Copyright 2007 by Cassandra S. Crawford ii ACKNOWLEDGEMENTS First, I want to thank the University of California, the National Institute of General Medical Sciences and the National Science Foundation for providing generous funding without which I could not have completing this project. Second, I want to thank my committee members Dr. Lucy Suchman, Dr. Virginia Olesen, and Dr. Adele Clarke for their tireless effort and creative inspiration. In particular, I want to thank Dr. Adele Clarke for her careful reading and generous commentary during all phases of my project. Third, I want to thank faculty members, friends and colleagues who have been invaluable in terms of commentary, feedback, critique and encouragement including: Rene Beard, Gay Becker, C.L. Cole, Brian Dolan, Carol Estes, Jennifer Fishman, Jennifer Fosket, Carrie Friese, Mauro Hernandez, Charlene Harrington, Sharon Kaufman, Nick King, Steve Kurzman, Maya Ponte, Dale Rose, Rachael Washburn, Tracey Weitz, and Alan Czaplicki. Fourth, I want to thank friends and family who have reminded me that there really is more to life than phantom limb syndrome, including: my sisters Ali Crawford and Stephanie Basko; my family John Ganchoff, Mary Ganchoff, John Kulczycki, Regina Bowgierd, Clay Kunz, Julie Kunz, and Jasper Kunz; my friends Amber Engleman, Steve Lugar, and Heather Rose. iii Lastly, I want to thank my best friend, my partner, my motivation, and my love Chris Ganchoff who supported and inspired me every step of the way. He always reminded me in the most poignant moments that humor is the best remedy for most ills, that life is sweet even when it seems sour or salty, that optimism is the finest intoxicant, and that everything really does always work out when we have each other. iv Ghost in the Machine: A Genealogy of Phantom-Prosthetic Relations Cassandra S. Crawford Situated at the intersection of science and technology studies (STS), medical sociology and the sociology of the body, this work is a genealogical analysis of phantom-prosthetic relations or the historically multifarious and dynamic relations between dismemberment and prosthetization understood through psychological, medical and biomedical constructions of phantom limb syndrome. I trace the major shifts in knowledges and discourses about phantom limb etiology, nosology, and epidemiology from the late-1800s through 2005 revealing how this amorphous, ethereal object became material or socially substantive over the 20th century. I further situate psychological and (bio)medical constructions of phantom limb in the larger socio-cultural and historical context of the modernization of dismemberment, including: the establishment of synchronic practices and principles between amputation surgery and prosthetic science; the state-sponsored rapid coalescence and professionalization of the field of prosthetic science; the elaboration and sophistication of prosthetic technologies and techniques; the institutionalization of post-surgical rehabilitation including pain treatment; and the use of visualizing technologies to situate phantom limb in the brains of amputee. One of the central concerns of the dissertation is historical changes in corporeal ideology or those ideas, knowledges, institutions and practices that make up what is taken for granted about the body, its use, its capacities, its “nature.” I explore the implications of corporeal v ideology for governing and disciplining partial-ized bodies and spectral parts. However, I also demonstrate how phantoms have also functioned as a window into corporeal resistance. I detail the ways in which phantoms have resisted attempts at biomedical domestication, as well as how they have been the force behind many transmutations within the field of phantom research, within bodies, and between bodies and technologies. Data included ten months of observation at a San Francisco bay area orthotic and prosthetic clinic, observation at an annual Amputee Coalition of America conference, eight in-depth semi-structured interviews with key researchers and practitioners in the field, and an interpretive content analysis of 439 articles published in the medical literature from 1930 to 2005. vi TABLE OF CONTENTS CHAPTER ONE: INTRODUCING PHANTOM-PROSTHETIC RELATIONS 1 Embodying Dismemberment: Body Curious. 5 Embodying Dismemberment: Corporeal Ideology. 9 Embodying Dismemberment: Phantom-ed Resistance. 10 The Biomedicalization of Phantom Limb Syndrome. 12 Phantom-Prosthetic Relations: The Modernization of Dismemberment. 15 Phantom-Prosthetic Relations: Prosthetic Transformations. 16 Phantom-Prosthetic Relations: Phantom Extinction. 18 Research Methods, Data Sources, and Data Analysis. 19 Research Methods, Data Sources, and Data Analysis: Situational Mapping. 