Episode Five Transcript: Grief in the Body
Amy S. Choi:
This is the Mash-Up Americans.
Rebecca Lehrer :
Welcome to Grief, Collected, where we explore how grief moves through our bodies, our families, and our communities, and why we need to feel it all in order to transform our future.
Amy S. Choi:
Today, we're talking to Dr. Dorothy Holinger, psychologist and author of The Anatomy of Grief. Did you know that grief can change our actual neural pathways? We're going to get into it.
Rebecca Lehrer :
Hey, I'm Rebecca Lehrer .
Amy S. Choi:
And I'm Amy Choi. And we are The Mash-Up Americans. Rebecca?
Rebecca Lehrer :
Yes.
Amy S. Choi:
So at this point in our Grief, Collected Series, we have established that being human is grieving.
Rebecca Lehrer :
Living is grieving, loving is grieving. It's very poetic.
Amy S. Choi:
It is very poetic. And I'm starting to, I'm on board with it not being a terrible experience. It's just something that is part of life. And so we got to celebrate it like we do all the other things. But so we've talked about, I think one of the more profound aspects that have come out of our conversation so far with George Bonanno and with Linda Thai is that, to grieve is to be human.
And I think one thing that was really fun about what we learned in preparing for our guests today, Dorothy Holinger, is that grieving is not just to be human, but grieving is to be any sort of living creature.
Rebecca Lehrer :
Mm-hmm. I cannot, there's so many animal stories in her book that when we were both reading it, we were just actually crying with amazement. So first of all, there's a story about how iguanas they stand vigil over their dead friends. And then that led to a whole line of research around maybe dinosaurs also grieved.
Amy S. Choi:
And the thing is, the iguana story is so amazing because there also, of course, which I think people may have heard this before, it's much more common. But this classic story of researchers observing whales that grieve, there is a case of an orca, a mother, who her baby died and she carried her calf for seven days on her nose trying to bring it to the surface so it could breathe.
Rebecca Lehrer :
I love whales.
Amy S. Choi:
I know.
Rebecca Lehrer :
And elephants, elephants grieve. They make distressed vocal sounds and facial expressions and change their eating patterns and other actions to signal despair. And they, oh, they also shed tears. Elephants shed tears. And remember in George Bonanno talked about how we evolved, our emotions have evolved to signal to people as well. And how our sad faces helps other people understand that we're sad and we need support. Elephants are doing that.
Amy S. Choi:
My God, she's signaling to her other elephant friends.
Rebecca Lehrer :
But the one that I cannot, we will talk a little bit about with Dorothy, you'll hear in the interview, but crows. So we know a group of crows is called a murder of crows. Let me tell you what they do. A crow dies. Okay? Thousands of other crows in their extended murder crew, show up, they scream for 15 minutes, then they sit silently together, and then they all fly off. It's just...
Amy S. Choi:
What?
Rebecca Lehrer :
Yeah. Isn't that incredible?
Amy S. Choi:
It is. It's wild to me. And it just, side note, first of all, I think a murder of crows is the coolest name for a group of animals ever. But my child is obsessed, one of my children, is obsessed with hippos. And did you know what a group of hippos is called?
Rebecca Lehrer :
Wait. Well, actually very hilariously played a game with my whole family the other day where we looked up all the group names, but I cannot remember.
Amy S. Choi:
It's called a float.
Rebecca Lehrer :
Of course. What a great name.
Amy S. Choi:
It's called a float of hippos. Okay, now I need to learn about how hippos mourn. But okay, so back on track. What we're taking from all of these experiences and learning about all of this in Dorothy's book is that grief is not only maybe the most human experience of all, but it is also truly a universal one, of basically every living being. And we tend to think about grief. Sometimes it's hard when I think about all of the different ways, but we tend to think about grief as a feeling, right?
I think that's something that we talked about with Natalia and George, is that it often presents as emotions or sadness or anxiety, but grief is also super physical. And if any of you have gone through this, I have had the experience of being like, "What? What is going on inside of me right now? What is happening?"
