Category Archives: body disorder

Provider’s Day: 3rd Annual TransOhio Transgender & Ally Symposium

Dear TransOhio Friends, Family and Allies!

Our 3rd Annual TransOhio Transgender & Ally Symposium is quickly approaching! We’re gearing up for 3 jam-packed days of workshops, seminars, networking, community building and special events!

This year is our first year we’re hosting a Provider’s Day. We’ve partnered with The OSU College of Social Work to be able to offer Continuing Education Units (CEUs) and with the LGBT Committee of the Columbus Bar Association to offer Continuing Legal Education (CLEs) credits as well. We’re pretty excited about that, and the workshops and presenters are FANTASTIC!

Here’s information specifically about Provider’s Day, which is primarily focused on providing continuing education to medical, legal and social service professionals who are currently working with transgender identified individuals, or who wish to open their practice to them.

Registration is now open and Social Service and Legal providers and professionals are being encouraged to register early as seating is limited and filling up fast. To register and view a full list of presenters and workshops, visit http://transohio2010.wordpress.com.

Planning to attend the General Symposium?
We hope so, because, well, how often do so many of the top surgeons, community activists, allies and educators gather in Central Ohio at the same time, for the same opportunities? That means, YOU get to meet-n-greet with (several) surgeons (you don’t have to go visit them out of state for a consultation!), have the opportunity to get access to OVER 70 workshops, food, friends, and entertainment all on the same weekend? Check out http://transohio2010.wordpress.com for a full list of presenters and workshops and events for the 3rd Annual TransOhio Transgender & Ally Symposium weekend (August 13-15, 2010)!

Provider’s Day will be held on Friday, August 13, 2010, 8am-5pm and is hosted by the OSU Longaberger Alumni House which is located at 2200 Olentangy River Road, Columbus, Ohio, 43210-1035 on the campus of The Ohio State University.

The General Symposium (Saturday and Sunday) will be hosted on site by the Ohio State University Multicultural Center at the Ohio Union. Registration is now open and Social Service and Legal providers and professionals are being encouraged to register early as seating is limited and filling up fast. To register and view a full list of presenters and workshops, visit http://transohio2010.wordpress.com.

Provider’s Day classes include:

Equine Assisted Psychotherapy: The Benefits for All Family Structures (CEU pending)
Holly Jedlicka, PBJ Connections, Inc.
This workshop gives participants an overview of Equine Assisted Psychotherapy (EAP) and how it benefits all types of family structures.  The focus is on how EAP provides a non-judgmental service to all types of families, using traditional social work theories in a barn setting. Participants learn how clients benefit from experiential family therapy with horses, how to identify family treatment objectives, and how to look for effective outcomes. Horses provide non-judgmental feedback for families in an exciting setting outside of the office, creating a safe and ideal place for families who are struggling with behavioral issues, mental health issues, or community-based issues.

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Transgender Employment Protections (CEU & CLE pending)
Tara McKenzie Allison, Esq., TransOhio Board of Directors
This presentation will provide a broad overview of federal, state and local statutory and case law providing protections against discrimination (based on gender identity and gender stereotyping) in the workplace. (1.5 hours)

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Facial Feminization (CEU pending)
Dr. Jeff Spiegel, Chief of the Division of Facial Plastic & Reconstructive Surgery, Boston Medical Center
Dr. Spiegel will review the goals and methods of facial feminization surgery.  Post-operative photos will be shown. There will be a discussion of what procedures are available, how to maximize results, risks, and how new technologies and advances have allowed for improving structural changes to bone.

The discussion includes differences in the facial anatomy of males and females, theories in gender recognition and feminization, the key changes in transforming a male face to a female face and the surgical techniques used during surgery.  Full forehead reconstruction with bossing to the orbital rim, mandible shaving and sliding genioplasty, rhinoplasty, cheek augmentation, upper lip reconstruction, browlift and scalp advancement are most commonly performed during these feminization procedures.  Trachea shave, blepharoplasty and rhytidectomy are also regular procedures performed during the feminization surgery.  Post-operative photos will be reviewed during the discussion.

