Ten Percent Happier with Dan Harris - 450: The Science of Loss and Recovery | Mary-Frances O’Connor

Episode Date: May 18, 2022

Very few of us will live a life without loss. As part of our Mental Health Reboot series in recognition of Mental Health Awareness Month, this week’s episodes talk a lot about grieving. Mary-Frances O’Connor, an expert in bereavement research, explores the science of how we grieve and experience loss, whether it’s a job or a loved one. Mary-Frances O'Connor is an Associate Professor of Clinical Psychology and Psychiatry at the University of Arizona, where she is also the Director of Clinical Training. And she is the author of a book called The Grieving Brain.In this episode we talk about: The distinction between grief and grievingHow her Buddhist practice has influenced her understanding of griefWhether or not we can ever quote/unquote “get over it”Why she argues for “a really big toolkit of coping strategies” How to understand the work of Elizabeth Kübler-Ross todayWhat grieving looks like in a pandemicWhat to say to people who are grievingThe new diagnosis of prolonged grief disorderContent Warning: Brief mention of suicide. Full Shownotes: https://www.tenpercent.com/podcast-episode/mary-frances-oconnor-450See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This is the 10% happier podcast. I'm Dan Harris. Okay, I'll be honest, I was both intrigued and mildly concerned when we booked today's guest intrigued because she's an eminent scientist at the forefront of some fascinating research. She also happens to be a practicing Buddhist. Concerned just mildly because her area of expertise is grief. And here's why that worried me a bit.

I am always thinking about how to make every episode as compelling as possible to as many people as possible. I'm borderline obsessed with that, actually. And the truth is, not all of you will be grieving as we traditionally understand that word right now, although obviously very few of us will live lives without loss. In any event, the good news is that my guest today defines grief in a broad way. It's not only when you lose a loved one in her view, but also when you lose a job or a relationship, and she even has thoughts about why so many of us grieve for public figures

who've never met. Mary Frances O'Connor is an associate professor of clinical psychology and psychiatry at the University of Arizona, where she's also the director of clinical training. And she is the author of a book called The Grieving Brain. In this conversation, we talk about the distinction between grief and grieving, what she's learned from neuroimaging studies of the grieving brain, how her Buddhist practice has influenced her understanding of grief, whether or not we can ever quote unquote get over it, why she argues for and these are her words, a really big toolkit of coping

strategies, which would include progressive muscle relaxation, which she will explain, and mindfulness, and we'll explore both the value and limitations of mindfulness when it comes to grief. We also talk about how to understand the work of Elizabeth Kubler-Ross today, what grieving looks like in a pandemic, why she likes the serenity prayer, what to say to people who are grieving, and the new diagnosis of prolonged grief disorder. This is week three of our four-week mental health reboot series, in which we are pairing personal stories on Mondays with cutting-edge science on Wednesdays. If you missed it, check out Mondays episode with Catherine Schultz, the Pulitzer prize-winning

writer who's just out with a memoir about gain and loss in her own life. Excellent interview, we, in my opinion, heads up on two things before we dive in here. There's a little bit of background noise in this interview, recording in a pandemic, et cetera. And there's also a brief mention of suicide. Before we jump into today's show, many of us wanna live healthier lives, but keep bumping our heads up against the same obstacles over and over again.

But what if there was a different way to relate to this gap between what you wanna do and what you actually do? What if you could find intrinsic motivation for habit change that will make you happier instead of sending you into a shame spiral? Learn how to form healthy habits without kicking your own ass unnecessarily by taking our Healthy habits course over on the 10% happier app. It's taught by the Stanford psychologist Kelly McGi McGonical and the Great Meditation Teacher Alexis Santos. To access the course, just download the 10% happier app wherever you get your apps or by visiting 10% dot com.

All one word spelled out. Okay, on experts the questions that are in my head. Like, it's only fans only bad. Where did memes come from? And where's Tom from MySpace? Listen to Baby This is Kiki Palmer on Amazon Music or whatever you get your podcast. Mary Frances O'Connor, welcome to the show. It's so great to be here, Dan. Thanks for having me. Pleasure. Let's start with you. How did you come to get interested in this happy subject?

Mm-hmm. You know, people often tell me I might be too happy to be studying this, but for me, it's really connected. So I think much of happiness is finding meaning. And while I've always been interested in the why of grief, how is it that the brain can understand these experiences we have in the world? And how does it literally encode those in that little gray computer? The reason that grief was so important to me to understand probably came from the fact that my mom got stage four breast cancer when I was

13 and we didn't know how long she would live. She lived till I was 26, which was really, I think of it as a reprieve from the universe. But it meant that I've always felt comfortable sitting with people who were grieving, like the idea of you crying uncontrollably just doesn't bother me. And so perhaps because of this personal experience of being okay with grief and then these sort of scientific questions, I was maybe able to match up those two experiences to really dig in with people about how they were feeling and what they were thinking and then match those two neuroimaging studies I was looking at. Get that your experience made you in some way okay or comfortable with other people's grief.

I'm curious though, was there something about your experience at age 26 losing your mom that fueled the questions you said about answering? Because I sometimes use this phrase I'm talking about death. It's this radical subtraction. You know, it's hard to grok. And I'm just wondering if there was something

that happened in your experience of 26 that led to the questions you said about answering. You know, I have come to think of grieving as a form of learning over a very long period of studying it. And I think that we never know what it is exactly that we're going to learn, but there is no way that that close brush with mortality doesn't change us. It changes the way we understand the world.

It changes how we understand relationships, our own mortality, what we should be spending our time doing this morning. It really changes everything, and I think there's just no way for that not to have influenced how I go about my life, the questions that I ask, the answers I'm looking for. But it was sort of all pervasive, I think, for many people who are grieving, it doesn't change just one thing. It completely shifts your perspective. And so it's almost hard to point to, isn't it? Because it just changes fundamentally how you think about the world.

You said that it changes, you know, what you're going to do this morning. Was that a reference to a kind of boost in vitality that comes from understanding that loss can happen at any time? It can certainly. So, you know so in psychology, we call this post-traumatic growth. And that comes in a few different flavors, doesn't it? One of them is this sort of carpe diem.

