0:00

Hello there, and

0:00

welcome to another episode of

0:02

Let's Chat... I'm Claire Sandys

0:02

host and blog writer of The

0:05

Silent Why podcast. And today

0:05

we're discussing what a grieving

0:09

brain looks like with

0:09

Mary-Frances O'Connor, a

0:12

renowned grief expert and

0:12

neuroscientist. In these Let's

0:15

Chat... episodes, I chat to a

0:15

guest who has experience or

0:18

expertise in a particular area

0:18

that can either help us deal,

0:21

with prepare for, or is linked

0:21

with, loss. And through them,

0:25

I'm building a whole tool shed

0:25

of equipment to help us face and

0:28

get through loss and grief. So

0:28

at the end of every episode, I

0:31

ask our guest, what sort of tool

0:31

their subject is, and then I add

0:34

it to my shed. In February 2022, Mary released

0:35

a book called 'The Grieving

0:39

Brain, the surprising science of

0:39

how we learn from love and

0:42

loss', where she shares

0:42

groundbreaking discoveries about

0:45

what happens in our brain when

0:45

we grieve, opening up new areas

0:49

of understanding around love,

0:49

loss and learning - all my kinds

0:53

of subjects! So you can see why

0:53

I just had to reach out to her.

0:57

Mary-Frances brings a new

0:57

perspective to loss, the part

1:00

love plays in grief, why going

1:00

through love and then loss is

1:03

still better than not loving at

1:03

all, and the distinction between

1:06

grief and grieving. And she

1:06

chats from a viewpoint that we

1:10

haven't really tackled yet on

1:10

the podcast - science. So grab a

1:14

cup of coffee, or a herbal

1:14

smelly tea or whatever your

1:16

drink of choice is, and chill

1:16

out with me and Mary-Frances

1:19

O'Connor as we chat grieving

1:19

brains.

1:29

I'm Mary-Frances

1:29

O'Connor, and I'm a professor of

1:33

psychology at the University of

1:33

Arizona. And I direct the Grief,

1:36

Loss and Social Stress lab - we

1:36

call it the Glass Lab. And the

1:41

Glass Lab studies the impact of

1:41

bereavement of grief and other

1:46

kinds of losses on the brain and

1:46

on the body. How does the brain

1:50

understand what the heck just

1:50

happened, when a loved one dies?

1:55

for example. And we've been

1:55

doing that for about 20 years

1:59

now.

2:00

So we talk a lot about

2:00

feelings and emotions, but we

2:03

haven't really strayed into

2:03

science on the podcast much yet.

2:05

So I'm really interested about

2:05

this area, but how did you get

2:08

into that area of grief?

2:09

Well, I've been

2:09

fascinated since the time I was

2:12

an undergraduate about how is it

2:12

that the brain you know, which

2:18

is this motion of grey matter,

2:18

how on earth does it understand,

2:23

does it encode relationships

2:23

that we have in the world? How

2:27

does that get transformed from

2:27

this experience that you have

2:31

with another person loving them

2:31

and being loved, how on earth

2:34

does that get translated into

2:34

the brain in a way that we can

2:38

remember and imagine and believe

2:38

and love? So that in and of

2:44

itself, that sort of physical

2:44

transformation fascinated me for

2:48

a long time. But in addition to

2:48

the sort of scientific

2:52

curiosity, which is strong for

2:52

me, I also experienced the death

2:58

of my mother when I was 26 and

2:58

she had been sick with breast

3:02

cancer for about 13 years. And

3:02

so I think some of it for me was

3:07

that I just became very

3:07

comfortable with grief, I'm

3:11

comfortable with people who are

3:11

grieving. So I do loads and

3:15

loads of interviews of grieving

3:15

people, and, you know, if you

3:19

cry uncontrollably, it just

3:19

doesn't bother me. And so I

3:23

think that somehow that

3:23

familiarity and willingness to

3:28

be vulnerable, enabled me to

3:28

sort of match up the experiences

3:32

people were telling me about

3:32

with some of their, their brain

3:35

scans and their blood tests and

3:35

their their data in a way that

3:40

really helped me put it all together.

3:42

It's fascinating, I

3:42

totally identify with you on the

3:44

kind of being comfortable around

3:44

grieving people. I think I find

3:48

if there's someone in the room

3:48

with a story like that, there's

3:50

a sort of a gravitation towards

3:50

them. It's like, that will be

3:52

the interesting person, that's

3:52

like, that's the conversation I

3:54

want to have.

3:55

That's right.

3:55

Which is weird. I don't know how that feels as a grieving person to know there

3:57

are people like us out there! So

4:01

in the science world? Like, what

4:01

is grief? You know, is it an

4:04

emotion? Is it... what is it?

4:05

It's a great

4:05

question. And I think in

4:09

bereavement science, if you want

4:09

to call it that, we think of

4:12

grief as the natural response to

4:12

loss. It simply is how we react

4:17

when something very important to

4:17

us, has been taken away. And

4:21

that encompasses emotion,

4:21

certainly those intense

4:25

feelings, but also all kinds of

4:25

thoughts and thought patterns,

4:29

like difficulty concentrating,

4:29

it involves physical reactions,

4:34

increased heart rate and blood

4:34

pressure. And it involves

4:38

behaviours as well, the things

4:38

that we do that change after we

4:42

lose a loved one. So it really

4:42

encompasses all of that. But I

4:45

have to admit, I make a very

4:45

tidy distinction between grief

4:50

and grieving because I think it

4:50

helps people to understand what

4:54

they're going through to make

4:54

this distinction. So grief on

4:57

the one hand, I said is this

4:57

sort of natural response you

4:59

could think of it as that wave

4:59

that overtakes you in the

5:03

moment. It's, it's a noun,

5:03

right? Grief. Grieving, on the

5:07

other hand, is the way that

5:07

grief changes over time. Right?

