When the hospice nurse called on the morning of 2 April to
tell me that my father had died at 7:38am, just two days after he was released
from the hospital and seven hours after I arrived in town to see him, the world
suddenly felt strange, half-formed. I recognised the shapes of things, but
struggled to comprehend what I was seeing. I didn’t realise how much of a
pillar of my existence he was, until that pillar crumbled.
Since the day I was
born, he was a constant presence, even at 2,000 miles away – he lived
in Maryland, I lived in New Mexico – and now he no longer existed. As much as
my rational mind knew this to be true, to the rest of me it just didn’t seem
possible.
On the outside, I remained calm, quietly cycling through the
unwanted tasks incumbent upon the eldest child of the bereaved: telling other
family members, making arrangements, notifying government agencies, companies,
organisations, the university where he was a librarian for 33 years. But
on the inside, I was a churning maelstrom of emotions: sadness, confusion,
anger, disbelief, fear, regret, guilt.
At times in those first hours, days and
weeks after his death, it was hard to breathe. I couldn’t concentrate. I forgot
things. Fatigue was a constant, no matter how much I slept. I came to
understand what Joan Didion meant in The Year of
Magical Thinking (2005), a chronicle of her grief over the
loss of her husband, when she wrote: ‘I realised for the time being I could not
trust myself to present a coherent face to the world.’
This fog of grief, it turns out, is as common as grief itself.
When the neurologist Lisa Shulman lost her husband to cancer nine years ago,
‘there was some serious sadness, but that wasn’t the main problem,’ she
recalls. ‘It was the disorientation. I felt like I was waking up in a
completely alien world. Because the whole infrastructure of my daily life was
fundamentally gone.’
She found herself becoming lost in time, ending up in familiar
places without knowing how she got there, she recalls. ‘It’s not simply a
matter of discomfort or anxiety. It’s frightening,’ she says. ‘Because you feel
like, as Didion said long ago, you feel like you’re going crazy.’
The idea of the five stages of grief, common in the Western world,
doesn’t help. It’s become part of the zeitgeist that we go through these stages
in turn, from denial to anger to bargaining to depression and finally to
acceptance. The psychiatrist Elisabeth Kübler-Ross first proposed these five
stages of grief in her book On Death and
Dying (1969) as a way to describe the experience of people
facing a terminal illness.
Later, with the death and dying expert David
Kessler, she extended the idea to explain the bereaved’s response to loss in On Grief and Grieving (2005). But in recent
years, psychologists and neurobiologists have come to realise that grief is far
more complex and individualistic.
The ravages of grief are many and varied. A
bereaved person feels sad, of course, but they might also feel angry,
irritable, tired, unmotivated, deflated, even bothered more than usual by
noise. Like Shulman, a neurologist at the University of Maryland School of
Medicine, they might question their identity, their place in the world.
The five stages of grief theory, it turns out, is not a
particularly helpful way to think about bereavement. In fact, it can be
harmful: if the way we feel doesn’t fit the mould, we might think that there’s
something wrong with us – or with the people around us.
‘Importantly, we may turn away from our instinct to do things that
comfort us in the belief that there are right and wrong ways to behave,’
Shulman writes in her book Before and After Loss (2018). ‘But our experience
of loss is personal and intimate. It doesn’t lend itself well to
generalisation; it’s as unique as we are.’
The study of the bereaved has revealed just how diverse
people’s experiences of grief are – but also some interesting patterns. In a
remarkable study of
depression in the bereaved, published in the Journal of
Psychiatric Research in 2015, researchers monitored 2,512
people who had lost a spouse or child – once before and three times after the
loss, over a span of 18 years.
They found that, while 7 per cent
had chronic depression that persisted throughout the study period, most of the
participants – about 68
per cent – experienced only mild depression, or none at all.
Meanwhile, 11
per cent reported dealing with depression before the death,
but the depression eventually lessened over time, and 13 per cent
experienced chronic grief – an onset of depression after the death.
Her own experience inspired Shulman, who studies Parkinson’s
disease, to investigate the neurology of grief as a way to understand what was
happening to her. In her book, which interweaves her grief story with the
science of bereavement, she notes that grief is a universal human experience
that our brains have evolved to manage.
