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Dying And Death Role-Expectation: A Comparative Analysis
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Dying And Death Role-Expectation: A Comparative Analysis
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DYING AND DEATH ROLE-EXPECTATION: COMPARATIVE ANALYSIS by James Thomas Mathieu A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (Sociology) August 1972 INFORMATION TO USERS This dissertation was produced from a microfilm copy of the original document. While the most advanced technological means to photograph and reproduce this document have been used, the quality is heavily dependent upon the quality of the original submitted. The following explanation of techniques is provided to help you understand markings or patterns which may appear on this reproduction. 1. The sign or "target" for pages apparently lacking from the document photographed is "Missing Page(s)". If it was possible to obtain the missing page(s) or section, they are spliced into the film along with adjacent pages. This may have necessitated cutting thru an image and duplicating adjacent pages to insure you complete continuity. 2. When an image on the film is obliterated with a large round black mark, it is an indication that the photographer suspected that the copy may have moved during exposure and thus cause a blurred image. You will find a good image of the page in the adjacent frame. 3. When a map, drawing or chart, etc., was part of the material being photographed the photographer followed a definite method in "sectioning" the material. It is customary to begin photoing at the upper left hand corner of a large sheet and to continue photoing from left to right in equal sections with a small overlap. If necessary, sectioning is continued again — beginning below the first row and continuing on until complete. 4. The majority of users indicate that the textual content is of greatest value, however, a somewhat higher quality reproduction could be made from "photographs" if essential to the understanding of the dissertation. Silver prints of "photographs" may be ordered at additional charge by writing the Order Department, giving the catalog number, title, author and specific pages you wish reproduced. University Microfilms 300 North Zeeb Road Ann Arbor, Michigan 48106 A Xerox Education Company 73-752 MATHIEU, James Thomas, 1933- DYING AND DEATH ROLE-EXPECTATION: A COMPARATIVE ANALYSIS. University of Southern California, Ph.D., 1972 Sociology, general | University Microfilms, A X J E R D X Company, Ann Arbor, Michigan * THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED. UNIVERSITY OF SOUTHERN CALIFORNIA TH E GRADUATE SCHOOL U N IV ER S ITY PARK LOS ANGELES, C A LIFO R N IA 9 0 0 0 7 This dissertation, written by James^ThomasJ under the direction of Dissertation Com mittee, and approved by a ll its members, has been presented to and accepted by The Graduate School, in partial fulfillm ent of requirements of the degree of D O C T O R O F P H IL O S O P H Y 'Tn Dean D ate AVSM^.1.972 PLEASE NOTE: Some pages may have indistinct print. Filmed as received. University Microfilms, A Xerox Education Company ACKNOWLEDGMENTS I wish to thank, first of all, the 487 persons who's time, energy, and interest is reflected in this dis sertation. Without the cooperation and openness of these special people, this paper could not have been written. It is my hope that what is written here is a faithful reflec tion of their thoughts, feelings, and responses. Then too, I wish to thank the following friends who have assisted in this research endeavor: Dr. James A. Peterson, Professor of Sociology and chairman of the dissertation committee, who early in my graduate education challenged me to undertake this project, worked closely with me at every stage and saw it through to its con clusion; Dr. Vern Bengtson, Professor of Sociology, for his counsel and support; Dr. Ruth Weg, Professor of Biology, for her kindness and encouragement; and Dr. Neil Warren, Professor of Psychology at the School of Psychology, Puller Seminary in Pasadena, for his research, help and friendship. And I close, still wondering how I could ever thank my lovely wife, Barbara, and our three boys, James, Jr., Christopher John, and Robert Alan for all that they have been during this endeavor. TABLE OP CONTENTS Page ACKNOWLEDGMENTS .......................................... ii LIST OP T A B L E S .......................................... v TENNESSEE WILLIAMS’ QUOTE ............................. vi Chapter I. INTRODUCTION ................................... 1 A. The General Problem..................... 1 B. The Specific Problem ................... 4 C. The General Hypotheses................... 6 D. The Rationale............................ 6 II. THEORY AND REVIEW OP LITERATURE................ 10 A. Role Theory............................... 10 1. Overview............................ 10 2. Role expectation................... 14 B. Consistency Theory 18 . C. Dying and Death Background 20 | 1. Socialization 21 | 2. Medical care system 22 ; 3. Religious institutional system . . 24 ; 4. Cultural system..................... 26 D. Conceptual Structure of the Study . . . 27 III. THE MODEL: CONCEPTS, OPERATIONALIZATIONS, AND PREDICTIONS 29 ' l A. Concepts 30 ? 1. Medical care concepts 30 | 2. Religious institutional concepts . 37 i 3. Cultural concepts 44 ; 4. Social aggregate concept 48 ; i iii Chapter Page B. Operationalizations ...................... 48 C. Predictions............................... 51 IV. RESEARCH PROCEDURES.... ......................... 53 A. General Strategy ........................ 53 B. Sample Design............................ 55' C. Description of the Social Aggregates . 58 D. Collection of D a t a ...................... 71 E. Insturment............................... 73 P. Preparation of D ata...................... 7^ G. Statistical Technique ................... 75 V. RESEARCH FINDINGS .............................. 77 A. Test of Hypothesis I ................... 77 B. Test of Hypothesis I I ................... 79 C. Test of Hypothesis I I I ................ 82 D. Interpretation and Discussion of the Findings.............................. 84 1. Medical care i t e m s ................ 85 2. Religious institutional items . . . 89 3. Cultural i t e m s ..................... 92 VI. SUMMARY AND IMPLICATIONS OF THE STUDY .... 96 A. Summary of General Findings ............ 96 B. The Theoretical Implications .... '--98 C. The Pragmatic Implications ............ 100 APPENDIXES............................................102 ; A. The Questionnaire Schedule ............ 103 B. Letter to Laguna Hills Aggregate . . . 127 REFERENCES............................................129 : iv LIST OP TABLES Table Page 1. Sex and Age of Social Aggregates.............. 60 2. Marital Status and Marital Satisfaction of Social Aggregates ......................... 6l 3. Annual Income of Social Aggregates ............ 63 4. Education of Social Aggregates ................ 64 5. Where Social Aggregate Lived Adult Life . . . 65 6. Perceived Health and Ideal Age of Social Aggregates ........................... 67 7. Life Satisfaction and Important Thing in Life for Social Aggregates . ......... 68 8. Religion, Religious Attendance and Involvement of Social Aggregates ........... 70 9. Mean Congruity Ratios for Medical Care S y s t e m .................................. 78 10. Mean Congruity Ratios for Religious Institutional System ......................... 8l 11. Mean Congruity Ratios for Cultural System . . 83 12. Medical Care Items of Treatment and Information.................................. 86 13* Religious Institutional Item of Comfort When Thinking of Death....................... 91 14. Cultural Item of Thinking of Dying and D e a t h ..................................... 94 15. Cultural Item of Talking About Dying and D e a t h ..................................... 95 v "Death, the opposite is desire." Streetcar Named Desire Tennessee Williams CHAPTER I INTRODUCTION The purpose of this research is to investigate the fit (congruity) between individuals1 role expectations and the social and cultural systems' role prescriptions in relation to dying and death. This introductory chapter presents the general problem addressed by this study: the exploration of the negative image that aging and the last part of the life cycle holds for many people in our society. The second section identifies the specific problem of the study. In light of this framework, three general hypotheses are generated. The concluding section sets forth the rationale for the present study. A. The General Problem The general objective of this study was to explore a possible explanation of the negative image that aging and the last part of the life cycle holds for many people in our society. It is commonplace to hear a middle aged person remark, "Well if that's what old age has in store for me, I don't want to have anything to do with it!"; or "If that is what could happen to me when I'm old, I want 1 to get out of this life while I still have some control!"; or to hear an older adult respond to the question "If you had your choice, what age would you most like to be?" with the answer "Oh, about 40 or 50, because that's when I had good health, and was independent and had some control over my life!" Many important reasons and hypotheses are put forward to explain the negative stereotypes regarding aging which saturates existence in the latter span of life, not the least of these being the decrement of health (Birren, 1959; Palmore, 1970), poor financial stability (Riley, 1968; Kreps, 1967), and role loss (Rosow, 1967; Cumming and Henry, 19.61) . Without exception, these tend to be categorized as "losses" with progression through the last half of the life cycle. The aim of the present investiga tion is to add to the existing research findings, and to supply a different perspective. With the addition of a social role, that of dying patient (actuarially set in old age), in the life space of an individual and in the framework of the social structure, role strain, structural stress, and alienation become significant factors in the ; aging process. LaPiere and Farnsworth (19^9) suggest that the factor which perhaps is predominate in making so many moderh people reluctant about growing old is that old age is a preface to death, for which they have not been 3 prepared by indoctrination (socialization) in any system. In approaching this problem of negativeism of aging persons, a particular event is examined, that of dying and death. In this research we are not interested„ in the phenomenon of dying and death, but in the relation ship created by this phenomenon between the individual and his society. Many studies have concerned themselves specifically with the phenomena of dying and of death in investigating the trajectory, or process of dying (Glaser and Strauss, 1965, 1968; Kalish, 1965), the psycho-social aspects of dying and death (Peifel, 1959, 1961; Hinton, 1967; Kastenbaum, 1967), and the dying patient's psycho logical well-being (Kubler-Ross, 1969; Bowers, 1964; Brim, 1970). Others have investigated relationships with family members, grief, and bereavement (cf. Bachmann, 1964; Eliot, 1948; Gorer-, 1967; Kutscher, 1969). Along with the above areas of investigation in dying and death, another fruitful exploration is in the area of the behavioral dimension of "expectations." There | is a void in the literature into this area of inquiry. ; With the exception of the two global expectations of being ; I treated as a human being, and, the ability to die with dignity, the myriad of other expectations remain unexpressed and unresearched. The present study concerns itself with the normal j aging population living in various communities and their I expectations toward the dying and death role. Hence, the focus is on behavioral dimensions, rather than dying and death pathology. B. The Specific Problem Social structures are made up of role relation ships,, which in turn are made up of role transactions. In the dying and death milieu, such transactions are between individuals and societal*s medical care system, religious institutional system, and cultural system which includes familial and friendship ties. The medical care system's, the religious institu tional system's, and the cultural system's role prescrip tions of individual behavior are highly institutionalized and normative in order that various societal and institutional activities are accomplished. Role pre scriptions, for this study, are defined as the rights and privileges, the duties and obligations, of any occupant of a social position in relation to persons occupying other positions in the social structure (cf. Sarbin and Allen, 1968). In other words, presceiptions are guides for behaviors in which persons should or ought to be engaged (cf. Becker and Bruner, 1931)* For example, doctors and staff in the medical care system are expected to use every medical treatment and device available to keep a person alive. The individual's role expectations in this dying and death milieu are frequently incongruent with societal's role prescriptions. Role expectations, for this study, are defined as a collection of cognitions— beliefs, orienta tions, values, subjective probabilities, and elements of knowledge which specify in relation to complementary rights and duties, the appropriate conduct for persons occupying a particular social position (cf. Sarbin and Allen, 1968). In other words, expectations are the dispositions, wants, and hopeful outcomes that an individual looks forward to incorporate in future reality. For example, a practitioner in the religious institutional system would expect his religion to comfort him most when he is dying. This lack of congruity between the prescriptions and the expectations produces role strain, a low level of aspiration, and a negative image and feeling toward aging by persons throughout the life cycle. The amount of agreement in role prescriptions and in expectations for a social position may be less than is commonly believed to be the case. In a study of role expectations of the institutionalized roles of school superintendent versus the school board member, no consensus on expectations about the division of labor was found (Gross, et al., 1958). The specific purpose of this exploratory, comparative research was to investigate the fit (congruity) between individuals1 role expectations and the social and cultural systems' role prescriptions in relation to dying and death utilizing three social aggregates— a stratified probability sample of the adult population of the city of Pasadena, California; and two purposive samples, one from Leisure World, Laguna Hills, California, and one from the mountain states of Idaho, Montana, and Wyoming. C. The General Hypotheses Based on the framework presented in the first two sections of this introductory chapter, the general and the specific problem of the study, the following three general hypotheses are posited: Hypothesis I: The role expectations of the personal system will be incongruent with the role pre scriptions of society's medical care system. Hypothesis II: The role expectations of the personal system will be incongruent with the role pre scriptions of society's religious institutional system. Hypothesis III: The role expectations of the | personal system will be congruent with the role pre scriptions of society's cultural system. D. The Rationale The central thrust of the process of socialization , is that it prepares an individual for the successive life | roles that will be ascribed to him, or that he will achieve; i as he moves through the life cycle. This process provides ; the individual with skills, information, psychological and emotional attributes which permit him efficiently and pleasurably to fulfill his roles with a sense of purpose about doing so. Goldfarb (1965), a geriatric psychiatrist and researcher, develops the thesis that most individuals in our culture and society are socialized,— or the more accurate terminology, "anti-socialized1 ’— for dependency and not for independence. Further, he suggests that dependent relationships must be recognized as critical, common, and pervasive influences in structural dynamics. This is to say that individuals are impelled toward acceptable social behavior by way of dependency ties and dependent relationships, which act as a social cohesive force and permit or force the more or less successful assumption of life roles even in the absence of skills, information, and rational social purpose. Dependency appears to be comprised of interlacing personal and systemic relationships in which manipulative maneuvering is called, and mistaken for, concern and affection; in which guilt, a crushing sense of obligation, and a compulsive need for social compliance join with fear and inability to act with rational independence. Depen dency involves not only changes in the individual's self- concept, but also changes in expectations and behaviors between the individual and his social environment, his systems and institutions. It is suggested here taht if Goldfarb's premise is valid for our society in general, it is an especially apropos premise for the last part of the life cycle. As persons move through the maturation process into a sequence of statuses and positions of "role loss," such as retirement, widowhood, physical and mental health decrements, income and. financial decline, a metamorphosis tends to take place,— socialization transforms into social control (cf. Wheeler, 1966; Rosow, 1967; Streib, 1955, 1956; Lowenthal and Boler, 1965; Cavan, 1962). This comes about because older persons in our society are valued as a low social loss (Glaser, 1966). Older adults are dealt with according to what others and society think and feel is best for them; not according to what older adults themselves think is best, or that they would like and want from their milieu. But, it could be hypothesized that most persons, regardless of their chronological age, would want to be a part of the decision making aspect of life long interactions. Development of the skills, information and the psychological and emotional context to deal with the reality in and of one's life is crucial for personal well-being and systemic credibility. Three significant structures and systems in our society, in terms of socialization and social control, are the cultural system, the medical care system, and the religious institutional system. They become more instru mental as they function in relation to the phenomenon of dying and death. By borrowing concepts from role and consistency theory, linked up with concrete events in the phenomenon of dying and death, a structural conceptualiza tion emerges. The study posits that dying and death socialization is primarily self-initiated. This self initiated socialization has its roots in cultural and societal prescriptions and in individual expectations. Thus, the present investigation examined the relationships between the individual's expectations and societal's cultural system, medical care system, and religious institutional system prescriptions. The research objective was to demonstrate association between the prescriptions and the expectations. CHAPTER II THEORY AND REVIEW OP LITERATURE. The present chapter presents the theoretical and the empirical background for this study, including brief summaries of the relevant aspects of role theory and consistency theory, and dying and death background. This review of the literature of role and consistency theory and the dying and death background summary is not intended to be an exhaustive review of these fields. It is rather intended to be a summary review of the development and the