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The long-term effects of loss in adolescence : exploration and extension of a conceptual schema McKintuck, Charlotte Ann 1992

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THE LONG-TERM EFFECTS OF LOSS IN ADOLESCENCE:EXPLORATION AND EXTENSION OF A CONCEPTUAL SCHEMAByCHARLOTTE ANN McKINTUCKB.Sc.N., The University of British Columbia, 1990A THESIS SUBMITTED IN PARTIAL FULFILMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF SCIENCE IN NURSINGinTHE FACULTY OF GRADUATE STUDIES(School of Nursing)We accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUMBIAApril, 1992© Charlotte Ann McKintuckIn presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature).-DepaFtment—of Qi\CC)1 OC^tin The University of British ColumbiaVancouver, CanadaDate DE-6 (2/88)iiABSTRACTThis study was designed to examine the long-term developmental effects of adolescentparental bereavement, to identify the factors or conditions that contribute to these effects, andto extend and refine Davies' (1991) conceptual schema. The method used in conducting thisstudy was the grounded theory approach of qualitative research.Data were collected through a series of interviews with eight adult subjects who asadolescents experienced the death of a parent. An interview guide created from themes inthe literature and Davies' conceptual schema was used to guide the initial interviews. Datawere subject to constant comparative analysis to uncover the categories and the corephenomenon. Axial analysis was used to re-assemble the data and make connections betweenthe categories. The resulting conceptualization was then reviewed and validated with threesubjects. Finally, the emergent fit technique was used to compare Davies' conceptualschema with the categories and core phenomenon found.Results indicated that adolescents experience a phenomenon of disillusionment whenthey suffer the loss of a parent. The causal conditions of disillusionment were the interactionof the grieving process and the developmental stage of adolescence. Disillusionment wasacute at first, became less so as time went on, but never disappeared altogether. Subjectsintegrated disillusionment into their lives using one or more of five action/interactionalstrategies: normalizing, rationalizing disappointment, re-sourcing needs, assumingresponsibility for others, or self-comforting. Strategies were developmental in nature, withsubjects employing unconscious behaviours in the acute phases of disillusionment, and morevolitional measures as they matured. What strategies were used and the success with whichthe strategies integrated the phenomenon were determined by certain intervening conditions.These conditions were personal or situational in nature and included gender, personality,maturity, sibling order, culture, religiosity, circumstances of the death, relationship with thedeceased parent, family dynamics and coping styles, characteristics of the surviving parent,availability of support, timing of the loss, and economics. Four short-term consequences of111integrating disillusionment were identified: growing up fast, drifting/meandering, takingresponsibility for the self, and fulfilling wishes of the dead parent. Four long-termconsequences were identified: becoming impermeable, becoming the lost parent, regretting,and discovering personal strengths.Results indicated that the adolescent parental bereavement experience was a complexone. Adolescents responded in ways which resembled normal adolescent behaviour, but alsoreflected the grieving process. Subjects described feeling `normless' and used the mostsalient of social cues to guide their behaviours at the time of their loss. Surviving parentswere, without exception, poorly viewed. Close peers provided support, but less intimatepeers reminded subjects how different they were. In later life, disillusionment affectedcareer choices, interpersonal relationships, self-concept, and health behaviours.Implications for nursing practice included that nurses provide norms for parentallybereaved adolescents, carefully assess coping behaviours as potential defenses, attempt toreduce the estrangement that sets in between adolescents and surviving parents, assess andsupplement support systems, and use their knowledge of disillusionment to guide their careof adults who as adolescents lost a parent, and might yet be experiencing its effects. Withregard to nursing research, the need for longitudinal, prospective designs using qualitativemethods was supported. The results reinforced the need to describe a comprehensive, well-integrated theory of the adolescent bereavement experience.ivTABLE OF CONTENTSABSTRACT ^  iiTABLE OF CONTENTS ^  ivLIST OF TABLES  viLIST OF FIGURES ^  viiACKNOWLEDGEMENTS  viiiCHAPTER ONE^Introduction ^  1Background and Conceptualization of the Problem ^  1Statement of the Problem  4Purpose ^  4Research Questions ^  5Assumptions  5Definition of Terms  5CHAPTER TWO^Review of the Literature ^  7Developmental Tasks of the Adolescent  7Sibling Loss in Adolescence ^  8Self-Concept  8Bereavement Responses  11Family Relationships ^  13Religiosity ^  15Gender Differences  16Parent Loss in Adolescence ^  17Self-Concept and Developmental Issues ^  18Family Relationships and Support Resources  19Bereavement Responses  22Religiosity ^  24Gender Issues  24Summary ^  27CHAPTER THREE^Methods ^  29Study Design  29Data Collection  30Instrumentation ^  32Sample Selection  32Criteria for Selection  33Recruitment of Subjects ^  34Data Analysis ^  35VValidity and Reliability ^  41Validity  41Reliability  42Ethical Considerations  43CHAPTER FOUR^Results ^  45Characteristics of Subjects  45The Process of Integrating Disillusionment ^  48Disillusionment^  49Action/Interactional Strategies  57Intervening Conditions  74Personal Factors  75Situational Factors ^  84Consequences  97Subjects' Experience of Participating in the Study  ^115CHAPTER FIVE^Discussion and Implications ^  117Integrating Disillusionment ^  118Disillusionment  120Action/Interactional Strategies and Associated Intervening Conditions^125Short-Term Consequences  145Long-Term Consequences ^  151Davies' Conceptual Schema - Emergent Fit ^  158Nursing Implications ^  161Implications for Nursing Practice  161Implications for Nursing Research ^  171Limitations and Strengths ^  174REFERENCES 177APPENDIXES ^Appendix AAppendix BAppendix CAppendix DAppendix EAppendix F183Interview Guidelines ^  184Demographic Data  187Advertisement for Volunteers ^  189Ethical Approval  190Summary of Study ^  191Consent to Study  192LIST OF TABLESTABLE^ PAGEI Decision Trail of Conceptual Analysis ^  37II Axial Coding of the Data ^ 40III Demographic Characteristics of Subjects ^  47viLIST OF FIGURESFIGURE^ PAGE1. The Process of Integrating Disillusionment ^ 502. Associations Between Intervening Conditions, Strategies and Consequences .. 119vi'vii'ACKNOWLEDGEMENTSI wish to recognise the many people who have supported this effort in a myriad ofways. First, I would like to express my heartfelt appreciation for my thesis committee: Dr.Betty Davies for her support, her guidance, her indomitable enthusiasm, and her very specialfriendship; Dr. Heather Clarke for her wisdom, her clarity of thought, and her sense ofhumour; and Wendy Hall for her careful attention to detail, her insightful and supportivesuggestions, and her genuine interest and warmth. I feel exceedingly enriched by myassociation with you all, and I thank you for that.Second, I would like to acknowledge the support of my professors at the University ofBritish Columbia Faculty of Nursing. From each I have gleaned some part of the individualwho I am today. I also wish to acknowledge the Faculty of Graduate Studies, University ofBritish Columbia for their financial assistance in this undertaking.I would like to express my deepest gratitude to the eight informants who so graciouslyshared their experiences and insights with me, stirring what I know to be remarkably painfulmemories of lost love and security. Without their generosity of spirit, this project would nothave been possible.There are many colleagues and friends who have supported various parts of thisprocess. I thank Debbie McMillan for her practical and spiritual support: practical, in herherculean efforts in preparing the transcripts, and spiritual, in her unflinching supportthrough all the uncertainties, and for patiently waiting for me to resurface when I would`disappear into the trenches.' I would like to thank Carmel for 'pulling it out at the end'with her sharp, but wise blue pencil. I also thank Ellen for being a 'bud' and for rescuingme from taking myself altogether too seriously.Finally, I am especially grateful to my husband, Dennis, who asked so little and gaveso much at a time when I so desperately needed it, and for his perpetual support of me andfaith in my abilities.1CHAPTER ONEIntroductionBackground and Conceptualization of the ProblemAdolescence is "the genesis of individuality; a second social birth" (Kuczynski, 1988,p.77). In adolescence there are beginnings and endings: preparations for future stages, anddepartures from earlier ones. Adolescence is more than a transition from childhood toadulthood, it is a period with characteristics of its own, a time of unique experiences thatbelong to this decade alone. It is characterized by fundamental changes in physical,cognitive, emotional, moral, and psychosocial development. It is a time when the repertoireof skills necessary for adult interpersonal relationships are honed; a rapid increase in thediversity of social roles is experienced; reasoning and a mature sense of morality areachieved; and the individual's identity is established. Adolescence ends with thedevelopment of an identity separate from parents, and the ability to form mature relationshipsof friendship and love (Brim, 1965; Erikson, 1968; Kohlberg, 1969; Papalia & Olds, 1981;and Piaget, 1971).During adolescence, the loss of a significant relationship may interfere in what seemsto be a natural, albeit tumultuous progression of development. The most intensebereavement responses are associated with the death of a parent (Raphael, 1983; and Palazzi,De Vito, Luzzati, Guerrini, & Torre, 1990). Death of a mother or father leaves theadolescent particularly vulnerable as the adolescent must deal with his/her own anguish in themidst of a grief-stricken family. In a similar vein, sibling death in adolescence has beendescribed as "one of the most traumatic and least-understood crises that an adolescent couldencounter" (Hogan, 1988, p.333). In their study of adolescent sibling bereavementOsterweis, Solomon and Green (1984) observed that bereaved siblings are at risk for2medical, psychiatric and behavioural dysfunction, and claim that adolescence is a particularlyvulnerable period during which to experience a sibling's death. What follows from theseobservations is that whether the adolescent experiences the loss of a sibling or the loss of aparent, bereavement at this time of life may disrupt the achievement of adolescent tasks, andas these tasks are foundational to the achievement of ensuing developmental milestones, hasthe potential to incur far-reaching effects for the individual's subsequent growth anddevelopment.Only in the past decade has research begun to emerge on the effects of bereavement onthe adolescent. Balk (1991), in his review of adolescent bereavement research, points to theneed for the development of theoretical models, and views those arising from qualitativemethods to be appropriate to furthering the understanding of the experience and effects ofadolescent loss. He states that adolescent researchers have neglected this area as theconcepts of death and bereavement are so foreign to our ideal of adolescence. Gordon(1986) observes that this denial has dire implications for the bereaved adolescent: "attemptsto deny death shortchange the normal adolescent by forcing him or her to deal with theshocking comprehension of loss alone or with uninitiated and uniformed peers" (p.22). Inorder to provide appropriate support to grieving adolescents as well as to better understandthe unique sensitivities that adults who have experienced adolescent bereavement may have,research is required to discern the developmental effects of the adolescent loss experience.Addressing this gap, Davies (1991) has begun to identify the long-term outcomes ofadolescent bereavement by developing a conceptual schema, which describes from agrounded theory approach, the experiences of adults, who as adolescents lost a sibling.Davies' conceptual schema identifies three essential themes: a) enhanced personal growth andmaturity; b) being different; and c) withdrawing. Her findings suggest that adolescents who3experience the loss of a sibling perceive a sense of enhanced personal growth and maturity ascompared to their peers who did not experience a loss of this kind. Her subjects perceivedthemselves as being well-equipped to face other deaths in later years, rather than feeling itnecessary or useful to avoid or deny death. Generally, her subjects reported having anunderstanding of the meaning of life which they believed was related to their early lossexperience - eg. they felt that they were better able to help others who experienced a death ofa loved one. Such prodigious psychological growth led to feelings for these individuals ofbeing dijferent from their adolescent peers, which for some, resulted in an intolerance fordevelopmentally appropriate behaviours demonstrated by their peers. Their newly-foundmaturity led to a higher regard for the seriousness of life, which prevented them fromcomfortably engaging in the developmentally appropriate activities of adolescence as theyperceived their peers' antics as trivial and intolerable. Some subjects responded to thesefeelings by withdrawing from their peers. They expressed a preference for solitary activitieswhich, in some cases led to long-term feelings of sadness and detachment from others.Withdrawal from peers occurs for the bereaved adolescent at a time when peer relationshipsare critical to the completion of their developmental tasks For these individuals, thepotential exists for long-term negative outcomes of sibling bereavement including a chronicsense of loneliness and isolation, and difficulty in initiating and maintaining interpersonalrelationships (Davies, 1991).Davies' three themes noted above were used as orienting points for the development ofthis study which focused on the similar, yet different experience of adolescent parentalbereavement. However, as the method used in the study was grounded theory, Davies'Schema provided merely a point of departure, and was neither a blueprint nor prescriptionfor analysis. Because the grounded theory approach is a recursive one, Davies' themes were4refined, extended or refuted as they were compared to the theoretical explanations emergingfrom the data generated throughout the course of this study.Statement of the ProblemThe general problem addressed in this study originated from a lack of knowledge abouthow parental bereavement in adolescence affects the achievement of adolescentdevelopmental tasks, and how differential task achievement might affect the completion ofadolescent development and entry into adulthood. This study aimed to explore the long-termdevelopmental effects of adolescent parental bereavement, as well as the factors andconditions which contribute to these effects. Knowledge gained about how adolescentparental bereavement may potentially affect an individual's development is necessary in orderto provide appropriate guidance and support to adolescents and their families at the time oftheir bereavement; and later, to foster insight in bereft individuals should the effects of theirloss prove to have long-term implications.PurposeThe objective of this study was grounded theory development, in particular, to extendand refine Davies' conceptual schema (1991). Davies' conceptual schema describes thelong-term developmental effects on a group of subjects who, as adolescents, experienced theloss of a sibling. This study sought to explore the experience of adults who have, asadolescents, experienced the loss of a parent. The two studies were similar as they bothexplore adolescent loss, however they differ in terms of the object of loss. Information fromthis study was used to determine whether the original schema describing the long-termdevelopmental effects of the loss of a sibling in adolescence "fits" for those who experiencedthe loss of a parent during adolescence. Fulfilment of this purpose served to elaborate on thedimensions of the original schema, and contribute to the much-needed groundwork to further5nursing theory development related to adolescent bereavement.Research QuestionsThe research questions that directed the study were:1. What are the long-term developmental effects of the loss of a parent in adolescence?2. What are the factors or conditions which contribute to these effects?3.^To what extent does Davies' conceptual schema fit the experiences of the sample ofadults who as adolescents experienced the loss of a parent?AssumptionsThe following assumptions were inherent in the study:1. the loss of a parent is an event of some significance for the adolescent at the time of itsoccurrence;2. individuals who were selected by the researcher to participate in the study hadlegitimately experienced the loss of a parent as an adolescent;3.^subjects answered the questions posed by the researcher honestly and frankly.Definition of TermsThe following definitions of major terms were used:Adolescence the span of years between 13 and 17 (this age span was chosen as itcorresponded precisely with the age of Davies' subjects)Sibling^a brother or a sister, natural or adoptive, sharing the same set of parents, orhaving at least one parent in commonParent^a father or a mother, either natural or 'step' - the person who was parentingthe child at the time of the lossLoss^a phenomenon that is individually perceived which occurs when anythingwhich has value is separated from the individual - in this study, restricted toloss associated with deathLong-term^a period of time greater than five years.67CHAPTER TWOReview of the LiteratureRelevant research studies and theoretical perspectives were examined in order to placethis study within the context of current knowledge in the field. First, an overview isprovided of the characteristics of normal adolescence, drawing largely on Erikson'spsychosocial theory of development. This is followed by a review of the adolescentbereavement literature which was generated by several disciplines. Studies examining theeffects of the adolescent's loss of a sibling outnumbered those focusing on loss of a parent.Both areas of inquiry reported similar factors and conditions related to the adolescent'sbereavement, but there was considerable variation in the findings. Therefore, the siblingbereavement literature is presented separately from the parental bereavement literature.Developmental Tasks of the AdolescentIn his psychosocial theory of development, Erik Erikson (1963, 1965, 1968) identifiedadolescence as the period of time where the individual faces the crises of ego identity versusrole confusion. The adolescents' rapid physiological growth, sexual maturation, andintellectual expansion underscore their impending adulthood, and they respond by beginningto examine the roles which they will take in adult society. Adolescence is a time forexistential confrontations: Who am I? Where am I going? Who do I want to be? Whatis life all about? Adolescents' search for identity involves a quest for values which they canaccept. These values are ideological and personal, and the extent to which adolescents canbe faithful to them is largely determined by their ability to resolve the crises associated withthis period (Erikson, 1965).By the time children reach adolescence, they are capable of propositional andhypodeductive thinking - they can dissect ideas, restructuring and recombining them into new8configurations. These cognitive abilities are necessary for the task of ego identity. Erikson(1965) emphasizes that the adolescent effort to make sense of the self and the world is ahealthy, vital process that contributes to the ego-strength of the mature adult. This is not tosay that the quest for self ends with the attainment of adulthood - Erikson asserts that thejourney is a lifelong one, and one which begins in adolescence.Sibling Loss in AdolescencePrior to the 1980's very little research attention has been given to adolescentbereavement, a situation which is possibly related to the unnatural aspect of death andbereavement during adolescence (Balk, 1991). Another reason that this group's needs mayhave been overlooked may be because society expects that adolescents are more mature, thatthey think rationally and can therefore understand and cope with what is happening. Inreality, sibling-bereaved adolescents are in an extremely vulnerable position when much thatthey perceive as stable, much that they value, and much that they have taken for granted isthreatened or swept away (Adams & Deveau, 1987). A review of the literature in this areayielded the following themes: self-concept, bereavement responses, family relationships,religiosity, and gender differences.Self-ConceptAdolescent researchers have focused their efforts mostly on studying the effect ofsibling bereavement on self-concept. Many of the studies which used self-concept measuresto compare sibling bereaved adolescents with their nonbereaved peers found no differencebetween the two groups (Balk, 1981, 1983; Hogan & Balk, 1990; Morawetz, 1982). Balk's(1983) descriptive study of sibling bereaved adolescents (14-16 years old, n==33) reportedthat approximately two years after their siblings' deaths, adolescents' adjustment on mostdimensions of self-concept as measured by the Offer Self-Image Questionnaire was the same9as that of non-bereaved adolescents. Exceptions were that the bereaved group had a bettergrasp of a system of moral values, an increased sense of personal maturity, and a sense ofhaving learned some hard life lessons from the experience which they believed theirnonbereaved peers had not.Guerriero and Fleming (1985), in their longitudinal descriptive study of adolescentreactions to sibling death (13-18 years old, n=63), found that bereaved adolescents'self-concepts, as measured by the Tennessee Self-Concept Scale, were actually healthier thanthose of control subjects during the first year of grief, and although this advantage did nothold over time (4 years), "at no time were the bereaved group's (self- concept) scoressignificantly lower than those of the control group" (p.15). This positive finding is supportedby the findings in a descriptive study of the long-term (7-9 years) effects of sibling death onself-concept (n=58) (Martinson, Davies, & McClowry, 1987). Bereaved siblings scoredhigher on the Piers-Harris Self-Concept Scale than did the group of children on which thescale was normed. Content analysis of interview data indicated that overall, siblingsperceived that they had gained a higher degree of maturity in adolescence, and had a sensepsychological growth as a result of their experience. Review of the lowest self-conceptscores revealed the factors of comparing unfavourably with the deceased sibling and feelingdisplaced in the family by other children as instrumental to the adolescents' low self-esteem.Similarly, in her exploration of the long-term effects of adolescent sibling bereavement,Davies (1991) found that subjects experienced psychological growth, a sense of feelingdifferent from, and withdrawal from their peers. Psychological growth was evidenced bysubjects' feelings of comfort with death, ability to help others similarly affected, and theirdevelopment of a sensitive outlook on life. These three elements contributed to a fourthpositive outcome: the subject's sense that they felt good about themselves. Feeling different10was a result of having come to view life as very precious, which itself led to a sense aboutthe seriousness of life which prevented the subjects from comfortably engaging in the"developmentally appropriate behaviours of childhood and adolescence" (Davies, 1991,p.90). This led to the third response, withdrawal from involvement with peers; this at atime when peer relationships are pivotal to the successful completion of the developmentaltasks of identity establishment and relationship forging.A further study by Balk (1990) found that differing levels of self-concept as assessed bythe Offer Self-Image Questionnaire for Adolescents were associated with various feelings,symptoms and behaviours for sibling-bereaved adolescents (n=42). Adolescents with lowself-concept reported greater feelings of depression and fear, suicidal ideation, difficulty withsleeping, persistent thoughts of the dead sibling, higher levels of confusion about the deathand concomitantly lower levels of anger. Adolescents with average self-concept scores weremore inclined to be angry after the death, but had less trouble eating and sleeping. Overtime, however, these adolescents reported more anger, loneliness, and depression than didother adolescents who had lost a sibling. Finally, adolescents with high self-concept weremost likely to feel confused and to have difficulty eating and sleeping immediately followingthe death, but over time were the least likely to feel confused, lonely, afraid or depressed ofall the adolescents studied.The foregoing results suggest that the relationship between adolescent bereavement andself-concept is complex: while it appears that self-concept affects how the adolescent dealswith bereavement, the adolescent's loss experience also seems to influence the developmentof self-concept for these individuals. Bereavement has either no effect on self-concept, oralternatively, a positive effect on certain aspects of self-concept. More research is requiredto understand the complicated interplay between self-concept and adolescent bereavement, as11this bears on the short and long-term adjustments to a profound loss.Bereavement ResponsesA number of studies detailed adolescent bereavement responses to sibling loss. In hisdescriptive studies Balk (1981, 1983), found that emotional responses were initially intense,but diminished over time. However, many adolescents in both studies continued toexperience lingering feelings of confusion, depression, anger and guilt. These results are notentirely supported by those of Guerriero and Fleming (1985), who found that their subjects'depression scores resembled those of their nonbereaved controls by the third yearpost-bereavement, although subjects persisted in their reports of confusion and sadness.These contrary findings may relate to different research methods: Guerriero and Flemingusing a standardized objective measure of depression (Depression Adjectives Checklist)administered four times at six-month intervals, and Balk using retrospective self-reportinterviewing subjects an average of 23.6 months after the death of their sibling. What isimportant is that the adolescents themselves in both studies felt more confused, depressed,angry, and guilty. One possible explanation for Guerriero and Fleming's nonsignificantfindings is that their adolescent subjects, over time, were better able to conceal their feelingsfrom outside observers.Adams and Deveau (1987) reporting on two in-depth case analyses, characterize theirsubjects' emotional reactions as sad, angry, ambivalent and guilty. Sad, about the loss oftheir sibling, as well as for the dramatic and unwelcome changes in their lives; angry atparents for adding to their responsibilities, at the same time as seeming to misunderstand orignore all that they were feeling; ambivalent towards the dead sibling for 'dying on them'and forever changing the family circle; and guilty for failing to resolve past disagreements12with the deceased sibling, and for being the survivor. Hogan (1987), in her descriptiveinvestigation of the sibling bereavement response after a three year period (n=40),discovered 39 concept areas which included emotional reactions of anger, anniversaryreactions, compassion for mother and father, and avoidance. In her study examining thelong-term (X=17 years) effects of adolescent sibling bereavement, Davies (1991) found thatimmediately following the loss of their sibling, subjects (n=12) remembered feeling shocked,numb, sad, lonely, angry, and depressed. Most of the participants (10) indicated that thesefeelings persisted over the years, but that they were much less intense than they were duringthe first few years. In both studies, sibling-bereaved subjects were to some extent stillgrieving their loss years after the event.Both Balk (1981, 1983) and Hogan (1987) reported that grades and study habits werenoticeably and adversely affected following a sibling's death. Bereaved adolescents reportedtrouble concentrating on their school work, feeling preoccupied by all that was going onaround them, and to some extent, justified in their failure to attend to their studies. Overtime however, grades and study habits returned to normal for most of these adolescents, butfor Balk's (1981) group, a few subjects continued to experience academic motivation andskills below their previous standards. This persistently reduced interest and skill in schoolwork has implications for setting educational goals, selecting career options, self-esteem, anda long-term sense of personal achievement for these individuals.Guerriero and Fleming (1985) also found that the physical health of their subjectsdeteriorated over time, and remained different from that of nonbereaved controls for the fouryear duration of their study. Additionally, female bereaved adolescents had, according to theCornell Medical Index, poorer physical health than both their male counterparts and theirsame sex controls, suggesting that there may be a sex difference in how adolescents deal with13their grief. Balk (1983) noted that, immediately following the loss of their siblings, hissubjects reported difficulty sleeping and eating where none had been experienced prior totheir loss. Contrary to Guerriero and Fleming's (1985) findings, these difficulties hadresolved by the time the study was conducted, an average of 23.6 months after thebereavement experience. Further study of these bereavement responses is required not onlyto clarify their short-term consequences for sibling bereaved adolescents, but also to elucidatetheir role in contributing to long-term developmental effects for these individuals.Family RelationshipsWhen an adolescent loses a sibling, the loss is one which is endured by the entirefamily. The survivors - both parents and siblings - must adapt to a new reality, a complexfamily process which is far more complicated than the sum of the individual responses of thesurvivors. Adams and Deveau (1987) theorize how sibling bereaved adolescents arevulnerable to the consequences of parental grief reactions. Parents may be so consumed bytheir own grief that they have little energy left to help surviving adolescents. In addition,parents, believing that adolescents desire independence and privacy, may not recognize thatadolescents need their support to decrease feelings of isolation and loneliness. Balk (1983)found that less than half his subjects reported talking to family members about their feelingsuntil well after the loss experience. Some authors believe that the lack of attention affordedadolescents is a result of society viewing loss and grief as being most difficult for the parentsand young children (Adams & Deveau, 1987; Rosen, 1986). As a result, when a child dies,sympathy and understanding is reserved first for mothers, then to the younger siblings, andto a lesser extent, is extended to the fathers. Adolescent needs are effectively eclipsed in thismodel - they are expected to deal with their own feelings, place other family members' needsbefore their own, and comfort and care for their stricken parents or young siblings. These14heavy expectations and responsibilities come to the bereaved adolescent at precisely the timethat they may need to be nurtured and cared for themselves. This theory portends direimplications for adolescents as they demonstrate a high degree of susceptibility to social cuesat this time in their development (Basow, 1986). In an attempt to be seen to do the rightthing, adolescents may deny their own grieving and grief related needs to attend to theirparents or younger siblings.Adolescent bereavement responses also vary according to the quality of familycommunication and cohesiveness. In families where members shared their feelings openly,bereaved adolescents reported feeling shocked, numb, lonely and afraid after their sibling'sdeath, but over time, these intense feelings subsided leaving only a lingering sense of sadness(Balk, 1981, 1983). In families marked by emotional distance, adolescents initially reportedfeeling guilty and angry, but denied feeling shocked, numb, or afraid. Over time, theseadolescents reported feeling confused about the death, but also indicated a sense of relief thatthe ordeal was over. These studies suggest that families and their characteristic dynamicsmay be factors which contribute to the long-term effects of bereavement outcome, but moreresearch is required to understand the nature of the relationship.Hogan's (1988) study of the effects of time on the adolescent sibling bereavementprocess found that as time from the death increases, mothers were identified as the principleperson with whom bereaved adolescents could talk. Her subjects (n=40) believed that theirfathers had become more distant and less available to them as time passed (18-36 months).Other changes in the family included a sense that the family moved from incomplete in theearly phase (3-18 months) to normal in the later phase (18-36 months). Hogan (1988)cautions that normal does not imply that the family returned to some pre-bereavement state,nor that bereavement is in any sense time-limited, but rather that a new sense of family is15established with a new set of boundaries and identities.Finally, in their descriptive study, Hogan and Balk (1990) reported adolescent reactionsto sibling death from the perspectives of the mothers (n=14), the fathers (n=14), and theadolescents themselves (n=14). Comparisons showed that the mothers reported theiradolescents as having a better self-concept than the adolescent actually had, and that fatherswere more accurate in their assessment of this measure in their adolescents. In the samevein, mothers also saw their adolescent's grief reactions as lasting longer than the adolescentsdid, and again, fathers were better predictors of this feature. These results reflect thecomplex dynamics related to family bereavement, and points to the need to study adolescentloss from the perspective of the bereaved adolescents themselves.ReligiosityReligious beliefs interact with the process of adolescent mourning. The evidencesuggests that specific bereavement reactions differentiate religious from non-religious youths,but that the relationship is not straightforward. Balk (1988, 1991) found that religiousadolescents report more confusion, while nonreligious adolescents report more depressionand fear, however he warns against erroneously concluding that religious belief in and ofitself makes coping with a sibling's death easier. While religion may have taken onincreased importance for sibling-bereaved subjects, this turn to religion only occurred afterconsiderable questioning of, and anger at God. Hogan (1988) describes two phases in siblingbereaved adolescents assigning blame for their loss, first to themselves 3-18 months after theloss, and then later to God at 18-36 months. Lagrand (1986) in his study of sibling-bereavedcollege students reports a gender difference associated with religiosity with female subjectsbuilding acceptance of their loss on a foundation of religious belief more so than did malesubjects. The question is whether the religious grounding shapes the bereavement16experience, or the bereavement experience effects the adolescent's spirituality. These studiessuggest that religiosity may be a significant factor in some adolescents' bereavementexperiences, but that generalizations in this area should not be made.Gender DifferencesSeveral gender differences have been noted. Females and males report differentfeelings during the first few weeks following the loss of a younger sibling, with femalesfeeling less shocked and fearful than did their male counterparts. (Balk, 1981, 1983). Incontrast with these findings, Guerriero and Fleming (1985) reported that bereaved femalesexperienced greater death anxiety (anxiety about their own death) than did bereaved malesfollowing their sibling's death. Looking at differential expression of feelings, Adams andDeveau (1987) reported that while subjects claimed to be angry following the death of theirsiblings, they expressed their anger in accordance with their gender. The male response wasto become openly demanding and defiant, rebelling against his parents and demonstratinghostility while the female response was more passive, withdrawing and seeking refuge inpeer support and substance abuse. Adolescents' sensitivity to social cues is strongestsurrounding the issue of gender appropriate behaviour (Basow, 1986). These studies supportBasow's theory, suggesting that gender differences exist in both the report of emotionalexperience of loss, as well as the expression of needs and feelings surrounding theexperience. No research was found describing the long-term gender differences in adolescentdevelopment following sibling bereavement.In summary, a number of studies and theorists have examined the immediate orshort-term effects of sibling bereavement in childhood and adolescence. Considerably lessresearch has been reported describing the long-term effects of sibling death on survivingchildren, and only three studies discussed the long-term effects of loss of a sibling in17adolescence. Factors and conditions of adolescent sibling bereavement which have beenexplored include self-concept, bereavement responses, family relationships, bereavementresponses, religiosity, and gender differences. Findings indicate that the relationship betweenself-concept and bereavement is complex; that psychological and physical bereavementresponses are long-lived but vary depending upon the measure used, time elapsed sincedeath, and sex of the subject; that the effect of family dynamics are important and stronglyinfluenced by social expectations; that religiosity of the adolescent, while significant, at thispoint in theory development, does not lead to conclusive insights; and that gender differencesmay well influence adolescent's emotional experience and expression of feelings concerningtheir loss.Parent Loss in AdolescenceWhile losing a parent in adulthood is grievous enough, it is an especially excruciatingexperience for adolescents because they have not yet achieved a sense of independence oridentity, nor has the intensity of their relationships with their parents been diluted by otherattachments and loves (Raphael, 1983; Segal, 1989). Most writings prior to the past decadefocused on disturbed adolescents or those who were already engaged in psychotherapy whenthey experienced their loss. As Corr (1989) points out, grief and mourning are notpsychiatric processes, and as such should not be studied from this frame of reference.What follows is a review of the literature which describes bereavement amongadolescents who have lost a parent. As with the research reviewed regarding siblingbereavement, this section will be subdivided according to the factors and conditions discussedin the research findings: self-concept and developmental issues, family relationships andsupport resources, bereavement responses, religiosity, and gender issues.18Self-Concept and Developmental IssuesSeveral researchers and theorists have explored the relationship between the adolescentbereavement and the development of self (Castiglia, 1988; Furman, 1984; Josephs, 1982;Palazzi, et al., 1990; Raphael, 1983; and Wass & Corr, 1984). Josephs' (1982) descriptivestudy of the effects of parental bereavement on adult women (n=30) found that subjectsfared differently depending upon their report of a disturbed childhood or of a relativelynormal one. Subjects who reported a disturbed childhood tended to feel isolated and insecureat the time of their loss. They frequently reported feelings of guilt and depression in theyears following the loss, and as adults tended to feel that their lives were full of emotionalturmoil and relationship difficulties. In contrast, subjects who claimed to have had a normalchildhood tended to view the bereavement as a painful experience that they endured and leftbehind without any lasting ill effects. All subjects felt that they had to grow up quickly atthe time of their loss; and that they became more mature, responsible, independent andcynical as a result of their loss. As adults they continued to miss the deceased parent andwished that the parent was still alive to share important events with them. He concluded thatparental bereavement does not create new personality disturbances, but rather reinforcestrends already present from childhood (Josephs, 1982).In their descriptive correlational study of the relationship between life events anddisturbed self-image, Palazzi et al. (1990) found that death of the mother, followed byabortion, and death of the father rated highest amongst events of importance to theiradolescent subjects (n=1296). Death of mother was found to have a very high associationwith disturbed self-image for these adolescents however, as was found with the siblingbereavement research regarding self-concept, the researchers caution against too conclusivean interpretation of the direction of this relationship.19Theorists who have attempted to describe developmental effects of parental loss inadolescence indicate that while vacillations between independence and dependence, andbetween mature and immature needs and behaviours are normal during adolescence, they areespecially consequential when the adolescent copes with the devastating loss of a parent(Raphael, 1983; Wass & Corr, 1984). Parental loss is especially difficult for adolescents astheir recent tentative steps towards independence lead them to believe that they no longerneed their parents as they did when they were a child, however as Wass and Corr state "it isone thing to be struggling to free oneself and become independent, knowing that both parentsare available when needed. It is quite a different experience when death removes a parent inthe midst of the struggle" (1984, p.212).Other theorists have related this interrupted struggle for independence with subsequentdifficulty for adolescents/young adults leaving home (Castiglia, 1988; Furman, 1984).Parentally bereaved adolescents, developmentally at the point of leaving the parents, mayexperience difficulty in either moving away from the surviving parent or following thedeceased parent into adulthood. In terms of the first difficulty, the adolescent often remainswith the surviving parent for fear that this sole parent might die, which results in theadolescent's emotional security being entirely invested in the one person. The seconddifficulty was less well documented in the literature, however both hypotheses meritexploration as the effect on the adolescent's subsequent development is potentially significant.Family Relationships and Support ResourcesSeveral investigators have studied the role of family relationships in adolescentbereavement (Cragg & Berman, 1990; Goodman, 1986; Gray, 1987a, 1988; and Hogan,1988). In his correlational descriptive study (n=50) of the role of the surviving parent in theadaptation of bereaved adolescents, Gray (1987a) found that adolescents who had a good20relationship with a surviving parent prior to and following the loss adapted better (asmeasured by depression) than those with a poor relationship with the surviving parent.However, he suggested that it may be difficult for adolescents to accept support from thesurviving parents for fear that this may compromise their need to be independent andseparate. Peers were an alternate source of support, if support was offered in terms of whatadolescents felt was appropriate for their age and gender. Findings from this study revealedthat the following were of importance to the bereaved adolescent: a) feeling that they wereheard; b) that the support received was embedded within a reciprocal relationship; and c) thatthey were not obliged to discuss anything that they were uncomfortable sharing. These threeitems relate to the adolescent's developmental task of ego formation, and their correspondingneeds to be acknowledged as an individual, to be accepted as an equal, and to exercisecontrol over their life situation.Cragg and Berman (1990) reported in their qualitative study of adolescents' reactions tothe death of a parent from cancer, that subjects (n =10) felt that communication about theparent's illness and death had been open prior to the death, but that patterns betweensurviving parents and the adolescents changed after the ill parent had died. Discussionwithin families decreased, with some adolescents reporting that they did not talk about