Scientists know that the intense stress of grieving can affect the body in various ways, but much remains a mystery.

By Ann Finkbeiner

In 1987, when my 18-year-old son was killed in a train accident, a chaplain and two detectives came to my house to notify me. I didn’t cry then, but a wall came down in my mind and I could do nothing except be polite and make the necessary decisions. When friends and relatives showed up, I was still polite, but the wall had now become an infinite darkness and I was obviously in shock, so they took over, helping me to eat and notify people and write death notices.

I’ve been thinking a lot lately about the more than 565,000 people who have died from Covid-19 in the United States. Each of them has left, on average, nine people grieving. That’s more than five million people going through the long process of grief.

Manisha Patel, a senior business systems analyst in Bensalem, Pa., lost her father, Ramesh Patel, to Covid-19 in June. “I have been through the toughest time of my life,” she said. “I feel heavier, but I weigh no more and I eat less. And there’s a lot of gray hair I didn’t have. My heart aches for him, it longs for him, it looks for him.”

When someone you love dies, experts have a pretty good sense of the path that grief takes through the mind, but have only a general sense of how it progresses through the rest of the body. First is a shock in which you feel numb or intensely sad or angry or guilty or anxious or scatterbrained or not able to sleep or eat or any combination of the above. During those first weeks, people have increased heart rates, higher blood pressure and may be more likely to have heart attacks. Over their lifetimes, according to studies done mostly on bereaved spouses, they may have a higher risk for cardiovascular disease, infections, cancer and chronic diseases like diabetes. Within the first three months, research on bereaved parents and spouses shows that they are nearly two times more likely to die than those not bereaved, and after a year, they are 10 percent more likely to die.

With time, most people stabilize; they begin to learn — gradually and on their own timeline — how to more or less continue with their lives and function in society. But studies suggest that after six to 12 months, about 10 percent of bereaved people have not begun to function better. They get stuck in what’s called “complicated grief”: they stay completely preoccupied with loss and persistent yearning, and remain socially withdrawn.

Scientists know that grief is not only psychological, it’s also physical. They know that it causes the brain to send a cascade of stress hormones and other signals to the cardiovascular and immune systems that can ultimately change how those systems function. But nobody knows how those systems act together to create the risks of diseases and even death.

One reason scientists don’t know more about the biology of grief is that only a handful of researchers study it, and they are usually psychologists with biological interests. Mary-Frances O’Connor, a psychologist who researches grief at the University of Arizona, studies both the psychology of grief and its biological changes in the laboratory and is one of the few researchers who straddles both fields. Hybrid science is seldom funded well; grief is neither a disease nor is it classified as a mental disorder, and the main funding agency, the National Institutes of Health, has no single established channel for funding it.

Nevertheless, researchers have found enough people to take surveys and get blood tests and scans to note some patterns.

Chris Fagundes, a psychologist at Rice University, said that in his own lab, he and his team have found links between grief, depression and changes to the immune and cardiovascular systems. In one study published in 2019, he and his team performed psychological assessments on 99 bereaved people about three months after the deaths of their spouses, and then took blood samples. Those who experienced higher levels of grief and depression also had higher levels of the immune system’s markers for inflammation.

“Chronic inflammation can be dangerous,” Dr. Fagundes said. “It can contribute to cardiovascular disease, Type 2 diabetes, some cancers.” In another study of 65 people, published in 2018, Dr. Fagundes and his colleagues found that bereaved spouses who had higher levels of markers for inflammation also had what experts refer to as lower heart rate variability — a characteristic that can contribute to an elevated risk for cardiovascular disease.

Other studies have found effects on the cardiovascular system, too. In one, published in 2012, researchers measured the heart rates of 78 bereaved people twice — once for 24 hours within the first two weeks of a spouse or child’s death, and again for the same amount of time six months later. They found that their heart rates were initially faster, then returned to normal, suggesting that the bereaved may have been at least temporarily at higher risk for heart disease. Another study published in 2012 found that those with higher scores on grief assessment tests also had increased levels of cardiovascular clotting factors, possibly raising the risk of developing blood clots.

And in one review of 20 studies, published in 2020, people who scored higher on psychological measures of grief also had higher levels of certain stress hormones like cortisol and epinephrine. Over time, chronic stress can increase the risk of cardiovascular conditions as well as diabetes, cancer, autoimmune conditions and depression and anxiety.

Put the studies together and on the whole, Dr. Fagundes said, “everything starts with the brain.” It responds to the death (and to intense stress in general), by releasing certain hormones that fan out into the body, affecting the cardiovascular system and the cells of the immune system. Aside from that generality, however, the biology of grief has no clear chain of cause-and-effect that the biology of, say, diabetes, has. That’s because the goals of these studies are to better understand the griever’s risks for disease, not to understand the path of grief through the body.

