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Complete Obsession
BBC2 9:30pm Thursday 17th February 2000

Complete ObsessionCORINNE: I don't understand where it comes from or what it is. I just don't want legs. Inside I feel that my legs don't belong to me, they shouldn't be there. It's as real to me as I imagine able-bodied people, the sense that they have, that they should have two arms and two legs and just to think of anything else is, is unthinkable. There is just an overwhelming sense of despair sometimes. I don't want to die, but there are times that I don't want to keep living in a body that doesn't feel like mine.

MONTAGE (31st January 2000): REPORTER: The Falkirk Royal Infirmary has confirmed that two men who had nothing physically wrong with them have each had a leg amputated. The patients…

REPORTER: A hospital in Scotland acknowledged this morning that it had carried out limb amputations on two patients who had nothing physically wrong with them. Falkirk and District Royal Infirmary said that both were suffering from body dysmorphic disorders…

REPORTER: A hospital in Falkirk, near Stirling has confirmed that it carried out leg amputations on two patients at their own request. The consultant surgeon who carried out the operations was Robert Smith.

ROBERT SMITH (Consultant General Surgeon): Certainly when I was first contacted by the patients who wished an amputation of a perfectly healthy limb it struck me as being absolutely utterly weird. I was worried and concerned about whether in fact we should even consider this procedure, but I became intrigued and I did a lot of research on the topic. It's quite a difficult change of view on my point really, to remove a healthy limb is an anathema to a surgeon, but I've become convinced over the years that there is a small group of patients who genuinely feel that their body is incomplete with their normal complement of 4 limbs.

The major concern with these individuals is that if they do not achieve their amputation by medical means they will try and achieve it by self-injury. We do have a number of individuals who have deliberately injured themselves with train tracks, shot guns and have achieved amputation this way.

NARRATOR (ADEN GILLETT): It was this fear that patients would injure themselves that led Robert Smith to perform the two operations. One of the people he operated on was Hans. Since childhood, Hans had felt that his right leg did not belong to him and had contemplated ways of removing it himself. Hans did not want to be identified.

HANS: I felt like at the age of 14 I'm, I'm in the wrong body and I should have a leg amputated. I consulted psychologists and psychiatrists and eventually I came to the point where I said well this, this has to be done. I felt like, you know, if, if the leg was removed I feel like being more complete and being just the way I like to be. I'm happy with it, quite happy with it.

NARRATOR: The surgery seems to have been effective. Amputation has freed Hans of his obsession. The success of these operations had led many more sufferers to demand the same surgical treatment.

ROBERT SMITH: Clearly there are many members of the medical profession who are totally opposed to the concept of an amputation for these people. I think some people will immediately turn off when they hear this, they will immediately feel revulsion, they will think this is so bizarre, this is, this is disgusting, we cannot do, we cannot have this, but I think these people are perhaps dealing with it on a superficial level.

I think you have to look carefully at the individuals as patients who have a problem and they have what they see is a solution. I certainly think that the solution is surgery, but people will disagree with me and I think that almost anything in medicine people will disagree about, but I think you really have to look at the patients carefully. I don't think you can condemn these patients without carefully looking at their stories, their background and the real compulsion that they have about this.

NARRATOR: Body dysmorphia is rare, but a worldwide network of sufferers is growing and demanding treatment. It is not, as has been suggested, a sexual fetish, but a genuine obsession to be rid of a limb. Very few psychiatrists have encountered patients with a disorder, but the profession is now being forced to respond and devise methods of treatment. Neither drugs nor therapy seem to be effective, yet the idea of surgery is still highly controversial.

This film traces a year in the lives of people who, like Hans, are body dysmorphic and are determined to have limbs surgically removed. It follows the process they went through to try and achieve this goal. Corinne, living in California, has heard about the surgical procedure and hopes Robert Smith will consider her.

