the structure of well-being in the life narratives of the elderly

THE STRUCTURE OF WELL-BEING IN THE LIFE NARRATIVES OF THE ELDERLY

EDMUND SHERMAN* State University of New York-Albany

ABSTRACT: The purpose o f this study was to explore the possibility that the manner and form in which the elderly tell their life stories (i.e., life narratives) might be indicative of their morale and adjustment in late life. In-depth interviews were conducted with a subsampling of 40 respondents from a questionnaire survey sample (N=IO0) o f elderly persons Jrom four senior service centers. The subsample was selected on the basis o f certain patterns o f adjustment indicated by an ego-integrity measure and the Affect-Balance Scale from the questionnaire survey. The tape- recorded interviews followed Jerome Bruner's procedures for obtaining "self-toM life narratives." The tapes were analyzed by independent raters according to the experiential level o f the narratives and a schema for determining the structure o f the narrative from social psychological research. Findings from the qualitative analysis o f the taped narratives suggest that recognition of the experiential level and structure o f life-narratives should be helpful to gerontological practitioners in assessing adjustment and facilitating life-review processes in the elderly, and the structural schema holds potential heuristic value and promise for gerontological researchers.

To what extent does the manner and form in which the elderly tell their personal life histories provide a basis for assessing their morale and psychosocial adjustment in late adulthood?

The case history has long been an important source of content for the purposes of assessment or diagnosis and treatment planning among clinical practitioners in fields such as social work, psychiatry, psychology, and counseling in general. The case history, when told personally by the client or patient, is a narrative, a self-narrative or an oral

* Direct all correspondence to: Edmund Sherman, Ringel Institute of Gerontology, State University of New York-Albany. 135 Western "Avenue, ATbany, NY [2222.

JOURNAL OF AGING STUDIES, Volume 8, Number 2, pages 149-158 Copyright © 1994 by JAI Press Inc. All rights of reproduction in any form reserved. ISSN: 0890-4065.

150 JOURNAL OF AGING STUDIES Vol. 8/No. 2/1994

"story" of the self. This has particular relevance for the elderly because it has been observed that " . . . narrative has the most evident and straight forward relationship to memory" (Ong 1982) and there is sound empirical evidence that elderly persons recall narrative content much better than expository content (Tun 1989).

There has also been a substantial literature on life history and personal narratives that goes well beyond these more clinical and applied implications for the field of aging. Anthropologists and sociologists have examined the life history as a vehicle for understanding social and cultural constructs of aging and for understanding the life course (Bertaux 1981; Meyerhoff and Tufte 1975; Meyerhoff 1978).

It is most often the historical content (developmental events, traumata, etc.) that is the focus of concern on the part of clinical practitioners in the assessment or diagnostic process. However, astute practitioners also pay close attention to the manner in which the personal history or self-narrative is told. How does the person express her or himself in the telling of that history? Is it animated or flat? Is it a matter-of-fact chronicle of events or a searching reflection on and formulation of a life history? These questions were central to the research reported here.

These were not only questions about the way the person tells his or her life history but questions about the form of the self-narrative. Jerome Bruner (1987), whose procedure for obtaining self-narratives was used in this study, believes that it is the form rather than the content that matters in the study of personal life narratives. He thinks this is so because "self-told life narrative may reveal a common formal structure across a wide variety of contents" (Bruner 1986). On this premise, another purpose of this study was to look at life narratives in terms of their forms or structures.

The opportunity to do this was provided by the availability of a sample of 100 elderly (60+) persons from four senior service centers who had just participated in a questionnaire survey. The survey was designed to study the extent and kinds of reminiscence the participants engaged in and whether this showed any relationship to their morale and psychosocial adjustment in late adulthood (Sherman and Peak 1991). Therefore, data were available on the frequency and different ways in which the participants claimed to think and talk about the past as well as self-report measures on their current affect or mood and their overall psychosocial adjustment.

By conducting audiotaped interviews to obtain oral life narratives of a subsample of the questionnaire survey participants it would be possible to see if their self-reported patterns of reminiscence and psychosocial adjustment from the questionnaire data would be reflected in their life narratives in the interviews. In short, this in-depth interview survey was intended to explore the possibility that the manner and form in which the elderly tell their life stories might be indicative of their current morale and psychosocial adjustment.