5:12

So that grief, you know, the

5:12

first 100 times you have a wave

5:17

of grief, when you've lost

5:17

something so important, you

5:21

think I'm not even gonna get

5:21

through this moment, right? So

5:24

this is just unbearable, and the

5:24

101st time, it doesn't feel any

5:29

better, but it may be familiar,

5:29

right? So that shift the way

5:35

that grief changes over time

5:35

that's grieving, it's a verb,

5:39

right? It's a process. And so

5:39

the reason I think that's

5:43

helpful, is because grief is

5:43

just a natural reaction to loss.

5:48

So we're human beings, we're

5:48

going to feel grief for the rest

5:52

of our lives, right? It doesn't

5:52

matter how long it's been, if,

5:55

in that moment, you know, my, my

5:55

sister's getting married in the

5:59

fall, and I know on that day,

5:59

she and I are going to be

6:03

overtaken into a puddle of tears

6:03

at some moment, because our

6:07

parents aren't there. And that's

6:07

just grief. And that's natural.

6:12

And it doesn't mean there's been

6:12

anything wrong with our

6:14

grieving. In the years leading

6:14

up to that moment, there has

6:18

been change over time, it's a

6:18

different experience now than it

6:22

was six years ago, you know. And

6:22

so I think knowing that you will

6:27

experience grief, but that it

6:27

will come less intensely and

6:32

less frequently over time, even

6:32

though in the moment it will be

6:36

intense. I think it'd be helpful

6:36

for understanding what's

6:39

happening to you.

6:40

So can you see on the brain?

6:42

Well, when we

6:42

study grief in the neuro imaging

6:46

scanner, right, just like you

6:46

would have a, an MRI on your

6:50

knee or your heart, we can do it

6:50

on the brain and look at

6:53

activity patterns in the neural

6:53

structures of the brain. What's

6:57

important to know is we're

6:57

always doing that at a group

7:00

level, so we're looking at

7:00

averages of how a group of

7:04

people who are bereaved might

7:04

respond, say to the photograph

7:09

of the loved one that they

7:09

brought us who's deceased. How

7:12

do they respond to that

7:12

photograph differently than,

7:15

say, a photograph of a stranger?

7:15

Right? So in both cases, you're

7:19

using visual processing, for

7:19

example, but there are specific

7:23

regions that are associated with

7:23

grief. And that we do see, but

7:28

it doesn't mean that as an

7:28

individual you can walk in and

7:32

we would be able to say, 'Ah,

7:32

this moment, I see from your

7:35

brain activity that you're

7:35

experiencing grief', we see

7:37

general patterns.

7:38

That might be useful. I

7:38

think, if you could see, like,

7:41

Am I really grieving this? Have

7:41

I dealt with this? Can you just

7:43

tell me what's on my brain?

7:44

Right, right.

7:44

Yeah, I think it's, it's

7:47

interesting, because, you know,

7:47

with some really fancy work, you

7:54

can sort of determine if the

7:54

person is thinking about the

7:59

deceased. Now, this requires the

7:59

person to sort of help to train

8:04

the neural imaging scanner. So

8:04

you do a bunch of scans where

8:07

the person says, 'Now I'm

8:07

thinking of them', and 'now I'm

8:09

not'. And so under those

8:09

circumstances, we could

8:13

determine for an individual with

8:13

some, you know, maybe 60%

8:16

probability. But you know, grief

8:16

is such a broad feeling and set

8:22

of reactions, it really involves

8:22

a lot of different parts of the

8:26

brain, parts about memory, parts

8:26

about emotion, but also emotion

8:30

regulation. So sort of the

8:30

salience the painfulness of

8:34

grief is... shows up. So lots of

8:34

different brain areas are

8:39

involved.

8:40

Does that brain a

8:40

grieving brain look different in

8:43

any way from a brain that is not

8:43

grieving and completely happy?

8:47

And no, not does it look different - is it functioning differently? I guess, is the

8:49

question.

8:50

I think that's a

8:50

great way to put it, because it

8:52

isn't that there's some, you

8:52

know, hole in the brain or

8:56

something [laughs]

8:57

And tears coming out of it!

9:00

But the

9:00

functioning means that we can

9:04

see different patterns, right?

9:04

So those patterns, we can we can

9:10

tell if there's a distinction

9:10

between the group who is

9:14

experiencing grief and the group

9:14

who is not, and to some degree,

9:17

even distinctions between people

9:17

who are experiencing really

9:20

severe or, they're sort of

9:20

adapting or resiliently. We can

9:25

see some differences there as

9:25

well, which is pretty

9:37

fascinating.

9:38

Yeah, I bet. I almost

9:38

wonder if there's ever a point

9:40

when we're not grieving, because

9:40

all the losses we're looking at

9:43

there's so many, and they're so

9:43

big and small all the time.

