for people of all ages, are there zero cost tools in the form of groups to help people grieve different types of grief? Because I think for some people it's like, I think we've all heard that the ultimate stressor is the loss of a child. And I can only think of one thing that might be equally stressful, if not more stressful, would be not knowing if your child is alive or dead.

That to me just seems like the ultimate form of agony. So presumably a bereavement group for that is very different than a bereavement group for someone who's really truly mourning the, I don't know, the separation from a spouse, right? Two different scales of grief, but it's hard to tell someone who's really grieving deeply, like your grief isn't as bad as someone else's grief.

So are there groups? And then I'll also ask the question I just asked, which is, why is it that knowing other people suffer too only provides mild support for grieving? Yeah. There's a fairly recent movement that we might call the public health model of bereavement support. And so the idea here is that, and this largely comes out of Europe, Canada, Australia, where they're trying to actually develop health care around bereavement.

Part of this is because we can talk about how we know that the physical cost of the loss of a loved one is so impactful on us, it can lead to dying of a heart attack, right? So we know that, for example, the day that a loved one dies, you are 21 times more likely to have a heart attack than any other day of your life.

21 times. And we know that in the first three months after the death of his wife, a man is nearly twice as likely to have a fatal heart attack compared to a man who remains married during that same time. Wow. Even if he has other support? Yes. Isn't that just crazy?

For women, it's about 1.8 times. So still just an astronomical number for medical risk. So what we know is this period of transformation is incredibly risky, right? So we can have all this physiological change, but if our body isn't resilient enough, where it actually breaks during that time, this is something we need to get ahead of.

So thinking about this public health model of bereavement, we can think of sort of at the foundation, even just understanding in a grief literacy kind of way, what can I expect? What is happening to me? Why is this happening to me? That is a psychoeducation level that is vitally important to people, regardless of sort of how much support they have.

Now, many people will go to bereavement support groups even just to get that, right? Even just to get good evidence-based information. Places that are no longer teaching the five stages of grieving, for example. And beyond that, we know how important support is. Social support, having loved ones around, just as you were describing.

And I think one of the reasons, I mean, imagine in that first seven days after your spouse dies, if there is someone in your house sitting Shiva, they are going to notice if you have a heart attack, right? So think about the idea that we might outsource our physiological regulation for a while.

Think of it this way. When we bond with someone, when you fall in love with your partner, say, for example, they become your external pacemaker, right? Think about co-regulation. If I go home now and I get a hug from my partner, just the way you were describing, I know that my blood pressure will drop a little bit.

My heart rate will drop a little bit. Now suddenly I have to imagine walking into an empty house where that's not going to happen. My cardiovascular system has to figure out how am I going to walk into my home again and again and again and regulate my heart rate.

And your brain is anticipating seeing the person that you lost. Yes, exactly. Like it doesn't, you can know, but the action systems, the go circuitry, if it were. All the subconscious processing, I should be, I'm doing the same motion of turning the key in the lock that I've always done.

And now there's a hole in the room when I enter it. And often it still smells like them. Absolutely. I think people really underestimate this thing about smell because it's operating at an unconscious level all the time. We're like bathing in somebody else's chemicals and then they're gone and then it starts dissipating.

But it's still there for a while. Absolutely. So I think recognizing your grieving body has to figure out how to regulate again is one reason why support is so important. There's a study of primates where, you know, as with other primates, there's a lot of infant mortality. And in this observational study, there are troops that are being observed by scientists.

And with the death of an infant primate, the mother will often carry that deceased infant, that baby monkey, for a long time after their death and spend a lot of time looking at the infant. The mother doesn't groom. She doesn't try to nurse. She's not confused that the infant is alive.

But what is interesting is she stops grooming herself during this time. Now, that's actually medically risky for a primate because we know that grooming is so important to their health to get rid of parasites and such. And, you know, usually in these troops, there's a really strict hierarchy. Who gets to groom who is, you know, the latest Kardashian show kind of thing.

And during this time, when the mother is trying to understand what's happened to this infant, the rules go out the window. Any member of the troop can groom this mother. Now, at some point, wide individual variation in how long the mother holds this infant from days to months. Once she relinquishes the infant, the rules go back into effect.

So she goes back to the troop and now she participates in social life, in medical social life, in the way that she did before. I think the analogy here, in addition to every time I think about it, it just rips my heart a little bit, right? But the idea here is that it is all of our jobs to groom the mourning person, to care for them, to say, hey, how long has it been since you saw your doctor for your regular checkup?

How long has it been since you had your mammogram or got your teeth cleaned, right? Often we've been caring for a loved one who's dying and we're neglecting our own medical care. Because here's the thing. Grief is the natural response. Our bodies are resilient. Many people are shocked by how much pain, physical pain, how they get a lump in their throat or they feel like their chest is on fire when they're grieving.

But actually our bodies are remarkably resilient. We do learn to re-regulate without this external pacemaker. But in those instances where the body isn't resilient enough to be able to do that, we need people around us supporting us. In a study in my own lab, we thought, well, probably this risk for a broken heart, this risk of dying of a heart attack, isn't, you know, 24-7 equally risky.

So we brought people into the lab and had them experience a wave of grief while they were hooked up to ECG and blood pressure and so forth. And what we saw was everybody's blood pressure goes up during a wave of grief. That's probably not too surprising. But what we saw was the people who, when they walked in the door, told us they were having the most intense grief, their blood pressure went up the most.

And then in a replication study in Germany, we saw that their blood pressure didn't recover. So you can see that these waves of grief that our body and our mind and our brain have to learn how to cope with and then eventually to adapt to. Those require a physical body that can sustain that.

They require relationships that can support us and sustain that. And this is why I think support is so important, even though it doesn't take away the pain of missing your person, right? Because we need every resource we can muster in the midst of this moment. Now, it does also mean that as much as we are missing our person and it feels so isolating to try and explain that there's a hole in the room when no one else can see that hole, it does help at some level to talk to this other person who is seeing a different hole in the room, who's also going through grief, because we recognize grieving is a human experience.

And that you're not connected because you both miss the same person, but you are connected because you're both missing, right? And so I think that bereavement support can be incredibly helpful to connect with others who are going through this same process. And frankly, I don't recommend and some bereavement support groups actually prohibit dating relationships from a grief support group.

But the reality is the people that we connect with are also people potentially that we develop stronger attachment bonds with. That's how community works, right? And so I think bereavement support can be incredibly important. We do know for the one out of 10 who develop a disordered grieving who really are not showing any changes over time, even though time is passing, those people might need a very specific evidence-based psychotherapy intervention because we know that those psychology interventions can get us back on a normal or typical grieving trajectory.

So,