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Exploring the lived meaning of grief for bereaving adolescent friends of a peer who has died Terkel, Romy Ronit 2001

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E X P L O R I N G T H E L I V E D M E A N I N G OF G R I E F F O R B E R E A V I N G A D O L E S C E N T F R I E N D S OF A P E E R W H O H A S D I E D by Romy Ronit Terkel B.A., C a r l e t o n U n i v e r s i t y , 1997 a thesis submitted in partial fulfilment of the requirements for the degree of Master of Arts in THE FACULTY OF GRADUATE STUDIES Counselling Psychology Department of Educational and Counselling Psychology and Special Education We accept this thj^is 4s>&)j>$&rrm|ig to thfe required standard T H E U N I V E R S I T Y OF B R I T I S H C O L U M B I A Vancouver, British Columbia Summer, 2001 ©Romy R o n i t ' T e r k e l , 2001 UBC Special Collections - Thesis Authorisation Form http://ww\v.library.ubc.ca/spcoll/thesauth.htm In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f the r e q u i r e m e n t s f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r ' agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y purposes may be g r a n t e d by the head o f my department o r by h i s or her r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . The U n i v e r s i t y o f B r i t i s h Columbia Vancouver, Canada 1 of 1 7/10/01 3:38 PM Abstract Research on friendship bereavement in general (including adolescent friendship bereavement) has been overshadowed by the voluminous literature on familial bereavement. This is a surprising limitation of the bereavement literature given the growing population of "survivor friends" in society. In an effort to understand more about the grieving process adolescents endure after a friend of theirs had died, four stories of adolescent friendship bereavement were explored from a phenomenological perspective. Findings from this study reveal that adolescents are deeply affected by the death of a close friend and yet, often exist as a "hidden" population left to mourn the death o f their friends silently and without formal resources, adult support, or death education. Implications for helping professionals are explored in light of these findings. Overall, it is recommended that parents, teachers, and counsellors be sensitive to the pain adolescents experience after losing a friend and offer them guidance and support in a manner which respects their changing boundaries. Table of Contents Abstract i i Table o f Contents i i i Acknowledgements v Chapter I Introduction 1 Overview 1 Significance of the Study 2 Chapter II Literature Review 5 Definition of Terms 5 Perspectives on Bereavement 6 Problems with the Literature 9 The Importance of Friendship 9 Friendship Bereavement Studies 11 Adolescent Friendship Bereavement 16 What is Adolescence? 16 Distinct Characteristics 17 Studies on Adolescent Friendship Bereavement 20 Do Different Modes of Death Cause Different Reactions? 25 Summary 27 Chapter III Methodology 29 Design 29 Co-Researcher Selection 32 Description of Co-Researchers 34 iv Procedure 35 Analysis 38 From Transcription to Formulation of Themes 39 Writing the General Story 40 Validation Interview 41 Chapter I V Results 42 Introduction 42 Condensed Outline of Clustered Themes 42 Exhaustive Description of the Bereavement Experience 44 Addendum 76 Chapter V Discussion , 77 Introduction to the General Story 77 The General Story 78 Significant Findings 82 Limitations 87 Recommendations for Future Research 88 Implications for Helping Professionals 91 Conclusion 93 References 95 Appendix A 103 Appendix B 105 Appendix C 108 Acknowledgements I would like to thank my committee members- Dr. Marv Westwood, Dr. Brian de Vries, and Dr. Rod McCormick- for their help and validation during the research period. I am especially grateful to Brian de Vries for bringing my attention to the "hidden" population o f "survivor friends" and for sparking my interest in this project. I am also grateful to my family and friends for their never-ending support and encouragement. I feel greatly indebted to Dan for his assistance, love, and patience throughout the research process, even when I was not much fun to be around. Finally, I would like to thank my co-researchers for their participation in this project. Without their willingness to share their bereavement experiences in such an open and courageous manner, this work would not have been possible. 1 Chapter I- Introduction Overview Demographic trends over the past three decades suggest that the population o f bereaved friends has been growing because of a shift in primary group relationships from family to friends (Deck & Folta, 1989; Sklar & Hartley, 1990). In spite of the social changes that have occurred, the major comprehensive studies in the grieving literature continue to focus on the familial grieving process. In contrast, only a handful o f studies have been exclusively devoted to the bereavement experience of close friends (Sklar & Hartley, 1990). Some researchers blame society, in general, for the relative absence of attention that has been given to the population of bereaved friends. They contend that it has been society's failure to acknowledge bereaved friends as legitimate grievers that has caused them to grieve the deaths of their close friends silently and essentially become a "hidden" population (Doka, 1989, p. 4; Sklar & Hartley, 1990, p. 104). Throughout the life cycle, and during adolescence in particular, "peers are often more significant in importance than k in" (Deck & Folta, 1989, p. 78). Thus, the death o f a friend during adolescence is likely to have a profound impact on the adolescent's life. This is because o f several reasons: (a) the intensity of relationships adolescents have with their friends, (b) the fragility of their youthful ego's, and (c) the leading causes of their deaths, which usually occur violently and without warning (Deck & Folta, 1989, p. 78; Sklar & Hartley, 1990, p. 105). It is presumptuous to assume that people experience the death of a friend in the same way as they do the death of a family member, and worse to assume that people are not affected by the death o f a friend at all. These expectations can be harmful to bereaved friends and even exacerbate their grieving process. The purpose of my thesis, then, is to gain a holistic understanding of the meaning and process of the grief period that bereaving adolescent friends endure. Specifically, it aims to investigate this question, "What is the lived meaning of grief for bereaving adolescent friends of a peer who has died"? Stenificance of the Study A review of the literature on bereavement reveals few publications on this topic. Furthermore, the methods that researchers employed to obtain information for these publications were quite structured (e.g., questionnaires), thus limiting the potential richness of research participants' stories. Since every person has an active perspective on his or her lived human experience, it seems necessary to allow people to describe the meaning they attach to their own experiences without limiting their stories and society's understanding by imposing our own structures (e.g., biases) on their lives. Currently, no studies have attempted to provide a holistic understanding of the meaning and process of the grieving experience that bereaved adolescent friends endure. Therefore, the aim of this.project is to provide a more complete understanding of this experience by using phenomenological methods, which attempt to limit researchers' biases and generate true reflections o f people's lived experiences. I decided to focus upon bereaving adolescent friends in this study for three main reasons. For one, there are distinct adolescent issues which make losing a friend during adolescence different, or possibly more difficult, than losing a friend during other stages in the life cycle. It is during adolescence that an "intense need to be accepted by peers" 3 develops, and "friends often become more important than k in" (Deck & Folta, 1989, p. 79). In addition, adolescent's grief may be compounded by virtue of their distinct developmental issues, including "their changing bodies, their struggle for independence, and the necessity o f making important choices concerning their future" (Baxter & Stuart, 1999, p. xii) . The final aspect of adolescent bereavement that makes it unique concerns the way in which adolescents die. Adolescence is the only era in the human life span for which the three leading causes of death are all human-induced (e.g., suicides, accidents, and homicides), which may be tougher deaths to grieve because they involve no prior warning (Balk & Corr, 1996, p. 18; Baxter & Stuart, 1999, pp. 9-10). A second reason for conducting this research on grieving friends in general, but adolescent friends in particular, is timeliness. Demographic trends since 1970 suggest that the population of bereaved friends wi l l continue to grow, and yet society at-large does not seem to acknowledge survivor friends as a legitimate grieving population (Sklar & Hartley, 1990, p. 105). Added to this point is the fact that social change is moving us away from traditional family structures as more people than ever before are "choosing the single life-style", marrying later in life, getting divorced, and putting their family members in the care of nonfamily institutions (Deck & Folta, 1989, p. 78; Sklar & Hartley, 1990, p. 111). It is within this framework that "there is a shift of primary group relationships from family to friends" (Deck & Folta, 1989, p. 78). It is also timely to investigate this phenomenon because of the large number of high school shootings that have occurred recently, which have left many adolescents as bereaved friends. Finally, on a personal level, my own experiences with friendship bereavement inspired me to prepare this study. I remember feeling deeply saddened by the death of an 4 acquaintance o f mine during high school. In particular, I remember being confronted with my own mortality for the first time and feeling scared, shocked, and confused. More recently, a friend of mine, with whom I lost contact in the last three years, died in a skiing accident. During my bereavement experience, it became clear to me that as a friend-griever with no connection to my friend's family, I had no place to grieve. I realized that I had few rights as a bereaved friend- nobody had to call upon me to help plan her funeral and nobody even had to notify me that she died. I found out that she died through a random connection several days after the accident happened. It took me a month to find out exactly how she died and when, and I received this information from strangers. In no way do I hold my friend's family accountable for my lonely and disconnected grieving period, for it was impossible for them to know how many lives my friend touched. I do, however, believe that bereaved friends need a socially recognizable state of grief, especially as the population of friend-grievers continues to grow in our society. 5 C H A P T E R II- Literature Review Definition of Terms The three terms that refer to loss in the literature- bereavement, grief, and mourning- are often used interchangeably, although several distinctions have been made between them (Rando, 1984, p. 15). This multiplicity of meanings reflects the complex and multidimensional nature of loss. To be precise, "bereavement" is an umbrella term subsuming the processes o f grief and mourning, and is a model used to explain the overall condition or state of having suffered a loss (Rando, 1984, p. 16; Sprang & M c N e i l , 1995, p. 5). The D S M - I V classifies bereavement under "Other Conditions That M a y Be a Focus of Clinical Attention" and defines it as "a reaction to the death of a loved one" (American Psychiatric Association, 1994, p. 684). This definition also emphasizes symptoms that are not characteristic of a normal grief reaction and they all appear to be exaggerated or prolonged aspects of normal grieving (e.g., "guilt about things other than actions taken or not taken by the survivor at the time of the death") (p. 684). " G r i e f refers to the "emotional components of the bereavement process" (Sprang & M c N e i l , 1995, p. 5). Grief is a universal aspect of human existence by virtue of our attachments to people, places, and things (Archer, 1999, p. 1; Rando, 1984, p. 16; Raphael, 1983, p. 3). It is a natural reaction to loss that is characterized as a state of personal anguish, intense turmoil and stress (Archer, 1999, p . l ; Averi l l & Nunley, 1993, p. 77; Shuchter & Zisook, 1993, p. 43). O f all possible losses, the death of a loved one is considered among the most painful and distressing (Stroebe, Stroebe, & Hansson, 1993, p. 3). 6 Lastly, "mourning" is the "behavioral component of bereavement" and consists of the cultural rituals performed around the death of another (Rando, 1984, p. 15; Sprang & M c N e i l , 1995, p. 5). In essence, mourning is the "cultural response to gr ie f , which implies that there is "no one style of gr ief , but that it is a reaction that is influenced by the individual's social and cultural environment (Rando, 1984, p. 16). Perspectives on Bereavement Theories of grief, mourning, and bereavement emerged from psychoanalytic thought (Freud, 1917/1957), attachment perspectives (Bowlby, 1973; Parkes, 1993; Weiss, 1993), and stage theories (e.g., Kubler-Ross, 1969). For Freud (1917/1957), grief was a long, active process of trying to accept the reality of one's loss and of freeing one's emotional energy and attachment from the lost person in order to form new relationships. Bowlby (1973) conceptualized grief as an extension of a typical response to separation from an attachment figure that might evoke feelings of anger, panic, sadness, and disbelief. Bowlby (1980) also proposed a stage model of grief to explain the process through which grief proceeds. Other researchers have also proposed stage models of grief. For instance, Kubler-Ross (1969) described the process of bereavement in terms of five stages: denial and isolation, anger, bargaining, depression, and acceptance. The psychoanalytic and attachment theories, in particular, continue to dominate current conceptualizations of grief, even though many of these theories have never been empirically tested (Middleton, Raphael, Martinek, & Misso, 1993, p. 49). More recently, researchers have been attempting to "look anew at some o f the established concepts of g r i e f (Archer, 1999, p. 23) by critically examining them "to achieve theoretical and 7 clarity regarding the symptomatology, process, and duration of g r i e f (Sprang & M c N e i l , 1995, p. v i i ) . ' Findings from this empirical research have revealed several changes in the way in which grief is conceptualized. Some of these major changes that have occurred wi l l be outlined below. In the past two or three decades, there has been a shift in the way researchers and helping professionals conceptualize grief. In particular, researchers have begun to view grief "as a highly individualized process", recognizing that there are many and varied ways in which people grieve (Stroebe et al., 1993, p. 5). Thus, there has been a movement away from a global conceptualization of how people experience grief to an understanding that "there may be variability in the manner in which individuals respond to the death of a loved one" (Sprang & M c N e i l , 1995, p. vii). Each person's grief is considered idiosyncratic because it is "a unique combination of psychological, social, and physiological factors", which impact a person's grief response (Rando, 1984, p. 43). One concept that has received much controversy in the last two decades is the "stages" or "phases" of grieving (Rando, 1984, p. 28). Although many researchers long accepted that grief proceeds in a linear progression through distinctly identifiable periods, follow-up studies with bereaved individuals demonstrate that this is not the case. This is because grief does not proceed as an invariant sequential process, but is "a composite of overlapping, fluid phases that vary from person to person" (Shuchter & Zisook, 1993, p, 23). Thus, stages are currently regarded as general guidelines only and do not prescribe where a person should be in the grieving process (Shuchter & Zisook, 1993, p. 23). A s Weiss (1993) states, "insofar as individuals move from grief to recovery, a sequence o f phases seems likely" (p. 279). 8 "Too frequently in the past, accounts of grief have been overly simplistic" and have failed to take individual differences into account (Stroebe et al., 1993, p.5). Thus, researchers assumed that there could be a length of time designated for the period of grief that would hold true for all bereaved individuals (Stroebe et al., 1993, p. 5). Currently, however, grief is viewed as a multidimensional phenomenon that is affected by a multitude of individual factors that influence one's response to loss (e.g., the relationship between the bereaved and the deceased, the mode of death, and cultural influences). These individual factors, in turn, make determining a definitive length o f time for the grieving process difficult. Although a universally agreed-upon time course for the duration of normal grief and bereavement does not exist, the time course expected by professionals in this field has increased over the years (Shuchter & Zisook, 1993, p. 24). More recently, some researchers have even found that many "normal" bereaved individuals never completely resolve their grief, and significant aspects of their grieving process can go on for years (Shuchter & Zisook, 1993, p. 25). For instance, people may "continue to feel the presence of the deceased", or still feel sadness, anger, and guilt for years (Shuchter & Zisook, 1993, p. 25). Even when bereavement is prolonged or does not end, many researchers contend that it "often promotes growth and development and may bring out hidden resources and strength" (Shuchter & Zisook, 1993, p. 43). Parkes (1993) also believes that there can be positive outcomes that result from the grieving process. For Parkes, the final outcome of healthy bereavement involves the attainment of a new identity and revised assumptions about the world. However, there are some circumstances in which an individual is 9 clearly unable to move on and his or her grief is associated with "excessive or prolonged psychological or physical morbidity" (Middleton et al., 1993, p. 44). In these cases, the individual's grief might be labeled as "pathological" (Middleton et al., 1993, p. 44). Problems with the Literature There are two major problems with the bereavement literature. The first major shortcoming of the bereavement literature concerns the current models o f grieving, as they tend to yield a linear understanding of this process and are impoverished of human meaning. The second problem with this literature is that the majority o f the comprehensive studies on bereavement have focused on the familial grieving process. In contrast, bereaved friends have not been included as participants in these studies, which is surprising given the pivotal role that friends play in people's lives (de Vries, 1996). The absence of attention given to bereaved friends in the literature suggests that researchers and other members of society alike, do not expect the death of a friend to impact people's lives. This is evidenced in one well-known bereavement researcher's theory, as he asserts that because friendships are not relationships of attachment (in contrast to family, for example), they are "replaceable", and thus do not evoke grief responses when someone dies (Weiss, 1993, p. 271). The Importance of Friendship Despite the impressive body of literature that attests to the significant role played by friends for individuals of all ages, researchers have given little attention to the impact of the death of a friend on surviving friends (de Vries, 1996, p. 49; Sklar & Hartley, 10 1990, p. 111). In order to understand what is lost when a friend dies, a brief overview o f the literature on what it means to be a friend wi l l be presented. Across friendship studies, what is meant by the term "friend" is variable (Deck & Folta, 1989, p. 78; Roberto & Kimboko, 1989, p. 10). This is because the way people define the word friend is highly individualized. Since a friend can be regarded as "an acquaintance, a neighbor, a close friend, a best friend, or a confidant", generalizing results from friendship studies is difficult (Roberto & Kimboko, 1989, p. 10). Although the way in which people conceptualize the word friend is elusive, there are several consensual meanings attached to this term. For instance, most people agree that friendships involve trust, loyalty, support, understanding, sharing, and pleasure (Deck & Folta, 1989, p. 78; Rubin, 1985, p. 7). In contrast