The interpersonal management of crying among survivors of stroke

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The interpersonalmanagement of crying amongsurvivors of strokeJohn F. Manzo a , Robin L. Heath b & Lee X.Blonder ca Department of Sociology , University ofToronto , 203 College Street, Toronto, Ontario,Canada , M5T 1P9 E-mail:b Department of Anthropology , University ofKentucky , Lexington, Kentucky, USAc Department of Behavioral Science , Universityof Kentucky , Lexington, Kentucky, USAPublished online: 30 Jul 2010.

To cite this article: John F. Manzo , Robin L. Heath & Lee X. Blonder(1998) The interpersonal management of crying among survivors of stroke,Sociological Spectrum: Mid-South Sociological Association, 18:2, 161-184, DOI:10.1080/02732173.1998.9982191

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THE INTERPERSONAL MANAGEMENT OF CRYINGAMONG SURVIVORS OF STROKE

JOHN F. MANZODepartment of Sociology, University of Toronto, Toronto,

Ontario, Canada

ROBIN L. HEATHDepartment of Anthropology, University of Kentucky,

Lexington, Kentucky, USA

LEE X. BLONDERDepartment of Behavioral Science, University of Kentucky,

Lexington, Kentucky, USA

This study concerns the social-interactional consequences of cryingamong survivors of stroke. The episodes of crying analyzed here tookplace during interviews including the patients, the patients' spouses, andan interviewer. This investigation innovates on past studies within thesociology of emotions by concentrating on the interpersonal dimension ofemotional displays of persons with brain damage. This study also con-tributes to research on stroke patients' "pathological crying" from the fieldof neuropsychology because it concentrates on the social, and not onlythe neurological or otherwise individual-level, nature of such crying. Wefirst present overviews of both the sociology of emotions and the neu-ropsychology of poststroke emotionalism and address how our study con-tributes to both fields. We then discuss our participants and method ofanalysis and finally present our findings with respect to the techniques ofthe management of crying exhibited by the stroke patients' interlocutorsas well as by the patients themselves.

This study concerns the social-interactional consequences ofcrying among survivors of stroke. Our focus in this investigation isdescriptive, and not causal or explanatory: We seek to expose tech-niques through which emotions are managed in social context.However, our understanding of the "management" of emotions dif-fers from that traditional in the sociology of emotions (cf. Hochschild

Received 10 August 1996; accepted 27 June 1997.This research was supported in part by Lee X. Blonder's National Institutes of

Health/National Institute of Neurological Disease and Stroke FIRST Grant NS29082 andNational Institute of Mental Health Training Grant MH15370 for John F. Manzo's postdoc-toral training. We thank research assistant Amy Kirkpatrick, the staff at Cardinal Hill Hospi-tal, and the individuals who participated in this study.

Address correspondence to John F. Manzo, Department of Sociology, University ofToronto, 203 College Street, Toronto, Ontario, Canada M5T 1P9. E-mail: [email protected]

SOCIOLOGICAL SPECTRUM, 18:161-184,1998Copyright © 1998 Taylor & Francis

0273-2173/98 $12.00+ .00 161

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162 J. F. MANZO ET AL.

1979) because our concern is with the sequelae of emotions, andnot how emotions are regulated according to emoters' larger socialroles. We address instances in which the social fabric is (or couldbe) disturbed by a participant's crying and examine how that fabricis "managed" in subsequent interactional moves among speakers.

The episodes of crying analyzed here took place in interviewsconsisting of stroke patients, the patients' spouses, and an inter-viewer. This investigation innovates on past studies within the soci-ology of emotions by concentrating on the interpersonal dimensionof emotional displays of persons with brain damage. This study alsosupplements research on stroke patients' "pathological crying"from the field of neuropsychology because it concentrates on thesocial, not only the neurological or otherwise individual level,nature of such crying. We first present overviews of both the soci-ology of emotions and the neuropsychology of poststroke emo-tionalism and address how our study contributes to both fields. Wethen discuss our participants and method of analysis and finallypresent our findings with respect to the techniques of the manage-ment of crying exhibited by the stroke patients' interlocutors aswell as the patients themselves.

SOCIOLOGY AND THE STUDYOF EMOTIONS

In the past decade, the study of emotions has emerged as a fer-tile subfield in sociology (for a comprehensive review, see Cuth-bertson-Johnson, Franks, and Dornan 1994). This development haspermitted sociologists to uncover the social character of phenom-ena that investigators in other fields had previously studied as indi-vidual level but that are now seen as appropriate for sociologicalanalysis. The perspective of sociology has similarly been brought totopics such as the production of narratives of personal experience(Manzo 1993) and even dreams (Fine and Fischer-Leighton 1993),which are construable as referencing social reality and as collec-tively interpretable. Emotions are thus part of the range of "private"experience that can be subject to sociological inquiry, and althoughwe accept the caveat that sociology can never provide the onlybasis for theoretical and empirical works on emotions (see Craib1995), sociology does provide an important strain in the study ofemotions, one that attends to previously neglected social aspects.