So common physical symptoms of grief are things like feeling like you have the flu, that feeling of having walked into a wall, sleep changes, whether it's insomnia or the reverse. You're always fatigued. Appetite changes. You get headaches and my migraines, people get really clumsy. And this is something that happens to me a lot when I'm grieving. It happened to me a lot in the past couple years where I would just be dropping things or I'd always have bruises around my shins or my hips because I would just walk into things.
And it turns out that grief impacts the cerebellum, which is associated with coordination, balance, and also emotions and cognition.
Rebecca Lehrer :
What a place.
Amy S. Choi:
Oh, wow.
Rebecca Lehrer :
She's doing a lot. She's doing the most, the cerebellum.
Amy S. Choi:
So yes, grief has an impact on the whole limbic system in the brain. So we really need her to be working that limbic system, it turns out.
Rebecca Lehrer :
Wow. So much. And one of the things here is, I mentioned some of this to a friend in my revelations in learning this, and she said, "That makes sense." Because it makes so much sense because that is our experience, and it's so validating to actually have it articulated, the science behind it, to understand what is actually happening in our bodies, in our brains, in our hearts.
Our hearts, which can literally have something called broken heart syndrome, which we'll get into later.
Amy S. Choi:
What we're going to get into today is how grief expresses itself in our bodies, how it transforms us, and also, here's the good part everyone, how we can heal.
Rebecca Lehrer :
Our guest today is Dr. Dorothy Holinger. She is a staff psychologist in the Department of Neurology at Beth Israel Deaconess Medical Center. She was a long time instructor in psychiatry at Harvard Medical School. Dr. Holinger has studied the human brain for over 30 years. And in her book, The Anatomy of Grief, she has drawn from brain science, psychology, paleontology, and literature to describe what happens to the brain, heart, and body of the bereaved.
She also has her own psychotherapy practice. So we're going to talk about the science of grief, grief in the body, and all the kinds of grief individuals feel and get Dorothy's take on what the beginning of collective grief may look like in America.
Amy S. Choi:
First of all, this is something that I was screaming to Rebecca and our whole team about while reading the book was just it felt so validating to know that these things are real and backed by science.
Rebecca Lehrer :
Yeah.
Amy S. Choi:
Because these are all things that if you have felt grief, you experience it in your body and you're like, "What is happening to me?" A friend died early in the pandemic, not from COVID, it was a horrible, traumatic death, and I kept dropping my drinks. It was a weird, I'm not clumsy like that. That's not a thing I do. And I think there was something about having experienced all of this, but then seeing that neural pathways are changed, knowing that scientists are actually observing these physical biological changes in us, that has been incredibly reassuring in its way. And I wonder from your point of view, what do you think is the most important thing for people to know about the science of grief?
Dorothy Holinger:
Oh, so very many things. Why I wrote the book was to describe, to grievers, to the survivors, to the bereaved, whatever word you want to use, that grief affects the entire human self, the brain, the heart and the body. And to be able to know that, to have the knowledge that, "Oh, okay, I can't think. What is the matter? I'm not thinking straight." Well, that could be related and probably is to your grief.
I write about in the book, a friend of mine lost her sense of taste for six months. And she told me that it wasn't until she put together that that was about the time her mother died. And as soon as she did, well, not immediately, but her sense of taste returned. And I think what people are surprised by is how grief can manifest itself in the body or thinking, but you don't know what happened or that you don't make the connection.
Amy S. Choi:
Yeah. Well, I think something that we found really profound in the book is that making that connection between grief and the symptoms can actually help alleviate the symptoms?
Dorothy Holinger:
Absolutely.
Amy S. Choi:
And I wonder if you could share more about that. What does that mean to be able to say, "This is grief," and then being able to experience some relief from the grief?
