How to blunt the perfect honey

The stump

The man is wearing three-quarter trousers and the prosthesis protrudes from his right trouser leg. “You don't believe how happy I am. How much I like to look at my stump, ”he says, running his hand over his trousers.

Let's call him Wolfram Beer (all names, places and temporal references were changed by the editors / this notice was not included in the print version).
Mr. Beer, do you feel guilty?
"Why should I feel guilty?"
Towards your family. You put a lot on her.
"No. I haven't. "
Not even with your children?
"No. I haven't done anything forbidden. "
What about your wife?
“I know it's gigantic what I've put on her. You can only make up for that with love and trust. "

Wolfram Beer slept badly in the past few nights and almost canceled the interview. His wife was against it from the start. She is afraid that his secret will be revealed. The people in his hometown would then ostracize him. And the health insurance could sue him for tens of thousands of euros in damages for the operating theater, the wheelchair, the prosthesis.

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But Beer smiles away at everything: his insecurity, his concerns, his fear. Its stump is 28 centimeters long. 14 centimeters longer than intended. But that doesn't bother him. He's fine again. As good as never before. His plan worked.

Wolfram Beer mutilated his right leg so that it had to be amputated. He almost died doing it. That sounds crazy. Beer knows that. But he's not crazy. He is sick. Beer has BIID. That stands for Body Integrity Identity Disorder, so: Body-Integrity-Identity Disorder. People who suffer from BIID feel that part of their body - a leg, a hand, their eyesight - does not belong to them. This part of the body is not deformed, paralyzed, or disfigured. It's a foreign body. You don't want to feel it anymore.

One could understand Beer's story as a visitation; as the story of a man who has lost his mind. But what if the amputation made him well?

Wolfram Beer says he's not proud of what he's done. He does not speak of "amputation"; he says he "came to an end". This path looks different for everyone. Beer also doesn't want this article to become a copycat guide.

One afternoon a good three years ago, August 29, 2011, Beer started up his laptop and registered in a self-help forum that he noticed a while ago: 500 affected persons are registered. It's not public. Whoever wants to be accepted has to write to the administrators and give a credible assurance that they have BIID.

Subject: Introduction
Mon 29 Aug 2011 2:54 p.m.
»Dear administrators,

I've dreamed of having my right leg amputated in the thigh since I was a child. {...} Now I've taken a first step - maybe it'll be the only one. I had the first three toes amputated on my right foot. "

Wolfram Beer is a clever man who tends to teach. He is 49 years old, married, has two children and is professionally successful. His colleagues respect him, his neighbors appreciate him, he has many friends. Beer likes the natural sciences, preferably mathematics and physics. Natural sciences are precise, they provide solutions. Some people think beer is pedantic. Beer thinks the people are not wrong.

Only four people know of its secret. First he reveals himself to his wife. One autumn day four years ago. Beer expects the worst: she may think I'm crazy and abuse me, he thinks. Maybe she'll kick me out and file for divorce.

But when Beer confides in his wife, she is very quiet. She swallows. She cries. They have been together for thirty years. She thought she knew this man. Now she's not so sure anymore. His secret feels like a scam to her.

But she won't let him fall. At that time she still thinks he was only interested in his toes.

Beer later tells his family doctor and two friends. You try to understand. But you can't understand BIID if you don't have BIID. Beer says it's like a cyclops trying to see in three dimensions.

Wolfram Beer is often online all day. Sometimes he writes during his lunch break, sometimes he writes at night when he cannot sleep. The forum becomes Beer's confessional. In this world it has a different name. Nobody knows who he is. But everyone in the forum knows his secret. He doesn't have to be ashamed anymore. He is no longer alone. You understand him.

Subject: Re: Introduction
Tue 30 Aug 2011 8:29 am
“I started tying my toes (only the big ones at first). That often went on for hours. I no longer had any feeling in my toes - it was nice to have that feeling. It became increasingly clear to me that the three toes have to go - completely gone. {...}

I don't miss her either. It's a release. I don't know whether I'll take one more step. Not every thought has to be implemented. I would never want to harm other people just so that I can satisfy my will. So put your leg on the rail and that's out of the question for me. "

BIID is an almost unexplored disease. Many scientists don't even recognize it as a disease. BIID is not listed in the ICD-10, the directory of all medical diagnoses published by the World Health Organization. As long as a disease is not there, it is as if it does not exist. And it doesn't look like that's going to change anytime soon.

