When an Amputation is the Only Way You'll Feel Complete
What happens when one's limb feels extraneous, repulsive even? A discussion of body integrity dysphoria and how it differs from body dysmorphic disorder.
In Gender Identity Ideology, I described the aetiological parallels between gender dysphoria (dissatisfaction with one’s sexed body) and body integrity dysphoria (dissatisfaction with one’s whole and hale body). This article is an elaboration on the latter condition, and how it differs from body dysmorphic disorder through a series of mock case studies inspired by a review of the literature and sufferers’ accounts.
Anne (body integrity dysphoria)
Anne feels her left leg “does not belong”. She’d be much happier without it and fantasises about having it removed. Anne has altered somatosensory processing in the premotor cortex of her brain, meaning she does not feel ownership of her left leg. Although Anne is able to feel and move her leg, it has not been correctly incorporated into a mental representation of her body due to a cognitive deficit.
In other words, Anne’s leg is missing from her body schema and therefore feels extraneous. Repulsive, actually. Even a passing glance at her unwanted leg plunges Anne into months of depression and suicidal ideation. Anne uses a wheelchair prop while out in public (but not at home) so that other people’s perceptions of her as a disabled person match her own. She uses both legs when she needs to hike, drive, or ski.
Previously, Anne gained some relief from a novel and non-invasive virtual reality treatment which allowed her to look down and see a body missing its left leg. Now she is making good progress with Cognitive Behavioural Therapy (CBT) to reunite perception of the body with reality. Anne is also on anti-depressants to deal with the depression caused by her condition, which leaves her alienated, not only from her body but also from the people around her who may view her secret desire as bizarre (if not downright offensive).
A transgender person cannot become anything other than a poor simulacrum of the opposite sex, but a transabled person can certainly become a real amputee. However, while amputation of a healthy limb does alleviate the psychological distress inherent in body integrity dysphoria it is considered controversial. Reuniting mind and body is preferred through “therapy to integrate the alien limb into the (disrupted) body image” rather than mutilating the latter as though it were at fault.
Body integrity dysphoria differs from body dysmorphic disorder which is an Obsessive-Compulsive spectrum issue, and where fixation on some perceived bodily imperfection persists even after it is “corrected” with cosmetic surgery. For someone with body dysmorphic disorder, the ideal body is like the receding line of the horizon, forever out of reach.
Meanwhile, phantom limb pain is an example of the same body schema issue, in reverse: the missing limb continues to be part of the body schema, however in an altered state, leading to a sense of paralysis and therefore of pain from being tightly “clenched” in the mind of the sufferer. This is relieved through mirror therapy—but that’s the subject of another article. Specifically, the missing limb is kept alive through sensation felt in the face and upper arm, adjacent areas on the cortical map which cannibalise the area once dedicated to processing sensation to the lower arm.
Betty (double amputee)
Betty does not have an extremely rare mental condition wherein she wishes to be affirmed as having a body she does not in fact possess. Some people call her “cisabled” (or is that cis-disabled?) because she is “privileged” enough to be recognised as a double amputee on sight, unlike transabled folk who really have to work at it.
Betty uses a wheelchair everywhere and doesn’t go hiking or skiing. Having a physical disability may be an opt-in identity these days, open to people with perfectly functional and complete bodies, but its physical realities are certainly not opt-out at will. (Or at the slightest lifestyle-related inconvenience.)
John (apotemnophilia)
John desires to be an amputee due to a paraphilia known as apotemnophilia, meaning the “the love to cut” in Ancient Greek. A paraphilia is an atypical sexual preference the result of neurological conditions rather than learned behaviours. Paraphilias are vastly more common in men than women. When paraphilias cause distress or harm to others they are termed paraphilic disorders, sadism and paedophilia are examples of such.
John does not meet the criteria for body integrity dysphoria because his motives are purely sexual with no invocation of identity. He longs for an amputation only to enhance his arousal, draw pleasurable attention to himself, and revel in the process of bodily modification.
