Healing From Grief & Loss | Dr. Mary-Frances O'Connor

Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday [Music] life. I'm Andrew Huberman and I'm a professor of neurobiology and opthalmology at Stanford School of Medicine. My guest today is Dr. Mary Francis Okconor. Dr. Okconor is a professor of clinical psychology and psychiatry at the University of Arizona where she directs the grief loss and social stress laboratory. Today we discuss the neuroscience of attachment and loss and why grief literally feels painful in our bodies. We also discuss the very real and serious health risks to being in a state of grief. Throughout the episode, we discuss ways to navigate and recover from grief, either from the death of a person, the death of an animal, or from the loss of a relationship, job, or other role in our lives. As you'll soon learn, Dr. Okconor's research is both fascinating and incredibly surprising. She discovered, for instance, that grief is best understood through the lens of human attachment and that dopamine, a molecule that we normally hear about in the context of motivation and pleasure, creates a sense of yearning that is central to the grieving process. She explains that to effectively move through grief, we have to work with both our feelings of protest and our feelings of despair. Those two things, the feelings of protest that we refuse to let go or our mind and body just don't want to let go, as well as the feelings of despair that we don't know what to do, that we feel like it's an endless sense of loss. Both of those feelings have to be acknowledged. And then we have to transmute those feelings into actions and feelings that maintain the memory of the person or role that we played in an active way and yet move forward. By the end of today's conversation, you'll have a much deeper understanding of grief, something that everyone goes through at some point in their lives. Not just as an emotion, but as a specific psychological and physiological process. The idea is not to intellectualize grief, but rather to better equip you to deal with it in more direct ways so you can honor the loss more completely and be able to move forward having grown from the experience. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however part of my desire and effort to bring zerocost to consumer information about science and science related tools to the general public. In keeping with that theme, this episode does include sponsors. And now for my discussion with Dr. Mary Francis Okconor. Dr. Mary Francis Okconor, welcome. It's so lovely to be here. I'm a huge fan of your work. It's such important work. Everybody grieavves at some point. Yeah. No one is immune from this process that we call grieving. And we get very mixed messages. Yeah. From a young age all the way up to adulthood about how best to grieve, what grieving is. Yeah. And your work has really highlighted that this is a process that doesn't always play out the same way for everybody. But if we were to try and drill into some of the core elements of grief, Yeah. Not to be overly reductionist, but just, you know, if you could highlight for us you what grief really is as a process, what some of the hallmarks of grief are, perhaps some things that everyone experiences that they shouldn't be shocked at, and then we can um leave into what your research has taught us about grief. Perfect. I think it's good to understand that grief is the natural response to loss. It is a natural physical, emotional, mental uh just reaction to the death of someone very close to us. And I think it can be helpful for people in unwinding some of these myths to think about the the idea that there's a difference between grief and grieving. So grief is that in that moment, you know, I could say, Andrew, on a scale of 1 to 10, how much grief are you feeling right now? And you would be able to tell me right now during this wave of grief how you're doing. But grieving is the way that grief changes over time. As you were saying, it's the process part. So I think of it as sort of, you know, uh you can imagine the stock market, right? Each day it's up, it's down, it's up, it's down. Some days it's really down. Some days it's really up, but at the end of the year, you can still see that there's been a trajectory, right, for the year. The stock market might actually be up even though you had some really terrible days. I think knowing that helps us to see that grief will never go away because it is a human emotion. Whenever we're aware, when whenever we remember that our loved one is gone, we're going to have a wave of grief. And that's okay 25 years later. But it doesn't mean that there hasn't been a process of grieving. I think of grieving as a form of learning, learning how to live with the loss of this person. So, I'm trying to square two things that we've all heard. One is that time heals all wounds and the other is that absence makes the heart grow fonder. You know, part of the reason I became a biologist is because of puzzles like this. Yes. You know, you don't have to uh have a particularly high IQ to realize that the world is full of contradictions. Yes. So, which one is it? I think it really helps us to hone in on the idea that you can't talk about grief without talking about love and bonding. Because unless you understand what you have, you don't really understand the impact of its loss. Right? So absence makes the heart grow fonder is a fantastic way to describe attachment. Right? When you fall in love with your baby or you fall in love with the person who becomes your spouse, that bond that gets created between the two of you, when you form an us, it comes with this implicit belief. I will always be there for you. You will always be there for me. And time and distance will not change that. If you are gone, it just means I have to go find you. And so now we have this unique and terrible circumstance of death where when we have a living loved one, the correct response to absence is to think about them more, to put more energy into going to find them or or making more noise so they come and find you. But in death, suddenly we have this circumstance that the brain is really going to struggle to wrap itself around, which is the idea that I'm not going to find you no matter how much effort I put in. I think of this as the as the gone but also everlasting theory, right? So, of course, we know that they are gone. We know that they've died. We have a memory of being at their bedside maybe or getting that phone call or being at the funeral or whatever it is in our memory. We have it recorded. We know that they're gone. But the attachment neurobiology means there's also this implicit belief, but maybe they're out there, right? And those two things, those two streams of information, they're gone, they're everlasting, can't both be true. And when we become aware, when we have that moment where we recognize those are in conflict, we have a wave of grief. I would like to take a quick break and acknowledge one of our sponsors, Wealthfront. I've been using Wealthfront for my savings and for my investing for nearly a decade, and I absolutely love it. At the start of every year, I set new goals. And one of my goals for 2025 is to focus on saving money. Since I have Wealthfront, I'll keep that savings in my Wealthfront cash account where I'm able to earn 4% annual percentage yield on my deposits, and you can as well. 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If you'd like to try Wealthfront, go to wealthfront.com/huberman to receive a free $50 bonus with a $500 deposit into your first cash account. That's wealthfront.com/huberman to get started now. This has been a paid testimonial of Wealthfront. Wealthfront brokerage isn't a bank. The APY is subject to change. For more information, see the episode description. Today's episode is also brought to us by BetterHelp. BetterHelp offers professional therapy with a licensed therapist carried out entirely online. I've been doing weekly therapy for over 30 years. In fact, I consider doing regular weekly therapy just as important as getting regular exercise, which of course I also do every week. There are essentially three things that great therapy provides. First of all, great therapy provides a great rapport with somebody that you can trust and talk to about any and all issues with. Second of all, great therapy provides support in the form of emotional support or directed guidance. And third, expert therapy can provide useful insights. Sometimes those come from the therapist. Sometimes you realize those yourself in the course of therapy. And sometimes you arrive at those insights together. Those insights can allow you to make changes to improve your life in immeasurable ways. Not just your emotional life and your relationship life, but also your professional life. With Better Help, they make it very easy to find an expert therapist you resonate with and that can provide you these benefits that come through effective therapy. Interestingly, in a recent survey, 72% of BetterHelp members reported a reduction in negative symptoms as a result of their BetterHelp therapy sessions. If you'd like to try BetterHelp, go to betterhelp.com/huberman to get 10% off your first month. Again, that's betterhelp.com/huberman. From what I understand about the research on stress, so much of our ability to tolerate stress is knowing that it has a defined end point. Yeah. So if we look at or if you look at from the perspective of your clinical work because you were indeed a clinical psychologist as well as a researcher a psychologist neuroscientist you wear many hats. Is there any evidence like what are the data on people that have some time to anticipate the loss of someone or a pet or maybe even a certain aspect of life like a job, right? They've been laid off but they get some time before their final day or retirement or retirement or um somebody is slowly dying uh versus a sudden death, a shock, a car accident or worse. um is what what do the data tell us about how that grief is handled? Um is it easier in some sense when you know there's an end point because you can anticipate the end. Um what's known about this? I think there's a a couple things there that I highlight. We we can think about something being stressful and we can think about grieving for it and those might be slightly different but we can get there. But what I would say most directly to your question is yes, it is true that sudden losses are harder for us to to learn to understand what's happened because we don't even have sort of a conscious you know we we've never run the scenario sort of through our mind. So of course it's more difficult for us to now imagine it. But there's something there's more to it than that. So we do know for example having closure conversations with someone who's in hospice care these are helpful actually after the loss because we can reflect on getting to say I love you and thank you and I forgive you please forgive me uh to say goodbye. We know that having that conscious process is helpful later on as we're reflecting on the loss. But I will say that it doesn't necessarily change the attachment biology. So the attachment is an implicit belief. It is an everlasting belief. And so I think it is actively trying to prevent us from learning that they are gone. And so what you see is a person, this will happen in studies. I ask a participant you know tell me about tell me about the death of of your loved one and they'll tell me the story of how they were you know in paliative care and they had this terminal diagnosis and so forth and then I'll say was the death sudden and they'll say oh absolutely I had no idea because I think that the belief that they will always be there does not respond to logical thinking you see and so you can still pick up the phone to text your loved one even though you have known they were going to go, even though you know they've been gone because there's a piece of your brain that is still operating under the belief they don't have to be in my time and space for them to exist. And so I think in some ways the learning might actually be how do I transform my understanding of this relationship now that they're not on this earthly plane? How do I understand where they are or how that makes sense? How can I have this continuing bond in my internal relationship with them? Right? Maybe I still tell them about my day or maybe I you know like when I see things I think oh my mom would love that right I have this moment of connection internally with my mom because that internal relationship goes on it is everlasting at the same time that I know ah she's not going to be at my wedding or she's not going to be at graduation right you can have both at the same time I think that's part of why grieving is so confusing and makes people feel like they're losing their mind. Yeah. The question that immediately comes to mind is whether some people have challenges getting through the grief process because of of a kind of deliberate refusal to enter this new reality that they're both gone and that there are elements of them that are still alive within us. as you pointed out in the form of the attachment. The attachment lives on. Y the body no longer lives on. That's right. And you know it's uh difficult to decide whether or not movies like Ghost um I think that was the movie, right? Where she loses her spouse or a loved one. I don't recall if it was a spouse and and he's essentially still there with her. That's right. I mean movies like that you could imagine are kind of a doubleedged blade because on the one hand um they give people the sense that the person they miss and are so attached to is still there but um I mean that's a movie where they could actually write in the image of the person. Yeah. And um it creates some complications. So do people delay the grieving process? Do they protract it and just make it much harder on themselves in in a kind of a stubborn refusal to quote unquote let go? I could understand why that would be. I I've been guilty of this. Yeah. Uh in the past. Um is that common? I think the question is a skew in the sense that there is no letting go of the attachment part. There is transforming our understanding of what that means. So for most periods of history, periods of time, cultures, we have usually a social system, often a religion set up to explain to us where did they go? Are they okay now? Will I ever see them again? Most of us through most of history have had a way to understand. Ah, I can't see them