By Randy Dotinga
HealthScout
http://www.freep.com
6-7-1a
At any given moment, a small number of Americans are searching for a surgeon willing to cut off their perfectly healthy limbs.
These men and women suffer from apotemnophilia, one of the most bizarre disorders in the annals of psychology, and they want to undergo amputations in order to "feel whole."
"You have this foreign body and you want to get rid of it," said one man who found a doctor in Scotland willing to remove his right leg.
But should such surgery even be allowed?
"It just flies in the face of everything that medicine holds dear," said Stacy Running, a San Diego assistant district attorney who successfully brought murder charges against an unlicensed surgeon who botched a leg amputation on an 80-year-old man with the disease three years ago and let the man die of gangrene.
Added Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics, "It seems indisputably ga-ga nuts to sit and reasonably talk back and forth about whether this should be done and where we are going to do it."
Though some recent high-profile cases have captured the media's attention, apotemnophilia is not a new disorder.
Medical experts have reported cases of amputation obsession since the 1860s, said Richard Bruno, a New Jersey psychophysiologist who specializes in brain-body disorders and is one of the few people in the world who have extensively studied apotemnophilia.
No one knows how many people are obsessed with amputation. However, there are Web sites devoted to the subject. One is named after the Venus de Milo statue.
Bruno has identified three groups within the larger community of people obsessed with amputation:
"Pretenders" use wheelchairs, crutches and other devices to make people think they are disabled.
"Devotees" are sexually attracted to people with amputations and disabled people, and will often search for them on the Internet.
"Wannabes," who get the most attention, live for the removal of their healthy limbs.
Usually, people with the disorder are men and they want one leg or both cut off, Bruno said. However, there are also female sufferers. They include Corinne, a California woman who refused to give her real name. She wants her legs removed.
"For me, sexuality is being comfortable with my body," she said. "Inside, I feel my legs don't belong to me and shouldn't be there. There's just an overwhelming sense of despair sometimes.
The cause of apotemnophilia isn't clear. John Money, a psychologist and sexuality expert at Johns Hopkins University in Baltimore, gave the disorder its name in 1977 and declared that people with the disorder have a sexual fetish centered on amputated limbs.
Apotemnophilia has also been linked to obsessive-compulsive disorder and homosexuality.
Some people with apotemnophilia say their obsession has nothing to do with sex; they say it's a body-image disorder that can be cured only through amputation.
Taking a different tack, Bruno suggests that people with the disorder desperately seek attention and love from others.
"What these people really want is to be accepted," he said. "They feel they are unlovable and want to be loved."
Speculation dismissed
But many people obsessed with amputation heatedly dismiss Bruno's theory.
Gregg Furth, a New York City child psychologist who suffers from apotemnophilia, said the disorder revolves around feeling like a complete person.
"It's about becoming whole, not becoming disabled," he said, adding that people with the obsession "feel there's an alien aspect of their body."
Furth told a San Diego courtroom in 1999 that he first began obsessing about amputation when he was 4 or 5 years old. He's now in his mid-50s
His search for a cure -- amputation -- ultimately led him to John Ronald Brown, an underground doctor in San Diego. The 77-year-old Brown lacked a license to practice medicine.
Furth and an 80-year-old friend, Philip Bondy, who also had apotemnophilia, traveled from New York to San Diego in 1998, both hoping to have Brown perform their amputations in Tijuana, Mexico. But Furth backed out.
Bondy went ahead and had his left leg removed. Brown left him to recover in a Holiday Inn across the border in a San Diego suburb, where he died a few days later of gangrene.
A jury convicted Brown of second-degree murder
Further resurfaced in the news last year when he found a doctor in Scotland who was willing to amputate his right leg. The doctor had previously amputated the limbs of two other people with apotemnophilia.
But the Scottish news media picked up on the plan, and the hospital where the operation was to take place quickly banned it.
Caplan, one of the top medical ethicists in the United States, said apotemnophilia is clearly a medical disorder, and can't be cured by giving in to the disease.
"It's like saying I'm a schizophrenic and I hear voices, so I want the doctors to communicate with my demons to exorcise them," he said.
Bruno said people with apotemnophilia often live hellish lives.
"I feel terrible for them," Bruno said. "There are just far more questions than answers about the disorder, and unfortunately, many of these questions may be unanswerable. We may never know why these guys want what they want."
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