theirfeelings for fear that they would further upset the surviving parent. This finding is consistentwith Castiglia's (1988) theory that parents may not be an adequate source of support foradolescents because at the same time as adolescents require their support, parents are copingwith their own feelings at the loss of their spouse. As with Gray's (1987a) findings,alternate sources of support were friends and siblings, with the exception that someadolescents reported having difficulty turning to peers who had not experienced the loss of aparent. Differentiating between experienced and inexperienced peers was repeated in21Goodman's (1986) descriptive study (n=30) where support from the surviving parent wasvaluable to the adolescent in terms of resolving their grief, followed by support from peerswho themselves had experienced the loss of a parent. These studies' findings regarding peersupport are consistent with Davies' (1991) findings, where sibling-bereaved adolescentsreported feeling different and withdrawing from their uninitiated peers.Gray (1988) interviewed 50 high school students who had lost a parent through death inthe previous five years to investigate who provides support to parentally bereaved teenagers,and how these people are helpful. Support, as measured by the Gottlieb (1978) classificationscheme, came from peers, parents, teachers, and school nurses or counselors. Peers werecited as the most helpful supports to subjects (40% of the time), however while close friendswere confided in and provided emotional support, the larger network of peers tended towithdraw from subjects leaving them feeling socially isolated and abnormal. Support fromsurviving parents varied considerably with 34% subjects reporting that their surviving parentwas "very helpful," and 30% rating the parent as "not at all helpful." For those subjectswho reported the surviving parent unhelpful, several indicated that they had been unable orunwilling to accept the support offered, while others indicated that they wished more supporthad been forthcoming. Support from teachers was poor, with 42% of subjects indicating thatteachers were often unhelpful or only helpful in minimal ways - ie. telling students to"buckle down" and focus on their school work; drawing attention to the bereaved student asdifferent from his or her peers; and for a few, displaying open hostility towards the subjects.School nurses or counselors were only found to be helpful if subjects were participating in apeer support program (68%).In summary, surviving parents and peers seem to represent the most important sourcesof support for parentally bereaved adolescents. For surviving parents, the critical variables22are the pre-death relationship with the adolescent, their ability to cope with their own loss,and the extent to which the adolescent can tolerate depending upon a figure from whom theyhave been recently pulling away. For peers, the issues appear to be closeness of therelationship, and the similarity between life experiences. For both, parentally bereavedadolescents deem support acceptable or not in accordance with what they feel is age andgender appropriate for them.Bereavement ResponsesMany authors have described the adolescent parental bereavement response (Castiglia,1988; Cragg & Berman, 1990; Goodman, 1986, Gray, 1987a, 1987b; Josephs, 1982;Murphy, 1986-87). Castiglia (1988) theorizes that when one parent dies, the adolescent maybecome preoccupied with the possibility of loss of the surviving parent. According to herhypothesis, this fear may be manifest in close attachment to the surviving parent, orparadoxically, in withdrawal or detachment. This theory warrants empirical investigation, asextremes of either alternative may have consequences for the subsequent development of theadolescent.Josephs (1982) describes subjects responding to the loss of their parent with feelings ofgrief and sadness. Other frequently reported reactions were shock, anger, and guilt.Subjects indicated that they did not tend to share their feelings or thoughts about the parent'sdeath with anyone else, and stated that they went through the bereavement experience alonewith few, if any interpersonal supports. Similarly, Gray's (1987a) participants demonstratedhigher depression scores than those reported for nonbereaved American high school studentson whom his instrument (BDI) was normed. In Gray's (1987b) study, it was also found thatalienation occurred for a number of the adolescents, and that this was associated with theadolescents': a) difficulty in tolerating and sharing intense feelings; b) anger directed at the23surviving parent, which was displaced from the deceased parent for having 'abandoned'them; and c) sense that parents were too preoccupied with their own grief to comfort them.He also reported that amount of elapsed time did not differentiate the adolescents' responses(the mean amount of time since parents' death was 28.6 months with a range of 6 months to5 years). Davies' (1991) study of adults who lost a sibling as adolescents suggests that for anumber of these individuals the sense of loss and sadness may lose its sharpness, but neverfades away altogether. This has implications in terms of normalizing these feelings forindividuals who have suffered either a sibling or parental loss in their adolescence, andrequires further investigation.Murphy (1986-87) completed descriptive correlational research with parentally bereavedcollege students (n=184) and found that adolescents who reported greater feelings ofloneliness also had the lowest self-esteem. She also confirmed that unresolved grief in thisgroup often emerged as the primary factor causing the individual to seek professionalcounselling. Significant findings were also reported regarding school performance and age ofthe subject, with younger adolescents (12-15 years) suffering the greatest drop in schoolgrades. Gray (1987b) who also found that younger adolescents experienced greater difficultywith school, hypothesized that this age-related difference may be due to obstructions tocognitive changes which normally occur at this time. What is of concern is whetherinterference with cognitive development at this time can be overcome, or if "it may be moredifficult to make up for lost ground later" (Gray, 1987b, p.523).Other bereavement responses reported by Goodman (1986) included somaticcomplaints, negative changes in school attendance and academic performance, and alterationsin sleeping habits. Hogan (1988) found that her subjects only experienced difficulty sleepingor concentrating on school work in the first eighteen months, but that this was resolved by24the 18-36 month period post bereavement. These results are contrary to positive findings inCragg and Berman's (1990) study. They found that their adolescent subjects (n=10) wereable to resume the activities and developmental tasks that had been suspended during theirparent's illness, that for two subjects their school work improved, and for four adolescentsthey became more involved in activities outside of the house. In terms of sleepingdisturbances, nightmares were reported by one subject only after the death of her parent.How an adolescent responds to such a profound loss will likely depend upon a number offactors including prior relationship with the deceased parent and with the surviving parent,usual methods of coping and previous experience with loss, and breadth and quality ofsupport systems outside of the family unit. More research is required to elucidate the role ofthese factors as they relate to both the short-term, and the long-term consequences ofadolescent bereavement.ReligiosityAs with sibling bereavement, investigators have found relationships between theadolescent's bereavement response and their degree of religiosity. Gray (1987b) found thatsubjects who stated that they had beliefs which were religious or spiritual in nature hadsignificantly lower scores on the depression measure (BDI) than did those who did not. Healso found that a major depression was found significantly less frequently among adolescentswith religious beliefs than among those without. These results, combined with the rather lessconclusive findings in the sibling bereavement research, point to the need to more fullyexplore the relationship between adolescent spirituality and their responses to bereavement.Gender IssuesRaphael (1983) noted, from his observations of parentally-bereaved adolescents, thatadolescents' powerful sex role expectations differentially affected their expression of feelings.25He observed that males encountered more prohibitions against the expression of grief andfrustration, and often responded in a more aggressive manner - testing authority figures andusing drugs and alcohol excessively. Females, on the other hand, displayed a longing forcomfort and reassurance, in accordance with what Basow (1986) has characterized as genderappropriate behaviours for their sex. Support for Raphael's clinical observations were foundin Gray's (1987a) study, where male subjects controlled their feelings to a greater degreethan did females.St. Clair and Day (1979) conducted a descriptive correlational study of the relationshipbetween the ego-identity status and values among high school females (n=80). Their tool,based on Erikson's construct of ego identity, isolated four identity statuses - each a pattern ofcoping with the identity crises: identity achievement, moratorium, foreclosure, and identitydiffusion. Their results indicate that two thirds of the adolescents classified as identityachievers came from homes disrupted by either divorce of the death of a parent. While theyadvise that their results must be considered cautiously, they point to the congruity betweentheir findings and Newman and Newman's (1978) hypothesis which suggests that instabilityin the home facilitates identity achievement of the adolescent female. These results are, inand of themselves interesting, but are even more so when contrasted with Jordan's (1970)results using the same tool with a population of adolescent male college students. He foundthat those subjects in the identity diffusion status were more likely to have come from brokenhomes than those who were in other statuses identified by the tool. The findings from thesestudies combine to suggest that there is a sex difference in adolescent bereavement responsesin terms of achievement of developmental tasks. This has important implications for thesubsequent development of these individuals, as successful completion of futuredevelopmental tasks relies upon the effective resolution of prior ones. While clearly needed,26no systematic research has addressed the issue of gender differences in the adolescentbereavement response.Finally, Raphael (1983) has noted that parentally bereaved adolescents may perceive, intheir extreme sensitivity to social cues, that they are expected to behave in certain ways.They may believe that they are expected to be 'grown-up' - to comfort other familymembers, especially if there are younger sibling survivors. These observations are supportedby Joseph's (1982) findings where subjects indicated that they felt compelled to grow upquickly at the time of their loss. Because of the tendency to regress at the loss of a parent,this expectation may be paradoxically gratifying for adolescents - to be treated like an adult,yet at the same time frightening - to be expected to fulfil such ponderous needs when feelingso much like children themselves (Castiglia, 1988; Gordon, 1986). Evident here is thenotion that adolescents are particularly vulnerable to social cues and expectations concerninggender appropriate behaviour. More research is required to illustrate the effect of sex roleexpectations on the adolescent bereavement response, considering both the short-term, andthe long-term effect that this interrelationship has on the adolescent's subsequentdevelopment.To summarize, the literature on adolescent parental bereavement investigatedapproximately the same areas as the literature related to adolescent sibling bereavement.Research findings suggest that there may be a relationship between bereavement andpersonality or self-concept but that the direction of this relationship is not completely clear.Theorists suggest that loss at this time may have critical consequences for adolescents'subsequent development, adolescents' ability to accept support from family, peers and othersdepends upon many factors including reciprocity, gender, ability and willingness to acceptthe support, manner in which the support is offered, and age-appropriateness of the aid, and27especially for peers, emotional closeness of the relationship and/or commonality ofexperience. Bereavement responses included depression, anger, withdrawal, loneliness,alteration in sleeping and school performance. While these responses may be modified bythe passage of time, they may not be altogether eradicated. Religiosity may be associatedwith lower levels of depression. And finally, gender differences may lead to a differentialexpression of feelings, and differing abilities for males and females to resolve thedevelopmental issues associated with this period.Summary Research on normal adolescent bereavement was sparse prior to 1981, but a substantialbody of literature has emerged in the past decade. Bereavement produces intense andenduring emotional consequences, and has been shown to affect and be affected by manyfactors and conditions in the adolescent's life - personality, self-concept, family relationshipsand support resources, school work and physical health, religiosity, and gender roles.Research and theory describing short-term adolescent bereavement responses are fairly welldeveloped in both the sibling-bereaved and the parent-bereaved adolescent literature. Lessempirical work has been done regarding the long-term effects of adolescent bereavement, butshort-term issues give rise to long-term implications as this relates to the establishment of theadolescent's self-esteem, his or her cognitive development and career goal achievement, andhis or her ability to establish and maintain interpersonal relationships. Only three studies(Davies, 1991; Guerriero & Fleming, 1985; & Hogan, 1988) were found describing the long-term effects of sibling loss in adolescence, and Davies (1991) alone has explored the long-term developmental consequences of adolescent sibling bereavement. One study (Josephs,1982) was found describing the long-term effects of adolescent parental bereavement, but thisstudy examined selected variables in the experience of women only.28This study has been designed to build upon and extend the conceptual schema begun inDavies' (1991) research on the long-term effects of sibling bereavement in adolescence. Theresearch questions which guided this study were established from a) the themes in Davies'conceptual schema; b) examining the factors and conditions identified as relevant in theadolescent bereavement research and theories; and c) exploring the speculations made bythese researchers and theorists as to the long-term consequences of the documented short-term effects of adolescent bereavement. The aim of this study was to complement, refine,and expand upon Davies' beginning conceptualization, broadening and raising the level of thetheory so that it might provide direction to nursing and other health disciplines in providingcare and guidance for this special population.29CHAPTER THREEMethodsStudy DesignThe selection of the research method should be determined by the research questionand the relative state of theory development in the area of study (Goodwin & Goodwin,1984; Morse, 1986; Woods, 1988). This study was based upon two questions which asked"what is going on and how," and sought to identify the basic social process used by adultswho as adolescents lost a parent. As the questions sought to discover what was operating inthe subject's world, to name it, and to understand it, qualitative methods were consideredappropriate (Munhall & Oiler, 1986). In terms of theory development, the literature offeredlittle about the long-term effects of adolescent loss of a parent. Based on these twoconsiderations: the nature of the research questions, and the submission of the long-termeffects of adolescent parental bereavement to little formal investigation, the researcherselected Glaser and Strauss' (1967) grounded theory approach.Grounded theory is a method in which factors within a situation are distinguished, basicpsychosocial processes are identified, a map of the relationship among these processes isdiscerned, and theory is generated - all from data which remain in the real world (Field &Morse, 1985; Stern, 1985; Woods, 1988). The aim of grounded theory is to understand howa group of people define, via social interactions, their reality (Stern, Allen, & Moxley,1982). From the emerging basic psychosocial process, the researcher sought to gain anunderstanding of the experience of adolescent loss, and the consequences of that loss forsubjects' development.After the initial analysis, coding and sorting of the data, this study utilized Glaser's(1978) "emergent fit" to explore the final research question - "to what extent does Davies'30conceptual schema fit the experiences of the sample of adults who as adolescents lost aparent?" The "emergent fit" method requires that the investigator "develop an emerging fitbetween the data and a pre-existing category that might work" (Glaser, 1978, p.4). In thisstudy, the pre-existing categories were the themes contained in Davies' conceptual schema.These themes were carefully "fit" with the concepts which emerged from interviews withsubjects who experienced the loss of a parent as an adolescent. In this manner, an extantcategory is not merely borrowed, but rather "earns its way into the emerging theory"(Glaser, 1978, p.4). The concepts resulting from this exercise remain grounded in the data,but are revised so that they fit with a similar but non-identical type of adolescentbereavement. This approach serves to strengthen and enrich a previously developedconceptualization, at the same time as it provides nursing with a broader theory in the area ofinterest.Data CollectionA number of qualitative methods of data collection were used. These included tapingand transcribing personal interviews, recording non-verbal cues and observations concerningthe environment in field notes, and recording commentary of an interpretive nature inmemos. Data of a more quantitative nature were collected using a researcher designeddemographic form (see Appendix B).Interviews were open-ended and semi-structured in nature. Interviews were conductedwith individual subjects (as opposed to subjects within their family circle) to encouragesubjects to reflect on and disclose their intimate feelings and perceptions. Subjects wereoffered the alternative of electing to be interviewed in their own home, or in a private roomin the Research Unit at the School of Nursing. In terms of the first interview, two elected tobe interviewed in their own home, and six in the Research Unit.31The first interview began with the researcher explaining the study, answering subjects'questions, and obtaining written consent to proceed with the study. Subjects were asked toinform the researcher if questions were too vague, or if their responses seemedmisinterpreted by the researcher. The aim was to provide enough guidance to direct thesubject to the area of interest, yet allow what was relevant to the subject to emerge. Eachinterview began with asking subjects to "tell their story of the death." Occasionally subjects'responses were tangential to the research purpose (ie. - describing sibling's development atgreat length) and the researcher redirected them. Subjects' comfort with this style ofinterviewing seemed to develop over the duration of the interview.Two subjects were interviewed whose data were disqualified from the analysis. Thefirst was a recent refugee immigrant from an Eastern Bloc nation. Her story of parental losswas found to be so intricately entwined with her experience of political oppression andeventual escape from her country, that the researcher was unable to determine the source ofthis individual's developmental challenges. Additionally these data were excluded as thesubject became an orphan as a result of the loss of her mother in adolescence. Orphaninghas unique consequences which require separate exploration. The second subject was notincluded as she represented the third nursing student in the sample group, and thereforelimited the breadth of the sample.Subsequent interviews were conducted with three of the eight subjects to validate theresearcher's conceptualization and to ensure that the emergent core social process was fullyexplored and characterised. Three subjects only were re-interviewed as saturation wasquickly achieved. The process for the second interview began with exploring the mostabstract conceptualization with the subject, and progressing through the more concretelevels - ie. the overall conceptualization of the phenomenon, followed by the major32categories, and the interrelationships between the concepts, and finally examining thesubject's in vivo codes. The researcher explained that the most abstract conceptualizationsshould fit loosely for the subjects: the analogy of fitting like a 'bulky loose sweater' wasposed. With each reduced level of abstraction, the researcher explained that the conceptsshould begin to match the subject's personal experience more closely, with the most personalcodes feeling very much like a 'second skin' for them. For each of the three subjects re-interviewed, this perception of an increasingly closer fit held true, and none of the subjectsdisagreed with the researcher's interpretation of the data.InstrumentationIn grounded theory approaches, the subjects are "the primary source of data," and theinterviewers are "the primary instruments" (Sandelowski, Davis, & Harris, 1989). Inaccordance with this, the interview guide was semi-structured and open ended - to allow thesubjects to share their perceptions, while at the same time keeping the inquiry focused ontopic. Davies' conceptual schema and the themes identified in the literature were used togenerate the trigger questions and formulate a variety of prompters (see Appendix A). Thisguide was tested for clarity and relevance with the first three subjects who met the study'sselection criteria and found to be both understandable and germane. Since no changes wererequired of the instrument, the data obtained from these subjects were included in theanalysis. As the research was concerned with development, while key areas were pursued,the researcher was careful to allow subjects to tell their own story where it departed fromthese themes. Probes were employed only to elicit the timing and detail of events significantto the subject, and to stimulate further exploration and clarification of the issues (Schatzman& Strauss, 1973). The demographic data were collected at the end of the interview.33Sample SelectionBoth purposive and theoretical sampling were used. These techniques are subsumedunder the general category of non-probability techniques for sampling. Such techniques arejustifiable when a grounded theory approach is taken, as the intent of the researcher is toselect subjects who can illuminate the psychosocial processes of interest to the researcher(Woods, 1988). Purposive sampling is the selection of subjects based on selection criteriaestablished by the researcher. This guided the initial selection of eleven potential subjectsfrom the applicants who sought to participate in the study. Of these eleven, one later changedher mind and decided to withdraw her application. Theoretical sampling was then used toguide the selection of the actual subjects who were interviewed. In theoretical sampling,subjects are selected because they can illuminate the phenomenon of interest (Sandelowski, etal., 1989). As indicated, the data from two subjects were found to be inadmissible, thereforethe final sample size was eight. Although it had been hoped that a balanced number of maleand female subjects could be recruited, after three months of recruiting, the researcher had tobe satisfied with a three to five ratio of male to female subjects. The researcher admittedsubjects and gathered data until "saturation" occurred (Hutchinson, 1986). That is, the dataseemed complete, without gaps, and contributed to the meaning and understanding of theresearch focus.Criteria for SelectionThe criteria for inclusion and exclusion in the study were set both to provide protectionto potential subjects, as well as to guide the researcher towards the selection of subjects whowere likely to provide maximum information. Inclusion criteria were as follows:Subjects must:341. have experienced the death of one parent only between the ages of 13 and 17years;2. be at least 18 years of age, to meet the five year lower limit set on theparameters of "long-term";3. be able about speak to the experience identified in the research question;4. be able to communicate in English; and5.^be living within a 25-kilometre radius of UBC.The first of these criteria was relaxed only slightly for one subject who was three monthsyounger than the lower age limit established. Consultation with an expert in the field ofadolescent/childhood research indicated that three months was not significant in terms ofvariations in developmental maturity for the adolescent.Criteria for exclusion from the study included the researcher's judgement that subjectswould not be traumatized by discussions of their past experience. This included individualswho:1. were under psychiatric care; and2. became seriously distraught on exploration of the issues ( ie. uncontrollableweeping, inability to sleep following interview session).One subject was extremely emotional in the interview session, but was included since she hadnot actually articulated her feelings about her experiences previous to this interview, andfound the session to be highly therapeutic in terms of finding words to express her rawfeelings, and an interested and empathetic ear to consider them.Recruitment of SubjectsSubjects were recruited from the general community by means of notices posted onbulletin boards at the University of British Columbia (UBC) campus facilities, localcommunity centres, libraries, churches, and colleges and by advertisements placed in the35"UBC Reports" newspaper (see Appendix C). Potential subjects responded by telephoningthe interviewer. During the initial call the researcher explained the nature of the project, thecommitment required of subjects (two interviews of a one hour length maximum), and theinclusion and exclusion criteria. Five respondents did not meet the inclusion criteria for ageat which the parent was lost.Data AnalysisInterviews were transcribed and entered in the Ethnograph software program (Seidel,Kjolseth, & Seymour, 1988). Field notes and memos were also recorded on computermedia. These data were then subjected to the constant comparative method, according to thegrounded theory approach described by Glaser and Strauss (1967). Constant comparativeanalysis of the interviews was performed and themes emerged concerning the developmentaleffects of adolescent parental bereavement, and the factors or conditions which contributed tothese effects. Constant comparative analysis of the interviews comprised the following steps:1. data were assigned substantive codes (level I of open coding);2. these substantive codes were then sorted into conceptual codes (level II of opencoding);3. conceptual codes were linked in term of their interrelationships (axial coding);and4. a core category or phenomenon emerged (level III) and linking of thecategories yielded a basic psychosocial process (Hutchinson, 1986; Strauss &Corbin, 1990).For the first few transcripts, substantive codes were assigned to virtually every line ofsubject dialogue to ensure that all existing themes were uncovered. These codes were mostoften couched in the subjects' exact wording - eg. "finding people like me," or departed fromactual text by one level of abstraction - eg. story of the death. Later transcripts were codedusing previously developed codes where the data reflected parallel themes.36In step two, level one codes were sorted into mutually exclusive and more abstractcategories. For example "it was different overnight," "I never felt secure again," and "Iknew that I couldn't do what I wanted to now" were subsumed under the more abstract levelII category of "forever changed" as these level one codes all described a sense that thesubjects perceived that their lives would never be as they were before their loss (see Table I).Step three involved exploring the relationships amongst the categories in terms of thephenomenon itself, its causal conditions, the context of the phenomenon, the interveningconditions influencing the phenomenon, the action/interactional strategies to cope with thephenomenon, and the consequences of the phenomenon as this relates to the other fourcategories. This procedure is called axial coding, and is differentiated from the open codingstrategy of dissecting and analyzing the data by using methods which put the data backtogether and make connections between the categories. Axial analysis was conducted both onthe level of each individual interview, and on the entire data set as a whole. This bi-levelanalysis provided the investigator with a micro-picture of the individual experience of thephenomenon, and a macro-picture or group rendering of the phenomenon. To ensure thatthe coding process did not invalidate the data, the researcher re-interviewed three subjects,asking them about the clarity and validity of the axial coding in terms of their ownexperience (micro-level) and the group rendering (macro-level). After this, the researcherrevisited the literature and consulted with expert clinicians to clarify, elaborate, and verifythe dimensions and properties of the categories and their interrelationships. During theprocess of axial coding, the central phenomenon which emerged was Disillusionment. Thephenomenon Disillusionment answers the question 'What is the action/interaction in this dataset all about?' The overall management of the phenomenon was 'Integrating37TABLE I DECISION TRAIL OF THE CONCEPTUAL ANALYSISMAJOR CATEGORIES INITIAL CATEGORIES^CODES1. DISILLUSIONMENT Unmasking reality^- surviving parent before/after(Phenomenon)^ death- all is forever changedUnbelieving^- loss of control, orientation,security and trustIntensity - acute to bluntDuration^- life-longFrequency - constant to intermittentPervasion - deep to superficial2. INTERVENING^Personal Factors^- genderCONDITIONS - personality- sibling order- culture- religiosity/spiritualitySituational Factors^- circumstances of the parent'sdeath- relationship with the deceasedparent- family dynamics & coping style- characteristics of surviving parent- availability of support- timing- economics3. ACTION/^Normalizing^- feeling differentINTERACTIONALSTRATEGIES - attending to social cues- playing down differences- reorienting normsAssuming Responsibility^- dealing with adversityfor Others- dealing with dependency/incompetence38MAJOR CATEGORIES INITIAL CATEGORIES^CODES4. CHANGING THEDEVELOPMENTALPATHWAY(Short-TermConsequences)Re-Sourcing NeedsComfortingRationalizingDisappointmentGrowing up fastDrifting/MeanderingTaking Responsibilityfor Self- seeking approval, attention,discipline, guidance, values- substituting for lost parent- dreaming about lost parent- carrying dead parent within- going back to better times- gilding- dealing with violation of norms- dealing with dependency- deferring personal needs- intuiting adult apprehension- making career choices- vacillating about decisions- separating/escapingFulfilling Wishes^- following the wishes of the deadparent5. LIVING WITH THEDEVELOPMENTALSEQUELAE(Long-TermConsequences)Discovering PersonalStrengthsBecoming Impermeable- learning empathy, tolerancecompassion- caring about connections- valuing self-reliance- raising barriers- withdrawing39MAJOR CATEGORIES INITIAL CATEGORIES^CODES- developing fear of:abandonmentcommitmentintimacy- blocked developmentBecoming theLost ParentRegretting- characteristics ofself after the loss- fear of dying like parent- lost adolescence- might have beensDisillusionment' and describes the basic psychosocial process that occurs when individualsexperience the death of a parent in adolescence, and integrate this experience into their lives.Discovery of the core category and synthesis of all the categories into a basic psychosocialprocess achieved the fourth and final step in the analysis and synthesis of the study's data.Table II illustrates the axial categories.After the data set was coded, analyzed, and synthesized, the researcher attempted to"fit" the themes developed by Davies to the categories and the core phenomenon found.This process required that the researcher remain completely open to potential inconsistenciesin data patterns, and the subsequent need to refine, extend or refute Davies' themes, orcreate new ones. This step in the process of data analysis and theory extension became asort of dialectic, with the data informing and shaping the schema, and the schemaconceivably organizing, but never imposing meaning on the data. The result was that allthree of Davies' (1991) concepts - psychological growth, feeling different, and withdrawalfrom peers - were discovered within the overall conceptualization of disillusionment.40TABLE II AXIAL CODING OF THE DATACausal Conditions Phenomenon- death of a parent^- sudden/anticipatedand grieving^- same/diff sexprocess duringadolescence- disillusionment^- a realization thatno-one and nothing isreliableContext Intervening Conditions- intensity----- pervasion----- duration ----- frequency----^of disillusionment- timing of the loss with respect to otherchanges- economic stability of the family unit- availability of support- characteristics of & relationship with thesurviving parent- family dynamics- culture- individual biographyAction/Interactional Strategies Consequences- normalizing- assuming responsibility for others- re-sourcing needs- comforting- rationalizing disappointmentearly - growing up fast- drifting/meandering- taking responsibility for self- fulfilling wisheslater - discovering personal strengths- becoming impermeable- becoming the lost parent- regrettingHowever, the arrangement of these concepts differed according to the action/interactionalstrategy used by the subjects, and the effect of subjects' personal and situational factors.Three developmental routes were identified which contained some or all of the elements ofDavies' (1991) schema. Subjects who used the 'assuming responsibility' strategy were foundto explain their experience and their development in ways which most closely approximatedthe schema.By using the emergent fit technique described in this design, the analysis completed the41grounded theory loop: the theory was extended and strengthened, and yet remains firmlygrounded in the experiences of the subjects who generated it.Validity and ReliabilityValidityValidity in grounded theory differs from that of empirical research approaches becauseit is "subject-oriented, rather than researcher-defined" (Sandelowski, 1986, p.30).Therefore, the data were valid as they were grounded in the lived experiences andpsychosocial processes described by the subjects (Hutchinson, 1986). However, in order tofurther enhance the truth-value of the data, the researcher employed several techniques.During the course of the interview, the researcher often reflected her perception of thesubject's message in an effort to ensure validity of the data.Ms. V.:^So I, we did go down [for mother's funeral], but it was the day afterInterviewer:^So you really didn't get a chance to be there with your family?Ms. V:^No, I didn't (voice trails off quietly)Interviewer:^It sounds like that's still something that's bothering you.Ms. V:^Yes, I haven't worked through that one totally and it still doesn't feelright.The researcher also reviewed and validated the categories and the process as a wholewith three subjects. This was undertaken to ensure that the identified categories wereaccurate and that the researcher's conceptualization of the process represented the subject'sexperiences.At this time, the investigator engaged in a "selective sampling of the literature" to seewhat has been written about the concepts which were emerging (Stern, 1985, p.156). Thisprocess enriches the emerging concepts without colouring them, as the researcher used onlyliterature which fit the concepts, and rejected that which did not (Stern, 1985). Theories ofgrief and adolescent development explained the causal conditions of the phenomenon42disillusionment. The distinctive features of the action/interactional strategies used by subjectswere supported by combining the synthesis of these theories with selected theoretical workwhich characterizes adolescent bereavement from a developmental perspective. Interveningconditions were supported by the adolescent bereavement literature which was presented inthe literature review in Chapter Two. It was at this point that the researcher realized thatthis body of literature deals with examining specific effects of adolescent bereavement in theimmediate or the short-term. Because neither a comprehensive nor a long-term approach hasbeen taken in adolescent parental bereavement research, no literature was found thatexplained the process of integrating disillusionment: the phenomenon as it relates to thecoping strategies used, as these both relate to the long-term developmental consequences.ReliabilityReliability assesses the degree to which the data represent the real phenomena orprocess (Krippendorff, 1980). According to Sandelowski (1986) rigour in a qualitativeresearch study is measured by the research's "audibility," which means that a researchconsumer should be able to clearly identify the decision trail used by the researcher in theproject (see Table I). The researcher also ensured reliability by asking the thesis advisor toaudit her findings. Upon completion of first level coding, the advisor coded the data in aparallel fashion and then the two sets of codes were compared. Agreement was almostunanimous. Later, as the researcher developed categories and synthesized them to createcore categories, the advisor challenged the researcher's conceptualization and providedguidance. The second advisor also reviewed the emerging conceptualization and providedfeedback concerning its soundness and comprehensiveness. Finally, the researcher soughtinput from an expert nurse clinician to determine the validity of the links forged between thecategories, and the clarity and relevance of the emergent conceptualization.43Ethical ConsiderationsInitially, ethical approval was sought and obtained according to the guidelines set forthby the University of British Columbia Behavioural Sciences Screening Committee forResearch and Other Studies Involving Human Subjects (Appendix D). The Ethics ApprovalForm and a summary of the study was given to institutions who agreed to post the studyadvertisement on their information boards (see Appendix E). Individuals interested inparticipating initiated the relationship with the researcher by telephoning her at her home.During this initial contact, the researcher provided information about the study, therequirements of participants, answered any questions that prospective participants had, andarranged a meeting time and place. At the first meeting, the researcher more fully explainedthe study and the commitment to participate, and again answered questions which wereraised. Respondents were then provided a consent form which they were asked to read,consider, clarify with the researcher, and sign (Appendix F). Although clearly indicated onthe consent form itself, a verbal reassurance was added that participants had the right to: a)refuse to participate; b) withdraw from the study without penalty; c) refuse to answer anyparticular questions; and d) elect to stop tape or erase recording at any point in the interview.Anonymity was assured by not using subject's names on any transcripts or writtenmaterial. Confidentiality was assured by conducting interviews in private locations, either atthe School of Nursing, or in subjects' homes. Cassette tapes, transcriptions, field notes andmemos were kept safely in a locked drawer in the researcher's home. The transcripts, fieldnotes, and memos will be kept indefinitely by the researcher, but the cassettes will be erasedonce approval for the final report of this work has been obtained.The process of recalling past feelings of bereavement and the investigation of theirlingering sense of melancholy was a visibly upsetting experience for most of the subjects. At44several points during the interviews, the tape recorder was stopped in order to give subjects achance to collect themselves. Taping was not resumed until subjects indicated that they wereprepared to continue. At several occasions, subjects were offered the opportunity to stop theinterview altogether, but at no time was this suggestion pursued. One subject who wasparticularly upset, was offered a referral for supportive counselling. She indicated that shewas aware of her resources, and declined the referral at that time. Several subjects remarkedat the conclusion of the interview how they felt "lightened" or "relieved" by the experienceof being able to tell their tale in its entirety.45CHAPTER FOURResultsThe results in qualitative research are the inferences that are drawn from analyzing thedata (Catanzaro, 1988). Subjects contributed information about their experience of their loss,and about how it changed their development and lives. From this data, common themeswere identified by building a logical chain of evidence and perceiving conceptual coherencein the data. The findings are presented in the following manner. First, the characteristics ofsubjects and their family situations are presented. Second, the process of integratingdisillusionment is described: the phenomenon of disillusionment itself, its causal conditionsand context, action/interactional strategies used by subjects, intervening conditions includingsituational and personal factors, and both the short and the long-term effects on thedevelopment of the individual. Third, the subjects' responses to participating in the study arepresented.Characteristics of SubjectsGeneral CharacteristicsEight subjects (five females, three males) participated in the study. All but one hadexperienced the loss of one parent between ages 13 to 17, and one subject was thought closeenough to the lower age limit to be admissible (12 years, eight months). All had sufferedtheir loss a minimum of five years previously (range of 5 to 34 years with a mean of 21years). Ages of subjects at the time of this research ranged from 22 to 47 years, with amean of 35 years. Four subjects were married, with one having married for the secondtime. The remaining four were single, with one subject having married and separated oncein her early twenties. Three subjects had their own children. Two families had threeadolescent/young adult aged children, and one was a single parent with a 21 month old46toddler. A summary of the subjects' characteristics is presented in Table III.Characteristics of Loss SituationTwo subjects had lost their fathers, while six had lost their mothers. Theadolescent/lost parent groupings were as follows: four were mother - daughter; two mother-son; one father-daughter; and one father-son. All six mothers died of cancer, and bothfathers died of heart failure. Only one parent died suddenly and unexpectedly, the remainderwere ill for periods ranging from 4 months to the subject's whole life (then 13 years old)with a mean of about 40 months.Sibling Relationships All subjects had at least one sibling at the time of their loss: two subjects had onebrother (one adopted); one had two sisters; one had two brothers; and four had two sistersand a brother. One female subject had lost a brother to a violent death a few years after theloss of their parent. All other siblings were alive and well at the time of the interview.In terms of sibling order, five were the youngest, and two were the eldest in thefamily. Only one subject was the middle child in sibling order but had been the eldest left athome at the time of the parent's death, and so identified with the eldest ordering more thanthe middle. This observation was borne out by this subject's data which appearedremarkably similar to that of other female eldest siblings.Religious Affiliation Subjects represented a variety of religious affiliations: Anglican (3); Catholic (1);Jewish (1); Protestant (1); Unitarian (1); and (1) agnostic. Only three subjects describedthemselves as practising their faith. All subjects' religions were the same as their family oforigin's - none were religious converts.TABLE III^Demographic Characteristics of Subjects1G1 1B1 2G1 2B1 3G1 3B1 5G1 7G1AGE NOW 39 47 35 34 22 27 46 31SEX F M F M F M F FAGE THEN 12 13 17 13 17 14 15 14INTERVAL 26yrs 34yrs 19yrs 21yrs 5yrs 13yrs 31yrs 17yrsPARENT father father mother mother mother mother mother motherCOMBO fath/daught fath/son moth/daught moth/son moth/daught moth/son moth/daught moth/daughtTIME ILL nil-sudden whole life lyr 4mos 