgbtqi/research/gender-affirming-c...
- iaml 4y ago
  [flagged]
  - the_only_law 4y ago
    Well, this isn’t particularly new, so yeah it might be time to pack up.
nitwit005 4y ago
We're there an actual such treatment, people might take it, but it doesn't exist. Therapy can help with a surprising number of issues, but it isn't magic.
dang 4y ago
Low-information flamewar comments are not welcome here. You've been doing it repeatedly and we ban such accounts, so please stop. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

xupybd 4y ago

As a though experiment I've thought a lot about the black alien project. Specifically the removal of his fingers. I'm not sure I know where to stand. Should he be free to do what he wants? Should doctors be required to avoid removing healthy fingers ( I don't think they were doctors but I've altered the situation for my thought experiment)? My conclusion is I have no idea how to even approach it. I'd be interested in others thoughts. I like this topic as it's less politically charged but explores similar ethics.

bruiseralmighty 4y ago

There will never be a clear cut definition of health, but most people can innately tell what a well regulated body looks like for their culture. For instance, most Americans know they're fat or obese and that this is not good for their long term health outlooks and will have detrimental affects on other aspects of their lives. Some may choose to be okay with this, but very few sincerely argue that being fat is 'healthy'. Most will try to lose weight (excess fat) at some point in their lives. Sometimes we remove body parts that are no longer well functioning within an understood ordering of the body. Inflamed tonsils can be removed, large wisdom teeth pulled, even ovaries can be discarded if they're found to be hosting cancers, but all of these are examples of organ dysfunction. We know what is regular, non-painful, and non-disruptive about the human body because many human beings spend a lot of time in that state and most begin life in that state before transitioning to a disordered state. When that transition happens, medical science seeks an explanation for the dysfunction: how did these tonsils become inflamed?, why do wisdom teeth crowd the mouth?, how did this woman's ovaries come to carry so much cancer? We look for the cause of a dysfunction in order to treat it. If instead we remove the well functioning breasts of a 15 year old, or replace a healthy penis because a patient informs us that they abhor their member, or prescribe a blocker for an otherwise well regulated puberty, then we have inverted the entire thrust of centuries of medical understanding. We are taking a healthy body and searching for a malady that we have been told must be there. Once there is no longer a discernment between the regular and the dysfunctional for a human body then an explosion of maladies abounds all begging for treatment. If enlarged breasts are causing spinal issues then perhaps they should be reduced in order to correct those issues. But why not removal? We remove enlarged tonsils, why not enlarged breasts? Surely the removal of them would also correct any spine issues. In fact, it may even be ethically easier as the doctor and patient do not have to contemplate a correct breast size. But of course it is unlikely the patient or doctor ever considered the wholesale removal of the breasts in these cases because both approached the question with an idea already in mind of what a healthy human body would look like despite they're not having any precise agreement on the topic beforehand. And in fact, we should question the ethics of both vasectomies and birth control. In 2023 these treatments are mostly, though not entirely, considered mostly in the pursuit of carefree pleasure and fun. Why should either be condoned? We condemn being fat on entirely the same terms. Often Americans are fat because they eat too often and always in excess due to eating feeling good. If one doesn't praise obesity, then what ought they find desirable about self-imposed sterility? Of course what compounds these ethical concerns is that in these cases the subjects are children. On the whole this takes the acts from merely questionable or wrong-headed to monstrous.

deleted 4y ago

[deleted]