Body Integrity Identity Disorder: Deranged Body Processing,Right Fronto-Parietal Dysfunction,and Phenomenological Experience of Body Incongruity

Body integrity identity disorder (BIID) is characterised by profound experience of incongruity between the biological and desired body structure. The condition manifests in “non-belonging” of body parts, and the subsequent desire to amputate, paralyse or disable a limb. Little is known about BIID; however, a neuropsychological model implicating right fronto-parietal and insular networks is emerging, with potential disruption to body representation. We argue that, as there is scant systematic research on BIID published to date and much of the research is methodologically weak, it is premature to assume that the only process underlying bodily experience that is compromised is body representation. The present review systematically investigates which aspects of neurological processing of the body, and sense of self, may be compromised in BIID. We argue that the disorder most likely reflects dysregulation in multiple levels of body processing. That is, the disunity between self and the body could arguably come about through congenital and/or developmental disruption of body representations, which, together with altered multisensory integration, may preclude the experience of self-attribution and embodiment of affected body parts. Ulimately, there is a need for official diagnostic criteria to facilitate epidemiological characterisation of BIID, and for further research to systematically investigate which aspects of body representation and processing are truly compromised in the disorder.     

Morality Work among the Transabled

In the present article, I address the process of moral stigma resistance using an accounts studies framework. Specifically, I delineate and illustrate the concept of morality work. I demonstrate morality work empirically through a qualitative analysis of 17 years (1994–2011) of blog posts, archived content, and links to and from Transabled.org. Transabled.org is a website, blog, support group, and interaction forum for people with body integrity identity disorder (BIID)—a highly stigmatizing condition of incorrectly abled embodiment. Detractors accuse people with BIID of deep moral failings, including sexual perversion, dishonesty, greed, and attention seeking. In turn, persons with BIID neutralize claims of immorality through medicalization and biologization, and locate themselves on a moral high ground with a discourse of authenticity. In deconstructing transabled bloggers’ moral battle, I examine the process underlying deviant accounts.     

Amputees by choice: body integrity identity disorder and the ethics of amputation

ABSTRACT Should surgeons be permitted to amputate healthy limbs if patients request such operations? We argue that if such patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder (BIID), such operations might be permissible. We examine rival accounts of the origins of the desire for healthy limb amputations and argue that none are as plausible as the BIID hypothesis. We then turn to the moral arguments against such operations, and argue that on the evidence available, none is compelling. BIID sufferers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests.     

Body ownership: When feeling and knowing diverge

Individuals with the peculiar disturbance of ‘overcompleteness’ experience an intense desire to amputate one of their healthy limbs, describing a sense of disownership for it (Body Integrity Identity Disorder – BIID). This condition is similar to somatoparaphrenia, the acquired delusion that one’s own limb belongs to someone else. In ten individuals with BIID, we measured skin conductance response to noxious stimuli, delivered to the accepted and non-accepted limb, touching the body part or simulating the contact (stimuli approach the body without contacting it), hypothesizing that these individuals have responses like somatoparaphrenic patients, who previously showed reduced pain anticipation, when the threat was directed to the disowned limb. We found reduced anticipatory response to stimuli approaching, but not contacting, the unwanted limb. Conversely, stimuli contacting the non-accepted body-part, induced stronger SCR than those contacting the healthy parts, suggesting that feeling of ownership is critically related to a proper processing of incoming threats.     

Renewing Medicine’s basic concepts: on ambiguity

Background

Edmund Pellegrino lamented that the cultural climate of the industrialized West had called the fundamental means and ends of medicine into question, leading him to propose a renewed reflection on medicine’s basic concepts, including health, disease, and illness. My aim in this paper is take up Pellegrino’s call. I argue that in order to usher in this renewal, the concept of ambiguity should take on a guiding role in medical practice, both scientific and clinical. After laying out Pellegrino’s vision, I focus on the concept of normality, arguing that it undergirds modern medicine’s other basic concepts. I draw on critiques by scholars in disability studies that show the concept of normality to be instructively ambiguous. Discussing the cases of Deafness and body integrity identity disorder (BIID), I argue that if medicine is to uphold its epistemic authority and fulfill its melioristic goals, ambiguity should become a central medical concept.

