Science: Drawing on real experience

When Geoff Norcott had his right arm amputated following a motorbike accident 34 years ago, he had a vivid experience that the arm was still there. Immediately after the operation, the missing limb would float through the air, even through bedclothes, and could be felt by his left hand in dreams. Over the years, the sensation has diminished so that now Norcott - a safety inspector with the London Borough of Merton - feels only the presence of a thumb, and that is up at his shoulder stump. Only when he is wearing his false arm does the thumb revert to its rightful location and a phantom arm "fills" the prosthesis.

The phantom limb is a well-known but puzzling phenomenon in medical science. The vast majority of amputees feel a presence of this kind, but scientific investigation has been hampered by the subjective nature of the experience. Now, a unique art/science collaboration has produced the first visual images of what amputees feel.

Artist Alexa Wright worked with Dr John Kew, a consultant neurologist based in Birmingham and Shropshire, and Dr Peter Halligan, a neuropsychologist at the Department of Clinical Neurology at Oxford University, first photo-graphing her subjects, then interviewing them and finally, still in consultation with her subjects, digitally ma- nipulating their image.

The pictures that emerged accorded with the subjects' views of themselves. "As a 53-year-old with a beer belly, I don't enjoy looking at pictures of myself anyway," says Norcott. "But the images did portray my injury."

The benefits of such multi-disciplinary investigation are increasingly being appreciated. It not only assists patients, but also offers new scientific insights, believe Dr Halligan and Dr Kew. "Far from being just a medical curiosity, phantom limbs may provide neuroscientists with one of the best markers of brain reorganisation."

The project is one of six awarded a total of pounds 90,000 by the Wellcome Trust's first Sci-Art Initiative, which aims to bring the techniques of science and art closer together. Six teams of artists and scientists were selected from more than 200 submissions and began work on their projects in May. Like conventional researchers, they presented their results at a conference in September.

The designer Helen Storey and her sister Kate, a developmental biologist, who devised a fashion collection based on stages in human embryo development, garnered most coverage at the time. The Storeys' designs were unquestionably spectacular, and may have succeeded in their objective of explaining something about embryology to people who would not otherwise be exposed to the subject. But they will not inform science itself.

Three of the winning proposals,however, do have the potential to do this. By chance, they share a theme, focusing on departures from what society considers normal appearance and on the subject's and society's perceptions of physical abnormality.

In addition to the phantom limb study, the other two projects that used the human body as their starting point explored perceptions of anorexia, and examined "desirable" outcomes in cleft lip and palate surgery.

Some of the resulting images of these three investigations are as striking, if not as shocking, as work seen recently at the Royal Academy's "Sensation" exhibition of Charles Saatchi's collection of contemporary British art, much of which also focuses on ideas about the human body. Similarly, gallery exhibitions planned for the Wellcome projects intend to challenge public attitudes toward appearance.

In return, says Ken Arnold, manager of the Wellcome Trust's exhibitions unit, "art has enabled science to deal with patients in different ways, allowing them to describe feelings and wishes that aren't always brought out in medical interviews." Dr Halligan and Dr Kew devised questions for Wright to ask interviewees that would enable them to say what they felt in totally subjective terms. "The questions gave me an introduction and gave them a sense that the project was rationally based," Wright explains. "The people were happy to talk to me as just another person where they might not have been so happy to talk to a medic."

Medical science has tended to deal only with the externals and to assume that it knows best. "There has been very little visualisation from the subject, the person actually perceiving the phantom limb," says Dr Halligan. "Often medics would describe the phenomenon on behalf of the patient, but were not interested in documenting its type or transience." Issues such as whether amputees felt they could "see" as well as "feel" a phantom limb and whether they felt it "belonged" to them, or was at body temperature, had never been touched.

In some cases, Wright discovered, the phantom fills the volume formerly occupied by the lost limb, even to the extent of amputees making allowance for its "presence" when passing through doorways. Where a subject uses a prosthetic limb, the phantom limb often "inhabits" the prosthesis. In other cases , they fill part of the space they used to, but are only hazily imagined in places, where feeling is "numb" or imagined appearance "blurred".

The fading does not necessarily occur towards the extremes. Wright's image of a man who lost his right arm above the elbow shows an eerily detached phantom hand positioned where the man's hand would naturally be, at the end of the missing arm that joined it to the body. In another remarkable case, a woman had lost her left hand in a car accident. The hand was reattached surgically, but following secondary infection had to be amputated, together with the lower part of the forearm. Under normal circumstances, the phantom hand was imagined as a sort of flat paddle. Greater concentration on the subject's part produced a more three-dimensional but grotesquely distorted hand, although still wearing its wedding ring.

