Aug 19, 2010

Phantom Limbs

Warning: this section gets gorey. We'll start off with fatality, trauma, and bear attack. Neurologists Robert Sapolsky and Antonio Damasio weigh in on 19th century philosopher William James, and his theory of emotion (and of bears), which says “emotion is a slave to physiology.”

Then we'll look at sensations of feeling that hang on long after the physiology goes away. Radiolab takes a field trip to the National Museum of Health and Medicine, Armed Forces Institute of Pathology (a collection of medical oddities), and finds a photograph of the severed feet of Civil War soldiers (pictured, on the right.). Photo courtesy of the National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, D.C., CP 1043.

And then we'll speed back into the present-day to see brain doctor V.S. Ramachandran solve the case of a painful phantom limb. Pain relief by but mere smoke and mirrors.

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JAD ABUMRAD: Testing, testing.


JAD: This is Radiolab. I'm Jad Abumrad.


ROBERT KRULWICH: And I'm Robert Krulwich.


JAD: And since this hour we'll be talking about brains and bodies and how they communicate, we thought we'd begin the program with a guy that we go to quite often who knows about this sort of thing.


ROBERT: Mm-hmm.


JAD: Oliver Sacks.


ROBERT: Oliver is a neurologist and very famous author. He took us to his study to show us something that just fascinates him.


OLIVER SACKS: I've become fascinated -- incidentally, I hope you -- you have to be careful with your watch or your computers.


JAD: He showed us a silver ball.


ROBERT: I should just describe here, I am looking at a silver ball about the size of a small, small ping pong ball.


JAD: Which he handed to you.


ROBERT: Right.


OLIVER SACKS: Would you care to lift that little steel ball?


JAD: And as soon as he did ...


ROBERT: I am -- I am trying.


JAD: ... the ball went flying through the air taking your hand with it, smack into the nearest bit of metal in the vicinity, which was a plate a little to your left.


ROBERT: Very fast and it hurt. Wow!


OLIVER SACKS: Now be careful. Be careful.


ROBERT: I've got it. Okay.


OLIVER SACKS: Now don't put it too near your watch. And also you have to put it down very gently, otherwise it may fly with great violence onto this nickel slab.


ROBERT: What is that? And why are we talking about it?


OLIVER SACKS: Okay. Well, this is a little rare earth metal magnet of great strength. These magnets orient themselves almost violently to the Earth's magnetic field. If you have a couple of these things say in your pockets and you go for a walk, as you turn a corner you will feel them reorient themselves in your pockets like -- like little animals.


ROBERT: [laughs] So your -- your pockets would tell you whether you were going north, south, east or west?


OLIVER SACKS: Your pockets or wherever you have the rare earth magnets.


ROBERT: And how -- you're very weird man. How would you propose to use this? In what situation that you have imagined would it be a happy advantage?


OLIVER SACKS: Well, I myself am always getting lost. I have ...


ROBERT: [laughs]


OLIVER SACKS: I have no sense of direction. I would function better.


ROBERT: I see. So if I said to you, "Oliver, come downtown to meet me," you would know because of the pressure on your thighs from these little balls that you were carrying around whether you were going downtown or not downtown.


OLIVER SACKS: Right. And you see, I may need things like this. I am very bad at orienting myself in space.


JAD: He's trying to do what the birds do.


ROBERT: Right. Birds ...


JAD: Because birds have magnets in their brains, or something like magnets which lets them fly south. Or wherever it is they fly.


ROBERT: Yeah, so they know -- when they're migrating.


JAD: Right.


ROBERT: Yeah. He's trying to start a conversation like a bird, but because he's chosen his thighs, and he wants his thighs to talk to his brain.


OLIVER SACKS: I've often wondered as an aside, the extent to which one could develop a new sense.


JAD: That's what this hour of Radiolab is about.


ROBERT: Human beings, not just Oliver, all kinds of folks who are attempting to add senses and mostly to subtract senses.


JAD: We'll have stories about both adding and losing senses, and more generally a look at how brains and bodies communicate, often fail to communicate. Because believe it or not, it's not an easy relationship between your brain and your body. There's a lot of confusion, deception even. That's what new research shows. And we'll get into all that.