Methods

In this theoretical paper, I consider how central concepts in the philosophy of medicine are challenged by research on experiences of disability. In particular, the idea that medical knowledge produces universal truths is challenged and the importance of historical, cultural, and otherwise situated knowledge is highlighed.

Results

I demonstrate how experiences of disability complicate dominant theories in the philosophy of medicine and why medical practice and the philosophy of medicine should make ambiguity a central concept.

Conclusions

If medical practitioners and philosophers of medicine wish to improve their understanding of the meaning and practice of medicine, they should take seriously the importance and centrality of ambiguity.

     

认知与身体:理论心理学的视角

文章站在理论心理学的立场,从具身的维度,探讨了认知与身体的可能关系。文章指出,自古希腊以来的西方文化中,二元论思想一直占据主导地位。柏拉图是二元论思想的最早代表,笛卡尔从认识论上确证了心、物二元世界的存在。传统认知心理学承袭了身心分离的二元论传统,视心智为独立于身体感觉运动系统的抽象符号信息加工。但是具身认知的兴起对二元论提出了挑战。从具身的维度来看,认知是身体的认知,身体是认知的主体。认知在以下三个方面表现出对身体的依赖性:a.身体限制着认知的特征与范围。有机体的身体结构、身体的活动能力限制了认知表征的性质和内容;b.身体不仅限制着认知加工,而且可以作为认知加工的一个组成部分,在大脑和身体之间分配认知任务,发挥着一种类似于分销商的作用;c.身体调节着认知,影响着思维、判断、情绪和动机等心智过程。上述事实说明,身心并非对立的二元,而是一体,身体与环境的互动造就了心智和认知。心智、身体、环境是一体化过程。     

A response to Dr Anthony Daniels

One of the sources of the diversity within psychotherapy is the conceptualization of the body. There are three main ways in which the body is seen. These correspond to three levels within the Wilber (1996) structural model. At level 1 the body is seen as something quite separate from the mind. We can treat the mind independently and leave the body to other specialists, such as medical doctors. If we do deal with the body, it is only in an external and behavioural way. At level 2 the body is seen as integrated with the mind, and the client is encouraged to see it this way too. One of the aims is bodymind unity. The body is continually referred to, and may be touched or asked to go through certain motions as part of the therapy. At level 3 the body is seen as the site for symbolic representations of divine archetypes, and reference is made to the subtle body. Both mind and body are seen as part of something greater, the soul. All three of these approaches are to be found within psychotherapy. It is argued that, unless these divisions are taken seriously, psychotherapy will remain confused. It is already confusing to others. By removing this particular form of confusion, it will be easier for psychotherapists to know what they are doing, and the scope and limits of their own particular orientation. Of these three versions of the body, the third is probably the least well known, but is growing the fastest. More lengthy attention is therefore paid to that.     

A response to Maggie Turp's paper from a body psychotherapy perspective

Whilst appreciating the quality of containment in Turp's work as a learning point for the Body Psychotherapy tradition, the author argues that Turp does not represent a psychotherapeutic way of ‘working with the body’. This would require a deconstruction of the body/mind dualism inherent in much psychotherapeutic (and psychodynamic) theory, so that the complexity of the spontaneous and reflective body/mind processes, especially in their polar extremes (body/mind dissociation – body/mind integration / ‘psyche/soma unity’), can be contained. An holistic body/mind formulation of countertransference is approached by which – rather than being used as a gratifying or cathartic therapeutic shortcut which avoids the intensity of the transference – the body can be seen to constitute an avenue into the full experience of the transference/countertransference process and its relational sources in early development.     

