Angel of GriefStatue of an angel grieving in a cemetery in Houston, Texas. (photo: Timothy Faust/Flickr, cc by-nc-sa 2.0)

There is no pain so great as the memory of joy in present grief. ~Aeschylus

UCLA researchers found that grief over losing a loved one can take an extreme form of bereavement, stimulating the part of the brain normally associated with reward and addiction. This is called “complicated grief” and the name alone gives more weight and depth to our varied experiences of loss.

This phrase is being considered for addition to the 2012 DSM-V, the American Psychiatric Association’s handbook for diagnosing mental disorders. There is no formal definition, but The New York Times describes its symptoms as:

“… a yearning for the loved one so intense that it strips a person of other desires. Life has no meaning; joy is out of bounds. Other symptoms include intrusive thoughts about death; uncontrollable bouts of sadness, guilt and other negative emotions; and a preoccupation with, or avoidance of, anything associated with the loss.”

Observed differences in brain scans

The nucleus accumbens (NA) is the part of the brain associated with reward and addiction. Participants in the study were asked to view images of their lost loved ones paired with words about their loss. The people who showed the most devastating patterns of grieving also showed more activation in the NA.

Mary-Frances O’Connor, an assistant professor of psychiatry at the University of California, Los Angeles, who used functional magnetic resonance imaging to monitor brain activity told the Times: “It’s as if the brain were saying, ‘Yes I’m anticipating seeing this person’ and yet ‘I am not getting to see this person.’ The mismatch is very painful.”

Hope for treatment

Though bereavement research and training is very limited, there are some clinical trials in the works modeling treatment of victims of PTSD.

The patient undergoes the painful task of recalling the death in detail while the therapist records the session on tape. Then the patient must listen to the tape at their home daily with a goal of learning that their grief can be put away or picked up again on their own terms, just as one can do with a tape. Also patients are asked to focus on future goals without their loved one.

Asking a bereaved person to compartmentalize and relive their pain in this way sounds painful, even insensitive. However, the method has shown signs of success and is an important early step in understanding this underserved population of sufferers.

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Reflections

it's hard to imagine grief more intense than "ordinary" grief.  It must truly be horrible.

Thanks for posting this. Helping people through prolonged grief is a tough process - with the brain scans we now can link it to similar processes in trauma, and actually have a map to guide us. Exposure therapy, in its many forms, has always been the way through for brain recovery in trauma and phobia. I'm so glad to learn of the technique mentioned in the article, and will keep looking for more about the research.

Buddhist thought is very useful in developing approaches to complicated grief.  Buddhism arose to deal with the facts of life -- that loss and sorrow are inseparable from life on earth -- that life is about change. 

What complicates grief is not the loss, but the anger and guilt that the loss leave unresolved. Good, close relationships may foster intense grief, but not complicated grief.

I do not judge complicated grief, and know it can have many causes.   However, as a grief and trauma specialist, I wince when I see how much pain the person is being put through to discharge this grief.  Brain imaging has been very helpful to my profession.   Therapies like the meridian based therapies (techniques that use points on the acupuncture meridians) for exapmple,  Emotional Freedom Technique, and a growing list of others can bring rapid relief without having to relive all the emotional pain. 

This sounds much like, grieving "by appointment" a strategy used in cognitive treatment in which the griever decides on a time period daily to grieve fully, and then to regulate the other time of the day when intrusive thoughts come, "No, I have a time for that". It also helps, low tech too.

apples