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2/14/12

Amputating a Phantom Arm

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You have lost your left arm but you still feel your left hand.  You not only feel it, but every minute of the day you are are nagged by an exhausting need to scratch the hand. But there is nothing there to scratch.

How can this be?  You feel something in the middle of nothing but air. You look down and you see empty space, but you still feel an extremely annoying itch right there where your hand is supposed to be.

You have a problem and it looks like there is no way to solve it. You can't scratch something that does not exist.

You have not met V.S. Ramachandran.  He had a patient who suffered from an excruciating pain in his phantom arm. It was the man's hand. The hand was clenched so tightly that the man could feel his fingernails digging into his palm.  His nonexistent fingernails digging into his nonexistent palm.

The guy was perfectly sane. He wasn't high on anything.  He was like many others who experienced what is called phantom limb syndrome. He didn't know what to do and then he was lucky enough to find Ramachandran.

He knew that this shouldn't be happening to him. He looked at the place where his hand was supposed to be. He could see it was not there. Yet, he felt his nonexistent fingernails digging into his nonexistent palm and it was torturing him.

Here is where an ingenious fix to his problem occurred. Ramachandran placed a mirror in a cardboard box. Nothing expensive here--very simple.  He told the patient to put his existing hand inside the box, so the mirror would reflect it.

The patient was told to look at the reflection, then to imagine that the mirror image was his lost limb, and to clench and unclench his hand while looking in the mirror.

Don't say that illusion does not affect reality.  In this case, illusion changed reality. It didn't happen all at once, but after two weeks of this imagining-practice, the patient's pain vanished. Not only that, he no longer experienced a phantom arm.

Phantom limb syndrome is not new. In the 1500s a French military physician described this sensation, and you can imagine that in those days of primitive field hospitals there was plenty of carnage to witness.

In 1872, the experience was given its modern name when Silas Weir Mitchell, another military surgeon, coined the term "phantom limb." He based it on his experiences at Philadelphia's "Stump Hospital" during the Civil War. Stump Hospital, of course, was the only recourse in a time before antibiotics.  The surgeon's saw was the sole prevention against gangrene.

My ancestor, a Captain in the 28th Iowa Volunteer Infantry, spent part of the war as a field surgeon at the Battle of Vicksburg. He reached a point when he could no longer look at another gangrened leg, or another soldier quite literally biting the bullet to keep from screaming in pain as a limb was sawn through. Preferring being shot to cutting off another leg, my ancestor asked for a transfer to combat. I understand why. I have seen the saw he used for amputation. Its teeth could as easily cut through a tree limb.

But back to Silas Weir Mitchell. He was quite puzzled by the soldiers complaining of sensations in amputated limbs and asked an Army doctor about them but the physician couldn't help.

Then Silas Weir Mitchell heard of a veteran who asked, "Whatever happened to my arm after you removed it?"

The veteran learned that his amputated arm had been sent to the pathology lab. He visited the lab and asked where his arm was.  He was told it had just been buried in the garden behind, the hospital. The arm was dug up, he looked at it and beheld it crawling with maggots.  He said,"Maybe that's why I'm feeling these bizarre sensations in my arm."

Here was no Ramachandran mirror and imagining-practice. The veteran took the arm and incinerated it. His phantom pain disappeared permanently.
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