Emotional reaction
Every individual is different and people will respond very differently to similar situations. Researchers have identified some common reactions to amputation, although you or your loved one may react differently from what is described below. It is thought that a stressful situation can trigger depression for a person who is already sensitive due to biological factors.
Amputation can be very stressful for the amputee as well as family and friends. The circumstances surrounding the amputation play a major role. A person's reaction will depend on what happened, the personality of the amputee and the amount of support he/she is getting. Not everyone becomes an amputee. Some people are born without one or more of their limbs. Sometimes the person has been in pain for years, or the amputation is a life saving measure due to complications from disease.
Different situations command different reactions.
The amputee has lost a part of him or herself which challenges a previously acquired body image. They have to learn to live their life with a different definition of themselves. The new amputee will most often grieve for the lost limb and the old body image, and is thought to go through four or five stages as a part of their grieving process. This often resembles the way in which people usually respond to the death of a loved one or being diagnosed with a life threatening illness. People do not have to go through these stages in sequential order, or they might even skip a stage.
- Denial: Disbelief and pushing away, the person stays in the past. This can be helpful to cope with the initial shock of what has happened. If the person has been well prepared this may not occur. This is common among those people that lose a limb(s) in an accident (trauma amputation).
- Anger: Blaming the doctor or others around them. This stage is difficult to cope with for the family and friends but can be releasing for the patient.
- Bargaining: This is an attempt to postpone the reality of the loss and is most commonly experienced as bargaining with a higher power, such as a religious figure. Not commonly experienced with amputees.
- Depression: See the discussion below. Here the anger is replaced by a deep sense of loss.
- Acceptance and Hope: Eventually the person will come to terms with their loss and start living their life again. This is more easily achieved with help from friends and family.
Life events such as amputation, divorce or loss of a loved one, will leave us feeling temporarily depressed. This will happen to most people and is completely normal. It is therefore not uncommon for the new amputee to show signs of depression. If you are aware of the symptoms of depression you are more likely to be able to accurately interpret how your family member / friend is feeling and seek help if necessary. If the symptoms described below apply to your family member / friend or yourself, please seek professional help immediately.
There is an important distinction between feeling depressed, as we commonly understand it, and being clinically depressed. A clinically depressed person should seek professional help as soon as possible and see a psychologist or a psychiatrist.
The most common symptoms of clinical depression include persistent long-standing sad, anxious or empty mood, loss of energy, irritability, difficulty in concentration, sleeping either too much or too little, negative connotations about the environment and the future, and feelings of hopelessness. Thoughts, talk and threats of death or suicide should always be listened to and taken seriously.
Remember that these symptoms (apart from suicidal thoughts, talk or threats) on their own or in conjunction with other symptoms, may be experienced by everyone at some point, but do not represent a problem until they persist for more than two weeks or interfere significantly with daily life.
Depression can also take the form of bipolar disorder, which is characterised by periods of depression alternated by periods of elation or mania. This is less common, but by no means less serious.
Depression is not a sign of personal weakness and should not be seen as such. Snapping out of a state of clinical depression is not possible. Seeking help is often a sign of mental wellness, as the person recognizes that the feelings he/she is experiencing are interfering with everyday life. These feelings can make adjustment to loss more difficult. Depression is very treatable and the illness responds well to medication and other forms of treatment. It is therefore crucial to seek help as soon as possible if you or a family member / friend is experiencing symptoms of depression.
National Mental Health Association : What is depression
Kubler-Ross E., On death and dying (1970).
The Journey through adulthood: Bee, Helen. (1996)
Therapy for amputees: Engstrom, B., Van de Ven, C. (1999)