Dr. Spiegel’s “less is more” approach to surgery allows patients to achieve their goals while still looking as natural as possible.  (1 hour)

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Introduction to Transgender Surgery (CEU pending)
Dr. Sherman Leis, Director and Chief Surgeon, The Philadelphia Center for Transgender Surgery
Dr. Leis will present an overview of the indications for transgender surgery, the prerequisites recommended prior to the performance of major surgical procedures, and several pre and post operative examples of the major procedures utilized in transgender surgery, both MTF and FTM.  (1 hour)

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Facial Feminization/Body Contouring: Artistic Subtlety (CEU pending)
Dr. Joel B. Beck, MD
Dr. Beck discusses Facial Feminization and Body Contouring. This is an opportunity for those who attend to explore their options in feminizing their face and body. Dr. Beck will explain the subtle changes he can achieve while retaining the beautiful qualities his patients already possess. He discusses the importance of collaboration on an individual level with each client. This helps to ensure an individual look, faster healing, and overall pleasing outcome.  (1 hour)

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Intersex 101 (CEU pending)
Elder A. Vickie Boisseau, Intersex Activist & Educator
This workshop will explore the social, legal, and medical issues faced by many intersex people, as well as the similarities and differences between intersex and transgender people. As time permits, we will talk about the top 3 medical conditions, as well as general knowledge on what to do with your intersex client.  (1 hour)

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Transgender: Basics & Beyond for Social Workers (CEU pending)
Jake Nash, TransOhio Board of Directors, Educator
The objective of this presentation is to have participants understand the occurrence, the distinctions, the disparities, the medical and mental health concerns, and dispel myths regarding transgender individuals.  Jake has delivered this presentation to social workers throughout the state of Ohio over the past 6 years.  (3 hours)

Section 1: The importance of Language
Participants will understand the distinctions of sexual orientation and gender identity, as well as the terms that fall under the transgender umbrella.

Section 2:  The disparities of the Transgender community
Participants will learn of the Harry Benjamin Standards of Care and Social Work implications in working with transgender individuals. Discussion of suicide, addiction, depression, homelessness, risk factors and lack of competent care will prepare participants to improve service delivery and outreach to the transgender community.

Section 3:  The importance of understanding legal and hate crimes issues
Participants will learn of the disparities the transgender community experiences regarding employment, legal documentation and hate crimes.

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LGBT Latin@s Victims of Interpersonal Violence (CEU pending)
José  Juan “J.J.” Lara Jr., MS, MA, Director of Advocacy and Training, Texas Advocacy Project, Inc.
In a culture celebrated for its rich traditions, close-knit families, and strong faith, being Latino and lesbian, gay, bisexual, or transgender is often unmentionable and often met with violence.
This workshop will focus on the stigmas associated with being Latino and LGBT and how negative stereotypes embraced by the Latino community regarding sexual orientation increases the likelihood for LGBT Latinos to be victims of inter-personal violence within their own families.

Participants will learn about homophobia as culturally expressed within the Latin@ community, the types of inter-personal violent crimes LGBT Latin@s are vulnerable to and barriers accessing hetero-centric social services and criminal justice systems. While LGBT Latin@s and their heterosexual counterparts share many of the same issues, LGBT Latin@s encounter additional barriers. LGBT Latin@s often face antigay or gender discrimination on two levels: racism and homophobia/heterosexism. Thus, categorizing LGBT Latin@s as a “twice-hidden” community renders them “invisible” limiting access to mainstream providers and vitally important services.  (1.5 hours)

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Utilizing Existing Federal Law to Protect Your Gender Variant/Transgender Youth in School (CEU pending)
Kim Pearson, Executive Director, TransYouth Family Allies
Currently, federal laws regulating schools and school districts are either ambivalent regarding the school experiences of gender variant youth or appear to condone the discrimination and harassment those youth face on a daily basis. However, in reality, those laws can be used to provide the very protections and supports gender variant youth need to be able to learn in a safe and supportive school environment.

This workshop will explore the mechanics of using those laws to advocate for gender variant youth who are experiencing difficulty and distress in school due to their gender expression.  Through hypothetical scenarios that mirror the common experiences of gender variant youth, this workshop will provide parents with the basic legal knowledge and tools to invoke federal law protections to improve the school experiences of their children.  (1 hour)

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Allies Supporting ‘T’ Youth & Their Families (CEU pending)
Kim Pearson, Executive Director, TransYouth Family Allies
This program is designed for those organizations and individuals who want to be more inclusive and supportive of gender variant and transgender children and their families. While many organizations have made a connection with the adult transgender community they are still struggling to understand how to support children and youth who come out as transgender or who are facing challenges because they are gender non-conforming.

