Ksenia Shishkova for Meduza
The term Body integrity identity disorder (BIID) in Western medicine describes people who want to get rid of their limbs - they are also called voluntary amputees. Those with this disorder perceive the limb as a foreign object; amputation for them is a way to feel "whole"; often these people purposefully harm themselves in order to get rid of a leg or an arm. Scientists began to research BIID only in the last 15 years and only in Western countries - however, there are voluntary amputees in Russia, where this problem is not being studied in any way. Sasha Sulim, a reporter for Meduza, talks about how their life works.
When Denis (the name was changed at the request of the hero) was four years old, he had a strange dream, which he still recalls. Dressed in black leather clothes, he was kneeling in front of an unknown woman, and she was beating him with all her might with a whip; but the main thing is that Denis had no legs in his sleep. That night, the boy woke up with pain from the blows and intense excitement from the sight of his stumps - he realized his sexual nature only many years later.
As a teenager, while his parents were at work, Denis liked to portray a disabled person: tying his leg, making a prosthesis, walking on crutches around his apartment in St. Petersburg, fantasizing about how and under what circumstances he could lose a limb. This game aroused in the boy sexual arousal, in which both the attraction to people without legs and the pleasure of realizing his own helplessness were mixed. Then the first thoughts appeared about how to lose limbs for real.
As a child, 45-year-old Igor from Kirov (the name and city was changed at the request of the hero), who grew up in an ordinary Soviet family: dad worked in a factory, mom in a hospital, also realized his desires. Once, when he was ten, the boy climbed a tree: “From the feeling of emptiness under my feet, I got an orgasm for the first time in my life. I think my father even noticed something, because he asked: did you happen to be pleased? But I, of course, did not confess to him. "
Igor does not admit to his family and friends that he is interested in people with amputated legs. “If my wife finds out about this, I have no idea what I’m going to do with myself. I don't think I can survive this, ”he says. He calls his attraction "demonic stigma", from which he can not get rid of. Igor fights with him, going to work (he has his own shoe repair business) or to his favorite hobby, hunting. According to him, even just observing animals distracts him from obsessive thoughts. “It happens that [people] sit for hours on guard ducks or wild boars. I can't do that, I need everything to change, I can't sit in one place, - says Igor. “To succumb to temptation and lose a leg means to lose the opportunity to do what you love and become a burden for your own family.”
An obstacle to happiness
For the first time, the disorder associated with attraction to people without limbs was described by the psychiatrist and one of the founders of sexology Richard von Kraft-Ebing in his work Sexual Psychopathy, published in 1906. The term "body perception integrity disorder" (BIID) appeared about a hundred years later - it was first used by Michael Furst, professor of clinical psychiatry at Columbia University, in his study of limb amputation: paraphilia, psychosis, or a new type of personality disorder "in 2004.
Eight years later, in 2012, Furst, along with his colleague Karl Fischer, assistant professor of clinical psychiatry at Columbia University, released another article on a rare disorder: Body Integrity Disorder Syndrome: A Persistent Desire to Become Disabled. In it, scientists propose a definition: the syndrome of violation of the integrity of the perception of one's own body is a poorly studied condition in which the physical picture of the body does not correspond to how a person perceives it psychologically.
In a conversation with Meduza, Furst called this medical phenomenon extremely rare, but at the same time widespread enough not to doubt its existence. “During the time that I have been studying this disorder, I have talked to about 150 patients suffering from BIID. But I am sure that there are thousands and thousands of them in the world, says Furst, noting that the development of the Internet and social networks greatly facilitated both his research and the lives of his patients. - Previously, people suffering from BIID thought they were the only ones in the world. They were very lonely and suffered madly from their dissimilarity. The realization that you are not alone, in some cases, can even save your life. "
For his first study, published in 2004 in the journal Psychological Medicine, Furst spoke with 52 people who admitted that they dream of amputating one or both limbs. The scientist found them on specialized forums; all interviews were conducted by telephone on condition of anonymity. The overwhelming majority of these people were men (there were only four women - and one transgender). Nine people admitted that they had already amputated their leg or arm, and six brought themselves to the operation on their own, using life-threatening methods - using an electric saw or dry ice, which causes tissue death. The three managed to persuade the doctor to amputate their healthy limb. Several people said that after the operation they felt much better and got rid of the obsession; none of the respondents had other psychiatric disorders (however, as Furst points out, the syndrome he identified can cause severe depression). All 52 people named the goal of voluntary amputation as the desire to find their own identity.
A more accurate quantitative analysis, according to Furst, is unlikely to be possible anytime soon. "You can't just bypass 20 or 200 thousand people with the question: do you want to amputate something for yourself?" he explains.
Another research paper on "voluntary amputees" was published in 2012 by several experts from the University of Amsterdam. They interviewed 54 people who admitted that they suffer from BIID and want to amputate or paralyze their limbs in order to feel like "full-fledged people" and find inner harmony with their bodies.
Scientists communicated with the majority of survey participants anonymously and only online, and collected data using detailed questionnaires; only five people agreed to meet with the scientists in person. The authors of the article note that in order to include in the study as many "voluntary amputees" as possible, they had to abandon the idea of offline communication, physical examination, and even telephone conversations. According to scientists, people with such a rare disorder find it very difficult to make contact, fearing that their identity may be revealed. In such conditions, it is almost impossible to ascertain the sincerity of the objects of research and the veracity of their answers. One way or another, each of the respondents (as in the case of Furst's study, the overwhelming majority were men) associated their first fantasies of amputation with early childhood; every second experienced sexual arousal when imagining that one day he would become an "amputee". The University of Amsterdam did not speak with Meduza, citing the excessive interest of journalists in their work.
