By Sarah Fitzgerald (Clinical Psychologist from Royal Talbot Rehabilitation Centre)
The loss of a limb can be devastating and is likely to cause significant disruption to many aspects of a person’s life. As well as the expected effect on a person’s mobility, independence and participation in day-to-day activities, it can also have a significant impact on one’s occupation, relationships, community and leisure involvement. Moreover, for some, an amputation can disrupt plans for the future and affect how they view themselves and the world. Amputees are often required to cope with ongoing health issues (eg. pain), learn new skills and sometimes even modify their expectations in relation to their capabilities. Therefore, the loss of a limb requires major adjustment, both for the person and their family/friends.
Feelings of shock, anger, frustration, sadness and grief/loss are all common and normal, particularly in the initial stages. People also tend to experience increased stress and worry (eg. due to financial strain), along with feeling a lack of control and a sense of isolation. Given the challenges people face, it is not surprising that symptoms of depression and anxiety are common. Studies have found that after an amputation the prevalence of depression and anxiety is as high as 41 per cent. Therefore, it is important that people take steps to tackle symptoms of depression and anxiety, as when left untreated they can have negatively impact on a person’s recovery and rehabilitation, and physical and mental health.
There are a number of things people and their families can do that may help to facilitate the process of coping, with some coping strategies below.
Amputees experience various challenges and will have different reactions and needs dependent on the stage of their journey. For example, the challenges after surgery vary compared with challenges faced by someone learning to use a prosthesis.
In the initial stages, amputees may experience emotions such as sadness, shock and anger. It may be useful to discuss these feelings with others. This could be with a trusted family member, friend, or professional. Moreover, reminders that such reactions are normal and will typically pass with time are also helpful.
The initial stages can also be stressful. Therefore, practical strategies for self-care are recommended. This includes ensuring one has adequate sleep and is maintaining a good diet. Furthermore, relaxation, breathing and mindfulness exercises are beneficial when experiencing increased stress. Should stress begin to disrupt one’s life, it is important that they seek support from a qualified professional. And, the earlier the better as mental health issues such as depression are treatable.
When one is faced with health issues and associated life changes, countless research has shown the significant role that social networks play in facilitating coping. This is also true for people following an amputation. Therefore, staying well connected to family and friends is valuable. Family and friends can often provide practical and emotional support, and can reduce the sense of isolation that is commonly experienced. Additionally, peer support, whereby one can observe and talk with other amputees who have “successfully” managed challenges, may also help with coping and reduce the fear of the unknown.
A lack of control over the situation is also frequently experienced following an amputation. A useful tip to manage this is being involved in your care by asking questions of the doctors, nurses and therapy team.
This allows the amputee and their family to gather the information required to tackle any concerns, reduce uncertainty and plan for the future, thereby creating a greater sense of control. Remember there is never a silly question!
Having goals to work towards, particularly during rehabilitation, is imperative. Goals should be meaningful to one’s life but also attainable and realistic and your therapists will be able to help develop such goals. Setting and achieving goals often provides people with a sense of purpose, structure, and improves confidence and self-esteem.
Similarly, having a daily routine and planned activities is a useful strategy that helps one to cope. It may keep people occupied, acting as a distraction, and prevents them from dwelling on their situation, which over time can be detrimental to physical and mental health.
However, one cannot always keep themselves busy. There will be times when worries pop up and may cause distress. Helpful tips for dealing with worrying thoughts include problem solving, taking action if able, relaxation, mindfulness and “letting go” strategies. It may also be useful to try to adopt an attitude of “taking things as they come”.
Amputees have found that maintaining a positive/optimistic attitude can help with coping. “Put things into perspective” and reminders of one’s achievements (both relating to rehabilitation/recovery and life in general) can encourage a helpful attitude. It is also beneficial to engage with a professional, such as a psychologist, to develop further coping strategies.
Finally, a key area in facilitating one’s coping following an amputation is to ensure they are able to again participate in meaningful life activities, to re-establish a sense of normality and self-worth. This includes important life role, such as caring for themselves, being a family member and returning to work, driving and hobbies. Having a prosthesis can assist with one’s integration back into such activities. Furthermore, we know from mental health research, participation in pleasant, community and social activities along with having a general purpose in life, are beneficial to one’s physical and emotional wellbeing. Lastly, re-engaging in life’s activities demonstrate to the amputee and their family that the loss of a limb does not define them.
Adjusting to an amputation takes time and people experience a variety of emotions throughout the journey. Utilising practical strategies such as self-care, staying in touch with support networks and being informed and involved in the recovery process can all facilitate the process of coping, leading to positive health outcomes.