Reviews have defined the sociology of emotions as divided

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CRYING AND STROKE 163

into two orientations, the positivist and the constructivist, whichsee emotions as rooted in biology and in social experience, respec-tively (see Franks, 1987). We reject the labels positivist and con-structivist because they reference stereotypical caricatures that wehave not found to exist among real practitioners in the field. Ourreview of the literature suggests that no sociologists have everasserted the purely positivist (biological) view and that no sociolo-gists reject, in toto, the idea that emotions have (on at perhaps asuperficial level) a biological component. Thus, descriptions of thefield as divided along positivist and constructivist lines have failedto capture the state of the sociology of emotions.

We propose that there are indeed two camps in the sociologyof emotions. We see a divergence more accurately, however, asbetween those who emphasize the place of emotions in largersocial-structural context, an approach we label variable-analytic,and those who examine persons' interpretation of emotions ininterpersonal encounters, which we call the interactionist perspec-tive. The former approach views emotions as resources in designsof research that attend to "larger" sociological issues and the latterconstrues emotions as topics in their own right.

Variable-Analytic Approaches

Central to a "sociology" of emotions is the idea that emotionscan in fact be treated as social phenomena. One obviously "social"aspect of emotions is their distribution and experience among dif-ferent groups of persons, and so researchers have examined the rel-ative experience of emotions among persons in various social cat-egories. They have thus delineated emotion(s) as either adependent or an independent variable that is correlated with, orconsequential for, individuals' social-structural locations, includ-ing (but not limited to) their social class (Barbalet 1992; Correno1992; Rubin 1976), gender (Hochschild 1983; Lyman 1990; Peplauand Gordon 1985; Sprecher and Sedikides 1993), and age (Lin,Ensel, and Dean 1986). This orientation is paradigmatic of socio-logical variable analysis (Blumer 1956), which examines associa-tions among different variables or classes of variables, and forthat reason we see the label variable-analytic as most appropriateto define this approach. In these studies, analysts envision social-structural characteristics as factors that influence emotional expe-rience, or as conceptual anchors that delimit the analysis to emo-tional behavior experienced by a specific social category, such as

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men, women, working-class families, and so forth. This perspectiveconstrues emotions as resources for study: Variable-analyticresearchers use emotions to address the larger issue of differencesamong social groups. The variable-analytic approach does notstudy emotions as topics in their own right. The predominant alter-native perspective, the interactionist approach, does, however, top-icalize emotions as such.

Interactionist Approaches

The interactionist variety of analysis examines the production,interpretation, and discovery of the meaning of emotions by personsin the course of social encounters. It is an approach that "unpack-ages" the social work that inheres in emotional displays, work thatmuch of variable-analytic study takes for granted. For example,Johnson (1992:183) has proposed a symbolic-interactionist modelof the "emergence of the emotional self," using an approach thatmakes emotion a focus of analysis instead of using emotion as a re-source for larger social study. Consistent with this approach are the-oretical works by Collins (1986), Denzin (1984), and Harré (1986).

One theme common to each of these works is that emotionsare, in the first place, indeterminate biological phenomena that aredefined through processes of social learning. Humans learn toname their feelings, and their instruction takes place in processes ofsocial interaction. Thus, the interactionist approach holds that thereis a biological substrate of emotions, but that emotions are onlyunderstandable through an interpretive lattice that socializationprovides, a framework that varies with larger historical and culturalchange (McCarthy 1989). However, that biological substrate, evenwhere it is emphasized (see Franks 1987), remains undefined.

This study examines the social and interactional managementof crying among survivors of stroke. It is more closely allied withthe interactionist tradition than with the variable-analytic tradition,and it concerns a topic that has not yet been studied by sociolo-gists. Our study acknowledges thoroughly the biological (in thiscase, the neurological) substrate of emotions and examines specifictechniques through which these biologically grounded emotionaldisplays come to be understood. We ask how interactants (in ourstudy, the patient, her or his spouse, and an interviewer) collabora-tively interpret episodes of crying and render them sociallyaccountable or "normal."

We begin with a brief overview of past research on "emotion-

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alism" following stroke. We then discuss how we address this topicin a way that exposes its social aspect, and we finally present ourfindings and their implications for the sociology of emotions andfor the experience of stroke survivors and their significant others.

