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UMI
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313/761-4700 800/521-0600
THE EXPERIENCE OF DEPRESSION, MEANING IN LIFE
AND SELF-TRANSCENDENCE IN TWO
GROUPS OF ELDERS
by
Deborah Jan Kindy Klaas
Copyright © Deborah Jan Kindy Klaas 1996
A Dissertation Submitted to the Faculty of the
COLLEGE OF NURSING
In Partial Fulfillment of the Requirements
For the Degree of
DOCTOR OF PHILOSOPHY
WITH A MAJOR IN NURSING
In the Graduate College
THE UNIVERSITY OF ARIZONA
1996
UMI Number: 9720690
Copyright 1996 by
Klaas, Deborah Jan Kindy
All rights reserved.
UMI Microform 9720690
Copyright 1997, by UMI Company. All rights reserved.
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2
THE UNIVERSITY OF ARIZONA ®
GRADUATE COLLEGE
As members of the Final Examination Committee, we certify that we have
read the dissertation prepared by Deborah Jan Kindy Klaas
entitled
The Experience of Depression. Meaning In Life and Self-Transcerxience
In Two Groups Of Elders
and recommend that it be accepted as fulfilling the dissertation
requirement for the Degree of
Doctor of Philosophy in Nursing
~ 9 I,
Pamela G. Reed, PhD
Date
Joanne Glitt^berg, PhD
Date
Joaj^i^aase, PhD
Date
/r~' //-/
- f C
u
Date
Date
Final approval and acceptance of this dissertation is contingent upon
the candidate's submission of the final copy of the dissertation to the
Graduate College.
I hereby certify that I have read this dissertation prepared under my
direction and recommend that it be accepted as fulfilling the dissertation
requirement.
//- /- f ^
Dissertation Director
Pamela G. Reed, PhD
Date
3
STATEMENT BY AUTHOR
This dissertation has been submitted in partial fiilfihnent of requirements for an
advanced degree at The University of Arizona and is deposited in the University Library to
be made available to borrowers under rules of the Library.
Brief quotations from this dissertation are allowable without special permission,
provided that accurate acknowledgment of source is made. Requests for permission for
extended quotation from or reproduction of this manuscript in whole or part may be
granted by the copyright holder.
SIGNED:.
4
ACKNOWLEDGMENTS
Dr. Pamela Reed who Chaired my dissertation committee: "The best teachers and
educators are not necessarily those who inq)art masses of in&rmation but those who help
us to think and to comprehend the world m fresher and more discerning ways." (Herman
Feifel) You did both. Words cannot express my gratitude for everything you have done.
Dr. Joanne Glittenburg: My source of spiritual mspiration. "Don't you hear it? she asked
& I shook my head no & then she started to dance & suddenly there was music
everywhere & it went on for a very long time & when I finally found words all I could say
was thank you." (Brian Andreas).
Dr. Joan Haase: Your gentle strength and kind support instilled hope and peace during
rocky passages.
Larry; Thanks for providing the motivation, then challenge and finally, despite not
understanding, the love and support that mitiated, accompanied and complemented this
extraordmary journey.
Curt: Thanks for keeping my head fi-om exploding and for being the light m my life.
Dad & Joan: Thanks for understanding the desire and process and for providing wisdom,
enthusiasm, pride and emotional support.
Eileen Breslin and Ilene Mezza: Without the two of you I would still be sitting at my
computer crying. Thank you for all the time and emotional and financial support you so
generously donated.
Northern Arizona University Department of Nursing Faculty and StafE You've all
assisted in this process more than you know, especially Kathy Ingeles and Judy Buzard.
Thank you.
Austin Klaas: Thanks for being quiet when I was stressed out and your help around the
house.
Becky and Mary: Thanks, GARA grad angels, for your help.
This research was supported by an mterdepartmental grant - Department of Nursing,
Northern Arizona University
DEDICATION
To my paients
Harold Glenn Kindy
May the rest of your journey be blessed with peace and joy.
I love you.
Janis Elaine Early Kindy
1927-1978
Je tiene chere ta parole
6
TABLE OF CONTENTS
LIST OF TABLES
10
LISTOFHGURES
12
ABSTRACT
13
CHAPTER I - THE PROBLEM
I*uq)ose
Significance
Philosophy of the Researcher
Foundational Lenses
Experiential Lenses
Conceptual Orientation
Life-Span Development
Existential Psychology
Narrative Theory
Conceptual Framework
Concepts and Constructs Definitions
Well-being
Depression
Spirituality
Meaning m Life
Self-Transcendence
Narrative/ Life Stories
Research Questions
Conclusion
14
16
17
20
20
22
25
27
30
33
36
38
39
39
42
44
46
48
51
52
CHAPTER 2 - LITERATURE REVIEW
Depression
Spirituality and Depression
Meaning in Life
Self-Transcendence
Conclusion
53
53
56
58
59
60
CHAPTER 3 - METHODOLOGY
Methodological Frame
Triangulation
Research Process
Saiiq)lmg and Setting
Retirement Community 1
Retirement Community 2
62
62
62
64
65
66
67
7
TABLE OF CONTENTS - Continued
Retirement Conununity 3
Response Rates
Instnunents and Administration
Reliability and Validity
Geriatric Depression Scale
Purpose in Life Test
Self-transcendence Scale
Procedures
Ethics
Human Subjects
Application
Codes and Consent
Deception
Privacy, Harm, Identification, Confidentiality
Trust and Betrayal
Quantitative Procedures
Qualitative Procedures
Narrative Analysis
Background
Development of Narrative Analysis Method
Steps of Narrative Analysis
First Level Analysis
Second Level A; Theme analysis
Second Level B: Analysis of manifestations of
self-transcendence
Evaluation of the Qualitative Method
Validation of Narrative Work
Persuasiveness
Correspondence
Coherence
Pragmatic Use
Conclusion
CHAPTER FOUR - FINDINGS
Overview
Sample Description
Quantitative Analysis
Research Question I
Research Question 2
Qualitative Analysis
The Informants
68
68
69
69
70
72
74
75
75
75
75
76
76
76
77
77
77
79
79
83
86
87
88
88
88
91
91
92
92
93
94
95
95
95
97
97
101
102
104
8
TABLE OF CONTENTS - Continued
Brief Partic^ant Proffles
106
Bfflie
106
Madge
106
David
107
Buit
107
Kathryn
108
Elma
108
Miriam
108
George
109
Karen
109
Margaret
110
First Level Analysis
110
Second Level A: Analysis of Themes
Ill
Research Question 3
112
Research Question 4
114
Careers
116
Family
118
Friends
119
Health
120
Memories
123
Interests/hobbies
124
Community environment
125
Activities of Daily Living
125
Problem-soKing
127
Beliefs
129
Education
131
Second Level B: Analysis of Manifestations of Self-transcendence ... 132
Research Question 5
132
Research Question 6
133
Bringmg It All Together
137
Research Question 7
137
Conclusion
140
CHAPTER 5 - DISCUSSION AND RECOMMENDATIONS
Overview
Study Limitations
Research Questions 1 and 2
Research Questions 3 and 4
Affective Perceptions
Outward Theme Focus
Research Questions 5&6
141
141
142
144
145
148
148
149
9
TABLE OF CONTENTS - Contimed
Ditrospecdve Activities
150
Outward Concerns
151
Temporal Integratioii
152
Theoretical Links
154
Research Question 7
156
Geriatric Depression Scale and Interviews
156
Ehirpose in Life Test and Interviews
157
Self-Transcendence Scale and Interviews
157
Discrepancies Between Financial Worries Questions and Interviews . 159
Links with Previous Research
160
Depression
160
Meaning in Life
162
Self-Transcendence
163
Narrative/Life Story
164
Links with Theoretical Frameworks
164
Life Span Developmental Psychology
165
Existential Psychology
168
Narrative Theory
170
Weil-Being, Spirituality & Researcher's Theoretical Framework
171
Implications for Nursing Theory and Practice
176
Implications for Nursing Research
180
Conclusions
182
APPENDIX A: INFORMED CONSENT AND DIRECTIONS
185
APPENDIX B: DEMOGRAPfflC QUESTIONNAIRE, GERIATRIC DEPRESSION
SCALE, PURPOSE EN LIFE TEST, SELF-TRANSCENDENCE SCALE
188
APPENDIX C:
INFORMED CONSENT FOR INTERVIEWS
196
APPENDIX D
SUMMARY PROFILES OF DEPRESSED GROUP
198
APPENDIX E
SUMMARY PROFILES OF NONDEPRESSED GROUP
213
APPENDIX F
EXAMPLE OF LEVEL I ANALYSIS
230
REFERENCES
235
10
LIST OF TABLES
TABLE 1
Sequence of Research Procedures
65
TABLE 2
Demographic Frequencies for Total Group, Nondepressed and Depressed Group ... 96
TABLES
Psychometric Properties and Scores on Instruments Across Groups
97
TABLE 4
Correlations for Total Group
98
TABLE 5
Correlations for Nondepressed Group
99
TABLE 6
Correlations for Depressed Group
100
TABLE 7
Mann-Whitney U Test of Diflferences Between Nondepressed and Depressed Groups
on Purpose in Life Test (PDL) and Self-Transcendence Scale (STS)
102
TABLES
Instrument Score Profiles of Participants Selected for Interviews
103
TABLE 9
Life Context Profile
105
TABLE 10
Life Story Themes Generated in Second Level Analysis
112
TABLE 11
Summarization of Themes Addressed By Each Participant, Themes Totals and
Instrument Scores
113
TABLE 12
Positive (P) and Negative (N) Perceptions of Life Story Themes m Nondepresesed
and Depressed Participants
115
TABLE 13
Manifestations of Self-Transcendence in Groups
134
11
LIST OF TABLES - Continued
TABLE 14
Participants'Favorite Activities
135
TABLE 15
Synthesis of Quantitative and Qualitative Analysis Results
139
LISTOFnGURES
FIGURE I
Conceptual Framework
nGURE2
Revised Conceptual Framework
ABSTRACT
Depression is a common source of morbidity and mortality in elders and has a
significant impact on their quality of life. Meaning in life and self-transcendence,
indicators of spirituality, have been linked to the ejq)erience of weE-being in the elderly.
Nurses are challenged to find ways to tap these natural health resources as a means of
addressmg the serious problem of depression in the aged. The purpose of this study was
to explore and compare patterns of depression, meaning in life and self-transcendence as
mianifested m instruments and life stories of depressed and nondepressed elders.
Life span development psychology, existential psychology and narrative theory
provided the conceptual framework for this triangulated study of depression, meaning in
life and self-transcendence in those over 75 years of age. The Geriatric Depression Scale,
Purpose in Life Scale and Self-transcendence Scale were completed by 77 people over the
age of 75 and living in one of three retirement commxmities. Those individuals achieving
the five highest and five lowest scores on the Geriatric Depression Scale were mterviewed.
Significant negative relationships were found between depression and meaning in
Ufe, and between depression and self-transcendence. A significant positive relationship
was found between meaning in Ufe and self-transcendence. Narrative analysis of the
interviews generated 11 themes of meaning in life. Different patterns of behaviors and
perceptions related to life story themes of meaning m life and self-transcendence were
identified in the Depressed and Nondepressed Group. The study conclusions support the
importance of meaning m life and self-transcendence for well-being in the elderly.
14
CHAPTER I
THE PROBLEM
As people age, vulnerability to depression may increase relative to losses,
disability, chronic illness (Lesnofif-Caravaglia, 1988; Rapp, Parisi & Wallace, 1991), and
physiological changes associated with aging (Katonia, 1994; Veith & Raskind, 1988).
Despite the fact that elderly persons may mask their depression by somatizing it, (Evans,
1993), depression remains the most common mental health problem diagnosed in this
cohort (Koenig & Blazer, 1992). Health problems associated with depression profoundly
effect the elderly, their families and communities, and the health care industry. The
significance of these problems is intensified by the fact that for the first time in history
those over 85 are the fastest growing segment of the population (Overholt, 1990), havmg
increased their numbers an average of 136% every 20 years since 1940. Those over 80
are expected to exceed 5.4 million by 2000, 7.6 million by 2020 and 13 miUion by 2040
(Longmo, 1988).
Consequences of depression for the elderly include a diminished quahty of life
(Reed, 1989a), increased mortality as the result of ilhiess (Shah, Phongsathom, George,
Bielawska,
BCatona, 1993; Silverstone, 1990), and suicide (Osgood, 199 la, 199 lb;
Lesnofif-Caravaglia, 1988). Suicide rates have been steadily climbing for those over 65
compared to fixed rates for the young and middle-aged (Osgood, 1991a). Currently
elderly white males have the highest suicide rate in the United States (MeUick,
Buckwalter, & Stolley, 1992), with the highest risk among those over 85 (Mcintosh,
1992).
15
Compared to parasuidde common in younger age groups, suicide attempts are
largely successfiil in older populations (Mdntosh, 1985; Valente, 1993). "They do it with
determination and single-mindedness of purpose not encountered among younger groups"
(Osgood, 199 la, p. 294). Unlike suicide notes of younger adults, elders' suicide notes
communicate less ambivalence and unconscious motivations, a greater wish to die and a
sense of meaninglessness (Leenaars, 1992).
Psychological autopsies indicate most elderly persons committing suicide exhibit
classic symptoms of depression before their deaths, often not formally diagnosed (Osgood,
1991). Further, for the elderly there is "...a drastic underreporting of the problem"
(Osgood, 199 la). Often intentional suicide such as over or under self medication, mixing
drugs with alcohol, avoidance of food and fluids, or intentional 'accidents' is labeled as
death from natural causes or accidental death (Osgood, 199 la).
Although knowledge of primary etiologies of elder suicide is limited (Leenaars,
1992), multiple precipitating factors have been postulated. Lesnoff-Caravaglia (1988)
proposed elders' experience of destruction of self-identity and independence through
multiple losses and isolation contributes to a loss of commitment to life. Integral to these
factors are influences at a societal level. Moody (1985) traced the historic evolution of
justifiable elderly suicide to Socrates and the Stoic philosophers. The view assumes elders'
suicide decisions result from an evaluative process incorporating a deliberate choice, and
perceptions of a negative fixture, disengagement or fewer obligations and a natural death
(as opposed to a premature death). Suicide then could be perceived by the elder as
fiilfilling an "obUgation to the greater welfare of society" (p. 89) or a final reciprocation.
DepressiocL, the most prevalent diagnosis preceding suicide, has been associated
with loss of personal meaning in life (Lesnofif-Caravaglia, 1988; Osgood, 1991b; Paterson
& Zderad, 1976; Reed, 1991b; Snaith, 1993). Meaning m life is a spiritual experience
that helps to sustani human life and well-being (Frank!, 1972; Paterson & Zderad, 1976;
Travelbee, 1971). For the elderly, well-being has been linked to achieving age-appropriate
developmental milestones (Erikson, 1986). Personal growth, environmental changes,
declining health and mounting losses create a need for reevaluation of life meaning to
integrate life circumstances and reconceptualize the self (Kaufinan, 1986).
Telling life stories to self or others is a principal means of constructing and
reaUzing meaning in life, makmg sense of self in the world (PoUdnghome, 1989; Reissman,
1989, 1993; Sarbin, 1986; Viney & Bousfield, 1991; Williams, 1984), and givmg "unity,
direction and coherence to the life course" (Gergen & Gergen, 1986, p. 31). Thus, life
stories are a primary means by which the elderly accompUsh age-appropriate
developmental milestones (Butler, 1963). Life stories as manifestations of explanatory
models of sel^ meaning, and the world, mirror elders' ongoing developmental process,
thus provide insights into then* health and well-bemg
Purpose
The general purpose of this study was to explore patterns of meaning m life as
conveyed m life stories and to compare these perceptions in two groups of elders, those
experiencing depression and those not experiencmg depression. Self-transcendence, as a
particular correlate of meaning in life and as manifested in life stories of depressed and
nondepressed elders vi/ill be examined and compared.
Significance
To date, the primary goals of geriatric research have been the cure of physiological
anomalies and extending the life span. Significant inroads have been made in these areas
as evidenced by the extended life spans of growing numbers of elders throughout
industrialized nations. However, this progress has raised cogent questions about the
quality of life of these aging persons. Images of nursing home residents lined in
wheelchairs along bare walls staring lifelessly mto their laps, mindless bodies connected to
various life' maintenance machinery, and the alarming rates of suicide m those over 65
exemplify the gravity and call attention to major concerns about quality of life in elderly
cohorts. Humphrey (1992) described these situations as "hovering at the point of a living
death without the release that death brings" (p.129).
For the first time in the history of humankind, the need for closure of human
life m meaningfiil, healthfiil, and rational ways for large numbers of older
persons has become a social and health care concern of major unportance.
(LesnoflF-Caravaglia, 1988, p.585)
Quality of life issues addressed in midtidiscipUnary publications report inqiortant
correlations between various aspects of spirituality and health in the elderly. Despite this
fact, there remains a dearth of inquiry about the critical interrelationships between the
spiritual issues of self-transcendence and personal attributions of meaning m Ufe as they
relate to health. Yet philosophers and scientists agree meaning m life is a critical element
of weU-being. Further, many have suggested that for the elderly, suicide may be the
resolution of the experience of meaninglessness (Harlow, Newcomb & Bentler, 1986;
18
Lesnoff-Caravaglia, 1988). Alanniag rates of suicide and depression, in addition to
increasing numbers of aged persons, underscore the importance of more in:q)assioned
efforts to understand their spiritual and health concerns.
Geriatric health care professionals may lack training and knowledge about
depression and suicide in those over 65 (Osgood, 1991). George & Clipp (1991) noted
perceptions of quality of life among the elderly are distinct from those of younger adults.
They suggested placing a high priority on research issues of meaning in life in the aged to
advance knowledge of elders' well-being. Accordingly, Acuflf (1985) called for a
refocusing of research to rediscover "...our anchors, our social fabric, our humanness, our
spirituality" (p.101).
In the past, most research of spirituality and health in the elderly used quantitative
designs to variously measure and compare degrees of associated concepts with
preconstructed instruments. While knowledge has been generated with this method, it is
likely that a more diverse approach to studying spirituality and health m the elderly wUl
yield informarion that heightens clinical effectiveness for addressing related problems such
as depression and suicide. Featberman (1983) noted "generalizations across persons about
constancies in human development, especially throughout the last half of life, are few and
difficult to formulate" (p.3). Alternate methods of inquiry may be required to investigate
lack of and possible misunderstandings of elders needs, development and perceptions;
augment needs identification techniques; and develop more efficacious age-appropriate
nursing interventions to meet those needs.
19
Perhaps the ultimate source of essential information for addressing these concerns
is found within life stories of aged persons. White (1980) noted the universality of
narratives (life stories) and their function as a solution to the problem of translating
knowing into telling, and human experience into structures of meaning. In the last 30
years the significance of stories eiders teU of their lives has become increasingly apparent.
Life stories assist and exhibit continuing development in old age (Birren, 1980; Butler,
1963; Ellison, 1981; Erikson, 1980; Freeman, 1984); reveal personal perceptions of self
and meaning (Nye, 1993; Reissman, 1989, 1990b; Thompson & Janigian, 1988; Williams,
1984); and are windows mto the spiritual and psychological being of the mdividual (Kerby,
1991; Ochberg, 1988; Robinson, 1990; Viney & Bousfield, 1991). Therefore a goal to aid
and nurtiure elders' experiences and perceptions of health and well-being might best be
strengthened by listening to them - the stories of who they are and how they perceive their
world.
Caring for this extremely diverse and growing population provides nurses with
complex challenges. An essential component of meeting these challenges is the generation
of knowledge through methods veneratmg the experience of elders m context, to gam
insight into their experiences and perceptions of life. Acufif (1985) m an address about
diminished humanity and the objectification of science stated:
A new day might be in store if a sociology of meaning would rebirth
diminished humanity through our theories, methods, and equations of
human interaction. To experience, to research, to teach and to inspire
our public to the rest of the story is the most basic quest, the search for
meaning and purpose m life, is the challenge, (p. 103)
Philosophy of the Researcher
Foundational Lenses
A research problem is the intimate, subjective and value laden creation of the
researcher, elements that subsequently influence the mquiry process as well (DeGroot,
1988). Research itself is an ethical endeavor because it inq)lies value and benefit for
society. Therefore it is imperative that the personal philosophical and experiential factors
molding the researcher's unique perspective/conceptual firamework be contemplated and
identified (Reed, 1989b).
The primary factors nifluencing scientiGc mquiry in nursing are (a) intrapersonal
factors such as ontology, epistemology, ethical concems, cognitive style, and experience,
and (b) extrapersonal factors such as influential others and the researchers sociohistorical
context (DeGroot, 1988). The ethos of this critical exercise m reflexivity is an avoidance
of undue bias or influence of the researcher's belief systems particularly in terms of
presuming the needs of society, and/or mchision of elements that might constrain or
damage human potential (Reed, 1989b).
Further, m qualitative research particularly, the researcher functions as the
instrument and the outcome is a mutual creation of the researcher and participants
21
(Lincoln & Guba, 1985). Accordingly, uncovering and exposing the researchers'
assun:q}tions and perspectives is a critical aspect of trustworthiness. Explication of these
personal assumptions and perspectives provides the research consumer an awareness of
the researcher's unique epistemological, ontological and ethical lenses.
This researcher performed the exercise of self identification/location formally in
two nursing graduate courses (Klaas, 1993; Klaas, 1992b) and has become aware that
neither the process nor outcome is static. The process has, however, become nearly
spontaneous wlien contemplating new projects. This self-identification as an evaluative
process is strikingly similar to the process of life review (Butler, 1963) or the construction
of self through stories (Polkinghome, 1989; McAdams, 1993; Sarbin, 1986), an interesting
personal encounter with a major concept of this research - life stories.
This study was conceived and conducted from a philosophical footing closely
related to eclecticism The Oxford English Dictionary defines eclectic as
...a class of philosophers vsdio neither attached themselves to any
recognized school nor constructed independent systems but selected
such doctrines that pleased them in every school., those who combine
elements derived from diverse systems of opinion or practice in any
science or art. (p. 830-831)
In other words there is no fifig best means for all things, rather multiple means for
multiple circumstances and ends. This opinion coincides with Riegel's assertion that
logical consistency m all things is a "mentalistic mirage" (1976). From this framework
elements of the mechanistic, organismic and contextual/ dialectical worldviews (Hultch &
22
Oeutsch, 1981; Lemer, 1986) and plan worldview (Schwartz, 1992), each may be most
appropriate, or alternatively contribute different aspects of knowledge, m any given
situation. Eclecticism shares with postmodernism (Reed, 1995) the contention that there
are no universal truths, rather multiple behe& and meanings.
Experiential Lenses
During 18 years of varied clinical nursing experience the researcher had the
privilege of hearing many life stories from clients. Most of these stories were shared in
situations of long term care or iterative encounters such as home care or respiratory
disease units; or m more short term but mtimate crisis situations such as intensive or
psychiatric care units. Though assessed informally, these stories reinforced the integrality
of holistic care in nursing practice, and consideration for the unique and iaestimable depth
and personhood of each human being. Further, these stories helped the author
individualize and optimize nursing care at an mtuitive level. The Ufe stories facilitated a
personally less judgmental attitude and understandmg of diverse perceptions of life,
rightness and wrongness and how things 'should' be.
An mterest ni depression, meaning m life and life stories in the aged began
approximately five years ago. While working as a research assistant administering a hefty
packet of mstruments to depressed individuals over 75 years of age, the researcher was
frustrated, then fascinated by the fact that these people inevitably inserted life stories into
the questionnaire framework. As the researcher fidgeted less and listened more, she
realized instrument answers were bemg qualified (often modifying the apparent meaning of
the answer chosen from the strictly limited selection): these elders were constructing a
portrait of themselves, the lines represented by time and story circiunstances, their
perceptions and emotions providing color and texture.
These portraits reflected profoimd life assessments, intrapersonal meaning or lack
of meaning and a need to be heard. Deeply moved, the researcher vowed to find a
research method that would honor and illuminate their stories while contributing
theoretical knowledge to enhance their sense of well-being. Thus, the goal of this
dissertation was not to predict or control elders' behavior from a positivist perspective,
rather to, as Gergen (1980) noted, render "...mtelligible and communicable [then]
experience of the world" (p. 32).
A 'storyboard' contained in a book created by Brian Andreas (1993), hangs on the
researcher's study wall and provides inspiration and motivation for this undertaking. It
says:
the feel of his spirit was too old for most people to understand and when he
walked by they would look up and say O, the sun went behind a cloud, or,
the moon must be fiiU and so he walked for a long time by himself with no
one to talk to.
Prelimmary studies of elder's life stories using the qualitative methods of groimded
theory and phenomenology were undertaken by the researcher (addressed m more detail in
Chapter 3). Story themes such as love, youthflil exuberance, loneliness, strength, wisdom,
vidnerability, wistfiihiess and accomplishment have profoundly influenced the author's
conceptualization of aging and mspired a deep reverence for the process of development
in later years. The following comments and stories illustrate some of the inspiration for
the focus of this study - that is patterns of meaning in life and self-transcendence revealed
m life stories of depressed and nondepressed elders.
"Well, I wouldn't like to live my life over. No, but there's some thmgs I wish I
could do over. I would be a kinder person, I think. It seems to me a time or two Fve had
a mean streak."
Sparky, age 93
Fve maintained and I don't mind telling anybody that I was a loser from
the first day I was bora, and Fve never won since. I don't think. I can't
remember ever winning anything. Td just Uke to...rd like to kick the
vmning field goal m a football game and have the plaudits of the crowd.
rd like to hit a home run in the World Series and, ah, instead of that
I'm a flmible heels.
Francois, age 78
"Fm always ready to help anybody that I can help and I want to do that. I've done
that probably more than anything else in my life. I don't think its been a glamorous life. I
wouldn't say that. Its just been a very peacefiil life, a fiilfilling Ufe."
Grace, age 87
One time a man lived round the comer from me. His wife had died an he
had an oxygen tank. An he was coming down the hall an I said, "how are
ya today?" An he said, "Fm coimting my blessmgs." An I wasn't. An I
thought "uhoh, if he can count his blessings I better start counting mine."
An from that day on that has kept...count your blessings, count them one
by one. Count your many blessings, see w^iat God has done. It goes
through my mind when I sit in the lobby. Sometimes I look out, watch the
cars, people go by. That goes through my head.
Adele, age 92
"An I been up and down with the Lord have brought me. An I thank God fer it
cause people don't know. You don't. You be so lonely. You bes lonely!"
Bessie, age 82
In conclusion, the theoretical perspectives and assumptions adopted for this study
are the result of an epigenetic personal worldview and exposure academically to various
theoretical constructs in context with life experiences. The study population and variables
were chosen as the result of life and academic experience.
Conceptual Orientation
Three theoretical perspectives comprise the conceptual orientation of this
dissertation; they are life span developmental psychology, existential psychology and
narrative theory. In the following paragraphs corollary assumptions, derived &om these
perspectives, are listed below each theoretical perspective. Following the outline of
theoretical perspectives and their corollary assumptions, the conceptual framework and
definitions of key concepts are presented.
Life span developmental psychology describes and explains the nature of human
development through the human life cycle. Assumptions include; (a) Human development
occurs multidimensionally throughout the life span and is irreducible; (b) Ufe is not
compatible with an equilibrium, rather life is a dynamic/dialectic process of continuous
26
change; (c) humans become increasingly heterogenous as they age; and (d) a major task
of aging is integration of the multiplicity of life experiences to realize a coherent sense of
self
Existential psychology describes and explains the hiunan struggle with four
paramount concerns of existence; death, freedom, isolation and meaninglessness.
Assumptions include: (a) humans uniquely create then* own reality and attribute meaning
m their lives - these perceived realities and meanings being fimdamental to their wellbeing; (b) finding meaning in life is a human requirement for experiencing well-bemg; and
(c) self- transcendence is a significant correlate of meaning m life.
Narrative theory suggests story telling is a primary intrapersonal and interpersonal
means of understanding self and other. Assumptions mclude: (a) poor memory does not
affect the validity of a story because the significance of a story is the meaning attributed
by the mdividual, not its veracity; (b) life stories/narratives reveal cognitive and affective
dimensions of the story teller; (c) individuals create meaning in their lives through stories
told mtrapersonally and interpersonally; and, (d) stories and meanmgs change throughout
the life span.
Propositions of the study include: (a) stories remembered by the elderly will be
those of personal importance (versus the immdane or irrelevant) and will reveal patterns of
self-perception, spiritual development, self-transcendence and attributions of meaning in
life, and; (b) an existential vacuum or a sense of life meaninglessness is intimately related
to elders' experiences of depression.
Thus, the conceptual orientations guiding this dissertation are multidisciplinary
corresponding with an eclectic/ postmodern philosophy and assumptions of diversity
among elders. Life-span development grand theory provides the general structure within
which elements of existential psychology and theory of narrative frame the meaning and
relationships of quantitative variables, qualitative key concepts and methodological
assumptions.
Life-Span Development
Life span development (Baltes & Brim, 1979; Nessehroade & Baltes, 1979) is a
general orientation about the mter-individual and intra-mdividual changes occurring from
conception to death (Sugarman, 1990). Within this framework, the term development
refers to successive and systematized change conceptualized in a variety of philosophical
and theoretical ways. Thus, life-span development can be described as "...a set of ideas
about the nature of human development and change" with implications for theory,
methodology and multidisciplinary scientific collaboration (Lemer, 1986, p. 142). Two
key tenets about the nature of human development are that development involves
embeddedness and dynamic interactionism (Lemer, 1986).
Embeddedness refers to the many levels of human and environmental influences
contributing to human fimction. Dynamic interaction refers to the exchanges that occur
among the multidimensional levels within which the human is embedded. This exchange is
influenced by normative events (similarity of timing and duration for many people) and
nonnormative events (diflFerences in timing and diuration for individuals) (Lemer, 1986;
Sugarman, 1990). Normative events are age-graded and history graded influences such as
physical growth or retirement, and wars or sex role expectations respectively.
Nonnormative or life-event influences are those of a more individualistic nature such as
iUness or career change (Lemer, 1986).
The influences of normative and nonnormative events are believed to differ across
the Ufe-span. For example mfant development is more likely to be influenced by agegraded events (growth development) than life-events, although these may be significant as
m the case of neglect. Alternately, for the elderly an accumulation of nonnormative life
events contribute to their increasing diversity and are likely to have a greater influence on
development than normative events (Bahes, Reese & Lipsitt, 1980).
The Ufe-span development principle of epigenesis posits that at each greater level
of development a new characteristic emerges that was not present at the previous levels
(an unfolding), and that these later forms of development are irreducible (Lemer, 1986).
Erikson (1959) called these levels of development stages. He described the final stage of
development as one in which individuals nearing death experience a need to look back and
evaluate their lives, thus presenting the opportunity to realize ego-integrity as opposed to
despair. More recently Bowlby (1988), while not discrediting the content of Erikson's
proposal, suggested the developmental process is more aptly described as a pathway,
versus the more static acquisition of a developmental stage.
Consequently, assumptions of life-span development include: (a) potential for
human development continues throughout Ufe; (b) development is multidirectional in that
there is no fixed pattern for all; (c) development is multidimensional or occurring on many
levels; (d) reciprocity occiu-s between the individual and environment mdicating a changing
organism in a changing context (Sugarman, 1986); (e) developmental changes cannot be
qualitatively reduced; and (f) development is hierarchically organized and occurs in the
direction of differentiation and integration (Hultch & Deutschl981; Lemer, 1986).
These assumptions are relevant for the elderly population of this study. They
reinforce a focus on patterns of affirmative and fimctional characteristics (Reed, 1983),
versus decremental characteristics common m many studies involving the elderly
(Brandtstadter, Wentiu"a & Greve, 1993; Karp & Yoels, 1982; Schmid, 1991).
Assumptions about life stories as the vehicle for investigating perceptions of
meaning in life correspond with and complement the tenets of life-span development.
McAdams (1993) noted life stories "...should ideally develop in the direction of mcreasmg
I) coherence, 2) openness, 3) credibility, 4) differentiation, 5) reconciliation, and 6)
generative integration" (p.110). The mtegration of life experiences predicted by life span
development principles is primarily accomplished with life stories mtrapersonally or
mterpersonally (Gergen & Gergen, 1986; McAdams, 1993). Nature and nurture, "...a
matrix of biological, psychological social, historical and evolutionary influences..." and
their timing (Featherman, 1983, p.2), influence the content and affect of life stories.
Consistent with assumptions of Ufe span development, life stories of the aged differ
from those of younger populations (McAdams, 1993). "Every generation ... experiences
the world m somewhat different ways than its predecessors. Not having participated m
the creation of its social world, each generation is likely to confer new meanings on old,
familiar objects" (Karp & Yoels, 1982, p. 170).
Butler (1963) described life review in an epigenetic manner - "...its nature and
outcome are affected by the lifelong unfolding of character" (p.66). Life stories can be
conceptualized as a verb or process to accomplish the noun or outcome of life review.
Life stories are the content that give form to the develpmental process called life review
(Klaas, 1992a).
The multidimensionality of humans consists of four elements; inner-biologicaL,
individual-psychological, cultural-sociological and outer-physical (Riegel, 1976). Life
stories may change as the result of perceived asynchrony among these four dunensions in
order to reconceptualize or redefine the self congruent with life circumstances. Life
stories exhibit multidirectionality m their use of past experiences to understand present
circumstances and perceive the future.
In conclusion then, the grand theory of life-span development provides an inclusive
organization and context appropriate for mvestigating elders' sense of meaning in life and
patterns of spiritual development through life stories.
Existential Psychology
Meaning m life, a primary focus of this dissertation, is conceptualized within the
fi'amework of existential psychology and is believed to be an essential element for the
experience of well-being among the aged. Antithetically, depression is conceptualized in
part, as an indicator of perceiving a lack of purpose or meaning in life, or the experience of
an existential vacuum. Self-transcendence, the expansion of personal boundaries inwardly,
outwardly and temporally, is regarded as the principal vehicle for reahzing meaning in life
by existential psychiatrists such as Frankl and Yalom. Self-transcendence has been
31
described as the essence of human existence (Khnble & EUor, 1989). A fundamental
dimension of spirituality (Frankl, 1966; Reed, 1992;), it has been suggested selftranscendence is a major correlate of meaning in life (Frankl, 1966; McCann & Biaggio,
1993), plus a fundamental source of well-bemg, inversely related to depression (Reed,
1986, 1989a, 1991a).
Existential psychology proposes that the four ultimate human concerns mciting
intraindividual conflict are death, freedom (the individual is solely responsible for her/his
life world, life design, choices and actions), isolation (existence and death are experienced
alone), and meaninglessness (Yalom, 1980). The existential premise is, "the basic conflict
is not with suppressed instinctual drives or with the significant adults in the individual's
early life; instead the conflict is between the individual and the givens of human existence"
(May & Yalom, 1989, p. 376). Contemplation of these issues is prompted by speculation
about one's death, a major irreversible decision, or disintegration of a key meaningprovidmg schema (Y alom, 1980).
The experiences of contemplating one's own death, making major irreversible
decisions, and losing a primary life meaning providing schema are frequent events m the
lives of the aged, and issues inducing deliberation about the four ultimate human concerns.