9:45

Yes.

9:46

Is there such a thing as a brain that's not?

9:48

Right. No, I think

9:48

that's a great example. So I

9:51

think that, as I said before,

9:51

we'll always have grief, right?

9:56

These sorts of discrete moments,

9:56

even intense, discrete moments

10:00

of grief. But there also isn't

10:00

an end point to grieving just as

10:05

you describe it. So here's the

10:05

analogy I sometimes make that I

10:08

think, sort of light hearted,

10:08

but I think makes the point. So

10:12

I'll say to people, when did you

10:12

get over your wedding day?

10:15

Yeah.

10:15

Because 'that doesn't make any sense, what do you mean?' You know? Well,

10:17

losing a loved one is the same

10:21

thing, right? It just changes

10:21

who you are, it changes what you

10:24

understand about the world. It

10:24

changes what you understand

10:27

about relationships, and to some

10:27

degree, even what you understand

10:31

about yourself. And so those

10:31

changes don't end. It's a matter

10:38

of how does that knowledge fit

10:38

into your life now, so sometimes

10:42

I say, grieving can be thought

10:42

of as a form of learning, right?

10:46

And learning never ends. You

10:46

just continue to understand

10:49

differently. As your life

10:49

evolves. To understand what you

10:54

have lost what you've experienced differently.

10:56

It's funny how we sort

10:56

of expect happy things to last.

10:59

Yeah.

11:00

And not the other way

11:00

round. Yeah, it's an interesting

11:02

differentiation.

11:03

Yeah.

11:03

So what happens if we don't deal with grief? What happens if we just push it down

11:05

and carry on? Is, is that

11:09

detrimental to what's happening in the brain?

11:12

It is. So I like

11:12

to make a distinction. You know,

11:15

I think you will appreciate

11:15

this. But I think of us as

11:18

needing a big, what I call a big

11:18

toolkit of coping strategies.

11:22

Perfect.

11:22

Yeah. And the

11:22

reason that I bring that up is

11:26

that there are perfectly

11:26

appropriate moments to be in

11:30

total denial, or just suppress

11:30

how you're feeling, right? So I

11:33

give the example, if you're at

11:33

your daughter's football game,

11:36

you may just decide, you know

11:36

what, for the next 45 minutes,

11:39

I'm going to pretend nothing has

11:39

happened, everything is fine.

11:42

I'm just going to cheer for my

11:42

daughter. And that's all that's

11:45

happening in my world. And so

11:45

that is total suppression,

11:48

potentially. And in that moment,

11:48

that's okay. Right, that's very

11:53

appropriate to living the life

11:53

that you're now living. But what

11:57

is problematic is if that's the

11:57

only tool in your toolkit, if

12:02

every time you feel grief, you

12:02

think, 'Well, I'm just not going

12:05

to feel that right now'. The

12:05

trouble with that is, it doesn't

12:10

allow us to understand to really

12:10

learn what has happened. And

12:15

that means often that then it's,

12:15

it just keeps coming back,

12:18

right, it keeps popping up. And

12:18

in order to process grief to

12:25

understand the loss that has

12:25

happened. We also need to, you

12:30

know, feel that it was painful

12:30

or is painful, and and to

12:35

connect with other people for

12:35

support, for example, or to even

12:39

just understand what does it

12:39

mean to be who I am now, like,

12:44

you know, I use the word

12:44

daughter to describe myself,

12:47

right? But that word daughter

12:47

implies two people, doesn't it?

12:52

All of our words that we use to

12:52

describe ourselves, so spouse,

12:56

right? Yeah. It implies to

12:56

people. And so how do I? How do

13:00

I even understand who I am now

13:00

as a daughter if if my mother

13:04

has died, right? So all of these

13:04

learnings, these changings, it

13:09

helps to have lots of different

13:09

strategies to learn.

13:12

So is that sort of a

13:12

scientific approach them?

13:15

Because if there is science to

13:15

this, then does that mean there

13:18

are definitive answers and help

13:18

and things we can do to maybe

13:21

prepare for loss, or deal with

13:21

it when it comes?

13:23

It's an excellent

13:23

question, and I will say that,

13:27

it has become very clear that

13:27

having what we call in, you

13:32

know, silly scientific terms -

13:32

Emotion Regulation Flexibility.

13:36

Oo that's very romantic.

13:37

Yeah, right. Which

13:37

just means a big toolkit. If we

13:42

have that flexibility, we know

13:42

that people adapt better. So

13:47

that you know, that piece of it

13:47

is a scientific sort of fact,

13:52

it's a piece of data. But I will

13:52

say that we don't necessarily

13:56

understand which strategies in

13:56

which moment for whom, under

14:01

what circumstances, right. It's

14:01

not, it's not worked out that

14:04

well. And there is even a bit of

14:04

a debate just at the moment in

14:08

the scientific literature, which

14:08

would be very boring, largely,

14:12

about sort of how much

14:12

rumination is a problem, you

14:15

know, these sorts of things. So

14:15

the important part about that

14:18

is, scientists are still

14:18

debating, and studying and

14:23

learning new information all the

14:23

time, just as we are about every

14:26

topic. And at the same time, I

14:26

think we're able to make some

14:30

generalisations and also to see

14:30

sometimes where we've swung too

14:36

far in one direction in our

14:36

advice. But I will say this, I

14:41

may be an expert on grief, but

14:41

you are the expert on you, you

14:45

know, you're the expert on your

14:45

relationships. And so, if I have

14:50

thoughts and ideas, they are

14:50

often about responding to grief

14:53

on average, and you are going to

14:53

be a much better judge of how to

14:57

respond to your own grief and

14:57

what may make sense for you.

