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August 20 - August 30, 2023
To be clear, reward as used by neuroscientists is not just something pleasurable. Reward is the encoding that means, yes, we want that, let’s do that again, let’s see them again.
It seems that those with more resilient grief may no longer be predicting this rewarding outcome as possible.
I am saying that yearning is very much like hunger or thirst.
But the most significant critique of my own study is that the neuroimaging scans took place on a single day in a whole trajectory of days for these grieving individuals. Interpreting the study relies on an inference of how one scan fits into the many days before, but we cannot know if that inference is correct without scans done several times across the trajectory of adaptation during grieving.
Most significant critique of study
In our grief study, those who are adapting well had stopped having activation in the nucleus accumbens region, and those with complicated grief continued to show the nucleus accumbens responding to these photos. The inference lies in the words “stopped” and “continued.”
It is only when these life-changing experiences happen to us while interacting with the other person that we fall in love—we deeply encode and remember the way they look, the way they smell, the way they feel, and provoke us to yearn to find them, over and over again.
Encoding someone means that yearning is the inevitable result of separation from them.
This reminded me that although there are shared features between depression and grief, they are not the same. For one thing, there is no specific person or thing that people with depression are preoccupied with, or yearn for. Depression is a more global experience, a hopeless and helpless feeling that attaches itself to everything that is happening and has ever happened and ever will happen.
Again and again, our loved one who has died is suddenly there in our mind. We find ourselves partway into a thought, and then they come to us, which makes us yearn for them. Sometimes we don’t even know what sets us off.
intrusive thoughts
Intrusive thoughts are memories of personal events and people that come to mind suddenly and spontaneously, without our intending to recall them.
The brain also accesses visual or auditory areas to add realism to our thoughts, giving us the impression of seeing or hearing what we are imagining.
You have always had intrusive thoughts about your spouse, your kids, or your best friend. The emotional impact of them is different now that they have died, but being reminded of our loved ones is the nature of having a relationship. You get reminders because these people are important to us. That does not change right away because the person has died. Your brain has to catch up.
Avoidance can be behavioral, where we avoid situations or reminders of the loved one or of death, or it can be cognitive, where we attempt to suppress thoughts of the person or of our grief—or a combination of both.
In the example of the daydream as a response to yearning, your brain is orchestrating an experiential simulation, a virtual reality of how things could be now, contrasted with how they actually are, sitting there alone.
In acute grief, these “what if” responses to the pangs of grief are common and completely normal.
Calling a friend for support, and deepening a relationship with someone you trust and who cares about you, could represent an oscillation from loss-oriented coping to restoration-oriented coping.
New relationsbips
What is important is the benefit of having many ways of responding to yearning that fit the situation and forward your goals, both at that moment and in the longer picture of adaptation.
The most reliable predictor of good mental health is having a large toolkit of strategies to deal with one’s emotions and deploying the right strategy at the right time.
Toolkit of strategies
Rather than asking which are the best strategies, the more appropriate question might be whether using a particular strategy is counterproductive at a given moment or in a specific situation.
The last two activities, which involve confronting negative emotions in response to the death of a loved one, are often called grief work.
Although engaging in activities that usually lift our mood is effective, bereaved people are often reluctant to engage in them.
Acceptance may be the outcome of learning that a new reality is here to stay and that we can cope with it.
Counterfactual thinking often involves our real or imagined role in contributing to the death or the suffering of our loved one.
Our brain, by focusing constantly on the limitless number of alternatives to reality, is numbed or distracted from the actual, painful reality that the person is never coming back.
Although we are trading painful guilt for equally painful grief, at least guilt means we had some control over the situation. Believing we had control, even though we failed to use it, means the world is not completely unpredictable. It feels better to have bad outcomes in a predictable world in which we failed, than to have bad outcomes for no discernible reason.
Researchers are actively grappling with the paradox that you cannot learn about what has happened, and therefore why you feel terrible grief, without focusing on yourself, on your sad and angry feelings. You cannot fully understand what has happened without letting your mind wander through the territory of rumination.
Rumination can be divided into two aspects, which Nolen-Hoeksema called reflection and brooding.
Feeling better requires stopping the seeking, or ruminating, or worrying, at some point.
This sounds like a task for a Zen master!
Zen Buddhism
Psychologists now think that being unable to stop these grief-related ruminations may be one of the complications that get in the way of typical adaptation during grieving.
The sneaky problem with rumination is that while one is ruminating, it feels as though you are seeking out the truth of the matter. The point is that the thoughts are prolonging our sad or irritable mood, not whether the thoughts are true.
The trick is not to determine whether the thoughts are true, but rather whether they are helpful.
But the data clearly show that high levels of rumination are associated with the brain avoiding reminders of loss, either by pushing or looking away.
To be clear, there is a distinction between accepting someone’s death and resigning oneself to their death.
Accepting is focusing on life as it is now without the deceased, without forgetting the deceased. Resignation goes one step further and suggests that your loved one is gone, and that you will never be happy again.
Hope is a fundamental part of human psychology, when people are given enough support and time.
I realized that restoring a meaningful life requires flexibly moving our attention from thinking about the past to thinking about the present and the future. It requires being able to move our thoughts from relationships that were, to relationships that are and relationships that could be, and back again.
In A Grief Observed, the beautiful book C. S. Lewis wrote after the death of his wife, he writes: “No one ever told me that grief felt so like fear.”
Social contact leads to the release of opioids in the distressed animal, which functions both to soothe and to teach. Coming into contact with others is paired with this powerful reward, the internally generated equivalent of opiates, and a powerful reward tends to increase whatever behavior preceded it.
But the present moment also offers us possibility. For example, it offers us other members of our species. And only in the present moment can you feel joy or comfort. You cannot feel those things in the past or in the future.
Human beings cannot choose to ignore only unpleasant feelings. If you are numb to your momentary experience, you are numb to it all, the good and the bad.
zeitgebers, which means “time givers.”
Most likely, all of these zeitgebers are disrupted by the absence of your loved one. Each one is instead a cue for grief, a reminder that they are not here.
Many physicians will prescribe benzodiazepines or sleep medications for bereaved patients, based on patients’ desperation when they report sleeplessness. Empirical evidence shows that these pills do not help grief and make the sleep of bereaved people worse over time.
This is another example of how time does not heal, but rather, experience heals over time.
We know that fewer side effects (and effective treatment) would come from learning cognitive-behavioral therapy for insomnia (CBT-I).
Cognitive behavioral therapy for insomnia
Although we cannot force ourselves to go to sleep, we can force ourselves to get up at the same time every day, the most powerful of the zeitgebers.
There is grief in this world—not just yours in particular—and feeling grief at some point is one of the rules of being human. What that allows, on the other hand, is that when we feel grief, we are suddenly joined by hundreds of people who have known grief, from your ancestors to your neighbors to perfect strangers.
C. S. Lewis writes, “I not only live each endless day in grief, but live each day thinking about living each day in grief.”
