The Consciousness of Lost Limbs by William James - HTML preview

The Consciousness of Lost Limbs

By William James (1887)

Classics in the History of Psychology

An internet resource developed by

Christopher D. Green

,

ISSN 1492-3713

(Return to index)

The Consciousness of Lost Limbs

By William James (1887)

First published in Proceedings of the American Society for Psychical Research, 1, 249-

258.

Posted March 2003

Many persons with lost limbs still seem to feel them in their old place. This illusion is so

well known, and the material for study is so abundant, that it seems strange that no more

systematic effort to investigate the phenomenon should have been made. Dr. Weir

Mitchell's

observations in his work on Injuries of Nerves (1872) are the most copious and minute

with

which I am acquainted. They reveal such interesting variations in the consciousness in

question, that I began some years ago to seek for additional observations, in the hope

that out

of a large number of data, some might emerge which would throw on these variations an

explanatory light.

The differences in question are principally these:

1. Some patients preserve consciousness of the limb after it has been lost; others do

not.

2. In some it appears always in one fixed position; in others its apparent position

changes.

3. In some the position can be made to seem to change by an effort of will; in others no

effort of will can make it change; in rare cases it would even seem that the very attempt

to will

the change has grown impossible.

I have obtained first-hand information from a hundred and eighty-five amputated

persons. Some of this was gained by personal interviews; but much the larger portion

consists

of replies to a circular of questions of which I sent out some eight hundred copies to

addresses

furnished me by some of the leading makers of artificial limbs.[1]

The results are disappointing, in that they fail to explain the causes of the enumerated

differences. But they tell certain things and suggest reflections which I here set down for

the

use of future inquirers.[2]

First, as to the relative frequency of the feeling of the lost parts. It existed at the time of

answering my interrogatories in about three-quarters of the cases of which I have

reports. I say

in about the proportion of cases, for many of the answers were not quite clear. It had

existed in

a much larger proportionate number, but had faded out before the time of answering.

Some

had ceased to feel it "immediately," or "an hour or two" after the amputation. In others it had

lasted weeks, months, or years. The oldest case I have is that of a man who had had a

thigh

amputation performed at the age of thirteen years, and who, after he was seventy,

affirmed his

feeling of the lost foot to be still every whit as distinct as his feeling of the foot which

remained.

Amongst my one hundred and seventy-nine cases only seven are of the upper extremity.

In all

of these, the sense of the lost hand remained.

The consciousness of the lost limb varies from acute pain, pricking, itching, burning,

cramp, uneasiness, numbness, etc., in the toes, heel, or other place, to feelings which

are

hardly perceptible, or which become perceptible only after a good deal of "thinking." The

feeling

is not due to the condition of the stump, for in both painful and healthy stumps it may be

either

present or absent. Where it is distinct both the lost foot or hand and the stump are felt

simultaneously, each in its own place. The hand and foot are usually the only lost parts

very

distinctly felt, the intervening tracts seeming to disappear. A man, for example, whose

arm was

cut off at the shoulder-joint told me that he felt his hand budding immediately from his

shoulder.

This is, however, not constantly the case by any means. Many patients with thigh

amputation

feel, more or less distinctly, their knee, or their calf. But even where they do not, the foot

may

seem separate from the stump, though possibly located nearer it than natural. A second

shoulder-joint case says his arm seems to lie on his breast, centrally with fingers closed

on

palm just as it did eight or ten hours before amputation.

It is a common experience, during the first weeks after amputation, for the patient to

forget that his leg is gone. Many patients tell how they met with accidents, by rising

suddenly

and starting to walk as if their leg were still there, or by getting out of bed in the same

way.

Others tell how they have involuntarily put down their hand to scratch their departed foot.

One

man writes that he found himself preparing with scissors to cut its nails, so distinctly did

he feel

them. Generally the position of the lost leg follows that of the stump and artificial leg. If

one is

flexed the other seems flexed; if one is extended so is the other; if one swings in walking

the

other swings with it. In a few correspondents, however, the lost leg maintains a more or

less

fixed position of its own, independent of the artificial leg. One such man told me that he

felt as if

he had three legs in all, getting sometimes confused, in coming down stairs, between the

artificial leg which he put forwards, and the imaginary one which he felt bent backwards

and in

danger of scraping its toes upon the steps just left behind. Dr. Mitchell tells of certain

arms

which appeared fixedly in the last painful attitude they had occupied before amputation.