CORINNE: I see myself as a very normal person with, you know, a good job, a stable home life. My Dad was a police office and my Mom was a teacher. I have brothers and a sister and we all are very normal, good people. Everything about my life is ordinary, except this one aspect and it's very hard to fit that in to the rest of my life. My legs are extraneous. They shouldn't be there, they don't feel, it doesn't feel right that they extend beyond where I feel my body should end.

INTERVIEWER: Where do you think your body should end?

CORINNE: Sort of high up the thigh. Perhaps higher. Legs in any form are not something that feel a part of me.

INTERVIEWER: How soon would you want the operation if you could choose?

CORINNE: Today.

NARRATOR: Robert Smith will only consider operating on a patient after they have been seen by at least two psychiatrists who confirm that they are sane and are body dysmorphic. One of the few psychiatrists who has seen such patients is Russell Reid. An experienced consultant psychiatrist, Dr. Reid usually specialises in treating transsexuals.

DR. RUSSELL REID (Consultant Psychiatrist): Certainly when I first heard of people wanting amputations it seemed bizarre in the extreme but then I thought well, I see transsexuals and transsexuals want healthy parts of their body removed in order to adjust to their idealised body image and so I think that was the connection for me. I saw that people wanted to have their limbs off with equally as much degree of obsession and need and urgency and it was a powerful emotion.

I think in that sense it's a psychological obsession. These people are not mentally ill in the sense of having a serious mental illness or psychosis. They're not hearing voices, they're not deluded. It's not as if some force is telling them to have their limb off and they're following their paranoid delusion to do that. If that were the case then they would be psychotic, but they're not like that.

CORINNE: I haven't lost touch with reality. I know I have legs, but I also simultaneously imagine and sort of live my life mentally as an amputee. I did start renting a wheelchair for weekends around the home to get a sense of how, how my daily life really would change. There are things that I won't be able to reach and I'll have to sort of rearrange my home, but the overwhelming emotion when I first settled into the chair the very first time was just, it was like coming home.

REPORTER: The verdict is in for the former doctor accused in the death of one of his patients. Bondy wanted his healthy leg amputated. He died of gangrene after Brown performed the operation in a Tijuana clinic.

NARRATOR: The desperate need of dysmorphic people to achieve their ideal body form has cost some of them their lives. Last year a sufferer died after turning to an unlicensed surgeon in Mexico. He had gone there with a fellow sufferer, Gregg. Seeing his friend die Gregg was determined to seek legal means for his amputation. He began the process that would lead him to Robert Smith.

GREGG: For me to have been born without my lower right leg would have been more the perfect theme of what I see my body as. It, it's almost I could say almost a deformity. It's, it's a wrongness, it's not a part of who I am. The desire that I have is for a, an amputation above the knee on the right leg. Now that's very specific and I have no way to under, understand it, comprehend it or to explain it to anybody in the world, let alone to explain to myself and you sitting out there think it's nuts, I'm sitting in here thinking it's nuts, but I can't help it. It's still the reality that it seems like my body stops at mid-thigh my right leg. It's, the rest of not me.

NARRATOR: The causes of the disorder are not known, but those affected report that the feeling started in childhood. They also have a strong memory of the first amputee they saw.

RUSSELL REID: The little that we do know about the background to people with this psychological disorder has some common threads, one of which is to have seen or known an amputee in childhood and to have identified with that person at a, at a defining moment.

GREGG: The first time I had the feelings of really wanting my leg amputated that I didn't feel like I wanted this as part of my being was around 7, 8 or 9, but I can trace that back to when I was 4 years of age I saw this man on the street who was an amputee. I knew I just wanted to be like that, sometimes I could even pretend I was him. I'd be going to school and I'd be looking out the window to see if I would see an amputee, I would have this going through my head, going to bed at night, going into the dream world that I would be thinking constantly this, it was almost like a possession.