This course is designed as a Youth/Children Gender 101 presentation that will educate you on the basic facts, myths and terminology. TYFA will also provide practical information and resources that will enable you to be more helpful and supportive to trans and gender variant youth and the families and friends who love them.  (1 hour)

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The Top 10 Lessons in What NOT to Do When Counseling Gender Variant Clients (CEU pending)
Brooke Kroto, LISW
This presentation is geared for mental health providers who are new to treating transgendered, transsexual and gender variant clients. Based on my own serendipitous journey, I will share some wisdom learned, many of which resulted from my own lack of experience and faux pas enacted along the way.

Participants will learn important fundamentals for helping those experiencing gender confusion, transgendered identity, and transitioning related issues.  (1 hour)

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Crime Victims Rights in Ohio (CLE pending)
Mel Fuhrmann, The Justice League of Ohio
This class will describe the rights that crime victims have in Ohio under the crime victims rights statute and the Ohio constitution.  We’ll discuss the services available to the LGBT residents of Ohio, including Bravo and the Justice League of Ohio.  We will also touch on the crime victim compensation program through the Attorney General’s office.  (1 hour)

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Health Reform for the Transgendered Community (CLE pending)
Travis Jackson, Columbus Bar Association LGBT Committee
The presentation would explore the impact of recently passed health reform laws on the transgendered community, with a particular emphasis on access to care. It would also examine recent announcements from the IRS regarding the tax treatment of SRS.  (1 hour)

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Successful Significant Other Partnering in Transgender Relationships (CEU pending)
Michael C. Owens, Licensed Marriage & Family Therapist, Licensed Professional Counselor, WPATH certified therapist & Amber Alaniz-Owens
This workshop will addresses the challenges, concerns, and positive solutions of being in a successful relationship of commitment and partnership with a trangender dynamic.
This workshop will cover common challenges, solutions, attitude is everything, disclosure, and the attributes of healthy couple dynamics. Room for questions and answers. Interactive workshop.  (1 hour)

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Services Outside the Box: Helping Your Clients Navigate Sex-Segregated Services (CEU pending)
Michael Munson, FORGE
In an ideal world, every client would have access to ANY medical and mental health service they need. Unfortunately, many services are sex-segregated, which provides additional barriers to clients (and providers).

This didactic and interactive workshop will examine how to creatively advocate for and with your clients around services such as sexual/domestic violence support groups and housing, OB/GYN/urology appointments, forms and policy management, referrals and networking. Providers will leave new solutions to old problems — benefiting their clients and their field.  This workshop is focused on providers and how they can better serve trans/SOFFA individuals.  (2 hours)

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THInC- Trans Hormones, Informed Consent (CEU pending)
Lisa Katona, Howard Brown Health Center
Introducing THInC, Howard Brown Health Center’s program to empower and support trans clients who wish to access hormones. THInC is a comprehensive 3-step program designed to assist clients in accessing hormones in an efficient, supportive and validating manner.

This presentation will offer information about what informed consent means, and why Howard Brown made the decision to make access to hormones as barrier-free as possible, and how clients can access this program.  (1 hour)


CSW, Office of Continuing Education is a provider with the State of Ohio Counselor, Social Worker, Marriage & Family Therapist Board. Provider Number: RSXX-038706 (Social Worker) and RCX-100503 (Counselor).

Our Sponsors:
The Ohio State University Multicultural Center; OSU’s Scarlet & Gay; OSU College of Social Work; The LGBT Committee of the Columbus Bar Association; Outlook; Stonewall Columbus; The Ohio Democratic Party LGBT Caucus; Apropos Promo; Irony Personal Training, LLC; United Way of Central Ohio; Stonewall Democrats of Central Ohio; Out for Work; The LGBT Center of Greater Cleveland; The National Gay & Lesbian Task Force; Case Western Reserve University GLBT Office; Equality Ohio; PBJ Connections; Delaware Christian Gay-Straight Alliance; Heart-Centered Healing; Evolved.

