LOSING A BROTHER UNTIL ADOLESCENCE: EXPERIENCE IN ADULT LIFE

Objetivo: descrever a experiencia de perder um irmao durante a infância e a adolescencia, o seu significado para a vida adulta e identificar as implicacoes para assistencia no âmbito da saude, em particular para a enfermagem. Metodos: estudo fenomenologico de natureza interpretativa, no qual participaram vinte e uma pessoas da comunidade, selecionadas intencionalmente, respeitando criterios previamente estabelecidos. Para a colheita da informacao foram realizadas entrevistas nao-estruturadas e necessariamente em profundidade. Resultados : O fenomeno revelou-se pela narrativa das participantes atraves de cinco temas comuns que foram denominados: “Ecos da vivencia do luto fraterno”; “A procura de uma justificacao”; “A felicidade e momentos!”; “Fontes de forca interior” e “A vida e a saude hoje”. Conclusoes: a vivencia de um processo de luto fraterno durante a infância ou adolescencia moldou a vida dos participantes, especificamente os comportamentos face as suas relacoes e, mais tarde, o significado atribuido a saude. Reconhece-se a importância na identificacao dos sinais e das carateristicas de uma perda fraterna experienciada durante a infância ou adolescencia, e da avaliacao do impacto da mesma na sua vida e das suas familias, que podem fundamentar uma intervencao de enfermagem planeada com vista a minimizar os efeitos que possam surgir na vida adulta. Identifica-se o impacto da morte da crianca na vida dos irmaos e de outros conviventes e o modelo de intervencao que aborda necessariamente a relacao de ajuda a familia enlutada, de forma integrada.

The child / adolescent is confronted when he loses someone significant, like a brother, with a whirlwind of feelings and emotions hitherto probably unknown -mourning. Mourning is not an event; it is a process of responding to a significant loss that, although it may not be linear, is necessary and it is by means of which the person assimilates the reality of the loss and discovers a way of living without the physical presence of the beloved person. It is known that, therefore, and despite being a difficult topic to address, children / adolescents in fraternal grief deserve particular attention. Nurses are perhaps the health professionals closest to the child and family because they are in a unique position to identify families with children or young people who have suffered a loss and who need help and specific interventions. Throughout his / her life, the child / adolescent crosses with the nurses in many situations (school, routine visits, health center, vaccination, urgency or hospitalization), and it is very important to be awake to recognize the impact of the loss of a brother identifying the signs. The death of the brother may have occurred some time ago, but it is necessary to be attentive and know the history of each child, each adolescent, each family. The experience of losing a sibling during childhood or adolescence brings repercussions in life and can continue to be reflected throughout his life.
• To describe the experience of losing a sibling during childhood and adolescence.
A phenomenological and interpretative study was carried out11 with the research question: How is the experience of losing a sibling in childhood or adolescence described and what is the meaning attributed to him in adult life? Since significant encounters were sought with people directly related to the phenomenon under study, participants were intentionally selected. People in the social circle of the researchers were asked to indicate individuals in their relationships who effectively met the following inclusion criteria: be 18 years of age or older; having suffered the death of a brother during childhood or adolescence; be able to verbally express and accept to participate in the study. Twenty-one women, aged between eighteen and seventy-nine, participated in the study and experienced a fraternal loss during their childhood or adolescence (between the ages of four and nineteen), and the attributed cause was varied: road accident; drowning; medical negligence; suicide and sudden or prolonged illness. People were contacted by telephone and, after the first approach, the validation of the established inclusion criteria was validated, the study objective was clarified, any doubts were clarified and the interview was scheduled for the following days whenever that was possible. Because the study population consists of only women, who were given a fictitious name. It was requested again the indication of individuals that fulfilled the included inclusion criteria, but, this time, that they were only men. Until November 2016, there were seven contacts with males, who are now adults but who lost a brother during their childhood or adolescence. All refused to participate in the study.
The information was collected through indepth, unstructured interviews conducted between June 2014 and September 2015, following the approval of the Health Ethics Committee of the Lisbon and Vale do Tejo Health Administration -Reference 4019 / CES / 2015 -opinion Proc. 013 / CES / INV / 2015. Each participant was also asked for their voluntary and informed consent in the form of a written document. Each interview was recorded on audio support and transcribed for narrative text. The analysis of information was initiated at the time of collection, by listening to meanings and attributing meaning to the voice of the people, and continued during the elaboration of the verbatins. In this way, information has been immersed and the singular has been identified in each people's life experience until one can understand the phenomenon in question. Significant statements were identified and extracted that were transcribed into sheets to facilitate the next phase, which consisted in apprehending the essential relationships between the statements and the preparation of a comprehensive and exhaustive final description of the phenomenon.
The literature was reviewed for the discussion of the information, after the analysis of the phenomena under study, in order to obtain a description of the same free of preconceived ideas.
Through the narrative of the participants, the experience of a fraternal loss until adolescence and the meaning attributed to it in adult life were revealed through a structure composed of five themes, all interconnected: (1) Echoes of the experience of the fraternal mourning; (2) Seeking justification; (3) Happiness is moments !; (4) Sources of inner strength and (5)