ROBERT: So let's get into it.


JAD: All right.


ROBERT: Okay, ready?


JAD: Yeah. Where first?


ROBERT: Well, let's begin with a neurologist.


ROBERT SAPOLSKY: Let's see. My cell phone is ringing. So let me pause until it stops.


ROBERT: That's Robert Sapolsky. He's a professor of biology at Stanford.


ROBERT SAPOLSKY: I've never figured out how to do voice messaging or whatever it is that is done in this century.


ROBERT: No, me neither. Prisoners of our machines.


ROBERT SAPOLSKY: Okay. We're in business here.


ROBERT: Okay, so to begin now, I said to Robert Sapolsky just to get my head around this, let's imagine that I decide to visit my best friend in the world, Tommy.


JAD: Tommy.


ROBERT: I walk over to his house. I have a key. So I open the front door. I walk into his apartment, and then I see him sprawled on the floor dead.


ROBERT: Tommy!


JAD: Hmm.


ROBERT: And in a horrible tragic instant like that, I wonder what would be going on in my brain. And I ask this because his answer, Sapolsky's answer was so weird. According to Sapolsky, what happens happens in the following order. First, light bounces off Tommy's corpse and enters my eyes.


ROBERT SAPOLSKY: Okay, it goes up some nerve from your eyes and into one part of the brain which turfs it onto the next part.


ROBERT: And then the information keeps moving.


ROBERT SAPOLSKY: A couple of steps down, it gets into what's called your visual cortex which turns the dots into lines and lines into shapes. And that's just like a local train you're taking.


ROBERT: Eventually, that local train carrying the image of Tommy will chug and chug deeper into my brain to my cortex, and after a few more stops I will finally know, I will consciously know that Tommy is dead.


ROBERT: Tommy!


ROBERT: But now here's the surprise. Information can move through the brain in different ways at the same time. And there is a second route, it turns out.


ROBERT SAPOLSKY: There's a second pathway ...


ROBERT: Into my body, into my nervous system.


ROBERT SAPOLSKY: ... which bypasses all of that visual cortex stuff ...


ROBERT: Like a bullet train.


ROBERT SAPOLSKY: ... and goes straight to this area called the amygdala. And what the amygdala does is ...


ROBERT: Instantly it tells the heart to pound.


ROBERT SAPOLSKY: Your heart speeds up.


ROBERT: The stomach to clench.


ROBERT SAPOLSKY: Stomach muscles clench.


ROBERT: Tears to flow.


ROBERT SAPOLSKY: And you're still a couple of seconds away from, like, even consciously making sense of what you're seeing. And by then already your stomach is heading towards your throat, your throat's in your mouth or whatever the cliche is.


ROBERT: So as I'm standing there in Tommy's apartment looking at this figure on the ground, before I even know what I'm looking at, before I am consciously aware that Tommy is dead, my body already knows.


ROBERT SAPOLSKY: That's exactly the punchline. Your body knows it before you consciously know it.


JAD: Which is an astonishing idea.


ROBERT: It is astonishing.


JAD: But it's not a new idea.


ROBERT SAPOLSKY: Yeah, this goes back to what was originally viewed as this totally asinine theory in psychology back around 1900. One of the, you know, grand old poobahs of psychology, William James.


JONAH LEHRER: William James. And he's trying to answer the question where feelings came from.


JAD: That's Jonah Lehrer, a science writer. He really likes William James. He's written a lot about him. And he says a hundred years ago, William James poses a thought experiment.


JONAH LEHRER: He gives the example of a bear.


JAD: He says, imagine you're walking through the woods. All of a sudden from behind a tree a bear attacks. And he wondered, William James did, okay so the bear attacks, you're gonna feel scared. But what exactly is that feeling of fear made of?


JAD: Which seems like a strange question to ask.


JONAH LEHRER: Yeah, but he was trying to be empirical about it. He was trying to be a good psychologist, and his answer was that the feeling is the perception of your body.


JAD: Meaning step one, you see the bear.


JONAH LEHRER: You see a bear.


JAD: With his teeth and his claws. Step two, your body responds.


JONAH LEHRER: The fast heartbeat, the adrenaline coursing in your bloodstream.


