To what extent is a person allowed to alter their body?

Medical ethics, mental illness and a physician's responsibilities to alleviate suffering are called into question in Anil Ananthaswamy's article for Matter Magazine, 'Do No Harm.'

Body Dysmorphic Disorder (BDD) is a mental illness commonly seen in adolescents and young adults with anorexia and bulimia, while in males it can cause excessive bodybuilding as well. The patient cannot reconcile his actual physique with the mental image he has of himself. This causes many young ladies who would be considered painfully thin to see themselves as bloated and disgusting, causing them to participate in risky behaviors to lose weight that isn't there to lose. In males, many see themselves as scrawny or weak, causing equally risky workout routines to 'bulk up' an already impressive physique. Mortality risk can be high in both instances, as the patient takes more and more extreme measures to achieve the unrealistic goals they've set for themselves. Once identified, psychiatric therapy and, in some cases, medication can be moderately effective in helping these individuals regain more healthy lifestyles.

Transgender individuals face some of the same problems. Their internal gender identity doesn't match up with their physical sex, and the social stigma of bringing their physical self in line with their mental and emotional self can cause years of depression, anxiety and other emotional problems. Unlike with BDD, transgender people do not respond to psychiatric treatment or medication, and generally are happiest when allowed to live as they wish, whether simply dressing and acting as their self-identified gender, or going farther with hormone therapy and surgery. These treatments are generally accepted to be medically valid, and a transgender person can have a reasonable expectation of treatment.

A much less well known phenomenon is starting to gain the attention of the medical community. Body Integrity Identity Disorder (BIID), on the ouside, seems fairly close to to BDD. These patients feel that their self, their internal body image doesn't include one of their limbs. These sufferers are the topic of Ananthaswamy's 'Do No Harm.'

Sufferers of BIID feel like the limb isn't theirs. They see that it's attached, it functions perfectly normally, but their mental image of themselves simply doesn't include it. It's a hunk of flesh that they don't want, but no amount of diet or exercise is going to get rid of it.

Unlike patients with BDD, neither therapy nor medication gets rid of the symptoms. There is no accepted physical cause, and in fact, if the limb is removed, the associated depression and anxiety go away. The patient is left perfectly happy, with a physical self that finally matches their self-image.

The problem that sufferers of BIID run into is that no medical practitioner is going to remove a perfectly healthy limb simply because the person in front of them says that they want it gone.This has caused many with this disorder to try life-threatening measures to damage said limb to the point where doctors have to amputate. Another path is to find a back-alley surgeon, or a doctor in a country where money talks more than medical licenses. Both paths have their own inherent risks, but after exhausting the medical establishment, there aren't many options left.

'Do No Harm' explores the medical ethics of the situation, as well as the desperation of those who suffer from BIID. No longer suffering alone, Ananthaswamy explores the support groups these people have formed online, interviews doctors who have come face-to-face with people with BIID, and challenges the reader to make her own decision regarding the question at the heart of this problem: does a person have the right to alter his own body as he sees fit?

Highs: Ananthaswamy does a wonderful job seeking out as many viewpoints as possible for this article, which gives it amazing depth.

Lows: Some of the people the author interviews aren't the most likable of people, but the perspectives they give are necessary to the narrative.

Verdict: A fascinating look at a mental illness that doesn't get much press, available for free at the Matter Magazine website.

Further Reading: 'Electric Shock!', The Immortal Life of Henrietta Lacks