4yrs 13mos 2yrs 5yrsCAUSE heart heart cancer cancer cancer cancer cancer cancerSIB ORDER eldest youngest eldest youngest middle youngest youngest youngestSIBS 1 brother(adoptive)1 brother 1 brother(deceased)2 sisters2 sisters1 brother2 sisters1 brother2 sisters 2 brothers 1 brother2 sistersRELIG-P/NP Jewish NP Anglican NP Unitarian P Anglican NP Catholic P Agnostic Anglican NP Protestant PCULTURE Russian British Scottish Canadian Swiss Croatian British CanadianACCULT complete part part --- complete complete part ---MARITAL S M (X2) M S S M M S# CHILDR 0 3 - 2F, 1M 0 0 0 0 3 - 2M, 1F IFEDUC masters high school college undergrad high school undergrad college undergradEMPLOY teacher apartment mgr student marketing student pharmacist home ec./mktg admin asst.interval = time since loss^combo = parent/subject^relig-p/np = practising/nonpractising^accult = degree of acculturation48Ethnic CharacteristicsAll but one subject were born and raised in Canada. The one was brought up inBritain, but had emigrated to Canada with her husband some 20 years previously. Threesubjects who identified their family's culture with their family's country of origin weredescribed as partly acculturated. Three other subjects who identified a non-Canadian culturefor their parents but who described themselves as Canadian in every way were identified ascompletely acculturated. The final two subjects described themselves as Canadian and assuch were not evaluated in terms of acculturation. None of the married subjects had adoptednew cultural orientations from their spouses.EducationAll subjects had a minimum of high school education. Two had graduated fromcollege programs; three had completed undergraduate degrees, and one had completed agraduate degree. One of the high school graduates was in the process of obtaining apsychology degree via distance education, while another of the college graduates was enroledin a post-RN baccalaureate program.EmploymentAll subjects were employed - seven gainfully. One was a teacher, one an apartmentmanager, one a pharmacist, and one an administrative assistant. Two subjects were involvedin marketing: one as a home economics consultant, and another in the field of mediarelations. Two were full time nursing students, one of whom held a part-time casual nursingposition.The Process of Integrating DisillusionmentThe following section describes the conceptual analysis of the process of integratingdisillusionment which characterizes subjects' perceptions of how their loss experience in49adolescence affected their subsequent development. First, the phenomenon disillusionment isexplained in terms of causal conditions and context; next, action/interactional strategies forresponding to, or managing the phenomenon are described; next, intervening conditionswhich determined selection of action/interactional strategies are described; followed finallyby the short and long-term developmental consequences of the phenomenon. Figure 1provides a schematic representation of the process of integrating disillusionment.DisillusionmentDisillusionment is the phenomenon which occurs when an adolescent experiences thedeath of a parent: it results when the grieving process is overlaid on the developmentalcharacteristics and tasks of adolescence. Disillusionment reflects aspects of both the grievingprocess and adolescent development, but is unique in that it represents a synthesis of bothcausal conditions in an integrated phenomenon. An analogy of a cake is useful - the cakeentails many distinct elements (ie. flour, eggs, baking powder) each with their own propertiesand characteristics, but when added to the cake batter, the elements combine to producesomething reminiscent of, but dissimilar to, any one of its constituent ingredients.Several theorists and researchers have characterized the grieving process through bothdescriptive and explanatory models. The grieving process is defined as the changes, overtime, in the experience (feelings and perceptions) that a person endures after realizing a loss(Burnell & Burnell, 1989; Kastenbaum, 1977; Osterweis et al., 1984). Numerousconceptualizations of the grieving process have been described, but Rando (1984) maintainsthat they all cover the same basic feelings, and that only their labels for these feeling differ.Because of this, she proposes a model for the grieving process with three broad categories orphases: a) avoidance, in which there is shock, denial and disbelief; b) confrontation, inSHORT-TERMCONSEQUENCES.,SITUATIONALFACTORSFIGURE 1 - THE PROCESS OF INTEGRATING DISILLUSIONMENTGROWTH &DEVELOPMENT ^ADOLESCENCETRIGGERING EVENTSPERSONALFACTORSMATURITY*^*^*^*^*ACTION/INTERACTIONAL STRATEGIESLOSSOFPARENTe m*DISILLusioNmE N TACUTE BLUNTGRIEVING^51which grief is most intense and reactions to the loss are most acutely felt; and c)reestablishment, where grief declines and a reentry into the daily routine follows.The second element in disillusionment is the developmental stage of adolescence.Adolescence has been characterized as a time when individuals begin their life-long struggleto make sense of their world. Adolescents perceive people and events with new cognitiveskills which redefine their reality. Ordinarily, this task of unmasking reality is a gradualone, allowing the adolescent to integrate new perceptions into his or her view of the world.Disillusionment embodies the key elements of the grief process as they interact with thedevelopmental process of adolescence. Both grief and disillusionment include feelings ofshock, denial and disbelief; separation, pain and loneliness; and resolution or reorganizationoccurring over time. How adolescents experience these feelings is strongly influenced bytheir stage of growth and development. Disillusionment differs from grief as the feelings ofshock, denial and disbelief are influenced by the normal adolescent re-vision of perceptionsand beliefs - unmasking reality becomes abrupt, occurring without the stability of the familyunit. Similarly, the grief feelings of separation, pain and loneliness interact with the normaladolescent separation from the family unit. Finally, resolution and reorganization arecomplicated by the adolescent's process of becoming. The question is one of resolution andreorganization to what, or to whom, as the adolescent's perception of self and his or herworld is so rapid and radically transforming.Disillusionment begins with feelings of shock and disbelief. Mrs. P's description ofthe first few days following the loss of her mother illustrates:Ms. P: Oh, just absolutely, I think, just empty and devastated, just like a shell. Asthough walking in a dream. I don't really remember the first few days. Iremember the first day and then I remember the funeral but I don't rememberanything else.52The sense of disorientation is long lasting. Four years after his mother's death, Mr. B.describes his persistent sense of disorientation:Mr. B: And I was, yeah, I was sort of searching for a solid ground, as it were, or aframework or something to try and latch on to. I was feeling a little bit setadrift from a, from a noisy, happy home with four kids and two parents...itwas just me and him...I think I was much more circuitous in my career path.When adolescents lose a parent, their family is shattered: the unthinkable has happened,and nothing will ever be as it was before. Subjects reported an acute sense that their worldhad changed forever - their family was irrevocably altered and their belief systems disrupted.A reorientation to reality was necessary to accommodate these changes. One subjectdescribed the difference between normal adolescent unmasking of reality and thedisillusionment experienced by the parentally bereaved adolescent:Mr. B: Ordinarily, when teenagers have this experience [unmasking reality], I think ofit like the careful peeling of an onion, exposing each layer as the kid feels he(or she) is ready. When I had this [disillusionment], it was like somebody cutthe onion in half...there was no time to leisurely explore the layers, they weresheered away abruptly, exposing raw and weeping edges.Disillusionment was characterized in terms of its context - the specific set of propertiesor dimensions that pertain to a phenomenon (Strauss & Corbin, 1990). The dimensions ofdisillusionment are its intensity, duration, frequency, and degree of pervasion. Subjectscharacterized disillusionment as initially acute and of long duration, but with diminishedintensity over time. Ms. T's description of her inability to make an emotional commitmentto people in her life for fear that they too would disappear like the lost parent captures theessence of the phenomenon:Ms. T: I had an incredible fear of commitment that, and it's not that strange 'causesince then, I've had other people die in my life and it was sort of like, if Ilove somebody, they could leave me and dying on you is the ultimate loss.The ultimate "out the door" gone. And I was really afraid to allow people toget close enough to hurt me, that they would leave, forever. And it took me along, long time to be able to trust somebody enough to make some kind of53emotional commitment to them. And I still have problems with it.Two phases of disillusionment were described by subjects with respect to thephenomenon's intensity: an initial acute phase, characterized by a keen sense of insecurity,and a subsequent blunted sense of disillusionment which receded, but did not completelydisappear altogether. The acute phase of disillusionment was characterized as follows:Ms. L: Yeah, I've never felt that I've had security. No. So, a big worry, has alwaysbeen for me about, when I was a teenager, about being an orphan, and beingable to look after myself and who would take us in.The subsequent blunt phase of disillusionment is illustrated in the following passage whichalso demonstrates the life-long duration of the phenomenon for the subject:Ms. T: Well, less than it used to but, no I don't think I'll ever have total control overit. That, that fear that somebody's going to leave me.Subjects also reported disillusionment having a frequency dimension, with intermittentexperiences of the feelings related to disillusionment associated with triggering events such asmeeting with people who reminded them of their lost parent, attempting to establish closerelationships with others, or exposure to perceptual stimuli such as familiar music or scenes.Mr. B: In fact the one woman I was probably closest too, I cried a reasonable amountwhen we were together...And it's so weird the way she'd, I'd connected herwith my mom. I could, I used to get this weird image of her and my mom inthe kitchen at our summer ranch...and I've got a real connection with the latesixties, the music and movies, most of them in music.The degree of pervasion of disillusionment can be characterized in terms of how deeplydisturbed subjects were by their altered perceptions of reality. One subject describes herdisillusionment with her surviving parent as one which involved a violation of her perceptionof social norms, not merely an altered perception of social norms:Ms. V: The next day, after my mom passed away, my aunt came from Switzerland.And I'd never met her before, she looked exactly like my mom, and she tookup with my dad, that, that same day. I'm not joking. Well, they started youknow acting like they were married. I guess my dad was going through a54crisis with loosing my mom, they were married for I don't know how manyyearsAnother subject's experience of disillusionment was less pervasive, demonstrated by hisdescription of his relationship with his surviving parent:Mr. M: I'd grown used to the fact that I felt that he [brother] was more supported bymy mother [than I was]. It wasn't that she didn't care for me, it's just thatthat was the way it was, you know. Having raised children of my own, I cannow understand this better.In addition to the foregoing dimensions of the phenomenon, disillusionment entailed areferent or referents. In this study, disillusionment occurred in connection with the survivingparent, authority figures in the adolescent's life, expectations surrounding what family lifeshould look like, and the individuals' own hopes and dreams for what might have been intheir lives had their deceased parent survived.Without exception, all eight subjects indicated that after the loss, their interaction withtheir surviving parent was negative:Ms. V: Well, I thought it was just because my mom passed away, that he stopped, justignoring us, but when I think about it now, he was always like that. But moreso, after my mom passed away because my mom used to get on his case topay attention to us. But he ignores us now very much so, ignoring me.Because he wants to live with his girlfriend now instead of us.Ms. P: Well, as I said my father fell to pieces, and I picked up the household chores.Ms. T: I loved my father but he was so dependent on me that I couldn't, I was, I wasthe adult in the family. He wasn't. I was parenting him, and I was takingcare of him, and I found that so oppressive and strange, you know. Because hejust reversed roles on me, right, like within a period of 24 hours. We were indifferent positions... And I was also taking care of children, and I was tooyoung to be responsible for three children and an adult male person in thehousehold.Clearly, some subjects' negative re-visioning of the surviving parent may be related to thesurviving parent's grieving process. Absorbed in their own grieving, surviving parents mayhave been incapable of caring for anyone other than themselves at the time of the loss.55Ms. L: But she [surviving parent] was you know, I mean obviously she was veryupset. Also, when somebody dies suddenly they do a police investigationautomatically, so that was something that she had to go through too.As well, surviving parents may not have perceived what their adolescent children required ofthem. Subjects reported that they felt that parents did not understand how they were feeling,but also owned that they were careful not to do anything that might have drawn directattention to their needs.Mr. N: At thirteen I'm not sure I would have know what to do with it, if he [survivingparent] had been nice to me. If he tried to be supportive. I'm not sure Icould have been receptive in an appropriate way then. I might have welcomedit but yeah, when I was 21, 22 you know, but not when I was thirteen.Another focus for subjects' disillusionment was previously esteemed authority figuresincluding teachers and health professionals. As adolescents develop, it is not unusual forthem to unmask the reality of who their teachers are (normal human beings) and comparethat with who they thought their teachers were (all-knowing, infallible super beings) and findthem wanting. However, what differed with disillusionment is the abruptness with which thisoccurred, and, as can be seen from the following excerpt, the insight which the adolescentdeveloped about peoples' new-found reactions to them:Ms. T: I don't think they'd [teachers] ever dealt with somebody who had lost a parentbefore, so it seemed like they were all kind of aghast that this would happen.It was really strange. I went to the guidance counsellor to ask for a studyblock instead of a class and she said, "Well", you know, got all kind of huffyand said, "Who do you think you are?" And I said, no I think you shouldhear why I want this study. And as soon as she heard my name she went,"You're the girl who ..." And I, yeah, well I guess, I'm the girl, who ... andevery teacher I approached with this kind of thing. You know, went "Ofcourse, you're the girl who ..." You know, and I was separated from mypeers that way by the adults in the high school. And that was a really strangeexperience. I guess they hadn't experienced loss either, I don't know... maybethey thought I was going to burst into tears in front of them, which they didn'twant me to do. I don't know, they did, they treated me different.Health professionals also became a focus for disillusionment, mainly due to their involvement56with the family during the course of the deceased parent's illness and death. The followingexcerpt illustrates one subject's deep disillusionment with her mother's [deceased parent]nurse:Ms. V: Not one of them [nurses] ever talked to me. One of them phoned me at home,I was seventeen, and said, "How old are you?" "I'm seventeen". She goes,"Where's your father?" And I said, "At work". And she goes, "Oh, wellyour mom's been admitted into the hospital this morning." And I thought shewas just at the doctor's office. And she told me to get down to there rightaway, and look after her, otherwise she was going to restrain her. It was thefirst time she'd been on that nurse was terrible and I want tokill her if I ever see her again.This experience motivated Ms. V to enter the nursing profession where she hoped to use herexperience to 'do things right' for individuals in such situations.Another focus for disillusionment was family life in terms of what it had been, andwhat subjects felt it had become:Ms. T: I had to take care of all these people who were so incredibly incompetent attaking care of themselves. And, I mean, you can't really blame the children,because they're children, but my brother was old enough to do some takingcare of himself, and never did actually until he died. They were quite young,they were, my sisters were 6 and 8 years old, respectively, so they were justkids...And I guess actually, my family fell apart and, at that time when mymother died. I say now that my family pull together but no, at that point, nowe didn't. We really, we really blew apart.The final focus for disillusionment was the individual's expectations: - the shattering ofhis or her hopes and dreams of what he or she had expected from life. This is wellillustrated by the following example where the subject contrasts where she felt she was goingwith her life before her father died, and how her expectations were altered after the loss ofher father:Ms. L: I had just found out coming home for lunch from school that day. I was reallyhappy, I remember being really happy that day too, one of my happier days ofmy life, I guess, for some reason. I don't know why, because I was gettingmore socially active and I was really happy about that and I was lookingforward to a volleyball game, I don't know if it was that night or the next57night we were going to play...[and after] A huge change, a huge change. I mean, I'm sure that I went through all myteenage years feeling like I had the weight of the world on my shoulders. Ihad to look after my brother. I mean, I had played piano, taken lessons. Ihad to quit my lessons. It was just, I was always worried. And I think I'venever really gotten over that.To summarize, the causal conditions for the process of integrating disillusionment werethe interaction between the grieving process and the developmental stage of adolescence.Disillusionment retained some resemblance to both, yet has unique dimensions of its own.These dimensions were intensity, characterized as acute to blunt; duration, characterized aslifelong; frequency, described as intermittent and associated with certain triggering events orsituations; and degree of pervasion, described as deep to relatively superficial.Disillusionment occurred in reference to the surviving parent, authority figures in theadolescent's life, expectations surrounding what family life should look like, and theindividuals' own hopes and dreams for what might have been in their lives had their deceasedparent survived.Action/Interactional StrategiesAction/interactional strategies have certain properties. First, they are sequential andthus can be examined in terms of movement or changes over time. Second, they arepurposeful or reflexive, in that they are either volitional responses or reflex reactions to aphenomenon. Third, failed or absent action/interactional strategies are as potentiallyimportant as are actual and/or successful strategies. Fourth, action/interactional strategiesare always subject to intervening conditions (Strauss & Corbin, 1990). Subjects used fiveaction/interactional strategies to integrate their disillusionment into their lives: normalizing,rationalizing disappointment, re-sourcing needs, assuming responsibility for others, and self-comforting.58Normalizing.The goal of normalizing was to live (or seem to live) as normally as possible despitethe effect of the disillusionment. This strategy was used when subjects sensed that they werevery different from their peers after their loss:Ms. V: What ways do I think I'm different? I have a totally different family. I don'thave a mother.Another subject compared how she saw herself in relation to her peers before her loss toafter her loss:Ms. T: I definitely felt isolated from the people I went to high school with, en masse,because I was treated differently. I was never particularly close to most of thepeople in high school. I had like a group of friends that I had, that I alwaysfelt different from the kids in high school anyways. And this just sort of wasthe final thing, well, I was different.This example demonstrates the intervening condition of the individual's personal biography.That is, feeling different (and subsequently using a normalizing strategy) cannot be ascribedto disillusionment alone - the subject had a predisposition to feeling isolated before herparent's death. The question of whether the events led to personality changes, or whetherpersonality characteristics prompted certain events, was addressed throughout the analysis.Normalizing was manifested by subjects 'playing down differences' from their peers.This was a means to encourage peers to make less of a fuss about the death, and thus reduceattention to how different subjects were from their peers:Int:^So then the appropriate thing that your peers could have done was to appear asif it didn't happen for you.Mr. N: Yeah, it's probably what I would have encouraged. Yeah, just regularbusiness as usual.Normalizing was also a strategy which served to hide the alterations in the family. Thefollowing excerpt poignantly describes how one subject utilized the opportunity of changing59her address to change her biography:Int:^But at the time you were with your friends you felt just like them.Ms. B: I sure did, but I didn't want them to see my family... When I went back up toCherryville nobody really knew, they didn't know that my mom died, like Iwas just the new kid to them, they didn't know how long ago she'd died. Tothem, I'd never had a mom so they didn't know how I felt.However, it seemed that no matter how hard subjects tried to be 'just like everyone else,' orhow successful those attempts were in terms of their peer groups perceptions, subjects stillwere acutely aware that they had experienced something that their peers had not, and this setthem apart from their peers in ways which they could not 'play down,' especially tothemselves:Ms. T: Well, there was no doubt [I was different] because, I was, I had three youngersiblings, and I spent my time at home taking care of the little kids and mybrother and the house, and doing the wife, mother things, instead of doinghigh school things. You know.Ms. P: Well they still had families around them, and two parents and they came homeand everybody was there and, they didn't come home to an empty house.Subjects who found the normalizing strategy unsuccessful, or who did not use it at allwere disturbed about the lack of norms for how parentally bereaved adolescents shouldbehave:Mr. B: You're not sure whether you're supposed to be really sad or, because nobodyever tells you...and you never knew, of course, you're not quite sure, howyou're suppose to act, what other people expect of you...I didn't have a senseof, I hadn't seen a movie about it and I hadn't read a book about it.Mr. N: I really felt that, like how am I supposed to act? These people want somethingfrom me, what is it?When information was unavailable about what was expected from them, subjects drew uponthe most salient social expectations which were either clearly spelled out for them by aconcerned onlooker, or deduced from subjects' past experience of how they sorted roleambiguities out. The following supports the first interpretation:60Ms. T: Somebody took me aside and said, "Are you ready for all this?" I said, "Whatdo you mean, am I ready for all this?" He said, "For what's going to happento you next. What your role is going to be?" Because he obviously, actuallyit was our minister, picked me out as the person who was going to be thestrong one. And I said, "I don't know what you mean." I was reallyconfused, like totally did not know what was going to happen to me. And hesaid, "Well, you know, you're really going to be put in position where you'regoing to be working really hard."And the next excerpt supports the latter:Mr. M: Well, if you felt bad or unsure, you, you just carried on, because this was amark of character, you carried on and did what you had to do.This second excerpt also related to the subject's culture. Mr. M's family was quite British,with specific emphasis on the military aspects of the British culture. Therefore, fewemotions were divulged by members to each other, or to outsiders, and stoicism was highlyregarded. Again, the likelihood to use (or fail to use) a coping strategy was rooted in theindividual's personal factors.In the absence of distinct models, subjects demonstrated a heightened sensitivity forwhat was, and what was not socially acceptable behaviour. These models for behaviourwere clearly divided along gender lines: subjects appeared to adopt a rigid conception of selfas male or female which was based upon stereotypical sex-typed behaviours. Femalesadopted the role of nurturer, regardless of whether or not they had lost the pivotal nurturingfigure:Ms. T: And I was always very competent and I guess, you know, that's the functionof being an eldest child in a way. But it's probably also a function of being afemale and expected to know how to do all these things, you know. How todo the grocery shopping, how to look after the children - all the mother work.In contrast, males tended to respond with strongly sex-typed masculine behaviours, avoidingemotional expressiveness and experiencing difficulty in both seeking or receiving help:Mr. M: Never thinking of asking for help from anyone and not really understandingwhy things didn't work. Surely if you just soldiered on it would always be all61right, but, no, that's not how I've found later that it works.Subjects reverted to sex-identities with which they were most comfortable. It is symbolicthat the female subject referred to herself as 'the mother,' while the male subject associatedhimself with 'soldiering' - both reminiscent of games children play about grown-up sex roles.This observation illustrates the synthesis of the grieving process and adolescent development:regression is a common grief response, while establishment of an adult sex role is one of thecentral tasks of adolescence. The synthesis becomes something different than either processwould ordinarily yield: in this case, subjects matured because of having to face thedevastating loss and upheaval in their family, but they expressed their gender role maturity inways that were familiar and comfortable - they reverted to those roles which they knew froman childlike conception of self as female or self as male.Over time, subjects saw themselves as less sharply different from their peers. Ratherthan continuing with the 'playing down' tactic or searching for external norms of behaviour,subjects reoriented their self-image a more comprehensive conception of how they 'ought tobe.' The following excerpt describes one subject's early discovery of new found normality:Ms. L: But then I found people who didn't question it [my loss], and I think that wellthey're probably having a problem too, and they probably see it as fine andwe're probably both the same.With time, this reorientation to 'self as normal' was reinforced as subjects expanded theircircle of acquaintances and discovered more people who shared their experience (or onesimilar). They came to view their experience as ubiquitous:Ms. P: But then two years after that I went away to do my teacher's training, andthen, I guess I met people who had come from different walks of life.Somebody, who, you know, separated, divorced. And in those days, thirtyyears ago, it wasn't done. There were people who operated with one parent.Maybe not suffered the same thing, but they had a trauma in their lives.However, at no time did subjects acknowledge feeling 'like ordinary people' - from the time62directly following their loss right up to the time of this study:Ms. L: Oh, definitely, I always felt different. I think I've always felt that my wholelife though...and I think this just augmented that, it just made me feel moredifferent, like I had less than anyone.Families as a whole also used normalizing strategies. The British subjects (3/8)indicated that a 'stiff upper lip' policy was adopted by family members, and that caution wastaken to hide from outsiders that they were experiencing difficulties:Ms. P: We put on a stiff upper lip, chins out and we'll carry on as normal and we'llpretend that nothing is untoward...but people were private in Britain, in thosedays. You know you always called them Mrs. So and so, your friends'parents. And you know they never asked, and of course, we never told howupset the family was.In all three cases, subjects indicated their grief would have been far less painful had theirfeelings and concerns been dealt with in a more open and accepting climate. Subsequently,two of these individuals chose careers in the helping professions, a choice which theyattributed to their own unsupported bereavement as adolescents.In summary, normalizing was an action/interactional strategy used by subjects tomanage the phenomenon of disillusionment and move through the process of integratingdisillusionment into their lives. Subjects tried to feel as normal as possible at a time whenall that they had depended upon was disintegrating. Normalizing was directed towards peers,with subjects using a technique of 'playing down' their feelings and concerns as a way toconvince peers that they were the same as the rest of the group. Normalizing failed as acoping strategy when subjects lacked clear social cues about how parentally bereavedadolescents ought to act. This void was filled, either by direct instruction from a concernedbystander, or by subjects drawing from their own personal interpretation of how they shouldbehave if outside help was unavailable. With the absence of clear cues, subjects adoptedmature behaviours, but ones which were based upon rigid conceptions of gender appropriate63behaviours. Over time, most subjects relied less heavily on external norm references andcame to use their personal and expanded notions of normality as a measure for theirbehaviour. Finally, normalizing was also used by the family unit as a whole. Although allfamilies used this strategy to some degree, normalizing was most used by families of Britishextraction.Rationalizing disappointment.Disillusionment varied from profound to relatively unimportant. Where it wasprofound, subjects described a violation of their perception of reality, rather than a merealteration of their perception. One strategy for integrating this aspect of disillusionment wasrationalizing disappointment. This strategy protected the adolescent from highly chargedemotions by transforming them into innocuous intellectualizations. Use of the strategy is notexclusive to the disillusioned adolescent, it is also used by normal adolescents to control theemotional upheaval associated with revising their reality. However, bereaved adolescentsrationalized disappointment in response to an abrupt and unthinkable alteration in reality, andwithout the benefit of family stability.The following three excerpts demonstrate the continuum of disappointment for whichsubjects used rationalizing disappointment. The first excerpt represents the most profoundfeelings associated with the loss with both a personal betrayal and a violation of socialnorms; the second demonstrates rationalizing disappointment when the subjects faced apersonal betrayal only; and the third excerpt demonstrates rationalizing the most moderatesense of disappointment. Note the ambivalence expressed in the accusation/acquittalsequence which is characteristic of rationalizing disappointment:Ms. V: The next day, after my mom passed away, my aunt came from Switzerland.And I'd never met her before, she looked exactly like my mom, and she tookup with my dad, that, that same day. [angrily shaking as she sobs] I'm not64joking. Well, they started you know acting like they were married [shakenand uncontrollably weeping]. I guess my dad was going through a crisis withloosing my mom, they were married for I don't know how many years.The early use of this strategy seems largely reflexive - subjects did not seem to consciouslyemploy it, and rationalizing was like a knee jerk reaction to having articulated true andexquisitely painful perceptions of people or expectations that the adolescent had come to relyupon. The second excerpt illustrates the accusation/acquittal sequence again when thedisappointment is a personal betrayal experienced with the surviving parent:Ms. T: Because he [father] just reversed roles on me, right, like within a period of 24hours. We were in different positions. And I didn't think it was right, and Iprobably still don't. But I mean that's what he had to do to survive. I mean Iunderstand, you know, understand what happened to him.This second example differs from the first as it lacks the sense of outrage that the firstexcerpt demonstrates. Ms. T. was disgusted and disappointed, but she was clearly notexperiencing the abhorrence that Ms. V. expressed. The third example illustratesrationalizing at the farthest end of the profound to unimportant disappointment continuum.In this situation, the disappointment had originated before the loss, was more chronic innature, and the subject had developed some insight into the dynamic through his ownrelationship with his children:Mr. M: I'd grown used to conflict with brother and in the fact that I felt that he wasmore supported by my mother. It wasn't that she didn't care for me, it's justthat that was the way it was, you know. Having raised children of my own, Ican now understand this better.Rationalizing disappointment seemed developmental in nature, being highly reflexive soonafter the loss, and becoming more conscious and purposeful as the individual matured.Rationalizing disappointment was also used when the adolescent was disappointed withother foci of disillusionment. The two following excerpts demonstrate how a subjectaccused/acquitted her family and excused her teachers:65Ms. T: I had to take care of all these people who were so incredibly incompetent attaking care of themselves. And, I mean, you can't really blame the children,because they're children. They were quite young, they were, my sisters were6 and 8 years old, respectively, so they were just kids.Ms. T: I don't think they'd [teachers] ever dealt with somebody who had lost a parentbefore, so it seemed like they were all kind of aghast that this would happen.When subjects attempted to use rationalizing disappointment, but were unsuccessful,they expressed a great deal of ambivalence toward the focus of their disappointment:Ms. B: My father [surviving parent] wasn't really supportive but like I said, thingswere pretty strained...My dad is, for a man really irresponsible and as an adultnow I would say he was an alcoholic...I remember thinking that he was a jerkat lot of times, but I guess that's not his fault.In summary, rationalizing disappointment was used by subjects to reduce the sharpimpact of the disillusionment. Saying 'it doesn't matter' or 'there was a good reason forthis' helped to blunt the pain of subjects' deep disappointment with people or circumstanceson whom they had once depended and/or respected. Rationalizing disappointment may be insome respects a normal process of adolescent development, however bereaved adolescenceused this strategy in response to an abrupt change in reality perception occurring without thebenefit of family stability. The nature of rationalizing disappointment changed as theindividual matured, being reflexive soon after the loss experience, and more purposive andwith maturity. Failure of the strategy was associated with feelings of ambivalence towardsthe focus of disillusionment that were never entirely resolved.Re-sourcing needs.Disillusionment resulted in adolescents perceiving that the object of disillusionmentcould no longer be relied upon to meet their needs for support, discipline, guidance, or hope.The goal of re-sourcing needs was to find alternative ways to satisfy needs, it was a strategyused to integrate disillusionment for the adolescents. The following set of excerpts66demonstrate how one subject perceived that his need for affirmation was previously met byhis father, how his mother failed to meet the need, and his attempts to re-source his need inother relationships. The pattern is one of losing the need meeting parent, testing and findingthe surviving parent wanting, and re-sourcing needs in new ways:Mr.M: He [lost parent] always treated me beautifully. I think that my success in life,and, these relationships, my own children, is due to the example I had withmy father. You know, that I was able to show them tenderness andcaring...and I was good in school. I was semi-decent in sports. I got alongwell with people. I think I felt that I was somehow or other capable of a lotof things, and identified this with my father.Mr.M: He [brother] said, "You know, I always looked on by my mother as my pal,my support," and that wasn't how I felt, about her. I felt I was trying to winher affection, trying to buy her affection and could somehow, quite never doit.Mr.M: I don't know what I was looking for. Here was a person [second wife] whowould accept me and, of course, sexuality is very important. In my secondmarriage, I was adopted by my wife's family and I just found that great! Veryloving, affectionate woman. Very caring, warm family, and where was allthis when I was a kid?Soon after the disillusionment, re-sourcing needs was reflexive and unconscious. Thefollowing excerpt demonstrates one subject's perception of her need meeting behaviourshortly after the loss of her mother:Ms. V: The reason I went out and got into trouble was because my girlfriends said,you should get out, should get out of the house. So I took a whole bunch ofgirls to a movie and crashed the car. I honest to God didn't know how todrive. It was, I think it was, a kind of message I think, well maybe it wassubconsciously a way to get my dad's attention.After a period of time, subjects were able to look back on their behaviour and view it aspurposive and goal directed. This insight developed only after years of reflection, and isdemonstrated by the following two excerpts:Ms. L: I mean I did crazy things that I mean were very risky, but I didn't put myselfin danger... But she [surviving parent] was really lenient, I mean I used to getaway with, I mean, I said to her she went too far. And, and I think, I realize67it now, that you know from whatever I've read, studies I've read, kids testtheir parents limits and it's a way of them getting security. And she never setup any boundaries for me.Mr. B: I had a great time in boarding school. One of the best periods of my life.Now as I look back I don't think I would have gone to boarding school hadmy mother been alive because I think I would have got a lot of those thingsfrom her. I certainly would have got the encouragement, which I never didfrom my father. I yeah, I would have got the encouragement, positivereinforcement from her, the attention.Later in life, subjects used the strategy quite consciously. They could articulate whatthey needed, and how their behaviour was consciously directed towards satisfying that need.In the following excerpt, the subject recognized that the loss of her mother deprived her of arole model which she consciously re-sourced years later in her boyfriend's mother:Ms. B: One person that I became very close to was my boyfriend's mother which waswhen I was nineteen, twenty. I was very close to her and she actually was alot like my mother and so I became very close to her and still am friends withher. I think that a lot of that was because she was just like my mom, and Iwanted to be around somebody who was like that.Intervening conditions determined a) what needs were salient, b) what resources weresought, and c) how successful subjects were in their re-sourcing strategies. The mostsignificant intervening conditions were personal characteristics, the pre-death relationshipwith the lost parent, characteristics of, and relationship with the surviving parent, and familydynamics and coping style.In some situations, subjects identified where they did not or were unable to use re-sourcing, and described the consequences of not using this strategy. In the followingexample, the subject is quite clear that he would have had less difficulties had he been ableto successfully re-source his need for guidance:Mr.M: Well, I look back in my late adolescence and I say, gee, you know, it's toobad I didn't have a little guidance you know. Because a lot of the problems Ihad then, were simply that if I'd been close to somebody, an adult who wasfairly well put together, I think I wouldn't have had the difficulties that I had.68Finally, re-sourcing needs was also used when other foci of disillusionment, such as thefamily unit, no longer met the subject's requirements. The following excerpt illustrates thesubject's attempt to re-source her sense of security, lost at the disintegration of her family, insubsequent relationships:Ms. B: I had probably, two major, major relationships. One was when I was forseven years from the time I was nineteen until I was twenty five. And he wasa nice guy, but too like my father. He didn't want commitment, he didn'twant responsibility in a lot of ways, wasn't willing to own up to that kind ofstuff like that. But I expected to marry him. That's what I wanted, I wantedstability, I wanted normal, I wanted what my friends' parents had, that senseof security.There were also successes and failures in attempting to regain the security that the dissolutionof the family structure had destroyed. Subjects who were unable to successfully re-sourcetheir needs never entirely dealt with the loss of security associated with the death, andthereby were less successful in integrating disillusionment:Ms. L: Yeah, I've never felt that I've had security. No. So, a big worry, has alwaysbeen for me about, when I was a teenager, about being an orphan, and beingable to look after myself and who would take us in.In summary, the action/interactional strategy of re-sourcing needs was a direct responseto subjects' perception that their familiar sources of need satisfaction were gone (as with thelost parent) or unsatisfactory (as with the foci of disillusionment). Re-sourcing needs wasoften directed at the surviving parent, who was often found wanting. This resulted in eitheran aborted attempt to satisfy the need, or in the adolescent using other ways to obtain whatthey felt their surviving parent could no longer provide. Aborted need-meeting attempts orfailure to re-source needs were associated with long-term difficulties. The strategy wasdevelopmental in nature, with the behaviours becoming more purposive as the individualmatured. The use of the strategy and the nature of the re-sourced need was dependent uponintervening conditions, most notably personal characteristics, the pre-death relationship with69the lost parent, characteristics of, and relationship with the surviving parent, and familydynamics and coping style.Assuming responsibility for others.Assuming responsibility entailed taking on the obligation of meeting other familymembers' needs. In so doing subjects avoided their own profound sense of disillusionment.This strategy was used exclusively by the females in the study, thus gender was anintervening condition. As noted under 'normalizing,' assuming a nurturing or fostering roleis gender appropriate for females, and as such, is another example of reverting to the mostfamiliar role in the face of disillusionment. Again, the strategy entails elements of the twooverlapping considerations of disillusionment: regression, associated with the grievingprocess; and search for a gender appropriate conception of the self, a task of adolescentdevelopment. The synthesis is mature, but rigidly sex-stereotypic behaviour.The avoidance gains of the strategy are illustrated in the following subject's descriptionof the first few days after her loss:Ms. T: And I didn't get to go through the, I didn't get a lot of time to go through allthat shock, denial, disbelief, whatever, stuff that you get to go through. I wentfrom my mother's dead to somebody has to do the cooking and I just put allthat other stuff on hold, a lot of my grieving on hold...and my father just fellapart. He was very, very dependent on me at that time. Yeah, so I just, youknow, picked myself up, pulled it together and just put everything on hold.As with other strategies, assuming responsibility for others was used