具身认知:认知心理学的新取向

具身认知强调身体在认知的实现中发挥着关键作用。其中心含义包括:(1)认知过程的进行方式和步骤实际上是被身体的物理属性所决定的;(2)认知的内容是身体提供的;(3)认知、身体、环境是一体的,认知存在于大脑,大脑存在于身体,身体存在于环境。具身认知最初仅仅是一种哲学思考,有深刻的哲学思想渊源,但是现在这种哲学思考已经开始走向实证领域,实验的认知心理学家开始从具身的角度看待认知,形成了具身认知研究思潮。但是具身认知研究也面临着许多亟待解决的问题。     

Educating For and Through Nature: A Merleau-Pontian Approach

This paper aims to explore the relationship between humans and nature and the implied intimacy, so-call ‘ecophilia,’ in light of the French philosopher Maurice Merleau-Ponty. It is revealed from the Merleau-Pontian view of body and nature that there may be a more harmonious relationship between humankind and nature than the commonly assumed, and an alternative understanding of education may thus arise. Following an introduction, this paper falls into three parts: an exploration of the meaning of nature, the corporeality of the body as central to our encounter with nature and the educational implications. The introduction argues that central to one’s understanding of nature is one’s understanding of oneself and the world. To some extent, our current environmental problems are related to a negative understanding of nature. The meaning of nature and our relationship with it will be elaborated by the exploration of the key significance of body to be found in Merleau-Ponty’s philosophy. It will be argued that overall, our understanding of the body may be central to reconnecting humankind and nature. Such a re-conceiving of the part played by the body in our relationship with nature may re-orient education towards a love of nature: ecophilia.

Mental body distance comparison: A tool for assessing clinical disturbances in visual body image

Despite numerous body size estimation studies, it cannot be concluded that the disturbance of body image in anorexia nervosa (AN) is specifically one of the visual body images.We adopted a visual imagery method, the Distance Comparison task, to enable across-population testing of differences in visual body image with respect to shape. Participants were asked to mentally scan across two body widths (e.g. hips and shoulders) and to decide as quickly as possible which one was longer or shorter. If the mental representation accessed to make such comparisons is visual, an inverse relation would be expected between RT and distance difference on the body to be judged (i.e. actual difference in size between the two body widths), with accuracy increasing with increasing distance difference. Females with high body shape concern (scoring high on the Body Shape Questionnaire: BSQ, n = 23) were compared to females with low body shape concern (scoring low on the BSQ, n = 19).RT and distance differences on the body demonstrated standard distance differences effects: RT increased and accuracy decreased with decreasing distance differences on the body. Groups differed with respect to accuracy, in that females high on body shape concern were significantly less accurate than females low on body shape concern when making evaluations involving small (?9 cm) differences, which implies a less appropriate visual image of the own body in the former group. With respect to the relation between RT and body distance difference, on the other hand, there were no differences between groups. We concluded that evaluations of own body size employ visual imagery and that the distance comparison task holds promise for the assessment of visual disturbances in body image in clinical populations.     

The Concept of Death: A Religio-philosophical Analysis

In an age in which vast progress has been made in organ transplant technology, it is imperative to determine the point at which a human being is considered dead, for transplantation cannot occur until after death. Traditional religious views imply that a human being is dead upon the departure of the soul from the body. Taking the biological death of the body as a conclusive sign of the soul's departure is not an option. Biological death refers to decomposition, and this cannot equate to the death of the person as such, for this would make the concept and practice of transplantation absurd, for transplantable parts of a biologically dead—i.e. decomposing—body could not be used. On the other hand, if parts of the human body are themselves still biologically alive, could it not be said that taking such parts would amount to murder?