Life is precious, time is short. I need to do meaningful things. And for other people, it's more about how important the people are close to us and that we never know. And so I need to express my love and gratitude to them and spend time with them. I think that for me, it is also about figuring out that you're a person in the world who now may be overcome with grief at any moment. And so knowing that you're walking into work and that, you know, there may be a point in the morning where you're dissolved into tears.

You also have to figure out how am I going to manage that, right? So the what I'm going to do this morning is partly, what am I going to do this morning given I have these goals in life? And yet I might be overcome with pangs of grief at any moment. How am I going to manage that? How am I going to move in and out of that grief so that I can also be restoring the life that I want to live? How do you manage it? Is that the $64 billion question? I think I have a lot of $64 million. $128 million up and on up. I think what I've learned from a lot of people's experiences, not just my own, from sitting

and talking with people who've experienced the death of someone very close to them, and these daily diary studies we do where people write down every day sort of what their experience was like. So we get a really fine-grained understanding. I think the biggest thing I've learned is you need a really big toolkit of coping strategies. Because no one strategy is going to work in every situation. So for example, we used to think when your grieving avoidance is just a terrible thing to do, it's terrible to be in denial.

Well, frankly, there are moments where it's totally appropriate, right? If you're standing at your daughter's soccer game, then to think, you know what, for the next 45 minutes, I'm just pretending this never happened. I'm just putting it out of my head. I'm going to cheer for her. I'm going to focus on that and I'm not going to think about anything else. That's really appropriate in that moment, right? There's nothing wrong with you. There's nothing wrong with your grieving because that's the way to cope in that moment. Now, if you did that every single day in every situation, you probably would have a hard time because grief would keep breaking in. So we have to learn other strategies like being able to cry on somebody's shoulder or being able to write in your journal or being able to pray or go for a walk.

There are so many ways that we can cope with these strong emotions and being able to try a bunch of different things that feel appropriate in the moment, that to me seems like the sin of mental health. I understand that you are practicing Buddhist and there's quite a few references to death and mortality and loss within Buddhism. And I'm just thinking of one, this notion of the eight worldly winds, which I've always loved, the thinking of the various changes that overcome us during life, not as something personal, but as different varieties of wind. You know, it's just part of nature.

And gain and loss are two of the wins. There's sort of matching pairs, fame and ill-reput, gain and loss, and I'm going to forget the rest of them. But yeah, I just wonder if you have thoughts about how your practice of Buddhism informs your work. Well, certainly while neuroscience is not the most obvious way to think about grief, or certainly wasn't at one time, Buddhism has been struggling with grief for a very long time. I mean, in the first noble truth, right, it's all about grief and losses of all sorts of kinds through aging and illness and death. And so perhaps having studied grief isn't surprising that I came to Buddhism,

perhaps more so than the other way around. It has really informed my understanding of the idea that everything is impermanent and to the degree that we can find a little bit of accepting that everything is impermanent. It really helps to apply that then in one of the most final types of impermanence with the death of someone we're really bonded to. That doesn't make it an easy process. Most things in Buddhism I find are not so easy. And maybe that's part of the point. That's part of why we have a tradition there

to keep those difficult things alive and teaching them to the next generation. I want to circle back to something you said earlier about. You've come to think of grief as a kind of learning. I'd be curious to hear you unpack a little bit more why you call it that. Well, I think to start with, it's really helpful to make this distinction between grief and grieving. So grief is that feeling that overwhelms you. You know, the wave we've been talking about, the wind, right? It just overwhelms you. And in that moment, you think, I'm not even going to get through this moment.

Griefing, on the other hand, is the way that grief changes over time without ever going away, right? So grieving means that, you know, the first hundred times you have grief, you have that thought, I'm not going to get through this. And then the hundred and first time, it's still grief. It still feels as awful as it did before, but it may be more familiar, or you may know that you are going to get through this moment, or even that you know what you might do to find some comfort in that moment. So that's grieving, the way that grief might change in frequency or intensity. And the reason I think that's helpful is because grieving then really is a form of learning. We're learning, oh, I am now a person in the world who has grief.

And that will probably always be true whenever I'm aware of having lost something, something so deep and bonded. And so grieving is really learning, how do I understand that every habit I have in the house? You know, when I brushed my teeth and my partner and I are sort of doing that dance around in the bathroom and you know where he's going to move and then where you're going to move and you know, when to reach for the floss. All of those habits have to change when that person is gone. All of the picking up the cell phone to call your mom, right, to tell her something

and then realizing, oh, I can't call her. All those habits we have to relearn. But bigger things as well, we have to learn, what am I going to do for retirement when I've been planning to do it with this person for decades? What on earth is retirement even going to look like? What am I going to do? How am I going to be in the world? Those are also learning processes. And it really has been the brain imaging work that kind of brought me around, reminded me of how much learning is a part of this process. We'll tell us about the brain imaging work. What does loss do to the brain? One of the pieces that we've gotten from taking a neuroscience perspective on grief

is that some of the neuroimaging studies we've done, and even in neuroscience with animals, made us really recognize that it is a bond first. That when we fall in love with someone, whether that's our mate or our baby, that process of bonding, it changes the brain. It changes the way the epigenetics are folded, in particular regions of your brain. It changes the physical connections,

the way neurons fire to activate each other. And so when that brain has formed this bond with the other person, part of that encoding is, this one is special, right? This particular one, this particular person, this particular mate or baby, the way they cry, the way they smell, they will always be there. I will always be there for them, they will always be there for me. And that encoding in the brain has that permanence to it, that special bond. So when a loved one dies then,

the problem is the brain solution to someone being absent, not in our presence. You know, you kiss your spouse and they go off to work. The solution to them not being present is simply, well, you should go find them or call them or text them. When the person dies, that solution doesn't work anymore.

And so the brain is still using all the same chemicals that dopamine and the oxytocin and the opioids to motivate us to reach out for this permanent loved one, for this special one who will always be there for, even though that solution doesn't work anymore. And we have memories, right? We were either there at the bedside when the person died, or we were at the funeral, we got that phone call, that terrible phone call to say they died.