One of

my correspondents writes that he feels constantly a blister on his heel which was there

at the

time of his accident; another that he had chilblains at the time of the accident, and feels

them

still on his toes.

The differences in the apparent mobility of the lost part, when felt, are strange. About a

hundred of the cases who feel (say) their feet, affirm that they can "work" or "wiggle"

their toes

at will. About fifty of them deny that they have any such power. This again is not due to

the

condition of the stump, for both painful and healthy stumps are found equally amongst

those

who can and amongst those who cannot "work their toes." Almost always when the will

is

exerted to move the toes, actual contraction may be perceived in the muscles of the

stump.

One might, therefore, expect that where the toe-moving muscles were cut off, the sense

of the

toes being moved might disappear. But this is not the case. I have cases of thigh

amputation, in

which all the foot-moving muscles are gone, and yet in which the feet or toes seem to

move at

will. And I have cases of lower-leg amputation in which, though the foot-moving muscles

contract in the stump, the toes or feet feel motionless.

But although, in a gross sense, we are thus forced to conclude that neither the state of

the stump nor the place of the amputation absolutely determines the differences of

consciousness which different individuals show, it is nevertheless hard to believe that

they are

not amongst the more important influencing conditions of the illusion which we are

studying. On

a priori grounds it seems as if they must be so. What is the phenomenon? It is what is

commonly known as the extradition, or projection outwards, of a sensation whose

immediate

condition is the stimulation of a central organ of perception by an incoming nerve or

nerves. As

the optical centres respond to stimulation by the feeling of forms and colors, and the

acoustic

centres by that of sounds, so do certain other centres respond by the feeling of a foot,

with its

toes, heel, etc. This feeling is what Johannes Müller called the "specific energy" of the

neural

tracts involved. It makes no difference how the tracts are excited, that feeling of a foot is

their

only possible response. So long as they feel at all, what they feel is the foot.[3] In the

normal

state the foot thus felt is located where the eye can see and the hand touch it.

When the foot which the eye sees and the hand touches is cut off, still the immediate

inner feeling of it persists so long as the brain-centres retain their functions; and, in the

absence of any counter-motive, it ought, one would think, to continue located about

where it

used to be. There would be a counter-motive, if nerves which in the unamputated man

went to

the foot and were excited every time the foot was touched, were to find themselves, after

the

amputation, excited every time the stump was touched. The foot-feeling (which the

nerves

would continue to give) being then associated with the stump-contacts, would end (by

virtue of

a law of perception of which I made mention in Mind for 1887, p. 196) by locating itself at

the

place at which those contacts were believed, on the testimony of the eye and the hand,

to

occur. In other words, the foot-feeling would fuse with the feeling resident in the stump.

In but

few cases does this seem to occur;[4] and the reason is easily found. At the places

where the

amputation is apt to be made, the nerves which supply the foot are all buried deeply in

the

tissues. Superficial contact with the stump never excites, therefore, the sensibility of the

foot-

nerves. All ordinary contacts of the stump, thus failing to awaken the foot-feeling in any

noticeable way, that feeling fails to grow associated with the stump's experiences; and

when

(on exceptional occasions) deep pressure of the stump awakens not only its own local

cutaneous feeling but the foot-feelings due to the deeper-lying nerve, the two feelings

still keep

distinct in location as in quality.

There is, usually, in fact, a positive reason against their local fusion. More than one of

my correspondents writes that the lost foot is best felt when the end of the stump

receives the

thrust of the artificial leg. Whenever the old foot is thus most felt at the moment when the

artificial foot is seen to touch the ground, that place of contact (being both important and

interesting) should be the place with which the foot-feeling would associate itself (by

virtue of

the mental law already referred to). In other words, we should project our foot-feeling

upon the

ground, as we used to before we lost the member, and we should feel it follow the

movements

of the artificial limb.[5] An observation of Dr. Mitchell's corroborates this view. One of his

patients "lost his leg at the age of eleven, and remembers that the foot by degrees

approached,

and at last reached, the knee. When he began to wear an artificial leg it reassumed, in

time, its

old position, and he is never, at present, aware of the leg as shortened, unless for some

time

he talks and thinks of the stump and of the missing leg, when... the direction of attention

to the

part causes a feeling of discomfort, and the subjective sensation of active and

unpleasant

movement of the toes. With these feelings returns at once the delusion of the foot as

being

placed at the knee."[6]

The latter half of this man's experience shows that the principles I have invoked (though

probably quite sound as far as they go) are not exhaustive, and that, between fusion with

the

stump and projection to the end of the artificial limb, the intermediate positions of the foot

remain unaccounted for. It will not do to call them vague remains of the old normal habit

of

projection, for often they are not vague, but quite precise. Leaving this phenomenon on

one

side, however, let us see what more our principles can do.

