by Lisa R. Lowry, MD
In the photo above, entitled Dog in Shadow and Light, darkness creeps around the subject, my 16.5-year-old Weimaraner. Silver dances over his ears and nose, and a band of sunlight emblazons his majestic form. Light and dark. Life and death. Love and loss. The persistent pairing of opposites, Nature’s modus operandi, should be fair warning that inevitably, if you dare to love … loss is in your future. Yet we dive headfirst into the heady waters of connection, hoping to stay afloat when those waters run thick with grief. We avert our eyes, shuffle our feet, and look for the door when grief approaches. But grief will not be denied. It is a universal truth that dances across each life with a unique cadence, volume, and expression. And when the darkness comes, to quote Yoda, “in you must go.”
Statistically speaking, I can expect a visit from the G Force any time now. My dog has lived a very long time for his size and breed. We have connection, history, and, if I may anthropomorphize, love. When one of us passes, there will be loss. Grief, most commonly, refers to the emotions we experience after the loss of a loved one. Grieving is the process by which we adjust to the loss and is an ongoing concern. An important revelation I have allowed myself is that grieving is not limited to those we have lost through death. Grief reaches into that big bucket of the human experience of loss and includes grieving those we have been separated from (think divorce, deployment, gone missing), or psychological separation despite physical presence (Alzheimer’s); we can grieve versions of ourselves we lost or never got to experience; we grieve when we have lost a sense of safety after violence or betrayal; we grieve the loss of body parts or abilities after significant illness or trauma; we grieve after life-changing upheaval, like loss of a job, lifestyle, or home. This is not an all-inclusive list.
A former University of Texas professor, Lisa Keefauver, describes Western Grief as “a culture with systems and institutions that values and rewards … productivity over process, simplicity over complexity, destinations over journeys…stoicism over vulnerability….” The Western grieving process was often tied to five stages: denial, anger, bargaining, depression, and acceptance. If you followed that sequence, and tried hard enough, you could wrap up the grieving in about a year. Now most researchers agree grieving follows neither stages nor timelines, and rarely in a linear fashion. She describes how putting unreasonable expectations on ourselves to “get over it” comes at a steep cost, compromising physical, mental, and collective well-being. Thankfully, new information about grief is being revealed. Backed by scientific research, we are learning why just “sucking it up” is choosing to fight a gazillion-year-old process embedded in the deepest parts of our brain. Having experienced enough grief to understand there is no denying it, I’ll take the opportunity to learn. Into the research I must go.
For just a moment, and only if it feels safe to you, remember your definition of grief. How did it find you, and what did you feel? I suspect I would get many different answers to these questions. There are many types of grief, and according to David Kessler, an authority on grief, grief is as individual as fingerprints. To throw myself out there as an example, my father died when I was 22 years old. It felt like the world I knew had just disappeared. Then the physical symptoms began. The uncontrollable sobbing, the deep aching in my limbs, the hurt in my chest, the inability to eat or sleep, and the sense there was nothing I could do to stop it. It raged until it was done. I felt alone, then the longing and yearning set in. This was my acute grief. Everyone will be different. Why does this happen?
Acute grief is a full-throttle launch of your stress response. You have been disconnected from a loved one. Loss of connection in the human brain puts us on high alert for a threat to our own survival, and your body will kick it into high gear appropriately. Your body is flooded with cortisol and adrenaline. Adrenaline may increase your heart rate and blood pressure. The shifting of blood from the gut may instigate gastrointestinal symptoms like nausea and loss of appetite. Your breathing may become shallow, or you may find it difficult to breathe. The immune system shifts to promote wound healing, but slumps in the antiviral department, leaving you more susceptible to viruses like the common cold. Cytokines released by immune cells may increase your pain sensitivity. The anterior cingulate cortex, a region of your brain’s limbic system responsible for processing pain, including emotional pain, also ramps up. Dr. George Slavich of the UCLA Semel Institute cites that heightened inflammation can add to “psychological and behavioral symptoms including feelings of sickness, fatigue, and loss of pleasure.” The gut microbiome also takes a hit and may contribute to a myriad of symptoms including disordered sleeping and eating. You physically can feel grief down to your bones.
In the first 24 hours of grief, you are 21 times more likely to suffer a heart attack than normal. Within a month’s time, older individuals who have lost a partner face twice the risk of stroke or heart attack. Within six months, grieving partners have a 41% increased risk of death from any cause. When you are grieving, you are less likely to pay attention to these warning signs, and it is wise to institute support systems that will.
The story of emotional grieving begins with the story of attachment. Humans, as a species, do not fare well on their own. We form attachments and trust to work in groups, and to survive. That survival instinct is STRONG within us, and the bonds necessary to support that are equally strong. Research shows our experiences with people, animals, and things are mapped three dimensionally in the brain, in an area called the inferior parietal lobule. We map in time, space, and emotional closeness. When loved ones appear in time, where they appear in our space, and how close we are bonded. This mapping attachment is built on episodic memories, or that vast collection of our interactions with the person, animal, or thing. Once we have a map, we use it to predict. Andrew Huberman sums it up beautifully when he states, “one of the most powerful aspects of our attachments to people, animals, and things is the ability to predict what it would take to see them and when we are going to see them.” It is how I know my dog will greet me when I come home. The brain, even after we have lost that loved one, continues to make predictions of where or when we will see them. Called reverberatory activity, it is why we continue to expect our loved ones to appear, why we search for them, why we have conversations with them. After they are gone. It is why I may look for my dog when I come home, even when I know he isn’t there.
Dr. Mary Frances O’Connor, a noted grief researcher, addresses what happens next. We feel disoriented because we have one area of our brain predicting when we will interact with our loved one based on our extensive memories, and another area of our brain that has stored the very real information that the person has died and will not be returning. It reminds us about the funeral, seeing the body, saying goodbye. She describes this as the “gone AND everlasting” conundrum. The beautiful thing about our brain is that it is set up to hold onto what she calls “continuing bonds,” allowing us to hold onto the memories of our loved one. But it also is designed to learn. That attachment mechanism we talked about can form new attachments and further develop existing attachment to living loved ones. She cautiously reminds us, “it takes a long time and lots of experiences before we are able to predict their absence more often than their presence.” We begin integrated grieving, moving us back into the land of the living, but remembering the lost.
There is no way around grieving; we must go through it. There are tools the experts recommend, and that time-honored and cultural traditions suggest are helpful.
• Avoid self-talk that involves the words “if only.”
• Set aside time to think about your loved one. Acknowledge their meaning in your life.
• Everyone experiences grief differently. Don’t compare.
• Connect with others. Someone who can witness your grief without minimizing it.
• Try to get adequate sleep, physical exercise, nutrition, and exposure to nature and sunlight
• Seek help for grief that is stuck or complicated by additional trauma
We grieve because we have lived and loved.
Wishing you the best, even in the hardest of times.