Female Wounded Warriors posterous

         Over 220,000 women have served in Iraq (OIF) and Afghanistan (OEF) (Alvarez, 2009), many with multiple deployments. Women are actively participating in many combat operations and sustaining traumatic injuries as a result.  These injuries included traumatic amputation, yet there is no published research on the psychosocial adaptation of servicewomen to this phenomenon.

         This phenomenological study sought to increase our understanding of the psychosocial adjustment issues women experienced after a traumatic amputation.  A search of the research literature did not retrieve any articles that specifically addressed the adaptation of women below the age of 55 to amputation. Research indicated that current issues for military women were military sexual trauma, PTSD, and deployment adjustment issues.  Research indicated the issues for women amputees were adjustment to a new body image, adjustment to prosthetics, and psychosocial adjustment to amputation. Limited current research indicated that women were less likely to be employed after an amputation and had more difficulties with self-care tasks. 

Six Army/Army National Guard women were interviewed in this study: three enlisted and three officers. At the time of the study, their ages ranged from 24 to 42; three were married and three were single; the lowest rank was Specialist and the highest was Major; five were injured in combat and one completed a tour of duty in Iraq on a prosthetic leg. Their injuries ranged from the loss of a lower limb, to the loss of one to two arms, or the loss of both legs.

         Each participant was asked three questions; (1) Please describe your experience in combat as a woman.  (2) In what ways, if any, has being injured changed your life?  (3) If you were to visit a woman in the hospital with your same injuries who was just beginning her journey to recover, what would you tell her? All of the women in this study had a positive experience in the Army and felt that in their unit they were treated the same as the male soldiers.   After losing one or more limbs they had to cope with both physical and psychosocial adjustments. The physical adjustment issues included loss of functionality/mobility, adjustment to a prosthetic device, adaptation to the loss of one or more arms without a prosthetic device, phantom pain, pain from prosthetic usage, and pain from posture issues due to the loss of an arm creating an unbalanced upper body. Sweating due to the loss of body mass was also an issue for some women. The two women who lost both legs also struggled with balance issues, particularly when trying to carry something.

         The psychosocial adjustment issues included adjustment to a new body image, personal safety fears, grief and loss, and adjustment to the attitudes of strangers to a woman amputee. Participants' adjustment to amputation was eased by maintaining a positive attitude; believing that their loss served a greater purpose; receiving social support from family, friends and other wounded warriors; maintaining a personal sense humor; realizing it could have been worse; and recovering in a military culture with the values of personal courage, mission focus and never give up.

         The advice these women would give to another woman just beginning the journey of adjustment to amputation was: maintain a positive attitude, seek out the social support of friends and family, and use humor to help others adjust to your changed body image.  These women would also say: life will return to normal and you will be able to do most everything you did before, but you may have to do it differently.  While two of the women stated that their positive attitude was a personality trait, military training also helped instill positivism. All three of the married women benefitted from having their spouse by their side during all or most of their recovery.  These women reported that during their recovery they were supported by family, friends, other wounded warriors and military comrades.  Amy said, “Surrounding yourself with family and friends, your support system, is huge.”  Lisa and Amy’s father noted that wounded warriors without strong social support were more likely to become depressed and give up.

Most of the women used humor to help put others at ease.  Lisa, who lost both arms above the elbow, used humor to help friends, family and strangers feel more comfortable in her presence. Two of the women in this study still serve in the National Guard, and one has applied to Army helicopter pilot school. Two are employed: One is a public relations executive, and another is CEO of a consulting company that hires many wounded warriors. Another is completing her internship to become a prosthetist, and three are planning to attend college.

         Losing a limb is life changing.  The process of adjustment requires an individual to first physically adapt to the injury and then complete physical and occupational therapy to regain mobility and/or functionality. They must also cope with the attitudes of others.  The near death experience of severe combat injury gave several of these women courage to explore new opportunities: Christine ran for political office and then became a public relations executive; Amy competed in the Paralympics, is a professional speaker, and is finishing her training to become a prosthetist; Sarah established a company that now has over one hundred employees; and Jessica volunteered for a tour in Iraq as an amputee. Amy said that she has “made more of her life with one leg than she ever would have with two.” Without the experience of becoming a combat amputee, three of these women probably would not have had the opportunities that led to new careers. While three women plan to pursue new careers through higher education, only one has yet to act on that plan. Yet, when you consider that she was in a coma for four weeks, and her physicians did not expect her to recover, she has come a long way.

         The process of building a reconstructed self requires an individual to let go of the past and look to the future. According to the Chaos Theory of Adjusting to Life Transitions (Bussolair & Goodell, 2009), when a major life change occurs, the initial stress reaction is to return to the safety of the past.  As an individual realizes that is no longer possible, he/she either adapts to change or gets “stuck.”  As she/he adjusts new possibilities emerge, and as these opportunities are explored, a new reconstructed self emerges. While the initial reaction of all the women was the desire to return to life as it was, they realized that, while you cannot return to the past, life offers new opportunities to those with the courage to “seize the day.”

         America has been slow to recognize the contributions of women to the combat efforts in Iraq and Afghanistan.  Sarah stated that she was often overlooked when she attended veteran events: Americans thanked the male veterans she was standing with, but did not recognize her as a wounded warrior unless she mentioned it.  By sharing their stories of personal courage and adaptation to traumatic amputation, these women are paving the way for a better understanding of how female wounded warriors adapt to traumatic injury.         

Chart 1.  Summarization of Demographic Data on Six Servicewomen with Traumatic Amputations