XII. The phantom limb

So-called “phantom” pain is pain felt in an amputated limb. Although the term was not coined until the 19th century, it became a notable object of study from the 16th century onwards. Starting with Descartes, focus turned to the brain as the seat of pain. A sensation of pain from an amputated limb thus served as a paradigmatic case confirming that there is not necessarily a correlation between the sensation of pain and the actual condition of one's body parts.

According to Ambroise Paré

The first descriptions of the phantom limb are attributed to surgeon Ambroise Paré (1552). They appear in the particular context of military surgery. The pain felt by amputees is, in Paré's view, a “false feelingAmbroise Paré, La maniere de traicter les playes faictes tant par hacquebutes, que par fleches, Paris, Veuve de Jean de Brie, 1552, p. 59r.”. The illusion of phantom pain would be comparable to the mistake we would make if someone were pulling on the fabric of our shirt but we felt as if our arm itself was being pulled.

Ambroise Paré notes that the use of a curved instrument avoids “great pain for the patientAmbroise Paré, La maniere de traicter les playes faictes tant par hacquebutes, que par fleches, Paris, Veuve Jean de Brie, 1552, p. 61v. at the start of the amputation.

According to Descartes

In the work of Descartes, phantom pain becomes a philosophical subject in its own right: on the one hand, it enables the philosopher to question the link between the mind and the body and, on the other hand, to highlight the path of the nerves, from peripheral organs all the way to the brain.

In Descartes's view, the pain of this amputee corresponds to a very real physiological phenomenon, but the illusion lies in an error in localizing the site of this pain: the sufferer believes that there is a lesion on her amputated hand, but in fact it is elsewhere in her body that the nerve has been damaged. He concludes: “And this shows clearly that pain in the hand is not felt by the mind insofar as it is in the hand, but as it is in the brainRené Descartes, Principles of Philosophy [Principes de la philosophie, 1647], part 4, article 196, in Philosophical Essays and Correspondence, ed. R. Ariew, Indianapolis/Cambridge, Hackett Publishing Company, 2000, p. 266. (1647).

René Descartes - The Brain as the Seat of Phantom Pain

Fire violently tugs at the nerve of the foot. As this movement spreads to the brain, the burning sensation is felt, as “when you pull on one end of a cord you cause a bell hanging at the other end to ring at the same timeRené Descartes, The Treatise on Man [L’Homme, 1664], in The World and Other Writings, ed. and trans. S. Gaukroger, Cambridge, Cambridge University Press, 2004, p. 117. (Descartes, L’Homme, 1664).

According to Van Swieten

In the 18th century, the Dutch physician Gerard van Swieten continued this neurophysiological reflection, considering that the sensation of pain was cerebral: “It seems very likely,” he writes, “that this idea of pain can [...] be excited, without any change in the nerves, provided something [changes] where the nerves originate, that is, in the brain itselfGerard van Swieten, Hermann Boerhaave, Aphorismes de chirurgie d’Hermann Boerhaave, commentés par Monsieur van Swieten, traduits du latin en français, Paris, Veuve Cavalier, t. I, 1753, p. 419-420..