Dorothy Holinger:
It's true. This is grief. You've used words to identify something that's going on in your body, all your emotions, you're naming it and you're using words. My goodness, the word that comes to mind for me right now are miraculous. They are. When you begin to use words to describe what you're feeling, what's going on, especially if you're talking about negative feelings and sad feelings like grief, you're changing brain processing.
Part of the limbic system is the amygdala. That's our alarm system for survival. But what happens, and research has shown this, that activity changes from that amygdala, which is subcortical up to the right prefrontal cortex, which is part of the thinking brain. And because that happens, that emotion is calmed down a bit. It's changed in a way that is more tolerable. And another part of grief that I think, Amy or Rebecca, you touched on was crying.
There are three types of tears, basal what we have now when it's just your regular moisturizing tears, reactive, which is when you're cutting an onion and tears want to flush out the fumes, and emotional tears and in emotional tears, you've got a chemical that is related to endorphin. And that chemical is called leucine enkephalin. And that's why we feel good after we cry. It's because of that enkephalin.
The heart, oh my goodness, the heart, we have a metaphorical one as well as a physical one. But physically and medically, something can happen. And it's called broken heart syndrome. I must preface this however, it's rare and there's usually a rapid recovery, and it happens more to women than to men. What happens physically to the heart is that the left ventricle doesn't contract properly and it balloons out. So it has a balloon like shape.
So the bottom of the heart is round in the top where the aorta is of course narrow. And that looks like a Japanese octopus catching pot called takotsubo. And it was in Japan in 2009 where they've identified this and it's called takotsubo cardiomyopathy.
But again, people recover quickly. Yet when somebody comes into the emergency room and they complain of shortness of breath and chest pains, it looks like a heart attack, except when they do the tests and the enzymes don't show up. So there are just so many ways the body responds to grief.
A patient just came in recently, she lost a very, very close friend of hers, and she kept vomiting afterwards. And we both realized as we talked, it was she just wanted to get rid of what had just happened, that her friend had died. And of course you can't, but I think the link here is to connect grief with what's going on in your body, especially if you don't know what's going on. What is the matter with me today? I'm stumbling. Like Amy, you said something about dropping something or dropping things, and it's a behavior that's changed, that you usually don't experience, especially if that's connected to somebody who has just died. It's a good bet that that's really what's happening is your body is expressing your grief.
Amy S. Choi:
I think you make mention in your book a lot about if grief is not allowed to be expressed or if we end up with this sort of forbidden grief, I think what I've been struggling with is if grief is unique to every individual, how do we define what is a healthy grief? What is then a full expression of grief?
Dorothy Holinger:
That's a great question, Amy. That people grieve and they can go through the amount of time that their grief needs. And that's different for everyone. Grief has its own timetable, it's different for everyone. And don't be afraid of your grief. It's normal. Grief is as large as the love you had for that person. That profound sorrow that we feel after a loved one has died, that's a simple way of saying that's what grief is. But more broadly speaking, it's the universal response that cuts across species, not just we as humans.
Non-human animals show grief and they give themselves permission. I have an example in the book of Carl Safina talks about he and his wife had two ducks on their property and they raised them from ducklings and one of them died, and the other one was just absolutely consumed with distress, just running all over the place, which in a duck life, that lasted for about, I don't know, a week or two weeks. And is that more humane than we as humans, not able to show our grief?
Amy S. Choi:
Maybe more in touch?
Rebecca Lehrer :
Well, also, your example of the crows who come, they scream for 15 minutes, then they're silent, and then they leave. I was like, "You know what? In a crow's life span, that's probably the same as us taking six months to a year to grieve."
Dorothy Holinger:
Yes. And so don't be afraid of grief. Allow it to be felt. It's okay. You're okay. Know that it will and can quiet, but don't be surprised when it erupts. And sometimes it's like, "Wait, that was two years ago. Why am I crying like this?"
