Cutting Desire

Neurologists at the Center for Brain and Cognition at the University of California, San Diego, who have studied phantom limb syndrome (in which accidental amputees still feel pain in their lost limb), stroke victims, and GID have recently turned their attention to BIID. They've only been able to conduct three brain scans on those with BIID, so far, but in those, they have found some variation in the right parietal lobe, the area of the brain responsible for creating a "map" or the image of where one's body exists in space. "What's suggested from this is that because of this dysfunction in the right parietal lobe, this sense of unified body image isn't formed," says McGeoch. "The senses don't coalesce. So, for a leg, for example, they can feel that it's there but it doesn't feel like it should be there. It feels surplus. Something's gone wrong." 

But some doctors are reluctant to chalk up the disorder to a hard-wired trait. Dr. Ray Blanchard, a professor at the University of Toronto and a member of the DSM work group (which decides which disorders are included in the manual), says that if amputee-identification really stemmed from the brain, there would be other symptoms beyond just the desire to amputate—it would be difficult to use the leg, for example, or there would be signs of neglect.

Blanchard thinks it's unlikely that surgery will ever be an option. "I can't see society in general accepting it," he says. "And I can't see medicine accepting it. Medicine is going to see it as conferring a disability on a patient. In that sense it's different from sex-reassignment surgery. Being a man or woman is not a disability." Still, Blanchard admits that some of the first patients with gender identity disorder faced some of the same obstacles. "There were some psychiatrists who saw [sex-reassignment surgery] as colluding with a patient's mental disorder. Instead of curing the patient of a delusion, you were validating it. But once again, all that had to be overcome there was that the patients really were happier as the opposite sex."

Some conservative voices in the medical community feel that the normalization of sex-change surgeries was the start of a slippery slope. "You keep pushing the envelope of impaired people who aren't in touch with reality in some fashion, who develop ideas about their normalcy," says Dr. Mark Schiller, a psychiatrist and past president of the Association of American Physicians and Surgeons. "Essentially from just claiming that something's the case, people just accept somebody's distorted version of reality and then we get surgeons and others responding to the point of mangling normal bodies."

Of course those who say they suffer from BIID may define normality differently. For now, sufferers are focused on getting official recognition in the DSM, which could open the door for more research funding. While not everyone agrees, an anonymous user called "TS" on transabled.org seemed to sum up a common view: "I don't see mental illness as being a bad thing for BIID to be labeled as, at least for now. ... Even if current BIID sufferers don't reap the rewards of their efforts to get it known, at least they may know they have given BIID people of the future a better chance of a mentally satisfactory life. Living a lie is the worst human punishment."

© 2008