ACADEMY SOCIETY SPOTLIGHT: Negative Media Portrayal of Characters With Amputations

Social Interactions After Limb Loss Being treated like everyone else and being accepted by friends and family are important to the emotional well-being of the person who has suffered limb loss. However, people living with limb loss often have negative social interactions with those who do not have an amputation, with studies reporting that post limb loss, strangers, friends, or family acted differently either by staring, avoiding eye contact, or asking intimate questions. 1 These interactions often left those with limb loss feeling stigmatized and uncomfortable. Reactions from others were more negative if the person was not wearing a prosthesis, such that he or she was suddenly viewed as a "cripple" to be taken care of. 1 These exchanges caused such anxiety that the respondents would go out of their way not to be seen without a prosthesis or to appear as if they still had all their limbs. 1-3 Further, many people with amputations reported offensive social interactions, which led them to hide their prostheses or refuse to take them off to combat stigma and prejudice. 2,3 These societal interactions may add to the already traumatic experience of losing a limb and may increase rates of depression, anxiety, and low self-esteem. 2 In turn, compliance with prosthetic treatment and quality of life may be sacrificed. The Media's Role in Reflecting and Impacting Social Perceptions Most people living in the United States today have access to and watch mass media daily. The impact of this exposure and the effects of the messages presented have been studied. Researchers have found that public attitudes and perceptions are founded on observational learning, of which media plays a large part. 4,5 Some of these studies have focused on people with disabilities in general. However, when it comes to people with limb loss specifically, few studies have been performed. The portrayal of people with disabilities has been predominately negative and unrealistic, which has resulted in stigmatized treatment from able-bodied people and even from themselves. 4,6 These negative attitudes are expressed through anxiety, pity, segregation, apathy, and embarrassment; yet these attitudes can be changed. 4-6 One study found that when the subjects were shown positive clips of characters with disabilities, they experienced positive perceptions and feelings. 5 Mass media has been shown to both reflect and impact society's perceptions of people with disabilities. 4 There has been increased media representation of people with limb loss, such as inclusion in reality shows like Dancing With the Stars , movies such as Mad Max: Fury Road and Kingsman: The Secret Service , and news coverage of the Boston Marathon bombing victims. This could be attributed to the advent of new, futuristic prosthetic technology and/or to news and reality television highlighting achievements of veterans and athletes with limb loss. This additional coverage could indicate an increased awareness of the struggle and/or an increase of stereotypes this population experiences. Users of Archaic Prostheses Negatively Portrayed in Movies Recently proposed policy changes for reimbursement (e.g., the Draft Local Coverage Determination for Lower Limb Prostheses that was released in July 2015) would limit prosthetic technology for Medicare recipients with amputations to more antiquated designs. The effect of such policies on how people with amputations may be viewed by society can be studied by analyzing how people with amputations are portrayed in movies. Classic villains such as Captain Hook, Darth Vader, and the one-armed antagonist in The Fugitive are a few examples of how characters with amputations have been negatively portrayed in past movies. These characters utilize an array of prosthetic technologies ranging from archaic (Captain Hook) to futuristic (Darth Vader). In contrast, heroes with amputations represent positive portrayals and have also been seen using antiquated, modern, and futuristic prosthetic technologies. Therefore, establishing a relationship between the prosthetic technologies being used in the context of how the character is being perceived would provide insight into the context in which society and the prosthesis user may be viewed based on prosthetic technology utilized. A recent study I coauthored revealed that characters wearing antiquated prostheses were more often portrayed as villains. 7 Movies were selected by searching the IMDB database for feature films released in theaters in the United States between the years 1965 and 2015. A content analysis codebook and coding form was used based on Neuendorf to quantify variables of interest. 8 All variables were determined before the official coding process began to reduce biases and invalidity. An intercoder reliability test was performed to ensure the reliability of the context codebook. Out of 115 movies viewed, 50 movies that included villainous or heroic characters with antiquated/archaic or modern prostheses were analyzed for content. A chi-squared analysis was conducted on the interaction between people with amputations being portrayed as a hero (positive) or a villain (negative) when wearing a modern prosthesis or an antiquated prosthesis (defined as wooden legs and nonfunctional hooks). Our analysis revealed a statistically significant correlation that villains were portrayed wearing archaic prostheses, while heroes typically wore more modern prostheses (Figure 1). There is also a higher frequency of traumatic amputations among both groups than amputations from other causes, despite the fact that in studies of today's population, 54 percent of amputations are secondary to dysvascular disease while only 45 percent are secondary to trauma (Figure 2). 