For just over a year now, I’ve been unofficially officially severely handicapped. This will come as a surprise to many, especially those closest to me who have accused me of being handicapped for decades now. (Family. Sigh …) But, whereas chronic depression got me close, a little bit of prostate cancer will do the trick every time.
(And, before I get started, a word to the Word Police: I have no idea what the accepted terms for “handicapped” or “disabled” this week are and whether or not you can even use any version of the first term in any context outside of golf anymore. And, to be honest, I care even less. The problem, you see, doesn’t lie so much in our choice of words as in our choice of attitudes: as long as we as a society continue to treat any identifiable group of people as second-class citizens, it doesn’t really matter what we call them. New labels combined with old attitudes does nothing except to create a need for more new labels after a couple of years.)
It wasn’t clear to me before this entire process began, even after having been in Germany for so long now, but there are rules involved to qualify as being disabled. A lot of them. In Germany, it’s all pretty much functionally summarized by the Grad der Behinderung (or GdB), a scale that quantifies the level of disability from 20 to 100. For almost any ailment or missing body part that you can think of, there’s a GdB-value attached to it on the official list. (A summary, albeit also in German, can be found here. The EU also has its own lengthy version.) For instance, if you happen to lose your penis and can’t for the life of you remember where you put it, that counts as GdB 50. By contrast, a missing vulva only gets you GdB 40, a clear sign that the list was probably written by men. (And, yes, I am well aware that the penis and vulva are not each other’s respective equivalents. However, in an even clearer indication as to the list’s male authorship, the clitoris is impossible to find.)
Rumour has it that this whole idea of levels of disability had its origins from war, that favourite of human pastimes that ensures for a lot of missing body parts. I know a version of it from my youth in Canada from ads for disability insurance, which, in a weird combination of Let’s Make a Deal then and reality TV now, would happily tell you how much your different body parts were essentially worth. So whereas losing a thumb got you enough money for a new car (with power windows if it was the thumb on your dominant hand), a small toe got you a packet of cheese doodles (maybe), and a head got you a brand new one, albeit one made out of stone, and much, much more for your next of kin.
If it seems curious that the modern German scale first starts at GdB 20, it makes even less sense that it all means nothing in practical terms until you hit GdB 50, the threshold for being severely handicapped. For instance, my chronic depression only got me GdB 30, which for all intents and purposes is the exactly same thing officially as being absolutely healthy. In other words, you also have to be sufficiently handicapped (cf. that missing penis) to be officially disabled.
But whereas depression maximally gets you only GdB 40 (= healthy), prostate cancer minimally gets you two years at GdB 50 (= severely handicapped). I’m stretching but still somehow suspect that this particular distinction might lie with how the two respective illnesses are viewed. Many, many years ago and before I knew any better, I said that I’d rather have a heart attack than depression at least insofar as the latter tends to get you more understanding and sympathy. Unlike me, that statement has actually aged pretty well many, many years later where I do now indeed know better. No heart attack yet (no rush, I’m patient …), but whereas my depression has always gone unmentioned, my cancer diagnosis shocked everyone.
Cancer has by far the worse reputation because it can strike anyone and kill them. Depression? Although society has become increasingly aware of it, the perhaps still common perception is that it only affects wimps and doesn’t kill them. (At least not directly. Via suicide, sure, but that’s just another form of wimpiness, isn’t it?) And, going back to the possible wartime origins of the entire disability system, war heroes that lost part of their body got any or all of respect and sympathy, a medal, and financial compensation. (Or at least they used to.) War cowards that only lost part of their sanity because of PTSD (AKA shell shock) mostly got scorn with the optional upgrade of incarceration in a rubber room with a matching new wardrobe.
The reality, however, is that mental illness lingers and there is usually no cure for it. Cancer tends to be much more clear-cut: either you get rid of it or it gets rid of you. And my case history mirrors this reality. My depression, although officially classified as only “moderate”, has been the way more debilitating of these two illnesses. At the height of my depression, I was on sick leave for an entire year and have missed countless days over the almost 10 years since then. (Scares me to think what severe depression must be like.) By contrast, my prostate cancer cost me just under a month in total, most of which was spent recovering from the surgery.
Admittedly, I was extremely lucky with the cancer, which was caught in its very early stages and which was also completely localized to the prostate. Plus everything south of the equator seems to be working fine after the operation too. (And, if it wasn’t, the incontinence might nab me a few extra GdBs too. Like I said, the catalogue covers just about everything. At least for men.)
But that’s exactly the point: the lack of much differentiation in the system means that cancer gets you an automatic GdB 50 regardless of what its outcome and repercussions are. Understandable, however, because they can’t possibly check every case individually, right?
You’d like to think so, but, as a matter of fact, THEY DO …
You see, the reason for the delay in my getting official severely handicapped status is manyfold. First, it’s all backdated to when I got the cancer diagnosis last May. Fair enough, I guess. But I only found out that I could apply after the operation last autumn, some five months and many missed cheaper movie tickets later. Second, the various disabilities all have to be documented by the handling physicians. Again, fair enough. But whereas my urologist took care of this relatively quickly, my psychiatrist took another couple of months to submit his report. (Can’t say that I blame him though. He couldn’t rely on already completed hospital statements and lab reports and loves paperwork just as much as I do.)
But the last couple months’ delay was because the two reports each had to be independently verified by the government’s very own team of medical officers, the Betriebsärzte. I’ve run up against the Betriebsärzte more than a couple of times now and still have absolutely no real idea why they exist.
Usually they came into play when some big medical expenses were looming, like braces for the kids or therapy for me, and the Beihilfestelle, the governmental half of the overly complicated health-insurance plan for civil servants, wanted to make sure that my kids were ugly enough and that I was nuts enough to justify the money they were going to have to pay out for the necessary adjustments. One time, however, I actually met a Betriebsarzt face-to-face after that year-long sick leave to ensure that I was indeed ready to start working again.
As much as transparency and second opinions are good ideas in general, you really have to wonder what good they are providing here at all. That I know of, no Betriebsarzt ever looked at one of my kids or, with the exception of the one I exceptionally met, asked me how I was feeling that day. And even for that one, the meeting took all of about 20 minutes, a short enough time for me to sincerely fake either sanity or insanity depending on what outcome I wanted.
In the end, they all must’ve relied on the doctors’ reports, which they can’t possibly contradict having never met us and having no knowledge of our case histories. Or is there a real danger that I can convincingly fake hospital reports for both the biopsy results as well as my prostate surgery?
Instead, the Betriebsärzte seem to be there more for their math skills. GdBs for whatever you’re missing (tumours, penises / vulvae, sanity, …), you see, aren’t strictly additive. Instead, it all depends on the “reciprocal relationships” of the individual ailments with one another. For instance, unless you’re a bird or very creative, a missing penis usually means sterility. According to the EU list, however, 40% for the penis + 25% for the sterility = 45% in total. But, like I said, a missing penis and sterility are pretty much the same thing, right? However, how my very different and completely unrelated cancer (GdB 50) and depression (GdB 30) only add up to GdB 60 raises more questions and non-missing eyebrows than Fermat’s Last Theorem did.
The obvious takeaway from all this is that it’s apparently better to misplace your body parts in Germany than the rest of Europe. Not only do you get those 10 extra penis points, but the added European bureaucracy means that—forget the clitoris—they can’t even find the vulva.



























