Friday, March 9, 2012

Got an ITCH for Biology?

Some of the most interesting functions (or malfunctions) of the nervous system are the things we understand the least. Why do amputees often feel their long-lost limbs? Why do we perform compulsive behaviors - like scratching an itch - when there isn't actually anything making us itchy? Read Dr. Atul Gawande's article 'The Itch,' and you need to respond and participate in this online discussion by the end of the day on Tuesday. You can use the questions below as a launching point, but it should be a discussion, responding to the article and other people's responses. (for 10 points, yes--better than a reading quiz!)
Some Questions to start your discussion:

1. What did you find interesting/fascinating/horrifying from this article? What would you like to explore more?

2. The patient 'M' experiences a strong, persistent itching sensation, but her doctors were not able to identify a medical basis for her itch. Do you think that M's itch was 'physical' or was it 'all in her head?'

3. Gawande states: "perception is the brain's best guess about what is happening in the outside world." How does this description of brain function relate to phantom limb pain?

33 comments:

  1. I think that this is an interesting phenomenon that makes us reflect on the voltaile relationship between our mind and our bodies. The brain has to make sense of the world with bits and pieces of different neurological input about colors, sensations, shapes, etc. and when there is a piece of the input that doesn't make sense, the brain will try to fill that in with what it knows.
    I think this idea is plausible because clothes and glasses often become unnoticeable to us when we have them on, and it must be even more drastically so for our limbs which are constantly part of us. So when a part of our body is suddenly gone, that is a big piece of our puzzle missing for the brain, and additional stress or trauma would very likely cause symptoms such as phantom limb.
    What horrified me was that M's loss of nerves in her scalp led the brain to mistake the lack of sensory input for a terrible itch (at least, that was one of the plausible theories in this article that I was most convinced by) and in her subconcious state, she relentlessly itched through her scalp and into her brain. Because she had no input in her nerves to send any pain signals as she scratched through her scalp, and her unconcious state left her very vulnerable to her own impulses, she inflicted serious self harm. This shows how important the nervous system is for our own protection.
    The author talks about the body like a car. In patients such as M, it may not be the body that is broken but the signal that the neurons are transmitting. Therefore, the mirror imaging technique has been very successful. If this is true, could hypnosis be a scientific and even viable medical practice?

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  2. (This is from Jazmine)
    This article was really shocking. The power of one's brain is truly remarkable. Like Saki I too was shocked and horrified that M was able to scratch all the way through her skull and cause brain damage that made her partially paralyzed. I never would have thought that a parsons nails could do co much damage. Whats even more frightening is the facts that the male patient next to M died because he scratched the shingles on his neck all the way through the carotid artery. That's scary.
    It's kind of overwhelming to think about just how little we still know about the human brain and body, and how unpredictable and dangerous they can be. How something like an itch or a sneeze can cause major damage to a person without and clearly reason as to why.
    Its truly shocking what our bodies are capable of.

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  3. I thought that it was very interesting that even as she slept, 'M' scratched her head nonstop. The fact that she scratched through her skin AND her skull all the way to her brain was horrifying. I would have assumed that some mechanism in the body would prevent someone from nearly destroying his or her brain, but apparently the urge to itch is greater than the desire for self-preservation.
    I believe that M's itch was 'in her head.' The theory that the itch wasn't a result of actual sensation but rather a result of the brain going haywire was convincing. It seemed more reasonable that the brain tried to guess what was happening than if there was actually an itch that couldn't be satisfied.
    If one lives with an arm for most of his or her life, then it is suddenly amputated, the brain will still believe that the arm is there. It makes a 'best guess' about what is going on in the outside world. It guesses that the limb is still attached because that is how it has been forever.

