Phantom limb: from medical knowledge to folk wisdom and back

'You don't need a body to feel a body': phantom limb syndrome and corporeal transgression

One of the central tensions within the literature on body studies concerns the degree to which the physical body is constituted by or through language, knowledges, and practices and the degree to which the body has foundational, purely material, or essential attributes. Three theoretical approaches have been at the heart of this debate: social constructionism, phenomenology, and structuration theory. Recently, body studies theorists have challenged scholars to move beyond the widely recognised limitations of dominant theorising by taking into account all three perspectives and conceptualising the body as surface, vehicle, and circuit. Because they embrace agnosticism and relational materialism, science and technology studies scholars are in a distinctive position to answer this call. Proponents fully acknowledge the materiality of the body without espousing essentialist claims by effacing the analytic division between agency and structure. Starting from this perspective, I use the concept of corporeal transgression and the phenomenon of phantom limb to reveal how 'immaterial'--indeed, at times, fictive and fanciful--body parts became socially and materially substantive, engendering transformations within the bodies, minds, and brains of amputees, as well as within the field of neuroscience.

From pleasure to pain: The role of the MPQ in the language of phantom limb pain

In opposition to the argument that pain is private, personal and unsharable, I propose that the intersubjectivity of pain is fundamental to it. Using the case of phantom limb, I show how a specific language of pain emerged and became concretized in the US circa 1975 with the advent of the McGill Pain Questionnaire (MPQ). Through widespread use of the MPQ, a language of pain materialized, one that was commonly used to describe the qualitative dimensions of phantom limb. After 1975, the terminology used within the medical literature was overwhelmingly consonant with the set of descriptors advanced by the MPQ. The utilization of a pain questionnaire to assess the qualitative dimensions of phantom limb effectively accentuated pain, and by 1980, what was once considered relatively rare became a common sequela of phantom manifestation.

The phantom limb in dreams

Mulder and colleagues [Mulder, T., Hochstenbach, J., Dijkstra, P. U., Geertzen, J. H. B. (2008). Born to adapt, but not in your dreams. Consciousness and Cognition, 17, 1266-1271.] report that a majority of amputees continue to experience a normally-limbed body during their night dreams. They interprete this observation as a failure of the body schema to adapt to the new body shape. The present note does not question this interpretation, but points to the already existing literature on the phenomenology of the phantom limb in dreams. A summary of published investigations is complemented by a note on phantom phenomena in the dreams of paraplegic patients and persons born without a limb. Integration of the available data allows the recommendation for prospective studies to consider dream content in more detail. For instance, "adaptation" to the loss of a limb can also manifest itself by seeing oneself surrounded by amputees. Such projective types of anosognosia ("transitivism") in nocturnal dreams should also be experimentally induced in normally-limbed individuals, and some relevant techniques are mentioned.

Five early accounts of phantom limb in context: Paré, Descartes, Lemos, Bell, and Mitchell

PHANTOM LIMB WAS described long before American physician and surgeon Silas Weir Mitchell coined the term and drew attention to the disorder in the 1860s. The early descriptions of Ambroise Paré, René Descartes, Aaron Lemos, Charles Bell, and then Mitchell of this strange consequence of amputation are presented in historical and cultural context. These five men described phantom limbs for various reasons. They also differed when it came to explaining and dealing with these illusory sensations. The rich history of phantom limbs can begin to be appreciated by viewing the contributions of these individuals in perspective and by realizing that their writings represent only a fraction of what was published about phantom limbs more than 130 years ago.

Phantom limbs: The body in mind

INTRODUCTION

Advances in our knowledge of corporeal awareness is not limited to patients with amputations, however, until recently, the study of ''phantom limbs'' was neglected by comparison with less common disorders of body perception.

METHOD

Reasons for the neglect of this potentially informative and common condition are conspicuous by their absence in previous reviews. Over the past decade, however, experimental investigations of phantom limbs have revealed the dynamic neural processes that provide for both phantom and normal corporeal embodiment. Moreover, these findings helped to overturn widely held scientific assumptions regarding the extent of neural plasticity in the adult brain.

RESULTS

It is suggested that throughout medical history, the construct of ''phantom limbs'' posed a challenge to fundamental folk assumptions regarding the assumed relationship between body and mind.

CONCLUSION

Reluctance to entertain the counter-intuitive phenomenon of a ''limbless perception'' contributed to the comparative neglect of this fascinating phenomenon until the late 20th century.

Phantom smelling

A case of phantom smelling (phantosmia) is described in a 28-yr.-old man who developed permanent bilateral anosmia after a serious injury to olfaction-related brain structures at the age of 25 years. The findings indicate that, even years after loss of input from olfactory receptors, the neural representation of olfactory perception can still recreate olfactory sensations without any conscious recall of them. This indicates that the neural representation of olfactory sensations remains functional and implies that neuronal activity in the olfactory organ or in other brain structures gives rise to olfactory experiences perceived as originating from the perception of original odor substances. The report suggests the intriguing possibility that the olfactory perception is not a passive process that merely reflects its normal input from the olfactory system but is continuously generated by a neural representation in the olfactory organ or in other olfaction-related brain structures, based on both genetic and sensory determinants. To the author's knowledge this is the first reported case of its kind.

Neurophysiological processes underlying the phantom limb pain experience and the use of hypnosis in its clinical management: an intensive examination of two patients

In a pilot study with 2 patients suffering from phantom limb pain (PLP), hypnotic suggestions were used to modify and control the experience of the phantom limb, and positron emission tomography (PET) was used to index underlying pathways and areas involved in the processing of phantom limb experience (PLE) and PLP. The patients' subjective experiences of pain were recorded in a semistructured protocol. PET results demonstrated activation in areas known to be responsible for sensory and motor processing. The reported subjective experiences of PLP and movement corresponded with predicted brain activity patterns. This work helps to clarify the central nervous system correlates of phantom limb sensations, including pain. It further suggests that hypnosis can be incorporated into treatment protocols for PLP.

Calcitonin in phantom limb pain

PLP is a challenging disorder that is often difficult to treat. Like all other types of pain, PLP is a tremendous source of morbidity and should be treated aggressively. Though evidence is very limited, one or two doses of intravenous salmon calcitonin 200 IU may be an effective treatment. The minor adverse effects reported in the literature would seem to indicate the relative safety of this regimen; however, clinicians should be aware of the rare but severe hypersensitivity reactions that can occur with salmon calcitonin. Intranasal calcitonin appears to be similar in efficacy to the parenteral formulation, at least in pain associated with vertebral crush fractures. Long-term studies using intranasal calcitonin for relief of PLP are warranted given the ease of administration of this dosage form.