JAD: It's only in step three, when the brain sees the body respond does it then trigger the feeling of fear.


JONAH LEHRER: And the feeling of fear comes from the perception of those changes in your body. If you took away the heartbeat, if you took away the body, there'd be nothing left to feel.


JAD: Needless to say, when William James proposed this idea people thought ...


ROBERT: He's absolutely crazy.


JAD: He was nuts. Completely nuts. They said, you know, if you're right then someone who's paralyzed from the neck down and who doesn't get signals from their body, well that person would see the bear in the woods and they wouldn't get scared.


ROBERT: Which is ridiculous, right?


JAD: Completely ridiculous. So the critics said William James is wrong, dead wrong. And that's the end of it.


ROBERT: Well, it's not quite the end of it. We happened to bump into a neurologist.


ANTONIO DAMASIO: Antonio Damasio. Director of the Brain and Creativity Institute at the University of Southern California.


JAD: Wow, what a nice place!


ROBERT: So we're sitting there with Damasio and we happen to be talking about William James and his critics.


JAD: As we always do.


ROBERT: Which we always do. You know, lunch -- we don't go into a luncheonette for lunch. Before we order a tuna fish sandwich, we always mention William James and his critics. It's just something we do.


JAD: Always.


ROBERT: So I said to Damasio, you know, the critics called James wrong because he people who were paralyzed couldn't feel anything. And he says, you know, it's funny you should mention this, because there's been a series of studies thinking about James one more time.


ANTONIO DAMASIO: And it's very interesting, because the first study that was made in this area was made by a paraplegic psychologist who thought that he felt less emotional than he was before, and he talked to others and others reported the same.


ROBERT: The studies reported that people who had once been able-bodied and then became paralyzed felt ...




ROBERT: ... less happy than able-bodied people, less sad than able-bodied people, just less.


ANTONIO DAMASIO: Our being is rooted in a body state. If I would be able to remove from your brain the representation of your body, you would not know that you were you.


ROBERT: And would I not be sorry at my friends death?


ANTONIO DAMASIO: You definitely would not be sorry of anything. What is, in fact, the essence of being joyful or sad if you don't hook those notions on a changed body?


JAD: He's right, you know? I mean, if you think about the last time you were sad, like really sad, how would you describe that feeling to yourself?


ROBERT: Well in fairness, I guess I would -- I would say I felt dragged out and heavy.


JAD: Yeah, that feeling is completely rooted in your flesh.


ROBERT: Well ...


JAD: The brain has nothing to do with it.


ROBERT: ... a thought made me sad. and then my body felt ...




JAD: Oh crap, I forgot to turn the ringer off. Hold on. Hello? Oh, hi. Yeah, hold on one second. It's your wife.


ROBERT: Here? Hello?






TAMAR LEWIN: I can't believe you're still there. What are you doing there?


ROBERT: What do you mean, what am I doing here?


TAMAR LEWIN: You were supposed to be home an hour ago.


ROBERT: Tamar, Tamar. You've called me in the studio. We're on the air.


TAMAR LEWIN: I don't care.


ROBERT: What do you mean you don't care?


TAMAR LEWIN: You were supposed to be home an hour ago. I reminded you this morning. I reminded you last night.


ROBERT: I was ...


TAMAR LEWIN: It's just not important to you.


ROBERT: It's not such a big deal. I'll be back in 10 ...


JAD: [WHISPERING] Actually, this is a perfect example of what we've been talking about. Robert's having a fight with his wife Tamar, and while he's fighting inside his body his stomach is clenching, his heart is palpitating. Hers is doing the same. Their brains are picking up these signals and thinking "Anger. Feel angry!"


ROBERT: I'm talking with other people here. There are other people who ...


TAMAR LEWIN: My work is just as important as your work and you've now screwed it up.


ROBERT: How did I screw it up? How did I screw up your work?


TAMAR LEWIN: This was your job ...


JAD: Now at a certain point, Robert will probably realize he has screwed up and ...


TAMAR LEWIN: Just get home.


JAD: He'll apologize.


ROBERT: Okay. If I get home in 20 minutes, will -- I'm really sorry. I know this is horrible.


JAD: [WHISPERING] Robert. Is everything okay?