direction that these theoretical approaches and background findings have taken and how they can provide a theoretical explanation for the research undertaken. The final section integrates the theoretical and empirical literature and formulates the conceptual structure for the study. A. Role Theory 1. Overview Within the field of role theory, there tends to be a proliferation of orientations (cf. Parsons, 1937* 19^2, 19^9, 1951; Merton, 19^0, 1957; Turner, 1956; Goffman, 1959, 1963; Biddle and Thomas, 1966). The role theory orientation used in this study will parallel the approaches 11 of Allen (1968; Sarbin and Allen, 1968) and Sarbin (1950, 1952, 1954, 1964). According to these two researchers, role theory is eclectic, in that its apparition is the convergence of two principle intellectual sources and traditions. These dichotomous roots lie in the sociologi cal and anthropological sources and traditions (Durkheim, 1933; Linton, 1936, 1945) which focus on implications of status differentiation and division of labor within society and in the theoretical investigations of the growth of self and social awareness (Cooley, 1902; Mead, 1934) which emphasize cognitive processes in social interaction. Role theory, being very broad and abstract, attempts to explain social behavior in terms of the inter relationships among variables at the comceptual levels of the personal system (individual or self), the social system (status or position), and the cultural system (role). The theory attempts to integrate the individual and society. Role, as a unit of analysis, is explicitly interindividual in nature. A role is meaningful only in relation to its complementary role, such as, husband-wife, or parent-child, and, therefore, role prescriptions (for social and cultural systems) or role expectations (for individual or self system) are always in terms of social interaction. Role as an explanatory mechanism for social behavior constitutes an interpersonal or systemic rather than an intrapersonal unit of analysis. It is the social act, in 12 Mead’s (193*0 terminology, that forms the basic unit of role theory. Thus, role theory Is on the molar (inter personal) level of explanation. The definition used in this study of the term "role" is the behavioral dimension of that part of the status which prescribes how the status occupant should act toward the social position (a collection of rights and duties, according to Biddle and Thomas, 1966) and persons with whom his status r-ights and obligations put him in contact. A role is a part assigned to a person, whether the part is in the' drama of the stage or in the drama of everyday life (Goffman, 1959)- To a part accrue certain requirements: requirements for a particular set of overt behaviors and actions, and also for the possession of particular dispositions, such as orientations, attitudes, beliefs and values. In other words, the part or role specifies what one should do, how one should do it, and what sort of person one who enacts the role should be. In its complementary role aspect, e.g., doctor and patient; each role has rights and obligations as regards the other. Society is composed of differentiated social positions, both formal and informal, which are often identifiable by label or a name. Integral to each social position is a set of norms, imperatives, or requisites of the social system specifying the appropriate and expected social behavior 13 for a person occupying such a position. These are called role prescriptions in this study. It has often been observed (cf. Parsons, 1951; Goffman, 1959; Biddle and Thomas, 1966) that role theory is unique in providing a theoretical integration of individual and society. Social behavior is a function both of the social system in terms of the social position occupied by individuals and of the individual in terms of his unique conception of self. The basic assumption underlaying role theory’s approach to social behavior is that, utilizing Peters' (1958) thesis, "man is a rule-following animal." This is to say that all societies conventionalize behavior. Even in the case of biologically based behavior such as food- seeking and illness-reduction, expression is governed by an elaborate set of rules and rituals which differ across cultures. Rules and rituals also govern the behavior of persons having specific statuses in society— such as doctor and patient, clergyman and layman, leader and follower. Rules for a particular social position are role prescrip tions which define how the occupant of the position ought to behave. Such role prescriptions exist for each social position within a society and define the appropriate behaviors for an occupant of the position. It can be said then, that individuals are "rule-following animals," and further that roles constitute the rules for behaving appropriately in accord with one's social position. Why is one a rule-following animal? Why do we conform to role prescriptions? The reasons are many and complex, but can be found in the nature of the life-long processes of socialization (to be discussed more fully later in the study) from which we attain self-identity, gain the ability to predict and control the social environment, and obtain approval or disapproval from others. We behave according to role prescriptions because such role prescriptions validate our occupancy of the social position, maintain our self-system, elicit pre dictable behavior from reciprocal roles, and produce positive reinforcement from other persons reacting to our role. An individual's behavior consists of role expectations, be it the prescriptions of a formal social role such as doctor or nurse or of an informal social role such as "visitor." A person's position (place or location) in the formal and informal social structure enables us to understand and predict his behavior because individuals are rule-followers and hence adhere to role expectations and role prescriptions. 2. Role Expectation A basic concept of role theory that is important in this research is the notion of role expectation (on the level of the individual) and role prescription (on the level of social and cultural systems) to which we have already alluded. A fuller explanation of role expectation is now undertaken. Blau (1964) describes the nature of both the generating and the correcting mechanisms of individual role expectations of social relationships. He states that "general expectations" cover all the broad events of an individual's life such as status, role, education, and family, which are governed by pervasive values and social standards, norms and prescriptions. When these "general expectations" are either achieved or thought to be achievable by an individual, his aspirations and positive image of that object or situation rises. But conversely, when a person's "general expectations" are neither achieved nor thought to be achievable, one's aspirations go down and a negative image of that object or situation is produced. In Blau's (1964:146) words, "Initially, dissatisfaction with achievements and rewards is likely to be a spur to greater effort, but continuing inability to attain important objectives tends to lead to resignation and embitterment." He goes on to discuss the "particular expectations of other" and the "comparative expectations of profits" (cf. Goode, i960) an individual expects from his social relationships. These "comparative expectations of profits" in the dying and death event .are the individual's 16 role expectations, such as the projection of being treated as a human being, and, the ability to die with dignity. The "particular expectations of others" in the context of this study of dying and death are the role prescriptions of the medical care system, the religious institutional system and the cultural system in our society. In the social context, roles are more or less structured, or patterned. Within a social system certain roles become well defined and there is reasonably wide spread agreement as to the behavior expected from the occupants of that social position. These patterned and widespread agreed-upon behaviors are referred to as role prescriptions. In contemporary American society, for example, the role of patient in the medical care system and the role of religious practitioner in the religious institutional system is relatively well structured. At the same time, a relatively wide range of variation in role enactment is permissible, even for well-structured roles. Therefore, it is useful to think of role as encompassing a range of behavioral dimensions defined rather broadly. Prescriptions are behaviors that indicate what other behaviors should or ought to be. Prescriptions may be further specified as demands or norms, depending upon whether they are overt or covert prescriptions. Because prescriptions are ubiquitous and salient in their various forms, they appear to be among the most significant guides and standards for our social life. Then too, by specifying the rights, duties, and obligations of individuals, prescriptions are among the most powerful factors in the control of human_interaction. Prescriptions are crucial, also, because they emerge from the interaction of individuals and groups and thus are themselves con trolled by some of the same behavior which they are supposed to govern. There are numerous and subtle inter relationships between prescriptions and the behaviors to which they relate. Among the reasons for the diversity of relationship between prescription and the behavior prescribed is that prescriptions themselves differ in important ways. Prescriptions are formal and informal, expressed and implicit, individual and shared; and whatever their form, prescriptions may vary in permissiveness, completeness, complexity, and in the degree to which they are codified and universal. Another basic concept in role theory is the cognitive organization of qualities called the self or self-conception, which refers to phenomenal experiences of individuals. But in order to perceive and understand this element of the structural makeup, role theory, up to this stage of its development, calls upon a further body of information and research, consistency theory. B. Consistency Theory A second body of theory dealing with systemic relations, the consistency framework, describes the process of balancing in the interaction of the self system with the social system. The dynamics of this process is to produce some kind of integration on behalf of an individual in terms of the social and cultural systems' role prescrip tions that are relevant to his situation and his self system's role expectations of that phenomena. This process hypothesizes that there is need for consistency of some kind, or congruency with objects or events in the social milieu on the part of the individual. The lack of con- gruity produces role strain on the part of both the social structure and the individual, dissonance (a state which occurs whenever an individual simultaneously holds two cognitions which are psychologically inconsistent, according to Pestinger, 1957), and/or a general negativism within the individual towards that object or event. Consistency theory-, unlike role theory, does not attempt to treat social behavior at such a broad, abstract, and inclusive level. Although the scope of some consistency theories is relatively broad (behavior theory, activation theory, and dissonance reduction theory, as examples) most are more restricted. But even the broadest consistency theory does not attempt to explain all social 1 behavior. 19 The basic assumption of consistency theory is that the cognitive system tends toward a state of simplicity and harmony, creating balance or consistency among cognitive elements. In essence, consistency theory is a tension- reduction model of the cognitive structure. Cognitive inconsistency presumably motivates a change of cognition in such a way that equilibrium or consistency results or, as Blau points to, leads to resignation, embitterment, and a negative image toward that event. Role theory is not a motivational model in this sense. Therefore, in this research investigation, role theory serves as the struc tural element or orientation and consistency theory functions as the motivational element. The unit of analysis for'consistency theory is intraindividual in which the primary concern is directed at the relation existing between cognitive elements. The explanatory mechanism is the state of consistency or inconsistency that exists between cognitions "inside-the- head" of a person. These "inside-the-head" cognitions may represent either the internal state of the individual or the social events and objects outside the head in the person’s environment. As a theory of cognitive function ing, consistency theory has relevance to social behavior, in the present framework, only when the cognitive elements represent social objects and situations, or have conse quences for behavior that is social in nature. This follows the work of E. Brunswik (1952). These theoretical formulations of role theory with consistency theory have been translated into meaningful operationalizations with fruitful research conducted. One aspect has been the effect of role prescriptions on cognition (attitudes, beliefs, values, self). Very early role theorists pointed out that prolonged contact with role prescriptions produced changes in the self system congruent with role prescriptions. Merton's (19*10) analysis of the effect of the rigid personality of the bureaucrat and Waller's (1932) analysis of the effect of teaching on the teacher are examples of this. Whereas others working in the areas of deviance and race relations (cf. Cloward and Ohlin, I960; Myrdal, 19*1*1; Pettigrew, 1964; Ransford, 1968) point out that prolonged contact with role prescriptions often produce role strain through alienation, anomie, and deviance. Other investigations utilizing the consistency theory orientation in relation to role prescriptions and expectations are Pulton’s (1965) study of the funeral director, Burchard's (1954) study of the chaplain, and Gross et al.’s (1958) study of the school superintendent. C. Dying and Death Background We are.at the genesis stage of inquiry and exploration into the dying and death phenomenon (in social research). This is in spite of the plethoric literature 21 on dying and death, mostly coming from medicine, philoso phy, and the arts. In a society where dying and death has been culturally prescribed as a "taboo topic" (Feifel, 1963), selected inroads in scientific investigation are now beginning to be delineated. One such area is that of dying and death socialization. 1. Socialization It can be posited that there is a socialization (the concept of socialization used in this study follows that of Brim, 1966, as the process by which persons acquire the knowledge, skills, and dispositions that make them more or less able members of their society) to dying and death in our culture just as there is a political or educational or religious or occupational socialization process. Unlike these other areas however, dying and death socialization is primarily self-initiated. Little attention has been given to the self-initiated attempts by persons in forming their cognitions and expectations for the dying role. The content of socialization can be considered analystically to include an understanding of society's status structure and of role prescriptions and behavioral expectations associated with the different social positions in this structure. Theoretically, then, self-initiated socialization has its roots in these societal prescriptions 22 and in the expectations that the significant others have for the individual's behavior. In the area of dying and death the source of our society's prescriptions come from the medical care system, the religious institutional system and the cultural system. Significant others, in this area, are doctors, nurses, aides, clergymen, religious leaders, family models and dying intimates. The distinction really is between whether the prescriptions are current, immedi ate, and from persons real and present, or whether by contrast the "others" involved are distant and symbolic. 2. Medical Care System The medical care system that functions in our society has not been, nor is it presently a socialization agency or agent for dying and death. In fact, the strong taboo on death has enabled the medical care system to function almost as an anti-socialization process in society. Glaser and Strauss (1968) state that the medical care system is in need of radical change in relation to the socialization of people in our society. The authors write, "our own position is $hat the current system is perhaps as good as it can be, but that the system itself needs radical reform" (Glaser and Strauss, 1968:252). After this admonition the following recommendations are offered: 23 (1) Training for giving terminal care should be greatly amplified and deepened in schools of medicine and nursing. (2) Explicit planning and review should be given to the psychological, social and organizational aspects of terminal care. (3) There should be explicit planning for phases of the dying trajectory that occur before and after residence at the hospital. (4) Finally, medical and nursing personnel should encourage public discussion of issues that transcend professional responsibilities for terminal care. (Glaser and Strauss, 1968:253-259) These recommendations are offered in hopes that the medical care system might operate as a socialization agent in our society for the dying and death event. On the interpersonal level of relationship, Dr. John Hinton (1967), Professor of Psychiatry at the Middlesex Hospital Medical School in England, gives us further insight into the avoidance of the socialization process: She was a retired teacher, who throughout her life had been concerned to help others as much as she could. While dying of cancer, although her physical condition began to deteriorate rapidly, shw was quite alert and welcomed visitors to her bedside. Like most people, when she was given the opportunity to talk freely about her illness and her feelings 24 she was glad to do so. 'I know I've got cancer; it's spreading over my body. I want to see Mr. _____ (her consulting surgeon) because I don't want just to be kept alive with radium. I know I'm going to go; I accept it. I'm not miserable about it.' This me'ssage was passed on to her surgeon, a doctor strongly concerned with his patients' general welfare as well as with the treatment of their diseases. As far as the physical treatment was concerned, he willingly agreed with his patient's viewpoint that there was little he could do to prolong any worthwhile life. He added that the pressure of work prevented him from visiting her again to talk further about it. This was reasonable enough from the practical point of view, but he also indicated that he was not sorry to have grounds to avoid such an inter view. His patient had considerable understanding of how he might feel. ’I know you doctors can't say. It's your job to save lives.' (Hinton, 1967:11) He goes on to say that "Some doctors are reluctant to stay long near the dying because they only like to talk to patients in terms of care. They are apt to see death as a medical failure, and retreat too hastily" (Hinton, 1967:14). (cf. White, 1969; Feifel, 1959, 1963; Poe, 1972. ) Also, Pearson (1969:vii) writes that "Despite the universality of death, the subject has long been viewed as a taboo area, especially by the professionals in the health field who are closest to it— physicians, nurses, social workers , and others." 