EMOTIONALISM AND STROKE

Previous Research

A British study using a probability sample of survivors of stroke(House et al. 1989) found that 20% experienced emotionalism, ora heightened tendency to laugh or (much more commonly) to cryfollowing their strokes. In their study of 30 stroke patients, Allman,Hope, and Fairburn (1992) found that participants reported between1 and 308 episodes of crying in the month before being interviewed.Participants also reported a tremendous range of social, affective,and cognitive events associated with the crying. Allman et al. (p.321 ) thus suggested that "cryingfollowing stroke can be seen to havea number of components each of which varies widely." Their studycalled into question the existence of a distinguishable condition,labeled pathological crying, of stroke survivors as defined by Poeck(1969). Allman et al. did not expose any unambiguous instance ofpathological crying; their observations suggested instead that thereis no unitary clinical phenomenon to warrant the label pathologicalcrying that denotes a specific, definable medical condition.

Although we find Allman et al. (1992) instructive in their dis-covery of poststroke crying as a complex topic, we would suggestthat it, and the study of poststroke emotionalism as a whole, wouldbenefit from direct observational study of crying as opposed toreliance on interviews that ask patients about their crying (see All-man et al. 1992; Robinson et al. 1993). Robinson et al., in con-structing a measurement scale for determining the presence ofpathological laughing or crying, relied not on the subjective expe-rience of the patients but rather on the ratings of interviewers andthe patients' caregivers. They did not examine crying directly. All-man et al. did observe 19 cases of patients crying in their interviewsbut described these cases only in terms of patients' facial expres-sions and the sounds they made while crying. Studies such as thesefail to attend to the social aspects of these emotional displays, espe-cially the observation of poststroke crying in social contexts. Thisstudy entails precisely this sort of examination.

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This Study

This study innovates on other sociological studies in severalways. First, although it treats emotion as socially organized, as havepast works, we do not attend to this social organization with defer-ence to "social structure." Instead, we are concerned with theendogenous social organization of emotion. In this report, our spe-cific concern was how persons party to episodes of crying by sur-vivors of stroke responded to it in order to render that crying inter-actionally seamless and "normal."

This study also innovates on past treatments of poststrokeemotionality. Whereas such studies have examined patients' cryingby either asking patients or their caregivers about the crying or,much more rarely, by observing patients' crying in isolation, we areinspecting instances of crying in asocial context. The following dis-cussion of our data and method clarifies the novelty of our data andour analytic approach.

DATA AND METHOD

Participants

Fourteen stroke survivors were interviewed in this investiga-tion. The participants included 7 right-hemisphere stroke patientsand 7 left-hemisphere stroke patients; none had experienced bilat-eral damage.1 Five were female. The average age of the inter-viewees at the time of stroke was 57, and their ages ranged from 34to 77 years. All interviews were conducted approximately 1 monthfollowing the stroke. All patients were married.

Interviews

The interviews were conducted, wherever possible, inpatients' homes to render the interview situation as comfortable,realistic, and spontaneous as possible. Spouses were present dur-

1Cenerally speaking, right-hemisphere strokes entail loss in or changes of affect(including the ability to comprehend humor) and changes in speech prosody, but not deficitsin vocabulary or any other linguistic deficits; left-hemisphere strokes are often associatedwith linguistic impairment. All types of stroke can result in wide ranges of physical disabil-ity. We could find no consistent pattern in our participants (and given the small size of oursample, such patterns could not be our concern) with respect to an association betweenstroke type or any sociodemographic characteristics and the phenomenon under investiga-tion in this article.

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¡ng all of the interviews. Each couple was interviewed approxi-mately 1, 6, and 18 months following the stroke. We have limitedour analysis to the first set of interviews only because patients aremore likely to experience heightened emotionalism soon afterstrokes and because as of this writing not all follow-up interviewshave been completed.

The interview schedule, which was composed specifically fora larger study concerning stroke and emotional expressivity, con-sisted of 22 open-ended questions. Some questions were directedto the patient, some to the spouse, and some to both. We have pro-vided the complete interview schedule in the Appendix. The ques-tions often pursued the topic of emotion (e.g., "tell me about a timewhen you felt sad"), and some were specifically intended (withvarying success) to elicit displays of emotion. Which questions"work" in this respect is highly variable, however, and we are notin this article evaluating the interviewer or the interview scheduleon that basis. We are instead reporting on what happened whencrying did occur, regardless of what elicited it.

Data and Investigative Approach

Data for this study consist of the videotapes and resulting ver-batim2 transcripts of the interviews. After the interviews were tran-scribed by support staff, John F. Manzo decided to treat crying, aprominent feature in several of the interviews, as this article's topic.Robin L. Heath then scrutinized each interview and each videotapeand extracted every instance of crying. Manzo examined the nat-ural history of each episode to determine how the patient and theirinteractants dealt with crying episodes. Our findings consist of dif-ferent varieties of management of the crying.

