Grief In The Body: How To Use Loss As An Opportunity For Healing
27:19 Share

Forget frequently asked questions. Common sense, common knowledge, or Google. How about advice from a real genius? 95% of people in any profession are good enough to be qualified and licensed. 5% go above and beyond. They become very good at what they do, but only 0.1%.

are real geniuses. Richard Jacobs has made it his life's mission to find them for you. He hunts down and interviews geniuses in every field. Sleep science, cancer, stem cells, ketogenic diets, and more. Here come the geniuses. This is the Finding Genius Podcast with Richard Jacobs.

Hello, this is Richard Jacobs with the Finding Genius podcast. I guess today is Mary Frances O'Connor. We're going to talk about a new book she's come out with called The Grieving Body, Sympathetic Nervous System and Grieving. We just got a complimentary copy, which I had to get through. Just got it recently, but thank you, Mary Frances. She's also a professor of psychology at the University of Arizona. So we're going to talk about this interesting topic. So welcome, Mary Frances. Thank you. Thank you so much for having me.

Tell me a bit about your background and how you got involved with trying to understand grief. I think I've had this curiosity about how we understand the world around us for a very long time. And specifically, you know, when we have something that feels sort of intangible, like emotions or relationships,

How does our brain understand that? But then also, how do we react when there's a shift in that? So how does our body react when a loved one has died?

is just a, I mean, it's a mysterious process, isn't it? But I think in addition, I've wondered how we might help people who are going through this process by understanding not just what they're experiencing, but why and how. And that's led me to doing, you know, 25 years now of research on the immune system and cardiovascular system as people are grieving.

Well, how have you done that? Have you instrumented them and then they get told bad news or how do you know? So I do a variety of different methods in my studies, but usually I have people participate in the studies when they've experienced the death of a loved one. So sometimes I learn about them through bereavement support groups. I have some strong relationships with hospices in Tucson, Arizona, where the University of Arizona is. And

And when people participate, it really depends what study they're in, but they are generous enough to let us sometimes take blood or to measure their heart rate and blood pressure while we're having a conversation with them, while they experience, say, a wave of grief, to figure out how the body is reacting. Okay, so what have you observed? What have you seen? Is it a person that's suffering themselves or is it family members that you're looking at?

So I'm looking at a person who is grieving themselves. And when they are going through that process, there are studies that come out of my own lab that show that, for example, when we're having a wave of grief, that our blood pressure and heart rate do in fact increase. And although that

might not sound terribly surprising. It increases as though we were doing moderate exercise, which, you know, we're just sitting having a conversation. So that's pretty interesting. But in addition to that, what we see is that it's the people who are struggling the most sort of day-to-day that are having the most grief intensity day-to-day. When they are having this wave of grief in our laboratory, their blood pressure actually goes up the most. And the reason that's important is

is because we know from other research, from really large data sets, that there is such a thing as the broken heart, that in fact people are at risk for heart attack and stroke after the death of a loved one. So by understanding that

during a wave of grief might be a time when they are most at risk because of the reactivity in their cardiovascular system. That can help us to understand better how to support people because the waves of grief are going to happen and they help us to understand what's going on emotionally. So we have to figure out how do we support their body emotionally?

while they are absorbing this new reality they're living in. Okay. So, I mean, how much does the heart rate go up? How much does the cardiovascular system get stressed? Are you able to quantify it?

We are able to quantify it. There's a paper out in a journal last year where we did just that. And I can't tell you the figure off the top of my head, but it's something around 10 millimeters of mercury. So blood pressure going up 10 points. I could get you a specific number, but that's approximately where it's at. And we

And we know... Systolic or diastolic or both? And what was the application? Mostly systolic. We see some movement in diastolic, but that's a number that doesn't move as rapidly as systolic blood pressure.

And so what we know about that is from other studies, there's some wonderful work in Australia showing also that 24-hour heart rate monitoring demonstrates increases in blood pressure and heart rate. And what's notable about that is they're studying very early within the first couple of weeks after a death and then measuring again at six months. And by six months, we see that that heart rate and blood pressure goes back down to the sort of

average for a matched sample of, say, married people. So we can think of the idea that that first acute grieving period is particularly risky for the cardiovascular response. I mean, the initial period. Exactly. That first six months is especially risky. So, for example, from large epidemiological studies, we know in the first three months that

that a man whose wife has died is almost twice as likely to suffer a fatal heart attack compared to a man who remains married during that same time. And that's, you know, in medical risk, that's a huge statistic to be twice as likely for something to happen. So what do you do about it then? This is exactly the question I'm so glad you asked. So we've had this data knowing that this is a time of increased medical risk

for decades. And there has not been much of an attempt to think about, well, if we know across a population that acute bereavement is a time of increased risk, what are we doing about it? And so we can think about a host of ideas of what we might do about it. Very few have been studied. But as one example, there was a study in my lab at

that looked at doing mindfulness meditation or progressive muscle relaxation. So progressive muscle relaxation is just like a structured way to do kind of a body scan where you contract and relax your muscles. And what we found was that

