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Volume 13, Issue 1 (2021)
Iran J War Public Health 2021, 13(1): 71-77 |
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Received: 2021/02/20 | Accepted: 2021/08/25 | Published: 2021/09/25
Received: 2021/02/20 | Accepted: 2021/08/25 | Published: 2021/09/25
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Sadri A, Khanjani M, Younesi S, Nabati Saravan E. Barriers of Adaptability with Spouse Death in Martyrs' Wives. Iran J War Public Health 2021; 13 (1) :71-77
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1- Consulting Department, USWR, Tehran, Iran
2- Consulting Department, USWR, Tehran, Iran ,sa.khanjani@uswr.ac.ir
3- Consulting Department, Faculty of Psychology and Educational Sciences, Allame University, Tehran, Iran
2- Consulting Department, USWR, Tehran, Iran ,
3- Consulting Department, Faculty of Psychology and Educational Sciences, Allame University, Tehran, Iran
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Introduction
The process of human life begins at birth by going through different stages and completing developmental-nature tasks, reaches the last stage of life. Death, the end of conscious action in the material world, is the beginning of another kind of life that is imagined in an infinite form and is far from the limitations of time and space [1]. The experience of mourning is natural in the lives of human beings. However, the loss of a loved one is one of the stressful events a person can experience and can be associated with several negative consequences in the physical, social, and psychological fields [2]. Among the types of death, the death of a person due to war has more destructive psychological and social effects on the survivors and creates a process of mourning different from the grief caused by natural death [3]. According to Holmes and Rahe, the loss of a spouse is the most stressful event in life [4].
The higher the quality of the marital relationship in the past, the more the loss of a spouse will be felt, and the consequent will be greater [5]. The death of a spouse is especially problematic for women who lack economic independence and have no shelter. It causes confusion and even leads to unpleasant psychological behaviors such as aggression and, in some cases, the possibility of suicide if the spouse dies suddenly, and generally compromises the individual's adaptation [6]. Adaptation is the set of reactions and behaviors that a person expresses in new situations and conditions to respond appropriately to existing stimuli. The dimensions of adaptability include physical, psychological, social, and moral adaptability. Social adaptability is the precondition for achieving psychological, moral, and physical adaptations [7].
Social adaptability reflects one's interaction with others, the satisfaction of people with their roles, and how they perform them, which is likely to be influenced by previous personality, culture, and family expectations [8]. Social adaptability in individuals is a considerable sign of mental health [9]. Addressing human mental health is of particular importance; because one of the goals of psychological research is to pay attention to the mental health of families, especially those who are injured. Studies have shown that individuals' mental health, well-being, and even physical health are affected by stress [3]. In addition, the mental health of society depends on the health of families. Because the family is the most important institution of society, on the other hand, one of the most important properties of mental health is adaptation [10, 11].
It is necessary to study acceptance and adaptation to loss and death, an important factor in the health of the individual and society, and examine people's experiences in a clear, comprehensive, and persuasive format. The martyrs' wives are a special group in society due to the valuable position of their husbands in the perspective of society, which may affect their coping with the situation. On the other hand, in most societies, the family man is the head of the family. However, those women who have taken on family responsibilities for reasons such as the death of their husbands are exposed to many vulnerabilities due to changing roles and increasing their responsibilities, and they often experience various psychological and physical injuries. The wives of the martyrs also have a spiritual responsibility, in addition to losing their husbands at a young age and subsequently creating new responsibilities, including parenting, providing living expenses, getting a widow label, and difficult conditions of remarriage. Because they are considered a representative of the martyrs and value the personality of the martyr while maintaining their dignity, according to society's expectations, these expectations put much psychological pressure on them, and they cannot mourn. In addition, the wives of the martyrs who defended the holy shrine have different conditions. Because the war against ISIS terrorist groups is a phenomenon that has happened in recent years, there is less awareness of the aims of the martyrs. The lack of awareness of the value of their action has had consequences for their families. In this regard, the results of Javidi research showed that the most problems of martyrs' wives are social issues such as the wrong looks of the people and their inappropriate treatment and dissatisfaction with the performance of the Martyr Foundation [12]. Such studies can increase the awareness of people and related organizations about the various problems of these women to consider better counseling services and remove the obstacles for their adaptability.
