Out on a Limb

Elective amputation: an irrational desire or a fundamental right?

His leg bleeding and in pieces, George Boyer reached for his cordless phone. Seconds before, he had fired a shotgun at his knee. It was all planned, down to the last detail. He knew where to aim to avoid the most pain and tied a tourniquet to prevent too much blood loss. He forgot only one thing: the cordless phone didn't work in his backyard. Boyer's landlady saved his life.

That was in September 1992, when Boyer wished that his leg would just vanish. After his landlady found him nearly dead, he spent 10 days in the hospital, as doctors tried to reconstruct his shattered leg against his wishes. Finally, they were forced to amputate it from the hip down. Boyer was happy. "My only regret is that it didn't happen sooner,” he admits to filmmaker Melody Gilbert in the documentary Whole. "I've finally realized myself.”

Boyer suffers from Body Integrity Identity Disorder (BIID), a strong desire for elective amputation of an otherwise healthy limb. Believing an undesired limb—sometimes two or more—is a burden and not a body part, people with BIID seek physicians who will perform the unnecessary surgery to treat them. Many have desired amputation since childhood, and some, like Boyer, go to extreme lengths to obtain their wish. BIID is also known as apotemnophilia, literally, "a love of cutting.”

Psychotherapist Francie Horn, who treated Boyer for anxiety and depression, wrote in an article at the time that BIID is not a means of gaining attention, but a yearning to reshape one's body to a desired form. "People with BIID are uncomfortable in their own «skin' until the limb they are fixated on is gone.” She indicated that Boyer and others are driven to extreme measures because physicians refuse to grant BIID patients' requests. Boyer tried to cause an amputation in 1968 by driving a metal stake into his leg, but it only resulted in acute infection. His doctors were able to save his leg, and the injury went on his medical record as an accident.

Calling themselves Wannabes, people like Boyer often offer lucrative sums of money to physicians in the hope of having the undesired body part removed. The internet has provided a growing forum for such "Wannabes,” as well as for two other BIID-related personality types: "Devotees” and "Pretenders.” Devotees are people who are attracted to amputees, often sexually, while Pretenders are healthy people who bind their limbs to look like amputees. Many Wannabes admit to being drawn to and envying people they knew in their childhoods who were amputees. People with BIID think of themselves as incomplete with all the parts of their body. To them, less really is more.

Phil, an 89-year-old homosexual from Germany, told me that he has had BIID since he was a young child but does not know the cause. "I saw a boy who was limping, and he immediately interested me more than anybody else,” he says. His greatest desire is to have a double-leg amputation. Phil has told his doctor of this wish, but rumors among the BIID community of phantom limb pain and after-surgery regret are disconcerting to him. Information about BIID is scarce, and most patients speak about it only with some level of anonymity, as voluntary amputation is still considered socially taboo. In a book titled Amputation Wanted, S.H. tells her story of having elective amputation at the age of 16. She went through two years of counseling before doctors determined drastic surgery was the right treatment. With parental consent, she had an upper-thigh amputation and now faces married life as a one-legged adult: "I consider myself extremely fortunate in obtaining the aid of physicians who saw my condition as a valid reason for surgery, as I do in having parents open-minded and loving enough to accept such a strange need on the part of their daughter.”

S. H. points out that society allows a woman to augment her breasts, reshape her tummy, and have her jaw redone. Yet when she desires to reform her body by removing an arm, it's considered going too far. Wannabes, she says, are entitled "to wonder why other surgeries with no more serious purpose than to confer a desired change in appearance are available on request, while our deepest desires and disabling frustrations are regarded as frivolous at best.”

Doctors must deal with a different discrepancy. The Hippocratic Oath mandates that they "never do harm to anyone,” but because BIID may actually disappear with surgery, the definition of harm is indistinct. The classification of BIID is unclear itself. Since the condition is not listed in the Diagnostic and Statistical Manual of Mental Disorders, the bible of mental diagnoses, the condition is not considered a disease. Nevertheless, some doctors are trying to add BIID to the official list of mental disorders in the manual's next edition.

While nobody knows for certain what causes this amputation obsession, there are correlations between patients. Grant Riddle, in his book Amputees and Devotees, claims that patients are likely to be professionals, highly educated, and have a dominant mother. Indeed, many with BIID come from broken or unhappy households.

This is true for a Pretender from Louisiana, a man who would only identify himself as Teeruss. He told me that his desire for an amputation, like that of most people with BIID, is specific: left leg at mid-thigh. Teeruss's father was away in the armed forces during WWII, and his mother would often become frustrated with him and his brother, telling them they couldn't do anything right. "I suspect that I developed a sense of inadequacy, and being an amputee would fulfill that,” he says. His wife of 30 years knew about his BIID before they got married.

Teeruss says his Christian beliefs prevent him from doing anything about his condition, however, other than pretending to be an amputee: "We are stewards of our bodies. The temple we live in is a divine gift and must be treated as such. As much as I want an amputation, I am morally obligated to take care of what I have.”

Like Phil, Teeruss was fascinated with amputees as early as age six. Now, at 71, he does not believe there is a cure and does not want one. "There is frustration with it when you don't have what you want, but the condition itself is quite pleasant,” he says. "The condition has been part of me all my life. Anytime you lose a natural function, it is a serious loss. . . . It is an odd thing about human nature, but we come to accept ourselves after adversity.”

Mark Dillof, director of the Philosophy Clinic in Binghamton, New York, has received emails from people with BIID ever since he wrote an article about apotemnophilia. "I tell them not to do it,” he says. "Of course, I'm asserting my own value system.” Dillof reminds these individuals that their bodies are not just theirs to remold and destroy. "God gave us a body, and it's wrong to think we can disfigure it as we wish,” he says. "We're given a body to help other people. To throw away this gift is fundamentally wrong.”

To Dillof, BIID is far more than just a desire to change one's body image: "It's a religious crisis.” According to his article When Less Feels Like More, an apotemnophiliac battles against a "god who demands life, or at least limb.” The only way to escape this struggle is to rid oneself of this god and discover a "god of goodness, love, and light,” Dillof argues.

But the desire for elective amputation is not simply the result of one person's spiritual failings; rather, many see it as a gangrenous condition of society as a whole. In a culture of implants, piercings, and sex-change operations, so this argument goes, it is merely the latest permutation of our mania for self-realization and absolute personal autonomy, the most glaring example (so far) of perversion as a fundamental human right.

The apotemnophiliac demands amputation on the grounds that he owns his body and so can do anything he wants with it. And such sentiments are pretty much ubiquitous these days, used to justify everything from sexual preference to suicide. Indeed, one could argue that there exists a continuum of contemporary behaviors, all predicated upon ostensibly "inborn” desires that do no harm to others, of which elective amputation is a logical part. Homosexuality, transvestitism, consensual incest, masochism, voluntary euthanasia, elective amputation: they're all of a piece in this sense (no pun intended)—evidence of a people gone mad with doing what feels good (no matter what that may entail) and then insisting that they not be judged for it. •

When Less Is More

The Three Types of Apotemnophilia

Wannabes: People who desire an unnecessary amputation. Some go to third-world doctors for surgery or find crude methods themselves, such as dry ice or mutilation.

Pretenders: People who pretend to have an amputation by binding limbs under clothing. Many pretend multiple times a day.

Devotees: People who exhibit an attraction to amputees. Devotees say that this attraction is most acute during childhood.

From Salvo 1 (Autumn 2006)

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