Respective examples of these experiences as they may occur in the lives of elders are: (a)
an appreciation of a relative nearness to death; (b) decisions to sell the family home and
move to a smaller apartment or nursing home; and, (c) changes in hfe pattern identities
caused by retirement, poor health or death of a spouse. These experiences prompt a
turning inward to evaluate one's life in light of the four ultimate human concerns, and
induce questions about the meaningftUness of ones life. Frankl (1959, 1961, 1978)
proposed that finding meaning in life is the ultimate question of human existence. Further,
he posited the experience of meaninglessness is common in modem society and associated
with depression and suicide.
Yalom (1980) provided an example of reflection prompted by existential concerns
and a sense of meaninglessness with the following quote firom Tolstoy's My Confession:
"What will come firom my ^^ole life?" otherwise expressed - "Why should
I live? Why should I wish for anything? Why should I do anything?"
Again, m other words: "Is there any meaning in my life which will not be
destroyed by the mevitable death awaiting me?"
Symptoms of the experience of meaninglessness are seen clinically as boredom,
apathy, emptiness, cynicism, lack of direction and questions, a void, vague discontent,
nihilism, vegetativeness, crusadism and compulsive activity (Frankl, 1978; Maddi, 1967;
Yalom 1980). Associated diagnoses of alcoholism, depression and obsessiveness are
common (Frankl, 1978). Mayand Yalom (1989) argued that proof of hiunans'need for
meaning can be found in our "perceptual neurophysiological organization" which
automatically patterns mcoming random stimuli If stimuli cannot be patterned,
discomfort ensues until a pattern is found. "In the same way individuals organize random
stimuli so too do they face existential situations: in an unpattemed world an individual is
acutely unsettled and searches for a pattern, an explanation, a meaning of existence" (May
& Yalom, 1989, p. 380).
JJ
Existential psychology complements life-span development in that the mdividual is
viewed as dynamic, a fimction of multiple dimensions (termed forces) operating at any one
time. Existential psychology acknowledges that each mdividual is a developing being.
Yalom (1980) noted that sources of meaning m life change over the life span and thus
must be viewed from a developmental perspective. Like the unique nature of any one
person's development, finding meaning in life is an individual experience of personal
discovery (Kimble & Ellor, 1989).
Yalom's (1980) theory that reflection about one's existence is prompted by
speculation about death and disintegration of patterns of life meaning, corresponds with
theories of life span development. Erikson's theory of stage attainment in the elderly (egointegrity versus despair) is also prompted by death speculation and successful or failed
resolution results in finding life meaningfiil or experiencing despair respectively. Riegel's
theory of conflict prompted development parallels Yalom's ideas about contemplation of
one's existence, prompted by dismtegration of patterns of meanmg. Successful resolution
results in realizing development or meaning.
Thus, existential psychology provides a framework for conceptualizing meaning m
life. Likewise, elements of an existential conceptualization of meaning-m-life correspond
with assumptions of life-span development.
Narrative Theorv
Narrative theory posits that tellmg stories is a primary means by which individuals
make sense of themselves and their worlds m the context of Ufe experiences (McAdams,
1993; Polkinghome, 1989; Reissman, 1989, 1993; Sarbin, 1986; Viney & Bousfield, 1991;
WOliams, 1984). Ahhough an experience may have a defined meaning in an interpersonal
or social context, the process of reinterpreting and re-creating the experience in a story is
an act of self-reflection (Hermans, 1989). Thus, stories reflect the meaning of the
experience for the teller (Borkan, 1991). "Much of our cognitive and emotional work is
performed using narrative structures: we create meaning in our lives by telling ourselves
stories about our experiences" (Viney & Bousfleld, 1991, p. 757).
Understanding is best achieved v^^en the individual bemg treated/studied generates
the information used to develop knowledge. "A central if not the central concern
underlymg narrative studies m the social sciences is to give voice to the subject: to collect,
interpret, and present materials about human experiences that preserve this voice..." (BelL
1991, p. 245). bi this naturally occurring situation new issues are introduced
spontaneously, rather than issues being limited to predetermined questions or mstruments
(Benner, 1991). Life stories flow naturally and often prolifically from the elderly, and can
be a primary means of communication. It is mconsequential that time or ill health may
have faded or altered Ufe story contents. Of importance are the meanings and values the
life stories impart to the teller and listener in the present. "Individuals construct past
events and actions m personal narratives to claim identities and construct lives" (Reissman,
1993, p.2).
Mancuso (1986) noted an individual organizes input based on then- "existing
structural representations..." thus "...meaning is accrued through assimilation mto existing
knowledge systems" (p.91). Mishler (1979) argues the meaning of human actions and
language cannot be discerned outside of context. Therefore story parts are not discrete
35
entities, nor are stories themselves but must be considered within the context of the whole
physical and psychological environment.
Life stories exhibit the multidimensionality of development at the historical,
societal, cultural and personal levels (Bertaux & Kohli, 1984). Similarly, within this
embeddedness and dynamism each person develops a working model of self and others
and communication between them (Bowlby, 1988). These changing and developing
models are revealed in personal narratives. McAdams (1993) stressed the intrapersonal
and mterpersonal mtegrative and contextual elements of narratives v^en he noted, the life
story (termed personal myth)-,
...can carry forward somethiag about humankind that is worth preservmg
and improving. The stories we create influence the stories of other
people, those stories give rise to still others, and soon we find meaning
and connection within a web of story making and story living. Through
our personal myths, we help to create the world we live m, at the same
time that it is creating us. (p.37)
Narrative theories are congruent with values of existential psychology in several
ways. Life stories are ways individuals "must try to comprehend the specific nature of our
unique Ufe course and personal journey if we are to know who we are and how our own
life may be made meaningfiil" (McAdams, 1993, p. 12). Thus, life stories are patterned
integrations of the "remembered past, perceived present, and anticipated fiiture" (p. 123).
The past is perceived as part of one's current existence contributing to an
mdividual's manner of confronting the idtimate existential concerns. Yalom (1980), Frankl
36
(1978) and Maddi (1967) note that existential analysts (and the author would add
researchers) must enter the patients' (informants') experiential worlds and listen without
the judgements and preconceived notions that distort understanding < a form of bracketing
used m phenomenology. May (1958) described this as achieNing imdergtandinp versus
treating the "life-history as modifications of the total structure of the patient's being-m-theworld" (p.5). Psychologists and psychiatrists have speculated the human creation of
meaning m life is accomplished through creating an organized and purposeful unitary life
story (Thompson & Janigjan, 1988; Hermans, 1989). McAdams (1993) wrote;
To make meaning m life is to create dynamic narratives that render
sensible and coherent the seeming chaos of human existence. To fail
m this effort of mythmaking is to experience the malaise and stagnation
that come with an msufficient narration of hiunan life. (p. 166)
Thus, narrative theory is compatible with aspects of life-span development and
existential psychology. It provides a fitting theoretical orientation for mvestigating
meaning in life and spiritual development in an elderly population.
Conceptual Framework
The conceptual firamework for this dissertation is the synthesis of the researcher's
prior mvestigations, academic readmgs, theoretical perspectives and clinical experiences.
A conceptual or theoretical orientation molds and guides the research process. Batey
(1992) described a conceptual framework as "...the organizing image of the phenomena to
be studied" (p.608). For a study about himian beings, a conceptual fi-amework mcludes
views of the target population, their behaviors and characteristics and the relationships
between the two. Conceptual frameworks are disdnguished based on an extant body of
knowledge combined with the researcher's creative use of experiential knowledge.
The tenets of qualitative research generally prechide the development of
hypotheses and a predetermined framework to allow knowledge emergence from the data
unencumbered by the researcher's preconceived ideas. However it is unrealistic to believe
the researcher enters the field as Locke's proposed "tabula rasa." Thus it is important that
the mvestigator reflect on and elucidate personal understanding of the relationships among
the major research concepts prior to beginning the investigation.
Concepts are "...complex mental formulations of events, objects or properties
which are derived from an individual's perceptual experience" (Chnm & Jacobs, 1992, p.
393). Meleis (1991) described a concept as a phenomenon organized and summarized
concisely. They are "a mental image of reality tinted with the theorist's perception,
experience, and philosophical bent" (p.203). Concepts are of major importance because
they are the building blocks of theory (Walker & Avant, 1988).
Due to their subjective nature, significance for theory building, and structure and
guidance for research, definitions ascribed to concepts are of great relevance. Concepts
requiring definition for this dissertation were identified by selecting the major ideas from
the study purpose. The three primary concepts of investigation include depression,
meaning-in-life and self-transcendence. For this study related constructs include
spirituality, well-being and life stories.
Concepts can be defined operationally and abstractly (Pieper, 1989). An
operational definition is one that mcludes a precise means for measuring the concept to
38
guarantee reliability and objectivity. Because operational definitions can artificially limit
the meaning and richness of concepts (Walker & Avant, 1988), abstract definitions will be
provided for the six major concepts identified above. Abstract definitions are those not
directly measurable and unlimited by time or space. Abstract definitions are fitting for this
dissertation because the major concepts are mtangible and abstract by nature. Because
depression, meaning in life and self'transcendence are being measured, they wall be defined
operationally as well as abstractly.
Concepts and Constructs Definitions
In this firamework spirituality is theorized to be a correlate of well-being.
Specifically, the three components of focus for this dissertation are depression, meaning m
life and self-transcendence. Depression is identified as an indicator of levels of well-being.
Self-transcendence and meaning in life are indicators of spirituality. Depression is
proposed to relate inversely to both self-transcendence and to a sense of meaning in life
(See Figure I).
Figure 1: Conceptual Framework
Well-being
(+)
Spirituality
[-]
Depression!
V]
(-)
Meaning in life
(-)•
[(+)] = positive indicator of the concept
[(-)] = negative indicator of the concept
(+)
Sel^anscendence
Depression and meaning in life are two distinct himian experiences, proposed to be
inversely related. It is fiirther proposed that depression is inversely correlated with selftranscendence, an mdicator of spirituality. According to this framework, the strongest
correlation could be expected to occur between self-transcendence and meaning m life,
smce they are conceptualized as mdicators of the same construct (spirituality).
Narratives/hfe stories reflect individual experiences of these five components.
Well-bemg
Well-being m general is a multidimensional construct, the dimensions bemg
mterdependent (Chamberlain, 1988a). The foUowmg definition of well-being was
structured fiom an analysis of published definitions and components. For this dissertation
the general dimension of well-being is defined as, a personal perception of being in which
the experience of connectedness, satisfaction and contentment is associated with a general
positive aflfect which emerges as meaning is structured. Well-being is negatively
associated with depression. As depression increases a sense of well-being decreases.
Depression. Possibly the best way to illustrate the experience of depression for the
purposes of this dissertations is with elders' voices. The following quotes are excerpts
fi'om preUminary studies and personal experience.
It's...Idont know what the hell it is. I dont know what is bothering me. I
find it difficult to sleep at night. I get up at 12 midnight and have somethiag
to eat agam. All these things come to me... and along with it comes the
depression.
Henry, age 84
"I have made it this &r and I dont want to. I dont have any kin people.
All of em is dead...mostly. I don't have anybody."
Bessie, age 82
I don't give a rfamn if I live or not. In feet many a nights I wish I would
die. Everything I got is a problem. I got arthritis - ankles, knees, hips
and spine. I got emphysema, Fve got hypertension, I got circidation
problems. What do you do? There's no medication to cure any of it.
They maintain it. It don't give me no comforts. The only comfort you
can get is to get drunk....aspirin and get drunk.
Gerald, age 77
I am alone, as though I stood
On the highest peak of the tired gray world.
About me only swirling snow.
Above me endless space unfiu-led.
With earth hidden and heaven hidden.
And only my own spirit's pride
To keep me from the peace of those
Who are not lonely having died.
Eunice, age unknown
There is little consensus about a definition of the term depression. It has been
conceptuaUzed as a state of mood, syn:q)tom of other mental iUness, syndrome and by
various classifications (Lehtinen & Joukamaa, 1994). Depression is rarely defined in the
41
literature. Because psychiatric disorders generally lack concrete easily measured markers,
conceptual models of symptom combinations forming diagnostic categories (e.g. the
Diagnostic and Statistical Manual for Mental Disorders) have become a primary means of
identification (George 1993). Unfortimately, using categorical symptoms as a definition
becomes problematic for the elderly whose synjptomology often differs from that of
younger populations. With the above caveats in mind, for this dissertation depression is
abstractly defined as, lacking perceptions of well-being, completeness or vitality in
outlook, often involving a loss of interest or pleasure in previously enjoyed activities and
accompanied by various mood disturbances.
Yesavage, Brink, Rose, Lum, Huang et aL, (1983), distinguished between
depression m the elderly and younger populations on several levels when developing the
Geriatric Depression Scale (GDS). For instance, questions about sexuality as mdicators of
depression found on other depression scales were deleted, and questions were constructed
to be less reflective of psychiatric evaluation. Further, for the GDS, somatic symptoms
are not emphasized as in other instruments commonly used in younger populations due to
the inevitable physical decline associated with aging. Among the elderly physical
symptoms are believed to be less discriminatory for depression than psychological
symptoms. For this study clinical depression is defined quantitatively as those scoring 12
or higher on the GDS. Higher scores correlate with increasing severity of depression
(Yesavage et al., 1983).
spirituality
Spiritual factors play a major role in the agmg process, and are significantly related
to elders' experiences of depression and well-being (Berggren-Thomas & Griggs, 1995;
Bianchi, 1982; Blazer, 1991; Jung, 1933). Smce the beginning of recorded history
spiritual and health concepts have been afiBliated (Stuart, Deckro & Mandle, 1989). Nurse
theorists have acknowledged the inq)ortance of spirituality m health care as it provides a
sense of connectedness within the person (Newman, 1986; Neuman, 1989; Parse, 1981;
Paterson & Zderad, 1976; Travelbee, 1971; Watson, 1988). Sustained by the nursmg
principle of holistic care, the importance of addressing patients' spiritual concerns has been
repeatedly stressed by nursing theorists and researchers (Boutell & Bozett, 1989; Carson
et al., 1990; Clark, Cross, Deane & Lowry, 1991; Labun, 1988; Smith, Airey & Salmond,
1990; Jacik, 1989; Stoll, 1989a & 1989b). Yet studies indicate nurses do not provide
adequate attention to spiritually-related concepts m their interventions (Highfield, 1992;
Carson, 1989; Stuart, Deckro & Mandle, 1989; Clark, Cross Deane, 1991; Boutell &
Bozett, 1989), often as a consequence of a predominant emphasis on technology and
medical reductionism.
In the past nursmg literature often equated spirituality with religiosity (Emblen,
1992; Trice, 1990; Burkhardt, 1989). Emblen (1992), from an analysis of the terms
spirituality and religion stressed the importance of understanding differences in meanings.
Spiritual needs and care are related to personal life principles, relationships and
transcendent ejq)eriences. These needs may be confiised with religious needs and care
related to personal beliefs and worship practices
Although not lacking definition in the literature, a multiplicity of definitions for
spirituality has resulted in enormous discrepancies when interpreting and applying study
outcomes. Conceptual analyses have attempted to illuminate these discrepancies (e.g.
Bensley, l991;Emblen, 1992; Burkhardt, 1989; Stoll, 1989a, 1989b; Haase, Britt,
Coward, Leidy, Penn, 1992). However, the analyses processes and outcomes themselves
vary and a consensus about assumptions, definition, antecedents, consequences,
properties, defining attributes and empirical referents, have yet to be reached.
Further, spirituality is comprised of a host of dimensions such as spiritual needs,
care, distress, pain, health, integrity (Emblen, 1992) dimension, well-bemg (Burkhardt,
1989), and perspectives (Haase, Britt, Coward, Leidy & Penn, 1992). Although
reductionistic m terms of human partitioning, Eberst (1984) suggested spirituality is where
physical, mental, emotional, social, and vocational dimensions mteract. Likewise,
spirituality has been described as the "...best unifier and coordinator of the physical,
mental, emotional, social and environmental dimensions of health" (Banks, Poehler, &
Russell, 1984, p.19). These notions imply that spirituality is the unifying foundation of
personhood and in part corresponds with existential assumptions and a description of
spirituality as a coalescmg force.
Reed (1992) cautioned that creating one variable by combining spirituality with
related variables could mtroduce ambiguity and false reductionism mto scientific
investigations. She suggested that spirituality is a broad topic and might best be
mvestigated through many observable components. These components can be grouped
mto mterpersonal, transpersonal and intrapersonal forms of human transcendence and
44
connectedness (Reed, 1992). These components include such concepts as hope, a sense
of forgiveness and connectedness, self-acceptance, a sense of meaning and purpose in life
and relationships with others and the universe.
Spirituality is represented in this dissertation by two crucial observable
components - meaning in life and self-transcendence. "Spirituality refers to the propensity
to make meaning through a sense of relatedness to dimensions that transcend the self.."
(Reed, 1992, p. 350).
Meaning in life. Frankl (1990) described the opposite of realizmg meaning in life
or well-being as "despair" - to suffer without meaning. Humans seem to require meaning
in their lives (Frankl, 1959; Gray, 1988; Maddi, 1967;Yalom, 1980). Meaning m Ufe must
be found mdividually, through one's conscience and self-transcendence (Frankl, 1972).
Kekes (1986) made further distinctions m that to experience meaning in life the mdividual
must be self-directed (rather than other-imposed) by mtellect and emotion or personal
engagement: there must be a perception of good or satisfaction and the experience must fit
life circumstances. Components of meaning in Ufe are believed to be affective, cognitive
and motivational (Maddi, 1967). Meaning m life is a concrete, implicit and immediate
experience that differs fi-om person to person and changes throughout the life span.
Blazer (1991) reported that elders often find life meaning m spirituality as a means of
transcending losses and providing purpose for continued existence.
Yalom (1980) distinguished terrestrial meanings a perceived sense of meaning,
purpose or fimction of one's personal life, fi-om cosmic meaning or a sense that life in
general fits some universal design or plan not mdividually conceived. Experiencing cosmic
meaning does not ensure a sense of terrestrial meaning and vice versa. Meaning in life as
used in this study is representative of the terrestrial, as opposed to the more ubiquitous
cosmic meaning af life. The antithesis of meaning in life was described by Maddi (1967)
as "...a chronic inability to believe in the truth, importance, usefiihiess or interest value of
any of the things one is engaged in or can imagine doing" (p. 313). Interestingly, this
description is analogous to descriptions of depression.
At a macro level, Kolarska-Bobmska (1990) theorized about the repercussions of
changes in life meaning that accompany sweeping political reorganizations. In an essay
about Poland's transition from communism to capitalism and democracy, she drew
conclusions about societal changes that this researcher believes are analogous to the
experiences of many North American elderly. Kolarska-Bobinska theorized that
increasing apathy, social passivity and anomie of PoUsh citizens were the result of a
change in fundamental life meanings and the sense of past, present and future,
accompanied by loss of identity of certain social groups. This phenomenon at a macro
level reflects aspects of aging experienced by many elders.
Within nursing literature, theory about the significance of elders reahzing meaning
in life is scarce. Peterson (1985) stressed the importance of perceiving meaning in life for
the aged, and Fftzpatrick's conceptual model of nursing (Fitzpatrick & Whall, 1989),
proposed that meaning is essential to maintaining human life.
For this dissertation, meaning in Ufe is globally defined as designated by
Crumbaugh & Maholick (1964) for the Purpose in Life Scales. Meaning m life is the
"...ontological significance of life from the point of view of the experiencing mdividual."
More specifically it is "...the cognizance of order, coherence, and purpose in one's
existence, the pursuit and attainment of worthwhile goals, and an accon^anying sense of
fiilfillment" (Reker & Wong, 1988, p.221).
Operationally defined persons experiencing meaning m life will have raw scores of
113 or above on the Purpose m Life Scale and those e?q)eriencing a lack of clear meaning
and purpose will have scores of 91 or below (Crtmibaugh & Maholick, 1981).
Self-transcendence. The author conceptualizes self-transcendence as an indicator
of spirituality and a correlate of meaning in life and depression. Frankl (1990) noted that a
deep sense of meaning can only be created through self-transcendence. "To be bestowed
with meaning, life must transcend itself .not in length...but m "height" m the sense of
spiritually growing beyond oneself - or in "breadth" - m the sense of social engagement"
(Frankl, 1990, p. 8). "Human existence is not authentic unless it is lived in terms of selftranscendence" (FrankL, 1966, p. 104). A concept analysis of self-transcendence identified
three critical attributes as "...reaching out beyond self-concern...stepping back fi'om and
moving beyond what is...and extending self-boundaries inwardly, outwardly and
temporally..." (Haase, et aL, 1992).
Similarly, Reed (1992) described self-transcendence as an expression of spirituality
and an "...e?q)ansion of [personal] boundaries inward, outward, upward" As a result of
contemplating death, developing patterns of self-transcendence is associated with wellbeing m the aged (Reed, 199 la). Coward and Reed (1996) fiirther explicated the wellbeing associated with self-transcendence for those fiicing end of life decisions as the
47
finding of meaning through "the integration of the adverse e?q>erience mto the self and the
restoration o£^ or even expansion o£^ one's sense of wlioleness that is healing" (p. 285).
In the following quote McAdams (1993) seems to describe and e?q)lam the
importance of patterns of self-transcendence m personally perceived life stories (myths) for
fulfillment of a 'mature identity* or well-being.
The most mature personal myths are those that enhance the mythmaking
of others. Mature identity in adulthood requires a creative involvement
in a social world that is larger and more enduring than the self It is to
that world as well as the self that the myth must be oriented...If our myths
do not integrate us into a social world and a sequenceof generations, then
the development of identity runs the risk of degenerating into utter
narcissism,(p. 113).
In conclusion the theoretical definition of self-transcendence for this dissertation
was generated by Reed (199 lb), and is the same definition used for development of Reed's
Self-Transcendence Scale. Self-transcendence is defined as "...the expansion of selfboundaries in multi-dimensional ways: a) inwardly in mtrospective activities; b) outwardly
through concerns about others' welfare; and c) temporally whereby the perceptions of
one's past and future enhance the present" (p. 5).
Persons experiencing self-transcendence are operationally defined as those scoring
nearer the maximiun score of 60 and fiuther fi-om the minimiim score of 15 on Reed's
Self-Transcendence Scale.
Narrative/Life Stories
If you want to know me, then you must know my story, for my story
defines who I am. And if I want to know myself^ to gain insight into
the meaning of my own life, then I, too, must come to know my own
story. I must come to see in all its particulars the narrative of the self the personal myth - that I have tacitly, even unconsciously, composed
over the course of my years. It is a story I continue to revise...as I go
on living. (McAdams, 1993, p.11)
For this dissertation, life stories, as perceived through theories of narrative (also
called the life story approach) will fimction as the means through which elders' sense of
meaning in life can be elicited and understood.
Nimierous interdisciplinary and multidisciplinary studies (e.g. psychology,
education, literary sciences, sociology, linguistics, busmess, anthropology, medicine and
nursing) have used theories of narrative to justify applications and outcomes of a variety
of qualitative narrative methodologies. Bertaux and Kohli (1984) noted
...[narrative] draws fi-om a variety of orientations that range fi"om
symbolic interactionism to phenomenology, hermeneutics,
ethnosociology, structuralism, and cultural variants of Marxism.
Accordingly, there is wide variation hi the basic questions asked and
the methods of data analysis used. (p.218)
This diversity resuhs from the universal and democratic nature of personal
narratives (Langellier, 1989). In other words, as stated by Hayden White (1980), a basis
for the disciplinary and methodological mult^Iicity of narratives is that;
...&i from being one code among many that a culture may utilize for
endowmg experience with meaning, narrative is a metacode, a human
universal on the basis of which transcultural messages about the nature
of a shared reality can be transmitted, (p.6)
As a result, despite the highly subjective and value-laden properties of narrative
methodology which negate the eflSciency and generalizability of more readily sanctioned
quantitative methods, narratives address a fimdamental dilemma of research - translating
"knowing into telling" (White, 1980).
Narratives/life stories are the means through which themes/patterns of spirituality
and well-being will be evaluated. A prelimmary conceptual analysis of reminiscence
(Klaas, 1993) was conducted, however, subsequent mvestigations of narrative analysis led
to an adoption of life story as a more meaningful concept for this dissertation.
Life stories are narratives about ones' life or relevant parts (Bertaux & KohU,
1984). Likewise, narratives are stories that attempt to make events personally and
culturally congruous in a temporal order (Sandelowski, 1991). Narrative,
...constitutes a kind of a) causal thinking, m that stories are efforts
to explore questions of human agency and explain lives; b) historical
(as opposed to scientific) and understanding that events cannot be
explained except in retrospect; c) moral enterprise, in that stories are
50
used to justify and serve as models for lives; and a kind of d) political
undertaking, in that individuals often struggle to create new narratives
to protest a perceived storylessness in the old ones. (p.163)
Much of the literature uses the term narrative interchangeably with life story and
personal myth (McAdams, 1993). Sometimes the terms are variously defined and
although sharing essential attributes, may vary in properties withm and between terms.
WiUiams (1984) disdnguished between the routine or practical mimdane narratives that
make daily life understandable, and reconstructed narratives representing the discursive
consciousness, that which occurs when life disruptions motivate a reconceptuaUzation of
the self The reconstructed narrative leads to personal understanding m Ught of past
experiences and reafiBrms a sense of life course and purpose. Similarly Mc Adams (1993)
defined personal myth as an act of imagination, a "... special kind of story that each of us
naturally constructs to bring together the different parts of ourselves and our lives into a
purposefiil and convincing whole" (p.12). It is the life stories' patterns described by
Wilhams and McAdams that are relevant to this study.
For this mvestigation life story is defined as purposefully constructed and
temporally ordered accounts of past life events in the present that make possible selfunderstanding and a sense of personal purpose and coherence m the present and future.
Further life stories refer to narrative vignettes of past experiences rather than the
chronological story of one's life.
Research Questions
The first two research questions address meaning in life and self-transcendence i
the context of depression among elders.
1. How does meaning in life and self-transcendence correlate with depression among
elders?
2. How does meaning in life and self transcendence differ among depressed and
nondepressed elders?
Research questions three and four address Irfe-story themes of meaning in life
among elders and between groups of depressed and nondepressed elders.
3. What are elder's life-story themes of meaning m life?
4. Do life-story themes of meaning in life difiFer between depressed and nondepressed
elders?
Research questions five and six address the manifestations of self-transcendence
elders' life stories and how these differ between groups of depressed and nondepressed
elders.
5. How is self-transcendence manifested in life stories of depressed and nondepressed
elders?
6. Do manifestations of self-transcendence in life stories differ between depressed and
nondepressed elders?
The final research question is based on a synthesis of data obtained in structured
questionnaires and life stories.
52
7. How do the outcomes of the qualitative and quantitative analyses compare and inform
each other?
Conclusion
In conclusion. Chapter 1 described the problem and significance of depression m
the elderly. The purpose of the dissertation was stated and the researcher's philosophy
was dicussed as well as the research conceptual orientations, life span developmental
psychology, existential psychology and narrative theory. The research conceptual
framework was presented in a model Following, the primary concepts, depression,
meaning in life and self transcendence, and primary constructs, spirituality and well-being,
were defined. Finally, research questions were presented.
53
CHAPTER TWO
LITERATURE REVIEW
The human agmg experience has been the subject of contemplation and
investigation by philosophers and scholars since the beginnmg of recorded history. What
constitutes "the aged' however has been a process of evolution. In Ancient Greece the
average life span was 20 years, evolving to 35 years in the Massachusetts Bay Colony
during the 17 century. In the course of the 20 century in the United States life expectancy
has mcreased from approximately 50 years to 75 years (Corr, Nabe, Corr, 1994). Those
persons now constituting the aged are the fastest growing segment of the population for
the first time m history (Overholt, 1990).
Unless otherwise noted, all studies reported in this literature review were
conducted with elderly populations variously defined m each mvestigation. The literature
review will be organized accordmg to the primary concepts defined in Chapter 1 (Le.
depression, meaning in life and self-transcendence) and will report various studies
employing those concepts. Proposed relationships among depression, meaning m life and
self-transcendence are supported by the ways m which they have been explored and tested
m the reported mvestigations.
Depression
Although a great deal of multidisciplinary literature about the aged and depression
exists, there remains much to be learned as evidenced by persistent and exigent quality of
life dilemmas in this population. Depression is the most common mental health problem
experienced by the elderly (Koenig & Blazer, 1992), with numerous and profound
54
implications for afiOicted individuals and society. Many studies have investigated
associations between depression and various elements of human biological, psychosocial,
political, spiritual and developmental ejq)eriences. The following is a brief summary of the
literature addressing depression as h: is relevant to the purposes of this dissertation.
The psychosocial focus of this dissertation does not imply a lack of regard for
physiological components of depression in the aged. Certainly biological aging and illness
induced factors contribute to high rates of depression m the elderly. As people age
vulnerability to depression has been linked to biological factors (Katonia, 1994; Veith &
Raskind, 1988), disabiUty and chronic illness susceptibility (LesnofiP-Caravagha, 1988;
Rapp, Parisi & Wallace, 1991), and various psychosocial factors (O'Connell & Mayo,
1988; Rapp, et al, 1991; Santor & ZuroflE^ 1994). However, current opinion suggests a
single or linear physiological cause of depression is not feasible due to the multimteractional complexity of the central nervous system, most especially in relation to mood
(Veith & Raskind, 1988).
Distinguishing elders' depression from physical illness or somatic complaints is a
serious challenge for geriatric care providers as evidenced by high rates of undiagnosed
depression in community and hospital elders (Evans, Copeland & Dewey, 1991; George,
1993; Osgood, 1991a; Stewart, Blashfield, Hale, Moore, Stat, 1991). Osgood (1991a)
stressed the importance of improved education about depression for geriatric health care
providers, elders, famiUes and communities.
Several studies have investigated relationships between depression, physical health,
social support and/or life satisfaction (Blazer, Burchett, Service & George, 1991; Caplan,
1981; Evans, Copeland & Dewey, 1991; George, 1993; Murphy, 1982; Neugarten,
Havinghurst & Tobin, 1961; Parkerson, Broadhead & Chhi-Kh, 1991). Controlling for
physical ailments, Evans et aL (1991) demonstrated a connection between depression and
psychosocial factors including perceptions of poor physical health, lonelmess, homebound
status and lack of social support. Interestingly, research indicates elders often receive
psychiatric care as the result of behaviors disturbing to those around them, versus seeking
care autonomously (Puyear, Lovitt & Miller, 1991). Elders' reluctance to seek help for
depression may in part, result from feelings of being worthless, a nuisance or a burden.
Leenaars (1992) recognized the impact of "...irrevocable loss of significant others (or
ideals) through death and other circimistances" (p. 69) as well as loss of social roles, and a
negative cultural attitude toward the elderly.
Other research identified affective and cognitive components experienced by
depressed elders including anhedonia, feelings of worthlessness and guilt, difficulty
concentrating or memory loss, psychomotor retardation, apathy, thoughts of death and/or
suicide, personality factors precluding intimacy, accepting the past and psychiatric
comorbidity (Blazer, 1989; Murphy, 1982; Rapp, Parisi, & Wallace, l99l;Santor&
Zuroflt 1994; Snaith, 1993). Depression from a developmental perspective is alluded to in
many of the above listed studies in terms of the elderly acquiring Eriksonian type
milestones to negate depression. Despite developmental assumptions being foundational
to much of the reported research, there is little primary investigation of age-appropriate
developmental resources as they relate to depression.
56
la conclusion, components, propeities, relationships and appropriate diagnosis and
treatment of geriatric depression is the subject of much research. Synthesis of research
conclusions indicates that geriatric depression is intricately related to a multiplicity of
factors, thus discovering ^ cause and effect is not likely. Although elders suffer a high
incidence of major depression which requires treatment, minor short term depression may
be associated with the process of development in aging. Thus depression is not
necessarily a pathological element m a geriatric "Deficiency Model' "Depressive symptoms
can be viewed as indicators of development and adjustment rather than as iUness, and
without pejorative connotations" (Schmid, 1991, p. 364).
Spirituality and Depression
Much of the literature addressing the role of spirituality m aging and depression
consists of opinions versus research (Berggren-Thomas, 1995; Bianchi, 1982; Blazer,
1991, 1989; Bumard, 1987; Carson, 1989;Frankl, 1959, 1978, 1990; George & Clipp
I991;Hiatt, 1986; Jung, l933;Maddi, 1967; Schmid, 1991;Yalom, 1980). M suggest
various elements of spuituality such as the realization of meaning m life, selftranscendence, faith and inner connectedness significantly effect the course of aging,
decrease depression and contribute to well-being. Some current multidisciplinary research
has demonstrated important ties between various elements of spirituality and health
(Thomas, 1989; Stuart, et al, 1989; Highfield, 1992; Brandtstader, Wentura & Greve,
1993; Husaini & Moore, 1990; Smith, Airey & Sahnond, 1990). These studies either (a)
found elements of spirituality such as Ufe satisfaction, "personal continuity," self-esteem or
"spiritual health" were associated with positive perceptions of health, or (b) spiritual
activities such as meditation, searching for meaning and hope or finding inner peace with
exercise or relaxation, were employed to improve outcomes from various a£Qictions
associated with agmg such as hypertension, arthritis and chronic pain.
More specifically, aspects of spirituality have been investigated in a few studies as
they relate to depression linked to various psychosocial distresses (Carson, Soeken,
Shanty & Terry, 1990; Reed, 1989a; Snaith, 1993; Smith, Ste&nek, Joseph & Verdieck,
1993; Gutmann, 1987). Carson et aL (1990) found spiritual well-being as opposed to
depression among ADDS victims, largely the result of existential well-being as opposed to
religious well-being. Although the participants in this study ranged m age from 22 to 70,
they, like the aged, were being confronted with their own mortality. Reed (1989a) testing
developmental resources in clinically depressed elders found a significant mverse
correlation between depression and transcendence, an element of spirituality and a
developmental resource found in mentally healthy elderly.
Gutmann (1987), m a study of five distinct cultures found that a diminished sense
of social purpose or life purpose led to depression m elders of these cultiu'es. Snaith
(1993) developed an instrument to measure anhedonia, an indicator of a diminished sense
of meaning in life, and used test results to identify patients suffering depression who might
be responsive to antidepressant drugs. And finally Smith et al (1993) conducted an
mvestigation of spiritual awareness and psychosocial distress in a group of men and
women with cancer. They found spiritual awareness to be negatively correlated with
psychosocial distress.
58
Meaning in Life
Frankl (1959, 1966, 1972) is a key figure in our understanding of meaning in life,
its role and significance in modem life. His works have generated a plethora of
multidisciplinaiy research and opinions regarding the character and components of
meaning m life. This research indicates perceptions of meaning in life are consistently
linked to positive affects and behaviors despite the possibility of a tragic etiology.
Several studies have identified sources and depth of meaning m Ufe for elders
(Mccarthy, 1983, 1985; Ebersole & Quiring, 1991; Ebersole & Kobayakawa, 1989;
Chamberlain & Zika, 1988); measured the experience of meaningflilness and existential
vacuum (often manifested as depression) (Crumbaugh, 1972; Crumbaugh & Maholick,
1964); and demonstrated differences in sources of meaning in life for young and old adults
(Ebersole & DePaola, 1987). Studies have fotmd meanmg in life to be a critical factor in
gaining and maintaining a strong sense of well-bemg as opposed to depression (Zika &
Chamberlain, 1987, 1992; Rappaport, Fossler, Bross & Gilden, l993;Florian, 1989;
Ebersole & DePaola, 1989).
