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Body Integrity Identity Disorder

This is a reposting of a topic from 2006 when I was the pastor of Holy Spirit Church in Forestville, MD. 

Body Integrity Identity Disorder (BIID), also known as Amputee Identity Disorder or Apotemnophilia (from Greek αποτέμνειν “to cut off”, and φιλία “love of”) is the overwhelming desire to amputate one or more healthy limbs or other parts of the body. Sometimes its sufferers take it upon themselves to amputate their own limbs and/or penis. Although it most commonly refers to people who wish to amputate limbs, the term BIID, or ‘wannabe’ also applies to those who wish to alter their bodily integrity.” (WIKIPEDIA)


Claire – October 28, 2006

Hi Father,

This doesn’t have a whole lot to do with sex, but a lot to do with life. I would very much like to have a Catholic viewpoint on the treatment of Body Integrity Identity Disorder. I have written an open letter to you here:


Thanks for your time and consideration.

God bless,


amputee.jpgDear Claire,

Certainly, I will keep you in my prayers. I cannot say that I had heard of Body Integrity Identity Disorder, but I have encountered people suffering from mental illnesses or problems akin to it.

It is unclear to me why my perspective is required. You already do a good job in your post focusing on the Catholic Church’s position regarding such matters as unwarranted amputation. It falls under the sin of mutilation. The inconsistency in the thinking of such individuals seems readily apparent. One might think that if he or she could have the impaired body of choice (with which one identifies) then he or she could go on with life and its responsibilities. However, speaking as a pastor of a small elderly community, physical handicaps can be as terrible as the mental ones. Mental or physical illnesses can both incapacitate the person and make it impossible to fulfill the duties of our state of life.

Not having an adequate expertise in the fields of psychology and medicine, I cannot speak to what experiences and/or biochemistry causes mental illness. What the Church would say is that, just as in gender mis-identification and same-sex attraction cases, there is a basic disorientation. This disorientation, in itself, is not a sin. However, the moral line is crossed with acting out and/or engaging in forbidden behavior. The American Psychiatric Association no longer considers homosexuality to be a mental illness. However, the Church has never accepted this revision as legitimate. It should also be said, that mental illness can mitigate somewhat from the gravity of a sin. The conditions for a sinful act are laid out as follows: the act must itself be evil or wrong; the agent must know that is immoral; and the agent’s volition must be sufficiently unimpaired or free.

Given the problem that you describe, the most serious wrongs would center upon the issue of causing self-harm, like amputation, causing blindness or deafness, or breaking one’s back and severing the spinal cord. If all you wanted was some general impairment, then I would just tell you to wait. The aging process itself robs us naturally of our ability to see, to hear and to move around comfortably. However, you indicate that those inflicted with this malady must also deal with a particular specificity regarding the desired impairment. Is it not all rather selfish? Our bodies are often not what we would want them to be. I would like to be thin and athletic, but I also like to eat too much. Short and tall men and women can do little to change their actual height. Indeed, I have known many people over the years who prayed that they might be healed from the very afflictions you describe.

I still recall a 20-something year old Marine who had a training accident and ended up permanently paralyzed from the neck down. He was supposed to get married the following month and his fiancee was at his bedside. Unable to perform the marital act, they would never be able to get married in the Church. All their dreams and hopes were lost in a moment. Many loved ones run away from those who become invalids. Such situations always leave me at a loss as to what to say. How could someone want that? The pity that good people give such victims becomes its own kind of poison. I have wiped the bottoms and washed the bodies of people so afflicted. They are embarassed and apologetic. But there is nothing for it. I am reminded of a line from an old Beatles song, “I get by with a little help from my friends.” That is indeed the truth. Speaking as a priest, our greatest friend is Jesus.

I do not know if pretending is a sin or not, I would doubt it. However, while it may give immediate relief, it is hardly a long-term solution to the anxiety you describe. The Catholic Church sees the human person in an integralist way. People these days mistreat the body. The implication is that the person is a mind or soul locked in a mechanical body that one manipulates. The Church rejects this view as well as the physicalism on the other extreme. The human person is a spiritual-corporeal composite. The unity is so intense that we can say that “You are your body.” This is not a crude materialism, but a recognition of our mortal nature. Even our views about the afterlife include the resurrection and glorification of the body. We are not angelic spirits and we will not remain disembodied souls forever after death. We find hints as to what this glorified body will be like in the mystery of Christ’s resurrection and Mary’s assumption. Our eternal destiny speaks to the importance of the human body in the present. If men and women did not have bodies they would have neither the desire nor the need for marriage or the sexual life. Our physical nature gives us many joys: eating, drinking, a leisurely nap, and so much else. Our bodies are God’s gifts to us.

