Huberman Lab - The Science & Process of Healing from Grief

Welcome to the Huberman Lab Podcast,

where we discuss science

and science-based tools for everyday life.

I’m Andrew Huberman,

and I’m a professor of neurobiology and ophthalmology

at Stanford School of Medicine.

Today, we are discussing grief.

Grief is a natural emotion that most everybody experiences

at some point in their life.

However, grief is something

that still mystifies most people.

For instance, we often wonder

why getting over the loss of somebody or a pet

is so absolutely crushing.

In some cases, it’s obvious

because we had a very close relationship

to that person or animal.

But in other cases, it’s bewildering

because somehow, despite our best efforts,

we are unable to reframe and shift our mind

to the idea that the person or animal

that at one point was here and so very present is now gone.

Today, we are going to discuss how we conceptualize grief,

both at an emotional and at a logical level.

I’m going to teach you about the neuroscience

and the psychology of grief

and incredible findings that have been made

in just a few key laboratories

that point to the fact

that we essentially map our experience of people

in three dimensions.

I’ll just give you a little hint

of what those dimensions are.

They relate to space, where people are,

time, when people are, I’ll explain what that means,

and a dimension called closeness

and how those three dimensions of space, time, and closeness

are what establish very close bonds with people

and are what require remapping, reorganization

within our emotional framework and our logical framework

when we lose somebody for whatever reason.

Within that understanding,

I’m confident that you will have greater insight

into the grief process.

And should you ever find yourself within the grief process,

as I imagine most everyone will at some point,

you will be able to navigate that process

in what psychologists and neuroscientists

deem to be the most healthy way of going through grief.

Indeed, moving through grief

requires a specific form of neuroplasticity,

a reordering of brain connections,

and also the connections between the brain and body.

I’m going to teach you about all of that today.

So you’re going to learn a lot of scientific information.

You will also learn a lot of tools

that you can put in your kit of emotional

and really emotional physical tools

that will allow you to move through grief

in this healthy way that I referred to earlier.

I’ll also point out some of the myths about grief.

For instance, many of you have probably heard

that there are designated stages of grief

that everybody moves through.

It turns out that recent research refutes that idea.

There are different stages of grief,

but not everybody experiences all of them.

And hardly ever does somebody move through

all of those linearly, meaning in the same order.

I also want to point out that for many of you

that are not experiencing grief in this moment,

there’s an important scientific literature

that teaches us that how we show up to grief,

meaning our psychological and our biological state

that we happen to be in when a loss occurs,

strongly dictates whether or not we end up

in what’s called complicated or non-complicated grief.

And non-complicated grief is a form of grief

that is very prolonged, and in fact,

often requires that people get

substantial professional help.

So whether or not you’re experiencing grief

that’s mild, moderate, or very intense right now,

or whether or not you are not experiencing

any grief at all, you’re going to learn

scientific information and tools that will help you

navigate through this process that we call grief.

Before I begin, I’d like to emphasize that this podcast

is separate from my teaching and research roles at Stanford.

It is, however, part of my desire and effort

to bring zero cost to consumer information

about science and science-related tools

to the general public.

In keeping with that theme, I’d like to thank

the sponsors of today’s podcast.

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Okay, let’s talk about grief.

I just want to remind you that everybody,

at some point in their life, experiences grief,

either mild grief, moderate grief, or extreme grief.

And it’s somewhat obvious, but worth stating nonetheless,

that how intense grief feels and how long it lasts

scales with how close we were with somebody.

And if you learn that the person who works at the coffee shop

or that you see at the coffee shop on a regular basis

happened to pass away or tragically get killed

in a car accident, that can be quite upsetting.

It can be somewhat disorienting to you.

If you, for instance, just saw them yesterday,

or they seemed perfectly fine when you saw them last.

But of course, the grief that results

from the loss of somebody

to whom you have that level of attachment

is far and away different than the level of grief

that you would experience

from the death of a very close loved one,

a sibling, a parent, God forbid, a child.

When that type of loss occurs,

it’s often the case that our entire relationship to life

feels different.

Places and things that at once brought us joy and laughter

now bring the opposite.

They bring us intense feelings of sadness and loss.

Psychologists and neuroscientists distinguish

between complicated grief and non-complicated grief.

They are very similar at the outset.

One of the fundamental differences between them, however,

is that complicated grief,

which occurs in about one in 10 people,

is a situation in which grief

does not seem to resolve itself

even after a prolonged period of time.

Later in the episode,

I’ll point you to the actual tests that are used.

I’ve provided links to those in the show note captions

that will allow you to distinguish

between complicated and non-complicated grief.

These arrive through the important research

of the world-class grief researchers that are out there

and the psychologists that treat grief.

The important thing to point out is that grief is a process.

Like any biological or psychological event,

it has a beginning, a middle, and an end.

And I do believe that being able to orient

in terms of where you are in that process

can be immensely beneficial,

not just for predicting how long it’s going to last,

but in order to conceptualize the person or animal

that you lost in a way that allows you

to best preserve their memory

while maintaining your own functional capacity in life.

Along those lines, I want to point out

that grief and depression,

while they can feel quite similar in certain ways

and have overlapping symptomology,

loss of appetite, challenges sleeping,

crying in the middle of the day

for no apparent reason, et cetera,

they are distinctly different processes.

The modern research teaches us, for instance,

that grief rarely responds well to antidepressants,

whereas depression can often respond well

to antidepressants.

Everything we know and understand about grief

is that it is a distinct psychological

and physiological event in the brain and body

from depression.

Rather, perhaps the best way to think about grief

is that it is actually a motivational state.

It is a yearning, it is a desire for something.

And somewhat surprisingly,

it’s not just a desire to have that person back

or to have that animal back.

You might think, well, that’s crazy.

Of course it is.

But of course there are instances

in which someone passing away or an animal passing away

is actually providing relief for that person

because of where they happen to be in their life.

Today, I’ll teach you about grief as a motivational process

because grief as a motivational process

really is the way that scientists and psychologists

now conceptualize grief and the treatments for grief

so that people can move through them effectively.

As we wade into this important topic,

I’d like to emphasize some of the common myths

and misunderstandings about grief.

Some of the myths and misunderstanding

arrive from the beautiful work of Elizabeth Kubler-Ross,

a psychologist who wrote the famous book

on death and dying.

And I should emphasize that while Kubler-Ross

was a real pioneer in establishing

that there are indeed different stages of grief,

the modern science, both psychology and neuroscience,

point to the fact that not everybody experiences

all of the stages that Kubler-Ross defined,

nor do they move through those stages in a linear manner.

Sometimes they’re out of sequence.

I’ll just highlight the five stages

that Kubler-Ross illustrated

because some people really do experience all of them.

Sometimes in the order I’ll read them,

but again, oftentimes they don’t.

The different stages of grief very quickly

are denial, anger, bargaining, depression, and acceptance.

In the Kubler-Ross model, denial is always the first stage.

And denial is just as it sounds, this disbelief.

It cannot be, there’s no way.

A refusal to accept the new reality

that the person or animal is gone.

The second stage, anger, is one in which

the individual recognizes that the person is indeed gone

or the animal is gone,

but their body and their mind go into a motivated state.

This is important.

We’re going to return to this idea of grief

as a motivated state that involves action plans

in more depth as we go further.

And then the third stage is bargaining,

what’s sometimes called the negotiating phase.

This idea that, well, if I had just done this,

or if they had just done that, or if I’d called more,

or somehow refusing to accept the reality.

So in a way this can be blended with denial in thinking,

well, if I just don’t think about it,

it won’t be real, this kind of thing.

So again, stages can be blended or braided together

because emotions are complex, right?

Even though there are different stages to this process,

they can sometimes be melded together.

The fourth stage of depression that Kubler-Ross described

is one of why go on living?

Why should I go on living?

Why should I continue in this grief stricken state

that seems to deprive me of all the richness of life

that I experienced when the person or animal was still here?

And then the fifth stage is acceptance.

This internalization, not just cognitively,

not just thinking, but emotionally,

that it’s going to be okay.

That not just this too shall pass, but that it has passed.

So again, the five stages of grief that Kubler-Ross defined

were immensely important as a critical parsing

of the different stages that one could move through.

But unfortunately those five stages

were sort of taken to be gospel for a long time.

And we now know based on neuroimaging,

based on more in-depth psychological evaluation,

and frankly, more researchers and clinicians

moving into this area and observing

that while much of what Kubler-Ross described

does hold true, it’s not always the case.

And in fact, the contour of the grief process

actually has a lot of dimensions

that are not encapsulated by those five stages.

There’s also a lot of variation

depending on whether or not the loss is due to old age,

disease, whether or not there was suffering prior or not,

suicide or non-suicide types, deaths and losses,

and even grief about non-death losses,

a relationship breakup or something of that sort,

or even homesickness and things of that sort.

So I do want to tip our hats

to the incredible work of Elizabeth Kubler-Ross.

By no means am I or do other researchers

try and discount her incredible contributions,

but I think nowadays we have a different

and frankly a better understanding

of what the grief process is like,

and as a consequence, better tools to move through grief.

In order to really understand what grief is

in your brain and body and how to best navigate grief,

I’d like you to do an experiment with me.

For the next five minutes or so,

I’d like you to at least try to discard

of all prior notions of grief as just a state of sadness.

I want to acknowledge that it is and does involve sadness,

but for right now, let’s think about grief

as a motivational state, as a desire for something specific.

In fact, I’d like you to think about grief

as an attempt to reach out and get something

that you very much want.

Imagine yourself extremely thirsty, for instance,

on a very hot day,

and a glass of water is right in front of you,

and it’s a beautiful, clean glass of water,

and it’s completely full,

and you so badly want to drink that water,

but no matter how intensely you want it

and no matter how hard you try and reach it,

it always shifts just outside your reach.

So if you can imagine that, even just a little bit,

you are touching into the experience of grief.

How do I know this?

Well, I know this because brain imaging studies

involving what’s called

Functional Magnetic Resonance Imaging, fMRI,

in which you can evaluate

which brain areas are more active than others

according to blood flow,

which correlates with neural activity and so forth,

teaches us that the brain areas that are associated

with motivation and craving and pursuit

are some of the primary brain areas and circuits

that are activated in states of grief.

I’d like to share an important paper with you

as one of the first to illustrate the fact

that grief is not just a state of sadness and pain.

It is indeed a state of yearning and desire

of something that is just outside your reach,

and unfortunately will always be just outside your reach

until you remap your relationship to that person or thing.

The title of this paper is posed first as a question,

so that’s why I’ll read it as such.

The title is Craving Love,

Enduring Grief Activates Brain’s Reward Center.

And the first author of this paper is Mary Frances O’Connor.

She’s a professor of psychology at the University of Arizona

and one of the world leaders in the study of grief

from a neuroscience perspective.

With some luck, we’ll get her here

on the podcast as a guest.

Now, this paper has several important features.

I’ll just highlight a few.

One of the features of this paper that’s not surprising

is they found that people who are in a state of grief

are in a state of pain.

That is brain areas associated with pain,

actual physical pain are more active

than in non-grieving individuals.

However, they also found that people who are experiencing

what’s called complicated grief

showed reward-related activity in a brain area

called the nucleus accumbens.

What is reward-related activity?

Reward-related activity is activity of neurons

that’s associated with motivational states.

And the nucleus accumbens is a brain center

in which dopamine has the effect

of creating a motivated state.