now. I will see them eventually. Dia de los Muertos I will see them once a year right or um they are in heaven now or they're in the pure lands or they're my ancestor there is a relationship that I can have with them I can ask them to you know uh speak on my behalf so to speak right intercessory prayers in in Catholicism so historically we've had this way of understanding this internal relationship that is so real you could put it on film it is really happening and they are also not present. So when I think of what it means to adjust and I don't think of it as recovery, I don't think of it as letting go. I think of it as integration. When I think about those things, I think what is my relationship? What is my internal relationship with this deceased person now? So my mother my mother was diagnosed with stage four breast cancer when I was 13. And there were cancer cells in every lymph node they cut out of her. So they knew it had already migrated and I think they told my dad that she would only live another year. She actually her oncologist called her his first miracle. She actually lived another 13 years, which is miraculous. But what it meant was we learned to live in this state of sort of waiting for the second shoe to drop. And I think because of that, I ca I I just became really comfortable and familiar with grief. It it doesn't bother me when my participants I'm interviewing, you know, sort of cry uncontrollably and then they apologize and I say, "This is just what grief is. This is just how it works. And so what it means is that now I have a very different relationship with my mother than I did at 26 when she died. At 26 I was really angry with her still. Now my friends, you know, in our 40s, suddenly my friends seemed really um accepting of their mothers. Like their relationships with their mothers improved. They were like, "Well, I understand why she did the thing she did or now I'm so grateful for blah blah blah." And I had a whole lot of grief cuz I didn't get to do that. I didn't get to have that transformation of our relationship. And then I realized, wait a minute, I can still have all those thoughts. I can look in the mirror now because I look a lot like her. I can look in the mirror now and be like, I'm doing this for you, mama. or you know it's not the way I would have done things but I get that you had a reason and and forgive her and doing that with the internal representation matters to how I function in my day-to-day life now but it has nothing to do with letting go. Do you see what I mean? You can still adapt to a world where the person is gone and that is incredibly painful and also they live on because they are deeply encoded in your brain. You cannot get rid of them. they are there with you physiologically with you and you can work with that relationship now as well so that I can spend time with my living loved ones. I don't spend a lot of time feeling guilty about how I handled her death or something like that. I'm busy living my life now because I've integrated my relationship with her. Does that make sense? That makes very good sense. Yeah. I'm wondering if you could um touch on some of the work that you've done related to how grief relates to the attachment and how attachment relates to wanting because you've made this incredible discovery that the dopamine system which most people associate with pleasure and thanks to the wonderful work of Anna LMK and others there's been more education now and people are more aware now of the fact that dopamine is much more about wanting than having more about craving than delighting in. Uh but I and I think everybody else will be kind of shocked to learn that dopamine and grief have a very close relationship. It's the hallmark of grieving is yearning, pining, right? These are other words for wanting, aren't they? And that dopamine, I've heard it described as dopamine and the reward system is really how much effort would you put in to get this thing you want. Right? How much effort would you put in? How much effort would you put in to see your loved one again? Right? One more time. And what that tells me and and really this came from the neuroscience. So I said earlier that you could think of stress and grief as as somewhat distinct. We used to think of the loss of a loved one as sort of like you can imagine you have a plate, right? You got all the things heaped on your plate you have to deal with. You've got getting the kids to school, you've got your boss, you've got blah blah blah. And now you've got this another thing heaped onto your plate. You have the loss of your spouse or the loss of your sister. That is one way to think about it. And in our peripheral physiology, a lot of the ways we respond look like a stress response. So that that makes sense. That was a good way to think about it in the 80s and early 90s. But the neuroiming research when we asked people, tell me how much you're yearning for your loved one. And then we put them in the scanner and we showed them photos of their loved one, compared those to them looking at a stranger. So what part is unique? Not looking at a person but looking at your person that you're yearning for. We saw that there was this little area in the deep in the brain called the nucleus cumbent. Probably from other studies we know it's sort of in it in the neighborhood called a vententral strriatam sort of area. And what we saw was the more people said, "I'm yearning for my loved one," there was a direct correlation with how much activity there was in the nucleus encumbent in this rewardlearning area of the brain. Now, in everyone who was bererieved, regardless of how much grief severity they were having, we saw things like memory areas, of course, they're looking at a photo of their loved one. they're having all sorts of memories of when the photo was taken or you know whatever. We had lots of emotion areas, emotion regulation areas, even some areas that had to do with autonomic physiology regulation. But what made it so unique was this idea that yearning is something that varies among people who are grieving and that it might be in part instantiated in this brain encoded region that says I'm looking at this photo and what that makes me want to do is reach out for you. And I think this was a very new way to understand what is lost. It isn't something new that's leap that's heaped onto your plate. It's that a part of it's a it's it's a part of us that was formed when you bonded has been amputated. You don't have the resources. You can't function in the world. You can't walk through the grocery store without figuring out how to do that without this other person. and then often yearning to have them back so that you could walk through the world in the normal way again. There's nothing wrong with yearning. It's just that we understand better now how the brain is doing it. And I can tell you if you want, but I've gone on a bit here. I can tell you if you want. A lot of people did point out, wait, this is the same area of the brain that's related to addiction. A lot of people talked about are we addicted to our loved ones? And it took me I never wrote about it the first in in the 2008 paper. I never wrote about it that way, but I've come up with a better maybe way to communicate, I think, what's going on. So, I live in the desert southwest in Tucson, Arizona, and I can tell you if you forget your water bottle and you are out on a hike and you're halfway through, you cannot think of anything else other than water, right? You are obsessed with thinking about it, getting it, imagining it, and so forth. But no one would say you were addicted to water, right? Water is something we need and we have a homeostatic function that says you need more of it and then once we have it we feel satiated, right? Yearning for a loved one is that kind of thirst. We need our attachment figures like we need food and water. They are basic to our survival. And I think we forget that in modern society where we can sort of fill in for so many needs. We need our spouse. We need our children, our parents, our siblings. And we fail to thrive when we don't have them. And so I think the activation in that area is just the cue of you really need to reach out for this person. And the process of grieving is if I'm going to reach out, it's going to look different than it did before. Maybe I'm going to have a conversation. and maybe I'm going to talk to my sister. But also, you have to find another way to get your attachment needs met. There has to be someone else in your life whom you would say, I will always be there for you. You will always be there for me. Because this person who's left this earthly plane cannot be that anymore. So interesting. I I loosely define addiction as a progressive narrowing of the things that bring you pleasure. And you beautifully described how on a hike in the desert southwest when you need water, the narrowing of what brings you pleasure comes down to what you need for survival. Absolutely. And presumably once you have that water, then your your notion of what's pleasureful expands again. Whereas addiction to say methamphetamine or to some uh you know process addiction or behavioral addiction, it really becomes like a tunnel. There's one thing and that one thing only. And sadly in addiction, the the rewarding properties of that thing also become diminished with time. But the way you describe grief as a sort of addiction like like the process of of grieving sort of addiction-like in that sense um raises for me a a question. You said that at some point in order to move through I don't want to say get over because to integrate the the grieving process one needs to either find um a replacement attachment figure. I mean, we don't like to think about this when we lose someone, but if it's a spouse, sometimes people remarry or repartner and sometimes they don't. But it's kind of a beautiful thing really to observe that. I've seen that several times over when somebody repartners and they seem like that attachment need is met at least partially. It's not the same, but it's met differently again. Yeah. But sometimes people refuse. Mhm. They hold on to the attachment or morph the attachment in a way that they are with that person forever to the exclusion of replacing that attachment figure. Are there any data that speak to uh which one works better or is it just kind of who you're at and where you're at in life? And you know some people are really stubborn with this aspect of the grief integration process. I think recently a lot about what is a good outcome. I've spent a lot of time in my career thinking what is a bad outcome when we're grieving and how might we most help people who are who are not integrating this in a way that's allowing them to restore a meaningful life. But and I and I've shied away a lot from the question of what is a good outcome because I think it it it has a normative quality to it. But I've started thinking about it in a very open way. So the first thing I would say is I I really don't think of it as addiction-like. So our need for our loved ones much like food and water is this homeostatic process right? you think, "Oh, you know, like I I'm visiting you, right, for this podcast." And at some point, there's some push notification in my brain that says, "You should text your partner, right?" And I pull out my phone and I text him and I wait for a few minutes and then he responds and I get that little, "Oh, he's there. He knows where I am. We're good." That's not an addiction, right? That is the normal homeostatic process. Just like I also got up and ate breakfast because I knew that I needed that, right? So I I think with addiction, the problem is those drugs of abuse override exactly these circuits that work in a homeostatic way. And by overriding them, they either pare down the number of uh receptors or uh mess with the affinity of the receptors in such a way that it really does narrow our what's rewarding to only this drug because only this drug can powerfully overfill those receptors. And now we have a situation where only meth, right, is the thing that gives makes us feel better. but not not quite the same with food, water, and and and living loved ones. To your question of and I think you've actually really hit on something that our culture is really struggling with right now. We've lost in our culture a lot of the grief literacy that was based around an understanding of what happens during bereavement during mourning that was very religiously focused, religiously oriented, right? So everything from sitting Shiva to um having uh the the mass after a year or awake with the body there. I've been to a wake people are laughing people are telling jokes they're drinking and I remember the first time I went to a proper Irish wake. I was thinking this is wild. I didn't quite know how to be Yes. And after some period of time I caught on. And it was remarkable. Yeah. It was It's clearly effective. Yes. For people that adhere to the Irish Wake as a That's right. The body is right there dead as can be and everyone's having a party. That's right. I with the name Mary Francis Okconor. It will not surprise you to know that I grew up in a big Irish Catholic family. And we used to say in the summers we saw our cousins for weddings and in the winter we saw our cousins for funerals. And we had these wakes. I saw numerous deceased bodies as a child of my family members while running around playing tag with my cousins. And what that does is it is a cultural way to say grief happens, death happens. This is what it looks like. And you can respond in a lot of different ways because I will tell you while there is drinking and playing tag, there is also a lot of crying and a lot of leaning on shoulders. It gives you some form of organization for how to understand the strong feelings that you're having. But in a different culture, you know, they'll hire funeral singers so that there can be singing while everyone is weeping. Right? So my point here is that we stand in an unusual moment in history and culture where we don't mostly adhere to some system for how to handle death and grief. And what it means is people are left to sort of manage those intense emotions without a lot of modeling, without a lot of philosophical understanding of what's going on and and and disconnected often from their families of origin. Um because those don't make sense to us right now. I'm not suggesting that we go back to a time when, you know, Catholicism was the way or uh Judaism was the only way or, you know, I'm