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The Phantom Limb: Body and Language, Cultural Expression and Difference


Notes: A Neurobiological diagnosis with aesthetic, cultural and philosophical implications.
Part 2: Displacements of the Imaginary and Virtual Schemata

Introduction

It would be legitimate to speak of ‘natural signs’ only if the anatomical organisation of our body produced a correspondence between specific gestures and ‘given states of mind’. The fact is that the behaviour associated with anger or love is not the same in a Japanese and an occidental. Or, to be more precise, the difference in behaviour corresponds to a difference in the emotions themselves. It is not only the gesture which is contingent in relation to the body’s organisation, it is the manner itself in which we meet the situation and live it. The angry Japanese smiles and the Westerner goes red and stamps his foot or else goes pale and hisses his words…What is important is how they use their bodies, the simultaneous patterning of body and world in emotion. The psycho-physiological equipment leaves a great variety of possibilities open, and there is no more here than in instinct a human nature finally and immutably given. …It is no more natural and no less conventional to shout in anger or to kiss in love…Feelings and passional conduct are invented like words Merleau-Ponty, The Phenomenology of Perception (hereafter PP), 1964, P189

Merleau-Ponty is adamantly anti a vulgar Darwinism or any crude form of social-biological reductionism- Desmond –Morris style, for it refuses to take into account the complexity of bodily language and modes of cultural expression.

Merleau-Ponty argues that there is no crude natural sign as far as the body is concerned and that the physiological equipment is radically open to many possibilities of emotion and expression. Emotion and expression simultaneously form as the gesture, and are the articulation of the body in its cultural specifity. It is the use of the body, the manner of expression and the emotions themselves that alter according to context.

Merleau-Ponty in agreement with the 19th Century German Biologist Uxkull views the organism and environment as interdependent, in terms of the interpersonal environment, body and world are in relation, and ontic context- cultural specifity is all important. Merleau-Ponty argues in ‘the body as speech and expression’ (PP) that the means of expression, the bodily gesture or other enactment is not separate from that which is expressed, there is no state of contemplative thought that lies elsewhere, but rather the means of expression brings the expressed –the emotion and meaning in to being. For M-P the gesture or other bodily expression is like the word, is a language, as the word is no mere clothing for thought but brings it into being and makes the thought possible, so is the bodily expression/gesture the means of expression which simultaneously produces the emotion and makes meaning possible. Meaning is the expression of body and world.

For Merleau-Ponty the gesture is signification, the specifity of gesture embedded in cultural context, gives rise to the unique manner of expression and mode of emotion, which varies radically according to cultural specifics. The angry Japanese smile is in fact not equivalent to the Westerner’s blush and stamp of the foot, the expression is different and so is the emotion and meaning, in other words the experience is not the same.

Merleau-Ponty’s thinking is situated within a broader contemporary European movement that cuts across disciplinary boundaries. A continental arena so extensive that it is neither possible or desirable to go into here, except in so far as to mention that there has been a blend of ideas that has gained momentum in contemporary social anthropology that has given rise to a trend in theorising / investigating the social nature of embodiment A field that encompasses Merleau-Ponty and ranges from the early anthropological work of Marcel Mauss and techniques of the body, including how sensation and body movement are culturally produced, to that of Foucault’ s work, whereby power relations are seen to bypass so called ‘consciousness’ and permeate the body, are directly lived as regulation, as excitation and so on.

The Phantom/missing Limb: the Bio-Medical Western Perspective- Limits and Correctives

There are certain taken for granted assumptions at work when inquiring into the experience of a phantom limb from a typical bio=medical western perspective. The analysis of the phantom limb is located in the individual body and brain system and it is assumed to disrupt body and self- integrity. The phantom limb is generated therein, from within the individual brain-body process and is a phantom in so far as the experience is not supported by the existence of an actual limb. Commonly the phantom limb would relate to a loss of a limb or in part, an extremity, that in principle would have belonged to the individual. Here we assume that the entity under study is the individual intact organism, rather than beginning with an approach to body and environment, the boundaries open and yet to be defined, we assume that the brain and body belongs to an individual system, rather than a group and social system and we assume that phantom is in opposition to something called actual reality.