The findings from the questionnaire survey indicated that two distinct types of reminiscence showed a significant relationship to the measure of psychosocial adjustment while a third type of reminiscence was significantly related to current mood or affect (Sherman and Peak 1991). Therefore, the subsample for the interview survey was selected to be reflective of the general patterns of adjustment and reminiscence found in the larger questionnaire sample, as will be described shortly.

The Stucture of Well-Being in the Life Narratives

METHOD

151

Participants

The participants in the interview survey consisted of 40 volunteers from the questionnaire survey ranging in age from 60 to 94 with a mean age of 72.3 years. There were 32 females and 8 males and their marital status was: 2 single, never married; 17 married, living with spouse; 20 widowed; and 1 divorced. Self-identification by race was optional, but all of the interviewees did so identify themselves in the following manner: 36 Caucasian; 3 African-American; and 1 Asian-American. It should be noted that there are relatively few Hispanics in the metropolitan area (Albany, New York) of this study.

Measures

A combination of quantitative and qualitative methods was applied in this study. The measure of psychosocial adjustment used was the Ego Integrity Scale which was developed and operationalized on the basis of Erikson's ego integrity concept (Boylin, Gordon, and Nehrke 1976). The ten-item scale is based upon Erikson's (1963) descriptions of the attitudes that are reflective of the two alternative solutions to his final stage of development, either ego integrity or despair. The five ego integrity items were: (1) I am satisfied with my life so far; (2) I am willing to take responsibility for my decisions; (3) I would not change my life if I had to live it over; (4) I am proud of what I have done; and (5) I accept myself the way I am. The five despair items were: (6) I worry about getting old; (7) I regret the mistakes I've made; (8) I am discontentetl with life; (9) Life is too short; and (10) I wish I could change myself. Responses to these items were scored on a seven-point Liken-type scale going from "Definitely the Most Unlike Me" to "Definitely the Most Like Me." Therefore, the ten items yield a possible range of scores of 10 to 70, with the higher scores representing higher levels of ego integrity. Walaskay, Whitbourne, and Nehrke (1983-1984), using a semi- structured interview procedure, found that subjects who achieved ego integrity according to Erikson's (1963) criteria scored significantly more positively on the ego integrity scale than persons classified as in despair by Erikson's criteria. Thus, the different methods of measuring the ego-integrity construct (Boylin et al. 1976, and Walaskay et al. 1983-1984) provided a measure of concurrent as well as construct validity for the ego integrity scale. Internal reliability for the scale was reported to be .76 (Walaskay et al. 1983-1984) and Tesch (1985) found the internal consistency by Chronbach's alpha to be .69.

The morale or affect variable was measured by the Affect-Balance Scale (Bradburn and Caplovitz 1965). This ten-item scale is based upon self-reported feelings about daily life experience "during the past few weeks" and is more reflective of current morale than overall psychosocial adjustment. It assesses happiness or psychological well-being as the net positive over negative affect, and it corresponds well to other measures of current morale or well-being (Stock, Okun, and Benin 1986).

The questionnaire items on uses of reminiscence were developed by Romaniuk and Romaniuk (1981) who found by factor analysis that thirteen reported uses fell into three factors or types of reminiscence: (1) Pleasure/Image Enhancement, (2) Problem-


Solving; and (3) Existential/Self-Understanding. The sorts of uses that fell within the pleasure/image enhancement type were: "because memories are pleasant and enjoyable," "to be amusing and entertaining," and "to inform people about the successes and accomplishments in my life." The problem solving type consisted of the following three uses: "to cope with a loss in my family; .... to deal with some difficulty I am experiencing;" and "to make plans for the future." The existential/self-understanding type of reminiscence consisted of the following three uses: "to solve something in my past which is troubling me," "to arrive at a better understanding of my past life and myself," and "to determine life's meaning." These were found to be characteristic of life review reminiscing described by Robert Butler (1963).

The manner in which the respondents told their life stories was based upon a phenomenological approach to the manifest content of spoken language and the extent to which it reflects the inner, subjective nature of lived experience as opposed to a more external, "factual" chronicle of events in a life (Gendlin 1973). This approach had been tested and developed into a scale reflecting the "experiential level" of oral communication. Measurement of the experiential level of the narratives in the audiotaped interviews consisted of ratings based on the Experiencing (EXP) Scale (Klein, Mathieu, Kiesler, and Gendlin 1970). This scale consists of seven stages or levels going from a low of 1, in which the manifest content of the n;,-rative or discourse is impersonal and superficial to a high of 7, in which the content is highly internalized and intensely personal. Table 1 shows the short-form of the EXP Scale, which indicates the kind of content covered by the speaker and the expressive manner in which the speaker treats that content at each of the seven stages or levels of experiencing.