not suggesting that. What I'm suggesting is anyone who has attachment. So, this can be prairie vos, little rodents, you know, that that mate for life. This can be infants. This can be good functioning human adults like you and me. When there is loss, when that attachment figure is missing and deceased, it is something our brain, our body, our mind is going to react to intensely. And without some way of understanding what is that supposed to look like and how do I manage this, we are a drift. and what it means. So John Bulby who really developed this theory of attachment right when he was looking at infants and colleagues of his were looking at animals right you see these invisible tethers right you think of uh you know think about the polar bear with the little baby polar bears right coming along behind you always see the following the following those invisible tethers they're not invisible they are in the brain s of those attached animals and humans in the form of neurobiology of dopamine and oxytocin and cortisol and adrenaline and in specific brain regions with receptors. Those tethers are what are keeping us searching for mom or for baby or for spouse, right? And so left to our own devices without any way of understanding this, all we know is we're having these intense emotions, reactions, behaviors, thoughts. And John Bulby divided the types of reactions that we see into two. Protest and despair. Now protest is the uh you know so let's say you're in the grocery store and you look down and your toddler is not next to you and you think oh no they're gone and you can even hear the embodiment of that right I am primed with every hormone and neurochemical to search for that child right you can feel that in your body that is protest oh no they're gone Despair on the other hand, despair is sitting in the living room and something arrives in the mail for your spouse and you know they are never going to open it. And in that moment you think, "Oh no, they are gone." And the gravity of that, right? You can feel that in your body as well. The giving up, the the withdrawal, the uh the the just the lethargy of it. Right now, notice that the information is the same. Oh no, they're gone. Is something we have to learn. And one way we learn that is protesting and trying to prove that they're not gone. and the acknowledgment, the accepting that they are gone. Now, we don't often think of despair as having a purpose, but what's interesting is in this moment, despair has the function of stopping us from searching. And searching is physically very costly. the amount of energy it takes to create the blood pressure and the cortisol to reach out like that. And so that despair does actually have a function. That withdrawal is for good reason. But many people are terrified of feeling despair. Some people are terrified of feeling protest as well and just avoid any thoughts or reminders in any way. But here's the thing. Despair isn't the end of the story either. And this is not a stage model. These are responses we have over and over again as we're trying to understand this new world we're living in. But despair leaves out hope. Despair says they are really gone and because they're never coming back, I am going to feel like this for the rest of my life. And that's not true either, right? We know that you can have grief, you can grow a life that restores meaning and that that you do have other connections with people. I wouldn't say replacing, but I would say adding because now you know what it means to love someone. You know what it means to forgive and and all those things you learned with your loved one, you can now love others as well. Or for some people, it isn't about creating new relationships. It's about having a transcendent experience. Now I can love nature or I can love God because I was taught how to do it by having this connection with this one vitally important person in my life. Or even now I know how to care for myself. I know how to love and care for and forgive and appreciate myself because my loved one taught me how to do that. This is what I mean about there's no normative outcome. Those are four very different life trajectories after the loss of someone that can all fulfill our attachment needs. 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Right now, Helix is giving a special offer to Huberman podcast listeners of up to 27% off sitewide, plus free bed sheets with any Lux or Elite mattress order. what you just said is so critically important that if I may, I'm just going to uh summarize for myself and for those listening and I'll never pass up the opportunity to weave in a little neuroscience lesson and since you're a fellow neuroscientist hopefully you'll collaborate with me on this. So what I heard was um at least two divergent responses to grief. One is a protest the other is a despair broadly speaking. Yeah. In protest, it's a no, I don't accept. Yeah. But there's an action step. There's a go response. Yes. And we know in the basil ganglia, a critical structure for action generation and action suppression. We can broadly think in terms of go and no go as separate circuits literally. So the protest circuit is a go circuit that's nested on this notion of hope that it can be resolved through action. Yeah, the despair circuit is a h I can't act on this. I can't hand this letter to somebody. I can't call them. I can text them, but they're not going to see it. Right. And this is a no-go pathway, the suppression of action. And you said that action is metabolically costly. Inaction is not costly. I'm not going to challenge that, but I have a question about that, which is it seems what's required in the despair step for it to be adaptive, functional, healing, is for that no-go to be converted into some new context. And as neuroscientists, we know that context dependent decision-making, strategy setting is this prefrontal cortical activity that humans are so good at. But it requires effort. It's like, oh, I can't hand them the letter. Yeah, but maybe I can do something else with the letter. Yes, maybe I can tear it up and write write to somebody else. So, this I'm I'm fascinated by this this word that largely comes through Eastern philosophy, but this notion of transmutation that we can take the energy of something and transmute it into something else that's functional. Yeah. So, this is the way that I see this divergent circuit. Mhm. Um and uh now people are aware that I also um indeed will never pass up the opportunity to weave in some additional neuroscience because I think that what you're describing is grief as a natural and fundamental part of the attachment circuitry. We're born into the world ready to attach. That's what Bulby and colleagues taught us. I'm also realizing and I'm very excited about the fact that we are born into the world also to grieve and to learn when and how to go to protest and when to despair to transmute. Yes. And I will say there is even some proof of that or I think of it as proof in the following way. So you are correct that the no-go it it's not that there's no cost with no go. You are correct. So it does stop us from the type of go which is searching right. So it stops maybe the cortisol or the adrenaline or something like that. But uh it comes with its own I think largely things like inflammation and things that enable the withdrawal right probably shifting hormones. We know prolactin changes in grieving, oxytocin changes in grieving. But think about it this way. So in a sort of evolutionary way, if your mate is gone or your your caregiver is gone, that withdrawal allows you to save resources because you don't know where when they're coming back. And that's important for your survival. But a transition through, oh, eventually I'm going to have to get my own food. I am going to have to move again, but not in the frantic searching way. I'm going to have to find meaningful activity to go on. Right? So, here is my theoretical reason why I believe we are set up to grieve. I know that you had attachment figures as as a child because you survived to adulthood, right? Proof. Proof that someone loved you. Mhm. Now children have caregivers as their primary attachment figures. But now in your life it is most likely that your primary attachment figure is a peer like a spouse or boyfriend, girlfriend etc. not your parent. So something had to change, right? And developmentally we are prepared. We come into the world prepared with a neurobiological developmental program that at some point says my parent is no longer the peak of my attachment hierarchy. I'm looking around. I'm motivated to see friends and I'm motivated to date and I'm motivated to create these enduring relationships with people my own age. And that means that our attachment hierarchy can shift. that we have the capacity in our neurobiology, in our hormones to shift from a primary attachment to a parent to a primary attachment to someone else. And the capacity to do that is innate. Now, I will say of course we are all programmed to do this at roughly the same period of our life. Parents know coming into the bargain that this is going to happen. Although parents experience a lot of grief during the empty nest when it is actually occurring. When a loved one dies in, you know, a dear friend 50 years old, her husband dies of sudden heart attack right in front of her in the living room. There's not a whole cohort of you going through this experience together of transitioning to a to a different attachment hierarchy, right? And we set up whole cultures around sending kids to college or sending them on a mission or or sending them through basic training as a way to get this whole cohort, you know, of young people through this transitional period. What we need is support for these individuals who are dealing with the death of a sibling or a parent or a spouse or a child who are all going through it on their own and trying to figure it out. without that infrastructure to support them, to help them understand what is natural and normal during grieving. And because we know it is a medically risky time, much like college is a medically risky time in in other ways. Because it is a medically risky time, we need to be able to assess what's going on with them physiologically and make sure we're supporting their grieving body through this intensely intensely stressful experience of transmuting. Yeah. And I don't know if I'm using that term correctly, but um and I can't say I'm the biggest Alan Watts fan that ever lived. I I like some of his stuff, not others. But I've heard two things from him. about transmutation which I thought was beautiful and very apt and from the perspective of neuroscience made a lot of sense because people talk about energy in the kind of uh newagy whatever crystals and yeah or even just the the the sort of non-scientific notion of of energy tends to be rather vague and at the same time it's more intuitive for most people um whereas neuroscientists love to talk about neurochemical energy or physiologist caloric energy but when I think about the energy that we're talking about I I think about it more as like neural circuit energy like which which pathway the go pathway or the no-go pathway um kind of requires our attention in order to move through this in the same way that kids learn action generation and they learn to sit still during a lesson some some more slowly like myself than others um you know I I blame my Y chromosome for that because there's a known delay in the maturation of the prefrontal cortex in those with Y chromosomes um it eventually catches up in most but not all. Um why chromosome possessing individuals a different podcast for another time. I am very struck by this idea that uh when an attachment is um hindered what like in grief that having others that are there to support us is extremely important especially nowadays in this crisis of isolation. Yeah. Um, and in this time where we can communicate about our experience, we can learn so much about others experiences, but we often don't have the fundamentals of support like um, uh, touch, right? Just like, you know, touch, hugs, somebody sitting there, the eye contact, you know, um, holding your hands, no doubt, um, smell is is probably related to this. just the smell of another person even if you're not aware of it consciously signaling at at a bodily level there's someone else here. You know there are a lot of people that um really struggle to sleep after the loss of someone and just having someone else in the room or a pet in the room can make a big difference. So, you know, in in terms of addiction, there are um incredible um zerocost programs all over the world in the form of 12step and other recovery programs that allow people to work through their physiology and their psychology in uh through the support of others, elders as it were, or those more experienced with whatever it is, alcohol, drugs, or a process addiction. Is there something similar for those um uh in grief? I mean, I'm aware that there are bereavement groups, but typically when I think of of a bereavement group, I think of like what my grandfather went to and met his like last girlfriend before he died. I think he only had one girlfriend after my grandmother died. They've been together since they were 13 years old. 13ing. So, 50 plus years. But that bereavement group became a real source of of support for him. And yes, he did find a girlfriend in bereavement group. and uh you know family members have mixed feelings about that but I was happy that he he didn't die without company um so for people of all ages are there zerocost tools um 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 um 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. Yes. So, presumably a bereavement group for that is very different than a bereavement group for someone who's really truly mourning the the um 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 um 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 a fairly recent um movement that we might call the 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 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 bereiement, we can think of sort of at the foundation even just understanding in a grief literacy kind of way. What am I what can I expect? What is happening to me? Why is this happening to me? That is a 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. 