So it's not that we don't have this other stream of information in our brain. We have memories, we understand that the person is gone, but those two mutually exclusive pieces of information on the one hand, they're always going to be here on the other hand. I know that they've died. It leads us to think things like it just feels like they're going to walk through the door again. Right? So it takes the brain a long time to update, to make new predictions, to understand

how the world works. Now that you have this really deep and different kind of knowledge. I am not a neuroscience nerd and it may be the case that most of the people listening are not either, but I'd be curious to hear to the extent you're willing to indulge. What regions of the brain are implicated in both size of this, the falling in love and the losing? Well, I think one of the most surprising things that happened in my second neuroimaging study of grief, the second one that was done was we looked at people who had all experienced the death of a loved one, but there was quite a range in the yearning they were still

experiencing for this person who was now gone, who was now dead. And so we just asked them in interview show, tell me about the last week and what has the yearning been like and they gave us you know sort of a quantitative rating, a number rating. And then when we did the imaging scans, when we had them lie in the neuroimaging scanner, they had brought us a photograph of the person who had died. And so we were able to show them that photograph on goggles as they're laying in the scanner, and look at the brain activity as they're perceiving that picture and feeling that grief. What was so surprising was there was this region of the brain that we call the nucleus acumbens. For the non-blobology geeks out there, it's a part of what we think of as the reward

network of the brain, so teaching us and helping us to want things, to yearn for things. Right? We discovered that the people who were describing more yearning in the weeks before this scan. They also had the most activity in this nucleus-accompanse region. And so there are other regions of the brain. There's parts of the brain that encode memories, for example, or strong emotions, and those were activated in everyone. But to see a place in the brain that was really tracking how much we were yearning for this person, that was very interesting because we know this is the same region of the brain that is required when there's bonding. So if you put people in the neuro-aging imaging scanner, you show them

a picture of their romantic partner or fathers, you show them photos of their kindergarten. This is the same region of the brain that we see activated in those studies as well. That's probably a major part of where this bond is really held. And so, as we are grieving, something in the brain has to change to update, to understand, I am no longer going to get to spend time in the presence of this person. That's not true anymore. And so I have memories, I have emotions, I have thoughts, but it's not the same as this reward prediction of, I want to be with this person and that will sometime happen in the future. And yet the same part of the brain is activated. person and that will sometime happen in the future. And yet the same part of the brain is activated.

So this is what's so interesting. In the people who had transformed, had integrated their grief so that they were what we might think of as more resilient. This was a group of people who, one of the women in the study, told me, yes, you know, I put out my mom's Christmas decorations. At Christmas, we think about her, we tell stories about her. But day to day, I don't yearn for her to be with me. I understand that this is how the situation is now, right? So she's still having memories. She still loves her mother. She still reflects on the importance of her mother

in her life, but she isn't spending time wishing that she was able to be with her mother in this moment, right? She just knows that's no longer the reality. As opposed to another woman who told me, my mother has died, and why would I even bother to give Barmit's face to my children? Life just has no meaning. Why would I even engage in life in this way? Why would I do these meaningful things if she's not around? Right?

So you sort of see this difference of, on the one hand, you can have moments of grief, but your grieving has brought you to a place where you accept. There's a certain accepting that this is the reality. Versus on the other hand, this just protests, this just isn't possible. I just don't, I want them to be back. That level of yearning is where we're still seeing this reward prediction in the brain that says, I want, I'm yearning, I'm thirsting for this person. Does that sort of make sense? So the same part of the brain, the yearning, the nucleus accumbens, the reward center,

is activated both when you're falling in love and when you're grieving, but for people who are more resilient, it's activating in a different way than folks who are still in the throes of the thing. It's activating less at least in this study. So it's almost as though the bond part is transformed, and so they don't need to use this part of the brain. It's not an active yearning process for this bonded loved one, but rather it's a part of memory. So it's in posterior singulate cortex or it's in some of the emotion areas of insula and so forth.

It's really transformed the way that we're perceiving with our brain. Would it be safe to say that from the brain's perspective, loss, death does not negate love. The love continues no matter what. Yes, I would absolutely say that. I would absolutely say that. There is no way that you know six months, six years, six decades after we experienced the death of someone, that the brain doesn't have this experience, doesn't create this experience of grief when we become aware that they're gone, and that's because we love them,

because they are so important to us. So the grief, that momentary feeling, that will always be true. That doesn't mean that we haven't also restored a meaningful life for ourselves, right? And so I think the trouble for people often is, when they experience these moments of grief, years after the loss, when they break down into tears,

as they pull out some memento, they see the handwriting, right, of their spouse who died. And in that moment, the grief feels just as awful as it did. Doesn't mean there's anything wrong with them. It doesn't mean there's anything wrong with the grieving that they have been doing. It just means that in that moment,

they have the awareness that they have been doing. It just means that in that moment, they have the awareness that this person is gone, that meant so much to them, they have that awareness of loss. That means that grief will be true forever while grieving means that we still come to integrate an understanding to live a meaningful life while being a person who can acknowledge and move into and out of those moments of grief. So your work, the neuroimaging, gives us understanding, but does it give us relief? Does it help us in any way to deal

with this universal human condition of grieving? Oh, that is such a good question. I think for me, part of writing this book was, you know, I say in the book, I'm not giving advice, actually. I don't think that's how insight works. I don't think, you know, someone else can tell you how it works. For me, it's that if we understand some of the basic science of how the brain might be doing this and why it might hurt so much, we can apply that then to our own lives.

So while this is not a part of the data, I find it very comforting. So not as a scientist, but as a human being, I find it very comforting to know that when I fell in love with this person, that it changed the physical aspects of my brain, because it means that even after they've died, I'm still carrying them, right? I'm still carrying a physical part of us in my own brain. So do you see what I mean? That's not the science isn't giving me the comfort in the sense that through data, I, you know, experience comfort.