There are few studies on BIID, and even fewer are representative. It is estimated that around 5000 people worldwide suffer from BIID. But only some of them overcome their shame and allow themselves to be examined. Still, the studies show a pattern. Most of those affected are therefore intelligent above average and work in management positions. They want to be better, faster and smarter than others. For most of them - unlike Beer - it is the left leg. And most of them report a key experience in childhood.

It's a weekend in the summer of 1972 for Wolfram Beer. He remembers exactly. He is seven years old and can watch TV with his parents, ARD, afternoon programs - and suddenly there is this boy: He is maybe twelve years old, he wears black clothes, he only has one leg. Beer is fascinated. He admires the boy. No, it's more than that: he envies him.

In the evening, Beer lies in bed and imagines what it would be like if he woke up in the morning and his leg would just be off. Thoughts keep coming back, mostly in summer when he's wearing shorts. He imagines himself tripping and his leg disappearing into a hole in the ground and never reappearing. Later he locks himself in the bathroom once and sticks his leg in the toilet. He hopes it will rot.

At some point he starts to tie off his leg, in the afternoon when he is alone in the house. He bends it, presses his foot to his bottom, straps a leather belt around it and pulls pants over it. Those affected by BIID call this “pretending”. They pretend.

Beer hops around the apartment. Sometimes he carefully opens the apartment door, peers into the hallway and hops out a few steps. Sometimes he sneaks into the neighbour's workshop, takes roof battens and screws wood that has been sawn into triangles on top of it. He takes the crutches upstairs to the apartment. He wants to know how it feels.

He doesn't talk to anyone about it. Every time he takes the crutches apart and stows them in the workshop. He knows he is doing something forbidden.

It feels so good.

Subject: Re: A Toe-Free Life
Sat Oct 22, 2011, 11:30 pm
“My need for a leg amputation has grown much stronger. In the hospital alone, I only had leg amputees around me. I would have loved to swap places with one of them. Now I've started tying my right leg in the thigh - that's how it started with my toes. {...} I don't know yet what will happen - but it is an uplifting feeling for me when I can no longer feel my leg and everything gets cool. "

When Beer is old enough for that, he works in a photo lab next to school. He photographs himself. He retouches one leg.

Beer is growing up, graduating from high school, studying, falling in love, getting married, having two children. His desire becomes stronger and stronger - whereby: It is not a desire, it is also not a wish, that does not describe it. Most likely it is a compulsion.

Beer doesn't find his right leg ugly, he even thinks it is more beautiful than his left. It's a normal leg, it reaches from the hip to the floor, it works, he can feel everything. He doesn't hate it, it's just a turn. That's the problem. He knows exactly where to stop his leg. Beer says: "I felt asymmetrical, I was looking for symmetry."

When he talks about it today, he often crosses his arms over his chest, says "you" instead of "I" and speaks in metaphors. Beer likes metaphors. You can hide well behind it. Beer says he felt like he was in a cage. From the cage he has to watch the others: They are romping outside in a meadow, they are allowed to do it, they have made it. He looks for the key to open the gate, but does not find it. It seems to him as if the cage is shrinking, as if he is crushing him. Beer was done. "If you feel like that, then you are no longer."

There are studies that show that people with BIID feel better after an amputation. Your depression is gone. You don't want to have any more body parts amputated. But every doctor who amputates a healthy part of the body may be liable to prosecution.

In 1997 the Scottish doctor Robert Smith took the healthy left lower leg from an Englishman; two years later, Smith removed a German leg. Upon hearing of this, the Medical Association forbade Smith to do anything. He almost lost his license to practice medicine.

Subject: Re: nature and disability
Sun May 20, 2012, 6:49 am
“My amputation will not make me feel handicapped. There will also be few restrictions. For me, life after the amputation is only 'normal'. "

For many years Beer didn't have a name for this feeling that wears him down. Sometimes he doubts: Am I just imagining it? Does this cage even exist? These bars? I have two healthy legs! The secret plagues him. But it also ennobles him. It makes him special.

Then, one evening in 2008, he was secretly browsing the internet again for photos of amputees. He comes across this word by chance. Beer didn't look for it, it's as if it had found him: "BIID". He begins to research, read reports and studies. They mean me, he thinks.

He registers in that BIID forum, meets with other affected persons, goes to a congress in Zurich, founds the "Association for the Promotion of Studies on Body Identity Disorders", exchanges ideas with professors, takes part in studies, and fills out questionnaires.

Professor Peter Brugger knows Beer. He heads the Neurology Clinic at the University Hospital in Zurich. Brugger is a polite man with a thinking forehead and Theo Waigel eyebrows. He says: "Mr. Beer is a sensible, normal person."

