“Give sorrow words. The grief that does not speak/ Whisper the o’er-fraught heart and bids it break.”
-Malcolm in Macbeth by William Shakespeare
Many people don’t know you can literally die from a broken heart. I will never forget a case during my intern year at Cooper Green Hospital. There was a mother admitted for heart failure. She had no history of coronary artery disease. She was not a smoker or drinker. Her high blood pressure was well-controlled with low-dose lisinopril. However, she had buried her only son just weeks prior to admission. That’s when I learned of a rare condition called Takatsubo’s cardiomyopathy.
In this condition, intense emotional stress causes the brain to release neurochemicals that cause coronary vessel spasm and abnormal heart muscle contraction. Truth is, as was the case for my patient, the heart failure is reversible with proper clinical support. However, I don’t believe her emotional heart ever normalized. It is such an unnatural thing for a parent to lose a child. As the adage goes, “children are supposed to bury their parents, not the other way around.” Still, the mind grapples with grief in remarkable ways and with proper emotional support, it can adapt to seemingly overwhelming loss.
Three major areas of the brain impacted by grief or loss include the parasympathetic nervous system, the prefrontal cortex/ frontal lobe, and the limbic system. As a result, those grieving may experience trouble eating and sleeping, difficulty with planning and task execution, as well as strong emotional responses to triggers that remind the person of the loss. The amygdala, a specific part of the limb system, causes us to run from these emotional triggers, which often prolongs the healing process.
It’s interesting how the coping mechanism used to numb the pain only depends the sorrow. To be isolated in grief is as devastating as the loss itself. This is why attending support groups is important to ushering in recovery and restoration. Doing so allows an individual to face the fear of grief with others who have gone through or are going through the same experience. Observing in others the various stages of grief (denial, anger, bargaining, depression and acceptance) is therapeutic. Although everyone deals with loss differently, support groups provide a road map of what to expect in general. Isolation allows the mind to remain in a state of confusion caused by stress hormones. However, a kind word or loving touch causes neurochemicals such as oxytocin to be released, which brings comfort in difficult times. That’s why counseling and support groups help the mind to adjust properly through confrontation and release of feelings that often hold its victim hostage.
How bereavement turns into clinical depression is thought to be linked to the brain’s loss of adaptability. Studies show that areas such as the hippocampus, which is linked to memory and mood, can produce new cells well into adulthood. However, the depressed brain loses the ability to generate new cells in this region.
We experience grief not only in bereavement. It can be felt with any major loss. More and more, patients are coming into the office primarily for an unrelated complaint and report depression and anxiety on review of systems. They are worried about rising insurance premiums, the cost of treatment, and the impact on their personal finances. People are concerned about their health or caring for an ailing parent and what this means for their own mortality. Patients are obsessed with local, national and international tragedies. They no longer feel physically, emotionally or financially safe. As a minister of health, my advice is usually the same:
1. Be patient with yourself. Allow time for your heart and mind to adapt to any major loss. Grief is a process that varies from person to person. Don’t judge your recovery based on another individual.
2. Surround yourself with positive people, those who support you wholeheartedly. Avoid isolation as it amplifies the pain even more.
3. Express your feelings in one form or another. Journaling, creative writing and psychotherapy are great ways to confront the hurt.
4. Meditation is good for the organic brain as well as emotional mind. Not only is it a great way to “check-in” with your internal milieu, but it actually allows brain to release natural antidepressant chemicals.
5. Trust the process. Emotions come like waves. Behavioral therapists teach patients means by which to bear the intense feeling until it passes. Such techniques include grounding and mindfulness. With time, the mind becomes conditioned to both endure the discomfort and begin to move forward. After all, what “they” say is true…”what doesn’t kill us DOES make us stronger.”
· CNS Neurol Disord Drug Targets. 2014;13(6):930-6. “ Neurological aspects of grief”
· Grounding is a psychological technique designed to keep the person present in the moment. For example, when an intense feeling or thought arises, a patient is instructed to focus on a particular part of their own body, a sound in the room or looking at the detail of an item nearby. By doing so, it trains the mind to avoid following a traumatic stream of thought. This is a good technique because it can be done anywhere without those in the surroundings even knowing.
· Mindfulness speaks to being attentive in a purposeful manner and on a moment-by-moment basis. Here again, the idea is not allow emotion to overtake your thoughts and actions. Rather, it is the intention to focus on the present experience instead of the past. Meditation is an excellent way to execute this concept. #DrDeeMD