15:01

I've already, you know, thought the amount of people we've spoken to about grief, I

15:03

said to my husband recently,

15:06

should I lose him in the near

15:06

future, I feel like, I know so

15:11

much about how people have

15:11

coped, I feel equipped, even

15:14

though I know that when it

15:14

happens, it just bowls you over

15:16

and none of it matters for a while.

15:18

That's right.

15:19

I know coming out the

15:19

other side of it, I have tools.

15:21

That's right.

15:22

To help me get through.

15:22

Or people to reach out to you

15:24

have been through it, where I'm

15:24

like 'help me! how did you do

15:26

this?

15:26

Yes. Well, I mean,

15:26

frankly, I think 90% of it is

15:30

just realising that you're

15:30

normal, you know, that these

15:33

intense experiences you're

15:33

having where you think I'm

15:36

losing my mind, or I don't

15:36

recognise myself, why did I do

15:40

that? Why did I say that? Those

15:40

are pretty normal. And just the

15:44

reassurance that what you're

15:44

experiencing is normal, is huge,

15:49

in just sort of getting through

15:49

the acute, you know, the very

15:54

having-the-rug-ripped-out-from-under-you

15:54

part of grief.

15:57

I first came across you

15:57

because a good friend of mine,

15:59

she's a Psychologist sent me an

15:59

article that was interviewing

16:02

you. And you mentioned in that

16:02

which was the title of it, 'You

16:05

can't really study grief without

16:05

studying love'. And I noticed

16:08

your your latest book, 'The

16:08

Grieving Brain', the kind of

16:10

strapline - 'how we learn from

16:10

love and loss'. So how does love

16:14

connect with loss, and what sort

16:14

of relationship do those two

16:16

have together?

16:18

I think for me, as

16:18

a person who studies the brain,

16:21

this is the piece of that that I

16:21

find most fascinating. So we

16:27

know some of this from animal

16:27

research on loss, and then some

16:32

of it from human research on

16:32

loss. And, and what what it is,

16:36

is that when we bond with

16:36

another person, you know, when

16:40

we fall in love with our spouse,

16:40

or when we fall in love with our

16:43

baby, there is a bond formed

16:43

because of that love, it is a

16:49

part of that love. And that bond

16:49

is actually changing the way the

16:53

proteins are folded in your

16:53

brain, right. And we can see

16:58

particular places in the brain

16:58

that are changed when this

17:02

loving bond happens. Just

17:02

incredible to me. And what that

17:07

means then is that along with

17:07

that there is something

17:12

additionally that happens when

17:12

that person dies. Because part

17:17

of what happens is when we form

17:17

that bond, when those proteins

17:22

get reorganised, and our neural

17:22

connections change. Along with

17:26

that comes this belief. And the

17:26

belief is, 'I will always be

17:30

there for you. And you will

17:30

always be there for me'. Right?

17:33

We call it the attachment

17:33

belief. And the reason the

17:36

attachment belief is so

17:36

important is that's the thing

17:39

that enables us to go off to

17:39

work every day, right? Because

17:43

we have this intense belief that

17:43

at the end of the day, we'll all

17:46

come back together, it's an

17:46

invisible tether, right, that

17:49

helps us to know that we will

17:49

return and they will return and,

17:53

and you know, evolutionarily,

17:53

you can imagine that was really

17:56

important. If you're gonna go

17:56

off and forage for food, you

17:58

want to make sure your co parent

17:58

comes back to the burrow or, or

18:03

you come back to your pups. So

18:03

that attachment belief, it

18:08

doesn't change automatically,

18:08

that bond doesn't change in your

18:12

brain automatically, the moment

18:12

that someone dies. So while in

18:18

part of your brain, you have

18:18

this memory, right? You were

18:20

there at the bedside, perhaps

18:20

caring for the person or when

18:24

they passed away, or you were at

18:24

the funeral or memorial. So you

18:28

know what the reality is you can

18:28

refer to the information in your

18:32

memory. But that attachment

18:32

belief persists. And it can't

18:37

both be true, right? It can't

18:37

both be true, there's somewhere

18:40

out there for you, and also that

18:40

they have died. And I think

18:44

these conflicting streams of

18:44

information, which the brain has

18:47

no problem holding on to both of

18:47

them, which is a bit of a

18:52

strange thing, but it's true.

18:52

The fact that they conflict

18:56

means that over and over and

18:56

over again, we are coming to

19:00

recognise 'Oh, this is why you

19:00

pick up your phone to text them.