The one exception is with the study of the brain. In 2001, Dr. O’Connor first began imaging the grieving brain, and a handful of similar studies have been done since. In these studies, a person lies immobile in a functional magnetic resonance imaging (or fMRI) scanner, looks at certain pictures and listens to certain words, and the machine maps the blood flow to parts of the brain. In one study published in 2003, Dr. O’Connor found three areas of the brain that were triggered by words related to grief (like “funeral” or “loss”) and a fourth triggered by pictures of the person who died. Some of the brain areas were involved in the experience of pain, others in having autobiographical memories. These findings were “not world-stopping,” Dr. O’Connor said, “like, sure, that’s what happens in grief.”

But the responses recorded in another area, called the nucleus accumbens, were more surprising. This region is part of the brain’s network for reward, the part that responds to, say, chocolate, and it was active only in people with complicated grief. Nobody knows why this is so, but Dr. O’Connor theorized that in the continuing yearning of complicated grief, being reminded of a loved one with pictures and words might have the same reward as seeing a living loved one. In regular, uncomplicated grieving, the reminder is no longer connected to a living reward but is understood as a memory of someone no longer here.

All of these studies, however, have limitations. Many of them are small and haven’t been replicated. The researchers also don’t have the resources to follow the participants over time to see whether those with higher risks for a disease eventually develop that disease. Many studies are also a snapshot of one point in time, and will miss the changes that occur in most people over months and years. Studies using fMRI have limits all their own, too: “A lot of things could make the same areas light up,” Dr. O’Connor said, “and the same thing might not make the same areas light up in everyone or in one person over time.”

Grief, biological and psychological, is of course the result of another hard-to-study state, human attachment or love. “Humans are predisposed to form loving bonds,” Dr. O’Connor said, “and as soon as you do, your body is loaded and cocked for what happens when that person is gone. So all systems that functioned well now must accommodate the person’s absence.” For most people, the systems adjust: “Our bodies are amazingly resilient,” she said.

In a recent issue of the research digest UpToDate, medical doctors outlined the most current scientific studies on bereavement. One way to think about grieving, they said, is that the feeling of connection to the person who died “gradually moves from preoccupying the mind to residing comfortably in the heart.” I’m unsure about that word, “comfortably,” but yes, I’m no longer preoccupied. Now, 34 years after my son’s death, I’m back in charge, and if pain never quite goes away, then neither does love.

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First and foremost: It’s okay not to be okay.

By Perri O. Blumberg

Along with what you’re going through individually, the world is going through collective grief: Amid the coronavirus pandemic, economic insecurity, and racial and political unrest, so many people are struggling to find hope. It’s hard to fathom the 562,000 lives (and counting) that we’ve lost in America alone from the pandemic. Hundreds of thousands of people are dealing with the loss of a loved one due to the virus.

On top of that, family members and loved ones are grappling with added layers of hardship and isolation the pandemic has created in the wake of a loved one’s passing, even if it’s not a COVID-19-related death. “Periods of grief following loss are notoriously isolating and difficult to navigate; grieving during a pandemic where many are socially distanced and unable to participate in traditional rituals of grieving, such as funerals and memorials, can make the process more complex,” says Courtney Bolton, PhD, a psychologist in Nashville, Tennessee.

And for the BIPOC community, it’s a particularly difficult time. “BIPOC communities have been disproportionately impacted by COVID deaths, and this reality is rooted in a long history of racial disparities within the healthcare system in the US,” says Pria Alpern, PhD, a psychologist in New York City who specializes in trauma and loss. Those inequities exist in mental healthcare too, which leaves BIPOC people in distress, less likely to gain access to the mental health services they need to process their grief, Alpern adds.

While navigating the death of a loved one is never easy, there are coping strategies out there that can help you through. Below, explore experts’ advice and steps you can take in dealing with loss.

How does loss affect you mentally and physically?

Can’t lie to you: It’s grueling, life-changing, and awful. “Losing a loved one triggers a grief response, which is a normal psychobiological response to loss. When someone is grieving, they may experience a combination of yearning, intense sadness, along with thoughts, memories, and images of the person who died,” shares Alpern.

Of course, grief is entirely individual, and just like no one reacts the same way emotionally, grief will physically manifest differently for everyone. But Alpern notes that common physiological symptoms of grief may include difficulty sleeping, fatigue, nausea, headaches, and decreased appetite.

What do the “stages of grief” mean and are they true for everyone?

You may have heard of the five stages of grief or the Kübler-Ross model, named after the Swiss American psychiatrist who formulated the theory. These stages consist of denial, anger, bargaining, depression, and acceptance. Some psychologists and researchers also go by a seven-stage model, which also considers shock and guilt, and pain as part of the grieving process. If you’ve lost a loved one and don’t feel like you’ve hit all these stages, does that mean there’s something wrong with you? Not at all.

Again, grief looks different on everyone, and many experts actually steer people away from reading into this definition of grief too heavily. “It’s important that we don’t define the grieving process by these stages, but rather acknowledge that grief varies individual to individual,” says Helen Rogers Pridgen, MSW, LMSW, vice president of programs at the American Foundation for Suicide Prevention. “Grief can be messy. It can be cyclical and linger around important life events, words not said, and memories of the one we lost. We must allow ourselves to feel whatever we feel.”