One of the main goals of the Dutch was to ensure that the syndrome was recognized by the medical community - and the disorder would be included in all official medical classifications. With a proposal to add BIID to the list of mental and behavioral disorders in new version International Classification of Diseases (ICD-11) in last years Professor Furst also speaks. The work on the new classification should be completed in 2018 - and in its draft version there is a mention of a similar syndrome. In total, as of January 2017, 7186 adjustments were proposed to ICD-11, two of which relate to mental disorders. BIID also tried to add to the American classification of mental disorders DSM-5, which in last time was updated in 2013, but it hasn’t worked yet
Psychotherapist, Doctor of Medical Sciences, Leading Researcher at the Serbian Center Lev Perezhogin indicates that the current International Classification of Diseases (ICD-10) contains a section "Other disorders of habits and impulses", which, in particular, describes behavioral disorders that " characterized by repeated actions that do not have a clearly expressed rational motivation, cannot be controlled and usually harm the patient himself and those around him. " “If there were a person, but there would be an article,” Perezhogin sneers, admitting that such cases have been studied very little, and therefore are described in very general terms.
In the 2000s, journalists also began to take an interest in BIID. In 2003, the documentary Whole was shown at the Los Angeles Film Festival, in which the main characters described how and why they tried to get rid of their limbs. Three years later, one of the largest American TV channels ABC posted on its website material about three voluntary amputees. One of them sat in his own car for six hours, dipping his feet into dry ice, and then independently got to the nearest hospital, using the manual control that he had installed on the car in advance (this is used by people with disabilities who cannot operate the car with their feet). After the operation - he eventually had both legs amputated - the obsessions disappeared, but, as the man admitted to reporters, not a day goes by that he does not regret what he had done. Another heroine twice unsuccessfully tried to amputate her legs, and the third almost decided on an illegal operation in the Philippines: local doctors offered him to cut off a healthy leg for 10 thousand dollars.
In recent years, reports with similar stories have also appeared on Fox News, in the British tabloids Mirror and Daily Mail, in the American Daily Star and the New York Post. All of them featured people who dreamed of injuring their limbs - and who felt relief when they succeeded; the New York Post even cited an example from the 18th century, when an Englishman who came to France demanded that the doctor amputate his leg. When the doctor refused, the man shot himself in the limb and simply forced the doctor to complete what he started. Returning home, he sent the doctor money and a letter in which he explained that the leg was an obstacle in his path to happiness.
As far as Meduza knows, BIID studies have not been conducted in Russia. The concept of the syndrome of violation of the integrity of the perception of one's own body in Russian is found almost only in translated articles (with rare exceptions); neither scientists nor doctors use it.
Ampouti, Devoti and Wanbi
"Voluntary amputees" find each other in closed groups and on forums, and their communication is replete with slang borrowed from English: amputi (those who have already lost their limbs), vanbi (those who dream of amputation), devoti (those who sexually attracted to amputees). For this article, Meduza spoke with several dozen subscribers to the VKontakte communities, one way or another related to the topic of amputations.
However, as in the case of anonymous scientific research, it is often impossible to check how serious the users are when they talk about their aspirations for amputation. Activists of various thematic groups, often using surnames like Vannabko or Vannabs on social networks, sometimes write about amputations even too openly. Their pages are filled with photographs of half and naked people without arms and / or legs, often of a pornographic nature. When communicating with the Meduza correspondent, most of them stopped correspondence when they were asked to change the format of the conversation - for example, to call. With the main characters of the material - Denis and Igor - "Meduza" has repeatedly talked on the phone and Skype.
Now, when he is already over forty, Denis explains his childhood experiences with a strong impression of an unusual meeting: once, when he was still very young, a man with a wooden leg came to their apartment in the center of Leningrad. “The sight of this man frightened me and interested me at the same time. Then the eroticization of disabled people took place - this is one of the protective mechanisms of our psyche, - explains the man who became so interested in psychology that he studied it at the university, and for the last 15 years has been working in the USA in his specialty. "Since then, I have dreamed of having my leg or both amputated."
“The strong impression of meeting a man without a leg can become a decisive factor in the formation of sexual deviation in a child under six years old,” confirms the psychoanalyst, co-author of the portal “Contemporary Psychoanalysis” Nadezhda Kuzmina. "At this age, it is very difficult to distinguish between where the child fantasizes and where he just plays, so it is almost impossible to track the first shoots of psychological disturbance in most cases." Furst's research confirms that most often BIID really grows from childhood experience - and often the reason for the disorder is meeting with an amputee.
According to Denis, he spent years wondering if he was crazy - and in the end came to the conclusion that he was not. He calls the disorder its "feature" - and explains: "Vannabi psychotherapy is necessary. But if a psychotherapist believes that he can save a person from the desire to amputate, then he is not a professional and has no idea what he is talking about. It's like convincing a black man that he is white. Perhaps this is possible, the question is how healthy such a position is. " The therapy, according to the man, is needed in order to learn how to live with BIID - but it still feels like living in a prison. Liberation would be amputation, to which the man is not yet ready to go. “There are, of course, constraints. First, the parents, he explains. “They don’t know about my desire, I protect them.”
Other obstacles are of a purely technical nature. “If my Insurance Company If he finds out that the amputation was done not for medical reasons, but at my request, he will sue me, and I will be doomed to poverty and ruin, ”says Denis. "And the chances of finding a doctor who will agree to conduct it are also zero."
Several years ago Denis went to Europe hoping that he could find the right specialist. At that moment it seemed to him that he was one step away from his dreams. “It was a terrible period of my life, I really hoped that they would help me, but it never happened,” the man recalls. - After all this, I was already ready to build the guillotine. If someone had helped me with this then, I would have already been without a leg. " The instinct of self-preservation prevented me from bringing the matter to the end on my own: “I’m used to it, I learned to live with it,” says Denis, who calls himself “a slave to his desire”.
