P.T. Hmue and Maha Y. See of Myanmar Clinical Psychology Consortium describe recovery beyond the physical after limb loss among young veterans in Myanmar.
Since the 2021 military coup in Myanmar, armed conflict has reshaped the lives of millions. The United Nations estimates that between 50,000 and 96,000 people have died as a result of the conflict. The exact number of individuals living with conflict-related disabilities remains unknown, but recent reports indicate that more than 700 civilians—nearly one-quarter of them children—are killed or injured by landmines each year. Myanmar now records the highest number of landmine casualties in the world.
As fighting continues between the military junta and a diverse coalition of resistance forces—including the People’s Defense Forces (PDFs), local defense forces, and ethnic armed organizations—life-changing injuries continue to occur. Among them are traumatic limb amputations resulting from landmines, artillery, airstrikes, and other explosive devices. In 2024, Myanmar’s National Unity Government estimated that between 300 and 500 members of the People’s Defense Forces had undergone limb amputations or experienced permanent disabilities. This figure does not include individuals from other resistance groups and civilians, suggesting that the true number of people living with conflict-related limb loss is considerably higher.
Why Psychological Rehabilitation Matters
Limb amputation is not only a physical injury; it is a life-changing event that affects mobility, employment, relationships, identity, and psychological well-being.
Ideally, care for individuals with limb loss involves a multidisciplinary team that may include orthopedic surgeons, vascular surgeons, plastic and reconstructive surgeons, prosthetists, physical and occupational therapists, rehabilitation physicians, and rehabilitation psychologists. Even under the best circumstances, delivering such comprehensive care can be challenging in a low-resource setting. In conflict-affected regions of Myanmar, the challenges are substantially greater.
Health professionals and patients alike recognize that rehabilitation does not end with surgery or the fitting of a prosthetic limb. Recovery also involves adapting to physical changes, coping with chronic pain, rebuilding a sense of self, and re-engaging with family and community life. Yet Myanmar has very limited access (some would say none) to specialized rehabilitation psychology services, particularly in areas affected by armed conflict.
In this context, community-based and culturally responsive approaches to psychological rehabilitation are essential. Such approaches can help bridge critical gaps in care while drawing upon local strengths, resilience, and social support systems.
The ReSPEK Program
To address some of these unmet needs, we developed the Reclaiming Strength: Psychoeducational Engagement and Knowledge (ReSPEK) program for combat-injured veterans living with limb loss in Myanmar and Thailand.
The program was designed around six primary goals:
- Building resilience and adaptive coping skills
- Normalizing emotional, cognitive, and physical reactions following limb loss
- Addressing chronic pain and phantom limb experiences
- Supporting identity reconstruction and a renewed sense of purpose
- Strengthening social connection and community reintegration
- Developing individualized plans for ongoing support and well-being
Importantly, ReSPEK is not a trauma-processing intervention. The program does not include trauma exposure or narrative processing. Instead, it emphasizes safety, choice, empowerment, and practical skills that participants can apply in their daily lives.
The pilot program consisted of six sessions, ideally conducted weekly, each lasting approximately two hours, with a closed group of six to eight participants. Session topics included: (a) safety, normalization, and peer connection; (b) understanding and managing pain; (c) thoughts, emotions, and behaviors; (d) trauma, memory, and meaning; (e) identity and social reintegration; and (f) action planning and graduation.
Eight veterans between the ages of 18 and 26 participated in the first group. The second author developed the ReSPEK curriculum, while the first author facilitated the sessions at a rehabilitation center inside Myanmar. Throughout the program, we remained in close contact for consultation, supervision, reflection, and program monitoring.
The intervention emphasized empowerment through knowledge and skill development rather than merely symptom reduction. Participants engaged in discussions, structured activities, worksheets, and peer sharing, creating a space where practical learning and personal reflection could occur side by side.
Meeting Beneath the Mountains
The participants and facilitator met during the cool evenings at a rehabilitation center nestled among the misty blue mountains of the Karenni region. Bamboo surrounded the grounds, and the setting offered moments of calm amid the harsh realities of war and recovery.
For the facilitator, the long journeys to the center—often along steep and rugged paths on an unreliable motorbike—became worthwhile the moment the group gathered each week. For security reasons, we do not disclose the exact location.
Reflections
ReSPEK was not an abstract program delivered to anonymous participants. What unfolded over six sessions was far more than a series of educational sessions. It became a space where eight young men could reflect on what had happened to them, what they had lost, and how they might continue moving forward with dignity, purpose, and hope. It was a brief but productive and meaningful journey. These young men—veterans, comrades, sons, and friends—remain in our thoughts.