differentially inassociation with the focus of the disillusionment. The foregoing example demonstrates Ms.T's assuming responsibility for her surviving parent. In the following example, the subjectassumed responsibility for her family situation:Ms. L: ...because I was eight and a half years older than my brother, and I had tolook after him all the time. So wherever I went somewhere on the weekend,he had to come with me. So I didn't have like a teen time really, and Icouldn't go get a part time job, either, cause I had to help my mom.70Assuming responsibility was only partially successful in integrating disillusionment. Mostattempts were deemed unsuccessful, with subjects estimating that the cost of the strategyoutweighed any benefit:Ms. B: I went right from being the kid the one who got no responsibility to all of asudden I was doing the sister, we split [learningresponsibility] could be advantageous but I didn't think I ever had a time ofbeing carefree.Ms. L: ...I think that, that I had to grow up too fast. I think I didn't, I've never hadthat carefree, well, maybe lots of people haven't. I don't know but I thinkother people have...had that carefree time, you know what I mean?Subjects indicated that assuming responsibility only deferred their sense ofdisillusionment, but never eradicated it. Feelings experienced but not addressed at the timeof the loss resurfaced later and had to be resolved. The following excerpt demonstrates thereappearance of the turmoil in the subject's life:Ms. T: So I just picked myself up, pulled it together and just put everything on hold.I can't say that I didn't experience my grieving and anger, cause I did it at alater day. I got out of home, and went through all the stuff that I wassupposed to when I was 17 when I was about 19.Assuming responsibility seems to have been a reflexive response to disillusionment,with subjects describing their actions as foregone conclusions - the sense that somebody hadto do it, and as females, it was just naturally their responsibility:Ms. P: Well, as I said my father fell to pieces, and I naturally picked up thehousehold chores.For some subjects, assuming responsibility was the cornerstone for later careerdevelopment. It is difficult to know if subjects had been predisposed to helping prior to thedisillusionment, but at the very least, the strategy enhanced any helping tendencies thatsubjects had:Ms. T: I'm in nursing. I think that, other than having to do all this mother work at17, I think I have an affinity for it...But I think it [the loss] really directed me71that way. I was always a really take charge kind of person, you know takingcare of everybody, but I think it [the loss] really accentuated thosecharacteristics in me.To summarize, the strategy of assuming responsibility entailed behaviours which wereaimed at dealing with the adversity of the family situation, and meeting the dependency needsof family members. It was a strategy used exclusively by females, in keeping with a verynarrow social interpretation of gender appropriate behaviours. The goal of the strategy wasto avoid dealing with and integrating disillusionment. The strategy was only ever partiallysuccessful, with avoidance leading to deferment of disillusionment to a later time, or withsubjects estimating the cost of the strategy far outweighing its gains. Assuming responsibilitymay be associated with intervening conditions such as personal predisposition to altruisticbehaviour. The strategy (with or without the predisposition to helping) was also associatedwith the choice of a helping career.Self-comforting.The goal of this strategy was to console the individual in the face of his or herdisillusionment. Self-comforting was manifest in reflexive and volitional ways. In terms ofthe former, two subjects dreamed about their lost parent, an experience which was at firstfrightening in face of the reality that the parent was dead, but which became morecomforting as subjects grew used to it:Ms. B: I used to have dreams about my mother, nightmares. I remember that I'ddream that I would say 'Well mom, you're dead' and she would say 'Yeah, Iam' and they were just like nightmares because I knew that she was dead, andthen she'd be there. And finally, after I don't know how long, I told my dad,and he said 'Oh, ---, why don't you think of it like she's visiting, and enjoythe time with her - yeah, she's dead, but accept that and think of it positively,that she's now here with you.' And ever since then they [dreams] werealways more positive - I still get them occasionally, but they're more positive.Other subjects reported that they purposively carried a notion of their dead parent72within themselves. Subjects expressed comfort in their feelings that their deceased parentwas with them and aware of their feelings and needs. The following two excerpts illustratethe more conscious use of self-comforting:Mr. B: Where did mom go? It's sort of good, I like remembering it. It makes mefeel good to have her memory. I like to think she'd be proud of me for thethings I've done and the person I've become. When I do something that's notso good I think, you know, she'd love me anyway you know.Mr. N: When I do something that I know my mom would have loved or whatever, Ireally feel good, you know...and the religious part of it at that time wouldhave been just believing that she was, in a superstitious rather that religiouspart of it, would be believing she was still around.Another means of self-comforting was for subjects to revel in the memories of betterfamily times before the loss. Subjects reported this activity to be a potent source of comfort,immediately after the loss experience, but moreso as they grew older. This strategy wasused when subjects felt especially dissatisfied with their world. The following excerptdescribes a subject's use of the strategy just after he had terminated a major relationship:Mr. B: I could, I used to get this weird image of her [ex-girlfriend] and my mom [lostparent] in the kitchen at our summer ranch. I was sitting around baking breadin the kitchen, this big mixing pot, and everything around there is original asit was in 1915, no electricity, right, and this big mixing pot and my mom usedto make sticky buns. And that was a big deal. We used to come in themiddle of the afternoon if you were doing, riding horses all day whatever,sticky buns. And that was great, you know, eight years old, mom made stickybuns.The same subject described keeping part of himself as adolescent in a fantasy world - heknew what time this world represented and exactly why he has chosen to keep the memoryalive and nurtured:Mr. B: There's a part of me that's stuck back in '69, it was the last time it was alltogether then...I think it was the last time I had any sense that life was goodand pure...I sort of wonder, there's part of me that's stuck back there, but Ilike that part too in a way, I like keeping that guy inside me.`Gilding' is a later self-comforting strategy, used when subjects developed a heightened73value for their deceased parents whom they described as having superhuman characteristics -more warm, compassionate, and understanding:Mr. B: I'm sure memories have become rosified as it were, but she's somebody whoall our friends, all the kids friends could relate to, it sort of like I mean I havefriends now whose mothers, or a couple, who are like that...and she wasalways, and she was a caregiver and sort of the motherly sense in that. Imean that I just know that she would have been the person to say, 'It's okay tobe scared, it's okay to be scared and not know what's going on - it's not yourfault."Mr. N: Well I do feel that realistically that I see her in a much more golden lightbecause she died because had she lived, I would have grown up to thatrealization that most people have that their parents are actually nincompoops orwhatever. You know, everybody goes through that, where you go 'You guysaren't perfect.' So, I felt that that would have happened and then, it wouldn'tbe the same. As it is I remember her being, the most angelic, although Iknow realistically that wasn't the case. 'Cause I remember, problems with hertoo, but these things take on a more golden light.The benefit of the strategy was that subjects felt comforted remembering such happytimes in their lost childhood. This comfort seemed to assist subjects to deal with their griefand to get on with their developmental tasks. The disadvantage was that the elevated regardfor the dead parent made it very difficult for subjects to have reasonable expectations ofothers, specifically the surviving parent:Mr. B: I really felt good about remembering mom this way, but I know that it didn'thelp the feelings that I had for my dad. I mean, dad was never my favourite,but I know that I did this comparison thing between what I chose to rememberof mom and what I chose to focus on in dad. Dad really didn't have much ofa chance.To summarize, self-comforting was an strategy used to soften the sharp edges ofsubjects' feelings and assisted them to integrate the disillusionment into their lives. Thisstrategy provided a safe fantasy world into which the adolescent, and later the adult, couldretreat and find consolation. Use of the strategy was unconscious soon after the loss(dreams) and more volitional as the individual matured. The use of the strategy was not74without cost. Comparisons were made between the gilded memory of the lost parent and thesurviving parent. In this way the strategy served to exacerbate the disillusionment associatedwith the surviving parent.Summary.This section has presented the five most frequently used action/interactional strategiesreported by subjects: normalizing, rationalizing disappointment, re-sourcing needs, assumingresponsibility, and self-comforting. The strategies used to integrate disillusionment weredevelopmental in nature, with subjects employing unconscious behaviours in the earlier andmore acute phases of disillusionment, and using more volitional or purposive measures asthey matured. Strategies were most often successful in managing the phenomenon ofdisillusionment, but all extracted a cost of some sort to the individuals who employed them.All five action/interactional strategies were subject to various intervening conditions. Insome instances it was difficult to explicate the relationship between the two: did theintervening condition predispose the individual to the use of the strategy (such as an altruisticnature and the use of assuming responsibility), or was the strategy modified by a pre-existingintervening condition (re-sourcing security where the surviving parent had never been able toprovide this)?Intervening ConditionsThis section presents the broader structural context pertaining to disillusionment - theconditions which facilitated or constrained the use of the action/interactional strategies.These conditions were classified as either personal or situational factors. Personal factorsrelate to those which were intrinsic to subjects, while situational factors were extrinsic tosubjects. This is not intended to be an exhaustive list of all possible intervening conditionspossible, but describes only those which clearly facilitated or constrained the75action/interactional strategies.Personal FactorsGender, personality, maturity, sibling order, culture, and religiosity/spirituality, werethe personal factors identified. Each factor is described separately for the sake of providingan accurate representation, although they were actually found to be interrelated.Gender.Female subjects all relied upon the strategy of assuming responsibility for others. Fortwo subjects, assuming responsibility was reinforced as the 'right thing' for them to do, asthey were also the eldest sibling. However, even where female subjects were the youngest insibling order, they still expressed a sense of duty for looking after someone, usually theirsurviving parent. In contrast, male subjects relied upon the normalizing strategy, expressinga desire to draw little or no attention to themselves and to be treated like 'one of the ordinaryguys.' The difference in choice of strategies correlates with stereotypical sex-typedbehaviours, with girls assuming caring nurturing roles and boys containing and suppressinghighly charged emotions. The following excerpts typify male and female coping strategies:Mr. N: I never talked with my peers...I don't recall, until just recently ever talkingabout my mom...I know I didn't want to articulate my feelings. I didn't evenwant to really think about them, because I felt that if I don't dwell on them,well they're not there.Ms. T: And he [minister] said 'Well, you know, you're really going to be put in aposition where you're going to be working really hard." And I didn't get togo through the, I didn't get a lot of time to go through all that shock, denial,disbelief, whatever, stuff that you get to go through. I went from my mother'sdead to somebody has to do the cooking and I just put all that other stuff onhold, a lot of my grieving on hold.The reliance on highly sex-typed behaviours has been explained as a synthesis of thegrief response of regression with the adolescence task of establishing a gender appropriateconception of the self. Faced with the normlessness of their predicament, subjects described76acting in very mature ways, but with behaviours which demonstrated they had reverted torigid sex-typed roles. Evidence for this lack of norms was provided by Mr. B:Mr. B: And you never knew, of course, you're not quite sure how you're supposed toact, what other people expect of you... I didn't have a sense of, I hadn't seena movie about it and I hadn't read a book about it.This intervening condition has implications, not only for the choice of strategy, butultimately for the consequences of disillusionment as a whole.Personality.Numerous personality factors were observed, but this discussion is limited to thosewhich were germane to subjects' selection of coping strategies. These factors includedaltruism/self-centredness and sociability/introversion.Altruistic individuals most often used the strategy of assuming responsibility. Onesubject who assumed the care of her father and three younger siblings describes herself:Ms. T: When I was a kid I always wanted to be a doctor. Then at one point, Ithought that I'd like to be a teacher. I sort-of got into nursing via becoming apre-school teacher, a child care worker. It always felt like that was where Iwas going.Int:^They're all helping professions.Ms. T: Oh yeah, like I said before, I was always like that, taking care of everybody,but I think it [loss] consolidated those traits in me real early.The strategy of assuming responsibility for others did not seem to inspire a newfound senseof altruism, but rather the subject was other-centred for as long as she could recall. Shechose the strategy, possibly as it was in keeping with her personality.Another subject recalled her self-centredness during her mother's terminal illness:Ms. B: And I remember some awful things like being embarrassed that she was sick,and she knew that I was embarrassed that she was sick. And I would havegirlfriends staying the night and she would get up and we would hear herbeing sick and I would think 'Oh God, I wish that you just wouldn't do that,'you know. I remember running downstairs and screaming at her just to takesomething, not so that she would feel better, but so that I wouldn't have tolisten to it.77Subjects with a self-centred personality showed a preference for the normalizing strategy.These individuals seemed to believe that 'if I pretend it's [unhappiness, disillusionment, etc.]not there, then it will go away.' The following excerpt illustrates how useful this subjectfound this strategy to be:Ms. B: You know, I have no patience at all with people that are sick now and I thinkthat I always tell myself they're just being a hypochondriac and not really sick,there's no reason for being like that. And I think it's a just sort of a way ofcoping - denial in there, I don't want people to be sick in my life...I thinkabout death, I deny it, nobody's sick.Ms. B: I don't do breast self examination. And it's almost, I wonder if, is it becauseI'm afraid of finding something.The second personality factor, sociability/introversion predisposed subjects to using re-sourcing needs, and rationalizing disappointment respectively. One sociable subjectdescribed how she utilized her peer relationships to help re-source some of her needs:Ms. T: I had a couple of very good friends in high school. Just help coming from thestrangest places. And they used to come home with me every afternoon. Oneof them would clean the kitchen for me, and the other would put on thelaundry for me. We'd walk home from school, they'd come over, and theywould help me so that I could get dinner ready for the family. And that wassort of their contribution to my making it through.It seems logical that re-sourcing needs would only be effective for individuals who were firstreasonably sociable.The following excerpt illustrates how an introverted subject felt isolated:Ms. L: After dad died, I went back to being very introverted, I dropped out ofsocializing, basically, and I became very studious. I'm a very introspectiveperson, maybe it's just my personality. I remember for a long time that Ididn't talk in any of my classes.For Ms. L, feeling isolated was associated with a sense that no one was there for her, whichitself may have become a self-fulfilling prophecy as she explored her interpersonalenvironment for support. The last excerpt demonstrates how Ms. L, finding her78interpersonal environment unresponsive to her needs, subsequently used the strategy ofrationalizing disappointment:Ms. L: I would say that I really didn't have anyone there for me to any great degree.My mom, you know she was pretty overcome and my brother was only three.My aunt, my mom's sister and only sibling, was there. But she's not a verysupportive type of person, but I'm sure she had her own problems at the timewith her marriage and her kids and everything else. A lot of cousins who hadlived here were all moving away...It's funny, because my closest cousin wasfourteen, and yet I don't remember her being that supportive. But I think shewasn't very happy at home and she had her own problems, you know,teenagers. I mean - god - everybody was going through something it seems.Ms. L suggested four potential sources of support: mother, sibling, aunt, and cousin. Foreach the rationalizing pattern of accusation/acquittal is discernable - mother was overcome,brother was too young, aunt had marriage problems, and cousin was not very happy athome. The subject was faced with accepting the unacceptable - that no-one cares for her.Rationalizing forestalls this disillusionment.To sum, altruism/self-centredness and sociability/introversion personality traitsinfluenced the choice of strategies. Altruistic individuals most often used the strategy ofassuming responsibility, self-centred personality types used normalizing, sociable subjectsused re-sourcing needs, and introverted subjects used rationalizing disappointment.Maturity.A third personal factor which influenced the use of strategies was the individual'smaturity, especially as this was related to their degree of separation from the family unit, andthe security and stability of their self-concept. Several subjects recalled the aftermath to theirloss, and the consequences to their self-concept:Ms. P: But in those days, one never talked about adolescence. Adolescence wasn'treally recognized as a definite stage. It was just you were no longer a childand you were getting older so you had to behave differently. And then, youknow if you were unsure of yourself you had to just buckle down make sureyou got sure of yourself.79Ms. L: And plus, I was chubby, and all I know is the kids were really tiny and I don'tknow why. But I felt like I'd been there [chubby] for years so I had a poorself image I would say in some ways. And I think this [loss] just augmentedthat, it just made me feel more different, like I had less...Ms. V: Has it changed me? I think I'm very insecure. Because I don't have anyoneto rely on like other people...I just know that. I know I'm insecure. But Idon't really demonstrate it very much...I have a totally different family. Idon't have a mother...I get jealous because a lot of friends have families thatthey talk about in nursing class. Isn't that terrible? Because they all haveregular families and stuff to go home to.These data suggest that most subjects felt that their most insurmountable feeling of lossto the self was their sense of security. How this insecurity affected the choice of strategieswas also dependent upon other personal/situational factors. For instance, Ms. P's cultureand family dynamics were associated with her use of normalizing; Ms. L's introvertedpersonality were associated with her use of rationalizing disappointment; and Ms. V'sgender, family dynamics and the characteristics of her surviving parent were associated withher use of assuming responsibility strategies. This clearly demonstrates theinterconnectedness of intervening conditions and the use of strategies.This above noted assault to the self-concept had implications for the second aspect ofpersonal development, degree of separation from the family. Some subjects reportedindecision about their separation from home and family:Ms. L: I don't think I would have been as involved in my family, I would have lefthome, I think I would have lived away from home more. I kept coming backand living at home, well into my well, it's thirty, even though I've lived awayfor two years, one year and then a few years later, another year, in othercities, I almost did that in order to pull away from my mother.Ms. T: Yeah, it was hard, just breaking away. And, then I couldn't do that, anymore really.Subjects experienced a tremendous sense of ambivalence in taking this normal step inadolescent development. Witnessing their surviving parents response to the loss of their80spouses, subjects indicated that they did not wish to add to their parents' pain by`abandoning' them. In this sense, degree of separation from the family was associated withthe strategy of assuming responsibility, with these adolescents assuming responsibility fortheir surviving parents' happiness.In contrast, another subject speculated that the loss of her parent might have been theonly thing that had made leaving home possible for her:Ms. P: Now my husband says that if my mother had still been alive, (he never mether), he said that, she was obviously a very, very strong personality person,from all he hears about her, but, maybe bigoted in a way in her ideas. Youknow this is his quote that he feels we never would have emigrated had shestill been alive, that the pull for me to stay there would have been to big forme to say, no, I'll leave.This subject used normalizing to integrate disillusionment. Perhaps Ms. P (and her husband)suspected that her need to be perceived as 'normal' might have prevented her from leavinghome - that had her mother lived, there may have been duress concerning the impropriety ofthe daughter's striving to be independent.Finally, another subject had vivid dreams about losing his right to be in his home:Mr. N: I had nightmares, repeated nightmares, about having that home ripped away.In one of them my friends are all over, and we'd just slept out on the backporch and it was a sunny day and we were making pancakes in the kitchen andeveryone's having fun. And someone says, 'Hey ^ , didn't your dad sellthis place?' I realize it's someone else's house and we were are makingpancakes and the people come home and we're hiding under the chairs.This subject differed from the first two as he did not feel a) that he ought to stay at home, orb) that there may have been any resistance to his leaving. Mr. N had a strong sense that hewas pushed out from his family circle. This sense was related to his perceptions of hissurviving parent's embarrassing courtship and untimely remarriage:Mr. N: He [surviving parent] didn't stay home alone every night. He ended up goingout. He was secretive about it, and so we were almost hating him for that.Like 'Who are you going out with?' He embarrassed us all by...he ended up81getting married to a woman he met in the classified ads in the paper, so heembarrassed us all.Mr. N used self-comforting to deal with his deep disappointment at his father's behaviour, aswell as his perception that he was forced out of the family circle.Sibling order.Subjects' sibling order also exerted considerable influence over the choice of strategy.Where the subject was the youngest in sibling order, there was a profound sense of needsbeing unmet or ignored by the surviving parent and older siblings:Mr. B: I certainly would have got the encouragement, which I missed. I would havegot the encouragement, positive reinforcement from her [deceased parent], theattention. You know, whereas my dad would sort of basically look at what'swrong, you know, why are you embarrassing me.Youngest siblings drew most heavily on re-sourcing needs. In contrast, eldest siblings weremore acutely aware of the added burden of their responsibility and the subsequent loss oftheir adolescence:Ms. V: It [household responsibilities] was just up to whoever was the oldest...myfeelings were that I had to take things on because I felt I was the oldest.Ms. T: And I was always very competent and I guess, you know, that's the functionof being an eldest child in a way.Ms. L: I've always, you know, being the eldest maybe, also, I always felt like, like Ifelt always that I took over the role of my father in my family in some way. Iknow it sounds weird...I'm sure that a lot of people feel, look back on theirteenage years and think, oh no, this and that, but I definitely did not feel I hada happy teenage period.Eldest siblings used the strategy of assuming responsibility.Culture.Culture, the fifth factor influencing subjects' use of strategies was especially notable inthose who described themselves as being British. These two subjects described their familyresponse to the loss as relatively stoic:82Mr. M: We were brought up very much in the English 'stiff upper lip' tradition and Ican remember...a friend of the family tried to talk to me about my feelingsthere [funeral] and everybody else hushed them up.Ms. P: I think they [family] did it out of the kindness of their hearts because they puton a stiff upper lip, chins out and we'll carry on as normal and we'll pretendthat nothing is untoward... so many things left unsaid.Both subjects used the normalizing strategy, and seemed to invest a substantial amount ofenergy in 'keeping things looking the same.'There were no two other subjects of the same culture to permit comparisons.Religiosity/spirituality.Religiosity, part of the sixth and final personal factor, refers to any aspect of religiousaffiliation. It is differentiated from spirituality which refers to a belief in a higher being or anatural order without subscribing to any one religious creed. They are presented together asthey both represent ideological sources of comfort.Three subjects described their connections with religious institutions or their religiousbeliefs as being instrumental to them during the time surrounding the loss, and at other timesof crisis in their lives:Ms. B: Yeah, I don't know how I would cope with her death if I didn't believe in Godand that I feel really strong about. I don't know how people can feel thatdeath is too final otherwise if they don't believe in God. Otherwise it justisn't fair, why would she be sick, you know she was just 39 when she gotcancer. She was 44 when she died.Ms. V: We're Catholic. So, I started going back to church and, I joined a youngadults group and they helped me to get through.Ms. T: And I had some good friends, even family, a youth group that I was involvedin...and I had a really strong sense of community in that church. Still do,even though I don't attend. I know that there are people there that wouldalways help me. And that love me. After many years. Love me because ofmy parents, you know they say, this is Peggy and Bill's daughter, and we willdo for her.These three subjects used the strategy of re-sourcing needs, with their respective religious83groups being the newly found source of comfort, guidance and security.Alternatively, two subjects reported feeling a sense of outrage with a God who wouldlet this happen to them:Ms. P: Religion was a social thing for me. That was all we could do was guides andwe'd go to church, a youth group. But as soon as I went away to be astudent, it became no part at all. In fact, I was sort of, you know, resentful.How could this be? Somebody [deceased parent] who's dedicated their life todoing good things and going to church regularly, you know, my mother diedat 49.Ms. P relied heavily on rationalizing disappointment and normalizing as methods to integrateher disillusionment.Finally, one subject, while he denied any religious feelings per se, identified himself as`spiritual' as a result of his loss experience:Mr. N: An old girlfriend of mine said 'You know, you've got a beam of sunshine thatfollows you around.' Something that I've had, it seems all through post-adolescence until now - I just have the best luck. Maybe that's an attribute ofmy own, that I'm happy and satisfied with the beauty of the things I have,things that come to me.Mr. N mostly used self-comforting and normalizing strategies. Self-comforting was a logicalchoice as Mr. N's spirituality was from within. Normalizing was also a reasonable choice ofstrategies as the subject perceived his external environment as offering him nothing at all, orworse, patronizing him:Mr. N: I still don't know how to act in that sort of situation [losing a parent] andconversely, I don't know how to talk to somebody who has had a loss orwhatever. But I think that's how I felt at the time [after mother died], youknow 'You don't know my mom, you don't know me - don't pretend that youknow how I feel!'To summarize, six personal factors influenced the subjects' choice of strategies tointegrate disillusionment. These factors included gender, personality, maturity, sibling order,culture, and religiosity/spirituality. These factors were presented here as separate entities,84although they actually occurred in various combinations in the interview data.Situational FactorsSituational factors which affected the strategies to integrate disillusionment included thecircumstances of the parent's death, the pre-death relationship with the deceased parent,family dynamics and coping styles, the characteristics of the surviving parent, availability ofsupport, timing of the loss with respect to other significant life events, and economics.These seven factors, like the ones described under developmental sequelae and personalfactors, occurred in constellations of circumstances, as opposed to being singlydistinguishable situational determinants. They are presented here as single elements for thesake of characterization only.Circumstances of the parent's death.Circumstances of the parent's death included the abruptness of the death, as well as thedegree to which subjects were aware of the impending death of their parent when this was ananticipated event. In terms of abruptness, subjects' foreknowledge of the loss ranged fromsudden and unexpected in one case, to one subject having lived with the knowledge that hisfather was unwell and could die at any time ever since he could remember. Both thesesubjects' parents died from heart disease. The other six subjects had some degree ofpreparedness for the loss as their parents were all diagnosed with cancer. The mean timebetween diagnosis and death for these parents was 26.8 months.Looking at the most sudden loss experience, the researcher noted that this subjectexpressed a great deal of concern about her instant loss of security, her lifelong remorse forwhat her life might have been had her father lived, and her fear for the vulnerability of hersurviving parent:Ms. L: It was just, I was always worried. And I think I've never really gotten over85that...And in therapy, I found out that I still have that, that I worry aboutlosing my mom [surviving parent]. And it's so ridiculous, of course you'regoing to lose your mother at some point, but I know it stems - I'm going toget upset now - from that adolescent, that feeling of suddenly loosing myfather.This subject used rationalizing disappointment as a means to deal with her profound sense ofloss and disillusionment.In contrast, the subject who knew his whole life that his father was ill and might dieexpressed his sense of loss quite differently. He focused on what he had gained from hisrelationship with his deceased parent, rather than what he had lost with his father's death:Mr. M: Obviously the pattern in my life would have been different. I don't feel bitterthat my father died. I mean that was, he was 79, he had a good life, youknow, he always treated me beautifully. I think that my success in life, andthese relationships, my own children, is due to the example I had with myfather.This subject used the strategy of re-sourcing needs - he had a very clear conception of whathe had enjoyed in his relationship with his father, and used this as a template in his searchfor the perfect family situation. The following demonstrates Mr. M's sense that he hadfound what he was looking for:Mr. M: Here was a person [second wife] who would accept me and, of course,sexuality is very important. In my second marriage, I was adopted by mywife's family and I just found that great! Very loving, affectionate woman.Very caring, warm family, and where was all this when I was a kid?Still other subjects who, knowing that their parent was ill and dying, took responsibilityfor their dying parents' peace and serenity. The following excepts illustrate this observation:Ms. T: And the other thing is I knew she was dying. I knew that I had to come tosome kind of resolution with her and make some kind of peace because...and Imean I wasn't able to totally do that but we spent more time together. Shespent a lot of time in her room doing, things like she was really immobilizedwith her pain still, even after she started chemo, and stuff like that. So shespent time doing really quiet things, and I used to go in and spend time withher after school. I'd sit with her and talk to her and, you know, justcompanionship kind of things and I think we became better friends.86Ms. B: Yes, I was close to my mom and my sisters were reacting at the time - theywere going through a lot of experimenting and partying and boys and drugswere happening with them. The usual sort of things that were happening inthe 70's, and what I thought I would do is not upset my mother. My sistersand my brother did upset my mother. And she would cry and be upset and Iwas a sweet thing.Later in life these subjects used the strategy of assuming responsibility to integrate theirdisillusionment.Where the loss was anticipated, one subject indicate that he was aware of theimpending loss of his parent shortly after the diagnosis was made:Mr. B: As I said it was one of those things where they didn't diagnose it right away.It wasn't readily apparent what it was. She was just unwell for a while andthen I went away to camp with the school, retreat, in early May, and when Icame back it [the terminal nature of the disease] was announced. I don't feelanything was kept from me.On the other hand, two subjects indicated that they were left pretty much on their own tofigure out what was happening:Ms. B: I think we tried to keep it quiet and I really had no idea that she was going todie because she had always gotten better, she was always in the hospital andshe was always getting better.Ms. P. And then I suppose I was about twelve when my mother first discovered shehad cancer, and then they [parents] became very, much more inwardly attunedto each other. And I felt as though at that time, although I didn't know itwas cancer, because that word was never mentioned, and one never discussedthings like that. And I guess for the kids' sake everybody pretended thateverything was normal.The latter group used the normalizing strategy, whereas the former subject was quite adept inre-sourcing his needs:Mr. B: I asked him [surviving parent] to send me to boarding school. I had justfinished grade 7. And you know, somehow I sort of figured out with myselfwhat I actually, sort of consciously knew or not, that things were going a littleweird with me at that point, or there were some things on the horizon.Boarding school was great because it gave me a framework, something to latchonto. There were rules. There were limits, and there was a lot ofencouragement which quite frankly I hadn't got from my dad.87Whether or not families shared information among themselves, and how much discussionoccurred concerning members' feelings was closely related to family coping styles andcommunication patterns.Family dynamics and coping styles.Some subjects described family relationships as highly individuated, and verging onchaotic with the superimposition of the loss:Ms. V: We [family] didn't deal with it [as a group] at all. We were all separateexcept for my younger sister and I.Mr. B: Well it certainly went downhill, because essentially the other three kids sort ofmoved on at that time. They were going off to school somewhere, living inEurope for a year and so it was myself and my father at home.Depending upon other intervening conditions these subjects used different strategies. Ms. V,the youngest in sibling order and quite self-centred, used normalizing, presenting a differentpicture of her family to the world than what her family truly was. Mr. B, also the youngestsibling order and very alienated from his surviving parent, used self-comforting measures.Ms. T, the oldest in sibling order, female, and altruistic used the strategy of assumingresponsibility for others. Again, the interplay between intervening conditions and strategyuse is evident in these examples.Family coping styles varied widely. In the short term some were maladaptive andalienating for subjects. One subject described the loss of his father as precipitating a shift inthe power balance within the family structure:Mr. M: The differences were about my brother was alive with my mother and I wasalive with my father became very pronounced and I felt in retrospect I feel Iwas scapegoated. The triangle that existed terms of physicaldominance, my brother dominated me physically. He played senior men'srugby when he was sixteen and usually pushed me around and knuckled myshoulders so that I was black and blue and stuff like this. And I just hated it,I hated the feeling of powerlessness.88Other subjects described a sense of being shut out of the family, either through coping stylesused by their parents during the loss, or by the behaviour of their surviving parentsubsequent to the loss:Ms. P: So then I suppose really, in the last couple of years when she was sick, thenthings changed a little bit. It was not so much fun being around and we feltwe were being shut out because my mother and father had this sort ofrelationship... so I think that we then stopped doing things as much as a family.Ms. V: So then, I, let's see, my dad got a whole bunch of different women, and he, Ithink about, this lady came to live with my dad. She was 18. I can't standher because when she moved in she told us that we were terrible, and thereason my mom died was because we caused it, her death.These two subjects used normalizing: the impropriety of their parents' behaviour made themwish to hide this from themselves and their world.Other subjects described reacting to their sense of alienation with highly self-destructivebehaviour:Mr. N: Looking back I feel bad about the things that I did that year [after the loss].The way I treated my girlfriend, was bad at the time. Relationships with myfriends went downhill, in fact, I drank a lot. The first year of university, Idrank a lot. And I was depressed for probably the first and only time ever,I'd never really been depressed, but I was then.In the next two excerpts, subjects describe how self-destructive their siblings were:Ms. V: My brother, he drew close to a sixteen year old, no twelve year old girl at thetime. He was fifteen, I guess. And he grew too close to her, so when shewanted to break up things four years later, he threatened to kill himselfbecause he was too attached to her because he took her on as family instead ofus at the time.Ms. T: But my brother was old enough to do some taking care of himself, and neverdid actually until he died. But that's another story.The "other story" for Ms. T was that her brother committed suicide as a young adult.In the long term, subjects reported the development of cohesiveness with their siblingswhich they felt would not have happened if their parent had lived:89Mr. B: We [subject and sibs] were just discussing that only one of the four of us havebeen married. We sort of wonder if we have unnaturally high expectations inour relationships, because we relate very well to each other.Ms. P: I think I mentioned the positive aspect is that my siblings and myself becamereally close. So that's really great.Ms. B: And that was how he [brother] dealt with it [loss] and he said that, and hereally tries to keep us all close now, and it's really kind of neat...I think of thenew relationship that's developing with my siblings is part of it, and that'sreally positive. It's taken a long time to come - fifteen, sixteen years - butthat part of it is very positive - I feel very close to my brother.Neither the self-destructive behaviour, nor the sibling cohesiveness was associated with anyone strategy per se, but both have implications for the consequences of integratingdisillusionment.Relationship with the deceased parent.The third situational factor was subjects' prior relationship with the deceased parent.The impact of the loss experience, as well as subjects' willingness to be dependent upon thesurviving parent were contingent upon the degree of attachment that the subject had for thelost parent.All subjects except one described the lost parent as being the pivotal parent in theirfamily unit. For these individuals, loss of their parent represented more than loss of one halfof the parenting team, it meant loss of family life as they had come to know it. Subjectsdescribed the feelings concerning the loss of this pivotal individual, and the subsequentdisintegration of their family unit:Ms. B: And my mom was the stable one... You know I mean it's funny. I never reallythought about that, but very well, I mean she was a great carer and she wasreally in the pivot of the sort of managing things at home andbacking up my father wholeheartedly.Mr. B: It [relationship with deceased parent] was pretty close. Because I was theyoungest by six years and because I guess, physically I had a strongresemblance to her, I guess there was quite a close bond. I suppose closer90than the other kids in a different way. You know I was sort of a tag on at theend. It was very different from the relationship with my dad. I was very closeto my mother and very comfortable with her and I always felt she was on myside. You could sort of tell her things and know that it was it wasvery different when it was just me and my father. The poor guy, I'm sure hehad a lot that he was, you know pretty sad, sad for him too.The special nature of this lost relationship prompted subjects to remember the lostparent as 'larger than life,' or 'better than the best,' a strategy which was described earlier asgilding. Idealizing the lost parent also caused subjects to be highly critical of their survivingparent. Therefore, the close relationship with the lost parent exacerbated the subjects'feelings of disillusionment with the surviving parent. Although rationalizing disappointmentwas attempted by these subjects, this strategy was constrained by the inequity of thecomparison between the lost parent and the surviving parent.Characteristics of the surviving parent.As described above, all subjects compared their surviving parents to their deceasedparents whose memory had been raised to the ideal, and all found their surviving parentswanting in some way or another. Subjects expressed varying degrees of insight regardingtheir criticism of their surviving parents' shortcomings, but all were critical nonetheless:Ms. B: The normality was gone, my mom was, my dad is, for a man reallyirresponsible and as an adult now I would say he was an alcoholic. At thetime I don't remember that I thought that or anything about him. I rememberthinking that he was a jerk at lot of times, but more that than anything else.Mr. B: You know whereas my dad would sort of basically look at what's wrong, youknow, why are you, you're embarrassing me. He's quite insecure and, but Ifeel sorry for him in a lot of ways. He's very anxious and, you know, he'sgot like these kids were underachievers... I can't imagine hugging my fatheror him hugging me. You know a hug, you know this must be tough for you[dad], something like that would have meant the world to me. It just wouldhave made all the difference.These perceived shortcomings in surviving parents intensified the disillusionment and wasmanaged by strategies such as rationalizing disappointment, assuming responsibility for91others, and re-sourcing