At first I thought I could conquer this by, being brought up a Catholic is through prayer or through being a good kid or doing something to try to repress it, but that just didn't work. Carrying that shame and guilt and moving on in life and holding onto it I knew that inside myself there's this enormous taboo and that people around me would think what's this guy crazy, he's wanting his leg cut off and he's, he's lulu and you know he should be institutionalised. A matter of fact if I got outside of my skin and I was in your shoes so to speak I would say you know the guy sitting over here, he's nuts, and I can relate to that, I can understand this. On the other hand, the, when you get to the feelings of what I'm about they're still real.

I had one therapist who told me I would grow out of this, but at that point I was like 28 years of age and I thought when the hell am I going to grow out of this? Eventually I got to a therapist who worked with me solidly for 4 years and she said the best thing for you to do is to go out and find a surgeon who would legitimately do this for you and not seek a way like throwing yourself under the train or doing some type of damage traumatically.

NARRATOR: Gregg actually became a psychotherapist himself in order to try and understand his condition, but his feelings have not changed in the 20 years that he has been practising. He travelled to Britain as a private patient and started consultations with psychiatrists. He saw Dr. Reid last May.

RUSSELL REID: When I met Gregg it was very clear that he was very sane and there was absolutely no question that he was thought disordered in any way or mentally ill or sexually bizarre. He wasn't, he was an ordinary, nice man who wanted his limb off. It seemed to me at the time that that was incongruous for a nice, rational man to want his limb off. It seemed very strange. I, couldn't, I couldn't quite, to be honest I couldn't quite understand it.

GREGG: This desire for the amputation is just something that I need to do for me and that's, that's my goal and I hope my fulfilment. As incomprehensible to all those around me I want that for my life.

NARRATOR: Six weeks after his first consultation Gregg went to see Dr. Reid for a second time. He had already been approved by one other psychiatrist. If this meeting was successful he would be eligible to meet the surgeon.

RUSSELL REID: When a person wanting an amputation comes to a psychiatrist the options are fairly limited. On the one hand you could give them drugs, you might say oh they're depressed, give them an anti-depressant, see if it cheers them up, or they're psychotic, give them an anti-psychotic. As we've said, they're not psychotic so that's not going to be any use. Counselling, talking treatment, psychotherapy, cognitive behavioural therapy, help them focus on the positive things in life and get away and forget about the negative things, the wanting to have an amputation.

Unfortunately psychotherapy talking treatment doesn't make a scrap of difference in these people. They are so fixed and so,. in a sense, locked in to what they want for themselves that you can talk till the cows come home it doesn't make any difference. They're still going to want their amputation and I know that for a fact, certainly in the case of Gregg.

NARRATOR: The purpose of the psychiatric consultations is to confirm the patient is sane and has body dysmorphia. They last about two hours.

RUSSELL REID: I met you 6 weeks ago and we talked about your need for an amputation, an above knee amputation on your right leg, is that right, and this is a fairly drastic procedure. Do you, do you see this leg as being alien to your body? I mean it's considered psychiatrically a body image disorder.

GREGG: I guess well I could say that it's, it's not part of my body, the balance of who I am is, is, it just feels that it ends at my mid-point here on my thigh. It just is, it's not me from there on.

RUSSELL: Are there any doubts in your mind about this, proceeding with this in the near future?

GREGG: I'm so convinced that I'm doing the right thing because I've spent 50 years of my life being devoured by this.

RUSSELL: It's, it's…

GREGG: And it's not going to go away. How much do I need 80 years to convince me it's not going to go away, or 100 years. I mean how many years do I need to convince myself it's not going to go away. It's not going anywhere.

RUSSELL: I need to know and you're going to have to reassure me that this is something that's essential and there's no alternative to having this done, such a drastic procedure as an above knee amputation of your right leg. How is it that this is so imperative?

GREGG: There has been no means way or form that has delineated this, this desire so that it could be packaged and then taken away from me and I can get on and live my life. I am, I don't see that happening in any other way except my going to what is core to what I'm about and that is that, that part, that lower part of the leg is not, is not part of my being.

