Life & Health
More than Words
The Neuroscience of Grieving
Winter 2007 Issue
Image courtesy Nahlinse
“Activity—any activity—helps against sadness. You take up life’s reins again. When you do something, you engage your brain and deprive it of the opportunity to go down thought’s darker paths.”
—Stefan Klein, The Science of Happiness
“Grief is itself a medicine, and bestow’d
To improve the fortitude that bears the load. . . . ”
—William Cowper, "Charity" (1782)
“When it comes to grief, nonjudgmental listening and open discussion may be the best tools for discovering what a person is truly experiencing and for offering meaningful emotional support. ”
—Thomas M. Meuser, Samuel J. Marwit and Sara Sanders, "Assessing Grief in Family Caregivers," in Living With Grief: Alzheimer's Disease (Kenneth Doka, Ed., 2004)
“Give sorrow words: the grief that does not speak
Whispers the o’er-fraught heart and bids it break.”
—William Shakespeare, Macbeth
The last decade has seen great strides in understanding some of the brain science behind emotions like sorrow and joy—at least of the mechanics. Using the latest technology, scientists can see what goes on materially in the brain when we have certain feelings, but there is still much more to understand. One area that begs further study is that of grief and bereavement. How can we use the discoveries of neuroscience to help those who are grieving avoid the pitfalls that often lead to depression? Such discussions must begin with an understanding of how bereavement affects us.
Anyone who has lost a close relative or friend knows that the grieving process can be lonely. Even though others may also have loved the one who is gone, each is mourning the loss of an individual relationship; and each of those relationships is unique. It may feel as though there is no one who fully identifies with our feelings at a time when we desperately wish someone could fill the emotional void left by the loss.
We may have a great number of friends who care deeply, but they may assume we are recovering well if we don’t call to cry on their shoulders. Indeed, we may appear to be recovering remarkably well—especially if we are the type that fills the void with work or other activity—but we may still feel isolated.
There are social pressures that add to the problem, especially in individualist cultures. Pull-yourself-up-by-the-bootstrap philosophies still exist in the West and are as pervasive and persistent in our mentality as seemingly opposite philosophies such as collectivism and victimization. Often thought of as mutually exclusive, in reality these ideas coexist in modern culture with surprising tranquility. The result is that we don’t call our friends, although we need them desperately. Perversely, we feel abandoned, though our abandonment is of our own making because we have been taught that it is despicable to appear “needy.”
Stefan Klein, a German scientist and journalist, makes an intriguing point about the neuroscience of sadness and its relationship to individualist culture. “German culture, especially,” he says, “has been fatally imbued with the idea that solitude is a particularly desirable and noble condition. . . . that solitude brings people closer to their innermost selves” (The Science of Happiness, 2006).
This is a trait of other cultures as well. The British are known for the “stiff upper lip,” and Klein points to the cliché of the cinematic American Western: cowboys leave the women they love to go riding off into the sunset alone. The message is that the truly strong need no one. However, “the exact opposite is true, as both clinical and neurobiological experiments show,” says Klein; “it’s loneliness, more than any other factor, that causes stress. It’s a burden on both mind and body. It results in restlessness, confusion in thought and feeling (caused by stress hormones), and a weakening of the immune system. In isolation, people become sad and sick.”
Study after study shows that supportive companionship is good for the body, mind and spirit; it lengthens life and improves its quality. But the wrong kind of companionship can be worse for us than no companionship at all. Destructive relationships increase stress and reduce healing time. This has been demonstrated on a physiological level in at least one American study by a husband-and-wife team of researchers, psychologist Janice Kiecolt-Glaser and immunologist Ronald Glaser. They found that people in high-conflict relationships healed at 60 percent of the rate of those in low-stress relationships. At the same time, they found that after interpersonal conflict, the body releases a protein that produces inflammatory reactions in autoimmune disorders such as rheumatoid arthritis and Crohn’s disease. “Moreover,” the Glasers noted, “inflammatory activation can enhance development of depressive symptoms.”
Results like these should not surprise us. Common sense alone might be enough to suggest that we should look for comfort among those with whom we are most comfortable. Klein notes that “the mere touch of someone who is familiar and trusted can ease sadness. This . . . is caused by neurotransmitters like oxytocin and the opioids that are released in moments of tenderness.”
We may understand these concepts academically when we’re grieving, but it still may not be easy to ask for what we need or for those around us to recognize that we need it. Alternatively, we may let our needs be known, only to have our family and friends respond negatively—especially if they, too, have absorbed the messages of an individualist culture. They may feel it is their duty to pull us out of the dumps and cheer us up; or they may be fearful that their sympathy will encourage us to wallow. Sadness is often viewed as a negative and unproductive emotion.
