PDF Summary:The Grieving Brain, by Mary-Frances O'Connor

The human brain responds to loss in ways that surprise, confuse, and often distress us, which can make it difficult to navigate the grieving process. In The Grieving Brain, psychologist Mary-Frances O’Connor explores the neurological basis of grief and how our brain’s learning systems grapple with understanding and adapting to the permanent absence of someone we love. She emphasizes that grief is not simply an emotional state to “get over,” but rather a complex learning process during which our brains must literally rewire themselves to accommodate a new reality.

In our guide, we’ll explain how grief works in the brain and how it manifests in our lives and our thoughts. We’ll also provide insights into how you can make navigating grief easier. In our commentary, we’ll add other theories, research that supports O’Connor’s ideas, and advice for how to put her ideas into practice.

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Counterfactual Thinking

Counterfactual thinking involves imagining alternative scenarios that could have prevented the death. These are thoughts like “If I had done something different, my loved one might still be alive.” While this type of thinking feels compelling and can help distract us from our grief, it’s ultimately illogical and doesn’t help us adapt to loss. O’Connor suggests that people engage in counterfactual thinking because believing we had control over a situation, even if we failed to prevent a death, feels better than accepting that bad things can happen for no reason.

(Shortform note: Psychologists have identified four types of counterfactual thinking: upward self-referent (wishing you had done something different), upward other-referent (wishing someone else had done something different), upward nonreferent (wishing the situation was different), and downward nonreferent (thinking of how the situation could have been worse). Counterfactual thinking, like many of the processes we’ve discussed, can be helpful in small doses but can become harmful if it persists. In particular, upward self-referent counterfactual thinking can worsen depressive symptoms and make acceptance more difficult.)

Rumination

O’Connor explains that rumination is another common aspect of grieving. Rumination involves spending time thinking over your memories or negative feelings, and it can be helpful or harmful, depending on the type of rumination. O’Connor discusses rumination as a type of avoidance—known as the rumination as avoidance hypothesis (RAH)—and suggests that engaging in repetitive thoughts about the loss is a way to avoid the emotions associated with the loss.

O’Connor distinguishes between two types: reflection and brooding. Reflection involves purposefully analyzing your thoughts and feelings to solve problems, while brooding is passive, repetitive negative thinking that you can’t easily stop. Research shows that reflection can actually lead to decreased depression over time, while brooding predicts increased depression.

(Shortform note: The distinction between brooding and reflection may not be as clearcut as O’Connor implies. Research suggests that most people experience comparable levels of brooding and reflection in rumination, with only a quarter of study participants showing higher levels of one over the other. Since they so often co-occur, this can make it difficult to clearly pinpoint their effects as separate processes. Some studies also suggest that reflection may have no effect on depressive symptoms or may even increase them, further muddying the waters on the benefits and harms of brooding versus reflection.)

What you ruminate on can also affect how helpful it is in your grieving process, explains O’Connor. Ruminating on how you feel about the loss can help lessen your grief over time. However, ruminating on how other people have reacted to your grief (such as others’ suggestions that it’s time for you to move on) or on how unjust the death was is associated with less reduction in grief.

O’Connor also explains the concept of co-rumination—the practice of discussing problems and negative feelings at length with close friends. While this can strengthen friendships and provide emotional support, research shows it can also increase depression and anxiety, creating a cycle where people seek more co-rumination as they become more depressed.

Rumination as Confrontation: The Response Styles Theory

While O’Connor espouses the rumination as avoidance hypothesis, other researchers view rumination as the opposite—a type of confrontation. This is known as the response styles theory (RST). According to this theory, excessive rumination leads to poorer outcomes not because it prevents you from engaging with your emotions, but rather because it causes you to engage with your emotions at the expense of other activities. Rumination requires a lot of time and energy, which leaves less energy for social and recreational activities that help you cope with grief. Co-rumination can also make others more reluctant to offer social support, creating a self-reinforcing cycle.

There’s evidence to support both of these theories, but treatment may differ depending on whether you approach rumination as avoidance or confrontation. The RST treatment approach would involve increasing activities that distract from the loss, whereas the RAH treatment approach would focus on confronting the loss through activities like exposure therapy. Research shows that both of these methods can be effective in reducing rumination and improving grief symptoms, suggesting that rumination is a nuanced and multifaceted practice that has characteristics of both avoidance and confrontation.

Models of Grief

Now that we’ve explained how grief works in the brain and how it affects our thoughts, we’ll explore the ways the grieving process can manifest in our lives.