But for me, it is by understanding why this happens and how it works. I find comfort in knowing how important that connection is, how it works that I'm carrying it with me, and that I will always have that. So your mom, for example, might not be drawing breath at this moment, but she lives in your nucleus, a cumbersome. She absolutely lives in my brain. And, you know, I perceive the world through that brain. So she's in everything, right? As I look at, but dress, I'm going to wear on Easter Sunday. I don't know. I see that in part through a brain that's been shaped by who she is, whether it's because I choose the dress she would hate, or whether I choose the dress she

would love. It really means that I'm just perceiving a world shaped by the love and relationship that we had. It's also kind of trippy in that that to the extent that we think about our own brains, we think of them as our own. And yet they are being, I don't love this word because it's a sort of new age cliche, but they're being co-created our brains in partnership with other human beings, with whom we have a relationship. They really are. You know, I'll say that for me, are. You know, I'll say that for me, I had perhaps an unusual entree into Buddhism because my dissertation advisor, actually Al-Kazniak, was a practicing Buddhist. I didn't know that at the time, but he went on to become Sensei. Al-Kazniak was president of the board of mine and life for a while and now runs the Upaya Sangha. And so he introduced me to this whole world of Zen brain

and the Varela symposium that the Upaya Institute in Santa Fe puts on. So for me, I think there is this connection of intersubjectivity, that we think of each of us as being individuals. But in fact, when we're bonded, we're not really just one. We're not really just two either, right? Which is a very non-dual sort of way of thinking about it, isn't it? That really, we are an entity.

We're a we different from you and me. And the brain actually encodes we as distinct from just you and just me. And so that representation we have, I think helps us to understand that then when that person is missing, when that person has died, you really have lost a part of yourself as well. Say we think of the word daughter. Right, I can use daughter to describe myself,

but it actually implies two people, right? And the word wife or husband, that implies two people as well. So we're always incorporating this we, and that really is this intersubjectivity. We are co-creating our experience. So intersubjectivity is that a Buddhist term or a neuroscientific term? This is part of my strange background. I think of it as both.

Coming up, Mary Frances O'Connor talks about whether grief is an evolutionary design flaw. She'll talk about tools for coping with grief and whether we ever really quote unquote, get over our losses after this. Celebrity feuds are high stakes. You never know if you're just going to end up on page six or do more or in court. I'm Matt Bellesai. And I'm Sydney Battle and we're the host of Wonder E's new podcast, Dis and Tell, where each episode we unpack a different iconic celebrity feud from the build up, why it happened,

and the repercussions. What does our obsession with these feuds say about us? The first season is packed with some pretty messy pop culture drama, but none is drawn out in personal as Britney and Jamie Lynn Spears. When Britney's fans form the free Britney movement dedicated to fraying her from the infamous conservatorship, Jamie Lynn's lack of public support, it angered some fans, a lot of them. It's a story of two young women who had their choices taken away from them by their controlling parents, but took their anger out on each other. And it's about a movement to save a superstar, which set its sights upon anyone who failed to fight for Brittany.

Follow Dissentel wherever you get your podcasts. You can listen ad free on Amazon Music or the Wonder App. You've talked a lot about how the brain reacts with pain in the face of losing a loved one. And I just wonder, is that from an evolutionary standpoint a design flaw? Hmm. No, I think it's a design perk. It's just that it's a solution for the wrong problem. So if you think about it this way, I think of the Emperor Penguins sometimes, you know, that sit on the ice for months, the father sits on the egg and incubates it, and the mother goes off and swims to the ocean and is gone for months so that they can bring back food.

So during that time, that father penguin has to have this belief. She is out there. She is coming back. And I'm going to sit here in the freezing cold believing that and not go hunt for fish for myself and not try and go and fight her. Because if I do that, this chick has the best chance of survival. Right? So there's a way in which we yearn for each other and when that mother penguin comes back,

you know, there are thousands of penguins on this beach and they find each other, right, through calls. Thousands of penguins are calling, but you find your special penguin because of that specific call that you share with them, right? When we're apart from each other, it can be painful, and that is in part to bring us back together, and that works really well when we're alive and attached to each other

and bonded. It doesn't work so well when that person is permanently gone, because it's not designed to work for that. It's designed to keep us together However, this attachment system is still flexible and the reason that we know that is There's a time in our life where our parents are the most important people, right? Our caregiver is the person we turn to when things are really bad or things are really good and at a certain point, we leave home, we make close friends, we start dating, we choose someone to spend our life with. And that is the most important person that we don't stop loving our parents,

but it does mean that our system is flexible enough to love our living loved ones. And for that change over time, if it needs to, I'm still not convinced because yeah, good grief is so painful and so debilitating. And is that the best thing for the species to have us almost inevitably at points in our lives? Just knocked down in this way. I like that you're not buying it. I like that you're skeptical.

It makes you sound like a scientist. So here's what I would say about that. Let's take physical pain as an example. Do you think it's a good thing that when you touch something very, very hot, it's extremely painful? Yes. Yeah. And the reason is we learn, right? We learn not to do that. When we're

in bonded relationships, we learn, don't spend too much time away from this person. This person is really important. You need to come back together. You need to support each other. You need to be there for each other. You need to ask for help from them, even. That pain of separation, I think, helps to teach us. Okay, this ask for help from them even. That pain of separation I think helps to teach us, okay, this is actually really important to me. When we lose someone through death, which thankfully is actually a very unusual experience, that pain is a byproduct of that love, inevitably what that can teach us is everyone has grief, right? There's a way in which that once we stop focusing on my grief, we realize human beings

have grief when they're separated from each other, and now I know what that feels like. And because of that, I'm able to have this kind of empathy and compassion that I may never have been able to have before. I never really did understand the people around me who had lost someone and been knocked down as you describe it. And now I really get it. Now I really get that there is grief, not just my grief. And in a moment when you feel very alone because you're missing your person, you can sometimes

find connection by recognizing that we are in this together. And so I think that pain has awful as it is, and I'm not trying to downplay how awful it is. It does also help us to learn. It has things that it teaches us. And that's part of why I think grief is just really an important part of life. So it may be debilitating, hopefully only temporarily, but it's adaptive in that it allows us to have empathy. Yeah, yeah, I think that's one of the ways, for sure. I mean, not to be political about this,

but whatever you think of Joe Biden, even his detractors will point out that the severity and frequency of loss in his life has helped him or appears to have helped him relate to other people. Absolutely. And you know, it can go many directions, right? Some people who are experiencing profound loss, they really feel cut off. Don't they, from the people around them, like, no one could understand me, no one can understand what I'm going through. And other people, often when you have enough support,

when you're around people who understand what you're going through, they are able to transform this into what I do matters, what I spend my day doing matters. And this other person, they want to live a happy life, but they're having pain in this moment. Is there anything I can do to ease that pain in this moment? It is a profound teacher in that way. It does not let you get around what's important when you're in the midst of grief.

