This is an email from Inside Your Head 🧠, a newsletter by Elemental.

This Is Your Brain on Grief

If you knew and loved one of the 500,000-plus people lost to the pandemic, here’s what might be going on in your brain right now.

Credit: sdominick / Getty Images

This is a modified excerpt from Inside Your Head 🧠, a weekly newsletter exploring why your brain makes you think, feel, and act the way you do, written by me, Elemental’s senior writer and a former brain scientist. Subscribe here so you won’t miss the next one.

Yesterday, the official U.S. death toll from the pandemic reached 500,000 people. Half a million husbands, wives, mothers, fathers, sons, daughters, sisters, brothers, friends, lovers. Covid-19 is now the leading cause of death in the U.S., and more lives have been lost to the pandemic than to World War II and the Vietnam War combined.

Each of those 500,000 people was loved by others, leaving millions of us to grieve those lost lives. Artists, philosophers, and better writers than I will help place this loss in context and perhaps bring meaning and a kind of sharp, beautiful truth to the pain that so many are feeling right now, a pain rooted in love. What I can offer is to explain a little bit about what’s happening in your brain when someone you love dies, and I hope that sliver of science may provide a small amount of clarity and understanding about why it’s so awful and confusing.

Your brain is grieving

Psychologist Mary-Frances O’Connor, who specializes in grief, says that there is a difference between grief and grieving. You will likely never stop grieving the loss of your spouse; 20 years later, the sadness and yearning will still be there, but it won’t always be the overwhelming waves of pain that bring you to your knees at the beginning. Those pangs can last for months or even years, but eventually, they will start to be balanced by a resiliency and the return to a meaningful life without the person.

There is no right or wrong way to grieve. You might be feeling sadness, disbelief, anger, guilt, or numbness right now, or all of the above at different times. “I think it’s useful for people to know that what they’re experiencing right now is a normal reaction,” O’Connor says. “It’s happening to way more people than it should be all at once because of the massive mortality rate, but that distress is the natural response to loss.”

O’Connor has studied these pangs of grief in the brain, and she sees a reliable pattern of activity among people who are thinking about a lost loved one. Areas involved in strong emotion, autobiographical memory, and emotion regulation are all activated during grief — the posterior and anterior cingulate cortex, and the medial prefrontal cortex, respectively. The brain’s reward circuit also gets activated, which O’Connor says corresponds to a feeling of yearning for the deceased.

A big part of the grieving process in the brain is trying to adjust to the new normal of life without that person. You remember them, you miss them, you crave them, and you don’t understand why they’re not there at the dinner table, on the couch, on the other end of the telephone. You have all of these established memories and routines with this person, and now your brain has to try to relearn life without them in it.

“There’s this learning process that has to happen where that encoded person still exists in the brain but doesn’t exist on a physical plane, and we have to learn how to make sense of that mismatch,” O’Connor says. “Grieving is partially a form of learning that this person is no longer here and [figuring] out how to have a meaningful life with the presence of that absence.”

In order to accept the loss, you have to create new memories about it. As distressing as it may be at the time, one thing that makes this updating process easier is being with the person as they die. Our rituals around death — the funeral, crying and hugging, and sharing stories with family and friends — can also be helpful to lay down new memories that acknowledge the person isn’t coming back.

In the pandemic, both of these fundamental parts of death and grieving have been disrupted, which can make it harder to accept and come to terms with the loss. Even though you know they’re gone, your brain still expects them to walk through the door at any moment because that’s what they’ve always done. When that disconnect exists, grief can become harder to resolve.

Try this to help you grieve

Grief is a normal, intense, painful human emotion, full stop. There is nothing pathological or unhealthy about grief, and it can last for a long time. It does usually become less raw and overwhelming with time, though, and most people are able to persevere and continue living their lives.

When acute grief doesn’t resolve for more than a year, and if it becomes a pervasive longing or preoccupation with the person who died, along with an absence of joy or satisfaction in life, it can tip over into what’s called prolonged grief disorder. Prolonged or complicated grief occurs in about 7% to 10% of people who are grieving, but the rates are double that in people who have lost a child or a spouse, or when the death is sudden, unexpected, or violent.

Grief expert Kathy Shear says difficulty accepting the reality of the death is often a component of prolonged grief disorder, and understanding and accepting your grief — in whatever form it shows up — is the first step toward coming to terms with it.

Shear developed a specific form of therapy for prolonged grief, which involves guiding the person through seven healing milestones. They include allowing yourself to have positive emotions and to think about the future in a positive way, as well as strengthening relationships with other people.

A particularly intense step in Shear’s treatment plan for prolonged grief disorder is having people tell the story of how they first learned about their loved one’s death, almost as a type of exposure therapy similar to PTSD. A final step is learning to live with reminders of the person and regaining a sense of connection to the memories without being in denial about their death.

If you’ve lost someone this year to Covid-19, my deepest condolences. If you need help processing your loss and this insane awful year we’ve all lived through, please seek help from a licensed therapist — it really can help. And please know that you are not alone, and we will get through this together.

Update: The pandemic has caused more American deaths than WWII (405,399) and the Vietnam War (58,220) together, but not more than three wars combined (WWI: 116,516).

Health and science writer • PhD in 🧠 • Words in Scientific American, STAT, The Atlantic, The Guardian • Award-winning Covid-19 coverage for Elemental

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