If ever you thought that dopamine

was only associated with feeling good,

you hear about dopamine hits,

well, this paper and papers like it

firmly tell us that dopamine is not about feeling good.

Dopamine is about placing us into a state

of desiring things and seeking things.

This is true in addiction.

This is true when we’re hungry and we want to eat.

This is true when we want to reproduce.

This is true in every state

in which we are reaching for something

outside our immediate ability

to give that thing to ourselves.

This is very important to understand

if you want to understand grief

and how to move through grief.

Grief is not just about sadness.

It is a state of sadness,

hence the activation of brain areas associated with pain.

And it is a state of desire and reaching for something.

And for those of you that have experienced grief,

I think that will resonate with you.

In that understanding that grief is both a state of pain,

but also a state of wanting.

And in the understanding that when we lose somebody,

either because of breakup or because of death,

or if an animal dies or gets taken away or is missing,

that state of wanting and desire

drives an activation state within us.

Now, the key thing to understand

is that the activation of those reward centers

and the involvement of dopamine

puts us into an anticipatory state,

a state of waiting for something to happen.

It also puts us into a state of action or desiring action.

Our body and our mind are what I like to refer to

as center of mass forward.

We are seeking how to resolve the craving,

even if we know that is impossible.

Why do I say that?

Well, we understand also on the basis

of brain imaging studies and also some studies in animals

that I’ll describe in a moment,

that in order to understand grief,

we have to understand how attachments

are represented in our brain.

And it turns out that both attachments

and the breaking of attachments in healthy ways

are governed by three important, what we call dimensions.

A dimension is just some feature of the world

that’s represented in our brain.

So for instance, the color red doesn’t exist in your brain.

You happen to have cells, neurons in your eye

that respond best to long wavelengths of light.

And those long wavelengths of light

happen to be what are reflected off things

that are perceived as red.

So in your mind, you have a notion of red.

I know this is a little bit abstract,

but you’re not actually lighting up red neurons

in your brain, and that’s why you see red.

You are lighting up neurons in your brain

that represent the presence of red things

in your environment.

Similarly, we have neurons and maps,

or we say representations of other dimensions.

We have dimensions of touch.

We have dimensions of sound.

And as I’ll now teach you,

we have three dimensions that define our relationship

to people and animals and things.

And when those people, animals, and things

are within our immediate vicinity,

or if we know how we could access them, right?

If somebody’s still alive,

there’s generally some way to access them

unless they’re refusing to interact with us.

Well, when we understand that,

our motivational states can operate in a way

that’s logical.

We know that, for instance,

if we want to find our mother, brother, sister,

significant other, dog, cat, parrot, et cetera,

we have to go through a certain set of steps.

What are those three dimensions and how do they work?

And that’s what I’m going to teach you now.

So at risk of sounding a little bit too reductionist,

we are now going to describe your relationship

to anything, everything, and anyone

in these three dimensions.

How can we do that?

Why would we even want to do that?

Why would we want to rob the complexity of relationships

of their contour and their detail?

Well, if we can understand the dimensions

in which we map our relationship to people,

animals, and things,

then we can understand why it is

that when those people, animals, or things

are not accessible to us,

why it hurts so much

and why it takes a certain amount of time

in order to re-understand, if you will,

or remap our association to them.

I promise that in grasping the information

I’m about to give you,

you will be able to better orient in the grief process

and you’ll be able to move through it more effectively.

The three dimensions of relating to someone

or an animal or a thing are space, time, and closeness.

And in order to illustrate each one

and how they work together to support relationships

and their involvement in the grieving process,

I’m going to tell you about an experiment.

This experiment was actually done.

The experiment involves putting people into a brain scanner

that allows the researcher to evaluate brain activity

in different areas.

In fact, can look in a very non-biased way,

not make any predictions about which brain areas

are going to be involved.

And the experiment is the following.

The person, we should say the research subject,

first sees images of things that reside

at different distances from one another.

And when I say things, these are objects.

So in one case, it’s a beach or a parking lot

with bowling balls set at different distances

from one another.

Their brain is imaged.

And as their brain is imaged,

they see different pictures of different scenes,

the beach, the parking lot, et cetera,

bowling balls spaced in different ways,

close together, far apart,

regularly spaced, non-regularly spaced.

When one does this sort of experiment,

you see a lot of brain areas activated,

not surprisingly the visual cortex,

the area of the brain that is responsible

for creating visual perceptions,

but also a brain area that seems uniquely tuned

to the distance between you and the objects.

So whether or not the bowling balls are far away

or close together from one another,

and whether or not they are far away

or close to you physically.

So literally the distance between you and these objects,

we’ll refer to that measure,

that dimension as we call it as proximity, okay?

Whether or not it’s very close to you,

high degree of proximity or far away, low proximity,

but it’s simply physical space.

Then subjects listen to tones.

Those tones also are spaced from one another.

So it could be something as simple

as my hand meeting the table top

that I’m happening to be sitting in front of.

So it’s,

they image the brain.

Of course, areas of the brain

that are associated with auditory perception are active,

not surprisingly,

but as they evaluate different types of sounds

and patterns of sounds, for instance,

they can start to parse brain areas

that seem uniquely tuned to the spacing of sounds,

independent of what sounds are coming in.

So whether or not it’s musical notes

or my hand hitting the table or human speech,

they identified a brain region that is uniquely tuned.

That is, it becomes active specifically in response

to changes in the spacing between sounds,

much in the same way as they could identify brain regions

that were only activated when there were changes

in the distance between objects,

such as the bowling balls

that I used in the previous example.

And then the subjects saw a different set of images.

The images that they saw were of people and of faces.

And some of the images that they saw

were of people’s faces right up close.

And other images were of people at a distance

where you could see the whole body of the person.

Now, they also varied the emotional relationship

to those people.

That is, they were able to get photographs

from these research subjects’ lives.

So they could show them pictures of, for instance,

their sister or some random person off the street.

They could show them pictures of a parent or of a neighbor

or of a celebrity that’s well-known

or of somebody that they didn’t know at all.

So they were able to vary both the position of the person,

close or far, and they were able to vary

the emotional distance to the person,

which is this dimension that I’m referring to

as closeness, which is not physical closeness,

but how attached or how well you know somebody.

Now, this is maybe sounding

like a somewhat complicated experiment,

but the takeaway from this experiment

is exquisitely simple and exquisitely important.

The result was that in all three conditions,

changes in the physical spacing of these objects,

changes in the temporal,

that is the time spacing of these sounds,

and changes in the emotional distance

between the subject and different people,

the same brain area was uniquely activated.

Now, that is an incredible thing to find

because what it suggests is that,

yes, of course, there are brain areas

that are associated with representation of visual objects.

And that, yes, of course, there are brain areas

associated with representation of different sounds.

And of course, there are brain areas

associated with faces.

We now know this.

In fact, there’s something called the fusiform face area,

which is uniquely tuned to faces.

But at the same time, there is a unique brain region

that is activated in all three of the conditions I described

that has to do with how far you are from somebody,

both in space, in time,

and in terms of emotional closeness.

And that brain area, it turns out,

is a brain area called the inferior parietal lobule,

the inferior parietal lobule.

Now, you don’t need to know

where the inferior parietal lobule is.

In fact, you don’t even need to know

the name of this brain area.

What you do need to know, however,

if you want to understand grief

and how to move through grief,

is that your map of people

is not a map of emotional closeness per se.

It is a map of emotional closeness,

what we call attachment,

that is interwoven, that is braided in

in a very intimate way

with your map of where they are in physical space

and where they are in time,

when you saw them last,

when you’re likely to see them again.

And if you were to want to see them,

how much time it would take to reach them

or for them to reach you.

Now, earlier I said that one of the key functions

of our nervous system is to be able to make predictions.

And so it’s somewhat obvious,

but nonetheless important to state and restate

that one of the most powerful aspects

of our attachments to people, animals and things,

is our ability to predict

what it would take to see them again

and when we are going to see them again.

In fact, we could say that our ability to locate someone

or an animal or a thing in space and time, right?

Where they are and how long it would take

for us to reach them or them to reach us,

is a prediction of the requirements

to engage in the attachment.

In order to illustrate this at a little bit more depth,

let’s just do a fill in the blank experiment.

You can do this now in real time.

I want you to think of somebody that you either rely on

or that you care about very, very much.

And I’ll just allow you to fill in the blank

on this sentence.

If I want to see blank, the person or animal,

I could see them within blank amount of time, right?

If right now you wanted to see this person or animal

or maybe even a thing,

how long would it take you to reach them?

Could be a day, could be a second,

could be there right next to you.

All you’d have to do is turn your head.

Now answer this.

If this person were to travel halfway around the world

and land in their plane,

I would expect to hear from them

within blank minutes of them landing.

The answers of this of course will differ.

Now I’d like you to answer this question.

If I’d like to find myself,

it would take me X amount of time.

And of course, if you’re listening to this

and you’re understanding it and you’re of a rational mind,

the answer to that should be zero seconds, instantaneous.

You are always able to locate yourself in space and time

provided you are in the appropriate state of mind,

meaning not asleep, for instance.

That last question might seem somewhat silly,

but it’s a fundamentally important one

because it illustrates the extremes

at which we map our relationship to ourselves

relative to other people and things.

Now, if all of this sounds like a bunch of neuropsycho

babble parsing of the obvious,

I’d encourage you to suspend that belief

for the moment, because if you understand

that all relationships are mapped in the brain and body

through these three dimensions,

space, time, and closeness or proximity of space,

proximity in time and proximity of attachment,

how close or rich or bonded you are to someone.

Well, if you can understand that,

then it almost becomes obvious

or at least it becomes intuitive

as to why after the loss of somebody,

in particular, a death or the loss of an animal,

this map has to be reordered.


Because if we are attached to someone or an animal

at a deep level, it is almost always on the basis

of a lot of what we call episodic experience,

a lot of episodic memories, memories of things that happen.

Episodic memories are literally the conscious recollection

of your experience of somebody or an animal or a thing.

And within that memory, you have an understanding

of what has happened with them in association to you,

what’s going on with them, where it happened,

when it happened.

You have a rich knowledge database

that we call implicit knowledge, right?

You might not be aware of it all the time,

but it’s within you of what this person is like

and what they’re doing in their life.

When somebody is taken away from us for whatever reason,

episodic memories persist for some period of time,

and they are still linked to our feelings of attachment.

Grief is the process of uncoupling, unbraiding,

and untangling that relationship

between where people are in space, in time,

and our attachment to them.

What I mean by this is when somebody or an animal

or a thing is taken from us, either by decision or by death,

or by circumstance, well, in that case,

our entire memory bank and our ability to predict

where and when they will be,

and therefore when we can feed our attachment to them again,

that whole map is obliterated,

except that the attachment itself has not been disrupted.

Assuming that you are deeply attached to someone

or an animal or a thing, that attachment persists,

and the grief process is one in which you have to reorder

your understanding of them in space and in time.

This is very, very hard to do, and for some people,

it’s almost impossible to do,

at least at the outset of grief.

This, in a very neuroscience-y way,

explains this stage that Kubler-Ross described,

which many, again, not all, but many people experience,

which is one of denial.

How could it be?


Well, when we have a rich catalog of experiences

with somebody or of them, right, ideas about them

and what they do, how they spend their day,

what they do and don’t do, where they do it, et cetera,

well, that memory bank is not just flushed out

the moment that we learn that they’re no longer with us.