to familial relationships, friendships inhabit "a world that is largely affective and normed on reciprocity and choice" (de Vries, 1996, p. 261). Friendships are also notable for their clear boundaries, mutually negotiated relations, unique voluntary commitments, and nonascribed role prescriptions (de Vries, 1996, p. 260). Many people find it easier to self-disclose to friends than to family members because their friends are more accepting and less judgmental (Rubin, 1985, p. 18; Sklar & Hartley, 1990, p. 104). Sometimes the way people are defined in their family is an inaccurate reflection of who they are. This happens when labels from childhood stick, or when old memories stay entrenched in the family's mind. These labels have the power to disable people from being themselves when in the presence of their family. Conversely, friends are able to see, validate, and understand the person who lives today without being tainted by baggage from the distant past (Rubin, 1985, pp. 28-29). Thus, from friendship, people 11 "derive a sense of self-confirmation, a sense of who we are, of self-worth, and self-esteem" (Deck & Folta, 1989, p. 79). Friends are often more significant in importance than family members throughout the life cycle. This is particularly true for young people and elderly for whom friends provide "the most meaningful and psychologically close relationships" (Deck & Folta, 1989, p. 78). Despite the pivotal role that friends play in the lives of others, the impact of their loss has rarely been studied, or even acknowledged, in traditional bereavement research. Friendship Bereavement Studies There are very few studies that have examined the bereavement experience of close friends. This is surprising given that the population of bereaved friends has expanded and wi l l likely continue to grow (Sklar & Hartley, 1990, p. 111). The handful of relevant studies that do exist wi l l be reviewed in this section, with the exception of those studies devoted exclusively to adolescent friendship bereavement (will be presented in a separate section). In a movement away from traditional research on bereavement, which focuses on the impact of familial death on family members, Sklar and Hartley (1990) sought to explore the bereavement of persons who experienced the death of a close friend. According to these researchers, studies on the impact of the death of a close friend were needed because it could be "as severe, and in some cases more severe" than the death of a family member (Sklar & Hartley, 1990, p. 104). For Sklar and Hartley, there is a "relatively large 'hidden' or invisible population silently grieving the deaths of close 12 friends" that needs to be recognized (p. 104). They coined the term "survivor-friends" to refer to such close friends in mourning (p. 106). Sklar and Hartley (1990) carried out two small-scale exploratory studies with a sample of 48 adolescents and young adults who had experienced the death of a friend within the previous five years. For one of these studies, 12 participants were interviewed and 23 others wrote essays about their experiences; for the other study, participants took part in a short-lived mutual-support group. On the whole, findings revealed that participants "shared many emotions and experiences commonly attributed to widows, widowers, and other family members" (p. 110). For example, participants felt unresolved feelings of despair, guilt, (particularly for things left unsaid or undone), fear of their own mortality, and a sense o f emptiness. Contrary to bereaved kin, however, many participants felt as though they were not "permitted" to grieve, and only one participant felt acknowledged as a legitimate griever (p. 110). The value of this study is limited by several factors, including sample bias (participants were selected purposively) and its structured design (interviews and essays were organized with questions), which may have biased participant's reflections on their experiences. In a follow-up article by Sklar (1992), a couple o f theories were proposed to explain why survivor-friends, as opposed to bereaved kin, are a "hidden" population. Firstly, he explained that society does not recognize friends as legitimate grievers (Sklar, 1992, p. 110). For example, friends do not enjoy any property rights in the absence of a deceased friend's w i l l because intestacy laws in the United States "l imit inheritance to k in" (p. 112). Thus, according to Sklar, friends are "nonpersons in the eyes of intestacy 13 law" because regardless of "how deep and extensive their social and emotional intimacy", they have no rights of inheritance (p. 112). Deck and Folta (1989) cite many other ways in which society denies bereaved friends of their emotions and rights to grieve. For instance, friends have no legal rights to be notified of a friend's death, or to plan a friend's funeral. In addition, unlike many family relationships, there are no labels to describe the death of a friend (e.g., children become "orphans"), leaving bereaved friends without an identity or prescription of role behaviour (Deck & Folta, 1989, pp. 83-84). Finally, there are many social institutions that do not make the same accommodations for bereaved friends as they do for bereaved family members (e.g., airlines only define close kin as acceptable grievers for ticket-changing purposes) (Deck & Folta, 1989, p. 82). Sklar (1992) continues with an additional theory that explains why bereaved friends are a hidden population. He states that the deceased's family members also play a role in denying bereaved friends the same rights to grieve. For example, at funerals, family members tend to sit together in a different seating area than friends (Sklar, 1992, p. 115). Rubin (1995) also observed this distinction between bereaved family and friends. She observed that "the separation between family and others, whether close friend or casual acquaintance, is clearly marked" at funerals (p. 2). Thus, family members sit together even i f they dislike each other. According to Doka (1989), the overall reason that friends are a hidden population is because they are "disenfranchised grievers". This concept of disenfranchised grief recognizes that "societies have sets of norms- in effect, 'grieving rules'- that attempt to specify who, when, where, how, how long, and for whom people should grieve" (p. 4). 14 Since any society can define who has a legitimate right to grieve without considering the feelings or circumstances of individual survivors, survivors' grief may be disenfranchised. This can occur for three reasons: i f the relationship between the bereaved and the deceased is not recognized by others, i f the loss itself is not recognized or defined as significant, or i f the bereaved person is considered to be incapable of grief (pp. 5-6). Thus, it seems clear that society in general, including many bereaved kin, does not yet recognize the grieving rights of bereaved friends. In fact, just by virtue of their blood ties, bereaved family members reserve more grief rights than friends, regardless of how close they are to the deceased. This explains why friends are disenfranchised grievers. Some researchers have shown interest in what may be helpful for bereaved friends while they are grieving. For instance, Park and Cohen (1993) examined the degree to which religion affected, or did not affect, people's ability to cope with the loss of a friend. For their study, they interviewed and gave self-report questionnaires to 96 undergraduates who had experienced the death of a close friend within the last year and who were either Catholic or some denomination of Protestant. Results from multivariate analyses o f variance ( M A N O V A ) revealed that intrinsic religiousness exerted both favourable and unfavourable effects on participants' ability to cope with the distress following the loss of a friend. Some positive effects of intrinsic religiousness included perceiving that one had support from god, that god is purposeful (and thus trusting that the world is meaningful), and personal growth. There were two main negative effects of intrinsic religiousness that were positively associated with stress and dysphoria: (a) perceiving the death as unfair, and (b) pleading with god to change things, which may 15 have caused individuals to "continue to ruminate over the death" (Park & Cohen, 1993, p. 574). Other researchers have investigated the effects of losing a friend on other populations, including elderly people. For instance, Roberto and Stanis (1994) examined the reactions of 38 older women who reported the death of a close friend within the past 12 years. Each woman was required to partake in a 20-minute phone interview and to fill out a questionnaire subsequent to the interview. Findings indicate that even years after their friend's death, the majority of participants still felt a sense of loss, and over one-third reported feeling alone. In addition, half of the women reported feeling more appreciative of their other friends following the death of their friend, and nearly this many women reported feeling an enhanced appreciation of life (Roberto & Stanis, 1994, p. 22). Results from this study suggest that bereaved older friends are affected by the death of a friend both immediately and in the long-term, similar to bereaved family. A s a final point, it is worthy of noting that a few bereavement studies have made comparisons across deaths, including the death of a friend. For example, Hays, Gold, and Pieper (1997) studied the bereavement experiences of over 3,000 people aged 65 and older. The focus of this study was on the impact of sibling deaths on older adults, but comparisons between those bereft of a sibling and those bereft of a friend or another family member were made. Bereaved siblings were more likely to report their overall health (e.g., greater physical problems) as worse than bereaved spouses or friends. Surprisingly, however, siblings were more likely than bereaved spouses or friends to evaluate their loss as positive. At the same time, spouses were more likely to evaluate the effect of their loss as negative, and friends experienced more neutral/mixed reactions. In 16 sum, although the "functional, cognitive and subjective* health" of bereaved siblings may be worse than that of bereaved spouses or friends, the likelihood of this population experiencing the death of a sibling is one-third that of losing a friend (Hays et al., 1997, p. 38). Thus, older adults lose many friends to death and it is important to consider the impact of these experiences. Overall, these research findings suggest that there are many similarities between the grieving processes that bereaved friends versus bereaved family endure. For instance, results from these studies suggest that individuals of all ages experience a wide range of emotions when they experience the death of a friend (e.g., despair, emptiness). The main difference between bereaved friends and bereaved kin concerns the way in which society in general treats each of these groups. Unlike bereaved family members, bereaved friends do not have grief rights and often remain a "hidden" population. Feeling "invisible" may be especially salient for adolescents who experience the death of a friend, and an investigation into this phenomenon is presented in the following section. Adolescent Friendship Bereavement What is adolescence? The period of life we call "adolescence", between the worlds of childhood and adulthood, has not always been regarded as a distinct era in the human life cycle (Balk & Corr, 1996, p. 4; Gordon, 1986, p. 18; Kastenbaum, 1986, p. 12). "Through much of history, people moved into adult responsibilities rather quickly, unencumbered by such institutions as compulsory education and such personal agendas as 'finding mysel f" (Kastenbaum, 1986, p. 12). Currently, most people agree that adolescents range between 17 12 and 19 years of age, although some researchers com end that dividing this era into more specific subperiods permits a more detailed description o f the developmental tasks adolescents accomplish during this time (Balk & Corr, 1996, p. 6; Gordon, 1986, p. 18). Above all, adolescence is a developmental period characterized by major change (Balk, 1991, p. 8; Hundley and Bratton, 1994, p. 14; Hustins and Kel ly , 1990, p. 22). Distinct Characteristics There are many reasons why the death of a friend during adolescence is distinctly different than the death of a friend during any other era in the human life span. In the following paragraphs, four unique characteristics of adolescence and the death of a friend wi l l be outlined. For one, they belong to an age category for whom friends often become more important than family (Deck & Folta, 1989, p. 79; Sklar & Hartley, 1990, p. 104). This is because both of the major tasks of adolescence, individuation and identity formation, are experienced within the context of peer relationships (Erikson, 1963, p. 262; Oltjenbruns, 1996, p. 201). One of the purposes of the peer group is to provide support to the adolescent who is in the process of individuating, which involves becoming psychologically separate from one's parents. The goal of individuation is not for the adolescent to negate all that his or her parents have said, but to have the "ability to be in emotional contact with others yet still autonomous in one's emotional functioning" (Innes, 1995, p. 216). Peers help adolescents confront their parents' rules and values so that adolescents can develop their own beliefs and "not simply mirror parental dictates" (Oltjenbruns, 1996, p. 202). As adolescents individuate from their parents, their 18 individuality becomes more developed, and their sense of identity is strengthened. Since friends play a crucial role in helping adolescents to define and accept themselves, losing a friend can upset the adolescent's identity formation (Deck & Folta, 1989, p. 84; O'Brien, Goodenow, & Espin, 1991; Podell, 1989). This is because the death of a friend who "questioned one's beliefs and values, debated one's ideas, and encouraged one to challenge adult authority may leave a profound void" in the support network designed to facilitate identity formation (Oltjenbruns, 1996, p. 202). Another reason why the death of a peer during adolescence is distinct concerns the way in which adolescents perceive their world. "For the adolescent, death is anathema. Everything emphasizes life, change, growth" (Raphael, 1983, p. 139). The adolescent's developing body, advancing cognitive abilities, and liberation from the umbrella o f parental protectionism, all make death seem impossible (Austin & Mack, 1986, p. 59; Raphael, 1983, p. 139). Indeed, adolescents' common engagement in high-risk activities (e.g., car racing, excessive drug use) suggests that they remain "cloaked in the remnants of belief in immortality" (Gordon, 1986, p. 27). In general, adolescents feel invincible and operate according to the principle "it can't happen to me" (Noppe & Noppe, 1996, p. 25). Experiencing the death of a friend during adolescence forces the adolescent to confront his or her own mortality and call into question the assumptions he or she holds about the world (e.g., young people do not die). The ego is most fragile, most open to doubt, and least protected, when exposed to the death of someone similar to oneself (e.g., same age) (Gordon, 1986, p. 26; Podell, 1989, p. 77). Since "the adolescent's ego and self-esteem are influenced by the identifications and protection 19 derived from peer bonds", "a breech in this bond results in increased ego vulnerability" (Podell, 1989, p. 75). Although adolescents' grief responses and mourning practices may not exactly parallel those of adults, many researchers contend that adolescents do have the cognitive capacity to understand the meaning of death (Balk, 1991, p. 15; Balk & Corr, 1996, p. 23). According to Piaget (1958), adolescents have the ability to understand the finality o f death because they have achieved formal operational thought, which allows them to think abstractly and reflectively. Yet, despite these beliefs, bereaved adolescents tend to be a particularly "hidden" population and disenfranchised grievers (Doka, 1989, p. 4; Sklar & Hartley, 1990, p. 104). Although the concept of "hidden" grievers has been used to describe bereaved friends of all ages, there are specific issues unique to adolescence that may exacerbate this feeling of being a "forgotten mourner" (Hundley & Bratton, 1994, p. 14). Firstly, adults may perceive adolescents' grief as an "expression of developmental conflicts or as acting out in response to family dynamics" and thus fail to acknowledge their changed behaviour as a direct result o f the grief that they are experiencing (Podell, 1989, p. 64). Secondly, adolescents may hide their grief from their parents because they are in the process of individuating, or becoming emotionally independent from them (Podell, 1989, p. 64). Added to this, adolescents are starting to look more like adults and people in society, including their parents, may assume that because they are mature and think more independently than children, they can cope with any crisis that transpires (Deveau, 1990, p. 67; Hundley & Bratton, 1994, p. 14). "And because issues related to death are seen as very personal, adolescents' privacy is upheld and they are often left on their own to manage difficult thoughts and feelings" (Deveau, 1990, p. 67). 20 The final distinct characteristic of adolescence is that it is the only age group for whom the three leading causes of death- accidents, homicides, and suicides- are all human-induced. This is unique to adolescence, as "all other eras in the human life span include at least one (usually, two or more) disease-related cause among the three leading causes o f death" (Balk & Corr, 1996, p. 16). Since human-induced deaths usually occur suddenly, unexpectedly, and violently, some researchers contend that death is more shocking and traumatic for adolescents than for others (Balk & Corr, 1996, p. 18; Sklar & Hartley, 1990, p. 105). Additionally, since many of these deaths are preventable, adolescents might become angry at the behaviours that led-up to the deaths and anguished over what could have been done to stop them from happening (Balk & Corr, 1996, p. 18). Studies on Adolescent Friendship Bereavement Although increased attention has been given to the impact of death on adolescents since the early 1980s, research in this area has focused more on bereavement resulting from the death of a sibling or a parent than on grief caused by the death of a friend (Oltjenbruns, 1996, p. 196). Notable exceptions to this include a handful o f studies that examined the impact and effects of adolescent friendship bereavement, and they are described in the paragraphs that follow. It is hoped that findings from these studies serve to highlight the characteristics of friendship bereavement that are unique to adolescence so that researchers, parents, and teachers alike, can help this population of bereaved friends work through their grief. 