Dr. Mary-Frances O'Connor on Huberman Lab: Why Grief Hurts

Andrew Huberman 0:00 Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Mary Francis O'Connor. Dr. O'Connor is a professor of clinical psychology and psychiatry at the University of Arizona, where she directs the Grief, Loss, and Social Stress Laboratory. Today we discuss the neuroscience of attachment and loss and why grief literally feels painful in our bodies. We also discuss the very real and serious health risks to being in a state of grief. Throughout the episode, we discuss ways to navigate and recover from grief, either from the death of a person, the death of an animal, or from the loss of a relationship, job, or other role in our lives. As you'll soon learn, Dr. O'Connor's research is both fascinating and incredibly surprising. She discovered, for instance, that grief is best understood through the lens of human attachment and that dopamine, a molecule that we normally hear about in the context of motivation and pleasure, creates a sense of yearning that is central to the grieving process. She explains that to effectively move through grief, we have to work with both our feelings of protest and our feelings of despair. Those two things, the feelings of protest that we refuse to let go or our mind and body just don't want to let go, as well as the feelings of despair, that we don't know what to do, that we feel like it's an endless sense of loss, both of those feelings have to be acknowledged and then we have to transmute those feelings into actions and feelings that maintain the memory of the person or role that we played in an active way and yet move forward. By the end of today's conversation, you'll have a much deeper understanding of grief, something that everyone goes through at some point in their lives, not just as an emotion but as a specific psychological and physiological process. The idea is not to intellectualize grief but rather to better equip you to deal with it in more direct ways so you can honor the loss more completely and be able to move forward having grown from the experience. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public. In keeping with that theme, this episode does include sponsors. And now for my discussion with Dr. Mary Francis O'Connor.

Andrew Huberman 2:22 Dr. Mary Francis O'Connor, welcome.

Dr. Mary-Frances O'Connor 2:25 It's so lovely to be here.

Andrew Huberman 2:27 I'm a huge fan of your work. It's such important work.

Dr. Mary-Frances O'Connor 2:31 Thank you.

Andrew Huberman 2:31 Everybody grieves at some point.

Dr. Mary-Frances O'Connor 2:33 Yeah.

Andrew Huberman 2:34 Uh, uh, no one is immune from this process that we call grieving. And we get very mixed messages-

Dr. Mary-Frances O'Connor 2:39 Yeah.

Andrew Huberman 2:40 ... from a young age all the way up to adulthood about how best to grieve, what grieving is.

Dr. Mary-Frances O'Connor 2:47 Yeah.

Andrew Huberman 2:48 And your work has really highlighted that this is a process-

Dr. Mary-Frances O'Connor 2:51 Mm-hmm.

Andrew Huberman 2:52 ... that doesn't always play out the same way for everybody. But if we were to try and drill into some of the, say, core elements of grief-

Dr. Mary-Frances O'Connor 3:00 Yeah.

Andrew Huberman 3:01 ... not to be overly reductionist-

Dr. Mary-Frances O'Connor 3:02 Mm-hmm.

Andrew Huberman 3:02 ... but just, you know, if you could highlight for us, y- what grief really is as a process, what some of the hallmarks of grief are, perhaps some things that everyone experiences that they shouldn't be shocked-

Dr. Mary-Frances O'Connor 3:14 Yeah.

Andrew Huberman 3:15 ... at, and then we can, um, lead into what your research has taught us about grief.

Dr. Mary-Frances O'Connor 3:20 Perfect. I think it's good to understand that grief is the natural response to loss. It is a natural physical, emotional, mental, uh, r- just reaction to the death of someone very close to us. And I think it can be helpful for people in unwinding some of these myths to think about the, the idea that there's a difference between grief and grieving. So grief is that, in that moment, you know, I could say, "Andrew, on a scale of one to ten, how much grief are you feeling right now?" And you would be able to tell me right now, during this wave of grief, how you're doing. But grieving is the way that grief changes over time. As you were saying, it's the process part. So I think of it as sort of, you know, uh, you can imagine the stock market, right? Each day, it's up, it's down, it's up, it's down. Some days it's really down. Some days it's really up. But at the end of the year, you can still see that there's been a trajectory, right? For the year, the stock market m- might actually be up even though you had some really terrible days. I think knowing that helps us to see that grief will never go away because it is a human emotion. Whenever we're aware, whenev- whenever we remember that our loved one is gone, we're gonna have a wave of grief. And that's okay 25 years later, but it doesn't mean that there hasn't been a process of grieving. I think of grieving as a form of learning, learning how to live with the loss of this person.

Andrew Huberman 5:09 So I'm trying to square two things that we've all heard. One is that time heals all wounds, and the other is that absence makes the heart grow fonder.

Dr. Mary-Frances O'Connor 5:19 Mm-hmm.

Andrew Huberman 5:19 You know, part of the reason I became a biologist is because of puzzles like this.

Dr. Mary-Frances O'Connor 5:23 Yes.

Andrew Huberman 5:24 You know, you don't have to, uh, have a particularly high IQ to realize that the world is full of contradictions.

Dr. Mary-Frances O'Connor 5:29 Yes. (laughs)

Andrew Huberman 5:30 So which one is it?

Dr. Mary-Frances O'Connor 5:31 I think it really helps us to hone in on the idea that you can't talk about grief without talking about love and bonding. Because unless you understand what you have, you don't really understand the impact of its loss, right?

Andrew Huberman 5:48 Mm-hmm.

Dr. Mary-Frances O'Connor 5:48 So "absence makes the heart grow fonder" is a fantastic way to describe attachment, right? When you fall in love with your baby or you fall in love with the person who becomes your spouse, that bond that gets created between the two of you, when you form an us-It comes with this implicit belief, I will always be there for you, you will always be there for me, and time and distance will not change that. If you are gone, it just means I have to go find you. And so now we have this unique and terrible circumstance of death where when we have a living loved one, the correct response to absence is to think about them more, to put more energy into going to find them or, or making more noise so they come and find you. But in death, suddenly we have this circumstance that the brain is really gonna struggle to wrap itself around, which is the idea that I'm not going to find you no matter how much effort I put in. I think of this as the, as the gone but also everlasting theory, right? So of course, we know that they are gone. We know that they've died. We have a memory of being at their bedside maybe or getting that phone call or being at the funeral or whatever it is in our memory, we have it recorded. We know that they're gone. But the attachment neurobiology means there's also this implicit belief, but maybe they're out there-

Andrew Huberman 7:25 Mm-hmm.

Dr. Mary-Frances O'Connor 7:25 ... right? And those two things, those two streams of information, they're gone, they're everlasting, can't both be true. And when we become aware, when we have that moment where we recognize those are in conflict, we have a wave of grief.

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Andrew Huberman 10:30 From what I understand about the research on stress, so much of our ability to tolerate stress is knowing that it has a defined endpoint.

Dr. Mary-Frances O'Connor 10:40 Yeah.

