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Phantom Pain
David Lott

Whenever a major natural disaster strikes, media outlets inundate us with pictures and stories that pull viewers this way and that, from desperation and hopelessness to inspiration and hope. One of the most disturbing reports I have heard in the wake of the devastating earthquake in Haiti detailed the extraordinary numbers of amputations that doctors are performing on victims whose limbs have been crushed. Such operations are not unusual under such circumstances, but the reporter explained how Haiti’s poverty-stricken society, with few treatment options at its disposal, has a pattern of neglecting and marginalizing amputees. As the country struggles to recover and rebuild, it also will have to grapple with rethinking of itself as an “amputee society” and using its already stretched resources on the amputees’ behalf.

One despairs all the more over Haiti’s plight when even a country as resource rich as the United States struggles with its own growing amputee population—mostly from wounded soldiers returning from Iraq and Afghanistan. The numbers of US military amputees escalate during wartime, especially so during our recent wars as medical science and battlefield rescue operations have advanced in sophistication, saving the lives of men and women who in earlier conflicts might have died from their grievous wounds. Most American military personnel can at least hope to return to their former lives even though their jobs, families, and communities may not all be well equipped to deal with their special needs, both physical and psychic. News reports about these American soldiers usually focus either on the miraculous advances in prosthetic devices or on the scandalous failures of military and medical institutions to deal adequately with their needs.

What receives little attention, however, is the discomfort amputees experience in their missing limbs and the efforts by physicians to deal with it, a phenomenon known as phantom pain. According to New Yorker writer Atul Gawande, “Doctors have often explained such sensations as a matter of inflamed or frayed nerve endings in the stump sending aberrant signals to the brain” (“The Itch,” The New Yorker, 30 June 2008)—that is, the sensation is a disorder of the body’s receptors, whereby one receives sensory data. But Gawande writes that recent research suggests that the problem is likely due more to issues of perception rather than of reception.

Working from this perspective, some doctors are successfully treating amputees with phantom-pain sensation using a mirror box. In this therapy, according to Gawande, patients “put their surviving arm through a hole in the side of a box with a mirror inside, so that, peering through the open top, they... see their arm and its mirror image, as if they had two arms.” Exercising their intact limbs over a period of time, their sense of phantom pain gradually subsides, and they perceive their mirrored missing limbs as if they were shrinking into stumps or even disappearing altogether. In treating this as a problem of perception rather than reception, these doctors acknowledge that what once was considered a physical, neurological issue is something altogether different. Doctors must be trained to help the amputee’s brain incorporate new information—perceptions—into mental pathways that are already well established.

 

Reflecting on how these medical advances might mitigate the horrors of war and natural disaster, I wonder if a parallel to the phantom-pain phenomenon has emerged in our society since Barack Obama’s inauguration last year. For what seems like an eternity, we have been hearing—and feeling—the outrage and pain that our fellow Americans are experiencing over a host of issues. And nearly everyone who speaks of this pain and outrage feels compelled to remind us that these feelings “are real.”

From my home in the Capitol Hill neighborhood of Washington, DC, I don’t have to go far to see several different sides of this situation. For instance, if I walk just twelve blocks due west, I find myself at the entrance to the US Capitol, where in recent months I more often than not have seen groups of protestors gathered to express their opposition to health-care reform. They carry signs bearing slogans such as, “I want my country back!” These placards don’t explain where their bearers think “their” country has gone or who has taken it away. But somehow, in the few short months since Barack Obama’s election and inauguration, they seem to have experienced a loss that they perceive as being as traumatic as an amputation.

If I walk less than half that distance north or east, I am in neighborhoods whose residents have felt marginalized and abandoned for not just months but for generations. Joblessness and homelessness are part and parcel of their lives. For many of these folks, health insurance, pensions, and retirement savings are wishful thinking. Violence, diabetes, AIDS, and other plagues have left some of them amputees as well, or all too well acquainted with the losses of early death. Obama’s election was the first time many of them really understood the United States as “their” country too, but the hope it beckoned for them is still far from a full reality, and the pain of their lives remains palpable.

