The Grieving Body: How to Heal After Loss with Dr. Mary-Frances O'Connor

0:07Forrest Hanson: Hello and welcome to Being Well. I'm Forrest Hanson. If you're new to the show, thanks for joining us today. And if you've listened before, welcome back. I'm joined today by a very special guest, back on the podcast for a second time, Dr. Mary Frances O 'Connor. Dr. O 'Connor is a professor of clinical psychology and psychiatry at the University of Arizona, where she directs the Grief, Loss, and Social Stress Laboratory. She's an expert on the science of attachment and loss and the author of two excellent books on grief. First, The Grieving Brain, and then her newest book, The Grieving Body, How the Stress of Loss Can Be an Opportunity for Healing.

0:42Forrest Hanson: And the paperback for that comes out on August 11th. So Dr. O 'Connor, thanks for joining me today. How are you doing? Oh, it's so lovely to be back, Forrest. Thanks for having me. Yeah, I feel very much the same way. I loved our first conversation. People seem to really appreciate and enjoy it as well. So we're so happy to have you back to talk about your new book and grief and loss in general. One of the things we talked about last time was how a big challenge for people who are experiencing grief or who are grieving is the way the brain changes based on the attachment bond that we have another person.

1:13Forrest Hanson: And then in your more recent book, you're kind of porting that out to how the body changes based on that same bond and how a lot of this is based on the way that we've come to rely on somebody in a very literal physiological kind of way. So we're going to be talking about a lot today. We're going to be talking about the physiology and a little bit of your research, and it's going to be great. We're going to really get into it. But I wanted to start in maybe a slightly surprising place, which is actually with the last phrase of the book, which is love requires the deep knowledge of loss. And after this deep scientific book, that's kind of the coda you put on the end of it.

1:51Forrest Hanson: And I was just curious, like, why do you end there? Why did I end there? I think there's a way in which losses in our life, not even just big losses, but even small losses, they sort of reveal what we have. Losses reveal to us, oh, this is what this means to me. This is what life is about. This is what love feels like. and hopefully by revealing that we can enter into that feeling of love more even than we did before we had loss. That connects to something that I appreciate about your work in general which is that a lot of people have a frame of grief as something that we get over like our job is to stop experiencing grief and go back to being a quote-unquote normal person whatever that means and you tend to frame it as more of an ongoing process that has natural ups and downs, times when it's better, times when it's worse.

2:53Forrest Hanson: And I think that speaks to how you're holding it here in terms of how you're talking about our relationship with love. This becomes a part of us in a kind of way that then can allow us to build a deeper relationship with other parts of us, whether that's investing more in our relationships or that's feeling more loved broadly. How do you think about that? You know, human beings, we like to put a very clear beginning and a very clear end on things. We like to tie things up with a bow. And of course, that's not how it happens. I mean, if I ask, you know, when did you fall in love with your spouse?

3:27You know, was it the first time you saw them? Was it the first time you kissed? Was it when you got married? Was it when you had your 10-year wedding anniversary? Was it, you know, or even before you met them, the yearning for that person in your life, right? The organizing your life so that you would meet someone. And there is no exact beginning. So why should it surprise us that there's no exact ending either? You know, is it when they get a diagnosis? Is it when we realize they're terminally ill? or when you get that phone call about an accident that's happened? Is it when you see them once they've died?

4:10Is it at the memorial? Is it at the one-year anniversary? Is it when you forget their birthday for the first time in your grieving trajectory, right? So there is no exact end point, just like there's no exact beginning. And it's because I think our life is made up of things that come in and things that go out and we continue to learn and grow from them regardless of how long it's been.

4:42Forrest Hanson: One of the pieces of your work that I connected with the most the last time that we talked and one of the things that makes this particularly difficult for people and also more of an ongoing process is your idea that the brain is running a kind of map to a place that no longer exists. The topography of everything has changed, but we're still running the same old software. I think it might be helpful to bring people kind of up to date on that if they didn't happen to listen to our first conversation. I think understanding how the brain works can give us more insight into how grief works. And it's certainly not the only way to think about grief, but I found it very helpful.

5:20And one of the ways I think it's incredibly useful is to know that the brain considers our attachment figures so important so critical to our survival that while our loved ones are alive, we always know, if I say, you know, where is your toddler right now and how long would it take you to get there? You have a pretty good idea of exactly where they are and exactly how you would get there. And the same is true for boyfriend, girlfriend, spouse, you know. We are constantly mapping the world with our loved one in it. And that is critical for reuniting with them, which is how attachment relationships work, which is so important to human beings and other social mammals.

6:08So what's interesting is you have this map then. This person exists in the world, even when they're not in your presence, right? They don't have to be, you know, you don't have to be able to see them or smell them to know that they are there and that you will get back together with them. You will move heaven and earth to be reunited. So the problem is that this way of viewing the world, this map that the brain has, doesn't change immediately when someone dies because they don't have to be in your presence for you to know they are everlasting, right? That was the whole premise of how attachment works.

6:54And so what it means is our brain really has a memory system. On the one hand, it knows the reality. You can tell me that your loved one has died. And simultaneously, so they're gone but also everlasting. There is a piece of you that feels they're just going to walk through the door again. This is some terrible mistake. And those two pieces of information are coexisting. these two maps of the world are coexisting and every time they conflict then we have a wave of grief you walk into the room and they're not in their favorite chair where they should be right and so then we have this wave of grief and our and our brain sort of struggles for a long time to update our understanding of the world to stop expecting them in all those myriad tiny ways that we do.

7:45Forrest Hanson: Is this one of the reasons that ambiguous loss can be really difficult for people? Because it's right there in the name of it, there's that additional layer of uncertainty or ambiguity that's kind of tied to it? Absolutely. And we think of two kinds of ambiguous loss. The one is sort of when the physical person is still present, but their personality is gone. So often in cases of dementia, you may walk into the room and your elderly dad or your spouse is still in the room, it still looks like them, but it's not the relationship that you had with them before, because they are not the same person any longer.

8:23And so you have this ambiguous loss where you're caring for the physical person, but you are mourning the loss of their personality, of your relationship. And the other kind of ambiguous loss that we think of is sort of the opposite, where someone is missing. And that can be for a host of different reasons. And family members don't know how to think about that. The person, their body is no longer in this physical world. They can't get to them, but they have no reason to, there's no closure on whether or not they've died. And so you're sort of stuck with this ambiguous two maps without a way to resolve necessarily how things are.

9:08Forrest Hanson: The other thing that I was just wondering about as you were giving the description of the map of the brain, and this might connect a little bit more to some of the physiology, which we're going to talk about in a little bit, but phantom limb syndrome, how if you lose a limb for whatever reason, people can still feel it in a funny kind of way. It's as if the hand is there, even though it's not there anymore. And I'm wondering if there's any connection there, or any relationship with the neurobiology? You've done so much imaging work and related work. I have to, you know, the scientist hat in me has to say that we don't have exact work supporting this hypothesis yet.

9:45But I think that the theoretical connection is strong enough that I suspect as we are starting to look to how the other person is sort of represented in our brain and the fact that we seem to represent not just the other person and ourself, but we also have a representation that is we, right? That is activated by the two of us together. You know, we moved to California or we bought a couch or there's not, it's not like I bought a couch and you bought a couch. It's we bought a couch, right? So, I mean, I think there's reasons to think that our brain is really mapping a sense of us as a unit, a we.