ROBERT: Yeah. It's -- it's -- just a second. I'm really sorry.




JAD: Now when it comes to brains and bodies in men and women, the interesting thing is that when a man and a woman fight, these systems in their body, the heart palpitating, the stomach clenching, while these systems do turn on at the same speed ...


ROBERT SAPOLSKY: And it takes, like, two seconds.


JAD: ... according to Robert Sapolsky ...


ROBERT SAPOLSKY: Where there's an interesting gender difference is how long it takes to turn off the system.


JAD: And ladies? Sorry in advance.


ROBERT SAPOLSKY: And in general, it turns off more slowly in women than in men.


JAD: Which may explain something that happens to couples all the time.


ROBERT: Okay. I'm really sorry.


TAMAR LEWIN: This just isn't right.


ROBERT: I know. Oh, I'm really sorry.


JAD: Like, here we are.


ROBERT: Maybe like -- maybe later we'll go do something, or -- I'm really sorry.


JAD: Robert's stomach is relaxing.


ROBERT: And this was really stupid, I know.


JAD: His heart is slowing.


ROBERT: It's very stupid.


JAD: He thinks the fight might be over.


TAMAR LEWIN: Okay. But, you know, this is something you do all the time. Remember when we were having a dinner right after we got engaged, and we went to the restaurant and I was waiting for you and I made the reservation and ...


ROBERT: Tamar, that was in the Carter Administration. You can't ...


TAMAR LEWIN: ... I was sitting there for, like, 45 minutes. You didn't even call.


ROBERT: I just apologized. I ...


JAD: Did you hear what just happened there?


ROBERT SAPOLSKY: It's this William James stuff coming back to haunt us a century later.


JAD: Sapolsky says that sometimes the body actually tricks the brain. Tamar knows the fight is over mentally, but her body is still tense, her heart is still racing and her brain thinks, "Whoa. Wait."


ROBERT SAPOLSKY: If my heart is still racing and I consciously know that this issue has been resolved, it must be because I'm still pissed off about that thing that happened in the Carter Administration.


TAMAR LEWIN: You minimize everything anybody does for you.


ROBERT SAPOLSKY: The brain fills a vacuum.


ROBERT: What, do you have a list? You have a list there or something?


TAMAR LEWIN: I do. I have a long list. Do you know how often you do this sort of thing?


ROBERT: I hard -- I do, like, once every ...


TAMAR LEWIN: No, I can count them. As soon as the babysitter calls when I'm going to be out of town and says, "Should I make dinner for Robert?" Because of course, you can't make dinner for yourself and the kids. No.


ROBERT: I do make dinner. I have made ...


TAMAR LEWIN: You don't do much of anything.


ROBERT: Baked potatoes last week. Wednesday. I made the baked potatoes.


TAMAR LEWIN: That's just applying heat.


ROBERT: [laughs] I want to thank my wife Tamar Lewin for what I think was a pretty startlingly realistic -- I mean, a performance which I don't know how she did that, because it's so unlike the rest of our marriage, you know? This story, by the way, came from Robert Sapolsky and he tells it about his wife too. But they're not reporters, they're scientists. So they do it differently.


ROBERT SAPOLSKY: My wife's in the same business as me. So the very words we will say to each other is, "Honey, don't forget what the half-life is on the autonomic nervous system." Then suddenly, it's all over with.


ROBERT: That's such a rare exchange between two people, you know?


ROBERT SAPOLSKY: I know. We're just sentimentalists.


JAD: By the way, Robert Sapolsky's latest book is called Monkeyluv, which is where that wife anecdote came from. And speaking of brains and bodies ...


ROBERT: Mm-hmm?


JAD: Let's put the science on pause for a moment and take a brief detour, because often what gets you into these ideas, like, take this kid for example.


CHRISTOPHER SAYLES: I'm Christopher Sayles. I go to the Blake High School.


JAD: Isn't the science. It's more basic than that. It's seeing something disgusting and not being able to look away.


CHRISTOPHER SAYLES: You really just can't believe that if something feels like this it actually came out of a real person. You just don't get the feeling ...


JAD: When we bumped into Christopher, he was gingerly holding a pair of human lungs.