Since there is no qualitative research on the wives of the martyrs, who defended the holy shrine, the aim of this study was the identification of barriers of adaptability with spouse death in wives of martyrs in accordance with Iranian culture and to create a suitable information base in this field for future use in the field of mourning counseling and other services for this group.
Participants and Methods
This qualitative study was carried out on 12 wives of martyrs of the holy shrine defenders from December 2019 to June 2020. The maximum diversity sampling was used in this study. Purposeful sampling is the purposeful selection of research samples to access the desired information in a specific field, which provides the maximum possibility of answering the desired questions [13]. Women who were in the age range of 20-40 and who lost their husbands in the last 2-4 years and lived in Tehran were included in the study.
Data were collected by semi-structured interviews using open-ended questions. For this purpose, after receiving the necessary permits, the participants were first contacted, and the appointments were set if they agreed to participate in this study. At the beginning of the interview process, the researcher tried to create an informal environment by communicating and asking general questions. Conscious consent was obtained from all participants in the study, and it was committed that the information would be kept confidential, and the subjects could cancel the participation in any stage of the study. Researchers were obliged to follow the related ethics codes. After creating a suitable space for conversation, the interview began using general questions and was conducted based on the expressed experiences. The general questions were such the question which "what problems did you experience after the martyrdom of your spouse". The exploratory questions were asked to obtain in-depth information (for example, if the answer was: there are many problems and obstacles, the following question was: can you explain more?). The aims of the study were also explained to the subjects before starting the interviews. The duration of an interview was between 30 and 60 minutes. Finally, the interview process continued until information saturation. Saturation is the completion of codes, the lack of need to expanding codes, and failure to obtain new information and concepts that require new code [14].
Data were analyzed using the contractual qualitative content analysis method according to the steps specified by Granheim and Landman [15]. As one of the qualitative methods in the simplest form, the content analysis extracts the concepts from the studied text, and the concepts will be organized into regular categories. The content analysis method is based on the assumption that we can achieve the meanings, priorities, attitudes, ways of understanding, and word organizing by analyzing language messages [16]. Therefore, the content of each of the recorded interviews was implemented verbatim, and then the semantic unit, a summary of semantic units, and open-ended coding were conducted. In this way, the answers to the questions raised in the interview were considered a semantic unit, and the code was assigned to the summary of the semantic unit. A set of subcategories was obtained by comparing similar codes with each other, and a name was chosen for each subcategory according to the participants' statements. Finally, the subcategories were classified based on similarity and named properly.
Findings
The subjects' experiences were investigated (Table 1), and the obstacles to the adaptability of the martyrs' wives with spouse death were revealed by the categories. These barriers included eight categories and 23 subcategories (Table 2).
The process of human life begins at birth by going through different stages and completing developmental-nature tasks, reaches the last stage of life. Death, the end of conscious action in the material world, is the beginning of another kind of life that is imagined in an infinite form and is far from the limitations of time and space [1]. The experience of mourning is natural in the lives of human beings. However, the loss of a loved one is one of the stressful events a person can experience and can be associated with several negative consequences in the physical, social, and psychological fields [2]. Among the types of death, the death of a person due to war has more destructive psychological and social effects on the survivors and creates a process of mourning different from the grief caused by natural death [3]. According to Holmes and Rahe, the loss of a spouse is the most stressful event in life [4].
The higher the quality of the marital relationship in the past, the more the loss of a spouse will be felt, and the consequent will be greater [5]. The death of a spouse is especially problematic for women who lack economic independence and have no shelter. It causes confusion and even leads to unpleasant psychological behaviors such as aggression and, in some cases, the possibility of suicide if the spouse dies suddenly, and generally compromises the individual's adaptation [6]. Adaptation is the set of reactions and behaviors that a person expresses in new situations and conditions to respond appropriately to existing stimuli. The dimensions of adaptability include physical, psychological, social, and moral adaptability. Social adaptability is the precondition for achieving psychological, moral, and physical adaptations [7].
Social adaptability reflects one's interaction with others, the satisfaction of people with their roles, and how they perform them, which is likely to be influenced by previous personality, culture, and family expectations [8]. Social adaptability in individuals is a considerable sign of mental health [9]. Addressing human mental health is of particular importance; because one of the goals of psychological research is to pay attention to the mental health of families, especially those who are injured. Studies have shown that individuals' mental health, well-being, and even physical health are affected by stress [3]. In addition, the mental health of society depends on the health of families. Because the family is the most important institution of society, on the other hand, one of the most important properties of mental health is adaptation [10, 11].