Suddenly, often things feel very revealed. Is it possible to take the wrong lessons from grief? I'm never going to put myself in a position to be disheart, again, et cetera? I mean, of course, I think that's a human judgment, which are the wrong lessons. But I would say to the degree that we think that a mentally healthy life includes loving our living loved ones. It takes a lot of courage to love again. It takes a lot of courage in part because let's say for example you have the death of a spouse or the divorce

from a spouse and you decide to try a new relationship. All of the habits are still in there. And so as you have experiences with this new person, they're going to remind you of the grief that you have, right? So the first time that you give a key to someone, you know, so that they can come into your home, the first time that you do laundry together, you know, all of those things are also going to bring back memories. And so it takes a lot of courage to say, I have grief over this loss, and I also want to live now with this loving, living person. And it takes time and courage. And I think a lot of support from the people around us. But the thing that amazes me is that we really are very resilient as human beings.

The reality is most of us experience grief and most of us find a way to integrate that into our understanding of the world and relationships, and we do lead meaningful lives. So I think the magnificence of the flexibility of human beings is just remarkable. I'm going to ask a deliberately obtuse and loaded question here, but are you saying that we can quote unquote get over it? It's a great question, and the answer is no. The reason is this, I think an analogy sometimes is most helpful here. So every woman wants to know, you know, first of all, it's so painful. Everyone wants to know when will I get over this?

And people want to know when will my friends get over this who are grieving right? Because it's so painful for them and it's so hard sometimes to be with them. There is no getting over. It's like asking, if I said to you, Dan, when did you get over your wedding day? You know, like, that's not really a question that makes sense because it just changes who you are, right? It just changes your understanding of who you are in the world and how you function and what you do every day. The death of a loved one is similar. We come to understand how to integrate that experience, how to come to know ourselves as people

who have loved and lost. And by doing that, we have a different experience in life. There's no over. There is, for most of us, a decrease in the frequency and intensity of those waves of grief, and there is an increase in accepting that this is the painful reality. And then also, there's restoring this meaningful life. I had a conversation recently with a man whose grandson had died, and it was at about the one-year

anniversary. And he told me, you know, I think all the time, oh gosh, I wish I could go back to that day. I wish I could make things different so he didn't turn out that way. He said, but I also have really come to realize there's so many living people to love. And I need to spend time doing that too. Right? It's sort of a bof and I've quoted this person before on the show. I don't actually remember his name, but it was a dad who wrote an article, I believe in the New Yorker, saying that after having lost a child, he realized that he now had a new organ

whose only job was to secrete sadness. Didn't mean he refused to go on living, but his new life included higher levels of sadness in the system. Absolutely. Absolutely. And it's interesting because I think part of the whole point of psychology studying grief is that there are ways that we get tripped up. There are ways we get derailed. And so while it is true that you will have grief and you will have sadness, we also can learn skills of sort of how to manage that as well. So part of what reminded me is there was a man

that I learned a lot from whose son had died by suicide and he told me at one point that those questions that just roll around and around and around in your head, he called them the wood of should of could've. He said he realized eventually there's no answers, there's no way through those questions to the answers, you have to find a way around, right? And so I think when we have those questions, especially initially, we think, well, we need answers to them. That's the solution. We need answers. But knowing that

there's an infinite number of how the story could have turned out, of the wood of the should of some that could have. It means that we have to find a way around instead that answers aren't actually the solution, even though they are questions. And so I think when we come to recognize, each of those scenarios,

the what if I could have gotten to the hospital sooner? What if the doctor would have ordered that extra test? What if they could have known that, you know, they shouldn't have that last drink? All of those virtual realities end in, and then my loved ones lived, but they didn't live. And so if we're going to be in the present moment, then that's to acknowledge what life is like now. If we're spending a lot of time in these virtual realities, we're not getting to spend time in the present moment where we can have meaningful experiences. You're talking about coping mechanisms, and I think there are cognitive coping mechanisms,

ways to reframe your experience, which you just described, one of them, but to go back to Buddhism, there are more embodied or experiential moves that we can make too, which would be to, you know, to the best of our ability, get into the habit of dropping out of the wood of could of should of rumination and into the experience in the body right now, which can be a bit of a circuit breaker,

not a permanent one, but a circuit breaker on whatever is dogging you mentally. Yeah, absolutely. Well, we did a study for my graduate student of mind-lincey-noles and myself, actually funded by mind-and-life, where we looked at mindfulness meditation and also progressive muscle relaxation

as two possible treatments for folks who were grieving. And we found that progressive muscle relaxation as two possible treatments for folks who were grieving. And we found that progressive muscle relaxation, they both were better than a control group that did nothing, a wait list. But actually, progressive muscle relaxation showed the most improvement the most quickly. For those who might not know Progressive muscle relaxation is a very concrete skill where you clench different segments of the muscles of your body and then you let them relax and you really notice the difference. What does it feel like when this part of my body is relaxed? I think with grieving, there's so many intrusive thoughts, we know it's difficult to concentrate. I think in that moment, it can be hard to learn something like mindfulness meditation. Not necessarily impossible, but it may not be the right moment

to take on a skill that is partially cognitive. But to do this aspect which provides relaxation for the body gives us something, as you say, to focus our attention on, is something we can do anywhere, right? You can be doing that in the middle of class or when you're in the middle of a meeting. It gave them something to attach their attention to when the grief was too much. And I think that really is a concrete skill we can use the body for. Griefing is also extremely stressful for the body. And so we saw that these people improve and part of it may be giving their body a moment's break in this long grieving process. You mentioned that grieving can impact cognitive function. Can you say a little bit more about that?

