ISSN 2477-1686
Vol. 11 No. 42 September 2025
Psychological Adaptation to Amputation and Prosthesis: How Indonesian Mental Health Professionals May Help?
Author:
Arqasha Putra Hardiansyah, and C. Mathilda V. Bolang
Fakultas Psikologi, Universitas Pelita Harapan
Introduction
In Indonesia, around 9 million people from the total population are affected by limb loss. By 2023, approximately 196 thousand noted casualties from traffic accidents have been recorded, making it one of the leading causes of limbic loss (Mughnie, 2019). According to Wahid, their statistical data in 2020 showed that Indonesia is the largest motorcycle market in the world and ranked the 2nd country out of 10 in the world with the highest motorcycle accidents and deaths number (Wahid, 2020). This article is therefore considered important as it provides documented proof on the psychologically debilitating effects that a person may experience after amputation and during recovery. It also offers eye-opening information that can help raise awareness among helping professionals, such as counsellors and psychologists, about the urgency of providing psychological treatments for amputees to support them through their mentally challenging times.
Adapting to sudden disability varies by individual resilience and tolerance. Prosthetic fitting, if accessible, is lengthy, and limb loss often disrupts daily functioning, triggering negative moods. Severe cases may involve Post-Traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder (GAD), depression, and grief. Amputation brings massive shock and post-traumatic stress, as individuals adjust to their new reality. According to Lazarus & Folkman’s stress appraisal theory, within their journal of Appraisal, coping, health status, and psychological symptoms (1986), amputees face constant awareness of loss and harm. This appraisal—evaluating and reacting to their condition—can be especially challenging for those lacking understanding of medical procedures, complicating emotional recovery throughout the rehabilitation process.
A study conducted by Şimsek (2020) also revealed five psychological post-traumatic effects of amputation:
· A noted affectional and behavioural change to the individual post-amputation
· A decline in self-esteem and a considerable degradation of body image
· Changes in familial and social relationships and situations, as individuals become more dependent on their loved ones for support
· A shift in general thoughts about the future, or moreover, the lack of it. Some cases from the original study indicate that amputees perceive their future as meaningless and increasingly pessimistic.
· An evident need for mental support, as evidenced by statements from individuals undergoing post-amputation grief. Many patients describe feelings of loneliness and uselessness, which not only affect their mental well-being but can also lead to severe psychological distress.
Unfortunately, there are many gaps and barriers existing within Indonesia’s pre-existing social and institutional structures. Prevalent issues experienced by many individuals that seek mental support that was conducted by a group of researchers (Munira et al., 2023) had found that there are around three key noted problems; an uneasy and tedious task of accessing mental healthcare facilities that have already existed in the population, an existing stigma and lack of social support in their circles, and the expensive costs that come from the medical facilities without a commitment to the national health insurance membership.
Theory & Explanation
Bradway et al. (1984) identified four psychological stages in adapting to amputation.
1) Pre-operative stage – Patients confront the reality of losing a limb, often experiencing grief and anxiety. Those aware of an upcoming amputation may worry about pain, finances, health, functional capacity, and even sexual ability.
2) Post-operative stage – Occurring immediately after surgery, this short phase involves realizing the limb is gone. Reactions vary depending on background and cause of disability. Bradway (1984) noted that military amputees often develop optimistic outlooks, while those losing limbs due to accidents or negligence tend to become pessimistic.
3) In-hospital rehabilitation – This stage reinforces the reality of loss while focusing on prosthetic fitting, therapy, and physical recovery. It is considered the second most difficult phase due to the emotional impact of hospitalization. Denial often gives way to grief, with patients sometimes exhibiting regression, withdrawal, or euphoric moods to avoid confronting anxiety about their new life. Bradway described “pinning” as grieving both the lost limb and the life roles it represented.
4) Return home – The final stage, continuing throughout life, involves transitioning from hospital care to independent living. With reduced support, patients must adapt to daily challenges. Success depends on self-reliance; failure to adjust may result in ongoing self-hatred. Understanding these stages can guide mental health professionals in providing timely, targeted interventions to support emotional recovery, resilience, and reintegration into daily life for amputees (Bradway et al., 1984).
5) The final stage is one that most patients will experience for the rest of their lives—the transition back home. After struggling to adapt to hospital life, the patient must now achieve a level of independence away from any nearby hospital. With a significant decrease in supportive care, they are essentially "forced" to confront a harsher reality. This stage is a true test of self-reliance and is recognized as a crucial turning point by Bradway himself. Depending on the patient’s ability to adapt, they may either learn to live with their disability or become trapped in a vicious cycle of self-hatred. In response to this challenge, an important question arises: How can Indonesian mental health professionals help?
Solution and Path to Recovery & The Role of Mental Health Professionals
The traumatic experience of amputation and subsequent loss of a major limbic body system can be very specific, and though family and friends may come to sympathize and extend their support, many people living with their disability may have trouble connecting and opening up with their affliction. This is where the help of mental health professionals is greatly needed.
