The prevalent explanations in Ponty’s time for the phenomenon of phantom limbs relied on empiricism and intellectualism (rationalism) for a conception of the body. These fields explained the body in a mechanistic sense, as “an assemblage of parts whose relations to external objects and to each other involve efficient or mechanical causality” (423). But during Ponty’s lifetime physiologists began to approach the conception of the body in a different way. They began to understand the lack of one-to-one correspondences between stimuli and reflexes which forced them to rethink the body and its relation to the world. At this point Ponty steps in with a novel idea: the body must be conceived of as a comprehensive living body which apprehends stimuli in more than just a point-to-point way, and which is to be understood in terms of a complex of projects through which it views the world. He says, “I cannot understand the function of the living body except by enacting it myself, and except in so far as I am a body which rises toward the world” (428).
Ponty then goes on to discuss more specifically why physiology alone, or why psychology alone cannot account for the phenomenon of phantom limbs. Rather Ponty attempts to understand how each complements the other; the body the mind and the mind the body.
He begins with the example of a man who has lost his leg. Stimulus is applied to, instead of the leg, the path between the stump and the man’s brain. It is then realized that the man will experience, once again, the feeling of his leg. Why is this? Ponty begins with the physiological, mechanistic approach, but soon reveals its shortcomings.
“What has modern physiology to say about this [phenomenon]? Anesthesia with cocaine does not do away with the phantom limb, and there are cases of phantom limbs without amputation as a result of brain injury. Finally, the imaginary limb is often found to retain the position in which the real arm was at the moment of injury” (428). This leads Ponty to the conclusion that physiology alone cannot account for this phenomenon; the psychic realm must also play a role.
He believes the phenomenon of phantom limb can be understood more completely if we are able to understand a similar phenomenon, that of anosognosia. Anosognosia is the phenomenon that occurs when a patient retains a limb, but refuses to acknowledge its presence. Ponty explains these patients “who systematically ignore their paralyzed right hand, and hold out their left hand when asked for their right, refer to their paralyzed arm as ‘a long, cold snake’, which rules out any hypothesis of anesthesia and suggests one in terms of the refusal to recognize the deficiency” (428). This phenomenon clearly demands a psychological explanation. But is a psychological explanation enough to account for phantom limbs? Ponty doesn’t think so: “…no psychological explanation can overlook the fact that the severance of the nerves abolished the phantom limb. What has to be understood, then, is how the psychic determining factors and the physiological conditions gear into each other.”
But this phenomenon cannot be understood simply as a combination of the psychic and the physical forces. It must be understood in terms of the person, as the living body rising toward the world with its various projects in mind as it does so; it must be understood as the relationship between the subjective person and the objective world.
Ponty then applies this view of the subject/object to the physiological and psychological explanations, pointing out their essential shortcomings. Along the way he begins to borrow an idea from psychoanalysis, the idea of repression. A purely physiological explanation of anosognosia and the phantom limb could be conceived of as the repression of what Ponty calls “interoceptive” stimulations. According to this idea, anosognosia would be the “absence of a fragment of representation which ought to be given, since the corresponding limb is there; the phantom limb is the presence of the part of the representation of the body which should not be given, since the corresponding limb is not there” (430). But this makes no sense, if a part does not exist it should not be represented, and vice versa. But the psychological account doesn’t do much better.
In the psychological account, the phantom limb is viewed as a memory or a perception, while anosognosia is forgetfulness or a negative perception. In this case the phantom limb is viewed as an actual positive perception of an entity which does not exist, while anosognosia is thought of as the absence of an actual presence, which, again, makes little sense.
Ponty resolves these issues by realizing that in both cases we are relying on the outside world and its inherent characteristics, which is problematic. He says, “In both cases we are imprisoned in the categories of the objective world, in which there is no middle term between presence and absence. In reality the anosognosic is not simply ignorant of the existence of his paralyzed limb: he can evade his deficiency only because he knows…what he does not want to face, otherwise he would not have been able to avoid it successfully” (430).
This is a critical point Ponty is trying to make. Just as in the psychoanalytic tradition, the patient can only be aware of and act on the basis of what he or she knows. In the case of the phantom limb patient and the anosognosic, each is aware of the deficiency and is attempting to make up for it on what could be considered the subconscious level. The anosognosic denies knowledge of the paralyzed limb in order not to feel the pain of the handicap, while the phantom limb patient demands that his exists for the same reason, so as not to be rendered handicapped.
This is what Ponty means when he says, “The phantom arm is not the representation of the arm, but the ambivalent presence of the arm” (430-431). There is no deliberate decision made by the patient to deny existence or assert existence (depending on the case), but it comes from something deeper. Ponty says that it finds its genesis elsewhere, not in the patient declaring: “I think that…”, but it needs-to-be for the patient.
This idea hinges on the aforementioned projective outlook of the living-body toward the world. The living-body views the world in terms of projects it wishes to accomplish, and to do this the body becomes unperceived as it learns to perform certain skills. The body, in this sense, is comprised of two layers: the habitual and the present. The habitual is that which we have learned to do and can do without thinking (turning a doorknob or tying a shoe). These skills are put at the disposal of the present body, and because one does not have to think about them, to bring them into the present body, they do not intrude upon the present body. When, as a young child, one learns to turn a doorknob, this becomes part of the habitual body and can be utilized by the present body.
The problem approaches when something interrupts this transmission from habitual body to present body, i.e. a disfigurement or a handicap. In this case, an amputated arm for example, the present body can no longer rely on the habitual. The tying-of-the-shoes becomes impossible, as well as the opening-of-the-door. This causes great pain for the patient and may result in the phenomenon of phantom limb or anosognosia, as a way for the patient to continue it his or her existence. The patient never really deals with the situation, but covers it up somewhat; thus the analogy to psychoanalytic repression.
So here we can come to understand that a merely physical or psychological explanation of the phenomenon of phantom limbs or anosognosia are lacking. The patient must be viewed as occupying a middle ground between the two. He builds a self through his past and relies on it in the present and in toward a future horizon. When this reliance is disturbed through a handicap, the patient must act (or not act) in someway so that he may continue in his existence. Often this results in a repression of the malady so that the patient believes he will continue on his same path, relying on his past and directing his living-body toward the future.
Mooney, Timothy & Moran Dermot, eds. The Phenomenology Reader. Routledge Publishing, London and New York. 2004. (Reprint of The Body as Object and Mechanistic Pysiology)