3. Religious Institutional System There are many similarities between the medical care system and the religious institutional system in the area of dying and death socialization. The religious institutional system, much like the medical care system in our society, has not been, nor is it presently a socializa tion agency for dying and death. The religious institutional system does, possibly, "socialize'’ for life-after-death but not for the dying and death event. Much like the medical care system's preoccupation with "cure" for disease, pain and suffering prior to dying and death, the religious institutional system tends to be preoccupied with the "cure" for dying and death after death. An intricate set of dogma and belief structure is established around the "heaven and hell" concept. The heavy emphasis that has traditionally (both in terms of theology and in practice) has placed upon this "heaven and hell" concept by the religious institutional system has enabled it to avoid the hard realities and experiences that are associated with the dying trajectory and the death event. An example of this is found in the writings of the great reformed exegete and theologian, John Calvin. In the only chapter that mentions the death of believers, Chapter IX, entitled "Of meditating on the future life," in the Institutes of the Christian Religion (1559, English translation, 1957), Calvin states, "Whatever be the kind of tribulation with which we are afflicted, we should always consider the end of it to be, that we may be trained to despise the present, and thereby stimulated to 26 aspire to the future life" (1957:25). In practicality, this thought of Calvin gets demythologized much like the story told by Dr. Kubler-Ross that after a four-year-old girl’s dog died and was buried in the backyard by the parents, she told them, "Next spring when the flowers come up out of the ground, Skippy will come up out of the ground too, and then he’ll be able to play with me again" (1971). 4. Cultural System Our cultural system's prescriptions tend only to negate the "reality" of dying and death and to avoid it, treating it only as a taboo subject until after the event of death (cf. Hinton, 1967; Peifel, 1959, 1963; Pearson, 1969). This is one of the principle reasons that dying and death has been such a closed and private event in our society. Peifel's (1963:66-67) position in this matter seems clear: We have been compelled, in unhealthy measure, to internalize our thoughts and feelings, fears and even hopes concerning death . . . Some think and say that it is cruel and traumatic to talk to dying patients about death. Actually, incoming data indicate that patients want very much to talk about their thoughts and feelings about death, but feel that we, the living, close off the avenues for their accomplishing this. A good number of them prefer honest and plain talk from physicians about the seriousness of their illness. They have a sense of being understood and helped rather than becoming frightened or panicking when they can talk about their feelings concerning death. 27 At one point though, after the event of death, our cultural system does adhere to an elaborate and rigid pattern and process for the funeral and burial ritual (Puckle, 1926; Warner, 1959; Harmer, 1963; Spiro, 1964). D. Conceptual Structure of the Study Goode (1960:483-484) states that "the widespread notion that institutions are made up of roles is fruitful because it links a somewhat more easily observable phenomenon, social behavior, to an important but less easily observable abstraction, social structure." The present study is based on this general view that society's institutions are made up of role relationships, and approaches both role prescriptions and role expectations through the phenomenon of dying and death. Thus, this research attempts to integrate the individual and his society. Utilizing the concepts of role prescriptions, on the level of social and cultural systems, and role expectations, on the individual level, this study examines the congruities and incongruities between the individual and the medical care system, the religious institutional system, and the cultural system. Because dying and death socialization in our society is primarily self-initiated, it is hypothesized that persons’ role expectations will be both congruent and ! 28 incongruent with societal's role prescriptions, dependent upon the social system. Research and investigations on dying and death in our society indicate that this event is experiencially avoided when it happens to persons around us and treated as a taboo subject. The cultural prescriptions of our society tend to be significant guides and standards for our social life and particularly the dying and death prescrip tions are ubiquitous and most salient. Thus it is predicted that role expectations will be congruent with the cultural system’s role prescriptions. Further, the medical care system and the religious institutional system, as they function in our society, are neither socialization agents nor agencies for dying and death, and therefore, this study predicts that role expectations will be incongruent with these systems' role prescriptions. CHAPTER III THE MODEL: CONCEPTS, OPERATIONALIZATIONS, AND PREDICTIONS The present study focuses on social structure as It investigates the congrulty between individuals' role expectations and the social and cultural systems' role prescriptions in relation to dying and death. This property of congruence (fit or correspondence) of a system's prescriptive and expectency (normative) structure warrants precise conceptualization, measurement, and analysis. The measurement and analysis aspects of the study will be dealt with in subsequent chapters. We proceed now with the concepts of this study of the congruence of the normative structure. The second section of this chapter discusses the operational definitions utilized in the investigation. The concluding part of the chapter sets forth the predictions of the study. The major question investigated in this study is: In our society, do individuals' dispositions, wants, and hopeful outcomes (expectations) fit with our norms and practices (prescriptions) in relation to dying and death? Further, will this congruity differ with the type of social aggregate? 29 In examining these questions, the focus was on the medical care system, the religious institutional system, and the cultural system. Following are the concepts of concern to these three systems, along with the social aggregate concept. A. Concepts 1. Medical Care Concepts The concept of treatment is central and crucial to the whole medical care context. Treatment in the medical framework is that act or process of caring for a patient medically or surgically in order to effect some cure or relief of a disease or illness. It has both medical and role impact upon the personal systems involved. Obviously the long range goal of treatment is a combination of prolonging and improving life. The physical outcomes of treatment are somewhat predictable and have been extensively studied, but the impact of treatment upon the occupants of the social positions has received much less consideration. This activity of treatment has often been under taken with very little basis for the activity outside of prolonging life (Brechner, 1970)* Worcester (19^0) relates his forbidding of an elderly man many pleasures in his last year of life because they interfered with the treatment procedings, only to have the patient, as he was dying, accuse him of "playing god" and extending life at the expense of enjoying it. White (1969) states that there is a whole range of treatment procedures engaged in that have role significance, such as spiriting a person away to a hospital for his final days, isolating the dying patient, prescribing drugs, and using heroic measures. He finds "this is part of the 'God-syndrome' the doctor acquires in the training process, and accounts for the ’defeatT and guilt the average physician feels when one of his patients dies" (White, 1969:1). In understanding the complementary nature of social roles, if this surfaces the doctor role, then the patient role must be one of dependence, awe, and responsiveness. But again, of the doctor, White (1969:1-2) goes on to say that "they are neither emotionally nor professionally equipped to make the patients comfortable in this experience, nor indeed to feel comfortable them selves . " Integral and crucial to both role and consistency theory is the concept of information: that process of communicating knowledge and reality. The consistency framework posits that it is this information exchange and communication that is a significant element of the cognitive structure of an individual. The self is informationally dependent as well as effect or outcome dependent (Jones and Gerard, 1967). This is so in the cognitive socialization of individuals. In role theory, 32 the sharing of information is intrinsic not only to the establishment of role relationships but to their crystal lization and maintenance. The present study focuses on the prescription of the transmission of information in the medical care system as a significant variable. Feifel (1963) reports from his research that some of the professional personnel with whom he had contact indicated that, as a matter of policy, they never told a patient that he had a serious illness from which he could die. "The one thing you never do," they emphasized, "is to discuss death with a patient." The reaction of an Associate Professor of Clinical Mrdicine in Psychiatry of a noted hospital, to Feifel's study of attitudes toward death, is suggestive: "No one is normal over age forty with regard to health, so I see no value to your study." Seventy to ninety per cent of the physicians studied in regards to information were found by Kasper (1959) to favor not telling the patients that he was dying. Glaser and Strauss’ (1965) studies confirm this finding. Nettler (1967) points out that, in American society, there is a mythology which sustains the pattern of patient ignorance. It includes the following: 1. Many who die are inexperienced with the premonitory signs of death. 2. Hospitals are structured to hide medical information from patients. 3. Physicians and family members dissemble with the dying and justify their deceit by the assumption that dying persons do not want to know their fate. 4. The process of "closed awareness" is also justified by the medical axiom, "It’s better not to tell." In practice, this rule of silence protects the physician from an unpleasant task. Many investigators, such as Glaser and Strauss (1965)9 encourage an open awareness regarding the diagnosis and prognosis for most patients. Feifel (1967) claims that patients desire open awareness, but physicians, although preferring open awareness for themselves as patients, tend to feel that a direct and open confrontation would be too threatening for most patients. This is one of the rationales for the extremely low degree of information exchange in the medical care system. The other principle rationale for this low degree of information exchange is the legal involvement of malpractice suits. But, says White (1969:2), "In my opinion, lawsuits against physicians usually are the result of poor communication between the doctor and his patient and the patient’s family." One further significant finding in regards to information exchange is brought out by Oken’s study (1961) that found physicians are more likely to tell businessmen than other occupational groups of their fatal condition so they can take care of their business affairs. Kalish (1969) states that any research into the most desirable place for a patient to reside must deal with the question "most desirable for whom?"; desirable for the patient, the family, those involved in the medical care, or others in this relationship matrix? The decision as to whether the patient remains in the hospital or at home is normally made by the physician, weighing the factors of health status, medical convenience, financial conditions, and family arrangements. However, the basis of this judgment is clinically weighted, since research in the other areas is fragmented and inconclusive, especially in regards to the psychological advantages and disadvantages (cf. Kalish, 1969; Feifel, 1963; Vernon, 1970). In 1963» Fulton (1964:364) found that 53 per cent of all deaths in the United States occurred in hospitals, and a good percentage more occurred in nursing homes and extended care facilities. It has been projected that by 1980, over three-fourths of all deaths will take place in hospitals and medical care institutions. This concept of the place of dying has importance to role analysis for an individual's place, location, or geographical position, as well as his social position, helps to define his role. Patients who express desire to be in medical care facilities to die, do so perhaps to avoid causing family inconveniences, perhaps to avoid what 35 they fear will be unpleasant interactions. Patients who desire to be at home, do so perhaps to maintain a measure of independence and of control over the remaining portion of their life. Following the thinking of Glaser and Strauss (1968), Americans tend to accept the patient's death in the impersonal hospital, where "the ebb and flow of events is controlled by routine and by strangers," instead of at home, in familiar surroundings and among familiar people. A finding of Kalish's research is significant in this regard. When Kalish (1965) asked the children of elderly patients where they felt their parent would prefer to die, only 8 of the 37 respondents indicated that the home was preferable. Whereas studies by Feifel (1959) and Fulton (1963) showed a significant preference by patients for home as the place to die. The place a person goes through the process of dying influences the people to whom he will be permitted to relate during the process. The other people in that place will inevitably influence the behavior of the dying person, including the set of role expectations he uses to understand himself and the experience he is going through. It is easier for an individual tp maintain a particular role and definition of himself in certain environments than in others. A fourth concept that is important to the medical care phenomenon is that of care relationships. During the dying trajectory the medical and the technical relation ships are crucial, but so too are the social and the psychological care relationships. The first two seem to receive the bulk of attention in practice and in investi gation, whereas the social and psychological care ones are just beginning to receive attention by practitioners and researchers. Two classical studies in this area of death and dying care relationships are the ones by Le Shan (1964) and Peifel (1959). Le Shan's research supports Peifel's finding of the tendency of medical staff to reduce contacts with patients diagnosed as terminal. It was observed that nurses took longer to answer the call bell of terminal patients than of a control group. Peifel adds that the time the nurses spent in these patients’ rooms was much shorter also. Reported along with these findings was a finding concerning the physicians’ rounds to dying persons. Physicians' visits to terminal patients were less frequent and the time spent with patients was shorter too. Are these medical prescriptions because, as Poe (1972) asserts, death always represents defeat to the doctor? Or, as posited in Glaser and Strauss' ’ ’low social loss" concept (1964), is it that the doctor believes he should spend his valuable time where it counts more, with "counting more" defined in years-to-live, not as quality-of-life need? Glaser and Strauss (1964) suggest that, in the American society, a high value is placed on having a full life, and the loss of a child who has not lived his full life is viewed as a greater loss than that of an adult or an aged individual. They suggest that, with reference to the treatment which patients receive from the medical staff, this factor may contribute to the younger patients receiving somewhat more personal and more extensive care. 2. Religious Institutional Concepts When one engages in the review of religious literature in relation to dying and death, it is heuristic how the myriad writings self-select themselves into a small number of classifications. The present study utilizes four of these categorizations for its investigations related to the religious institutional system for dying and death research. The concepts of attitude, approach, orientation, and comfort are discussed in this section. The concept of attitude is ubiquitous when thinking, talking, or researching the area of dying and death. Wolff (1965) found that previous psychopathological conditions of the mentally ill do predict attitudes toward death, but similar studies and systematic investigation of other life-shaping influences need to be conducted with a variety of "normal" populations. Attitude is a strong 38 concept when investigating the religious institutional system's prescriptions because of the essential nature of "attitude" itself. In understanding this concept, the present study will use Jones and Gerard's (1967) concept of attitude. Attitude is defined as the convergence and conclusion of a belief system with a relevant value concerning dying and death. A belief expresses the relations between two cognitive categories when neither defines the other. An example would be "the righteous will enter the kingdom of heaven." Rokeach and Rothman (1965:129) define a belief similarly as "two stimuli, each having their separate meanings . . . : a subject, capable of being characterized in many ways, and a characterization, capable of being applied to many subjects." The element of value in attitude formation expresses a relationship between a person's emotional attachment toward a particular symbol which has meaning for him. It involves the desirability or undesirability of a state of affairs which may be related to an object, an idea, an event, a person, or any experience that is relevant to an individual's ability to survive and prosper in his lifespace. A value exists whenever an emotion, either liking or disliking, attaches itself to this cognition. Attitude concerning dying and death in the religious institutional system tends to have a sense of immediateness or presence pervading it. For example, even though dying and death may lie somewhere in the future, it has the element of a sacrificial role expectation and prescription about it that is salient to day-to-day living (cf. Calvin, 1957)- This attitude is illustrated in the very popular phrase— "forgetting oneself, one should be about the building of the kingdom of God on earth." This is the religious prescription even in the event of dying and death. The concept of approach in the religious institu tional system is the total human response toward dying and death. It manifests itself in the idea that death is the end of all, or of the notion of heaven and hell, and all the apprehension, anxiety and fear that are associated with either of these. Malinowski (1948) posits that death and its denial-immortality have always formed, as they form today, the most poignant theme of man’s forebodings. He goes on to develop an extensive theory with his basic thesis being that if death were vague or unreal, man would have no desire to so much as mention it. But the idea of death is frought with horror, with a desire to remove its threat, with the vague hope that it may be, if not explained, at least explained away, made unreal, and actually denied. Sumner (1927) endorsed the same hypothesis and suggested that man developed the concepts of an afterlife 40 and a soul to assuage the terror that he experienced in the face of the unexplainable, Inevitable fact of death. The notion of heaven and hell is one of the most pervasive doctrines or dogmas in the