Section III: Amputation, Loss of Mobility, Disfigurement

Mourning and Acceptance

Goals of the Exercise

1. Verbalize feelings about the injury.

2. Verbalize an understanding that losing a limb, the ability to walk, stand, or hold a child, and/or bodily disfigurement is a loss that must be grieved.

3. Accept the nature of the injury and understand its psychological and physical consequences.

4. Learn to compensate for any physical, occupational, interpersonal, and/or social limitations that the injury may create.

5. Return to pre-injury levels of self-esteem and confidence.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veteran/Service Member

The “Mourning and Acceptance” activity is designed for use with veterans/service members who, as the problem topic indicates, have experienced severe and long-term/ permanent physical injuries. Follow-up or concurrent interventions could include encouraging the veteran/service member to create a personal mourning ritual; assigning the veteran/service member to contact the Disabled American Veterans (DAV) or the Military Order of the Purple Heart (MOPH) for practical assistance in dealing with the Department of Veterans Affairs (VA); bibliotherapy using books listed in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner; videotherapy using The Waterdance or another film on the topic of “Chronic Illness and Disabilities” suggested in Rent Two Films and Let's Talk in the Morning, 2nd ed., by John W. Hesley and Jan G. Hesley, also published by John Wiley & Sons; encouraging the client to do volunteer work with disabled children or the elderly; and reporting back to the therapist/therapy group on actions related to this assignment and their outcomes.

EXERCISE III.A Mourning and Acceptance

What is the most effective response to the life-changing loss of the function of a part of one's body, or the loss of that body part itself? How do people best adapt to this situation?

It may be useful to think about similar situations, either ones you've encountered or ones experienced by other people whose experiences may serve as a guide. From these sources, you may be able to learn both what strategies will serve you, and what mistakes or mental and emotional traps to avoid. This exercise is designed to help you deal with this issue and, hopefully, find the methods and resources that will enable you to achieve the best quality of life possible.

1. As with any process or journey, to reach your goal you must start with the here and now. No one else can truly know how you feel or what you think about the injuries you've experienced, even if they have suffered similar losses—each person and each situation are unique. The first step is to express to yourself, to your therapist, and to any other people working to help you achieve your goals, your thoughts and feelings about your injury. Please use this space to write down the most important facts and emotions that come to mind for you when you consider your current situation:

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2. Although no one else knows exactly what your thoughts and feelings are about your injury, it's also true that many people have had to deal with similar losses, as noted in this assignment's introduction. Why is this important? Because you may be able to tap into some of the lessons they have learned. Some of those people might not have experienced injuries similar to yours, but may have gone through losses with the same kinds of impacts on their lives, despite the types of injuries or if they happened differently. There are people who may never have had some or all of the things you've lost, or people who have had similar losses but whose losses took place more gradually, as the result of a chronic illness or aging. What situations come to mind that might present people with parallel challenges to the ones you're dealing with due to your own injury?

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3. A common thread running through all these situations and experiences is loss—each of them means that some abilities and experiences are either taken away or were never there for the person involved. To deal with any loss effectively, a person needs to start by acknowledging its reality and letting it sink in—in other words, by mourning. You may have been advised to beware of self-pity, and that is sound advice, because self-pity can be a trap that keeps a person miserable for life—but healthy mourning is not self-pity. Please think of someone you respect and admire, and think of a loss that person has experienced. How did he or she cope with the reality of that loss?

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4. There seems to be something in human nature that leads us to create rituals or ceremonies to mark losses and other major life changes, so-called rites of passage. Our society has clear-cut ways of mourning some kinds of losses—a funeral or wake is a good example—but not others. You might find it helps to create a private mourning ritual of your own. Please use this space to describe what that ritual might consist of for you:

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5. Now, think about what you've done after other losses in your life, or what you've seen done by others to whom you can relate. The ultimate goal of mourning is not only to accept a loss, but to move ahead with life and regain peace of mind and the ability to be happy. To do this—it helps to bring as much satisfaction into your life as you can—here are three things you can do:

a. List at least three activities you enjoy that you can still do:

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b. List at least three activities you enjoyed at an earlier time in your life but stopped doing, which you can return to and do again:

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c. List at least three activities you've always wanted to try but haven't yet, that you can still do:

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Choose one activity from each list and make a commitment to yourself and to your therapist that you will engage in those three activities at least once each within the next month.

