The Role of Aesthetic Realism in Amputee Psychology

Michelle Mun
Intern/Mentor
March 8, 2017
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Abstract
Aesthetic or cosmetic realism in prostheses is a rarely studied topic, yet holds significant
influence on the psychological states of amputees. The contrasting effects of non-realistic and
realistic prostheses are often overlooked and disconsidered in amputee therapy and rehabilitation.
Debunking the common misconception that realistic prostheses are more beneficial for amputees
is important to ensure optimal psychological rehabilitation; many clinics and families of
amputees fail to consider the negative effects of realistic prostheses and blindly assume that the
more realistic the prosthetic, the better. For data collection, a naturalistic observation of amputees
was carried out in a hospital environment. Through this, commonalities in amputee behavior
were recorded (during beginning stages) to connect back to the validity of the research and
sources that involved amputees preferences towards realistic or nonrealistic prostheses and basic
background in amputee behavior. To present the data to amputees and medical assistants,
elaborations on the results of the study in the form of pamphlets will be distributed throughout
the University of Maryland Rehabilitation and Orthopedic Center.

Word Count: 169

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Introduction
After losing a limb, amputees experience intense psychological stress and trauma. Nearly

40% of amputees experience suicidal thoughts and 35% are diagnosed with PTSD after the loss

(Bhuvaneswar, 2007). Such trauma additionally induces an extreme drop in self esteem and a

desperation to appear normal as the amputee were prior to the amputation; this remedy for

normalcy is often identified through the realistic design of prostheses.The common

misconception that realistic prostheses induce greater psychological growth in amputees

misleads patients and inadvertently leads them into worsened psychological states. The effects of

the Uncanny Valley in realistic prostheses may cause hindrances in social interactions and the

process of self acceptance in amputees, which consequently prolongs the rehabilitation process.

Thus, users with less realistic or unenhanced prosthetic limbs often experience a higher sense of

self identity and psychological health/rehabilitation than users with more realistic prostheses.

Literature Review

Realistic prostheses negatively impact the psychological states of amputees through the

subsequent effect of self hate and hindered rehabilitation. Initially, being fit with a human-like

prosthetic may induce negative feelings about the injury and about the amputee himself/herself.

Realistic prostheses fall under the threshold of The Uncanny Valley wherein overly human-like

objects elicit aversion and repulsion in observing people, which causes amputees to feel disdain

towards their own prostheses and thus feel uncomfortable using them (Sansoni, Wodehouse,

McFayden, & Buis, 2015). In a data collection, an overwhelming number of amputees who

requested realistic prostheses began to experience aversions towards their own artificial limbs
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after several months (Sansoni, 2014). This statistic serves as a specific example of realistic

prostheses inhibiting the psychological rehabilitation of amputees, as aversion towards

prostheses causes amputees to feel uncomfortable with their own bodies; when an amputee feels

distaste towards his/her own body, he/she is inherently unable to progress psychologically due to

the lack of acceptance of himself/herself. This also supports the idea that non-realistic prostheses

serve as better alternatives for amputees to feel comfortable with themselves psychologically, as

non-realistic prostheses cannot induce the effects of the Uncanny Valley.

An amputees failure to identify with his/her prosthetic results in an inability to accept

his/her disability and overall deteriorated psychological health. When realistic prostheses - as a

result of the effects of the Uncanny Valley - elicit feelings of repulsion from amputees, its users

are inherently unable to personally identify with their devices (Masahiro, 2005). This inability to

identify reaches farther than simply feeling uncomfortable with a prosthetic appearance as

mentioned earlier; identification is a core aspect of what allows amputees to rehabilitate and

grow therapeutically - it is both the acceptance of the amputation and the mental incorporation of

a foreign object into ones own body. The psychological effect of identification holds more depth

than simple aversion towards the outward features of the prosthetic; the feature of realism in

prostheses takes away the ability to add unique or personal attributes, so the amputee is less able

to personally identify with his/her prosthetic and thus the device simply becomes a foreign object

in the user/amputees eyes rather than an extension of himself/herself (Plettenberg, 2005).

