Wannabee amputees going to Asia for secret surgery

Michael Cook
30 April 2013
Reproduced with Permission

A feature story in the new online magazine Matter gives an exclusive account of how an American man found a surgeon in Asia who was willing to amputate his healthy leg.

"David", the pseudonymous protagonist of this strange story, suffers from what psychiatrists are starting to call Body Integrity Identity Disorder(BIID). Another name is apotemnophilia, an overpowering longing to become an amputee. This was originally thought to be a sexual fetish, but it now seems that it is not necessarily sexual.

It was psychologist Gregg Furth who coined the term apotemnophilia in 1977. He suffered from it himself and spent many years acting as a middleman between sufferers and surgeons. In 1998, a botched operation in Tijuana ended in gangrene and death for one of his clients. A Scottish surgeon did a few operations before he was forced to stop in 2000. Then he located a surgeon in Asia who did amputations for US$6,000. After Furth died in 2005, one of his amputee clients, "Patrick", became the broker.

What explains the obsession with amputation? The article offers a few explanations including the feeling that the limb is not part of one's personal identity and a neurological theory about incomplete brain development.

The ethical question, of course, is whether a surgeon, who is obliged to do no harm, may amputate a perfectly healthy limb.

The doctor in the unnamed Asian city has his doubts, but he is well-paid and his patients have all been delighted to have their limbs removed. But he has to resort to subterfuge - lying to nursing staff, falsifying paperwork, coaching patients to give a false history and so on - to carry out the operation. Matter sums up his ethical reasoning:

"Dr Lee is convinced that what he does is ethical. He has no doubt that BIID patients are suffering deeply. On the question of whether to amputate to relieve their pain, he invokes the WHO's definition of health: a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. As far as he can tell, people with BIID are not healthy, there is no non-surgical cure in sight, and no evidence that psychotherapy helps."

Actually there seems to be no evidence that it doesn't either. A 2005 survey found that 65% of 52 BIID patients had not been helped by psychotherapy - but half of those had not told the psychologist of their desires. David was not evaluated by a psychiatrist before his operation.