Have you ever felt the type of grief where it seemed like you would never recover, like your heart was actually broken? Whether it’s a member of your family, a friend or a beloved pet, all of us will experience the loss of a loved one, and the deep and difficult emotions that follow.
One of the reasons grief can be so difficult is actually more about our brains than our hearts. Dr. Mary-Frances O’Connor has been studying grief for decades, and she has learned its profound effects on our brains and our bodies. She will reveal some surprising insights about why our minds struggle to understand and process when someone is gone. She’ll also provide some very practical ways to help us cope with one of the most difficult experiences of our lives.
Plus, how animals grieve on land and sea.
Phil Stieg
At some point in our lives, we will experience the pain of losing a loved one. While the impact of loss on our emotions, on our hearts is obvious, what about its impact on our brains? Today we are speaking with Dr. Mary Frances O’Connor, a neuroscientist and psychologist who has spent decades studying the effects of what happens in our brain and our entire bodies while we grieve. In her book, “The Grieving Brain”, she explains why our brain struggles so much with the concept of that our loved ones are gone and how the brain processes this new reality. Her follow up book, “the Grieving Body”, explores how grief affects the rest of our bodies, our hearts, immune system, endocrine and nervous systems, and how and why grief can have such a profound physiological impact on our health. Can someone actually die of a broken heart?
Mary Frances, thank you for being with us today.
Mary-Frances O’Connor
It’s so lovely to be here. Phil, thank you for having me.
Phil Stieg
In reading through your book, the Grieving Body, it seemed to me that the storyline throughout it was really a personal story about the death of your mother, her cancer, your diagnosis with MS.
Mary-Frances O’Connor
When I was 13, my mother was diagnosed with stage four breast cancer.
I didn’t know this at the time, but she was not supposed to survive through the year. I did know that grief came to our house, and it turned out, you know, her oncologist described her as his first miracle. She lived another 13 years. But it meant I felt. comfortable with grief. It felt familiar to me. So when I was doing this research, I realized that I could sit with people and have them cry and tell me what had happened and listen to their moments of despair and maybe in a different way, could map that on to the neuroimaging scans and the blood draws that I was doing.
After my mom’s death, I was diagnosed with multiple sclerosis. Now, my MS was not caused by my mother’s death. It runs in my family. And I have other risk factors. But the fact that it emerged at a moment where I was dealing with the stress of my mom’s loss was probably in part because my body was really taxed at a moment when we know that there’s a physiological response that comes with those emotions of grief. So, you know, for me, it’s both a personal and a scientific investigation, I guess
Phil Stieg
Which I guess is a very strong motivator.
Mary-Frances O’Connor
Yes, I’ll say.
Phil Stieg
And as I was reading through this and just thinking, you focused on death, you know, but my mother died of Alzheimer’s, and it was a slow death. And it made me think about my father. I observed his grieving process while he was watching her wither away. Are there similarities? Have you looked at that in terms of the slow death process?
Mary-Frances O’Connor
Well, you know, to talk about grief, we sort of have to talk about love and bonding. Right. Because it’s when we understand what we have that then we can better understand what has been lost.
So when we bond with someone who becomes our wife, like your father and mother, or we fall in love with our baby, that person becomes encoded in our brain in this everlasting way. I will always be there for you. You will always be there for me. And what that means is when there is a shift in that relationship, either because the person dies and so they can’t be there in the same way anymore, or when something profoundly changes them, like dementia, where they’re just – they’re not the person who was always there, then we experience grief in response to that loss. So as you say, that can happen before the death of the body of the person, when their personality shifts and how they interact with you. It can happen in divorce. It can happen in, you know, even the empty nest. Right. It’s never quite the same as when your children were at home. And so it’s really, I think, in many ways, the response in us is that change of the relationship, that separation, that change in who we are because our loved one isn’t there in the same way.
Phil Stieg
You talk about the five stages of grieving, which I’d like you to briefly tick off for us. But then also importantly, since you were the first person to really look at functional MRI. Can you inform us about the specific parts of the brain that light up during the grieving process?
Mary-Frances O’Connor
So the five stages of grief comes from the work of Dr. Elizabeth Kubler Ross, who was a brilliant psychiatrist who had this revolutionary idea that you could actually talk with people who were terminally ill and ask them what they were feeling. And then she wrote “On Death and Dying” for the public. And in doing that research, she did what all good scientists do initially. She described what she was getting from these interviews. So she talked about denial and anger, bargaining, depression and acceptance as ways of expanding the idea. Grief is not just sadness, right? Grief is yearning and anger and also avoidance and all these other things.