In nursing literature Burbank (1992) developed a FulfiUment of Meaning Scale
and conducted a study in which she identified categories of meaning in hfe important to
aged individuals. Relationships provided the most important impetus for reaUzing
meaning m life for 57% of the participants. Religion, service and activities (13%, 12%
and 10% respectively) were also important aspects of meaning m life. Trice (1990)
generated four themes closely resembling self-transcendence common to all elders' stories
59
of meaningful life e?q)eriences. The themes included a concern for others, perceptions of
being helpful or useful, taking action and positive feelings.
Self-Transcendence
Although self-transcendence is commonly believed to relate positively to meaning
m life and well-being, particularly in aged populations, there is little applicable research
supporting these assertions. The preponderance of available literature explores the source
and significance of self-transcendence. Coward and Reed (1996) summarized several
studies investigating self-transcendence as it related to "dealing m the form of well-being
or mental health" (p.281). Reed conducted several studies investigatiag various aspects of
self-transcendence as they relate to depression and well-being in the elderly (1986;
I987;l989a; 1991b; 1992), all supporting relationships (in some cases predictive) between
self-transcendence and the mental health of older adults. In a triangulated study Reed
(199 lb) found self-transcendence to be negatively correlated with depression. Withm a
matrix analysis of interviews with elders, four patterns of self-transcendence emerged as a
resource of developmental maturity and important for perceiving well-being in the aged
and others facing end of life decisions. These patterns mclude generativity, temporal
mtegration, body-transcendence and introjectivity.
Likewise findings from studies by Coward (1990a & b; 1991; 1995) and Coward
and Lewis (1993) revealed significant relationships between well-being and selftranscendence m young terminally ill adults. Young and Reed (1995) investigated group
psychotherapy as a means of facilitating elder participants' experience of selftranscendence through remmiscence and mterpersonal learning. They found that what was
therapeutic for elders was ejq)eriences of self-transcendence, particularly the experience of
connectedness within the group.
Santor and ZuroflF(1994) did not address self-transcendence per se, however they
investigated the relationship between depression and the temporal aspect of selftranscendence which they called accepting the past. Depression was positively correlated
with an inability to accept the past, particularly when depression was associated with a
negative mood or negative affectivity and even when taking physical health, age and
gender into account. This correlation would mdicate that depression is negatively
associated with self-transcendence.
KiMea (1980) stressed the unportance of self-transcendence and its significance
for meaning when he wrote;
To &ce death honestly is to perceive not only one's vulnerability but one's
identity and equality with others and one's need for connection in the
broader human community. To be able to yoke one's ego and still value
the contribution one can make to enrich others' lives that the sense of
commimity provides is to have the support to face death knowing that
one's life has indeed counted for something, (p. 199)
Conclusion
In conclusion research has expUcated various aspects of depression, meaning in
life, spirituality and self-transcendence and supports relationships among depression, selftranscendence and meaning m life. Further, the literature review demonstrated gaps in
aursing literature about these critical factors in gerontology and a need for research
focusing on the integration of these concepts essential to the weQ-being of the elderly.
CHAPTERS
METHODOLOGY
The description of methods used to investigate aspects of spirituality and health
among older adults is organized in three primary sections. The first section describes the
methodological firame of the study and discusses the appropriateness of triangulation as a
means of inquiry. The second section contains an explanation of the quantitative and
qualitative research processes. This e>q)lanation addresses sampling, setting, instruments,
reliability and validity, ethics, and analysis procedures. The third section describes and
discusses issues related to qualitative evaluation techniques.
Methodological Frame
Triangulation
Methodological triangulation is the use of multiple research methods to investigate
a single research problem. Lincohi and Cuba's (1985) metaphor for methodological
triangulation is a fisherman using several nets so the holes in one are covered by the
netting of another. Knafl and Breitmayer (1991) noted the importance of selecting the
purpose of triangulation - either to confirm or enhance completeness. Triangulation was
used in this study to enhance completeness. Because of the complexity and diversity of
human beings and especially the elderly, the author believes the use of multiple methods
contributed a greater depth and breadth of knowledge about indicators of their spirituality
and health.
63
Methodological triangulatioii can "facilitate integration, capitalizmg on the putative
synergistic effects of muldmethods" (Guba & Lincobi, 1989, p. 162). Haase and Myers
(1988) noted ^ common purpose of qualitative and quantitative research paradigms is to
further understanding. They note hiherent limitations ^^4len either paradigm is used singly,
particularly as each relates to the complexities of hximan centered nursmg phenomena.
Stake (1994) suggests triangulation clarifies meaning by identifying different ways
the phenomenon of mterest is seen or known. Triangulation incorporates multiple means
of investigating a problem without negating or ignoring the epistemological assumptions
of qualitative and quantitative approaches. Recognizmg the unique contributions of each
approach provides "...a balanced perspective that values both approaches" (Haase &
Myers, 1988, p. 136). Nurses integrate qualitative and quantitative epistemological
assumptions in practice by individualizing care while relying on theoretical commonahties
among clients to make predictions (Myers & Haase, 1989). This practice infers a regard
for, and iuteraction between, different levels of knowing. "When only one level is
represented, the understanding of reality is artificial and recognition of interrelationships
across levels is not possible (Myers & Haase, 1989, p. 299).
BCastenbaum (1992) noted "...the views of the elderly person should themselves be
well represented and enhanced by the msights that can be contributed fi'om an informed
observer...what we would hope to avoid is the rigid application of stereotyped
assumptions" (p.12). This statement infers a need for both qualitative and quantitative
approaches. Vmey and Bousfield (1991) produced excellent research using narrative
analysis but noted;
We recommend that this method is used, not alone but in conjimction
with other methods to add mfonmtion and to confirm findings firom
other methods. It [narrative analysis] is likely to be of value especially
in research programmes which have been based on analytic approaches
to the psychosocial phenomena, m that it can then provide some
synthesis of those phenomena, (p.764).
Therefore, methods to be used for this mvestigation will iaclude three
questionnaires to measure depression, meaning in life and self-transcendence respectively,
as well as narrative analysis of life story interviews. By combining the precision and
efficiency of quantitative measures with the richness and contextualism of qualitative
methods, it is believed a broader and more authentic description of elders' spirituality is
possible.
Research Process
An outline of the sequence for data collection and analysis is depicted m Table 1
(pg. 66).
65
Table 1: Sequence of Research Procedures
Identificatioa of sampling sites
Dissemination and collection of quantitative instruments
Tabulation of Geriatric Depression Scale (GDS) scores
Selection of subgroups of participants for interviews based on GDS scores
Transcription of interviews
quantitative analysis of instruments
Analysis of qualitative data
a. first level analysis
b. second level analysis
c. third level analysis
Merging of qualitative and quantitative data
Sampling and Setting
Criteria for mclusion m this study consisted of bemg 75 years of age or older,
English-speaking and residing independently or semi-mdependently in a retirement
community/facility. A requirement for living independently or semi-independently is an
ability to attend to personal needs. This automatically excluded from the study those older
adults sujBfering from significant cognitive and mcapacitating physical impairments. To
strengthen reliability the researcher excluded those persons who would be unable to
independently complete the questionnaires or the mterviews. These sampling criteria, plus
restraints on budget and time, precluded random sampling of individual elders over 75
years of age m the community at large, and mandated the use of convenience sanq)ling.
66
Because random sampling was not practical in this circiunstance, the results of this
dissertation simply suggest possible conclusions that cannot be generalized to the
population as a v^ole.
To obtaia the sample initially, phone contact was made with the administrators of
all retirement communities listed m the Yellow Pages in a small Southwestern town to
introduce them to the research and to assess the agency's receptivity to participation.
Retirement communities flourish in the Southwest because the climate is mild and dry and
the lifestyle is generally relaxed. The administrators of three retirement commimities
indicated mterest and a meeting was scheduled with in which the research purpose and
logistics were explained. A copy of the research proposal was also presented for reference
as were copies of all documents to be distributed to community residents. Members of
the administration of all three communities agreed to support the research eflfort. They
assisted by identifying the addresses of eligible participants.
Retirement Communitv I
The first commimity consisted of250 individuals residing in smgle level apartments
situated as duplexes, triplexes and quads spread across a large mesa overlooking the town.
Apartment sizes ranged from efficiency to two bedrooms with convenient and relatively
spacious floor plans. The majority of the apartments were federally subsidized with a
waiting list of over one himdred applicants. The cotmnunity was well maintamed with
gravel yards, many displaying personal touches such as flower gardens, bird baths, wind
chimes, ceramic animals and cactus. Assistive devices were on many porches and several
residents kept small pets. The majority (N=57) of quantitative participants who completed
questionnaires, and all those subsequently interviewed to obtain qualitative data, came
from this community.
Packets containing an mtroduction, disclaimer statement explaining the rights of
human subjects and directions for instrument completion (Appendix A), demograhic
questions and the three instruments (Appendix B) were hung on the doors of 175 eligible
participants. A decorated and labelled box was placed in the administration building in
which residents placed their completed questionnaires. Two weeks later Thank-you notes
were distributed to all eUgible residents with a lottery tickets mside.
Retirement rnmmimitv 2
Next arrangements were made with a small government subsidized retirement
community to distribute questionnaires to all eligible and interested parties during a
morning meeting. This retirement community was a simple, pleasant, well-maintained two
story building with 24 residents. The building had two wings with a meeting room in the
center of the first floor and a recreation room m the center of the second. Administrators
posted a notice announcing the meeting a week prior and the requirements for eligibility to
participate. The day of the meeting the administrators set up tables m the meeting room
and the researcher, brought cookies and juice. After all participants were assembled the
purpose of the research was explained and all interested residents were asked to complete
the questionnaires. All persons attending the meeting agreed to participate. A lottery
ticket was enclosed m the research packet to thank participants for their time. All
participants quietiy and diligently self-administered their questionnaires. A great deal of
congeniality and warmth were extended to the researcher by the residents and
admmistrators at this &cility.
Retirement rnmmiinftv 1
The third community was a three story non-subsidized retirement facility housing
65 residents. The reception area was luxuriously furnished and a large dining hall also
functioned as a meeting room. The researcher attended a multi-purpose community
meeting in which, near the end of the meeting, she explained the purpose of and criteria
for participating m the research. Following, packets containing an introduction,
disclaimer, directions, demographics, instruments and a lottery ticket were hung on the
doors of eligible persons identified by the administrator as those who might be willing to
participate. A decorated and labelled box was placed hi the administrative office m wliich
participants deposited completed questionnaires. Extra packets were left in case eligible
others not identified by the administrator expressed an mterest m participating. A thankyou card was sent to the administrators and residents of the three retirement facilities.
Response Rates
In Retirement Community I fifty-seven people returned questionnaires for a
return rate of 33%. Fourteen residents had not completed the back portion of the
Geriatric Depression Scale and the researcher and one assistant returned to these
participants to request that they complete the form. In Retirement Community 2 nine
residents consented to participate (all who attended the meeting), read the disclaimer and
directions, and completed the packet questionnaires. It is unknown how many of the 24
residents were eligible to participate. In Retirement Community 3, 11 of the 15
questionnaires distributed were returned for a return rate of 73%. Again it is unknown
how many of the residents in retirement community 3 were eligible to participate as
questionnaires were distributed only to those residents identified as likely to participate by
the administration.
Instruments and Administration
Reliability and Validity
The merit of quantitative outcomes are judged by the reliability and validity of the
instruments used to test a particular hypothesis and appropriateness of the statistical
analyses. In the following paragraphs the iQStnunents will be described, reliabilities and
vaUdities for each will be reported, then statistical analyses will be addressed. In general,
reliability pertains to the consistency or repUcability of results for a given procedure or
"...the accuracy or precision of a measuring mstrument" (Kerlinger, 1986, p. 405).
Kehability improves as tests mdicate increased variance of individual differences and
decreased error variance.
Validity means the degree to which what is said to be measured is what is
measured (Carmines & Zeller, 1979). As will be seen in the following segments, these
forms of validity are not entirely discrete and procedures for assessing them are similar or
identical (Vogt, 1993). Bums and Grove (1987) defined mtemal validity as "the extent to
which the effects detected m the study are a tme reflection of reality rather than... the
result of ..extraneous variables" (p.234). They defined external validity as the "extent to
which study findings can be generalized beyond the sample..." (P. 240). Kerlinger (1986)
identified three kinds of mstrument validity of essence m quantitative research; 1) content -
the representativeness or sampling adequacy of the instrument topic; 2) criterion-related the ability of a test to make accurate predictions, and most importantly; 3) construct
validity - the degree to which the conceptual or theoretical definition fits the operational
definition of the variable.
The instruments consisted of the Geriatric Depression scale, the SelfTranscendence Scale and the I*urpose in Life Test.
Geriatric Depression Scale
The unidimensional Geriatric Depression Scale (GDS) (Appendix B) was selected as a
screening tool for depression because it was developed specifically for aged populations,
has less of an emphasis on physical health and is responsive to degrees of depression.
Most existing depression scales have been developed and validated in
younger populations and their applicability with older persons has not
yet been demonstrated...[the GDS] was specifically designed to measure
depression in the aged, primarily as a screening instrument, and validated
within this population (Yesavage, Brink, Rose, Lum, Huang et al, 1983,
p. 37).
The test consists of 30 "yes/no" items arranged in an order intended to optimize
acceptance of the questionnaire. Twenty questions mdicate the presence of depression
when answered "yes" and 10 indicate depression udien answered "no." Higher scores
(score range = 0 to 30) are associated with greater depression. The test is constructed
simply and completion does not require the skills of a tramed administrator.
The following information was reported by Yesavage et aL (1983). Development
of the 30 item GDS began with construction of a 100 item questionnaire generated by a
team of clinicians and researchers. Subsequently it was admmistered to 47 depressed and
well elders and the 30 items correlating best with the total score were chosen to comprise
the GDS.
Next, to validate the test, 40 normal subjects and 60 depressed subjects labelled
'mild' and 'severe' (defined by Research Diagnostic Criteria (RDC)), were given the GDS,
the Hamilton Rating Scale for Depression (HRS-D), and the Zung Self-Rating Depression
Scale (SDS). The HRS-D and ZSD had previously been found valid and reliable measures
of depression. Validity was determined on all three tests by analyzing variance of scores
of those persons RDC labelled normal, mildly and severely depressed. The main effect of
the RDC label on scores was significant (p=0.001). The GDS classifies persons as
severely depressed (score 21-30), mildly depressed (11-20) and normal (0-10). The three
tests' means for each RDC label were tested with a /-Test and showed scores for all
mcreasing with the severity of diagnosis (^0.001).
To test reliability, four measures of mtemal consistency were computed for each
test. Tests correlated on all measures as statistically reliable at or beyond the 0.001 level
of probability. The reliability coeflBcient was highest for the GDS (<3=. 94). Several
subsequent studies have substantiated these findings.
Olin, Schneider, Eaton, Zemansku & PoUock (1992) found high concurrent
validity between the Beck Depression Inventory and the GDS (r=.91). The GDS is
commonly used diagnosticaUy and has been employed in hundreds of research studies.
I*iirpose in Life Test
The unidimensional Purpose in Life (PEL) test (Crumbaugh & Maholick, 1964) (Appendix
B) was chosen to measure fiilffllment of meaning in life because it has been well tested
over 30 years and is based on Frankl's concepts of meaning and meaninglessness.
Crumbaugh & Maholick (1964) defined purpose in life as "...the ontological significance
of life firom the pomt of view of the experiencing individual" (p. 201). "The scale has
successfully distinguished a variety of populations according to predictions based on their
expected degree of meaning and purpose in life" (Crumbaugh & Maholick, 1981, p. 2).
The mstrument is plainly constructed, and instructions printed on the form can be
understood by those with a fourth grade or higher education. (Crumbaugh & Maholick,
1981).
The test contains three sections. The objective portion consists of 20 statements
each with a seven point Likert-type scale bounded by descriptive adjectives. Only the
objective portion will be used by the researcher because the other subjective portions
require interpretation by psychologists or psychiatrists. Past attempts to quantify the
subjective portions have added Uttle objective niformation to that afforded by the scale.
"Raw scores of 113 or above suggest the presence of definite purpose and meaning in life,
while raw scores of 91 or below suggest the lack of clear meaning and purpose"
(Crumbaugh & Maholick, 1981, p. 3).
The following was reported by Crumbaugh and Maholick (1981). The PIL "...is
an attitude scale constructed firom the orientation of Logotherapy... meanmg treatment
through finding meaning m life...the scale is intended as a measure of Frankl's basic
73
concept, existential vacuum" (p. 1). Tests of reliability and validity were conducted to
determine if the PIL was indeed representative of Frankl's idea of existential vacuum;
represented a concept different from other pathologies and; differentiated between normal
populations and those with existential vacuum.
Two split-half tests of a population of 105 nonpatients and 120 patients, and later
120 nonpatients indicated good reUabilities (r=.81. Spearman Brown=.90: r=.85.
Spearman Brown=.92, respectively). Hutzel (1987) reported subsequent split-half
reliabilties have ranged from .77 to.88 (cited m Coward, 1996). Multiple tests relating the
PEL to other variables have been accomplished. Pertinent to this dissertation, correlations
between the PIL and depression, anomie, and well-being have been demonstrated in these
tests. No consistent relationship between the PIL and age, sex, IQ or education have been
established.
Construct validity was established by testing large multiple groups of patient and
nonpatient populations. Variance between the two groups was significant (F=2.20,
/?=.01). A group of therapists and a group of ministers evaluated patients' degrees of
purpose and meaning in life and ratings were compared to patient scores on the PEL. The
correlation between therapists' ratings and PIL scores was r=.47, while the relationship of
ministers' ratings and patient scores was r=.38. "These results are m Ime with the level of
criterion validity which can usually be obtained from a single measure of a complex trait"
(Crumbaugh & Mahohk, 1981, p.2). The PIL has been used clinically for diagnosis and in
hundreds of research studies.
Self-Transcendence Scale
The unidimensional Self-Transcendence Scale (STS) (Appendix B) was developed to
measure
...a major psychosocial resource of developmental maturity...
transcendence refers to the capacity to expand personal boundaries and
be oriented toward perspectives, activities, and piuposes beyond the
self without negating the value of the self ..[it] is defined as the
expansion of self-boundaries in multi-dimensional ways: a) mwardly in
introspective activities; b) outwardly through concerns about others'
welfare; and c) temporally whereby the perceptions of one's past and
future enhance the present. (Reed, 1987, p. 1)
The test consists of 15 statements addressing self-transcendent experiences typical
in aged populations. Participants' agreements with statements are rated on a four item
Likert-type scale rangmg firom "not at all" to "very much." Total scores range fi'om 15 to
60. Permission for scale use in this dissertation was obtained from Dr. Reed.
The Self-Transcendence Scale was generated as the result of a factor analysis of an
mstrument measuring elders' developmental resources, the Developmental Resources of
Later Adulthood Scale (Reed, 1989a). Self-transcendence contributed up to 80% of the
variance in factor analyses. The 15 statement items were specifically tailored for the
elderly or others facing the end of life.
Items were developed to avoid bias toward the physically strong or healthy
person, and mstead to measure the older adult's ability to derive a sense of
75
well-being from less physically-oriented hiiman experiences through
cognitive, creative, social and introspective avenues. (Reed, 1987, p. 1)
Content validity was supported by a thorough literature review, further
strengthened by refinement of test items. Construct validity has been sustained by multiple
testing, qualitative analysis and ..."in secondary analysis of data from correlational and
longitudinal studies on developmental resources m the elderly" (Reed, 1987, p. I) Coward
(1996) reported a Cronbach's alpha reliability in previous studies ranging from .77 to .88.
Procedures
Ethics
Hiiman Siihjfip.t«;
The human rights of the informants were protected according to the guidelines
established by the University of Arizona Human Subjects Committee. A formal review by
this committee was waived and permission granted for the research to proceed. Informed
consent was obtained from all participants m the quantitative portion of the research
(Appendix A) and signed informed consent was obtained from all participants of the
qualitative portion of the research (Appendix C).
Application
During the last 55 years, multiple atrocities perpetrated m the name of science
exposed fimdamental problems in the seemingly neutral and beneficial world of research.
Ethical issues disclosed as the result of these atrocities have been brought to the forefront
but universal resolution of some have proven diflScult. The researcher's ethical stance
therefore, determines the approach to unresolved ethical issues.
76
The researcher holds a contextualized/consequentialist ethical stance (Punch,
1994), with values of mutual respect, noncoercion, nonmanipulation and the importance of
context when making ethical decisions. Punch (1994) identified four areas of ethical
concern to qualitative researchers (and applicable to quantitative research) including codes
and consent; deception; privacy, harm, identification, and confidentiality, and; trust and
betrayal.
Codes and consent. Subject instructions for the quantitative portion of this
research included explanation of consent assumption (Appendix A). Informed verbal
consent for resident testing was disseminated to all participants with the initial
questionnaire packet. For the more intimate and intrusive qualitative interviews, a consent
form explaining the study subject, process, risks, benefits and participant rights was signed
by participants prior to mterviews (Appendix C).
Deception. To avoid deception, the rights of the participant dominate the goals of
the researcher: participants were niformed verbally and in writing (Appendix A and C)
they can refiise to participate or withdraw at any time. Participants were informed of the
tme purpose and processes of the study and no covert observations took place.
Privacv. harm, identification, confidentiality. To protect participants' privacy and
ensure confidentiality, only the identities of interviewees (versus those completing only
questionnaires) were known to the researcher. These people were given pseudonyms for
interview analysis and dissemination, and tapes and transcripts will be kept five years and
locked m the researchers oflSce.
Trust and betrayal. Because the subject naatter of the interviews is of an mtimate
nature, participant debriefing occurred at the completion of each interview. In the case of
one man \^dio was terminally ill a phone call and follow-up visit was made with him and a
family member. The researcher did not discuss the interviews except for debriefing with
peers, and then used no names.
Quantitative Procedures
After obtaining informed consent, instruments were all self- administered with the
exception of one person who requested assistance due to poor health. Self-administration
was chosen m an effort to prevent any inadvertent influence by the researcher on the
participants' answers and for expediency.
Z-scores were run on the GDS to assist in visuaUzation of score distribution.
Demographic fi'equency distributions, and scores and measures of central tendency and
variability plus reliabilities were analyzed for all scales/tests within the inclusive group and
groups identified as nondepressed and depressed on the GDS. Following, correlations
were run for the three variables and demographics as well as tests for diflferences.
Qualitative Procedures
Scores fi"om the GDS were summed and used to determine those to be interviewed
for the qualitative portion of the study. Ten persons were identified for qualitative in
terviews. The intent of this form of selective sampling (Glaser, 1978) was to elicit the
greatest possible divergence between depressed and nondepressed elders in themes of
meaning and meaninglessness within their life stories. Questionnaires were marked with
78
the residents' mailbox numbers so the identities of those with the highest and lowest
depression scores could be retrieved.
The five persons scoring the lowest (those without depression as measured by the
GDS) had scores of 0 or 1 and all agreed to be mterviewed. Of the five people having the
highest GDS scores (indicating depression), three refiised interviews. The spouse of the
person with the highest score refiised for the participant stating he was too ilL The person
with the second highest score stated she would need to rely on her daughter to do the
interview because she had trouble thinking. The person scoring fifth highest on the scale
stated she was havmg a bad week and when called the following week snnply refiised.
The next three persons scoring consecutively high scores within the depressed range were
contacted and all agreed to be interviewed. Each interview was scheduled at a mutually
convenient time m the participant's home. The home setting was a distraction-free
environment m which the participant fek at ease. In addition the home setting lent context
and richness adding insight mto the lives of the participants.
The researcher and an assistant performed the audio-taped didactic interviews.
Each interview was initiated with the researcher's question, "I would like for you to tell me
the stories fi:om your life you find yourself remembering the most - the stories that are
important to you." The rest of the interview was unstructured allowing for maximum
participant control and to avoid introducing or mfluencing participants' choices of topics.
Interpretive accuracy and fluency were promoted by restatement, clarifying questions, and
supportive techniques. The objective of the mterviews was to ehcit life stories from the
participants as a means of discerning their perceptions or patterns of meaning in his or her
own life.
Narrative Analysis
The narrative analysis of the participants' life stories provided answers to research
questions three, four, five and six 3) What are elders' life-story themes of meaning m life?;
4) Do life story themes of meaning in life differ between depressed and nondepressed
elders?; 5) How is self-transcendence nianifested m life stories of depressed and
nondepressed elders? and; 6) Do manifestations of self-transcendence in life stories of
depressed and nondepressed elders difier?
Background
Narrative analysis falls within the paradigm of naturalistic inquiry, thus assumes
general principles of qualitative application and evaluation. Application principles include:
I) exploration - of little known entities; 2) description - providing rich contextual
information for interpretation of quantitative findings, or monitoring processes; 3)
illustration - to exemplify more general research findings; 4) realization - to make real the
particulars of a case, and; 5) testing - of hypothesis or to answer questions (Guba &
Ltncohi, 1989). This study employed qualitative methods for the purposes of description,
illustration, realization and testing (of research questions).
Likewise, the researcher believes the emic (as understood by the story teller) life
story perspective of elders' attributions of meaning in life may enrich understanding of
spiritual elements of health and well-being in the aged. Despite these advantages which
80
correspond to nnrsing interests and values, narrative analysis is uncommon in nursing
research.
A plethora of studies have been accomplished using narratives to inform various
aspects of the himian condition. Sociologists have used narratives to generate knowledge
about the experience of injury (Borkan, Quirk & Sullivan, 1991), aging (Heikkinen, 199293; Nye, 1992-93), medical errors (Paget, 1882), and chronic ilhiess (ICleinman, 1988;
Reissman, 1990a, 1993; Robinson, 1990; Viney & Bousfield, 1991; Williams, 1984). As
is generally true, the logistics of story analysis vary, however results provide emic
understanding of the people and processes being investigated. Examples of health issues
illuminated through personal narratives include noncompliance (Robinson, 1990); selfimage of the physically disabled (Reissman, 1990); affective disorders in ADDS infected
men (Viney & Bousfield, 1991); and, perceptions that aide or hinder recovery from hip
fractures (Borkan, Quirk and Sullivan, 1991). A well-known and poignant accounting of
the experience of aging and illness is contained m Kleinman's (1988) niness Narratives
Readers of this work will comprehend the importance of organizmg health care around
"the phenomenological appreciation of the experience" for the individual.
Psychologists are using narratives/life stories to diagnose and treat clients (Swartz
& Swartz, 1987; Weenolsen, 1991). Sherman (1994) proposed the manner and form in
which elderly persons tell their life stories reveal their sense of well-bemg, fiunishing
geriatric health care workers with a readily available assessment tool Similarly, McAdams
(1993) noted "...a personal myth delineates an identity, illimainating the values of an
individual life. ..the personal myth is not a legend or fairy tale, but a sacred story that
81
embodies personal truth" (p.34). He noted that story content indicates what a person
believes to be right and true, and story structure reveals how those beliefe are organized.
Although nurses are often the privileged recipients of chent stories, in the United
States few studies have used this precious resource in scientific mvestigations. As with
other disciplines, studies of narratives in nursing were analytically widely varied. Two
studies purporting to analyze narratives/life stories used fieldnotes of interviews as a data
base (HalL, Stevens & Meleis, 1992; Stevens, Hall & Meleis, 1991). This method
disregards elemental principles of narrative (linguistic factors). Analysis of interview notes
incipiently introduces the researchers' perceptions prior to the formal analysis prompting
questions about the authenticity of the study conclusions.
Alternatively, excellent studies using transcribed verbatim narratives have been
accomplished in mirsmg. Gregory (1994) and Gregory and Longman (1992) generated
compelling research of the experience of suffering firom stories of clients and family
members. Sandelowsld, Holditch-Davis & Harris (1990) identified explanatory models of
purpose firom stories told by infertile couples. Benner (1991) designated types of
narratives of ethical and caring comportment and concerns from stories told by practicing
nurses. In another study, low-mcome lesbians told of their experiences accessing health
care - rich narratives that spoke powerfiilly without reinterpretation by a researcher
(Stevens, 1993).
Vezeau (1992) in a daring and brilliant dissertation, used personal narratives (her
own life experience stories) to "...explore territory that often cannot be revealed by fact­
finding - reflections, relationships, transitory sensory influences" (p. 105). An intent of
her method was to illustrate how narratives "enlarge the vision of individual possibilities"
and lead to discovery about personal meanings in health and life. She noted that rather
than deducing prescriptions and scientijGc generalizations, her stories represented the
exception, particular and individual, an exercise in viewing alternatives versus reflex
responses in nursing care.
Narrative as a method of mquiry for nursing can lead to a type of
knowledge that is contextual and retains the mystery and complexity
of human experience...nursing can engage story to further the caring
of others m practice by developmg personal knowmg...nursing can
embrace narrative inquiry to iUuminate the subjective realm in health
care. (p. 103-104)
Because narrative analysis is relatively new to nursing, a description of the new
analysis method and methodological steps of analysis used for this study will follow.
Numerous techniques have been used to analyze narratives but aU systematically mterpret
stories (themselves interpretations) in context for meaning. Theoretical assumptions
fundamental to the various narrative techniques mclude; (a) mdividuals create and
communicate meaning with stories (Reissman, 1993); (b) the way a story is told is as
important as the story elements (Polanyi, 1985); (c) stories are naturally and continually
occurring texts of identity (McAdams, 1993) and; (d) the text is not evaluated by discrete
fragmentation of phrases but is considered as a whole m context (Labov, 1982).
83
Halliday (1973) (cited in Reissman, 1993; Viney & Bousfield, 1991) reported
meaning is conveyed in a story on three levels, (a) textual, or the structure of syntax and
semantics; (b) mterpersonal, or the role and emotions of the speaker and; (c) ideational, or
the content representing the speaker's experience. All levels are analyzed simultaneously.
Further, political and social contexts are niherent m life stories and significantly relate to
attributions of meaning.
Development of the Narrative Analysis Method
From a thorough review of the literature addressing various methods for
conducting narrative analysis, three methods were identified as possibly being compatible
with this researcher's purposes. They were contained in Reissman's book entitled
Narrative Analysis (1993). These methods presented narrative research as a series of
'transformations" involvmg telling, listening, transcribing, analyzing and reading, and were
replications of three previously published analyses by Reissman (1990a), Ginsburg (1989)
and Bell (1988).
Narrative analysis was conducted on recordings of life stories from five women
living m a subsidized urban high-rise for low mcome people. In an effort to maximize
potential for capturmg the meaning intended by the participant, audiotaped interviews
were transcribed verbatim as heard, including noting pauses and emphases (a method used
by both Reissman (1990) and Bell (1988)). An assumption of this process is that pauses
and verbal emphases or volume denote degrees of importance, emotional involvement and
intended meaning. In other words, the way words are spoken is as important as the words
84
themselves, and textual structure influences interpretive accuracy. Ginsburg's method was
rejected because it did not use this means of illuminating mtended meaning.
The methods of Bell and Reissman each were then used to analyze the interview
narratives in the pilot study. Analysis of the interviews using Reissman's method (Klaas,
1994) resulted in a clearer and more intimate look into these women's lives and seemed
more reflective of their attributions of meaning. Bell's method of analysis involved the
fragmentation of stories into individually analyzed phrases. Reissman and this researcher
believe a story has meaning as a whole, a meaning possibly different than the sum of its
parts.
Further, Reissman found Bell's way of identifying stories, based on Labov's
method (1972), was not always applicable. Labov's (1982) theory of story structure
depicts a methodology that clearly defines parts of a story and frequently serves as the
basis of narrative analysis. During the pilot study, the researcher found Labov's method
was suitable for simple stories but did not always fit the complexity of elders' stories. In
most cases however, Labov's method is an excellent tool for identifying story boundaries.
He argues that stories consist of an abstract, orientation, complicating action, evaluation,
resolution and coda (return to present). Applying these concepts to a jumbled narrative
aides discrimmation of story boundaries. This researcher, while using Labov's method at
times to distinguish story boundaries did not use it consistently. Therefore, a modified
form of Reissman's Narrative Analysis of Poetic Structures and Meaning was identified as
the form of narrative analysis most compatible with the researcher's interests and goals.
Reissman's ideas for poetic structure arose from the work of James Gee (1991,
1985, 1986), a psycholinguist wiio published several mteresting analyses of narratives of
children and the mentally ilL He suggested that poetry is an extended form of everyday
speech, both sharing the same elements. Like poetry, a narrative consists of lines, stanzas
and parts (Reissman, 1993) or sections (Gee, 1986). "The global organization of the
narrative, like all deeply sensefiil uses of language, flows from the organization of the
discourse system (line and stanzas) and from the lived and earned coherence of the
narrator's life (Gee, 1991, p.15).
Reissman's initial steps of analysis involve transcribing interviews as lines.
Properties of a line often mchide being relatively short; simple clauses; starting with a
conjunction or Verb of saying'; parallel syntactically and semantically with adjacent lines,
and; terminating with a hesitation, pause or lengthening of the final syllable (Gee, 1986).
From the lines, stanzas are identified. "Stanzas are a series of Imes on a single topic that
have a parallel structure, and soimd as if they go together by tending to be said at the same
rate and with little hesitation between Imes" (Reissman, 1993, p.45).
Stanzas are grouped mto sections or Parts which are one or more stories Unked
temporally or thematically, for example stories of childhood or a series of events related to
courtship and marriage respectively. Properties of Parts or sections often mclude having
larger topic units; no internal change of place, time or major characters; stanzas with
parallel structures or patterns; a falling pitch glide; openings with hesitations and false
starts.
Reissman (1993), while detailing the initial steps of transcriptioii and analysis
described above, leaped to a conclusive theoretical model with no explanation of how that
model was derived. Therefore, this researcher developed a process not based on a
predetermined method which involved synthesizing meanings of each Stanza and Part.
Stanzas and Parts were further abstracted to develop story themes.
In summary, problems evolved in three areas of analysis during the pilot study
necessitating a modification ofReissman's method. Problems mchided I) occasional
diflficulty identifying boundaries of a story or stanza, 2) what to do with nonstory phrases
and, 3) what to do after Stanzas and Parts were identified to develop theory. Paget
(1982) defined a story as an account of something which develops and changes. It has a
plot or action wdiich occurs over time, with a mmimum of one temporal jimcture
describing what happened and what followed. Despite this definition, at times it was
di£5cult to determine when a story began and ended, thus the researcher employed
Labov's (1982) method. Nonstories were generally commentaries in some form. These
commentaries consisted of stating opinions and beliefs and contributed a great deal to the
understanding of the mtentions and perceptions of the interviewees. Therefore, these
commentaries were included in the narrative analysis; were instrumental m the
development of life story theme, and; helped qualify manifestations of self-transcendence.
Steps of Narrative Analysis
Interviews were transcribed verbatim as they were heard noting word
pronunciation, emphases and pauses. Pauses by the speaker signaled a new line creating a
87
visually poetic form. Words emphasized with pitch or volume were underlmed and
extreme emphasis warranted capitalization. To demonstrate consider the following:
"An he says ta me Fll see ya tanight."
contrasted with;
"An he says ta me
ril see YOU tanight."