It is necessary to study acceptance and adaptation to loss and death, an important factor in the health of the individual and society, and examine people's experiences in a clear, comprehensive, and persuasive format. The martyrs' wives are a special group in society due to the valuable position of their husbands in the perspective of society, which may affect their coping with the situation. On the other hand, in most societies, the family man is the head of the family. However, those women who have taken on family responsibilities for reasons such as the death of their husbands are exposed to many vulnerabilities due to changing roles and increasing their responsibilities, and they often experience various psychological and physical injuries. The wives of the martyrs also have a spiritual responsibility, in addition to losing their husbands at a young age and subsequently creating new responsibilities, including parenting, providing living expenses, getting a widow label, and difficult conditions of remarriage. Because they are considered a representative of the martyrs and value the personality of the martyr while maintaining their dignity, according to society's expectations, these expectations put much psychological pressure on them, and they cannot mourn. In addition, the wives of the martyrs who defended the holy shrine have different conditions. Because the war against ISIS terrorist groups is a phenomenon that has happened in recent years, there is less awareness of the aims of the martyrs. The lack of awareness of the value of their action has had consequences for their families. In this regard, the results of Javidi research showed that the most problems of martyrs' wives are social issues such as the wrong looks of the people and their inappropriate treatment and dissatisfaction with the performance of the Martyr Foundation [12]. Such studies can increase the awareness of people and related organizations about the various problems of these women to consider better counseling services and remove the obstacles for their adaptability.
Since there is no qualitative research on the wives of the martyrs, who defended the holy shrine, the aim of this study was the identification of barriers of adaptability with spouse death in wives of martyrs in accordance with Iranian culture and to create a suitable information base in this field for future use in the field of mourning counseling and other services for this group.
Participants and Methods
This qualitative study was carried out on 12 wives of martyrs of the holy shrine defenders from December 2019 to June 2020. The maximum diversity sampling was used in this study. Purposeful sampling is the purposeful selection of research samples to access the desired information in a specific field, which provides the maximum possibility of answering the desired questions [13]. Women who were in the age range of 20-40 and who lost their husbands in the last 2-4 years and lived in Tehran were included in the study.
Data were collected by semi-structured interviews using open-ended questions. For this purpose, after receiving the necessary permits, the participants were first contacted, and the appointments were set if they agreed to participate in this study. At the beginning of the interview process, the researcher tried to create an informal environment by communicating and asking general questions. Conscious consent was obtained from all participants in the study, and it was committed that the information would be kept confidential, and the subjects could cancel the participation in any stage of the study. Researchers were obliged to follow the related ethics codes. After creating a suitable space for conversation, the interview began using general questions and was conducted based on the expressed experiences. The general questions were such the question which "what problems did you experience after the martyrdom of your spouse". The exploratory questions were asked to obtain in-depth information (for example, if the answer was: there are many problems and obstacles, the following question was: can you explain more?). The aims of the study were also explained to the subjects before starting the interviews. The duration of an interview was between 30 and 60 minutes. Finally, the interview process continued until information saturation. Saturation is the completion of codes, the lack of need to expanding codes, and failure to obtain new information and concepts that require new code [14].
Data were analyzed using the contractual qualitative content analysis method according to the steps specified by Granheim and Landman [15]. As one of the qualitative methods in the simplest form, the content analysis extracts the concepts from the studied text, and the concepts will be organized into regular categories. The content analysis method is based on the assumption that we can achieve the meanings, priorities, attitudes, ways of understanding, and word organizing by analyzing language messages [16]. Therefore, the content of each of the recorded interviews was implemented verbatim, and then the semantic unit, a summary of semantic units, and open-ended coding were conducted. In this way, the answers to the questions raised in the interview were considered a semantic unit, and the code was assigned to the summary of the semantic unit. A set of subcategories was obtained by comparing similar codes with each other, and a name was chosen for each subcategory according to the participants' statements. Finally, the subcategories were classified based on similarity and named properly.
