Extracts from 'The Disembodied Lady' by Dr Oliver Sachs
What is more important for us, on an elemental level, than the control, the owning, and operation, of our own physical selves? And yet it is so automatic, so familiar, we never give it a thought.
Christina was a strapping young woman of 27, given to hockey and riding, self-assured, robust in body and mind. She had two young children and worked as a computer programmer at home. She was intelligent and cultivated, fond of the ballet, and of the Lakeland poets. She had an active, full life - had scarcely known a day's illness. Somewhat to her surprise, after an attack of abdominal pain, she was found to have gallstones, and removal of the gallbladder was advised.
She was admitted to hospital three days before the operation date, and placed on an antibiotic. This was purely routine, a precaution, no complications of any sort being expected at all. Christina understood this, and being a sensible soul had no great anxieties.
The day before surgery Christina, not usually given to fancies or dreams, had a disturbing dream of a peculiar intensity. She was swaying wildly, in her dream, very unsteady on her feet, could hardly feel the ground beneath her, could hardly feel anything with her hands, found them flailing to and fro, kept dropping whatever she picked up.
She was distressed by this dream. ('I never had one like it,' she said. 'I can't get it out of my mind.') - so distressed that we requested an opinion from the psychiatrist. 'Pre-operative anxiety,' he said. 'Quite natural, we see it all the time.'
But later that day the dream came true. Christina did find herself very unsteady on her feet, with awkward flailing movements, and dropping things from her hands.
The day of surgery Christina was still worse. Standing was impossible - unless she looked down at her feet. She could hold nothing in her hands, and they 'wandered' - unless she kept an eye on them. When she reached out for something, or tried to feed herself, her hands would miss, or overshoot wildly, as if some essential control or coordination was gone.
She could scarcely even sit up - her body 'gave way'. Her face was oddly expressionless and slack, her jaw fell open, even her vocal posture was gone.
'Something awful's happened,' she mouthed, in a ghostly flat voice. 'I can't feel my body. I feel weird - disembodied.'
We did some tests and there seemed to be a very profound, almost total, proprioceptive deficit, going from the tips of her toes to her head. She had no muscle or tendon or joint sense whatever. She had a slight loss of other sensory modalities - light touch, temperature, pain - but it was predominantly position-sense - proprioception - which had sustained the damage.
The sense of the body, I told her, is given by three things: vision, balance organs (the vestibular system in the ear), and proprioception - which she'd lost. Normally all of these work together. If one fails the others can compensate, or substitute - to a degree.
Christina listened closely as I described the situation.
'What I must do then,' she said slowly, 'is use vision, use my eyes, in every situation where I used - what do you call it? - proprioception before. This "proprioception" is like the eyes of the body, the way the body sees itself. And if it goes, as it's gone with me, it's like the body's blind. My body can't "see" itself if it's lost its eyes, right? So I have to watch it - be its eyes.
It is as well that Christine showed such strength of mind from the start, for the damage to her proprioceptive fibres persisted - so that there was no neurological recovery a week, or a year, later. Indeed there has been none in the eight years that have now passed.
That first week Christina did nothing, lay passively, scarcely ate. She was in a state of utter shock, horror and despair. What sort sort of a life would it be with every move made by artifice? What sort of a life, above all, if she felt disembodied?
Then life reasserted itself, as it will, and Christina started to move. She could at first do nothing without using her eyes, and collapse in a helpless heap the moment she closed them. She had, at first, to monitor herself by vision, looking carefully at each part fo her body as it moved, using almost painful conscientiousness and care. Her movements, consciously monitored and regulated, were at first clumsy, artificial, in the highest degree. But then her movements started to appear more delicately modulated, more graceful, more natural (though still wholly dependent on the use of the eyes).
Increasingly now, week by week, the normal, unconscious feedback of proprioception was being replaced by an equally unconscious feedback by vision. Was it possible too, that something more fundamental was happening? That the brain's visual model of the body, or body-image - normally rather feeble (it is, of course, absent in the blind), and normally subsidiary to the proprioceptive body-model - was gaining by way of compensation or substitution, an enhanced, exceptional, extraordinary force?
But these measures were, at best, partial. They made life possible - they did not make it normal. Christina learned to walk, to take public transport, to conduct the usual business of life - but only with the exercise of great vigilance, and strange ways of doing things - ways which might break down if her attention was diverted.
It became possible, finally, for Christina to leave hospital, go home, rejoin her children. She was able to return to her home-computer terminal, which she now learned to operate with extraordinary skill and efficiency, considering that everything had to be done by vision, not feel. She had learned to operate - but how did she feel? Had the substitutions dispersed the disembodied sense she first spoke of?
The answer is - not in the least. She continues to feel, with the continuing loss of proprioception, that her body is dead, not real, not hers. 'I feel my body is blind and deaf to itself... it has no sense of itself'.
Christina has brief, partial, reprieves, when her skin is stimulated. She goes out when she can, she loves open top cars where she can feel the wind on her body and face (superficial sensation, light touch, is onnly slightly impared). 'It's wonderful,' she says. 'I feel the wind on my arms and face, and then I know, faintly, I have arms and a face. It's not the real thing but it's something - it lifts the horrible, dead, veil for a while.'
