The Neuroscience of Grief: Understanding Attachment, Loss, and the Path to Integration

In a profound episode of the Huberman Lab Podcast, host Dr. Andrew Huberman is joined by Dr. Mary Francis O'Connor, a professor of clinical psychology and psychiatry at the University of Arizona and director of the Grief, Loss, and Social Stress Laboratory. The discussion delves into the complex landscape of grief, exploring its neurobiological underpinnings, its deep connection to attachment, and the multifaceted ways individuals navigate the loss of loved ones, relationships, or significant life roles. Dr. O'Connor offers insights into why grief feels physically painful, the serious health risks associated with it, and strategies for integrating loss to move forward while honoring what has been lost. This episode is relevant for anyone who has experienced or will experience grief, or those seeking to understand and support others through this universal human process.

Key Insights

• Grief vs. Grieving: Dr. O'Connor distinguishes between "grief" – the momentary wave of emotion experienced when remembering a loss – and "grieving," which is the dynamic, ongoing process of how grief changes over time. Grieving is a form of learning to live with the loss, and while grief itself may never fully disappear, the process of grieving involves adaptation and integration.
• Attachment and the "Gone but Everlasting" Paradox: Grief is inextricably linked to love and attachment. The bond formed with a loved one creates an implicit belief in their everlasting presence. Death creates a conflict between the knowledge that the person is gone and the attachment system's insistence that they might still be found, leading to waves of grief.
• The Neuroscience of Yearning: Dopamine's Role: Contrary to its common association with pleasure, dopamine plays a crucial role in the "yearning" or "pining" characteristic of grief. Neuroimaging studies show activity in the nucleus accumbens (a reward-learning area) correlates with the intensity of yearning, likening this need to a fundamental biological drive, similar to thirst, rather than an addiction.
• Protest and Despair: Two Core Responses to Loss: Drawing from John Bowlby's attachment theory, Dr. O'Connor explains that grieving involves two primary types of reactions: "protest" (the active, searching response, a refusal to accept the loss) and "despair" (the withdrawal and acknowledgment of the finality of the loss). Both are natural and serve functions in the learning process of grieving.
• Integration, Not "Letting Go": The goal of grieving is not to "let go" of the attachment, which is deeply encoded, but to integrate the loss. This involves transforming the internal relationship with the deceased and finding ways for them to live on within us while we adapt to a world where they are physically absent.
• Grief's Physical Toll and Health Risks: Grief is a profoundly physiological experience. There's a significantly increased risk of heart attack immediately following the death of a loved one (21 times more likely on the day of loss). Chronic grief can lead to elevated blood pressure and other health issues, highlighting the need to support the "grieving body."
• The Importance of Support and Coping Toolkits: Navigating grief effectively involves a "toolkit" of strategies, including social support, practices like progressive muscle relaxation (which studies show can be more effective than mindfulness for grief), and allowing oneself to oscillate between feeling the loss and engaging in life-restoring activities.

Understanding Grief: Beyond Sadness

Dr. Mary Francis O'Connor begins by establishing that grief is the natural response to loss—a multifaceted reaction encompassing physical, emotional, and mental dimensions following the death of someone close. A crucial distinction is made between "grief" and "grieving." Grief is the acute emotional wave experienced in a moment of remembrance or awareness of the loss. In contrast, "grieving" is the dynamic process of how grief evolves over time. Dr. O'Connor likens this to the stock market: despite daily fluctuations, there's an overall trajectory. Grief itself, as a human emotion, may never entirely vanish—25 years later, remembering a loved one can still evoke a wave of grief, and this is normal. Grieving, however, is akin to a form of learning: "learning how to live with the loss of this person."

The conversation highlights that grief cannot be understood without considering love and bonding. The profound attachment formed with a loved one ("forming an us") carries an implicit belief of mutual, enduring presence. Death shatters this, creating a cognitive dissonance. Dr. O'Connor refers to this as the "gone, but also everlasting theory": consciously, we know the person is deceased (we have memories of the death or funeral), but the neurobiology of attachment maintains an implicit belief that "maybe they're out there." This conflict between these two streams of information—"they're gone" and "they're everlasting"—is what triggers a wave of grief when they collide in our awareness.

The anticipation of loss, such as in cases of terminal illness, versus sudden loss is also discussed. While sudden losses are generally harder to process initially because there's no mental preparation, even with anticipated loss, the attachment biology's implicit belief in the person's permanence remains. People may intellectually understand a loved one is dying or has died, yet still instinctively reach for the phone to text them. The grieving process, therefore, involves learning to transform the understanding of this relationship now that the person is no longer physically present, fostering a "continuing bond" or internal relationship.