The investigative approach used in analyzing the data did notentail the development of a priori analytic frameworks. Theapproach is instead associated with that of conversation analysis,or CA (Heritage 1984:232ff). Analysis in CA is an inductive enter-prise in which the investigator uncovers patterns of talk that aresequential in nature. Doing CA entails considering speakers' turnsof talk in light of the accompanying talk and related activities ofother speakers, and it attempts to specify phenomena that are rele-

2Transcripts were verbatim except for names, geographical references, and otheridentifying information, all of which are represented with pseudonyms in the transcriptexcerpts to protect the privacy of the study participants.

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vant for and created by the speakers themselves. Because we wereinterested in how participants themselves managed emotional dis-plays, in real time, CA was the most appropriate approach becauseit highlights the speakers' organization of their activities, not, perother formal analytic techniques in social science, the categoriesimposed on the data by the analyst (p. 234). The topic of this arti-cle was discovered following scrutiny of all the data; it was notspecified beforehand in hypothetical terms. Instead, the data wereallowed to present themselves in multiple viewings and hearings,and what follows is one result of that examination.

FINDINGS

General Observations

Seven of the 14 stroke patients cried at least once during theinterviews. The number of crying episodes ranged from 1 to 15.Table 1 summarizes the number, average duration, and range ofduration of crying episodes for each of these 7 stroke survivors.These data suggest, first, that crying among persons who recentlysuffered a stroke is relatively common and, in the case of Patient18, recurrent. Second, the number of crying episodes and the dura-tion of these episodes are widely varied, and this observation sug-gests that poststroke crying resists categorization as a unitary phe-nomenon such as the term pathological crying suggests.

TABLE 1 Summary of crying episodes

Patient

16

11

13141718M

Sex

mfmmmff

NA

Age atstroke

7456775255405960.88

Site of

stroke

LHLHRHLHLHRHRHNA

Numberof cryingepisodes

162563

155.43

Average duration(m:ss:ss/100)

0:27:320:44:01 (SD = 0:21:10)0:34:16 (SO =0:02:83)1:05:42 (5D = 0:47:90)0:25:64 (SO =0:14:17)0:16:15 (SD =0:12:65)0:30:62 (50=0:19:33)0:35:50 (SD = 0:27:72)

Range

0:09:97-1:07:170:31:33-0:36:980:12:25-2:09:890:13:63-0:50:830:06:29-0:34:37

0:08:39-1:17:490:13:74-1:06:07

Note, m = male; f = female; RH = right hemisphere stroke; LH = left hemisphere stroke;

NA = not applicable.

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Analysis

We are, in this report, concerned with the sequelae of strokepatients' crying. We have uncovered a number of methods thatinteractants deploy after crying takes place, and each of theseresponses serves to "normalize" the episode. They are as follows:

1. Empathy from the spouse and/or the interviewer.2. Derision of the crying by the patient.3. Explanations and excuses from the interviewer.4. Biographical accounts from the patient or the spouse.

The first two might be termed emotional responses because theyare themselves infused with emotion. In addition are the next tworational (nonemotional) responses, which provide reasons, ac-counts, theories, and so forth that explain the immediately priorcrying episode. In the following section, we provide examples fromour data of each of these resources and discuss their unfolding.

Empathy

Empathy refers to a hearer's displayed capacity to feel, and toexpress, the same unhappy emotions produced by the speaker. Dis-playing empathy with stroke patients' crying helps to explicate thecrying as warranted by the patient's innate sadness and thus to nor-malize the crying as justifiable: To cry along with the patient (or toexpress why the patient would be crying on the basis of empatheticunderstanding, as in Excerpt 1 below) establishes the crying as nor-mal and explicable and as nonpathological. Excerpt 1 contains anexample of a spouse's deployment of empathy. In this and allexcerpts, / is the interviewer, Pthe stroke patient, and S the spouse.

EXCERPT 13

Patient 131 I: Tell me a little bit, if you can, about your marital2 relationship. How has the stroke affected it?3 P: Different.4 I: Different for you?

3We use a very simplified version of the transcription conventions used in CA in theseexcerpts. Text in double parentheses represents commentary on the part of the transcrip-tionist, colons represent sound stretches, and some dialogue is spelled phonetically toattempt to capture the dysfluency of some of the speakers.

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5 P: Uh huh. (starts to cry)6 I: It's different. Okay.7 S: And that's probably why he don't want to talk about it.