The desire for an impaired body would seem to violate the gratitude we should show God for the gift of health and physical integrity. Does the person who has sight but would prefer blindness not curse the divine gift itself? If God gives us two hands to do his work, who are we to act as if we have only one?

I no longer have the body I would most desire. Arthritus causes almost crippling pain in my back and even pain relief medicine can only do so much. My eyesight is poor and daily medicine regulates my bloodpressure. I become easily winded upon walks. Here too, the mental image of myself and my abilities does not reflect the reality that harshly faces me every day. The difference between us is that I have a rather positive mental image of myself that no longer reflects my physical condition. You have a negative mental image for yourself even though the body is in actuality not so handicapped. In both cases, we have to live with the discrepency. We need to accept who we are, no matter what our shortcomings or disappointments.

There is no real benefit to being handicapped. It is a challenge that we can overcome or deal with, but as we see in the Scriptures, most people pray to be whole. No one asked Jesus in the Gospels to be made blind, or deaf, or crippled.

Well, these are my quick ramblings, nothing scholarly, just a quick evening reflection.

Again, you have my prayers, Claire. God bless you!

Father Joe

Sean – October 29, 2006

Dear Father Joe,

Thank you for your response to Claire. I am the owner of the site transabled.org, and must admit to not being religious. This probably explains part of my incomprehension of some points you made. Please understand I’m not trying to be argumentative, just to better understand your comments.

God made us the way we are. For transabled individuals it is not a question of *choice* to feel the way we do, no more than it is a question of choice or lifestyle to be gay. It is an integral part of who I am, and I dearly wish I didn’t feel the way I do. So, God gave us the body we have, but one would assume he also gave us the brain connections that make us feel the way we are. Of course, there is something about free-will, but if BIID could be willed away, I’d have been free of it decades ago!

People pray to be taller/etc. But they can’t do anything about it. Well, some do, getting breast implants, etc. For most of these people, it’s also not a question that consumes them all day (and night) long. Whereas we *could* do something about it, given the options. I am sorry you have arthritis, my late wife (who was a paraplegic) also did, and was barely able to pick up a pen towards the end. I understand both issues related to paralysis and arthritis. Were there a relatively simple “cure” to arthritis, would you not take it? Is it against God’s will to heal yourself if it is possible?

I see the body/mind as a whole, and cannot separate the mental well being from the physical well being. To me, it only makes sense that if I have a cancer that will kill me, I will remove the cancer, cut the affected limb. In a way, BIID is such a cancer, of the mind. And to become a paraplegic would address the cancerous problem. This is a conceptual problem I have with the approach of “don’t damage the body God gave you”, because I trully believe that one cannot separate body and mind, at least not on *this* plane. One must look at the entire package to define “optimal”.

It was about ten years ago that a paraplegic friend of mine pointed out the irony. She’d do anything to walk again, whereas I’d do anything to be unable to walk. She said that in many ways, that fact alone made our experiences rather similar in a way. I couldn’t disagree with her, yet, that doesn’t make it any easier.

Again, thank you for taking the time to respond to Claire.



97_1.jpgCatholicism acknowledges that creation is good and that human nature is as well, in addition to being supplemented by divine grace because of the Incarnation and the gifts that God gives believers in the Church. This is different from certain non-Catholic Christian perspectives that see the human being as essentially bad for whom salvation is juridically imposed but without any real transformation or conversion.

Nevertheless, we do believe that both human and natural evil inflict us because of the primordial rebellion. God offers us hope and redemption, but the negative consequences of sin upon nature and in the hearts of men is still with us. Thus, apart from any moral judgment upon the person, the Church would still contend that a person with same-sex attraction suffers from a disorientation that should not be pursued. Similarly, while “transabled individuals” may not always be such through choice, and thus are culpable of no sin in this regard; nevertheless, any effort at physical mutilation would be judged morally wrong.

