Grief: How pain affects the brain
Grief isn’t just associated with the death of a loved one — other situations can also trigger a sense of grief, such as getting divorced or coming out of a long-term relationship, learning that you are sick, losing your job, losing financial stability, breaking up with a toxic friend, miscarriage, moving house and retirement. Even graduating from college / high school can bring feelings of grief. Experiencing the pain of grief can be an overwhelming feeling where a variety of emotions can be felt at once, such as shock, anger, guilt, deep sorrow, and disbelief. It can also present in physical ways, most commonly insomnia, lack of concentration and loss of appetite. The intensity of this usually depends on the significance of the loss: The greater the loss, the greater the pain.
If you google the word “Grief”, you may come across the five stages of grief: denial, anger, bargaining, depression, and acceptance. Although not bad as a guideline, sadly this model has been heavily criticised for its lack of theoretical background, so I’m not going to cover these stages as there is no proof that they really exist in that form. The point I’m making here is that we all digest pain differently.
My experience of grief throughout life was gradual. A cousin of mine, 3 years older than me, committed suicide when he was aged 16. In the years that followed I lost my grandparents, aunties and uncles. The grief definitely became heavier as I grew older, as the meaning of loss really took shape. But it wasn’t until I lost my beloved father, that I learned how harrowing, lonely, dark and foggy it is to really lose a loved one. To lose someone that is essentially responsible for who and what I am was a devastating experience. The void it left, huge, unfathomable. I tried to approach it with an open mind, psychologically aware of how this would take some time to process, I tried to give myself the time to heal. I remember taking a few months off work. I would repeat this over and over again that “When my dad died, I took a few months off work” and it would be met with tilted, understanding, head nods. It wasn’t actually until I filed my business tax return the following year that I learned I had in fact only taken 17 days off work. I couldn’t even remember it clearly. The days had seemingly blurred into just being a general time period which felt like a few months.
This was only part of my personal experience of dealing with my grief. I remember my sister constantly reminding me to drink water. My mother imparting words of wisdom about making an effort to be out amongst the living, rather than sitting at home wallowing in my darkness. I realized that the problem was not the deep unwavering sorrow I felt, it was the fog of confusion, disorientation, and delusions of magical thinking about the afterlife. This insight spurred me to delve into the study of psychology and neuroscience, to really learn how loss, and the subsequent emotional trauma, can affect the brain.
How pain affects the brain
For people experiencing loss, demystifying the experience is an important step toward healing. When we think about brain trauma, we usually think about physical injury. But we now understand that the emotional trauma of loss also has profound physiological effects on the brain. An especially pronounced example is the Broken Heart Syndrome where stress hormones result in abnormal heart movements and symptoms of chest pain and shortness of breath. This may result in an actual heart attack although more often than not, it resolves without lasting heart damage.
Imaging studies of the brain show that the same brain regions are activated by both physical and emotional pain. The three regions are:
- The pre-frontal cortex (PFC), also known as the brain’s “Thinking Centre” becomes underactive — leading to difficulties in concentrating and learning.
- The anterior cingulate cortex (ACC), also known as the brain’s “Emotion Regulation Centre” becomes underactive — leading to difficulties with managing emotions
and lastly - The amygdala, also known as the brain’s “Fear Centre” becomes overactivated learning to difficulties in feeling safe, calming down and sleeping.
There are serious consequences of emotional trauma. In fact, there are even statistics that show a pronounced increase in accidents, illness, and death of the surviving spouse in the year following the loss.
As our understanding of physical traumatic brain injury expands to include concussive sports injury, it’s time to expand the definition to include emotional traumatic brain injury. It wasn’t so long ago, that concussions (brief alterations of consciousness after a blow to the head) were considered harmless; athletes were routinely returned to the field after they appeared to recover from being dazed or unconscious. We now understand that although no injury is seen on MRI or CT scans of the brain, brain injury has occurred. Emotional trauma can result in the exact same serious changes in brain function. So let’s take it seriously, ok?
Treatment
Seeking help as soon you have experienced trauma is preferable, but that’s not always possible — especially for individuals who have struggled with trauma from early childhood incidents or post-traumatic stress from other experiences. New techniques for managing and processing traumatic stress are being continuously developed, typically including a combination of psychotherapy and medical intervention. Often, a typical trauma treatment plan will include elements of the following therapeutic techniques:
- Cognitive-Behavioral Therapy (CBT): Cognitive-Behavioral Therapy uses a conversation-based approach with a therapist to explore patterns of challenging behaviour or traumatic memories. Unpacking these behaviours with a therapist can help you find new, healthier ways of coping with stress.
- Dialectical Behavior Therapy (DBT): Dialectical Behavior Therapy helps those who are struggling with impulsive emotional responses. Guided by a therapist, individuals can better understand their emotional triggers and common responses, then use a series of strategies to manage them in healthy ways.
- Eye Movement Desensitization and Reprocessing (EMDR): EMDR uses eye movements guided by a therapist to process emotional trauma and traumatic memories. Using the eye movement technique allows the brain to better access and process traumatic memories that may be causing flashbacks, nightmares, or panic attacks within individuals.
Trauma treatment may also include other components, such as:
- Medication-assisted treatment: If needed, physicians or psychiatrists may prescribe an antidepressant or anti-anxiety medications whilst undergoing psychotherapy. This can help reduce depression and symptoms of PTSD that individuals may experience due to traumatic stress. Typically medication is used in conjunction with psychotherapy, not as a replacement.
- Dual Diagnosis Treatment: Often individuals struggling with trauma may also struggle with addiction and substance use disorders. In these cases, it’s important that you let your treatment provider know so that they can diagnose and treat any addictive behaviours that may be worsening your body’s response to traumatic stress.
The real takeaway from this should be: seek the help you need. Speak to your GP and be honest with yourself because only you know your pain and how it is impacting you.
