Instant Genius - The Neuroscience of Grief, with Mary-Frances O’Connor

Episode Date: March 14, 2022

Neuroscientist and psychologist Mary-Frances O’Connor explains the latest thinking on what happens to our brains when we experience grief and loss. Once you’ve mastered the basics with Instant Genius, dive deeper with Instant Genius Extra, where you’ll find longer, richer discussions about the most exciting ideas in the world of science and technology. Only available on Apple Podcasts. Produced by the team behind BBC Science Focus Magazine. Visit our website: sciencefocus.com Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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science of how we learn from love and loss. Just finish reading your book, The Grieving Brain, the Surprising Science of How We Learn from Love and Loss. So obviously, this is all about grief and how the brain responds to grief. And it's very much a neuroscientist's approach to grief in the brain. So I thought the best place to start, I mean, you described. in terms of certain aspects of how the brain works with grief. And it's split into maps, timing, and closeness.

So I'd just like you to walk us through that. And then maybe if I have a question, I'll interject. So our loved ones are so vitally important to us. It turns out they are as important to our survival as food and water. And for that reason, the brain devotes a lot of space, you know, in the neural systems to keeping track of our loved ones. So you can imagine how important it is to know, where am I going to get food?

When are my next going to eat? Well, similarly, I believe that the brain has adapted that to think about where are my loved ones and when will I see them next. For example, if I said to you right now, you know, where's your girlfriend or where's your spouse? You'd probably have a pretty good idea. And that is because of this internal mapping that the brain takes care of for us. So what's so unique and just devastating about the death of a loved one then is that our brain,

if our loved one is missing, our brain is really trying to tell us, well, go find them. They're out there. Go get them. Or possibly, you know, make enough noise, attract their attention. and make them come back to you. But in the devastating circumstance and unusual circumstance of the death of a loved one,

it isn't that they are lost. It is that there is no map. And that is very disorienting for the brain. That is not something it is prepared to understand. It's like suddenly arriving on a foreign planet. So when you think about it that way, then I think you can think about these dimensions of space and time, right? So the where are they and the when will I see them next? Well, what's so

interesting is to think that there might be a third dimension actually works in quite the same way that literally the brain is encoding it as a dimension in a similar way to time and space. And that's the dimension of closeness. So when I say closeness, what I mean is you can think of, if I ask you the question, are you and your sister close? That's what I mean sort of my closeness. You have some sort of intuitive sense of how close the two of you are. Well, I mean, sometimes even in our language, we use similar terms for these dimensions, don't we? Which is so interesting, sort of like in the book I give the example of way out, right? You can say that that appointment is way out, meaning in the future. You can say, you know, the ball is way out in the field, meaning distance,

but you can also say that someone is way out, right? Like they're not really close. It's hard to make contact with them psychologically, right? So that closeness dimension then, if we think of the difficulty that the brain has with losing the map, with there being no here and no now, with the person that we've lost, then I think in a similar way, there's suddenly no close. And that means that it's very difficult for us to understand why are they gone? Why can I not feel close to them right now? And so I think the brain really struggles to make sense of that and tries to use solutions that we might use if they were still alive. I think this is one of the reasons why some bereaved people just feel irrationally angry with the person who's died, which not everyone experiences,

but I have really noted over time, as I've interviewed bereaved people, they will say, I know this is, I know this doesn't make any sense, but I feel so angry with them for leaving me. And that is how you might feel if they had left in the sense, of they had disregarded your closeness and they weren't talking to you anymore. Well, I think in the same way the brain gets confused about time and space, it can also get confused about closeness and feel either angry with them and a sense of blame or the alternative feeling very guilty when it isn't, you know, rationally makes sense. You didn't lead to their death.