These stages of grief are often not linear, Bolton adds. You might experience denial and anger even long after you’ve reached a place of acceptance, or you may skip over certain stages altogether.

What are healthy ways to cope with grief?

Know that it’s okay not to be okay. If you are experiencing grief or loss, Dominique Pritchett, PsyD, LCSW, a therapist in Kenosha, Wisconsin, emphasizes that now is not the time to pretend that everything’s fine. “It’s okay not to have all the answers. And it’s okay to ask for help.”

Feel your feelings. We know, it sounds like your friendly meditation app coach, but it’s true. Sometimes, simply telling yourself “I feel sad,” acknowledging it, sitting with it, and observing your feelings and bodily sensations as they arise can help make you feel better.

In certain marginalized communities, being in touch with your emotions can prove especially difficult. “It’s important to keep in mind that based on the role you’re in, you may feel obligated to suppress these feelings because of stereotypes or un-empathetic environments,” says Pritchett. “For example, Black women are typically criticized for appearing angry and aggressive, whereas their white counterparts may be given more empathy and compassion.” Those feelings of anger and frustration can build up over time if they go unexpressed, she adds.

Focus on having a routine and making plans. “While initially, you may not want to do anything, after a couple of weeks of mourning, getting back into a daily routine helps reset our habits and helps our minds move forward,” says Bolton. Routines and goals can be useful when you’re mourning, to reintegrate back into your community and remind you of the meaning in your life, she says.

Don’t stop pursuing your hobbies. Bolton suggests filling your days with small, fleeting pleasures. That could be a hot bath, dinner with a friend, or something as simple as a good piece of chocolate. And whatever you enjoy doing on a regular basis, keep doing it. “Passions, or our hobbies, give us purpose and more fulfilling enjoyment. Both of these are excellent tools to combat the stressful feelings that may arise from loss,” Bolton says.

Honor your loved one’s life. Right now, this can feel challenging with the pandemic limiting in-person gatherings. But there’s still so much you can do. “It’s critical for many people to have a way to say goodbye or commemorate the passing of a loved one,” says Bolton. And currently, people might have to mourn in different ways, but “recalling positive memories and having the opportunity to share those with others helps us reimagine part of the mourning process that we enact in person at funerals,” adds Bolton.

She recommends creating some kind of keepsake about a loved one. That could mean putting together an album, a slideshow, or sharing pictures on a virtual site.

Trust in the passage of time. “Be patient with yourself and know that the process takes time, but the immediate pains will transform,” offers Bolton. “They may catch you by surprise down the road, and that’s okay. Be gentle and take care of yourself.” Time doesn’t heal all, but it can get you to a place where you may be able to look back on memories more fondly rather than being inundated with a surge of pain.

What can you say to someone who is experiencing the loss of a loved one?

It’s never easy to know how to comfort those who are grieving, whether it’s a relative, friend, or co-worker. Above all, sometimes just knowing you’re there for them can make a difference. “It’s important to validate, listen, and ask questions,” advises Alpern, cautioning people to avoid platitudes at all costs. Instead of saying things like “So sorry for your loss” or “That sucks,” try “I’m upset that this happened to you. What can I do to help?” or “It’s not fair that they’re gone. I don’t have words, but I’m here and listening,” she suggests. Or, a simple “How are you doing today?” a few weeks and months after a loved one’s death can really touch someone, too.

Alpern also recommends asking questions about the life and favorite memories of the person who died to create space for the grieving person to talk about the person they lost. It can feel uncomfortable but it supports the person grieving to create that space. “This is an important part of the grieving process. Be prepared to witness searing emotional pain and to sit with it,” says Alpern.

Even years after someone’s passing, on especially tough days, reaching out goes a long way. “Make note [to let someone know you’re thinking of them on] anniversaries of the passing, birthdays, or holidays, as these are often the most difficult times for individuals who are grieving,” Pritchett says.

Know that grief doesn’t just go away.

The experience of losing a loved one endures for a lifetime. Certain dates and even times of year will be hard annually, and even certain locations can be triggering. “The biggest misconception in our society is that grief goes away. Grief doesn’t go away, but it changes,” comments Alpern. “Over time, acute grief transforms and people integrate their grief in a way that allows them to continue living a fulfilling life.”

If you’re feeling consumed by grief and don’t feel you can continue with the routines of daily life, professional support, and in some cases, medication, can be key. “Seek out the support of a professional if you are struggling with your mental health. It can be comforting to share what you are experiencing with a trained professional,” says Rogers Pridgen.

In serious situations, you can also reach out to The Crisis Text Line by texting TALK to 741741 or National Suicide Prevention Lifeline at 1-800-273-TALK, Rodgers Pridgen notes. There are also many grief support groups, so you may want to ask a friend for a local recommendation or consider a virtual bereavement group therapy platform, like Grouport and the Association for Mental Health and Wellness’ COVID-19 Bereavement Support Groups. The bottom line is that you’re not alone, and there are so many people grieving along with you—and resources out there to help you through it.

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