Philosophy 2044F/G Lecture Notes - Hippocratic Oath, Mental Disorder, Identity Disorder
13 Jun 2018
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(1) Do you believe that BIDD is a genuine mental disorder. Explain why or why not?
(2) Do you agree with amputation as a treatment for BIDD, when it is requested by the patient?
(3) How has this film affected your view of mental disorder and the people who suffer from this this
problem or disorder?
BIID (amputee wannabees):
- Epidemiology of this condition is unclear
- Early onset, prompted by seeing an amputee, this triggers an identity in the person that I would
like to be like that person, need develops and aggravated with time
- Osessio: delusio, peeptual halluiatio – imagining that part of body is not there, stable
fixed obsession, idea, delusion makes it a mental disorder
- Obsession tied with identity in a very direct and forceful manner, feel like having leg is threat to
identity, people struggling to feel whole and be fully themselves
- Not a sexual disorder, o seual eleet to this desie philia, ostly in men not women
- Waaes at this to e eogized D“M, ot hae to feeze their own leg this way,
great threat to health, medical legitimacy is very important
- Role of internet – aess is deteiats of this oditio, if ou at opae it ith othes,
may think you are freak and alone, can relate to others
- Question: do we need more research before categorizing this as a medical condition?
Film:
Whats og ith these people? What is ot odeed ad og? Ho ae the oal?
- Metal disode doest ea oplete isait
- Title: hole
- These group of people call themselves wannabes, want to self-amputate, a lot have died in
process, no medication exists for this condition
- Body integrity identity disorder (BIID)
o Peso ealized that the eoe hole afte aputatig thei o leg, knows that
its insane thing but was obsessed, has the ight id as a ake his life deisios, at
be considered insane as is a normal person
o Person feels easier to walk and act as an amputee than a person with both legs, uses a
band to tie his leg behind his hip
o Person felt this is how they should be, pretends to be an amputee
o Peso feels that thei od doest etiel elogs to the, e oal i tes of
habits like enjoys daily life activities
o Person felt leg was not necessary to him, does job daily thus normal, wanted surgeons
to amputate his leg
- Hippocratic oath: ethics code that doctors must follow, are doctors violating it if the harm their
patients by amputating them, Robert smith did this
find more resources at oneclass.com
find more resources at oneclass.com
Limb amputation and other disability desires as a medical condition by Peter Brugger
What is BIID:
- BIID (Body Integrity Identity Disorder): Some people have profound dissatisfaction with what
others would consider an able-bodied state as they have a desire to be disabled
- Desire for a major limb amputation or paralysis (xenomelia) exists
- People with these have been discovered to have functional and structural abnormalities in right
hemisphere cortical circuits of higher-order bodily representation.
o This doest ea that thee is a euologial ause ehid this
o More research required in this area to reach any conclusions
- Disability desires are also accompanied by disabling body dysphoria
- Peter Brugger suggests that disability desires should be considered a mental disorder
Features of disability desires:
- People with a disability desire describe a profound mismatch between their actual and their
desired body, with respect to its shape or functionality
- The oplai aout oeopleteess
- People suffer from having 4 limbs, because their felt identity is that of an amputee, and their
ie od doest ath thei phsial appeaae
- Desire for a specific disability is not stronger than the desire to compensate for it by use of
prosthetics,
- An onset of disability desires in childhood or early adolescence, between the ages of 5 and 15
years, is required for diagnosis
- Marked suffering
- Typically, high education status in person affected
- Most common form is the desire for limb amputation (xenomelia)
Prevalence:
- Overall prevalence is unknown but its higher in western cultures with few cases in Asian
countries
- Overwhelming majority is men that suffers this
Diagnosis and diagnostic criteria:
- Disability desires not listed in DSM 5
- Diagnostic criteria by its advocates included in appendix
- The desire to become disabled must be longstanding and intense, must produce persistent
discomfort, and attempts to reach a disabled state may result in harming oneself
- Onset of disorder must be before adulthood
- desire for major body modifications must not result from a psychotic disorder, in which self-
amputations and mutilation fantasies are occasionally observed.
- Diagnosis of acute brain damage should also be excluded, because cerebral lesions can be
accompaied a estageet fo oes o lis.