What happens is the brain continues

to make these predictions

that they will be in a certain place or a certain time,

right, that they’ll be in a certain time zone

or they’ll walk in the door any moment.

All of those predictions still hold.

The neural activity continues.

We call this reverberatory activity.

That explains the yearning for and the desire to interact,

and yet it’s just beyond our reach,

because once they’re gone,

our brain still functions in a way,

these neural circuits still function in a way

that put us into an action state of seeking them,

looking for them in the same location,

expecting them to contact us at whatever frequency

that we were used to hearing from them

or that we could reach out to them

and reliably get a response.

It is immensely disorienting, in other words,

to maintain a close attachment and at the same time,

to not be able to make predictions

about where that person, animal, or thing is

in space and time.

Now, if this seems somewhat abstract,

I’m going to continue to flush it out.

And actually right now, I’d like to flush it out

with a real world example of grief and loss

that comes to us from perhaps one of the greatest minds

in human history and somebody who was intensely grounded

in reality and logic and indeed the physics of the world.

And the person I’m referring to is none other

than the Nobel prize-winning physicist, Richard Feynman.

Many of you are probably familiar with Richard Feynman.

Some of you perhaps are not.

Richard Feynman was a Nobel prize-winning physicist

known for his thick New York accent.

He was actually not from Brooklyn,

as many people think.

He was actually from Far Rockaway in Long Island.

Thick New York accent, very personable, exceptional teacher,

brilliant mind, hence the Nobel prize in physics.

Also a quite funny and amusing person,

told great anecdotes, et cetera.

Feynman had a childhood sweetheart

who turned out to be his first wife.

Her name was Arlene.

And it was well-known that Feynman

was absolutely in love with her.

He would talk about her all the time.

She had a profound influence on him and his thinking

and ultimately on his public education efforts later.

If you haven’t already read books

such as Surely You’re Joking, Mr. Feynman,

or What Do You Care What Other People Think?

I encourage you to do so.

And in fact, that quote,

what do you care what other people think

is actually a quote, not a Feynman,

but of his first wife, Arlene,

who sadly died at a very young age from tuberculosis.

Why am I sharing Feynman’s story of loss of his first bride?

The reason is Feynman continued to write letters to Arlene

for a long period of time.

This is well-known only because after Feynman died,

it was discovered that he kept an archive of letters

to his deceased first wife.

And even though he did eventually marry

and in fact had many relationships with many people,

and I think was married twice more,

maybe it was once, maybe it was twice,

the intensity of his grief,

but also his lack of ability to transition his mind

to a place where he understood that Arlene had died

is one of the more profound examples

of this inability to reconcile the logical world

and the emotional world.

And I’m now going to read to you a letter

that Feynman wrote to Arlene.

This was discovered after Feynman’s death

when they went through his desk and his belongings.

And as I read this,

you’re going to hear some of the typical narrative of grief

that is not unique to Feynman and his dead wife.

But there are also some elements in there

that I think you’ll recognize as highlighting

this disbelief and this dissociation

between the reality of somebody’s location

and space and time,

and the emotional attachment that they hold for us.

And therein lies the information

about how to better navigate grief.

So now I’m reading from the letter.

This was a letter dated October 17th, 1946.

It’s not terribly long, but bear with me.

Dear Arlene, I adore you, sweetheart.

I know how much you like to hear that,

but I don’t only write it because you like it.

I write it because it makes me warm all over inside

to write it to you.

It is such a terribly long time since I last wrote to you,

almost two years, but I know you’ll excuse me

because you understand how I am, stubborn and realistic.

And I thought there was no sense to writing.

But now I know my darling wife

that it is the right thing to do

what I have delayed in doing,

and that I have done so much in the past.

I wanted to tell you I love you.

I want to love you.

I will always love you.

So here we can hear the intense emotional attachment

that clearly has persisted.

I find it hard to understand in my mind

what it means to love you after you are dead,

but I still want to comfort and take care of you.

And I want you to love me and care for me.

I want to have problems to discuss with you.

I want to do little projects with you.

I never thought until just now that we can do that.

What should we do?

We started to learn to make clothes together

or learn Chinese or getting a movie projector.

Can’t I do something now?

No, I am alone without you.

And you were the idea woman and the general instigator

of all our wild adventures.

When you were sick, you worried

because you could not give me something that you wanted

and you thought I needed.

You needn’t have worried.

Just as I told you then there was no real need

because I loved you in so many ways so much.

And now it is clearly even more true.

You can give me nothing now,

yet I love you so that you stand in the way

of my loving anything else.

But I wanted you to stand there.

You dead are so much better than anyone else alive.

So you can really appreciate the depth

and intensity of the attachment.

Despite two years time, it clearly has not waned.

I’ll read the final paragraph now.

I know you will assure me that I am foolish

and that you want me to have full happiness

and don’t want to be in my way.

I bet you’re surprised that I don’t even have a girlfriend

except you sweetheart after two years.

But you can’t help it darling, nor can I.

I don’t understand it for I’ve met many girls

and very nice ones and I don’t want to remain alone.

But in two or three meetings, they all seem ashes.

You only are left to me.

You are real.

My darling wife, I do adore you.

I love my wife.

My wife is dead.


PS, please excuse my not mailing this,

but I don’t know your new address.

So there’s a lot contained in this letter.

We could parse it line by line,

but I think it’s fair to say that clearly

there’s an immense attachment that’s been maintained.

So that’s that dimension of closeness of attachment.

Clearly there’s an understanding that she’s dead.

In fact, the last line of this love letter

is my wife is dead, right?

He now moves her into the third person in fact,

in that final line.

So he understands this and yet he maintains the attachment

and the very last portion of the letter, the PS,

the postscript, I don’t know your new address, right?

Somewhat humorous in the typical vein

of a Feynman writing or speech,

he always had an intensely amusing

and playful sense of humor.

And yet there’s something really contained in this.

I don’t think we’re reading into this too much

in that he doesn’t know where to find her.

He feels her as very real

and yet he doesn’t know where to find her.

He doesn’t know her address.

He obviously knows she’s dead.

So there’s nowhere to mail it to.

The reason I shared this letter with you,

as opposed to one of the almost infinite number

of other letters that have been written by poets

and authors and scientists and everyday people,

is that it really encapsulates all three dimensions

of attachment and grief.

These notions of space, where is something or somebody?

Time, this dimension of how long would it take me

to reach them or for them to reach me?

What would it take in terms of time to be reunited?

And then that last dimension of closeness.

And the letter beautifully illustrates the fact

that in grief, we maintain that sense of closeness

and yet we have to uncouple it from these other

two dimensions as we’re referring to the space and time.

So with this current understanding in mind,

a few things start to become obvious and entirely normal

to us in the best and most healthy sense of the word normal.

For instance, if you’ve lost somebody or an animal

or even a thing that was vitally important to you,

it should make perfect sense to you

as to why you keep looking for that person.

I recall this in my own life.

I had the unfortunate circumstance of my graduate advisor,

who I was very close with, died quite young of breast cancer

and her daughter, she has two daughters, kept her cell phone

and would occasionally call me.

I had a quite close relationship to their family.

And when it would come in,

the number would pop up on my phone of not the daughter,

but the name that showed up was of my graduate advisor.

So for years after she died,

my initial impulse when the phone would ring was,

oh my goodness, she’s calling.

It was a reflexive excitement

because I truly always enjoyed hearing from her.

She was a wonderful, incredibly wonderful person,

I should say.

Similarly, when somebody passes away,

we will find ourselves looking into a room,

expecting to see them there

or expecting them to knock on the door any moment

or to call on Sunday morning, as it were.

Those expectations, those predictions

that the brain is making are entirely normal

because they are based on that deep catalog

of episodic memory that you maintain about that person.

Again, the depth and richness of that catalog,

scaling, of course, in direct relation

to how close you were with that person, right?

Closer to somebody means more information about them.

More information about them means your brain

has a lot of implicit, unconscious notions

of when and where and how they show up.

So the fact that your brain,

and indeed, sometimes your body reacts

to the expectation that they’ll be there is entirely normal.

It’s simply an activation of this map

that involves closeness, space, and time.

Not surprisingly then, the reordering of that map

that’s required in order to move through

the grieving process is going to involve some remapping.

And you as the person grieving have the opportunity

to ask which node, as it’s called,

which element or dimension within that map

are you going to focus on?

Some people really try hard to disengage with

and remap their sense of emotional closeness to the person.

That is, it’s so unbelievably overwhelming to them

that the person is no longer accessible,

that they try and change their ideas

about how close they really were.

They try and change their emotional attachment

to the person after they’ve died.

Clearly in the example that I gave in the Feynman letter,

that’s not the case.

The attachment seems indeed quite fixed

and not going anywhere.

Psychologists and neuroscientists generally agree

that the best way to approach moving through grief

is actually to remap these dimensions

while maintaining the close sense of attachment

to the person by not in any way trying to undermine

the intensity of the attachment

or how important it was to you.

So we’ll now talk about how that process works

and the different entry points, as they’re called,

to engaging in that process.

So one straightforward way to think about

this state of mind and body that we call grief

is that the idea that someone or an animal or a thing

simply does not exist anymore

is not something that the brain can easily conceptualize.

And the reason for that is that we,

as beings that have a brain,

and a brain, as an organ that makes predictions,

tends to rely more on experience than knowledge.

In other words, the knowledge that someone

or an animal or a thing is gone, that it doesn’t exist,

at least not in the dimensionality

that we were accustomed to relating to them in,

is something that we can understand logically,

but that emotionally is very hard to undo,

and from a memory perspective, is very hard to undo.

So it’s not just that we are in a state

of emotional disbelief.

It’s that we have neurons, literally nerve cells

and neural circuits, connections between nerve cells

that are dedicated to this vast implicit knowledge

of all the things we know about that person,

animal, or thing.

And just because they are no longer in the dimensionality,

meaning in the configuration alive or present in our life

that they were before, doesn’t eliminate those memories.

Those memories persist.

And so anytime we call to mind the person’s name,

or we call to mind things that remind us of them,

or we suddenly feel the desire to engage with them,

the memories, those episodic implicit memories,

as they’re called, all that menu and library of knowledge

slams us straight in the face and pushes us into a mode

of wanting to act in a way that’s consistent with them

still being here in the way that all that knowledge

told us they were when we acquired it.

That’s a very long-winded way of saying

that there’s nothing wrong about the emotional state

when we are in a state of grief.

In fact, quite the opposite.

But there is something wrong about the memories

because the memories are based on our prior knowledge

of them, and those memories actually do not apply

to our current knowledge of them.

And again, even though our brain is a prediction machine

and it’s a very good one, it’s not perfect.

In fact, it’s far from perfect.

So really moving through grief is a process

of understanding how relationships are mapped in the brain,

space, time, and closeness, also called attachment,

understanding those three dimensions,

understanding that they are closely linked,

and then understanding that simply the knowledge

that somebody or something or an animal

isn’t accessible to us does not allow us to discard

of all the knowledge that we have.

And as a consequence,

our brain is constantly generating expectations

of how to access them,

even if we know that’s completely irrational.

Now, this should, I would hope,

assist you in moving through grief.

It’s not a tool of the sort of like a switch

that you can flip and suddenly not feel grief,

but it does point to a specific set of mechanisms

or a specific set of steps that you can engage

in order to start to move through the grieving process

in the most adaptive and effective way,

and in a way that still holds in mind

your close attachment to the person.