There are only around a dozen researchers in the world who work with BIID. Above all, they argue about the question: where does BIID come from? Psychologists say the causes lie in the head. Difficult childhood. Desire for recognition. Narcissism. The neurologists say the causes lie in the brain.

Peter Brugger interviewed Beer and examined his brain. In addition to Beer, six other victims took part. The results of the brain wave measurement surprised him.

According to Brugger, the homunculus is where BIID takes its roots. The homunculus is located in the cerebral cortex. You can imagine it like a map. All parts of the body are drawn on this, only the scale has been shifted: the hands are shown larger than the stomach, for example, because they are more sensitive and are used more often.
On Wolfram Beer's map there is a blind spot where his right leg should be. That's why Beer's brain is pushing off his right leg. It doesn't understand that it belongs to it. Brugger compares this to phantom pain in people born without a limb. With them the limbs are animated but not made flesh. In the case of BIID sufferers, it is exactly the other way around than the mirror image: the leg is flesh, but not soul.

Do people have BIID because their brain is different? Or is their brain different because they have BIID? Brugger has not yet found an answer to this question. He says both are possible. However, until the causes are properly researched, doctors cannot cure BIID.

Wolfram Beer always refused to be treated by a psychiatrist. He doesn't want to swallow pills. Only a surgeon could help him. But he is not allowed to do that.

Doctors allow women to enlarge their breasts and tighten the labia. They are allowed to remove a patient's ribs, suction off fat, or bleach the anus. You can operate men into women and women into men. Who actually determines how we are allowed to determine our bodies?

"I'm awake. Can't sleep anymore, toss and turn. The same thing every morning. My right leg is still there. Why? It grabs my head. "

Doctors have an obligation to help a patient; but they must not cause him any harm. This is what the Geneva Declaration of the World Medical Association prescribes for them; it is something like the modern form of the Hippocratic oath. If Beer has its way, the doctors are there to make you healthy again. And health insurance companies are there to pay for it. They do the same with smokers and drinkers. And what do smokers and drinkers do other than willfully destroy their bodies? That's how he sees it.

Subject: Re: The pressure of suffering is increasing again
Tue 26 Mar 2013, 06:40
“My sick leg.
Four thirty.

I'm awake. Can't sleep anymore, toss and turn. The same thing every morning. My right leg is still there. Why? It grabs my head. The thoughts only revolve around it.
Five o'clock.
Now I've decided to get up. In my mind, my leg ends in a stump about six inches long. Then I look down at myself. It's just a phantom feeling. The leg is still there. The same story every morning. "

Wolfram Beer has two options for getting rid of his leg. One way costs around 25,000 euros. You travel to Eastern Europe or Asia. A police officer is bribed and he issues a fake accident form. And you pay a surgeon to cut off the body part you want.

This route is out of the question for Beer. He doesn't have the money. And it seems too dangerous, unpredictable to him. He doesn't want to hand himself over to a doctor, anywhere in the world, in some backyard.

The other way is cheaper, but it takes more courage. It was a difficult decision, says Beer. He talks about it like a physics experiment.

Question: How can I injure my leg in such a way that it has to be amputated?

Hypothesis: You need an object sharp and heavy enough to cut through a femur. It has to be quick and abrupt. Big drop weight. A kind of guillotine. It's all a question of mechanics.

Method I.

Beer could put his right leg under the wheel of a freight train. A freight train has an axle load of ten tons. A full disk wheel is sharp. There are routes on which freight trains run very slowly. Beer stands on the tracks three times. You can only mutilate yourself in such a way at great risk, you can bleed to death quickly if a train rolls over your leg. That's why he has a helper with him, a friend, to call the ambulance. Beer wants to wait until the locomotive drives past him, then throw himself on the ground and put his leg on the rails. The train driver wouldn't notice. Beer doesn't care about the friend's possible trauma.

But then he can't. He needs a different method. One that is more accurate and minimizes risk.

Method II

David Openshaw, an Australian, was the first person affected by BIID to be known to have mutilated his leg. In 2008, he put his leg in a bucket of dry ice. It stayed there for six hours. Dry ice is frozen carbon dioxide, minus 78 degrees Celsius. When dry ice touches the skin, the tissue tears open and cuts inwards in a cone shape. The tissue dies within a few seconds.

Openshaw had himself delivered to a hospital. The doctors removed his leg from below the knee. Beer knows Openshaw's story.She is out of the question for him. Six hours of dry ice, who would believe there was an accident?