In relation to this taken for granted view, as Gordon 1988 points out, there are particular definitions of subjectivity at work. The phantom limb conceived as the product of a private subjective perception. As an extension of this view, sensation, (such as pain) is conceived as the domain of personal experience alone, studied as the product of the individual organism. From this perspective it is assumed that the individual/organism exists as an independent entity, set apart from and prior to culture; the underlying biological mechanisms can be studied as an isolated system. Cultural considerations then get somehow added on add a later stage, to a constituted biology in a rather superficial and indeed clumsy way.

Despite the ethnocentric aspect of most social anthropological studies, it is nevertheless possible to gleam some correctives to the bio- western phantom limb perspective. In studies of ‘African ‘ societies where sorcery, witchcraft and spirit possession exist, collective constructions of these rituals have been emphasised and are viewed as indicative of dependence on a relational and collective field (Corin 1998). In spirit possession the body is inscribed in the group ritual and is experienced within the shared belief system. There is no distinction between belief and reality, because the belief is lived as true, as in the case of physiology, belief kills for example in Voodoo death. There are several moves that are made here 1) the body is part of a group and cultural experience, so any change to a brain-body process is located within the relational setting and is embedded in the ambience of shared affect and enacted cultural meanings.2) Phantoms of the body –affects/sensations and images –are not set up in contradistinction to the actual body, but are taken as bodily because they are lived as such and there is a fluidity between bodily attributions and actual bodily states. Belief that the spirit is possessing the body is fluid with images of the body, to that of trance states and muscle and nervous activity ect…3) Finally, these bodily experiences brought about by belief are not embedded in a definition of subjectivity that is private and only known to the individual, there is no immediate attribution of ownership, volition or control. Will is a group experience, and in crucial ways is neither- located inside or outside but is part of the inter-group process.

Taking spirit possession as one area of Anthropological stomping ground, and the different version of body and world that comes into focus, it is significant but perhaps less surprising that there have been few anthropological studies documenting ‘subjective’ experiences of phantom limbs. The closest one gets to such a study that directly addresses the aftermath of amputation is Lindsey French’s study (1994) of amputees on the Thai-Cambodia border after the Poll –Pot genocide. Many in the study were suffering the aftermath of Land mines, effecting civilians and soldiers that together made up the disparate high proportion of amputees in the community. The closest this study brings us to the experience of the amputation is in the specific redefinition of the ‘self’ that is linked to the effects of the amputation. Amputees reporting a decline in their intelligence, their ability felt diminished, and in general in relation to the community they felt a decrease in ‘competence’ and ‘capacity’, ‘useless’ and were seen as a threat, potentially violent and disruptive by the community. French notes that amputees were socially placed in a position of degradation and abandonment, but she emphasises that the experience of the amputee has to be viewed in the context of Buddhist belief, and the Buddhist hierarchy of virtue and definition of Karma, the misfortune of the amputees being their karma and they’re placing low -down in the virtue hierarchy.

French focuses on the definitions of person in relation to social position and ingrained beliefs, the question of social status in relation to the community context. She evades an introspective bias. This, both reflects the nature of the study, as well as raising questions as to the importance given to ‘subjective’ perception of the lost limb, for this cultural group of amputees privilege does not seem to be placed on inner states . Contemporary trendy theorising in Social anthropology study can have the opposite effect to expanding thinking and result in an inverted reductionism. Whereby phenomenological descriptions of ‘subjective’ experience fail to be addressed, because the anthropological subject becomes necessarily decentred and viewed as a product of the culture, of course this is not wrong, but may prevent certain questions about ‘subjectivity’ from being asked. It is also the case that an amputee who focuses on the missing limb and recognises the experiential state, phantom or otherwise, adopts an introspective attitude that reflects, monitors inner experiences and notes them as such. Foucault has made much of those practices of the self that produce through incitement and consent the self-regulating and monitoring subject. How relevant is this form of body focus for less individualised and self obsessed cultures?

Cultural Variability and the Experience of Sensation /Pain

Zborowski’s earlier studies address the experience of the missing limb. Despite being somewhat anachronistic, mainly because the approach to the Western war veteran amputee reinforced various stereotypes of ethnicity, in this case: the American Yankee, the Jew, the Irish and the Italian. The study nevertheless observes that third-generation Americans tended to respond to the pain of the lost limb in a matter of fact way and act as if they should not complain, the Irish were similar in their pain expression, but there suffering was more visibly shown. On the other hand, more overt responses to the pain were forthcoming from Italian and Jewish subcultures. The Italians felt that pain had to be avoided at all costs, and their expression were aimed at eliminating the pain .The Jewish group were more concerned with the memory of pain and its implications.