A Folded Sheet of Paper
At first, the young men were shy and hesitant to speak.
As part of an early activity, they were invited to write their thoughts and feelings on small pieces of paper, fold them, and hand them to the facilitator. Before long, those folded papers began to open—literally and figuratively. Through them emerged stories that were thoughtful, poetic, humorous, and at times quietly rebellious.
The papers became a bridge between silence and conversation.
“Like Before”
Although each participant’s story was unique, many shared a common phrase:
- “I can’t walk like before.”
- “I can’t run like before.”
- “I can’t play football like before.”
- “I can’t go wherever I want like before.”
The words reflected loss, but they did not tell the whole story.
The young men still spoke enthusiastically about soccer, gaming, fishing, making lanterns, learning English, and other interests. Beneath the grief was evidence of something equally important: hope.
The Phoenix
One evening, the facilitator drew a bird on the board.
The young men immediately recognized it as a phoenix and began discussing what it symbolized: resilience, renewal, and the possibility of rising again after hardship.
The image became a powerful metaphor for the group’s conversations. They reflected on how life could never be exactly “like before,” yet could still be meaningful. Although some activities might require adaptation, new possibilities remained. Together, they explored what it might mean to build a life not defined solely by loss.
A Dream That Wants to Wake Up
One participant wrote:
“If this is just a dream, maybe when I wake up tomorrow, my leg will grow back.”
The statement captured a reality often overlooked in physical rehabilitation: the psychological impact of limb loss.
From the moment of injury onward, many individuals experience recurring cycles of grief, disbelief, anger, sadness, anxiety, and acceptance. These experiences rarely follow a straight path. Some participants had reached a degree of acceptance, while others continued to move between hope and despair as they adjusted to their new circumstances.
The comment reminded us that psychological support is not secondary to rehabilitation—it is an essential part of it.
The Milk-Weaned Child
During one discussion, we explored how sudden life changes can alter a person’s sense of identity.
We brought up about a young child who had long enjoyed being the center of attention, only to experience an abrupt shift when a new sibling arrived. The child’s role changes without choice.
For these young men, limb loss represented a similarly profound disruption. Their identities, routines, relationships, and futures had changed unexpectedly.
Together, the group reflected on how these changes affected many aspects of life, including work, income, education, social status, religious and cultural identities, psychological well-being, family relationships, romantic relationships, and sexuality. More importantly, they explored ways to move forward with courage and confidence.
The Courage to Speak
In one session we addressed assertive communication—the ability to express one’s needs respectfully and confidently.
A participant shared his frustration with being over-helped by others. Although well-intentioned, people often assumed he was incapable of completing tasks that he could still do independently.
The group discussed ways to decline unwanted assistance without seeming rude, while also learning how to ask for help when it was genuinely needed. For many participants, finding that balance was an important step toward rebuilding autonomy.
Learning About Pain
“Our brain and nervous system remember patterns of pain. If we understand those patterns, we can learn ways to manage them.”
The statement, written on the board by the facilitator, sparked immediate interest.
The young men listened closely as they learned that pain was not something against which they were entirely powerless. They discussed medications, hot and cold compresses, physical exercise, and psychological strategies. Together, they practiced breathing exercises, distraction techniques, and progressive muscle relaxation.
They also learned that the severity of pain is not directly related to the amount of tissue loss. This realization helped them understand why comparing one person’s pain to another’s is neither accurate nor helpful.
The topic that generated the greatest discussion was phantom limb pain—the sensation of pain in a limb that no longer exists. All eight participants reported experiencing it. They described how its intensity changed depending on emotions, weather conditions, and time of day.
One Story—and Many Others
“I don’t want to visit friends like before,” one participant shared.
“When I walk outside, people look at me. It feels like they’re looking at my weakness. Maybe it’s just in my head, or maybe it’s real—I can’t tell. But I feel ashamed and very stressed. So, I stay at home instead of going out.”
As the conversation continued, it became clear that many participants shared similar feelings.
This led to a discussion of cognitive reframing—the practice of identifying unhelpful thoughts and considering alternative interpretations. For example, if a friend had not visited during a hospital stay, the immediate assumption might be rejection. Yet there could be other explanations: distance, financial limitations, family obligations, or concerns about saying the wrong thing.
The group practiced applying this approach to different situations, recognizing that our first interpretation may not always be the most accurate one.
Another Universe
One evening, under a moonlit sky, stars shone through the bamboo overhead as a cool breeze drifted across the rehabilitation center.