needs, depending upon the presence and effect of other interveningconditions, especially gender, sibling order, personality, and the availability of support.Availability of support.Support was described in the positive sense as not expected and available, or expectedand available, and in the negative sense as expected and not available, or not there at all.Not only was availability of support an issue to subjects, but also was the acceptability of interms of what subjects felt comfortable receiving from whom. Support came from varioussources - peers, family, friends of the family, and the church. The following examplesdemonstrate subjects' positive experience of support. Mr. B recounted the support that hereceived from friends:Mr. B: Actually, now that I think of it there's a fellow who was my best friend at thatpoint, who was, was sort of whole gang of people I hung out with, kids, likehe was not necessarily part of the gang but he was my best friend. He, Iremember was someone I could talk to about stuff like that. We had the kindof friendship, or were the kind of people who could be easily verbal, for 13year olds.Ms. P and Ms. B describe the support they received from their family:Ms. P: Well she [aunt] came to stay before my mother died, she was there when shedied and stayed you know, a few days but then I ended up staying with her fora couple of weeks in the summer.Ms. B: And so I went to my sisters' a lot I remember going there late at night and justcrying and crying that I hated it at home, and they would say, 'Just hop on thebus and come over' so they were really good to me in those days and I wouldstay with them until I felt better about things.Ms. T describes the support that she received from friends of her family:Ms. T: Yeah, there was, my mom had a really, she had a really close circle of friendswho were with her when she died and those people to this day, kind of keepan eye out for my family. Especially, me because they know me betterbecause the other kids were sort of young, and an unknown quantity, but, theyknew me as an almost adult, fledgling adult, I guess. And still, see me, andfeeling responsible for me in a funny way.92And finally, Ms. T again describes the support that she received from people at her church:Ms. T: And I had some good friends, even family, a youth group that I was involvedin...and I had a really strong sense of community in that church. Still do eventhough I don't attend. I know that there are people there that would alwayshelp me. And that love me. After many years. Love me because of myparents, you know they say, this is Peggy and Bill's daughter, and we will dofor her. That still exists.Source of support was related to other intervening conditions in terms of facilitating orconstraining strategies. For example, Ms. T's numerous sources could be associated withher sociable personality, sibling order (eldest) and religiosity. These intervening conditionstogether were associated with Ms. T's use of both the assuming responsibility and re-sourcing needs strategies. Mr. B's excerpt is also most revealing. He had an exceptionallyclose relationship with his mother [deceased], an antagonistic relationship with his father duein part to a poor previous relationship but exacerbated by gilding, and a strongly sex-typedaversion to any display of emotion. This combination of intervening conditions wasassociated with normalizing - which Mr. B. did with the 'whole gang of people he hung outwith,' and also re-sourcing needs - which Mr. B used with the best friend.Peers figured prominently in this overview of support sources, which was notunexpected as adolescents' developmental tasks include becoming more reliant upon peersand less so on family members. The difference when disillusionment occurs may be that thepeer group become even more essential in terms of representing one of the only bastions ofnormality left to the disillusioned adolescent: if all else fails, they can always turn to theirpeers.Not all expected sources of support proved reliable to subjects. Most notable wereteachers and health professionals. The following excerpts illustrate the expectations anddisappointment experienced with teachers:93Ms. L: Nobody came to me from the schools - they knew my father had diedsuddenly, and I did get a card, a nice card from the class. And my Englishteacher, who also happened to be a school counsellor, it's unbelievable to menow, and she asked me a question and of course I would always say "I don'tknow" because I'd never talk. That was my standard line. And she got, Iguess so frustrated with me that she started to rant and rave in front of theclass, saying, "How can anyone ever stand you, you never talk?" And "Howcan your parents stand you?" And obviously she didn't know, I guess but youknow another teacher, especially a counsellor would have taken me aside andsaid, you know, "Is everything all right?" or, or looked at me and my life.And nothing was ever done like that. She just totally humiliated me in frontof the class and I still wouldn't talk.Ms. P: I remember the head mistress calling me and saying, "Look unless you getbuckled down to it you're going to fail - you'll be terrible, useless. And Ithought, I'm going to show you. So I passed them [exams] defiance,but oh no, nobody said "How are you managing?The next excerpt describes one subject's disappointment with health professionals:Mr. N: I, I think that any help would have been done before, at the time she wasdying...just talking to us, I mean having someone who knows what to say, topeople who are going through...I'm looking at it now because I work at thecancer clinic and I see these people go through all sorts of consultation withevery health care professional, and I think they have a better time of it than Ido because no one ever said anything to me.The strategy of rationalizing disappointment was used most extensively when expectedsupport was not forthcoming.Finally, some subjects remembered the experience as one where they felt that they hadreceived no support from anyone:Ms. L: I would say that I didn't really have anyone there for me to any great degree.Ms. B: All around the ground were all these flowers for mom and there was nothing,nothing for these four little kids who didn't have a mother. We felt as ifnothing was for us kids. All four of us felt that way, our house was lockedand sealed, to probate the will or whatever, and this was our house with allour stuff in it. It was just our stuff and I think we needed it because we hadnothing else, we really felt that nobody was there for us.These two subjects represent the poorest in terms of their resource bases. Both described aprofound sense of disillusionment with their loss, with little to reassure them that their world94would eventually right itself. Both had undergone psychotherapy for a period of time, andcontinued to experience problems with establishing long-term interdependent relationships.Overlaid on subjects' perception of the availability of support was their sense of theacceptability of support. In the following three excerpts, subjects' willingness to acceptsupport is seen to be a potent constraint to their ability to re-source needs, especially as thisrelated to their peers:Mr. B: I mean, I think they were being sort of respectful of my feelings, by, in onesense carrying on as if nothing happened but also just letting me do whatever,including me but not seeking me out too much...basically they were just kindof there and letting me know that we're all a group together still. But notputting you on the spot.Int:^But it seems to me, as I hear you speaking, that had someone come forwardand said, "^ , you must be terribly sad", that you would have found veryinvasive.Ms. P: That's right.In these examples, while the strategy of re-sourcing needs was constrained, normalizing wasfacilitated.To conclude, subjects' availability and acceptability of support combined with otherintervening conditions to influence the use, and the success of certain strategies in integratingdisillusionment.Timing.Timing was conceptualized in terms of timing of the loss with respect to other lifeevents. Adolescence involves many developmental changes which are normal and expectedfor this age such as physical, cognitive, and interpersonal changes. In addition to theseexpected developmental changes, some subjects experienced concurrent changes in residenceand/or schools. While developmental changes are a part of the disillusionment experienceitself, the relative salience of these changes at the time of the loss, combined with other95intervening conditions, influenced the use of various strategies. The following exampleillustrates Ms. P's experience of developmental changes:Ms. P: Adolescent years, which you know you probably feel very insecure anyway, asyou're growing up and you're probably, I know I was heavier than I am now,and you know, you get spots and you're sort of learning to get to knowpeople. And you think, oh, is this really what I wanted from life?Ms. P's negative experience of her developmental changes was associated with the use ofrationalizing disappointment (to delude herself), and normalizing (to delude others).Other subjects experienced situational changes at the time of their loss. The followingtwo excerpts demonstrate first the benefits of moving, and second the disadvantages:Ms. B: There I was I guess, living in a strange city when I went back up toCherryville nobody really knew, they didn't know that my mom died, like Iwas just the new kid to them, they didn't know how long ago she'd died.Ms. V: And we just moved out to Orangeville, at the time was a difficult timebecause I was graduating from high school and wondering what to do.How this transition was perceived depended upon the subject's personality. Ms. B wassociable, but quite self-centred; Ms. V was the opposite - introverted and other-centred. Ms.B used normalizing strategies, while Ms. V used rationalizing disappointment to integratedisillusionment into their lives.This final excerpt portrays how the two changes (developmental and situational) interactwith one another:Ms. L: ...and then I went to high school in grade eight - which is just like a big, youreally feel lost when you first go to high school. So it wasn't really goodtiming for me - that transition.Ms. L was to spend years of insecurity and disorientation as a result of her experiences.Economics.This particular factor was only salient for two subjects who experienced a lack ofmoney, and was totally irrelevant for the six who had adequate economic resources. The96following excerpts demonstrate the influence of inadequate finances:Ms. L: My mom [surviving parent] had to go to work, and she didn't really havereally good job skills. She had very limited education. Although she hadworked before we were born, but you know, it had been some years and shecouldn't make enough money to support a family.Ms. V: Well, I didn't have any money all the time because I paid the mortgage on thehouse and stuff like that, because we went into debt after my mom died too,because of course she couldn't work. So she didn't have any social security.So we got into major debt from the funeral and when my dad was spendingmoney on his girlfriend.These two subjects indicated that their feelings of insecurity, and regrets for whatmight have been were strongly rooted on their financial lack:Ms. L: It was just, I was always worried. And I think I've never really gotten overthat...I mean I had a lot of trouble concentrating and I mean, and I think Iwouldn't have had that trouble concentrating so much if I wasn't so worriedabout all these different things. And preoccupied. Money was a big thing.Ms V: I actually took some art for a while, because I'm good at that'swhat I like to do, but it's not financially the smart thing to do...I sold somepictures as an artist, one brought me $200. I was making money, but itwasn't reliable, so I didn't think it was any good, so I went to nursing school.Both subjects used rationalizing disappointment (for what might have been) and assumingresponsibility (as a means to exert control over their chaotic world) to integrate theirdisillusionment.Summary.This section described the situational factors which influenced subjects' selection anduse of strategies, and therefore the integration of disillusionment into the subjects' lives. Themost significant situational factors included the circumstances of the death of the parent, therelationship with the deceased parent, family dynamics and coping styles, the characteristicsof the surviving parent, availability of support, timing of the loss with respect to othersignificant life events, and economics.97ConsequencesThe strategies used in response or to manage a phenomenon result in outcomes orconsequences. Consequences may be actual or potential, happening in the past, the present,or the future. Consequences themselves may be in the form of action/interactionalstrategies - they are not restricted to situations or states. One final feature of consequences isthat while they may be outcomes, they are not necessarily endpoints. That is, consequencesof one action or set of actions, may become a condition affecting subsequent action orinteractions (Strauss & Corbin, 1990). With this feature in mind, the researcher categorizedconsequences as short-term or long-term, and neither as mutually exclusive of one another.Short-term consequences are grouped under the heading 'Altering the DevelopmentalPathway,' and represent the ways subjects perceived their loss experience altering how theygrew up. Long-term consequences are grouped under the heading 'Developmental Sequelae'and represent the more enduring consequences of both the loss experience, and the short-termconsequences of that experience. Differentiating consequences in this way, the researchersought to distinctively characterize the long-term effects of adolescent parental bereavement.Short-term consequences - Altering the developmental pathway.Four distinctive, but not mutually exclusive 'pathways' were identified as the short-term consequences of disillusionment: growing up fast, drifting/meandering, takingresponsibility for self, and fulfilling the wishes of the lost parent. These themes arepresented here as separate entities only for the sake of description, however subjectsexperienced one or more consequences at the same time.Growing up fast.Four (out of eight) subjects described a sense of an accelerated maturity, and indicatedthat circumstances were such that they felt compelled to grow up fast. These four were98female subjects who relied heavily on the strategy of assuming responsibility for others. Sogreat was their sense of obligation to others that they felt the need to mature rapidly, and thatthey had no time to waste on their own adolescent needs and interests:Ms. L: ...I think that, that I had to grow up too fast. I think I didn't, I've never hadthat carefree, well, maybe lots of people haven't. I don't know but I thinkother people have... had that carefree time, you know what I mean?Ms. T: ...I think it consolidated those traits in me really early, that I became this kindof a person at 17 instead of going into that kind of a person at 25...yeah, Igrew up in very short order.Ms. P: ...because I feel as though now, I never had an adolescence. I didn't reallyhave a teenage time.These demands were made on subjects at a time when they felt their peers to be carefree andhappy. The contrast induced feelings of being different from other people, and a sense ofremorse for this lost epoch of childhood.A feature of growing up fast was a heightened sensitivity to environmental cues.Subjects who stated that they had to grow up fast, also described their ability to perceiveadult apprehension in a manner that they felt exceeded the 'normal' intuitive capacities oftheir peers. The following excerpt illustrates this feature:Ms. T: I don't think they'd [teachers] ever dealt with somebody who had lost a parentbefore, so it seemed like they were all kind of aghast that this would happen.It was really strange... You know, I was separated from peers by [thebehaviour of] the adults in the high school. And that was a really strangeexperience. I guess they hadn't experienced loss either, I don't know... maybethey thought I was going to burst into tears in front of them, which they didn'twant me to do. I don't know, they did, they treated me different.As time went on, subjects reported their peers 'catching up' to them. However, whilethe perception of feeling different was diminished somewhat, the sense of remorse for theloss of adolescence was heightened. One subject describes blaming some of her less adeptbehaviours as an adult on her lost adolescence asserting itself:99Ms. P: And now as an adult when I do something stupid or clumsy like if I dropthings on the floor, I just tell my kids, it's okay, it's just your mom being ateenager, making up for the lost time.Male subjects did not speak to the issue of growing up fast, and when this wasexplored during the second interviews, this concept was rejected as 'not fitting for me' by themen. This response is consistent, as the strategy associated with this consequence was onewhich was used by female subjects alone.Drifting/meandering.Drifting/meandering refers to subjects' incapacity or reluctance to undertake decisiveaction. One of the foci of disillusionment was the adolescent's hopes and dreams,characterized by a loss of orientation - to what was, to what is, and to what would be nowthat their world had changed so radically. This sense of disorientation made it difficult forsome subjects to make and act upon decisions, and consequently they described a period ofdrifting or meandering. The following excerpts portray two subjects' experience ofdrifting/meandering:Mr. B: And I was sort of searching for a solid ground, as it were, or a framework orsomething to try and latch on to. I was feeling a little bit set adrift from a,from a noisy, happy home with four kids and two parents, it was just me andhim...I think I was much more circuitous in my career path.Mr. N: The only reason I came to university was because I wanted to live inCherryville and, so that somebody said 'Go into pharmacy, there'll be lots ofjobs, you can make lots of money.' I had all the prerequisites so I just jumpedin and did it. Never serious about it, I'm still not completely serious about,but it's been pretty good - better than some of my friends who have gottendegrees but no jobs. But I never really made up my mind about what I wantedto do...everyone was going to university. I didn't know what else to do.As can be seen from these examples, drifting/meandering occurred in relationship with re-sourcing needs: Mr. B's need for guidance and security, and Mr. N's need for belonging.Where a decision was resolved, subjects reported a sense of vacillation, especially100where the options appear to favour self interest over other interestMs. V: Well, I tried to [help pay for the food and bills] but I was also thinking ofmyself and trying to save money for university. Isn't thatterrible?...sometimes I feel guilty about it, once in a while.Ms. L: But I don't think I would have been as involved in my family, I would haveleft home, I think I would have lived away from home more. I kept comingback and living at home, well into my thirties, even though I've lived away fortwo years, in other cities. I almost did that in order to pull away from mymother. I always felt like I couldn''s sort of weird, I felt as though I wasso responsible.As can be seen from the excerpts above, much of the ambivalence surrounded the issue ofseparation, with subjects expressing a great deal of concern about withdrawing their supportfrom their surviving parent or the family unit. This ambivalence was associated with thestrategy of assuming responsibility, which was in conflict with the normal adolescent task ofseparating from the family unit. These subjects felt the normal yearning to 'get out and geton with their lives,' but were impeded by their sense of responsibility for the family.Another area where subjects expressed indecisiveness was concerning career choices.Disillusionment was described as an abrupt unmasking of reality which led to a sense ofmistrust concerning the world that subjects lived in and the people whom they had respected.To manage this sense of disillusionment, some adolescents used the self-comforting strategyof gilding, which resulted in unrealistic expectations and subsequent disappointment with thesurviving parent. The following excerpt demonstrates the affect that disillusionment hadupon decisions surrounding career choices:Ms. P: But I wonder if my mother had still been alive, whether I would have chosen adifferent career and a different vocation... I think I might have gone intopharmacy or into rehab nursing.This example suggests that Ms. P felt compelled to take a course of action which, onreflection, she might not have taken had her mother survived.101Taking responsibility for the self.Taking responsibility for self was an affirmative step away from the state ofdisorientation associated with the loss in an effort at integrating disillusionment and beingmore decisive about determining choices. It can be thought of as the same ambivalence aswas described in drifting/meandering, but where the need for separation and individuationprevailed over their sense of obligation for the family. Taking responsibility for the self waseither proactive or reactive. The following excerpts illustrate the proactive consequence:Ms. L: Anyway, they [psychologists] instigated my moving out of home at thatprogram. It was good.Ms. T: And I went from taking care of three other people to taking care of just me,and it felt really, really good.This particular developmental pathway represents a sharp divergence for Ms. L. andMs. T, both of whom had used the strategy assuming responsibility for others. Ms. L hadparticular difficulty with changing her priorities, whereas Ms. T claimed to have had none.Evidently the strategy of assuming responsibility was still useful in some way for Ms. L, buthad become useless for Ms T.Taking responsibility for the self was also reactive. When asked, several subjects (4/8)characterized their eventual leave-taking as 'escaping from an intolerable situation' ratherthan 'moving towards a desirable situation:'Mr. M: No, I had, no I had no difficulty leaving home. I was, I wanted to get out ofthere so badly.Ms. P: Part of leaving home was because I didn't want to stay.Mr. N: It [leaving home] was, I got to get out of here.Int:^Are you still at home?Ms. V: No, thank God. No, not at all. I couldn't wait to be out.Whether proactive or reactive, subjects expressed a great deal of ambivalence about102what they were doing, but also realized the importance to their own development to take suchaction when they did. The following excerpts illustrate subjects' satisfaction with theirdecision to leave home:Ms. T: I was still 17. I graduated from high school and left two weeks later.Int:^And was that difficult for you?Ms. T: No, it was great, actually. It was, yeah, one of the most liberatingexperiences of my of these friends of my mother's had a house shewas vacating for the summer. She needed somebody to keep care of it, so Ileft with 50 dollars in my pocket and a place to stay and a job. And I left andI, I never went back.Ms. P: I lived with a group of girls who, who really [gave me] wider perspective onthings that I'd had...when you're British, you know the game, we were allprobably, restricted, some more so than others. No. This was the first timewhen I felt that I had no restrictionsFor some subjects (2/8), responsibility for the self was associated with a sense ofreinvesting their energies in living, and regaining their previously lost sense of equilibrium:Mr. B: When I got there [boarding school] I was in set three, set four, you know, butin six months I was in set one doing well and it seemed pretty obvious that Iwas flourishing. Got into sports for the first time ever and I was basically atall, lanky kid, who grew tall without hardly any muscle. And yeah, sportswere great.Ms. L: Seventeen, eighteen, yeah, I guess that's when I came out to some degree. Butthen I sort of had a mini crisis at the end of grade twelve thinking, well whatam I going to do with the rest of my life.As might be suspected from the above noted excerpts, taking responsibility for the selfguided subjects towards a heightened value for self-reliance. This longer-term developmentalconsequence is addressed in the next section of the report.Fulfilling wishes.Fulfilling wishes refers to subjects engaging in behaviours or making decisions with theaim of pleasing the deceased parent. This was described as a means of guiding decisionmaking, with the correct decision being that which the subject felt their deceased parent103would have wanted for them. This consequence stems from the strategy of self-comforting,with the adolescent operating in a quasi-real world of here and now behaviours aimed atpleasing a cherished memory. The following excerpt illustrates one girl's difficulty indeciding what to do and whom to do it for, herself or her dead mother:Ms. V: And my mom had asked me to be a nurse actually, when she passed away, sheasked me to go back to church, she asked me to be a nurse, and I was thinkingabout it but I didn't want to do it. I was kind of mad with her for about twoweeks, but I didn't want to do that. I'm just doing it because my mom, afterthinking about it, you know thinking, any way, I'm here [nursing school].Other subjects described the similarity between who they had become and who they thoughtthat their deceased parents might have wanted them to be. This type of fulfilling wishesdiffered from the decision guiding one, as it was not a conscious consequence and onlybecame perceptible in retrospect. In either type of fulfilling wishes, subjects expressedmixed reactions: comfort for having 'pleased' the deceased parent, but also concern forhaving done what was truly right for them.Summary.Subjects were asked to describe how their loss experience changed the way in whichtheir life unfolded. Four short-term consequences or developmental pathways wereidentified: growing up fast, drifting/meandering, taking responsibility for self, and fulfillingthe wishes of the lost parent. Each was described as a separate entity, but in reality, subjectsexperienced one or several consequences at one time or another during their development.These pathways were predicated by the strategies used by the subjects to integrate theirdisillusionment, and themselves lead to what has been characterized as long-termconsequences.Long-term consequences - Living with the developmental sequelae.The developmental sequelae or long-term consequences of integrating disillusionment104were characterized as positive, negative and relatively neutral. On the negative side, subjectsdescribed a feeling of becoming impermeable as well as a sense of remorse for what mighthave been in their lives if this loss had not occurred. On the positive side, subjectsperceived that they had discovered personal strengths which they were sure they would nothave developed otherwise. Neutrally, subjects perceived that they had become (in bothpositive and negative ways) just like their lost parent. These consequences - becomingimpermeable, regretting, discovering personal strengths, and becoming the lost parent, areconsidered the long-term consequences of disillusionment as they are more indelible inquality that the short-term consequences were. As with the action/interactional strategiesfrom which these concepts arise, the developmental sequelae are more salient to individualsin relation to triggering events which occur in their lives. However, whileaction/interactional strategies were considered relatively temporary in nature, the long-termconsequences were described as never completely fading away.Becoming impermeable.Becoming impermeable describes subjects achieving a state where, like a membrane,they were highly selective about who they let in and who they kept out. Although mostpeople practice some kind of control over the emotional proximity of others, for parentally-bereaved adolescents the criteria for admittance to the inner emotional circle becomes muchmore critical. Through the phenomenon of disillusionment, subjects learned that their worldwas unpredictable, that it was not trustworthy, and often cruel. Strategies described tointegrate this realization were often aimed at protecting the adolescent's fragile ego:normalizing - where the individual refused to accept that they were different from otherswhen they so desperately wanted to fit in and be understood; rationalizing disappointment -where the individual sought means to blunt the sharp edges of their disappointment with their105world; self-comforting - where the individual employed means (consciously or otherwise)which served to console them over their loss; and assuming responsibility for others - whereconcentrating on other peoples' requirements served to divert the focus from the bereavedadolescent's own acute needs.Becoming impermeable was manifest in a combination of behaviours: withdrawing,raising bathers, and developing a fear of abandonment, commitment, and intimacy.Withdrawing was described by subjects as a way to keep emotionally distant from peoplewho might hurt them. When evaluating who might, and who might not hurt them, subjectsindicated that they never expected that their lost parent would hurt them, and that eventhough it was unintentional, (through their death), they had. After this injury, subjectsindicated that no-one was ever as truly trustworthy, and that withdrawing ensured that theywould never be vulnerable to peoples' fallibility again. The following excerpt describe onesubject's experience of withdrawing:Ms. L: Yeah, I, well I think I've often felt alone. It's hard for me to talk about. Ithink I've often felt alone, now because I couldn't relate to other people of myage.For some subjects who were acutely disillusioned, withdrawing was not perceived ascompletely sufficient to protect the self, as there was always an opportunity that people might`come in after them.' One further protective measure was employed to prevent this - raisingbarriers. Mr. B, who was particularly close to his lost parent, described how he protectshim self from 'it' ever happening again:Mr. B: [I've had] No long term romantic relationships. Which in some ways I'vecontinued throughout my life...I hide what I feel and I don't want to expose allthe safe little areas inside, kind of scared spots inside of me, the private self.To open that up and then, what if they're gone. You know what if, you'ddone that and something happens, they leave you.Behind these barriers Mr. B described sheltering his 'self' as he was at thirteen years106old, when his mother had died. He indicated that he was aware of this aspect of his self,that he nurtured and protected it. It represented a place where he could go when he was inneed of comfort and reassurance: back to a time and self that existed before all that hadhappened had occurred:Mr. B: But I also, I think somewhere in there I don't want to let them into my soulplace. That's pretty close to my mom. I don't know, I think, I know, part ofme, is still this thirteen year old kid, is always stuck there, and will be thisthirteen year old kid kind of wondering where his mom went, and where she'sgone. And I kind of protect that part of me and I don't probably let a romanticpartner get there too much. I sort of wonder, there's part of me who's stuckback there, but I like keeping that guy inside me.This passage demonstrates a direct consequence of the self-comforting strategy, with thesubject using an internal means to meet his need for love and belonging.Other themes related to the concept of becoming impermeable included behaviourswhich were manifestations of fear of commitment, fear of intimacy, and fear ofabandonment. Again, Mr. B illustrated how he met his physical needs for closeness withouthaving to risk emotional proximity:Mr. B: More than a few women I had basically a sexual relationship with and did notlet them get to know me very well and shut that down and, if I put myself intheir position, to be honest, I'm not real proud. I know that I basically hurttheir feelings. I certainly in my younger years I enjoyed my sexualrelationship. Not so much now, I don't feel real proud about hurtingsomeone's feelings. I guess that I know what I'm capable of now. I knowthat I've encouraged women to like me, more for the purpose of being sexualwith them, from my standpoint. I'm the kind of person who tends to holdthings inside more. You know, somewhere along the line I figure out a wayto let it out, but I'm not a wildly emotional person. So, it's sort of self-defeating in a way. You don't want to be tough, you don't want to shut stuffdown, show pain or hurt, and then, it's sort of funny. You have to be carefulwhat you ask for in life, because sometimes you get it.These fears interfered significantly with subjects' abilities to form close interpersonalrelationships with others. For two subjects, concerns about establishing relationshipseventually became the impetus to seeking professional counselling:107Ms. L: Well, I've gone through actually, quite a bit of therapy. I don't really know.I wasn't really aware consciously that if I wouldn't spend the night with a manthat it's because I didn't want to let him into that much of my life. I don'tknow if I finally figured this out from some of my relationships or fromtherapy.Ms. B: I had probably, two major, major relationships. One was when I was, forseven years, from the time I was nineteen until I was twenty five. And he wasa nice guy, but too like my father. He didn't want commitment. He didn'twant responsibility in a lot of ways, wasn't willing to owe up to that kind ofstuff like that . But I expected to marry him. That's what I wanted, I wantedstability, I wanted normal, I wanted what my friend's parents had...and theother fellow was, is, the father of my child, and he is even more irresponsiblethat the first fellow. And that's actually why I went into counselling, I've gotto look at me, you know with this latest term co-dependence, I think that I'mprobably a lot of that, you know.Of the eight subjects interviewed, six had difficulties establishing relationships, with oneother most likely to encounter this as she matures. Although all three males expresseddifficulty in establishing relationships, only these two females were concerned enough by thisto seek professional counselling. This may be reflective of the strong sex-typing describedearlier, where relationship tending would be seen as the sole responsibility of women.Becoming the lost parent.Becoming the lost parent described consequences which were characterized by subjects'perceptions that they had grown up, for good or evil, into a person remarkably similar towho their lost parent had been. This consequence differs from fulfilling wishes, in thatbecoming the lost parent is more permanent than fulfilling wishes, and the former is theembodiment of who the parent was, and not merely what the parent wanted for the subject.Becoming the lost parent was also a consequence restricted to those individuals who lost thesame sex parent.Becoming the lost parent was associated with the strategies of self-comforting - withthe subject drawing comfort from being just like someone they remember so extraordinarily108fondly (gilding); and assuming responsibility - where the subject (knowingly or unknowingly)used their deceased parent as the model for how a responsible person behaves.Paradoxically, becoming the lost parent was a source of comfort for some individuals, and asource of dread for others. The following excerpts describe a positive association with thelost parent:Ms. T: I was, you know, sixteen, and breaking out of home, and getting independentand my mother, I guess she was too much like me, in a way. Well, I knowshe was, now, at the time I couldn't see it, but now I can...and the fact, Ithink, the fact that my mother was a nurse probably affected my career choicetoo.Mr. M: He [lost parent] always treated me beautifully. I think that my success in life,and, these relationships, my own children, is due to the example I had withmy father. You know, that I was able to show them tenderness andcaring...and I was good in school. I was semi-decent in sports. I got alongwell with people. I think I felt that I was somehow or other capable of a lotof things, and identified this with my father.In contrast, two subjects regarded their becoming like the lost parent with dread. Bothhad lost their mothers and had, later in life, become parents themselves. Having had theirown children set into motion a concern that history might repeat itself - that they too wouldsuffer the same illness and/or death that their mothers had. The following demonstrates thefear that these subjects lived with:Ms. P: I'm anxious about all sorts of things. Neurotic, first of all about cancer of thebreast, so that, you know, I measured the time when I had actually overtakenwhen my mother first discovered it, over that hump. It's been like climbingMount Everest. You know, going up and up and up and getting to the top,and then sort of going, phew, but just a little bit. But then also, you knowevery time the kids have gone out in the car, those sorts of things. And also,probably when my own children were little, well not so much I don't think,because I didn't really think of crib death quite so much. But, that veryspecial, sort of, almost a great feeling of responsibility being a mother, buthere I am as a mother...I want to emphasize the, I guess the fear, ofrepetition.Ms. B: I mean I don't do breast self examination. And it's almost, I wonder if, is itbecause I'm afraid of finding preoccupies me. I think about it109and I think about how awful it would be, to be sick like that...It would behorrid to, yeah, I think of what would happen if I wasn't here for her[subject's own daughter]. Yes, with birth comes death, and you start thinkingabout those things.This fear of dying like the lost parent was rather free-floating, and was triggered bydevelopmental periods which were reminiscent of the lost parents' circumstances shortlybefore dying. Ms. P's excerpt demonstrates this best with her measuring her own lifeagainst her mothers to mark the exact time of the discovery of the metastatic lump. Ms. Pwas so connected with her mother's experience that she could poignantly describe thefeelings her mother must have had shortly before her death:Ms. P She must have felt dreadful because she was leaving before her job wasfinished and I know exactly now, being in the same position. But here shewas, leaving a family she hadn't finished bringing up.Regretting.The third long-term consequence was regretting, specifically for the loss of subjects'adolescent period, and more generally for all that 'might have been' had the lost parent lived.Those who expressed regret for their loss of adolescence were typically those individualswhose use of the assuming responsibility strategy had resulted in the short-term consequenceof growing up fast. As assuming responsibility was used only by females, the long-termconsequence of regretting the loss of adolescence was also expressed only by females:Ms. T: Well, there was no doubt, because, I was, I had three younger siblings, and Ispent my time at home taking care of the little kids and my brother and thehouse, and doing the wife, mother things, instead of doing high school things.You know. Yeah, I grew up in very short order.In this sense, assuming responsibility was not wholly successful in integrating disillusionment- its use deferred the disillusionment, it did not eradicate it.Other sources of regret were related to what has been described as 'might have beens,'which included career choices, relationship choices, and life choices in general. The110excerpts reply to the question 'Who might you be if your parent had lived?:Ms. V: I'm sure that I'd be a lot different if mother had lived. I'm sure, but becauseI would have my mom and dad living together still, I'm sure they'd still bemarried. And she'd probably would have supported me going to school, youknow she wanted me to continue education, that was important to her. And,let's see, I think I'd be much different. I think I would have been happier.Mr. B: And in terms of if my mother had been alive, I think I would have been quitesimilar to my brother who was six years older, you know, I guess. I wouldhave gone through largely what he did. Go through public school. He'sbasically fairly average, reasonably successful. Fairly middle of the road andjust, you know, grow up an average kid, I think...I think I would have beenmore comfortable with myself and more at ease in relationships, is what I see.I'm guessing I would have been involved in more long-term relationships.Both responses reflect the changes that the subjects sustained following their loss: Ms. Vexperienced less happiness; Mr. B. had less capacity to trust. Both are outcomes ofintegrating disillusionment.One final expression of regret described by one subject was the lost potential toexperience a mature relationship with her mother who had died when she was 15 years old.She expressed regret for the lost opportunity, as well as resentment towards people who didnot value their parents enough:Ms. P: One of the things I do have is almost resentment in a way when I seedaughters now complaining about their elderly mothers. You know I meansome have a really nice relationship and are obviously very happy to becaregivers, but others are sort of bitter about looking after their parents. Butwhen I see a happy relationship of mother and daughter. I see them going offfor lunch, and doing things together, I think I'm resentful in that respect thatI, gosh, I couldn't have that.Subjects expressed a fairly astute perception of who they might have been and how their lifemight have unfolded had this loss not occurred when it did.Discovering personal strengths.The fourth and only positive long-term consequence was discovering personal strengths.Discovering personal strengths involved subjects' perception that their efforts at integrating111disillusionment had made them stronger or better persons in some way. This consequencewas associated most strongly with the use of normalizing, or with assuming responsibility forothers. With normalizing, discovering personal strengths was only a consequence for thosewho reached a point of reorienting their norms to an internal and more comprehensiveconception of how they 'ought to be.' By reorienting their norms, these subjects allowedthemselves to be themselves, and accepted this as worthy and good. On the other hand,assuming responsibility for others was, in itself, praiseworthy, and subjects who used thisstrategy had little difficulty in discovering personal strengths as a consequence.One personal strength that subjects described was having acquired a greater capacity forempathy and understanding than they might otherwise have had. For the `normalizers' thisstrength came from reorienting their norms and discovering the worth in people likethemselves. For the 'responsibility assumers' this strength arose from dealing with theadversity that they had grappled with. The following excerpts demonstrate the two differentsources (respectively) of the personal strength:Mr. M: I'm quite such successful with borderline kids. And with young adults becauseI think I identify very much with them.Ms. T: I think, it [mother's death] probably, made me kinder, you know. And more,more understanding of what, of pain that people go through, that it's hard toexplain myself. That I don't think you can be empathetic until you've hadsome kind of experience that you can, you know, relate it to. Not that I'msaying that I should lay my own feelings on top of somebody else's, but Iknow, I know, I mean, I say I know, when I say to myself I know how theyfeel, I know how they feel. And I give people, a lot more room, I'd say,more accepting of, of people's deviations in emotions. I try and see whythey're doing, as opposed to saying, "This is really ridiculous. I can't seewhy they're doing that." I, yeah, I think that as an adult it's made me a betterperson in a way.In general, subjects believed that their own trials of loss and hardship had fostered a morecompassionate attitude towards kindred sufferers. Subjects who expressed this heightened112sense of empathy were also ones who described their experience of their parent's illness (allwere deaths which occurred after long illnesses) in terms of their parents' pain and anguish,and not in terms of their own suffering. This other-centredness reinforces the notion that thepredisposition towards an altruistic nature might have already been established for theseindividuals before their loss experience, and that perhaps their experience only heightenedtheir capacity for compassion.In contrast to these other-centred individuals, one subject who was described as havinga self-centred personality expressed a decreased tolerance for ill people - that she suspectedthem of malingering or hypochondria if they claimed to be ill. Her intolerance, sheunderstood, was a manifestation of a coping strategy of denial: that if she refused