The patient began to cry after being asked about "the maritalrelationship" (Lines 1-2), which we interpreted as addressing theissue of the couple's sexual relationship, although the intervieweesmight have interpreted the question more broadly. In any case, onhis crying after assessing the relationship as different, the spouse'sresponse (Line 7) to the interviewer's restatement was "that's prob-ably why he don't want to talk about it." This statement signals aspecific interpretation on the part of the spouse in managing thepatient's crying. She did not address the crying as problematicitself. Instead, she expressed empathy and understanding concern-ing "why" he was crying: The "marital relationship" has changed,for the worse one must assume, and "he don't want to talk aboutit." Even though there is without question a neurological cause forhis crying (e.g., damage to his brain has caused him to be disin-hibited enough to permit him to cry), the account provided in thiscontext has nothing to do with neurological damage; it has to dowith the (justifiable) sorrow he feels about his marriage.

A clearer example of empathy produced by a spouse wouldbe in instances in which the spouse cried as well. Excerpt 2 con-tains an example of a spouse (Patient 18's husband) crying inresponse to the question concerning a time he "felt sad." Hisresponse references the stroke as something about which one cries,and in so doing he helps establish his wife's crying as justifiable.

EXCERPT 2Patient 181 I: How about a situation in which you felt sad.2 S: I felt very sad when she was in the hospital because I3 felt like I was going to lose her and the first three4 days she was very bad and I couldn't imagine living alone5 without Tonya, because we're so close and that made me6 very sad. But after three days she started to rally and7 then I gained, I felt a lot more hope that would have8 her because I couldn't think of going into retirement9 years without her. Now we're both going to cry. ((starts

10 to cry))

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In Excerpt 3, the spouse and the interviewer cry along with thepatient, which reinforces the notion that crying is warrantedbecause normal people engage in it as well:

EXCERPT 3Patient 141 I: . . . her mood? How would you describe (your wife's)2 mood, the last few weeks.3 P: Assists, assi- her mood has been s::: the accident toward4 mine, I can't peter the- don't she crying sometimes and5 that why I think, I think that she crying for me.6 ((patient starts to cry))7 I: She goes in her room and you think she's crying for you?8 Maybe she's just got a good soap opera on.9 P: No.

10 I: Maybe she's just watching Bambi ((laughs; patient11 stops crying)). Well, has she been supportive12 has she bitten your head off?13 P: Oh no no no.14 S: A few times, a few times=15 P: =no no no first time. She would be would=16 I: =so she's a good egg, huh.17 P: ((starts to cry)) yeah.18 I: Yeah. How would you describe your mood in the last few19 weeks? I think we all need a Kleenex, ((interviewer and20 spouse laugh while wiping their eyes))

One important feature of the strategic use of empathy is its ini-tiation by the spouse or some other hearer; one cannot empathizewith one's own emotions. The next technique of management is ini-tiated by the crier herself, and it entails the use of derision, of one'sself and of the crying.

Derision of the Crying

Patient 18, who cried in Excerpt 3, was a recurrent crier whoexpressed through a very moving narrative how her stroke affectedher well-being. A former musician, she could no longer teach orperform. This loss of agency and meaning in her life emerged fre-quently in the course of the interview. It is, perhaps, inevitablegiven her previously independent lifestyle that she uses a greatamount of self-derision in her talk, infused with anger and sadness

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at her new physical limitations and her sudden dependence on herspouse. Excerpt 4 contains a clear example of derision of her cry-ing as a tactic that only the patient herself may deploy:

EXCERPT 4Patient 181 I: Do you notice any changes in the way you feel about2 yourself?3 P: Yes, lower self-esteem, ((crying)).4 I: That's okay. Can you try and tell me about it or is it5 too painful to talk about?6 P: I hate it that I cry too much. I hate it.7 I: Did you use not to cry?8 P: Very little. Oh I thought I was pretty even temp- even9 tempered and a fairly happy person. So this bothers me.

10 I: So you don't think you're as happy person now as you11 were before?12 P: Not when I cry too easily. That upsets me. I would like13 not to do that.

The question that the interviewer issues in Lines 1-2 is espe-cially productive of emotional responses on the part of the patient.She responded with an emotionally infused reference to "lower self-esteem" in Line, 3, crying throughout her delivery ofthat response.Her reported loss of self-esteem could issue from a number ofcauses, and one might imagine that the more obvious physical man-ifestations of the stroke (in this patient's case, partial paralysis on oneside of her body, including facial paralysis) might account for sucha change. However, what bothers her most here is not any of thesemore salient physical problems, but the crying itself. This she clari-fies in subsequent turns of talk (Lines 6, 8-9, and 12-13).

