Review published in HMS Beagle 69.
A new book offers a cure for phantom pains, explains how to grow a nose the size of Pinnochio and even explains why some people experiences orgasms in their foot.
PHANTOMS
By MORTEN KRINGELBACH

According to many religions our body is merely an illusory frame, inhabited for a short while by the soul. In Phantoms in the Brain, neurologist V.S. Ramachandran and science-writer S. Blakeslee provide thought-provoking examples of just how illusory our mental body-image is. By itself, the brain creates subjective feelings, such as pain and joy, commonly regarded as characteristic of the soul. Could we finally be beginning to get a scientific handle on the soul?

A striking example of how our body-image is remarkably malleable is the following experiment: take a scarf, and two helpers (let us call them Anna and Nina), and seat yourself, blindfolded, on a chair behind Anna. Tell Nina to guide the index finger of your right hand to Anna’s nose. Then with your index finger repeatedly stroke and tap Anna’s nose unpredictably, like Morse code. At the same time, ask Nina, with the index finger of her left hand, to stroke and tap your nose in exactly the same way. After 30-40 seconds your nose will seem to be the size of Pinnochio’s! The more random and unpredictable the movements, the stronger this illusion.

This is a simple example of how quickly the brain constructs meaning on the basis of the information present.

Phantom pains
The brain’s fundamental function seems to be to construct and attach meaning to events. This can create bizarre conflicts, such as the ‘Pinocchio nose’ experiment described above, where an effect conflicts with what we know logically to be the case. Characteristically the brain tries to avoid these conflicts, in order to help us navigate our complex environment. However, this at times creates absurd situations. For example, neurological patients suffering from neglect disorders consistently deny the existence of all objects in one half of their visual field - including their own body! Patients who have lost a hand may still insist they can feel the missing limb. Amputees also suffer from violent phantom pains in their missing limb. This is a strange but important problem. How can pain in non-existent body parts be cured?
The whole arm
Numerous medical strategies have been tried for many years. With pain in a phantom hand, for instance, further amputation was attempted, first up to the elbow and sometimes even as far as the shoulder. When that didn’t work (which it rarely does) neurons were removed from the spinal cord. In some cases there was even surgical intervention in the brain. All too often these treatments were at best ineffective, and had many unpleasant side-effects.

Consequently, scientists became unwilling to accept phantom pains as a real physiological disorder. Instead, some neo-Freudian theoreticians saw them as repressed wishes for the lost body parts.

Of fetishisms and orgasms
This was more or less the situation when some scientists, led by Ramachandran, came up with a bright idea. The pioneering research on epileptic patients by the neurosurgeon W. Penfield in the 1950s demonstrated how our body is represented as maps in the cortex of the brain. Importantly, these maps do not reflect the true proportions of the body: they are distorted. For instance, the face and genitals occupy a greater area in the brain than the elbow and toes; next to the area for the face we do not find the area for the upper body, but for the hand; next to the genitals, not the thighs but the feet are represented.

Now, what if part of the brain area for the hand were taken over a neighbouring area, in this case the face? Then stimulation of parts of the face should be felt in the amputated hand.

Surprisingly, that is exactly what Ramachandran discovered. An amputee’s whole hand could be found on his chin: not only could he feel needle pricks there - he also felt them in his non-existant hand.

Ramachandran thus demonstrated that the function of a large area in the brain can be overtaken by neighbouring areas. Previously, many scientists had not thought such reorganisation was possible. An analogous effect has since, however, been demonstrated in violinists, who use a larger part of cortex than normal subjects to represent hands and fingers.

Interestingly, according to Ramachandran, similar mechanisms might explain bizarre phenomena such as foot fetishism and orgasms in the foot: for since the brain area for the genitals is right next to the feet, crosstalk may arise.

Amputation of the phantom
Explaining phantom pains does not cure them, however. But then Ramachandran had a bright idea. At least half the cortex is used for vision, and vision itself has a controlling impact on our cognitive capacities. So he made a special mirror box, creating the illusion that one part of the box is a mirror of the other. When one hand was inserted into this, it looked as though there were two hands. When both hands (that is, the real and the non-existent amputated hand) are put in, the missing hand seems to have magically returned.

Many patients have strong pains in their phantom limb, especially in their hand, which is often felt to be agonisingly clenched. This pain can be alleviated by asking the patient to open and close both hands in the mirror box. In one case the mirror box not only cured the pain but even amputated the phantom hand (which probably had been defined by the pain).

Laughter until death
Phantoms in the Brain contains many refreshing and original ideas. Just as the neurologist Oliver Sacks manages to relate important parts of human nature by describing a number of neurological disorders, Ramachandran achieves a similar effect in his descriptions of patients. Furthermore, he is not afraid to go out on, as it were, a limb to offer ingenious explanations of the phenomena he describes.

We are therefore taken on a tour of a number of interesting disorders, ranging from blindsight (blind patients able to see more than they realise), via phantom pregnancy (labor pains occuring without a real baby), to Capgras’ syndrome (the patient accuses close relatives of being impostors).

Ramachandran describes rare neurological cases, such as the lady with a brain haemorrhage that made her laugh herself literally to death, or the woman who could not see movement, but only still pictures, and who therefore had severe problems crossing busy roads.

We are also told of temporal lobe epileptics who are prone to attach deep cosmic significance to every event in their life, and how damage to the frontal lobes can induce remarkable changes in personality.

Epistemology
This is an astute and admirable book, even if the writing is uneven, with some tiresome and almost banal examples of where, for example, Baywatch should be represented in the brain. Yet those are minor faults in a remarkably readable book dedicated to what Ramachandran (primarily to annoy philosophers) calls experimental epistemology.

It culminates in an attempt to determine those parts of the brain that are used to create the self. The self has a number of aspects, of which embodiment, memory, executive functions, awareness, sociality and unity may all have an equivalent in the brain.

Books such as Phantoms in the Brain give us ideas about where to look in the brain for answers to the big interesting questions of self and consciousness - even if the soul itself still eludes scientific enquiry.

V.S. Ramachandran & S. Blakeslee: Phantoms in the Brain. Human Nature and the Architecture of the Mind. 4th Estate, £17.99