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 it often it still smells like them. Absolutely. People I think people really underestimate this thing about smell because it's operating at a at an unconscious level all the time. We're like bathing in somebody else's chemicals and then they're gone and then it 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 a study of we were talking about earlier before the podcast started. 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 u 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 has 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 bere the morning 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 reeregulate 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, 247 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 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 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. 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 um to connect with others who are going through this same process. And frankly, you know, I don't recommend and and some bereavement support groups actually prohibit uh dating relationships in 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 uh uh disordered grieving who really are not showing any changes over time even though time is passing. those people might need very specific evidence-based psychotherapy intervention because we know that those uh those psychology interventions can get us back on a normal or typical grieving trajectory. I want to talk about the somatic the bodily aspect of of this. We've been talking about the brain which of course is connected to the body and vice versa. But um before I do that, I want to ask you a question uh about alcohol. Yeah. Uh did an episode about alcohol a couple years ago and um I think it got a lot of people who wanted to stop drinking to stop drinking. It got some people who wanted to keep drinking drinking a little less and some people uh hate that episode um and keep drinking. And my goal with that episode was not to change anyone's behavior, just to give them information. Yeah, I will be the last person to promote drinking because we know it's basically not good for us despite the headlines that it might be. The mere disruption in sleep and microbiome probably explains in my opinion about 50% of the detrimental effect. But with that said, it is very customary in a lot of traditions that close to the to the death in the very early days and stages of grieving to actually promote alcohol use. And if I take an open-minded perspective to this, we know that alcohol at a low dose disinhibits us. It's why people start talking more. At a higher dose, it's more of a seditive. Mhm. And we can all agree, I believe, that chronic alcohol use or continuing to drink to avoid one's feelings is just a bad idea. Anyone that disputes that is probably drinking while they do it. However, I am struck by the fact that so many traditions encourage the use of alcohol. And I wonder based on what you told us about the risk of heart attack whether or not this is some attempt to lower blood pressure in the short term and basically just keep the person from dying. Yeah. is a drink or two, assuming you're of age and you're not an alcoholic, upon hearing the devastating news, is it the worst thing in the world? I will tell you a story which is that so when my mother died, she was in our very tiny hometown in Montana and in tiny towns, rural places like this, of course, everyone knows what's going on. So, the morning after my mom died at about 1:00 in the morning, my best friend and I went downtown to a Mexican restaurant for breakfast and the woman came by who owned the place came by the table and said, "Hey, I heard your mom was in the hospital. I'm so sorry." And I said, "Yeah, she she died last night." And she said, "Oh, Miha, what can I get you? Anything. What do you want?" And I said, "Can I have a beer?" And she said, "Of course you can." Mhm. And I had a beer for breakfast. I like to think of us as needing a big toolkit of strategies to deal with waves of grief. And that was the right tool in the toolkit at that moment. Now, if I had a beer for breakfast every day for the rest of my life, probably not so good for my liver, right? And potentially for my job retention, but in that moment, it was the right tool. Do you see what I mean? So, it was also the right tool that I was sitting with my best friend, right? And I that inhibition allowed me to cry right there in the middle of the restaurant. I think we have always found ways to interact with the body that may not make sense to us at some level, but probably when they are cultural ways have come about for reasons. I don't have evidence for the things you were just saying, but the idea that it can bring people together who are feeling a little less inhibited so that they can talk about emotions and difficulties. The fact that it brings people together just to watch each other is vital. The fact that it impacts our cardiovascular system is important. And here's what I would say about this. So people think that dying of a broken heart is a metaphor. We look at, you know, uh, when Carrie Fischer died, her mom, Debbie Reynolds, died the next day, and we think, oh, isn't that a tragic, beautiful story? This is a piece of evidence that we have known about from huge epidemiological studies that the increased risk of all cause mortality is much higher in newly bereaveved people. And my question is, why do we keep just proving it over and over? What are we going to do about it? In my own lab and then replicated later in a study in Australia, we did a a a proof of concept study. Now, to be very very clear, this was not a randomized clinical trial and not at a level that would be uh worthy of using it as medical advice. But we said, you know, when someone dies in the ICU, in the emergency department, in hospice, in a nursing home, the person standing next to them should become our patient. We know that their medical risk has just gone through the roof. So we gave aspirin, a baby aspirin to people in the first two weeks after the death of their loved one and looked at whether that was cardioprotective, which of course it was because we understand how aspirin works. Now the reason we need big studies is to make sure that there isn't some negative side that we're uh that we would want to bar against, right? But my point here is if we know that bereiement is medically risky, if we know that we need to support the grieving body so that you can even get through those days and weeks and months so that you can start to restore a life again. What are we going to do about it? I think of it this way. Grief is not a disease. Grief is totally natural. But you know, pregnancy is not a disease. Pregnancy is totally natural. But no one would say it's not physiological. No one would say there aren't huge hormone shifts and that it is medically risky. So that for the vast majority of people who are pregnant, they're perfectly healthy. But we have whole systems of of care in place to assess whether people are are are healthy during this period. And then if they're not, if we find gestational diabetes or hypertension, we know how to treat that and intervene for that person so that they can get through this transition period. What if it was the same with bereavement? Why at our bereavement support groups do we not also take their blood pressure to find out where they're at physically in addition to teaching them the many coping skills they might use in addition to having a beer so that they can learn what grief is like and how to elicit support and ultimately how to adapt and develop a meaningful life that that includes grief but includes all the other wonderful things in life as well. Yeah. A amen to all of that. I was not aware of the medical risk of of being in grief or even adjacent to somebody in grief, but it makes perfect sense. Uh, you know, I mean, I've heard stories of people attending funerals where the brother of the deceased died at the funeral weekend or even at the funeral and you just go, "Oh my goodness." It's almost like uh beyond comprehension. That's right. But we now know there's a logical medical basis for this. That's right. Exactly. And and here's the thing that's crazy, Andrew. Every time I do a podcast or I get interviewed by a reporter, everyone has a story like this. And so, I mean, honestly, insurance companies before the 1960s figured this into their actuarial tables. They knew that life expectancy in that time was short. And so if we've known for this long, what stops us from really caring for grieving people? So important. I'd like to take a quick break and acknowledge one of our sponsors, Function. Last year, I became a Function member after searching for the most comprehensive approach to lab testing. Function provides over 100 advanced lab tests that give you a key snapshot of your entire bodily health. This snapshot offers you with insights on your heart health, hormone health, immune functioning, nutrient levels, and much more. They've also recently added tests for toxins such as BPA exposure from harmful plastics, and tests for PASES or forever chemicals. Function not only provides testing of over 100 biomarkers key to your physical and mental health, but it also analyzes these results and provides insights from top doctors who are expert in the relevant areas. For example, in one of my first tests with Function, I learned that I had elevated levels of mercury in my blood. Function not only helped me detect that, but offered insights into how best to reduce my mercury levels, which included limiting my tuna consumption. I've been eating a lot of tuna while also making an effort to eat more leafy greens and supplementing with knack and acetylcyine, both of which can support glutathione production and detoxification. And I should say by taking a second function test, that approach worked. Comprehensive blood testing is vitally important. There's so many things related to your mental and physical health that can only be detected in a blood test. The problem is blood testing has always been very expensive and complicated. In contrast, I've been super impressed by function simplicity and at the level of cost. It is very affordable. As a consequence, I decided to join their scientific advisory board and I'm thrilled that they're sponsoring the podcast. If you'd like to try Function, you can go to functionhealth.com/huberman. Function currently has a wait list of over 250,000 people, but they're offering early access to Huberman podcast listeners. Again, that's functionhealth.com/huberman to get early access to function. I'm curious about compartmentalization. It's clear to me now that at least in this culture in the United States, we aren't taught how to grieve unless it's, you know, part of our family or part of our religion. Uh we aren't instructed how to grieve. There seems to be a another uh set of contradictions in the world of psychology, health, self-help. Doesn't matter if it's the most woo uh sector of it or the most uh reductionist medical sector of it. And and the conflicting message is this. On the one hand, feel your feelings. Bottling it up isn't good. Yep. raises your blood pressure, increases your risk of heart attack, aneurysm, makes you a miserable person to be around and to including with yourself, etc. But then we also know we have to be functional. We can't dissolve into a puddle of our own tears 24 hours a day, 7 days a week. Even if we're not a caretaker, we just can't. No, it's just so I can recall when I was a kid getting really devastating news. Just it doesn't matter what the what the news was, but just devastating news for for any age, but I think at that point I was like 16. It was like Yeah. And I remember like my chest hurt. My heart hurt. Yes. And I remember actively pushing it down. Yeah. And it's I I know how to do that, right? It's a skill. Yeah. And there was a while where I thought that was a terrible thing to do. On the other hand, that's how you get up and go to work the next day. Yep. That's how when you run in a lab, you go to your lab. That's how you deal with life. But the key is, of course, to be able to pop that lid and let the emotions out when you need to. So, in the context of the idea that emotions are in the head and emotions are in the body, something that I think everyone agrees on now. Yeah. What do we know about the way to let emotion out and through? And what do we know about healthy adaptive compartmentalization as skills? And here I'm hoping that perhaps people can glean some tools like take an hour a day and let it whail. Take two hours a day and handle your stuff. Yeah. I think it is helpful to remember that emotions are actually the output. They're the product. It isn't so much that we have to figure out how to deal with emotions, although I will come back and say that differently in a moment. We have to figure out how to handle what physical and mental state resulted in those emotions. So what I mean by that is if you are in a moment where everything in your body is in protest, you are amped up and you can't sit still. Then working with your body, right? Maybe you are the person who needs to go for a run every day where that hasn't really been who you were before, right? Uh on the other hand, maybe you're the person who needs to develop a yoga practice to figure out how to breathe through that amped up feeling and soothe yourself physically soothe yourself so that you can bring your heart rate down. Right? So, those are two entirely different behaviors, but I can tell you at the end of either of them, your body's going to be in a different state. And I bet your emotions are in a different state, too. Right? So, there's one way to think about it, which is coming at how do we handle the emotions? But there's another way to come at it, which is how do I handle all of the demands and resources I have? when demands and resources get out of balance that stress. So, how do I increase the resources in my life? How do I reduce the demands in my life because I am suddenly in a really difficult situation? So, that's one way to think about it. We did an intervention study in my lab with widows and widowers where one arm uh received mindfulness training. Another arm received progressive muscle relaxation which is sort of like learning a really fancy body scan. You contract and relax different muscle groups in your body and you become aware of what that feels like to really understand what relaxation feels like. And then there was a weightless control group and we did it because the progressive muscle relaxation was the control group. We thought