By William James (1887)
Classics in the History of Psychology
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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
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