religious structure. Its impact exists from the theologian to the dying patient to the little child. Meissner’s (1958) study of forty clergymen implies that the clergyman, like the physician, may have more intense fears of death than others. His findings are only suggestive, certainly not conclusive. But Luther, Calvin, Knox, and Wesley, to mention only a few religious thinkers, expressed a fairly fearful approach to dying and death because of the idea of justice that has as its components punishment and reward (see, for example, Erikson's work on Luther, 1958). It is suggestive that in Caprio's (1950) study of 100 adults who recalled childhood reactions to death, he found that for many children fear of death was related to fear of punishment for their sins. Faunce and Pulton (1958), in their study of 104 college i age students, found that the spiritually oriented students were more likely than the temporally oriented students to fear death. Pear of death has been found to be related to religious affiliation by Diggory and Rothman (1961), Martin: and Wrightman (1965), and Vernon (1968). Further, Peifel (1959) found that among those he studied, the religious person, when compared with the nonreligious person, was in s ill general personally more afraid of death. Strong fears of death were expressed in the latter years of life by a substantial number of religiously inclined individuals. Also, the religious person held a significantly more negative orientation toward the later years of life than did his nonreligious peers. Crucial to the whole religious institutional context is the concept of orientation toward dying and death. Orientation is defined as the awareness of the past, the existing, and the future situation with reference to time, place or position, and identity. In other words, it is the affective or feeling adaptation toward dying and death. The significant element in this concept tends to be that of hope; hope in that which is yet to be. All religions and meditations have something akin to immortality, resurrection, eternal life, reincarnation, or transcendentalism for the individual, the community of believers, or as Vernon (1970:36) suggests, "historical immortality." The religious prescription on orientation is always toward the future state or the afterlife in relation to dying and death. This is so when one's life point-of-reference is that all of life is "good," but it will be "better" in the life-to-come. It.is so too when one's life point-of-reference is the obverse of this thought of the goodness of life. The future existence will; rectify and compensate for all the pain and suffering, all ; 42 the violence and dehumanization. Orientation concerning the dying and death event in the religious institutional system tends to have the future dimension pervading it as has been quoted by Calvin (1957:25), "that we may be trained to despise the present, and thereby stimulated to aspire to the future life." Religious orientation about the hereafter may facilitate death, as it appeared to do for the early Christian martyrs who wanted to realize their heavenly reward earlier, and a bigger reward at that, by laying down their lives for the faith. This may have its psychological counterpart in contemporary society in the "historical" martyrs. Consider the letter which President Vargas of Brazil wrote to his people before committing suicide. It ends: I fought against the looting of Brazil. I fought against the looting of the people. I have fought barebreasted. The hatred, infamy, and calumny did not beat down my spirit. I have given you my life. Now I offer my death. Nothing remains. Serenely I take the first step on the road to eternity and I leave life to enter hidtory. (Kaufmann, 1959:50) And a letter a Japanese flier, trained for a suicide mission, wrote to his parents: Please congratulate me. I have been given a splendid opportunity to die . . . I shall fall like a blossom from a radiant cherry tree . . . How I appreciate this chance to die like a man! . . . Thank you, my parents, for the 23 years during which you have cared for me and inspired me. I hope that my present deed will in some small way 43 repay what you have done for me. (Kaufmann, 1959:50) Ylnger (1957) has stated that "one of the funda mental effects of religion is to rescue Individuals and societies from the destructive force of death." Religion provides man with a definition of death, which, it is affirmed by those involved, helps man adjust to death and comforts him in the dying activity. Pulton (1964:359) suggests that: Within such a theological structure, man could stand secure in the knowledge that death was a personal matter between God and himself. The very purposefulness of his death placed him at the center of existence and elevated him above all other creatures as the principal subject of creation. As part of a divine plan, death was the brother to life, and as such could be confronted openly, spoken of freely, and treated as a natural phenomenon. It is perhaps at moments of extreme pain or sorrow that the individual becomes most acutely aware of his human existence and it is to these experiences that some religious or spiritual comfort is most likely applied. An individual tends to turn to something or someone that is outside of himself or supernatural for help and reassur ance. Firth (1957) concludes that "Men who exist in life-long cooperation and mutual assistance cannot easily face the dissolution of these bonds when life ceases." Religious comfort tends to bridge this dilemma, or at least in our society, is prescribed to do so. 3. Cultural Concepts Every society develops role prescriptions which spell out the socially expected behavior patterns con sidered "normal" for the dying and death situation. The three items, experiences with the death of intimates, thinking of dying and death, and talking of dying and death are significant concepts in studying the individual's interface with our cultural system's normative structure. Sickness itself isolates one from the rest of humanity and more so when one is dying. It is a common place observation that as death approaches others depart. This detachment is not only psychological, but it is also a social phenomenon— a reflection of our urban technology where the process of dying has become mechanized, impersonal, and dehumanized. There is inevitable separation in death, and' yet our culture is perhaps one of the first in the history of humanity to reinforce the isolation of the dying. In our culture death seems to be deliberately and consistently shunted to the periphery of our conscious experience. Except for those whose profes sions throw them into common contact with it, death possibly has become a less encountered phenomenon. Insofar as possible, death is confined to the hospital and extended care institutions for the aged and mentally ill. Yet death itself and especially our modes of relating to it of necessity partake of a paradoxical quality. If it is fact that Americans are encountering fewer deaths in their lifetime because of the functional structure established for the dying and death process, it still is an experience which most must go through with dying intimates; family and friends. First-hand experience with dying persons may not be as widespread an experience as it once was when the death of a neighbor or community member was expected to be a shared event, or the social impact of epidemics. However, the death of an intimate, even today, asserts itself as an extraordinary event. In this sense death is not an ordinary, everyday, commonplace experience of which one can remain indifferent. Dying and death is experienced as a crisis today. In yet another sense, one's exposure to the dying and death of an intimate has been significantly elongated. Medical science, such as the use of chemotherapy and antibiotics, and medical technology, such as the use of machines and organ transplants, enables persons not only to live longer but has, as a corollary, extended the dying trajectory. This means that individuals are usually involved over a longer period with others that are significant to them. This finding is detailed by research ers such as Sudnow (1967), Saunders (1959), Kalish (1966), and Glaser and Strauss (1965, 1968). Every culture has a configuration of taboos that are operant for its members’ behavior. Taboo prescriptions specify factors which are considered important to avoid. They are high-intensity prescriptions. Sumner (1906:30-31) defined taboos as "things which must be done . . . Taboos carry on the accumulated wisdom of generations which has almost always been purchased by pain, loss, disease and death." But as Vernon (1970:12) says, "The taboos may carry on the accumulated wisdom of generations, but such wisely conceived taboos may have had one set of conse quences under the conditions of origin, and quite a different set of consequences under subsequent changed conditions." In many respects thinking and talking of dying and death are high-intensity prescriptions which may have served to reduce fear of death at a time when a person's exposure to death was widespread, but may now, under changed conditions, serve to increase such fears. The attitude advocated by Promm (19^7), that death is simply not to be thought of, has tended to be the prescription of our culture. Pulton (1963) found that *10 per cent of his respondents reported that they never or rarely thought about dying or death and 12 per cent thought about it frequently. In this same study, a regional difference is of note. Those who refused to complete Pulton's questionnaire were concentrated on the West and East coasts. Shneidman (1971) reports that 21 per cent of his respondents never or rarely thought about dying or death and 57 per cent occasionally thought about it. H7 In regards to the concept of talking of dying and death, Glaser and Strauss (1965) suggest that Americans, if they talk of dying and death at all, prefer to talk of particular deaths rather than about death in general; and not about their personal death at all. Alexander and Adlerstein (1958) conclude from their study of 108 males between 5 and 15 that dying and death is not a welcome conversation subject in our society regardless of one's attitudes toward the subject. In a later study (i960), these same authors reach the conclusion that "the material from empirical sources reveals that on a conscious, verbal level people in American culture do not seem to be seriously concerned with thoughts of death." Vernon (1970) says that "In a 1959 study of American funerals, Bowman talked with an executive of a ministerial association in a large upstate New York city who told him that he never heard a discussion of funerals among ministers or laymen. Further, the director of a social center in a city of considerable size told Bowman that he had never talked about funerals as the main topic of conversation before his talk with Bowman, although he was conversant with the norms of the various social groups in the community as related to death and burial and to social and economic problems." In conclusion, one cannot live and work long in our American culture without becoming blatantly aware of the taboo nature of thinking and talking of dying and death. Research tends to support the impression that this avoidance appears to be widespread. 4. Social Aggregate Concept A useful concept with respect to the group or community nature of the sample utilized in this present study is that of social aggregate. Social aggregates form the source of prescriptions, expectations, norms, attitudes, beliefs, and values. As Nisbet (1970:80-81) says, "What is essential to the social aggregate is the sense of mutual awareness, either directly in a face-to- face manner, as in the small primary group, or through common possessions of symbold, as in a vast nation or world-wide church." What is indispensable to the aggregate is the interaction of a symbolic and mutually determinative character. The three communities of the present study, Pasadena, Laguna Hills, and the Mountain States evidence, through their comparative descriptive data, the utilization of them as social aggregates for analysis of the individuals' expectations. B. Operationalizations The multidimensional normative and prescriptive structure of each— the medical care system, the religious institutional system, and the cultural system— are 49 integrated for operation by utilizing single behavioral dimensions, the responses of which lie on a continuum. This appraoch follows Jackson’s (1966) model for measure ment and analysis of norms. To assess role expectations we have recourse to the same techniques that are used to measure cognitive structures in general; self reports such as questionnaires and interviews, or inferences from overt behavior. The investigator can ask, for example, "How should a person behave who is a teacher (or a doctor, or a patient, and so on)?" Prom such a question we may expect to obtain a consistent and integrated cluster of rights and duties of the social position (Sarbin and Allen, 1968:500). Several instruments have been used to assess role expectations. Sarbin and Jones (1956) used a 200-word adjective checklist; Thomas (1955) used a sentence- completion test; while Sherwood (1958) allowed greater freedom in self-reporting by using a "write an essay" technique. But these three instruments have proved difficult for older respondents. Therefore, the instrument chosen for the present study was a forced-choice response to a continuum of possible role behavior dimensions. The rationale for this instrumentation was that the social aggregates of the investigation were predominately com prised of elderly persons who are not accustomed to questionnaire and interview. 50 The major problem In operationalizing and empirically testing the concepts discussed in the preceding section is the selection of the behavioral dimensions that will lend isomorphism to the model. The following dimensions were selected and used on the strength that they adequately corresponded to their conceptual counterparts (Wilier, 1967). The medical care dimensions of treatment, informa tion, place of dying, and the care relationships were assessed by receiving responses to the following (see questions #78, 79, 80, 8l in Appendix A): If a person has an incurable disease and death is imminent, what treatment and methods should be used - If you suffered an incurable illness, who should have this information - If you had a choice, where would you rather die - Who would you most like to take care of you when you are dying - The religious institutional dimensions of attitude,: approach, orientation, and comfort were assessed by receiving responses to the following (see questions #73, 76, 7^, 77 in Appendix A): i What is your attitude toward death - ; How do you approach death - Do you feel that death is - Which of the following comforts you most as you think of death - The cultural dimensions of experiences with the death of intimate family and friends, thinking of dying and death, and talking of dying and death were assessed by receiving responses to the following (see questions #84 and 83, 75, 82 in Appendix A): If any of the following members of your family are deceased, please record the year they died - Within the past five years, how many of your close friends have died - How frequently do you think of your death - Within the past five years, how often have you talked about death with your friends, lawyer, doctor, children, spouse, clergyman - C. Predictions Based on the above operationalizations of the major concepts, the predictions to be tested are as follows: Hypothesis I predicted the individuals' expecta tions will be incongruent with the medical care system's prescriptions in terms of (1) treatment, (2) information. 52 (3) place of dying, and (4) care relationship; and the incongruity will differ with the type of social aggregate because the medical system does not function as a socialization agent for dying and death in our society. Hypothesis II predicted the individuals’ expecta tions will be incongruent with the religious institutional system's prescriptions in terms of (1) attitude, (2) approach, (3) orientation, and (4) comfort; and the incongruity will differ with the type of social aggregate because the religious system does not function as a socialization agent for dying and death in our society. Hypothesis III predicted the individuals’ expecta tions will be congruent with the cultural system’s prescriptions in terms of (1) experiences with the death of intimate family and friends, (2) thinking of dying and death, and (3) talking of dying and death; and the congruity will not differ with the type of social aggregate because of the ubiquitous and salient nature of the taboo on dying and death in our society. CHAPTER IV RESEARCH PROCEDURES This chapter describes the procedures utilized in testing the congruity-incongruity between the individuals’ expectations and the social and cultural systems1 pre scriptions. The first part presents the general strategy of the research design, followed by the particular elements of the design, e.g., sample design, description of the social aggregates, collection of data, instrument employed, preparation of data, and the statistical technique for testing the hypotheses. A. General Strategy The major objectives of the investigation are to determine if, in our society, the individuals' disposi tions, wants, and hopeful outcomes fit with our norms and practices in relation to dying and death; and if this fit differs with the type of social aggregate. Therefore, the general strategy was to be both analytical and comparative in nature. Analytical in assessing the strength and weakness of the fit; comparative in evaluating the consistency of that fit across social aggregate type. In order to accomplish these objectives of the investigation and to address the research question of why the negative image and stereotypes regarding aging in our society a cross-section of age groupings and social classes of our society would be necessary and strategic. Dying and death is a phenomenon that elicits thought, concern and feelings at all stages of the life cycle and occurs within all categories of individuals. But predominately it focuses in at the latter part of the life cycle. With this basic assumption, the methodological strategy was to secure a stratified probability sample drawn from the adult population (minimum age 18) of an urban city which was to be utilized as the baseline sample, and two purposive non-probability samples of older adults for comparison. The stratified probability sampling was conducted in the city of Pasadena, California and the purposive samples were drawn from the retirement community of Leisure World, Laguna Hills, California and the rural, mountain states of Idaho, Montana, and Wyoming. Pasadena was selected as the baseline sample because of its urban community nature, intricately a part of the large metropolitan area of Los Angeles. Leisure World, Laguna Hills was selected as one of the purposive samples because of Its characteristic of being a restricted residential community for older persons. It also met the criteria of being high socio-economically and metropolitan- cosmopolitan in nature. The mountain states were selected as the contrast purposive sample because of their rural- provincial and low socio-economical cahracteristics. Also, the respondents from the mountain states were non- institutional and "natural" community residents. The following section discusses the sample design of these three. B. Sample Design For the Pasadena aggregate a stratified probability sample was drawn in such a way as to give each housing unit an equal chance of coming into the