The Science & Process of Healing from Grief | Huberman Lab Podcast #74

- Welcome to the Huberman Lab Podcast,

where we discuss science,

and science-based tools for everyday life.

I'm Andrew Huberman, and I'm a professor of neurobiology

and ophthalmology at Stanford School of Medicine.

Today, we are discussing grief.

Grief is a natural emotion

that most everybody experiences at some point in their life.

However, grief is something

that still mystifies most people.

For instance, we often wonder

why getting over the loss of somebody, or a pet,

is so absolutely crushing.

In some cases it's obvious,

because we had a very close relationship

to that person or animal,

but in other cases, it's bewildering,

because somehow, despite our best efforts,

we are unable to reframe and shift our mind

to the idea that the person or animal

that at one point was here, and so very present,

is now gone.

Today we are going to discuss how we conceptualize grief,

both at an emotional and at a logical level.

I'm going to teach you about the neuroscience

and the psychology of grief,

and incredible findings that have been made

in just a few key laboratories,

that point to the fact

that we essentially map our experience of people

in three dimensions.

I'll just give you a little hint

of what those dimensions are.

They relate to space, where people are,

time, when people are,

I'll explain what that means,

and a dimension called closeness,

and how those three dimensions

of space, time, and closeness

are what establish very close bonds with people,

and are what require remapping,

reorganization within our emotional framework

and our logical framework,

when we lose somebody, for whatever reason.

Within that understanding,

I'm confident that you will have greater insight

into the grief process.

And should you ever find yourself

within the grief process,

as I imagine most everyone will at some point,

you will be able to navigate that process

in what psychologists and neuroscientists deem to be

the most healthy way of going through grief.

Indeed, moving through grief

requires a specific form of neuroplasticity,

a reordering of brain connections,

and also the connections between the brain and body.

I'm going to teach you about all of that today,

so you're going to learn a lot of scientific information.

You will also learn a lot of tools

that you can put in your kit

of emotional and really, emotional physical tools,

that will allow you to move through grief

in this healthy way that I referred to earlier.

I'll also point out some of the myths about grief.

For instance, many of you have probably heard

that there are designated stages of grief

that everybody moves through.

Turns out that recent research refutes that idea.

There are different stages of grief,

but not everybody experiences all of them,

and hardly ever does somebody

move through all of those linearly,

meaning in the same order.

I also want to point out that for many of you

that are not experiencing grief in this moment,

there's an important scientific literature

that teaches us that how we show up to grief,

meaning our psychological and our biological state

that we happen to be in when a loss occurs,

strongly dictates whether or not we end up

in what's called complicated or non-complicated grief.

And non-complicated grief is a form of grief

that is very prolonged,

and in fact often requires

that people get substantial professional help.

So whether or not you're experiencing grief that's mild,

moderate, or very intense right now,

or whether or not you are not experiencing any grief at all,

you're going to learn scientific information

and tools that will help you navigate

through this process that we call grief.

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 zero cost to consumer information

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Okay, let's talk about grief.

I just want to remind you that everybody,

at some point in their life, experiences grief,

either mild grief, moderate grief, or extreme grief,

and it's somewhat obvious, but worth stating nonetheless,

that how intense grief feels,

and how long it lasts,

scales with how close we were with somebody.

And if you learn that the person

who works at the coffee shop

or that you see at the coffee shop on a regular basis,

happened to pass away

or tragically get killed in a car accident,

that can be quite upsetting.

It can be somewhat disorienting to you

if you, for instance, just saw them yesterday

or they seemed perfectly fine when you saw them last.

But of course the grief that results

from the loss of somebody

to whom you have that level of attachment

is far and away different than the level of grief

that you would experience

from the death of a very close loved one,

a sibling, a parent, God forbid a child.

When that type of loss occurs,

it's often the case

that our entire relationship to life feels different.

Places and things that at once brought us joy and laughter

now bring the opposite.

They bring us intense feelings of sadness and loss.

Psychologists and neuroscientists

distinguish between complicated grief

and non-complicated grief.

They are very similar at the outset.

One of the fundamental differences between them, however,

is that complicated grief,

which occurs in about one in 10 people,

is a situation in which grief

does not seem to resolve itself,

even after a prolonged period of time.

Later in the episode, I'll point you

to the actual tests that are used.

I've provided links to those in the show note captions,

that will allow you to distinguish

between complicated and non-complicated grief.

These arrive through the important research

of the world-class grief researchers that are out there

and the psychologists that treat grief.

The important thing to point out is that grief is a process.

Like any biological or psychological event,

it has a beginning, a middle and an end.

And I do believe that being able to orient

in terms of where you are in that process

can be immensely beneficial,

not just for predicting how long it's going to last,

but in order to conceptualize the person or animal

that you lost, in a way that allows you

to best preserve their memory

while maintaining your own functional capacity in life.

Along those lines, I want to point out

that grief and depression,

while they can feel quite similar in certain ways,

and have overlapping symptomatology,

loss of appetite, challenges sleeping,

crying in the middle of the day

for no apparent reason, et cetera,

they are distinctly different processes.

The modern research teaches us for instance,

that grief rarely responds well to antidepressants,

whereas depression can often

respond well to antidepressants.

Everything we know and understand about grief

is that it is a distinct psychological

and physiological event

in the brain and body from depression.

Rather, perhaps the best way to think about grief

is that it is actually a motivational state.

It is a yearning.

It is a desire for something,

and somewhat surprisingly,

it's not just a desire to have that person back,

or to have that animal back.

You might think, "Well, that's crazy, of course it is."

But of course, there are instances

in which someone passing away or an animal passing away

is actually providing relief for that person,

because of where they happen to be in their life.

Today, I'll teach you about grief as a motivational process,

because grief as a motivational process

really is the way that scientists and psychologists

now conceptualize grief, and the treatments for grief,

so that people can move through them effectively.

As we wade into this important topic,

I'd like to emphasize some of the common myths

and misunderstandings about grief.

Some of the myths and misunderstanding arrive

from the beautiful work of Elisabeth Kubler-Ross,

a psychologist who wrote the famous book on death and dying.

And I should emphasize that while Kubler-Ross

was a real pioneer in establishing

that there are indeed different stages of grief,

the modern science, both psychology and neuroscience,

point to the fact that not everybody

experiences all of the stages that Kubler-Ross defined,

nor do they move through those stages in a linear manner.

Sometimes they're out of sequence.

I'll just highlight the five stages

that Kubler-Ross illustrated,

because some people really do experience all of them,

sometimes in the order I'll read them.

But again, oftentimes they don't.

The different stages of grief, very quickly,

are denial, anger, bargaining,

depression, and acceptance.

In the Kubler-Ross model,

denial is always the first stage,

and denial is just as it sounds,

this disbelief, it cannot be, there's no way,

a refusal to accept the new reality

that the person or animal is gone.

The second stage, anger,

is one in which the individual recognizes

that the person is indeed gone,

or the animal is gone,

but their body and their mind go into a motivated state.

This is important.

We're going to return to this idea of grief

as a motivated state that involves action plans,

in more depth as we go further.

And then the third stage is bargaining,

what's sometimes called the negotiating phase,

this idea that, well, if I had just done this,

or if they had just done that,

or if I had called more,

or somehow refusing to accept the reality.

So in a way this can be blended with denial in thinking,

"Well, if I just don't think about it,

it won't be real," this kind of thing.

So again, stages can be blended or braided together,

because emotions are complex, right?

Even though there are different stages to this process,

they can sometimes be melded together.

The fourth stage of depression that Kubler-Ross described

is one of, why go on living?

Why should I go on living?

Why should I continue in this grief-stricken state

that seems to deprive me of all the richness of life

that I experienced when the person or animal was still here.

And then the fifth stage is acceptance.

This internalization, not just cognitively,

not just thinking,

but emotionally that it's going to be okay,

that not just this too shall pass, but that it has passed.

So again, the five stages of grief

that Kubler-Ross defined were immensely important

as a critical parsing of the different stages

that one could move through.

But unfortunately those five stages

were sort of taken to be gospel for a long time.

And we now know, based on neuroimaging,

based on more in-depth psychological evaluation,

and frankly, more researchers and clinicians

moving into this area and observing

that while much of what Kubler-Ross described

does hold true, it's not always the case.

And in fact, the contour of the grief process

actually has a lot of dimensions

that are not encapsulated by those five stages.

There's also a lot of variation,

depending on whether or not the loss

is due to old age, disease,

whether or not there was suffering prior or not,

suicide or non-suicide type deaths and losses,

and even grief about non-death losses,

a relationship breakup, or something of that sort,

or even homesickness and things of that sort.

So I do want to tip our hats to the incredible work

of Elisabeth Kubler-Ross.

By no means am I or do other researchers

try and discount her incredible contributions.

But I think nowadays we have a different and frankly,

a better understanding of what the grief process is like,

and as a consequence, better tools to move through grief.

In order to really understand what grief is

in your brain and body,

and how to best navigate grief,

I'd like you to do an experiment with me.

For the next five minutes or so,

I'd like you to at least try to discard

of all prior notions of grief

as just a state of sadness.

I want to acknowledge that it is

and does involve sadness,

but for right now,

let's think about grief as a motivational state,

as a desire for something specific.

In fact, I'd like you to think about grief

as an attempt to reach out

and get something that you very much want.

Imagine yourself extremely thirsty, for instance,

on a very hot day,

and a glass of water is right in front of you.

And it's a beautiful, clean glass of water,

and it's completely full,

and you so badly want to drink that water.

But no matter how intensely you want it,

and no matter how hard you try and reach it,

it always shifts just outside your reach.

So if you can imagine that, even just a little bit,

you are touching into the experience of grief.

How do I know this?

Well, I know this because brain imaging studies

involving what's called functional magnetic

resonance imaging, FMRI,

in which you can evaluate

which brain areas are more active than others,

according to blood flow,

which correlates with neural activity and so forth,

teaches us that the brain areas

that are associated with motivation and craving and pursuit

are some of the primary brain areas and circuits

that are activated in states of grief.