So let’s talk about some of the tools

for adaptively moving through grief.

These are tools gleaned from the research psychology,

the clinical psychology, and the neuroscience literature.

So I’ve synthesized my understanding

of those three literatures

to provide the tools that I’m about to describe.

The first one involves the acknowledgement

and really the understanding

that you don’t want to disengage

or dismantle your real attachment

to someone, an animal, or a thing.

That’s a real thing,

and there is actually no adaptive reason

to try and persuade yourself or numb yourself

or somehow avoid the thinking

of just how much they meant to you.

What is important, however,

is that you make some effort to shift your mindset

and your understanding of that person

in a way that holds in mind that,

yes, indeed, the attachment is very real,

and in some cases is very, very intense,

but is now going to be uncoupled

from the other two dimensions of the map,

namely space and time.

So again, just to make absolutely clear,

there’s no reason to try and convince yourself

that you weren’t actually that close to this person

or them to you.

There’s no reason to try and reduce the intensity

of that attachment.

To the contrary, you want to anchor yourself

to that attachment,

but you want to make sure that your thoughts

about the person and your feelings about the person

are not oriented toward or in reference to,

I should say, that map,

that deep catalog of memories that you had.

Now, this is not simply a fancy way of saying,

don’t live in the past.

This is saying you need to maintain

your sense of attachment,

but you need to start making predictions

and understanding about how you’re going to engage

with that attachment,

how you’re going to feel those things

without the expectation that things

that once happened before are going to happen again.

So it’s a complicated process, you can imagine,

but you really want to hold and register two things at once.

It’s sort of like spinning two plates at once,

and therefore it’s going to feel like effort.

One way to do this is to set aside

a dedicated period of time of maybe five or 10,

maybe even as much as 30 minutes,

or depending on your capacity, 30 to 45 minutes,

in which you are going to feel deeply

into your closeness and your attachment

to that person, animal, or thing.

But you’re consciously going to try

and prevent yourself from thinking

about a couple of categories of things.

First of all, you want to actively try

and disengage from any attempt to engage

in what’s called counterfactual thinking, the what-ifs.

What if I had called them a day earlier?

What if they had taken a different route home?

What if I had taken a different route home?

These counterfactual modes of thinking

are an infinite landscape of possibility,

and they are very closely tied to guilt.

Guilt is an interesting emotion.

We should probably do an entire episode about guilt.

But guilt, as defined by psychologists and neuroscientists,

is actually a way of assigning ourselves more agency,

more capability of controlling reality than actually exists.

And it’s a very slippery slope, and I want to be clear,

it’s not the case that guilt

is never an appropriate response,

but in the context of grieving,

guilt is very precarious

because in thinking I could have done this,

or if I had only done that,

you are essentially exploring an infinite landscape

of things that you can never refute.

You will never know that had you not gone down

a different path,

or they had not taken a particular path in life

that things would have turned out different,

but you can’t know that it would have worked as well,

meaning you actually don’t know

that your what-ifs are true,

and you don’t know that they’re not true.

And so as an infinite space, it’s a very precarious one,

and it will not allow you

to uncouple that intense emotional attachment

that I’m telling you is actually vital to hold on to

from that catalog of episodic memory that you’ve established.

In fact, it’s going to strengthen those bonds.

So in this dedicated five or 10 or 30,

whatever period of time you can tolerate and maintain focus,

the idea is to think about your attachment in a rich way,

and to perhaps even experience that in your brain and body.

I think if you’re in a stage of grief,

that actually will be fairly reflexive to do,

but to try as much as possible

to hold that grief in the present

and to be connected to your immediate physical environment.

So you want to orient yourself in current space and time

rather than focus on memories

or what you would have liked to see happen

or the wish that they were still there,

while at the same time,

thinking about the depth and richness of that attachment.

This is obviously a tightrope walk, so to speak.

It’s an emotionally challenging,

and sometimes even will be experienced

as a physically challenging tool or experience.

But in our understanding of how attachments and grief

are represented in the brain,

this can be an immensely beneficial practice

because it is the first step.

And indeed it represents many of the steps in the voyage

from the initial shock of loss

to our ability to hold in mind somebody

or an animal or a thing in a way

that still allows us to feel the depth

and fullness of connection to them

without feeling the yearning,

that reaching for the glass of water

that unfortunately will never be resolved.

Keep in mind that as you embark on this process,

it is entirely normal for your mind

to flip into various states of expectation,

that they’re suddenly going to be there.

In fact, because of the closeness

of these three dimensions in the map,

space, time, and attachment,

it’s entirely normal that when you start to think

about your attachment to somebody or an animal or a thing,

that you almost start to experience them

as present in that environment.

I’ll share with you a somewhat bizarre,

or it sounds bizarre to articulate out loud,

but many of you perhaps will resonate with this.

For years after my graduate advisor died,

I would get an experience of someone touching the back

of my neck when I would think about her.

And that was not an experience

that I ever had with her, right?

It was a professional relationship.

I don’t ever recall her touching the back of my neck

or me touching the back of my neck in her presence,

at least not on a regular basis.

So it was very perplexing to me.

And then I encountered this incredible literature on grief,

which said the following.

Grief in many ways is like a phantom limb.

For those of you that aren’t familiar,

many people who experience amputation of a limb,

either through surgery or accident or otherwise,

will feel in a very genuine way

that the limb is still present,

even though when they look for the limb, it’s not there.

So they can feel pain in limbs.

They can feel the sensation of touch.

There’s some famous experiments from the neurologist

and my former colleague at University of California,

San Diego, who goes by his last name, Ramachandran.

Some people just call him Rama.

He’s an incredible scientist

and has done a lot of really important work,

in particular on phantom limb, among other things.

And has done some beautiful experiments

showing that people who have phantom limb pain

or that are experiencing different sensations

in their phantom limb, that can be very intrusive,

much in the same way that expecting someone

to walk through the door who you happen to know is deceased

can be very intrusive.

Ramachandran has done beautiful experiments

showing that if you give people what’s called a mirror box,

this is a box in which you insert an intact limb.

And there are some mirrors that give you

the visual impression that the other limb is still present.

And you move the intact limb

and you get a mirror image of the non-existent,

but nonetheless visual image of the phantom limb moving,

that you can resolve some of the pain of a limb

that feels otherwise cramped up.

In other words, the visual perception

can reverse some of these phantom sensations.

In many ways, the phantom limb scenario,

and what I described about a sensation

of being touched on the back of the neck

or this feeling that we have when we engage in the thinking

and the emotions of our attachment

to someone, an animal, or a thing

is very much like a phantom limb,

only it exists in the emotional space.

And it exists because it is reactivation

of these maps about space, time, and person.

And so if the process of moving through grief adaptively

in a healthy way involves maintaining the attachment,

but uncoupling that attachment

from the space and time representation

of that person, animal, or thing that we had before,

well, then the question becomes,

where should we place our expectation of them, right?

Now that of course will vary from person to person.

Some people with particular religious beliefs

will indeed believe that the soul of the person,

the molecules of the person have been reordered

and exist in some sort of either distributed domain, right?

That they are in everything or they are in one location.

I’m not here to speak to that one way or the other.

There’s no good experiment I know

either to prove or disprove that, nor would I want to.

It’s not the job of science, frankly.

However, allowing ourselves to place notions

of where that person, animal, or thing is

in their current new configuration,

whatever that might be, ashes to ashes, dust to dust,

or that the person’s soul comes out of their body.

These are all the different variations that people hear.

Or some people think, well, it’s just molecules

and they disintegrate and are reordered

and come up as the plants and the trees.

Again, a near infinite number of possibilities

and it depends a lot on personal belief.

It is however essential that no matter what you believe,

that you have some firm representation

of where that person, animal, or thing is

so that you can plug it into this map,

this three-dimensional map of space, time, and attachment.

The process of moving through grief can’t simply be

that we hold onto the attachment and we discard

with any understanding of where they are in space and time.

And actually the letter that Feynman wrote

to his deceased wife, Arlene, again, so beautifully

and really poignantly illustrates the fact

that he doesn’t really know where to find her.

On the one hand, he really understands that she’s gone.

And on the other hand, he understands

that he still very much expects her to be there,

that he would like to mail the letter.

But then of course, in this final, somewhat humorous line,

he doesn’t know where to send the letter, he tells us.

What’s very clear and I think is very healthy

is the fact that the emotional bond is still there,

that that is maintained.

And so this tool, if you will, of dedicated blocks of time

for really spending some effort, and it is indeed effort

to access the emotional connection

while starting to uncouple the other nodes of the map,

as it were, is something that is hard.

You should expect it to be hard.

But in terms of the options one has

in order to deal with grief,

it is indeed the most adaptive way to go about it.

You’re not trying to avoid thinking about it.

You’re not engaging in this counterfactual thinking,

the what if, what if, what if.

You’re not drowning it out with substances or delusion

or with other ways of distracting yourself.

So in that sense, it is truly adaptive.

Now, of course, I don’t want to imply

that I’m a clinical psychologist.

I’m certainly not.

There is absolutely a place for working

with a trained professional to move through grief,

especially these situations,

these one in 10 people who deal with

what’s called complicated grief or very prolonged grief.

Those are somewhat different things,

but in general point to the fact that there are people

who have an exceptionally hard time moving through grief.

We’ll talk about who those people are

and ways to move through them with or without

a professional to assist you.

But nonetheless, we’re starting to understand

on the basis of neuroscience,

what some of the more adaptive and functional ways

of moving through grief are.

In order to really understand how a tool of the sort

that we’re describing ought to work

and what it’s designed to accomplish at a mechanistic level,

I’d like to teach you about a very important aspect

of your brain function that has everything to do with grief

and the process of moving through grief,

but has a lot to do with other aspects

of our life experience as well.

Some of you are probably familiar with a brain area

called the hippocampus.

The hippocampus is a structure that’s involved

in the formation of new memories,

but not the maintenance of memories.

I discuss the hippocampus in detail in our episode

on memory and our episode with our guest,

Dr. Wendy Suzuki from New York University,

an expert on learning and memory.

During those two discussions,

I did not, however, touch into what the different cell types

are in the hippocampus and the different roles they perform.

And it turns out that there are indeed different cell types

in the hippocampus and they perform very different roles

that are absolutely central to the grief process.

We have cells in our hippocampus,

meaning you have cells in your hippocampus.

These cells are neurons, nerve cells,

that fire anytime, and when we say fire,

I should just remind you, I mean, have electrical activity,

anytime that we enter a particular familiar location.

So for instance, think about your bedroom

and think about where the bed is.

As you’re doing that,

these so-called place cells are firing,

not necessarily to represent that it’s a bed

at that location, but to represent the location itself.

We also have neurons in our hippocampus

and elsewhere in our brain, I should say,

that represent proximity.

So for instance, if you were to wake up

in the middle of the night and walk into the kitchen

and it’s somewhat dark and you orient toward the sink

to get yourself a glass of water or to the refrigerator

to get yourself something to drink or to eat,

as you get close to the sink or the refrigerator,

there are neurons in your hippocampus

that are going to start engaging electrical activity

because you are in the mere expected proximity

of the sink or refrigerator

and you know where they are, hence the word expected.

Now that all seems fine and good.

You’ve got neurons that represent where things are

and sort of goes without saying that those same neurons

map to our emotional attachments.

