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A descriptive analysis of helpful behaviour for assisting the widowed in bereavement Easton, Jessica Louise 1986

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A DESCRIPTIVE ANALYSIS OF HELPFUL BEHAVIOUR FOR ASSISTING THE WIDOWED IN BEREAVEMENT by J e s s i c a L o u i s e E a s t o n B a c h e l o r o f A r t s , San J o s e S t a t e U n i v e r s i t y , J a n u a r y , 1971 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS THE FACULTY OF GRADUATE STUDIES Department of C o u n s e l l i n g Psychology We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d THE UNIVERSITY OF B R I T I S H COLUMBIA A p r i l 1986 ©Jessica L o u i s e E a s t o n , 1986 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of C o o r \ A * J & i A ^ fe-^^ioo^ - t c ^ C L x d ^ The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date 4 ~ °l - 9?G?  DE-6(3/81) ABSTRACT Widowhood and bereavement was ex p l o r e d i n depth to determine an e f f e c t i v e c r i t e r i a f o r h e l p i n g the widowed through bereavement, based upon t h e i r d e s c r i p t i v e r e p a l l of the experience of g r i e f . F i f t e e n a d u l t women, who had engaged i n group therapy, were i n t e r v i e w e d . The c r i t i c a l i n c i d e n t technique was used to i d e n t i f y what f a c t o r s hindered o r f a c i l i t a t e d the widows d u r i n g g r i e f i n the two hundred and f o r t y - o n e e x p e r i e n c e s c o l l e c t e d . Each i n c i d e n t was c a t e g o r i z e d a c c o r d i n g t o which f a c t o r s were considered h e l p f u l and which f a c t o r s were c o n s i d e r e d harmful. The study y i e l d e d two l e v e l s of c a t e g o r i z a t i o n : c a t e g o r i e s and s u b - c a t e g o r i e s . F i v e c a t e g o r i e s of h e l p f u l i n c i d e n t s emerged from the data which were l a b e l l e d t a k i n g a c t i o n , r e c e i v i n g support, s h a r i n g the g r i e f , v e r b a l reassurance and p h y s i c a l comfort. F i v e c a t e g o r i e s of h i n d e r i n g i n c i d e n t s emerged from the data which were i n a b i l i t y t o a c t , l a c k of support, f e e l i n g alone, v e r b a l c r i t i c i s m and p h y s i c a l d i s t r e s s . Of these, the l a r g e s t number of i n c i d e n t s i n both the h e l p f u l and harmful c a t e g o r i e s were found i n r e c e i v i n g support and lack of support. In the r e c e i v i n g support sample, p e r c e i v e d support whether i n i t i a t e d o r r e c e i v e d by the widow was experienced as h e l p f u l . In the lack of ( i i ) s u p p o r t s a m p l e , t h e widow e x p e c t e d o r n e e d e d t o be t r e a t e d d i f f e r e n t l y a n d when o t h e r s r e s p o n d e d i n a way s h e d i d n o t e x p e c t t h e widow p e r c e i v e d i t as l a c k o f s u p p o r t . I n d e p e n d e n t j u d g e s f o u n d t h e s e c a t e g o r i e s r e l i a b l e . R e s u l t s a r e e x a m i n e d by c o m p a r i n g t h e d a t a g e n e r a t e d t o r e l e v a n t l i t e r a t u r e and s u g g e s t i n g some c r i t e r i a f o r h e l p i n g t h e wid o w t h r o u g h g r i e f . ( i i i ) ACKNOWLEDGEMENT The l o s s o f a h u s b a n d who i s d e a r l y l o v e d b r i n g s g r e a t e m o t i o n a l p a i n and g r i e f . I am d e e p l y i n d e b t e d t o t h e f i f t e e n women who o f f e r e d t o r e c a l l p a i n f u l m e m o r i e s t o c o n t r i b u t e t o t h e k n w o l e d g e o f t h e g r i e v i n g p r o c e s s . T h e i r s u f f e r i n g a n d t h e i r d e t e r m i n a t i o n t o r e i n t e g r a t e i n t o l i f e b e a r s w i t n e s s t o t h e s t r e n g t h o f t h e human s p i r i t . ( i v ) TABLE OF CONTENTS Page Abstract i i Acknowledgment iv Table of Contents v L i s t of Tables v i i i CHAPTER I INTRODUCTION 3 Overview 3 Research Questions 8 CHAPTER II REVIEW OF LITERATURE 11 CHAPTER III METHODOLOGY 21 The C r i t i c a l Incident Technique 21 J u s t i f i c a t i o n for the Choice of Methodology 21 Col l e c t i o n and C l a s s i f i c a t i o n of Data 24 R e l i a b i l i t y and V a l i d i t y of the Technique 27 Subjects 29 Selection of Sample 29 P r o f i l e of the Participants 31 General Information 31 Death of Spouse Information 34 Procedure and Data C o l l e c t i o n 36 Assumptions 36 Interview Structure 37 P i l o t Study 37 (v) D a t a A n a l y s i s 40 R e l i a b i l i t y o f C a t e g o r i e s 41 CHAPTER I V RESULTS 44 H e l p f u l I n c i d e n t C a t e g o r i e s 45 T a k i n g A c t i o n 45 R e c e i v i n g S u p p o r t 48 S h a r i n g t h e G r i e f 51 V e r b a l R e a s s u r a n c e 53 P h y s i c a l C o m f o r t 56 H a r m f u l I n c i d e n t C a t e g o r i e s 58 I n a b i l i t y t o A c t 58 L a c k o f S u p p o r t 60 I s o l a t i n g E x p e r i e n c e 63 V e r b a l C r i t i c i s m 67 P h y s i c a l D i s t r e s s 70 CHAPTER V DISCUSSION AND SUMMARY D i s c u s s i o n o f R e s u l t s 73 T a k i n g A c t i o n a n d I n a b i l i t y t o i A c t 73 R e c e i v i n g S u p p o r t a nd L a c k o f S u p p o r t 76 S h a r i n g t h e G r i e f a n d F e e l i n g A l o n e 80 V e r b a l R e a s s u r a n c e a nd V e r b a l C r i t i c i s m 83 P h y s i c a l C o m f o r t a nd P h y s i c a l D i s t r e s s 86 S i g n i f i c a n c e o f t h e S t u d y 89 T h e o r e t i c a l S i g n i f i c a n c e 89 ( v i ) P r a c t i c a l S i g n i f i c a n c e 94 R e c o m m e n d a t i o n s f o r F u t u r e R e s e a r c h 99 L i m i t a t i o n s o f t h e S t u d y 106 Summary 107 BIBLIOGRAPHY 109 APPENDIX A L e t t e r 119 APPENDIX B C l i e n t C o n s e n t Form 120 APPENDIX C D e m o g r a p h i c Q u e s t i o n n a i r e 122 APPENDIX D The I n t e r v i e w S t r u c t u r e 123 ( v i i ) L I S T O F T A B L E S TABLE 1 Demographic Data: G e n e r a l I n f o r m a t i o n 32 TABLE 2 Demographic Data: Death of Spouse 33 I n f o r m a t i o n ( v i i i ) 1 CHAPTER ONE I n t r o d u c t i o n O v e r v i e w Widowhood i s a phenomena t h a t h a s become a s e r i o u s s u b j e c t o f s c i e n t i f i c r e s e a r c h . I t a p p e a r s t h a t many d i s t r e s s i n g e x p e r i e n c e s o c c u r d u r i n g t h e " c r i s i s " t i m e o f b e r e a v e m e n t , e s p e c i a l l y t h e e a r l y m o n t h s : t h e s e i n c l u d e b o t h b o d i l y and p s y c h o l o g i c a l e x p e r i e n c e s . T h e y a r e o f t e n e x p e r i e n c e d as symptoms and may l e a d b e r e a v e d widows a n d w i d o w e r s t o s e e k m e d i c a l c a r e . C l a y t o n , H a l i k a s , and M a u r i c e (1971) have c a r e f u l l y v i e w e d s y m p t o m a t o l o g y d u r i n g t h e f i r s t month i n b e r e a v e d w i d o w s and w i d o w e r s . T h e y c o n c l u d e t h a t c r y i n g (94 p e r c e n t ) , d e p r e s s e d mood (84 p e r c e n t ) , and s l e e p d i s t u r b a n c e (80 p e r c e n t ) w e r e t h e m a j o r symptoms o f b e r e a v e m e n t . A n o r e x i a , w e i g h t l o s s , t i r e d n e s s , d i f f i c u l t y c o n c e n t r a t i n g , p o o r memory, and l o s s o f i n t e r e s t i n t e l e v i s i o n and f r i e n d s w e r e f r e q u e n t . O n l y 15 p e r c e n t saw o r c a l l e d a p h y s i c i a n f o r t h e s e symptoms. B e r e a v e m e n t h a s a l s o b e e n s i g n i f i c a n t l y a s s o c i a t e d w i t h f i r s t e n t r y i n t o p s y c h i a t r i c c a r e ( S t e i n and S u s s e r , 1969) o r p s y c h i a t r i c a d m i s s i o n ( P a r k e s , 1 9 6 5 ) . 2 T h e r e i s much t o s u g g e s t an i m p a i r m e n t o f p h y s i c a l h e a l t h i n t h e b e r e a v e d , e v e n t o t h e d e g r e e o f an i n c r e a s e d m o r t a l i t y r i s k i n c l o s e r e l a t i o n s h i p t o t h e b e r e a v e m e n t . P a r k e s , B e n j a m i n , and F i t z g e r a l d ( 1 9 6 9) d e s c r i b e a n i n c r e a s e d m o r t a l i t y f r o m c a r d i o v a s c u l a r d i s e a s e i n w i d o w e r s a g e d f i f t y - f i v e and o l d e r d u r i n g t h e f i r s t s i x mon t h s f o l l o w i n g t h e d e a t h o f a s p o u s e , and c o n c l u d e t h i s i s a p s y c h o s o m a t i c c o n s e q u e n c e o f b e r e a v e m e n t , t h a t t h e s e men d i e d o f a " b r o k e n h e a r t " . G r e e n b l a t t ( 1 9 7 8 ) a l s o comments on h i g h e r m o r t a l i t y i n w i d o w s , r e s u l t i n g f r o m h e a r t d i s e a s e a nd a r t e r i o s c l e r o s i s b u t t h e r e i s no d i s c u s s i o n on t h e t i m e r e l a t i o n s h i p t o t h e b e r e a v e m e n t . C o t t i n g t o n e t a l . ( 1 9 8 0 ) r e c e n t l y s t u d i e d s u d d e n c a r d i a c d e a t h i n women a g e d t w e n t y - f i v e t o s i x t y - f o r t y . They f o u n d t h a t t h e s e women we r e s i x t i m e s as l i k e l y a s t h e c o n t r o l p o p u l a t i o n s t o h a v e e x p e r i e n c e d t h e d e a t h o f a s i g n i f i c a n t o t h e r w i t h i n t h e p r e c e d i n g s i x m o n t h s . B e r e a v e m e n t h a s a l s o b e e n s u g g e s t e d as a c a u s e f o r u l c e r a t i v e c o l i t i s ( L i n d e m a n n , 1 9 4 4 ) ; n e o p l a s t i c d i s e a s e , s u c h as c a r c i n o m a o f t h e b r e a s t , c a r c i n o m a o f t h e c e r v i x , a n d l e u k e m i a ( K l e r m a n and I z e n , 1 9 7 7 ) ; t h y r o t o x i c o s i s ( L i d z , 1 9 4 9 ) ; and a s t h m a ( M c D e r m o t t and Cobb, 1 9 3 9 ) . A number o f s t u d i e s have b e e n c o n d u c t e d t o d e t e r m i n e t h e m a n i f e s t a t i o n s o r s t a g e s o f g r i e f ( L i n d e m a n n , 1944; 3 P a r k e s , 1972; G l i c k , W e i s s and P a r k e s , 1974; and K u b l e r - R o s s , 1 9 6 9 ) . E a c h o f t h e s t u d i e s h a v e d e s c r i b e d t h e s t a g e s o f g r i e f i n d i f f e r e n t w a y s . The i m p o r t a n t p o i n t i s t h a t g r i e f d o e s a p p e a r t o be a p r o c e s s where some common r e a c t i o n s c a n be a n t i c i p a t e d . B o t h K a v a n a u g h (1972) and K u b l e r - R o s s (1969) d e l i n e a t e t h e s t a g e s as d e n i a l , a n g e r , b a r g a i n i n g , d e p r e s s i o n , p a n i c , w o r r y and a " g o o d b y e " o r a c c e p t a n c e s t a g e . S c h n i e d e r ( 1 9 80) p o s t u l a t e d a m o d e l o f g r i e f t h a t e n c o m p a s s e d a g r o w t h p o t e n t i a l i n t h e r e s o l u t i o n o f g r i e f . G r i e f i s d i s t i n g u i s h e d f r o m b e r e a v e m e n t by m o s t w r i t e r s a s a p s y c h o l o g i c a l r e a c t i o n t o l o s s and s e p a r a t i o n . T h e y a r e n o t synonymous t e r m s . Our s o c i e t y e x p e c t s t h a t a p e r s o n w i l l o r s h o u l d e x p r e s s g r i e f i f b e r e a v e d ( V o l k a r t and M i c h e a l , 1 9 5 7 ) . F o r b e r e a v e d p e r s o n s who a r e g e n u i n e l y g r i e v e d , i t i s i m p e r a t i v e t h a t t h e y f i n d t h e o p p o r t u n i t y t o r e s o l v e t h e i r g r i e f . F o r t h o s e who a r e s i m p l y b e r e a v e d , b u t n o t g r i e v e d , h o w e v e r , i t w o u l d a p p e a r t o be i n a p p r o p r i a t e and p o s s i b l y e m o t i o n a l l y h a r m f u l t o i n s i s t t h a t t h e y e x p r e s s f e e l i n g s t h e y do n o t h a v e ( F u l t o n , 1 9 7 0 ) . Y e t , w h i l e g r i e f d o e s a p p e a r t o be a p r o c e s s , i t i s a l s o a u n i q u e e x p e r i e n c e f o r e a c h i n d i v i d u a l . T h e r e a r e a 4 number o f f a c t o r s t h a t i n f l u e n c e t h e q u a l i t y and t h e i n t e n s i t y o f t h e g r i e f r e s p o n s e ( L i n d e m a n n , 1 9 4 4 ) . Not a l l p e r s o n s w i l l e x p e r i e n c e a l l t h e r e a c t i o n s t o g r i e f t h a t h a v e b e e n c a t e g o r i z e d and t h e s t a g e s o f g r i e f may be e x p e r i e n c e d i n d i f f e r e n t o r d e r , a l l a t o n c e , o r w i t h t i m e g a p s ( K u b l e r - R o s s , 1 9 6 9 ) . G r e e n b l a t t (1978) d e s c r i b e d t h i s p r o c e s s when he s t a t e d : G r i e v i n g i s n o t a s t e a d y s t a t e ; i t i s a p r o c e s s , one p h a s e f a d i n g g r a d u a l l y i n t o a n o t h e r . Form and m a n i f e s t a t i o n may v a r y g r e a t l y as a f u n c t i o n o f e d u c a t i o n , p e r s o n a l i t y , r i t u a l s and c u l t u r e . The t i m e i t t a k e s t o move f r o m one p h a s e t o a n o t h e r i s a l s o h i g h l y v a r i a b l e ( p . 4 4 ) . I n an a t t e m p t t o work t o w a r d d e v e l o p i n g a t h e o r y o f g r i e f more e m p h a s i s needs t o be p l a c e d on t h e s p e c i f i c v a r i a b l e s t h a t d e t e r m i n e b e h a v i o u r . One o f t h e more c r u c i a l p r o b l e m s i n a l l m e n t a l h e a l t h r e s e a r c h i s t o d i s c o v e r why some p e r s o n s a r e more v u l n e r a b l e t o p a r t i c u l a r s i t u a t i o n s o r e x p e r i e n c e s t h a n o t h e r s ( L e i g h t o n , C l a u s e n and W i l s o n , 1 9 5 7 ) . P a r k e s (1965) s t a t e s , "much more work n e e d s t o be d one t o e s t a b l i s h t h e f u l l r a n g e o f r e a c t i o n t o b e r e a v e m e n t and t o f i n d o u t what f a c t o r s d e t e r m i n e a p a r t i c u l a r r e s p o n s e " ( p . 2 2 8 ) . 5 B e r e a v e m e n t i s a c o m p l e x e x p e r i e n c e w i t h many f a c t o r s i n v o l v e d . M a d d i s o n a nd V i o l a (1968) f o l l o w e d by r e p l i c a t i n g s t u d i e s ( M a d d i s o n , V i o l a , and W a l k e r , 1969) c o n c l u d e d t h a t a number o f v a r i a b l e s p l a y e d an i m p o r t a n t p a r t i n t h e widows s u c c e s s f u l c o m p l e t i o n o f t h e g r i e f p r o c e s s . The f i n d i n g s w e r e t h a t f o r a "good o u t c o m e " , t h e d e g r e e and q u a l i t y o f s u p p o r t d u r i n g t h e b e r e a v e m e n t c r i s i s , t h e l o n g s t a n d i n g p e r s o n a l i t y c h a r a c t e r i s t i c s o f t h e s u r v i v o r , and t h e i n t r a p s y c h i c a s p e c t s o f g r i e f and m o u r n i n g p l a y e d an i m p o r t a n t p a r t . The s p e c i f i c f a c t o r s t h a t seemed t o c o n t r i b u t e t o an " u n s a t i s f a c t o r y o u t c o m e " o f b e r e a v e m e n t w e r e y o u n g a g e , number o f d e p e n d e n t c h i l d r e n , f i n a n c i a l p r o b l e m s , m u l t i p l e c r i s e s , l a c k o f f a m i l y o r p r o f e s s i o n a l s u p p o r t and i n t e r p e r s o n a l p r o b l e m s n o t r e l a t e d t o d e a t h . L o p a t a ' s s t u d y (1979) o f C h i c a g o w idows shows t h a t e v e n t h o u g h many had been b e r e a v e d f o r an a v e r a g e o f e l e v e n y e a r s , h a l f s a i d l o n e l i n e s s was t h e i r m o s t s e r i o u s p r o b l e m , and a t h i r d s a i d i t was t h e i r s e c o n d m o s t s e r i o u s p r o b l e m . I t a p p e a r s t h e k e y v a r i a b l e s i n f l u e n c i n g outcome a r e t h e p r e e x i s t i n g r e l a t i o n s h i p , t h e n a t u r e o f t h e d e a t h , o t h e r c r i s i s , and p e r c e i v e d s o c i a l n e t w o r k ( P a r k e s , 1975; R a p h a e l , 1 9 7 8 , V o l k e n , 1 9 7 0 ) . A k n o w l e d g e o f t h e s e f a c t o r s c o u l d be u s e f u l i n p r e v e n t a t i v e c o u n s e l l i n g f o r t h o s e c o n j u g a l l y 6 b e r e a v e d , t h u s l e s s e n i n g t h e r i s k o f p a t h o l o g i c a l outcome ( R a p h a e l , 1977; S i n g h and R a p h a e l , 1 9 8 1 ) . R e s e a r c h Q u e s t i o n s The r e s e a r c h i s i n t e n d e d t o c o n t r i b u t e t o t h e g r o w i n g b o d y o f k n o w l e d g e o f s o c i a l and p s y c h o l o g i c a l f a c t o r s t h a t h e l p p r o d u c e e m o t i o n a l l y s t a b l e s u r v i v o r s , p a r t i c u l a r l y t o e s t a b l i s h e f f e c t i v e c r i t e r i a f o r h e l p i n g t h e widow. I t i s c l e a r t h a t a c o m p r e h e n s i v e s t u d y o f t h e f a c t o r s r e l a t i n g t o r e s o l u t i o n o f t h e g r i e f p r o c e s s i s n e e d e d . I n a l o n g i t u d i n a l s t u d y o f b e r e a v e d w i d o w s , V a c h o n (1979) f o u n d t h a t 38% o f t h e r e s p o n d e n t s w e re e x p e r i e n c i n g a h i g h l e v e l o f d i s t r e s s a f t e r one y e a r . Two y e a r s a f t e r t h e l o s s , s h e r e p o r t s t h a t o n e - q u a r t e r o f h e r s a m p l e was s t i l l e x p e r i e n c i n g a l e v e l o f p s y c h o l o g i c a l d i s t r e s s s u f f i c i e n t t o w a r r a n t p s y c h i a t r i c a s s e s s m e n t . The e v i d e n c e s u g g e s t s t h a t a s i m p l e e x p e c t a t i o n o f a c c e p t a n c e o r r e c o v e r y f r o m g r i e f i s u n w a r r a n t e d f o r a l a r g e m a j o r i t y o f p e o p l e . Most s t u d i e s f i n d s i g n i f i c a n t l e v e l s o f d i s t r e s s a f t e r a y e a r , and t h o s e t h a t f o l l o w t h e i r s a m p l e f o r a l o n g e r p e r i o d o f t i m e h a v e n o t t y p i c a l l y f o u n d s u b s t a n t i a l i m p r o v e m e n t ( G l i c k e t a l . , 1974; P a r k e s , 1975; V a c h o n , 1 9 7 9 ) . What f a c t o r s a r e h e l p f u l i n d e t e r m i n i n g why 40% o f t h e b e r e a v e d c o n t i n u e t o e x p e r i e n c e i n t e n s e a n x i e t y two t o f o u r y e a r s a f t e r t h e i r l o s s ( G l i c k e t a l . , 1 9 7 4 ) ? 7 I t may be d i f f i c u l t t o d e f i n e what i s g o o d c o p i n g b e h a v i o u r i n t h e b e r e a v e d i n a b s e n c e o f n o r m a t i v e d a t a r e g a r d i n g how p e o p l e r e s p o n d t o t h a t e v e n t . F o r e x a m p l e , i t w o u l d be d i f f i c u l t t o r e g a r d " f r e e d o m f r o m i n t e n s e e m o t i o n a l d i s t r e s s " as an i n d i c a t i o n o f g o o d c o p i n g among t h e r e c e n t l y b e r e a v e d , s i n c e most e v i d e n c e i n d i c a t e s t h a t m o s t b e r e a v e d m a n i f e s t t h a t t y p e o f d i s t r e s s . S i n c e i t i s now r e c o g n i z e d t h a t d e p r e s s i o n i s a common f e a t u r e o f t h e b e r e a v e m e n t e x p e r i e n c e , t h i s symptom may no l o n g e r h a v e d i a g n o s t i c v a l u e . I n f a c t , d e p r e s s i o n f o l l o w i n g t h e l o s s o f a l o v e d one h a s b e e n d r o p p e d f r o m t h e d i a g n o s t i c c a t e g o r i e s o f t h e D i a g n o s t i c and S t a t i s t i c a l M a n u a l o f M e n t a l D i s o r d e r s ( A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n , 1 9 8 0 ) . S c h o e n b e r g , C a r r , P a r e t z and K u t s c h e r (1969) s u r v e y e d p h y s i c i a n s and f o u n d t h a t 52% e x p e c t t h e b e r e a v e d t o h a v e e a r l y " e x p e r i e n c e s o f p l e a s u r e " - w i t h i n a few weeks a f t e r t h e d e a t h o f a s p o u s e . I n c o n t r a s t , o n l y 19% o f t h e b e r e a v e d widows and w i d o w e r s t h e y s u r v e y e d a n t i c i p a t e s u c h p l e a s a n t f e e l i n g s ( S c h o e n b e r g , e t a l . , 1 9 7 5 ) . The l a y p u b l i c may be e v e n l e s s a w a r e o f t h e a d j u s t m e n t p r o b l e m s o f t h e b e r e a v e d . I n r e v i e w o f t h e l i t e r a t u r e on t h e b e r e a v e m e n t c r i s i s , W a l k e r e t a l . (1977) c o n c l u d e s t h a t "widows f r e q u e n t l y r e p o r t t h a t e v e n i n t i m a t e s do n o t s u p p o r t 8 t h e n e e d t o mourn t h e i r l o s s b e y o n d t h e f i r s t f e w d a y s a f t e r t h e d e a t h " ( p . 3 8 ) . B o t h t h e p r o f e s s i o n a l c a r e g i v e r and t h e l a y p e r s o n w i l l be i n v o l v e d w i t h b e r e a v e d p e o p l e and w i l l n eed t o know what w o u l d be b e n e f i c i a l i n w o r k i n g w i t h t h e widowed p e r s o n . What t y p e o f b e h a v i o u r w o u l d f a c i l i t i a t e a s u p p o r t i v e and t r u s t i n g r e l a t i o n s h i p ? What k i n d s o f h e l p w o u l d t h e widowed p o p u l a t i o n p r e f e r and what k i n d s o f h e l p w o u l d t h e y f i n d h a r m f u l ? G i v e n t h i s f u n d a m e n t a l l a c k o f i n f o r m a t i o n o f t h e s o c i a l and p s y c h o l o g i c a l f a c t o r s t h a t h e l p p r o d u c e e m o t i o n a l l y s t a b l e s u r v i v o r s and t h e l a c k o f e s t a b l i s h e d c r i t e r i a f o r h e l p i n g t h e b e r e a v e d t h i s s t u d y p r o p o s e s t o g a t h e r p e r t i n e n t d a t a f r o m t h e widowed t h e m s e l v e s i n o r d e r t o b e g i n e s t a b l i s h i n g an e f f e c t i v e c r i t e r i a f o r h e l p i n g t h e w i d o w e d t h r o u g h b e r e a v e m e n t . The q u e s t i o n t h a t w i l l be a s k e d t h e widowed w i l l b e , "What h a s b e e n h e l p f u l o r h a r m f u l f o r y o u d u r i n g y o u r e x p e r i e n c e o f g r i e f ? " 9 CHAPTER TWO R e v i e w o f L i t e r a t u r e C a r e y (1980) c o n d u c t e d an i n t e r v i e w w i t h 119 widows and w i d o w e r s t o h e l p i d e n t i f y f a c t o r s r e l a t i n g t o a d j u s t m e n t d u r i n g b e r e a v e m e n t and t o i d e n t i f y p r o b l e m s o f w i dowed p e r s o n s . The c l e a r e s t f i n d i n g was t h a t w i d o w e r s were s i g n i f i c a n t l y b e t t e r a d j u s t e d t h a n w i d o w s . S e v e r a l f a c t o r s w e r e c o n s i d e r e d i n a n a l y z i n g t h i s f i n d i n g . A number o f i m p o r t a n t f a c t o r s came f r o m t h e comments o f t h e r e s p o n d e n t s s u g g e s t i n g t h a t t h e d i f f i c u l t y w i d o w s e x p e r i e n c e d i n m a k i n g d e c i s i o n s and i n h a n d l i n g f i n a n c i a l m a t t e r s a l o n e , t h e i r c o n c e r n a b o u t p e r s o n a l s a f e t y and w o r r y a b o u t d e p e n d e n t c h i l d r e n o u t w e i g h e d t h e d i f f i c u l t y w i d o w e r s e x p e r i e n c e d i n m a i n t a i n i n g e m o t i o n a l n e e d s o f t h e c h i l d r e n a l o n e . When a s k e d t o name t h e m a i n p r o b l e m s f a c e d a f t e r t h e d e a t h o f t h e i r s p o u s e s , l o n e l i n e s s was named by 27% o f t h e w i d o w e r s and 54% o f t h e widows a s b e i n g a g r e a t p r o b l e m . They a l s o s t a t e d t h a t t h e y f e e l l o n e l y d o i n g t h i n g s by t h e m s e l v e s . The widowed had a " need t o be n e e d e d by someone". The w i d o w e d , e s p e c i a l l y w i t h o u t c h i l d r e n , f o u n d i t d i f f i c u l t t o f i n d someone w i t h whom t o s h a r e t h e i r f e e l i n g s and b u r d e n o f t h e i r g r i e f . 