BIID: "Chain saws, shotguns, and railroad tracks..."

“If we are all unique creature of God, as Christians affirm, normality becomes a meaningless concept.”
-- Ted Harrison 1948-- : In “Sunday Times 31 January 1999

As noted before, my posts on BIID (Body Integrity Identity Disorder) have been a source of constant interest since the inception of this blog, and I’ve promised to say more on this issue. One of the readings I’ve assigned my Argumentative Writing class this semester provided the impetus to do just that. Sally Satel’s 2006 New York Times op-ed piece, “Death’s Waiting List,” takes up the organ transplant issue, and in doing so begs the following question: Given that it is legal and widely acceptable to sell blood, sperm, and eggs, is there any significant difference between selling such things and selling a kidney? Between selling a kidney and renting a womb? Satel argues that, as unsavory as it seems, a market solution is a viable answer to the lack of available organs.

How does this relate to BIID? Consider the final quote Satel cites from the International forum for Transplant Ethics: “The well-known shortage of kidneys for transplantation causes much suffering and death. If we are to deny treatment to the suffering and dying, we need better reasons than our own feelings of disgust.”

Now recall an earlier post where Sean, a wannabe from down under wrote the following comment:

“I am someone who has BIID. I need to be paralyzed. I have been feeling like this for over 35 of my 40 years. It is not something I have control of. It is not something sexual (though it is for some people).One thing to correct is in the very opening statement, saying that BIID is only for people who need an amputation. That is inaccurate. Recent research is confirming that the condition may also manifest itself in people needing to be paralyzed, or blind, or deaf, etc.”
Key here is the term “Disgust.” Typically, the idea that someone might see their arms or legs, for example, as alien appendages is unthinkable. That they might long to have this foreign body part amputated almost invariably produces a sense of disgust or revulsion in most of the able-bodied public.

Even after learning of this seemingly bizarre phenomenon, most of us assume it to be a rare disorder shared by few, something relegated to the realm of shock-oriented talk shows and sensationalistic tabloids. Given that the medical literature is equally scant -- most psychiatrists and psychologists are ill-informed on this condition – one might think BIID a freak occurrence, something considered a deviance or perversion.

In a piece published in “Bioethics: An Anthology,” ‘Amputees by Choice’ (Kuhse and Singer 2006), Carl Elliott writes: “On the internet, however, it is an entirely different story. Acrotomophiles are known on the Web as ‘wannabes.’ ‘Pretenders’ are people who are not disabled but use crutches, wheelchairs, or braces, often in public, in order to feel disabled [See blog, ‘About BIID’ 9/9/08]. Various Web sites sell photographs and videos of amputees, display stories and memoirs, recommend books and movies, and provide chat rooms, meeting points, and electronic bulletin boards. Much of this material caters to devotees, who seem to be in far greater number than wannabes. It is unclear just how many people out there actually want to become amputees, but there exist numerous wannabe and devotee list-servs and Web sites”(626).

Now circle back to Satel’s point that “disgust” alone should not preclude organ sales as a valid answer to a critical public health issue. While I don’t know there are BIID sufferers (if that’s the right word) who feel that their very organs serve to make them feel incomplete, if there were, might they not achieve a feeling of satisfaction by donating, or selling, a kidney, adrenal gland, or a part of their liver, as way of feeling whole, while at the same time saving the life of someone else. More to Sean’s point, if a BIID wannabe sought to be blind, deaf, or paralyzed, might they not donate their eyes, or provide a cochlear transplant, or donate their sexual organs below the point of paralysis to a needy recipient? Even crazier, assuming that graft-host disease and immuno-rejection issues can be overcome, why shouldn’t wannabes be considered as hand, foot, arm, and leg donors?

The objection to allowing this hinges on the ethical question of whether or not BIID is a psychiatric or neuropsychological disorder. Given that those, like myself, sympathetic to the wannabes plight, accept the rhetoric of autonomy, identity, and selfhood, framing this debate, Elliott’s conclusion that BIID “has less to do with desire than with being stuck in the wrong body,” makes sense. The analogy I draw here is that of sexual orientation. We no longer think that homosexuality is a psychiatric disorder, but we do see it as having to do with neuropsychological factors stemming from the hard-wiring of the brain.
This is why the idea that sexual orientation is a choice is absurd. Who would choose to be discriminated against and shunned by mainstream society? One doesn’t choose to over-ride the brain in favor of the mind. Much of the problem stems from long standing false dichotomy associated with the brain/mind dyad. Upholding this distinction has resulted in the wrongheaded conclusion that the manipulation of one’s mental life can alter the nature of what, in fact, the brain dictates.

The same can be said of most body modification impulses. These desires are anchored in being comfortable with one’s identity, rather that psychiatric explanations that attribute such behaviors to causes like narcissism or unresolved psychological complexes. This from Wikipedia: “Neurologists have focussed objectively on organic nervous system pathology, especially of the brain, whereas psychiatrists have laid claim to illnesses of the mind. This antipodal distinction between brain and mind as two different entities has characterized many of the differences between the two specialties. However, it is argued that this division is simply not veridical; a plethora of evidence from the last century of research has shown that our mental life has its roots in the brain.”

I leave you with this from Elliott: “There is a simple, relentless logic to these people’s request for amputation….They realize that life as an amputee will not be easy. They understand the problems they will have with mobility, with work, with their social lives; they realize they will have to make countless adjustments just to get through the day. They are willing to pay their own way. Their bodies belong to them, they tell me. The choice should be theirs. What is worse: to live without a leg or to live with an obsession that controls your life? For at least some of them the choice is clear – which is why they are talking about chain saws and shotguns and railroad tracks”(632).

Best – Randy Tessier