Excessive poststroke emotionality is, presumably, disturbing,embarrassing, and disruptive for all survivors of stroke and thosewith whom they interact. The thesis of this report is that patientsand their interlocutors have a variety of ways of managing the cry-ing, to lessen its negative impact on interaction. Patient 18 was oneof the few participants in this sample to topicalize the crying itselfand to explain that she was not crying because she was sad; rather,she was sad because she was crying. In so doing, she helped to dis-tance herself from the crying as behavior that is not normal for herand that she acknowledges as abnormal behavior, and paradoxi-

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cally normalizes the crying by accounting explicitly for it as intru-sive and an unwanted feature of her poststroke existence.

Most of the techniques that we discovered do not treat the cry-ing as directly as did Patient 18. In the next excerpt the initiative fornormalizing a stroke survivor's crying is on the part of the inter-viewer. In this case, the interviewer implies two possible explana-tions for the crying, neither of which address the neurological aspectof it.

Explanation or Excuse

The previous four interview extracts illustrated techniquesused by the spouse and the patient herself in attending to cryingepisodes. This next category, which we call explanation or excuse,entails the interviewer offering a "candidate" explanation (i.e., anaccount proffered for acceptance or rejection by the other speak-ers) or sometimes a menu of explanations, for the crying episode;we saw one jocular example of this phenomenon in Excerpt 3,when the interviewer asked whether the patient's wife was "watch-ing Bambi." In Excerpt 5, the interviewer offered two candidateexplanations, one grounded in emotional considerations and theother based on physical reasons for crying, or for appearing to cry:

EXCERPT 5Patient 61 I: Were you at your mom's house when it happened?2 S: See, her mother had a stroke.3 I: That's right. Okay. Do you remember being at your mom's4 house now. Yeah? I know and Mom just died a while5 back. I know it's hard for you.6 P: ((begins to cry))7 I: Did you feel—got a Kleenex? How's your cold? How are8 your sinuses? Still bad? Still got the draining?9 P:Yeah.

In recounting the history of the patient's stroke, the inter-viewer asks the patient to confirm that she was at her mother'shouse when the stroke occurred and that this patient was, ironi-cally, caring for her stroke-afflicted mother when she had a strokeherself. After the patient's husband noted that his mother-in-lawhad had a stroke, the patient's expression becomes dour; she wason the verge of crying. In response, the interviewer references themother's recent demise and acknowledged that it must be "hard for

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you" (Lines 4-5). This utterance proffers an explanation for thepatient's forthcoming crying, one that is tied to the local conversa-tional topic (mother's stroke and subsequent death) and thus treatsthe crying, preemptively, as justifiable.

After the patient began to cry, the interviewer asked aboutproblems with her sinuses that seem to propose another explana-tion for the crying, or at least physical symptoms (such as nasalcongestion) associated with crying. This is another approach to nor-malizing the crying, one that attends to the possible associationbetween non-stroke-related physical problems (sinus congestion)and some of the biological components of crying. In her utterance,the interviewer managed to render the crying as neither pathologi-cal nor as solely relevant to the emotionally laden topic at hand:People blow their noses when they have excessive drainage fromtheir sinuses. In this excerpt, one can see how crying can beexplained, in minute conversational moves, by referencing emo-tional or (non-stroke-related) medical issues. The stroke itself neednot be an issue, as in Excerpt 5.

Biographical Accounts

Another method available to the crier and his or her interac-tants to explicate crying episodes is to present them as completelynonpathological by saying that the patient has always been a crieror to describe the patient more generally as a person who is sensi-tive, emotional, soft-hearted, and so forth. Excerpt 5 contains anexample of a spouse, and not the patient himself, providing bio-graphical information that accounts for the crying:

EXCERPT 6Patient 111 I: When do you become tearful?2 P: ((begins to cry))3 S: Tell it like it is. Ah, prayer. He's always been4 accustomed to the blessing and the prayers and so on.5 And this is a real part of his life. And uh so he uh and this6 has been uh I'd say Kevin the only difference in your7 uh personality and uh he's always been uh I said a very8 tender-hearted person.

The question preceding this instance of crying was "When doyou become tearful?" One cannot say conclusively that this ques-

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tion caused the outburst in Line 2, but it did help set up the spouse'sutterance in the balance of the excerpt as responsive to when thepatient "becomes tearful." Note that her answer addresses bio-graphical features of her husband that do not bear in any way onthe stroke but rather on his familiarity with "blessing and prayersand so on" (Line 4) and that she went on to describe her husbandas "very tender-hearted" (Lines 7-8). Tender-hearted people cry,especially when thinking about the blessings bestowed on themafter a stroke or other near-fatal event. The spouse helps to estab-lish her husband's crying as part of his normal behavior by dis-cussing his personal history surrounding emotions.