God is indeed our Creator, but the harmony we would desire in the world does not exist. Children sometimes die from spontaneous abortions or miscarriages, others may be severely retarded (I knew one child who lived eight months without a brain), and countless people are born with serious mental and physical defects. Such things are permitted by God’s passive will, but not his active will; although, all things will mysteriously work out in his divine providence. Consequently, just because we are born or develop a certain way does not mean that God would want us to enshrine a defect as something that is neutral or beneficial, even if God himself can draw good out of evil.

You say yourself that you wish you did not suffer from BIID, and so there is already a pejorative admission. This does not mean that you can will the problem away. I have known some homosexuals who have successfully changed their orientation to heterosexual and they seem happy; however, most of the gays I have met have been unable to do so. The ones in the Courage Movement see their situation as a witness to faith as they live out chaste lives of service for others. Their struggle remains and short of some medical cure or miracle, they are as they will be for the rest of their lives.

As for cures, they should not in themselves entail a moral evil. My leg might hurt, but cutting it off would be a rather extreme way of trying to deal with the problem. A cure for Alzheimer’s would be a great blessing, but not if we have to kill unborn children to do so. Relieving the pain of arthritis and restoring full mobility would be a godsend, but not if it damaged another faculty like my liver or kidneys.

As for the body/mind connection, the soul itself is informed by matter. What we are really talking about here is the connection between the brain and the rest of the body. It seems to me that the problem here is in the brain, not in some other body part or in our mobility. It may be that surgical or chemical intervention is warranted, but the technique has not yet shown itself and that it should focus upon the brain itself and not chopping off limbs.

The late Christopher Reeves also demonstrated the terrible cost of keeping paraplegic people alive and how it is often a losing battle with infections, respiratory ailments, etc. Body mutilation and euthanasia for people suffering from BIID would all fall under the commandment, “Thou shall not kill.”

Anyway, no offense taken, I knew there might be disagreement. I am just offering a priest’s perspective.

Take care, Sean,
Father Joe

Claire – October 29, 2006

Dear Fr. Joe,

Thank you for your response! I appreciate your taking the time out to help this strange little marginal community of ours. Your prayers are appreciated. I just have a few comments:

>It is unclear to me why my perspective is required.

Because I might have missed something! :o)

> It falls under the sin of mutilation.

But circumstances alter cases. Take the case of a tubal pregnancy. You remove the diseased tube (with the fetus in it) because the intent of the operation is to remove the diseased tube, NOT to end a life, and the abortion of the fetus is just an unhappy side-effect of this action. This is allowed in the Church, is it not? In the case of BIID, your intent isn’t to mutilate the person, your intent is to counter an otherwise incorrigible neurological(?) problem in the brain. Can’t some parallel be drawn there, for the treatment of BIID? Researchers at the University of San Diego are now studying BIID from a neurological, as opposed to a psychological viewpoint. They believe there are actual, physical, neurological differences in the brain of a person with BIID. Were that to be proven true, would that change anything? We’d now have a biological cause of BIID, and then would surgery not fall under “therapeutic medical reasons?”

> Mental or physical illnesses can both incapacitate the person and make it impossible to fulfill the duties of our state of life.

> There is no real benefit to being handicapped.

Many of us were drawn at an early age to have close contact with people with disabilities. I myself have seen first-hand the consequences of long-term paraplegia, to the point of death. It isn’t pretty. But that’s why this is a mental illness, because it’s not logical. Most of us aren’t under any delusions that life would be physically easier. Only that we’d be free of a pathological obsession. And, given the choice, we’d RATHER HAVE A HEALTHY MIND THAN A HEALTHY BODY (caps for emphasis, not for shouting :o) ). They are both God’s gifts to us. My mental illness makes it, while not quite impossible, very difficult to fulfill the duties of my state in life, and certainly impairs my ability to do so with any great success. Why should we have to choose the body over the mind? Is the body more important than the mind? You can’t change the brain to fit the body, but you can change the body to fit the brain, and evidence tells us that this is, in fact, effective.

> Is it not all rather selfish? Our bodies are often not what we would want them to be.