10:27And what I think has been helpful about bringing neuroscience to grief, bringing that lens, is that, you know, in the sort of 80s and even 90s, we sort of thought of bereavement, the stress of loss, as kind of another thing added to the plate, right? If you're trying to carry a big plate and it's got, you know, you got to do the taxes and you got project at work and your child, you know, bit someone in kindergarten. And, you know, there's all this.

10:56Forrest Hanson: Kind of a wild frame to put like serious grief on the same level as like, you know, struggling with your taxes or whatever it is. But yeah. But in the sense that you sort of have this plate of stressful things you're managing, right? Sure. No, I totally get it. It just sort of, it seems like categorically so different to me at this point. But to your point, that's the culture I came up in. Yeah. Exactly. Right. That this is granted a more profound stress, but the idea was this is another stressor. But now the way I think about it is more that you've lost the arm that would hold the plate up, right?

11:33That it's not just that you're trying to manage a plate of things. It's that part of you, the part of you you rely on in times of stressful events, part of you is gone. And so managing it isn't just about an extra level of stress, but it's actually that a part of your resource, a part of who you are, has been taken from you.

12:00Forrest Hanson: So this is probably a good moment to do the little turn toward what you've been working on more recently. Grief is usually described as something that's mostly emotionally driven, something we feel, we think about it, we kind of carry it in our minds in a kind of way. And what I found really radical in this book, which I was not personally aware of before reading it, is how grief is a difficult experience, not just because it's an emotional experience, but it's a physical one, a physiological one as well. The idea from the book that I found the most radical was the notion of an external pacemaker.

12:33Forrest Hanson: So that might be a way into talking about this a little bit. I think it connects really well to this description I was just giving you. So you could imagine lots of things make your heart rate go up, right? You know, you get into a fender bender, of course your heart rate's going to go up. And so the idea was sort of, well, you have this loss and of course your heart rate will go up because you're responding to this external stressor. But I think there is more to it than that. When we are in a relationship with someone, it isn't only in our mind that we are in a relationship with them. It isn't only a mental event, but our body is in a relationship with them as well.

13:15And what I mean by that is, we know from scientific research, if I walk into a room and my partner is there, my heart rate goes down a little bit, right? If I come home at night, my blood pressure drops a little bit. We know that if you do what we call kangaroo care, if you put an infant on the bare chest of a mother or a father, that the infant regulates their temperature better, their body temperature better, and has less pain responses. And so it isn't just because of something mental that these things are happening. It is a physical interaction. You are in a physical relationship with this other person.

14:03And so what that means then is when I have to walk into my home night after night, you know, five o 'clock, 5.30, I open the door and I walk inside, my heart rate should drop. But it doesn't because they're not there. And in fact, it is a cue. What is there is their absence, right? And so my blood pressure may actually go up rather than down. And so this is what I mean about them being an external pacemaker. When a relationship is present, we are co-regulating each other. You know, your partner can give you a look from across the room that says, oh, I understand what's happening to you right now.

14:45And you can both sort of feel better in that moment without any words exchanged. So I think thinking about the idea that when there is loss, our physical body has had something taken away. We have to learn how to regulate our heart rate when we walk in the door. We have to learn how to wake up in the middle of the night and go back to sleep, even though our partner isn't next to us.

15:13Forrest Hanson: The most dramatic example of what you're talking about would be things like stories of somebody dying of a broken heart. For starters, is that a real thing? It is. And we've known about this actually from even the 1960s, 1970s. In fact, insurance companies could see in the data the likelihood of a widow or widower was not as likely to survive. And so the statistic that I often quote that comes from very large epidemiological data is that in the first three months after the death of his wife, a man is almost twice as likely to have a fatal heart attack compared to a man who remains married during that same time.

15:58almost twice as likely, which is just a huge medical risk statistic. And for women, it's slightly less, but it's still 1.8. So this tells us that the body having to navigate this amputation, having to navigate how to regulate in a world without our loved one, it means that it tears at our tissues, as it were. It impacts our body as we are trying to grapple with a map that makes no sense.

16:35Forrest Hanson: And so just expanding that out for people who might be listening to this, who are probably, because they clicked on an episode like this, are disproportionately likely to have gone through something or be thinking about these kinds of topics. Also, we've all gone through things along these lines. Everybody's lost somebody. And I think that the grief frame is most commonly used for, you know, you lose a loved one or something like that. But there are many kinds of grief. There are many ways that this can show up in a person's life. And so just kind of shifting the frame from it being this purely psychological process to being a physiological one that includes symptoms, symptoms that you've written and talked about, like brain fog or fatigue or, you know, immune vulnerability, other stuff we'll get into.

17:18Forrest Hanson: It's uncommon for people to recognize these as being directly tied to a grief experience. So layered on top of all of the other stressors that you've been talking about, there can be the sense of like something is wrong with me or just like something is not right that then becomes another kind of stressor on the pile. So just the psychoeducation around it, I think, is already pretty valuable for people. Yes. And I think I finally have come up with this phrase as a way to kind of condense a lot of information into one sentence. our body is being remodeled as we are living through this bereavement.

17:55Over 90 % of people indicate that they have sensations in their chest while they are grieving. So what's important here is if it's over 90%, it's totally normal, right? And so I don't want people to be afraid of their body, of their grieving body. I want them to notice it because, and here's the sentence, we want to support heartache, which is natural, but we want to prevent heartbreak when the body gets outside the bounds of what it can sustain as we are grieving.

18:33Forrest Hanson: Are there things that you would point to that are kind of in that second category? Like how do you draw the distinction between those two things? Well, I will say I think that this is an area ripe for research. I think there's an interesting analogy here between pregnancy and bereavement. Stick with me. The idea is that no one would say pregnancy is a disease, right? Pregnancy is totally normal and natural. No, but it is a risk factor. Yeah, totally. But it is a risk factor. It's a time that is medically risky. No one would say pregnancy isn't physiological. And so what we've done is we've created systems of care.

19:12We have guidelines of what is normal in a pregnancy. And at what point in our assessment of a pregnant person do we decide, ah, this is gestational diabetes, we should treat this. Imagine now if we thought of grieving as the same thing where a person, it's not a disease, It's a totally natural and physiological phenomenon. But we can come up with guidelines. At what point is bereavement-related hypertension require intervention? Do you see what I mean? And so, you know, people will say to me, oh, yeah, my blood pressure is high, but it's my grief. And I think, yes, but it still needs to be treated.

19:53Your high blood pressure still needs blood pressure medication. It doesn't matter if it's salt or genetics or bereavement. you still have to, you know, at a certain point, protect the heart. And so thinking about it that way, I think is useful, because people might be less afraid of their grieving body. What I recommend is that we get our normal doctor visits. Have you had your annual checkup? Have you had a blood draw with just your regular levels tested? Have you had your blood pressure tested? Have you been to your dentist? Have you had your mammogram? These are the sorts of normal health-promoting surveillance that we do that will catch when things are getting outside the normal bounds of what the body can handle.

20:43And it doesn't entirely matter if it's because of the grief or not, except in the sense that it may improve as we adapt, right? And so you also want to just follow up. If you have hypertension right now and you get treatment for that, six months later, you should also be going back just to make sure, is this still appropriate treatment given where I'm at psychologically as well as physiologically?