RUSSELL REID: Gregg on his second interview today confirmed what he said on his first interview. I saw him for about an hour and a half. He has a pretty profound problem. It, it's led him through his life like as if it's been a ring through his nose. It's really been absolutely traumatic for him and he's reaching the point in my opinion where the only way forward for him is to have his leg off. He's going to be a whole man, paradoxically, ironically, without that leg.

INTERVIEWER: Do you have any doubts at all about recommending him for surgery?

RUSSELL: Yes I do. I worry that he may regret it. I worry that he might want the other leg off. I worry that he might want to be a quadruple amputee. I mean I don't think that's going to happen. He's assured me that that's not the case. He has his ideal image of himself as someone with one leg missing. It's been a constant theme throughout his life. That's what he wants and that's what I'm going to recommend.

ROBERT SMITH: The patients that I've seen, I've had psychiatric reports on them and the psychiatrists have indicated that these patients perfectly understand, they perfectly understand the consequences of what they're requesting. They really are probably the best informed patients that I have ever had to deal with.

NARRATOR: Unable to find a psychiatrist in the US willing to deal with such controversial surgery, Corinne, too, travelled to Britain. She has arranged to see the same psychiatrist as Gregg.

CORINNE: This is sort of where I see my journey beginning on the way to realising my hope. I'm preparing to see the first doctor, a psychiatrist and this'll be the first time that I've spoken to a professional about this condition so I'm looking forward to it. I'm also I'm not sure what to expect.

RUSSELL REID: I want to, I really just want to understand what, where it comes from. I mean how far does it go back?

CORINNE: Probably my earliest experience that, that is of interest to me was when I was 3 years old. My Sunday School teacher had a prosthesis and at the time I remember just being utterly fascinated and thinking to myself she's got a plastic leg, isn't that interesting. I didn't understand that she was an amputee, I didn't understand anything that went along with it, but just the image was interesting to me.

One of my, my earliest memories, apart from my Sunday School teacher and it was about the time I was 4, was that when I was playing with Barbies I thought Barbie would look much more interesting if she didn't have legs, so I popped her legs off. I mean Barbie is Barbie and you know she's an attractive woman, but she just looked so much better, so much more interesting and and intriguing without legs and, and I can say that, you know, that, that's something that I want for myself.

RUSSELL: Right, right. Next question: did you, did you pull the legs off spiders or flies. I mean…

CORINNE: Oh dear. No.

RUSSELL: Some children do that. It's a bad sign if they do apparently.

CORINNE: It's not a good thing.

RUSSELL: It means that they're destined for psychopathy I gather.

CORINNE: Yes, no I never did that.

RUSSELL: Right, didn't torture animals.

CORINNE: Kind to animals and children.

RUSSELL: Sure, sure, just Barbies.

CORINNE: Yes.

RUSSELL: What sort of an amputee would you want to be?

CORINNE: Double above knee.

RUSSELL: Both legs. (Yes) Right, right.

CORINNE: Fairly high.

RUSSELL: Right. And that sounds a fairly drastic position to be contemplating, to, to actually have your, both legs removed above the knee. How do you account for this?

CORINNE: At best my legs seem extraneous. I would almost say as if they're not part of me although I feel them, I see them, I know they are and at worst they're a nuisance.

RUSSELL: One of the problems that I have in appreciating and understanding where you're coming from is, is just the, the enormity of the request and I'm trying hard to understand, but it occurs to me that you need, in a sense, to, maybe it's me that needs therapy but I think in the way that you need therapy to help you try and tease out the different factors that are involved in this decision to request amputation, or am I, do you feel that I'm being insulting?

CORINNE: I do in a sense. It's so much a part of me. (Yeah) It's hard to say that…

RUSSELL: Consider that one leg might be OK, two legs is too much for the doctors, particularly the surgeon, to contemplate recommending. I mean what would happen then? Would you rather go without it altogether?

