The Psychological Aspects of Amputation

By Saul Morris, PhD

If you have had an amputation or are going to have one, let me assure you that others have already gone through the same experience. You may be feeling physical pain, fear, apprehension, loneliness, uncertainty and sadness but I can assure you that you will make it though all of this. You are probably dealing with amputation because you and your doctor deemed it necessary to save your life or because it was the result of circumstances beyond your control. Either way, you had no choice.

Regardless of the cause of your amputation, you will probably go through basically the same psychological stages. It is essential that you go through the grieving process, and some people will do it in a short time, while others will take several months. It is important, however, that you acknowledge and understand the process as you are going through each stage.

With the loss of a limb, the two most common types of grief are anticipatory grief and normal uncomplicated grief. Anticipatory grief occurs before a loss and is associated with a diagnosis of a life-threatening illness, and a forthcoming amputation. Here, we will only deal with normal uncomplicated grief, and it is important to understand that this is the normal process.

The Five Stages of the Grieving Process

Denial
Denial is usually experienced by people who go through traumatic amputations, and normally those who have had surgical amputations will not experience it.

Anger
Often people will blame God, the doctor, or others for their loss.

Bargaining
In this stage, patients may attempt to postpone the reality of amputation, and most patients will try to bargain with their doctor or through a higher authority such as a religious figure.

Depression
In this stage, anger is replaced by depression. This is probably the most complicated stage of grief, but it too will go away. This is not clinical depression. It is normal. Common symptoms include sleeping either too much or too little, negative feelings about the environment and the future, feeling of hopelessness, and talking about death. Depression is not a sign of weakness, however, and should not be seen as such. It is treatable and you should not hesitate to seek help from your doctor, nurse, family and friends.

Acceptance and Hope
Eventually, you will come to terms with your loss and start to live again. This is more easily achieved if you have a visit from a peer counsellor who has been through this entire process and can give you some tips on coping with your loss.

Complicated Grief
Although complicated grief is not common in amputee patients, you should be aware of its symptoms, which include severe isolation, violent behaviour, suicidal ideation, workaholic behaviour, severe or prolonged depression, nightmares, and avoiding reminders of your amputation. If you do experience any of these symptoms, please inform the appropriate medical professionals.

Compounding factors
Along with the loss of your limb(s) you may also experience other complications, depending on your situation and your support from others.

During this period you will probably find that stress is at its highest level. There are, however, many ways of coping with this problem. If you speak to your medical professional, perhaps he or she can help you. You may also experience loss of self-esteem. loss of self-confidence, fear of rejection from your mate, questions about your body image, and financial problems. Probably one of the most difficult problems is losing your sense of independence and having to rely on others for some of your most common everyday needs.

This is not to scare you but to warn you that these feeling may occur. A lot of them may, however, be based on false assumptions. The loss of self-confidence and self-esteem for example, is not necessary. Your self-confidence and self-worth are in your mind, not in the leg or arm you have lost. You are still the same valuable person you were before this loss. You will find that as time goes by, you will learn to adapt, and your whole attitude will change for the good.

Another mistake we amputees make is in out self-perception of our body. After an amputation, it is quite normal to feel that you may no longer be attractive to your partner. Perhaps this might be true is some cases, but if your partner really loves you, the loss of a limb will make no difference in your relationship, sexual or otherwise. Of course, some adjustments may be necessary, but they can and will be made, and eventually things will get back to normal.

Yes, we are a little different, but so is everyone else. After my amputation, I sat at home ashamed to go out because I was too concerned about my body. We have a swimming pool, and I was ashamed to even use it. Boy was I foolish! Don’t fall into the same trap. This false shame is in your mind. We are overly concerned because we fear what others will think about our appearance. I felt the same way until one night I was watching America’s Funniest Home Videos and saw the strangest thing I have ever seen. It was a dog running at top speed with two amputations, both on the same side! I thought it was strange, but do you think the dog did? Of course not. The dog was able to cope with his loss, and he was out in the back yard playing. He didn’t care that he was different. All he cared about was enjoying his life. We can learn a lot from a dog.

If you have these false impressions of yourself, try to work them out. There are many sources of help available, and you should not be afraid to talk about these problems with someone. Most amputees have felt some of these things, but they have gotten through them, and so will you.

I am a strong advocate of amputee peer counselling, and if you are fortunate enough to be visited by a trained peer counsellor, he or she will take the time to sit with you alone and enquire about your concerns. He or she will also take the time to speak with your family and your partner as well. As you are going through the grieving process, be aware that your entire family is also going through it. It is important to get these feeling out into the open and communicate them honestly. Otherwise, they will just fester and cause more harm to you, your family and your partner.

We all have the right to be the person we want to be, and the only person who can take that right away from us is our self. As someone who has counselled many amputees, I know that all of your difficulties will pass. It is up to you to thing about you and your life in a positive way to ensure that you have a productive future. It is easy to fall into the pit of self-pity, decide that you are worthless, and end up spending most or all of the rest of your valuable life hibernating. Don’t let this happen. If you need help coping, there are many resources that can be useful to you. If you have a peer counsellor, talk it over with him or her. After all, he or she has made it through the same thing that you are going through. You can too.

About the Author:
Saul Morris, PhD, is a below-knee amputee. He is educated in both psychology and medicine. He is a veteran naval commander and has served in both the Vietnam and Gulf wars. He is the founder and director of M-STAR (Michigan Society to Advance Rehabilitation), an organisation that provides amputee peer counselling to new amputees. He spends an enormous amount of time educating the medical profession about the value of amputee peer counselling and the psychology of amputation.

© 2004 Amputee Coalition of America. Local reproduction for use by ACA constituents is permitted as long as this copyright information is included. Organizations or individuals wishing to reprint this article in other publications, including other World Wide Web sites must contact the Amputee Coalition of America for permission to do so.