Abstract
Body integrity identity disorder (BIID), formerly also known as apotemnophilia, is characterized by a desire for amputation of a healthy limb and is claimed to straddle or to even blur the boundary between psychiatry and neurology. The neurological line of approach, however, is a recent one, and is accompanied or preceded by psychodynamical, behavioural, philosophical, and psychiatric approaches and hypotheses. Next to its confusing history in which the disorder itself has no fixed identity and could not be classified under a specific discipline, its sexual component has been an issue of unclarity and controversy, and its assessment a criterion for distinguishing BIID from apotemnophilia, a paraphilia. Scholars referring to the lived body—a phenomenon primarily discussed in the phenomenological tradition in philosophy—seem willing to exclude the sexual component as inessential, whereas other authors notice important similarities with gender identity disorder or transsexualism, and thus precisely focus attention on the sexual component. This contribution outlines the history of BIID highlighting the vicissitudes of its sexual component, and questions the justification for distinguishing BIID from apotemnophilia and thus for omitting the sexual component as essential. Second, we explain a hardly discussed concept from Maurice Merleau-Ponty’s Phenomenology of Perception (1945a), the sexual schema, and investigate how the sexual schema could function in interaction with the body image in an interpretation of BIID which starts from the lived body while giving the sexual component its due.
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Notes
A distinction is made on the basis of a traditional paraphilia classification in pairs, in which one term is reciprocal to the other (e.g. sadism and masochism). In this case, the pair consists of autoapotemnophilia (self-directed) and alloapotemnophilia (other-directed) (cf. Money et al. 1977, p. 124).
In the same year, a second publication by Wakefield et al. (1977) appears that describes another case.
In 1977, apotemnophilia and acrotomophilia were not clearly distinguished by Money. Both fell under the name of apotemnophilia, although the latter had two faces: self-directed or other-directed (see also note 1).
Earlier surveys exist. The earliest survey was made in 1976, by Ampix, a company selling stories and photographs of amputees. A second one was made in 1996 (see Lawrence 2006 for details). These surveys, however, recruited acrotomophiles rather than apotemnophiles, although in the second survey, of 50 devotees, 22% agreed that they would like to be an amputee (cf. Lawrence 2006, p. 264).
For an account of how experiences of in- and overcompleteness may issue from the normative dimension of an unusal body-model, (cf. De Preester et al. 2009).
The percentages in First (2004) Table 1 p. 922: ‘Reasons provided (in open-ended narrative) for wanting amputation’ and in Table 3, p. 924: ‘Co-occurence of restoring identity and sexual arousal as motivations for desire for amputation’ differ with n = 1 for ‘Restoring true identity as an amputee’ (with −1 for primary reason and +1 for secondary reason), but this does not considerably influence the percentages. Based on the percentages of Table 6 (this article), the two percentages together even are as high as 77%.
Body image is distinct from body schema. For a clarification, cf. note 11.
Homosexual male-to-female transsexualism includes persons who were overtly feminine as children and very feminine as adults and who are exclusively attracted to men. Non-homosexual male-to-female transsexualism includes persons who do not show these characteristics, and who may be sexually attracted to women, to women and men, or to neither sex (cf. Lawrence 2006 p. 265).
According to Kant, in the Critique of Pure Reason ([1781/1787] 1998), experience and knowledge are a result of subsuming the givens of intuition under the categories of the understanding. Without intuition, the understanding remains empty, but without the concepts of the understanding, intuition remains blind. Sexual and erotic perception is, according to Merleau-Ponty, blind in the latter sense. This blindness implies that sexual and erotic preferences cannot be objectified.
Merleau-Ponty tries to elucidate the operation of the sexual schema by comparing it to the body schema. It is important to notice that body image and body schema differ in important respects. “The conceptual distinction between body image and body schema is related to the difference between having a perception of (or belief about) something and having a capacity to move (or an ability to do something). We can characterize the body image as involving perceptions, mental representations, beliefs, and attitudes where the intentional object of such perceptions, beliefs, etc. (that which they are directed towards or that which they are about) is one’s own body. The body schema, in contrast, involves certain motor capacities, abilities, and habits that enable movement and the maintenance of posture. It continues to operate, and in many cases operates best, when the intentional object of perception is something other than one’s own body.” (Gallagher and Meltzoff 1996, p. 215).
The English version of Phénoménologie de la Perception translates ‘schéma corporel’ as ‘body image’, whereas the characteristics of the sexual schema resemble better those of the body schema than those of the body image. Moreover, and in spite of the Merleau-Ponty’s lack of differentiation between body image and body schema, Merleau-Ponty explicitly refers to the context of movement and thus to the body schema when discussing the sexual schema (cf. Phénoménologie de la Perception, Paris: Gallimard, 1945a, p. 196).
References
Bayne, T., and N. Levy. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy 22(1): 75–86.
Becerra, R. 2004. “Atmosphere”, a precursor of “cognitive schemas”: Tracing tacit phenomenological influences on cognitive behaviour therapy. Indo-Pacific Journal of Phenomenology 4(1): 1–13.
Bensler, J.M., and D.S. Paauw. 2003. Apotemnophilia masquerading as medical morbidity. Cse report. Southern Medical Association 96(7): 674–676.
Blanke, O., F.D. Morgenthaler, P. Brugger, and L.S. Overney. 2009. Preliminary evidence for a fronto-parietal dysfunction in able-bodied participant with a desired for limb amputation. Journal of Neuropsychology 3: 181–200.
Brang, D., P.D. McGeoch, and V.S. Ramachandran. 2008. Apotemnophilia: A neurological disorder. Neuroreport: Cognitive Neuroscience and Neuropsychology 19(13): 1305–1306.
