‘You don’t need a body to feel a body’: phantom limb syndrome and corporeal transgression
Address for correspondence: Cassandra S. Crawford, Department of Sociology, Northern Illinois University, 806 Zulauf Hall, Dekalb, IL 60115, United States
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.
The first meeting between a phantom limb and its owner is, typically, a rather dramatic affair. As the patient wakes up from surgery he feels his leg present, he seems to be able to wiggle his toes quite normally – and then someone steps up to him and tells him that the operation went very well and he will be able to walk on an artificial limb in no time at all. No matter how well and how long before the operation he was prepared for the loss of the leg, the patient typically cannot believe that it is really gone … [because] he continues to feel the absent limb as if it were still present (Simmel 1966: 346).
Phantom limbs are those ghostly appendages that persist sometimes with uncanny realness long after intact limbs have been traumatically, surgically, or congenitally amputated. They are often felt as thoroughly mimetic, all but faultless copies of the genuine thing, or even as possessing more awareness than the pre-amputated limbs they emulate and consequently, as exceptionally pleasant or pleasurable. One of Simmel’s (1956: 641) patients reported, ‘The leg felt good … real good’. For other amputees, phantoms have been sensed as paralysed and functionally dead to the world, as if submerged in mercury, weighed down by plaster, or imbedded in a block of ice. And quite disturbingly, these bodily apparitions have also subjected some amputees to a lifetime of one of the most intractable and merciless pains ever known (Crawford 2009). Phantom limbs are curious to be sure because they often move in the world like fleshy limbs – waving goodbye or gesticulating during conversation – because they possess lovely or disturbing histories – wearing precious engagement rings, favourite lace-lined socks or blood-filled boots – because they can exist tenaciously and sometimes audaciously – penetrating solids, objects and even the very viscera of others – and because they ‘physically’ detach from the body – leaving gaping holes as the hovering bit follows the body with reverence and in perfect harmony. Embodied ghosts are curious for these and many other reasons, and it is their curiousness – their many eccentricities – that make phantom limbs a uniquely productive ingress into epistemological and ontological questions about the body, corporeality and embodiment, questions that have (re)surfaced over the last few decades as the body has become an increasingly fruitful object and site of inquiry.
One of the most enduring tensions within the literature on the sociology of the body or body studies concerns the degree to which the physical body is constituted by or through languages, discourses, knowledges, ideologies, and practices and the degree to which the body has purely material or essential attributes. Which features of the body or aspects of embodiment are acquired and which, if any, are intrinsic or foundational? Three theoretical approaches have been at the heart of this debate: social constructionism, phenomenology, and structuration theory.
Social constructionism has prioritised the role of discursive and normative regimes in disciplining or governing and representing or politicising the corporeal, and it has been a primary impetus for the ‘corporeal turn’ in social theory. Proponents argue that the physical body is devoid of essential attributes and as such, is amenable to inscription and re-inscription. Although social constructionists illuminate the myriad ways in which bodies have been constrained and managed, constituted and represented within power relations, they have been criticised for overemphasising the role of social structure, for disregarding lived experience or embodiment, and for devaluing the body as a source of and resource for the formation, maintenance, and transformation of social institutions, knowledges, and practices.
Conversely, phenomenology prioritises experience and materiality, recognising the body as a source of individual and collective social action, as well as social structure. Indeed, it is only vis-à-vis bodily experience that it is possible for the self and society to be constituted. Starting with or from a lived body that is practically engaged with the world, phenomenologists consider reflective thought, inter-subjectivity, and social order to be preceded by embodiment. Although the body is undeniable at the centre of analysis, the role that power relations play in making up the body or the role that external constraint has on lived experience is considered by critics to be woefully neglected.
The theory of structuration was developed as a means of overcoming the asserted division between agency and structure by emphasising the fundamentally co-constitutive, recursive nature of the relationship between bodies and society. Proponents call attention to the contingency of late-modern corporeality and the equally contingent quality of social life and social institutions in the contemporary context. For example, Giddens (1991) argues that body image and body practices have become central to reflexive body projects that draw the increasingly malleable and uncertain body into the reflexive (re)organisation of risk-oriented social life. The body is amenable to self-design, to being ‘reflexively mobilized’ (Giddens 1991: 7), precisely because ‘the contingency of the contemporary social world is incorporated and reinforced by the contingency of the body’ (Shilling 2005: 18). While avoiding the asserted weaknesses of social constructionism and phenomenology, structuration theory has been criticised for conflating social action and social structure, while also reducing the embodied actor to the cogitative self.
