Whole again and how to get there: An anthropological study of experience and identity in cases of leg amputation

WHOLE AGAIN AND HOW TO GET THERE. AN ANTHROPOLOGICAL STUDY OF EXPERIENCE AND IDENTITY IN CASES OF LEG AMPUTATION. Oestergaard E; JCVU, University College Jutland, School of Physiotherapy, Skejbyvej 15, DK-8240 Risskov, Denmark. Homepages: www.jcvu.dk and www.efaa.dk

PURPOSE: How do people who have had one leg amputated experience themselves and their body in the period after the amputation and in taking up everyday life again? Do they become themselves again, whole again and do they feel integrated into society again? Which factors are important for this process? RELEVANCE: Physiotherapists should pay close attention to the manner in which prostheses are incorporated; to the profound identity issues raised by the alteration in the body; and to factors important for feeling whole again. PARTICIPANTS: Fifteen informants: nine people who had one leg amputated and then had prosthesis, and six health professionals (four physiotherapists, one doctor and one physiotherapy assistant). METHODS: Fieldwork for seven weeks in Denmark using participant observation: passive and moderate (n=6), active (n=countless); focus group discussion (n=1) and qualitative interviews: semistructured (n=19), unstructured (n=countless). The fieldwork took place at different locations. ANALYSIS: My analytical perspective was anthropological theory about �rites de passage� and about the body as a subject. RESULTS: All the informants felt whole and themselves again. For most of them, the prosthesis had been incorporated (after �-3 years), and now felt like a part of the person and of the body, extending the scope and active radius of touch and sensation. Most of the informants experienced that their body now could be absent, after it had demanded focus for a period of time. Most of the informants felt integrated into society again. CONCLUSIONS: In a ritual perspective, the informants had moved from separation through liminality to integration. Separated from earlier life, body, work and society; through liminality, in which they were no longer classified and not yet classified, not themselves, outside society and with an unknown future; finally integration in themselves, their body and society � now in a new state. Important factors were: to use the prosthesis as much as possible, to obtain and maintain phantom sensations, to do specific physical training, to experience success, to be recognized as a person, to meet other people with amputated leg(s), to get a job, to get a car and to have an independent everyday life. Future studies to recognize important factors in the incorporation process are relevant. IMPLICATIONS: The ritual perspective can be used in relation to crisis, diseases and handicaps. It inspires us to consider the individual human crisis in a society perspective, and it directs the attention to the characteristics of liminality and to the bodily aspect of reintegration into society. It is a way to look at the illness/life process and the new life, which gives meaning because people can see themselves in it. It is relevant for physiotherapists to work actively with incorporation of the prosthesis and the maintenance of phantom sensations. After having focused attention on feeling/sensing the body, this study points out another important aspect: leaving the bodily focus, letting the body become absent again allowing attention to be directed elsewhere. It is relevant to plan experiences of success; immediately after the amputation to request a visit from another person who has experienced amputation; and later to plan group activities. KEYWORDS: Amputation, incorporation of prosthesis, �rites de passage�, phantom sensations. FUNDING ACKNOWLEDGEMENTS: The work was unfunded. CONTACT: [email protected]

ETHICS COMMITTEE: The Regional Committee on Biomedical Research Ethics of Aarhus County, Lyseng All� 1, DK-8270 H�jbjerg, Denmark, fax +4589446111, www.aaa.dk/komite