Ann Finkbeiner: My son died, as did my husband; and so did parents and grandparents whom I loved dearly. I’ve written articles and LWON posts about grief, plus a book. So I consider myself a kind of expert, the kind who knows what she’s lived and read and what other people tell her. But I’ve never done any science to find out whether what I know is wrong. Dr. Mary-Frances O’Connor is that kind of expert.
She’s a psychologist who’s studied what goes on in the human mind, and who’s crossed scientific disciplines to do neuroscience about what goes on in the human brain. I interviewed Dr. O’Connor a year or so ago and was impressed not only by what she knew about the mind and the brain, but also about the nature of grief itself and its connection to love. Also she listens hard. And she’s written a very readable, thorough, kind book called The Grieving Brain.
So. Now. Dr. O’Connor. What got you interested in this field of the grieving brain? Because it’s not exactly a field, is it.
Dr. Mary-Frances O’Connor: I have been interested for a long time in how we physically encode the world. For grief, I imagined that part of that encoding took place in the brain–when someone is “lost”, how does the brain understand that information? What neural connections change, or epigenetic proteins are added, or do the waves of electrical activity “up there” change their pattern? This seemed like a big enough question that I could spend an entire career on it.
And if I’m also honest, not so much as a scientist but as a person, when my mom died when I was in graduate school, I realized that I could talk to people about death (and therefore grief), and this was pretty unusual. It meant that by engaging other people in such an important part of their lives, my own work felt meaningful, and talking about grief was something that not many people (even psychologists) were willing to do. So studying grief felt like a unique contribution I could make, even though, as you say, grief in the brain wasn’t really a field. Although I hope that is changing.
Ann: So when you ask how the brain encodes “lost,” you’re asking what happens in the brain when you can’t find the person any more or the person is gone, dead. And you learned to give brain scans (functional MRI’s, fMRI’s) to find the parts of the brain that are busy as you grieve. But that’s neuroscience and your PhD is in psychology, which is the field that normally studies grief. Almost no one else does that, both psychology and neuroscience, mind and brain both, right? What did you find?
Mary-Frances: A few of us around the world have studied grief in the mind and brain (Joseph Goveas at Medical College of Wisconsin, Richard Bryant at University of New South Wales, Australia), although I suppose no one else has grief as the sole topic of their neuroscience research. And what I have found in just one study can’t really tell us enough about what the brain is doing during grief and grieving.
Ann: So the question of what the brain does while grieving is a field that’s relatively new and still has no real answers. But you must have a partial answer, right?
Mary-Frances: Indeed. One thing is, the parts of the brain important in grief are also involved in reward. We know that reward is important in creating a bond with a loved one, like a partner or a child. In one of my own neuroimaging studies, those who report the most yearning for their deceased loved one also show the most activation in the nucleus accumbens–a key node in the brain’s reward network. It’s interesting that there wasn’t a correlation between how “good” or “bad” the bereaved participants felt, but with how much of that yearning motivation they reported.
Ann: So regardless of how people felt, the more they yearned to see their dead again, the more the brain’s reward system lit up. That took me a while to understand but I think I do: the feeling of yearning, of wanting someone to please come back please, is run by the same part of the brain that runs rewards, the things that make you feel good. It’s really nice, isn’t it, that the person you’re missing also made/makes you feel good. Sad but nice. So what else does neuroscience say about grief?
Mary-Frances: The same Richard Bryant I referred to above did a neuroimaging study of people whose grieving prevents them from functioning day-to-day, people with what’s called prolonged grief disorder. Bryant compared prolonged grief disorder with two other disorders with similar symptoms, post-traumatic stress disorder and major depression. Compared to those two, people with prolonged grief disorder used more of their orbitofrontal cortex when looking at photos of people with sad faces. This orbitofrontal region is also part of the reward network of the brain, which we are finding over and over in different studies is an important part of bonding, and therefore of grief.
Ann: You’re bringing up a subject I have Opinions on. “Prolonged” grief disorder suggests that grieving has a time limit. Plus, the old psychological theories, like Freud’s and Kübler-Ross’s, suggest that grieving resolves into acceptance and the griever “detaches” from the dead person and reattaches to some one or thing else. I’ve always thought this is sheerest moonshine. Do you think those ideas are still out there?
Mary-Frances: I have an Opinion on this, too! The field debated what term to use for a long time, which is why you may have heard “traumatic grief” and “complicated grief” as well. I personally like the term complicated grief because it feels like what we are trying to point to–that some bereaved folks show complications that get in the way of them restoring a meaningful life, much like a broken bone will heal on its own unless you get complications of an infection or a second break. Having said that, prolonged grief disorder is definitely the term chosen by the International Classification of Diseases (ICD-11) put out by the World Health Organization, and by the DSM-5-TR, so I use that term, too. Importantly, psychological science has developed psychotherapeutic interventions (by Kathy Shear and Paul Bolen, for example) that target these complications, which are highly effective .
