The Science & Process of Healing from Grief

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.280 | where we discuss science and science-based tools

00:00:04.880 | for everyday life.

00:00:05.900 | I'm Andrew Huberman,

00:00:10.440 | and I'm a professor of neurobiology and ophthalmology

00:00:13.460 | at Stanford School of Medicine.

00:00:15.560 | Today, we are discussing grief.

00:00:18.340 | Grief is a natural emotion that most everybody experiences

00:00:21.880 | at some point in their life.

00:00:24.280 | However, grief is something

00:00:25.600 | that still mystifies most people.

00:00:27.840 | For instance, we often wonder why getting over the loss

00:00:31.160 | of somebody or a pet is so absolutely crushing.

00:00:36.160 | In some cases, it's obvious

00:00:37.880 | because we had a very close relationship

00:00:39.840 | to that person or animal.

00:00:41.720 | But in other cases, it's bewildering

00:00:44.360 | because somehow, despite our best efforts,

00:00:46.900 | we are unable to reframe and shift our mind

00:00:49.880 | to the idea that the person or animal

00:00:52.800 | that at one point was here and so very present is now gone.

00:00:57.640 | Today, we are going to discuss how we conceptualize grief,

00:01:00.940 | both at an emotional and at a logical level.

00:01:03.980 | I'm going to teach you about the neuroscience

00:01:05.860 | and the psychology of grief and incredible findings

00:01:09.600 | that have been made in just a few key laboratories

00:01:12.760 | that point to the fact that we essentially map

00:01:16.580 | our experience of people in three dimensions.

00:01:19.920 | Let's just give you a little hint

00:01:21.100 | of what those dimensions are.

00:01:22.720 | They relate to space, where people are,

00:01:25.480 | time, when people are, I'll explain what that means,

00:01:29.580 | and a dimension called closeness

00:01:32.160 | and how those three dimensions of space, time, and closeness

00:01:35.840 | are what establish very close bonds with people

00:01:39.100 | and are what require remapping,

00:01:41.400 | reorganization within our emotional framework

00:01:43.880 | and our logical framework when we lose somebody

00:01:47.000 | for whatever reason.

00:01:48.500 | Within that understanding,

00:01:50.200 | I'm confident that you will have greater insight

00:01:52.600 | into the grief process.

00:01:54.640 | And should you ever find yourself within the grief process,

00:01:57.580 | as I imagine most everyone will at some point,

00:02:01.160 | you will be able to navigate that process

00:02:03.560 | in what psychologists and neuroscientists deem to be

00:02:06.240 | the most healthy way of going through grief.

00:02:09.240 | Indeed, moving through grief requires a specific form

00:02:12.280 | of neuroplasticity, a reordering of brain connections,

00:02:15.920 | and also the connections between the brain and body.

00:02:18.760 | I'm going to teach you about all of that today.

00:02:20.740 | So you're going to learn a lot of scientific information.

00:02:23.000 | You will also learn a lot of tools

00:02:25.620 | that you can put in your kit of emotional

00:02:28.000 | and really emotional physical tools

00:02:30.720 | that will allow you to move through grief

00:02:32.280 | in this healthy way that I referred to earlier.

00:02:35.080 | I'll also point out some of the myths about grief.

00:02:37.800 | For instance, many of you have probably heard

00:02:39.280 | that there are designated stages of grief

00:02:41.320 | that everybody moves through.

00:02:43.040 | It turns out that recent research refutes that idea.

00:02:46.760 | There are different stages of grief,

00:02:48.120 | but not everybody experiences all of them.

00:02:50.380 | And hardly ever does somebody move through

00:02:53.060 | all of those linearly, meaning in the same order.

00:02:55.740 | I also want to point out that for many of you

00:02:57.860 | that are not experiencing grief in this moment,

00:03:00.980 | there's an important scientific literature

00:03:03.540 | that teaches us that how we show up to grief,

00:03:07.100 | meaning our psychological and our biological state

00:03:10.640 | that we happen to be in when a loss occurs,

00:03:14.320 | strongly dictates whether or not we end up

00:03:16.480 | in what's called complicated or non-complicated grief.

00:03:19.800 | And non-complicated grief is a form of grief

00:03:23.120 | that is very prolonged.

00:03:24.680 | And in fact, often requires that people get

00:03:26.880 | substantial professional help.

00:03:28.860 | So whether or not you're experiencing grief,

00:03:31.080 | that's mild, moderate, or very intense right now,

00:03:35.160 | or whether or not you are not experiencing any grief at all,

00:03:39.080 | you're going to learn scientific information and tools

00:03:41.280 | that will help you navigate through this process

00:03:43.720 | that we call grief.

00:03:45.360 | Before we begin, I'd like to emphasize that this podcast

00:03:48.000 | is separate from my teaching and research roles at Stanford.

00:03:50.920 | It is, however, part of my desire and effort

00:03:53.120 | to bring zero cost to consumer information

00:03:55.120 | about science and science-related tools

00:03:57.200 | to the general public.

00:03:58.620 | In keeping with that theme,

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00:08:35.820 | Okay, let's talk about grief.

00:08:37.560 | I just want to remind you that everybody,

00:08:40.720 | at some point in their life, experiences grief,

00:08:44.120 | either mild grief, moderate grief, or extreme grief.

00:08:48.160 | And it's somewhat obvious, but worth stating nonetheless,

00:08:51.800 | that how intense grief feels and how long it lasts

00:08:56.360 | scales with how close we were with somebody.

00:08:59.320 | And if you learn that the person who works

00:09:02.040 | at the coffee shop or that you see at the coffee shop

00:09:04.120 | on a regular basis happened to pass away

00:09:06.500 | or tragically get killed in a car accident,

00:09:09.140 | that can be quite upsetting.

00:09:10.400 | It can be somewhat disorienting to you if you,

00:09:13.080 | for instance, just saw them yesterday,

00:09:14.840 | or they seemed perfectly fine when you saw them last.

00:09:19.060 | But of course, the grief that results

00:09:21.000 | from the loss of somebody to whom you have

00:09:23.600 | that level of attachment is far and away different

00:09:26.880 | than the level of grief that you would experience

00:09:29.640 | from the death of a very close loved one,

00:09:32.080 | a sibling, a parent, God forbid, a child.

00:09:36.140 | When that type of loss occurs, it's often the case

00:09:38.900 | that our entire relationship to life feels different.

00:09:42.640 | Places and things that at once brought us joy and laughter

00:09:45.780 | now bring the opposite.

00:09:47.400 | They bring us intense feelings of sadness and loss.

00:09:51.040 | Psychologists and neuroscientists distinguish

00:09:53.240 | between complicated grief and non-complicated grief.

00:09:56.580 | They are very similar at the outset.

00:09:59.360 | One of the fundamental differences between them, however,

00:10:01.500 | is that complicated grief, which occurs in about one

00:10:03.960 | in 10 people, is a situation in which grief does not seem

00:10:08.640 | to resolve itself even after a prolonged period of time.

00:10:12.660 | Later in the episode, I'll point you

00:10:14.040 | to the actual tests that are used.

00:10:16.480 | I've provided links to those in the show note captions

00:10:19.900 | that will allow you to distinguish

00:10:21.620 | between complicated and non-complicated grief.

00:10:23.900 | These arrive through the important research

00:10:26.160 | of the world-class grief researchers that are out there

00:10:29.300 | and the psychologists that treat grief.

00:10:31.600 | The important thing to point out is that grief is a process.

00:10:34.620 | Like any biological or psychological event,

00:10:36.760 | it has a beginning, a middle, and an end.

00:10:39.280 | And I do believe that being able to orient in terms

00:10:41.560 | of where you are in that process can be immensely beneficial,

00:10:45.580 | not just for predicting how long it's going to last,

00:10:48.120 | but in order to conceptualize the person or animal

00:10:51.480 | that you lost in a way that allows you

00:10:53.260 | to best preserve their memory

00:10:54.780 | while maintaining your own functional capacity in life.

00:10:58.060 | Along those lines, I want to point out

00:11:00.020 | that grief and depression,

00:11:01.900 | while they can feel quite similar in certain ways

00:11:05.140 | and have overlapping symptomology, loss of appetite,

00:11:08.300 | challenges sleeping, crying in the middle of the day

00:11:11.560 | for no apparent reason, et cetera,

00:11:13.480 | they are distinctly different processes.

00:11:16.140 | The modern research teaches us, for instance,

00:11:18.320 | that grief rarely responds well to antidepressants,

00:11:22.620 | whereas depression can often respond well

00:11:25.320 | to antidepressants.

00:11:27.380 | Everything we know and understand about grief is

00:11:29.440 | that it is a distinct psychological and physiological event

00:11:34.020 | in the brain and body from depression.

00:11:36.300 | Rather, perhaps the best way to think about grief is

00:11:39.460 | that it is actually a motivational state.

00:11:42.480 | It is a yearning, it is a desire for something.

00:11:46.140 | And somewhat surprisingly, it's not just a desire

00:11:49.180 | to have that person back or to have that animal back.

00:11:52.940 | You might think, well, that's crazy, of course it is.

00:11:55.620 | But of course, there are instances

00:11:57.460 | in which someone passing away or an animal passing away

00:12:00.180 | is actually providing relief for that person

00:12:03.100 | because of where they happen to be in their life.

00:12:05.400 | Today, I'll teach you about grief as a motivational process

00:12:08.640 | because grief as a motivational process really is the way

00:12:12.440 | that scientists and psychologists now conceptualize grief

00:12:15.640 | and the treatments for grief

00:12:17.820 | so that people can move through them effectively.

00:12:20.120 | As we wade into this important topic,

00:12:22.620 | I'd like to emphasize some of the common myths

00:12:24.620 | and misunderstandings about grief.

00:12:26.900 | Some of the myths and misunderstanding arrive

00:12:28.940 | from the beautiful work of Elizabeth Kubler-Ross,

00:12:32.060 | a psychologist who wrote the famous book

00:12:33.740 | on death and dying.

00:12:35.180 | And I should emphasize that while Kubler-Ross

00:12:38.040 | was a real pioneer in establishing

00:12:40.380 | that there are indeed different stages of grief,

00:12:43.380 | the modern science, both psychology and neuroscience,

00:12:45.860 | point to the fact that not everybody experiences

00:12:48.060 | all of the stages that Kubler-Ross defined,

00:12:50.660 | nor do they move through those stages in a linear manner.

00:12:53.820 | Sometimes they're out of sequence.

00:12:55.820 | I'll just highlight the five stages

00:12:57.500 | that Kubler-Ross illustrated

00:12:59.160 | because some people really do experience all of them.

00:13:02.220 | Sometimes in the order I'll read them,

00:13:03.820 | but again, oftentimes they don't.

00:13:06.660 | The different stages of grief very quickly are denial,

00:13:09.540 | anger, bargaining, depression, and acceptance.

00:13:12.540 | In the Kubler-Ross model, denial is always the first stage.

00:13:15.900 | And denial is just as it sounds,

00:13:17.700 | this disbelief, it cannot be, there's no way,

00:13:21.120 | a refusal to accept the new reality

00:13:23.740 | that the person or animal is gone.

00:13:26.880 | The second stage, anger, is one in which

00:13:29.820 | the individual recognizes that the person is indeed gone

00:13:33.540 | or the animal is gone,

00:13:35.620 | but their body and their mind go into a motivated state.

00:13:40.080 | This is important.

00:13:40.920 | We're going to return to this idea of grief

00:13:42.780 | as a motivated state that involves action plans

00:13:46.940 | in more depth as we go further.

00:13:48.940 | And then the third stage is bargaining,

00:13:50.540 | what's sometimes called the negotiating phase.

00:13:52.940 | This idea that, well, if I had just done this,

00:13:55.880 | or if they had just done that, or if I'd called more,

00:13:58.140 | or somehow refusing to accept the reality,

00:14:02.180 | so in a way this can be blended with denial in thinking,

00:14:05.940 | well, if I just don't think about it, it won't be real,

00:14:09.340 | this kind of thing.

00:14:10.160 | So again, stages can be blended or braided together

00:14:12.940 | because emotions are complex, right?

00:14:14.740 | Even though there are different stages to this process,

00:14:16.600 | they can sometimes be melded together.

00:14:19.460 | The fourth stage of depression that Kubler-Ross described

00:14:22.820 | is one of why go on living?

00:14:25.780 | Why should I go on living?

00:14:27.020 | Why should I continue in this grief-stricken state

00:14:30.900 | that seems to deprive me of all the richness of life

00:14:33.580 | that I experienced when the person or animal was still here?

00:14:36.400 | And then the fifth stage is acceptance,

00:14:38.900 | this internalization, not just cognitively,

00:14:41.700 | not just thinking, but emotionally that it's going to be okay

00:14:45.460 | that not just this too shall pass, but that it has passed.

00:14:50.300 | So again, the five stages of grief that Kubler-Ross defined

00:14:53.860 | were immensely important as a critical parsing

00:14:58.340 | of the different stages that one could move through.

00:15:01.180 | But unfortunately, those five stages were sort of taken

00:15:03.460 | to be gospel for a long time.

00:15:05.300 | And we now know based on neuroimaging,

00:15:08.020 | based on more in-depth psychological evaluation,

00:15:10.620 | and frankly, more researchers and clinicians

00:15:13.520 | moving into this area and observing

00:15:15.460 | that while much of what Kubler-Ross described

00:15:18.340 | does hold true, it's not always the case.

00:15:21.020 | And in fact, the contour of the grief process

00:15:23.700 | actually has a lot of dimensions

00:15:25.180 | that are not encapsulated by those five stages.

00:15:27.960 | There's also a lot of variation

00:15:29.260 | depending on whether or not the loss is due to old age,

00:15:32.140 | disease, whether or not there was suffering prior or not,

00:15:35.300 | suicide or non-suicide types, deaths and losses,

00:15:38.540 | and even grief about non-death losses,

00:15:42.600 | a relationship breakup or something of that sort,

00:15:45.380 | or even homesickness and things of that sort.

00:15:48.100 | So I do want to tip our hats to the incredible work

00:15:51.900 | of Elizabeth Kubler-Ross.

00:15:53.660 | By no means am I or do other researchers

00:15:56.020 | try and discount her incredible contributions,

00:15:58.620 | but I think nowadays we have a different

00:16:00.940 | and frankly, a better understanding

00:16:02.880 | of what the grief process is like,

00:16:04.760 | and as a consequence, better tools to move through grief.

00:16:08.140 | In order to really understand what grief is

00:16:10.540 | in your brain and body and how to best navigate grief,

00:16:14.300 | I'd like you to do an experiment with me.

00:16:16.920 | For the next five minutes or so,

00:16:19.060 | I'd like you to at least try to discard

00:16:21.780 | of all prior notions of grief as just a state of sadness.

00:16:26.780 | I want to acknowledge that it is and does involve sadness,

00:16:30.940 | but for right now, let's think about grief

00:16:34.040 | as a motivational state, as a desire for something specific.

00:16:38.820 | In fact, I'd like you to think about grief

00:16:41.500 | as an attempt to reach out and get something

00:16:44.660 | that you very much want.

00:16:46.340 | Imagine yourself extremely thirsty, for instance,

00:16:49.240 | on a very hot day,

00:16:50.940 | and a glass of water is right in front of you,

00:16:54.120 | and it's a beautiful, clean glass of water,

00:16:56.800 | and it's completely full,

00:16:58.520 | and you so badly want to drink that water,

00:17:01.680 | but no matter how intensely you want it,

00:17:05.480 | and no matter how hard you try and reach it,

00:17:07.780 | it always shifts just outside your reach.

00:17:11.200 | So if you can imagine that, even just a little bit,

00:17:14.780 | you are touching into the experience of grief.

00:17:17.700 | How do I know this?

00:17:19.060 | Well, I know this because brain imaging studies

00:17:22.540 | involving what's called functional magnetic

00:17:24.340 | resonance imaging, fMRI, in which you can evaluate

00:17:27.940 | which brain areas are more active than others

00:17:30.100 | according to blood flow,

00:17:31.280 | which correlates with neural activity and so forth,

00:17:33.880 | teaches us that the brain areas that are associated

00:17:37.220 | with motivation and craving and pursuit

00:17:40.420 | are some of the primary brain areas and circuits

00:17:43.300 | that are activated in states of grief.

00:17:46.460 | I'd like to share an important paper with you

00:17:48.120 | as one of the first to illustrate the fact

00:17:50.060 | that grief is not just a state of sadness and pain.

00:17:54.820 | It is indeed a state of yearning and desire

00:17:58.340 | of something that is just outside your reach

00:18:01.180 | and unfortunately will always be just outside your reach

00:18:04.460 | until you remap your relationship to that person or thing.

00:18:08.780 | The title of this paper is posed first as a question,

00:18:11.660 | so that's why I'll read it as such.

00:18:13.200 | The title is Craving Love.

00:18:15.180 | Enduring Grief Activates Brain's Reward Center.

00:18:17.940 | And the first author of this paper is Mary Frances O'Connor.

00:18:20.580 | She's a professor of psychology

00:18:22.440 | at the University of Arizona and one of the world leaders

00:18:26.520 | in the study of grief from a neuroscience perspective.

00:18:30.020 | With some luck, we'll get her here

00:18:31.160 | on the podcast as a guest.

00:18:32.620 | Now, this paper has several important features.

00:18:35.880 | I'll just highlight a few.

00:18:37.220 | One of the features of this paper that's not surprising

00:18:39.980 | is they found that people who are in a state of grief

00:18:42.820 | are in a state of pain.

00:18:43.980 | That is, brain areas associated with pain,

00:18:47.080 | actual physical pain, are more active

00:18:50.680 | than in non-grieving individuals.

00:18:53.740 | However, they also found that people who are experiencing

00:18:56.240 | what's called complicated grief showed reward-related

00:18:59.920 | activity in a brain area called the nucleus accumbens.

00:19:02.820 | What is reward-related activity?

00:19:04.300 | Reward-related activity is activity of neurons

00:19:08.140 | that's associated with motivational states.

00:19:11.220 | And the nucleus accumbens is a brain center

00:19:13.780 | in which dopamine has the effect

00:19:16.160 | of creating a motivated state.

00:19:18.700 | If ever you thought that dopamine was only associated

00:19:22.140 | with feeling good, you hear about dopamine hits.

00:19:24.640 | Well, this paper and papers like it

00:19:28.260 | firmly tell us that dopamine is not about feeling good.

00:19:32.000 | Dopamine is about placing us into a state

00:19:34.500 | of desiring things and seeking things.