Dream operation
"Surgery is a drastic measure," says Furst. "Of course, this immediately raises the question of ethics." At the same time, today amputation operations are, according to researchers, almost the only examples of effective treatment. Furst himself supports this method only in the most extreme case: if nothing else helps - and if it is reliably established that the patient is aware of his actions. However, according to the scientist, it is impossible to exclude the possibility that a person will regret what he has done, even in this case.
By Russian legislation amputation without medical evidence can be recognized by the court as intentional harm to health - up to eight years in prison is due for this. However, in groups devoted to amputations, one can often find sentences with a similar wording: “ Full set services. Expensive, but reliable, legal and confidential. " The author of one of these announcements - he introduced himself as Viktor from Rostov - says that he himself is not going to cut anything off to anyone, but he can advise in detail and for money on all issues related to amputation. Victor once studied at the Faculty of Psychology; his diploma was devoted to attraction to “non-standard girls”: “It's easy to write when the patient is yourself,” he explains. It was then that he met his first Wannabi and realized that it was possible to earn extra money on this topic.
According to Victor, there are many scammers among his colleagues. "I immediately tell [clients] that if they come across an ad here [on VKontakte] that says: 'Give me money, and we will cut off your leg,' I do not advise you to write - it is either swindlers or a crime." More realistic options, according to Victor, are to simulate terrible pain in the leg, or better, to inflict at least a minor injury on yourself. “The most working scheme is to find a surgeon and agree with him (for money or for a bottle of brandy) that on a certain day you will be brought to him with a leg injury incompatible with life, and he will amputate it at a predetermined place,” he continues. explaining that Wannabis usually know exactly where they need to cut. - But the person should still get this trauma himself. Doctors run the risk of losing not only their licenses, but also going to jail. "
This is approximately how one of the interlocutors of "Meduza" acted - a resident of Blagoveshchensk Tamara (the name and city were changed at the request of the heroine). Her left leg was amputated five years ago. A 35-year-old woman who works as a hairdresser went to this operation for two decades: first, she independently removed her phalanges of her fingers, then received a minor injury, introduced an infection into the wound and achieved amputation for medical reasons. As she recalls now, after the operation, she experienced "relief" and "found herself." Now she continues to work by profession from home, brings up a twelve-year-old daughter (after the amputation, her husband left Tamara) - and says that she is already used to crutches, which are "very convenient for her" to use.
The only known case of a physician performing formal amputation of healthy limbs on patients with BIID was in 2000 in the UK. Dr. Robert Smith, a surgeon at the Royal Falkirk Infirmary in Scotland, published the monograph Questions, Answers and Recommendations for Voluntary Amputation, in which he announced that he had performed two operations to amputate healthy limbs on his patients. Smith stated that he had to go to extreme measures because of the risk that patients could self-harm - and noted that he had previously checked the mental health of his patients and made sure they were not sexually motivated. He refused patients who wanted to be amputated solely because of their sexual fantasies. According to Smith, after the operation, his clients felt much better - however, when the public learned about the non-standard procedure, he was forced to stop working, despite the steady demand for such surgical interventions.
Psychoanalyst Nadezhda Kuzmina notes that the current consensus on voluntary amputations may change - after all, not so long ago, plastic surgery was also "treated with skepticism." “A person of the XXI century has an extremely difficult relationship with his body, and fantasies of amputation can be one of the forms of rejection of his corporeality,” says Kuzmina.
Coming out of the shadows
Several years ago, Denis studied the medical histories of 150 transgender people as part of a scientific internship at a European research center. “As strange as it may sound now, but transgender people made me feel disgust and nausea. And it terribly embarrassed me, - the man recalls. - But I left the internship with a feeling of admiration and deep respect for these people: they are truly strong personalities, whose life is a real tragedy. But the Wannabis experience the same thing. I believe that we deserve to be treated with the same understanding as transgender people. "
Psychotherapist Perezhogin considers such a comparison to be incorrect, pointing out that not all transsexuals go for surgery, confining themselves to changing their passports. And even if surgical sex reassignment is carried out, such an operation does not cause any harm to a person. “In Russia, in the case of transgender people, a medical examination is needed to make sure that if they change their sex, they will be able to adapt to society in a new capacity,” Perezhogin explains. - What will be the adaptive effect of amputation for Wanbi? After all, in fact, their lives will not change from this in any way - except for the fact that they will have to walk in a prosthesis. "
Michael Furst, on the other hand, agrees with Denis's analogy. “In both cases, a person feels very uncomfortable in his body: some are embarrassed by the genitals and secondary sexual characteristics, others by four healthy limbs. Both transsexuality and BIID first appear in childhood or adolescence, then a person begins to portray the desired ideal, changing clothes into the opposite sex or tying limbs, the scientist explains. “To achieve the same ideal, both there and there, surgical intervention is required, which is not an end in itself, but a medicine against an irresistible desire to change sex or lose a limb.”
For Denis, the first step towards accepting his own identity was that he began to tell others about his desires. Denis's good friend was the first to know that he was a Wanbi and immediately shared the information with her husband. “Of course, I was shocked,” the man recalls, “but it helped me realize that it is impossible to live under this fear forever.” According to him, now he does not hide his desires from his boyfriends.
