Some consider altered body image to be more of a "handicap" than their physical limitations.
This is the second half of an article that appeared in the August, 1996 issue of InMotion on Perceptions of Body Image by Amputees. Go to Part I
Often, the most significant event for someone who has had a surgical amputation, after the surgery itself, is receiving the first prosthesis. Acceptance of an artificial limb and one's attitude towards it are, in many cases, central to a sense of well-being and of self. Use of a prosthesis not only helps regain physical mastery and freedom, it also can lead to many emotional advantages. Greater acceptance of the physical impairment, feelings of social equality, enhanced independence, and a sense of security may all result from prosthetic use.
Most persons with amputation will incorporate their prosthesis into their self-image. In fact, many say they feel incomplete when not wearing it. Those who do not wish limb loss to be apparent will find an artificial limb is an excellent way to mask the presence of amputation and enable them to "fit in" better with others. Therefore, the cosmetic appearance of a prosthesis may be important to a sense of well- being.
Conversely, others may be perfectly at ease with an obvious physical difference, whether or not a prosthesis is worn. Depending upon unique circumstances, it may not make sense to use one. Comfort level is a highly individual matter. It is neither "better" nor "worse," nor any indication of emotional adjustment, whether or not one chooses to wear an artificial limb.
Note the differences in the attitudes of these two well-adjusted men:
Kent: "I regard the prosthesis as 'my leg.' I am a little self-conscious, just as everybody is. I'm sensitive about the cosmetic appearance of my leg. Some people don't even know I'm an amputee. Sometimes, out of the clear blue sky, someone will ask, 'Did you hurt your ankle? I noticed you are limping a little today.' A few who have known me for a year just recently found out that I had lost my limb."
Mark: "I consider my prosthesis an addition to my body, I don't mind being without my leg at all.
You may discover that you have two different body images of yourself one with your prosthesis, and one without it. If you have two different styles of prostheses (or if you choose to use crutches or a wheelchair), you may find your self-image is altered, depending upon which you use, and in what context you find yourself. For example: you may feel very comfortable at work wearing a hook, whereas you feel more comfortable wearing a prosthetic hand when out socially with others.
Relating Body Image to Self-Image
Self-perception makes a big difference in a sense of well-being and in enjoyment of life. Negative self-concept can lead to loss of the motivation necessary to proceed in rehabilitation. If distortions in your view of reality are not corrected, you may have problems adjusting to your prosthesis. The way you respond to physical changes in your body depends in part upon: your overall emotional balance, your life values, the priority you place on the lost limb, how well prepared you were for the surgery, responses received from family, friends, and colleagues, and meeting others who have successfully recovered following amputation and are enjoying their lives.
You may have difficulty accepting your body and assume that others do, too, even when this is clearly not the case. You may "project" your non-acceptance onto others, and thus needlessly alienate yourself. Compounding this after amputation, you suddenly find yourself lumped into the group of "disabled," with all of the social stigma this entails.
Some persons with amputation consider altered body image to be more of a "handicap" than their physical limitations. Individuals who have a poor self-image may use limb loss as an excuse for not doing more with their lives. "You can't expect much from me. I'm not like you; I'm an amputee." This self-pity and victim-like mentality are ways of defending oneself from failure and from reaching out to life. While this mentality may shield one from risk, it does not promote a rich, involved life.
Such attitudes contribute to poor self-esteem, depression, shame, and decreased quality of relationships with others. Studies have shown it is not actual appearance, but rather self-image that contributes most to feelings of self-worth. Body image and feelings of self-worth are highly influenced by each other. Have you ever had a good day, when you look at yourself in the mirror and feel great? Or, have you ever had a day when you were feeling depressed and hated what you saw when you looked in the mirror? Self-confidence and self-acceptance can be independent of actual appearance.
If you are self-conscious, you will be anxious about how others view and judge you. Being self-conscious is actually a state of great self-involvement, since you feel that all eyes are focused on you. When you are comfortable with yourself, you relax. You are relatively unconcerned by the evaluations and judgments of others. It may take months to years to integrate your altered body into your self-concept. As with other aspects of rehabilitation, there is no "correct" timetable for recovery. You will move at your own pace.
Learning to Cultivate a Positive Body Image
It is said that "beauty is in the eye of the beholder." Whether you look at yourself in the mirror on the wall or in the mirror of your mind, you are both the beholder and the beheld. How you feel about the way you look is more important to your self-esteem than your actual appearance. Therefore, it helps to alter those feelings which don't enhance your sense of well-being. Catch yourself when you are being self-critical and replace those messages with ones that are positive and enhance your sense of self. When you project yourself as comfortable and at ease with whom you are, others will tend to be more at ease, too. The benefits of cultivating a positive body image include the following: feeling at ease and less preoccupied by body image; enjoying your physicality, appearance, sensations, and sexuality; and no longer comparing yourself with artificial societal standards. In short, the overall result of a positive body image is acceptance and enjoyment of whom you are, with the body you now have.
When you have the courage to embrace your uniqueness as a human being, you will be comfortable and discover that the differences which distinguish you can be a source of strength and satisfaction.
About the Author
Ellen Winchell, Ph.D., is the former Amputee Coalition vice president for education and a frequent contributor to InMotion. She is the author of Coping with Limb Loss: A Practical Guide to Living with Amputation for You and Your Family, which can be ordered through the Amputee Coalition Resources form.