00:19:37.540 | This is true in addiction.

00:19:40.280 | This is true when we're hungry and we want to eat.

00:19:43.000 | This is true when we want to reproduce.

00:19:45.620 | This is true in every state in which we are reaching

00:19:48.580 | for something outside our immediate ability

00:19:51.380 | to give that thing to ourselves.

00:19:53.220 | This is very important to understand

00:19:55.380 | if you want to understand grief

00:19:56.740 | and how to move through grief.

00:19:58.460 | Grief is not just about sadness.

00:20:00.660 | It is a state of sadness,

00:20:03.220 | hence the activation of brain areas associated with pain.

00:20:06.340 | And it is a state of desire and reaching for something.

00:20:11.340 | And for those of you that have experienced grief,

00:20:14.660 | I think that will resonate with you.

00:20:16.460 | In that understanding that grief is both a state of pain,

00:20:22.320 | but also a state of wanting,

00:20:26.040 | and in the understanding that when we lose somebody,

00:20:30.240 | either because of breakup or because of death,

00:20:34.580 | or if an animal dies or gets taken away or is missing,

00:20:39.580 | that state of wanting and desire drives

00:20:42.900 | an activation state within us.

00:20:45.220 | Now, the key thing to understand is that the activation

00:20:47.860 | of those reward centers and the involvement of dopamine

00:20:50.560 | puts us into an anticipatory state,

00:20:54.420 | a state of waiting for something to happen.

00:20:56.900 | It also puts us into a state of action or desiring action.

00:21:01.240 | Our body and our mind are what I like to refer to

00:21:04.260 | as center of mass forward.

00:21:06.020 | We are seeking how to resolve the craving,

00:21:09.480 | even if we know that is impossible.

00:21:11.600 | Why do I say that?

00:21:13.420 | Well, we understand also on the basis

00:21:16.700 | of brain imaging studies and also some studies in animals

00:21:20.480 | that I'll describe in a moment,

00:21:22.240 | that in order to understand grief,

00:21:24.900 | we have to understand how attachments

00:21:26.820 | are represented in our brain.

00:21:28.340 | And it turns out that both attachments

00:21:31.040 | and the breaking of attachments in healthy ways

00:21:33.880 | are governed by three important, what we call dimensions.

00:21:37.460 | A dimension is just some feature of the world

00:21:40.580 | that's represented in our brain.

00:21:42.840 | So for instance, the color red doesn't exist in your brain.

00:21:46.680 | You happen to have cells, neurons in your eye

00:21:51.680 | that respond best to long wavelengths of light.

00:21:55.620 | And those long wavelengths of light happen to be

00:21:58.400 | what are reflected off things that are perceived as red.

00:22:02.320 | So in your mind, you have a notion of red.

00:22:04.820 | I know this is a little bit abstract,

00:22:06.280 | but you're not actually lighting up red neurons

00:22:09.760 | in your brain and that's why you see red.

00:22:12.040 | You are lighting up neurons in your brain

00:22:14.280 | that represent the presence of red things

00:22:17.740 | in your environment.

00:22:19.280 | Similarly, we have neurons and maps,

00:22:22.880 | or we say representations of other dimensions.

00:22:25.780 | We have dimensions of touch.

00:22:26.920 | We have dimensions of sound.

00:22:28.580 | And as I'll now teach you, we have three dimensions

00:22:32.440 | that define our relationship

00:22:34.380 | to people and animals and things.

00:22:36.940 | And when those people, animals and things

00:22:39.460 | are within our immediate vicinity,

00:22:42.120 | or if we know how we could access them, right?

00:22:45.740 | If somebody is still alive,

00:22:46.660 | there's generally some way to access them

00:22:50.020 | unless they're refusing to interact with us.

00:22:53.140 | Well, when we understand that,

00:22:55.420 | our motivational states can operate

00:22:58.180 | in a way that's logical.

00:22:59.400 | We know that, for instance,

00:23:00.460 | if we want to find our mother, brother, sister,

00:23:04.220 | significant other, dog, cat, parrot, et cetera,

00:23:07.540 | we have to go through a certain set of steps.

00:23:10.380 | What are those three dimensions and how do they work?

00:23:12.900 | And that's what I'm going to teach you now.

00:23:14.560 | So at risk of sounding a little bit too reductionist,

00:23:16.860 | we are now going to describe your relationship

00:23:20.540 | to anything, everything, and anyone

00:23:24.380 | in these three dimensions.

00:23:26.860 | How can we do that?

00:23:28.440 | Why would we even want to do that?

00:23:30.740 | Why would we want to rob the complexity of relationships

00:23:34.800 | of their contour and their detail?

00:23:37.420 | Well, if we can understand the dimensions

00:23:41.140 | in which we map our relationship to people,

00:23:44.460 | animals and things, then we can understand why it is

00:23:49.100 | that when those people, animals or things

00:23:52.700 | are not accessible to us, why it hurts so much

00:23:57.300 | and why it takes a certain amount of time

00:23:59.540 | in order to re-understand, if you will,

00:24:02.740 | or re-map our association to them.

00:24:05.940 | I promise that in grasping the information

00:24:08.380 | I'm about to give you, you will be able

00:24:10.820 | to better orient in the grief process

00:24:14.060 | and you'll be able to move through it more effectively.

00:24:17.420 | The three dimensions of relating to someone

00:24:21.600 | or an animal or a thing are space, time, and closeness.

00:24:26.600 | And in order to illustrate each one

00:24:29.240 | and how they work together to support relationships

00:24:32.820 | and their involvement in the grieving process,

00:24:35.140 | I'm going to tell you about an experiment.

00:24:37.720 | This experiment was actually done.

00:24:40.080 | The experiment involves putting people into a brain scanner

00:24:43.080 | that allows the researcher to evaluate brain activity

00:24:46.700 | in different areas.

00:24:47.540 | In fact, can look in a very non-biased way,

00:24:51.060 | not make any predictions about which brain areas

00:24:52.880 | are going to be involved.

00:24:54.520 | And the experiment is the following.

00:24:57.000 | The person, I should say the research subject,

00:25:00.300 | first sees images of things that reside

00:25:03.380 | at different distances from one another.

00:25:05.000 | And when I say things, these are objects.

00:25:07.620 | So in one case, it's a beach or a parking lot

00:25:11.700 | with bowling balls set at different distances

00:25:14.040 | from one another.

00:25:14.900 | Their brain is imaged and as their brain is imaged,

00:25:20.240 | they see different pictures of different scenes,

00:25:23.340 | the beach, the parking lot, et cetera,

00:25:25.380 | bowling balls spaced in different ways,

00:25:27.700 | close together, far apart, regularly spaced,

00:25:30.000 | non-regularly spaced.

00:25:32.180 | When one does this sort of experiment,

00:25:33.460 | you see a lot of brain areas activated,

00:25:35.780 | not surprisingly the visual cortex,

00:25:37.480 | the area of the brain that is responsible

00:25:39.020 | for creating visual perceptions,

00:25:41.840 | but also a brain area that seems uniquely tuned

00:25:46.060 | to the distance between you and the objects.

00:25:50.380 | So whether or not the bowling balls are far away

00:25:52.340 | or close together from one another,

00:25:54.840 | and whether or not they are far away

00:25:56.640 | or close to you physically.

00:25:58.200 | So literally the distance between you and these objects,

00:26:00.960 | we'll refer to that measure, that dimension,

00:26:03.640 | as we call it as proximity, okay?

00:26:05.880 | Whether or not it's very close to you,

00:26:08.560 | high degree of proximity or far away, low proximity,

00:26:12.720 | but it's simply physical space.

00:26:15.800 | Then subjects listen to tones.

00:26:19.220 | Those tones also are spaced from one another.

00:26:22.000 | So it could be something as simple as my hand

00:26:25.720 | meeting the table top that I'm happened to be sitting

00:26:28.360 | in front of, so it's.

00:26:29.360 | They image the brain.

00:26:34.360 | Of course, areas of the brain that are associated

00:26:36.220 | with auditory perception are active, not surprisingly,

00:26:40.160 | but as they evaluate different types of sounds

00:26:42.620 | and patterns of sounds, for instance,

00:26:45.920 | they can start to parse brain areas

00:26:50.920 | that seem uniquely tuned to the spacing of sounds

00:26:55.040 | independent of what sounds are coming in.

00:26:56.740 | So whether or not it's musical notes

00:26:57.960 | or my hand hitting the table or human speech,

00:27:01.160 | they identified a brain region that is uniquely tuned.

00:27:05.520 | That is, it becomes active specifically in response

00:27:08.860 | to changes in the spacing between sounds,

00:27:11.880 | much in the same way as they could identify brain regions

00:27:14.460 | that were only activated when there were changes

00:27:16.960 | in the distance between objects, such as the bowling balls

00:27:20.080 | that I used in the previous example.

00:27:22.320 | And then the subjects saw a different set of images.

00:27:25.860 | The images that they saw were of people and of faces.

00:27:29.660 | And some of the images that they saw

00:27:31.400 | were of people's faces right up close

00:27:33.880 | and other images were of people at a distance

00:27:37.540 | where you could see the whole body of the person.

00:27:39.920 | Now, they also varied the emotional relationship

00:27:43.420 | to those people.

00:27:44.280 | That is, they were able to get photographs

00:27:46.880 | from these research subjects lives.

00:27:49.120 | So they could show them pictures of, for instance,

00:27:51.140 | their sister or some random person off the street.

00:27:55.080 | They could show them pictures of a parent or of a neighbor

00:28:00.000 | or of a celebrity that's well-known

00:28:02.880 | or of somebody that they didn't know at all.

00:28:05.480 | So they were able to vary both the position of the person,

00:28:09.120 | close or far, and they were able to vary

00:28:12.440 | the emotional distance to the person,

00:28:14.840 | which is this dimension that I'm referring to as closeness,

00:28:17.520 | which is not physical closeness,

00:28:18.980 | but how attached or how well you know somebody.

00:28:22.580 | Now, this is maybe sounding

00:28:24.180 | like a somewhat complicated experiment,

00:28:25.680 | but the takeaway from this experiment is exquisitely simple

00:28:29.740 | and exquisitely important.

00:28:32.260 | The result was that in all three conditions,

00:28:36.880 | changes in the physical spacing of these objects,

00:28:41.840 | changes in the temporal,

00:28:44.400 | that is the time spacing of these sounds,

00:28:46.600 | and changes in the emotional distance

00:28:49.480 | between the subject and different people,

00:28:51.840 | the same brain area was uniquely activated.

00:28:56.080 | Now, that is an incredible thing to find

00:28:58.360 | because what it suggests is that, yes, of course,

00:29:01.760 | there are brain areas that are associated

00:29:03.160 | with representation of visual objects,

00:29:05.140 | and that, yes, of course, there are brain areas

00:29:06.680 | associated with representation of different sounds,

00:29:09.960 | and of course, there are brain areas associated with faces.

00:29:12.180 | We now know this.

00:29:13.320 | In fact, there's something called the fusiform face area,

00:29:15.560 | which is uniquely tuned to faces,

00:29:18.120 | but at the same time, there is a unique brain region

00:29:23.040 | that is activated in all three of the conditions I described

00:29:28.040 | that has to do with how far you are from somebody,

00:29:31.120 | both in space, in time, and in terms of emotional closeness,

00:29:36.120 | and that brain area, it turns out,

00:29:39.360 | is a brain area called the inferior parietal lobule.

00:29:43.200 | The inferior parietal lobule.

00:29:44.540 | Now, you don't need to know

00:29:45.960 | where the inferior parietal lobule is.

00:29:48.540 | In fact, you don't even need to know

00:29:49.680 | the name of this brain area.

00:29:51.500 | What you do need to know, however,

00:29:52.960 | if you want to understand grief

00:29:54.360 | and how to move through grief,

00:29:56.000 | is that your map of people

00:29:58.520 | is not a map of emotional closeness per se.

00:30:02.840 | It is a map of emotional closeness, what we call attachment,

00:30:07.200 | that is interwoven, that is braided in,

00:30:10.680 | in a very intimate way,

00:30:12.340 | with your map of where they are in physical space

00:30:16.140 | and where they are in time,

00:30:18.320 | when you saw them last,

00:30:19.400 | when you're likely to see them again,

00:30:21.280 | and if you were to want to see them,

00:30:24.840 | how much time it would take to reach them

00:30:26.960 | or for them to reach you.

00:30:28.840 | Now, earlier, I said that one of the key functions

00:30:31.160 | of our nervous system is to be able to make predictions,

00:30:34.560 | and so it's somewhat obvious, but nonetheless,

00:30:37.560 | important to state and restate

00:30:40.000 | that one of the most powerful aspects

00:30:42.280 | of our attachments to people, animals and things,

00:30:46.100 | is our ability to predict

00:30:48.160 | what it would take to see them again

00:30:49.640 | and when we are going to see them again.

00:30:52.340 | In fact, we could say that our ability to locate someone

00:30:57.340 | or an animal or thing in space and time, right,

00:31:01.920 | where they are and how long it would take

00:31:04.120 | for us to reach them or them to reach us,

00:31:07.060 | is a prediction of the requirements

00:31:10.160 | to engage in the attachment.

00:31:11.920 | In order to illustrate this at a little bit more depth,

00:31:15.160 | let's just do a fill in the blank experiment.

00:31:17.800 | You can do this now in real time.

00:31:19.680 | I want you to think of somebody that you either rely on

00:31:22.900 | or that you care about very, very much,

00:31:25.760 | and I'll just allow you to fill in the blank

00:31:28.400 | on this sentence.

00:31:30.560 | If I want to see blank, the person or animal,

00:31:33.940 | I could see them within blank amount of time, right?

00:31:38.920 | If right now you wanted to see this person or animal

00:31:41.880 | or maybe even a thing,

00:31:43.640 | how long would it take you to reach them?

00:31:46.440 | Could be a day, could be a second,

00:31:48.920 | could be there right next to you.

00:31:50.120 | All you'd have to do is turn your head.

00:31:52.080 | Now answer this.

00:31:54.560 | If this person were to travel

00:31:59.280 | halfway around the world and land in their plane,

00:32:04.280 | I would expect to hear from them

00:32:06.240 | within blank minutes of them landing, okay?

00:32:10.680 | The answers of this of course will differ.

00:32:13.720 | Now I'd like you to answer this question.

00:32:16.420 | If I'd like to find myself,

00:32:18.240 | it would take me X amount of time.

00:32:21.400 | And of course, if you're listening to this

00:32:23.540 | and you're understanding it and you're of a rational mind,

00:32:26.600 | the answer to that should be zero seconds.

00:32:29.120 | Instantaneous.

00:32:29.960 | You are always able to locate yourself in space and time,

00:32:32.800 | provided you are in the appropriate state of mind,

00:32:35.640 | meaning not asleep, for instance.

00:32:37.580 | That last question might seem somewhat silly,

00:32:41.160 | but it's a fundamentally important one

00:32:43.720 | because it illustrates the extremes

00:32:45.240 | at which we map our relationship to ourselves

00:32:47.360 | relative to other people and things.

00:32:49.800 | Now, if all of this sounds like

00:32:51.360 | a bunch of neuro psycho babble parsing of the obvious,

00:32:57.640 | I'd encourage you to suspend that belief for the moment,

00:33:00.600 | because if you understand that all relationships

00:33:03.080 | are mapped in the brain and body

00:33:04.680 | through these three dimensions,

00:33:06.040 | space, time, and closeness, or proximity of space,

00:33:11.000 | proximity in time, and proximity of attachment,

00:33:15.040 | how close or rich or bonded you are to someone,

00:33:20.040 | well, if you can understand that,

00:33:22.760 | then it almost becomes obvious,

00:33:25.480 | or at least it becomes intuitive as to why,

00:33:28.560 | after the loss of somebody, in particular a death

00:33:31.040 | or the loss of an animal, this map has to be reordered.

00:33:35.840 | Why?

00:33:36.680 | Because if we are attached to someone or an animal

00:33:40.880 | at a deep level, it is almost always on the basis

00:33:45.000 | of a lot of what we call episodic experience,

00:33:47.760 | a lot of episodic memories, memories of things that happen.

00:33:51.340 | Episodic memories are literally the conscious recollection

00:33:55.720 | of your experience of somebody or an animal or a thing.

00:33:59.920 | And within that memory, you have an understanding

00:34:03.920 | of what has happened with them in association to you,

00:34:08.280 | what's going on with them, where it happened,

00:34:10.680 | when it happened, you have a rich knowledge database

00:34:14.140 | that we call implicit knowledge, right?

00:34:16.120 | You might not be aware of it all the time,

00:34:17.760 | but it's within you of what this person is like

00:34:20.280 | and what they're doing in their life.

00:34:22.120 | When somebody is taken away from us for whatever reason,

00:34:26.020 | episodic memories persist for some period of time,

00:34:30.900 | and they are still linked to our feelings of attachment.

00:34:34.440 | Grief is the process of uncoupling, unbraiding,

00:34:38.800 | and untangling that relationship between where people are

00:34:43.040 | in space, in time, and our attachment to them.

00:34:46.000 | What I mean by this is when somebody or an animal

00:34:48.500 | or a thing is taken from us, either by decision

00:34:51.660 | or by death or by circumstance, well, in that case,

00:34:56.660 | our entire memory bank and our ability to predict

00:35:02.100 | where and when they will be, and therefore,

00:35:04.640 | when we can feed our attachment to them again,

00:35:08.440 | that whole map is obliterated,

00:35:11.760 | except that the attachment itself has not been disrupted.

00:35:16.240 | Assuming that you are deeply attached to someone

00:35:18.600 | or an animal or a thing, that attachment persists,

00:35:21.600 | and the grief process is one in which you have to reorder

00:35:24.840 | your understanding of them in space and in time.

00:35:28.300 | This is very, very hard to do, and for some people,

00:35:31.840 | it's almost impossible to do,

00:35:33.600 | at least at the outset of grief.

00:35:35.600 | This, in a very neurosciency way,

00:35:38.680 | explains this stage that Kubler-Ross described,

00:35:42.040 | which many, again, not all, but many people experience,

00:35:44.760 | which is one of denial.

00:35:46.560 | How could it be?

00:35:47.600 | Why?

00:35:48.440 | Well, when we have a rich catalog of experiences

00:35:52.440 | with somebody or of them, right?

00:35:54.400 | Ideas about them and what they do, how they spend their day,

00:35:56.720 | what they do and don't do, where they do it, et cetera.

00:35:59.300 | Well, that memory bank is not just flushed out

00:36:03.760 | the moment that we learn that they're no longer with us.

