Alien Hand Syndrome

Alien Hand Syndrome

Battle of the Wills

Nada El Jundi

Originally submitted to Dr. Diala Ammar as an assignment for PSY256  Lebanese American University, Beirut, Lebanon

Date: 31/05/2013

 

Most of us sense that we are in control of our own actions: we think about performing something then we do it; I decide to turn the TV on, and then get the remote. Basely, we have direct introspective awareness of all our motivated actions; we can see by this introspection that these choices are fully ours to make. Hence it’s no surprise that many people would think our conscious thoughts drive our will. But suppose we lose our sense of free will whereby we are no longer in control of our own executes; we’re merely remote spectators of our body’s actions.  This bizarre phenomenon is demonstrated in “alien-hand syndrome,” where brain damage leaves patients struggling with actions they cannot restrain or control. Patients suffering from AHS feel that they are no longer in charge of their hand because the brain region that provides us with the sense of control over our own bodies has been afflicted. When that occurs, the hand seems to behave autonomously.

This condition causes the patient’s hand to move and grasp involuntarily. What distinguishes Alien hand syndrome (AHS) from other disorders such as chorea is that the unwilled movement of the hand appears to be purpose oriented. The limb can perform complex actions while remaining outside the sufferer’s realm of awareness. Too bad the rogue hand can’t do dishes. In all seriousness, AHS is the only disorder in which intricate and dexterous movements, such as unzipping a jacket, are carried out instead of pointless flailing.

Perhaps the reason alien hand syndrome is still unheard of is its rareness; there have been no more than 50 recorded cases up to now (Scepkowski & Cronin-Golomb, 2003). AHS was first reported in 1908 by a German neurologist & psychiatrist named Kurt Goldstein, whose patient’s left hand seemed to do whatever it pleased, including one attempt to throttle the patient However, the term ‘alien hand syndrome’ was first coined by Joseph Bogen to portray an erratic behavior observed after certain types of brain surgery. Dr. Goldberg describes that “such patients would react with surprise, concern, and perplexity at the capacity of their non-dominant hand to perform purposeful acts over which they felt no control” (Goldberg, 2000).  AHS cases have been particularly reported after corpus callostomy which is when the corpus callosum joining the right and left hemisphere is cut (usually in severe epilepsy). AHS may also occur due to some types of infections and strokes.

It should be noted that even though AHS is relatively rare, it varies widely within case studies (Biran, Giovannetti, Buxbaum, & Chatterjee, 2006). For this reason, this mental disorder remains a strange and puzzling research subject, and the term ‘Alien Hand Syndrome’  is used  as a canopy to cover several different syndromes. Indeed, the interpretation of AHS is still debated, and many disagreements are due to vague definitions; alien hand means different things to different authors[1]. From here, Marchetti and Della Sala made a distinction between Alien hand and Anarchic hand syndrome[2] which were often used synonymously. The authors explain that patients with anarchic hand syndrome perform acts that are not under their deliberate control but they accept the movements as their own even though they didn’t intend it. As for alien hand, it’s when patients fail to present proprietorship of their alien hand and won’t even know when a proper execute has been made (Marchetti & Della Sala, 1998). However, for the sake of simplicity, we’re going to use both terms interchangeably.

As claimed by Dr. R.S. Doody and Dr. J. Jankovic, there are four hallmarks of AHS. First, AHS is associated with a feeling of foreignness of the limb. Second, patients fail to recognize ownership of the hand when visual clues are not present. Third, they report autonomous involuntary motor activities different from other identifiable movement disorders, and finally patients tend to personify the affected limb (Doody& Jankovic, 1992). Indeed, sufferers of AHS will very often believe the limb to be “possessed” by some spirit or any other entity that they may identify; one patient claimed that he could feel God guiding him during an arm movement; while another said: “I felt like an automaton, guided by a female spirit who had entered me during it [my arm movement].” The alien hand is usually viewed as “obstinate” and sometimes “disobedient” and broadly out of voluntary control. Sometimes, specifically in patients with callosal damage, the hands seem to be acting in opposition. For example, if the patient tries to button a shirt with the unaffected hand, the ‘alien’ hand would unbutton it.

At first, the general assumption was that AHS occurs when the corpus callosum is damaged where the hemispheres can no longer communicate (exchange information), and when there is a lack of communication, things get confused. But of course, matters are never this simple, for it has been found that AHS can also be associated with damage to the right parietal lobe[3]  and damage to the frontal lobe.

To have a better understanding of the volitional control of a movement, it is important to remember the human motor pathways. In a voluntary movement, the primary motor cortex, supplementary motor area (SMA), pre-SMA and other frontal, parietal, and limbic areas are all involved. The frontal lobes act as the “Senior Executive” of the brain; serving to integrate, assimilate process, remember and inhibit impulses and perceptions. Through this, the frontal lobe engages in decision making and goal formation, modulates and shapes character and personality and partakes in the process of remembering and information storage (Hendry, 1996). In addition, the SMA[4]  can guide actions by operating movement and the body’s motor control, and along these lines, suffice to what is best represented as freedom of the will.