21:11Forrest Hanson: I have so many questions about this because I find this totally fascinating. To start at the simplest one, which I'm sure is also totally not simple, about how long does this elevated risk take to resolve for a person? Does it just totally depend? This is such an excellent question. And so I think of it in a couple of ways. First, I would just put a plug for more research is needed so that we have a better sense. I think from these epidemiological studies, what we see is that the first 24 hours after the death of a loved one, you are 21 times more likely to have a heart attack that day than any other day of your life.

21:5721 times more likely. And so what's important here is the acute risk is the highest, and then it drops off really rapidly, but say at three months, it's still twice as high. Do you see what I'm saying? And we can still see elevated risk even three years after the death of a spouse, but it's not nearly as elevated. So one pattern that we can see is that acute grief has these physiological effects, and we do seem to, you know, the body is resilient, right? The body sort of gets the systems back into regulation. But in addition to that, the other thing I think that's so important is it isn't about, it isn't just about the loss, the day of the death.

22:48It's about our grief. And so for most of us in the first six months, in the first year, we start to feel like we see change. It doesn't mean we stop grieving. What it does mean is grief starts to feel more familiar. We start to understand this is what I can do to comfort myself or this is how I can navigate life given that my loved one is gone. And so what's important is if you're feeling really stuck, if your grief remains as terrible as it was in that acute few weeks or months, if your grief is severe and elevated, your body is still reacting in that acute way. And so what we see is that this type of chronic grief, this type of elevated grief severity can continue in some people.

23:48And so those people we know remain at high risk for medical outcomes, even though time is passing. Does that make sense?

23:56Forrest Hanson: Yes. And that's totally fascinating to me that the experience of prolonged grief for just, you know, people who are still feel that intensity of maybe not quite the same way it was in the initial moment, but still the intensity is very, very high years and years after. That that is also associated with higher physiological risk factors because it suggests what your work suggests, which is that these things are very intimately connected with each other. But it's just a really interesting finding. Yes, and I think it just warrants us learning to listen to our body, right? So that we start to wonder, is there a way that I could learn to soothe myself that I haven't figured out yet?

24:44And it can require not just medical intervention, but psychological intervention, which has a consequence then for our physical body.

24:53Forrest Hanson: Is there anything that people can do during that elevated risk period to take better care of themselves? Absolutely. So I think one of the difficulties of, you know, me saying so, you know, off the cuff, you should be, you know, making sure you get to your doctor for your annual checkup. For many people who are bereaved, yeah, they can barely get their shoes on the right feet, you know. Yeah, understandably. That's tough. Yeah. Right. All those habits start to fall away because the external support's just like totally vanished. Yeah. That's it. Exactly. And so I think, you know, I know my girlfriends and I will text each other, had my mammogram.

25:32Have you had yours this year? You know. And I think that this is where social support really matters. If you're supporting someone who's grieving, you're not just supporting their mental health. you're also reminding them about their physical health in a way that works in your relationship. I don't mean you're nagging them, but the sort of, hey, you know, you told me that you were going to go get that colonoscopy, but I haven't heard anything since then. Did that ever happen? You know, or, hey, let's take a walk and just sort of get some movement, you know, into our day. Or How is your sleep these days?

26:13Is there anything you're worried about about your health that you haven't really told anyone? These types of questions provide support for the body as well as the mind.

26:25Forrest Hanson: We'll be back to the show in just a minute, but first a word from our sponsors. This episode is sponsored by Rocket Money. A while back, I was looking through my bank accounts and I found a subscription that I had completely forgotten about. It wasn't that much on the surface, but it had been auto-renewing every month for longer than I'd like to admit. And these days, it feels like everything is a subscription. It can be really difficult to stay on top of all of them, and they can add up pretty quickly. Rocket Money makes all of this easier to handle. It tracks your subscriptions, and if there's one you don't want anymore, you can cancel it right inside the app in just a few taps.

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29:52Forrest Hanson: It has 35 grams of protein, 7 grams of fiber and under$5 a meal. This is a limited time offer. Make healthy eating simple. Get Huel today with my exclusive offer of 15 % off online with my code beingwell at huel.com slash beingwell. New customers only. Thank you to Huel for partnering and supporting our show. Now, back to the show. There was a particular intervention I read about in the book that I I don't know if this is just because I'm a huge nerd or what, but it just popped for me off the page, was low-dose aspirin for people who are going through acute bereavement. And again, it just really highlighted the idea of aspirin as a treatment for grief.

30:38Forrest Hanson: In the frame that I'm walking around with, before I read this book and walked into this conversation, grief is a psychological experience, essentially. So the idea of a physical pain medication as an intervention would have just been totally wild to me before reading this thing. So I just want to talk about that a little bit. So the first thing I have to say up front is that the studies that have been done with aspirin have been very, very small, really just proof of concept. And I appreciate you mentioning that, by the way. Like every time you're like, hey, caveats, it's great. Yeah, exactly.

31:09This is not the established frontline treatment. But in the studies that have been done, what's notable is that heart health was improved with a baby aspirin. This is the low-dose aspirin you were mentioning. And of course, it shouldn't come as any surprise that heart health was temporarily improved. What's important is we don't actually use aspirin as a preventive medication anymore across the population. So what I'm suggesting needs to be researched is in this time of greater risk, does it then make sense to use this type of prevention treatment. So for example, taking aspirin in the first two weeks or the first six weeks after the death of a loved one, could this reduce that elevated risk in a way that we wouldn't do it, you know, for the rest of the person's life?

32:08And what's important to know is, of course, aspirin is over the counter. If you are allergic to aspirin or you have had a history of ulcers, then aspirin is not a good idea. And there are specific, you know, reasons why people may have been told not to take aspirin, and this does not supersede any of that. But the idea here is, if we want to think about the fact that bereavement happens across the population, if we want to think of a public health approach to bereavement, then potentially a brief duration of aspirin, which might have very low risk profile, could help in a very large population to just tap down the risk of a broken heart that we see.

32:54Forrest Hanson: Yeah, that's, again, just totally wild to me. Is aspirin's primary intervention on reducing inflammation? Is it like some other pain medications that way? Or does it have a different way of interacting? Because if it's inflammation-based, then that would be really interesting based on some of the other stuff that you were writing about. Yes, it is a type of inflammation. So it turns out there's multiple kinds of inflammation in the body. What it does is also has a very specific effect on clots, blood clots. And so it prevents clotting from causing stroke and heart attack in a very specific way.

33:34Forrest Hanson: Really interesting. I found the relationship between the immune system and inflammation and brain function and grief that you walked through in the book really fascinating. And I I would love if you shared some of that here. One of the findings, one of the scientific facts that shows up again and again in research is that people don't only die of a broken heart. They are actually dying from all types of causes and getting all types of illnesses. They literally call it all-cause mortality. So they're getting more COPD. They're getting more diabetes. they're getting more cancer recurrences, they're getting, right?

34:16And as a researcher, I thought, well, this doesn't make sense in my knowledge of physiology. What on earth could be affecting all of those body systems? And then, of course, it dawned on me that the immune system is affecting all of our organs. And that research from my lab has, and research now from other labs with larger samples, has shown that inflammation increases in bereavement. And so for a person who has asthma, that looks like more difficulty breathing. But for a person with rheumatoid arthritis, that looks like joints that are achier, right? So the symptoms look totally different, even though the cause could be at its base the same.

