Grief: A Learning Curve and a Health Disparity

Research at the University of Arizona is multifaceted, with talented faculty both breaking scientific ground and paving the way for the next generation of researchers to pursue their own research interests. To trace one of these throughlines, we sat down with two luminaries in the department of psychology who are shedding light on an experience that impacts everyone, though not always in the same ways: grief.

Mary-Frances O’Connor is an associate professor of clinical psychology and psychiatry at the university. Her research centers on how emotion and physiology correlate with bereavement-related experiences such as yearning and isolation. She believes that clinical science can support the development of interventions for prolonged grief disorder, which is a newly recognized psychological phenomenon. O’Connor’s book, “The Grieving Brain: The Surprising Science of How We Learn from Love and Loss,” offers a new paradigm for understanding loss through the lenses of how we love and how we learn.

While O’Connor’s book is not meant to offer advice, it helps readers navigate their own grief or the process of supporting another person who is grieving. In it, O’Connor frames grieving as learning to live a meaningful life without a loved one, and she reminds readers that the brain is excellent at solving problems and learning. She explains one especially difficult aspect of grief, which involves our brains’ preferences for habits and predictions, many of which are directly at odds with accepting the death of a loved one. But that’s not the end of the story. O’Connor takes readers through the neuroscience of how our brains grapple with reconciling the assumptions we need to survive life with the new reality we need to accept in the wake of bereavement.

Da’Mere Wilson is a psychotherapist and doctoral candidate in clinical psychology who is advised by and has worked with O’Connor on grief-related research. Wilson specializes in racial trauma and grief, including intergenerational trauma within the Black community. Wilson’s work questions the concept of grief as an experience of individual loss and personal pain, as it is often framed in psychological literature. She explores possibilities for the expansion of our definition of grief as well as whether the experience of grief — not just its certain visitation in our lives — is universal. She also addresses the roles racism, racialization, collective history and racial identity have to play in understanding the answer to these questions.

Wilson’s research interests were inspired in part by her observations of layered losses within her own family and community and the fact that these layers are not discussed in current psychological literature. Wilson’s work, including her article “From Grief to Grievance: Combined Axes of Personal and Collective Grief Among Black Americans,” explores how the racialization of Black people in the United States has resulted in a unique experience of loss, grief and bereavement, including forms of collective grief that have not yet been researched. She also addresses grief as a health disparity that disproportionately impacts Black people.

Part I: Q&A with Mary-Frances O’Connor

Q: Could you talk a little about the history of grief research?

A: It’s pretty spotty! I think most people think about Elisabeth Kübler-Ross’ five stages of grieving when they think about grief. While those stages are a good description of what grief can feel like, they can be used as a prescription for how to grieve, as though we go through them in a linear way and then we’re done grieving. More contemporary research recognizes that, over time, there’s increased acceptance of the painful reality that a person is gone, and there is less yearning for them, but that isn’t a linear process.

Q: How has your research intervened on previous understandings of grief?

A: In 2003, I published the first fMRI [functional magnetic resonance imagining] study on grief. We asked people to bring a photograph of the person who had died into our lab and then showed it to them while they were lying in the scanner. And we were able to see the brain activation that was a reaction to that photograph as compared to when they were looking at just a person they didn’t know. Not surprisingly, we found that grief involves complex brain activation.

But I think it was really the next study that changed our landscape of understanding grief, because we discovered that yearning — the experience of wanting our loved one so much — was correlated with nucleus accumbens activation, which is part of the reward network. It seemed a little odd at first that grieving would be related to the reward network. But if you think about it, this wanting is a part of seeking something that’s important to us.

Q: Could you talk a little about the gone-but-everlasting theory and how you frame grieving as a learning curve?

A: Our brains can actually have two streams of information going on at the same time, even though they can’t both be true. On the one hand, we have a memory system that tells us that this person has died, but on the other hand, we have attachment neurobiology. And part of that attachment neurobiology is this deep belief: I will always be there for you, and you will always be there for me. And this works really well when both people are alive. It keeps us safe. The trouble is that when someone dies, the attachment neurobiology doesn’t go away, so we have to adjust to the new reality.

Q: Could you talk about avoidance and the trap of rumination feeling like it holds solutions to grief?

A: They say time heals. But in reality, it’s actually experience that heals. Experience helps us understand what does feel fulfilling given all these terrible things that have happened. And one of the problematic things we can end up doing is engaging in avoidance. There may be a place or feelings you avoid because you’ll think about the person who’s died and feel pain. However, avoidance doesn’t give the brain a chance to adjust to what your life is like now.

Rumination involves thoughts you keep having over and over again that are typically about the person who has died. Being caught up in those thoughts can actually be a form of avoidance. I think about it this way: One flavor of these rumination thoughts is what I call the “would have, could have, should have,” which are all those stories we play out in our head. The end of each of those stories is “and then my loved one lived.” But the painful reality is that they didn’t. There are no answers to those questions, so if we are caught in them, then we’re not necessarily in the present moment, which is where we heal.