CHRISTOPHER SAYLES: But it is a real person. But you just don't really associate it with a real person because it's there in front of you and it doesn't look like real person.


JAD: In any case, that sense of, "Whoa," that's why we originally went to the Walter Reed Army Medical Center in Washington, DC. But here's what happened. Our tour guide ...


STEVEN SOLOMON: Okay. Steven. S-T-E-V-E-N. Solomon. S-O-L-O-M-O-N.


JAD: He showed us a particular photo that got us thinking.


STEVEN SOLOMON: It's a famous photo in our archives. It's called Field Day.


JAD: It's a Civil War photo hanging in a side gallery. It's a picture of legs.


STEVEN SOLOMON: A pile of amputated legs ...


JAD: A huge heap of severed legs.


STEVEN SOLOMON: ... some feet thrown sort of haphazardly into a pile.


JAD: Wow.


JAD: It's oddly beautiful in a way. Gruesome.


JAD: It's gruesome.


JAD: But the next thought immediately after was, what was happening at that moment? Right to one side of the picture frame must have been an operating table, and on the table a soldier inhaling chloroform. And at the foot of the table must have been a doctor sawing away.


STEVEN SOLOMON: A circular amputation involved cutting straight through the skin to the bone. A flap amputation required the tissue to be cut leaving two flaps of skin that were used to create a stump. And in fact, your typical army surgeon was basically graded on how quickly they could do an amputation.


JONAH LEHRER: It was one of the first wars where we really had doctors being aggressive in terms of taking off limbs.


JAD: Like I said, that photo got us thinking. So we went back to Jonah Lehrer who has written about a very ghostly side effect that pops up during the Civil War as a direct result of all of that taking off of limbs.


JONAH LEHRER: This one astonishing syndrome that these men who have had their limbs taken off, they describe very, very often, this is a very common thing, that they still feel their phantom limbs. They say ...


JAD: I feel it. I still feel it.


JONAH LEHRER: Yeah. They say, "Doctor. I still feel it move." They can feel it hurt, they can feel it sometimes get hot, sometimes very cold.


JAD: Imagine you're a Civil War doctor and you hear this. You don't even know what germs are yet. But one guy ...


JONAH LEHRER: Dr. Silas Weir Mitchell.


JAD: ... decides he's gonna get to the bottom of it.


JONAH LEHRER: The first thing he did was he wrote some clinical reports.


[ARCHIVE CLIP: Only about five percent of the men who have suffered amputation never have any feeling of the part as being still present.]


JONAH LEHRER: And circulated them around the hospitals.


[ARCHIVE CLIP: While the remainder seem to retain a sense of its existence so vivid as to be more definite and intrusive than it is of the truly living fellow member. The stump is liable to the most horrible neuralgias, and to a certain curious spasmodic paralysis.]


JAD: No one could make sense of this, even our guy ...


JONAH LEHRER: William James.


JAD: Even he looks into it.


JONAH LEHRER: He did a very authoritative study where he sent out questionnaires to all these amputee victims and wanted to know about their lost limbs.


JAD: He asked all of these Civil War amputees all these questions. Does your phantom limb hurt? Can you move it if you really concentrate? And what he found was that there were no patterns.


JONAH LEHRER: No stereotypical lost limb.


JAD: Every experience was different. In other words, phantom limbs are like real limbs. They're yours.


ROBERT: Well, on this topic of phantom limbs, there is a guy who has figured at least something out about this phenomenon. Dr. V.S. Ramachandran.


V.S. RAMACHANDRAN: I am V.S. Ramachandran.


ROBERT: Remember him?


JAD: I remember him.


ROBERT: He's a well-known neurologist. He works in California.


V.S. RAMACHANDRAN: The University of California, San Diego.


ROBERT: And one day he says, a patient showed up in his office and it seems that the guy had had his arm amputated. It was his left arm. And then ever since, this man had an uncanny feeling that he still had an arm where his real arm used to be.


V.S. RAMACHANDRAN: Yes. Now, it's important to emphasize this is not a delusion. He doesn't think he has an arm. He knows he doesn't. He's not crazy. But he vividly feels its presence.


