1.43 The Brain Changes, Part 3 of 3: Mirror Box

V.S. Ramachandran treated phantom limb pain by developing a ‘virtual reality box’ or what is commonly known as the mirror box. Through research into neuroplasticity, Ramachandran believed that the brain could remap the messages being sent to the missing limb and reestablish a new connection that recognized the illusion it created. The ingrained body image must change in order for the phantom limb to disappear and let go of the painful memories associated with the loss. The brain must confront reality and reinterpret itself, recreate itself – resurrect a new body image.

Ramachandran believed that if the brain could ‘see’ the phantom limb physically, it would be able to remap this internal body image. Through a visual representation and repetition of new messages, the brain and a new body image – one that recognized that the messages were communicating to a limb no longer there – could be updated. The memories imbedded in the limb would be exposed and released.

How to make your own mirror box:

Take one cardboard box with the roof removed and place a vertical mirror down the centre. Cut two holes in the front of the box, one on each side of the mirror. Through the holes, the patient places the normal hand and the phantom limb. By looking at the reflection on the side with the normal hand, the mirror creates the illusion of the resurrected lost limb. From this perspective, the patient gains motor control over the phantom limb and can release it from the clenched position that was causing the pain.

Ramachandran experimented on many patients who had successful treatments with the mirror box: “It occurred to us that if one could somehow enable the patient to generate voluntary movements in his phantom he might be able to unclench it during the spasms. The very first time he tried this the patient exclaimed with considerable surprise, that all his movements had ‘come back’: that he now vividly experienced muscle and joint movements in his phantom. He was immediately able to unclench his phantom. The procedure was repeated several times with identical results.”

Through repeated uses of the mirror box, patients have reported that the phantom limb disappears along with the pain. The repeated remapping of the messages being sent from the brain to the phantom gradually helps the brain re-imagine its own body image. The brain and body accept the change that has occurred and recreates itself. The brain has a predisposed ‘belief system’ and the mirror box forces it to question these ideals ingrained in our body image.

In order to alleviate pain, we can reinterpret the messages in our memories. Just as we can remap our physical body image, experiential belief systems can be put into question. The brain can change. Memories and what they mean can change.

***

We had taken to shooting pool. One of my friends went so far as to purchase a personal cue stick. I enjoyed walking into a pool hall strutting beside him – high school boys moonlighting as hustlers.

Pool halls offered a place where we could establish ourselves. The games were friendly, the point to embrace our position as outsiders. There was no status, no need to prove or seek approval.

We were playing an unusually intense game. The eight ball was up for grabs and a hushness surrounded the table before each shot. A winter wind blew every time the door opened and just as I was about to take the winning shot, a shot of cold air distracted me. Tyler walked through the door with a few friends. I missed the shot, scratching on the eight ball resulting in a forfeit.

Tyler picked a table in the corner opposite us. He came over to me and said hello. There might have been a smugness to my response, a coldness – my contentment as an outsider displayed externally. The conversation did not last much longer after hello and he retreated back to his table.

It was time to leave. Outside, Tyler and his friends were loading into a car. They reversed and the car stopped perpendicular in front of us. Tyler looked at me through the window. I won’t say there was a sadness in his eyes, more of a realization that although he might have made the effort to speak to me, our original friendship was based on little more than proximity and convenience. Our lives intersected for a short period of time and transformed.

I have not thought about Tyler in almost fifteen years. When I was thinking about memories and how the brain interprets them and if it is possible to change what they mean, he popped into my head. This caused me to reflect on other relationships and how many of them mirrored this experience. I considered myself an outsider but still chased the cool crowd, wanted to be liked by people of status and by association, be considered interesting.

I placed these memories that I wanted reinterpreted in one side of the mirror box and in the other side, I inserted the part of me who I am. Not who I think I am or who I think I should be or who I thought I was, the part that I have come to understand as me. I look at the reflection of these memories in the mirror from a different perspective. Through multiple viewings, they have changed. I see a sensitive boy that wanted to fit in. I see that the very qualities that were suppressed or ‘uncool’ survived intact and are welcomed and wanted. I see that the people I want to pull closer want to pull me closer, in spite of my insecurities and inconveniences. I see those memories unclenching a little more every time I use the mirror box. I look at them from a different perspective. I see how memories can be changed and how those tiny increments add up and create moments of overwhelming understanding. I see how incredible pain can be released, I see how the absolute joy of unclenching and releasing cannot be achieved without the pain. They exist in order to define the other – joy or pain cannot exist autonomously. They transform.

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