Shilling (2005: 18 original emphasis) and others have challenged scholars to move beyond the widely recognised limitations of dominant theorising; he proposed, ‘It is one thing to acknowledge the body’s importance as a location on which the structures of society inscribe themselves [social constructionism], as a vehicle through which society is constructed [phenomenology] or as a circuit which connects individuals with society [structuration theory] but any comprehensive theory of the body needs to take account of all three of these processes’. Because they embrace agnosticism and relational materialism, science and technology studies (STS) scholars are in a distinctive position to answer this call.
STS takes seriously the materiality of bodies, conceptualising artifacts, things, substance and matter – as well as the ostensibly discursive or ideational – as mediating objects in social relations. Bodies are understood as one dynamic element in heterogeneous networks that are historically situated and nested in broader dynamic and shifting networks. Berg and Akrich (2004: 2) write,
STS’s emphasis on the material heterogeneity of practices and its struggle with the concurrent historicity and durability of ‘objects’ and ‘matter’, when applied to the body provides the analyst with theoretical tools adequate … to acknowledge the body’s active status as agent without implying its immediate, pre-fixed presence.
Many STS scholars advance a form of relational materialism that is concerned with the material aspects of social life, how these are brought together and the implications of such associations. Networked elements are made meaningful only in relation to other elements in the network (and as a consequence of the network’s nature or features). Thus, proponents fully acknowledge the materiality of the body – without espousing essentialist claims – by effacing the analytic division between agency and structure. Importantly, because they embrace agnosticism, any a priori assumptions about ‘objects’ and ‘matter’ are avoided, and in fact, assumptions like these are thought to be in need of critical examination. Accordingly, bodies or even body parts (cells, genes, organs, limbs, etc.) are objects of importance that are ‘dissected’ in an effort to expose the processes underlying their emergence as interactional effects. In other words, the qualities and characteristics of the network, the processes and practices that make up networking, and the networked objects themselves are all of interest and foci of analysis.
As a conceivably unorthodox means of intervening in this controversy, 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 as well as materially substantive and as a result, meaningful interactional, relational, or affiliative partners. While historicising and contextualising phantom limb syndrome – situating ethereal appendages within the social worlds of psychology, medicine, and biomedicine – I also show how phantoms have clearly been the source of and a resource for embodied recalcitrance. Corporeal transgressions are, of course, not new. Many scholars have detailed accounts of and theorised about the leaky (Shildrick 1997), recalcitrant (Williams and Bendelow 2000), seepy (Lawton 1998), and transgressive (Monaghan 2001), aspects of bodies. Perhaps most notably, Williams (1998: 60) argues that ‘Human corporeality [is] primarily excessive/transgressive’; transgression is a primordial, pre-discursive, and pre-social feature of the human body, that ‘always threatens to ‘overspill’ the boundaries which currently seek to ‘contain’ it’ (Williams 1999; Williams and Bendelow 2000: 53).
This work makes two significant contributions to the agency-structure debate broadly speaking and more expressly to the literature on corporeal transgression. First, I highlight the ways in which bodies or more specifically body parts (ethereal limbs that ‘belong’ to amputees and are embodied or lived) meaningfully act as relational partners when associating with objects and others – even in the context of biomedical attempts to construct these same limbs as productive technologies of the body – without the need to resort to the primordial or the pre-social. I show how the body, ‘dissected’ into parts and seemingly absent ‘raw materiality’, is nevertheless a distinct and significant presence that is imbued with social substance and material integrity. Second, I argue that corporeal transgression or recalcitrance is always relationally accomplished. The leaky nature of bodies materialises in response to attempts at containment, control, regimentation, management, or in the case of phantoms, (bio)medical rationalisation. I do not mean to suggest that phantoms have been indifferent or impervious to attempts at rationalisation. Rather, I want to underscore the fact that phantoms are not simply objects that can be made ‘explicit’ once and for all as science ‘progresses’, as measurements become more sensitive and researchers more discerning, as the naivety of the past transitions into the deep insight of the present or potential future. The qualities and peculiarities of phantoms are not merely uncovered or discovered with wonder. Rather, phantoms are agents in their own right, shape-shifters that have what Suchman (2005: 379) called ‘affiliative powers’; they are not, in her terms, ‘innocent’ but rather are ‘fraught with significance for the relations that they materialize’. As such, they have power-as-effect and indeed, they have been the force behind many transmutations within the bodies, the minds, and the brains of amputees, as well as within the field of neuroscience.
In the postbellum context, phantoms transformed the bodies of some of America’s bravest and most sacrificing soldiers while also transforming their psyches through fraudulence and emasculation. Still, despite efforts from the late-19th through the mid-20th centuries to definitively ‘psychologise’ phantoms, embodied ghosts refused to acquiesce to this origin story. In fact, in response to attempts to situate phantoms deep in the mind, to define them as pure fantasy, and to characterise them as fundamentally mimetic, mid-20th century ghosts began to distort in profoundly perverse ways. Increasingly, distortion became a common sequela of phantom limb syndrome and their transgressions would eventuate in the complete abandonment of psychogenic theories of phantom aetiology or cause. By the late-20th century, phantoms fundamentally transformed the brains of amputees through the growth of new connections and the crossing-over of brain-based body parts. And, as shape-shifting phantoms proliferated to territorialise parts of the body far removed from the site of amputation, they were hailed as the new Holy Grail of neuroscience forcing reconsideration of one of the most elemental and enduring dogmas of the field: the ‘hardwired’ adult human brain.
