The Concept of Apotemnophilia - Research Paper Example

The Concept of Apotemnophilia Abstract Apotemnophilia is a psychological condition where an individual feels a strong desire for amputation of a healthy limb. There are various descriptions of this condition by psychologists, neurologists and psychiatrists. In addition, there are various reasons and causes for this desire with different individuals experiencing different moves for amputation. However, there are those opposed to the amputation of a healthy limb due to medical ethical issues. This paper will critically analyze the concept of Apotemnophilia, the causes for this desire, effects as well as recommendations for treatment of this condition. It will also provide a brief history of the condition as well as its various features. Introduction Some people experience an overwhelming desire to amputate one or more healthy limbs, a condition referred to as Apotemnophilia. This condition to some authorities is regularly sexual in origin. There is a chronic dissatisfaction in a sexual relationships or even complete sexually dysfunctional in a person with true Apotemnophilia until their desire for amputation is carried out. Therefore, there is some sort of obsession in an apotemnophile about executing a self-planned amputation, or getting one in a hospital. Although this condition is similar to Acrotomophilia, the difference is that in Apotemnophilia the desire is for oneself to be an amputee as opposed to one's spouse having an amputation in Acrotomophilia (Depression-guide.com, 2005). According to researchers, this rare condition, also known as the Body Integrity Identity Disorder (BIID), opposes everything known about animal and human intuitions. People suffering from BIID normally keep their condition unknown to their family members and the community they live in, but make up stories about how they lost a limb in a grotesque accident (Gache, 2008). Although such patients are not psychotic or delusional, they do articulate a strange emotional hatred to the limb they wish amputated. Additionally, patients show a left-sided prevalence for their desired amputation (McGeoch & Ramachandran, 2007). Despite the fact that these limbs could be healthy, the patient with Apotemnophilia compulsively wants to change from the discontent state they could be in to that of an amputee (Acosta, 2011). Because of this obsession, there is a great effect on the patients’ social behavior and societal integration. These patients resemble transgendered individuals in some ways and they feel that the body part in question is just “not a part of them”, making them uncomfortable with their own bodies (Dua, 2010). Some of the patients decide on mutilating themselves while others request surgeons for the spinal cord operation or for an amputation. There are different explanations about this phenomenon by both psychologists and physicians but still there is no known successful pharmaceutical or psychotherapeutic therapy (Muller, 2009). In 1977 at Johns Hopkins University, the late sex researcher John Money and his colleagues illustrated about two individuals who desired to become amputees since the idea aroused them sexually. Consequently, Money identified their condition as Apotemnophilia, a paraphilia, or sexual deviation, in which a pair of crutches, a stump, or wheelchair is eroticized. He concluded therefore that some people obtain amputation to accomplish sexual fulfillment. Males especially homosexuals and transsexuals appear to be more affected from BIID as from most paraphilias compared with females (Muller, 2009). Causes and effects of Apotemnophilia This condition may stem from an unsatisfactory sex life or lack thereof because of an inability to perform. An Apotemnophile gets sexual gratification through cutting off limbs and the accompanying pain. According to Ian Gregson, a British author and physically disabled activist, an Apotemnophile relates the pain amputating of their limbs with previous internal pains or unfulfilled sexual desires. However, others psychologists, like John Money, claims that pain is not an objective, but just the way to become an amputee (Acosta, 2011). For a long time this disorder has been considered as being only psychological in origin. However, others propose that seeing an amputee at a young age has made this to be in some way ‘imprinted’ onto the sufferer’s psyche as the ‘ideal body image’. Strangely, there are suggestions that the basic motivator is the supposed phallic resemblance of an amputee’s stump (Bran et al, 2008). Body Integrity Identity Disorder in some cases could result from a secondary injury. For instance, the neurologist Oliver Sacks in 1974 severely injured his left thigh in an experience with a bull in the mountains of Norway. However, he felt no connection to his thigh after the wound healed and would occasionally wish the amputation of the leg. Similarly, some BIID patients remember childhood injuries involving the limb that subsequently caused them to become abruptly obsessed with amputating. In First’s 2004 survey, about one-fifth of the patients said that a disability for example a