00:36:07.560 | What happens is the brain continues to make

00:36:09.960 | these predictions that they will be in a certain place

00:36:13.120 | or a certain time, right?

00:36:14.720 | That there'll be in a certain time zone

00:36:15.960 | or they'll walk in the door any moment.

00:36:17.900 | All of those predictions still hold.

00:36:19.480 | The neural activity continues.

00:36:21.040 | We call this reverbatory activity.

00:36:22.980 | That explains the yearning for and the desire to interact,

00:36:27.640 | and yet it's just beyond our reach because once they're gone

00:36:31.240 | our brain still functions in a way,

00:36:34.000 | these neural circuits still function in a way

00:36:36.380 | that put us into an action state of seeking them,

00:36:39.160 | looking for them in the same location,

00:36:41.460 | expecting them to contact us at whatever frequency

00:36:44.060 | that we were used to hearing from them

00:36:45.840 | or that we could reach out to them

00:36:47.020 | and reliably get a response.

00:36:48.920 | It is immensely disorienting, in other words,

00:36:53.840 | to maintain a close attachment and at the same time,

00:36:58.120 | to not be able to make predictions about where that person

00:37:02.520 | and more thing is in space and time.

00:37:06.000 | Now, if this seems somewhat abstract,

00:37:08.020 | I'm going to continue to flush it out.

00:37:09.880 | And actually right now I'd like to flush it out

00:37:11.980 | with a real world example of grief and loss

00:37:14.940 | that comes to us from perhaps one of the greatest minds

00:37:18.640 | in human history and somebody who was intensely grounded

00:37:23.380 | in reality and logic and indeed the physics of the world.

00:37:27.340 | And the person I'm referring to is none other

00:37:29.320 | than the Nobel prize winning physicist, Richard Feynman.

00:37:33.200 | Many of you are probably familiar with Richard Feynman.

00:37:35.480 | Some of you perhaps are not.

00:37:36.940 | Richard Feynman was a Nobel prize winning physicist,

00:37:39.780 | known for his thick New York accent.

00:37:42.440 | He was actually not from Brooklyn, as many people think.

00:37:45.160 | He was actually from Far Rockaway in Long Island,

00:37:49.000 | thick New York accent, very personable,

00:37:53.080 | exceptional teacher, brilliant mind,

00:37:55.640 | hence the Nobel prize in physics.

00:37:57.280 | Also a quite funny and amusing person

00:37:59.680 | told great anecdotes, et cetera.

00:38:01.600 | Feynman had a childhood sweetheart

00:38:05.760 | who turned out to be his first wife.

00:38:07.920 | Her name was Arlene and it was well known

00:38:10.440 | that Feynman was absolutely in love with her.

00:38:14.260 | He would talk about her all the time.

00:38:15.860 | She had a profound influence on him and his thinking

00:38:18.600 | and ultimately on his public education efforts later.

00:38:21.700 | If you haven't already read books such as

00:38:24.220 | "Surely You're Joking Mr. Feynman"

00:38:26.240 | or "What Do You Care What Other People Think?"

00:38:28.580 | I encourage you to do so and in fact, that quote,

00:38:30.280 | "What Do You Care What Other People Think?"

00:38:32.100 | is actually a quote, not of Feynman,

00:38:34.400 | but of his first wife, Arlene,

00:38:36.040 | who sadly died at a very young age from tuberculosis.

00:38:39.800 | Why am I sharing Feynman's story

00:38:42.380 | of loss of his first bride?

00:38:44.160 | Well, the reason is Feynman continued to write letters

00:38:49.160 | to Arlene for a long period of time.

00:38:50.940 | This is well known only because after Feynman died,

00:38:54.700 | it was discovered that he kept an archive of letters

00:38:59.560 | to his deceased first wife.

00:39:02.880 | And even though he did eventually marry and in fact,

00:39:06.740 | had many relationships with many people,

00:39:08.320 | and I think was married twice more,

00:39:09.680 | maybe it was once, maybe it was twice,

00:39:12.320 | the intensity of his grief,

00:39:14.360 | but also his lack of ability to transition his mind

00:39:19.360 | to a place where he understood that Arlene had died

00:39:23.600 | is one of the more profound examples of this inability

00:39:27.760 | to reconcile the logical world and the emotional world.

00:39:31.240 | And I'm now going to read to you a letter

00:39:34.280 | that Feynman wrote to Arlene.

00:39:35.920 | This was discovered after Feynman's death

00:39:37.900 | when they went through his desk and his belongings.

00:39:41.000 | And as I read this,

00:39:43.160 | you're going to hear some of the typical narrative of grief

00:39:45.940 | that is not unique to Feynman and his dead wife.

00:39:50.920 | But there are also some elements in there

00:39:53.360 | that I think you'll recognize as highlighting this disbelief

00:39:57.700 | and this dissociation between the reality

00:40:00.500 | of somebody's location in space and time

00:40:03.040 | and the emotional attachment that they hold for us.

00:40:05.700 | And therein lies the information

00:40:07.420 | about how to better navigate grief.

00:40:09.540 | So now I'm reading from the letter.

00:40:10.860 | This was a letter dated October 17th, 1946.

00:40:14.740 | It's not terribly long, but bear with me.

00:40:17.860 | "Dear Arlene, I adore you, sweetheart.

00:40:21.980 | I know how much you like to hear that,

00:40:23.600 | but I don't only write it because you like it.

00:40:26.060 | I write it because it makes me warm all over inside

00:40:28.460 | to write it to you.

00:40:30.200 | It is such a terribly long time since I last wrote to you,

00:40:33.100 | almost two years, but I know you'll excuse me

00:40:35.660 | because you understand how I am, stubborn and realistic,

00:40:38.860 | and I thought there was no sense to writing.

00:40:41.900 | But now I know, my darling wife,

00:40:43.240 | that it is the right thing to do

00:40:44.540 | what I have delayed in doing

00:40:45.900 | and that I have done so much in the past.

00:40:48.260 | I wanted to tell you I love you.

00:40:50.040 | I want to love you.

00:40:51.300 | I will always love you."

00:40:53.000 | So here we can hear the intense emotional attachment

00:40:55.760 | that clearly has persisted.

00:40:59.320 | I find it hard to understand in my mind

00:41:00.940 | what it means to love you after you are dead,

00:41:03.500 | but I still want to comfort and take care of you,

00:41:05.940 | and I want you to love me and care for me.

00:41:08.740 | I want to have problems to discuss with you.

00:41:10.780 | I want to do little projects with you.

00:41:12.860 | I never thought until just now that we can do that.

00:41:15.680 | What should we do?

00:41:17.380 | We started to learn to make clothes together

00:41:19.380 | or learn Chinese or getting a movie projector.

00:41:22.560 | Can't I do something now?

00:41:24.040 | No, I am alone without you,

00:41:26.340 | and you were the idea woman and the general instigator

00:41:29.400 | of all our wild adventures.

00:41:31.080 | When you were sick, you worried

00:41:33.380 | because you could not give me something that you wanted,

00:41:36.000 | and you thought I needed.

00:41:38.000 | You needn't have worried.

00:41:39.440 | Just as I told you then, there was no real need

00:41:41.440 | because I loved you in so many ways so much,

00:41:43.940 | and now it is clearly even more true.

00:41:46.280 | You can give me nothing now,

00:41:47.940 | yet I love you so that you stand in the way

00:41:49.960 | of my loving anything else,

00:41:51.760 | but I wanted you to stand there.

00:41:53.320 | You, dead, are so much better than anyone else alive.

00:41:57.800 | So you can really appreciate the depth

00:42:00.740 | and intensity of the attachment.

00:42:02.320 | Despite two years time, it clearly has not waned.

00:42:05.660 | I'll read the final paragraph now.

00:42:08.240 | I know you will assure me that I am foolish

00:42:11.520 | and that you want me to have full happiness

00:42:13.580 | and don't want to be in my way.

00:42:15.520 | I bet you are surprised that I don't even have a girlfriend,

00:42:17.980 | except you, sweetheart, after two years,

00:42:20.660 | but you can't help it, darling, nor can I.

00:42:22.640 | I don't understand it, for I've met many girls

00:42:25.140 | and very nice ones, and I don't want to remain alone,

00:42:28.360 | but in two or three meetings, they all seem ashes.

00:42:30.960 | You only are left to me.

00:42:33.920 | You are real.

00:42:35.440 | My darling wife, I do adore you.

00:42:37.560 | I love my wife.

00:42:39.080 | My wife is dead.

00:42:40.760 | Rich.

00:42:42.320 | P.S., please excuse my not mailing this,

00:42:45.000 | but I don't know your new address.

00:42:46.700 | So there's a lot contained in this letter.

00:42:51.140 | We could parse it line by line,

00:42:53.300 | but I think it's fair to say

00:42:54.240 | that clearly there's an immense attachment

00:42:56.100 | that's been maintained.

00:42:57.080 | So that's that dimension of closeness of attachment.

00:43:00.940 | Clearly there's an understanding that she's dead.

00:43:02.940 | In fact, the last line of this love letter

00:43:05.660 | is my wife is dead, right?

00:43:08.660 | He now moves her into the third person, in fact,

00:43:11.500 | in that final line.

00:43:12.700 | So he understands this, and yet he maintains the attachment.

00:43:17.880 | And the very last portion of the letter,

00:43:20.740 | the P.S., the postscript,

00:43:22.980 | I don't know your new address, right?

00:43:24.740 | Somewhat humorous in the typical vein

00:43:26.920 | of a Feynman writing or speech.

00:43:30.020 | He always had an intensely amusing

00:43:33.460 | and playful sense of humor.

00:43:35.300 | And yet there's something really contained in this.

00:43:37.060 | I don't think we're reading into this too much,

00:43:39.680 | in that he doesn't know where to find her.

00:43:41.880 | He feels her as very real,

00:43:44.640 | and yet he doesn't know where to find her.

00:43:46.740 | He doesn't know her address.

00:43:48.480 | He obviously knows she's dead,

00:43:49.840 | so there's nowhere to mail it to.

00:43:51.900 | The reason I shared this letter with you,

00:43:53.380 | as opposed to one of the almost infinite number

00:43:56.280 | of other letters that have been written by poets

00:43:59.280 | and authors and scientists and everyday people,

00:44:02.860 | is that it really encapsulates all three dimensions

00:44:06.100 | of attachment and grief.

00:44:08.100 | These notions of space, where is something or somebody?

00:44:12.320 | Time, this dimension of how long would it take me

00:44:15.320 | to reach them or for them to reach me?

00:44:17.500 | What would it take in terms of time to be reunited?

00:44:21.220 | And then that last dimension of closeness.

00:44:23.980 | And the letter beautifully illustrates the fact

00:44:26.880 | that in grief, we maintain that sense of closeness,

00:44:31.880 | and yet we have to uncouple it

00:44:34.460 | from these other two dimensions,

00:44:36.660 | as we're referring to space and time.

00:44:39.780 | So with this current understanding in mind,

00:44:42.480 | a few things start to become obvious

00:44:44.980 | and entirely normal to us in the best

00:44:48.060 | and most healthy sense of the word normal.

00:44:51.620 | For instance, if you've lost somebody or an animal,

00:44:55.180 | or even a thing that was vitally important to you,

00:44:58.820 | it should make perfect sense to you

00:45:00.200 | as to why you keep looking for that person.

00:45:03.160 | I recall this in my own life.

00:45:04.580 | I had the unfortunate circumstance of my graduate advisor,

00:45:08.100 | who I was very close with, died quite young of breast cancer.

00:45:12.500 | And her daughter, she has two daughters,

00:45:16.660 | kept her cell phone and would occasionally call me.

00:45:19.700 | I had a quite close relationship to their family.

00:45:22.880 | And when it would come in,

00:45:24.260 | the number would pop up on my phone of not the daughter,

00:45:28.060 | but the name that showed up was of my graduate advisor.

00:45:30.820 | So for years after she died,

00:45:33.300 | my initial impulse when the phone would ring was,

00:45:35.380 | "Oh my goodness, she's calling."

00:45:36.740 | It was a reflexive excitement

00:45:38.860 | because I truly always enjoyed hearing from her.

00:45:41.980 | She's a wonderful, incredibly wonderful person,

00:45:45.000 | I should say.

00:45:45.840 | Similarly, when somebody passes away,

00:45:48.780 | we will find ourselves looking into a room,

00:45:50.580 | expecting to see them there,

00:45:52.180 | or expecting them to knock on the door any moment,

00:45:54.540 | or to call on Sunday morning, as it were.

00:45:58.360 | Those expectations, those predictions

00:46:02.720 | that the brain is making are entirely normal

00:46:06.860 | because they are based on that deep catalog

00:46:09.580 | of episodic memory that you maintain about that person.

00:46:12.680 | Again, the depth and richness of that catalog scaling,

00:46:16.300 | of course, in direct relation to how close you were

00:46:19.400 | with that person, right?

00:46:20.740 | Closer to somebody means more information about them.

00:46:23.740 | More information about them means your brain has a lot

00:46:26.600 | of implicit, unconscious notions of when and where

00:46:30.820 | and how they show up.

00:46:31.980 | So the fact that your brain,

00:46:35.500 | and indeed sometimes your body,

00:46:36.980 | reacts to the expectation that they'll be there

00:46:40.780 | is entirely normal.

00:46:42.820 | It's simply an activation of this map

00:46:45.700 | that involves closeness, space, and time.

00:46:48.140 | Not surprisingly then, the reordering of that map

00:46:54.420 | that's required in order to move through

00:46:56.380 | the grieving process is going to involve some remapping.

00:47:02.420 | And you, as the person grieving, have the opportunity to ask

00:47:07.420 | which node, as it's called, which element or dimension

00:47:10.960 | within that map are you going to focus on?

00:47:13.400 | Some people really try hard to disengage with

00:47:18.540 | and remap their sense of emotional closeness to the person.

00:47:21.600 | That is, it's so unbelievably overwhelming to them

00:47:25.500 | that the person is no longer accessible,

00:47:27.620 | that they try and change their ideas

00:47:30.480 | about how close they really were.

00:47:32.300 | They try and change their emotional attachment

00:47:34.220 | to the person after they've died.

00:47:36.060 | Clearly in the example that I gave in the Feynman letter,

00:47:38.980 | that's not the case.

00:47:39.920 | The attachment seems indeed quite fixed

00:47:41.860 | and not going anywhere.

00:47:43.020 | Psychologists and neuroscientists generally agree

00:47:46.500 | that the best way to approach moving through grief

00:47:49.440 | is actually to remap these dimensions

00:47:52.740 | while maintaining the close sense of attachment

00:47:55.780 | to the person by not in any way trying to undermine

00:48:00.240 | the intensity of the attachment or how important it was

00:48:02.900 | to you.

00:48:04.200 | So we'll now talk about how that process works

00:48:07.380 | and the different entry points, as they're called,

00:48:11.180 | to engaging in that process.

00:48:13.260 | So one straightforward way to think about this state

00:48:16.020 | of mind and body that we call grief

00:48:18.780 | is that the idea that someone or an animal or a thing

00:48:23.780 | simply does not exist anymore is not something

00:48:27.100 | that the brain can easily conceptualize.

00:48:29.900 | And the reason for that is that we as beings

00:48:34.900 | that have a brain and a brain as an organ

00:48:38.280 | that makes predictions tends to rely more on experience

00:48:42.480 | than knowledge.

00:48:43.820 | In other words, the knowledge that someone or an animal

00:48:47.440 | or a thing is gone, that it doesn't exist,

00:48:49.980 | at least not in the dimensionality

00:48:51.960 | that we were accustomed to relating to them in,

00:48:55.920 | is something that we can understand logically,

00:48:59.500 | but that emotionally is very hard to undo

00:49:02.520 | and from a memory perspective is very hard to undo.

00:49:06.880 | So it's not just that we are in a state

00:49:08.420 | of emotional disbelief.

00:49:10.500 | It's that we have neurons, literally nerve cells

00:49:13.620 | and neural circuits, connections between nerve cells

00:49:15.780 | that are dedicated to this vast implicit knowledge

00:49:19.380 | of all the things we know about that person,

00:49:21.540 | animal or thing.

00:49:23.020 | And just because they are no longer in the dimensionality,

00:49:27.340 | meaning in the configuration alive or present in our life

00:49:31.980 | that they were before, doesn't eliminate those memories.

00:49:35.280 | Those memories persist.

00:49:37.500 | And so anytime we call to mind the person's name

00:49:41.020 | or we call to mind things that remind us of them,

00:49:44.580 | or we suddenly feel the desire to engage with them,

00:49:47.860 | the memories, those episodic implicit memories,

00:49:52.800 | as they're called, all that menu and library of knowledge

00:49:57.680 | slams us straight in the face and pushes us into a mode

00:50:02.120 | of wanting to act in a way that's consistent

00:50:04.960 | with them still being here in the way

00:50:07.400 | that all that knowledge told us they were

00:50:10.680 | when we acquired it.

00:50:12.240 | That's a very long-winded way of saying

00:50:14.420 | that there's nothing wrong about the emotional state

00:50:17.160 | when we are in a state of grief.

00:50:19.660 | In fact, quite the opposite.

00:50:21.260 | But there is something wrong about the memories

00:50:23.580 | because the memories are based on our prior knowledge

00:50:27.180 | of them and those memories actually do not apply

00:50:30.960 | to our current knowledge of them.

00:50:33.260 | And again, even though our brain is a prediction machine

00:50:36.060 | and it's a very good one, it's not perfect.

00:50:38.540 | In fact, it's far from perfect.

00:50:40.240 | So really moving through grief is a process

00:50:42.140 | of understanding how relationships are mapped in the brain,

00:50:45.900 | space, time, and closeness, also called attachment,

00:50:49.220 | understanding those three dimensions,

00:50:50.660 | understanding that they are closely linked,

00:50:52.840 | and then understanding that simply the knowledge

00:50:55.420 | that somebody or something or an animal

00:50:57.280 | isn't accessible to us does not allow us to discard

00:51:02.240 | of all the knowledge that we have.

00:51:05.640 | And as a consequence, our brain is constantly

00:51:07.720 | generating expectations of how to access them,

00:51:10.800 | even if we know that's completely irrational.

00:51:13.740 | Now, this should, I would hope,

00:51:17.180 | assist you in moving through grief.