Findings
The subjects' experiences were investigated (Table 1), and the obstacles to the adaptability of the martyrs' wives with spouse death were revealed by the categories. These barriers included eight categories and 23 subcategories (Table 2).
Table 1) Demographic characteristics of the subjects
Table 2) Barriers to adaptability with spouse death
Psychological instability
One of the important factors identifying obstacles to coping with the loss of a spouse in this group was psychological trauma, which was created after this incident and remained stable over time. In other words, these people have suffered from mental instability in coping issues that were not problematic for them before the death of their spouse, but now they create stress. Some of the subjects in this field were in the two subcategories: negative psychological changes and instability of spiritual feelings. "I feel like a veteran… I want to watch TV, but its sound is bothering me. The crowd is bothering me. I suffered a serious injury. I'm pretending to be fine. However, I'm not well. I am no longer that former person" (participant no. 4), stated one of the subjects.
Upsetting with the spouse's family
Among the issues, most participants mentioned the problems with the family of their ex-spouses. According to their statements, legal and financial issues after the death of a spouse, the interference of the spouse's family, and the lack of follow-up and support by the family of their spouses have been important issues, which was classified into subcategories, including harassment by the spouse's family and lack of support by the spouse's family. "The stress that his mother put on me was greater than the stress caused by the death of my husband. I never imagined that a mother who lost her child could easily cope with this issue and pursue material issues. She refers to the Martyr Foundation and expresses our problems, and tarnishes the honor of the martyr. It bothered me a lot more" (participant no. 10), stated one of the subjects.
Emotional emptiness of losing a spouse
The issue that involved the martyrs' views was the emotional emptiness despite the passing more than two years after the death of their spouses. According to the participants' statements, the factors that caused this feeling were divided into four subcategories: high dependency, difficulties enduring missing, difficulties accepting the loss of a spouse, and lack of inner happiness. "To be honest, I did not come to terms with the loss of my wife very soon. It is not easy to say that it is over, and the children and I are used to its absence. No! There is still not a night that I do not review his photos and memories. Nostalgia persists, even after nearly five years. I still post poems and clips for him. Many around me ridicule this and say stop this behavior after five years! But I like to write a poem for Mohammad," Said one of the subjects.
Children's problems
One of the barriers mentioned by the subjects who had children was the children's problems, which were created after the death of their spouses, and a young woman struggles to deal with them alone. Participants' statements in these cases were classified into three subcategories: psychological trauma, dealing with the loss of a father, and parenting problems. "Early in her father's death, she was afraid of losing me, saying that you should sleep with me. She held my hand until morning. She woke up quickly until I moved. It took at least three years for Mobina to deal with this problem. Now he has come to terms with the fact by writing her diary and problems for her father. Because I told her, your father sees and your father is always by your side. For example, in the Covoid pandemic, she wrote to her father, "Dad, can you help eradicate this disease?" I'm afraid of losing someone! This means that this fear is still there" (participant no. 12), said one of the subjects.
Feeling lonely
According to the statements of the subjects, the loss of a partner returns the person to the feeling before marriage and the absence of a companion, with the difference that this time the person has enjoyed the same path with her children. In addition, according to the statements, living alone in this position is more difficult than someone who is not married. Because before marriage, it was only her personal needs that she had to solve on her own; but now, in addition to the past, other needs and responsibilities are added. The factors mentioned by the subjects in this field were classified into three subcategories, including lack of companionship in life, responsibility fatigue, and lack of understanding by people. "Friends and family did not allow mourning and did not sympathize. Only they refer to people with the worse condition for healing. Indeed, everyone around me slowed down the process of coping. Some people could not bear my tears and mourning. Some people compared me to the divorced women in the family and always say you are happier, and a group constantly compared me to other widows and reminded my happiness with my ex-husband. Indeed their support had not helped me" (participant no. 9): Stated one of the participants.
Incorrect beliefs and behavior
One of the common obstacles, according to the statements of the subjects, as people's inappropriate behaviors with martyrs' families concerning misconceptions about the special benefits to which they are entitled; interference of others in their lives, and negative attitude towards the widow and finally, the different expectations of society from the martyr's wife. The items in this field were classified into dour subcategories, including society misconceptions about privileges belongs to martyrs families, negative attitude towards the widow, remarriage problems, and interference of others in their lives. "What bothered me after the death of my husband was people focusing on my life, every class of people, even religious people and devoted to the martyrs for compassion, ignorance, curiosity, or interference, and so on. Every martyr's wife has their own life; they determine the path of life according to their spirits. If anyone asks for help, she will ask for advice themselves. They want to know my life plan after the death of my husband. Older people want to know if I will remarry" (participant no. 1), said one of the participants.
