Vestibular caloric stimulation as a treatment for phantom limb pain and somatoparaphrenia

[frameacloud]

Trigger warnings: Medical practices, physical health problems, mental health problems, paralysis, stroke, amputation, brains, and weird health treatments. In the comments on this post, there's some discussion about gender dysphoria (transgender issues) and private body parts.

Summary: If a person's idea of their body doesn't match how their body is shaped, putting water in their ear can temporarily change that.

A person’s inner ear (and other parts of the vestibular system) gives them their sense of balance and sense of their body’s position and movement. It also has something to do with a person’s sense of the shape of their body (body schema). If you put water in a person’s ear, it can temporarily change their senses of balance, position, and body schema. (Different things happen if the water is warm or cold, or which ear it's put into.) This practice is called vestibular caloric stimulation. It’s useful because it sometimes helps treat people who have problems with those senses. It can also show things about the relationship between the inner ear and the body schema in the brain.

For some people, their body schema doesn’t match their physical body. Either the person has a body part and feels like it isn’t theirs (somatoparaphrenia), or they’re missing a body part and feel like it’s still there (a phantom limb). People have to learn more about the body schema in order to treat these. Likewise, studying these will help people learn about the body schema. Treatment of these can involve trying to repair the person’s body schema. One of the ways to do that is by showing the person a type of optical illusion, called “mirror box therapy,” but that’s another story. You can also temporarily treat both of these conditions by means of vestibular caloric stimulation. That is to say, these are problems that can be helped by putting water in a person’s ear.

Sometimes people who have had a stroke or become paralyzed on one side end up feeling like one of their body parts isn’t theirs. The sufferer develops far-fetched beliefs about how the body part got there. (It’s called a somatoparaphrenic delusion.) Since there isn’t necessarily anything wrong with the body part itself, doctors try to repair the person’s body schema. A 1991 study showed that putting water in the sufferer’s ear can temporarily change their body schema, so that they feel like the body part is theirs again.

People who have lost a body part (amputees) sometimes feel like the missing body part is still there. Even if the person knows nothing is there, the “phantom limb” can feel very real. Phantom limbs happen because the person’s brain still has that body part in its body schema. The brain gets confused about why it isn’t getting sensory messages from the limb anymore, so it makes things up to fill in the blank. Sometimes a phantom limb even feels like it hurts. You can’t just use pain killer on a body part that isn’t there.

A study published in 2001 found that vestibular caloric stimulation can do things to phantom limbs. When the researchers put water in the ears of amputees who never felt phantom limbs, it made the amputees temporarily feel phantom limbs. When the researchers put water in the ears of amputees who had suffered phantom limb pain, the phantom limbs stayed there, but they stopped hurting.

I heard about these discoveries in recent post in a non-academic blog (io9), but when I read the sources, it turns out that these aren’t very recent discoveries. Please note, I’m not a neurologist or any kind of doctor. I’m an interested layperson. I can’t guarantee that I got the facts right. If you're curious about this stuff, you should talk to a professional who has studied it in particular. I’m including this article in Otherkin News because therianthropes and otherkin often report that they have, so to speak, a body schema that doesn’t match their physical body. Any information and discoveries about the formation of the body schema in the brain could lead toward helping them understand why theirs might be that way.

- O. Scribner

Sources

Esther Inglis-Arkell, “The weird way to eliminate—or evoke—phantom limbs.” 2013-01-20. io9. http://io9.com/5976618/the-weird-way-to-eliminateor-evokephantom-limbs

Edoardo Bisiach, Maria Luisa Rusconi, and Giuseppe Vallar, “Remission of somatoparaphrenic delusion through vestibular stimulation.” Neuropsychologia 29: 10 (1991), pp. 1029–1031. http://www.sciencedirect.com/science/article/pii/002839329190066H

J. M. André, et al., “Temporary Phantom Limbs Evoked by Vestibular Caloric Stimulation in Amputees.” Neuropsychiatry, Neuropsychology, & Behavioral Neurology 14:3 (2001), pp. 190-196. http://journals.lww.com/cogbehavneurol/Abstract/2001/07000/Temporary_Phantom_Limbs_Evoked_by_Vestibular.8.aspx

Comments

[slinkslowdown.livejournal.com]

Huh, interesting... I wonder if this and its associated research could be used to help with gender dysphoria in trans* people.

[frameacloud]

I was wondering that, too. The articles I looked at didn't talk about it in relation with transgender people, and I didn't look for any that did.