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  4. I thought that this article was incredibly interesting, both in the content and in what it implied. A few things horrified me along the way - the fact that M was able to scratch through her skull and into her brain (how is that even physically possible?) and the man who scratched through his carotid artery. It just proves how extremely vulnerable our bodies are and how much the brain and nervous system control them.
    The analogy that Saki mentioned, of a body and nerve being like a car and the signal light, was really effective in helping me understand the article. For cars, there is always the possibility that the signal light itself is faulty, but for people, doctors assume that it is the person who has a problem, not the nerve ending itself. I had never thought about it in this way before and as soon as I understood it, it seemed to bring about a whole new perspective for me.
    What fascinated me was the fact that the brain tries to predict or guess what should happen. If a person's arm is amputated, the brain guesses what the person should be feeling and tries to recreate that. Unfortunately, that usually ends up being detrimental to the patient. It completely amazes me what the brain is capable of, and what the body does to itself in order to follow through with the brain's orders. And when the brain is finally tricked out of its guessing game, the body is finally able to feel relief.

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    1. Dina, I really liked what you said about how the brain tries to predict or guess what should happen. I never thought about the brain being something that has to predict or guess what a human is going through. I thought the brain just does what it does without having any attachment to the human. This idea really creeps me out because I have never in my life felt as if my brain was playing tricks on me. I have always thought of my brain being my support system and helping me think out my problems. I just never would have thought that other people in the world have issues with their brain. The brain in a sense took over M. for their worse and she had no control over the situation. This articles was SUPER interesting and quite creepy, disgusting, and horrifying at moments.

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  5. I find It really interesting that both M. and H. felt the need to satisfy an itch was more important that preventing the pain they would inevitably cause. I am also amazed that the treatment prescribed for both phantom-limb pain and for incessant itching is the use of a mirror. I feel as though this would act as evidence supporting Dr. Oaklander’s theory of the neurological cause of M.’s itch. Claiming that these problems are solely sensory creates the question of whether or not any joint problems or chronic pains are sensory problems or actual joint problems. The use of virtual worlds to solve phantom-limb pain leads to the idea that other psychological perception disorders could easily be solved through a virtual treatment.

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  6. This article was really fascinating as a whole. But I think the most fascinating part has to be the "Mirror Theory". It's amazing how that could actually change the way our brain perceives reality and almost "resets" our brain in the process. It's just so interesting how the brain's perception of the outside word affects the way the human body physically feels. It makes me question if what we physically feel, is something physical at all and not just a mental response. If so, I agree with Saki's concluding sentence, wouldn't this make hypnosis a viable medical practice? Hypnosis could possibly cure these "illnesses" or at least soothe the symptoms if they were neurological issues.
    I think this article really pushes the reader in the direction toward believing that M's itch is "all in her head" because it gives lots of examples, like the mirror theory, proving that these itches and sensations aren't just physical attributes. Also the article specifically stats that the surgeons cut off all her nerve signals, and yet she still feels an itch, leaving us with no other conclusion.
    Gawande's statement relates to the phantom limb pain because the brain no longer sees a limb at the designated location, and it believes that the limb is just clenched or contorted (which is another method for the brian to try to locate the limb). As a result, the phantom limb is in constant pain and the pain can not be alleviated because there is no actual limb there to show the brain that the limb is normal and not clenched or contorted.

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  7. This article was a very interesting read. It definitely provokes thought on how much control our brains have in relation to our physical senses. I think it's really difficult to know exactly how much of a connection there is between the brain and the senses until we can study these incidents more - with more examples, we can learn more and attempt to figure out the details of that relationship. However, I do agree with Khanh that the itches are probably not actual physical ailments of the patient but rather "in her head" (by "in her head", I don't mean mentally ill, but rather that M's sensory reactions are controlled by her brain). I think this article also begs the question of how we determine if a person is mentally ill or has some kind of neurological disorder like M or H. The article said that the doctors thought she had a mental illness at first and she described feeling very relieved when Dr. Oaklander said that she thought it wasn't true. How do we make that determination? I think more knowledge about brain function is probably the only way.

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  8. I'm happy that I read this because I feel like information in this article proves that brain is a super multi-complex organ in our bodies that we need to pay a lot more attention to. I also feel that a lot of scientists should start researching and testing out more information about conditions that M. and others like her had. I know M.'s condition was not the first and know one really doesn't know the answer to this problem but I would be very interested in learning more about M.'s condition. I would say that M. had it all in her head which at the end of the day for me personally is just sad. I don't want to see her go through all of this knowing that she is mentally ill and she can't help it. The brain works in mysterious ways and I would have never known how until today when I read the article. Great article; I hope more people are aware of this problem and that people are looking for ways to handle this problem. I think that the brain is the organ that all humans should look out for. I thought that other things such as the heart, cancer had such an effect on humans but I'm starting to rethink and say that the brain can have just as many effects on us than anything else.

