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EMILY KWONG, HOST:
COVID-19 has claimed the lives of 5 million people around the world, which means that, globally speaking, there are hundreds of millions of people grieving the death of a loved one.
MARY-FRANCES O'CONNOR: Grief is like someone turned up the volume dial all of a sudden.
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KWONG: And the grieving process can look very different from person to person. Psychologist Mary-Frances O'Connor says the range of emotions is wide.
O'CONNOR: Commonly, there's panic. There's anxiety. There's sadness. There's yearning. There's also difficulty concentrating and confusion about what happens next.
KWONG: Mary-Frances says it's like the spin cycle of a washing machine. Our whole world turns upside down.
O'CONNOR: When we have the experience of being in a relationship, the sense of who we are is bound up with that other person. The word sibling, the word spouse implies two people. And so when the other person is gone, we suddenly have to learn a totally new set of rules to operate in the world.
KWONG: And to do this, our brains are processing a lot. Mary-Frances studies what happens neurologically when we experience grief.
O'CONNOR: I really think of grieving as a form of learning. And the background is running all the time for people who are grieving.
KWONG: Today on the show, we get into the nitty-gritty of grief - why we experience it and how the brain registers it as a learning process just as much as a healing process. You're listening to SHORT WAVE, the daily science podcast from NPR.
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KWONG: Mary-Frances, thank you so much for joining me. To start, let's begin with the description. What does grief typically look like?
O'CONNOR: I like to make a distinction between grief and grieving. So grief is that emotional state that just knocks you off your feet, but grieving has a time component to it. So grieving is what happens as we adapt to the fact that our loved one is gone, that we're carrying the absence of them with us. But grieving means that our relationship to that grief changes over time. So the first time - maybe even the first hundred times - you're knocked off your feet with grief, it feels terrible and awful and unfamiliar. But maybe the 101st time, you think to yourself, I hate this. I don't want this to be true, but I do recognize it, and I do know that I will get through the wave.
KWONG: Yeah. Even thinking about some of the people I love not being there just strikes total terror...
O'CONNOR: Yes.
KWONG: ...'Cause I don't know who I am without them.
O'CONNOR: Exactly.
KWONG: Yeah.
O'CONNOR: The we is as important as the you and me. And the brain, interestingly, really does encode it that way. So when people say I feel like I've lost part of myself, that is for a good reason. The brain also feels that way, as it were, encodes the we as much as the you and the I.
KWONG: What do you tell people when they ask you how long it will take to move through grief?
O'CONNOR: This is the million-dollar question - isn't it? - that when you're knocked over by that wave of grief...
KWONG: Yeah.
O'CONNOR: ...You want to know, when will this end?
KWONG: Yeah.
O'CONNOR: But it isn't something that you get over. It becomes a part of who you are. It becomes a part of how you understand the world. And so the when of the intensity, you know, resolving, it's as different as every person and every relationship that you have. A very small proportion of people who might have what we now call prolonged grief disorder - that we tend to start looking for at either six months or a year. We are seeing that this person has not been able to function day to day the way that they wish that they could. So these types of concerns suggest it would be helpful to intervene and get them back on the healing trajectory where they will still feel grief, but they will adapt to it differently.
KWONG: And I think what you're describing here is the difference between grief and prolonged grief that goes on for years. Can you talk about what that is and what you've learned about the brains of people who experience a prolonged period of grief?
O'CONNOR: Yeah. The only thing that I do like to sort of say is, you know, it's less than 10% of people who experience prolonged grief disorder. The older term that we were using for a long time was complicated grief. And there's a reason that I like the term complicated - because it makes you think of complications. So I think of the complications as being, there's something getting in the way for this person of their natural process.
KWONG: Yeah. And what kinds of complications can arise from having prolonged grief?
O'CONNOR: As an example, one of those is the grief-related rumination that people sometimes experience. So the better term for that that people will recognize is the would have, should have, could have. So when a person dies...
KWONG: What I could have done differently...
O'CONNOR: Exactly.
KWONG: ...What if we had acted sooner...
O'CONNOR: That's right.
KWONG: ...What if that hadn't happened that day kind of stuff.
O'CONNOR: Yes. Yes. And they just roll and roll and roll through your head over and over again, don't they? The problem with these thoughts we sometimes called counterfactuals is that they all end in this virtual scenario where the person doesn't die. And that's just not reality. And so by spinning in these thoughts, not only is there no answer, but it also isn't necessarily helping us to adapt to the painful reality that they did die. And so our virtual version is not really helping us to learn how to be in the world now.
KWONG: Yeah. I bet a lot of folks can connect with what you're saying right now. And from the world of science, you know, using neuroimaging techniques, what has been revealed about what grieving does to our brains?