21 Podell (1989) examined adolescents' bereavement experiences following the sudden and traumatic death o f five male students from their school. Social workers, including the author himself, assisted bereaved students by providing them with individual or group counselling and information about the nature and course o f grief and mourning. Longer-term individual follow-up sessions over the following year were provided to 22 students who experienced prolonged mourning (p. 66). Overall, students were profoundly affected by the death of their peers. The most pervasive effects that students experienced were: fear (e.g., of exposing grief in front of others), loneliness, vulnerability in the world (i.e., unprotected from death), identification with the victims (feeling dead too), and scary thoughts. In addition, follow-up sessions with students who experienced complicated and prolonged grief revealed that the majority of them felt extreme guilt and responsibility for their friend's death (p. 72). Two case vignettes of students suffering from prolonged grief revealed that previous losses (unique to each person) impacted the meaning that these students attached to the loss of their friend. For example, vulnerability to past traumatic losses left one student feeling responsible for the prevention of her friend's death and another student feeling unprotected and vulnerable (ego-wise) in the world (p. 73). In sum, many participants in this study were affected by the death of their peers both immediately and in the longer-term. O'Br ien , Goodenow, and Espin (1991) explored adolescent reactions to the death of a peer by means other than suicide by conducting semi-structured interviews with ten college students (18 to 21 years old) who had lost a friend during high school. Nine of the deceased peers had died from accidents and one had died from natural causes. The nature of the relationship between the participants and the deceased ranged in description 22 from an "intimate friend" to "more of a friend when I was younger" (p. 434). Overall, participants experienced the death of a friend as different and more difficult than experiencing the loss of an older person. In fact, even years later, at the time this research was conducted, none of the participants were completely over the loss. Areas of their lives that were affected included church attendance (difficult to attend), sensitivity to others who experienced a similar death, and their social life (withdrew more from others) (p. 435). Participants also reported that their relationships with their parents and peers were affected (e.g., many felt unsupported by their parents; some found it difficult to talk with peers) and that having little support from their schools exacerbated their grieving process (p. 436). Participants who first heard about the death of their friend in an impersonal way, felt even less supported and also found it difficult to discuss their loss with others (p. 437). Finally, although the intensity of the students' relationships with their deceased friends varied, the degree of closeness o f their relationships did not predict the intensity or duration of the grieving process (p. 435). Although the findings from this study are limited for numerous reasons, including its small sample size, it seems clear that losing a friend during adolescence had long-term effects on these participants. In addition, findings suggest that schools may give little attention to deaths that are not suicide-related. Schachter (1991) used a 22-question survey instrument with a convenience sample of 53 participants, 13 to 19 years of age, who had experienced the death of a friend within the previous five years. Overall, 70% of the deaths were accidental, 7% were cancer-related, 7% resulted from murder, 2 % were due to suicide, and the remaining 14% resulted from a combination of medical illnesses. Participants 23 experienced a wide range o f emotions following the death o f their friend including, sadness, shock, disbelief, surprise, and anger. Interestingly, anger was more paramount when the deaths were related to causes other than illnesses. Most participants reported other friends (for comfort, support, and validation), and partaking in rituals (i.e., funerals), as helpful during this time (pp. 7-8). Although many participants found funerals helpful, they often felt concerned or confused about what to do and say at funerals. Most people's feelings about death changed as a result of their loss (e.g., fear of dying, life is precious). In addition, participants experienced three main behaviour changes: (a) they became closer to their other friends, (b) they shared feelings more openly, and (c) they took more time to tell others that they cared. In sum, the death of a friend during adolescence for these participants was a life-altering event. However, findings from this study are limited by the relatively small sample size and by sample bias (the participants are not representative of the larger adolescent population, for whom suicide is the second leading cause of death, as opposed to the lowest cause) (p. 5). M c N e i l , Silliman, and Swihart (1991) conducted a study with 94 high school students (14 through 18 years) 18 months after the death from leukemia of a popular, 16-year-old male student in their school. In terms of collecting data, participants were required to complete questionnaires, and interviews were conducted with school personnel. Participants' relationships with the deceased ranged from "very close" to "very distant acquaintances", although most participants knew and had contact with him. Immediately following the death of their peer, students described themselves as significantly affected by the news and typically felt sad, shocked, angry, and numb (McNei l et al., 1991, p. 136; Swihart, Silliman, and M c N e i l , 1992, p. 56). In addition, 24 many students reported that during the first week following their friend's death they thought about him often. In general, students affirmed the value of talking about their feelings, although there was a small group of individuals who tried to avoid doing so (mainly students who had not been close friends to the deceased) (McNei l et al., 1991, p. 138). Although a few students reported feeling comfortable talking with their parents, most reported an "overwhelming preference for communication with their own peers" as most helpful, and perceived their parents and teachers as unsupportive or unapproachable (McNei l et al., 1991, p. 138; Swihart et al., 1992, p. 57). Eighteen months subsequent to their peer's death, a compelling number of students still carried intense feelings of sadness, anger, or confusion (McNei l et al., 1991, p. 139). At this time, the majority o f students reported feeling changed by their peer's death (e.g., appreciated their friends more, worried about death more); their teachers and the authors of this study also observed changes in their behaviour (e.g., appeared more thoughtful, serious, and solemn). In sum, both close friends and acquaintances were affected by the death of their peer. Close friends, however, differed from others in several ways: (a) they were most likely to think about their deceased friend both immediately and in the long-term, (b) they had more difficulty accepting the death, and (c) they were most likely to feel changed by the death. Dyregrov, Wikander, and Vigerust (1999) were interested in the reactions of 26 adolescents following the accidental death of their eighth grade classmate on the care they received from their school. In addition, six of the deceased student's closest friends from outside his class were interviewed regarding their evaluation of school support (p. 192). One month after the accident, students in the class were given a questionnaire and 25 interviews were conducted with 13 of the deceased's closest classmates and with the six friends from outside his class. Nine months later, the same procedures were carried out, although some parts of the questionnaire were modified. Overall, the deceased's classmates perceived the school's efforts as very supportive and regarded the school's follow-up procedures as helpful (e.g., funeral, rituals), especially in the beginning. Students also reported the opportunity to talk about the loss as important and meaningful, and an overwhelming majority felt most comfortable talking to peers, as opposed to family (pp. 198-199). Many students experienced problems interacting with other students (e.g., hurtful comments from others) and some reported being bothered by others' reactions (e.g., i f not sensitive enough) (p. 200). Even nine months later, many students were still affected (e.g., stated it would take a long time to overcome the loss; had difficulty concentrating on schoolwork). The six friends outside the deceased's class were much more ambivalent in their perception of support from their school, as they felt excluded from activities (e.g., not making things for the boy's family) and had less opportunities to talk about their feelings and to mourn in general (p. 197). To conclude, there are two major findings to draw from this study: (a) adolescents appreciated support from their school following the death of a peer, and (b) some adolescents may become forgotten mourners and grieve alone i f school personnel do not take extra measures to ensure that all o f the deceased students' friends are acknowledged. Do different modes of death cause different reactions? Unlike any other stage of the human life cycle, the vast majority o f adolescent deaths are due to sudden, man-made causes. The literature on sudden deaths (particularly 26 deaths resulting from suicide) contains many statements suggesting that unexpected grief is different and more devastating than deaths that are expected (Carter & Brooks, 1991, p. 231; Mcintosh & Kel ly , 1992, p. 83). What is implied, then, is that bereaved adolescents are more at-risk o f experiencing debilitating grief than other age groups because the three leading causes of their deaths are unexpected. One of the major limitations of research on this topic is that researchers have generally neglected to include control or comparison groups in their studies. Thus, although personal opinion, experience, and intuition may indicate that sudden deaths are more debilitating, without appropriate control or comparison groups, it is not possible to know for sure (Cleiren & Diekstra, 1995, p. 13; Mcintosh & Kel ly , 1992, p. 83). Another limitation of this research concerns the participants included, as most studies have examined the grief reactions of family members, as opposed to friends, following different kinds of death. Added to this problem of participant sampling is that none of the studies found have included an adolescent sample. Interestingly, findings from the handful of studies that have actually included appropriate control groups reveal greater similarities than differences between the groups (Cleiren, 1993; Cleiren & Diekstra, 1995, p. 13; Mcintosh & Kel ly , 1992). Moreover, no major long-term health differences have resulted between unexpected, expected, accidental, and suicide deaths (Cleiren & Diekstra, 1995, p. 13). There is, however, one difference that has been consistently reported across these studies: that sudden death survivors (e.g., suicide or accident) tend to feel a bit more shocked than other survivors (Cleiren & Diekstra, 1995, p. 13; Mcintosh & Kelly, 1992, p. 89). Contrary to popular belief, no differences in the degree to which guilt is felt by different survivor groups has 27 been found (Cleiren, 1993; Mcintosh & Kel ly , 1992, p 90), although some researchers have reported that the question of responsibility was more common among those bereaved o f suicide (Cleiren, 1993). These comparative studies have also revealed some contradictory findings. For instance, although some researchers have not found that suicide survivors experience more social isolation than other survivor groups (Cleiren, 1993; Mcintosh & Kel ly , 1992, p. 90), others have found that survivors of suicide do encounter more isolation than survivors of death from accidental or natural causes (Calhoun, Abernathy, & Selby, 1986, p. 218). In sum, it is still not known whether or not the human-induced deaths that adolescents most often experience exacerbate their grieving process. This is because researchers have not yet empirically investigated this phenomenon with the adolescent population of bereaved friends. Findings from other comparative studies reveal that there seem to be more similarities than differences between the reactions to different causes of death, but even these findings are based on just a few studies. Summary Results from the studies described above (on adolescent friendship bereavement) reveal several significant findings. For one, across studies, it can be seen that experiencing the death of a peer during adolescence had both immediate and long-term effects for participants. Although it is unclear i f the intensity and duration of an adolescent's grieving process is affected by how close he or she was to the deceased, all adolescents seemed to experience some distressing emotions following the death of a peer. The most commonly experienced emotions for adolescents in these studies 28 included sadness, shock, and anger. Interestingly, anger may be a more prominent emotion for adolescents who have lost friends suddenly. Another important finding is that in general, adolescents preferred to talk to their peers following the death of a friend, as opposed to their family members. Overall, adolescents felt more comfortable talking with their friends and also felt more supported by friends than by their family. A third finding is that adolescents seemed to benefit and appreciate support from their schools following the death of a friend (e.g., planning and participating in rituals). In contrast, bereaved students who went unnoticed by school personnel felt excluded and lonely. For this reason, it seems imperative that school personnel try and acknowledge all students affected by the death of a peer (e.g., friends outside the deceased's class as well). In order to gain a better understanding of the experience adolescents endure after losing a friend, more studies are needed on this topic. This is because only a handful of researchers have investigated this phenomenon, rendering their findings somewhat inconclusive. Future studies should be conducted using different instrumentation than previous studies. This is because previous studies were conducted using interviews or questionnaires that were at least semi-structured in nature (i.e., included questions developed by the researchers). Consequently, participants' accounts of their lived bereavement experiences may have been restricted (i.e., in terms of meaning and richness) by the research procedures implemented in these studies. 29 Chapter III- Methodology Design The purpose of this study is to understand the lived meaning of grief for bereaving adolescent friends of a peer who has died. A s shown in Chapters I and II, formal investigations on friendship bereavement have neglected to investigate the meaning of this phenomenon. Instead, these investigations have been conducted in a traditional scientific manner, using objective, rigorous, and controlled experiments aimed at finding universal dimensions o f this human experience that can be generalized to everybody. The meaning of human experience has, in fact, been "eliminated from psychological methodology since the very inception of scientific psychology" (Colaizzi , 1978, p. 51). This is because traditional scientists believed that human experiences could not be investigated scientifically unless they were controlled or transformed "into operationally defined behavior" (Colaizzi, 1978, p. 53). Over the past three decades, however, several scholars (Giorgi, 1970, 1975; Val le and K i n g , 1978) have argued that the notion o f science should be expanded to include "a human science of psychology" that "can still be practiced with rigor and discipline" (Giorgi, 1975, p. 82). This human science approach is called "phenomenology". Phenomenology aims at describing and understanding phenomena (e.g., events, occurrences, experiences) as they are lived and experienced by persons in the world (Colaizzi, 1978, p. 56). Phenomenological psychology is aimed at "explicating the meaning of human phenomena" as "we live them in our everyday existence" (Colaizzi, 1978, p. 4). Unl ike the natural science approach which "aims at knowledge that is generalizable to everybody", the phenomenological researcher thinks of "people as 30 unique" (van Manen, 1990, p. 6). Thus, meaning is considered distinctly personal, as each person experiences aspects of his or her life in a unique way. This human science approach is oriented around the question, "What is this or that kind of experience like?" (van Manen, 1990, p. 9) and aims to capture a deeper understanding o f any aspect of our lifeworld- "the world as we immediately experience it pre-reflectively" (van Manen, 1990, p. 9). Phenomenological reflection is retrospective- "it is reflection on experience that is already passed or lived through" (van Manen, 1990, p. 10), which means that participants in phenomenological research should no longer be immersed in their experience, but be able to recollect their experience as they lived it. In order to obtain an objective and faithful description of participants' lived experiences, the phenomenological researcher listens respectfully "to what the phenomenon speaks o f i t se l f and refuses "to tell the phenomenon what it is" (Colaizzi, 1978, p.52). However, the problem is that we often know too much about the phenomenon we are investigating and our assumptions "predispose us to interpret the nature of the phenomenon before we have even come to grips with the significance of the phenomenological question" (van Manen, 1990, p. 46). Thus, in order to obtain a truthful account of participants' lived experience, phenomenological researchers must take care "to avoid leading the person, imposing biases, or planting elements o f one's own" (Cochran & Claspell, 1987, p. 42). Phenomenological researchers do this by making their assumptions explicit prior to doing their research. That is, they bracket- or put out of play- everything they "know" (personal biases) about the specific human experience they are investigating in order to 31 prevent their assumptions from creeping back into their reflections and questions while they are doing their interviews (van Manen, 1990, p. 47). M y personal biases (assumptions) on the nature and process of the bereavement experience for adolescent friend-grievers are: 1. The leading causes of adolescent deaths, none of which are disease-related, exacerbate the bereavement process for adolescent friend-grievers as compared to all other populations. 2. The fragility of the adolescent ego and the importance o f the peer group during adolescence make the death of a friend during adolescence a qualitatively different experience than the death of another person (i.e., family member). 3. The death of a friend during adolescence confronts the adolescent with his or her own mortality for the first time. 4. Friend-grievers, especially adolescents, are hidden or dismissed from the grieving process. 5. Adolescents have a particularly difficult time grieving their friends because their parents and teachers often do not understand the importance o f the relationship that was lost to them and thus do not validate their experience (e.g., " Y o u are young- you w i l l make many new friends"). 6. Males and females deal with the bereavement experience differently- for example, girls tend to talk to their friends more openly and boys tend to be more closed and introspective. B y stating my presuppositions at the beginning of my study, I attempted to minimize the interference of my biases during the interview and analysis procedures so 32 that I could provide an objective and faithful description of the phenomenon under investigation. Finally, it should be noted that this type of research "takes place only among persons on equal levels, without the divisiveness of social or professional stratifications" (Colaizzi, 1978, p. 69). Thus, in phenomenological research, the term "co-researchers" is used in lieu o f "researchers" and "subjects" because it "engenders contacting the co-researchers not as researchers but as persons" (Colaizzi, 1978, p. 69). Co-researcher Selection Co-researchers were four adult volunteers bereaved of a friend during their adolescence. These participants were invited to take part in this study through word of mouth solicitation by friends and professional colleagues, and through advertisement notices placed at The University of British Columbia (see Appendix A) . A l l those who took part had "experience with the investigated topic and articulateness", which are the necessary and sufficient criteria for selecting co-researchers, according to Colaizzi (1978, p. 58). Overall, selection criteria included: (a) being able to provide a description o f their past bereavement experience that is consistent with the way "bereavement" is defined in the D S M - I V , (b) offering a self report of being genuinely not immersed in the grief period for a significant period of time, and (c) having the ability to articulate their grieving experience and to elaborate on their descriptions. A s I spoke to potential co-researchers on the telephone, I asked them to tell me about the effects their bereavement experience had on their thoughts, feelings, and behaviours to ensure that their symptoms were characteristic of "bereavement", as 33 defined in the D S M - I V . Additionally, I asked them to describe how deeply impacted they were by the death and how close they were to their friend who died, as I was searching, in particular, for participants who were deeply affected by a close friend's death. During these pre-screening phone calls, I also asked potential participants for further specification of the second criterion- offering a self-report of being genuinely not immersed in the grief period for a significant period of time. Although it was essential for my co-researchers to have temporal closeness to their bereavement experience in order to recall significant details, it was also important that they have enough distance from it in order to provide a holistic account (beginning, middle, and end) o f what they experienced. It was challenging to determine what amount of time constituted "enough distance" from the bereavement experience for several reasons. Firstly, in the few published articles that exist on friendship bereavement, there are no current hypotheses on what constitutes a "normal" grieving period for adolescent friend-grievers. Secondly, the D S M - I V , which currently includes bereavement as a V code (American Psychiatric Association, 1994) does not specify a "normal" time to grieve for people in general, as it is written that "duration and expression o f 'normal' bereavement vary considerably among different cultural groups"(p. 684). Consequently, after reviewing some grieving literature in general, most o f which focused on conjugal loss, I decided to go with a period of two years as a minimum requirement for co-researchers. This is because although a period of one year used to represent the time course of normal grief for most people (in the literature), researchers are currently stating that the expected time for what 34 would be considered normal grief, has increased over the years (Shuchter & Zisook, 1993, p. 24). It is important to note that although choosing a definitive time period for this study was necessary, it seems to preclude individual differences and the fact that all losses are not equal. Description of Co-researchers The co-researchers involved in this study were four volunteers (three females and one male) between the ages of 32 and 47. (A fifth co-researcher was also interviewed. During the course of meeting with him, however, it became clear that he did not fit the criteria for selection of co-researchers. Consequently, the content of this interview was not analyzed for this study.) Each co-researcher involved in this study either is, or has recently been, a graduate student in Counselling Psychology or Special Education. Prior to experiencing the death of their friend during adolescence, only one co-researcher had experienced the death of another person, and none of the co-researchers had been to a funeral. Descriptions of each of the co-researchers are provided below. For confidentiality purposes, all o f their names have been changed. "Rachel" is a 32-year-old graduate student. When Rachel was 16, she lost two peers to suicide within a six-month period (a friend and an acquaintance). Rachel's friend died from an overdose and her acquaintance died after jumping from the 16 t h floor of a hotel. Prior to these deaths, Rachel had never experienced the death o f another person or been to a funeral. Although Rachel did not attend her friend's funeral (did not even learn of her friend's death until months later), she was able to attend her acquaintance's funeral. 