Q: What would you most like people to take away from your work?

A: The first thing I would want people to take away from my work is just how normal grief is, even though it often feels wrong. The second thing is that, when we love each other, it rearranges the way proteins are folded in our brains and the types of neural firing that happen. Our brains are forever changed because of our love relationships, and I find that to be very heartening.

ʻWhen we love each other, it rearranges the way proteins are folded in our brains and the types of neural firing that happen. Our brains are forever changed because of our love relationships, and I find that to be very heartening.’ — Mary-Frances O’Connor

Part II: Q&A with Da’Mere Wilson

Q: What is the commonly accepted definition of grief and how you would expand it?

A: For many people, the concept of grief refers to acute pain that accompanies the loss of a loved one, and it’s considered an individual process. I think we could broaden the definition to include loss in general. It can result from having your child taken away or from seeing your loved one go to jail. When we have such a limited definition, we’re missing so many things.

I think one thing we’re missing is that there are different processes within racialization that mean grief is not just experienced on a personal level. There’s also the grief that that comes from the collective. Whether that’s violence in the local community or what you’re exposed to on the national landscape, those experiences can contribute to a level of grieving that I don’t think is even really thought about or asked about.

Q: What is universalism in psychology and how does it impact findings on grief?

A: Universalism within psychology means that certain experiences are considered consistent across all people and cultures. And it’s very common for psychological samples to be predominantly white. An unspoken assumption, then, is that even if you have a predominantly white sample, you can say the experience of that sample is true for everyone, and not simply true for that particular population. That is a racist assumption because it accepts that whiteness is the norm.

Q: Could you talk about the false narratives that can arrive from samples that aren’t representative and the “decontextualized comparison” that you have described in your work?

A: Consider “prolonged grief disorder.” Studies with predominantly white samples have concluded that Black people are two times more likely to experience this disorder than white people, and the implication is that Black people are at a relative psychological deficit. It could very well be that Black folks are struggling more with grief. But is that the case because they’re inherently deficient in some way? Or is that the case because the particular death that was studied was actually the 12th that they’d experienced over their lifespan, and they also have a cousin who’s locked up? If so, is that disordered, or is that a population struggling under immense oppression and grief? Also, if we are going to understand Black grief, we at least need to include Black people in meaningful numbers in our samples.

Q: You discuss bereavement as a health disparity. Could you talk about that reality?

A: As of 2020, the average life expectancy for a white American is 78 years, while the average life expectancy for a Black American is 72 years. This gap increased by more than 2.5 years from 2019, largely due to the unequal distribution of COVID-19 deaths. The COVID-19 pandemic death rate for Black Americans is more than 1.5 times higher than it is for white Americans. Black children were nearly 2.5 times more likely than white children to lose a parent or caregiver during the COVID-19 pandemic. This is on top of the fact that Black Americans are twice as likely to die from heart disease as white Americans and are 50% more likely to have high blood pressure. Black Americans are also more likely to die at early ages from all causes than white Americans, according to the CDC.

Think for a moment about how all of these statistics actually impact surviving loved ones. In addition to psychological consequences, these many losses have medical consequences, such as thickening of heart tissue. Even the widowhood effect, in which a surviving spouse dies soon after their partner dies, is 1.5 times higher among Black Americans. These statistics are often blamed on “social factors,” but when those “social factors” are not linked to racialization and racism, we miss important root causes of sickness and early death among Black individuals.

The idea of bereavement as a health disparity is really speaking to a preventable difference in the burden of disease between different groups. This is not about the genetics of Black people. It’s about the result of 400-plus years of extreme oppression, extraction and dispossession and the consequences of racism in the United States, which means that we’re made to grieve more often and made to live sicker lives.

Q: How are parasocial grief, linked fate and fictive kinship related to grief?

A: A parasocial relationship is generally considered a onesided relationship where someone has an attachment to someone they see in the media. Linked fate is the idea that what happens to someone who looks like me or shares an identity marker with me could happen to me or to someone I love with that identity overlap. It’s similar to fictive kinship, which is a direct throughline to dealing with chattel slavery specifically in the American context. The idea is that our family ties were so loose, because of the nature of how we were treated like livestock, that people just came together around other people that they didn’t necessarily have a blood relation with, and these bonds were in many ways familial. This is why I think we’re more apt to experience the murders of Trayvon Martin or George Floyd and think about and feel them personally and deeply: It feels like, “I’ve just lost an uncle” or “That could happen to my son.”

Q: What would you most like people to take away from your work?

A: Grief is expansive. The profound loss of a loved one to death or familial separation, or a of community member to racialized violence, vastly impacts us mentally and physically. It’s my goal to give people, especially those who experience racism, permission to grieve for the many losses we face. I hope to influence the field of psychology to broaden its definition of grief to study these unique experiences and provide tailored therapeutic interventions.