00:51:19.400 | It's not a tool of the sort of like a switch

00:51:22.620 | that you can flip and suddenly not feel grief,

00:51:24.880 | but it does point to a specific set of mechanisms

00:51:27.580 | or a specific set of steps that you can engage

00:51:30.620 | in order to start to move through the grieving process

00:51:33.760 | in the most adaptive and effective way

00:51:36.500 | and in a way that still holds in mind

00:51:39.380 | your close attachment to the person.

00:51:41.380 | So let's talk about some of the tools

00:51:42.680 | for adaptively moving through grief.

00:51:44.820 | These are tools gleaned from the research psychology,

00:51:47.160 | the clinical psychology, and the neuroscience literature.

00:51:50.320 | So I've synthesized my understanding

00:51:52.400 | of those three literatures to provide the tools

00:51:56.740 | that I'm about to describe.

00:51:58.100 | The first one involves the acknowledgement

00:52:01.620 | and really the understanding that you don't want

00:52:04.760 | to disengage or dismantle your real attachment

00:52:08.020 | to someone, an animal, or a thing.

00:52:10.000 | That's a real thing, and there is actually

00:52:11.880 | no adaptive reason to try and persuade yourself

00:52:15.840 | or numb yourself or somehow avoid the thinking

00:52:18.820 | of just how much they meant to you.

00:52:21.420 | What is important, however, is that you make some effort

00:52:24.720 | to shift your mindset and your understanding of that person

00:52:28.800 | in a way that holds in mind that yes, indeed,

00:52:31.740 | the attachment is very real,

00:52:33.920 | and in some cases is very, very intense,

00:52:36.640 | but is now going to be uncoupled

00:52:40.360 | from the other two dimensions of the map,

00:52:42.640 | namely space and time.

00:52:44.520 | So again, just to make absolutely clear,

00:52:47.420 | there's no reason to try and convince yourself

00:52:49.920 | that you weren't actually that close to this person

00:52:51.980 | or them to you.

00:52:53.000 | There's no reason to try and reduce the intensity

00:52:57.320 | of that attachment to the contrary.

00:52:59.240 | You want to anchor yourself to that attachment,

00:53:01.860 | but you want to make sure that your thoughts

00:53:04.340 | about the person and your feelings about the person

00:53:07.560 | are not oriented toward, or in reference to, I should say,

00:53:11.860 | that map, that deep catalog of memories that you had.

00:53:15.940 | Now, this is not simply a fancy way of saying

00:53:18.640 | don't live in the past.

00:53:20.020 | This is saying you need to maintain your sense of attachment,

00:53:24.340 | but you need to start making predictions and understanding

00:53:28.100 | about how you're going to engage with that attachment,

00:53:31.180 | how you're going to feel those things

00:53:32.700 | without the expectation that things that once happened before

00:53:37.520 | are going to happen again.

00:53:39.140 | So it's a complicated process you can imagine,

00:53:41.980 | but you really want to hold and register two things at once.

00:53:44.740 | It's sort of like spinning two plates at once,

00:53:46.460 | and therefore it's going to feel like effort.

00:53:49.440 | One way to do this is to set aside a dedicated period

00:53:52.460 | of time of maybe five or 10,

00:53:56.140 | maybe even as much as 30 minutes,

00:53:58.380 | or depending on your capacity, 30 to 45 minutes,

00:54:02.460 | in which you are going to feel deeply into your closeness

00:54:05.420 | and your attachment to that person, animal, or thing.

00:54:08.600 | But you're consciously going to try and prevent yourself

00:54:12.820 | from thinking about a couple of categories of things.

00:54:16.700 | First of all, you want to actively try and disengage

00:54:20.820 | from any attempt to engage in what's called

00:54:23.640 | counterfactual thinking, the what ifs.

00:54:26.500 | What if I had called them a day earlier?

00:54:28.840 | What if they had taken a different route home?

00:54:31.880 | What if I had taken a different route home?

00:54:34.900 | These counterfactual modes of thinking

00:54:38.560 | are an infinite landscape of possibility,

00:54:41.240 | and they are very closely tied to guilt.

00:54:43.860 | Guilt is an interesting emotion.

00:54:45.200 | We should probably do an entire episode about guilt,

00:54:48.120 | but guilt, as defined by psychologists and neuroscientists,

00:54:52.660 | is actually a way of assigning ourselves more agency,

00:54:55.700 | more capability of controlling reality than actually exists.

00:54:59.840 | And it's a very slippery slope, and I want to be clear,

00:55:03.580 | it's not the case that guilt is never an appropriate

00:55:06.340 | response, but in the context of grieving,

00:55:09.620 | guilt is very precarious because in thinking

00:55:12.460 | I could have done this, or if I had only done that,

00:55:15.280 | you are essentially exploring an infinite landscape

00:55:20.620 | of things that you can never refute.

00:55:23.300 | You will never know that had you not gone down

00:55:26.420 | a different path, or they had not taken a particular path

00:55:29.660 | in life that things would have turned out different,

00:55:31.700 | but you can't know that it would have worked as well.

00:55:35.100 | Meaning you actually don't know that your what ifs are true,

00:55:38.740 | and you don't know that they're not true.

00:55:40.020 | And so as an infinite space, it's a very precarious one,

00:55:42.980 | and it will not allow you to uncouple

00:55:46.060 | that intense emotional attachment that I'm telling you

00:55:48.240 | is actually vital to hold onto from that catalog

00:55:51.700 | of episodic memory that you've established.

00:55:53.820 | In fact, it's going to strengthen those bonds.

00:55:56.920 | So in this dedicated five or 10 or 30,

00:56:00.760 | whatever period of time you can tolerate

00:56:02.860 | and maintain focus.

00:56:03.800 | The idea is to think about your attachment in a rich way

00:56:06.940 | and to perhaps even experience that in your brain and body.

00:56:11.160 | I think if you're in a stage of grief,

00:56:12.860 | that actually will be fairly reflexive to do,

00:56:16.180 | but to try as much as possible to hold that grief

00:56:19.680 | in the present and to be connected

00:56:21.700 | to your immediate physical environment.

00:56:23.960 | So you want to orient yourself in current space and time

00:56:28.400 | rather than focus on memories or what you would have liked

00:56:31.500 | to see happen or the wish that they were still there

00:56:34.660 | while at the same time, thinking about the depth

00:56:37.260 | and richness of that attachment.

00:56:39.420 | This is obviously a tight rope walk, so to speak.

00:56:43.180 | It's an emotionally challenging,

00:56:44.740 | and sometimes even will be experienced

00:56:46.500 | as a physically challenging tool or experience.

00:56:50.580 | But in our understanding of how attachments

00:56:53.860 | and grief are represented in the brain,

00:56:55.780 | this can be an immensely beneficial practice

00:56:58.420 | because it is the first step.

00:57:00.360 | And indeed it represents many of the steps

00:57:03.360 | in the voyage from the initial shock of loss

00:57:07.480 | to our ability to hold in mind somebody or an animal

00:57:10.960 | or a thing in a way that still allows us to feel the depth

00:57:14.080 | and fullness of connection to them

00:57:15.860 | without feeling the yearning,

00:57:17.280 | that reaching for the glass of water

00:57:19.440 | that unfortunately will never be resolved.

00:57:22.120 | Keep in mind that as you embark on this process,

00:57:25.080 | it is entirely normal for your mind

00:57:26.880 | to flip into various states of expectation

00:57:30.240 | that they're suddenly going to be there.

00:57:31.280 | In fact, because of the closeness

00:57:33.480 | of these three dimensions in the map,

00:57:35.340 | space, time, and attachment,

00:57:37.980 | it's entirely normal that when you start to think

00:57:40.980 | about your attachment to somebody or an animal or a thing,

00:57:44.640 | that you almost start to experience them

00:57:46.880 | as present in that environment.

00:57:48.980 | I'll share with you a somewhat bizarre,

00:57:50.920 | or it sounds bizarre to articulate out loud,

00:57:53.060 | but many of you perhaps will resonate with this.

00:57:55.960 | For years after my graduate advisor died,

00:57:58.880 | I would get an experience of someone touching

00:58:00.440 | the back of my neck when I would think about her.

00:58:03.360 | And that was not an experience I ever had with her, right?

00:58:06.640 | It was a professional relationship.

00:58:07.920 | I don't ever recall her touching the back of my neck

00:58:10.760 | or me touching the back of my neck in her presence,

00:58:13.360 | at least not on a regular basis.

00:58:15.760 | So it was very perplexing to me.

00:58:17.800 | And then I encountered this incredible literature on grief,

00:58:21.160 | which said the following, "Grief in many ways

00:58:25.420 | is like a phantom limb."

00:58:26.880 | For those of you that aren't familiar,

00:58:28.860 | many people who experience amputation of a limb,

00:58:31.920 | either through surgery or accident or otherwise,

00:58:35.160 | will feel in a very genuine way

00:58:36.940 | that the limb is still present,

00:58:38.280 | even though when they look for the limb, it's not there.

00:58:41.140 | So they can feel pain in limbs,

00:58:42.680 | they can feel the sensation of touch.

00:58:45.140 | There's some famous experiments from the neurologist

00:58:47.460 | and my former colleague at University of California,

00:58:49.400 | San Diego, who goes by his last name, Ramachandran.

00:58:52.400 | Some people just call him Rama.

00:58:54.680 | He's an incredible scientist

00:58:56.400 | and has done a lot of really important work,

00:58:58.960 | in particular on phantom limb, among other things.

00:59:01.760 | And has done some beautiful experiments

00:59:03.720 | showing that people who have phantom limb pain

00:59:07.120 | or that are experiencing different sensations

00:59:10.000 | in their phantom limb, that can be very intrusive,

00:59:11.800 | much in the same way that expecting someone

00:59:15.120 | to walk through the door who you happen to know is deceased

00:59:18.820 | can be very intrusive.

00:59:20.480 | Ramachandran has done beautiful experiments

00:59:22.720 | showing that if you give people what's called a mirror box,

00:59:25.420 | this is a box in which you insert an intact limb

00:59:29.280 | and there are some mirrors

00:59:30.200 | that give you the visual impression

00:59:32.100 | that the other limb is still present

00:59:33.720 | and you move the intact limb

00:59:35.280 | and you get a mirror image of the non-existent,

00:59:38.760 | but nonetheless, visual image of the phantom limb moving,

00:59:42.320 | that you can resolve some of the pain of a limb

00:59:44.400 | that feels otherwise cramped up.

00:59:46.000 | In other words, the visual perception

00:59:48.120 | can reverse some of these phantom sensations.

00:59:50.420 | In many ways, the phantom limb scenario

00:59:54.460 | and what I described about a sensation

00:59:56.940 | of being touched on the back of the neck

00:59:58.420 | or this feeling that we have

00:59:59.840 | when we engage in the thinking and the emotions

01:00:02.960 | of our attachment to someone, an animal or a thing,

01:00:06.140 | is very much like a phantom limb,

01:00:07.540 | only it exists in the emotional space.

01:00:10.060 | And it exists because it is reactivation

01:00:13.580 | of these maps about space, time, and person.

01:00:18.160 | And so if the process of moving through grief adaptively

01:00:21.420 | in a healthy way involves maintaining the attachment,

01:00:24.240 | but uncoupling that attachment

01:00:25.600 | from the space and time representation

01:00:27.560 | of that person, animal, or thing that we had before,

01:00:31.020 | well, then the question becomes,

01:00:32.800 | where should we place our expectation of them, right?

01:00:37.040 | Now, that of course will vary from person to person.

01:00:40.280 | Some people with particular religious beliefs

01:00:42.360 | will indeed believe that the soul of the person,

01:00:45.820 | the molecules of the person have been reordered

01:00:48.860 | and exist in some sort of either distributed domain, right?

01:00:52.100 | That they are in everything or they are in one location.

01:00:55.140 | I'm not here to speak to that one way or the other.

01:00:58.240 | There's no good experiment I know

01:00:59.940 | either to prove or disprove that, nor would I want to.

01:01:03.820 | It's not the job of science, frankly.

01:01:05.700 | However, allowing ourselves to place notions

01:01:11.540 | of where that person, animal, or thing is

01:01:16.100 | in their current new configuration, whatever that might be,

01:01:19.980 | ashes, dashes, dust to dust,

01:01:21.500 | or that the person's soul comes out of their body.

01:01:23.420 | These are all the different variations that people hear.

01:01:25.260 | Or some people think, well, it's just molecules

01:01:27.380 | and they disintegrate and are reordered

01:01:28.860 | and come up as the plants and the trees.

01:01:30.700 | Again, a near infinite number of possibilities,

01:01:34.300 | and it depends a lot on personal belief.

01:01:38.860 | It is however essential that no matter what you believe,

01:01:42.380 | that you have some firm representation

01:01:45.580 | of where that person, animal, or thing is

01:01:48.020 | so that you can plug it into this map,

01:01:51.060 | this three-dimensional map of space, time, and attachment.

01:01:56.060 | The process of moving through grief can't simply be

01:01:58.520 | that we hold onto the attachment and we discard

01:02:00.860 | with any understanding of where they are in space and time.

01:02:03.420 | And actually the letter that Feynman wrote

01:02:05.780 | to his deceased wife, Arlene,

01:02:08.460 | again, so beautifully and really poignantly

01:02:12.140 | illustrates the fact that he doesn't really know

01:02:14.060 | where to find her.

01:02:15.260 | On the one hand, he really understands that she's gone.

01:02:17.900 | And on the other hand, he understands

01:02:19.460 | that he still very much expects her to be there,

01:02:22.760 | that he would like to mail the letter.

01:02:23.960 | But then of course, in this final somewhat humorous line,

01:02:28.520 | he doesn't know where to send the letter, he tells us.

01:02:32.300 | What's very clear and I think is very healthy is the fact

01:02:36.420 | that the emotional bond is still there,

01:02:38.860 | that that is maintained.

01:02:40.420 | And so this tool, if you will,

01:02:43.100 | of dedicated blocks of time for really spending some effort,

01:02:47.220 | and it is indeed effort to access the emotional connection

01:02:50.220 | while starting to uncouple the other nodes of the map,

01:02:53.420 | as it were, is something that is hard.

01:02:56.420 | You should expect it to be hard,

01:02:58.440 | but in terms of the options one has

01:03:00.700 | in order to deal with grief,

01:03:02.580 | it is indeed the most adaptive way to go about it.

01:03:06.160 | You're not trying to avoid thinking about it.

01:03:08.540 | You're not engaging in this counterfactual thinking,

01:03:11.260 | the what if, what if, what if.

01:03:13.200 | You're not drowning it out with substances or delusion

01:03:17.920 | or with other ways of distracting yourself.

01:03:21.160 | So in that sense, it is truly adaptive.

01:03:23.260 | Now, of course, I don't want to imply

01:03:24.760 | that I'm a clinical psychologist, I'm certainly not.

01:03:27.900 | There is absolutely a place

01:03:29.340 | for working with a trained professional

01:03:31.060 | to move through grief, especially these situations,

01:03:34.280 | these one in 10 people who deal

01:03:38.060 | with what's called complicated grief or very prolonged grief.

01:03:40.880 | Those are somewhat different things,

01:03:41.940 | but in general point to the fact

01:03:43.500 | that there are people who have

01:03:44.860 | an exceptionally hard time moving through grief.

01:03:46.920 | We'll talk about who those people are

01:03:48.860 | and ways to move through them

01:03:50.040 | with or without a professional to assist you.

01:03:53.980 | But nonetheless, we're starting to understand

01:03:56.760 | on the basis of neuroscience,

01:03:59.420 | what some of the more adaptive and functional ways

01:04:01.380 | of moving through grief are.

01:04:02.900 | In order to really understand how a tool of the sort

01:04:05.980 | that we're describing ought to work

01:04:08.440 | and what it's designed to accomplish at a mechanistic level,

01:04:12.800 | I'd like to teach you about a very important aspect

01:04:15.980 | of your brain function that has everything to do with grief

01:04:19.960 | and the process of moving through grief,

01:04:22.060 | but has a lot to do with other aspects

01:04:24.700 | of our life experience as well.

01:04:26.940 | Some of you are probably familiar

01:04:28.060 | with a brain area called the hippocampus.

01:04:30.100 | The hippocampus is a structure that's involved

01:04:32.300 | in the formation of new memories,

01:04:33.860 | but not the maintenance of memories.

01:04:37.100 | I discussed the hippocampus in detail

01:04:39.940 | in our episode on memory and our episode with our guest,

01:04:43.600 | Dr. Wendy Suzuki from New York University,

01:04:45.660 | an expert on learning and memory.

01:04:47.320 | During those two discussions,

01:04:50.460 | I did not however touch into what the different cell types

01:04:53.560 | are in the hippocampus and the different roles they perform.

01:04:56.640 | And it turns out that there are indeed different cell types

01:04:59.140 | in the hippocampus and they performed very different roles

01:05:01.640 | that are absolutely central to the grief process.

01:05:04.780 | We have cells in our hippocampus,

01:05:07.760 | meaning you have cells in your hippocampus.

01:05:10.600 | These cells are neurons, nerve cells that fire anytime,

01:05:15.020 | and when we say fire, I should just remind you,

01:05:17.440 | I mean have electrical activity,

01:05:20.940 | anytime that we enter a particular familiar location.

01:05:25.580 | So for instance, think about your bedroom

01:05:28.340 | and think about where the bed is, as you're doing that,

01:05:31.960 | these so-called place cells are firing,

01:05:34.600 | not necessarily to represent that it's a bed

01:05:37.240 | at that location, but to represent the location itself.

01:05:40.180 | We also have neurons in our hippocampus

01:05:43.600 | and elsewhere in our brain, I should say,

01:05:45.680 | that represent proximity.

01:05:48.380 | So for instance, if you were to wake up

01:05:49.660 | in the middle of the night and walk into the kitchen

01:05:51.760 | and it's somewhat dark and you orient toward the sink

01:05:54.900 | to get yourself a glass of water or to the refrigerator

01:05:57.600 | to get yourself something to drink or to eat,

01:06:00.960 | as you get close to the sink or the refrigerator,

01:06:05.120 | there are neurons in your hippocampus

01:06:07.680 | that are going to start engaging electrical activity

01:06:10.760 | because you are in the mere expected proximity

01:06:14.080 | of the sink or refrigerator and you know where they are,

01:06:16.920 | hence the word expected.

01:06:18.940 | Now that all seems fine and good,

01:06:20.440 | you've got neurons that represent where things are

01:06:23.020 | and sort of goes without saying that those same neurons

01:06:27.160 | map to our emotional attachments.

01:06:29.520 | We generally know where to find our loved ones,

01:06:31.840 | even if they don't live with us,

01:06:33.520 | we generally know what city they're in.