35 "Peter" is a 33-year-old graduate student and an early interventionist (autism). When he was 18 and in his first year of university, one of his two best friends committed suicide by jumping off a bridge. Although Peter had experienced the death of another person (an aunt) before his friend's death, he said that it was a different experience because she was older and he was not close to her. The first funeral Peter attended in his life was his best friend's funeral. "Laura" is a 44-year-old woman, who recently graduated from graduate school. When Laura was in grade 10 and 16 years old, her boyfriend of two months died in a car accident. (Although she identified this person as a "boyfriend", the relationship fit the criteria for a "close friend" and thus she fit the selection criteria for this study.) Prior to her boyfriend's death, Laura had never experienced the death of another person or been to a funeral. Thus, the first funeral Laura ever attended was her boyfriend's funeral. "Lynne" is a 47-year-old counsellor. Lynne lost a close friend to leukemia when she was 15 years old. Lynne had never experienced the death of another person or been to a funeral before her friend's death. Unlike the other co-researchers, Lynne did not attend her friend's funeral (she lived in a different city than he did at the time of his death). Procedure After establishing that the four callers seemed to fulfill the selection criteria for being included in this study, each of them was contacted by telephone to schedule an interview time. The interviews took place in quiet rooms in the Psychoeducational Research and Training Centre at the University of British Columbia during M a y and June of 2001. Prior to starting the interview process, I explained the purpose of my research 36 project, my research methodology, and what participation in my study would entail in more detail. Ethical issues were addressed, too, such as the possible distress participants could endure while re-counting their lived experience and thus, they were informed that counselling options would be made available to them, i f they wanted. I subsequently gave each co-researcher the informed consent form to read over (see Appendix B) . Before having them sign the consent form, and after going over it in detail, I encouraged all o f the co-researchers to ask any questions they had and verified that each of them was still interested in participating in this project. Prior to tape recording the interviews, I spent some more time with each co-researcher establishing rapport and answering any questions pertaining to my study. Once the co-researchers were ready to begin, I encouraged them all to talk for as long as they wanted (Colaizzi, 1978). The time it took to conduct each interview ranged between 45 minutes and one-and-a-half hours. I then read the following paragraph to each of them: The purpose of this study is to gain a more complete and holistic understanding of the grieving experience bereaving adolescents endure when a friend of theirs has died. B y sharing your personal knowledge about your grieving process, people wi l l gain a deeper understanding of this aspect of human existence. Please tell me about your experience in as much detail as possible. Tell me about your bereavement period as i f it is a story with a beginning, middle, and end. -The interviews were unstructured in order to allow the co-researchers to recount their stories as freely as possible. As each co-researcher spoke, however, I reflected his or her thoughts and feelings, and asked questions to help clarify and/or elaborate the 37 meaning of his or her bereavement experience. In order to refrain from asking leading or biased questions and to ensure that my co-researchers could stay with their experiences, I developed a list o f unbiased specific research questions prior to starting the interview process and used them during the interviews when appropriate (see below). In addition, I attempted to make my assumptions explicit so that I could investigate the "experience as we live it rather than as we conceptualize it" (van Manen, 1990, p. 29). B y doing so, I hoped to be "totally present to... [co-researchers]" in a "special way" by listening to them "with more than just ears" (Colaizzi, 1978, p. 64), which includes being "attentive to;., [their] nuances o f speech and gestures" (Colaizzi, 1978, p. 62). Finally, throughout the interviews, participants were encouraged to be specific, concrete, and detailed in describing their experiences. A t the end of each interview, I summarized the session as a means o f verifying or clarifying the information given and as a way of immediately exploring any apparent inconsistencies. I also asked the co-researchers some of my specific research questions to help them elaborate on their bereavement stories in cases where doing so during the interview seemed inappropriate. The research questions were as follows: 1. What were the turning points in your experience? When did you notice these changes in your grieving process? 2. What were you thinking, feeling, and doing during these turning points? 3. What helped you or could have been more helpful to you during your grief period? 4. How did you perceive your relationships with others to be during your experience and how do you perceive these relationships now? 5. What have you learned from this experience? 38 A s mentioned above, these research questions were developed to help co-researchers elaborate on their experiences. To be precise, the purpose of the first question was to help co-researchers sequence events in their experiences (beginning, middle, and end). In a similar vein, the aim of the third question was to get at what facilitated or hindered each co-researcher's ability to move through their bereavement experience (from beginning to end). The second question was chosen to help co-researchers remember details and meaningful moments in their experiences by encouraging them to get back in touch with their thoughts, feelings, and behaviours during their bereavement experience. The rationale behind the fourth question was to understand more about adolescents' relationships with others (e.g., friends versus family members) during their grieving process and how those relationships are seen today (i.e., did the death affect their relationships with others?). Finally, the fifth question was developed in order to understand more about what the impact of losing a close friend during adolescence has on a person's life. Analysis In order to analyze the co-researchers' protocols (transcripts), I used Colaizzi 's (1978) existential-phenomenological approach as a guideline to explicate the meaning of the bereavement experience for adolescent friend-grievers, as w i l l be depicted in the following paragraphs. 39 From transcription to formulation of themes. After each interview, I transcribed the audiotapes verbatim, which took approximately six hours per interview. Although I found this process quite demanding, it was also a rewarding experience because it allowed me to become more deeply involved, both emotionally and intellectually, with the data. In order to maintain confidentiality on the interview protocols, any identifying information on the tapes was changed (i.e., using initials and changing names). After transcribing the interviews, I read the co-researchers' protocols to "acquire a feeling for them, a making sense of them" (Colaizzi, 1978, p. 59). I then began "extracting significant statements", phrases or sentences directly related to the bereavement experience, from the richest and most detailed protocol (Peter's), and then returned to the three remaining protocols to continue extracting statements (Colaizzi, 1978, p. 59). A l l o f these significant statements were typed on the computer; one file name was chosen for each co-researcher. The next step of the analysis consisted of "formulating meanings" for each significant statement by "moving beyond the protocol statements" and making hidden meanings in the protocols explicit without severing the connection with the original stories (Colaizzi, 1978, p. 59). Although at times this step involved taking a leap between what the co-researcher actually said to what they meant to say, I tried to use each co-researcher's own words as much as possible (Cochran & Claspell, 1987, p. 58). After each meaning was formulated, I wrote the words under the corresponding significant statement in italicized print (to make them stand out). Subsequently, I formulated themes, for which I was required to develop a common meaning label for several meanings (Cochran & Claspell, 1987, p. 59). I formulated themes for each co-researcher's individual protocol and then referred back to each original protocol in order to ensure that the themes covered everything described in the original transcripts and nothing alien to them (Colaizzi, 1978, p. 59). I had an independent rater (a professional colleague) review the themes and original protocols as well to ensure that I did not overlook any original content. The themes from each participant's story were then organized into "clusters of themes" and I validated these clusters by referring to the original protocols again (Colaizzi , 1978, p. 59). I tried to ensure that the clusters corresponded to the order in which the co-researchers experienced them in their grieving process. After clustering the themes, I was left with four major theme clusters for each co-researcher, each of which was composed of several themes. The majority of themes were similar in people's stories, although a few differences were apparent. I then created a "master list" of themes (see Appendix C) , which included themes from all o f the co-researcher's stories. Writing the general story. Subsequent to clustering the themes, I wrote a description of the meaning of the bereavement experience described by the co-researchers by transforming my "list o f themes into an integrated structure" (Cochran & Claspell, 1987, p. 61). Writ ing "The General Story" was very challenging because themes had to be temporally sequenced, and it seemed unnatural to place them in this way since many themes were experienced 41 as cyclic. It was also difficult to write one succinct story that reflected all co-researchers' lived bereavement experiences, as there were some themes that were present in some stories, but not in others. Val ida t ion interview. I returned to all four co-researchers a second time so that each of them could validate the accuracy of my findings and the appropriateness of the labels I used to describe the themes in their stories. I asked them if they wanted any themes clarified or changed. Afterward, I read themes from the "master list" that were not evidenced in their story (different for each co-researcher) to see i f any other themes also reflected their experience. Finally, each participant was asked to read the "The General Story". Overall, the validation interviews went well, as co-researchers were in agreement with most findings and seemed very interested in the results. Each co-researcher provided some feedback, mostly on "The General Story", and these comments were then integrated into the story. A s a final step, I sent an e-mail to all o f my co-researchers to ask them i f "The General Story" was representative of their experience and i f there were any aspects o f their experience that I did not include in my description (Colaizzi, 1978, pp. 61-62). Each participant responded to my e-mail with a couple of comments, all o f which I incorporated into "The General Story" (final story). 42 C H A P T E R IV: RESULTS Introduction This chapter is based on interviews given by four co-researchers. It begins with a condensed outline of clustered themes, which are organized into four sections: (A) Beginning, (B) Middle, (C) End, and (D) Subsequent Impact. (There is a number beside each theme that reflects how many co-researchers experienced it.) The Beginning starts with the adolescent learning of the death of his or her friend, and extends through the deceased's funeral. The Middle refers to a difficult and lonely period during which the adolescent must grow, change, and heal. The End occurs after most of the grieving has taken place and reflects personal growth and integration. Subsequent Impact themes reflect co-researchers' present-day understanding of past events related to their bereavement experience. Following the condensed outline of clustered themes, a detailed, exhaustive description of each of the themes is presented. This comprises the bulk of the chapter and includes excerpts from each of the co-researchers' interviews. Condensed Outline of Clustered Themes A. Beginning 1. Shock and disbelief (3) 2. Grieving affects me physically (4) 3. Anger and betrayal 0 ) 4. Group bonding is helpful (4) 5. Funeral as uncomfortable: I 'm not a recognized mourner (4) 6. Sadness and loss (4) B. Middle 1. Confusion and wonder 2. Putting the pieces together 3. Guilt and personal responsibility 4. Changing dynamics with peers 5. Wanting to get on with normalcy 6. Grief as cyclic 7. Fear 8. M y world is shaken 9. Questioning why: Where is the meaning? 10 Culminating experience C. End 1. N o definitive end: The experience gradually fades 2. M y friend's essence is always here 3. Changed perspectives on life: Meaning-making D. Subsequent Impact 1. Moment of fuzziness: When I was told 2. Adolescents and parents: We are different 3. I wish somebody had guided me through 4. This death had a huge impact 44 Exhaustive Description of the Bereavement Experience A. Beginning 1. Shock and disbelief. After most co-researchers heard about the death of their friend, they immediately entered a period of shock, especially for those deaths that occurred suddenly and unexpectedly. When the co-researchers were in shock, they were in a state of utter disbelief, virtually unable to believe that their friend had actually died. In some cases of shock, co-researchers also became numb and were not able to feel much at all. In reference to learning about his friend's suicide, Peter explained, " . . D E F I N I T E L Y for the first two weeks I was really in shock ... I didn't really even feel that much actually- like just totally numb..." It seems that the majority of adolescents feel shocked initially because it is their first experience losing a friend, or somebody their age, to death. In fact, the co-researchers in this study had very little, i f any, experience with the death of anybody-young or old- prior to losing their friend. Losing someone one's own age to death is exceedingly difficult for the adolescent, as it often forces the adolescent to confront his or her mortality for the first time. This is difficult to do for the majority of adolescents, who either believe they are invincible or who have not yet entertained the notion of themselves dying. A s Laura explained, ... she came and told me about it and I was kind o f in shock, and the shock lasted for quite a while-1 don't know, like- you kind of go in and out of shock I think for the first few months and so it's kind of like disbelief- "No, this can't be true- like this person is my age- people my age don't die"- right, it's only old people who 45 die you think at that age... it made me realize that we are mortal and that maybe we need to prevent this from happening and take precautions to be safe about things like that... you think you're invincible when you're a teenager, which is kind of fun, you know- kind of G R E A T cause you can explore more and not worry about it. Yeah, but that changes, definitely, when someone your age dies-it really makes you aware that it can happen. In essence, co-researchers felt shocked because losing a friend was not something that they planned for- not something that was supposed to happen to them at this time in their lives. One participant felt as though this was something that happened to him personally and initially gave little consideration as to how this death may have affected others. A s Peter explained during the validation interview, his friend's death was shocking because "That's not the way my life was supposed to go". A possible exception to this theme of shock and disbelief may occur when an adolescent hears of a friend's death, which was expected. This was the case for Lynne, whose friend had struggled with leukemia for months before dying. Lynne explained that the death was not shocking because her friend's "physical presence was already gone" a year before his death, when his family moved away from her town. 2. Grieving affects me physically. After losing a friend to death, adolescents may experience a multitude of physical symptoms, many o f which are experienced by people who suffer from depression. These symptoms varied for different co-researchers and included being unable to sleep, suffering from body, heart, and head- aches, lacking an appetite, being slowed down 46 physically, and having panic attacks. Laura experienced aches in her body. For both Lynne and Peter, aches and sleeplessness were predominant. As Peter explained, .. I don't think I slept much at all during that period-1 couldn't really and I didn't really want to.. .my body really hurt also- sort of, not in an emotional way, but in a physical way-1 remember being really tense and achy muscles for the whole period- that sort of two week period... Peter continued to explain that there were similarities between the physical symptoms he experienced after his friend died and the symptoms he had later during a bout with moderate clinical depression- adding that he also experienced "stomach stuff-like there is a rock in your stomach, not being able to eat very well, not really even wanting to. . ." For the co-researchers in this study, physical symptoms tended to be most prevalent during the beginning stage of bereavement. This was not the case for Rachel, however, who experienced several panic attacks during the middle phase of her grieving experience. A s Rachel explained, I woke up in the middle of the night hyperventilating- woke up hyperventilating !-like a panic attack!- and I had a flood of thoughts- like total schizophrenic attack-I couldn't think straight.. I would not be able to breathe-1 would feel really dizzy. . . Although some co-researchers' symptoms did not last beyond the first couple o f weeks of their grieving period, for Lynne, one of her physical symptoms never entirely disappeared. That is, when asked about the ache in her heart, Lynne responded, "it 's probably still there in a lot of ways.. ." 