So the last, as I always say and emphasize, try to so very much, is put grief into words. Your words, any words, write it in a journal, write it on slips of paper. And also something that may sound strange, paint your grief or garden your grief, if you're a gardener. I think the main answer to the question is to be in touch with that grief.
So there are three things that I say to patients as well as to people who are grieving. I have three E's, exercise, education, and aesthetics. Exercise, move, the bereaved, you don't feel like moving, you want to stay in bed, you just want to keep crying. Just move. Just get up from the chair, get up from the bed, move around, go outside, stretch.
And the other education. Find out as much as you can about your grief, about what's happening, what can happen. There's my book, of course, but there are other books. Learn as much as you can. And those who aren't grieving challenge yourself.
And the last one, which I always smile at, esthetics. Put yourself in places that give you pleasure. Look at the outdoors when you go out, how beautiful it is, even when it's cold in the midst of winter. Look at the shape of the trees, the branches. Look at the color of the sky, how the clouds change shape. Go to a museum, read a book. Go into worlds that are not your own, that give you pleasure. And if the book isn't good, do not spend the entire time reading it because you think you cannot finish it. You can't stop reading it. Just stop.
Rebecca Lehrer :
That's all so beautiful. And I feel like just in personal grieving, I think, it's evoking so much for me. I'm wearing this ring that was my mother-in-laws, my late mother-in-laws. And I put it on recently because she was an educator and our daughter would've been her first granddaughter, is her first granddaughter, but she didn't get to meet her, started kindergarten.
And I put it on the day before kindergarten because I was like, "Oh, I need her to be with us in this moment." And it can evoke tears. It makes me feel her loss, but it also makes her present with me. And I think there's something about the way you're describing the way you can carry something with you and acknowledge it, that both gives it power, but also takes the acute pain from it. And my personal experience with that has been very ripe with that.
Dorothy Holinger:
Yeah. Oh, that's lovely, Rebecca.
Rebecca Lehrer :
Also, my ring is really nice. I love this ring. Kris was the best.
Amy S. Choi:
She was the best.
Rebecca Lehrer :
Yes, she was.
Amy S. Choi:
Well, that marks time number one of crying on the show. Yeah, just one. There's going to be a lot more.
Rebecca Lehrer :
That's pretty good.
Amy S. Choi:
We have suffered personal losses that are death related. And I think that's one of the ways in which Americans, in particular, maybe it's just people in particular think solely about grief, is that you grieve when somebody dies. And I think there are so many griefs that we are suffering right now.
And I wonder if you could talk a little bit about the relationship between bereavement, grief of a loved one, versus grief when it comes to something like a loss of faith or a loss of innocence, or a loss of a hope, that I think right now, in 2022, if you are a conscious person in this world, there's so much to grieve.
My husband, he truly grieves his loss of faith as a Catholic, somebody who grew up Catholic and somebody who in some ways always felt like even when he grew away from the church, that he would go back to it. And it's hard. Just other grief, it comes up. We'll watch a movie. Do you remember that movie Spotlight about the Boston Globe, the hometown paper?
Dorothy Holinger:
Oh, absolutely.
Amy S. Choi:
And there is a scene where one of the reporters in Spotlight, which is a dramatized version of when the Boston Globe investigated the Catholic Church about its sex crimes. And there's a scene where one of the reporters, who's played by Mark Ruffalo, is just devastated because he was raised Catholic. And he's like, "I always thought I would go back and something in this, this broke something in me."
This story about the church and my husband, who is an emotional guy, he is very in touch with things, but he's sitting there weeping while we're watching the movie. And for him, I think it presents as real grief also. And I wonder if I have felt this in different moments. I just wonder, is this also grief? And does all the information and the knowledge that we know about grief and our brains and our bodies also apply to grief that is not death?
Rebecca Lehrer :
Or loss, that is not death related?
Dorothy Holinger:
Absolutely. Oh, absolutely. The way it's made sense for me is to see it on a continuum. There is that death related grief, which is, there's no grief that's like that because you've lost that person forever. But there are other griefs that come from different stages in your life, developmental stages that one enters into it, and you do grieve many different kinds of losses.