By focusing in on this aspect of relaxation, we actually saw improvement in the widows and widowers who were participating in that intervention. But I think it's more a shift in our mindset. It means that when someone dies in the hospital or in the ICU or in the emergency department, we know that the person standing next to them

has suddenly become at medical risk. And so the question is, how do we approach thinking about buffering them from that risk? Does that mean better follow-up? Does that mean more regular checkups on our bereaved folks in society?

ways to think about that are still really in early days. So no one has an idea of what to do or what kind of interventions work and what does work mean? That's exactly right. Those are the scientific questions we need to be asking. Not just is this happening, but given we know that it's happening, what is the evidence base for what will work now? We don't have that evidence yet. Who's doing a study? Anybody or not?

Yes, there are people doing studies. Not very many. There was a study in Australia that looked at acute bereavement, and it was a very small study, but it looked at the idea of giving an aspirin, giving a beta blocker, just during that initial risky period to

to try and, yeah, mitigate the risk. And of course, they found their cardiovascular health improved during that time. But it was a very small study. It would be important to replicate that in a much larger sample if that was something we wanted to, you know, roll out more widely. What's your role in all this? What's your goal? How do you help to intervene and help people?

So continuing to do studies that look at the mechanisms of what is happening. One mechanism that I think hasn't been talked about nearly enough, but we have some studies that examine this, is that it may be the fact that multiple losses are, especially multiple losses close in time, create a particular kind of stress for the body. So there's a study published

out of Emory University that was a large longitudinal study. And it found that when you had women, Black women who had experienced three or more losses, that they actually showed greater thickness in their arteries than either the

those who showed less than three losses during this time or compared to white women. And so we have this situation where the context in which loss happens matters as well. When loss is one of many stresses that we're experiencing, that can start to accumulate in the body, something we call the weathering hypothesis. And we saw this a lot during COVID, where people actually

had multiple deaths in a fairly short period of time, making greater medical burden for them. Okay, so it makes sense, right? If you have more trauma, then you'd be more traumatized. But what are some of the suggestions on how to help people besides just giving them a pill? What about counseling? I mean, exercise? What do you do for these people?

Before we continue, I've been personally funding the Finding Genius Podcast for four and a half years now, which has led to 2,700 plus interviews of clinicians, researchers, scientists, CEOs, and other amazing people who are working to advance science and improve our lives and our world. Even though this podcast gets 100,000 plus downloads a month, we need your help to reach hundreds of thousands more worldwide. Please visit findinggeniuspodcast.com and click on support us. We have three levels of membership. For

from $10 to $49 a month, including perks such as the ability to see ahead in our interview calendar and ask questions of upcoming guests, transcripts of podcasts you're interested in, the ability to request specific topics or guests, and more. Visit FindingGeniusPodcast.com and click support us today. Now back to the show.

So this is one of the reasons that we were so interested in that mindfulness and muscle relaxation intervention, because we thought, what are some ways to approach this at multiple levels? Right. And so what's unclear, many of the studies that are done on the physical outcomes in grieving are

are different from the studies that are looking at the psychological outcomes of grieving. So one of the things I like to do is bring these researchers together and try to do studies that include both. So we know that people also feel better emotionally when they're getting exercise, when they have other coping mechanisms.

strategies for waves of grief, for understanding this new difficult world where their loved one is missing, not missing, has died. And so while we know that psychologically that toolkit of strategies is useful, we don't really know yet what is the physical outcome of those types of interventions or changes people might make. Are you, so you think you had a meta-analysis of the existing studies would help or what would

what would move this forward in terms of understanding and helping people? Unfortunately, we have too few studies yet to do something like a meta-analysis. So I think right now what we're hoping for is larger studies where we're focused in on some of these mechanisms. So a longitudinal study that looks at both the physical functioning of the grieving person across

many months and the emotional health of the person across many months. By being able to bring those pieces of data together in a large longitudinal data set, we would get a much better causal picture. Does our physical health improve first and then our emotional health improves? Is it the other way around that once we start to have

less intense and frequent waves of grief that we see changes in the cardiovascular system? We don't really know. And so a larger study like that would very much be important for the field.

