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There is nothing these days that can ever be safely considered to be permanently beyond the pale, unthinkable, flat-out undoable—and that apparently includes cutting off healthy limbs of patients with BIID. When I first heard of body integrity identity disorder—BIID—in which sufferers have a powerful compulsion to become amputees (hence the nickname for the term, “amputee wannabe”), the idea that cutting off healthy limbs would ever be considered a legitimate treatment option seemed ridiculous. No longer. An influential psychiatrist is using the power of analogy to push us toward that very end. From the story:

“It actually sounds a lot like another condition which we already do recognize called gender identity disorder—where, for example, people are born as a male, but feel they’re really a woman trapped in a man’s body,” said Dr. Michael First, a professor of clinical psychiatry at Columbia University in New York City, who has been studying this rare condition since 1999. “Typically it’s more common legs than arms, there are people who want bilateral amputations, and I actually know of someone who has achieved that,” he added.

Achieved multiple amputations! Can you imagine describing a maiming in that positive way? First says in the story that he coined the term body integrity identity disorder with the explicit purpose of linking the condition to gender disorders—the treatment for which includes surgeries to amputate healthy breasts and genitalia. Indeed, once we opened the door to surgically removing or altering healthy body parts based on mental compulsions or desires, what made anyone think that there would ever be a stopping point?

BIID is not recognized in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV-TR), a book published by the American Psychiatric Association and regarded by most of the mental health community as the bible of identified mental illnesses. But First, as editor of the last two editions of the DSM, is working to change that, in an effort to create a reference for mental health professionals to use in identifying and treating the condition.

“Number one—for the people who have it—there’s a whole issue of labeling something as a disorder, and there are pros and cons labeling,” he said. “The disadvantage of labeling is stigma. We’re basically saying this is a mental illness—this is a sickness. But the advantage of having it in the book is twofold. It might encourage more work on treatment by getting it on the map and getting therapists and people aware of it.”

Mark my words, even though today virtually all of these unfortunate people get through life without chopping off their own limbs, we will eventually see BIID sufferers receive amputations. And once amputation is deemed to be a legitimate treatment for BIID, it will be harder for sufferers to fight against actually doing the deed. Oh, and surgeons who don’t want to participate in removing healthy body parts had better hope that conscience clauses are put into effect, since there are already proposals on the table to require their participation or referral.

But here’s the thing: Once amputations become as routine as surgical sex reassignments, we will “discover” another, even more extreme condition, that will also have to be accommodated. You see, there is no limit to how far into the macabre and harmful that terminal nonjudgmentalism has the power to take us. We are falling into a bottomless pit.

(Note: This post originally appeared at the old SHS, and has not yet been transferred here. The conversation then was very hot and heavy, and so I thought it best to import the post immediately.)

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