egkelly - you read my mind - I was going to bring up the alien abduction scenario. I’m sure there are a lot of dopers out there who have read Carl Sagan’s “The Demon-Haunted World”, a book which deal with (among other things) the whole alien abduction epidemic, and it’s point-by-point similarities to demon possession, seeing elves & fairies, and other cultural phenomena. Same symptoms, different cultural interpretation. Once you get a bunch of people with degrees declaring it to be so (loudly, often, and in a news-worthy way), suddenly everyone who has had a similar, and apparently quite common and normal experience has been abducted by aliens.
Sorry, I should have realized that folks would think I meant to imply that it was. I mentioned schizophrenia specifically mainly because it is the oldest still-extand psychiatric diagnosis, and because I used it as the “example diagnosis” in the paper I cited in the link.
Admittedly, the topic of mental illness / psychiatric treatment is the one that gets me on my soapbox quickest loudest and for the longest time 
::having said that::
Oh, is that once again a theory considered current and reputable? That was popular a couple decades ago, and then they switched their attention to serotonin. They are ALWAYS right on top of being able to make a physiological explication of schizophrenia (any day now, for the last 100 years), but it continues to be a very badly defined illness, diagnoses on the basis of behavior alone, for which sufficient reliable data is still lacking for being able to say with any certainty much more than “It would appear that the population of people who seem to have aberrant thinking processes have some small but statistically significant differences in their brains from those who do not.” (well, duh!)
The only coherent theory concerning schizophrenia that I have ever seen was covered in the book;
“The Origins of Consciousness in the Breakdown of the Bicameral Mind”
by Julian Jaynes. Has anyone else here read this? It is a superb treatise on the function and origins of consciousness and also gives an explanation of that other psych boondoggle, hypnosis.
Jaynes’ theory that schizophrenia is merely a revision to an older form of non-conscious behavior is quite compelling and the evidence that he provides makes his case very well. If you read this book you will not look upon history or the human mind quite the same ever again.
This is a popular theory, especially with people involved at the chemical dependency end of the spectrum. However, according to “The Biochemical Basis of Neuropharmacology” (p. 332) “Although there is a lot of data that supports the dopamine hypothesis, at present we have no direct experimental evidence of an excess of dopamine-dependent neuronal activity or an elevation of dopamine levels at central synapse in schizophrenics.”
Well, told ya I wasn’t an expert! 
It’s all pretty interesting though, isn’t it?
lucie, if you are seriously interested in this question, you should read Michel Foucault’s Madness and Civilization.
by the insanity it produces?
i would be inclined to wonder if warlike cultures would be more likely to produce this desire for amputation because a peaceful culture might have fewer amputees and no need to glorify heroism. didn’t read the entire article but wonder now if more men or more women want amputations.
i southeast asia they have panics of men fearing their penis will be shrink into their bodies. read of cases of people having someone hold their penis while they slept.
a culture has to put wierd ideas into peoples heads in order for them to get ridiculous about it. can the american love affair with the automobile be included as a cultural insanity? no that’s NORMAL.
Dal Timgar
Random observations from an addled perspective:
EVERYBODY has multiple personalities. (I myself have 28.) It’s only a problem if it’s a problem (if you have conflicts integrating them on a day to day basis). A solitary, unifying “I” is a lovely fiction.
Brain chemistry is a part, but not the whole story. Environmental factors tend to be overlooked in treatment. The CIA has been studying was of inducing symptoms of mental illness in otherwise “healthy” people with rousing success for 50 years now. Also, people with equal genetic predisposition and brain chemistry deficiencies: one will develop schizophrenia, the other won’t. That’s a big riddle.
Me too! lucie, be my sock puppet!
Okay, on the subject of my OP, talk to me about treatment. Should the desire to amputate a limb be regarded and treated as a mental illness with therapy alone, therapy with drugs, therapy with surgery (amputation, not a lobotomy)? Or should it be regarded as an identity issue (once a diagnosis of , I don’t know, otherwise normal? is pronounced) and amputation permitted as cosmetic surgery?
If someone came to you and said their HMO referred them to you because they wanted to amputate both legs at the knee and would only do the surgery if you signed off on it, what would you do? How would you treat them?