Okay. So what seems to be the effect of the grief? It's literally killing these people, or is it shortening their lifespan, or is it leading to, you know, like large-scale medical intervention? Like what is the, you know, what is the result of the grief, and what is it preferentially affecting in their bodies? That's an interesting question. What we know from research is that bereavement increases the risk of what we call all-cause mortality. So

So actually across many different types of medical fatalities and medical morbidity, we actually see increased risk. So it is also bereaved people are also at increased risk for flu and pneumonia, for example. They are at increased risk

for recurrence of cancer. They're at increased risk for, in some studies, for autoimmune disorders. So when I started thinking about that as a researcher, I thought, well, how could this be? How could it be that something like this is affecting all of these different organ systems? And so I became very interested in the

the impact on our stress hormones and immune system. Because, of course, hormones and inflammation in the immune system affect all of the organs, right? They're going to exacerbate any pre-existing weaknesses that might exist in the body. And in fact, research from my lab and now research from other labs on even larger samples has found that inflammation is increased in bereaved people on average. And superpowers

And so the idea that inflammation is important in heart health, but of course it's important in many, many illnesses, made a little more sense that if that's one pathway through which this stress is getting under the skin, then that's one way to prevent it.

think about why we might get increased risk in all these different medical categories. What about leading up to a catastrophic event? You know, is there much study there or the stress doesn't just magically start when they pass away, I would think. That's absolutely right. So we know that caregiving in and of itself is very physically taxing for caregivers. And we do see that in changes in the immune system and changes in stress hormones.

We see that the stresses are a little bit different from each other, obviously. Caregiving, there's a large demand on time and resources. And part of what is a challenge is transitioning from living a life as a caregiver where there's a lot to do, there's a lot to manage, but you're really providing meaningful care day to day to a

a moment suddenly where you have just as much care to offer, but your loved one is no longer alive. So there's a complete shift in just your daily activities. Everything about your day-to-day life has shifted when you're not then caring for a person. And frequently, caregivers' social circles have shrunk quite a bit because they didn't have a

as much time to put into friendships and relationships. And we know that social support is so important in bereavement. So this is a moment where now suddenly your social circle has shrunk and you're in a situation where social support is really important. So this shift from being a caregiver to being a bereaved person can be very challenging for people. I mean, is there anything in the medical system there to help people at this point? Or is it just, you know,

do whatever you can on your own, go find counseling, you're lucky. Right. Hospices, hospice programs have a requirement to provide 13 months of bereavement support for anyone who had a family member die in the hospice program. This is an excellent, very foresighted thing that went into the hospice legislation specifically around Medicaid, Medicare, this 13-month requirement.

Unfortunately, that can be very widely interpreted. So sending out letters every couple of months to bereaved people can sometimes be the extent of the support that is provided. And many people will not find that to be enough support. So

So fortunately, there are many good hospice programs that offer bereavement counseling and even sort of group counseling where people can come together with other people going through the same bereavement stresses that they are or related bereavement stresses. Everyone has a different grief experience. But by bringing people together, it sort of normalizes the experience of loss and can also educate people about

What do we typically expect during grieving and how to reach out for support? And some of the strategies that bereaved people are using to navigate those waves of grief is something that gets shared then across people. So many people find bereavement support groups to be useful. Not everyone responds to them. Not everyone really understands.

likes that type of support, but they are effective for many people. Well, what makes those groups work or not? Do you have to have the same type of bereavement, like for the same cause, like cancer, or the same relationship, meaning, you know, people that have lost a parent versus lost a spouse? Like, what seems to work to have enough familiarity between the group members that they help each other more? Yeah.

That is a great question. Anecdotally, we often try to put people in bereavement support groups who do have similarities, either the type of loss or the type of relationship, right? So loss of a parent versus loss of a child, those look kind of different in people's lived experience. But what we know from research, at least, the research that has been done, is there are a couple of characteristics there.

that increase the likelihood of good outcomes for participants. And those include having what's called a closed group, meaning some support groups, grief support groups are what we call drop-in groups, where it's a different group of people week to week.

So you're not necessarily seeing the same people over time. With a closed group, and another characteristic that seems to be helpful is a time-limited group. So for example, you might say, we're going to do a six-week group and sign up here. It'll be, you know, the same 10 people or however many for that six weeks. So you sort of build relationships. You come to understand each other's experience and build trust, I think, within the group. And then having the group led by

by someone who has some training. Now, that doesn't mean a psychologist, but someone who has some training in grief education specifically. So that could be a pastor, that could be a nurse, that could be a social worker, chaplain. The sort of title doesn't matter. But what does seem to matter is that they have some training when they're facilitating these time-limited closed groups. So in grief training, I mean, what does that do for people? What do they learn and how does it help them to help other people

Unfortunately, in many of our helping professions, there is not grief training. So I'm trained as a clinical psychologist, and there was actually no training about what grief would look like, what is the typical course that we expect, what are the mechanisms that maintain grief versus those that seem to help people navigate this experience. So I

That is also true. Most social workers or psychiatrists and general practitioner doctors very rarely get any education at all or get, you know, a brief lecture or part of a lecture. So I think this is something we're recognizing is problematic. There is a scientific literature on grief, grieving and providing, you know, evidence-based support. So my hope is that

As that research grows, as programs like this sort of disseminate the fact that there's a growing field of grief research, that training will improve in those areas for those types of clinicians. Hopefully it won't be like the beatings will continue until more alum grooves.

