Book Summary: The Grieving Brain

I learned so much reading this book that I'm writing up my notes to share them. The Grieving Brain by Mary-Frances O'Connor, PhD. Subtitle: The surprising science of how we learn from love and loss.

Dr. O'Connor is both a neuroscientist and a psychologist who has spent her career learning about how our brains work. She shares her own research, stories and summarizes other research in the field of grief and grieving.

First, she educates us that how we all thought grief worked (the 5 stages of grief) "we now know this is not at all how it works."

"In 1969, Elisabeth Kubler-Ross published On Death and Dying. The model of the five stages of grief (denial, anger, bargaining, depression, acceptance)... The world remembers, despite the fact that research progress in the decades since has shown the model is inaccurate or incomplete."

Kubler-Ross used clinical interviews and distilled what people grieving described into a model. BUT the clinicians were not interviewing all people grieving and did not have a large sample size. The psychologists were seeing and helping people with extreme grief. Dr. O'Connor writes, "Many bereaved people do not experience anger, for example and therefore feel they are grieving wrong or have not completed all their 'grief work'...the stages are not linear...very few people experience the orderly progression of the stages that Kubler-Ross proposed and tragically they may feel they are not normal if they do not."

Instead, the Four Trajectories of Grieving was discovered

The majority of people grieving (66.3%) learn how to adapt and do not fall into depression. They are categorized as "Resilient". "What was remarkable was how many fell into this 'not depressed' resilient category: more than half of the widowed spouses. That means that resilience is the most typical pattern of grieving, showing that most people who experience death of a loved one do not experience depression at any time point. This surprised many people...This insight reminded us that clinicians had primarily been studying bereaved people who sought help after their loss, a smaller group than the larger 'resilient' group.

Other grief trajectories:

• 14.5% of people were depressed before and continue to be depressed after the death of a loved one (Chronic Depression)
• 10% of people are less depressed after the death of a loved one (Depressed Improved)
• 9.1% of people experience extreme grief (Chronic Grieving). "The primary symptoms are 1) preoccupation with yearning for the deceased, and 2) traumatic symptoms caused by the loss...intense emotional pain, a feeling of disbelief or an inability to accept the loss, difficulty engaging in activities or making plans, and feeling that part of oneself has been lost...these feelings interfere with the ability to fulfill one's job, school, or family responsibilities."

They also found: "A person who cannot remember well, or cannot form new memories, has to be told and retold over and over again that their loved one has died. Without the brain structure to hold the memory in place, they are freshly confronted with the loss again and again."

Grief vs. Depression

"Though they can look the same, one difference between them is that depression often seems to come out of nowhere, whereas grief is a natural response to loss. For example, depression tends to pervade every aspect of life. People who have depression feel that almost all facets of their life are awful, rather than feeling that it is just the loss they are struggling with."

Here's what I learned about grief and grieving from The Grieving Brain:

• "Grief is the intense emotion that crashes over you like a wave, completely overwhelming, unable to be ignored."
• "Grieving is the process, not the moment of grief."
• "Grief never ends and it is a natural response to loss. You will experience pangs of grief over this specific person forever...your grieving, your adaptation, changes the experience over time."
• Waves of grief: "You may think, 'I will never get through this, I cannot bear this.' The one hundred and first time, you may think, 'I hate this, I don't want this - but it is familiar and I know I will get through this moment."

How the brain works when someone dies...