01:06:35.800 | Even if they're traveling,

01:06:36.720 | we generally have a sense of where they're traveling

01:06:39.120 | or the general area in which they're traveling.

01:06:41.900 | Place cells and proximity cells are involved

01:06:43.920 | in that kind of mapping and representations as well.

01:06:46.960 | Now there's a third kind of cell

01:06:48.160 | that's particularly important for the sort of tool

01:06:50.960 | that we were talking about earlier,

01:06:52.420 | that tool of holding onto the emotional attachment

01:06:55.160 | to somebody and yet trying to deliberately remap

01:06:58.600 | our understanding of where they are in space and time.

01:07:02.040 | And that has to do with a category of cells

01:07:04.660 | called trace cells.

01:07:06.640 | Trace cells were discovered by a number of laboratories.

01:07:09.440 | I think the most renowned of those is the Moser Laboratory.

01:07:13.020 | The Mosers are a couple,

01:07:14.840 | actually they were a couple, they're now,

01:07:17.240 | I think amicably separated or divorced.

01:07:19.920 | That's not what this episode's about.

01:07:21.280 | If I have that wrong, forgive me.

01:07:24.160 | Edvard and Brittain are their names.

01:07:26.960 | Their relationship isn't what's important,

01:07:28.420 | except what is important is the work that they did together

01:07:32.420 | in one form or another,

01:07:33.320 | which was very important work establishing

01:07:36.080 | this category of cells in the, not just in the hippocampus,

01:07:38.700 | but in an area of the brain called the entorhinal cortex

01:07:40.700 | that act as a sort of coordinate system

01:07:43.080 | to orient us in space and time.

01:07:44.940 | Trace cells are activated when we expect something

01:07:50.860 | to be at a given location, but it's not there.

01:07:54.460 | Experiments done in their laboratory

01:07:56.700 | and in other laboratories have shown that, for instance,

01:08:00.460 | if you give a rodent or frankly a person,

01:08:04.840 | a object that always resides at the same location

01:08:08.140 | and we reach to it in order to access it,

01:08:12.700 | let's say where your coffee maker is in the morning.

01:08:16.360 | I do a pour over coffee.

01:08:18.420 | If I'm drinking coffee or mate, I'll do a pour over.

01:08:21.240 | It's always more or less in the same location.

01:08:23.980 | And so there are place cells and proximity cells

01:08:26.920 | that relate to my being able to find

01:08:28.460 | that pour over coffee cone thing.

01:08:31.320 | However, if I were to go to that location

01:08:34.760 | and it wasn't there, the trace cells,

01:08:38.560 | these neurons in my hippocampus

01:08:40.300 | and an entorhinal cortex and elsewhere,

01:08:42.400 | 'cause again, these cells are connected by way of circuitry,

01:08:44.680 | by way of connections, those trace cells would fire.

01:08:48.180 | We could even call it a trace circuit.

01:08:49.940 | It's a circuit that has an expectation

01:08:52.580 | that something will be in a location,

01:08:53.920 | but when something is not at that location,

01:08:56.620 | this circuit becomes active.

01:08:58.320 | This is important because what we're talking about here

01:09:00.260 | is a neural circuit and a set of neurons

01:09:02.920 | that are responsible not for the presence of something,

01:09:05.260 | but the absence of something.

01:09:07.360 | We have every reason to believe

01:09:10.100 | based on neuroimaging studies and studies in animal models

01:09:13.340 | that trace cells become very active in the immediate stage

01:09:17.580 | after the loss of a loved one,

01:09:19.380 | that the brain and our maps of the person, place, or thing

01:09:25.900 | that we know cognitively, we understand,

01:09:29.220 | we even believe they are gone.

01:09:31.840 | They are not accessible for whatever reason,

01:09:33.940 | death or otherwise.

01:09:35.580 | And yet we have neurons that are firing

01:09:37.900 | to reveal that absence to us.

01:09:41.420 | And these neurons are closely associated with neurons

01:09:46.140 | that tell us where things ought to be.

01:09:48.940 | So if you feel the expectation

01:09:51.380 | or you sense that somebody should walk through the door

01:09:53.940 | any moment or call at any moment

01:09:55.780 | or be next to you when you wake up,

01:09:57.620 | and yet you cognitively understand that they won't,

01:10:00.900 | that there's no real reason why they should

01:10:02.540 | because they are indeed gone, you are not crazy.

01:10:06.180 | In fact, it's simply a reflection of the normal functioning

01:10:11.180 | of these trace cells and trace circuits.

01:10:13.780 | Now I'd like to consider why two people,

01:10:16.060 | both who are intensely attached to a person

01:10:21.060 | that is no longer there, can experience the grief

01:10:25.060 | of the loss of that person in such different ways.

01:10:27.940 | This is often observed.

01:10:29.260 | You can have, God forbid, incredibly sadly,

01:10:33.600 | in cases where a child is lost,

01:10:35.520 | where both parents are grieving intensely,

01:10:38.760 | but one seems to feel it at a emotional depth and level

01:10:42.400 | that seems distinct from the other.

01:10:44.040 | Now, of course, keep in mind

01:10:46.260 | that we never really know how other people are feeling.

01:10:49.540 | This is something actually that was raised in the episode

01:10:52.600 | where I interviewed a psychiatrist

01:10:54.700 | and researcher colleague of mine from Stanford,

01:10:56.740 | Carl Deisseroth.

01:10:57.820 | As a psychiatrist, I heard him say once

01:11:02.440 | that we really don't know how other people feel.

01:11:04.820 | In fact, a lot of the times we don't even really know

01:11:06.600 | how we feel, or at least describing that

01:11:08.300 | is quite challenging with language often.

01:11:11.940 | And indeed that is the case.

01:11:13.020 | We don't really know how other people feel.

01:11:15.360 | There's no clear way of knowing

01:11:17.440 | that the expression someone else has

01:11:19.920 | or whether or not they're crying or not,

01:11:21.420 | or their body language really represents

01:11:23.700 | how they feel inside.

01:11:24.740 | So that is important to keep in mind.

01:11:27.120 | Nonetheless, there does seem to be

01:11:29.560 | a sort of a split among people,

01:11:32.740 | and indeed among animals as well, even within a species,

01:11:37.100 | in terms of how intensely they feel

01:11:39.360 | the yearning aspect of grief.

01:11:42.680 | And it appears based on a number of different lines

01:11:45.400 | of evidence that that relates to this molecule

01:11:47.960 | that some of you have probably heard of, which is oxytocin.

01:11:50.760 | Oxytocin is a hormone slash peptide.

01:11:54.200 | A peptide just means a protein, generally a small protein.

01:11:58.160 | And a hormone is generally something that functions

01:12:01.320 | at numerous locations in the body

01:12:02.860 | to impact numerous organs and areas of the brain.

01:12:05.740 | So a peptide can be a hormone and a hormone can be a peptide.

01:12:08.700 | They are not mutually exclusive.

01:12:10.260 | Oxytocin has a variety of roles in the brain and body.

01:12:13.740 | It's involved in milk letdown during lactation.

01:12:16.600 | It's involved in pair bonding, both in males and females.

01:12:19.820 | It's involved in bonding of parent to child

01:12:22.300 | and indeed between romantic partners, et cetera, et cetera.

01:12:27.300 | Let's talk about some of the animal models that inform us

01:12:30.100 | about the potential roles of oxytocin

01:12:31.900 | in the grieving process.

01:12:33.200 | There's a species of animal called the prairie vole.

01:12:37.180 | And believe it or not, the prairie vole

01:12:38.820 | has been studied fairly extensively

01:12:40.980 | by neuroscience and psychology researchers.

01:12:44.140 | In fact, our former director

01:12:45.840 | of the National Institutes of Mental Health, Tom Insel,

01:12:49.220 | his laboratory focused quite heavily on prairie voles.

01:12:52.780 | Prairie voles are one species of animal,

01:12:54.620 | but depending on where they live,

01:12:56.820 | you find that some prairie voles are monogamous.

01:12:59.900 | That is, they mate with the same prairie vole for life.

01:13:04.960 | They raise litters of little prairie voles for life.

01:13:09.140 | And other prairie voles generally

01:13:11.600 | that live in different locations in the wild

01:13:14.420 | are non-monogamous, sometimes called polygamous.

01:13:17.780 | The neurochemical and circuit basis

01:13:22.020 | for this monogamy versus non-monogamy are quite interesting.

01:13:25.980 | However, in the context of grief and attachment,

01:13:29.780 | the prairie voles have taught us a lot.

01:13:31.820 | And they've taught us a lot through the following experiment.

01:13:34.560 | Take two prairie voles that are coupled up.

01:13:37.100 | So these would be monogamous prairie voles

01:13:39.560 | that have established a couple-dom.

01:13:43.140 | I guess you would call that a prairie voledom, anyway.

01:13:46.860 | Put them in a cage together, they mate together,

01:13:48.900 | they raise young together, and then you separate them.

01:13:53.040 | You literally put a physical barrier

01:13:55.480 | between the two of them, and you can evaluate

01:13:58.580 | how strongly one prairie vole will work

01:14:02.140 | to get access to the other prairie vole, right?

01:14:04.920 | This is sort of the Romeo and Juliet

01:14:07.760 | of prairie vole experiments.

01:14:09.340 | And what you observe is that the monogamous prairie voles

01:14:13.840 | will work very hard to get back to their mate,

01:14:16.440 | to get access to their mate.

01:14:17.560 | They will lever press.

01:14:18.800 | They'll even walk across a metal plate

01:14:21.640 | that they get an electrical shock.

01:14:23.760 | They will work very, very hard.

01:14:25.440 | They will cross rivers and valleys, if you will,

01:14:28.100 | in the experimental context, that is.

01:14:32.000 | The polygamous prairie voles, and again,

01:14:36.400 | we don't know if they're polyamorous.

01:14:38.320 | We don't know what they feel, right?

01:14:40.040 | We don't know if they're in love

01:14:41.040 | or if they're motivated simply for other things,

01:14:43.900 | but the non-monogamous prairie voles

01:14:46.740 | will not work as hard to access a prairie vole partner.

01:14:51.740 | Now, you could argue that's because they expect

01:14:54.940 | that there will be other prairie vole partners,

01:14:56.500 | but even if they've never experienced

01:14:57.720 | another prairie vole partner,

01:14:59.180 | they won't work quite as hard to get back

01:15:02.080 | in connection with this other prairie vole,

01:15:04.800 | to mate or otherwise.

01:15:06.800 | This turns out to be interesting

01:15:08.640 | when you start to explore the patterns

01:15:10.920 | of so-called oxytocin receptors in the brain.

01:15:14.720 | To make a long story short,

01:15:15.960 | and to also bridge to the human literature,

01:15:18.200 | it turns out that the monogamous prairie voles

01:15:23.120 | have far more oxytocin receptors in this brain area

01:15:26.560 | that I mentioned earlier, the nucleus accumbens.

01:15:29.300 | And again, to remind you,

01:15:30.340 | the nucleus accumbens is the brain area

01:15:31.980 | associated with motivation, craving, and pursuit.

01:15:35.660 | So it's as if the monogamous prairie voles

01:15:39.020 | have a capacity to link the attachment circuitry

01:15:44.020 | and the molecules of attachment, in this case, oxytocin,

01:15:47.460 | to reward pathways and to motivational pathways.

01:15:51.820 | Polygamous, or we should say non-monogamous prairie voles,

01:15:55.000 | do as well.

01:15:56.800 | However, they have less oxytocin receptors.

01:15:59.740 | So in other words, non-monogamous prairie voles

01:16:03.300 | seem to have less yearning for attachment overall,

01:16:06.620 | at least to a single individual prairie vole.

01:16:09.620 | And when we look at the human literature

01:16:11.740 | in terms of oxytocin receptor expression

01:16:14.380 | and brain imaging experiments and so on,

01:16:17.380 | what you find is the same.

01:16:18.320 | The people that experience intense grief

01:16:20.980 | and a deep yearning and a motivation

01:16:24.100 | to reconnect with the person, animal, or thing that is lost,

01:16:28.760 | in many cases have heightened levels of oxytocin,

01:16:32.320 | specifically, or I should say oxytocin receptors

01:16:35.480 | to be exact, specifically within the brain regions

01:16:38.660 | associated with craving and pursuit.

01:16:41.520 | So for those of you that find yourself

01:16:43.140 | in this kind of stuck mode,

01:16:45.700 | this persistence of trying to reach into the past

01:16:49.620 | or wishful thinking, this counterfactual thinking,

01:16:53.900 | if only, if only, if only,

01:16:55.640 | you don't necessarily want to pathologize that thinking.

01:16:59.220 | First of all, we should acknowledge

01:17:01.100 | that it's not necessarily adaptive.

01:17:02.780 | And in fact, in the complete loss of somebody,

01:17:05.020 | or if somebody says they don't want anything to do with you

01:17:06.940 | ever again, by all means, if that's expressed clearly,

01:17:10.700 | then you need to accept that reality.

01:17:13.600 | But the yearning, the desire and the impulsivity,

01:17:17.140 | the kind of leaning in and at a almost reflexive way

01:17:21.660 | to try and access that person again,

01:17:23.240 | to text them, to want to hear from them could,

01:17:25.940 | and I have to highlight, could reflect the fact that

01:17:28.940 | you just so happen to have more oxytocin receptors

01:17:31.420 | or maybe more oxytocin overall in this brain area

01:17:35.260 | that's associated with motivation and pursuit.

01:17:38.360 | It does not necessarily mean that you are more capable

01:17:40.900 | of attachment than people who move through grief

01:17:44.000 | more quickly.

01:17:44.900 | And I should say that people move through grief

01:17:47.880 | at different rates, even if two people lost the same person

01:17:51.540 | or same animal, people move through this at different rates.

01:17:53.800 | And some of that is no doubt psychological,

01:17:56.880 | but some of it no doubt is also neurochemical

01:18:00.400 | and biological.

01:18:01.640 | And in sharing this with you,

01:18:02.860 | I hope it sheds some understanding

01:18:05.080 | and perhaps even some compassion for people

01:18:08.580 | who are moving through things more quickly

01:18:10.460 | or in a different way.

01:18:12.040 | And of course it should also, I would hope,

01:18:15.120 | shed compassion and understanding for people that seem

01:18:19.100 | incapable of "moving on."

01:18:21.400 | It's taking them far longer to move on.

01:18:24.100 | Earlier, we talked about complicated grief,

01:18:26.360 | non-complicated grief, and prolonged grief disorder.

01:18:29.340 | And I should say that the precise divisions

01:18:31.660 | between these categories is not very precise.

01:18:36.220 | It takes a really trained expert to be able to identify

01:18:39.080 | whether or not somebody is in the prolonged grief disorder

01:18:41.480 | category, complicated or non-complicated grief.

01:18:45.100 | There's actually a set of questionnaires that I invite you

01:18:48.000 | to answer if you like.

01:18:49.640 | They were provided, or I should say,

01:18:51.420 | I accessed them through a public site

01:18:54.080 | on Mary Frances O'Connor's webpage.

01:18:56.720 | We'll put them in the show note captions.

01:18:58.500 | You actually can submit those answers in an anonymous way

01:19:00.920 | to a study that she's doing.

01:19:02.780 | She has several surveys,

01:19:04.600 | one for loss of a romantic relationship,

01:19:07.360 | other for loss due to death of somebody,

01:19:11.240 | and still another one that relates to homesickness.

01:19:13.800 | And it's also available in several different languages.

01:19:15.960 | So I provide a link to that website.

01:19:18.240 | It's very easy to download.

01:19:19.200 | There's no cost to that at all.

01:19:20.680 | You can contribute to the scientific data collection process

01:19:23.680 | if you like.

01:19:24.520 | And I do believe that you get your scores back

01:19:26.760 | or an interpretation of your scores by participating there.

01:19:30.080 | When Mary Frances O'Connor hopefully comes on the podcast,

01:19:34.360 | she can tell us some more of the detail

01:19:36.000 | about separating out this prolonged grief disorder,

01:19:38.880 | complicated and non-complicated grief.

01:19:40.780 | But in the meantime,

01:19:42.560 | it's very clear that people move through grief

01:19:45.120 | at different rates.

01:19:46.380 | And as I mentioned just a moment ago,

01:19:48.200 | that this is entirely normal,

01:19:49.720 | probably has a basis in neurochemicals

01:19:52.360 | and hormones such as oxytocin.

01:19:54.920 | There are probably other reasons as well.

01:19:56.200 | In fact, we can assume with almost certainty

01:19:58.760 | that there are other reasons as well.

01:20:01.160 | Nonetheless, I think it is really important to think about

01:20:04.800 | why some people might have a harder time

01:20:06.720 | moving through grief due to life circumstance,

01:20:09.880 | innate differences, and so on.

01:20:13.000 | There's a very nice set of studies,

01:20:15.320 | but one in particular entitled

01:20:17.240 | "Catecholamine Predictors of Complicated Grief Outcomes."

01:20:20.960 | Here again, the first author is Mary Frances O'Connor

01:20:23.840 | reminding us that she's done so much important work

01:20:25.720 | in this area.

01:20:26.540 | This paper has several conclusions,

01:20:29.960 | but one of the key conclusions

01:20:32.000 | is that this particular category of molecules

01:20:33.800 | we call the catecholamines.

01:20:34.960 | The catecholamines include epinephrine,

01:20:37.320 | which is also adrenaline, norepinephrine,

01:20:39.360 | which is noradrenaline, and dopamine,

01:20:41.760 | which you've learned about before.

01:20:43.520 | Here I'm just going to paraphrase,

01:20:46.260 | or I'll read directly actually,

01:20:48.240 | what they found was that participants,

01:20:50.440 | again, this is human subjects,

01:20:51.840 | with the highest levels of epinephrine, of adrenaline,

01:20:54.760 | pretreatment had the highest levels

01:20:57.280 | of complicated grief symptoms post-treatment,

01:21:00.040 | and that could account for their baseline level of symptoms.

01:21:02.440 | What this means is that people

01:21:04.120 | that have a lot of circulating adrenaline,

01:21:05.880 | we might even call these people who are,

01:21:09.160 | or typically reside at a higher level of autonomic arousal,

01:21:13.080 | right, we have an autonomic nervous system

01:21:14.460 | that dictates how calm or alert or stressed

01:21:17.620 | we happen to be just at baseline.

01:21:19.260 | People who tend to be more alert and anxious at baseline

01:21:22.300 | prior to any grief episode tend to have,

01:21:25.780 | or statistically on average, we should say,

01:21:28.280 | are more likely to experience complicated grief

01:21:31.680 | and maybe even prolonged grief symptoms.

