The Slow Upward Spiral of Grief

Grief is often thought of as a psychological and emotional phenomenon. Yet loss also has a profound impact on our bodies, potentially impacting our cardiovascular, endocrine, and immune systems.

As a Professor of Clinical Psychology and Psychiatry at the University of Arizona, Mary-Frances O’Connor specializes in studying the physiological impact of grief. In her new book, The Grieving Body: How the Stress of Loss Can Be an Opportunity for Healing, she draws from her clinical research and her personal experience to explore the toll that loss takes on our bodies—and what this can teach us about care, compassion, and interdependence.

In a recent episode of Life As It Is, Tricycle’s editor-in-chief, James Shaheen, and meditation teacher Sharon Salzberg sat down with O’Connor to discuss how grieving can be thought of as a form of learning, how meditation can change how we show up for others, and the challenges of rediscovering a sense of purpose in the wake of loss.

Sharon Salzberg (SS): Your book focuses on how we experience the suffering of grief physiologically. So how can understanding grief as physiological help us support the people in our lives who are grieving?

Mary-Frances O’Connor (MO): We often forget that grief is physiological. We tend to think of grief as an emotion, and we think of people as reacting emotionally, or with their thoughts or behavior. But I think we forget that grief is also a bodily response, and I mean that quite literally in the sense that we know that, on average, blood pressure goes up a few millimeters of mercury for people in the first six months after a loss. We know that, on average, people’s cortisol levels increase, in addition to the many feelings that many people have of “Oh, I don’t feel like eating anything,” or “Gosh, I just cannot fall asleep now,” or “I wake up in the middle of the night.” These are also physical responses that are very common in grieving.

Remembering that grief is a physiological response helps us to remember to care for our body. Often when we’ve been caregiving for a loved one, all of our attention has been on the pharmacy trips and the questions for the doctor, but it’s also necessary to focus on your own physical health, to remember, “Oh, gosh, I haven’t made a mammogram appointment in more than a year,” or “I haven’t been to my regular doctor’s visit. I haven’t had blood work in forever.” By supporting the body, we provide that cushion for us to get through the learning curve. The body can help us to have those resources so that we can have waves of grief and not let them overwhelm us. That’s the primary way that I think about it: Can we care for the body as we’re going through this process? How can we be compassionate for this body that’s absorbing a blow?

SS: Drawing from your research, you identify two core responses to the loss of a loved one, which are protest and despair. Can you tell us about these responses?

MO: Listeners might know the work of attachment theorist John Bowlby, who was a British psychiatrist who studied orphans from World War II. He recognized two behavioral and physiological responses that infants had, and he named them protest and despair. What’s interesting is he paired up with a biologist who had seen these exact patterns of response in other animals.

I don’t know if you’ve ever been in a grocery store and you look down and your toddler is not next to your leg, or you were a child and you looked up and those were not your parents’ legs that you were next to, right? Imagine that feeling right now, that just sheer panic of, “Oh, what? They’re missing. They’re gone.” It’s a very energized feeling, isn’t it? You can physically feel what that’s like. Now imagine the difference in realizing they’re gone forever and that feeling of, “Oh, no, they’re gone,” and how different that feels physically, how withdrawn and hopeless that feels.

With these two responses, it’s not that we have one and then we have the other and then it’s over—this is a cycle as we learn. Every morning, a widow might wake up and think, “Oh, wait, my husband isn’t next to me in bed. Oh, that’s right, they’ve died.” This goes on over and over again as we’re learning: What does it mean? How can I understand the world now?

Protest and despair have different physiological responses, and that’s part of why we see such difficulty in physical functioning: It’s hard to digest your food or fall asleep when your body is responding to loss. What I find interesting is that although Bowlby was not a Buddhist, as it turns out, these responses remind me a lot of grasping and avoiding: the protest of “No, this hasn’t happened. This can’t be true. I’m not willing to believe that,” and also the clinging to despair of “This has happened, and it is central to every single thing in my life, and my life will never be different.”

Sometimes I say we can lend each other our hope: I don’t know what your life will look like in the future, but I know it will not look like this, and I’ll be here with you until we figure out what it will be like.

