Summary:
For this month, we read "The Grieving Brain: The Surprising Science of How We Learn from Love and Loss" by Mary-Frances O'Connor, who directs the Grief, Loss, and Social Stress (GLASS) Lab at the University of Arizona. I would say that the underlying theme throughout the book is that grieving is a period of tremendous learning.
The beginning of the book tries to lay some groundwork for understanding the extent of that learning. We are introduced to the idea that our brain is sort of a prediction machine, constantly evaluating current circumstances against what it has learned to be true through lived experience. This is how you can detect the "not thereness" of a table in the dark that you expect to be there. Critically, these predictions are determined by lived experience alone, and not by knowledge, so when someone who is so integrated into your life dies, the patterns that the brain has learned about the reality of the world are challenged. This can lead to strange effects: such as the feeling of presence of a loved one, or hallucinating them walking in a crowd, and can also cause a strong sense of denial that someone is gone forever.
She then goes on to discuss how this relationship knowledge is organized in the brain. We map knowledge relationally, as spatial relationships, ordering events in time, and we use a similar system for mapping "closeness" with others. This system for evaluating our closeness with others is very important for a social animal but can also cause complex feelings during grief. That's because if we sense a loss of closeness, we will often try to mend those relationships. In grief, the "signals" of the loss of closeness don’t change at all based on our behavior, which can lead to feelings of anger at the person that we lost or guilt that we are not doing enough.
The way that these feelings dissipate is through the effort of engaging with the present so that our brain learns patterns that do not include the lost loved one. Although life will never be the same without the loved one, the intensity of the grief decreases, and it is possible to function well again.
However, the process of grieving is very heterogeneous and can take a lot of different forms, and that's what O'Connor discusses in the middle of the book. One important lesson is that the incredibly well-known 5-stages of grief model put forward by Elisabeth Kubler-Ross is not backed up by a lot of data. In reality, grieving is much more flexible with periods of not feeling any grief to periods of feeling different aspects of the complex emotions involved in grief. The prevalence of the 5-stage model in popular culture often makes people feel guilty that they are grieving incorrectly. The second big lesson is that most studies on grieving have historically focused on samples that have had very complicated grief, and in reality, it is most common to have resilient grief, which is where grief dissipates, and the griever begins to function normally after a short time.
However, some people have chronic grieving problems, called complicated grief. O'Connor is emphatic in pointing out that we should be careful to use the term too lightly because it could muddle the science of different grieving processes, and that sometimes people attach the label "complicated grief" too haphazardly, which can have a negative effect. Basically, people want the label because they believe that the incredible pain that they are experiencing is too much to be the same thing that other people are experiencing, but that feeling can disconnect someone from the people around them. If instead, they can realize that this intensely painful experience is a common part of the human experience, they can connect with those around them who have also experienced grief for support.
Chronic grief may be predicted in differences in neurotransmitter systems, such as in the dopamine system of the nucleus accumbens which leads to elements of craving, and in the oxytocin system, which modulates feelings of attachment. O'Connor takes some time to address common difficulties with grieving. One lesson that I found interesting was that humans are bad forecasters of how they'll feel. So engaging in fun activities, such as watching comedies or going to parties is usually helpful in improving the negative feelings of grief, but often people will choose not to do those things. Another lesson is that ruminating or playing out alternatives is often linked with depression. O'Connor frames ruminating as a kind of avoidance strategy to avoid the painful reminders of loss. She suggests focusing on whether or not thoughts are helpful.
The main theme of learning is summed up in a line towards the end of the book, that "time doesn’t heal. Experience heals over time." And this is used in the context of avoiding sedatives to try to "ride out" the painful periods. Insomnia is super common during grieving because the body is so stressed. Instead, the best strategy is to stay engaged in the present, and she recommends using memorials or certain kinds of rituals as ways to connect the past to the present - that let one stay feeling connected to their lost loved one, but also do so in the context of the current place and time.
Thought Questions
- The book uses the phrase, "the surprising science" in the subtitle. What, if anything, surprised you most about the book?
- Do you think that lessons about grief presented in this book could be applied to other forms of loss besides the death of a loved one, such as the loss of a job? Or is the emotional landscape of grief confined to the loss of relationships?
- Did you feel like O'Connor presents grief in a way that felt intuitively right to you? For me, the idea of grieving being primarily a form of learning seemed like a useful analogy for some aspects of grief, but I wondered if it captured all the complexity of the different innate types of emotional mechanisms we have going on. For instance, I've heard of people with complex grieving for parents that they had been estranged from for many years. Or grieving strongly for a relatively new significant other that someone was falling in love with. She discusses attachment in Chapter 6, but I was surprised that she emphasized the "learning" model of grief rather than focusing on attachment.
- In chapter 4, O'Connor discusses how the anterior cingulate cortex and the insula are the primary areas involved in pain processing and are activated with stimuli personalized to evoke grief. The periaqueductal gray, which is known to be involved in feelings of pain, is often hypothesized to be involved as well (from animal and lesion studies) but is sometimes not found. I was thinking about how our tools (like fMRI) might limit our conclusions because the PAG is so small and would be difficult to see activated. It's a good reminder that not seeing an effect doesn't mean that an area is not involved.