This work is part of a larger study that chronicles the relationship between dismemberment and prosthetisation in the context of the modernisation of amputation by deconstructing psychological, medical, and biomedical accounts of phantom limb syndrome from the late-19th century to the present. This larger study employs semi-structured interviews, participant observation, and an interpretive content analysis of the psychological/psychiatric and (bio)medical literatures. Here, I rely on a grounded theory-inspired, interpretive content analysis of over 780 articles and texts published from circa 1870 to 2010.
A ghost story
This ghost story arguably begins with the famed American surgeon Silas Weir Mitchell who is attributed with coining the phrase ‘phantom limb’ and with providing the first modern description in the mid-1800s (Herman 1998). His first reference appeared in a fiction article published in The Atlantic Monthly where he presented the story of George Dedlow, an assistant surgeon in the American Civil War (Mitchell 1866). Dedlow experienced an horrific series of amputations, losing an arm and both legs to battlefield wounds and his remaining arm to hospital gangrene after which he became a fraction of himself, ‘a useless torso, more like some strange larval creature than anything of human shape’ (Mitchell 1866: 4). Dedlow’s story ostensibly resolved during a séance when a medium contacted the spirit of his amputated legs using assigned Army Medical Museum numbers. The medium facilitated a brief reunion with 3486 and 3487 after which Dedlow sunk to the floor left with the sense that he would never be enough of himself, always only a ‘fraction of a man’ (Mitchell 1866: 8).
Unaware of the fictitious nature of George Dedlow, the public sent donations to the ‘stump hospital’ on his behalf and attempted to visit him during his convalescence. This prompted the Surgeon-General’s office to search their records in an effort to find this quadruple amputee (Finger and Hustwit 2003) and led Mitchell to publish a clarifying article in Lippincott’s magazine, which printed general articles in literature and science during the late-19th and early-20th centuries. As Whitaker (1979: 273) concluded, in his article ‘the literary “limbs invisible” became the medical “phantom limbs”, and the term has been with us since’.
Mitchell’s scholarly article presented a less ‘humorous sketch’ of phantom limbs including the temporal aspects of ‘ghostly members’, the morphology of ‘the spirit member’ and the kinesthesia of ‘shadowy fingers and toes’ (Mitchell 1871: 564, 566, 567, 568). This article and his Injuries of Nerves and Their Consequences published in 1872 – a volume that documented an impressive 90 cases of phantom limb – established what was known about ethereal appendages in terms of symptomatology (the set of symptoms characteristic of a disease), epidemiology (the distribution of a disease within a population), and aetiology (the cause of a disease) well into the first half of the 20th century.
For Mitchell, phantoms were psychical replacements of lost physical parts and were demonstrative of just how gravely the self could be fractured by amputation. Because the physical body was central to masculine identity during the Victorian era – communicating power, vitality, and productivity – dismemberment could effectively undermine personhood. The amputee lacked physical integrity, productive potential, and masculine vitality, the kinds of deficiencies that could lead to a ‘falsification of the self’; because he made untenable and insane claims about his body, the civil war amputee was equated to the female hysteric (O’Connor 2000: 104). For example, Mitchell (1872: 196) described how phantom pain reduced even the ‘strongest man [to] scarcely less nervous than the most hysterical girl’. Like the hysteric whose theatrical displays revealed ‘a fraudulent body language’, the amputee whose stump thrashed about and writhed from excruciating phantom pains, or even simply periodically awakened to preoccupy or misbehave, demonstrated that a man’s body could betray him, that it could be deeply inauthentic (O’Connor 2000: 104). When the male body was emasculated, fractioned, and falsified little could be done to restore its integrity. More disturbingly, his mind was also irreparably damaged by the same bullets that had torn his body asunder. A soldier who confessed of limbs that no longer existed was unequivocally compromised and his phantom was proof of his psychical troubles.