Andrew Huberman 10:41 So if we look at, or if you look at, from the perspective of your clinical work, because you were indeed a clinical psychologist as well as a researcher-

Dr. Mary-Frances O'Connor 10:51 Yeah.

Andrew Huberman 10:51 ... a psychologist/neuroscientist.

Dr. Mary-Frances O'Connor 10:53 (laughs) Yeah.

Andrew Huberman 10:54 You wear many hats. Is there any evidence, uh, like what are the data on people that have some time to anticipate the loss of someone or a pet or maybe even a, a certain aspect of life like a job?

Dr. Mary-Frances O'Connor 11:07 Yeah, yeah.

Andrew Huberman 11:08 Like they've been laid off, but they get some time before their final day or-

Dr. Mary-Frances O'Connor 11:10 Or retirement.

Andrew Huberman 11:11 ... or retirement or, um, somebody is slowly dying.

Dr. Mary-Frances O'Connor 11:15 Mm-hmm.

Andrew Huberman 11:16 Uh, versus a sudden death, a shock, a car accident, or worse. Um, is, what, what did the data tell us about how that grief is handled? Um, is it easier in some sense when you know there's an endpoint because you can anticipate the end? Um, what's known about this?

Dr. Mary-Frances O'Connor 11:36 I think there's a, a couple things there that I highlight. We, we can think about something being stressful and we can think about grieving for it, and those might be slightly different, but we can get there. But what I would say most directly to your question is, yes, it is true that sudden losses are harder for us to, to learn, to understand what's happened, because we don't even have sort of a conscious... You know, we, we've never run the scenario sort of through our minds, so of course it's more difficult for us to now imagine it. But there's something... There's more to it than that. So we do know-For example, having closure conversations with someone who's in hospice care. These are helpful, actually, after the loss because we can reflect on getting to say, "I love you," and, "Thank you," and, "I forgive you," "Please forgive me," uh, to say goodbye. We know that having that conscious process is helpful later on as we're reflecting on the loss. But I will say that it doesn't necessarily change the attachment biology. So the attachment is an implicit belief. It is an everlasting belief. And so I think it is actively trying to prevent us from learning that they are gone, and so what you see is a person... This will happen in studies. I ask a participant, you know, "Tell me about, tell me about the death of, of your loved one." And they'll tell me the story of how they were, you know, in palliative care and they had this terminal diagnosis and so forth, and then I'll say, "Was the death sudden?" And they'll say, "Oh, absolutely. I had no idea." Because I think that the belief that they will always be there does not respond to logical thinking, you see? And so you can still pick up the phone to text your loved one even though you have known they were going to go, even though you know they've been gone, because there's a piece of your brain that is still operating under the belief, "They don't have to be in my time and space for them to exist."

Andrew Huberman 13:53 Mm.

Dr. Mary-Frances O'Connor 13:54 And so I think in some ways the learning might actually be, "How do I transform my understanding of this relationship now that they're not on this earthly plane? How do I understand where they are or how that makes sense? How can I have this continuing bond in my internal relationship with them?" Right? Maybe I still tell them about my day, or maybe I... You know, like when I see things I think, "Oh, my mom would love that," right? I have this moment of connection internally with my mom-

Andrew Huberman 14:30 Mm-hmm.

Dr. Mary-Frances O'Connor 14:31 ... because that internal relationship goes on. It is everlasting. At the same time that I know, "Oh, she's not gonna be at my wedding," or, "She's not gonna be at graduation." Right? You can have both at the same time. I think that's part of why grieving is so confusing and makes people feel like they're losing their mind.

Andrew Huberman 14:52 Yeah. The question that immediately comes to mind is whether some people have challenges getting through the grief process because of, of a kind of deliberate refusal to enter this new reality that they're both gone and that there are elements of them that are still alive within us, as you pointed out, in the form of the attachment.

Dr. Mary-Frances O'Connor 15:17 Yeah.

Andrew Huberman 15:17 The attachment lives on.

Dr. Mary-Frances O'Connor 15:19 Yep.

Andrew Huberman 15:19 The body no longer-

Dr. Mary-Frances O'Connor 15:21 Yes.

Andrew Huberman 15:21 ... lives on.

Dr. Mary-Frances O'Connor 15:21 That's right.

Andrew Huberman 15:22 And, you know, it's, uh, difficult to decide whether or not movies like Ghost, um, I think that was-

Dr. Mary-Frances O'Connor 15:30 Mm-hmm.

Andrew Huberman 15:30 ... a movie, right?

Dr. Mary-Frances O'Connor 15:31 Yes.

Andrew Huberman 15:31 Where she loses her spouse-

Dr. Mary-Frances O'Connor 15:33 Mm-hmm.

Andrew Huberman 15:33 ... or a loved one, I don't recall if it was a spouse, and- and he's essentially still there with her.

Dr. Mary-Frances O'Connor 15:38 That's right.

Andrew Huberman 15:38 I mean, movies like that, you could imagine, are kind of a double-ed- edged blade because on the one hand, um, they give people the sense that the person they miss and are so attached to is s- still there, but, um, I mean, that's a movie-

Dr. Mary-Frances O'Connor 15:51 Mm-hmm.

Andrew Huberman 15:51 ... where they could actually write in the image of the person.

Dr. Mary-Frances O'Connor 15:53 Yeah.

Andrew Huberman 15:54 And, um, create some complications. So do people delay the grieving process? Do they protract it and just make it much harder on themselves in, in a kind of a stubborn refusal to, quote, unquote, "let go"?

Dr. Mary-Frances O'Connor 16:11 Mm-hmm.

Andrew Huberman 16:11 I could understand why that would be.

Dr. Mary-Frances O'Connor 16:12 Mm-hmm.

Andrew Huberman 16:12 I- I've been guilty of this-

Dr. Mary-Frances O'Connor 16:14 Yeah.

Andrew Huberman 16:14 ... uh, in the past. Um, is that common?

Dr. Mary-Frances O'Connor 16:18 I think the question is askew in the sense that there is no letting go of the attachment part. There is transforming our understanding of what that means. So for most periods of history, periods of time, cultures, we have usually a social system, often a religion, set up to explain to us, "Where did they go? Are they okay now? Will I ever see them again?" Most of us through most of history have had a way to understand, "Ah, I can't see them now. I will see them eventually." Dia de los Muertos, "I will see them once a year," right? Or, um, "They are in heaven now," or, "They're in the Pure Lands," or, "They're my ancestor." There is a relationship that I can have with them. I can ask them to, you know, uh, speak on my behalf, so to speak, right? Intercessory prayers in- in Catholicism. So historically, we've had this way of understanding this internal relationship that is so real you could put it on film.

Andrew Huberman 17:29 Mm-hmm.

Dr. Mary-Frances O'Connor 17:30 It is really happening, and they are also not present. So when I think of what it means to adjust, and I don't think of it as recovery, I don't think of it as letting go, I think of it as integration. When I think about those things, I think, "What is my relationship, what is my internal relationship with this deceased person now?" So my mother, my mother was diagnosed with stage four breast cancer when I was 13, and there were cancer cells in every lymph node they cut out of her, so they knew it had already migrated, and I think they told my dad that she would only live another year. She actually... Her oncologist called her his first miracle. She actually lived another 13 years.

