She worked for thirteen years in health 
  care, becoming the director of a residence 
  program for men who’d suffered severe head 
  injuries. But she and her husband began 
  fighting. There were betrayals. By the time 
  she was thirty-two, her marriage had 
  disintegrated. In the divorce, she lost 
  possession of their home, and, amid her 
  financial and psychological struggles, she 
  saw that she was losing her children, too. 

  Within a few years, she was drinking. She 
  began dating someone, and they drank together. 
  After a while, he brought some drugs home, 
  and she tried them. The drugs got harder. 
  Eventually, they were doing heroin, which 
  turned out to be readily available from a 
  street dealer a block away from her apartment.

  One day, she went to see a doctor because 
  she wasn’t feeling well, and learned that 
  she had contracted H.I.V. from a contaminated 
  needle. She had to leave her job. She lost 
  visiting rights with her children.

God, that is hellishly brutal. I'm assuming she's dead now, and a de-identified version of the story can be told.

The article is 8 years old. So she'd be only 56 years old now.

> I met M. seven years after she’d been discharged from the rehabilitation hospital. She is forty-eight now. She lives in a three-room apartment, with a crucifix and a bust of Jesus on the wall and the low yellow light of table lamps strung with beads over their shades. Stacked in a wicker basket next to her coffee table were Rick Warren’s “The Purpose Driven Life,” People, and the latest issue of Neurology Now, a magazine for patients. Together, they summed up her struggles, for she is still fighting the meaninglessness, the isolation, and the physiology of her predicament.

Pretty unexpected that it turned out to be a literal itch and not metaphorical.

Great article, but I really wanted to read M's story as a contiguous block. The interruptions to explain the historical context and research detracted from the immediacy of her (and H's) situation. In fact, the most important theory in the article seemed to be the sensor treatment theory using mirrors. All the other explanatory text may as well have been cut.

I wonder if it worked for M.

> She had scratched through her skull during the night—and all the way into her brain.

What?! Is this even possible?

I suspect that she got an infection which weakened the material, and got through her skull by basically growing its way in instead of scratching. Just a guess since it doesn't give any details.

I know! This was a horrifying read first thing in the morning - especially this part.

Western medicine is fantastic for injuries, and utterly medieval when it comes to chronic problems. It was agonizing to read this.

> Researchers at the University of Manchester, in England, have gone a step beyond mirrors and fashioned an immersive virtual-reality system for treating patients with phantom-limb pain. Detectors transpose movement of real limbs into a virtual world where patients feel they are actually moving, stretching, even playing a ballgame. So far, five patients have tried the system, and they have all experienced a reduction in pain.

Could be a pretty killer future VR/EEG (or are they using physical motion sensors configured to the "good" side of the body?) app.

> In one study, a German professor of psychosomatics gave a lecture that included, in the first half, a series of what might be called itchy slides, showing fleas, lice, people scratching, and the like, and, in the second half, more benign slides, with pictures of soft down, baby skin, bathers. Video cameras recorded the audience. Sure enough, the frequency of scratching among people in the audience increased markedly during the first half and decreased during the second. Thoughts made them itch.

I itched while and after reading the article. At various times I scratched my head, my nose, my lip. I don't normally have a problem with itching, and none of them were extreme.

Writing this comment made it way worse! I've scratched my arm, my leg, my back, my eye socket all since I went to copy and paste the quote above. Anyone else find the same?

I loved reading this in 2008, was my first encounter with Atul Gawande and caused me to seek out other medical writers like Oliver Sacks. Thanks to @dove for reposting this incredible piece of writing.

I hadn't noticed this was from Atul Gawande -- I loved his book Being Mortal. Neat to see what he was writing about in 2008.

Can someone provide a tl;dr version? :)

When the brain gets incomplete signals from its peripheral nerves, it does its best job to "fill in the gaps" with its best guess of what that information should be.

Unfortunately, this mechanism can lead to symptoms like phantom pain or itching. As the author puts it, sometimes the check engine light is really nothing wrong with the engine but a faulty light itself.

One promising solution to these medical problems is to fill in the missing data in a different way. For example, phantom limb sufferers can look in a mirror image of their good limb, pretend it's their missing limb, and feel immediate and lasting relief. This may help with things like phantom itching, too.

I don't think there's an easy tldr. The lead character is a woman with a number of maladies, but develops an itch that had no apparent physical manifestation and shouldn't have been possible as the nerve endings in the itchy location were dead. The article is a sprawling overview of the history of diagnosing not just itches, but understanding the cause of such phenomenon as "phantom limbs"