to believethat someone was ill, she did not have to seriously entertain the idea that they might die andleave her:Ms. B: You know, I have no patience at all with people that are sick now and I thinkthat I always tell myself they're just being a hypochondriac and not really sick,there's no reason for being like that. And I think it's a just sort of a way ofcoping - denial in there, I don't want people to be sick in my life...I thinkabout death, I deny it, nobody's sick.This subject was, before her mother died, equally concerned with how her mother's illnessand suffering affected her as she was about how it affected her mother:Ms. B: And I remember some awful things like being embarrassed that she was sick,and she knew that I was embarrassed that she was sick. And I would havegirlfriends staying the night and she would get up and we would hear herbeing sick and I would think 'Oh God, I wish that you just wouldn't do that,'you know. I remember running downstairs and screaming at her just to takesomething, not so that she would feel better, but so that I wouldn't have tolisten to it.Again, this reinforces the notion that subjects may not have become whom they did withoutsome predisposition to that personality or characteristic before the loss.A second personal strength that grew out of subjects' loss and their subsequent113hardships was caring about connections. Subjects' early loss had provided them with anunderstanding that life is fragile, and a concern about maintaining the vital connections withloved ones:Mr. B: But essentially we always got along fine, and in fact if anything, we were justchatting about this the other day, because all of us were together. We werejust discussing that only one of the four of us have been married. We sort ofwonder if we have unnaturally high expectations in our relationships, becausewe relate very well to each other.Ms. B: And he [brother] really tries to keep us all close now, and it's really kind ofneat...I wonder, I don't know now I think of the new relationship that'sdeveloping with my siblings is part of it, and that's really positive. It's takena long time to come - fifteen, sixteen years - but that part of it is very positive- I feel very close to my brother.Ms. P: I mentioned the positive aspect is that my siblings and myself became reallyclose. So that's really great. And even though we're on far corners of theworld we tend to try and see each other every year or every other year...that'sa real positive thing. And that probably is the most positive thing, that we'rea very close family.The third personal strength identified by subjects was a heightened sense of self-reliance. This personal strength was a natural outcome of taking responsibility for the self,and/or assuming responsibility for others. Subjects indicated that having had to look afterthemselves and others from an early age had resulted in a perception that they were highlyself-sufficient and 'masters of their own destiny:'Ms. B: When I went to university, my friends, that it was their first time out on theirown, they would blow all their money, on, on going out for food going outfor, buying a bunch of clothes and not have anything left, but I was used tobudgeting, I was used to doing all that.Ms. P: I think it made me stand on my own two feet. Probably a good organizer.Ms. T: I think I was always a really, take charge kind of a person, you know, takingcare of all those people, but I think it really accentuated those characteristicsin me...I guess I never knew how much I was capable of doing for myself andhow strong and independent I am. And I know that if it comes right down toit, I will always be all right...yeah, I'm definitely a survivor.114Ms. T: I guess I wouldn't have known how capable I was at taking, I was alwaystaken care of as a child. You know, my parents always did everything for me.I guess I never knew how much I was capable of doing for myself and howstrong and independent I am. And I know that if it comes down to it, I willalways be alright.Closely related to self-reliance was one subject's description of resiliency - he had beenthrough it all and was now immune to anything that remotely resembled disillusionment:Mr. N: I feel very strong, I feel resilient to stress, and to grief and the pressure andall that. I feel tough, super tough. I think I became very mature at that time,and so much so over that year now, I probably became more mature than Iwould have at all, the other way. That's how I feel just because of what Iwent through and how I dealt with it.Finally, this same subject described an overall sense that he felt that he was likely a farnicer human being than he might have been had his mother lived:Mr. N: So I was the baby and got everything, I wouldn't say, just as an aside - theonly thing that prevented me from growing up to the spoiled jerk was the factthat my mom died and I had to grow up real fast and get into a lot of thingsand then get out on my own, which wouldn't have happened otherwise. Ithink, I remember myself being very different sort of person before than after.Over time, subjects indicated that they were able to 'make something good' out of theircatastrophic experiences, lending evidence to the old adage that 'every cloud has a silverlining' although the lining may take considerable time to show through.Summary.This final section of the conceptual analysis has described the long-term consequences,or developmental sequelae of the process of integrating disillusionment. Consequences werefound to be positive, negative, and relatively neutral. Subjects described their consequencesas becoming impermeable, becoming like the lost parent, regretting, and discovering personalstrengths, and related these consequences to their disillusionment, and the action/interactionalstrategies that they had used to integrate their disillusionment into their lives. The long-termconsequences were described as being indelible in nature, as they were ones which subjects115described as having become very much a part of who they are today.Subjects' Experience of Participating in the StudyThis third and final section presents an account of subjects' experience of participatingin the study. Most subjects indicated that the interview was of therapeutic value to them.Mr. B's comments underscored his perception of the therapeutic value of the interviewsession:Mr. B: I'd been thinking about mom [deceased parent] quite a bit over the summer,it'd been close to the top of my mind for a couple of months, and sort ofincreasingly, and then you came along, and I realize that since we've talkedI've been very peaceful about the whole thing, and I've been very easy in myfeelings, and I haven't been troubled by it. I just sort of have gone back to,something that happened twenty one years ago - the memory's still there, but Ifeel very calm about it, whereas obviously it was simmering near the topbefore we talked. So it's nice for me, I really appreciate this...and I enjoyedgetting it out and analyzing it a bit, and talking about things.The subject who was youngest and closest to the loss experience indicated that she wasunsure why she had volunteered as she felt that the whole episode might be disturbing:Ms. V: I thought, what am I doing because I'm going to get upset and ruin my day.This subject revealed that this was the first time she had told her tale in its entirety, and thefirst time that she had put words to feelings which, until then, she could scarcely bear.Another subject expressed an interest in how she would 'measure up' in terms of therest of the subjects' experiences, suggesting that the feelings of being different from otherswere still highly operative for her, and that she continued to use an external measure for herstrategy of normalization:Ms. L: I'll be interested to hear how this all [research] ends up, if I'm like the otherpeople that you speak to.In terms of the researcher's subjective observations, one subject's motivation toparticipate in the project seemed to be his need to be seen as an expert on his own116experience. This subject 'quizzed' the researcher on her knowledge of the field of adolescentbereavement, and seemed to relish recommending authors and studies about the phenomenonto the researcher.Finally, while some subjects possessed their own personal reasons for participating inthe study, all participants expressed gratification to have had the opportunity to contribute ina meaningful way so that other parentally bereaved adolescents might benefit.117CHAPTER FIVEDiscussion and ImplicationsThe purpose of this chapter is to explain the findings of the current study, to orient thestudy within the context of related knowledge, and to consider the implications for nursingpractice and research. This study sought to describe the long-term developmental effects ofparental bereavement in adolescence. In Chapter Two, a review of the literature establishedthat while a substantial body of literature concerning adolescent bereavement has emergedsince 1980, very little exists that describes the long-terms effects of adolescent bereavement,and only one study was found which specifically explored the long-term effects of adolescentparental bereavement. Although the literature reviewed in Chapter Two served as a basis forthe discussion, themes discovered in the data which did not arise in this original reviewrequired the addition of research and theoretical literature.The discussion is organized to reflect the three research questions which directed thestudy. The first question is addressed in relation to the long-term developmental effects ofthe loss of a parent in adolescence - the consequences of integrating disillusionment. Thisdiscussion will include an exploration of the factors and conditions which contributed to theseeffects, the focus of the second research question. The third question exploring the extent towhich this study's findings fit Davies' (1991) conceptual schema will also be addressed.A word must be said here about the nature of the existing adolescent bereavementliterature. Research in this area has been, almost exclusively, quantitative in its approach.Thus, a body of knowledge has been developed which examines particular variables inrelation to adolescent bereavement - eg. self-concept, support systems, alteration in specificbehaviours such as school performance, eating, and sleeping. What has not been reported isa comprehensive description of the experience of the parentally bereaved adolescent. One118theory of adolescent parental bereavement was discovered, but could only be used sparinglyas the theory is rooted in psychoanalysis and thus shares this approach's shortcomings. Noliterature was found that supported this study's conceptualization in its entirety. Howevermany of the variables discussed in the literature were embedded in this study's findings, butit was exceedingly difficult to discuss this study's comprehensive conceptualization usingsuch narrowly focused research.Integrating DisillusionmentThe research findings revealed that the adolescent who loses a parent experiences thephenomenon of disillusionment which provokes behaviours which have been described as theprocess of integrating disillusionment. Disillusionment was characterized as the interactionof the grieving process with the developmental tasks of adolescence, and as such comprisedelements which were similar to both, but not exactly like either. Subjects responded to, ormanaged the their experience of disillusionment by using certain action/interactionalstrategies which to denied, blunted, or forestalled the impact of disillusionment. Thesestrategies included normalizing, assuming responsibility, re-sourcing needs, self-comforting,and rationalizing disappointment, the selection of which was related to certain interveningconditions (see Figure 2). The use of these strategies resulted in specific outcomes orconsequences, which were classified as short-term or long-term in nature. Short-termconsequences at one point in time became action/interactional strategies or the interveningconditions that lead to the long-term, or more indelible consequences of disillusionment. Theinterrelationship between consequences and action/interactional strategies is illustrated inFigure 2.Growing Up Fast11Assuming Responsibility A \ f\k ONG-TERM CONSEQUENCESAlit ecoming ImpermeablA` Becoming the Lost ParentRegrettingDiscovering Personal StrengthsNormalizingDrifting/MeanderingTaking Responsibilityfor the selFulfilling WishesRationalizing DisappointmentRe-sourcing NeedsSelf-Comfortingfemaleother-centred/outgoing personalitysurviving parent - weakattached to familyeldest siblingdeath expected maleself-centred personalityBritish cultureill-informed about deathmaladaptive family coping stylesupport unacceptableconcurrent negatively perceived changesintroverted personalityreligious but angry with Goddeath expectedpositive relationship with dead parent +negative perception of surviving parentsupport unavailableeconomics inadequateconcurrent negatively perceived changesoutgoing personalityyoungest siblingconnected with religious groupsdeath expectedsurviving parent negatively perceivedsupport available & acceptable surviving parent perceived asinappropriate/embarrassingmore separated from the familyspiritualFIGURE 2 - ASSOCIATIONS BETWEEN INTERVENING CONDITIONS, STRATEGIES, AND CONSEQUENCESINTERVENING CONDITIONS^ STRATEGIES^ SHORT-TERM CONSEQUENCES120DisillusionmentDisillusionment was the phenomenon that occurred when the adolescent's parent died.Disillusionment resulted when the individual confronted the developmental issues ofadolescence at the same time as he or she must deal with the stressors of the grievingprocess. The concept of disillusionment is new to the field of adolescent bereavement, andas such was not found in the literature. However, support for aspects of the phenomenonwas found in the literature which describes adolescence, grieving, and adolescentbereavement.During adolescence, previously held conceptions and understandings are re-examined,analyzed and changed to meet a maturing view of reality. Ordinarily, this process ofunmasking reality is gradual, with adolescents pulling away from familiar beliefs and modelsas their own identity and values steadily take shape. Unmasking reality can, and often doesresult in the childlike images of all-perfect, all-knowing models disintegrating, never to bereassembled as they were in childhood. Although the process of unmasking may be a steadyone, it is not without its ups and downs. Adolescents vacillate widely between child andadult perceptions and feelings, and experience a great deal of ambivalence between wantingto be independent of their parents, and realizing how dependent upon their parents theyactually are. The upheaval of unmasking reality is made tolerable for adolescents becausethey usually experience these changes from within the security and stability of their familyunit (Papalia & Olds, 1981; Wass & Hannelove, 1989). Erikson (1963) describesadolescence as a `psychosocial moratorium,' where the adolescent is focused on a search forcommitments to which they can be faithful. He maintains that these commitments are bothideological and personal, and the extent to which young people can be true to themdetermines their ability to resolve the identity vs. role confusion crisis of this stage,121determines their capacity for future development, and ultimately influences their adultpersonalities.Numerous authors have proposed theories of grief and bereavement (Bowlby, 1980;Freud, 1957; Lindemann, 1944; Parkes, 1986; and Rando, 1984). Rando's (1984) workexamined the various theories of the grief process, and concluded that while each may focuson different foci and may use different labels for concepts and theories, they all describe thesame basic feelings associated with loss. Because of this similarity between theories, Rando(1984) suggested that the normal grief process could be described as fitting into three broadcategories/phases, into which all other conceptualizations could be collapsed. She describesthese categories/phases as avoidance, in which there is shock, denial and disbelief;confrontation, in which the grief is most intense and reactions to the loss are most acutelyfelt; and reestablishment, where the grief declines and a reentry into the daily routinefollows.Fleming and Adolph (1986) state that studies of adolescent bereavement leave theinvestigator perplexed, as the conflicts associated with adolescence are so similar to the onesinherent in the grieving process. Both adolescent development and the grieving processinvolve adapting to a loss and coping with changed inner and external realities, and bothmust encounter the ambivalence and conflicts inherent in the phases of grieving or ofseparation - avoidance, confrontation, and reestablishment.Integrating disillusionment embodied the conflicts, ambivalences, and the adaptations ofthe parentally bereaved adolescent. Disillusionment, the phenomenon, was characterized interms of its dimensions, and was found to occur in relationship to one or a combination offour referents. The dimensions of disillusionment were described as intensity, duration,frequency, and degree of pervasion.122Phases.Two phases of disillusionment were described by subjects with respect to thephenomenon's intensity: acute and blunted. The acute phase is characterized by a keen senseof shock, followed by a debilitating insecurity. This initial phase of disillusionmentcorresponds with Rando's (1984) first and second phases of grieving. The first phase of thegrief process is characterized by a sense of shock, numbness and disbelief; the second by asense of generalized anxiety associated with the unknown and unfamiliar, and feelings ofanger and/or guilt. The first phase of disillusionment differs from Rando's (1984)conceptualization of the grief process because the adolescent has been caught in the midst ofvoluntarily attempting to separate themselves from the parents. When a parent dies, insteadof the adolescent gradually peeling away from the constant parent, the parent is sheared awayfrom the adolescent, abruptly and prematurely. The resulting disorientation and insecurityare profound - just when the adolescent is trying to figure out the meaning of life, lifesuddenly becomes meaningless. Parentally bereaved adolescents learn, in this acute phase,that their world is unsafe and that no-one is impervious to death and/or abandonment(Fleming & Adolph, 1986).The second phase of disillusionment was described by subjects as 'blunted,' and onewhich did not ever completely disappear. This corresponds to Rando's (1984) third phase ofthe grief process, characterized by a gradual decline of grief and the beginning of the socialand emotional re-entry into the everyday world. What is markedly different for theparentally-bereaved adolescent is that there is no previously established point of re-entry.The bereaved adolescent is caught in the midst of becoming - "he [sic] is seeking an imagehe does not know in a world he rarely understands, with a body he is just discovering"(Jones, 1969, p.332).123Duration.The notion that the blunted phase of disillusionment never really disappears altogetherrelates to the phenomenon's duration. The research that has been conducted on the durationof grief is inconclusive. Most studies follow the bereaved individual for a period of eighteenmonths, and do not include information about what happens after this point. This preventsresearchers from making valid, generalized statements about the 'normal' length of thegrieving process. Rando (1984) states that although it was once thought that grief symptomsonly lasted six months, it is now believed that some symptoms may take up to three years toresolve. Furthermore she asserts that the adage "Once bereaved, always bereaved" remainstrue, and that there will be aspects of the loss that will remain with the bereaved until he orshe dies (Rando, 1984). This notion that bereavement is lifelong is supported by Castiglia"It is important for caregivers to understand that mourning never ends" (1988, p.158). Withadolescence being a particularly decisive time for the formation of identity, it is notsurprising that the experience of bereavement at this time would lead to seemingly indelibleconsequences for the individual. Foundations are being laid which, for good or for ill, willremain with the individual for the rest of his or her life.Frequency.Disillusionment was also found to have a frequency dimension, with subjects reportingperiodic exacerbations of disillusionment associated with triggering events such as meetingwith people who reminded them of their lost parent, attempting to establish closerelationships with others, or exposure to perceptual stimuli such as familiar music or scenes.This feature is not unlike the normal anniversary reaction associated with grieving, exceptthat the feelings which are mobilized include a profound sense of mistrust and insecuritywhich is atypical of normal anniversary grief reactions (Osterweis, et al., 1984).124Degree of pervasion.Degree of pervasion described how deeply disturbed subjects were by their alteredperceptions of reality. This dimension seemed closely related to the magnitude of departurefrom previously held norms, as well as the degree of intimacy concerning the focus of thedisillusionment. Magnitude of departure varied from a mere alteration to a serious violationof the subject's perceptions of reality. Alterations in perceptions of reality and social normsare normal tasks of adolescence, but are disrupted for the bereaved adolescent when thesurviving parent (and other role models) act in ways which the adolescent perceives asviolating their newly forming value-system. Surviving parents may be particularlysusceptible to negative `revisioning,' as they themselves are preoccupied with their own griefreactions to the loss of their spouse. This observation is consistent with Galloway's (1990)findings that 60% of young adults' relationships with their surviving parent altered greatlyfollowing the other parent's death. They expressed anger and resentment at the survivingparent's coping behaviours, along with a compulsion to assume the parenting role.Referents.Disillusionment occurred in connection with specific referents: surviving parents,authority figures, expectations surrounding what family life should look like, andadolescents' hopes and dreams for what their lives might have been had their deceased parentsurvived. The first two referents are commonplace to the normal adolescent experience ofunmasking reality, while the third and fourth referents are the usual foci of reorientation inthe grieving process. When adolescents ordinarily unmask reality, they can do so from therelative security of a stable family life and their own expectations of what their future holds.When adolescents ordinarily encounter loss it can be faced from the relative security of thestability of relationships with significant others in the bereaved's life. When all four foci are125the subject of disillusionment, the consequences threaten to overwhelm the bereavedadolescent.The following section discusses the action/interactional strategies used by adolescents tointegrate disillusionment. Woven into this discussion is the role of the various interveningconditions in determining the selection and/or the effect of the differing strategies (see Figure2).Action/Interactional Strategies and Associated Intervening ConditionsSubjects used five action/interactional strategies to integrate disillusionment:normalizing, assuming responsibility, re-sourcing needs, self-comforting, and rationalizingdisappointment. Which strategy was used, and the success with which the strategy served tomove the adolescent through the process of integrating disillusionment was determined bycertain intervening conditions. These conditions were characterized as personal or situationalin nature. Personal factors consisted of gender, personality, maturity, sibling order, cultureand religiosity, while situational factors included circumstances of the parent's death, pre-death relationship with the deceased parent, family dynamics and coping style, characteristicsof the surviving parent, availability and acceptability of support, timing of the loss, andeconomics.Normalizing.Normalizing is similar to what Fleming and Adolph (1986) have conceptualized as self-image and belonging, as it demonstrates the adolescent's adjustment to a new and unwelcomeself-image of being bereaved and relates to a fear of being misunderstood/rejected or dislikedby peers for being different. Adolescents used normalizing to protect their self-image andtheir family image. The strategy was used most often by individuals who were characterizedas both self-centred and sociable.126Normalizing helped the adolescent to forestall or deny his or her integration of thedisillusionment brought about by changes which occurred in the self and the family. In thissense, normalizing is similar to denial in helping to protect the adolescent's fragile ego.Accepting that one is bereaved compels the adolescent to accept that he or she is differentand somehow set apart from his or her peers. Several subjects indicated that peers' mostsupportive actions were in fact non-actions - treating the subject as if nothing had happened.This strategy helped the adolescent to keep one thing stable (peer relationships) in the midstof a complete loss of stability in the family unit. This finding is consistent with Raphael's(1983) observations of parentally bereaved adolescents who felt different from their peersbecause they were fatherless or motherless. This difference was heightened by the fact thatthey were at an age where they were particularly sensitive to the norms of the peer group.Adolescents may resent any stigma associated with their altered status, in particular any pityor shame. Feeling different was also extended to the family which was perceived as alteredor incomplete. The stigma of being bereaved caused adolescents to suppress or repress theiremotional responses and needs, so that the process of grieving became a rather private onefor adolescents, or it occurred intermittently when circumstances were favourable and the egocould allow the susceptibility (Raphael, 1983). In either case, normalizing extended theprocess of bereavement over a considerable period of time as the loss was slowly resolved.Normalizing was used most often by subjects who were characterized as both self-centred, and sociable. Self-centredness is not unusual for normal adolescents - they are oftenpreoccupied with how they are seen by their peer group and others (Cook & Phillips, 1988).Sociability is also characteristic of normal adolescents as they undertake the task of forgingnew relationships with people outside of their immediate family (Corr & McNeil, 1986).The combination of the two personal characteristics makes adolescents vulnerable to the127impact of others' perceptions on their self-image.Other subjects expressed distress about the lack of norms for how parentally bereavedadolescents should behave. This finding is consistent with adolescent bereavement responsesstudied by Gapes (cited in Raphael, 1983). His subjects maintained that they often had littleknowledge of what was normal in a grief reaction, and so were most hesitant to show theirnatural responses for fear that they would be seen as abnormal. In the current study, theeffect of normlessness was exacerbated by the personal intervening condition of maturity,with the adolescent's behaviour vacillating between childlike and dependent, and mature andself-reliant. Adolescents faced a dilemma: while the loss experience caused regression,family dynamics required that they assume grown-up roles (Castiglia, 1988; Gordon, 1986).Subjects reported that in the face of this dilemma, no norms were available to them .When information was unavailable about what was expected from the adolescents, theyreported drawing upon what seemed to be the most salient of social expectations. Thesemodels for behaviour were clearly divided along gender lines with subjects adopting a rigidconception of self as male or female which was based upon stereotypical sex-typedbehaviours. Females responded by adopting the role of nurturer, irrespective of whetherthey had lost the pivotal nurturing figure or not, while males described an inclination forstrongly male sex-typed roles such as 'soldiering on' and testing authority. Thus, genderproved to be a powerful intervening condition that influenced the use of this strategy.Similarly Raphael (1983) reported that bereaved adolescent males often repressed theirfeelings, as they perceived the longing for a father or mother as childish or unmasculine.This resulted in an inability to talk about what happened or to express their feelings. Incontrast, girls more easily expressed their feelings of longing and loss, as it was moreacceptable that they do so. Gray (1987a) confirmed these findings, with parentally bereaved128male adolescents controlling their feelings to a greater degree than did female subjects.As time went on, subjects found similarly affected individuals and came to seethemselves as less sharply different from their peers. Rather than using external norms onwhich to model their behaviour, subjects reoriented to their own internal norms anddeveloped a more comprehensive perception of how bereaved individuals ought to be. Asimilar observation was made by Cragg and Berman (1990) and Goodman (1986) who foundthat adolescents learned to come to terms with their identity as 'bereaved' by interacting withother people who had suffered a similar loss. Although in time, subjects found, and wereable to relate to people who had experienced losses like themselves, at no time did subjectsacknowledge feeling 'like ordinary people' - from the time directly following their lossexperience right up to the time of this study. Feeling different is examined later in the studyas a long-term consequence of adolescent bereavement.Normalizing was influenced by the presence and salience of developmental changes inthe adolescent's life (presented under 'Timing' as a situational factor). These changes werenegatively perceived (ie. weight gain, acne), and combined with disillusionment, proved apowerful assault to the subjects' self-concept. Normalizing protected the subjects from thisoffensive. This observation is consistent Palazzi et al.'s (1990) documentation of theinterrelationship between the adolescent's self-concept and the subjective importance ofparental bereavement. The authors, however, caution against a too rapid interpretation of thedirection of this relationship. The relevance of parental bereavement may be heightened by apoor self-concept, or parental bereavement may impair the adolescent's sense of self asworthwhile: the relationship is unclear. Whatever the direction of the relationship, thecombined effect of parental bereavement and a shaky self-image leads to the more urgentneed for a coping strategy such as normalizing to integrate the disillusionment.129Finally, normalizing was also used by the family unit as a whole, and was therebyinfluenced by the intervening conditions of family dynamics and coping styles as well asculture. To some degree normalizing was used by all families, but was strongly associatedwith subjects whose families had a strong British cultural influence. These familiesemployed a 'stiff upper lip' policy amongst the family members and towards individualsoutside of the family. Those subjects whose families reacted in this manner indicated thattheir loss experience would have been far less painful had their feelings and concerns beendealt with in a more open and accepting climate. This is consistent with findings concerningthe effect of family communication and cohesiveness on adolescent bereavement responses.Adolescents of families marked by emotional distance reported feeling confused about thedeath long after its occurrence, while those whose families' were characterized by opennessreported only a lingering sense of loss (Balk, 1981; 1983).To summarize, normalizing was a strategy used by parentally bereaved adolescentsbecause they were highly sensitive to the social stigma of being bereaved and uncertain aboutbeing somewhere between a child and an adult. The strategy was associated with a self-centred and sociable personality, and the presence of other negatively perceiveddevelopmental changes. Bereaved adolescents adopted highly sex-typed gender appropriateroles in response to a lack of norms. Normalizing was also used by the family unit as awhole, particularly for those families who were of British cultural origins. Support for thestrategy was not found in the literature per se, but certain aspects of normalizing andassociations between these aspects and other variables were supported by several authors.Assuming responsibility for others.Assuming responsibility was one of the strategies participants used to integratedisillusionment. Subjects who used this strategy tried to deal with the adverse family130situation and meet the dependency needs of family members. The purpose of the strategywas to distract the bereaved adolescent's attention from her feelings of disillusionment withthe family situation or the surviving parent, or both, by focusing her attention on her dutiesand obligations that she felt compelled to undertake as a result of the loss. The strategy wasused exclusively by females in keeping with a fairly narrow interpretation of genderappropriate behaviours. Similarly, Josephs (1982) reported that adolescent girls who losttheir mother or father felt that they had to become more mature and responsible as a result ofthe loss. Newman and Newman (1978) also suggested that instability in the home facilitatesidentity achievement in female adolescents. Raphael's (1983) observations of bereavedadolescents provide an explanation for these findings: "If there is great uncertainty in theself about who one is and what one will become, there may be strong ego pressures toconsolidate some identity choice... bereavement heightens the uncertainty about who one isnow that one is 'fatherless' or `motherless'...and the adolescent may seek an identity, anyidentity to resolve the anxiety" (p.159).Assuming responsibility was influenced by subjects' altruistic and/or sociablepersonalities. Altruism is compatible with this strategy as it is other-centred, rather thanself-centred in its motivation. Assuming responsibility for the surviving parent and siblingswas facilitated by the adolescent's ability to re-source her needs through her outgoing andsociable personality. These findings demonstrate the complex interplay between interveningconditions and action/interactional strategies - rarely were they found to be unidirectional andsimplistic. Palazzi et al. (1990) made a similar observation : they emphasized the complexityof the interactions between external and internal factors as this related to life events(including parental bereavement) which disturb the self-image of adolescents.The greater the ambivalence about separation from the family unit, the more likely131were subjects to assume responsibility. Several subjects described curtailing the beginningsof their adolescent struggle for independence out of concern for leaving the surviving parentall alone, or for fear that left unattended, this parent might also 'die on them'. Thesefindings are supported by theorists Castiglia (1988) and Furman (1984). Both maintain thatthe singularity of the surviving parent, coupled with the adolescent's new found sense of theprecariousness of life, may make it difficult for the adolescent to move away from thesurviving parent, with adolescents inappropriately assuming the responsibility for theirsurviving parents' happiness and/or well-being.Assuming responsibility was also associated with the circumstances of the death as thisinteracted with gender. Two females described consciously altering their behaviour in aneffort to please their sick parents when they perceived that they were dying. This isconsistent with gender appropriate behaviour for females as nurturers, and is interestingwhen compared to male subjects who, having the same foreknowledge of their loss, did notdescribe altering their behaviour in any way to please or comfort their dying parent. Noresearch or theories describing the constellation of these factors was found in the literature tosupport or refute these observations.A fourth intervening condition, lack of economic stability, influenced the use of thestrategy. Subjects described a heightened sense of responsibility in terms of their ability and,consequently their obligation to assist in the family's finances. Raphael (1983) stated thateconomic lack potentiates the adolescent's fear and helplessness which is already experiencedas a result of the loss of their parent. He describes assuming adult or 'bossy' behaviour as areaction formation against this profound helplessness and fear. No other studies or theorieswere found which dealt with the impact of financial lack on the adolescent bereavementexperience or its consequences. Research samples are typically drawn from white, middle132class families and may not reflect the economic lack that other groups experience. As thispresent study suggests that economic lack may negatively influence the experience ofdisillusionment, investigation of this variable is warranted.The strategy of assuming responsibility was only ever partially successful in integratingdisillusionment. Avoiding disillusionment led merely to a deferment of the experience of thephenomenon. Feelings associated with the loss resurfaced again at a later time in theindividual's development, but at a time when the subject felt prepared to deal with it.Raphael's (1983) observations are consistent with this finding. He describes parentallybereaved adolescents as suppressing their emotional responses in fear that if they do not, theymay lose emotional control and be censured. Feelings resurface when secure relationshipsfacilitate them - ie. the surviving parent is able to respond to the adolescent's needs, oranother significant other provides the opportunity for the adolescent to safely share his or hermemories and feelings. This finding underscores the benefit that the adolescent accrues interms of enhancing their sense of control with assuming responsibility. However, subjectsalso found that they could not gainsay their own emotional needs forever, and that when theywere prepared, when they felt safe enough, they were able to express their anger, their grief,and their profound disillusionment.Another drawback of this strategy was the enormous cost that it extracted from itsusers. These subjects all expressed a sense of having lost their adolescence - that assumingresponsibility catapulted them into adulthood missing the innocent and carefree years of theiryouth. This loss will be further explored under both the short and the long-termconsequences of disillusionment.To summarize, assuming responsibility was a strategy undertaken solely by femalesubjects to integrate disillusionment. The purpose of the strategy was to distract the133bereaved adolescent's attention from her feelings of disillusionment with the family situationor the surviving parent, or both, by focusing on her duties and obligations that she feltcompelled to undertake as a result of the loss. Use of the strategy as a means to managedisillusionment was supported by several references in the literature. Assumingresponsibility was influenced by intervening conditions of gender, an altruistic and sociablepersonality, maturity, lack of economic stability, and the circumstances of the death as thisfactor interacted with the subject's gender. The strategy was only ever partially successful,with subjects deferring disillusionment, rather than avoiding it altogether. Use of thestrategy wrest a very high cost from the subjects, who claimed that they had to forfeit theyears of their adolescence.Re-sourcing needs.Re-sourcing needs was a direct response to subjects' perception that their familiarsources of need satisfaction were gone (as with the lost parent) or unsatisfactory (as with thefoci of disillusionment). The strategy and the nature of the re-sourced need were found to bedependent upon several intervening conditions, most notably personality characteristics as thisinteracted with availability of support, circumstances of the death, religiosity, and theinteraction between the pre-death relationship with the lost parent and characteristics of, andrelationship with, the surviving parent.This strategy was used most often by subjects who were sociable, and who were able toaccept outside support. Support sources included peers, family, friends of the family,teachers and health professionals, and the church. Several studies by Gray (1987a; 1987b;1988) examined the role of social support in the adaptation of bereaved teenagers. Incomparing the difference in helpfulness between surviving parents and peers, Gray (1987a)reported that most (40%) adolescents chose a peer as being most helpful, rather than the134surviving parent (28%). These findings are consistent with the current study, where allsubjects expressed difficulty in relating to their surviving parent.Subjects reported receiving support from other members of their family - in particular,siblings and aunts. Although several authors have explored the role of the surviving parentin adolescent parental bereavement (Cragg & Berman, 1990; Gray, 1987a, 1987b, 1988;Hogan, 1988; and Raphael, 1983) no research was found that examined the role of siblingsor the extended family. Moreover, subjects in the current study received support from`friends of the family' - other families who had been involved with their own family prior tothe loss. No research was found examining this aspect of social support either. Both areasrequire investigation to reach a better understanding of the influence of social support onparentally bereaved adolescents' endeavours to re-source their needs.Not all persons who were sources of support to subjects proved to be dependable. Ofparticular note were teachers and health professionals. Gray (1988) examined the role ofteachers in the support of bereaved adolescents. His subjects (n=50) reported that theirteachers were often unhelpful (42%) or only helpful in minimal ways. Unhelpful responseswere similar to the ones described in the current study: a) telling students to 'buckle down';b) drawing attention to their loss (and therefore their difference) in front of peers; and c)open hostility towards the student.Re-sourcing needs was used often used when the loss was expected. Similarly Gray(1987b) found that suddenness of death was associated with a significantly lower measure ofintellectual control. The relationship suggests that where the loss is anticipated, theadolescent may have better intellectual control, which may lead to the use of more efficientproblem solving strategies such as re-sourcing needs.In addition to re-sourcing needs from peers and surviving parents, this strategy was135also found to be used in conjunction with God and religious groups. Belief in God wasexpressed by one subject as a way to cope with the unfairness of her loss - that as long asshe believed in God, she could believe that her mother was not gone in any final sense, andthat the untimeliness of her death had some rationale. Two subjects described turning toreligious groups for support. They reported receiving unqualified love and support from thisgroup which they could not expect from any other source. The unqualified nature of suchsupport is very likely similar to the sense of acceptance experienced in the lost relationshipwith the deceased parent. These findings are consistent with those of Galloway (1990) andCragg and Berman (1990). Galloway found that subjects who reported important religiousaffiliations prior to the death felt comforted by their religion and noted that their faith in Godbecame deeper. Cragg and Berman findings reported that parentally bereaved adolescentsidentified both clergy and church contacts as supportive.Re-sourcing needs was often directed at the surviving parent who, more often than not,was found wanting. Several studies support this finding. Bowlby (1980) found that after aparent dies, the modes of discipline often change, with the surviving parent either becomingexcessively strict, or inconsistent. Elizur and Kaffman (1982) and Hilgard, Newman andFisk (1960) noted that favourable adjustment for parentally bereaved adolescents was relatedto the parenting strengths of the surviving parent. These strengths included being reality-oriented, strong in terms of keeping the home intact, and having attitudes that fosteredindependence and tolerance for separation. Possessing these strengths is a challenge for anyparent, especially one who is grieving for a lost spouse, who may have previously playedonly a peripheral role in child rearing, and evaluation as a 'good' or 'bad' parent is basedupon the adolescent's comparison of their parenting abilities with the deceased parent'sabilities.136This third point is particularly significant to the adolescent's perception of the adequacyof the surviving parent in meeting their needs. In the current study, the bereaved adolescentsgilded the dead parent, a process which