You didn't cause their death. But because that's how we might repair a relationship when someone is alive. I think the brain on some level maybe tries to do that and creates those emotions. So that sort of leads on then to something else that sort of struck a chord with me. There's this common feeling that people have that when a loved one has died, they feel like still they're not gone and they'll be able to walk into the room at any given moment or, you know, they expect them to come home at the usual time that they used to come. And often people say, oh, you know, and I know it sounds crazy, rationally,

I know that they're not with us anymore. But so you actually say that our brain, this isn't an unusual thing at all. We're actually wired up to thinking this way. If you think about it from the perspective of what is it that we've, you know, what is it that we're missing when a loved one dies from the perspective of the brain? It is actually that first there was a bond. So when we bond with our loved ones, right? whether that's our spouse or our child, even a best friend, really, the brain creates that

encoded bond. And that then is what gets lost. But because of that encoding, the brain is really a prediction machine, isn't it? Right. It's trying to figure out what's going to happen next. And one way that it does that is, well, I know that I have a bond with you. this other person, that means I had this deep-seated belief, they will be there for me and I will be there for them. That's, you know, part and parcel of the encoded bond. And so when a loved one dies, the brain continues to use its predictions. So think of it this way. You know, on the first day that your wife doesn't come home at six o'clock at the end of the workday. And it's not actually a very good prediction that she's died, right? You have thousands of days of experience

and here's this one day or even two days or even 30 days or 90 days, right? It just isn't in comparison to this deep-seated belief. And I think that leads to a lot of what people experience as irrational feelings. Our brain just tries to complete the prediction, complete the habit often. And what that leads to is we actually kind of experience them and also know when we consult our memories, we know that they're not there any longer. So this is tied up with sort of something that you mentioned is the notion of yearning and how our memories can be triggered. So could you tell me a bit about that, please? yearning really is the heart of grief, I think. It's just that overwhelming desire to have things back the way they were or to have your loved one back with you. It's just such an intense experience. And I really liken it to the motivation of hunger or thirst because we know that having these close loved ones were attached.

to is so important to our survival, but that motivation, you know, our brain is really trying to encourage us to seek out our loved ones and spend time with them. And so, you know, it uses everything at its disposal, dopamine and oxytocin and cortisol, anything it can to sort of motivate us to seek them out. And so this sense of yearning is just with us then for a very long time and in, you know, and in moments is with us sort of forever because, you know, just because time passes doesn't mean that this person isn't important to us still and that we aren't still aware that there's a loss or an absence. And I liked something that I read this. I mean, I think most people find it quite cute, which is pair bonding in animals. And so we can say

this and, you know, we experience it instinctually. But you mentioned there some of the different hormones they're involved in this. But it's something that we can physically study, isn't it? It is fascinating idea. So these little pair bonded rodents that we get in North America and Canada, they mate for life. And so they, you know, once they have mated, it means they always prefer to be in the presence of their partner and they raise their pups together and so forth. And what I think is so interesting is the idea that we can actually see in their little tiny brains before that, you know, first time that they mate and after the first time that they made when then forever their behavior has changed. The proteins in their brain are actually folded

differently in this area called the nucleus accumbens. The proteins around their genes, epigenetics are actually folded differently. And it means that the number of receptors for oxytocin in this part of the brain are increased. And even more recent work, because this is such a burgeoning field, the neuroscience of grief, in recent work, even after the book went to press, there's evidence that there are specific neurons that fire as we approach our mate. So that's their sole job is to encode, is to qualify that you are approaching your mate. And as the bond grows stronger over time, there are more neurons devoted to this specific activity. It just really highlights for me how important our loved ones are. Yeah. And so sort of carrying on from that,

you mentioned hormones there. There's a lot of stuff, studies that you've been carrying out using neuroimaging techniques on brains, which I thought was really fascinating. Could you tell us a bit about that? I really felt that grief might be something we could look at, again, in a very quantitative neuroscience way. And that seemed very unusual when I first started this work about 20 years ago or so. And I think we have come to a point where, you know, the neuroimaging scanner functional magnetic resonance imaging or fMRI really does allow us to sort of peer into the brain in real time and see, you know, where is the blood flowing? And that tells us what neurons are firing. So in trying to figure out how can we create a moment of grief for people who are in this sort of hospital setting, you know, in this very sterile environment, we actually asked them to bring photographs of the person who had died, as you might, if you're telling anyone about a loved one, that's passed away. And so we were able to scan these photographs and take words that they had used

as they were describing their loss and show them on goggles in the scanner so that the person is actually experiencing that wave of grief that is caused when we think of our loved ones, when we're bereaved, and especially in the first few years of being bereaved. And so by doing this, we can see what particular brain regions are activated, in contrast to the person looking at a photograph of a stranger, say, for example. So it's still a person. It's a good contrast because the brain is using similar regions that you would use for looking or for perceiving a human being, right? But what's unique is this grief over this relationship. And so what we find is partly that there are many, many parts of the brain that are involved.