Over the next several decades, phantoms continued to be conceptualised as psychological in origin, but by the mid-20th century, researchers and clinicians were debating the degree to which phantoms were inherently pathological – as Mitchell intimated – and the concept of wish-fulfilling denial became the crucial pivot. The work of Sigmund Freud (1856–1939) and Anna Freud (1895–1982) on psychoanalytic defence mechanisms was enormously influential within American psychology particularly after the 1950s when Anna began to lecture regularly throughout the United States (Young-Bruehl 1988). Her The Ego and the Mechanisms of Defence first published in German in 1936 (1976) soon became the principal elaboration of the concept of denial for American psychoanalytic thought. Within the literature on phantom limbs, the concept was invoked from the early-1950s through the early-1980s. However, there were two distinct renderings or applications of the concept that overlapped temporally. For some, denial was desirable or at least a favourable sign of adaptation to limb loss. For others, denial was deleterious, a toxic state that had to be protected against. Denial was either an indication that an amputee was positively attached to or invested in his body (a mark of security) or it was a reaction stemming from over-investment vis-à-vis pathological egotism (a mark of insecurity). Either way, phantoms were rooted squarely in the mind. They were psychical replacements of limbs lost but not forgotten that were pure fiction or fantasy conjured up by the mind to protect good men from the debilitating effects of profound physical loss. Consequently, phantoms were conceived of as morphologically and kinesthetically mimetic of fleshy limbs. They ‘looked’ and ‘acted’ like the intact limbs they emulated.
Mimesis and distortion
As uncanny imitators, phantom limbs were long thought of as replicas of the original, copies in terms of size, shape, posture, and movement. In fact, phantoms were frequently described as emulating the pre-amputated limb in very precise ways. Mitchell (1871: 568) wrote:
Many readers will recall a bit of newspaper science which described the retina of the eye as having indelibly fixed upon it the last scene which it reflected during life. This fable is realized in the case of many lost limbs … There are some cases of hands which have been crushed or burned, and the fingers remained painfully rigid in life or bound on a splint … The latest and most overpowering sensation is thus for all time engraved upon the brain.
Phantoms often maintained the fixed, relaxed, flexed, or twisted posture of pre-amputated limbs, particularly the position of the limb just prior to loss – what Simmel (1956: 641) termed the ‘last moment of life’. For instance, a soldier who had tried to protect himself from flying shrapnel permanently sensed his splayed phantom hand in the same position it had occupied at the moment of traumatic amputation. When he was asked to describe it, the soldier replied, ‘The hand is right in front of my face. I’m looking at it’ (Harber 1958: 20). Most commonly, the pain experienced weeks, days, or hours before the amputation, such as the pain of an ulcer, swelling, or gangrene endured indefinitely. Phantom pain also aped the pain of an injury that occurred prior to the amputation, perhaps years before, as well as pain completely unassociated with the amputation itself. Henderson and Smyth (1948: 101) wrote about the quality of phantoms and their ‘parent sensations’:
The sensation may be divided into three groups, depending on the relationship of the parent sensation to the time of wounding: (1) the revivification of a sensation experienced in the limb before wounding … for example, the discomfort of an ingrown toe-nail …; (2) the wound itself; (3) the persistence of a sensation experienced between the times of wounding and amputation … for example … the sensation of a traction pin [or] the sensation of lice crawling under plaster.
The mimetic phantom ‘seem[ed] to maintain such perfect connexion and harmony with the stump … [and] as a rule the phantom seemed to be a replica of the original’ (Henderson and Smyth 1948: 99); ‘show[ed] considerable uniformity, since they reflect[ed] constant and generic features’ (Harber 1956: 625); ‘[was] experienced as self-evident and belonging to the normal integrity of the body’ (Frederiks 1963: 75); and ‘[felt] as the original limb did in every respect as to shape, size, consistency, position, sensation and ability to move’ (Frazier and Kolb 1970: 487). Given the assumption that phantoms were mimetic of pre-amputated limbs in form and function, distortion was unintelligible and thus, rare specimens were typically described as incomplete, resized, or strangely postured versions of what was referred to as the ‘natural phantom’. Incomplete phantoms were just ‘not filled in’ or finished, while resized phantoms were nothing more than tiny or large versions of the ‘real McCoy’. Phantoms that occupied a strange position or posture did so for the most part within anatomical limits and importantly, in ways that reflected the positioning of the limb just prior to amputation, a tendency that actually testified to their mimetic nature.
By circa 1980, the ‘unnatural phantom’ was typical and strange distortions were recast as among the many forms that phantoms could assume. Distorted phantoms began to appreciably deviate from normal structure and were reorganised in profoundly perverted ways. Abramson and Feibel (1981: 105) commented, ‘There are many reports of images [phantoms] that are deformed in amputees and images that are uncoupled and markedly out of place from where they should be’ such as a knee located lower than normal at shin level (Melzack et al. 1997), a phantom arm irregularly shaped with a thin forearm (Cole et al. 2009) or a phantom foot on backwards (DiMartino 2000).
