First and foremost, it seems extremely problematic to argue that a female-assigned individual who deeply believes they were supposed to be born without breasts is experiencing a mental state that resembles anything like suicide. Regardless of any legitimate concerns about gender surgery, this analogy immediately breaks down.
Treatments and behaviors surrounding mental illness are usually framed in terms of how adaptive they are, i.e. walking off a bridge leads to death, therefore not adaptive (ever). Having a mastectomy, if it allows someone to live a happier more fulfilling life: potentially adaptive.
Many people still believe that being gay is a mental illness, and that this is an affliction that must be “cured”. Many people still argue that the LGBTQ+ community is essentially leading hordes of people off of bridges by the thousands.
I’m not accusing you of holding this view, but I bring it up here because in the minds of many, both issues lie somewhere on the same slippery slope, and at its foundation, the analogy assumes that these people are deeply ill, and the only cure is to change one’s brain.
As our understanding of consciousness grows and we learn more about the links between our physical bodies and mental states, many avenues of mental health treatment increasingly acknowledge the role of the whole body in this picture.
To your point, this doesn’t make the topic an easy one, and I have plenty of concerns about people making decisions without the proper education and counseling. But it seems that many people project their own inability to comprehend such changes onto those who are not locked into the same world view, and the result starts to look a lot like the rampant homophobia of recent decades past: understandable given the trajectory of culture up to that point, but extremely problematic.
As medical technology advances, such surgeries may become less and less risky. In a hypothetical future, if someone could “try out” the body parts of the gender they identify with without that being a permanent decision, would that change your assessment of these surgeries and their potential utility?
Part of the confusion around this topic might come from the many different perspectives on what it means to help someone in need.
Any parent knows that a child could (and have been known to) kill itself given the option to only eat what they want (candy, cookies, etc.) There are documented cases of near-death experiences of children due to parents who gave in and only fed the child favorite sugar rich-cereal for every meal.
It may seem unfair to the child that their parents are disrespecting their deeply held beliefs about their diet, but they aren’t mentally developed enough to understand what’s best for them.
Another analogous phenomenon is transeablism: “The desire to acquire a disability through choice rather than happenstance”
People suffering from this have been known to band-saw off their arms, or throw themselves into machinery to acquire disabilities to help their body match their internal mental identity/state.
One could imagine a nice doctor helping someone band-saw off their arm to achieve their mind/body peace if the technological cost on everyone was zero in some future, just as today we see well-meaning doctors chemically band-saw off people’s healthy body functions through chemical castration.
Definitely a difficult topic.
Clearly wanting something isn’t enough to justify it, for many reasons.
I think the thing that needs more examination is how we tell the difference between the kind of mind that wants to saw its own arm off for no apparent direct gain from the kind of mind that knows it was born into the wrong body. These are clearly both deviations from the norm, but as a bisexual man, I also realize that a large portion of the population still believes I’m mentally ill, even if wanting other body parts isn’t part of my “illness”, and so I can’t reduce the plight of a pre-op trans person to just a simple matter of wants.
Continuing on the future tech thought experiment, I also wonder how opinions would change if a test were developed that could reliably predict if someone would be happier after an operation. Something that detects/indicates compatibility.
It seems that most opposition to these operations fall into two buckets:
1. The religious one, where this is an abomination and no amount of progress will change the nature of the opposition. I have little interest in arguing against this, since the premise is inherently illogical.
2. The logical one, built on the legitimate concern that an operation can’t be undone, and therefore could potentially cause more harm than benefit in the long run if the patient later realizes that they were mistaken.
Difficult for sure.
For example, I have met utilitarians that have little regard for life that has no economic value, but they are upfront regarding the value of life in economic terms, versus inherent value which a decision one has to make that is inherently illogical.
My point is that I have little interest in arguing against the claims in a book or books, written by men, claiming to be the infallible word of whichever god or gods in a discussion about an individual’s bodily autonomy and pursuit of personal well-being. I think it is as irrelevant as invoking any other random work of fiction.
Someone else can have that argument and I’ll eat popcorn, but as a child and survivor of a dogmatic and traumatic religious upbringing that taught me to hate my own sexuality, I have no interest in wasting more energy on it.
Not an easy topic by any means, especially in the context of a culture that so stigmatizes mental illness (even mentioning that it might be an issues is controversial to the ignorant on these topics).