The first sentence could be read as endearing, the second, a threat. Although no
true representation of speech can be made (Mishler, 1991), representing textual,
interpersonal and ideational elements augments the researcher's capacity for authentic
interpretation. "Decisions about displaymg talk are inseparable fi-om the process of
mterpretation (Reissman, 1993, p.51).
First Level Analysis. During the initial transcription of the research participants'
mterviews, lines were delineated by pauses \^dlich allowed more appreciation of pitch and
glides (phonetics), aspects difBcult to transcribe, as well as the natural poetry of speech.
Following, stanzas were identified from the transcript based on lines holding together as a
story or commentary as described by Reissman. Labov's (1982) method of identifying
story parts was used to clarify story boundaries. Commentaries were defined as
statements of opinion not specific to a story or, talk of current activities not in story form.
Embedded stories and commentaries were identified because experts in narrative
psychology believe they hold special significance to the teller. Stanzas were then reviewed
for appropriate designation wMe listening to phonetics and accuracy of transcription on
the audiotape. Stanzas were individually summarized for meaning. Identification of Parts
88
generally flowed from stanza review and served to illustrate thematic or temporal patterns
of meaning. An example of first level analysis is contained in Appendix F.
Second Level A: Theme Analysis. Stanza meanings and Part categories were
grouped under inchistve abstracted headings across participants. Further abstraction and
generalization generated themes of meaning in life representative of all stories and
commentaries shared by participants. These themes served to answer research question 3,
"what are elders' life-story themes of meaning m life?"
Second Level B: Analvsis of manifestations of self-transcendence. Perceptions of
life-story themes were compared between the nondepressed and depressed groups. The
outcome answered research question 4, "do life story themes of meaning m life differ
between depressed and well elders?" Perceptions of themes of meaning in life and answers
to a demographic question (favorite activities) were compared between groups of
depressed and non depressed elders. With further analysis common characteristics of selftranscendence were identified within the groups of depressed and nondepressed elders.
The result of this exercise answered research question number 5, 'liow is selftranscendence manifested in life stories of depressed and nondepressed elders?"
Following, the manifestations of self-transcendence in the Depressed and Nondepressed
Groups were compared to answer research question number 6 "do manifestations of selftranscendence in life stories of depressed and well elders differ?"
Evaluation of the Qualitative Method
Guba and Lincohi (1986) noted "...a disciplined inquiry process must be publicly
acceptable and open to judgments about the compression and rearrangement processes
89
involved" (p. 228). Basic elements from which the caliber of qualitative research can be
judged fall under the trustworthiness construct. Trustworthiness involves the credibility,
transferability, dependability and confirmability of the research findmgs.
Credibility addresses the match between v^at is said by the participant and how it
is represented by the researcher. For this study, the qualitative focus was on the
perception and construction of participants' stories rather than their accurate,
comprehensive recall Because the participants were relating experiences of self chosen
significance, issues of confabulation, defensiveness and halo efifect were minimized.
Prolonged engagement and persistent observations were enhanced by the researcher's
preliminary studies and research assistantships addressing similar concepts or variables
with elderly populations. A form of negative case analysis was built mto the research
design by interviewmg only those scoring at opposite ends of the depression scale.
Ongoing joumaling of perceptions and expectations from the time of preliminary studies,
and specifically before and during this investigation, provided a means of monitoring the
researcher's influence on analysis and mterpretation. Further, the researcher's theoretical
orientation (Chapter I) was delineated prior to data collection which aided m recognition
of the influences shapmg and guiding the research process. Reissman's (1993) form of
detailed transcription and successive tape review add to the credibility of this study by
enhancing the authentic replication and interpretation of the participants' stories.
Transferabilitv is relative, parallels generalizability, depends on the degree of
comparative overlap and is the prerogative of the reader rather than the researcher. For
this investigation, transferability was addressed by providing a comprehensive data base or
"thick" descriptions of participants through demographics, environmental descriptions and
participant portraits as context for analysis of the data.
Dependabilitv or the stability of data, was established by keeping detailed records
(audit) of the analysis process mcluding transcription, the process of analysis and the
emerging theory. Inclusion of data exhibiting this process is included m the dissertation so
the reader may judge the researcher's interpretations.
rnnfirmability. or assurance that findings were rooted m the context of those
concepts mvestigated (or the focal source of information) rather than the researchers
imagination, was also addressed with the audit process. Confirmability was maintained by
keeping tapes of mterviews, demographic information and detailed description of the
environment and participants.
Some of the unique positive, negative and simply neutral considerations effecting
the evaluation of the scientific merit of narrative analysis were delineated by Viney and
Bousfield (1991). They noted narrative analysis:
...comes much closer to the unique meanings of research participants and
to doing justice to their pictiu"e of events than other methods. Also the
narratives it identifies represent the content of their experience, so that h;
extends beyond mere fi:equencies. Further narrative analysis seems to us to
be more respectful of research participants...Because it can be based on an
interview style which acknowledges their e}q)ertise and can result in
relatively undistorted accounts of their contributions, it also seems more
ethical It can even be potentially empowering for them because it can lead
to their hearing their own stories being told...Narrative analysis, too, has
the advantage over other methods in that it brings together rather than
separates elements of human e^qperience m the integrating concept of the
story, (p. 764)
However, Manning and CuUum-Swan (1994) noted:
To a striking extent, narrative analysis is rather loosely formulated, ahnost
intuitive, using terms defined by the analyst...themes, principal metaphors,
definitions of narrative, defining structures of stories and conclusions
are often defined poetically and artistically and are quite context
bound, (p.465)
The researcher's experience with these issues of scientific merit and
parsimony are addressed in part, below.
Validation of Narrative Work
Reissman (1993) proposed four ways to approach validation of narrative work;
persuasiveness, correspondence, coherence and pragmatic use.
Persuasiveness
"Is the interpretation reasonable and convmcing?... persuasiveness is greatest when
theoretical claims are supported with evidence £rom informants' accounts and when
alternative mterpretations of the data are considered" (p.65). Reissman tempers this claim
of validity with the notion that narratives have changing meanings thus, due to historical
changes, persuasiveness is time limited. This researcher used techniques described in
92
Qualitative Evaluation (trustworthiness) to address persuasiveness. Further, the
tenqporality of findings is inherent m any methodology in which context is a primary factor.
Correspondence
Although researchers can take analysis to the participants for verification (member
checks), implications for improved validity of narrative analyses are questionable.
Meanmgs of stories change as consciousness changes - they are not static. Also
abstraction across a number of narratives cannot be evaluated by an individual participant.
"In the final analysis, the work is ours. We have to take responsibility for it" (p.67). This
researcher addressed correspondence as suggested by Reissman, by distinguishing
between the participants and researchers views m the dissertation.
Coherence
Coherence criterion is judged at three levels - global (overall goals of the speaker),
local (the hnguistic mechanisms speakers use to make a point - e.g. contrasting situations,
metaphors), and themal (predominance of certam themes in an interview). These levels
may differ or refaiforce the same perspective.
Investigators must continuously modify initial hypotheses about speakers'
beUefs and goals (global coherence) m Ught of the structure of particular
narratives (local coherence) and recurrent themes that unify the text
(themal coherence). Interpretation of meanmg is constrained by the text
m miportant ways, offering a check on ad hoc theorizing, (p.67)
This researcher addressed coherence through joumalmg and auditing procedures
described in Tnistwnrthine««
Pragmatic use
Future oriented, this approach refers to the extent the research is used by others.
Use by others can be enhanced by describing the interpretation process; providing
examples of the interpretation process; identifying the transformation (research) process,
and; making primary data available to readers. Enhancement procedures are evident in the
body of the dissertation.
In general, the intuitive, poetic and artistic-like practices of narrative analysis are
anathema in the traditional positivistic reahn of science and to a certain extent, the more
traditional qualitative methods with their distinct terminology, philosophies and clean
analytic steps. Further they create dilemmas for the analysts themselves. Vmey &
Bousfield (1991) found the analytic process time consuming, and had difficulty identifying
the unique features of a narrative, and criteria for credibility. This researcher also found
the process time consuming and found the identification of stories, commentaries and
abstracted meanings at times ambigous. The process however, was made less ambiguous
by employmg Labov's (1982) method of story identification. Further, as famiUarity with
the process mcreased and patterns of meaning began to emerge, story and commentary
ambiguity began to dissipate. Thereafter the analysis process move ahead at a relatively
faster pace, although interviews with multiply embedded stories and commentaries
remained more diflSculty to analyze. Iterative reviews of the taped interviews until the
participants voice could be imagined while reading the text, assisted greatly in story
interpretation as did the additional measures employed to reproduce phonetic elements of
speech.
94
Bertaux & Kohli (1984) noted the hmnense challenge of narrative analysis is both
its strength and weakness. Similarly, Reissman (1993) wrote;
The methods are slow and painstaking, they require attention to subtlety,
nuances of speech, organization of a response, local contexts of
production, social discourses that shape \^at is said, and what cannot be
spoken. Not suitable for investigators who seek an easy and imobstructed
view of subjects' lives, the analytic detail may seem excessive to those who
view language as a transparent medium, (p. 69)
Bertaux & Kohli (1984) argued the multiplicity of methods and application of
narrative analysis prechides the development of a standard methodology or theoretical
school The value of narrative lies m looking at old questions with new eyes, opening new
perspectives and approaches, and forcing attention to the various levels of social Ufe and
the impact of history.
Conclusion
In conclusion. Chapter Three focused on the methods, means, evaluation criteria
and ethics employed for this dissertation. Narrative analysis was addressed in more detail
because it is relatively new to nursmg and lacks the specificity and theoretical development
of other more established qualitative methods. The wide use of narrative among other
disciplines and European coimtries however, is testimony to its unique capacity for
generating knowledge. Criteria for evaluating the credibility of narrative analysis was
addressed in conjunction with, and independently of the more general criteria used for
evaluating qualitative studies.
95
CHAPTER 4
FINDINGS
Overview
This chapter describes the results of the quantitative and quaUtative analyses.
Study samples and demographics are described as well as the results of statistical analyses
of quantitative instruments and demographics. Levels of qualitative analysis are elucidated
and finally, the quantitative and qualitative outcomes are merged.
Sample Description
A convenience sample {N=ni) was obtained fi"om three retirement communities in
a small Southwestern town. This N exceeds by one the rule of thumb for reUability with
multiple correlations of an
= or >50, plus eight cases for each mdependent variable
(Tabachnick and Fidell, 1996). Table 2 illustrates demographics of all participants
completing questionnaires at all sites as well as those who scored within the depressed and
nondepressed ranges on the GDS.
96
Table 2: Demographic Frequencies for Total Group. Nondepressed and Dqiressed Group
Inclusive
Nondepressed
Depressed
Group
grqqp
grggp
{N=ll)
{N=60)
(iV=12)
Demographic Label
Age
82 (4.7)
81.6 (4.7)
81.6(4.3)
Mean (SD)
75-91
75-91
76-88
Range
N {%)
%
N %
Gender: Female
Male
60(78)
17 (ir\
48(80)
12f20^
8 (67)
4(32)
Education; Elementary
Jr. High
High School
College
Graduate School
10(13)
6 (8)
40 (52)
14(18)
im
5(8)
4(7)
33 (55)
13 (22)
5 (8)
4(33)
2(17)
3(25)
1(8)
2ri7>
Health: poor
fair
good
excellent
8(10)
29(38)
37(48)
3f4^
3(5)
25(42)
30 (50)
2(3)
5(42)
3(25)
4(33)
0
Within the total group the average participant was an 81 year old high school
educated female, without financial worries. Few demographic di£ferences were found
between the groups with the exception of perceptions of health. For the Nondepressed
Group, perceptions of health averaged solidly in the "good" range. For the Depressed
Group, health perceptions averaged "&ir." Further although the Depressed Group was
small (A^=12), 50% were male compared to 28% males in the Nondepressed Groups. The
distribution of educational levels was similar across groups.
97
Quantitative Analysis
Table 3 presents the range and reliability coefficients for the three mstruments, the
GDS, STS and PIL, and the means and standard deviations achieved among the Total,
Nondepressed and Depressed Groups.
Table 3: Psychometric Properties and Scores on Insiniments Across Groups
Total Group
Scale
Geriatric Depression Scale
Scale Range: 1-30 (a=.84)
M
6.5 (4.6)
Self-transcendence Scale
Range: 15-60 (a=.75)
45.5 (6.7) 27-57
Purpose in Life Test
Range: 20-140 (a=.89)
Range
0-20
109.2 (20.4) 20-140
Nondepressed Group
Depressed Group
Af fSDt Range
5.5 (3)
O-I
M fSD't
14.4(2.6)
Range
12-20
45.9 (6.4) 38-56
41.2 (6.9) 31-48
110.5(19.6) 122-140
92.5 (15.1)66-101
The reliability of the mstruments were all above .70 and withm an acceptable
range (Kerlinger, 1986). Those in the Depressed Group had slightly less variance on
GDS and PEL scores than those in the Total and Nondepressed Groups. Variance scores
among all groups reflected little difference for the STS.
Research Question 1. The research question, "how does meaning m life and selftranscendence correlate with depression among elders," was analyzed using the Pearson
correlation. Higher levels of meaning m life and self-transcendence were significantly
associated with lower levels of depression m the total group (r=-.59,/7=< 01; r=-.40,
p<.01 respectively). The pattern of correlations was similar in the Nondepressed and
Depressed Groups. The relationship between depression and meaning in life was
significant in the Nondepressed Group (r=-.50,p=<0l), though not in the Depressed
Group (r=-.12) wdiich had a smaU sample size of 12 individuals.
Table 4 depicts results of the multiple correlations for the Total Group. Because
the demographic variable labeled "financial worries" did not produce significant results
when compared with any other category it was deleted fi"om the replicated Tables.
Table 4: Correlations for Total Group W=77)
Age
Gender
Gender
-.11
Religion
.06
-.11
Health
-.09
-.29**
Education
.06
GDS
Religion
Health
Education
GDS
PEL
-.01
-.10
.16
.24*
.20
-.11
PEL
-.08
-.34*
STS
-.11
-.0
.15
-.52**
-.18
.53*
.42**
.20
-.58**
.04
4Q**
.26*
_ 29**
4j**
*p=.05 (2-tailed)
**p=.Ol
Several significant correlations were revealed m the Total Group. Correlations
among the three mstruments were significant, as well as correlations among the
instruments and perceived health. These correlations indicated a significant negative
relationship between being depressed and experiencing more meaning in life and selftranscendence. Experiencing meaning in life was positively correlated with experiencmg
99
self-transcendence. Scores indicating depression were negatively correlated with
perceiving good health. The correlation between gender and health mdicated more men
perceived more health problems. Further, gender correlated negatively with meanmg in
life indicating elderly men experienced less of a sense of meaning in life than their female
comiterparts. Having reUgious beUefe was positively associated with having a sense of
meaning m life and higher levels of education were associated with self-transcendence.
Table 5 depicts correlation results for the Nondepressed Group and Table 5
depicts results for the Depressed Group.
Table 5: Correlations for Nondepressed Group (A^=60^
Age
Gender
Rehgion
Health
Gender
Health
Education GDS
PIL
-.17
.19
-.26
-.10
-.21
.10
.29*
Education
.17
-.03
GDS
.29*
.15
PIL
.03
-.41**
STS
-.14
-.05
* p=.05
••p=OI
ReUgion
(2-tailed)
.09
-.41**
-.10
.61**
.33**
.24
.08
.11*
.22
-.07
49*#
-.24
.32*
100
Table 6: Correlations for Depressed Group (iV=12)
Rehgion
Religion
-.25
.21
Health
.11
.55
Education
-.30
-.04
-.09
.24
GDS
.30
.31
.29
-.61*
.35
PEL
-.21
.16
.55
.34
-.06
-.12
STS
-.07
.06
-.22
.47
-.13
* p=.05
**p=.Ol
Health
Education
Age
-.19
Gender
Gender
GDS
PIL
-.38
.53
.3
(2-tailed)
Correlations in the Nondepressed Group roughly paralleled correlations for the
Total Group. Two differences m correlations were revealed between the Nondepressed
Group and the Total Group. These included 1) for the Total Group there was a significant
relationship between gender and health but there was no such relationship for the
Nondepressed Group; 2) for the Nondepressed Group religion was positively associated
with education but the relationship was not significant for the Total Group. Selftranscendence was not significantly associated with education in the Nondepressed Group
as it had been m the Total Group.
In the Depressed Group oidy one correlation of significance was revealed, most
likely due to the small sample size and consequently low analytic power to achieve
significance. The single significant correlation revealed an inverse relationship between
lOl
being depressed and being healthy. However, all correlations were in the direction and
magnitude expected, and consistent with correlations in the other group analyses. As
measures of meaning in life and self-transcendence decrease, measures of depression
increase.
Research Question 2. The research question 'liow does meaning m life and selftranscendence differ among depressed and nondepressed elders" was analyzed using
comparative tests. Because the groups of depressed and nondepressed elders were of
unequal size and the Depressed Group in particular was small, a t-test could not be used
to investigate differences between groups. Violations of assumptions for the t-test
included nonrandom sampUng and an unequal distribution. Therefore a nonparametric or
distribution free test using the Mann-Whitney U statistic (Table 7), was computed to
mvestigate the possibility of significant differences between the Depressed and
Nondepressed Groups on PEL and STS scores.
The results indicated there is a significant difference between groups of depressed
and nondepressed elders on both PDL and STS scores such that the Depressed Group
scored significantly lower on the measures of meaning m life and self-transcendence
(Table 7, pg. 105).
102
Table 7: MaTiTi-Whitney U Test of Differences Between Nondq)ressed and Depressed
Groups on Purpose in Life Test fPIL^ and Self-Transcendence Scale fSTS^
Nondepressed
(A^=60)
Depressed
(N=12)
PEL 1
(Means)
110.5
92.5
139»*
STS2
(Means)
45.9
41.2
212»
U
*p<03
**p<QOl
In conclusion, quantitative analysis of research questions one and two indicated
that lower levels of meaning in life and self-transcendence are significantly related to
depression. Likewise being nondepressed was significantly related to higher levels of
meaning in life and self-transcendence. Significant differences existed between levels of
meaning in life and self-transcendence in the Depressed and Nondepressed Group.
Qualitative Analysis
Qualhative analysis was used to address Research C^estions three through six.
Ten participants were chosen for qualitative inteviews based on their Geriatric Depression
Scale scores as described m Chapter 3. Interview participant test scores are listed in Table
8.
103
Table 8: Instrument Score Profiles of Participants Selected for Interviews
Name
Geriatric Depression
Swi?
0-30
Range
Self-Transcendence
Scale
15-60
Purpose in Life
Test
20-140
00
1
12
(M=A\\
46
Madge
16
48
89
David
13
36
101
Burt
17
44
93
Kathryn
13
31
67
Depressed
BiUie
66
rA/=48.6^
Non-depressed
Elma
1
38
134
Miriam
0
48
140
George
0
56
122
Karen
0
50
140
Margaret
0
51
128
The five people having the lowest scores on the GDS (nondepressed) had scores of
zero with the exception of one who had a score of 1, and all agreed to be interviewed. All
persons being mterviewed as representative of the Depressed Group scored within the
mildly depressed range (scores = 12-20) on the Geriatric Depression Scale; no one in the
Total Group scored in the seriously depressed range as defined by Yesavage et al. (1983).
Thus, "depressed" as used here, is not meant as a diagnostic label, rather a means of
dividing and identifying the two groups of participants based on GDS scores for the
purpose of answering the research questions.
Thft Tnfnrmanfs
Six interviews were conducted by the researcher and four were conducted by a
research assistant, both using the interview method described m Chapter 3. A
demographic profile of each of the participants is contained m Table 9.
105
Table 9: Life Context Proffle
Name
Age
Occupation
Marital
Education
Health
Financial
Worries
Depressed
BiUie
85
rancher & sheepherder
W
high school
good
No
Madge
76
LPN and secretary
S
9 mos.business school
fa ir
Yes
David
85
jack of all trades
W
elementary
fair
No
Burt
78 boodegger & parole officer D
high school
poor
Yes
Kathryn 80 beaudcian and sales manage W
high school
poor
No
high school
good
No
high school
fair
Yes
Nondepressed
Ehna
90
administrative assistant
Miriam
76 dental assist. & homemaker W
George 84
Karen
76
Margaret 75
W
jack of all trades
W
elementary
good
Yes
grocery store clerk
W
high school
excellent
No
homemaker
W
hish school
good
No
W=widowed
S= never married
D=divorced
The participants differed profoundly m nature, each clearly manifesting and
articulating their mdividuality. Further, their interviews differed in content, delivery, ease
of retrieval, interpretation of the research request and spontaneity. It is in^ortant for the
reader to have a sense of who these people are to provide context for determining in part,
the credibility and transferability of the findings. The following brief profiles of those who
106
chose to participate serve as an introduction. More detailed summaries containing
interview quotes are contained in Appendixes C and D.
Brief Participant Profiles
Billie. Orphaned as an adolescent during the Depression, Billie married at the age
of 19 and spent much of her married life working as a migrant ranch-hand until she and
her husband bought a ranch of their own. In her interview she e?q)ressed a great love and
knowledge of animals and preferred vigorous labor outside with men rather than
performing roles traditionally held by women at that time. Because of her gender no one
would hire her for the jobs in which she was skilled following her husband's death.
Therefore, she worked for several years in a factory. After retirement she began
developmg her artistic talents and had pamted several portraits of animals and people that
hung in her apartment. Billie, still hardy in mind, was experiencing health problems
severely limiting her mobility and adventurous nature. She had not painted for the past
year.
Madge. Madge was an energetic wiry woman who had never married and during
her interview became quite intense. She told numerous stories of being misunderstood
and betrayed by family members, especially her sisters, despite her hard work and good
mtentions. These incidents had been occurring since her childhood. In addition, she told
stories of similar mcidents in the retirement community involvtDg misunderstanding and
betrayal by her neighbors. Madge's careers consisted of being an LPN and secretary,
neither of which she found particularly rewarding. At the time of the interview she was
107
e7q)erieiicing financial difiSculties as the result of being cheated by a sister, and health
problems that sporadically caused her to be incapacitated.
David. Terminally ill with hmg cancer, David tired easily in his interview but
exhibited great zeal for telling stories firom his life. He came to this country fi-om
Germany at the age of 12 with no F.nglish language skills and little formal education.
David began work immediately and despite his lack of formal education, rose through the
ranks to relative corporate success. He attributed his accomplishments to his personal
qualities which included perseverance and intuition - an ability to read people. The
retirement community in w^ch he resided had recently tried to have him placed in a
nursing home. This experience had severely shaken his self-confidence. Throughout his
numerous opinions he tended to view people dichotomously as good or bad.
Burt. Burt, an mtrospective man, was engulfed m trying to put his past m a
comfortable perspective through the use of Rational-Emotive Theory. Much of his
mterview used the lingo of this form of psychotherapy. As a child, after his parents'
divorce, Burt lived and worked with his mother who was a bootlegger. He described
much of his child and adulthood as "rough" and mdeed his stories supported this claim.
He had abandoned his wife and sons when his wife was dying of a terminal disease.
Following a four year recovery fi-om an accident resulting fi-om his drunkenness, he
decided to make several life-style changes. Burt stated as the result of his new
philosophies he was becoming more 'Isolative" in his retirement community and described
irritations and run-ins with various neighbors. He concluded his interview by noting that
he was adopted.
108
Kathryn. Kathryn was a physically beautifiil, gracious lady whose sad affect was
unexplained in her interview. She found herself divorced with a young child m early
adulthood and subsequently left her &nn community and went to the city to seek her
fortune. There she carefiilly analyzed options and with hard work became a successful
beauty operator, enough so to send her son to private school. She described her dilemma
in choosing the right beau to marry after her financial success and emphasized her love of
dancing. She helped run a lucrative businesses with the man she eventually married and
adopted the orphaned daughter of her sister of whom she lovingly. Following her
husband's retirement Kathryn worked until her early 70*s taking care of blind children, a
career she described with enthusiasm.
F.lma Elma was raised on a remote farm in Nebraska by a German speakmg
grandmother and had difficulty in school with the English language and shyness. After
high school graduation she moved to town and with the help of her father began working
in the retail business where she developed a knack for interacting with people. Ehna
described herself as very independent, spoke only briefly of her deceased husband, and
exhibited a great deal of forthrightness and mtelligence. She managed a department for
the Secretary of State for many years and eventually became a major contributor to the
development of the retirement community in wliich she was residing. At the age of 91 she
continued to be a "watchdog" and quite active in this community.
Miriam. Miriam described a very happy marriage until the death of her husband
and an ongomg mvolvement in the lives of friends and family. Most of her interview
consisted of critical but humorous opinions on a wide range of topics to include education
109
and discipline of children, cost of drugs, gambling, politics and the state of the world.
Among opinions e7q)ressed, she believed her grandchildren and children of today were
being robbed of their childhoods by sitting m front of computers. She ventured the high
cost of drugs required by the elderly might be society's way of getting rid of the aged.
Miriam expressed great satisfaction with the retirement community in which she lived and
her friends. She concluded her mterview by saying old folks, at least her friends, were
wonderfid people.
George. George, highly animated, could certainly spin a yam and obviously
enjoyed the role of entertainer. Several times during his interview he played his
harmonica, a lifelong hobby. George had a rugged childhood on a Montana ranch with an
abusive father. He ran away at an early age and throughout his life made a living domg a
wide variety of jobs mcluding ranching, construction and forestry. He'd lost one son in a
racing accident but had two other highly educated and successfiil children. He'd been
happily married twice, his latest wife having died a few months before the interview. He
described himself currently as being happier than he'd ever been. George also had critical
opinions on many subjects including politics, religion, cholesterol and war. Having never
had much education, he stated due to his physical decline he was enjoying developing his
mind.
Karen. Karen was an enthusiastic, gregarious, energetic woman who was quite a
talker. She had worked as a grocery store clerk and bookkeeper and told numerous
stories about these experiences. A widow, she had been married twice to men with
medical problems and like George, stated she was quite happy livmg alone now, taking
110
care of no one but herself She happily noted she had no medical problems and did not
even have a doctor. She played cards with fiiends five days a week, was taking piano
lessons and made quihs for fiiends and family. Further, she had crocheted 42 bookmakers
for family members to be distributed at a famify reunion in Michigan this summer, a trip
she had planned in great detail
Margaret. Margaret was a no-nonsense woman with a deUghtfiil sense of humor
and an air of competency. She lost her husband several years before his retirement and
found herself without job skills and unable to drive. She also lost her oldest son to AIDS
and later her mother to Alzheimer's Disease. Throughout these losses and challenges
Margaret's attitude was that she would "keep on going" and never feel sorry for herself.
At the time of her interview she was taking care of her sister who had Alzheimer's Disease
and although distressed by aspects of her sister's behavior, also found humor m the
situation. She had an ongoing interest m and good relations with her sons but had refused
to live with them when asked because she did not believe in interfering m their lives.
First Level Analysis
All interviews were transcribed by the researcher. Each tape was heard fax its
entirety (range of 30 to 120 minutes) a minimum of four times. Numerous replays
occurred during transcription and checking to duplicate the participant pauses and
emphases in the transcriptions. Each tape was initially listened to immediately following
the interview. They were listened to a second and third tune during transcription and
checking for transcription accuracy. The fourth listening occurred during analysis. The
researcher found analysis was facilitated by imagniing the voice of the participant speaking
HI
the words being analyzed. After hearing the voice of the participant execute the interview
four times, the researcher could imagine the mdividual voices as she read the transcriptioas
without the tape playing.
Participants' contributions consisted of stories and commentaries. Commentaries
mvolved opinions about mmierous subjects and did not fit the story elements defined by
Labov (1982) to include abstracts, orientations, complicating actions, resolutions and
codas. Neither did they fit Paget's (1982) description of a story as something that
develops and changes. Although there were great interindividual differences in stories,
there were few differences in the rate of commentaries to stories across the two groups;
both averaged about half as many commentaries as stories.
As described in Chapter 3 narratives were formatted into Stanzas, which were then
segmented according to Parts. This first level analysis resulted in 13,690 lines, 706
stanzas and 146 parts. There were 387 episodes of laughter or chuckling, 295 of those
among the non-depressed participants. The nondepressed participants averaged 1.83
laughs per page while the depressed averaged .53 laughs per page. Two episodes of
tearfiihiess occurred with one of the depressed participants.
Second Level A: Analysis of Themes
Following the first level analysis, the identification of Stanzas and Parts, a second
level analysis involvmg synthesis and abstraction of the 146 Parts was conducted. Eleven
major life story themes of meaning resulted.
112
Research Question 3.
The research question, 'Svhat are elders' life story themes of meaning m life" was
answered in the second level analysis by identifying the 11 themes of meaning. These 11
themes are listed m Table 10.
Table 10: Life Story Themes Generated in Second Level Analysis (N=\0 mfonnants
career
memories
problem solving
family
mterests/hobbies
beliefs
friends
community environment
education
health
activities of daily living
These themes represent the essence of what participants chose to talk about - the
important stories and commentaries personally meaningflil m their lives. Despite the
complexity and heterogeneity of these participants, there were many shared story Parts
which served to establish themes of perceptions of meaning in life. The reader is
cautioned that not only were stories analyzed but commentaries as well, thus some of the
themes do not have a strictly past orientation but a present and future orientation as welL
for example beliefs.
Subthemes existed for two themes, beliefs and problem solving. Current affairs
and self-concept/personal development were subthemes for beliefs, all coming from
conmientaries rather than stories of the participants. Problem solving contained four
subthemes; dealing with losses, helping others, help from others, and humor.
113
Each theme was not addressed by every participant. A summary of themes
addressed by whom, and the total number of participants who addressed each theme are
listed in Table 1 l(pg. 116).
Table 11: SiiTnniariyation of Themes Addressed bv Each Participant. Theme Totals and
Instrument Scores
Depressed
Nondepressed
BiUie Madae David Burt Kathrvn Elma Mriam George Karen Marearet Total
career
X
X
X
X
X
X
X
X
X
family
X
X
X
X
X
X
X
X
X
friends
X
X
X
X
X
X
X
X
health
X
X
X
X
X
X
X
memories
X
interests/
hobbies
X
X
X
X
X
X
X
9
X
10
8
8
X
4
X
X
community
environment
X
X
activities of
daily living
X
X
X
9
X
X
3
X
X
X
4
problem
X
X
X
X
X
X
X
X
X
X
10
beliefs
X
X
X
X
X
X
X
X
X
X
10
education
X
X
X
X
X
X
X
X
X
10
X
The themes "family", "career" and 'health" were addressed by eight to ten
participants and most frequently in terms of how much of the interview was devoted to
114
these topics. 'Triends" were mentioned by eight of the participants and overall were less
frequently the topic of conversation, often mentioned in a more ofiBiand manner. It was
not possible to rank all themes in terms of frequency addressed because discourse varied in
length of time a theme was addressed as well as the passion with which it was addressed.
"Memories" were of particular significance to certain participants as a principal
source of pleasure or pain, engendering a strong affective component. "Interests/
hobbies" and "beUefs" were also of major significance to some participants and of little
interest to others. "Beliefs" was an outgrowth of the participants' commentaries and
consisted of the widely disparate subcategories, "current affairs" and "selfconcept/personal development." "Current affairs" and "self-concept/personal
development" were a major focus of some participant's commentaries and of little
significance to others. "Problem-solvmg" mcluded four major subcategories - "dealmg
with losses", "helping others," "humor" and 'lielp from others." Again, with the
exception of humor, whether the subcategory was perceived as enhancing or detracting
from well-bemg differed among the participants. Interestingly all participants mentioned
"education."
Research Question 4.
The research question, "do life story themes of meaning m life differ between
depressed and nondepressed elders" was answered by examining the positiveness with
which each theme was addressed by the informants. Theme perceptions differed greatly
within and between groups m reference to the affective perceptions attributed to each.
The positive and negative perceptions linked to each are listed in Table 12 for each group.
115
The context within which the theme was perceived and the participants' affective
demeanor furnished clues to the meaning each story and commentary held for the
mdividual participant.
Table 12: Positive fP) and Negative fNO Perceptions of Life Story Themes in
Nondepressed and Depressed Participants
Life Story Themes
Affective Perceptions
Depressed
Nondepressed
Careers
P,N
P
Family
P,N
P,N
Friends
N
P
Health
N
P
Memories
P
Interests/hobbies
P,N
P
Community environment
P
Activities of daily living
P
Problem-solving
N
P
Beliefs
N
P,N
P,N
P,N
Education
Total
6P 9N
1IP3N
Activities of daily living and community ettvironment were of intense interest to the
Nondepressed Group but were not mentioned by the Depressed Group. For the
Nondepressed group these themes were a source of joy and motivation. Further,
were a source of joy to the Nondepressed Group but created problems for the Depressed
116
Group. For the Nondepressed Group health was either good or heahh problems were
viewed as something the participant was addressing actively and successfiilly. For the
Depressed Group health problems had significantly mterfered with a previous life-style.
Problem solving had been accomplished satis&ctorily for those in the Nondepressed
Group. Further this group impUed they were confident in their abilities to solve problems
the future might hold. Those in the Depressed Group had not solved their problems and
this was a source a great distress. One participant in the Depressed Group was
ambitiously and forthrightly seeking to rectify hfe problems but had yet to accomplish this
feat.
The followmg illustrations have been composed to fiuther clarify Table 12.
Examples from interviews with those in the Nondepressed and Depressed Groups for each
theme elaborate on the positive and negative nature of perceptions about what is
meaningfid m their Uves. These examples consist of perception summaries and quotes
from the participants.
Careers. Every participant in the Nondepressed Group (with the exception of
Margaret who was a homemaker and did not address this theme) expressed great pleasure
in and love of their jobs. Karen said, "I enjoyed my work very much." (S51, L989,990)
Miriam said, "Worked bout 12 years n I just loved it." (S8, L107,108) Elma described
each boss and job in enthusiastic, appreciative terms. George expressed great pride in his
talent and proficiency for handling a wide variety of jobs. Careers seemed to be held m
higher esteem overall by the Non-depressed Group.
117
In reference to the Depressed Group, the same expressions of pleasure came from
two members, David and Kathryn. Kathiyn however, quit three jobs she loved to abide by
the desires and needs of her husband. David's self-made success is now both a source of
happy reflection and constemation as he increasingly experiences situations in which he is
no longer capable. Billie expressed pride in doing masculine work however was chagrined
by the fact that for most of her life she had worked at things that would not have been her
first choice. Madge had trouble finding secretarial work for which she was trained and
had to work as a homecare LPN, a job she described as essentially housework.
So I went to vdiat they call AIB American Institute of Business. And that is
where a concentrated uh short hand, typing everything, uh bookkeephig,
everything that a secretary might need along that Ike. An ya do that fer nine
months. Anthenthey were supposed to find you a job. Weill did that for nine
months but they didn't find me a job. (S12, L237-247)
When employed she described quitting niunerous jobs and never spoke of work fondly.