Despite attempts by researchers and practitioners to rationalise phantoms, to delimit the parameters of phantom morphology, embodied ghosts morphed or shape-shifted. They twisted, contorted, warped, spread, flattened, and ‘pathologised’ in many other ways. Phantoms increasingly refused to abide by the laws that had always governed bodies, such as gravity (floating like helium-filled balloons), symmetry (growing from the middle of the chest), time (suddenly disappearing or reappearing, popping in and out of sensorial experience) or permanence (telescoping to curl up inside the stump as if hibernating). In response to medical attempts at ‘containment’, phantoms transgressed; they did not acquiesce to an origin story that defined them as nothing more than copies, replicas, fakes.
Phantoms began to materialise in ways that were quite ‘unnatural’, and they did so despite the widely accepted assumption of their psychogenesis, an assumption that made distortion entirely incomprehensible. If phantoms were psychical manifestations – fictive limbs that the mind manufactured in response to profound loss for protective purposes – then they should be sensed as flawless copies. If phantoms were fantasy, they should be thoroughly authentic, perhaps even ‘ideal’ representations of what was familiar. If phantoms were purely imaginary, they should be undeniably pleasant and devoid of even the most subtle hint of pathology. Increasingly, they were not. And, as distortion became more and more normative, the phenomenon had to be accounted for and accordingly, the aetiology of phantom limb had to be entirely reimagined. Ethereal appendages did not abide by the established tenets of phantom morphology, and they did not submit to attempts at their ‘psychologisation’. What they did do was to engender a shift in knowledge that would radically change the lived experience of amputation, dramatically alter assumptions about the structure and function of the brains of amputees, and effectively undermine one of the most fervently held doctrines of modern neuroscience.
Although phantom limb ostensibly fell under the purview of medicine in the mid-1950s through inclusion in the Index Medicus (Whitaker 1979), phantoms were predominantly thought to be psychological in origin until circa 1960 when overt and ever more derisive critiques of psychogenesis began to appear more frequently in the medical literature. Increasingly, phantom limb syndrome – as it began to be called – was considered physiologic or more specifically neurologic in origin. Since the late-20th century, embodied ghosts have no longer resided in the dark recesses of the disturbed or repressed mind, but rather in the pink, convoluted folds of the cerebral cortex. Networking with neuroscientists, animal rights activists, and brain imaging technologies among many others, misbehaving ghosts found their way out of the dark and into the (lime) light. Phantoms had for decades remade the psyches of some of America’s most courageous boys and men, and as history would reveal, phantoms would also remake their brains becoming nothing less than the Holy Grail of neuroscience, nothing less than a truly precious window into the very future of our humanity.
Phantoms in the brain
Canadian neurosurgeon, Dr. Wilder Penfield (1891–1976), initiated groundbreaking research during the 1930s and 1940s into intractable epileptic seizures (Finger 1994). Using cortical stimulation during neurosurgical operations, Penfield was able to induce what is termed the aura stage in his patients which is typically felt by epileptics just prior to the onset of a seizure. With the surface of the subject’s brain exposed, he used electrodes to pinpoint and excise the section of brain matter that caused replication of the aura stage effectively curing some patients of their seizures. Serendipitously, he also made a discovery that would profoundly impact the then nascent field of neuroscience. With fully conscious patients, a stenographer, photographer, electrodes, and tiny numbered tickets dropped onto the brain, Penfield constructed maps of human sensory and motor function, maps that have remained virtually unchallenged since (Stevens 1971).
Equipped for exploration with his tiny territorialising flags, Penfield localised what are commonly referred to as the sensory and motor homunculi (Penfield and Boldrey 1937, Penfield and Rasmussen 1951). When the intact physical hand is introduced to heat, pressure, or pain for example, the sensation ‘registers’ in the cortical area of the somatosensory cortex known as the homuncular hand. Likewise, stimulation of the homuncular hand (using an electrode) is felt by subjects as sensation originating in the physical hand. These topographical maps of sensory and motor function that lay across each of our cerebral hemispheres are bilaterally reversed (the left side of the homunculus corresponds to the right side of the body), upside-down (the homuncular feet are at the ‘top’ of the brain) and not fully continuous (from homuncular head to neck to shoulder, etc.). For example, the area corresponding to the feet in the sensory homunculus can be found located next to the genitalia, the face next to the hand, and the breast next to the ear.
Penfield first published on the homunculi in 1937 (Penfield and Boldrey 1937), but it was his The Cerebral Cortex of Man (Penfield and Rasmussen 1951) and The Excitable Cortex in Conscious Man (1967) that were among his most significant contributions to modern neuroscience (McNaughton 1977). And, although there were correspondingly early references to the sensory (and sometimes motor) cortex during the 1940s, 1950s, and 1960s within the literature on phantom limb, it was not until the mid-1980s that the role of Penfield’s homuncular maps in the aetiology of phantom limb was widely acknowledged.