The Scale was designed for psychotherapy research in which stages 4 to 7 reflect major clinical shifts or breakthroughs. The lower levels of I to 3 would be expected in everyday discourse and personal narratives. It has shown good inter-rater reliability and relationships to client gains in psychotherapy process research (Klein, Mathieu- Coughlan, and Kiesler 1986).

TABLE 1 Short Form of Experiencing Scale

Stage Content Treatment

I External Events; Refusal to Participate. Impersonal, Detached.

2 External Events; Behavioral or Intellectual Interested, Personal, Self- Self-Description. Participation.

3 Personal Reactions to External Events; Limited Se l f - Reactive, Emotionally Descriptions; Behavioral Descriptions of Feelings. Involved.

4 Description of Feelings and Personal Experiences. Self-Descriptive; Associative.

5 Problems or Propositions about Feelings and Personal Exploratory, Elaborative, Experiences. Hypothetical.

6 Felt Sense of Inner Referent. Focused on There Being More about "It."

7 A Series of Felt Senses Connecting the Content. Evolving, Emergent.

The Stucture of Well-Being in the Life Narratives 153

Determining the form or structure of the self-narratives involved a qualitative analysis of the content rather than measurement on any scale. The analysis was based upon the seminal work of Mary M. Gergen (1988), a social psychologist, who proposed a scheme for looking at life narratives in terms of whether they are progressive, regressive, or stable over time and whether they are positive, negative, or neutral in the expressed sense of well-being over time in the life cycle. The trajectory of the expressed sense of well-being at different stages in the life cycle thus provided a retrospective "narrative structure" of well-being as reflected in the self-told life story.

Procedure

The purpose of the original questionnaire survey was explained to potential volunteers by this investigator in open meetings at each of four senior service centers in the Albany, New York area. The volunteer respondents were paid $10 each for filling out the six-page questionnaire. If they were interested in participating in the interview survey, they were asked to give their names and telephone numbers on a sheet attached to the questionnaire. A payment of $20 was offered for a 1 to 1 1/2 hour interview. Seventy-six of the 100 respondents gave their names and numbers, which enabled us to obtain a subsample selected on the basis of the patterns of morale, adjustment, and reminiscence indicated in the questionnaire data. That is, there was a representative range of subjects based upon the combined affect-balance and ego integrity scores and the three identified types of reminiscence. Essentially, the subsample represented the four quartiles (i.e., 10 subjects in each quartile) going from lowest to highest on the combined affect and integrity scores. All the interviews were conducted by this investigator within three weeks of completion of the questionnaire, and they were held either in a private room in the respective senior center or in the respondent's own home.

The interviews were based on Bruner's (1986) approach to obtaining self-narratives, which began simply by asking the participants to tell the story of their lives in the context of a I-1/2 hour interview. They were told that the stories did not have to be neat and well-organized and that we were just interested in "how people see their lives", not in judging them. It was suggested that they begin by telling where and when they were born, a little about their parents and what they were like, what their early home life was like and from there begin to work their way up to the present. Every attempt was made to avoid probes so as to let the respondent determine the structure of the narrative as it unfolded in progressing to the present stage of life. After they had done this they were asked about the kinds of events they considered crucial in their lives--the circumstances, happenings, crises, or turning points that might have shaped their lives. All forty interviews were audiotaped and available for EXP Scale ratings and content analysis.

RESULTS

There were two types of EXP ratings (i.e., the modal score and the peak score) made by two independent raters of the typed narratives. The taped interviews and typed transcripts were broken into 10-minute segments for the purposes of analysis and scoring. The raters had to determine the most frequently occurring (modal) and highest


(peak) stage or level of experiencing within each segment of the interview. The most frequent modal score across the segments (ranging from 6 to 10 segments per interview) and the highest peak score across the segments then represented the overall modal and peak ratings for each subject.

The raters were two graduate (MSW) social work students who were trained to evaluate the experiential level of each tape through the use of The Experiencing Scale Manual (Klein, Mathieu, Kiesler, and Gendlin 1970). They showed a high percentage of agreement on the two types of EXP ratings, 97.5% on the modal score and 85% on the peak score.