O’Connor explains that most people’s understanding of the grieving process comes from the five-stages model developed by Elisabeth Kübler-Ross in 1969: denial, anger, bargaining, depression, and acceptance. Kübler-Ross developed this model from interviews with terminally ill patients, cataloguing the feelings they described and incorporating those into her five-stages model. While there are merits to this model, there’s no empirical proof for it, and it has since been misapplied as a rigid formula for how people should grieve. Thus, people whose grief doesn’t follow these five stages often feel that they’re grieving incorrectly.

(Shortform note: The misconceptions O’Connor describes may have more to do with others’ oversimplification and misapplication of Kübler-Ross’s theory than with inaccuracies in the theory. The Elisabeth Kübler-Ross Foundation website notes that Kübler-Ross herself didn’t claim that her five stages were a universal prescription for grief. She also acknowledged that the stages weren’t intended to be linear and that people may go through them in different orders, skip some stages, or experience more than one stage at a time. Additionally, the theory has been oversimplified: While the five stages O’Connor lists were the ones highlighted the most in her work, she also identified other stages, including shock, hope, anxiety, guilt, and numbness.)

Instead, O’Connor advocates the dual process model of coping with bereavement, developed by Margaret Stroebe and Henk Schut. This model identifies two types of stressors: loss-oriented (emotional responses to the death) and restoration-oriented (practical challenges of life without the deceased). The model’s key insight is that people oscillate between facing these two types of stressors, and this flexibility is crucial for healthy grieving. The dual process model challenges earlier beliefs that grieving requires constant confrontation with loss, suggesting that taking breaks from grief can be beneficial for long-term adjustment.

For example, after losing a spouse, you may spend one day or part of a day immersed in memories of your loved one and all the feelings that come with that (loss-oriented stressors). Then later, you go see a movie (that you might previously have gone to with your spouse) with a friend (restoration-oriented stressor). You’re spending part of your time confronting your feelings, and part of your time adjusting to life without the deceased without focusing on your feelings.

Other Models of Grief

In addition to the two models O’Connor describes, researchers have developed numerous other models of grief.

John Bowlby and Colin Murray Parkes proposed four stages based on their research into attachment theory: shock, yearning, disorganization, and reorganization. Shock involves feeling numb, a coping mechanism that allows for immediate emotional survival. Yearning involves longing for the loved one’s return and can include feelings like anxiety, anger, and preoccupation. Disorganization involves disengaging from other people and activities and can be accompanied by feelings like apathy and despair. Finally, reorganization involves adapting to life without the deceased and can include a reduction in sadness and an increase in positive memories.

Therese Rando identified three phases of grief, along with six processes for getting through those phases. The phases are avoidance, confrontation, and accommodation. During avoidance, according to this theory, people must recognize the loss they’ve experienced in order to process it healthily. During confrontation, they must react to the loss, recall memories of the deceased, and relinquish their attachments to the deceased. During accommodation, they must readjust to the world without their loved one and reinvest their emotional energy into new relationships and activities.

While Bowlby and Parkes’s model focuses more on feelings experienced during grief and Rando’s model focuses more on processes involved in navigating through grief, both share an emphasis on actively engaging with what you’re feeling. Like Stroebe and Schut, Rando’s theory acknowledges that grievers can oscillate between phases and processes along the way. All of these models provide different insights; the key is to remember that everyone experiences grief differently, and just because your grieving doesn’t seem to match up with any of the models doesn’t mean you’re grieving incorrectly.

Four Trajectories of Grief

In addition to discussing the models of grief, O’Conner also discusses how depressive symptoms can manifest during the grieving process.

Depression and grief can look similar, but the key difference is that depression permeates every part of life, while grief is specifically focused on the loss of the loved one. O’Connor identifies four distinct trajectories grieving can take in relation to depressive symptoms. These are: 1) resilience, where people never develop depression after their loss, 2) chronic grief, where depression begins after the loss and persists, 3) chronic depression, where pre-existing depression continues or worsens, and 4) depressed-improved, where pre-existing depression actually improves after the loss.

The five stages model assumes that everyone experiences depressive symptoms during grief. However, research shows that resilience—the first trajectory—is the most typical response to loss.

(Shortform note: Research into attachment theory suggests that your attachment style may impact what trajectory your grief takes. As mentioned in earlier commentary, Bowlby identified four attachment styles: ambivalent attachment, avoidant attachment, disorganized attachment, and secure attachment. Securely attached people tend to have more resilient trajectories, whereas anxiously attached people are more likely to experience greater distress and may spend more time grieving. Avoidantly attached people may appear resilient but are often suppressing or avoiding their feelings rather than actually processing them. Harmful coping mechanisms like substance abuse are common responses for those with a disorganized style.)