What happened was that rather than just being taken as a description of grief, people came to use it as sort of a prescription, as though you would go through those five stages sequentially, and then you were done, and then grief was over. We know now from longitudinal studies that people do not all go through five stages, and certainly not that there is an end to grief after this event, time limited period.
So it’s valuable to know that there’s more to grief than sadness. But it is not accurate any longer to describe five stages of grief.
What we know from this longitudinal research in larger studies now is that over time, it’s a little like you can sort of visualize the stock market. It goes up, it goes down, it goes up, it goes down, it goes up, it goes down. And even though you can have the worst day of the stock market, just the crash of the stock market at the end of the year, we might still say that the stock market was up. So grieving then is this trajectory. It’s what’s changing over time. And that is the important part. Not having a really tough day, not having an anniversary reaction or something like that. But rather, over time, are we seeing more acceptance and less yearning as we come to find grief more familiar as we learn how to comfort and soothe ourselves as the intensity and frequency of those waves of grief is reduced?
In terms of the brain, of course, What we know from the neuroimaging studies is that all parts of the brain, of course, are involved in grieving. We need our memory, we need emotion regulation. We even need parts of our brain that help to regulate our cardiovascular system. But we have seen something unique.
There’s a small group of people who are not adapting. We’re just not seeing any change over time. That months and even more than a year later, it’s still as though it just happened.
And what we see is that these people are yearning, really just pining for their loved one to be back. And what we’ve seen in this neuroimaging work is that there’s a part of the brain that has to do with reward related learning that parallels this self-reported yearning. So, the nucleus accumbens, this little region the middle of the brain, shows more activity, the more yearning people tell us that they’re experiencing.
So why that is useful is to understand the. This process of adapting is coming to understand. I can’t predict they will be there anymore. They are a part now of my memory. They’re a part of my experience of the world. But I don’t yearn for them to be back in the same way as though I’m predicting that could happen. So understanding the way the reward related parts of the brain are working helps us to see there are those who struggle to really incorporate this new knowledge that we can’t predict them.
Phil Stieg
The nucleus accumbens, that part of the brain as you know, it also plays an important role in addiction. So is prolonged grieving an addiction?
Mary-Frances O’Connor
It’s a very good question and my answer would resolutely be no… But let me help to explain this differently than what we think about with drugs of abuse, where we see addiction.
So I live here in the desert southwest, and if you go out hiking and you’ve not remembered to take your water bottle somewhere on the hike, you start thinking, I’m so thirsty. I need water. I really want water. All you can think about is water, right? No one would ever say you were addicted to water. I can tell you that your nucleus accumbens would very likely light up if you saw a photo of water, but that doesn’t mean you’re addicted to it.
So what we forget is that our attachment figures, our loved ones, are as important to our survival as food and water. And so it makes sense that in their absence, we yearn for them, we thirst for them. And what happens in many of us is that as we adapt, we find ways to fulfill those attachment needs other than yearning for the person who’s died.
So that might mean that we connect more deeply with living loved ones. Some of us create new relationships – but in a different way. Some of us connect with nature or with God and find that our attachment needs are sort of met in that way.
So lots of ways to restore our life. But I think that is why that part of the brain is motivating us to try and reach them, to try and find them, because it works when our loved ones are alive. And we have to learn that this is no longer a “seeking” that is going to be useful or helpful, even though that’s a very painful thing to acknowledge.
Phil Stieg
You also point out there are certain activities that we can pursue that are going to make our grieving process worse. And I’m thinking about avoidance and rumination. Can you describe what those terms mean as it relates to grieving? And then give us an example, and also an example of how you can turn it around and change them so you don’t do those things.
Mary-Frances O’Connor
You know, grieving is a learning process, right? The process of understanding what’s happening and what this loss means for your life. And how to restore your life. That’s a learning process, but it’s a very painful one. And so avoidance is an understandable strategy that people use because this is such a painful experience. So I like to talk about having a really big toolkit of coping strategies.
There’s nothing wrong with avoidance per se. The trouble is, if it’s your only coping strategy. Avoidance means that we have a harder time learning how to be in the world as a widowed person or as an orphaned person, or as a person whose child has died. So we need other coping strategies as well, like learning to soothe ourselves by learning to take some deep breaths as a way to calm our nervous system. Avoidance is not a good all time strategy, even if we use it once in a while because it prevents us from learning the new reality, from restoring our life now.