Echoes of the experience of fraternal mourning
It can be seen that the experience of the loss of a sibling during childhood or adolescence definitely has repercussions on the brothers' lives and also on their relationship with others and can continue to be reflected throughout their lives. Faced with this unforgettable loss for parents and the rest of the family, older siblings tend to take on more responsibility, sometimes with the need to drop out of school and start early to contribute to the family economy, revealing their childhood and / or stolen youth to take care of the family. On the other hand, very close bonds are often created with younger siblings fostering almost more maternal rather than fraternal bonds. In fact, it is not easy to accept this death and may even be a lengthy process.
My sister ... has also suffered a lot over the years because my sister has to take care of me and take care of her mother and father, she was thirteen years old, she was a child and they demanded a lot from her. ( It is revealed that in the family, sometimes also comparisons of the parents and / or family with the brothers who have lost. These parallels, which still remain in the voice of some people, and the allusion to the child or young man who died as perfect or holy, hurt and sometimes contribute to the feeling of inferiority. It is possible that, after the brothers' departure at a certain point in their lives, people may fear not meeting the expectations of others in the role of substitution for all that is implied here, and especially if their personality is not at all comparable to that of the brother who died. It is evidenced that living the death of a brother during childhood or adolescence is something that will hardly be forgotten. The brothers who designate this event as a mark that was left to them for life, which has sifted through childhood, adolescence and now, as adults, is still present, often restricting their daily life. People's lives may be limited not only by their own depressive processes (which may or may not be present) but also by fears, often without any foundation. Living life apprehensively, insecurely, perhaps with a few panics, can eventually lead to the (almost) permanent need to do introspection, self-analysis, a continual search for better understanding of the pursuit of happiness. These phobias may be related to situations in which people have no control over them, and sometimes the memories are so painful that they are as if they are eliminated from memory. Fears, phobias, panics that rob them of their autonomy and make people dependent on others. It is noted that the love that a father or mother has for their own children is so great that it is not possible to measure or quantify, and the same can be said about the fear of losing them. And the idea of this possibility is always present: the memory of the suffering of their parents is often above the desire to play a maternal or paternal role. Fear of loss can be directly related to the difficulties that may eventually arise in the relationship with others, often mirrored in the insecurity at the level of affection, trust in others. In fact, this fear of losing someone significant again is so deeply rooted in the hearts of people that it is an emotionally limiting factor in the building of affective bonds, even with their own children. It is emphasized that people are the fruit of their past, their experience, the family in which they grew up and the relationships that were built here. In a situation of great suffering, sharing with the peers the burden of inner hurt is central to emotional balance, especially if they are talking about a child or teenager. But if the family itself closes itself and blames the closeness and contact with those who are foreign to the nucleus, it will be particularly difficult to create such ties. Later, people complain that they have not cultivated these relations of friendship and realize not only that in the face of adversity of life it is manifestly difficult to feel comforted without any support, but also to realize that it is difficult for them to change this way of being.

Looking for a justification
It should be noted that regardless of the cause of the brother's death, people tend to seek justification, to identify the guilty or to blame, although finding an explanation is always difficult, especially if it is a child or a young person. The lack of knowledge of the cause of the brothers' death is another factor that may be related to fraternal grieving, especially if the brothers who suffered the loss are small. The lack of communication in the family contributes, in part, to the feeling of exclusion of the same. It is understood that death, as a rule, is not a simple situation and suicides are always complex situations for witnesses and for those who remain. They are remembered by the brothers as something announced, but which they themselves never believed. Although they are not able to recognize it explicitly, they realize that there is a sense of guilt that they did not perceive their brother's message. But when this doubt persists, when there is no certainty of what actually precipitated death, people seem to be unable to calm down, which conditions, in a certain way, the experience of their mourning. The echoes of the attitudes of each one of those who have a relationship to two can be intensified, be it a marriage, when a serious problem arises like the death of a child. In the wake of parents 'emotional outbursts, it is possible for people to take some responsibility for their brothers' death, which is later reflected directly in their own grieving process.