The more I think about this issue, the fuzzier the lines seem, once over the initial yuck reaction. How different is wanting a limb removed (psycho alert!) from wanting a sex change (nature screwed up, we must fix this person)?
They Call Me Sneeze–
Wait a minute. You’ve complicated things with this example:
Are we talking about someone with only DID, or are we talking about someone with DID and another psychological problem on top of that? Granted, we were vague when we talked about ignoring “aspects” and “symptoms” of their illness, but I wasn’t expecting you meant the symptoms of an entirely different illness altogether.
Furthermore, given how difficult it can be to treat anorexia, I don’t think it’s a good example of an compounding mental illness.
Anyway. I’m no expert in any branch of psychology, so I’m just guessing here. But I seriously doubt that even with patients with two distinct psychological conditions, that any doctor would ignore anything about that patient. If there was such an unfortunate patient who suffered from both DID and anorexia, my guess is that the illnesses would be tackled concurrently, and that more than one psychiatrist and/or psychologist would be involved. And although they’d be working together (communicating, exchanging notes, etc.), each would focus on one disorder.
I still don’t buy it. Are you saying that the only reason the disparate personalites existed before the person sought treatment for it was because he/she was paying attention to them? The problem I have with that is that it suggests that the person is an observer to his personalities at some root level. DID doesn’t work that way.
Or do you mean that if other people (such as family, friends, and doctors) ignore the personalities, they’ll go away and the person will be “themself” again? I don’t accept that either. You’re saying that the other personalities will simply dissolve out of feeling unwanted or from lack of use. I doubt that that will work either; my guess is that the person with DID would just walk away and cut you out of their lives. That treatment also approach doesn’t address what may have caused the personalities to distinguish themselves in the first place, and it places no safeguards against relapse.
lucie–
I think DID just became the hot diagnosis-of-the-moment. It caused doctors to re-examine their patients and patients to take a look at themselves and wonder if that disorder was what they had. Since it was early into DID’s discovery and little was known about it, people could have been mistakenly diagnosed. (To know for sure, though, we’d need the numbers of how many people were diagnosed with DID, and then how many later had their diagnoses changed.)
Patient reactivity to DID could also be responsible for the sudden increase in diagnoses. It’s not unheard of for people to read about the symptoms of an illness and start seeing those symptoms in themselves; this is called medical students’ syndrome. Given that, I don’t think it’s too much of stretch to see how people could convince themselves that they have DID. The tricky part then becomes separating those who actually do have DID from those who just think they do.
Why would someone want to have DID? Because maybe for them it explains a lot of the things they’re thinking or experiencing. Because it places a name on what problem it is they have, which is preferable to not knowing what’s wrong with you. Because knowing what you have leads to a treatment and possibly a cure.
Mistakenly, yes, but as I said, misdiagnoses could have/would have been corrected afterwards. I think DID always existed, but because of the rarity of a genuine case (a rarity which continues today), it was just not recognized as being different from other mood disorders or schizophrenia.
If they did develop new symptoms after hearing of DID, then it’s likely because of reactivity.
Should it be regarded as a psychological problem? I say yes. I don’t see how it could be normal (by any context or definition) to want to have part of your body removed or altered. For that reason, I don’t think surgery to fulfill the desire to become an amputee should ever be carried out.
(I also would not consider it a “cosmetic” surgery, because that likens it to nose jobs and breast augmentations. For them to truly be the same thing, you’d have to come away from surgery with a nose that obstructs your breathing, or breasts so large they put a strain on your back and shoulders. Your ability to function and your comfort in doing day-to-day things would have to be reduced somehow.)
In order to figure out the best way to treat something, it helps to know what it is in the first place. I don’t know where among psychological disorders apotemnophilia would fit; my guess is with somatoform disorders, such as body dysmorphic disorder. If that’s so, then their treatment methods should be similar. BDD is treated with cognitive therapy. Anti-depressants sometimes help, but not really in treatment of the BDD itself. People with BDD are often depressed because of the perceived major flaws in their appearance.
Excellent question. The best I can do is this: Nature did screw up for transsexuals-- they were born into the wrong bodies. Nature, however, made no mistakes in giving someone two arms and two legs and ten each of fingers and toes.
