One of the most bizarre of psychological maladies is the overwhelming
desire to have one's perfectly healthy arms or legs amputated. This
once rare disorder, known by the psychiatric term apotemnophilia,
appears to be on the rise.1
There have been various explanations of the meaning of apotemnophilia
as well as explanations for its increasing incidence. But none of
these explanations seems very cogent, as evidenced by the fact that
clinicians have not been able to illuminate the dark feelings of those
suffering from the disorder.
What, then, is the
meaning of this psychological mystery? The key to deciphering a
strange and apparently inexplicable compulsion is uncovering the
normal desire of which the compulsion is a deviation, or perversion.
As we shall see, the desire to have one's limbs amputated is a
perversion of a fundamental human longing: the will to transcend the
limits of egocentric existence through the act of self-denial.
The will to
self-denial is not, in itself, perverse or crazy. On the contrary, it
is the driving force behind all psychological maturation. To have the
patience to be a good parent, for example, certainly requires
self-sacrifice, an abdication of one's desire to control one's
personal time, energy and resources. Indeed, the struggle to renounce
one's egocentric mode of existence is the very meaning of an ethical
or religious life.
Even self-denial in
the extreme -- the self-sacrifice and self-mortification that
approaches death's door, and sometimes, when necessary, enters the
door -- is not, in itself, crazy. Such self-denial is the energy
behind the noble asceticism of the saints, prophets, holy men of all
religions, and of true philosophers.
To understand
self-sacrifice and asceticism, we must realize that it is not about
losing; it is about gaining. The life of ego inevitably seems unreal.
After all, we all know that our personal existence is something that
will soon pass away. Our knowledge that we shall die creates a sense
of unreality that is experienced as a dread of death. It is also
experienced as fault. Fault is the perception that our egotism has
injured that which is truly real, namely the universe, the divine
harmony, or something akin to that, depending upon one's beliefs.2
Only by sacrificing
what is unreal, namely our finite and transient ego, can we gain what
is truly real, in the sense of infinite and eternal. This longing to
become unattached to what is unreal, so as to connect with true
reality is the motive behind all sacrifice and self-denial -- normal
or perverse.
Perverse
Self-Negation
Many current
psychological maladies are essentially a perverse expression of the
will to the self-denial that belongs to ego-transcendence. Anorexia
would be an example. The anorexic experiences any excess weight as
egotism, and therefore as fault. Eating has always been connected, on
a psychological level, with fault. After all, to eat we must take the
lives of other creatures.
Most religions seek to
sanctify and justify eating. Christians, for example, say grace before
eating. The defense most often used to justify eating is that the
plant or animal, by being eaten, will be converted into man's higher
purposes. The anorexic apparently does not subscribe to this
hierarchical metaphysics in which lower life exists to support higher
life. Consequently, the anorexic feels unjustified not only in eating,
but in existing at all. The anorexic must therefore display as little
fat on her body as possible, for any fat seems indicative of
gluttonous greed, self-assertion and egotism.3
Like anorexia,
apotemnophilia is a perverse form of self-denial. It too stems from a
sense of fault. Arms and legs, since they are our physical means for
action, are psychologically connected to action in the world, to
doing. But here is the problem: action that isn't justified, in the
sense of being grounded in something absolute -- such as truth, good,
the eternal, the Logos, God -- seems egotistical. Consequently, one
cannot act without the risk that one will be plagued by a sense of
guilt.
There are a multitude
of psychological and physical disorders that are similarly connected
with the inability to act. Existential neurosis -- the Hamlet-like
impotence to decide and to accomplish, the incapacity "to take
arms against a sea of troubles," due to one's inability to
perceive meaning in the universe -- is in this class of psychological
maladies. So is hysteria, the disorder -- rare today; more common in
the 19th century -- in which a person's leg or arm became paralyzed,
with no known physical basis. Catatonic psychosis, chronic fatigue
syndrome, sexual frigidity and impotence -- when these disorders lack
a significant physiological basis -- may have a related etiology.