The Absence of "Clinical" Accounts

Of course, one ready-made account for crying is for patient,spouse, or interviewer to say something such as "The doctor saysthat crying is normal." Significantly, this type of account neveremerged in our interviews. The only instance in which the idea ofclinical pathological crying was mentioned is when Patient 18'shusband invoked the concept specifically to note that his wife isnot suffering from it but rather exhibiting emotions that are rational:

EXCERPT 7Patient 181 S: . . . She cries frequently but it's not uh as a psychiatrist2 that we have seen says she's not really clinically de-3 pressed, it's just that she responds in a normal, de-4 pressive reaction to events and occurrences and it's very5 appropriate I feel in most instances when she cries that6 it's something either the symphony playing or attend7 a symphony concert or she sees some of her violin or8 hears some of her violin students performing and she's9 aware that she cannot do some of the things she did

10 before. She responds sadly to these things. But it's not11 as I have heard some stroke patients do where they will12 cry very inappropriately or laugh inappropriately their13 emotions are extremely label or labile and I have not14 found that with her.

It is a matter of speculation as to why there are no instances ofpatient, spouse, or interviewer explicitly denoting pathological cry-ing as the reason for a patient's emotional displays. Even Patient 18,

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who, along with her husband, expressed some facility with neuro-logical terms (as with her husband's use of labile in Line 13 of theprevious excerpt and in another unexcerpted part of the interviewwhere the patient referred to her own "flat affect" in speaking)refused to account for the crying as a straightforward result of braindamage. It appears likely, on the basis of our sample here, that allstroke patients and those with whom they communicate will steeraway from that explanation. Our findings suggest the breadth oftechniques that are available to obviate references to the stroke as"causing" their crying.

CONCLUSIONS

Although the sample of stroke survivors interviewed for thisresearch project was small, we feel our findings are broadlyinstructive for the study of poststroke crying as well as the sociol-ogy of emotions and also more general sociological issues.

First, this article is an illustration of how the meaning of emo-tional displays needs to be defined in social context. Among theepisodes of crying analyzed here, the meaning of crying is neverobvious but is treated as meaningful through subsequent interac-tional practices. Furthermore, the episodes of crying we observedwere neither random nor pathological. They were in every instancecontextually tied, but they were made contextual in conversationalmoves. This study demonstrates how this clarifying, "contextualiz-ing" work is done in specific, studiable, concerted activity on thepart of the stroke survivor and the persons with whom he or sheinteracts. This finding shows that studies of poststroke emotionality,as well as emotions generally, should be conducted while recog-nizing that emotions are part of sociality. Even among people withbrain damage, emotions should be studied as features of socialinteraction and as subject to social definition.

This study addresses two more general sociological themes.The first of these concerns social responses to deviance. F"atholog-ical crying is a kind of residual deviance (Scheff 1984); that cate-gory refers to nonnormative, seemingly random acts that aredefined, and interpreted, by onlookers only after the acts have beencommitted. For example, bizarre behavior, regardless of its clinicalpathology or any other official explanation, often comes to belabeled as symptomatic of mental illness, but this definition, thissense-making, of the behavior is only decided on after the act has

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taken place. Residual deviance is not, strictly, rule breaking, assuch deviance is usually defined, because the rules that residualdeviants break are tacit and undefined. Onlookers and interlocu-tors manage residual deviance by naming it and thus accountingfor it.

Managing stroke patients' crying, crying that often has noclear empirical or contextual cause, requires responses on the partof the persons interacting with the stroke patient as well as on thepart of the patient her- or himself. This investigation suggests thatmanaging stroke patients' emotions is not a matter of controllingtheir emotions, and this finding militates against the idea that emo-tional management (cf. Hochschild 1979) is (only) an aspect ofcoercive social control, whether on the interpersonal or social-structural level. We see emotional management more as anapproach to the accommodation of behaviors that can disturb thestream of social interaction. This study has uncovered several tech-niques through which the disruptive, deviant, or simply atypical isrendered normal and explicable.

A final sociological issue addressed here concerns the topic ofmeaning and its discovery and construction among persons insocial interaction. We agree with Palmer (1991), who suggestedthat the process of ascribing meaning often entails ascribing emo-tions. For example, persons often describe inanimate objects asexpressing emotions; they describe the sky as angry, the sea ascalm, and so forth. Palmer examined anthropomorphism, espe-cially the use of emotional labels with pets, and the processthrough which nurses ascribe emotions to (human) neonates at anintensive care facility. Palmer cited nurses as saying that a baby was"angry at me" and that babies "miss me when I am away" (p. 223).In both of these examples, the interpretation and naming of emo-tions is the task of observers, not the entity (human, nonhuman, orinanimate) to which the emotion is ascribed. In our study, we founda similar process of ascription of emotions, and we also maintainthat the interactants were making meaning by asserting the truecharacter of behavior that might remain undefined or bizarre. Webelieve that we contribute to Palmer (1991) in two ways: first, bydiscovering that the task of interpreting emotional displays is some-times assumed by the person producing them, even to the extentthat it entails statements that are highly self-effacing, and second,by analyzing the specific interactional moves and strategies that gointo the process of constructing meaning. We have, in sum,

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addressed some examples of the social construction of emotionsand have demonstrated how this process emerges in real time.

