Free The Naked Lady Who Stood on Her Head by Dr. Gary Small Page B

ABLE to squeeze me in for half an hour. He wasn’t surprised by what had happened with Kenny. “You had to do it, Gary,” Will said.
    “I know. I just feel bad that I’m the first person he’s ever trusted with his secret, and he thinks I’ve screwed him over.”
    “You probably saved his life, and now you have a chance to really help him.” Will went to his file cabinet and pulled out some papers. “Check out this article.”
    I read the title out loud: “Apotemnophilia: Two Cases of Self-Demand Amputation as a Sexual Preference.” I scanned the abstract describing these unusual cases of male patients who had a sexual obsession with their own amputated stump.
    “Gary, I think you’ve stumbled upon a very rare condition. Kenny finally told you what he wants—amputation of his left upper extremity,” Will said. “Did you find any sexual connection to his wish to amputate?”
    “I don’t think there is a sexual component to his obsession,” I answered.
    “Then it could be a form of dysmorphophobia, where the patient perceives himself or part of himself as grotesque, even though he looks perfectly normal.”
    “That sounds closer to what he’s got,” I said. “But I don’t think he sees his hand as grotesque. He just feels it doesn’t belong there—like he won’t feel normal until it’s gone.”
    Dysmorphophobia was first described by an Italian psychiatrist, Enrico Morselli, in 1886. Today we call it body dysmorphic disorder, which describes people who seek body modification to rectify some perceived physical imperfection. The condition has some similarities with obsessive-compulsive disorder, and patients often suffer from both illnesses simultaneously. Sometimes these people appear to be addicted to plastic surgery, and the results can be irreversibly grotesque. Usuallythey don’t pose an immediate danger to themselves, unless their symptoms become extreme.
    Kenny had some of these symptoms but actually suffered from a related and extremely rare condition that today we term body integrity identity disorder (BIID). Patients suffering from BIID believe their bodies don’t match the image of themselves they have in their minds. They might feel their unwanted limb is not necessarily ugly but makes them incomplete or disabled. They’re often jealous of actual amputees and experience such shame about their feelings that they rarely discuss them. They are typically not suicidal but just want the limb gone, so they seek out surgeons for elective amputation. Occasionally BIID victims will damage the unwanted limb to the extent that it requires amputation. In one reported case, a man rigged his car with automatic hand controls and then froze his unwanted legs in dry ice until they were unsalvageable. He then calmly drove himself to the hospital, where his legs had to be amputated.
    For most BIID victims, the wish for self-mutilation begins in childhood or adolescence. Some experts think the condition results from a brain disorder that somehow disrupts body image, but a specific cause has not been pinpointed. Treatment involves both psychotherapy and medication, and though patients may continue to have thoughts of removing their extremity, they can be helped to improve their quality of life and find ways to function reasonably well with their unwanted body part. Antidepressants can reduce the obsessive thoughts, and an important aspect of therapy is helping the patient reveal his secret to people in his life who can offer support.
     
    I WAS WALKING BETWEEN THE HOSPITAL CLINIC buildings and saw Neil Cooper in the distance, so I shouted “Neil!” but he didn’t turn. I picked up my pace and shouted again, “Dr. Cooper!”
    His walking slowed and he shouted back, “My God, I’m hearing voices. Get me a psychiatrist. Stat.”
    I caught up with Cooper and gave him an update on the Kenny Miller case.
    “You know, Gary, this is an interesting situation. At what point do you say a person doesn’t have