Being whole after amputation.

Assessing various studies on Body Integrity Identity Disorder (BIID), Müller (2009) claims that while psychology and psychiatry may have provided accurate descriptions of this rare disorder so far, they fail to actually explain it. According to her, only neurology can convincingly explain it: it is most likely that this disorder involves a congenital malformation in the brain. This claim about the cause of BIID is crucial for her answer to the question whether elective amputation is ethically justified or not. Taking for granted the neurological explanation of this disorder, she argues that elective amputation is not justified; if the problem can be located in the brain, it is the brain that should be treated, instead of amputating a healthy limb. Referring to the so-called four principles of medical ethics, she also maintains that elective amputation can also not be justified by a patient’s autonomous decision, since it is not clear how autonomous such a person actually is. In this review we would like to comment on two issues in Müller’s target article: 1) her emphasis on a neurological explanation and treatment, and 2) her principlist ethical approach. As an alternative we would like to provide an existential clarification of BIID, and a phenomenologicalnarrative ethical approach which leaves the possibility for interpreting a person’s autonomy against the background of the person’s embodied experience and his or her life world. Although it might be true that psychology and psychiatry research on BIID leaves us with unresolved questions of classification, we doubt whether resorting to neurology will resolve this problem. At least four objections can be raised here: 1) The suggestion that a neurological disturbance should be seen as the cause of a distorted embodied self-experience entails a crucial fallacy: every experience correlates with a certain neuronal activity, but this does not mean that neuronal activity causes experiences. Correlation does not necessarily imply a causal relation. 2) The neurological “explanation” is in fact no more than a hypothesis (Ramachandran and McGeoch 2007). 3) The idea that it may be better to adapt one’s neuronal body image to one’s body than to adapt one’s body to one’s neuronal body image does not take into account that manipulation of the brain is very risky and that an exact manipulation is in fact not (yet) possible. Neuroscientists who have established that transsexualism also correlates with a deviation in the brain, consider sex reassignment surgery as an adequate therapy (Cf. Swaab 2007) and do not even mention the possibility of a “causal therapy” which would influence the brain. 4) It is