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Applying Dr. Kubler-Ross’ Theory to Amputation
By Kim Doolan  "Depression, anger, existential questions--"why
me?"--and finally, acceptance," is how Army Lt. Col. Alfredo
Montalvo, a psychiatric clinical nurse at Brooke Army Hospital,
Fort Sam Houston, Texas, describes the emotions of soldiers who
have undergone recent amputations. "It isn't that smooth. Sometimes
they may jump back to anger, depression. There's good days; there's
bad days."
When I saw this interview last December on The News Hour, I was
intrigued that Lt. Col. Montalvo chose the words he did because
they come from Dr. Kubler-Ross's study, On Death and Dying. I
believe Kubler-Ross's approach is extremely helpful to someone
coping with limb loss. My adoption of it began in the early 1990s
when I read a medical journal blurb about criteria life insurance
companies used to assess rates. Death of a spouse, loss of limb,
death of a child, divorce, and buying a home made the list of
life's traumas that companies felt they could charge more for. This
was the first time I equated the experience of amputation with
grieving. However, once put in such a context, and remembering my
own surgeries, I realized I might have coped better if I'd had this
perspective.
Helping Your Patients
You may choose Kubler-Ross's approach to help your patients deal
with their bereavement. Most will have some knowledge of the five
stages involved, and others may find the theory logical and be able
to apply it to feelings they had after the death of someone dear.
Once people have this new frame to put around their emotions, those
emotions won't seem as unexpected or bewildering.
Many other aspects of their lives have spun out of control, but
they often find that this area, at least, has some pattern and
predictability.
The Five Stages of Grieving
Although Dr. Kubler-Ross writes about terminal illness,
correlations exist when one is living with limb loss. This is why
similar feelings are experienced in both circumstances and can be
outlined in certain stages:
Denial and Isolation: Disbelief and the need to
withdraw are typical initial reactions. Although hard for
caregivers to understand, this stage can "function as a buffer"
providing time "to mobilize other, less radical defenses."
Anger: Rage aimed at whoever is nearby can make
new amputees unpleasant to be around. However, you may find this is
a stage of increased energy, and you may want to encourage your
patients to channel it constructively.
Bargaining: Much of this is experienced
privately, but it is important to keep in mind that "the bargaining
is really an attempt to postpone" and "psychologically, promises
may be associated with quiet guilt."
Depression: Sadness is felt over the immediate
loss of limb and the worries grow of what the "impending losses"
may be. You can help by giving realistic encouragement about the
expected function the amputee will regain.
Acceptance: "The pain has gone; the struggle is
over" at this point. Most amputees are never happy that they've
lost a limb, but they are now able to think of it without plunging
into one of the other stages.
Just as Lt. Col. Montalvo said, not all people go through all
the stages, nor do the stages necessarily go in order. However, Dr.
Kubler-Ross' theory may give you another way to reach out to your
patients.
Kim Doolan works as clinical coordinator at Allen Orthotics
& Prosthetics Inc., Midland, Texas; public relations
coordinator at Aesthetic Concerns Prosthetics Inc., Middletown, New
York; and volunteers for Hospice. 
Table Of Contents - February 2004
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