Producing Identity: Elective Amputation and Disability

Harminder Dosanjh Kaur

CORRINE: I don?t understand where it comes from or what it is, I just don?t want legs. Inside I feel that my legs don?t belong to me, they shouldn?t be there. It?s as real to me as I imagine able-bodied people, the sense they have, that they should have two arms and two legs and just to think of anything else is unthinkable. There is just an overwhelming sense of despair sometimes. I don?t want to die, but there are times that I don?t want to keep living in a body that doesn?t feel like mine (Complete Obsession, 2000: 1).

The taboo subject of elective (also called self-demand2) amputation came to attention in the UK in the late 1990s when the media reported that Robert Smith, a consultant surgeon at Falkirk hospital near Stirling, had, at patients? request, carried out amputations of healthy limbs. The idea that an apparently sane person might request the removal of one or more healthy limbs is generally received with unease. When first writing about the issue I wondered if self-demand amputation could be read within a paradigm of mutilation and self-harm. However, I was frustrated in this attempt by the self-demand narratives I encountered. Unexpectedly, the desire for amputation was framed as an "identity disorder", thus referring to the language and arguments of the trans (gender) debate. On the one hand, framing the phenomenon in this way provides a recognised template through which surgery can be obtained. However, on the other hand the condition itself, as well as the way it has been framed, presents a conceptual knot. How can "normal" limbs be extraneous to the body? Are lived body boundaries different to anatomical boundaries? Can surgery produce identity? Furthermore, is disability an identity?

The elective amputation of a healthy limb is an extreme form of body modification that questions one?s assumptions and beliefs about bodies, "disability" and the limits of medicine. The idea that someone might elect to alter their body to "disable it", and for medicine to be complicit in this is difficult to grasp, and the difficulty in understanding the phenomenon is compounded by limited information and the shame that people feel about their need for this procedure. The patients seen by Smith had travelled as far as America and Germany, and it was reported that if they did not have access to surgery, there was a risk that their despair would cause them to seek backstreet amputations or intentional accidents that might lead to amputation. Originally these patients were diagnosed in terms of existing conditions such as Munchausen?s syndrome and Body Dysmorphic Disorder (BDD), or in terms of a paraphilia such as apotemnophilia (amputation love) and ameliotasis (attraction to the absence of a limb). These terms have been rejected and this is reflected in the book written on the subject by Robert Smith and one of his clients Gregg Furth. When the book came out in 2000 it was entitled Apotemnophilia, however, the 2002 edition is entitled Amputee Identity Disorder. Other terms have also been used to describe the condition include the rhyming informal description prevalent on the internet "amputee wannabe".

The re-framing of the "disorder" from a BDD, or a sexual fetish, to an identity disorder is reflected in the language people use in their narratives, using phrases such as "I?m in the wrong body" (Complete Obsession, 2000: 1). This is a famous phrase used in trans narratives; the first recorded use was in 1893 in Krafft-Ebbing?s Case 99, "I feel like a woman in a man?s form" (Whittle, 2000: 39). This essay does not focus on explaining the condition, but rather considers: firstly, the way self-demand amputation illuminates issues about body boundaries, and, secondly, the way that the 2002 framing of the condition as Amputee Identity Disorder (AID)3 can be useful as a tool to bring to the surface the production of disability as an identity.

Morphological Boundaries

I see myself as a very normal person with, you know, a good job, a stable home life. My dad was a police officer and my Mom was a teacher. I have brothers and a sister and we are all very normal, good people. Everything about my life is ordinary, except for this one aspect and it?s very hard to fit that in to the rest of my life. My legs are extraneous. They shouldn?t be there, they don?t feel, it doesn?t feel right that they extend beyond where I feel my body should end (Complete Obsession, 2000: 2).

In the twentieth century, what one might understand unproblematically as "the" body has been destabilised through a series of theoretical shifts. Two of the primary theorists implicated in this shift are Foucault (1973; 1978; 1991) and Butler (1993). Foucault?s work has undermined the notion that bodies are a natural phenomenon, introducing the idea that culture and hence disciplines of power are inscribed on the body. Butler?s work, meanwhile, has taken the critique of the "naturalness" of the body a conceptual step further. Her analysis questions the assumption that there is a pre-given body that can be inscribed upon. Although she does not deny the materiality of the body, she shifts the terms of the debate by arguing that we cannot think the body outside of culture and by suggesting that discourse might be material. Butler?s account of performativity displaces axiomatic beliefs about the materiality of the body and destablises the sex/gender binary. Her work reverses the formulation that sex produces gender, to explore the possibility that gender produces sex. "Facts" of the body such as "sex" and "race" are materialised through a repetition in which such categories function as "regulatory ideals" (Butler, 1993: 1). The materiality of the body is thus discursive, rather than anatomical.