ROBERT: And the rough part was that this arm, it hurt. This sometimes happens to people with phantom limbs. He would have days where his phantom arm would seize up in pain.


V.S. RAMACHANDRAN: "Doctor, it hurts!"


ROBERT: Really badly.


V.S. RAMACHANDRAN: "It goes into this painful clenching spasm. The nails dig into my palm."


ROBERT: So he has a phantom hand at the end of his phantom limb.


V.S. RAMACHANDRAN: Yes. And he'll say things like, "It's going into a cramp with the nails digging into the phantom palm and it's excruciatingly painful."


ROBERT: But there are no nails. There is no palm.


V.S. RAMACHANDRAN: There is no nails, no palm.


ROBERT: And weirdest of all, the patient couldn't do anything about it. He'd try to unclench his phantom nails from his phantom palm to make the pain stop, but he couldn't.


V.S. RAMACHANDRAN: He said, "I cannot move the phantom."


ROBERT: The phantom arm wouldn't obey.


V.S. RAMACHANDRAN: "I cannot volitionally move it." And I started thinking to myself, "What does he mean when he says he cannot move his phantom limb?" It's like an oxymoron. There is no arm there.


ROBERT: Dr. Ramachandran was confused. What's going on? He -- he checked with the patient and discovered that 11 years earlier, before the amputation, he'd had an injury to his spine. And after that, his real left arm was paralyzed. He could not move it. He tried, his brain would issue the commands.


V.S. RAMACHANDRAN: His brain was saying, "Move the arm," but he was getting visual feedback, and indeed feedback from his muscles saying, "Nope." "Move the arm." "No." "Move." "No."


ROBERT: And this went on for months.


V.S. RAMACHANDRAN: "Move." "No."


ROBERT: So maybe, thought Dr. Ramachandran, maybe this patient got so frustrated trying to move his real arm, that at some point ...


V.S. RAMACHANDRAN: After a few months or a year, the paralysis got learned by the brain, stamped into the circuitry of the brain. And I call it learned ...


ROBERT: Learned ...


V.S. RAMACHANDRAN: ... paralysis.


ROBERT: So even when they cut the patient's arm off a year after the accident, he still didn't get any relief because the problem wasn't in his arm. It was learned paralysis. It was in his head now. And that is when Ramachandran thought "Well, maybe the solution here is to trick this man's brain to unparalyze, to get his cells to think. "Well, actually we can move an arm." But how do you trick a brain? How would you do that? How would you do that?


JAD: How would you do that?


V.S. RAMACHANDRAN: How would you do that, indeed?


ROBERT: He thought for a bit.


V.S. RAMACHANDRAN: Then I hit on this way of using a mirror propped inside a cardboard box.


ROBERT: A what?


V.S. RAMACHANDRAN: A mirror. Mirror propped inside a cardboard box.


ROBERT: A mirror parked inside a -- you mean like a ...?


V.S. RAMACHANDRAN: Propped up.




ROBERT: It was kind of a Home Depot solution, really. Ramachandran took a long and skinny mirror, the kind you'd hang on a closet door?


JAD: Right.


ROBERT: And he propped it up using a cardboard box, and then turned it sideways. Placed the side right in front of the patient, like, right on his nose.


JAD: So he couldn't see himself?


ROBERT: No, couldn't see anything in the mirror yet, unless he hooked his neck around and took a peek.


JAD: Oh, okay.


ROBERT: Otherwise, he's just looking at the side. Ramachandran says -- and I want you to imagine this with me, Jad.


JAD: Sure.


ROBERT: He says, "I want you to take your good arm, your real arm, okay, and stick it out in front of the mirror." So do that.


JAD: Okay.


ROBERT: Now make it do what the phantom arm does. Take your good arm, make it stiff, curl your hand into a fist, dig your fingernails into your palm deeply, make it hurt. You doing that?


JAD: Yeah, it's kind of hurting.


ROBERT: Okay. Now when I tell you, crook your head so you can look into the mirror, and on your left just where the phantom ought to be, let's pretend that that's your phantom arm. It's cramped, it's curled exactly as you'd imagine it. So now look in the mirror.


JAD: Okay.


ROBERT: And there's your arm. You see it there in the mirror, your phantom arm.


JAD: Got it.