01:21:34.040 | So if you're somebody that is anticipating losing someone

01:21:38.740 | or an animal or a thing at some point,

01:21:40.320 | and I think that really means everybody,

01:21:42.880 | utilizing tools to adjust your epinephrine,

01:21:45.960 | your adrenaline levels down

01:21:47.940 | has a number of important benefits,

01:21:49.480 | improving sleep, health metrics, et cetera.

01:21:52.040 | There are tools to do that.

01:21:53.200 | We have an episode on mastering stress

01:21:55.140 | that you can find at our website, humorinlab.com.

01:21:58.240 | It has a lot of behavioral tools that are backed by science,

01:22:01.160 | some of work that was done in my laboratory,

01:22:02.920 | but certainly other laboratories as well

01:22:05.620 | that will allow you to control your autonomic nervous system

01:22:09.780 | both in real time and reduce the overall level of stress

01:22:13.720 | and even chronic activation

01:22:15.960 | of the so-called sympathetic arm

01:22:17.220 | of the autonomic nervous system,

01:22:18.280 | which is just fancy geek speak for saying,

01:22:20.500 | there are tools to help you be calm,

01:22:22.540 | not just for sake of navigating daily stress,

01:22:24.840 | but as this paper illustrates,

01:22:27.360 | for anticipating the fact that at some point

01:22:30.120 | you will lose somebody, an animal or a thing.

01:22:32.880 | And there is a way to move through that process

01:22:35.960 | that we call healthy, normal grieving.

01:22:37.840 | And then there's the so-called complicated grief

01:22:39.840 | or prolonged grief disorders

01:22:41.900 | that reflect immense challenge in moving through grief

01:22:45.760 | at a reasonable rate.

01:22:47.420 | So you can somewhat inoculate yourself

01:22:51.040 | against complicated or prolonged grief

01:22:53.280 | by reducing your resting levels of,

01:22:56.240 | or your pre-loss levels of epinephrine, of adrenaline.

01:23:00.400 | And again, there are excellent tools to do that.

01:23:02.320 | I won't review them here for sake of time,

01:23:03.880 | but they're timestamped and you can access those easily.

01:23:06.840 | Again, zero cost tools.

01:23:09.060 | Going back to this paper,

01:23:12.000 | catecholamine predictors of complicated grief

01:23:14.440 | treatment outcomes should say that not only did participants

01:23:18.520 | with the highest levels of adrenaline

01:23:19.900 | have the highest levels of complicated grief symptoms

01:23:22.280 | post-treatment,

01:23:23.400 | but the predictive relationship between these two things,

01:23:27.320 | adrenaline and complicated grief,

01:23:28.980 | was not seen in depression.

01:23:30.560 | And I find that incredibly interesting

01:23:32.400 | because it further separates depression from grieving

01:23:35.560 | and grieving from depression.

01:23:37.380 | A resounding theme again and again,

01:23:39.160 | grieving is not depression

01:23:40.360 | and depression is not necessarily grieving.

01:23:42.480 | They can coexist, but they are separable as well

01:23:45.920 | and indeed reflect separate brain circuitries entirely.

01:23:50.240 | So the conclusion they draw is that the present study

01:23:52.080 | supports the hypothesis that catecholamine levels,

01:23:54.280 | again, epinephrine, dopamine, norepinephrine,

01:23:56.480 | are the catecholamines, are affected by bereavement

01:23:58.800 | and in turn can affect the ability of those

01:24:01.200 | with complicated grief to benefit from psychotherapy.

01:24:03.880 | So what does all this mean?

01:24:04.720 | What this means is we can prepare ourselves

01:24:08.040 | to be in a better state to access,

01:24:11.320 | yes, access grief when it's appropriate.

01:24:14.060 | And indeed grief is the appropriate response

01:24:17.080 | when we lose someone, an animal or a thing

01:24:19.480 | that we are closely attached to.

01:24:21.200 | And yet to be able to move through that at a pace

01:24:25.640 | and in a way that is most adaptive for us.

01:24:29.280 | And to just, again, highlight what adaptive means,

01:24:31.660 | it does not mean dissociating from the attachment

01:24:34.400 | to the person, animal or thing.

01:24:36.000 | I just want to pause for a second

01:24:38.480 | and mention why I keep repeating person, animal or thing.

01:24:43.480 | I'm saying that because while grieving the loss of a person

01:24:49.160 | or a relationship with a person,

01:24:51.240 | doesn't have to be through death, of course,

01:24:53.040 | but death or otherwise,

01:24:55.120 | is something that we all can intuitively understand,

01:24:57.320 | even if we haven't experienced it.

01:24:59.760 | We are capable of achieving great attachments

01:25:03.080 | to animals as well.

01:25:04.920 | And while the loss of a thing of an object

01:25:07.760 | in no way, shape or form,

01:25:10.500 | approximately the loss of a person or an animal,

01:25:12.960 | I would never suggest that it does.

01:25:15.120 | It would also be naive and unfair of me

01:25:17.600 | or anyone else to suggest that things can't hold

01:25:19.880 | immense importance to us.

01:25:21.300 | And that the loss of them can feel quite significant

01:25:24.320 | and invoke the grieving process.

01:25:26.660 | This isn't always about materialism.

01:25:28.480 | Sometimes it's purely about the sentimental attachment.

01:25:31.400 | So for instance, the loss of a wedding ring

01:25:34.040 | or an engagement ring that was very meaningful to you,

01:25:36.840 | or an article of clothing or a painting,

01:25:39.800 | or even a small, seemingly an important object

01:25:43.320 | to somebody else,

01:25:44.140 | but something that held great meaning to you,

01:25:45.300 | maybe a seashell that you collected with somebody

01:25:48.080 | on the beach, and then somehow it gets lost.

01:25:51.040 | And it's the relationship with that person

01:25:53.620 | that's contained within that object for you

01:25:55.700 | as a representation within that object that's important.

01:25:59.600 | That's the reason why I keep saying person, animal,

01:26:02.540 | or thing.

01:26:03.380 | I think it's only fair to include things in that category.

01:26:06.120 | But of course, with the understanding

01:26:07.620 | that they don't hold the absolute same magnitude

01:26:11.260 | as the loss of a being.

01:26:13.160 | One thing that we ought to consider for a moment

01:26:15.160 | is whether or not the depth of attachment

01:26:18.360 | that you have to somebody predicts how long it will take

01:26:20.800 | for you to move through the loss of that person.

01:26:23.900 | We often hear this.

01:26:25.380 | Actually, I can remember some years ago,

01:26:27.560 | at the end of a relationship,

01:26:29.800 | a friend and colleague of mine saying,

01:26:32.200 | for every year that you were together,

01:26:34.860 | it's going to take you one month to get over that person.

01:26:38.100 | And I thought, well, where in the world

01:26:40.220 | do those data come from?

01:26:42.180 | And this is what I call anecdata or collective data,

01:26:45.200 | where this is like phrases such as,

01:26:48.080 | absence makes the heart grow fonder.

01:26:50.140 | And indeed sometimes absence can make the heart grow fonder

01:26:53.080 | in the context of two living people

01:26:55.280 | or people in a loving relationship,

01:26:57.220 | or even in the context of grief and loss.

01:26:59.600 | But of course, there's absence makes the heart grow fonder.

01:27:02.360 | And then you also will hear out of sight, out of mind.

01:27:05.280 | And if you've been listening to this episode,

01:27:08.160 | clearly out of sight does not mean out of mind

01:27:10.800 | or out of emotional connection.

01:27:13.600 | So these sayings of, well, it takes X number of months

01:27:16.680 | for a number of years, or out of sight, out of mind,

01:27:18.760 | your absence makes the heart grow fonder.

01:27:21.120 | They really don't hold a lot of meaning,

01:27:22.660 | at least not for somebody like me who likes science

01:27:25.300 | because science is at least geared toward

01:27:28.840 | or aims towards establishing things in fact, not opinion,

01:27:32.360 | but also because science allows you to make predictions.

01:27:35.900 | It allows you to orient yourself in a process

01:27:38.620 | and make predictions and understand.

01:27:41.200 | So what are we to think of people who seem very,

01:27:45.340 | very attached to somebody,

01:27:47.060 | they break up and they seem just crushed, devastated,

01:27:50.000 | but three weeks later,

01:27:50.840 | they're in a new relationship and they seem perfectly fine,

01:27:53.500 | or somebody whose spouse dies,

01:27:57.020 | and then suddenly they're in a new relationship.

01:27:59.340 | I think there are rates of transition, if you will,

01:28:02.260 | that suggests some dysfunction, pathology, et cetera.

01:28:06.500 | But here we aren't in a position to judge.

01:28:08.640 | We're only in a position to speculate about this.

01:28:11.360 | And I think we can reasonably speculate

01:28:14.000 | that it sort of makes sense

01:28:16.300 | why someone who has an intense attachment to somebody

01:28:20.260 | might be able to form a tense attachments generally, right?

01:28:24.160 | That they aren't restricted to one person,

01:28:25.500 | whereas other people who have an intense attachment

01:28:27.700 | to somebody might find themselves entirely incapable

01:28:30.540 | of moving on, or it would take them a very long time.

01:28:33.200 | Hence the lines in the Feynman letter to Arlene

01:28:36.300 | about he had met various other young women,

01:28:40.020 | they seem perfectly nice,

01:28:41.020 | and yet they were meaningless to him

01:28:43.660 | in the shadow of her memory,

01:28:46.440 | or we should say in the light of Arlene's memory

01:28:48.640 | or the memory of Arlene rather.

01:28:50.500 | So these dimensionalities of attachment,

01:28:54.500 | they cut in every direction.

01:28:56.500 | And I don't think any well-trained psychologist

01:28:59.420 | or neuroscientist would ever say,

01:29:01.220 | oh, if you are somebody who becomes very attached,

01:29:03.860 | therefore it's very hard to move on.

01:29:05.660 | I think that could be true.

01:29:06.580 | It could also be that if you're somebody

01:29:07.820 | who has a great capacity for attachment,

01:29:09.360 | you have a great capacity for attachment overall.

01:29:12.360 | Neuroscience nor psychology is really in a position

01:29:15.620 | to judge certainly,

01:29:17.100 | but it's also not in a position

01:29:18.580 | to make those kinds of predictions.

01:29:19.740 | At least the field as it stands right now

01:29:22.820 | of attachment and grieving,

01:29:25.180 | can't really speak to why that's the case.

01:29:27.360 | So that's my attempt to de-pathologize

01:29:30.020 | some of what we observe.

01:29:31.500 | Although I have to confess

01:29:33.520 | from a just sort of everyday stance

01:29:36.400 | that sometimes the rate in which people move

01:29:38.640 | out of attachments and grieving can be somewhat eerie.

01:29:42.160 | I'd like to take a moment and explore this idea

01:29:44.980 | that allowing ourselves to really feel the attachment

01:29:48.100 | to somebody can accelerate

01:29:50.020 | or at least support adaptive transitioning through grief.

01:29:53.580 | There's a really wonderful study

01:29:56.860 | that on the face of it appears to be a,

01:30:00.200 | what we call negative result.

01:30:01.860 | A negative result is when a hypothesis is posed

01:30:04.740 | and then turns out the hypothesis is not true.

01:30:07.660 | But as is the case

01:30:08.860 | with so many interesting scientific findings,

01:30:11.460 | often when there's a negative result,

01:30:13.960 | there's a more interesting result nested

01:30:15.840 | in that negative outcome.

01:30:17.260 | And this is the case in a particular paper

01:30:19.620 | I'll share with you now.

01:30:20.460 | There's a paper published

01:30:21.300 | in the journal biological psychology.

01:30:23.360 | And again, the title is posed as a question,

01:30:26.340 | which is emotional disclosure for whom?

01:30:29.700 | A study of vagal tone in bereavement.

01:30:32.500 | What this study explored was whether or not

01:30:35.640 | written disclosure of the emotional connection

01:30:38.120 | to somebody that was lost would be effective

01:30:41.420 | as a way for people to move through the grieving process.

01:30:45.380 | The study also explored the so-called vagus nerve.

01:30:49.320 | The vagus nerve is an extensive nerve pathway

01:30:51.860 | that is bi-directional between brain and body.

01:30:54.040 | So brain to body and body to brain.

01:30:56.540 | It generally is associated with calming effects

01:30:59.940 | on our brain and body,

01:31:00.900 | although that's certainly not always the case.

01:31:03.860 | The way to think about it in terms

01:31:05.220 | of what we're going to talk about now is heart rate

01:31:08.660 | and heart rate variability.

01:31:10.480 | And in very simplistic terms,

01:31:12.460 | if your heart was just allowed to beat

01:31:15.700 | at its sort of default rate,

01:31:17.980 | that rate would be rather high because of the activation

01:31:21.560 | of the so-called sympathetic arm

01:31:23.320 | of the autonomic nervous system,

01:31:24.500 | the alertness component of the autonomic nervous system.

01:31:28.600 | The parasympathetic nervous system as it's called

01:31:32.760 | involves calming.

01:31:33.760 | We sometimes hear sympathetic is for stress

01:31:36.100 | or fight or flight.

01:31:37.460 | It's for a lot of other things as well I should mention,

01:31:39.300 | and it is not for sympathy.

01:31:40.820 | Simpa simply means together,

01:31:42.100 | and it reflects the activity of a bunch of neurons

01:31:43.960 | being active at the same time or together, simpa.

01:31:47.280 | Whereas parasympathetic is often associated

01:31:49.840 | with quote unquote rest and digest functions

01:31:52.220 | or calming functions,

01:31:53.260 | although it is certainly involved in other things as well.

01:31:55.540 | So sympathetic nervous system drives alertness,

01:31:58.420 | panic, stress, et cetera.

01:32:00.800 | Parasympathetic nervous system,

01:32:02.080 | meaning a distinct set of neurons drive calming,

01:32:04.940 | falling asleep, digestion, sexual arousal for that matter,

01:32:09.860 | and so on.

01:32:10.920 | So you sort of like a seesaw of alertness and calm,

01:32:13.340 | alertness and calm,

01:32:14.180 | sympathetic and parasympathetic, back and forth.

01:32:16.740 | The vagus nerve is generally associated

01:32:19.160 | with parasympathetic functions

01:32:21.120 | and has the capacity to slow down our heart rate,

01:32:24.980 | in particular by exhales.

01:32:27.540 | And just simply because of the movement of the diaphragm

01:32:29.780 | and its relationship to the heart and the thoracic cavity,

01:32:32.460 | exhales result in slowing down of the heart rate.

01:32:36.360 | This is what we call an increased vagal tone.

01:32:41.160 | So let me explain for a moment.

01:32:43.140 | And actually here's a tool you can use,

01:32:44.400 | not just in terms of navigating grief,

01:32:46.240 | but in terms of stress modulation generally.

01:32:48.720 | We have a muscle called the diaphragm.

01:32:50.560 | When we inhale, whether or not it's through our mouth

01:32:53.680 | or nose, our diaphragm moves down.

01:32:56.440 | As a consequence, there is more space overall

01:32:59.740 | in the thoracic cavity.

01:33:01.040 | The heart gets a little bit bigger,

01:33:02.680 | believe it or not, volume-wise.

01:33:04.300 | Blood flows more slowly through that large volume.

01:33:08.800 | And there's a signal conveyed from the nervous system

01:33:11.420 | to the heart to speed the heart up.

01:33:13.460 | So inhales literally speed your heart up.

01:33:15.400 | And when you exhale, the diaphragm moves up.

01:33:19.560 | And as a consequence,

01:33:20.720 | there's less space in the thoracic cavity.

01:33:22.480 | Heart gets a little bit smaller.

01:33:24.860 | The existing blood volume in the heart at that time

01:33:26.780 | moves more quickly through that small volume, right?

01:33:28.960 | Given amount of blood volume,

01:33:30.180 | make the compartment it's in the heart smaller,

01:33:32.700 | and the blood moves more quickly through that volume.

01:33:35.040 | And as a consequence, the nervous system sends a signal

01:33:37.600 | to the heart via the vagus and other pathways

01:33:41.040 | to slow the heart down.

01:33:42.380 | In other words, exhale, slow the heart down.

01:33:44.560 | That process, that relationship between inhale,

01:33:47.200 | speeding the heart up, and exhale, slowing the heart down,

01:33:49.900 | is something called respiratory sinus arrhythmia.

01:33:52.660 | Some people are able to engage respiratory sinus arrhythmia

01:33:56.720 | more naturally, more reflexively than others.

01:33:59.080 | You can actually train this by consciously thinking

01:34:01.600 | about slowing your heart rate while you exhale

01:34:04.080 | and consciously thinking about increasing your heart rate

01:34:06.920 | as you inhale.

01:34:07.760 | You can literally strengthen these pathways.

01:34:10.240 | Now, respiratory sinus arrhythmia

01:34:13.160 | and the ability to slow your heart rate with exhales

01:34:16.680 | is one dimension of what's called vagal tone,

01:34:19.640 | or your ability to control your overall level

01:34:22.720 | of activation of alertness and stress

01:34:25.240 | with these vagus nerve pathways.

01:34:27.800 | So vagal tone is something that varies

01:34:29.600 | from person to person.

01:34:30.460 | If you've trained up or you've thought about

01:34:32.240 | your relationship between breath and heart rate,

01:34:34.160 | you can improve vagal tone.

01:34:36.320 | Some people have very robust vagal tone

01:34:39.400 | without having done any training.

01:34:40.720 | Other people have less of it, et cetera.

01:34:43.660 | I'll just paraphrase from this paper

01:34:46.040 | and you'll see where this takes us

01:34:47.440 | in terms of navigating grief, because it's quite important.

01:34:50.600 | The vagus nerve provides inhibitory regulatory influence

01:34:53.020 | on the heart, allowing the heart rate to increase rapidly

01:34:55.940 | through vagal withdrawal.

01:34:56.900 | That means kind of coming off the brake

01:34:59.120 | of the parasympathetic nervous system

01:35:00.980 | as in response to a stressor in one's environment, right?

01:35:03.900 | When you're stressed, you rarely take the opportunity,

01:35:06.600 | if it's an immediate stress or threat, to actively exhale.

01:35:09.900 | That would be a great tool to use.

01:35:11.140 | And in fact, we promote that tool

01:35:12.280 | in our Mastering Stress episode.

01:35:14.580 | Vagal withdrawal usually co-occurs with an increase

01:35:16.780 | in sympathetic activation of the heart.

