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Thread: Doctor, I am perfectly healthy. Cut my leg off and make me happy.

  1. #1
    Politics.ie Member Mr. Bumble's Avatar
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    Default Doctor, I am perfectly healthy. Cut my leg off and make me happy.

    On another thread I got involved in an interesting discussion (thanks Nakatomi, Bill, Des Squirrel et al) regarding the similarities and differences between Gender Identification Disorder (GID) which is essentially transexualism, and Body Image Integrity Disorder (BIID).

    BIID is a rare mental illness that has no classification in DSM IV (TR) or ICD-10 so there is no standardised diagnostic criteria, yet it is an accepted and recognised mental illness. Little research has been done on the condition but this paper PLOS ONE: Body Integrity Identity Disorder is an excellent attempt to describe and understand the condition. They propose that BIID exists where people "feel their body-image does not match with their body shape. When we use the term “BIID” or “BIID feelings” here we mean to indicate all these different forms of the condition. For example, some people would like to have their leg to be amputated under their knee, whereas others prefer to resemble someone who is paralysed.”

    Further reading:
    1. A philophical discussion on the ethics of amputation for BIID patients: http://users.ox.ac.uk/~sfop0174/biid.pdf
    2. An online resource for people with BIID: Body Integrity Identity Disorder


    Essentially, the person feels that they would be much happier paralysed or as an amputee. While in some cases there is a sexual arousal element to this desire to be paralysed/an amputee, the primary motivation is to feel complete or ‘satisfied inside’. BIID patients have higher levels of anxiety and depression, and functioning is inhibited by obsessive thinking about amputation/paralysis. Medication and therapy can help to ameliorate the symptoms of depression and anxiety but they do not provide long term relief. However, amputation seems to provide long term remission from BIID and significant improvement in quality of life. Essentially, patients are significantly happier.

    Some people with BIID will deliberately damage their limb by crushing it under a car or immersing it in dry ice for hours thus necessitating amputation. Some patients have tried using homemade guillotines. In 2000 a Scottish surgeon removed healthy limbs from two people who had BIID. No such elective surgery has been perfomed in Britain since.

    Some questions:

    • Is it moral and ethical to amputate a healthy limb?
    • What of medicine’s prime directive Primum Non Nocere (“first, do no harm”)?
    • How do you weigh the pain of surgery and permanent disfigurement and disability against persistent psychological distress?
    • Is it better to offer surgery rather than force people to try to amputate a limb themselves?
    Cry your hardest now, it opens the lungs, washes the countenance, exercises the eyes and softens down the temper. So cry away.

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    Moderator NYCKY's Avatar
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    I remember reading about the Scottish surgerys some years ago. Thankfully this is a rare disorder.

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    Politics.ie Member ruserious's Avatar
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    Best to get them to a shrink asap. This is a psycological issue clearly, and cutting off legs and arms to satisfy that need is not solving the problems as it will just inspire more people to do likewise.
    If a person gets over their BIID through psycho-treatment, then I'm sure they would be happier than they would if they had their arms taken off whilst suffering the condition.
    Boycott the "Irish" Sun rag.

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    Quote Originally Posted by Mr. Bumble View Post
    On another thread I got involved in an interesting discussion (thanks Nakatomi, Bill, Des Squirrel et al) regarding the similarities and differences between Gender Identification Disorder (GID) which is essentially transexualism, and Body Image Integrity Disorder (BIID).

    BIID is a rare mental illness that has no classification in DSM IV (TR) or ICD-10 so there is no standardised diagnostic criteria, yet it is an accepted and recognised mental illness. Little research has been done on the condition but this paper PLOS ONE: Body Integrity Identity Disorder is an excellent attempt to describe and understand the condition. They propose that BIID exists where people "feel their body-image does not match with their body shape. When we use the term “BIID” or “BIID feelings” here we mean to indicate all these different forms of the condition. For example, some people would like to have their leg to be amputated under their knee, whereas others prefer to resemble someone who is paralysed.”

    Further reading:
    1. A philophical discussion on the ethics of amputation for BIID patients: http://users.ox.ac.uk/~sfop0174/biid.pdf
    2. An online resource for people with BIID: Body Integrity Identity Disorder


    Essentially, the person feels that they would be much happier paralysed or as an amputee. While in some cases there is a sexual arousal element to this desire to be paralysed/an amputee, the primary motivation is to feel complete or ‘satisfied inside’. BIID patients have higher levels of anxiety and depression, and functioning is inhibited by obsessive thinking about amputation/paralysis. Medication and therapy can help to ameliorate the symptoms of depression and anxiety but they do not provide long term relief. However, amputation seems to provide long term remission from BIID and significant improvement in quality of life. Essentially, patients are significantly happier.

    Some people with BIID will deliberately damage their limb by crushing it under a car or immersing it in dry ice for hours thus necessitating amputation. Some patients have tried using homemade guillotines. In 2000 a Scottish surgeon removed healthy limbs from two people who had BIID. No such elective surgery has been perfomed in Britain since.

