The taboo subject of elective (also called self-demand 2) amputation came to attention in the UK in the late 1990s when the media reported that Robert Smith, a consultant surgeon at Falkirk hospital near Stirling, had, at patients’ request, carried out amputations of healthy limbs. The idea that an apparently sane person might request the removal of one or more healthy limbs is generally received with unease. When first writing about the issue I wondered if self-demand amputation could be read within a paradigm of mutilation and self-harm. However, I was frustrated in this attempt by the self-demand narratives I encountered. Unexpectedly, the desire for amputation was framed as an “identity disorder”, thus referring to the language and arguments of the trans (gender) debate. On the one hand, framing the phenomenon in this way provides a recognised template through which surgery can be obtained. However, on the other hand the condition itself, as well as the way it has been framed, presents a conceptual knot. How can “normal” limbs be extraneous to the body? Are lived body boundaries different to anatomical boundaries? Can surgery produce identity? Furthermore, is disability an identity?
The elective amputation of a healthy limb is an extreme form of body modification that questions one’s assumptions and beliefs about bodies, “disability” and the limits of medicine. The idea that someone might elect to alter their body to “disable it”, and for medicine to be complicit in this is difficult to grasp, and the difficulty in understanding the phenomenon is compounded by limited information and the shame that people feel about their need for this procedure. The patients seen by Smith had travelled as far as America and Germany, and it was reported that if they did not have access to surgery, there was a risk that their despair would cause them to seek backstreet amputations or intentional accidents that might lead to amputation. Originally these patients were diagnosed in terms of existing conditions such as Munchausen’s syndrome and Body Dysmorphic Disorder (BDD), or in terms of a paraphilia such as apotemnophilia (amputation love) and ameliotasis (attraction to the absence of a limb). These terms have been rejected and this is reflected in the book written on the subject by Robert Smith and one of his clients Gregg Furth. When the book came out in 2000 it was entitled Apotemnophilia, however, the 2002 edition is entitled Amputee Identity Disorder. Other terms have also been used to describe the condition include the rhyming informal description prevalent on the internet “amputee wannabe”.
http://www.geocities.com/legcaliper/5identity.htm
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