A sense of collective sorrow had emerged from the COVID-19 pandemic. The virus took away lives and livelihoods, wiped away memories, and forced endings before people were ready to say goodbye. What ties these together is grief—one of humans’ most profound emotions.
Timeless, universal, and complex, grief is a natural response to loss. Yet, it is also an experience that is unique to each person. When viewed from an all-encompassing perspective, grief involves a history of attachments and biological mechanisms. Because it is so personal and complicated by many factors, it can be difficult to understand.
Is it grief or depression?
Grief is often associated with emotional distress, especially when a loved one has passed away. As death is a final and irreversible state of life, bereaved individuals may feel hopeless and disconnected. It may also cause symptoms of insomnia, loss of appetite, and physical sluggishness—which are also symptoms of depression.
The relationship between grief and depression is multifaceted. According to Brown University Clinical Psychology Research Fellow Roman Palitsky, grieving can trigger a depressive episode and be prolonged by depression. While the two conditions overlap in some ways, he stresses that they are not synonymous. Distinguishing between grief and depression is essential for people to receive proper support and treatment.
Unlike grief, Palitsky explains, depression may not have a clear cause. Depression is often described as an imbalance of neurotransmitters that regulate mood. While this can be a factor in certain symptoms, they do not tell the whole story. Genetics and environmental conditions are also to be considered. Apart from this, depression is also pervasive. Whereas the symptoms of grief can be less or more apparent over time, depression is persistent throughout the duration that a person is affected by it.
Meanwhile, grief hinges on attachment—the deep, long-term bond between people. Attachment behavior is best illustrated by children, who often scream and cry to avoid being separated from their primary caregivers. Likewise, grief may also be triggered when someone’s source of security is threatened. Palitsky points out that these behaviors are not always negative. For example, a grieving individual may experience warmth or pride when recollecting tender memories of their loved ones. Depending on the person’s beliefs about death and the afterlife, they may even feel relief.
In terms of treatment, cardiologist Michael Agbayani says that antidepressants are often prescribed to help people manage their depression. While certain medications have the capacity to divert and distract someone from their grief, they only provide short-term relief.
Viewing grief as a condition with a cure also raises questions about what is normal—and abnormal—about an experience that is universal. When taking these treatments, Agbayani says it is important to remind people that grief is “a process they have to go through.” Otherwise, they run the risk of reducing grief to an illness rather than an essential part of being human.
Rewiring the body
Many see grief as an emotion one should not suppress. They say that all that is left to do is just be. Grief, however, is more than an emotion—it is a biological response, and in many cases, has physical effects one cannot simply get rid of.
Following the loss of a loved one, a cascade of physiological changes occurs, causing “a detrimental effect on the immune system,” Palitsky prefaces. It batters the immune system by decreasing the number of immune cells, removing some of their functions, and causing others to act slower.
Further, people experiencing bereavement run the risk of having elevated blood pressure and heart rate—symptoms that can last for at least six months. Due to the stress resulting from chronic inflammation, cardiovascular disease is the most common health issue for those grieving. These symptoms, however, are not universal; people experience grief in various ways, and some are more resilient than others. “That’s not bad, that’s not abnormal,” Palitsky adds.
According to University of Maryland Neurologist Dr. Lisa Shulman, the brain rewires itself depending on the duration and degree of an emotional response. “Over the long term, grief can disrupt the diverse cognitive domains of memory, decision-making, visuospatial function, attention, word fluency, and the speed of information processing,” making it more difficult for one to move on. However, she notes that all of these are reversible with proper mindfulness and calmness practices such as journaling, counseling, and meditation.
Shulman furthers that grief is a normal, protective process that must not be avoided. If one does not go through the traumatic and distressful experience, then this will continue to be an obstacle in life.
Having a broken heart—literally
As aforementioned, of the many physical effects of grief, cardiovascular disease is the most prevalent. Although feeling devastated while grieving is often metaphorically expressed as heartbreak, takotsubo cardiomyopathy (TCM), or broken heart syndrome, gives this emotional state a literal meaning. TCM is characterized by heart attack-like symptoms such as severe chest heaviness, shortness of breath, and drowning sensations that occur soon after one experiences an emotionally painful event. In severe cases, these symptoms could progress to acute heart failure and sudden cardiac arrest.
This condition is named after the Japanese word “takotsubo”—an octopus trap—because of its similar shape with the ill heart. People suffering from TCM have an enlarged left ventricle which causes the weakening of the heart muscle. Though not yet fully understood, it is believed that this arises from the latching of negative hormones on to the heart. “This flood of stressful hormones overwhelms your heart and weakens that particular part of the [organ],” highlights Agbayani. He adds that TCM is more prevalent in women. However, the reasoning for this is not yet known. Biologically, Agbayani posits that this could be due to the distribution of neurohormone receptors in their heart. However, he believes this could be also rooted in the socio cultural situation of women. “There are more stresses on women,” he explains, suggesting that these may give women more reasons to grieve.
Despite not having a definite cure, there are still available treatments for TCM. In the hospital, patients with TCM are usually treated with the same medication given to heart attack or acute heart failure patients. While TCM has severe symptoms, it fortunately also has a relatively low mortality rate.
Amplifying the silence
Looking into how loss impacts both the mind and biological process shows that the antidote to grief is not always found in the attempt to forcefully brighten ourselves up. Instead, it is found in paying extreme and bold attention to the body throughout the grieving process, neither hanging on for too long nor moving on right away.
Though time does heal, there are times when grief requires extra attention. Nonetheless, it should be reminded that grieving is an inevitable part of life that is experienced by everyone. As Palitsky puts it, “This is a key aspect of change and it is universal. It’s a phenomenon shared with others.”