It was one of
psychoanalysis' seminal insights that neuroses -- particularly
obsessive compulsions and fetishes -- are private religions. The
person with apotemnophilia seeks self-denial, ego-abdication,
self-sacrifice. But here the normal spiritual longing goes awry.
Rather than seeking an inner psychological change, and thus becoming a
"reborn" person, he short-circuits the energy of
transformation by expressing -- on a primitive symbolic level -- what
the spirit is requiring of him. He views the possession of all of his
limbs as indicative of egotism. It means that he can act in the world
freely, and self-centeredly, as an individual. Consequently, only by
sacrificing a limb can he feel whole, because only then has he
achieved oneness with the god he unconsciously worships.
The apotemnophiliac
worships a Moloch, a god who demands life, or at least limb, from its
followers. If the apotemnophiliac is to attain psychological and
spiritual renewal, he must commit theocide. For only in killing
Moloch, can a new god emerge in his soul -- a god of goodness, love
and light.
We might add that just
as a psychological malady like anorexia could only appear in time of
abundant food, so it is that apotemnophilia could only appear in a
time of peace and prosperity. The energy that would normally be used
to oppose outward conditions is instead being turned, by the
apotemnophiliac, inward against himself, self-destructively.4
Perhaps there is a certain wisdom in Freud's perception that therapy
must free us of the self-destructive excesses of the superego by
turning our life energies outward towards the world.
Only in an age in
which many people are awfully busy, but inwardly feel that nothing
significant exists for them to do, could they conclude that their
limbs have become superfluous. Consider, then, William James' cure for
suicidal thoughts -- outward aggression against that which oppresses
us.5
The apotemnophiliac's thoughts are not suicidal, but they are
self-destructive, and so he should be encouraged to enter into battle
against life's evils, rather than negating himself. When he does enter
the battle, he will then feel that he needs all of his limbs.
Why
the Energy of Transformation Short-circuits
Why does the energy of
transformation short-circuit in the case of the apotemnophiliac and in
many other psychological disorders? The key to neurotic behavior is
that something is gained psychologically from an apparent loss.
Despite the terrible suffering that the neurotic must usually endure
on account of the emptiness of his life, he gets to stay himself. The
neurotic person -- in love with his wretched self -- would rather
commit suicide than let go of who he is.
In the middle ages,
the church sold indulgences. An indulgence was a set fee accepted in
advance by the church for future sins to be committed by the faithful.
In other words, it was a bribe. Analogously, the apotemnophiliac
attempts to bribe the inner voice of his spirit so that it will allow
him to stay himself. The price he pays is a limb. Essentially stated,
the apotemnophiliac pays with bodily sacrifice so that he does not
have to transform inwardly. This transaction occurs, of course, on an
unconscious psychological level.
It may shed some light
on this matter to contrast true sacrifice with perverse sacrifice. A
soldier who loses his leg in battle doesn't seek to lose his leg. He
seeks, if he is idealistic, to bring about freedom, or democracy, or
some other higher cause. The loss of his limb is an unfortunate result
of the heroic life. It ends up being a sacrifice for the higher cause.
Sometimes a deliberate sacrifice is required for a higher purpose, for
example, when a person donates blood, bone marrow, or a bodily organ
to someone else.
Perverse
self-negation, on the other hand, is not a consequence of genuine
sacrifice and heroism. Perverse self-negation grows out of a need to
expiate fault. An example would be Oedipus blinding himself, when he
realized, to his horror, that he had killed his father and married his
mother. The film The Pawnbroker offers another example. The
protagonist of that film, stabs himself in the hand out of an
overwhelming sense of guilt and remorse for his cold heartless
existence. The hand is symbolic, in the pawnbroker's case, of his
grasping nature. Those who seek to have their hand or arm amputated
have a similar sense of fault.