ROBERT: Now very slowly, keeping your eye on the mirror now, I want you to uncurl your hand.


V.S. RAMACHANDRAN: Patient says, "Okay." He opens his real hand. "My God!" And of course, it looks like his phantom is opening. That's not surprising, he's got the mirror there. But he says, "My God, Doctor, you're not gonna believe this. The movements have all come back. All these movements in my fingers, in my elbow, in my wrist from 11 years ago come flooding into my mind."


ROBERT: So his pretend nails are now ungripping from his pretend palm and the whole problem of the pretend pain goes away.


V.S. RAMACHANDRAN: Goes away. That's what he said.


ROBERT: For how long, by the way?


V.S. RAMACHANDRAN: Until the mirror was in place.


ROBERT: But when Dr. Ramachandran took away the mirrors, the pain came back.


V.S. RAMACHANDRAN: I said fine. C'est la vie, you know? And then I said, "Look, why don't you practice with a mirror for a few weeks every day for an hour. Then maybe if you do it repeatedly, you can unlearn the learned pain.


ROBERT: So the guy goes home, takes out a mirror. You give him a mirror to take home?




ROBERT: And he does this over and over.


V.S. RAMACHANDRAN: This mirror was $2. Take it with you, you know? So he takes it with him, he's delighted. And then after about another week he phones me, and he sounds all agitated on the phone. And I said, "What's going on?" He said, "Doctor, you're not gonna believe this. It's gone." I said, "What's gone?" I thought maybe the mirror was gone. He said, "No, no, not the mirror. The phantom has gone."


ROBERT: Gone gone?


V.S. RAMACHANDRAN: That's what I said, "Gone, gone? What do you mean phantom is gone?" He said, "Well, the phantom arm I've been having for the last 11 years has disappeared." Well, my initial reaction was alarm. I said, "My God, does this bother you?" And he said, "No, you know, this has happened three days ago. And in the last three days, you remember the excruciating elbow pain and wrist pain I got several times a day? Well, I don't have them anymore because I don't have an arm. But my fingers, they have not disappeared, and they're still up here dangling near my shoulder and they're still painful."


ROBERT: You mean just disconnected, disembodied fingerlets?


V.S. RAMACHANDRAN: Yeah, fingerlets dangling from the shoulder.


JAD: What? What does that mean?


ROBERT: This guy's saying that he seems to have fingertips hanging on his shoulder.


V.S. RAMACHANDRAN: He said, "Your mirror doesn't work anymore. So can you redesign it and push it, prop it near my nose so I can look at the reflection and maybe get rid of the fingers.


ROBERT: So he now wants to get Dr. Ramachandran to prop up the mirror, point them at these phantom fingertips and have the mirror erase the fingertips.


V.S. RAMACHANDRAN: He thought I was a magician and I could, you know, eliminate his different body parts in sequence. And ...


ROBERT: This is amputation by mirror.


V.S. RAMACHANDRAN: Yeah. So as I tell my medical colleagues jokingly, I say, "this is the first example in the history of medicine of a successful amputation of a phantom limb."


ROBERT: So don't leave me hanging here. Did the phantom fingers eventually dissolve?


V.S. RAMACHANDRAN: No, we still haven't been able to devise a technique to get them. And it turns out that the pain there subsided a bit, so he's not that worried about us getting rid of them.


ROBERT: So somewhere in California, there's still a guy walking around with a sense ...


JAD: With fingers on his shoulder.


ROBERT: Yeah, are still dangling out of his shoulder. Which is not only weird, it suggests that there's an awful lot to know about how brains and bodies interact. Many things to learn. But for a workaday doc who has to deal with whatever comes through the door, Dr. Ramachandran had what I would call a pretty good day at the office.


V.S. RAMACHANDRAN: Yeah. Exactly.


ROBERT: V.S. Ramachandran is a neuroscientist at the University of California in San Diego, author of many books, including A Brief Tour of Human Consciousness, which is where you can find out all about that mirror experiment.


JAD: Next up, let's scale it up a bit. We're gonna go from lost limbs to a guy who's lost everything, his entire sense of his body. I'm Jad Abumrad. Robert Krulwich and I will continue in a moment.


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