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August 20 - August 30, 2023
The neural connections that serve as the algorithm for the mental representation of our loved one are permanently encoded.
But implicit knowledge is much harder to update, as it is responsible for the attachment-related beliefs that our loved one can be found, that we are not searching hard enough for them, that if we tried harder or were better in some way, they would return to us. Because this implicit knowledge conflicts with the episodic memories, we are less likely to acknowledge this implicit magical thinking. I call these conflicting streams of information the gone-but-also-everlasting theory, and I think it is because they conflict that grieving takes so long.
In other words, episodic memory and habit, on the one hand, conflict with implicit magical thinking created through attachment, on the other hand, and this conflict leads to the extended period of time that grieving takes.
Developing this new knowledge requires the willingness to engage fully in our life during bereavement, and we will talk more about engagement in our day-to-day life during loss in chapters 8 and 9.
Most neuroimaging is based on the subtraction method.
Kübler-Ross and others applied the stages of grief she originally described in terminally ill patients to grief in the wake of bereavement, which is a big leap.
The problem, and the damage that this has caused for bereaved people, is that the model she developed has been considered more than a description of grief of those she interviewed, and taken as a prescription for how to grieve.
Holland and Neimeyer conducted an empirical study that looked for the five stages and found that adaptation is not so linear or orderly. Grief distress is usually more pronounced in folks who have been grieving for a shorter period of time. But the distress includes all types of grief experiences, including disbelief, anger, depressive mood, and yearning.
Acceptance is most evident among those who have been grieving for a longer period of time.
The journey doesn’t typically have a clear beginning, middle, and end that we may hope for, or that our loved ones may hope for us, in the midst of our distress.
The real genius of the dual process model, however, is the jagged line connecting the two ovals in the figure, showing that people go back and forth between these stressors. This oscillation line highlights the process of grieving, rather than only the content of our thoughts and feelings.
Time off from grieving might look like denying, suppressing, or distracting oneself from one’s feelings about the death, and this was presumed to be bad for long-term adjustment. But time off from grieving can give your mind and your body a break from the stress of the emotional upheaval.
resilient
chronic grieving
chronic dep...
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depressed improved
What was remarkable, however, was how many fell into this “not depressed” resilient category: more than half of the widowed spouses.
Focusing on those who have a grief disorder, by using these criteria, has led to psychotherapies that can alleviate this disorder effectively.
Because we are still in the middle of making history, disordered grieving has developed a few different names, including complicated grief and prolonged grief disorder.
traumatic grief has come to mean the grief after a traumatic death;
I like the term complicated grief, because it reminds me of complications that can happen in any normal healing process.
Grief is similar, in that anyone’s life is forever changed because of loss, even when they have adjusted well. However, there can be complications with a healing bone fracture, like an infection or a second injury, and I think of prolonged and severe grieving in the same way.
Our cognitive capacity to keep memories, make plans, remember who we are, and imagine the future may help us restore a meaningful life.
So greater grief severity in older adults, and not just experiencing bereavement, was associated with a slightly smaller brain volume.
This data suggests that loss is a normal life event to which the majority of people adjust without lasting deficits.
Therefore, prolonged grief and poorer cognitive function may be associated, though not causally. If the prolonged grief remits, then the cognitive difficulties may resolve as well.
He taught her to observe and write down her thoughts and feelings, so they could discover which ones were most problematic for her.
This homework requires great self-compassion to face the suffering of grief, and part of this self-compassion entails “dosing” the feelings and also learning to set them aside; this is the oscillation we see in the dual process model.
For many bereaved people who have been suffering for a long time, finding goals and activities with a therapist that elicit even small amounts of interest is a revelation. Before therapy ends, the therapist and bereaved person work on strengthening social connections, finding or improving relationships with kind or loving people who will be in their life afterward.
There are still relatively few therapists trained in evidence-based psychotherapy for complicated grief. In addition to CGT, other forms of psychotherapy that have an empirical basis include exposure therapy and cognitive-behavioral8 therapy.
have seen the term complicated grief adopted by people like a badge of loyalty to the deceased loved one, a description of how deeply they loved. But connection to the universal nature of grief helps connect us to our fellow human beings, so a diagnosis needs to be used carefully, in cases where the complications uniquely require intervention.
Aching for a loved one while they are alive but far away is useful for maintaining our bond with them; the ache can become unbearable when we know they will never return.
In fact, an entire brain region, the fusiform gyrus, specializes in remembering human faces and identifying and remembering which person is your person.
prosopagnosia,
Prairie voles live all over the plains of North America, whereas montane voles live at higher elevations in the western United States and Canada. What brought these two mammal species to the attention of scientists was that prairie voles are monogamous, while montane voles are polygamous, despite being very similar genetically.
The monogamous prairie vole has more of its receptors for oxytocin in a part of the brain called the nucleus accumbens, compared to the montane vole. We will see later in this chapter that the nucleus accumbens region in the human brain is important for bonding in people as well.
Chemicals and receptors are made by genes. Genes are the cookbook for how to make everything in the body. However, enzymes prevent some of the recipes from being made at any given time. These enzymes are involved in the epigenetic process (“epigenetic” means “near to the genes”).
This all has to happen while the vole is looking at, smelling, touching, and interacting with their new love, so that the new neural connections and associations are made for the sight, smell, and feel of this one very specific vole.
The mate has to be present during that time so that the memory and knowledge of this particular vole becomes stamped in their brain, in their very epigenetics.
Important experiences, like having sex for the first time with a partner, can change whether we use particular genes (following our metaphor, this would be the equivalent of making the recipes).
This permanent epigenetic change is what motivates us to return to this specific mate over and over again, recognizing them as our one-and-only. Once we are with them, the nucleus accumbens has other chemicals it deploys in the service of our bonds, including dopamine and opioids, that make us feel good together. Not only do we recognize them when we return, but it also feels good to come back to them again and again.
Upon separation from their mate, voles make more of a hormone that is very similar to human cortisol, a stress hormone.
I have heard bereaved people describe this in their own way, saying that the extraordinary stress of grieving feels particularly awful because they are facing it without the one person they would usually turn to in difficult times.
In bereavement, the physiological stress continues without the input of the pair-bonded mate.
Most of us can learn over time to have our attachment needs met in a new or different way. This happens through strengthening the bonds we have with other living loved ones, by developing new relationships, and by transforming the bonds we have with the person who has died.
Attachment needs met in new ways .
Although we now know that emotional pain is not encoded in exactly the same neurons as physical pain, the areas that encode the salience (the sense that this is important, this is bad, this is serious) of both physical and emotional pain are very close together, and enable both experiences to include suffering.
One brain region distinguished the complicated grief and resilient groups; it was the nucleus accumbens,4 the same brain region important in developing the monogamous pair bond in voles.
The group with complicated grief showed greater activation in this region than the more resilient group.
We found that the length of time since the death and the age of the participant were not related to the nucleus accumbens activation.