    Some questions:

    • Is it moral and ethical to amputate a healthy limb?
    • What of medicine’s prime directive Primum Non Nocere (“first, do no harm”)?
    • How do you weigh the pain of surgery and permanent disfigurement and disability against persistent psychological distress?
    • Is it better to offer surgery rather than force people to try to amputate a limb themselves?
    I don't think you can offer surgery to prevent people performing their own amputations. It seems too much like blackmail, as though the threat of autoamputation is being held over you. Moreover, we allow elective surgery for cosmetic reasons, why not for psychological ones? Without involving the broader discussion of GID, people have serious procedures every day to improve their quality of life, not their health (if you narrow the definition of health to life expectancy). Provided a complete psychiatric assessment and a complete psychological assessment, I see no reason why this procedure shouldn't be allowed.

    With regards to primum non nocere, I think that belongs to an older age. A large proportion of treatments these days have the potential for great harm. Besides which, I always viewed it as quite paternalistic. Given a more patient centred approach, the duty is shifted to giving the patient all the information, and allowing them to make an informed decision. As long as they have capacity, I don't see a problem with that approach.

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    Quote Originally Posted by Mr. Bumble View Post
    On another thread I got involved in an interesting discussion (thanks Nakatomi, Bill, Des Squirrel et al) regarding the similarities and differences between Gender Identification Disorder (GID) which is essentially transexualism, and Body Image Integrity Disorder (BIID).

    BIID is a rare mental illness that has no classification in DSM IV (TR) or ICD-10 so there is no standardised diagnostic criteria, yet it is an accepted and recognised mental illness. Little research has been done on the condition but this paper PLOS ONE: Body Integrity Identity Disorder is an excellent attempt to describe and understand the condition. They propose that BIID exists where people "feel their body-image does not match with their body shape. When we use the term “BIID” or “BIID feelings” here we mean to indicate all these different forms of the condition. For example, some people would like to have their leg to be amputated under their knee, whereas others prefer to resemble someone who is paralysed.”

    Further reading:
    1. A philophical discussion on the ethics of amputation for BIID patients: http://users.ox.ac.uk/~sfop0174/biid.pdf
    2. An online resource for people with BIID: Body Integrity Identity Disorder


    Essentially, the person feels that they would be much happier paralysed or as an amputee. While in some cases there is a sexual arousal element to this desire to be paralysed/an amputee, the primary motivation is to feel complete or ‘satisfied inside’. BIID patients have higher levels of anxiety and depression, and functioning is inhibited by obsessive thinking about amputation/paralysis. Medication and therapy can help to ameliorate the symptoms of depression and anxiety but they do not provide long term relief. However, amputation seems to provide long term remission from BIID and significant improvement in quality of life. Essentially, patients are significantly happier.

    Some people with BIID will deliberately damage their limb by crushing it under a car or immersing it in dry ice for hours thus necessitating amputation. Some patients have tried using homemade guillotines. In 2000 a Scottish surgeon removed healthy limbs from two people who had BIID. No such elective surgery has been perfomed in Britain since.

    Some questions:

    • Is it moral and ethical to amputate a healthy limb?
    • What of medicine’s prime directive Primum Non Nocere (“first, do no harm”)?
    • How do you weigh the pain of surgery and permanent disfigurement and disability against persistent psychological distress?
    • Is it better to offer surgery rather than force people to try to amputate a limb themselves?
    If it makes them happy sure why not?



    She's smiling isn't she?

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  6. #6
    Politics.ie Member Mr. Bumble's Avatar
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    Quote Originally Posted by ruserious View Post
    Best to get them to a shrink asap. This is a psycological issue clearly, and cutting off legs and arms to satisfy that need is not solving the problems as it will just inspire more people to do likewise.
    If a person gets over their BIID through psycho-treatment, then I'm sure they would be happier than they would if they had their arms taken off whilst suffering the condition.
    Psychotherapy is largely ineffective as a treatment.
    Cry your hardest now, it opens the lungs, washes the countenance, exercises the eyes and softens down the temper. So cry away.

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    Quote Originally Posted by Mr. Bumble View Post
    Psychotherapy is largely ineffective as a treatment.
    Not exactly my field, but there are people doing good work with cognitive behavioural therapy. I'm told it gets good results, particularly for anxiety disorders. Not aware of the evidence myself though.

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    Politics.ie Member Mr. Bumble's Avatar
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    Quote Originally Posted by Icemancometh View Post
    Not exactly my field, but there are people doing good work with cognitive behavioural therapy. I'm told it gets good results, particularly for anxiety disorders. Not aware of the evidence myself though.
    Yes, you're right, CBT is very helpful for anxiety disorders, but I don't think that BIID would be classified as an anxiety disorder. The literature and research, such as it is, is clear that therapy has limited impact.
    Cry your hardest now, it opens the lungs, washes the countenance, exercises the eyes and softens down the temper. So cry away.

  9. #9
    Dylan2010
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    Wont these people need more nursing care in their old age, if they pay it fine but the taxpayer should not be responsible. They should probably pay for the operation to boot

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    Politics.ie Member Victor Meldrew's Avatar
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    Why is there a thread on this?

    Seriously...?

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