But could it be good for us in the right doses? Klein thinks so. He makes an interesting observation about the value of darker moods like sadness. “As unpleasant as they might be,” he says, “they’re programmed into the brain and can actually be very useful. When we have lost something, when a relationship ends, or when we have failed to reach a goal, the organism responds with sadness—a signal that we should relinquish a possibly senseless goal. Depression is a natural energy-saving program. When we feel drained of energy, we pull back and reflect, and in the end we often attain a new strength and clarity.”
Klein tempers this with the warning that persistent sadness over a prolonged period can spiral into a more harmful kind of depression. However, there are no concrete timetables for grief. What constitutes a prolonged period? Many people who have not experienced bereavement underestimate the length of time required for recovery. Professional counselors vary in their estimates, which range from several months to three years for the bereaved to reach the acceptance stage. Unless there are other concrete signs of serious depression, it is counterproductive to attempt to shorten or suppress the natural and very individual grieving process.
Does this mean we shouldn’t work to replace negative mental images with positive ones? Of course not. The neurobiological sciences consistently find that we have the power to reinforce the positive in our brains and bring about practical neurological changes to prevent grief from declining into debilitating depression. However, we make a mistake if we attempt to force others to abandon their grief by pulling away from them. Researchers find that it’s the validation rather than the downplaying of grief that helps the bereaved cope with their loss in a healthy way.
In the background to their 2002 Caregiver Grief Study, Thomas Meuser, associate professor of neurology at Washington University, and Samuel J. Marwit, professor of psychology at the University of Missouri, state that “grief is our innate adjustment process to loss and, when ignored or downplayed, can result in complications such as depression and other co-morbidities.” Poets, though well known for their depression and its “co-morbidities,” have been telling us this for centuries. William Cowper insisted that “grief is itself a medicine,” and Shakespeare remarked wryly in Much Ado About Nothing
“. . .’Tis all men’s office to speak patience
To those that wring under the load of sorrow,
But no man’s virtue nor sufficiency
To be so moral when he shall endure
The like himself.”
Whatever our loss, however, allowing sorrow to spiral into clinical depression is not a healthy option. The stress hormones that can be beneficial in the short term can turn on us in the long term, eventually affecting the hardwiring of the brain. “In the process,” says Klein, “the brain loses its adaptability.” Even worse, “if this condition is prolonged, the consequences can be devastating: gray cells shrink. . . . Other parts of the brain lose so much matter that they just shrivel up.”
The science behind Klein’s statement involves the process of neurogenesis. Over the last decade, neuroscientists have discovered that the adult brain can continue to produce new neurons in some areas of the brain. One of the most important of these is the hippocampus, which is crucial for learning and memory and is also linked to emotion and mood. Science has found that while some activities seem to boost neurogenesis in the hippocampus, long-term depression seems to inhibit it. When sadness spirals into depression, neurogenesis halts, and over repeated episodes of depression, some areas of the brain actually shrink. While there is still much study to be done on the link between depression and neurogenesis, it is blatantly obvious that depression is not a good state of mind.
So what can we do to keep our minds healthy even during long periods of grief? Because neurogenesis and depression are incompatible states, reason compels us to pursue those activities that are known to increase neurogenesis. Researchers suggest that this boils down to exercise in three key areas: the body, the mind and the heart.
Anyone who exercises regularly knows the feeling of well-being that results from sustained physical activity, so it’s no surprise that exercise has repeatedly been found to promote neurogenesis in that crucial region, the hippocampus. One study by the Salk Institute in California found that while “exercise increases hippocampal neurogenesis and improves learning,” these benefits can be realized by old and young alike, because “maturation of newborn neurons [is] not affected by aging.”
Behavioral biologist Paul Martin adds encouragingly: “Measurements have confirmed that even a brisk ten-minute walk can help to lift mood and dispel gloom for a few hours. More vigorous and regular exercise produces bigger and longer-lasting improvements in mood and vitality. . . . There is good evidence that exercise reduces anxiety and helps to cope with stress. It even provides relief in some cases of mild depression” (Making Happy People,2006).
A recent study from the University of Texas at Austin confirms this. For clinically depressed patients, even one 30-minute exercise session was enough to elevate scores relating to “vigor” and “well-being,” at least in the short term. John Bartholomew, one of the researchers involved in the study, feels this is significant considering that depressed people often try to self-medicate using alcohol or other questionable methods. “Low-to-moderate-intensity exercise appears to be an alternate way to manage depression,” he suggests. While moderate amounts of wine provide health benefits, including that of “gladdening the heart,” alcohol is a depressant and in excess could sabotage even the best intentions toward coping adequately with grief. Fortunately, it’s much less likely that one will exercise to excess, and physical activity is one of the easiest and most effective things we can do to ease our own sadness.