APPENDIX: INTERVIEW SCHEDULE

Introduction: I am going to be asking you some questions. Some ofthese will be directed to the patient [acknowledge with Mr. X orMrs. X] and some to the spouse [acknowledge with Mr. X or Mrs.XJ.Then there will be some questions that I would like both of youto answer. Any questions?** Q1 in Initial Interview Only **

1. To patient: Can you tell me a little bit about the history ofyour illness? When did it begin? What were the symptoms?What do you think caused your illness? What other thingswere happening in your life when this problem began?

To spouse: Do you agree with that? What do you thinkcaused your spouse's illness?

2. To patient: Please tell us a little bit about how you have beenfeeling since the stroke/surgery/injury

[Initial] in the past few weeks.

[6 months] in the months since you came home from thehospital.

[18 months] in the last year since our 6-month interview.

Probes: What kinds of problems or symptoms areyou having? Where do you feel ill?

Further probes: Let me ask you some specific ques-tions.

Have you noticed any changes in the way you look?Have you noticed any changes in your ability to getaround?Have you noticed any changes in the way you com-municate?

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Have you noticed any changes in the way you feelabout yourself?Have you noticed any changes in your mood?Have you noticed any changes in your memory?How have others acted toward you since thestroke/surgery/injury? Are they sympathetic or sup-portive? Do they ask questions? Do they feel uncom-fortable?

3. To spouse: In your opinion, what kinds of problems orsymptoms have you noticed

[Initial] in conjunction with the stroke/surgery/injury?

[6 months] since s/he came home from the hospital?

[18 months] since our 6-month interview?

Probes:

Have you noticed any changes in the way s/he looks?Have you noticed any changes in her/his ability toget around?Have you noticed any changes in the way s/he com-municates?Have you noticed any changes in the way s/he feelsabout her/himself?Have you noticed any changes in her/his mood?Have you noticed any changes in her/his memory?How have others acted toward her/him since thestroke/injury/surgery? Are they sympathetic or sup-portive? Do they ask questions? Do they feel uncom-fortable?

4. To patient: What kinds of problems has your illness causedyour spouse?

To spouse: What kinds of problems has your spouse's illnesscaused you?

5. To patient and spouse: What kinds of things do the two ofyou do in response to this illness? What kinds of adjustmentshave you made?

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6. To patient: How would you describe your mood in the[Initial] last few weeks since your stroke/surgery/injury?

[6 months] months since your stroke/surgery/injury?

[18 months] year since our 6-month interview?

7. To spouse: How would you describe your spouse's mood inthe

[Initial] last few weeks since her/his stroke/surgery/injury?

[6 months] months since her/his stroke/surgery/injury?

[18 months] year since our 6-month interview?

8. To patient and spouse: Tell me a little about your maritalrelationship.

Probes:

How has the stroke/surgery/injury affected it?Do you feel as if your spouse understands you?What things do you disagree about?What things do you agree about?Are there times when you find your spouse's behav-ior difficult to tolerate?

9. To patient and spouse: How would you describe your per-sonalities?

Probe: What type of people are you?

10. To patient and spouse: What kinds of things do you enjoydoing together?

11. To patient and spouse: How often do you see friends andrelatives? Is that something you enjoy?

12. To patient and spouse: Can you tell me how you spent yourmost recent holiday [or birthday, Christmas, Easter, Thanks-giving, 4th of July, wedding anniversary, New Year's, etc.]

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**Take a short break**

13. To patient: Can you tell us about a situation in which you feltvery happy?

Probes: What happened? Where? Who was in-volved? What were your specific reactions?

14. To patient: Can you tell us about a situation in which you feltvery sad?


15. To patient: Can you tell us about a situation in which you feltvery angry?


16. To patient: Can you tell us about a situation in which you feltvery frightened?


17. To spouse: Can you tell us about a situation in which you feltvery happy?


18. To spouse: Can you tell us about a situation in which you feltvery sad?


19. To spouse: Can you tell us about a situation in which you feltvery angry?


20. To spouse: Can you tell us about a situation in which you feltvery frightened?

Probes: What happened? Where? Who was involves?What were your specific reactions?

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21. To patient and spouse: Is there anything else you would liketo tell us about yourself or your feelings that we haven't dis-cussed?

22. To patient and spouse: Where do you think you will be 6months from now? A year from now?

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Documents

The interpersonal management of crying among survivors of stroke