Integrity, Mayhem, and the Question of Self-demand Amputation
 Original article
Continuum: Journal of Media & Cultural Studies, Volume 19, Number 3, September 2005 , pp. 325-333(9). Available from IngentaConnect
Self-demand amputation has been on the rise in the West since the 1970's. In the small number of analyses currently available, self-demand amputation is regarded as at best problematic and at worst abhorrent. The phenomenon has prompted public figures such as Dennis Cavan, a member of the Scottish parliement to call for legislation outloawing 'medically unnecessary' amputations. And yet, at present, in the United States alone, over 1,000,000 circumcisions, 200,000 breast modifications procedures, and 800-1,000 male to female sex reassignment surgeries are performed annyually. Up to 117,000 peopel undergo abdominoplasty; 384,00 undergo liposuction; and approximately one or two in every 1,000 babies born receives surgery to 'normalize' genital appearance In short, the modification of bodies is prolific in contemporary Western culture and a significant number of modificatory procedures involves the removal of 'healthy' tissue or body parts. The obvious question this raises is why self-demand amputation is pathologized when qualitatively similar procedures are condoned. My task in this paper, then, is to interrogate the ontological background from which our conceptions and lived experiences of the corporeality of others and of ourselves appears in releive (Alcoff, 2001, P.281). More specifically, this undertaking will unfold via a consideration of current discussions of what I will refer to as 'self-demand amputation'.
The phenomenon has prompted public figures such as Dennis Cavan, a member of the Scottish parliament, to call for legislation outlawing ‘medically unnecessary’ amputations. And yet, at present, in the United States alone over 1,000,000 circumcisions, 200,000 breastmodification procedures, and 800–1,000 male to female sex reassignment surgeries are performed annually.Up to 117,000 people undergo abdominoplasty; 384,000 undergo liposuction; and approximately one or two in every 1,000 babies born receives surgery to ‘normalize’ genital appearance.
Those statistics are staggering. What we ask for seems benign in comparison.
In short, the modification of bodies is prolific in contemporary Western culture and a significant number of modificatory procedures involve the removal of ‘healthy’ tissue or body parts. The obvious question this raises is why self-demand amputation is pathologized when qualitatively similarprocedures are condoned.
Why indeed? Jumping ahead of the author's conclusion, we'd suggest that the medical bias against disabilities is a prime factor in this.
Self-demand amputation is described in medical literature and in the popular press as the removal of ‘healthy’ tissue or ‘healthy’ limbs, and as such is most often regarded as anathema. Interestingly, it is rarely the case that the surgical reduction or removal of ‘healthy’ breast tissue, of ‘healthy’ genital tissue, or of excessive but nevertheless ‘healthy’ facial tissue is regarded as (self-demand/elective) amputation.
Seems to us that this split in thinking is quite handy, and perhaps somewhat hipocritical. As the popular saying states: "You can't have it both ways.".
Likewise, despite the fact that one could well argue that both circumcision and intersex surgeries not only involve the elective amputation of ‘healthy’ genital tissue but, moreover, are ‘performed without a patient’s consent, and occur when he [or she] is most vulnerable and completely dependent’ (Zoske, 1998, p. 189),1 these practices are rarely, if ever, discussed in accounts of elective amputation.
The author raises interesting issues.
The distinction that is frequently posited in both medical and personal accounts of self-demand amputation between the removal of ‘healthy’ digits or limbs (read: self-demand amputation), and the removal of other forms of ‘healthy’ body tissue (read: cosmetic surgeries, sex reassignment surgeries, circumcision, or simply institutionally authorized surgeries), is founded on the unquestioned assumption that the former results in ‘disability’, whereas the latter procedures allegedly do not (or at least not intentionally).
And this support our position on medical bias. The moment a disability is perceived, it stops any further possibility of going forward. Because impairments are perceived as negative by the medical community.
Some autoamputees regard the procedures they undertake as forms of extreme body modification.
We disagree with that approach, quite passionately. BIID as Extreme Body Modification is our position about it.
Engineered ‘accidents’ also occur amongst self-demand amputees who do not identify with body modificatory practices and communities and who do not, or at least would not, perform autoamputations unless this were the only way for them to gain access to surgical procedures and thus to fulfil their compelling desires.
Self-injury or auto-amputation is indeed the only way to get where we need to get at this point.