In the first place they oblige us to invert the popular way of looking at the problem. The

popular mind wonders how the lost feet can still be felt. For us, the cases for wonder are

those

in which the lost feet are not felt. The first explanation which one clutches at, for the loss,

is that

the nerve-centres for perception may degenerate and grow atrophic when the sensory

nerve-

terminations which normally stimulate them are cut off. Extirpation of the eyeballs

causes such

atrophy in the occipital lobes of the brain. The spinal cord has been repeatedly found

shrunken

at the point of entrance of the nerves from amputated limbs. And there are a few

carefully

reported cases in which the degeneration has been traced ascending to the cortical

centres,

along with an equal number of cases in which no such ascending degeneration could be

found.

[7] A degenerated centre can of course no longer give rise to its old feelings; and where

the

centres are degenerated, that fact explains all-sufficiently why the lost member can no

longer

be felt. But it is impossible to range all the cases of non-feeling under this head. Some of

them

date from the first hours after the operation, when degeneration is out of the question. In

some

the perceptive centres are proved to be there by exciting electrically the nerve-trunks

buried in

the stump. "I recently faradised," says Dr. Mitchell, "a case of disarticulated shoulder

without

warning my patient of the possible result. For two years he had altogether ceased to feel

the

limb. As the current affected the brachial plexus of nerves, he suddenly cried aloud, 'Oh,

the

hand, the hand!' and attempted to seize the missing member. The phantom I had

conjured up

swiftly disappeared, but no spirit could have more amazed the man, so real did it

seem."[8]

In such a case as this last, the only hypothesis that remains to us is to suppose that the

nerve-ends are so softly embedded in the stump as, under ordinary conditions, to carry

up no

impressions to the brain, or none strong enough to be noticeable. Were they carried, the

patient

would feel, and feel a foot. Not feeling the foot, and yet being capable of feeling it (as the

faradization proves), it must be either that no impressions are carried, or else that for

some

reason they do not appeal to consciousness. Now it is a general law of consciousness

that

feelings of which we make no practicable use tend to become more and more

overlooked.

Helmholtz has explained our habitual insensibility to double images, to the so-called

muscæ

volitantes caused by specks in the humors of the eye, to the upper harmonics which

accompany various sounds, as so many effects of the persistent abstraction of our

attention

from impressions which are of no use. It may be that in certain subjects this sort of

abstraction

is able to complete our oblivescence of a lost foot; our feeling of it has been already

reduced

almost to the vanishing point, by reason of the shielded condition of the nerve-ends, just

assigned. The feeling of the lost foot tells us absolutely nothing which can practically be

of use

to us.[9] It is a superfluous item in our conscious baggage. Why may it not be that some

of us

are able to cast it out of our mind on that account? Until a few years ago all oculists

believed

that a similar superfluity, namely, the second set of images seen by the squinting eye in

squinters, was cast out of consciousness so persistently that the eye grew actually blind.

And,

although the competency of the explanation has probably been disproved as regards the

blindness, yet there is no doubt that it is quite competent to prove an almost invincible

unconsciousness of the images cast upon a squinting eye.

Unconsciousness from habitual inattention is, then, probably one factor in the

oblivescence of lost extremities,-- a factor which, however, we must regard as unavailing

where

impressions from the nerve-ends are strong.[10]

Let us next consider the differences in regard to the illusion of voluntary movement in

the lost parts. Most of the patients who seem to themselves able to move their lost feet,

hands,

etc., at will, produce a distinct contraction of the muscles of the stump whenever they

make the

voluntary effort. As the principle of specific energies easily accounted for the

consciousness of

the lost limb being there at all, so here another principle, almost as universally adopted

by

psychologists, accounts as easily for the consciousness of movement in it, and leaves

the real

puzzle to reside rather in those cases in which the illusion of movement fails to exist.