sample, and insure a representative.percentage of racial housing units. Two strata were formed. One strata called the Black strata consisted of the five census tracts 4609s 46l6, 4617* 46l8, and 4620. According to the i960 census, these tracts contain most of the non-white population of Pasadena, each having at least 40 per cent Blacks. The White strata consisted of the remaining 25 tracts, most of which had no Blacks, and none having a percentage of Blacks greater than 17 per cent according to the i960 census. The number of housing units taken from each strata was taken proportional to the respective strata population totals and then adjusted upwards assuming a 35 per cent 56 non-response rate for the Black strata and a 25 per cent non-response rate for the White strata. Based on this, 11 blocks were selected from the Black strata with probability proportional to the estimated number of housing units in each block, the estimated number of housing units being taken from the I960 census block M data. A systematic random sample of 6 ^ housing units was M then drawn from each block, where M is the number of housing units in a given block according to the current y\ survey listing and M is the number of housing units according to the I960 census. Because of the wide area covered by the White strata, to reduce travel expense, a systematic random sample of six tracts was drawn, then seven blocks per tract with probability proportional to the i960 estimate of M number of housing units and 6 — housing units from each M block. This sample design of the city of Pasadena yielded a total of 189 respondents which comprised the Pasadena aggregate for analysis in the present study. The second aggregate used in this study was drawn from the population of individuals residing in the retirement community of Leisure World, Laguna Hills, California. A residence search of the 4ll respondents of two previous waves of investigation of "first-movers into Leisure World" yielded 196 potential respondents for the 57 present survey. These individuals were contacted by letter and invited and encouraged to participate in a third phase research project conducted at Leisure World by the Gerontology Center of the University of Southern California (see Appendix B). Of the 196 persons to whom letters were sent, 13 returned post cards stating that they were unable to participate because of travel, vacations, or other involvements. Of these 13, 9 wrote that they were disappointed not to be able to participate this time but would like to be included in any further studies of Leisure World residents. This was a response rate of 93 per cent for this aggregate. This unusually high response rate may be attributed to their past participation in studies of this retirement community by the chairman of this dissertation committee, Dr. James A. Peterson. Therefore, this elderly sample of residents of Leisure World, Laguna Hills numbered 183 respondents for inclusion in the sample design of this investigation into the phenomenon of dying and death. The third aggregate used in this study was drawn from individuals residing in the mountain states of Idaho, Montana, and Wyoming. This, as was the Laguna Hills aggregate, was purposively designed to secure data from elderly individuals. These respondents were to be non institutionalized persons residing in their natural community. The technique of quota sampling for this aggregate was designed to insure a comparable sample. Two other reasons influenced the design; they being (1) the geographical distance involved between the principal investigators and the field of study, which was prohibitive in terms of time and money, and (2) the purpose of the present investigation is analytical and comparative (Riley, 1963)— investigating the congruence between personal systems' role expectations and societal and cultural's role prescriptions; rather than descriptive of sample characterists as representative of the total population of the rural elderly in our society. Having previously secured the Pasadena and Laguna Hills aggregates, the quota was selected to be at least comparable to these two in terms of the number of respondents. Thus, this aggregate utilized in the sample design of the investigation into the phenomenon of dying and death has a definite selection bias in that it only includes those individuals who were available and willing to participate in the study. The final total for this rural,'mountain states aggregate was 115 respondents. C. Description of the Social Aggregates The final sample size utilized in the present study. I consisted of 189 individuals residing in the city of Pasadena, 183 individuals residing in Leisure World, Laguna. [ 59 Hills, and 115 individuals residing in the mountain states of Idaho, Montana, and Wyoming. The demographic and descriptive data in this section is presented not only for the purpose of reference, but for the additional purpose of bringing out the fact that each group could be categorized as a social aggregate identifiable one from the other. Table 1 indicates the distribution of the social aggregates by sex and age. The Pasadena aggregate is distinguishable in that the majority (60.8 per cent) are males, whereas the other two aggregates reflect that females are in the majority. The latter two correspond with the fact that females are more numerous in the older adult population. The mean age of 73-4 of the Mountain States establishes it as the eldest of the purposive samples. The Pasadena range is from 18 years to 92 years with the mean age being 49•2 years. This is comparable to the census enumeration of the adult population of this city. Pasadena and Laguna Hills, according to the data on Table 2, are reflective of married respondents whereas 52.2$ of the Mountain States respondents are widowed. The adjusted distribution in regards to the marital satisfac tion shows Laguna Hills 92$ happy in their marriages. But Pasadena shows over one-fourth (25.7$) unhappy in their marriages, and the Mountain States almost the same with TABLE 1 SEX AND AGE OP SOCIAL AGGREGATES Pasadena (N = 189) Laguna (N = Hills 183) Mountain (N = States 115) Frequency Per Cent Frequency Per Cent Frequency Per Cent Sex Male 115 60.8 79 43.2 35 30.4 Female 74 39.2 104 56.8 80 69.6 Age 18-30 31 16.4 0 0 0 0 31-40 28 14.8 0 • 0 0 0 41-50 43 22.8 0 0 0 0 51-60 38 20.1 21 11.5 2 1.7 61-70 23 12.1 64 34.9 38 33.1 71-80 21 11.2 81 44.3 54 46.9 81-90 4 2.1 17 9.3 21 18.3 91+ 1 .5 0 0 0 0 Mean Age = 49.2 Mean Age = 69.1 Mean Age = 73.4 cr\ o i TABLE 2 MARITAL STATUS AND MARITAL SATISFACTION OF SOCIAL AGGREGATES Pasadena (N = 189) Laguna Hills (N = 183) Mountain States (N = 115) Frequency Per Cent Frequency Per Cent Frequency Per Cent Marital Status Married 121 64.0 136 74.3 46 40, 0 Widowed 28 14.8 40 21.9 60 52.2 Single 16 8.5 0 0 1 .9 Never Married 9 4.8 2 1.1 5 4.3 Divorced 15 7-9 5 2.7 3 2.6 Marital Satisfaction Perfectly Happy 42 30.0* 59 43.1* 12 25.5* Somewhat Happy 23 17.0 20 14.6 6 12.7 Little Happy 12 8.3 7 5.1 3 6.4 Happy 27 19.1 40 29.2 15 31.9 Little Unhappy 16 11.4 4 2.9 8 17.1 Somewhat Unhappy 5 3.6 2 1.5 0 0 Very Unhappy 15 10.7 5 3.6 3 6.4 NA** 49 25.9 46 25.1 68 59-1 *Adjusted % on response. **Not applicable/No answer, ON 23-5% unhappy. Table 3 summarizes the annual Income character istics of the aggregates. The disparity in the economic position of the elderly in our society is again surfaced by the data reported in this table. The literature of the economics of aging is beginning to reflect that some of the barest poverty, as well as some of the greatest wealth, resides in the aged population of our nation. In this study, 58*3% of the Mountain States reports yearly incomes of under $2,000. The mean income of this aggregate is $1,950. The Laguna Hills aggregate reflects the opposite position. Fifty-nine per cent of the respondents stated incomes of $10,000, plus, with the mean being $13,300. Pasadena reported a mean annual income of $9,700. In regards to another socio-economic dimension, education, Table 4 reflects that 57-1% of the Pasadena aggregate have had some college education with the mode of the distribution being 4 years of college. The mode of the; Laguna Hills distribution shows completion of 12 years of schooling. For the Mountain States, the mode of the distribution was 7-8 years of education. A statistic worth' noting concerning the Mountain States aggregate is that almost 1H% of the respondents completed 4 years of college education. Table 5 summarizes where the respondents have lived; most of their adult lives. Those presently living in the TABLE 3 ANNUAL INCOME OP SOCIAL AGGREGATES Pasadena (N = 189) Laguna Hills (N = 183) Mountain States (N = 115) Income Frequency Per Cent Frequency Per Cent Frequency Per Cent Under $2,000 15 7-9 4 2.2 67 58.3 $2,000-3,999 20 10.6 7 3.8 18 15.7 $4,000-5,999 24 12.7 10 5.4 14 12.1 $6,000-9,999 37 19.6 56 29.6 13 11.3 $10,000-21,999 61 32.3 62 33.9 3 2.6 $22,000 & over 30 15.9 44 25.1 0 0 NA* 2 1.1 0 0 0 0 Mean $9,700 $13,300 $1,950 *No Answer. CT\ U J TABLE 4 EDUCATION OP SOCIAL AGGREGATES Pasadena (N = 189) Laguna Hills (N = 183) Mountain States (N = 115) Education Frequency Per Cent Frequency Per Cent Frequency Per Cent None 1 • 5 0 0 2 1.7 1-4 years 4 2.1 3 1.6 5 4.3 5-6 years 1 .5 7 3.8 14 12.2 7-8 years 11 5.8 14 7.6 25 21.7 9-11 years 23 12.2 : 19 1 10.5 15 13.0 12 years 39 20.6 63 34.7 21 18.3 1-3 years college 48 25.4 . 31 16.9 17 14.8 4 years college 60 31.7 : 46 25.2 16 13.9 NA 2 1.1 0 0 0 0 TABLE 5 WHERE SOCIAL AGGREGATE LIVED ADULT LIFE Pasadena (N = 189) Laguna (N = Hills 183) Mountain States (N = 115) Lived Adult Life Frequency Per Cent Frequency Per Cent Frequency Per Cent Farm 3 1.6 11 6.1 37 32.2 Open Country 2 1.1 3 1.6 8 7-0 Town 7 3-7 19 10.4 40 34.8 City 104 55.0 110 60.7 22 19.1 Large City 70 37.0 39 20.6 8 7.0 NA 3 1.6 1 .6 0 » 0 U1 I 66 Mountain States reflect that they have been predominantly rural residents. Almost three-fourths (7^%) report that they have lived most of their adult lives in towns, open country, or on farms. Only 7% say that they have been residents of a large city. Of the Pasadena and Laguna Hills sample, 92% and 8l.3%, respectively, state that they have lived in cities. On the perceived health dimension, all three aggregates of the sample are skewed toward the positive end of average to extremely good health. Only 2.6$, 4.4$, and 6.1% of the Pasadena, Laguna Hills, and Mountain States sample, respectively, rated themselves as having not very good health. The second dimension reflected on Table 6 shows what the respondents perceive as being the ideal age. Over one-third of Pasadena (3^«^$), but merely 1.7%, or 2 individuals, of the Mountain States, thought their present age was the most ideal age. Sixty-one and eight- tenths per cent of the Mountain States stated that the 20's, 30's, or 40's were the ideal age, whereas 58.5% of Laguna Hills thought that the 40’s. 50's, or 60's were the ideal age. Data on life satisfaction and what is the most important thing in life is summarized in Table 7- Laguna Hills reflects that 60.1$ are very satisfied with their lives and only 2.2$ are not very satisfied. Sixty and eight-tenths per cent of Pasadena reflect that they are TABLE 6 PERCEIVED HEALTH AND IDEAL AGE OP SOCIAL AGGREGATES Pasadena Laguna Hills Mountain States (N = 189) (N = 183) (N = 115) Frequency Per Cent Frequency Per Cent Frequency Per Cent Perceived Health Extremely good Very good Average Fairly good Not very good NA Ideal Age Present age Teens 20' s 30 1 s 40's 50 1 s 60 1 s 70 1 s 80 1 s 37 19.6 71 37.6 46 24.3 29 15.3 5 2.6 1 .5 65 34.4 20 10.6 20 10.6 17 9.0 11 5.8 14 7.4 19 10.1 23 12.2 0 0 39 21.3 74 40.4 38 20.8 22 12.0 8 4.4 2 1.1 20 10.9 32 17.5 5 2.7 10 5.5 38 20.8 47 25.7 22 12.0 7 3.8 2 1.1 19 16.5 42 36.5 32 27.8 15 13-0 7 6.1 0 0 2 1.7 1 .9 20 17.4 21 18.3 30 26.1 18 15.7 9 7-8 11 9-6 3 2.6 TABLE 7 LIFE SATISFACTION AND IMPORTANT THING IN LIFE FOR SOCIAL AGGREGATES Pasadena (N = 189) Laguna Hills (N = 183) Mountain States (N = 115) Frequency Per Cent Frequency Per Cent Frequency Per Cent Life Satisfaction Very satisfied Fairly satisfied Not very satisfied NA 56 115 16 2 29.6 60.8 8.5 1.1 110 68 4 1 60.1 37-2 2.2 .5 40 51 24 0 34.8 44.3 20.9 0 Important Thing in Life Personal 86 Family 28 Religion 9 Other 55 NA 11 45.5 14.8 4.8 29.1 5.8 54 • 9 1 19 14 5 29.5 49.8 10.4 7.7 2.7 45 32 24 5 9 39.1 27.8 20.9 4.3 7.8 CT\ OO fairly satisfied with their lives. But the responses by the residents of the Mountain States are more evenly distributed. Thirty-four and eight-tenths per cent report they are very satisfied, 44.3# are fairly satisfied, and 20.9$, or more than 12 to 18 percentage points higher in this category than the other two aggregates, are not very satisfied with their lives as they are. In regards to what the respondents feel is the most important thing in life, also on Table 7, the mode measure for the Pasadena distribution is on the personal category. The mode for the Laguna Hills distribution is in the category of the family. The category of religion has its largest per cent of the three aggregates with the Mountain States aggregate (20.9$)* Only 4.8$ of Pasadena state that religion is the most important thing in life. This same direction is reflected in Table 8 which reports religion, religious attendance and involvement. The Mountain States aggregate is most religiously involved in regards to both worship attendance and activity, with the Pasadena aggregate being least religiously involved in regards to these two elements. The Laguna Hills distribution falls between these two positions of the Pasadena and Mountain States, but closer to the less institutionally religious as reflected in these categories. The majority of all three aggregates reported themselves as Protestant. TABLE 8 RELIGION, RELIGIOUS ATTENDANCE AND INVOLVEMENT OP SOCIAL AGGREGATES Pasadena (N = 189) Laguna Hills (N = 183) Mountain States (N = 115) Frequency Per Cent Frequency Per Cent Frequency Per Cent Religion None Roman Catholic Jewish Protestant Other NA 23 23 5 122 12 4 12.2 12.2 2.6 64.6 6.4 2.1 7 13 5 140 16 2 3.8 7-1 2.7 76.5 8.7 1.1 5 11 0 98 1 0 4.3 9.6 0 85.2 .9 0 Religious Attendance Not at all 54 Several times a year 63 Once a month 13 Once a week 40 More than once a week 16 NA 3 28.6 33-3 6.9 21.2 8.5 1.6 49 31 18 72 10 3 26.8 16.9 9.8 39.3 5.5 1.6 10 24 3 62 16 0 8.7 20.9 2.6 53.9 13.9 0 Religious Involvement Not at all 117 Several times a year 35 Once a month 16 Once a week 11 More than once a week 8 NA 2 61.9 18.5 8.5 5.8 4.2 1.1 88 40 23 8 18 6 48.1 21.9 12.6 4.4 9.8 3.3 21 29 25 18 22 0 18.3 25.2 21.7 15-7 19.1 0 71 D. Collection of Data The data collection procedures were essentially different for each of the aggregates. This was due to the nature of each aggregate and the characteristics of the three communities in the research design. But in each case, the data for the study were gathered by means of a questionnaire schedule. Each set of data from the three aggregates is part of a larger set of findings. The Pasadena data comes from a study completed by Dr. Neil C. Warren, School of Psychology, Puller Theological Seminary, Pasadena, California which utilized a shortened version of the questionnaire but with all the descriptive and dying and death questions appearing intact. This data was collected according to the sample design and utilized the self administered questionnaire technique (Oppenheim, 1966) with field editors taking the questionnaire to each selected housing unit. The first person, 18 years of age or over, answering the door was informed as to the nature and purpose of the research project and then asked to take and complete the questionnaire. The field editor stated that he would return at a specifically agreed upon time to collect the completed questionnaire. When the question naire was returned it was field edited in the presence of the respondent to insure usable data. The length of time indicated to complete the questionnaire ranged from 30 72 minutes to an hour and 45 minutes, with an average of 1 hour. The Laguna Hills aggregate data was collected utilizing a modified group-administered questionnaire technique (Oppenheim, 1966). Through the medium of closed-circuit T.V., letters, and personal phone calls, the sample was informed about the nature and purpose of the study and invited to the library of the Medical Center at Leisure World in small groups throughout a specified day. Each individual was asked to complete the question naire in the library. Twenty-four field editors were available to each group to assist and make sure the questionnaires were completed properly by each respondent. It was felt that older adults may need specific instruction and help in completing and follow-up events. For these respondents the length of time indicated for completion ranged from 45 minutes to 2 hours, with an average of 1 hour and 30 minutes. The Mountain States aggregate data was collected utilizing a modified self-administered questionnaire technique. Again the writer is indebted to Dr. James A. Peterson for securing the field editors for this sample from among college professors, community agency workers, clergymen, and governmental employees. The strategy for gathering the data from this older adult aggregate was to have the field editors take the questionnaire to the respondent's place of residence, explain the study carefully, and invite the individual to complete the task while the editor remained in their home. This approach was followed because the rural, elderly tend to be unfamiliar with interviews and questionnaires, and research projects in general. The length of time indicated by these respondents average well over two hours for completing the questionnaire. These methods of data-collection from each of the three aggregates ensured a high response rate, accurate sampling, and a minimum of interviewer bias in regards to the sensitive questions on dying and death. They permitted field editing assessments and gave the respondents the benefit of a degree of personal contact in the research investigation. E. Instrument The instrument utilized in gathering the data for this study was a questionnaire schedule (see Appendix A). The rationale for this decision was due to the focus of the investigation on dying and death. It was felt that if the respondents could respond "privately" on a questionnaire, rather than having to respond to an interviewer's questions verbally, more direct, open, and honest answers would be communicated. The literature on dying and death reveals that there is between a 20$ and 80$ refusal rate when interviews have been conducted in regards to this phenomenon. The questionnaire consisted of demographic and descriptive questions as well as open-ended and fixed- response questions and contained items for another, but related, research project. In the case of the Pasadena aggregate it was for additional data on dying and death and with the Laguna Hills and Mountain States aggregates it was on social-psychological aspects of aging. The schedule was pre-tested in a limited way with two senior citizen groups that totaled 31 individuals over the age of 65. The primary purpose of this pre-test was to give the writer the opportunity to evaluate the general utility of the instrument in relation to older respondents, e.g., length of time to complete the questionnaire, ease in following the questionnaire format, and clarity of the questions. This pre-test resulted in a significant change in the questionnaire, especially in regards to the dying and death questions. P. Preparation of Data In this study we have tried to conform to the characteristics of scientific knowledge by employing the comparative methodology which pursues grouped data, attempts to relate them meaningfully, and then demonstrate these relationships empirically (Wilier, 1967). Therefore, I 75 the basic unit of analysis for the study was the type of social aggregate of the respondents. The rationale for this decision is brought out in the literature that role prescriptions are group-formed norms and expectancies, tending to be the product of group consensus, and an individual's role expectations are molded and shaped by interactions with significant others in his environment and life space. In order to prepare the data so that they would represent this unit of analysis, the aggregate mean congruity ratio for each item, based on the individuals within each type of social aggregate, was calculated. G. Statistical Technique To test the congruity between the individuals 1 expectations and the social and cultural systems’ pre scriptions a mean congruity ratio was calculated (Jackson, 1966) . Congruity-incongruity was viewed as manifestations of the distributions of approval-disapproval responses by persons toward the social and cultural prescriptions. This was operationalized by scoring a response as approval if the respondent chose one of the systemic prescription items on the behavioral dimension continuum. Disapproval was scored when the respondent chose a non-systemic prescrip tion item on the continuum. Prom this a mean congruity 76 ratio (d^gapproval^ was calGUlate^ for> the aggregate on each behavioral dimension under each of the three systems. Therefore, a mean congruity ratio of 1.0 would indicate congruity, a higher score than 1.0 would indicate high congruity, whereas a score lower than 1.0 would indicate incongruity between the personal system and the social or cultural system. CHAPTER V RESEARCH FINDINGS In this chapter the findings of the analysis are presented. The first three sections are the results of the hypotheses testing. The concluding section is the interpretation and discussion of the findings. A. Test of Hypothesis I The first hypothesis predicted the individuals' expectations will be incongruent with the medical care system's prescriptions in terms of (1) treatment, (2) information, (3) place of dying, and (4) care relation ship; and the incongruity will differ with the type of social aggregate because the medical system does not function as a socialization agent for dying and death in our society. This hypothesis, which predicted incongruity, tended to be supported by the data as reflected in Table 9- An examination of this table, which presents the mean congruity ratios of the individuals for the medical care system, shows the expectations are incongruent with the prescriptions for the Mountain States aggregate in terms of all four Items; treatment, information, place of dying and care relationships. 