In addition to the possible loss of certain bodily
functions, soldiers may experience other
psychological, emotional, cognitive, and physical
problems. Battle fears from persistent threats,
anxieties related to your military performance,
and emotional reactions to the overwhelming
experiences you have had may all contribute to
your struggles. Though any of these alone may
be enough to disrupt a person’s psychological
balance, combined with the loss of a limb or
any other part of your body, the trauma can
be especially devastating. The resiliency and
strength of each individual can be remarkable,
however, and acknowledging these feelings
does not in any way diminish these soldiers. In
fact the ability to share emotions, feelings and
perceptions may set the stage for future growth.
Most soldiers who must have amputations
were young and healthy before their war injuries.
Like many others, you may have only recently
married, you may be hoping to marry soon, you
may be a new parent, you may be single and
worrying about dating, or you may be wondering
what your future holds as far as education and
a career are concerned. Losing a limb has the
potential to affect all of these areas of your life
and, therefore, it may be extremely difficult to
deal with. Of course, there are many possible
ways to respond to this loss and trauma, and
soldiers’ responses may vary. Support from
family, friends and professionals, as well as
observing successful amputees as role models,
may help restore the balance.
Responses to Trauma
After your initial trauma and throughout your
rehabilitation process, you may experience
depression, anxiety, flashbacks, resentment,
anger, rage, fear, helplessness, hopelessness,
and the loss of body integrity. You may express
anger in many ways, and it is important to
understand that anger is a normal expression. If
you are suffering from depression or anxiety, you
may benefit from medication, psychotherapy and
professional support.
Some patients describe the loss of a body part
as similar to the loss of a loved one. However,
though a brief period of mourning for the loss
of your limb is considered normal, lengthy
mourning periods may cultivate additional
psychiatric responses, disrupt the rehabilitation
process, and hinder your ability to adjust to your
loss. Professional support can be beneficial.
Avoiding or denying the loss of a limb can for
some lead to persistent phantom pain. While
some amount of phantom and residual limb pain
is normal, if it interferes with sleep or function,
more aggressive treatment should be sought.
Unfortunately, the loss experienced by
amputees is not only the physical loss of a body
part but also the loss of your former appearance,
function, athletic ability, and hobbies. You may, in
fact, grieve more for the loss of these functions
than for the loss of your limb.
Following an amputation, you may
have many concerns. Some express
more concern about maintaining their
physical appearance, while others
express more concern about regaining
normal function. You may have fears
about social and personal relationships,
and you may wonder if your peers and
family members will accept you with an
amputation. You may also be worried
about the impact an amputation will
have on employment possibilities and
recreational activities.
Some patients fear that an amputation
will affect overall functioning in some
way. You may experience a fear of
falling, a fear of not being able to master
the use of your artificial limb, and a fear
of your artificial limb malfunctioning. You
may become very frustrated if these
problems actually occur, even if only
temporarily.
Changes in your physical appearance
may initially make it more difficult for
you to engage in personal relationships
and may have a significant impact on
your ability to view yourself sexually. You
may wonder if members of the opposite
sex will still find you attractive or if your
limb loss will be a “turn off.” If you are
an upper-limb amputee, you might even
have more specific questions about
weight-bearing during sexual activity.
If you have any of these concerns, it is
important that you discuss them with
your healthcare team before you are
discharged from the hospital. Additional
personal concerns may develop after
your return home, and it may be helpful
to ask for support then as well.
Family Responses to the
Patient’s Amputation
Many spouses and family members
have an overwhelming sense of
hopelessness in response to learning of
the serious injury of a relative. They may
feel stressed due to uncertainty about the
future, lack of control over the patient’s
rehabilitation, lack of information, lack
of support, and fear about or resistance
to role changes. Spouses may, in fact,
display more depressive symptoms than
the patients themselves.
In a 1984 study by Thompson
and Haran, primary caregivers (often
spouses) of amputees were often
more realistic about amputees’ abilities
and limitations than the patients were
(“Living With an Amputation: What It
Means for Patients and Their Helpers,”
International Journal of Rehabilitation
Research). Although patients in this
study initially welcomed discharge from
the hospital and the ability to return
home, caregivers were realistically more
apprehensive.
Family members may also respond
with denial and feelings of anger and
guilt. Their social interactions with
other family members and friends
may decrease due to their new
role as a caregiver and their added
responsibilities. Therefore, primary
caregivers of amputees may be prone
to developing depression, and they too
may need support from team members,
peers, other family members and
professionals.
Children of new amputees may
also face difficulties adjusting to their
parent’s limb loss. Your child might think
that your amputation is a punishment,
be concerned about your pain, fear that
it can happen to them, be concerned
that it is their fault in some way, fear that
it is contagious, or be afraid that you will
no longer be able to play with them.
The Importance of
Social Support
Social support is important during the
rehabilitation process. You may want
to vent your concerns about your loved
ones, your concerns about how you will
be perceived after your amputation, your
feelings about how to respond to stares
from others, and many other things.
It is important that a safe place be
provided where you can discuss such
anxieties, concerns, and personal
problems in confidence. The medical
staff may be able to alleviate some
of your anxiety by merely taking the
time to listen to you and understand
your fears. Whether they are from the
surgical, medical, nursing, or psychiatry
services, or whether they are physical or
occupational therapists, they may play
an important role in your psychological
rehabilitation. All staff members should,
therefore, be prepared to provide
emotional support to reinforce your
strengths and help you regain your
independence.
Visits from other amputees, especially
those who have had training in peer
support, can be extraordinarily helpful.
In fact, the members of the healthcare
team who continue to receive the
highest satisfaction rating from
patients attending the Amputee Clinic
at WRAMC are the volunteer peer
amputee visitors (PAVs).
Attendance in support groups can
also provide you with support from
others who have lost limbs and have
gone through an experience similar to
the one you are going through. This
type of support, along with group
discussions, can help facilitate your
acceptance of your limb loss. Group
therapy has been shown to be helpful
during Operation Desert Storm, the
embassy bombing in Nairobi, and the
conflicts in Iraq and Afghanistan.
Talking with others who have gone
through amputation themselves and are
living happy, successful lives can give
you hope for your own future. Seeing
amputees who are happily married,
who are employed in a wide variety of
occupations, and who are active in all
kinds of sports can change your entire
perspective on the possibilities that
are open to you. Once you realize that
there are others who have gone through
amputation and have returned to a
“normal” life, you will perhaps believe
that you can too.
—by Harold J. Wain, PhD
To learn more about other amputees
who are not merely surviving after limb
loss, but thriving, contact the Amputee
Coalition of America at 888/267-5669
for a subscription to inMotion magazine
and a copy of First Step – A Guide for
Adapting to Limb Loss.
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