34:58And so if we think about it that way, knowing that inflammation is increased, and knowing that there's sort of a very personalized response in grief, where inflammation will affect you in one way and someone else in another, can be very helpful. In my own case, after my mother died, a little over a year after my mother died, I was diagnosed with multiple sclerosis. And to be very clear, her death did not cause my multiple sclerosis. I have lots of risk factors. It runs in my family and so forth. But the fact that it emerged at a moment where I was having this profound stress, that my immune system was under greater duress, perhaps it isn't so surprising that these things would come together and that would be the moment that it would emerge as a diagnosis.

35:53this.

35:53Forrest Hanson: We're pretty confident that inflammation can increase for people, broadly speaking, like broad markers of inflammation after bereavement, and it can remain relatively elevated for somebody for an extended period of time. I'm quoting you to you a bit here. So I want to ask a little clarification about those different terms. How much do these markers increase? What does it mean that broad inflammation increases? What are the consequences for people of this in terms of their experience. It'd be great to kind of piece this out a little bit. Absolutely. And unfortunately, you might not be super happy with my response.

36:32Forrest Hanson: Vagueness is great and totally wonderful in science. We had a couple of episodes recently on essentially like the scientific method in psychology and research and evidence and, you know, what you can trust and what you can and all that. So I appreciate all of your caveats here. The good news is I can help to explain why there is vagueness. That might at least be reassuring. So one reason is that the type of inflammation that we can see in research studies that is elevated is not the same kind of inflammation that you get from a regular blood test at your doctor's office. And so we're looking at a very specific marker, something like interleukin-6, IL-6 is elevated.

37:17But that's not a regular test that doctors do in the lab when you get a blood test. So one reason is that the types of inflammation we're seeing aren't necessarily, in research studies, aren't necessarily something that you're going to go in and ask to have tested. What's important here is that we know the body is under greater strain, that we know from the research that there's greater inflammation going on. And so that only becomes important, remember, if we're dealing with sort of end-stage diseases that one might get, like something like getting rheumatoid arthritis or an MS diagnosis or a Crohn's disease diagnosis.

38:04So on the one hand, I can't give you super specific, like, here's the guideline for how much it should go up. But this is why the subtitle of the book, The Grieving Body, is how the stress of loss can become an opportunity for healing. And the reason that I say that is, you know, many of us, our body, at least this was true for me, our body is really just there to move our brain around. We don't spend a lot of time in our body listening to its signals, measuring our heart rate or blood pressure until we can't ignore it any longer. So what's important here is when a loss happens, when you get that terrible phone call, when you go to that funeral of a loved one.

39:02You walk into that scenario with whatever body you have in that moment. So if you are going through menopause as you walk into bereavement, that's going to be a totally different physical experience than if you're 26 years old and you run a mile every day, right? So who our body is when the loss happens is going to come together and form a unique constellation that is our grieving body. And this is the second reason why I can't give you too many specifics because I don't know you.

39:41Forrest Hanson: Yeah, it's such an individual process, totally. Exactly. But you can come to learn yourself. You can start listening to your grieving body and ask, what helps? What makes me feel worse? How do I explore the opportunities for health here? Given that I am rewriting my narrative now anyway, not that anyone wants to, but the reality is you are now cooking for one or sleeping alone or deciding what retirement activities will look like, how do I do that in a healthy way that makes sense for my body, given my age and interests and emotional makeup and relationships and neighborhood, right? Totally. And as a part of that, I'm wondering how the form that grief is taking for a person affects this whole process, this idea of the external pacemaker, another physical body, literally serving a kind of regulatory function for our own, you could imagine how in cases of bereavement, that all falls away, right?

40:52Forrest Hanson: But there are other forms of grief or loss that people experience that aren't bereavement. And I'm wondering if they still have these kind of physical aspects to them, or if these physical risk factors exist, or is this exclusively for bereavement? How do you part all of this out? Absolutely. And I could enumerate some research, for example, in divorce, we also see the risk factors increase for physical illness. But I think actually, in my experience, there's maybe a better sort of grief literacy way to think about this. When we have a loss, and that loss can be the death of a mother, that loss can be a loss of health, it could be the loss of a job, it could be moving house, you know, any of the things that you might think of, that's a real loss in my life.

41:45That's something important that has really shifted. We know that there are two classic responses when we have loss. And I'll describe it at first in terms of the loss of a person, because that's the easiest way for us to think about it. And then I think you'll see the connection kind of quickly. So let's say you're in the grocery store and you look down and your toddler is not next to your leg, right? That feeling that you're having right now that, oh no, they're gone. That is what we call protest. And protest is a really important response to the separation from someone in our life, right? It motivates us.

42:29It literally gives us adrenaline and cortisol to find them and to call out to them and to do everything in our power to seek them out. But you can see how physiological that is.

42:42Forrest Hanson: Yeah, for sure. Now, if that was a death, eventually there is a second classic response that we see. We see this in animals. We see it in infants. And this response we call despair. And that is, oh, no, they're gone. And even just hearing it, you can feel how physically different that is from protest, can't you? You can feel the withdrawal. You can feel the heaviness. What's important is that the information, oh no, they're gone, is the same in both cases. It's our response to that information that is completely different and is completely physical, right? And so what's notable here is despair is important.

43:36It is important to have these moments of despair because we stop questing for them. Despair resolves protest. protest. Despair allows us to say, I'm not going to keep reaching and yelling and trying to make them return. Now, despair is not the end of the story either, because in despair, we feel, oh no, they're gone, and I will feel this way forever. And that is also not true. So when we have enough experiences of protest and despair, and I should say this doesn't happen once and it doesn't happen in a linear order, we go through this sort of again and again as we learn what it means that our loved one is gone.

44:28But when we have despair, we eventually learn, oh, they are really gone, and also I can continue to live a meaningful life even with their absence. And that takes a long time and often requires borrowing the hope of those around us who might support us during that time. But here's the connection now to other losses. When I was diagnosed with MS, I will say there was a lot of protest where I said, oh, no, no, this is not going to stop me. I'm going to do everything. I'm going to be the best academic and I'm going to work out anyway and I'm going to you know, take trips to Hawaii. And the protest of, oh, no, this is not happening, was not very good for my body.

45:20And then there were other moments of despair where I said, I can't do anything. I can't go to work. I shouldn't write this grant. I'm, you know, I'm not going to, you know, have children. I'm not going to go out to dinner. I'm the despair of I can't do anything given I have this diagnosis. And then, of course, eventually, although I still have moments of protest and despair, I'm not going to lie, but eventually I realized I can have MS and I can also have a meaningful life. It doesn't look the way I thought it would by any stretch of the imagination, but I can have that with loss. And so you can see how moving home or your children leaving for college or the loss of your job or retirement or whatever it is, that response of protest and that response of despair are going to be very common.

46:14And we can learn how to respond to those in ways that allow us to continue to go on and continue to build a life even though the loss is true.

46:26Forrest Hanson: I remember reading in the book that you had this part of it where you wrote about going from panic to despair and being able to, I don't know what quite the right word is, you have a pretty strong meditative practice in addition to the work that you do as a science and researcher. And you mentioned that this might have contributed to your ability to hang out in the feeling without being in resistance to it anymore. We talk about resistance a lot, both in psychology and to some extent in contemplative Buddhist practice as well. A kind of resistance to acceptance or to landing fully in the moment just as it is, as opposed to having a lot of preoccupation with what we would prefer it be.