77 TABLE 9 MEAN CONGRUITY RATIOS FOR MEDICAL CARE SYSTEM Items: Pasadena Laguna Hills Mountain States Treatment Information Place of Dying Care Relationship 1.25 .22* 1.28 1.27 .51* .24* .63* 1.69 .51* .23* .59* ' .55* 1.0 and above ratio = congruity with prescriptions. Below 1.0 ratio = incongruity with prescriptions. *Incongruity with prescription. 79 This data reflects that the expectations of the Laguna Hills aggregate are incongruent with the medical care prescriptions in terms of treatment, information, and place of dying, but not in terms of care relationship. As for the Pasadena aggregate, only the item of information was incongruent with the prescription, the other three were congruent with the medical care prescriptions. In regards to the second part of this hypothesis, the incongruity did differ with the type of social aggregate as predicted because dying and death socializa tion is primarily self-initiated and influenced by significant others rather than the medical system as a whole. Therefore, incongruity would vary from aggregate to aggregate. The Mountain States and Laguna Hills differed with Pasadena in the items of treatment and place of dying. The Mountain States differed with both the Laguna Hills aggregates in relation to the item of care relationships. But in terms of information, the difference; was one of strength of incongruity between the three aggregates. B. Test of Hypothesis II The second hypothesis predicted the individuals' expectations will be incongruent with the religious institutional system’s prescriptions in terms of (1) attitude, (2) approach, (3) orientation, and (4) comfort; and the incongruity will differ with the type of social aggregate because the religious system does not function as a socialization agent for dying and death in our society. This hypothesis, which also predicted incongruity, tended to be supported by the data as reflected in Table 10. An examination of Table 10, which presents the mean congruity ratios of the individuals for the religious institutional system, shows the expectations are incongruent with the prescriptions for the Pasadena aggregate in terms of three of the four items; attitude, approach, and comfort of religion. Only the item of religious orientation in dying and death was congruent with the religious institutional prescriptions. This same finging holds with the Laguna Hills aggregate in that there is incongruity with regards to attitude, approach, and comfort, and, congruity with regards to orientation. The Mountain States aggregate, in contrast to Pasadena and Laguna Hills, reflected congruity in terms of attitude and approach, as well as orientation. The only incongruity between the expectations and the prescriptions by the Mountain States was in the area of religious comfort in looking toward death and dying. In regards to the second part of this hypothesis, the incongruity did differ with the type of social aggregate as predicted because dying and death TABLE 10 MEAN CONGRUITY RATIOS FOR RELIGIOUS INSTITUTIONAL SYSTEM Items: Pasadena Laguna Hills Mountain States Attitude Approach Orientation Comfort .54* .55* 2.19 .89* .60* 1.21 1.17 2.17 1-92 .49* .46* .60* 1.0 and above ratio = congruity with prescriptions. Below 1.0 ratio = incongruity with prescriptions. *Incongruity with prescription. 82 socialization is primarily self-initiated and influenced by significant others rather than the religious system as a whole. Therefore, incongruity would vary from aggregate to aggregate. The Pasadena and Laguna Hills differed with the Mountain States aggregate in items of attitude and approach. The difference in terms of orientation between the three aggregates was one of the strength of congruity with the prescriptions, but in terms of comfort it was in the strength of incongruity. C. Test of Hypothesis III The third hypothesis predicted the individuals' expectations will be congruent with the cultural system's prescriptions in terms of (1) experiences with the death of intimate family and friends, (2) thinking of dying and death, and (3) talking about dying and death' and the congruity will not differ with the type of social aggregate because of the ubiquitous and salient nature of the taboo on dying and death in our society. This third hypothesis, which predicted congruity, received strong support by the data as reflected in Table 11. An examination of this table, which presents the mean congruity ratios of the individuals for the cultural system, shows that for both the Laguna Hills and the Mountain States aggregates the expectations are congruent with the prescriptions in terms of all three items; TABLE 11 MEAN CONGRUITY RATIOS FOR CULTURAL SYSTEM Items: Pasadena Laguna Hills Mountain States Experiences with Family .22 2.21* 4.48* Experiences with Friends .73 1.54* 3.26* Thinking of Dying 2.63* 5.10* 1.80* Talking of Dying 1.15* 1.47* 1.02* 1.0 and above ratio = congruity with prescriptions. Below 1.0 ratio - incongruity with prescriptions. *Congruity with prescription. 00 LO 84 experiences with the death of intimate family and friends, thinking of dying and death, and talking about dying and death. Both of the items of thinking and talking of dying and death for the Pasadena aggregate were congruent with the cultural prescriptions. The only incongruent rela tionship was in terms of experiences with the death of intimates with the Pasadena aggregate. In regards to the second part of this hypothesis, the congruity did not differ with the type of social aggregate as predicted because the cultural prescriptions are significant guides and standards in regards to the general and pervasive taboo on dying and death. The difference was only one of strength of congruity between the three aggregates, with the exception of Pasadena's experiences with dying and death. D. Interpretation and Discussion of the Findings The findings of this investigation indicate, according to our sample of three social aggregates, that in our society, persons' dispositions, wants, and hopeful outcomes (expectations) do not fit with our norms and practices (prescriptions) in relation to dying and death. But yet our expectations in dying and death do correspond to the general and pervasive taboo on the subject. In the attempt to develop a logical interpretation of these findings, we must keep in focus the nature and distinguishable characteristics of the sample aggregates described in previous chapters. 1. Medical Care Items In light of the medical care items of this study, the Pasadena aggregate tends to share and reflect the medical prescriptions of our society, whereas, the Laguna Hills and Mountain States aggregates tend to find the medical care system’s prescriptions incongruent with their expectations. When an individual is in a dying trajectory, the medical prescription, both in ethical mandate and practical application is to use reasonable life-maintaining treatment, often utilizing "heroic" treatments and devices. The Pasadena aggregate concurs with this prescription, whereas Laguna Hills and the Mountain States concur that "withdrawal of all treatments except those designed to maintain comfort and reduce pain" ought to be the pre scription in this circumstance. Table 12 reflects the responses to these prescriptions. An interpretation of the phenomenon raised here would be that there seems to be a difference of emphasis between the quantity-of-life and the quality-of-life value for the random adult community sample and the purposive elderly samples. The discrepancy, most possibly, is in relation to the pursued goal of all treatment of the TABLE 12 MEDICAL CARE ITEMS OF TREATMENT AND INFORMATION Pasadena Laguna Hills Mountain States Items: (N = 189) (N = 183) (N = 115) Frequency % Frequency % Frequency % If a person has an incur able disease and death is imminent, should a doctor: 1. Use every treatment and device available. 2. Use life-maintaining treatment, but avoid "heroic1 ' methods. 3. Withdraw all treatment except those to main tain comfort and reduce pain. If you suffered an incurable illness, would you like the doctor to: 1. Keep information to himself. 2. Inform the attending nurses and staff. 3. Share the information with your family. 4. Tell you. 45 23.8 7 60 31.7 55 84 44.5 121 16 8.5 7 3 1.6 7 15 7-9 23 155 82.0 146 3.8 11 9.6 30.1 28 24.3 66.1 76 66.1 3.8 2 1.7 3.8 1 0.9 12.6 19 16.5 79.8 93 80.9 CO o-\ 87 combination of prolonging and improving life of human beings. The one aggregate reflects the value of the length of life and the other two aggregates reflect the value of the quality of life yet remaining. There seems to be no discrepancy in regards to who should have the information concerning the dying status of persons in our society. All three aggregates very strongly agree that the prescription should be that of "open awareness" on the part of the medical care system with the patient. The patient, himself, should be the recipient of the medical information, as is reflected in Table 12. This finding of the study supports both the work of Glaser and Strauss (1965, 1968) encouraging an open awareness regarding the diagnosis and prognosis— for most patients, and the finding of Peifel (1963) that most patients want to be informed as to their dying status and trajectory. Again, in the item of the place that one would rather die if he had the choice, reflects the positive inclination of the Pasadena aggregate toward the medical prescription of our society. This tends to be in direct contradiction to the Laguna Hills and Mountain States expectations. The response is given by these latter two i that if a choice could be made, they would rather die at home than in a hospital or neighborhood nursing home. This1 is in awareness to the fact that the majority of deaths do ! occur in institutions and to the advantages of hospital ! 88 medicine and technology. What seems to be operating in relation to this response is the difference in perception of independence and control over one's life in a hospital or institution versus in one’s home. Laguna Hills and the Mountain States possibly perceive less independence and more external control in the institutional setting, which tends to be the fact for the elderly in our society, than in the familiar surroundings of their home environment. This perception seems not to be shared by the Pasadena aggregate. In the item of who one would most like to care for him when he was dying, Pasadena is joined by Laguna Hills in responding to the medical care prescription. They would prefer to be taken care of by a member of the medical staff— doctor or nurse, rather than a spouse, their children, or a best friend. This finding is in contrast to the Mountain States who find their expectations incongruent with this prescription. This response, along with the responses to the other medical care items by the Mountain States in this investigation, could be a reflection of the unfamiliarity with the medical system or the inadequate care received by them when ill, or both of these. This variable remains to be explored. 2. Religious Institutional Items In regards to the religious institutional system's prescriptions in relation to dying and death, Pasadena and Laguna Hills tend to find them incongruent with their role expectations. The only exception is with the item of orientation. The Mountain States find only the item of religious comfort when thinking of dying and death incongruent with its expectations. The other items of attitude, approach, and orientation are congruent. The items of religious attitude and approach, which have as their prescriptions a wonderful experience to look forward to by an individual— but with a kind of aprehension anxiety, and fear, were found to be incongruent with their role expectations by the Pasadena and Laguna Hills aggregates. But this same finding did not hold for the Mountain States aggregate. This finding in regards to the congruency to the religious institutional prescriptions by the Mountain States tends to reaffirm the concensus that the rural, provincial people are more institutionally religious, not only in their involvement as shown in the descriptive data, but also in their adherence to religious expectations. The one prescription of the religious institutional system that all three aggregates held congruent expecta tions with was the item of orientation, which has as its essential element the feeling of hope in the face of dying 90 and death. Hope in that which is yet to be, The most pervasive and universalistic thrust or drive of all religions and meditations is not the feeling that death is the end of all or an extended sleep, but that death is a process toward a different life existence, however that may ■ be projected. In light of this feeling of hope, the finding of congruence between the individuals' expectations and the religious orientation prescription, may be interpreted. Hope of a "better" life-to-come, whether one views his present life good or not so good, tends to be a ubiquitous and salient prescription for our society. As unanimous as the three aggregates were found to be congruent in terms of the religious orientation prescription, they were equally unanimous in their incongruity in terms of the prescription that religion is to be the comforting element when thinking of dying and death. Table 13 reports the responses to the question, "Which one of the following comforts you most as you think of death?" with the religious prescription being— "my religion." The other responses are "love from those around me" and "memories of a full life." The plausible interpretation of this finding is that the element of religious or spiritual comfort for the dying process as one looks toward death has not been TABLE 13 RELIGIOUS INSTITUTIONAL ITEM OF COMFORT WHEN THINKING OF DEATH Item: Pasadena (N = 189) Laguna Hills (N = 183) Mountain States (N = 115) Frequency Per Cent Frequency Per Cent Frequency Per Cent Which one of the following comforts you most as you think of death? 1. My religion 62 32.8 58 31-7 43 37.4 2. Love from those around me. 49 25.9 51 27.9 29 25.2 3* Memories of a full life. 78 41.3 74 40.4 43 37.4 vo H 92 stressed by the religious institutional system because of its emphasis as a ’’socialization agent" for life-after death. Comfort during the dying trajectory may well be the prescription but it lacks a rationale from the religious institutional system and the application to the behavioral dimension. 