Burt mentioned work very Uttle except that he found that he "couldn't handle" some parts
of probation work. He did say however that he learned patience when working with
"special ed kids." (S59. L1335)
In summary, careers were of great importance and pleasure to most of those in the
nondepressed group with the exception of Margaret who did not work outside of the
home. Among the Depressed group careers were a source of fiiistration for many.
Kathryn and David were the exceptions both feelmg great love of and pride m their
118
careers. However, the loss of careers through retirement seemed to have created
confiision in David's self-identify and a sense of loss for Kathryn.
Family. In the Nondepressed Group as with careers, families were an mtense
source of joy for many participants. For some, family portraits were pamted m glowing
terms such as "wonderfid" and the "best parents in the world." George proudly spoke of
his eight brothers and sisters who wanted him to return to their home state, his sons and
his two "fine" wives. As quoted in his interview smnmary though, he suffered abuse at the
hands of his father. Although Miriam was not above soundly critiquing the schooling and
discipline of her grandchildren she spoke of them with great affection. Margaret had spent
a good deal of her adult life caring for her mother and sister, and although she didn't deny
the difficulty, she found it deeply rewarding. Interestingly, Alice other than to describe her
childhood, spoke little of family wiiich she suggested was due to her "self-selfsufficiency." Karen's life is literally devoted to happily making and doing things for her
family.
In the Depressed Group, although much of Madge's time had been devoted to her
family, they were also the source of her intense anger and feelings of betrayal- She
believed her efforts were not appreciated or reciprocated. Family matters were allconsuming in Madge's life. Billie expressed dismay at the loss of her family heritage:
I wish I had known somethin about my folks. I didn't know anything. I was uh
16 when mother passed away. I think I was kind of a stupid little jack-ass I don't
know. I didn't know my butt fi:om a hole in the ground. (S66, 67, L849-855)
David expressed great love for his family with the exception of his father.
119
It had to do with my dad. He took all my money when I worked. An my mom
an I, she went with me an she bought a suite and overcoat an signed for it. An
when she came back with me he ahnost killed her. I mean he beat her up. An
that's v\4en I took that suite and overcoat and I got myself from Milwaukee into
Chicago. (SI6, L234-246)
Burt had abandoned his family but talked of a recent reunion with his dymg son whom he
had not seen for 20 years. "I called him wdien he was in ICU and he soimded so weak and
so terrible that I, I broke down." (S29, L603-605) In summary, both Groups
experienced joy as well as pain within their families, however, the Depressed Group
expressed more painful experiences.
Friends. Within the Nondepressed Group friends were a great source of pleasure,
especially for Karen.
Monday afternoon at one o'clock we play. Tuesday night we play dominos.
Thursday night at six we play cards like last night. Tonight at six o'clock we're
gonna go eat at four fifteen so we'll be back in time (laughs) ta play cards.
(laughs) An we play on Sunday afternoon. Sunday is a long draggy day for a lot
of people so we find that playing cards Sunday aftemoon kinda breaks up the day.
(S43, L779-791) I have fiiends and relatives practically all over this country. (S72,
L1604, 1605)
Elma's fiiendships thrived within her extensive committee work and through
knowing everyone in the commxmity. Friends and fiiendly people were of great
importance to Miriam. "I think that's why I like it here. If you walk out to the mailbox
120
and somebody's out there they're ahvays speaking you know. Hi, how are you or
something. I like that." (S39. L731-734) George told a story about a new friendship:
An one day I thought well I'm gonna see if I can't get acquainted with that
woman. I met her. She lives here in the Manor. An I see her outside talkin n
goin on the street to the mail An uh I thought well I'll stop an see. So I stopped
m my car and joined their conversation. I said would you like ta hear (laughs) a
tune about an Irish lady? N yea she would. N here's the tune I played. (Chuckles)
An I been acquainted with er ever since. We (laughs) go out ta bingo n everything
now. It's just somethin. We just companionship. (S38, LI087-1106)
For those in the Depressed Group friendships had a different connotation. Billie
ofiP-handedly mentioned friends from her past but did not mention any current friendships.
Madge mentioned acquaintances she had worked vsdth. Kathryn did not mention
friendships at all. Burt felt that he hadn't had good "associates" "relationships" and was
finding himself'Isolative." David described a phone fiiendship he'd had for a year but the
woman died m a tragic accident.
Thus, fiiends played a bigger role in the lives of the Nondepressed Group, past and
present, than in the Depressed Group. If mentioned by the Depressed Group, generally
fiiends were addressed as part of the past.
Health. For the Nondepressed Group, health was either viewed positively or poor
physical health was being compensated with other strengths. Miriam described a very rare
surgery she had as a young adult and her encounter recently with a physician. "The doctor
121
said I couldn't possibly have had that operation when I said I did. An I said weQ I know I
did. But he said no cause those people are dead. An I said well I'm not." (S32, L590592). Miriam addressed minor health problems with vigor and believed in prevention.
Ehna mentioned health only briefly to say she tires more easily now and "I do have a little
high blood pressure they're keeping tabs on. I've had a httle problem here [indicating
stomach]. I just don't push myselE" (S46, L993-996) Although Geroge said he was
"fading away," he appeared and sounded vigorous and spoke only of health problems that
had been resolved. Of a testicular tiunor that had plagued him much of his adult Ufe he
stated.
Well they took me to the hospital an operated on me n they took it out through
my navel an I'm a new man. Well (laughs) that's one way it changed my life.
Course there's several others. I shouldn't a told ya that but that don't hurt nothin.
(S28, L810-814)
Karen stated:
I'm healthy. I take nothing but vitamins. An I try ta eat right. None whatever
I don't even take an aspirin. An coiurse if you'd tell a doctor you don't take any
he looks at cha like yer lyin. You know you must be lyin at your age an you don't
take medication? But I really don't. In fact I don't even have a doctor. I've been
up here for pretty near four years an I haven't found a doctor but I don't have any
need for one so I don't worry about it. (S39, L699-712)
Margaret noted with amazement the number of people in her family with
osteoporosis and Alzheimer's Disease and wondered how she escaped these afiOictions.
122
Among the Depressed Group, David, dying of lung cancer, did not mention health
although his discomfort was apparent m the interview. Biut spoke of his increased
physical 'Vuhierability" as "galling" and described things he could no longer do, in
particular drinking alcohol Billie was experiencing several health problems and stated:
I need to have somethin done about my back though. I can't walk anymore
without h hurting. The only way it quits hurting is when I sit down or lie down.
So it kinda puts a hiatus on a lot of things I'd like ta do. But you know after
you've worked an awfid lot during yoiu" life doing very active things, it's kind of
hard not to do anything. Not be able to do what you wanna do. Course at my age
you can't expect to. Doesn't make it a bit easier. (S42, 43, L550-562)
Madge complained about a multitude of health problems, particularly problems
with her back and wrists. Kathryn's interview was an enigma. Although there was a sad
and tired tone in her voice she spoke of nothing that could explain her mfld depression as
measured on the GDS. In reviewmg her demographics questionnaire however, she gave
the clue that provided an explanation. Two qualitative questions were included at the
bottom of the document. BCathryn wrote these answers:
Current favorite activity: "dancing can't 3 hip replacements"
Current biggest worry:
Can't walk much only for groceries and things I need to do get pills and things
I need. Doctor made my left leg to long even build up shoe don't help. Dr.
has me cripple for rest of my Ufe. I'm on blood thnmer for 3 months. I can't even
123
help myself
In summary, those who were depressed perceived themselves as less healthy than
those who were not depressed. Although the Non-depressed Group experienced health
problems, they either adjusted their lives to health limitations by finding strengths in
other areas, or simply chosing to deal with the problems and either fix them or forget
them.
Memories. Although obviously memories were a source of pleasure for the
Nondepressed Group, no one in this Group mentioned memories specifically or their
importance, nor did they share photographs with the researcher or researcher's assistant.
In the Depressed Group Kathryn found memories a great source of joy and
seemed to dwell
them. She stated: "Well I have a lotta beautifiil memories I know
that." (S30, L675) She showed the researcher many family pictures and seldom spoke of
the present. Both she and David seemed to cling to these memories as a means of
knowing themselves. Billie also showed the researcher many pictures and seemed much
more attuned to the past than present. Burt had gone to great lengths to forget his past as
illustrated in his mterview summary. Madge was consumed by memories of her family
strife.
In summary, the difference in "memories" between the Nondepressed and
Depressed Groups seemed to be of primacy and purpose. Both Madge and Burt seemed
consumed with unpleasant memories - Kathryn consumed by pleasant memories. For the
Nondepressed Group memories were vahiable but had been integrated into present
perceptions and relegated to the sidelines versus fi'ont and center.
124
Interests/hobbies. Of those in the Nondepressed Group the interests/hobbies
theme was perceived as a source of delight. Karen's life was a study of hobbies and
interests from which she drew happiness and satisfaction. Additionally, she had plans for
fiiture adventures. "Another thing I've never done is taken a cruise n I'm gonna do that
one a these days. Yea I'm lookm forward to a cruise someday." (S36, L635-637)
George's hobbies and interests included his "reorganization" as the result of slowmg
down physically. His reorganization mcluded a passion for politics, story telling and
religion. Playing the harmonica had provided onging pleasure since he was a young lad.
Miriam enjoyed making fiiends, chatting and bmgo. Margaret stated, "Well I talk
business or politics. An uh banking mtrigues me." (S22, L463-465) Elma's major
mterest, hobby and conmiitment derived from the community she lived in and helped
develop.
The Depressed Group found hobbies and interests a source of pain as well as joy.
David described no hobbies and none were obvious m his environment. Billie described
her painting talent as "wasted" and had not painted for a year. Kathiyn could no longer
dance, her favorite activity, and she spoke of no other pleasurable pastimes. Madge
believed her interest m helping others was not appreciated. She mentioned no other
hobbies nor were any apparent in her apartment. Taken in context with the rest of his
mterview Burt's hobby of fishing provided fertile ground for disagreements with
neighbors:
125
I been canyin this stuff in the back a my car so he could go fishing. Which was
often very inconvenient fer me you know. An I ahnost had to say is it akight if
I go fishing today? You know and it, it was gettin bad. So I carried his stuff
over and said OK no more. (S52, L1217-1222)
Burt's main hobby seemed to be studying Rational-Emotive Therapy and reformulating
his life.
Thus, hobbies and mterests were embraced with greater joy by those m the
Nondepressed Group than in the Depressed Group. Moreover, for some in the Depressed
Group hobbies and mterests were a source of consternation.
Community environment. Within the Nondepressed Group, Karen stated: "I
love Arizona. I think it's the best place I've ever lived." (S5, L55, 56) As noted in her
interview summary, Miriam commented on how happy she was in her community. She
fiirther stated, "Here everybody's fiiendly. You go in a store, people speak. They're
friendly n I think its so much nicer to meet somebody who can say good morning whether
you know em or not." (S38, L701-708) Ehna's commitment to her community
environment is notable and she takes great pride and satisfaction m h. Neither Margaret
nor George specifically commented on the retirement commimity.
Data on this theme differed greatly between groups. For the Nondepressed Group,
the community enviromnent was a source of pleasure and for some, commitment. No one
from the Depressed Group talked of the community environment.
Activities of daily living. This theme was important for members of the
Nondepressed Group. For Margaret activities of daily livmg were paramount. She made
126
a daily agenda and kept busy with her own activities and caring for her sister. "I take her
out every afternoon. And we you know we just go around the post oflSce or grocery
shopping or whatever. Ya know. An then a course I do all her bills, her checking." (S23,
L486-496) Karen was cheerfully caught up in the minutiae of daily living:
I have a niece in Texas. I have a nephew in Missouri. I have a cousin in
California. I have one in Utah. An um just a lot of people.(laughs) An I keep m
touch pretty well with all of em ya know. I write a lot a letters. I been doin a lot
more phone calling lately but...I called Michigan twice one Saturday an it cost me
a dollar sixty-eight cents ta each one of em. You can't bother ta write a letter.
Not fer a dollar sixty-eight cents. Specially ya get ta hear their voice n you know
so...an course I call Vegas quite often. I called them the smoming about eight
o'clock. Their time is hour different now. It won't be the end of April but right
now it's an hour. So when it was nine here it was eight there so I got ta talk to
them this morning. (S72, LI614-1636)
Ralph stated:
I got this new rug - the new rug underneath. Then I got a man ta come m an first
of all I sold everything. Got rid of it. An I sold a lotta stuff". Then I got a man
m ta decorate this room. I mean the walls. An they're fairly clean. Well he went
that fer. That wasn't enough. I decided ta finish it up - the two bedrooms. Cost
me $400.00. An I'm reaUy proud a what it, an I didn't like the looks of it exactly,
this rug, so I bought these rugs. (S16, L367-383)
Ehna stated;
127
And (chuckles) she said to me one day I wish you'd take some of this stuff she
said and then she suggested taking those vines. Well I had oh I guess maybe six
or eight little clumps about like that. I call them little clumps. They were root
things and I started sticking em out here anyplace jut to keep em going you know.
And after we got the yard kinda landscaped, started in on inq)roving the yard. I
got the idea, said well why don't I stick those things here and there. And divide
em and that's w^iat happened. They just took oflE Then I have it all around on
this side too.(S50, L1096-1110)
This category like the category community environment, was not addressed by
those m the Depressed Group. The omission of the theme activities of daily living, was
striking when compared with the intense interest and pleasure expressed by the Nondepressed Group.
Problem-solving. All members of the Nondepressed Group had suffered
significant losses. Margaret's sense of hardiness after the loss of parents, husband and son
is depicted in her interview summary. Margaret's interview indicated she believed herself
to be quite capable of managing her problems and her sister's as well. As evidenced in
their interview summaries, Karen and George stated they were happier after the deaths of
their spouses. Both expressed a joy in being able to do things their way mstead of their
spouses way and living on their own. Karen solved problems by immersing herself in daily
life and being happily and tenaciously interested in her family and friends. George had
"reorganized" himself to transcend physical Ihnitations and remained assertively m control
of his life. His opinions were firm and he enjoyed confronting challenges. Miriam does
128
aot address this category directly but her interview indicated that she had many ideas for
solving problems in today's society. Alice stayed quite busy, respectfiilly cared for herself
and didn't hesitate to become involved m solving community issues.
The Depressed Group had also suffered numerous losses. David lost his mother,
son and wife and was facing the ultimate loss of his own life. Perhaps of greatest import
to David at the time of his interview was the loss of confirtaation of his self-image. Daily
he was experiencing assaults to the person he believed he was. '1 never depended on
nobody. 1 was able ta take care of my own affairs all of my life because I knew enough
what ta do and what not ta do." (S2l, L327-329) Madge was engrossed in the loss of
her family and their failure to acknowledge her worth. This perception extended mto the
community where she tried to help neighbors but was unable to solve their problems and
be appreciated for it. BCathryn felt powerless to rectify the disability that had curtailed her
favorite activity, dancing. Billie was also having diflSculty overcoming the health barriers
interfering with her painting as well as physical activity. Burt was actively attempting to
problem solve the many dilemmas on his mind by studying and applying a psychological
theory. At the time of his interview he seemed to be in a state of confiision.
In summary, all participants experienced numerous losses in their lives. For those
m the Non-depressed Group, there was an attitude of strength and buoyancy that did not
diminish the sense of loss, but allowed them to detach and move on with their lives. Some
even perceived their lives as improved. In general members of the Depressed Group were
embedded in emotions associated with grief such as anger, depression and confiision.
129
Beliefs. Beliefs were a primary source of meaning for some in the Nondepressed
Group. Miriam and George had many salient critiques of today's society. These were
often tendered with a sense of humor. Miriam stated:
I don't think those casinos lose that much money. There's too many of em and
they keep building em every day n so they have to be makin money. You
betcher life. They didn't build Laughlin with five dollars I can tell you. The last
time we were there my husband and I went over. We did some fishing m
Bullhead and we went over one night and had dinner and such. Each one tries
to be bigger and more fabulous than the last one. An they're gettin to be like
they're maggots almost... (S23, L 373, 383)
George stated:
An another thing's gonna destroy this country is we constantly build for war.
We're gonna have nothing left. We're gonna have nothing left. It's hard ta get
things but we're gonna destroy the world with building fer ta have wars. I
guess it's a bigger job ta have peace fi'om the way they look. (S24, L648-658)
Margaret stated, "She knows how her mother is but she doesn't want to face the facts.
There are people like that. You've got to face the facts. (Laughs) when they're there in
fi-ont of you, you've got to face them." (S17, L374-377) Ehna integrated her religious
beliefs into her behavior this way;
I am pleased if anybody asked me in a way to prove what the Lord has
been so good to give to me. Why shouldn't I be up and honest and say
sure I'm ninety whatever. And give him credit for what he's domg for me
130
and has done for me in all these past years. To keep me going and to
watch over me now at this age when I really need it to as well as younger.
And I feel it's a discredit to God not to be upfront and honest about it (S42,
L930-947)
In the Depressed Group, Kathryn had few commentaries and all were family
related. For example, she noted her grandson was domg a wonderful job of raising his
daughter by himself Burt's commentaries were associated with his introspection. "I'm
not sure that constructive criticism is a very usefid tool. Uh I think a critique is
worthwhile. You can very easily step on some overtender toes you know. Even with a
good critique." (S49, L1084-1091) His commentaries did not broaden beyond his
immediate world. David said, "Most anybody you meet today anymore, they're all tryin to
get somethin out a ya or somethin or other. Rip you oflE An that's what I call rotten
people. An this whole coimtry's fiill of em." (S39, L635-641) Madge's commentaries
were overwhelmingly related to her family problems and concerned her perceptions of her
sisters. Billie's commentaries were, m general, related to her current health problems or
qualifying her past.
In summary, beliefs in the Nondepressed Group were held as strongly as those in
the Depressed Group but with a sense of hiunor that seemed to be lacking m the
Depressed Group. Beliefs among members of the Depressed Group seemed to be more
personally oriented versus observations on the state of the world expressed by members of
the Nondepressed Group.
131
Education. Of those m the Nondepressed Group, Margaret noted, "T had an
education you know partly. I had eight years of granxmar an then uh a year I thmk of high
school and I left. And um (laughs) foolidily." (S12, L227-233) She is hopmg to take
community coUege courses after her sister dies. Karen's only reference to education was
her piano lessons "at the age of 76." As reported in his interview sunmiary, George
always wanted a formal education but was unable to get one. Miriam did not mentioned
education. Elma's childhood formal education experience had been uncomfortable due to
her language deficit and shyness.
In the Depressed Group, Kathryn pursued a trade education and was quite
successfiil m her beauty career as a result. Burt was educating himself with psychology
books at the time of his interview. Of formal education, he stated skipping two years in
school caused him problems. As reflected in his interview summary, David was extremely
proud of his self-education and graduation fi:om the "college a hard knocks." Madge's
sole mention of education was of having trouble finding work m the trade in which she had
been educated. Billie stated:
I never had any formal education until I was in [Houston]. An then uh got ahold
of a man that, what the hell is his name, [Korlaz]. He was European trained and a
very good artist an I admired his worL An a lot of this new fangled stuff I can't
stand. If rt doesn't look Uke somethin I can identify I don't want any part of it.
An uh I studied with him there for about 2 years. He helped me an awfid lot.
(SI9,L253-269):
132
Educatioa revealed the least discrepancy m perception among the Nondepressed
and Depressed Groups, both expressmg roughly equal positive and negative sentiments.
In conclusion, the positive and negative perceptions of themes of meaning differed
between and within the Nondepressed and Depressed Groups. However between Group
differences were most prevalent. Although both Groups perceived themes positively and
negatively, the life stories of those experiencing depression revealed more negative
perceptions than those \\dio were not depressed. Everyday occurrences such as activities
of daily livmg and the residential community were a major source of joy for those in the
Nondepressed Group, yet were not addressed by those m the Depressed Group.
Perceptions of health also emerged as a major difference between the two groups.
Second Level B: Analysis of Manifestations of Self-Transcendence
The research question concerning how self-transcendence was manifested in life
stories of depressed and nondepressed elders was answered by a Second Level analysis of
manifestations of self-transcendence in Group interviews. Fmther analysis and synthesis
of mtragroup interviews was conducted, vs^ch illustrated the manifestations of selftranscendence in life stories from the Nondepressed and Depressed Groups. Comparisons
between groups illustrated some primary differences m life stories and commentaries
between the Nondepressed and Depressed Groups.
Research Question 5
This research question 'liow is self-transcendence manifested in life stories of
depressed and nondepressed elders" was answered by examining the life stories for
manifestations of three key elements of self-transcendence: 1) temporal mtegration of past.
133
present and future; 2) extension of self-awareness outward; and, 3) extension of selfawareness inward. Results revealed that all three areas were manifested by the informants
(see Table 13). For example, those in the Depressed Group were unable to reconcile the
past and/or the present conq}ared with Nondepressed Group who seemed to have
pleasurably integrated past and present.
Research Question 6
The research question "do manifestations of self-transcendence in life stories of
depressed and nondepressed elders differ" was answered by comparing manifestations of
self-transcendence between the Depressed and Nondepressed Groups for each element of
self-transcendence. This was done by examination of the stories, commentaries, theme
perceptions (Table 12, p. 118) and Activity Question (p. 138) of the participants for
mdications of inward expansion of boundaries, outward expansions of boundaries and
temporal mtegration. Differences m self-transcendence between the Depressed and
Nondepressed Groups resided in the temporal aspect of self-transcendence where the two
groups were qualitatively different in terms of their responses concerning temporal
integration. Further, the lack of temporal mtegration spilled over mto other expressions of
self-transcendence whereby the Depressed Group, I) displayed an inward, ongoing
rumination over the unresolved temporal paradoxes and, 2) were unable to extend the self
outward beyond the famer rummations (see Table 13,
p.
137).
134
Table 13: Manifesfations of Self-Transcendence in Groups
Elements of self-transcendence
Depressed
I. Temporal integration
Unresolved paradoxes
of past and present
Q. Outward expansion
None evident
in. Inward expansion
ongoing rumination over
unresolved paradoxes
Non-depressed
Buoyant integration
of life circumstances
Pleasurable immersion
in life
Integrated sense of self
Participants' stories and commentaries indicated the primary difiEerence in selftranscendence between the Nondepressed and Depressed Groups lay in the temporal
aspect of self-transcendence rather than the mward and outward expansion of boundaries.
However, the inward and outward expansion of boundaries were greatly aflfected by a lack
of temporal integration.
Diflferences m manifestations of selF-transcendence are fiirther elucidated by
comparing participant replies to the question about current favorite activity on the
demographic questionnaire. Table 14 (pg 138) lists these replies.
135
Table 14: Participants' Favorite Activities
Nondepressed
Margaret: (no reply)
George: " bingo, taking care of life as the best I can"
Ehna: "volunteer work"
Karen: "games, quilting, coimted crosstitch"
Miriam: "bingo and card games with friends"
Depressed
Burt: "reading"
Billie: "reading, watching TV"
Henry: (no reply)
Kathryn: "dancing, can't 3 hip replacements"
Madge: "companionship of my dog"
Multiple examinations of the mterviews and demographic data revealed several
unresolved paradoxes among the Depressed Group. By paradoxes the researcher means
experiences and/or perceptions that are contradictory. These paradoxes were
representative of the lack of tenq)oral integration experienced by this group. Those who
were experiencing no depression may have had similar paradoxes in the past (most
certainly George and Margaret had) but those had been resolved. Unresolved paradoxes
were not apparent in the interviews of the Nondepressed Group. The following
136
representative paradoxes were identified among those who were depressed and an
interpretation of the affected element of self'transcendence follows in parentheses.
Billie: I) spent "a lot of time" thinking about ^\ilat she should have done and didn't
(thwarted temporal integration)
2) had a great love and knowledge of farm animals but no current access or outlet
(thwarted outward expansion)
3) was experiencing activity limitations not consistent with her self-concept of
betQg active (thwarted mward expansion)
Madge: 1) spent most of her life helping others but was not appreciated (thwarted
outward and inward expansion)
David: 1) was experiencing the incongruity of a self-concept of strength and capability
combined whh present dependency (thwarted mward expansion & temporal
integration)
Burt: I) was contemplating dilemmas of past life experiences which were causing
confusion and a sense of disconnectedness (thwarted temporal mtegration)
Kathryn: I) can no longer dance, an activity that was primary source of joy throughout
her life (thwarted outward expansion and temporal integration)
2) quit three successful careers to assist her husband (thwarted outward
expansion)
In conclusion self-transcendence was manifested m the Ufe stories of the
Nondepressed Group through an inward self-awareness and outward (other) mterests
combined with a cohesive sense of self derived through integration of the past and future
137
to enhance the present. Those experiencing depression were inadequately experiencing an
inward and outward expansion of boundaries. What no one m the Depressed Group had
achieved was a cohesive sense of self that would have facilitated the inward and outward
expansion and temporal integration of self-transcendence. The ten^oral integration aspect
of self-transcendence present in the Nondepressed Group contrasted sharply with that in
the Depressed Group, and was a key difference m self-transcendence between Groups.
Bringing It All Together
Research Question 7.
The research question "how do outcomes of the qualitative and quantitative
analyses compare and inform each other" was answered by comparing tables and
discussing how combining results firom the two methods facilitated a greater depth and
breadth of understandmg of the concepts m question (see Table 15).
Results of both analyses were consistent and served to inform each other at
different levels (Table 15; pg 142). Fimdamentally, the GDS identified groups of
depressed and nondepressed persons. The interviews within these two groups reflected
the instrument diagnoses and gave voice to the people within these groups to heighten
understanding of the factors mvolved. Depression correlated negatively with purpose m
life and self-transcendence (the independent variables). Scores on each of the scales
measuring the independent variables were significantly lower for those experiencing
depression mdicadng as depression increased a sense of meaning in life and selftranscendence decreased.
138
The qualitative anafysis served to identify themes from life stories and
commentaries reflective of meaning in life and self-transcendence. Characteristics of
depression and well-being were derived from themes of meaning in life and selftranscendence. Individual perceptions and experiences of meaning in life and selftranscendence emerging from the interviews paralleled the mstrument scores for each
variable. Finally, health was a primary factor influencing a person's sense of well-bemg as
depicted in the demographics and interviews.
139
Table 15: Synthesis of Quantitative and Qualitative Analysis Resuhs
Group Instrument Scores
Depressed (^=12)
Nondepressed (N=60)
mean (range)
14.2 (12-17)
41 (31-46)
83.2 (66-101)
GDS
STS
PIL
(N=5)
Individual Instrument Scores
GDS score
12 16 13 17 13
mean (range)
.20 (0-1)
48.6 (38-56)
132.8 (122-140)
(N=5)
I
0
0
0
0
48 56 50 51
ST score
46 48 36 44 31
38
PIL score
66 89 101 93 67
134 140 122 140 128
Positive rP"* and Negative fN) Perceptions of Themes of Meaning in Life and Self-Transcendence
Across Grouos
DEPRESSED ^=5-)
MEANING IN LIFE THEMES
Career
N
Family
P,N
Friends
N
N
Health
P
Memories
Interests/hobbies
P,N
Community environment
Activities of daily living
E^oblem-solving
N
Beliefs
N
Education
P,N
Total 4 P 8 N
NONDEPRESSED (N=5)
P,N
P,N
P
P
P
P
P
P
P,N
P,N
10P4N
Manifestatioiis of Self-Transcendence in Grouos
Elements of self-transcendence
I. Temporal Integration
n. Outward expansion
HI. Inward expansion
Total
DEPRESSED
Unresolved paradoxes
of past and present
None evident
ongoing rumination over
unresolved paradoxes
3N
NONDEPRESSED
Buoyant integration
of life circumstances
Pleasurable immersion in life
Integrated sense of self
3P
140
Conchisioii
In conclusion, the results of the quantitative and qualitative analyses are congruent.
Scores indicatmg depression were correlated with lower scores on mstruments measuring
meaning in life and self-transcendence. These resuhs were fiuther depicted m analyses of
interviews of the Depressed and Nondepressed Groups. Negative perceptions of
meaningfiil life experiences were more evident in the Depressed Group than the
Nondepressed Group. The essential elements of self-transcendence, inward and outward
expansion of boundaries and temporal mtegration were either missing or inadequately
represented in the stories of the Depressed Group. These same essential elements of selftranscendence were clearly present in the stories of the Nondepressed Group.
Through the use of multiple methods - a larger picture was generated than would
not have been feasible using a single method, histruments allowed a greater number of
participants to be tested, thereby generating statistics demonstrating significant
relationships among the primary concepts; depression, meaning in life and selftranscendence. Interviews with participants scoring at the extreme ends on the depression
scale for this group provided insight into not only the experience of depression but
meaning m life and self-transcendence as welL Interviews provided the essential context
for mterpretation of the quantitative findings.
141
CHAPTERS
DISCUSSION AND RECOMMENDATIONS
The findings presented in Chapter 4 ilhistrate relationships and differences among
meaning in life, self-transcendence and depression. Within Chapter 5 the researcher will
address interpretations of these findings as they inform the research questions, as well as
considerations relevant to the literature and theoretical fi'ameworks. Implications for
nursing theory and practice are discussed as well as recommendations for future research.
Overview
Elders' perceptions and experiences of depression and spirituality (represented in
part by meaning in life and self-transcendence) were investigated fi'om a quantitative and
qualitative perspective. The purpose was to gain an improved understanding of &ctors
that are related to emotional well-being or depression at the end of life. Overall the results
of the quantitative and qualitative investigations supported and enhanced understanding of
the data fi:om each.
Quantitative data collection allowed the researcher access to larger numbers of
people than could have been accomplished in the same circumstances with solely
qualitative data collection. As a result of mcorporating quantitative data collection into
the research design, the study was strengthened in terms of generalizability and
representativeness of qualitative sample selection.
The qualitative data collection allowed the researcher a brief glimpse into the lives
and perceptions of the 10 elders interviewed. Although the ioterview encounters were
relatively fleeting (lasting one to three hours), the participants received the researcher
142
warmly
openly and freely shared of themselves. A colorful portrait of each participant
emerged from their stories and commentaries; rich portraits that fostered a greater
miderstanding of answers to quantitative instruments as well as generating inclusive
categories representing characteristics of meaningfiil aspects and self-transcendence m the
lives of depressed and nondepressed elders.
On the other hand, the color and richness ehicidating the complexity and
individuality of each participant made it difiScult for the researcher to move beyond the
individuaL To combine characteristics in an effort to achieve greater levels of abstraction
for the purpose of analysis seemed to sUght the heterogeneity, essence and complexity of
each participant. Therefore the researcher provided a brief sketch of each participant as a
means of illustrating this distinctiveness (Appendix D & E) as well as contributing to
quaUtative analysis credibility.
Study Limitations
The internal and external vaUdity of the quantitative portion of this study was
limited by several issues. The use of nonprobability sampling mcreased the possibility of
sampling error thereby limiting the internal validity of the findings. GeneraUzability was
limited by the sample being all White, with the overwhehning majority being women with
religious beliefs and professing to have no financial worries. Additionally, division of the
sample into groups of depressed and nondepressed elders based on their GDS scores
rendered unequal groups, which would be expected in a community-based sample.
Because assumptions of normality for the parametric tests were violated, nonparametric
tests were used.
143
For the quantitative and qualitative portions of the study, there may have been a
difference between those who chose to participate by completing questionnaires or
granting interviews, and those who did not. The majority of those eligible in the two
largest retirement communities sampled chose not to participate. A large body of research
suggests those who are depressed tend to be isolative. This behavior may have been
demonstrated by one or more of the three members of the depressed group who refused to
be mterviewed for the qualitative portion of this study. Accordingly, isolative behaviors
may account for the fact that no one completing questionnaires scored in the severely
depressed range - those being more severely depressed choosing not to participate in the
research. In the two largest retirement conamunities mstnunents were completed without
the researcher present. Therefore, it is unknown whether questions were answered in a
distraction free environment and whether collaboration occurred.
Within the qualitative portion of the study, credibility is Umited by the fact that
three participants with higher GDS scores than others in the Depressed Group refused to
participate. Credibility may also be limited by the fact that interviews were conducted by
two separate researchers (the author and a research assistant) however, the taped
interviews revealed little difference m the mterviewers' styles. Further, Umiting credibility
was the researcher's knowledge of participants' GDS scores prior to interview analysis.
The results of the qualitative analysis of the Depressed Group must be mterpreted keeping
in mind these participants tested within the mildly depressed range on the GDS. Interview
analyses of participants scoring within the seriously depressed range would likely have
differed. Therefore, the use of the term Depressed Group must be cautiously interpreted.
144
Further, as is often the case in qualitative research those interviewed comprised a
relatively small group a£fecting the transferability of this study. Member checks were not
done for reasons discussed in Chapter 3.
Research Questions 1 and 2
The findings concerning meaning in life and self-transcendence in the context of
depression among elders supported existing theory. The strong negative correlations
between meaning m life and depression, and self-transcendence and depression supported
the researcher's theoretical fi:amework, theoretical works by authorities m the field (e.g.
Frank!, May, Yalom, fBatt, Maddi, Schmid, etc.), as well as current research (e.g. Reed,
Coward, Crumbaugh and Maholik, Blazer, Osgood, LesnoflF-Caravaglia etc.). Theoretical
authorities and researchers suggest that meaning in life and self-transcendence are strongly
associated as well as primary elements of the experience of well-bemg. Those who are
depressed experience a lack of self-transcendence and negative connotations to, or a lack
of meaning in life.
Further, the average score on the PIL among the depressed group was 93 as
compared to an average score of 111 among the nondepressed group, a significant
difference. Also supporting the idea that meaning in Ufe is an important correlate of wellbeing; Crumbaugh and Maholik (1981) designated a score of 91 or below on the PIL as an
indicator of a lack of clear meaning and purpose in Ufe. Several researchers found
meaning in life was a critical factor for maintaining a strong sense of well-bemg (Zika &
Chamberlain, 1987, 1992; Rappaport, Fossler, Bross & Gilden, 1993; Florian, 1989;
Ebersole & DePaola, 1989).
145
bi addition, statistically significant differences in mean scores on the STS
between Depressed and Nondepressed highlight one nnportant distinction in life
perspectives between depressed and nondepressed elders. The results of the quantitative
analysis of the GDS, PEL STS and demographics mdicate those ^^o are suffering from
depression appreciate less of a sense of self-transcendence than those who are not
depressed. Likewise, several studies by Reed (1986; 1987; 1989a; 1991b; 1992), Coward
(1990a, b; 1991; 1995; 1996), Coward and Reed (1996) and Coward and Lewis (1993)
revealed a strong relationship between self-transcendence and gaining or maintaining a
sense well-bemg.
Research Questions 3 and 4
Findings concerning the life story themes of meaning m life identified specific areas
of meaning for elders and revealed distinct differences between depressed and
nondepressed elders. Eleven themes were abstracted from Ufe stories and commentaries
of all mterview participants and served to represent the themes of meaning in life for this
study. These themes included career; family; fiiends; health; memories; interests/hobbies;
community environment; activities of daily livmg; problem solving; beUefs; and, education.
Each theme generated a uniquely perceived sense of meaning for each participant. For
example, Madge's devotion to domg things for her family was not appreciated by the
family, thus these efforts contributed to her ejqjeriencing a different sense of meaning from
her family relations that the meaning experienced by Karen. For Karen, doing things for
her family was an important and joyfiil experience.