Aesthetic/personal qualities added to prostheses (i.e, extravagant colors, outlandish designs,

tattoos, etc.) relieve stress and enable amputees to comfortably utilize their devices (Nguyen,

2013). The more personal a prosthetic becomes to the amputee, the more accepting he/she will be

of it. This is analogous to the scenario of a child bringing a stuffed animal from home to a sleep
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away camp in order to feel more comfortable with the new environment. In this case, the new

environment would be the prosthetic, and the stuffed animal would be the personal features such

as favorite color, favorite design, etc.. For example, children in an experiment study unanimously

chose wildly colored prostheses rather than flesh-colored ones (Plettenberg, 2005). The children

likely chose their preferred/favorite colors for their individual prostheses because it allowed them

to personally identify with the devices and feel a more positive connection. This experiment

shows that identification with prostheses holds more impact and positive results over the

aesthetic benefits of realistic prostheses. Another example includes that of a child who originally

rejected standard, realistic prostheses but accepted a multi-colored, hand-made prosthetic

developed by his own father; the device included personalized features that would adapt to his

sons interests as he grew (Reilly, 2013). This example supports the fact that non-realistic

prostheses ability to individualize/personalize prostheses induces identification in amputees and

consequently improves rehabilitation whereas, in contrast, realistic prostheses inhibit

identification and therefore reap negative results.

Realistic prostheses promote the stigmatization of disabilities and induce a sense of

shame and embarrassment in amputees, as well as negative social relations. The underlying

purpose of realistic prostheses is to hide an amputees disability; by avoiding the reality that

he/she has lost a limb, the amputee is unable to move on from the loss (Murray, 2009).

According to Murray, realistic prostheses essentially isolate amputees into a repressive state

rather than progressive. Stigma-induced identity threat explains that the stigmatization of body

or personality results in an inability to identify with said stigmatized component, which results in

detrimental psychological effects including depression, anxiety, etc. (Major, 2004, p. 2). This

specified term for the correlation between stigmatization and self-identity illustrates the negative
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effect of realistic prostheses on amputee psychology; as prostheses are stigmatized, amputees are

less able to identify with them and thus cannot fully accept their disabilities or progress

psychologically. Furthermore, an amputees efforts to blend in with society by hiding his/her

disability through the use of realistic prostheses results in negative social effects. The Uncanny

Valley not only elicits repulsion from the amputee towards his/her own artificial limb, but also

from the non-disabled people around him/her (Papavassiliou, 2015). Observing people are less

likely to interact with the amputee as they are deterred from the prosthetic, thus instinctively

isolating him/her socially. Testimonies given by amputees who attempted to hide their disabilities

also claimed that doing so did not benefit their social lives but instead harmed relations with

others. Non-disabled people who initially befriend amputees but later learn of their disabilities

feel uncomfortable and offended that such information was withheld from them (Murray, 2009).

This deprivation of social inclusiveness damages the amputees psychological growth and further

discourages him/her from accepting his/her disability. The social, personal, and psychological

damages of realistic prostheses outweigh the scarce negative effects of non-realistic prostheses.

Non-realistic prostheses provide increased psychological well-being in amputees and

improved progress in rehabilitation due to positive social interaction and potential anti-

stigmatization of prostheses. When using non-realistic prostheses, amputees become more

involved in social events and interactions and grow more comfortable with sharing their

disability with others - resulting in better acceptance of themselves. Uniquely-designed

prostheses receive positive responses not only from amputees but from non-disabled people;

others are more inclined to ask about the unique features due to curiosity and be more open with

the amputees, thus increasing social interaction which increases overall psychological health

(TedMed, 2015). This shows that non-realistic prostheses, essentially, open more opportunities
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for amputees to interact socially, which ironically serves as a direct contrast to the socially

debilitating nature of realistic prostheses. Through the open use of an obvious prosthetic,

amputees also become more accepting of their losses and appear outwardly confident in their

bodies (Rybarczyk, 1995). This allows non-disabled people to feel more comfortable with

discussing the amputation and building social relations with the amputee. For example, a runway

model provided a testimony explaining that since she began wearing her non-realistic prosthetic,

others became more open with her, noticed her, and recognized her (Mashable, 2015). These

results allowed the runway model to become more confident in herself and relieved social

pressures against her disability, enabling the model to accept her disability, pursue her dream

career, and interact socially. Non-realistic prostheses ability to add personal and unique features

to their devices - as mentioned earlier - also hold the power to normalize prostheses.

