Body Integrity Identity Disorder and the Phantom Limb
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Body Integrity Identity Disorder and the Phantom Limb: Reflections on the Bodily Text Monika Loewy 1 Monika Loewy Goldsmiths College, University of London Thesis submitted for the degree of Doctor of Philosophy (PhD) I confirm that the work presented in this thesis is my own. --------------------------------- Monika Loewy 2 Thesis Abstract Body Integrity Identity Disorder (BIID) describes a condition in which a person desires to self-amputate in order to feel whole, and the phantom limb syndrome (PLS) occurs when an individual feels (typically painful) sensations in a non-existent limb. These conditions have been predominantly researched through biomedical models that struggle to find comprehensive reasons or cures, while a psychological model is lacking. Thus, these conditions insist that we debate them from a more nuanced view, which I approach through literature, cultural works, and psychoanalysis. In order to do this, we must attend to what is central to both phenomena: a feeling of rupture that contrasts a desire for wholeness. This theme will be elaborated through a discussion of the mirror-box, which is a therapeutic device that alleviates phantom limb pain by superimposing a mirror image of the existent limb onto the absent one, to create an illusion of bodily unity. I use this example to illuminate how texts and psychoanalysis involve reflections of self that can lead to a symbolic reconstitution. What this dialogue illuminates is how theoretical and psychical notions are intertwined with physical experience. I begin by surveying BIID and PLS, which is followed by two case studies that convey personal experiences of living with the syndromes. Chapter Two examines how BIID and PLS bring out an affinity between psychoanalysis and literature. The third chapter uses examples to fortify these links by tracing the theme of the double. The question of recuperation is raised in Chapter Four through the work of D.W. Winnicott, and Chapter Five investigates a novel by Georges Perec, which ties together those themes in discussion. Reading BIID and PLS through these works ultimately raises questions concerning what we can discover about how we are constituted through signs, and how this affects our sense of self. 3 Acknowledgments I would like to thank Professor Josh Cohen who served as my supervisor, and who shared with me his great breadth of knowledge, as well as being the one who encouraged me throughout my time spent studying under him. To my family, who have expressed their pride in me, challenged me, supported me, and who taught me to trust the process. And my dad: an ironic inspiration. I am very grateful to Christopher Lloyd, who allowed me to believe in my work, and who always asked and listened. And to Victor Sevilla-Diaz, Ananda Grace, Mary Richards (and co.), Tiago Gandra, Alice Condé, Jane Desmarais, Anna Siemiaczko, Jimmy Card, Joe Mattei, Holly Farler, Donald Underwood, Lily Buckley, Nichole Kerman, Joaquim Bastos, Nayantara Premakumar, Rebecca Pitkin, Dana Stall, Rachel Shepley, Christopher Clark, and Jo Baker, for all the conversations, to say the least. To my grandparents, Laura Paquette, and Sue Jordan, who made this thesis possible. 4 Table of Contents Introduction ……………………………………………………6-57 Chapter One: We didn’t ask for this pain …………………….58-89 Chapter Two: Why Psychoanalysis and Literature? …………90-115 Chapter Three: The Double …………………………………..116-149 Chapter Four: Breakdown ……………………………………150-177 Chapter Five: Almost Artificial Limbs ………………………..178-213 Conclusion: (…) ……………………………………………….214-222 Bibliography …………………………………………………...223-243 5 Introduction La suppression radicale d’un membre, ne présentant plus au cerveau que des images [...] de bras et de jambes, de membres lointains et pas à leur place. Une espèce de rupture intérieure. Suppression of a limb, transmitting to the brain no more than images […] in the shape of arms and legs, images of distant and dislocated members. Sort of inward breakdown. --- Artaud, Anthology (29) Antonin Artaud’s fragmented description of dislocated limbs reflects the focus of this thesis, which involves experiences of physical, psychical, imaginary, and linguistic fracture in relation to illusory limbs. Body Integrity Identity Disorder (BIID) is a condition in which individuals desire to amputate a limb because they feel that it does not belong to their body: they feel “incomplete” with four healthy limbs. A phantom limb occurs when amputated individuals feel the sensation that their absent limb still exists. Thus, BIID and the phantom limb syndrome (PLS) are the inverse of one another. Though individuals with both conditions desire to remove an extraneous limb (in BIID an existing limb, and in PLS a phantom), they reflect a similar problem with a feeling of incompleteness and a dissonance between the mind and body. While in BIID, the concept of completion concerns a sense of being in physical excess, a fantasy of destruction, and appears to begin in the mind, PLS involves a