Phantom Limbs and Body Integrity Identity Disorder

Literary and Psychoanalytic Reflections

Monika Loewy

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781000753547
• Edition: 1
• Topic: Literature
• Subtopic: Literary Criticism
• Index: Literature

Phantom Limbs and Body Integrity Identity Disorder discusses the conditions of Phantom Limb Syndrome and Body Integrity Identity Disorder together for the first time, exploring examples from literature, film, and psychoanalysis to re-ground theories of the body in material experience.

The book outlines the ways in which PLS and BIID involve a feeling of rupture underlined by a desire for wholeness, using the metaphor of the mirror-box (a therapeutic device that alleviates phantom limb pain) to examine how fiction is fundamentally linked to our physical and psychical realities. Using diverse examples from theoretical and fictional works, including thinkers such as Sigmund Freud, Jacques Lacan, Maurice Blanchot, D.W. Winnicott, and Georges Perec, and films by Powell and Pressburger and Quentin Tarantino, each chapter offers a detailed exploration of the mind/body relationship and experiences of fragmentation, bodily ownership, and symbolic reconstitution. By tracing these concepts, the monograph demonstrates ways in which fiction can enable us to understand the psychosomatic conditions of PLS and BIID more thoroughly, while providing new ways of reading psychoanalysis, literary theory, and fictional works.

The first book to analyse BIID in relation to PLS, Phantom Limbs and Body Integrity Identity Disorder will be essential reading for academics and literary readers interested in the body, psychoanalysis, English literature, literary theory, film, and disability.

PART I

Why psychoanalysis and literature?

1

INTRODUCTION

La suppression radicale d’un membre, ne présentant plus au cerveau que des images […] de bras et de jambes, de membres lointains et pas à leur place. Une espèce de rupture intérieure.

The radical suppression of a limb, presenting the brain with no more than images […] of distant and dislocated limbs. A sort of internal severance.

Artaud, Anthology (1965, 29)

Antonin Artaud’s fragmented description of dislocated limbs reflects the focus of this book, which involves experiences of physical, mental, imaginary, and linguistic fracture in relation to illusory limbs. It is the purpose of this book to examine two physical phenomena alongside literary, fictional, and psychoanalytic works, to re-ground theories of the body in lived, material experience. In so doing, it ultimately raises questions concerning how we are constituted through signs, how this affects our sense of wholeness, and how fiction is fundamentally linked to our physical and psychical realities. Body Integrity Identity Disorder (BIID) is a condition in which individuals desire to amputate a limb because they feel that it does not belong to their body: they feel “incomplete” with four healthy limbs. Phantom limbs occur when amputated individuals feel the sensation that their absent limbs still exist. Thus, BIID and the Phantom Limb Syndrome (PLS) are the inverse of one another. Individuals with both conditions desire to remove an extraneous limb (in BIID an existing limb, and in PLS a phantom) and reflect a similar problem with a feeling of incompleteness and a dissonance between the mind and body. However, while in BIID, the concept of completion concerns a sense of being in bodily excess, a fantasy of destruction, and appears to begin in the mind, PLS involves a fantasy that fills an absence, originates in the body, and can, in certain cases, be healed through a mirror illusion. V.S. Ramachandran invented the mirror treatment in 1996 through what he called the mirror-box (also known as mirror therapy), a box with a mirror in the centre into which amputees place their whole limb on one side, and the stump on the other. When they move the existent limb and look at its reflection, it appears as though there are two limbs, and that their phantom is moving. Consequently, the often uncomfortable or painful phantom sensations can disappear. Thus, a re-imagined version of the self transforms a disturbing experience of rupture, a concept that is also central to certain psychoanalytic, fictional, and literary works. These types of texts, therefore, can provide insight into BIID, PLS, and the mirror-box phenomena, which this book sets out to accomplish. It examines, in other words, how BIID and PLS are representative of a fractured sense of self, and how a certain type of reflection may have a healing effect.

Since BIID and PLS have only been studied through a medical model that fails to find definitive answers or cures, I argue that a theoretical analysis is necessary. Through the use of psychoanalytic, literary, and fictional texts that foreground bodily fragmentation, this book explores various ways of thinking about the fracture and drives towards wholeness experienced by those with BIID and PLS. Specifically, it attends to how a form of possession (the need to control one’s sense of being complete) can be mediated by a particular kind of exchange. Since, moreover, mirror therapy takes place through a process of reflection, the mirror-box acts as a metaphor for the structure of this book, which is a linguistic reflection upon BIID and the phantom limb syndromes.

Psychoanalysis provides a starting point for this exploration because, in the words of Marilia Aisenstein,

if psychoanalysis is unique, and irreplaceable, in relation to other forms of psychological treatment, it is so, in my view, because it opens up thought processes and enables the subject to reintegrate into the chain of psychic events even something unthinkable, such as the appearance of a lethal illness.