19:04

And then you realise that

19:04

they've died', right? Or you see

19:08

something in a store and you

19:08

think 'Ah that will be perfect

19:11

for their birthday. Oh, wait,

19:11

they, they won't have another

19:14

birthday'. Right? So there are

19:14

these two parts going on at the

19:18

same time. And the conflict

19:18

between them a) causes a lot of

19:22

emotion, it's very stressful and

19:22

very painful to realise over and

19:27

over and over again that they've

19:27

died. And also I think helps to

19:31

explain why grieving takes so

19:31

long. You know, when I have a

19:35

class of students, I know where

19:35

they all sit in that you know,

19:38

in the fall semester and you

19:38

know who's here and who's there,

19:41

what their name is, you know,

19:41

who has a brother, etc. Well,

19:44

after the class ends, it's not

19:44

like I expect them all to show

19:47

up in spring semester. I just

19:47

learned that automatically. They

19:51

leave the classroom and I never

19:51

expect them to show up again.

19:54

Well, attachment doesn't work

19:54

that way. You always expect them

19:58

to show up again. Do you see

19:58

what I mean? Yeah, so it takes a

20:01

long time to learn to predict

20:01

their absence instead of their

20:07

presence.

20:08

So there's something in

20:08

me hearing that that thinks,

20:11

wouldn't we be better off trying

20:11

not to attach to anybody?

20:14

Yeah. And lots of

20:14

people use that strategy after

20:17

they've experienced loss. I'm

20:17

not actually joking, right?

20:20

I can see that.

20:21

A lot of people

20:21

really isolate, because it's so

20:24

painful. And I will tell you two

20:24

things. One, it creates a very

20:31

painful life, right? So

20:31

basically, instead of only

20:34

having a painful life, once

20:34

they've died, you get to have a

20:36

painful life before and after,

20:36

so to speak, right? That's not

20:40

so great. But the other thing

20:40

is, you wouldn't actually

20:44

survive. We need our attachment

20:44

figures, as much as we need food

20:50

and water. You see this in

20:50

infants, and in the elderly, we

20:54

call it 'failure to thrive',

20:54

when they are not connected to

20:58

another person to a caregiver,

20:58

to someone who they're attached

21:04

to, they actually physically

21:04

cannot thrive. And so we're just

21:08

not wired that way. It isn't

21:08

possible for us not to be

21:12

attached and to be thriving. So

21:12

I think the reason is that we

21:20

have this need as human beings

21:20

to explore, it's important for

21:24

us at many different levels. And

21:24

we have this need to be

21:28

attached. And so our system,

21:28

fortunately, as painful as it

21:33

can be, our system is actually

21:33

remarkably flexible. We can

21:36

learn, we can fall in love. And

21:36

we can also experience loss, and

21:41

understand that as a part of the

21:41

human experience, and continue

21:47

to restore a meaningful life,

21:47

even after great loss.

21:50

Are there people who,

21:50

this is probably going way off

21:53

topic, but I'm just interested,

21:53

are there people who can't form

21:56

those attachments, because when

21:56

you hear about things like

21:58

psychopaths and sociopaths,

21:58

sometimes you hear the brain

22:01

talked about as actually being

22:01

formed slightly differently (I

22:03

don't know if that's true, that

22:03

might just be crime I've been

22:06

watching on TV). But is it

22:06

possible to have a brain that

22:08

can't make those connections?

22:08

And if they can't make them,

22:10

does that mean they don't grieve?

22:13

That's an

22:13

excellent question. And I will

22:15

say a) I'm not an expert in

22:15

this. I will say there are

22:19

people who are a host of

22:19

different reasons who have

22:21

difficulty with attachment. One

22:21

is the example you give with

22:25

psychopathy. There are others

22:25

who simply have different kinds

22:30

of attachment, as we often see

22:30

in something like autism, which

22:35

doesn't mean that they're not

22:35

attached, but it does look

22:37

different. And what's

22:37

fascinating is a lot of things

22:41

are contributing to those

22:41

different patterns. Other people

22:44

have experienced trauma early

22:44

on, in their attachment

22:48

relationships, whether that was

22:48

the death of a parent, or

22:50

whether that was abuse. And

22:50

those things really shape

22:54

whether we're able to make

22:54

strong and enduring attachments

22:57

after. So I would say that there

22:57

are many contributing factors to

23:02

the strength and type of bonds

23:02

that we make. It's part of what

23:06

makes us all unique. But there

23:06

are differences that we can even

23:10

see at the level of the brain

23:10

that do show differences between

23:14

different groups of individuals

23:14

who may have different patterns

23:19

than others of us.

23:21

Yeah, fascinating. Are

23:21

the areas of grief that just

23:23

baffle science?

23:25

Oh, many, many,

23:25

the study of grief is really at

23:28

its infancy, honestly, I make it

23:28

sound, I think very accessible.

23:33

And like, you know, we have all

23:33

the answers. And part of that is

23:36

because I really want to get the

23:36

information that we do know,

23:42

into the hands of people who

23:42

could use it, into your hands,

23:44

into the hands of your

23:44

listeners. And one way that

23:47

scientists have to learn how to

23:47

do that is to not go into quite

23:52

as much nuance all those debates

23:52

that we're having in science, at

23:56

the end of the day, they're not

23:56

as important as conveying that

24:00

we do know a lot. And we can use

24:00

that information. While

24:05

simultaneously saying there's a

24:05

lot we still have to understand

24:08

there's a lot we still have to

24:08

learn. For example, in neuro

24:12

imaging, we have a lot of

24:12

studies now, which I find it

24:15

amazing to have said this, I did

24:15

the first neuro imaging study of

24:19

grief in 2002, published in

24:19

2003, and I don't think I ever

24:23

thought I would be able to say

24:23

there are a bunch of studies now

24:26

of people who are experiencing

24:26

grief. But we have less than a

24:30

handful of studies of 'grieving'

24:30

where we look at the same person

24:34

more than once and see what's

24:34

changing across time. So you

24:39

see, there's an example of where

24:39

we don't actually know very much

24:41

at all.

