Q&A: World-building a settings where amputation is common

 

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The following question was left on my Tumblr account by an anonymous user: 

Anonymous Asks:

"What kind of worldbuilding would you expect from a world where amputation is really common? (NOT a cyberpunk thing. The technology is somewhere between Bronze Age and Middle Ages, which I know is really broad but I’m indecisive). Also the most common cause of amputation is disease, not war or anything like that, in case it makes a difference. So far all I’ve come up with is that assistive technology isn’t limited to more urban/populated areas, and people treat amputations as commonplace. Sorry if this is too random"

My answer:

Ok, so my answer to this will depend of what kind of tone you want. Do you want it to be normalised in a more idealist/optimistic way, or do you want to do world-building around the new problems that would likely arise and take a more pessimistic approach? Either way there's a lot you can do with a setting like that and I absolutely love world building stuff like this! I was actually working on another post kind of similar to what you're asking for, so I have a lot prepared lol. apologies for the long post in advance!

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Here are some questions/suggestions I would consider:

What are the views around Amputation in this setting? Do any stereotypes or beliefs appear around it?

Just because a disability is common, doesn't always mean it's accepted, or accepted unconditionally, nor does it mean people won't make odd assumptions about it. Obviously, if you want something more optimistic, you'll want to go with "it's just a normal part of life, most folks don't really think about it much" but in that case, even accepted disabilities get weird assumptions, stereotypes or even religious beliefs surrounding them. The best example of this in the real world is people who wear glasses. Most folks wouldn't even consider it a disability because it's just so normalised, but it is - glasses are a type of accessibility device. But what comes to mind when you think of someone who wears glasses? Chances are, it's someone smart, maybe a nerd? Glasses have nothing to do with intelligence but we associate people who wear them with it anyway. From what I found, that association formed in the middle ages, as monks and priests wore them to read, and those were people who studied religious texts and passed that information to the public. the common folk saw these people as a source of information and wisdom, forming the idea that glasses were worn by intelligent or wise people. If amputation is common and/or accepted, this kind of thing will probably happen with it too. If amputations are more common in some lines of work than others (either because that job leads to more amputations, or because a lot of people go into that line of work after their amputation) people will start to associate qualities needed for that job with amputees. For example, If the most common reason for amputation is illness, and if that illness is contagious, you might actually end up with a similar belief, that amputation is a sign of intelligence because doctors and healers, who people view as intelligent, are more likely to catch the illness, resulting in more amputations among doctors.

On the flip side, a lot of cultures have disabilities at the heart of many of their beliefs. For example, they idea of the fey replacing children with other fey, is thought to have been people's way of explaining neurodivergence like autism, ADHD and personality disorders before we had words for those disabilities.

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Likewise, some European Christians believed people born with disabilities (including limb differences) could be explained by their mothers participating in witchcraft or deals with the devil. These disabilities were pretty common at the time due to malnutrition and a general lack of understanding about how to be safe while pregnant, but they lacked the medical knowledge to be able to explain it, and so superstition took over. If your setting has a similar level of medical knowledge/understanding, something similar might occur. Not every example of this is negative btw. It's thought that early ancient Egyptians believed disabilities such as blindness, especially if it was from birth, were the result of the gods calling them to speak for them. Similar lack of understanding about where the disability came from but this time it has a much more positive outcome.

Also, consider that if it's so normalised, people are going to be much less likely to be afraid of becoming amputees. This can be a positive thing, but it could have run on effects, both in the sense that people are less likely to care to take precautions to avoid things that could result in amputation, and that people may underestimate the impact it will have. Even in the real world, as being an amputee has become less stigmatised (though we are still far from normalised), some people have started underestimating how it will impact you. My prosthetist says the hardest part of his job is watching the realisation that a prosthetic won't be a magic cure hit his patients in real-time. this isn't to say being an amputee is always a terrible and awful and all the other things people think about disability, but it is a BIG adjustment that a lot of folks are unprepared for. In a setting where it's even more common, this is even more likely. It's also more likely that non-amputees will underestimate this impact, and say things like "but I know someone with the same amputation and they're fine!" when someone tries to say they can't/struggle to do something because of their amputation - something that also already happens to me in real life lol. People are going to take to their amputations differently, they'll have different limits and different capabilities. how well does your society as a whole understand this?