(Aisenstein 2006, 679)

Psychoanalysis, therefore, offers new ways of thinking about BIID and PLS, two phenomena that are to a great extent, incomprehensible. This work draws relationships between psychoanalysis and the two bodily conditions, which focus on the fractured psyche and soma. By attending to the body, this exploration will illuminate what is involved in the disorders, while also providing nuanced ways of reading psychoanalytic theories. Naomi Segal states of Didier Anzieu that, “[s]ince Lacan, the stress on language had meant that the body was not being psychoanalytically theorised; yet ‘every psychic activity leans on [s’étaie sur] a biological function.’ Anzieu’s aim is to fill this gap” (Anzieu 2009, 44). This thought provides a helpful backdrop for my exploration here, because I am interested in corporeality. However, not unlike Anzieu, I do not only investigate the body, I also foreground the importance of language and the way in which it mediates between the mind and body. In reading the two bodily conditions through a psychoanalytic and literary lens, I address the importance of linking literature, the body and the mind. As Peter Brooks writes:

There ought to be a correspondence between literary and psychic dynamics, since we constitute ourselves in part through our fictions within the […] symbolic order, that of signs, including, pre-eminently, language itself. Through study of the work accomplished by fictions we may be able to reconnect literary criticism to human concern.

(Brooks 1992, xiv)

Studying literature and the psyche together can help elucidate the ways in which we are constituted through fictions, and BIID and PLS both concern fictive versions of the self that involve an imagined sense of unity. Moreover, the mirror-box demonstrates how visualising oneself as a sign (the mirror illusion is a sign of one’s phantom limb) can have bodily effects. Mirror therapy acts as a material and metaphorical example of the way in which we are formed through signs, of the way the body is understood and constituted as a language and through language. In drawing these connections between psychoanalysis, literature and the body, this work explores how the fictions through which we are formed can alleviate experiences of fragmentation. To provide a foundation for these analyses, a survey of relevant literature follows.

Body Integrity Identity Disorder

BIID, also known as xenomelia and apotemnophilia, is a condition wherein individuals desire to amputate an existing limb because they feel that it does not belong to their body. Paradoxically, then, the present limb makes these individuals feel incomplete, while the idea of its removal enables a sense of completeness. “The main motivation for the preferred body modification”, explains Rianne Blom, “is believed to be a mismatch between actual and perceived body schema” (2012, 1),¹ a disjunction between physical structure and identity. Those with the syndrome complain of feeling that with four limbs they are not themselves and become obsessed with the desire for the removal of a limb. Some who are unable to amputate have a strong urge to commit suicide. Though there are no known cures, some individuals explain that they have found most relief when they are able to amputate the limb. However, many are driven to continue to amputate parts of their body after they have followed through with the original amputation.

According to a survey conducted in 2003 by Dan Cooper (“Fighting It”), who initiated the Internet Yahoo! Group “Fighting It”, 36% of those with BIID believe it is a neurological problem, while 63% believe it has psychological origins, 44% with the syndrome are straight males, 28% gay males, 13% straight females, 4% gay females, and 8% transgendered. However, Cooper also writes in an email that “[t]hese are informal polls. There is no control over who chooses to participate. Nevertheless, these are probably the best data available” (“Fighting It”). Other studies demonstrate that although the most common request is an above-the-knee amputation of the left leg, BIID may also involve other parts of the body or a desire to remove certain senses (hearing, sight, and so on). The syndrome, moreover, usually originates in childhood, and is often associated with a memory of seeing an amputee for the first time. Amy White explains that in one of the first studies conducted on BIID, Michael First “found that 65% of patients experienced onset of BIID before age eight and 98% of patients before age 16. Some subsequent studies have reported that most individuals with BIID experience early onset” (2014, 231). Since BIID involves the fantasy of losing a limb, it is often confused with (though may still be linked to) acrotomophilia, a sexual attraction to other amputees (as some with BIID are attracted to amputees). In order to self-cure, some sufferers² (referred to as “pretenders” in the BIID community) may feign a disability by using devices such as wheelchairs, prostheses or leg braces. The term “wannabes”, on the other hand, refers to those who self-injure, self-amputate, or pursue black-market surgery. Some simply want to be disabled, some desire the challenge of living in a disabled body, and others wonder if a physical disability will reduce a felt psychical one. This raises the question as to what a disability means. As one sufferer (Nelson) explains, when he pretended to be an amputee, he “never felt disabled” (2010, 86). Another individual states that he

crafted and used the term “transabled” to describe someone who has BIID […]. Transabled means to me that I am in a transitional position, between a body that is not what I need it to be, and hopefully reaching that body at some point soon.

(Schmidt 2010, 89)

According to Ferguson (2012), disability studies should “reshape the way that society understands people with disabilities” (72). The field “looks at disability, through politics, the arts, ethics, history, and more recently, phenomenology and personal experiences” (Ferguson 2012, 71).³ Although it is a wide field that involves the humanities and is largely analytical, it was founded as a predominantly social movement aimed at reducing stigma, calling for changes in healthcare, and bringing visibility to those with disabilities. My study of BIID and the phantom limb is also analytical. However, rather than focusing on a social movement, I embark upon a more detailed discussion that is specifically concerned with issues of fragmentation, wholeness and imperfect bodies.