47 In sum, grieving the loss of a friend during adolescence seems to invariably cause co-researchers to experience physical symptoms, most of which faded by the middle of their grieving experience; for some of them, however, an achy heart may remain forever. 3. Anger and betrayal. Before coming to the full realization that one has lost a friend, and while the adolescent is still in a state of numbness, he or she might become angry at the injustice or the senselessness of his or her loss. This anger often has real targets, such as oneself or one's friends. This theme was only clearly evident in Peter's story, as he explained that he felt, " . . . really angry and resentful and hurt by my [friend] and my other friends who were just like- sort of dismissed what I was saying". In addition, Peter admitted to feeling angry because he felt "betrayed by [name of his friend] who died, but more so, by the other people around me". Finally, Peter felt angry toward himself for not doing more to help his friend and for not trusting his intuition, which was telling him there was something really wrong with his friend. During this time, the adolescent may also feel anger at god or a world that could allow such a tragedy to happen. Peter felt angry at the possibility that "someone else has more control over my life than me". This realization made him aware that life does not proceed in a set pattern, which made him feel angry and betrayed by life. 4. Group bonding is helpful. For the co-researchers in this study, other friends played a crucial role in their bereavement experience, even more important than their family members. Participants 48 did not seek their parents help or guidance while they were grieving, even though several of them admitted to having decent relationships with their parents during their adolescence. In fact, co-researchers in this study did not even consider reaching out to their parents as an option. This held true for co-researchers without peer support. For example, Lynne did not seek her parents' support even though she knew they loved her and despite the fact that she was devoid of any peer support. When asked about her experience, Lynne admitted that although she remembers observing her peers hugging each other after her friend died and ". . .thinking I would have liked to have had that kind of support", she did not turn to her parents for guidance because " . . nobody in our family had died before- I had no idea, you know, what you're allowed to say- what's acceptable". Instead of turning to their parents, then, co-researchers turned to their friends with whom they were able to air grievances and express true feelings. Even when they were not talking about the loss of their friend, the co-researchers felt comforted being surrounded by those with whom they shared a loss. These co-researchers bonded and became closer over their loss, which in turn became a huge part of their group's identity. A s Peter explained, "definitely... there was a group of people that I think took that to be their- his death- to be their common bond for quite a length of time after that." Overall, having peer support was considered to be the most significant factor in helping one get through the bereavement period by three of the four co-researchers interviewed for this study. As Peter put it, "that was the deciding factor for me that I think made me get through it really well- the whole sort of grieving process, was having 49 these people". It seems that even those adolescents without friendships (e.g., Lynne) find themselves yearning for comfort from their peers at this time. 5. Funeral as uncomfortable: I am not a recognized mourner. Three o f the four participants interviewed for this study were able to attend their friend's funeral. Two participants felt particularly uncomfortable at their friend's funeral and their reasons for this follow. Firstly, these two participants had little, i f any, experience going to a funeral. As a result, they felt worried and confused about what to do and say at the funeral service. This was true for Laura who recalled, " . . I 'd never been to a funeral before so I didn't know what's involved in funerals and what you're supposed to say and do. . ." Co-researchers also felt uncomfortable at their friend's funeral because they were not consulted about what kind of service they would have like for their friend. This left them feeling awkward and out-of-place. For Rachel, being at an open-casket funeral was devastating: "there was an open casket and that just freaked me out-1 had never seen a dead body before-1 sure as hell didn't want to see one of my friend's dead bodies". Additionally, Rachel remembers "feeling so wrong- to go to this place and do this ritual that everybody does, you know, that everyone has to go and sit in a chair and then go look at the body and talk to the family". Finally, co-researchers felt uncomfortable at their friend's funeral because they felt like forgotten mourners. For example, Rachel said that it did not matter that she left her friend's funeral early because nobody there knew who she was. As she described, "it wouldn't make any difference anyway- there was 500 other people [there]." In the beginning o f their bereavement experience, participants felt like unrecognized mourners in other contexts as well. Some felt this way because they were not acquainted with either the deceased's family members or his or her close friends. For Lynne, who could not attend her friend's funeral, "not being recognized as a mourner by his friends or by my family even" was extremely difficult and lonely. Rachel felt similarly- essentially without a place and alone, as she admitted "I was a new person and an outsider and I wasn't part o f this popularity group or the family who had taken him in or their friends". In sum, two of the three co-researchers who attended their friend's funeral felt uncomfortable. Additionally, each participant felt like an unrecognized mourner, either at the deceased's funeral, or in the presence of others in a different context at some point during the beginning phase of bereavement. 6. Sadness and loss. Although sadness was felt throughout co-researchers' bereavement experience, the intensity o f this theme was strongest in the beginning phase of bereavement. A l l co-researchers felt sad about their loss; some felt this sadness immediately. This was true for Rachel who, immediately following the news of her friend's suicide, went to her room, grabbed a doll that she had not touched in years, and cried. As she explained, "I was crying to the doll saying, 'Don' t worry, I won't let anything happen to you' , and I was crying- like for hours- rocking this doll, saying, 'You ' re going to be okay, you're going to be okay. . . ' " In some cases, however, it was not until after the initial state of shock subsided that co-researchers began to realize what had happened and felt sadness and pain. For 51 some of them, it was the funeral that shook them out of shock and awakened them into the reality of what they had lost. It was during this awakening when these co-researchers were able to feel sadness for the first time. As he reflected back on his friend's funeral, Peter said, .. .1 think that was when and seeing all these people around me- and seeing them mostly devastated by the whole thing and obviously you know, the finality kind o f aspect of any funeral, I think led to really understanding- like, "Oh my god, like, this guy is really gone- I've lost my best friend" kind of thing. So, I think that's when it got really sad... B. Middle 1. Confusion and wonder. The theme o f confusion was experienced by three of the four co-researchers involved in this study. Since both Lynne and Laura felt that this theme was especially prevalent for them during the middle of their bereavement experience, it has been placed here, in the middle; however, it is important to note that Rachel felt particularly confused during the beginning phase of her experience. According to the co-researchers, adolescents feel especially confused about how to grieve. Having little experience with death, they presume that there is a right way to grieve and they feel confused about what that right way is. Rachel explained that she felt overwhelmed by the feeling of, "What am I supposed to do?- like how am I supposed to react?" 52 Some adolescents are confused about what is "normal" and they try and observe how others are reacting as a way of gauging i f they are normal. Laura described this as, " . . . I wonder what they're going through-1 wonder i f they feel as I do. . ." When some co-researchers believed that others were coping more normally than they were, their feelings o f confusion were exacerbated because they wondered why they were coping differently. As Lynne said, I didn't know-1 was just trying to muddle through the best I could with no resources-1 don't think I had a conscious thought that certain things might help me, but I did feel abnormal. And also because his friends kind of talked about it for a few days and then it didn't seem to bother them at all, so I didn't know why I was struggling with it for so long. In essence, co-researchers involved in this study searched for a grieving protocol because they were confused about how to grieve and about what the grieving process should look like in general. As Laura recalled, ". . for the first year or so after it happened, it was more like, ' H o w do I deal with these feelings? And when is it going to stop hurting and feeling this way?'" 2. Putting the pieces together. "Putting the pieces together" refers to a participant's process of trying to make sense o f their friend's death. It is related to one's struggle with understanding the details and circumstances of the lost life. As the bereaved friend works through this figuring out process, they move through the middle phase toward closure and ending. 53 This theme was evident for both Peter and Laura and has to do with trying to understand how the death happened. For Peter, who was in shock after his best friend committed suicide, this involved thinking back to what was happening for his friend prior to his death. This was essentially a search for clues to help him make sense of what happened. For the adolescent whose friend has committed suicide, looking back may involve finding those pieces that help put the puzzle together. For Peter, remembering that his friend was behaving differently and out-of-character for months prior to his death, helped him make some sense of what had happened. I was hanging out with him constantly until he went through this kind of strange period, which entailed him just sort of totally changing his personality... I remember he used to have this drawer in his bedroom that was filled with these paper bags of these mushrooms- like the whole thing was filled- he spent hours and hours picking them and then he made his parents take them and stuff like that and they did (laughs)- it was really weird and I just felt like that seemed really out or character for him because he didn't seem to be somebody prior to that who wanted his parents to kind of know what he was up to and just this idea of being this really intense kind of guy into drugs- like, we did quite a lot of drugs, but not to the extent of sort of living it- and it just seemed like it had just taken over his whole life and that was sort of all he was concerned with - at different times were these various little projects- so for two weeks, was like this mushroom thing and then it was- he got really into this Volkswagen van that he bought and that lasted for about a month and uh, and then his other project after that was he started going to old girlfriends' houses and having to take some piece of their house from 54 each one and he had this collection of objects from their houses and it just- in everything he did, he became so obsessed with those particular projects that it's like he almost had no time for humans anymore- it was just objects he was into or activities that revolved around the objects... for about a month prior to his committing suicide, which happened on [date of death], he sort of secluded himself and didn't really have anything to do with his friends or- even his closest friends, such as myself and another friend who was sort of part of our little clique... For Laura, whose boyfriend died in a car accident, "Putting the pieces together" also meant searching for clues to try and make sense of what happened. However, the focus of Laura's search was different than Peter's, as her search had more to do with the circumstances of her boyfriend's death- how he died exactly and where, because she was never told. Laura described this as a "kind of morbid curiosity kind of wondering like, ' W e l l , how exactly did he die?' 'What kind o f injuries?' N o one ever told me- like, 'was it a head injury?' Like , 'what exactly physically happened to his body?'" She explained further that she used to "drive past the road where it happened and wonder like where exactly did it happen- how exactly did it happen". Laura wondered about whether or not the death could have been prevented and how close her boyfriend came to surviving, as she remembered thinking, "Maybe i f it hadn't been quite as severe an injury, maybe- or i f they had gotten there sooner, maybe he wouldn't have died". Thus, two of the three co-researchers who experienced their friend's death suddenly, were left with many questions for which they tried to find answers to make sense of what had happened. 55 3. Guilt and personal responsibility. For co-researchers who lost friends to suicide, feeling guilty was an extremely prevalent theme in their bereavement experience. In general, they felt guilty for not doing enough to help or save their friend. They believed their friend's death was preventable and they held themselves responsible for allowing it to occur. These co-researchers carried this feeling of guilt for years. As Peter explained, M y thing was not only did I feel like I 'd let [deceased friend's name] down because I 'd seen all this stuff- like I was saying, "He needs help", and I didn't really do anything myself- made it doubly guilty... I certainly felt a lot of guilt for a L O N G time afterwards and I ' l l try to think how long- by "a long time afterwards", that it was really kind of my fault or I could've changed it anyway-that probably would've lasted- hmmm-1 can remember talking to another group o f friends about 6 years later and just sort of having them help me realize just how guilty I did feel for it... This feeling of personal responsibility may extend beyond the belief that one is to blame for the death of one's friend. This is because some adolescents may feel responsible to do something for their deceased friend's parents as well. This is an intense feeling of owing the family something. Rachel described it as follows, .. .1 remember spending a long time wondering how I could do something for her family- how I could go there and tell them something about who she was to me-or something about something- to keep her alive in a way, um, cause I thought-six months they haven't had their daughter, their sister, their- their auntie- or whoever she was to her family, and I could come and give them something by 56 telling them something about her I knew, or a piece of her, because in my mind-the image of our friendship, although it had been over for a while, there were so many moments of life that would be lost forever i f I didn't do something with them -1 felt like I had to do something and tell someone. When co-researchers believed that they could not give their friend's family what they believed they owed them, they felt guilty. Peter, who felt he owed his friend's family an explanation, described this as a feeling of" . . I just could N O T give them what I felt they were asking for" but feeling "the guilt on top for feeling like I wasn't giving them what they wanted or what they needed or what somehow I owed to them for some reason." In sum, feeling guilty and personally responsible about a friend's death was extremely significant for co-researchers who lost a friend to suicide. 4. Changing dynamics with peers. Three of the four co-researchers explained that at some point in the middle of their bereavement experience, the dynamics with their peers changed. Participants' dynamics with their peers changed for various reasons. For instance, both Peter and Laura said that after a while, they no longer bonded about their friend's death with their peer group. For Laura this meant simply not talking about the death anymore, but still remaining friends with the same people. For Peter, however, this meant his group o f friends "had sort of come together and been really strong and then sort of dissolved." A couple of participants explained that the reason the dynamics changed with their peers was because they could not relate to them anymore. According to Rachel, her 57 friend "was never the same- the guy that I knew didn't live anymore so there was no one to relate to- he just wasn't the same person." Peter could not relate to one of his friends either following the death of their mutual friend because he was bothered by the way his friend reacted to their loss. .. .this [name of a close friend] guy, for example, I remember just sort of moving away from him during that period because feeling like he was too eager to move on- way too eager to just- and I also now see, or now think I see that I think I kind of felt like he hadn't learned the same kind of lessons about the linearity of life that I had and I could see him sort of getting back on the path. So, for example, me and this other guy I was telling you about went traveling, another guy- another friend o f ours didn't go traveling, but he did drop out of university just cause he wanted to explore stuff, but I remember this [name of a close friend] guy did go back to university and I think at the time I thought, "You're a bit of a sell out, aren't you buddy- like here we are- went through this intense thing and did it mean nothing to you?", and then we were never really very good friends ever again after that. So, it was all kind of like yeah, I mean, when I 'm thinking now, I guess I link it back to that event- like that sort of changed the trajectory of friendships also. 5. Wanting to get on with normalcy. This theme was only distinctly present for Peter. It seems that Peter tried to distance himself from his bereavement experience because he wanted his life to go back to normal again. For Peter, this meant spending less time with his deceased friend's 58 parents after a while because being around them meant rehashing the events surrounding his friend's death, which preventing him from moving on. In reference to spending time with his friend's parents, Peter explained, .. .the more we were there, actually like, we kind of thought- "Okay, get on with it- can't we get back to sort of normal life where we just have nice conversations or pleasant ones?". I don't know why I felt that way-1 just didn't really want to talk to them about it too much- ... I was sort of going like, "Okay, get on with it now- like fuck, you guys".. .1 think that at the time, unlike his parents, we obviously wanted to just decide- get on with it- we're already not sleeping, so can we have some sort of at least, rest, from the strain of it? L ike my body really hurt also... Thus, Peter felt compelled to live normally again and attempted to do so by physically distancing himself from people who made it more difficult for him to move on. 6. Grief as cyclic. During the middle phase of bereavement, each co-researcher experienced his or her grief as cyclic. That is, although they were able to proceed with their lives quite normally, they had moments of sadness creep in from time to time. A s Laura explained, .. .there would kind of be moments of sadness that would just hit you unexpectedly and you could be alone or you could be with a group of people- it could be in the middle of a party- um, those moments would just come randomly, right, and you feel really sad and kind of lonely about it and then other times, you could forget about it and just go on with things normally in your life. For these co-researchers, reminders of their deceased friend sometimes triggered moments of sadness. For instance, Laura remembers "certain songs would trigger memories of him and you know, bring up feelings and stuff'. Thus, it was during the middle phase when co-researchers started to move away from sadness and toward a semblance of normal life again. 