In relation to "Amputee Identity Disorder", the participants (surgeon included) appear to be seeking to change and/or fix identity by intervening in the "materiality" of the body. Yet it is not clear what this materiality is, or whether identity can be bestowed by a surgeon.

In her essay on conjoined twins "The Body Which is Not one: dealing with differences", Shildrick explores the need society has to separate conjoined twins and to define neat, incontestable boundaries. She argues that the surgical division of conjoined twins does not effect their affective division. Regarding a conjoined twin, Eilish, who had been separated from her sister Katie, and subsequently died, she writes:

For her parents, her social and physical recovery is clearly a matter of relief, but it is evident too that for Eilish herself, the splitting of her (subject) body has produced an affect somewhat akin to the phenomenon of the phantom limb. The wound she experiences, unacknowledged, is as much psychical as material, a severe disruption to the unified, albeit imaginary, body map that founds the ego. When Teresa, the elder sister says of Katie, "She had freckles", the response from Eilish is both confused and defiant: "So did I, so do I [pushes Teresa], I still do."? Katie both is and isn?t there, a shifting body memory and continued inscription on the flesh of her twin (Shildrick, 2000: 86).

It is clear that the surgical division of Elish and Katie has not fully effected a psychic division questioning the implicit belief that that surgeons can articulate our limits for us; that the scalpel can draw the outline of the body in a definitive way. However, the idea that the boundaries of the subject with can be determined with a knife, and that identity can be produced surgically, is extremely problematic.

Within medicine there is an insistent forgetting that medical charts, drawings and other discourses produce anatomy, and that these drawings are, as Jordanova (1989) argues, cultural artefacts. The medical body is an inanimate thing, an object, not a subject. The relevance of Shildrick?s arguments in this context is that in the medical model of the body, body boundaries are not affective, but anatomical and hence can be articulated surgically. However, feminist philosophers have drawn attention to various disciplines, notably psychoanalysis and phenomenology of the body, that contest the idea that "the body" and hence body boundaries, are purely anatomical entities.

One of the key icons in the phenomenological debate on embodiment is intriguingly, the phantom limb. The phantom limb is a phenomenon that has been frequently observed in subjects after a limb has been (involuntarily) amputated. Following the amputation the subject has a haptic experience of the missing limb that often includes extraordinary pain. This phantom also reputedly has weight, sensation and position in space. This phantom may change in intensity and detail over time, and it is often experienced as smaller, and lighter, than the missing appendage. However, the sensation can be so convincing that people with leg amputations have been known to fall over when mobilising, forgetting that the leg is missing, and that the phantom will not bear weight. The phenomenon of the phantom limb has animated issues of body image. The body must be more than just anatomy, or this phenomenon would not exist. This has given rise within phenomenology to ideas of body image or schema, and the thesis that habit, repetition and memory play an integral part in corporeality and subjectivity.

Similarly psychoanalysis has given rise to the idea that our bodies are more than anatomy. This is particularly evident in Freud?s notion of psychical topography and Lacan?s work on imaginary anatomy. Freud argues that "the ego is first and foremost a bodily ego" (Freud, 1923: 26), that the body is in fact inseparable from ego and not (as the Cartesian dualism would have it) inanimate anatomy. The idea is that our earliest perceptions of the world are through our bodies, and through touch, lack of touch and other forms of bodily investment. These charge the contours of our bodies with affect and salience; some areas, due to society and individual differences are more highly charged than others. This theory speaks to many of the experiences people have of their bodies; the shame, neglect, pleasure and alienation that is caught up in them. The idea that body boundaries are fixed or stable, is of course a fiction; a fiction that must be constantly reproduced.

The desire for a stable or fixed body boundary can be understood in relation to Lacan?s notion of imaginary anatomy. This account also contests the idea that we can reduce the lived body to anatomy. In the famous account of the mirror stage, the infant acquires an aspirational body image, one of unity, co-ordination and fixed body boundaries. The coherence and clear margins of the "imago" contrast with the infant?s haptic understanding of herself. This image becomes something that the infant desires. However body boundaries are always permeable and this goal can never be attained.