146
These themes ehicidate the dejSnitioii of meaning in life adopted for this study "...ontologjcal significance of life from the point of view of the experiencing individual
(Crumbaugh & Maholick, 1964) and "...the cognizance of order, coherence, and purpose
in one's existence, the pursuit and attainment of worthwhile goals and an accompanying
sense of fiilfiUment" (Reker & Wong, 1988, p.221). The themes generated are of primary
significance in the lives of the individuals interviewed, whether their meanings are
perceived as positive, negative or both.
Because only 10 people were interviewed, the themes generated are not
necessarily representative of themes of meaning in life that might be abstracted from any
other group of depressed and nondepressed participants. The themes family and frietids
could have been grouped under a broader heading such as relationships. However
families and fiiends were of such disparate significance to most of these participants, to
merge them would have been misrepresentative.
The theme beliefs, while a composite of the subthemes current affairs and selfconcept/persotial development, represented a roughly similar significance among the
participants addressing these issues. All represented beliefs about the sel^ others or the
environment. Beliefs about the self and ciurent afiairs were held firmly among participants
and provided great msight into mdividual perceptions. For example, George, having been
physically active all of his working life, now perceived his health as failing, so alternatively
was enthusiastically developing his mtellectual capacities. Kathryn, on the other hand, had
not changed her self-image as a dancer, thus, was greatly distressed by the fact that she
could no longer dance due to health problems.
147
The theme problem-solving was coitq)osed of fom" subthemes includmg dealing
with losses, helping others, help from others and humor. Humor was an inferred
category, one not expressly addressed by the participants, rather concluded by the
researcher from the way it was used to qualify stories and comments, and from laughter
during the interviews. Dealing with losses had an mdividual or self-initiated and focused
orientation, as opposed to being helped by or helping others. Stories represented by this
subtheme provided an mtimate view of the cognitive and affective processes of the
participants and revealed some of the greatest diSerences between the Depressed and
Nondepressed Groups.
Identification of discrete story and commentary themes in the first level of analysis
was initially an exercise in confusion and ambiguity. Labov's (1982) method of story part
identification assisted discrimination of stories and commentaries greatly. Constant
comparative analysis led to multiple reformulations of story and commentary meanings as
patterns emerged and themes became distinct.
Differences m meaning in life themes between depressed and nondepressed elders
were described in a matrix comparing themes and perceptions (Table 12). The matrix
revealed differences between Depressed and Nondepressed Groups, particularly in
reference to the affective perceptions and directional (outward) focus of these themes.
Those in the Depressed Group had more negative affective perceptions of the themes of
meaning in life than those in the Nondepressed Group. Further, the themes of meaning m
life addressed by the Nondepressed Group had more of an outward focus than those
addressed by the Depressed Group
148
Affective Perceptions
Positive and negative perceptions of commonfy identified themes differed between
Groups as depicted m Chapter 4 narrative. Appendix D and E and Table 12. Stories and
commentaries were analyzed for overall positive or negative affect or attention, affect
bemg the observed emotional component and mtention being participants' interpretations
or perceptions. A positive affect or mtention is one that leaves the listener/reader with a
sense that something satisfying or hopefiil was perceived. A negative affect or intention is
one that implies a sense that things were worse, unrewarding or nullifying. For example,
Margaret lost several important people in her life but the pomt of her story was that she
didn't dwell on the losses but marched forward. When David lost his wife he "died with
her."
Although perceptions of themes were positive and negative within both Groups,
those who were nondepressed expressed far more positive perceptions than those who
were depressed. Those who were depressed expressed far more negative perceptions than
those who were nondepressed, particularly in themes such as friends, health and problem
solving. Therefore, differences in stories and commentaries between Depressed and
Nondepressed Groups occurred not onfy in themes but in affective perceptions of each.
Outward Theme Focus
Those who were not depressed addressed two themes not addressed by those
experiencing depression, community environment and activities of daily living. Both
themes have an outward focus, as opposed to more mtrospective themes such as beliefs
and problems solving, and when appraised ia context reveal a reUsh of and delight in the
149
everyday, the mundane. Nondepressed mdividuals found pleasure in such things as
planning tomorrow's agenda, schedulmg dinner around a card game, chatdng at the
tDailbox, creative ways of using the garden vegetables so none would be wasted, the
independence of living alone and living a common life. This group expressed grateful
pleasure with their living environment and participated actively in the community.
Those m the Depressed Group were not community oriented at the time they were
interviewed. Three were preoccupied with heahh problems (David, Billie and Kathryn),
one with family problems (Madge) and one with past life circumstances (Burt). Their
focus was mward, often perceiving circmnstances negatively. Nor did they appear to
delight m everyday activities. For some, these activities had been negatively nifluenced by
ongoing health problems (Billie, Kathryn and David). Others did not appear mclined to
consider the blessings of performing everyday activities due to being intensely focused on
other issues (Burt and Madge).
Research Questions S and 6
Fmdings concerning the manifestation of self-transcendence in life stories identified
three ways in which self-transcendence was experienced and revealed differences between
depressed and nondepressed elders. Research questions five and sbc were answered with a
third level analysis of the qualitative mterviews as well as answers to a question
concerning favorite activities. Reed's (199 lb) definition adopted for this study indicated
self-transcendence is "...the expansion of self-boundaries in multi-dimensional ways; a)
inwardly in mtrospective activities; b) outwardly through concerns about others' welfare;
and c) temporally whereby the perceptions of one's past and future enhance the present"
150
(p.5). Members of the Depressed Group exhibited deficiencies, while members of the
Nondepressed Group exhibited proficiencies in the three dimensions of self-transcendence,
introspective activities, outward concerns and temporal mtegration. ti general, these
dimensions were significantly mterrelated for both Groups.
Introspective Activities
For most in the Depressed Group, introspective activities were of primary concern.
The affect demonstrated by the one participant (Madge) with an outward focus, was one
of anger because her efforts to help others were not appreciated. This anger and the focus
on self suggests a strong mward component. Her tone of voice, rapidity of speech and
focus on family betrayals were interpreted by the researcher as an ongoing rummation over
perceived injustices. However there seemed to be continuity m Madge's perceptions of
herself as an unappreciated caretaker which surpassed her family and reached mto the
commimity as well
Burt seemed to be in the throes of Ufe review and actively and passionately
attempting to resolve perceived problems and mconsistencies in his Ufe. There was a
sense of vitality suppressed by poor health and sad introversion when talking with Billie.
She took pride m her male-oriented pursuits yet in a fiustrated tone stated she spent most
of her life doing things she knew nothing about. She believed her talent and love of
painting were wasted. She had a great knowledge and love of animals, particularly horses
and sheep, but had no access to them nor had she experienced any deshe fi'om others for
her to share that knowledge. Her previously active life which she relished was now
151
sedentary due to poor health. And finally she lost her femily heritage, now important to
her, with the eaily death of her parents.
Although the Nondepressed Group as a \\diole were not as consumed with
introspective activities as the Depressed Group, they had expanded their mner boundaries
by altering their self-perceptions to be compatible with current circumstances (fiuther
described in "temporal integration"). Their mward focus seemed less of a present
circumstance compared with the Depressed Group. In other words, they were not
consumed with introspection yet had achieved an integrated sense of self Perhaps for the
Nondepressed Group, an inward focus had been more predominant previously m their
lives.
Outward Concerns
The predominantly outward focus of the Nondepressed Group indicated a
pleasurable immersion in life in that they found pleasure in bemg productive and
contributing to others or the community. Karen kept herself "too busy to be lonely."
Activities listed by the Nondepressed Group all mvolved interaction with others, with the
exception of Margaret who did not answer this question. Her interview led the researcher
to infer that Margaret, who is ever vigilant for sales scams, may have believed answering
this question provided potential grist for inventive and sneaky sales people, of uiiom the
researcher might be one. Margaret beheved these salespeople preyed on the elderly, and
in fact she had thwarted attempts to bilk her sister of her savings. In support of this
allegation, she also did not list her biggest wony on the demographic form, and was quite
suspicious when initially contacted for her interview.
152
Overall the stories of the Depressed Group demonstrated little outward focus with
an expansion of boimdaries, particularly compared to participants in the Nondepressed
Group. For most in the Depressed Group, outward concerns were nonexistent or clearly
overshadowed by introspective activities. Among the Depressed Group, Billie and Burt
listed solitary activities as their favorites (reading and watching TV); David listed no
activity and Madge listed the companionship of her dog. Kathryn hsted a social function
(dancing), but indicated she could no longer take part in the activity due to serious and
permanent health constraints.
Temporal Integration
In all cases, the Depressed Group had not achieved temporal integration as had
members of the Nondepressed Group. The activities and stories of those who were
nondepressed reflected a buoyant integration of life circumstances, a manifestation of
temporal integration. The word buoyant, a floating above or transcendence of life's
myriad problems, characterized all of the interviews of the Nondepressed Group.
While members of both Groups had experienced many of the same traumas
throughout life, the Nondepressed Group found meaning in life as the result of their ability
to transcend and integrate problems m a number of ways. For example, George was
reorganizing to transcend his physical limitations (an introspective activity resulting in
temporal integration). Ekna maintained a productive mterest in her community to
transcend not only her problems but those of the community as well (an outward focus
resulting m temporal mtegration).
153
Despite extraordinarily different pasts, the Nondepressed Group displayed more
characteristic homogeneity in terms of self-transcendence than the Depressed Group.
They had all achieved temporal integration through reorganizing their self-concepts to
positively mcorporate changes accompanying aging. The activities and stories of those in
the Depressed Group reflected various unresolved paradoxes of the past and present
mdicating a lack of temporal integration. All of those m the Depressed Group were
experiencing ongomg ruminations over imresolved paradoxes, an inward focus without
boundary expansion.
Kathryn, maintaining a passion for dancing, beUeve this activity had been usurped
by a physician as the result of improper hip surgery. She had not found a replacement or
alternative interest for dancing compatible with her physical limitations. Further, BCathryn
manifested a wistfidness when talking about her careers, cut short to meet the needs of her
husband. She mferred she spent time wondering about the past asking "what if' she had
continued with her careers and functioned to her fiiU potential, fiiterestingly, congruent
with her life of fiilfiUing other's requests, this gracious lady followed the researcher's
directions ("I would like for you to tell me the stories from your life you find yourself
remembering the most - the stories that are important to you") by only telling pleasant
stories from her past. Not asked to expound on her current activities or problems, she did
not. In addition during the mterview Kathryn appeared to be reliving her wonderful life
and finding pleasure in the escape. Not until answering the demographic questions about
activities and worries did any discontent surface with clarity.
154
Madge's paradox consisted of devoting most of her life to others and receiving
little but negative consequences m return. Despite seemingly coherent self-perceptions,
and an outward focus, she had not been able to reconcile her past to enhance her present
life. One of Billie's paradoxes was reconciling her physically active past and male oriented
pursuits with her current life of poor health nnposed inactivity.
At the time of his interview, David's paradox was experiencing dependency versus
a lifelong self-concept of self-sufficiency. The researcher visited David twice after his
mterview to check on his welfare. Hospice personnel had begun visiting and his daughter
had moved ia with him. He maintained his spark although was very ill and weakened. He
continued to talk of his life in short bursts, particularly his wife but without the anger and
fiustration expressed in his interview. In general, David seemed more at ease with his
situation - possibly a resolving paradox.
Burt was having difficulty accepting physical limitations and expressed antithetical
opinions regarding multiple subjects. He seemed to be testing theories that might explain
and/or rectify concerns and doubts about certain aspects of his life. His focus was inward,
nearly to the exclusion of all else, in a vigorous attempt to reconcile his past to enhance his
present state of mind. At the time of his interview he was managmg his past by trying to
forget it.
Theoretical Lniks
Frankl (1966) noted self-transcendence, a key component for realizing meaning m
life, mvolves the ability to maintain a cohesive sense of self when faced with an
unchangeable situation. The perceived paradoxes in the lives of the Depressed Group had
155
interrupted this sense of sel^ creating the impetus for scrutiny. This scrutiny nnphes a
sense of hope of eventual resolution of the fragmented self-concept. The time required
for resolution varies as widely as the mdividual and may take months, years or never
occur. Of note to nurses, none of the participants in the Depressed or Non-depressed
Groups had relied on health care workers to assist in this process.
The second level B analysis descriptions characterizmg the Depressed and
Nondepressed Groups reflect, m part, a^ects of maturity, Erikson's eighth stage of
development. During the eighth stage of development individuals are reachmg the end of
their life span. The developmental task is to accomplish a sense of ego integrity versus a
sense of despair. A person experiencmg ego integrity will face life with a childlike
enthusiasm and eagerness. This enthusiasm and tenacious grasp on life is vibrantly
depicted m the interviews of the Nondepressed Group.
Alternatively, those who have yet to achieve ego mtegrity may experience a sense
of despair. Lemer (1986) described this state as "mistrustfid, guilty, a sense of identity
diflEiision, isolation and stagnation" (p. 318). Each member of the Depressed Group
exhibited one or more of these characteristics. Perhaps the most apparent characteristic,
the characteristic shared by aU m the Depressed Group, was a sense of identity difllision
described above as unresolved paradoxes or lack of the temporal conq)onent of selftranscendence.
In conclusion, mterviews with the Nondepressed Group illustrated all attributes of
self-transcendence listed by Reed: they knew themselves as sound, autonomous, whole
persons (evidence of boundary expansion introspectively) who were socially oriented
156
(evidence of outward boundaiy expansion), and were consistent and connected in their
inward and outward perceptions in a way that enhanced their lives (a temporal fusion that
infers congruency with perceptions of past, present and fiiture). Those in the Depressed
Group were experiendng paradoxes yet to be resolved in various arenas. These paradoxes
epitomized the lack of connectedness and enhancement of the present referred to ta the
temporal portion of Reed's definition of self-transcendence. Some were intensely
mwardly focused, albeit in some cases struggling to expand their boundaries. One
participant was and always had been outwardly focused. What they had not acquired was
an enhanced perception of the present acquired through hopeful integration of the past and
future.
Research Question 7
The outcomes of the triangulated qualitative and quantitative analyses were
compared and conclusions were informed and strengthened as a result. Quantitative and
qualitative methods of data collection and analysis, although quite different, produced
outcomes that paralleled and complemented one another. Outcomes generated by both
methods were wholly compatible but differed in character.
Geriatric Depression Scale and Interviews
The GDS was used to identify the Depressed and Nondepressed Groups.
Subsequent analysis of interviews with these groups substantiated participants' scores on
the Geriatric Depression Scale, and provided insight into the circmnstances of
participants' well-being or depression. The affective perception of themes of interviews
reflected GDS scores in that those in the Nondepressed Group had more positive
157
perceptions of themes of meaning in life than those in the Depressed Group. Those in the
Depressed Group had more negative perceptions of themes of meaning m life than those in
the Nondepressed Group.
Purpose in Life Test and Interviews
Scores on the Purpose in Life Test were reflected and enriched by the interviews
of groups of depressed and nondepressed elders. Items on the PIL corresponded to the
abstracted meanings of the stories and commentaries offered by participants. For
example, item number 19 on the PIL read, facing my daily tasks is... The respondent had
to choose an answer on a scale of one to seven rangmg from a source of pleasure and
satisfaction to a painfid and boring experience. Karen's ebuUient stories of daily life
reflected the highest ranking of the PEL sci\e, facing my daily tasks is...a source of
pleasure and satisfaction, and indeed that was her answer on the PIL. David, confronting
a terminal disease and disruption of his self-concept answered at the lowest end of the
scHLq, facing my daily tasks is...a painful and boring experience. Question 11 on the PIL
reads. If I shoidd die today, I woiddfeel that my life has been.. Agam on a scale of seven
the choices ranged from very worthwhile to completely worthless. BiUie, who talked of
her wasted artistic talent and who was now experiencing a sedentary life domg little
congruent with her hfelong interests, circled completely worthless. Ehna who was
devoted to her community circled very worthwhile.
Self-Transcendence Scale and Interviews
Items on the Self-transcendence Scale reflected several of the interview themes.
For example participants talked of behefs, hobbies and interests, physical concems.
158
memories, helping others and being helped by others, all components of the STS
questionnaire. Question 2 on the STS asked if the respondent saw her/himself as
accepting myself as I grow older. Kathryn, miable to pursue her passion for dancing
responded, very little. Margaret, opmionated and devoted to caring for her sister
responded, very much. Question 15 asked if respondents spent much time dwelling on my
past unmet dreams or goals. Burt answered somewhat (rather an understatement
considering his interview) and Karen answered not at all.
Interestingly, STS scores did not reflect as much significance as PEL scores when
compared with GDS scores. The interviews however, reflected a strong relationship
between well-being, depression and self-transcendence. Ehna had a low GDS score of 1
(range = 0 to 30), and a relatively low STS score (38, range = 15 to 60), particularly when
compared to other STS scores of those in the Nondepressed Group (range=48-56). In
fact her STS score was low when compared to members of the Depressed Group
(range=36-48). Her interview however, revealed devotion to the welfare of her
community, a cohesive sense of self and pleasure in her current circumstances.
She indicated m STS answers that she did not share her wisdom with others, was
not adjusting to changes in her physical abilities and that she was not helping others. All
of these answers were contradicted in her mterview. Ehna shared her wisdom with the
administration and community members firequently, was devoted to helpmg others and
noted that as a result of tiring more easily, simply took it easy. Whether Ehna was
fatigued at the time the questionnaire was completed, was having problems seeing or
inteipreted the questions m another fashion is unknown. Another possibility could be that
159
a belief in humility, a primaiy value of certain cultural groups identified by religious
afGliations, geographical locations or age defined cohorts, may have mfluenced her
answers. These findings are also usefiil in examining the construct validity of the STS.
All mterview participants discussed health. Reed (199 lb) suggested that body
transcendence is a principle component of self-transcendence in the elderly. This notion
was reflected in the STS with the statement adjusting to the changes in my physical
abilities. As might be expected, in general this statement was answered by those in the
depressed group with not at all or very little. Those who accomplished body
transcendence had effectively integrated physical changes into their lifestyle and were well
represented in the Nondepressed Group. Those in the Nondepressed Group experiencing
health problems referred to ways in which they were successfiilly managing their physical
changes to avoid disruption in their lives. Those who were experiencing depression were
all suffering fiom unresolved health problems that were causing significant difficulties in
their lives. These unresolved problems indicated those in the Depressed Group had yet to
achieve body-transcendence.
Discrepancies Between Financial Worries Question and Interviews
Discrepancies existed between answers to the question about financial worries and
a question about current worries. The majority of participants answered that they did not
have financial worries, yet within the same questionnaire several responded that their
biggest current worry was meeting monthly biUs. Additionally some of those interviewed
answered they had no financial worries, yet went on to describe financial concerns m their
interviews. In the past literature supported a positive link between having financial
160
problems and depression in the elderly (Evans et aL, 1991; Neugarten, Havinghurst &
Tobin, 1961; Murphy, 1982; Parkerson, Broadhead & Chiu-Kit, 1991).
A possible confoimding factor may have been the &ct that the majority of
participants benefitted fi'om subsidized housmg yet how this mfluenced their answers is
unknown. The elderly may be hesitant to divulge information about their finances because
they are frequently victimized financially by the unscrupulous. Because the questionnaires
were distributed and completed without establishing a relationship, the response
discrepancies m interviews and questionnaires may reflect an element of distrust at the
time questionnaires were completed (a relatively anonymous procedure). Perhaps
interviews provided a more trustmg environment then, in which to discuss financial
concerns.
In conclusion, the examples above demonstrate the larger picture resulting fi'om
combining qualitative and quantitative methods. Misinterpretation of outcomes is reduced
through the verification afforded by using multiple methods to examine an issue. In this
study, the qualitative and quantitative analyses generally corroborated and informed each
other through analogous outcomes and informed gaps at times evident within a single
method. Inconsistent results of the two methods, particularly discrepancies between STS
scores and interviews, provide fertile groimd for fiiture research.
Links with Previous Research
Depression
The literature documented several cognitive and affective factors experienced by
depressed elders such as anhedonia, feelmgs of worthlessness, guilt, di£Bculty
161
concentrating or memory loss, apathy, and problems with intimacy and accepting the past.
Feelings of worthlessness were most strikingly identified m the mdividnal item PEL scores
of the Depressed Group and in their interviews. Anhedonia, guilt, memory loss, apathy
and problems with intimacy and accepting the past were well illustrated in interviews of
the Depressed Group. These characteristics were not evident m the PIL scores and
interviews of those in the Nondepressed Group.
Unlike many past studies, this study did not directly identify a lack of social
support as a key factor in depression. Neither the instruments nor the demographic
questions addressed social support. However, neither did the stories and commentaries
address social support. Those m the Nondepressed Group were mtensely socially
mteractive, and often they were providing the social support versus having it provided for
them. Of those in the Depressed Group, Burt chose to be isolative and avoided social
interaction. A bachelor, he had the attention of many of the women in the retirement
community but responded with irritation rather than flattery to the attention. Kathryn and
David, while arguably lacking social support in terms of curative medical care, had strong
family support and seemed to primarily be suffering fi-om health problems. Madge may
have suffered from lack of social support in terms of family support however, believed she
spent much of her time providing social support to others.
Comparing this study to those in the literature review is limited by the fact that
none of the Depressed Group was severely depressed as defined by various instruments
testing depression. Those labeled depressed in most previous studies had scores within
the entire range delineated as depressed, mcludmg mild and severe. The mild depression
162
indicated by scores of individuals in this study, may represent what Schmid (1991) termed
"indicators of development and adjustment." None of the Depressed Group had sought
assistance for their depression but then again, none mdicated they believed they were
depressed. Results of the quantitative and qualitative portions of this study corroborated
multiple studies identifying a relationship between depression and a lack of physical health,
loneliness, homebound status and life satisfaction.
Meaning m Life
Meaning m life was strongly supported both qualitativeiy and quantitatively as a
critical factor associated with whether an individual was or was not experiencing
depression. These findings corroborated multiple previous studies. Interestingly, some of
those who were not experiencing depression had negotiated fundamental changes in
mtrapersonal life meanmgs and identities.
Kolarska-Bobinska (1990) addressed the apathy, social passivity and anomie of
Polish citizens foUowmg the radical political reorganization in that country. She
postulated these characteristics occurred as the result of changes in flmdamental life
meanings and the sense of past, present and future, accompanied by the loss of identity of
certain social groups. These observations parallel experiences encountered by many
elderly. In particular several of the Depressed Group participants described properties of
anomie m then- mterviews, as well as apathy. They were unique m that they lacked a
positive identification with a social group. Most however, continued to hold strong
opinions that could not be described as social passivity. However social passivity was
evident m their relative isolation and disinterest in community affairs. As did the Polish
163
citizens, the Depressed Group had little intraindividual congruency in perceptions of past,
present and fixture, the temporal aspect of self-transcendence.
Interviews from the Nondepressed Group contained human characteristics
described by Trice (1990) as providing meaning. These elements included concern for
others, perceptions of being helpfiiL, taking action and positive feelings. The first three
elements were evident to a lesser extent m interviews of some of the Depressed Group as
well, however, positive feelings were not well represented.
Propositions of the study were supported in that participants told stories that were
of personal importance and these stories revealed patterns of self-perception, spnitual
development, self-transcendence and attributions of meaning in life (Table 15; Appendix
D; Appendix E). Further, members of the Depressed Group revealed perceptions that
their life had less meaning than those in the Nondepressed Group as demonstrated by
scores on the Purpose in Life Test.
Self-Transcendence
Study results indicated that self-transcendence is composed of those aspects
identified by Reed (199 lb), inward and outward extension of boundaries and temporal
integration (or expansion of boundaries). Stories and commentaries of members of the
Depressed Group exhibited certain elements of self-transcendence such as introjectivity
and generativity. An element missing firom most of these interviews was "steppmg back
firom and movmg beyond what is" (p. 144) although all of these participants appeared to
be m a process that involved a move in that direction.
164
The Depressed Group had not achieved body transcendence. These results
corroborated those found by Reed (199 lb). Body transcendence, "reflecting integration
of the physical changes due to agmg or ilhiess" (p.8), an indicator of self-transcendence,
was negatively related to depression. Most apparent in the Depressed Group however,
was a lack of temporal mtegration - the paradox of incongruency m self-concept and
current circumstances.
Narrative/ Life Storv
Interviews performed in this study truly humanized and personalized the
participants. Stories and commentaries revealed participants' identities, values,
perceptions, affect, cognitive patterns, histories, relationships and accentuated then- very
special heterogeneity and complexity. As Vezeau (1992) noted, for narrative, the exercise
is not in fact finding, rather enlarges "...the vision of individual possibilities." For the
researcher, narratives afforded an intimate and poignant glance mto the lives and minds of
the research participants. The interviews and their analyses provided insight into and
improved understanding of the results of the quantitative mstruments. It fixrther generated
a respect for the spirituality inherent m all participants regardless of their degree of wellbemg.
Links with Theoretical Frameworks
As reported m Chapter I, the theoretical perspectives of this dissertation were life
span development psychology, existential psychology and narrative theory. Fmdings of
this study were congruent with the fi-ameworks and assumptions of these theoretical
perspectives.
165
Life Span Developmental Psychology
Quantitative and qualitative results soundfy supported the major assumptions of
life span development psychology (Bahes & Brim, 1979; Erikson, 1959, 1980; Lemer,
1986; Sugarman, 1990). Life stories of elders clearly depicted their ongoing
multidimensional growth. Further, stories relating how each individual managed the
dynamic/dialectic life process illustrated the persistent influence and power of life change.
Those who found satis^dng ways of creating and responding to changes in their lives were
not experiencing depression. Those who had yet to accept their life changes seemed to be
strugglmg to find fiilfiUment based on the way things had been or perceptions of the way
things should have been.
Closely related to the dynamic/dialectic life process is the human process of
integrating multidimensional development within the embeddedness of human experience
to realize a coherent sense of self (Lemer, 1986; Erikson, 1980). This was one of the
most striking outcomes of the qualitative analysis. The Nondepressed Group seemed to
clearly know and be accepting of themselves. Those who were experiencing depression
were living an uncomfortable paradox, grappling to hold on to a self-concept that was
mconsistent with their current circumstances.
That human potential for development continues throughout the lifespan is well
demonstrated by the Nondepressed Group in terms of their self-transcendent temporal
integration. Likewise those m the Depressed Group were clearly mvolved m a process of
development that may have been illimiinated had the researcher performed a longitudinal
study. Serendipitously David's development of a more cohesive sense of self was
166
aoticeable during a brief visit after his interview. Burt, Billie and Kathryn seemed clearly
to be involved m vs^at Butler (1963) termed life review and follow-up interviews may
have captured developments m this process.
The stories of all individuals clearly characterized reciprocity between the
mdividual and the environment. Rather than simply coping, adapting and responding (a
popular theoretical framework in psychiatric/mental health nursing texts), these individuals
were also shaping and modifying their worlds. For example, Burt, as the result of his
newfound theories, told his neighbor he would no longer take him fishing. Karen
showered her family with homemade gifts. Ehna saw to it that administrators of the
retirement community stayed on then toes and that community residents actively
addressed and participated in community issues and events.
Baltes, Reese & Lipsitt (1980) suggested that nonnormative Ufe events have a
greater nifluence on development than normative events in the elderly. The interviews
from this study documented that nonnormative events contribute greatly to
multidimensional development in the elderly, but also mdicated that a single relatively
normative event, increasing health problems m the aged, also had a great impact on elders'
development. All members of the Depressed Group were affected by significant health
problems for which they had yet to find an antidote. Of those in the Nondepressed Group,
George was developing his intellectual capabilities as the result of slowing down
physically; Miriam had become quite assertive with regards to her health problems, and;
Ehna was happily enjoying word puzzles as a means of slowing down physically but
stimulating her mind.
167
Havinghurst (cited in Sugannaa, 1986) suggested several developmental tasks
pertinent to elders. These mchided:
Adjusting to decreasmg physical strength
Adjusting to retirement and reduced income
Adjusting to the death of one's spouse
Establishing an explicit afiEQiation with one's age group
Adopting and adapting social roles m a flexible way
Establishing satisfactory physical living arrangements (p. 97)
These tasks were e>q)licitly illustrated within the stories and commentaries of
mterview participants and specifically addressed in the STS. For those in the
Nondepressed Group, these tasks had been accomplished. However many of these tasks
were a source of consternation to the Depressed Group.
Fmally, the differences between the Depressed and Nondepressed Groups closely
approximated Erikson's final stage of development, ego-mtegrity versus despair. Those
experiencing well-being had a fiilfilling, strong and coherent sense of self Likewise,
Erikson described manifestations of ego-integrity as acceptance o^ and taking
responsibility for, one's own life without excessive remorse that it had not been different.
While those who were experiencing a degree of depression may not be necessarily
characterized as despairing, they were not experiencing life as fiilfilling. Erikson
characterized despairing as a fear of death and believing life was too short to alter it's
course. Further, despairing individuals may express contempt for individuals or
mstitutions. These characteristics were only evident to a limited degree in the interviews
168
of the Depressed Group. This may have been the resuk of bemg mildly versus severely
depressed. Items on the PIL and the STS represented key elements of this stage of
development from a broader perspective and indeed, high scores for meaning m hfe and
self-transcendence were positively correlated with bemg nondepressed, and reflected the
developmentally related outcomes of the third level qualitative analysis.
In conclusion, findings of this study were congruent with and supported life span
development psychology. Participants were experiencmg ongoing development within the
context of life change.
Existential Psychology
The assumptions of existential psychology adopted in this study, I) humans
uniquely create their own reaUty and attribute meanmg m their lives - these perceived
realities and meanings being fimdamental to their well-being; 2) findmg meaning in hfe is a
human requirement for experiencing well-bemg, and; 3) self-transcendence is a necessary
component of meaning m life, were well supported by the results of the qualitative and
quantitative portions of this study. Test results revealed a strong inverse correlation
between meaning in life and self-transcendence as they relate to depression. Those
experiencing depression were experiencing less of a sense of meaning in life and selftranscendence as disclosed m test scores and interviews. The diversity of narrative
portraits obtained in the interviews supported the assumption that people uniquely create
their reality and meanings.
Differences hi a£fective perceptions of meaning in life as an indicator of spiritualhy
were clearly evident when groups of depressed and nondepressed elders were compared
169
(reflected in Table 12). likewise, self-transcendence, the second mdicator of spirituality,
was strongly evident m the interviews of those in the Nondepressed Group (reflected m
Table 13). Although certain aspects of self-transcendence (inward and outward expansion
of boundaries) were evident in interviews of some in the Depressed Group, selftranscendence inclusive of temporal mtegration was not apparent. Aspects of selftranscendence were perhaps more explicitly depicted m the interviews than the STS,
where scores between Depressed and Nondepressed Groups revealed less significant
differences than those on the PIL.
Existential psychologists believe contemplation of the four ultimate human
concems (death, flreedom, isolation and meaninglessness) is prompted by pondering one's
own death; a major irreversible decision; or disintegration of a key spiritual and meaningproviding life design. Again this peering inward was clearly portrayed in participants'
mterviews, most notably those in the depressed group. The PIL tested the outcome of
these ponderings of the four ultimate concems at a single point in time. For those in the
Depressed Group a disintegration of meaning-providing Kfe design appeared to be the
paramount catalyst for their concems.
Experiencing life as meaningless is associated with depression, alcoholism and
obsessiveness (Frankl 1978), factors evident in some of the interviews of the Depressed
Group. Disintegration of the life schema intermpts the perceived organized life pattem
necessary for realizmg meaning as suggested by May and Yalom (1989). This
dismtegration of life schema or inability to reconcile v^iat had been with present
170
experiences, was evident in the interviews of depressed participants in terms of their lack
of the temporal aspect of self-transcendence.
In conclusion, data from the qualitative and quantitative investigations supported
the assumptions of existential psychology. Person's in the Nondepressed Group were
perceiving more meanmg in life than those hi the Depressed Group. Self-transcendence
was radiantly evident m the mterviews of those experiencing meaning in life and no
depression.
Narrative Theory
Congruent with narrative theory, stories and commentaries displayed in part the
cognitive and affective nature of the participants. A specialized form of narrative
transcription was used in an attempt to capture some of the cognitive and affective
dimensions evident in speech and difficult to capture with standard transcription
techniques. Field notes assisted recall of an mdividual's affect in particular and patterns in
stories and commentaries Uluminated cognitive characteristics of participants. The
individuality of patterns of thinking emerged distinctly from each of the mterviews and
assisted in the generation of group characteristics associated with self-transcendence.
Participants created meaning in their lives through stories told interpersonally, and
it appeared to the researcher that some participants told stories intrapersonally more than
others. For example, Madge's words flowed as if rehearsed or reiterated many times. Yet
it is difficult to know with any certainty if this smooth verbosity was simply a personal
characteristic or mdeed represented more mtrapersonal story telling.
171
While meaning was certainly created with stories, the outcome of the meaning
derived was at times a sense of de^air or isolation resuhing in anger, con&sion,
frustration and depression. These affective components, rather than stagnant or
permanent, appeared to represent an ongoing perceptual process, thus supporting the
assumption that stories are of varying significance at different times in life. For example,
Burt, through the lens of a psychological theory, was reframing life stories that caused him
distress m the past. Karen's story of the sudden death of her second husband was most
assuredly perceived differently at the time of the interview (she was happy living alone)
than immediately after his death (investigating why her husband had no gotten up for
breakfast she discovered his lifeless body m bed).
McAdam's (1993) assertion that life stories ideally develop in the direction of
increased coherence, openness, differentiation, reconciliation and integration held true for
those in the Nondepressed Group. Among those in the Depressed Group these same
factors were problematic, particularly in terms of reconciliation and integration, once again
components of the temporal aspect of self-transcendence.
In conclusion, in line with narrative theory, participants revealed much about their
cognitive and affective processes as well as meaning producing schemas m their stories
and commentaries.
WeU-Being. Spiritualitv and the Researcher's Theoretical Framework
Researchers have mvestigated the structure and flmction of well-being through
testing and concept analysis. Chamberlain (1987) investigated the structure and
dimensions of subjective well-being and although multidimensional, found evidence of a
172
general well-being factor. Ellison (1983) reported well-being is dependent on the
fiilfillment of four general needs; having, relating, being and transcendence.
Researchers correlating well-being with various fectors report physical health plays
a significant role in the realization of well-being (Bowling & Browne 1991; Heidrich,
1993; Bowsher & Gerlach, 1990) as does social mteraction (Tobin and Neugarten, 1961).
Zika and Chamberlain (1992) reported a "substantial and consistent" association between
meaning in life and well-being; and a negative correlation between stress and well bemg
(Zika & Chamberlain, 1987). Fmdmgs of this research support reports m the literature
that realizmg meaning m life and self-transcendence is related to a sense of well-being.
Ellison's (1983) report that well-being is dependent on meeting needs for having,
relating, being and transcendence was well supported in participants' mterviews as well as
test results. The need for relating, being and transcendence are closely related to or
aspects of the concepts of meaning in life and self-transcendence, both positively
correlated with not being depressed. Reports that physical health and social interaction
were important factors m experiencing well-being were also corroborated in this study
quantitatively and qualitatively.
