When a part of our body is lost, we experience a grieving process much like a death. In her book On Death and Dying, Dr. Elizabeth Kubler-Ross has outlined five stages of the grieving process that occur in conjunction with dying. These stages, in the context of limb loss, are:

1. Denial and Isolation. "This is impossible. It’s not really happening! I feel nothing at all."
2. Anger. "Why is this happening to me? I’m enraged! God is unjust."
3. Bargaining. "If I promise to do such and such, maybe I’ll get my old life back."
4. Depression. "I feel hopeless. Everything is beyond my control. Why bother trying? I give up."
5. Acceptance. I don’t like it, but the amputation is a reality. I’ll find ways to make the best of it and go on."

The cycle of grief does not flow easily. Emotional recovery, like physical recovery, is based on your own timetable and other factors. These include: age, gender, circumstances of your limb loss (accident, disease, birth), how you coped with problems in your life before your limb loss, support or lack of support from family or friends, cultural values and norms, and socioeconomic factors.

The new amputee may experience feelings of depression that are difficult to ward off. What are these feelings and how can you work through them?

Signs & Symptoms of Depression

Loss of appetite, changes in eating patterns
Lack of energy
Sleeplessness or sleeping more than usual
Poor concentration
Diminished interest in enjoyable activities
Loss of interest in sex
Social withdrawal
Feelings of hopelessness, worthlessness, or inappropriate guilt
Emotions that are flat – expressed robotically rather than with feeling

Surviving Depression

Following are some suggestions for overcoming your depression, physically, emotionally, mentally, and spiritually.

PHYSICALLY

1. Get your rest. Each day get out of bed, get dressed, and, if possible, go out of the house.
2. Make sure you eat well – not too many sweets. Foods with sugar will give you quick bursts of energy then quickly let you down, taking you deeper into depression.
3. Get involved in physical and recreational activities that do not cause you pain. Exercise and gentle movement will release endorphins to help decrease depression.
4. Practice deep breathing. This will help relax muscles, decrease pain, and relax and focus the mind.
5. Decrease alcoholic beverage intake. Alcohol is a depressant. Eliminate other drugs that you use to self-medicate. If using prescription drugs, make sure you take them when prescribed.
6. Accentuate your best features; don’t focus on the loss. For example, if you have beautiful skin or eyes, a bright smile, a terrific figure or a great personality, this is the time to value your assets.

EMOTIONALLY

1. You are not alone.
2. You are not to blame. It is important that you feel the anger, because if you don’t, it will lead to depression.
3. Write letters and don’t mail them. Journal your feelings.
4. Increase contact with supportive family and friends.
5. Assert yourself and communicate clearly. Tell those around you what you need and don’t need. For example, you may need to expend less energy this year; conserve your energy. Go to a movie or rent a video, especially if the weather is harsh.
6. Tell your loved ones you are experiencing grief and talk about your loss together. This gives your loved ones the chance to express their feelings, since they, too, have to adjust to your loss. So don’t skirt around the issue, walk on eggshells or ignore the problem. Be honest and talk it out. This will give you and yours a greater chance to heal and adjust.
7. Remember, people want to help but often don’t know what to do to support you. So ask, ask, ask! You can remain independent – but let go of the controls for now. Allow others to give to you, so you can replenish your energy.
8. Explore the potential benefits of meditation, guided imagery and hypnotherapy.
9. Contact a support group. If there isn’t one in your area, contact the ACA office toll-free at 1-888/AMP-KNOW for information and help.
10. Laughter is a healer of depression, so add humor; make light of something that is serious, and laugh at yourself.
11. Get professional help if the depression becomes overwhelming and no small changes are occurring. Everyone needs help at some point in his or her life. Be a positive statistic. You are worth it. If finances are a problem, call your local mental health office or the ACA at 1-888/AMP-KNOW for information on financial resources. (See articles on funding beginning on page 84.) [Web Note: See Prosthetic Costs and Financial Assistance for Prostheses and Other Assistive Devices]
12. Most importantly, know that these feelings will lessen over time; however, for now, get support!

MENTALLY

1. Commit yourself to work with the medical staff, physicians, nurses, occupational and physical therapists, and prosthetists, even when you don’t want to.
2. Do not make big decisions such as beginning or ending a relationship, or buying or selling a house or car, when you are depressed. You may regret this later.
3. Go to a psychiatrist for evaluation and medication if necessary.
4. Seek alternative medicine, massage, acupressure, acupuncture and hypnotherapy for pain management, phantom pain, sleeplessness, anxiety and depression.
5. Replace negative self-talk about your body and life with positive cognitive messages.

SPIRITUALLY

1. Forgive yourself; don’t judge. Dr. Harold H. Bloomfield, co-author of How to Heal Depression, states, "The primary reason to forgive is for your peace of mind and the quality of all your future relationships. That’s what we do when we forgive – let go of the imaginary (but painful) control of the way we think things could be, and we untie ourselves from the burden of judging the way they are."
2. Learn to redefine yourself.

• Forgiveness. Keep your dreams and create a new definition of success.
• Accept support from loved ones while remaining independent.
• Make new rituals/memories thus creating hope for the present and future. A part of you is only physically gone or altered; the core of you is still the same. Make goals and objectives for the future and start small.
• If your religion or spirituality is important to you, become more involved with it.

Summary

Amputation is an enormous loss and learning to adjust is a process that takes time – so be gentle with yourself. Try not to isolate yourself or withdraw from people; use your experiences to build new memories and start new traditions to reach your goals. Sure, there will be adjustments for your disability along the road to success – but it is still your path. Who you are has not changed. Always remember, you are much more than your physical experience.

About the Author:

Omal Bani Saberi is an above-knee bilateral amputee. She is a licensed clinical social worker (LCSW) and a certified clinical hypnotherapist (CCHT) with Master’s Degrees in Social Work and Counseling Psychology. Currently, she is in private practice, providing mental health services, including counseling and psychotherapy. You may reach her by e-mail at OBSPEACE@cs.com

Resources

National Mental Health Information Center
1020 Prince Street
Alexandria, VA 23314-2971
800/969-6642 (Or contact your county mental health association)

How to Heal Depression
Harold H. Bloomfield, MD, and Peter McWilliams

Coping with Limb Loss
Ellen Winchell, PhD (Available through ACA – 1-888/AMP-KNOW)

On Death and Dying
Dr. Elizabeth Kubler-Ross (New York: MacMillan Publishing, 1969)

© 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.