Complicated Grief

In some cases, grieving seems to go on longer than is typical, to the point that it becomes chronic. This type of grief is often referred to as prolonged grief disorder, though O’Connor prefers the term “complicated grief,” as it suggests complications in a natural healing process, similar to complications that can occur in physical healing. People experiencing complicated grief feel fixated on their yearning for their lost loved one, and they exhibit symptoms of trauma as a result of their loss. O’Connor emphasizes the importance of careful diagnosis of this condition, warning against over-applying the term “complicated grief” to normal grieving processes that simply take time to resolve.

(Shortform note: In contrast to prolonged or complicated grief, some people may experience grieving that appears to resolve much more quickly than expected. This is called abbreviated grief. People may experience abbreviated grief if they quickly “replace” the lost loved one (for example, by remarrying very soon after the loss of a spouse), if they didn’t have a strong attachment to the lost loved one, or if they have already experienced some anticipatory grief (meaning they had processed some of their grief before the loss occurred). Other types of grief include delayed grief, cumulative grief from many losses, and disenfranchised grief (when the type of grief you’re experiencing isn’t socially accepted, like the loss of a pet).)

While it’s unclear what causes complicated grief, O’Connor cites research showing that people experiencing complicated grief had lower brain volume and performed slightly worse on cognitive tests than people experiencing a resilient grief trajectory. Based on this, some scientists have concluded that cognitive impairment predisposes people to complicated grief. However, O’Connor notes several issues with this research, including its reliance on averages (meaning the data can’t be generalized to specific cases), limitations in sample populations (the research focused on older adults specifically), and attributing causation (she argues that complicated grief might contribute to cognitive decline instead of being caused by it).

(Shortform note: The circumstances of a loss may also increase the likelihood of experiencing complicated grief. These circumstances can include the loss of someone due to a sudden or violent death such as an accident or suicide, loss of a child, loss of someone you’re heavily dependent on, social isolation, history of depression or trauma, and other stressors such as financial issues. A history of mood disorders or substance abuse can also be risk factors.)

O’Conner writes that treatments like Complicated Grief Therapy (CGT), developed by Kathy Shear, can help people through this condition. CGT helps people address both loss-related and restoration-related stressors through exercises like revisiting memories of the death, imagined conversations with the deceased, and developing new meaningful activities. If you think you may be experiencing complicated grief, consider seeking out CGT or other grief-oriented therapies.

(Shortform note: You may not know if you’re suffering from complicated grief until after you seek help. Indicators that you should consider seeking out grief-related therapies include but aren’t limited to the following: suicidal thoughts, appetite loss, sleep disturbances, panic attacks, difficulties in everyday functioning, self-destructive coping mechanisms, social withdrawal, feelings of worthlessness, or unexplained illnesses.)

Dealing With Grief

Though understanding how grief works neurologically and psychologically can be helpful, people often desire more concrete advice for how to navigate their grief. O’Connor acknowledges that there are many limitations to grief advice: Even though everyone experiences grief, no one can provide a universal roadmap of how grief will feel to anyone else or how to handle it. She explains that while she can share scientific knowledge about grief and her personal experiences, each person must find their own way through grief based on their values and beliefs. Just because your grieving doesn’t seem to mirror the path you think it should take doesn’t mean you’re grieving “wrong.”

(Shortform note: Because there’s no universal way to grieve, there’s also no universal way to support someone who’s grieving. However, experts offer some general tips: Avoid phrases that minimize or try to make light of their loss, like trying to point out the positives of the situation or suggesting that everything happens for a reason. Also avoid telling them what their deceased loved one would want or claiming to know how they feel. Instead, you could share a fond story of the deceased with the grieving person or offer concrete support by bringing them meals or providing other help.)

Still, O’Conner offers some potential ways people can better navigate through what they’re feeling after a loss. These include living in the moment, connecting with others, and embracing grief as a type of learning.

Live in the Moment

We’re often tempted to try to numb our feelings after a loss and avoid thinking about the present, as the grief can feel so overwhelming. While it may initially be unbearable to face reality, the present offers possibilities for healing and connection. O’Connor argues that attempting to avoid painful feelings by disconnecting from the moment also blocks positive experiences and learning opportunities. Instead of tuning out of what’s going on right now, she recommends that you try to be mindful in the moment and stay aware of your surroundings and the people around you.

This doesn’t mean you can’t spend time thinking about the past or the future. Choosing to engage with the present doesn’t mean forgetting the deceased, O’Connor explains. Rather, healthy grieving involves maintaining the ability to move between memories of the past and engagement with the present, without using either as a way to avoid the other. Remember your loved one, but also spend time thinking about the bonds you have now and the things you can look forward to.