We generally know where to find our loved ones.

Even if they don’t live with us,

we generally know what city they’re in.

Even if they’re traveling,

we generally have a sense of where they’re traveling

or the general area in which they’re traveling.

Place cells and proximity cells are involved

in that kind of mapping and representations as well.

Now there’s a third kind of cell

that’s particularly important for the sort of tool

that we were talking about earlier,

that tool of holding onto the emotional attachment

to somebody and yet trying to deliberately remap

our understanding of where they are in space and time.

And that has to do with a category of cells

called trace cells.

Trace cells were discovered by a number of laboratories.

I think the most renowned of those is the Moser Laboratory.

The Mosers are a couple, actually, they were a couple.

They’re now, I think, amicably separated or divorced.

That’s not what this episode’s about.

If I have that wrong, forgive me.

Edward and Brittan are their names.

Their relationship isn’t what’s important,

except what is important is the work that they did together

in one form or another,

which was very important work establishing

this category of cells in the, not just in the hippocampus,

but in an area of the brain called the entorhinal cortex

that act as a sort of coordinate system

to orient us in space and time.

Trace cells are activated when we expect something

to be at a given location, but it’s not there.

Experiments done in their laboratory

and in other laboratories have shown that, for instance,

if you give a rodent or frankly a person a object

that always resides at the same location

and we reach to it in order to access it,

let’s say where your coffee maker is in the morning,

I do a pour over coffee.

If I’m drinking coffee or mate, I’ll do a pour over.

It’s always more or less in the same location.

And so there are place cells and proximity cells

that relate to my being able to find

that pour over coffee cone thing.

However, if I were to go to that location

and it wasn’t there, the trace cells,

these neurons in my hippocampus

and an entorhinal cortex and elsewhere,

because again, these cells are connected

by way of circuitry, by way of connections,

those trace cells would fire.

We could even call it a trace circuit.

It’s a circuit that has an expectation

that something will be in a location,

but when something is not at that location,

this circuit becomes active.

This is important because what we’re talking about here

is a neural circuit and a set of neurons

that are responsible not for the presence of something,

but the absence of something.

We have every reason to believe

based on neuroimaging studies and studies in animal models

that trace cells become very active in the immediate stage

after the loss of a loved one.

That the brain and our maps of the person, place, or thing

that we know cognitively, we understand,

we even believe they are gone.

They are not accessible for whatever reason,

death or otherwise.

And yet we have neurons that are firing

to reveal that absence to us.

And these neurons are closely associated with neurons

that tell us where things ought to be.

So if you feel the expectation,

or you sense that somebody should walk through the door

any moment or call at any moment,

or be next to you when you wake up,

and yet you cognitively understand that they won’t,

that there’s no real reason why they should,

because they are indeed gone, you are not crazy.

In fact, it’s simply a reflection of the normal functioning

of these trace cells and trace circuits.

Now I’d like to consider why two people,

both who are intensely attached to a person

that is no longer there,

can experience the grief of the loss of that person

in such different ways.

This is often observed.

You can have, God forbid, incredibly sadly,

in cases where a child is lost,

where both parents are grieving intensely,

but one seems to feel it at a emotional depth and level

that seems distinct from the other.

Now, of course, keep in mind that we never really know

how other people are feeling.

This is something actually that was raised in the episode

where I interviewed a psychiatrist and researcher colleague

of mine from Stanford, Carl Deisseroth,

as a psychiatrist, I heard him say once

that we really don’t know how other people feel.

In fact, a lot of the times

we don’t even really know how we feel,

or at least describing that

is quite challenging with language often.

And indeed, that is the case.

We don’t really know how other people feel.

There’s no clear way of knowing

that the expression someone else has,

or whether or not they’re crying or not,

or their body language really represents

how they feel inside.

So that is important to keep in mind.

Nonetheless, there does seem to be a sort of a split

among people and indeed among animals as well,

even within a species in terms of how intensely

they feel the yearning aspect of grief.

And it appears based on a number of different lines

of evidence that that relates to this molecule

that some of you have probably heard of, which is oxytocin.

Oxytocin is a hormone slash peptide.

A peptide just means a protein,

generally a small protein.

And a hormone is generally something that functions

at numerous locations in the body

to impact numerous organs and areas of the brain.

So a peptide can be a hormone

and a hormone can be a peptide.

They are not mutually exclusive.

Oxytocin has a variety of roles in the brain and body.

It’s involved in milk let down during lactation.

It’s involved in pair bonding, both in males and females.

It’s involved in bonding of parent to child

and indeed between romantic partners, et cetera, et cetera.

Let’s talk about some of the animal models that inform us

about the potential roles of oxytocin

in the grieving process.

There’s a species of animal called the prairie vole.

And believe it or not,

the prairie vole has been studied fairly extensively

by neuroscience and psychology researchers.

In fact, our former director of the National Institutes

of Mental Health, Tom Insel,

his laboratory focused quite heavily on prairie voles.

Prairie voles are one species of animal,

but depending on where they live,

you find that some prairie voles are monogamous.

That is, they mate with the same prairie vole for life.

They raise litters of little prairie voles for life.

And other prairie voles,

generally that live in different locations in the wild

are non-monogamous, sometimes called polygamous.

The neurochemical and circuit basis

for this monogamy versus non-monogamy are quite interesting.

However, in the context of grief and attachment,

the prairie voles have taught us a lot.

And they’ve taught us a lot

through the following experiment.

Take two prairie voles that are coupled up.

So these would be monogamous prairie voles

that have established a couple-dom.

I guess you would call that a prairie vol-dom, anyway.

Put them in a cage together, they mate together,

they raise young together, and then you separate them.

You literally put a physical barrier

between the two of them,

and you can evaluate how strongly one prairie vole

will work to get access to the other prairie vole, right?

This is sort of the Romeo and Juliet

of prairie vole experiments.

And what you observe is that the monogamous prairie voles

will work very hard to get back to their mate,

to get access to their mate.

They will lever press,

they’ll even walk across a metal plate

that they get an electrical shock.

They will work very, very hard.

They will cross rivers and valleys, if you will,

in the experimental context, that is.

The polygamous prairie voles,

and again, we don’t know if they’re polyamorous.

We don’t know what they feel, right?

We don’t know if they’re in love

or if they’re motivated simply for other things.

But the non-monogamous prairie voles

will not work as hard to access a prairie vole partner.

Now you could argue that’s because they expect

that there will be other prairie vole partners,

but even if they’ve never experienced

another prairie vole partner,

they won’t work quite as hard to get back

in connection with this other prairie vole

to mate or otherwise.

This turns out to be interesting

when you start to explore the patterns

of so-called oxytocin receptors in the brain.

To make a long story short,

and to also bridge to the human literature,

it turns out that the monogamous prairie voles

have far more oxytocin receptors in this brain area

that I mentioned earlier, the nucleus accumbens.

And again, to remind you,

the nucleus accumbens is the brain area

associated with motivation, craving, and pursuit.

So it’s as if the monogamous prairie voles

have a capacity to link the attachment circuitry

and the molecules of attachment,

in this case, oxytocin,

to reward pathways and to motivational pathways.

Polygamous, or we should say non-monogamous prairie voles

do as well.

However, they have less oxytocin receptors.

So in other words, non-monogamous prairie voles

seem to have less yearning for attachment overall,

at least to a single individual prairie vole.

And when we look at the human literature

in terms of oxytocin receptor expression

and brain imaging experiments and so on,

what you find is the same.

The people that experience intense grief

and a deep yearning and a motivation

to reconnect with the person, animal, or thing that is lost,

in many cases have heightened levels of oxytocin

specifically, or I should say oxytocin receptors

to be exact,

specifically within the brain regions

associated with craving and pursuit.

So for those of you that find yourself

in this kind of stuck mode,

this persistence of trying to reach into the past

or wishful thinking, this counterfactual thinking,

if only, if only, if only,

you don’t necessarily want to pathologize that thinking.

First of all, we should acknowledge

that it’s not necessarily adaptive.

And in fact, in the complete loss of somebody,

or if somebody says they don’t want anything to do

with you ever again, by all means,

if that’s expressed clearly,

then you need to accept that reality.

But the yearning, the desire, and the impulsivity

that kind of leaning in at a almost reflexive way

to try and access that person again,

to text them, to want to hear from them could,

and I have to highlight could reflect the fact

that you just so happen to have more oxytocin receptors

or maybe more oxytocin overall in this brain area

that’s associated with motivation and pursuit.

It does not necessarily mean

that you are more capable of attachment

than people who move through grief more quickly.

And I should say that people move through grief

at different rates,

even if two people lost the same person or same animal,

people move through this at different rates.

And some of that is no doubt psychological,

but some of it no doubt is also neurochemical

and biological.

And in sharing this with you,

I hope it shed some understanding

and perhaps even some compassion

for people who are moving through things more quickly

or in a different way.

And of course it should also, I would hope,

shed compassion and understanding

for people that seem incapable of quote unquote moving on.

It’s taking them far longer to move on.

Earlier, we talked about complicated grief,

non-complicated grief, and prolonged grief disorder.

And I should say that the precise divisions

between these categories is not very precise.

It takes a really trained expert to be able to identify

whether or not somebody is in

the prolonged grief disorder category,

complicated or non-complicated grief.

There’s actually a set of questionnaires

that I invite you to answer if you like.

They were provided, or I should say I accessed them

through a public site on Mary Frances O’Connor’s webpage.

We’ll put them in the show note captions.

You actually can submit those answers in an anonymous way

to a study that she’s doing.

She has several surveys,

one for loss of a romantic relationship,

other for loss due to death of somebody,

and still another one that relates to homesickness.

And it’s also available in several different languages.

So I provide a link to that website.

It’s very easy to download.

There’s no cost to that at all.

You can contribute to the scientific data collection process

if you like.

And I do believe that you get your scores back

or an interpretation of your scores by participating there.

When Mary Frances O’Connor hopefully comes on the podcast,

she can tell us some more of the detail

about separating out this prolonged grief disorder,

complicated and non-complicated grief.

But in the meantime,

it’s very clear that people move through grief

at different rates.

And as I mentioned just a moment ago

that this is entirely normal,

probably has a basis in neurochemicals

and hormones such as oxytocin.

There are probably other reasons as well.

In fact, we can assume with almost certainty

that there are other reasons as well.

Nonetheless, I think it is really important to think about

why some people might have a harder time

moving through grief due to life circumstance,

innate differences, and so on.

There’s a very nice set of studies,

but one in particular entitled

Catecholamine Predictors of Complicated Grief Outcomes.

Here again, the first author is Mary Frances O’Connor,

reminding us that she’s done so much important work

in this area.

This paper has several conclusions,

but one of the key conclusions

is that this particular category of molecules

we call the catecholamines.

The catecholamines include epinephrine,

which is also adrenaline,

norepinephrine, which is noradrenaline,

and dopamine, which you’ve learned about before.

Here, I’m just going to paraphrase

or I’ll read directly actually.

What they found was that participants,

again, this is human subjects,

with the highest levels of epinephrine,

of adrenaline pretreatment,

had the highest levels of complicated grief symptoms

post-treatment, and that could account

for their baseline level of symptoms.

What this means is that people

that have a lot of circulating adrenaline,

we might even call these people who are,

or typically reside at a higher level of autonomic arousal.