The Neurobiology of Grief: Yearning and Dopamine

A significant insight from Dr. O'Connor's research is the central role of "yearning" or "pining" in grief, and its connection to the brain's dopamine system. Traditionally, loss was viewed as another stressor added to life's burdens. However, neuroimaging studies conducted by Dr. O'Connor and her colleagues revealed a different picture. When bereaved individuals viewed photos of their deceased loved one (compared to a stranger), the degree of their self-reported yearning correlated with activity in the nucleus accumbens, a brain region deeply involved in reward learning and motivation, and rich in dopamine.

Dr. Huberman notes that dopamine is often misunderstood as solely a pleasure molecule, but it's more accurately associated with motivation, craving, and the effort one is willing to expend to achieve a desired outcome. In the context of grief, this translates to: "How much effort would you put in to see your loved one again, one more time?" This finding reframes grief not merely as a response to a stressor, but as a consequence of an "amputation" of a part of oneself formed through bonding. The brain, through dopamine, signals the profound need to reach out for the missing person.

Dr. O'Connor clarifies that this yearning is not an "addiction" to the loved one, a common misinterpretation when discussing reward circuitry. Instead, she uses the analogy of being desperately thirsty in a desert: the obsession with finding water isn't an addiction but a response to a fundamental homeostatic need. Similarly, attachment figures are essential for our survival and well-being, like food and water. The yearning experienced in grief is a signal of this deep, unmet need. The process of grieving, then, involves learning how to manage this yearning and find new ways to meet attachment needs, either through transformed internal relationships or new external connections.

Navigating the Grieving Process: Protest, Despair, and Integration

John Bowlby, the pioneer of attachment theory, described two primary behavioral and emotional responses to the separation from an attachment figure, which Dr. O'Connor applies to grief: "protest" and "despair."

Protest is the active, often frantic, search for the lost individual, characterized by an energetic "go" response. It’s the "Oh no, they're gone!" feeling that primes the body to search, to make noise, to try and find the person. This response is deeply rooted in the survival mechanism of attachment: when a living loved one is missing, increased effort to find them is adaptive.

Despair, on the other hand, is the giving up, the withdrawal, the lethargy that sets in with the dawning realization of the permanence of the loss. It's the "Oh no, they're gone" that carries immense gravity. While seemingly passive, despair serves a function: it conserves energy by stopping the costly searching behavior. However, despair can become maladaptive if it leads to a belief that one will feel this way forever, which is not true.

Dr. O'Connor emphasizes that these are not linear stages but responses that individuals oscillate between as they learn to live in a world changed by loss. The process of grieving involves working with both these feelings. The "go" pathway of protest needs to be acknowledged, as does the "no-go" pathway of despair. Dr. Huberman and Dr. O'Connor discuss the concept of "transmutation" – taking the energy of these intense states and converting it into actions and feelings that maintain the memory actively yet allow for forward movement.

A key theme is "integration" rather than "letting go" or "recovery." The attachment to the deceased is deeply encoded and doesn't disappear. Integration involves adapting to a world where the person is physically gone while acknowledging that they live on within us, in our memories and internal narratives. Dr. O'Connor shares her personal experience of her relationship with her deceased mother evolving years after her passing, demonstrating how this internal relationship can continue to grow and change. Historically, cultures and religions provided frameworks (e.g., sitting Shiva, wakes, Dia de los Muertos) to understand and process these intense experiences, a "grief literacy" that Dr. O'Connor feels is somewhat diminished in contemporary secular society, leaving many feeling adrift.

The Physical Toll of Grief: Health Risks and Somatic Experiences

Grief is not merely an emotional or psychological experience; it has profound physiological consequences. Dr. O'Connor highlights startling statistics: on the day a loved one dies, an individual is 21 times more likely to suffer a heart attack. In the first three months after a wife's death, a man is nearly twice as likely to have a fatal heart attack compared to a married peer. For women, the risk is about 1.8 times higher. These statistics underscore that bereavement is a medically risky period.

The body's stress response systems are heavily engaged during grief. Dr. O'Connor describes how our loved ones can act as "external pacemakers," co-regulating our physiology (e.g., a hug lowering blood pressure). When this co-regulation is lost, the bereaved person's body must learn to re-regulate on its own, which is a significant physiological adjustment. Her lab's research showed that during a wave of grief, everyone's blood pressure increases, but for those experiencing the most intense grief, the increase is greater and their blood pressure takes longer to recover.

This "grieving body" needs support. Dr. O'Connor draws an analogy to pregnancy: both are natural processes, but pregnancy is recognized as physiologically demanding and medically risky, warranting systems of care. She advocates for a similar public health approach to bereavement, suggesting that support groups could, for instance, monitor blood pressure alongside providing emotional support.