Dissatisfaction with the performance of related organizations
One of the obstacles was abandonment or forgetfulness by organizations that can help solve problems for martyrs' families, especially their spouses. This issue was categorized into three subcategories: poor service delivery of the foundation of martyrs, inappropriate treatment of the foundation's officials, and lack of follow-up by related military units. "The services of the Martyr Foundation were not good at all. I had a problem in this area. Because my husband was the holy shrine defender as a volunteer, and we did not even have a salary until nine months after the martyrdom. We did not receive any income, and I spent this time with the money that my wife had invested, and in these five years, I only met with the families of the martyrs once, and they only asked me if I had a problem", (participant no. 10), expressed one of the subjects.
Emotional inhibition
Emotional inhibition can delay the mourning process for any reason. Lack of conditions and space to show emotions, refusal of mourning to prevent family discomfort were the factors that the subjects mentioned. This issue was classified into two categories: lack of expression of excitement to prevent family upset and spatial constraints for expression of excitement. "Sometimes I wanted to shout, cry ... but there was nowhere. It is easier for a man to express his emotions. I remember my father-in-law shouting in the street riding a motorcycle, and he expresses his excitement in this way. I was not an extrovert, maybe I was crying a little, I cried at night and alone" (Participant No. 2), expressed a subject.
Discussion
This study was carried out concerning the importance of a spouse's role in a person's life, the effects of losing him, and difficulties to adaptability with the loss of him. The findings indicate that various factors are effective to adaptability after the spouse's death. The findings confirm the results of previous research and, in some cases, complement them. As Mojahed et al. revealed, losing a spouse leads to depression and reduced life satisfaction and, in general, endanger their mental and physical health, but this decreases during 4-8 years after spouse death [3]. The findings of this study are somewhat similar to the present study in terms of the subcategory of negative psychological changes. However, this study does not address the spiritual instability, and only the dimensions of mental health such as life satisfaction and life expectancy, and grief of women have been considered. Kalantari et al., in their study, found that adaptability with spouse death is a part of the mourner person's daily life and can be seen in other aspects such as reading, watching TV, sleeping, and communicating with friends [17]. These findings follow the present study's findings in terms of negative psychological changes based on the subject's statements that they do not concentrate enough to watch TV and study their college courses, and they miss their spouse at night.
Regarding the subcategory of upsetting with the spouse's family, it can be said that one of the factors that are effective on the strength of the family foundation is the couple's inappropriate relationship with the spouse's family and relatives. The interference of the spouse's family, relatives, and friends is a very important factor in the collapse of the family center [18], which is consistent with the participants' experiences. According to the researcher, the spouse's family is one of the most important sources of support for the individual and can somehow compensate for the spouse's absence from his wife and the father for the children. Because the family is the first source of support for individuals and the mental premise is that family members are supportive and it is expected that in times of crisis, this support will not only be sustained, but also it will become stronger, in other words, the family will be a partner in grief and happiness. Therefore, if the expected role is not performed by the family and even causes hardship and harassment for them, the perception of individuals from the concept of family will be distorted, and emotional relationships between them will be severed [19]. As for the emotional emptiness of losing a spouse, according to Assyria and Hall, the stronger the marital relationship in the past, the more the loss of a spouse is felt [5]. This theme with various literature was also retrieved from the interviews and confirmed by the subjects. Because spouses provide support and emotional satisfaction for each other, it is natural that with the death of a spouse, the survivor loses her emotional refuge.
One of the barriers mentioned by participants in the problems of children. Ahmadi & Fathi Ashtiani addressed the psychological problems of the children of the martyrs. They showed that the father's absence (according to the child's age) could be problematic in creating personality immaturity, social relationships, behavioral disorders, and academic problems [20], and the results of this study can be considered in line with the present study.