The results of this analysis showed that most of the participants related their life narratives at EXP level 2, which was the modal rating for 36 of the 40 interviews. This meant that most of them told their life stories in an interested, personal, and self- participating way. They related their stories as a series of external events to which they gave behavioral or intellectual descriptions of themselves in the context of those events. A few of them (N ---- 7) remained at that level throughout the interview but most of them became more animated and involved at various points. Thus, many of them (N = 20) reached peak EXP ratings of 3, which meant that they were describing personal reactions to external events, giving at least limited descriptions of themselves and their feelings. At this level they were reactive and emotionally involved. Others (N = 9) went even higher to EXP level 4 where the narratives became largely descriptions of personal experiences along with descriptions of their feelings in the here-and-now about those experiences from the past. Thus, their treatment of the narrative content was highly self-descriptive and associative. Just a few (N = 4) went even higher than that, but those with ratings of 4 and above need to be analyzed in relation to the assessment of their mood and psychosocial adjustment according to the Affect-Balance Scale and Ego Integrity Scale, respectively. This will be done shortly.

First, it should be noted that there was no significant relationship between the modal EXP ratings and the scores on the Affect-Balance or Ego Integrity scales. This is not surprising in light of the fact that there was so little variability in the modal rating; almost everyone had a rating of 2. There was, however, a significant negative relationship (r = -.26, p < .05) between the peak EXP ratings and the Affect-Balance scores. This is not a strong correlation coefficient, but when examined more closely it was not a linear relationship, and this served to attenuate the coefficient somewhat.

Closer analysis showed that when the EXP level is studied in relationship to the self- reported types of reminiscing from the questionnaire survey a pattern emerges. People who reported using reminiscence to deal with current problems or to cope with a loss (i.e., the problem-solving type) or to solve past troubles and to achieve better understanding of self (i.e., the existential/self-understanding type), tended to show higher peak EXP scores than the sample in general. They also showed lower Affect Balance Scores as well as Ego Integrity scores than the total sample.

This becomes understandable in light of the finding from change-process in psychotherapy research that peak EXP levels of 4 and above indicate that the person is effectively engaged in problem-solving and change processes (Klein et al. 1986). The affect at these levels of experiencing is apt to be painful and negative because people are working through emotional problems from the present and past, hence the negative affect-balance scores of the participants who reported engaging in problem-solving and


life review (existential/self-understanding) types of reminiscence. They were more apt to display experiential level 4 and level 5, in which the narrative content is "problems or propositions about feelings and personal experiences."

It is important to reiterate that personal narratives falling within EXP levels 5 through 7 are not apt to be found in the course of normal autobiographical life histories. They are only apt to be found under intense (current) emotional life circumstances or in intensive psychotherapy. At level 5, for example, the person's speech becomes dysfluent as s/he gropes for words to express the nature, depth, and intensity of the feelings currently being experienced. Levels 6 and 7 occur only infrequently and usually toward the end of psychotherapy when the person is experiencing strong affective and cognitive insight based on considerable prior therapeutic work (Klein et al. 1986). Therefore, the fact that most people in this study related their life narratives at a modal level of 2 with a peak of 3 would be considered normative for a population such as this covering content such as this.

Even without knowledge of the EXP Scale it was not difficult to determine the generalized sense of well-being at various points across the life-span as depicted by the respondents in their life narratives. This became evident when this investigator and two graduate assistants independently portrayed the narrative structures or forms of the past from the taped interview according to Gergen's (1988) schema as illustrated, for example, in Figure 1.

This was a fairly clear narrative structure in which a 75-year-old widow reported having an unhappy childhood but whose sense of well-being went up with the advent of her marriage in her early twenties and remained positive throughout her marriage and the raising of her children. Her sense of well-being dropped precipitously at the death of her husband when she was 61 years of age. For about a year and a half it became less negative and finally stabilized at 'a relatively neutral level up to the time of the interview.

Gergen proposes that all narrative plots can be converted from a story form to a linear form with respect to their evaluative shifts over time. She calls these linear forms "story lines", and by conceptualizing narratives in this way it may be seen readily that variations in narrative form can move from the rudimentary to the more complex. At the more rudimentary level there is a stability narrative. This is characterized by an unchanging story line with respect to the evaluative dimension over an extended period of time. Thus, for the widow's story depicted in Figure I, there is a stability narrative with respect to her childhood, her marriage, and then her widowhood after about a year and a half of grieving and mourning.

