Don't try this at home: extreme body make-overs

A second is the prospect of doing something we consider monstrous to prevent something even more monstrous. The obvious precedent here is abortion. One of the more convincing arguments advanced for legalised abortion - even for those passionately against it in general - was harm minimisation: women were going to have terminations anyway, and it would be far better if they not run the risk of dying at the hands of a backyard abortionist.

There has been at least one death at the hands of a backyard amputationist, and there is no way of knowing if other apotemnophiles have died attempting somehow to do it unaided. Given the means to which many have already resorted, it is unlikely there have been no fatalities. And such people are harming, if anyone, only themselves.

A third reason is that while the treatment inspires involuntary shudders, it could be seen as merely a logical, if extreme, extension of, for example, a nose job. We accept the one, so why not the other? For the (presumably) very few who would want such surgery, it might be considered an act of mercy. And I doubt this particular operation would be the beginning of a slippery slope.

If, purely for argument’s sake, we concede voluntary amputation might be acceptable, what should be done with another from the catalogue of unusual physical modifications - trepanation (cutting a hole in your skull)? Adherents claim this gives them a permanently higher level of spiritual vision, through increased blood volume in the capillaries of the brain. They're also willing to engage in do-it-yourself surgery when they cannot get professional medical assistance. In fact, it is possible to buy a video guide to self-trepanation.

This is, if anything, even more problematic than voluntary amputation. The claim that drilling a hole in your skull can get you to a permanently higher state of consciousness is all very well. But it is just the sort of thing that could attract someone with severe depression, or a more florid mental disorder. It also sounds like the kind of state a great many people will take a great many drugs to attempt to reach. How many of those willing to risk addiction and death for a living nirvana might think a hole in the head worth chancing? It can be done: all you need is an electric drill, and a hell of a lot of luck.

What if, unlikely though it may seem, trepanation lived up to the claims made for it? Imagine a groundswell of support building for the fashion, little by little. Where would this be most visible? Almost certainly on the Internet.

The way the Internet is being used raises, for the liberal, some truly disturbing questions. Have we unwittingly produced an effective device for disseminating mania? (A lot more worrying, I would have thought, than most varieties of pornography.) Are we feeding the desire for self-harm by letting those who have it in an extreme form express themselves?

American bioethicist Carl Elliot suggests this might be exactly what is happening. Writing on the voluntary amputation phenomenon, Elliot describes the interest shown on the Internet as “enough to support a minor industry. One discussion list has over 1,400 subscribers.”

Elliot describes his interviews with apotemnophiles, for whom the ’net has proved a boon in a lot more ways than one. According to several of his contacts, it provides “instant validation”. Along with instructions on how to lose your legs. But the blessing can be mixed:

To discover that she was not alone was wonderful - but it also meant that a desire she had managed to push to the back of her mind now shoved its way to the front again. It occupied her conscious thoughts in a way that was uncomfortable.

This indicates the danger inherent in exposing some things to the light. Elliot floats the idea of “semantic contagion”, recounting a conversation with a professor of psychology who had been appointed to a censorship committee. Certain rather alarming sexual acts, the psychologist said, would never occur to most people in an entire lifetime of thinking about sex if they hadn’t seen them pictured. In his opinion people were better off never having conceptualised such acts.

Illiberal this opinion may be, but certainly not inarguable. The idea of having one's legs amputated might never even enter the minds of some people until it is suggested to them. Yet once suggested, and paired with imagery a person's past may have primed him or her to appreciate, that act becomes possible. It has become thinkable in a way it had not been before. I think about it, therefore I can (and should) do it.