01:35:18.220 | You now know what that is,

01:35:19.760 | or is known as the fight or flight response.

01:35:21.340 | Vagal tone reflects the degree to which there is tonic,

01:35:24.820 | meaning ongoing, vagal influence on the heart.

01:35:28.500 | So when you have a high degree of vagal tone,

01:35:32.060 | it means that you are always activating that brake

01:35:36.620 | on your stress system, just at default.

01:35:38.820 | And some people just happen to do that more.

01:35:40.260 | Other people need to practice long exhale breathing

01:35:42.660 | in order to build up vagal tone,

01:35:45.040 | something that's very useful to do,

01:35:46.960 | whether you're grieving or not.

01:35:48.860 | Now, in this study, what they did

01:35:50.240 | is they had people, and I should say it was 35 participants,

01:35:54.500 | go through a writing exercise for a period of weeks.

01:35:58.460 | They actually wrote about three times per week.

01:36:00.860 | Then there was a follow-up at some period of time.

01:36:02.920 | And then again, about a month later.

01:36:04.420 | And there were two different groups.

01:36:06.800 | One group was in the so-called written disclosure group.

01:36:09.860 | What they did is they, on day one,

01:36:12.300 | they would write about what happened when a loved one died.

01:36:16.180 | And indeed they used people who had experienced real loss.

01:36:19.500 | And so they were asked to talk about and write about

01:36:23.060 | their deepest emotions and thoughts about it,

01:36:25.820 | memories of their loved one.

01:36:26.860 | Very intense stuff, if you think about it,

01:36:28.660 | if they're in the immediate period of having lost someone.

01:36:31.580 | Then they actually were asked to write a letter

01:36:33.780 | to the person that they lost.

01:36:35.180 | So again, a very intense exercise to go through

01:36:39.060 | if you did indeed lose somebody as these subjects had.

01:36:42.180 | And then of course there was the testing

01:36:43.620 | some period of time later.

01:36:45.060 | And I'll tell you what that testing involved.

01:36:49.080 | The other group was a so-called control group

01:36:51.680 | where they were simply told to write

01:36:53.220 | about how they use their time.

01:36:54.520 | So an emotionally kind of empty writing exercise,

01:36:56.960 | if you will.

01:36:57.800 | They described what they would do today

01:36:59.040 | after they woke up, et cetera.

01:37:00.520 | No heavy emotional content and so on.

01:37:03.420 | Now, as I mentioned earlier,

01:37:05.880 | the immediate results of this study were a negative result,

01:37:09.680 | meaning no effect.

01:37:11.700 | The disclosure that we should say

01:37:13.240 | the emotionally intense writing group and the control group

01:37:15.740 | did not differ at baseline on any symptom measures

01:37:18.240 | or psychological variables they tell us.

01:37:20.300 | And at least at face value, somewhat disappointingly,

01:37:24.740 | there really wasn't any kind of difference in outcome

01:37:28.420 | between the group that wrote

01:37:30.080 | about a very emotionally intense stuff

01:37:31.920 | versus non-emotionally intense.

01:37:33.680 | Now, what I didn't tell you thus far

01:37:35.840 | is why they had them do this exercise at all.

01:37:38.480 | They had them do this exercise

01:37:39.760 | because many of the effective practices

01:37:41.760 | for moving through grief involve, as I mentioned earlier,

01:37:44.960 | getting close to and actually deliberately experiencing

01:37:49.840 | the attachment that one has to that person that was lost,

01:37:52.680 | not distracting oneself,

01:37:54.480 | not getting into this counterfactual thinking,

01:37:56.920 | the what if, what if, what if,

01:37:58.160 | but rather thinking about, or in this case,

01:38:00.420 | writing about the real attachment.

01:38:02.540 | And so the initial idea was

01:38:04.800 | if people write about this attachment,

01:38:06.480 | that they're going to experience this attachment

01:38:08.120 | and that will serve them in some or many ways

01:38:11.060 | in terms of moving through grief.

01:38:13.000 | And that wasn't what they found.

01:38:14.080 | They found no difference between the two groups

01:38:15.920 | until they explored who had higher vagal tone,

01:38:20.920 | who had a greater degree

01:38:23.160 | of so-called respiratory sinus arrhythmia.

01:38:25.520 | In other words, who was able to modulate their state

01:38:29.240 | using their breathing and their body.

01:38:31.220 | And what they discovered was that a subset of individuals

01:38:34.840 | who had a high degree of vagal tone

01:38:37.480 | seemed to get more benefit from this writing type exercise.

01:38:41.620 | Now, this is one study,

01:38:42.960 | and I would consider it fairly preliminary

01:38:45.340 | with 35 subjects, although, you know,

01:38:47.840 | it's a study unto itself and I think a quite nice one.

01:38:51.280 | And it really set the stage for a number of other studies

01:38:53.520 | that followed from this group and other groups

01:38:55.800 | that really point to the fact that yes, indeed,

01:38:58.640 | accessing these states of emotionality by writing

01:39:02.140 | or thinking about somebody is quite powerful

01:39:04.320 | in terms of engaging the bodily states

01:39:07.460 | and the mind states associated with the attachment.

01:39:09.560 | And that is very beneficial for moving through grief.

01:39:13.000 | That is very beneficial for sensing the attachment.

01:39:16.520 | And now it makes perfect sense as to why some people

01:39:19.420 | would benefit from that sort of practice more than others,

01:39:21.960 | because some people are able to access

01:39:24.300 | more real somatic feelings of attachment

01:39:27.720 | by writing about the attachment

01:39:29.120 | or by thinking about it than others.

01:39:31.080 | So this brings us back to an earlier discussion

01:39:33.260 | we were having where we were talking about

01:39:35.680 | how some people seem to move through things very quickly

01:39:37.920 | or don't seem to be grieving constantly.

01:39:40.080 | And, you know, a spouse or a family member of that person

01:39:42.840 | might think, gosh, why aren't you upset?

01:39:44.640 | How is it that you can be functional and I'm not?

01:39:46.860 | Or how is it that you can be functional?

01:39:48.120 | There can even be fractures in families and relationships

01:39:51.500 | on the basis of differences in rates of grieving and so on.

01:39:54.960 | Well, some of this, again, probably relates to psychology

01:39:57.800 | and the different attachments that people had

01:39:59.360 | to the person or animal or thing that was lost,

01:40:01.360 | but it no doubt also has to do

01:40:04.200 | with how much of a mind-body connection,

01:40:06.340 | how much of a vagal tone exists in the person

01:40:10.020 | when they suddenly found themselves in the grief episode.

01:40:13.500 | So this actually offers multiple opportunities.

01:40:15.780 | If you're somebody, for instance,

01:40:17.360 | who is grieving so intensely and so often

01:40:20.900 | that you're finding it immensely difficult

01:40:22.700 | to move through grief at a reasonable rate,

01:40:25.260 | and you might even say,

01:40:26.620 | or find yourself diagnosed with prolonged grief disorder

01:40:29.160 | or with complicated grief syndrome in a way

01:40:31.020 | that's really impairing your adaptive functioning in life,

01:40:35.840 | well, then it's not clear to me,

01:40:38.200 | at least by my read of the data,

01:40:39.960 | that you would want to engage in a lot of practices

01:40:43.040 | to increase the mind-body relationship

01:40:45.080 | and feeling so much of this attachment

01:40:46.880 | because you're already feeling an immense amount of it.

01:40:48.940 | Whereas other people who are feeling challenged

01:40:52.720 | in accessing the feelings of attachment

01:40:55.720 | and perhaps not functioning well as a consequence of that

01:40:59.320 | might find that practicing breathing

01:41:02.080 | in order to encourage respiratory signs of arrhythmia,

01:41:05.360 | again, focusing on slowing your heart rate consciously

01:41:08.320 | while you exhale and concentrating

01:41:10.360 | on increasing your heart rate as you inhale,

01:41:12.640 | even just as a brief practice

01:41:13.900 | of even just one to three minutes or one to five minutes

01:41:16.760 | every once in a while or per day,

01:41:18.580 | that could be immensely beneficial

01:41:19.960 | in building this mind-body relationship.

01:41:21.560 | Because again, what this paper really points to

01:41:23.680 | and set off a number of other investigations related to

01:41:26.960 | is that for those that can really feel the relationship

01:41:30.560 | between breathing, heart rate, what we call vagal tone,

01:41:34.040 | well, those people are going to be in a better position

01:41:37.320 | to move through grief,

01:41:38.160 | not because they are disengaging

01:41:40.460 | from the feelings of attachment,

01:41:42.000 | but because they are better able to access

01:41:44.280 | those feelings of attachment.

01:41:45.800 | So what this relates to, of course, is that tripartite map,

01:41:49.520 | that three-part map that we talked about earlier,

01:41:52.480 | that representation of space, where things are,

01:41:55.700 | where the person is, where their belongings are,

01:41:57.520 | where their car is, where their bicycle is,

01:41:59.780 | time, when you were expecting to see them

01:42:02.520 | on a regular basis, when they would call,

01:42:05.200 | when they would come home from work, et cetera,

01:42:07.540 | and that third node or that third dimension of attachment,

01:42:10.680 | which is literally attachment and closeness.

01:42:13.620 | Well, what we're talking about here

01:42:15.280 | is anchoring to that attachment

01:42:17.080 | and really feeling into that,

01:42:18.440 | but then disengaging from the space and time map

01:42:23.040 | that we call episodic memory,

01:42:24.480 | that menu of prior experiences

01:42:26.600 | that keeps us in many ways maladaptively

01:42:29.880 | in an expectation of what never can be again.

01:42:32.920 | Now I'd like to take a moment

01:42:33.840 | and consider some of the tools that you can access

01:42:36.940 | that support healthy transitioning through grief.

01:42:39.720 | And these are tools distinct from that neural map,

01:42:42.160 | that space, time, and closeness attachment map

01:42:44.400 | that we were talking about before.

01:42:46.120 | Rather, it's important to remind ourselves

01:42:48.440 | that everything exists in a context

01:42:52.080 | of our baseline physiology.

01:42:54.160 | And I'm certainly not going to be the first

01:42:56.160 | or the last to tell you that everything in life,

01:42:59.320 | learning, relationships with people that are still around,

01:43:02.360 | our health in every way, immune system, et cetera,

01:43:06.040 | function far better when we're sleeping really well

01:43:08.900 | and when we are generally awake during the daytime

01:43:12.160 | and asleep at night.

01:43:13.520 | I realize there are shift workers out there,

01:43:15.420 | people who are traveling and are jet lagged.

01:43:17.680 | First of all, thank you, shift workers, we rely on you.

01:43:20.640 | We have an episode all about jet lag and shift work for you

01:43:23.600 | and for trying to maintain the best possible mental

01:43:26.400 | and physical health in the face of ongoing shift work

01:43:28.780 | and jet lag, you can find that episode

01:43:30.480 | on our website, hubramlabs.com.

01:43:32.280 | Lots of behavioral tools, some other tools as well.

01:43:35.180 | Nonetheless, human beings are diurnal.

01:43:39.480 | We were really designed to be awake mostly in the day

01:43:42.640 | and asleep at night.

01:43:43.960 | There are rare exceptions to this

01:43:45.120 | where people like to stay up late and sleep in late,

01:43:46.840 | but we are a diurnal species by way of our genetic wiring

01:43:51.800 | and our neural circuit wiring.

01:43:54.560 | There's a particular feature to our diurnal,

01:43:57.320 | and diurnal meaning the opposite of nocturnal,

01:43:59.560 | our diurnal pattern of the release

01:44:02.740 | of a hormone called cortisol.

01:44:04.840 | Cortisol is a stress hormone, it's sometimes called,

01:44:07.660 | but cortisol has a lot of other effects,

01:44:09.940 | many of which are positive.

01:44:10.880 | Cortisol, for instance, protects us against infection.

01:44:14.100 | It can help us in terms of waking up in the morning.

01:44:17.140 | In fact, the pulse as it's called

01:44:19.500 | or the spike in cortisol early in the day

01:44:21.880 | is part of the reason we wake up.

01:44:23.240 | It's linked to our increase in temperature rhythms

01:44:26.220 | and can further increase our temperature,

01:44:29.000 | which leads to waking and so on.

01:44:30.600 | The typical pattern of cortisol in a healthy individual,

01:44:34.360 | and we really can say physically

01:44:36.380 | and emotionally healthy individual,

01:44:38.500 | is that cortisol is going to be somewhat high

01:44:41.360 | right around waking, and then is going to be highest

01:44:45.060 | as it ever will be in the 24 hour period,

01:44:47.540 | about 45 minutes post waking.

01:44:50.060 | Not exactly 45 minutes, but about 45 minutes.

01:44:52.780 | And then it will drop gradually

01:44:55.460 | such that by about 4 p.m. in the afternoon,

01:44:58.220 | which is actually when body temperature

01:45:00.180 | tends to start to drop as well,

01:45:02.340 | cortisol tends to be very low,

01:45:04.060 | and then remains low in a healthy individual,

01:45:07.160 | such that at 9 p.m. it's very low,

01:45:09.700 | and throughout the night as we sleep, it's very low.

01:45:12.020 | In fact, spikes or pulses in 9 p.m. cortisol

01:45:16.740 | are a fairly reliable biomarker readout

01:45:20.380 | of certain forms of depression and chronic anxiety.

01:45:23.100 | This relates to the beautiful work

01:45:24.540 | of my colleagues at Stanford

01:45:25.740 | and Stanford School of Medicine,

01:45:26.900 | Dr. David Spiegel, who's been on this podcast,

01:45:28.940 | and Dr. Robert Sapolsky, who has also been on this podcast.

01:45:33.460 | There's a very interesting paper

01:45:36.580 | exploring the relationship between cortisol rhythms

01:45:40.300 | and grieving, in particular,

01:45:42.260 | complicated versus non-complicated grieving.

01:45:44.500 | Again, complicated grieving being the form of grieving

01:45:46.380 | that reflects a immense challenge

01:45:49.460 | of people moving through the grieving process

01:45:51.020 | such that it really needs to be dealt with, right?

01:45:54.500 | Again, grieving is healthy,

01:45:55.740 | but complicated grieving is a prolonged grieving

01:45:58.160 | and has other dimensions as well,

01:45:59.620 | hence the name complicated.

01:46:00.900 | The title of this paper is

01:46:02.820 | diurnal cortisol in complicated and non-complicated grief,

01:46:06.540 | slope differences across the day.

01:46:09.100 | And the figure to orient to in this paper,

01:46:11.820 | if you do decide to check it out,

01:46:14.100 | and we'll put a link to it,

01:46:15.600 | is figure one, which beautifully shows,

01:46:19.220 | or I should say very clearly shows,

01:46:21.700 | that in individuals that are experiencing complicated grief,

01:46:26.140 | there's the same general contour

01:46:28.080 | of high cortisol upon waking,

01:46:30.080 | even higher about 45 minutes after waking,

01:46:32.620 | and then a reduction in cortisol by 4 p.m.

01:46:35.300 | and even further reduction by 9 p.m.,

01:46:37.280 | so just as it were in a typical individual

01:46:39.780 | or somebody who is in non-complicated grieving.

01:46:42.620 | However, when you compare the cortisol levels

01:46:45.340 | between people experiencing complicated grieving

01:46:48.020 | versus non-complicated grieving,

01:46:49.740 | what you find is the 4 p.m. and 9 p.m. cortisol levels

01:46:54.000 | are significantly higher

01:46:55.900 | than they are in the non-complicated grieving group.

01:46:59.580 | This raises a very interesting idea

01:47:02.020 | and relates very closely

01:47:03.500 | to what we were talking about with vagal tone.

01:47:06.120 | You could imagine a situation

01:47:07.660 | in which people who are experiencing complicated grief

01:47:11.380 | have higher levels of afternoon and nighttime cortisol

01:47:14.880 | because they are in complicated grief,

01:47:17.260 | but you could also imagine the opposite,

01:47:19.300 | that they're experiencing complicated grief

01:47:21.740 | because of the fact that they have elevated cortisol.

01:47:24.980 | Now, it's very likely that it's bi-directional,

01:47:27.820 | that the answer isn't one or the other, but both,

01:47:31.200 | that complicated grief changes patterns of cortisol

01:47:34.580 | and that patterns of cortisol change the likelihood

01:47:37.260 | that one has complicated grief.

01:47:39.860 | That's the most logical interpretation of data like these.

01:47:43.100 | However, when taken along with the data on vagal tone,

01:47:47.340 | that people who have a higher level of vagal tone

01:47:50.640 | are better able to navigate situations

01:47:54.460 | of the sort that we're talking about,

01:47:56.100 | and that some people perhaps have oxytocin receptors

01:48:00.020 | or patterns of catecholamines or epinephrine

01:48:02.740 | that position them to be more likely to grieve

01:48:04.760 | in a particular way,

01:48:06.020 | we arrive at a scenario where it makes very good sense

01:48:10.260 | to think about modulating,

01:48:12.220 | that is controlling the foundation of your life

01:48:15.200 | in a way that establishes cortisol rhythms

01:48:18.080 | and sleep patterns and patterns of autonomic arousal

01:48:21.120 | and catecholamine release that position you

01:48:23.900 | to navigate the grief process in the best possible way.

01:48:28.020 | If that was a complicated mouthful to digest,

01:48:30.400 | let me restate it in a simpler way.

01:48:32.840 | If you are somebody who is heading into grief

01:48:36.040 | or is challenged with grief, complicated grief or otherwise,

01:48:39.000 | prolonged grief or otherwise,

01:48:41.980 | getting adequate sleep at night

01:48:44.280 | and establishing as normal a pattern of cortisol as possible

01:48:49.280 | is going to be very important.

01:48:51.260 | And there's a very simple, straightforward way to do this.

01:48:53.620 | And I apologize to the listeners of this podcast in advance

01:48:56.180 | if I sound like a repeating record,

01:48:57.500 | but the most powerful way to do this

01:48:59.940 | is to view sunlight very close to waking.

01:49:03.980 | It does not have to be right at sunrise,

01:49:05.620 | but when you get up in the morning, if the sun isn't out,

01:49:09.500 | please turn on as many bright lights

01:49:11.980 | as possible in your environment.

01:49:14.100 | And then once the sun is out,

01:49:16.480 | try and get some bright sunlight in your eyes.

01:49:18.860 | Never look at any light so bright

01:49:21.260 | that it's painful to look at sunlight or otherwise.