The material outlined in this section suggests that although on the surface we might view the phenomenon of self-demand amputation as surprising, the idea that the body on the anatomical chart defines the boundaries of the subject is illusory. Although there are many differences between phenomenological and psychoanalytic accounts of the body, as well as within these disciplines; the narratives all contest the idea that morphology as it is lived is the same as anatomy.

It is also worth thinking further about Lacan?s account of imaginary anatomy. There are several ways we can view this account in relation to the issue of self-demand amputation. It is tempting to suggest that the individuals have internalised and idealised a body image that is "abnormal" and indeed many people suggest moments of this kind in their accounts (Complete Obsession, 2000). According to Lacan, the imago is a fiction and can never be achieved. This raises the question what happens after surgery? Are the feelings displaced onto other body parts, or do the individuals achieve the relation to their bodies they require? In addition, what can be made of the assertion that the phenomenon is about identity?

"Happy Ever After"

Once amputation has occurred, apotemnophiliacs take good care of themselves and venture into life with full force, not as disabled second-class citizens, but rather as able-bodied, self-fulfilled individuals, supporting themselves and their families via work and parenting (Smith and Furth, 2002: 30).

The male has been living very happily ever since (Smith and Furth, 2002: 46).

The narratives given in the book Amputee Identity Disorder about life after surgery are, perhaps surprisingly, narratives of the "happy ever after". The information about people after surgery emphasises that people are now adjusted, calm, happy and live full, productive working lives. For example in the following case study:

The client was a 47-year old male, married with two children, a blue-collar worker in a middle class community? Within weeks [of the amputation] the client was in rehabilitation and within two months walking about on a prosthesis. He returned to work, having adjusted to compensate for his amputation. His immediate family knew of this elective amputation and accepted it as part of who he was. They have seen a remarkable change in him for the good. His friends, fellow employees and employer now have information of the apotemnophilia desire and have accepted that his leg difficulties required amputation ? Both family and workers communicate that the client has a different attitude, and is more related in his approach to others and himself ? The findings in this case are consistent with other apotemnophiliacs who have undergone self-inflicted traumatic experiences ending in amputation of a limb or digit. After the amputation they can get on with life, free of the burden of the alien extension of their body, and they can and do finally live freely and happily (Smith and Furth, 2002: 45).

There is a disturbing lack of detail in these cases, for example after surgery is there a desire for further amputations? Do self-demand subjects suffer from a phantom limb and does this haunt them and their attempts to articulate their body boundaries surgically? Have the person?s feelings of what it is to be an "amputee" changed or altered after surgery? In Amputee Identity Disorder, the operation appears to put a "full stop" on people?s narratives, and their identities, at precisely the same place where many narratives of people who have gained "disability" in their lifetimes start (Keith, 1994). The potential loss of a limb is reframed by these individuals as a gain, the gain of an identity that brings a sense of wholeness and completeness, but what is this identity? As a non-disabled person it was not immediately obvious to me what the identity of "disabled" or "amputee" might be.

What Identity is Being Invoked in "Amputee Identity Disorder"?

The central move in disability studies has been the promotion of the "social model" above the "medical model" as a more liberating paradigm to frame disability. The "medical model" of disability relied on the idea that disabled people had bodies that needed to be fixed, and that these bodily deficiencies were the inevitable cause of practical difficulties experienced in the world. The "social model" of disability, which emerged in the 1970s, and has since dominated disability studies, challenged the oppression of the medical model via a paradigm that proposed the dual terms "impairment" and "disability" (Thomas, 2002). "Impairment" referred to a defect, absence or loss within the body, while "disability" categorised society?s reaction to "impairment" and documented the oppressive practices "impaired" people were subjected to such as exclusion and discrimination. Although the idea of "impairment" retains the notion that something is "wrong" or different about the body, the impairment/disability binary, which underpins the social model, has undoubtedly been experienced as a breakthrough by disabled people. While theorists may seek to take apart this binary in the same way that Butler has dismantled the sex/gender structure, they may also wish to reiterate it strategically because of its potential to challenge dominant preconceptions in non-disabled discourse. Arguably, the aims of the social model and the aims of Butler?s account of the body are not, as they are often perceived to be, irreconcilable. Self-demand amputation has the potential to mark the difference between impairment and disability, in that people claim a disabled identity, prior to gaining an impairment. However, it can also be useful as a means to explore the performativity of disability.