And the loss of a relationship, a boyfriend, a girlfriend, a significant other that has a divorce. And you also, as one of my patients has said recently, because of the age they are, "I miss who I used to be. I grieve that young adult who could do so much. I grieve that person who just would jump into the water or would just throw a softball or a baseball. I'm not that person. And I'm sad. And sometimes I cry about that."
And it's part of that stage of life that Eric Erickson called Integrity Versus Despair. And it's a tough time. And I think as we're all living longer, that more research needs to be done about this. One of my patients just yesterday actually, who's in his 50s, said, "What about you in your generation who said that as you age, as you get older, you get happier?" And I said, "Listen, I don't..."
Amy S. Choi:
How dare you?
Dorothy Holinger:
I don't know that research. I really didn't. And I said, "I think part of it comes down to how do you define normal? How do you define happy?" Well, all of this is ephemeral, not normal. But some days we're very happy, everything comes together, and some days we think, "I can't believe I feel this awful." I'm not swearing if I weren't on this show...
Rebecca Lehrer :
Oh, you can swear.
Dorothy Holinger:
Okay.
Rebecca Lehrer :
This is the least I've sworn in a long time, so yes.
Dorothy Holinger:
Okay. Or when you lose something material, if there's been a robbery or you've sold a house that you used to love but your husband still loves and you couldn't wait to get out of there.
Rebecca Lehrer :
For example.
Dorothy Holinger:
Yeah, for example, but I think all of this comes down to you have to give your permission to feel terrible. There are just sometimes you do. And I think the more you give yourself permission to do that, the easier it is to be happy and to enjoy being happy. The other day I was thinking, "Wow, I'm happy right now." It was so strange. What was so strange is to think that thought and part of it, "I'm happy right now."
Amy S. Choi:
Well, I love that.
Rebecca Lehrer :
That is so gorgeous. And actually it's realizing, I think, one of the parallels you talk about in your book, one of the many types of grief or loss, and you talked about miscarriage and then more extreme shadow grief. And it almost feels like this could be what Amy, what you were talking about with the idea of loss of a future that you thought?
At least my personal experience with miscarriage and fertility stuff is that personally I wasn't grieving any, it was a sack of cells in my personal experience. And there were physical implications of much of the hormone, all of that. But I was grieving a future I thought was going to be there that wasn't like, "Oh, in January of this next year, I'm going to have a baby. And what is a baby? And that's my parenthood begins there. And what is that life?" Again, personally, I was not grieving that. I was grieving an idea of a future that now I have a future that's different.
It's not that one, it's other ones. And they're these incredible humans and they wouldn't have been these people if I had had that other one. And these days, think of it only in connecting to people who are suffering through it now, but not as a pain for me. But it was really like, oh, I started to think this is what this would look like and it's not and I have to recalibrate that.
I have to grieve that. I have to feel that loss. It was nothing except something in my mind, but it was, that was real. And I think that's what we are doing, Dorothy, I think, that Amy and I are doing some grieving around some of the things we thought it would be?
Amy S. Choi:
And I don't think that we are alone here. I think this is, a lot of people are feeling this. And I think I wondered what happens when we think about grief on a societal scale. We've talked a lot about what happens in our bodies and to individuals and how an individual can kind of healthfully let the grief flow through them and tools for how to name it. But what do we do when America is grieving?
Dorothy Holinger:
Well, it's such a difficult and yet important, important question. It's collective grief that we have, that we all experience, and it's outside of our individual grief. This is so unbelievably complicated. I think knowing that we're strong enough to bear this, to endure it, crisis can create growth. And we do grow, we do change.
Rebecca Lehrer :
And our very last question is, what do you hope for the conversation about grief in the future?