The discussion touches on somatic practices. A study in Dr. O'Connor's lab found that progressive muscle relaxation was even more helpful for grief than mindfulness training. This practice, involving tensing and relaxing muscle groups, helps individuals become aware of and release physical tension, providing a tangible tool to manage the body's stress response in various situations. This underscores the importance of addressing the physical manifestations of grief directly.

Coping Mechanisms, Support Systems, and Special Cases of Grief

Dr. O'Connor emphasizes the need for a "big toolkit of strategies" to deal with waves of grief, acknowledging that what works can vary from moment to moment and person to person. This can range from physical activity like running or yoga, to emotional expression like crying, to seeking social connection. Compartmentalization, or "suppression," is discussed as a potentially adaptive short-term strategy (e.g., putting grief aside to handle a work meeting), but it becomes problematic if it's the *only* strategy, as it prevents the necessary learning and processing.

The critical role of social support is repeatedly highlighted. Just as primate mothers grieving an infant are groomed by other troop members, humans need others to help "groom" them – to provide care, remind them of their own health needs, and offer co-regulation. Bereavement support groups can be beneficial, not because attendees share the same specific loss, but because they share the experience of *missing* someone, fostering a sense of connection and validating the grieving process. For the approximately one in ten individuals who develop "disordered grieving" (prolonged grief disorder), where grief remains intensely debilitating without significant change over time, specific evidence-based psychotherapy interventions are recommended.

The painful topic of suicide is addressed. Dr. O'Connor notes that grief after sudden, violent, or unexpected deaths—categories that often include suicide—is typically more challenging. A common and tormenting aspect for those grieving a suicide is the "would of, could of, should of" thoughts – an infinite loop of self-blame and rumination. She explains that these thoughts are a form of protest, an attempt to find a reason or assert control in an unbearable situation. The way through this is not to answer these unanswerable questions, but to recognize them as thoughts and learn skills to cope with them, shifting focus back to the present reality of living with the loss. It's about finding a narrative that, while perhaps not objectively "true," allows the person to move past the repetitive, guilt-ridden thoughts and re-engage with life.

Belief Systems, Meaning-Making, and Moving Forward with Joy

The role of belief systems, whether religious, spiritual, or philosophical, in navigating grief is explored. Dr. O'Connor acknowledges that historically, religions have provided communities for social support and frameworks for understanding death and what comes after. A prospective study (the Changing Lives of Older Couples study) found that individuals who had a pre-existing way of understanding the role of death in life (often religious, but also philosophical) experienced less grief severity after a spouse's death. This suggests that contemplating these existential issues in advance can be protective, though a profound loss can also challenge existing beliefs.

Dr. O'Connor also offers a neurobiological perspective on the "everlasting" nature of a loved one: the epigenetic changes that occur in the brain during bonding mean that the loved one is literally, physiologically embedded. This scientific understanding can itself offer a form of transcendence and a way to appreciate the enduring impact of the relationship.

A crucial aspect of integrating grief is giving oneself "permission" to experience joy, to form new connections, or to move forward in life. Guilt can arise from the feeling that enjoying life is a betrayal of the deceased or the ongoing internal relationship. Dr. O'Connor suggests reframing this: one can live life more fully *because* of the deceased, carrying their influence forward, or doing things in their honor. The internal relationship with the deceased can continue to evolve, allowing for forgiveness, gratitude, and a sense of their ongoing presence in a new way.

The conversation concludes by reinforcing that grieving is a process of oscillation – moving between acknowledging the pain of loss and engaging in life-restoring activities. Dr. O'Connor shares an anecdote of a widower who cried talking about his deceased wife but was also genuinely excited about a new relationship, illustrating this healthy capacity to hold both profound sadness for what was lost and embrace new joy. Ultimately, while there's no way to optimize or shorten the grieving process (indeed, trying to shorten it may prolong it), understanding its nature, allowing for its full expression, and seeking support can help individuals navigate this inevitable part of life and eventually find restored meaning and the capacity for joy.

Conclusion

Dr. Mary Francis O'Connor's discussion on the Huberman Lab Podcast offers a deeply informative and compassionate exploration of grief. The core message is that grief is a natural, multifaceted response to loss, deeply rooted in our biology of attachment. It is not a pathology to be overcome but a process of learning to integrate the loss into our lives. Understanding the neurobiology of yearning, the dynamics of protest and despair, the physical toll on the body, and the importance of social support can equip individuals to navigate their grief more effectively.

The episode emphasizes that while grief involves profound pain, it is also a testament to the depth of love and connection. By embracing the grieving process, allowing for the oscillation between sorrow and restoration, and cultivating an ongoing, albeit transformed, relationship with those we've lost, we can honor their memory while continuing to live meaningful and joyful lives. The insights shared are invaluable for anyone seeking to understand this universal human experience, whether for themselves or to support others with greater empathy and knowledge.