Personalized features in prostheses such as sparkles, sharp edges, and artistic designs are able to

be glamorized/romanticized through media and fashion which in turn would desensitize the

predisposed stigmas placed on prostheses on a societal scale; this serves as a parallel to the

glamorization of glasses, which were originally stigmatized as disabilities in the early 1800s but

are now major fashion accessories (Vainshtein, 2012). The less condemned prostheses become,

the easier it will be for amputees to accept their disabilities and be accepted by society.

The use of less realistic and unenhanced prosthetic limbs correlate with increased

psychological health/rehabilitation and sense of self identity while the use of realistic prosthetic

limbs results in destructive effects. Realistic prostheses, by the Uncanny Valley, not only cause

amputees to feel disdain towards their own bodies and prostheses, but also deter surrounding

people from interacting socially with the user. This induced self hate inhibits amputees from

being able to identify with their prostheses and thus prolongs the rehabilitation process. On top
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of this, the use of realistic prostheses promotes the stigmatization of disabilities and amputations;

if an amputee utilizes a realistic prosthetic as a means of concealing his/her disability, he/she is

unable to move on from the loss and thus cannot come to accept it or rehabilitate. Non-realistic

prostheses, unaffected by the effects of the Uncanny Valley, allow amputees to personally

identify with their prostheses and improve social interaction, which promotes the growth of

psychological health. Amputees who utilize non-realistic prostheses are able to augment their

devices to have personalized details, features, or designs, which allows them to personally

identify with the devices. On top of this, non-disabled people are more inclined to associate with

amputees who utilize non-realistic prostheses both due to the absence of effects of the Uncanny

Valley and the social curiosity/interest towards the unique features and designs of non-realistic

devices. Overall, non-realistic prostheses hold greater benefits and results for the psychological

health of amputees than realistic prostheses; thus, the use of such devices must be enforced in

order to optimize rehabilitation for future amputees.

Data Collection and Methods

To answer the question of whether amputees prefer realistic or unrealistic prostheses and gain

background on amputee behavior/psychology, a naturalistic observation was carried out on three

amputees over the course of two months during the beginning stages of their amputations. Each

of the amputees had recently come out of surgery (two months post-amputation) and were
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observed in a hospital setting. Common behaviors shared by the amputees included desires to use

realistic prostheses, requests to augment prostheses to possess realistic features, frequent

emotions of denial, and frustration towards the amputations. All three amputees initially desired

realistic prostheses, but one amputee eventually preferred non-realistic.

Data Analysis and Results

Graph 1
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This graph depicts the data collected from several amputees during a naturalistic observation of

their behaviors. The categorized descriptions of the behaviors are labeled as the x-axis while the

total number of days out of the ten days of observation that the amputees displayed these

behaviors serves as the y-axis. Certain amputees displayed similar behaviors in a similar

frequency, while another amputee would stray from the majority entirely; an example of this is

the displayal of denial in which amputee #1 served as an outlier from the data. This

representation of data provides a visual understanding of the commonalities in amputee

psychology/behavior and distinguishes each amputees individual experience. The data relates to

my hypothesis in that it demonstrates that all amputees desired realistic prostheses in the initial

stages of amputation.
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Discussion/Conclusion

The results of the study both supported the predicted behavior of amputees and demonstrated the

common denial that amputees feel in the beginning stages of amputation, which correlated with

the desire to use a realistic prosthetic - this exhibited the prevalence of the misconceptions

revolving around the benefits of realistic prostheses. Limitations of this study was the time

constraint in the naturalistic observation; because it takes months for prostheses to be fitted, the

amputees were unable to be observed in the later stages of amputations wherein they likely

would have experienced the aversion towards the realistic designs of their devices. Non-realistic

prostheses, unaffected by the effects of the Uncanny Valley, allow amputees to personally

identify with their prostheses and improve social interaction, which promotes the growth of

psychological health. Overall, non-realistic prostheses hold significantly greater benefits and

results for the psychological health of amputees than realistic prostheses. Continuing the research

of realistic prostheses versus non-realistic prostheses and enforcing the use of non-realistic

devices is imperative to the optimization of psychological rehabilitation for amputees.

Reference Page
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