9 Changes in portrayal over time are not accounted for in this data however, as this is an overview for the past 50 years. The frequency of unrealistic portrayals has a negative effect as it leaves an inaccurate impression on the audience. Negative stereotypes and unrealistic expectations could increase misunderstandings of what real people who are missing limbs experience. Prosthetic Media Portrayal and Its Relationship With Reimbursement Policies Current prosthetic treatment involves factoring in all aspects of the individual's needs and potential abilities according to his or her K-level or functional activity level. However some proposed reimbursement policy changes would require treating all patients the same or forcing them to pass benchmarks using outdated prostheses with limited design functions. 10 Societal perceptions of people who use prostheses drive how they interact with prosthesis users. Therefore, reimbursement policies that force the use of antiquated prosthetic technology could have a larger impact on the prosthetic community beyond restrictive function. The psychosocial aspect of wearing an obsolete prosthesis may help drive further social stigmas and negative stereotypes, compounding an already daunting recovery after limb loss, and inhibit prosthesis users from reintegrating into society. Conclusion Improving social perceptions, education, and realistic representations of limb loss is vital to reducing stereotypes and stigma. Movies are a popular form of entertainment in the United States and the portrayal of people with amputations in movies provides insight to how these individuals are perceived and whether perceptions are shifting. An analysis of how people with limb loss are represented in film may also help shed light on how society views people with amputations who use different forms of prosthetic technology, which, in turn, would allow us to predict the impact of changes to reimbursement policies. Determining how and why people with amputations are presented to the audience is important for establishing how they are being portrayed, the effect it has on social interactions, and how to develop future interventions to minimize potential negative associations. Realistic representations in a widely consumed media form, like movies, could have a major impact on improving the quality of life of those with amputations. Further studies are needed for a comprehensive view of the portrayal of these characters. Given the frequency of villains with antiquated prostheses, an in-depth look at other aspects of portrayal, such as specific stereotypes and changes in portrayal over time, should be explored. Further research should be done to investigate other media influences, including commercials and social media, and the effects on the audience's perceptions and interactions with those living with limb loss. Lisa Abernethy is a student in the Master of Science in Prosthetics and Orthotics program at Alabama State University and a member of the Lower Limb Prosthetics Society of the American Academy of Orthotists and Prosthetists. Academy Society Spotlight is a presentation of clinical content by the Societies of the American Academy of Orthotists and Prosthetists in partnership with The O&P EDGE. Acknowledgements W. Lee Childers, PhD, CP, contributed to the editing of this article. References Murray, C., and M. Forshaw. 2013. The experience of amputation and prosthesis use for adults: A metasynthesis. Disability and Rehabilitation 35 (14):1133-42. Horgan, O., and M. MacLachlan. 2004. Psychosocial adjustment to lower-limb amputation: A review. Disability and Rehabilitation 26 (14):837-50. Murray, C. 2009. Being like everybody else: The personal meanings of being a prosthesis user. Disability and Rehabilitation 31 (1):573-81. Elliott, T., and E. Byrd. 1982. Media and disability. Rehabilitation Literature 43 (11):348-55. Farnall, O. and K. Smith. 1999. Reactions to people with disabilities: Personal contact versus viewing of specific media portrayals. Journalism & Mass Communications Quarterly 16 (4):659-672. Hartnett, A. 2000. Escaping the 'evil avenger' and the 'supercrip': Images of disability in popular television. Irish Communications Review 8(21-9). Abernethy, L., C. Duncan, and L. Childers. 2015. Going back in time: A content analysis on the media portrayal of characters with antiquated prostheses. Poster presented at the American Orthotic & Prosthetic Association National Assembly, San Antonio. Neuendorf, K. 2002. The content analysis guidebook . Thousand Oaks, CA: Sage Publications. Ziegler-Graham, K., E. J. MacKenzie, P. L. Ephraim, T. G. Travison, and R. Brookmeyer. 2008. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation 89 (3), 422?9. Wurdeman, S., and P. Stevens. 2015. Raising the bar while shortening the pole: The conflict of requiring "stability, ease of movement, energy efficiency and a natural gait" with a limited device. Developed in Response to Draft LCD, Lower Limb Prostheses (DL33787), released by CMS July 2015. saveprosthetics.org/assets/docs/Raising the Bar.pdf .

ACADEMY SOCIETY SPOTLIGHT: Negative Media Portrayal of Characters With Amputations

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ACADEMY SOCIETY SPOTLIGHT: Negative Media Portrayal of Characters With Amputations

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