Two conclusions follow from this predicament. First, death as a ‘normative’ concept stands in sharp distinction from a purely biological concept. Second, a normative concept of death is entangled with a normative concept of personhood. That is to say, from the moment that a human being is not considered a person as such, parts of the body could be removed for transplantation or, indeed, for any other justified medical purpose. In this regard, various theories of the person are put forward. Which of these theories is compatible with a workable concept of death? In this paper two principal theories of the person will be discussed and it will be argued that a brain-based theory of death is conducive to a normative concept of death, thus allowing for organ transplantation.     

Gender Differences in Population Versus Media Body Sizes: A Comparison over Four Decades

Mean body mass indices (BMIs, kg/m²)of North Americans aged 18 to 24 collected from 11national health surveys were compared to: Playboycenterfold models, Miss America Pageant winners,andPlaygirl models. The survey samples were representative of themix of different ethnic and racial groups in Canada andthe USA. No racial or ethnic information was availablefor either the Playboy women or the Miss America Pageant winners. Ninety percent of the Playgirlmen were white; 10%, black; 1.5%, Hispanic black; and.8%, American Samoan. From the 1950s to the present,while the body sizes of Miss America Pageant winners decreased significantly and the body sizes ofPlayboy centerfold models remained below normal bodyweight, the body sizes of Playgirl models and youngadult North American women and men increasedsignificantly. The increase in body size of Playgirl modelsappears to be due to an increase in muscularity, whereasthe increase in body size of young North American menand women is more likely due to an increase in body fat. Thus, in the 1990s, the body size andshape of the average young adult North American becameincreasingly different from the ideal being promoted bythe media. Furthermore the difference in male and female body sizes depicted by the media inthe 1990s was huge, whereas the difference between thebody sizes of 18- to 24-year-old North American womenand men was actually quite small. These discrepancies are discussed in relation to the differentsociocultural expectations for the two genders and theincreasing prevalence of body dissatisfaction reportedby both women and men.     

A cross-sectional study of changes in Norwegian adolescents' body image from 1992 to 2002

The present study examines changes in adolescents’ body image over a 10-year period. Both satisfaction with appearance in general, and satisfaction with different aspects of appearance (e.g., face, muscle tone, and weight) are considered. We analyzed data from two general population studies of 13–19-year-old Norwegians, “Young in Norway 1992” (N = 10,460, response rate = 97.0%) and “Young in Norway 2002” (N = 11,371, response rate = 92.3%). These studies used identical sampling procedures, data collection procedures, and measures of body image. The analyses showed a polarization in adolescents’ body image — concurrent with an increase in the proportion of adolescents with a very negative body image, there was an increase in the proportion of adolescents with a very positive body image. The greater proportion of adolescents with a very negative body image could partly be explained statistically by the increased body mass index (BMI) in the same period. Girls had a more problematic body image than boys, both in 1992 and in 2002. Whether the strength of this gender difference changed or not depended on the aspect of appearance considered.     

Making the body (w)hole: A semiotic exploration of body modifications

Abstract

Cultural norms of attraction are dynamic and fluid, and are psychologically intertwined with acts of corporeal modification that use the body as signifier. These norms are expressed in various ways by individuals, but can be seen most plainly when they are worn on the body, such as with body piercing and tattooing. An intertextual understanding of how body modifications play a role in the integration of psyche and soma appears to motivate understanding of how individual choices are reflections of cultural mores. Psychodynamic and semiotic processes from case examples are provided to illustrate how individuals may move between affect and expressiveness as well as how reading the body as text can generate new understandings of an individual's decision to modify, thus allowing clinicians to better work with their modified clients.     

A Macintosh and Windows program for assessing body-image disturbance using adjustable image distortion

Body image is one of the most important concepts in the study of eating disorders. The assessment and treatment of body-image issues are considered to be integral aspects of assessment and clinical management of eating disorders (Thompson, 1996b). The program, BodyImage, is software for the assessment of body-image disturbance. It uses an image-distorting technique to estimate body size. The image of the whole body or parts of the body can be captured as a digital image by a digital camera. Response data from participants are recorded as ASCII files so that other computer programs such as spreadsheets or word processing programs can handle the data. BodyImage works on personal computers, both Macintosh and Windows. It is available at no cost, and it can be obtained from the following URL: http://homepage2.nifty.com/s_shibata/softwares/bodyimage.html.     