7. Fear. After experiencing the death of a friend during adolescence, one may begin to develop fear. In general, co-researchers in this study developed fears because their world suddenly became devoid of the security it once provided for them. Different fears developed for different individuals, as described below. Subsequent to losing a friend, some participants feared that they would also die. This was especially true of Lynne, whose friend died of leukemia. .. I also had a lot of fear because his birthday was the same day as mine and I thought- like what I came to was that death was coming for me next and that I would die of leukemia. And I carried that for a long time- probably until my mom died of leukemia... But, I always carried that with me that I was next and I was going to die of leukemia. But I always knew leukemia was lurking- my grandpa died of leukemia actually, but when he died of leukemia, I didn't think that- like I felt this presence of leukemia lurking around my family- and when my grandpa died of leukemia, I didn't think that it was lurking for him-1 thought it was lurking for somebody-1 thought it was lurking for me. Other participants became fearful that they would lose more loved ones to death. This happened for Rachel, who began having horrifying visions of people close to her being killed or injured after losing two friends to suicide in a short period of time. As she explained, .. I started to have hallucinations of a sort- like nightmares, but during the day... what would happen was I 'd just be walking on the street and I 'd suddenly have a vision of something very grotesque and violent happening to someone I loved.. . I remember at the time thinking everyone I cared about I was having violent images of them dying and it somehow being my fault... I was afraid to tell anyone cause i f l tell somebody, maybe something bad wi l l happen to them... Can you imagine sitting there looking at someone and then all of a sudden having a horrible image of them being violently destroyed in front of you and you can't tell anyone you just had that, you know? For a couple of co-researchers, the fear of others dying has never gone away. Laura, who lost her boyfriend in a drinking and driving accident, feared that other loved ones would also be hurt or die from drinking and driving accidents. She continues to have this fear today. But, I remember for years after that- and even now still, it kind of left an impression on me- like drinking and driving can actually lead to death- cause it really sinks in- like, wow, this can really happen, so I became really, really conscious about not drinking and driving and really worried about other people drinking and driving and kind of saying, "Yeah, this happened to someone I know, so you know, be really careful cause it does happen"... the drinking and driving thing still makes me kind of nervous i f my husband is out and comes home later than he said- like really late- like he usually says, "Okay, I ' l l be home this time" and I 'm not nervous at all . But, i f he comes- and he usually phones i f he's going to be like an hour later than that time- after like 12 midnight or 1:00,1 start to kind of get a bit nervous... Finally, for one participant, fear resulted from feeling betrayed by his friend who died. In this case, fear had more to do with being afraid that others would leave too, which is different than being afraid that others w i l l die. This co-researcher became fearful of trusting others. Peter, who felt betrayed by his best friend who died, had difficulty trusting other people for years afterward. In reference to how losing a friend affected him, Peter explained, .. .you can't rely on people and things like that like that- like I really kind of see that becoming quite a large theme in my life for a number of years after that-really, just this sort o f like people are out to betray you, so you can't trust them and this and that and uh, it took, you know, a partner of mine-1 was with for seven years- it really took her, I think, to see that in me- the sort of inherent resentfulness and I think largely I would attribute that to that event. I can't say why exactly, but definitely that was the antecedent to it, even i f not the cause, right, because I don't think I was like that prior to-1 was kind of a really trusting person and like I said, really lived my life for and with other people and that sort 62 of changed. And now, I can see that for a long rime- or for a number of years, I went too far in the other direction. In sum, losing a friend during adolescence caused participants to develop a variety o f fears, including fear of oneself dying, fear of others dying, or fear of trusting others. 8. M y world is shaken. " M y world is shaken" is a theme that reflects the participants' awareness that their lives had changed dramatically. This theme involves losing some of the assumptions one has about the world, and manifests itself in different ways, including isolation, loneliness, unpredictability, and existential questioning. A l l participants spoke about feeling particularly alone during the middle phase of their bereavement experience. For some, this meant feeling lonely and completely isolated from their friends and family members. For others, this feeling was o f an existential nature- in essence, an overwhelming realization that one is alone in the world. For Lynne, being socially isolated at school and not being recognized by a mourner by her family was devastating. Lynne explained that what made her experience especially difficult to go through, was the feeling of being lonely. I think it was the isolation- kind of loneliness and not being recognized as a mourner by his friends or by my family even because my mom, you know, knew that we kind of hung out as a gang, but I don't think she understood how close I felt to him and I couldn't really explain it because it wasn't really ["Tangible, or?"]- well, no it wasn't a boyfriend-girlfriend thing or anything like that. 63 For Peter, the experience of being alone in his grief was of an existential nature. After his friend's death, he felt betrayed and realized that he could not rely on others to be around because the world was too unpredictable. For Peter, the realization that he was essentially alone in the world was extremely troubling, as he had always been able to trust and depend on others. .. .changed my perspective that uh, yeah, there was no sort of set pattern- this was N O T supposed to happen, right, so therefore, you kind of can't rely on any set beliefs about the way life proceeds and C E R T A I N L Y , you can't rely on other people to sort of be there and I think that was the first big realization that I was essentially alone in the world and I wasn't living for or with other people because um, I guess to a certain extent I felt betrayed by [name of deceased friend] who died, but more so, by the other people around me. 9. Questioning why: Where is the meaning? This theme reflects participants' search for meaning. It differs from putting the pieces together in several ways. That theme is concerned with the details of the death (e.g., how it happened), whereas this theme is concerned with why the death occurred. This theme owns a deeper questioning and can spark a spiritual quest. Three participants went through a period of trying to make sense of what happened and of asking "why". For Peter and Laura, questioning "why" was often "done through a group process". As Laura put it, "I guess we went through a period of thinking, 'Why?- Why him? Why? Why would this happen now?'" 64 Lynne, who wondered i f god existed and i f she had a purpose on the planet, searched for her answers independently. She defined her search for meaning as a "spiritual quest". As Lynne explained, she was .. .kind of struggling with the spiritual thing is i f god exists and i f god is good, why the heck would god take [name of deceased friend]? Because, I mean, of all the guys I've ever met, he was the kindest most decent person- guy I've even known-1 mean he wasn't arrogant or boastful or macho or all those weird things that guys in high school are- he was just a really solid, nice person, and I had a real struggle with you know, how that could be i f god existed. 10. Culminating experience. A culminating experience is defined as a major turning point in participants' bereavement experience. For each of the three participants for whom such a turning point was experienced, a major shift away from grieving and toward healing was endured. Two participants linked this experience with the end of the middle of the bereavement process; one linked it with the start of the end of her grieving process. Each participant's culminating experience was different, as is described below. For Rachel, who was concerned that she was not grieving in the right way, and who was feeling as though she had to suffer in order to do her part after her peers' suicides, learning to trust that how she was feeling was okay, was a major turning point. For Rachel, this occurred by observing the different ways in which her peers were grieving and choosing the way she wanted to grieve. Rachel's turning point occurred when she gave herself permission to no longer be caught up in her grief. here's another model of grief- a girl who cared a lot about him also who is okay with it like, she's sad, but she's not losing her mind over it. ... I said, she's my best friend-1 don't have to get lost in his grief. For Peter, who had been feeling guilty and responsible for his friend's suicide, being told that it was not his fault for the first time six years subsequent to his friend's death, was instrumental in helping him heal because he felt "quite a sense of burden taken off my shoulders." I can remember talking to another group of friends about six years later and just sort of having them help me realize just how guilty I did feel for it and the first people that ever said to me, "That's bullshit- it's not your fault"- ... like I said, I had sort of said to people how bad I felt about it, but I- that they didn't listen to me, but I don't think anyone had ever said back to me, "Wel l , not only is it okay what happened, but it's not your fault on top of it". After struggling with whether or not god existed and what her purpose might be in the world, Lynne experienced a culminating experience. She was miraculously saved from what could have been a fatal accident, and this served as a pivotal turning point in her life. This is because she came to the awareness that certain things were out of her hands and beyond her understanding. This awareness allowed her to trust the universe again and believe that her life was meaningful. I think that day probably consolidated my whole kind of view of the world because I realized I could've died- we all could've died right then and there. I pondered that for a long time- what that meant that I could've died and we all lived- somebody should've been killed or paralyzed or something-1 mean, that 66 was such a bizarre situation that we A L L survived and that's when I really felt like I had a purpose in life and that I had been saved for a reason and that-1 guess that's probably when it coalesced for me- you know, that the purpose was to do good and be kind and do good things in the world and live an honest and good life because it could all be over so soon. ... I just felt- it was completely out of my hands- there was nothing I could do-1 was hanging on to this piece of wood, but it was so big- it was way beyond me and then to come out of that alive without being injured... I just felt like somebody else is in control here ... There was stuff that was way beyond me and I'd never be able to figure out and so I just had to kind of give myself over to that and trust that- whatever that was. Thus, although each participant's culminating experience was unique, each of them served as a turning point that helped shift each participant's journey toward healing and integration. C. End 1. No definitive end: The experience gradually fades. According to the four participants involved in this study, there is no finite end to the experience of losing a friend. Instead, all participants agreed that the experience gradually faded over time. As Laura explained, It kind of gradually faded a bit and then became part of my life experience, I guess. There was no definite end- it wasn't like that. But I guess the thoughts-like thinking of him and thinking that I see him here and there and remembering and feeling the loss- all those things gradually fade away in the first few years 67 afterwards... it was more like very gradual kind of assimilating the idea and then integrating it. Peter also spoke about his experience fading over time and recalled two specific events that helped him become aware of this. Peter explained that he had two very difficult periods in his life during which he contemplated suicide. During the first period, which occurred a couple of years after his friend's suicide, thoughts of his friend played a role in shifting his own thoughts away from suicide, "Fuck, it's not worth it- i f he had said something to us, we could have helped him get through it and I can do that with my friends now". Therefore, the circumstances of his friend's death- how easily it could have been avoided and how terrible the effects were on others- were in the foreground of his mind and made him think of other options. Years later, however, when Peter was having a difficult time, his friend's death did not play a role in his decision not to commit suicide. This demonstrates how the experience faded for him. A s he explained, "I never thought- 'Oh , I can't do it because look at the effects- or look how easy it would've been to avoid in that situation'. It's fading." 2. Their essence is forever with me. Just as there is no definite end to one's bereavement experience, the spirit, or essence of one's friend, remains indefinitely. As Lynne put it, " . . I've never forgotten him-1 mean, he's one of the people that I carry". In addition, when asked about the ache in her heart that she experienced after her friend's death, Lynne responded, 68 Ahh, it's probably still there in a lot of ways-1 nean the physical sensation o f it being with you all the time fades, but as soon as you start talking about it or thinking about it, it's right there. Y o u know, you can feel it. Memories play a big role in keeping a friend's spirit alive. Beyond Peter's words, there was a spark and a liveliness that was conveyed as he spoke of his late friend. I remember a big thing for all o f us early on that we talked about a lot was however old we would be or wherever we would be in life, he would always be this 18-year-old and could we relate back to someone who was 18? And uh, I don't have an answer to that. I think of him as this guy who really is still a really good buddy- I don't think of him as some 18-year old-1 think of him like he's my age now and- but then I think of some of the things we do and it's like, oh yeah, that was pretty goofy- yeah, only 18-year-olds would do that (laughs). Funny. 3. Changed perspectives on life. A major theme that characterizes the end of the bereavement experience is the person arriving at a changed perspective on life. In general terms, this refers to working-through a personal issue related to the death experience, and of arriving at some new awareness or understanding. Related to the concept of 'changed perspectives' are words such as expanded knowing, acceptance of what is, and a deeper understanding o f how life (and death) works. What is common is that participants linked changed perspectives with the ending of the bereavement process. However, each participant's story, situation, and individual struggle led them to different perspective shifts, which wi l l be outlined below. 69 Peter had two revelations in particular that helped change his perspective on life. Firstly, the death of Peter's friend made him realize that life is not linear and does not proceed in a set and predictable manner. From this, Peter concluded that one is essentially alone in the world because "you can't rely on other people to sort of be there". Although Peter struggled with this notion of being alone for a while, he began to accept and even embrace his aloneness in the world at the end of his grieving period. In other words, Peter's changed perspective on life was that because life does not follow a set pattern, the only person one can rely on is oneself, and that is okay. I still don't believe that you can live your life for and with other people- there's a sort of essential aloneness- but actually I think that essential aloneness is a really cool thing now-1 really like that and uh, understand that that is the basis for community and friendship and what have you- it's not a negatively charged thing... Lynne's changed perspective on life culminated after she survived what could have been a fatal accident. It was at this time, two years after her friend's death, that she began to believe in god and to believe that she had a purpose in this world. Coming to the belief that there is a higher power helped Lynne learn to trust her world again. .. .that's when I really felt like I had a purpose in life and that I had been saved for a reason and that-1 guess that's probably when it coalesced for me- you know, that the purpose was to do good and be kind and do good things in the world and live an honest and good life because it could all be over so soon. ... I just felt like somebody else is in control here-1 just have a life to live and I just got to do the best I can, but really it's out of my hands. And maybe that moment helped with 70 [name of deceased friend] death too as that- you know, it's out of my hands. ... I think in terms of the questions- that incident kind of answered my questions- like I could have all the questions I want, but really it was out of my hands. There was stuff that was way beyond me and I 'd never be able to figure out and so I just had to kind o f give myself over to that and trust that- whatever that was. For Laura, coming to the realization and acceptance that "people our age can die that we know" had life-changing consequences. From this realization, Laura concluded that life was short and time was precious; Rachel commented on the fragility o f life as well . When asked i f there was anything that changed about her following the death of her boyfriend, Laura responded, L i v e your life to the fullest- enjoy your life as much as you can, to a certain degree, like you can't constantly live your life like you're going to die tomorrow, but you have to make some long-range future plans, but you know, it may be shorter than you think, so enjoy it. Laura also experienced a real shift in her thinking during the end of her bereavement experience. This is because she was coming out of her egocentrism and thinking a lot about others' well-being and not just her own. I guess it made me conscious of thinking about like what's it like for the survivors when Y O U die-1 guess cause I had never thought that way before cause you're kind of egocentric when you're younger so I thought about what's it like for Y O U i f Y O U die, but not like what's it like for other people i f you die- what's it like for the people left, right, cause I was one of them-1 was left, so it's like- " O h yeah"... 71 In sum, each participant's tragic loss helped them develop changed perspectives on life. D. Subsequent Impact 1. Moment of fuzziness: When I was told. In retrospect, especially many years later when recounting their stories, co-researchers cannot remember many of the details surrounding the beginning moments of their bereavement experience. Some co-researchers had difficulty remembering who informed them of their friend's death. For example, when telling of the moment she learned of her friend's death, Rachel said, ". . .1 don't remember who this person was, but someone said to me, 'Hey, did you hear about [friend who died]?'" Other participants mentioned that they could not remember exactly what it was they were told. A s Peter clearly stated, H m m m (long pause)-1 don't remember it-1 certainly don't remember the words, but I do remember the next like, the following sort of evening-1 don't remember them actually saying it to me-1 just remember being in that numbness immediately... Finally, other participants had difficulty recalling what they did afterwards; some spoke of the first few days as a blur, and others could not remember how many days passed before their friend's funeral. For instance, when describing the moment her mother told her that her boyfriend had died, Laura said that she remembered being in shock, but " . . .1 don't remember what I did-1 don't think I did much, like I just went downstairs and hung around the house and I don't know." Similarly, although Lynne 72 remembered going to her room after she heard about her friend dying, she was not able to recall what she did there- "I don't know i f l played the guitar-1 probably did cause that's what I did every day after school, is play the guitar, so it's quite possible I did that or I may have just sat there." Thus, all o f the participants in this study had some difficulty remembering various details pertaining to the beginning days of their bereavement experience. 