1.42 The Brain Changes, Part 2 of 3: Phantom Limb

The first recorded and studied phantom limb appeared in 1871 by Silas Weir Mitchell. Amputee patients expressed a feeling that the lost limb was still present and in some cases, caused pain, discomfort or cramping. Phantom limb pain has largely been more of a curiosity but studies over the past twenty years have used this phenomenon to research neuroplasticity – the brain’s ability to change. A phantom limb occurs when an extremity is amputated but the patient physically feels that the lost arm or leg is still attached to the body. In many instances, phantom pain accompanies the illusioned limb. The phantom appears most commonly in external amputations, but patients have experienced menstrual cramps after a hysterectomy or acute pain of appendicitis following the removal of the inflamed appendix.

V.S. Ramachandran, Center for Brain and Cognition, University of California analyzes phantom pain through the following pieces of information surrounding the limb loss: Incidence, onset, duration and posture.

Research has shown that the incidence of phantom pain in patients is higher following a traumatic loss or if there was a pre-existing painful condition in the limb prior to amputation. Phantom pain is seen less in early childhood due to the limited accumulation of experiences. 75% of cases experience phantom pain immediately and the appearance may be delayed by a few days or weeks in the remaining 25%. The duration of phantom pain can last from a few days or weeks to reported cases of up to 57 years. Phantom limbs tend to occupy a habitual posture that creates the pain or discomfort.

Ramachandran discusses cases such as a soldier who had a grenade explode in his hand, leaving behind a phantom hand stuck in a permanently clenched and painful posture. Another man lost a finger over 30 years ago. The phantom finger appeared 28 years later, the ingrained memories in the digit brought back to life after an extended respite. Memories expand beyond the limits of the mind and lay dormant in every part of our body, waiting to be woken.

According to Ramachandran: “Another fascinating but poorly understood aspect of phantom limbs concerns not only the continued existence of ‘memories’ in the phantom – of sensation that existed in the arm just prior to the amputation – but also the re-emergence of long-lost memories pertaining to that arm.”

Imagine curling your wrist and holding it in this position for hours, days, months, years. The discomfort would be intolerable. But there is a psychological reason why the arm is clenched. Ramachandran draws a very stern line that phantom limb pain is an illusion, not a delusion. Even though the limb has been removed, the pain is a very real physical ailment involving suffering but also contains a psychological condition within the mind. Our brains have mapped out a physical body image. The millions of messages and decisions necessary to operate everything from breathing to moving fingers is so ingrained that the removal of a limb is difficult to perceive. It is physically obvious that the limb is missing, but not in accordance with our internal map. If the state of California falls into the Pacific Ocean, a new map of the United States will have to be created. Until the new map is created, California still exists, topographically speaking. In order to dispel the phantom pain, the messaging from the brain must change, the narrative it has created must adapt to the new circumstances. Old connections must be broken and new ones established. A new map must be drawn.

When dealing with an amputated arm, the brain is confronted with a flood of conflicting signals. Ramachandran: “Frontal areas send motor commands to the phantom that are simultaneously monitored in the cerebellum and parietal lobes. In a normal person, execution of these commands is verified by visual feedback from the arm, but in an amputee there is no verification, hence the conflict.”

The body image or internal map that the brain established contradicts what is physically happening externally. The brain wants its messages to be heard, so it creates the phantom limb in order to continue consistency, even if this includes pre-existing pain. Everything must continue to go according to the plan. Patients claim they can generate voluntary movements in their phantom. They experience sensations of reaching out to grab an object, make a fist or move fingers individually. Other patients have phantoms that include paralysis. Usually, the stasis has been carried over from before amputation. Ramachandran claims that the patient develops a ‘learned paralysis’. During the months leading up to amputation, the brain re-maps its messages to adapt the paralyzed limb and transitions these messages into the phantom. The brain does not know the limb is missing, it cannot ‘see’ that there is no arm or leg to receive messages. It does not re-interpret but creates the phantom to conform to what it expects to ‘see’.

Phantom limbs show how the brain is adamant to retain consistency. This is all very interesting, but how does it apply to memories? This concept of brain-body image, learned movement and consistency can be applied to the interpretation of messages in relation to experiential past memories. Just as the phantom limb is created to retain consistency with our body image, memories affect us in a way that creates a consistent internal image of who we are and how we develop. The phantom limb commonly retains its painful memories. Past experiences can contain similar painful memories – they do not necessarily affect us physically, but psychologically. We create ‘phantom limbs’ out of past experiences and memories that impact how we develop into adulthood.

By re-mapping the messages sent from the brain to the phantom limb, can the pain be released? By re-interpreting past experiences, can we change how they have affected our lives?

***

“Let’s see who has more friends: You or me,” Tyler said to the boy. “We’ll ask everyone and we’ll figure out just who’s more popular.”

Safe to say the relationship between the boy and Tyler had taken a strange turn. Everything changes, nothing stays the same. There was little explanation besides the abstract concept of growing older and Tyler realizing the irrefutable differences between them. Status became important and there wasn’t much that the boy had to offer.

They walked around the playground, the boy trailing behind Tyler as he asked every kid, “Who do you like better? Me or him?” Due to Tyler’s place in the elementary school hierarchy as compared to the boy’s, and from the perspective of the other kid’s long-term reasons for social seeding during the year ahead in junior high school, it was an overwhelming landslide. The boy was confused as to what this actually proved. The facts were already quite relevant, there was something else at work here. Some message the boy had yet to comprehend.

The boy and Tyler drifted apart after this. Junior high school turned into high school. Tyler was the basketball star and football star and surrounded himself with friends of equal value and similar stature. The boy would irregularly pass Tyler in the hallway as he exited the advanced mathematics class, a fleeting look of recognition appeared until one of Tyler’s more appropriate associates clapped him on the back to regain his attention. There was no going back for both of them.

The boy made his own friends, others that found themselves on the fringes. Others on the outside looking in. They were interesting people not concerned with popularity, status or stimuli that clouded the average high schooler’s mind. There was nothing to prove to them, they took the boy as he was. He was thankful.

Sometimes the boy thought about Tyler. In his meanderings, he wondered why their friendship was impossible. His thoughts often turned from Tyler, relocated to looking internally at his own defects, at what was wrong with him.

The boy watched a lot of movies and read a lot of books and noticed that the hero was often an outsider. He transferred the narratives created with toys and explored his defects through these fictional characters on screen and on paper. They were so confident in their independence, demonstrative in their defects. The heroes were contented as the outsider: It gave them an edge and made them cool. Scars were worn on their sleeves. The boy felt he had no edge and was not remotely cool. He was a robot transforming into a space shuttle that wanted to orbit the moon. Tyler was transforming into a train, accumulating other passengers he would become bored with, his destination of little interest even to himself.

Time is needed in order to see that change is possible. And tiny increments of change add up over time.

With notes from The Perception of Phantom Limbs, V.S. Ramachandran and William Hirstein, Center for Brain and Cognition, University of California.