We know that when we're doing all this updating from our habits to sort of the big meaning questions in life, there's a lot of parts of your brain that are working on the backburner. And just like if you have a computer that's trying to do uploads in the background, you can't always type in the word document that you're trying to type in, right? Everything's a little slowed down. It's a little jerky. I think that's a good analogy for all this background work that's happening in the brain can often make it very difficult for us to concentrate on the task at hand or or encode something someone said so we can remember it later. And so people experience that as a

lot of difficulty concentrating, a lot of difficulty paying attention. You get to some location and you think, oh my god, I don't remember driving here at all. Those sorts of things, I think, in part are happening because your brain is trying to process a lot of the world as me and not we, and that takes a lot of effort. Back to grieving as learning. Yeah. It's a little surprising to me that we've gotten this far in the interview and have not talked about the stages of grief Elizabeth Kubler Ross. What do you make of those stages?

Was Kubler Ross describing something real? She absolutely was in one sense. It was a good description of grief, not of grieving. And so, I have a ton of respect for Dr. Lisbeth Kubla Ross. I actually got to meet her before she died because she retired to Arizona where I live. She was a psychiatrist at a time when there were not a lot of women in psychiatry.

In fact, she was prevented from taking two jobs in psychiatry because she was pregnant. In the midst of all that, she had this revolutionary idea that you could talk to terminally ill patients, and she taught a generation of residents and nurses and chaplains and social workers and doctors to talk to people who were dying. And that is just such an enormous contribution. And in 1969, she published that book on Death and Die, where she talked about these stages she described as a scientist does when they start working on a topic. She described people's experiences of denial and anger and acceptance and depression. But she was working in 1969,

science has come a long way since then. And so what we have now is not just momentary snapshots of grief, but we have grieving. So we have the same person who's measured over many months, right, so that they can tell us how they're feeling in month two and month six and month 13 and so forth. And from that, from these larger studies that we're able to do now with more sophisticated statistics. We know that over time, acceptance increases and yearning decreases, but that that's not a linear process. It isn't like you do all of anger and then you go into all of depression. That's just not how it works. It's not a linear process, rather we have these sort of waves where goes up and goes down, even though the overall trajectory over years is more acceptance.

So this is newer work, some done by George Bonanno, some done by Paul and a Neemire. And so from that, we know also that at anniversaries, we have more grief. The birthday of the person who's died, we have more grief. And the birthday of the person who's died, we have more grief. It doesn't mean there's anything wrong with the trajectory, just in those moments where more aware. And so the problem is that she was using a description, but it came to be used as a prescription.

And so now people think there's something wrong with them if they haven't done it in this order. Or, you know, I will hear people say, I don't think I'm done grieving yet because I haven't felt anger. Well, first of all, I would say there's no done grieving, but even so, I would say there's nothing wrong with you for not having anger, not everyone does. And they don't happen in an orderly fashion and you can go through anger and then go through it again 30,000 more times and so she was describing something true, but not all the way true.

I think of it. Yes, she was describing what was true in the moment for these people, right, but not the way that would change over time. After the break, we're going to talk about what to say when people are grieving, how the grieving process has been impacted by the pandemic, and we're going to explore the elasticity of the term grief, how it can apply to more than just the loss of a loved one. Keep it here. Why do we sometimes feel grief for people we don't know, famous people? This is such a fascinating phenomena, isn't it? When a celebrity dies or an artist, you get this outpouring of grief sometimes,

whether that's sometimes you see candles and teddy bears and cards at a hospital where someone died or online in social media, we see an outpouring of grief for Betty White or Princess Diana. I think while that seems strange, there is a kind of bonding that can happen with celebrities. Right? We actually know a lot about their lives in some ways, and for artists especially, we've often spent a very large amount of time listening to them, the lyrics that they wrote, the prose

that they wrote, and often they are able to describe things that are exactly how we feel, and we feel known, right? We feel like, wow, they really understand me, because they wrote that. And so I think there can be this deep connection so that when that person dies, although we didn't actually know them, I think there's still a piece of us that we lose,

right? A piece that really was able to connect with an artist in the world or a political figure, or whoever it is that really understood us, and we really believed in them. I think that is a true grief, even though it's not an attachment bond of someone that you knew and spent time with. And we call this parasocial grieving. Does grief have to be for the loss of a loved one? Can you grieve a former life, what you've gotten married or had a kid? Can you grieve a full head of hair? Can you grieve a job?

How elastic is the term? Well, I think that grief over the death of a loved one probably has a neurobiology that evolved because our loved ones are so important to our survival that there had to be a way to sort of manage what that looked like. And so while I think that the original evolution may have come about because of the death of a loved one, that losing a part of ourselves? We recognize that grief experience in lots of losses just as you describe. So even if we think about a romantic breakup or divorce, there is still that loss of the bond isn't there. So the person hasn't died, but that bond we've been talking about is not the same. It's not the way it was. It's not

that trust and you will be there for me and I will be there for you. But in other ways as well, if you think about trying to understand how to be a daughter in the world without a mother, you can also think about how to be a valuable person without this job that has been such a part of my identity after I retire or after I get fired. Or when our children leave home, when we have the empty nest, it's not that they've died, but how do I understand myself if I'm not, you know, waiting at 11 o'clock to see if they come home and making sure they eat some breakfast?

So I think those experiences of grief are very similar that they reflect this loss of ourselves that even if it evolved somewhat differently, it's still true in this moment for this particular important thing, this part of us that is gone. So you've done quite a bit of research on, as you've described, on people who lost loved ones. Has there been research neuroscientific or otherwise on people who've lost a job or, you know, we're all losing all the time in life and gaining too.