Though “BIID” was not coined until 2004 by Michael First, and was renamed xenomelia by Paul McGeoch in 2011, documented cases date back to 1785. The syndrome is recently beginning to gain recognition through films such as Complete Obsession (2000), Whole (2003), Quid Pro Quo (2008), and Armless (2010), through Ramachandran’s interest in the condition, and with the rising popularity of Internet forums, specifically, the Internet Yahoo! Group called “Fighting It”. This forum is dedicated to “discussion and support for living with or reducing this need [to be an amputee] and understanding its origins” (“Fighting It”). Although I aim to understand the syndrome more thoroughly, I am not searching for a definitive origin or reason. I am interested in learning more about the condition by investigating various theories that pertain to experiences related to BIID. It is this more analytical perspective that differs from those biomedical paradigms currently in discussion.

Although research on the syndrome is limited, what literature exists suggests that the majority of sufferers remember having idolised an amputee at an early age and know exactly what part of their limb must be removed (Bayne and Levy 2005, 11). Reports also reveal that patients feel as though they are not themselves with all their limbs intact, that the primary reason for amputation is the wish to feel complete through a lack (First 2005), and that most fear social stigma and therefore keep the desire secret. Although the condition remains a mystery to medical science, some psychological and physiological hypotheses exist. Sabine Müller writes that

psychologists, psychiatrists, and neurologists offer quite different explanations for the amputation desire: they discuss whether it is a neurotic disorder, an obsessive-compulsive disorder, an identity disorder like transsexuality, or a neurological conflict […] which could stem from damage to a part of the brain that constructs the body image in a map-like form.

(Müller 2009, 37)

One psychological study conducted in 2015 examined the role of childhood experiences with BIID, as well as

abnormalities in parents’ behaviour of BIID sufferers, which should be followed up in future research. […]. Until now, there are no other studies about childhood-related experiences in BIID-people. Childhood experiences have not been subject of [sic] systematic psychological research in BIID context, yet.

(Obernolte 2015, 7)

This book attends to this lack by exploring childhood experiences, albeit from a theoretical, psychoanalytic, and literary standpoint, as opposed to a biomedical one. It does not conduct a survey of individuals’ childhood experiences, but rather explores ideas about the way in which infants and children are formed in relation to their environments, particularly through the works of psychoanalyst Donald Woods Winnicott.

In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V, published in 2013), BIID is listed under Body Dysmorphic Disorder (BDD). However, the manual asserts that in BIID, “the concern does not focus on the limb’s appearance, as it would in body dysmorphic disorder” (247). Noll writes that “[i]n contrast to body dysmorphic disorder (BDD) is in BIID subjects only a very small tendency to judge the attractiveness of the concerned limb as ‘unaesthetic’ ” (2014, 230). Those with BIID focus on a body image, not the visual aspect of bodily incongruity, and are less “delusional” than those with BDD. Moreover, “[t]hose with BDD have a consuming preoccupation with an ugly body part or parts” (Lemma 2010, 61). They “often describe that they are not seeking an ideal body; they just want to be ‘normal’ ” (Lemma 2010, 83). Another difference between BDD and BIID is that those with BDD associate the ideal body with normality, while those with BIID associate the ideal body with what is considered to be abnormal. Although BIID is also sometimes compared to anorexia, according to White,

[a] person with anorexia will believe they are overweight despite contrary evidence. Persons with BIID acknowledge that their bodies are healthy, they just identify as a disabled person […]. It is a mismatch that causes a BIID patient to suffer, not an alleged false belief.

(2014, 229)

(though I note that this may not always be the case). Nevertheless, anorexia illuminates another way of viewing BIID: it demonstrates the way in which desiring to erase part of one’s body to reach an imagined ideal is not entirely uncommon, as the same principle applies on a lesser scale to disordered eating (or any form of dieting). In this way, there is a gradation between the less radical and more radical forms of desire for bodily removal, a recognition that may allow for a more comprehensive understanding of the syndrome.⁴

BIID is also often paired with Gender Identity Disorder (GID), in which individuals are uncomfortable with their anatomy and desire to alter their body as a result. Both disorders, then, involve a drive to seek out surgery to meet an imagined ideal. Moreover, in both, writes First, “the individual reports feeling uncomfortable with an aspect of his or her anatomical identity” (First 2005, 8). Thus, “[s]ufferers of BIID”, writes White, “often describe themselves as being transabled, drawing a parallel with transgendered individuals” (2014, 226).⁵ They also display a male predominance, symptoms tend to begin in childhood, and there have been individual case reports and descriptions of MtF transsexuals who have undergone limb amputation. Furthermore, many BIID patients exhibit gender identity issues, are often homosexual or bisexual, and some have reported feelings of wanting to be the opposite sex (Lawrence 2006, 264). This has caused some researchers to ask: “[h]ow can our understanding of GID help us to better ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• Acknowledgements
• PART I Why psychoanalysis and literature?
• PART II Symbolic exchanges and reconstitutions
• Index