10 The r e s p o n d e n t s were a l s o a s k e d w h i c h p e o p l e w i t h i n and o u t s i d e t h e h o s p i t a l g a v e them h e l p ( l i t t l e ? some? g r e a t ? ) . I f t h e widowed r e s p o n d e d u s i n g t h e c a t e g o r y " g r e a t h e l p " o r s a i d t h e y were d i s a p p o i n t e d i n some p e r s o n o r g r o u p t h e y w e r e a s k e d t h e i r r e a s o n s . P h y s i c i a n s were r a t e d a s o f f e r i n g g r e a t h e l p by 47% o f t h e w i d o w e r s and 40% o f t h e w i d o w s . T h e y were c o n s i d e r e d o f g r e a t h e l p when t h e y were " h o n e s t , c o m p a s s i o n a t e , a v a i l a b l e , n o t h u r r i e d , and c o m f o r t i n g t o t h e f a m i l y " . Y e t , 27% o f t h e w i d o w e r s and 33% o f t h e widows e x p r e s s e d d i s a p p o i n t m e n t i n t h e p h y s i c i a n s . They f a i l e d t o be h e l p f u l b e c a u s e t h e y w e re n o t h o n e s t w i t h t h e p a t i e n t a n d / o r f a m i l y , a v o i d e d t h e f a m i l y , l a c k e d g e n t l e n e s s , h ad a " p o o r b e d s i d e manner", were c o l d , i m p e r s o n a l , c o n c o n c e r n e d and m i s d i a g n o s e d p a t i e n t s . N u r s e s , c h a p l a i n s , s o c i a l w o r k e r s , f a m i l y , f u n e r a l d i r e c t o r s , l o c a l c l e r g y and n e i g h b o u r s were r a t e d i n t h e same manner. Of a l l n o n - h o s p i t a l p e r s o n n e l , t h e f a m i l y was r a t e d a s t h e m o s t h e l p f u l g r o u p t o t h e b e r e a v e d . T h o s e p e o p l e who were r a t e d as g r e a t h e l p seemed t o h a v e t h e c h a r a c t e r i s t i c s o f s u p p o r t , u n d e r s t a n d i n g , g e n t l e n e s s and h o n e s t y . C a r e y c o n c l u d e s t h a t a p h y s i c i a n may a s s i s t a d j u s t m e n t i n b e r e a v e m e n t by " c l e a r l y , g e n t l y and t a c t f u l l y " i n f o r m i n g a w i f e o f t h e s e r i o u s n e s s o f . h e r h u s b a n d ' s 11 c o n d i t i o n s . He a l s o s u g g e s t e d t h a t n o n - t e c h n i q u e h u m a n i s t i c a s p e c t s o f h e a l t h c a r e d e l i v e r y were s e e n as h a v i n g g r e a t v a l u e by f a m i l i e s o f p a t i e n t s who a r e s e r i o u s l y i l l . B o t h p h y s i c i a n s and n u r s e s w e re e s t e e m e d f o r t h e i r h o n e s t y and g e n t l e n e s s as t h e y w e re f o r t h e i r t e c h n i c a l c o m p e t e n c e . S h e s k i n and W a l l a c e ( 1 9 7 6 ) c o n d u c t e d a c o m p a r a t i v e s t u d y o f b e r e a v e m e n t s w h i c h a t t e n d e d s u i c i d e , n a t u r a l a nd a c c i d e n t a l d e a t h f o r w i d o w s . B e r e a v e m e n t was f o u n d t o be a l o n e l y and i s o l a t i n g e x p e r i e n c e r e g a r d l e s s o f t h e c a u s e o f d e a t h o f a s p o u s e . I n e f f e c t , t h e l o s s o f t h e widow's r e l a t i o n s h i p w i t h h e r h u s b a n d i s o n l y one o f s e v e r a l t h a t t h e woman must s u s t a i n . The d e a t h o f h e r h u s b a n d t r i g g e r s l o s s e s i n o t h e r r e l a t i o n a l s p h e r e s . A n o t h e r p r o b l e m was t h a t t h e r e were few good l i s t e n e r s a v a i l a b l e t o b e r e a v e d p e r s o n s . Members o f t h e c l e r g y were r a r e l y c i t e d a s s o u r c e s o f h e l p i n t h i s s t u d y w h e r e a s i n C a r e y ' s s t u d y 56% o f w i d o w e r s and 62% o f w idows r a t e d t h e c l e r g y a s g r e a t h e l p . S h e s k i n and W a l l a c e ( 1 9 7 6 ) c o n c l u d e d t h a t r e c o v e r y i s f a c i l i t a t e d by b o t h i m a g i n e d as w e l l a s r e a l l i f e i n d e p e n d e n c e , i n i d e n t i t y , r o l e and r e l a t i o n s h i p . B a l l (1977) i n a s t u d y t o d i s c o v e r i f widows who e x p e r i e n c e a n t i c i p a t o r y g r i e f w o u l d r e s o l v e t h e b e r e a v e m e n t 12 c r i s i s i n an e a s i e r manner t h a n t h o s e who e x p e r i e n c e d t h e s u d d e n d e a t h o f t h e s p o u s e a s k e d i n h e r q u e s t i o n n a i r e what t h e widow c o n s i d e r e d most h e l p f u l t o h e r . C h i l d r e n , f r i e n d s and r e l a t i v e s were s e e n as t h e g r e a t e s t h e l p . K e e p i n g b u s y and a r e l i g i o n o r p h i l o s o p h y o f l i f e w ere a l s o i m p o r t a n t f o r a d j u s t i n g . The b i g g e s t p r o b l e m s i n c e b e r e a v e m e n t was l o n e l i n e s s , l e a r n i n g t o t a k e r e s p o n s i b i l i t y and make d e c i s i o n s , e c o n o m i c and f i n a n c i a l p r o b l e m s and c h i l d r e n . B a l l s u g g e s t s t h a t t h e d e s c r i p t i v e e v a l u a t i o n o f t h e q u e s t i o n n a i r e s c o u l d o f f e r c l u e s t o o t h e r e v i d e n c e c o n t r i b u t i n g t o a widow's a d j u s t m e n t . A c o n s e n s u s o f t h e w i d o w s ' a d v i c e t o o t h e r s w o u l d be t o m a i n t a i n a c e r t a i n amount o f i n d e p e n d e n c e and d e c i s i o n m a k i n g a b i l i t y , s e e t h a t f i n a n c i a l s u p p o r t i s s u f f i c i e n t i n t h e e v e n t o f a d e a t h a n d m a i n t a i n a s o c i a l l i f e w i t h g o o d , t r u s t i n g and l o y a l f r i e n d s . B a l l s t a t e s t h a t a s t u d y s u g g e s t e d by h e r r e s e a r c h w o u l d be one t h a t h e l p e d e s t a b l i s h c r i t e r i a o f how t h e l a y p e r s o n c a n a s s i s t f r i e n d s , r e l a t i v e s and o t h e r s d u r i n g t h e i r b e r e a v e m e n t c r i s i s . I n a l l t h r e e s t u d i e s t h e q u a l i t a t i v e r e p o r t s o f t h e w i d o w s and w i d o w e r s r e v e a l e d a c o n s i s t e n t theme o f l o n e l i n e s s b e i n g t h e b i g g e s t p r o b l e m and t h e most h e l p f u l p e o p l e were t h o s e who w e r e t r u s t i n g , a v a i l a b l e and 1 3 compassionate l i s t e n e r s . When advice was g i v e n by the respondents the themes of independence and f r i e n d s h i p continued through the three s t u d i e s . I t appeared i n the s t u d i e s that the degree and q u a l i t y of support d u r i n g the bereavement c r i s i s a f f e c t e d the s u c c e s s f u l completion of the g r i e f p r o c e s s . Regardless of the v a r i a b l e s of age, type of bereavement, or gender of the bereaved, i t appeared t h a t t here was a commonality of q u a l i t i e s i n p e r c e i v e d h e l p f u l n e s s and a commonality of q u a l i t i e s i n p e r c e i v e d harmfulness. The experience of i s o l a t i o n and l o n e l i n e s s was pe r c e i v e d as the most d i f f i c u l t task of bereavement as w e l l as a l o s s of i d e n t i t y f o r the widows. These common themes suggest f u r t h e r r e s e a r c h i n what types of behaviour and experiences may prove h e l p f u l or harmful to the bereaved person. A d e t a i l e d study of s p e c i f i c i n t e r a c t i o n s of the widow with her s o c i a l network and i t s i n f l u e n c e on the bereavement process comes from Maddison's work (Maddison and Walker, 1 9 6 7 ; Maddison, V i o l a and Walker, 1 9 6 9 ) . He ex p l o r e d widows p e r c e p t i o n s of t h e i r s o c i a l - n e t w o r k i n t e r a c t i o n s i n q u i t e s p e c i f i c terms of a c t u a l i n t e r a c t i o n s ( f o r example, what oth e r s s a i d or d i d ) , t h e i r p e r c e i v e d h e l p f u l n e s s or un h e l p f u l n e s s , and needed i n t e r a c t i o n s t h a t d i d not oc c u r . He a l s o i n v e s t i g a t e d the p a r t i c u l a r r e l a t i o n s h i p s i n v o l v e d . 14 The f i n d i n g s were as f o l l o w s : widows who went on t o p o o r outcome p e r c e i v e d t h e m s e l v e s as h a v i n g many more u n s a t i s f i e d n e e d s i n i n t e r p e r s o n a l e x c h a n g e s d u r i n g t h e b e r e a v e m e n t c r i s i s t h a n d i d t h o s e w i t h g ood o u t c o m e . They f e l t t h a t t h e y needed more e n c o u r a g e m e n t and s u p p o r t i n e x p r e s s i n g t h e i r a f f e c t s , s u c h a s g r i e f and a n g e r . They n e e d e d more o p p o r t u n i t y t o t a l k a c t i v e l y , p a r t i c u l a r l y a b o u t t h e h u s b a n d and t h e i r l i f e t o g e t h e r . T h e s e widows w a n t e d s u p p o r t t o t a l k b o t h n e g a t i v e l y and p o s i t i v e l y a b o u t t h e i r l o s t r e l a t i o n s h i p . They w a n t e d n o n j u d g e m e n t a l a c c e p t a n c e o f t h e e x p r e s s i o n o f t h e i r f e e l i n g s o f g u i l t . T h ey a l s o w a n t e d p r a c t i c a l s u p p o r t . P o o r outcome was a l s o a s s o c i a t e d w i t h i n t e r a c t i o n s p e r c e i v e d a s u n h e l p f u l i n t h a t t h e y b l o c k e d t h e widow's e x p r e s s i o n o f a f f e c t s : o t h e r s may h a v e b e e n s h o c k e d by h e r f e e l i n g s ; t o l d h e r t o c o n t r o l h e r s e l f and p u l l h e r s e l f t o g e t h e r ; s u g g e s t e d t h a t s h e t h i n k o f t h e s u f f e r i n g o f o t h e r s ; a d v i s e d h e r n o t t o be a n g r y o r g u i l t y ; o r t o l d h e r n o t t o c r y . The widows a l s o f e l t t h a t i n t e r a c t i o n s w h i c h a d v i s e d h e r t o t h i n k o f . t h e f u t u r e and t o t h i n k o f r e m a r r i a g e w e re u n h e l p f u l . T h e r e i s commence o r e v i d e n c e i n c r e a s e t o s u g g e s t t h a t t h e b e r e a v e d may t h e u s e o f p s y c h o t r o p i c d r u g s . 15 T r a n q u i l i z e r u s e i n c r e a s e d s i g n i f i c a n t l y i n P a r k e s and Brown's b e r e a v e d widows and w i d o w e r s ( 1 9 7 2 ) , M a d d i s o n and V i o l a ' s widows ( 1 9 6 8 ) , and a n t i d e p r e s s a n t u s e i n f i f t y - t w o p e r c e n t o f C l a y t o n , H a l i k a s , and M a u r i c e ' s w i d o w s , ( 1 9 7 2 ) . N o t o n l y d i d many o f t h e s e w i d o w s and w i d o w e r s commence s u c h d r u g u s e f o r t h e f i r s t t i m e f o l l o w i n g t h e b e r e a v e m e n t , b u t f o r many i t was m a i n t a i n e d f o r a l o n g p e r i o d a f t e r w a r d , b e c o m i n g p a r t o f a p a t t e r n o f c h r o n i c d r u g u s e t h a t a p p e a r s t o do l i t t l e f o r t h e b e r e a v e d ' s c o n d i t i o n and a d j u s t m e n t . A l t h o u g h i t i s d i f f i c u l t t o s o r t o u t c a u s e and e f f e c t r e l a t i o n s h i p s , s t u d i e s do s u g g e s t t h a t s u c h d r u g s may n o t i m p r o v e o utcome i n b e r e a v e m e n t ( M a d d i s o n and R a p h a e l , 1 9 7 2 ; Bowman, S t r i e m e r , and P e r k i n s , 1 9 8 1 ) , and may e v e n become a f u r t h e r f a c t o r h a m p e r i n g o u t c o m e . H i l t z (1975) f o u n d t h a t i n c o n d u c t i n g t h e r a p e u t i c d i s c u s s i o n g r o u p s a t t h e Widows C o n s u l t a t i o n C e n t e r t h a t " t h e f a c t t h a t someone i s a p s y c h i a t r i s t and h a s a r e l a t i o n s h i p w i t h - a w e l l - k n o w n i n s t i t u t i o n i s n o t a g u a r a n t e e t h a t he o r s h e i s a b l e t o d e a l w i t h widows e f f e c t i v e l y " . The k e y t o s u c c e s s o f a widow d i s c u s s i o n g r o u p was an e f f e c t i v e l e a d e r and s h e a d v i s e d t h a t i t w o u l d t a k e some " t r i a l and e r r o r " t o o b t a i n an e f f e c t i v e l e a d e r . S i l v e r m a n (1970) d e v e l o p e d a p r o g r a m where widowed 16 c a r e g i v e r s c a l l e d " a i d e s " w e re t r a i n e d t o work w i t h l e a d e r s i n o r d e r t o b r i n g new widows i n t o t h e p r o g r a m and a c c o m p l i s h t h e g o a l o f p r e v e n t i n g e m o t i o n a l i l l n e s s i n a p o p u l a t i o n o f b e r e a v e d p e o p l e . S i l v e r m a n f o u n d t h e a i d e s were a c c e p t e d a s f r i e n d s b e c a u s e t h e y u n d e r s t o o d t h e b e r e a v e m e n t p r o c e s s and t h e "common p r o b l e m s " o f w i d o w h o o d . V a c h o n e t a l . (1980) c o n d u c t e d a s t u d y o f 162 widows u n d e r 70 y e a r s o f a g e , 68 r a n d o m l y s e l e c t e d widows w e r e o f f e r e d o n e - t o - o n e and l a t e r g r o u p s u p p o r t f r o m o t h e r w i d o w s . T h e s e h e l p i n g w i d o w s had r e s o l v e d t h e i r own b e r e a v e m e n t s and were t r a i n e d b y V a c h o n ' s team t o " r e a c h o u t w i t h an o f f e r o f h e l p " . The w i d o w s who r e c e i v e d h e l p and a c o n t r o l g r o u p w e r e f o l l o w e d up 6, 12 and 24 months a f t e r d e a t h . W h i l e t h e r e was no s i g n i f i c a n t d i f f e r e n c e s i n g e n e r a l h e a l t h m e a s u r e s b e t w e e n t h e g r o u p s , t h e r e were t h r e e m e a s u r e s o f p s y c h o l o g i c a l c h a n g e t h a t f a v o u r e d t h e g r o u p t h a t h a d r e c e i v e d s u p p o r t . T h o s e widows who had h i g h s c o r e s on t h e g e n e r a l h e a l t h q u e s t i o n n a i r e (GHQ) a t 1 m o n t h , b e f o r e t h e o f f e r o f h e l p was made, and were assumed t o be a h i g h - r i s k g r o u p , seemed t o be p a r t i c u l a r l y l i k e l y t o be h e l p e d by t h e p r o g r a m i n t h a t t h e y were much b e t t e r a t f o l l o w - u p t h a n h i g h - r i s k s u b j e c t s who had r e c e i v e d no s u p p o r t . The f i n d i n g s s o seem t o i n d i c a t e t h e v a l u e o f s e l f - h e l p o r g a n i z a t i o n s f o r t h e b e r e a v e d . 17 The S i l v e r m a n (1970) and H i l t z (1975) r e s e a r c h shows t h a t many c a r e g i v e r s a r e i l l e q u i p p e d t o d e a l w i t h t h e p r o b l e m s o f w i d o w s . A p r o g r a m i s l i k e l y t o be s u c c e s s f u l t h a t u t i l i z e s widows t h e m s e l v e s t o r e a c h o u t t o t h e n e w l y b e r e a v e d ( V a c h o n , 1 9 8 0 ) . I n t h e l a s t d e c a d e much a t t e n t i o n a n d r e s e a r c h h a s been d e v o t e d t o g r i e f and b e r e a v e m e n t i n h o p e s o f u n d e r s t a n d i n g t h e phenomena and a i d i n g t h e w i dowed p o p u l a t i o n who a r e p r o n e t o e m o t i o n a l andd p h y s i c a l i l l n e s s . I t seems c u r i o u s t h a t l i t t l e r e s e a r c h h a s b e e n c o n d u c t e d w h i c h a s k s t h e b e r e a v e d what w o u l d be h e l p f u l o r w h a t w o u l d be h a r m f u l i n a i d i n g them d u r i n g t h i s t i m e o f c h a n g e . S i l v e r m a n f o u n d t h a t t h e widowed c a r e g i v e r s " q u i c k l y c o r r e c t e d t h e n o t i o n t h a t w i t h i n 1 y e a r , o r l e s s , a widow h a s r e c o v e r e d f r o m h e r b e r e a v e m e n t " . The w i d o w s f e l t t h a t a l t h o u g h t h e a c u t e s t a g e o f g r i e f may be o v e r , t h e widow may n o t be r e c o v e r e d and i n f a c t d e p r e s s e d by h e r g r o w i n g a w a r e n e s s o f l o s s . I n summary, t h e l o s s o f a s p o u s e w i l l i n e v i t a b l y be p a i n f u l . N o t o n l y i s t h e r e t h e c r i s i s o f l o s s , b u t a l s o t h e d i f f i c u l t l o n g e r t e r m s o c i a l a d j u s t m e n t s t o new r o l e s , i d e n t i t y a nd i n t e r a c t i o n . The s u p p o r t o f s i g n i f i c a n t o t h e r s w i l l be v i t a l t o most o f t h o s e who a r e s o b e r e a v e d . I t i s c l e a r t h a t a c o m p r e h e n s i v e s t u d y o f t h e f a c t o r s r e l a t i n g t o 18 r e s o l u t i o n o f t h e g r i e f p r o c e s s i s n e e d e d . B a l l ( 1 9 7 7 ) s u g g e s t s t h a t s t u d i e s a r e n e e d e d t o i s o l a t e t h e s o c i a l a n d p s y c h o l o g i c a l f a c t o r s t h a t p r o d u c e s t r o n g , i d e p e n d e n t , e m o t i o n a l l y s t a b l e s u r v i v o r s who c a r r y o u r g r i e f work and t o e s t a b l i s h c r i t e r i a o f how t h e l a y p e r s o n c a n a s s i s t f r i e n d s , r e l a t i v e s and o t h e r s d u r i n g t h e i r b e r e a v e m e n t c r i s i s . 19 C H A P T E R T H R E E Methodology The C r i t i c a l I n c i d e n t T e c h n i q u e J u s t i f i c a t i o n f o r t h e C h o i c e o f M e t h o d o l o g y The c r i t i c a l i n c i d e n t t e c h n i q u e ( F l a n a g a n , 1954) c o n s i s t s o f a s e t o f p r o c e d u r e s f o r c o l l e c t i n g i n f o r m a t i o n f r o m p e o p l e a b o u t t h e i r d i r e c t o b s e r v a t i o n s o f t h e i r own o r o t h e r ' s b e h a v i o u r . T h e s e i n d e p e n d e n t d e s c r i p t i o n s a r e s u b j e c t e d t o an i n d u c t i v e c a t e g o r i z a t i o n p r o c e s s w h i c h c a p t u r e s t h e e s s e n t i a l f e a t u r e s o f an i d e n t i f i e d a i m . The a i m o f t h i s s t u d y i s t o g a t h e r p e r t i n e n t d a t a f r o m t h e w i dowed t h e m s e l v e s i n o r d e r t o g e n e r a t e e f f e c t i v e c r i t e r i a f o r h e l p i n g t h e widowed t h r o u g h t h e e x p e r i e n c e o f g r i e f . P r e l i m i n a r y work o f t h i s s o r t must be d e s c r i p t i v e a n d q u a l i t a t i v e . T h e r e f o r e , s t a t i s t i c a l h y p o t h e s i s t e s t i n g i s n o t a p p r o p r i a t e a t t h i s e x p l o r a t o r y s t a g e . F l a n a g a n (1954) d e v e l o p e d t h e t e c h n i q u e f r o m s t u d i e s i n t h e A v i a t i o n P s y c h o l o g y P r o g r a m o f t h e U n i t e d S t a t e s Army A i r F o r c e s i n W o r l d War I I . The p r o c e d u r e a i d e d i n e s t a b l i s h i n g c r i t i c a l f a c t o r s t h a t w e re e f f e c t i v e o r 20 i n e f f e c t i v e i n a c c o m p l i s h i n g a s p e c i f i c a c t i v i t y , s u c h a s l e a r n i n g t o f l y o r b e i n g a g ood l e a d e r . I n t h e 30 y e a r s s i n c e F l a n a g a n ' s o r i g i n a l s t u d y t h i s t e c h n i q u e h a s b e e n a u s e f u l m e t h o d o l o g y f o r p s y c h o l o g i c a l s t u d i e s . Cohen and S m i t h ( 1 9 76) u s e d i t t o s t u d y g r o u p p r o c e s s . The a u t h o r s f o u n d t h a t c r i t i c a l s i t u a t i o n s a r i s e w i t h i n g r o u p s where a g r o u p l e a d e r must c h o o s e a n a p p r o p r i a t e i n t e r v e n t i o n . D a c h e l o t , W e r n e t t , G a r l i n g , C r a i g - K u h n , K e n t , and K i t z m a n (1981) u s e d t h e c r i t i c a l i n c i d e n t t e c h n i q u e t o e x a m i n e c o n d i t i o n s w h i c h f a c i l i t a t e d c l i n i c a l t r a i n i n g o f n u r s e s . C a t e g o r i e s w e re d e v e l o p e d w h i c h p r o v i d e d i n f o r m a t i o n on a c t i v i t i e s w h i c h o c c u r r e d i n c l i n i c a l s e t t i n g s and t h e ways i n w h i c h t h e s e a c t i v i t i e s w e r e p e r c e i v e d by b o t h e d u c a t o r s and s t u d e n t s . Rimon ( 1 9 7 9 ) e x a m i n e d t h e p s y c h o l o g i c a l a s p e c t s o f n u r s i n g by c o l l e c t i n g t h e n u r s e s ' o b s e r v a t i o n s o f t h e c r i t i c a l a s p e c t s o f t h e i r r o l e i n p r o v i d i n g p s y c h o l o g i c a l c a r e o f t h e p a t i e n t i n t h e h o s p i t a l . W e i n e r , R u s s e l l , and "Lerman ( 1 9 7 9 ) u s e d t h e c r i t i c a l i n c i d e n t t e c h n i q u e f o r t h e o r y d e v e l o p m e n t . They c o l l e c t e d 21 c r i t i c a l i n c i d e n t s t o s t u d y t h e c o n n e c t i o n b e t w e e n c o g n i t i o n s and e m o t i o n s i n a c h i e v e m e n t r e l a t e d c o n t e x t s . F l a n a g a n (1978) c o n d u c t e d a s t u d y o f t h e A m e r i c a n q u a l i t y o f l i f e . He c o l l e c t e d 6,500 i n c i d e n t s f r o m a l a r g e s a m p l e i n an a t t e m p t t o d e f i n e t h e c r i t i c a l f e a t u r e s o f t h e q u a l i t y o f l i f e o f A m e r i c a n s . The c r i t i c a l i n c i d e n t t e c h n i q u e c a n be c o n s i d e r e d a s a p h e n o m e n o l o g i c a l a p p r o a c h as i t l e g i t i m i z e s t h e e x p e r i e n c e and p e r c e p t i o n s o f i n d i v i d u a l s . As an e x p e r i e n t i a l r e s e a r c h a p p r o a c h , i t assumes t h e i m p o r t a n c e o f p e r c e i v e d a s c o m p a r e d t o o b j e c t i v e r e a l i t y a s t h e b a s i s f o r human b e h a v i o u r ( C o l a i z z i , 1 9 7 8 ) . I t , t h e r e f o r e , e n a b l e s e x p l o r a t i o n o f d i m e n s i o n s o f human l i f e t h a t may be d i f f i c u l t t o m e a s u r e o r o p e r a t i o n a l i z e . F l a n a g a n ( 1 984) f o u n d t h a t s u b j e c t s ' r e c a l l e d e v e n t s w e re e s s e n t i a l t o t h e p u r p o s e s o f h i s s t u d y as a s o u r c e o f r i c h and u s e f u l i n f o r m a t i o n r e g a r d i n g t h e q u a l i t y o f l i f e o f A m e r i c a n s . The c r i t i c a l i n c i d e n t t e c h n i q u e i s an e x p l o r a t o r y , q u a l i t a t i v e r e s e a r c h m e t h o d o l o g y t h a t i s h i g h l y f l e x i b l e ( W o o l s e y , 1 9 8 5 ) . I t , t h e r e f o r e , i s an a p p r o p r i a t e m e t h o d o l o g y f o r t h e g e n e r a t i o n o f d a t a f r o m t h e s u b j e c t s o f 22 t h i s s t u d y i n o r d e r t o b e g i n t o e s t a b l i s h e f f e c t i v e c r i t e r i a f o r h e l p i n g t h e widowed t h r o u g h t h e e x p e r i e n c e o f g r i e f . C o l l e c t i o n and C l a s s i f i c a t i o n o f D a t a The C r i t i c a l I n c i d e n t T e c h n i q u e r e f e r s b o t h t o a s e t o f p r o c e d u r e s f o r c o l l e c t i n g d i r e c t o b s e r v a t i o n s o f human b e h a v i o u r and t o t h e a n a l y s i s o f d a t a . The i n c i d e n t s a r e c o l l e c t e d t h r o u g h t h e u s e o f i n t e r v i e w s o r q u e s t i o n n a i r e s . I n o r d e r f o r an i n c i d e n t t o be c o n s i d e r e d a s a " c r i t i c c a l i n c i d e n t " , F l a n a g a n (1954) s t a t e s t h a t i t must be d e f i n e d a s an e x t r e m e b e h a v i o u r t h a t s i g n i f i c a n t l y c o n t r i b u t e s , e i t h e r p o s i t i v e l y o r n e g a t i v e l y , t o t h e o b j e c t i v e s b e i n g s t u d i e d . I t i s e a s i e r t o i d e n t i f y e x t r e m e b e h a v i o u r t h a n b e h a v i o u r w h i c h i s more n e a r l y a v e r a g e i n c h a r a c t e r . The c r i t i c a l i n c i d e n t t e c h n i q u e i s f r e q u e n t l y u s e d t o g a t h e r d a t a on o b s e r v a t i o n s w h i c h w ere p r e v i o u s l y made and a r e r e p o r t e d f r o m memory. A c c u r a c y o f r e p o r t i n g i n c i d e n t s c a n be d e t e r m i n e d by t h e i n c i d e n t i t s e l f . I f t h e p e r s o n c a n g i v e f u l l and p r e c i s e d e t a i l s , t h e i n f o r m a t i o n c a n be r e l i e d u p o n as a c c u r a t e , w h e r e a s v a g u e r e p o r t s may i n d i c a t e t h a t t h e i n c i d e n t i s w e l l remembered and t h e d a t a i n c o r r e c t ( F l a n a g a n , 1 9 5 4 ) . 23 Flanagan (1954) d e f i n e s an i n c i d e n t as any observable human a c t i v i t y that i s s u f f i c i e n t l y complete i n i t s e l f t o permit i n f e r e n c e s and p r e d i c t i o n s to be made about the person performing the a c t . To be c r i t i c a l , an i n c i d e n t must oc c u r i n a s i t u a t i o n where the purpose or i n t e n t of the a c t seems f a i r l y c l e a r to the observer, and where i t s consequences are s u f f i c i e n t l y d e f i n i t e to leave l i t t l e doubt concerning i t s e f f e c t . In order to ensure o b j e c t i v i t y , Flanagan (1954) has e s t a b l i s h e d a set of g u i d e l i n e s to be f o l l o w e d p r i o r to c o l l e c t i o n of data. These g u i d e l i n e s ensure o b j e c t i v e , c l e a r e v a l u a t i o n , r e c o r d i n g and c l a s s i f i c a t i o n of a l l behaviours, both p o s i t i v e or n e g a t i v e , which are r e l e v a n t to the g e n e r a l aim of the a c t i v i t y . Included i n these g u i d e l i n e s i s the use of p r o b a b i l i t y estimates to p r o v i d e more o b j e c t i v i t y i n s t u d y i n g the a c t i o n s which i n f l u e n c e the s i t u a t i o n being observed. Flanagan (1954) s t a t e s t h a t the i n t e r v i e w procedure must be designed i n advance to p r o v i d e f o r d e l i n e a t i n g c l e a r l y the purpose of the study; the s p e c i a l q u a l i f i c a t i o n s of the person being i n t e r v i e w e d and the r e s e a r c h q u e s t i o n asked the o b s e r v e r s . A f t e r the c o l l e c t i o n of the c r i t i c a l i n c i d e n t s , the d a t a must be summarized and d e s c r i b e d i n an e f f i c i e n t manner 24 s o t h a t i t c a n be e f f e c t i v e l y u s e d . F l a n a g a n (1954) i d e n t i f i e s t h r e e p r i m a r y p r o b l e m s : (a) t h e s e l e c t i o n o f t h e g e n e r a l f r a m e o f r e f e r e n c e t h a t w i l l be m o s t u s e f u l f o r d e s c r i b i n g t h e i n c i d e n t s ; (b) t h e i n d u c t i v e d e v e l o p m e n t o f a s e t o f m a j o r a r e a and s u b a r e a h e a d i n g s ; and ( c ) t h e s e l e c t i o n o f one o r more l e v e l s a l o n g t h e s p e c i f i c i t y - g e n e r a l i t y c o n t i n u u m t o u s e i n r e p o r t i n g t h e r e q u i r e m e n t s . F l a n a g a n (1954) d i s c u s s e s s o l u t i o n s t o t h e s e p r o b l e m s a s b e l o w : a) Frame o f r e f e r e n c e . The s e l e c t i o n o f t h e f r a m e o f r e f e r e n c e s h o u l d be b a s e d on t h e i n t e n d e d u s e o f t h e d a t a . The p r e f e r r e d c a t e g o r i e s w i l l be t h o s e b e l i e v e d t o be m o s t v a l u a b l e i n u s i n g t h e s t a t e m e n t o f r e q u i r e m e n t s . b) C a t e g o r y f o r m u l a t i o n . A t e n t a t i v e c l a s s i f i c a t i o n f r a m e w o r k i s done i n d u c t i v e l y by s o r t i n g a s m a l l number o f i n c i d e n t s i n t o p i l e s l a b e l l e d w i t h d e s c r i p t i v e t i t l e s . A f t e r t h e s e t e n t a t i v e c a t e g o r i e s h a v e b e e n e s t a b l i s h e d , b r i e f d e f i n i t i o n s o f them a r e made, and a d d i t i o n a l i n c i d e n t s i n t o them. A p r o c e s s o f r e d e f i n i t i o n o f c a t e g o r i e s , and r e c l a s s i f i c a t i o n o f i n c i d e n t s , o c c u r s u n t i l a l l i t e m s a r e d i s t r i b u t e d . c) G e n e r a l b e h a v i o u r s . T h i s i s t h e p r o b l e m o f w e i g h i n g a d v a n t a g e s o f t h e s p e c i f i c i t y a c h i e v e d i n s p e c i f i c 25 i n c i d e n t s a g a i n s t t h e s i m p l i c i t y o f a r e l a t i v e l y s m a l l rtumber o f h e a d i n g s . S t r i c t c r i t e r i a a r e o u t l i n e d , i n a d v a n c e , f o r t h e h e a d i n g s o f c a t e g o r i e s , w h i c h i n c l u d e : p r o v i d i n g c l e a r c u t and l o g i c a l o r g a n i z a t i o n ; c o n v e y i n g m e a n i n g s w i t h o u t n e e d i n g e x p l a n a t i o n s ; r e f l e c t i n g a s i m i l a r l e v e l o f i m p o r t a n c e ; b e i n g n e u t r a l i n t o n e w i t h c r i t i c a l r e q u i r e m e n t s d e f i n e d i n p o s i t i v e t e r m s ; and a r e c o m p r e h e n s i v e and i n c l u s i v e o f a l l s i g n i f i c a n t i n c i d e n t s . F i n a l l y , f r e q u e n c y c o u n t s o f i n c i d e n t s i n e a c h c a t e g o r y a r e t a l l i e d a n d i n t e r p r e t a t i o n s o f them a r e made w i t h r e s p e c t t o t h e i d e n t i f i e d p r o b l e m . The s i z e o f t h e s a m p l e i s c o n s i d e r e d t o be t h e number o f c r i t i c a l i n c i d e n t s o b t a i n e d f r o m t h e i n t e r v i e w i n g p r o c e d u r e , n o t t h e number o f p e o p l e i n t e r v i e w e d . O n l y one i n c i d e n t i s r e q u i r e d t o f o r m a c a t e g o r y . T h e r e i s no p r e c i s e t e s t f o r s a m p l e s i z e b u t when r e p e t i t i v e p a t t e r n s b e g i n t o d e v e l o p and no new c a t e g o r i e s a r e f o r m e d , i t i s a s sumed s u f f i c i e n t i n c i d e n t s h a v e b e e n c o l l e c t e d . R e l i a b i l i t y and V a l i d i t y o f t h e T e c h n i q u e F l a n a g a n (1954) d e r i v e d a method o f c h e c k i n g t h e r e l i a b i l i t y o f t h e c a t e g o r i e s by s u b m i t t i n g t h e i n c i d e n t s and c a t e g o r i e s t o one o r more i n d e p e n d e n t r a t e r s ( F l a n a g a n , 26 1 9 5 4 ) . The r a t e r i s t r a i n e d i n t h e method o f c a t e g o r i z a t i o n t h a t was u s e d by t h e r e s e a r c h e r and i s i n s t r u c t e d t o s o r t t h e i n c i d e n t s i n t o t h e a p p r o p r i a t e c a t e g o r i e s . A c r i t e r i o n e s t a b l i s h e d i n a d v a n c e , s u c h a s 80% a g r e e m e n t , d e t e r m i n e s w h e t h e r t h e c a t e g o r i e s a r e r e l i a b l e . An 80% a g r e e m e n t c a n be e x p e c t e d i f t h e c a t e g o r i e s a r e w e l l - f o r m e d and t h e r a t e r s a r e t r a i n e d i n t h e m e thod o f c a t e g o r i z a t i o n . C o n s t r u c t v a l i d i t y o f t h e c a t e g o r i e s c a n be p a r t l y a ssumed by t h e f a c t t h a t t h e e x p e r i e n c e o f t h e s u b j e c t i s r e p o r t e d i n d e p e n d e n t l y . The i n d e p e n d e n c e c r e a t e d by t h e c r i t i c a l i n c i d e n t t e c h n i q u e p r o v i d e s f o r a v a r i e t y o f o b s e r v a t i o n s where i n d i v i d u a l b i a s e s a r e e l i m i n a t e d ( F l a n a g a n , 1 9 8 4 ) . The d a t a g e n e r a t e d by t h e c r i t i c a l i n c i d e n t t e c h n i q u e c a n be c o m p a r e d w i t h r e l e v a n t l i t e r a t u r e . T h i s c o m p a r i s o n t e c h n i q u e c a n p r o v i d e a n a d d i t i o n c h e c k o f c o n s t r u c t v a l i d i t y and p r o v i d e a n o p p o r t u n i t y f o r d i s c r e p a n c i e s t o be a n a l y z e d and e x p l a i n e d . A n d e r s o n and N i l s s o n (1964) h a v e r e s e a r c h e d t h e r e l i a b i l i t y and v a l i d i t y o f t h e c r i t i c a l i n c i d e n t t e c h n i q u e i n t h e a n a l y s i s o f t h e j o b o f a s t o r e manager i n a S w e d i s h g r o c e r y company. I n s p e c t i o n o f t h e c l a s s i f i c a t i o n o f i n c i d e n t s i n t o c a t e g o r i e s and r a t i n g o f d a t a by i n d e p e n d e n t 27 j u d g e s , as w e l l as i n q u i r i e s i n t o t h e i m p o r t a n c e o f t h e e l i c i t e d i n c i d e n t s r e s u l t e d i n t h e f o l l o w i n g c o n c l u s i o n s : A c c o r d i n g t o t h e r e s u l t s o f t h e s t u d i e s r e p o r t e d h e r e on t h e r e l i a b i l i t y and v a l i d i t y a s p e c t s o f t h e c r i t i c a l i n c i d e n t t e c h n i q u e , i t w o u l d a p p e a r j u s t i f i a b l e t o c o n c l u d e t h a t i n f o r m a t i o n c o l l e c t e d by t h i s m e t hod i s b o t h r e l i a b l e and v a l i d , ( p . 402) S u b j e c t s S e l e c t i o n o f t h e S a mple .......... V o l u n t e e r s i n t h i s s t u d y w e r e widows 65 y e a r s and y o u n g e r whose s p o u s e s had d i e d w i t h i n 2 y e a r s o f t h e c o n t a c t d a t e w i t h N o r t h S h o r e F a m i l y S e r v i c e s . T h o s e o v e r 65 y e a r s o f age were e x c l u d e d s o t h a t t h e e f f e c t s o f a d v a n c e d age w o u l d n o t be c o n f u s e d w i t h t h e e f f e c t s o f b e r e a v e m e n t . P r e v i o u s s t u d i e s have s u g g e s t e d t h a t t h e v e r y o l d show a d i f f e r e n t t y p e o f r e a c t i o n t o b e r e a v e m e n t w i t h l e s s o v e r t r e s p o n s e s as a c o n s e q u e n c e o f t h e n o r m a l a g i n g p r o c e s s ( P a r k e s , 1 9 7 0 ) . N o r t h S h o r e F a m i l y S e r v i c e s h a s a n e x i s t i n g p r o g r a m f o r t h e r e c e n t l y b e r e a v e d and h a v e e s t a b l i s h e d a r e f e r r a l r e l a t i o n s h i p w i t h L i o n s G a t e H o s p i t a l P a l l i a t i v e C a r e U n i t . A 6 month i n t e r i m p e r i o d s i n c e b e r e a v e m e n t was c o n s i d e r e d b e f o r e c o n t a c t i n g t h e widowed p a r t i c i p a n t s i n 28 o r d e r t o show c o n s i d e r a t i o n o f t h e i r p e r s o n a l f e e l i n g s . C l a y t o n , D e s m a r i s , and W i n o k u r ( 1 9 6 8 ) f o u n d t h a t i n n o r m a l b e r e a v e m e n t a c u t e g r i e f h ad s u b s i d e d by t h e s i x t h m o n t h . The v o l u n t e e r s w e re s e n t a l e t t e r ( s e e A p p e n d i x A) a s k i n g i f t h e y w o u l d c o n s i d e r b e i n g a p a r t o f t h e s t u d y . The l e t t e r was f o l l o w e d up by a t e l e p h o n e c a l l f r o m t h e i n t e r v i e w e r o f t h i s r e s e a r c h . I t was assumed t h e p o p u l a t i o n w o u l d be more w i l l i n g t o p a r t i c i p a t e w i t h t h i s s t u d y s i n c e t h e i n t e r v i e w e r i s t h e l e a d e r o f t h e N o r t h S h o r e F a m i l y S e r v i c e g r i e v i n g g r o u p and h a s a w o r k i n g r e l a t i o n s h i p w i t h L i o n s G a t e H o s p i t a l and many N o r t h S h o r e n u r s e s and p h y s i c i a n s . A l l t h e r e s p o n d e n t s a g r e e d t o be i n t e r v i e w e d and t h e i n t e r v i e w was h e l d i n e a c h o f t h e p a r t i c i p a n t s p r i v a t e r e s i d e n c e . The p a r t i c i p a n t s were g i v e n d u p l i c a t e c o n s e n t f o r m s ( s e e A p p e n d i x B) w h i c h were r e a d a l o u d o u t l i n i n g c l e a r l y t h a t : p a r t i c i p a t i o n was v o l u n t a r y and c o u l d be d e t e r m i n e d a t any p o i n t ; t h e i n t e r v i e w s w o u l d be t a p e d , h o w e v e r a l l d a t a w o u l d be c o n f i d e n t i a l and t a p e s e r a s e d upon c o m p l e t i o n o f t h e a n a l y s i s ; and i n v o l v e m e n t i n t h e r e s e a r c h w o u l d i n no way e f f e c t t h e r e l a t i o n s h i p t h e s u b j e c t had w i t h N o r t h S h o r e F a m i l y S e r v i c e s . A l l s u b j e c t s s i g n e d t h e c o n s e n t f o r m i n d u p l i c a t e and k e p t one c o p y t h e m s e l v e s . 29 A t o t a l o f 15 a d u l t women were i n t e r v i e w e d a l t o g e t h e r , o u t o f a n a n t i c i p a t e d 20 p a r t i c i p a n t s . F i f t e e n r e s p o n d e n t s p r o v i d e d a s u f f i c i e n t number o f c r i t i c a l i n c i d e n t s t o meet t h e r e d u n d a n c y c r i t e r i o n ( F l a n a g a n , 1 9 5 4 ) . P r o f i l e o f P a r t i c i p a n t s W o o l s e y (1985) s t a t e s t h a t i t i s i m p o r t a n t t o g a t h e r r e l e v a n t d e s c r i p t i v e b i o g r a p h i c a l d a t a a b o u t r e s p o n d e n t s i n c r i t i c a l i n c i d e n t r e s e a r c h . The d e t a i l e d d e m o g r a p h i c q u e s t i o n n a i r e ( A p p e n d i x C) p r o d u c e d t h e f o l l o w i n g p r o f i l e o f t h e w i d o w s i n t e r v i e w e d i n t h i s s t u d y . A c t u a l s t a t i s t i c s a r e p r e s e n t e d i n T a b l e s 1 and 2. G e n e r a l I n f o r m a t i o n . The women i n t h i s s t u d y a r e p r i m a r i l y C a n a d i a n w i t h a n a v e r a g e age o f 54. The a v e r a g e age o f 54 r e f l e c t s t h e C a n a d i a n s t a t i s t i c s s i n c e more t h a n a t h i r d o f C a n a d i a n widows a r e u n d e r t h e age o f 65 and t h e a v e r a g e age t o become a widow i n Ca n a d a i s 56 ( S u t t o n , 1 9 7 8 ) - They were m a r r i e d t o t h e i r h u s b a n d s f o r an a v e r a g e o f 28 y e a r s w i t h t h e e x c e p t i o n o f 1 r e s p o n d e n t who was m a r r i e d o n l y a y e a r and i t was h e r s e c o n d m a r r i a g e . A g a i n , w i t h t h e e x c e p t i o n o f 1 widow, t h e women h a d c h i l d r e n whose a v e r a g e age was 26.6. T h e y were p r i m a r i l y p r o t e s t a n t s who were o n l y s l i g h t l y i n v o l v e d i n t h e i r r e l i g i o n . The m a j o r i t y 30 Table 1 Demographic Data; General Information N a t i o n a l i t y C a n a d i a n : 12 E n g l i s h : 3 L e n g t h o f M a r r i a g e Y e a r s 1-4 : 1 5-9 : 0 1 0 - 1 4 : 2 15-1 9 : 1 2 0 - 2 4 : 1 2 5 - 2 9 : 2 3 0 - 3 4 : 2 3 5 - 3 9 : 3 4 0 - 4 5 : 3 a v e r a g e l e n g t h : 27.9 R e l i g i o n C a t h o l i c : 4 P r o t e s t a n t : 9 O t h e r : 3 Age 4 0 - 4 4 : 3 4 5 - 4 9 : 2 50-54: 0 5 5 - 5 9 : 4 60-64: 6 a v e r a g e a g e : 54.4 C h i l d r e n 1 0 6 4 3 1 R e l i g i o u s I n v o l v e m e n t I n v o l v e d : 2 M o d e r a t e : 4 S l i g h t : 9 M a r i t a l S t a t u s f i r s t m a r r i a g e : 14 s e c o n d m a r r i a g e : 1 Age o f C h i l d r e n 0-10 11-20 21-30 31-40 a v e r a g e age 4 6 13 18 26.6 O c c u p a t i o n Homemaker: 7 S e c r e t a r y / C l e r k : 2 P r e s c h o o l T e a c h e r : 2 N u r s e ( R N ) : 1 P y s i o t h e r a p i s t : 1 S m a l l B u s i n e s s : 1 F r e e l a n c e W r i t e r : 1 31 Tab le 2 Demographic Data — Death of Spouse In fo rmat ion T y p e o f D e a t h P l a c e o f D e a t h D a t e o f D e a t h S u d d e n : 13 Home: 4 1981: 5 E x p e c t e d : 2 H o s p i t a l : 7 1982: 6 O t h e r : 4 1983: 4 P s y c h i a t r i c H e l p S i n c e B e r e a v e m e n t Y e s : 5 No: 10 F i n a n c i a l S i t u a t i o n E a s y : 7 M o d e r a t e : 8 D i f f i c u l t : 0 32 of the women were homemakers with 7 women working o u t s i d e the home as p r e s c h o o l t e a c h e r s , h e a l t h care p r o f e s s i o n a l s , c l e r k s , or as an owner of a sm a l l b u s i n e s s . Death of Spouse I n f o r m a t i o n . S t u d i e s e v a l u a t i n g bereavement both r e t r o s p e c t i v e l y and p r o s p e c t i v e l y d e l i n e a t e the importance of the nature of death i n d e f i n i n g the outcome of c o n j u g a l bereavement (Raphael and Maddison, 1976). T h i r t e e n of these women s t a t e d t h a t t h e i r husbands d i e d suddenly, although 4 s t a t e d that t h e i r husbands had been s e r i o u s l y i l l . The knowledge of t h e i r husband's i l l n e s s d i d not help them to a n t i c i p a t e the death of t h e i r spouse and, i n f a c t , they f e l t t h e i r spouses death was sudden. Raphael (1983) s t a t e s even when death i s a n t i c i p a t e d and seems t i m e l y , i t may not come at the time i t i s expected, thus producing shock e f f e c t s . Sudden, unexpected and untimely deaths are a s s o c i a t e d with g r e a t e r problems f o r the bereaved than are a n t i c i p a t e d deaths: g r e a t e r d i f f i c u l t i e s with acceptance of the l o s s and adjustment to i t ; g r e a t e r d i f f i c u l t i e s with h e a l t h and with a r e t u r n to normalcy (Lehrman, 1956; Parkes, 1975). Sudden deaths prove to be a r i s k f a c t o r f o r poor outcome f o l l o w i n g bereavement (Raphael, 1977). One widow's husband committed s u i c i d e . S u i c i d e s are deaths of s p e c i a l s i g n i f i c a n c e . Here 33 t h e p e r s o n has c h o s e n t o d i e , t o d e s e r t t h o s e who a r e b e r e a v e d . They l e a v e a l e g a c y o f s u i c i d e ( C a i n , 1 9 6 6 ) , o f u n c e r t a i n t y , o f g u i l t , o f b l a m e , and h o s t i l i t y . T h e r e w e re o n l y 2 widows who e x p e c t e d t h a t t h e i r h u s b a n d w o u l d d i e . A n t i c i p a t i o n o f t h e d e a t h , as w i t h t e r m i n a l i l l n e s s , seems t o g i v e a g r e a t e r c h a n c e f o r p r e p a r a t i o n . T h e r e may be a n t i c i p a t o r y g r i e f and m o u r n i n g . F o u r o f t h e s p o u s e s o f t h e s e women d i e d away f r o m home o r h o s p i t a l . The s u d d e n n a t u r e o f t h e s e 4 d e a t h s and t h e i n a b i l i t y o f t h e s e women t o s e e t h e body o f t h e i r s p o u s e may ad d t o t h e p r o b l e m o f a c c e p t i n g t h e f i n a l i t y o f t h e l o s s ( S i n g h and R a p h a e l , 1 9 8 1 ) . The r e m a i n i n g women r e p o r t e d 7 o f t h e i r s p o u s e s d i e d i n h o s p i t a l and 4 s p o u s e s d i e d a t home. The women had become widows f r o m 1981 t o 1983 and t h e g r o u p was d i s t r i b u t e d e v e n l y i n t h e l e n g t h o f t h e i r b e r e a v e m e n t f r o m 6 months t o 2 y e a r s . T h e r e i s no f i x e d end p o i n t o f g r i e v i n g d u r i n g t h e f i r s t o r e v e n s e c o n d y e a r , b u t much o f t h e work o f r e l i n q u i s h i n g t h e bon d s i s a c c o m p l i s h e d i n t h e e a r l y months and c o n t i n u e s g r a d u a l l y , i n s t e p s a n d p h a s e s , o v e r t h e f i r s t y e a r ( R a p h a e l , 1 9 8 3 ) . 34 P s y c h i a t r i c help i n coping with the l o s s of spouse was sought by 5 of the 15 widows. Both widows who expected the death of t h e i r spouse attended p s y c h i a t r i c care a f t e r the death of t h e i r spouse. Parkes (1975) suggests t h a t socioeconomic f a c t o r s may l e a d to g r e a t e r " s u r v i v a l " problems f o r the widow and her f a m i l y . Maddison and V i o l a (1968) found t h a t f i n a n c i a l problems were a s p e c i f i c f a c t o r c o n t r i b u t i n g to "high r i s k " widows (those e x p e r i e n c i n g an u n s a t i s f a c t o r y outcome of bereavement). E i g h t widows r a t e d t h e i r f i n a n c i a l s t a t u s as moderate and 7 r a t e d t h e i r s t a t u s as easy. The problem of f i n a n c i a l l o s s d i d not e f f e c t the women i n t h i s study. In f a c t , 2 of the women who ranked t h e i r f i n a n c i a l s i t u a t i o n as easy complained of f e e l i n g g u i l t y because t h e i r l i f e s t y l e improved due to the death of t h e i r spouse. Procedure and Data C o l l e c t i o n  Assumptions For many p a r t i c i p a n t s , a s i g n i f i c a n t l e n g t h of time e x i s t s between the experience of i n c i d e n t s and the r e c o l l e c t i o n of these i n c i d e n t s i n the i n t e r v i e w . Given t h i s f a c t , the assumptions made by the r e s e a r c h e r p r i o r to the c o l l e c t i o n of the data are i d e n t i f i e d as f o l l o w s : 35 1. s u b j e c t s w i l l r e c a l l i n c i d e n t s i n d e t a i l as they happened; 2. the r e c a l l of i n c i d e n t s w i l l be e s s e n t i a l l y f a c t u a l ; and 3. s u b j e c t s w i l l be able to d i s t i n g u i s h between c r i t i c a l i n c i d e n t s t h a t were h e l p f u l d u r i n g t h e i r experience of g r i e f , and those t h a t were harmful dur i n g t h e i r e x p e r i e n c e of g r i e f . Interview S t r u c t u r e P r i o r to commencing the i n t e r v i e w , the p a r t i c i p a n t s were g i v e n a d e t a i l e d demographic q u e s t i o n n a i r e (Appendix C) i n c l u d i n g b a s i c s such as age, m a r i t a l l e n g t h , and o c c u p a t i o n , as w e l l as f a c t s about the death of t h e i r spouse. The f a c t s c o n s i d e r e d i n c l u d e d type of death, p l a c e of death, date of death and c o u n s e l l i n g r e c e i v e d . Upon completion of t h i s q u e s t i o n n a i r e , s u b j e c t s were then i n t e r v i e w e d by the r e s e a r c h e r , a c c o r d i n g to the s t r u c t u r e d e t a i l e d i n Appendix D. P i l o t Study The p i l o t study had two main o b j e c t i v e s . The f i r s t of these was to determine whether or not s u b j e c t s were able to r e c a l l s p e c i f i c events t h a t were h e l p f u l or harmful to t h e i r e x p e r i e n c e t e s t t h e F l a n a g a n ' s o f g r i e f . The p i l o t s t u d y was a l s o c o n d u c t e d t o i n t e r v i e w s t r u c t u r e ( A p p e n d i x D ) , b a s e d o n (1954) C r i t i c a l I n c i d e n t T e c h n i q u e . T h r e e women, who had v o l u n t e e r e d t o p a r t i c i p a t e , were i n t e r v i e w e d f o r t h e p i l o t s t u d y . One woman was 40 y e a r s o f age and i t had been 18 mon t h s s i n c e t h e d e a t h o f h e r h u s b a n d . I t had been a p r o l o n g e d d e a t h and s h e had r e q u i r e d p s y c h i a t r i c c o u n s e l l i n g d u r i n g h e r b e r e a v e m e n t . The o t h e r two women were 64 y e a r s o f age and b o t h t h e i r h u s b a n d s h a d d i e d a y e a r p r i o r t o t h e i n t e r v i e w . The d e a t h s o f t h e i r h u s b a n d s h a d b e e n s u d d e n a nd n e i t h e r h a d r e q u i r e d c o u n s e l l i n g . One woman d e f i n e d h e r s e l f a s o n l y s l i g h t l y i n v o l v e d i n h e r r e l i g i o n , w h i l e t h e o t h e r two w e r e i n v o l v e d a c t i v e l y i n t h e f u n c t i o n s o f t h e i r c h u r c h . T h e r e f o r e , t h e s e 3 women w e r e r e p r e s e n t a t i v e o f t h e p o p u l a t i o n t h a t t h i s s t u d y w o u l d be i n t e r v i e w i n g . The i n t e r v i e w e r a d h e r e d t o t h e i n t e r v i e w s t r u c t u r e as o u t l i n e d i n A p p e n d i x D. The t h r e e women had l i t t l e d i f f i c u l t y r e c a l l i n g s p e c i f i c i n c i d e n t s t h a t w e r e h e l p f u l o r h a r m f u l d u r i n g t h e i r e x p e r i e n c e o f g r i e f . The f o l l o w - u p q u e s t i o n s d i d i n s u r e 37 t h a t i m p o r t a n t c r i t e r i a c i t e d by F l a n a g a n (1954) was met by t h e i n c i d e n t s r e p o r t e d : t h e a c t u a l b e h a v i o u r was r e p o r t e d ; i t was o b s e r v e d by t h e r e p o r t e r ; r e l e v a n t f a c t o r s o f t h e i n c i d e n t w e r e g i v e n ; t h e o b s e r v e r s made d e f i n i t e j u d g e m e n t s r e g a r d i n g t h e c r i t i c a l n e s s o f t h e b e h a v i o u r ; and why t h e b e h a v i o u r was j u d g e d c r i t i c a l . The i n t e r v i e w s l a s t e d a p p r o x i m a t e l y 2 h o u r s . E a c h o f t h e 3 women i n t e r v i e w e d s t a t e d t h a t t h e y h a d d e r i v e d some p e r s o n a l v a l u e f r o m t h e i n t e r v i e w p r o c e s s . I t a l l o w e d them t o r e f l e c t on t h e d e a t h o f t h e i r h u s b a n d and t h e i r b e r e a v e m e n t f r o m a d i f f e r e n t p e r s p e c t i v e . Two o f t h e women s t a t e d t h a t t h e y had n o t r e a l i z e d how w e l l t h e y w e re c o p i n g w i t h t h e i r g r i e f u n t i l t h e y t a l k e d a b o u t t h e h e l p f u l and h a r m f u l i n c i d e n t s w i t h t h e r e s e a r c h e r . I n summary, t h e p i l o t s t u d y r e s u l t e d i n t h e d e t e r m i n a t i o n t h a t t h e i n t e r v i e w s t r u c t u r e met t h e c r i t e r i a e s t a b l i s h e d by F l a n a g a n ( 1 9 5 4 ) and t h a t t h e s u b j e c t s w e r e a b l e t o r e c a l l s p e c i f i c e v e n t s . The p i l o t s t u d y r e s p o n d e n t s w e r e i n c l u d e d i n t h e s a m p l e b e c a u s e t h e y met t h e c r i t e r i a . The most v a l u a b l e i n s i g h t a b o u t t h e i n t e r v i e w f o r m a t was t h e c l a i m f r o m t h e s u b j e c t s t h a t t h e y had d e r i v e d some t h e r a p e u t i c b e n e f i t f r o m l o o k i n g a t t h e i r e x p e r i e n c e o f g r i e f . The r e s e a r c h e r f o u n d t h a t i t was n e c e s s a r y t o 38 l e n g t h e n t h e t i m e o f t h e i n t e r v i e w due t o t h e n a t u r e o f t h e t o p i c and t o i n s u r e t h a t t h e r e s p o n d e n t d i d n o t c o n s i d e r t h e i n t e r v i e w , i t s e l f , a h a r m f u l i n c i d e n t . D a t a A n a l y s i s The c r i t i c a l i n c i d e n t s f r o m t h e t a p e d i n t e r v i e w s w e r e e x t r a c t e d and t r a n s f e r r e d o n t o 3 x 5 c a r d s . An i n c i d e n t was j u d g e d t o be c r i t i c a l i f t h e s u b j e c t c o u l d r e c a l l d e t a i l s o f t h e e x p e r i e n c e a nd remember what i t was a b o u t t h e i n c i d e n t t h a t was h e l p f u l o r h a r m f u l i n t h e e x p e r i e n c e o f g r i e f . C a t e g o r y f o r m u l a t i o n was done i n d u c t i v e l y . The i n c i d e n t s w e r e s o r t e d i n t o c l u s t e r s t h a t seemed t o h a v e t h e same theme. The r e s u l t o f t h e f i r s t a t t e m p t a t c a t e g o r i z a t i o n was u n h e l p f u l . S e v e r a l more a t t e m p t s a t c a t e g o r i z a t i o n s p r o v e d u n s a t i s f a c t o r y . The i n t e r v i e w e r a d d e d i n f o r m a t i o n t o t h e i n c i d e n t c a r d s , s u c h a s , t h e a g e n t . The a g e n t i s who made t h e d i f f e r e n c e i n t h e i n c i d e n t - t h e r e s p o n d e n t , a r e l a t i v e , a f r i e n d , o r a p r o f e s s i o n a l . I t was h e l p f u l t o r e v i e w t h e t a p e d i n t e r v i e w . W o o l s e y (1985) a s s e r t s t h a t t h e a n a l y s i s o f c r i t i c a l i n c i d e n t d a t a i s t h e most d i f f i c u l t and f r u s t r a t i n g a s p e c t o f t h e method. F l a n a g a n (1954) s t a t e s t h a t t h e t r i a l and e r r o r p r o c e d u r e i s t y p i c a l o f c r i t i c a l i n c i d e n t s t u d i e s . 