The way in which an individual classifies themselves following amputation is deemed by prosthetists as having an important influence on their rehabilitation. The categorisation of patients in terms of their personal acceptance or non-acceptance of their amputation was prevalent amongst the prosthetists with labels such as “disabled” or “non-disabled” being used to describe individuals. The implication made was that patients who think of themselves as being “disabled” or “invalid” are less likely to make a concerted effort with the rehabilitation programme. In addition they were thought of as being more likely to rely on others than to try to be self-sufficient while other individuals who do not categorise themselves in this way are more focused and determined to help themselves:
Other people will say, ‘Well, I’m now an amputee, I’m going to sit here in my wheelchair and let everybody do everything for me’. It can be family influences, their wife or their husband, just takes over and does everything for them. They are now treated as an invalid and they will be for the rest of their life and they just fall into that role; they are now helpless and they need somebody to do everything for them, other people are so determined that they are going to lead a normal life that they’ll do everything they can to do that. They will spurn help from partners and family because they want to be independent and really, I don’t know what the trigger is for these people to go from one extreme to the other but there’s definitely that category. (Chris 123-131)
58 The prosthetists’ perception is that patients not only have a personal influence in the “role” which they play but also that distinct categories exist within their patient population. Once set, they view these characteristics as static within that individual rather than dynamic categories determined by personal, social or familial factors.
Similarly this classification was raised again in distinguishing between those patients who accept this identity label and those who do not. This is construed in negative terms suggesting that those who did classify themselves as “disabled” were less willing or able to facilitate their own rehabilitation and relied upon this disabled identity in order to justify their lack of physical activity:
you do get some people who don’t like to say ‘classified as disabled’ because they don’t think they are (…) Then you get the other people that feel they don’t get enough support from maybe Disabled Living Allowance and Benefits because they think they’re disabled and they can’t work and the DLA think they can. (Kate 385-390)
By using the term “disabled” to describe oneself the individual is perceived as negating any overt attempt to achieve goals in positive rehabilitation or as being less active than those who did not like to use this term or categorisation for themselves. The implication from the prosthetist is that not only do patients classify themselves but that this will have wide reaching influence on their lives, their rehabilitation and further into their life in general, such as work patterns or expectations of benefits. In addition this categorisation is considered to be enduring, with the individual being perceived as maintaining the properties of this category over a long-term period.
Positive categorisation is also used by the prosthetists to identify individuals who have reached what they would deem a successful or satisfactory level of rehabilitation. While those who struggle to cope may be assumed to be self-categorising as “disabled”, those individuals who are able to proudly present themselves to the world as a newly rehabilitated
59 individual living with amputation and are happy to display their prosthesis with little or no concern are deemed to be successfully rehabilitated:
so they’re actually just saying: I’ve had an amputation. I’ve got a prosthetic leg. Here it is. (Kate 212)
This would appear to reflect on the prosthetists’ own perceptions of what successful rehabilitation of self following amputation should entail and in turn reflects their clinical goals.
The perception of the prosthetists that such categories and personal identities exist gives an insight into their anticipation of how a patient will react to rehabilitation or the goals that they may have, based on the prosthetists’ own categorisation of them. The change from able bodied to disabled, as identified by the prosthetists, reflects a personal view on disability and on the disabled population as a whole. “Disabled” or “invalid” are used to describe the patients who they feel are not achieving a standard of rehabilitation that they as professionals and also as individuals would be willing to accept. Similarly “accepting” or “adjusted” are terms used to describe individuals on the opposite end of the spectrum who are unwilling to be limited by their amputation and who are perceived by the prosthetists as having overcome this obstacle. The division of individuals into one of these two categories appears to be pervasive. The dualistic and static nature of this perception of identity and the assumed implications on rehabilitation and outcome reflects a potential for a differing understanding to that of the individuals. Such differing understanding offers a circumstance in which clinical practice and individual priorities may differ. The personal reaction to amputation of the patients and the impact that this may have on rehabilitation is similarly linked to the second sub-theme of individual attitude and adjustment.
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