We have an autonomic nervous system

that dictates how calm or alert or stressed

we happen to be just at baseline.

People who tend to be more alert and anxious at baseline,

prior to any grief episode,

tend to have, or statistically, on average, we should say,

are more likely to experience complicated grief

and maybe even prolonged grief symptoms.

So if you’re somebody that is anticipating losing someone

or an animal or a thing at some point,

and I think that really means everybody,

utilizing tools to adjust your epinephrine,

your adrenaline levels down,

has a number of important benefits,

improving sleep, health metrics, et cetera.

There are tools to do that.

We have an episode on mastering stress

that you can find at our website,

It has a lot of behavioral tools that are backed by science,

some of work that was done in my laboratory,

but certainly other laboratories as well,

that will allow you to control

your autonomic nervous system, both in real time,

and reduce the overall level of stress

and even chronic activation of the so-called sympathetic arm

of the autonomic nervous system,

which is just fancy geek speak for saying

there are tools to help you be calm,

not just for sake of navigating daily stress,

but as this paper illustrates,

for anticipating the fact that at some point

you will lose somebody, an animal or a thing.

And there is a way to move through that process

that we call healthy, normal grieving.

And then there’s the so-called complicated grief

or prolonged grief disorders that reflect immense challenge

in moving through grief at a reasonable rate.

So you can somewhat inoculate yourself

against complicated or prolonged grief

by reducing your resting levels of,

or your pre-loss levels of epinephrine, of adrenaline.

And again, there are excellent tools to do that.

I won’t review them here for sake of time,

but they’re timestamped and you can access those easily.

Again, zero cost tools.

Going back to this paper,

catecholamine predictors

of complicated grief treatment outcomes

should say that not only did participants

with the highest levels of adrenaline

have the highest levels of complicated grief symptoms


but the predictive relationship between these two things,

adrenaline and complicated grief,

was not seen in depression.

And I find that incredibly interesting

because it further separates depression from grieving

and grieving from depression.

It’s a resounding theme again and again.

Grieving is not depression

and depression is not necessarily grieving.

They can coexist, but they are separable as well.

And indeed reflect separate brain circuitries entirely.

So the conclusion they draw

is that the present study supports the hypothesis

that catecholamine levels,

again, epinephrine, dopamine, norepinephrine,

are the catecholamines,

are affected by bereavement

and in turn can affect the ability of those

with complicated grief to benefit from psychotherapy.

So what does all this mean?

What this means is we can prepare ourselves

to be in a better state to access,

yes, access grief when it’s appropriate.

And indeed grief is the appropriate response

when we lose someone, an animal or a thing

that we are closely attached to.

And yet to be able to move through that at a pace

and in a way that is most adaptive for us.

And to just again, highlight what adaptive means.

It does not mean dissociating from the attachment

to the person, animal, or thing.

I just want to pause for a second

and mention why I keep repeating person, animal, or thing.

I’m saying that because while grieving the loss of a person

or a relationship with a person,

doesn’t have to be through death, of course,

but death or otherwise,

is something that we all can intuitively understand

even if we haven’t experienced it.

We are capable of achieving great attachments

to animals as well.

And while the loss of a thing, of an object

in no way, shape, or form approximates the loss

of a person or an animal,

I would never suggest that it does.

It would also be naive and unfair of me or anyone else

to suggest that things can’t hold immense importance to us

and that the loss of them can feel quite significant

and invoke the grieving process.

This isn’t always about materialism.

Sometimes it’s purely about the sentimental attachment.

So for instance, the loss of a wedding ring

or an engagement ring that was very meaningful to you

or an article of clothing or a painting

or even a small seemingly inimportant object

to somebody else,

but something that held great meaning to you,

maybe a seashell that you collected with somebody

on the beach, and then somehow it gets lost.

And it’s the relationship with that person

that’s contained within that object for you

as a representation within that object that’s important.

That’s the reason why I keep saying

person, animal, or thing.

I think it’s only fair to include things in that category.

But of course, with the understanding

that they don’t hold the absolute same magnitude

as the loss of a being.

One thing that we ought to consider for a moment

is whether or not the depth of attachment

that you have to somebody predicts

how long it will take for you to move through

the loss of that person.

We often hear this.

Actually, I can remember some years ago

at the end of a relationship,

a friend and colleague of mine saying,

for every year that you were together,

it’s going to take you one month to get over that person.

And I thought, well, where in the world

do those data come from?

And this is what I call anic data or collective data

where this is like phrases such as,

absence makes the heart grow fonder.

And indeed, sometimes absence can make the heart grow fonder

in the context of two living people

or people in a loving relationship,

or even in the context of grief and loss.

But of course, there’s absence makes the heart grow fonder.

And then you also will hear out of sight, out of mind.

And if you’ve been listening to this episode,

clearly out of sight does not mean out of mind

or out of emotional connection.

So these sayings of,

well, it takes X number of months for a number of years,

or out of sight, out of mind,

or absence makes the heart grow fonder.

They really don’t hold a lot of meaning,

at least not for somebody like me who likes science

because science is at least geared toward

or aims towards establishing things in fact, not opinion,

but also because science allows you to make predictions.

It allows you to orient yourself in a process

and make predictions and understand.

So what are we to think of people

who seem very, very attached to somebody,

they break up and they seem just crushed, devastated,

but three weeks later they’re in a new relationship

and they seem perfectly fine.

Or somebody whose spouse dies

and then suddenly they’re in a new relationship.

I think there are rates of transition, if you will,

that suggests some dysfunction, pathology, et cetera.

But here we aren’t in a position to judge,

we’re only in a position to speculate about this.

And I think we can reasonably speculate

that it sort of makes sense

why someone who has an intense attachment to somebody

might be able to form a tense attachments generally, right?

That they aren’t restricted to one person,

whereas other people who have an intense attachment

to somebody might find themselves entirely incapable

of moving on, or it would take them a very long time.

Hence the lines in the Feynman letter to Arlene

about he had met various other young women,

they seemed perfectly nice,

and yet they were meaningless to him

in the shadow of her memory,

or we should say in the light of Arlene’s memory

or the memory of Arlene rather.

So these dimensionalities of attachment,

they cut in every direction.

And I don’t think any well-trained psychologist

or neuroscientists would ever say,

oh, if you are somebody who becomes very attached,

therefore it’s very hard to move on.

I think that could be true.

It could also be that if you’re somebody

who has a great capacity for attachment,

you have a great capacity for attachment overall.

Neuroscience nor psychology is really in a position

to judge certainly,

but it’s also not in a position

to make those kinds of predictions.

At least the field as it stands right now

of attachment and grieving

can’t really speak to why that’s the case.

So that’s my attempt to depathologize

some of what we observe.

Although I have to confess from a just sort of

everyday stance that sometimes the rate

in which people move out of attachments and grieving

can be somewhat eerie.

I’d like to take a moment and explore this idea

that allowing ourselves to really feel the attachment

to somebody can accelerate

or at least support adaptive transitioning

through grief.

There’s a really wonderful study that on the face of it

appears to be a, what we call negative result.

A negative result is when a hypothesis is posed

and then turns out the hypothesis is not true.

But as is the case with so many

interesting scientific findings,

often when there’s a negative result,

there’s a more interesting result nested

in that negative outcome.

And this is the case in a particular paper

I’ll share with you now.

This is a paper published in the journal

Biological Psychology.

And again, the title is posed as a question,

which is emotional disclosure for whom?

A study of vagal tone in bereavement.

What this study explored was whether or not

written disclosure of the emotional connection

to somebody that was lost would be effective

as a way for people to move through the grieving process.

The study also explored the so-called vagus nerve.

The vagus nerve is an extensive nerve pathway

that is bi-directional between brain and body.

So brain to body and body to brain.

It generally is associated with calming effects

on our brain and body,

although that’s certainly not always the case.

The way to think about it in terms of

what we’re going to talk about now

is heart rate and heart rate variability.

And in very simplistic terms,

if your heart was just allowed to beat

at its sort of default rate,

that rate would be rather high

because of the activation of the so-called sympathetic arm

of the autonomic nervous system,

the alertness component of the autonomic nervous system.

The parasympathetic nervous system, as it’s called,

involves calming.

We sometimes hear sympathetic is for stress

or fight or flight.

It’s for a lot of other things as well, I should mention,

and is not for sympathy.

Sympa simply means together,

and it reflects the activity of a bunch of neurons

being active at the same time or together, sympa.

Whereas parasympathetic is often associated with

quote-unquote rest and digest functions

or calming functions,

although it is certainly involved in other things as well.

So sympathetic nervous system drives alertness,

panic, stress, et cetera.

Parasympathetic nervous system,

meaning a distinct set of neurons,

drive calming, falling asleep, digestion,

sexual arousal for that matter, and so on.

So it’s sort of like a seesaw of alertness and calm,

alertness and calm,

sympathetic and parasympathetic, back and forth.

The vagus nerve is generally associated

with parasympathetic functions

and has the capacity to slow down our heart rate,

in particular by exhales.

And just simply because of the movement of the diaphragm

and its relationship to the heart and the thoracic cavity,

exhales result in slowing down of the heart rate.

This is what we call an increased vagal tone.

So let me explain for a moment.

And actually here’s a tool you can use,

not just in terms of navigating grief,

but in terms of stress modulation generally.

We have a muscle called the diaphragm.

When we inhale, whether or not it’s through our mouth

or our nose, our diaphragm moves down.

As a consequence, there is more space overall

in the thoracic cavity.

The heart gets a little bit bigger,

believe it or not, volume-wise.

Blood flows more slowly through that large volume.

And there’s a signal conveyed from the nervous system

to the heart to speed the heart up.

So inhales literally speed your heart up.

And when you exhale, the diaphragm moves up.

And as a consequence,

there’s less space in the thoracic cavity.

Heart gets a little bit smaller.

The existing blood volume in the heart at that time

moves more quickly through that small volume, right?

Given amount of blood volume,

make the compartment that’s in the heart smaller

and the blood moves more quickly through that volume.

And as a consequence of the nervous system

sends a signal to the heart via the vagus

and other pathways to slow the heart down.

In other words, exhales slow the heart down.

That process, that relationship

between inhale speeding the heart up

and exhale slowing the heart down

is something called respiratory sinus arrhythmia.

Some people are able to engage

respiratory sinus arrhythmia more naturally,

more reflexively than others.

You can actually train this by consciously thinking about

slowing your heart rate while you exhale

and consciously thinking about increasing your heart rate

as you inhale.

You can literally strengthen these pathways.

Now, respiratory sinus arrhythmia

and the ability to slow your heart rate with exhales

is one dimension of what’s called vagal tone

or your ability to control your overall level

of activation of alertness and stress

with these vagus nerve pathways.

So vagal tone is something that varies

from person to person.

If you’ve trained up or you’ve thought about

your relationship between breath and heart rate,

you can improve vagal tone.

Some people have very robust vagal tone

without having done any training.

Other people have less of it, et cetera.

I’ll just paraphrase from this paper

and you’ll see where this takes us

in terms of navigating grief because it’s quite important.

The vagus nerve provides inhibitory regulatory influence

on the heart, allowing the heart rate to increase rapidly

through vagal withdrawal.

That means kind of coming off the brake

of the parasympathetic nervous system

as in response to a stressor in one’s environment, right?

When you’re stressed, you rarely take the opportunity

if it’s an immediate stress or threat to actively exhale.

That would be a great tool to use.