Over millennia of collective loss, the
brain has developed a sophisticated strategy to help us endure bereavement and,
eventually, to heal, says the psychologist Natalia Skritskaya. ‘Grief is a
natural reaction,’ she says. ‘However unsettling, and however strange those
reactions are, there are good reasons for them.’
Grief has such a powerful effect on us, I learned, that it rewires
the brain: the limbic system, a primal part of the brain controlling emotions
and behaviours that ensure our survival, takes centre stage, while the
prefrontal cortex – the centre of reasoning and decision-making – retreats to
the wings.
‘From an evolutionary standpoint, we are strongly hardwired to
respond to something that is a threat,’ Shulman says. ‘We oftentimes don’t
think of a loss of a loved one as a threat in that way, but, from the
perspective of the brain, that’s the way it is literally perceived.’
That perception of threat means that our survival response –
‘fight or flight’ – kicks in, and stress hormones flood the body. The work of
the psychologist Mary-Frances O’Connor at the University of Arizona and others
has found heightened
levels of the stress hormone cortisol in the bereaved.
While the cortisol is flowing fast, the brain remakes itself – at
least temporarily – to help us endure the trauma of grief. In the weeks after a
loss, the brain, like a stern nurse imposing temporary bed rest for itself,
suppresses the control centres of higher functions, such as decision-making and
planning. At the same time, Shulman says, areas involved in emotion and memory
work overtime, gatekeeping which emotions and memories get through.
Brain scans
of the bereaved show that grief activates parts of the limbic system –
sometimes referred to as the ‘emotional brain’. Among the limbic regions
impacted are the amygdala, which governs the intensity of emotions and threat
perception; the cingulate cortex, involved in the interplay between emotions
and memory; and the thalamus, a sort of relay station that conveys sensory
signals to the cerebral cortex, the brain’s information-processing centre.
‘To sustain function and survival, the brain acts as a filter sensing
the threshold of emotions and memories that we can and cannot handle,’ Shulman
writes in her book. There is little we can do to change this response, she
adds, though we wouldn’t necessarily want to; it’s essential for adjusting to
the loss. ‘We’re at the mercy of this whole process, basically,’ Shulman says.
So my inability to form coherent sentences or remember what I
opened the refrigerator to get is nothing to be worried about, Skritskaya
assures me; my brain has simply powered down my thinking to enable me to
tolerate the loss. The tradeoff is fuzzy cognition – what I’ve come to describe
to friends as ‘grief brain’.
‘Grief takes up a lot of bandwidth in the brain,’ Shulman writes
in her book. ‘Odd behaviour and incoherence are expected consequences of the
brain’s protective responses following emotional trauma.’
Just as the body knows what to do to heal a wound, the
brain knows what to do to heal itself after a loss. But that healing takes
time, Skritskaya says: ‘It requires kindness and being gentle with yourself.’
How long grief lasts varies from one person to another. For some
people, the pain of loss can pass within a few weeks or months, while others
might still feel deep sorrow a year later.
If the grief is too intense for too long, though, it can become
problematic, recent research suggests. If there’s a preoccupation with the loss
that lasts more than a year, treatment might be needed to help the bereaved
come back to themselves, many psychologists now believe. The condition, called
prolonged grief disorder or complicated grief, is included in the latest volume
of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which psychologists and psychiatrists use to
diagnose clients.
That’s not to say that if someone is still grieving deeply on the
366th day after a loss, their bereavement has suddenly become disordered.
‘There’s some arbitrariness to that [one-year] time point,’ says Skritskaya,
who is also a researcher at the Centre for Complicated Grief at Columbia
University in New York. ‘It’s a balance between making sure we don’t
pathologise normal reactions, but then also that we do give attention to people
who seem to be struggling and need more help – those who are having a more
intense experience.’
People who lost loved ones to violence, or had a very close
relationship to the deceased, tend to be more vulnerable to complicated grief,
a 2019 study by
researchers in the Netherlands and the US found. While it can be easy to assume
that prolonged grief is simply a form of depression, and can be treated the
same way, it’s not.
The same study notes that complicated grief is distinct
from depression, and from post-traumatic stress or anxiety, though there is
some overlap in symptoms, such as a diminished sense of self and social
isolation. Other research has found that cognitive decline is more pronounced
in people with complicated grief.