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  9. This article was quite thought provoking but also horrifying in its implications. The most interesting issue that was explored in this article was how the brain attempts to create or predict what is happening. The example of the woman who was born without either arm but still had the sensation that she could move them illustrates how powerful and scary our brains can be. It’s a little disconcerting that our brains try to make sense of the world by integrating scattered signals and playing a sort of guessing game.
    I believe that M.’s itch was in her head—if it was physical, she would have discovered some sort of medication or remedy to relieve it. But the prediction that it is possibly caused by “loose wires sending false signals” is quite convincing. Even though M. didn't have an itch, her brain sent out signals that influenced her body to react. Because she had no nerves in her scalp to send signals of pain to her body, M. could not help but constantly itch. M. was incapable of protecting her scalp because her nervous system was altered.

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  10. Along with everyone else, I found the most disturbing thing in the article to be when M. scratched through her skull. I also found H's. symptoms to be interesting. More than that, that his urge to scratch was more severe than the pain he knew would come from it.
    For me, the article really made me think about how we need to start thinking about how we can trick the brain, rather than trying to identify a symptom that isn't there. It really makes you think about how much the brain can influence everything we do, see, hear, and feel. Everything we do goes through our brain before we actually can comprehend what's going on. The article made me rethink how we take in all the information around us, and how our conscious brain has very little to do with it. For me, it brings up the question of whether we are really in control of our own brains or not.

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  11. Of course, I think the most shocking thing about this article is the fact that M itched through her skull during the night. It seems impossible that she could do this without noticing or experiencing any pain, and is it even physically possible to scratch through bones with your own hands? I definitely think that the scratching was from inside, and she had a neurological disorder. About amputees who experience a "ghost limb," I think this is very similar to what M was experiencing. In both cases the brain creates the sensation of something that is not there, like the itch that M had. This article is a little scary because it implies the fact that the brain can make your body do extreme things - if the brain can make someone scratch through their own skull what else can it potentially make you do to yourself?
    - Sissy

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  12. I definitely think that it was all in M's head. Not saying that she's OCD or has some medical disorder, but just that her brain has gone "haywire," as they said in the article.
    I think that perception is everything, and like what Dina said, it's funny how the brain tries to predict what will happen. There's a channel on Youtube, called "Vsauce," and he talks about a lot of brain things, and brain phenomenons.
    This article reminded me a lot of the mental disorder tricho-tillomania, trich (pronounced "trick") for short. I had a friend who had trich, and got peeved whenever somebody told her to stop. She said as much as she'd like to, she couldn't, and it was a constant urge. Also, tourette syndrome is another example of a mental disorder that occasionally causes self-harm. Somebody's "tick" could be to punch themselves repeatedly, or attempt to stab themselves. I find it scary that someone's brain would be able to do that, is there no mechanism that stops these impulses from happening? Is there any medical way, besides human intervention, that could stop these ticks from happening?
    - Pinkie

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    1. One of my best friends in college, my roommate sophomore year, had trichotillomania (hair loss from repeated urges to pull or twist the hair until it breaks off). It was truly fascinating to see this brilliant person totally unable to control this urge. It did seem to get worse when she was stressed, but it never went away completely.

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    2. I had trichotillomania when I was younger. (so did one of my sisters, and she still has relapses even to this day) Pinkie, I can totally relate to what your friend said because it was extremely frustrating to know that I shouldn't be doing something and to stop so badly. But I felt like my brain (or at least, my conscious brain) couldn't always control my body. and that was the most difficult part of all, just not feeling in control of anything. I don't even remember how I finally stopped.

      I'm fairly sure that everybody in the world has at least one tick/habit/impulse. I feel so bad for people like M, whose habit of choice happens to be both 1) physically noticeable and 2) self-harmful. But that's just genetics, right? We don't choose our what our impulses are, just as we don't choose to act on them.

