[Blog/Commentary] [New Zealand] Psychiatric Politics: Look Who's lob

Posted by: "Stephanie Stevens" stephaniekaystevens@gmail.com

Thu Dec 4, 2008 9:47 pm (PST)

Joanne Proctor, New Zealand

Wednesday, December 3, 2008

Psychiatric Politics: Look Who's lobbying Who down at the APA?

Apotemnophilia or Body Integrity Identity Disorder (BIID)

In its most extreme form Apotemnophilia is characterized by
individuals who experience a strong desire for the removal of healthy
limbs. There is also a lesser form of the disorder. With the secondary
variety apotemnophiliacs present as 'pretend' amputees, often going to
considerable lengths to conceal limbs in attempt to appear as if the
appendages had been removed. In BIID jargon the latter group are known
as 'wannabes.'

Apotemnophiliacs use the term 'Amputee Identity Disorder' (AID) to
describe their fixations. The usage intentionally parallels the GID
diagnosis in an apparent attempt to derive legitimacy by association.
For example BIID discourse associates the desire for limb removal with
male to female genital reconstruction, which is interpreted by BIID
proponents as amputation of healthy tissue. (below)

But apotemnophilia can extend way past limb removal. Sometimes spinal
damage is requested because the BIID patient identifies as a
paraplegic. Castration may be demanded when a male targets his
testicles as superfluous. Female apotemnophiliacs may request the
removal of one or both breasts for the same reason.

To equate the disorder with GID, (Gender Identity Disorder)
apotemnophiliacs have constructed a comparative rationalization that
parodies transgenderism, and associates BIID with primary or true
(HBS) transsexualism. Their arguments do not recognize the
pseudo-scientific nature of transgenderism, or that many, if not most,
primary transsexuals regard it as irrelevant to their own experience.
As if to complete the parody, parallels are drawn between
transsexualism (which they see as a form of BIID) and transvestism (as
alike to wannabes)

This is a cut from an Apotemnophilia website
<http://biid-info.org/Amputee_identity_disorder_and_related_paraphilias>
. (Note the use of 'AID' or identity disorder, terminology.)

"AID appears to develop in the early years, usually between the ages
of 5 and 15. Most sufferers have a well-formed impression of their
desired body image by the time they reach their teens."

And just a little further down:

"Other groups of patients who may seek amputation include those with
factitious disorder (Munchausen's syndrome) and body dysmorphic
disorder (BDD). Those with BDD perceive the limb as being defective in
some way, in contrast to patients with AID who see the limb as being
normal but extra to their perceived body image. It seems that AID
patients are similar to those transsexuals who amputate their
genitalia in order to achieve their desired body image."

The BIID parody has its champions. Self professed autogynephilic, Anne
Lawrence, writes
<http://www.annelawrence.com/publications/amputation-GID.pdf> :

"Body Integrity Identity Disorder (BIID), has sometimes been regarded
as a paraphilia (apotemnophilia). BIID appears similar in some ways to
gender dysphoria or transsexualism, which is termed Gender Identity
Disorder (GID) in the DSM-IV. Persons with BIID and GID both
experience a profound sense of wrong embodiment and seek surgical
assistance to modify their bodies".sic

Both Lawrence and Ray Blanchard take an interest in BIID, which places
them in some fascinating company. An example is Dr Russel Reid. In
2007 Reid, an expatriate New Zealand psychiatrist, was forced to stop
treating so-called Gender Identity Disorders at his London practice
following a string of misdiagnoses'.

This is one of several examples reported by England's Guardian
newspaper <http://www.guardian.co.uk/uk/2007/may/25/health.society> .

Patient D, who suffers from manic depression, told the GMC [General
Medical Council] that Dr Reid failed to recognize that she had manic
depression when he treated her.

She became wrongly convinced she needed a sex change after watching a
TV documentary. The GMC heard that she eventually became so ill that
she thought she needed a sex change in order to fulfill her delusion
that she was Jesus.

The patient told the inquiry that she only avoided surgery to remove
both her breasts - recommended by Dr Reid - because she was found
wandering the streets naked and was sectioned.[Legally Committed].

Once in a psychiatric hospital, she was correctly diagnosed with manic
depression and, after treatment, said she had no desire to change sex.
Dr Reid's treatment of her was found to be inappropriate, not in her
best interests and contrary to international medical guidance.

Reid was involved in a BIID controversy in 2000, when he recommended
two patients for non-essential amputations. Britain's 'Sunday
Telegraph' <http://www.guardian.co.uk/uk/2007/may/25/health.society>
quotes Reid as saying,

"I see transsexuals and they want healthy parts of their body removed
in order to adjust to their idealized body image and so I think that
was the connection for me. I saw that people wanted to have their
limbs off with equally as much degree of obsession and need."

Clearly Reid has as much difficulty as Lawrence, Blanchard and the
BIID community, in understanding that male to female genital
reconstruction actually involves the fashioning of one living,
functional, highly sensitive and sexually responsive organ, from the
tissue of another. Like them, he conveniently omits female to males
from the equation. Genetic and neurobiological variation is never
mentioned. The life-long commitment to hormones, to maintain the
secondary sex characteristics is ignored. Like the others he sees only
those few aspects of anatomical sex normalization that support his
beliefs. He has been a regular contributor to BIID events, along with
Blanchard and Lawrence, since going into semi-retirement.

Apotemnophilia was not included in the DSM-iv. But with BIID
disordered individuals actively lobbying to be in the next version
(alongside the other 'identity' disorders) it is probably a safe bet
for inclusion this time round.

Its anyones guess what new mental disorders will be invented, or old
ones resurrected by Messrs Blanchard and Zucker to explain the classic
HBS dissonance between brain and body. But given their obsessive
search for new ways to deny the mounting pile of scientific evidence
in favor of a biological explanation, and considering the politics
involved with DSM inclusion and terminology, primary (HBS)
transsexuals have good reason to feel nervous.

Apotemnophiliacs are assured of a more sympathetic ear. The new DSM is
due for publication in either 2011 or 2012, and APA/DSM politics could
easily see primary (HBS) transsexuals misrepresented as an offshoot of
BIID.8 Much as they have been misrepresented as a gender role
transgressive behavioral disorder in past versions.

A PDF copy of this document is freely available on request.

Contact HBS-NZ <http://www.harrybenjaminsyndrome-nz.co.nz/>

Labels: Amputee Identity Disorder, Ray Blanchard; DSM RE-Write

posted by Joanne Proctor @ 6:44 PM

http://joanneproctor-hbs.blogspot.com/2008/12/psychiatric-politics-look-whos-lobbying.html