24:42

It'd be really

24:42

interesting to just see if maybe

24:44

if people have raised in a

24:44

certain way, are they more more

24:47

predisposed to cope with it

24:47

better than others and you know,

24:50

all those kinds of things, that would be a really interesting area. Yeah, I can see now why

24:52

you got into this.

24:55

And why I've stuck with it so long.

24:56

Yeah. So how does

24:56

medication interact with that,

25:00

because obviously a lot of people who are grieving might end up on maybe some form of

25:02

antidepressant or something

25:05

else, how does that

25:05

affect/hinder/partner with the

25:07

brain?

25:08

This is such an

25:08

important question. And I will

25:11

say this is one of the, I think

25:11

this is a great example of where

25:15

science has really, genuinely

25:15

helped us. So, there have been

25:19

some studies of people who have

25:19

what we might call Prolonged

25:22

Grief Disorder, so people who

25:22

are really struggling with

25:25

disabling grief, those waves of

25:25

grief haven't changed over time,

25:30

and they're really preventing

25:30

people from getting dinner on

25:33

the table or getting their kids,

25:33

you know, birthday parties or

25:37

the sorts of things. So what we

25:37

know is that there are targeted

25:42

psycho therapies that can

25:42

genuinely help people who are

25:47

very stuck in this type of

25:47

disabling grief. And that can be

25:51

true even years after the death

25:51

has happened. And it isn't that

25:55

we're taking the grief away.

25:55

It's that we're getting them

25:59

back on a trajectory of

25:59

grieving, right, where there's

26:02

change over time. And so, in one

26:02

of those randomised clinical

26:07

trials, they also included

26:07

antidepressants to see you know,

26:12

what was going to be most

26:12

effective was that when you put

26:14

them together, where you just

26:14

have one or just have the other.

26:19

And we have a really clear

26:19

answer now that antidepressants

26:23

do not help with yearning, and

26:23

yearning is essentially the core

26:29

of that type of grief, right?

26:29

Antidepressants did help people

26:34

who also had depressive

26:34

symptoms, right? So depressive

26:39

symptoms, like difficulty eating

26:39

and sleeping, difficulties with

26:45

feelings of guilt across many

26:45

different situations, not just

26:49

around the death of a loved one.

26:49

Those other types of symptoms of

26:52

depression, were helped by the

26:52

antidepressants, but the

26:57

experiences of grief, the

26:57

yearning for that person was not

27:01

changed. And so we know now, at

27:01

least, as we stand today,

27:05

psychotherapy is the frontline

27:05

treatment. And that there is a

27:10

difference between grief and

27:10

depression, even at a sort of

27:13

neurological level. The other

27:13

medication that people who are

27:17

grieving are often prescribed

27:17

are sleep aids. And I'll say

27:21

that we have pretty clear

27:21

evidence now that sleep

27:24

medication does not help, it

27:24

doesn't help the grief symptoms

27:28

themselves. And although it may

27:28

help the sleep symptoms,

27:31

temporarily, the issue with

27:31

grieving is that you suddenly

27:36

have to learn again, how to fall

27:36

asleep, and how to wake up

27:42

without this person in your

27:42

life. And that is a huge

27:45

adjustment, and that is going to

27:45

take a long time to adjust to.

27:49

But if you add another piece, so

27:49

you add in a sleep medication,

27:54

you're still going to have to

27:54

adjust at some point to that

27:57

medication not being there. So

27:57

honestly, it appears from

28:01

research that it is better to

28:01

simply learn to adjust. And one

28:06

of the best ways we can sort of

28:06

reset our circadian rhythm is by

28:09

setting the alarm at the same

28:09

time every morning, sort of

28:12

resetting ourselves, because you

28:12

can't force yourself to go to

28:15

sleep, that you can force

28:15

yourself to get up, right? And

28:18

so that's one example of how it

28:18

really is an adjustment process.

28:23

And we want to support people,

28:23

but try not to interfere with

28:28

that adjustment, even while it

28:28

is very painful.

28:31

As I've learned more

28:31

and more about about grief over

28:34

the last year or so I'm becoming

28:34

increasingly aware of how little

28:38

medical professionals, not all

28:38

of them, would be aware of the

28:43

impact of grief. And even I

28:43

remember about five or six years

28:46

ago, I was in a workplace and a

28:46

girl who was in her early 30s,

28:49

her brother died very suddenly.

28:49

And she was off with with grief,

28:54

bereavement kind of leave. And

28:54

then I remember I was part of

28:58

the HR department I saw her sick

28:58

notes coming through from the

29:00

doctor. And eventually they

29:00

arrived through and they they've

29:04

been they've moved from just the

29:04

bereavement across to

29:07

depression. I felt like it had

29:07

been labelled too early and too

29:10

quickly.