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  13. I agree that the most disturbing part of the article was M's scratching her head, all the way down to her skill. The scariest aspect of this is that often times your brain is uncontrollable--even though M tried wearing caps and other things on her head while she slept, her nails would always find a way through those things to her head.
    Also, the article re-enforced the importance of properly functioning senses. M continued scratching her head because that part of her head was numb. Therefore, it's crucial for us to feel pain in order to prevent harm to our bodies.
    Another thing to keep in mind is that M had a lot of psychological and physical issues prior to "the itch" --her problems with her husband and children, drinking, drugs, HIV, etc. It seems that a lot of this built of stress can lead to malfunctions of the brain. Many people have mentioned that this is all in M's head, and I think this explanation is consistent with all of the psychological trauma that M had experienced.
    -Kelly

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  14. I was shocked when I learned the length that M. (and the patient in the bed next to her) would go to in order to relieve this itch. At first, I thought this urge must be exceptional in order to create such chaos, but while continuing the article, I came to the conclusion that this itch must be all in her head. This is most supported by the fact that she was able to (somewhat) control the itching while she was awake, but had no control while she was asleep.
    Like my wonderful friend Dina, I was most captivated by the brains' attempts to recreate "phantom limbs" or any sort of memory. Its frightening to think that our brain is deceiving every moment we open our eyes. Of course it controls all of our actions and thoughts, but if we look at a light or feel texture, are we sure that it is really there? Our own experiences and standards seem to be manipulating these functions. At first the mirror box, and some of the other psychological methods mentioned, seemed almost irrational. I assumed that methods like hypnosis were misleading and had no scientific basis, but this article opened me up to these ideas. -Emma E

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  15. I found this article to be both fascinating and disturbing. In fact, the article was fascinating in much the same way as it was disturbing. It is disturbing, and I would even go so far as to say disgusting, that M was able to scratch all the way through her skull into her brain; the mere thought of this action is horrifying. However my fascination arises when I realize that what led M to have such an uncontrollable itch (which had horrifying consequences of unspeakable disgust) was a simple malfunction of her brain. M's brain led her to believe that she had an itch. The implications of this fact are, again, both horrifying and fascinating. It leads to the conclusion that reality is very subjective; our brains control our entire perception of the environment; there is no way to know an objective reality. Thus, if a brain malfunctions, our perceptions, and thus what we perceive to be reality, can change drastically. This can have horrifying consequences, such as itching through one's skull, or having phantom limbs that act on their own, even though there is no limb there. This article led me to reflect deeply on the nature of reality.
    -Nathan L

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  16. I found, of course, the fact that she scratched through her skull to her brain horrifying. I didn't even know that was possible. I, like Dom assumed there would be a mechanism to stop that but I guess since only her itch nerves were there there were no pain receptors. Another interesting thing is that I found myself scratching a ton. I knew this would happen but it was still uncontrollable and I even feel it now. I just scratched my head and neck.
    I think that M's pain itch was in her head. Her brain had gone "haywire" as it says in the article. That seems to be the most likely explanation. The other two didn't seem to make as much sense.
    When a limb is amputated, your brain makes a 'best guess' and presumes that the limb is still there, since that is how its always been. So, the brain still sends signals that usually end up in pain. This recreation of past perceptions is, like Dina and Emma, slightly scary to me. Is anything we see really there?

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  17. The article was definitely horrific and gruesome in parts. I can't imagine what M must have felt like to wake up with the greenish fluid flowing down her face. How could her brain not send pain signals when she cut through the skull? Despite the gory details, I found the section on Phantom Limbs fascinating. It was also a reassurance that there was some sort of treatment for these sorts of issues. I hope that the doctors find some way of helping M...her story was truly tragic. Her problem was most likely deeply rooted inside her own mind, rather than an actual outward stimulus. The shingles probably cut off her scalp's nerves, leaving her nerves in a painful loop that caused the itching. The Phantom Limb idea works similarly; if a person's arm is amputated, the brain goes into a sort of shock where it continues to believe that the limb exists and sends it signals, creating a feeling of a "phantom", nonexistent limb. The mirror-box method disrupts the brain's loop cycle by feeding it new visual information forcing it to reassess the condition of the "limb".

