Tolerance, Relativism, and Accommodation
posted by Frank Pasquale
I was recently reading Prof. Annemarie Bridy’s article on “elective amputations” resulting from apotemnophilia–a “desperate desire [of able-bodied individuals] to live as amputees” because they are “unable, despite considerable efforts, to reconcile themselves psychologically to living with the bodies with which they were born.” (Bridy, Confounding Extremities, 32 J. Law, Med., and Ethics 148 (2004). The condition has been consistently “identified . . . as an extreme variant of Body Dismorphic Disorder (BDD),” but advocates for apotemnophiles claim that they “see themselves with an amputated limb as becoming able-bodied and more fully functioning, more whole, more complete.” Therefore a stark question is raised by the apotemnophile: is the desire to have a limb amputated itself a form of mental illness, or is amputation the therapy the condition demands? Bridy raises an interesting analogy:
[C]osmetic surgery patients essentially embrace the same paradox that underlies the apotemnophile’s desire for elective amputation: they seek to alter themselves (i.e. physically) precisely in order to become more authentic to themselves (i.e. as they imagine themselves to be). The cosmetic surgery patient’s personal Ideal, like the apotemnophile’s, is an imaginary self-construct that can become reality only through surgical intervention. Cosmetic surgery patients aspire to beauty as an end in itself; apotemnophiles aspire analogously to disability.
Of course, things diverge rather rapidly from there. The cosmetic surgery patient frequently aspires to some common (and perhaps oppressive) ideal of beauty; the apotemnophile can most charitably “be understood as implicitly challenging the pervasive stigma of disability not only by embracing but by seeking to literally embody an alternative conception of bodily integrity.”
While thinking about societal tolerance of apotemnophiles, I browsed this story in the NYT on the presumed-dog-invite trend. There is some pretty funny stuff here on the way in which society responds (or fails to respond) to an unusual person’s “needs:”
Difficult guests are no longer limited to humans. The boundaries between humans and animals have been so eaten away by pet therapists, pet designer outfits and pet bar mitzvahs, that it has reached a point where devoted owners, who treat their animals as privileged children, lose all perspective on the pet’s role in their social lives.
[For example, at one wedding, t]he name of the puppy — a truly out-of-control guest — was Dude.
“It was unbelievable that good friends of mine and good friends of the parents of the bride would even consider bringing this dog,” said the hostess . . . . “The first thing Dude did was jump into the outdoor pond,” Sally said. “He shakes off on the grass lawn, then promptly heads inside and leaps onto the white couches, leaving a trail of pond scum. Then he runs outside, jumps onto one of the dining chairs, jumps on the table and helps himself to the hors d’oeuvres and fillet.”
One thought here; will norms evolve so that people are more and more accepting of others’ accounts of what they “need”? How will technology play a role? Presumably, rapidly advancing medical technology will make the prospect of amputation less painful and expensive over time…and perhaps the rise of prosthetics will make it seem almost reversible. But the “problems” caused by dog-guests may not be well-contained by technology.
On the other hand, the “complete internalization” of cosmetic surgery or elective amputation externalities is itself a myth. Medical resources are limited by many factors, including restrictions on the number of medical schools and the number of doctors who are licensed by the state. Those who care about broader access to health care should probably cheer when, as now, consumers start reconsidering cosmetic procedures. . . . and apotemnophiles seek psychiatric, rather than surgical, treatment for their illness.
Cross-posted from Madisonian.