What Happens To Your Body When You’re Grieving

In a new book, Dr. Mary-Frances O’Connor explores the ways grief affects the body, from the heart to the immune system.

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• 0:52Ira Flatow?

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• 1:12Flora Lichtman?

  This is Science Friday. I'm Flora Lichtman. Today on the podcast, why grief hurts.

• 1:18Speaker 04

  It is our body's way of absorbing this blow and just telling us, hey, we're taking on a little extra load here as we're trying to understand what's happening in this new world where your loved one isn't with you.

• 1:34Flora Lichtman?

  We have all these expressions to describe the pain of loss. Heartache, a broken heart, a punch in the gut. I think of them as figures of speech. But my next guest says it's not so simple. Grief is an emotional experience, but it's also a physical one. Studies show that grief can change your physiology. Here with me is Dr. Mary Frances O'Connor, professor of clinical psychology and psychiatry at the University of Arizona. She's also the author of a new book, The Grieving Body, that looks at the physiological effects of grief. Mary Frances, welcome back to Science Friday.

• 2:11Speaker 04

  It's so nice to be here, Flora.

• 2:14Flora Lichtman?

  So a few years back, you were on the show talking about your previous book, The Grieving Brain. When was it clear to you that, yeah, there is enough science to write a whole other book on the grieving body?

• 2:27Speaker 04

  It's funny, I've been studying the reaction to loss, you know, just that natural grief response in the brain, but also the body for, gosh, 25 years now. And as I was writing The Grieving Brain, I thought I would put all the information all in one book. And then I realized, wait, I think there's a whole other book in here. I'm not going to have room. So it got transformed into two books. The second book, The Grieving Body, is about the research on cardiovascular and immune responses we have in grieving.

• 3:00Flora Lichtman?

  Let's get into the science. I mean, when you're grieving, you know, many of us know you feel it in your heart. It physically hurts. What's actually happening?

• 3:12Speaker 04

  We don't often realize that grief is a physiological response, as well as an emotional one. And I think the research has really helped us to hone in a little bit on what's going on in the body. So we know that there are changes, from excellent research by Tom Buckley and others from Australia, that in the first few months after the death of a loved one, our blood pressure actually goes up a few millimeters mercury and our heart rate actually goes up a few beats per minute across 24 hours. And seeing that in black and white, those mechanisms was very compelling to me.

• 3:53Speaker 04

  It really sort of validated what a lot of grieving people have been saying, that it feels like grief is in the body.

• 4:03Flora Lichtman?

  I mean, does that mean that when you have a heartache, your heart is actually being injured in some way?

• 4:10Speaker 04

  Isn't that interesting? So I think there's two parts of that that are really interesting. The first one is we don't actually know, we need better research to know exactly what's happening. We have these tantalizing, sort of on average, across the population kind of statistics. But we need to understand for this individual, what does that feeling mean? That I think the other thing you said that's so interesting is it may not be that it's an injury. That is to say, our body simply reacts and recover. So during a wave of grief, we may have, you know, a knot in our throat,

• 4:50Speaker 04

  or our gut may hurt, or we may find it more difficult to breathe. That doesn't necessarily mean something is broken. It is our body's way of absorbing this blow and just telling us, hey, we're taking on a little extra load here as we're trying to understand what's happening in this new world where your loved one isn't, isn't with you.

• 5:16Flora Lichtman?

  Hmm. You write about people dying of a broken heart, which I thought, again, was sort of a metaphor or just a, you know, a turn of phrase. But it sounds like it's, it's more than that.

• 5:29Speaker 04

  This has been one of the most compelling findings because we've seen this in very large epidemiological research. So one and a half million Finnish people, for example, in a study. And what we know from the evidence is that, for example, in the first three months after a man's wife dies, he is almost twice as likely to have a heart attack as a married man during that same period of time.

• 5:56Flora Lichtman?

  Twice as likely?

• 5:58Speaker 04

  Twice as likely. Isn't that a crazy statistic?

• 6:01Flora Lichtman?

  It really is.

• 6:02Speaker 04

  It's like 1.8% for women, so slightly lower, but an extraordinary risk when we think about medical risks. And this has been replicated again and again in large studies across the population.

• 6:14Flora Lichtman?

  Do we understand the mechanism? Why are you more likely to, why are you more likely to have a heart attack?

• 6:20Speaker 04

  This is where my research really sort of tried to dig in. So in a study that I did with Roman Politsky, who's now at Emory University, we looked at, could it be that during a wave of grief is sort of the riskiest moment? And in that study, what we found was, sure enough, people's blood pressure rose during a wave of grief. What's fascinating is the people who were struggling the most with grief when they walked into the lab. So how they'd been doing in the past couple of weeks, they actually showed the greatest increase in blood pressure during that wave of grief.

