At war with their bodies, they seek to sever limbs


[edit] Original Article

[edit] Author

Marantz Henig, Robin

[edit] Source

New York Times

[edit] Abstract/Overview

[edit] Comments/Analysis

"But an obsessive desire for limb amputation - one that drives people to cut off healthy arms and legs - tests the tolerance of even the most open minded."

Does it? Says who?

And if it does, why?

"Body Integrity Identity Disorder has led people to injure themselves with guns or chain saws in desperate efforts to force surgical amputations. A few have sought out amputations abroad, including one man who died of gangrene after an elective amputation in a clinic in Tijuana, Mexico"

People do hurt themselves, unlike the suggestion that people "may" hurt themselves in Confounding Extremities: Surgery at the Medico-ethical Limits of Self-Modification.

"Dr. David Spiegel [...] added taht he had not seen any patients with the integrity disorder.

The connection to anorexia, he said, is that people with BIID 'have a clearly mistaken belief about their bodies'"

Having not spoken or examined any individuals with BIID, how can Dr. Spiegel make such a statement? That aside, there is a clear distinction between anorexia and other similar conditions, where the person believes their body is "ugly" (oversimplification), and the case of people who know their body is "normal", though perceive that state to be innapropriate for them.

"Mike Bensler and Dr. Douglas S. Paauw [...wrote that...] the condition is at its heart an 'erotic fantasy'"

If one looks at apotemnophilia, then one would have to agree with Bensler and Paauw, however, BIID is quite different from apotemnophilia, in that it is a question of body image rather than a sexual philia.

It is important to make that distinction as we believe that suggesting a desire for an impairment is sexually driven can only muddle the issue, as well as making less acceptable because of society's taboo against most things sexually related.

"Dr. Spiegel [...said...] 'I don't think the answer is fitting in with the obsession or delusion'"

Dr. Spiegel admitted that he did not see anyone with BIID. How can he declare the condition a delusion when many other experts in the fields are repeatedly stating it is not a delusion?

"[...Dr. Smith says...] The Hippocratic oath says first do your patients no harm [ the film 'Whole'...]

But maybe the real harm, he said, is to refuse to treat such a patient, "leaving him in a state of permanent mental torment.' when all it would take for him 'to live a satisfied and happy life' would be to amputate."

We must agree with this viewpoint, even though it pushes typical understanding of the Hippocratic oath.

"But [...Dr. First...] added, 'the DSM already is a very big book'

'And as far as clinical utility,' Dr. First said, ' the thicker it gets, the less useful it gets'.

And while the disorder is genuine, he said, he has to recognize that it may be too rare for mention in a book that is already buckling under the weight of its inclusiveness."

How can we hope to get resolution if it is not included in the DSM? No research because it's not accepted/recognised. Back to the chicken/egg status.

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