Upon reading Carl Elliott's article "A New Way To Be Mad," I was struck, as I'm sure many others were, with a combination of fascination and repulsion. Being faced with a phenomenon that seemed so far outside my perception of what's "normal," I didn't really know what to make of it. The thought of anyone feeling they needed to chop off a perfectly healthy limb to be the person they felt they were sounded kind of ridiculous and almost selfish--after all, there are many "non-voluntary" amputees out there who I'm sure would give anything to have their arm or leg back. I still can't say I have a comprehensive grasp and stance on the issue, and in many ways I'm torn as to what I think the best method of "treatment" would be and how to move forward once we know enough about the condition to make any decisions about it. But for me the article raised some questions about how apotemnophilia should be handled both medically and socially.

My initial reaction to the mere existence of something like apotemnophilia--it seeming weird and unnatural--began to change as soon as soon as Elliott introduced the idea that it parallels transsexualism. Since John Money's study of apotemnophilia in 1977, it has been classified as a paraphilia, defined by Elliott as a psychosexual disorder or perversion. To whatever extent this has shaped what little knowledge the public has about this condition, the term "perversion" certainly carries heavy connotations, ones which I personally think should cause us hesitation in applying such a label to anyone. That aside, for me the comparison to transsexualism has had an effect on how I view apotemnophilia and what should reasonably considered for its treatment.

Once presented with this comparison, I couldn't think of any way apotemnophilia differs from transsexualism significantly enough for them to be regarded and treated differently both socially and medically. Both are cases of people who feel their physical bodies don't match their image of themselves. Transsexuals feel trapped in a body of the wrong gender, and apotemnophiliacs feel their bodies are somehow incomplete with all four of their limbs, that a specific arm or leg, though attached, is not a part of them. Both struggle with the feeling that they will not truly be themselves until they have their bodies physically altered. And those who obtain surgery, in both groups, seem significantly happier with their lives afterward.

This is where my struggle with treatment and insurance begins. Elliott doesn't take a strong position one way or the other in supporting what seem to be either of the two main options at this point: covering surgical procedures with insurance for apotemnophiliacs, or psychiatric treatment. He does express his hesitance towards surgery as a cure, though. Initially this was my feeling as well; giving surgery to these people wouldn't really be solving the problem, psychiatry is more likely to get to the root of it and hopefully eliminate the desire altogether. Avoiding possibly unnecessary amputations seemed like the best solution to me. However, when I make the comparison, I can't in any good conscience consider applying the same idea to transsexuals. The thought of trying to "cure" a transsexual through therapy and drugs is, to me, insulting and immoral. Insulting because it means denying or ignoring the legitimacy of another person's ability to know who they are, and immoral because it means dictating, based on a certain perspective, what an acceptable identity is. To me this seems an inevitably harmful attempt to make people something they are not.

I definitely think that at this point, there simply hasn't been enough research done on apotemnophilia to make a determination about what the standard medical procedure should involve if it's diagnosed. The part I struggle with is that while the doctors and scientists take their time figuring this out, there are people out there who are in pain every day because of this condition, and have nowhere to turn for support besides each other. However, I think one of the first steps we need to take is to make sure that as public knowledge of apotemnophilia grows, we don't immediately assign it a stigma, at least keeping the terminology neutral. If it must be labeled, label it a condition or identity rather than a disorder or perversion. We need to acknowledge that there is still a lot to be learned about apotemnophilia, and that we are doing our best to grapple with the complexities of this issue.