Andrew Huberman 18:23 Wow.

Dr. Mary-Frances O'Connor 18:24 Which is-...miraculous. But what it meant was we learned to live in this state of sort of waiting for the second shoe to drop, and I think because of that I ca- I- I just became really comfortable and familiar with grief. It- it doesn't bother me when my participants I'm interviewing, you know, sort of cry uncontrollably and then they apologize, and I say, "This is just what grief is. This is just how it works." And so what it means is that now I have a very different relationship with my mother than I did at 26 when she died. At 26, I was really angry with her still. Now, my friends, you know, in our 40s, suddenly my friends seemed really, um, accepting of their mothers. Like, their relationships with their mothers improved. They were like, "Well, I understand why she did the things she did," or, "Now I'm so grateful for blah, blah, blah." And I had a whole lot of grief 'cause I didn't get to do that. I didn't get to have that transformation of our relationship. And then I realized, wait a minute, I can still have all those thoughts. I can look in the mirror now, 'cause I look a lot like her, I can look in the mirror now and be like, "I'm doing this for you, Mama." Or, "You know, it's not the way I would have done things, but I get that you had a reason." And- and forgive her, and doing that with the internal representation matters to how I function in my day-to-day life now, but it has nothing to do with letting go. Do you see what I mean?

Andrew Huberman 20:03 Mm-hmm.

Dr. Mary-Frances O'Connor 20:03 You can still adapt to a world where the person is gone, and that is incredibly painful, and also they live on because they are deeply encoded in your brain. You cannot get rid of them.

Andrew Huberman 20:20 Mm-hmm.

Dr. Mary-Frances O'Connor 20:20 They are there with you, physiologically with you, and you can work with that relationship now as well so that I can spend time with my living loved ones. I don't spend a lot of time feeling guilty about how I handled her death or something like that. I'm busy living my life now because I've integrated my relationship with her. Does that make sense?

Andrew Huberman 20:43 That makes very good sense.

Dr. Mary-Frances O'Connor 20:45 Yeah.

Andrew Huberman 20:46 I'm wondering if you could, um, touch on some of the work that you've done related to how grief relates to the attachment and how attachment relates to wanting.

Dr. Mary-Frances O'Connor 20:57 Mm-hmm.

Andrew Huberman 20:58 Because you've made this incredible discovery that the dopamine system, which most people associate with pleasure-

Dr. Mary-Frances O'Connor 21:05 Mm-hmm.

Andrew Huberman 21:06 ...and thanks to the wonderful work of Anna Lembke and others, there's been more education now and people are more aware now of the fact that dopamine is, uh, much more about wanting than having-

Dr. Mary-Frances O'Connor 21:16 Yeah.

Andrew Huberman 21:16 ...more about craving than delighting in.

Dr. Mary-Frances O'Connor 21:19 Yeah. Yeah.

Andrew Huberman 21:19 Uh, but I and I think everybody else be kinda shocked to learn that dopamine and grief have a very close relationship.

Dr. Mary-Frances O'Connor 21:27 It's the hallmark of grieving is yearning, pining, right? These are other words for wanting, aren't they? And that dopamine, I've heard it described as dopamine and the reward system is really how much effort would you put in to get this thing you want, right?

Andrew Huberman 21:48 Mm. Mm-hmm.

Dr. Mary-Frances O'Connor 21:48 How much effort would you put in? How much effort would you put in to see your loved one again, right, one more time? And what that tells me... And- and really this came from the neuroscience, so I said earlier that you could think of stress and grief as- as somewhat distinct. We used to think of the loss of a loved one as sort of like, you can imagine you have a plate, right? You got all the things heaped on your plate you have to deal with. You've got getting the kids to school. You've got your boss. You've got blah, blah, blah, and now you've got this another thing heaped onto your plate. You have the loss of your spouse or the loss of your sister. That is one way to think about it. And in our peripheral physiology, a lot of the ways we respond look like a stress response, so that- that makes sense. That was a good way to think about it in the '80s and early '90s. But the neuroimaging research, when we asked people, "Tell me how much you're yearning for your loved one," and then we put them in the scanner and we showed them photos of their loved one, compared those to them looking at a stranger. So what part is unique? Not looking at a person, but looking at your person that you're yearning for. We saw that there was this little area in the- deep in the brain called the nucleus accumbens. Probably from other studies, we know it's sort of in a- in the neighborhood, caudate-ventral striatum sort of area. And what we saw was the more people said, "I'm yearning for my loved one," there was a direct correlation with how much activity there was in the nucleus accumbens, in this reward learning area of the brain. Now, in everyone who was bereaved, regardless of how much grief severity they were having, we saw things like memory areas. Of course, they're looking at a photo of their loved one. They're having all sorts of memories of when the photo was taken or, you know, whatever. We had lots of emotion areas, emotion regulation areas, even some areas that had to do with autonomic physiology regulation, but what made it so unique was this idea that yearning is something that varies among people who are grieving and that it might be in part instantiated in this brain-encoded region that says, "I'm looking at this photo and what that makes me want to do is reach out for you." And I think this was a very new way to understand what is lost. It isn't something new that's leap- that's heaped onto your plate. It's that a part of... It's e- it's- it's a part of us that was formed when you bonded-... has been amputated. You don't have the resources. You can't function in the world, you can't walk through the grocery store without figuring out how to do that without this other person. And then, often yearning to have them back so that you could walk through the world in the normal way again. There's nothing wrong with yearning, it's just that we understand better now how the brain is doing it. And I can tell you if you want, but I've gone on a bit here-

Andrew Huberman 25:11 No, please.

Dr. Mary-Frances O'Connor 25:11 ... I can tell you if you want, a lot of people did point out, "Wait, this is the same area of the brain that's related to addiction." A lot of people talked about, "Are we addicted to our loved ones?" And it took me, I never wrote about it the first, in, in the 2008 paper. I never wrote about it that way, but I've come up with a better maybe way to communicate, I think, what's going on. So I live in the desert southwest, in Tucson, Arizona. And I can tell you, if you forget your water bottle and you are out on a hike, (laughs) and you're halfway through, you cannot think of anything else other than water, right?

Andrew Huberman 25:53 Mm-hmm.

Dr. Mary-Frances O'Connor 25:53 You are obsessed with thinking about it, getting it, imagining it, and so forth. But no one would say you were addicted to water, right?

Andrew Huberman 26:02 Mm-hmm.

