Self-Image, Stress and Amputation: Could Conditions Like Cyberpsychosis Exist?

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Many near-future fictional settings feature consequences for replacing too much of your body with machinery.

In Deus Ex: Human Revolution, certain groups claimed that cybernetics somehow took away from the human identity - and that those in favor of augmentation were playing god.  In the Shadowrun RPG, installing cybernetics meant losing part of your "essence" - install too much, and you'd start to dull your emotions and connection to the spirit world... or flat-out die.

The Cyberpunk setting has the most extreme example of all.  Replace too much of yourself and you'll spiral down into "cyberpsychosis" - a dangerous state of dissociation where the affected individual lacks empathy, becomes detached from humanity and often becomes prone to violence.

Advanced prosthetic arm
Modern replacement limbs are limited - but the technology is improving... (Shahabudin Ibragimov)

So what's the reality?  Could cybernetic implants have a damaging effect on a human's mental state in the real world? We'll need to explore some known psychological conditions relating to amputation, transplantation, prothesis and self-image to answer that, so let's take a look at...

  • Phantom Limbs
  • The Body Transfer Illusion (aka the Rubber Hand Illusion)
  • Body Dysmorphic Disorder
  • Psychological Transplant Rejection
  • Body Integrity Identity Disorder (or Body Integrity Dysphoria)
  • Schizophrenia
  • Depersonalization-Derealization Disorder
  • Cotard's Syndrome

Phantom Limbs

You might have heard of the phenomenon of phantom limbs.  It's a problem sometimes found in amputees, whether from an accident, injury or surgery.

The condition isn't limited to pain - sufferers may experience sensations as though the limb is still present, including touch, temperature, itching and even the way it's positioned.  It's also surprisingly common - it's thought that more than 50% (some estimates go up to 85%) of people who lose a limb will experience it to some degree.  The sensations can persist for some time (it's relatively common for victims to feel some pain even a couple of years down the line) but can potentially never fade away.  

It's also not entirely clear why the condition occurs - a common theory is that the brain is misinterpreting fragmented nerve signals from the amputation stump, while trying to map them onto a mental picture of the body pre-amputation.  Fatigue, stress, anxiety and depression, along with infections or further injury to the limb's stump are thought to increase the risk of phantom limb pain developing or getting worse.

Stranger still is the fact that phantom limbs can be treated using mirror therapy.  By positioning a mirror to reflect the patient's remaining limb, one can create an illusion that the patient retains both of their limbs.  By performing actions with their intact limb, patients can make the mirrored missing limb do the same... and this seems to be enough to trick the brain in to thinking everything is all right, allowing some relief to those suffering phantom limb sensations - and has the side benefit of allowing the missing limb to be repositioned, or hand to be unclenched.

Researchers are not entirely clear on how mirror therapy actually works.  However, we know that there are specialized neurons in the human brain that allow us to "feel" what other people are feeling based on what we see them experiencing (for example, if you see someone stand up and hit their head on a shelf, you'd probably wince in sympathy.)  It's been suggested that these "mirror neurons" might be responsible for interpreting the reflected limb in mirror therapy as the real limb.  

It seems fairly clear that "phantom limb" could be a potential consequence of having one's limbs replaced with cybernetics.  The amount of pain experienced varies, but it's been described as everything from pins and needles to burning, stabbing, electrical jolts and worse.  A life of constant pain and sleepless nights would be a stressful one - and might trigger some of the other conditions mentioned below.

Interestingly, some sufferers have reported that their phantom limb symptoms are lessened when wearing a prosthetic!

Three fake hands
A simple model of a hand is enough to trick the brain, sometimes... (David Underland)

The Body Transfer Illusion (or the Rubber Hand Illusion)

On a similar vein to the mirror therapy mentioned above, the human brain can be "tricked" into believing a fake limb is its own.

The procedure's actually quite simple.  Participants put one of their hands inside a box that conceals it from their sight, and a fake rubber hand (with the "stump" covered by a cloth) is placed on the table in front of them, lined up with the participant's shoulder.

Next, a researcher strokes the middle finger of the rubber hand while also stroking the concealed real middle finger of the participant inside the box... and after a couple of minutes, participants start to feel that the fake hand is their own, and that their real hand seemed to disappear.

I'd say that for the most part, the rubber hand illusion actually implies a human could adjust to a cybernetic replacement.  On the other hand, I can't help but wonder if thinking of a prosthetic as being your "real" limb might contribute to conditions like body dysmorphic disorder, depersonalization-derealization disorder or Cotard's syndrome.

Body Dysmorphic Disorder

Those suffering from body dysmorphic disorder find themselves obsessing over aspects of their appearance - often focusing on a perceived flaw that others might not be even be able to detect, f it exists at all.

Sufferers might spend a lot of time grooming themselves in front of a mirror... but in more extreme situations, they may seek out cosmetic surgery in an attempt to "fix" the issue.  This tends to provide only short term relief until obsession kicks in again.  Interestingly, the "flaw" can change over time - a concern about a birthmark may morph into worry about the nose, then skin condition, then wrinkles and so on.

Scientists are still not entirely sure what causes body dysmorphic disorder (it may be a complex combination of dysfunctions in the brain) but risk factors include having relatives with the same condition (or obsessive-compulsive disorder) perfectionist tendencies, anxiety, or depression.  When it comes to treatment, serotonin reuptake inhibitors seem to be fairly effective (which implies the condition may be linked to low serotonin levels) as does cognitive behavioral therapy.

Given the cosmetic procedures people will endure just for looks today, can you imagine how appealingly addictive it would be to seek out cybernetics that offered real physical benefits as well as mere aesthetics?  For example, some people have fake muscles implanted to make themselves look stronger... but how much more enticing would it be to have functioning synthetic muscles implanted that actually made you physically stronger as well?

