When I was an undergraduate student of psychology, I stumbled across the term “BIID – Body Integrity Identity Disorder”. Learning about it has been a chance encounter since, back then, the phenomenon had not been recognized by either of the international classification systems for medical conditions, namely the DSM (Diagnostic and Statistical Manual of Mental Disorders) and the ICD (International Classification of Diseases). In 2018, however, it entered the ICD-11 under the name of “Body Integrity Dysphoria” (BID).

BIID or BID describes a very rare condition in which “your mental body image doesn’t match your physical body.”

This could mean that the mental image of a person’s body does not include, for example, an arm, or a leg, or one’s eyes. Seeing one’s own reflection in the mirror through the very eyes that do not appear to belong to that body, feeling the sensations stemming from that alien arm or leg, causes a great deal of distress to those suffering from BIID. So much so that the people affected might desire to amputate or disable the respective body part. Since it poses a moral as well as a legal dilemma for doctors to help, people with BIID are left to either bear their condition forever or to try to attain mental and physical congruency by choosing dangerous means: intentionally hurting themselves in trying to get rid of the respective part of their body or its full functionality.

The reason why I got hooked on the topic of BIID is the interesting ethical debate it requires. On the one hand, you have medical professionals who, by Hippocratic Oath, are obliged to treat their patients to the best of their abilities but not to apply methods that are not helpful, or even harmful. For a surgeon willing to amputate a perfectly functional limb or another body part, dooming the patient to a life of physical obstacles, social disadvantages, and perhaps dependency could be an outrageous notion. For a psychiatrist wanting to pinpoint and treat the real origin of a condition, instead of blindly acting on the subjective needs of a patient – needs that might not even be present if the underlying issue was treated – is an understandable approach. On this side of the opinion spectrum, BIID might be viewed as a neurological issue that should not be treated by manipulating a person’s physical reality (e.g. by amputation).

On the other hand, though, you have human beings who have a right to live a life without suffering, to be taken seriously in their unique subjective experience, to be respected in their identity. One comparison that is quickly made when discussing BIID is with transgender individuals. Though not unanimously, in our society it is widely understood and accepted that people do change their physical appearances by means of medical intervention if their experienced gender identity does not match the physical attributes they were born with as well as the respective gender assignment at birth.

If it is ethically okay to insert breast implants or to construct a neophallus where a vulva had been, why is it so unthinkable to remove a leg?

Now, the answer to this question is manifold, for sure. And I want to stress that I do not intend to judge the matter of BI(I)D and how medical professionals ought to respond to it. The reason why I am using this example is to make tangible where an important revelation for me came from.

Back then, when I was researching and discussing the ethics of BI(I)D treatment, one aspect struck me most: The idea of wanting to be an amputee, living the life of a disabled person – by CHOICE (as if it was out of a flimsy idea, not a history of suffering) – is so incomprehensible for most of us that we cannot accept its validity.

I asked myself back then:

Most likely, there is no such thing as a solution for all conflicts.

But it would ease many tensions, big or small, if we accepted that we can firmly believe something to be true, while at the same time knowing that there could be more to it.

We do not have to believe in something for it to exist. Helping someone with a problem should not depend on us understanding the issue. And something can be valid, even if I cannot see it.

Whether it be a friend who confesses their deep longing to sit in a wheelchair, a colleague with an opposing political view, or a person on the internet who says they have found their spiritual truth, no one forces you to understand, or support, or like, or accept that other person’s truth as yours. You are allowed to be appalled, or amused, or unmoved all you want. It is not a prerequisite to be free of any judgement in order to be a good person.

We get to be the opinionated, self-righteous idiots AND the wise, selfless saints – simultaneously. Isn’t that great? We only need to seize the opportunity to be both.