I'd like to share an important paper with you,

as one of the first to illustrate the fact

that grief is not just a state of sadness and pain.

It is indeed a state of yearning and desire of something

that is just outside your reach,

and unfortunately will always be just outside your reach

until you remap your relationship to that person or thing.

The title of this paper is posed first as a question,

so that's why I'll read it as such.

The title is "Craving Love?

Enduring Grief Activates Brain's Reward Center."

And the first author of this paper

is Mary-Frances O'Connor.

She's a professor of psychology

at the University of Arizona,

and one of the world leaders in the study of grief

from a neuroscience perspective.

With some luck, we'll get her here

on the podcast as a guest.

Now this paper has several important features.

I'll just highlight a few.

One of the features of this paper that's not surprising

is they found that people who are in a state of grief

are in a state of pain.

That is, brain areas associated with pain,

actual physical pain, are more active

than in non-grieving individuals.

However, they also found that people who are experiencing

what's called complicated grief

showed reward-related activity

in a brain area called the nucleus accumbens.

What is reward-related activity?

Reward-related activity is activity of neurons

that's associated with motivational states.

And the nucleus accumbens is a brain center

in which dopamine has the effect

of creating a motivated state.

If ever you thought that dopamine

was only associated with feeling good,

you hear about dopamine hits,

well, this paper and papers like it,

firmly tell us that dopamine is not about feeling good.

Dopamine is about placing us into a state

of desiring things and seeking things.

This is true in addiction.

This is true when we're hungry and we want to eat.

This is true when we want to reproduce.

This is true in every state

in which we are reaching for something

outside our immediate ability

to give that thing to ourselves.

This is very important to understand,

if you want to understand grief

and how to move through grief.

Grief is not just about sadness.

It is a state of sadness,

hence the activation of brain areas associated with pain,

and it is a state of desire and reaching for something.

And for those of you that have experienced grief,

I think that will resonate with you.

In that understanding that grief is both a state of pain,

but also a state of wanting,

and in the understanding that when we lose somebody,

either because of breakup or because of death,

or if an animal dies or gets taken away or is missing,

that state of wanting and desire

drives an activation state within us.

Now, the key thing to understand

is that the activation of those reward centers,

and the involvement of dopamine

puts us into an anticipatory state,

a state of waiting for something to happen.

It also puts us into a state of action or desiring action.

Our body and our mind

are what I like to refer to as center of mass forward.

We are seeking how to resolve the craving,

even if we know that is impossible.

Why do I say that?

Well, we understand,

also on the basis of brain imaging studies,

and also some studies in animals

that I'll describe in a moment,

that in order to understand grief,

we have to understand how attachments

are represented in our brain.

And it turns out that both attachments

and the breaking of attachments in healthy ways

are governed by three important, what we call dimensions.

A dimension is just some feature of the world

that's represented in our brain.

So for instance, the color red doesn't exist in your brain.

You happen to have cells, neurons, in your eye

that respond best to long wavelengths of light.

And those long wavelengths of light

happen to be what are reflected off things

that are perceived as red.

So in your mind, you have a notion of red.

I know this is a little bit abstract,

but you're not actually lighting up red neurons

in your brain, and that's why you see red.

You are lighting up neurons in your brain

that represent the presence of red things

in your environment.

Similarly, we have neurons and maps,

or we say representations of other dimensions.

We have dimensions of touch.

We have dimensions of sound.

And as I'll now teach you,

we have three dimensions that define our relationship

to people and animals and things.

And when those people, animals and things

are within our immediate vicinity,

or if we know how we could access them, right?

If somebody's still alive,

there's generally some way to access them,

unless they're refusing to interact with us.

Well, when we understand that,

our motivational states can operate

in a way that's logical.

We know that, for instance,

if we want to find our mother, brother, sister,

significant other, dog, cat, parrot, et cetera,

we have to go through a certain set of steps.

What are those three dimensions and how do they work?

And that's what I'm going to teach you now.

So at risk of sounding a little bit too reductionist,

we are now going to describe your relationship

to anything, everything, and anyone,

in these three dimensions.

How can we do that?

Why would we even want to do that?

Why would we want to rob the complexity of relationships

of their contour and their detail?

Well, if we can understand the dimensions

in which we map our relationship

to people, animals, and things,

then we can understand why it is that when those people,

animals, or things are not accessible to us,

why it hurts so much,

and why it takes a certain amount of time

in order to re-understand, if you will,

or remap our association to them.

I promise that in grasping the information

I'm about to give you,

you will be able to better orient in the grief process,

and you'll be able to move through it more effectively.

The three dimensions of relating to someone,

or an animal, or a thing,

are space, time, and closeness.

And in order to illustrate each one

and how they work together to support relationships

and their involvement in the grieving process,

I'm going to tell you about an experiment.

This experiment was actually done.

The experiment involves putting people into a brain scanner

that allows the researcher to evaluate

brain activity in different areas.

In fact, can look in a very non-biased way,

not make any predictions about which brain areas

are going to be involved.

And the experiment is the following.

The person, we should say the research subject,

first sees images of things that reside

at different distances from one another.

And when I say things, these are objects.

So in one case it's a beach or a parking lot

with bowling balls set

at different distances from one another.

Their brain is imaged,

and as their brain is imaged,

they see different pictures of different scenes,

the beach, the parking lot, et cetera,

bowling balls spaced in different ways,

close together, far apart,

regularly spaced, non-regularly spaced.

When one does this sort of experiment,

you see a lot of brain areas activated.

Not surprisingly, the visual cortex,

the area of the brain that is responsible

for creating visual perceptions,

but also a brain area that seems uniquely tuned

to the distance between you and the objects.

So whether or not the bowling balls are far away

or close together from one another,

and whether or not they are far away

or close to you physically,

so literally the distance between you and these objects.

We'll refer to that measure,

that dimension, as we call it, as proximity, okay?

Whether or not it's very close to you,

high degree of proximity,

or far away, low proximity.

But it's simply physical space.

Then subjects listened to tones.

Those tones also are spaced from one another.

So it could be something as simple as

my hand meeting the table top

that I'm happen to be sitting in front of.

So it's [hand hits].

They image the brain.

Of course, areas of the brain

that are associated with auditory perception are active,

not surprisingly, but as they evaluate

different types of sounds and patterns of sounds,

for instance, [hand hits]

they can start to parse brain areas

that seem uniquely tuned to the spacing of sounds,

independent of what sounds are coming in.

So whether or not it's musical notes,

or my hand hitting the table, or human speech,

they identified a brain region that is uniquely tuned.

That is, it becomes active specifically in response

to changes in the spacing between sounds,

much in the same way as they could identify brain regions

that were only activated

when there were changes in the distance between objects,

such as the bowling balls

that I used in the previous example.

And then the subjects saw a different set of images.

The images that they saw were of people, and of faces.

And some of the images that they saw

were of people's faces right up close,

and other images were of people at a distance,

where you could see the whole body of the person.

Now, they also varied

the emotional relationship to those people.

That is, they were able to get photographs

from these research subjects' lives,

so they could show them pictures of, for instance,

their sister or some random person off the street.

They could show them pictures of a parent,

or of a neighbor,

or of a celebrity that's well known,

or of somebody that they didn't know at all.

So they were able to vary

both the position of the person, close or far,

and they were able to vary

the emotional distance to the person,

which is this dimension that I'm referring to as closeness,

which is not physical closeness,

but how attached, or how well you know somebody.

Now, this is maybe sounding like

a somewhat complicated experiment,

but the takeaway from this experiment

is exquisitely simple, and exquisitely important.

The result was, that in all three conditions,

changes in the physical spacing of these objects,

changes in the temporal,

that is, the time spacing of these sounds,

and changes in the emotional distance

between the subject and different people,

the same brain area was uniquely activated.

Now that is an incredible thing to find,

because what it suggests is that, yes,

of course there are brain areas

that are associated with representation of visual objects,

and that yes, of course there are brain areas

associated with representation of different sounds.

And of course, there are brain areas associated with faces.

We now know this.

In fact, there's something called the fusiform face area,

which is uniquely tuned to faces.

But at the same time,

there is a unique brain region that is activated

in all three of the conditions I described,

that has to do with how far you are from somebody,

both in space, in time,

and in terms of emotional closeness.

And that brain area, it turns out,

is a brain area called the inferior parietal lobule,

the inferior parietal lobule.

Now, you don't need to know

where the inferior parietal lobule is.

In fact, you don't even need to know

the name of this brain area.

What you do need to know, however,

if you want to understand grief

and how to move through grief,

is that your map of people is not a map

of emotional closeness per se.

It is a map of emotional closeness,

what we call attachment,

that is interwoven, that is braided in,

in a very intimate way, with your map

of where they are in physical space,

and where they are in time,

when you saw them last,

when you're likely to see them again,

and if you were to want to see them,

how much time it would take to reach them,

or for them to reach you.

Now earlier, I said that one of the key functions

of our nervous system

is to be able to make predictions.

And so it's somewhat obvious,

but nonetheless important to state and restate

that one of the most powerful aspects

of our attachments to people, animals, and things

is our ability to predict what it would take

to see them again, and when we are going to see them again.

In fact, we could say that our ability

to locate someone, or an animal, or a thing

in space and time, right,

where they are and how long it would take for us

to reach them or them to reach us,

is a prediction of the requirements

to engage in the attachment.

In order to illustrate this at a little bit more depth,

let's just do a fill in the blank experiment.

You can do this now in real time.

I want you to think of somebody that you either rely on

or that you care about very, very much.

And I'll just allow you

to fill in the blank on this sentence.

"If I want to see blank," the person or animal,

"I could see them within blank amount of time," right?

If right now you wanted to see this person or animal,

or maybe even a thing,

how long would it take you to reach them?

Could be a day, could be a second,

could be they're right next to you.

All you'd have to do is turn your head.

Now answer this.

"If this person were to travel halfway around the world,

and land in their plane,

I would expect to hear from them

within blank minutes of them landing."

Okay, the answers of this of course, will differ.