Henry (body integrity dysphoria, apotemnophilia)
Like Anne, Henry deeply desires to acquire a physical disability, however, the underlying mechanism appears to differ. This is often the case for a wide variety of behaviours, for example, “the sexes may appear to be similar in care giving behavior, but the underlying neurocircuitry regulating the behavior can be markedly different in males and females”.
In contrast to Anne, however, Henry’s desired amputation site is not stable. Previously he desired the amputation of his left arm, but now he wishes for the removal of his left leg, prior to which he desired to become a paraplegic. If Henry has a faulty body schema, why does the fault appear to shift and alter in a body that does not? The second clue is that Henry reports being sexually aroused by both Betty who is missing her legs, and the image of himself as an amputee.
It appears there is a subtype of bodily integrity disorder characterised by having a sexual motive for acquiring a disability or desiring to be treated as though having a disability. Unfortunately, people like Henry are more likely to follow through with bodily injury than people who lack a sexual dimension to their bodily dissatisfaction, in the hope that medical gatekeepers will be left with no choice but to oblige him.
The reason Henry is said to have body integrity dysphoria, while John merely has an amputation-related paraphilia, is that Henry invokes identity politics. Like Anne, Henry’s primary motive is one of identity; he wishes to “feel complete” and “satisfied inside”. Henry claims his sexual motives are only secondary — and that makes all the difference.
In fact, Henry says perhaps it’s that he would feel more comfortable sexually if he could embody his authentic self. And after all, how can identity be reasonably separated from sexuality? Nevertheless, the fact remains that when people are compelled to treat Henry as though he were physically disabled, they are rendered involuntary participants in his sexual fetish.
Henry’s desire for a limb amputation appears to be “the direct outgrowth of paraphilic sexual arousal/attraction to the idea of being an amputee”.
Henry calls himself “transabled” and is part of a community of like-minded people. He wonders if it would be permissible to swim against amputees in the Paralympics Games, considering he too has a felt, biologically-based identity as a person with a disability. Henry considers amputee fetishists who are not interested in having sex with him to be ignorant and bigoted “biological essentialists”.
Steve (self-ids as transabled but does not have body integrity dysphoria)
Steve is a bad actor making use of the political assertion that your inner sense of self— no matter how divorced from reality — dictates how society ought to treat you. Steve does not meet the clinical definition of body integrity dysphoria but self-identifies into the demedicalised “transabled” category. Anyone can. To suggest unscrupulous people would refrain from doing so is absurd, particularly given that only a declaration of inner feelings is required.
Recently Steve picked up a sports scholarship conceived as being for people with an actual physical disability, and not as a means of validating identity. Steve only came in second place in the 400m freestyle, however, which just goes to show transabled people don’t have an unfair advantage. In fact, Steve was at a disadvantage as possession of more limbs means more surface area, and greater surface area means more drag. (That’s the sort of reasoning employed to justify male athletes competing against female ones, by the way.) Steve swimming against amputees is no less fair than for Anne or Henry to do so, however, there are more Steves in this world than there are people with body integrity dysphoria.
Joe Public
Joe does not consider transabled people to be physically disabled, given that sitting in a wheelchair, while not objectionable behaviour per se, confers no actual disability. What transabled activists are pushing for is indeed to “steal resources from disabled people; and be disrespectful by denying, fetishizing, or appropriating marginalized realities” by insisting a physical disability is merely a state of mind.
Joe Public wonders what he can do for the man or woman who experiences months of suicidal ideation and depression after a passing glance at their legs. He is, after all, not a psychiatrist able to dispense professional help. Should he privilege their inaccurate perception above his own? Above shared reality? Should any of us be complicit in restructuring all of society to validate feelings whilst denying material reality? Regardless of how it affects occupants of their target class and wider society?
Heart, share, subscriber—it’s not like it’ll cost you an arm and a leg!