Dealing with the Psychology of Limb Loss

Any health care professional who works with people who have lost limbs recognizes that the psychological challenges their patients battle every day are tough. This is perhaps an understatement, since for most people, losing a limb greatly impacts every aspect of their life– mentally, emotionally, physically and spiritually. De-pending upon age, psychological health before the loss, financial situation, circumstances of the loss (trauma, disease or congenital), society’s values and support or lack of support from family and friends, the road to recovery can be relatively quick or prolonged.
Most psychiatrists, psychologists and social workers who treat people who have lost a limb stress the importance of treating patients holistically. The totality of a patient’s life must be considered, e.g., work, family, gender, self-esteem, age and health. No two people will experience the processing of the natural feelings of grief, denial and anger at the same preconceived time or sequence, nor will the intensity of these feelings be exactly the same. Some individuals never encounter certain feelings. While people who receive an amputation do tend to go through psychological stages, there is no standard pattern.
It is crucial that prosthetists and other rehabilitation professionals listen to their patients. Whether prosthetists realize it or not, they are much more than “the person who made my leg.”.
As one 24-year-old woman named Robin who recently lost a leg due to a traumatic accident told O&P Business News, “I owe my life to my prosthetist. They are not doctors; they are confidants. In many ways it is only through them that we can find some solace and peace. They are the ones with whom we share the most private and personal things. They must cope with that special position with care. It is not just a clinical thing, it’s a matter of the heart.”.
Work and Play.
Returning to work as soon as possible after an amputation is essential for self-esteem and overall well being.
“A person who goes back to work will recover a lot quicker than a person sitting at home,” said Carroll.
Being productive is an inherent need in everyone, and the loss of work can be a terrible blow, especially to people who believe their work to be their identity. Some people can’t physically manage their previous occupation and must change careers. Vocational rehabilitation is an option if that’s the case. This too can be a source of grief, especially if the person loved the work. But it can also open up a new world of possibilities. According to Saberi, most people with a disability have a lot to prove to themselves, and the workplace is just another challenge.
“This means the person has to self-advocate,” she said. “The individual needs to know his or her legal rights and have backup resources that will vouch for his or her ability to perform the job.”.
Jana found it hard to apply for jobs.
“I was up-front and always honest about my disability and this seemed to frighten potential employers.”.
Limb loss need not interfere with sports, hobbies or other recreational activities,” said Winchell. Involvement in recreational activities can enhance one’s sense of competency by shifting the focus of disability to capability,” said Winchell.
Body Image and Sexuality.
For the most part, society maintains an absurdly narrow view of physical beauty, particularly for women. This can be especially difficult for an amputee because no matter what, society’s standards of beauty can never be attained. A healthy self-image depends on several things– level of self-worth, experiences, society’s views and gender. It can be quite subjective.
In a 1996 issue of inMotion, Winchell said that how we feel about the way we look is more important to self-esteem than actual appearance.
“An amputee sees himself or herself differently physically and sexually than a nondisabled person. People need to redefine what sexuality or sensuality is. It’s mostly an uphill struggle, since it counteracts society’s definition,” Saberi said.
“Everything has changed,” said Robin, who is deeply grieving over the loss of her leg. “I am now a completely different person, and I wasn’t ready to not be who I was. My legs were me in the physical sense.
Robin said she couldn’t look at her residual limb for quite a while and it took months before she could look at her body in a full-length mirror.
Complications from diabetes caused Stacey to lose her leg below-the-knee.
“I was upset that my ideal image of motherhood was crushed,” she said. “I agonized over whether I would be able to share the experiences of skipping, jumping rope, riding bikes and running over hills with my kids.”.
Stacey also had trouble merging her ideal of femininity with the world of prosthetics with its bulky shapes, metal, plaster and screws, nuts and bolts.
Self Image and Age.
Depending on the person, a prosthesis can either become an integral part of a positive self image or be seen as a hindrance. The authors state, “Health professionals must be aware of the amputees’ relationship with their prosthesis as a physically and psychically invested aspect of the self …”.
The age at which one receives an amputation plays a role in the recovery process. Desmond and MacLachlan note that for a young traumatic amputee, limb loss may represent the loss of life opportunities, whereas for an elderly person with peripheral vascular disorder, amputation may offer increased mobility, a decrease in pain, or both.
Hank, a 64-year-old who is scheduled to undergo an above-the-elbow amputation due to an injury said, “I feel a great deal of sadness, but I’m also extremely happy it’s happening at age 64 instead of age 24.”.

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