47:07Forrest Hanson: and I'm wondering if there was anything from that experience that you had that you would want to share with people, whether that be as advice or just more of a sense of kind of common humanity in this whole thing. Learning a contemplative method, doing training in Zen Buddhism, in mindfulness meditation, in self-compassion meditation has quite literally probably saved my life. learning to sit in a body that is having strong emotions, that is having physiological responses, and both allowing that to be true and also finding equanimity, not giving it more attention than it deserves in that moment.

47:52I think of it kind of this way now. The wisdom is things are not the way I want them to be. I did not want this loss or I did not want this diagnosis. And the compassion is, I feel for you for having to be in this life where things are not how you want them to be. I can understand that you would feel anger and protest and despair and, and it isn't your grief, it is human grief. And this connection, this realization that the grief that I am experiencing is not my fault, I am not to blame, it is the natural human reaction to loss. And that means when I see you experiencing grief, I feel a connection.

48:55I feel compassion for you that you have to endure this loss. And somehow by sitting side by side, silently maybe in meditation, or just sitting drinking tea with you, I know that it is not on me that I am feeling grief, but rather I am having a human experience. And this gives me strength and also, yeah, self-compassion to just be with that, allow it to be true, and then walk into whatever the next moment holds, which will be different.

49:31Forrest Hanson: I wanted to ask you a little bit about prolonged grief, which occurs for about 10 % of people, if I'm remembering the statistic correctly, who just seem to experience the kinds of things that we're talking about for a longer period of time than other people for whatever reason. Maybe it's physiological on some level, like you were talking about. Maybe it's psychological on some level. Maybe it's a kind of resistance to landing in despair, understandable resistance to landing in despair and doing the process related to it. How do you think about prolonged grief, maybe connecting it to what you're talking about now, which I think is a really interesting frame for it.

50:11I think it's really important to distinguish the idea that, you know, grief never goes away. The feeling of grief, the arising of those thoughts and feelings, and then the ceasing of them, those waves, that doesn't go away. 10 years later, 20 years later, 30 years later, you're still going to have waves of grief when you think about your mom not being here now. And there's nothing wrong with that. That is totally normal. What we mean about prolonged grief is the type of grief, these waves of grief that are preventing you from doing other things in your life. So that it's preventing you from getting dinner on the table.

51:00It's preventing you from being able to listen to music. It's preventing you from going to dinner with your friends or going to church, whatever it is preventing you from doing. Prolonged grief means that you're stuck, that there's no learning trajectory, which is what we anticipate. It is that you feel frozen in time as though it is still happening the same way it did initially. And what's important about being able to identify prolonged grief, which we can now with really clear criteria for someone who's trained to use those criteria, what's important about that is we have evidence-based interventions, psychotherapy, that find ways to help us get unstuck.

51:50That can be that with the support of a therapeutic relationship, we can find the courage to try new ways of experiencing the world. We can decrease some of that avoidance that's getting in the way of our learning. We can try new habits. We can consider what is meaningful, you know, what values do we hold and how do we take small steps to live those values even in the face of loss. So there are these evidence-based psychotherapies that can help us to get unstuck. It doesn't get rid of grief because grief doesn't go away, but it does enable us to build a life around grief. Now, the question of sort of how does that relate, I think, to our contemplative traditions is the idea that, you know, when we sit in meditation, the idea is not to get rid of your thoughts.

52:51you would be a zombie if you got rid of your thoughts. Who wants to grow up to be a zombie? That's not the goal. The ability to let those settle so that they're not preventing you from seeing reality as it is now, that is sort of the goal. And so allowing grief to be true, but not allowing grief to prevent you from living in the life that you've been miraculously given. That is ultimately the goal.

53:26Forrest Hanson: I think there's also some overlap here between prolonged grief and one of the things you write about, and again in the book, the dual process model of grief. We talked about this about three years ago in our previous conversation. It's this idea that there are different kinds of stressors that a person might be facing. There are loss-related stressors. We've talked about those so far, essentially. But then there's this other category, restoration-related stressors. And the idea is that the person not only has to learn how to carry the loss of a loved one if we're dealing with a situation like bereavement, they also have to figure out how to live a meaningful life without that loved one.

54:04Forrest Hanson: And these are called restoration-oriented stressors. Like what will, you were giving some examples earlier on in the conversation. What might retirement look for me? And now that my spouse isn't around anymore for whatever reason. If you're a younger person, you're going off to college and you lost your parent recently. How are you balancing these two things together? How are you going to form a meaningful relationship with this new experience now that that person is no longer here? When I was prepping for this conversation, one of the really interesting ideas that I ran into is that people who get kind of stuck in the acute grief experience are doing this in part because healthy grief is a kind of movement from loss-related stressors to restoration-related stressors.

54:50Forrest Hanson: And in persistent or prolonged grief, you kind of get stuck in one of those camps. And I was wondering, for starters, is this more or less how you think about it? Would you want to put a finer point on this? What does this look like in practice, all of that good stuff. That is such an excellent description for us. Oh, thank you. You've all said it as well or better than I would, I think. That was really useful. And what's important is it just also looks different for different people. So I'll give you a very simple example. Yeah, the idea of getting stuck in restoration might not make intuitive sense for somebody.

55:26Forrest Hanson: So what does that kind of look like? Yeah. So one of the classic examples of getting stuck in restoration. And again, this is sort of culturally bound. It's bound by the gender roles that we're taught and so forth. So when I was a clinician, I worked a lot with families where there was breast cancer, and especially the genetic form of breast cancer. So women who often died young and their daughters who were then being followed as adult women because they were at higher risk themselves, would talk about what happened after their mom died. And they would sometimes talk about the idea that their father, who was himself a young or middle-aged man, didn't always know how to handle the grief, didn't know how to handle the loss-oriented stressors, and especially given he was now a single parent.

56:17And so many of these women described that suddenly all the photos of mom were taken out of the house. Mom was not talked about. We didn't go to the graveside. Dad sort of got remarried and it was as though it never happened.

56:35Forrest Hanson: Just moving on in that kind of way. Yeah. Exactly. And while these things are very important to restore in one's life, new relationships, to restore habits and rituals, right, that are about today, if they are done in the absence of recognizing those loss-related stressors as a way to avoid the feelings that come with loss and grief, then that tends not to make a very healthy environment. As you said, the most kind of the healthiest outcome is to be able to oscillate back and forth. So another couple that I knew whose teenage daughter had died, she wanted to have photographs up all over the house of their daughter.

57:23And her husband couldn't bear to look at these photographs. But because they understood grief, because they understood that they were each dealing with these stressors differently, what they created was a situation where there was one room that had all the photographs that you could want of her in all the stages of her beautiful life. And what it meant was he could go into that room if he wanted to, to confront that loss. And she could go into that room when she wanted to be with those memories and photographs. but that as he was walking through the house, he wasn't confronted with them kind of unexpectedly.

58:02And that for him was important in restoration, that he would have the ability to regulate when he was sort of confronting loss. And so what it means is together they decided a way that could work for both of them while supporting each other and seeing that both ways of grieving were natural, that they needed both aspects, that maybe they needed them in different proportions or they needed them in different activities.