Now, I'd like you to answer this question.

"If I'd like to find myself,

it would take me X amount of time."

And of course, if you're listening to this

and you're understanding it and you're of a rational mind,

the answer to that should be zero seconds, instantaneous.

You are always able to locate yourself in space and time,

provided you are in the appropriate state of mind,

meaning not asleep, for instance.

That last question might seem somewhat silly,

but it's a fundamentally important one,

because it illustrates the extremes

at which we map our relationship to ourselves

relative to other people and things.

Now, if all of this sounds

like a bunch of neuropsycho babble,

parsing of the obvious,

I'd encourage you to suspend that belief for the moment.

Because if you understand that all relationships

are mapped in the brain and body

through these three dimensions,

space, time, and closeness,

or proximity of space, proximity in time,

and proximity of attachment,

how close or rich or bonded you are to someone,

well, if you can understand that,

then it almost becomes obvious,

or at least it becomes intuitive,

as to why, after the loss of somebody,

in particular, a death, or the loss of an animal,

this map has to be reordered.

Why, because if we are attached to someone, or an animal,

at a deep level,

it is almost always on the basis

of a lot of what we call episodic experience,

a lot of episodic memories,

memories of things that happen.

Episodic memories are literally

the conscious recollection of your experience of somebody,

or an animal, or a thing.

And within that memory,

you have an understanding of what has happened with them

in association to you,

what's going on with them,

where it happened, when it happened.

You have a rich knowledge database

that we call implicit knowledge, right?

You might not be aware of it all the time,

but it's within you, of what this person is like

and what they're doing in their life.

When somebody is taken away from us, for whatever reason,

episodic memories persist for some period of time,

and they are still linked to our feelings of attachment.

Grief is the process of uncoupling, unbraiding,

and untangling that relationship

between where people are in space, in time,

and our attachment to them.

What I mean by this is when somebody or an animal

or a thing is taken from us,

either by decision or by death, or by circumstance,

well, in that case, our entire memory bank

and our ability to predict where and when they will be,

and therefore when we can feed our attachment to them again,

that whole map is obliterated,

except that the attachment itself has not been disrupted.

Assuming that you are deeply attached to someone

or an animal or a thing, that attachment persists,

and the grief process is one

in which you have to reorder your understanding of them

in space and in time.

This is very, very hard to do,

and for some people it's almost impossible to do,

at least at the outset of grief.

This, in a very neurosciencey way,

explains this stage that Kubler-Ross described,

which many, again, not all,

but many people experience,

which is one of denial.

How could it be, why?

Well, when we have a rich catalog

of experiences with somebody or of them, right,

ideas about them and what they do,

how they spend their day,

what they do and don't do,

where they do it, et cetera,

well, that memory bank is not just flushed out

the moment that we learn that they're no longer with us.

What happens is, the brain continues

to make these predictions

that they will be in a certain place

or a certain time, right,

that they'll be in a certain time zone

or they'll walk in the door any moment.

All of those predictions still hold.

The neural activity continues.

We call this reverberatory activity.

That explains the yearning for,

and the desire to interact,

and yet it's just beyond our reach.

Because once they're gone,

our brain still functions in a way,

these neural circuits still function in a way

that put us into an action state of seeking them,

looking for them in the same location,

expecting them to contact us at whatever frequency

that we were used to hearing from them,

or that we could reach out to them

and reliably get a response.

It is immensely disorienting, in other words,

to maintain a close attachment,

and at the same time to not be able to make predictions

about where that person, animal,

or thing is in space and time.

Now, if this seems somewhat abstract,

I'm going to continue to flesh it out.

And actually right now, I'd like to flesh it out

with a real-world example of grief and loss

that comes to us from perhaps

one of the greatest minds in human history,

and somebody who was intensely grounded

in reality and logic, and indeed the physics of the world.

And the person I'm referring to is none other than

the Nobel Prize-winning physicist, Richard Feynman.

Many of you are probably familiar with Richard Feynman.

Some of you perhaps are not.

Richard Feynman was a Nobel Prize-winning physicist,

known for his thick New York accent.

He was actually not from Brooklyn, as many people think.

He was actually from Far Rockaway in Long Island.

Thick New York accent, very personable,

exceptional teacher, brilliant mind,

hence the Nobel Prize in physics.

Also a quite funny and amusing person,

told great anecdotes, et cetera.

Feynman had a childhood sweetheart

who turned out to be his first wife.

Her name was Arline, and it was well known

that Feynman was absolutely in love with her.

He would talk about her all the time.

She had a profound influence on him and his thinking,

and ultimately on his public education efforts later.

If you haven't already read books such as

"Surely You're Joking, Mr. Feynman,"

or "What Do You Care What Other People Think,"

I encourage you to do so.

And in fact, that quote,

"What do you care what other people think,"

is actually a quote, not of Feynman,

but of his first wife, Arline,

who sadly, died at a very young age from tuberculosis.

Why am I sharing Feynman's story

of loss of his first bride?

Well, the reason is, Feynman continued

to write letters to Arline for a long period of time.

This is well known only because after Feynman died,

it was discovered that he kept an archive

of letters to his deceased first wife.

And even though he did eventually marry,

and in fact had many relationships with many people,

and I think was married twice more,

maybe it was once, maybe it was twice,

the intensity of his grief,

but also his lack of ability to transition his mind

to a place where he understood that Arline had died,

is one of the more profound examples

of this inability to reconcile

the logical world and the emotional world.

And I'm now going to read to you a letter

that Feynman wrote to Arline.

This was discovered after Feynman's death,

when they went through his desk and his belongings.

And as I read this, you're going to hear

some of the typical narrative of grief

that is not unique to Feynman and his dead wife,

but there are also some elements in there

that I think you'll recognize

as highlighting this disbelief and this dissociation

between the reality of somebody's location

in space and time,

and the emotional attachment that they hold for us.

And therein lies the information

about how to better navigate grief.

So now I'm reading from the letter.

This was a letter dated October 17th, 1946.

It's not terribly long, but bear with me.

"Dear Arline, I adore you, sweetheart.

I know how much you like to hear that,

but I don't only write it because you like it.

I write it because it makes me warm all over inside

to write it to you.

It is such a terribly long time

since I last wrote to you, almost two years,

but I know you'll excuse me,

because you understand how I am,

stubborn and realistic,

and I thought there was no sense to writing.

But now I know, my darling wife,

that it is the right thing to do,

what I have delayed in doing,

and that I have done so much in the past.

I wanted to tell you I love you.

I want to love you.

I will always love you."

So here we can hear the intense emotional attachment

that clearly has persisted.

"I find it hard to understand in my mind

what it means to love you after you are dead,

but I still want to comfort and take care of you.

And I want you to love me and care for me.

I want to have problems to discuss with you.

I want to do little projects with you.

I never thought until just now that we can do that.

What should we do?

We started to learn to make clothes together,

or learn Chinese, or getting a movie projector.

Can't I do something now?

No, I am alone without you,

and you were the idea woman

and the general instigator of all our wild adventures.

When you were sick,

you worried because you could not give me

something that you wanted, and you thought I needed.

You needn't have worried.

Just as I told you then,

there was no real need,

because I loved you in so many ways so much.

And now it is clearly even more true.

You can give me nothing now,

yet I love you so that you stand in the way

of my loving anything else.

But I wanted you to stand there.

You, dead, are so much better than anyone else alive."

So you can really appreciate the depth

and intensity of the attachment.

Despite two years' time, it clearly has not waned.

I'll read the final paragraph now.

"I know you'll assure me that I am foolish,

and that you want me to have full happiness,

and don't want to be in my way.

I bet you are surprised

that I don't even have a girlfriend,

except you sweetheart, after two years,

but you can't help it, darling, nor can I.

I don't understand it, for I've met many girls,

and very nice ones, and I don't want to remain alone.

But in two or three meetings, they all seem ashes.

You only are left to me.

You are real.

My darling wife, I do adore you.

I love my wife.

My wife is dead.

Rich.

P.S., please excuse my not mailing this,

but I don't know your new address."

So there's a lot contained in this letter.

We could parse it line by line,

but I think it's fair to say that clearly,

there's an immense attachment that's been maintained.

So that's that dimension of closeness of attachment.

Clearly, there's an understanding that she's dead.

In fact, the last line of this love letter is,

"My wife is dead," right?

He now moves her into the third person, in fact,

in that final line.

So he understands this,

and yet he maintains the attachment.

And the very last portion of the letter, the P.S.,

the postscript, "I don't know your new address," right?

Somewhat humorous in the typical vein

of a Feynman writing or speech.

He always had a intensely amusing

and playful sense of humor.

And yet there's something really contained in this.

I don't think we're reading into this too much,

in that he doesn't know where to find her.

He feels her as very real,

and yet he doesn't know where to find her.

He doesn't know her address.

He obviously knows she's dead,

so there's nowhere to mail it to.

The reason I shared this letter with you,

as opposed to one of the almost infinite number

of other letters that have been written

by poets and authors and scientists and everyday people,

is that it really encapsulates all three dimensions

of attachment and grief.

These notions of space,

where is something or somebody,

time, this dimension of,

how long would it take me to reach them

or for them to reach me?

What would it take, in terms of time, to be reunited?

And then that last dimension of closeness,

and the letter beautifully illustrates the fact

that, in grief, we maintain that sense of closeness.

And yet we have to uncouple it

from these other two dimensions,

as we're referring to, space and time.

So with this current understanding in mind,

a few things start to become obvious

and entirely normal to us,

in the best and most healthy sense of the word normal.

For instance, if you've lost somebody, or an animal,

or even a thing that was vitally important to you,

it should make perfect sense to you

as to why you keep looking for that person.

I recall this in my own life.

I had the unfortunate circumstance

of my graduate advisor, who I was very close with,

died quite young of breast cancer.

And her daughter, she actually has two daughters,

kept her cellphone and would occasionally call me.

I had a quite close relationship to their family.

And when it would come in,

the number would pop up on my phone of not the daughter,

but the name that showed up was of my graduate advisor.