• 7:00Speaker 04

  So it starts to give us an inkling that maybe, in fact, we could start to do some predicting of these mechanisms. Maybe we could figure out how to include bereavement in medical care.

• 7:12Flora Lichtman?

  Like, maybe we could treat people or intervene in some way?

• 7:15Speaker 04

  You know, I think of it a little bit like pregnancy. This sounds like a funny analogy, but, you know, pregnancy is very physiological. That's sort of an obvious statement, but it's not a disease. It's not a disorder.

• 7:28Flora Lichtman?

  Although it can sometimes feel like one.

• 7:30Speaker 04

  Well, this is the thing. You really want medical care, right? And that's mostly in the sense that we need surveillance, so we need prenatal care. And then we need to know what's happening so we can intervene if something goes wrong. Similarly, in bereavement, it's just a riskier time for our physiology. And so it's important to think about how are we supporting that grieving body for this person who's undergoing what we know is the greatest life stress?

• 8:00Flora Lichtman?

  What's happening with the immune system when you're grieving?

• 8:03Speaker 04

  When I was at UCLA, I did a postdoc in psychoneuroimmunology. And part of the reason I wanted to do that is because I really wanted to understand what we call all-cause mortality. So while cardiovascular risk goes up in acute bereavement, in those first couple of months specifically, we actually see increased risk for all sorts of different outcomes. Um, cancer recurrence and even things like a pneumonia. And so I thought, well, what on earth could be a mechanism that's affecting all these different causes of morbidity and mortality? And of course, the immune system acts on every single one of our organ systems.

• 8:48Speaker 04

  So it makes autoimmune disorders harder, like rheumatoid arthritis. And so by looking at blood draws from people who were grieving, who were courageous and agreed to be in my studies, we saw that inflammation levels are higher in bereaved people. And now, you know, larger studies than mine have confirmed that from other labs as well.

• 9:16Flora Lichtman?

  After the break, what grief tells us about love?

• 9:19Speaker 04

  When there's a death, it reveals all the ways that we're being externally regulated by our loved ones. They are our external pacemaker, but we can't really see that often until they're gone.

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• 12:02Flora Lichtman?

  Are the physical effects from grief different than the effects you see of stress on the body, acute stress?

• 12:11Speaker 04

  That's such a good question. So I like to say, you know, the heart doesn't have a lot of choices. Heart rate goes up or it goes down, right? Blood pressure goes up or it goes down. So at that level of peripheral physiology, we might say, so at the sort of output in the body, there's not a lot of differences necessarily between the stress of grieving and the stress of other things, like being in a threatening situation. But in the brain, we think there are differences because you have to think about the idea... Well, really, you can't think about loss without first thinking about love and bonding,

• 12:56Speaker 04

  right? So when you fall in love with your partner, you fall in love with your baby, the brain is encoding what we like to say, the brain encodes a we, right? It encodes the relationship as a functioning unit. Your body no longer really ends at the end of your skin, but incorporates that other person.

• 13:18Flora Lichtman?

  Yeah, I think anyone who's had kids can feel this. You feel like your heart's outside of your body.

• 13:23Speaker 04

  Absolutely. But even beyond metaphorically, think about what we call kangaroo care, where we lay an infant on the skin, right, of the chest of the parent. And it reduces pain, it improves breathing, all these good factors physiologically, right? Or if I, you know, get a hug from my partner, my heart rate goes down. So it turns out that couples and bonded infant caregiver, they form this we. And what happens is when there's a death, it reveals all the ways that we're being externally regulated by our loved ones.

• 14:05Speaker 04

  They are our external pacemaker, but we can't really see that often until they're gone.

• 14:13Flora Lichtman?

  I want to get a little personal for a minute. I mean, in your book, you write about your own grief related to a medical diagnosis. Are you comfortable talking about that?

• 14:22Speaker 04

  I am now. You know, there's a lot of stigma in society. So this wasn't something I talked about early in, you know, being a postdoc, being an assistant professor, because you're nervous about how that will go. But I have multiple sclerosis and What I didn't realize for many years was that I was actually diagnosed a little more than a year after my mother died in my early twenties. And I want to be very clear that that my mom's death did not cause my MS. We have a family history. But the idea that the predispositions we all carry around

• 15:00Speaker 04

  can be really revealed again during this stressful time, I think, is one way that that happened for me. But what it meant was, in my lived experience, I came to deeply know the grief of of health, the grief of loss of health, loss of certainty about, you know, my functioning. And it meant that day to day, I had to make room for my body. I had to start incorporating how to care for my body in my day to day life because I wanted to do the meaningful work that that was so important to me.