58:29Forrest Hanson: And I think this just highlights something that's been running under the whole conversation and that you've been careful to name over and over again, which is how individual this whole thing is. There's a great line in the book, the data from laboratory science or even intervention science tells us very little about you specifically you. This is one of the things we talked about recently when we did this episode on research, how we're talking about distributions with all of this stuff, a wide range often of distributions. And so if I say an intervention is pretty good for fill in the blank, what I'm saying is that depending on how that researcher sliced and diced the sampling and information inside of the studies, you can be reasonably confident that for the average person inside of that distribution, this intervention does something.

59:19Forrest Hanson: That's a lot of reasonables and maybes and averages and some things. And what you often find inside of any given study is that there were subsets of people for which any given intervention was either extremely effective or extremely not effective. Now, do those subsets exist due to entirely random factors like luck, chance, sampling bias, whatever's going on there? Or does it say that there are some particular interventions that really are really good for some people. And it's really hard to say with all of this stuff. And so one of the things that I appreciate about conversations like this are actually the number of caveats that you've given as we've been talking and a kind of appreciation for the individuality of this whole thing as we've been exploring it.

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1:01:27Forrest Hanson: Now, back to the show. I think I am more and more struck by the idea that, you know, science can give us this sort of parenthetical phrase, right? Like, I'm going to study this little phrase here and know everything about it, the ins and the outs of it. But I am more and more, and it is very important, right? It's so important to know that you're at higher medical risk, for example. But it's only important to know that so that you can use that information. And I think at the end of the day, what I think about more and more isn't just the scientific studies, but is how should we treat each other given that there is loss, given that there are these physiological and psychological consequences of loss, and how should we treat each other is not a scientific question.

1:02:25it's an ethical or humanistic or even philosophical religious question. And those can be informed by science, but it's not the same thing.

1:02:35Forrest Hanson: As we wander into the last quarter-ish of our conversation here, I would love to do a little bit more on what can help people through this whole thing. Another thing that was in the book that I thought was really interesting was this idea of progressive muscle relaxation as a kind of intervention for grief. I believe it was one of your graduate students who did this study comparing it to mindfulness and you got some really interesting results there. So this was a project by Lindsay Knowles, who is now a faculty member at University of Washington in her own right as a psychologist. And she was very interested in mindfulness, as you say, as an intervention to help people sort of deal with some of the thoughts that they're having when they're grieving.

1:03:18And so she did this study. She got funding and did this study. She got funding from Mind and Life and did this study. Oh, very cool. Yeah. But as a good scientist, she wanted a strong control condition. So people met in groups and she did mindfulness training with them. And then in other groups, she did what is called progressive muscle relaxation. And this is something that was developed in the 1970s and has been refined in a minor way, but is largely the same since then, where people are taught to clench and relax the muscle groups of their body in a systematic way and really noticing what it feels like.

1:04:05What's the difference between muscle tension and relaxation? And so it's a wonderful control condition for mindfulness because it's not about your thoughts at all. It's about that physical relaxation, that physical noticing. Oh, and I should say, as a really great scientist, she also had what we call a wait list control group. And so this was a group, because grieving tends to improve on its own naturally, we also had a group who did not receive either intervention, but they were taking all the same assessments over time that the other two groups were. Ethically speaking, we also then allowed them to do the treatment later, so they got something in the end.

1:04:43But the upshot here is, of course, we were anticipating mindfulness would be the most effective treatment. And lo and behold, both treatments were effective, mindfulness and progressive muscle relaxation. But PMR worked more quickly and overall was slightly more effective than mindfulness. And this is very interesting, isn't it? That attention to the grieving body could affect the grief severity outcomes, the emotional, psychological outcomes is very interesting. And I think potentially, Lindsay talked a lot about it being for two primary reasons. The first one is when we're grieving and we're having all these intrusive thoughts and we're having brain fog and, you know, there's a lot going on in our mind, it might not be the easiest time to take up a new skill like learning mindfulness meditation.

1:05:42The second reason is that people talked a lot about the progressive muscle relaxation was something they could do anywhere, anytime. If they were standing in the grocery line, they could practice it. If they were trying to fall asleep at night, they could practice it. It gave them a sense of a skill that they could rely on at any time to help them with these waves of grief. And your mind, of course, is being utilized in slightly a different way. And so I think this, yeah, this skill set gave them an opportunity to find calm and soothing within their body that supported them through this process.

1:06:27Forrest Hanson: This is a really complicated topic that I'm just going to hand wave at right now, and then we're going to kind of keep moving. But just in general, in the Western psychological tradition, our approach to mental chatter is to kind of try to go head on a lot of the time. Stinking thinking, CBT approaches to working with thoughts. And to be clear, these can be really wonderful for a lot of different things. But there's also a lot to wade through when you're doing that. You kind of got to battle it out, you know. So if you're able to some extent to kind of drop down to a different level, which is more or less what PMR is doing, you're really interacting with the body as a body, it can be kind of a way to almost get around all of that mental content that can be so debilitating for people when they're experiencing grief and grieving.

1:07:11Forrest Hanson: So I just thought this was a really cool way through something that can be a very difficult part of the experience for people. Well put. Maybe related to this, There was another thing that you wrote about that I wanted to ask you about a little bit in terms of, again, what to do, which is exploration inhibition. The idea that attachment figures aren't just regulating physiology. Of course, they're doing that to some extent. They're serving as this idea of a secure base. This is the home from which you're venturing out into the world. And one of the things you wrote about is how people who are going through a grief experience often start to lose interest in a lot of the things that are also regulators for us, like work, social relationships, hobbies, not because they're depressed exactly, although that could be a piece of it, but because the person who made those things feel worth doing is now not around anymore.

1:08:03Forrest Hanson: And then this then carries over to having all of these negative knock-on effects for them because those things have disappeared from their life. Yes. And I think often what we do in prolonged grief treatment when we're specifically trying to address this difficulty that people who've been grieving a long time are having, not wanting to explore the world, is to really think through who are you now that you've had this loss experience. You're not the same person that was married to your spouse because you have gone through this whole experience. Sometimes it also means reconnecting with who you were before you had the relationship with the person who has died.

1:08:49So what were the things as a teenager or even as a child that just brought innate pleasure to you? There's a very good chance that if we try to do some of those things again, and it's a very slow upward spiral. But if we try to do some of those things again, something is stimulated in us that is inherently pleasant. So, you know, I sometimes give this example of, so for example, let's say you have a married couple and the wife dies and the husband says, I'm not going out to dinner with our couple friends anymore because it would be too painful. I would just be thinking about my wife all the time.

1:09:31And maybe in a therapeutic context, he is encouraged to try this out. And he, you know, has a good enough relationship with his couple friends to say, okay, I'm going to try and do this. I don't know how it's going to go, you know. And maybe the first time he goes, the therapist asks, how was that? And he says, that was awful. I was so upset. You know, everything reminded me of her. And the therapist says, let's try it again. Mm-hmm. Exposure is tough, man. One of the hardest things to do. Yeah. So hard. And maybe, though, with that courage and also with the, you know, life isn't working right now, I might as well try something else, he goes to dinner again.