The principle I refer to is that of the inheritance of ancestral habit. It is all but

unanimously admitted at the present day that any two experiences, which during

ancestral

generations have been invariably coupled together, will have become so indissolubly

associated that the descendant will not be able to represent them in his mind apart. Now

of all

possible coupled experiences it is hard to imagine any pair more uniformly and

incessantly

coupled than the feeling of effected contraction of muscles, on the one hand, and that of

the

changed position of the parts which they move, on the other. From the earliest ancestors

of

ours which had feet, down to the present day, the movement of the feet must always

have

accompanied the contraction of the muscles; and here, if anywhere, habit's hereditary

consequences ought to be found, if the principle that habits are transmitted from one

generation to another is sound at all.[11] No sooner then should the brain-centres for

perceiving

muscular contractions be excited, than those other centres functionally consolidated with

them

ought to share the excitement, and produce a consciousness that the foot has moved. If

it be

objected to this that this latter consciousness ought to be ideal rather than sensational in

character, and ought therefore not to produce a fully developed illusion, it is sufficient to

point to

what happens in many illusions of the same type. In these illusions the mind, sensibly

impressed by what seems a part of a certain probable fact, forthwith perceives that fact

in its

entirety. The parts supplied by the mind are in these cases no whit inferior in vividness

and

reality to those actually impressing the sense.[12] In all perception, indeed, but half of

the

object comes from without. The larger half usually comes out of our own head. We can

ourselves produce an illusion of movement similar to those which we are studying by

putting

some unyielding substance (hard rubber, e.g. ) between our back teeth and biting hard. It

is

difficult not to believe that our front teeth approach each other, when we feel our biting

muscles

contract.[13] In ourselves the feeling of the real position of the jaws persists unchanged

to

contradict the false suggestion. But when we recall that in the amputated no such

positive

contradiction can occur, since the parts are gone, we see how much easier it must be in

their

case for the false sense of movement to flourish unchecked.[14]

But how, then, comes it that there can be any patients who lack the false sense in

question? In one hundred and forty of my cases, about fifty lacked it completely; and

even

when the stump-muscles contract violently, many patients are unable to feel any change

at all

in the position of the imaginary extremity. This is not due to the fact that the amputation

is made

above the origin of the hand-or-foot-moving muscles; for there are eleven cases where

these

muscles remain and contract, but yet no sense of movement exists. I must say that I can

offer

no clear solution of this anomaly. It must be left over, together with those obstinate

cases of

partial apparent shortening of which we spoke above, for future investigators to treat.

One reflection, however, seems pertinent to the entire set of phenomena we have

studied. They form a group in which the variations from one individual to another, if they

exist at

all, are likely to become extreme. notices that no organs in animals are so subject to

variation

as rudimentary organs. Being functionless, selection has no hold on them, the

environment

exerts no influence to keep them up (or down) to the proper standard, and the

consequence is

that their aberrations are unchecked. Now phantasms of lost legs and arms are to the

mental

organism just what rudimentary organs are to the bodily organism. They have no longer

any

real relations with the environment, being mere vestiges of something which formerly

had real

relations. The environment does not correct such a phantasm for any odd course it may

get

into. If it slips away altogether, the environment lets it go, and doesn't call it back. If it

happen

"by accident" to harden itself in a fixed position, or shorten itself, or to dissolve

connection with

its ancestral associates in the way of muscular feeling, the accident is not repaired; and

experience, which throughout the rest of our mental life puts prompt bounds to too great

eccentricity, here lets it luxuriate un-rebuked. I do not know how far one ought to push

this idea.

But (what we can call by no better name but) accident or idiosyncrasy certainly plays a

great

part in all our neural and mental processes, especially the higher ones. We can never

seek

amongst these processes for results which shall be invariable. Exceptions remain to

every

empirical law of our mental life, and can only be treated as so many individual

aberrations. It is

perhaps something to have pointed out the department of lost-limb-consciousness as

that in

which the aberrant individuals are likely to reach their maximum number.

The apparent changes of temperature of the lost parts form an interesting chapter,

which, however, I will not discuss. Suffice it to say, that in many patients the lost foot can

be

made to feel warm or cold by warming or cooling the stump. A draught of air on the

stump

produces the feeling of a draught on the foot. The lost foot also sympathizes sometimes

with

the foot which remains. If one is cold, the other feels cold. One man writes that

whenever he

walks through puddles and wets his sound foot, his lost foot feels wet too.

My final observations are on a matter which ought to interest students of "psychic

research." Surely if there be any distant material object with which a man might be

supposed to