Grief is very complex. And some of those are areas like the dorsal anterior cingulate that really seems related to pain or the salience maybe of pain. So emotional pain in this case, although also the salience of physical pain. And interesting, given I was just talking about the nucleus accumbens, a very surprising finding that came out of a 2008 study, of mine was that when we looked at people who had the most yearning, right? So who were reporting

to us that week to week, their intense yearning, that level of yearning was correlated with the amount of activity, of activation in the nucleus accumbens. And for readers who are, or listeners who aren't as familiar, the nucleus accumbens is part of what we call the reward network in the brain. But not to confuse people, not rewarding in the sense of, oh, this feels good, you know, because that's not something we expect as a person is looking at their loved one. But in that motivation way, I was talking about yearning. So this idea of, yes, I want to be with that person. Yes, I want to seek them out. So reward in the more psychological sense of trying to increase the behavior, you know. So people who were having more yearning for their loved one when presented with an

image showed more activity in this very specific region compared to those who perhaps had adjusted more to knowing that they would not be able to predict that this loved one would be seen again on this earthly plane. I think this is in a separate experiment, but there was when you were showing the photographs, there was a heightened association with the parts of the brain that involved in facial recognition when you said, I thought that was really interesting. Isn't that fascinating? So it turns out facial recognition is a very specific and very important thing for human beings to do. And it's kind of a very, it's like a mini function, right? It's sort of able to be parceled out. And so we know looking at faces,

uses this fusiform gyrus area. We know that partly because sometimes people have damage to this area of their brain and they lose the ability to distinguish between faces, for example. So as people are looking at the photo of their loved one, in contrast to looking at the photo of a stranger, where of course they're still looking at a face. But there's more activation in this facial recognition area when you're looking at a loved one.

I think again, sort of pointing out how important it is that we really cue in, oh, no, this is my one and only, right? I need to very carefully identify this is the one, not those other people out in the world that are not so important to me. And I think that's why probably we see more activation in this region.

So they're sort of more universal things, but of course not everybody responds or copes with grief in the same way. So there are several sort of distinct different types of response, aren't there? And what's interesting about this is, I think it has been very helpful to me as a scientist, to think about the difference between grief and grieving. So the vast majority of fMRI studies that we have to date are actually about grief. they are about that moment that just washes over you, the emotion that we think of with grief, with the thoughts and feelings that come with it.

Grieving, on the other hand, is the way that grief changes over time, right? So grieving necessarily is a trajectory. It has been very useful, I think, for people who are bereaved to understand this difference between grief and grieving as well. So this is part of why I find it helpful sometimes to talk about. But the point is that when we have grief, it is simply the recognition, the awareness of this loss. And that will be true any time we become aware of the loss, even years and decades after we've had the death of a loved one. That wave can still come over us.

But grieving means that how we cope with that grief, perhaps the frequency with which that wave overcomes us will change over time. And so what we see is that there are some distinct patterns in this grieving trajectory. And this is some work done by George Bonanno at Columbia University, where across just many, many studies now. He's looked at the way that bereaved people's experience changes over time, and we identify a few different patterns. So one of those is what we might call resilience. And so that is that for the majority of people who are bereaved, we don't actually lose the ability to kind of function in our life. That doesn't mean people don't experience sadness and suffering, but that they also are