Dr. Mary-Frances O'Connor 26:04 Water is something we need, and we have a homeostatic function that says, "You need more of it." And then once we have it, we feel satiated, right? Yearning for a loved one is that kind of thirst. We need our attachment figures like we need food and water. They are basic to our survival, and I think we forget that in modern society where we can, sort of, fill in for so many needs. We need our spouse, we need our children, our parents, our siblings, and we fail to thrive when we don't have them. And so I think the activation in that area is just the cue of you really need to reach out for this person. And the process of grieving is, if I'm going to reach out, it's gonna look different than it did before. Maybe I'm gonna have a conversation, maybe I'm gonna talk to my sister. But also, you have to find another way to get your attachment needs met. There has to be someone else in your life whom you would say, "I will always be there for you. You will always be there for me," because this person who's left this earthly plane cannot be that anymore.

Andrew Huberman 27:21 So interesting. I loosely define addiction as a progressive narrowing of the things that bring you pleasure.

Dr. Mary-Frances O'Connor 27:27 Yes.

Andrew Huberman 27:28 And you beautifully described how on a hike in the desert southwest when you need water, the narrowing-

Dr. Mary-Frances O'Connor 27:34 Yes.

Andrew Huberman 27:34 ... of what brings you pleasure comes down to what you need for survival.

Dr. Mary-Frances O'Connor 27:38 Absolutely.

Andrew Huberman 27:38 And presumably, once you have that water, then your, your notion of what's pleasurable expands again.

Dr. Mary-Frances O'Connor 27:43 Yes.

Andrew Huberman 27:43 Whereas addiction to, say, methamphetamine or to some, uh, you know, process addiction or behavioral addiction, it really becomes, uh, like a tunnel. There's one thing and that one thing only.

Dr. Mary-Frances O'Connor 27:52 Mm-hmm.

Andrew Huberman 27:53 And sadly, in addiction, the, the rewarding properties of that thing also become diminished with time.

Dr. Mary-Frances O'Connor 27:57 Yes.

Andrew Huberman 27:57 But

Andrew Huberman 27:58 the way you describe grief as a, a sort of addiction-like, like the process of, of grieving sort of addiction-like in that sense, um, raises for me a question. You said that at some point in order to move through, I don't wanna say get over because one-

Dr. Mary-Frances O'Connor 28:14 Integrate maybe.

Andrew Huberman 28:15 ... to integrate the, the grieving process, one needs to either find, um, a replacement attachment figure. I mean, we don't like to think about this when we lose someone, but if it's a spouse, sometimes people remarry or re-partner, and sometimes they don't. But it's kind of a beautiful thing really to observe that. I've seen that several times over when somebody re-partners and they seem like that attachment need is met, at least partially. It's not the same, but it's met differently again.

Dr. Mary-Frances O'Connor 28:41 Yeah.

Andrew Huberman 28:42 But sometimes people refuse.

Dr. Mary-Frances O'Connor 28:44 Mm-hmm.

Andrew Huberman 28:44 They hold onto the attachment or morph the attachment in a way that they are with that person forever, to the exclusion of replacing that attachment figure. Are there any data that speak to, uh, which one works better?

Dr. Mary-Frances O'Connor 28:59 Mm-hmm.

Andrew Huberman 28:59 Or is it just kind of who you're at and where you're at in life, and, you know, some people are really stubborn with this aspect of the grief integration process?

Dr. Mary-Frances O'Connor 29:09 I think recently a lot about what is a good outcome. I've spent a lot of time in my career thinking, what is a bad outcome when we're grieving? And how might we most help people who are, who are not integrating this in a way that's allowing them to restore a meaningful life? But... And I, and I've shied away a lot from the question of what is a good outcome, because I think it- it- it has a normative quality to it. But I've started thinking about it in a very open way. So the first thing I would say is, uh, I really don't think of it as addiction-like. So our need for our loved ones, much like food and water, is this homeostatic process, right? You think, "Oh," you know, like, I- I'm visiting you, right? For this podcast. And at some point, there's some push notification in my brain that says, "You should text your partner," right? And I pull out my phone and I text him, and I wait for a few minutes, and then he responds and I get that little, "Oh, he's there. He knows where I am. We're good." That's not an addiction, right? That is the normal homeostatic process, just like I also got up and ate breakfast, 'cause I knew that I needed that, right? So I- I think with addiction, the problem is those drugs of abuse override exactly these circuits that work in a homeostatic way. And by overriding them, they either pare down the number of, uh, receptors or, uh, mess with the affinity of the receptors in such a way that it really does narrow our what's rewarding to only this drug, because only this drug can powerfully overfill those receptors. And now we have a situation where only meth, right? Is the thing that gives, makes us feel better. But-... not, not quite the same with food, water and- and- and living loved ones. To your question of... (sighs) And I think you've actually really hit on something that our culture is really struggling with right now. We've lost, in our culture, a lot of the grief literacy that was based around an understanding of what happens during bereavement, during mourning, that was very religiously focused, religiously oriented, right? So everything from sitting shiva to, um, having, uh, the- the mass after a year, right?

Andrew Huberman 31:45 Or a wake.

Dr. Mary-Frances O'Connor 31:45 Or a wake.

Andrew Huberman 31:46 With the body there.

Dr. Mary-Frances O'Connor 31:47 With the body right there.

Andrew Huberman 31:47 I've been to a wake. People are laughing, people are telling jokes, they're drinking.

Dr. Mary-Frances O'Connor 31:52 Yeah.

Andrew Huberman 31:52 And I remember the first time I went to-

Dr. Mary-Frances O'Connor 31:54 Mm-hmm.

Andrew Huberman 31:54 ... a proper Irish wake.

Dr. Mary-Frances O'Connor 31:55 Yep.

Andrew Huberman 31:56 I was thinking, "This is wild."

Dr. Mary-Frances O'Connor 31:58 Yes.

Andrew Huberman 31:58 And I didn't quite know how to be.

Dr. Mary-Frances O'Connor 32:00 Yes.

Andrew Huberman 32:01 And after some period of time, I caught on.

Dr. Mary-Frances O'Connor 32:03 Mm-hmm.

Andrew Huberman 32:03 And it was remarkable.

Dr. Mary-Frances O'Connor 32:05 Yeah. S-

Andrew Huberman 32:06 It was... It's clearly effective-

Dr. Mary-Frances O'Connor 32:08 Yes.

Andrew Huberman 32:09 ... for people that adhere to the Irish wake as a-

Dr. Mary-Frances O'Connor 32:13 That's right.

Andrew Huberman 32:13 The body is right there-

Dr. Mary-Frances O'Connor 32:14 Yes.

Andrew Huberman 32:15 ... dead as can be.

Dr. Mary-Frances O'Connor 32:15 Yes.

Andrew Huberman 32:16 And everyone's having a party.

Dr. Mary-Frances O'Connor 32:17 That's right. I... With the name Mary Frances O'Connor, it will not surprise you to know-

Andrew Huberman 32:21 Mm-hmm.

Dr. Mary-Frances O'Connor 32:21 ... that I grew up in a big Irish Catholic family. And we used to say, in the summers we saw our cousins for weddings, and in the winter, we saw our cousins for funerals. And we had these wakes. I saw numerous deceased bodies as a child of my family members while running around playing tag with my cousins. And what that does is, it is a cultural way to say, "Grief happens. Death happens. This is what it looks like." And you can respond in a lot of different ways, because I will tell you, while there is drinking and playing tag, there is also a lot of crying-

Andrew Huberman 32:59 Mm-hmm.