As mentioned previously, AHS can result from a pathology involving specific regions of the brain, mainly the medial frontal lobe, the corpus callosum and the parietal areas (Goldberg & Bloom, 1990). According to the affected areas, AHS can be divided into distinct subtypes each exhibiting unique symptoms. Patients who exhibit damage in the corpus callosum (the callosal variant) for example, have their non-dominant hand performing purposeful and often oppositional movements, i.e. their hands act in opposition.  This is portrayed by an incident with a patient who is a smoker; whenever she put a cigarette in her mouth, the alien hand pulled it out (Derakhshan, 2003). Such act is an example of ‘inter-manual conflict’[5]. As for the frontal version (when the frontal lobe is affected), the alien hand will reach, grasp and perform other purposeful movements. The patient also exhibits trouble in releasing objects once grasped by the hand; this behavior Frontal version is also called ‘tonic grasping’ (Goldberg, Mayer & Toglia, 1981). Another variant of AHS is associated with damage to the parietal lobe; this triggers hand levitation and avoidance of palmar contact.

Alien hand is a syndrome so grotesque that it brinks on the comic. Although AHS is obviously a debilitating condition, the case reports of patients can be somewhat funny because of the bizarreness of behavior done by the alien hand. One patient for example struggled with her alien hand as they competed to answer the telephone. Another patient had to dispose of the book he was reading because every time he turned a page, the left hand tried to close the book. A woman would even sleep with her left hand tied, to prevent it from throttling her in her sleep! It has been said that ‘truth is sometimes stranger than fiction’, but in the case of AHS, truth is as bizarre as fiction.  For instance, in the classic comedy Dr. Strangelove[6], the main character is afflicted with AHS; his right hand does not obey him; it tries to give Nazi salutes at inappropriate times and even attempts to strangle him, and he is often forced to use his left arm to beat it down.
There’s nothing quite like suffering from a disorder where your hand seems to be controlled by another intelligence. Although it isn’t typically fatal, treatment options are greatly undeveloped. Yet the symptoms can be reduced and managed by keeping the affected hand occupied and involved in a task. Patients have even resorted to coping methods such as wearing an oven mitt or wedging the hand between legs or even slapping their alien hand. However, on the positive side, there is a gradual reduction in the frequency of alien behaviors observed over time and a gradual restoration of voluntary control over the affected hand. Exactly how this may occur is not well understood, but a process of gradual recovery from alien hand syndrome when the damage involves a single hemisphere has been reported.

Interestingly, Alien Hand Syndrome has sparked the old pleonastic free will debate. It shows via neurology that it is possible to distinguish between consciousness and the experience of free will. It also raises fascinating questions about the nature of free will and the gap between intention and actions. Some even postulated an intriguing hypothesis that there maybe two consciousnesses in a single individual. This startling assumption led researchers to maintain that alien hand could be due to the right hemisphere, lacking language and memory, attempting to assert its independence using tactile and visual modes (Baynes et al., 1997). These ‘alien’ perturbations were so resolute, it was as if these patients had developed two distinct “free wills” conserved by independent minds housed in the right and left hemispheres of the brain; two free wills each of which had a ‘mind of its own’.  So  regardless of how little we know about its cause or how many cases exist, the enigma of alien hand syndrome will no doubt continue to inspire writers, philosophers and filmmakers to explore its potential. For the same reasons, I hope it inspires further scientific research.

References

Baynes, K. (1997). Isolation Of A Right Hemisphere Cognitive System In A Patient With Anarchic (alien) Hand Sign. Neuropsychologia, 35(8), 1159-1173.

Biran, I., Giovanneti, T., & Baxbaum, L. (2006). The alien hand syndrome: What makes the alien hand alien?. Cognitive Neuropsychology, 23(4), 563-582.

Carrazana, E. (2001). “Ictal” Alien Hand Syndrome. Epilepsy & Behavior, 2(1), 61-64.

Derakhshan, I. (2003). A New Callosal Syndrome. Neurorehabilitation and Neural Repair, 17(1), 72-73.

Doody, R. S., & Jankovic, J. (1992). The Alien Hand And Related Signs.. Journal of Neurology, Neurosurgery & Psychiatry, 55(9), 806-810.

Gasquoine, P. G. (1993). Alien Hand Sign. Journal of clinical and experimental neuropsychology, 15(5), 653-667.

Goldberg, G. (2000). When aliens invade: multiple mechanisms for dissociation between will and action. Neurology, Neurosurgery & Psychiatry, 68(7), 6-8.

Goldberg, G., & Bloom, K. K. (1990). The Alien Hand Sign. American Journal of Physical Medicine & Rehabilitation, 69(5), 228-238.

Goldberg, G., Mayer, N.H., Toglia, J.U. (1981). Medial frontal cortex infarction and the

alien hand sign. Archives of Neurology, 38, 683-686.

Hendry, M. (1996). Alien Hand Syndrome: Diagnosis Of Disconnection Through Behavioral Observations And Bimanual Testing. Archives of Clinical Neuropsychology, 11(5), 399-400.

Sala, C. M. (1998). Disentangling The Alien And Anarchic Hand. Cognitive Neuropsychiatry, 3(3), 191-207.

Sala, S. D., Marchetti, C., & Spinnler, H. (1991). Right-sided Anarchic (alien) Hand: A Longitudinal Study. Neuropsychologia, 29(11), 1113-1127.

Scepkowski, L., & Cronin-Golomb, A. (2003). The Alien Hand: Cases, Categorizations, and Anatomical Correlates. Behavioral and Congnitive Neuroscience Reviews, 2(4), 261-277.


[1]Oliver sacks uses alien to represent phantom limb.

[2] The confusion was due to a mistranslation from French “main étrangère”

[3] possibly because of a disconnection between the part of the motor cortex that moves the left hand and the parietal cortex that perceives the left hand movement as its own

[4] The SMA is of particular concern in AHS. It’s takes part  in the initiation, planning  and inhibition of motor responses

[5] When the alien hand acts at cross purposes to the other hand.

[6] In fact, AHS is often called Dr strange love’s syndrome.

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