Dorothy Holinger:
That people talk their grief, they allow their grief. It's okay. It's part of us. And even if someone has been brought up not acknowledging negativity or negative things, this is not negative. This is part of love. Grief is love. Grief is love lost. And it's really can be quite beautiful. I know that sounds antithetical to what we feel, but there's an alchemy. There's a change from grief in its leaden state, but that changes into this golden joy of remembering the loved one who died.
Rebecca Lehrer :
Well, that is the best way to end this, which is we agree and we are so appreciative to you for joining us, for spending so much time and sharing your expertise with us. And thank you for being here.
Dorothy Holinger:
Thank you both doing this interview, prepping for it, answering your questions in my prepping. It's been incredible and has expanded my sense of grieving. So thank you.
Amy S. Choi:
Thank you so much, Dorothy.
Rebecca Lehrer :
Thank you to Dorothy Holinger that, I think, for both of us, there was, as we said at the beginning, there's so much validation in understanding the fact that she's observing, researching how we actually are and what is actually happening behind the scenes in our bodies and brains that feels a certain way to us that, it's been incredible to learn about it.
Amy S. Choi:
And I just also always appreciate when Western Science and Eastern Medicine come together, because I think that this is something actually that we have talked about a lot, and that I fully believe that the mind body connection, we are holistic beings, and as we're learning here, grief is not just being sad. Grief is not just missing somebody. It affects everything in our body. And I think that's something that Traditional Chinese Medicine, which I grew up with a lot of that, teaches us as well.
And Chinese Medicine also has a specific system for grief, which is that you store grief in the lung. And I think as somebody who grew up with Chinese Medicine, and it's still often scoffed at by so many Western practitioners, and you're like, "By the way, Chinese people have been around for a very long time."
Rebecca Lehrer :
Oh, you want to talk about inflammation now? You want to talk about inflammation now? We've been out here inflamed for centuries.
Amy S. Choi:
But just knowing again, that there's just more and more and more mainstream consensus that how we feel affects our whole bodies and vice versa, that we are all connected. And so this is...
Rebecca Lehrer :
I remember having after a particular moment of grief in my own life, my acupuncturist being like, "Of course you have a chest cold. Grief is held in your lungs."
Amy S. Choi:
Mm-hmm.
Rebecca Lehrer :
And it held. Also my first migraine came after some very grieving moments. Yeah, it's incredible. It's a joy to keep learning about this, truly. It's very empowering,
Amy S. Choi:
So empowering and so validating. So we encourage you to also do your research and you can start on the website that we made for this project. It's called griefcollected.com. Go there. There are resources, there are articles. There are not places where you can go get acupuncture because I think you need to be licensed to share that information. But we encourage you to do that too.
Rebecca Lehrer :
And in the spirit of Dorothy saying, "We need to do aesthetics, we need to look at beautiful things." In a few days, you'll have a meditation in your feed, which is the extraordinary journalist and illustrator, Wendy McNaughton, who started Draw Together, and she will guide us through a drawing exercise to get us out of our heads and into our bodies and breathing and making something beautiful.
Amy S. Choi:
I can't wait. And next week we'll speak to Rabbi Danya Ruttenberg about community and cultural grief and how we get some repair.
Danya Ruttenberg:
The US is so individualistic that when there's any kind of rupture of care or loss, we don't know what to do. We don't know how to take care of each other.
Rebecca Lehrer :
Well, I'm ready to learn how we can take care of each other better in grief. See you next week.
Amy S. Choi:
Bye.
Grief, Collected is a production of The Mash-Up Americans. Executive produced by Amy S. Choi and Rebecca Lehrer, Senior Editor and producer is Sara Pellegrini, Development producer is Dupe Oyebolu, production manager, Shelby Sandlin. Original music composed by the Brothers Tang. Sound Design support by Pedro Raphael Rosado, website designed by Rebecca Parks Fernandez. Grief, Collected is supported in part by a grant from the Pop Culture Collaborative. Please make sure to follow and share this show with your friends. Ciao.