GailyFWD Interviews Karen Patrick & Shane Morgan of TransOhio

GailyFWD has released its latest episode. Check it out.

Erin and Adam talk with Karen Patrick and Shane Morgan, the co-chairs of TransOhio, about transitioning, identity, and how the law affects people’s every day lives.

http://www.ashantynolemon.com/gailyfwd/

Dying Real: Honoring Queer Relationships and the Gender Variant Body at the End of Life

In the Oscar-winning movie “Departures,” Yojiro Takita shows traditional Japanese customs for preparing bodies for casketing prior to cremation. The art is beautiful, precise and utterly respectful of the deceased. From the very first scene, however, the movie-going audience’s expectations of the “traditional” are ruffled. First, the film shows a contemporary Japanese society in which rather than family members, professionals hired by the funeral parlor prepare the body. Second, the lovely young woman being prepared for burial is revealed to have elements of male anatomy.

ILLUSTRATION MARY ANN ZAPALAC

After a discreet moment of surprise, the “casketers” offer the family a choice: Which way shall we make up the deceased, as a man or as a woman? The family honors the life of the deceased by choosing to prepare her as a woman. After the service, the father bows before the casketers in gratitude for restoring the memory of his child’s smile, lost during many years of family estrangement. Restoration of the smile allowed the father to recognize that happiness was found through her life’s choices.

Traditional Jewish tahara (ritual preparation of a body for burial) does not offer a gender choice; the sex of a body is determined by the appearance of the genitals, and gender is assumed to map directly to sex. Men prepare males for burial; women prepare females. While tachrichim (shrouds) are simple garments, there are minor gender differences. Male bodies are buried in shrouds designed for men. If the scenario from “Departures” had taken place in a Jewish funeral home, with a Jewish woman revealed in death to have male genitals, tradition dictates that the woman would be prepared by men and dressed in a male shroud.

If a person who lived a female life is buried as a man, no one will see, since only the burial society and the next of kin see the body from the time of death until the time of interment. Nevertheless, tradition seems to point in the wrong direction: Disavowing a female role dishonors the life of the deceased. The highest ethic of the burial society is kavod ha-meit/meitah (honor the male or female deceased), but in the scenario I have proposed, tradition would trump honor.

Death may come suddenly. What if a person has no time to set the expectations of the community for the unique requirements of a body? Can a family that rejected a person’s choices during life dictate the burial and funeral rituals undertaken at the time of death? Since in many states, sex-changed partners are allowed to marry heterosexually, it is also possible that the legal wife of a transsexual man might lose any right to communally mourn a lifelong partnership once the deceased is revealed to be transgender. What if a religious family undertook the burial of a not-so-religious child? Whose wishes take priority?

One of the goals possible for a transgender life is to be viewed as “real” — to be seen as a “real boy,” like Pinocchio. What will it take for transgender individuals to die real — recognized as the gender they lived?

Tradition can be kinder than it appears. Burial societies operate with a surprising amount of autonomy. While rabbinic authorities are often consulted to guide the tahara team onsite during difficult decisions, the rabbi most intimate with the family is often engaged with the surviving family members. Because of a history of condemnation rooted in the biblical prohibitions against cross-dressing and inducing sterility, the rabbi will likely not be privy to the gender status of the deceased. So when the time arrives for a decision about how to handle such a body, the team must make its own decision, while holding fast to the ethic of kavod ha meit. Given the autonomy of the burial society and the ethic of kavod ha meit, it is unlikely that a person who lives an entire life in a gender other than the one he or she was assigned at birth will have the accomplishments of that life dishonored at death. While the official position of tradition suggests intolerance, local custom and the relative autonomy of the burial society can provide opportunities for humane, appropriate treatment of gender-variant bodies.

Earlier this year, at Kavod v’Nichum (Hebrew for “honor and comfort”), the annual conference for burial societies, I met Lynn Greenhough, one of the organization’s founding members and the wife of a transgender man. Greenhough has a dozen years of experience as a member of a burial society; she’s seen many faces of death, and she has seen the principle of kavod ha-meit operating in many challenging situations. Greenhough assured me that while each Hevra Kadisha (“burial society”) operates according to tradition and is guided by a community’s customs, all bodies are treated with respect. Even so, education, living wills and other legal documentation help prepare members of burial societies for unique bodies. For burial societies, education about transgender bodies might have ramifications for the living as well as for the deceased: Education about compassion for human differences at the end of life might help transgender Jews be more accepted during their lives.