CORINNE: One leg to me is the same as a no answer.

RUSSELL: Yes. It's quite clear in the time that I've spent talking to you that you, you know you've got, in a sense got your feet on the ground at the moment. You're sane and sensible, you're not psychotic, but it's, I have to admit that it's, it's a, it's a big, it's a tall order, big request and at the present time I, I can't give you any assurance that that'll happen.

I was flabbergasted at her request for an above knee amputation of both legs. It, it, it threw me and I really, I wouldn't recommend it at this stage now.

CORINNE: It went worse than I expected. He referred a couple of times to it being drastic. He didn't understand I think that to me it's drastic to have these feelings and feel that, that I can't do anything about them, that there isn't anyone that would be able or, or willing to help me and that the change in my lifestyle is not drastic. He referred once to it being perhaps a matter of self-hatred which floored me. I mean more now than ever if I'm very much more accepting of myself and this is something that I'm doing for me.

RUSSELL REID: There's a lot of conflicts going on in this woman. There's the obsession for wanting, wanting to be mutilated. What causes this sort of thing?

INTERVIEWER: If you're talking about mutilation why isn't that the same with one leg?

RUSSELL: It, it is in a word. Mutilation is, is what these people want. It suggests that the psyche is damaged in some way and that this is, that this is their single solution to be rid of a leg. To be rid of one leg is, you know, OK. To be rid of two is a disaster. That's my view.

CORINNE: The next step now is to see the second doctor, to tell him my story, to hope that perhaps this time I can clearly explain what it is I need and why I need it and that he will have the capacity to understand.

DR. RICHARD FOX (General Psychiatrist): If, if a fairy godmother could grant you 3 magic wishes, especially in relation to your leg or legs, what would they be?

CORINNE: That I could find someone who would be willing to amputate both legs.

RICHARD: You want them both off?

CORINNE: Yes.

RICHARD: No doubt about that.

CORINNE: No doubt.

RICHARD: Where? Below or above the knee.

CORINNE: Above the knee, fairly high.

RICHARD: Fairly high. Are you worried about the dangers?

CORINNE: I'm not worried, no. I, I understand many of them, but they don't concern me.

RICHARD: Content to lead the rest of your life in a wheelchair?

CORINNE: Yes.

RICHARD: Have you practised that, have you, have you sort of sat in… (Yes) Tell, now that's important.

CORINNE: I've had what I call no cheek weekends where I'll order myself that the entire weekend staying at home I cannot leave the chair.

RICHARD: Have you tried to harm yourself, have you had a, a go at your legs to try and make them septic to force the medic to amputate you?

CORINNE: I have had plans, I have not acted on them yet.

RICHARD: What kind of plans?

CORINNE: Many and practical - railroad tracks and…

RICHARD: You've thought, you've actually thought about the railroad.

CORINNE: Yes.

RICHARD: Do you have a boyfriend at the moment?

CORINNE: I actually have never really had someone that I would characterise as a boyfriend.

RICHARD: You're a virgin?

CORINNE: Pardon?

RICHARD: You're still a virgin.

CORINNE: Oh no, no, I just, I haven't had the pleasurable experiences that I think are available to other people.

RICHARD: And it never struck you that having your legs off might be kind of a sexy thing.

CORINNE: For me sexuality is being comfortable with your body (Right) and enjoying your body.

RICHARD: Do you think you could maintain a, a married relationship under these circumstances?

CORINNE: I know I can.

RICHARD: Yeah. Well obviously you meet a lot of the criteria for recommending to my surgical colleague whether or not a person is suitable to have the operation. The motivation is very clear, the facts in my opinion as so, so far assessed you're psychiatrically normal in other respects.