Of course, why I can accept transsexualism and not apotemnophilia is something I should think about.
AudreyK quote:
But I seriously doubt that even with patients with two distinct psychological conditions, that any doctor would ignore anything about that patient.
It happens all the time, especially with co-occurring diagnoses of mental illness and chemical dependency. (I’m not sure what the Surgeon General’s Report pegged that at – at least 20% of the mentally ill are dually diagnosed. What insurance covers is what gets treated. Welcome to managed care)
lucie quote:
Did people find a new way to “go mad”, developing symptoms they would not otherwise have manifested if they did not hear of them?
AudreyK reply:
If they did develop new symptoms after hearing of DID, then it’s likely because of reactivity.
AK, have you ever studied suicide clusters? We are, unfortunately, uncomfortably, positioned in the culture we’re in. Waving away real deaths, over thousands of years (see Loren Coleman) under the cloak of “medical student’s syndrome” or “reactivity” isn’t really addressing the milieu both the doctor and the patient find themselves in. It’s real if you think it’s real.
[OT] You get to do this (psych research)? for a living? in Hawaii? First, let me direct you to the “What is the best job in the world” thread, and secondly, let me offer my services as, um, collator, blanket folder, grant writer, gadfly, banjo tuner… umm… Devil’ Advocate, bell hop, scorpion exterminator…shell sorter, carbuncle eliminator, expert on the fall of 1923 International Spanish surrealism artists who’s collaborator’s middle initial scores less than 7 no matter where you put it on the board in Scrabble. [\OT]
lucie quote:
Okay, on the subject of my OP, talk to me about treatment. Should the desire to amputate a limb be regarded and treated as a mental illness with therapy alone, therapy with drugs, therapy with surgery (amputation, not a lobotomy)? Or should it be regarded as an identity issue (once a diagnosis of , I don’t know, otherwise normal? is pronounced) and amputation permitted as cosmetic surgery?
Well, AK completely misses the point here. When I got my ear pierced, back when Lincoln was president, my father made the same argument. That said, as a physician, the 1st rule is: do no damage. Someone wants their leg cut off, they got to go to the barber.
At work, they frown on me doing freelance counseling – unless someone is decompensating and violent, which I happen to be very good at. It’s not a billable activity, you see. And taking phone calls from delusional people. And re-engaging people from being hospitalized back into the community.
Sorry! My third random personality is Boingo, the over- exuberant banjo tuner who has no social skills. My apo logies.
Well now, that totally sucks.
In the case of anorexia with DID, I can see how anorexia would receive treatment first; it’s a life-threatening illness. Even so, I can’t see how any illness would be ignored in hopes that it’ll just go away, as They Call Me Sneeze said.
Tell me about suicide clusters. I haven’t heard of them until now.
I didn’t mean to say that people who exhibit symptoms because of reactivity aren’t experiencing real problems or distress; my point was just that they could have increased the incidence of DID diagnoses.
I guess I need to elaborate:
I don’t see how it could be normal (by any context or definition) to want to have part of your body removed or altered so drastically. Things like tattoos and piercings and brandings (I’ve seen it) excluded.
[OT]
I’m a volunteer lab leader for four PSY 100 classes. I’m not paid.
[sub](However, one of my students calculated that if I obtained the answers for all 4 variations of the quizzes for all the chapters, and then sold them to all my students for $1 each, I’d rake in $12,000 this semester.) :)[/sub]
Thank you. 
You and Boingo can help me photocopy stuff and stare down evil library book-shelvers.
Is your random second personality named Oingo, by any chance?
Fnzbit! She’s found me out.
I’ve had roughly 15 years of experience in the field.
I am currently on social security disability due to ongoing clinical depression. The most accurate diagnoses I’ve gotten to date is: bipolar affective disorder(manic depression to the lay folk), attention deficit disorder, and obsessive compulsive disorder (in the form of anxiety attacks over the same minor concerns. With out the proper medication I would be unable to sleep due to fear that a friend had borrowed a tape and not returned it.).
I began studying psychology at age 10. I realised that the doctors had quite a bit of control over my life. Almost immediately, I realised that some of them were completely wrong about me. I went on to major in Psychology at Penn state. I was a star pupil and in the honors program. Then in fourth semester, the medication stopped working. I've been unemployed and unable to return to school for the past six years. So I consider myself something of an expert on mental illness.