Gay Grief

On August 1, two Israelis were shot and killed at a drop-in center for gay, lesbian, bisexual and transgender youth. The press carried stories about the Tel Aviv center being a safe space for teenagers who had not yet found the spiritual strength to disclose their G,L,B or T identity to their parents.

Memorial services were held for Nir Katz, 26, and Liz Trubeshi, 16, in communities across the globe, but I found myself wondering about Liz’s funeral. About Nir’s. Were their bodies reverenced as other Jewish children’s bodies would have been? I thought about the grief of family members, but I also wondered if either one of the deceased had friends who were excluded. I wondered if the identities of the deceased were commemorated at their funerals — in Nir’s case, as a gay man who counseled others in the coming-out process, and in Liz’s, as an ally to the GLBT community, with many queer friends. I read with sorrow the report stating that after hearing where the attack had taken place, the parents of one young man would not visit him at the hospital where he lay injured.

As members of GLBT communities live Jewish lives across the spectrum of Jewish practice, we build compassion by focusing on similarities between our lives and the lives of other Jews. We, too, get married and raise children and work at our jobs. Throughout our lives, we support our communities. We age; our spouses die. We grieve.

Here is where the similarities end. While all deaths and family mourning are unique, transgender bodies and gay grieving tell a more complicated story, a story that cannot be covered over by efforts to assimilate our lives in heterosexual, gender-normative communities. While normative expectations may paper over some differences during our lifetime, our death and our mourning sing of our differences. Let that song not be solely a lamentation, but a Kaddish exulting in the diversity of lives our God created.

Noach Dzmura edited “Balancing on the Mechitza: Transgender in Jewish Community”(North Atlantic Books), now available for pre-order on Amazon.

Article can be found at: http://www.forward.com/articles/117279/

From TransOhio: Interesting article drawing the parallels of Transgenderism to Body Integrity Identity Disorder

(From TransOhio: Interesting article drawing the parallels of Transgenderism to Body Integrity Identity Disorder)

Cutting Desire

A rare condition compels its sufferers to want to amputate, or paralyze, their own healthy limbs. Inside the strange world of what sufferers call Body Integrity Identity Disorder.

Jesse Ellison
Newsweek Web Exclusive
Updated: 9:20 AM ET May 28, 2008

“Josh” says he was fully prepared when he amputated his left hand with a power tool. He says he had tried to cut it off before—once putting it underneath a truck and trying to crush it (the jack didn’t collapse right); once attempting to saw it off with a table saw (he lost his nerve). He even spent countless miles driving around with his hand dangling out the window, hoping to get side-swiped. But this time he was determined to succeed. Josh, who insisted on anonymity because his family thinks he lost his hand in an accident, says he practiced on animal legs he got from a butcher, and he was equipped with bandages to stop the bleeding and a charged cell phone in case he got dizzy. Now, years later, Josh says he feels wonderful without his hand, that his amputation finally ended a “torment” that had plagued him since middle school. “It is a tremendous relief,” he told NEWSWEEK. “I feel like my body is right.”

Surprising as it may seem, Josh is not alone. He has what some scientists are calling Body Integrity Identity Disorder (BIID), an exceedingly rare condition characterized by an overwhelming desire to amputate one or more healthy limbs or become paraplegic. The desire to be disabled seems so bizarre and contrary to basic human instincts that those who suffer from BIID have largely kept their compulsion a secret. But online communities of those with BIID have formed over the last decade, galvanizing a small movement to bring the disorder into the open.

They may soon be getting some support from the scientific community. BIID is attracting the attention of researchers who suspect that the condition may be related to other body image disorders—including anorexia, body dysmorphic disorder, and gender identity disorder—that at first glance may seem entirely psychological, but may be linked to physical differences in the brain. “In studying the hinterland between neurology and psychology, we can tell not just about people with conditions themselves, but how all our brains work,” says Paul McGeoch, a neurologist at the University of San Diego who is currently doing brain scans on people with BIID. McGeoch’s research may help answer the fundamental question: is BIID a mental illness or a hard-wired identity?