• 15:37Flora Lichtman?

  Is that one of the lessons for us, sort of working with your body, being attuned to what's happening with your body?

• 15:45Speaker 04

  I often think, why would I bother to tell people all this scientific information that I know? And I think it's because when we know these facts, and they're on average, they're across people, they might not be perfectly attuned to your situation. But by knowing these things, we can figure out how to work with your body because grief is a natural response to loss. Our body, our mind, it mostly knows what we're doing if we don't get in the way. And so finding, you know, here's a silly sort of example. You can't force yourself to go to sleep.

• 16:25Speaker 04

  Every grieving person will tell you that sleep is really difficult when we have loss. But you can, for the most part, force yourself to get up at the same time every day. What's important about that is it resets your circadian rhythm if you intervene in your behavior. It means that your hormone system, your endocrine system, knows, oh, this is the set point that I can come back to again and again and regulate all those stress hormones that's going to help you emotionally to deal with your loss as well.

• 16:59Flora Lichtman?

  If you're just joining us, I'm speaking with Mary Frances O'Connor, author of The Grieving Body. This is Science Friday from WNYC Studios. I think a lot of people who've grieved may have had this experience. There can be this annoying feeling when you're grieving a loss, like, I should be doing it better. I should be getting through this faster, or, you know, I should be optimizing this in some way. I know you're interested in helping people grieve better. How do you do that? Or how do you navigate that? How do you, how do you help people without putting pressure on people?

• 17:33Speaker 04

  I think it's really important to remember that this is a natural process, right? In my laboratory, we do something where, at the beginning of the summer, we plant seeds, flower seeds in the lab. And the reason is because, think how long it takes. You have to keep watering, right? Like, there's no evidence that that seed is sprouting below the surface. You have to keep watering with faith in order to see those first sprouts. There's something about when we look at living systems to recognize that adapting, growing, learning, it takes a long time. If you cut your hair, think how long it takes for your hair to grow back.

• 18:18Speaker 04

  And no one says to you, why isn't your hair growing faster? What is wrong with you?

• 18:22Flora Lichtman?

  Right. The same should apply to our response to the loss of a loved one.

• 18:28Speaker 04

  This is the thing. If it is partly a physiological response, to some degree, there's no rushing that. And you're right, our society is consumed with optimizing our experience. I think many cultures, many periods of history, teach us bereavement is a time to pause. It's a time to give ourselves a little more time and space because our bodies, our minds, our relationships are doing so much to understand the enormity of the loss of this person in our midst. And that pause, that reflection, just giving each other a little bit of extra space

• 19:12Speaker 04

  and, and, and grace maybe, helps us to process what the heck is going on.

• 19:19Flora Lichtman?

  You've dedicated your career to the subject, the science of grief and bereavement. You have a whole lab studying it. Why is this such a compelling topic for you?

• 19:30Speaker 04

  When I was 13 years old, my mother was diagnosed with stage IV breast cancer. And there was cancer cells in every lymph node they took out. So they knew it had already migrated to other parts of her body. And you know, I didn't understand this. You know, no one told me when I was 13 that the doctor didn't expect her to live through the year. But I did understand that grief came to our house, you know? And so, in many ways, you know, he described her as his first miracle. She actually lived another 13 years.

• 20:10Flora Lichtman?

  The doctor did?

• 20:11Speaker 04

  Yeah, isn't that incredible? She lived till I was 26.

• 20:15Flora Lichtman?

  Wow.

• 20:17Speaker 04

  And it meant that during that time, I think I just became more familiar with grief from a very unfamiliar experience to feeling OK about having people cry uncontrollably when they talk to me. And so, in some ways, it's not so much about figuring it out for myself, but like, how can we help each other? How can we sit with each other as we go through this? And maybe, you know, because of my unique background, how do I take what people are telling me and map that on to neuroimaging scans and blood draws that I'm doing, hopefully in a way that helps us to make sense of both the emotional, the relational, and the physical response?

• 21:02Flora Lichtman?

  Well, I think you have. I've learned so much. Thank you, Mary Frances.

• 21:06Speaker 04

  You're so welcome. Thank you, Flora.

• 21:08Flora Lichtman?

  Dr. Mary Frances O'Connor, professor of clinical psychology and psychiatry at the University of Arizona. Her new book, The Grieving Body, is out now.

• 21:19Flora Lichtman?

  And that is about all we have time for. Lots of folks helped make this show happen, including

• 21:25Speaker 06

  Praise Abu Chee. Sandy Roberts.

• 21:28Flora Lichtman?

  Robin Kazmer. Jordan Smudgick. I'm Flora Lichtman. Thanks for listening.