mindfulness training would be very helpful. Turns out mindfulness training was helpful, but progressive muscle relaxation was even more helpful for people's grief. So what does this practice look like? It's a So you're tensing your fists, then relaxing, then forearms, then so working through head to toe, contracting for about how long? I'm just trying to get the rough contour. It's a brief contraction. It's, you know, you can go online. There's really easy instructions. It's often done with a sort of guided uh audio um to help you figure out. But the important part is also feeling what what's the difference between my clenched fist and my relaxed fist. Oh gosh, I didn't even realize I was had so much muscle tension. Right? So what's fascinating is people told us in any situation I'm in the grocery store, I'm in a work meeting, I'm trying to fall asleep, I can use this tool now to help my body to get into a different state and that helps my grief. Now mindfulness training was effective but not as effective as I said and I think some of this is that we have you know grieving is a form of learning. I'm not kidding about that. Your brain is busy while you are grieving and it might not be the right time to take up a new practice that requires a lot of concentration. If you do mindfulness, it can be very helpful. Anyway, the upshot of all that is on the one hand, it's not that we have to deal with emotions because they are an output. we have to deal with our demands and our resources and uh developing a whole toolkit of ways to think about adapting in our life. Now on the other hand, even specifically for waves of grief, having a toolkit of what to do with those emotions, I think you described it beautifully, Andrew, that we do have the capacity for suppression. Mhm. And if you are about to walk into a pitch meeting, suppression is probably the way to go in that moment where suddenly your deceased child has popped into your head and thinking, I am not going to think about this right now. I am completely going to pretend this has not happened and I'm going to do this pitch. Right? But if it's your only strategy, then you don't have the learning process going on. Right? that at another moment you might be looking through a photo album and just be overcome with tears but over time realize I can't say stay in that puddle either when I'm doing this I need to you know if it was me I need to text my sister and tell her you know I'm looking at photos of mom and this is what I'm thinking about and she'll text me some funny story about mom or or even just say, "Oh man, I feel you. And if my sister isn't available, then I'll text my best friend, right?" Because in that moment, it is important to have that puddle. It's also important to know how to get out of the puddle again. And so, this is really a process of learning. How do I cope with these waves of grief? It's like being a basketball player. One possession after another after another. How am I going to get through this possession? Each possession looks different. How am I going to get through this possession with this constellation? What's the right skill to use right now? I think what you just said is is so vitally important because I know for a number of years the um the model was one in which grief progresses through some very standard stages of um disbelief, anger, acceptance and no disrespect to was it Elizabeth Kubler Ross. Kubler Ross. Is there a theme of um of hyphenated names in her fields? Yeah. Sorry. That's funny. Yeah. The uh um incredibly important work because it cracked open the awareness of grief as a process both psychological and to some extent biological. Yeah. So we want to you know pay respect to the people that opened up these fields and yet as an outsider to the field I can uh safely say uh because my grants and papers don't rely on it that I think work such as yours and your uh your colleagues have really expanded on that model to really show us that in many ways it was important but not completely true in the sense that it's not disbelief then anger then acceptance. It might be all three at once and then they get shuffled in a different order and then there's a bunch of other things too. Yeah. And I think it's important for people to hear because that disbelief, anger, acceptance trajectory got so much press that we were kind of taught it in high school and elementary school and and it needs some updating just like the notion that dopamine is pleasure needs some updating. Absolutely. So she published on death and dying in 1969. And you're right, it was groundbreaking the idea that grief is more than sadness. And she did what all good scientists do initially. It was descriptive. She did clinical interviews and she described but it became a prescription, didn't it? Right? Those stages. And we know now, think how far science has come. Right? We know now with longitudinal studies where we're looking at the same person over and over again that we do see trajectory. So we see that acceptance increases over time. We see that yearning decreases over time, but that it's not linear and that it's not just as you say, it's not one stage and then you're done with that. I've had people say to me, "Well, it's been 20 years, but I haven't felt anger yet, so I don't think I'm done grieving." And I just my heart goes out to them. It's not a prescription. And modern grief research tells us so much more, not just about what happens, but why and how. Uh sometimes I wonder if um despite the incredibly devastating experience that grief can be, whether or not people don't um allow themselves to feel okay. Yeah. I mean, earlier when you were talking about this uh this picture of this this monkey holding its dead infant, I confess I I'm like out have a bit like a reaction. It's um and I think that it is a universal one would hope uh human and animal reaction that the whale Yes. of a mother that's lost her child. Absolutely. Just an animal that whale whether or not it's a human animal or a monkey or a dog. It's just it's this it it's like a it's got to be some forgive me for playing neuro anatomist here but teach neuratomy. It's got to be some deep deep literally deep nerve path in the body because you just feel it everywhere. It's not like over here or over there. You don't hear it in your ears. You feel it down your core. Yeah. And um and anything that deep is as uh primitive and ancient and important as hunger, thirst, reproduction or anger. Yes. So, I think it's so important that you placed grief right up there on the shelf next to those primary drives and mentioned homeostasis. The desire to stay in some ground where we're the seessaw isn't tilted. Yes. Toward just complete collapse. That's right. And yet there are times when people are grieving and they find themselves laughing at something they hear Yeah. maybe on a podcast or they find themselves attracted to a potentially new partner. Absolutely. Despite the fact that they adored their spouse. Yes. And what's the permission piece? Yeah. Big time. You know, part of this is a cultural piece, right? Part of this is that we have we joke about you know there's apparently a big book of rules about grief that no one can get a hold of but people have very strong feelings on right and people will talk about how you know I got hammered with the big book of grief rules today somebody told me I shouldn't be or I should be fill in the blank believe me it's hard enough as it is without expectations around you of whether you're doing it right. You know, at one level then there's the social expectations. A woman contacted me about 10 days after her husband died and she said, "I just am not sad and I'm worried something's deeply wrong with me." She was an older woman. We did like a neurosych evaluation. I did a clinical interview and so forth and I said, "I think the reality is you're just okay." And she said, "Okay, that's what I thought, but I can't tell any of my friends that I'm not sad because I'd be a pariah." You know, people think she's a sociopath. People will think she's a sociopath. Instead, they had a wonderful relationship together. She knew that this was coming. She had a big full life and it was okay for her in that moment. So, I think on the one hand, there's the social component about permission. It's going to look different for each person and most importantly it's going to look different than we think it will be. We try to anticipate what grief is going to feel like. But because so much of attachment is below the level of consciousness because our physiology is below the level of consciousness, it's not like we can know how we're going to react. So the natural response is just the reacting and then grieving is over time the way we react starts to feel more familiar. We start to develop better coping tools for the natural way we react. It's not that the grief goes away. It's that we come to understand it. We understand how to work with it. But the other piece is about permission. I think remember how I said you still have an ongoing internal relationship. I think people feel guilt about having joy doing things that are fun, falling in love, connecting with people, going on a vacation. Because at some level there is a piece of them that the believes my loved one is out there is everlasting and I'm choosing to do this instead of going to seek them out. I'm choosing to do this when they can't. And you can understand how that comes about, right? You can understand this internal misgiving, but it's because of that everlasting encoding of this relationship, but it's not true. Your brain can believe it and it can be not true. And so working on that internal relationship to say, "Hey, I'm going to do these things because you can't. I'm going to do them through a body and eyes that were shaped by you so that you can come along with or I mean every interpretation is going to work differently for each person or you can say you valued this so much my mother would be so incredibly proud that I've written books that I am a professor something that she couldn't do and I often think to myself this one's for you mama, right? And so that way of changing the internal relationship, remembering that your internal relationship can evolve with them. And similarly, if they were a less than loved one, which happens as well, it's okay to say, you know what, this chapter of my life is over. That was a tough chapter and I'm gonna wrap that up and put that in a box and it's done now. And maybe it will come back at another time and I'll deal with that relationship more later, but for right now it's okay to put that aside. So I think permission is such a great word. Think to yourself, who is judging me for going on vacation? Who is judging me for falling in love? Is it me? Is it in the internal relationship? Is it my neighbor, my pastor? Figure out who's judging you and then how do you get permission? Sounds like giving oneself permission to move through that protest stage at whatever rate happens to be. Yes. And to move through that despair step and just to stay with the word because I don't know a better one to transmute that feeling of despair. Yeah. Like you can't get them back. No, they're gone. They're gone over curtains. As a friend of mine who has suffered more loss than any human being ever should, he just goes curtains. It was just, you know, but learned to transmute that into new things. Yeah. I will tell you, Andrew, many people, you know, I teach a psychology of death and loss class at the University of Arizona, and my students will say to me, "You are way too happy to be teaching this class." And I say to them, "That's not a mistake. That's not incidental. It is because every single day I'm thinking about death and dying. I'm thinking about grief and loss. And so when they come to me and they got a B+ instead of an A minus, I'm sort of like, you know, big picture, right? Not not the end of the world. And there's a way in which I can say grieving is a form of learning. But I don't know what you're going to learn from this loss experience. But what I hope is that you learn good lessons. Lessons like, "Wow, I am tougher than I thought I was." Or, wow, when I really need someone, people step up. Or, wow, that person utterly shaped my view of the world and I am so grateful. Other people learn, "Wow, the world is an unsafe place or uh I can't tell anyone how I really feel." These are very different lessons that some people learn. And my hope is that no one grieavves alone because the risk of them thinking it's my fault is so bad for society that people walk around believing that that we need to support others so that we come out learning better lessons about what it means that death is a part of life. I'm always amazed at how much life can hurt and I'm always amazed at how resilient Yeah. humans are. They really are. It's like the two things are both true. Both are true and often in the same people. Yeah. I'd like to talk about a very difficult aspect of grieving and death. Yeah. Which is suicide. Yeah. I think sadly nowadays almost everyone is aware of somebody that died by suicide. Yeah, I certainly have known people that have died by suicide and we hear about it all too often uh in the public sphere. It seems that a human taking their own life Yeah. defies all logic. Mhm. And yet having sat with the spouse of a really close friend of mine and mentor who um took his own life. Yeah. She came to this place where I think a lot of people close to people who die by suicide come to where she said to me literally he seemed to really need that. Yeah. which brings us to this place where like you know maybe they were hurting that badly and then you kind of reason some sense of relief etc. But I had the both fortune and misfortune of seeing this movie the bridge. It's a movie that I I can't really recommend. It's it's it's so intense. Yeah. Um but where they fixed cameras on the Golden Gate Bridge. Oh yeah. um filmed people jumping and talked to the people that knew those people. And in one case, they were able to talk to the young man who jumped and survived. As I recall, he was diagnosed bipolar, um high suicide rate in people with bipolar and so on. And he describes moments after he jumped, his first thought was he didn't want to die. Yeah. So I think if for no other reason that message and that movie plays a very important role because it uh argues against what I just talked about you know and if some but you know forgive me but let's just be direct here since we're let's not let's not nip you know let's not um