This may sound difficult, but according to O’Connor, doing it deliberately will help rewire your brain to make the grief easier to handle. Research shows that practicing awareness in the moment can strengthen connections between different brain networks, potentially helping with adaptation to loss. She emphasizes that while it’s natural for thoughts to wander to the deceased, developing the ability to return attention to the present is a skill that can be cultivated.

Techniques for Living in the Moment

Living in the moment can be challenging to do consciously, but there are many techniques you can use to practice this. For example, present-moment meditation is a practice designed to center your awareness on the present, pushing out thoughts about the future or the past and tuning in to your senses—what you see, hear, and feel—in the moment. This can help you train yourself to tap into the moment at will.

In The Happiness Trap, Russ Harris explains a process for mindfulness that can also help you learn to live in the moment. He recommends connecting with your observing self, or the part of your mind responsible for awareness of your surroundings (as opposed to the part responsible for thinking and processing). He also suggests practicing defusion, or detaching yourself from your thoughts and viewing them not as objective reality, but simply as words and images. This can help reduce the pain associated with your thoughts and lessen your need to get rid of them.

Next, he recommends expansion, a process of making space in your body for negative feelings by connecting with and accepting your bodily sensations. Finally, he encourages you to practice connection, which is the act of shifting your attention away from the past and future and engaging fully with the present. The more you engage with these practices, the easier they’ll become over time, and the easier it will be to shift between thinking about the past or future and living in the present.

Connect With Others

O’Connor also recommends connecting with others through your grief. Loss can make you feel profoundly alone, but everyone experiences grief, and understanding that can make it feel less lonely. She suggests that shifting your perspective to recognize our common human experiences can help you feel closer to others, even during intense grief. This connection can provide comfort and support during the grieving process.

(Shortform note: The Covid-19 pandemic made it difficult for many people to grieve normally, as the isolation caused by self-quarantining and sheltering in place prevented people from connecting with others. This loss of connection made many people feel alone in their grief, and the scale of death associated with the pandemic led them to feel that their grief wasn’t important or that they had no right to grieve. While the social restrictions of the pandemic have since lessened, the threat of the virus can still create these isolating feelings for grieving people. To deal with this, experts recommend acknowledging that times have changed (which will help you manage your expectations), focusing on self-care, and adapting grief rituals to be more remote.)

You can also work to cultivate bonds with new people. O’Connor acknowledges that it can be challenging to form new relationships after a loss: She explains that new relationships often trigger fresh grief and uses the concept of loss aversion to explain why new relationships might not feel as satisfying initially—psychologically, we view losses two times more intensely than gains, so a new relationship would have to feel twice as good as your relationship with your lost loved one in order to feel equally satisfying. She emphasizes that the goal isn’t to replace the deceased but to create new meaningful connections that are different but still fulfilling.

(Shortform note: While meeting new people after a loss can be daunting, experts offer some advice on how to make it easier: Listen to your own needs as you begin to branch out—if you’re not sure you’re up for a big outing, plan to leave early, or ask friends to spend time together in small groups instead of large ones. Additionally, consider activities that align with your interests, whether it’s a book club, a fitness class, volunteering, or something else. This can not only serve as a restoration-oriented practice (aligning with the dual process model described earlier), but may also help offset the feeling of loss as two times more intense than the gain of a new relationship, increasing the satisfaction you feel from the new connections formed in this way.)

Embrace Grief as Learning

O’Connor asserts that grief is a form of learning, but one that’s particularly challenging. When someone dies, our brains must update countless predictions and habits that involved the deceased person—reworking our neural maps. As described earlier, we must learn that they no longer exist in the physical dimensions we expect and find new ways to maintain our bonds with them; we must also learn to stay grounded in the present while maintaining a transformed, dynamic relationship with the deceased that reflects our current self and the wisdom gained through grieving. Understanding this process can make it easier to undergo it.

O’Connor recommends taking on a growth mindset—the belief that you have the capacity to learn and improve—to help you develop a set of tools to get you through the grieving process. O’Conner explains that everyone can learn and grow through grief, regardless of their starting point or intellectual abilities. When you’re feeling stuck, she recommends seeking new strategies from others who have experienced and learned from their grief, while recognizing that each person’s journey is unique.

(Shortform note: Embracing grief as learning aligns with the theory of metacognition, which is the process of using your understanding of learning and of yourself as a learner to improve your cognition—essentially, thinking about your thinking makes learning easier. Research shows that metacognitive practices improve both learning and self-efficacy—so applying them to grief can not only help you grow more during the grieving process, but also make you feel more in control and capable of handling grief. To capitalize on this unique learning ability, consider engaging in metacognitive therapy, a method developed by psychologist Adrian Wells that’s proven to be effective in treating a range of mental health symptoms.)