19 Research Methods, Data Sources, and Data Analysis: Interpretive Content Analysis. 20 Research Methods, Data Sources, and Data Analysis: Observation. 23 Research Methods, Data Sources, and Data Analysis: Interviews. 24 Overview of the Dissertation. 25 CHAPTER TWO: PART-LOSS 34 Interfacing The Body and The World. 34 A Very Short History of Amputation. 36 A Very Short History of Amputation: Vitalizing Amputation Surgery. 40 Postmodern/Human Malleability. 44 Postmodern/Human Malleability: Re/de/sign and Transformation. 47 Postmodern/Human Malleability: Pathetic Vulnerability. 48 Postmodern/Human Malleability: Cyborgology. 50 Postmodern/Human Malleability: Imagined Corporal Futures. 55 Conclusion. 57 CHAPTER THREE: CONTEXTUALIZING RELATIONS 59 A Ghost Story. 62 Body Consciousness and Fraudulent Bodies. 64 Organizing and Reorganizing Bodies. 68 The Modernization of Dismemberment: They All Must be Mad. 72 The Modernization of Dismemberment: Nice Pictures and the New Visual Culture. 74 The Modernization of Dismemberment: The Militarization of Prosthetics and Techno-Induced Liberation. 76 Phantom-Prosthetic Relations. 84 CHAPTER FOUR: CHARACTERIZING PHANTOMS 90 Shape-Shifting. 90 The Phantom Complex. 93 The Qualitative Peculiarities of Phantoms: Substantive Variation. 98 The Qualitative Peculiarities of Phantoms: Recounting Phantom Quality. 100 vii The Qualitative Peculiarities of Phantoms: From Phantom Pleasure to Phantom Pain. 106 The Qualitative Peculiarities of Phantoms: Phantom Pain. 107 The Qualitative Peculiarities of Phantoms: Treating Phantom Pain. 116 The Temporal Peculiarities of Phantoms: Phantoms in Time. 121 The Morphologic Peculiarities of Phantoms: Limb Facsimiles. 125 The Morphologic Peculiarities of Phantoms: Distorted/ing Phantoms. 129 The Morphologic Peculiarities of Phantoms: A Nest of Hands in Her Bed. 133 The Morphologic Peculiarities of Phantoms: Phantom Telescoping. 136 The Kinesthetic Peculiarities of Phantoms: Phantom Movement. 141 The Kinesthetic Peculiarities of Phantoms: Object Relations. 144 The Kinesthetic Peculiarities of Phantoms: Phantom Potentiality. 147 Conclusion. 148 CHAPTER FIVE: CONTESTED TERRITORY 150 Etiological Tumult. 151 Psychological Approaches: The Body Scheme. 153 Psychological Approaches: The Body Scheme as Psychological Organ. 157 Psychological Approaches: The Body Scheme, the Gestalt, and Denial. 164 Psychological Approaches: The Two Faces of Denial. 170 Psychological Approaches: The Central Representation or Engram. 176 Phantoms in the Brain: Denying Denial. 180 Phantoms in the Brain: Chasing the Phantom. 185 Phantoms in the Brain: The Decade of the Brain. 188 Phantoms in the Brain: The Exceedingly Minute Man. 190 Phantoms in the Brain: Timothy Pons and His Implicated Actors. 197 Phantoms in the Brain: Referred Sensations or Mislocation Phenomenon. 200 Phantoms in the Brain: Cortical Plasticity. 206 Phantoms in the Brain: We a Smarter Than Our Brain. 210 Phantoms in the Brain: The Functional Significance of Phantom and The Plasticity of Plasticity. 213 CHAPTER SIX: PHANTOM-PROSTHETIC REALTIONS 220 Phantom- Prosthetic Relations: Vitalizing Prostheses. 222 Phantom- Prosthetic Relations: Phantomization and Prosthetization. 225 The Prosthetization of Phantoms. Pain Prevention. 227 The Prosthetization of Phantoms: Phantom Disappearance. 231 Cortical Reorganization and Phantom Potentiality. 234 Cortical Reorganization and Phantom Potentiality: Phantom Extinction. 236 Conclusion. 238 CHAPTER SEVEN: CONCLUSION 240 The Biomedicalization of Phantoms: Poor Copies. 241 Techno-Corporeal Coupling: Authenticity. 243 Corporeal Futures: Facsimiles and Other Representations. 244 Future Directions. 246 viii ENDNOTES 249 WORKS CITED 254 APPENDICES Appendix A: Situational Map of Phantom-Prosthetic Relations 298 Appendix B: Medical Literature Coding Scheme 299 Appendix C: Phantom Parts 300 Appendix D: Map of Respondents 302 Appendix E: General Interview Protocol 303 Appendix F: Interview Protocol for Dr. Edward Taub 304 Appendix G: Phantom Populations 307 Appendix H: Phantom Quality 310 Appendix I: Phantom Pain Prevalence 314 Appendix J: Treating Phantom Limb Pain 317 Appendix K: Phantoms in Time 321 Appendix L: Phantom Prevalence 323 Appendix M: Phantom Posture 325 Appendix N: Phantom Telescoping 326 Appendix O: Using Phantoms 327 Appendix P: Phantom Nosology 328 Appendix Q: Phantom Breast Prevalence 330 Appendix R: Predicting Phantom Limb Pain 331 Appendix S: Provoking Phantom Limb 334 LIBRARY RELEASE 336 ix LIST OF TABLES Table 1: Principles of Cortical Reorganization. 209 x LIST OF FIGURES Figure 1. Photo of Sarah Reinertsen at the 2005 annual Amputee Coalition of America Conference. 2 Figure 2: The Distorted Phantom. 99 Figure 3: Sherman’s Typology. 104 Figure 4: Phantom Limb Pain Treatment Attempts.