Happiness is Moments!
It is believed that people with a childhood and / or adolescence marked by the experience of a fraternal mourning are able to find happiness, even if only for moments. Life happens, has to continue and time heals everything are expressions that reveal some individual strategies eventually used in the process of fraternal mourning. People recognize that the period after the brothers' deaths is undoubtedly a very troubled time and they strive to overcome it. Each, in its own way, seeks the impulse, the strength necessary to react to pain, sorrow, loneliness. It is added that the departed brothers remain alive in the memory, but the hearts end up being able to calm even if after some time. Overcoming the loss of a sibling is difficult. One learns to live with lack, with nostalgia, with pain and with grief, although one knows that everything passes, and that time is always a valuable ally in this process, and people keep in mind that troubled period.

-Internal power sources
Resilience and courage are characterized, though in part, by the way in which some people view the period following the loss of a sibling, namely whether this time is experienced during childhood or adolescence. People take refuge in their faith, belief, their religious practice and believe that everything will pass. Some also know, or feel, that the brothers who have lost in a certain way have made a difference in the lives of some people and who still continue to occupy a significant place in their lives. In fact, as they drink from these sources of inner strength, feel the presence of the brothers who have already departed and find some consolation in their memory, they can attribute meaning to this experience. Through the adversities with which life sometimes surprises them, people's faith is put to the test. In the face of the pain of losing a child, this faith, which thought itself strong, tenacious, unbreakable, sometimes gives way to sadness, anger, discouragement. It is described that faith, trust in God, is one of the strategies that some people use to be able to deal with the loss of the brothers, affirming that it is in Him that they find strength, support, safe harbor and it is through this faith that try to rediscover the path, strength and hope, making this attitude an example for other brothers. Even though there may have been periods of disappointment, of revolt, there are people who, despite the suffering experienced with the loss of a brother, recognize that they never completely left their lap, their embrace, their warmth. It almost seems that your faith came out strengthened by this ordeal.

Life and health today
It is considered that the perspective of life and health today, for people who lost a brother during their childhood or adolescence, seems to be related to fraternal mourning, although it is known that this period of mourning is essential to re-encounter with stability and emotional harmony. Living, knowing, and understanding the experience of each person's fraternal grief all contribute to a particular vision of what, in fact, means health now in adult life, of which it is important to value. People who have experienced fraternal grief during their childhood or adolescence and who are carriers of a chronic illness refer to taking care of themselves and being aware of the symptoms that can arise in order to live with quality for many, many years.

From an early age, I have learned to deal with the symptoms and I know when I am not well and I know how to stop if I have to. So I do not think that's limiting. (...). I also do not let walk, I do not make a drama, but I also do not let things go. And ready! (Constança)
It is understood that, as a result of the experience with the siblings, some people recognize that they feel insecure about the health aspects of their own children or a close and significant family, especially if it recalls the events that precipitated the death of the children. brothers. They can not, at all, rule out the likelihood that something similar might happen to theirs, and so they live in permanent anxiety and distress. This lack of confidence, this fear, this need to be continuously vigilant, to keep control of everything and everyone, brings them much anxiety and anxiety, not allowing them to be with their own and enjoy their company. It is known that the lived experience of losing a brother during childhood or adolescence tends to resonate in the life of each person, in the relationships that he establishes with himself, with others and with the world. From the analysis of the narratives, the meanings attributed by the people to the experience of experiencing a process of fraternal mourning until adolescence and the meaning attributed to them in adult life, emerged through an essential structure translated by five components: Living the loss of a brother -paths; Grow with parents in mourning; Integrate loss into life; Life fosters the demand for meaning; Losing a brother and Meaning attributed to health.

