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A Foreign Attachment

A Foreign Attachment. BIID Megan Read Psych 1010.

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A Foreign Attachment

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  1. A Foreign Attachment BIID Megan Read Psych 1010

  2. Definition- it is a very rare and highly secretive disorder where the mental and physical body do not match. People who suffer from this have very strong feelings of a desire to amputate a major limb or severe the spinal cord in order to become paralyzed. • Wannabes simply want to become disabled. Pretenders want to simulate a physical disability • 1) Almost two thirds of study subjects said they wanted an amputation to reach their "true identity” • 2) It is similar to transgender patients because they are uncomfortable with part of their anatomy because it is not matching up with their internal sense of self and are still completely sane. Topic

  3. Since the late 1800s, physicians have written about men and women who pretend to be or would like to become disabled. In 1977 the late sex researcher John Money and his colleagues at Johns Hopkins University (Baltimore, MD) described two individuals who wanted to become amputees because they were sexually aroused by this idea. Money defined their condition as apotemnophilia, a sexual deviation, or paraphilia, in which a stump, pair of crutches, or wheelchair is eroticized. He concluded that people seek amputation to attain sexual fulfillment (Money et al. 1977). • In 1997, Richard L. Bruno, a specialist in brain-body disorders at the Englewood Hospital and Medical Center in New Jersey, published a classification of apotemnophiles: • 1) wannabes (would-be amputees) whose desire for an amputation was not primarily driven by erotic fantasies but rather by disability itself; • 2) pretenders who simulate physical disability, for example, by wrapping bandages around a limb and using a wheelchair or crutches; • 3) devotees who are sexually attracted to amputees and are thrilled by the idea of being an amputee. History

  4. In 1997, Richard L. Bruno, a specialist in brain-body disorders at the Englewood Hospital and Medical Center in New Jersey, published a classification of apotemnophiles: • 1) wannabes (would-be amputees) whose desire for an amputation was not primarily driven by erotic fantasies but rather by disability itself; • 2) pretenders who simulate physical disability, for example, by wrapping bandages around a limb and using a wheelchair or crutches; • 3) devotees who are sexually attracted to amputees and are thrilled by the idea of being an amputee. • 2004 is when the official name (Body Integrity Identity Disorder) was proclaimed. History cont.

  5. Parts of the parietal lobe might also be damaged (VilayanurRamachandran and Paul McGeoch (2007) of the University of California, San Diego) • “The BIID account can be developed in different ways depending on the type of bodily representation that is thought to be involved. On the one hand, one could conceive of BIID in terms of a mismatch between the patient’s body and their body schema.” (Bayne, T., & Levy, N. (2005) Brain Chemistry

  6. The suggestion that a neurological disturbance should be seen as the cause of a distorted embodied self-experience entails a crucial fallacy: every experience correlates with a certain neuronal activity, but this does not mean that neuronal activity causes experiences. Correlation does not necessarily imply a causal relation. (Slatman, J., & Widdershoven, G. (2009) • The neurological “explanation” is in fact no more than a hypothesis (Ramachandran and McGeoch 2007). Brain Physiology

  7. The idea that it may be better to adapt one’s neuronal body image to one’s body than to adapt one’s body to one’s neuronal body image does not take into account that manipulation of the brain is very risky and that an exact manipulation is in fact not (yet) possible. Neuroscientists who have established that transsexualism also correlates with a deviation in the brain, consider sex reassignment surgery as an adequate therapy (Cf. Swaab 2007) and do not even mention the possibility of a “causal therapy” which would influence the brain. • It is true that one’s sense of body ownership (or disownership in the case of BIID) can be explained in terms of “body image.” Brain Physiology cont.