So for years after she died, my initial impulse,

when the phone would ring was,

"Oh my goodness, she's calling."

It was a reflexive excitement

because I truly always enjoyed hearing from her.

She was a wonderful,

incredibly wonderful person, I should say.

Similarly, when somebody passes away,

we will find ourselves looking into a room

expecting to see them there,

or expecting them to knock on the door any moment,

or to call on Sunday morning, as it were.

Those expectations, those predictions

that the brain is making, are entirely normal,

because they are based on that deep catalog

of episodic memory that you maintain about that person.

Again, the depth and richness of that catalog

scaling, of course, in direct relation

to how close you were with that person, right?

Closer to somebody means more information about them.

More information about them

means your brain has a lot of implicit,

unconscious notions of when and where and how they show up.

So the fact that your brain,

and indeed, sometimes your body reacts

to the expectation that they'll be there is entirely normal.

It's simply an activation of this map

that involves closeness, space, and time.

Not surprisingly, then, the reordering of that map

that's required in order to move through

the grieving process,

is going to involve some remapping.

And you, as the person grieving,

have the opportunity to ask which node as it's called,

which element or dimension within that map,

are you going to focus on?

Some people really try hard to disengage with

and remap their sense of emotional closeness to the person.

That is, it's so unbelievably overwhelming to them,

that the person is no longer accessible,

that they try and change their ideas

about how close they really were.

They try and change their emotional attachment to the person

after they've died.

Clearly in the example that I gave in the Feynman letter,

that's not the case.

The attachment seems indeed quite fixed

and not going anywhere.

Psychologists and neuroscientists generally agree

that the best way to approach moving through grief

is actually to remap these dimensions

while maintaining the close sense of attachment

to the person,

by not in any way trying to undermine

the intensity of the attachment

or how important it was to you.

So we'll now talk about how that process works,

and the different entry points, as they're called,

to engaging in that process.

So one straightforward way to think about

this state of mind and body that we call grief,

is that the idea that someone,

or an animal, or a thing,

simply does not exist anymore

is not something that the brain can easily conceptualize.

And the reason for that is that we,

as beings that have a brain,

and a brain, as an organ that makes predictions,

tends to rely more on experience than knowledge.

In other words, the knowledge that someone,

or an animal or a thing, is gone, that it doesn't exist,

at least not in the dimensionality

that we were accustomed to relating to them in,

is something that we can understand logically,

but that emotionally is very hard to undo,

and from a memory perspective is very hard to undo.

So it's not just that we are in a state

of emotional disbelief.

It's that we have neurons, literally nerve cells

and neural circuits, connections between nerve cells,

that are dedicated to this vast, implicit knowledge

of all the things we know

about that person, animal, or thing.

And just because they are no longer in the dimensionality,

meaning in the configuration,

alive or present in our life that they were before,

doesn't eliminate those memories.

Those memories persist.

And so anytime we call to mind the person's name,

or we call to mind things that remind us of them,

or we suddenly feel the desire to engage with them,

the memories, those episodic implicit memories,

as they're called,

all that menu and library of knowledge,

slams us straight in the face,

and pushes us into a mode of wanting to act in a way

that's consistent with them still being here

in the way that all that knowledge

told us they were when we acquired it.

That's a very long-winded way of saying

that there's nothing wrong about the emotional state

when we are in a state of grief,

in fact, quite the opposite.

But there is something wrong about the memories,

because the memories are based on

our prior knowledge of them,

and those memories actually do not apply

to our current knowledge of them.

And again, even though our brain is a prediction machine

and it's a very good one, it's not perfect.

In fact, it's far from perfect.

So really, moving through grief

is a process of understanding

how relationships are mapped in the brain,

space, time, and closeness, also called attachment,

understanding those three dimensions,

understanding that they are closely linked,

and then understanding that simply the knowledge

that somebody or something or an animal

isn't accessible to us,

does not allow us to discard

of all the knowledge that we have.

And as a consequence,

our brain is constantly generating expectations

of how to access them,

even if we know that's completely irrational.

Now this should, I would hope,

assist you in moving through grief.

It's not a tool of the sort of,

like a switch that you can flip

and suddenly not feel grief,

but it does point to a specific set of mechanisms

or a specific set of steps that you can engage

in order to start to move through the grieving process

in the most adaptive and effective way,

and in a way that still holds in mind,

your close attachment to the person.

So let's talk about some of the tools

for adaptively moving through grief.

These are tools gleaned from the research psychology,

the clinical psychology, and the neuroscience literature.

So I've synthesized my understanding

of those three literatures,

to provide the tools that I'm about to describe.

The first one involves the acknowledgement

and really the understanding

that you don't want to disengage or dismantle

your real attachment to someone, an animal, or a thing.

That's a real thing,

and there is actually no adaptive reason

to try and persuade yourself or numb yourself,

or somehow avoid the thinking

of just how much they meant to you.

What is important, however,

is that you make some effort to shift your mindset

and your understanding of that person,

in a way that holds in mind that yes, indeed,

the attachment is very real,

and in some cases is very, very intense,

but is now going to be uncoupled

from the other two dimensions of the map,

namely space and time.

So again, just to make absolutely clear,

there's no reason to try and convince yourself

that you weren't actually that close to this person

or them to you.

There's no reason to try and reduce the intensity

of that attachment.

To the contrary, you want to anchor yourself

to that attachment, but you want to make sure

that your thoughts about the person,

and your feelings about the person,

are not oriented toward or in reference to, I should say,

that map, that deep catalog of memories that you had.

Now, this is not simply a fancy way of saying,

don't live in the past.

This is saying, you need to maintain

your sense of attachment,

but you need to start making predictions and understanding

about how you're going to engage with that attachment,

how you're going to feel those things,

without the expectation

that things that once happened before

are going to happen again.

So it's a complicated process, you can imagine,

but you really want to hold and register two things at once.

It's sort of like spinning two plates at once,

and therefore it's going to feel like effort.

One way to do this is to set aside

a dedicated period of time,

of maybe five or 10, maybe even as much as 30 minutes,

or depending on your capacity, 30 to 45 minutes,

in which you are going to feel deeply

into your closeness and your attachment

to that person, animal, or thing.

But you are consciously going to try

and prevent yourself from thinking about

a couple of categories of things.

First of all, you want to actively try and disengage

from any attempt to engage in

what's called counterfactual thinking, the what ifs.

What if I had called them a day earlier?

What if they had taken a different route home?

What if I had taken a different route home?

These counterfactual modes of thinking

are an infinite landscape of possibility,

and they are very closely tied to guilt.

Guilt is an interesting emotion.

We should probably do an entire episode about guilt,

but guilt as defined by psychologists and neuroscientists

is actually a way of assigning ourselves more agency,

more capability of controlling reality than actually exists.

And it's a very slippery slope.

And I want to be clear.

It's not the case that guilt

is never an appropriate response,

but in the context of grieving,

guilt is very precarious,

because in thinking "I could have done this,"

or "if I had only done that,"

you are essentially exploring an infinite landscape

of things that you can never refute.

You will never know that had you not gone down

a different path or they had not taken

a particular path in life,

that things would've turned out different,

but you can't know that it would've worked as well,

meaning you actually don't know

that your what ifs are true,

and you don't know that they're not true.

And so as an infinite space, it's a very precarious one,

and it will not allow you to uncouple

that intense emotional attachment that I'm telling you

is actually vital to hold onto,

from that catalog of episodic memory

that you've established.

In fact, it's going to strengthen those bonds.

So in this dedicated five or 10 or 30,

whatever period of time you can tolerate and maintain focus,

the idea is to think about your attachment in a rich way,

and to perhaps even experience that in your brain and body.

I think if you're in a stage of grief,

that actually will be fairly reflexive to do,

but to try as much as possible

to hold that grief in the present

and to be connected to your immediate physical environment.

So you want to orient yourself in current space and time,

rather than focus on memories,

or what you would've liked to see happen,

or the wish that they were still there,

while at the same time,

thinking about the depth and richness of that attachment.

This is a obviously a tightrope walk, so to speak.

It's an emotionally challenging,

and sometimes even will be experienced

as a physically challenging tool or experience,

but in our understanding of how attachments and grief

are represented in the brain,

this can be an immensely beneficial practice,

because it is the first step,

and indeed, it represents many of the steps

in the voyage from the initial shock of loss,

to our ability to hold in mind somebody

or an animal or a thing in a way that still allows us

to feel the depth and fullness of connection to them,

without feeling the yearning,

that reaching for the glass of water

that unfortunately will never be resolved.

Keep in mind that as you embark on this process,

it is entirely normal for your mind to flip

into various states of expectation

that they're suddenly going to be there.

In fact, because of the closeness

of these three dimensions in the map,

space, time, and attachment,

it's entirely normal that when you start to think about

your attachment to somebody,

or an animal, or a thing,

that you almost start to experience them

as present in that environment.

I'll share with you a somewhat bizarre,

or it sounds bizarre to articulate out loud,

but many of you perhaps will resonate with this.

For years after my graduate advisor died,

I would get an experience of someone

touching the back of my neck when I would think about her.

And that was not an experience I ever had with her, right?

It was a professional relationship.

I don't ever recall her touching me

on the back of my neck,

or me touching the back of my neck in her presence,

at least not on any regular basis.

So it was very perplexing to me.

And then I encountered this incredible literature on grief,

which said the following.

"Grief in many ways is like a phantom limb."

For those of you that aren't familiar,

many people who experience amputation of a limb,

either through surgery or accident or otherwise,

will feel in a very genuine way

that the limb is still present,

even though when they look for the limb, it's not there.

So they can feel pain in limbs.

They can feel the sensation of touch.

There's some famous experiments from the neurologists

and my former colleague

at University of California, San Diego,

who goes by his last name, Ramachandran.

Some people just call him Rama.

He's an incredible scientist,

and has done a lot of really important work,

in particular on phantom limb,

among other things,

and has done some beautiful experiments

showing that people who have phantom limb pain

or that are experiencing different sensations

in their phantom limb,

that can be very intrusive,

much in the same way

that expecting someone to walk through the door,

who you happen to know is deceased,

can be very intrusive.

