Some of you may or may not know about something called Body Integrity Identity Disorder, formally known as Amputee Identity Disorder. It’s supposed to be this thing where people feel they were meant to live as an amputee and that they are not complete unless they have some part of them surgically amputated.
According to Dr. Michael B. First, who is helping write the DSM-V, BIIS is not simply about amputation. “It involves any wish to significantly alter body integrity. Some people suffer from the desire to become paralyzed, blind, deaf, use orthopaedic appliances such as leg-braces, etc” But, I’ll focus on amputation since it seems to be most common.
Here’s where I think it gets...complicated. Many have drawn parallels between BIIS and what is known as Gender Identity Disorder because they are both about a problem of identity and wanting to be in a different body.
In case you don’t know, Gender Identity Disorder is still listed in the DSM describing people who experience significant gender dysphoria — “a man trapped in a woman’s body” or vice versa. Transgender individuals who are seeking hormone replacement therapy or sex reassignment surgery are diagnosed with GID. The listing of GID in the DSM is controversial for a lot of reasons, including the fact that there is evidence from studies of transsexual (I say transsexual because I’m talking about those who want hormone therapy and/or surgery) people’s brains along with the fact that it’s called a disorder in the first place. Nonetheless, disorder or not, the concept seems to be the same: a problem of identity and wanting to be in a different body.
This disturbs me. I don’t know about you, but I think wanting a limb removed is pretty fucked up and having it compared to the so-called “GID” freaks me out. If we humor this idea for a bit, there seem to be two possible implications: (1) transsexuals are “as fucked up as BIIS individuals” or (2) BIIS is not well-understood and individuals suffering from it need more support. And because the first implication is dangerous and frightening...well, you can see where BIIS support comes from.
But is this a valid comparison? Some are outraged and think BIIS could mean trouble for the transgender community.
Critics say that supporters of BIIS fail to see that transgenderism is more than wanting to be in a different body and that many, in fact, say its irrelevant to their experiences. They say apotemnophiliacs are using language that is congruent with the concept of GID to validate their illness.
There seems to be some inconsistencies as to what exactly BIIS is. There is a paraphilia called apotemnophilia. Paraphilias are regarded as abnormal sexual behaviors, fantasies and/or urges. Apotemnophilia is a sexual desire for amputation. It seems to happen often in conjunction with BIIS and many websites use the terms interchangeably. Other websites delineate the distinction between the two and contend that they are NOT the same, that people with BIIS are not always apotemnophiliacs. And more parallels are drawn — between transvestitism and amputee-wannabes.
So it’s hard to know exactly what the hell is going on. Furthermore, critics say that BIIS supporters fail to see the differences between sex reassignment surgery and voluntary amputation. SRS involves “fashioning of one living, functional, highly sensitive and sexually responsive organ, from the tissue of another. Genital reconstruction giveth: it does not taketh away.” They also say BIIS supporters often neglect to mention female to male surgeries. Moreover, critics say supporters don’t mention the genetic and neurobiological differences — for example, the life-long commitment to taking hormones. There is outrage because some supporters even regard GID as falling under the umbrella of BIIS.
Neurologically speaking, there is evidence that BIIS results from a failing of the right parietal lobe in the brain, which helps control the brain’s inner body mapping function. “According to this theory, the brain mapping does not incorporate the affected limb in its understanding of the body’s physical form.” This also makes sense because somatoparaphrenia (believing a certain limb does not belong to oneself) is a common result from biparietal or parietal strokes (strokes of that part of the brain) and somatoparaphrenia is linked to BIIS. So, some believe BIIS may be a congenital form of somatoparaphrenia, which can be treated by, basically, squirting cold water in the patients right ear. Also some say studying phantom limb phenomena would help understand how to treat BIIS.
HOWEVER, there is also evidence to suggest “GID” is also medical in nature. Regardless of sexual orientation, men have twice as many somatostatin neurons (found in some limbic nucleus). It was found that MTFs have female numbers of said neuron and FTMs have male numbers of it in their brains. So, there you have it.
Regardless of its possible neurological bases, GID is treated by changing physical appearance and not changing psychological makeup or implementing neurological treatments. Currently, no medical professionals in the U.S. will perform amputations for people with BIIS. This is sad, because many will go to extreme lengths to damage their limbs to the point where they require amputation and some even self-amputate. But the idea of medically amputating the unwanted limb of a person with BIIS is highly controversial and many instead advocate psychological treatment. And in cases where amputation is attained, BIIS sufferers seem to be much happier. This phenomenon dates far back. In France in 1785, there was a man who held a physician to gunpoint asking him to amputate his leg. The doctor did so and later received a thank you letter from the man, who said he’d been made “the happiest of all men.”
Dr. Ray Blanchard, however, is skeptical of the neurobiology of BIIS. He says that if it were truly biological in nature, there would be other symptoms, like difficulty using the leg and signs of neglect. He doesn’t think society will be able to accept BIIS and can’t see the medical community accepting it or performing the surgeries for it. Medicine would see it as administering a disability, which is another way it’s different from GID — gender is not a disability.
These things are important to think about. After all, homosexuality was at one point regarded as a mental illness, not anymore. And Gender Identity Disorder seems to possibly be on its way out of the DSM. What's defined as a mental illness or disorder has strong societal implications. Sadism and masochism are listed in the DSM as paraphiliic disorders. Yet, it’s controversial because both can be practiced by consenting adults under safe conditions. There are some pretty hard to define lines going on there.
Now think about this: we often talk about all kinds of identity equalities but seem to leave out ability as a way to identify. Some people have issues with the term handicapped. In Deaf culture, being Deaf is not seen as a disability and is in fact, celebrated and sometimes even thought of as "better" than being hearing. PfP: remember gender theory, queer theory? If we can deconstruct race, gender, and sex, why not ability?
It all seems so ridiculous at first, but people can, will, and are using logic to win their arguments. And we DO have to think about these things because people commonly think in terms of slippery slopes and domino effects when they think about things. Example: the notion that allowing same-sex couples to marry will make people want to marry more than one person. And more related to the issue at hand: some conservatives in the medical community feel the normalization of SRS was the “start of a slippery slope.”
And so...
Maybe, BIIS is just really misunderstood and not such a weird thing...but I don’t know. It still freaks me out. And I don’t know what to make of its comparison to transgender individuals. Is it a dangerous comparison to make? Should they even be compared — is it a valid comparison or not? And if it’s valid...what does that mean?
Sources:
Wikipedia
http://www.biid.org/meetings.php?lan=en
http://jcem.endojournals.org/cgi/reprint/85/5/2034
http://www.newsweek.com/2008/05/28/cutting-desire.html
http://ts-si.org/guest-columns/3643-psychiatric-politics-body-integrity-identity-disorder-biid
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