2. Parents and adolescents: We're different. Upon reflecting on their experiences, all participants agreed that their parents had no idea about the extent to which their friend's death had impacted their lives. A s Lynne explained, " i f you had told my parents that this was a subject that was on my mind for three years, they would have been surprised. I never said anything." Although a couple of parents told their teenagers that they were available i f they needed anything, none of them reached out to their children or tried to talk to them. This was true for Peter. L i k e my parents are actually really good about it, but only in the terms like, "Just do whatever you want and we ' l l be here and i f you need anything let us know" and blah, blah, blah, but in terms of concrete advice on how to deal with things, nobody ever gave us really anything like that... A l l participants also agreed that as adolescents, talking to their parents about personal matters would have been strange or awkward. For Lynne, who felt that she could have used some support from her parents, it was too awkward to "go to my mom 73 and say, " M o m , I need a hug"-1 was 15.. ." Rachel also reflected on the difference between being a child and an adolescent in terms of one's relationship to one's parents, a child w i l l say, "Mommy, I hurt my finger", or "Mommy, B i l l y punched me", but your teenager is not going to come home and talk to you about their existential crisis and their popularity problems and god knows what else... Thus, according to all participants, adolescence is an awkward stage at which to approach one's parents for help. It is also a stage of life during which parents may not know what their children are going through. That being said, all participants agreed that they would have appreciated their parents reaching out to them and supporting them in some manner. 3. I wish somebody had guided me through. When asked about what could have been more helpful to them during their bereavement experience, in retrospect, all participants said that help from others to guide them through their grief would have been very useful. Upon reflecting on his experience, Peter noted that he feels angry that nobody helped him. it really would've been great i f somebody- i.e., my parents or somebody else's parents had said, "Look you guys- you really need some help here". L ike my parents are actually really good about it, but only in the terms like, "Just do whatever you want and we ' l l be here and i f you need anything let us know" and blah, blah, blah, but in terms of concrete advice on how to deal with things, nobody ever gave us really anything like that and I kind of wish-1 don't know.. . 74 L i k e how did that escape? That's I guess now something I 'm realizing I 'm kind of angry about- that we were just sort of left hanging... Rachel also feels resentful for having to be "psycho for anyone to really take notice" and help her. She believes that she should not have had to endure her experience alone and that It's the parents' and teachers' jobs to be sensitive and attuned to teenagers. I feel really strongly about that- very opinionated, but I feel that i f somebody had reached out to me, I would have said, "Phew, here is my baggage"... In essence, co-researchers felt they needed to have some sort of grief protocol in order to normalize their feelings and support them in their experience. Lynne thought some books would have been helpful and Rachel felt that " i f l heard from anyone that some people, without support, could take it on so intensely that they might feel guilty and have panic attacks, I would go, 'Oh my god, I 'm normal and need help, you know' ." Peter agreed that the main change he would have made was "to have somebody really help you to really focus your energies on understanding the depths to which the event is affecting you whether you like to think that way about yourself or not". 4. This death had a huge impact. Years after their friend's death, all co-researchers became aware of the immediate and long-term impacts this loss had on their lives. Both Lynne and Rachel believe that the impact of their friend's death affected their subsequent research interests and career choices. As Rachel explained, These experiences affected what areas of research I was interested in (at school). Why does a 16-year-old have to go out in the world and look for- look for clues and cues on how to grieve or handle the loss of a friend, you know, it shouldn't be like that. Laura, who lost her boyfriend in a drinking and driving accident, still worries about family and friends when they are out late and driving. For Laura, "the drinking and driving thing still makes me kind of nervous i f my husband is out and comes home later than he said . . . so I know that that's always kind o f there in me." Peter acknowledged both the immediate and long 7term impacts his friend's death had on his life, although he did not come to this realization until years after his loss. I've often thought- and I think I gave you some examples o f that at the time, a lot of the decisions I made in say, the few months afterwards, or even the next couple of years afterwards, were largely predicated on that event. Where at the time, I didn't see it that way-1 didn't really see it that way. In particular, Peter was referring to his awareness years later that the reason he was unable to trust people was because he felt betrayed after his best friend committed suicide. I was kind of a really trusting person and like I said, really lived my life for and with other people and that sort of changed. And now, I can see that for a long time- or for a number of years, I went too far in the other direction- like I still don't believe that you can live your life for and with other people... 76 In sum, although they were not necessarily aware of it during their grieving period, all participants' lives were impacted by their friend's death, both immediately and many years later. Addendum Although there was a fifth co-researcher interviewed for this study, the contents of that interview were not included in the data analysis. This is because it became clear during the interview with him that he had not been very affected by the death of his friend, which was one of the criteria for inclusion of participants in this study. Interestingly, his story seemed different than the other co-researchers' stories in other ways as well . There are several things that can be learned from having conducted this interview and they wi l l be discussed in the following chapter. 77 Chapter V- Discussion Introduction to the General Story The purpose of "The General Story" is to incorporate the themes from all bereavement experiences into one integrated structure that reflects each participant's individual story. The most challenging part about writing a description was placing themes temporally- at the beginning, middle, or end. This is because some themes do not occur linearly, but arise and continue throughout one's bereavement period (Cochran & Claspell, 1987, p. 62). For example, although the participants involved in this study felt sad at the beginning of their experience, feeling sad was not just something that occurred for them at the beginning and then stopped. Consequently, it is important to note that themes were placed in accordance with where they were most predominantly experienced by participants, but that many occurred cyclically or throughout their grieving period. Another challenging aspect about writing a description was creating a story that fit each person's experience. There are certain themes that were extremely significant in some participants' stories, but not in others. For instance, only participants who lost friends to suicide felt extreme guilt and personal responsibility throughout their grieving period. Thus, themes like these that were not universally experienced, but certainly worthy of mentioning, were included in the general description, but prefaced with the point that only some adolescents, in specific situations, experienced these themes. The following story is a "negotiated reconstruction of experience" (Cochran & Claspell, 1987, p. 62), as each co-researcher was consulted twice about the accuracy with which this description reflects his or her experience. This story is considered to be one interpretation of what adolescents experience following the death of a close friend. 78 Although each participant involved in this study was able to "move on" from their grief eventually (while still carrying the essence of their deceased friend), other adolescents may have a more difficult time "moving on". It is important to remember that this interpretation is only based on four people's experiences and that each of these people is highly educated and resourceful. Thus, a description of other adolescents' bereavement experiences might not be the same as the following story. The General Story The beginning of grief. For the adolescent friend-griever, the bereavement period begins with learning o f the loss o f one's friend- often from somebody else and after the deceased's family is aware. Particularly when the death is sudden and unexpected, the adolescent becomes shocked, which is described as a state of intense disbelief and emptiness. Many adolescents feel shocked because they have not yet confronted their own mortality, making it extremely difficult to accept that a young person has died. Once the initial shock subsides, the intensity of the pain of one's loss sets in and the adolescent feels sad. In general, regardless o f how supportive adolescents perceive their parents to be, they do not seek their help or guidance during this time. This holds true even for the adolescent without peer support. Instead, adolescents turn to their friends with whom they are able to air grievances, express true feelings, and bond over the loss. Even when they are not talking about their friend, adolescents feel comforted being surrounded by those with whom they share a loss. 79 To the adolescent, the death of one's friend serves as a violation of one's path because "it was not supposed to happen". The adolescent may become angry at this time-angry over the injustice of the loss and resentful of a world that could allow it to happen. This anger often has real targets, such as oneself or one's friends. In addition, this anger may be targeted towards god- a god that did not do anything to prevent this death from happening. Adolescents' grief is exacerbated by the fact that they are often forgotten mourners. This is because many adolescents do not know their deceased friend's family or other friends. In turn, even at their friend's funeral, the loss they are experiencing is rarely acknowledged. Adolescents' grief may also go unnoticed in their homes, as many parents do not know what their children are experiencing. The beginning of grief involves the loss of many assumptions about one's world. For some adolescents, this means learning that one is not invincible and that young people can die. For others, who expected life to proceed in a set pattern, this means a loss o f control. Overall, life appears different to the adolescent who has experienced the death of a friend. The middle of grief. The middle o f grief is sparked by feelings o f confusion and wonder. Most adolescents have little experience with death and are confused about how to proceed. They wonder about how they are supposed to react, what they should do or say, how long they w i l l feel upset, and whether or not what they are experiencing is normal. 80 Confusion is also experienced when adolescents have lost friends suddenly and these adolescents search for clues to try and understand what has happened. For the adolescent who has lost a friend to suicide, finding clues that help make sense o f the death's occurrence cause one to feel guilty and personally responsible for not noticing the signs or doing enough to help one's friend. This feeling of personal responsibility extends beyond the belief that one is to blame for the death of one's friend. This is because some adolescents feel responsible to do something for their deceased friend's parents as well. This is an intense feeling of "I am compelled to do something for my friend's parents-1 owe them something, but I don't know i f l can give it to them". This confusion leads the adolescent on a spiritual quest- a period of questioning during which he or she asks "Why" and searches for some meaning in the world. Why did this happen to me? If there is a god and god is good, why would he have taken my best friend? What is the meaning of this world? Who am I and why am I here? Asking questions at this time in one's grieving period is usually a solitary process, as many adolescents no longer discuss their friend's death in their peer group. It is during this spiritual quest that the adolescent begins to realize that he or she is essentially alone in the world. For many adolescents, feeling alone is very scary and disconcerting and they feel disoriented to living. Adolescents develop other fears at this time as wel l - fear of oneself dying, fear of others dying, and fear of trusting others. In this period of disorientation- not seeing the world as one used to, one struggles to gain some control of one's world. The adolescent may do this by distancing oneself from the death and by trying to get on with normalcy. The adolescent, however, experiences grief as cyclic, and although he or she is able to live "normally" at times, 81 there are still moments when he or she feels sad or contused. During this time, the adolescent is still asking questions. If this happened for a reason, what is it? What 's the purpose of a teenager dying? What should I be learning from this experience? Eventually, the adolescent finds a new way of being by seeking answers to the questions he or she is asking and by examining himself or herself. I f l could die at any given moment, how do I want to live? A culminating experience often helps adolescents find answers to their questions and/or free them from the intensity of their grief. For Lynne, it was believing that she had a purpose in life after a near death experience; for Peter, it was hearing that his friend's suicide was not his fault six years after his friend's death. At the end of the middle phase of bereavement, the adolescent has a sense of peace and acceptance about life and how it proceeds. . The end of grief. Fol lowing the culminating experience, the adolescent does not return to his or her past life, but begins to actively shape the life he or she chooses to live. There is a meaning and purpose in life, even in bad things. One accepts that life is short and that time is precious. In the best of circumstances, one also accepts that there is a higher power and rather than struggling to gain control over that, the adolescent resolves to trust whatever that power is. This is a resolution of no control. The bereavement period does not come to a definitive end, but gradually fades, becoming part of one's life experience and part of the ground for one's new way of viewing and experiencing the world. Just as there is no definite end to one's bereavement 82 experience, the spirit, or essence of one's friend, remains indefinitely. Reminders of one's loss come up sometimes- songs, places, and people- but there is less o f an emotional impact when they do. During this time, what often emerges, is the intense desire to be a good person and to help others who are in need. A s grief recedes, people regard the experience as a turning point in their lives that helped them become reborn in a different world. It is in retrospect that people can see the enormous impact o f their bereavement experience and how it changed the path they traveled. Significant Findings Friend support versus parental support. Consistent with developmental theories on adolescence, results from this study indicate that "friends often provide the most meaningful and psychologically close relationships" in adolescence (Deck & Folta, 1989, p. 78). Subsequent to losing a peer during adolescence, it seems that many young people turn to their friends with whom they are able to air grievances and express true feelings. Each participant, even Lynne, who did not have close friends during her bereavement experience, acknowledged the importance of having peer support for adolescent friend-grievers. Interestingly, none o f the four co-researchers turned to their parents for support during their bereavement experience, even though all o f them acknowledged that having their parents or someone with expertise on grief and loss guide them through their grief, would have been extremely helpful. There seems to be a paradox here, that of adolescents saying both "leave me alone" and "help me" to their parents simultaneously. 83 This paradox can be explained by the developmental stage adolescents are in- one in which they are expected to individuate from others (primarily one's parents), which is defined as "the ability to be in emotional contact with others yet still autonomous in one's emotional functioning" (Innes, 1995, p. 216). Many parents thus assume that adolescents are able to think and act independently and are less dependent on adults for guidance and consequently leave their children alone to cope with their experiences (Deveau, 1990, p. 67). Although it is important for adolescents to establish their own identities by individuating from their parents, it is clear that they need some guidance from adults when they are grieving. This is because many adolescents have very little experience with death and feel confused about how to grieve. Adolescents need to be able to discuss their friend's death in a forum that feels safe for them. The challenge is for adolescents' parents, teachers, and counsellors to recognize what they are going through and provide them with such a forum, without overstepping their boundaries. Bereaved friends versus bereaved kin: A comparison. Findings from this study reveal that there are both similarities and differences between friendship bereavement and bereavement associated with familial loss, which is consistent with other research findings (de Vries & Johnson, in press). However, although bereaved friends experience similar emotions to bereaved kin (e.g., sadness and numbness) and are impacted by the death of a loved one both immediately and in the long-term, they also experience many differences in their grieving period. 84 Unlike family members, friends do not have a socially recognizable "right, role, or capacity to grieve", which makes their grief disenfranchised (Doka, 1989, p. 3). For example, in contrast to family, bereaved friends do not have the legitimate right to be notified o f a death, or even be consulted about planning funerals (Deck & Folta, 1989, p. 84). This point was clearly evidenced in participants' bereavement stories, as none of them helped plan their friend's funeral, and one of them did not even learn of her friend's death until months after it happened. Thus, although participants in this study were affected by the death of their peers, they were not likely to be seen as bereaved "since the bereavement of families takes precedence" (Raphael, 1983, p. 146). For these participants, not being recognized as a mourner by one's own family, or by the family and friends of one's deceased friend, was extremely difficult. Each participant admitted that their parents had no idea what they were going through and most mentioned not being acknowledged or socially supported by their deceased friend's family or friends. Funerals were especially awkward for participants, as some felt uncomfortable with various rituals that were chosen (e.g., having an open casket), and others felt like forgotten mourners. In sum, bereaved friends and kin go through some comparable processes in bereavement, but the differences that exist between these two groups are significant, and may exacerbate the bereavement process for friends (Doka, 1989, p. 7). In order to prevent bereaved friends' grieving process from becoming more complicated, changes in society that acknowledge friend-grievers' right and capacity to grieve, must be made. 85 Creating new assumptions about one's world. One of the major findings in this study, which is consistent with other research findings, is that the death of a friend during adolescence upsets some of the assumptions adolescents have about their world (Cleiren & Diekstra, 1995, p. 19). For some co-researchers in this study, this meant learning that young people can die; for others, this meant learning that life has no set pattern and that someone else is in control. Losing one's assumptions about the world means losing those beliefs and cognitions that help one "make sense" of one's life. For the adolescent who loses his or her beliefs about the world, life appears different- lonely, uncontrollable, and scary. When an adolescent's life becomes devoid of some of the meaning it once had, he or she often embarks on a spiritual quest to understand his or her world again (Cleiren, 1993). Eventually, it is hoped that what emerges from this very difficult and confusing time, is a restoration of one's identity. One's world begins to make sense again, although it is not the same world as before. For each co-researcher in this study, being reborn into a different world meant accepting something that was previously difficult to accept. For some participants, this meant accepting that living involves loss; for others, this meant accepting "that someone else has more control over my life than I do". Furthermore, the meaning-making process involves creating a permanent space within one's being for the deceased friend. In sum, experiencing the death of a friend is extremely difficult, but it does not have to be in vain. L iv ing through the death of one's friend may lead bereaved persons to greater levels of awareness about the meaning of life and towards "an inner calmness, strength, and sense of wisdom that is peaceful" (Cochran & Claspell, 1987, p. 109). 