The young men closed their eyes and listened to a recorded voice guiding them through breathing exercises, grounding techniques, and progressive muscle relaxation.
Slowly, shoulders softened. Breathing slowed. Tension eased.
For a brief moment, it felt as though the group occupied another universe—one characterized not by conflict, injury, or uncertainty, but by calm, warmth, and hope.
For the facilitator, it became one of the most memorable moments of the entire program.
Imagining a Future Home
Although many dreams had been interrupted, the young men continued to dream.
One participant said:
“I’ll keep fighting until the revolution ends. When we win, I’ll rest.”
Another shared:
“I’ll fly drones again. I’ll serve in any way I can.”
One wrote:
“I want to learn English and live happily with my mother.”
Another declared:
“Within a year, I’ll recover my leg. When I do, I’ll return as a comrade.”
Beneath these aspirations were enduring values: justice, freedom, service, family, and belonging.
Letters to a Friend
One ReSPEK activity invited participants to write letters to a friend.
The letters revealed courage, conviction, grief, and hope. Rather than focusing solely on their own struggles, many participants wrote messages of encouragement to others who had also experienced limb loss.
These letters pointed toward a future possibility: a peer-support program grounded in shared lived experience, where individuals can both receive and offer support to one another.
The Sixth Day
The sixth session was also the last.
The young men would eventually leave the rehabilitation center once their care was deemed complete. For some, that day was approaching quickly. Some would return to their military units; others hoped to return to their hometowns, if conditions allowed. Each would carry forward a different path, shaped by both the injuries they had endured and the futures they continued to imagine with degrees of clarity and confusion.
At the conclusion of the program, participants were provided with information about free online counseling services that they could access if they wished to continue receiving psychological support.
As a farewell gift, each participant received a pen and a small stack of colorful papers titled Let’s Write Down Our Feelings.
The idea was simple. In the days ahead, whenever they felt overwhelmed, hopeful, lonely, angry, or grateful, they could write. Under the flicker of a lamp or flashlight, they could place words onto paper, fold the page, and set it aside before sleep. Perhaps when they wake up, they talk with a friend.
A small act of reflection.
A small act of care.
And perhaps, one more tool to carry forward on the road ahead.
ReSPEK Moving Forward
While the first ReSPEK group was underway in Myanmar, MCPC also began offering the program with another group of individuals living with limb loss at a camp along the Thailand–Myanmar border. More recently, camp authorities implemented a policy that no longer permits visits by outside facilitators, bringing the program there to a temporary pause. As circumstances continue to evolve, we remain hopeful that opportunities to return may emerge in the future.
For now, we continue to explore opportunities with other communities that may welcome ReSPEK as a learning and support program. While the locations may change, the need remains the same: creating spaces where individuals living with limb loss can learn, connect, and move forward with hope.
This article is part of an ongoing series highlighting mental health and psychosocial services for people in Myanmar and Myanmar diaspora communities in Thailand. Through field experiences, community initiatives, and professional reflections, the series explores efforts to expand access to mental health care and psychosocial support in contexts affected by displacement, conflict, and social change.
P. T. Hmue, MBBS, is a physician currently providing supervised counseling services while pursuing advanced training through the Myanmar Clinical Psychology Consortium (MCPC). He is interested in integrating clinical and counseling psychology into medical practice to support holistic patient care. Like the young men who participated in ReSPEK, he continues to reflect on his future educational and professional path.
Maha Y. See, PsyD, is the founder, director, and faculty member of the Myanmar Clinical Psychology Consortium (MCPC). A community worker for more than 30 years and active in the mental health field since 2006, he was born and educated in Myanmar before continuing his studies in Singapore and the United States. His work has included clinical services, education, training, research, and community-based mental health initiatives with individuals and communities across diverse cultural contexts.
About the Myanmar Clinical Psychology Consortium (MCPC)
Founded in Yangon in August 2017, the Myanmar Clinical Psychology Consortium (MCPC) was established to help address gaps in mental health education and to build a sustainable, pay-it-forward learning community. Supported by volunteer professionals and an international network of experts, MCPC provides free education, training, supervision, and community-based research opportunities in clinical and counseling psychology.
With the support donations through our social connections, MCPC has expanded its activities to include community outreach, mental health education, psychosocial support, and well-being programs in parts of Myanmar and among Myanmar diaspora communities in Thailand.
Acknowledgements
The authors gratefully acknowledge the support of Agga Educational Support Group, UK and Nang Phyu Education Support Group, NY, whose contributions helped make the Reclaiming Strength: Psychoeducational Engagement and Knowledge (ReSPEK) program possible.