This may be contrasted with two other rudimentary narratives in which the narrative can be structured in a form that indicates things get continuously better or worse over time. When the events become increasingly positive over time the structure is called a positive narrative and when events become increasingly negative over time the structure is called a regressive narrative. Thus, the once-wealthy, dissolute playboy who describes a steady procession of events leading to the gutter is constructing a regressive narrative.

Actually, most of the life narratives in this study were more complex. There would often be a series of ups and downs in the story line, interspersed sometimes between periods of calm or stability and sometimes not. This complexity made it difficult to


Feelings of generalized well-being

HIGH

death of husband

a/rliage 'I NEUTRAL ....... ~/~--- ........................ -~/~

/

LOW

0 10 20 30 40 50 60 70

AGE (YEARS)

FIGURE 1 Narrative Structure and Trajectory of the Past in a 75 year old Widow

determine and classify the different types of trajectories according to Gergen's conception of progressive, regressive and stable narrative forms. It also made it difficult to develop a meaningful typology of narrative forms or trajectories within a reasonable number of types across a full life span. However, since the main concern of this study was morale and psychosocial adjustment in old age, a viable typology was developed for the age range of 60 years and over. Thus, the focus of assessment shifted to the narrative trajectory going into and within old age. On this basis, it was possible to identify six types of narrative structures in the life histories of these 40 elderly individuals: (1) progressive (becomes more positive in old age); (2) regressive (becomes more negative in old age); (3) positive-stable (remains positive in old age); (4) negative-stable (remains negative in old age); (5) neutral-stable (remains neutral in old age); and (6) variable


(varies within old age). According to this typology, the life narrative depicted in Figure 1 would be classified as neutral since the generalized sense of well-being remains neutral within the period of old age. Using this typology the two graduate assistants achieved 95 percent agreement on 38 out of the 40 audiotaped narratives.

The actual frequencies of life narratives falling into each type of structure were as follows: (1) progressive = 8; (2) regressive = 3; (3) positive-stable = 13; (4) negative- stable = 7; (5) neutral-stable ---- 5; and (6) variable -- 4. Thus, the positive stable was the most frequent type we encountered and the regressive the least frequent.

A statistical analysis based on these structural types was undertaken by dividing the sample into two groups: (1) those with progressive + positive-stable versus (2) the other remaining types. Using this dichotomy, group i showed a mean Affect-Balance score of 8.60 (SD = 2.18) compared to group 2 with a mean of 6.58 (SD -- 1.98), which represents a statistically significant difference (t = 3.06, d.f. = 38, p < .01). On the Ego Integrity measure group I showed a mean of 54.09 (SD = 9.77) compared to 48.16 (SD = 9.03) for group 2, which also represents a significant difference (t = 1.99, d.f. = 38, p < .05).

DISCUSSION

Thus, persons with progressive and positive-stable trajectories had the higher Affect- Balance and Ego Integrity scores in the study. Additionally, the regressive and the negative-stable trajectories had the lowest scores, and the neutral-stable and variable trajectories fell in between in the assessment of current mood and psychosocial adjustment. Although not analyzed statistically due to non-linearity, the experiential" levels were lower in the three stable categories, with the lowest in stable negative as compared to the stable positive and neutral. In line with the findings about problem- solving and existential/self-understanding types of reminiscence the regressive and variable types of trajectories showed higher EXP scores. The problem-solving types displayed mostly regressive trajectories and were dealing with recent losses and current problems, whereas the variable type seemed to include people who were going through life reviews and who were characterized by existential/self-understanding types of reminiscence.

The progressive type of narratives also showed higher EXP scores. One 69 year old woman in this category was highly animated and enthusiastic in telling her life story with a modal EXP of 4 and a peak of 6 in which she was highly focused on her positive feelings and experience at this stage of life.

The overall impression from this study of life narratives is that there is a relationship between the experiential level of the narrative and the assessment of late life adjustment, whether that assessment is based on the person's own way of telling the life story or on assessment instruments measuring current mood and psychosocial adjustment. This suggests that recognition of the experiential level and structure of life narratives could be helpful to gerontological practitioners in assessing adjustment and facilitating life- review and other adjustment processes in working with the elderly. For gerontological researchers, particularly those with a qualitative bent, Gergen's narrative structure conceptualization has potential heuristic value and provides an interesting schema for further study in this burgeoning area of inquiry in the field of aging.


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