uh you know hang on at the margins let's just take this face it's on you know if somebody kills themselves uh by gunshot there isn't uh usually a second opportunity to think oops I I I really don't want this. Yeah. Um, so what do we know about the research on suicide? If we could just start there, like do we know anything from uh studies of people who tried to commit suicide and were unsuccessful? Um, do we know whether or not that's a typical experience? And what do we know about grieving suicide that's different than grieving other forms of death? Yeah, I can say upfront that I am not an expert in suicide and there is so much that is known scientifically uh about the mental health surrounding suicide and um suicide attempts and so forth. But I think about it this way. I think we can separate out a conversation that I'm I'm I'm not expert in that says, you know, suicide is a permanent solution to a probably temporary problem. And there are lots of reasons, mental health care and so forth that suicide may happen. And it is a tragedy that this permanent solution seems the only one given what might be a temporary situation. But I can put all of that a little bit on a shelf honestly and still tackle something that I think you're getting at which is what about the person who's grieving after a suicide? And I think about that in this way because we do know that grief after a sudden death, grief after a violent death, grief after an unexpected death, and all of those often describe a suicide is more challenging. It is more difficult to adapt. It is more difficult to restore a meaningful life. a a friend of mine who used to come to the class that I teach whose son died by suicide helped me really see the insight into the grieving process there though and it's something that actually probably applies even more broadly but is very common in the thought patterns of people who are grieving someone who died by suicide and that is what he called the would of could have should have thoughts. So this is if only I would have picked up the phone. If only I could have gotten them to the hospital sooner. The doctor should have known to check for. And the thing is that the brain because it is a wonder. The brain can come up with an infinite number of stories. An infinite number of reasons why this loss is your fault. And the reality is there is no way through those questions because there is an infinite number of them. And what he taught me and I think the research bears this out is that the solution is not to find answers to an infinite number of questions. If you think about it, each of those stories, if only I would have picked up the phone, each of those stories ends in and then my loved one would have lived. But the reality that we're dealing with right now, today, here in this room, is that they didn't live. And so none of those things matter anymore because now the question is how do I live given that it is true that they are gone. It's almost like those questions are another form of this protest. Yes, that's exactly it. You know, I don't want to um hold the model that we talked about earlier up on a pedestal that that implies it doesn't have um exceptions and nuance, etc. But but this idea of a a divergent circuit where you can protest to the end of time like no I could have done this, no I could have done that. You even see this in a a much lesser example if I may in breakups. Yes. Right. If only. Exactly. I I was once told uh that the two most dangerous words in the English language are if only. Yes. Because everything that follows is a is a false narrative. It's a false narrative. But the question is why are we doing it? Right? So if grieving is a form of learning and all of this rumination as we would call it these peververative thoughts what if if only why are we doing it then and I think there's a couple of possibilities one is that it is unbearable to think that bad things happen for no reason and that protest can be ground. It is as painful as guilt is, it can make more sense to me than just abject random terrible events happening in the world that it that at least there is a sense of control if I failed to do something, you know. So the question is well and and the second possibility I sometimes think about well what would you be doing if you weren't ruminating right now and the problem is that when we are going round and round and round in our head about these things that cannot be true we're not in the present moment right we're in some other internal world and that means that you know If your grandchild is telling you this hilarious story, you're not really paying attention because you're in this other world in your head. And so you don't get to have all the joy in life that comes from being in that moment with your grandchild. And so we miss out by being stuck in this other guiltridden infinite possible terrible world. The question is then we have to come to understand these are thoughts. How do I deal with the thoughts? Not what is the answer to the thoughts but how do I deal with the fact that I am having these repetitive thoughts. And we can learn a lot of skills around how to cope with our thoughts. For me, one of the things I had to learn was I need to shift my environment. If I realize, oh, I'm doing the rumination thing again. Literally, I just need to get up and walk outside, right? Just that shift alone can help to change my thought patterns. So, there's lots of skills we can learn, but this is really the question. It isn't is this scenario true? It's is this thought helpful in my ongoing life? And so, I think that the solution that your friend came to around maybe they needed that We often have to find the story that may be true. It may not be true, but that quells the thoughts. It has to feel true to us. So there's no point in debating the truthiness of it, but it is the thing that allows us to move past the repetitive thoughts and back into the present moment. Thank you for that. I I don't think there are any um clear solutions or roadmap for this suicide issue which unfortunately is more common now as I understand unless it's more just a better detection. I think it's I think the statistics tell us that suicide rates are increasing. They are very much increasing and I can tell you you know I've taught psychology of death and loss since 1999 and when we talked about suicide in the class I used to ask the students do any of you know someone who died by suicide and I'd get a few hands and I will tell you Andrew a third of the class raises their hand now and these are 20-year-olds you know who often had a friend in high school or a grandparent or an uncle Um and and so we have to talk about the epidemic itself, but we also have to talk about how do we cope with those losses. This increase in suicide rate cuts across all communities and level of academic prowess and athletic prowess. It's it's and it's always just kind of baffling. Yeah. It's just like so I don't think we're going to solve it in this discussion, but thank you for um shedding light on on the importance of allowing oneself to grieve it in the way that that feels right. Yeah. And that takes us back to this notion of of um taking uh oneself from the understandable response of protest and despair to a place of adaptive grieving. Yeah. Uh I'm very curious about belief systems. Yeah. And moving through grief. And it's sometimes challenging on a podcast where we emphasize science and health uh to bring up notions of faith and religion, belief in afterlife and God and so forth. Mhm. But I think we can do it in a in a way that's uh neither reducing any of that to neurons and neurochemicals because yes there are studies of you know where is God in the brain and these kinds of things but those studies always leave me personally feeling pretty underwhelmed. That's just my own own response. But it's very clear that for many many of the 8 billion plus people on this planet, they believe in something larger than the experience we can see. They have true faith in God, Christ, Allah, whatever particular religion they h happen to orient toward or um some larger spirituality that's not nested in any of those things. Yeah. and that it can provide an enormously powerful structure to their thinking around loss. Yeah, I I don't want to go too deeply into this because it's fresh um but I have a family member that right now um this isn't a I won't mention the relationship, but um who's dealing with arguably one of the worst losses I could possibly imagine. M um he lost his wife and the baby in childbirth. Oh. And I wrote them um he's now, you know, living with my cousin and his wife and I, you know, extended what I could. Right. I mean, what are you going to say? Yes. Exactly. So, you attempt to say something. That's right. And I got back two words. Mhm. Infinite grief. Yeah. Yeah. like there's just there's, you know, which is probably two words more than, you know, is needed to Yeah. you know, to even attempt to capture that. Yeah. But he's a very devout Catholic. Yeah. And I don't know, but I would hope that provides some path. And I can also say that the absence of a path Yeah. is probably harder than having a path. Yeah. I think about this in a few different ways. I I think about the idea that death is something we have to contemplate. We don't get out of doing it. And a lot of really smart, really wonderful people have gone before us who've thought about it and come up with ideas around God and the afterlife and in in multiple religions, in multiple cultures, in multiple times in history. I don't need to know whether that's true or not to be able to see whether it's helpful or not. And I can say a couple of things. Religion often offers a community, a social support, which we've just been talking about is so vitally important. So that's one function that it serves outside of belief really to some degree. I mean, not outside of it because obviously you fit with these people because you belong with them because you have a shared belief, right? I think one of the things that's really challenging, one of my graduate students, now a professor at Emory University named Roman Pitzky looks at this idea of spirituality and religion and notes that while it can be very supportive for people who are grieving, it can also be a moment where our beliefs are challenged. How could God let this happen? How could a benevolent God let this happen? Those sorts of things. And that what he finds is uh if you think about sort of spiritual quest or existential quest that that the loss of someone close to you is often this turning moment and that that actually can be incredibly difficult and sort of add a whole layer of stress and and disruption in in grieving. So it isn't universally good um to have religious beliefs or community because we can find ourselves at odds suddenly with what we believed before. But I think about it in in one other way as well. So you know I'm a I'm a died in the wool neuroscientist. Uh, I think that when I fall head over heels for this person that that becomes encoded in my neurons. I also think that's proof that they are everlasting. They are physiologically my there is an epigenetic change that we know happens when prairie vos those little rodents I was talking about in the 24 hours after they mate for life there's epigenetic changes the proteins around the genes in that nucleus encumbent region of the brain change because they fell in love not because they fell in love with just anyone but they fell in love with this vole VO and they will return to this VO and spend the majority of their time with this VO for the rest of their life. I cannot think of proof of something beyond the ordinary more than the idea that now two have literally become one. that literally those neurons will forever be embedded with the other. So for me I don't I don't need it to be organized religion. I am perfectly happy to see the beauty and transcendence in the neural understanding of what happens in attachment and then how that has to change during grieving. And for those that believe in an afterlife by virtue of religious belief, um there must be data exploring whether they move through the grieving process in a um more complete way. I mean, I I could imagine that for people that have to accept the realities of biology without any real faith of in an afterlife that it's pretty hard to shut down the protest. Mhm. Mhm. Um and for those that believe in an afterlife, the idea that somebody's energy or maybe even reincarnation depending on someone's beliefs, um that takes the whole process out of protest through despair. You don't get to skip any steps. That's what I'm learning from you today. No one gets to skip any steps. Uh through despair and to this process of transmutation that there's a path. I mean there's a path laid out should they believe in it that they can follow. Whereas for people that don't have faith, they have to find their own path. I think the the research that speaks to this that I stick with this is an older study now but has always um been remarkable to me and the reason that it is remarkable is it is a truly prospective bereavement study which is incredibly rare. So what that mean this was called the changing lives of older couples study. It was done in in Michigan uh funded by NIH and it was a 10-year study. So to be accepted into the study, they looked for couples where one of the members of the couple was over 65. That was the entry criteria. You're a couple, one of you is over 65. They interviewed both members of the couple about a host of different things. And then they followed the couples for 10 years. and when one of them died, they went back and reintered the the um surviving spouse. So, what it means is usually when we're doing grief related studies, we're recruiting participants into the study after the death has happened or maybe shortly before the death happens. But in those cases, we know that there's going to be a death, right? So, this was how are people just functioning in their life and then later what happens? and and there was a natural control sample uh where they reinterviewed couples where both remained alive during that time. All of this is to say I mean it's a it's a magnific I don't think it will ever be funded again because it was such a large and long study. But what it allowed us to do was look at their religious beliefs, look at their understanding of life and death before anyone was sick and then see how that predicted how they handled grief later. And what we learned from that study is for