Having raised the question of the relation between what is commonly understood as self-demand amputation and other somatic technologies, I would like, at this point, to make it clear that I am neither interested in attempting to answer this question by defining and/or delineating the practices mentioned thus far, nor in celebrating the impossibility of doing so. Rather, what concerns me is the ways in which various somatic technologies [...] come to matter. In other words, I am interested in interrogating the terms and confronting the limits of the powerfully enduring perceptual frames which currently constitute bodies of flesh, bodies of knowledge, and bodies politic in specific (and often troubling) ways.
While interrogations are often beneficial in creating movement, we are not particularly happy to have our very real and painful experiences used as a rethorical exercise in academia. Particularly since so many writers discussing BIID seem to take this approach of not wishing to take a position, but merely to discuss and debate the issue.
Nikki Sullivan responded to this in an email and said: In response I really want to stress that my research is in no way simply a rhetorical exercise, and I hope that people who identifiy as wannabes/BIID sufferers don't feel that my work (and by implication, I) pays little or no regard to the real suffering they experience. All of my work is very much driven by a desire for social justice, by an inability to accept inequities, injustices, unethical practice. And this is my reason for being (and remaining) in academia (even though for the most part I find it a frustrating, and at times soul-destroying environment to be in). My position, both academically and personally, enables me to make certain kinds of interventions (and makes me ill suited to other forms of intervention that are no less important), and I do believe that making people aware of the desire for amputation/BIID and the inequitable way in which such desires are currently responded to by the medical profession, and by society more generally, is an important task to undertake. I hope that my work goes some way to fulfilling this task. I guess its worth pointing out that my research isn't designed to speak on behalf of people with BIID, or even to speak to people with BIID. Rather, its an attempt to bring to the attention of other academics, of medical professionals, of policy makers, of legal professionals etc, a situation that needs to be addressed from a whole range of persepctives and in a whole range of ways. In refusing to define the desire for amputation as singular, and the 'just' response as a singular definable one, I am not refusing to take a position, rather, I am saying that any response must necessarily recognise that the/a desire for amputation, just like any other desire, is experienced differently by different people and that different responses may be appropriate in different situations and in regards to different individuals. For example, not everyone who desires to remove a digit (or who removes one themselves) wants to identify as suffering from BIID, and its important that psych professionals recognsie this otherwise 'extreme body modification' can only be read as a pathology. Not everyone who feels their breasts don't belong to them would identify with the category BIID either.
In other words, Furth lacks a sense of bodily integrity and believes that he will gain one in and through amputation. Ironically, arguments against the surgical removal of ‘healthy’ limbs also tend to be informed by the assumption that bodily integrity is essential to the well-being of individuals and of the body politic more generally.
Is this difference then a result of the differences in perception between the medical and social models of disabilities? If both "camps" claim different results based on the same argument, the difference can only be based on different value-systems.
The problem is that for those who share medical ethicist Arthur Caplan’s opinion that ‘it’s . . . utter lunacy to go along with the request to maim someone’, elective amputation (at least a specific conception of elective amputation—one that does not include practices such as circumcision, intersex surgeries, and so on) and bodily integrity are mutually exclusive.
For Caplan, then, in so far as elective amputation involves the ‘maiming’ of someone, it constitutes ‘mayhem’. It is interesting to note here that in the United States in the 1950s, medical practitioners who objected to ‘sex-change surgery’ (especially castration) often argued that such procedures were illegal in so far as they contravened local mayhem statutes. These statutes, which were based on English common law, outlawed the maiming of men who might serve as soldiers [...]. Here we see that the term mayhem does not, as many of us might presume, simply refer to a state of havoc.
So, one of the arguments against surgery as an option to treat BIID derives from ancient laws that have no real place in today's society? Is it a silly and outdated law or does it still have its place in the books? And if it has its place, surely it needs revision. Either way, it seems problematic to base an argument against surgery on an outdated law. Especially considering that the same law/concept was used well over 50 years ago against SRS, and SRS is now an accepted treatment option for GID.
To put it more simply, perception is central to the paradox with which this paper is concerned. If this is the case, we must, as Lennard Davis suggests, develop different way[s] of . . . thinking about seeing, of perceiving thinking’
Absolutely, the medical community (and the press, along with the general public) must shift their thinking.