Unlike Denis, Igor did not talk about his desire for amputation with any of his relatives - he only discussed it on the Internet with strangers, but close in addictions. “I'm afraid the doctor will think I'm crazy,” the man explains. - I even turned to God, prayed, swore an oath. After that I could not go to websites and forums for only three weeks, and then everything returned with even greater force. " According to him, when he began to tell the priest about his problem, hinting that he was experiencing an unusual sexual attraction, he asked if Igor had Udmurts in the family (the man's father was Udmurt) - “and said that the Udmurts have very strong pagan roots and they are punished so much for this. "
Psychoanalyst Kuzmina admits that when she was preparing for an interview with Meduza, she called a dozen of her colleagues asking if any of them had encountered similar cases in their practice. “Even among colleagues, the first reaction was denial, reluctance to talk about it,” she admits, adding that until there is a medical consensus about voluntary amputees, experts are unlikely to be able to help them. “The pain is very difficult to bear alone. Communication on the Internet is at least some way to cope with it, "admits Kuzmina, who believes that sooner or later" Wanbi will have to come out of the shadows. "
According to Professor Furst, his American patients also keep their identity a secret. Very few people decide to open up to their relatives and friends, even fewer of those who find support and understanding from them. “One of my patients in New York has dreamed of becoming paralyzed for years. And at some point he decided to move only in a wheelchair. He's a sales assistant in a store, says Furst. - And then one day he just came to work in a wheelchair and announced to everyone that he had BIID. But his case is an exception. Usually people are very afraid to face negative reactions from others. "
At the end of his conversation with Meduza, Igor again returns to his desire to get rid of his “shameful” fantasies. “I really want to repent,” he says. - Just not in the order of the queue, as it usually happens in the church, but to talk to someone heart to heart. It seems that if I tell everything and the person listens to me and understands, then it will immediately become easier for me. "
Ampouti, Devoti and Wanbi
"Voluntary amputees" find each other in closed groups and on forums, and their communication is replete with slang borrowed from English: amputi (those who have already lost their limbs), vanbi (those who dream of amputation), devoti (those who sexually attracted to amputees). For this article, Meduza spoke with several dozen subscribers to the VKontakte communities, one way or another related to the topic of amputations.
However, as in the case of anonymous scientific research, it is often impossible to check how serious the users are when they talk about their aspirations for amputation. Activists of various thematic groups, often using surnames like Vannabko or Vannabs on social networks, sometimes write about amputations even too openly. Their pages are filled with photographs of half and naked people without arms and / or legs, often of a pornographic nature. When communicating with the Meduza correspondent, most of them stopped correspondence when they were asked to change the format of the conversation - for example, to call. With the main characters of the material - Denis and Igor - "Meduza" has repeatedly talked on the phone and Skype.
Now, when he is already over forty, Denis explains his childhood experiences with a strong impression of an unusual meeting: once, when he was still very young, a man with a wooden leg came to their apartment in the center of Leningrad. “The sight of this man frightened me and interested me at the same time. Then the eroticization of disabled people took place - this is one of the protective mechanisms of our psyche, - explains the man who became so interested in psychology that he studied it at the university, and for the last 15 years has been working in the USA in his specialty. "Since then, I have dreamed of having my leg or both amputated."
“The strong impression of meeting a man without a leg can become a decisive factor in the formation of sexual deviation in a child under six years old,” confirms the psychoanalyst, co-author of the portal “Contemporary Psychoanalysis” Nadezhda Kuzmina. "At this age, it is very difficult to distinguish between where the child fantasizes and where he just plays, so it is almost impossible to track the first shoots of psychological disturbance in most cases." Furst's research confirms that most often BIID really grows from childhood experience - and often the reason for the disorder is meeting with an amputee.
According to Denis, he spent years wondering if he was crazy - and in the end came to the conclusion that he was not. He calls the disorder its "feature" - and explains: "Vannabi psychotherapy is necessary. But if a psychotherapist believes that he can save a person from the desire to amputate, then he is not a professional and has no idea what he is talking about. It's like convincing a black man that he is white. Perhaps this is possible, the question is how healthy such a position is. " The therapy, according to the man, is needed in order to learn how to live with BIID - but it still feels like living in a prison. Liberation would be amputation, to which the man is not yet ready to go. “There are, of course, constraints. First, the parents, he explains. “They don’t know about my desire, I protect them.”
Other obstacles are of a purely technical nature. “If my insurance company finds out that the amputation was done not for medical reasons, but at my request, it will sue me, and I will be doomed to poverty and ruin,” says Denis. "And the chances of finding a doctor who will agree to conduct it are also zero."
Several years ago Denis went to Europe hoping that he could find the right specialist. At that moment it seemed to him that he was one step away from his dreams. “It was a terrible period of my life, I really hoped that they would help me, but it never happened,” the man recalls. - After all this, I was already ready to build the guillotine. If someone had helped me with this then, I would have already been without a leg. " The instinct of self-preservation prevented me from bringing the matter to the end on my own: “I’m used to it, I learned to live with it,” says Denis, who calls himself “a slave to his desire”.
Dream operation
"Surgery is a drastic measure," says Furst. "Of course, this immediately raises the question of ethics." At the same time, today amputation operations are, according to researchers, almost the only examples of effective treatment. Furst himself supports this method only in the most extreme case: if nothing else helps - and if it is reliably established that the patient is aware of his actions. However, according to the scientist, it is impossible to exclude the possibility that a person will regret what he has done, even in this case.
According to Russian law, amputation without medical evidence can be recognized by the court as deliberate harm to health - up to eight years in prison is required for this. However, in groups dedicated to amputations, one can often find sentences with a similar wording: “Full package of services. Expensive, but reliable, legal and confidential. " The author of one of these announcements - he introduced himself as Viktor from Rostov - says that he himself is not going to cut anything off to anyone, but he can advise in detail and for money on all issues related to amputation. Victor once studied at the Faculty of Psychology; his diploma was devoted to attraction to “non-standard girls”: “It's easy to write when the patient is yourself,” he explains. It was then that he met his first Wannabi and realized that it was possible to earn extra money on this topic.