And in fact, we promote that tool

in our mastering stress episode.

Vagal withdrawal usually co-occurs with an increase

in sympathetic activation of the heart.

You now know what that is,

or is known as the fight or flight response.

Vagal tone reflects the degree to which there is tonic,

meaning ongoing vagal influence on the heart.

So when you have a high degree of vagal tone,

it means that you are always activating that brake

on your stress system, just at default.

And some people just happen to do that more.

Other people need to practice long exhale breathing

in order to build up vagal tone,

something that’s very useful to do

whether you’re grieving or not.

Now, in this study, what they did is they had people,

and I should say it was 35 participants,

go through a writing exercise for a period of weeks.

They actually wrote about three times per week.

Then there was a follow-up at some period of time.

And then again, about a month later,

and there were two different groups.

One group was in the so-called written disclosure group.

What they did is they, on day one,

they would write about what happened when a loved one died.

And indeed they used people who had experienced real loss.

And so they were asked to talk about

and write about their deepest emotions

and thoughts about it, memories of their loved one,

very intense stuff if you think about it,

if they’re in the immediate period of having lost someone.

Then they actually were asked to write a letter

to the person that they lost.

So again, a very intense exercise to go through

if you did indeed lose somebody as these subjects had.

And then of course there was the testing

some period of time later.

And I’ll tell you what that period,

what that testing involved.

The other group was a so-called control group

where they were simply told to write

about how they use their time.

So an emotionally kind of empty writing exercise,

if you will.

They described what they would do today

after they woke up, et cetera.

No heavy emotional content and so on.

Now, as I mentioned earlier,

the immediate results of this study

were a negative result, meaning no effect.

The disclosure that we should say

the emotionally intense writing group

and the control group did not differ at baseline

on any symptom measures

or psychological variables they tell us.

And at least at face value, somewhat disappointingly,

there really wasn’t any kind of difference in outcome

between the group that wrote

about a very emotionally intense stuff

versus non-emotionally intense.

Now, what I didn’t tell you thus far

is why they had them do this exercise at all.

They had them do this exercise

because many of the effective practices

for moving through grief involve, as I mentioned earlier,

getting close to and actually deliberately experiencing

the attachment that one has to that person that was lost.

Not distracting oneself,

not getting into this counterfactual thinking,

the what if, what if, what if,

but rather thinking about, or in this case,

writing about the real attachment.

And so the initial idea was

if people write about this attachment,

that they’re going to experience this attachment

and that will serve them in some or many ways

in terms of moving through grief.

And that wasn’t what they found.

They found no difference between the two groups

until they explored who had higher vagal tone,

who had a greater degree

of so-called respiratory sinus arrhythmia.

In other words, who was able to modulate their state

using their breathing and their body.

And what they discovered was that a subset of individuals

who had a high degree of vagal tone

seemed to get more benefit from this writing type exercise.

Now this is one study,

and I would consider it fairly preliminary

with 35 subjects.

Although, you know, it’s a study unto itself

and I think a quite nice one.

And it really set the stage

for a number of other studies that followed

from this group and other groups

that really point to the fact that yes, indeed,

accessing these states of emotionality

by writing or thinking about somebody is quite powerful

in terms of engaging the bodily states

and the mind states associated with the attachment.

And that is very beneficial for moving through grief.

That is very beneficial for sensing the attachment.

And now it makes perfect sense

as to why some people would benefit

from that sort of practice more than others,

because some people are able to access

more real somatic feelings of attachment

by writing about the attachment

or by thinking about it than others.

So this brings us back to an earlier discussion

we were having where we were talking about

how some people seem to move through things very quickly

or don’t seem to be grieving constantly.

And, you know, a spouse or a family member of that person

might think, gosh, why aren’t you upset?

How is it that you can be functional and I’m not?

Or how is it that you can be functional?

There can even be fractures in families and relationships

on the basis of differences in rates of grieving and so on.

Well, some of this, again, probably relates to psychology

and the different attachments that people had

to the person or animal or thing that was lost,

but it no doubt also has to do

with how much of a mind-body connection,

how much of vagal tone exists in the person

when they suddenly found themselves in the grief episode.

So this actually offers multiple opportunities.

If you’re somebody, for instance,

who is grieving so intensely and so often

that you’re finding it immensely difficult

to move through grief at a reasonable rate,

and you might even say, or find yourself diagnosed

with prolonged grief disorder

or with complicated grief syndrome in a way

that’s really impairing your adaptive functioning in life.

Well, then it’s not clear to me,

at least by my read of the data,

that you would want to engage in a lot of practices

to increase the mind-body relationship

and feeling so much of this attachment

because you’re already feeling an immense amount of it.

Whereas other people who are feeling challenged

in accessing the feelings of attachment

and perhaps not functioning well as a consequence of that

might find that practicing breathing

in order to encourage respiratory signs of arrhythmia,

again, focusing on slowing your heart rate consciously

while you exhale and concentrating

on increasing your heart rate as you inhale,

even just as a brief practice

of even just one to three minutes

or one to five minutes every once in a while or per day,

that could be immensely beneficial

in building this mind-body relationship.

Because again, what this paper really points to

and set off a number of other investigations related to

is that for those that can really feel the relationship

between breathing, heart rate, what we call vagal tone,

well, those people are going to be in a better position

to move through grief,

not because they are disengaging

from the feelings of attachment,

but because they are better able to access

those feelings of attachment.

So what this relates to, of course,

is that tripartite map,

that three-part map that we talked about earlier,

that representation of space, where things are,

where the person is, where their belongings are,

where their car is, where their bicycle is,

time, when you were expecting to see them on a regular basis,

when they would call,

when they would come home from work, et cetera.

And that third node or that third dimension of attachment,

which is literally attachment and closeness.

Well, what we’re talking about here

is anchoring to that attachment

and really feeling into that,

but then disengaging from the space and time map

that we call episodic memory,

that menu of prior experiences

that keeps us in many ways maladaptively

in an expectation of what never can be again.

Now I’d like to take a moment

and consider some of the tools that you can access

that support healthy transitioning through grief.

And these are tools distinct from that neural map,

that space-time-closeness attachment map

that we were talking about before.

Rather, it’s important to remind ourselves

that everything exists in a context

of our baseline physiology.

And I’m certainly not going to be the first or the last

to tell you that everything in life,

learning, relationships with people that are still around,

our health in every way, immune system, et cetera,

function far better when we’re sleeping really well

and when we are generally awake during the daytime

and asleep at night.

I realize there are shift workers out there,

people who are traveling and are jet lagged.

First of all, thank you, shift workers, we rely on you.

We have an episode all about jet lag and shift work for you

and for trying to maintain the best possible mental

and physical health in the face of ongoing shift work

and jet lag.

You can find that episode on our website,

Lots of behavioral tools, some other tools as well.

Nonetheless, human beings are diurnal.

We were really designed to be awake mostly in the day

and asleep at night.

There are rare exceptions to this

where people like to stay up late and sleep in late,

but we are a diurnal species by way of our genetic wiring

and our neural circuit wiring.

There’s a particular feature to our diurnal,

diurnal meaning the opposite of nocturnal,

our diurnal pattern of the release of a hormone

called cortisol.

Cortisol is a stress hormone, it’s sometimes called,

but cortisol has a lot of other effects,

many of which are positive.

Cortisol, for instance, protects us against infection.

It can help us in terms of waking up in the morning.

In fact, the pulse as it’s called,

or the spike in cortisol early in the day

is part of the reason we wake up.

It’s linked to our increase in temperature rhythms

and can further increase our temperature,

which leads to waking and so on.

The typical pattern of cortisol in a healthy individual,

and we really can say physically

and emotionally healthy individual,

is that cortisol is going to be somewhat high

right around waking,

and then is going to be highest

as it ever will be in the 24 hour period,

about 45 minutes post waking,

not exactly 45 minutes, but about 45 minutes.

And then it will drop gradually

such that by about 4 p.m. in the afternoon,

which is actually when body temperature

tends to start to drop as well,

cortisol tends to be very low

and then remains low in a healthy individual

such that at 9 p.m. it’s very low,

and throughout the night as we sleep, it’s very low.

In fact, spikes or pulses in 9 p.m. cortisol

are a fairly reliable biomarker readout

of certain forms of depression and chronic anxiety.

This relates to the beautiful work

of my colleagues at Stanford and Stanford School of Medicine,

Dr. David Spiegel, who’s been on this podcast,

and Dr. Robert Sapolsky, who has also been on this podcast.

There’s a very interesting paper

exploring the relationship between cortisol rhythms

and grieving, in particular,

complicated versus non-complicated grieving.

Again, complicated grieving being the form of grieving

that reflects a immense challenge

of people moving through the grieving process

such that it really needs to be dealt with, right?

Again, grieving is healthy,

but complicated grieving is a prolonged grieving

and has other dimensions as well,

hence the name complicated.

The title of this paper is

Diurnal Cortisol in Complicated and Non-Complicated Grief,

Slope Differences Across the Day.

And the figure to orient to in this paper,

if you do decide to check it out,

and we’ll put a link to it,

is figure one, which beautifully shows,

or I should say very clearly shows

that in individuals that are experiencing complicated grief,

there’s the same general contour

of high cortisol upon waking,

even higher about 45 minutes after waking,

and then a reduction in cortisol by 4 p.m.

and even further reduction by 9 p.m.

So just as it were in a typical individual

or somebody who is in non-complicated grieving.

However, when you compare the cortisol levels

between people experiencing complicated grieving

versus non-complicated grieving,

what you find is the 4 p.m. and 9 p.m. cortisol levels

are significantly higher

than they are in the non-complicated grieving group.

This raises a very interesting idea

and relates very closely

to what we were talking about with vagal tone.

You could imagine a situation

in which people who are experiencing complicated grief

have higher levels of afternoon and nighttime cortisol

because they are in complicated grief,

but you could also imagine the opposite,

that they’re experiencing complicated grief

because of the fact that they have elevated cortisol.

Now, it’s very likely that it’s bi-directional,

that the answer isn’t one or the other, but both,

that complicated grief changes patterns of cortisol

and that patterns of cortisol change the likelihood

that one has complicated grief.

That’s the most logical interpretation of data like these.

However, when taken along with the data on vagal tone,

that people who have a higher level of vagal tone

are better able to navigate situations

of the sort that we’re talking about,

and that some people perhaps have oxytocin receptors

or patterns of catecholamines or epinephrine

that position them to be more likely to grieve

in a particular way, we arrive at a scenario

where it makes very good sense to think about modulating,

that is controlling the foundation of your life

in a way that establishes cortisol rhythms

and sleep patterns and patterns of autonomic arousal

and catecholamine release that position you

to navigate the grief process in the best possible way.

If that was a complicated mouthful to digest,

let me restate it in a simpler way.

If you are somebody who is heading into grief

or is challenged with grief, complicated grief or otherwise,

prolonged grief or otherwise,

getting adequate sleep at night

and establishing as normal a pattern of cortisol as possible

is going to be very important.

And there’s a very simple, straightforward way to do this.

And I apologize to the listeners of this podcast in advance

if I sound like a repeating record,

but the most powerful way to do this

is to view sunlight very close to waking.

It does not have to be right at sunrise,

but when you get up in the morning, if the sun isn’t out,

please turn on as many bright lights

as possible in your environment.

And then once the sun is out,

try and get some bright sunlight in your eyes.