Since then there has been a number of anthropologically and related studies considering the cultural experience of somatic discomfort and pain not specifically in relation to the phantom limb phenomena, but to a whole range of somatic experiences. Low (1981), (1988) in the paper ‘embodied metaphors of lived experience’ (in Csordas 1994) explores the culturally specific condition ‘Neveis’ or nerves, typical in Costa –Rica and Guatemala. Shifting definitions of the experience are to be found, ranging from shaking like a leaf, pins and needles, intensifying heat experience and spatial expansion. Sufferers complained of feeling strange. The analysis linked interpersonal and social tensions to the somatic states, that such social tensions were expressed as the condition. Delvecchio, etal point out how pain is experienced and expressed differently according to cultural context: Ohnuko-Tierney 1981 describes complaints among the Sakhalin Ainv of Japan of bear headaches that sound like the heavy steps of bear and dear headaches as like running dear. Or OTS 1990 study of Chinese who complained of dizziness and vertigo as the experience of head pain and which conforms to traditional Chinese categories that emphasise imbalance and ill health. In contrast Nigerians used what in the west we would consider almost psychotic language to describe headaches-like ‘ants are eating my brains out’.

There have also been studies on chronic pain (cf Jackson 2000), whereby a range of somatic states can not be accounted for in terms of an organic basis, but nevertheless are lived with great intensity and discomfort. Longevity of condition and intensity of pain is increased with accompanying negative emotional states such as depression and anxiety.

Melzack 1973 presents evidence of the way in which culture can affect the very experience of pain itself. In some romote Indian villages, an annual hook swinging ceremony takes place. Two steel hooks are placed in the lower back of a youth who is to experience the ceremony. He is then hosted on a pole and transported from village to village. During the whole of this process the youth displays no pain whatsoever. We can only infer from the youth’s reaction that little pain was present, but in our cultural context such an experience would be excruciatingly painful, and our pain receptors would be producing pain. Jackson (2000) points out that where pain is not expressed such as in certain cases of Martyrdom, cultural ritual, honour and rites of passage it is not the case that pain is silent but that pain itself is not the same, implying that social beliefs when deeply ingrained in feeling and lived as such bring about physical alterations where the nociception of physical pain is knocked out of the picture. There are both radical observable cultural differences in response to pain as well as the fact that the experience of pain alters with cultural meaning and emotion. Cultural belief and the emotion with it can alter the physiological process of pain production and perception.

Neural and Social Plasticity in the Phantom/missing Limb

The impact of social relations and situation on somatic expression has been under explored in respect to phantom limb phenomena, the fact is phantom limb phenomena as we know it and talk about it is a western condition, it is about loss of a limb in an otherwise idealised intact body, in a culture that defines the person in terms of the individual unit. Now we shall turn to this form of phantom limb and within its terms of discourse discuss the question of neural and social plasticity.

In discussions of the Phantom limb experience some of the neuroscientific investigations of the phenomena emphasise the genetic body map, the homunculus in the brain and more complex dynamic brain representations of self-body in discussion of the neuromatrix and signature (see.Melzack) In such accounts importance is placed on the brain mapping the body, the problem with such accounts is when the brain is studied in a vacuum, as auto–generating experience or when genetic mapping is studied in isolation. The argument goes–it is all in the brain per se. Melzack argues that sensory input can be done away with in the formation and manufacture of the brain body map, the brain can do it all by itself. Even when somatic information is lacking there is the cultural organisation of body maps, the way beliefs and emotion structure brain experience. Social-emotional body maps can not be added on as an awkward after thought; they are part and parcel of brain process. The brain’s capacity to generate experience relates to social plasticity, and cultural complexity and variety in terms of experience and expression informs the brain-body map.

The idea of a brain- auto-generating experience as if a discrete organ is problematic. Panksepp notes the obvious; the brain is not in a vat but of body and in a world. Even the example of congenitally born amputees -who have an experience of the phantom limb-, does not prove it is all innate in the brain. This is because such amputees by the time they communicate about the phantom limb experience have been exposed to the world of others, to the appearance of their body for others which informs the amputees own body image, and they have been exposed to other body forms and how other bodies relate to theirs. As Price argues the formation of the visible appearance of the body in relation to others is already underway and this is enough to produce an experience of desire or loss, and a phantom experience, based on a socially informed body image.