Those who congregate on the dozens of Web sites for people who identify themselves as having BIID say that safe and legal surgery, or a medically supervised way to become a paraplegic, is the only solution for their problem. (While researchers have interviewed dozens of BIID patients, there are no estimates of how many people are afflicted. However, transabled.org claims 1,500 visitors per day, while a Yahoo Web group of BIID suffers who say they are resisting the urge to amputate has 1,700 members.) They are most often white middle-aged males who refute the idea that the disorder can be treated like a mental illness with talk therapy and medication. They describe a persistent, torturous chasm between their mind’s image of their own body, and the physical body they inhabit. They say their urge to “right” themselves is overwhelming. Controversially, some people who say they suffer from BIID draw parallels to the transgender community. They point out that it took years for people who felt they were born into the wrong gender to convince the medical and psychiatric professions to recognize their plight, and that transgender individuals are now protected by anti-discrimination laws in many cities and states.

“Nothing touches it, other than surgery,” says Sean O’Connor, who runs the Web sites transabled.org and biid-info.org. “Psychotherapy doesn’t work. Psychiatry doesn’t work. Medication doesn’t work. I’m a pretty typical example of someone who’s attempted a [number] of ways to address the problem, done years of therapy of many types, including cognitive-behavioral therapy, and nothing helps.” O’Connor says he identifies as someone with BIID, and uses a wheelchair, but has not taken the final step of finding a way to paralyze his legs.

While the idea of deliberately becoming disabled could seem offensive to disabled advocacy groups, the ones NEWSWEEK contacted were reluctant to pass judgment. “Certainly, there are some who would be repulsed by the idea that someone would intentionally disable themselves,” says Nancy Starnes, senior vice president at the National Organization on Disability, noting that according to the Americans With Disabilities Act, anyone who appears to have a disability is protected. “But I think they would be treated the same way anybody with a mental health problem would be treated.”

Dr. Michael First, a professor of clinical psychiatry at Columbia University in New York, has been trying to gain insight into the disorder and the question of how to treat it. In 2004, he conducted a study of 52 people who identified as amputee-wannabes. He found that they were far from psychotic. “You almost have to see it to believe it,” First says. “These people say, ‘Every minute of my life I feel like something is wrong.’ But it doesn’t impair their ability to relate to other people. They are completely in touch with reality.”

First is campaigning for the disorder’s inclusion in the next Diagnostic and Statistical Manual of Mental Disorders (DSM), the Bible of the psychiatric field, slated for publication in 2012. For sufferers, inclusion in the DSM would legitimize what they believe is a genuine identity trait. “The largest goal is to figure out the treatment for the people who have it,” First says. He thinks that inclusion in the DSM could help pave the way. “Clearly, surgery has helped some people more than anything else. That’s a fact.”

As it currently stands, BIID sufferers have little option for treatment, and many of them take extreme and dangerous measures to amputate or paralyze themselves. One patient featured in Melody Gilbert’s 2004 documentary “Whole,” froze his leg off with dry ice. Another blew one off with a shotgun. In one case, a man traveled to Mexico and paid $10,000 for an illegal amputation, only to die of gangrene.

Perverse and gory stories like that have become fodder for television dramas including CSI and Grey’s Anatomy. And a new independent feature film starring Nick Stahl, “Quid Pro Quo,” tells the story of a paraplegic journalist who becomes involved with a shadowy world of disability “wannabes,” who gather in a dim Manhattan basement in their wheelchairs and help each other track down people and methods to paralyze themselves. At the start of the film, set for June 13 release, Stahl’s character gets a tip that a man has gone into a New York City hospital and offered a doctor $250,000 to amputate his leg.

In reality, there’s only been one widely publicized case of a doctor performing amputations on healthy patients in modern times: Dr. Robert C. Smith, a surgeon at Scotland’s Falkirk and District Royal Infirmary, who in January 2000, made headlines in the U.K. tabloids when it was revealed that he had amputated the legs of two patients with BIID. Dr. Smith argued that by preventing his patients from pursuing more life-threatening alternatives, he was following the Hippocratic oath to do no harm. But Dr. Smith’s hospital disagreed. He was prevented from doing any further surgeries. (Other doctors in history have faced this same dilemma. In 1785, a man in France held a gun to the head of a surgeon, forcing him to amputate his leg, and later sending a thank-you note. “You have made me the happiest of all men by taking away from me a limb,” he wrote.)