What is fortunate is that these responses are so universal, even across species, that in many ways our brain and body knows what it’s doing. So we may think of despair as a terrible, terrible thing, but despair resolves protest. You’re not going to go out looking for this person anymore if you truly understand that they’re gone. And when that happens, that can be with a moment of despair: “Oh no, they are truly gone.” And so I think supporting despair is important because it’s part of the learning process. But then despair leaves out hope. It leaves out the idea that “Yes, this will always be true, they’re not coming back, and at the same time my life won’t necessarily be like it is at this moment forever.” It’s often hard to grab that hope in the moment when you’re in the midst of despair. Sometimes I say we can lend each other our hope: I don’t know what your life will look like in the future, but I know it will not look like this, and I’ll be here with you until we figure out what it will be like.

James Shaheen (JS): Right, in addition to the stress of loss, you also discuss the stress of restoration—that is, the challenges of figuring out how to live a meaningful life without the person we’ve lost. So can you talk about that process?

MO: This is something that is often very meaningful for people: How can I carry forward the goals and values of this person who is no longer here? And so there may be a myriad of ways that we find meaning again in life given that we have this knowledge now that life is fragile and uncertain and precious. You know, we think about the stresses of loss around what it means that this has happened, and at the same time we talk about the restoration stressors: How do I live? How do I build? How do I find community again? What’s important is being able to go back and forth between them, not ignoring the loss but at the same time not ignoring the tasks that we have to do to restore our life now.

In grief research, we call this the dual process model, where we go back and forth between the stress of loss and the stress of restoration. I think when we understand how human beings before us have thought about and talked about and interpreted loss, that can be a resource in and of itself. Our ways of understanding meaning in life take time and change across our lifetime, but they are a resource as we try to cope with whatever comes our way.

JS: You mentioned meaning, and part of the restoration process is the rediscovery of a sense of purpose, which takes time and can’t be forced. That’s why it’s so difficult when you see somebody trying to push someone to get better. In fact, it’s a process. So can you say more about this rediscovery of a purposeful life?

MO: I’m really glad you said that, James. I’m talking about loss right now from a third-person perspective. As a scientist, I look for patterns across people. But each individual has to discover their own process. It can be helpful to understand studies of how has this happened in other situations, or on average what the patterns are. But it’s not the same as an individual who’s going through grief. It’s important to understand that this process will take however much time it takes, and in fact, there’s no end date. There’s no moment where grief is over. As human beings, we will have grief because we’ve had loss, and that will always be true. On the other hand, this also means that we become more familiar with what waves of grief are like. We become better at understanding how to manage them. And hopefully this sense of purpose is sort of a slow upward spiral. So it isn’t just time; it’s also about experience. You have to put yourself in new situations, knowing that they will be painful and knowing that you will need support. You have to go out to dinner with your couple friends and see what it’s like now that your spouse is gone, and the first time you go out to dinner, it may be truly awful, and you come home and you think, “That was awful. I just couldn’t stop thinking about my spouse. Why would I do that?” And then you do it again, and the second time you think, “That was awful. But that was an interesting book my friend mentioned at dinner. I should look into that.” The added piece of life around the grief that you have is this slow upward spiral of rediscovering purpose and meaning, and it takes great courage, as well as lots of support.

JS: Yeah, it was very helpful for me to read that. I remember thirty years ago, somebody told me when I was in the depths of grief, “It doesn’t go away, but it changes.” That was helpful. That was allowing for space there.

MO: You have to be honest with people, right? If you tell them it’s going to go away, they’re going to be disappointed. On the other hand, if you give the impression that it will always be like the pit of despair they’re in right now, that’s not accurate either. So trying to convey the nuances that it will never be like this again and also it will not go away is pretty complex. This is where I find the physiology to be quite useful as well. There’s a Native American tradition in some Native nations where people will cut their braid off when a loved one dies. I find the symbolism of that so moving of having an outward demonstration that you are a grieving person without having to say anything. But the other thing I love about that is just think about how long it takes your hair to grow. No one says to you, “Why isn’t your hair growing faster?” You know, that’s just a natural process. That is how the body does what it does. And to some degree, I think of grieving in the same way. It will take the time it will take in your individual life and experience.

This excerpt has been edited for length and clarity.