by Edward Murphy, Psy.D.
BMR Psychology Associates

Mr. Jones is a 43- year-old who was diagnosed with diabetes at the age of 21. Despite his illness he was a high achiever, a successful family man and a business entrepreneur. However in May, he began to experience significant vascular difficulties relating to his diabetes. In July after seven surgical procedures, he underwent a traumatic above knee amputation of his right leg. While he showed a rapid physical recovery and was successful in learning to use an artificial limb, emotionally he was not recovering. He was experiencing significant symptoms of depression and his self-esteem had changed drastically. His family was unable in the beginning to understanding the impact of his amputation on his ability to adapt. 

Adjustment to physical disability, such as an amputation, is dependent upon a wide variety of social, psychological, and environmental factors. From a psychological point of view, a person's response to disability is related to their level of psychological functioning prior to their amputation. In other words, if they had difficulty coping with life problems and if they had low self-esteem prior to disability, they are likely to have more difficulty adjusting than previously well-adjusted people.

Environmental factors relate to the actual physical changes and obstacles that the new amputee must face, both at home and at the work site. Individuals whose amputation presents a handicap in their physical environment can have serious adjustment difficulties. Someone who has been physically active may be more seriously affected, particularly if their self-image is dependent on these physical aspects.

Many of us largely define ourselves by our careers. When vocational aspirations are affected by one's disability, adjustment may be tenuous. Luckily, technology has improved to the point where prostheses are more functional and work sites can be modified to accommodate physical constraints.

Social factors can often have the most profound impact on one's adjustment to disability. The family can play a pivotal role in the successful adjustment of the new amputee. Research suggests that the support of family members correlates with a positive adjustment. Friends can likewise make the return to the social sphere easier by showing their support and acceptance. Interviews with well-adjusted persons with disabilities suggest that families who respond empathetically to the person's feelings and maintain high levels of expectation for them are most helpful.

Family attitudes toward disability affect their ability to support the amputees' attitude toward him/herself. Many of the feelings that the amputee has, such as anger and depression, can be experienced by family members, often to a greater degree. Guilt is another common feeling, particularly for spouses for remaining healthy while their partner is not.

Family members can often be over-protective of the new amputee. This response, however, may stimulate feelings of weakness, low self-esteem and inability. It is more helpful for the family to express love and acceptance while encouraging the individual to return as quickly as possible to his or her previous pattern of functioning and activities.

Maintenance of family, social, and vocational responsibilities should be encouraged. Functional limitations can be treated in a matter of fact manner to further promote acceptance. This normal treatment model does not suggest that family members should ignore the feelings, fears, and questions that the new amputee faces. On the contrary, family members can aid the person's adjustment by listening to their concerns and allowing them to express negative feelings, particularly around the time of the amputation.

On the other side of the relationship, new amputees can be helpful to the family as it struggles to regain its equilibrium following such trauma. Speaking openly and freely about the amputation, body changes, and feelings will encourage family members to do the same. The new amputee can break the ice while talking about the amputation while family or friends might find this awkward or invasive. Asking for help when needed and being independent whenever possible can help alleviate family concerns about responsibility.

Amputees who have children should answer questions and be sensitive to children's' concerns about being cared for. Involving the children at each stage can help lessen their fear and anxiety. It is often the amputee themselves who help the family maintain a positive and healthy outlook. Returning to one's normal activities as soon as possible will promote adjustment within the family.

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