1:10:14And he does remember her. And he maybe even gets teared up at one point. But he also hears about this book that his friend has read that sounds really interesting. And he thinks, yeah, I'm going to check that book out. and he realizes that he can have all those feelings of grief and he can still have a connection with people now about things that are happening in this life and that it can stimulate him to find enjoyment and creativity and interest in things that are going on right now as well. And that is the slow upward spiral, but requires going out into the world and connecting with other people.

1:10:57And that is very difficult.

1:10:59Forrest Hanson: There was a line related to this in the book. Bereaved people who describe fewer likes and dislikes had higher levels of grief severity. Clarifying what you like without your loved one's input is another task of grieving. The joy of having a PDF copy of the book is that I can do things like search for a phrase, control F, task of grieving, and see if it appeared anywhere else. It didn't. It was the only place in the book that this phrase appeared. But I loved this phrase, actually. And there was something about it that kind of stuck with me. and I wonder about it as a kind of useful frame for people.

1:11:32Forrest Hanson: The idea that, you know, I think task can be a complicated word for somebody who's already going through a lot, but the idea that there are these things that can serve as stepping stones for a person toward not resolving something, but moving into kind of a more integrated relationship with it. I just thought it was a great phrase and I'm wondering if you've thought about it that way at all. So some listeners might know, but there is a grief researcher, long more senior than I am, named Bill Warden, William Warden. But we in the community know him as Bill Warden. And he wrote about the four tasks.

1:12:13Forrest Hanson: Oh, there you go. Okay, so it's kind of a shout out. Yeah. But, you know, maybe in book three, maybe there will be more exploration of what these tasks are and why we think of them that way. I love that. I love that. And yeah, I didn't know about that before I asked you about it. That's really great. Because there was just something about it that seemed like such a tight summary of a very fraught territory. There was another story in the book, the Purple Towels story, the idea of reasserting yourself. To paraphrase, this was somebody who I think their partner passed away. And was this actually your dad?

1:12:52Forrest Hanson: Oh, there you go. Okay, so I just had a moment where I was like, wait a second, I think this was actually her dad. Anyways, you can tell the story better than I could. I just love the purple towels. Oh, I love this story because, you know, and this is such an interesting thing. We are honored to watch others go through grieving and we are honored to learn what they experience that then can help us as well. And certainly watching my father go through the loss of his wife, my mother, and how that changed him and the ways he navigated it well and the ways it was difficult was so much teaching. So my father would come and visit me in, you know, the big city.

1:13:37I grew up in a very rural area in Montana where he continued to live. And so we would go shopping sometimes because he didn't have big department stores. And he said, yeah, I want to get towels. And I said, great, we'll go shopping. And he said, I want purple towels. And I was like, Dad, that's bizarre. You don't want purple towels. What are you talking about? And anyway, they won't match the bathroom. Why would you? And fortunately, I realized that what he was telling me was he was revealing a part of who he was, not as a part of a we with my mother, who had always had yellow towels. And apparently he'd always hated yellow towels, but that it wasn't important at the time what color the towels were to him because the we meant it was more important that she had the towels that she liked.

1:14:27And now that he was living in the house on his own, he was telling me, I like purple. It's who I am. And fortunately, we got purple towels and he repainted the bathroom and they looked fantastic.

1:14:43Forrest Hanson: It's on the one hand so mundane, but on the other hand such a great encapsulation of so much of the stuff that we've been talking about. at least one more thing that I wanted to mention here, because I think that it just beautifully brings together a lot of the themes that we're exploring today. You tell a story in the book actually about shaving and about this idea of directing a kind of embodied love and care and support to yourself the way that you might direct it to another person as you're going through something difficult. And I was wondering if you could talk about that really more from the perspective of this as like a, I don't know, we aim this at other people so often in our lives, if you have any kind of empathy at all.

1:15:31Forrest Hanson: And it's so rare to do it in this kind of very careful, physical way with yourself. And again, there was just something about it that stuck with me. I was watching the television show Ozarks, and there is this incredible scene in that show where the main character, Marty, is caring for a terminally ill man who's living with them. And he offers to shave his beard, to shave the stubble, to make him more comfortable. And it's such a touching scene because we very rarely see the care and physical caregiving between adult men. And the scene just really stuck with me. It was just very moving to me. Also the stakes, you know, so high of this man's sort of last few days.

1:16:26And I happened to be in the tub shaving my own leg the next morning and still thinking about this scene. And as you say, I just had this sudden embodied experience that I could look at my own leg, and then I could hold that razor in the same loving, prizing, caring way and take the time and attention to do it gently and thoughtfully and with love. And, you know, on the one hand, it sounds and even might feel utterly ridiculous. And at the same time, if we can do it for others and we find it meaningful, then we can accept that care and love as well. And to be able to do both the giving and the receiving is such a resource to, you know, what this compassion, what this life we have in a human body is all about.

1:17:40I have found that it isn't just, you know, I told a friend once, it's not just about not saying mean things to yourself in your internal world. It's about being overtly kind to yourself and saying meaningfully encouraging things as well.

1:18:03Forrest Hanson: And in that moment, one of the things I think is so wonderful about it is that love is not a reaction. One of the things you talk about in the book is that we often have a model of love as a kind of reaction to another person. They come into the room and therefore we feel love. But love is something that we can cultivate as a feeling on its own that emerges from us. We get to direct it. It can be directed at that moment of shaving the same way that it's directed at another person that we really care about. And it really is possible to develop more of a sense of that as it flows out of us, as it flows into us, and develop a less conditioned relationship with it.

1:18:41Forrest Hanson: So it's more just there. And it becomes more permeable over time. It's like a cellophane, as opposed to saran wrap, as opposed to tinfoil. Over time, it becomes more and more transparent. And that kind of deliberate practice with cultivating the feeling in an embodied sense, you're interacting with something and you're letting that feeling come through, just felt so real to me. And such a great encapsulation of your own process with it and how you bring together these different aspects as a researcher, a scientist, a person going through this kind of an experience, a contemplative practitioner yourself, all of it.

1:19:18Forrest Hanson: And it was really like, just put a bow on the whole thing. I think for me, the thing that could not have been explained to me before I had loss was that love, the love that we learned because of being in a relationship with this specific person, that that love is still in us, that we learned it in relationship, but that we now can cultivate it in ourself, just as you said. That we had the experience of feeling it means that we can conjure that up again. Our brain and our body allows us to feel that love again. And because we know it, because of them, we know it. And now we can give that love away to anyone, including ourselves, because they taught us.

1:20:11They don't have to be present for us to continue to use that lesson that they gave us.

1:20:17Forrest Hanson: Dr. O 'Connor, thanks so much for doing this today. I absolutely love this conversation. I always love talking with you. I feel like I learn a lot. It's pretty uncommon for me to get to the end of these and be like, wow, we could have done another 80 minutes on just the physiology of the whole thing. I feel like I had to hand wave so much stuff to land the plane on this conversation and get you out of here on time. But again, thanks so much for taking the time. It was a real joy, Forrest. You really deeply think about and understand these topics and then you bring them to everyone. I really appreciate that, truly.

1:20:54Forrest Hanson: I really love talking today with Dr. O 'Connor about her work on grief, attachment, loss, physiology, her scientific research, all of the things that we got into during today's conversation. And I want to start by saying just how much I appreciate Mary Frances's clarity in her approach around scientific communication. She gave a lot of caveats during this conversation. She said a lot of, we're not quite sure yet, or this needs more research, or we still have a lot to learn, or we know the broad strokes of this thing, but maybe we don't have all of the details yet. And it's just really refreshing to me to hear somebody talking that way.