limp or broken leg offered the motivation for their amputation desire (Muller, 2009). Apart from circumcision, very few surgeons will treat Apotemnophilia patients by giving in to their desires. Therefore, there are a number of recorded cases of patients opting to self-amputation of a "superfluous" limb, for instance by allowing a train to run it. Frequently, the obsession is with one particular limb, for example the patient feeling incomplete while they still have a left leg. To many, the circumcision obsession is a form of Apotemnophilia, especially in the case of a voluntary circumcision of an adult male. Some cultures in addition, perform rituals, often voluntary, which involve removal of body parts, in many cases involving the sex organs (Depression-guide.com, 2005). Acosta (2011) adds that the main reason why most doctors do not treat such patients in order to satisfy their desires is due to unethical implications. Consequently, this desire by the patients is very strong that it prompts them to carry out their own operations to satisfy their strong desire. One example of such a scenario happened in the UK where a man with such a desire drunk excessively and laid on a railway line. After the train run on him, he did not satisfy his desire but rather experienced more pain as most of his limbs were fractured. The reason why this man chose such a dangerous path is that he became upset due to refusal by the medical community to gratify his desire. Therefore, he chose to go his own way. This illustrates how dangerous it can be, when such patients try to carry out their own operations to satisfy their desires. Another frustrated Apotemnophile, aged 79 in the UK, traveled to Mexico for a ten-thousand dollar black-market amputation, but passed on in a hotel room due to gangrene. Other patients claim that other than actual surgery, not all other methods of treatment work. For instance, one patient proclaimed that even medication, psychotherapy and psychiatry do not treat the condition. This patient further asserts that he had tried treating this condition using multiple methods but to no avail. He states that he underwent several therapies for instance cognitive-behavioral therapy, but he remained the same. This Apotemnophilia victim, who runs two of the websites for the Apotemnophilia community states that his circumstance occurred as a desire to become paraplegic. This clearly implies that this condition is very sensitive since it follows a strong desire, whose satisfaction can only occur through surgery (Gache, 2008). Once surgery or successful amputation occurs, most victims assert that they become happy with making such a decision and even feel that they become complete (Bran et al, 2008). Features of Apotemnophilia Psychiatrists, neurologists and Psychologists, present rather diverse explanations for this amputation desire. They argue whether it is a neurological conflict between the patient’s anatomy and body image, an obsessive-compulsion disorder, an identity disorder for instance transsexuality, or a neurotic disorder. Because of these conflicting explanations, there is no yet a standard description of this condition but there is much research directed on the issue (Muller, 2009). Apotemnophilia overlaps the border between psychiatry and neurology. Most victims of this condition often have a strong and precise desire for amputation of a healthy limb in a particular circumstance. This means that there is no single drive for amputation that can generally describe this condition. There is always a specific circumstance following a desire for amputation and this varies from patient to patient. Neurological studies assert that the origin of the condition occurs when “the body image centers of the brain lack a cortical representation for a particular limb.” On the other hand, psychiatry asserts that Apotemnophilia is a merely psychiatric condition. In this regard, sources deem that the condition originates from a Freudian wish-fulfillment desire -the amputation stump asserted to be like a huge penis. Other sources deem the condition as an attention getting approach although this assertion is contradictory to the fact that victims conceal the condition from others for fear of harassment (Ramachandran et al, 2009). Acosta (2011) asserts that most people confuse Apotemnophilia with Acrotomophilia, which is a parallel condition. A John’s Hopkins psychologist, John Money, distinguished Apotemnophilia from Acrotomophilia. It is evident that these two conditions share a similar suffix, philia, in their names, which refers to affection. Nonetheless, the difference is that an Acrotomophile sexually desires amputees instead of desiring to be an amputee. Shockingly, “American women suffer more from Acrotomophilia than American men.” Conversely, some cultural aspects denote a difference in this prevalence. For instance, Islamic men are more prone to Apotemnophilia than Islamic women, which indicate aspects of cultural orientation. Dialogues with some Apotemnophilia victims disclose that the condition is apparent as an inexpressible feeling that their body is someway wrong. This is similar to