3. Cultural Items According to the findings of this study, all three aggregate responses toward the cultural prescriptions find congruity. The only exception to this is with the Pasadena sample in relation to the item of the experiences with the death of intimate family and friends. The cultural prescription, in spite of the increased isolation of dying patients and the lessening of the "shared event" concept of dying and death, is that the death of an intimate is not an ordinary, everyday expe rience toward which one can remain indifferent. The number of intimate experiences for the Pasadena aggregate is considerably less than for either the Laguna Hills or the Mountain States and therefore, there is a finding of incongruity for Pasadena. This phenomenon could be interpreted solely from the age distribution of the research sample. The configuration of taboos that are operant in relation to dying and death in our culture find expression ; 93 in the high-intensity prescriptions of thinking and talking of death. The findings in terms of these items of thinking and talking of death are that the individuals' expectations of all three aggregates are congruent with the cultural system’s prescriptions that dying and death are not to be thought of or talked about in our society. Tables 14 and 15 report and reflect the concurrence to these prescriptions. The overwhelming majority of those investigated in this study either thought very seldom or not at all of their dying and death. The talking patterns, as shown in Table 15, are of a heuristic interest as well as of analytical importance. The rank order of who is most often talked with by persons in these aggregates is revealing. Spouse, friends, and then children are most often talked with, when there is conversation on the subject. Of the three professions ordinarily thought to be involved at the end-of-life event, both doctors and clergymen are reported to rank lower than lawyers in frequency of conversation about dying and death, with the clergyman being lowest of all. TABLE 14 CULTURAL ITEM OP THINKING OP DYING AND DEATH Pasadena Laguna Hills Mountain States Item: (N = 189) ' (N = 183) (N = 115) Frequency Per Cfent Frequency Per Cent Frequency Per Cent Do you think of your death: 1. Very frequently 12 6.3 3 1.6 10 8.7 2. Fairly frequently 40 21.2 27 14.8 31 27.0 3. Very seldom 109 57 -7 126 68.9 59 51.3 4. Not at all 28 14.8 27 14.8 15 13.0 - ■ TABLE 15 CULTURAL ITEM OF TALKING ABOUT DYING AND DEATH Item: Never Sometimes Often Within the past five years, how often have you talked about death with your: Pasadena L.H. M.S. Pasadena L.H. M.S Pasadena L.H. M.S. 1. Friends 57 91 70 82 66 38 17 5 7 2. Lawyer 107 95 92 26 62 19 2 0 4 3- Doctor 110 131 103 22 13 7 1 2 5 4. Children 84 98 67 49 39 41 5 1 6 5. Spouse 49 48 71 84 99 30 7 6 3 6. Clergyman 110 136 105 18 5 7 1 2 2 vo V Jl CHAPTER VI SUMMARY AND IMPLICATIONS OP THE STUDY The purpose of this chapter is to summarize the general findings briefly and to discuss the theoretical and pragmatic Implications of the study. A. Summary of General Findings The focus of the present study was on the congruity (fit) between individuals' role expectations and societal’s medical care system, religious institutional system, and cultural system's role prescriptions in relation to dying and death utilizing three social aggregates— a stratified probability sample of the adult population of the city of Pasadena, California; and two purposive samples, one from Leisure World, Laguna Hills, California, and one from the mountain states of Idaho, Montana, and Wyoming. A major finding of the study is that there is incongruity between the individuals' expectations and the prescriptions of the medical system and the religious system, and congruity between these expectations and our cultural system's prescriptions. The role strain is evident throughout the adult life cycle, becoming more 96 97 pronounced in the latter states, as evidenced by the congruity/incongruity differential with the type of social aggregate. Another finding of the study that is evident by the data of this investigation is that dying and death is a further explanation of the negative image and stereotypes held by many in our society toward aging and the last part of the life cycle. The dying and death role is a social and psychological role "addition" to go along with the older adult's many "losses." The question may well be,— why not this perspective of pessimism and negativism if one's expectations do not fit with the practices and remain unfulfilled? This study confirms the notion that older adults are dealt with according to what others and society think and feel is best for them; not according to what older adults themselves think is best, or that they would like and want from their milieu. Along with the specific expectations brought out in the investigation, the two global expectations held by most persons in our society, that of being treated as human beings and the ability to die with dignity have been demonstrated by the findings. This has been done by utilizing specific end-of-life events, such as having the information about one's dying status and the treatment one would like if he suffered an incurable illness. A descriptive finding of interest in regards to the two purposive elderly aggregates is that of the wide discrepancy in the economic structure of their situations. The rural elderly reported extremely low yearly incomes (almost 60$ under $2,000 per year), whereas the Laguna Hills respondents reported very high annual incomes (over 50$, $10,000 plus per year). This one factor alone may influence the psychological well-being and outlook of the respondents, which was reflected in other findings of the study. B. The Theoretical Implications The theoretical implications of the study lie in two directions. The first direction is in bringing into question some of the basic tenets and findings of role and consistency theory. This implication is theoretically assumptive directed. The dying and death event and milieu, as shown by the present study, affords both role theory and consistency theory a mutual and interesting contact profitable for empirical investigation. The nature of this intersect seems to be in the specification of the cognitive factors responsible for particular, concrete social behavior. The content of this study, death and dying expectations, tends ; to point to the relatively underdeveloped finding of ' Hovland (i960) stating that under some conditions inconsistency is tolerated or even sought out, rather than j 99 avoided, reduced, or a negative drive state (Pestinger and Aronson, i960). This seems to be the case in regards to the dying and death event in our society. Role theory approach to this kind of a problem would point out that inconsistency is partially a function of the social system, particularly when inconsistency has important implications for the individual. This leads to the developing question that this study points to for further research,— Why, if the individuals role expecta tions tend to be in conflict with the social systems' practices, and even the fit with seemingly dysfunctional cultural entreaties, do individual's role enactments tend to go along with these prescriptions? According to role theory, when characteristics of the self (such as expectations) are incongruent with the requirements of the role, role enactment will be poor in terms of appropriateness, effectiveness, and convincing ness. A considerable amount of evidence supports this fundamental hypothesis (cf. Bunker, 1967; Milton, 1957; Smelser, 1961). This does not seem to be the case with the phenomenon of dying and death. Role enactment of the prescriptions tends to be very high in terms of appropriateness, effectiveness, and convincingness. The question may be,— What is the dynamic involved here that is unique or different in role enactment than in role expectations? 100 The second direction questions the theory and findings of the present study. This implication is theoretically content directed. The present findings supported a theoretical model derived from role and consistency theory and directed its attention to the importance of expectations and prescrip tions, and the relationship between the two. This was done using an area of inquiry, dying and death, that is still open for question and debate in relation to its applicability for scientific research and investigation. The study was explicitly exploratory in nature and the study's theoretical implication is towards scientific replication. Such replication would need to utilize a more basic rationale, a sharper and more sound conceptional framework, more precise operationalizations, and hypotheses: that are more readily testable. A concentrated endeavor directed toward these elements will benefit both the areas of social science research and the "problem" of dying and death. C. The Pragmatic Implications The findings of this study tend to raise some pertinent questions with respect to dying and death as a ■ cultural phenomenon. They raise questions in regards to j | the systems in our society, such as the medical and religious, that are intimately involved in this significant j 101 process and event. For example, a question that has grown out of this study: "What impact will the revealed findings of research reports and all the "new-found" interest in this whole area have in directing the inevitable changes that are on the horizon for these systems that deal with dying and death?" Will there be, for example, as has been evidenced in other fields, a proliferation of "special ists" to occupy ever-increasing functional positions, such as the marantologists in medicine or the institutional chaplain in religion? These findings also raise questions in terms of how one is to perceive himself in the sick and dying role. What is the nature of the complementary role to the medical staff, or to the clergyman, or to one’s children, or to one's spouse when they project society's prescriptions that are incongruent with one's expectations? These are but some of the issues and practical concerns which this study has touched upon, many more could be raised, and must be raised for the "well-being" of our society and culture. APPENDIXES APPENDIX A THE QUESTIONNAIRE SCHEDULE 103 Disregard This Colnan Csjd 01 7 T 1 T T5 TTTZT3 I? TSTST? 15 T?2TT 2T ZZ 2J 104 GERONTOLOGY CENTER University of Southern California University Park Los Angeles, California 00007 Phonei 213 7^6-6o6o James A. Peterson, Ph.D. James T. Mathleu Lear Research Participanti Your cooperation Is Invaluable to us and your answers will bo held In the strictest confidence. Host of the questions can be answered simply by circling the appropriate "code" number and some ask for short written comments. First of all, we would like to know about the people In your household. li How many people live there? (CIRCLE) 1 2 3 . 2. Who Is the head of the household? (Record on Line 1 in the table below) 3« THEN TSLLi (a) What Is the relationship of the rest of tfie adults living there to the head of the household? (b) Age? (c) Sex? (d) Marital status? (PILL IN AND CIRCLE) Line No. a. Relationship b. Age c. Sex d. 1 * Mar arita Wld 1 stat Sing us Nev Mar Divorced 1 Head 1 2 3 4 5 2 1 2 3 4 5 3 1 2 3 4 5 4,.What Is your total household income? 1 - Under $2,000 2 - $2,000-5,999 3 - $6,000-9,999 4 - $10,000-21,999 j - $22,000 and over 5. What kind of house do you live In? 1 - Single or Attached house .2 - Duplex or Triplex 3 - Apartment 4 - Other (Specify)_______________ Card 01 f Cont* d ) 35 55 5? 55 5? 30 31 32 55 3? 55 55 57 105 Now wo would like to know more about your background, 6. Vfhere were you born? 1-- United States 2 - Foreign Country (Specify). 7. Are you an American citizen now? 1 - Yes 2 - No 8. Where have you lived during most of your adult life? a. Was that in the country? Was that oni b. Or the city? Was that ini 1 - a farm? 2 the open country away from a city? 3 - a small town? 4 - a medium sized city? 5 - a large city? 9. What was the highest grade In school that you completed? * 1 - None 5 - 9-U years 2 - 1-4 years 6-12 years 3 - 5-6 years 7 - 1-3 years college If _ 7-8 years 8 - 4 or more years college 10, Are you presently retired? 1 - Yes Skip to Q. 21 2 - No 11. What kind of work do you do? 12. What kind of business or Industry Is that?___ 13. Is this a part-time or a full-time position? 1 - Part-time 2 - Full-time 14> . * Are you self employed or do you work for someone else? 1 - .Self 2 - Someone else 15. Would you say you enjoy the work you do? 1 - Very much 2 - Somewhat 3 - Not very much Card 01 (Cont'd) 35 39 55 57 m 55 55 55 55 5? 55 106- 16. Does your Job require that you retire by a certain age? 1 - Yea a. What age? _____ b. At what age do you plan to retire? ___ 2 - No a. At what age do you plan to retire? _ _ 17. Some people say that retirement Is good for a person. Some say It Is bad. In general, what do you think? 1 - It.Is good for a person 2 - It Is bad for a person 18. Do you mostly look forward to the time when you will stop working and tetlre, or In general do you dislike the idea? . 1 - I look forward to It • 2 - I do not look forward to It 19. If It were up to you alone, would you continue working In your present occupation? 1 - I would stop working 2 - 1 would not stop working 20. Have you made plans for anything you would like to do after you stop working? 2 - Ho 1 - Yes a. What are they? (Please skip to Q. 28) FOR RETIRED PERSON ONLY 21. Why did you retire* was It because your company required you to because of your age, was It because of some disability that prevented you from working, or was It some other reason? 1 - Compulsory age retirement 2 - Health reasons. What kind of health problem was it? ____ 3 - Other (Specify) Card 01 (Cont'd) J J 9 50 52 35.55 35 To TT T? 35 107 22, Vhen did you retire? Month Year Non no would like to ask you questions about the Job that you retired fromi 23. S/hat kind of work did you do? 24. What kind of business or Industry was that? 25. Were you self employed or did you work for someone else? 1 - Self 2 - Someone else 35 26. a. Bow often do you have times when you Just don't know what to do to keep occupied? Often 1 Seldom 2 Never 3 b. How often do you miss the feel ing of doing a good Job? 1 2 i 35 c. How often do you feel that you want to go back to work? 1 2 3 39 d. How often do you miss being with other people at work7 1 2 3 Disagree Completely 27. Could you tell us whether you agree completely, .agree some what, disagree somewhat, or disagree completely with the following statements! Agree Agree Disagree Completely Somewhat Somewhat a. No one should re tire If he can still work. 1 2 3 . b. We are coming to value play and leisure more than work. 1 2 3 e. It will be good when the work week Is re duced to 30 hours or lower. 1 2 3 d. Most people get more satisfaction from their family life than from their work. 1 2 . 3 Card 01 (Cont»<n 35 S3. 35 37 w 3y 75 Card 02 15 IT IT 15 V* rs 108 28. How satisfied are you now with your present residence In terms of the following features* Very Somewhat Somewhat Very Satisfied Satisfied Dissatls. Dissatisfied a. Climate 1 2 3 4 b« Access to shopping and other facilities 1 2 3 4 o. Being near key professional people 1 2 3 4 d. Being near relatives 1 2 3 4 e. Being near friends 1 2 3 4 f. Opportunities to participate In your favorite recreation ^ and leisure time activities 1 2 3 4 g. Meeting your health and medical needs 1 2 3 4 29. On the whole, how satisfied are you with your present residence I - Very satisfied v ■ 2 - Somewhat satisfied 3 - Somewhat dissatisfied 4 - Very dissatisfied 30. Have you ever thought of moving away from here? 2 - No 1 - Yes 31. When? 32. Why? _ 33. Why have you not moved? , , . ■ . . . . . - ■ — - 34. If it were possible, would you like to move into a retirement community? 15 17 1 - Yes 2 «- No a. Why is that? ____ J Curd 02 (Cont'd) I f f 19 20 IT 2? 25 25 ■ 25 I f f 17 109 35. Compared to most people your age, how would you rate your general health at the present time? 1 - extremely good 2 - very good 3 - about average 4 - fairly good 5 - not very good 36, Do you have any particular physical ailments or health problems at the present time? 2 - No 1 - res 37. Do you feel these arei 1 - very serious .2 - somewhat serious 3 - not very serious 38. What Is the nature of your aliment or problem? 39. Is there anything at all you'd like to do but can't because of your-age, health or physical condition? 2 - No 1 - les a. What is that7 40. When you go out, do you usuallyi 1 - drive my own car 2 - have someone drive me 3 - use public transportation 4 - walk 41. Have you consulted a doctor In the last five years? 2 - No I 1 - Yes 42. Did you go fori 1 - Illness 2 - checkup Card 02 (Confd) 2f 29 39 3 T 3 ? 5 3 39 33 55 37 35 39 5o ST ¥2 53 110 43. Would you say that generally most of the older people In your town act likei 1 - elderly people 2 - middle aged people 3 - young people 44. Would you say that generally most of your friends act like 1 - elderly people 2 - middle aged people 3 - young people 45. Would you say that In general, compared to your friends, you act« 1 - younger than most of them 2 - about the same ' 3 - older than most of them 46. People often speak of the ideal or nicest age. If you had your choice, what age would you most like to be? _ _ _ _ _ _ 4?. Why Is that?______________________________________ _ _ _ _ _ _ _ _ _ 48. X What do you like most about being the age you are now? ___ 49. What would you say you like are now? least about being the age you 50. Lots of people feel blue sometimes. Do you ever feel blue or depressed? No 1 - Yes 51. Do you feel this wayi 1 - very often 2 - often 3 - sometimes 4 - seldom 5 - almost never Card 02 t Cont*d) 55 55i»5 ' 5 ? , ™ 5 9 35 5T5? 35 35 i n 52. Are you likely to feel this way at any particular time? 2 - No 1 - Yes 53. Do you associate this feeling with anything In particular? ___________ 54. Do you feel this way more often or less often now than you did five years ago? 1 - more often now 2 - about the same 3 - less often now 55. On the whole, compared to five years ago, would you say you arai % 1 - happier now 2 - about the same 3 ■ • less happy now 56. How often do you find yourself feeling lonely? 1 - almost never 2 - sometimes 3 - fairly often 57. As. you get older, would you say your life seems to be better or worse than you thought It would be? 2 - as expected 1 - better 3 - worse a. In what ways? 58. How satisfied would you say you are with your way of life? 1 - very satisfied 2 - fairly satisfied 3 - not very satisfied 59. Would you agree with the following statement about yourself) ■Things Just keep getting worse and worse for me as I get older? 3 - les Neither yes nor no 1 - No Card 02 (Cont»d) 55 55 57 55 59 So ST ZZ 53 w zs zs S? S ff 112 60. All In all, how-.much unhappiness would you say you find In your life today? 1 - almost none 2 - some 3 - a good deal Cl. How much do you plan ahead the things you will be doing next week or the week after — would you say you maket 3 - many plans 2 - a few plans 1 - almost no plans 62, What Is the most Important thing In your life right now? 63. a. Would you say that you are more or less popular now than you were five years ago? 2 - same V. 1 - more 3 - less (1) Why Is that? xb. Would you say that you are more or less respected now than you were five years ago? 2 - same 1 - more 3 - less (1) Why Is that? c • Would you say that you are more or less useful now than you were five years ago? 2 - came 1 - more 3 - less (1) Why Is that? Card 02 (Confd) S9J0 7l Part 03 T5 n if 15 15 15 15 17 15 19 113 6fr. In what ways do you expect your life to be different five yeare from now? (WHAT CHANGES FOR THE BETTER OR THE WORSE) 65. How often would you say you think of the future? 1 - very often 2 - sometimes 3 - almost never 66. How often would you say that you think of the "old days" when you were considerably younger? 1 - very often 2 - sometimes * 3 - almost never 67. Generally, when you think of the future, would you say it lsi 1 - with a great deal of pleasure 2 - with more pleasure than worry 3 - with more worry than pleasure if - with a great deal of worry 68.'Generally, when you think of the past,-would you say it lsi 1 - with a great deal of happiness 2 - with more happiness than unhappiness 3 - with more unhappiness than happiness 5 - with a great deal of unhappiness 69. What are some of the pleasant prospects you see ahead In the future? ____________ __________________________________________ ' 70. What are some of the unhappy prospects you see ahead In the future? _________________ ■ __________________________________________ Card 03 (Cont'd) 5o 5 T 5 ? 55 5*53 55 5? 55 59 3o nit' 71. When you think of the past, what are some of the things you miss? ____________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 72. When you think of the past, what are some of the things you are glad to have behind you? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 73, What Is your attitude toward death? 1 - Just don't think about It 2 - think about It with fear 3 - accept It as another life experience 4 - look forward to It 5 - a wonderful experience to look forward to 6 - none of these fit my feelings, mine would be 74. Do you feel that death 1st 1 - the end of all 2 - an extended sleep V . 3 - a process toward a different life existence 75* Do you think of your deatht 1 - very frequently 2 - fairly frequently 3 - very seldom 4 - not at all How do you approach death? 1 - unworrled 2 - not very fearful 3 - fairly fearful 4 - very fearful Card 03 {Cont'd) 31 5? 33 35. 33 3? 115' 77. Which one of the following comforts you most as you think of death7 1 - my religion 2 - love from those around me 3 - memories of a full life 4 - Other (Specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 78. If a person has an incurable disease and death Is Imminent, should a doctor) - 1 - use every medical treatment and device available to keep the person alive 2 - continue to use reasonable llfe-malntalnlng treatment, but avoid "heroic1 1 methods 3 - withdraw all treatments except those designed to maintain comfort and reduce pain * 79. If you suffered an Incurable Illness, would you like the doctor tot 1 - keep the information to. himself 2 - Inform the attending nurses and staff 3 - share the Information with your family 4 - tell you 80. If you had a choice, would you rather dies 1 - at home 2 - In a neighborhood nursing home 3 - In a hospital 4 - Other (Specify) 81. Who would you most like to take care of you when you are dying? 