1:21:35Forrest Hanson: And I think this kind of ethical stance is really present in her work as a whole, how she talks about the incredibly individual nature of all of this, how there's only so much that we can learn about you and your personal experience, including your personal experience of something as difficult and as individual as the grieving process. There's only so much that we can learn about that from a scientific study, which is about populations. It's about averages of groups of people. But still, we can use science to inform our decision-making, including how we think about grief and grieving in general, and also the actual actions that we take in our lives once we experience grief or if we're having a difficult time with our grieving process.

1:22:15Forrest Hanson: And grief is a process. That's another thing that Mary Frances said over and over again. This is not something that has an end point. We often think about grief as something that we're supposed to get over, but this isn't something that has a defined beginning, middle, and end. There are ways to do grief and grieving that are easier or harder for people. There are individuals who have an easier or harder time with the grief process, but there's no one right way to do this. Something that does tend to help people, though, is an appreciation of grief as a human experience. It's a part of life. It's a part of love.

1:22:53Forrest Hanson: It is a part of who we are as arguably the most social species on the planet. And we talked at the beginning of our conversation about how the nature of the brain and the body can make grief a particularly challenging experience for people, how the brain builds a kind of map of our world. And our big attachment relationships are a big part of that map. And when they vanish, the map doesn't update overnight. It takes a long time for the brain to do this. And so a part of the pain of grief is the pain of the brain constantly going, wait, something was supposed to be here and it isn't, now what? And Mary Frances's new work focused on how the body is doing something quite similar, how these other people function as a kind of external pacemaker to us.

1:23:37Forrest Hanson: They perform actual regulatory functions for the body. The body is having experiences that are below the level of our conscious awareness, but they are clearly going on. And grief isn't just a set of thoughts and feelings that we can point to, like sad or anxious or whatever else. Our experience of grief is also a physiological loss, and this is part of why people have all of these common physiological symptoms that are associated with grief, brain fog, fatigue, immune vulnerability, restlessness. And it's very common for people to not recognize these symptoms as being tied to the grieving process.

1:24:12Forrest Hanson: The most acute example of this is dying of a broken heart, and it turns out that your heart attack risk is indeed much higher, 21 times higher, in fact, in the first 24 hours after a loved one's death. This risk goes down every day, but it still sustains for people for quite a long time. Six months is common. It can go on for even longer than that. And bereaved people show other measurements of elevated risk, like elevated blood pressure and reduced heart rate variability. An interesting intervention that Mary Frances and her team came up with is the idea of using low-dose aspirin during acute bereavement.

1:24:49Forrest Hanson: To be clear, this is not medical advice. Please talk to your doctor. There are a lot of reasons for people to use aspirin or to not use aspirin, but there have been studies on this. There was a study of 85 participants that used both aspirin and a beta blocker for six weeks after acute bereavement, and the people who ran this study found a reduction in cardiovascular risk indicators in the medication group. Another thing that can make these factors so important to keep an eye on if you're somebody who's been recently bereaved is that it's very difficult to maintain our habit patterns, understandably, after something like this happens.

1:25:22Forrest Hanson: So that's when Mary Frances talked about social support. If that's something that you're getting, if you can find a community or lean on other people who are in your life, that can be enormously helpful for somebody. And just those little moments of reminding yourself, hey, you know, maybe I should go to the doctor. Hey, have I talked to that friend recently? Are there other things that I'm doing to do this kind of healthy movement that we talked about back and forth from what are called loss-related stressors to restoration-related stressors? Are there things that I can do in my life to bring a sense of purpose and meeting and broader possibility, even alongside the fact that this thing has happened?

1:26:04Forrest Hanson: And can I move back and forth in healthy ways from the pain, the experience of loss, the natural aspects of the grieving process that include a lot of that, with all of this other stuff, you know, how I want the towels to be now that my partner is gone. Related to this, I thought that what she said about the relationship between protest and despair was really interesting. When a person has a experience of separation, you think about a kid who's separated from their parents, they're going to be in protest. Protest looks a certain kind of way. Over time in the grieving process, there can be a healthy movement into despair, which is not how we normally think about despair.

1:26:48Forrest Hanson: We think about despair as something we are trying to avoid. But despair includes acceptance. It includes this feeling of this person is gone. They are not coming back. Here we are. This is what it is. And that experience can be painful and overwhelming for somebody. but hopefully over time it relaxes and it softens and it becomes more manageable and we don't want to hang out there forever but we do have to make this movement from panic or protest into that feeling in order to be with reality just as it is which is a foundational part of buddhist contemplative practice and mindfulness practice more generally one of the things that i'm really going to remember from this conversation is actually the shaving story.

1:27:37Forrest Hanson: This idea of directing love and care toward yourself in this very deliberate, very embodied way. And it speaks to a broader relationship that we can have with love without sounding too saccharine about it or too warm and fuzzy. Love is typically framed as a kind of reaction. Somebody walks into the room and we feel a certain way all of a sudden. But love is actually an emotion that emerges from us. We can have a relationship with it as we're creating it. We can deliberately evoke that kind of feeling. Maybe not perfectly on command or something like that, but it's a feeling that we can have that sort of direct relationship with.

1:28:22Forrest Hanson: And again, to universalize it, I think there are aspects of this that we can all learn from. We all have something that we feel this kind of way about, or that we have a feeling of sadness attached to, or a feeling of loss attached to. And we can interpret that really quite broadly, in addition to being with and in relationship with the natural flow of life, a core part of Buddhist practice, and particularly Zen Buddhism, which is the tradition that Mary Frances has as far as I'm aware I think the deepest relationship with and sometimes Rick and I will do a little bit of work with the New York Zen Center so shout out to New York Zen, really love the people over there and as part of the work that we've done with New York Zen I've been in sessions with them where at the beginning or at the end of them typically at the end of them a kind of prayer or chant is recited called the Evening Gatha and it goes like this Let me respectfully remind you, life and death are of supreme importance.

1:29:25Forrest Hanson: Time swiftly passes and opportunity is lost. Each of us must strive to awaken. Awaken. This night your days will be diminished by one. Take heed. Do not squander your life. And I think there's something about coming into this more direct, more unmediated relationship with the reality of death and dying, which includes grief, that allows us to face it and accept it as a natural part of life, and even as something that gives life more joy, more meaning, more importance, because we're grounded in the fact that it is finite. And in that finiteness is everything that gives it meaning. And I think that that connects back to what I began the conversation with Mary Frances with, which was ironically the last phrase in the book, love requires the deep knowledge of loss.

1:30:28Forrest Hanson: So I hope you enjoyed today's conversation. I had a fantastic time talking with Mary Frances. Her book, again, is The Grieving Body, how the stress of loss can be an opportunity for healing, and the paperback of that book is coming out on August 11th. If you made it this far and you haven't subscribed to the podcast yet, we would really appreciate it. If you took a moment to subscribe, if you're watching on YouTube, listening on Apple or Spotify, or anywhere else in the world of podcasting, really helps us out when you do that. If you could leave a rating and a positive review, if you could leave a comment, that all helps as well.

1:30:59Forrest Hanson: We really appreciate it. So until next time, thanks for listening, and I'll talk to you soon. Thank you.