Anyone who hasn’t felt at least frustration, if not outright anger, over the bank bailout, the health-care debate, and other contentious issues of the past year, hasn’t been paying attention. The despair and anger of the precarious middle class over losses of job, home, health insurance, or pension is as “real” as the financial losses caused by the economic recession. But the rage many express is not simply about their straitened economic condition, but about a perceived loss of status, privilege, and cultural standing. Some blame advocates for the impoverished and dispossessed, and often even these very persons who are wrestling with their own losses, losses that are generational and chronic and linked to race, class, immigration status, and other marginalizing factors. Thus, we hear sniping about “elites” and assertions that “health care is a privilege, not a right.” People complain about the undeserving instead of caring for the underserved. Indeed, it appears that the newly dispossessed middle class is experiencing a good deal of phantom pain amidst these other hurts and grievances.

 

To speak of our current populist unrest in terms of phantom pain is not to dismiss it as unreal but, rather, to take it seriously. When pain is attached to the concrete loss of houses, savings, and jobs, we can at least hope they will be restored at some point in the future. But when our losses are inchoate—an ache or a sensation of something no longer there that makes itself apparent in ways that refuse succor—then we are more apt to respond with rage and confusion, and our first instinct may be to seek relief from these sensations by demanding treatment of the “receptors”—those places where the institutions of government and civil society most directly touch us.

Often those who pledge to relieve our suffering eagerly acknowledge the “realness” of our pain but propose to assuage those bruised nerve endings with packages of tax cuts and entitlement benefits. They simultaneously promise both more personal rights and greater restrictions on those who threaten our privileges and security, promises that are mostly incoherent political pandering.

While these programmatic fixes may address a policy issue, treating our deeper suffering as a problem of reception usually only provides very temporary relief for our society’s phantom pain, leaving sufferers dissatisfied in the long run. The need for respite always increases, and usually it is beyond our capacity to alleviate.

Perhaps we should look instead to the example of the neuroscientists who have devised the new treatment of phantom pain in amputees. Even as we try to help people with their material needs, it is essential in a democracy to address the deeper despair. For that we will have to change perceptions, letting go of what is no longer and never will be by holding a mirror up to our society and helping one another focus on what is and continues to be. In gazing steadily on what we still have, we can place our losses in new perspective and gain hope for a less painful future. The mirrors that can help provide the healing we seek already exist among us—they are in the words and actions of our best-respected elders and the brightest of our young as well as the most thoughtful of our politicians and pundits and preachers and professors. Likewise, artists, poets, novelists, musicians, and other performers have always helped us to perceive our lives anew.

And, yes, we even have a mirror in the rubble of Haiti, where the suffering is so great that to hold it up as a reflection on our own losses is to provide a perspective that dims the ache which seems so magnified when viewed in isolation. If we will listen, we may hear our own cries amplified in the voices of the amputees who experience the phantom pain created by disasters both natural and social. The parents cut off from their children, the children severed from families, the countless and unnamed dead buried in mass graves­—the ghosts and the living who cry out from Haiti are not expressing simply phantom pain, but a howling agony that has risen from that island nation for generations and is only now, in the face of cruel and unimaginable suffering, reaching our ears.

Our healing as a society, the alleviation of our phantom pain will likely come only when we refuse to settle for the placebos of political posturing and instead dare to gaze upon these mirrors and move the limbs we still possess, even when to do so is excruciating. The results may not come as rapidly or as completely as what the amputees’ doctors are achieving for their patients. But surely working to transform our patterns of perception holds more promise than the endless cycles of disappointment that come from scratching our itching receptors.

 

David Lott is a religious book editor and a graduate of St. Olaf College and Luther Seminary. He lives in Washington, DC, where he does freelance editing and writing.

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