Volume 16 · Issue 2 · March/April 2006 | Download PDF
by Terrence P. Sheehan, MD
My mother was not one to be silent. But how could she have been raising six children, the last of which was me?
I can still hear her yelling, “Ah, for crying out loud, would you ______!” You can fill in the blank with any number of commands, including the following:
• Stay off my clean floor!
• Clean up after yourself!
• Turn that music down!
It wasn’t easy for my mother. When I was 8, Dad died silently in his sleep of a “massive” heart attack, leaving Mom with the job of raising six children, while having to work full time as a secretary in the basement of a hospital. Such loss, such pain, such hardship, but she never did any real “crying out loud.” She “sucked it up” as she was taught, thanked God for what she had, and, essentially, suffered in silence.
This is what she was taught within her family, within her neighborhood, and from her friends. “Loss is a part of life, and you don’t dwell on it, you don’t wear it on your sleeve, you don’t go crying on someone’s shoulder, you don’t wallow in your self-pity, etc.” This was the philosophy of my mother’s generation, and it was how she lived.
She was born three months before the beginning of the Great Depression, and then World War II followed. This was not a time to sit and chat; it was a time to “grin and bear it, pull yourself up by your own bootstraps, move on and help each other for the common good, and be thankful that you know where your next meal is coming from.”
Today, I understand that Mom’s rants of “for crying out loud” were just her way of venting other squelched emotions. I know now that loss and pain are difficult to express and that people express – or don’t express – these emotions and feelings in a variety of ways.
The most difficult, and probably the most healthful, way is to face them head-on through words, emotions and tears that show how you feel and why. If needed, this can be done with the help of friends, family members, and healthcare professionals.
Alternative ways of “facing” these emotions and feelings are yelling and crying about things that don’t really matter and shopping or cleaning excessively. Though these indirect methods of expression aren’t totally bad and do offer some relief to people, they don’t really help you solve your problems.
Harmful, indirect ways of “facing” these emotions and feelings include behaviors like overmedicating with pain pills, alcohol abuse, overeating, isolating yourself, and “suffering in silence.”
Dealing With Limb Loss
So what does all of this have to do with people who have lost limbs?
Well, as a physiatrist, I know that many of my patients do not face their loss, their emotions, and their feelings head-on; they, like my mother, continue to “suffer in silence.”
Some are having difficulty climbing out of the emotional wreckage of their lives and haven’t found a voice yet. Others suffer with physical pain and discomfort and don’t know how or where to ask for help. In fact, some do not even realize that they need to ask for help because they’ve been taught all of their lives that suffering is a normal part of life – that it’s just something that they have to live with.
Unfortunately, this belief can be especially dangerous for people with limb loss. Just because you have lost one or more limbs, it doesn’t mean you have to settle for an emotionally or physically painful existence.
Certainly, the loss of one or more limbs is a dramatic, life-changing event that probably altered forever many of your hopes and plans. Indeed, your body has been permanently changed and your soul probably aches. But still, you must protect yourself from further damage, and you cannot do so by “suffering in silence.”
If, for example, you are suffering from depression and do not seek help, the problem is likely to get worse and perhaps immobilize you or lead you to thoughts of suicide.
If you have already had to have one leg amputated as a result of diabetes, “suffering in silence” when you have an injury on your remaining foot could cause you to lose that leg as well.
If you have back pain from wearing your prosthesis and don’t ask for help, the problem might only get worse until you are no longer able to walk or use your prosthesis. And it might simply be a problem that can be fixed with a minor adjustment of your prosthesis or your walking pattern – if only you would seek help.
Learning to Reach Out
Understanding the era that produced the proud, stoic generation of human beings like my mother helps me understand why the idea of “suffering in silence” is acceptable to many of my patients who were raised during this period.
While the next generations would benefit from their parents’ “Grin and bear it” philosophy, they would also be the recipients of a message that their parents did not hear – “Express yourself.” The 60s and 70s said, “Let it all hang out,” and taught us that it’s important to express our pain and discontent.
