The Amputee War Casualty in a Military Hospital: Observations on Psychological Management

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Abstract
The psychological tasks facing the amputee war casualty change according to the phases of rehabilitation from wound healing through ambulation and the transition to civilian life. Psychiatric experience on the amputee ward in a military hospital over an eighteen month period, including individual and group psychotherapy, reveals that patient conflict over feelings of loss, guilt, dependency and anger are not uncommon. Impulsive behavior, social withdrawal, and lack of cooperation with recommended medical procedure may be symptomatic of earlier maladaptive responses to stress which have been exacerbated by the loss of a limb. Clinical examples are presented which highlight the importance of attachment to loved ones and magical wishful thinking in the experience of loss in the hospital setting. The psychiatric-orthopedic liaison helps to increase staff awareness of psychological processes so that the patient's emotional difficulties can be defined and minimized.

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