people who had a way of understanding the role of death in life, which for many people was a religious understanding, having a a religious faith, a religious belief, but for some people was more of a philosophical or even sort of agricultural cycle of life kind of understanding. For those who had a way to understand these life and death type issues, it predicted less grief severity after the loss of this specific individual. As though having thought through some of these existential issues in advance enables us when one situation happens to kind of at least hearken back to what we believed with the caveat that it may throw your beliefs into disarray. But but regard in this empirical study at least it offered a path just as you said. Um and so that to me suggests you know if we take it out of just the empirical finding that maybe we ought to be thinking about these things you know maybe we need to contemplate what happens. How do we understand death and life and grief and illness and how do we live our lives now knowing that that is a part of the future? I think thinking about death is incredibly useful. Yeah. And I think most people are terrified to do it and I was for a long time and then eventually enough friends of mine died. Yeah. Um some of whom were my age or younger and I realized I got to think about this one. I know. So I have a couple of questions about practices specifically. I have this practice that I do every day which is more or less like yoga nidra self-directed relaxation long exhale breathing which sort of coined non-sleep deep rest. Yeah. Uh people who listen to this podcast have heard of it before. On the first long exhale, I I like to, believe it or not, I like to imagine that at some point Yes. and this is a very realistic thought, by the way, at some point I will take my last exhale. Yeah. And I want to be present for it. Yes. Hopefully I will be unless I go in my sleep or by sudden sudden accident or who knows, right? Yeah. It serves a particular role for me which is to just re really acknowledge that time is finite and it allows me to lean into life more. Yes. I don't I don't exit that practice terrified. I exit that practice rejuvenated and with the understanding that days are are limited. Yes. The other thing is that I'm not such a huge fan of Hunter Thompson for any particular reason related to the drug taking or the wild stories. I mean I um I'm amused by him. Um, and certainly he did some interesting creative work. I love the stories about him. I have friends that live in Aspen and stories about Hunter are everywhere still. But I learned that his wish for his funeral was that his ashes be shot out of a cannon over Aspen and that there be a giant celebration. And when I learned about that, this was some years ago, I decided to write out a document which was not a will of assets. I have that separately, but just a a note to people. Yeah. And it literally starts, if I die, here are some things I'd like you to know. And I did that because I sort of wish people had done that for me. Yes. And for the other people in their lives because I see how much confusion and sadness and time is lost of life. Yeah. By peat and friends and loved ones of people that I have to believe didn't want that for the people they loved because they loved them. Right. So I thought this is like a simple thing to do but very hard to do. Yes. And so if I went out on a limb here and I said listen I think everyone should do this and by the way I update this document quite often. Yeah. Sometimes I add people to it add things to it. Some people get deleted. Um it's true. Um I'm not a spiteful person but some people just they they uh they don't belong on that page any longer. But I feel very good about having this document and I have a place where it's password protected and it's someone has the password and why don't we do this? I'm not saying we should do this in the second grade. That's a lot to put on a second grader. Yeah. But why don't we do this when we graduate high school or middle school and then just update that document. Are we so terrified of dying that we're willing to shoulder the people we leave behind with immense amounts of grief? That's frankly unnecessary. Maybe I'm being too logical about this. Yeah. I mean, I can tell you, Andrew, your friends will still grieve. Well, even with the documents. All right. Well, hopefully they I don't know. They go adopt bulldogs while they do it. You know, there's things that for me, if they really want to know what what they could do. Yeah. If if the desire is to transmute my memory, a lot of it just has to do with I wouldn't want them to miss a moment. I really wouldn't. I mean, I wouldn't want them necessarily to forget me, but the notion that people would lose life energy trying to bring back what's impossible. Like to me, I understand that you can't skip this process. No. But I don't know. I just would want everyone I think Hunter had it right. Yeah. Throw a big party. Absolutely. And I think you are right. And many cultures, you know, you think of the New Orleans jazz funeral, right? There are many cultures where it is very celebratory and there is nothing wrong with wanting that. And there is nothing wrong with giving permission from beyond the grave to your friends and loved ones and family to to feel that way. I will also say, you know, I also wish that child birth wasn't painful, but it is, you know, so they're going to grieve because they are attached to you. It's just how it works. They don't get to pick. They don't get to say, "Oh, Andrew wouldn't want this to happen and so I won't grieve. Darn it. I'm sorry, but I still think that it is valuable for them. I also think it's very valuable for you. So, what you said was, are we all just so terrified? And yes, the answer is yes. Even research shows us something called terror management theory um tells us that we are so terrified of dying that we have all these psychological ways that we avoid the reality that we all know is true that we do all sorts of things to keep it out of sight keep it out of mind and one of the ways we can do that is by not writing about it right not talking about it I had an experience when My mother was in the final stages of dying. I was flying back and forth to this little tiny mountainous hometown over and over again. And because I was in graduate school at the time and whenever there was turbulence, I would have a panic attack. Whenever the plane took off, whenever the plane landed, I would have a panic attack. And I and I worked with that for a long time. I was studying clinical psychology. I knew the first and most important thing was not to avoid flying. The exposure of doing it again and again, as brutally painful as it was, was important. I never wanted to give up flying, give up that way of living. But at some point, as time went on, I realized I was terrified of dying. And I also realized that was going to happen. And I also developed a practice partly through Buddhist training as as you yourself talked about. But I developed a practice of whenever there was timbulence saying to myself, "Yes, you are not wrong. This could be the day. Are you okay with that?" And if you're not okay with that, what do you need to do to get your life right so you are okay with it? and to live your life with the knowledge that we will die and to prepare to say, "I love you. I forgive you. Please forgive me. And I'm grateful as often as we need to." But also to know that we might not die. And so, of course, we also have to plan for that, too. But my point here is that terror you're talking about is real. It is physiological. And for many of us, I think learning how to deal with the terror around death is in part a way of learning how to live and understand and cope with and use a toolkit to think about the pain of grief, those waves of grief that come. All of these things teach us more about how our body reacts. Our unique body only this one, right? This is the one time that this instance will happen that is Mary Francis. How does it respond to loss? How does it react? What what soothes Mary Francis? What actually makes Mary Francis feel more connected? Learning all of those things, they teach us how to be more authentic in the world because we're the only one that gets to do this instance. You know, I will say that in in the book that I wrote recently, The Grieving Body, some of these lessons have come to me because I have multiple sclerosis. And so, learning to live in a body that I don't know when I wake up some mornings, will I be too fatigued to lecture standing up? Guess I'm going to have to, you know, change how I do today. Has meant I have a lot of empathy for people who are grieving. They don't get to pick that today is the day that they're going to be a basket case or today is the day they're going to be so foggy they can't remember where the heck they parked even though they're a perfectly normal functional human being or today is the day that really cereal is all they can muster for dinner. You know, I have a lot of empathy for that because that is just the natural reaction. You don't get to pick. You do get to pick a little bit over time how you cope with it, how you adapt to it. But it gives me a lot of empathy for people who are listening right now who are in infinite grief even though it won't be infinite like it is today. Beautifully put. The um the thought that comes to mind is you know we we hear about people like say going through a really rough cancer treatment. Yeah. Or some other rough patch of life. Yeah. And there's this will to live thing. Um the more I read about this in the neuroscience, there seems to be some relationship to this anterior mid-sulate cortex tenacity willpower thing. We never want to boil things down to a single brain structure, but um the inter midsulate cortex and structures within its network do seem to be related to this idea of I'm going to lean into the challenge. Yeah. And that's a beautiful notion. And I think it's made even more beautiful by what I'm learning today, which is the understanding that we need to learn how to go from that that sort of protest. No, it's like I'm going to Yep. get up, shower, get dressed. Even if it feels like running a marathon today. Um, if you've grieved, you've been there. Yes. And then also to the, you know what, I'm just going to dissolve into a puddle of my own tears for Yep. couple hours under a blanket. And then I know that I'll be able to emerge from that. Yeah. And do it again. And for people that are responsible for kids or for anything, Yeah. um even taking a dog out for a walk. Um what I just described is, you know, truly a mental and physical marathon. It's not just a mental emotional marathon. So what I'm learning and realizing and and talking to you and learning about your work a bit more here is that you know this is a process of learning to go back and forth from the accelerator to the break to the just collapse to repeat. Yes. And we don't know how long it's going to last. And we know from the literature on stress that not knowing how long something is going to last is one of the most stressful things about a stressor. It is. So for people that are navigating this grief process in the context of loss of life or perhaps breakups, you know, we didn't really get into this, but for some people, especially people that have never been through a major breakup before, Yeah. it it can be devastating. Absolutely. You talked about some of the steps and we can put some more, you know, of broad advice around it to just feel or but is there anything that uh you want people to make sure to remember in the moments where it feels like too much overwhelming? They can't remember if they're in protest despair. They don't give a damn about go or no go or transmutation. They're just like this sucks. Yeah, I would say it does. And it is okay. There is no way to optimize your grieving. It is it is you know when people say I say this jokingly but you know I say to people sometimes well when did you get over your wedding day because that's not a question that makes any sense right? That's like saying when did you get over your loss? Right. So I think it's funny that you've really picked up on this. Um we talk about in the literature on grief and grieving this idea of oscillation that mental health is really about oscillation. We call it the dual process model of bereavement. And and the idea is that when people can have the loss, feelings, thoughts, behaviors, barely can make cereal and also can have the restoration stressors they have to deal with. And I don't mean this is a good thing. I mean this is like, wait, I have to do the taxes and I've never done the taxes, but I got to figure it out because apparently life goes on. So it is stressful but the capacity to oscillate back and forth between dealing with the loss of this loved person and restoring a meaningful life. Being able to go back and forth is actually the sign of health. And and I will give you uh an example that has always stuck with me. I think knowing that people they cry a lot when they're grieving and it is hard to see until you get familiar with the idea that nope this is just what it is right and this older man that uh was in one of my research studies when I was at UCLA I often will ask people how did your loved one die at the beginning of a clinical interview and I let them start wherever They interpret that as broadly as they want to. And he said to me, he told me that he had fallen in love with his high school sweetheart and they had gotten married and had two kids and there was a picket fence in there somewhere. And he told me that she got breast cancer and that he cared for her while she was on hospice. And then he cried when he told me about her dying, which had been about two years ago. And then he told me that he had been going to dinner with this woman who was very different from his wife, but that she brought out like really different parts of his personality and that he was really enjoying having dinner with him and he was very surprised by this. And then he looked at me and he said, "The thing is it was really good then and it's really good now." And to me that was sort of the encapsulation, you know, of mental health. Not that he didn't cry when he talked about her dying, but that he could go back and forth and fully participate in life now, too. It's awesome. It's a very warming story and and what you said before about um you know that it's okay and you need to just feel it. I and that there's no way to