Wright photographed her subjects with a digital camera, and then downloaded the images on to a computer. Images of phantom limbs were first generated by reversing an image of the surviving limb. Feelings of transparency, telescoping and distortion were represented digitally in consultation with subjects' descriptions. The final images will appear both as artistic exhibits and in scientific papers. "The illustrations are the same, but the contexts are different. In the gallery, they become more challenging to us," says Dr Kew.

But it is in its potential to advance scientific knowledge that the artistic collaboration could really pay off. Wright's anecdotal evidence has confirmed recent research establishing that the brain holds a "map" of the body, and that when a body part is lost, the brain experiences its residual presence from that map rather than from nerves at the limb stump. The information gained from the artist's interviews may also prove valuable in the psychological preparation of patients about to undergo amputation surgery.

Another of the winning proposals has also been shown to help in medical treatment. Cleft lip and palate deformity is a relatively common congenital anomaly that affects one in 600 babies. Surgical operations are usually performed in infancy and, as needed, into young adulthood. Surgeons are able to gauge the effectiveness of their work by assessing hearing and speech development and by measuring facial bone growth. However, they have no handle on what, for many patients, is a crucial measure - the degree of approximation to "normal" facial appearance. The psychological outcome of treatment for cleft lip and palate patients is seldom investigated, according to research published this year in The British Journal of Plastic Surgery.

Working with Stephen Farthing, Master of Drawing at the Ruskin School of Drawing and Fine Art at Oxford University, Dr Anthony Rowsell, a consultant plastic surgeon at Guy's and St Thomas's Hospital Trust came to learn that cleft lip and palate patients hold very clear ideas of what they feel is their correct "look". At the Ruskin School, digitised video stills of the face are man- ipulated by the patient under Farthing's guidance to get to this look. The process typically takes an hour. "In the past, a surgeon has said, 'is this what you want?' But that is very hard to verbalise. With imaging, a patient can prescribe their desired appearance - which is not necessarily what the surgeon would have set out to achieve. Patients' perceptions of how they want to look is sometimes very different from mine. This is the first time the patients have been in control. They are entirely realistic: they ask for what can be achieved anatomically." While surgeons tend to focus on the major problem of the lip, patients are more concerned to get the comparatively minor associated distortion of their noses corrected - something that is easy to do but seldom addressed.

The procedure has proved so successful that Guy's Hospital proposes to set up a video conference link with the Ruskin School. "If you can achieve what the patient wants in one operation instead of three, it's well worth the effort," says Dr Rowsell. There is the promise of reduced costs as well as greater patient satisfaction.

Sculptor and photographer Shelley Wilson has used both her media to portray body shapes on either side of "the perfect body". Professor Arthur Crisp, a retired psychiatrist from Atkinson Morley's Hospital, London, has promoted ideas about the psychopathology of anorexia nervosa based on evidence that it is triggered by pubertal milestones, and acts to reverse pubertal processes. Wilson has attempted to communicate Professor Crisp's ideas to the large numbers of 16- to 18-year-olds affected by this potentially life-threatening condition.

She models clay figures based on accurate measurements of sitters' body dimensions. The soft clay sculpture is then manipulated in various ways - rotated, scanned and sliced - to generate new surfaces which are photographed. The sculptures represent a subject's objective externals; the photographs aim to represent in composite form these people's subjective experience.

In the final exhibit, two sets of these photographs - one a composite of a number of anorectics, the other of normal subjects - are arranged in respective rows. They are regarded by a clay figure of a 17-year-old girl who has already lost perhaps a stone in weight and now stands at the mental crossroads, "choosing" between returning to a diet in which she will gain weight normally or taking the downward path into anorexia. "Control is the key," says Wilson. "They want to be in control of their development, but are becoming imprisoned in themselves. That's what I'm hoping to convey."

Professor Crisp believes the artist's work may be a new way to reach patients with a condition notoriously difficult to confront. "The anorectic perceives her destiny in terms of the body. My team has tried to understand what drives the syndrome and communicate that back to patients to help them understand themselves. Sculpture is a concrete way of expressing the dilemma. It's important for the whole canvas of schoolgirls who can imagine themselves at this crossroads."

The Wellcome Trust is now accepting entries for the second round of Sci-Art partnerships. For details contact the Trust on 0171 611 8888. Alexa Wright's work will be shown at the Impressions Gallery, York, in February and at the Ruskin School, Oxford, in April. Shelley Wilson's work will be shown in London at the Annual Conference of the Royal College of Psychiatrists in January and at Danielle Arnaud Contemporary Fine Art in March.