• Dr. O'Connor uses a metaphor of someone stealing your dining room table. "The absence of something is what has drawn your attention...the brain has entire areas devoted to error detection - perceiving any situations where the brain map and the real world do not match."
• "The brain is trying to solve a problem when faced with the absence of the most important person in our life...for your brain, your loved one is simultaneously gone and also everlasting, and you are walking through two worlds at the same time. You are navigating your life despite the fact that they have been stolen from you...which is both confusing and upsetting."
• "When someone close to us dies, our neurons still fire every time we expect our loved one to be in the room. And this neural trace persists until we can learn that our loved one is never going to be in our physical world again. We must update our virtual (brain) maps."
• "We use brain maps to find our loved ones, to predict where they are, and to search for them when they are gone." After our loved one dies, our brain sets off alarms and is confused. Our brains are problem-solving.
• "Death presents a particularly devastating problem. Suddenly you are told (and on a cognitive level, you believe) that your loved one can longer be located...the brain cannot predict this possibility, because it is out of the brain's experience (with that person)...Furniture does not magically disappear. If the person we love is missing, then our brain assumes they are somewhere else and will be found later...This confusion is not as simple as denial. Instead it is utter disorientation."
• "The brain is a remarkably good prediction machine...it completes the patterns it expects to see...imagine the man whose wife has returned home from work at six o'clock every day for years. After her death, when he hears a sound at six o'clock, his brain simply fills in the garage door opening. For that moment, his brain believed his wife was arriving home. And then the truth brings a fresh wave of grief."
• "Our predictions change slowly, because the brain knows better to update its whole prediction plan based on a single event. Or even two events. The brain computes the probabilities that something will happen."
• "Our brain trusts and makes predictions based on our lived experience. When you wake up and your loved one is not in the bed next to you, the idea that she has died is simply not true in terms of probability...We need enough new lived experiences for our brain to develop new predictions, and that takes time." "That is why we say that time heals. But actually, it has less to do with time and more to do with experience."
• The brain struggles to understand where your loved one is. Our brain simply believes they are far away and will return later. "If they are not responding to us, even though we logically know they cannot, then our brain may believe we are not trying hard enough to reach them."
• Our brain can feel regret, guilt or anger - why aren't they there? Why aren't they being predictable? "When our loved one is living, these emotions would motivate us to repair the relationship...but when someone dies, there is no chance for resolution."
• "The brain doesn't function like a camcorder, recording every moment...function more like cooking a meal. The ingredients of the meal are stored across many areas of the brain...sights, sounds, smells, feelings, association with particular people...a cake appears to be a single entity, not a combination of ingredients."

Different types of memories: ones we call upon and ones that are intrusive. Intrusive memories are both positive and negative. Intrusive negative memories are part of grief waves and the grieving (learning) process. "For intentional memories, our executive control in the frontal lobes gets involved to instruct us to remember them...Intrusive thoughts arise for extremely emotional events, including those that are positive - they are not all reserved for extremely negative events...but we worry about these unwanted negative intrusive thoughts...this is what the brain does naturally, in order to learn from these important, emotional events...Your brain is bringing them up in order to try to understand what happened, in the same way that you may share memories and stories with friends to talk them through and gain a deeper understanding."

"These push notifications from our brain intrude on our consciousness...to help us remember those things that are most important. This is how we remember, for example, not to leave the baby behind in the car seat when we do autopilot tasks like grocery shopping."

"During bereavement, these same reminders bring the realization that our loved one is no longer with us, and these pangs of grief catch us off guard...we continue to get reminders to call or text our loved ones, but now these reminders conflict with reality. Seeing these intrusive thought from the perspective of the brain may help make them less worrisome."

"You get reminders from your brain because these people are important to us. That does not change right away because the person has died. Your brain has to catch up. It is still running its regular programming of sending out notifications. You are not losing your mind; you are just in the middle of the learning curve."

More On How The Brain Functions

• "Attachment bonds keep us connected to our loved ones; motivate us to return to them, like a pliable elastic band; and create a feeling that something is missing when we are apart." "When we are together the brain...has chemicals it deploys in the service of our bonds, including dopamine and opioids, that make us feel good together...it also feels good to come back to them again and again." And after the death, the brain is confused, problem-solving and not depositing the feel-good chemicals.
• "Being in isolation is stressful...that creates cortisol, a stress hormone."
• "Bereaved people describe the extraordinary stress of grieving that feels particularly awful because they are facing it without the one person they would usually turn to in difficult times."
• "Our brain, by focusing on the limitless number of alternatives to reality, is distracted from the actual, painful reality that the person is never coming back."

Rumination

"For some of us, a wandering mind lapses into worrying or ruminating. Rumination focuses on things that have happened in the past. Worry focuses on events in the future about worst-case scenarios."

"Rumination is a way of coping by narrowing your attention to your negative feelings in an attempt to understand them...we were able to predict who was depressed, or would develop depression, by identifying people who spent more time ruminating."

Reflection is helpful; brooding is not. "Whether a person is seeking or solving...feeling better usually requires seeking and then getting to the solving part. Feeling better requires stopping the seeking, or ruminating, or worrying, at some point."

"The mind ruminates when it cannot resolve the discrepancy between its current state, such and feeling down, and its desired state, such as feeling happy or content...Rumination predicts depression and grief-related rumination predicts complicated grief."

"The thoughts are prolonging our sad or irritable mood, not whether the thoughts are true...the trick is not to determine whether the thoughts are true, but rather whether they are helpful."

"Rumination is an avoidance process...does not help us learn to tolerate the painful reality over the long term."