Dr. Mary-Frances O'Connor 32:59 ... and a lot of leaning on shoulders. It gives you some form of organization for how to understand the strong feelings that you're having. But in a different culture, you know, they'll hire funeral singers so that there can be singing while everyone is weeping, right? So my point here is that we stand in an unusual moment in history and culture, where we don't mostly adhere to some system for how to handle death and grief. And what it means is people are left to sort of manage those intense emotions without a lot of m- modeling, without a lot of philosophical understanding what's going on and- and- and disconnected often from their families of origin, um, because those don't make sense to us right now. I'm not suggesting that we go back to a time when, you know, Catholicism was the way or, uh, Judaism was the only way or... You know, I- I'm not suggesting that. What I'm suggesting is anyone who has attachment, so this can be prairie voles, little rodents, you know, that- that mate for life, this can be infants, this can be good functioning human adults like you and me, when there is loss, when that attachment figure is missing and deceased, it is something our brain, our body, our mind is going to react to intensely. And without some way of understanding what is that supposed to look like and how do I manage this, we are adrift. And what it means... So John Bowlby, who really developed this theory of attachment, right? When he was looking at infants and colleagues of his were looking at animals, right? You see these invisible tethers, right? You think of, uh, you know, think about the polar bear with the little baby polar bears, right? Coming along behind. You always see the following. The following, those invisible tethers, they're not invisible. They are in the brains of those attached animals and humans in the form of neurobiology of dopamine and oxytocin and cortisol and adrenaline and in specific brain regions with receptors. Those tethers are what are keeping us searching for mom or for baby or for spouse, right? And so left to our own devices without any way of understanding this, all we know is we're having these intense emotions, reactions, behaviors, thoughts. And John Bowlby divided the types of reactions that we see into two: protest and despair. Now, protest is the, "Uh..." You know, so let's say you're in the grocery store and you look down and your toddler is not next to you and you think, "Oh No! They're gone!" And you can even hear the embodiment of that, right? I am primed with every hormone and neurochemical to search for that child, right? You can feel that in your body. That is protest. "Oh no? They're gone?" Despair, on the other hand, despair is sitting in the living room and something arrives in the mail for your spouse and you know they are never gonna open it. And in that moment, you think, "Oh no, they are gone."And the gravity of that, right? You can feel that in your body as well, the giving up, the withdrawal, the, uh, the, the, just the lethargy of it, right? Now, notice that the information is the same. "Oh, no, they're gone," is something we have to learn. And one way we learn that is protesting and trying to prove that they're not gone, and the acknowledgement, the accepting that they are gone. Now, we don't often think of despair as having a purpose, but what's interesting is in this moment, despair has the function of stopping us from searching.

Andrew Huberman 37:58 Mm-hmm.

Dr. Mary-Frances O'Connor 37:58 And searching is physically very costly, the amount of energy it takes to create the blood pressure and the cortisol to reach out like that. And so that despair does actually have a function. That withdrawal is for good reason, but many people are terrified of feeling despair. Some people are terrified of feeling protest as well and just avoid any thoughts or reminders in any way. But here's the thing. Despair isn't the end of the story either, and this is not a stage model. These are responses we have over and over again as we're trying to understand this new world we're living in, but despair leaves out hope. Despair says, "They are really gone, and because they're never coming back, I am going to feel like this for the rest of my life." And that's not true either, right? We know that you can have grief, you can grow a life that restores meaning and that, that you do have other connections with people. I wouldn't say replacing, but I would say adding because now you know what it means to love someone. You know what it means to forgive and, and all those things you learned with your loved one, you can now love others as well. Or for some people, it isn't about creating new relationships. It's about having a transcendent experience. Now I can love nature, or I can love God because I was taught how to do it by having this connection with this one vitally important person in my life. Or even now I know how to care for myself. I know how to love and care for and forgive and appreciate myself because my loved one taught me how to do that. This is what I mean about there's no normative outcome.

Andrew Huberman 40:00 Yeah.

Dr. Mary-Frances O'Connor 40:00 Those are four very different life trajectories after the loss of someone that can all fulfill our attachment needs.

Andrew Huberman 40:09 As many of you know, I've been taking AG1 daily for more than 13 years. However, I've now found an even better vitamin mineral probiotic drink. That new and better drink is the new and improved AG1. This next gen formula from AG1 is a more advanced, clinically backed version of the product that I've been taking daily for years. It includes new bioavailable nutrients and enhanced probiotics. The next gen formula is based on exciting new research on the effects of probiotics on the gut microbiome, and it now includes several specific clinically studied probiotic strains that have been shown to support both digestive health and immune system health, as well as to improve bowel regularity and to reduce bloating. As someone who's been involved in research science for more than three decades, and in health and fitness for equally as long, I'm constantly looking for the best tools to improve my mental health, physical health, and performance. I discovered and started taking AG1 way back in 2012, long before I ever had a podcast, and I've been taking it every day since. I find that it greatly improves all aspects of my health. I just feel so much better when I take it. With each passing year, and by the way, I'm turning 50 this September, I continue to feel better and better, and I attribute a lot of that to AG1. AG1 uses the highest quality ingredients in the right combinations, and they're constantly improving their formulas without increasing the cost. So I'm honored to have them as a sponsor of this podcast. If you'd like to try AG1, you can go to drinkag1.com/huberman to claim a special offer. Right now, AG1 is giving away an AG1 welcome kit with five free travel packs and a free bottle of vitamin D3 K2. Again, go to drinkag1.com/huberman to claim the special welcome kit with five free travel packs and a free bottle of vitamin D3 K2. Today's episode is also brought to us by Helix Sleep. Helix Sleep makes mattresses and pillows that are customized to your unique sleep needs. Now, I've spoken many times before on this podcast about the fact that getting a great night's sleep is the foundation of mental health, physical health, and performance. When we aren't doing that on a consistent basis, everything suffers, and when we are sleeping well and enough, our mental health, our physical health, and our performance in all endeavors improves markedly. Now, the mattress you sleep on makes a huge difference in terms of the quality of sleep that you get each night. How soft that mattress is, how firm it is, how breathable it is, all play into how well you'll sleep, how much deep sleep you get, how much rapid eye movement sleep, and it needs to be tailored to your unique sleep needs. So if you go to the Helix website, you can take a brief two-minute quiz, and it will ask you questions such as, "Do you sleep on your back, your side, or your stomach? Do you tend to run hot or cold during the night?" Things of that sort. Maybe you know the answers to those questions, maybe you don't. Either way, Helix will match you to the ideal mattress for you. For me, that turned out to be the Dusk mattress, D-U-S-K. I started sleeping on a Dusk mattress about three and a half years ago, and it's been far and away the best sleep that I've ever had. So if you'd like to try Helix, you can go to helixsleep.com/huberman, take that two-minute sleep quiz, and Helix will match you to a mattress that is customized for your unique sleep needs. Right now, Helix is giving a special offer to Huberman Podcast listeners of up to 27% off site wide, plus free bedsheets with any luxe or elite mattress order.What

Andrew Huberman 43:21 you just said is so critically important that, if I may, I'm just going to, uh, summarize for myself and for those listening, and I'll never pass up the opportunity to weave in a little neuroscience lesson. And since you're a fellow neuroscientist-

Dr. Mary-Frances O'Connor 43:35 Love that.