  8. “To turn a man into a cockroach—as we don’t need Kafka to show us—would be dehumanizing. To try to turn a man into more than a man might be so as well. We need more than generalized appreciation for nature’s gifts. We need a particular regard and respect for the special gift that is our own given nature” Leon Kass (2003) • Males seem to be more likely affected from BIID as from most paraphilias than females (Braam et al. 2006, 33); especially homosexuals and transsexuals are affected (Berger et al. 2005; Dyer 2000; First 2004; Lawrence 2006; Money et al. 1977). Psychological Theories

  9. Antidepressants have little to no affect • The majority opinion permits cosmetic surgery based on the obligation to ’love your neighbor like yourself’—in my mind, it is hard to argue that therapeutic amputation is an act of ‘loving your neighbor.’ The operation also needs to be viewed from the perspective of the surgeon, who needs to be assured that he or she is not violating the traditional charge to the physician of ‘first, do no harm’.( Jotkowitz, A., & Zivotofsky, A. (2009) • Sacks (1984) helped many of his patients with movement therapy, eventually supported by music. Such therapy is thought to reintegrate the estranged body part with its representation in the brain. Such simple cures may work to reinvigorate atrophied neural connections between body and brain, but they may not be effective, if the foreign part of the body has actually been deleted from the brain’s body map. Treatments

  10. The method proposed by Ramachandran and McGeoch (2007)—rinsing an ear canal with warm and then cold water to stimulate the parietal lobe opposite the treated ear—temporarily alleviated somatoparaphrenia in stroke patients and possibly could alleviate BIID. • If the method helps such patients, physicians might try repetitive magnetic stimulation (rTMS), which can improve the tactile discrimination performance and enlarge the corresponding cortical somatosensory maps (Tegenthoff et al. 2005). • Another possibility might be the implantation of stimulation electrodes into the affected brain area. If a benign brain tumor or an arteriovascular malformation is the cause of BIID, microsurgery or radiosurgery might be efficient therapies. • The most drastic measure, amputation, has apparently helped in some cases. But there is reason for hope that scientific advances will lead to ways of correcting the underlying neurological problem, quenching the thirst for amputation before it leads to disability. (Müller, S. (2009) Treatments cont.

  11. BIID has an onset in early childhood; 80% are men. Main rationale given for their desire for body modification is to feel complete or to feel satisfied inside, sexual motives are often secondary. (Blom RM, Hennekam RC, Denys D (2012) • Prevalence rates of homosexual and bisexual orientation are high. Somatic and severe psychiatric comorbidity is unusual, but depressive symptoms and mood disorders can be present, possibly secondary to the enormous distress BIID puts upon a person. (Blom RM, Hennekam RC, Denys D (2012) Inputs

  12. Kass, L. 2003. Ageless bodies, happy souls, biotechnology and the pursuit of perfection. The New Atlantis 1: 9–28. • Jotkowitz, A., & Zivotofsky, A. (2009). Body Integrity Identity Disorder (BIID) and the Limits of Autonomy. American Journal Of Bioethics, 9(1), 55-56. doi:10.1080/15265160802588210 • Bayne, T., & Levy, N. (2005). Amputees By Choice: Body Integrity Identity Disorder and the Ethics of Amputation. Journal Of Applied Philosophy, 22(1), 75-86. doi:10.1111/j.1468-5930.2005.00293.x • Blom, R. M., Hennekam, R. C., & Denys, D. (2012). Body Integrity Identity Disorder. Plos ONE, 7(4), 1-6. doi:10.1371/journal.pone.0034702 • Craimer, A. (2009). The Relevance of Identity in Responding to BIID and the Misuse of Causal Explanation. American Journal Of Bioethics, 9(1), 53-55. doi:10.1080/15265160802626986 • Slatman, J., & Widdershoven, G. (2009). Being Whole After Amputation. American Journal Of Bioethics, 9(1), 48-49. doi:10.1080/15265160802626994 • Müller, S. (2009). Body Integrity Identity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethically Justified?. American Journal Of Bioethics, 9(1), 36-43. doi:10.1080/15265160802588194 Bibliography

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