"Grief is the cost of loving someone."

"Grief is as unique as our relationship."

The goal of grieving is for your brain to adapt to learn how to restore a meaningful life.

• "Confronting one's emotions and understanding them has been considered a good coping strategy. Suppressing one's feelings, and avoiding thoughts that bring up emotions, on the other hand, has been put in the category of bad coping. The most recent research suggests that the subject is not as straightforward, however. The most reliable predictor of good mental health is have a large toolkit of strategies to deal with one's emotions and deploying the right strategy at the right time. It can be exhausting to have such high emotional intensity...there are good reasons to ignore our grief some of the time, in order to give the brain and the body a break, or even to give a break to those around us who feel emotional contagion. Distraction and denial have their usefulness."
• "Time off from grieving might look like denying, suppressing, or distracting oneself from one's feelings...and this was assumed to be bad for long-term adjustment. But time off from grieving can give your mind and your body a break from the stress of the emotional upheaval."
• "The key to coping well after you lose someone is flexibility, attending to what is happening day-to-day, and also being able to focus on coping with whichever stressor has currently reared its ugly head."
• "Our attachment needs are so basic...most of us learn over time to have our attachment needs met in a new or different way...this happens through strengthening the bonds we have with other living loved ones, by developing new relationships, and by transforming the bonds we have with the person who has died. These transformed, continuing bonds allow us to have access to them at least through the virtual world of our mind."
• "It seems that people with more resilient grief may no longer be predicting the rewarding outcome (of being with their loved one) as possible."
• "Confronting negative emotions in response to the death of a loved one, are often called 'grief work'. In the Western world, they are typically considered the most appropriate and most effective ways to cope. Ironically, engaging in activities that typically raise positive emotions, such as going to a party or watching some form of entertainment, are actually more effective in reducing sadness and grief. The undoing of negative emotions with positive emotions works because emotions change cognitive and physiological states. Positive emotions broaden people's attention, encourage creative thinking, and expand people's coping toolkit."
• "There are usually two reasons why we usually don't choose mood-boosting activities when grieving. First, doing fun things is not considered the 'right' way to act, so we worry what other people will think about our choice. Second, we anticipate that doing something enjoyable after a sad experience will make us feel guilty. When we violate social norms and expectations, guilt is a common response. However, even though people anticipated that they would feel guilty doing something fun, no one in the study felt guilty after watching the funny clip But the anticipation of guilt can deter people from engaging in enjoyable activities. Other research supports this finding that humans are pretty bad forecasters of how they will feel in future situations... Flexibility is beneficial...mood-boosting activities are a helpful part of your toolkit."
• "Do something to shake us out of our ruminative mood."
• "Try new strategies when we feel stuck."
• "Initially, in acute grief, we are just trying to stay upright, to put one foot in front of the other. As time passes, being stuck often feels like we are just going through the motions and unable to feel love, to be creative, or to help others...a toolkit of things to try when you feel overwhelmed."
• "Saying, 'I am not able to adapt to life after loss, yet.' Your brain is sorting out what works and what doesn't."
• Pay attention to what actually makes you feel better in the present moment.
• "Adaption requires the support of their friends and family, the passage of time, and some considerable bravery...to let the brain learn and adapt."
• "Yearning, anger, disbelief, and depressive moods decrease across time after the death of a loved one. These feelings do not follow stages, and people still experience them years after their loss. But their frequency declines as the frequency of acceptance increases. Acceptance may be the outcome of learning a new reality is here to stay and that we can cope with it."
• "Accepting does not have any bearing on whether or not you hate the fact that your loved one died. It simply acknowledges the reality, and stops the reaction there. No ruminating, no problem solving, no anger, no protest - just accepting the way it is."
• "There's a difference between accepting someone's death and resigning oneself to their death. Accepting is knowing the person is gone, that they will never return, and that there is nothing to be done about it...Accepting is focusing on life as it is now without the deceased, without forgetting the person."
• "We turn to our loved ones for what wisdom they can give us. We may also turn to our spiritual and moral values to guide us. Finally, we wait for our own brain to develop the wisdom to discern the best course of action that comes from learning from each new day's experiences."
• "Letting our tears come, and then letting them go. Knowing that the moment of grief will overwhelm you, feeling its familiar and knowing that it will recede."
• Often widowed older adults say that evenings and weekends are the hardest, when they feel the most lonely, because "everyone else has things to do and people to do them with...If grieving is a kind of learning, that means...we must learn how to plan and do those days and times differently...This is especially important for imagining upcoming holidays..."
• "Be places with fewer triggers and reminders". Change it up.
• "Restoring a meaningful life requires flexibly moving our attention from thinking about the past to thinking about the present and future. It requires us to move our thoughts from relationships that were, to relationships that are and relationships that could be, and back again...grieving does not mean we forget our loved ones who have died...Choosing to spend time thinking of someone you care for now does not mean forgetting someone you loved intensely, and whom you will love forever."
• "This person you have fallen in love with, whether it is your partner or your baby, has opened up new pathways in your brain..." and the brain creates the positive chemicals as before. "This has a powerful effect on our behavior, on our motivation, and on how we feel."
• New relationships "It was good then and it's good now." Yearning is not only for the past. It also means that there is something we do not like about the present and we want to change that by creating new relationships. Those new relationships can be with friends and pets, as well as a new partner.
• "Losses are twice as powerful psychologically as gains...gaining a new relationship is simply not going to fill the hole that exists. New roles and relationships are not able to fill the hole. Expecting that can only lead to disappointment."
• "If we are living in the present, we need to have someone who loves us and cares for us, and we need someone to love and care for us as well. If we can imagine a future in which we are loved, then we must start a relationship that eventually will become important to us in a way that is different from our previous relationship, but rewarding and sustaining...There will not be another person available who can easily fill that role. A huge investment must be made again in order to develop another strong bond and trust must be built over time and through shared experiences."
• "To temporarily relieve your stress a doctor might recommend, have two conversations with caring people, preferably including a hug, and call me in the morning."
• Insomnia is common and a reminder that your loved one is not there. That can trigger rumination...sleeping pills don't seem to really help...Fewer side effects and better outcomes from learning cognitive-behavioral therapy for insomnia. Waking at the same time every day helps.
• "Suppressing one's thoughts is, ironically, related to a rebound of those thoughts."
• "Our loved ones are not gone, because they are with us in our brain and in our mind."
• "If one believes that the only way to have a meaningful life is to be with the person who died, this goal can never be reached. Instead, one may have to give up this specific way of achieving the goal of a meaningful life, while elaborating on other ways...that's hard. You have a better chance of reaching your goal of a more meaningful life if you have many ways you might consider your life meaningful...a different life than you had before...death has a brutal way of clarifying to us what is meaningful."
• "The ability to imagine our future, a new and unknown future that no longer includes our deceased loved one, seems to have a similar brain network than remember our past...remembering the past and imagining the future is a significant overlap in the brain regions that uses the same neural machinery."
• "Only in the present moment can you feel joy or comfort...When you are present in the moment, the dopamine, opioid and oxytocin feedback help you move toward a restored, meaningful life."

