Brain’s Unconscious Loss Processing May Support Grief Resolution

Guest blog by Brenda Patoine

Animated GIF-source

A whole-brain representation of the neural signature associated with processing the loss of a loved one. Activation of this signature in the absence of a conscious thought of the loss correlated with less severe grieving. (GIF courtesy of Noam Schneck; adapted with permission from Biological Psychiatry: CNNI 2018 in press.)

What might grief look like in the brain? Is there a neural “fingerprint” associated with thoughts of a loved one, conscious or otherwise? Does the frequency with which that fingerprint shows up have anything to do with whether or not a bereaved person is able to move on from the death of a loved one and resume normal daily activities?

As psychiatry grapples with how to differentiate “normal” grief from bereavement-related depression and otherwise complicated or prolonged grief, one young scientist is tackling these questions from an altogether different angle, looking inside the brains of people recently bereaved due to suicide to identify grief-related patterns of neural activity and to track how those patterns might affect grief resolution.

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Brainwave’s “Grief and Gratitude”

Attachment is the theme of the Rubin Museum of Art’s 2015’s Brainwave series—what does it really mean to attach? Yes, we become attached to a large range of “things,” including our smartphones, our daily routines, and even our feelings of success and happiness. The greatest and most powerful attachments we form, however, are to people. I may fear losing my iPhone or breaking my favorite mug, but the loss of a loved one would be exceedingly more devastating.

In a poignant and honest talk between professor of clinical psychology and researcher George A. Bonanno and economist Sonali Deraniyagala, author of Wave, a book about the loss of her immediate family—her two sons, husband, and parents—to the 2004 tsunami in Sri Lanka, she eloquently discussed her personal experience with grief.

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PTSD in Haiti: Expert warns on post-quake mental health

With efforts in Haiti currently focusing on basic necessities and medical emergencies, the stage is set for a mental health epidemic. Lack of food, water, shelter and medical attention has left little time and effort for grieving or for psychological treatment. David Spiegel, a psychiatry professor at Stanford University, researches post-traumatic stress disorder and in a recent interview shed some light on what we should expect in the coming months in Haiti.

Half of the Haitian population will eventually show some signs of PTSD or depression, expects Spiegel, who has received brain and immuno-imaging grant funding from the Dana Foundation in the past. Witnessing deaths or severe injuries, as well as dealing with disease, hunger, dehydration and violence, are all stressors that lead to PTSD, he points out. The loss of a daily routine that included loved ones, friends, work and school, along with a lack of identification or proper burial for many quake casualties, can contribute to the onset of depression.

Symptoms of PTSD typically begin no less than a month after a trauma, Spiegel says. That means that there is still time for emotional support and organized mental health relief. The National Center for Posttraumatic Stress Disorder lists cognitive and exposure therapy, medication, eye movement desensitization and reprocessing, and counseling as some potential treatments for PTSD.  According to news reports, thousands of volunteers have shown up in Haiti on their own without clear direction or organization. Although these people have shown compassion to grieving children and adults and are doing their best to offer emotional support, they are not the mental health professionals that many Haitians currently need.

Spiegel points out that after the Sept. 11, 2001, attacks in New York and Virginia, trauma symptoms resolved pretty quickly because of an abundance of resources offering emotional and social support to onlookers and victims. The situation in Haiti, on the other hand, more closely resembles the aftermath of Hurricane Katrina, in which a delayed response by the government increased feelings of despondency and desperation. “I expect plenty of that in Haiti,” Spiegel says, “since the government has all but evaporated.”

-Angie Marin

Grief: a musical case study

   Grief and depression are distinctly different human experiences, but even experienced psychologists and brain scientists sometimes have trouble teasing the two apart.

   Those slivers of contrast were the central theme of “Music and Grief,” a panel discussion held on Tuesday at the Library of Congress in Washington, D.C. The event kicked off the second season of the “Music and the Brain”lecture series (an earlier program on the mystery of Beethoven’s deafness had to be rescheduled for next year).

   In keeping with the series’ mission to delve into how brain science gives us insight into the mysteries and benefits of music, the three speakers recounted their personal and professional experiences with music, grief and depression. Live illustrations were provided by the Julliard School graduate string quartet in residence.

   Kay Redfield Jamison, a psychiatry professor at Johns Hopkins University and co-director of its Mood Disorders Center, outlined the rawness of her grief following the 2002 death of her husband, Richard Wyatt, then chief of neuropsychiatry at the National Institute of Mental Health. Jamison, who was previously written at length about her struggles with bipolar disorder, read from her new memoir, “Nothing Was the Same,” about how her grief was at times overwhelming, even causing her to give away her entire music collection because of unpleasant associations. But, she said, she didn’t suffer from a single day of depression, which she had greatly feared given her history. Unlike grief, in which the comfort and company of others is powerfully helpful, “the capacity for solace does not exist in depression,” she added.

   Her colleague J. Raymond DePaulo, chairman of Johns Hopkins’s psychiatry department, expounded on some of her comments based on his experiences treating more than 15,000 patients. Grief generally begins with a period of numbness that is followed by a bout of “profound sadness” that has ups and downs and varies in length from weeks up to years, he said. People slowly re-engage with normal life, though memories of the lost loved one can bubble up suddenly and unexpectedly for decades afterward.

   In contrast, while extreme grief can cause depression, only a fraction of depressed people consider themselves sad. Rather, the dominant feeling in depression is one of hopelessness or emptiness, which erodes people’s self-confidence, causes them to pull away from friends and damages their ability to function in daily life. “We must distinguish these conditions, but it can be extremely difficult, and we must be prudent,” DePaulo said. “We don’t want to medicalize a universal human condition [grief], and at the same time we want to give them solace.”

   In between those presentations came an interesting case study: the extreme reaction of musical virtuoso Felix Mendelssohn to the death of his beloved sister Fanny. Ara Guzelimian, provost and dean of the Juilliard School, described how Mendelssohn—then at the height of his prowess and celebrity—largely withdrew from the world, writing only a few pieces of music before his death less than six months later. But his prolific correspondence emphasizes the depths of his feelings, as does his last major composition, String Quartet No. 6 in F minor, Guzelimian said. Characterized by an unrelenting bleakness and harshly conflicting notes, this is “an extraordinary extreme piece of music” with a “music vocabulary utterly uncharacteristic of Mendelssohn,” he said before the Julliard musicians played its first movement. “Every restraint comes off the music.”

   Responding to audience questions, the presenters emphasized that music has shown, at least anecdotally, therapeutic benefits both for grief and depression. Pieces like String Quartet No. 6, for instance, can help listeners purge or come to terms with their negative emotions, Guzelimian said, and the Julliard performers remarked about the emotional exhaustion they feel after playing the entire piece. Guzelimian gave a personal example of how music can serve different roles at different times: A particular piece that he had found comforting when undergoing a major surgery, contemplating his own possible death, was unbearable to him shortly after the death of a close friend.

   The Dana Foundation funds the Music and the Brain series. Jamison and DePaulo are members of the Dana Alliance for Brain Initiatives.

—Aalok Mehta

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