I want to be thinner, but I don’t obsess over it. It doesn’t make me miserable or unable to think straight because I can’t get my mind off of it. I want to be free of hearing loss, but these thoughts don’t consume nearly every waking moment. There is a fundamental difference between my wanting to be thinner or to hear better, and my wanting to be a paraplegic. The former two are normal everyday human desires. The latter is a pathological obsession going back to age 6; that’s 30 years now, Father. I don’t see how someone with a mental illness could be termed selfish. It’s not logical, it’s just obsessive and uncontrollable — until you get the surgery, according to those who have actually done it.

Again, thanks Father Joe for your time. Now you and your readers have seen yet another strange variation of the human condition, one you probably never imagined possible! You don’t have to spend any more of your time answering this, I can imagine the demands on your time. In any case, it’s all a moot point because the surgery is not yet available. But there are many teams around the world right now studying BIID from several different viewpoints, and the day may come when the Church is called on to respond to this new challenge in medical ethics.

God bless you,

amputeefamily2.jpgDear Claire,

Mutilation is defined in Catholic morality as the unnecessary deforming of the human body. Obviously the removal of a cancerous organ, a gangrenous limb, etc would be permissible. Mental disconnects with the body would not make an amputation legitimate. Thus, it falls under mutilation.

As for the example you offer, it is not without its own controversy. What you describe in regard to a tubal pregnancy is not quite correct. Doctors are instructed by Catholic ethicists to do what they can to transfer the unborn child from the fallopian tube to the uterus. This is often not successful and only a few hospitals are equipped to even try. In some cases pregnant mothers are kept in a hospital bed throughout the pregnancy until the child is large enough for possible survival with medical assistance outside the mother. If the tube itself is diseased, as with cancer, or even the womb itself suffers a malady, then surgery might be permitted under the principle of double-effect. However, the intention and the act itself has be morally neutral or good. In this instance, the concern is the cancer, and the “immediate” unfortunate consequence is the loss of the child.

The Church would condemn the mutilation or crippling of the body as an evil act, even though the personal culpability might be mitigated somewhat by mental illness. Any doctor that assisted in such a procedure would commit mortal sin. Such mutilation is also condemned in cases where people suffer from gender misidentification and procure so-called sex-change operations.

If the intent is to “counter the otherwise incorrigible neurological problem in the brain” then it must be the brain itself that requires treatment and not the handicapping of some other corporeal appendage or power. Surgery might be warranted, but it would be brain surgery, not the subtraction of arms and legs or the breaking of a person’s spinal cord.

Really, the situation can become quickly silly. What if your body image is a head and torso without arms and legs? Would we store such a person in a box and take him out for supper? How would he make a living, displayed as a side-show freak? Who is going to feed and care for such people? If a person deliberately has his spinal cord broken, why should society pay the millions of dollars to sustain such a life when others who are so because of tragic accidents need the limited funds? Where do we draw the line? Maybe you want your eyes and ears removed…maybe you want to be skinned alive…might there be no end to the madness? Therapeutic treatment cannot make evil acts legitimate. We are not permitted a utilitarian approach where an evil is condoned for some purported good.

It is true that mental and physical illnesses can incapacitate a person. But such a situation must be tolerated when the only relief or alternatives seem to be immoral acts. One might argue that euthanasia is the surest way to end a suffering person’s pain; however, it is still murder. Sometimes there is nothing for it except suffering. The Christian embraces the Cross and finds something redemptive in it.

Further, why is it that you suppose that the crippling or amputation of an element of the body might bring an end to a pathological obsession. The mental illness would still be there, even if it no longer offered the mental and emotional trial that it once did. You can have cancer and sometimes feel quite well. All you would be doing is masking the real problem and adding new physical challenges.

As for selfishness, it can afflict anyone, even those with mental diseases. No one can want the life of an invalid and not be somewhat selfish and self-absorbed. We were put here to serve and not to be served. Catholicism in particular does not see suffering as a waste, and those with BIID are no doubt challenged by the Lord to add their crosses to the Cross of Jesus. It might not seem fair, but life is not fair. There is an old saying, “Man was made to suffer.” It sounds fatalistic, but it is also quite true. We are not promised perfect happiness in this world, just in the next.

This disease was not one about which I had given much thought, but it is a question that Church ethicists have discussed over the years. Catholicism would never approve of crippling the body for the sake of a person’s mental image. I suspect what we shall see is more work on the mystery of the brain itself.

God bless you,
Father Joe