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Interesting article at Slate about people who want to have amputations, some of whom are turned on by amputees.

I find paraphilias interesting, but this one particularly so because it's also mixed with issues relating to, for example, transsexuality: specifically, the notion of feeling that your physical body doesn't match your true self, that you would be more yourself if your body were different.

The article's author definitely has an axe to grind—my impression is that he considers apotemnophilia to be a mental illness that should be treated in some way other than actual amputation. And I do agree with him that someone who wants to have a healthy limb amputated should be encouraged to explore other options first. But on the other hand, it seems to me that this falls to a large degree under the freedom to do what you like with your own body. If we as a society let people get piercings, tattoos, and brandings, why should we draw the line at letting them remove limbs?

Yeah, okay, there may be a societal cost: is the person going to be able to work afterward? (In most cases, I assume the answer is yes.) Is part of the financial cost of the surgery going to have to be shouldered by insurance companies or the state? (I have no idea.) But I doubt that those would be most people's primary objections.

But I admit it's a more complex issue than I'm making it sound here. Interesting stuff.


I think a large issue is:

Who are you going to get to do the surgery?

As a physician (and an n=1, single data point), I'd be very uncomfortable recommending that someone, for instance, amputate a perfectly healthy big toe.

It doesn't need to come off.

That operation would affect your balance.

There are risks (there are always risks) of infection-- and later complications, things like needing special orthoses so that you don't get footsores.

First, we're supposed to do no harm. (Now, admittedly, plastic surgeons doing cosmetic operations can and will stretch the point, IMO...)

So who would you get to DO an operation like this, if a physician won't? Would it end up being a 'chop shop', or a situation like the 60's, where people were performing abortions on themselves with coathangers??

Too many ethical issues, at least for me.

The article mentions a surgeon in Scotland named Robert Smith who has done several of these amputations. I agree with Stella that this seems ethically problematic. The article makes the point that very little research has been done on this disorder, so that there isn't any basis to make the claim, as Smith does, that amputation is the only effective treatment.

Note that most people with this disorder who have managed to have amputations, it appears, have either done them themselves or damaged themselves sufficiently that a real surgeon would have to amputate.

A broader question that the article raises briefly is the issue of trends in mental disorders -- it seems as though this particular disorder has "taken off" recently, while others were "popular" in previous eras and have died out now. Interesting....

Apparently there are also folks who are into trepanation -- boring a hole in one's skull. Yikes!

Would you rather I didn’t let the demons out?

Well, DM, wouldn't that depend on where the demons go and what happens next?

Trepanation has always fascinated me—I first encountered it in a great article in a newsgroup (I think) back in college; iIrc, it was about Huges and Mellen (mentioned in the Straight Dope piece that Jacob pointed to above).

As for ethical problems with amputation: I can more or less see y'all's point, but to take a devil's advocate position for a moment, what about SRS (sex-reassignment surgery)? Surgical procedures to remove completely healthy body parts, done at the request of a patient who feels that their body doesn't match their identity. It seems to me that most of the issues Stella mentions would apply equally well to SRS, yet (I think—I could be wrong) SRS is considered a valid and reasonable medical procedure these days. (Though it's usually only done after a person has lived as someone of the other sex for at least a year.)

So is there an ethical difference between SRS and amputation? What if the amputation were something smaller, like a finger?

There are studies that show that people who are serious about sex reassignment do better (in terms of various quality-of-life statistics) if they have surgery than if they don't. Quality of life seems to be significantly diminished from average if they don't have surgery -- people are less likely to go out of the house, to have friends, to be sexual, etc.

Certainly there aren't formal studies like this for the amputation seekers. And it isn't clear from the article that their quality of life is diminished by not having surgery -- they have an intense desire to have an amputation, but how does it affect their lives? What other treatments have been tried?

I think it could be ethical if the research showed clear problems without surgery, no other adequate solution, and clear improvement with surgery.

Well, it's more a matter of opinion. Like transexuality that was stated it's becoming more accepted for a person to have a gender change. A person who wants cosmetic surgery that certainly isn't needed let us say a nose job or having a little lipsuction to make yourself look better isn't needed either but doctors do it all the time. Along those lines it's just society's opinion that one would make you look better and the other wouldn't.

Also, if you want to take the matter of doctors doing no harm then you'd have to consider that doctors also do circumsions that aren't needed or asked for in most cases and abortion as well.

If a person wants to have something removed then I don't think it should be thought of as no better or worse than any other person who has an unneeded surgery.

Apparently there was an article in the Village Voice recently about apotemnophilia, which is leading to people doing web searches for the term, which is leading them to this journal entry because it's currently the fourth search result on Google.

I have no interest in turning this entry's comments section into a referendum on the topic, and especially no interest in turning it into a place for people to post rants about how awful it is to want to have a body part removed. I know very little about the topic, and I'm not ready to pathologize things that people choose to do to their own bodies without more information.

So I'm going to close comments for this entry. Sorry. If you have something calm and rational you want me to add to the comments section here, drop me a note in email and I'll consider posting it. If you say anything nasty, or call anyone names, or otherwise rant, I'll just ignore your email.

Note: This isn't because of Brittany's comments, which I thought were fairly interesting; it's because of another comment that was a fair tad bit rantier, which I'm not going to post.