Since the publication of Smith and Furth?s book, the phenomenon has become associated with issues of identity; in seeking to frame the issue as an "identity disorder", the authors have unproblematically assumed that there is an "amputee" identity. Notwithstanding the fact that some people may wish to contest the noun and label "amputee" in itself, as other terms have been contested or reclaimed such as "disabled" and "crippled", the idea that there is a fixed identity among people with amputations, and that this identity is fixed by amputation appears to be not only politically problematic but also improbable. The categorisation "disabled" covers enormous diversity including differences in age, nationality, family, status, class, sex, job, education, sexual orientation and so on. One might assert that disabled activists have sought to bridge differences and identify with the term "disabled" to invoke opportunities for collective action; however there is no evidence that self-demand subjects seek this political identity.

However, it is also the case that disabilities carry a strong social stigma, and that people with amputations and other disabilities are framed in mainstream society by their "infirmity". As Carol Thomas writes:

If we have missing limbs, debilitating chronic diseases, or cannot see or hear, then we can expect to be grouped with others whose bodies and bodily behaviours are seen to vary from the usual in problematic ways ? then we belong to the ranks of the "disabled"? (Thomas, 2002: 64).

Terms like "amputee" camouflage multiple differences. Perhaps a major component of the desire for amputation is the desire for a coherent monolithic identity, one that can be somehow fixed through surgery. This is inherently paradoxical, in that the self-demand subject may be actually producing the identity of "amputee", yet at the same time denying this production by seeking it in the "real". This also raises the possibility that not only are the following things being fetishised: amputation, surgery in general, and the amputation operation in particular - but also identity itself.

As well as wondering what it means to claim this very specific form of disability as an identity, there are many particularities to consider: do people with non-elective amputations consider themselves to have changed identity radically following surgery? In framing this desire as an "identity disorder" who is assuming agency over self-definition? Is there such a thing as an inauthentic disability? Should elective disabilities be received differently?

What is clear is that these people are distressed, and subject themselves to mutilation, painful procedures and possible death to find a way of being in their bodies that they can live with. They also appear to be seeking out ways of being in society that many disability theorists may want to contest. However, it should be noted that self-demand subjects also appear to challenge deeply embedded ideas that disability is undesirable. This leads one to question whether the identity "disabled", as it is produced in non-disabled discourse, is encompassing, and whether this is exposed by the self-demand subject. Is this an identity that is so deeply embedded in non-disabled society that it is taken as pre-given?

Does the Self-demand Subject Expose that "Disability" is an Identity?

The issue of self-demand amputation does not appear to fit into existing paradigms, consequently listening to the voices in play in this debate, causes us to re-think these paradigms. As a non-disabled person, I was initially sceptical for the reasons outlined above, that there was a coherent identity "disabled". However, upon reading narratives by disabled activists and theorists I began to change my perception and realise that in fact, the everyday problems that people were describing on gaining a disability, were often not just problems of "impairment", of unequal access to education or resources, or of overt discrimination, but those of being inducted into a new, unwanted identity.

The "weight", dare I say "materiality", of this identity is something that Lois Keith vividly illustrates in her narrative "Encounters with Strangers". This is particularly demonstrated in this narrative because she is describing an experience of transition, from one identity to another: the "normative" identity of non-disabled to the new one of "disabled". It is often in trans narratives that one can see how the invisible mechanisms that produce identities operate (Prosser, 1998). In her narrative, the way she is being inducted into an identity is palpable. She describes various encounters she experiences after gaining a wheelchair. Her goal seems to be to manage various day-to-day encounters while remaining psychically intact, however she is arrested in this undertaking by "normal discourse" with the non-disabled people she encounters. They, in their discourse with her, implicitly frame her in an identity she does not identify with. This is done persistently and repetitively. She can see through the rhetoric that the people she encounters try to subsume her with, like the city executive who "helps her/hurries her" and the people who asks her two children aged four and six if they "look after mummy" (Keith, 1996: 86). About one such encounter she writes:

The first time I went out in my wheelchair without another adult I was going just around the corner to see an accessible flat which I was hoping to rent. I had been in hospital for five months, home but always accompanied for the next two or three and this was an important, confidence-building trip for me. I was talking control of my life again. I wasn?t completely alone, my four-year-old daughter was with me and this was another important feature of this journey: we were out on our own together, mother and daughter.