By the 1990s, monkey cortices and Dr. Timothy Pons would offer unequivocal proof that Penfield was one of history’s most masterful cartographers of the human brain. In 1991, Dr. Timothy Pons (1956–2005), a neuroscientist at the Laboratory of Neuropsychology at the National Institute of Mental Health, conducted a series of experiments on the now infamous 15 Silver Spring macaque monkeys (Holden 1989). In the summer of 1982, in an unrelated rehabilitation experiment, the monkeys underwent rhizotomy, a procedure in which the nerves from the arm are completely severed from the spinal cord. Years later, with the help of animal rights activists and a court order, the research was discontinued. The monkeys were seized by police but languished in the custody of the National Institutes of Health until the court demanded that three be humanly euthanised (Shreeve 1993). In a sardonic twist of fate, Pons was given permission to examine their brains before their euthanasia, and the monkeys spent their last days back in the laboratory.
During his examination, Pons found that in each of the monkeys the cortical area previously corresponding to the arm (the homuncular arm/hand) was not dormant or inactive as one might assume after all those years of paralysis, but instead responded to stimulation of the face (Pons et al. 1991). Pons proposed that because the homuncular face and the homuncular hand are adjacent to one another in the somatosensory cortex and because the neural region belonging to the homuncular hand ‘sat unused’, the homuncular face began to encroach upon or make use of the idle region. And, it was the neuronal crossing-over of brain-based body parts – in cases of paralysis, amputation, and others – that some researchers argued was the cause of phantom sensation, awareness, and pain.
Moreover, Pons found that the idle region had been reorganised to such a degree that it suggested the growth of new connections between neurons, a phenomenon referred to as neuronal sprouting or aborisation. As Shreeve (1993: 3, emphasis added) concluded, ‘In effect, fully a third of the entire touch map [the sensory homunculus] – over half an inch of cortex – had switched its allegiance. With no orders coming in from the numbed limb, it had married its fortunes to those of the face instead. This is neural reorganisation on a massive scale, unimaginable in a hardwired brain’. Pons’‘finding’ that the cortex was amenable to reorganisation through the growth of new connections after deafferentation (the loss of nerve impulses) contrasted with the hardwired conception of cortical organisation and development that then prevailed in the neurosciences. Phantoms visualised through the reorganised somatosensory cortices of macaque monkeys had further legitimated Penfield’s maps, but more significantly, they had effectively upset the very foundation of modern neuroscience and caused the hardwired brain to be all but abandoned – at least in some circles. Ramachandran and Blakeslee (1998: 31) enthusiastically explained, ‘The implications are staggering. First and foremost, they suggest that brain maps can change, sometimes with astonishing rapidity. This finding flatly contradicts one of the most widely accepted dogmas in neurology – the fixed nature of connections in the adult human brain’.
The brain was amenable to dramatic remapping through the growth of new connections, and accordingly, researchers in the field began to argue that if the sensory and motor maps of the brain were reorganising in response to limb loss, there should be a sensorial equivalent. In other words, cortical reorganisation or remapping must somehow be felt by amputees.
The new Holy Grail
Researchers and practitioners have long documented in cases of major amputation what is termed ‘referred sensation’ or the referral of sensation from a particular trigger zone located on the stump into or onto the phantom limb. For example, a light touch, a breeze, a thump, or a painful pinch on the stump could be referred to or projected onto a phantom hand producing ‘separate sensations in the … [phantom] and stump which appear to come from the same point’ (Katz 1992: 286). Because the nerve supply that ‘fed’ the hand is still functional after amputation, stimulation of the stump should produce sensation felt as though it originates in the phantom. In addition, according to Penfield’s sensory map, the homuncular hand is adjacent to the homuncular face so that stimulation of the physical face should also produce sensation referred to the phantom. As Ramachandran (1998: 1853) explained, ‘Because the hand area in the Penfield map is flanked on one side by the upper arm and the other side by the face, this is precisely the arrangement of points that one would expect if the afferents from the upper arm skin and face skin were to invade the hand territory from each side’.
Consequently, researchers expected to find remote trigger zones far removed from the site of amputation, zones that produced sensation in or on the phantom as a result of cortical remapping. And in fact, they did. For example, Ramachandran and Blakeslee (1998: 29) found two distinct trigger zones on Tom. Using a Q-tip brushed along the contours of his face while Tom was blindfolded, they discovered one ‘beautifully laid out “map” ’ of his phantom hand on his stump and another complete map of Tom’s phantom hand superimposed on his face. ‘Neurologically speaking, at least, the hand was not missing at all – indeed, it was now a pair of left hands one meticulously laid out across his lower face, the other wiggling its digits just below his shoulder’ (Shreeve 1993: 4 emphasis added). Without warning, shape-shifting phantoms were proliferating in ways that were utterly unthinkable. Indeed, this same process of cortical invasion or takeover began to be documented in cases of phantom feet and homuncular genitalia (stimulation of the genital was felt in the phantom foot), as well as phantom breast and homuncular ear (stimulation of the ear produced sensation in the phantom breast) because these body parts reside next to one another in the somatosensory cortex or sensory homunculus.