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  18. I find it interesting that more people didn't bring up the obvious discrepancies between H.'s and M.'s response. Although M. had such a strong urge that she physically scratched through her own skull, H. merely developed calluses from his own "incessant scratching." I feel like M's condition is more related to Oaklander's theory that it's a brain problem rather than a nerve problem, and the same goes for H's condition. At the same time, it seems hard to explain why his "constellation of sensations" would arise after a supposedly successful operation. It seems more likely that the operation was not, in fact, so successful, and that these are real side-effects than that he's simply imagining them.

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    1. On the same topic of H. and his symptoms, one thing I thought was particularly strange was when mirror therapy helped his arm. I can understand when someone is feeling a phantom limb that isn't there, but when you are aware the limb is there and you're feeling intense pain I don't necessarily see how mirror therapy would help. Yet, it seemed to show immediate relief for H. so I guess there must be something to it.

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  19. Like the majority of people, I found the fact that M. scratched her scalp all the way to the brain to be very disturbing. Beyond just scratching to her brain, which I was unaware somebody could do in one night let alone ever, I was shocked to read just how incapable M. was of preventing herself from harming herself. This shows how both powerful and delicate the brain is.
    This article demonstrates the ways that the brain is capable of filling in information and creating illution. This is particularly shown in the "phantom limb" case where the brain created sensations that were counter to a person's physical state. The ways in which the brain can deceive a person shows how much more scientists have to learn about the complex abilities of the brain. Though I am not completely sure what was the key reason behind M.'s itching, I believe the concept provides a glimpse into the powers of the brain and all we have left to learn about it.

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  20. To me, not only the fact that M. scratched all the way to her brain, but also that she could not keep herself from doing it, even when she was sleeping, is terrifying.
    It seems that the itch that M. felt was actually all in her head - her brain filled in that itching sensation, and scratching granted reprieve merely because her brain was expected her to.
    Gawande's quote is indicative of how our brains get used to routine, and how whatever they expect to happen, they will emulate even if it is not actually happening. Phantom limb pain comes from the brain expecting pain there, even if it doesn't actually exist, and thus reacting in the same way.

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  21. As was the case with most of my classmates, I too was completely shocked that M. scratched her way through to her brain. I wanted to believe that the green fluid was from an infection simply because I could not comprehend just how out of control M.’s urge to scratch was. I found M.’s whole story heart breaking and extremely disturbing as it sounded like a problem from a “Saw” slasher movie. I honestly had difficulty empathizing with the problem, especially when reading the quote from M. about how she fantasied about grating her upper right face off with a metal grill. Her issue showed me that the body really is a machine because it is capable of malfunctioning and behaving against our wishes. I would like to explore the link between mind and body further because I think that the mind can override the body as shown in the case of the mirror therapy patients and the mechanics of our body can take more control than our wishes over our physical forms as shown in the case of M.. I really do think that although M. clearly has experienced traumas in her life that could result in mental disorders, the itching is probably the result of phantom sensations that stem from her case of shingles.

    As for Gawande’s statement about perception being the brain’s best guess about the outside world, I think the statement is pretty straightforward. From reading the article, I get the sense that the brain is used to having all appendages, even if the body was born without them because that is what the brain has evolved to expect. So, the brain projects pain that is not there because it has not adapted to reality without all of the limbs present. I also agree with Nathan B. regarding the mirror therapy. It does sound a bit sketchy, but I personally think the method works as a result of mind over matter. There are scientists who believe that most of what we see is actually memory and inference, so it’s not a stretch to think that if we could make the mind believe it was seeing something specific, the brain would react and consequently change the body’s state through the central than peripheral nervous systems.

    Additionally, I really want to know what happened to M. This might be my optimism, but it seemed that the article was almost implying that mirror therapy was the solution she needed. I truly hope that that was the case, but if it was, then why aren’t her results in the article?

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  22. What do you guys think happened to M.? Do you think mirror therapy worked?