I have a close friend who has DID. They were subjected to serious abuse as a child. In case one of my friends finally takes my advice and joins the SD board, I’ll call my multiple friend Lou. Most of the people in Lou’s life do not know that he has multiple personalities. The shift in voice and body language that accompanies a shift in personality usually goes unnoticed. Thus, most people never address any of Lou’s other personalities. Ignoring them has not made them go away. Lou was subjected to extreme abuse as a child. His father once threw him out of a moving car. Certainly some cases of any illness are attributable to medical student’s syndrome, but Lou is a very genuine case of DID.
As for the original op, what is and is not an illness is definitely defined by culture. In many societies the carrying of talismans and the casting of spells is a normal part of everyday life. Psychology textbooks define this as "magical thinking". Diagnostic manuals list magical thinking as a symptom of some conditions and as something to be cured. To most psychologists, psychiatrists, and other shrinks a practicioner of Santeria, Voudoun, or Wicca is not some one with an active spiritual life but some one with delusions and megalomania.
There is a tendency to lump difficult cases under a condition that has been recently discovered or in which there has been a recent discovery. I was born in 1975, well before the media spotlight fell on ADD. My own resarch and my various problems when not on medication, have convinced me that ADD does exist and that I have it. Sadly awareness of ADD has caused many children who have other conditions or no condition at all to be misdiagnosed and given unnecesary medication. This is not confined to mental health however. When silicone implants were recalled many women claimed that they had caused a wide variety of symptoms. A few universities did research on this. They found that most of the complaints were unrelated to the implants. People want an answer to their problems. If the doctors have been unable to diagnose or help little Bobby, parents are happy to accept a diagnosis of ADD or DID because it is the first step toward getting help for their child.Bullshit. I mean, pardon me for accepting the word of the Surgeon General and the Encyclopedia Britannica (to name just two) over yours.
You sound like some who, when they get cancer, refuse to believe that they have cancer, and may even declare there is no such thing as cancer, all to avoid accepting the uncomfortable, frightening truth.
You also sound like a creationist who, when hearing scientists say they don’t know exactly how evolution works, will then pounce on the scientists and ask, illogically, “If you can’t explain it, how can you say it exists?!”
I read most of “Witchpaper '97.” You actually condemn psychiatric institutions for existing in order to protect society from the mentally ill, as if society had neither right nor obligation to protect itself.
You claim that scientists can’t say there is schizophrenia because they can’t agree on what causes it, whether it’s “oversensitive dopamine receptors” or “interference in the uptake of serotonin.”
That’s like saying there is no such thing as cancer because we don’t know everything about it. And that is bullshit.
It’s unfortunate you have schizophrenia. I’m clinically depressed myslef, so I know what it’s like to have a mental illness that may never be cured. But I learned one thing:
They can’t help you if you won’t let them.
DocC is my new favorite poster. I’d like to write an essay to respond to issues raised in the last post. Instead, this.
One of the things I do these days is fix computers for social workers. They push a button, it flails. I push the same button, it works. I have to ward against magical thinking, or they’ll intake me (even tho that seems to be the most logical conclusion).
Yesterday was my 8 year anniversary in the mental health field… I’ve worked at the State, Municipal, & private non-profit level, doing everything except forging the Docs sig on ccccccccccc gvbbbhhhggfddedddddddddddddddddghbbb
Sorry. 1st hijack by Isadore, 2 years, 11 months.
I was going to list my credentials here, but I’m on Dada duty. I’ll be back in about 18 hours.
Actually, I’m taking a class on this very subject this semester. An interesting book is Sanity, Madness and the Family by R.D. Laing and Esterson.
The book has some very interesting proof and discussion on how schizophrenia is socially intelligeable. Namely, the families of the girls in this book (randomly selected) are causing their symptoms. Truly fascinating.
50 years ago, the encyclopedia said that homosexuality was a mental illness.
200 years ago, it said that drapetomania was a mental illness.
I’m not necessarily agreeing with AHunter3 about schizophrenia. But authorities are subject to error, just like us mortals.