What Happens To Your Body When You’re Grieving

FLORA LICHTMAN: This is Science Friday. I’m Flora Lichtman. Just a heads up, next up, we’re talking about a sensitive subject, grief. We have all these expressions to describe the pain of loss, heartache, a broken heart, a punch in the gut. I think of them as figures of speech, but my next guest says it’s not so simple.

Grief is an emotional experience, but it’s also a physical one. Studies show that grief can change your physiology. Here with me is Dr. Mary-Frances O’Connor, Professor of Clinical Psychology and Psychiatry at the University of Arizona.

She’s also the author of a new book, The Grieving Body, that looks at the physiological effects of grief. Mary-Frances, welcome back to Science Friday.

MARY-FRANCES O’CONNOR: It’s so nice to be here, Flora.

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

MARY-FRANCES O’CONNOR: It’s funny, I’ve been studying the reaction to loss, just that natural grief response in the brain, but also the body for, gosh, 25 years now. And as I was writing The Grieving Brain, I thought I would put all the information all in one book.

And then I realized, wait. I think there’s a whole other book in here. I’m not going to have room. So it got transformed into two books. The second book, The Grieving Body, is about the research on cardiovascular and immune responses we have in grieving.

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

MARY-FRANCES O’CONNOR: We don’t often realize that grief is a physiological response as well as an emotional one. And I think the research has really helped us to hone in a little bit on what’s going on in the body.

So we know that there are changes from excellent research by Tom Buckley and others from Australia that in the first few months after the death of a loved one, our blood pressure actually goes up a few millimeters mercury, and our heart rate actually goes up a few beats per minute across 24 hours. And seeing that in black and white, those mechanisms, was very compelling to me. It really sort of validated what a lot of grieving people have been saying, that it feels like grief is in the body.

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

MARY-FRANCES O’CONNOR: Isn’t that interesting? So I think there’s two parts of that that are really interesting. The first one is we don’t actually know. We need better research to know exactly what’s happening.

We have these tantalizing sort of on-average, across-the-population kind of statistics. But we need to understand for this individual, what does that feeling mean? That I think the other thing you said that’s so interesting is it may not be that it’s an injury.

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

FLORA LICHTMAN: You write about people dying of a broken heart, which I thought, again, was sort of a metaphor, or just a turn of phrase. But it sounds like it’s more than that.

MARY-FRANCES O’CONNOR: This has been one of the most compelling findings, because we’ve seen this in very large epidemiological research. So 1.5 million Finnish people, for example, in a study. And we know from the evidence is that, for example, in the first three months after a man’s wife dies, he is almost twice as likely to have a heart attack as a married man during that same period of time.

FLORA LICHTMAN: Twice as likely?

MARY-FRANCES O’CONNOR: Twice as likely. Isn’t that a crazy statistic?

FLORA LICHTMAN: It really is.

MARY-FRANCES O’CONNOR: It’s like 1.8% for women. So slightly lower, but an extraordinary risk when we think about medical risks. And this has been replicated again and again in large studies across a population.

FLORA LICHTMAN: Do we understand the mechanism? Why are you more likely to– why are you more likely to have a heart attack?

MARY-FRANCES O’CONNOR: This is where my research really sort of tried to dig in. So in a study that I did with Roman Palitsky, who’s now at Emory University, we looked at could it be that during a wave of grief is the riskiest moment.

And in that study, what we found was, sure enough, people’s blood pressure rose during a wave of grief. What’s fascinating is the people who were struggling the most with grief when they walked into the lab, so how they’d been doing in the past couple of weeks, they actually showed the greatest increase in blood pressure during that wave of grief.

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

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

MARY-FRANCES O’CONNOR: I think of it a little bit like pregnancy. This sounds like a funny analogy, but pregnancy is very physiological. That’s sort of an obvious statement. But it’s not a disease. It’s not a disorder.

FLORA LICHTMAN: Although it can sometimes feel one.

MARY-FRANCES O’CONNOR: Well, this is the thing. You really want medical care, right? And that’s mostly in the sense that we need surveillance. So we need prenatal care. And then we need to know what’s happening so we can intervene if something goes wrong.

Similarly in bereavement, it’s just a riskier time for our physiology. And so it’s important to think about how are we supporting that grieving body for this person who’s undergoing what we know is the greatest life stress?

FLORA LICHTMAN: What’s happening with the immune system when you’re grieving?

MARY-FRANCES O’CONNOR: When I was at UCLA, I did a postdoc in psychoneuroimmunology. And part of the reason I wanted to do that is because I really wanted to understand what we call all-cause mortality. So while cardiovascular risk goes up in acute bereavement, in those first couple of months specifically, we actually see increased risk for all sorts of different outcomes, cancer recurrence, and even things like a pneumonia.

And so I thought, well, what on Earth could be a mechanism that’s affecting all these different causes of morbidity and mortality? And of course, the immune system acts on every single one of our organ systems. So it makes autoimmune disorders harder, like rheumatoid arthritis.

And so by looking at blood draws from people who were grieving, who were courageous and agreed to be in my studies, we saw that inflammation levels are higher in bereaved people. And now larger studies than mine have confirmed that from other labs as well.

FLORA LICHTMAN: Are the physical effects from grief are different than the effects you see of stress on the body? Acute stress.

MARY-FRANCES O’CONNOR: That’s such a good question. So I like to say, the heart doesn’t have a lot of choices. Heart rate goes up or it goes down. Blood pressure goes up or it goes down.