Then there is the message of the 80s and 90s – “What about me, me, me?” Oprah and Phil Donahue have brought the American culture light years from the Great Depression era by combining this growth of self-expression with finding therapeutic channels for healing.
Today, I am thankful for the courageous attitude my mother embodied in the face of adversity and loss. But I’m also thankful for the years in which I was raised. I had my own losses to face. My brother Billy died when I was 20 in a freak work accident, and Mom died shortly after that from complications of a rare disease.
The message out there was, “Hit this straight on, talk about your loss, face the pain, console yourself, and grow.” And I did. As a result, today I don’t carry around bags of pain, regret, guilt and frustration about the life I can’t totally control.
I’ve moved into today with a freedom that my mother didn’t have because she didn’t have the tools that I was given. The thought of going to a doctor to talk about anything “mild” was not acceptable for those of her generation. You only sought out help when you were sick, dying, or your head was hanging off.
People tried to talk about the future with hope and encouragement. “Things will get better,” they’d say. Well, that “better” doesn’t come very quickly when you’re sitting at home in physical and emotional pain, holding on to bags filled with “this shouldn’t have happened to me, this is unbearable, I don’t want to look like this, I want my leg back, I had other plans, I don’t want to wear a prosthesis, I don’t want to walk like this, I feel like _________, I wish I ______ .”
For you to really be able to go on and be present in today, you need to take the time to deal with these issues and not just sit silently and hope that things will improve.
Be kind to yourself; go through your baggage and face each one of these emotions and physical complaints until you empty the bag. It ends and begins with an acceptance of your loss and this new segment of your life as an amputee, proud and whole (in body and spirit) again. Not an acceptance of a life paralyzed by emotional and physical pain.
There is help, and it’s important to find the help that you need. If your prosthesis does not fit or it is painful, find an amputee program to help you. In an amputee clinic, the physiatrist, the prosthetist, and the physical therapist will work together and try different techniques for helping you. They might, for example, change the alignment of your prosthesis to prevent the pain or prescribe special medications to help you deal with it. Their goal is to improve your comfort and function.
There are many ways to free yourself, and it starts with breaking the silence. I have the privilege of treating mostly people who are older than me. Thus, this whole cultural change toward expressing oneself that I absorbed when I was a child was missed by many of those I work with.
For those people and others, I would recommend taking the first step toward ending the silent suffering, which is listening to yourself and then talking about what is spinning around in your head. Face the physical and emotional pain. You can do this with friends and family, at an amputee clinic, in a support group, and/or with a trained counselor.
Then, come up with a plan.
You don’t necessarily have to go to a psychiatrist; you might just need someone who will listen.
I have repeatedly sent folks to try counseling, and they almost always come back with the same complaints: “He 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.”
It often takes a great deal of coaxing to get someone who is “suffering in silence” to go to a trained counselor. And when I hear these follow-up complaints, I usually side with the counselor. The more trained counselors are, the less they talk and the more they listen. This 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. It doesn’t feel good to stir up all of your painful issues, and things don’t suddenly un-stir when you leave the counselor’s office or the support group. It keeps turning until the tears flow and the “Aha!” occurs, and then it feels better.
Seeking and obtaining help for whatever ails you is not for the light-hearted; there is certainly work to be done if you are going to hit your problems head-on and overcome what holds you back from living and being what you want.
But I have to tell you that the functional outcomes are often outstanding for those who “cope” well after the loss of their limb. What returns is confidence, the “I can do attitude,” and the peace.
These are the folks I see running support groups, going back to work, traveling, and going to the gym so that they can stay in shape and LIVE. These are the people who overcome their pain, function at a higher level, and don’t let their physical or emotional problems destroy their lives. And perhaps not so strangely, these are also the people with whom I often enjoy the biggest laughs.
About the Author
Terrence P. Sheehan, MD, is the medical director for Adventist Rehabilitation Hospital of Maryland and the director of the Amputee Rehabilitation Program. He is also a member of the Amputee Coalition’s Medical Advisory Committee.