But have we studied these many deaths? There has been a little bit of research. In fact, there's a great neuroimaging study by David Cresswell who took people who had been laid off and took them on retreats to learn mindfulness meditation, for example, and looked at the kind of brain imaging changes that you could see. So there has been some research on other losses. I have to say there's not been as much research on the death of a loved one, as I would like. I think we often as a culture, but also as clinicians, psychiatrists and psychologists don't get a lot of training about grief, and some of that is because it hasn't been a traditional area of research. And I think that's changing,

but I think there's a lot of sort of basic work to be done that might then be applied to other types of losses. Do we know whether meditation helped people who lost a job? It did, actually. So it was as compared to a group of people who learned sort of healthy habits and mindfulness meditation was more helpful and

showed these interesting changes in connectivity in the brain. It's a very interesting, very well done study. I use the term mini-death and I think I picked that up in Buddhist circles. The idea that everything is falling away all the time. My meditation teacher Joseph Goldstein, who I invoke probably too often on the show, you're putting your hand on your heart. You like them too. And the last retreat I was on with him, he was talking about just walking around in your daily activities, maybe just use this little mantra that you can drop into your mind of each step because that will keep you connected to whatever is happening right now.

But then he pointed out that you might occasionally consider where is the step from five minutes ago, and where is the last step? Well, then you're right on the lip of impermanence, as he described it. These are hard, but vital things to face, I think. Buddhism has taught me a lot that we come up with these categories, and that isn't really necessarily how reality works. The categories can keep us sane, make us feel sane for a while until they don't work anymore.

And so I think of it this way, you know, when a loved one dies, is it when we know that they're terminally ill? Is it when they can't talk to us anymore? Is it when they're not breathing anymore? Is it when we have the funeral? Is it when we don't think of them that first morning that we wake up and they're not the first thing on our mind? Is it when we move from the house that we lived in together?

When is it exactly that we lose them, right? We are constantly losing and constantly gaining, but constantly losing. And I think it can help to think about it that way that we have this understanding of your person out there and I'm a person in here. And in this moment, we are married, say. And then in this other moment we're not married

because you died or because we got divorced. But our mind and reality isn't necessarily quite like that. There's a lot more shades in between. And perhaps the man that I might have married at 22, it's not the same man that I married to at 32 or at 42 or at 52. So was I actually with five different people? Was I the same person? I think that that impermanence helps us to not just think about death, but rather to think about life and how things are really working.

Do you think of meditation and Buddhism as kind of a training for loss, a training for losses large and small, where you are not cognitively, but experientially put right up against the rapidity of change so that when it happens, it's maybe not so surprising. I think of it as a practice, right? I like the term accepting rather than acceptance

because it really is a practice, right? You're accepting. This is what's true in this moment. This person is no longer on this earthly plane. And so without any reaction to that, no anger, no protest, no sadness, no regret, no it just is. I think it's not less painful when we lose a loved one. But we may have this practice as sort of a support to give us moments where we can set it down. And I think that's what it brings us, not necessarily less pain, but these moments of understanding, accepting, comfort. And that practice, it does change the way we see things. I wonder if perhaps it's different as it pertains to losing our own lives, because to use the meditative cliche, pain is inevitable, suffering is optional.

We might learn through being able to accept in the moment physical pain, fear, etc., etc., to navigate our final days and moments with less suffering even if the pain is non-negotiable. I think it can be true and there's such wonderful writings about very well-practiced Buddhist going through that process of those last days and weeks, even those last hours and moments before death, which I think are remarkable and again strikes me that we have sort of these concepts, these categories of how it's going to work and often our Buddhist mentors make it work differently somehow and that's kind of amazing because they're not constrained maybe in the same way to the categories or

the concrete ways of thinking about things that we are. I'd be remiss if I didn't note that we are in the midst of a pandemic. And I wonder if you have thoughts about the special difficulties of grief at a time where for some of us, we can't even be at the bedside. I've been doing research in this past year, talking with people by phone, talking with people who've experienced the death of a loved one and really trying to understand their experience and what was unique about it. And there are several of these things which we sort of take for granted that we'll be

able to provide care at the end of their life when they need us the most. And so to have that ripped away because of the necessary social distancing, the inability to go into hospitals and long-term care to be with our loved ones. It means that many people are really struggling with the sense of guilt for not having been there, with not having those memories, making it harder to make the death seem real. People describe to me, you know, I feel like she was there and that she wasn't there. And I didn't see anything in between, so it just doesn't feel real. Like, has it really happened? I think that then the loss of these rituals that we also often use to acknowledge this change

for people to get together socially at funerals and memorials and sitting chiva as a way to offer support in a moment when people feel so desperately alone, that changed as well. But you know, I am just incredibly amazed at the resilience of people as well. I think that whoever thought that Zoom funerals would be a thing, right? The idea that we just really need each other and we're gonna find a way to reach out. And it was interesting to me that while some of the people I was talking to, who it experienced the death of a loved one, really talked about how painful it was for them not to have a funeral, there were those who said, for example, that at the Zoom funeral, they could all see each other's faces and there was no travel and so maybe some people were there that might not have been

able to be there. And it was even in this particular woman's case, she said it was a smaller group of people and so it felt very honest. We were able to tell stories in a way that might not have happened at a much more formal kind of funeral. So I think if we really honor this deep human desire to connect and to reach out and to care for the people around us who are suffering, we do often find a way, and it's the intention that can be made into action that's so important here. In your book, you talk about the serenity prayer. What is the serenity prayer for those who are

not familiar with it and why do you talk about it? So the serenity prayer is God grant me the serenity to accept the things I cannot change, courage to change the things that I can, and the wisdom to know the difference. And it really is about that wisdom of sort of, when do you struggle and when do you accept? I was at a retreat at Upaya in Santa Fe with Rochijon Halifax, who is just such an important teacher. And she was telling a story during the retreat was when the earthquake happened in Nepal,

and she had been speaking on the phone with Alama there, and toward the end of the conversation, he said to her, you know, there's so much to do, I really must go now, I need to go sit. so much to do, I really must go now. I need to go sit. I just, I've always carried that with me, the idea that how will we know what to do, unless we sit and become aware of what's important? There's a way in which often in grief we withdraw, we need to spend time alone, many of us do, and some of that can be, wow, I have just been hit with all this new understanding of the world, all of this suffering and pain. I kind of need to understand before I can figure out what to do next. I probably should have asked this earlier, but I'm seeing now that on my list of questions

I had one that I'm actually still very curious about and I think will be useful for a lot of people. And it's this, what do you say to people who are experiencing a loss now because the words that often escape our lips in these moments is, I don't know what to say. Yeah. And I think that can be the right thing to say, because it's true. And I think you can say, I don't know what to say.