CORINNE: Seeing Dr. Fox was an incredible relief. For the first time I felt that someone really did understand and perhaps had an acceptance that, that what I want is a valid solution to the feelings that I have. I think if, if ever I was able to let someone know how important this was to me he was the one.

RICHARD FOX: Yes well Corinne is a very interesting lady from my point of view because she is the first member of the female gender who, who I have seen suffering from this disorder and I think disorder we must call it. This is, let's face it, a potentially fatal condition. We know a number of people who have died as a result of attempts to remove a limb which they felt wasn't, just wasn't part of them, something they needed to be without, something which left them short of perfection.

She's got a lot going for, for her in terms of the personality and the stable background and the job, supporting herself, the rehearsal in the legless condition in her flat. The drive, the determination. I suppose a surgeon would say really amputating two legs is no more difficult than amputating one. It is, in good hands it is a very safe and straight-forward procedure and if that's what it takes to make her the happy person she is convinced she would become then so be it.

NARRATOR: Dr. Fox and Dr. Reid will confer before deciding whether Corinne should be referred for surgery.

ROBERT SMITH: Certainly a number of individuals have requested having both legs amputated and that is really quite a, quite a concept to, to try and grasp. Physically it's perfectly feasible to do bilateral amputations, but I think from a surgeon's point of view it's really asking a bit much to expect us to take this on. I agree there is an irrepressible logic that if you're prepared to remove one leg why shouldn't you be prepared to remove two legs if the patient has this particular problem, but to a surgeon that's a very difficult concept to take on board.

NARRATOR: While Corinne waited to hear the results from the psychiatrists Gregg had already received their approval and in the same week travelled to Edinburgh to meet the surgeon.

ROBERT SMITH: Now you wish an above knee amputation?

GREGG: Yes I do.

ROBERT: Which side?

GREGG: The right.

ROBERT: There are a variety of, of complications and problems which can arise during and after amputation. During there are all the risks of an anaesthetic, but basically the fundamental risk is that, that the procedure can kill you and you have to be aware of that 'cos that risk does exist.

GREGG: I understand that.

ROBERT: And obviously there are situations in which people may not be able to be fitted with an artificial limb. The stump may be too sensitive, there may be problems with the scar and inevitably walking with an above knee prosthesis is an extremely uncomfortable procedure to start off with. From what you've been telling me and from what I've heard from the psychiatrists I think you fulfil very adequately the criteria that certainly I would accept. My, my own gut feeling is that an amputation is the best thing for you.

GREGG: So what period of time are we talking about here?

ROBERT: I'm confident that the private hospital will be happy for me to proceed. I would be able to operate on you within 2 or 3 weeks.

GREGG: In many ways I'm sort of stunned with it all. I'm overly delighted with the possibility of being able to achieve this and get on living who I think I really am. I realise that when I come back after the surgery I'm going to be changed. I see myself in the mirror as an amputee. I can imagine that I would feel a lot of glee inside, a lot of happiness. I can imagine there'd be a real calming effect, you know, of finding my own identity, yeah. There is still the potential of dying, but it doesn't take me off the course for the surgery. I'm willing to, to, to go that way.

NARRATOR: 6 weeks after returning home Corinne received her letter from the psychiatrists.

CORINNE: As the weeks went by I started to get a little more anxious about well why wasn't I hearing yet from the doctors. The first, first correspondence I got actually turned out to be a bill. Last Monday I came home and there was an airmail letter from England and I just, I went straight in the house and opened it up without thinking. I didn't read it that closely. I saw certain words about we know this will disappoint you and right there I knew this is, is not good and as I went back through one more time it was like being kicked in the stomach.

RICHARD FOX: She appeared to be properly motivated, she appeared to be quite a good personality, she was looking after herself, she had had this rehearsal behaviour in her apartment, in her wheelchair looking after herself as if she had lost her legs, so it was certainly a lady that I was considering and she had had 2 years of counselling. What worried me was that during the 2 years counselling her leg problem had never been mentioned.