As we have said, what
makes bodily sacrifice perverse is that it is really a surrogate for a
true inner transformation. Oedipus blinded himself because what he had
to see, the transforming insight, was too powerful to bear. His
blinding was, symbolically, a regression to a level where nothing
further could be seen. And as for the pawnbroker in the film by that
title, Schopenhauer's words come to mind, "The only cure for
mental suffering is physical pain." Of course, there is a much
better cure for mental suffering: the illumination of one's desires,
anxieties and conflicts. Self-illumination is the route to health for
the anorexic, the apotemnophiliac, and all those who would seek to end
their suffering.
The
Problematic of Action in the World
The person with
apotemnophilia, like those with related psychological disorders, is in
flight from the problematic of action in the world. This problematic
has two dimensions. The first concerns the will to be oneself, to
exist. To exist in the world means that we must compete and contend
with other people, and if not with other people, then certainly with
other creatures and life forms. The second dimension of the
problematic is not about fighting. It is about loving. It has to do
with the need to give oneself to other people out of care, concern and
love.
The first problematic,
the will to be oneself, is embroiled with the perplexities of
justification. Arjuna, hero of the Bagavad Gita, was in a terrible
state of self-doubt and couldn't fight. After all, he was required to
go to battle against those whom he cared about, his relatives and
teachers. Cutting off his own arm, and so not fighting, would probably
have been a welcome relief for him. But Arjuna's mentor, Lord Krishna,
argued that refusing to fight would be cowardly, ignoble and a
forsaking of his duty as a warrior. The only solution to Arjuna's
suffering was to have his awareness ascend to a new level of answer to
the problematic of action in the world.
The apotemnophiliac,
the anorexic, the hysteric, the person riddled with the moral
complexities and therefore rendered impotent to act -- all are
troubled by this same problematic that Hamlet and Arjuna faced. But
instead of transcending the problematic, those who are neurotic
short-circuit their psychological and spiritual development through
their self-negation.6
The other problematic,
we said, has to do with love. To truly love requires a shift of
psychic energy beyond egocentricity, but the apotemnophiliac has found
a way to abort his own self-development. He does this by turning
himself into someone with a handicap. Consequently, he receives
preferential treatment. After all, this is an age when people with
handicaps are often viewed as heroes or as victims, or both; even if
it is not understood, it feels right.
Contemporary
egalitarianism -- which ennobles those who have suffered a loss
because they are thought to be victims, and perhaps martyrs, of some
social injustice -- may explain why such psychological disorders have
been on the rise. All this makes the milieu just right to breed
apotemnophiliacs. After all, the apotemnophiliac is not interested in
loving. He is involved in a warped effort to be loved, and to him that
means receiving. He receives economic benefits perhaps, maybe a
handicapped parking sticker for his car, but more importantly,
sympathy.
As a victim, the
apotemnophiliac feels justified in receiving help from others, and he
feels justified in not doing anything for anybody since his disability
renders him unable to do anything. Without his limbs, he can only beg,
or receive subsidies from the state. He says in effect, "I'd love
to help, but just look at me." Most people who are handicapped
are quite unlike the apotemnophiliac. They are more like the soldier
who lost his arm in battle, in the film The Best Years of Our Lives.
They are too proud to want other people's sympathy, and would be
totally independent, if they could.
There is something
rather comical in creating a situation in which one is rewarded for
not serving. The novel The Good Soldier Svejk by Jaroslav Hasek
(Viking Press, 1985) offers an example. The completely able-bodied
protagonist, Svejk, pulls up to the draft board in a wheelchair with a
fake cast on his leg, claiming to have a broken leg, and patriotically
volunteers for service. Unaware that he is faking his injury, the
draft board rejects him for service. The whole town treats Svejk like
a hero for wanting to serve his country, on the front line of battle,
despite his incapacity. Here, then, is a person who has refused to
enter military service -- and, symbolically, a higher life of
"service" to God and country -- but gets to be regarded as a
hero.