Let's hope not. It just doesn't, I don't know, it's just odd that, how can people that deal with this every day have no tools to help people in the mainstream? It just doesn't make sense. I agree. All right, what were you working to accomplish with your book? Did it just shine a spotlight on all of this, or was there some other reason? This was definitely my experience, that even though I, day to day, am doing and am reading all sorts of studies about,

about grief and grieving, I recognized that the message wasn't getting out. No one really understood that grief research was being done. And although I can, you know, cite statistics for you and so forth, that people didn't know how to get a hold of that information that might help them to manage their own situation differently, that might help them to work with clients differently. And so it really was a desire to...

put what I know into the hands of people who could really use it. And hopefully the book, also by using many stories and some personal experiences, allows people to

understand why this information would matter, right? So it's one thing to have a bunch of facts. It's very different to understand, oh, if people knew that, then this outcome might look different or this person might make different decisions or choices. So really hoping to, yeah, get the book into the hands of grieving people so they can learn...

at least what we know scientifically, sort of on average in studies to help them make decisions in their own life. So what's, I mean, is anyone coming up with kind of a comprehensive program for people or how is this going to evolve and look over time? There are some programs that exist. So one of the most longstanding programs is at Columbia University,

And if people are interested, you could Google prolonged grief and Columbia University and it would pop up. There's a center there run by Dr. Kathy Shear, and they have been doing research on evidence-based interventions in prolonged grief now for a couple of decades. And what's great about that is those research studies then give us what intervention is working and for whom and how

And then what are things that we can do to improve those interventions? The other reason that particular center is so wonderful is that they then also train clinicians of all different stripes in providing prolonged grief therapy as well. So there are quite a few programs around the country that do train bereavement counselors.

But this one is in particular very, very well, well organized and long standing. So they have three national institutions of health funded studies, large studies that have come out using that intervention. Okay.

Very good. Where can people find resources in the current state of the art? It doesn't sound very far advanced, but what kind of resources can people find if they've been told they have cancer or family members sick or they're entering this process or they've been thrust into it, someone's passed, etc.? The SAMHSA is the acronym. So SAMHSA is the Substance Abuse and Mental Health Agency.

part of our federal government, they have begun a website with good resources available on it. So SAMHSA, and if you Google that, you know, with grief or grieving, there's now a set of web pages that have some good handouts and articles. There's another website called What's Your Grief?

That has quite a wide range of resources that many people find useful. There are quite a number of good resources, but you want to find one where it looks like it's being really actively updated because this research is coming out all the time. And so understanding what's the most recent understanding is most helpful. Okay.

So Samson would be good. Then your book, is it more for people that are experienced with the grief or is it a newer thing to them? Like what's your recommendation there? Both of the books, I think, resonate with people in different moments. It isn't necessarily, I mean, I don't imagine it's the first book I would necessarily read right after I've had a loss, but other people have told me that they did read it then and that it was very useful to them. So I think it

You know, the thing with reading books about grieving, there's such a wide range of them. I think getting, you know, friends who have had loss tell me, I have a stack of books and I'll open one and read for a little while and I think I'm going to throw it across the room. And then the next book I open actually makes a lot of sense to me. But then six months later, I go back to that first book and I realize, gosh, this makes sense to me now. So I think it's really about finding what resonates for the person as they go through the process.

Okay. Maybe a guide in the beginning of the book or something, you know, on where you're at. But all right. Well, very good. Yeah. Thank you, Mary, for instance, for coming and for explaining all this. And it seems like it's an area that needs a ton of work and it would be very helpful to people. So I hope that, you know, researchers really get on it and come up with some efficacious stuff. Great. Rich, thank you so much for bringing this to people. No problem. If you like this podcast, please click the link in the description to subscribe and review us on iTunes.

You've been listening to the Finding Genius Podcast with Richard Jacobs.

If you like what you hear, be sure to review and subscribe to the Finding Genius Podcast on iTunes or wherever you listen to podcasts. And want to be smarter than everybody else? Become a premium member at FindingGeniusPodcast.com. This podcast is for information only. No advice of any kind is being given. Any action you take or don't take as a result of listening is your sole responsibility. Consult professionals when advice is needed.