- In this context following terms are also commonly discussed:
o Misoplegia: the hatred of own body parts
o Somatoparaphrenia: the denial of ownership over functionally impaired limbs
find more resources at oneclass.com
find more resources at oneclass.com
- Such neurological syndromes are superficially linked to disability desires and none of them
captures the essence of disability desires i.e. the non-delusional fantasy, in the absence of
sensory misperceptions, that some body modification would enable the person to realize their
true identity
- All these syndromes have sudden onset
- Disability desires are a developmental disorder in the experienced unity of body and self
- Body dysmorphic disorder is sometimes confounded with disability desires. Both conditions can
share a preoccupation with a specific body part but body dysmorphic disorder is usually
oeed ith isual aspets of that pat hih ist the ase i disailit desies. Concerns in
body dysmorphic disorder concerns facial parts not limbs
- Desire for health limb amputation and gender dysphoria have close links:
o The term BIID was modelled after Gender Identity disorder (GID)
o Some similarities include early onset, predominance in male sex, and frequent
simulation of the desired state
o Elevated prevalence of non-righthandedness points to abnormalities at early
neurodevelopmental stages but relevant neural structures have not yet been identified
- Before being conceptualized as an identity disorder, desire for amputation was considered
paraphilia
- Apotemnophilia denotes sexual arousal by fantasy of being a amputee is more often than not
accompanied by Aotoophila is seual aousal othes disailities otal a aputatio
- Aptemnophiles who are lobbying for an inclusion of amputation (so that they could avail surgical
treatements) desies i D“M ague that the dot hae a paapili oigi, laied that its a
broad-based identity disorder and not narrowly sexually determined, so disability desires were
released from the too-narrow focus on sexuality
- However, sexual aspect is involved in disability desires and forms an important part of
bodily/corporeal identity: recent surveys prove that those who reported specific sexual desires
when imagining a disabled state were as high as 90.7%
- Therefore, due to the inseparability of sexuality and identity, the author concludes that the
proposed diagnostic criteria for disability desires should not exclude a sexual motivation
Xenomelia vs Transableism:
- Xenomelia states disability desires result from developmental brain damage
- Transableism is a sociological construct that tries to demedicalize disability desires by viewing
the as a health pesos hallege to the stiga of disailit that is eated soial os
- Both these terms try to avoid allusion to either paraphilia or the concept of identity
- Xeoelia: eo eaig foeig ad elos eaig li eas estageet fo oes
own limbs
o It was introduced to counter previous terms like BIID and apotemnophelia
o Its authors suggested that disability desires represent a neurological disorder specifically
a focal syndrome of the right parietal lobe
o Several clinical observations support the concept of a neurological origin of disability
desires concerning limbs
o Findings state that the type of disability being desired is commonly circumscribed and
developmentally stable + left sided limbs are far more frequently targeted by an
amputation desire than right sided limbs, being in line with the leading role of the right
cerebral hemisphere in representation of bodily self and its disorders → doest
invalidate the neurological hypothesis
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
(1) do you believe that bidd is a genuine mental disorder. Obsession tied with identity in a very direct and forceful manner, feel like having leg is threat to identity, people struggling to feel whole and be fully themselves. Not a sexual disorder, (cid:374)o se(cid:454)ual ele(cid:373)e(cid:374)t to this desi(cid:396)e (cid:894)(cid:858)philia(cid:859)(cid:895), (cid:373)ostly in men not women. Wa(cid:374)(cid:374)a(cid:271)es (cid:449)a(cid:374)t this to (cid:271)e (cid:396)e(cid:272)og(cid:374)ized (cid:271)(cid:455) d m, (cid:449)o(cid:374)(cid:859)t ha(cid:448)e to f(cid:396)eeze their own leg this way, great threat to health, medical legitimacy is very important. Role of internet a(cid:272)(cid:272)ess is dete(cid:396)(cid:373)i(cid:374)a(cid:374)ts of this (cid:272)o(cid:374)ditio(cid:374), if (cid:455)ou (cid:272)a(cid:374)(cid:859)t (cid:272)o(cid:373)pa(cid:396)e it (cid:449)ith othe(cid:396)s, may think you are freak and alone, can relate to others. These group of people call themselves wannabes, want to self-amputate, a lot have died in process, no medication exists for this condition. Hippocratic oath: ethics code that doctors must follow, are doctors violating it if the harm their patients by amputating them, robert smith did this.
