Scientists know that the intense stress of grieving can affect the body in various ways, but much remains a mystery.
By Ann Finkbeiner
In 1987, when my 18-year-old son was killed in a train accident, a chaplain and two detectives came to my house to notify me. I didn’t cry then, but a wall came down in my mind and I could do nothing except be polite and make the necessary decisions. When friends and relatives showed up, I was still polite, but the wall had now become an infinite darkness and I was obviously in shock, so they took over, helping me to eat and notify people and write death notices.
I’ve been thinking a lot lately about the more than 565,000 people who have died from Covid-19 in the United States. Each of them has left, on average, nine people grieving. That’s more than five million people going through the long process of grief.
Manisha Patel, a senior business systems analyst in Bensalem, Pa., lost her father, Ramesh Patel, to Covid-19 in June. “I have been through the toughest time of my life,” she said. “I feel heavier, but I weigh no more and I eat less. And there’s a lot of gray hair I didn’t have. My heart aches for him, it longs for him, it looks for him.”
When someone you love dies, experts have a pretty good sense of the path that grief takes through the mind, but have only a general sense of how it progresses through the rest of the body. First is a shock in which you feel numb or intensely sad or angry or guilty or anxious or scatterbrained or not able to sleep or eat or any combination of the above. During those first weeks, people have increased heart rates, higher blood pressure and may be more likely to have heart attacks. Over their lifetimes, according to studies done mostly on bereaved spouses, they may have a higher risk for cardiovascular disease, infections, cancer and chronic diseases like diabetes. Within the first three months, research on bereaved parents and spouses shows that they are nearly two times more likely to die than those not bereaved, and after a year, they are 10 percent more likely to die.
With time, most people stabilize; they begin to learn — gradually and on their own timeline — how to more or less continue with their lives and function in society. But studies suggest that after six to 12 months, about 10 percent of bereaved people have not begun to function better. They get stuck in what’s called “complicated grief”: they stay completely preoccupied with loss and persistent yearning, and remain socially withdrawn.
Scientists know that grief is not only psychological, it’s also physical. They know that it causes the brain to send a cascade of stress hormones and other signals to the cardiovascular and immune systems that can ultimately change how those systems function. But nobody knows how those systems act together to create the risks of diseases and even death.
One reason scientists don’t know more about the biology of grief is that only a handful of researchers study it, and they are usually psychologists with biological interests. Mary-Frances O’Connor, a psychologist who researches grief at the University of Arizona, studies both the psychology of grief and its biological changes in the laboratory and is one of the few researchers who straddles both fields. Hybrid science is seldom funded well; grief is neither a disease nor is it classified as a mental disorder, and the main funding agency, the National Institutes of Health, has no single established channel for funding it.
Nevertheless, researchers have found enough people to take surveys and get blood tests and scans to note some patterns.
Chris Fagundes, a psychologist at Rice University, said that in his own lab, he and his team have found links between grief, depression and changes to the immune and cardiovascular systems. In one study published in 2019, he and his team performed psychological assessments on 99 bereaved people about three months after the deaths of their spouses, and then took blood samples. Those who experienced higher levels of grief and depression also had higher levels of the immune system’s markers for inflammation.
“Chronic inflammation can be dangerous,” Dr. Fagundes said. “It can contribute to cardiovascular disease, Type 2 diabetes, some cancers.” In another study of 65 people, published in 2018, Dr. Fagundes and his colleagues found that bereaved spouses who had higher levels of markers for inflammation also had what experts refer to as lower heart rate variability — a characteristic that can contribute to an elevated risk for cardiovascular disease.
Other studies have found effects on the cardiovascular system, too. In one, published in 2012, researchers measured the heart rates of 78 bereaved people twice — once for 24 hours within the first two weeks of a spouse or child’s death, and again for the same amount of time six months later. They found that their heart rates were initially faster, then returned to normal, suggesting that the bereaved may have been at least temporarily at higher risk for heart disease. Another study published in 2012 found that those with higher scores on grief assessment tests also had increased levels of cardiovascular clotting factors, possibly raising the risk of developing blood clots.
And in one review of 20 studies, published in 2020, people who scored higher on psychological measures of grief also had higher levels of certain stress hormones like cortisol and epinephrine. Over time, chronic stress can increase the risk of cardiovascular conditions as well as diabetes, cancer, autoimmune conditions and depression and anxiety.
Put the studies together and on the whole, Dr. Fagundes said, “everything starts with the brain.” It responds to the death (and to intense stress in general), by releasing certain hormones that fan out into the body, affecting the cardiovascular system and the cells of the immune system. Aside from that generality, however, the biology of grief has no clear chain of cause-and-effect that the biology of, say, diabetes, has. That’s because the goals of these studies are to better understand the griever’s risks for disease, not to understand the path of grief through the body.
The one exception is with the study of the brain. In 2001, Dr. O’Connor first began imaging the grieving brain, and a handful of similar studies have been done since. In these studies, a person lies immobile in a functional magnetic resonance imaging (or fMRI) scanner, looks at certain pictures and listens to certain words, and the machine maps the blood flow to parts of the brain. In one study published in 2003, Dr. O’Connor found three areas of the brain that were triggered by words related to grief (like “funeral” or “loss”) and a fourth triggered by pictures of the person who died. Some of the brain areas were involved in the experience of pain, others in having autobiographical memories. These findings were “not world-stopping,” Dr. O’Connor said, “like, sure, that’s what happens in grief.”