CORINNE: I had been in therapy for quite a while and I, I sort of got the feeling that the fact that I had never told my therapist about this was a mark against me, more so than if I had never been in therapy and I, I'm still sort of battling with that.

RUSSELL REID: Corinne's quite desperate. The only, the only consolation that I suggested was that she get involved in therapy and continued to talk about this and to share her obsession, fears, worries, needs with another person that she can relate to and maybe she'll get help in that regard. I don't think it'll be helpful in terms of producing her desire to have the double thigh amputation, but I think it would be, in a sense, placatory, it should make her appreciate what she's doing and help to understand, her to understand herself.

CORINNE: I know this is right for me right now. I don't need to prove to myself that this is right and I need to do what I can to get the surgery as soon as I can.

NARRATOR: Gregg, who had satisfied the criteria of the psychiatrists and the surgeon, was expecting his operation within weeks, but there is a problem. The hospital in Falkirk have refused to allow any further surgery for body dysmorphia. They have announced that while nothing unethical has taken place, they do not want to be associated with such a controversial procedure. The news has picked up the story.

REPORTER: it was here at Falkirk Royal Infirmary that the operations took place. The only hospital in the United Kingdom where it's known such surgery has occurred when there was nothing physically wrong with the patients.

CHIEF EXECUTIVE, NHS TRUST: I don't believe that it's appropriate for a hospital like the one here in Falkirk to be importing patients and treating them privately, particularly when this is clearly such an unusual procedure.

REPORTER: Today Robert Smith, the surgeon who carried out the procedures, said they were the most satisfying operations he'd performed and had no doubt that they were for the good of the two patients. His worry is that those seeking similar amputations may now become desperate.

ROBERT SMITH: I have very serious concerns that they will either go to unlicensed practitioners and there are practitioners advising on the Internet to provide this service. They may take the law into their own hands, they may lie under a railway line, on a railway line and be run over by a train. They use shotguns and shoot their limbs off and they are really quite a desperate bunch.

REPORTER: Given the questions that have been raised it's highly unlikely that such amputations will take place again at this hospital.

GREGG: It isn't that it's just me. I'm not coming out of the rain just coming in and saying I want this. My God, how many years of therapy have I had working on this. Not only that, we have individuals who've had this surgery and it's worked for them and their lives have changed and all the individuals that I know that have either shot their leg off, thrown themselves under a cart, dropped an axle of a car on their leg, or they've thrown themselves under the train, these individuals have all told me that the only thing they regret is that they'd never did it earlier in their life.

ROBERT SMITH: Yes obviously Gregg is, is bitterly disappointed and I think a little angry and I think justifiably angry in that he feels that the decisions on whether this procedure should be undertaken are based on, to a certain extent, a fear of public reaction to what's going on and not really based on the clinical needs of the patient and I can share his concerns.

GREGG: And of course there's a taboo in our society against dismemberment or self-multination and, and amputation desires as this, but what I'm speaking about is not for the mass. I'm speaking about a few individuals that are stepping forward and saying this is what we want, this is what we believe and this is what we feel and that's being denied.

ROBERT SMITH: As we know with these patients there is a real concern that they can injure themselves. Gregg is a very intelligent and able and sensible man and I doubt if he will, but clearly at the back of my mind there is a concern that he may ultimately become so desperate that he takes matters into his own hands.

NARRATOR: Because the doctors did not recommend surgery for Corinne she planned another way of achieving her aim.

CORINNE: A couple of months ago when I got the doctors reports saying that they couldn't approve me for the surgery I started formalising plans to, to force the issue and to compel doctors to amputate, so I put together a plan that was, would cause complete damage, that there was no, there would be no way of saving my legs and they would have to amputate. Was a plan that I'd put a lot of, lot of thought into and had spent months sort of perfecting and fine-tuning and then a month ago I went to a distant city where no-one would know me and there wouldn't be any publicity intending to carry it out and fully planning on achieving my goal and you know in the weeks since, since that plan didn't work I haven't really felt that I had other options, nowhere else to turn, so I, I feel like I'm back at square one except that all along I had this fake hope that I could do it myself and now I don't even have that. I know that I need to make it happen. I don't know how I'm going to do it, but at some point it will happen, it's got to happen.