Ramachandran's done beautiful experiments,

showing that if you give people

what's called a mirror box,

this is a box in which you insert an intact limb,

and there are some mirrors

that give you the visual impression

that the other limb is still present,

and you move the intact limb

and you get a mirror image of the non-existent,

but nonetheless a visual image

of the phantom limb moving,

that you can resolve some of the pain

of a limb that feels otherwise cramped up.

In other words, the visual perception

can reverse some of these phantom sensations.

In many ways, the phantom limb scenario,

and what I described about a sensation

of being touched on the back of the neck,

or this feeling that we have

when we engage in the thinking

and the emotions of our attachment to someone,

an animal, or a thing is very much like a phantom limb,

only it exists in the emotional space,

and it exists because it is reactivation

of these maps about space, time, and person.

And so if the process of moving through grief,

adaptively in a healthy way,

involves maintaining the attachment,

but uncoupling that attachment

from the space and time representation of that person,

animal, or thing that we had before,

well, then the question becomes,

where should we place our expectation of them, right?

Now, that of course will vary from person to person.

Some people with particular religious beliefs

will indeed believe that the soul of the person,

the molecules of the person

have been reordered and exist in some sort

of either distributed domain, right?

That they are in everything,

or they are in one location.

I'm not here to speak to that one way or the other.

There's no good experiment I know

either to prove or disprove that,

nor would I want to.

It's not the job of science, frankly.

However, allowing ourselves to place notions

of where that person, animal, or thing is

in their current new configuration,

whatever that might be,

ashes to ashes, dust to dust,

or that the person's soul comes out of their body.

These are all the different variations that people hear.

Or some people think, "Well, it's just molecules

and they disintegrate and are reordered,

and come up as the plants and the trees."

Again, a near infinite number of possibilities,

and it depends a lot on personal belief.

It is, however, essential

that no matter what you believe,

that you have some firm representation

of where that person, animal, or thing is

so that you can plug it into this map,

this three-dimensional map of space, time, and attachment.

The process of moving through grief

can't simply be that we hold onto the attachment

and we discard with any understanding

of where they are in space and time.

And actually, the letter that Feynman wrote

to his deceased wife Arline,

again, so beautifully

and really poignantly illustrates the fact

that he doesn't really know where to find her.

On the one hand, he really understands that she's gone.

And on the other hand,

he understands that he still very much expects her

to be there, that he would like to mail the letter.

But then of course, in this final,

somewhat humorous line,

he doesn't know where to send the letter, he tells us.

What's very clear, and I think is very healthy,

is the fact that the emotional bond is still there,

that that is maintained.

And so this tool, if you will,

of dedicated blocks of time

for really spending some effort,

and it is indeed effort

to access the emotional connection

while starting to uncouple the other nodes

of the map, as it were, is something that is hard.

You should expect it to be hard,

but in terms of the options one has

in order to deal with grief,

it is indeed the most adaptive way to go about it.

You're not trying to avoid thinking about it.

You're not engaging in this counterfactual thinking,

the what if, what if, what if.

You're not drowning it out with substances

or delusion or with other ways of distracting yourself.

So in that sense, it is truly adaptive.

Now, of course, I don't want to imply

that I'm a clinical psychologist.

I'm certainly not.

There is absolutely a place

for working with a trained professional

to move through grief,

especially these situations,

these one in 10 people

who deal with what's called complicated grief,

or very prolonged grief.

Those are somewhat different things,

but in general, point to the fact

that there are people who have

an exceptionally hard time moving through grief.

We'll talk about who those people are

and ways to move through them,

with or without a professional to assist you.

But nonetheless, we're starting to understand

on the basis of neuroscience,

what some of the more adaptive

and functional ways of moving through grief are.

In order to really understand how a tool

of the sort that we're describing to work,

and what it's designed to accomplish at a mechanistic level,

I'd like to teach you

about a very important aspect of your brain function

that has everything to do with grief

and the process of moving through grief,

but has a lot to do

with other aspects of our life experience as well.

Some of you are probably familiar

with a brain area called the hippocampus.

The hippocampus is a structure that's involved

in the formation of new memories,

but not the maintenance of memories.

I discussed the hippocampus in detail

in our episode on memory,

and our episode with our guest,

Dr. Wendy Suzuki from New York University,

an expert on learning and memory.

During those two discussions, I did not however,

touch into what the different cell types are

in the hippocampus, and the different roles they perform.

And it turns out that there are indeed

different cell types in the hippocampus,

and they perform very different roles

that are absolutely central to the grief process.

We have cells in our hippocampus,

meaning you have cells in your hippocampus.

These cells are neurons,

nerve cells that fire any time,

or, and when we say fire, I should just remind you,

I mean, have electrical activity,

any time that we enter a particular familiar location.

So for instance, think about your bedroom,

and think about where the bed is.

As you're doing that,

these so-called place cells are firing,

not necessarily to represent

that it's a bed at that location,

but to represent the location itself.

We also have neurons in our hippocampus

and elsewhere in our brain, I should say,

that represent proximity.

So for instance, if you were to wake up

in the middle of the night

and walk into the kitchen,

and it's somewhat dark,

and you orient toward the sink

to get yourself a glass of water,

or to the refrigerator to get yourself

something to drink or to eat,

as you get close to the sink or the refrigerator,

there are neurons in your hippocampus

that are going to start engaging electrical activity,

because you are in the mirror expected proximity

of the sink or refrigerator,

and you know where they are, hence the word expected.

Now that all seems fine and good.

You've got neurons that represent where things are,

and it sort of goes without saying

that those same neurons map to our emotional attachments.

We generally know where to find our loved ones.

Even if they don't live with us,

we generally know what city they're in.

Even if they're traveling,

we generally have a sense of where they're traveling

or the general area in which they're traveling.

Place cells and proximity cells

are involved in that kind of mapping

and representations as well.

Now there's a third kind of cell

that's particularly important for the sort of tool

that we were talking about earlier,

that tool of holding on

to the emotional attachment to somebody,

and yet trying to deliberately remap our understanding

of where they are in space and time.

And that has to do with a category of cells

called trace cells.

Trace cells were discovered by a number of laboratories.

I think the most renowned of those is the Moser Laboratory.

The Mosers are a couple.

Actually, they were a couple.

They're now, I think, amicably separated or divorced.

That's not what this episode's about.

If I have that wrong, forgive me.

Edvard and Britt are their names.

Their relationship isn't what's important,

except what is important

is the work that they did together in one form or another,

which was very important work,

establishing this category of cells

not just in the hippocampus,

but in an area of the brain called the entorhinal cortex,

that acts as a sort of coordinate system,

to orient us in space and time.

Trace cells are activated when we expect something

to be at a given location, but it's not there.

Experiments done in their laboratory

and in other laboratories have shown that, for instance,

if you give a rodent or frankly, a person,

a object that always resides at the same location,

and we reach to it in order to access it,

let's say where your coffeemaker is in the morning.

I do a pour-over coffee.

If I'm drinking coffee or latte, I'll do a pour-over.

It's always more or less in the same location.

And so there are place cells and proximity cells

that relate to my being able to find

that pour-over coffee cone thing.

However, if I were to go to that location

and it wasn't there, the trace cells,

these neurons in my hippocampus

and in the entorhinal cortex and elsewhere,

'cause again, these cells are connected

by way of circuitry, by way of connections,

those trace cells would fire.

We could even call it a trace circuit.

It's a circuit that has an expectation

that something will be in a location.

But when something is not at that location,

this circuit becomes active.

This is important because what we're talking about here

is a neural circuit and a set of neurons

that are responsible, not for the presence of something,

but the absence of something.

We have every reason to believe,

based on neuroimaging studies

and studies in animal models,

that trace cells become very active in the immediate stage

after the loss of a loved one,

that the brain and our maps of the person, place,

or thing that we know cognitively,

we understand, we even believe they are gone.

They are not accessible for whatever reason,

death or otherwise.

And yet we have neurons that are firing,

to reveal that absence to us.

And these neurons are closely associated

with neurons that tell us where things ought to be.

So if you feel the expectation,

or you sense that somebody

should walk through the door any moment,

or call at any moment,

or be next to you when you wake up,

and yet you cognitively understand that they won't,

that there's no real reason why they should,

because they are indeed gone, you are not crazy.

In fact, it's simply a reflection

of the normal functioning of these trace cells

and trace circuits.

Now I'd like to consider why two people,

both who are intensely attached

to a person that is no longer there,

can experience the grief of the loss of that person

in such different ways.

This is often observed.

You can have, God forbid,

incredibly sadly, in cases where a child is lost,

where both parents are grieving intensely,

but one seems to feel it at a emotional depth and level

that seems distinct from the other.

Now of course, keep in mind that we never really know

how other people are feeling.

This is something actually that was raised

in the episode where I interviewed a psychiatrist

and researcher colleague of mine

from Stanford, Karl Deisseroth.

As a psychiatrist, I heard him say once

that we really don't know how other people feel.

In fact, a lot of times we don't even really know

how we feel, or at least describing that

is quite challenging with language, often.

And indeed that is the case.

We don't really know how other people feel.

There's no clear way of knowing

that the expression someone else has

or whether or not they're crying or not,

or their body language really represents

how they feel inside.

So that is important to keep in mind.

Nonetheless, there does seem to be

a sort of a split among people,

and indeed, among animals as well,

even within a species,

in terms of how intensely they feel

the yearning aspect of grief.

And it appears, based on a number

of different lines of evidence,

that that relates to this molecule

that some of you have probably heard of, which is oxytocin.

Oxytocin is a hormone slash peptide.

A peptide just means a protein,

generally a small protein,

and a hormone is generally something

that functions at numerous locations in the body

to impact numerous organs and areas of the brain.

So a peptide can be a hormone,

and a hormone can be a peptide.

They are not mutually exclusive.

Oxytocin has a variety of roles in the brain and body.

It's involved in milk letdown during lactation.