the transgender disorder that some individuals’ experience, and who now enjoy protection by law in some nations due to the disorder being recognized both psychologically and medically. Definitely, some people would be repelled by the notion that someone would deliberately immobilize his or hey body. However, these people should receive equal treatment like other sick people in the society (Gache, 2008). Most victims of Apotemnophilia feel that how their physical bodies are, is not how they should be internally. This feeling of incompleteness by these people starts primarily in their brain. They feel that a healthy limb in their body should not actually be there. This is because they deem that such a limb destroys their body image generated in their brains. This s the reason why this desire for amputation s very strong that the sufferer can do anything to get rid of the limb. They often express an expressive uneasiness towards the limb and deem they wish rid of it to feel complete regarding themselves. Generally, they recollect these feelings as being present since early childhood (McGeoch & Ramachandran, 2007). Several studies assert that victims of Apotemnophilia tend to be sexually attracted to other individuals with amputations. In addition, these studies also assert that these victims deem themselves as striking more sexually with their Amputations. This implies some victims of Apotemnophilia feel that they need this amputation exclusively for sexual purposes. In this regard, they deem that by performing the amputation, it would serve as an aid of sexual perversion. However, a bigger percentage of people desiring for amputation have a drive for identity and body image rather than sexual drive. The reason why sexual drive becomes a concern is that romantic orientations contribute considerably to identity (Dua, 2010). There are medical ethical issues that surround the issue of amputation of a healthy limb. There are those who believe that this amputation is necessary for purposes of body modifications and imposing a sense of easiness. On the other hand, others deem that amputations are bodily injuries, even if they would bring about easiness. They deem that amputations would bring about neuropsychological disturbances and cause body malfunctioning. This group suggests that rather than curing the symptom, there should be the development of a causal therapy to incorporate the strange limb into the body image (Muller, 2009). Dua (2010) adds that even if amputations apotemnophiles should have amputations, there is a strong ethical controversy surrounding this practice. Some people argue that seeing an apotemnophiles ask for amputation is the moral action. In this regard, there should be considerable examination of the main arguments opposed to such amputations and supporting such amputations. In addition, there should be critical analysis of these arguments with reference to various moral standards including beneficence, patient autonomy, non-maleficence and justice with reference to every individual’s right to happiness. Most people suffering from this condition recommend that the only way they can receive treatment is through implementing legally binding strategies. In this regard, they deem that these legal means would help them benefit from medically supervised amputations. Some studies indicate that there are approximately 1,500 people visiting the community of Apotemnophilia victims on a daily basis and 1,700 individuals, part of another group, assert that they are trying to oppose their inherent desire of amputating one of their limbs (Gache, 2008). Conclusion It is evident that Apotemnophilia is a very sensitive condition that needs urgent attention. Even though many doctors would argue based on medical ethics, failure to address this condition causes many harms than good. This is because the desire for amputation is very strong such that the victims would even devise their own ways of gratifying their desire. Although there are diverse descriptions of the condition by neurology, psychiatry and psychology, it is evident that many people are suffering from this condition. References Acosta, B. (2011). Apotemnophilia. Retrieved from Bran, D. et al. (2008). Apotemnophilia: A neurological disorder. Neuroreport, 19, 13, 1305-1306. Depression-guide.com. (2005). Apotemnophilia: Symptom, Cause and Treatment. Retrieved from Dua, A. (2010). Apotemnophilia: Ethical considerations of amputating a healthy limb. Journal of Medical Ethics, 36:75-78. Gache, G. (2008). Apotemnophilia, a Disorder Making People Want to Cut Their Own Limbs. Retrieved from McGeoch, P. & Ramachandran, V.S. (2007). Can vestibular caloric stimulation be used to treat Apotemnophilia? Medical Hypotheses, 69, 250-252. Muller, S. (2009). Body Integrity Identity Disorder (BIID): Is the Amputation of Healthy Limbs Ethically Justified? The American Journal of Bioethics, 9, 36-43. Ramachandran, V.S. et al. (2009). Sexual and food preference in Apotemnophilia and anorexia: Interactions between beliefs and needs regulated by two-way connections between body image and limbic structures. Perception, 38, 775-777. Read More