29:10

Yeah, I will say

29:10

that it is possible to have

29:14

depression after the death of a

29:14

loved one. Absolutely. But I

29:17

will also say that it doesn't

29:17

mean that we can't provide

29:21

treatment. So it is true that we

29:21

do not diagnose Prolonged Grief

29:25

Disorder until a year has

29:25

passed. But that doesn't mean

29:28

that we can't provide

29:28

psychoeducation and skills and

29:33

support even in that first year.

29:33

On the other hand, you're

29:37

absolutely right, so there's

29:37

been a lot of debate about using

29:42

a disorder using a label for

29:42

Prolonged Grief Disorder. And

29:48

while there's a lot of nuance

29:48

there, and I think it is part of

29:52

a larger debate of how we deal

29:52

with stigma around mental

29:56

disorders in general. I will say

29:56

that by creating this label that

30:02

enables us to see this 1 in 10,

30:02

who are really disabled by

30:07

grief. What it means is that

30:07

suddenly all clinicians have to

30:10

be trained. I will tell you, as

30:10

a clinical psychologist, I never

30:14

received a single lecture on

30:14

grief in six years of training,

30:18

not a single lecture on grief.

30:18

And that is true for

30:21

psychiatrists. It's true for

30:21

GPS. And now that there is a

30:25

diagnostic category, what it

30:25

means is, they have to be

30:28

trained in what grief looks

30:28

like, in general, in order to

30:32

make a distinction between just

30:32

that and disabling grief. And so

30:36

my hope, although there's a lot

30:36

of nuances, I say, to adopting

30:40

this, my hope is that because of

30:40

this increased education, and

30:45

continuing education for

30:45

existing clinicians, what it

30:48

means is that as a society as a

30:48

whole, we will know so much more

30:54

than we ever have before, and

30:54

that that will have very

30:56

positive impacts as well.

30:58

Yeah, that sounds really good. We've got something in this country moment, we've

31:00

got a real surge in people

31:04

finding out and being educated

31:04

about menopause, which, you

31:06

know, a lot of women are standing up about and saying, we didn't know about this, how do

31:08

we not know?

31:10

Absolutely! 'Who didn't tell me about this?!'

31:12

It's crazy, 50% of the

31:12

population will definitely go

31:15

through it, but we don't know

31:15

much about it. And it's the same

31:17

with GPS. I think one of them

31:17

said, 'I got two hours training

31:20

on it'. And it's like, that's

31:20

incredible. How is this

31:23

happening? It's affecting the

31:23

mental health, physical health

31:26

of hundreds of women, and it's,

31:26

it feels like a similar thing,

31:29

and that one is getting momentum

31:29

now it's out that everybody

31:31

heard about it on the news. If

31:31

we could do the same with grief,

31:35

that would be a wonderful thing.

31:35

Because I had no clue going into

31:39

childlessness, even stuff you've

31:39

been saying now, I'm like, 'Oh,

31:42

the attachment thing!' You know,

31:42

I probably, without even

31:44

thinking about it, attached to

31:44

the idea of having a child.

31:47

Absolutely.

31:48

So when it was taken away, I didn't know it was broken.

31:51

Exactly.

31:52

Yeah. And that makes so

31:52

much sense. And just having

31:55

those tools help me to know

31:55

that.

31:58

And I think actually, menopause is a fantastic analogy, and here's

31:59

why. So menopause is physical,

32:04

it is, you know, you we can

32:04

pinpoint in time. And it is

32:08

something that the medical

32:08

profession can aid. It doesn't

32:12

mean it's a disease, or a

32:12

disorder, right?

32:15

Yeah.

32:15

However, there can

32:15

be diseases and disorders,

32:19

right, that happen with

32:19

menopause. And so the important

32:22

part in my mind, the important

32:22

analogy here is everyone will

32:25

experience grief, some more

32:25

profound than others. It is

32:30

something that medical

32:30

professionals can help with, and

32:33

that and it is physical. But

32:33

that doesn't mean that it is not

32:37

a natural state. It simply means

32:37

that we need to better

32:41

understand how to support that

32:41

natural state of grieving just

32:45

as we need to understand how to

32:45

support the natural state of

32:47

menopause.

32:48

Yeah, we need to get campaigning.

32:49

That's right.

32:51

We're a powerful force, you and me. I've got the podcast, you've got the science.

32:54

Yes, we're in!

32:56

So just on a personal

32:56

level, you've obviously got all

32:59

this information on grief

32:59

scientifically, has it helped

33:03

you personally, in going through

33:03

loss yourself? Or do you find

33:06

it's a bit hard to put into practice yourself?

33:08

Well, I can say

33:08

yes and no, the larger answer

33:12

being 'yes'. And part of the

33:12

reason I say that is, you know,

33:16

as I said at the beginning, my

33:16

mother passed away when I was

33:19

26. And my father passed away

33:19

about seven years ago. Now,

33:23

there are lots of things that

33:23

are different between those two

33:25

scenarios for my relationship

33:25

with each of them to my age, I

33:29

was certainly much older and

33:29

knew myself a lot better when my

33:33

father passed away. But a lot of

33:33

it was because I really had

33:37

spent almost 20 years, 15 years

33:37

understanding what grief is like

33:44

and why and how. And it meant

33:44

that grief for my father was not

33:50

less intense, but I was able to

33:50

react to the intensity

33:54

differently. And I was able, I

33:54

think, to incorporate that

34:00

experience into my ongoing life

34:00

and sort of retain a meaningful

34:05

life, despite that loss in a

34:05

very different way than I did

34:11

when my mother died and I knew

34:11

so little about grief. I

34:14

remember seeing a counsellor

34:14

about this was actually when my

34:19

mom was she was terminally ill

34:19

and I said to her, I said to the

34:24

counsellor, 'Well, you know, I

34:24

know she's gonna die. I don't

34:27

really know what else there is

34:27

to say about it.' You know, here

34:31

I am decades later, still

34:31

talking about it.

