My mother was not one to be silent. How could she be? After all, she was raising six children, the youngest of which was me. I can still hear her yelling, “Ah, for crying out loud, would you (stay off my clean floor, clean up after yourself, turn down that music)” or some such command. Life was not easy for my mother. Dad died in his sleep of a massive heart attack when I was eight years old. This left Mom raising six children while working full-time as a secretary at the local hospital.

But my mother never did any real “crying out loud” despite her loss, pain, and hardship. Instead, she thanked God for what she had and suffered in silence. She was born just before the Great Depression and lived during World War II. My mother learned that loss is a part of life -- you don’t dwell on it, wear it on your sleeve, cry on someone’s shoulder, or wallow in self-pity. She and her family, neighbors, and friends all lived by the philosophy to grin and bear it, pull yourself up by the bootstraps, move on, help each other, and be thankful that you know where the next meal is coming from. When Mom yelled “for crying out loud,” I know now that this was her way of dealing with loss, pain, and other emotions she did not want to talk about.

Today, we know that it is much better to deal with emotions “head-on” rather than suffer in silence. This means expressing feelings in words and tears. I have learned from experience that friends, family members, and healthcare professionals can help by listening when you are ready to talk.

Feelings about limb loss

So what does this have to do with people who have limb loss? As a physiatrist, I know many patients who do not face their feelings and, instead, suffer in silence. People may do this because they are too upset to talk or do not know what to say, who to talk with, or how to express their feelings. And sometimes people stay silent because they have been taught that suffering is a part of life and something they need to live with. But beliefs like these can hurt your health.

While limb loss affects your life forever, it does not mean you need to suffer emotional or physical pain. It is true that your body is different -- your soul may ache and your dreams or plans may need to change. But keeping these feelings private can hurt, not help, your health. Suffering in silence can lead to thoughts of suicide (killing yourself), increased fears (such as losing your other leg), and reduced movement (maybe less walking because of pain). It can also lead to yelling, crying about things that do not matter, shopping or cleaning too much, taking too many pain pills, abusing alcohol, eating too much, or always being alone. The good news is that almost all these problems and worries can be fixed or eased once you let someone else know.

How people deal with feelings

As I described, people in my mother's generation were often taught to be proud, stoic, and suffer in silence. This changed over the years. People who grew up in the 1960’s and 1970’s were often taught that it is good to express yourself and “let it all hang out” when in pain or feeling upset. And those who grew up in the 1980’s and 1990’s tend to focus more on “me, me, me.” They learned, through watching television shows like Oprah and Phil Donahue, that there are ways to heal through self-expression.

I know these lessons well. Unlike my mother and those of her generation, I learned it is okay to ask for help when you are sick, dying, or feel your head is hanging off. My brother Billy died in a freak work accident when I was 20 years old and my mother died soon thereafter. I dealt with my feelings by talking to others about my loss and pain. This gave me comfort and helped me grow. As a result of talking about my feelings, I do not feel pain, regret, guilt, or frustration about parts of my life I cannot control.

The patients I treat agree that helps to express feelings. They say that it is much harder to feel better when alone at home in physical and emotional pain. And even when others tell you that “things will get better,” this does not happen when you spend all your time wishing it was otherwise or thinking “this should not have happened to me,” “this is unbearable,” “I don’t want to look like this,” “I want my leg back,” “I had other plans,” or “I don’t want to wear a prosthesis.”

Ways to express emotions

Rather than suffer in silence, here are some ways to express your emotions:

• Be present in today and take time to deal with issues. This means not just suffering in silence and hoping things will improve.
• Be proud and whole in body and spirit. This begins with accepting your limb loss and new life as an amputee. Not doing so can mean a lifetime of emotional and physical pain.
• Know that there is help. Talk with your physiatrist, prosthetist, and physical therapist if your prosthesis does not fit or is painful. They might be able to change the alignment of your prosthesis or prescribe medication to help manage your pain. Their goal, like yours, is to improve your comfort and function.
• Break the silence. First listen to yourself and then talk with others about what is spinning around in your head. You might want to talk with friends, family, and health professionals at your amputee clinic, other amputees in a support group, a trained counselor, or psychiatrist. Come up with a plan to find someone who will listen.

Talk with people who listen

It often takes a lot of coaxing (from me) and courage (from people suffering in silence) to talk with a trained counselor. Sometimes people complain, “The counselor didn't really say anything. I spent 45 minutes and big money, and I did all the talking. I don’t feel better so I’m not going back.”

I almost always side with the counselor when I hear this complaint. This is because the less that counselors talk, the more they listen. Talking with a counselor is not “feel good” therapy as much as it is “get the pain out” therapy. The goal is to get back to truly living your life. Seeking and getting help for what ails you is not for the light-hearted. It takes a lot of work to face your problems and overcome what keeps you from living the life you want. Often, your tears need to flow before the “aha!” can begin. And then you can start feeling better.

I see so many patients who cope well after limb loss. They are confident, have a “can do” attitude, and feel at peace. These are the folks who lead support groups, work, travel, and go to the gym to stay in shape and LIVE. These people have overcome their pain, function at a high level, and do not let physical or emotional problems destroy their lives. And perhaps not so strangely, people who do not suffer in silence are also the ones with whom I often enjoy the biggest laughs.