simultaneously able to experience pride and joy and, you know, they can do things like get dinner on the table, you know, sort of just function in their day-to-day life. But there's another group of people. Historically, we've called this complicated grieving, although now the term that the DSM uses is prolonged grief disorder. And so for this group of individuals, they experience elevated distress and some very specific kind of emotional and cognitive responses, but that those don't change much over time. So they don't see the same increase in acceptance that typically accompanies adapting, you know, to the death of a loved one. But the slight distinction I just want to, for listeners who might struggle with this, if you expect that you will never experience

that wave of grief again, you will be disappointed. And you might think it means that you've done something wrong, that you're not grieving properly. But that's not what it means. It just means you've become aware of it. And so that's, I think, the usefulness of the distinction. So have there been any studies carried out on perhaps what the differences of the people that have the different responses are? I mean, is that something that's actually being studied yet? It is. And actually that study that I referred to before that showed the people who were yearning more had more nucleus accumbens activation, those individuals also yearning is sort of the hallmark symptom of prolonged grief disorder. And so what we see then is that people who have this prolonged grief disorder may show more nucleus accumbens activation. And interestingly as well, this is one way we've been able to tease apart the idea. that depression and PTSD or post-traumatic stress disorder and prolonged grief disorder are actually distinct. So if we look at a study by Richard Bryant from Australia, when he looked at individuals

in the scanner, all of whom were bereaved, but some had post-traumatic stress, some had depression, and some had prolonged grief disorder, their brain region responses to sad faces was distinct. And so we think there may be different neurobiology underlying these different disorders, even though, of course, you can have more than one disorder at a time. You can have prolonged grief disorder and major depressive disorder at the same time, just like you can have depression and anxiety at the same time. But nonetheless, if we look at those individuals differently, there's some indications then that there may be some different neurobiology. So was that also an imaging study? It was, actually, yes. Are there any common features? You said they're distinct. Are there any common features between these types of grief, different types of grief, depression and PTSD? There are some similarities. At the most basic level, I think one thing that is true is the emotional reactions that people are having are really interrupting their day-to-day life. And so in each of those cases, although depression tends to be more around,

sort of sadness and guilt. Prolong grief disorder tends to be more around yearning and emotional pain. And post-traumatic stress disorder tends to be more about anxiety and fear and helplessness. Nonetheless, with each of those emotions that people are experiencing, they're having difficulty regulating them such that they can be loving toward their grandkids and get out to work and go to, you know, a friend's wedding and all those sort of typical things because of the intensity of their reaction. So with these studies, we've been talking about, the imaging studies, have we got anything coming up in the future? Like anything that is a particularly hot area that you'd like to talk about or like to share with us?

I can tell you that a former graduate student of mine, Saren Sili, has done some remarkable work with what's sometimes called the default mode. And so this is when we just ask people to rest in the scanner, so there's no activity, they're not looking at anything, but just in this resting state, what parts of the brain, what networks of the brain are sort of simultaneously active? And there's some good research that in other situations, people's resting state network connectivity looks different in something like depression than in healthy controls. Well, the study that she has done, which is sort of under review at the moment, is looking at bereaved people in this situation and finding that those who are having the most trouble grieving, those who might qualify as prolonged grief disorder, your brain can be in different states, right? So you have a particular group of regions that are connected and then sort of your thing shift

and a different group of regions are connected primarily. and people with difficulty grieving, there was a particular set of networks and people spent more time in that particular state. So we call it dwell time, which I think is just such a tremendously helpful word. So they're dwelling for more time than people who are adapting more resiliently. Now, I can't tell you, you know, this is still a very new area. So I can't tell you exactly why. And it can't necessarily even tell you what the mind is doing while their brain is sort of stuck in the state. But I think for many of us intuitively, it makes sense that part of the difficulty with grief is that you can get stuck in your thoughts or in the way you feel and you just feel like you can't get out of it.

And so I think this is a really interesting, possibly useful future area for neurobiology research. Thank you for listening to this episode of Instant Genius. That was psychologist Mary Francis O'Connor. If you want to know more about how psychologists and neuroscientists study grief, check out her book, The Grieving Brain, the surprising science of how we learn from love and loss. Or, to hear a tell me more about the grieving process, head over to the Instant Genius Extra podcast.

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