Medical model of a kidney
Some patients have trouble psychologically accepting a transplant... (Robina Weermeijer)

Psychological Transplant Rejection

If you know one thing about organ transplants, it's probably that they can be rejected by the body - that's why doctors look for as close a match as they can, and why patients typically require a life-long regimen of immunosuppressant drugs.  What you might be less aware of are the psychological consequences of an organ transplant.

Despite a successful transplant procedure, patients sometimes psychologically "reject" the donor organ.  The phenomenon has been document amongst those receiving kidney, liver and hand transplants, with some people even reporting a kind of survivor's guilt (since the organ came from another human) or viewing the hand as not part of "them."

While cybernetics would (hopefully, anyway) avoid the survivor's guilt problem, they'd still potentially not be accepted as part of the person.  As for why that could be a problem, take a look at...

Body Integrity Identity Disorder (or Body Integrity Dysphoria)

There's another (admittedly extremely rare) condition known as body integrity identity disorder.  It's thought to occur when your mental image of your body doesn't match the physical reality... and those experiencing it display an overwhelming desire to have a limb amputated, or have the spinal cord severed so as to paralyze part of the body.

It's thought that the disorder begins to develop early in life, and it can certainly result in a great deal of stress for those undergoing it.  None of this is helped by the fact that most medical professionals are reluctant to amputate a healthy limb, which can result in the sufferer taking drastic measures themselves.  Take the case of David Openshaw, who immersed his leg in dry ice for six hours and forced doctors to amputate.  Despite having inflicted a life-changing injury on himself, he seems pretty happy with the outcome - a finding mirrored in other cases of the disorder where an amputation has been successfully solicited.

You might be wondering how this condition relates to cybernetic implants... well, what happens if the mind rejects them, failing to integrate them into the mental self-image of the body?  Perhaps you'd experience the same stress - and take extreme actions to rectify it.

Replacement knee joint
Given how much time they spend trying to save limbs, surgeons are understandably reluctant to remove a healthy one... (Judy Beth Morris)

Schizophrenia

If you were asked to picture a mental illness, schizophrenia would probably be the first thing that sprang to mind.  

It's actually a rather broad condition.  Sufferers can experience symptoms such as hallucinations, delusions and confused speech and though patterns... or can seem to withdraw from the world, neglecting themselves and their needs, feeling disconnected from their feelings and emotions or simply tuning out the rest of humanity and the world in general.

It's thought that schizophrenia emerges from a combination of genetic and environmental factors.  Those with a genetic predisposition for the condition may start to exhibit symptoms after experiencing extreme stress (e.g. bereavement, being abused, losing one's home, job or significant other.)  There also seems to be a link to drug use, though it's unknown if substance abuse is a risk factor or if those with schizophrenia are more likely to turn to drugs.

I'd argue that having one's limb amputated or organs replaced (along with the requisite hospital treatment) might qualify as a highly stressful situation, especially if the patient struggled to psychologically accept the replacement.  There's also the fact that schizophrenia is a risk factor for both depersonalization-derealization disorder and Cotard's syndrome.

Depersonalization-Derealization Disorder

Depersonalization-derealization disorder is a poorly documented condition - there's very little research on it, despite that fact that almost every human will have experienced the symptoms a few times in their lives.  Characterized as an out-of-body experience, a dreamy state in which things around you don't feel real or a combination of both, it only becomes a disorder when these experiences keep occurring (or never fully stop.)

It's unknown what causes the condition, but extreme stress or experiencing traumatic events (especially  emotional trauma) seem to be risk factors, as do certain kinds of physical or mental illness (particularly anxiety disorders, but also schizophrenia and depression) and substance abuse.

Symptoms of depersonalization include out-of-body experiences (for example, feeling as though you are floating above you body, or viewing yourself from the outside) or a robotic feeling.  You might also feel that you're not entirely in control of yourself or that your body is the wrong shape.  You might also seem numb to the world around you, or even perceive you own memories dully and without any emotional attachment. 

Derealization symptoms tend to apply to the world around you instead.  You might feel that people, objects and even time not quite real, as though you're in a movie.  You might also feel that you've emotionally disconnected from those you previously cared about.

Between the causes, dream-like state and the disconnection from humanity, this condition fits into depictions of "too much cyberware" quite well.

Shadowy hand reaching towards fogged window and tower block
Depersonalization-derealization disorder can leave one feeling like nothing is real... (Etienne Boulanger)

Cotard's Syndrome

One of the strangest (and rarest) syndromes in psychology is Cotard's - a condition in which a person may come to believe that their organs have failed, are missing or are rotting away.  In extreme cases, the patient may believe themselves to be dead (for example, a 53 year-old self-professed dead woman who claimed she could smell her own flesh rotting and requested that she be taken to a morgue) despite still walking walking around.  On the flip side, a surprising proportion (one study found around 55%) of sufferers believed themselves to be immortal.

Researchers are not entirely sure what causes Cotard's syndrome, but risk factors include severe depression, dissociative disorders (including depersonalization disorder) and schizophrenia, as well as neurological conditions and brain trauma.

Though incredibly rare, Cotard's can result in a disregard for one's own survival that fits in quite well with depictions of "cyberpsychosis" or "essence loss."

Stress and Self-Image

So you might have noticed that many of the above conditions are tied either to stress or self-image... and by definition, going under the knife to replace parts of your body with cybernetics will affect both.  That's not to say that something like cyberpsychosis is a likely outcome (after all, how many people do you know that have gone on a rampage after getting a pacemaker or hip replacement) but it seems that there are some undeniable psychological risks to augmentation!

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