Snowbirds, those people who live in a warmer climate during the winter months, raise Florida’s population by about a million each year.2
How common is amputation currently in medicine? There are nearly two million people living with limb loss in the United States and among those, the main causes are vascular disease (54 percent), trauma (45 percent), and cancer (less than 2 percent).3 Approximately 185,000 amputations occur in the United States each year. Amputations date back to the time of Hippocrates and were performed most often due to injury or war. With loss of blood, though, amputations were often dangerous and not necessarily lifesaving. Not until the 1500s did physicians begin using ligatures to restrict a patient’s blood vessels. Tourniquets were introduced in 1674 and continued to be used during the period of World War I, which saw an unprecedented number of amputations.
Edgar experiences phantom limb sensation due to his amputation. Is this common? It was first reported in 1551 by surgeon Ambrose Pare. He noticed that patients would complain about pain or a sensation in a limb after it had been removed. Studies show nearly all people who undergo an amputation experience this phenomenon. Why is that? Understanding the way our brains work, phantom limb sensations could be due to reorganization in the somatosensory cortex. This part of the brain receives and processes sensory information for the entire body including the sensations of touch, pain, and vibration. Doctors don’t agree on exact causes for this phenomenon but treat it using medications, hypnosis, and biofeedback. Mirror therapy, in which a person views their working limb in a mirror and mimics the movement with their phantom limb, is sometimes used but has not proven to be entirely effective.
Studies have shown that low education status, preamputation pain, and untreated depressive symptoms are more common in patients with phantom limb pain than in patients with amputation but no phantom limb pain.4
Edgar suffers a traumatic head injury after his accident. His moods become volatile and he and his wife get divorced. How can a brain injury change a person’s personality? Brain injuries can damage connections that go from the cerebral cortex to the limbic system. The cerebral cortex is the part of the brain that affects memory, attention, perception, cognition, and awareness. The limbic system is the part of the brain that has to do with emotions, behavior, and motivation. When everything is in working order, we are able to evaluate our emotional reactions and respond in a reasonable way. When these connections are damaged in some way, we may react differently. The most famous case of someone having a changed personality after a brain injury is Phineas Gage. He was a railroad worker who survived having an iron rod go through his head. His personality and behavior changed so significantly afterward that his friends said he was no longer himself.5
Traumatic brain injury (TBI) is a major cause of death and disability in the United States. From 2006 to 2014, the number of TBI-related emergency department visits, hospitalizations, and deaths increased by 53 percent.6
In Duma Key, Edgar’s doctor recommends he move to Florida for some “geographical healing.” Does weather affect mood and healing? According to experts, absolutely! Edgar is encouraged to move out of cold, snowy Minnesota to warm, sunny Florida. Those of us who live in Minnesota absolutely understand how the lack of warm weather and the opportunity to be outside can affect mood. Seasonal Affective Disorder (SAD) is a real condition that affects people’s mood. Being exposed to sunlight, especially during morning hours, can greatly change someone’s outlook for the day. Warmer weather has also been linked to people self-reporting that they are happier and have less stress.7
Even physical wounds can be impacted by weather. According to The Wound Care Education Institute, cold weather can negatively influence the healing process and may affect how you care for and dress your wounds.8 Research has found that those in warmer climates are more likely to stay physically active after an injury and will have increased blood flow and circulation. Cold weather could also cause skin or wounds to dry out or become chapped whereas wounds that are kept moist heal 50 percent faster.
Edgar begins to paint when he’s in Florida and it seems to be helping with his mood. To understand more about art therapy, we spoke to Theresa Hoglund Mueller, an art therapist who works for Creative Pilgrimages.
Art therapy can help people reduce levels of stress, anxiety, and burnout connected to their work or everyday life.
Kelly: “How did you become interested in art therapy?”
Theresa Hoglund Mueller: “I have a strong background in both art and in human services. I have also always been fascinated with the ‘flow’ state that art-making involves which brings people to ‘center,’ if you will. Also, the symbolism of dreams fascinated me. I never met one of my grandfathers but I knew him very well through his art, including a series of humorous yet gory cartoons he drew to cope with his stomach cancer that killed him.”
Kelly: “Wow! I’d love to see those.”
Meg: “What training do you need to become an art therapist?”
Theresa Hoglund Mueller: “It requires a clinical master’s degree with an intensive internship of about eight hundred hours and post-supervision work of a thousand hours. Prerequisites for the masters include specific undergrad work in psychology and art classes and proving competence in a variety of mediums with a submitted portfolio. Credentialing only occurs after the post-supervision work starting with registration and after passing an intensive exam to prove competence and skills for those who are board certified.”
Kelly: “In Stephen King’s book Duma Key, the main character begins painting and starts to feel better mentally and physically. How can art therapy improve a person’s mood and/or physical health?”
Theresa Hoglund Mueller: “Doing art can be both very cathartic and meditative given the right application. It can help someone in getting in a flow or altered state of mind. In such states, the mind can stop racing thoughts and the body can begin to relax. A person becomes ready to problem solve in this more relaxed, less judgmental state.”
Meg: “How have you seen art therapy impact people?”
Theresa Hoglund Mueller: “I have seen profound catharsis, needed calming, and much insight from my clients allowing them to see themselves in new ways that allow them to be open to needed change and/or acceptance.”
After speaking with Theresa Hoglund Mueller, it becomes clear that art therapy can have an immense impact on people as it did with Edgar in the book. Although, not in the supernatural way!
Elizabeth Eastlake, a character that lives on Duma Key, has experienced much of what Edgar is going through. She has Alzheimer’s disease, though, and this causes Edgar to not trust the things she is saying initially. How does Alzheimer’s affect the brain? In a healthy brain, neurons communicate with each other and transmit information via electrical and chemical signals. The brain then sends messages to the rest of the body including muscles and organs. Alzheimer’s gets in the way of this communication and, in turn, causes cell death and loss of function. People with this disease lose their ability to function and live independently and will eventually die from it.