A computer-graphic technique for the study of body size perception and body types

We present a novel approach for measuring body size estimation in normal and eating-disordered women and men. Clinical categories of body types were used as prototypes. By comparing the subjective appearance of a person’s body with prototypes, we can understand how different attributes of his or her body shape contribute to perception of body size. After lifelike random distortions have been applied to parts of their body image, individuals adjust their body shapes until they converge on their perceived veridical appearance. Exaggeration and minimization of particular body areas measured with respect to their true shape and with different prototypes can be expressed as numerical deviations. In this way, perceived body size and body attractiveness can be appraised during the course of diagnosis and treatment of eating disorders.     

Asymmetrical Body Perception: A Possible Role for Neural Body Representations

ABSTRACT— Perception of one's body is related not only to the physical appearance of the body, but also to the neural representation of the body. The brain contains many body maps that systematically differ between right- and left-handed people. In general, the cortical representations of the right arm and right hand tend to be of greater area in the left hemisphere than in the right hemisphere for right-handed people, whereas these cortical representations tend to be symmetrical across hemispheres for left-handers. We took advantage of these naturally occurring differences and examined perceived arm length in right- and left-handed people. When looking at each arm and hand individually, right-handed participants perceived their right arms and right hands to be longer than their left arms and left hands, whereas left-handed participants perceived both arms accurately. These experiments reveal a possible relationship between implicit body maps in the brain and conscious perception of the body.     

From body to body: A post‐gender politics for the cosmic homo1

This article engages in establishing some common ground, some human and humane politics for the global Luther, in contradistinction to the focus in much recent scholarship on difference/s as an almost hegemonic way of understanding human life. The aim is to move beyond feminist, poststructuralist, and postcolonial theories to a post‐gender politics by employing Judith Butler's concepts of performativity and “abject” bodies. Homo, the human being, will be the hermeneutical key for examining Luther's understanding of God's creation and incarnation as well as of baptism, the Lord's Supper, and the church. The aim is that of searching out Luther's differing performances of body, from the carnal body of the incarnate Christ and the human body to the spiritual body of church and community, and how these matter, materialize and intersect in the body of Christ as one body/homo.     

Peer Culture and Body Image Concern Among Australian Adolescent Girls: A Hierarchical Linear Modelling Analysis

Peers may influence the body image concerns and disordered eating behaviours of adolescent girls through the creation of appearance cultures within friendship cliques. The present study investigates the role of friendship cliques and school gender composition in impacting upon adolescent girls’ body image concern and disordered eating behaviours, using hierarchical linear modelling (HLM), a statistical procedure employed in the analysis of nested data. A sample of 156 girls was drawn from four private schools located in the capital city of Western Australia (one single-sex school and three mixed-sex schools). Eighty students from the single-sex school and 76 female students from the mixed-sex schools, comprising 35 friendship cliques, completed questionnaires assessing body image, disordered eating, and a range of variables that have previously been associated with body image concern and disordered eating, including appearance-based social comparison, frequency of appearance-based conversation, appearance-based criticism, friends’ concern with thinness, media influence and media pressure. Hierarchical linear modelling analyses found that friendship cliques in all-girls schools exhibited similar levels of body image concern and dieting behaviours, with various peer and other media influence variables accounting for these similarities. Friendship cliques in mixed-sex schools were not found to be similar with regard to body image concern or disordered eating. These findings support the notion that friendship groups can be an important source of influence on the body image concerns of adolescent girls in single-sex schools, and show that both individual and friendship clique level measures of attitudes and behaviours make independent contributions to the prediction of these body image concerns.