De Preester, H., and M. Tsakiris. 2009. Body-extension versus body- incorporation: Is there a need for a body-model? Phenomenology and the Cognitive Sciences 8(3): 307–319.
Donix, M., and T. Reuster. 2007. ‘Apotemnophilie. Zur diagnostischen Klassifikation zwischen Paraphilie und Körper-Integritäts-Identitätsstörung’. Nervenheilkund 6: 477–479.
Dyer, C. 2000. Surgeon amputated healthy legs. British Medical Journal 320: 332.
Everaerd, W. 1983. A case of ampotemnophilia: A handicap as sexual preference. American Journal of Psychotherapy 37(2): 285–293.
First, M.B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine 35: 919–928.
Freund, K., and R. Blanchard. 1993. Erotic target location error in male gender dysphorics, paedophiles, and fetishists. British Journal of Psychiatry 162: 558–563.
Furth, G.M., and R. Smith. 2000. Amputee identity disorder: Information, questions, answers, and recommendations about self-demand amputation. Bloomington, IN: 1st Books.
Gallagher, S., and J. Cole. 1995. Body schema and body image in a differenced subject. Journal of Mind and Behaviour 16: 369–390.
Gallagher, S., and A.N. Meltzoff. 1996. The earliest sense of self and others: Merleau-Ponty and recent developmental studies. Philosophical Psychology 9(2): 211–233.
Hilti, L.M., and P. Brugger. 2010. Incarnation and animation: Physical versus representational deficits of body integrity. Experimental Brain Research 204: 315–326.
Johnston, J., and C. Elliott. 2002. Healthy limb amputation: Ethical and legal aspects. Clinical Medicine 2(5): 431–435.
Kant, Immanuel. [1781/1787] 1998. Critique of Pure Reason (The Cambridge Edition of the Works of Immanuel Kant in Translation). Cambridge: Cambridge University Press.
Kasten, E. 2009. Body integrity identity disorder (BIID): Befragung von Betroffenen und Erklärungsansätze. Fortschritte der Neurologie Psychiatrie 77(1): 16–24.
Lawrence, A.A. 2006. Clinical and theoretical parallels between desire for limb amputation and gender identity disorder. Archives of Sexual Behavior 35(3): 263–278.
Lowenstein, L.F. 2002. Fetishes and their associated behavior. Sexuality and Disability 20(2): 135–147.
McGeoch, P.D., Brang, D.J., and Ramachandran, V.S. 2009. A new right parietal syndrome? In Body integrity disorder: psychological, neurobiological, ethical and legal aspects, eds. Stirn, A., Thiel, A., Oddo, S, 225–237. Lengerich: PABST Science Publishers.
Merleau-Ponty, M. 1945a. Phénoménologie de la Perception. Paris: Gallimard.
Merleau-Ponty, M. [1945b] 2002. Phenomenology of perception (Trans: Smith, C). London/New York: Routledge.
Money, J., R. Jobaris, and G. Furth. 1977. Apotemnophilia: Two cases of self-demand amputation as a paraphilia. The Journal of Sex Research 13(2): 115–125.
Money, J. 1984. Paraphilias–phenomenology and classification. American Journal of Psychotherapy 38(2): 164–179.
Money, J., and K.W. Simcoe. 1986. Acrotomophilia, sex and disability: New concepts and case report. Sexuality and Disability 7(1/2): 43–50.
Patrone, D. 2011. Disfigured anatomies and imperfect analogies: Body integrity identity disorder and the supposed right to self-demanded amputation of healthy body parts. Journal of Medical Ethics 35: 541–545.
Person, E.S. 1980. Sexuality as the mainstay of identity: Psychoanalytic perspectives. Signs 5(4): 605–630.
Rossetti, Y., G. Rode, and A. Farnè. 2005. Implicit body representations in action. In Body image and body schema, ed. H. De Preester, and V. Knockaert, 111–125. Amsterdam/Philadelphia: John Benjamins.
Rubin, H.S. 1998. Phenomenology as method in trans studies. GLQ: A Journal of Lesbian and Gay Studies 4(2): 263–281.
Schwoebel, J., and H.B. Coslett. 2005. Evidence for multiple, distinct representations of the human body. Journal of Cognitive Neuroscience 17(4): 543–553.
Slatman, J., and G. Widdershoven. 2009. Being whole after amputation. The American Journal of Bioethics Neuroscience 9(1): 48–49.
Slatman, J., and G. Widdershoven. 2010. Hand transplants and bodily integrity. Body and Society 16(3): 69–92.
Sorene, E.D., C. Heras-Palou, and F.D. Burke. 2006. Self-amputation of a healthy hand: A case of body integrity identity disorder. Journal of Hand Surgery (British and European Volume) 31B(6): 593–595.
Stoller, R.J. 1974. The Samuel Novey lecture–does sexual perversion exist? Johns Hopkins Medical Journal 1: 43–57.
Wakefield, P.L., A. Frank, and R.W. Meyers. 1977. The hobbyist–euphemism for self-mutilation and fetishism. Bulletin of the Menninger Clinic 41(6): 539–552.
Wise, T.N., and R.C. Kalyanam. 2000. Amputee fetishism and genital mutilation: Case report and literature review. Journal of Sex and Marital Therapy 2000: 339–344.
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This research was supported by a research grant of University College Ghent.
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De Preester, H. Merleau-Ponty’s sexual schema and the sexual component of body integrity identity disorder . Med Health Care and Philos 16, 171–184 (2013). https://doi.org/10.1007/s11019-011-9367-3
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DOI: https://doi.org/10.1007/s11019-011-9367-3