You want us to do what?

Some urges are so horrifyingly self-destructive that they defy belief. I hesitate to post on this disturbing NYT article. (Sitemeter says that most of my readers prefer posts about eating crayons.) But Ann Althouse has already noted it. What to make of physically healthy people who demand to have their limbs amputated, and what to make of surgeons who do their bidding?

The patients' disorder already has an unpronounceable name: "apotemnophilia." There's debate about whether to include it in DSM:

...an obsessive desire for a limb amputation - one that drives people to cut off healthy arms and legs - tests the tolerance of even the most open-minded.

Body integrity identity disorder has led people to injure themselves with guns or chain saws in desperate efforts to force surgical amputations. A few have sought out amputations abroad, including one man who died of gangrene after an elective amputation in a clinic in Tijuana, Mexico.

The disorder has been known by several names. In 1977, Dr. John Money, an expert on sexuality at Johns Hopkins University, named it apotemnophilia (literally, love of amputation). He considered it a form of paraphilia - that is, a sexual deviation.

The syndrome apparently may share features of delusional disorders, obsessive-compulsive disorders, gender-identity disorders (which may involve sex-change surgeries) and eating disorders (which may involve starvation and the belief that one is obese). When patients request amputations, I'm hopeful that surgeons won't simply take them at face value, but will arrange to get Psychiatry involved. It looks like some of these patients are hard to stop, though:

In May 1998, the urge drove one man to a California surgeon who had lost his license more than 20 years earlier for several botched attempts at sex reassignment surgery. At a clinic in Tijuana, the surgeon, John Ronald Brown, 77, cut off the left leg of Philip Bondy, 79, of New York, who had paid him $10,000. Then Mr. Brown sent Mr. Bondy to a motel in a run-down section of San Diego to recover on his own.

Two days later, Mr. Bondy was dead of gangrene, and Mr. Brown was charged with second-degree murder. During the trial, newspaper reports said that Mr. Bondy had sought the operation to satisfy a "sexual craving." Mr. Brown was found guilty in October 1999 and sentenced to 15 years to life in prison.

Mr. Bondy was not alone in his desperation. Among the body integrity identity disorder sufferers in the documentary "Whole" by Melody Gilbert, broadcast on the Sundance Channel in May 2003, is a Florida man who shot his own leg so it would be amputated in the emergency room, and a man from Liverpool, England, who packed his leg in dry ice for the same reason. The man who froze his leg referred to the resulting amputation as "body correction surgery."

As Dr. Hamlet once told Horatio: "There are more things in heaven and earth than are dreamt of in your Psychiatry..."