39 A s a t i s f a c t o r y c a t e g o r i z a t i o n r e s u l t e d f r o m i n c l u d i n g t h e s o u r c e , t h a t i s what r e a l l y made t h e i n c i d e n t s o h e l p f u l , as t h e b a s i s f o r c a t e g o r y f o r m a t i o n . W o o l s e y ( 1 9 8 5 ) s t a t e s t h a t i t i s i m p o r t a n t t o c o n t i n u e w o r k i n g w i t h c a t e g o r i e s u n t i l a s u b j e c t i v e p o i n t i s r e a c h e d w here i t seems t h e r e s e a r c h e r h a s d i s c o v e r e d some u n d e r l y i n g s t r u c t u r e and n o t an a r t i f i c i a l o r d e r . H e l p f u l and h a r m f u l i n c i d e n t s were b o t h c l a s s i f i e d i n t h i s manner. R e l i a b i l i t y o f C a t e g o r i e s The c l a s s i f i c a t i o n s y s t e m d e v e l o p e d was t e s t e d f o r r e l i a b l i t y by two i n d e p e n d e n t j u d g e s , b o t h o f whom were g r a d u a t e s t u d e n t s i n C o u n s e l l i n g P s y c h o l o g y . The j u d g e s w e r e t r a i n e d i n t h e c a t e g o r y s y s t e m t o be u s e d . The p e r c e n t a g e o f a g r e e m e n t by t h e j u d g e s w i t h t h e i n v e s t i g a t o r ' s c l a s s i f i c a t i o n o f i n c i d e n t s p r o v i d e d t h e m e a s u r e o f r e l i a b i l i t y . A n d e r s s o n and N i l s s o n ( 1 9 6 4 ) s u g g e s t t h a t r e l i a b i l i t y i s r e a c h e d i f r a t e r s c a n c l a s s i f y 7 5 - 8 5 % o f t h e i n c i d e n t s i n t o t h e c a t e g o r i e s . A minimum o f 80% a g r e e m e n t was d e c i d e d i n a d v a n c e t o i n d i c a t e r e l i a b l e c a t e g o r i e s . A l l 241 i n c i d e n t s w e r e t e s t e d by e a c h j u d g e . The f o l l o w i n g r e s u l t s w e r e o b t a i n e d : 40 Table 3 Reliability of Classification System ( P e r c e n t a g e A g r e e m e n t ) J u d g e H e l p f u l C a t e g o r y H a r m f u l C a t e g o r y A 80% 79% B 80% 69% B a s e d on t h e r e s u l t s o f t h e j u d g e s c a t e g o r i z a t i o n , t h e h a r m f u l i n c i d e n t s were r e - e v a l u a t e d by t h e i n v e s t i g a t o r . D i f f i c u l t d e c i s i o n s o c c u r r e d d u r i n g t h e c a t e g o r i z a t i o n p r o c e s s . T r a d i t i o n a l l y , a l l members o f a c a t e g o r y a r e e q u a l l y g o o d e x a m p l e s o f t h a t c a t e g o r y . M c C l o s k e y and G l u c k s b e r g ( 1 9 7 8 ) , and R o s c h ( 1 9 7 5 ) s u g g e s t t h a t t h e r e i s a c o n t i n u u m o f c a t e g o r y m e m b e r s h i p w h i c h l e a d s t o t h e n o t i o n o f " f u z z y s e t s " . T h e r e i s no c l e a r b o u n d a r y b e t w e e n c a t e g o r i e s s o t h a t some o f t h e f u z z i e s t o b j e c t s c a n be c a t e g o r y members and non-members s i m u l t a n e o u s l y . C o g n i t i v e p s y c h o l o g i c a l r e s e a r c h i n t o c a t e g o r y f o r m a t i o n i s n o t a p u r e l y s u b j e c t i v e p r o c e s s . C r i t i c a l i n c i d e n t s c o n t a i n i n c i d e n t s t h a t f o r m a c o n t i n u u m o f c a t e g o r y m e m b e r s h i p r a n g i n g f r o m p r o t o t y p i c a l i n c i d e n t s e a s i l y c a t e g o r i z e d by i n d e p e n d e n t r a t e r s t o f u z z y i n c i d e n t s 41 w h i c h p o s s e s s a t t r i b u t e s o f more t h a n one c a t e g o r y . I t i s t h i s phenomena t h a t c a n p r o d u c e l e s s a g r e e m e n t among i n d e p e n d e n t r a t e r s . S e v e n i n c i d e n t s w e r e p l a c e d i n d i f f e r e n t c a t e g o r i e s when i t was d i s c o v e r e d t h a t b o t h j u d g e s A and B had p l a c e d t h o s e i n c i d e n t s i n t h e same d i f f e r e n t c a t e g o r i e s . I t was assumed t h a t t h e s e s e v e n i n c i d e n t s p o s s e s s e d a t t r i b u t e s o f more t h a n one c a t e g o r y a n d , i n f a c t , were b e t t e r r e p r e s e n t e d i n a d i f f e r e n t c a t e g o r y . A d d i t i o n a l l y , t h e r e s e a r c h e r p l a c e d more i n f o r m a t i o n o n t h e 3 x 5 c a r d s a f t e r r e v i e w i n g t h e t a p e t o i n s u r e t h a t a l l t h e n e c e s s a r y i n f o r m a t i o n f o r e a c h i n c i d e n t was a v a i l a b l e . The j u d g e s w e re a s k e d t o s o r t t h e h a r m f u l i n c i d e n t s f o r a s e c o n d t i m e . The f o l l o w i n g r e s u l t s w e r e o b t a i n e d : T a b l e 5 R e l i a b i l i t y o f C l a s s i f i c a t i o n S y s t e m ( P e r c e n t a g e A g r e e m e n t ) J u d g e H a r m f u l C a t e g o r y A 87% B 85 % 42 CHAPTER FOUR Results A t o t a l o f 241 i n d e p e n d e n t c r i t i c a l i n c i d e n t s w e r e e x t r a c t e d and t r a n s c r i b e d f r o m t h e t a p e d i n t e r v i e w s o f t h e f i f t e e n f e m a l e p a r t i c i p a n t s . Of t h e s e , one h u n d r e d and t h i r t y w e r e f a c t o r s t h a t w e r e c o n s i d e r e d h e l p f u l , and one h u n d r e d and e l e v e n were f a c t o r s c o n s i d e r e d h a r m f u l . The a v e r a g e number o f i n c i d e n t s p e r s u b j e c t was s i x t e e n . T he s t u d y y i e l d e d two l e v e l s o f c a t e g o r i z a t i o n : c a t e g o r i e s and s u b - c a t e g o r i e s . The h e l p f u l i n c i d e n t s a n d h i n d e r i n g i n c i d e n t s f i t i n s i m i l a r c a t e g o r i e s , one h a v i n g a p o s i t i v e v a l e n c e and t h e o t h e r a n e g a t i v e v a l e n c e . B o t h t h e h e l p f u l i n c i d e n t s and h i n d e r i n g i n c i d e n t s had t h e same number o f c a t e g o r i e s . The s u b - c a t e g o r i e s were d i f f e r e n t b o t h i n n a t u r e and number f o r t h e two t y p e s o f i n c i d e n t s . The s u b - c a t e g o r i e s p r o v i d e d t h e c a t e g o r i e s w i t h a r i c h n e s s o f d e t a i l . T a b l e 6 r e v e a l s t h e d i s t r i b u t i o n o f c r i t i c a l i n c i d e n t s w i t h i n e a c h o f t h e c a t e g o r i e s . B e l o w a r e t h e d e f i n i t i o n s f o r e a c h o f t h e c a t e g o r i e s and s u b - c a t e g o r i e s . M e e t i n g t h e o r i g i n a l a s s u m p t i o n s , t h e women o f f e r e d t h e i r e x p e r i e n c e s i n p r e c i s e , f a c t u a l d e t a i l . The women's e x a c t w o r d s w i l l be u s e d t o i l l u s t r a t e t h e s u b - c a t e g o r i e s . 43 Table 6 Distribution of Incidents within Categories H e l p f u l H a r m f u l T a k i n g A c t i o n 30 R e c e i v i n g S u p p o r t 48 S h a r i n g t h e G r i e f 29 V e r b a l R e a s s u r a n c e 9 P h y s i c a l C o m f o r t 14 T o t a l I n c i d e n t s 130 I n a b i l i t y t o A c t 19 L a c k o f S u p p o r t 30 F e e l i n g A l o n e 27 V e r b a l C r i t i c i s m 24 P h y s i c a l D i s t r e s s 11 T o t a l I n c i d e n t s 111 TOTAL = 2 4 1 I n c i d e n t s Helpful Incident Categories  Taking Action A s shown i n T a b l e 6, t h i r t y o u t o f one h u n d r e d and t h i r t y h e l p f u l i n c i d e n t s c o u l d be c l a s s i f i e d i n t h i s c a t e g o r y , a c c o u n t i n g f o r a p p r o x i m a t e l y 2 3 % o f t h e h e l p f u l i n c i d e n t s . D e f i n i t i o n : T h i s c a t e g o r y seems t o encompass a g r o w t h p o t e n t i a l i n t h e e x p e r i e n c e o f g r i e f . The i n c i d e n t s e n h a n c e t h e s e n s e o f p e r s o n a l power o f t h e r e s p o n d e n t i n a n a r e a w h e r e she f e e l s s he h a s become o u t o f b a l a n c e s i n c e t h e d e a t h o f h e r h u s b a n d . She may e x p e r i e n c e a g r o w t h i n h e r c o m p e t e n c e , t h a t i s , h a n d l i n g t h e c r i s i s and m a n a g i n g by h e r s e l f . I t i s an a c t t h a t r e s u l t s i n t h e widow e m p o w e r i n g h e r s e l f . 44 S u b - C a t e g o r i e s : T h e r e a r e f i v e s u b - c a t e g o r i e s w h i c h a r e b a s e d on t h e t y p e o f a c t i o n s t h a t t h e w i dows t o o k . T a b l e 7 shows t h e f r e q u e n c y o f i n c i d e n t s i n e a c h o f t h e f i v e s u b - c a t e g o r i e s f o u n d i n t h e T a k i n g A c t i o n C a t e g o r y . E x a m p l e s r e f l e c t i n g t h e s e s u b - c a t e g o r i e s a r e : T a b l e 7 D i s t r i b u t i o n o f I n c i d e n t s i n t h e T a k i n g A c t i o n C a t e g o r y B a c k t o Work 5 On a T r i p 4 C o p i n g w i t h D e p r e s s i o n / A n x i e t y 9 S o c i a l L i f e 9 Coming t o Terms w i t h D e a t h _3_ T o t a l i n c i d e n t s 30 1. Back t o Work: I became a t r u s t e e o f S.P. H o s p i t a l and I f e e l l i k e I am b e c o m i n g i n v o l v e d i n l i f e a g a i n . I d o n ' t want t o p l a y b r i d g e and g o l f e v e r y d a y ... i t g i v e s me d i r e c t i o n . 2. On a T r i p : I went on a t r i p by m y s e l f - on my own. I t makes me f e e l s t r o n g . I d o n ' t s a y t h a t w i t h p r i d e . I s a y t h a t w i t h d e t e r m i n a t i o n . 45 3. C o p i n g w i t h D e p r e s s i o n / A n x i e t y : I had an o v e r w h e l m i n g p a i n . I r a n i n t o t h e bedroom and k n e e l e d by t h e bed. I was c r y i n g . I had my arms o u t s t r e t c h e d and s a i d , 'Help me, L o r d . I c a n ' t manage a l o n e ..." I c r i e d . I began t o f e e l empty and e x h a u s t e d and i n t h e e n d , I was a b l e t o c a r r y on. 4. S o c i a l L i f e : I g a v e m y s e l f a b i r t h d a y p a r t y . I i n v i t e d a l l t h e p e o p l e who had c a r e d a b o u t me. I t was g r e a t ! F o u r c a k e s ! I t u r n e d a p o s s i b l e n e g a t i v e i n t o a p o s i t i v e . 5. Coming t o Terms w i t h D e a t h : I was p l a y i n g g o l f on t h e e i g h t e e n t h t e e by a l a k e and i t s t r u c k me - t h e r e i s where t o p u t h i s a s h e s . He a l w a y s l o v e d t o g o l f . We went a t dusk ... my e l d e s t s o n s c a t t e r e d them. We a l l f e l t r e l i e f . We were n o t s a d . I f e l t he was f r e e and we were f r e e ... I had made an i m p o r t a n t d e c i s i o n . The u n d e r l y i n g f e a t u r e o f t h e s e i n c i d e n t s i s t h a t t h e widows had an awareness o f a c h o i c e , and g a i n e d a measure o f c o n t r o l i n t h e i n c i d e n t t h r o u g h e x e r c i s i n g an o p t i o n and 46 e x p e r i e n c i n g t h e c o n s e q u e n c e as g a i n i n g some s e n s e o f p e r s o n a l p o w e r . Receiving Support A s shown i n T a b l e 6, f o r t y - e i g h t o u t o f one h u n d r e d and t h i r t y h e l p f u l i n c i d e n t s c o u l d be c l a s s i f i e d i n t h i s c a t e g o r y , a c c o u n t i n g f o r a p p r o x i m a t e l y 37% o f t h e h e l p f u l i n c i d e n t s . D e f i n i t i o n : The b e r e a v e d widow i s v e r y d e p e n d e n t on t h e s u p p o r t o f o t h e r s d u r i n g t h e t i m e o f g r i e f . The i n c i d e n t s i n t h i s c a t e g o r y d e a l w i t h t h e widow p e r c e i v i n g s u p p o r t f r o m o t h e r s and b e i n g a b l e t o g i v e s u p p o r t t o o t h e r s . S u p p o r t may be s e e n as a n y t h i n g f r o m p r a c t i c a l a s s i s t a n c e t o r e a s s u r a n c e o f w o r t h . I t i s a s e n s e t h a t p e o p l e c a r e a b o u t t h e widow and c a n h e l p h e r i n t h e e x p e r i e n c e o f g r i e f . S u b - C a t e g o r i e s : T h e r e a r e f o u r s u b - c a t e g o r i e s w h i c h a r e b a s e d on t h e a c t i o n s o f o t h e r s o r t h e widow's a c t i o n . The r e s u l t o f t h e s e a c t i o n s i s t h e widow e x p e r i e n c i n g s u p p o r t e i t h e r f r o m o t h e r s o r by g i v i n g i t t o o t h e r s . T a b l e 8 shows t h e f r e q u e n c y o f i n c i d e n t s i n e a c h o f t h e f o u r s u b - c a t e g o r i e s f o u n d i n t h e R e c e i v i n g S u p p o r t c a t e g o r y . E x a m p l e s r e f l e c t i n g t h e s e s u b - c a t e g o r i e s a r e : 1. P r o f e s s o n a l s P r o v i d i n g S e r v i c e s : I had a s e s s i o n w i t h a c o u n s e l l o r . I c o u l d be m y s e l f a n d e x p r e s s my f e e l i n g s . T h e r e was no d i s a p p r o v a l . When t h e s e s s i o n was o v e r , I g o t r i d o f a g r e a t l o a d . . . a w e i g h t l i f t e d o f f . h e l p e d me make t h e b e s t , p r a c t i c a l d e c i s i o n . H i s p r a c t i c a l a d v i c e h e l p e d me. A f r i e n d came o v e r and when I a s k e d i f s h e w a n t e d t e a s h e s a i d , ' n o , my h u s b a n d w o u l d be u p s e t i f I d i d n ' t t a k e y o u t o o u r h o u s e ' . She t o o k me t o h e r h o u s e u n t i l 2:00 a . m . I f e l t l o v e and s u p p o r t . 3. Widow G i v i n g S u p p o r t : I w r o t e a l e t t e r t o D. F . , t h e j u d g e who was a r r e s t e d f o r h i t a n d r u n w h i l e i m p a i r e d . I t o l d h i m t o know t o b a r g a i n . A y e a r f r o m now i t w i l l be b e t t e r . I g o t a w o n d e r f u l l e t t e r b a c k . I t f e l t g o o d t o r e a c h o u t a n d s u p p o r t s o m e o n e . 2. P e o p l e P r o v i d i n g S u p p o r t : A m a l e f r i e n d h e l p e d my buy a c a r . He knew a b o u t c a r s a n d 48 4. L i n k i n g W i t h O t h e r s W i t h The Same E x p e r i e n c e : I a t t e n d e d a b e r e a v e m e n t g r o u p . I h e a r d o t h e r p e o p l e s r e a c t i o n t o g r i e f . I had a s e n s e o f s h a r i n g ... a s e n s e o f w h o l e n e s s . The p e r c e i v e d s u p p o r t i n t h e s e i n c i d e n t s w h e t h e r i n i t i a t e d o r r e c e i v e d by t h e widow, was e x p e r i e n c e d a s h e l p f u l . S u p p o r t a p p e a r s t o h a v e many c o m p o n e n t s . The f i r s t i n c i d e n t i n v o l v e d e x p r e s s i o n o f p o s i t i v e a f f e c t . I n t h e l a s t i n c i d e n t s u p p o r t was c o n v e y e d by p r o v i d i n g i n f o r m a t i o n t h a t t h e widow was a p a r t o f a n e t w o r k - a s u p p o r t s y s t e m . As d i s p l a y e d i n T a b l e 8, h a l f o f t h e i n c i d e n t s i n t h i s c a t e g o r y were l o c a t e d i n t h e s u b - c a t e g o r y P e o p l e P r o v i d i n g S u p p o r t . T a b l e 8 D i s t r i b u t i o n of I n c i d e n t s i n R e c e i v i n g Support Category P r o f e s s i o n a l s p r o v i d i n g s e r v i c e s , c o n c r e t e , e m p a t h y , u n d e r s t a n d i n g 14 P e o p l e p r o v i d i n g s u p p o r t 24 Widow g i v i n g s u p p o r t 6 L i n k i n g w i t h o t h e r s w i t h same e x p e r i e n c e 4 T o t a l i n c i d e n t s 48 49 Sharing the Grief As shown i n T a b l e 6, t w e n t y - n i n e out o f one hundred and t h i r t y h e l p f u l i n c i d e n t s c o u l d be c l a s s i f i e d i n t h i s c a t e g o r y , a c c o u n t i n g f o r a p p r o x i m a t e l y 22% o f the h e l p f u l i n c i d e n t s . D e f i n i t i o n ; T h i s c a t e g o r y r e f l e c t s the widow's p e r c e p t i o n of the communication of empathy from a n o t h e r p e r s o n t h a t p r o v i d e s h e r w i t h v a l i d a t i o n of some f e e l i n g s and a sense t h a t she has p e r m i s s i o n t o t a l k . She a l s o can e x p e r i e n c e the freedom t o v e n t i l a t e h e r f e e l i n g s but the i n t e n s i t y seems t o depend upon t h e r e l a t i o n s h i p she has w i t h the i n d i v i d u a l . A key f e a t u r e of t h i s c a t e g o r y i s t h a t when t h e widow engages i n t h i s t y p e o f s h a r i n g , she does not f e e l a l o n e i n g r i e f . S u b - C a t e g o r i e s ; There a r e t h r e e s u b - c a t e g o r i e s which a r e based on the a c t i o n s o f o t h e r s o r the widow's a c t i o n . T a b l e 9 shows the f r e q u e n c y of i n c i d e n t s i n each of the t h r e e s u b - c a t e g o r i e s found i n t h e S h a r i n g the G r i e f c a t e g o r y . The r e s u l t of these a c t i o n s i s a sense of b e i n g u n d e r s t o o d by a n o t h e r o r u n d e r s t a n d i n g a n o t h e r . Examples r e f l e c t i n g t h e s e s u b - c a t e g o r i e s a r e : 1. P e r s o n a l Bond: I t was s u n s e t . I a s k e d t h e g r a n d c h i l d r e n t o j o i n me a t t h e f r o n t d o o r and w a t c h i t w i t h me. I t was t h e f i r s t t i m e we c o u l d t a l k a b o u t K. The k i d s a s k e d me q u e s t i o n s ... t h e s u n s e t became g r a n d p a ' s p a i n t i n g ... t h e s u n s e t . I f e l t a bond. The m i n i s t e r came t o t h e house and wanted t o t a l k a b o u t J . He s a i d ' I s t h e r e a n y t h i n g y o u want t o t e l l me a b o u t y o u r h u s b a n d ' ... no one had wanted t o t a l k a b o u t J . 2. I n f o r m a t i o n and I n s p i r a t i o n : A woman came t o t h e house who was s t u d y i n g t h e o l o g y who I d i d n o t know. She v i s i t e d me t o c o m f o r t me. She j u s t came t o l i s t e n and t o s h a r e h e r e x p e r i e n c e s as a widow. My m o t h e r , who was widowed w i t h f o u r s m a l l c h i l d r e n , had s e t an e x a m p l e . I c o u l d f o l l o w h e r example ... be as s t r o n g as h e r . 3. G r i m W a r n i n g s : I was w i t h a f r i e n d who was v e r y d e p r e s s e d and I r e a l i z e d t h a t I was c l o s e t o e n d i n g up l i k e t h a t . I t gave me s t r e n g t h t o f i g h t my d e p r e s s i o n . 51 Table 9 Distribution of Incidents in Sharing the Grief Category 1. P e r s o n a l Bond - c r y i n g , a c k n o w l e d g i n g / s h a r i n g g r i e f , b e i n g a b l e t o t a l k a b o u t f e e l i n g s and h u s b a n d 18 2. I n f o r m a t i o n and I n s p i r a t i o n 7 3. " G r i m W a r n i n g s " _4 T o t a l i n c i d e n t s 29 The s e n s e o f s h a r i n g i n t h e s e i n c i d e n t s w h e t h e r i n i t i a t e d o r r e c e i v e d by t h e widow was e x p e r i e n c e d a s h e l p f u l . An i m p o r t a n t a s p e c t o f t h i s c a t e g o r y seems t o be t h e e x p r e s s i n g a g r e e m e n t w i t h , o r a c k n o w l e d g e m e n t o f , t h e a p p r o p r i a t e n e s s o f a p e r s o n ' s b e l i e f s o r f e e l i n g s a s w e l l a s e n c o u r a g i n g t h e o pen e x p r e s s i o n o f s u c h b e l i e f s and f e e l i n g s . Verbal Reassurance As shown i n T a b l e 6, n i n e o u t o f one h u n d r e d and t h i r t y h e l p f u l i n c i d e n t s c o u l d be c l a s s i f i e d i n t h i s c a t e g o r y , a c c o u n t i n g f o r a p p r o x i m a t e l y .07% o f h e l p f u l i n c i d e n t s . D e f i n i t i o n : W e i s s (1974b) o u t l i n e s a s e r i e s o f " p r o v i s i o n s " o r n e e d s t h a t a r e n o r m a l l y met i n r e l a t i o n s h i p s . One o f 5 2 t h e s e i s c a l l e d r e a s s u r a n c e o f w o r t h w h i c h means a t t e s t i n g t o a p e r s o n ' s c o m p e t e n c e . A widow e x p e r i e n c e s t h e p o t e n t i a l l o s s o f r e a s s u r a n c e when h e r h u s b a n d d i e s . She t u r n s t o o t h e r s f o r s u p p o r t and s h e i s a l s o much more i n f l u e n c e d by t h e r e s p o n s e s o f o t h e r s t o h e r t h a n s h e w o u l d be a t a n o n - c r i s i s t i m e ( C a p l a n , 1 9 6 4 ) . The i n c i d e n t s i n t h i s c a t e g o r y a r e t h e v e r b a l r e s p o n s e s o f o t h e r s t h a t t h e widow e x p e r i e n c e s as r e a s s u r i n g . S u b - C a t e g o r i e s : T h e r e a r e two s u b - c a t e g o r i e s w h i c h a r e b a s e d on t h e widow r e c e i v i n g r e s p o n s e s f r o m o t h e r s o r g i v i n g a r e s p o n s e ( t a l k i n g t o s e l f ) w h i c h s h e p e r c e i v e s a s r e a s s u r i n g and g i v i n g h e r a s e n s e o f p e r s o n a l c o m p e t e n c e . T a b l e 10 shows t h e f r e q u e n c y o f i n c i d e n t s i n t h e t w o s u b - c a t e g o r i e s f o u n d i n t h e v e r b a l r e a s s u r a n c e c a t e g o r y . E x a m p l e s r e f l e c t i n g t h e s e s u b - c a t e g o r i e s a r e : 1. P e o p l e t e l l i n g widow s h e c o u l d do s o m e t h i n g o r t h a t s h e was c o p i n g : My b e s t f r i e n d r e a s s u r e d me by s a y i n g , ' I know y o u ' r e g o i n g t o be a l r i g h t . T h i n g s w i l l t u r n o u t a l r i g h t . ' She had a f a i t h i n my a b i l i t y t o c o p e . 53 I went to a t e a c h e r i n t e r v i e w f o r my son and the t e a c h e r s a i d I was d o i n g a good job w i t h my c h i l d . I t was good to hear I was d o i n g okay because I had j u s t f e l t l i k e I was r u n n i n g around i n c i r c l e s . 2. R e a s s u r i n g o r t e l l i n g s e l f she c o u l d go on a l o n e : I f e l t down - l i k e a d r i e d up w i t c h . I s a t down and t a l k e d out l oud to myse l f f o r a long t ime . . . s e l f t a l k . I c o u l d see i f i t made sense and I d e c i d e d to make new memories . Tab le 10 D i s t r i b u t i o n of I n c i d e n t s i n V e r b a l Reassurance Category 1. People t e l l i n g widow she c o u l d do something o r t h a t she was cop in g 7 2. Widow r e a s s e s s i n g o r t e l l i n g s e l f t h a t she c o u l d go on a lone 2. T o t a l i n c i d e n t s 9 The i n c i d e n t s i n these c a t e g o r i e s are c h a r a c t e r i z e d by v e r b a l messages tha t g i v e the widow a sense of competence t h a t she i s , i n f a c t , c o p i n g w i t h her g r i e f because o t h e r s see her as do ing s o . The menta l e x e r c i s e of s e l f - t a l k seems 54 i n t h e same manner f o r t h e widow and h e l p s h e r s e n s e o f s e l f - d i r e c t i o n . P h y s i c a l Comfort A s shown i n T a b l e 6, f o u r t e e n o u t o f one h u n d r e d and t h i r t y h e l p f u l i n c i d e n t s c o u l d be c l a s s i f i e d i n t h i s c a t e g o r y , a c c o u n t i n g f o r a p p r o x i m a t e l y 1% o f h e l p f u l i n c i d e n t s . D e f i n i t i o n : The most b a s i c o f human r e s p o n s e s t o t h o s e who a r e g r i e f - s t r i c k e n and d i s t r e s s e d i n v o l v e t h e o f f e r i n g o f c o m f o r t a nd c o n s o l a t i o n . The a p p e a r a n c e and b e h a v i o u r o f t h e b e r e a v e d p e r s o n i s u s u a l l y s u c h a s t o e v o k e c a r i n g r e s p o n s e s f r o m o t h e r s . The n a t u r a l r e s p o n s e i s t o h o l d , t o u c h , a nd murmur s y m p a t h y t o t h i s p e r s o n . The i n c i d e n t s i n t h i s c a t e g o r y a r e p h y s i c a l r e s p o n s e s f r o m o t h e r s o r t h e p h y s i c a l r e s p o n s e s t h e widow g i v e s w h i c h t h e widow e x p e r i e n c e s a s c o m f o r t . t o f u n c t i o n e s t a b l i s h a S u b - C a t e g o r i e s : T h e r e a r e two s u b - c a t e g o r i e s w h i c h a r e b a s e d on p h y s i c a l c o m f o r t . T a b l e 11 shows t h e f r e q u e n c y o f i n c i d e n t s i n t h e two s u b - c a t e g o r i e s . 55 Table 11 Distribution of Incidents in Physical Comfort Category 1. B e i n g t o u c h e d o r h u g g e d by someone 8 2. Widow t o u c h i n g o r h o l d i n g a p e t _6 T o t a l i n c i d e n t s 14 E x a m p l e s r e f l e c t i n g t h e s e s u b - c a t e g o r i e s a r e : 1. B e i n g t o u c h e d o r h u g g e d by someone: I was i n a b e r e a v e m e n t g r o u p . A w i d o w e r r e a c h e d o u t and t o u c h e d me ... c o m f o r t ... I c o u l d be me. My f r i e n d ' s m i n i s t e r came t h e d a y my h u s b a n d d i e d . He t o u c h e d me. He h e l d my h a n d . I t was i m p o r t a n t . I f e l t l i k e I was p u t t i n g w e i g h t somewhere ... i t h e l p e d me. 2. Widow s h o w i n g o r h o l d i n g p e t : I f e l t s o d e p r i v e d o f t o u c h . My c a t jumped up on my l a p and I c o u l d p e t h i m . I r e a l i z e d how much i t c o m f o r t e d me. I r a n my hand t h r o u g h my d o g ' s h a i r and s h e a c k n o w l e d g e d me and r u b b e d h e r n o s e on my h a n d . I f e l t c o m f o r t e d . 56 Harmful I n c i d e n t C a t e g o r i e s  I n a b i l i t y t o A c t A s shown i n T a b l e 6, n i n e t e e n o u t o f one h u n d r e d and e l e v e n h a r m f u l i n c i d e n t s c o u l d be c l a s s i f i e d i n t h i s c a t e g o r y , a c c o u n t i n g f o r a p p r o x i m a t e l y 17% o f t h e h a r m f u l i n c i d e n t s . Def i n i t i o n ; T h i s c a t e g o r y r e f l e c t s t h e widow's s e n s e o f p o w e r l e s s n e s s . S h o n t z ( 1 9 7 5 ) s t a t e s t h a t one p h a s e o f r e a c t i o n t o c r i s i s i s t h e e n c o u n t e r p h a s e i n w h i c h t h e i n d i v i d u a l b e g i n s t o e x p e r i e n c e p r o f o u n d h e l p l e s s n e s s , d i s o r g a n i z a t i o n and p a n i c . The i n d i v i d u a l c a n become o v e r w h e l m e d by r e a l i t y and f e e l u n a b l e t o p l a n o r e n g a g e i n a c t i v e p r o b l e m - s o l v i n g t o i m p r o v e t h e s i t u a t i o n . I n t h i s c a t e g o r y , t h e women w o u l d e i t h e r a t t e m p t t o do s o m e t h i n g o r f i n d t h e m s e l v e s i n a s i t u a t i o n w h ere t h e y were u n a b l e t o a c t o r come t o a r e s o l u t i o n o f a p r o b l e m . S u b - C a t e g o r i e s ; T h e r e a r e t h r e e s u b - c a t e g o r i e s i n w h i c h t h e women a r e u n a b l e t o a c t o r f e e l o v e r p o w e r e d . The s u b - c a t e g o r i e s a r e d i v i d e d by t h e widow w a n t i n g t o a c t t o p r o t e c t h e r c h i l d r e n ; t r y i n g t o do s o m e t h i n g w i t h a f r i e n d o r f a m i l y member; o r f e e l i n g o v e r p o w e r e d by a s i t u a t i o n i n v o l v i n g a t a s k o r t h e t e l e v i s i o n and r a d i o . T a b l e 12 57 s h o ws t h e f r e q u e n c y o f i n c i d e n t s f o u n d i n t h e I n a b i l i t y t o A c t c a t e g o r y . T a b l e 12 D i s t r i b u t i o n s of I n c i d e n t s w i t h i n I n a b i l i t y t o A c t Category 1. W a n t i n g t o a c t t o p r o t e c t c h i l d r e n 5 2. T r y i n g t o do s o m e t h i n g w i t h f r i e n d / f a m i l y and f a i l i n g 4 3. Widow o v e r p o w e r e d by s i t u a t i o n ( t a s k , T.V., r a d i o ) 10^ T o t a l i n c i d e n t s 19 E x a m p l e s r e f l e c t i n g t h e s e s u b - c a t e g o r i e s a r e : 1. W a n t i n g t o a c t t o p r o t e c t c h i l d r e n : My y o u n g s o n a s k e d me q u e s t i o n s a b o u t d y i n g and God. I c o u l d n ' t a n s w e r h i m . I w a n t e d t o . I w a n t e d t o f i n d t h e a n s w e r s f o r m y s e l f 1 I w a n t e d t o h e l p h i m . I w a n t e d t o do more f o r h i m . 2. T r y i n g t o do s o m e t h i n g w i t h f r i e n d o r f a m i l y and f a i l i n g : One week a f t e r A's d e a t h I went t o l u n c h w i t h a f r i e n d . I c o u l d n ' t j o i n i n t h e c o n v e r s a t i o n . I b e g a n t o p a n i c . 