• Experience the Loss of a Brother -Paths
It is noteworthy that the loss of a sibling during childhood or adolescence echoes in people's lives, often deafeningly. In others, in a discreet and gradual way, almost imperceptible, but, in any case, it is always felt. The death of a loved one, significant, always implies a later period of adjustment, of mourning, and this is a normal and necessary process to rediscover the inner balance. [3][4][5] The relation between siblings is perhaps the most significant and lasting relation that if you live The child, who loses a brother during his or her childhood or adolescence, is naturally the family member who lives the most time with this loss. 2,[6][7]30 It is explained that in the situation where there is a child / adolescent with a complex chronic life-limiting illness, which may even be prolonged for some time and which is understandably the center of care for the whole family, the brother resents for lack of equal attention, 9,24 loses visibility within his own family, 10,28 sometimes receiving messages from close friends to restrain his hurt, to be strong by his parents. These behaviors lead the child to feel that the pain of their loss is discredited, devalued, misunderstood, ignored. 21 21 Here, pediatric palliative care plays a key role in supporting the child / adolescent with a complex chronic life-limiting illness as well as support for the family, including siblings and grandparents, including during the mourning period, that the care plan must be individualized, always focused on the childfamily, prepared in a holistic, proactive, flexible and transversal way to all the services and structures involved. In assessing needs and care delivery, siblings should not be forgotten, as should all family caregivers. 16 The diagnosis or recognition of a chronic and complex disease in children or adolescents does not only affect each individual element, but it has an impact on the family as a unit, as evidenced by the analysis of the interviews of this study.

• Grow with parents in mourning
It is important to highlight how parents live their work of parental grieving, influencing the process of brotherly mourning of other children, 12,27 especially mothers. 15 And this fact was made clear in the interviews of the study when people made reference to the relationship with their own parents also immersed in an absurd sadness and pain.
Some participants are the reflection of putting themselves at the margin of the family, of not being able to continue being an integral part of the family since the death of their brother. Plunged into the sadness of loss, the family often has no notion of how such a condition disturbs these brethren. There must be openness in the family to share feelings and ventilate emotions. The inclusion of the child / adolescent in the family mourning is fundamental not only for his adaptation to the loss lived in that moment but also, to all the losses that he will experience in the future.
Remember that sometimes alcohol and physical violence, depression or aggressiveness versus passivity, or conflicts in family relationships are like an escape, as a therapy for that wound that stubbornly fails to heal. It is not an easy task to live with the loss of a child, but often, and as some participants have pointed out, parents sink into their own mourning and forget about the other tasks inherent in their parental role: other children. And these other children have to replace them in that role they are not able to performcaring for other siblings, taking care of the house, taking care of the family business, leaving the house to work for the family economy -and perhaps losing their place in the family and this will never be forgotten.
It is believed that the loss of a child alters the family 25 and the relationship between parents and siblings by the fact that the mourning lived is not only for the loss of the brother's identity, 20 but also for the relationship lost with his parents. 2,10,12, Many people often try hard to find the support and support they have lost with the death of their brothers. This uneasiness, of regaining the emotional equilibrium of once, of erasing the pain of loss, of loneliness, sometimes leads to many decisions of life being governed by these aspects.
With the loss of a brother, others who stay or strive to make themselves present sometimes adopt some behaviors and attitudes of opposition and challenge, breaking rules or, on the other hand, adjust their personality and try not to disillusion parents by engaging in school performance and shaping their behavior as an example.