Finally, think about if there are certain types of amputations that are more accepted/normalised/understood than others. In the real world, leg amputees tend to be more accepted than arm amputees in my experience, and larger amputations/multi-limb amputations carry more stigma and have a lot more bizarre misinformation and stereotypes about them. Is this the same for your world?

What is the general populations view of other disabilities?

Just because one disability is more common or accepted, doesn't mean they all are. This is especially important to consider for co-morbid disabilities (disabilities that are connected to, are caused by being, or are usually seen alongside being an amputee). For example, a lot of leg amputees choose wheelchairs over prosthetics, but the degree of acceptance for that in your world will depend on people's view of wheelchair users as a whole. In real life, it's an unfortunate reality that the use of a wheelchair is looked down on and there are a lot of negative stereotypes about wheelchair users which deters a lot of leg amputees from using a wheelchair, even when they really need one. When leg amputees specifically use wheelchairs, we are often said to be giving up or even lazy for not "pushing through" or "trying hard enough" - I have another post here talking about that. This has resulted in a lot of amputee-specific spaces being completely inaccessible wheelchair users. An example of this would be a camp I used to attend specifically for amputees being held in a non-wheelchair accessible location until recently, or amputee clinics (where you go to see doctors who specialise in treating/rehabilitating amputees) having equipment needed for taking measurements essential for getting quality prosthetics, being unusable to people who can't stand up. If they do accept other related disabilities though, there's more stuff to think about (which I'll come back to in the next few points)

Of course, how your world's views unrelated disabilities is important to consider too, because chances are there's someone out there with both. How does the general view of disability affect those people? Are people more or less likely to accept that having this other disability means they won't be able to things other amputees can? I'm autistic for example and find it nearly impossible to wear my prosthetic when I'm in burnout, both because it's a lot of energy I don't really have, but also because when I'm in burnout, I'm very sensitive to certain textures, and the feeling of wearing my prosthetics when I'm like that is unbearably uncomfortable.

What has the acceptance/normalisation of amputees done to influence beauty standards?

You see this a lot in cyberpunk but it's worth considering for other settings too. Amputation can be a very visible disability if you want it to be, but in the real world, there is a big emphasis on "looking normal" because of beauty standards. This isn't just a modern thing either, there are many stories of real-life knights who lost arms during battle and had armour made for them that hid their missing limb. They were functionally useless (except for maybe backhanding people lol) but the desire to look "normal" outweighed the need for functionality to many.

If amputation is common though, this might not be the case in your setting. This might mean people are freer to explore prosthetics that put function over aesthetics, meaning they might have more advanced prosthetics than you'd typically expect to see in that time period. Alternatively, it might go the other way and you could end up with people who still favour aesthetics over function, but they try to make it look as outlandish and unique as possible.

Beyond how it effects amputees though, if prosthetics are seen as fashionable, do non-amputees try to mimic the look of prosthetics in their outfits? Consider the first point I mentioned here too. If there are certain desirable characteristics associated with amputees, would people trying to present themselves a certain way try to make it look like they're an amputee, even when they are not? Kind of like how people wear fake glasses to look smart or just as an accessory. Alternatively, how dose being an amputee play into other beauty standards and expectations? Another real-world example, is that there is a lot of fatphobia in amputee circles, to the point where most teenage amputees I know have or had eating disorders. Part of it comes from the general fatphobia in the wider population, but its amplified by the fact that many prosthetic components have weight limits on them, and many prosthetic companies refuse to make components for bigger people, not because they can't or because it's too hard, but because they say there's no demand for it. So Doctors push the importance of staying below a certain weight so their patents can have access to better tech and it becomes a self-fulfilling prophecy. If there are a lot more amputees though, this might be different, but it's worth considering.

How will it impact architecture?