optimize. Um, I realized that uh perhaps the only way to prolong the process is by trying to shorten it. Yeah. You know, Oh, Andrew, that's brilliant. I may have to borrow that. The only way to prolong the process is to try and shorten it. Well, having gone through different forms of loss and seen other people go through different forms of loss. It's like the the brain, especially the thinking brain, will do anything to try and get around the thing, anything. And then um you know, it's there's there's no easy way to to jump in the cold water. take take a take a gut punch or you just at some point you just you just got to do it. I mean I think it is true that along with rumination that avoidance actually makes it harder. So you know sometimes people are avoiding a conversation sometimes people are avoiding driving by the hospital. you know, they'll drive an hour out of the way so they don't have to go by the place where it happened and be reminded. Oh, it makes sense when you say it, but absolutely. Or they avoid dealing with the closet of the person, right? All of these methods of avoidance, which as you said in in some way are are partially protest, you know, um it makes it harder for us to learn how to be in life. Now, the classic example is the couple who used to go to dinner with their couple friends, you know, every Friday or or whatever, and one of them dies and and and she just can't go to dinner with her friends anymore. You know, say that's what she's avoiding. We each have to, you know, have a come to ourselves moment and be honest with ourselves about what it is we're avoiding. But if let's say that's the case and let's say she reaches out and she says, "Look, I I don't want to do this. It seems really painful, but I miss you guys too and so let's try going to dinner." And I will tell you, it's going to suck. She is going to feel awful. And she is going to be reminded of him the whole time. And she is going to think, "I never want to do that again." And then when she does it again, she it's still going to suck, but maybe she also has a conversation with her friend about a book she hadn't heard of, and she thinks, "Well, maybe I'll get that book." And then there's this slow upward spiral, right, with the support of the people around us where we start to figure out what is life like with this person not on this earthly plane? How do I do things? You do the things first. The motivation, the good feelings, they come much later. Like so many things in life. They told us it was the other way around. I know. They lied. They lied. They lied. There's a great Simpsons episode where Lisa Simpson has a poem about her cat that died. They said they said that he was sleeping. They lied. They lied. And I lied. Like it's so true. Lisa is very smart. She is very She's very smart. maybe the only one in the family. You offered a really beautiful parallel to an anniversary. Um or we could say or the birth of a child. We have memorials. We have the one upon death. We have the memorial usually on the year anniversary of someone's passing. And over time, they become celebrations of life, not death. I've always been struck by this. despite everything we know about memory, the recency effect that we remember things that happened more recently more than we remember things that happened at the beginning. There's also the primacy effect. Okay, we had an episode about this. People can look it up, but we remember things that are more recent in time than more distant in time, you know, um obviously. And yet, if somebody has a a long life or even a short life, and then there's a really rough ending at the time of the memorial, it's hard to set that aside, but it does seem to get erased without a lot of specific intention. Now, I guess there are exceptions if somebody, you know, died a violent death or in cases of suicide. I realize there are exceptions, but having been a pawbearer at funerals and it felt the body roll in the casket and you're like, you know, it's just it's just a rough feeling. It's a really rough feeling. Or um watching somebody really suffer, you know, I'll never forget seeing my grandfather like really trying to take breaths and it was just it was just awful to see. But that's not what I think about when I think about him. With each passing year, you remember more of the life, not the death in most cases. That's a beautiful feature to all this. It's like nature made all of this very very difficult but then like scored us one like little twist in the whole thing that violates everything I understand about memory. Yeah. What do you think that is? I think that it's a mystery. Why does it work this way? Except that it helps us to be more resilient. Right. I think there's a lot of things where around the time of the loss, we're very zoomed in. People feel guilty. I should have done this, right? They're zoomed in on the role that you played, you know, even though a hundred different people interacted or we're zoomed in on how they felt during that last week instead of how they felt their whole life. you're zoomed in on I didn't say goodbye, but think of all the times you said goodbye and I love you. And so I I mean I think it makes sense, right? Our brain is trying to understand this very important thing that is happening. Of course you are zoomed in on it happening. But over time as we adjust we realize we sort of are able to zoom out more and we're able to see this in context of so many things. You know, I'm I'm reminded that, you know, as we sleep, one of the functions of those dreams seems to be that we'll go through events again and again, but it's as though the brain is finding a way to detach some of the intensity of the emotion from the memory, right? And so maybe this is a similar process over many, many nights and many days, right? where we're able to gain a little more perspective over time um and over experience. So if for example you won't allow yourself to think about those loss moments, the moment that he was struggling to breathe or when you saw the car accident or whatever it is, if you won't allow yourself to think about it, that has different implications for memory. And then often it does get um more uh emotional so that the process of avoidance is actually sort of calling it up and then suppressing it. So you're actually calling it up more often than you would if you would just let it come. Right? So I mean I I don't want to make light of it. In some of those cases, it can be very helpful if people are having troubling memories and especially if the troubling memories are getting worse over time. This is an important time to seek out a psychologist because we have intervention strategies of how to navigate that. It is not normal for people to get worse over time and for that to persist. So, it is understandable to feel worse on the anniversary. It's understandable to feel worse on their birthday or something like that in time limited ways. But if in general the stock market is is getting worse consistently, that is a time to seek professional help. Thank you for that message. I have one last question, but it's a kind of big one. So, we can take as much time as we need uh to parse it, and that's about time perception. So, when we're kids, you know, hopefully we don't have a whole lot of notion of death, at least at the beginning, and it seems like life is going to go on forever. And that can last into one's teens and 20s. It can be constructive in certain ways. It can be destructive in certain ways. I had the experience where my second adviser, my graduate adviser, all three of my adviserss are dead incidentally, but my graduate adviser was dying of breast cancer and she was very close to the end. She died at 50. Incredible woman. Um, and I did have the opportunity to have a call with her, which you know was an incredible experience and and I'm just going to talk about it superficially because this is I don't want this to be about my experience. I'm using this by way of example. I've cried before on this podcast and a few others. I don't feel like crying today and I'm just going to take that and that's good emotion regulation and and it's my podcast so I can decide when I most of the time I can decide when I when I cry or not cry. So um but it was so interesting that in that conversation you know I wanted to know what I could do you know visit the girls um take there was a course that I helped fund raise for in her name etc etc. Um but one thing that we talked about was the fact that there were these little moments that she had accred in the weeks leading up to what she she knew she was going to die and she even said yeah you know this is going to be our I'll stop she said this will be our last conversation okay so and it was like whoa she got it and she was describing these little moments I'm saying this with joy even though I'm welling up a little bit like the little things like the she had watched the Giants she was a big Giants fan watched the Giants came with the girls. Um they had uh gone to the house of flowers. She was married there. Sently we did her memorial there as well. Like these little moments and it almost seemed as if she was fine slicing time down to a such narrow slices like I almost expected her to tell me that like you know like a bird flew past her window you know like the things that we miss when we're in the speed of life. So it's like not thinking about death allows us to think in these bigger bins. Yep. It's very adaptive. And yet there was something really beautiful. Yeah. About you know what she was experiencing this fine slicing of time. Yeah. And I've been motivated to read there's a wonderful book the secret pulse of time that talks about this somewhat. Um you know if you read uh the denial of death you learn about this. So as people get closer and closer to the end um their time perception changes. They're in a high frame rate and they're gleaning tons of experience in short amounts of time. Do we have any idea what this is? Like I'm I'm sure there's a neural circuit, but I'm curious what you think about this in terms of our experience of life, dying, and grief. Like I said, small questions. Yes, small questions. I know that there is a scientific basis. Um although it is a very difficult time to do research during terminal illness and especially close to the end of life. Um but there is some research in this area. Not again an expert in it but I will tell you that learning to regulate our attention is of course at the basis of learning to regulate a lot of things about our body, our mind, our emotions. And I think that, you know, I think of it this way there are periods of my life where I have very little energy, where I can't shower standing up, for example. I don't have that kind of energy to because of the MS because of the MS. And what it teaches me is first the difference between motivation and energy. So, I can be unmotivated to go to the gym, but if I can overcome the motivation problem, I often have the energy to work out. On the other hand, sometimes I don't have the energy and then it is important for me to stop, right? Because I can do more damage than good. Some days I don't have energy or motivation and that is just the worst of despair. And then some days magically I have both. And it is only because I have known the deprivation that the days I have both motivation and energy are such gifts. And I savor those days. So I think there's a way in which until we can know loss, we can't know abundance either. And when we know loss, it takes smaller and smaller things for it to feel abundant. And it sounds a lot like that's what she's describing in many ways. And what's interesting is the degree to which we can use practices like yoga nidra like other religious or philosophical practices to teach us to regulate our emotions through shifting our attention. I right now can learn to make this the most enjoyable moment of the whole day right now. But that takes a lot of practice, right? I have learned to do that over time because otherwise I couldn't get through those periods of fatigue, you know? So, I don't know. I think there are ways again that we can learn to work with our mind with our brain with our body. We don't get all we don't get to pick all the parameters but we can learn about the parameters to sort of understand how to work with them instead of against them. I think both in terms of the length of our life, the losses and separations we have to endure, and just getting to have this one wild and crazy moment. Love it. Mary Francis, thank you so much for coming here today and sharing your wisdom and telling us about the incredible work you're doing in your lab. You know, you're not just talking about this stuff. you research this stuff in very controlled studies of humans and you know the animal literature and I marvel at your ability to pull from these different sources of scholarship but also that you're so grounded in the clinical practice but also in the in the uh the realities of daily life because if things get too scientific or too clinical they can become a bit detached and you clearly have all three and I also appreciate your willingness to embrace the the spiritual side too u because many people I think about that. Yeah. Or arrive to these kinds of topics with that in mind. So, thank you for the work you're doing in your lab. Thank you for educating us and um I learned so much and I know everyone else did as well. Uh tons of things to put to practice here in the inevitable grief. Yeah. Uh that everyone will experience and uh hopefully the inevitable um reflections that grief also highlights the the good parts of life too. So, please do come back again and and share with us your next steps in the lab. I absolutely will. And Andrew, thank you for bringing the science to people. My pleasure. Thank you. Thank you for joining me for today's discussion with Dr. Mary Francis Okconor. To find links to her laboratory's research and to her two excellent books, please see the show note captions. If you're learning from and or enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zerocost way to support us. In addition, please follow the podcast by clicking the follow button on both Spotify and Apple. And on both Spotify and Apple, you can leave us up to a five-star review. And you can now leave us comments at both Spotify and Apple. Please also check out the sponsors mentioned at the beginning and throughout today's episode. That's the best way to support this podcast. 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