Education and debate

Coping with loss: Surgery and loss of body parts

BMJ 1998; 316 doi: 10.1136/bmj.316.7137.1086 (Published 4 April 1998)
Cite this as: BMJ 1998;316:1086

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  1. Peter Maguire, directora,
  2. Colin Murray Parkes, consultant psychiatristb
  1. a CRC Psychological Medicine Group, Christie Hospital, Manchester M20 9BX
  2. b St Christopher's Hospice, Sydenham, London SE26 6DZ
  1. Correspondence to: Dr Maguire

    This is the fourth in a series of 10 articles dealing with the different types of loss that doctors will meet in their practice

    The loss of body parts can have distinct but overlapping psychological consequences. These can be bodily changes—alterations in the way patients, their families, and others perceive their bodies—or changes of function—alterations in the activities and roles that they are able to carry out. Some types of surgery affect one more than the other. Thus a unilateral mastectomy may have little influence on a woman's functional ability, but the effect on her body image will usually be profound. Most types of surgery, however, affect both form and function. Losing a limb is a clear example of this.

    Summary points

    The loss of body parts can give rise to grief for loss of body image or function, or both

    Anxiety, depression, and sexual problems are related to the magnitude and type of loss as well as the personal vulnerability of the patient

    Both avoidance of and obsessive preoccupation with the loss can be problematic

    Members of the caring professions can help to prepare people for the losses that are to come; reassure them of the normality of fear, grief, and their physiological consequences; introduce them to support groups; recognise and monitor any problems that may arise; and ensure that specialist help is given when needed

    Amputation of a limb

    The similarity between grief at loss of body part and grief caused by the death of a loved person has been clearly shown in comparative studies of the reaction to amputation of a limb and of widowhood.1 People with either of these losses were preoccupied with feelings of loss: bereaved people were missing the lost person and the amputees were missing the loss of physical attractiveness (loss of body image) or the occupational and …

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