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When we think of medieval or even older structures, "accessible" isn't the word we usually think of. Most buildings had stairs, and the needs of people with different bodies was rarely, if ever considered. But if amputation is more common, this might not be the case, especially if things like wheelchair use are also common/accepted (told you I'd come back to that). Buildings will be more likely to use ramps, lifts (even in ancient times - this could be achieved via pullies or something similar, though it would need to be usable to arm amputees too) or forgo multiple levels entirely where possible. Roads would probably be paved or at least smoothed to allow for easier travel via wheels and cities would be laid out in way that would make traversing them from a wheelchair easier. This would likely have a run-on effect and lead to cities being more accessible to people with horse-drawn carts, wagons, carriages etc too. things would be made with the idea that someone lower to the ground, or someone who needs to use their feet to grab things (and therefore can't reach as high) needs to be able to access the thing too, and a lot more. Even small things, like the way doors are opened might be altered to make it easier to use for someone missing an arm/who's arms are occupied with pushing a wheelchair. Making spaces more accessible in these ways also has run-on effects. I already mentioned the carriages in cities, but it also means you might start seeing small changes to the world, like chairs being made to be more comfortable, or single-handed versions of tools/weapons being more common.

What type of illness is the most common cause of amputation in your setting? How do people view it? Is it understood?

You mentioned illness is the most common cause of amputation in this setting. In that case, consider what kind of illness is usually the cause? Is it a single disease? if so, is it contagious? How high is the mortality rate? Who does it mostly impact? I lost my own legs to an illness, one that is well-known where I live, but poorly understood - most people just know it's contagious and acts kind of like the flu. This has resulted in some very bizarre interactions with non-disabled people when they find out how I lost my legs. There was a rumour about me in school that I still had the illness, and so because of that my amputations were contagious. It wasn't just children who believed it either lol. Now as the public has been better educated, those ideas are less common, but weird stuff still comes up occasionally, like the lady who thought my illness was a government conspiracy theory made up to control people and scare them into getting vaccinated, apparently my amputations were unnecessary and all a part of the plot lol. I think it's probably my favourite weird interaction lmao.

You can also look at how people reacted to COVID for ideas about how people react to wide-spread illnesses that have a high chance of disabling you. Diabetes is another good example too, while it's one of the most common causes for amputation in the real world, people are still very weird about it and a lot of people insist it either doesn't exist or can be treated without medicine (insulin). Does the disease in your world have a lot of untrue information about it too? are there people peddling fake "cures" to take advantage of people who are more at risk?

How has this impacted Medicine as a whole

In medicine, advancements in one field are rarely isolated. When advancements are made in one area, other areas usually follow or are at least influenced. As much as the modern medical industry structure likes to pretend otherwise, it's all connected. In the real world, amputees were a lot rarer (not unheard of mind you, but rarer) because well, bronze-age understandings of things like infection and disease in general wasn't great. people would often die from the side effects of the amputation or the surgery itself (e.g. infections, going into shock because the surgery was preformed while the person was awake, blood loss during surgery, a general lack of understanding of how important hygiene is post-op/a lack of access to proper hygiene etc). So if amputees are more common, that would imply their understanding of medicine is at least a little better than real-life bronze age folks. This won't just stop at amputees though, like i said, it's all connected. Having a better understanding of, say, how infection happens in an amputee, means they will probably have a better understanding of infection in general, which could stop a lot of deaths in other ways. Likewise, sewing a stump closed in a way that won't cause immense amounts of nerve and phantom pain implies a decent understanding of the nervous system in general, which will have run on effects in how a lot of other conditions can be viewed and maybe even treated.

Conclusion

There's a lot more you could consider, but I hope this gave you some additional stuff to think about (sorry for the long response, but like I said, I was already working on a nearly identical post so this was perfect timing lol). Let me know if you need more help, I love this kind of world-building stuff! Also, just to be clear as well, as long as you aren't just ignoring the fact so much of your world is disabled or being super ableist about it, there's no right or wrong answers here. You can have more positive answers to these questions than what I've given as examples, you can go darker, you can have a mix of both, whatever you like. Depending on the tone you want, you don't even have to answer every question if you don't want to. If you have a rather light-hearted setting for example, you probably don't need to know how all your amputees are surviving infections and un-medicated amputation surgery lol, but if its a darker tone where the illness you mentioned is a central focus, then it's probably a good thing to think about at least.