Andrew Huberman 43:36 ...hopefully you'll collaborate with me on this.

Dr. Mary-Frances O'Connor 43:38 Love that.

Andrew Huberman 43:38 So, what I heard was, um, at least two divergent responses to grief. One is a protest. The other is a despair, broadly speaking.

Dr. Mary-Frances O'Connor 43:48 Yeah.

Andrew Huberman 43:49 In protest, it's a "No, I don't accept."

Dr. Mary-Frances O'Connor 43:53 Yeah.

Andrew Huberman 43:55 But there's an action step.

Dr. Mary-Frances O'Connor 43:56 Yes.

Andrew Huberman 43:56 There's a go response.

Dr. Mary-Frances O'Connor 43:58 Yes.

Andrew Huberman 43:58 And we know in the basal ganglia, a critical structure for, uh, action generation-

Dr. Mary-Frances O'Connor 44:03 Yeah.

Andrew Huberman 44:03 ...and action suppression, we can broadly think in terms of go and no-go-

Dr. Mary-Frances O'Connor 44:07 Mm-hmm.

Andrew Huberman 44:08 ...as separate circuits, literally. So the protest circuit is a go circuit that's nested on this notion of hope-

Dr. Mary-Frances O'Connor 44:15 Yeah.

Andrew Huberman 44:15 ...that it can be resolved through action.

Dr. Mary-Frances O'Connor 44:18 Yeah.

Andrew Huberman 44:18 The despair circuit is a, "Ugh, I can't act on this. I can't hand this letter to somebody. I can't call them. I can text them, but they're not going to see it."

Dr. Mary-Frances O'Connor 44:31 Right.

Andrew Huberman 44:32 And this is a no-go pathway-

Dr. Mary-Frances O'Connor 44:35 Mm-hmm.

Andrew Huberman 44:36 ...the suppression of action. And you said that action is metabolically costly, inaction is not costly. I'm not going to challenge that, but I have a question about that, which is, it seems what's required in the despair step for it to be adaptive, functional, healing, is for that no-go to be converted into some new context.

Dr. Mary-Frances O'Connor 44:59 Mm-hmm.

Andrew Huberman 45:00 And as neuroscientists, we know that context-dependent decision-making, strategy-settiing is this prefrontal cortical, uh, activity-

Dr. Mary-Frances O'Connor 45:09 Mm-hmm.

Andrew Huberman 45:09 ...that humans are so good at. But it requires effort.

Dr. Mary-Frances O'Connor 45:12 Yeah.

Andrew Huberman 45:12 It's like, "Ugh, I can't hand them the letter."

Dr. Mary-Frances O'Connor 45:14 Yeah.

Andrew Huberman 45:15 "But maybe I can do something else with the letter."

Dr. Mary-Frances O'Connor 45:18 Yes.

Andrew Huberman 45:19 "Maybe I can tear it up and write, write to somebody else."

Dr. Mary-Frances O'Connor 45:22 Yes.

Andrew Huberman 45:22 So this, I'm, I'm fascinated by this, this word that largely comes through Eastern philosophy, but this notion of transmutation.

Dr. Mary-Frances O'Connor 45:29 Mm-hmm.

Andrew Huberman 45:29 That we can take the energy of something and transmute it into something else that's functional.

Dr. Mary-Frances O'Connor 45:33 Yeah.

Andrew Huberman 45:33 So this is the way that I see this divergent circuit.

Dr. Mary-Frances O'Connor 45:36 Mm-hmm.

Andrew Huberman 45:36 Um, and, uh, now people are aware that I also, um, indeed will never pass up the opportunity to weave in some additional neuroscience, because I think that what you're describing is grief as a natural and fundamental part of the attachment circuitry. We're born into the world-

Dr. Mary-Frances O'Connor 45:52 Yep.

Andrew Huberman 45:53 ...ready to attach.

Dr. Mary-Frances O'Connor 45:54 Yes.

Andrew Huberman 45:54 That's what Bowlby and colleagues taught us.

Dr. Mary-Frances O'Connor 45:55 Yes.

Andrew Huberman 45:56 I'm also realizing, and I'm very excited about the fact, that we are born into the world also to grieve-

Dr. Mary-Frances O'Connor 46:02 Yes.

Andrew Huberman 46:02 ...and to learn when and how to go-

Dr. Mary-Frances O'Connor 46:06 Yes.

Andrew Huberman 46:06 ...to protest, and when to despair-

Dr. Mary-Frances O'Connor 46:08 Yes.

Andrew Huberman 46:08 ...to transmute.

Dr. Mary-Frances O'Connor 46:09 Yes. And I will say there is even some proof of that, or I think of it as proof in the following way. So, you are correct that the no-go, it, it's not that there's no cost with no-go. You are correct. So, it does stop us from the type of go which is searching, right?

Andrew Huberman 46:32 Mm-hmm. Mm-hmm.

Dr. Mary-Frances O'Connor 46:32 So it stops maybe the cortisol or the adrenaline or something like that. But, uh, it comes with its own, I think, largely, things like inflammation and things that enable the withdrawal-

Andrew Huberman 46:47 Mm-hmm.

Dr. Mary-Frances O'Connor 46:47 ...right? Uh, probably shifting hormones. We know prolactin changes in grieving, oxytocin changes in grieving. But think about it this way, so in a sort of evolutionary way, if your mate is gone or your, your caregiver is gone, that withdrawal allows you to save resources because you don't know where, when they're coming back. And that's important for your survival, but as transition through, "Oh, eventually I'm going to have to get my own food. I am gonna have to move again." But not in the frantic searching way. "I'm gonna have to find meaningful activity to go on," right? So here is my theoretical reason why I believe we are set up to grieve. I know that you had attachment figures as, as a child because you survived to adulthood.

Andrew Huberman 47:51 Mm-hmm.

Dr. Mary-Frances O'Connor 47:52 (laughs) Right? Proof.

Andrew Huberman 47:53 Mm-hmm.

Dr. Mary-Frances O'Connor 47:53 Proof that someone loved you.

Andrew Huberman 47:54 Mm-hmm.