involved preserving and idealizing the good qualitiesof the deceased parent. In comparison, the surviving parent was perceived as the 'bad'parent. This dynamic was consistent with other findings of studies rooted in psychoanalysis,where bereaved adolescents experience hostility, which is displaced from the deceased parentonto the surviving parent, and represents an attempt to undo prior feelings of hostilitytowards the parent who died (Arthur & Kemme, 1964; Neubauer, 1960; and Wolfenstein,1966). Still other studies found that surviving parents may not be an adequate source ofsupport for the adolescent, as they are in the midst of trying to cope with their own grief atthe loss of their spouse (Castiglia, 1988; Cragg & Berman, 1990; and Goodman, 1986).Both groups of research are germane, with the consequences for bereaved adolescentsrepresenting the results of a powerful combination of the two. Whatever the reason foradolescents disillusionment with surviving parents, adolescents responded by either abortingthe attempt to satisfy the need or turning to other individuals or structures to provide whatthey felt their surviving parent could not.Re-sourcing needs was developmental in nature with the behaviours becoming morehighly conscious and thus more purposive as the individual matured. Looking first atadolescent attempts to resource needs, one male subject's need for guidance was manifest inhis desire to be sent to boarding school. He did not see this as such until his behaviour wasreviewed in terms of his unmet needs. Another female subject's need for attention wasmanifest in her crashing her father's car. Again, she did not see this as a cry for attentionuntil much later in life. The male subject's response to seek guidance is consistent withHodges' (1990) findings which suggested that parentally bereaved males are more likely to137cope with their loss through seeking order and organization. The female's behaviour isconsistent with Raphael's (1983) findings that parentally bereaved adolescents may angrilyact out, partly to elicit care from those who do not seem to recognize their needs, and partlyto punish the self for what has happened. Fleming and Adolph (1986) also describeddramatic or resistive behaviour as a means of 'attracting care' for the bereaved adolescent.Adolescent 'acting out' is a normal means for adolescents to draw attention to their needs;however bereaved adolescents differ in their profound sense of insecurity - they are markedas less worthwhile (or this terrible thing would not have happened to them) and their world isunsafe.As subjects matured, they were able to clearly articulate what they needed and howthey went about getting their needs met. For example, the need for a 'normal' familystructure was consciously sought out by one female subject as an adult when she selected herboyfriends. Pregnancy was the outcome for this subject. A male subject experienced anearly and failed marriage as a result of his attempts to resource a family through marriage.These findings are consistent with Weizman and Kamm's (1985) theory which suggests thatbereaved adolescents will act out their wish for replacement and need to belong to someonethrough sexual activity. This search for someone to alleviate the deprivation can, they state,lead to pregnancy and early marriage. As the sense of disillusionment blunted, the needsremained but the individual had a more accurate perception of what they are and how to goabout meeting them.Failure to re-source needs led to long-term problems such as difficulty in establishingclose interpersonal relationships. There is a body of literature which points to long-termconsequences of adolescent bereavement, but most subjects were drawn from samples outsidethe mainstream (criminals and psychiatric patients). These studies have been criticized by138the researcher as being of little value in explaining the experience of the parentally bereavedadolescent. The long-term consequences of unmet needs for parentally bereaved adolescentswill require empirical support from future research.To summarize, re-sourcing needs was a strategy used in direct response to subjects'perception that their familiar sources of need satisfaction were gone (as with the lost parent)or unsatisfactory (as with the foci of disillusionment). The use of the strategy and the natureof the re-sourced need was influenced by personality characteristics which interacted with theavailability of support, circumstances of the death, religiosity, and the interaction betweenthe pre-death relationship with the lost parent and the characteristics of the surviving parent.As with other strategies, re-sourcing needs was unconscious in the early and acute stage ofintegrating disillusionment, and more highly conscious in the later and blunt stage of theprocess.Self-comforting.Self-comforting was used by subjects to console themselves in the face of theirdisillusionment. This strategy provided a safe fantasy world into which the adolescent, andsubsequently the adult, could retreat and find consolation. The use of the strategy was lessconscious at the time of the loss, and more volitional as the individual matured. Self-comforting was influenced by the personal factors of maturity and religiosity, as well as thesituational factors of family dynamics as this interacted with sibling order and gender, andthe relationship with the deceased parent.Self-comforting was manifest in the bereaved adolescent's dreams of the lost parent.According to Osterweis et al., (1984) dreaming represents one of a constellation of searchingbehaviours associated with an intense yearning for the lost person. They state that when thelost person fails to materialize, searching behaviours decrease and despair sets in. This139theory is partly consistent with the findings in this study. For one subject, dreams of herdeceased mother were confusing at first until they were reframed as comforting by herfather. Thereafter, the subject dreamt of her mother less frequently, and found her dreamsmore comforting. This finding differs from Osterweis et al.'s (1984) theory in that thesubject did not report a sense of despair that her mother failed to materialize.As subjects matured, they employed the self-comforting strategy more purposively.Subjects perceived that they 'carried the dead parent within,' and that this parent watchedover them and cared for them. Similarly, Elizur and Kaffman's (1982), in a study ofchildren's bereavement reactions following the death of the father, reported that bereavedchildren fantasized in an attempt to maintain the illusion that the deceased person wasnearby. This was achieved by two means: a) intensive revival of the image of the lost parentfrom the past (recalling joint experiences); and b) denying the finality of the death andexpecting the father's return in the future. The second strategy was not relevant to thecurrent study since the subjects had achieved a higher level of cognitive development,understanding death in abstract and reality-based terms.Self-comforting was also associated with religiosity. Subjects differentiated betweenorthodox religiosity and 'spirituality' or 'superstition.' Religiosity in the first sense referredto a belief in a god, being part of a religious community, and attending religious ceremonies:the purpose was to provide structure and support of a more tangible nature for theadolescent. Spirituality or superstition described a personal sense of an ethereal world, moreoften ambiguous than concrete. This provided a fantasy world for the subjects, one thatcould be accessed at will, especially when subjects felt particularly dissatisfied with theirexisting world.Males who had lost their mothers with whom they had been particularly close, who140were youngest in sibling order, whose family dynamics tended towards individuation asopposed to cohesiveness, and whose relationship with their surviving parent was antagonisticused this spiritual self-comforting strategy. The constellation of these features led to gilding,where only the happy, good memories of the deceased were saved, and the painful, troublingmemories were pushed back. Carter's (1989) study of bereaved adults uncovered a similartheme which she called 'holding.' She described holding as a "selective preservationencompassing the bereaved one's desire to maintain all, particularly that which was good,from the loved one's lost existence" (p.356). Subjects in the current study acknowledged thegilding process and its benefits. They were also aware that this process led to exceptionallyhigh expectations of the surviving parent. Gilding was damaging in that it created distancebetween the adolescent and a potential source of comfort and support, the surviving parent.Arthur and Kemme (1964) found that adolescents who had lost a parent denied their angertowards the deceased parent and projected this hostility towards the surviving parent. Theresearcher concurs with the displacement of anger from the deceased parent to the survivingone: however, she submits that the anger may not be just prior to the death, but rather, isborn of the profound sense of disillusionment at having been abandoned by the parent at atime when the adolescent still feels that he or she needs them so much.To summarize, adolescents used self-comforting to deal with their profound sense ofdisillusionment with their world. The purpose of the strategy was to create a fantasy worldinto which the adolescent, and subsequently the adult, could retreat and find comfort. Self-comforting was unconscious soon after the loss of the parent (dreams) but was used later inlife by those who identified themselves as 'spiritual' or 'superstitious.' This retreat intofantasy contrasts with the 'religious' subjects who used their belief systems to providestructure and predicability in their worlds. Gilding was a self-comforting measure141undertaken exclusively by males of the youngest sibling order who had lost their motherswith whom they had been exceptionally close. Use of the gilding strategy was not withoutcost: elevating the deceased parent amplified the disillusionment associated with the survivingparent, and removed a significant source of support.Rationalizing a intment.Rationalizing disappointment attenuated the impact of adolescent disillusionment withothers and their world. Saying 'it doesn't matter' or 'there was a good reason for this'helped to blunt their deep disappointment with people or circumstances which they had oncerespected and/or depended upon. Rationalizing disappointment may be a normal process inadolescent development, as suggested by Oscar Wilde: "Children begin by loving theirparents. After a time they judge them. Rarely, if ever, do they forgive them" (ConciseOxford Dictionary of Quotations, 1985, p.271). Bereaved adolescents used this strategy inresponse to an abrupt change which occurred without the benefit of family stability. Forparentally bereaved adolescents, if the disillusionment with parents, or other foci isunmanageable, they most certainly do not forgive, nor do they ever forget.Although no research was found which directly examined the bereaved adolescent's useof rationalizing disappointment as such, Murphy (1986-87) reported findings which areconsistent with the conceptualization of this strategy. In his study of parentally bereavedcollege students, he reported that those who reported fewer grief responses to their parent'sdeath also reported greater feelings of loneliness and lower self esteem. This study foundthat when subjects said 'it doesn't matter,'what they really meant was 'my feelings don'tmatter' or 'I don't matter.' Rationalizing disappointment was an method of objectifying aprofoundly disturbing experience. The strategy served to protect the self: at the same time itparadoxically denied the significance of the self.142Rationalizing disappointment was unconscious soon after the loss experience, and morevolitional as adolescents matured and gained insight into their behaviour. When subjectswere more mature, they based their assessments of situations 'having a good reason forhappening' and, in fact 'not mattering to them' on more reasonable evidence. This evolutionis consistent with Piaget's (1952) conceptualization of the intellectual development ofadolescents. He maintains that adolescence marks the beginning of the capacity forhypodeductive reasoning which is rarely fully operational until the age of 16. The shift inrationalizing disappointment from an unconscious defense mechanism to a reasonedinterpretation of reality fits with this theory of the development of the individual's capacity toreason.Rationalizing disappointment was used with all foci of disillusionment: persons,situations, and expectations. This strategy often directly followed failed attempts to re-sourceneeds with these foci. When the strategy failed, feelings of ambivalence towards the focus ofdisillusionment resulted. Adolescents either despaired entirely, or vacillated betweendespising and pitying their surviving parent. Rationalizing disappointment embodied thisambivalence. Contrary to these findings, Gray (1987a) reported that most parentallybereaved adolescents found their surviving parent helpful, and only a few found them to bevery unhelpful. He stated that "the extreme ratings of surviving parents as either veryhelpful or not at all helpful make sense in terms of the adolescents' conscious or unconsciousrecognition that this relationship was important to their emotional survival" (p.32).Rationalizing disappointment was used by subjects who had introverted personalities.This is consistent as rationalizing disappointment is an internal adjustment of reality, ascompared to the normalizing strategy (undertaken mostly by extroverted or sociable persons)which involved an external alteration of reality. Similarly Gray (1987b) reported higher143levels of sensitivity regarding the perceptions of others with independent and aggressivepersonalities, and increased incidence of depression with passive and dependent personalities.Although the variables differ between Gray's study and the current one, it can be seen thatan external orientation is associated with the more outgoing individual, while an internalorientation (depression) is associated with the more introverted individuals.Rationalizing disappointment was also associated with economic need. Raphael (1983)stated a reduced financial status represents a very significant additional loss to the bereavedadolescent, one that may be resented but yet to which they must adapt. Subjects weredisappointed when, following their parents' death, they had to give up their accustomedlifestyle. Although subjects felt deprived, they were reluctant to blame either the deceasedparent for not having provided for them, or the surviving parent for being unable to maintaintheir lifestyle. Subjects typically voiced their disappointment, articulated their blame, andquickly recanted their indictment with statements like "But that wasn't her fault" or "he didwhat he could, considering everything." Subjects were acutely uncomfortable with theaccusation and chose to rationalize their disappointment instead. The alternatives were bleakfor these individuals: if they held that it was negligent of the deceased parent not to haveseen to their needs, then they were faced with the unacceptable conclusion that the deceasedparent did not care enough about them to look after them. Similarly, if they held that thesurviving parent was not capable of supporting them, then they must face the question ofwhat would become of them. In either case, rationalizing disappointment protectedadolescents from highly charged emotions by substituting relatively innocuousintellectualizations. It provided a sense of control to adolescents who were especially fearfulthat things were out of control.One final factor which significantly constrained rationalizing disappointment was the144prior relationship with the deceased parent as this was compared to the relationship with thesurviving parent, or gilding. Elevated perceptions of the deceased parent (especially wherethe relationship had been particularly close) made it difficult, if not impossible, for thesurviving parent to 'measure up.' Where the focus of rationalizing disappointment was thesurviving parent, and the gilding strategy was employed, even the most cleverly conceivedintellectualizations about the surviving parent's shortcomings proved inadequate. Thedisparity between what the adolescent expected, and what the surviving parent was humanlycapable of providing was too great for the strategy to bridge. Evidence of this dynamic wasnot found elsewhere in the literature.To summarize, adolescents used rationalizing disappointment to attenuate the impact oftheir disillusionment with others and their world. As such, evidence for this strategy was notfound in the literature, but the denial aspect and the intervening conditions that influencedthis strategy were consistent with the literature on adolescent bereavement. Adolescentsemployed rationalizing disappointment with all foci of their disillusionment, particularly inresponse to failed attempts to re-source needs with these foci. Failure of the rationalizingdisappointment led to ambivalence towards the focus of the strategy. The strategy wasinfluenced by maturity, an introverted personality, economic lack, and gilding.Summary.This section described the five most frequent action/interactional strategies reported bysubjects to integrate their disillusionment: normalizing, assuming responsibility, re-sourcingneeds, self-comforting, and rationalizing disappointment. Adolescents used normalizing todeal with their sensitivity to the social stigma of being bereaved and the normlessness ofbeing somewhere between child and adult. Assuming responsibility was used solely byfemale subjects and distracted the bereaved adolescent's attention from her feelings of145disillusionment with the family situation or the surviving parent, or both, by focusing moreon the obligations that she felt compelled to fulfil as a result of the loss, than the loss itself.Re-sourcing needs was a direct response to subjects' perception that their familiar sources ofneed satisfaction were gone (as with the lost parent) or unsatisfactory (as with the foci ofdisillusionment). Self-comforting was used for consolation in the face of adolescents'disillusionment. Finally, subjects used rationalizing disappointment to attenuate the impact oftheir disillusionment with others and their world. The choice of strategy, and the successwith which it integrated disillusionment into subjects' lives was determined by variouspersonal and situational factors. Strategies were developmental in nature, with unconsciousbehaviours employed in the earlier and more acute phase of disillusionment, and morepurposive measures used as subjects matured and integrated disillusionment into their lives.Strategies had varying degrees of success in integrating disillusionment, and all extractedsome cost from the individuals who employed them. No support was found for theconceptualization per se, however evidence for various aspects of the strategies were foundin general bereavement literature, adolescent developmental theory, and research whichexplores particular variables associated with the adolescent bereavement experience.Short-Term Consequences Short-term consequences of integrating disillusionment were described as alterations inthe developmental pathway as they were consequences, but also because they led to morepermanent long-term consequences. Four consequences were identified: growing up fast,drifting/meandering, taking responsibility for the self, and fulfilling the wishes of the lostparent.Growing up fast.Subjects who had used the strategy of assuming responsibility to integrate their146disillusionment described an accelerated maturation. Their sense of obligation to supportand/or provide for the family was so great that they felt an urgency to mature quickly,thereby precluding any opportunity to meet their own adolescent needs and interests. Josephs(1982) reported that subjects felt that they had to grow up fast, believing that they hadbecome more mature, responsible, independent and cynical as a result of the loss. SimilarlyCook and Phillips (1988) theorized that "the adolescent may have new family responsibilitiesforced upon him [sic] or may feel that society expects this maturity of him which makes himassume adult behaviour before he is ready to do so" (p.41).Growing up fast led to a heightened perception of being different from peers. Subjectsfelt duty-bound and encumbered at a time when their peers were carefree. Similarly Davies(1991) reported that adults who, when adolescents, suffered the loss of a sibling felt differentdue to their new found maturity and their sense of the preciousness of life. Raphael (1983)also documented parentally bereaved adolescents adopting adult behaviour as a reactionformation against their profound sense of helplessness and fear. Current findings differ inthat the sense of growing up fast was experienced only by female subjects who used theassuming responsibility strategy. Male subjects, when questioned about this perception ofgrowing up fast, denied experiencing this. Other researchers investigating sex differences inadolescent parental bereavement indicate that only female subjects grow up fast (St. Clair &Day, 1979; Jordan, 1970). Since adolescents are vulnerable to social cues about appropriatebehaviour, especially gender role behaviours (Basow, 1986), one explanation for this findingmay be that females receive strong behavioural cues that they should properly be nurturers,especially where pain or infirmity are involved. Gender differences in the area of adolescentbereavement need further investigation before any conclusions can rightfully be drawn.Subjects reported that another feature of growing up fast was a heightened sensitivity to147environmental cues - they were able to perceive adult apprehension in a highly intuitivemanner. This finding can be explained as a combination of two features: one, the normalacute sensitivity to social cues experienced in adolescence; and two, the sense of stigma thatbereaved persons are made to feel in a society that becomes embarrassed and strained whenfaced with death and bereavement (Papalia & Olds, 1981; Parkes, 1986). No other researchwas found that identified this heightened intuition with adolescent bereavement.Growing up fast and the sense of being different from their peers was most acute earlyin the disillusionment, but this sense of being different faded (although did not ever disappearaltogether) as the subjects discovered others in the course of their life who had sufferedlosses similar to their own. What remained, however, was a feeling of remorse for the lossof their adolescence - a feeling which was found to be life-long.Drifting/meandering.Drifting/meandering referred to subjects' inability or reluctance to take decisive action.This short-term consequence related specifically to the adolescent's disillusionment with hisor her hopes and dreams, and the sense of disorientation which resulted. Subjects who usedthe strategy of re-sourcing needs most often experienced drifting/meandering. Their searchfor what they needed was poorly focused, and largely unconscious, making their choices inschool, jobs, or careers seemingly random and aimless. Even bereaved adults, whilereasonably articulate about what they do not want or need, have great difficulty focusing onand articulating what they do want or need (Davidowitz & Myrick, 1984). The task is muchmore onerous for adolescents who are only learning who they are and what their life isabout, and who have just discovered that their world seems completely untrustworthy.Indecision centred around the issue of separation for several subjects, and for some ledto longer term consequences of never fully separating from the surviving parent: a) never148marrying; and/or b) experiencing separation as a catapult into independence, rather than astep-by-step move in that direction. Separation was especially difficult for those who usedthe assuming responsibility strategy. Assuming responsibility for the family was at odds withthe normal adolescent yearning to 'get out and get on with life,' and this led to a profoundsense of conflict for these adolescents. Consistent with these findings, Gordon (1986) statedthat:the family system, fragmented by the death, may attempt to turn the older adolescentinto a surrogate parent, thus truncating the separation process. Responses to this threatto independence include staying home to care for mom or dad and never marrying or,feeling the tug of war between independence and inappropriate family responsibilities,severing ties to the family more quickly than would have occurred if the parent's deathhad not taken place. (p.25)The short-term consequence for parentally bereaved adolescents in Gordon's work was a 'tugof war,' overlaid upon normal adolescent vacillations and restlessness.In comparing the normal adolescent separation experience with that of the parentallybereaved adolescent, Wass and Corr (1984) indicated that the normal family with two parentsallows the adolescent to break away gradually on a trial basis, and to thrive on activityoutside of the immediate family setting. Even during periods of intense independence whereadolescents are critical and often openly hostile towards their parents, there still remains thecomforting knowledge that they can return home and be taken care of as they were in formeryears. Parentally bereaved adolescents do not separate with the benefit of this comfort.Drifting/meandering was also influenced by the loss of one role model, and thesubsequent disillusionment with the other. The self-comforting strategy of gilding furthercomplicated the situation. Subjects who used this strategy created one impossibly perfectmodel, and one hopelessly incompetent one. Little wonder they had difficulty deciding on acourse of action. The consequence of drifting associated with the gilding dynamic was not149found in the literature.Taking responsibility for the self.Taking responsibility for the self is described as the sociological attainment ofadulthood, and as such is considered to be one marker of the end of adolescence.Sociological adulthood entails self-supporting activities such as choosing a career, choosing amate, founding one's own family, and taking responsibility for legal and sociopoliticalobligations (Papalia & Olds, 1981). For the individual who was parentally bereaved as anadolescent, taking responsibility for the self differs from the normal adolescent process as itis preceded by situations of extreme disorientation and ambivalence (as indrifting/meandering), or conversely, of inappropriately high levels of responsibility (as inassuming responsibility for others).For individuals who drifted or meandered after their loss, taking responsibility wascharacterized as a positive, proactive step towards reintegration of their life. This finding isconsistent with Furman's (1984) description of parentally bereaved adolescents' resumptionof living: "Often their [bereaved adolescents] mourning of the deceased and thedevelopmental step toward independence from him or her coincide and speed the adolescent'sreaching out for new and different relationships outside the family" (p.197). The proactivestep of reinvesting their energies into living led to subjects highly regarding self-reliance.In contrast, for subjects who assumed inappropriately high levels of responsibility for thefamily, taking responsibility took a different course. It was either painfully drawn out withsubjects never truly establishing a self-supportive life, or impetuous, with subjects describingtheir separation from family as an 'escaping from' rather than a 'moving towards.' Thesefindings are consistent with Gordon's (1986) conclusions: adolescents who lose a parent mayeither stay home to take care of the surviving parent and never marry, or sever ties with the150family more quickly and more permanently than they ever would have, had the parent'sdeath not taken place. With either consequence, the potential for unresolved anger and/orremorse was high.Fulfilling wishes.Fulfilling wishes referred to actions taken by subjects to please the deceased parent,and stemmed from the action/interactional strategy of self-comforting. Subjects who usedthis strategy not only dreamed or imagined the deceased parent being with them, but alsoenvisioned what the deceased parent would have wanted for them. These images were thenused to guide subjects' decisions. Subjects expressed mixed reactions to this process:comfort with having done what they thought would have pleased the deceased parent, yetgreat uncertainty about having done what was truly right for them.Fulfilling wishes in the sense that it has been presented here was not found in theliterature, however Raphael's (1983) description of the bereaved adolescent's tendency toidentify with the deceased parent offers some explanation. He stated that adolescents wholose a parent experience a great uncertainty within the self about who and what they are andwill someday become. This uncertainty may spur the adolescent to seek an identity, anyidentity to resolve this anxiety. In this study, the bereaved adolescents used their perceptionof their deceased parent's wishes to guide who they become and resolve their anxiety aboutthis issue.Summary.Four short-term consequences of integrating disillusionment were described: growingup fast, drifting/meandering, taking responsibility for the self, and fulfilling wishes. Eachconsequence was discussed as a separate entity; however, subjects actually experienced oneor several consequences after their loss. Support for aspects of the consequences were found151in the literature, however, with the exception of growing up fast, support for the conceptsthemselves was not discovered. As with other aspects of integrating disillusionment, theseconsequences related to normal adolescent growth and development and the resolution of thegrief process.Long-Term ConsequencesThe long-term consequences of integrating disillusionment were identified as 'livingwith the developmental sequelae.' The concepts that comprise these consequences -becoming impermeable, becoming the lost parent, discovering personal strengths, andregretting - are considered `long-term' as they represent the more permanent aftermath ofdisillusionment. As with the short-term consequences, these four concepts are discussedseparately; however, in reality they were highly interrelated.Becoming impermeable.Becoming impermeable was described as subjects' developing a highly selective semi-permeable membrane around the self. Parentally bereaved adolescents not only have lost aparent, but also have lost the stability of the family structure. These adolescents perceivedtheir world as unpredictable and untrustworthy. Adolescents used one or several strategies tocope with their loss and keep them safe from their untrustworthy world. The strategieswhich resulted in the long-term consequence of becoming impermeable were ones whichdrew heavily on denial - normalizing, assuming responsibility for others, rationalizingdisappointment, and self-comforting. Becoming impermeable protected subjects from theemotional proximity of others in three ways: withdrawing, raising barriers, and developing afear of abandonment, commitment, and intimacy.1. WithdrawingWhen an adolescent's parent died, he or she immediately sensed the sharp difference152between him or herself and peers. If peers reacted with discomfort and awkwardness, thisdifference was reinforced. Parentally bereaved adolescents perceived themselves as beingalone - no one could really understand them. This sense of being misunderstood combinedwith the perception that emotional proximity leads inevitably to grief. Subjects withdrew tokeep people at an emotional distance. They had invested their love and trust in the safest ofrelationships and had been profoundly disappointed - why should they risk again?Withdrawing is a normal part of grieving. In their review of the bereavement literature,Osterweis et al. (1984) indicated that social isolation and feelings of loneliness are common,and often continue for some time. They associate this withdrawal with shifts, not only inself-perception, but also in ways that a person is perceived by others. Similarly, Raphael(1983) noted that parentally bereaved adolescents show marked withdrawal from relationshipswhen they lose a parent; they avoid emotional closeness for fear that they may be hurt again.Unchecked, this sense of isolation can prove problematic in establishing adult relationships.In contrast, Epp (1989) reported no significant difference in isolation between bereavedindividuals and their nonbereaved controls. Epp's study focused on young adults and olderadolescents therefore, at the time of parental death, her subjects may have been moreadvanced in terms of having accomplished the developmental tasks of adolescence. Epp'ssubjects would have mastered the tasks of separation, identity formation (beginning), andestablishing intimate relationships, placing them in a less vulnerable position than individualsin early or mid-adolescence who either do not yet have these skills, or who are caught in themidst of attaining them.2. Raising bathers.A profound sense of isolation occurred for the parentally bereaved adolescents preciselywhen they should have been cultivating the interpersonal skills which lead to healthy and153mature relationships. Failure to achieve this adolescent task resulted in, not only to a senseof self as isolate, but also an active cultivation of boundaries to keep people out. Behavioursused to keep people out included lying and treating other people particularly badly preciselywhen intimacy was intensifying. Similar findings were reported by Weizman and Kamm(1985) who stated that adolescents may experience not only the inability to form close andlasting relationships for fear of losing someone important again, but also an unwillingness toovercome their fear. No studies were found which specifically supported this active aspectof becoming impermeable, possibly due to the fact that so little attention has been given tothe long-term consequences of adolescent bereavement.3. Developing fears.Parentally bereaved adolescents developed a fear of commitment, intimacy, andabandonment which persisted into adulthood. Of the eight subjects interviewed, six haddifficulties establishing relationships, with one other likely to encounter this as she matures.Intimate relationships were evaded by a) establishing a relationship with someone whosubjects knew to be unreliable; b) entering into a series of superficial short-termrelationships; and c) demanding perfection from the partner. As with all aspects of becomingimpermeable, the behaviours protected the individuals from the unbearable vulnerability of anintimate interpersonal relationship which would normally be expected during adolescentdevelopment, thereby saving them from the repetition of the abandonment experience(Gordon, 1986; Jacobson, 1988).Becoming the lost parent.Becoming the lost parent related to subjects' perception that, for better or worse, theyhad become a person remarkably similar to their deceased parent. This consequence was154restricted to those subjects who had lost the same sex parent.Becoming the lost parent in the positive sense was associated with the strategy ofgilding. In this case, subjects not only remembered, but actually became the best of whatthey recalled the deceased parent to be. Assuming responsibility led to the sameconsequence, with subjects consciously or unconsciously relying on their memories of thedeceased parent to model how they should responsibly behave. In a study by concerning therole of identification in bereavement, Johnson and Rosenblatt (1981) reported that emulatingthe good qualities of the deceased parent represented both a conscious and an unconsciousdefense mechanism, and that done in moderation, could be enriching for the subject.Becoming the lost parent in this context was both conscious and enriching for subjects in thecurrent study. Subjects expressed a sense of satisfaction with being similar to someone whothey admired so much.In the negative sense, becoming the lost parent entailed a perception that subjects wouldbe so much like the lost parent, that they too would grow ill and die. This was a source ofdread for subjects: a general anxiety concerning the precariousness of life and their ownmortality, and a more specific fear that they too would contract cancer, or suffer a heartattack, as their parent had done. Fleming and Adolph (1986) also reported that generalconcerns about death were a manifestation of the bereaved adolescent's concern about theunpredictability of events. Adolescence is normally the time where individuals achieve amature conception of death as an integral part of life and as an irreversible phenomenon.Usually, however, adolescents integrate this cognition while retaining the comfortable illusionthat it will 'never happen to me.' When bereavement occurs in adolescence, the individualis struck by both the finality and the proximity of death at the same time - this can lead to afear, a fascination and/or a preoccupation with death. One of the ways that adolescents cope155with their death fears is by believing that they are invincible (Austin & Mack, 1986; Wass &Hannelove, 1989). Parentally bereaved adolescents know that they are not.Fear of becoming ill or dying like the lost parent is consistent with other researchers'findings (Furman, 1984; Johnson & Rosenblatt, 1981). They indicated that subjectsidentified with their deceased parents' symptoms and experienced difficulty in following theirdeceased parents' pathway into adulthood. In the current study, however only femalesubjects expressed this concern. Gender differences were also noted by Guerriero andFleming's (1985) who reported that bereaved adolescent females had greater death anxietythan bereaved males. These findings have implications for the adult client who wasparentally bereaved in adolescence. Even what seems the most innocuous of symptoms orprocedures may hold them in what is truly mortal fear.Regretting.Regretting referred specifically to the subjects' loss of their adolescence, and moregenerally, for all that might have been had the deceased parent lived. Lost adolescence wasmost closely associated with assuming responsibility for others. Regretting was theemotional consequence of realizing just how much the protective strategy had cost theindividual. Raphael (1983) also addressed this cost stating that parentally bereavedadolescents may experience strong pressures to fulfil the role of the absent parent, but that ifthey should take over this role, they are likely to be forced to premature identity foreclosure.The result is regret for the loss of the carefree feeling of adolescence that parentally bereavedadolescents perceive their peers experienced.More generalized feelings of regret stemmed from comparisons between how life hadunfolded and what their prebereavement expectations of life had been. Subjects perceivedthat their experience had handicapped them in their ability to trust, to form relationships, and156to experience joy. Similar findings were not noted in the literature, likely because long-termconsequences of adolescent bereavement have not been investigated to any great extent.Regretting also referred to the lost opportunities for significant parent/childexperiences: daughters who would never be given away by their fathers, grandchildren bornwho would never know their grandparents, and adult mother-daughter friendships that werenever to be experienced. Rando describes these types of reactions as "normal grief reactionsoccasioned by certain specific changes and experiences that illustrate to them [the bereaved]the loss they have sustained" and likens them to normal anniversary grief reactions (1984,p.116). This type of regret underscores the indelible feature of disillusionment - not onlyconcerning the expectations that were decimated at the time of the loss, but for all the futureexpectations that would never be realized.Discovering personal strengths.This consequence varies from the first three as it was the only one representing apositive aftermath of the parent's death. It was associated with two strategies - normalizingand assuming responsibility for others. For subjects who used the normalizing strategy,discovering personal strengths was a consequence only for those who were able to reorienttheir norms to an internal and more comprehensive conception of how they ought to be.These subjects learned, not only to accept themselves but also to value that self. Thearduous task of accepting themselves brought with it a measure of tolerance and compassionfor other seemingly unacceptable people.Subjects who used the assuming responsibility strategy were readily able to articulatetheir personal strengths which had enabled them to assume the responsibilities and enduretheir adversity. They also learned about compassion and empathy by having to practice itwith dependent family members. Moreover, they valued connections with others to a higher157degree, and valued their self-reliance.Positive outcomes have been reported in other studies of bereavement. Galloway(1990) noted that young adults gained an increased sensitivity to human suffering and pain,and felt a new sense of maturity and strength following a parent's death. Kessler (1987)described adult subjects experiencing positive changes in their self concepts in terms ofincreased independence, compassion, strength, and purposefulness. Oltjenbruns' (1991)study of 93 late adolescents who had suffered the death of a loved one found that 74%reported having a deeper appreciation for life, 67% showed greater caring for loved ones,56% strengthened emotional bonds with others, and 53% developed emotional strength.Balk (1983; 1990) also reported that adolescents who were sibling bereaved believedthey were more mature than their peers. Finally, Davies (1991) reported that nine out oftwelve sibling bereaved subjects experienced positive consequences of their loss including apsychological comfort with death, being able to help others, developing a sensitive outlookon life, and a general positive feeling about the self. Similar to the 'responsibility assumers'of the current study, Davies' subjects indicated that the catalyst for their psychologicalgrowth had been dealing with the adversity of their situation.Summary.Adolescents who lost a parent experienced the phenomenon disillusionment whichresulted from combining the developmental tasks of adolescence with the grieving process.Adolescents integrated disillusionment into their lives using a variety of strategies includingnormalizing, assuming responsibility, re-sourcing needs, self-comforting, and rationalizingdisappointment. Which strategy was used, and the success with which the strategy managedand/or responded to the disillusionment was determined by various personal and situationalfactors. Personal factors consisted of gender, personality, maturity, sibling order, culture,158and religiosity; situational factors included circumstances of the parent's death, pre-deathrelationship with the deceased parent, family dynamics and coping style, characteristics ofthe surviving parent, availability of support, timing of the loss, and economics.Consequences of integrating disillusionment were either short-term or long-term, withlong-term consequences lasting up to the time of the study (a mean of 21 years). Four short-term consequences were evident: growing up fast, drifting/meandering, taking responsibilityfor the self, and fulfilling wishes. Likewise, four long-term consequences were discussed:becoming impermeable, becoming the lost parent, discovering personal strengths, andregretting. As with all other aspects of the process of integrating disillusionment, theseconsequences were shown to proceed from normal adolescent growth and development as itinteracts with the experience of being parentally bereaved at this time. Support for thesefindings was found in the literature which examined specific variables in association withadolescent bereavement. These variables were imbedded in the conceptualization, howeverno comprehensive theory of adolescent parental bereavement was found. This section hasaddressed the first and second research questions. The third research question which will beconsidered in the next and final section of the discussion.Davies' Conceptual Schema - Emergent FitDavies (1991) conducted in depth interviews with 12 adults, who in their earlyadolescence lost a sibling. Long-term outcomes were identified as psychological growth, asense of feeling different, and withdrawal from peers. Davies' theoretic schema relatingthese outcomes is as follows:The sense of personal growth and maturity arouses feelings of being different frompeers, and may result in an intolerance of developmentally appropriate behavioursdemonstrated by peers. Some siblings respond to these feelings by withdrawing fromtheir peers at a time when peer relationships are critical to completing developmentaltasks. For such siblings, feelings of sadness and loneliness become long-term. (p.83)159The results