I'd really like to understand what you're going through. I also understand if now is not the right moment. And I want you to know that I'm gonna be here, where right now I'm sure it's hard for you to even imagine what the future could be like. I want you to know I'm going to be here until we get there. I don't know what it's going to look like either, but I'm going to be with you along the way. And then make that true, right?

So reaching out again and again, hey, check it in on you. And then being quiet, letting them actually tell you, what are they learning? What is their experience? And also, in those moments where their mind is running in the background, it may also be hard to get the groceries, you know, or take the kids to the dentist. So offering also to do things. Hey, I'm going to the store, just wondered if you needed anything. I could drop by on my way home and bring you some toilet paper, anything you need.

Those kinds of things really matter. It means that the person understands, they think there's nothing wrong with you. I know you're having a tough time. I know you can't figure out if the right shoe goes on the right foot or the left foot, and that's okay. We're gonna get through this.

You're doing the best that can be done in an impossible situation. But I will also tell you, I say the wrong thing all the time. I've been doing this for a very long time. And I still say things and I think, why did I just say that? That's a terrible thing to say. Because in that moment, you're sitting with someone who's suffering. That is not an easy thing to witness. It is often our instinct to want to make them feel better. But if you think about it, it's really more about wanting to be with them, right? If they're already in a place where they can't quite figure out what they're feeling and what they're feeling

is pretty awful. And now there's this expectation from this person sitting next to you that you should be happier. You just feel moral alone, right? But if you're sitting with someone who says, hey, I don't know what you're feeling, but I'd like to know if that's helpful or even, hey, do you wanna go for a ride?

We could take a drive out into the country, what I have to talk, we had just drive in quiet, where we could go to the movie. You know, it doesn't have to be about talking about it. It's about what do we do in life that feels meaningful? There's this natural and even lottable impulse to try to fix things for people, but often that's what you're really trying to do,

I think is fix your own discomfort. I've always been struck by something Brunei Brown said, I think on this show where she was talking about when her kids have a problem and she would say, you know, I don't know the answer, but I'm willing to sit in the dark with you. And I think that's a pretty good way to put it. Let me ask you two final questions that I often ask. One is, did I fail to ask a question that I should have asked? I mean, I don't think so because it went wherever it was going to go, right? I had thought you might ask me about prolonged grief disorder, which I don't necessarily want to get into. I had just been told that you might ask me about. So I only mentioned it in case you had one to two, but it slipped your mind.

I actually think it'd be worth dwelling on that for a moment or two. What is prolonged grief disorder? dwelling on that for a moment or two, what is prolonged grief disorder? So this is a newer term. The DSM-5, the Revive's edition, has taken a diagnosis of prolonged grief and incorporated it into one of the things that we can identify in people who seek help. I have been a part of this process of trying to understand this very small group of people for a very long time. I've been trying to understand them. There is about one in 10 or one in 20 people who just don't have the typical response to grief where usually you know in that trajectory we were talking about, you can see that the frequency and intensity of grief,

it declines over time without ever going away, right? But there's this other group of people, you can see it right in the data. It just doesn't change. They're just having the same frequency and intensity of grief over time. And it means that they're not able to function very well in their day-to-day life. What I think is really important, people are often hung up on this word disorder. Anything in the DSM is considered a disorder, right? So it's PTSD. It's post-traumatic stress disorder. It's major depressive disorder. They're all disorders. What I think it means is,

we now have an opportunity because we know we have psychotherapy, that when we apply that, when we offer that to people who've had this experience for years even, that they can get back on the natural trajectory of grieving. And that to me is the most important reason to be able to identify them. And also because, as I said before, our training for our clinicians, our psychiatrists and psychologists in the world, has never included training about grief. So now, they have to learn about it, right? It's a part of the medical canon. It means that they have to understand what typical grief looks like, what acute grief looks like, so that they can make a distinction with these very small group of people.

And we don't even begin to think about whether it's complicated grief or prolonged grief disorder, which is the newer term. We don't even begin to think about it until a year after the death. Before that, people are kind of all over the place, like I said, it's not a linear process. But at that point, we really see the separation. We can really see these are people who are on a grieving trajectory, and these are people who are just not changing over time. To me, that

feels like a moment to intervene, and it is different from depression. So we know that from really elegant research that's been done, for example, if you give antidepressants to a person who has prolonged grief disorder, antidepressants don't help with yearning. You know, yearning is the core. Now, if they have depression as well, which you can, right? You could have both just like you can have depression and anxiety. Ed to depressants can help with depressive symptoms. But as a neuroscientist, that makes me aware

that there are probably different neurobiological processes going on here with depression, with grief, with anxiety. And our best frontline treatment, the treatment that we know really works is a psychotherapy for prolonged grief. It can really help people get back on that change of her time trajectory. I'm glad we touched on that. And just for the uninitiated, remind us what DSM stands for. Diagnostic and Statistical Manual. Final question, please, if you don't mind plug your book. So the book, The Grieving Brain, it has this subtitle, the surprising science of how we learn

from love and loss. And I think people reading the book will really see the ways that love gets encoded in the brain and what that means for how we understand loss as it's encoded in the brain. If they want to learn more about it, they can go to MaryFranciseOconner.com and see the book there and the other research that I've been doing in the academic world and on Twitter, I'm Dr. MFO. So I hope to see many of you there and I hope that you'll be interested to apply things to your own life. Okay, Dr. MFO, thanks for coming on. Thanks so much. Thanks again to Mary Frances O'Connor. Thank you as well to all the people who work so hard on this show. Gabrielle Zuckerman, DJ Cashmere, Justine Davey, Maria Wartell, Samuel Johns, and Jen

Poyant. And we get our audio engineering from the good folks over at Ultraviolet Audio. We'll see you on Friday for a bonus. Hey, hey, prime members. You can listen to 10% happier early and ad free on Amazon Music. Download the Amazon Music app today. Or you can listen early and ad free with Wondery Plus in Apple Podcasts. Before you go, do us a solid and tell us all about yourself by completing a short survey at Wondery.com slash survey.