Of course, the
apotemnophiliac goes one step further than Svejk -- he actually
becomes a cripple. This is necessary, because Svejk is a charlatan, a
person intent on deceiving other people. The apotemnophiliac, on the
other hand, is involved in a self-deception.
To summarize, the
apotemnophiliac is in flight from the problematic of action in the
world. He can neither affirm his individual existence, nor can he
transcend it through care and concern for other people. As is often
the case with those who are mad, the outer man desperately seeks to
mirror the inner man -- lacking justification for his existence, the
apotemnophiliac wants the world to know that he is an
"in-valid," and that he truly does not have "a leg to
stand on."
The
Erotic Attraction to Amputees
Discussions of
apotemnophilia often lead to discussions of acrotomophilia. The latter
disorder is an erotic attraction to people with missing limbs. As an
appendix to our discussion of apotemnophilia, we'll try to decipher
the meaning of acrotomophilia. We shall see that acrotomophilia really
belongs to a different class of mental disorders from those that we
have just discussed.
The acrotomophiliac is
threatened by the potency of the opposite sex, and therefore seeks the
object of his desire in an apparently weakened, and therefore less
threatening, form. The acrotomophiliac can be a man who is threatened
by the feminine, or a woman who is threatened by the masculine.
In my book Awakening
with the Enemy, (Philosophy Clinic Press, 2000), I analyzed some of
the perverse forms that fear of the feminine or masculine can take.
The Humbert Humbert Complex, named after the protagonist of Vladamir
Nabokov's novel Lolita, involves an erotic attraction to young girls.
Part of this attraction is simply an attraction to innocence and
immediacy, but it is also based on the sense that young girls are less
sexually potent than mature women. The fear that men have of the
feminine is that they will be castrated, they will lose their
masculine potency. It is similarly true that a woman who fears the
masculine can be attracted to young boys. Acrotomophilia is allied to
the class of perversions involving a fear of the full potency of the
opposite sex. In the eyes of the acrotomophiliac, the amputee appears
to be less sexually threatening.
Why, then, would this
fear of the opposite sex manifest itself as acrotomophilia, rather
than any of the other perversions? There are people who can only love
someone who is suffering. Usually this concern for the sick and infirm
manifests itself in a relatively normal, socially approved, way. A
person with such a predilection might be attracted to working in a
hospital or in a hospice, and could even become saintly like Mother
Teresa. When normal, this love expresses itself as compassion, and not
as Eros.
In any case, a person
who is healthy, both physically and mentally, seems to the
acrotomophiliac to be just another ego-centered person in a world full
of such people with whom he must contend. The ill, infirm, or disabled
person, on the other hand, appears to be less threatening than the
able-bodied person, and so elicits the acrotomophiliac's sympathy.
There is much implied,
symbolically, in standing on one's own two feet. It implies
self-reliance, independence, self-assertion. The lack of a leg may
make the amputee appear "unable to stand on his or her own two
feet," and therefore in need of the "support" of the
acrotomophiliac. It is not surprising, in an age in which women have
become economically "self-supportive," that there would be
an increasing population of men who feel unneeded as men, and who are
attracted to women who, symbolically speaking, need men's support.7
The acrotomophiliac --
possessing a sickly Eros coupled with a perverse sympathy -- would,
not surprisingly, choose as his object of affection, or object of
lust, an amputee.
Unsettling,
but Slightly Edifying, Conclusion
It is unsettling to
peer into the shattered mirror of insanity, for what we discern may
begin to look vaguely familiar. We may recognize a nightmarish
caricature of our own desires, conflicts and anxieties. Few people
actually desire to have their arms and legs amputated, but many of us
-- on an unconscious psychological level -- negate ourselves, and thus
diminish our "stature" more essentially than if we had made
stumps of our legs. The late Dr. Edmund Bergler, a Freudian
psychoanalyst, called this self-destructive tendency "psychic
masochism." According to Dr. Bergler,
"Psychic masochism is a
universal phenomenon: Every human being has
a good-sized amount of it. But
the bearer of this unconsciously pleasure-
coated self-damaging tendency
has no inkling of the fact."8
Of course, most human
beings devote less psychological energy to hamstringing themselves
than they devote to "cutting other people down to size." But
such is the subject of another essay.