58 3. Widow f e e l i n g o v e r p o w e r e d by a s i t u a t i o n ( t a s k , T.V., r a d i o ) : I was w o r k i n g w i t h an o l d man who had a s t r o k e . I k e p t f e e l i n g I c o u l d n ' t h e l p h i m . How c a n I h e l p a n y b o d y ? I c o u l d n ' t e v e n k e e p my h u s b a n d a l i v e . I was w a t c h i n g T.V. I was s e e i n g v i o l e n c e ... a n a m b u l a n c e . I f e l t g l u e d . I c o u l d n ' t move. I t b r o u g h t b a c k p a i n f u l m e m o r i e s . I f e l t s t u n n e d -a s i f i t was h a p p e n i n g a g a i n . I n t h e s e i n c i d e n t s , t h e widow f i n d s h e r s e l f i n s i t u a t i o n s where s h e f e e l s a s e n s e o f h e l p l e s s n e s s and h e r c o p i n g s t r a t e g i e s a r e no l o n g e r s u c c e s s f u l i n m a s t e r i n g t h e p r o b l e m . Lack o f Support A s shown i n T a b l e 6, t h i r t y o u t o f one h u n d r e d and e l e v e n i n c i d e n t s c o u l d be c l a s s i f i e d i n t h i s c a t e g o r y , a c c o u n t i n g f o r a p p r o x i m a t e l y 27% o f t h e h a r m f u l i n c i d e n t s . D e f i n i t i o n : The i n c i d e n t s f o u n d i n t h i s c a t e g o r y a r e o n e s i n w h i c h t h e widow p e r c e i v e d a l a c k o f s u p p o r t i n h e r s o c i a l o r f a m i l y n e t w o r k . The l a c k o f s u p p o r t may have been i n 59 t e r m s o f s p e c i f i c n e e d s f o r e n c o u r a g e m e n t o f g r i e f , l a c k o f p r a c t i c a l a d v i c e , o r r e a s s u r a n c e o f w o r t h . Some o f t h e w i d o w s f e l t a need t o t a l k a b o u t t h e i r h u s b a n d and t h e i r p a s t l i f e t o g e t h e r . Many o f t h e widows n e e d e d more e n c o u r a g e m e n t and s u p p o r t t o p e r m i t them f r e e r e x p r e s s i o n o f a f f e c t s , p a r t i c u l a r l y g r i e f and a n g e r . A l l t h e s e i n c i d e n t s r e f l e c t t h e widow e x p e r i e n c i n g t h e e n v i r o n m e n t as f a i l i n g t o p r o v i d e an o p p o r t u n i t y o f s u p p o r t . S u b - C a t e g o r i e s : T h e r e a r e two s u b - c a t e g o r i e s w h i c h a r e b a s e d on t h e l a c k o f s u p p o r t c a t e g o r y . The f i r s t s u b - c a t e g o r y r e f l e c t s t h e widow's e x p e r i e n c e o f p e o p l e d i s c o u r a g i n g h e r t o t a l k a b o u t h e r s p o u s e o r h e r f e e l i n g s . The s e c o n d s u b - c a t e g o r y a d d r e s s e s t h e phenomena d i s c u s s e d i n t h e v e r b a l r e a s s u r a n c e c a t e g o r y i n w h i c h t h e widow i s v i e w e d as b e i n g much more i n f l u e n c e d by t h e r e s p o n s e s o f o t h e r s ( C a p l a n , 1 9 6 4 ) . I n t h i s c a s e s h e e x p e r i e n c e s r e s p o n s e s as h u r t f u l b e c a u s e h e r f e e l i n g s a r e n o t a c k n o w l e d g e d . T a b l e 13 shows t h e f r e q u e n c i e s o f i n c i d e n t s i n t h e two s u b - c a t e g o r i e s o f t h e L a c k o f S u p p o r t c a t e g o r y . 60 T a b l e 13 D i s t r i b u t i o n s o f I n c i d e n t s w i t h i n L a c k o f S u p p o r t C a t e g o r y 1. P e o p l e r e f u s i n g o r u n a b l e t o t a l k a b o u t d e a t h o f s p o u s e o r l i s t e n t o widow's f e e l i n g s 10 2. O r d i n a r y h u r t s b e c o m i n g e x t r a o r d i n a r y due t o g r i e f 20_ T o t a l i n c i d e n t s 30 E x a m p l e s r e f l e c t i n g t h e s u b - c a t e g o r i e s a r e : 1. P e o p l e r e f u s i n g o r u n a b l e t o t a l k a b o u t d e a t h o f s p o u s e o r l i s t e n t o w i d o w ' s f e e l i n g s : A m e d i c a l h e a l t h o f f i c e r who was a f r i e n d o f m i n e met me i n t h e h a l l and o n l y s a i d ' H i ' . I t was t h e f i r s t t i m e he had s e e n me s i n c e A d i e d . He c o u l d s a y n o t h i n g a b o u t me, A, o r my s o r r o w . I was g o i n g i n t o my h o u s e and saw t h e n e i g h b o u r s . I waved and t h e y t u r n e d away. T h e y d i d n ' t want t o g e t i n v o l v e d . 2. O r d i n a r y h u r t s b e c o m i n g e x t r a o r d i n a r y due t o g r i e f : I w o u l d phone f r i e n d s t o k e e p i n t o u c h and t h e y s a i d , ' w e ' l l h a v e t o g e t t o g e t h e r s o m e t h i n g . ' 61 No i n v i t a t i o n s came. No c a l l i n g b a c k . I was d i s a p p o i n t e d . The d o c t o r s a i d r i g h t o u t t h a t I had t o h a v e a h y s t e r e c t o m y . He d i d n o t b r e a k i t t o me g e n t l y . I was i n s h o c k . T h e s e i n c i d e n t s r e p r e s e n t t h e widow e x p e c t i n g o r n e e d i n g t o be t r e a t e d d i f f e r e n t l y . When o t h e r s r e s p o n d e d i n a way s h e d i d n o t e x p e c t , t h e widow p e r c e i v e d i t a s a l a c k o f s u p p o r t . I s o l a t i n g E x p e r i e n c e A s shown i n T a b l e 6, t w e n t y - s e v e n o u t o f one h u n d r e d and e l e v e n h a r m f u l i n c i d e n t s c o u l d be c l a s s i f i e d i n t h i s c a t e g o r y , a c c o u n t i n g f o r a p p r o x i m a t e l y 24% o f t h e h a r m f u l i n c i d e n t s . D e f i n i t i o n : L o n e l i n e s s was r e p o r t e d t o be t h e s o u r c e o f g r e a t e m o t i o n a l d i s t r e s s a n d d e s p a i r f o r t h e women i n t h i s s t u d y . The i n c i d e n t s were o n e s w h e r e t h e widow f e l t a l o n e . L o p a t a ( 1 9 7 1) p o i n t s o u t how much s o c i e t y i s o r i e n t e d t o c o u p l e s . The widow u s e d t o t h e c o u p l e - r e l a t i o n s h i p i n s o c i a l i z i n g , f o u n d h e r s e l f t h e "odd one o u t " a t d i n n e r 62 p a r t i e s w i t h f a m i l y o r f r i e n d s . She f o u n d h e r s e l f t r a u m a t i z e d by h e r s o l o s t a t u s and s u s p e c t e d t h a t o t h e r s d i d n o t f e e l c o m f o r t a b l e w i t h h e r a l t h o u g h t h e y had p r e v i o u s l y s h a r e d f a m i l i a r p a t t e r n s o f s o c i a l i n t e r a c t i o n . S u b - C a t e g o r i e s ; T h e r e a r e t h r e e s u b - c a t e g o r i e s w h i c h r e f l e c t t h e f e e l i n g o f a l o n e n e s s i n d i f f e r e n t w a y s . The f i r s t c a t e g o r y t h e r e s e a r c h e r c a l l s t h e Empty House c a t e g o r y s i n c e t h e f e e l i n g o f l o n e l i n e s s o c c u r r e d upon r e t u r n i n g t o t h e home a l o n e a f t e r a t r i p o r e v e n i n g o u t . I t was r e p o r t e d by many widows t h a t t h e a n t i c i p a t i o n o f r e t u r n i n g t o a n empty h o u s e k e p t them f r o m c o m i n g home o r r e q u i r e d them t o l e a v e t h e i r s t e r e o o r r a d i o on t o c r e a t e t h e f e e l i n g t h a t someone e l s e was i n a t t e n d a n c e a t t h e i r home. The s e c o n d c a t e g o r y r e f l e c t s t h o s e s o c i a l s i t u a t i o n s w h i c h t h e widow e x p e r i e n c e d as a n x i e t y - p r o v o k i n g . The women r e p o r t e d f e e l i n g t r a u m a t i z e d by t h e i r s i n g l e p e r s o n s t a t u s and a l s o f e e l i n g t h a t o t h e r s may n o t f e e l c o m f o r t a b l e w i t h them a l t h o u g h t h e y p r e v i o u s l y s h a r e d f a m i l i a r p a t t e r n s o f s o c i a l i n t e r a c t i o n . The t h i r d c a t e g o r y i n c l u d e s i n c i d e n t s w h e r e t h e widow r e a l i z e s h e r s p o u s e i s d e a d a n d e x p e r i e n c e s t h e r e a l i z a t i o n as h a r m f u l . I t i s i m p o r t a n t t o n o t e t h a t t h i s i s n o t t h e " p e a c e f u l a c c e p t a n c e " t h a t s t a g e m o d e l s o f g r i e f d e s c r i b e as t h e o p t i m a l e n d - p r o d u c t o f t h e g r i e f p r o c e s s . 63 R a t h e r , i t i s t h e b e g i n n i n g o f t h e widow's a w a r e n e s s o f t h e l o s s o f h e r s p o u s e a n d , t h e r e f o r e , t h e i m m e d i a t e i m p l i c a t i o n i s l o n e l i n e s s and h e l p l e s s n e s s . T a b l e 14 shows t h e f r e q u e n c y o f i n c i d e n t s i n t h e t h r e e s u b - c a t e g o r i e s o f t h e i s o l a t i n g e x p e r i e n c e c a t e g o r y . E x a m p l e s r e f l e c t i n g t h e s u b - c a t e g o r i e s a r e : 1. R e t u r n i n g home t o an empty h o u s e : I came b a c k home f r o m a t r i p t o C a l i f o r n i a . I had b e e n w i t h my d a u g h t e r ' s f a m i l y . I went i n t o my h o u s e . -I t was empty ... q u i e t ... nobody b u t me. I f e l t a b a n d o n e d ... a l o n e . 2. F e e l i n g i s o l a t e d i n s o c i a l o r g r o u p e x p e r i e n c e s : I went t o P a r k s v i l l e ... a r e s o r t . T h e r e were t h e c o u p l e s we u s e d t o be w i t h ... I f e l t u n c o m f o r t a b l e - o u t o f p l a c e . They t a l k e d a b o u t l i f e - what t h e y h a d d o n e . What c o u l d I c o n t r i b u t e ? I went t o v i s i t my s o n and d a u g h t e r - i n - l a w . I t made me s a d when t h e y h e l d h a n d s . I t h u r t b e c a u s e I f e l t s o a l o n e . I had no one t o h o l d my h a n d . 64 3. R e a l i z i n g f o r t h e f i r s t t i m e t h a t t h e s p o u s e i s d e a d : I p u t my h u s b a n d ' s a s h e s on t h e w a t e r . I r e a l i z e d i t was r e a l l y f i n a l . He was d e a d . I s t o p p e d c r y i n g . No more t e a r s . I r e a l i z e d t h i s i s t h e way i t w o u l d be f r o m now o n - no f u t u r e . I must l i v e one d a y a t a t i m e t o s u r v i v e . T a b l e 14 D i s t r i b u t i o n o f I n c i d e n t s w i t h i n I s o l a t i n g E x p erience Category 1. R e t u r n i n g home t o a n empty h o u s e 9 2. F e e l i n g i s o l a t e d i n s o c i a l o r g r o u p e x p e r i e n c e 10 3. R e a l i z i n g f o r t h e f i r s t t i m e t h a t t h e s p o u s e i s d e a d 8 T o t a l i n c i d e n t s 27 The women r e p o r t e d t h a t e v e n t h o u g h c h i l d r e n may need them, o r s t a y w i t h them, i t d i d n o t u s u a l l y h e l p t o d i m i n i s h t h e w i dow's s e n s e o f l o n e l i n e s s . A need f o r a d u l t a t t a c h m e n t seems t o be a s i g n i f i c a n t p a r t o f t h e l o n e l i n e s s t h e women e x p e r i e n c e d . W e i s s ( 1 9 7 4 a ) s e e s t h e c o m p l a i n t o f " l o n e l i n e s s " as t h e e m o t i o n a l r e s p o n s e t o t h e l o s s o f t h e a d u l t a t t a c h m e n t b o n d . The i n c i d e n t s c i t e d i n t h i s s t u d y 65 l e n d s u p p o r t t o t h i s v i e w a nd a l s o i n d i c a t e t h a t i t c a n be t h e l o s s o f s o c i a l i n t e g r a t i o n o r r e a s s u r a n c e o f w o r t h . V e r b a l C r i t i c i s m A s shown i n T a b l e 6, t w e n t y - f o u r o u t o f one h u n d r e d and e l e v e n h a r m f u l i n c i d e n t s c o u l d be c l a s s i f i e d i n t h i s c a t e g o r y , a c c o u n t i n g ' f o r a p p r o x i m a t e l y 22% o f t h e h a r m f u l i n c i d e n t s . D e f i n i t i o n : The i n c i d e n t s i n t h i s c a t e g o r y w e r e p e r c e i v e d by t h e widow as h a r m f u l i n t h a t t h e y b l o c k e d t h e widow's e x p r e s s i o n o f a f f e c t : o t h e r s may h a v e been s h o c k e d by h e r f e e l i n g s ; t o l d h e r t o c o n t r o l h e r s e l f and p u l l h e r s e l f t o g e t h e r , o r s u g g e s t e d t h a t s he m i n i m i z e d h e r g r i e f by t h i n k i n g o f t h e s u f f e r i n g o f o t h e r s . S u b - C a t e g o r i e s : T h e r e a r e two s u b - c a t e g o r i e s w h i c h s e p a r a t e p e r c e i v e d c r i t i c i s m i n t o c r i t i c a l w i t h t h e widow f e e l i n g h u r t o r a l i e n a t e d and h o s t i l e w i t h t h e widow f e e l i n g a n g r y . The l a s t c a t e g o r y h a s t o do w i t h t h e s p e c i f i c a d v i c e g i v e n t o t h e widow t o f i n d a n o t h e r man. I t seemed t h a t what was c r i t i c a l i n t h e s e i n c i d e n t s was t h e s u g g e s t i o n o f a new man i n t h e l i f e o f t h e widow. T a b l e 15 shows t h e f r e q u e n c y o f 66 i n t h e t h r e e s u b - c a t e g o r i e s o f t h e v e r b a l c a t e g o r y . Table 15 Distributions of Incidents within Verbal Criticism Category 1. R e c e i v i n g o p i n i o n s o r a d v i c e f r o m o t h e r s as c r i t i c a l and f e e l i n g h u r t o r a l i e n a t e d 10 2. R e c e i v i n g o p i n i o n s o r a d v i c e f r o m o t h e r s as h o s t i l e and f e e l i n g a n g r y 10 3. B e i n g t o l d t o f i n d a man o r r e m a r r y _4_ T o t a l i n c i d e n t s 24 E x a m p l e s r e f l e c t i n g t h e s u b - c a t e g o r i e s a r e : 1. R e c e i v i n g o p i n i o n s o r a d v i c e f r o m o t h e r s a s c r i t i c a l and f e e l i n g h u r t o r a l i e n a t e d : T h r e e weeks a f t e r J ' s d e a t h I went t o s e e my p h y s i c i a n . He t o l d me t h a t I had t o b l o c k my f e e l i n g s t o g e t o v e r my g r i e f . He t o l d me t o go t o a s t r e s s management s e m i n a r . I n e v e r w e n t b a c k . A m a l e c o l l e a g u e t o o k me o u t t o l u n c h . He s a i d ' I t o l d y o u r c o l l e a g u e s what y o u n e e d i s a good k i c k i n t h e a s s t o g e t o v e r i t ' . I was h u r t . i n c i d e n t s c r i t i c i s m 67 2. R e c e i v i n g o p i n i o n s o r a d v i c e as h o s t i l e and f e e l i n g angry: My f r i e n d ' s husband t a l k e d to me a t my desk where peop le walk b y . ' I had a w i f e tha t d i e d t o o . I had to c a r r y on w i t h my l i f e . Look at the Korean p l a n e t h a t went down. What about them?' I got a n g r y . I am what I am. A m i n i s t e r came to v i s i t me ten days a f t e r the death of my husband as a source of s p i r i t u a l s u p p o r t . He s a i d , ' i t i s t ime you q u i t f e e l i n g s o r r y f o r y o u r s e l f . I f e l t l e t down. I f e l t a n g r y . He was out of l i n e . I asked him to l e a v e . 3. Widow b e i n g t o l d to f i n d a man o r to marry: My d o c t o r , a f t e r t h r e e months , s a i d go to Hawai i and meet a man. ' Y o u ' r e j u s t the t y p e ' . I was r e a l l y a n g r y . I d i d n ' t l i k e i t . A f r i e n d s a i d , ' I t won't be long u n t i l you r e m a r r y ' . I f e l t i n s u l t e d , as i f I wasn' t a p e r s o n w i t h o u t a husband. The i n c i d e n t s i n t h i s c a t e g o r y were a s s o c i a t e d w i t h v e r b a l i n t e r a c t i o n s t h a t were viewed as c r i t i c i s m because 6 8 t h e y b l o c k e d t h e widow's e x p r e s s i o n o f a f f e c t and were p e r c e i v e d as i n a d e q u a t e i n t h e f a c e o f c r i s i s . P h y s i c a l D i s t r e s s A s shown i n T a b l e 6 , e l e v e n o u t o f one h u n d r e d and e l e v e n h a r m f u l i n c i d e n t s c o u l d be c l a s s i f i e d i n t h i s c a t e g o r y , a c c o u n t i n g f o r a p p r o x i m a t e l y 1% o f t h e h a r m f u l i n c i d e n t s . D e f i n i t i o n : The widows s p o k e o f many "symptoms" t h a t may r e p r e s e n t s i m p l y t h e p s y c h o l o g i c a l d i s t r e s s o f t h e b e r e a v e m e n t c r i s i s . The i n c i d e n t s t h a t were e x p e r i e n c e d i n t h i s c a t e g o r y d e a l t w i t h t h e symptoms o f i n s o m n i a , n e r v o u s n e s s , c h e s t p a i n s , p a l p i t a t i o n s , s l e e p l o s s , a p p e t i t e l o s s , g e n e r a l a c h i n g a nd f a t i g u e , and r e d u c e d c a p a c i t y t o w o r k . I t seemed t h a t d i s t r e s s i n g e x p e r i e n c e s o c c u r r e d d u r i n g t h e e a r l y months o f b e r e a v e m e n t . A m a j o r i t y o f t h e widows s t a t e d t h a t t h e y b e g a n t a k i n g t r a n q u i l i z e r s and a n t i d e p r e s s a n t s s h o r t l y a f t e r , i f n o t i m m e d i a t e l y a f t e r , t h e d e a t h o f t h e i r h u s b a n d s . S u b - C a t e g o r i e s : T a b l e s i x t e e n shows t h e f r e q u e n c y o f i n c i d e n t s i n t h e two s u b - c a t e g o r i e s o f t h e p h y s i c a l d i s t r e s s c a t e g o r y . The two c a t e g o r i e s a r e d i v i d e d i n t o t h e p h y s i c a l r e a c t i o n t o s t r e s s and t h e p h y s i c a l r e a c t i o n t o m e d i c a t i o n . 6 9 T a b l e 16 D i s t r i b u t i o n s o f I n c i d e n t s w i t h i n t h e P h y s i c a l D i s t r e s s C a t e g o r y 1. P h y s i c a l R e a c t i o n to S t r e s s 9 2. P h y s i c a l R e a c t i o n to M e d i c a t i o n 2 T o t a l i n c i d e n t s 11 Examples r e f l e c t i n g the s u b - c a t e g o r i e s a r e : 1. P h y s i c a l r e a c t i o n to s t r e s s : I was a v o l u n t e e r a t the h o s p i t a l . When I came home t h a t day I f e l t p h y s i c a l p a i n . I was d r a i n e d , l i k e r u n n i n g to the p o i n t of e x h a u s t i o n and a c c o m p l i s h i n g n o t h i n g . I c o u l d n ' t c r y . I f e l t so much I c o u l d n ' t c r y . I had swallowed my f e e l i n g s . 2. P h y s i c a l r e a c t i o n to m e d i c a t i o n : I went to a p s y c h i a t r i s t and he gave me p i l l s and s a i d tha t I would have no r e a c t i o n . I d i d . He s a i d i t was a l l i n my head. 70 The d o c t o r g a v e me a n a n t i d e p r e s s a n t and a f t e r one p i l l I b e g a n t o p a n i c . I was f e e l i n g o u t o f b o u n d s . My r e a c t i o n was a n i g h t m a r e . T h e s e i n c i d e n t s i l l u s t r a t e d t h a t many d i s t r e s s i n g e x p e r i e n c e s c a n o c c u r d u r i n g b e r e a v e m e n t , e s p e c i a l l y i n t h e e a r l y s t a g e s o f g r i e f . T h e y a r e b o d i l y e x p e r i e n c e s a s w e l l a s p s y c h o l o g i c a l . They a r e o f t e n e x p e r i e n c e d a s symptoms a n d may l e a d t h e widow t o s e e k m e d i c a l c a r e . 71 CHAPTER FIVE D i s c u s s i o n o f R e s u l t s T a k i n g A c t i o n and I n a b i l i t y t o A c t A l l t h e women i n t h i s s t u d y c i t e d a t l e a s t one i n c i d e n t i n t h e T a k i n g A c t i o n c a t e g o r y . They a l l s p o k e o f an i n c i d e n t w h ere t h e y d i d s o m e t h i n g w h i c h g a v e them a s e n s e o f c o n t r o l o r c o m p e t e n c e . I t d i d n o t i n v o l v e c o n s u l t i n g o r a s k i n g anyone e l s e f o r d i r e c t i o n . E a c h c i r c u m s t a n c e was s u c h t h a t t h e widow c h o s e t o a c t b e c a u s e s h e f e l t s h e was c a p a b l e o f a c t i n g and t h e r e s u l t c o n f i r m e d t h e f a c t t h a t s h e c o u l d h a n d l e t h e s i t u a t i o n . The i n c i d e n t s h a d v a r y i n g d e g r e e s o f i n t e n s i t y f r o m p u t t i n g t h e t e l e v i s i o n on t o d e c i d i n g w h ere t o p l a c e t h e a s h e s o f t h e s p o u s e . Most o f t h e women c i t e d an i n c i d e n t i n t h e I n a b i l i t y t o A c t c a t e g o r y . They s p o k e o f an i n c i d e n t w h e r e t h e y were u n a b l e t o do s o m e t h i n g w h i c h g a v e them a s e n s e o f p o w e r l e s s n e s s , c o n f u s i o n o r p a n i c . I n many c a s e s i t d i d i n v o l v e t r y i n g t o r e s p o n d t o a n o t h e r p e r s o n o r s i m p l y d o i n g a n a c t i v i t y t h a t t h e y w o u l d h a v e f e l t c a p a b l e o f d o i n g p r i o r t o t h e d e a t h o f t h e i r s p o u s e . 72 B o t h t h e s e c a t e g o r i e s r e f l e c t e d t h e woman d i s c o v e r i n g w hat s h e was c a p a b l e o r i n c a p a b l e o f d o i n g . I d e n t i t y seems t o be one f a c t o r t h a t i s s t r o n g l y a f f e c t e d by t h e d e a t h o f t h e s p o u s e . The i d e n t i t y o f t h e widow may h a v e b e e n d e f i n e d by m u t u a l r o l e s , by t h e s a t i s f a c t i o n o f m u t u a l l y g r a t i f y i n g e x p e r i e n c e s , o r by t h e r e i n f o r c e m e n t o f c o m p e t e n c e . The d e f i n i t i o n o f s e l f may h a v e r e l i e d s o s t r o n g l y on t h e s p o u s e t h a t i t i s v e r y d i f f i c u l t f o r t h e widow t o f i n d a new i d e n t i t y w i t h o u t h i m . I t may be p a i n f u l a nd d i f f i c u l t a s d e m o n s t r a t e d by t h e I n a b i l i t y t o A c t c a t e g o r y o r s a t i s f a c t o r i l y w o r k e d t h r o u g h as d e m o n s t r a t e d by t h e T a k i n g A c t i o n c a t e g o r y . The s u b - c a t e g o r i e s o f t h e s e two c a t e g o r i e s show some d i s t i n c t i o n s b e t w e e n t h e i n c i d e n t s . I n T a k i n g A c t i o n t h e widow c h o s e t o do t h e a c t i v i t y when s h e f e l t s h e was a b l e o r s h e e n g a g e d i n an a c t i v i t y s u c h as p r a y i n g , p o e t r y , g a r d e n i n g o r work t h a t s h e had done p r i o r t o t h e d e a t h o f h e r h u s b a n d . I n I n a b i l i t y t o A c t t h e widow f e l t c o m p e l l e d t o r e s p o n d when h e r c h i l d r e n n e e d e d h e l p w i t h t h e i r g r i e f o r a d e c i s i o n had t o be made. A d d i t i o n a l l y , s h e w o u l d t r y t o e n g a g e i n an a c t i v i t y t h a t s h e had done p r i o r t o h e r h u s b a n d ' s d e a t h b u t f a i l a n d f e e l a s e n s e o f p a n i c b e c a u s e s h e " s h o u l d " be a b l e t o do i t . 73 S h o n t z (1975) h o l d s t h a t a p e r s o n ' s f i r s t r e a c t i o n t o c r i s i s i s s h o c k . F o l l o w i n g t h e i n i t i a l s h o c k , an e n c o u n t e r p h a s e o c c u r s i n w h i c h t h e i n d i v i d u a l b e g i n s t o e x p e r i e n c e p r o f o u n d h e l p l e s s n e s s , d i s o r g a n i z a t i o n and p a n i c . I t i s a t t h i s t i m e when an i n d i v i d u a l may be u n a b l e t o p l a n , r e a s o n o r e n g a g e i n p r o b l e m - s o l v i n g t o i m p r o v e t h e s i t u a t i o n . B e c a u s e t h e e x p e r i e n c e i s s o i n t e n s e , i n d i v i d u a l s b e g i n t o m a n i f e s t a t y p e o f a v o i d a n c e t h a t S h o n t z c a l l s " r e t r e a t " . He v i e w s an a d a p t i v e s e q u e n c e as one t h a t i s c h a r a c t e r i z e d by a c o n t i n u a l s h i f t i n g b e t w e e n e n c o u n t e r and r e t r e a t f r o m c r i s i s . E a c h t i m e a n i n d i v i d u a l b e g i n s t o f a c e r e a l i t y , f e e l i n g s o f a n x i e t y , f r u s t r a t i o n o r d e p r e s s i o n may o c c u r . S h o n t z a r g u e s t h a t t h e s e f e e l i n g s may n o t be m a l a d a p t i v e , b u t a r e n e c e s s a r y p r e c u r s o r s t o p o s i t i v e p s y c h o l o g i c a l g r o w t h . T h e s e c y c l e s " o c c u r p r o g r e s s i v e l y l e s s f r e q u e n t l y . . . u n t i l t h e y become v i r t u a l l y u n n o t i c e a b l e when a d a p t a t i o n i s c o m p l e t e ( 1 9 7 5 , p . 