The disorder may have a sexual component, possible link to transgenderism

A small, increasingly vocal group of individuals is demanding the right to put themselves in a permanent state of disability. Known as Body Integrity Identity Disorder (BIID) or “transableism,” the condition entails a discrepancy between the person’s body and body image: the victim often wants to become an amputee or paraplegic.

The Daily Mail reported on the experience of Chloe Jennings-White, a research scientist educated at Cambridge University who wants both her legs paralyzed. Her fantasy began in childhood and since then she has participated in risky activities hoping to cause injury to her legs. She now uses a wheelchair most of the time but, as the Mail reports, “has to get out for various household tasks and walk down the steps to her car.”

There are doctors willing to help BIID sufferers realize their desires. In 2010, Jennings-White found someone who would cut her nerves to make her disabled, but could not afford to pay the £16,000 fee. MATTER featured an article about an American man, “Patrick,” who was able to get his leg amputated by an Asian surgeon. In 1997 and 1999, Scottish surgeon Robert Smith operated on two patients reportedly suffering from Body Dysmorphic Disorder, (the obsession that part of one’s body is defective) with the consent of the Falkirk and District Royal Infirmary. Because of public outcry, he was later barred from performing any more of these procedures.

Bioethicists Tim Bayne and Neil Levy argue in the 2005 Journal of Applied Philosophy that amputation is justified for reasons of harm minimization, patient autonomy, and therapeutic efficacy. They also posit a bizarre argument that amputation is more benign than gender-reassignment surgery because “men who believe that they are really women ‘trapped in a man’s body’…typically reinforce a stereotyped view of femininity, and contribute, however unwittingly and obliquely, to gender inequality.”

Advocates of voluntary amputation argue that complying with the patient’s demands is the best treatment, as a standard effective ethical therapy has not yet been developed.  Nevertheless, BIID is an issue of personal identity to many sufferers. In the MATTER article, when asked by a psychiatrist whether he would take a pill for the condition if it provided a cure, Patrick replied that he would not do so at this point in time: “This has become the core of who and what I am.”             

Scientists are not sure about what causes BIID. One possible explanation is damage to parts of the brain that create a body image map that normally corresponds to the limbs that an individual possesses. There is also evidence, however, that it could be due to sexual arousal towards other amputees, as well as the idea of being disabled oneself. 

In 2004, psychiatrist Michael First published the results of his research into 52 people who wanted to become amputees. Fully two-thirds – 67 per cent – reported that their primary or secondary reason for desiring an amputation was feeling sexual arousal and 87 per cent were attracted to other amputees. In a 2009 article for the American Journal of Bioethics, Sabine Müller wrote that males, homosexuals, and transsexuals are disproportionately affected by BIID. She reported that Michael First compared BIID to gender identity disorder (GID). “Both BIID and GID typically originate in childhood, are often expressed by the imitation of the desired identity… induce a paraphiliac sexual arousal, and are sometimes successfully resolved with surgery. In fact many of the people who utter the desire for the amputation of a healthy limb are man-to-woman-transsexuals,” she said.

Paul McHugh, former psychiatrist-in-chief at Johns Hopkins Hospital whose investigations stopped sex-change operations at the establishment under his leadership, had psychiatrist and psychoanalyst John Meyer follow up with sex-change patients after they received the operation. He found that they still faced the same relationship, work, and emotional problems, although they mostly said they were happy with the operation. Meyer’s research revealed two groups of clients: conflicted homosexual men and older bisexual or heterosexual men attracted to women who are aroused by cross-dressing. “We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it,” he concluded in a 2004 article for First Things.

Sex-change operations and voluntary amputations are expensive, however, and health care resources needed to treat life-threatening conditions are already limited. As well, some BIID sufferers who have received one amputation go on to demand more.

Furthermore, once accepted, the condition could become more popular. “It is because all mental disorders, even those with biological roots, have a social component,” Carl Elliott wrote for Slate in 2004. This is encouraged by professionals who profit from the new disorder, the lack of “hard data,” and the presence of a treatment despite insufficient knowledge about the condition. “Patients begin to reinterpret their own psychological histories in light of what they hear, and their behavior changes to match what is expected of people with the condition they believe they have,” he wrote.

“Radical individualism is now the avatar with powerful forces urging that self identity become the be all and end all – no judgment allowed – perhaps even to the point that one day it will mean permission to chop off healthy limbs and other body parts,” Wesley Smith said on his blog for National Review Online. “If we follow this path to its logical conclusion, it will mean using the medical system to surrender to serious mental illnesses.”