Even before neuroscience began to lay bare the inner workings of the brain, studies told scientists that those who love learning for learning’s sake tend to be happier than those who don’t. New discoveries continue to underscore the benefits of learning. According to Martin, “research shows that better-educated people tend to experience lower levels of unpleasant emotions like anxiety, anger and depression, and fewer physical symptoms such as aches and pains.” He suggests that this is because “the knowledge and problem-solving skills provided by education can liberate us from irrational worries that would otherwise leave us prey to anxiety.”
From a scientific standpoint, learning picks up where exercise leaves off in the process of neurogenesis. After birth, new brain cells either become integrated or die off, but according to Rutgers psychology professor Tracey J. Shors, “the formation of new memories seems to directly enhance the likelihood that new neurons will remain in the brain, even after the experience is over. These findings fit loosely with the phrase ‘use it or lose it.’” So mental activity is just as important to neurogenesis as physical activity.
There is a third contributor to the dual ends of encouraging neurogenesis and preventing grief from devolving into depression. It brings us right back to where we began: the importance of the right kind of companionship.
According to Princeton researchers Alexis Stranahan, David Khalil and Elizabeth Gould, “in the absence of social interaction, a normally beneficial experience can exert a potentially deleterious influence on the brain.” One of their studies found that even exercise could not encourage neurogenesis if the subjects were living in isolation. In other words, both exercise and social interaction were required for neurogenesis to take place.
This only confirms what humanity knows instinctively: people need other people. Klein believes science has contributed to our innate understanding of this by providing the solid proof that “a well-functioning communal structure benefits even physical health. . . . People live better and longer when they are socially rooted.”
James Coan is a University of Virginia neuroscientist who has found that people need more than simple social roots, however. The most tangible benefit of a solid support structure may be the increased likelihood of being touched. Coan conducted what he believes to be “the first study of the neurological reactions to human touch in a threatening situation, and the first study to measure how the brain facilitates the health-enhancing properties of close social relationships.” His method? Using magnetic resonance imaging (MRI) to monitor results, he applied electric shocks to create stress for his subjects, who were all married women. By turns they endured the shock alone, while holding a stranger’s hand, or while holding the hand of their own husband. Predictably, the MRI showed that the women responded with the least anxiety when their husbands held their hands, and the most anxiety when there was no human touch at all.
Though it seems an obvious point, this is still significant, because high levels of stress hormones are strongly linked to clinical depression. Could physical touch be biologically crucial to those who are working through bereavement? If so, it’s one aspect of the recovery process that the bereaved cannot manage for themselves. Again, though self-evident by common sense, this has been biologically established by British neuroscientists in a study using functional magnetic resonance imaging (fMRI) to track neural responses to touch. The study reports that “more activity was found in somatosensory cortex when the stimulus was externally produced.” Speculating as to why this occurs, researcher Sarah-J. Blakemore and her colleagues propose that “our sensory systems are constantly bombarded by a multitude of sensory stimuli, from which we must extract the few stimuli that correspond to important changes within the environment. One of stimuli that are in most circumstances unimportant, and therefore can be discarded, are those that arise as a necessary consequence of our own motor actions.”
Clearly this would also apply to the kinds of touch that, as other scientists have established, reduce anxiety and ease sadness. There are some forms of comfort that can come only from others.
As for giving sorrow words? One doesn't like to contradict Shakespeare, but experts say some people simply don't need to talk about their grief. That doesn't mean they don't have other grief-related needs, however. We just may need to step away from our mobile phones and e-mail, and reach out to touch someone in the old-fashioned way instead. For if there's one adage that applies to the bereaved and their supporters alike, it would be the tried and true "Actions speak louder than words."
1 Daniel G. Amen, M.D., Change Your Brain, Change Your Life: The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness (1998). 2 Elizabeth DeVita-Raeburn, The Empty Room: Surviving the Loss of a Brother or Sister at Any Age (2004). 3 T.J. Wray, Surviving the Death of a Sibling: Living Through Grief When an Adult Brother or Sister Dies (2003). 4 John Bowlby, Attachment and Loss (1980). 5 Jeffrey M. Schwartz, M.D., and Sharon Begley, The Mind and The Brain: Neuroplasticity and the Power of Mental Force (2002).
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