According to Victor, there are many scammers among his colleagues. "I immediately tell [clients] that if they come across an ad here [on VKontakte] that says: 'Give me money, and we will cut off your leg,' I do not advise you to write - it is either swindlers or a crime." More realistic options, according to Victor, are to simulate terrible pain in the leg, or better, to inflict at least a minor injury on yourself. “The most working scheme is to find a surgeon and agree with him (for money or for a bottle of brandy) that on a certain day you will be brought to him with a leg injury incompatible with life, and he will amputate it at a predetermined place,” he continues. explaining that Wannabis usually know exactly where they need to cut. - But the person should still get this trauma himself. Doctors run the risk of losing not only their licenses, but also going to jail. "
This is approximately how one of the interlocutors of "Meduza" acted - a resident of Blagoveshchensk Tamara (the name and city were changed at the request of the heroine). Her left leg was amputated five years ago. A 35-year-old woman who works as a hairdresser went to this operation for two decades: first, she independently removed her phalanges of her fingers, then received a minor injury, introduced an infection into the wound and achieved amputation for medical reasons. As she recalls now, after the operation, she experienced "relief" and "found herself." Now she continues to work by profession from home, brings up a twelve-year-old daughter (after the amputation, her husband left Tamara) - and says that she is already used to crutches, which are "very convenient for her" to use.
The only known case of a physician performing formal amputation of healthy limbs on patients with BIID was in 2000 in the UK. Dr. Robert Smith, a surgeon at the Royal Falkirk Infirmary in Scotland, published the monograph Questions, Answers and Recommendations for Voluntary Amputation, in which he announced that he had performed two operations to amputate healthy limbs on his patients. Smith stated that he had to go to extreme measures because of the risk that patients could self-harm - and noted that he had previously checked the mental health of his patients and made sure they were not sexually motivated. He refused patients who wanted to be amputated solely because of their sexual fantasies. According to Smith, after the operation, his clients felt much better - however, when the public learned about the non-standard procedure, he was forced to stop working, despite the steady demand for such surgical interventions.
Psychoanalyst Nadezhda Kuzmina notes that the current consensus on voluntary amputations may change - after all, not so long ago, plastic surgery was also "treated with skepticism." “A person of the XXI century has an extremely difficult relationship with his body, and fantasies of amputation can be one of the forms of rejection of his corporeality,” says Kuzmina.
Coming out of the shadows
Several years ago, Denis studied the medical histories of 150 transgender people as part of a scientific internship at a European research center. “As strange as it may sound now, but transgender people made me feel disgust and nausea. And it terribly embarrassed me, - the man recalls. - But I left the internship with a feeling of admiration and deep respect for these people: they are truly strong personalities, whose life is a real tragedy. But the Wannabis experience the same thing. I believe that we deserve to be treated with the same understanding as transgender people. "
Psychotherapist Perezhogin considers such a comparison to be incorrect, pointing out that not all transsexuals go for surgery, confining themselves to changing their passports. And even if surgical sex reassignment is carried out, such an operation does not cause any harm to a person. “In Russia, in the case of transgender people, a medical examination is needed to make sure that if they change their sex, they will be able to adapt to society in a new capacity,” Perezhogin explains. - What will be the adaptive effect of amputation for Wanbi? After all, in fact, their lives will not change from this in any way - except for the fact that they will have to walk in a prosthesis. "
Michael Furst, on the other hand, agrees with Denis's analogy. “In both cases, a person feels very uncomfortable in his body: some are embarrassed by the genitals and secondary sexual characteristics, others by four healthy limbs. Both transsexuality and BIID first appear in childhood or adolescence, then a person begins to portray the desired ideal, changing clothes into the opposite sex or tying limbs, the scientist explains. “To achieve the same ideal, both there and there, surgical intervention is required, which is not an end in itself, but a medicine against an irresistible desire to change sex or lose a limb.”
For Denis, the first step towards accepting his own identity was that he began to tell others about his desires. Denis's good friend was the first to know that he was a Wanbi and immediately shared the information with her husband. “Of course, I was shocked,” the man recalls, “but it helped me realize that it is impossible to live under this fear forever.” According to him, now he does not hide his desires from his boyfriends.
Unlike Denis, Igor did not talk about his desire for amputation with any of his relatives - he only discussed it on the Internet with strangers, but close in addictions. “I'm afraid the doctor will think I'm crazy,” the man explains. - I even turned to God, prayed, swore an oath. After that I could not go to websites and forums for only three weeks, and then everything returned with even greater force. " According to him, when he began to tell the priest about his problem, hinting that he was experiencing an unusual sexual attraction, he asked if Igor had Udmurts in the family (the man's father was Udmurt) - “and said that the Udmurts have very strong pagan roots and they are punished so much for this. "
Psychoanalyst Kuzmina admits that when she was preparing for an interview with Meduza, she called a dozen of her colleagues asking if any of them had encountered similar cases in their practice. “Even among colleagues, the first reaction was denial, reluctance to talk about it,” she admits, adding that until there is a medical consensus about voluntary amputees, experts are unlikely to be able to help them. “The pain is very difficult to bear alone. Communication on the Internet is at least some way to cope with it, "admits Kuzmina, who believes that sooner or later" Wanbi will have to come out of the shadows. "
According to Professor Furst, his American patients also keep their identity a secret. Very few people decide to open up to their relatives and friends, even fewer of those who find support and understanding from them. “One of my patients in New York has dreamed of becoming paralyzed for years. And at some point he decided to move only in a wheelchair. He's a sales assistant in a store, says Furst. - And then one day he just came to work in a wheelchair and announced to everyone that he had BIID. But his case is an exception. Usually people are very afraid to face negative reactions from others. "
At the end of his conversation with Meduza, Igor again returns to his desire to get rid of his “shameful” fantasies. “I really want to repent,” he says. - Just not in the order of the queue, as it usually happens in the church, but to talk to someone heart to heart. It seems that if I tell everything and the person listens to me and understands, then it will immediately become easier for me. "
This rare mental state is expressed in the desire to get rid of or paralyze their own healthy limbs. What is the world, which its inhabitants themselves call the Non-acceptance of the Integrity of their own body?