1 6 6 ) " . One e x p e r i e n c e s a r e n e w e d s e n s e o f p e r s o n a l w o r t h and l o w e r i n g o f a n x i e t y . The i n c i d e n t s i n t h e I n a b i l i t y t o A c t c a t e g o r y w e re a l l i n t h e f i r s t t h r e e months o f g r i e f . I t i s a t i m e when a f f e c t i v e r e s p o n s e s a r e i n t e n s e . The b e r e a v e d knows i n t e l l e c t u a l l y t h a t t h e s p o u s e i s d e a d ; y e t t h e w h o l e a s s u m p t i v e w o r l d ( P a r k e s 1972; W o o d f i e l d a n d V i n e y 1982) i s 74 s t i l l o r i e n t e d t o w a r d h i m and t h e widow has n o t r e a l i g n e d h e r s e l f t o a new s e t o f a s s u m p t i o n s . One i m p o r t a n t new a s s u m p t i o n seems t o be t h a t s h e i s a p e r s o n w i t h o u t h i m . As c i t e d i n C h a p t e r Two, S h e s k i n and W a l l a c e (1976) f o u n d t h a t i n d e p e n d e n c e i n i d e n t i t y , r o l e and r e l a t i o n s h i p f a c i l i t a t e d r e c o v e r y . The i n c i d e n t s i n A b i l i t y t o A c t t e n d e d t o be a r o u n d t h r e e t o s i x months i n t o t h e e x p e r i e n c e o f g r i e f . A f t e r t h e i n i t i a l c r i s i s o f t h e e a r l y weeks and m o n t h s , t h e i n t e n s i t y o f g r i e f and p r e o c c u p a t i o n w i t h t h e m o u r n i n g p r o c e s s l e s s e n ( R a p h a e l , 1 9 8 3 ) . I t may be t h a t t h e s e two c a t e g o r i e s r e f l e c t t h e s e n s e o f power and p o w e r l e s s n e s s o f t h e widow a t d i f f e r e n t s t a g e s o f b e r e a v e m e n t . I t may be t h a t S h o n t z (1975) m o d e l o f c o p i n g w i t h c r i s i s i s r e f l e c t e d i n t h e r e p o r t e d i n c i d e n t s o f i n a c t i o n w i t h a s e n s e o f p o w e r l e s s n e s s o r p a n i c and a c t i o n w i t h a s e n s e o f p e r s o n a l p o w e r o r c o m p e t e n c e . I t i s c l e a r t h a t t h e r e s u l t o f a t t e m p t i n g t o a c t i s an i m p o r t a n t f a c t o r a s w e l l a s t h e widow p e r c e i v i n g s h e had a c h o i c e t o a c t . R e c e i v i n g S u p p o r t a n d L a c k o f S u p p o r t A s shown i n T a b l e 6, t h e l a r g e s t number o f c r i t i c a l i n c i d e n t s i n b o t h t h e h e l p f u l and h a r m f u l c a t e g o r i e s w e r e f o u n d i n R e c e i v i n g S u p p o r t and L a c k o f S u p p o r t . As c i t e d i n 7 5 C h a p t e r One and d i s c u s s e d i n C h a p t e r Two, t h e v a r i a b l e o f s o c i a l - n e t w o r k may be c r i t i c a l t o t h e outcome o f t h e g r i e f p r o c e s s . The women i n t h i s s t u d y c i t e d more i n c i d e n t s o f s u p p o r t f r o m f a m i l y and f r i e n d s t h a n f r o m p r o f e s s i o n a l s . I t was r e p o r t e d t h a t t h e f a m i l y and s o c i a l g r o u p came t o g e t h e r t o o f f e r e m o t i o n a l s u p p o r t and p r a c t i c a l a s s i s t a n c e i m m e d i a t e l y f o l l o w i n g t h e d e a t h o f t h e s p o u s e . The widow was p e r c e i v e d as t h e p r i n c i p a l b e r e a v e d p e r s o n i n t h e f a m i l y and was u s u a l l y c o m f o r t e d by h e r c h i l d r e n . M o s t h e l p f u l i n c i d e n t s w i t h p r o f e s s i o n a l s o c c u r r e d w i t h c o u n s e l l o r s who p r o v i d e d e m o t i o n a l s u p p o r t o r p r a c t i c a l a s s i s t a n c e t h a t f a m i l y o r f r i e n d s w e r e u n a b l e t o p r o v i d e . Some widows r e c e i v e d s u p p o r t f r o m o t h e r w i d o w s when t h e y a t t e n d e d b e r e a v e m e n t g r o u p s h e l d by t h e N o r t h S h o r e F a m i l y S e r v i c e s . " I c o u l d e x p r e s s how I was f e e l i n g and p e o p l e u n d e r s t o o d . " The widows who e x p e r i e n c e d l a c k o f s u p p o r t r e c a l l e d i n c i d e n t s w h ere t h e y s e n s e d p e o p l e ' s r e l u c t a n c e t o be i n v o l v e d w h e t h e r i t was t h e n e i g h b o u r " t u r n i n g away" o r a c h i l d ' s l a c k o f c o m m u n i c a t i o n . They e x p e c t e d o r needed t o be t r e a t e d d i f f e r e n t l y . O r d i n a r y h u r t s seem t o become e x t r a o r d i n a r y , s u c h as a s o n l e a v i n g on a h i k i n g t r i p a f t e r 76 t h e f u n e r a l o r a p r i e s t who seemed t o o b u s y t o s e e a widow f o r as l o n g as s h e n e e d e d . B o t h t h e s e c a t e g o r i e s r e f l e c t e d t h e widow's p e r c e p t i o n o f s u p p o r t o r l a c k o f s u p p o r t . H o w e v e r , H e l l e r ( 1 9 7 9 ) n o t e d t h a t p e o p l e who a r e p o o r l y a d j u s t e d o r i n i l l h e a l t h may u n d e r e s t i m a t e t h e amount o f s u p p o r t a v a i l a b l e t o them o r may l a c k s o c i a l c o m p e t e n c e , and t h e r e f o r e d r i v e o t h e r s away by e n g a g i n g i n s o c i a l l y i n a p p r o p r i a t e b e h a v i o u r ( M a d d i s o n and W a l k e r , 1 9 6 7 ) . H e l l e r (1979) s t a t e s t h a t d e f i c i t s i n s o c i a l c o m p e t e n c e may " p r o d u c e t h e p o o r e r l e v e l s o f a d j u s t m e n t r e p o r t e d f o r u n s u p p o r t e d i n d i v i d u a l s , a s w e l l as a c c o u n t i n g f o r t h e l o w e r l e v e l s o f s u p p o r t t h e y r e c e i v e ( p . 3 7 5 ) . " The i n c i d e n t s i n t h e L a c k o f S u p p o r t c a t e g o r y may h a v e i n v o l v e d p e o p l e who w e re w e l l - m e a n i n g i n t h e i r a t t e m p t s t o s u p p o r t t h e widow. The widow may p e r c e i v e t h e a t t e m p t as i n a d e q u a t e and p o s s i b l y h o s t i l e . A f r i e n d s a i d t o me, 'you a r e s t r o n g . Y o u ' l l g e t o v e r i t . ' I f e l t weak and t h a t s h e was s a y i n g s h e w o u l d n o t s u p p o r t me. A f r i e n d i n s i s t e d I a t t e n d h e r d a u g h t e r ' s w e d d i n g t h o u g h I f o u n d i t d i f f i c u l t t o c o p e o r d r i v e . She 77 d i d n o t h e a r me. She j u s t k e p t p u t t i n g t h e p r e s s u r e o n . I t i s e v i d e n t f r o m t h e s e i n c i d e n t s t h a t more a t t e n t i o n s h o u l d be p a i d t o t h e p o s s i b l e d e l e t e r i o u s e f f e c t o f b e h a v i o u r s t h a t a r e i n t e n d e d t o be s u p p o r t i v e . M a d d i s o n and W a l k e r (1967) a s k e d w idows t o i n d i c a t e how p e o p l e r e s p o n d e d t o them i n t h e f i r s t t h r e e m o n t h s o f b e r e a v e m e n t and t o i n d i c a t e w h i c h r e a c t i o n s w e r e h e l p f u l . T hey r e p o r t t h a t a number o f r e s p o n s e s t h a t a r e f r e q u e n t l y made t o w idows ( e . g . b e i n g t o l d " a b o u t t h e n e e d t o g e t o u t among p e o p l e a g a i n and make new f r i e n d s " o r b e i n g t o l d t h a t " I must c o n t r o l m y s e l f and p u l l m y s e l f t o g e t h e r ( p . 1 0 6 6 ) " ) w e r e r e g a r d e d as u n h e l p f u l . C o a t e s and Wortman (1980) h a v e p r o v i d e d a t h e o r e t i c a l a n a l y s i s t h a t i l l u s t r a t e s how o t h e r s w e l l - i n t e n t i o n e d s t a t e m e n t s ( e . g . " C h e e r u p " , " i t ' s n o t a s b a d a s i t seems") c a n b l o c k m e a n i n g f u l c o m m u n i c a t i o n a b o u t a c r i s i s . I t may be t h a t p e o p l e c a n b e s t s u p p o r t a widow by p r o v i d i n g an o p p o r t u n i t y f o r f r e e e x p r e s s i o n o f f e e l i n g s and c o n c e r n s . 78 My f r i e n d , Agnes, popped i n without c a l l i n g to see how I was doing and she d i d n ' t care i f I was c r y i n g . I t was important f o r me. I f e l t support. I j o i n e d a g r i e v i n g group. I could express how I was f e e l i n g and people understood. Again, i t i s important to note that the widows i n t h i s research reported that they derived some personal value from the i n t e r v i e w process. I t may be the opportunity to express t h e i r experience of the death of t h e i r spouse and the g r i e f process were h e l p f u l . Researchers i n v e s t i g a t i n g r e a c t i o n s to undesireable l i f e events have reported that many respondents are q u i t e eager to discuss t h e i r experiences and concerns and r e a d i l y cooperate with an i n t e r v i e w e r (Bulman and Wortman, 1977; Hamburg and Adams, 1967; Hinton, 1963; Schwab e t . a l . , 1975). Sharing the G r i e f and F e e l i n g Alone In the Sharing the G r i e f category, the widows reported i n c i d e n t s where they were able to t a l k about t h e i r experience of g r i e f w i t h o t h e r s . The category r e f l e c t e d the d e s i r e of the widow to express f e e l i n g s and concerns and to r e c e i v e feedback that those f e e l i n g s are understood by 79 o t h e r s and a r e a p p r o p r i a t e f o r a woman whose h u s b a n d h a s d i e d . I t , t h e r e f o r e , was more t h e d e s i r e t o e x p r e s s f e e l i n g s t h a n t h e d e s i r e t o o b t a i n s u p p o r t . A f r i e n d f r o m E n g l a n d came t o s t a y . I t a l k e d t h e w h o l e t i m e and I c r i e d w i t h h e r f o r d a y s . She n e v e r s t o p p e d me. ' I t was a r e a l m o u n t a i n I c l i m b e d . I t was n o t o n l y t h e widow's a b i l i t y t o s h a r e h e r f e e l i n g s t h a t was h e l p f u l . I t was i m p o r t a n t t h a t t h e r e s u l t o f h e r s h a r i n g c r e a t e d a s e n s e o f b e i n g u n d e r s t o o d o r t h e widow b e i n g a b l e t o u n d e r s t a n d a n o t h e r . A c o l l e a g u e s a i d t o me, ' I d o n ' t know w h a t t o s a y o r what t o do.' I a p p r e c i a t e d t h a t s h e l e t me know where s h e was a t and I t h a n k e d h e r . I went t o a p a r t y . A s t r a n g e r came up and t a l k e d t o me a b o u t h e r e x p e r i e n c e as a widow and a s k e d a b o u t m i n e . I t g a v e me c o u r a g e . I n t h e l o n e l i n e s s . F e e l i n g A l o n e L o n e l i n e s s was c a t e g o r y , t h e m a j o r theme was e x p e r i e n c e d when r e t u r n i n g home 80 t o a n empty hous e o r when i n v o l v e d i n a s o c i a l e v e n t . I t d i d n o t l e s s e n by o t h e r c o m p a n i o n s h i p , e x c e p t t e m p o r a r i l y . W e i s s (1974a) v i e w s t h e l o n e l i n e s s a s a r e a c t i o n t o t h e a b s e n c e o f t h e l o v e d one r a t h e r t h a n t o b e r e a v e m e n t i t s e l f . T h u s t h e l o n e l i n e s s i s l i k e l y t o c o n t i n u e o v e r t i m e u n t i l t h e d e f i c i t s t a t e i s r e s o l v e d . B a h r and H a r v e y ( 1 9 7 9 ) s t u d i e d widows f o l l o w i n g a m i n i n g d i s a s t e r and f o u n d t h a t t h e y m a n i f e s t e d v e r y h i g h l e v e l s o f p e r s o n a l l o n e l i n e s s b u t n o t o f p e r c e i v e d c o m m u n i t y u n d e r i n v o l v e m e n t . As c i t e d e a r l i e r , L o p a t a ' s s t u d y ( 1 9 79) o f C h i c a g o widows shows t h a t e v e n t h o u g h many had b e e n b e r e a v e d f o r a n a v e r a g e o f e l e v e n y e a r s , h a l f s a i d l o n e l i n e s s was t h e i r m o s t s e r i o u s p r o b l e m , a n d a t h i r d s a i d i t was t h e i r s e c o n d m o s t s e r i o u s p r o b l e m . A n o t h e r i m p o r t a n t a s p e c t o f t h i s c a t e g o r y was t h e w i d o w ' s r e a l i z a t i o n t h a t h e r h u s b a n d h ad d i e d a n d t h a t r e a l i z a t i o n was n o t n e c e s s a r i l y e x p e r i e n c e d a s h e l p f u l o r e m p o w e r i n g . I t was e x p e r i e n c e d as a h a r s h r e a l i t y t h a t r e q u i r e d h e r t o f a c e t h e r e s t o f h e r l i f e a l o n e w i t h o u t t h e l o v e a n d s u p p o r t o f h e r h u s b a n d . T h e s e i n c i d e n t s w e r e r e p o r t e d as d e b i l i t a t i n g a n d h i n d e r i n g a n y p r o g r e s s t h a t t h e widow f e l t s h e was a c h i e v i n g i n h e r g r i e f p r o c e s s . A g a i n , t h i s may be i n d i c a t i v e o f a " r e t r e a t p h a s e " i n S h o n t z ' s ( 1 9 7 5 ) m o d e l o f c o p i n g . A p r o b l e m w i t h t h i s p e r s p e c t i v e i s 81 d e t e r m i n i n g what i s t h e a p p r o p r i a t e d u r a t i o n o f p a r t i c u l a r p h a s e s s u c h as " e n c o u n t e r " o r " r e t r e a t " , o r t h e l e n g t h o f t h e c y c l e s t h a t o c c u r ? How d o e s one d e t e r m i n e w h e t h e r a p e r s o n i s r e m a i n i n g i n a p a r t i c u l a r p h a s e , s u c h a s r e t r e a t , f o r t o o l o n g ? G l i c k e t a l . ( 1 9 7 4 ) r e p o r t e d t h a t some o f t h e w i d o w s i n h i s s t u d y b e l i e v e d t h a t : s o r r o w c a n be t r e a t e d as an e n t i t y t h a t e x i s t s i n a c e r t a i n q u a n t i t y , and t h a t e x p r e s s i n g s o r r o w u s e s i t up o r e x p e l s i t . T h e r e f o r e , i t s h o u l d be p o s s i b l e f o r t h e i n d i v i d u a l t o ' g e t i t a l l o u t ' , t o f u l l y e x t e r n a l i z e o r d i s c h a r g e i t (pp 5 8 - 5 9 ) . I n t h i s s t u d y w i d o w s ' e x p r e s s i o n o f f e e l i n g became h e l p f u l o r h a r m f u l d e p e n d e n t on t h e t y p e o f f e e d b a c k t h e y r e c e i v e d f r o m o t h e r s . A q u e s t i o n t h a t r e q u i r e s f u r t h e r e x p l o r a t i o n i s w h e t h e r w i d o w s who e x p r e s s t h e i r f e e l i n g b u t e l i c i t n e g a t i v e r e s p o n s e s f r o m o t h e r s a r e b e t t e r o f f t h a n t h o s e who w i t h h o l d t h e i r f e e l i n g s ? V e r b a l Reassurance and V e r b a l C r i t i c i s m T h e s e c a t e g o r i e s i l l u s t r a t e d t h e i m p o r t a n c e o f v e r b a l r e s p o n s e s t h a t t h e widow r e c e i v e d f r o m o t h e r s . I n a l l o f 82 the 33 r e p o r t e d i n c i d e n t s , the widow c o u l d e a s i l y remember the s p e c i f i c s tatement t h a t the person made to h e r . I t was as i f these responses o c c u r r e d a t a t ime when the widow needed the suppor t and s p e c i f i c feedback from a n o t h e r . When she r e c e i v e d the feedback the i n c i d e n t was p e r c e i v e d as h e l p f u l . I t was u s u a l l y the p e r s o n t e l l i n g the widow she was capab le of do ing a p a r t i c u l a r a c t o r t h a t she was capab le of c o p i n g w i t h the e x p e r i e n c e of g r i e f . Two of the i n c i d e n t s i n the V e r b a l Reassurance c a t e g o r y were i n c i d e n t s where the widow h e r s e l f was engaged i n " s e l f t a l k " , t h a t i s , t a l k i n g to h e r s e l f i n an o b j e c t i v e , r e a s s u r i n g manner. When the widow r e c e i v e d feedback from o t h e r s i n the V e r b a l C r i t i c i s m c a t e g o r y the feedback was not what the widow expected to r e c e i v e . The feedback was seen as c r i t i c a l o r h o s t i l e and the widow f e l t a l i e n a t e d , h u r t o r a n g r y . I asked a nephew to come and s t a y f o r a w h i l e . My husband's b r o t h e r and s i s t e r s a i d I s h o u l d l e a r n to d e a l w i t h my l o n e l i n e s s by be ing a lone wi thout h e l p . The i n c i d e n t s i n these c a t e g o r i e s r e f l e c t not o n l y a d e s i r e to o b t a i n s u p p o r t , but a l s o a d e s i r e to express 83 f e e l i n g s and c o n c e r n s and t o r e c e i v e f e e d b a c k t h a t t h o s e f e e l i n g s a r e u n d e r s t o o d by o t h e r s and a p p r o p r i a t e u n d e r t h e c i r c u m s t a n c e s . The i n c i d e n t s c o n t a i n e d v e r b a l r e m a r k s t h a t e i t h e r r e a s s u r e d t h e widow o r c r i t i c i z e d t h e widow f o r a b e h a v i o u r o r f e e l i n g . The w i dows s t a t e d t h a t f o l l o w i n g t h e i n c i d e n t s i n t h e V e r b a l C r i t i c i s m c a t e g o r y t h e y f e l t i m p e l l e d t o b e h a v e i n c e r t a i n ways i n t e r m s o f e x p r e s s i o n o f g r i e f , r e v i e w o f t h e l o s t r e l a t i o n s h i p w i t h t h e i r h u s b a n d , an d d i s c u s s i o n o f t h e i r h u s b a n d t h a t was c o n t r a r y t o t h e i r r e a l f e e l i n g s . I t i s i m p o r t a n t t o n o t e t h a t M a d d i s o n a n d W a l k e r (1967) i n a t t e m p t i n g t o i d e n t i f y t h o s e f a c t o r s a s s o c i a t e d w i t h a d e c l i n e i n p h y s i c a l a n d / o f m e n t a l h e a l t h d u r i n g t h e f i r s t y e a r o f b e r e a v e m e n t f o u n d t h a t widows who e x p e r i e n c e d s u c h a d e t e r i o r a t i o n r e p o r t e d a l a r g e number o f u n h e l p f u l i n t e r a c t i o n s i n w h i c h e x p r e s s i o n o f f e e l i n g s was d i r e c t l y o r i n d i r e c t l y b l o c k e d . A r e t h e b e n e f i t s o f e x p r e s s i o n o f f e e l i n g s d e p e n d e n t on t h e t y p e o f f e e d b a c k one r e c e i v e s f r o m o t h e r s ? As a s k e d e a r l i e r , a r e widows who e x p r e s s t h e i r f e e l i n g s b u t r e c e i v e n e g a t i v e f e e d b a c k f r o m o t h e r s b e t t e r o f f t h a n t h o s e who w i t h h o l d t h e i r f e e l i n g s ? W i l l b e n e f i c i a l f e e d b a c k more l i k e l y o c c u r w i t h some p e o p l e ( i . e . o t h e r w i d o w s ) t h a n o t h e r s ? 84 A t h i r d s u b - c a t e g o r y r e p r e s e n t e d i n t h e V e r b a l C r i t i c i s m c a t e g o r y was t h e widow b e i n g t o l d t o f i n d a man o r t h a t r e m a r r i a g e w o u l d r e s o l v e t h e g r i e f e x p e r i e n c e . When I went i n t h e h o s p i t a l my f r i e n d s a i d , 'You n e e d a man. I f y o u had a man a l l t h i s w o u l d be s e e n i n p e r s p e c t i v e . ' I was f l a b e r g a s t e d . The widows were d i s t r e s s e d by p r e m a t u r e a t t e m p t t o s u g g e s t i n v o l v e m e n t w i t h men. A l l o f t h e i n c i d e n t s i n t h i s s u b - c a t e g o r y o c c u r r e d i n t h e f i r s t s i x months o f g r i e f . M a d d i s o n and W a l k e r ( 1 9 6 7 ) f o u n d t h a t p r e m a t u r e s u g g e s t i o n s a b o u t r e m a r r i a g e a r e p e r c e i v e d as u n h e l p f u l and may i n t e r f e r e w i t h t h e r e s o l u t i o n o f b e r e a v e m e n t . I t may be t h a t i n c i d e n t s i n t h i s c a t e g o r y w o u l d h a v e been v i e w e d a s h e l p f u l i f t h e y had o c c u r r e d l a t e r i n t h e g r i e f p r o c e s s . P h y s i c a l Comfort and P h y s i c a l D i s t r e s s The i n c i d e n t s i n t h e s e two c a t e g o r i e s i n v o l v e d p h y s i c a l c o m f o r t o r d i s c o m f o r t . The widows s t a t e d a n e e d f o r n u t u r a n c e , body c o m f o r t i n g and c o n t a c t . I t i s n o t t o be c o n f u s e d w i t h s e x u a l i t y and s e x u a l n e e d s . The widows s t a t e d t h a t t h e need r e l a t e d t o s e x u a l i t y was l i m i t e d o r , i n some c a s e s , t o t a l l y i n h i b i t e d . I n r e v i e w i n g t h e l i t e r a t u r e 85 c o n c e r n i n g " n o r m a l " s e x u a l r e s p o n s e p a t t e r n s i n widows f o l l o w i n g a p a r t n e r ' s d e a t h , i t seemed t h a t t h e s e p a t t e r n s a r e v a r i e d and i n d i v i d u a l . The p h y s i c a l c o m f o r t d e s c r i b e d i n t h e P h y s i c a l C o m f o r t c a t e g o r y was b e i n g t o u c h e d o r hugged b y someone o r t h e widow s t r o k i n g o r h o l d i n g a p e t . The r e s u l t o f t h e p h y s i c a l r e s p o n s e was t h e widow f e e l i n g c o m f o r t and c o n s o l a t i o n . I t seemed t h a t t h e c o m f o r t i n g was o f f e r e d a u t o m a t i c a l l y i n e m p a t h i c r e s p o n s e t o t h e w i d o w ' s d i s t r e s s . I w ent t o t a l k w i t h a m i n i s t e r o f a g r i e v i n g g r o u p a t a c h u r c h an he p u t h i s h a n d on my arm. He was s e n s i t i v e a n d I f e l t he c a r e d . I t i s i m p o r t a n t t o n o t e t h a t 6 o u t 15 o f t h e i n c i d e n t s i n t h e P h y s i c a l C o m f o r t c a t e g o r y w e re a widow s t r o k i n g o r h o l d i n g a p e t . The p e t seemed t o be t h e c h i e f s o u r c e and r e c e p t a c l e o f n o n d e m a n d i n g a f f e c t i o n . The dog was f e e l i n g a l l a l o n e and a n x i o u s . He jumped on my l a p and I p e t h i m and groomed h i m . I c o u l d t a k e c a r e o f h i m . He w a n t s t o be w i t h me .... u n c o n d i t i o n a l l o v e . 86 D i s t r e s s c a t e g o r y , t h e widows r e l a t e d had p h y s i c a l r e a c t i o n s i n s i t u a t i o n s . I went t o $1.49 d a y a t Woodwards w i t h my g i r l f r i e n d . I g o t d i z z y and a p a i n i n my c h e s t . I t h o u g h t I was g o i n g t o d i e . " I was s u r e I was h a v i n g a h e a r t a t t a c k . I had a g r e a t p a i n i n my h e a r t . I went t o t h e d o c t o r and t h e t e s t s showed n o t h i n g w r o n g . M a d d i s o n and V i o l a ( 1 9 6 8 ) f o u n d t h a t f o r t y p e r c e n t o f t h e w idows t h e y s t u d i e d h a d m a j o r d i f f i c u l t i e s w i t h symptoms s u c h as c h e s t p a i n s , p a l p i t a t i o n s and i n s o m n i a . I n t h i s r e s e a r c h , f i f t y p e r c e n t o f t h e widows e x p e r i e n c e d p h y s i c a l d i s t r e s s and t h e i n c i d e n t s r e p o r t e d o c c u r r e d d u r i n g t h e e a r l y months o f b e r e a v e m e n t . The widows i n t h i s r e s e a r c h r e p o r t e d a t t e n d i n g a t t h e i r g e n e r a l p r a c t i t i o n e r ' s o f f i c e w i t h g r e a t e r f r e q u e n c y t h a n t h e y h ad p r i o r t o t h e i r h u s b a n d ' s d e a t h . I t i s i m p o r t a n t t o s t a t e t h a t one widow i n t h i s s t u d y was f o r t u n a t e t o have gone t o h e r g e n e r a l p r a c t i t i o n e r b e c a u s e s h e r e c e i v e d a n e a r l y d i a g n o s i s o f c a n c e r o f t h e c e r v i x and was a b l e t o s u c c e s s f u l l y t r e a t t h e c a n c e r . I n t h e P h y s i c a l i n c i d e n t s w h ere t h e y 87 Two o f t h e e l e v e n P h y s i c a l D i s t r e s s i n c i d e n t s were r e l a t e d t o a s t r o n g p h y s i c a l r e a c t i o n t o m e d i c a t i o n . T h e s e i n c i d e n t s were d e s c r i b e d a s p r o d u c i n g d e t r i m e n t a l p h y s i c a l e f f e c t s f o r t h e widows and a n a d d i t i o n a l p r o b l e m t o d e a l w i t h - i n a t i m e o f g r e a t d i s t r e s s . B o t h o f t h e s e i n c i d e n t s o c c u r r e d i n t h e f i r s t t h r e e months o f b e r e a v e m e n t . Do d r u g s h e l p i m p r o v e t h e o u t c o m e o f b e r e a v e m e n t o r c a n t h e y be a f u r t h e r f a c t o r h a m p e r i n g r e s o l u t i o n ? S i g n i f i c a n c e o f t h e S t u d y T h e o r e t i c a l S i g n i f i c a n c e The s t a g e t h e o r y o f g r i e f assumes t h a t g r i e f i s a p r o c e s s w h i c h v a r i e s among i n d i v i d u a l s . S p e c i f i c s t a g e s h a v e b e e n d e v e l o p e d i n o r d e r t o i l l u s t r a t e t h e p r o c e s s i n w h i c h an i n d i v i d u a l moves w h i l e g r i e v i n g . S t a g e s do n o t h a v e a c l e a r l y d e f i n e a b l e b e g i n n i n g o r e n d . The a c c e p t a n c e o f t h e l o s s i s t h e o p t i m a l e n d - p r o d u c t . Time i s a d i m e n s i o n o f t h i s p r o c e s s w h i c h , d e p e n d e n t on t h e t h e o r i s t , c a n be f r o m a few weeks t o s e v e r a l y e a r s . The number o f s t a g e s and t h e i m p o r t a n c e o f e a c h i s a l s o v a r i a b l e a c r o s s t h e o r i s t s . I t seems t h a t t h e p u r p o s e o f k n o w i n g w h i c h s t a g e an i n d i v i d u a l i s i n h a s some v a l u e i n g a u g i n g how c l o s e o r f a r away t h e p e r s o n i s f r o m f i n a l a c c e p t a n c e . I n t h i s r e s e a r c h , 88 i t demonstrated t h a t i n the b e g i n n i n g of g r i e f widows e x p e r i e n c e d an i n a b i l i t y t o a c t , d i s t r e s s a t s u g g e s t i o n s of invo lvement w i th men and s t r o n g p h y s i c a l r e a c t i o n s to g r i e f . Lindemann (1944), Parkes (1972) and Enge l (1961) view g r i e f as a p r o c e s s , but w i t h an emphasis upon r e a c t i o n s . There may be d e n i a l or shock , somat ic d i s t u r b a n c e s , g u i l t , anger , i d e n t i f i c a t i o n w i t h the deceased , a r e c o v e r y p e r i o d and some sense of d u r a t i o n and i n t e n s i t y . The r e s u l t s of t h i s r e s e a r c h s u p p o r t the emphasis upon r e a c t i o n s . As shown, response to engaging i n a t a s k , r e c e i v i n g s u g g e s t i o n s from o t h e r s and p h y s i c a l r e a c t i o n s to s t r e s s seemed to be p e r c e i v e d by the widow as h a r m f u l i n the f i r s t three months of g r i e f . These f i n d i n g s suppor t the n o t i o n t h a t "process" c o n t a i n s s tages which are c h a r a c t e r i z e d by s p e c i f i c symptoms. A l l the s tages of g r i e f are o r d e r e d so t h a t "peace fu l acceptance" i s l i k e l y to be viewed as an e n d - p r o d u c t of the g r i e f p r o c e s s . In the I s o l a t i n g E x p e r i e n c e c a t e g o r y , a s u b - c a t e g o r y l a b e l l e d R e a l i z i n g f o r the F i r s t Time the Spouse i s Dead r e v e a l e d 8 i n c i d e n t s where widows e x p e r i e n c e d the r e a l i z a t i o n t h a t t h e i r spouse was d e a d . These r e a l i z a t i o n s were viewed as h a r m f u l f o l l o w e d by e x p e r i e n c e s o f l o n e l i n e s s o r h e l p l e s s n e s s . The r e s u l t s suggest t h a t the 89 e x p e c t a t i o n o f m o v i n g t o w a r d " a c c e p t a n c e " a s a v a l u e o f t h e s t a g e m o d e l may n o t be a v a l u e t o t h e g r i e v e r . What becomes o f a widow who d o e s n o t a c h i e v e t h i s i m p l i c i t g o a l ? S c h n e i d e r (1980) p o s t u l a t e d a m o d e l o f g r i e f t h a t e n c o m p a s s e d a g r o w t h p o t e n t i a l i n t h e r e s o l u t i o n o f g r i e f . I t c o n t a i n s s i x s t a g e s t h a t i n c l u d e s e l f - a c t u a l i z a t i o n and t r a n s p e r s o n a l a w a r e n e s s as a p a r t o f t h e g r i e f p r o c e s s . One p h a s e i s t h e A w a r e n e s s o f L o s s . The p u r p o s e o f t h i s p h a s e o f g r i e v i n g i s an i n t e n s i v e e x p l o r a t i o n o f t h e e x t e n t o f l o s s and t h e i m p l i c a t i o n s i t p r e s e n t s s u c h a s l o n e l i n e s s , h e l p l e s s n e s s , e x h a u s t i o n , e t c . I t may w e l l be a s t h e f i n d i n g s o f t h i s s t u d y s u g g e s t t h a t a m o d e l o f g r i e f n e e d s t o i n c o r p o r a t e t h e i d e a o f j j r i e f as m u l t i d i m e n s i o n a l . P e r c e i v e d s u p p o r t h a s b e e n shown t o be a s s o c i a t e d w i t h e m o t i o n a l a d j u s t m e n t among t h e b e r e a v e d ( B o r s t e i n e t . a l . , 1 9 7 3 ; C a r y , 1974; C l a y t o n , H a l i k a s and M a u r i c e , 1972; J a m i s o n , W e l l i s c h , and P a s n o v , 1978; Weisman, 1 9 7 6 ) . The l a r g e s t number o f c r i t i c a l i n c i d e n t s i n b o t h t h e H e l p f u l and H a r m f u l c a t e g o r i e s w e r e f o u n d i n r e c e i v i n g s u p p o r t a nd l a c k o f s u p p o r t . A p p r o x i m a t e l y t h i r t y - s e v e n p e r c e n t o f h e l p f u l i n c i d e n t s w e r e i n c i d e n t s w h e r e t h e widow p e r c e i v e d s u p p o r t f r o m o t h e r s and b e i n g a b l e t o g i v e s u p p o r t . A p p r o x i m a t e l y t w e n t y - s e v e n p e r c e n t o f h a r m f u l i n c i d e n t s were i n c i d e n t s 90 w h e r e t h e widow p e r c e i v e d a l a c k o f s u p p o r t i n h e r s o c i a l o r f a m i l y n e t w o r k . The s t u d y d i d s u p p o r t t h e e v i d e n c e w h i c h s u g g e s t s t h a t s o c i a l s u p p o r t f a c i l i t a t e s t h e c o p i n g p r o c e s s . I t a l s o s u g g e s t e d t h a t when t h e widows r e c e i v e d u n e x p e c t e d r e s p o n s e s , t h e y p e r c e i v e d i t as l a c k o f s u p p o r t . I t may be t h a t s u p p o r t i s n o t a u n i t a r y c o n c e p t a n d t h a t i t h a s many d i f f e r e n t c o m p o n e n t s . Kahn (1979) and W a l k e r , M a c B r i d e and V a c h o n (1977) f o u n d t h a t a d i s t i n c t k i n d o f s u p p o r t i n v o l v e s e x p r e s s i n g a g r e e m e n t w i t h , o r a c k n o w l e d g i n g o f t h e a p p r o p r i a t n e s s o f a p e r s o n ' s b e l i e f s , i n t e r p r e t a -t i o n s , o r f e e l i n g s . C l e a r l y , one f a c t o r w h i c h seemed t o be i m p o r t a n t i n d e t e r m i n i n g w h e t h e r a n i n c i d e n t was h a r m f u l i n a l l o f t h e h a r m f u l c a t e g o r i e s was t h e widow e x p e r i e n c i n g f e e d b a c k a s u n e x p e c t e d a n d / o r n e g a t i v e . A d d i t i o n a l l y , many o f t h e w i d o w s s t a t e d t h a t t h e y f e l t t h e y h a d t o b e h a v e d i f f e r e n t l y a f t e r r e c e i v i n g h a r m f u l f e e d b a c k . T h i s f i n d i n g s u p p o r t s G l i c k e t a l . ( 1 9 74) r e s e a r c h i n w h i c h l e s s t h a n o n e - h a l f o f t h e s a m p l e o f widows were a b l e t o e x p r e s s t h e i r g r i e f f r e e l y w i t h a t l e a s t one o t h e r p e r s o n . S i x t y - s e v e n p e r c e n t r e p o r t e d t h a t t h o s e who a l l o w e d o r e n c o u r a g e d s u c h c o n v e r s a -t i o n s were h e l p f u l . I n a s u r v e y c o n d u c t e d by S c h o e n b e r g , C a r r , P e r e t z , K u t s c h e r a n d C h e r i c o (1975) e i g h t y - e i g h t 91 p e r c e n t o f t h o s e b e r e a v e d f e l t t h a t " e x p r e s s i o n r a t h e r t h a n r e p r e s s i o n o f f e e l i n g s , a nd c r y i n g , s h o u l d be e n c o u r a g e d a t l e a s t s o m e t i m e s ( p . 