Grief
is universal, and most of us will probably experience
the pain grief brings at some point in our lives, usually
with the death of a loved one. In time, we move on,
accepting the loss.
But for a substantial minority, it's impossible to
let go, and even years later, any reminder of their
loss -- a picture, a memory -- brings on a fresh wave
of grief and yearning. The question is, why? Why do
some grieve and ultimately adapt, while others can't
get over the loss of someone held dear?
Reporting in the journal NeuroImage, scientists at
UCLA suggest that such long-term or "complicated"
grief activates neurons in the reward centers of the
brain, possibly giving these memories addiction-like
properties. Their research is currently available in
the journal's online edition.
This study is the first to compare those with complicated
and noncomplicated grief, and future research in this
area may help psychologists do a better job of treating
those with complicated grief, according to Mary-Frances
O'Connor, UCLA assistant professor of psychiatry and
lead author of the study.
"The idea is that when our loved ones are alive,
we get a rewarding cue from seeing them or things that
remind us of them," O'Connor said. "After
the loved one dies, those who adapt to the loss stop
getting this neural reward. But those who don't adapt
continue to crave it, because each time they do see
a cue, they still get that neural reward.
"Of course, all of this is outside of conscious
thought, so there isn't an intention about it,"
she said.
The study analyzed whether those with complicated grief
had greater activity occurring in either the brain's
reward network or pain network than those with noncomplicated
grief. The researchers looked at 23 women who had lost
a mother or a sister to breast cancer. (Grief is very
problematic among survivors of breast cancer patients,
particularly among female family members who have increased
risk based on their family history). They found that,
of that number, 11 had complicated grief, and 12 had
the more normal, noncomplicated grief.
Each of the study participants brought a photograph
of their deceased loved one and were shown this picture
while undergoing brain scanning by functional magnetic
resonance imaging (fMRI). Next, they were scanned while
looking at a photograph of a female stranger.
The authors looked for activity in the nucleus accumbens,
a region of the brain most commonly associated with
reward and one that has also been shown to play a role
in social attachment, such as sibling and maternal affiliation.
They also examined activity in the pain network of the
brain, including the dorsal anterior cingulate cortex
and the insula, which has been implicated in both physical
and social pain. They found that while both groups had
activation in the pain network of the brain after viewing
a picture of their loved one, only individuals with
complicated grief showed significant nucleus accumbens
activations.
Complicated grief can be debilitating, involving recurrent
pangs of painful emotions, including intense yearning,
longing and searching for the deceased, and a preoccupation
with thoughts of the loved one. This syndrome has now
been defined by an empirically derived set of criteria
and is being considered for inclusion in the DSM-V,
the psychiatric manual for diagnosing mental disorders.
O'Connor, who is a member of UCLA's Cousins Center
for Psychoneuroimmunology, cautions that she is not
suggesting that such reveries about the deceased are
emotionally satisfying but rather that they may serve
in some people as a type of craving for the reward response
that may make adapting to the reality of the loss more
difficult.