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  23. It is indeed very frightening that a person could obey the brain's demanding itch to a point where they grind through their skull with mere finger nails, but considering how the brain tends to ritualized nasty habits like this into routines, it's not too surprising. It actually makes sense that M. would be the one to have this little itching addiction seeing as how she was addicted to drugs. It sounds as though she has a very addictive personality but i've no idea if that had anything to do with the itch. It seems as though all brains have at least a small addiction problem, whether it be candy, soda, coffee, drugs or itching. I'm presuming that M. simply had a greater problem. On a psychological scale, scratching her raw scalp was soothing, even though the imaginary itch was unbearable.

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  24. I found it horrifying how M had to wear a football helmet and to strap her arms down every night for, I think the article said, two years. I also found it interesting that her obsessive itching was not caused by any type of disorder, but simply by a difficulty with her nerves. Like Freddy said, M's scratching became an addiction, and the stronger the addiction got, the more numb she became. I thought it was interesting how she became so automatically responsive to the itching that it started to feel natural to her. I also wonder why she still had the itch even after she scratched through her skull and into the brain.

    I, like Elsa, think that M's reaction is "in her head," meaning that her physical and mental reaction is based of sensory reaction. Seeing that only one person, out of the numerous doctors and psychologists, could identify what M had, and that even after M was diagnosed and no one could really pinpoint why her nerves got "haywired" in the first place, it's crazy to think that one small internal alteration can cause such a great effect on the body as a whole.

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  25. Answering Emma's question. I think that is a very interesting thing to think about. I know that mirror therapy has been very successful for people who have lost limbs but can still feel them. However, I feel as though M's case is a little different than cases of lost limbs. Obviously she has not lost a limb, but also with a lost limb when you look in the mirror and try to move it, it is very clear that there is nothing to move. However, with an invisible itch it is harder to prove that the itch is just in your head because it was on a part of her body that could potentially actually have an itch, whereas with a lost limb, there is no possible way to have an itch on a hand you don't have.

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  26. I also found, like Zane, that the comments that Gawande made about how the brain feels things it expects to feel was very interesting. It is especially interesting to think about what that means for everything else we feel. Do we sometimes just react to things because our brain expects their to be a feeling we need to react to? What does this question mean for the feelings of pleasure and pain that we have? It would be interesting to look at how much of what we feel is actually a real sensation.

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  27. A agree with Clare, the idea that our brains create responses based on things that are not real impulses is a very fascinating prospect. Better understanding of what the brain does could be very valuable in learning about human interactions and feelings.

    Regardless, both of the cases mentioned in the article were intriguing and terrifying. I really hope M finds some way of stopping the itching and returning to a normal life.

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  28. What I found the most horrifying was the fact that she was scratching herself so much that she was scabbing on her head and she even said that green liquid was flowing down her face. I definitely agree with Matt Romer that I hope M finds a way of stopping the itch. I thought that the itch was probably mental and it was a weird reaction to her withdrawal from her past. It is a really scary reaction in my opinion and I really hope it goes away.
    Gawande's statement, like Emma said, is very straightforward and it seems very true. The brain is a real center for the processing of many things, yet it also is a great mystery, which is why so much of this article is unknown. I think that sometimes the brain will just think things are there, like when we are at a haunted house. We think a ghost will be there, and the fact that we don't know when it will appear is why we get scared. It's the brain that really is the center of how we see ourselves and the world and it's a big translation center in my opinion.

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  29. The first part of the article that I found intriguing was how the brain was able to make the scalp go numb while still causing patient M. to feel an itch. The other thing that was interesting was the fact that she was not able to control herself. She lost the ability of free will of whether or not to scratch. I found the fact that she scratched all the way to her brain through her skull impressive and horrifying.
    This shows that the concept of pain in a phantom limb can occur as a phantom symptom. Such as the brain sending signals that she has shingles even if she does not have them.
    Like Gawande says how the brain processes everything and sends out signals and yet can send out contradicting signals. This is just one example of how we know so little about the brain. The mirror therapy if it works would show an interesting phenomenon that everything is a relative so in theory we are itchy all over and all the time but we only would feel an itch if one spot had a more intense itch. Adrian

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