Mental health professionals’ main role in the treatment of amputation patients is to improve psychological adaptation by normalizing patients’ emotions and experiences related to amputation, and to equip the patients with adaptive coping mechanism skills (Jo et al., 2021). They also play an important role in encouraging communications between patients and therapists within a multidisciplinary treatment. Furthermore, Jo et al. (2021) highlights that it is highly important for mental health professionals to have an in-depth understanding of the psychological characteristics and outcomes of patients with amputation, as explained in the previous section, before performing their roles. Explained in the following section are forms of supports that mental health professionals can do for amputation patients:
1) Preoperative stage – Mental health evaluations before amputation help reduce psychological distress. Healthcare providers should monitor emotional responses, identify needs for psychological support, and refer to mental health professionals when appropriate.
2) Immediate postoperative stage – Within hours or days post-amputation, patients may experience anxiety, fear, or emotional numbness due to safety concerns, pain, or trauma (Silander, 2018). Families may also face shock and stress, often hiding their struggles to protect the patient. Professionals should validate emotions, encourage open expression, and support both patients and families.
3) In-hospital rehabilitation – Anxiety often increases from body changes, pain, prosthetic fitting, medication, and fears about social/professional reintegration (Darter et al., 2018; Desmond, 2007). Early rehabilitation can benefit from motivational enhancement and solution-focused brief therapy, while later stages may use CBT, mindfulness, and ACT to foster adaptation.
4) Return to daily life – Patients may face employment worries, social acceptance issues, and relationship adjustments (Klerman et al., 1984; Markowitz & Weissman, 2004). Dependence on others and frustration may emerge, especially for former primary providers. Interpersonal therapy helps address grief, role transitions, interpersonal sensitivity, and conflicts, recognizing that distress often stems from social and relational challenges.
Conclusion
Though painful and a harrowing experience, the process of amputation is much more than the hospital visit and the surgical appointment and has a lasting effect on the amputee after leaving the hospital. Their path to recovery will require their own motivation and desire to get better, like many other people who follow recovery stages from medical afflictions or addictions.
Observation and support must be focused on a long-term time window, creating an inclusive environment as well as opportunities that allow them the freedom to heal and improve themselves both physically and psychologically. Many amputees with more financial difficulties must be presented with alternative recovery options to avoid feelings of hopelessness and despair and understand that help will always be available if they have the power to seek it out themselves.
Bibliography
Bradway, J. K., Malone, J. M., Racy, J., Leal, J. M., & Poole, J. (1984). Psychological Adaptation to Amputation: An Overview. Orthotics and Prosthetics, 38(3), 46-50.
Darter, B.J., Hawley, C.E., Armstrong, A.J. (2018). Factors influencing functional outcomes and return-to-work after amputation: a review of the literature. Journal of Occupational Rehabilitation, 28, 656–665. https://doi.org/10.1007/s10926-018-9757-y
Desmond, D. M. (2007). Coping, affective distress, and psychosocial adjustment among people with traumatic upper limb amputations. Journal of Psychosomatic Research, 62(1), 15–21. https://doi.org/10.1016/j.jpsychores.2006.07.027
Emotional recovery. (2025, February 23). Amputee Coalition. https://amputee-coalition.org/resources/emotional-recovery/
Folkman, S., Lazarus, R. S., Gruen, R. J., & DeLongis, A. (1986). Appraisal, coping, health status, and psychological symptoms. Journal of Personality and Social Psychology, 50(3), 571-579. https://doi.org/10.1037//0022-3514.50.3.571
Jo, S. H., Kang, S. H., Seo, W. S., Koo, B. H., Kim, H. G., & Yun, S. H. (2021). Psychiatric understanding and treatment of patients with amputations. Yeungnam University journal of medicine, 38(3), 194–201. https://doi.org/10.12701/yujm.2021.00990
Klerman, G. L., Weissman, M. M., Rounsaville, B. J., & Chevron, E. S. (1984). Interpersonal psychotherapy of depression. Basic Books.
Markowitz, J. C., & Weissman, M. M. (2004). Interpersonal psychotherapy: Principles and applications. World Psychiatry, 3(3), 136–139.
Mughnie, B., Annisa, G. N., & Adyas, A. J. (2019). The effect of educational counseling on the knowledge of the amputee in using and caring the prosthesis. Interprofessional Proceedings Collaboration on Urban Health, 2(1), 198-204.
Munira, L., Liamputtong, P., & Viwattanakulvanid, P. (2023). Barriers and facilitators to access mental health services among people with mental disorders in Indonesia: A qualitative study. Belitung Nursing Journal, 9(2), 110-117. https://doi.org/10.33546/bnj.2521
Silander, N. C. (2018). Life-changing injuries: psychological intervention throughout the recovery process following traumatic amputations. Journal of Health Services Psychology, 44, 74–78. https://doi.org/10.1007/BF03544666
Şimsek, N., Öztürk, G. K., & Nahya, Z. N. (2020). The mental health of individuals with post-traumatic lower limb amputation: A qualitative study. Journal of Patient Experience, 7(6), 1665-1670. https://doi.org/10.1177/2374373520932451
Wahid, O. (2020, January 30). 10 countries with the highest proportion motorcycle-related deaths. BikesRepublic.com. https://www.bikesrepublic.com/english/archive/10-countries-with-the-highest-proportion-motorcycle-related-deaths/