1 - doctor 2 - nurse 3 - spouse 4 - one of your children 5 - be3t friend Card 03 (Cont»d) 35 39 Z fo 5T ZS 53 ZPT z?5 W5 3 * 7 $5 59 50 51 52 55 35 53 35 57 35 116 (32. Within the past five years, how often have you talked about death with youn Often Sometimes Never a.'friends 3 2 b. lawyer 3 2 e. doctor 3 2 d, children 3 2 e, spouse 3 2 f, clergyman 3 2 rlends 83. Within the past five years, how many of your close have died? 1 - one 2 - two 3 - three or more 4 - none 8^. If any of the following members of your ramlly are deceased, please record the year they died. Year deceased a. Father b. Mother c. Spouse d. Brothers e. Sisters f. Sons g. Daughters T3 I 7 * " 15 T£ 1? 15 19 5o 5T 55 55 55 25 55 117 85. About how often do you attend religious services? 1 - not at all 2 - several times a year 3 - once a month U - once a week 5 - more than once a week 86. How often do you participate In church groups or activities? 1 - not at all 2 - several times a year 3 - once a month 4 - once a week 5 - more than onoe a week * 67. What is your religion? 1 - none 2 - Homan Catholic 3 - Jewish 4 - Protestant, Denomination? ____________________________ 5 - Other (Specify) ________________________________________ 88. Do yott have relatives (other than those living with you) living In this area at the present time? 2 - No fco on to Q. 91) 1 - Yes 89. How many relatives In this area? _______ (Number) 90. In the table below, would you tell us about the Relationship Age How far from vour home? FREQUENCY OF CONTACT H w o y D e . n e N a e t a e 1 k h r v TYPE OF 1 1 1 1 e CONTACT y y v y r Phone 5 4 3 2 1 Visit 5 4 3 2 1 Letter 5 4 3 2 1 Phone 5 4 3 2 1 Visit 5 4 3 2 1 Letter 5 4 3 2 1 (PLEASE GO OH TO NEXT PAGE WITH THIS TABLE) rd 04 ont»d) 53 59 3? 33 35 3^ 39 3o 5? ¥3 33 37 3? 50 52 53 35 55 35 59 31 33 33 35 37 33 70 71 118 Relationship ■ % Age How far from vour home? FREQUENCY OF CONTACT M W 0 Y D e n e N a e t a e 1 k h r v TYPE OF 1 1 1 1 e CONTACT .v y y y r Phone 5 9 3 2 1 Visit 5 3 3 2 1 Letter ^ 4 3 2 1 Phone 5 ^ 3 2 1 Visit 5 4 3 2 1 Letter 5 4 3 2 1 - Phone 5 4 3 2 1 Visit 5 4 3 2 1 Letter 5 ^ 3 2 1 91* During the past year, what kinds of help or assistance have you given members of your family or other relatives — such as care when ill, baby-sitting, help with house work/carpentry or repair work, financial assistance, advice,etc a. Type of helpi _______________ b. Cave help toi________ ' 92. What kinds of help or assistance did members of your family v or other relatives give you during the past year — such as care when 111, help with housework/carpentry or repair work, financial assistance, advice, etc.? a. Type of helm b. Gave help tot 93, In general, do you wish you could see your relatives more often than you do, or would you like more time to yourself? 1 - would like to see more of relatives 2 - see them right amount 3 - want more time to myself Card OS Toll 15 1515 15 15 I? 15 19 55 5T H9 9^. How many friends do you have that you would call really close friends, such as those you can confide In and talk over personal matters with? (Number) 95* How many other friends do you. have, people whom you would consider more than casual acquaintances? (Number) 96, Are most of your friends older or younger than you? 1 - considerably older than I am 2 - a little older 3 - about the same age U - a little younger 5 - considerably younger than I am 97, Do you have more or less contact with friends now than you did five years ago? ' 1 - more contact 2 - same amount 3 - less contact 98, Would you like to see your friends more or less often than you do ? 1 - more often v 2 - sane amount 3 - less often • 99* We would like to know where most of your friends live at the. present time. How many of them live l m Very All Host Some few Noi a. your neighborhood? 5 3 2 1 b. .your town? 5 if 3 2 1 c. retirement communities? 5 if 3 2 1 d. somewhere else? 5 if 3 2 1 120 100. About how often do you get together with your friends? 1 - almost every day 2 - once a week or more 3 - a few times a month 4 - once a month 5 - Less than onee a month (SPECIFY) 101, Do you know any of your neighbors well enough to talk to when you meet them on the street? 2 - No 1 - Yes . 102. About how many do you know that well? 103. How often do you and your neighborsj (NUMBER) Once/ twice week Once/ twice month Less/ once month Never 4 3 2 1 ' 4 3 2 1 4 3 2 1 a. lend each other things or do favors? 5 b. visit each other? 5 c. ask each other for ' advice on problems? 5 104. Would you like to get together with your neighbors more often than you do, or would you like more time to yourself? 1 - more often with neighbors 2 - see them right amount 3 - more time alone 105. Do you have any living children? 2 - No (Go to Q. 112) 1 - Yes 106 (NUMBER) 107. _own or adopted children _step children (NUMBER) 108. About how often do you get together with your children? 1 - almost every day 2 - once a week or more 3 - a few times a month 4 - once a month 5 * less than once a month 121 109. Do you have more or less contact with your children now than you did five years ago? 1 - sore contact 2 - same amount 3 - loss contact 110. Would you like to see your children more or less often than you do? 1 - more often 2 - same amount 3 •» less often 111. Do you have more or less contact with grandchildren now than five years ago? 1 - more contact ' 2 - same amount 3 - less contact 4 - do not have grandchildren IF NOT MARRIED, GO ON TO QUESTION 121. IF MARRIED, CONTINUE WITH QUESTION 112 BELOW. 112. How much would you say you agree or disagree with your spouse on the following items> JS a. Handling family finances Agree Agree Disagree completely somewhat somewhat 1 2 3 Disagree completely 4 39 b. Matters of recreation 1 2 3 4 5o o. Demonstrations of affection - 1 2 3 4 ST a. Friends 1 2 3 4 5? e. Sex relations 1 2 3 4 S3 . f . Right, good, or proper conduct 1 2 3 4 5S £• Philosophy of life 1 2 3 4 S5 h. Ways of dealing with ln-laws 1 2 3 4 Card 05 fCont’d) 55 57 55 JS 122 ' 113. Would you say that you confide In your spouse 1 1 - often 2 - sometimes 3 - seldom 5 - never 114. Would you say that when disagreements arise, they most often result in your giving in or your spouse giving in? t - my giving In 2 - agreement by mutual give and take 3 - spouse giving In 115> Do you and your spouse engage In any outside activities and Interests together? 2 - No 1 - Yes 116. Would you say you and your spouse participate together Ini 1 - all of them 2 - most of them 3 - some of them 4 - very few of them 117'i Do you participate together more or less often now than you did five years ago? 1 - more often now 2 - about the same amount 3 - less often now 118. Please circle the dot on the scale line below which best represents the degree of happiness, everything considered, of your present marriage. Very Unhappy Happy -e-------------e Perfectly Happy 123 Card 05 t Cont»d) 57 15 59 V0 Z1 &Z5 Vi Vs f f f f V} 35 59 70 71 119. Do you ever wish you had hot married? 1 - often 5? 2 - sometimes 3 - seldom 4 — never 120. Do you feel closer to your Yes spouse No 55 a. 20-30 years old 1 "T 5? b. 30-40 years old 1 • 2 55 c. 40-50 years old 1 2 55 d. 50-60 years old 1 2 121. Have you reduced your participation In any clubs or organ izations such as recreation groups, lodges, social clubs , v church groups, etc., in the past five years? 2 - No 1 - Yes 122. Which ones? b. Why? 123.- Has your participation In any club or organization Increased? 2 - No 1 - Yes 124. Which ones? b. Why? 125. Do you feel that your greatest participation in clubs and organizations Is ahead of you or behind you? 1 - ahead 2 - behind 3 - right now 4 - has not changed Card 06 *5. IT TZ 15 Tf 15 75 17 75 19 Zo ZT 2? 21 2? ZJ 25 2? ZB 29 30 JT jS 55 y* 124 126. We are Interested In what things you do In your spare time for your enjoyment and relaxation In addition to the work with clubs and organizations that we have Just talked about. For- example, how often do you watch TV? Not Several Several Once a at .Every times a times a month/ all day week month less a. Watching TV 1 2 3 4 5 b. Listening to radio 1 2 3 4 5 c. Reading 1 2 3 4 5 d. Talking with friends 1 2 3 4 5 e. Travel, tours, etc. 1 2 3 4 5 f. Playing cards 1 2 3 4 . 5 g. Going to movies 1 2 3 4 5 h. Attending musical or theatrical events 1 ' 2 3 4 5 1. Sports events 1 2 3 4 5 J. Do-it-yourself projects 1 2 3 4 5 k. Participative sports 1 2 3 4 ' 5 1. Hiking, walking 1 2 3 4 5 m. 1 2 3 4 5 n. 1 2 3 4 5 o. 1 2 3 4 5 Please list by name, and In order of preference, your favorite TV programsi (1) _______________ (2) ________________ (3) _____________________ (4) _____________________ (5) _____________________ 125 Card 06 (Cont'd) 55 35 37 35 59 So 128. About how much free time would you say you have? 1 - a great deal t 2 - a moderate amount 3 - very little 129. Would you say that you have more or less free time now than you did five years ago? 1 - more free time now 2 - same amount 3 - less free time now 130. Would you say that you have more or less free time than you would like to have? 1 - more free time than I would like 2 - right amount 3 - less free time than I would like 131. In your spare time, do you generally prefer! 1 - to be on the go 2 - to stay at home 132. Do you feel that your greatest participation In free time activities Is ahead of you or behind you? 1 - ahead 2 - behind 3 - right now - has not changed 133. Do you feel that your greatest enjoyment of activities in your free time is ahead of you or behind you? 1 - ahead 2 - behind 3 - right now k - has not changed 126 Name Date Address Phone Age Sexi 1 - Hale 2 - Female Harltnl Status: .1 - Married ? - Widowed 3 - Single k - Never Harried 5 - Divorced Approximate time Jt tools you to complete this questlonalre? (hours/ minutes-) We wish to thank you for your time, patience, and cooperation In our research. The information y->u have giver us Is very important to our knowledge of the ’•lews of older people. DC NOT-WHITE IN THIS SPACE Edited !>yi Date Address Phone APPENDIX B LETTER TO LAGUNA HILLS AGGREGATE 127 128 UNIVERSITY OF SOUTHERN C A L IFO R N IA GuONTOMWV CsNTKK UNIVERSITY PARK L O S A N G K LB S, CALIFO RNIA 90007 (213) 7464060 April 7, 1969 Researchers from the University of Southern California are now ready to embark on the third phase of their study concerning the Leisure World community. Persons conducting this project are most grateful for your cooperation in previous interviews. As this is a continuation of the study you were involved with during the 196 5 phase, we are particularly interested in talking to you. The validity of this entire project depends on your kindness and willingness to give some of your time to answering questions regarding life in a retirement community, your activities and interests. This time we will come together to fill out a somewhat shorter questionnaire. We shall meet in the library of the Medical Center at Leisure World on Saturday, April 19, 1969. A choice of two time periods have been scheduled for your convenience — 10:00 a.m. and 2:00 p.m. Would you please mark the time most convenient for you on the enclosed postcard and return it to us by mail as soon as possible? The questionnaires are completely confidential. This is a statistical study, and no names will be used in any report. Following completion of the questionnaires, refreshments will be served for those who wish to chat with the researchers and other participants in the study. Dr. James A. Peterson will give a brief report on present research findings and thinking in the area of retirement and will be available to answer any questions you might have. On the basis of past experience, we think we can safely say that your participation in this event will be an enjoyable and rewarding experience. Sincerely, James A. Peterson, Ph.D. Executive Director REFERENCES 129 [ 130 REFERENCES Abelson, R. , E. Aronson, et al. (eds.) 1968 Theories of Cognitive Consistency. Chicago: Rand McNally. Alexander, I. and A. Alderstein 1958 "Affective Responses to the Concept of Death in a Population of Children and Early Adolescents." Journal of Genetic Psychology, 93, December: 167-177. I960 "Studies in the Psychology of Death." In H. David and J. Brengleman (eds.), Perspectives in Personality Research. New York: Springer. Allen, V. L. 1968 "Role Theory and Consistency Theory." In Abelson (ed.), Theories of Cognitive Consistency. Chicago: Rand McNally. 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Faunce, W. and L. Fulton 1958 "The Sociology of Death: A Neglected Area of Research." Social Forces, 36, March: 205-209. Feifel, H. 1959 "The Meaning of Death." New York: McGraw-Hill. 133 Feifel, H. 1961 "Attitudes toward Death in Older Persons: A Symposium." Journal of Gerontology, 16: 44-46. 1963 "The Taboo of Death." American Behavioral Scientist, 6: 66-67. 1967 "Physicians Consider Death," Proceedings, 75th Annual Convention, American Psychological Association, 201-202. Pestinger, L. 1957 A Theory of Cognitive Dissonance. Evanston, Illinois: Row, Peterson. Pestinger, L. and E. Aronson i960 "The Arousal and Reduction of Dissonance in Social Contexts." In D. Cartwright and A. Zander (eds.), Group Dynamics (2nd ed.) Evanston, Illinois: Row Peterson. Pirth, R. (ed.) 1957 Man and Culture: An Evaluation of the Work of Bronislaw Malinowski. New York: The Humanities Press. Fromm, E. Man for Himself. New York: Henry Holt. R. The Sacred and the Secular: Attitudes of the American Public Toward Death. Milwaukee: Bulfin Printers. "Death and the Self." Journal of Religion and Health, 3, July: 359-368. Death and Identity. New York: Wiley. B. "The Social Loss of Aged Dying Patients." Gerontologist, 6: 77-80. B. and A. Strauss "The Social Loss of Dying Patients." American Journal of Nursing, 64: 119-121. Awareness of Dying. Chicago: Aldine. Time for Dying. Chicago: Aldine. 1947 Fulton, 1963 1964 1965 Glaser, 1966 Glaser, 1964 1965 1968 134 Goffman, E. 1959 The Presentation of Self in Everday Life. Garden City, New York: Doubleday Anchor Books. 1961 Asylums. Garden City, New York: Doubleday Anchor Books. 1963 Behavior In Public Places. New York: The Free Press. Goldfarb, A. I. 1965 "Psychodynamics and the Three-Generation Family." In E. Shanas and G. Streib, Social Structure and the Family. Englewood Cliffs, N. J.: Prentice-Hall. Goldfogel, L. 1970 "Working with the Parent of a Dying Child." American Journal of Nursing, 70, August: 1674- 1679. Goode, W. J. i960 "A Theory of Role Strain." American Sociological Review, Vol. 25, No. 4, August: 483-496. Gorer, G. 1967 Death, Grief, and Mourning. Garden City, New York: Anchor Books. Gross, N., W. L. Mason, and A. W. McEachern 1958 Explorations in Role Analysis. New York: Wiley. Harmer, R. 1963 The High Cost of Dying. New York: Crowell- Collier. Hinton, J. 1967 Dying. Baltimore: Penguin Books. Hovland, C. and M. Rosenberg i960 "Summary and Further Theoretical Issues." In Rosenberg, et al. (eds.), Attitude, Organization and Change: An Analysis of Consistency Among Attitude Components. New Haven: Yale University Press. Jackson, J. 1966 "Structural Characteristics of Norms." In Biddle and Thomas, Role Theory: Concepts and Research. New York: Wiley. 135 Jones, E. E. and H. B. Gerard 1967 Foundations of Social Psychology. New York: Wiley. Kalish, R. 1963 "An Approach to the Study of Death Attitudes." American Behavioral Scientist, 6, May: 68-70. 1969 "The Practicing Physician and Death Research." Medical Times, Vol. 97, No. 1, January: 211-220 Kasper, A. 1959 "The Doctor and Death." In H. Feifel (ed.), The Meaning of Death. New York: McGraw-Hill. Kastenbaum, R. 1967 "The Mental Life of Dying Geriatric Patients." Gerontologist, 7: 97-100. Kaufmann, 1959 "Existentialism and Death." In Feifel (ed.), The Meaning of Death. New York: McGraw-Hill. Kreps, W. 1967 Notes from course on "Economics and the Aged." Summer, University of Southern California. Kubler-Ross, E. 1969 On Death and Dying. New York: Macmillan. 1971 University of Southern California, Gerontology Center Institute— Confrontation with Dying. Los Angeles, December 10-11. Kutscher, A. (ed.) 1969 Death and Bereavement. Springfield: Charles Thomas. LaPiere, R. and P. Farnsworth 19^9 Social Psychology. New York: McGraw-Hill:. LeShan, L. 1964 "The World of the Patient in Severe Pain of Long Duration. Journal of Chronic Diseases, 17: 119-126. Linton, R. 1936 The Study of Man. New York: Appleton-Century. 19^5 The Cultural Background of Personality. New York: Appleton-Century-Crofts. 136 Lowenthal, M. and D. Boler 1965 "Voluntary and Involuntary Social Withdrawal." Journal of Gerontology, 20, July: 363-371. Malinowski, B. 1948 Magic, Science, and Religion and Other Essays. Boston: Beacon Press. Martin, D. and L. Wrightman 1965 "The Relationship Between Religious Behavior and Concern About Death." Journal of Social Psychology, 65, 317-323. Mead, G. H. 1934 Mind, Self, and Society. Chicago: University of Chicago Press. Meissner, W. 1958 "Affective Responses to Psychoanalytic Death Symbols." Journal of Abnormal Social Psychology, 56: 295-299. Merton, R. 19^0 "Bureaucratic Structure and Personality." Social Forces, 19: 560-568. 1957 Social Theory and Social Structure. Glencoe, 111.: Free Press. Milton, G. A. 1957 "The Effects of Sex-Role Identification upon Problem Solving Skill." 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Glencoe, 111.: The Free Press. 1951 "Illness and the Role of the Physician: ■ A Sociological Perspective." American Journal of Orthopsychiatry, 21: 452-460. 1963 "Death in American Society: A Brief Working Paper." American Behavioral Scientist, 6, May: 61-65. Pearson, L. 1969 Death and Dying. Cleveland: The Press of Case Western Reserve University. Peters, R. 1958 The Concept of Motivation. London: Routledge & Kegan Paul. Pettigrew, T. 1964 A Profile of the Negro American. Princeton, New Jersey: D. Van Nostrand. Poe, W. 1972 "Specialty for Losers." In Time Magazine, March 13-' 87. Puckle, B. 1926 Funeral Customs. London: T. Weiner Laurie. Ransford, E. 1968 "Isolation, Powerlessness, and Violence: A Study of Attitudes and Participation in the Watts Riot." .American Journal of Sociology, 63, March: 581-591. 138 Riley, M 1963 1968 Rokeach, 1965 Rosow, I 1967 Sarbln, 1950 1952 1954 1964 Sarbin, 1968 Sarbin, 1956 Saunders 1959 Sherwood 1958 . W. Sociological Research: A Case Approach. New York: Harcourt. Brace & World. An Inventory of Research Findings. New York: Russell Sage Foundation. M. and G. Rothman "The Principle of Belief Congruence and the Congruity principle as Models of Cognitive Interaction." Psychlogical Review, 72: 128-143. I. Social Integration of the Aged. New York: Free Press. R. "Contributions to Role-taking Theory." Psychological Review, 57* 255-270. "Contributions to Role-taking Theory: III A Preface to a Psychological Analysis of the Self." ; Psychological Review, 59: 11-22. "Role Theory." In G. Lindzey (ed.), Handbook of Social Psychology, Vol. 1. Cambridge, Mass.: Addison-Wesley. "Role Theoretical Interpretation of Psychological | Change." In P. Worchel and D. Byrne (eds.), Personality Change. New York: Wiley. R. and L. Allen "Role Theory." In G. Lindzey and E. Aronson (eds.)| Handbook of Social Psychology. Reading, Mass.: Addison-Wesley. '. R. and D. S. Jones "An Experimental Analysis of Role Behavior." 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Mathieu, James Thomas
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Core Title
Dying And Death Role-Expectation: A Comparative Analysis
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Doctor of Philosophy
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Sociology
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