July 11, 2019 – It's surprising how physical grief will be. Your heart literally aches. A memory comes flooding back that makes your stomach clench or sends shivers down your spine. Some nights your mind is racing and your heart is racing with it, your body so filled with energy you may barely sleep. Other nights you're so drained you go to sleep straight away. You get up the subsequent morning still exhausted and spend a lot of the day in bed.Amy Davis, a 32-year-old from Bristol, Tennessee, became sick with grief after Molly, an in depth 38-year-old member of the family, died of cancer. “The grief was very physically taxing for me,” Davis says. “After the shock and adrenaline of the first few weeks wore off, I went through a few months of extreme fatigue, with nausea, headaches, loss of appetite, disrupted sleep cycles, dizziness and sun sensitivity. It was extremely difficult to anything… If there’s one thing people should know about grief, it’s how awful it can make your body feel.” What causes these physical symptoms? A number of studies show the powerful effects grief can have on the body. Grief increases inflammation, which can worsen existing health problems and cause new ones. It weakens the immune system, weakening the body and making it vulnerable to infections. The heartache of grief can increase blood pressure and increase the risk of blood clots. Intense grief can change the heart muscle so much that it causes “broken heart syndrome,” a form of heart disease with the same symptoms as a heart attack.Stress combines the emotional and physical aspects of grief. The systems in the body that process physical and emotional stress overlap, and emotional stress can activate the nervous system just as easily as physical threats. When stress becomes chronic, elevated adrenaline and blood pressure levels can contribute to chronic disease.Research shows that emotional pain activates the same brain regions as physical pain. This may be why painkillers from opioids to Tylenol relieve emotional pain.Normal vs. pathological grief
Depression is not a normal part of grief, but a complication of it. Depression increases the risk of grief-related health complications and often requires treatment to resolve them, so it's important to know how to recognize its symptoms. Sidney Zisook, MD, a grief researcher and professor of psychiatry at the University of California, San Diego, says people can distinguish normal grief from depression by looking for certain emotional patterns.
“In normal grief, the sad thoughts and feelings typically are available waves or bursts followed by periods of calm, versus the prolonged depressed mood and distress of major depressive disorder,” Zisook says.
He says that in normal grief, people usually retain “their self-esteem, their humorousness, and the power to be comforted or distracted from pain,” while those with depression struggle with feelings of guilt and worthlessness and have limited ability to “feel or expect any pleasure or joy.”
Complicated grief is different from both depression and normal grief. M. Katherine Shear, professor of psychiatry at Columbia University's School of Social Work and director of its Center for Complicated Grief, defines complicated grief as “a type of persistent, profound grief” that does not improve on its own. It occurs when “a few of the natural thoughts, feelings, or behaviors that occur during acute grief take hold and interfere with the power to just accept the fact of the loss.”
Symptoms of complicated grief include persistent attempts to ignore the grief and to deny or “rewrite” what happened. Complicated grief increases the risk of physical and mental health problems, such as depression, anxiety, sleep problems, suicidal thoughts and behavior, and physical illness.
How does avoidance harm your health?
Margaret Stroebe, PhD, a grief researcher and professor of clinical psychology at Utrecht University, says recent research has shed light on many of “the cognitive and emotional processes underlying complications of grief, particularly rumination.”
Research shows that rumination, or repetitive, negative, self-focused thoughts, is actually a way to avoid problems. People who ruminate divert their attention from painful truths by focusing on negative things that are less threatening than the truths they want to avoid. This pattern of thinking is strongly associated with depression.
Rumination and other forms of avoidance drain energy and block the body and mind's natural abilities to integrate and heal new realities. Research by Stroebe and others shows that avoidance behaviors make depression, complicated grief, and the physical health problems associated with them more likely. Efforts to avoid the reality of loss can cause fatigue, weaken your immune system, worsen inflammation, and prolong other suffering.
How do role adjustments affect your health?
When someone close to you dies, your social role changes, which can affect your sense of meaning and self-esteem.
Before she lost Molly, Davis found personal value in “being good at helping and caring for other people.” But after Molly's death, she felt like she “couldn't help anyone for some time.” Losing that role “tipped the bucket” of her identity. Davis says, “I felt like I had nothing to supply. So I needed to learn my value from other angles.”
Caregivers face particularly difficult role adjustments. The physical and emotional demands of caregiving can leave them feeling exhausted even before the death of a loved one, and the loss of the person they cared for can cause them to lose their sense of purpose in life.
“Studies show that caregivers are not only exposed to high levels of stress during intensive care phases, but also do not find the time and energy to take care of their own health,” says Dr. Kathrin Boerner, grief researcher and professor of gerontology at the University of Massachusetts in Boston.
“This can result in recent health problems arising after the death of the care recipient or the re-emergence of existing, 'dormant' health problems. These health problems may or is probably not directly related to the caregiver's experience of grief, but they’re likely related to the life situation created by the demands of care,” says Boerner.
It can be difficult to get back on track with life after the death of a close family member. Losing a partner may mean moving out of the shared home or asking other loved ones for help, which can add to emotional stress and worry. According to Strobe, the stress of adjusting to life and health changes during and after a loss can “increase vulnerability and reduce adaptive reserves for coping with grief.”
What can you do to cope with your grief?
Emotional and physical self-care are important ways to ease the complications of grief and promote recovery. Exercising, spending time in nature, getting enough sleep, and talking with loved ones can contribute to physical and mental health.
“Normal grief doesn’t require skilled intervention normally,” says Zisook. “Grief is a natural, instinctive response to loss, adaptation occurs naturally, and healing is the natural consequence,” especially with “time and the support of family members and friends.”
Grief researchers stress that social support, self-acceptance and good self-care usually help people overcome normal grief. (Shear encourages people to “plan small rewarding activities and take a look at to enjoy them as much as possible.”) But researchers say people need professional help to heal from complicated grief and depression.
Davis says therapy and physical activities like walking have helped her cope. Social support helped her the most, with friends trying to reach out to her rather than waiting or asking her to reach out to them.
“The problem with grief, depression, sorrow and suicidal thoughts is that you cannot reach. For many people going through a difficult time, reaching out is impossible. If your friend is grieving, reach out. Do the legwork. You're too exhausted!”
Davis' advice to most grieving people is: “Go for it. You can only grieve for your loved one once. Don't spend all your time distracting yourself or trying to suppress it. It does will eventually disappear, and you will miss feeling connected to that person again. And if you feel like your whole life has fallen apart, that's OK! It absolutely has. Now you can decide how to put yourself back together. Be creative. There is new life to live all around you.”