E45: The Physical Domain of Grief

My daddy died about 50 years ago. He was what I now would consider a young man in his mid-40s, and it tore my world apart. It wasn't unexpected. I started grieving nine months before when he was diagnosed with cancer and told that he would have about six months to live. I was, of course, sad for him. He'd never see his four children grown. I was mostly grown, but his other kids were teenagers and still into their wild days, and they got a little wilder as the grief worked its way to the top.

Anyhow, my grief was all about me. It was about abandonment. It was about profound insecurity, and it continued on for years. I was so sad whenever I thought about him. And the first time I saw him vulnerable in the ICU, I almost fainted and had to sit down. And thereafter, during my medical school training, whenever I went into the ICU, I had to sit down before I passed out because the echoes of the memory of the beeping and the white sheets just pulled back to my daddy.

Did I have a normal grieving process? Well, everyone grieves differently, and their past grief informs every future loss. Did it go on for too long for me? Probably not as I was able to function after several months and successfully finished my senior year at the university. Did it color everything I am? It's the reason I chose medicine.

With this introduction, we're going to start the seven domains of grieving. We'll start with the physical domain. We'll have conversations with people who know the emotional domain and with social and intellectual domain, even the environmental domain. Why does the smell of Old Spice deodorant for men knock me off my feet? And why did I want my husband and my son to wear the same deodorant my daddy wore? Is that weird? And thank God, they didn't wear it. But anyway, we'll talk about the financial domain, how to prepare for the financial part of grieving, and how it might be different in different cultures, and, of course, the spiritual domain.

Each of these domains will be their own podcast. You can listen at your pace or binge them all. By the way, if you haven't listened to the seven domains of crying, this podcast would be a helpful addition to our approach to grieving.

So the physical domain. First, what is grief? Well, grief is a primary emotion of sadness. So it's something that overwhelms, and it informs all the other kinds of emotions. So it's a primary emotion, and it's a response to loss, particularly to the loss of someone or some living thing that has died, to which a bond or affection was formed. Now we can grieve the loss of a place, and we'll be talking about that in the environmental domain, but it's usually the loss or losing of a person.

Now what's the difference between grief and grieving? Grief is that emotional state that really just knocks your socks off, as I mentioned myself, and it comes over you like a big wave and it comes unbidden sometimes. Grieving necessarily has a time component. So it is not just the emotion. It's the process by which that emotion affects the parts of your lives and the parts of your body, which we're going to discuss. And it has a time component, and it has a spiritual component. So grief is the emotion and grieving is the process.

Well, why do we grieve? If it's something that's so overwhelming and if it's something that's so dysfunctional that it makes you pass out in the ICU, why do we do this, and why does almost everyone who is normal emotionally grieve when they lose somebody? Evolutionary biologists and evolutionary psychologists would say it probably has to do with the separation of child and mother.

You've probably all seen a little baby who's separated from her mother or his mother go into total meltdown and look like their world is falling apart. This is normal. This is biological. These kids are little. They're too little to actually know what's really going on. And it's a profound, hardwired response to the loss of someone to whom you are very close. Particularly in humans where we are so dependent on our social situation, we're dependent on adults to be with us for so long, that bonding, that grieving, that despair that comes when you're separated from your adult caregiver, your mom, or whoever it might be, is really important to you to feel it and then the response that it causes in others to come and get you.

So as a very social species, grieving seems to be pretty important biologically. It would be great if we lost it. So we don't continue to suckle the way we did as infants. We learn how to drink out of a cup or a straw, and we don't do that same kind of sucking, thank God. Well, most of us don't anymore. So why don't we lose that? Why does it continue to be such a hardwired, profound response to loss of a loved one and then it spills over to a loved thing sometimes?

Well, we don't know, but it's something that has to do with big-brained animals who are social. They've looked at other big-brained animals, like elephants, and other cetaceans, like orcas. There's the very famous story of the orca mom in the Pacific Northwest who gave birth to a stillborn calf and kept that calf afloat, kept by this calf's side even though it wasn't living for day after day after day after day and looked like she was grieving. And the same thing as elephants and other big-brained animals. And there's certainly some evidence in dogs that when their owner or loved one or their number one dies, they grieve too. So animals that have profound connections to each other or, in the case, of dogs to humans may grieve.

So there we go. It's got an evolutionary perspective for something that seems pretty dysfunctional because when you're grieving, you don't eat much, you don't go hunting and gathering. You sit around. You cry a lot. You don't feel good. You don't sleep. And let's get into some of those things that it can cause in the physical domain.

There are 12 systems in the human body. There's the nervous system, the digestive system, the musculoskeletal system, cardiovascular, renal, reproductive, lymphatic, endocrine, respiratory, immune, and the red blood cells and white blood cells. And grief can affect all of those systems. Maybe not so much the renal function. I think people still pee the same way they ever pee when they are grieving, but it certainly can affect all the other physical domains.