Josh says that he carefully prepared for the amputation of his own left arm, which he performed with the help of a power tool. He says that before that he made repeated attempts to lose his hand. Once he put it under the trolley (but the cable holding the trolley did not break completely). He tried to saw off his hand on a circular saw, but his nerves broke down and he could not do it. He even came up with the idea that he drove for hours in a car around the city and its environs, sticking his hand out of the window, in the hope that it would be knocked off by an oncoming object. Not a single attempt yielded the desired result. But this time he was serious.
Josh (whose real name will remain unknown to the reader, as his family believes he lost an arm in an accident) says that he trained to amputate the legs of cows and pigs that he bought from a butcher shop. He had everything he needed ready: bandages and dressings to stop bleeding, and a well-loaded mobile phone, in case he gets sick.
Now, years later, Josh says he feels great without his arm and that the amputation has ended the "anguish" that has plagued him since high school. "It is an indescribable relief," he says in an interview with Newsweek. "I feel like my body is in order."
Oddly enough, Josh is not unique. Scientists call it a syndrome Rejection of the Integrity of Your Own Body(NCST), which is an extremely rare state of the psyche in which a person desires to have a perfectly healthy arm or leg amputated or wants to be paralyzed. This urge to become disabled seems so wild and contrary to basic human instincts that those who may be called NCST sufferers often keep their desires a secret. The Internet space has become the starting point for people with NCST syndrome to come out of the shadows.
A person with NCST strives for amputation of a healthy limb, seeking from doctors to perform such an operation, including resorting to shadow medicine or self-harm.
Perhaps academia will soon support this community. People with NCST syndrome attract the attention of scientists dealing with the problems of bodily integrity and such diseases as anorexia, a violation of the bodily scheme of the body, as well as transsexuality - which at first glance may seem to be the concern of only psychologists, but may also be a consequence of the peculiarities of the structure of the brain. “By studying the deep connections between neuroscience and psychology, we are able to talk not only about the prerequisites for development, but also about the work of the brain in general,” says Paul McGosh, a neurologist at the University of San Diego. Paul works with people with NCST syndrome, using one of the research methods, brain tomography. Such studies will help resolve the problem: is NCST syndrome a mental illness or an innate personality trait?
The Internet community of people with NCST syndrome insists that legal and safe surgery, or a special paralysis procedure under the supervision of doctors, is the only way to solve the problem. (While the researchers surveyed several dozen patients with NCST, there is no exact data to give an idea of the actual number of people with this syndrome. On the website transabled.org, where people with NCST syndrome have the opportunity to discuss their problems, today there are 1,500 visitors per day, while on the Yahoo Web group of BIID suffers - another site for discussing the same issues - 1,700 registered as permanent members) Most people with the syndrome are middle-aged European men who refute the opinion that that the syndrome can be treated as a mental illness through counseling and medication. They describe an obsessive, excruciating feeling of not being matched. ideal the bodily image that they have about themselves and the real body in which they exist. They say that their urge to become bodily themselves is irresistible. Some statements of people with NCST syndrome, comparing themselves to transsexuals, look somewhat contradictory. They also note that it took transsexuals years for medical psychologists to recognize their situation, and the law came to their defense.
Site owner and Sean O "Conor says that nothing but surgery can help him and his site visitors." Psychotherapy, like psychiatry, is powerless in this matter. Medication is useless. I myself am a typical example of a person who has gone through everything this, but convinced that it's all useless, "says Sean. He moves in a wheelchair, but has not yet found a definitive way to paralyze himself.
The very idea of becoming disabled seems offensive to persons who have become disabled not of their own free will. People with disabilities are reluctant to comment on the topic “Of course, this idea of depriving yourself of a healthy part of the body is outrageous,” says Nancy Stames, vice president of the National Disability Organization, pointing out that under the American Disabled Act, everyone, those who are recognized as disabled have the right to protection. “But I think that such people (people with the desire to amputate healthy limbs) should be approached by specialists in psychiatry,” concludes Stames.
Dr. Michael First, professor of clinical psychiatry at Columbia University in New York, is interested in the problem of body schema disorder and is trying to find a way to approach this rare condition. In 2004, he examined 52 people who wanted to amputate their healthy limbs. Fest found that their psyche was quite stable. “It is necessary to observe this in order to understand. These people say that every moment of their lives they feel the incompleteness of their bodies. But this does not in any way affect their ability to forge connections with other people. They are fully aware real world", Says Michael about his research.
"B and some" volunteers "achieved the operation to amputate the limbs without having any obvious medical indications. Such a person after the required operation (even after the amputation of both legs) finally feels comfortable and full, mental and physical inconsistency and felt sick. "
Fest is campaigning to include the disease in the next edition of the Bible of Psychiatrists and Psychologists - the Diagnostic and Statistical Manual of Mental Illness (DMC) - due out in 2012. For people with NCST, its inclusion in the JEM means recognizing as legal what they believe to be an integral part of their personality. “The biggest challenge is figuring out how to treat these people,” says Föst. He believes that the inclusion of the syndrome in the Manual of Mental Illness will help advance the resolution of the problem. "One thing is clear, and it is a fact that surgery has actually helped many of these people more than anything else."
There are only about a thousand people with this rare disorder in the world. Since childhood, they have been playing with disabled people, and, having matured, they strive to achieve amputation, causing damage to themselves. They clearly understand which limb and how much should be absent: “ten centimeters below the knee”, “no hand with the shoulder joint” - other options do not suit them.
The situation today is such that people with NCST syndrome do not have a great chance of surgical assistance, and this leads to the fact that they themselves make attempts to “cure”. The film by Melody Gilbert, dedicated to this problem, tells the story of a man who deliberately froze his leg by covering it with dry ice. Another solved the problem by shooting his own leg. In another case, a man took the risk of an illegal operation in Mexico, paying 10,000 dollars for it, only to die of gangrene a few days later.
