The Grieving Brain: The Surprising Science of How We Learn from Love and Loss

by Mary-Frances O'Connor

George Bonanno termed the new science of bereavement.

On the one hand, there is grief—the intense emotion that crashes over you like a wave, completely overwhelming, unable to be ignored. Grief is a moment that recurs over and over. However, these moments are distinct from what I call grieving, the word I use to refer to the process, not the moment of grief. Grieving has a trajectory. Obviously, grief and grieving are related, which is why the two terms have been used interchangeably when describing our experience of loss.

grief never ends, and it is a natural response to loss. You will experience pangs of grief over this specific person forever. You will have discrete moments that overwhelm you, even years after the death when you have restored your life to a meaningful, fulfilling experience. But, whereas you will feel the universally human emotion of grief forever, your grieving, your adaptation, changes the experience over time.

Grief is a heart-wrenchingly painful problem for the brain to solve, and grieving necessitates learning to live in the world with the absence of someone you love deeply, who is ingrained in your understanding of the world. This means that for the brain, your loved one is simultaneously gone and also everlasting, and you are walking through two worlds at the same time. You are navigating your life despite the fact that they have been stolen from you, a premise that makes no sense, and that is both confusing and upsetting.

If someone close to us dies, then, based on what we know about object-trace cells, our neurons still fire every time we expect our loved one to be in the room. And this neural trace persists until we can learn that our loved one is never going to be in our physical world again. We must update our virtual maps, creating a revised cartography of our new lives. Is it any wonder that it takes many weeks and months of grief and new experiences to learn our way around again?

This confusion is not the same as simple denial, although that may be how others describe it. Instead it is the utter disorientation people experience in acute grief.

When you wake up one morning and your loved one is not in the bed next to you, the idea that she has died is simply not true in terms of probability. For our brain, this is not true on day one, or day two, or for many days after her death. We need enough new lived experiences for our brain to develop new predictions, and that takes time.

The loss of that celebrity is not only the loss of a person who helped to define us, but also grief over a time in our lives that we can never return to. That grief is real because we feel the loss of a piece of ourselves.

When a clinician is faced with a person who is suffering during bereavement, they need to ask if it is a long-standing problem. We must not assume that the death can be pinpointed as the cause of the suffering, even though they are suffering after the loss. You may notice that by four years, or forty-eight months, the woman experiencing chronic grieving has the same level of depressive symptoms as those who followed a resilient trajectory. We know that there are people who experience chronic grieving for much longer, even a decade. So, even in the trajectory of chronic grieving, adaptation is possible, even if the process is much slower.

I like the term complicated grief, because it reminds me of complications that can happen in any normal healing process. If you break a bone, the body creates new cells that remodel the bone and return it to its original strength. Although doctors might support this process by stabilizing the bone with a cast, knitting bone back together is a natural healing process. Even years later, if you have broken a bone, from an X-ray a doctor can still tell it was broken. Grief is similar, in that anyone’s life is forever changed because of loss, even when they have adjusted well.

The important point is that in a very large study of older adults, on average, some structural brain differences existed for those with the most difficulty adapting.

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.

Attachment to our loved ones is also characterized by the normal motivational state of yearning. I am saying that yearning is very much like hunger or thirst.

After the yearning scale was published, Harvard psychologist Don Robinaugh assessed yearning with the YSL scale in a much larger clinical sample of treatment-seeking bereaved adults.2 In his study as well, yearning was more closely associated with prolonged grief disorder than with depression. The level of yearning did not vary by gender, race, or cause of death, although those who lost a spouse or a child exhibited higher yearning than other types of kin losses. Yearning was somewhat lower when a longer time since the loss had passed, suggesting that even for those seeking therapy, yearning may subside somewhat over time. With specific descriptions of the nuances of how people were feeling, we now had a better understanding of what it means to yearn for our loved ones.

It is still unpleasant to be caught off guard and have your thoughts and feelings turn to grief. But your brain is bringing them up in order to try to understand what happened, in the same way that you may share memories and stories with friends to talk them through and gain a deeper understanding. When you think of intrusive thoughts this way, it feels more normal that they happen: your brain is doing this for a reason. They seem more functional, and less like a sign you are not handling your grief well.

In acute grief, these “what if” responses to the pangs of grief are common and completely normal.

if you are numb or cannot express your deep sadness, you are less likely to receive the support and comfort you need. If we never allow the feelings of grief to surface, and we cannot contemplate them, or accept them, or share them, they might continue to plague us. Each individual is different, and there are no rules that every single person can use to adapt during grieving. But flexibility in our approach and openness to dealing with feelings as they arise give us the best opportunity to regulate our emotions in a way that allows us to live a vibrant and meaningful life.

Let’s say you know four bereaved people. One of them chooses to go to a party with friends, and another one decides to stay home to watch a favorite movie. A third person spends some time with family telling stories about the loved one who died, and a fourth one writes in a journal about their grief. Which of these four people would you be most interested in meeting and which one do you think is most like you? How appropriate do you think each activity is, and how do you think the bereaved person would feel after engaging in it? These questions were part of a study done by Melissa Soenke, a social psychologist at California State University, Channel Islands, and Jeff Greenberg, a social psychologist at the University of Arizona. If you liked the last two people better and thought the activities that they chose were most appropriate and effective, you are like the majority of people who participated in the study. The last two activities, which involve confronting negative emotions in response to the death of a loved one, are often called grief work.

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. You forgo having your heart warmed by the barista who gives you a bright smile or being amused by the puppy loping in the park. If you avoid painful feelings by avoiding the awareness of what is going on around you, what you end up with is being unaware of what is going on around you. It is not possible to avoid only negative feelings. Ignoring the present makes it difficult to learn what works in the new ways you are living your life. On the other hand, when you are present in the moment, the dopamine, opioid, and oxytocin feedback help you move toward a restored, meaningful life.

This requires time and gentleness with yourself, and remembering that the new person you love now and the person you loved then are not the same. Gaining a loving, supportive relationship does not mean forgetting or rejecting the one that came before. A new relationship is ripe with new things to be learned, and many adjustments have to be made in order to be present in the current relationship and not to live in the virtual reality of the previous one. For those who are supporting someone who is grieving, there is real benefit in listening and offering encouragement, without judging when it is “normal” to develop new relationships.