Dr. Mary-Frances O'Connor 47:56 Now, children have caregivers as their primary attachment figures. But now in your life, it is most likely that your primary attachment figure is a peer, like a spouse or boyfriend, girlfriend, et cetera. Not your parent. So something had to change, right? And developmentally, we are prepared, we come into the world prepared with a neurobiological developmental program that at some point says, "My parent is no longer the peak of my attachment hierarchy." I'm looking around, I'm motivated to see friends and I'm motivated to date and I'm motivated to create these enduring relationships with people my own age. And that means that our attachment hierarchy can shift. That we have the capacity in our neurobiology, in our hormones to shift from a primary attachment to a parent to a primary attachment to someone else. And the capacity to do that is innate. Now, I will say, of course, we are all programmed to do this at roughly the same period of our life. Parents know coming into the bargain that this is going to happen, although parents experience a lot of grief during the empty nest when it is actually occurring.When a loved one dies and, you know, a dear friend, 50 years old, her husband dies of sudden heart attack right in front of her in the living room, there's not a whole cohort of you going through this experience together, of transitioning to a, to a different attachment hierarchy, right? And we set up whole cultures around sending kids to college or sending them on a mission or, or sending them through bra- basic training as a way to get this whole cohort, you know, o- of young people through this transitional period. What we need is support for these individuals who are dealing with the death of a sibling or a parent or a spouse or a child, who are all going through it on their own and trying to figure it out without that infrastructure to support them, to help them understand what is natural and normal during grieving. And because we know it is a medically risky time, much like college is a medically risky time in other, in other ways, because it is a medically risky time, we need to be able to assess what's going on with them physiologically and make sure we're supporting their grieving body through this intensely, intensely stressful experience of transmuting.

Andrew Huberman 50:47 Yeah. And I don't know if I'm using that term correctly, but-

Dr. Mary-Frances O'Connor 50:50 Yeah.

Andrew Huberman 50:50 ... um, and I can't say I'm the biggest Alan Watts fan-

Dr. Mary-Frances O'Connor 50:53 Mm-hmm.

Andrew Huberman 50:53 ... that ever lived. I like some of his stuff-

Dr. Mary-Frances O'Connor 50:55 Mm-hmm.

Andrew Huberman 50:55 ... n- not others, but I've heard two things from him, one about transmutation, which I thought was beautiful and very apt, and from the perspective of neuroscience, made a lot of sense.

Dr. Mary-Frances O'Connor 51:03 Mm-hmm.

Andrew Huberman 51:04 Because people talk about energy-

Dr. Mary-Frances O'Connor 51:06 Yep.

Andrew Huberman 51:06 ... in the kind of, uh, new agey-

Dr. Mary-Frances O'Connor 51:09 Mm-hmm.

Andrew Huberman 51:09 ... whatever.

Dr. Mary-Frances O'Connor 51:09 Crystals and-

Andrew Huberman 51:10 Yeah, or even just the, the sort of non-scientific notion of, of energy-

Dr. Mary-Frances O'Connor 51:14 Yeah.

Andrew Huberman 51:15 ... tends to be rather vague.

Dr. Mary-Frances O'Connor 51:16 Yeah.

Andrew Huberman 51:16 And at the same time, it's more intuitive for most people.

Dr. Mary-Frances O'Connor 51:19 Yeah.

Andrew Huberman 51:20 Whereas neuroscientists love to talk about neurochemical energy-

Dr. Mary-Frances O'Connor 51:23 Yeah.

Andrew Huberman 51:23 ... or physiologist caloric energy.

Dr. Mary-Frances O'Connor 51:24 Yeah.

Andrew Huberman 51:25 But when I think about the energy that we're talking about, I, I think about it more as, like, neural circuit energy.

Dr. Mary-Frances O'Connor 51:30 Yeah.

Andrew Huberman 51:30 Like, which, which p- pathway, the go pathway or the no-go pathway-

Dr. Mary-Frances O'Connor 51:34 Mm-hmm.

Andrew Huberman 51:34 ... um, kind of requires our attention in order to-

Dr. Mary-Frances O'Connor 51:36 Yeah.

Andrew Huberman 51:36 ... move through this. In the same way that kids learn action generation and they learn to sit still during a lesson.

Dr. Mary-Frances O'Connor 51:42 Yeah.

Andrew Huberman 51:43 Some, some more slowly, like myself-

Dr. Mary-Frances O'Connor 51:45 (laughs)

Andrew Huberman 51:45 ... th- than others. Um, you know, I, I blame my Y chromosome for that.

Dr. Mary-Frances O'Connor 51:49 (laughs)

Andrew Huberman 51:49 Because there's a known delay in the, uh, maturation of the prefrontal cortex-

Dr. Mary-Frances O'Connor 51:53 That is true.

Andrew Huberman 51:53 ... in those with Y chromosomes.

Dr. Mary-Frances O'Connor 51:55 Mm-hmm.

Andrew Huberman 51:55 Um, it eventually catches up in most, but not all-

Dr. Mary-Frances O'Connor 51:58 (laughs)

Andrew Huberman 51:59 ... um, Y chromosome possessing individuals. A different podcast for another time.

Andrew Huberman 52:05 I am very struck by this idea that, uh, when an attachment is, um, hindered, l- like, in grief, that having others that are there to support us is extremely important-

Dr. Mary-Frances O'Connor 52:18 Yeah.

Andrew Huberman 52:18 ... especially nowadays in this crisis of isolation.

Dr. Mary-Frances O'Connor 52:20 Yeah.

Andrew Huberman 52:21 Um, and in this time where we can communicate about our experience, we can learn so much about others' experiences, but we often don't have the fundamentals of support like, um, uh, touch.

Dr. Mary-Frances O'Connor 52:32 Mm-hmm.

Andrew Huberman 52:33 Right? Just, like, you know, t- touch.

Dr. Mary-Frances O'Connor 52:35 Yeah.

Andrew Huberman 52:35 Those hugs, somebody sitting there.

Dr. Mary-Frances O'Connor 52:37 Yes.

Andrew Huberman 52:37 E- eye contact.

Dr. Mary-Frances O'Connor 52:39 Mm-hmm.

Andrew Huberman 52:39 You know, um-

Dr. Mary-Frances O'Connor 52:40 Holding your hand.

Andrew Huberman 52:41 N- no doubt, um, smell is-

Dr. Mary-Frances O'Connor 52:43 Yes.

Andrew Huberman 52:43 ... is probably related to this. Just the smell of another person-

Dr. Mary-Frances O'Connor 52:45 Mm-hmm.

Andrew Huberman 52:45 ... even if you're not aware of it consciously-

Dr. Mary-Frances O'Connor 52:47 Yeah.

Andrew Huberman 52:47 ... it'll be signaling at, at a bodily level, there's someone else here.

Dr. Mary-Frances O'Connor 52:51 Yes.

Andrew Huberman 52:51 You know, there are a lot of people that, um, really struggle to sleep after the loss of someone.

Dr. Mary-Frances O'Connor 52:55 Absolutely.

Andrew Huberman 52:55 And just having someone else in the room-

Dr. Mary-Frances O'Connor 52:57 Mm-hmm.

Andrew Huberman 52:57 ... or a pet in the room-

Dr. Mary-Frances O'Connor 52:59 Yes.