Rumination, on the other hand, are those thoughts that go round and round and round in your head and you just can’t stop having them when you get into bed at night or you’re stopped at the stop sign or whatever it is. One flavor of rumination that’s very common in grieving a friend of mine whose son died by suicide calls the “would’ve, should’ve, could’ve” thoughts. And so this is, you know, if only I would have known to pick up when they called, or if only I could have gotten them to the hospital sooner or. I mean, the brain can come up with an infinite number of these stories.
But if you think about it, all of those stories end in “and then my loved one would have lived.” But the reality is that your loved one didn’t live. And no amount of stories will change that and instead, what we have to do is figure out how to live in this world that can be painful with loss.
When we’re stuck in our head like that, when we’re going round and round and torturing ourselves, we’re not in the present moment, right? So in the present moment, we’re missing out on, you know, the barista that gives you this really sweet smile or you know, the puppy who’s doing some hilarious thing in the park. When we’re stuck in our head and ruminating we’re not fully in contact with the present moment that has grief and pain, but also has pride and joy and all of the good emotions that make up a complete life. There is never a time when grief goes away. Your loved one will always be gone. But there is a time where grief is not the only emotion that we are focused on, where all of these other positive and negative emotions can live all together in our experience.
Phil Stieg
What proportion of all this is due to guilt?
Mary-Frances O’Connor
Guilt is a powerful motivator. And I think one of the really challenging things with guilt is that guilt is often at some level a wish that we could have done something different. It makes more sense to us at some level that we didn’t do something and that led to this outcome. Rather than: Deaths happen, they happen to children, they happen to people we love, they happen for no good reason. And that living in a world that is chaotic like that can almost be harder for us to comprehend than “I should have done this thing and then it would have worked out okay”. Having to live with the uncertainty that is reality is almost harder sometimes.
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Narrator:
Grief may be very personal, and each person’s experience of grief is unique. But the experience of grief is not uniquely human.
In her book “How Animals Grieve”, Anthropologist Barbara King, argues that “We humans don’t own love or grief – these emotions are widespread in other animals.”
Evidence of grief has been reported in many other mammals, and e ven some birds.
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Dolphin and whale mothers have been known to spend days attending to the body of a dead calf, refusing to eat and abandoning the company of the rest of their pod. Marine mammal researcher Dr. Joan Gonzalvo theorized that since social animals are able to form strong emotional bonds – it takes time for their brains to adjust to the loss of that bond. Or, as one writer put it – “Grief” is the price we pay for “Love”.
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Perhaps the most striking examples of animal grief are seen in Elephants.
Veteran wildlife filmmakers Vicky Stone and Mark Deeble spent four years following a matriarch elephant and her family. Mark recalls a vivid moment…
Mark Deeble
We’ve been following a family of elephants and the smallest calf was obviously seeing in a bad way. It was a desperate time for them because the drought was coming on. The matriarch was trying to get the family to water and the female and the small baby were holding up the herd. It was getting weaker and weaker by the day. We knew the inevitable would happen. It got stuck in mud and the effort of it trying to get itself out of the mud was just too much – it literally died there and then. It had a heart attack.
The female, she just stood there and didn’t move for perhaps 30 or 40 seconds. And then she let out this incredible shriek and knelt down and plunged her tusks into the ground.
The rest of the family had gone on ahead of her but then when they heard this, they came running back. The matriarch led the others back and she came in. And when she came, the mother just calmed down immediately. And she came forward and she tried to lift the baby out of the mud with her tusks and she wasn’t able to do it. This unfolded over a period of about 40, 45 minutes. And then at the end, she turned around and led them all away.
The last one to leave was the calf’s mother. It was as if she couldn’t bear to turn it back on her, because she actually walked backwards away from the calf. I just kept the camera running, she left the frame walking backwards, as if that was a last glimpse she was going to get to her calf.
Looking at elephants, it’s easy to be sort of anthropomorphic about them. I feel that what I saw was genuine grief. I was convinced that the feelings I saw were very real and I think that elephants show them in just the same way as we do.
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Phil Stieg
If I were talking to a psychological anthropologist, they would be telling me that the brain’s function is to keep the brain alive. So why is it so hard for the brain grieving to just say, this is a waste of energy – stop, let’s move on.
Mary-Frances O’Connor
Yeah, It’s such a good question. And I think I can answer that in two different ways.
The first one is grieving is a form of learning, but your brain makes it very hard to learn that your loved ones are gone. Let me give you a simple story;
So, you know, bereaved people will tell me, I still pick up the phone to call my mom or my sibling. I still buy a birthday card and then remember, oh, wait, they don’t need a birthday card this year. So why do we persist? Why is it so hard to learn? The brain should be good at learning.