86 Do different modes of death cause different reactions? The majority of controlled studies have shown that the bereavement process after different types o f death is marked more by similarities lhan by differences (Cleiren, 1993; Mcintosh & Kel ly , 1992). Findings from this study also reveal many similarities between the bereavement trajectories associated with different modes of death. However, two important differences were also unveiled in this research, and they contest current research findings. In contrast to most comparative studies that "do not find the suicide bereaved to feel more guilty" than other bereaved persons (Cleiren, 1993; Mcintosh & Kel ly , 1992), findings from this study suggest otherwise. In this study, participants who lost a friend to suicide, felt extreme guilt (and personal responsibility) Furthermore, this theme o f guilt and personal responsibility was extremely predominant during their bereavement experience. In fact, both participants admitted taking several years to believe that they were not responsible for their friend's death. A second difference between research findings and results from this study concerns when shock is experienced. Findings from other studies suggest that shock may be slightly more common following unexpected deaths than other modes of death (Cleiren & Diekstra, 1995). This implies that shock is a normal reaction following all modes of death. Findings from this study, however, suggest that only those who experience unexpected deaths experience initial shock. This is because the three co-researchers who experienced their friend's death unexpectedly all felt shock. Conversely, Lynne, the only co-researcher who did not lose her friend unexpectedly, did not feel 8 7 shocked. In sum, more research is needed to explore how the different types o f death affect adolescents' bereavement experience. Limitations This study has the following limitations: (a) interviewing participants who may have been too far removed from their experiences, (b) being required to write participants' stories in a linear manner, and (c) having to rely on a non-standardized way of defining "close friends". In phenomenological studies, participants are required to give retrospective accounts of their lived experiences, but it is recommended that they be "neither too removed from their experience nor so close to the experience that one lacks perspective" (Cochran & Claspell, 1987, p. 41). It is possible that participants involved in this study were too removed from their experiences to remember certain significant details, as the time gap between their experiences and the current study ranged between 15 and 32 years. Consequently, the findings from this study may be somewhat limited. Another limitation to this study may have been asking participants to recount their stories in a linear fashion- with a beginning, middle, and end. It is recognized that in order to write a story, which was one of the goals of the study, it is necessary to sequence events temporally. However, in addition to it being an unnatural way for people to conceptualize their lived experiences, it may also be arbitrary. This is because people do not necessarily experience themes of bereavement linearly, as many occur in a cyclical fashion. Therefore, it is recommended that people interpret the sequencing of information in people's stories with caution. 8 8 Although one of the criteria for the study was to investigate the meaning behind losing a "close" friend during adolescence, it became clear during the interview process that the way people define "close" is very subjective. This might be because "our language offers few possibilities for distinguishing among friendships (Rubin, 1985, p. 5). Thus, the phenomenon under investigation- the impact of the death of a "close" friend during adolescence- should be interpreted with caution, as it was subjectively defined by all participants. Since there is no agreed-upon definition for this term and since it would be unfair to tell someone who uses this term that he or she is incorrect, research of this nature is difficult. In sum, this work is presented with a clear understanding that it is just one interpretation o f the lived meaning of grief for bereaving adolescent friends of a peer who has died. Finally, because a person cannot be thoroughly researched, as "research can never exhaust the investigated phenomenon" (Colaizzi, 1978, p. 70), it is recommended that the certainty of these findings be held with reservations. Recommendations for Future Research The following recommendations for future research are based upon the findings and research methodology used in this study, as well as the current literature on adolescent friendship bereavement. 1. More qualitative studies (phenomenological) are needed to further explicate the meaning o f the bereavement experience for persons who experienced the death of a close friend during adolescence. Studies of this nature wi l l enhance our current knowledge on the longitudinal effects of this experience. A major focus of future 89 research should be on testing the themes of the bereavement experience by replicating this study with a larger and more diverse sample of people. 2. The only participant who experienced anger in the grieving process was Peter- the only male participant involved in this study. Although findings from this study are preliminary, it is recommended that future research examine factors, such as gender differences, in adolescent friend-grievers' experiences. Among other things, it would be interesting to find out i f males do feel more anger while they are grieving than females, or i f females feel more sadness than males during their bereavement experience. 3. There are many other factors that researchers should consider when conducting future studies on adolescent friendship bereavement. For instance, what are the cultural differences that exist between adolescent friend-grievers' experiences? Another factor that should be given attention in future research is that adolescents of different ages are at different stages of development, which might affect their grieving process. Thus, it seems useful for future studies to explore the similarities and differences that exist between the bereavement experiences of a 12-year-old versus a 19-year-old, for example. 4. Findings from this study reveal that there are more similarities than differences in the types of reactions that different causes of death evoke in individuals. However, the two main differences that were found between different survivor groups in this study are not consistent with the differences between survivor groups that have been cited in the literature. Thus, more comparative studies (quantitative and qualitative) are needed in order to determine how bereaved individuals' reactions to the loss of a 90 loved one are affected by different modes of death. It is recommended that researchers include samples of bereaved adolescent friends in these studies who have lost friends to all types of death: (a) suicide, (b) accidents, (c), homicides, and (d) natural causes. 5. In future studies on adolescent friendship bereavement, researchers should be careful about whom they select to interview (e.g., the participant's age, the time gap between the participant's bereavement experience and the study). In particular, they should realize that people need substantial time to integrate their bereavement experience. Thus, interviewing an adolescent too soon after he or she has lost a friend does not seem appropriate. For phenomenological research, participants need to provide a retrospective account of their lived experience. If a person is still " l i v ing" his or her bereavement experience (e.g., still grieving, or worse, denying his or her grief), there is limited potential to this research, as information on the entire bereavement process cannot be obtained. For instance, 21-year-old "Bobby", who experienced the death o f his friend two-and-a-half years ago, admitted that he had not been profoundly affected by the death. (For this reason, his interview was not included in this study.) Interestingly, "Bobby" was the youngest participant interviewed and also the participant who experienced the death of his friend most recently. Although it is possible that "Bobby" has integrated this experience and that it simply did not impact his life much, it is also possible that one needs maturity and time (several years) to fully integrate one's bereavement experience. In addition, "Bobby's" relatively young age and the time gap between his friend's death and this study may have been factors that 91 affected his ability to be forthcoming in the interview (e.g., he did not seem to want to talk at-length about his experience, his feelings, etc.). It seemed to take the other co-researchers involved in this study several years to integrate their bereavement experience. Consequently, it is likely that had they told their bereavement story only a couple of years after their friend's death, it would have been a very different story-less integrated, less meaningful, and devoid of perspective on how it impacted their life. Implications for Helping Professionals 1. Classroom teachers need to acknowledge the death of students and provide a forum in which students can talk and publicly mourn. It might be a good idea to hold assemblies for memorial services and have the students take part in designing these services. In some situations, having a counsellor facilitate special sessions for close friends of the deceased is necessary. School systems need to make special allowances for students to be absent from class to attend funerals (Deck and Folta, 1989, p. 87). In order to ensure that no friends go unnoticed, teachers or counsellors can ask classmates of the deceased and his or her family to identify close friends. School authorities should encourage students to come together in group sessions because adolescents prefer to talk to their friends than their parents or other adults following the death of a friend. (Dyregrov, Wikander, & Vigerust, 1999, p. 204-205). 2. There is a need to educate counsellors, school personnel, and parents alike about the effects of this kind of loss on young people because they should be prepared to handle such losses sensitively and have resources to draw on i f needed. It is especially 92 important to provide death education for these people because the suicide rates of late adolescents (and young adults) for both sexes in Canada have increased dramatically over the last four decades (Leenaars, 1995, p. 43). One example of death education would be for counsellors, teachers, parents, and adolescents themselves to learn about the warning signs of suicidal behaviour because i f people were better able to recognize these signs, perhaps many suicides could be prevented. According to the co-researchers in this study, especially Peter, there are clues to pick up on when an adolescent is suicidal (e.g., major changes in behaviour), but they may be missed i f people are not educated. 3. It is hoped that helping professionals can provide students access to stories (e.g., other people's bereavement stories, the story created from this study) because they might help normalize and validate bereaved adolescents' experiences. Since adolescents may have little experience dealing with death, they may wonder i f what they are going through is normal and they may be curious about what to expect in the long-term. "The General Story" generated from this study may provide a useful framework for helping adolescents who are not comfortable asking adults questions about grieving. This is because the story outlines some of the immediate and long-term impacts of losing a friend and it also indicates the emotional, physical, cognitive, social, and spiritual changes which adolescents can expect to endure. 4. Counsellors and other helping professionals can also utilize information about what helped or hindered adolescents' grieving process (obtained in this study) to help inform their practice when working with bereaved adolescents. For instance, all four co-researchers stated that having adults with expertise on grief and loss talk to them 93 and answer their questions about grieving, would have been extremely helpful to them following the death of their friend. In addition, two co-researchers mentioned being told that "It is not your fault" following a friend's suicide would have been extremely helpful in relieving them of the guilt they carried. Most importantly, counsellors need to help bereaved adolescents complete their grief process so that they do not experience arrested or prolonged grief, which often occurs for this population because of the fragility of their youthful egos. Conclusion Research on friendship bereavement in general (including adolescent friendship bereavement) has been overshadowed by the voluminous literature on familial bereavement, a surprising limitation of the bereavement literature given the growing population of "survivor friends" in society. Is there a need for adolescent friendship bereavement studies? Yes. Far more than people in society expect, adolescents are deeply affected by the death of a friend. Yet, bereaved adolescent friend-grievers often exist as a "hidden" population left to mourn the death of their friends silently and without formal resources, adult support, or death education. In order for adolescents to recover from their grief, they should be acknowledged by society as legitimate grievers and be provided with rights and roles in the grieving process. In addition, they need to be educated on the topics of dying, death, and bereavement by adults so that they are not shortchanged by society and forced to deal with their losses alone or with uninformed friends. When adolescents are left to stumble in darkness after experiencing the death of a friend, they wi l l likely endure a more complicated and prolonged bereavement 94 experience. 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New York: Oxford University Press. van Manen, M . (1990). Researching lived experience: Human science for an action sensitive pedagogy. London, O N : State University of New York Press. Weiss, R S . (1993). Loss and recovery. In M . S . Stroebe, W. Stroebe, & R . O . Hansson (Eds.), Handbook of bereavement: Theory, research, and intervention (pp. 271-284). New York: Cambridge University Press. Appendix A Advertisement Notice Appendix B Informed Consent Fo r 106 T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A Department of Educational and Counselling Psychology, and Special Education Faculty of Education 2125 Main Mall Vancouver, B.C. Canada V6T 1Z4 Informed Consent Form Exploring the Lived Meaning of Grief for Bereaving Adolescent Friends of a Peer who has Died Principal Investigator: Dr. Marvin J. Westwood Ful l Professor Department of Educational and Counselling Psychology and Special Education University o f British Columbia Phone #: 822-5259 Co-investigator: Romy Terkel ( M . A . Student) Department o f Educational and Counselling Psychology and Special Education University o f British Columbia Phone #: 822-5259 Research wi l l be completed as part of a Master's ( M . A . ) thesis in the Department of Educational and Counselling Psychology and Special Education Purpose: The purpose of this research is to gain a holistic understanding of the meaning and process of the grief period that bereaving adolescent friends of a peer who has died endure. * Study Procedures: I understand that I must be 18 years of age or over to participate in this study. If I agree to be a participant in this study, I wi l l be interviewed by Romy Terkel 2-3 times for 1-2 hours in length each time over a period of one month or greater. The interviews wi l l be audio taped and this information wi l l be transcribed and then analyzed. I wil l be provided with the opportunity to confirm the information derived from the analysis o f my audio-taped interviews with Romy Terkel. Main Office Tel: (604) 822-8229 Fax: (604) 822-3302 Program Areas Special Education School Psychology Measurement, Evaluation & Research Methodology Human Learning. Development, & Instruction Counselling Psychology Tel: (604) 822-5259 Fax: (604) 822-2328 Page 1 o f2 107 Confidentiality: Any information resulting from this research will be kept strictly confidential. No information will be provided to others without my permission. All documents will be anonymous and kept in a locked filing cabinet that belongs to Romy Terkel. I will not be identified by name in any reports of the completed study. Any features which might make it possible for others to identify me, will be disguised so as to protect my confidentiality. Audio tapes will be erased by Romy Terkel upon completion of this research-Contact: Ifl have any questions or desire further information with respect to this study> I may contact Dr. Marvin J. Westwood or one of his associates at 822-5259. Ifl have any concerns about my treatment or rights as a research subject, I may contact the Director or Research Services at the University of British Columbia, Dr. Richard Spratley at 822-8598. Consent: I understand that my participation in this study is entirely voluntary and that I may refuse to participate or withdraw from the study at any time without any consequences. I understand that the interview may cause me to revisit the pain of my grieving experience. I understand that I can withdraw from this interview for this reason (or any other) and that I will be given several referral sources by Romy Terkel. I have received a copy of this consent form for my own records. I consent to participate in this study. Participant Signature Date Witness Signature Date Investigator's Signature Date Page 2 of 2. 108 Appendix C Master L is t of Themes 1. Finding Out About M y Loss: Fuzziness 2. Shock and Numbness and Disbelief 3. Grieving Affects M e Physically 4. Anger 5. Sadness and Pain 6. Group Bonding as Helpful 7. Funeral: This doesn't feel right 8. I am Not a Recognized Mourner 9. Parents and Adolescents: We're Different 10. Guilt and Personal Responsibility 11.1 owe his/her parents something 12. Putting Pieces Together 13. Confusion/Curiosity/Wonder 14. Group is Different/Relating Differently to Peers/Bothered by Others' Reactions 15. Fear 16. M y World is Shaken: Isolation and Loneliness 17. Coming Out of Egocentrism: Concern for Others 18. Culminating Experience 19. Spiritual Quest: Questioning Why: Where is the Meaning? 20. There is a V o i d in M y Life 21. Grief as Cycl ic 109 22. Distancing Oneself from the Death. Wanting to get on with Normalcy 23. Life is Short/There's more to life than linearity/Death is Final/Better try new things 24. Learning that Anybody can Die: "There is no type that commits suicide"; I am mortal 25. There are Always Reminders- songs, restaurants; being busy distracts you/helps you forget 26. Changing Perspectives on Life 27. N o Definitive End: The Experience Gradually Fades (no specific date); gradual assimilating and integrating 28. His/Her Spirit/Essence is Forever with M e 29. Embracing Aloneness- acceptance of existentialism-1 am alone, but that's okay 30. Life is Meaningful: I have a purpose 

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