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- 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
about science and science-related tools
to the general public.
In keeping with that theme,
I'd like to thank the
sponsors of today's podcast.
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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,