Cutting the Drama Out of Body Integrity Identity Disorder

A recent issue I've been preoccupied with is the issue of BIID, which is also often referred to as apotemnophilia. It is an interesting and perplexing issue, I'd say, and before I proceed I probably have to ask for you to keep an open mind; to many of us, the idea of amputating a perfectly healthy limb is disturbing and beyond the normal sphere of things, but what I'd like to say as a follow-up to this is that I was a non-believer, and now - at least with regard to amputation for sufferers of BIID - I have been converted.

BIID is an extremely rare condition where the sufferer expresses a desire to amputate a perfectly healthy limb. Most sufferers demonstrate feelings of mismatch between themselves and that particular limb; basically that they feel that that particular limb feels like it doesn't belong to them. Now, the common conception of people with BIID is that they must be bonkers, nutters, completely raving mad. The thing is, academics and psychiatrists often state that most of the time, the only thing that seems unusual about these people is the fact that they want a healthy limb removed. In fact, most of them are in functional long-term relationships, have careers and may even have children. Christopher Ryan, a prominent psychiatrist at Westmead Hospital in Sydney states in his 2009 article: '... the BIID sufferers' unusual beliefs about their limbs are typically the only unusual things about them. .... Though the beliefs of sufferers of BIID are very unusual, there is nothing obviously crazy about BIID. .... People with BIID are probably best described as preoccupied with their unusual belief.' [Christopher James Ryan, 'Out on a Limb: The Ethical Management of Body Integrity Identity Disorder' (2009) 2 Neuroethics 21 at 24]

The thing about BIID is that amputation seems to be the only cure for this disorder. Sufferers have been subjected to SSRI (Selective Serotonin Reuptake Inhibitor) treatments, cognitive behavioural treatment sessions, etcetera, but have only really been cured of their preoccupation after they actually remove that particular limb they've been preoccupied about amputating. On top of that, sufferers of BIID report actually having happier, more fulfilling lives post-amputation.

There are countless controversial issues relating to BIID, among which are: illegality, religious objections, the medical paean of primum non nocere (first, do no harm), harm minimisation, etcetera. The thing is, people with BIID often get so affected by their belief that this limb does not belong to the rest of their bodies that they sometimes end up damaging that particular limb pretty badly just so that a surgeon has to remove it. Some sufferers resort to sort-of 'backyard' amputations, resulting in gangrenous infections and subsequent death for gangrenous infections. It is a really interesting topic with a million ethical questions, that's for sure.

What about the Malaysian reaction? Well, undoubtedly there will be vehement religious objections. Self-harm is considered a sin in at least two of the major religions in Malaysia, but this leads to another important question. Would it be averting (or minimising, at least) harm to allow the amputations of the healthy limbs in that it would lead to sufferers of BIID no longer having to be preoccupied about it (No. 1) and No. 2, the avoidance of backyard amputations? Thing is, I'm not really sure of the prevalence of BIID in Malaysia at all. I'm not saying that there isn't any, because BIID sufferers often find it difficult to come forth and admit that they have these issues. It would certainly be interesting to find out from a few Malaysian psychiatrists as to any data on BIID sufferers in Malaysia. Controversial topic, certainly. But for academic reasons, instead of being repulsed by BIID, it would be really interesting if we could have some discussions on the ethics of amputation as a cure for BIID.