What is so remarkable about these far-removed trigger zones is their relative absence within the literature until circa 1990. Incredibly, just as visualising technologies such as CAT scans and PET imaging began to be used regularly to peer into the brains of amputees, and just as cortical remapping surfaced with the work of Pons and others, embodied ghosts morphed once again. Phantom breasts lay across the ears of mastectomy patients, phantom feet spread their toes over genitalia and phantom hands reached their fingers nimbly over jaws and across cheeks. As devoted shape-shifters and practised transgressors, phantoms spread to territorialise new and ‘erroneous’ body parts just as they were being captured by the (biomedical) camera, just as they were being ‘pinned down’ by neuroscientists in an effort to buttress claims about cortical plasticity.
At the turn of the 21st century, assumptions about the structure, functionality, and organisation of the human brain was being entirely rethought, and as some researchers zealously argued, phantoms found in the remapped brains of traumatic, surgical, and congenital amputees offered the promise of unparalleled answers. Study devoted to this illusive and obscure phenomenon, they claimed, has and will provide heretofore unimaginable and invaluable insights. Phantoms have been exceedingly fruitful experimental objects and the researchers dedicated to their investigation serendipitously in a position of exploitation. For example, Ramachandran and Blakeslee (1998: 3) proposed that the study of phantoms has allowed us to:
address lofty ‘philosophical’ questions about the nature of the self … By moving these patients [amputees] out of the clinic and into the laboratory, we can conduct experiments that help reveal the deep architecture of our brains. Indeed we can pick up where Freud left off, ushering in what might be called an era of experimental epistemology … and start experimenting on belief systems, consciousness, mind-body interactions.
Brain-based body parts, researchers implored, should be brought into experimental contexts in an effort to answer some of the most elemental and lofty questions about human sensation, perception, experience and much more. In fact, we would be remiss if we did not give phantoms the chance to show us that cartographers of the brain can expose what even the most formidable architects of the mind could not. In an interview appearing in Discover a few years earlier, Ramachandran was quoted by Shreeve (1993: 2) who wrote, ‘If neuroscientists like Ramachandran … are correct, the exotic phenomenon of phantom limb offers one keenly magnified perspective on what routinely happens in the brain as we engage the world around us … We’re looking at a new route to the Holy Grail of neurobiology’.
The eerie appendages of the past – those that Michell (1871) argued betrayed so many good men – were being touted as the Holy Grail of neurobiology providing a window into the very secrets that the brain had always so fervently guarded, a window into ‘the last great-unsolved problems in science’ (Ramachandran 2009: 777). Phantoms became invaluable enabling revolutionary insight into – among many other curiosities – the true nature of the mind-body connection. For instance, Melzack (1993: 620) boldly proposed, ‘You don’t need a body to feel a body’, and he argued that the phantom functions as quite compelling evidence of the body’s epiphenomenal quality. He wrote, ‘The brain itself can generate every quality of experience which is normally triggered by sensory input’ (Melzack 1993: 620), so that the body is ‘not essential for any of the qualities of experience … from excruciating pain to orgasm’ (Melzack 1989: 1, 9). Ramchandran and Blakeslee (1998: 58 original emphasis) took this supposition to its logical extreme when they argued, ‘Your own body is a phantom, one that your brain has temporarily constructed purely for convenience’.
As a distinctively productive way of tapping into the most vital and compelling mysteries of the human cortex, as persuasive evidence of the brain’s ability to generate the most complex of sensory experiences, as clear proof that the body has always only been a phantom constructed by the brain for our convenience, embodied ghosts have secured a prominent place in the history of neuroscience and have become entirely indispensable. Moreover and paradoxically, phantoms have become more real than real, more substantive than the intact limbs they have at times mimicked with such meticulousness and ease. In fact, intact limbs have become superfluous to corporeality, as well as comparatively fruitless in experimental contexts, while phantom limbs have become, at least in some respects, better than the best fleshy limbs because they are brain-based.
We know that the source of phantom limb is in the brain itself … Far from being deadweight in the brain, the cortex associated with the lost limb is alive and well, passing messages further on up into the system. The messages may not be originating in the limb anymore, but the rest of the brain doesn’t know that (Shreeve 1993: 5, added emphasis).