Surgeons who perform voluntary amputations today are understandably underground. Alex, a 60-year-old BIID sufferer, learned about a surgeon willing to amputate his leg five years ago and “jumped right on it,” flying to Asia and paying $10,000 to have the limb removed. “The only regret I have is that I wasn’t able to do it 30 years ago,” Alex says. He calls himself “completed,” and now works as a gatekeeper to the surgeon, who will not go public, operating a sort of ad hoc screening process, interviewing prospective amputees, and making sure they get psychological evaluations and complete physicals prior to the surgery. Alex, who also did not want his real name used, has even accompanied some patients to Asia; he would not reveal the exact location.

“There isn’t a single one of us that enjoys having this,” Alex says. “We’re all trying to figure out how we got it and how to get rid of it. It’s a mental torture. And the only way to get rid of it is by getting the surgery. Unfortunately, there’s too many people that take it into their own hands and end up dying.”

In his study, Dr. First saw some immediate parallels between BIID and gender identity disorder (GID) in which people feel that the gender they were physically born with is not their true gender. “[BIID] is not just about enhancing your appearance,” he says. “This is much deeper. This is a sense of your core identity.” Although many members of the transsexual community take issue with GID’s inclusion in the DSM and its characterization as a mental illness, there is no question that gender reassignment surgery has become more acceptable in the last few decades, which has also paved the way for more funding and research into the disorder. (Advocacy groups for the transgendered contacted by NEWSWEEK were reluctant to comment without knowing about BIID.)

Neurologists at the Center for Brain and Cognition at the University of California, San Diego, who have studied phantom limb syndrome (in which accidental amputees still feel pain in their lost limb), stroke victims, and GID have recently turned their attention to BIID. They’ve only been able to conduct three brain scans on those with BIID, so far, but in those, they have found some variation in the right parietal lobe, the area of the brain responsible for creating a “map” or the image of where one’s body exists in space. “What’s suggested from this is that because of this dysfunction in the right parietal lobe, this sense of unified body image isn’t formed,” says McGeoch. “The senses don’t coalesce. So, for a leg, for example, they can feel that it’s there but it doesn’t feel like it should be there. It feels surplus. Something’s gone wrong.”

But some doctors are reluctant to chalk up the disorder to a hard-wired trait. Dr. Ray Blanchard, a professor at the University of Toronto and a member of the DSM work group (which decides which disorders are included in the manual), says that if amputee-identification really stemmed from the brain, there would be other symptoms beyond just the desire to amputate—it would be difficult to use the leg, for example, or there would be signs of neglect.

Blanchard thinks it’s unlikely that surgery will ever be an option. “I can’t see society in general accepting it,” he says. “And I can’t see medicine accepting it. Medicine is going to see it as conferring a disability on a patient. In that sense it’s different from sex-reassignment surgery. Being a man or woman is not a disability.” Still, Blanchard admits that some of the first patients with gender identity disorder faced some of the same obstacles. “There were some psychiatrists who saw [sex-reassignment surgery] as colluding with a patient’s mental disorder. Instead of curing the patient of a delusion, you were validating it. But once again, all that had to be overcome there was that the patients really were happier as the opposite sex.”

Some conservative voices in the medical community feel that the normalization of sex-change surgeries was the start of a slippery slope. “You keep pushing the envelope of impaired people who aren’t in touch with reality in some fashion, who develop ideas about their normalcy,” says Dr. Mark Schiller, a psychiatrist and past president of the Association of American Physicians and Surgeons. “Essentially from just claiming that something’s the case, people just accept somebody’s distorted version of reality and then we get surgeons and others responding to the point of mangling normal bodies.”

Of course those who say they suffer from BIID may define normality differently. For now, sufferers are focused on getting official recognition in the DSM, which could open the door for more research funding. While not everyone agrees, an anonymous user called “TS” on transabled.org seemed to sum up a common view: “I don’t see mental illness as being a bad thing for BIID to be labeled as, at least for now. … Even if current BIID sufferers don’t reap the rewards of their efforts to get it known, at least they may know they have given BIID people of the future a better chance of a mentally satisfactory life. Living a lie is the worst human punishment.”

URL: http://www.newsweek.com/id/138932