Hand, World and Self

Mark Cahill has just had a hand transplant. His existing hand was so damaged by gout as to be useless, so surgeons amputated it and transplanted a donor’s hand. The team involved are pleased. Not only does the the transplant seem to be a surgical success; it is also a psychological one, because for Mark “It just doesn’t feel like someone else’s hand” (BBC,January 2012).

Transplanting a hand is not only surgically challenging; it is also psychologically risky. The world’s first hand transplant failed. The recipient, Clint Hallam, had it amputated in 2001, saying it felt like “a dead man’s hand”. Clint had lived with his new hand since the operation in 1998 but ended up begging his doctors to remove it, saying he felt “mentally detached” from the hand. He told the BBC that his body and mind had said “enough is enough” (BBC, February 2001).

Clint Hallam with his new hand (copyright BBC)

Clint Hallam with his new hand (© BBC)

In a sense Hallam was right; it was a dead man’s hand. But in another sense it was, at least potentially, his own hand. This odd situation sheds light on the nature of our embodiment. Our bodies are not simply tools that a disembodied Cartesian self uses to carry out its projects in the world. Merleau-Ponty is much closer to the truth when he wrote that “the body is much more than instrument or a means; it is our expression in the world, the visible form of our intentions. Even our most secret affective movements … help shape our perception of things” (Merleau-Ponty, 2007: 285).

No surprise then, that surgeons considering a hand transplant consider the psychological aspects. “The hand has a ‘psychology’ that involves issues of one’s body-image and sense of identity” (Hand Transplantation and Psychiatric Issues). Losing a hand is both physically and psychologically traumatic and can “affect one’s self-image”; adjusting to the loss of a hand entails mourning, coming to terms with a new body-image and a changed sense of self (ibid.).

Two key factors differentiate Mark from Clint. First, Mark’s existing hand was still attached, even though it was useless to him, whilst Clint had lost his in an accident over a decade before the transplant. Had Clint’s adaptation to not having a hand make it harder to accept his new one? Second, Mark has had a lot of counselling “because the biggest thing is afterwards, whether I would accept it as mine” (The Telegraph, January 2012).

As Merleau-Ponty shows “the body gives our general medium of having a world” (Merleau-Ponty, 2007; 169), but furthermore it is through our being-in-the-world that we know ourselves (ibid., 2007: xii). Within that context, we can see that there is something very special about our hands: not only are they highly visible to us, but they are literally how we grasp our world. We touch ourselves and others, reach out, hold and make things happen with our hands. If all this is done with the hand that was for decades part of another person’s life, and they are now dead, how might that feel? How might that impact on your sense of self? Psychologists have found that hand transplant patients sometimes feel a loss of identity and may experience issues with intimacy (Psychological Risks). Psychological impairments can include “social withdrawal, embarrassment, reduced self-esteem, and a depressive coping style” (Kumnig et al.)

I suspect that there is much more we can can learn about embodiment by studying hand transplant patients. Merleau-Ponty described the way that our hands give us a kind of “double sensation”: If I touch my left hand with my right, I both touch and am touched. It seems that we can’t have both sensations at once: I either focus on touching or being touched. When I am more aware of touching, the touched left hand become like an object; conversely, if I focus on the sensation of being touched, the right hand recedes from my awareness (Merleau-Ponty, 1968: 133). How would that experience be for Mark or Clint before he had the “dead hand” removed?

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