Mundo extraño

Every evening when I leave work I just miss the subway. (Yes, the universe is against me. I'll have to remember to start leaving 45 seconds before I actually intend to.) So last night, as usual, the train is just pulling out as I get to the top of the stairs. On the platform, I passed a young woman of college age or just past, with the requisite backpack and stud in her nose, on her way to the escalator. A minute later, I glanced to the top of the escalator and saw she had turned around and was heading back down the stairs. Passing in front of me at that moment was a man pushing a middle-aged woman in a wheelchair.

"Do you know her?" the young woman yelled. "Stop pushing her! She walks! She can walk better than me! She's just lazy!" and so on. The guy looked nonplussed, but he finished pushing the woman to the elevator and headed on up the stairs himself, with the young woman walking alongside and continuing to berate him.

That all seemed sufficiently odd (to say the least) that I did some googling. It turns out there is a well-recognized phenomenon of disability pretending, and, you guessed it, on-line communities of people who are into it. The motivation is not, in fact, laziness, but it is somewhat mysterious. I read a case history of a woman who experiences powerful sexual arousal after rolling around in public in a wheelchair pretending to be disabled. Indeed, the proclivity seems to be closely associated with attraction to people with disabilities, and actually desiring to become disabled, as by having an amputation. There's even an acronym, DPW, for DesirerDevotee, Pretender, Wannabe, which is thought to be some form of continuum -- and the basis for virtual communities.

I find this a bit disconcerting, but whatever my -- I don't know what the word is, aesthetic reaction, I suppose -- it is an extreme case that demonstrates the complexity of defining health and quality of life. What would be a physician's patient-centered approach to such a person? How would we evaluate her responses to a health status/quality of life questionnaire? She's not actually disabled enough to be happy? Or should we impose our own judgment and decide that she's mentally ill and she needs her brain fixed, therefore we should ignore her wishes?

Perplexing indeed.