ROBERT SMITH: You've got a good, good sound stump which helps.

HANS: Yeah, yeah it's true, I've no problems with that.

NARRATOR: It has been almost a year since Robert Smith operated on Hans. They met again a few months ago for a follow-up consultation. Hans is still delighted with his new body image though it seems he will be the last person ever to receive the surgery at Falkirk Hospital.

ROBERT SMITH: Are you happy having only one leg?

HANS: Yeah.

ROBERT: You, you, you enjoy…

HANS: I do.

ROBERT: …being a one legged man.

HANS: Yes, I enjoy being one legged, yeah that's correct. I'm happy with it, quite happy with it.

ROBERT: Is there any aspect of your life that has deteriorated as a result of us having taken your leg off?

HANS: Today if you ask me today which you have done, I would, you know I would not hesitate saying yes without any reservations or anything. It improve my life quite a bit 'cos that's the way I wanted to be, that's the way it is so I'm quite happy about that.

ROBERT SMITH: He has noticed there have been a few disadvantages of having had a leg removed. His mobility is slightly less good than it used to be, he has to walk more slowly, but he regards this as a very minor inconvenience in comparison to the enormous benefit that he's derived with regard to his social and public life.

You've got no, no tender spots on it.

HANS: No, no, no.

ROBERT: Not even down there.

HANS: No.

ROBERT: No. Yes, that's fine and you can get it right straight, you can bend it right up?

HANS: Absolutely, no problem.

ROBERT: Good range of movement, yeah.

HANS: Full range of movement.

ROBERT: That's excellent.

HANS: Yeah I can, I can move in the back and there's no problem (MUMBLES)

ROBERT SMITH: Certainly when we operated on Hans, is he really satisfied with the, with the amputation? If he wasn't satisfied with it would he admit it, but if you look at Hans life now he's extroverted, he's, he was going to retire from business. He's now carrying on his business because he finds it's a new challenge now that he's an amputee. I, I certainly don't think Hans is suffering from having had the operation. I'm pretty definite in my mind that Hans has been enormously benefited by it.

NARRATOR: Gregg is still trying to come to terms with the fact that he will not be given the surgery.

GREGG: I've had an additional amount of time to really contemplate and think and to get inside myself to know what's happened since everything has gone kaput and I find that it's been very frustrating, that an enormous amount of despair, real anger and I have to say that there's a lot of sadness that has set in. In many ways I try to, to rationalise or I try to think about or to explain really what this is about and I feel like the people you love and you really care about who you think understand - they don't.

Something had to happen as I was growing up. I don't know what it was. Something happened. All I know is that it's real, the feeling is so powerful that you can't stop it. The feeling as it approaches is uncontrollable. It's like the wind comes over you and there's such a depth of lossness and loneness that you want to just give up on life, you want to leave.

ROBERT SMITH: These people at present are desperate. They are, Gregg's now 55 and he has a limited time in which to wait for the end results. Is he going to continue in this state of limbo he is at present where he's unable to have his wishes fulfilled, he has this desperate need for this particular procedure to be undertaken. He can't wait. We, we certainly don't know which way this is going to go.

It may be in 10 years time that people will look back and say good heavens, they actually had doubts about whether this was the right form of treatment or not in the 1990s, but on the other hand they may look back and say look what these mad people were doing in the 1990s, they were cutting people's legs off when in actual fact there is another form of treatment that is successful. We don't yet know what's going to happen. I would hope possibly in the future that there is a less radical solution produced, but at present we don't have any other form of treatment that appears to be successful.

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