• Integrating loss in life
It is noted that children or adolescents who experience a fraternal grieving process find it difficult to express their emotions, appearing to them that such a demonstration is not important to anyone, fearing to speak with their parents so as not to sadden them even more and sometimes , these feelings can lead to social isolation, school drop-out, and poor school performance. 22 The basic training of educators and teachers should provide a foundation to help grieving children and adolescents and to understand how the process actually unfolds of mourning in a child or adolescent, who is not necessarily the same as the adult and does not always benefit from the same kind of help. For children or adolescents, school is often their refuge, a free place, unhindered by sorrows and sorrows, where they find support. Thus, the school has a very important task in supporting these children and young people, as well as in the detection of situations that can lead to social isolation and the difficulty in dealing with and overcoming the problems inherent in family dynamics. 11 It becomes, despite being a difficult time, essential to hear and respond honestly to their questions. 1,4 The loss of a brother is a mark in people's lives. In fact, with this death, everything changes, in particular the dynamics of the family that, in some situations, ceases to be a home, a place of refuge, of love. Accepting the loss of a brother may take a while, but also talking about this grieving process, remembering the emotions and experiences of that period, talking and sharing those feelings with others can be difficult. There is a certain tendency for people to close their shells and fear trusting relationships based solely on friendship. But there is an emotional conflict, an ambivalence between wanting to be alone and the fear of your own loneliness.
It is revealed that family and social dynamics are complex and suffer the interference of stressors and the impact of the loss of a child / adolescent. It is important to consider the impact of death on the whole family system, since the most significant losses occur in the context of a family unit. 9 For people who have lived fraternal mourning, their parents' of a child has been and continues to be fundamental. 15 Being able to continue to face life even though sometimes it is not possible to share the subject, because it is very difficult and painful, mood to proceed.
It is observed that the relationship between the siblings significantly influences the development of each one at the level of social as well as emotional relations. Thus, living the loss of a brother during childhood or adolescence also echoes the other fraternal relationships that remain with grief for all that they could not live to take care of others or, on the other hand, the intensity and depth of the bonds fraternal who are raised from there, assuming a protective position, bearing and supporting each other. But, on the other hand, there are less positive experiences whose attachment to the brothers has deteriorated and where, surely, the trigger point of this acrimony was exactly the experience of a fraternal loss during his adolescence. Some studies 8,14,21,28 show that, in the long run, surviving siblings may still feel guilty, high vulnerability, anxiety, fear of dying prematurely, excessive concern with others, especially with regard to their own children. 18 It is evidenced, through the results of investigations, 6,30 fraternal grieving as a period of vulnerability and an important focus of attention for the accompaniment of the people who live this experience. They also underline the relevance to public awareness of the importance of developing support structures for bereaved people.
It is also proven by analysis that, in fact, it is not only the depressive processes that can guide and regulate people's lives. Fears, insecurities, situations in which people can not at all have direct control over them make them dependent on others. The fear that the story is narrated again destroys dreams once built and the memory of their parents' suffering sometimes outweighs the desire to play a maternal or paternal role. The panic of being able to lose a child forces people, albeit perhaps unconsciously, to exercise tight control over it. On the other hand, and in the wake of this idea, difficulties may arise in trust and in relationship with others, translated by the insecurity of affections.

• Life fosters the requirement of a sense
It is reported that through this experience of fraternal grief, some people who participated in this study discovered how to turn pain and suffering into inspiration for their own lives, growing and maturing. And it is on these occasions that life is sometimes put into perspective, especially when one experiences a profoundly significant loss, like that of a brother with whom a strong and intimate relationship has been built. In an attempt to escape the family environment drenched in tears and sadness, some people leave in search of something that is their refuge sometimes getting surprised by the discovery of gifts.
It is inferred that brothers stolen by death are still alive in memory, but time turns out to be complicit in overcoming the displeasure of that loss. And this keep alive in the memory allows the people that the brothers who have lost continue as an integral part of the family, which, in a way, brings some serenity in life. Nowadays, in addition to photographs and videos, social networks are tools that are available to all to keep alive in the memory, especially to share, with others, memories that evoke dates and / or significant events for the relationship fraternal shattered. In the last three decades, the Internet has become an important source of information not only as a source of support for people who have suffered a loss.
It is stated that to live a process of fraternal mourning is something unique and these brothers are considered the "forgotten mourners." 7,10,26 Regardless of the cause that precipitated the brother's death, it is fundamental to recognize the importance of accompanying a brother in order of life and sharing moments where nothing was left unsaid, being able to say good-bye, forgive and / or ask for forgiveness, also add the importance of explicitly declaring the importance of the brother for himself and his life and to manifest clearly his affection. 13 No one can erase the past. No matter how hard you try, such a thing is not possible. However, people who have lost a brother during their childhood or adolescence learn exactly how to incorporate fraternal loss into their daily life and are able to discover and accept that there are times when they are happy.
For this purpose, therefore, an inner strength which supports, protects, is the breath that impels people to seize life, which gives them the courage to be surprised by all that it has to offer, from let them dare to be happy, even for a moment, to realize that the essential can be in simple things because, in fact, everything passes. Sometimes this inner strength is born in faith, in a belief in something higher, where people take refuge, although others revolt and withdraw to later return to drink from that source. Indeed, one of the strategies people use to overcome the English/Portuguese J Nurs UFPE online., Recife, 12 (9) loss of a brother is the support found in personal beliefs, religion. 17 It is faith and trust in God or the recognition of signs of the existence of something higher that assures them that the brothers are still present in their lives, caring, looking for them. Some also know, or feel, that the brothers who have lost, in a certain way, have made a difference in the lives of some people and who still continue to occupy a significant place in their lives. In fact, by drinking these sources of inner strength, despite the longing that remains, feeling the presence of the brothers who have already departed and finding some consolation in their memory can attribute meaning to this experience.