It's involved in pair bonding, both in males and females.

It's involved in bonding of parent to child,

and indeed, between romantic partners, et cetera, et cetera.

Let's talk about some of the animal models

that inform us about the potential roles of oxytocin

in the grieving process.

There's a species of animal called the prairie vole,

and believe it or not,

the prairie vole has been studied fairly extensively

by neuroscience and psychology researchers.

In fact, our former director

of the National Institutes of Mental Health, Tom Insel,

his laboratory focused quite heavily on prairie voles.

Prairie voles are one species of animal,

but depending on where they live,

you find that some prairie voles are monogamous.

That is, they mate with the same prairie vole for life.

They raise litters of little prairie voles for life,

and other prairie voles,

generally that live in different locations in the wild,

are non-monogamous, sometimes called polygamous.

The neurochemical and circuit basis

for this monogamy versus non-monogamy, quite interesting.

However, in the context of grief and attachment,

the prairie voles have taught us a lot,

and they've taught us a lot

through the following experiment.

You take two prairie voles that are coupled up.

So these would be monogamous prairie voles,

that have established a couple bond.

I guess you would call that at a prairie voledom.

Anyway, you put them in a cage together.

They mate together, they raise young together,

and then you separate them.

You literally put a physical barrier

between the two of them,

and you can evaluate how strongly one prairie vole will work

to get access to the other prairie vole, right?

This is sort of the "Romeo and Juliet"

of prairie vole experiments.

And what you observe is that the monogamous prairie voles

will work very hard to get back to their mate,

to get access to their mate.

They will lever press.

They'll even walk across a metal plate

that they get a electrical shock.

They'll work very, very hard.

They will cross rivers and valleys, if you will,

in the experimental context, that is.

The polygamous prairie voles,

and again, we don't know if they are polyamorous.

We don't know what they feel, right?

We don't know if they're in love

or if they're motivated simply for other things.

But the non-monogamous prairie voles will not work as hard

to access a prairie vole partner.

Now you could argue that's because they expect

that there will be other prairie vole partners,

but even if they've never experienced

another prairie vole partner,

they won't work quite as hard to get back

in connection with this other prairie vole,

to mate or otherwise.

This turns out to be interesting,

when you start to explore the patterns

of so-called oxytocin receptors in the brain.

To make a long story short,

and to also bridge to the human literature,

it turns out that the monogamous prairie voles

have far more oxytocin receptors in this brain area

that I mentioned earlier, the nucleus accumbens.

And again, to remind you, the nucleus accumbens

is the brain area associated with motivation,

craving and pursuit.

So it's as if the monogamous prairie voles

have a capacity to link the attachment circuitry

and the molecules of attachment,

in this case, oxytocin,

to reward pathways and to motivational pathways.

Polygamous, or we should say,

non-monogamous prairie voles, do as well.

However, they have less oxytocin receptors.

So in other words, non-monogamous prairie voles

seem to have less yearning for attachment overall,

at least to a single individual prairie vole.

And when we look at the human literature,

in terms of oxytocin receptor expression

and brain imaging experiments, and so on,

what you find is the same,

that people that experience intense grief,

and a deep yearning and a motivation

to reconnect with the person, animal,

or thing that is lost,

in many cases have heightened levels

of oxytocin specifically,

or I should say, oxytocin receptors to be exact,

specifically within the brain regions

associated with craving and pursuit.

So for those of you that find yourself

in this kind of stuck mode,

this persistence of trying

to reach into the past or wishful thinking,

this counterfactual thinking,

"if only, if only, if only."

You don't necessarily want to pathologize that thinking.

First of all, we should acknowledge

that it's not necessarily adaptive.

And in fact, in the complete loss of somebody,

or if somebody says they don't want anything

to do with you ever again,

by all means, you know, if that's expressed clearly,

then you need to accept that reality.

But the yearning, the desire, and the impulsivity,

that kind of leaning in at a almost reflexive way,

to try and access that person again,

to text them, to want to hear from them, could,

and I have to highlight, could reflect the fact

that you just so happen to have more oxytocin receptors

or maybe more oxytocin overall in this brain area

that's associated with motivation and pursuit.

It does not necessarily mean

that you are more capable of attachment

than people who move through grief more quickly.

And I should say that people move through grief

at different rates.

Even if two people lost the same person, or same animal,

people move through this at different rates.

And some of that is no doubt psychological,

but some of it, no doubt,

is also neurochemical and biological.

And in sharing this with you,

I hope it sheds some understanding

and perhaps even some compassion for people

who are moving through things more quickly

or in a different way.

And of course it should also, I would hope,

shed compassion and understanding

for people that seem incapable of quote unquote moving on.

It's taking them far longer to move on.

Earlier, we talked about complicated grief,

non-complicated grief, and prolonged grief disorder.

And I should say that the precise divisions

between these categories is not very precise.

It takes a really trained expert

to be able to identify whether or not

somebody is in the prolonged grief disorder category,

complicated or non-complicated grief.

There's actually a set of questionnaires

that I invite you to answer if you like.

They were provided, or I should say I accessed them

through a public site on Mary-Frances O'Connor's webpage.

We'll put them in the show note captions.

You actually can submit those answers in an anonymous way

to a study that she's doing.

She has several surveys,

one for loss of a romantic relationship,

other for loss due to death of somebody,

and still another one that relates to homesickness,

and it's also available in several different languages.

So I'll provide a link to that website.

It's very easy to download.

There's no cost to that at all.

You can contribute to the scientific

data collection process, if you like.

And I do believe that you get your scores back

or an interpretation of your scores by participating there.

When Mary-Frances O'Connor hopefully comes on the podcast,

she can tell us some more of the detail

about separating out this prolonged grief disorder,

complicated and non-complicated grief.

But in the meantime, it's very clear

that people move through grief at different rates.

And as I mentioned just a moment ago,

that this is entirely normal,

probably has a basis in neurochemicals

and hormones, such as oxytocin.

There are probably other reasons as well.

In fact, we can assume with almost certainty

that there are other reasons as well.

Nonetheless, I think it is really important

to think about why some people might have a harder time

moving through grief due to life circumstance,

innate differences, and so on.

There's a very nice set of studies,

but one in particular,

entitled "Catecholamine Predictors

of Complicated Grief Outcomes."

Here again, the first author is Mary-Frances O'Connor,

reminding us that she's done

so much important work in this area.

This paper has several conclusions,

but one of the key conclusions

is that this particular category of molecules

we call the catecholamines,

the catecholamines include epinephrine,

which is also adrenaline,

norepinephrine, which is noradrenaline,

and dopamine, which you've learned about before.

Here, I'm just going to paraphrase,

or I'll read directly, actually.

What they found was that "participants",

again, this is human subjects,

"with the highest levels of epinephrine,

of adrenaline, pre-treatment,

had the highest levels

of complicated grief symptoms post-treatment,

and that could account

for their baseline level of symptoms."

What this means is that people

that have a lot of circulating adrenaline,

we might even call these people,

people who are, or typically reside

at a higher level of autonomic arousal, right?

We have an autonomic nervous system

that dictates how calm or alert or stressed

we happen to be just at baseline.

People who tend to be more alert and anxious at baseline,

prior to any grief episode,

tend to have, or statistically on average,

we should say, are more likely to experience

complicated grief and maybe even prolonged grief symptoms.

So if you're somebody that is anticipating losing someone,

or an animal, or a thing at some point,

and I think that really means everybody,

utilizing tools to adjust your epinephrine,

your adrenaline levels down

has a number of important benefits,

improving sleep, health metrics, et cetera.

There are tools to do that.

We have an episode on mastering stress

that you can find at our website, hubermanlab.com.

It has a lot of behavioral tools that are backed by science,

some of work that was done in my laboratory,

but certainly other laboratories as well,

that will allow you to control

your autonomic nervous system, both in real time,

and reduce the overall level of stress

and even chronic activation

of the so-called sympathetic arm

of the autonomic nervous system,

which is just fancy geek speak for saying,

there are tools to help you be calm,

not just for sake of navigating daily stress,

but as this paper illustrates,

for anticipating the fact that at some point,

you will lose somebody, an animal, or a thing,

and there is a way to move through that process

that we call healthy, normal grieving.

And then there's the so-called complicated grief,

or prolonged grief disorders,

that reflect immense challenge

in moving through grief at a reasonable rate.

So you can somewhat inoculate yourself

against complicated or prolonged grief,

by reducing your resting levels of,

or your pre-loss levels of epinephrine, of adrenaline.

And again, there are excellent tools to do that.

I won't review them here for sake of time,

but they're time-stamped,

and you can access those easily.

Again, zero cost tools.

Going back to this paper,

"Catecholamine Predictors of Complicated

Grief Treatment Outcomes,"

should say that not only did participants

with the highest levels of adrenaline

have the highest levels

of complicated grief symptoms post-treatment,

but the predictive relationship between these two things,

adrenaline and complicated grief,

was not seen in depression.

And I find that incredibly interesting,

because it further separates depression from grieving

and grieving from depression.

It's a resounding theme again and again.

Grieving is not depression,

and depression is not necessarily grieving.

They can coexist, but they are separable as well,

and indeed, reflect separate brain circuitries entirely.

So the conclusion they draw is that

"The present study supports the hypothesis

that catecholamine levels,"

again, epinephrine, dopamine, norepinephrine

are the catecholamines,

"are affected by bereavement and in turn,

can affect the ability of those with complicated grief

to benefit from psychotherapy."

So what does all this mean?

What this means is, we can prepare ourselves

to be in a better state to access, yes,

access grief when it's appropriate.

And indeed, grief is the appropriate response,

when we lose someone, an animal, or a thing

that we are closely attached to,

and yet, to be able to move through that

at a pace and in a way that is most adaptive for us.

And to just, again, highlight what adaptive means.

It does not mean dissociating from the attachment

to the person, animal, or thing.

I just want to pause for a second,

and mention why I keep repeating person, animal, or thing.