of the current study are similar in some respects to Davies' (1991) findings, anddifferent in others. First, in the current study parentally bereaved adolescents emotionallywithdrew from their peers immediately following their parent's death because they had asense that they were different. They were bereaved, they felt marked, set apart, andexcruciatingly awkward. For many, a great deal of energy was invested in the normalizingstrategy. Although feeling intensely distressed at the loss of their parent, they insisted thatpeers treat them 'just like always,' concealing from their peers their profound disillusionmentfor fear that they would be perceived as abnormal and/or pitiable. Where this strategyevolved into an internal orientation of 'normal,' these subjects then experienced a perceptionof personal growth leading to a positive sense of feeling different which led, not to awithdrawal from peers, but to a more tolerant and compassionate view of people.Other subjects who 'felt different' were those who used the assuming responsibilitystrategy to integrate their disillusionment. These individuals, all of whom were female, felt acompulsion to assume adult responsibility for siblings and/or their surviving parent. Thiscompulsion arose from two sources: a) the adolescent reverting to a fixed and rigidconception of gender appropriate behaviour in an attempt to hold fast to somethingimmutable in the midst of their upheaval; and b) the adolescent picking up adult behaviouralcues in their extreme sensitivity to social expectations. The compulsion to assume adultbehaviours and responsibilities was reinforced by the paucity of normative information abouthow bereaved adolescents should behave. These individuals indicated that they felt differentfrom their peers because their adult responsibilities prevented them from engaging in whatthey perceived to be the carefree, irresponsible activities of adolescence. They feltcompelled to grow up fast, to be selfless in their service to family members, and to viewadolescent 'antics' as frivolous and 'not for me.' These subjects tended to withdraw from all160but the most supportive of their peers, and where peers were unequal to this task, wereinclined to be somewhat isolate. As a result, subjects who used the assuming responsibilitystrategy felt different from others, and experienced a life-long regret for the untroubledadolescence that they should have had, but did not. This pattern more closely resemblesDavies' (1991) schema, but differs in that the long-term outcome is regret, and not lonelinessper se.Long-term loneliness was experienced by those subjects who never having resolvedtheir fear of commitment, intimacy, and abandonment associated with this first anddevastating loss, became impermeable. Becoming impermeable was a sort of permanentwithdrawal, where the subjects became highly selective about who would gain access to theirinner self. What is operative here is a profound lack of trust - a fear that should theindividual ever allow him or herself to become emotionally close to someone again (like thelost parent), that they would again be susceptible to disillusionment and abandonment. Toprevent this, subjects who came to this point were willing to forgo intimacy altogether. Thisdevelopmental route contains Davies' (1991) elements of feeling different and withdrawal,and results in long-term feelings of sadness and loneliness, but it does not entail to the samedegree the outcome of psychological growth as Davies' schema does.In summary, all three of Davies' (1991) concepts - psychological growth, feelingdifferent, and withdrawal from peers - were found to be embedded in the conceptualizationof integrating disillusionment, however, the arrangement of these concepts differed accordingto the strategies used and the effect of subjects' personal and situational factors. Threedevelopmental routes were identified which contained some or all of the elements of Davies'(1991) schema. Subjects who used the assuming responsibility strategy to integrate theirdisillusionment were found to explain their experience and their development in ways which161most closely approximated Davies' (1991) conceptual schema.Nursing ImplicationsThe study's findings are relevant to two realms of nursing: nursing practice, andnursing research. Implications for nursing education are implied from those which impact onpractice, and are summarized after the practice implications are presented.Implications for Nursing PracticeThe paucity of work in adolescent bereavement has left nurses without guidanceconcerning the effects of bereavement on adolescents, how to recognize these effects, andhow best to support the adolescent during this time in a manner which fosters theadolescent's completion of age appropriate psychosocial tasks. Understanding adolescentbereavement reactions is essential to nursing, as nurses are most often in optimal positions toassess the impact of loss on the adolescent. Results from this study have implications fornursing practice in three time phases: a) before the loss - in predicting problems resultingfrom adolescent grief at an early stage and providing anticipatory guidance to adolescentswhose parents are seriously ill; b) shortly after the loss - in preventing complications thatmay arise from adolescent parental bereavement; and c) long after the loss - inunderstanding and supporting clients who, because of their loss experience as adolescents,may encounter life changes from a unique standpoint.Anticipatory guidance.Where the death of a parent is expected, nurses are in an excellent position to offeranticipatory guidance to adolescents and their families. First, nurse can assess the extent towhich the adolescent and/or the family has accepted the inevitability of the event. Familieswho have not first accepted the impending death of a member are not psychologicallyprepared to hear, or benefit from guidance about that event. Until this state is achieved, the162nurses can only support and observe, ensuring that no one family member is lost in theprocess. When acceptance of the inevitability of the death is achieved, nurses can use theirknowledge of bereavement to support and guide the adolescent and the family.Specifically, nurses should provide adolescents with behavioural,and emotional norms.Adolescents need to know what to expect in terms of the grieving process and how theymight feel as a result of being bereft at their particular stage of development. They need toknow that unmasking reality is a normal adolescent task, but that it will be more abrupt forthem because their circumstances will require that they urgently engage in a review of theirbeliefs and values. If adolescents can expect the sense of disillusionment to a degree, thereis a chance that its effects may be less negative, if not less profound. Anticipatory guidancecan be aimed at enhancing the positive consequence of psychological growth, while at thesame time preventing less adaptive consequences such as becoming impermeable ordeveloping a morbid fear of becoming ill and dying like the parent. To do this, nurses needto: a) reassure adolescents that their feelings are normal and tolerable; b) reinforce that it ispermissable and desirable to show people how they feel; c) relate that peers may need somespecific guidelines for how to behave towards them; and d) counsel that adolescents maycome to see life in a different light as a result of their experience but that this is a good andhealthy way to "be different."The results of this study also direct nurses to assess specific intervening factors whichhave the potential to influence adolescents reactions to, and consequences of, parental loss.Of particular note are personality, gender, maturity, pre-death relationship with the deceasedparent, characteristics of the surviving parent, availability and acceptability of support,timing of the loss, family dynamics and coping style, and economics. Findings pointedtowards the effect of the adolescent's personality on the experience of disillusionment, rather163than vice versa. Adolescents who are sociable and altruistic might be counselled with respectto the likelihood that they will feel that they should assume responsibility for the family unit,especially where the adolescent is female. Other family members should be involved in thisexploration, as results indicate that their behaviour supports and feeds into this strategy.Means whereby responsibilities can be shared should be explored so that no members feelthat their needs must be sacrificed to meet those of the family.Maturity is a point of assessment for nurses, as this study suggests that the degree towhich adolescents have separated from the family will play a major role in the adolescent'sability to confront the issue of independence from the family. Those adolescents who arewell differentiated from the family, and who have the rudiments of a life separate from thefamily unit seem to be least vulnerable. Nurses should be alert to adolescents who are yethighly dependent upon their family for identity and security - these individuals may needmuch support in the restructuring of the family unit. If surviving parents are cognizant ofthis, at the very least, nurses can counsel against behaviours which serve to exacerbate theadolescent's indecision - ie. over-reliance on the adolescent, giving the adolescent mixedmessages about separation expectations, etc. On the constructive side, nurses can point outother sources of support for providing some stable ground in the midst of the bereavedadolescent's acute disorientation. Such support might include members of the extendedfamily such as grandparents, aunts or uncles, or other supports available in the communitysuch as church groups, or friends of the family.Where the adolescent is particularly close to the dying parent, care should be taken thatestrangement does not set in between the adolescent and the surviving parent. Nurses canhelp both adolescents and parents to find ways to build bridges between one another, and notwalls. To a certain extent gilding will occur for all parentally bereaved adolescents.164However, if adolescents are aware of the potential for denigrating their surviving parents,then they can perhaps reframe their perceptions.The foregoing nursing implication relies upon yet another situational factor, theavailability of support. Nurses should help adolescents make a list of whom they feel theycan turn to and for what needs. The process of compiling a list will make the source ofsupport more apparent for adolescents, and possibly more likely to be accessed. Taking aninventory of support sources will also uncover gaps in the adolescent's support network andnurses can plan strategies to remedy this. Not only can nurses can provide information onsources of support, but also about how adolescents can access these supports. The behaviourelement is crucial here, because it would be an oversight to assume that adolescents knowhow to ask for help or how to receive it; findings from this study indicated that support mustbe both available and acceptable to parentally bereaved adolescents.Finally, nurses should make an assessment of the family's dynamics and coping style,especially as this might be influenced by either economics or culture. Results from thisstudy suggest that families for whom the dying parent is the pivotal parent are likelyexperience greater disruption. This situation is only further complicated if the impendingloss will also entails a downward adjustment of the family's economic status. Nurses,working with social workers and social agencies, should direct the family towards sources ofassistance before they are in a state of disorientation and disillusionment, so that adequatesupports will be in place when the parent eventually dies. Thus, the impact of thedisillusionment might be reduced, and adolescents safeguarded from developing in ways thatleave them indelibly bereft, not only of their parent, but also of their hopes and dreams.In terms of cultural influences on disillusionment, this study revealed that families ofBritish cultural origins behaved in ways which turned family problems inward upon the165adolescent, and also thwarted their drawing on outside support. The finding that cultureinfluences bereavement is worth noting: nurses should be alert to the possibility that families'culture will effect how adolescents respond to their situation.Preventing complications.The findings of this study demonstrate that parental bereavement in adolescence has thepotential to effect the individual both in the short-term and the long-term. Understandingdisillusionment would help nurses develop skills in assessing, planning, and intervening withadolescents who have recently experienced the loss of a parent, so as to prevent the negativelong-term consequences of this experience and enhance the positive ones. Nurses couldexplore which foci are involved, and which might yet be unaffected. From this assessment,nurses could help parentally bereaved adolescents find ways to access the unaffectedreferents. This involves the nurses helping adolescents to reframe their experience in wayswhich allows for, and tolerates imperfections in others or their beliefs. Thus, nurses reducethe sense of betrayal for adolescents, and build upon their sense of compassion and empathy.Second, nurses should be aware of the integrating strategies that adolescents mightemploy, and assess the personal and situational factors that might predispose adolescents tousing one or another. Nurses' understanding of the purpose of a particular strategy helps inplanning interventions that affect adolescents' underlying fears, and not solely theirsymptoms. For example, nurses observing seemingly capable female adolescents would becautioned against presuming that they are coping with their loss in a healthy and maturemanner. What may prompt this behaviour is a profound sense of disillusionment, anoverwhelming fear of loss of control, and may result in bitter resentment for having toassume this role. In contrast, parentally bereaved adolescent males who behave as if all isnormal may be concealing feelings of loss and loneliness for fear that they will be seen as166abnormal, or worse still, pitiable. Neither behaviours should be reinforced, however nursesmust exercise extreme sensitivity when breaching theses defences. Having trusted and beenabandoned once in their lives, parentally bereaved adolescents are likely to be difficult toreach. Nurses who understand this experience can use strategies that build a trustingrelationship with such adolescents, using this relationship to demonstrate a counter exampleof trust invested, and not betrayed.Third, understanding that adolescence is a time of searching for meaning in life, nursescan help adolescents to reframe their experience as one which strengthens them, rather thandiminishes them. This particular strategy would not be an early one, and nurses would needto be sensitive to cues indicating that adolescents were open to a new interpretation of theirloss. Soon after the loss, adolescents need to time to experience their outrage, grief, andanger. Attempting too early to reframe the loss as an experience for which there may begains could either shortchange bereaved adolescents' need to express their outrage, orconversely, exacerbate their sense of social stigma by suggesting that they should think or beotherwise. However, if nurses are perceptive, they will know when adolescents are ready;when they ask questions which indicate that they are ready to hear constructive suggestions.Fourth, from the study's findings, it appears that teachers need some direction whendealing with parentally bereaved adolescents. Subjects described teachers as eitherunsupportive, or actively nonsupportive, adding to their disillusionment and sense ofisolation. School nurses, or where these are not available, community health nurses couldformulate programs which explain adolescent parental bereavement: the strategies that areused to integrate disillusionment, and the role that teachers may play in influencing thecourse of parentally bereaved adolescents' development. Well-prepared teachers couldbecome a source of support for parentally bereaved adolescents instead of the impediment167that these findings suggested they were.Finally, a word needs to be said addressing communication with parentally bereavedadolescents. Subjects indicated that nonsupportive things were said to them; moreover whenguidance or comfort was offered, it was often by people who subjects felt had no right tospeak to their experience. The nonsupportive aspect of support was addressed in theforegoing discussion of teachers, but legitimacy of support persons remains an issue.Individuals who would be supportive to parentally bereaved adolescents must have firstearned the privilege of this position. Unqualified support persons were not only ineffectivein their attempt to support, but were in fact, damaging. Subjects who spoke of thisexperience indicated that they felt patronized and that their loss experience was belittled.Before support can be legitimately offered, nurses must first have established somelegitimacy in their role as support person. Legitimacy, according to the subjects in thisstudy, is derived from either having personal knowledge of the adolescent from anestablished relationship, as having experienced a loss which is comparable theirs. The firstconstraint relates to relationship building between nurses and bereaved adolescents. Thismust be done carefully, with respect given to the emerging adolescent-as-adult, andconsideration shown for the adolescent-as-child's need to be dependent. The secondconstraint relates to nurses' therapeutic use of self and/or their ability to connect bereavedadolescents with others who have had this experience. If nurses can relate to the experiencethemselves, they have a unique opportunity to normalize bereaved adolescents' feelings inways that are permissive and supportive. Also, putting adolescents in touch with othersimilarly bereaved individuals will expose them to people who legitimately know how theyfeel, and from whom they can learn adaptive ways to come to terms with their loss andintegrate their disillusionment.168Care of adult clients who were parentally bereaved adolescents.This study demonstrated that adolescents whose parents died experienced long-termdevelopmental consequences. Nurses can use these findings to help understand and supportclients who, because of their adolescent loss experience, confront critical periods in theirlives from a unique standpoint.Individuals who lose a parent in adolescence may learn from that experience that theirworld and the people in it are untrustworthy which may lead to the long-term consequence ofbecoming impermeable. The impermeable adult is likely to meet all situations calling fortrust with fear and uncertainty. This has implications for such clients as a) those who areabout to undergo major (or even minor) surgery; b) those who must depend upon nurses toaccomplish some or all of their activities of daily living; or c) those who are waiting for, ofhave just received information that their disease is either benign or malignant.Clients facing procedures will require a great deal of support and reassurance. Nursesneed to realize that whether or not a procedure is life threatening may be inconsequential -the fact that these clients are compelled to trust is likely to mobilize their fears. Clients whoneed to be dependent upon nurses will do so with great reluctance: they have learned thatdepending upon people leads to disappointment and abandonment. Nurses need to reassureclients that they trustworthy, that clients' needs are significant, and will be met. Clients whoare expecting information of a life-threatening or life-saving nature (eg. biopsy results) arelikely to receive the information, good or bad, with scepticism. Good news could be viewedas an oversight, or attempts to conceal 'the truth' from them. Bad news could be denied orignored leading to behaviours which are life-threatening. Nurses who can establish trustingrelationships with their clients are in an excellent position to overcome this perceptualhandicap, teaching them that there are people in their world on whom they can depend.169Parentally bereaved adolescents also developed a fear of becoming ill and dying liketheir parent. Understanding this consequence of adolescent parental bereavement, nurses canbe alert to situations that may trigger the adult's fear of becoming ill and dying. Potentially,any contact with the health care system could trigger this fear, but specifically, thosesituations which closely resemble the deceased parent's illness and death are most potent.This has implications for acute care intervention, as well as prevention strategies. In termsof acute care intervention, any situation which resembles the dead parent's may beoverwhelmingly fearsome, with clients being unable to see anything but the worstconclusions. Nurses can use their knowledge of this dynamic to assess the circumstances ofthe parent's death, and to find ways to: a) support the client's anxiety, but reinforce that thecurrent situation is not like the parent's; or b) if the situation is similar, support the client inwhat might be an inordinately gloomy view of the possible outcome, and try to instill somehope. In terms of prevention strategies, one subject indicated that she was negligent in herbreast examination because she was afraid to find a lump - that this might lead to thehorribly disfiguring surgery, the pain, and the death that she remebered her mother suffering.Nurses who are aware of this dynamic will know to take a family history and to follow up onconcerns such as this one presents. Fear, combined with ignorance, presents a formidablebarrier to programs aimed at reducing risk in certain patient populations. This finding hasdire implications, especially for the children of cancer victims, as the susceptibility to manycancers has been shown to have familial tendencies. Nurses involved in community healthwho are aware of this problem can redouble their efforts to reach this fearful, but highlysusceptible population.Subjects who used the assuming responsibility strategy expressed a sharp sense ofregret for their lost adolescence, and all subjects indicated a sense of remorse for what might170have been in their life had their parent not died. This finding has implications for nurseswho support clients engaging in their life review. This could occur with the threat of anupcoming procedure, in anticipation of a potentially life-threatening pathology report, and incaring for clients who are terminally ill. Nurses who understand the significance of this lostperiod and/or the lost opportunities, are in an excellent position to listen and respond to theirclients who dwell on this in their life review. Nurses who are unfamiliar with this feature ofdisillusionment might undervalue this aspect of their client's experience.The positive long-term consequence of integrating disillusionment was the individual'sdiscovery of personal strengths. Understanding this, nurses can assess how this may bemanifested for clients who as adolescents were parentally bereaved, and use this knowledgeto guide interventions. For instance, nurses who are aware that a client has a high regard forself-reliance can be especially careful to approach care in a way that supports and buildsupon this. The approach would be collaborative, and respect would be shown to the client asthe expert on his or her own needs and abilities. The second positive consequence was thatthese individuals have extremely strong connections with significant others. Nurse can findmeans to ensure that clients who experience this positive consequence have ready access tothese people, and devise ways in which these people can be closely involved in the plan ofcare. A third aspect of discovering personal strengths was learning empathy, tolerance andcompassion. Nurses can help these clients to extend their compassion and/or tolerance tothemselves at times when they may need to be dependent upon others, or require care. Allthe foregoing strategies are ones that nurses are likely to consider in giving care to any oneof their clients, parentally bereaved or otherwise. However, what this study helps to do is toguide nurses towards those areas that require careful assessment, and given certain situations,to suggest strategies which are likely to be successful in promoting the health and holistic171well-being of parentally bereaved clients.Implications for nursing practice have ramifications for nursing education. Implicit toan understanding of parentally bereaved adolescents and the adults that they are likely tobecome, is an appreciation of development during adolescence, the grieving process, and theresults when the two come together. The researcher recommends that grief, bereavement,and loss be included in the basic nursing curriculum, and that these concepts be studied asthey affect the individual at various points across the life span. Only in this way will nursesgain an understanding of the dynamic interplay between the stage of development and theloss experience, as this occurs for adolescents, and for individuals at all life stages.Implications for Nursing Research Implications for nursing research are discussed in terms of both the methodologicalissues inherent in studying adolescent bereavement, as well as the recommendations that canbe made for theory building in this area of investigation.Methodological issues.The findings emphasized the need for research which addresses the long-term effects ofadolescent bereavement, rather than merely the short-term or immediate consequences. Thedata obtained from exploring the long-term developmental effects showed some resemblanceto short-term and immediate effects, but were distinctively different. Undoubtedly, studieswhich include the short-term and the long-term effects of bereavement as well as the factorswhich influence both, would be illuminating sources of information about the individual'sexperience of the loss event and the effects that this event has for him or her over time. Inturn, this would lead to preventative, corrective, and supportive interventions which could beprovided by all members of the health care team. Ideally, adolescents who are likely to losea parent ought to be observed before the event, and followed through the experience to their172adulthood using a longitudinal, prospective design. The enormous investment in such aresearch program may prove prohibitive, but it is an ideal nonetheless towards which toaspire.A second reason that a longitudinal, prospective design is desirable is that it addressesthe biases and shortcomings that have been criticized in much of the adolescent bereavementliterature. In terms of bias, much of the work prior to 1980 studied subjects with establishedpsychiatric conditions to attempt to see if loss in adolescence had been a variable. Thisapproach has obvious implications for the generalizability of findings which a longitudinal,prospective design would effectively overcome. Subjects' experiences could be studied asthey 'unfolded' and findings from this type of research would be readily generalizable. Interms of shortcomings, it was noted the research in adolescent parental bereavement has beencircumscribed, with researchers studying the effects of bereavement on select variables, orvice versa. A longitudinal, prospective study would yield comprehensive portrayal of theadolescent bereavement experience providing a much needed framework in which otherresearch might be oriented.Another suggestion is to build upon this study, comparing parentally bereavedadolescents who lost a parent suddenly, with ones who lost a parent to an expected death,and both to a control group of normal adolescents who had not suffered any significant lossexperience. This approach would bring into sharper definition the effects of adolescence asthey differ from those of bereavement, and would provide researchers with much neededinformation about the effects of the abruptness of the loss experience.Since the findings from this study reflect information that has not been reported in theadolescent parental bereavement literature, it seems appropriate to suggest that qualitativemethods are well-suited to the address the general area of bereavement investigation. Data173emerging from qualitative methods is rich and deep, in contrast to quantitative data whichtends to be broad and more generalizable. Triangulating both methods would prove to be themost powerful design of all. However, the discovery of new concepts which had nototherwise been uncovered by adolescent bereavement researchers, suggests that all areas ofbereavement theory might develop exponentially if qualitative methods were to be employed.Theory building.This study demonstrated that conducting the same research with other similar but non-identical groups can extend and refine beginning conceptualizations. Davies' (1991)conceptual schema provided a point of departure for this research, and the findings were thenbrought full circle to extend and refine the schema from which the study was generated. Inthis way, information can be systematically collected, analyzed, compared, and integrated,making theory building an orderly and progressive undertaking. For theory building in ayoung science like nursing, and one which involves the use of theories borrowed fromadjacent disciplines, an orderly approach is necessary to ensure that the theories on which theprofession is based are sound and well-integrated.To perpetuate this approach to theory building, the following questions which this studyraises are posed to contribute both to the knowledge of parentally bereaved adolescents, andto their care management.1. What difference exists in the experience of adolescents who are unexpectedly parentallybereaved, those who are parentally bereaved when the loss was expected, and betweenboth these groups and normal nonbereaved adolescents?2. What effect does gender have on the experience of adolescent bereavement?3. What effect on adolescent bereavement does the gender of adolescent have as itinteracts with the gender of the lost parent?1744. What influence does alteration in economics have on the parentally bereavedadolescent?5. How does culture influence adolescent bereavement?6. What action/interactional strategies do sibling bereaved adolescents use?7. How does integrating disillusionment differ in functional and dysfunctional families?8. How do adolescents perceive the role of the nurse in terms of meeting their needs afterthe death of a family member?Limitations and Strengths This study was a descriptive study designed to investigate the long-term effects ofadolescent parental bereavement, and how various personal and situational factors affectedthat experience. The intent of the study was to better understand how the adolescentresponds to parental bereavement so that caregivers might more finely tune their therapeuticinterventions to prevent, alleviate or mitigate negative consequences of the loss experience.The descriptive in depth nature of this study and the time and financial constraints of theresearcher limited the number of informants who were interviewed, and the number ofinterview sessions that could be undertaken with each. The small sample size tends to limitthe generalizability of the results. In qualitative research however, the term generalizabilityis used to refer to the depth of the data, rather than to the breadth of representativeness ofthe subjects or the research setting (Sandelowski, 1986). The researcher's option for depthover breadth was based on the premise that "anyone's experience, if well described,represents a slice from the real world" (Denzin, 1978, p.134). As this study demonstrateshowever, further study and comparison of results from similar but non-identical groupsbroadens the development of the theory, but also keeps the theory securely grounded in thedata from which it was originally generated (Stern, 1985).175The second limitation related to the threat of self-selection, although as the intent wasto select informants who could best illuminate disillusionment, self-selection to some degreewas necessary. Subjects were recruited by way of written advertisements to which theyresponded by telephone. This required several decisions to be taken by potential subjects:the decision to take down the number, the later decision to call the researcher, the thirddecision to agree to participate, and the fourth decision to actually show up at the interviewsession. The researcher was fascinated by the commitment demonstrated by subjects, andasked them if they would share their reasons for participating in such a study. Responsesincluded: a) they wanted to help others; b) they were interested to see how they comparedup to other subjects; and c) they were curious about the research. The tenacity toparticipate, combined with subjects' reasons for wanting to share in the research project mayhave made this a highly selective group of subjects.Other potential bathers were subjects' literacy and their access to a telephone. Aswell, exclusion criteria purposely eliminated subjects who were other than English speakingand/or under psychiatric care. As the relationship between emotional problems andadolescent parental bereavement has been demonstrated, the exclusion of those underpsychiatric care may have eliminated important information about the effects ofdisillusionment. Excluding non-English speaking subjects may also have depleted the resultsas all subjects who declared a cultural leaning were British, and there were no other culturesadequately represented in the sample for comparison. This is an especially importantlimitation as nurses care for an increasingly mixed patient population about whom they havelimited theory from which to draw. The literature concerning parentally bereavedadolescents shares this cultural homogeneity, with white anglo-saxon subjects being thenorm.176The third limitation related to the purpose and design of the research. The researcherasked subjects to speak to their experiences over time, which itself entailed a degree ofreflection. However, the research question sought to investigate the subjects' developmentup to the present time, and thus only relied upon memory recall in a small part.A strength of the study was that it began to address the paucity of research pertainingto the long-term developmental effects of adolescent parental bereavement. 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Helping children cope with death. In D. Papadatou & CPapadatos (Eds.), Children and death (pp.16-32). New York: Hemisphere.Weizman, S.G., & Kamm, P. (1985). About mourning: Support and guidance for thebereaved. New York: Human Sciences Press.Wolfenstein, M. (1966). How is mourning possible? Psychoanalytic Study of the Child, 21,93-123.Woods, N.F. (1988). Selecting a research design. In N.F. Woods & M. Catanzaro (Eds.)Nursing research: Theory and Practice  (pp. 117-131). St. Louis, MO: Mosby.APPENDIXES183184Appendix AInterview GuidelinesAs we discussed, the purpose of this study is to understand the long-term effects on thedevelopment of individuals who, in their adolescence, experienced the death of a parent.There are no right or wrong answers to the questions which I will ask you: what I need tohear from you is a description of your experiences, so I expect that your observations will beas unique as you are. Please feel free to skip any question that you may feel uncomfortableanswering. The tape can be stopped at any time, and we can erase anything that you wouldrather not have recorded. First we will start with your experience of the event of yourmother/father's death, and then try to follow how that experience may have effected the waythat you have grown into who you are now.1. Please tell me the story of your mother/father's death.2. Please describe for me the relationship you had with your mother/father before her/hisdeath.What were things like at home after your mother's/father's death?3. What effect did the death have on you at the time?Prompters:shockedconfuseddepressed^ > describelonelyafraid > of what?guilty^ > about what?angry > at whom?illnessescloser to/withdrew from familycloser to/withdrew from friendsfelt different from friends ---- > how?changed eating habitsdifficulty sleepingchange to school work/school attendance185How long did^ (insert effect) last?4. How do you think people expected you to feel?5. Do you think that if you had have been a boy/girl (opposite sex of informant) that youwould have felt or behaved differently?6. What effects do you see your mother's/father's death having had on you since that timeand up to the present - good and bad?Prompters:harder to make friends/closer to friendsafraid that other parent will dieafraid that people you love will die/leavealways feel older than friends - how?difficulty leaving home - how?increased sense of responsibility - for sibs, - for surviving parentchanged the direction that your life might have taken - education, career, marriage,other?changed your sense of what is important in life?5. What factors/conditions do you think made a difference to how you felt about thisexperience at the time?Prompters:family dynamicsquality of friendshiprelationship with Godother significant others (ie. teacher, Big Brother/Sister)outlook on life6. What factors/conditions helped or hindered your ability to deal with this experience?Prompters:parent supportfriend supporttalking with others who had lost a parentrelationship with Godpast experience with deathother interests/distractionspassage of timeleaving home/staying home/travelling1867. How do you think you might have turned out differently if your mother/father had notdied?8. Is there anything else that you would like to add about the effects of this loss on your lifethat we haven't touched on?Appendix BDemographic DataAge: ^  Sex: ^Age when parent died: ^Which parent: mother father(circle one)Time interval:Number of brothers:  ^sisters: ^Name:^  Age:Name:  Age:^Name:^  Age:Name:  Age:^Religion:  ^Culture:Practising Non-practising^Degree of acculturation(circle one)Marital status:Name:^  Age:^# of children: ^Name:  Age:^Name:^  Age:Name:  Age:^Name:^  Age:187188Education History: ^Occupation: ^Did one of your parents die while you were a teenager?andHas it been five years or more since then?andAre you willing to share your experience to help others?If so, then please call me. I am studying the long-term effects of adolescentbereavement. The study is for my MSN thesis, and is conducted under thesupervision of the School of Nursing, UBC. Two interviews, each one hourlong, will be required. If you are interested or if you know someone who maybe, please call 224-3921 and ask for Ann.AdolescentBereavementStudyCall Ann224-3921AdolescentBereavementStudyCall Ann a224-3921AdolescentBereavementStudyCall Ann224-3921AdolescentBereavementStudyCall Ann @224-3921 AdolescentBereavementStudyCall Ann @224-3921189Appendix CAdvertisement for Volunteers1. Advertisement placed in "UBC Reports"Participants needed for a study investigating the long-term effects of adolescentbereavement. Must have lost either parent at least five years ago, and have beenbetween 13 and 17 years at the time of the loss. Two one-hour interviewsrequired. Please call Ann McKintuck in Nursing at 224-3921/224-39992. Advertisement posted on community bulletin boards: R.D.‘ pratleyDirector, Research Servicesand Acting Chairman190Appendix DEthical ApprovalThe University of British Columbia^B91-186Office of Research ServicesBEHAVIOURAL SCIENCES SCREENING COMMITTEE FOR RESEARCHAND OTHER STUDIES INVOLVING HUMAN SUBJECTSCERTIFIC'ATE^of APPROVALINVESTIGATOR: Davies, E.UBC DEPT:^NursingINSTITUTION:^UBC-CampusTITLE:^Long-term effects of loss in adolescence:Exploration of a conceputal schemaNUMBER:^-B91-186CO-INVEST:^McKintuck, A.APPROVED:^JUN 27 1991The protocol describing the above-named project has beenreviewed by the Committee and the experimental procedures werefound to be acceptable on ethical grounds for researchinvolving human subjects.THIS CERTIFICATE OF APPROVAL IS VALID FOR THREE YEARSFROM THE ABOVE APPROVAL DATE PROVIDED THERE IS NOCHANGE IN THE EXPERIMENTAL PROCEDURES191Appendix ESummary of StudySTUDY BACKGROUND:^Long-term effects of loss in adolescence:Exploration of a conceptual schemaThe long-term effects of bereavement have not been studied in any sort of systematicfashion. Bereavement research is usually limited to the first year or two following the loss,that period being widely accepted as the 'normal' time duration for grief resolution. Thecontinuation of grief responses beyond this time has been cited as manifestations ofunresolved, chronic, or pathological grief. This is disturbing, as the concepts of whatconstitutes 'normal' or 'resolved' are ambiguous, and as such subject to wide variation intheir interpretation.Research conducted by Dr. Betty Davies indicates that the non-pathological bereavementresponse continues for much longer than commonly assumed. Dr. Davies' research wasconducted on adults, who as adolescents lost a sibling. From her investigation she hasdeveloped a conceptual schema which describes themes which were prevalent in thediscussions of what subjects perceived as being different for them as a result of their loss.This project seeks to examine the experience of adults who as adolescents experiencedthe loss of a parent. Data arising from this investigation will then be utilized in an attemptto extend and refine Dr. Davies' conceptual schema. The study is descriptive in nature,employing qualitative methods of data collection and analysis. The goal of this project isgrounded theory development. It is hoped that findings will further theory development inthe area of adolescent bereavement, and should eventually contribute to the improvement ofnursing practice in this field. Informants will be recruited from the general public accordingto the following inclusion criteria:1) must have experienced the death of one parent (natural or adoptive) between the ages of13 and 17 years of age2) must be five or more years past that experience (no ceiling on how long ago)3) must be willing to speak about their experiences4) must be able to communicate in English5) must consent to participate in the study after having received a verbal and writtenexplanation of the research.Exclusion criteria includes that informants must not:1) be under psychiatric care2) be seriously distressed on exploration of the issues.192Appendix FConsent to Study The School of NursingT. 206-2211 Wesbrook MallVancouver, B.C. Canada V6T 2B5SIRCONSENT TO PARTICIPATEPROJECT TITLE:^The Long-Term Effects of Loss in Adolescence:Exploration and Extension of a Conceptual SchemaCo-InvestigatorAnn McKintuck, RN, BSN - Master's CandidateUBC School of Nursing,Tel: 224-3921PURPOSE OF THE STUDY:Principal Investigator/Faculty Advisor:Dr. Betty Davies - Assoc. ProfessorUBC School of Nursing,Tel: 822-7456The intent of this study is to describe the experience of adults who in their adolescenceexperienced the death of a parent. Specifically, the purpose is to describe the long-termeffects of parent loss in adolescence, and to identify those factors or conditions which mayhave contributed to these effects. This study follows from an initial undertaking by Davies(1991) and seeks in part, to explore and/or extend her findings. It is anticipated that theresults of this study will contribute to knowledge about the bereavement process over time,and will provide direction for appropriate intervention by health care professionals.I, ^ , agree to participate in the research studydescribed above. I have had the study explained to me and I understand that:a) I may refuse to comment or answer any question at any time;b) I may withdraw from the study at any time without penalty;c) I am free to stop the interview at any time;d) It is not the Investigator's intent to provide health care; however, in the event of a seriousconcern, she may exercise her professional judgement and refer me to the appropriatehealth care services;e) I may not directly benefit from this study....^2193I expect that:a) The average duration of the interview will be 45-60 minutes;b) I will be interviewed twice, in a private room at UBC School of Nursing or in my home,as mutually agreed-upon;c) The interviews will be audiotaped and transcribed, and the audiotapes will be erased uponcompletion of the study;d) The transcriptions will be secured in a lock cabinet for five years and will then bedestroyed;e) All transcripts will be identified by a code number known only to the Investigator andmembers of her Thesis Committee; my name will not appear in any research reports,published or unpublished;t) The content of my discussions with the Investigator will be held in the strictestconfidence.I have been given the opportunity to ask whatever questions I desire of the Investigator,and have had all such questions answered to my satisfaction. I realize that I can ask foradditional information at any time. I will be given an opportunity to see a summary ofthe final report. I acknowledge that I have received a copy of this consent form.Subject^ WitnessDate


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