If we already have an illness and we start to grieve, it can be exacerbated by grief, and it may take more time to resolve. And in some studies, it's found that grief affects the immune system so that all other systems and diseases get worse. Grief is a deep sadness that can over time cause suppressed immune system and cardiac function. One study showed that there's an increased risk in people over 60, the first 30 days after the death of their partner, there's an increased risk of heart attack. And in the first month of a loss of a loved one, there is something called takotsubo cardiomyopathy or a broken heart syndrome, where just having an acute loss can cause someone's heart to "break," in other words immediately stop functioning. So it looks like a severe heart attack where it's just an overwhelming response to the overwhelming neurohormones that come with grief.

So broken heart syndrome can cause symptoms similar to a heart attack, such as chest pain, and you can also have arrhythmias and other heart dysfunction. So the cardiac function can be abnormal. People can have tachycardia the way they can with any acute stress. But the stress can go on for a significant amount of time if the grief goes on for a significant amount of time.

There can be weight loss over time. People with gastrointestinal dysfunction may lose many, many pounds. People don't feel like they have to eat. They lose their appetite. They may even feel nauseated when their body goes into mourning. Weight loss is very common as is a sense of nausea, maybe even vomiting when things get bad enough.

So, certainly, physical science can include the GI symptom and the cardiovascular system. There's enough studies that have been repeated to show that your immune system is compromised when you have prolonged grief because it's a profound stress, and stress hormones suppress the immune system. And when the immune system is suppressed, inflammation increases. And when inflammation increases, musculoskeletal pain, joint pain, and other symptoms can be added to the grief process.

There's fatigue. People can't sleep, or they sleep all the time, or they can't sleep when they're supposed to sleep, and they nap during the day. Certainly, there's headache that can be very common along with other signs of pain, such as musculoskeletal pain. The sleep disturbances can be quite substantial and may require some kind of intervention with a therapist for cognitive behavioral therapy.

So your tummy can get upset, and you can't sleep, and you can't eat. Just you are sick with grief. "I am just sick with grief." And literature is filled with prolonged grief, stories of people who lost weight, withered away, got sick, maybe their tuberculosis was reactivated in the old stories from the 1800s.

Mental problems also include this sense of complete exhaustion that comes from being so physically depleted and difficulty thinking clearly. And this is often a time when you need to think clearly. And we're going to have, in the financial domain, the difficulties in managing financial issues on top of grieving when you've lost someone and you are in charge of trying to settle financial things. So difficulty with thinking clearly and depression. And for people who are trying to self-medicate, it may actually exacerbate substance abuse. People might be returning to alcohol to help them feel a little bit better, or to help them sleep. Or they may be returning to other substances that may help them, or they believe may help them.

So it's a complicated time. The question of how you cope is an important one. And how long is too long? This is sort of an, "Am I normal? I am still losing weight, I'm still not eating, and I lost my husband six months ago. Is this normal?" And the answer is it can be normal. But after six months, if you're still losing weight, if you're still not sleeping, if you're not able to do your job, then whether it's normal or not, it needs some kind of intervention to help people continue on and function in their lives, get back to work if they can, get back to caring for others if that's their job, get back to feeling well enough to get some exercise and help their bodies return to their homeostasis, to their foundational health.

How does one move ahead if you have a complex grieving process? Clearly, if it keeps going on and you're not able to function, then you may need some help. Talking to your primary care provider, talking to a religious leader if that's where you find your solace, talking to a bereavement counselor, and there are bereavement counselors usually in every institution that deals with death. And every medical institution, every cancer center has bereavement counselors. And hospital chaplains can be helpful as well. Getting help from people who can move you toward healing if self-care isn't enough.

And self-care is important, understanding that eating, you have to eat, and sleeping, you have to sleep. You need to get outside and walk around a little bit. You need to be reaching out to people in your social circle. So that inward evolution, that inward not going out, not talking to people, not being able to eat or sleep, actually doing the thing that you don't want to do, which is getting out, being with people, talking with people, going for a walk, all of those can help your body return to some sense of normal, even though you've suffered a profound sense of loss.

So coping with these symptoms, which may include this intense sorrow, and you can focus on little else but your loved one's death, and an extreme focus on reminders of the loved one, little things set you off, whether it's a song, or whether it's a conversation, or whether it's a place. And you may have bitterness about your loss. You may be numb and detached. Some people just walk away from their grief, but they're really deep inside their grief and not really responding to their feelings. You may feel that life holds no meaning or purpose. So moving ahead is important in carrying out your own health, and seeing a doctor, seeing a grief counselor could be very important.

It's not only your physical health, but your mental health is important. And if you are considering suicide, if that's part of your grief process, please know that there's a suicide hotline, and there are people waiting to help you if that suicide is a part of your grieving process.

As we go along on the seven domains of grieving, we're going to be talking about parts of the grief process, which actually can help you be better. So we've talked a lot about the emotional aspects and the physical aspects of grieving, but know that for many people, the process of healing can be self-started if you are ready, or it can be started with your friends or family or with grief counselors if that's what seems to be best for you. But it's going to be very important for you to get the help you need, take the time that you need, and make sure that you return to your healthy self as you recover from your grieving process in the physical domain.

So for those of you who are grieving or know someone who's grieving, we are going to be following up this podcast with more podcasts in the seven domains on grieving. You can reach our podcast wherever you get your podcasts, or you can get it at women7.com. Stay with us. We're going to be talking about some more. We're going to be helping you work your way through or help someone you love work your way through their grieving.