Furthermore, Body image can be inter-modal, both tactile and visual. We only have to think of the mirror neurones and Lacan’s mirror phase as constitutive of the ego- in the other- to get a sense of this. If a person has a congenitally missing limb from birth, the body image build from the world of others with intact limbs will inform experience (Price).

Memory is crucially involved: we know that war veterans who have had traumatic war experiences at the time of losing the limb, the extreme states of fear with the threatened physical disintegration of body integrity as a land mine shatters the limb to pieces, seeing grotesque deaths around you- have greater intense phantom limb pain. The pained memories live on, captured in the phantom. We can say for those with phantom limbs as Freud did in his study of hysteria and in particular hysterical paralysis, they suffer from reminiscences, are caught in them

As Jackson reminds us, memory is of key importance and memory is construed. Memory is a symbol and meaning producing process; and it is interpersonal, social and historical. The body map –schema is not reducible to genetic mapping alone, nor can it simply be auto-productive, this image –schema is importantly visual as well as sensory and derives from ‘the other’. The body map schema relates to other and world. From our perspective the body schema-image is an emergent bodily situation in a world. Image as Henri Bergson describes it is both composed out of matter and memory and belongs to belief and material life. It is this body schema situated in the relational space of body and environment. We can not assume that this body-image/schema is singular or unified, it could be fragmented or multiple, take on different forms and be experienced in different ways according to social specifity. In normal circumstances, the sensory-image is lived in bodily enactment and is renegotiated and moulded in every new corporeal enactment in a world, which allows for further social plasticity of body expression and experience.

In contrast, in certain cases of the phantom limb the visual and sensory memory from the past lives on but now in a vacuum- cut off from sensory input from the limb. Thus bodily action as such and thus fresh sensory input and renegotiation of body- in- world fails to be re-established. That is why treatment that stimulates and activates the action-body memory or uses artificial limbs and mirrors to trick the brain into thinking the limb is real and moving, can create corrective corporal feedback mechanisms. This playing with mirrors is a direct intervention into the visual imaginary in the Lacanian sense with the purpose to create misrecognition to reinforce the body image as an enacted schema.

Jackson in the discussion of pain in the case of phantom limb experience in amputees explains that the brain detects in some cases the lack of input as in the instances of dead nerves endings and in such circumstances can generate perceptual experience. Jackson addresses this generation of perceptual experience as involving memory and this memory does not instrumentally connect synapses but involves a sculpting process – that is organising and constructive. Jackson refers to bio-mental symbols materially impacting on the brain informing the brain response. He also refers to this as ’mind’ controlling the body’s reaction to nociceptive stimuli, which rather brings us back to a dualist terminology. So long as we do not return to the brain in the vat type metaphor, this fact of generating the perception of the phantom limb that is irreducible to the sense data derived from the sense organs, plus the discovered fact of cortical remapping opens up the phantom limb experience to the possibilities of neural and social plasticity and the vicissitudes of the body image and memory .

The Missing/Phantom Limb of the West – The Myth of the ‘intact’ Body

In many cases, although not all, Phantom limbs are not pleasurable experiences, and it is true that pain is only in some cases, however, the itching, the pins and needles and other reported unusual sensations are often associated with discomfort and can be found to range from unpleasant –to even strange. Such phantom limbs are to do with the trauma of loss that lives on, is not sufficiently worked through. The phantom limb is about unresolved mourning both creative and often- pained for a loss of a body part in an otherwise idealised intact body. In cultures obsessed with bodily-self integrity, a missing limb can signify an unacceptable loss that resists integration into a new body schema that could incorporate that loss as part of the re-formed body-self. It is a memory that lives on present in its absence and in that way hung on to and not let go off. Phantoms of the limb can thus simultaneously be a denial of that loss, the experience of the limbs presence – can be a disavowal, all depending on the nature of the phantom , the phantom can be the signifier of loss or a denial and both. In this context it is the concern for the intact body, a unit all in one piece –that lies at the basis of the experience of loss and inability to fully accept that loss. Affirmation of loss is not easy in cultures that abide to the intact singular unity of body form and its link to definitions of self –hood. It would seem then that the distressful symptoms of the phantom are inseparable from cultures that are embedded in the egoistic conviction in a body-self. Again would phantom limb experience of unpleasant symptoms be a focus in less self-obsessed and individualist cultures?