Gender dysphoria does sometimes include phantom sensations of body parts that the person feels should be there, as well as a sense of disassociation from having certain body parts. It's definitely a fruitful area of research for people trying to find out about how the brain gets its information about its body and forms a body schema. There are some studies on phantom limbs that show that a transgender person has a different body schema from a cisgender person. Here's a non-academic source that summarizes some studies of that kind: http://news.softpedia.com/news/The-Phantom-Penis-Is-in-the-Brain-69534.shtml

I just hope psychoanalysts won't start insisting that transgender people put water in their ears instead of letting them get whatever gender-confirming surgeries that they want. 9_9 It wouldn't be much sillier than a lot of other things that psychoanalysts have said and done to trans people.

[slinkslowdown.livejournal.com]

Eugh, of course I had too much faith to think of that. @_@

I get my ears flushed out at the doctor a few times/year, and from now on this'll be in the back of my head, wondering if just for that short time, my tits won't bother me, heh.

[frameacloud]

Take note of what happens, for science! ^_^

Gender dysphoria feels worse at some times than others, anyway, so it might be informative to pay attention to when it feels less/more, and try to figure out what influences might be involved in making it feel that way. The upside to that experiment is that it would be pretty cool to find a quick fix for getting temporary relief from gender dysphoria. The downside is that a person would have to consider some pretty strange things as possible influences on their dysphoria, if even having water in your ear might be one. No way would I have ever guessed that having water in one's ear might be a possible influence on that! o_O The times I've had water in my ear, all I remember thinking about the experience was, "Those are the nastiest cartilage noises ever, ugh."

[slinkslowdown.livejournal.com]

For me, the worst trigger/cause for my gender dysphoria was menstruation and the hormone surge[s] leading up to it. Before I started T in January, I was on the pill and took it without the placebo days so I didn't bleed, it helped a lot. Now the female hormones just aren't an issue and I feel even better.

[arkofeden.livejournal.com]

I also was worried that this was the start of some trend suggesting that TG/GID/body dysphoria could have a silver-bullet science cure. (Then again, there was a similar concern back when people were talking about genetically curing homosexuality once they isolated genes for that as well...) I'd hope that they'd realize that the schema/body-sense is just one aspect of a complete gender identity.

My group is now very curious about watering our ears. Strange that there's no particular technique to it, just "put water in them"...:/

--R.

[frameacloud]

There probably is a more elaborate technique to it than just "put water in them." I just haven't seen a description of it that goes into detail so far. I haven't looked into it very much, though.

A few hours after I wrote the above comments, where I was wondering about whether vestibular caloric stimulation might someday be explored as a treatment for gender dysphoria... I realized why it probably won't be! I'm guessing here, but I'm getting the impression that vestibular caloric stimulation helps people who have a problem that has to do with the symmetry of their body or their body schema. Either they're missing an arm, or they feel like it's not there, that kind of thing. They're asymmetrical, their left side doesn't match their right. Putting water in one ear might help them feel symmetrical again. If that's the case, then vestibular caloric stimulation wouldn't influence people with gender dysphoria, because their body schema is symmetrical. As in, I've never heard of a transgender person who, say, felt like they should have a breast on the left and not on the right. Asymmetry is not where their sense of mismatch comes from. So, if I understand what it's about, then vestibular caloric stimulation wouldn't help treat gender dysphoria. Just the same as how mirror box therapy doesn't help gender dysphoria. Mirror box therapy helps people who have a phantom arm or leg, but I've never heard of a version of it for treating gender dysphoria, and it doesn't sound like it could be modified to treat it, since mirror box therapy is about providing a temporary illusion of symmetry between a person's left and right sides.

[frameacloud]

I'm looking around to see if anybody has written about this yet. I did find that VS Ramachandran, who kind of specializes in studies on phantom limbs and on people who are transgender, published an article where he hypothesized that vestibular caloric stimulation (putting water in the ear) might help treat "Apotemnophilia, or body integrity image disorder (BIID)," sufferers of which want to have a certain part of their body removed, because although it's healthy, it doesn't feel to them as if it's theirs, and isn't part of their body schema. But he only hypothesized it. In 2007. Apparently nobody's done a study on it yet.

Doesn't look like anybody's researched vestibular caloric stimulation as treatment for gender dysphoria! Wow! I'm not finding anything about it in the academic databases. A search for "vestibular caloric stimulation" "gender dysphoria" just brings up other articles citing that one Ramachandran article, and some things on BIID that just had a brief mention of gender dysphoria.