I'm saying that because,

while grieving the loss of a person,

or a relationship with a person,

doesn't have to be through death, of course,

but death or otherwise is something that we all

can intuitively understand,

even if we haven't experienced it.

We are capable of achieving great attachments

to animals as well.

And while the loss of a thing, of an object,

in no way, shape or form,

approximates the loss of a person or an animal,

I would never suggest that it does,

it would also be naive and unfair of me or anyone else

to suggest that things can't hold immense importance to us,

and that the loss of them can feel quite significant,

and invoke the grieving process.

This isn't always about materialism.

Sometimes it's purely about the sentimental attachment.

So for instance, the loss of a wedding ring

or an engagement ring that was very meaningful to you,

or an article of clothing or a painting,

or even a small, seemingly unimportant object

to somebody else,

but something that held great meaning to you,

maybe a seashell that you collected

with somebody on the beach,

and then somehow it gets lost.

And it's the relationship with that person

that's contained within that object for you,

as a representation within that object that's important.

That's the reason why I keep saying,

person, animal, or thing.

I think it's only fair to include things in that category,

but of course, with the understanding

that they don't hold the absolute same magnitude

as the loss of a being.

One thing that we ought to consider for a moment,

is whether or not the depth of attachment

that you have to somebody

predicts how long it will take

for you to move through the loss of that person.

We often hear this.

Actually, I can remember some years ago,

at the end of a relationship,

a friend and colleague of mine saying,

"You know, for every year that you were together,

it's going to take you one month to get over that person."

And I thought, "Where in the world

did those data come from?" [laughs]

And this is what I call anecdata or collective data,

where this is like phrases such as,

"Absence makes the heart grow fonder."

And indeed, sometimes absence

can make the heart grow fonder,

in the context of two living people

or people in a loving relationship,

or even in the context of grief and loss.

But of course, there's,

"Absence makes the heart grow fonder,"

and then you also will hear,

"Out of sight, out of mind."

And if you've been listening to this episode,

clearly, out of sight does not mean out of mind

or out of emotional connection.

So these sayings of, "Well, it takes X number of months

for number of years,"

or "out of sight, out of mind,"

or "absence makes the heart grow fonder,"

they really don't hold a lot of meaning,

at least not for somebody like me,

who likes science because science is at least geared

toward or aims towards establishing things

in fact, not opinion,

but also because science allows you to make predictions.

It allows you to orient yourself in a process,

and make predictions and understand.

So, what are we to think of people

who seem very, very attached to somebody?

They break up, and they seem just crushed, devastated.

But three weeks later,

they're in a new relationship

and they seem perfectly fine.

Or somebody whose spouse dies,

and then suddenly they're in a new relationship.

I think there are rates of transition, if you will,

that suggest some dysfunction, pathology, et cetera.

But here we aren't in a position to judge.

We're only in a position to speculate about this.

And I think we can reasonably speculate

that it sort of makes sense

why someone who has an intense attachment to somebody

might be able to form

intense attachments generally, right,

that they aren't restricted to one person,

whereas other people who have

an intense attachment to somebody

might find themselves entirely incapable of moving on,

or it would take them a very long time,

hence the lines in the Feynman letter to Arline about,

he had met various other young women.

They seemed perfectly nice.

And yet, they were meaningless to him

in the shadow of her memory,

or we should say, in the light of Arline's memory,

or the memory of Arline, rather.

So these dimensionalities of attachment,

they cut in every direction.

And I don't think any well-trained psychologist

or neuroscientist would ever say,

"Oh, if you are somebody who becomes very attached,

therefore it's very hard to move on."

I think that could be true.

It could also be that if you're somebody

who has a great capacity for attachment,

you have a great capacity for attachment overall.

Neuroscience nor psychology is really in a position

to judge, certainly,

but it's also not in a position

to make those kinds of predictions,

at least the field, as it stands right now,

of attachment and grieving,

can't really speak to why that's the case.

So that's my attempt to depathologize

some of what we observe,

although I have to confess,

from a just sort of everyday stance,

that sometimes the rate in which

people move out of attachments and grieving

can be somewhat eerie.

I'd like to take a moment and explore this idea

that allowing ourselves to really feel

the attachment to somebody

can accelerate or at least support

adaptive transitioning through grief.

There's a really wonderful study that, on the face of it,

appears to be a, what we call negative result.

A negative result is when a hypothesis is posed,

and then turns out the hypothesis is not true.

But as is the case with so many

interesting scientific findings,

often when there's a negative result,

there's a more interesting result

nested in that negative outcome.

And this is the case in a particular paper

I'll share with you now.

This is a paper published

in the journal "Biological Psychology."

And again, the title is posed as a question, which is,

"Emotional Disclosure for Whom?

A Study of Vagal Tone in Bereavement."

What this study explored

was whether or not written disclosure

of the emotional connection to somebody that was lost

would be effective as a way for people

to move through the grieving process.

The study also explored the so-called vagus nerve.

The vagus nerve is an extensive nerve pathway

that is bidirectional between brain and body,

so brain to body and body to brain.

It generally is associated with calming effects

on our brain and body,

although that's certainly not always the case.

The way to think about it in terms of

what we're going to talk about now

is heart rate and heart rate variability.

And in very simplistic terms,

if your heart was just allowed to beat

at its sort of default rate,

that rate would be rather high,

because of the activation of the so-called sympathetic arm

of the autonomic nervous system,

the alertness component of the autonomic nervous system.

The parasympathetic nervous system,

as it's called, involves calming.

We sometimes hear sympathetic is for stress

or fight or flight.

It's for a lot of other things as well, I should mention,

and it is not for sympathy.

Sympa simply means together,

and it reflects the activity of a bunch of neurons

being active at the same time or together, sympa,

whereas parasympathetic is often associated

with quote unquote rest and digest functions,

or calming functions,

although it is certainly involved in other things as well.

So sympathetic nervous system drives alertness,

panic, stress, et cetera.

Parasympathetic nervous system,

meaning a distinct set of neurons drive calming,

falling asleep, digestion,

sexual arousal for that matter, and so on.

So it's sort of like a seesaw

of alertness and calm, alertness and calm,

sympathetic and parasympathetic, back and forth.

The vagus nerve is generally associated

with parasympathetic functions,

and has the capacity to slow down our heart rate,

in particular, by exhales,

and just simply because of the movement of the diaphragm

and its relationship to the heart

and the thoracic cavity.

Exhales result in slowing down of the heart rate.

This is what we call an increased vagal tone.

So let me explain for a moment.

And actually here's a tool you can use,

not just in terms of navigating grief,

but in terms of stress modulation, generally.

We have a muscle called the diaphragm.

When we inhale, [inhales]

whether or not it's through our mouth or our nose,

our diaphragm moves down.

As a consequence, there is more space overall

in the thoracic cavity.

The heart gets a little bit bigger,

believe it or not, volume-wise,

blood flows more slowly through that large volume.

And there's a signal conveyed

from the nervous system to the heart to speed the heart up.

So inhales literally speed your heart up.

And when you exhale, the diaphragm moves up.

And as a consequence,

there's less space in the thoracic cavity.

Heart gets a little bit smaller.

The existing blood volume in the heart at that time

moves more quickly through that small volume, right?

Given amount of blood volume,

make the compartment it's in, the heart, smaller,

and the blood moves more quickly through that volume.

And as a consequence, the nervous system

sends a signal to the heart,

via the vagus and other pathways,

to slow the heart down.

In other words, exhales slow the heart down.

That process, that relationship

between inhales speeding the heart up,

and exhales slowing the heart down,

is something called respiratory sinus arrhythmia.

Some people are able to engage respiratory sinus arrhythmia

more naturally, more reflexively than others.

You can actually train this

by consciously thinking about slowing your heart rate

while you exhale,

and consciously thinking about increasing your heart rate

as you inhale.

You can literally strengthen these pathways.

Now, respiratory sinus arrhythmia,

and the ability to slow your heart rate with exhales,

is one dimension of what's called vagal tone,

or your ability to control

your overall level of activation of alertness and stress,

with these vagus nerve pathways.

So vagal tone is something

that varies from person to person.

If you've trained up or you've thought about

your relationship between breath and heart rate,

you can improve vagal tone.

Some people have very robust vagal tone

without having done any training.

Other people have less of it, et cetera.

I'll just paraphrase from this paper,

and you'll see where this takes us

in terms of navigating grief, because it's quite important.

"The vagus nerve provides

inhibitory regulatory influence on the heart,

allowing the heart rate to increase rapidly

through vagal withdrawal,"

that means kind of coming off the break

of the parasympathetic nervous system,

"as in response to a stressor in one's environment."

Right, when you're stressed,

you rarely take the opportunity,

if it's an immediate stress or threat, to actively exhale,

although that would be a great tool to use.

And in fact, we promote that tool

in our "Mastering Stress" episode.

"Vagal withdrawal usually co-occurs

with an increase in sympathetic activation of the heart."

You now know what that is,

"or is known as the fight or flight response.

Vagal tone reflects the degree to which there is tonic,"

meaning ongoing, "vagal influence on the heart."

So when you have a high degree of vagal tone,

it means that you are always activating that break

on your stress system, just at default.

And some people just happen to do that more.

Other people need to practice long exhale breathing

in order to build up vagal tone,

something that's very useful to do,

whether you're grieving or not.

Now in this study, what they did

is they had people,

and I should say it was 35 participants,

go through a writing exercise for a period of weeks.

They actually wrote about three times per week.

Then there was a follow up at some period of time,

and then again, about a month later.

And there were two different groups.

One group was in the so-called written disclosure group.

What they did is they, on day one,

they would write about what happened when a loved one died.

And indeed they used people who had experienced real loss.

And so they were asked to talk about

and write about their deepest emotions

and thoughts about it, memories of their loved one,

very intense stuff, if you think about it,

if they're in the immediate period of having lost someone.

Then they actually were asked to write a letter

to the person that they lost.

So again, a very intense exercise to go through,

if you did indeed lose somebody as these subjects had.

And then of course there was the testing,

some period of time later,

and I'll tell you what that period,

what that testing involved.