O'CONNOR: We have neuroimaging studies basically of grief, of the momentary reaction where you have that emotional yearning experience. They're less than a handful of studies looking at more than one moment in the same person across time - so looking at their grieving trajectory. So what we know right now in the early days of the neurobiology of grief is really coming from snapshots. Having said that, one of the things that we know is that grief is tied to all sorts of different brain functions we have, from being able to recall memories to taking the perspective of another person, to even things like regulating our heart rate and the experience of pain and suffering.
We have a study that compares people who have complicated grief from people who are bereaved but are not having that experience. And one of the key findings there was that there is a specific brain region called the nucleus accumbens that seems to be distinct, where people who are having complicated grief show more activation in this region. What's interesting about that is this is a very important region for reward. We know in other human and animal studies, it's important in the reward created when we make a pair bond, when we deeply connect with someone else in a long-term relationship. This is part of the brain that enables us to do that.
KWONG: So you're saying that when people are experiencing complicated grief, prolonged grief, the reward centers of their brains light up when they, like, think about the person that is gone?
O'CONNOR: I am saying that. And it sounds a little confusing. And I'll be honest, when I saw those results, I was confused, too. But this is how I've come to understand what I believe is going on there. You and I, when we use the term reward, we think of something pleasurable. But when the brain is thinking about reward, it really is a signal, you should do this again. So when we see our loved ones, all sorts of neurochemistry is saying, oh, yes, we like this. Please, you know, come home after dinner, and let's sit together on the couch and snuggle. I think that this rewarding experience is something that, when people are adapting to the absence of this person, they realize that is never going to happen again.
But for people who have complicated grief, it is perhaps as though that reward is still something they could potentially experience. They still yearn for that person to walk in the door so that they can sit with them on the couch. And that kind of learning has to be updated and is maybe taking longer or is more difficult for this group of people.
KWONG: So you write about this very thing in your upcoming book, coming out in February 2022, about this concept of post-traumatic growth.
O'CONNOR: Yeah.
KWONG: I'm very intrigued by this. What is that?
O'CONNOR: Although grief and the loss of someone we love is terrible suffering, it does also teach us that this is how the world is, that we never know when a loved one will be taken from us, which is a terrible, terrible reality to have to face. But if we are in fact aware of that, often that makes us live our life in a very different way. What we see in science is if you have a grief experience and you have support so that you have a little bit of time to learn and confidence from the people around you that you will, in fact, adapt - if you have that support, post-traumatic growth is more likely out of a bereavement circumstance.
And the thing is, we sometimes forget this, but bereavement is a health disparity. And when people don't have the support because they are dealing with other issues, whether that be food insecurity or racism or other things going on their life, when you don't have the support to process what has happened, to learn to restore a meaningful life, it can be harder to do.
So even when we think about COVID, it's not all the same people who have grief. Say, for example, Black children were twice as likely to lose a parent or caregiver than white children.
KWONG: I'm really glad you brought up COVID because there has been so much loss the past year and a half through the pandemic.
O'CONNOR: There has.
KWONG: What would you say to people who know someone who lost someone to COVID?
O'CONNOR: It really is more about listening to them and seeing where they are at in their learning than it is about trying to make them feel better. The point is to be with them and let them know that you will be with them. But I would also say about the pandemic specifically - one of the topics I think is not much in the national conversation is that so many of the deaths of our loved ones happened in hospitals, in emergency rooms, in ICUs, and we weren't there to see it. Watching those changes that happen in their body that prepare our mind for the possibility that they might die and to go through that process without those memories makes it much harder to learn what has happened. So many people feel it hasn't really sunk in yet even that they're gone.
One of the few other situations historically where a large number of people have died when we weren't there has actually been soldiers in war. And I think when we do eulogies and speeches around those kinds of deaths, we talk about the sacrifice that was made by the remaining people, those loved ones who are left behind. What I don't hear very often is the fact that with COVID, the loved ones that are left behind made the sacrifice of not being with their loved ones in the hospital in order to stop the spread. And that sacrifice needs to be recognized, I think, in part, to help people heal.
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KWONG: Mary-Frances O'Connor, thank you so much for coming on SHORT WAVE. This has been a really, really important and actually a conversation I'm going to take with me personally, so thank you so much.
O'CONNOR: It's wonderful to share what we know in science about this, but most of all, to connect with people who are going through this experience, given there are so many of them.
KWONG: Mary-Frances O'Connor's book, "The Grieving Brain: The Surprising Science Of How We Learn From Love And Loss" is coming out February 1, 2022.
This episode was produced by Berly McCoy, edited by Gisele Grayson and fact-checked by Margaret Cirino. The audio engineer was Josh Newell and Rene Pringle. I'm Emily Kwong. Thank you so much for listening to SHORT WAVE, the daily science podcast from NPR.
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