Never look at any light so bright

that it’s painful to look at sunlight or otherwise.

If you live in an area of the world

where there isn’t a lot of sunlight,

please keep in mind that sunlight coming through cloud cover

is going to still be a very effective mechanism

for establishing this cortisol rhythm.

Why do I say this thing about sunlight

over and over and over again?

Well, having an early day cortisol peak

and a very low cortisol level late in the day,

4 p.m. and 9 p.m. is immensely beneficial.

It reflects a properly regulated autonomic nervous system.

It means being alert during the day

and your ability to sleep at night

is tightly correlated to this viewing of sunlight

in the morning.

If you have additional questions about this

or these protocols,

please see our mastering sleep episode

also at

But in brief,

you don’t want to wear sunglasses when you do this.

You do not want to do this through a window or a windshield.

It is 50 times less effective at least

because of filtering of the proper wavelengths.

It is fine to wear eyeglasses,

meaning corrective lenses or contacts,

even if they have UV protection.

Again, sunlight is best 10 minutes to 30 minutes

depending on how bright it is outside

and so on and so forth.

I keep coming back to this protocol

because first of all,

it is a zero cost,

but very effective way to regulate

things like cortisol rhythms,

melatonin rhythms,

wakefulness during the day,

ease of falling asleep at night and so on.

And second of all,

because I want to emphasize this idea of modulation.

There are processes in our brain and body

which directly mediate some psychological effect

or physiological effect, right?

Dopamine is directly involved in motivation.

If you’re somebody who struggles with motivation,

your dopamine system is likely to be dysregulated

in some way,

and there are behavioral tools and other tools

to adjust that.

We had an episode on dopamine motivation and drive

that talks extensively about those tools.

However, the process of grief

can’t be distilled down to one molecule,

one circuit such that we can say,

oh, you know,

take this supplement or eat this diet

and or exercise in the following way,

and you’ll recover from grief more quickly.

It’s simply not the case.

It is the case, however,

that proper sleep at night sets the foundation

for the proper emotional tone

to be able to navigate physical, psychological,

and other types of challenges.

And not incidentally, sleep at night,

I should say sufficient duration and quality

of sleep at night

is the way in which you engage neuroplasticity,

the reordering of neural connections.

And everything we’ve been talking about today

about reordering of the maps in your mind,

this tripartite three-part map of space, time,

and closeness involves neuroplasticity,

the reconfiguring of connections between neurons,

strengthening certain pathways

and not strengthening others.

Actively trying to disengage from the what if, right?

This counterintuitive thinking.

Actively trying to disengage from the expectations

that someone will be there.

Although when you find yourself doing that,

understanding why it’s so reflexive and normal to do that.

Actively trying to lean into the real attachment

to somebody, animal, or thing.

And yet at the same time,

not diluting yourself

and undermining the whole process of grieving

by trying to imagine that they are in fact

still truly there, right?

It’s a very narrow knife edge of a process,

which is why it’s so challenging.

Regulating your cortisol rhythm

through viewing sunlight early in the day.

And I should also say avoiding bright lights

from artificial sources in the evening,

generally 10 p.m. to 4 a.m.

But certainly in the evening,

trying to dim lights in your immediate environment,

trying to avoid bright screens,

bright artificial lights as much as possible

and accessing that deep sleep.

That’s modulating.

It’s setting an overall autonomic state

or an overall autonomic landscape

would be the better way to describe it.

That’s going to allow you to sleep and get neuroplasticity.

Sleep and be in the best emotional state

to navigate the grieving process.

Because it’s only fair to say that the grieving process

as we’re describing it is hard.

And not just because it’s emotionally hard,

it’s cognitively hard.

You just think about what’s required

to move through grief properly, if you will.

It’s thinking about and actually physically experiencing

the depth, the full depth of the attachment to the person,

while at the same time trying to uncouple

from that rich menu, that catalog of episodic memories

that can date back many, many years

and have so much richness, so many predictions

form on the basis of those episodic memories

and actively trying to distance ourselves

from those memories by being very anchored

in the fact that we are present.

We are the person alone in that room,

or in some cases with a bereavement group in that room

or with other people that are mourning the loss

of that individual animal or thing.

And that knife edge of feeling the intense attachment

while also disengaging from all the things

that led to that attachment.

Well, it’s understandable why that would be so challenging

and it should also be understandable

why positioning yourself to be able to do that

in the best possible way requires proper sleep.

So what are the tools that we can think about using

in terms of healthy, adaptive moving through grief,

trying to avoid complicated grief

and prolonged grief disorders?

I realize that word disorder implies all sorts of things,

but again, those are just naming categorizations

that people come up with that I think fairly reflect

the fact that some people have more challenge

moving through grieving than others.

And for some people, it can be very extended.

I think the common misunderstanding is that proper grieving

involves moving through something quickly.

We’re certainly not saying that.

However, it is very clear that some people can get stuck

and that process of getting stuck, you should now understand

has a lot to do with maintaining

or reactivating those episodic memories,

those expectations of where somebody

will be in space and time.

So what can we say about the tools for moving through grief?

Clearly, it’s a value to dedicate some period of time,

perhaps every day, perhaps every other day,

depending on your capacity and schedule.

These could be periods of time ranging anywhere

from five to 45 minutes, maybe longer.

These blocks of time would be appropriately described

as rational grieving, right?

Rational grieving is a clear acceptance of the new reality

that the person, animal, or thing no longer exists

in the same space-time dimensionality

that we knew them before,

and yet holding onto an anchoring

to the attachment that we had.

This is, again, not an unhealthy anchoring

to the attachment.

This is really anchoring to the depth and the intensity

of the attachment that existed as a way to,

for lack of a better way to put it,

push off from those episodic memories,

to distance ourselves from them,

because those episodic memories are the ones

that lead us to look for the person in our current reality.

And assuming this is a real and complete loss,

those sorts of expectations are maladaptive.

They do not serve us well.

The second aspect of this is to understand

that the node of the map,

the component of the neural map that you’re anchoring to,

is a very real component of you.

These are literally cells

that represent the depth of attachment.

They are linked up with your emotional centers in the brain,

and indeed, they are linked up with your body.

I think one of the things that comes up so often

when people are grieving is why does it hurt so much?

Well, that hurt is that yearning.

It’s that anticipation of action that you want to engage in,

but some part of you at least knows

that it leads nowhere.

It’s that reaching for that glass of water

in a kind of desert of thirst,

and you know you can’t have it.

That’s why it hurts so badly,

because the systems of your brain and body

are in a place of anticipation, of readiness.

And given the activation of these brain reward systems,

like the nucleus accumbens,

given your now understanding of oxytocin,

being more enriched in the nucleus accumbens

of some individuals as opposed to others,

it should make perfect sense

as to why it’s so painful in your body.

We talked a moment ago about the importance

of accessing quality sleep on a regular basis.

Gave you at least one tool to do that.

There, again, a rich array of tools to do that

in the Mastering Sleep episode.

And again, highlighting the importance of sleep

for not just emotion regulation and autonomic control,

which is so vital,

but also for making sure that neuroplasticity takes place,

because again, neuroplasticity is a two-part process.

There’s the triggering of the plasticity,

which in the case of the things we’re talking about today,

will be naturally activated

by the practice of a dedicated focusing on the attachment,

feeling the attachment to the person,

maybe even writing about the attachment to the person

as was described in that previous study.

But also just the plasticity is triggered

by the mere loss of that person,

the intensity of that experience.

But neuroplasticity,

the literal rewiring of connections occurs

during deep sleep and in what I call non-sleep deep rest,

or NSDR.

You can find NSDR scripts.

These are short behavioral protocols

that you do for 10 to 30 minutes

at some point throughout the day,

maybe even multiple times a day

that have been shown to accelerate neuroplasticity.

So having such a practice can be very useful

and understand that it involves some cognitive work.

We have to hold onto the attachment

and imagine and feel as much as we can the attachment,

while also being extremely rationally grounded

and trying to not try to hold onto the past,

trying to not anticipate the person walking in the room.

This is very hard because when we think

about the attachment,

the attachment tends to drag with it

those episodic memories,

that rich catalog of experiences.

The expectation that they will walk in the room

is perfectly natural.

The hard cognitive work

is to experience the deep emotional attachment

while at the same time severing from

or distancing ourselves from these expectations

that they’ll suddenly show up in our reality

when in fact they won’t.

And we talked about preparing ourselves for grief, right?

If we have a loved one that’s dying,

or we anticipate that at some point

we are going to have a loss of some sort,

could be death, could be a loss of another type,

breakup, et cetera,

that we can prepare ourselves to grieve more adaptively

by regulating the level of catecholamines,

in particular epinephrine.

That was well-described in the study

that I referred to earlier.

And tools such as the one found

in our mastering stress episode

and tools of the sort that we talked about today,

increasing that vagal tone

by actively building up the relationship between exhales

and slowing down of the heart rate,

so-called respiratory sinus arrhythmia.

Those things can be very useful tools.

So we can actually encourage our nervous system

and build our nervous system

and build our mind to prepare for grief

when it inevitably will come.

Again, this is not about buffering ourselves

from the realities of life.

This is not about disengaging from grief

as a real and important process.

And indeed it is a real and important process to engage in.

Those that enter denial

or trying to distract themselves with substances

or thinking or distracting of behavior,

substances or otherwise,

won’t move through grief as well,

as adaptively as those who embrace a process

of the sort that I’m describing here.

And of course, I want to restate again

that even though grief and depression

are now known to be fundamentally different,

even though people move through the different stages of grief

at different rates and sometimes skip stages, et cetera,

it is often important to access

a trained professional psychologist or psychiatrist

or both or bereavement group or all of the above

in order to get the proper support for grieving.

So this is a podcast about science and science-based tools,

but I absolutely want to emphasize

that there are terrific resources out there

that you can access.

I don’t say this in any kind of glib

or kind of pass the buck kind of way.

There are wonderful trained therapists,

bereavement groups, psychiatrists

that are expert in navigating these sorts of things.

I like to think that the tools that we’ve talked about today

would be not only compatible,

but would be complimentary to the sorts of approaches

that they take.

And as we think about this process of grief,

as we all should at some point in our lives,

because we all indeed will experience grief

in one form or another,

I would hope that the information that we discussed today

would not only give you some tools,

but hopefully give you a better understanding

of not just the people that you’ve lost

or that you stand to lose,

not just the animals that you’ve lost and stand to lose,

but also give you a sense of why it is

that the people who are still in your life

and that you’re attached to,

the animals that are still in your life

that you’re attached to have such profound meaning for you.

And I would encourage you to not lean away from,

but rather to lean into the building

of those episodic memories,

to build up a richer and richer set of experiences

and emotional attachments.

Because while the process of grieving

is in direct relation to how close we are attached to people

there are ways to move through it.

And of course it is the depth of our attachments

and the number and the depth of meaning of experiences

that we share with others and with animals

that makes life so rich and worth living.

So I just want to take a moment and say,

thank you for being willing to explore

this rather complicated

and sometimes extremely challenging thing

that we call grief from the perspective

or through the lens of neuroscience and psychology.

I certainly learned a lot in exploring this literature.

I also really look forward to hosting people

like Dr. O’Connor on the podcast and others on the podcast

who’ve done such beautiful work in this area.

I’ve put out the request and hopefully they’ll join us soon

to further elaborate and teach us

about this fundamental component of our lives.

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