Jess Ellison
Newsweek Web Exclusive
Hand for cutting, leg - under the knife:victims of mental illness are obsessed with amputations
Baz first saw an amputee when he was 4 years old. By the age of 7, thoughts began to come to him, "This is how I should be." At the age of 50, he managed to carry out his plan in early childhood - to amputate his leg. Baz froze her with dry ice so that she could no longer be saved and persuaded the surgeon to "finish the job." When he woke up from anesthesia and his leg was gone, he said: "The torment is over."
Melody Gilbert's documentary "Whole", which hit the Los Angeles Film Festival, tells the story of a group of people who call themselves "amputees of their own free will" ("voluntary handicapped"). Amputees at will crave to have a healthy limb cut off, and some have succeeded by taking matters into their own hands. Kevin, a university teacher, one of the heroes of the film, whose leg was amputated by Robert Smith, is a Scottish surgeon. Smith performed two more amputations of healthy limbs for people like Kevin. The film tells about George Boyer, who shot his own leg. Others used chainsaws or homemade guillotines for these purposes. What for? No one can say for sure, including the "amputees at will" themselves, who usually say that the desire to be left without any of the healthy limbs haunted them since childhood. “It’s definitely an unusual desire,” says Kevin, “but knowing that it’s“ unusual ”and saying it’s weird doesn’t solve the problem.”
“I want to be recognized what a state of exists", - says one of the heroes of the film Baz," and that there can be no other way than amputation in the treatment of the syndrome. "
In the film, there is practically no view of the problem from any other angle. With the sole purpose of filming unusual stories about unusual people (and possibly gaining their trust), Gilbert did not avoid a one-sided view of the problem. Voluntary disabled people talk about their condition and tell how they can be helped, and clinicians nod in agreement, showing their consent. The only dissenting person in the entire film is Jenny, the wife of one of the American "voluntary amputees" living in France. When Jenny decides that she cannot continue to stay with the man who wants to cut off his good leg, her husband accuses her of being narrow-minded.
Carl Eliot
Some scientists at lectures on various disorders of perception of the scheme of the body (one's own and another's) cite, as a comic example, Andersen's fairy tale "The Little Mermaid". According to the underwater princess, a prince with two legs will not fall in love with a girl with a fish tail, and decides to change his body scheme forever. But what is the norm for an earthly being, then torment for an amphibian: “You will maintain your smooth gait - no dancer can compare with you, but remember: you will step as on sharp knives, and your legs will bleed. And remember, since you will take on a human form, you will not become a mermaid again! " So the witch says to the girl-fish, who gives her the ability to move on land, besides taking her voice in return.
The desire to change at all costs, having acquired the appearance that is “your real body”, is subordinated in the fairy tale to the eternal idea of love. The little mermaid loves the prince, wants to be with him, and not lose hope that he will someday want the same.
What is the subject of the desire of a person seeking to change his body? if the motive of a given desire is rooted in strong impressions of childhood, then why does society deny its "practicality"? What is the "real body" in the Internet age? Why, so difficult and slowly taking root, the idea of surgical care for people with altered gender identity now does not seem so challenging, and the change in body scheme seems wild and unnatural?
What is so inviolable (and almost sacred) in the four-limbed of a person, and why, mastering nature, subjecting it to his will, he is not afraid to chop down giant trees and turn rivers back, but his own body remains a taboo for him?
REFERENCES AND TRANSLATION: SUPERCRIP
Compulsory writing of dismissal of your own free will. and got the best answer
Answer from Michael [guru]
Unfortunately, the situation now occurs quite often .. .See the recommendations of the deputy. the head Federal Service on labor and employment of Ivan Shklovets h ttp: //
and the Center for Social and Labor Rights h ttp: //trudprava.ru/index.php? id = 1510
(In http, remove the space)
Good luck!
And already to the heap, about honey. service (saw an old question) - :))
Appendix to the order of the Health Committee of the Government of Moscow and the Moscow City Fund of mandatory health insurance dated 12.07.2002 No. 352/75
4. Citizens insured under the compulsory medical insurance in Moscow receive medical assistance upon presentation compulsory medical insurance policy or a health insurance card (when first contacting a medical institution, in addition to the compulsory medical insurance policy, you must present a passport). Attaching the insured under compulsory medical insurance in Moscow to medical service in an outpatient clinic at the place of actual residence that does not correspond to registration at the place of residence, is carried out on the basis of a personal application addressed to the head physician. In case of violation of his rights, the patient can apply:
- to the head or another official medical institution, to the health care management of the administrative district of Moscow, the Moscow City Health Department;
- to an insurance medical organization that has assumed responsibility for payment medical care provided to the patient and the protection of his rights;
- to the City Arbitration Expert Commission - if the patient's claims have already been considered by the insurance medical organization and were not satisfied. Applications for transfer to the commission are accepted by the Office organization of compulsory medical insurance Moscow City Fund compulsory insurance, tel. 952-93-21;
- to court.
Answer from Nelichka L[guru]
Going on vacation, of course. But if you don't like the job, and there is another option, you can leave. You only need to leave when there is definitely an agreement about another job. Only.
Answer from Zoya[guru]
he has the right to refuse both options, let him be dismissed under the article with the payment of unemployment benefits, this is 2 salary. or for circumstances beyond the control of the parties (the record of dismissal must contain a link to the relevant paragraph of Article 83 of the Labor Code of the Russian Federation)
Answer from Evgeny Kulikov[guru]
If the employer insists on writing an application of his own free will, the employee can take a number of retaliatory actions and inaction. Retaliatory actions are the involvement of the labor inspectorate and the prosecutor's office to verify the legality of the employer's actions. Inaction - refusal to write a letter of resignation at will. The employee should not just write any statements, but it is necessary to continue working in normal mode... Record the time of arrival at work, the end time. Do not allow violation of labor duties, in case of imposition of a penalty, immediately appeal against it with the involvement of the Labor Inspectorate and the court, if necessary. " You can also contact the prosecutor's office: employees of this instance will redirect your complaint to the Labor Inspectorate.
