Neurobiology of Grief

Eventuality of death is often incomprehensible until we are thrust into the circumstances outside of our control.  The emotions of grief that come up when a loved one dies are overwhelming and difficult to regulate. Here in the Western world, we have been conditioned to view the grief response as a finite process with neat phases that should be traveled in private. However, if we look at the grieving process through the lens of interpersonal neurobiology and Polyvagal theory, it becomes clear that the traditional way of approaching mourning in the Western culture is maladaptive. This blog post explores the adaptive responses to loss by examining the latest findings in relational neuroscience.

Grief is not an Illness

By putting a strong emphasis on assessment and diagnosis, the predominant medical model treats grief as an illness that needs to be cured. Moreover, our modern understanding of grief and loss prioritizes happiness while diminishing the importance of suffering. Those who can’t keep their mourning “under control” are shamed into thinking that there is something is wrong with them.

When researching this topic, I was surprised to find that most articles aim to help clinicians with diagnosing and treating grief, rather than explaining what is going on inside the physical bodies. I came upon many variations of medical terms for grieving disorders that pathologized responses that fall outside of some arbitrary norm. These articles used adjectives such as prolonged, exaggerated, abnormal, disturbed, and complicated to describe the process of grieving; words that are deeply rooted in evaluation, as opposed to compassion. In fact, it was challenging to find academic resources that approached grief through the lens of interpersonal neurobiology and Polyvagal theory.

In fact, grief has very little to do with the actual event, and more to do with the whole-body response to the particular event. These reactions are not inherently good or bad, they are simply adaptive and have evolved not only during our lifetime, but over the course of evolutionary human development.

Polyvagal Theory

A couple of decades ago, in a paradigm-shifting theory, Stephen Porges informed us of the relationship between behaviour and the state of the autonomic nervous system. It was previously thought that the autonomic system had two branches: the sympathetic and the parasympathetic. This pattern of thought ignored the ever-important role of sensory feedback from the visceral organs on brain processes and the hierarchical nature of autonomic reactivity to environmental changes.

Polyvagal theory differentiates between two defense systems, the first of which is the fight-or-flight system that has always been associated with the activation of the sympathetic nervous system. However, the parasympathetic system is more complicated than originally thought as it is anatomically composed of the vagus nerve with its two main branches: the ventral vagal and dorsal vagal. The ventral vagal responds to cues of safety and supports a sense of readiness for social engagements. Whereas the dorsal vagal pathway responds to cues of life-threat, causing us to dissociate, immobilize and to disconnect from others.

Stephen Porges articulates the hierarchical relationship between these parts of the autonomic nervous system that have developed in order to support adaptive behaviours in response to signs of safety, danger, and life threat. This revised model of the nervous system provides an explanation for the autonomic states that support dissociation, freeze, collapse and shut down.

Our unique mammalian ability to differentially respond to safe and dangerous environments is built into our evolutionary heritage. The concept of “neuroception” describes how neural circuits distinguish whether situations or people are safe, dangerous or life threatening. The human nervous system evolved to be sensitive to miniscule changes in people’s body language, facial expressions and voice prosody because shifting physiological states are communicated from visceral organs to the brain via the vagus. This process of scanning the environment and people for clues on safety or danger happens below the level of our conscious awareness, and it is not something we can control.

Grief from Polyvgal Perspective

Looking at grief from the polyvagal perspective, it follows that the experience of loss can be a threatening event that generates overwhelming emotions and elicits life-threat responses. Furthermore, these events activate a unique grief response in every individual based on factors such as the griever’s external and internal environments, neuroception, and social support systems.

Therefore, one of the key goals of grief therapy is to help clients to firstly identify where on the Polyvagal ladder they think they are. Here, we can use visual displays and a bit of psychoeducation as an aid to teach clients about the magical, adaptive responses of our bodies.

The second goal of therapy is to assist clients with finding ways to move out of a dysregulated state and into the state of ventral connection.

Lastly, perhaps the most important goal of therapy is for the therapist to provide a nervous-system-to-nervous-system connection by attuning to their client and sending signals of calm and safety to their right brain hemisphere. This means that therapists need to be aware of the nonverbal messages they are sending to clients through their tone of voice, softness of gaze, and body position.

Attachment

Loss of a loved one has been called an “attachment emergency” because a permanent absence of a loved one is the “epitome of acute disconnectedness”. The griever is left with a biological drive to connect and no outlet. As we start to better understand the neurobiology of attachment, it has emerged that in fact, attachment is the “essential matrix for creating a right-brain self that can regulate its own internal states and external relationships”.

In other words, early attachment experiences shape the organization of the right brain, the neurobiological core of the human sub-conscious. According to latest research, any early relationship or attachment trauma will lead to disturbances in affect regulation, and later adaptation to loss. 

It is clear from many studies that attachment security affects physiological wellbeing, and when one loses an attachment figure, it can have a slew of somatic consequences such as insomnia, anxiety, shortness of breath, nausea, lack of muscular power, extreme tensions, mental pain, headaches, fatigue and more.

In the absence of explanation, these uncomfortable and often painful sensations lead grievers to narrate their experience in a self-evaluative way, rather than in a kind, self-compassionate manner.

Here too, Polyvagal theory can be of great help, because as therapists, we can explain the adaptive nature of these responses. By pointing our clients towards a healthier narrative and challenging the limiting assumption that there is a singularly appropriate way to grieve, the goal is to regulate our clients and orient them towards health.

Conclusion

The clinical lens that is used for viewing grief as an illness is a side-effect of our culture’s left-brain (i.e. rational focus). Because grief is not a problem that can be solved, but rather a transformative experience, we need more therapists who understand the underpinnings of interpersonal neurobiology and have mastered the art of presence, compassion, and kindness.

With highly attuned nervous systems, dysregulated clients can sense any incongruence between the therapist’s intentions, words and actions. Furthermore, when the therapist views grief in a pathologizing manner, clients can straightaway sense that their feelings are not welcome, which only increases their shame and moves them further down the Polyvagal ladder of disconnection.

From this perspective, it becomes crystal clear that the therapist’s self-regulation could be considered an ethical obligation, since lack of awareness has the potential to neurologically and unconsciously dysregulate the client. Here too, Polyvagal theory offers a roadmap to work with autonomic activation in building up regulation and resilience.

When the therapist has dealt with their own personal trauma and triggers, they are better able to develop right-hemisphere connection and be fully present in the room. However, nobody is perfect and triggers are bound to arise, in which case it can be helpful to name whatever is happening in the here-and-now, addressing the experience with the client, and then taking a moment to ground and regulate before proceeding with the rest of the session. Doing so, can provide our clients with a framework for attending to our mental states in a way that is healthy and honest, something many of us struggle with.

By learning the art of regulation, rupture repairs and self-compassion, my hope is that we all get to inhabit a better world. Ultimately, every one of us is wired for connection and it is through cultivating the types of connections that raise the vibration of our collective subconscious, that we will be able to affect change on a global level.