Let us put it this
way: there are certain questions that life asks all of us, and of
which our life is an answer. These questions concern how life should
be lived. Outwardly, the insane person, the everyday neurotic, and the
relatively normal person, all have very different answers to these
questions. On a more essential level, the answers are not far afield
of each other. But whatever the differences, the questions are the
same for all of us. That is what makes us able to understand people
whose desires and conflicts may initially seem alien and unlike our
own. We begin to understand the apotemnophiliac, the anorexic --
indeed the entire sea of struggling humanity -- when we detect the
familiar questions behind each person's uniquely problematic answer.
Looking into the
shattered mirror of insanity -- and coming to understand the real
meaning of these dark and unhappy answers to life's fundamental
questions -- we discover deep truths about the human condition. And in
the process we come to know ourselves.
1. See the
December 2000 issue of The Atlantic Monthly for an interesting and
informative article by Carl Elliott on apotemnophilia entitled "A
New Way to Be Mad." The online version of the article has
valuable links to other articles and information on apotemnophilia. It
can be found at www.theatlanticmonthly.com. There is also an
interesting article on apotemnophilia by Randy Dotinga called
"Out on a Limb," which appears in the August 29, 2000 issue
of Salon Magazine. www.salon.com. Both articles form links to related
websites.
2. We are
giving short shrift to the philosophical possibilities so as not to go
far afield of the main point. For a larger discussion of the
phenomenology of fault, we recommend The Symbolism of Evil by Paul
Ricoeur (Beacon Press, 1969)
3. The
story of the unfortunate singer Karen Carpenter is revealing in this
regard. Originally, Karen Carpenter was accompanied by her brother on
piano. They were billed as "The Carpenters," and produced a
number of hit records. Ms. Carpenter then decided that she would be a
bigger star if she were to be billed as a solo act. It was upon taking
that step that her anorexia became fatal. We can speculate that she
felt a sense of fault from breaking away from her brother and being
billed independently. Independence is far more likely to be
experienced as fault by women than by men, despite changing social
mores. The result, in any case, was that Ms. Carpenter experienced her
independence as egotism, and expressed her sense of fault by not
eating to the point of starvation.
4. We must
understand that man is never static; he is dynamic. He is not a being,
but a becoming, as the psychologist Abraham Maslow and others have
stated. Man's dynamism always involves him with overcoming. If he does
not seek to overcome the world, his aggressive energy will turn
inward. Then either of two things will happen. He may seek to overcome
himself, in the spiritual sense. That would be the much desired
outcome, but it is rare. Almost invariably, when the energy of
world-overcoming turns inward, the result is depression, inner
conflict, fault, and sometimes illness.
5. See
William James' Essay, "Is Life Worth Living?" anthologized
in his book, Essays on Faith and Morals (Meridian Books, 1967)
6. Few
people have transcended the problematic of action, as have Hamlet or
Arjuna. Why is it, then, that most people do not end up impotent to
act in the world, or become just plain crazy? It has been said that
the neurotic, like the artist, is more sensitive and aware than the
average person. Consequently, the neurotic is unable to accept the
facile false solutions that most people find satisfactory. The truth
of the matter is that although most people's "solutions" to
the problematic of action are the root cause of their difficulties in
life, they are still able to work and do things in the world. That is
what is meant by normality.
7. Apropos
is the ancient Chinese practice of binding the feet of girls so that
when they became women they would be unable to walk well.
8. Money
and Emotional Conflicts, by Edmund Bergler M.D., International
Universities Press, Inc. 1970, Page 33.