• Losing a brother and the meaning attributed to health
It is understood that, even if the death of the brother has been precipitated due to the scarcity of the offer of medical care, or when at all it is not easy to access the same, for the people it is always important to understand how everything happened. If this is not the case, doubt remains and other scenarios are imagined which may well influence the significance that will later be attributed to health by themselves and others who have grown up with them.
It was clarified, through the participants' discourse analysis, that the probability that death was precipitated by medical malpractice, besides being a factor of indignation and revolt, also intervened directly in the experience of the fraternal grieving process. The hypothesis of medical negligence to have been the cause of death of the brothers is something that marks people and in the future it will be difficult for them to trust again, not only in the health system itself, but also in its professionals, even if it is currently their own profession. The fear of neglect always underlies the meaning that today, as adults, attribute to health.
People's perspective on life and health, in particular on mental health, has been changed through loss. Mental health is not limited to the absence of disease, but is closely related to development itself, involves sociocultural interference and is reflected in adaptation to changes, facing crises, relating to others, finding a meaning for the life. In order to find this emotional stability, the essential is to discover what, at bottom, brings happiness, to bring back to oneself, to reinvent itself. The death of a brother experienced at any age, though in a peculiar way until adolescence, is stuck in the memory. The fear of falling ill, of dying and of being also the cause of the parents' sadness seems to have taken on a larger dimension at that time, almost as a wake-up call upon themselves, and then, over time, to dissipate.
It is noted that some people acknowledge fearing and feeling some insecurity in the health aspects of their own children, and / or significant people, especially if the situation fuels the memory of the brothers' deaths.
In fact, it is very difficult for these people to withdraw from their whole past, to forget the experienced in their families, and to depart from the thought of the likelihood that something similar might happen to theirs, even though they try to give primacy to reason. Some admit that they live in a permanent anxiety and anguish, that the zeal for the health of their, in some situations, can even be out of place and, for this reason, they feel limited in their own existence, impotent when they realize that they can not control over everything and everyone.
On the other hand, if for some the probability of a genetic cause for the death of the siblings causes them anguish, especially for the hypothesis of seeing history repeated in their descendants, for others, this fact is not a factor of anxiety. People with chronic illness who have experienced fraternal loss until adolescence recognize that, perhaps because of this experience, they take it upon themselves to take care of themselves and refer to being aware of the signs and symptoms that may arise so that they can live with quality for many, many years.
It was also evident in this study that when people themselves experience a serious illness, even if with unknown diagnosis, they not only give more value to their health but also the suffering experienced by those who have lost. The fear of falling ill or of losing someone significant again is so overwhelming that there are people who stubbornly deny any possibility that someone who wants to be sick can adopt a hard, cold and distant posture.
In this way, the meaning that these people confer on health will certainly be different from those who have had a contrary experience. Indeed, looking at life and health today by people who have lost a brother during their childhood or adolescence seems to be influenced by this experience, although this period of mourning is predominant for the emotional stability of those who remain.
It is concluded that the experience of the loss of a sibling during childhood or adolescence definitely brings echoes to the brothers' lives and can continue to be reflected throughout their lives. People try to find support, support, emotional balance and discover subterfuge to fill the pain of loss, of loneliness. The confrontation with death and the experience of an overwhelming loss, especially of someone significant as a brother, can leave deep marks on people and often cause life to be placed in another perspective. In a way, this experience of loss contributes to the personal growth of each.
In the face of all the sadness and heartache resulting from the loss of their brothers, some people can find inspiration in their lives as the choice of the professional path, for example. People's lives may be restricted not only by their own depressive processes (which may or may not be present), but also by fears, often without any foundation. Living life apprehensively, insecurely, perhaps with a few panics, may eventually lead to the (almost) permanent need for introspection, self-analysis, a continual search for better understanding of the pursuit of happiness.