It's the same with vacations. The vacation schedule is drawn up in advance. Leave at own expense (at the initiative of the administration) is not legal.
Answer from Catherine[guru]
Sew an application for leave without pay, because firstly, the experience goes, and secondly, perhaps the company will really be ok in 3 months.
And if she quit, she may not find a job now. Now this situation is everywhere, but on vacation you can earn extra money ...
Answer from Yoer[guru]
No one has the right to force anyone to do anything. I would not do anything, but would continue to work.
Answer from Andrey[guru]
PLENUM OF THE SUPREME COURT OF THE RUSSIAN FEDERATION
RESOLUTION
dated March 17, 2004 N 2
ON THE APPLICATION BY THE COURTS OF THE RUSSIAN FEDERATION
LABOR CODE OF THE RUSSIAN FEDERATION
22. When considering disputes on termination of an employment contract concluded for an indefinite period at the initiative of an employee, as well as a fixed-term employment contract (clause 3 of part one of Article 77, Article 80 of the Labor Code of the Russian Federation), the courts must keep in mind the following:
a) termination of the employment contract on the initiative of the employee is permissible in the case when the submission of the application for dismissal was his voluntary expression of will. If the plaintiff claims that the employer forced him to apply for dismissal of his own free will, then this circumstance is subject to verification and the obligation to prove it rests with the employee;
Answer from Ўriy[guru]
Going to complain, or to sue, or there is nothing to simply do nothing - this is a war with the employer! To fight or to humble yourself is a difficult choice and YOU make it. How to fight - they gave you a couple of correct advice (but not according to Art. 83 of the Labor Code). Chances of winning are great (but not 100%) - if you win, you will get 2-3 average monthly wages... But only from the white salary. And if it is black, then it's a penny, and then is it worth wasting time and nerves?
Courage and good luck!
Answer from Yotas Donin[newbie]
Yes, it’s nothing to write, I don’t bother The truth will be frightened that they will be fired under the article. Say let them fire under the cut sauce. For this and the severance pay will work out and there will be something to say to the future employer for the reason of leaving the former place of work.
Answer from SVik Karlson[newbie]
of these two options, only one choice arises (for a reasonable person) - choose the lesser of two evils!
or are you looking for a third option?
Answer from Marina Lvovna[newbie]
The advice they gave you is good only if the firm is firmly on its feet and just wants to get rid of the employee. But there is another option - what if the company is bankrupt? Analysis required financial condition firms. And only after him make a decision.
Answer from Alexander...[active]
It is very difficult to prove in a dispute with an employer. If desired, they can find any reason to justify their actions.
Can all combine: go on vacation and quit as soon as a new job is found?
Answer from Larochka[guru]
And we are in a similar ass! Excuse me for writing this, it's a shame to tears, we all cry, but we are fired because someone needs a place. Found on the internet free consultations lawyers, they called, they told us everything, they called the labor inspectorate, and they explained everything there, and good and truthful advice was written above. I understand how hard it is for you, we have two children and I am still on maternity leave.
Answer from Ўlya Nova[newbie]
If the question of dismissal is acute .. then let him quit "by agreement of the parties" ... I don’t know how about severance payments and compensations, but he will definitely be able to receive unemployment benefits at the employment center.
Prosthetics for children with amputated limbs presents particular difficulties due to the fact that the formation of the stump in them is influenced by continued growth, high tissue plasticity, as well as incomplete development of motor and, importantly, mental functions. All this is associated with the emergence of a number of problems and, in particular, defects and painful conditions of the stump, forcing to resort to additional, in some cases to multiple, surgical interventions. Characteristic feature stump in small patients is its developmental lag due to resection of the distal growth zone and the absence of normal, full-fledged function of the limb. In addition, the sharpened (due to the resorption process) end of the bone often grows into the surrounding soft tissues, up to the perforation of the skin. This interferes with normal prosthetics and causes repeated stump remutations in children.
Due to the faster growth of the radius and fibula, fibrous and bony adhesions can occur with paired, parallel bones with them (respectively, with the ulna or tibia), which ultimately leads to varus (O-shaped) or hallux valgus (X-shaped) deformity of the leg and forearm stumps and joint recurvation. Subluxations and dislocations in the shoulder joint often occur after a child has undergone a high amputation of the shoulder, and subluxations in the proximal tibiofibular joint and in the knee joint after amputation of the lower leg. Phantom pains, osteophytes, and painful neuromas are much less common in children than in adults.
In order to reduce the intensity of the development of pathological processes in the cult when performing amputation in children, the following requirements must be met: first, the growth zones of the bone, the bone itself and the soft tissues of the affected limb should be preserved as much as possible; secondly, it is necessary to think about the use of atypical approaches to amputation along with traditional bone, fascio and myoplastic methods; thirdly, apply skin grafting in case of skin deficiency.
In fact, the maximum saving of the length of the bone lever and, of course, the soft tissues of the stump in this situation is one of the main conditions for creating a functional limb stump, taking into account the forthcoming long-term use of the prosthesis. In children, as a rule, based on the above requirements, doctors try to isolate the joints without cutting off the growth zones, including the articular cartilage of the tubular bones. Since bone growth occurs at the expense of the basal layer of the articular cartilage, during amputations at the level of the hand or foot, it is not excised if possible, thus preserving the entire joint and providing the prerequisites for the normal growth of the remaining bones.
In order to prevent the stump lagging in growth in situations where the limb is amputated according to Pirogov or according to Gritti, the truncation of the bones is made distal to the level of the growth cartilage. Bearing in mind the advanced growth of bones, at every opportunity at the end of the stump, it is recommended to preserve the excess soft tissues available there, or to create a supply of them specifically by lowering skin-cellular flaps from the superior proximal sections of the stump.