Caring for the Bereaved

• "If you are listening to your grieving friend and supporting them with the goal of taking away their grief, you will only be frustrated. It is vital to provide support, love and care, but not because it will take away their pain. It is vital because by sharing and listening to their pain, they feel love and we feel loving."
• "We have to decide in any given moment, if it is wiser to hold them while they cry or to encourage them to get up and keep playing, because flexible approaches to strong feelings are most useful."
• "Gaining a loving, supportive relationship does not mean forgetting or rejecting the one that came before. For those supporting someone who is grieving, there is a real benefit in listening and offering encouragement, without judging when it is 'normal' to develop new relationships."
• "I do not think that other people can give advice to someone who is grieving...I think advice is exactly what makes grieving people hold at arm's length those who would like to help them. People are experts at their own grief, their own life, their own relationships...I can expose people to lots of ways of thinking about grief and scientific evidence...but each person must make their own path."

In Summary Dr. O'Connor shares...

"Grieving is a form of learning...we find new ways to express our continuing bonds, transforming what close looks like, because while our loved one remains in the epigenetics of our DNA and in our memories, we can no longer express our caring for them in the physical world or seek out their soothing touch...We must learn to be connected with them with our feet firmly planted in the present moment. This transformed relationship is dynamic, ever-changing over the years."

"We must learn to restore a meaningful life...which is hard." It requires having a growth mindset with learning to adapt.

"Because the brain is designed for learning, thinking about grief from the perspective of the brain can help us understand why grief happens...If we gift ourselves with the present moment, we may find opportunity in the present, even when we least expect it and the opportunity for connection and joy."

"I encourage you to stay in the present and try to learn from what happens day to day, and to learn from what works for you. I believe in your ability to solve your problems and to live a meaningful life after having experienced devastating loss...Death changes us, and we cannot function in the world in the same way we once did."