As we neared our first corner, a man I had never seen before, far from young and definitely wobbly on his pins, stopped straight ahead of me and said. "Are you alright love, shall I give you a push?" Now this might have been laughable if it wasn't so intrusive. Of the two of us, I was definitely the most mobile even as a neophyte wheelchair user. However, I hadn?t yet developed the antennae which would help me to predict what was going to happen next and I was just trying to work out I should respond when he lurched at me, taking hold of the back of my wheelchair, nearly knocking it and me off balance. I was so surprised I didn?t know what to do and mumbling something pathetic like, "I?m fine really, please let go", and I just kind of pushed harder round the corner, while my daughter said "why did he do that mummy, do we know him? (Keith, 1996: 69).

The literature vividly communicates the idea of peril, of the damage that can be done to someone?s identity, self-esteem, feelings of worth, and their sense of self. Some literature explores this in relation to the "stranger encounter", but alludes to even more disquieting "encounters" with people known well. Keith cites Robert Murphy, a social theorist on this matter:

The recently disabled person faces the world with a changed body and an altered identity- which even by itself would make his (sic) [Keith?s parentheses] re-entry into society a delicate and chancy matter. But his future is made even more perilous by the way he is treated by the non-disabled, including some of his oldest friends and associates and even family members (Keith, 1996: 70).

The terrible irony here is that not only is "disabled" an identity role, but that the tyranny of the role might mean that it has the potential to confer a relatively stable identity. Disabled activists have been resisting, challenging and re-making this identity through collective action, but dominant non-disabled discourse has a long way to go in terms of recognising and challenging its part in the formation of the identity "disabled", and the formation of identities which depend upon a relation to the identity "disabled".

Self-demand subjects appear to demonstrate that "disability" is a profoundly different way of being in the world. If this is recognised at all in the non-disabled community, a fiction is generated and maintained that this is the result of "impairment" and not because one is produced differently as a subject. The distinction between impairment and disability is helpful here. The self-demand subject inadvertently illustrates the difference between impairment and disability, in that they claim a disabled identity prior to gaining impairment. In this respect, in a surprising way they reinforce the argument that disability is separate from impairment and also raise difficult questions, such as where is identity located? Is it in the "materiality" of the body, or the "materiality" of culture?

The self-demand community appear to understand that "disability" is an identity in non-disabled discourse in the way that many non-disabled people, who are complicit in reinforcing such an identity, do not. Although their desire for amputation may border on the incomprehensible, self-demand people are, apart from anything else, witnesses to the power of the identity "disabled". Keith quotes Murphy on this matter:

A serious disability [i.e. impairment] inundates all other claims to social standing, relegating to secondary status all attainments of life, all other social roles, even sexuality. It is not a role, it is an identity, a dominant characteristic to which all social roles must be adjusted (Keith, 1996:73).

We are all subjected to identities that are not of our choice that might oppress, stigmatise, label and exclude us. There is something about the particularity of the identity "disabled" in mainstream discourse that has in the past had a profound capacity to oppress people subjected to it, grind them down, and eliminate or transcend any other identities they might have. It should be reiterated that this is something that predominant non-disabled discourse is complicit in, but rarely acknowledges or reflects on. The self-demand subject appears to crave that "disabled" identity and the "perceived" attention, notwithstanding that this might be unwanted, and thought of as infantilising, by disabled activists.

It is worth noting that the "attention" bestowed by the non-disabled community on the disabled confirms both identities. The disabled person may be infantilised and made the recipient of help, while the non-disabled person may be afforded the position of "normality" and bestower of kindness. Keith appears to describe the stranger encounter as one that involves "generosity" and "gratefulness" on both sides. The non-disabled person is grateful he/she is not disabled ("there, but for the grace of God ?") and so imposes help and patronage even when it has not been requested, and expects generous praise. In contrast, the disabled person in his/her role, is expected to be grateful for this act of charity and pity, and be generous in his/her thanks and praise to the non-disabled person. In this scenario non-disabled identity appears to be bolstered at the expense of the disabled subject.

One might imagine a pleasing symmetry in the encounters between people with self-demand amputations and the non-disabled, both enjoying and thriving in their roles of giver and receiver of charity and pity. However, this is apparently at the expense of the many disabled people who resist the role that society has carved out for them and desire agency in the way they are produced as subjects.