Far from being psychic baggage – the manifestations of wish-fulfilling denial buried deep within the disturbed mind the purpose of which was seemingly only to torture and horrify – far from being ‘deadweight’– defunct or silent cortical tissue taking up valuable neural space in those rare brains ‘fractured’ by dismemberment – today phantoms are the Holy Grail of neurobiology, sacred objects with wondrous and enigmatic qualities that assertedly deserve our collective curiosity and concern. They are unique neurologic windows that allow us to peer intently and with awe into the cortical processes that are considered constitutive of human experience and the very essence of our humanity. They are precious windows that have become elemental to our understanding of how and why the body-in-the-brain is so amenable to (re)mapping and thus, inclined toward misbehaviour, toward transgressive shape-shifting. Indeed, phantoms are distinctive and invaluable tricksters that testify to and are demonstrative of just how easily the brain can be haunted and misled, to just how easily the haunted body can betray, and to just how fragile all physical bodies have become in the wake of neuroscientific preeminence. Phantoms seen in circuitous ways have developed an import far beyond that of the many fleshy limbs that reside contentedly in the realm of the easily visible, and perhaps ironically, it turns out that they have much to teach us about the role of the immaterial in all things corporeal.
As awkward as it is to theorise about the body, corporeality, and embodiment starting from ‘mere traces’ or the apparent ‘residue’ of that which is no longer ‘me’ but still definitively ‘mine’, phantoms can also show us how one might take seriously Shilling’s (2005) challenge to move beyond the limitations of dominant theorising within body studies. Starting from the STS-inspired premises that phantoms are agential, emergent, and obdurately relational, ethereal appendages with their many peculiar eccentricities force us to attend to the fact that the body (and its parts), even if fractured and haunted or brain-based and epiphenomenal, is at once – in Shilling’s terms – surface, vehicle, and circuit.
In the postbellum context, fictive and fanciful embodied ghosts were: (1) the location or surface on which Victorian ideals of masculine vitality, productivity, and prowess were inscribed; (2) the vehicle or means through which modern ideas about dismemberment were manifest especially in terms of bodily authenticity and fraudulence; and (3) the circuit through which wounded soldiers were intimately associated with the successes (or failures) of post-war renormalisation efforts vis-à-vis the increasingly palpable fear that emasculation by way of amputation could effectively disrupt selves, families, and communities. Untrustworthy and fraudulent spectres of limbs functioned as undead connective tissue linking what Goler (2004: 161) described as ‘a profound mixture of love and horror, fascination and anxiety’ with the widespread commitment to rebuilding a fractured nation.
Today, phantoms are: (1) the location or surface on which notions of corporeal integrity and embodied experience are inscribed, especially as these relate to pain and pleasure, consciousness, and the mind-body connection; (2) the vehicle or means through which late-modern ideas about the import or more specifically the primacy of the exalted brain are manifest in terms of human sensorial experience and even the very essence of ‘being’; and (3) the circuit or conduit that connects amputees to the promises of neuroscientific discovery and preeminence, as well as to some of the most engrossing mysteries of the human cortex.
Conceptualising phantoms as at once surface, vehicle and circuit underscores the historicity of fictive and brain-based appendages, and it elucidates their many transgressive responses to psychological/psychiatric and (bio)medical efforts at rationalisation including falsification, distortion, proliferation, migration, reorganisation, and many others. It has also been in these contexts, in response to the many formidable attempts at containment or rationalisation, that phantoms became substantive, came to matter, or – in Young’s (1995: 6) terms – came to ‘penetrate people’s life worlds, acquire facticity, and shape the self-knowledge of patients, clinicians and researchers’. Phantoms acquired facticity not because of their physical properties per se but rather because of their power-as-effect. Today, ethereal limbs animate brains in order to be seen, and they proficiently animate prostheses in order to be felt. In fact, they can be seen quite clearly using brain imaging technologies – often in vibrant and stunning colour – and they can be felt quite keenly as vital body parts rather than defunct remains when they occupy or inhabit prostheses bringing ‘dead wood’ and ‘cold steel’ to life. Moreover, phantoms remake the morphology of human bodies – sometimes in bizarre and very distorted ways – and they remap the geography of human cortices effectively disturbing what was once considered immutable.
Misbehaving ghosts are meaningful interactional or relational partners for individuals, collectives, objects, and the like. As such, they have engendered significant transmutations within the bodies, minds, and brains of amputees, as well as within the field of neuroscience. However and importantly, phantoms are far from expressions of primordial recalcitrance. Their transgressions have always materialised out of friendly or contentious networked relations with hysterics, post-war renormalisation policies, psychoanalytic theorising, neuroscientists, macaque monkeys, epileptics, cortical cartographers, and brain imaging technologies to name a few. Phantom limbs have always been historically-situated, relational or networked effects with affiliative qualities and transgressive tendencies. To be sure, embodied apparitions of lost limbs have never been ontologically protean; rather, shape-shifting is their quintessence just as it is for all affiliative objects.