Be sure to bring this handout back to your next session with your therapist, and be prepared to discuss your thoughts and feelings about the exercise.

What Makes Me Who I Am?

Goals of the Exercise

1. Accept the nature of the injury and understand its psychological and physical consequences.

2. Learn to compensate for any physical, occupational, interpersonal, and/or social limitations that the injury may create.

3. Verbalize an understanding and acceptance that outer “beauty” is diversely defined and that physical scars do not detract from a person's inner beauty and strength.

4. Return to pre-injury levels of self-esteem and confidence.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “What Makes Me Who I Am?” activity is designed for use with veterans/service members who, as the result of severe and long-term/permanent physical injuries, are struggling with problems of self-image based on their former physical capacities or appearance. Follow-up or concurrent treatment activities could include bibliotherapy using one or more of the books listed for this issue in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner and/or videotherapy using The Waterdance or another film on the topic of “Chronic Illness and Disabilities” suggested in Rent Two Films and Let's Talk in the Morning, 2nd ed., by John W. Hesley and Jan G. Hesley, also published by John Wiley & Sons.

EXERCISE III.B What Makes Me Who I Am?

In our mainstream culture today, we tend to be swamped with the message that who we are is based on how we look. If we are young, fit, and attractive, we are meeting the expectations we've been encouraged to set for ourselves, and if we aren't, the message we get is that we are “less than,” or not up to the standards of that culture.

Most of us are confronted with this issue sooner or later, normally as we age—and although that is a gradual transition for most of us, giving us quite a bit of time to adjust, many still struggle with accepting the inevitable loss of youthful physical abilities and appearance. For people whose bodies and lives are suddenly and traumatically changed by serious injuries, it's an even harder transition. Still, we're the same people inside no matter how our outward appearances change, and it's vital to our quality of life to find ways to keep that in mind. The purpose of this exercise is to share some ways that many people have succeeded in doing just this.

1. Sometimes, to see where we're going it can help to see where we've been—where we come from. With that thought in mind, please list some important qualities in yourself that have always been part of who you are (e.g., things that make you laugh, things you've always liked and disliked, interests you've held throughout your life):

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2. Think of someone you've admired and respected for much of your life. This could be a family member, a longtime friend, a neighbor, a mentor such as a teacher or the coach of a sports team, a member of the clergy, and so on. Once you have someone in mind, please use this space to list qualities about that person that have been consistent throughout the time you've known him or her and that you can expect to remain constant in the years ahead:

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Do you think that your admiration and respect for this person would change because his or her physical appearance and abilities changed, whether due to age, illness, or injury?

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3. If you're like most people, you've thought from time to time about what your own life might be like in old age. When you imagined your long-term future, what kind of life and activities did you picture for yourself, and what parts of that picture could you achieve regardless of the physical limitations resulting from your injuries?

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4. There is a saying that has been useful to many people, in many situations, and one that would apply in your situation as it does in a variety of others:

I am not my thoughts; I am the person who thinks the thoughts, but even when those thoughts change, I will remain who I am.

I am not my emotions; I am the person who feels the emotions, but even when those emotions change, I will remain who I am.

I am not my actions; I am the person who takes the actions, but even when those actions change, I will remain who I am.

To this we can add:

I am not my body; I am the person who lives in this body, but even when this body changes, I will remain who I am.

With this in mind, what do you see in yourself today that remains the same, regardless of any changes in your thoughts, in your emotions, in your actions, and in your body?

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5. To complete this exercise, look at your answers to questions 1, 3, and 4, and use this space to list the items from those answers that you think will continue to be true in the years ahead—regardless of any physical changes:

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Be sure to bring this handout back to your next session with your therapist, and be prepared to discuss your thoughts and feelings about the exercise.