The researcher's ideas about spirituality have been modified as the result of
interaction with the participants in this study and, as a resuh, assumptions regarding the
relationship between spirituality and well-being have been altered. Degrees of spirituality
cannot be measured. In other words one person is not more spiritual than another based
on how high their PEL and STS scores are or how they perceive life stories. All
participants possessed a spiritual component of no more or less importance or degree than
173
their counterparts. Those in the Depressed Group, ^\i^ile achieving lower scores on the
PEL and STS evidenced great human depth manifesting their relationship to the universe m
their interviews. This negates the assumption that degrees of spirituality rise
correspondingly with degrees of well-being or that well-being is an outcome of being
spiritual Labun (1987) defined spirituality as a "...person's ejq)erience of wholeness with
the sel^ with other human beiags, and in transcendence with another realm (p. 318). This
statement must be interpreted not as something to be achieved m order to possess greater
amounts of spirituality. Spirituality is not a goal but a given, inherent m humankind. What
can be enhanced are the experiences of wholeness, achieved through perceptions of
meaning m life and self-transcendence, primary mdicators of spirituality.
The spiritually associated concepts meaning in life and self-transcendence can be
quantitatively measured, though levels and manifestations of the concepts fluctuate with
ever present life changes. Further, although meaning m life and self-transcendence are
indicators of spirituality, their levels as measured in the PEL and STS do not necessarily
reveal how spiritual an mdividual is. Rather they may indicate certain qualities of
spirituality that differ between groups of people, such as depressed and nondepressed.
Spirituality equated with "good" - how happy or well a person is, seems fiivolous.
Certainly history's greatest authors, artists and musicians have produced works bom of
great suffering that were not the products of academic education or happy contemplation,
rather spiritual inspiration. They arouse in us a tremendous sense of awe, of something
larger than an mdividual, of spirituality. Who can read the work of Tony Morrison, hear
Beethoven's Fifth Symphony or view the Pieta without wonder at the creator's source of
174
inspiratioii and seemingly superhiiman talents. From a historical religious perspective it is
nearly impossible to isolate spirituality from pain and sufTering. And it is unknown
whether the great artists transcended or immersed themselves m their pain and suffering
while creating their masterpieces.
Dideed, spirituality is manifested by the experience of self-transcendence and a
human need to make meaning which, when foimd, contributes to a sense of well-being.
However, human angst, the yearning of the soul and the torment of unfulfilled dreams are
also aspects of spirituality. They represent another dimension of the human spirit - one
not associated with well-being, yet often associated with developmental processes and
creative works. Therefore, spirituality is not good or bad but a reflection of the souL,
intangible and what makes us human. Spirituality may contribute to, but does not
guarantee well-being.
The finding that spirituality may be related to depression, as well as meaning m life
and self-transcendence is consistent with the definition of spirituality adopted for this
study (p. 43). Spirituality was defined as "the propensity to make meaning through a
sense of relatedness to dimensions that transcend the self.." (Reed, 1992, p. 350). For
participants m the Depressed Group, a propensity to make meaning was exhibited in
searching behaviors manifested by intensely mtrospective and life review activities. These
activities however, had a diflferent character than those of the Nondepressed Group and
had not resulted in an mtegrated sense of self Those m the Depressed Group may have
had a diminished awareness of their spirituality. The "propensity to make meaning" was
emphasized in the interviews with the Depressed Group rather than the achievement of
175
self-transcendent relatedness evident in the interviews with the Nondepressed Group.
Therefore, people e?q)eriencing depression may be manifesting a difierent form or
dimension of spirituality.
In conclusion, the results of the quantitative and qualitative analyses as they
compare with the literature and m conjunction with msights acqtiired through the
dissertation process, led the researcher to modify the conceptual framework (Figure I, p.
39). The chief differences between Figure I and Figure 2 he in the conceptualization of
the construct spirituality as depicted in Figure 2 (p. 180). Spirituality is now more clearly
viewed as a multidimensional concept that embraces many human experiences includmg
self-transcendence, meaning m life and depression. Within life's spiritual journey, selftranscendence and meaning in life are negatively related to depression, though depression
nonetheless can be conceptualized as part of a person's spirituality.
During the analyses of interviews with the Depressed and Nondepressed Groups, it
became evident that although the Nondepressed Group experienced more meaning in life,
self-transcendence and a greater sense of well-being than the Depressed Group, they were
not more spiritual. The Depressed Group, while e;q)eriencing less meaning m Ufe, selftranscendence and most certainly a sense of well-being, were nevertheless, spiritual m their
depression. Depression, may be the impetus for spiritual pursuits such as creative works
or introspection leading to developmental achievements. Meaning in life and selftranscendence are mdicators of well-being, an aspect of spirituality and a means of
experiencing well-being.
176
Figure 2: Revised Conceptual Framework
Spirituality
H
Well-being
/
Awareness of Spirituality
[-]
Depression
Meaning in Life
(+)
Self-transcendence
Implications for Nursing Theory and Practice
Nursing is a discipline professing to wholistically care for the well-bemg of human
bemgs. To acconq)lish this rather daunting feat from a spiritual perspective, nurses have
been chastised to minister to the religious needs of their clients, help them find meaning in
their suffering, and otherwise meet their spnitual needs. However, m light of the
researcher's proposal that spirituality is faiherent ni all persons and self-realized, suggesting
that nurses meet the spiritual needs of their clients may be a presumptuous and arrogant
declaration. On the other hand, nurses can enhance processes for perceiving well-befaig,
through facilitating the activities that promote a sense of meaning fai life and the
Ill
experience of setf-transcendence. However, this is best accomplished when the catalyst
for such development is intra-individually realized and sought.
bivestigating and understanding sphituality has been an ongomg human endeavor
throughout the ages and remains one of life's great o^steries, although some profess this
understanding within their own beliefe or culture. HeUker (1992) reported a few of the
significant mdividual and cultural differences related to understanding spirituality and
noted shortcomings in the preparation of niu^ses to meet the spiritual needs of their clients.
Preparing niu'ses to "meet spiritual needs" seems qtiite a ponderous and godlike task.
What nurses may truly be neglecting is recognition of the mherency and more specifically
the mdividual nature of spirituality. Before jimjpmg into the fi:ay to facilitate an
mdividuars spiritual development, niu'ses must be cautious of defining spirituality too
narrowly; and they must consider the distinctiveness and ofl;en strong cultural influence of
the experience of spirituality.
This is not to say that a nurse cannot assist clients to meet their spiritual needs.
Emblen (1982) noted, "...spiritual care includes helping people to identify meaning and
purpose m their lives, maintain personal relationships and transcend a given moment" (p.
47). However, only the individual can fiilfiH spiritual needs. Nurses can recognize, be a
sounding board and provide opportunities for the individual to address spiritual needs:
they cannot fix the individual spiritually/ meet their needs. To promote meeting the
spiritual needs of an individual is a holdover firom the medical curing model, still
prominent (and vahdly so) in some areas of nursing. This model, grounded m a
patemaUstic structure, advocates domg things for, rather than with, the cUent. Because
178
spiritual needs are unique to each individual, self-realized and one of the most intimate of
human experiences, it is not possible to accurately diagnose and meet individual spiritual
needsIdeally nurses should understand the multidimensional and individually manifested
spiritual nature of human-kind. Identifying ones own belief and ethnocentricity is a first
step in understanding this spiritual diversity. Educating oneself in the myriad ways
spirituality is manifested is another. Reading about and experiencing different forms of
spirituality (e.g. religious, artistic, philosophical) can expand boundaries. However,
caution must be used when generalizing lest stereotyping occur.
Context is a powerful and often defining influence and spirituality must be
examined with great discretion isolated firom context. A respect and veneration for the
various ways in which spirituality is lived and expressed is essential. Meaning m life and
self-transcendence are indicators of spirituality, but do not define spirituality. While a
sense of well-being seems to increase with the realization of both, well-being does not
indicate that a person is more or less spiritual.
For the elderly, nurses must be cautious of iotervening in what might be a principal
process m human development and the experience of life, the inward turning associated
with depression. As nurses we may be disturbed by people who are experiencing
depression and reflexively identify means of eliminating this uncomfortable and sometimes
deadly pathology. To intervene or not intervene is a difficult dilemma. A major impetus
for this research was the discomfort engendered in the researcher when early in doctoral
studies she was exposed to severely depressed individuals and learned of the staggering
179
number of suicides among the elderly. However, as Schmid (1981) noted, 'Tor the
elderly, developmental or existential considerations are largely ignored...deficiency-model
thinking sweeps away the elderly's chances for healing, repair or conflict resolution" (p.
363).
Perhaps a partial answer to the question of intervention is the degree to which
individuals are experiencing depression. This statement is not meant to imply that the
degree of depression is a static entity. However, when an elder is recognized as severely
depressed, mtervention may be a necessity, and may assist the elder to mobilize energies
knotted intemally to promote ongoing development.
Because elders' depression is seldom formally diagnosed, improvements in
depression screening outreach is a key element to better detection of this disorder. The
symptoms of depression m elders have been well docimiented. Appropriate and eflScient
diagnostic tools have been developed and need to be consistently and thoughtflilly
implemented. In addition to formal screening tools, nurses working in the community
with elderly populations can learn a great deal about their cUents fi'om listening to their
stories and attending to story and behavioral patterns.
The STS and PIL, as well as being excellent measures of the concepts of selftranscendence and meaning in life, are also valuable tools for identifymg areas of concern
to the depressed elder. Answers to individual items may demonstrate ways in which the
nurse can facilitate opportunities that might positively influence clients' sense of wellbemg. As Nightingale noted, a nurses responsibility is to "put the patient in the best
condition for natiu-e to act upon him" (Fitzpatrick and Whall, 1989, p.34). The nurse
180
cannot find meaning for the client or cause the client to become self-transcended. Nurses
can however, facilitate participation in a self-transcendent roles, or assist the elder to
identify new or current meaningfiil aspects of their lives.
Nurses can assist the client to move toward a greater sense of well-being by simply
listening to their stories. This provides an opportunity for the cUent to self-reflect and may
advance recognition of problem areas m the client's life. This activity is an exemplar of
the interpersotial process, the central concept in Peplau's model of nursing. The
interpersonal process is, a "method by which the nurse facilitates useful transformations of
the patient's energy or anxiety" (Fitzpatrick & Whall, 1989, p.56).
Nurses can impart feelings of confidence and trust that the elder can problem-solve
by standing beside rather than stepping in firont of and directing the elder. The greatest
fear of elders is that of dependence on others. Therefore nursing plans and mterventions
must be mutually derived in context, for the mdividual elder to avoid dependency.
Further, due to the heterogeneity of this cohort and the individually realized nature of
spirituality, it is doubtfiil that meaningfiil solutions to the problem of what nurses term
"spiritual distress" can be constructed out of context and without input fi-om the elder. In
general, the experience of being aged should be viewed as one of growth and transition
toward a sense of wholeness or self-integration.
Imphcations for Nursing Research
A fiiistratmg aspect of this research was an mability to reach the more severely
depressed individuals (assummg they existed) within these retirement communities.
Experience with previous research projects m v^ch the researcher gamed access to
181
severely depressed individuals indicated that impromptu face to face personal recruitment
is more successfiil than impersonal dissemination of instruments for self-administration.
Depressed individuals may enjoy the opportimity to talk but may lack the energy to
answer numerous questionnaires mdependently, or to schedule an appointment for which
they may perceive a need to prepare. In addition, an important factor when interviewing
severely depressed individuals is to have procedures m place for debriefing and referral if
their safety is m question or the interviews become upsetting for the participant.
Repeating the quantitative portion of this study with a larger sample would provide
a more normal distribution allowmg for more sophisticated statistical analyses. These
analyses could provide more information about linear relationships and drSerences among
variables. A more detailed demographic questionnaire would add to the study's
generalizability. The researcher mtentionally avoided detailed questions about
participants' financial status because of elders' distrust of these types of questions
experienced m previous studies. There was a concern that the added impersonal nature of
individually administered questionnaires might increase this distrust level and cause
residents not to participate. However, the unidimensional nature of the finance question
(do you have financial worries) led to answers that conflicted with other demographic data
and interview content. In the fiiture a better means of assessing this area of concern could
be found contributing more reUable outcomes. Previous studies revealed a strong
association between financial concerns and depression.
Mild depression experienced by the Depressed Group may have been the
manifestation of a developmental process. To confirm this notion and form a better
182
understanding of the developmental process, a longitudinal study could be performed in
which narrative mterviews are conducted with the same group of participants (depressed
and nondepressed) over a period of months or years. In addition to expanding knowledge
of the developmental process, the study could inform the changing nature of meaning m
life and self-transcendence. Further the study might provide mformation addressing the
need for mterventions for mildly depressed mdividuals. In addition as mdividuals
successfully moved through their developmental processes, means of facilitating this
process might be illuminated and could be hnplemented with others suffering from more
severe degrees of depression. A similar longitudinal study could be designed aimed at
identifying the important prognostic indicators of well-bemg m elders' narratives.
And finally, research mvestigating the role of spirituality as it relates to depression
could provide much needed mformation regarding the multidimensional aspects of
spirituality, not only in terms of well-being but as a force of discomfort, creativity bom of
suffering and development as well.
Conclusions
The results of this study mdicate meaning in life, self-transcendence and
perceptions of health are statistically and clinically associated with the experience of
depression. Depression, a major manifestation of diminished well-bemg m the elderly is
associated with poor health and lack of a sense of meaning m life and self-transcendence.
The alarmmgly high rates of suicide in this age group, particularly among men, have been
linked to feelings of meaninglessness. This study indicated meaning in life and selftranscendence are self-developed and self-realized. None of the participants acquired
183
these life enhancing resources through nurses or other health-care professionals. Nurses,
however, can facilitate opportunities for realizmg meaning in life and self-transcendence as
well as health.
The aspect of self-transcendence missing from all of those m the Depressed Group
was temporal integration. Further, the inward and outward expansion of boimdaries
necessary for self-transcendence were madequately experienced. That the realization of
meaning in life and self-transcendent behaviors are fluctuating ongoing processes offers
hope for those experiencing depression. The accumulation of losses (of which health is
one) over a life span are perceived and handled differently by those experiencing wellbeing and those depressed. For the Depressed Group losses have not been resolved in a
way that enhanced their lives. Perhaps nurses can best support a journey of self-discovery
and resolution by assisting elders to maximize and maintain their health. Perceptions of
good health seem to be intricately mterwoven with a sense of weU-being, providing a
foundation of energy for, and in turn bemg energized by, realizmg meaning m life and selftranscendence.
So to, nurses can listen as elders sort through their past, present and future
providing support for the process of pattern recognition and integrating the temporal
aspect of self-transcendence. Nurses must be cautious of trymg to move elders through
this process at an accelerated rate or medicating them out of a mild temporary depression
that may be the impetus or result, most likely both, of the process of human development.
As noted in life span development theory, human development while natural and good is
not necessarily comfortable.
184
Finally, a word of caution about recent attempts to quantify an individual's
spirituality. To view any human being as more or less spiritual than another is setting a
dangerous precedent of valuing one hiunan above another. Spirituality is mherent in all
persons, a potential force of angst and well-being - the force relating the mdividual to the
rest of the universe. Spirituality is manifested m numerous ways, not always comforting
or comfortable. Assisting a person to find ways of realizing meaning in life and selftranscendence is not contributing to an increase m spirituality, rather contributes to a sense
of well-bemg.
Solutions for the problems of depression and suicide in the elderly will come fi"om
the elderly themselves, in their stories and opinions if we will only listen. As Irene
Bumside (1975) noted, "All old people have something to teach us about the aging
process, illness and health, life and death, and philosophy; they are a distinguished faculty
who teach not fi^om books but fi'om long experience in living" (p. 1806).
APPENDIX A
INFORMED CONSENT AND DIRECTIONS
186
Make a Difference
Seniors 75 and over living in
Cottonwood Village
wanted to participate in research
about health and spirituality
My name is Deborah Klaas. I am a nurse completing a
doctoral degree at the University of Arizona and a
professor at Northem Arizona University. I am
investigating ways nurses can better address the health and
spiritual needs of senior citizens. Therefore, I am
interested in your opinions on these issues and hope you
will agree to assist in my dissertation research. If you
choose to participate you will:
1. Answer 4 questionnaires
2. Take about 30 minutes of your time
3. Return the questionnaires when completed
Thank you for your consideration. I hope to meet many of
you soon.
187
Disclaimer Statement
The purpose of this study is to leam more about elders' experiences of spirituality
and health. You are being asked to voluntarily answer these questionnaires.
Your name is not on the questiormaires and only the investigator (Deborah Klaas)
and designated assistants will have access to these papers. Your questionnaires are
identified by your address number only. You are under no obligation to
participate in this research project and there are no known risks to participating in
this study.
A few of those who answer the questionnaires will be identified by your address
number and asked to participate in a follow-up interview requiring about one hour
of your time. Again, you may refiise to participate.
By completing and turning in these questionnaires you will be giving your consent
to participate only in this research. It does not imply permission for any other
activities.
DIRECTIONS
If you choose to participate in this research please answer each and every question
to the best of your ability. If you would like to participate but have trouble writing
or reading please contact your housing administrator. I will then be in contact
with you to arrange a time to help you complete your questiormaires.
When you have completed your questionnaires, please seal them in the brown
envelope they came in and return them to the office of resident services. There
will be a box in resident services in which you can deposit your envelope. Again,
your questionnaires are strictly confidential and will not be seen by anyone other
than myself (Deborah) and two nursing graduate students (Becky and Mary).
Finally, let me thank you for your time and attention - and if you choose to
participate, for your valuable input.
Deborah Klaas, RN, PhDc
188
APPENDIX B
DEMOGRAPHIC QUESTIONNAIRE, GERIATRIC DEPRESSION SCALE,
PURPOSE IN LIFE TEST, SELF-TRANSCENDENCE SCALE
189
DEMOGRAPHICS
Please answer the following questions by filling in the blanks or circling the correct answer.
Age:
Female
Male
Highest level of school completed;
Elementary
Jr. High
Do you have religious beliefs?:
High School
Yes
College
No
Current physical health:
Poor
Fail
Good
Do you have financial worries?:
Current favorite activity
Current biggest worry.
ExceUent
Yes
No
Graduate School
190
GDS
1. Are you basically satified with your life?
YES
NO
2. Have you dropped many of your activities and
interests?
YES
NO
3. Do you feel that your life is empty?
YES
NO
4. Do you often get borad?
YES
NO
5. Are you hopeful about the future?
YES
NO
6. Are you bothered by thoughts you can't get out
of your head?
YES
NO
7. Are you in good spirits most of the time?
YES
NO
8. Are you afraid that something bad is going to
happen to you?
YES
NO
S. Do you feel happy most of the time?
YES
NO
10. Do you often feel helpless?
YES
NO
11. Do you get restless and fidgety?
YES
NO
12. Do vcj prefer to stsy at home, ralhet than going
out and doing r.ev things?
YES
NO
13. Do you frequently worry about the future?
'-ES
NO
14. Do you feel you have more problems with memory
than most?
YES
NO
15. Do you thin)c its is wonderful to be alive now?
YES
NO
15. Do you often feel downhearted and blue?
YES
NO
17. Do you feel pretty worthless the way you are now?
YES
NO
18. Do you worry a lot about the past?
YES
NO
19. Do you find life very exciting?
YES
NO
20. Is it hard for you to get started on new projects?
YES
NO
21. Do you feel full of energy?
YES
NO
22. Do you feel
YES
NO
that your situation is hopeless?
191
23. Do you thinjc that most people are better off than
you are?
YES
NO
24. Do you f r e q u e n t l y get upset over little things?
YES
NO
25. Do you frequently feel
YES
NO
25. Do you have trouble concentrating?
YES
NO
27. Do you enjoy getting up in the morning?
YES
NO
28. Do you prefer to avoid social gatherings?
YES
NO
29. Is it easy for you to make decisions?
YES
NO
30. Is your mind as clear as it used to be?
YES
NO
like crying?
192
nrSSsm
JEJW-
James C. Crumbaugh. Ph.D.
P
1 L
Ccoyri^hr ;976
Leonard T. Maholick. M O
PSYO^.MeTRIC ArrlLIATiS
PART A
For each of the following statements, circl? the number that would be
most nearly true for you. Note that the numbers always extend from one
extreme feeling to its opposite kind of feeling. "Neutral" implies no judg­
ment either way; try to use this rating as little as possible.
1.
1 am usually:
1
4
2
completely
bored
2.
(neutral)
exuberant,
enthusiastic
Life to me seems;
7
1
4
6
always
(neutral!
t:omp!et6!y
routine
exi::rir:q
3.
In life I have:
1
4
2
no goals or
aims a: all
4.
(neutral)
My personal existence is:
1
2
Utterly meaningless
without purpose
5.
Very clear goals
and aims
3
4
6
(neutral)
7
very purposeful
and meaningful
Every day is;
7
constantly new
2
6
(neutral)
ps'/CHOuETiirc AFFnnres
SOX so 7
MUHFJiEESBO^O, T!J 37UJ-0i07
[6151 3<)6-Z3iS S90-5256
1
exactly the same
193
6.
I f I could choose. I would;
1
2
3
" 4
prefer never to
have been born
6
•
(neutral)
7
Like nine more
lives just like
this one
7.
After retiring, I would;
7
6
5
do some of the exciting
things I have always wanted to
3.
3
1
4
(neutral)
8
7
progressed to com­
plete fulfillment
2
4
6
(neutral)
7
6
running over with
exciting good things
2
4
In thinking of my life, I:
1
2
3
4
6
7
always see a
(neutral)
why I exist
reason for my
being here
As I view the world in relation to my life, the world:
1
2
completely confuses me
13.
1
completely
worthless
(neutrsi;
often wonder
12.
7
If I should die today, 1 would feel that my life has been:
very worthwhile
n.
loaf completely
the rest of my life
My life is:
empty, filled only
with despair
10.
1
(neutral)
In achieving life goals I have:
1 2
made no progress
whatever
9.
2
4
3
4
5
6
(neutral)
7
fits meaningfully
with my life
I am a:
1
very irresponsible
person
2
•
4
(neutral)
6
7
very responsible
person
194
14.
Concerning man's freedom to make his own choices. I behove man is:
7
a
6
(neutral)
absolutely free to
make all life choices
2
1
completely boinul by
limitations of heredity
and environment
15.
With regard to death. I am;
7
6
5
prepared and
unafraid
16.
1 2
3
4
2
(neutral)
1
practically none
My life is;
7
2
6
in my hands and I
am in control of it
(neutral)
1
out of my hands
and controlled
by external factors
Facing my daily tasks is;
7
6
5
a source of pleasure
and satisfaction
20.
never given it a
second thought
I regard my ability to find a meaning, purpose, or mission in life as;
4
19.
1
unprepared and
frightened
(neutral)
very great
18.
2
With regard to suicide. I have:
thought of it seriously
as a way out
17.
4
(neutral)
4
2
(neutral)
1
a painful and bor­
ing experience
I have discovered;
1 2
no mission or
purpose in life
3
4
(neutral)
6
7
clear-cut goals
and a satisfying
life purpose
195
CcxJe No.
Self-Transcendence Scale
DIRECTIONS: Please indicate the extent to which each item below describes you. There are no
right or wrong answers. I am interested in your frank opinion. As you respond to each item,
thinV of how you see yourself at this time of vour life. Circle the number that is the best response
for you.
AT THIS TIME OF MY LIFE,
I SEE MYSELF AS:
NOT AT
ALL
VERY
\'ERY
LirTLE SONfEWHAT NfTJCH
L
Having hobbies or interests I
can enjoy.
2.
Accepting myself as I grow older.
2
3
3.
Being involved with other people
or my community when possible.
2
3
4.
Adjusting poorly to retirement
or to my present life situation.
3
5.
Adjusting to the changes in my
physical abilities.
3
6.
Sharing my wisdom or experience
with others.
3
7.
Finding meaning in my past
experiences.
2
3
8.
Helping younger people or others
in some way.
2
3
9.
Ilavir.g sn interest in continuing
to learn about things.
2
3
10.
Putting aside some thiiigs that I
once bought were so important.
2
3
11.
Accepting death as a part of life.
2
3
3
12.
Finding meaning in my spiritual
beliefs.
2
3
4
13.
Letting others help me when I may
need it.
14.
Enjoying my pace of life.
2
3
15.
Dwelling on my past unmet dreams
or goals.
2
3
APPENDIX C
INFORMED CONSENT FOR INTERVIEWS
197
Spirituality and Health in Old Age
The following material is to inform you of the nature of this study and how you will
participate if you choose to do so. Federal regulations require informed consent so if you
decide to participate, it will be in a free and informed manner.
The purpose of this research is to collect life stories from older adults to learn more about what is
important in their lives.
You are being invited to participate because you are at least 75 years of age and living independently
in Northern Arizona.
If you agree to participate, you will be asked to share stories from your life in a tape recorded
interview. This will take approximately one hour of your time. Your name will not be used at any
time. I will answer any questions you m^ have and you may terminate the interview at any time.
The interview will be conducted at a time convenient for you.
There is no known risk to you
Only [ (Deborah Klaas) or my research assistant will have access to your taped interview and it will
be kept locked in my office.
There is no cost to be in this study except your time.
Authorization
BEFORE GIVING MY CONSENT BY SIGNING THIS FORM, THE PURPOSE, METHODS,
AND RISKS HAVE BEEN EXPLAINED TO ME AND MY QUESTIONS HAVE BEEN
ANSWERED. I UNDERSTAND THAT I MAY ASK QUESTIONS AND THAT I AM FREE TO
WITHDRAW FROM THE STUDY AT ANY TIME. I UNDERSTAND THAT ACCESS TO MY
INTERVIEW IS RESTRICTED TO DEBORAH KLAAS OR HER DISSERTATION
COMMITTEE. I UNDERSTAND THAT MY SIGNED CONSENT IS SOLELY FOR THE
PURPOSES OF THIS SINGLE RESEARCH PROJECT AND THAT I DO NOT GIVE UP ANY
LEGAL RIGHTS BY SIGNING THIS FORM.
Participant's Signature
Date
Investigator's Affidavit
I have carefully explained to the participant the nature of the above project. I certify that to the best
of my knowledge the person signing this consent understands clearly the nature of their participation
and that their signature is legally valid. A medical problem, language or educational barrier has not
precluded this understanding.
Investigator's Signature
Date
APPENDIX D
SUMMARY PROFILE OF DEPRESSED GROUP
199
Rinie- BQlie looked much younger than her age. She spoke m a soft, high voice
and the longer she spoke the saltier her language became. She had been raised m a city on
the West Coast. Her parents divorced diuing the depression and Billie, during her early
adolescence, went with her mother to a rural, wild mining area of the Pacific Northwest.
There were no roads and all travel was on foot or by horse/mule. Durmg this time Billie's
mother died and she was taken m by the locals and treated as a "pet." At 19 she married a
man who ran the mail train, packing the mail fiom a river boat in by mule to the
faihabitants of the community. FoUowmg a brief stint of ranching m the Northwest, Billie
worked with her husband transiently on ranches and m orchards. Although she was
frequently hired to cook, she preferred to be out in the fields workmg with the men. She
proudly displayed a picture of herself taken on her 40'th birthday beside the gravel truck
she drove. She and her husband finally had their own sheep ranch and in the descriptions
of life here Billie's deep respect for and love of animals became poignantly evident.
I was so damn mad there's one a my husband's fiiends. He had a girlfiiend
and he'd come up there and he got Patches. An uh what the hell was that
sorrel horses name. I don't remember. Poncho I think. Anyway they got
them. Patches and Poncho, an he's gonna show oflFfor his girlfiiend. So
they rode down to the saloon in town and rode in the damn saloon with
those horses. And I didn't care about that part. What biunt me up was
they all the way back they, he wanted to show off so he had to run the
horses back on the hard road and that's no good for a horse's feet. They
weren't shod for that. Poor old Patches was so stiff the next day he could
200
hardly walk. You never felt anything fek any worse than get on a horse
that's sdff and sore. He can't handle himself right and he sure feels funny.
I told that dam bastard... (S98, L1365-1385)
Throughout her interview Billie told stories of animals describing their
personalities and actions with great affection.
We were comin down the trail and I had both feet on one side of the
saddle wiiich you do when you're ridin for long distances...but anyway
somethin stung poor little Speck on the nose, (chuckles) Yea a yellow
jacket or a hornet or somethin. An he just come unloaded an course I
went right off the ...I might've stayed on if I'd a had both feet on both
sides where they belonged. But anyway I lit right square on my fanny.
God my head ached fer hours afterward. So he didn't go anyplace. He
just went right up against the horse in front of im and started rubbing his
nose on im. (laughs) An so he didn't object when I got back on. (S74,
L976-998)
Billie also often referred to hunting as a means of survival taking "a lot of care to
keep the game warden off our tail" (S7, L81,82) After several years her husband had to
retire due to poor health and died shortly thereafter.
Her husband's death left Billie in a situation she described as, "...there's a lotta
tilings 1 knew about I couldn't get a job dom... who's gonna hire an over aged female
sheep herder?" (S 14,L 189, 190) She then worked m an electronics factory until
retirement when she began studying painting. Several of her paintings are hung on the
201
walls of her tiny apartment. The pictures are of animals or people and reveal warmth,
insight, tenderness as well as artistic talent. Some have been sold or "thrown out." Billie
stated, "...I haven't done anything in the last year...like a jackass I've been sittin around
doin nothin." (S23, L299-300) About her artistic talent she stated "most of it's wasted I
guess." (S36, L485-486). When evaluating her life she said she spent a lot of time
thmking about the "things I should have done and didn't do." (S46, L588)
Billie described her stomach as lookmg 'like a roadmap of the Los Angeles
freeway" (S41, L548) due to several surgeries. As the result of an unsuccessfiil
laminectomy Billie cannot walk far due to severe pain and spends most of her time sitting
or lying down working crossword puzzles, reading, watching TV and listening to classical
music. BOlie concluded her mterview by saying, "I don't like people that handle animals
like they're not supposed to be handled. Well I could bore you stiflFbut I'm not going to."
(S100,L1388-1390)
Madge: Madge had never married and spoke rapidly and softly until excited or
angry at which time her voice became loud, thin and intense. She occasionally mimicked
the voices of others. These instances occurred exclusively when talking of her sisters.
"Oh she was conniving all the way through, everything for herself yes oh yes, everything
for her...she ruined a lot of lives." (S54, L1004-1008: S25, L1037) Madge was one of
several children and describes her childhood as one of servitude to her family.
My other sister was there she didn't do a danm my oldest sister but she
didn't do anything cept directing that was it. Yep. Yea she didn't do
anything. When you stop an think about it she didn't even do her own
202
washing or anything else. She didn't help with the washing the ironing,
she didn't do any of that. Mom and I did all a that. And I was working.
(S73, L1324-1332)
Madge left home because "I got fed up with my sister arranging all my spare time
any spare time I had she had arranged for me doin somethin else..." (S11, L216-217)
Madge told numerous stories of being betrayed by her family. She described several
situations m which she sacrificed time and money for her sisters, who through plotting,
managed to relieve her of all of her savings. She described numerous slights and
confi"ontations with her sisters, one in particular. With bitterness Madge told stories of
this sister who will no longer associate with her. Once Madge accompanied a niece to
visit this sister. She said, "So I got to the door she told us says you're not welcome here.
My sister did. She let her m. She was happy to see her an then she saw me, well you're
not welcome here." (S45, 804-809)
She had an extremely high IQ. An boy she took advantage of that. Fer
she shouldn't have to do this, this, this or this. I have too high an IQ to
do this. She uh this was her thinking all the way through...but after she
found that out that she had a high IQ, then she really went overboard
with it. (S55, L10I7-1025)
Most of Madge's mterview involved family stories m which she gave and sacrificed
for her family and was victimized m return. "Most of my life has been involved with my
family until I was cast out by them." (S58, L1077-1078)
203
Regarding her current life Madge described no social activities. She stated, "all of
my life has been in doing an helping for others. Now since I moved in here I have helped
one, two, three, oh four, five of em, three of em a lot." (S87, L1697-1704) Madge
described helping these neighbors significantly in terms of moving, assisting with ADL's,
contactmg family when the neighbor was not managing adequately, health care and
chauffeuring. Yet these situations have also been problematic. Several neighbors have
not cooperated despite her diligent efforts and one accused her of stealing. "So sometimes
you get thanks and sometimes it's nothing but. But at least I know I helped em out when
they needed it. That's some consolation. But it hurts when they don't appreciate it at all
it hurts." (S104,L2051-2055)
Madge talked little of her work as an LPN and secretary although she reported
quitting jobs frequently to help with femily matters. She described her own multiple health
problems and surgeries. She was "forced" into early retirement as the result of neck and
wrist problems from secretarial work and she has developed sporadic and severe back
problems as the result of heavy lifting. Madge concluded her interview by talking about
her back problems and her self care because "the doctor didn't help at alL All he'd do was
give me a pill that I had side effects." (S106, L2103-2104)
David: The researcher first met David while collecting quantitative data. He was
the participant who requested help answering his questionnaire. David was a tall,
cachectic appearing man who was dying of lung cancer although interestingly, he
perceived his health as "fair" when answering the demographic questions. Despite his
debilitation, David exhibited a great deal of passion m his heavily German and East Coast
204
accented speech. However, he tired quickly during the interview and was uncomfortable.
Because his questionnaire was hand administered he told stories during the quantitative
data collection and some of these had become vague by the time of his interview three
months later. Throughout his interview David complained of having diflSculty
remembering specifics from his past.
David came to the United States from Germany at the age of 12. He received no
formal language education and taught himself to speak and read English by reading
advertisements and going to movies.
Oh I come ta tell ya how I learned my English and educated myself I
used to read all the ads that I could see. I used to go to the movies un
when they still had the silent movies an all that. An I kinda learned myself
just it was difficult because on the screen it went fast an I hadda keep up
tried to follow. An the buses and trolleys wherever I was, whatever ads I
saw I read. Well I educated myself (S7, L80-92)
He became so adept at the language that he helped North American soldiers write
letters home during the war. Following his arrival m the U.S. David began work
immediately doing odd jobs for a wealthy man "an my dad got the money an I got the
shaft." {S5, L65) David expressed great affection for all members of his family except his
father who he described as a brutal man who beat his mother and "ruined a whole family.'"
(S35, L554) As a result he ran away from home in Minnesota and arrived in Chicago
"poor, penniless, an freezm m the wintertime." (S18, L262) With the help of Chicago
police who gave him shelter in the jail and found him jobs, David became self-supporting.
205
He eventually moved to the East Coast and worked in a candy factory, followed by
employment as a trouble shooter for a defense company. David expressed extreme pride
in tus accomplishments and having graduated from "the college a hard knocks, an that's
the best college." (S6, L78,79)
David credits his "psychic" ability to read people for much of his success.
I could spot when somebody was dishonest whh me. I had the ability I
could read you just by lookin in your eyes or shakm your hands. I could
judge people. If you were good, OK. Ifyou were not, if you were a shady
side I'd feel that just by touchin your hand, or lookin m your eyes, or how
you speak. I could detect that you're lyin. Somehow the Lord told me.
Honest I tell ya people would give millions if they knew how I got that
way. (S23, L341-356)
Recently his confidence was challenged when the retirement community he
lived m tried to put him m a nursing home. He became teary when describmg this
situation and how his daughter helped.