But the responses recorded in another area, called the nucleus accumbens, were more surprising. This region is part of the brain’s network for reward, the part that responds to, say, chocolate, and it was active only in people with complicated grief. Nobody knows why this is so, but Dr. O’Connor theorized that in the continuing yearning of complicated grief, being reminded of a loved one with pictures and words might have the same reward as seeing a living loved one. In regular, uncomplicated grieving, the reminder is no longer connected to a living reward but is understood as a memory of someone no longer here.
All of these studies, however, have limitations. Many of them are small and haven’t been replicated. The researchers also don’t have the resources to follow the participants over time to see whether those with higher risks for a disease eventually develop that disease. Many studies are also a snapshot of one point in time, and will miss the changes that occur in most people over months and years. Studies using fMRI have limits all their own, too: “A lot of things could make the same areas light up,” Dr. O’Connor said, “and the same thing might not make the same areas light up in everyone or in one person over time.”
Grief, biological and psychological, is of course the result of another hard-to-study state, human attachment or love. “Humans are predisposed to form loving bonds,” Dr. O’Connor said, “and as soon as you do, your body is loaded and cocked for what happens when that person is gone. So all systems that functioned well now must accommodate the person’s absence.” For most people, the systems adjust: “Our bodies are amazingly resilient,” she said.
In a recent issue of the research digest UpToDate, medical doctors outlined the most current scientific studies on bereavement. One way to think about grieving, they said, is that the feeling of connection to the person who died “gradually moves from preoccupying the mind to residing comfortably in the heart.” I’m unsure about that word, “comfortably,” but yes, I’m no longer preoccupied. Now, 34 years after my son’s death, I’m back in charge, and if pain never quite goes away, then neither does love.
Ann Finkbeiner is a freelance science writer who usually writes about astronomy and the science of national security. She lives in Baltimore.
The five stages of grief model was developed by Elisabeth Kübler-Ross, and became famous after she published her book On Death and Dying in 1969.Who is the leading grief researcher? ›
Mary-Frances O'Connor conducts studies to better understand the grief process both psychologically and physiologically. She is a leader in the field of prolonged grief, a clinical condition in which people do not adjust to the acute feelings of grief and show increases in yearning, avoidance, and rumination.What is the new model of grief? ›
This model suggests that individuals actively engage in the reevaluation of their beliefs, values, and sense of identity following the death of a loved one. It encourages individuals to make sense of their loss, find purpose in their grief, and create new narratives that incorporate the memory of the deceased.What are the 3 C's of grief? ›
Practice the three C's
As you build a plan, consider the “three Cs”: choose, connect, communicate. Choose: Choose what's best for you. Even during dark bouts of grief, you still possess the dignity of choice. “Grief often brings the sense of loss of control,” said Julie.
In reality, we do not experience feelings of grief one at a time or in a particular order. We know that there are no set stages that everyone goes through. You may experience these things – because they are all normal feelings of grief.Are there 7 or 5 stages of grief? ›
People often describe grief as passing through 5 or 7 stages. The 5 stages are denial, anger, bargaining, depression, and acceptance. The 7 stages elaborate on these and aim to address the complexities of grief more effectively. They include feelings of guilt.What denomination is GriefShare? ›
GriefShare is a nondenominational program offered by local churches. People of all faiths (and those who do not practice a faith) are welcome and will feel comfortable attending. Our program includes practical information from the Christian Bible.Who published a grief observed? ›
Elisabeth Kübler-Ross. A Swiss American psychiatrist and pioneer of studies on dying people, Kübler-Ross wrote “On Death and Dying,” the 1969 book in which she proposed the patient-focused, death-adjustment pattern, the “Five Stages of Grief.” Those stages are denial, anger, bargaining, depression and acceptance.What is the new 6th stage of grief? ›
As mentioned above, David Kessler has recently documented a sixth stage, which is finding meaning. Many people talk about finding "closure" after a loss, but Kessler talks about learning to remember those who have died with more love than pain and learning to move forward in a way that honors our loved ones.
Silent grief, also known as disenfranchised grief, occurs when individuals feel they need to carry their pain alone and hide their emotions from the people around them. It usually occurs when a person feels others won't be receptive to their pain.What are the 4 models of grief? ›
The Four Stages of Grief Model. British psychologists Bowlby and Parkes were the first to propose the Four Stages of Grief model. Their four stages include shock-numbness, yearning-searching, disorganization-despair, and reorganization. Bowlby applied his work focusing on attachment and relationships to this theory.What are the 5 grief indicators? ›
The 5 grief indicators achieved their respective maximum values in the sequence (disbelief, yearning, anger, depression, and acceptance) predicted by the stage theory of grief.What are the 5 pillars of grief? ›
The five stages, denial, anger, bargaining, depression and acceptance are a part of the framework that makes up our learning to live with the one we lost. They are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief.What are the 6 R's of grief? ›
- Recognize the loss.
- React to the separation.
- Recollect and re-experience.
- Relinquish old attachments.
A Grief Observed is a collection of C. S. Lewis's reflections on his experience of bereavement following the death of his wife, Joy Davidman, in 1960. The book was published in 1961 under the pseudonym N.W.When was grief published? ›
Grief is a novel by American author Andrew Holleran, published in 2006. The novel takes place in Washington D.C., following the personal journey of a middle-aged, gay man dealing with the death of his mother. The novel received the 2007 Stonewall Book Award.When was on grief and grieving published? › Who developed the five stages of grief and what are they? ›
Introduced to the world in the 1969 book On Death and Dying by Elisabeth Kübler-Ross, the Kübler-Ross model (sometimes called the DABDA model) surmises that there are sequential stages of various emotions that a patient goes through when diagnosed with a terminal illness, starting with denial and ending with acceptance ...