Mirror Shock: Viewing Self After Limb Loss

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By Wyona M. Freysteinson, PhD, MN

After a terrible car accident, Danielle saw her badly burned body and missing lower limbs for weeks while she was in the hospital. When she got home, she caught sight of a person she didn't recognize in a full-length mirror. When she realized that she was looking at herself, she says she felt numb: "I cannot be me in this body."

To people without limb loss, mirrors are simply tools for daily self-care such as shaving or applying makeup. One is no more aware of a mirror than a watch on a wrist or the fork used to eat. However, after suffering the loss of a limb, the mirror takes on an entirely different meaning.

In a qualitative study I conducted with a research team that included registered and clinical nurses, physical and occupational therapists, and physicians, nine women and eight men between the ages of 19 and 68 years old met in focus groups to discuss their mirror experiences after limb loss. "Mirror shock" was used to describe the initial mirror viewing for some participants. All participants experienced mirror anguish, a stage of torment, suffering, and focus on the missing limb. Over time, for some, this stage transformed into recognizing and accepting the new self in the mirror. Individuals who did not make this progression often avoided mirrors to avert feelings of discomfort.

Nurses and other healthcare providers appeared to be unaware of the mirror experience, which was not surprising as there were no mirror intervention guidelines, and that hospitals lacked full-length mirrors. Participants described mirrors in lobbies, hospital elevators, and other common areas, but mirrors to view lower-limb loss and incisions in private were nonexistent.

The study also suggested that the use of mirrors may lead to a decrease in wound infections following limb loss. Using hand-held mirrors to assess the residual limb may lead to a decrease in skin breakdown, and many participants indicated reflective surfaces helped them correct their gait and balance.

The findings from this study were used to develop two videos featuring eight individuals with limb loss. One video describes the stages of mirror viewing for the limb-loss community. In it, one man said, "If I am comfortable looking at myself in the mirror, I am comfortable anywhere." The other video teaches nurses how to intervene in mirror viewing in the hospital and the use of mirrors for patients' wound and skin care. Without training, offering a mirror to an individual who has just suffered limb loss can be frightening.

Three hospitals in Houston are testing the mirror educational intervention; initial results are that it allays patients' fears and improves their confidence. Two individuals with limb loss and nurse researchers have developed the Mirror Image Comfort and Acceptance Scale. For use in continued research, the mirror scale must be validated by 150 civilians with amputations and 150 veterans with amputations. Following the nurse education research study and validation of the mirror scale, research studies will evaluate if a nursing mirror intervention after limb loss improves mirror viewing and body image and decreases wound infections and skin breakdown.

 Wyona Freysteinson, PhD, MN, is an associate professor and graduate faculty scholar at the College of Nursing at Texas Woman's University in Houston. She can be reached at wfreysteinson@twu.edu. Individuals with amputations are invited to fill out the survey at www.psychdata.com, survey 184894.