Cases of complicated grief are rare, though; only about 10 per cent
of bereaved people will develop the disorder, according to a 2017 study by
researchers at Aarhus University in Denmark. Most bereaved people vacillate
between actively grieving and moving through the obligations of daily life with
some semblance of normality.
This oscillation between sorrow and kind-of-OK describes my own
experience. While working on this essay, for example, at times I was able to
enter states of flow – extended periods of unfettered, focused writing – much
as I could before my father’s death.
But at other times, often in the same work
session, I was overcome by despair and an acute awareness of my father’s
absence from the world, an incomprehensible erasure. When thoughts of him
surfaced, either wending their way into my consciousness of their own accord or
through the trigger of an email from a friend or family member, an unbidden
memory, even a letter from the hospice centre, there was nothing I could do but
stop and let the sobs come. It’s like my primal brain knows exactly what I need and will make
sure I get it.
Indeed, researchers now recognise that the vagaries of grief,
however unpleasant, are a way of helping the brain, mind and body cope with the
loss – and, eventually, adapt to the new reality of life without a loved one.
Gradually, in ‘the process of dealing with loss, coming to terms
with that world where you don’t want to be’, grief becomes more integrated into
the bereaved’s everyday life, rather than a dominant force in it, says Judith
Murray, a psychologist with the University of Queensland in Australia.
‘That’s the incredible power of healing from grief,’ she says.
‘We’ve got this idea that you get over your grief, but it becomes a part of who
we are.’
With the cerebral cortex back at the helm and a return
to higher-level thinking, the mind is able to spend more time reflecting on the
loss and the relationship, and grappling with the meaning of it all can lead to
positive growth. Loss can inspire people to examine life more deeply than they
did before, and foster a greater awareness of their own fragility and a
stronger sense of purpose, Shulman writes in her book.
She cites a 2004 study that found that
loss can lead to positive growth in a number of different ways: a new sense of
priorities and a greater appreciation of life; better relationships; feeling
stronger; a tendency to see new possibilities; and spiritual development. In
her own life, Shulman found that journalling helped
her to process her grief. In reflecting on her loss, she found meaning in it.
Not everyone experiences such growth after a deep loss, however.
For some, the consequences can diminish their own health – and even hasten
their own demise. Writing in the journal Psychosomatic
Medicine in 2019, O’Connor notes that
multiple studies have found increased rates of mortality among bereaved people.
My dad might be yet another sad example of grief contributing to a premature
death. Four months before he passed, his wife died, and his health
deteriorated. When he finally went to the hospital, the doctors eventually
diagnosed the source of the pain that had left him bedridden: he had developed
severe stomach ulcers. I can’t know for sure, but my last conversations with
him in the months before his death have left me with a deep suspicion that his
own grief and loneliness contributed to his rapid demise.
Even for those who navigate the rough rapids of grief without
falling overboard, grief never recedes completely. A 1995 study found
that two to 15
years after bereavement, people who’d lost a child or a
partner reported lower overall satisfaction with their lives – but greater
coping skills.
Understanding the neurological underpinnings of my grief, and that
growth often follows it, is a comfort – though I know any growth I gain from my
father’s death is a long way off. For now, I’m tending to the emotions that
arise as they come, (mostly) without judgment, and seeking comfort from
supportive friends and immersion in the ponderosa pine forests near my home.
An email I received the other day from my father’s oldest friend,
who knew him for 70 of his 79
years, gives me hope for a future in which this irrevocable
loss no longer feels so potent, when my neural pathways re-order themselves
once again and my ‘grief brain’ yields to a new reality, and a new way of
remembering.
‘When we lose a friend, we have grief accompanied by fond
memories,’ he wrote. ‘Eventually fond memories push the grief into the
background. I’m waiting sadly, but patiently.’
To read more about the
emotions, visit Psyche, a digital magazine from Aeon that illuminates the human
condition through psychology, philosophical understanding and the arts.
April
Reese is an independent science and environment journalist based in
Santa Fe, New Mexico. Her work has appeared in Scientific American, Outside,
bioGraphic and The Guardian, among many other outlets.