fantasy that fills an absence, originates in the body, and can, in certain cases, be healed through a mirror illusion. V.S. Ramachandran invented the mirror treatment in 1996 through what he called the mirror-box (also known as mirror therapy), a box with a mirror in the centre into which amputees place their whole limb on one side, and the stump on the other. When they move the existent limb and look at its reflection, it appears as though there are two limbs, and that their phantom is moving. In turn, the often uncomfortable or painful phantom sensations can disappear. Thus, a re-imagined version of the self transforms a disturbing experience of rupture, a concept that is also central to certain psychoanalytic, fictional, and literary works. These types of texts, therefore, can provide insight into the BIID, PLS and mirror-box phenomena. In this thesis, I will explore BIID and PLS as psychosomatic conditions that involve a dissonance between the mind and body, and fragmentation and 6 wholeness. Since they have, thus far, only been studied through a biomedical paradigm that fails to find definitive answers or cures, I argue that a theoretical analysis is necessary. Through the use of psychoanalytic, literary, and fictional texts that foreground bodily fragmentation, this thesis explores various ways of illuminating the drives towards wholeness experienced by those with BIID and PLS. More specifically, it attends to how a form of possession (the need to control one’s sense of being complete) can be mediated by a particular kind of exchange. Moreover, since through mirror therapy the restored self is made possible through a process of reflection, the mirror-box acts as a metaphor for the structure of this thesis, which is a linguistic reflection upon BIID and the phantom limb syndromes. Psychoanalysis provides a starting point for this exploration because, in the words of Marilia Aisenstein, if psychoanalysis is unique, and irreplaceable, in relation to other forms of psychological treatment, it is so, in my view, because it opens up thought processes and enables the subject to reintegrate into the chain of psychic events even something unthinkable, such as the appearance of a lethal illness. (“Indissociable” 679) Psychoanalysis, therefore, offers new ways of thinking about BIID and PLS, two phenomena that are to a great extent, incomprehensible. In this thesis, therefore, I draw relationships between psychoanalysis and the two bodily conditions, which focus on the fractured psyche and soma. By paying attention to the body, this exploration will illuminate what is involved in the disorders, while also providing nuanced ways of reading psychoanalytic theories. Naomi Segal states of Didier Anzieu that, “[s]ince Lacan, the stress on language had meant that the body was not being psychoanalytically theorised; yet ‘every psychic activity leans on [s’étaie sur] a biological function.’ Anzieu’s aim is to fill this gap” (Consensuality, 44 emphasis in original). This thought provides a helpful backdrop for my exploration here (although I do not discuss Anzieu’s work), because I am interested in corporeality. However, not unlike Anzieu, I do not only investigate the body, I also foreground the importance of language and the way in which it mediates between the mind and body. In reading the two bodily conditions through a psychoanalytic 7 and literary lens, I address the importance of linking literature, the psyche and the body. As Peter Brooks writes: [T]here ought to be a correspondence between literary and psychic dynamics, since we constitute ourselves in part through our fictions within the […] symbolic order, that of signs, including, pre-eminently, language itself. Through study of the work accomplished by fictions we may be able to reconnect literary criticism to human concern. (Reading xiv) Studying literature and the psyche together can help elucidate the ways in which we are constituted through fictions, and BIID and PLS both concern fictive versions of the self that involve an imagined sense of unity. Moreover, the mirror- box demonstrates how visualising oneself as a sign (the mirror illusion is a sign of the phantom limb) can have bodily affects. Thus, mirror therapy acts as a material and metaphorical example of the way in which we are formed through signs, in the way the body is understood and constituted as a language and through language. In drawing these connections between psychoanalysis, literature and the body, this thesis explores how the fictions through which we are formed can alleviate experiences of fragmentation. To provide a foundation for these analyses, a survey of relevant literature follows. I begin with a detailed review of BIID, PLS, and the mirror-box, focusing on the neurological and psychological hypotheses already in play. This will be followed by a discussion of the “hysterical body,” which introduces concepts about how the body can symbolise psychical pain, and how this can be worked through in psychoanalysis. For this, I focus on the concepts of “conversion,” psychosomatics, symbolism, and transference.