the train do the job. Even survived to tell about it.
Though an obsession with limb amputation was rare, the syndrome had a nameâapotemnophilia. The phrase had been coined by an expert in sexuality at Johns Hopkins. Apotemnophilia victims, he wrote, wanted to cut off their limbs so they could have better sex. The suffix philia grouped it with the psychosexual disorders that the average person thinks of as perversions. Emily and I had discussed whether this diagnosis fit Mr. Black. To both of us, the way he talked about his desire for amputation seemed more about being stuck in the wrong bodyâbody dysmorphiaâthan about sexual desire.
âAnd how do you think things will be different after the operation?â Emily asked.
âMuch better. Infinitely. With thisââhe stretched out a perfectly normal-looking armââI know how odd I look.â He crossed his other arm over the one he despised.
âSo you think your arm makes you look deformed?â
âIt doesnât belong there.â
âUm-hmm.â
âI donât feel right, and itâs all I think about. Itâs cost me my marriage. My job.â
âYour boss fired you because of your arm?â
âYes.â
âThatâs what he said?â
âNo, of course not.â
âWhat did he say?â
âSome mumbo-jumbo about inadequate job skills. I didnât swallow it for a minute.â
âDid he offer you job training?â
He shrugged. âIt wasnât about that. I couldâve learned the goddamned computer shit. It was about this , not that.â
âBut theyâd promoted you before.â
âOut of pity. Thatâs all it was. They felt sorry for me so they gave me the promotion. But I know the truth. No one can stand to look at me. Iâve never had a healthy relationship with anyone. Itâs why my wife left me. How could she make love to someone as deformed as I am? Not when Iâve got this thing that doesnât belong to me. I get such an overwhelming sense of despair sometimes.â He glanced quickly up at Emily, then back down. âI donât want to die, but there are times I donât want to keep living in a body that doesnât feel like my own.â
âIâm sorryââ Emily started.
âI donât need your pity,â he said, spitting out the words. âI just need to fix whatâs wrong with me. Itâs so simple. Why is it such a big deal?â
âThink about what itâs going to mean,â Emily said. âYou cut off your arm, you wonât be able to write, shake hands.â
He blinked at her, as if unsure how to respond. Then he seemed to stare right at me with a look of loathing. I realized he was looking at himself in the one-way glass.
âIf I had a great big nose, no one would think twice if I got a nose job. And what about all those Hollywood actors who get half their body fat suctioned away? My brother rubs Rogaine into his scalp every day and no one tells him heâs nuts.â
âThose are different, and I think you know that.â
âMy brother actually suggested maybe what I needed instead of an amputation was a new car. After his divorce he got himself a Hummer.â Mr. Black rolled his head around so the bones in his neck cracked. âYou drive a red Miata. Isnât that about the same thing?â
Emily opened her mouth. She seemed at a loss for words. Course correction â¦I tried to telegraph the thought. Therapy is about the patient, not the doctor. This was classic resistance. Mr. Black was using this remark to shift the focus onto the therapist. The next thought wouldnât have occurred to me if Emily hadnât been stalked: How the hell did Mr. Black know she drove a red Miata?
âAre you sure this is what you want? You wonât be able to change your mind later.â
âI know what I want. Iâve known it ever since I was