Method III

One steel beam weighs around 140 kilograms, two steel beams weigh 280 kilograms. Beer wants to be sure. He opts for four steel girders, 560 kilograms, more than half a ton. He draws a sketch, builds a model out of wood, drops the beams, records everything with a video camera. Yes, that could work!

A Saturday in September 2013, late summer, 19 degrees. Beer spreads a mattress on the tiles in his living room. He is well prepared. He has watched videos on the Internet that explain how to proceed. Beer sits down on the mattress. The sun shines through the tilted window. It is quiet. He can hear his wife raking the flower beds in the garden. She tries to distract herself. When the time comes, she should call the ambulance. She puts the rake down, picks up the spade. Dig up half the garden. It is their fifth attempt together. Today he would pull it off.

In the living room, Beer grabs the lashing belt and ties his right leg to the bar. He injects nerve poison into his muscle. There is sweat on his forehead, he is afraid of injections. Beer feels the feeling slip out of his legs, they slowly go numb.

Beer examines his leg. Then he rubs the dry ice pellets on his lower leg. The leg becomes stiff and completely white. Like a frozen lake.

He gets up and limps to the patio door, looks around, no one there, drags himself into the garage. The guillotine is set up. Beer lies down. He clenches his fist. The adrenaline kicks into his body. His breath is shallow. If someone asks afterwards, they would say they cleaned the steel girders with dry ice.

Then Wolfram Beer brings the guillotine to collapse. The steel beam falls. A scream rings through the settlement.
"I don't wish anyone this pain," says Beer.

His wife is with him first, she calls an ambulance.
The femoral artery supplies blood to the thigh. If it rips open, it is life-threatening. The heart pumps about five liters of blood around the body every minute. Beer would have bled to death in five to ten minutes.
The first neighbors rush over. The ambulance drives up. The ambulance pulls Beer up.
"What's your name?" He asks.
"How old are they?"
"How heavy are you?"
Beer looks down at himself. Blood and flesh and bones. The leg is still there, but it's smashed. Then he sags.

Diagnosis: open thigh fracture, open tibia fracture, ankle joint shattered. The nerves are numb from the thigh to the foot. The doctors are not puzzled. Nobody becomes suspicious. Everyone believes in an accident.

When Beer opens his eyes, he is lying in a hospital room. He sees his wife and two children sitting next to the bed. The machines gurgle, the monitors beep. Breathing tubes in the nose, a tube in the mouth. Beer wants to know what time it is, but his tongue is heavy. He can barely speak, dazed from the pain reliever that is seeping into his veins from the drip. He points with his uninjured foot at the clock hanging on the wall above the door. They finally understand him. It's Sunday, almost 24 hours later. He can no longer feel his right leg. Then he falls asleep again. The gate of the cage is wide open. He's almost there.

In the four weeks that followed, the doctors operated on Beer ten times. He is being transferred to another hospital. Doctors consider transplanting skin from the left leg to the right. You want to save his leg. Doctors are not allowed to amputate within the first 14 days if it is not a matter of life and death. Not even if the patient agrees. Then he is not yet sane.

Four weeks later, after the tenth operation, a nurse pushes Beer into a recovery room. Beer is still foggy from general anesthesia, he blinks, slowly becoming clear. The doctor comes in the door.
"How are you, Mr. Beer?"
"Would you like to see what we did?"
Beer nods. The doctor pulls back the covers. Beer looks down at himself, he sees the stump. A bead bandaged with white gauze. He tries to move his right leg and feels that it is no longer there.

Subject: ... now on one leg
Sat Oct 19, 2013, 7:04 am

"Hello my dears,
now i did it. It was a rocky road to get there, but I made it. I am a BIID-ler with implementation. My right leg was amputated just over a hand's breadth above the knee on my right thigh.

I'm not cured of BIID, that's not how I feel, otherwise I might now have a problem with my amputation. But I am myself again and I can be happy again. "

A year later, on a slate-gray morning in September, Beer rolls his wheelchair through the gate of the Ospedale Niguarda Ca ’Granda, the largest hospital in Milan. The Institute for Neuropsychology is on the edge of the campus, it's an old building, plaster is peeling from the walls.

Beer is a little early. Dr. Anna Sedda, a petite woman with chin-length hair, has only just arrived. She is a neuropsychologist and researches the causes of BIID. Beer heaves himself out of his wheelchair with his arms, hops over on one leg and hugs her as if she were an old friend. "Good to see you again," he says and hands her an extra-large pack of "Merci". It is his second visit to Sedda.