The research has definitely advanced since Freud and Kübler-Ross. And we do have a different way of understanding “detachment” and “reattachment”. I would say it this way–humans often have more than one person that they are attached to at one time, several close loved ones. For example, you really love and are connected to your spouse, but also to your child and your best friend. They are very different relationships, but they each fulfill our vital human need for attachment.
Human beings need to be loved, to know that they are important to other people, that they can trust them, that they are needed by them. You might think of this small group in a pyramid–there is often one person at the top you turn to first when things are bad (or good!), and then a couple of others in the rungs below you might also seek out. When that primary person dies, it takes time; but if our earthly attachment needs are going to be met and if we are to thrive, we need someone else to fill those needs.
But I believe that the deceased does not actually leave the pyramid–in fact, we use the term “continuing bonds” to describe the ongoing, transformed relationship with the deceased loved one. Many people continue to talk to their loved one, ask their advice, or allow their deceased loved one’s values to influence their behavior. For example, a woman told me that when she was having a difficult conversation with her son, it felt like her deceased husband was with her, helping her to find the words.
Ann: Oh I LIKE that — you’re not “detaching.” Just as you’re still attached to all the other people in your life, you’re still attached to the person who died. Really, we should embroider that and hang it up on every kitchen wall. Is that continuing attachment to all your loved ones, alive or dead, related to resilience? Because I remember that the people with complicated or prolonged grief are about 10% of all grieving people, meaning that the other 90% are what psychologists call “resilient.” Does resilience show up in the brain too?
Mary-Frances: Oooh, yes, I said in my book, The Grieving Brain, that we need a neuroimaging study of people who are adapting really well during grieving–we have as much to learn from them. Unfortunately this study has not been done–yet! In fact, almost all of the neuroimaging studies we have are of grief–that single moment when a person is overwhelmed with the feeling. We have almost none of grieving–more than one fMRI scan done on the same person at different time points after the death of their loved one.
Ann: Well, whether or not neuroscience can say anything about grieving over the months and years, it does at least suggest that grief is probably run by the parts of the brain that also run reward and bonding. That’s so reassuring! I mean, sure, grieving is trauma and pain and depression; but it’s related to the things that make you smile and feel close and satisfied and have meaning. In a way, it’s like the neuroscience behind that saying, “you grieve because you love.”
So what do you tell someone who’s worried that they’re grieving too long or in the wrong way or too intensely? And before you answer, I’ll tell you that I LOVED the sentence in your book, “You’re not crazy, you’re just in the middle of a learning curve.”
Mary-Frances: I think that grief will be different over each relationship, because love is different in each relationship. There is no Big Book of Grief Rules that you aren’t following–you are having your natural reaction to loss.
What we do with the grief we carry along with us, that can change over time. So, we may want to find ways to do new things, even while the grief is still part of our experience. Or, we may decide that doing certain things are no longer worth it, now that we have the insider experience of the painful reality of mortality. I think one of the best things I heard when I was grieving over my dad was from my best friend–she said, “you’re doing really well, you’re just in an impossible situation”. Her belief in me, when I couldn’t quite believe it myself, helped me to go on. Every person wants to hear that they are still valued by those around them, even when they feel broken.
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Illustration courtesy of Pixabay
Oh Ann, thank you so much for this. I love that sentence you loved too, “You’re not crazy, you’re just in the middle of a learning curve.”
I think you would like her book, Christie. And that sentence! It applies to so much of life.
Thanks so much, Ann, from all of us–for who has not suffered loss? Learned a lot-but especially this “thing is, the parts of the brain important in grief are also involved in reward. We know that reward is important in creating a bond with a loved one, like a partner or a child.” So it seems the harder we love, the harder we grieve…the world’s way of leveling the playing field, I suppose.
That’s it, Ellen! It’s interesting to me that this equation of love and grief, which in a way seems so obvious, is also encoded in the brain.
I liked reading about the connection between love and grief. I remember telling you (Ann) that I reread your book about the death of a child periodically after it was published, You asked how I could stand to do that because most people found it too difficult. I don’t remember what I told you, but I found the stories in the book to be affirming because they demonstrated the incredible power of love. It’s taken me years to verbalize this to myself. Now I can take a couple of years to figure out how reward, love and grief are intertwined.
What you say is touching, Gail. And I think you’ve got it exactly. Thank you for writing, I mean that.