The other group was a so-called control group,

where they were simply told to write

about how they use their time.

So an emotionally kind of empty writing exercise,

if you will.

They described what they did today after they woke up,

et cetera, no heavy emotional content, and so on.

Now, as I mentioned earlier,

the immediate results of this study were a negative result,

meaning no effect.

The disclosure that, we should say,

the emotionally intense writing group

and the control group did not differ at baseline

on any symptom measures

or psychological variables, they tell us,

and at least at face value, somewhat disappointingly,

there really wasn't any kind of difference in outcome

between the group that wrote about

the very emotionally intense stuff

versus non-emotionally intense.

Now, what I didn't tell you thus far

is why they had them do this exercise at all.

They had them do this exercise

because many of the effective practices

for moving through grief involve, as I mentioned earlier,

getting close to and actually deliberately experiencing

the attachment that one has to that person that was lost,

not distracting one's self,

not getting into this counterfactual thinking,

the what if, what if, what if,

but rather thinking about,

or in this case, writing about the real attachment.

And so the initial idea was,

if people write about this attachment,

that they're going to experience this attachment,

and that will serve them in some or many ways,

in terms of moving through grief.

And that wasn't what they found.

They found no difference between the two groups,

until they explored who had higher vagal tone,

who had a greater degree

of so-called respiratory sinus arrhythmia.

In other words, who was able to modulate their state,

using their breathing and their body.

And what they discovered was that a subset of individuals

who had a high degree of vagal tone

seemed to get more benefit from this writing-type exercise.

Now, this is one study,

and I would consider it fairly preliminary with 35 subjects.

Although, you know, it's a study unto itself

and I think a quite nice one,

and it really set the stage

for a number of other studies that followed,

from this group and other groups,

that really point to the fact that yes, indeed,

accessing these states of emotionality

by writing or thinking about somebody

is quite powerful in terms of engaging the bodily states

and the mind states associated with the attachment.

And that is very beneficial for moving through grief.

That is very beneficial for sensing the attachment.

And now it makes perfect sense as to why some people

would benefit from that sort of practice more than others,

because some people are able to access

more real somatic feelings of attachment

by writing about the attachment,

or by thinking about it, than others.

So this brings us back to an earlier discussion

we were having, where we were talking about

how some people seem to move through things very quickly,

or don't seem to be grieving constantly,

and a spouse or a family member of that person might think,

"Gosh, why aren't you upset?

How is it that you can be functional and I'm not,"

or, "how is it that you can be functional?"

There can even be fractures in families and relationships

on the basis of differences in rates of grieving and so on.

Well, some of this, again,

probably relates to psychology

and the different attachments

that people had to the person or animal

or thing that was lost,

but it no doubt also has to do

with how much of a mind/body connection,

how much vagal tone exists in the person,

when they suddenly found themselves in the grief episode.

So this actually offers multiple opportunities.

If you're somebody, for instance,

who is grieving so intensely and so often

that you're finding it immensely difficult

to move through grief at a reasonable rate,

and you might even say, or find yourself

diagnosed with prolonged grief disorder

or with complicated grief syndrome

in a way that's really impairing

your adaptive functioning in life,

well then, it's not clear to me,

at least by my read of the data,

that you would want to engage in a lot of practices

to increase the mind/body relationship

and feeling so much of this attachment,

because you're already feeling an immense amount of it.

Whereas other people who are feeling challenged

in accessing the feelings of attachment,

and perhaps not functioning well

as a consequence of that,

might find that practicing breathing

in order to encourage respiratory sinus arrhythmia,

again, focusing on slowing your heart rate consciously

while you exhale,

and concentrating on increasing your heart rate

as you inhale,

even just as a brief practice

of even just one to three minutes or one to five minutes,

every once in a while or per day,

that could be immensely beneficial

in building this mind/body relationship.

Because again, what this paper really points to

and set off a number of other investigations related to,

is that for those that can really feel

the relationship between breathing heart rate,

what we call vagal tone,

well, those people are going to be in a better position

to move through grief,

not because they are disengaging

from the feelings of attachment,

but because they are better able

to access those feelings of attachment.

So what this relates to of course is that tripartite map,

that three-part map that we talked about earlier,

that representation of space, where things are,

where the person is, where their belongings are,

where their car is, where their bicycle is,

time, when you were expecting to see them

on a regular basis,

when they would call,

when they would come home from work, et cetera,

and that third node,

or that third dimension of attachment,

which is literally attachment and closeness.

Well, what we're talking about here

is anchoring to that attachment

and really feeling into that,

but then disengaging from the space and time map

that we call episodic memory,

that menu of prior experiences,

that keeps us in many ways,

maladaptively in an expectation

of what never can be again.

Now I'd like to take a moment and consider

some of the tools that you can access

that support healthy transitioning through grief.

And these are tools distinct from that neural map,

that space, time and closeness attachment map

that we were talking about before.

Rather, it's important to remind ourselves

that everything exists

in a context of our baseline physiology.

And I'm certainly not going to be the first

or the last to tell you that everything in life,

learning, relationships with people that are still around,

our health in every way, immune system, et cetera,

function far better when we're sleeping really well,

and when we are generally awake during the daytime

and asleep at night.

I realize there are shift workers out there,

people who are traveling and are jet-lagged.

First of all, thank you, shift workers.

We rely on you.

We have an episode all about jet lag and shift work,

for you and for trying to maintain

the best possible mental and physical health

in the face of ongoing shift work and jet lag.

You can find that episode

on our website, hubermanlab.com.

Lots of behavioral tools, some other tools as well.

Nonetheless, human beings are diurnal.

We were really designed to be awake mostly in the day

and asleep at night.

There are rare exceptions to this

where people like to stay up late and sleep in late.

But we are a diurnal species,

by way of our genetic wiring

and our neural circuit wiring.

There's a particular feature to our diurnal,

and diurnal, meaning the opposite of nocturnal,

our diurnal pattern of the release

of a hormone called cortisol.

Cortisol is a stress hormone, it's sometimes called,

but cortisol has a lot of other effects,

many of which are positive.

Cortisol for instance, protects us against infection.

It can help us in terms of waking up in the morning.

In fact, the pulse as it's called

or the spike in cortisol early in the day

is part of the reason we wake up.

It's linked to our increase in temperature rhythms,

and can further increase our temperature,

which leads to waking, and so on.

The typical pattern of cortisol in a healthy individual,

and we really can say physically

and emotionally healthy individual,

is that cortisol is going to be

somewhat high right around waking,

and then is going to be highest as it ever will be

in the 24-hour period, about 45 minutes post waking,

not exactly 45 minutes, but about 45 minutes.

And then it will drop gradually,

such that by about 4:00 p.m. in the afternoon,

which is actually when body temperature

tends to start to drop as well,

cortisol tends to be very low,

and then remains low in a healthy individual,

such that at 9:00 p.m., it's very low.

And throughout the night as we sleep, it's very low.

In fact, spikes or pulses in 9:00 p.m. cortisol

are a fairly reliable biomarker readout

of certain forms of depression and chronic anxiety.

This relates to the beautiful work of my colleagues

at Stanford and Stanford School of Medicine,

Dr. David Spiegel, who's been on this podcast,

and Dr. Robert Sapolsky, who has also been on this podcast.

There's a very interesting paper

exploring the relationship

between cortisol rhythms and grieving, in particular,

complicated versus non-complicated grieving.

Again, complicated grieving being the form of grieving

that reflects a immense challenge

of people moving through the grieving process,

such that it really needs to be dealt with, right?

Again, grieving is healthy, but complicated grieving

is a prolonged grieving,

and has other dimensions as well,

hence the name complicated.

The title of this paper is,

"Diurnal Cortisol in Complicated and Non-Complicated Grief,

Slope Differences Across the Day."

And the figure to orient to in this paper,

if you do decide to check it out,

and we'll put a link to it,

is Figure One, which beautifully shows,

or I should say very clearly shows,

that in individuals that are experiencing complicated grief,

there's the same general contour

of high cortisol upon waking,

even higher about 45 minutes after waking,

and then a reduction in cortisol by 4:00 p.m.,

and even further reduction by 9:00 p.m.,

so just as it were in a typical individual,

or somebody who is in non-complicated grieving.

However, when you compare the cortisol levels

between people experiencing complicated grieving

versus non-complicated grieving,

what you find is the 4:00 p.m.

and 9:00 p.m. cortisol levels

are significantly higher than they are

in the non-complicated grieving group.

This raises a very interesting idea,

and relates very closely

to what we were talking about with vagal tone.

You could imagine a situation

in which people who are experiencing complicated grief

have higher levels of afternoon and nighttime cortisol,

because they are in complicated grief,

but you could also imagine the opposite,

that they're experiencing complicated grief

because of the fact that they have elevated cortisol.

Now, it's very likely that it's bidirectional,

that the answer isn't one or the other, but both,

that complicated grief changes patterns of cortisol,

and that patterns of cortisol change the likelihood

that one has complicated grief.

That's the most logical interpretation of data like these.

However, when taken along with the data on vagal tone,

that people who have a higher level of vagal tone

are better able to navigate situations of the sort

that we're talking about,

and that some people perhaps have oxytocin receptors

or patterns of catecholamines or epinephrine,

that position them to be more likely

to grieve in a particular way,

we arrive at a scenario where it makes very good sense

to think about modulating,

that is controlling the foundation of your life,

in a way that establishes cortisol rhythms,

and sleep patterns,

and patterns of autonomic arousal and catecholamine release

that position you to navigate the grief process

in the best possible way.

If that was a complicated mouthful to digest,

let me restate it in a simpler way.

If you are somebody who is heading into grief

or is challenged with grief,

complicated grief, or otherwise,

prolonged grief or otherwise,

getting adequate sleep at night

and establishing as normal a pattern of cortisol as possible

is going to be very important.

And there's a very simple, straightforward way to do this.

And I apologize to the listeners of this podcast in advance,

if I sound like a repeating record,

but the most powerful way to do this

is to view sunlight, very close to waking.

It does not have to be right at sunrise,