Beer likes to be here because Sedda doesn't pity him. He paid for the flight out of pocket. That is his service to science. He was here for the first time a few weeks before his "accident" - that's what he calls it now. Professor Brugger from Switzerland recommended his colleagues in Milan to him. Sedda suspected at the time that Beer was up to something. But she didn't ask. She was afraid of the answer, she didn't know what to do. Stop him? Sedda says, “We don't know whether you can even treat BIID or not. We know tablets don't work. Amputations may work. "

Sedda leads Beer into a small room with a tiled floor and deep windows. Outside the clouds are clustering in the sky, as they have been all morning, it is about to rain. That didn't stop Beer from putting on shorts. Its stump peeps out like a plucked chicken. The thigh muscle jerks sharply downwards, in front of it the bursa is turned inside out, sewn together like a quilt. Beer left his prosthesis at home. He carries his stump like a trophy. He wants everyone to see it.

But Sedda pretends not to notice the leg thing and puts him in a questionnaire. It's a great day for her. She wants to know how Beer's brain and psyche changed after the amputation. The tests last all day. Sedda is the first to show Beer photos on an old laptop. He has to rate how gross he thinks the photos are. On a scale from one to seven. One stands for not disgusting, seven for very disgusting.

The first picture pops up: A drunk man in a soccer jersey. Beer presses the 7.
A dirty kitchen: 7.
A shitty loo: 7.
A dead child, blood on the face: 4.
A severed arm covered in blood: 1.

Disgust protects people from disease, dirt or poison. It's a mechanism like a security lock. It's different with Beer. Sedda says people with BIID don't find violence gross. But that does not mean that Beer would inflict violence on others. Just yourself. For some reason, his security lock was cracked.

After an hour and a half, Beer can't take it anymore, Sedda still hasn't asked him about his leg. Then it bursts out of him: "Everything went well!" He says and looks at the stump.
“Was it the right decision for you, Wolfram?” Sedda asks.
"Absolutely," he says.
"It's good."

It wasn't an easy time for Beer after he was released from the hospital: physiotherapy, weeks of rehab, the pain. Doctors prescribed Lyrica, a pain reliever that numbs the sore nerve endings. He has no phantom pain.

At some point Beer got a prosthesis that weighed 15 kilos. He doesn't like her, she feels wrong. She rubs against the groin and bum. And when he walks on it, his movements seem stiff and awkward, as if he were a puppet. He wears them anyway. Because he thinks that there are also norms for disabled people that must be adhered to.
Sometimes when he walks around his hometown, people say, “It's great how you do it! Nice to see you on two legs again! "

After the photo test, Sedda Beer leads into her office, puts her cell phone on the table, looks at him and presses the record button.
"Wolfram, do you sometimes think of amputating another part of your body?"
"No never. I feel complete and balanced. "
"How has your mood changed?"
"Extreme. I don't have to hide anything anymore and I don't ponder so much anymore, about BIID and who I am. "
"Are you planning to tell your children the truth?"
"Maybe later. But now it doesn't make any sense. I don't want to cause problems where there aren't any. "
"How is your wife? Is she happy?"
“I'm not sure if she's happy. She accepted it. She knows I'm better. "

Beer falls silent, he puts his hand on his stump and kneads it. His wife didn’t come to Milan, supposedly because she didn’t like Milan.

Anna Sedda says they need to keep collecting data to unravel the BIID puzzle. She won't be able to tell whether the amputation really made Beer happier for three or four years. Their research has shown that Beer's feeling of disgust is the same as it was before the amputation. This could suggest that the basis of BIID is not psychological, but neurological.

Sedda says, “I don't care whether Wolfram has two legs or just one. The most important thing is that he's okay. "

Eight hours later, at the end of a long day, after they had pushed him into the MRI and photographed his brain, Beer was sitting in a wheelchair in the departure lounge at Milan airport. He is tired and wants to go home. His flight is in an hour. Beer takes his cell phone and tries to call his wife, she doesn't answer. He texted her: “I've just checked in. I'll be there at 9:15 p.m. Shall we meet up at departure? ”Then he puts the cell phone away again.

Mr. Beer, do you find yourself selfish?
He looks puzzled, as if he doesn't understand the question. After a while he says, “We had this conversation, my wife and I, otherwise I would not have gone through with it. Otherwise it would have been difficult. Well, at least more difficult. "

Photos: Peter Granser