Accordingly, the researcher's explanation concerning the theme of "children's problems" is that acceptance of the phenomenon of death, in general, has a complex and time-consuming process, and this will naturally be more difficult for young children. Because the concept of death is not understood by children up to three years old, they are not aware of the basic components of death, namely irreversibility and universality, and death means long sleep or a long journey for them. Because they lacked abstract perception and the father's absence and not seeing him by their side is considered to his complete absence. Therefore, it is more difficult for them to cope with their father's loss and its understanding even though they may not express feelings in this regard. They go through this issue in their minds repeatedly and show many unconscious reactions in the content of dreams or games, and because the mother is the only refuge for them, the fear of losing her is one of their most important concerns [21].
Another major barrier mentioned by the participants was feeling lonely after the spouse's death. According to Aghajanian in his study, the effects of widowhood in Iranian society are different for women; because one of the main features of the family system in Iran is to limit the role of women to family roles such as wife and mother. Therefore, most women do not have other responsibilities and roles as long as their husbands are alive. Therefore, the death of a husband is a crisis for women who are forced to assume new roles [22]. This finding is in accordance with the findings of this study in the responsibilities fatigue. It seems natural that most people who lose an important person feel somewhat helpless and find themselves in a disappointing situation. Because a spouse is a person with whom the relationship creates satisfaction and peace of mind for both parties, his absence will replace the negative emotions in the person. This factor causes a person to perceive that after his wife, those around him cannot understand his situation. This factor makes a person feel that after his wife, those around her cannot understand her situation and cannot help her solve problems because they consider a special position for their spouses and cannot find a replacement for them.
The findings of this study are in accordance with the previous studies concerning the content of people's beliefs and misconceptions. As Haeri found in her research, widows are considered a threat to other marriages and family centers. Also, due to the existing conditions, fewer of them remarry; because many cultural factors may prevent women from remarrying. For example, in Iranian culture, virginity is an important factor in choosing a spouse, which is one problem [23]. These findings follow the present study's findings regarding remarriage problems and negative attitudes toward widows. This kind of view has caused a person not to talk about being the wife of a martyr in many places to maintain peace of mind for himself and his children and to give up many of her reasonable demands and accept loneliness, disconnection of social relations, and numerous restrictions despite her desires.
One of the problematic factors in martyrs' wives is the weak performance of related organizations. The findings of Javidi's research [12] are in accordance with the present study in two parts: people's beliefs, misconceptions, and the weakness of the performance of related organizations. On the other hand, the results of the Behravan study show the positive effect of the supportive programs of the Martyr Foundation in reducing the main economic and physiological concerns of the veterans [24], which is inconsistent with the findings of the present study. In this area, it seems that the economic problems cause the person to feel the problem of losing a spouse, and consequently, she tries to solve the other problems, which ultimately hinders the process of coping with the loss of a spouse. Also, the findings show that the families of the martyrs consider the relevant organizations as a source of support. Therefore, if this expectation is not met, the impression will be created that the families of the martyrs have been neglected by the authorities, which has also caused anger and dissatisfaction among the participants.
Emotional inhibition is another factor mentioned by the participants. This can be explained by the fact that the martyrs' wives suppress their emotions due to social considerations. Finally, there is a disruption in the process of their adaptability; because feelings expression is necessary for mourning, and its refraining can lead to delayed mourning in the future, which will have devastating effects on the individual.
Conclusion
The families of the martyrs, who defended the holy shrine, especially their young wives, face individual and social problems that sometimes cannot be addressed alone, so it is necessary to take strategies to solve them. Obstacles can also be overcome by teaching problem-solving skills. This becomes possible by the support of families and professional counselors organizations and familiarity with their problems. These include helping with the mourning process, dealing with children without a father, new role-playing, and presence in the community.
Acknowledgments: The authors appreciate the cooperation of the martyrs' wives in advancing science and awareness.
Ethical Permissions: The study was approved by the ethics committee of the University of Rehabilitation Sciences and Social Health with the code of IR.USWR.REC.1399.156.
Conflicts of Interests: This article is retrieved from the master thesis of the first author.
Authors' Contribution: Sadri A. (First Author), Main Researcher (25%); Khanjani MS. (Second Author), Assistant Researcher/Discussion Writer (25%); Younesi J. (Third Author), Methodologist (25%); Nabati Saravani E. (Forth Author), Introduction Writer/Assistant Researcher (25%)
Funding/Support: The research has not received any financial support.
Keywords:
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