Conscious Entities

It often happens that when someone has had a limb amputated, they experience feelings in the limb they haven’t got any more – the ‘phantom limb’ phenomenon. The phantoms may be just temporary, a curious by-product of the operation. Sometimes the feelings are partial – where an arm has been removed, for example, patients may feel as though they still had their hand, but attached to the shoulder without any intervening arm. Sometimes the experience is more of a problem, with feelings of intense pain in the amputated part which won’t go away and can’t be treated by normal means.

I therefore winced slightly on learning that as well as phantom limbs, there are phantom penises, experienced by those who have undergone a penectomy (a word which is well worthy of a wince in itself). V.S.Ramachandran, who devised an ingenious way of using mirrors to help people with phantom limb pain, by fooling the brain into briefly believing that the missing limb was back, has now turned his attention to penises, together with P.D. McGeoch. This time the research is not about pain relief, however, but gender identity, where the possession or lack of a penis is clearly highly relevant.
Penectomies, it seems, are performed for two main reasons; to eliminate a malignant cancer, or as part of gender reassignment treatment. Since male-to-female transsexuals typically feel themselves to be ‘a woman in a man’s body’, Ramachandran and McGeoch reasoned that their response to penectomy might well be different from that of other patients. And so it proved: while 58% of men who have undergone penectomy for other reasons reported sensation in a phantom penis afterwards, only 30% of those who had done so as part of gender reassignment had a similar experience. So people who felt that a penis was not part of their true body image were much less likely to experience a phantom penis after removal.

Stranger still, perhaps, 62% of a group of female-to-male transsexuals reported having had phantom penis sensations before any surgery. In many cases the sensations dated back for years: in others, they did not occur until hormone treatment had begun. No non-transsexual women, unsurprisingly, reported the sensation of having a phantom penis (‘even when prompted’ as the researchers say).
Ramachandran and McGeoch conclude that the study backs the view that gender identity feelings are hard-wired into the brain, and in transsexuals may be at odds with actual physical shape. They recognise, however, that there are some potential criticisms of the way the research was done.

One weak point is the risk of confabulation. By asking female-to-male transsexuals whether they had ever had phantom penis sensations, were the researchers discovering a phenomenon, or creating one? Transsexuals often have to struggle for the acceptance of their view of themselves; they have a natural reason to want to assert anything that might strengthen their case. The experience of a phantom penis would clearly be a useful piece of evidence in this context. Since female-to-male transsexuals by definition feel that they ought to have a penis, it may not be much of a leap to say they feel as though they have one, once the possibility is suggested.

To some extent, moreover, male-to-female transsexuals might have been inclined to feel that any report of phantom sensations was letting the side down in some subtle way; suggesting that they or their bodies somehow couldn’t give up the idea of having a penis very readily. Indeed, an old Freudian theory which the researchers pour scorn on, had it that the symptoms of phantom limbs expressed an unconscious desire that the limb was still there, so reasoning along those lines is by no means impossible.

However, the researchers have a number of counterarguments. Perhaps the most striking is that female-to-male transsexuals were often able to report details of the phantom penis and its behaviour, saying that it fell short of their ideal penis, for example. Surely an imagined penis, a wish-fulfilment penis, would be fully satisfactory? Less convincingly, I think, the researchers quote cases where the subjects reported the phantom penis behaving in ways – morning or unprompted erections, for example – which a female subject allegedly would have been unlikely to add to a confabulated account. I suspect the female subjects are likely to have been more aware of this kind of detail than the researchers suppose.

At the end of the day, we seem to have some suggestive evidence, but not a fully convincing case. Ramachandran and McGeoch rightly say that evidence from brain imaging studies would be very useful – notably in establishing whether a pre-operative female-to-male transsexual having a phantom penis experience has similar brain activity to a male having normal penis sensations.