So at that level of peripheral physiology, we might say. So at the output in the body, there’s not a lot of differences necessarily between the stress of grieving and the stress of other things, like being in a threatening situation. But in the brain, we think there are differences because you have to think about the idea– well, really, you can’t think about loss without first thinking about love and bonding.

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

FLORA LICHTMAN: Yeah. I think anyone who’s had kids can feel–

MARY-FRANCES O’CONNOR: Yes.

FLORA LICHTMAN: Feel this. You feel like your heart’s outside of your body.

MARY-FRANCES O’CONNOR: Absolutely. But even beyond, metaphorically, think about what we call kangaroo care, where we lay an infant on the skin of the chest of the parent. And it reduces pain, it improves breathing, all these good factors physiologically.

Or if I get a hug from my partner, my heart rate goes down. So it turns out that couples and bonded infant-caregiver, they form this “we.” And what happens is when there’s a death, it reveals all the ways that we’re being externally regulated by our loved ones. They are our external pacemaker, but we can’t really see that often until they’re gone.

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

MARY-FRANCES O’CONNOR: I am now. You know, there’s a lot of stigma in society. So this wasn’t something I talked about early in being a postdoc, or being an assistant professor, because you’re nervous about how that will go. But I have multiple sclerosis.

And what I didn’t realize for many years was that I was actually diagnosed a little more than a year after my mother died in my early 20s. Now I want to be very clear that my mom’s death did not cause my MS. We have a family history.

But the idea that the predispositions we all carry around can be really revealed again during this stressful time, I think, is one way that that happened for me. But what it meant was, in my lived experience, I came to deeply know the grief of health, the grief of loss of health, loss of certainty about my functioning.

And it meant that day to day, I had to make room for my body. I had to start incorporating how to care for my body in my day-to-day life because I wanted to do the meaningful work that was so important to me.

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

MARY-FRANCES O’CONNOR: I often think, why would I bother to tell people all this scientific information that I know? And I think it’s because when we know these facts, and on average, they’re across people. They might not be perfectly attuned to your situation.

But by knowing these things, we can figure out how to work with your body, because grief is a natural response to loss. Our body, our mind, it mostly knows what we’re doing if we don’t get in the way. And so finding– here’s a silly sort of example.

You can’t force yourself to go to sleep. Every grieving person will tell you that sleep is really difficult when we have loss. But you can, for the most part, force yourself to get up at the same time every day. What’s important about that is it resets your circadian rhythm if you intervene in your behavior. It means that your hormone system, your endocrine system, knows, oh, this is the set point that I can come back to again and again and regulate all those stress hormones that’s going to help you emotionally to deal with your loss as well.

FLORA LICHTMAN: If you’re just joining us, I’m speaking with Mary-Frances O’Connor, author of The Grieving Body. This is Science Friday from WNYC Studios. I think a lot of people who’ve grieved may have had this experience.

There can be this annoying feeling when you’re grieving a loss, like I should be doing it better. I should be getting through this faster, or I should be optimizing this in some way. I know you’re interested in helping people grieve better.

How do you do that? Or how do you navigate that? How do you help people without putting pressure on people?

MARY-FRANCES O’CONNOR: I think it’s really important to remember that this is a natural process. In my laboratory, we do something where, at the beginning of the summer, we plant flower seeds in the lab. And the reason is because think how long it takes.

You have to keep watering. There’s no evidence that that seed is sprouting below the surface. You have to keep watering with faith in order to see those first sprouts.

There’s something about when we look at living systems to recognize that adapting, growing, learning, it takes a long time. If you cut your hair, think how long it takes for your hair to grow back. And no one says to you, why isn’t your hair growing faster? What is wrong with you?

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

MARY-FRANCES O’CONNOR: This is the thing. If it is partly a physiological response, to some degree, there’s no rushing that. And you’re right, our society is consumed with optimizing our experience.

I think many cultures, many periods of history, teach us bereavement is a time to pause. It’s a time to give ourselves a little more time and space because our bodies, our minds, our relationships are doing so much to understand the enormity of the loss of this person in our midst. And that pause, that reflection, just giving each other a little bit of extra space and grace, maybe, helps us to process what the heck is going on.

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

MARY-FRANCES O’CONNOR: When I was 13 years old, my mother was diagnosed with stage IV breast cancer. And there was cancer cells in every lymph node they took out. So they knew it had already migrated to other parts of her body.

And I didn’t understand this. No one told me when I was 13 that the doctor didn’t expect her to live through the year. But I did understand that grief came to our house. And so in many ways, he described her as his first miracle. She actually lived another 13 years.

FLORA LICHTMAN: The doctor did?

MARY-FRANCES O’CONNOR: Yeah. Isn’t that incredible? She lived till I was 26.

FLORA LICHTMAN: Wow.

MARY-FRANCES O’CONNOR: And it meant that during that time, I think I just became more familiar with grief, from a very unfamiliar experience to feeling OK about having people cry uncontrollably when they talk to me. And so in some ways, it’s not so much about figuring it out for myself, but how can we help each other? How can we sit with each other as we go through this?

And maybe because of my unique background, how do I take what people are telling me and map that on to neuroimaging scans and blood draws that I’m doing, hopefully in a way that helps us to make sense of both the emotional, the relational, and the physical response?

FLORA LICHTMAN: Well, I think you have. I’ve learned so much. Thank you, Mary-Frances.

MARY-FRANCES O’CONNOR: You’re so welcome. Thank you, Flora.

FLORA LICHTMAN: Dr. Mary-Frances O’Connor, Professor of Clinical Psychology and Psychiatry at the University of Arizona. Her new book, The Grieving Body, is out now.

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