When all the words were startin ta ta wow on me whatcha call it. But
we got em an we we stopped em m the nick a time she did it. I needed
help an I, she, (teary) she said she'd come an take care of me. An
that's how she saved my skin. (S32, L516-5524)
David met his wife on the East Coast and described her affectionately this way;
She was never 50 miles away from home! An she knew nothin! I usta
call her Calamity Jane! An I tell you somethin I showed her how ta do
206
things. But she could do em better than I. She was smart. (S33,
L530-538)
After his wife died David had a supernatural experience in which his wife
came to him and let him know she was all right. He revealed this incident v^dth awe and a
firm beUef m the authenticity of the occurrence. He was anxious that the researcher
believe it also and referred her to a Reader's Digest volume documenting such cases.
"That volume that Reader's Digest sold is on the level. Whoever's mentioned in there,
that's not lyin'. They are fact!" (S62, LI 162-1166) Regarding his wife's death David
stated, "when her [referring to his daughter] mom died I died with her. That is I says
whatever is material it ain't worth a nickel An I said money don't mean nothin. An I, I
let a fortune slide out firom under me." (S67, L1296-1305)
David held passionate beUefe that the government was fixll of "rotten apples" and
that young people needed to be more aware of what was going on. He stated if he had
not left Germany before the Nazi's came into power he would not be alive. David's
mterview ended when he began to sweat and complained of a headache.
Burt: When the qualitative research statement was read Burt began his mterview
by saying
I've done this m gomg over a lot of the past to get rid of it. You know to
uh to work through the angers n the hiuts n all that kinda stuff! And to try
to get up to date to now. That's been my goal So I tend to not wanna
dwell on the past. And so this is why I'm tending to wanna block out the
stories. (SI, L8-20)
207
Thus, Burt had more commentaries than stories in his iaterview and remarked to
the researcher, "When I get all sober with ya I wish I didn't get all sober to ya all the time
an dronin on an on an on an on..." (S51, LI 115-1116)
Burt's parents were divorced when he was a child and his mother became a
bootlegger as a means of survival during the depression. Burt described his childhood as:
"I learned the bootleggin business very early. And uh my experience was very rough."
(S16, L336-340). On the other hand he was also a boys choir soloist m a large West
Coast city and skipped two grades m school He stated however that skipping grades
"...caused me problems at a later time, with behavior and stuff like that." (S38, L894-895)
Burt described an early and middle adulthood of hard living. He drank and smoked
heavily and met his future wife while serving alcohol to she and her husband. After they
were eventually married he walked out on her and the children when she was dying of a
neurological disease and never returned. He was later hit by a car while drunk entailing a
four-year recovery and near loss of a leg and his life. However, he also adopted his wife's
two children and they had one of their own. Further he took a great interest in his sons
and worked hard at parenting them; won singmg contests; and worked as a probation
officer.
When his lawsuit over being hit by a car failed as a result of his being drunk at the
time, he decided he had to make some changes. He quit drinking and smoking "cold
turkey." "I'm, I'm pretty capable of most things. And uh I think the will is probably
strong. An inasmuch as it's just as strong the other way that is kmd of has a danger
factor." (S21, L435-441) He later admitted he can't drink now due to heart medication
208
because he is famuediately dnmk. "An that's too dangerous fer me because if I fall down I
can't get up uh...I have a hard time if IM, if I'm on that floor uh I hafta crawl over to the
thing and it takes me forever ta get up..." (S25, L533-537) He fiirther said, "So it's being
aware I think of the fact that I'm much more vuhierable now. An I hafta be much more
carefiiL An it's kinda galling." (8284^565-567).
A recent devotee of Albert Ellis, Burt admitted "I feel uh I I've become more
intolerant of people with the now situation." (S45, L1006-1011) He told two stories of
incidences in the neighborhood m which he ended friendships and refused to participate
because he was irritated with the people. He stated "what I'm doing is not easy. Because
it tends to isolate me a little bit. I'm more comfortable." (S49 L1069-I071). Burt
stressed the importance of good relationships and following a dialogue on the importance
of a good critique, he noted that criticizmg others is "dumb as heU." (S61, L1362) Burt
stated:
I'm finding that I can say now an mean now an realize that I'm I'm very
vuhierable an I have some limits. Some thmgs I can't do. And I'd rather
say so in a nice way you know and uh, and if I don't get uh consideration
uh, I won't be back. That's all, you know I just won't be back An so
rather than, I have former associates and fiiends here that they wanna go
back they wanna go back to the year one when he left n when he left n he
married that damn whatever an on an on and so forth an so on and they
wanna go back through their whole life history uh to justify something or
209
Other mstead of just accepting OK what was my part in it. Nobody ever
says what was my part in it. (S53, 54, L1230-1254)
Burt concluded his interview by stating that he was adopted and continued;
But I try not ta dwell on the past. She was 18 and he was 18 n its rough
enough an an this was in 1917. An that's a tough time by itself ya know.
So so so this is another reason I try ta stay m the now and uh grit my teeth
ya know some times. Cause I wanna punch somebody in the nose.
Whatever ya know. An I've hadta leam ta walk away. Walk away.
(S6l,62, L1368-1380.)
Kathryn: Kathryn was a beautifiil, gracious woman who spoke m an even,
somewhat sad tone. She found herself divorced at a young age with a child so she left her
rural community to seek her fortune in the city. She was admitted to nursing school
where she excelled but after weighing the pros and cons decided to become a beautician
instead.
So I got ta thinking well now I'm gonna have ta be three years n [my
son's] gonna be ready for school when he's six years old before I get outta
nurses' training. OK nurses training I would always have a job. But
beauty work I still would always have a job. An I could have it in my home
so that I'd be there when he come home from school, see. An I maybe
wouldn't make as much that was up ta me. (S7, L94-104)
Followmg training she opened very successfiU beauty shops, enough to put her son
in private school. For six years she was courted by two suitors - one a very wealthy son
210
of a local business man and the other a Jewish merchant. She chose to marry the Jewish
merchant whom she referred to throughout her interview as Mr.
"Cause I'd never been brought up that way I think that's the one reason I
made the decision between the two. Cause he was just crazy about [my
son] you know. But uh I thought now I just didn't feel like I'd fit in with
that kind of life if I wasn't brought up in it. You know. An uh, but he was
one I love ta dance with cause he loved ta dance fast. An Mr
was a
ballroom dancer. Which I liked that too but still I like my rumba and my
tango you know. An uh course I lived in jitterbug days you know. An I
loved music an dancing. So uh when it come right down to it then I just felt like
like Mr
would be the one. An he was. (S38, 39, L831-856)
She stated. No when I look back I think cause my husband more or less
just put me on a pedestal an I always had help." (S40, L867-869) When her sister
died she took in her sister's daughter because she had always wanted a daughter
and she and Mr.
relationship
could not have children. Relative to her husband's
her son and daughter she said;
I fell in love with my husband over again. Because he treated her he
treated her an my son like his own children...today men today they woulda
tried to make a pass at her. Not my husband. She was his daughter and
this was his son." (S31, L691-697).
After BCathryn's marriage to Mr.
she gave up her business to help him with his
and worked successfully within his jewelry store until his retirement. They moved to
another community where he began work of a different kmd, and she was recruited to
manage a department in a local store. She loved this job and expressed great pride in it
but her husband, who had never driven, decided he needed someone to drive him around
in his business. Of this she said, "So I had ta decide if I wanted ta give up that job or if I
wanted ta disappoint him So uh we'd always got along real good an I just felt like you
know that was extra on my duty to do that." (S21, L450-455) Kathiyn quit her job and
she and her husband made a few moves to other commimities. Eventually she was
recruited to work at a school for the deaf and blmd. When she spoke of this experience
her eyes lit up and she became animated.
The job was um ta anybody else it'd probably been a job. But it wasn't
ta me. It was fim. It was fim with those children. It wasn't no menial
job you know 1 mean. But just uh being able ta cope with uh the children
you know an I was able to do that. So I'd come home an I'd teU him all
these stories you know just like as if I just got up, you know. An he just
couldn't get over that. He thought I should be so tired cause I had gotten
up at four-thirty. (S27, 28, L605-620)
Kathiyn worked there until the age of 71 when she retired. Her husband died a
few months later. She spoke of having many beautiiid memories. Kathryn expressed a
great interest m and talked of contact with her children, grandchildren and great
grandchildren. She concluded her interview by saying
From my uh six sisters I have nine nieces and nephews. Everybody's gone
but me. My family. I'm the last one of the family. Well now they put me
on a pedestal An that's ^^dlat the reunion was family reunion was in
f aiighlhi was um aU these nieces and nephews. (S44, L949-960)
APPENDIX E
SUMMARY PROFILES OF NONDEPRESSED GROUP
214
Following Elma's interview by the research assistant, the researcher
received a phone call from her stating she would like to redo the interview because she did
not feel it had been m sequential order and she could do a much better job if she did it
again. Serendipitously the battery had been low during this mterview and the latter part of
the tape could not be heard; therefore, the researcher returned for a second go at Elma's
interview, assuring her the sequence of the interview was of no consequence. Elma was a
spritely lady appearing a great deal younger than her age of 90. Although sounding
spontaneous (versus rehearsed), mdeed she had organized her life sequentially for the
interview and proceeded m that manner.
Ehna was raised on a farm m Nebraska by a German grandmother who spoke no
English. Both parents worked in the fields from before she got up m the morning until
after she went to bed at night. There were no siblings until five years after her birth. She
described herself as "the shyest little ol thing. Everybody says they can't believe that I was
shy n timid at one time " (laughs). (S3, L4l,42). Of school she said;
It was hard for me to get accustomed to the English that they spoke in
school because everybody had always spoken English an nothing but. An
they just rattled it off ya know. An 11 was kind of I don't know how to
explain it, kind of oh, I always felt out of place I guess is the best word I
could think of because of that. I think that had a lot to do with it. I was
always kinda, I don't know, I didn't wanna be around people to much.
(S7, L88-100)
215
Of high school Elma said, "Well high school was hard to because I always felt
kinda had an inferior complex I think and so it was a little rough." (S7, L106-108) Elma
described coming out of her shell when her parents moved to town and she took a job as a
salesperson. With tutoring from her father she learned to enjoy and become good at
meeting the pubhc. She eventually worked for a high ranking government official m a
western state and was in charge of cattle brands. Following her retirement Elma says:
I had been home about three months and the telephone every morning bout
ten o'clock here was Mr.
on the phone. He says aren't you rested up?
How you feel today are you rested up? Gradually he was coaxing me back.
An h ended up I went back for another two years. (S13, L250-257)
Elma retired again but became bored staying at home and began work for a
church. Of all her employers and jobs she has only praise and remembers humorous
incidents with delight. FoUowmg a third retirement she and her husband (previously
unmentioned and seldom referenced in the interview) began the RV life and became
officers of the Good Sam Club. Eventually they were recruited to help develop the
retirement community she ciurently lives in. They lived on the property from the time its
was 'just a desert ranch" and Elma speaks with pride of the hard work and sacrifices they
made to assist in development. Both were managers of the development, the eventual
opening and admissions process. She took great pride m the commimity, chaired
committees and described herself as the "watch dog." Maintaining a close interest in her
communhy, she spent little time watching TV. About herself and her husband she stated:
216
My husband passed away several, few years ago. So I've been by myself.
(Chuckles) But as I mentioned earlier in the interview I've always been more
or less by myself because see being the older and under childhood early
childhood like that being with Granny more or less. And she was oh I've
always had a good home an everything. I never was neglected I don't want
to give that impression. But it's just the fact that I was a little kid alone on
the farm and you don't have the toys those days. (S37, L806-824)
Ehna said this about her age and herself:
I've never been hesitant anybody asked my age because look, I look at it
this way. Maybe I'm not at the right angle at all but I feel this way. I am
pleased if anybody asks me in a way to prove what the Lord has been so
good to give to me. Why shouldn't I be up and honest and say sure I'm
ninety whatever. And give him credit for what he's doing for me and has
done for me in all these past years. To keep me going and to watch over
me now at this age when I really need it as well as younger. And I feel it's
a discredit to God not to not to be up-front and be honest about it. Now
that's my theory. An I don't know maybe (chuckles) I'm way offbeat but
I feel that that's giving credit where credit is due in other words. And I
sure have my weak spots everybody does I think. And I've got a lot of
things to learn. I know that I'm not to old to learn. You're never too old
to learn. And I have a lot of faults I'll admit that just like I think I have a
217
lotta company (laughs) to. So anyway I just go on eveiyday an do the best
I can an always try to have something m mind to do. (S42-44, L923-960
Miriam- Miriam was bom in a Southem state and moved with her family to a rural
Westem town where she met and married her husband.
My husband n I were married 53 years n 3 days when he died. An we went
through some pretty meager times n some afiQuent times both. Mostly
meager. But we had a very happy life. It was one of the fortimate things
we had a very happy marriage and a very happy life. I loved my husband
(Laughs) (S4,5, L55-66)
Miriam's son was at Pearl Harbor when it was bombed and it was two years before
they knew he had survived - a time she described as the "worst period of ma life." (S2,
L26) During the war she worked as a dental assistant which she loved and had a great
affection for her boss who was a family friend as well. About work she stated "And if
you're working at something you really love its more like, I mean you don't mind going to
work...! think the only way you're successfid m life is to like what yer doing. (S41, L789791, 798-799) Miriam told of many happy experiences with friends and family and
described her life as:
Rest is just common everyday livm. Jes day m and day out. I mean it's a
happy life. I enjoyed myself I I'm not one of these sits around an broods,
thinks life's terrible cause I've had a good life. Had ups and down. (S31,
L554-559)
218
Miriam was 6irty critical of today's society and didn't hesitate to share her
opinions on everything from today's children to the cost of drugs.
I had the greatest parents ever walked the face of this earth. Both of em.
An if they told ya don't do something you didn't do it. You minded because
if you didn't you got a spankin and ya knew it an so you behaved. An I've
seen kids m the stores hitting their mothers and kicking their mothers and
screamin an doing tantrums n I look at that, thmk if I had done that when I
was that age I couldn't a walked out a the store probably. An yet I don't
think I ever got a spanking ever that I didn't deserve. (S14, LI89-200)
After a "shocking" visit to her great grandchildren's school Miriam had this to
say:
You didn't do that when I was a kid you didn't git up and leave your seat and
walk around. An if your folks came you really tried to watch your teacher n
obey cause if you'd been naughty your mother would have corrected you
when you got home with a beating now because it would have embarrassed
her. I think kids learned more m those days to. These uh, I know they have
computers an all that but we had to leam all ours by by learning not by a
computer do the work for ya. (S260-269)
Miriam went on to observe that kids should be outside playmg instead of being
"like old people sittin there in front of the computer." (S18, L279)
About the current political situation Miriam stated:
And say we're goin forward - we're just gom back and as far as I'm
219
concerned, the middle ages v^diere you're almost fraid to go outta your door
an do anything. Now things have changed. We don't have the freedom in
America we usta have. We can say what we wanna say but cha better be
inside the house time anyone hear you say it. So it's uh it's really kind of a
tragedy I think. The way the world's turning out. (S19, L300-309)
Miriam critiqued casinos, voting policies, why people no longer vote and no
mandatory retirement for politicians. Following this she stated, "NI guess thats about the
only complaints I have. 1 can't think of anything. An I'm gettin so that it doesn't matter
anyways." (laughs) (S24, L389-392) Her last critique was about the cost of drugs for
older folks on limited mcomes. Of this she stated, "An they hafta get em to stay alive
so...I think maybe they figure they can weed out the old people that way. (Laughs) Get rid
of us. That'd be a good idea I guess. (Chuckles) (S48, L1003-I008)
Miriam expressed great pleasure with her current living circumstances and a love
of friendly people. She told of experiences earlier m her life in which being friendly and
among friendly people influenced where she lived. About the retirement center she was
living m she stated:
It's a beautifril place an an it's free for seniors and they are so they got
such wonderful help they re so nice. An all the neighbors are nice. I guess
you get as old as we all are they are past that jealous cantankerous stage an
become human beins. (S12, LI44-150)
220
Miriam continued by saying "and you feel feirly safe here because its just old
people n guess the people that go out an rob realize they don't have nothin." (S13, L164166) She closed her mterview by saying, "Course I like us but then a lot of em are nuts.
But most of eh, they talk about the old people gettin...but mosta my friends, n they're my
age, are happy go lucky." (S49, LI009-1-15)
George: George's porch and apartment were cluttered and outside his door was a
partially spray- painted large prickly pear cactus with a few little elf type figures hanging
from it. A talented harmonica player (he played four tunes) and story teller extrodinaire
('1 could go on by the hour tellin stories"), George performed his mterview. He had a
delightful sense of humor, took pride m his manly pursuits and spoke with great gusto. He
spent his childhood on a cattle ranch and used to steal his father's harmonica and taught
himself to play, something he takes great pleasure in today. Of his parents and leavmg
home he said:
I tell ya another un I run away from home when I was a boy. Well my
mother and I got along very well. An its still with me my father and I
didn't get along too well I don't think he was honest with mother. An uh
I was scared of him. He beat me up over no purpose. And I was a little
boy. And my brain was developed enough that I knew an I uz scared. An 1
lived on vegetables, grass an many thmgs m the hills for several days an
stole stuflF outta cabins and eat it. An I ended up fairly welL I, I got m a
logging camp an become a man. (Laughs) (S3, 65-82)
221
Regarding marriage George said "So I'm really blessed by being married to two
good women. And I was very &ir with em to and they was fair with me. So that's one
thing I got m the back of my mind I'm thankfid for." (SIO, L238-243) Of his last wife he
stated;
By the way I don't know you'll like ta hear this but I lost my wife about
three months ago. This house is gettin plumb dirty. She had pictures all
over the walls and nail holes everywhere. An I said to er I says lets get
this house cleaned up an painted. Well it was fine the way it was. She
had trinkets everywhere. It was just fiill oftrinkets. (S16, L352-360)
About his wife's death George stated, 'Tm not exactly disappointed because uh
I'm tryin ta make the...I'm happier than I've ever been in one respect. I didn't know I
could live alone." (SIS, L419, 420)
George had three sons with his first wife, the oldest of whom died in a Nascar
race. One son is a doctor and another is an accountant. The sons want him to come live
m their communities m the Northwest but George adamantly refuses stating "I'm gonna
die right here. Little bit determined natiue." (S19, L439-441) Several times in his
mterview George said he is not going anywhere and plans to die in his apartment.
George elaborated on a plethora of jobs and told some fimny stories about
finagling his way into positions with which he'd had no experience.
I give ya a little experience about my life. I got no education. My father
wanted me to work. I wanted an education but I didn't get one. I mean
out of a book. I never passed the 7th grade see. And uh I got educated
222
all right. la a dififerent way. I followed every trade under the sun to make
a living. And uh I hadta provide for my family and it was tough. I
worked ranches. 1 worked rock quarries. I worked pulp mOls, saw mQls,
worked in woods. I worked underground. I even worked for the forest
service for several years. I've done many many different jobs. (S8,
L179-197)
George told of being an avid hunter to provide food and at one point said, "I killed
so many elk eatn em in the wintertime when I got hungry that uh, they ahnost run me out
of Montana." (Laughs) (S3, L962-964) He also had a multitude of critiques regarding the
current state of affairs in the US to include niflation, honesty in the media, quality of
goods, radicaUsm, the environment, sUck politicians, wars between countries and
violence between races and m society. About cholesterol he stated.
Another thing thats eh amazes me is uh constantly over that TV. Don't
eat them nuts don't eat that egg. It give you uh high cholesterol. Is that
it yea. I've lived 86 years an have not ever thought about cholesterol.
Now certainly somethin musta went right with the way I lived.
Sbcty-eight years and never worried about cholesterol. Isn't that amazmg
my heart has never quit on me. (S26, L684-697)
George explained how he was dealing with his physical losses:
And I'll just give ya a little bit of my history right now. Right now I'm a
little bh under the doctor's care fer different things due to the fact that
I'm like McArthur. I'm fadin away. I'm unactive. Cause I've been a
223
very active man in my life. But the only thing I got left now is to
reorganize. Something I lacked when I was workin I spent aU my time
working. An I never realized eh what it takes through uh many branches
to do some thinkin. One is politically. The other is religion er not religion.
It it pertams to religion. It's uh Christianity. Politics very serious to me
today. (SI 1,12, L244-248, 267-282)
George concluded his interview by telling me about a new companionship he had
with an Irish lady and playing a tmie on his harmonica.
Karen-
Karen was dressed in green and white for a St. Patrick's Day party.
Around her tidy apartment were several handicraft projects in progress. Karen spoke
rapidly, fluently and described her daily activities in great detail She was an energetic
woman who took great pleasure in her daily activities, handicrafts, planning and
socializmg. Much of her mterview had to do with ciurent activities, family, life in an RV
park and her experiences as a grocery store clerk. She stated:
I'm very very active. I play cards three an four days a week I'm taking
piano lessons at the age of 76 an enjoying it. Oh an I made forty-two
bookmarks for my family forty-four bookmarks for my family reunion
which they don't know anything about. They're all uh things so you can
look at em if you like. An uh I have those finished ready for the reunion.
An uh each one of em is different. There's only two names out of
forty-four that are the same, there's two Carols the rest are different. So
I put a name on one side an uh something on the other. So I've got those
224
all done for the reunion an they thtnk I outta tell em ^^ilat I made but I said
no way. Gonna be a surprise, gonna be a surprise. (S9, L96-117)
Karen does not have a doctor, takes care of her own health and stated;
I'm healthy. Take no medication. An I exercise. We take aerobics here
twice a week Tuesdays and Thmsdays uh fer an hour in the mornings. An I
have a cardioglide I ride once m awhile. I should ride it more than 1 do but
it says fifteen minutes three times a week but the highest I can go is five at
any one time. I get winded at five. That's it ya know. (S14, L208-221)
Karen expressed great pleasure with where she was living, all of her fiiends, and
the community. She spoke of her family lovingly. She had no biological children but had
step-children from her second marriage that she visited frequently. Her trip back East for
the family reunion was planned in detail mcluding the travel route, how long she would
be staying each place, what motels she would stay in along the way, plus, she had just had
her car tuned up and detailed. Karen spent no time critiquing current afiairs other than to
say.
My family's always been very close. All of us. An uh it makes me so sick
to hear someone say well I haven't spoke to my sister m fifteen years. Well
what I think of that is they oughtta be ashamed to admit it. Right? Even if
it's so you shouldn't tell anybody (laughs) (S26, L431-438)
Karen talked extensively of making things from pies to quilts for members of her
family;
225
Meg and I made her graduation dress. An they had lotsa rhubarb so I
made her mother twenty-three liiubarb pies an twenty-one apple pies to
put in the fi:eezer. An she had one a those racks wiiere the pies fit ya
know. So after she got em froze she put em aside an used the rack again
n so I made forty some pies while I was there. They weren't baked er
anything they were just raw pie. I'm sure they're all gone now. (Laughs)
(S35, L610-625
Karen loved her work as a grocery store clerk - "But grocery store work is
interesting. No two days are alike. No two days are alike." (S84,11902-1904) She told
numerous stories of mcidents with customers with great relish:
An there was this little ol lady usta come to the store. An she every time
she came to the check stand she said we cheated her. I mean this went
on fer oh ferever. So one day Annie come ta work with a bad headache.
Oh she had such a headache n the woman said somethin to her about
cheating her. She said maam, why don't you shop at Krogers. Maybe
they don't train their girls to cheat as well as we do. An she never said it
again. Never. After all the years she'd been coming there she never once
said that again after Annie told her that. Oh it was fiumy. (S75,
L1681-1696)
Karen concluded her mterview this way:
Well I been married just about fifty years. Twenty-six to the first one
and twenty-four to the second. I've been married all my Ufe practically.
226
Yeuk. (Laughs) Well now [Karen] is takin care a [Karen] from now on.
Nooooo more marriages. I'm not takin on any more sick men. No. I
went through that twice that's enough. Nope...I like living alone for the
simple reason I can look at the TV programs that I wanna look at. I can
eat when I feel like it not when I'm supposed to. An I um don't have ta
cater to somebody else's ideas. If I wanna get up in the middle of the
night an look at a movie I'll get up an look at it. An if I wanna read till
one o'clock in the morning I do it. An uh I just don't uh an if I get up
some morning an decide I wanna go somewhere I just get m the car an go.
I don't have anybody you know so I love it. I really love it. An as far as
being lonesome. I don't let myself be lonesome because I have too many
friends ta play cards with n I'm takin piano lessons now at 76 an I'm, you
know I'm busy. I'm busy. An I gotta get my quilt together. An um when
I do this part then I iron all that... (S94, 95, 96, L2204-2213, 2227-2252)
And Karen finished by explaining the intricacies of quilt making.
Margaret: Margaret, the only smoker among the participants, was an assertive
woman with a strong sense of family devotion. She had a sharp M/it and an air of
capabiUty. About her youth Margaret stated. "It was a wonderfiil childhood. Very
wonderfiil. I had a great mom and dad." (SI, Ll-4) With the help of surgery she
overcame some unique health problems as a chUd and went on to marry and have three
children. Near the beginning of the mterview she spoke of the difficulty she experienced
losing her mother, father and oldest son in close proximity.
227
It was very tough at that thne. But um I don't let things like that bother
me. I mean they bother me but uh you just have to go on. You can't
stop. That's my opinion so... (chuckles) Well you have to do that there's
no other way. (S7,1124-134) Uh you know you don't ejq)ect your
children to go before you, you know (chuckles) You figger you will go an
your children will live on. (S8, L154-157)
Further her husband had died several years previously at a time when "everything
was gomg so good." (S11, L205). She went on to state "There's a lot has left me.
(laughs) But um like I said eh life goes on. You have, you can't just stop. At least I
don't." (SIO, L180-I85) When her husband died Margaret found herself lacking in living
skills and with no job skills. '1 never drove uh alone before. I thought well now is the
time. Your on your own baby." (S12, L248-251) So she got her license and drove from
Florida to her mother's home on Long Island. She and her mother lived together and then
moved to a location m the Southwest where her sister lived. Her mother "...went into
Alzheimers. And uh that was rough. That was another rough time (laughs) Eh you know
I would not put her away in a home or anything. I took care of her." (S14, L299-305)
Now her sister who lives across the sidewalk has Alzheimers Disease and Margaret is
taking care of her also. She related several humorous mcidents about her sister's
Alzheimer's related confusion and confabulation and saving her from unscrupulous sales
people. She also stated;
It makes me feel bad m a way because she was always so alert an right up
to the minute with everything. And now this. You know it's like eh well
228
I feel with her as I did with my mom. I figured my mom died long
before she actually did. Now I'm feeling the same with my sister you
know. I usta go to my sister if I had a little problem or anything or I
wanted some advice or something. I'd go to her an ask her. Course
sometimes I wouldn't take it but... (laughs) I listen to people's advice
an then I do what I wanna do anyway. But I can't do that anymore
with her. It's like I've already lost her. But I push on. Oh yeah, that's
my motto (S45, 46, L969-995, 1001-1004)
Margaret's daughter is encouraging her to take courses at the community college however
"right now all I can think about is my sister." (S23, L475)
Margaret is concerned about the firequency with which senior citizens get
swindled and related several mcidents m which she refused to cooperate with sales
people, including a solicitor for the police department whom she briskly niformed of her
opinion of solicitors. Of these types of mcidents she stated "I can't understand how
anybody can be so gullible. Or is it just my way of thinking I don't know. I question. I
question everything. I even questioned you." (S52, L1132-1137)
Margaret described herself as healthy and had addressed recent minor health
problems with vigor resulting m resolution. She mamtained a busy schedule and was
happy that way. She related the story of a miserable neighbor who didn't have any
family, stayed shut in and felt sorry for herself About this Margaret stated.
But you would think that she would um get m contact with other people.
I would think. I mean if I had no one I would even maybe take in a
229
roommate. You know another woman that would think as I do. Which
is very hard (laughs) I have a unique way of thinking I guess. (Laughs) I
don't know. (Laughs) Well to me uh I don't know really, I believe m live
an let live. An that's about it you know. So my son once called me a
hard woman (laughs) An my daughter well I don't know she thinks I'm
just perfect but I'm not. (Laughs) No way. No I'm not, I don't have a
halo. Nope no halo. (Laughs) (S29, 30, L591-625)
Margaret's son wanted her to come live with him to which she responded:
Course he wanted me ta come there n live with them and I said no way I
says. Uh no house is big enough for two families, (laughs) No I never
butted in with uh with my children. I never told them what to do. Uh I
always figured if they wanted to try something they should try it. If they
fail they faiL No big deal That's my idea. So I was always available. I
said if you need my advice I'm available. If you don't need it all well an
good. (Laughs) (S20, L404-421)
Of her current living situation she stated, "I'm quite happy the way 1 am. Uh I
enjoy living by myself It doesn't bother me. I like people." (S18, L380-384) Margaret
concluded her interview by telling several humorous stories about a recent accident in
which she recovered well with help from her daughter and fiiends.
APPENDIX F
EXAMPLE OF LEVEL I ANALYSIS
;.9l
•.1
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
'3
tl4
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
I -5.1
So I went u got a JQIL.
An I was one on
one corner of a stack.
There was four men on the stack
with overshot stackers.
^
An I think there uz 9 or 10 of them.'
The hay come m just like that
ever little bit.
An that was work that wasn't a kids job that was a mans job.
An fer dniner
I was stripped down pert near naked
'
only my pants on
/
because it was so hot.
_
j
We'd run for the irrigalia ditch. J . An take a quick bath.
Then we
I remember this part
_,
/
we went ta this ranch. ^
An the men set in the lawn before we eat we didn't go mside
because we uz probably too dirty for one thing. An m fairly clean
L"t, •
uh ranch home.
An thLs giri wasuhprobably^
e.vperience4)retty well
*
"
,
yoimger
; .
an uh
;•
probably uh
a little bit uh
I'll describe it as
she's pretty uh
.
world wise
'
.
was cookm dinner.
'
An she'd come out on the porch an she say come on git it er will
throv/ it
to ye.
So we dive m (laughs)
^
/ \'
an eat her dinner an then leave. (
\
Well this girl hummed a time aU the time i sang the song.
\
All the time we was eatin. C. ' "•
"
^
She was probably 18 20 years old.
\
But I was just a kid.
;
I don't remember how old I was.
But she sang she played she
!
she uli
^
/
sang a song.
•
/
I'll tr^to think of a few words to it if I can play it on the mouth again maybe
231
'
,
'
3
il6
'j1
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
•8
159
160
161
162
163
164
165
166
167
I had a kind old mother.
This is her son speaking to you.
Her son,
was a cowboy an he says
I am a cowboy an a good one you all know.
Thats some a the words.
An some a the words are
I had a kind ol mother
an she wept and prayed for me.
Well I understand
^was a little bit on the borderline.
Do you want me to play that on this here?/
Now underhand I uh
/
,
I've memorized this from 60 70 years ago.
.^
So I can't do itjjenfectly
•,
|X
by any means.
'
But I'll do it the best I can.
(Plays harmonica)
/l ;
Thats all I'm gonna play that I
I'll hafta play you a different one (chuckles)
I've forgot most of it (laughs)
Want me ta play you one more while I'm
Well 11 gotta stand up on my lungs.
J
See you gotta breathe to do this.
x
(Plays harmonica)
(laughs)'
Wei] I've nlaved lots of em.
(You like playin that)
Well vea because it's a
its a pasttime an its somethin I accomp'lished
tnplished;an <
a little bit.
;
I could a been a musician
^with it./
,
^.,;.
But 11was deprived a that.
/
i
"
-•
168
169
170
171
172
173
174
175
176
177
"m
179
0
..V
I show off once in a while but
don't we all? (
Even the politicians d&MxdZ iveryday(^
Well thats about all I know ta say now^
I could
I could go on by the hour
tellin stories.
)
Well
I
I uli give ya a little experience about my life T have
I got no education my father wanted me to work
232
'
>
'/
\
'
• v
J
198
199
I wanted an education but 1 didn't get one.
Lmean
out of a book.
I never passed the 7th grade see?
Anduh
I got educated all right.
In a different way.
I followed every trade under the sun to make a living.
And uh
1 hadta provide for my family
an^ it was tough.
I run ranches.
I worked in rock quarries 1 worked hi pulp mills saw mills
worked in the woods.
I worked underground.
I even worked for the forest service for several years.
I've done manv many different jobs.
I wns married to two~^od'womenr
Can vou beat that? (Laughs), ^
200
I
201
my first wife
I met her when she was
not quite ^
• 'v:2
183
184
185
186
187
188
189
190
191
192
193
194
195
196
151
202
, ^3
Z.04
205
'
18.
yV-
210
An T rinn't^
212
Uh
.
she was a very good woman very smart.^
Veryuh
.-s
bram wise. ^ ^
An she helped me a lot but I lost her. ^
When shes fairly young I mean young ta meT' "
She wasn't even 70 years old 69 I think.0
She died of a heart attack. C
BecauseJ. was
retired in Arizona at that tune. ^ '
I lived with er 43 years. ^ ^
And raised three boys,
209
213
214
215
216
217
218
219
220
221
222
223
224
5
^
^
\
211
207
208
'
'
233
•. ^
j U--'" •
' T'
f
•—
An
she wrote her father a letter er
said she wanted to marry me and he objected.
I wouldn't let cha marry an^ man.
But she che
she decided fer herself she married me. ^
206
,
v..
P
.
I become awflillv lonesome ^ ^
•
•"I -•
^
^ yM
-Avy-'
v
.
^ .J "
i
i
1
\
?'16
• .7
228
229
230
231
232
233
234
235
236
237
238
^39
240
^41
242
243
244
245
246
247
•8
i49
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
0
in Camp Verde. •.,
And uh
/
I was uh lonesome for two years I met a lady here in Cottonwood
at the senior citizens. • •
Uliuh
she carryin three names so I can't ^ ^ 0
^
I can't exactly memorize em but she's nwmed
twice before she met me.
/•
But an awfiii nice woman.
/
But I've just lost, her.
Bout two months ago.
A fine Indv,
So I'm I'm really blessed
by being married to two good women.
And I was very fair with em to and they was fair wii
So thats one tlihig I
•zr ^ upI got in the back of my mind it
I'jnthankfiil for.
"And rn jiist give va a little bit of my history right now.
Right now
I'm a little bit under the doctoR care fer difiFerent things/'
due to the fact that I'm like McAoher I'm
fadin away.
I'm like that mnn m uh in uh in uh
X
you heard about that black man who waa^
wasuh
\ ^ \
let me get my bram ta workin was uh ^
'
a judge in the supreme court?
Tliat got too old ta be a judge
a few years ago did ya hear about im?
I forgot his name.
/
But
V
somebody asked him why are you retired Mr so, tod so?
/•
Now he's a black man.
Well he says can't you tell? (Laughs)
Thats what he said to the young.people.
He says can't you tell well he's gettin oldUna cttve,
Tliats what he nieant.
At least thats the way I.see it.
And thats kinda the way Lam today.
I inactive
cause I've been a very active man
in my life.
But tile only thing I got left now is to reorganize
234
r>---
.V /
r.
A
. \.
235
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