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For the first time that I am aware of, we are seeing clusters of people seeking voluntary amputations of healthy limbs and performing amputations on themselves. The cases I have identified are merely those that have made the newspapers. On the Internet there are enough people interested in becoming amputees to support a minor industry. One discussion listserv has 1,400 subscribers.

“It was the most satisfying operation I have ever performed,” Smith told a news conference in February. “I have no doubt that what I was doing was the correct thing for those patients.” Although it took him eighteen months to work up the courage to do the first amputation, Smith eventually decided that there was no humane alternative. Psychotherapy “doesn’t make a scrap of difference in these people,” the psychiatrist Russell Reid, of Hillingdon Hospital, in London, said in a BBC documentary on the subject, called Complete Obsession, that was broadcast in Britain last winter. “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.” Both Smith and Reid pointed out that these people may do themselves unintended harm or even kill themselves trying to amputate their own limbs. As the retired psychiatrist Richard Fox observed in the BBC program, “Let’s face it, this is a potentially fatal condition.”