Amputee wannabes

The New York Times delves into body integrity identity disorder, a psychiatric condition marked by an overwhelming desire to have one more limbs amputated.

According to (Columbia University psychiatrist Dr. Michael) First, people with body integrity identity disorder are quite specific about how many limbs they want amputated, and where. The most common is the left leg above the knee; the least common is a finger or toe. "Some people actually know the exact spot where they want the amputation," said Dr. First. "Not just above the knee, but four inches above the knee."

Anything short of that specific site can be insufficient. One man from Dr. First's sample had a lifelong fixation on being a double leg amputee. After a shotgun accident, he lost his left arm. Amazingly, this did nothing to diminish the intensity of the man's desire to have his legs amputated…
"When the first sex reassignment was done in the 1950's, it generated the same kind of horror" that voluntary amputation does now, Dr. First said. "Surgeons asked themselves, 'How can I do this thing to someone that's normal?' The dilemma of the surgeon being asked to amputate a healthy limb is similar."

Still, the analogy is imperfect. "It's one thing to say someone wants to go from male to female; they're both normal states," Dr. First said. "To want to go from a four-limbed person to an amputee feels more problematic. That idea doesn't compute to regular people."


UPDATE: Annemarie Bridy writes:

"I published an article in the Journal of Law, Medicine & Ethics last spring (2004) that speaks directly to the issue and that challenges the assumptions underlying Dr. First's proposition that elective amputation is different from sex-reassignment surgery in that those seeking sex reassignment desire to go from one 'normal' state to another (whereas apotemnophiles want to be 'abnormal').  The title is "Confounding Extremities: Surgery at the Medico-ethical Limits of Self Modification."  My take is that apotemnophilia offers bioethicists and their ilk an opportunity (which they are so far declining to take) to examine and maybe question their disciplinary assumptions–unique to medicine or psychiatry or bioethics or whatever–about what is "normal" with respect to the appearance and function of the body.

I think the psychiatrists and bioethicists who approach this problem unfortunately approach it from inside a conceptual box of fairly limited dimensions. In the article, I tried to call attention to the existence of this box and to the problem it might represent for our attempts to understand and treat people who put pressure on our assumptions about bodily integrity by desiring to be disabled."

Link (to PDF of article)