And the counterexample is I teach a Psychology of Death and Loss class, and I used to teach it in the same seminar room every year. You know, one of those sort of amphitheater seminar rooms. And if you’ve ever taken a class, you know, students often sit in the same seat. At the end of the semester, they all leave. And then the next time the semester starts and I come back into that room, I never expect to see those students in the same seats. I never wonder where they are. And it’s because as much as I care for my students, they are not attachment figures. I am not attached to them. There’s nothing in my understanding of our relationship that suggests they should be there again. And so that’s the counterexample.
I can do one trial learning. I know the semester’s over, but with a loved one, it’s hard to learn. It’s also very physically expensive. It’s physically costly to grieve, Right? So if you think about two of the responses we see after separation, protest and despair that some of your listeners might know come from John Bowlby, who studied this both in infants and his colleagues, studied it in animals when there’s separation, that first response, if you look down and your child is not next to you in the grocery store and you think, oh, no, they’re gone. Right? You can feel the energy to find them or call out and have them come back to you.
The other response that is very common, this despair response, is, “oh, no, they’re gone. And you can feel how different that feels in your body, the gravity of that. Now, notice that in both cases, the information is the same. Right? And in protest, our response to that information is different. But despair has a purpose. And the purpose of despair is to stop seeking them, to let go of that desire, partly because it is so costly for our body to keep trying to get to them. And so we don’t usually think of despair as having a purpose. Right. We try to get out of that as quickly as possible. But part of that is because despair isn’t the end of the story.
It’s okay to support someone in despair, but to lend them your hope. So in that moment, despair says, “oh, wow, I feel so terrible. They are really gone. I’ve finally, really connected with that painful truth, and I will never feel any differently”.
Lending someone your hope says, “I agree that they are not coming back, and I support you in this moment of that is your reality right now. And I can also tell you, you will not feel this way forever”. So that we can together figure out what your life will look like. We don’t know what it’s going to be yet, but I will be here with you until we figure it out.
Phil Stieg
This kind of links us to your concepts about attachment, neurobiology, and “gone, but also everlasting.” Explain that and give an example of how that might play out in my life.
Mary-Frances O’Connor
Yeah, so I think about, you know, older couples, when one of them has died, will talk about waking up in the morning. And often older couples, the surviving spouse will still sleep on the same side of the bed as they always have. And in the morning, they’ll look over at the other side, and for a moment, it’s like their loved one is still alive. Then they have this realization, “oh, they’re not here.” And then they might even have a moment of despair. How am I going to get out of bed knowing that they’re not a part of my day?
And then over time, we do learn the parts of life that we still want to pursue as meaningful because we have this gift of today, and our loved one would want us to use that gift of today. It’s not that this it’s not that you just learn that they’re gone and then it’s done. Right. It’s that we keep remembering and we keep seeing that gone and everlasting can’t both be true. We’re going to have waves of grief forever because our loved one is always going to be gone. But we will learn how to integrate that into our life so that the wave comes and the wave recedes again and our body can absorb that and then, you know, like the rubber ball can sort of expand back to the shape that it should be.
Phil Stieg
So let’s start focusing on your body. You’re not the first person that I’ve talked to that focused on the concept of dying of a broken heart. Describe to us the events leading up to dying of a broken heart. And really what is that, both emotionally, but also what’s going on in the heart.
Mary-Frances O’Connor
We think it’s a metaphor, dying of a broken heart. But in fact, we see in very large population level studies that, as you say, there’s an increased risk.
So one case control study showed that you are 21 times more likely to have a heart attack on the day that a loved one dies than any other day of your life. Isn’t that crazy? 21 times more likely to have a heart attack, and then that risk drops off precipitously, almost immediately. But you can still see it at three months and it’s not as high, but at a year, we can still see somewhat increased risk for heart attack.
So the reason I think that many of us who study bereavement have stuck on this finding is that it proves very clear to us that there’s something physiological going on. Mortality is a pretty hard endpoint.
In my own line of work, I’ve wondered why and how. Let’s not stop with the broken heart happens. We kind of are getting to the point where we understand that to be true.
So I’ll give you an example. In my own lab, we did a study looking at blood pressure. The question was, are people 24/7 who are grieving at equal risk for dying of a broken heart across the day? And so we brought people into the lab and we asked them to sort of go through a wave of grief with us. We sort of allowed a wave of grief to happen in our lab while they were hooked up to blood pressure and EKG and so forth. And what we found was, not surprisingly, people’s blood pressure goes up during a wave of grief, although it might surprise you to know it actually goes up as much as moderate exercise, even though they’re just sitting in a chair talking to us.