3 6 5 ) . " A r e t h e b e n e f i t s o f e x p r e s s i n g f e e l i n g s d e p e n d e n t on t h e t y p e o f f e e d b a c k one r e c e i v e s f r o m o t h e r s ? P e r h a p s work on s u c c e s s f u l g r i e f r e s o l u t i o n s h o u l d c o n t a i n an e d u c a t i v e e m p h a s i s f o r t h o s e i n t h e w i dowed p e r s o n ' s c l o s e p e r s o n a l s u p p o r t n e t w o r k . L o n e l i n e s s was r e p o r t e d t o be a s o u r c e o f e m o t i o n a l d i s t r e s s f o r t h e widows i n t h i s s t u d y . T h i s f i n d i n g c o n f i r m s t h e c u r r e n t r e s e a r c h w h i c h s u g g e s t s t h a t l o n e l i n e s s i s a s e r i o u s p r o b l e m f o r w idows ( B a h r and H a r v e y , 1979; C l a y t o n , 1975.; L o p a t a , 1979; W e i s s , 1 9 7 9 a ) . P h y s i c a l c o m f o r t d e f i n e d a s t h e p h y s i c a l r e s p o n s e s f r o m o t h e r s o r t h e p h y s i c a l r e s p o n s e s t h e widows g a v e t o p e t s was e x p e r i e n c e d a s h e l p f u l . The r e s p o n s e s were d e f i n e d as b o t h n a t u r a l a nd a u t o m a t i c . R a p h e a l (1983) s t a t e s t h a t c o m f o r t i n g i s m o s t n e c e s s a r y a t t h e a c u t e t i m e s o f l o s s , o r when t h e r e a l i t y o f t h e d e a t h and l o s s f i n a l l y b r e a k s t h r o u g h t h e i n i t i a l s h o c k e d d e n i a l . The w i d o w s i n t h i s r e s e a r c h v i v i d l y remembered t h e i n c i d e n t s i n t h i s c a t e g o r y a n d s t a t e d t h a t t h e y w e r e v e r y p o w e r f u l i n h e l p i n g them t h r o u g h t h e i n i t i a l s t a g e o f g r i e f . 92 F i n a l l y , t h e r e p o r t s by t h e widows c o n f i r m many of t h e c h a r a c t e r i s t i c b e h a v i o u r a l and e m o t i o n a l r e s p o n s e s o u t l i n e d b y S h o n t z ( 1975) i n h i s t h e o r y o f r e a c t i o n t o c r i s i s . W h i l e i s o l a t e d c r i t i c a l i n c i d e n t s do n o t c o m p r i s e t h e e n t i r e p r o c e s s o f r e a c t i o n a n d r e c o v e r y , t h e p a n i c , d i s o r g a n i z a -t i o n , h e l p l e s s n e s s , d e p r e s s i o n and s h o c k r e p o r t e d by t h e w i d o w s c o n f i r m s t h a t t h e g r i e v i n g e x p e r i e n c e f o r them c o n s t i t u t e d a c r i s i s e x p e r i e n c e . Practical Significance B o t h t h e p r o f e s s i o n a l c a r e g i v e r and t h e l a y p e r s o n w i l l be i n v o l v e d w i t h b e r e a v e d p e o p l e and w i l l n e e d t o know w h a t t y p e o f b e h a v i o u r w o u l d f a c i l i t a t e a s u p p o r t i v e a n d t r u s t i n g r e l a t i o n s h i p . What k i n d s o f h e l p w o u l d t h e widowed p o p u l a t i o n p r e f e r and w h a t k i n d s o f h e l p w o u l d t h e y f i n d h a r m f u l . The r e s u l t s o f t h i s s t u d y s u g g e s t some c r i t e r i a f o r h e l p i n g t h e widow t h r o u g h b e r e a v e m e n t . The f i r s t t h r e e months o f g r i e f seemed t o be an i m p o r t a n t v a r i a b l e i n t h e widow's a b i l i t y t o c o p e w i t h b o t h t h e p h y s i c a l and p s y c h o l o g i c a l a s p e c t s o f g r i e f . I t seemed t h a t a l t h o u g h p e o p l e w e re w e l l - m e a n i n g i n t h e i r a t t e m p t s t o s u p p o r t t h e widow, t h e i r e f f o r t s c o u l d be p e r c e i v e d a s h a r m f u l and c o u l d c a u s e t h e widow t o b l o c k h e r f e e l i n g s . I t 93 a p p e a r s t h a t widows who p e r c e i v e t h e i r s o c i a l n e t w o r k s as f a i l i n g t o e n c o u r a g e o r s u p p o r t t h e i r t a l k o f t h e d e a d h u s b a n d c o u l d be h e l p e d by i n t e r v e n t i o n s t h a t f a c i l i t a t e d t h i s . The c a r i n g p e r s o n c a n g i v e a c l e a r i n d i c a t i o n t h a t he i s w i l l i n g t o t a l k a b o u t t h e d e a t h and s e e s i t as i m p o r t a n t t o t h e widow. Many o f t h e w i d o w s i n t h i s s t u d y s a i d t h a t t h e u s e o f t h e w o r d " d e a t h " was r e a s s u r i n g t o them. The u s e o f c l i c h e s o r euphemisms s e n t t h e message t o t h e widow t h a t t h e p e r s o n t h e y were c o m m u n i c a t i n g w i t h was r e l u c t a n t o r u n a b l e t o t a l k w i t h them a b o u t t h e i r g r i e f . The f e e d b a c k t h e w idows r e c e i v e d was f u n d a m e n t a l i n t h e i r p e r c e p t i o n o f w h e t h e r t h e s h a r i n g o f t h e i r f e e l i n g s was h e l p f u l o r h a r m f u l . P r a c t i c a l s u p p o r t i m m e d i a t e l y f o l l o w i n g t h e d e a t h o f a s p o u s e was r e g a r d e d a s h e l p f u l as e m o t i o n a l s u p p o r t . I n c i d e n t s o f p r a c t i c a l s u p p o r t r a n g e d f r o m f o o d p r e p a r a t i o n , i n f o r m a t i o n on w i l l s , p u r c h a s i n g c a r s t o p a i n t i n g a n d g e n e r a l h o u s e r e p a i r . Many w i d o w s s t a t e d t h a t t h e y w e re u n a b l e t o r e q u e s t h e l p w i t h p r a c t i c a l o r e m o t i o n a l p r o b l e m s f o r f e a r t h a t t h e y w o u l d a l i e n a t e t h e i r p e r c e i v e d s u p p o r t s y s t e m by b e i n g s e e n as " d e m a n d i n g " o r t h a t t h e y s i m p l y d i d n o t know what t o a s k f o r . The f r i e n d who a r r i v e d w i t h f o o d o r " j u s t d r o p p e d i n " t o c h e c k on t h e widow was s e e n a s s u p p o r t i v e . 94 Emotional support came from the a b i l i t y to c r y , be h e l d or to t a l k about t h e i r f e e l i n g s with another without being t o l d to a c t or f e e l d i f f e r e n t l y . Again, the widows f e l t v u l n e r a b l e and r e a c t e d s t r o n g l y to unexpected feedback e s p e c i a l l y i n the f i r s t t h ree months of g r i e f . When the widow would attempt an a c t i o n which she f e l t she could choose to do without pressure and which may have been an a c t i v i t y she engaged i n p r i o r to her husband's death, the r e s u l t of the a c t i o n would be empowering. When the widow f e l t she had to a c t to p r o t e c t her c h i l d r e n or to attempt to f i n d meaning i n her husband's death f o r the c h i l d r e n she would experience a sense of h e l p l e s s n e s s . A s s i s t a n c e with the c h i l d r e n by p r o v i d i n g books on death and dying or by i n c l u d i n g the c h i l d r e n i n the d e c i s i o n making process around some aspects ( r e g a r d l e s s of importance) of the f u n e r a l was found h e l p f u l f o r some of the widows. I t provided them with a sense of having the a b i l i t y to cope with the g r i e f f o r both themselves and t h e i r c h i l d r e n . I t was a l s o d i s c u s s e d that many t e l e v i s i o n programs which contained dying scenes or ambulances c r e a t e d a high l e v e l of s t r e s s i n the f i r s t s i x months of g r i e f . Music was a l s o mentioned as a powerful agent i n a r o u s i n g f e e l i n g s f o r the widow which the widow f e l t as overpowering or too p a i n f u l . 95 L o n e l i n e s s was c o n s i s t e n t l y mentioned as a major problem f o r the widows. The Empty House sub-category of the I s o l a t i n g Experience category contained the experience of a r r i v i n g home to an empty house and f e e l i n g i s o l a t e d , f r i g h t e n e d and alone. I t was c o n s i d e r e d t h a t l e a v i n g l i g h t s and the r a d i o p l a y i n g was h e l p f u l i n a l l nine i n c i d e n t s . A l l the widows who responded to t h i s sub-category s t a t e d t h a t the knowledge that these f e e l i n g s c o u l d occur upon r e t u r n i n g home d i d not help to ease the experience. I t was c i t e d by s i x of the widows that the experience of having a pet helped ease the l o n e l i n e s s and pr o v i d e d them with at l e a s t one source of u n c o n d i t i o n a l l o v e . The a b i l i t y t o s t r o k e , h o l d and groom a pet was experienced as h e l p f u l . Engaging i n s o c i a l a c t i v i t i e s as a s i n g l e person was d e c i d e l y s t r e s s f u l f o r many of the widows. The widows s t a t e d that they found s o c i e t y was o r i e n t e d to c o u p l e s . These events were regarded as h e l p f u l when the widow was i n c l u d e d i n group d i s c u s s i o n s , asked how she was f e e l i n g and g i v e n time to respond. I t was a l s o s t a t e d as h e l p f u l when f r i e n d s t a l k e d about the widow's husband and/or the a c t i v i t i e s he or they as a couple had engaged i n p r i o r t o h i s death. 96 I n t h e I n f o r m a t i o n and I n s p i r a t i o n s u b - c a t e g o r y o f t h e S h a r i n g t h e G r i e f c a t e g o r y t h e widows f e l t t h a t t a l k i n g t o a n o t h e r widow was h e l p f u l b e c a u s e she u n d e r s t o o d and c o u l d o f f e r i n f o r m a t i o n and s u p p o r t i n a way t h a t no one e l s e c o u l d . A d d i t i o n a l l y many widows f o u n d a g r e a t d e a l o f h e l p by a t t e n d i n g g r i e v i n g g r o u p s . The g r o u p s p r o v i d e d a s u p p o r t n e t w o r k o f p e o p l e who were g o i n g t h r o u g h t h e same e x p e r i e n c e . P r o f e s s i o n a l s were v i e w e d as h e l p f u l when t h e y p r o v i d e d b o t h p r a c t i c a l and e m o t i o n a l s u p p o r t . The p r a c t i c a l s u p p o r t r a n g e d f r o m h e l p i n g t h e widow e s t a b l i s h f a m i l y r u l e s t o p h o n i n g f o r i n f o r m a t i o n r e g a r d i n g p e n s i o n b e n e f i t s . The most f r e q u e n t comment r e g a r d i n g e m o t i o n a l s u p p o r t f r o m t h e p r o f e s s i o n a l was a s e n s e t h a t t h e widow had p e r m i s s i o n t o t a l k and t h a t t h e p r o f e s s i o n a l was n o t o n l y e m p a t h e t i c b u t w o u l d v a l i d a t e h e r f e e l i n g s . I t seems t h a t i t i s i m p o r t a n t f o r t h e c o u n s e l l o r t o communicate h i s / h e r r e c o g n i t i o n o f t h e p a i n i n v o l v e d f o r t h e widow and t o p r o v i d e an o p p o r t u n i t y f o r t h e widow t o e x p r e s s t h e a f f e c t s i n v o l v e d as w e l l as t o p r o v i d e d a t a on t h e p r o c e s s o f g r i e f t o h e l p n o r m a l i z e t h e p r o c e s s f o r t h e widow. Two o f t h e widows s t a t e d t h e y had a s t r o n g r e a c t i o n t o t h e m e d i c a t i o n t h a t was g i v e n t o them. The r e m a i n i n g 97 t h i r t e e n w i dows s t a t e d t h a t t h e y f e l t i t was i m p o r t a n t t o go t h r o u g h t h e g r i e f w i t h l i t t l e o r no m e d i c a t i o n . S i x o f t h e w i d o w s u s e d a m i l d t r a n q u i l i z e r t o s l e e p a t n i g h t . The u s e o f t h e s e m i l d t r a n q u i l i z e r s c e a s e d a f t e r s i x m o n t h s f o r f i v e o f t h e s i x w i d o w s . A l l o f t h e widows s p o k e o f m e d i c a t i o n a s a d e t e r r e n t f o r them i n t h e i r a b i l i t y t o e x p r e s s g r i e f . I n f a c t , m o s t o f t h e w i d o w s f e l t t h a t t h e s u g g e s t i o n o f m e d i c a t i o n u s e was, i n f a c t , t e l l i n g them t h a t t h e y s h o u l d n o t be f e e l i n g p a i n o r d e p r e s s i o n b e c a u s e t h e i r s p o u s e had d i e d . Recommendations f o r Fu tu re Research The s t a g e t h e o r i s t s v i e w g r i e f as a p r o c e s s . R e s e a r c h c l a i m s t h a t i n d i v i d u a l s f o l l o w a p r e d i c t a b l e , o r d e r l y p a t h o f e m o t i o n a l r e s p o n s e f o l l o w i n g a l i f e c r i s i s . The b e s t known p a t t e r n i s d e s c r i b e d by K u b l e r - R o s s ( 1 9 6 9 ) : d e n i a l , a n g e r , b a r g a i n i n g , d e p r e s s i o n and a c c e p t a n c e . The number o f s t a g e s and t h e i m p o r t a n c e o f e a c h i s v a r i a b l e a c r o s s s t a g e t h e o r i s t s . I t i s s u g g e s t e d t h a t i n d i v i d u a l s w i l l r e s o l v e t h e g r i e f c r i s i s , and t h u s move on t o t h e n e x t s t a g e o f t h e i r l i v e s . What h a p p e n s t o t h e widow who d o e s n o t a c h i e v e t h i s a c c e p t a n c e o r c h o o s e s n o t t o a c h i e v e t h i s a c c e p t a n c e ? M o s t s t u d i e s f i n d s i g n i f i c a n t l e v e l s o f d i s t r e s s o r d i s o r g a n i z a t i o n a f t e r a y e a r , and t h o s e t h a t h a v e c o n t i n u e d 98 t o f o l l o w t h e i r s a m p l e f o r a l o n g e r p e r i o d o f t i m e have n o t t y p i c a l l y f o u n d s u b s t a n t i a l i m p r o v e m e n t ( G l i c k e t a l . , 1974; M o r r i s e t a l . , 1977; P a r k e s , 1975; V a c h o n , 1 9 7 9 ) . T h i s r e s e a r c h f o u n d t h a t f o r many widows a c c e p t a n c e o r r e c o v e r y i s n o t a p p a r e n t d e s p i t e t h e p a s s a g e o f t i m e . T h e s e n o t i o n s o f r e c o v e r y and a c c e p t a n c e n e e d t o be r e c o n s i d e r e d . An i m p o r t a n t q u e s t i o n t h a t r e q u i r e s a t t e n t i o n i s i f r e s o l u t i o n o f g r i e f i s n o t e x p e r i e n c e d o v e r a l o n g p e r i o d o f t i m e c a n a s t a g e m o d e l a c c o u n t f o r s l o w , u n s t e a d y p r o g r e s s and be u s e f u l i n i d e n t i f y i n g t h o s e i n d i v i d u a l s who a r e l i k e l y t o h a v e d i f f i c u l t y i n r e s o l v i n g t h e i r g r i e f s u c c e s s f u l l y . T h e r e i s l i t t l e e v i d e n c e t o i n d i c a t e t h a t p e o p l e go t h r o u g h s t a g e s o f e m o t i o n a l r e s p o n s e f o l l o w i n g t h e d e a t h o f a s p o u s e . What v a r i a b l e s may m e d i a t e i n d i v i d u a l c o p i n g r e s p o n s e and h e l p e x p l a i n t h e v a r i e t y o f r e s p o n s e s t o t h e d e a t h o f a s p o u s e ? Many i n v e s t i g a t o r s h a v e c o n c l u d e d t h a t s o c i a l s u p p o r t f a c i l i t a t e s t h e c o p i n g p r o c e s s . Does e x p e c t i n g a n d r e c e i v i n g s u p p o r t f r o m f a m i l y and f r i e n d s i n f l u e n c e p e o p l e ' s e m o t i o n a l r e a c t i o n s t o a c r i s i s , o r h e l p them c o p e more e f f e c t i v e l y ? A l t h o u g h p e r c e i v e d s u p p o r t h a s be e n a s s o c i a t e d w i t h e m o t i o n a l a d j u s t m e n t among t h e b e r e a v e d c a n a c a u s a l i n f e r e n c e be w a r r a n t e d . As s t a t e d e a r l i e r , H e l l e r (1979) n o t e d t h a t p e o p l e who a r e p o o r l y a d j u s t e d o r 99 i n i l l h e a l t h may u n d e r e s t i m a t e t h e amount o f s u p p o r t a v a i l a b l e t o them. I s i t p o s s i b l e t h a t c o p i n g and s o c i a l s u p p o r t a r e c a u s a l l y r e l a t e d , b u t t h a t o n e ' s c o p i n g o r p r o g n o s i s d e t e r m i n e s t h e amount o f s u p p o r t a v a i l a b l e ? A c a u s a l r e l a t i o n s h i p b e t w e e n s u p p o r t and e f f e c t i v e l o n g t e r m a d j u s t m e n t c o u l d be e s t a b l i s h e d by i n t e r v e n t i o n s t u d i e s i n w h i c h p a r t i c i p a n t s a r e a s s i g n e d t o t r e a t m e n t s w h i c h s u p p l e m e n t t h e s u p p o r t a v a i l a b l e t o . t h e m . C o n s i d e r a b l e v a l u e e x i s t s i n e x a m i n i n g t h e r o l e o f p h y s i c a l t o u c h i n f a c i l i t a t i n g t h e g r i e v i n g p r o c e s s . C o m f o r t seemed m o s t n e c e s s a r y t o t h e widows a t t h e t i m e o f t h e i r s p o u s e s d e a t h o r when t h e r e a l i t y o f t h e d e a t h and l o s s b e g a n t o b r e a k t h r o u g h t h e i n i t i a l s h o c k e d d e n i a l . T h o s e c a r i n g f o r t h e b e r e a v e d may f e e l h e s i t a n t , n o t a b l e t o t o u c h , b e c a u s e t h e y f e a r i t w o u l d b r e a k some p e r s o n a l b a r r i e r . T h o s e who h a v e b e e n p r o f e s s i o n a l l y t r a i n e d may f i n d i t d i f f i c u l t t o o f f e r c o m f o r t b e c a u s e i t r e p r e s e n t s t h e human s i d e o f t h e i r r e s p o n s e , s o m e t h i n g t h e y may h a v e l e a r n e d t o d e t a c h o r d i s a s s o c i a t e i n some t h e r a p e u t i c f r a m e w o r k s . I n t h i s s t u d y t h e widows s t a t e d t h a t t h e s i m p l e s t t o u c h was h e l p f u l i n d e a l i n g w i t h t h e g r i e f e x p e r i e n c e . I s p h y s i c a l t o u c h as a r e s p o n s e t o g r i e f h e l p f u l when i t i s an a u t o m a t i c r e s p o n s e ? S h o u l d c a r e g i v e r s 100 who f e e l h e s i t a n t , n o t a b l e t o t o u c h , a t t e m p t t o t o u c h t h e b e r e a v e d o r w o u l d i t be b e t t e r t o o f f e r c o m f o r t w i t h a q u i e t and c o n t i n u i n g p r e s e n c e o r w o r d s o f r e a s s u r a n c e ? I s i t h e l p f u l f o r p e o p l e who a r e g r i e v i n g t o h a v e p e t s t h a t t h e y c a n t o u c h and groom? The r e a c t i o n s o f t h e w i d o w s t o t h e f e e d b a c k f r o m o t h e r s s u g g e s t s t h a t an i m p o r t a n t a r e a o f r e s e a r c h w o u l d be t o e x a m i n e t h e p o s s i b l e d e l e t e r i o u s a f f e c t o f b e h a v i o u r s t h a t a r e i n t e n d e d t o be s u p p o r t i v e . W a l k e r e t a l . (1967) d i s c o v e r e d t h a t a number o f r e s p o n s e s t h a t a r e f r e q u e n t l y made t o w idows were r e g a r d e d a s u n h e l p f u l . T h e r e was e v i d e n c e i n t h i s r e s e a r c h t h a t s h a r i n g o n e ' s f e e l i n g s may h a v e f a c i l i t a t e d c o p i n g . I t seems i m p o r t a n t f o r f u t u r e r e s e a r c h t o i d e n t i f y any l i m i t i n g c o n d i t i o n s on t h e v a l u e o f d i s c u s s i n g o n e ' s f e e l i n g s . A r e t h e b e n e f i t s o f s h a r i n g f e e l i n g s d e p e n d e n t on t h e t y p e o f f e e d b a c k one r e c e i v e s f r o m o t h e r s ? A r e widows who e x p r e s s t h e i r f e e l i n g s b u t e l i c i t n e g a t i v e r e s p o n s e s f r o m o t h e r s b e t t e r o f f t h a n t h o s e who w i t h h o l d t h e i r f e e l i n g s ? B o t h i m m e d i a t e and l o n g t e r m e f f e c t s o f o p e n e x p r e s s i o n o f f e e l i n g s need t o be c o n s i d e r e d i n f u t u r e r e s e a r c h . The g r i e f e x p e r i e n c e h a s b e e n d e s c r i b e d a s a s e r i e s o f p h a s e s , r e p r e s e n t i n g some o f t h e p r o c e s s e s o f a d a p t a t i o n t o l o s s ( K u b l e r - R o s s , 1 9 6 9 ) . As s t a t e d e a r l i e r , t h e p h a s e s a r e n o t c l e a r c u t o r f i x e d and t h a t t h e widow may p a s s b a c k w a r d and f o r w a r d among them. The widows i n t h i s s t u d y s t a t e d t h a t i n t h e f i r s t t h r e e m o n t h s o f g r i e f t h e i r w h o l e w o r l d seemed d i s o r g a n i z e d . I t was a l l t h a t t h e y c o u l d do t o c o n t i n u e t h e b a s i c t a s k s o f s u r v i v a l . They r e l i e d on o t h e r s t o i n i t i a t e a c t i o n s t o h e l p them f o r m a c o h e r e n t f r a m e w o r k o r p a t t e r n o f d a i l y a c t i v i t y . The most p o w e r f u l i n f l u e n c e f o r t h e m a j o r i t y o f t h e s e women were t h e f a m i l y and s o c i a l n e t w o r k . As d i s c u s s e d e a r l i e r , r e s p o n s e t o e n g a g i n g i n a t a s k , r e c e i v i n g s u g g e s t i o n s f r o m o t h e r s and p h y s i c a l r e a c t i o n s t o s t r e s s seemed t o be p e r c e i v e d by t h e widow as h a r m f u l i n t h e f i r s t t h r e e months o f g r i e f . I f l o s s i s r e s o l v e d by t h e i n d i v i d u a l i n h i s s o c i a l c o n t e x t t h r o u g h t h e i n n e r -p s y c h o l o g i c a l p r o c e s s e s o f m o u r n i n g and t h e i r f a c i l i t a t i o n t h r o u g h i n t e r a c t i o n w i t h o t h e r s t h e n t h e f a m i l y and s o c i a l n e t w o r k c o u l d a s s i s t t h e widow i n f o r m i n g more a c c u r a t e p e r c e p t i o n s o f what b e h a v i o u r s a r e , i n f a c t , n o r m a t i v e . A s d e m o n s t r a t e d i n t h e V e r b a l C r i t i c i s m c a t e g o r y , when t h e widow v i e w e d h e r b e h a v i o u r as i n a p p r o p r i a t e s h e w o u l d n o t 102 seek, s u p p o r t d u r i n g t i m e s o f d i s t r e s s . She w o u l d b e h a v e i n c e r t a i n ways w h i c h w e r e c o n t r a r y t o h e r r e a l f e e l i n g s . I t seems i m p o r t a n t f o r f a m i l y , f r i e n d s and h e a l t h p r o f e s s i o n a l s t o l e g i t i m i z e t h e f e e l i n g s and r e a c t i o n s t h a t commonly o c c u r among t h e w i d o w e d . Can e d u c a t i n g t h e s u p p o r t n e t w o r k o f t h e widow i n t h e r e a c t i o n s o f widows i n t h e f i r s t t h r e e months o f g r i e f f a c i l i t a t e r e s o l u t i o n o f g r i e f f o r t h e widow? W i l l a k n o w l e d g e o f t h e d i f f e r e n c e i n r e a c t i o n s o f t h e widow t o t h e d e a t h o f a s p o u s e i n t h e f i r s t t h r e e months o f g r i e f as c o m p a r e d t o l a t e r s t a g e s o f g r i e f p r o v i d e a f r a m e w o r k f o r s p e c i f i c p r e v e n t a t i v e i n t e r v e n t i o n w i t h t h e b e r e a v e d who a r e a t h i g h r i s k o f m a l r e s o l u t i o n ? The v a l u e o f p e e r s u p p o r t g r o u p s ( H i l t z , 1 9 7 5 ; S i l v e r m a n , 1 9 7 0 ; and V a c h o n , 1980) may s t e m i n p a r t f r o m t h e i r a b i l i t y t o h e l p r e a l i g n t h e norms o f t h e w i d o w s . Some w i d o w s i n t h i s s t u d y c i t e d a t t e n d a n c e a t a p e e r s u p p o r t g r o u p a t N o r t h S h o r e F a m i l y s e r v i c e s as h e l p f u l and s u p p o r t i v e . S h o u l d a p r o g r a m o f p r e v e n t a t i v e i n t e r v e n t i o n s u c h as a p e e r s u p p o r t g r o u p be a v a i l a b l e i m m e d i a t e l y o r s o o n a f t e r t h e d e a t h o f t h e s p o u s e ? G i v e n t h e w idow's d i f f i c u l t y i n i n i t i a t i n g a c t i o n and r e q u e s t i n g h e l p , w o u l d t h e widow be a b l e t o a v a i l h e r s e l f t o s u c h a g r o u p i n t h e f i r s t t h r e e months o f g r i e f ? 