In her 1969 book "On Death and Dying," Dr. Elisabeth Kubler-Ross outlined the five stages of grief: denial, anger, bargaining, depression and acceptance. Though originally used to describe the way people deal with terminal illness or the death of a loved one, the stages can apply to anyone suffering a great loss--including amputation. Note that not everyone goes through all five stages, and the stages don't have to come in any particular order.
Denial
Denial is a refusal to accept the situation as it really is, and it can come before amputation or after. Pre-amputation, you may deny that this step is necessary, insist that your condition will improve and dismiss the idea that delaying amputation could harm you further. "I won't let you do this to me" is a common response, according to the "Amputees Guide to the Amputation and Recovery Process," written by two U.S. Army medical experts. Post-amputation denial, meanwhile, is more common among traumatic amputees than surgical amputees, who have time to process the loss before it even occurs, says Saul Morris, a double amputee who counsels others who have lost or are facing the loss of a limb. Denial after amputation doesn't mean pretending you haven't lost the body part. More likely, you'll acknowledge the loss but refuse to concede that it has any affect on lifestyle, self-image or well-being. "I'm just fine," may be your mantra.
Anger
Anger may be directed inward or outward. You may blame yourself for getting into this situation, or the doctors who tell you that there's no choice, or loved ones who you don't think understand what you're going through. The important thing to recognize, according to "The Amputees Guide," is that much of the anger stems from frustration over a lack of control. Don't stifle your anger. Let yourself experience it, get it out of your system, and move on. What happened to you can't be undone, no matter how mad you get.
Bargaining
Bargaining is a frequent response when people are first told that amputation will be necessary. You may try to "cut deals" with your doctors or with God, saying, "I'll do whatever it takes to avoid this." Such determination is admirable, and it can serve you well as you begin your recovery, but don't allow it to blind you to the realities of your condition. Amputation is a last resort; if there were a way to avoid it, your health-care team would be pursuing that option first.
Depression
Morris calls depression the most complicated stage for amputees. This isn't clinical depression, however; it's sadness, and it's a natural and normal part of the healing process. In "Applying Dr. Kubler-Ross' Theory to Amputation," Kim Doolan writes that the depression doesn't stem merely from the loss of the limb, but also from your dread about "impending losses"--things that you think you will lose because of the amputation. And it's common to exaggerate the effects amputation will have on your life, your work and your relationships. But once you begin to realize that, for example, your family will continue loving you, or that you will still be able to do your job just as well as before, the depression will begin to lift.
Acceptance
You're never going to look back on amputation and say you're glad you lost a limb. That's not what acceptance is about. It's about understanding that the limb is gone and it's not coming back. But it's up to you to take control of what happens from here on out.