34:33

So simple. Yeah. What

34:33

more is there? [lauighs]

34:38

What more could

34:38

you say? [laughs] I think the

34:41

counsellor who completely

34:41

understood where I was coming

34:43

from, as a young person, but

34:43

just sort of, I think thought

34:47

'oh, well, we have a lot to talk

34:47

about then'.

34:49

Were you a scientist back then?

34:51

Well, I was I was

34:51

in graduate school, but at the

34:54

very, very beginning,

34:55

Right, okay. That's a

34:55

scientific brain is it? I can

34:57

see the facts - she's going to

34:57

die. Is there anything else I

35:00

need to know?

35:00

Yeah [laughs]. But

35:00

I would say also, you know, the

35:05

'know' part, you know, I said,

35:05

there's a little piece of

35:07

'know'. And it is that that, you

35:07

know, when we are in the middle

35:11

of that natural response, it is

35:11

still our response, right? It

35:16

doesn't change the fact that we

35:16

respond to great loss with

35:20

grief, it doesn't take the grief

35:20

away. But it may change how

35:25

we're able to react to feeling

35:25

that grief.

35:28

Is there anything else

35:28

that you'd want to share about

35:30

what you've put in your book and

35:30

who it's for and things like

35:33

that, that people might want to know about?

35:35

I think, you know,

35:35

the book is, it does describe a

35:38

lot of science. But what I'm

35:38

told by readers is that it is it

35:42

is really meant for everyone,

35:42

you aren't supposed to have any

35:44

background in neuroscience or

35:44

anything in order to understand

35:48

it. And, and a lot of that is

35:48

because of all the examples that

35:51

that I use, but also just, you

35:51

know, the way I guess I

35:55

described things.

35:56

So we were chatting

35:56

about what's going on in the

35:58

brain as a useful tool to help

35:58

people preparing for loss and

36:01

going through loss. So if I went

36:01

into the shed, and I picked out

36:04

a tool that represented the

36:04

science behind grief in the

36:07

brain, what kind of tool would

36:07

it be?

36:10

The visual that

36:10

comes to me, is the set of

36:13

shears where you're sort of

36:13

snipping your way out of those

36:17

vines, you know, all those

36:17

tangled vines, but you can snip

36:21

them away, you can step out into

36:21

the garden, and clear them away.

36:25

A way to describe that would be

36:25

not getting stuck in thoughts.

36:29

And in particular, the 'would

36:29

have should have could have'

36:32

thoughts. So these are those

36:32

thoughts that just go round and

36:36

round and round in your head.

36:36

And especially early on, they're

36:40

very natural, it's, you know, if

36:40

only I could have gotten them to

36:44

the hospital sooner or the

36:44

doctor should have run another

36:48

test, or if only they would have

36:48

known the train was going to be

36:52

late. All of those stories that

36:52

we tell in our in our brain, our

36:56

brain is uniquely capable of

36:56

coming up with an infinite

37:00

number of these. But the trouble

37:00

is, if you think about it, each

37:04

of those stories ends in and

37:04

then my loved ones lived, and of

37:08

course, your loved one didn't

37:08

live. And so to live in the

37:11

present moment is to be aware of

37:11

the painful reality that they're

37:16

not with us. And so to get stuck

37:16

in those stories means that

37:19

you're also not fully

37:19

participating in the present

37:23

moment with all its pain and

37:23

suffering, but also with all its

37:27

love and joy and connection. And

37:27

so I think not getting stuck in

37:31

the 'would have should have

37:31

could have' would be the tool I

37:34

would I would add to the shed.

37:39

Well, there you have

37:39

it, I now have another set of

37:42

useful shears in my tool shed to

37:42

help us snip our way out of

37:46

thoughts that aren't helpful and

37:46

can entangle us. My shed is

37:49

filling up nicely. Thank you

37:49

Mary-Frances for your time and

37:52

opening up a new area of love

37:52

and loss that very few people

37:55

would have heard about or

37:55

touched on. If you'd like to

37:58

find out more about Mary-Frances

37:58

and her book The Grieving Brain,

38:02

visit www.MaryFrancesOConnor.com

38:02

or visit the show notes. The

38:06

paperback of her book actually

38:06

comes out very soon in early

38:09

February 2023. And to see a full

38:09

list of other Let's Chat

38:12

episodes and topics that you

38:12

might want to listen to visit

38:15

www.thesilentwhy.com/Letschat.

38:15

Thanks for listening to The

38:19

Silent Why podcast. If you've

38:19

got a subject you'd like me to

38:22

chat to an expert on, please get

38:22

in touch via social media or the

38:25

website or on our email

38:25

[email protected] And let's

38:29

chat...