We can say that the ego as described by Freud as always a body ego, existing as a projection of the body surface, is not so much experienced as inside ‘somewhere’ but as on the skin surface in direct contact with the world. The phantom figuring as part of the sensorial ego where the activity at the stump construes the rest of the body, but the phantom can also feel strange and uncomfortable not part of me in the same way. When the phantom is made up of generated sensations, memory and body image, it no longer has to follow the laws of anatomy and physiology and can tip into the area of uncanny sensations, of a experience of unheimlich and of alterity, that is not quite me –but eerily so. A fundamental blip of the body ego-an altered state, can tip into the arena of sensation where organic limits no longer reside and the body without organs can be evoked, which can provoke fear because it is unknown in image-could take any form, can feel limitless and unpredictable, and this can be in the estranged marginal affect of the phantom sensation. I like Ansell Pearson’s reading of Deleuze and Guattari when he states that they construe no binary opposition between the body without organs and the organism, his suggestive reading being that the creative forces, intensities involved in the becoming of the body without organs is in play with stratified life, there is non organisation in organisational life and it is not so much an attack on the notion of organism as such , but rather a notion of organism that is construed as a given and hierarchized transcendent organisation.

At the moment I am supervising an analytic trainee who works with transsexuals, who wish to be Women and are to have the operation where their cocks are cut off. We have also discussed cases where a person wishes to have a limb cut off- whether it be an arm or a leg. In such cases the phantasy of completion is represented in the removal of a limb or organ, to return them to what they truly are and should be. The experience of that which is not me, alien and disowned is placed on a body part that can be removed and then perfection and greater completion will be reached, and indeed become, it will be fixed, there is no becoming no more. Alterity can never infact be got rid off, and when we have all our limbs and organs in organism place, it is still with us, if alterity fails to be incorporated then it always has to find an outlet even in the so called intact organism body, we can go to the extreme lengths of inverting the hierarchy where loss is gain, rather than vice versa but keep the same logic, or go to lesser extremes like shedding that unwanted pound of flesh from diet to liposuction the story is the same: the pursuit of pure identity- of the same, where no sense of otherness or the alien entity would be had anymore. As the body image can take all sorts of forms and yet still be ensconced in a logic of identity, and as Lacan reminds us the woman can be phallic in the imaginary as can the man so knocking of your penis can be Whole, and their can be anatomical and physiognomic plasticity –plastic surgery- which keeps the old order still in place without any radical social plasticity in fact.

Finally a way of thinking this question of loss and phantom limbs in a less ethnocentric way and examining cultural differences has been undertaken by Dr Kalpana Ram. Immigrant community now living in Australia have a n Indian dance performed by the Women that in their movements react a revocation of lost Indian roots and articulates a phantom culture, the women’s dance Ram argues acts like a phantom limbs-the women’s limbs representing the loss. The phantom limb no longer owned by an individual but the dance of the Women’s limbs acting as a signifier for the lost culture.

Nicola Diamond, formerly Senior Lecturer in Sociology currently is Director of PhD Program in Psychotherapy, Regents College, validated City University-London. She is also a psychoanalytic therapist in private practice, associate member of the BAP (British Association of Psychotherapists), BCP reg. Her specialist area is the body in the context of interdisciplinary studies- cultural, neuroscience, philosophical and psychoanalytic perspectives. Publications include: ''Towards an Interpersonal Understanding of Bodily Experience'' in Psychodynamic Counseling 2001, Routledge Publishers, ''Attachment, Trauma and the Body'' in Attachment and the Psychoanalytic Process 2002 Whurr Publishers, Co-author of Attachment and Intersubjectivity 2003 Whurr Publishers, '' Thin is the Feminist Issue'' extract in Book compilation called The Body 2005, Routledge "Between Touches'' in book The Meaning of Touch in Psychoanalysis, 2005, Karnac Publishers, ''When Thought is not enough'' in How Does therapy Work? 2005, Karnac Publishers and is currently writing her book ‘Between Skins’, to be published by Whurr 2006.