103 I t r e m a i n s t o be d e t e r m i n e d w h e t h e r p r e p a r i n g t h e widow f o r t h e v a r i e t y o f r e s p o n s e s she may e n c o u n t e r and t h e l e n g t h o f t i m e t h e y may p e r s i s t w i l l be b e n e f i c i a l . F u r t h e r r e s e a r c h needs t o be e n c o u r a g e d t o e x a m i n e s u c h q u e s t i o n s a s , w i l l e x p e c t a t i o n s o f p o s s i b l e l o n g - t e r m d i f f i c u l t i e s r e s u l t i n a dded d i s t r e s s f o r t h o s e who a r e a b l e t o a d j u s t more q u i c k l y ? C o n s i d e r a b l e v a l u e e x i s t s f o r i n c o r p o r a t i n g m e d i a t i n g v a r i a b l e s s u c h as p e r c e i v e d s o c i a l s u p p o r t and t h e o p p o r t u n i t y f o r f r e e e x p r e s s i o n o f f e e l i n g s i n f u t u r e r e s e a r c h as i t may o f f e r more p r e c i s e p r e d i c t i o n s a b o u t t h e c o n d i t i o n s u n d e r w h i c h p a r t i c u l a r e m o t i o n a l r e a c t i o n s w i l l o c c u r . E m p e r i c a l r e s e a r c h n e e d s t o c o n s i d e r v a r i a b i l i t y n o t o n l y i n t h e i n i t i a l r e a c t i o n t o t h e d e a t h o f a s p o u s e and i n c o p i n g s t r a t e g i e s e m p l o y e d , b u t a l s o i n t h e t i m e n e c e s s a r y f o r s u c c e s s f u l r e s o l u t i o n o f t h e g r i e f e x p e r i e n c e . I t i s i m p o r t a n t t o s t r e s s t h a t a l t h o u g h many t h e o r i s t s i m p l y t h a t p e o p l e w i l l r e c o v e r f r o m t h e g r i e f e x p e r i e n c e and resume t h e i r l i v e s , d a t a s u g g e s t t h a t t h e d i f f i c u l t i e s f o l l o w i n g a c r i s i s may be e x p e r i e n c e d i n d e f i n i t e l y . What a r e t h e i m p l i c a t i o n s o f t h i s phenomena on t h e c a r e and t r e a t m e n t r e c e i v e d by w i d o w s ? 104 Limitations of the Study A l i m i t a t i o n o f t h i s s t u d y i s t h e u n r e p r e s e n t a t i v e n e s s o f t h e s a m p l e . The s u b j e c t s w e re widows who s o u g h t t h e h e l p o f t h e N o r t h S h o r e F a m i l y S e r v i c e s B e r e a v e m e n t S u p p o r t G r o u p . T h e r e f o r e , t h e women w e r e a c t i o n - o r i e n t a t e d and s o u g h t t h e h e l p o f a t h e r a p y s u p p o r t g r o u p . T h e i r i n v o l v e m e n t i n t h e g r o u p t h e r a p y may h a v e e l i c i t e d r e c a l l o f c e r t a i n t y p e s o f m e m o r i e s o f t h e g r i e f e x p e r i e n c e w h i c h d e p e n d e d on t h e e x p e r i e n c e o f o t h e r s i n t h e i r g r o u p . G e n e r a l i z a b i l i t y o f t h e r e s u l t s o f t h i s s t u d y a r e l i m i t e d , t h e r e f o r e , u n t i l r e p l i c a t i o n o f t h i s r e s e a r c h w i t h o t h e r w i d o w s , p r e f e r a b l y t h o s e n o t i n t h e r a p y g r o u p s , c l a r i f i e s t h e i n f l u e n c e o f t h e s e v a r i a b l e s . No s t a t i s t i c a l h y p o t h e s e s w e re f o r m e d and t e s t e d . The r e s u l t s o f t h i s s t u d y a r e n o t d e c i s i v e . The p u r p o s e o f t h i s s t u d y was t o p r o b e and c o l l e c t i n f o r m a t i o n f r o m t h e w idows t o b e g i n t o e s t a b l i s h an e f f e c t i v e c r i t e r i a f o r h e l p i n g t h e w i d o w e d t h r o u g h b e r e a v e m e n t . S u b s e q u e n t r e s e a r c h w i t h q u a n t i t a t i v e m e t h o d o l o g y i s n e c e s s a r y t o p r o d u c e c o n c l u s i v e r e s u l t s . 105 Summary The r e s u l t s o f t h i s r e s e a r c h show t h a t t h e e x p e r i e n c e o f g r i e f c a n be a f f e c t e d b y : t h e r e s u l t o f a t t e m p t i n g a n a c t i o n , s o c i a l n e t w o r k s u p p o r t , e x p r e s s i o n o f f e e l i n g , v e r b a l f e e d b a c k f r o m o t h e r s and p h y s i c a l c o m f o r t . S p e c i f i c a l l y t h e r e s u l t s o f t h i s s t u d y s u g g e s t some c r i t e r i a f o r h e l p i n g t h e widow t h r o u g h b e r e a v e m e n t . The f i r s t t h r e e months o f g r i e f seemed t o be a n i m p o r t a n t v a r i a b l e i n t h e widow's a b i l i t y t o e n g a g e i n a t a s k , r e c e i v e s u g g e s t i o n s f r o m o t h e r s , and c o p e w i t h t h e p h y s i c a l and p s y c h o l o g i c a l a s p e c t s o f g r i e f . P r a c t i c a l s u p p o r t was r e g a r d e d a s h e l p f u l a s e m o t i o n a l s u p p o r t d u r i n g t h i s t h r e e month p e r i o d . The widows s t a t e d t h a t t h e y were v e r y d e p e n d e n t on t h e s u p p o r t o f o t h e r s and w e r e o f t e n more i n f l u e n c e d b y t h e r e s p o n s e s o f o t h e r s t o them t h a n t h e y w o u l d h a v e b e e n b e f o r e t h e d e a t h o f t h e i r s p o u s e . The i n c i d e n t s i n t h i s s t u d y r e f l e c t n o t o n l y a d e s i r e t o o b t a i n s u p p o r t , b u t a l s o a d e s i r e t o e x p r e s s f e e l i n g s a n d c o n c e r n s and t o r e c e i v e f e e d b a c k t h a t t h o s e f e e l i n g s a r e 106 u n d e r s t o o d by o t h e r s and - a p p r o p r i a t e u n d e r t h e c i r c u m s t a n c e s . Many o f t h e widows were d i s t r e s s e d by p r e m a t u r e a t t e m p t s t o i n v o l v e them s o c i a l l y d u r i n g t h e f i r s t f ew months o f g r i e f , b u t as t i m e p r o g r e s s e d t h e r e i n t e g r a t i o n i n t o t h e s o c i a l f i e l d became i n c r e a s i n g l y i m p o r t a n t . The widows s t a t e d a n e e d f o r n u t u r a n c e , body c o m f o r t i n g and c o n t a c t . The p h y s i c a l c o m f o r t d e s c r i b e d was b e i n g t o u c h e d o r hugged by someone o r t h e widow s t r o k i n g o r h o l d i n g a p e t . The r e s p o n s e s were d e f i n e d a s n a t u r a l , a u t o m a t i c and p o w e r f u l i n h e l p i n g them t h r o u g h t h e i n i t i a l s t a g e o f g r i e f . C o n s i d e r a b l e s u p p o r t f o r s t u d i e s f r o m d i f f e r e n t s o u r c e s a b o u t t h e f a c t o r s t h a t a r e r e l e v a n t t o t h e outcome o f c o n j u g a l b e r e a v e m e n t i s s u g g e s t e d by t h i s r e s e a r c h . R e s u l t s r e v e a l t h e i m p o r t a n c e a nd i n f l u e n c e o f s o c i a l n e t w o r k v a r i a b l e s and a t t e m p t s t o i n c r e a s e t h e s p e c i f i c i t y o f t h e t e r m by i d e n t i f y i n g i t s c o m p o n e n t s . F u r t h e r r e s e a r c h i s recommended, h i g h l i g h t i n g o t h e r c o m p o n e n t s o f s o c i a l s u p p o r t . 107 REFERENCES American Psychiatric Association, (1980). 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The d e p r e s s i o n o f w i d o w h o o d . B r i t i s h J o u r n a l o f P s y c h i a t r y , 1 2 1 , 71-78. C o a t e s , D., & Wortman, C.B. ( 1 9 8 0 ) . D e p r e s s i o n m a i n t e n a n c e and i n t e r p e r s o n a l c o n t r o l . I n A. Baum & J . S i n g e r ( E d s . ) , A d v a n c e s i n e n v i r o n m e n t a l p s y c h o l o g y ( V o l . 2 ) , H i l l s d a l e , N . J . : L a w r e n c e E r l b a u m A s s o c i a t e s . C o h e n , A.M., & S m i t h , R.D. ( 1 9 7 6 ) . The c r i t i c a l i n c i d e n t i n  g r o w t h g r o u p s : T h e o r y & t e c h n i q u e . L a J o l l a , C a l i f . : U n i v e r s i t y A s s o c i a t e s . C o l a i z z i , P.F. ( 1 9 7 8 ) . P s y c h o l o g i s t r e s e a r c h as t h e p h e n o m e n o l o g i s t v i e w s i t . I n R.S. V a l l e & M. K i n g ( E d s . ) , E x i s t e n t i a l - P h e n o m e n o l o g i c a l A l t e r n a t i v e s f o r  P s y c h o l o g y ( p p . 4 8 - 7 1 ) . 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A r e s e a r c h a p p r o a c h t o i m p r o v i n g o u r q u a l i t y o f l i f e . A m e r i c a n P s y c h o l o g i s t , 3 3 , 13 8 - 1 4 7 . F u l t o n , R. ( 1 9 7 0 ) . D e a t h , g r i e f and s o c i a l r e c u p e r a t i o n . Omega, 1, 2 3 - 2 8 . G l i c k , I.O., W e i s s , R.S., & P a r k e s , C M . ( 1 9 7 4 ) . The f i r s t  y e a r o f b e r e a v e m e n t . New Y o r k : W i l e y I n t e r s c i e n c e . G r e e n b l a t t , M. ( 1 9 7 8 ) . The g r i e v i n g s p o u s e . A m e r i c a n  J o u r n a l o f P s y c h i a t r y , 1_, 4 3 - 4 7 . Hamburg, D.A., & Adams, J . E . ( 1 9 6 7 ) . A p e r s p e c t i v e on c o p i n g b e h a v i o u r : s e e k i n g and u t i l i z i n g i n f o r m a t i o n i n m a j o r t r a n s i t i o n s . A r c h i v e s o f G e n e r a l P s y c h i a t r y , 1 7, 277 - 2 8 4 . 109 H e l l e r , K. ( 1 9 7 9 ) . 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( 1 9 7 9 ) . A g i n g a nd s o c i a l s u p p o r t . I n M. W h i t e R i l e y ( E d . ) , A g i n g f r o m b i r t h t o d e a t h : i n t e r d i s c i p l i n a r y p e r s p e c t i v e s . B o u l d e r , C o l . : W e s t v i e w P r e s s . K a v a n a u g h , R. ( 1 9 7 2 ) . F a c i n g D e a t h . B a l t i m o r e : P e n g u i n B o o k s . K l e r m a n , G.L., & I z e n , J . E . ( 1 9 7 7 ) . The e f f e c t s o f b e r e a v e m e n t and g r i e f on p h y s i c a l h e a l t h and g e n e r a l w e l l b e i n g . A d v a n c e s i n P s y c h o s o m a t i c M e d i c i n e , 9_, 6 3 - 6 8 . K u b l e r - R o s s , E. ( 1 9 6 9 ) . On D e a t h and D y i n g . L o n d o n : T a v i s t o c k . L i d z , R. ( 1 9 4 9 ) . E m o t i o n a l f a c t o r s i n h y p e r t h y r o i d i s m . P s y c h o s o m a t i c M e d i c i n e , 1 1 , 2-9. L i n d e m a n n , E. ( 1 9 4 4 ) . S y m p t o m a t o l o g y and management o f a c u t e g r i e f . A m e r i c a n J o u r n a l o f P s y c h i a t r y , 1 0 1 , 141-148. L e h r m a n , R. ( 1 9 5 6 ) . R e a c t i o n s t o u n t i m e l y d e a t h . P s y c h i a t r i c Q u a r t e r l y , 3 0 , 5 6 7 - 5 6 9 . L e i g h t o n , A., C l a u s e n , J . , & W i l s o n , R. ( 1 9 5 7 ) . E x p l o r a t i o n  i n s o c i a l p s y c h o l o g y . New Y o r k : B a s i c B o o k s . L i n d e m a n n , E. ( 1 9 4 4 ) . S y m p t o m a t o l o g y and management o f a c u t e g r i e f . A m e r i c a n J o u r n a l o f P s y c h i a t r y , 1 0 1 , 1 4 1 - 1 4 8 . 110 L o p a t a , H.Z. ( 1 9 7 1 ) . Women as a m i n o r i t y g r o u p . G e r o n t o l o g i s t ( s u p p l e m e n t ) , 61-11. L o p a t a , H.Z. ( 1 9 7 9 ) . Women as w i d o w s . New Y o r k and N o r t h H o l l a n d : E l s e v i e r . M a d d i s o n , D . C , and R a p h a e l , B. ( 1 9 7 2 ) . N o r m a l b e r e a v e m e n t as an i l l n e s s r e q u i r i n g c a r e : p s y c h o p h a r m a c o l o g i c a l a p p r o a c h e s . J o u r n a l o f T h a n a t o l o g y , 2, 7 8 5 - 7 9 3 . M a d d i s o n , D . C , V i o l a , A., & W a l k e r , W.L. ( 1 9 6 9 ) . F u r t h e r s t u d i e s i n c o n j u g a l b e r e a v e m e n t . A u s t r a l i a n and New  Z e a l a n d J o u r n a l o f P s y c h i a t r y , 3_, 6 3 - 6 6 . M a d d i s o n , D . C , & V i o l a , A. ( 1 9 6 8 ) . The h e a l t h o f widows i n t h e y e a r f o l l o w i n g b e r e a v e m e n t . J o u r n a l o f P s y c h o s o m a t i c R e s e a r c h , 1 2 , 2 9 7 - 3 0 6 . . M a d d i s o n , D . C , & W a l k e r , W.L. ( 1 9 6 7 ) . F a c t o r s a f f e c t i n g t h e o utcome o f c o n j u g a l b e r e a v e m e n t . B r i t i s h J o u r n a l  o f P s y c h i a t r y , 1 13, 1 0 5 7 - 1 0 6 7 . M c C l o s k e y , M.E., & G l u c k s b e r g , S. ( 1 9 7 8 ) . N a t u r a l c a t e g o r i e s : w e l l - d e f i n e d o r f u z z y s e t s ? Memory and  C o g n i t i o n , 6_, 4 6 2 - 4 7 2 . M c D e r m o t t , N., & Cobb, S. ( 1 9 3 9 ) . A p s y c h i a t r i c s u r v e y o f 50 c a s e s o f b r o n c h i a l a s t h m a . P s y c h o s o m a t i c M e d i c i n e , _ l f 201-204. M o r r i s , T., G r e e r , H.S., & W h i t e , P. ( 1 9 7 7 ) . P s y c h o l o g i c a l and s o c i a l a d j u s t m e n t t o m a s t e c t o m y : a two y e a r f o l l o w - u p s t u d y . C a n c e r , 4 0 , 2 3 8 1 - 2 3 8 7 . P a r k e s , C M . ( 1 9 6 5 ) . B e r e a v e m e n t and m e n t a l i l l n e s s . B r i t i s h J o u r n a l o f M e d i c a l P s y c h o l o g y , 3 8 , 1-26. P a r k e s , C M . ( 1 9 7 0 ) . The f i r s t y e a r o f b e r e a v e m e n t . P s y c h i a t r y , 3 3 , 4 4 4 - 4 6 7 . P a r k e s , C M . ( 1 9 7 2 ) . B e r e a v e m e n t : s t u d i e s o f g r i e f i n  a d u l t l i f e . 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( 1 9 7 5 ) . S t u d i e s i n g r i e f : a p r e l i m i n a r y r e p o r t . I n B. S c h o e n b e r g , I . G e r b e r , A. W i e n e r , A.H. K u t s c h e r , D. P e r e t z , & A.C. C a r r ( E d s . ) , B e r e a v e m e n t : i t s p s y c h o s o c i a l a s p e c t s , New Y o r k : C o l u m b i a . U n i v e r s i t y P r e s s . S c h n e i d e r , J . ( 1 9 8 0 ) . G r o w t h f r o m b e r e a v e m e n t . P r o c e e d i n g s  o f t h e 1980 i n t e r n a t i o n a l c o n g r e s s on d e a t h and d y i n g . L o n d o n : P i t t m a n M e d i c a l P u b l i s h e r s . S c h o e n b e r g , B.B., C a r r , A . C , P e r e t z , D. , & K u t s c h e r , A.H. ( 1 9 6 9 ) . P h y s i c i a n s and t h e b e r e a v e d . G e n e r a l P r a c t i t i o n e r , 40, 1 0 5 - 1 0 8 . S h e s k i n , A., & W a l l a c e , S. ( 1 9 7 6 ) . D i f f e r i n g b e r e a v e m e n t s : s u i c i d e , n a t u r a l and a c c i d e n t a l d e a t h . Omega, 1_, 3. S i l v e r m a n , P. ( 1 9 7 0 ) . The widow a s a c a r e g i v e r i n a p r o g r a m o f p r e v e n t a t i v e i n t e r v e n t i o n w i t h o t h e r w i d o w s . M e n t a l  H y g i e n e , 54 , 5 40-547. S i n g h , B.S., & R a p h a e l , B. ( 1 9 8 1 ) . P o s t - d i s a s t e r m o r b i d i t y o f t h e b e r e a v e d . J o u r n a l o f n e r v o u s and m e n t a l d i s e a s e , 1 6 9 ( 4 ) , 2 0 8 - 2 1 2 . 112 S t i e n , Z., & S u s s e r , M.W. ( 1 9 6 9 ) . Widowhood and m e n t a l i l l n e s s . P r e v e n t a t i v e and S o c i a l M e d i c i n e , 23, 106. S u t t o n , M. ( 1 9 7 9 , M a r c h ) . Widowhood: a k e y n o t e a d d r e s s . S t a t u s o f Women News, 6-8. V a c h o n , M.L.S. ( 1 9 7 9 ) . The i m p o r t a n c e o f s o c i a l s u p p o r t i n t h e l o n g i t u d i n a l a d a p t i o n t o b e r e a v e m e n t and b r e a s t c a n c e r . P a p e r p r e s e n t e d a t t h e m e e t i n g o f t h e A m e r i c a n  P s y c h o l o g i c a l A s s o c i a t i o n ^ New Y o r k . V a c h o n , M., L y a l l , W., R o g e r s , J . , F r e e d m a n - L e t o f s k y , K., & F r e e m a n , S. ( 1 9 8 0 ) . A c o n t r o l l e d s t u d y o f s e l f - h e l p i n t e r v e n t i o n f o r w i d o w s . A m e r i c a n J o u r n a l o f P s y c h i a t r y , 1 3 7 , 1 3 8 0 - 1 3 8 4 . V o l k a n , V. ( 1 9 7 0 ) . T y p i c a l f i n d i n g s i n p a t h o l o g i c a l g r i e f . P s y c h i a t r i c q u a r t e r l y , 44, 2 3 1 - 2 5 0 . V o l k a r t , E.H., & M i c h a e l , S.T. ( 1 9 5 7 ) . B e r e a v e m e n t a n d m e n t a l h e a l t h . I n J . C l a u s e r and R. W i l s o n ( E d s . ) , E x p l o r a t i o n i n s o c i a l p s y c h o l o g y (pp 281-307) New Y o r k : B a s i c B o o k s . W a l k e r , K.N., M a c B r i d e , A., & V a c h o n , M.L.S. ( 1 9 7 7 ) . S o c i a l s u p p o r t n e t w o r k s and t h e c r i s i s o f b e r e a v e m e n t . S o c i a l  S c i e n c e and M e d i c i n e , 1 1 , 3 5 - 4 1 . W e i n e r , B., R u s s e l l , D., & L e r m a n , D. ( 1 9 7 9 ) . The c o g n i t i o n - e m o t i o n p r o c e s s i n a c h i e v e m e n t - r e l a t e d c o n t e x t s . J o u r n a l o f P e r s o n a l i t y and S o c i a l P s y c h o l o g y , 37, 1 2 1 1 - 1 2 2 0 . Weisman, A.D. ( 1 9 7 6 ) . E a r l y d i a g n o s i s o f v u l n e r a b i l i t y i n c a n c e r p a t i e n t s . A m e r i c a n J o u r n a l o f t h e M e d i c a l S c i e n c e s , 2 7 1 , 1 8 7 - 1 9 6 . W o o l s e y , L.K. ( 1 9 8 5 ) . S o c i a l S c i e n c e s and H u m a n i t i e s  R e s e a r c h C o u n c i l A p p l i c a t i o n . 113 A P P E N D I X A Dear : My name i s J e s s i c a L. Eas t o n and I am the group l e a d e r of Growing but G r i e v i n g f o r N o r t h Shore F a m i l y S e r v i c e s . As a group l e a d e r i t has become i n c r e a s i n g l y c l e a r t h a t many p e o p l e a re unsure about how t o a s s i s t a f r i e n d o r l o v e d one i n bereavement. I have proposed t o conduct a s t u d y as a Ma s t e r of A r t t h e s i s i n C o u n s e l l i n g P s y c h o l o g y i n t h e Department of E d u c a t i o n a t the 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 . I t i s a s t u d y which w i l l h e l p b e g i n t o e s t a b l i s h some c r i t e r i a f o r a s s i s t i n g you and o t h e r s i n t h e g r i e f p r o c e s s . The i n t e r v i e w w i l l t a k e about an hour. I w i l l ask you what you have e x p e r i e n c e d as the most h e l p f u l o r the most h a r m f u l d u r i n g your bereavement. You have the r i g h t t o r e f u s e t o p a r t i c i p a t e o r withdraw a t any time w i t h o u t j e o p a r d i z i n g any r e l a t i o n s h i p you may have w i t h N o r t h Shore F a m i l y S e r v i c e s . I w i l l be c o n t a c t i n g you by phone i n the next few weeks t o see i f you would be i n t e r e s t e d i n h e l p i n g me by p a r t i c i p a t i n g i n t h i s s t u d y . S i n c e r e l y , J e s s i c a L. E a s t o n 114 APPENDIX B I / ' , c o n s e n t t o be a p a r t o f t h e s t u d y , A D e s c r i p t i v e A n a l y s i s o f H e l p f u l B e h a v i o r f o r A s s i s t i n g t h e Widowed i n B e r e a v e m e n t . I am aware t h a t J e s s i c a L. E a s t o n i s t h e i n v e s t i g a t o r o f t h i s p r o j e c t w h i c h w i l l be s u b m i t t e d as a M a s t e r s o f A r t t h e s i s i n C o u n s e l l i n g P s y c h o l o g y i n t h e Department o f E d u c a t i o n a t 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 . The p u r p o s e o f t h i s s t u d y i s t o c o l l e c t i n f o r m a t i o n a b o u t t h e h e l p f u l and h a r m f u l i n c i d e n t s a s s o c i a t e d w i t h b e r e a v e m e n t f r o m b e r e a v e d p e o p l e . The p a r t i c i p a n t w i l l be a s k e d t h e q u e s t i o n , "What has been h e l p f u l o r h a r m f u l f o r y o u d u r i n g y o u r e x p e r i e n c e o f g r i e f ? " The i n v e s t i g a t o r w i l l t a p e t h e r e s p o n s e t o t h e q u e s t i o n and t h e p r o c e s s w i l l t a k e a p p r o x i m a t e l y one h o u r . The i d e n t i t y o f t h e p a r t i c i p a n t w i l l be k e p t c o n f i d e n t i a l and t h i s w i l l be a c c o m p l i s h e d by t h e r e s e a r c h e r r e t a i n i n g a l l i n c i d e n t s i n w r i t t e n f o r m , s t r i p p e d o f any i d e n t i f y i n g d a t a . Tapes o f t h e i n t e r v i e w s w i l l be e r a s e d . Any i n q u i r y c o n c e r n i n g t h e p r o c e d u r e s w i l l be welcome by t h e 115 i n v e s t i g a t o r t o i n s u r e t h e p a r t i c i p a n t u n d e r s t a n d s t h e a i m a n d p r o c e s s o f t h i s s t u d y . The p a r t i c i p a n t h a s t h e r i g h t t o r e f u s e t o p a r t i c i p a t e o r w i t h d r a w a t any t i m e he o r she c h o o s e s w i t h o u t j e o p a r d i z i n g any r e l a t i o n s h i p he o r s h e h a s w i t h N o r t h S h o r e F a m i l y S e r v i c e s . I , , c o n s e n t t o p a r t i c i p a t e and a c k n o w l e d g e a r e c e i p t o f a c o p y o f t h i s c o n s e n t f o r m . I , , do n o t c o n s e n t t o p a r t i c i p a t e and a c k n o w l e d g e a r e c e i p t o f a c o p y o f t h i s c o n s e n t f o r m . 116 APPENDIX C DEMOGRAPHIC QUESTIONNAIRE PARTICIPANT NUMBER: G e n e r a l I n f o r m a t i o n : 1. What i s y o u r age? 2. What i s y o u r o c c u p a t i o n ? 3. What i s y o u r r e l i g i o n ? 4. Would y o u d e s c r i b e y o u r d e g r e e o f r e l i g i o u s i n v o l v e m e n t as s l i g h t , m o d e r a t e o r i n v o l v e d ? 5. How l o n g were y o u m a r r i e d ? 6. Was t h i s y o u r f i r s t m a r r i a g e ? 7. Would y o u d e s c r i b e y o u r h u s b a n d ' s d e a t h as sudden o r was t h e d e a t h e x p e c t e d ? 8. Where d i d y o u r husband d i e ? I n y o u r home, h o s p i t a l o r e l s e w h e r e ? I f answer i s " e l s e w h e r e " p l e a s e be s p e c i f i c as t o t h e l o c a t i o n o f h i s d e a t h . 9. Have you r e c e i v e d any p s y c h i a t r i c h e l p s i n c e b e r e a v e m e n t ? 10. What was t h e d a t e o f y o u r h u s b a n d ' s d e a t h ? 11. Do you have c h i l d r e n ? I f t h e answer i s y e s , p l e a s e s t a t e t h e number o f c h i l d r e n you have and t h e i r a g e s ? 12. What i s y o u r e t h n i c o r i g i n ? 13. How wou l d you d e s c r i b e y o u r p r e s e n t f i n a n c i a l s i t u a t i o n s i n c e t h e d e a t h o f y o u r h u s band? I s i t d i f f i c u l t , m o d e r a t e o r e a s y ? 117 APPENDIX D P r o c e d u r e s : " B e f o r e we b e g i n , I w i l l e x p l a i n t o y o u t h e p r o c e d u r e s t h a t I am r e q u i r e d t o f o l l o w . " " I am t a p i n g t h e i n t e r v i e w so t h a t I c a n l i s t e n t o t h e i n t e r v i e w a g a i n and w r i t e down t h e main i d e a s f r o m i t . No one e l s e w i l l l i s t e n t o t h e t a p e and I w i l l e r a s e i t a f t e r c o m p l e t i o n o f t h i s s t u d y . " "You a r e n o t r e q u i r e d t o p a r t i c i p a t e i n t h i s r e s e a r c h and y o u r i n v o l v e m e n t w i l l n o t a f f e c t y o u r p r e s e n t o r f u t u r e r e l a t i o n s h i p w i t h N o r t h S h o r e F a m i l y S e r v i c e s . I f you d e c i d e , a t any t i m e , t h a t you do n o t w i s h t o be i n t e r v i e w e d , l e t me know and I w i l l s t o p t h e i n t e r v i e w . " "Do you have any q u e s t i o n s y ou wo u l d l i k e t o ask b e f o r e we b e g i n ? " I n t r o d u c t i o n ; "The s t u d y I am d o i n g i s t o f i n d o u t what h e l p e d o r what d i d n ' t h e l p p e o p l e d u r i n g t h e i r e x p e r i e n c e o f g r i e f . I ' d l i k e t o know i n s p e c i f i c d e t a i l what you l e a r n e d o r d i s c o v e r e d t h a t h e l p e d you d u r i n g g r i e f as w e l l as t h e 118 s p e c i f i c t h i n g s t h a t y o u d i d o r o t h e r s d i d t h a t y o u e x p e r i e n c e d as h a r m f u l , o r t h a t made i t d i f f i c u l t f o r y o u . N e g a t i v e I n c i d e n t s : " W e ' l l s t a r t w i t h i n c i d e n t s t h a t h a p p e n e d t h a t y o u f e l t w e r e h a r m f u l o r n o t h e l p f u l . T h i n k b a c k t o a s p e c i f i c t i m e when y o u f o u n d y o u r s e l f i n a d i f f i c u l t s i t u a t i o n w h i c h was n o t h e l p f u l t o y o u w h i l e y o u were g r i e v i n g . What d i d y o u do o r what h a p p e n e d t o make y o u f e e l t h i s way? T a k e t h e t i m e t o t h i n k o f a s p e c i f i c i n c i d e n t i n a s much d e t a i l a s p o s s i b l e . When y o u h a v e t h e i n c i d e n t i n m i n d c l e a r l y , l e t me know..." F o l l o w - U p Q u e s t i o n s : "What were t h e g e n e r a l c i r c u m s t a n c e s l e a d i n g up t o t h i s i n c i d e n t ? " "What a c t u a l l y h a p p e n e d when t h i s i n c i d e n t t o o k p l a c e . " "Why was t h i s b e h a v i o r s o h a r m f u l ? " "How i m p o r t a n t was t h i s i n c i d e n t t o y o u a t t h e t i m e ? " "Was t h i s s o h a r m f u l o r u n h e l p f u l t h a t i t c h a n g e d y o u r b e h a v i o u r f o r a d a y , a week, e t c . ? " "When d i d t h i s i n c i d e n t o c c u r ? Was i t i n t h e b e g i n n i n g o f y o u r g r i e f o r l a t e r ? C an y o u be s p e c i f i c a b o u t t h e t i m e i t o c c u r r e d ? " 119 "Do y o u h a v e a n y t h i n g e l s e y o u ' d l i k e t o a d d ? " " T h i n k o f a n o t h e r t i m e e t c . P o s i t i v e I n c i d e n t s : "Now I ' d l i k e y o u t o t h i n k o f a s p e c i f i c t i m e when y o u f o u n d y o u r s e l f i n a s i t u a t i o n w h i c h was h e l p f u l t o y o u w h i l e y o u w e re g r i e v i n g . T a k e t h e t i m e t o t h i n k o f a s p e c i f i c i n c i d e n t i n as much d e t a i l a s p o s s i b l e . What d i d y o u do o r wh a t h a p p e n e d t o make y o u f e e l t h i s way? L e t me know when y o u h a v e a s p e c i f i c i n c i d e n t i n m i n d . . . . ? " F o l l o w - U p Q u e s t i o n s : The same q u e s t i o n s u s e d w i t h t h e n e g a t i v e i n c i d e n t s w e r e a s k e d h e r e . 

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