Disability, Self-demand Amputation and Medicine

The area of self-demand amputation is also interesting because it raises issues about the intertwined relationship between disability and medicine. In fact it may be impossible to untangle the relationship between them; however there are many things one can say on the subject. Although disabled activists might find the labelling inherent in medicine pernicious, one of the complexities of the situation is that on another level this labelling is vital to gain access to basic resources. Wendell (1996) describes occasions of people weeping with tears of relief and joy on the receipt of a chronic diagnosis such as MS, because it will validate their experience of their bodies. Wendell writes the following on the subject:

? many people whose bodies cause them great physical, psychological and economic struggles are not considered disabled because the public and/or the medical profession do not recognize their disabling conditions. These people often long to be perceived as disabled because society stubbornly contents to expect them to perform as healthy people when they cannot and refuses to acknowledge and support their struggles (Wendell, 1989: 109).

In her endnotes, Wendell cites pelvic inflammatory disease as an example of this description. One of the complications of the situation however, is that we might also read this passage with the self-demand individual in mind. In an attempt to address their experiences, the self-demand community, request the "cognitive authority" (Wendell, 1996: 124) of two distinct medical labels, that of "Amputee Identity Disorder" as well as that of "disabled". Medicine it appears is a route to gain identity and validation, even if that identity is "invalid". It is clear that medicine can confer identity, however, I think both parties are mistaken in their belief that the scalpel confers it. To complicate the issue Wendell also writes:

Of course, no one wants the social stigma associated with disability, but social recognition of disability determines the practical help a person receives from doctors, government agencies, insurance companies, charity organizations, and often from family and friends. Thus, how a society defines disability and whom it recognizes as disabled are of enormous psychological, economic and social importance, both to people who are experiencing themselves as disabled and to those who are not but are nevertheless given the label (Wendell, 1989: 108).

The confusion I am trying to invoke here is that not only do some people need the medical label "disabled", although they may simultaneously be oppressed by it, but also that some people, it appears, do want the "social stigma associated with disability" and appear on the surface to have framed their identity in a significantly different way. They have perceived that the label of disabled can confer identity and a certain role, something that is not usually apparent (to the non-disabled) in the non-disabled world, notwithstanding that this identity is one that many disabled people are profoundly struggling against. It appears that self-demand individuals expose something about the way society operates in relation to identity and disability.


This paper explored two main areas of debate, firstly the issue of body boundaries and secondly disability and identity. The section entitled "Morphological Boundaries" demonstrated that body boundaries do not necessarily correspond with the margins and contours of the anatomical body. At first glance the body image of the self-demand subject appears to be radically different to the norm; however this discounts the fact that the lived body is not analogous to the body on the anatomical chart. Thus, a person finding a limb superfluous to their body image is not as surprising as it may seem at first. Although medical discourse may construct it as such, the anatomical body is not a comprehensive map of the body, and contrary to one?s axiomatic beliefs, body boundaries are not invariably demarcated by the top layer of skin.

The second issue explored in this paper is the way in which self-demand amputation might cause us to question non-disabled preconceptions about disability, and bring to the surface some of the invisible, yet pervasive ways that "disabled" is produced as an identity. The 2002 framing of self-demand amputation as "Amputee Identity Disorder" helps to foreground the way that disability is produced as an identity.

In summation, identity orientated body modification raises questions about the relationship between identity and "the body". That people seek to alter identity through surgery suggests that the materiality of the body is being fetishised as the place where identity resides. It is clear that medicine confers identity, however I do not think it is the scalpel that confers it. Indeed the self-demand subject appears to confirm this by claiming the identity "disabled" prior to gaining an "impairment". The information examined in this essay would appear to support Judith Butler?s (1993) argument about embodiment, in that the materiality sought by self-demand subjects is not found in any straightforward way in the anatomical body, but on the contrary is found in a body which is not exterior to discourse. To put it another way, although surgery appears to provide access to the desired identity, that identity is not located in any simple way in anatomy.

[Although race is not discussed as a "topic" in this essay I want to draw to the reader?s attention to the fact that in writing about a "stigmatised identity" I am also always writing about race.]


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1 This article focuses on the connections between visible physical disability and identity. It is probable that the issues also have significance in other forms of disability such as learning disabilities, but the author has not had the opportunity to explore these at the present time.

2 "Self-demand" is the term used by Smith and Furth in Amputee Identity Disorder (2002).

3 Since writing this article AID has gained another name: Body Integrity Identity Disorder (BIID) which avoids some of the emotive connotations of the word "amputee"; neither AID nor BIID has yet gained recognition in the DSM. The categorisation of the condition is constantly evolving, and it is likely that this evolution will offer new possibilities for analysis, and for tracing how a phenomenon becomes a diagnostic category.