But what was notable was the people who are struggling the most, the people who have the highest grief severity when they walk into the lab, are the ones whose blood pressure goes up the most. Right. And their blood pressure goes up quite significantly. And so it’s not proof. We need more research in this area to know what’s happening in heart attacks that happen during grieving. But it makes sense. That puts a lot of pressure – a lot of stress on the heart. And so teaching people and working with people to learn how to soothe their body, as well as how to find comfort, could be an important part of learning to respond to the fact that we have waves of grief and helps us to understand how to work with our grieving body instead of against it.
Phil Stieg
So a surprising moment for me in reading your book was the fact that you highlight how little research has been done on crying. I would think that, you know, I mean, I have to admit, I’m a sop. You give me a sad movie and tears come to my eyes. So I’m really surprised that you said there’s very little research, number one. But number two, that too many people don’t want to be seen crying, which I think is also surprising. So what are your thoughts on that?
Mary-Frances O’Connor
Isn’t that interesting? So we do have some – A little bit of research on crying. Enough to know that if we show someone sad movies in the laboratory, the chemical makeup of those tears, (psycho emotional tears, they call them), the chemical makeup of them is actually different than the makeup of tears if you cut an onion open, the irritant tears. Right.
So we know that there are these hormonal changes that are happening when crying occurs that we can even see in the tears themselves. But we have zero studies of crying in bereavement, which is the classic time. I mean, my students in the psychology course tell me often the only time they have seen their father cry was with the death of one of his parents.
We do know crying also has this expression component, that part of crying seems to elicit feelings of care from those around us, you know, and probably has good consequences for support in the context of loss, where we need extra support.
There’s a young emerging adults support group that I contribute to. These are young people who are just emerging in life and they’ve had a really significant loss. And for many of them, it has sort of taken their life off track.
And especially the young men, because of course, we get different messages about how we express our emotions in society. The young men have said more than once, it was the only place that I could, that crying was not seen as a form of weakness. And I think, gosh, if ever there was a moment where it was okay to be weak, but also to know that it’s okay to need someone in the midst of grief and to learn, you know, that when we are grieving is a time that people will be there for us. That is what makes grieving a universal experience. I may feel lonely for my loved one, and you may feel lonely for your loved one, but we can feel lonely together.
Phil Stieg
All right. We spent considerable time describing what grief is and the effects. Now, please help me. A loved one dies. How do I effectively deal with grief? What are the steps that I should take logically to get through it in a timely fashion? Which my sense from your book is that a timely fashion is, I don’t know, three to six months. Right. If I’m wrong, I’m wrong. But what are the steps that I need to take to get to the light at the end of the tunnel?
Mary-Frances O’Connor
Yeah, I definitely would not say three to six months. I would say there’s huge variation in how we experience grief, but most of us are still, for a very close loss, someone who is sort of a part of oneself. It is very uncommon that after three to six months that we wouldn’t be still experiencing waves of grief.
I think it’s one of those things where learning looks different in everyone. Right. So I think some of it is Recognizing that this is a natural process to some degree. Your brain, your body, your mind, your community, your relationships know how to absorb this loss. You are pulled forward, we go on. And as we go on, we figure out what it means to be a grieving person. And so I think there are things of allowing grief to come through you, knowing that it is a wave and so it will rise, but it will recede. So not being afraid of that.
I think, oscillating between dealing with the loss feelings and dealing with sort of restoring life so not getting stuck in one or the other.
And then I think to the degree that you can, finding people who get it. Not just that they get it, what grief is, but that they get you, you know. So I know myself as I was going through a divorce, my best friend was like, “you know, you can call me at 4am” and I never did. But I will tell you, knowing that I could call her at 4am made a huge difference, that she wasn’t going to judge me for having done that.
And I remember my sister saying to me, “you know, you’re doing really well in an impossible situation”. So the people who make sense to you, their way of responding to you is comforting, really connect, try to be, spend time, talk to those people, even if that’s, you know, your grandmother or your pastor or your yoga instructor. Find people who’ve been down this road before.
Phil Stieg
Mary Frances O’Connor, thank you for spending this time helping us understand how the brain and the entire body responds to grieving process, and how we can come out of the end of the tunnel positively. Thank you again for being with us.
Mary-Frances O’Connor
Thank you for bringing this conversation to people, Phil.