01:49:23.980 | If you live in an area of the world

01:49:25.380 | where there isn't a lot of sunlight,

01:49:27.460 | please keep in mind that sunlight coming through cloud cover

01:49:29.660 | is going to still be a very effective mechanism

01:49:32.260 | for establishing this cortisol rhythm.

01:49:33.940 | Why do I say this thing about sunlight

01:49:35.260 | over and over and over again?

01:49:36.740 | Well, having an early day cortisol peak

01:49:39.700 | and a very low cortisol level late in the day,

01:49:43.820 | 4 p.m. and 9 p.m. is immensely beneficial.

01:49:47.340 | It reflects a properly regulated autonomic nervous system.

01:49:50.980 | It means being alert during the day

01:49:52.300 | and your ability to sleep at night is tightly correlated

01:49:55.320 | to this viewing of sunlight in the morning.

01:49:57.700 | If you have additional questions about this

01:49:59.680 | or these protocols, please see our Mastering Sleep episode

01:50:03.660 | also at hubermanlab.com.

01:50:04.980 | But in brief, you don't want to wear sunglasses

01:50:07.860 | when you do this.

01:50:08.700 | Do not want to do this through a window or a windshield.

01:50:11.780 | It is 50 times less effective at least

01:50:13.740 | because of filtering of the proper wavelengths.

01:50:15.760 | It is fine to wear eyeglasses,

01:50:18.140 | meaning corrective lenses or contacts,

01:50:19.780 | even if they have UV protection.

01:50:21.460 | Again, sunlight is best, 10 minutes to 30 minutes,

01:50:24.260 | depending on how bright it is outside

01:50:25.600 | and so on and so forth.

01:50:27.300 | I keep coming back to this protocol

01:50:28.740 | because first of all, it is a zero cost,

01:50:31.460 | but very effective way to regulate

01:50:35.220 | things like cortisol rhythms, melatonin rhythms,

01:50:37.400 | wakefulness during the day,

01:50:39.000 | ease of falling asleep at night and so on.

01:50:41.300 | And second of all,

01:50:42.280 | because I want to emphasize this idea of modulation.

01:50:46.000 | There are processes in our brain and body

01:50:48.020 | which directly mediate some psychological effect

01:50:51.300 | or physiological effect, right?

01:50:53.320 | Dopamine is directly involved in motivation.

01:50:55.960 | If you're somebody who struggles with motivation,

01:50:58.500 | your dopamine system is likely to be dysregulated

01:51:00.820 | in some way, and there are behavioral tools

01:51:02.300 | and other tools to adjust that.

01:51:03.880 | We had an episode on dopamine motivation and drive

01:51:06.240 | that talks extensively about those tools.

01:51:09.140 | However, the process of grief can't be distilled

01:51:12.740 | down to one molecule, one circuit such that we can say,

01:51:15.960 | oh, you know, take this supplement or eat this diet

01:51:18.540 | and or exercise in the following way,

01:51:20.840 | and you'll recover from grief more quickly.

01:51:23.540 | It's simply not the case.

01:51:24.900 | It is the case, however, that proper sleep at night

01:51:27.840 | sets the foundation for the proper emotional tone

01:51:32.220 | to be able to navigate physical, psychological,

01:51:35.680 | and other types of challenges.

01:51:36.940 | And not incidentally, sleep at night, I should say,

01:51:41.180 | sufficient duration and quality of sleep at night

01:51:43.860 | is the way in which you engage neuroplasticity,

01:51:46.180 | the reordering of neural connections.

01:51:47.980 | And everything we've been talking about today

01:51:50.460 | about reordering of the maps in your mind,

01:51:52.720 | this tripartite, three-part map of space, time,

01:51:54.880 | and closeness involves neuroplasticity,

01:51:57.580 | the reconfiguring of connections between neurons,

01:52:00.500 | strengthening certain pathways and not strengthening others,

01:52:03.540 | actively trying to disengage from the what if, right?

01:52:07.120 | This counterintuitive thinking,

01:52:08.320 | actively trying to disengage from the expectations

01:52:11.220 | that someone will be there.

01:52:12.640 | Although when you find yourself doing that,

01:52:14.200 | understanding why it's so reflexive and normal to do that,

01:52:18.400 | actively trying to lean into the real attachment

01:52:21.760 | to somebody, animal or thing.

01:52:24.280 | And yet at the same time, not deluding yourself

01:52:28.480 | and undermining the whole process of grieving

01:52:30.920 | by trying to imagine that they are in fact

01:52:32.760 | still truly there, right?

01:52:34.680 | It's a very narrow knife edge of a process,

01:52:38.240 | which is why it's so challenging.

01:52:40.400 | Regulating your cortisol rhythm

01:52:41.940 | through viewing sunlight early in the day.

01:52:44.280 | And I should also say avoiding bright lights

01:52:46.560 | from artificial sources in the evening,

01:52:49.360 | generally 10 p.m. to 4 a.m.,

01:52:51.040 | but certainly in the evening,

01:52:53.540 | trying to dim lights in your immediate environment,

01:52:56.020 | trying to avoid bright screens, bright artificial lights

01:52:58.920 | as much as possible, and accessing that deep sleep.

01:53:01.520 | That's modulating, it's setting an overall autonomic state

01:53:05.580 | or an overall autonomic landscape,

01:53:08.360 | would be the better way to describe it,

01:53:10.200 | that's going to allow you to sleep and get neuroplasticity,

01:53:12.600 | sleep and be in the best emotional state

01:53:14.340 | to navigate the grieving process,

01:53:15.780 | because it's only fair to say that the grieving process

01:53:19.240 | as we're describing it is hard,

01:53:21.720 | and not just because it's emotionally hard,

01:53:23.480 | it's cognitively hard.

01:53:24.960 | You just think about what's required

01:53:26.400 | to move through grief properly, if you will.

01:53:28.960 | It's thinking about and actually physically experiencing

01:53:33.560 | the depth, the full depth of the attachment to the person,

01:53:37.580 | while at the same time trying to uncouple

01:53:39.480 | from that rich menu, that catalog of episodic memories

01:53:44.040 | that can date back many, many years

01:53:45.680 | and have so much richness,

01:53:46.840 | so many predictions form on the basis

01:53:49.940 | of those episodic memories,

01:53:51.240 | and actively trying to distance ourselves

01:53:53.440 | from those memories by being very anchored

01:53:55.500 | in the fact that we are present,

01:53:56.760 | we are the person alone in that room,

01:53:58.720 | or in some cases with a bereavement group in that room,

01:54:02.280 | or with other people that are mourning the loss

01:54:04.440 | of that individual animal or thing.

01:54:06.760 | And that knife edge of feeling the intense attachment

01:54:11.760 | while also disengaging from all the things

01:54:14.920 | that led to that attachment,

01:54:17.080 | well, it's understandable why that would be so challenging.

01:54:20.080 | And it should also be understandable

01:54:22.520 | why positioning yourself to be able to do that

01:54:24.720 | in the best possible way requires proper sleep.

01:54:28.040 | So what are the tools that we can think about using

01:54:30.640 | in terms of healthy adaptive moving through grief,

01:54:33.440 | trying to avoid complicated grief

01:54:35.280 | and prolonged grief disorders?

01:54:38.480 | I realize that word disorder implies all sorts of things,

01:54:41.040 | but again, those are just naming categorizations

01:54:44.080 | that people come up with that I think fairly reflect

01:54:47.520 | the fact that some people have more challenge

01:54:49.720 | moving through grieving than others.

01:54:51.840 | And for some people, it can be very extended.

01:54:54.120 | I think the common misunderstanding

01:54:56.640 | is that proper grieving involves

01:54:59.700 | moving through something quickly.

01:55:01.080 | We're certainly not saying that.

01:55:03.400 | However, it is very clear that some people can get stuck.

01:55:07.160 | And that process of getting stuck,

01:55:09.280 | you should now understand has a lot to do with maintaining

01:55:13.560 | or reactivating those episodic memories,

01:55:15.720 | those expectations of where somebody

01:55:18.040 | will be in space and time.

01:55:19.460 | So what can we say about the tools for moving through grief?

01:55:23.480 | Clearly it's a value to dedicate some period of time,

01:55:27.320 | perhaps every day, perhaps every other day,

01:55:29.760 | depending on your capacity and schedule.

01:55:32.200 | These could be periods of time ranging anywhere

01:55:34.940 | from five to 45 minutes, maybe longer.

01:55:37.340 | These blocks of time would be appropriately described

01:55:42.280 | as rational grieving, right?

01:55:44.980 | Rational grieving is a clear acceptance of the new reality

01:55:49.200 | that the person, animal or thing no longer exists

01:55:51.780 | in the same space time dimensionality

01:55:54.000 | that we knew them before.

01:55:55.480 | And yet holding onto and anchoring

01:55:57.820 | to the attachment that we had.

01:56:00.120 | This is again, not an unhealthy anchoring to the attachment.

01:56:03.860 | This is really anchoring to the depth

01:56:05.820 | and the intensity of the attachment that existed

01:56:08.500 | as a way to, for lack of a better way to put it,

01:56:12.660 | push off from those episodic memories,

01:56:15.500 | to distance ourselves from them.

01:56:16.860 | Because those episodic memories are the ones

01:56:19.460 | that lead us to look for the person in our current reality.

01:56:22.840 | And assuming this is a real and complete loss,

01:56:25.480 | those sorts of expectations are maladaptive.

01:56:28.820 | They do not serve us well.

01:56:30.240 | The second aspect of this is to understand

01:56:33.480 | that the node of the map,

01:56:36.160 | the component of the neural map that you're anchoring to

01:56:40.160 | is a very real component of you.

01:56:41.700 | These are literally cells

01:56:42.760 | that represent the depth of attachment.

01:56:45.120 | They are linked up with your emotional centers in the brain.

01:56:47.480 | And indeed they're linked up with your body.

01:56:49.540 | I think one of the things that comes up so often

01:56:51.960 | when people are grieving is why does it hurt so much?

01:56:54.960 | Well, that hurt is that yearning.

01:56:57.600 | It's that anticipation of action that you want to engage in.

01:57:01.200 | But some part of you at least knows that it leads nowhere.

01:57:04.840 | It's that reaching for that glass of water

01:57:06.640 | in a kind of desert of thirst.

01:57:09.280 | And you know you can't have it.

01:57:11.020 | That's why it hurts so badly

01:57:12.120 | because the systems of your brain and body

01:57:14.400 | are in a place of anticipation of readiness.

01:57:17.440 | And given the activation of these brain reward systems

01:57:21.500 | like the nucleus accumbens,

01:57:22.960 | given your now understanding of oxytocin

01:57:25.400 | being more enriched in the, excuse me,

01:57:28.000 | in the nucleus accumbens of some individuals

01:57:31.420 | and as opposed to others,

01:57:33.320 | it should make perfect sense

01:57:34.320 | as to why it's so painful in your body.

01:57:37.480 | We talked a moment ago about the importance

01:57:39.120 | of accessing quality sleep on a regular basis,

01:57:42.320 | gave you at least one tool to do that.

01:57:43.960 | There again, a rich array of tools

01:57:46.160 | to do that in the Mastering Sleep episode.

01:57:48.440 | And again, highlighting the importance of sleep

01:57:51.240 | for not just emotion regulation and autonomic control,

01:57:54.840 | which is so vital,

01:57:55.680 | but also for making sure that neuroplasticity takes place.

01:57:58.420 | Because again, neuroplasticity is a two-part process.

01:58:00.680 | There's the triggering of the plasticity,

01:58:02.200 | which in the case of the things we're talking about today

01:58:04.920 | will be naturally activated by the practice

01:58:08.040 | of a dedicated focusing on the attachment,

01:58:10.360 | feeling the attachment to the person,

01:58:11.680 | maybe even writing about the attachment to the person

01:58:14.200 | as was described in that previous study.

01:58:16.400 | But also just the plasticity is triggered

01:58:19.200 | by the mere loss of that person,

01:58:21.740 | the intensity of that experience.

01:58:23.100 | But neuroplasticity, the literal rewiring of connections

01:58:26.260 | occurs during deep sleep

01:58:28.460 | and in what I call non-sleep deep rest or NSDR.

01:58:31.360 | And you can find NSDR scripts.

01:58:32.840 | These are short behavioral protocols

01:58:34.760 | that you do for 10 to 30 minutes

01:58:36.700 | at some point throughout the day,

01:58:37.740 | maybe even multiple times through the day

01:58:38.960 | that have been shown to accelerate neuroplasticity.

01:58:43.180 | So having such a practice can be very useful

01:58:45.640 | and understand that it involves some cognitive work.

01:58:48.880 | We have to hold onto the attachment

01:58:50.480 | and imagine and feel as much as we can the attachment

01:58:53.560 | while also being extremely rationally grounded

01:58:57.420 | and trying to not try to hold onto the past,

01:59:01.500 | trying to not anticipate the person walking in the room.

01:59:04.460 | This is very hard

01:59:05.480 | because when we think about the attachment,

01:59:07.600 | the attachment tends to drag with it

01:59:10.320 | those episodic memories, that rich catalog of experiences.

01:59:13.720 | The expectation that they walk in the room

01:59:15.640 | is perfectly natural.

01:59:17.300 | The hard cognitive work

01:59:19.180 | is to experience the deep emotional attachment

01:59:23.160 | while at the same time severing from

01:59:25.580 | or distancing ourselves from these expectations

01:59:28.860 | that they'll suddenly show up in our reality

01:59:30.700 | when in fact they won't.

01:59:32.180 | And we talked about preparing ourselves for grief.

01:59:36.720 | And if we have a loved one that's dying

01:59:39.300 | or we anticipate that at some point

01:59:41.360 | we are going to have a loss of some sort,

01:59:43.700 | could be death, could be a loss of another type,

01:59:46.100 | breakup, et cetera,

01:59:47.560 | that we can prepare ourselves to grieve more adaptively

01:59:51.460 | by regulating the level of catecholamines,

01:59:54.140 | in particular epinephrine.

01:59:55.660 | That was well-described

01:59:56.980 | in the study that I referred to earlier.

01:59:58.940 | And tools such as the one found

02:00:01.020 | in our Mastering Stress episode

02:00:02.580 | and tools of the sort that we talked about today,

02:00:05.300 | increasing that vagal tone

02:00:07.300 | by actively building up the relationship between exhales

02:00:11.000 | and slowing down of the heart rate,

02:00:13.060 | so-called respiratory sinus arrhythmia.

02:00:15.180 | Those things can be very useful tools.

02:00:16.740 | So we can actually encourage our nervous system

02:00:20.500 | and build our nervous system

02:00:21.780 | and build our mind to prepare for grief

02:00:23.820 | when it inevitably will come.

02:00:25.460 | Again, this is not about buffering ourselves

02:00:28.500 | from the realities of life.

02:00:29.700 | This is not about engaging from grief

02:00:33.400 | as a real and important process.

02:00:35.420 | And indeed it is a real and important process to engage in.

02:00:38.700 | Those that enter denial

02:00:40.900 | or trying to distract themselves with substances

02:00:43.820 | or thinking or distracting of behavior,

02:00:47.460 | substances or otherwise,

02:00:49.200 | won't move through grief as well,

02:00:50.980 | as adaptively as those who embrace a process

02:00:54.080 | of the sort that I'm describing here.

02:00:55.500 | And of course, I want to restate again

02:00:58.500 | that even though grief and depression

02:01:01.260 | are now known to be fundamentally different,

02:01:04.260 | even though people move through the different stages of grief

02:01:06.700 | at different rates and sometimes skip stages, et cetera,

02:01:09.980 | it is often important to access

02:01:11.720 | a trained professional psychologist or psychiatrist

02:01:13.900 | or both or bereavement group or all of the above

02:01:18.900 | in order to get the proper support for grieving.

02:01:21.620 | So this is a podcast about science and science-based tools,

02:01:26.620 | but I absolutely want to emphasize

02:01:29.580 | that there are terrific resources out there

02:01:31.980 | that you can access.

02:01:33.500 | I don't say this in any kind of glib

02:01:35.220 | or kind of pass the buck kind of way.

02:01:37.580 | There are wonderful trained therapists, bereavement groups,

02:01:41.940 | psychiatrists that are expert

02:01:45.720 | in navigating these sorts of things.

02:01:47.740 | I like to think that the tools that we've talked about today

02:01:50.700 | would be not only compatible,

02:01:52.580 | but would be complimentary

02:01:54.020 | to the sorts of approaches that they take.

02:01:56.280 | And as we think about this process of grief,

02:01:59.500 | as we all should at some point in our lives,

02:02:02.620 | because we all indeed will experience grief

02:02:04.560 | in one form or another,

02:02:05.820 | I would hope that the information that we discussed today

02:02:10.160 | would not only give you some tools,

02:02:13.120 | but hopefully give you a better understanding

02:02:14.980 | of not just the people that you've lost

02:02:17.520 | or that you stand to lose,

02:02:18.580 | not just the animals that you've lost and stand to lose,

02:02:21.800 | but also give you a sense of why it is

02:02:24.020 | that the people who are still in your life

02:02:26.360 | and that you're attached to,

02:02:27.200 | the animals that are still in your life

02:02:28.760 | that you're attached to have such profound meaning for you.

02:02:31.860 | And I would encourage you to not lean away from,

02:02:35.160 | but rather to lean into the building

02:02:37.260 | of those episodic memories,

02:02:39.260 | to build up a richer and richer set of experiences

02:02:42.740 | and emotional attachments.

02:02:44.620 | Because while the process of grieving

02:02:47.060 | is in direct relation to how close we are attached to people,

02:02:50.220 | there are ways to move through it.

02:02:51.940 | And of course it is the depth of our attachments

02:02:54.540 | and the number and the depth of meaning of experiences

02:02:57.220 | that we share with others and with animals

02:02:59.580 | that makes life so rich and worth living.

02:03:02.300 | So I just want to take a moment and say thank you

02:03:04.200 | for being willing to explore this rather complicated

02:03:07.940 | and sometimes extremely challenging thing that we call grief

02:03:11.740 | from the perspective or through the lens

02:03:13.580 | of neuroscience and psychology.

02:03:15.740 | I certainly learned a lot in exploring this literature.

02:03:18.260 | I also really look forward to hosting people

02:03:21.020 | like Dr. O'Connor on the podcast and others on the podcast

02:03:25.500 | who've done such beautiful work in this area.

02:03:27.980 | I've put out the request and hopefully they'll join us soon

02:03:30.140 | to further elaborate and teach us

02:03:32.420 | about this fundamental component of our lives.

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The Science & Process of Healing from Grief | Huberman Lab Podcast #74

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