Andrew Huberman 52:59 ... can make a big difference. So, y- you know, in, in terms of addiction-

Dr. Mary-Frances O'Connor 53:04 Mm-hmm.

Andrew Huberman 53:06 ... there are, um, incredible, um, zero cost programs all over the world in the form of 12 step and other recovery programs that allow people to work through their physiology and their psychology in, uh, through the support of others, elders as it were-

Dr. Mary-Frances O'Connor 53:21 Mm-hmm.

Andrew Huberman 53:21 ... or those more experienced-

Dr. Mary-Frances O'Connor 53:23 Mm-hmm.

Andrew Huberman 53:23 ... with whatever it is, alcohol, drugs, or a process addiction.

Dr. Mary-Frances O'Connor 53:26 Mm-hmm.

Andrew Huberman 53:27 Is there something similar for those, um, uh, in grief? I mean, I'm aware that there are bereavement groups.

Dr. Mary-Frances O'Connor 53:33 Mm-hmm.

Andrew Huberman 53:33 But typically, when I think of a gr- of a bereavement group, I think of, like, what my grandfather went to and met his, like, last girlfriend before he died.

Dr. Mary-Frances O'Connor 53:40 Mm-hmm.

Andrew Huberman 53:41 Uh, I think he only had one girlfriend after my grandmother died. They'd been together since they were 13 years old.

Dr. Mary-Frances O'Connor 53:47 Yeah.

Andrew Huberman 53:47 Thirteen.

Dr. Mary-Frances O'Connor 53:48 Amazing.

Andrew Huberman 53:48 So 50 plus years.

Dr. Mary-Frances O'Connor 53:50 Yeah.

Andrew Huberman 53:50 But that bereavement group became-

Dr. Mary-Frances O'Connor 53:51 Mm-hmm.

Andrew Huberman 53:51 ... a real source of, of support for him.

Dr. Mary-Frances O'Connor 53:53 Yes.

Andrew Huberman 53:53 And yes, he did find a girlfriend in bereavement group-

Dr. Mary-Frances O'Connor 53:56 Yes.

Andrew Huberman 53:56 ... and-

Dr. Mary-Frances O'Connor 53:56 Mm-hmm.

Andrew Huberman 53:56 ... uh, you know, family members have mixed feelings about that, but I was happy that he-

Dr. Mary-Frances O'Connor 54:00 Yes.

Andrew Huberman 54:00 ... he didn't, uh, die without company. Um, so for people of all ages, are there zero cost tools-

Dr. Mary-Frances O'Connor 54:10 Mm-hmm.

Andrew Huberman 54:11 ... um, in the form of groups to help people grieve different types of grief? Because I think for some people, it's... Like, I think we've all heard that the ultimate stressor-

Dr. Mary-Frances O'Connor 54:20 Mm-hmm.

Andrew Huberman 54:21 ... is the loss of a child.

Dr. Mary-Frances O'Connor 54:22 Mm-hmm.

Andrew Huberman 54:23 Um, and I can only think of one thing that might be equally stressful, if not more stressful, would be not knowing-

Dr. Mary-Frances O'Connor 54:30 Mm-hmm.

Andrew Huberman 54:30 ... if your child is alive or dead.

Dr. Mary-Frances O'Connor 54:32 Yeah.

Andrew Huberman 54:32 That, to me, just seems like the ultimate form of agony.

Dr. Mary-Frances O'Connor 54:35 Yes.

Andrew Huberman 54:36 So presumably, a bereavement group for that is very different than a bereavement group for someone who's really truly mourning the, the, um, I don't know, the separation from a spouse, right?

Dr. Mary-Frances O'Connor 54:48 Mm-hmm.

Andrew Huberman 54:48 Two, two different scales of grief, but-

Dr. Mary-Frances O'Connor 54:50 Mm-hmm.

Andrew Huberman 54:51 ... it's hard to tell someone who's really grieving deeply-

Dr. Mary-Frances O'Connor 54:53 Mm-hmm.

Andrew Huberman 54:53 ... like, "Your grief isn't as bad as someone else's grief."

Dr. Mary-Frances O'Connor 54:56 Mm-hmm.

Andrew Huberman 54:56 So are there groups?

Dr. Mary-Frances O'Connor 54:57 Mm-hmm.

Andrew Huberman 54:58 And, um, and then I'll also ask the question I just asked, which is, why is it that knowing other people suffer too-

Dr. Mary-Frances O'Connor 55:06 Mm-hmm.

Andrew Huberman 55:07 ... only provides mild support for-

Dr. Mary-Frances O'Connor 55:09 Mm-hmm.

Andrew Huberman 55:09 ... grieving?

Dr. Mary-Frances O'Connor 55:10 Yeah. There's a, a fairly recent, um, movement that we might call the, the public health model of bereavement support. And so the idea here is that, and this largely comes out of Europe, Canada, Australia, where they're trying to actually develop healthcare-... around bereavement. Part of this is because we can talk about how we know that the physical cost of the loss of a loved one is so impactful on us, it can lead to dying of a heart attack, right? So we know that, for example, the day that a loved one dies, you are 21 times more likely to have a heart attack than any other day of your life. 21 times. And we know that in the first three months after the death of his wife, a man is nearly twice as likely to have a fatal heart attack compared to a man who remains married during that same time.

Andrew Huberman 56:13 Wow, even if he has other support?

Dr. Mary-Frances O'Connor 56:15 Yes. Isn't that just crazy? For women, it's about 1.8 times. So still just an astronomical number for medical risk. So what we know is this period of transformation is incredibly risky, right? So we can have all this physiological change but if, if our body isn't resilient enough where it actually breaks during that time, this is something we need to get ahead of. So thinking about this public health model of bereavement, we can think of sort of at the foundation, even just understanding in a grief literacy kind of way, "What am I, what can I expect? What is happening to me? Why is this happening to me?" That is a, a psycho-education level that is vitally important to people regardless of sort of how much support they have. Now many people will go to bereavement support groups even just to get that, right? Even just to get good evidence-based information, places that are no longer teaching the five stages of grieving, for example. And beyond that, we know how important support is, social support, having loved ones around, just as you were describing. And I think one of the reasons, I mean, imagine in that first seven days after your spouse dies, if there is someone in your house sitting shiva, they are gonna notice if you have a heart attack, right? So think about the idea that we might outsource our physiological regulation for a while. Think of it this way. When we bond with someone, when you fall in love with your partner, say, for example, they become your external pacemaker.

Andrew Huberman 58:08 Mm-hmm.

Dr. Mary-Frances O'Connor 58:09 Right? Think about co-regulation. If I go home now and I get a hug from my partner, just the way you were describing, I know that my blood pressure will drop a little bit. My heart rate will drop a little bit. Now suddenly I have to imagine walking into an empty house where that's not gonna happen. My cardiovascular system has to figure out how am I gonna walk into my home again and again and again and regulate my heart rate?

Andrew Huberman 58:35 And your brain is anticipating seeing the person that you lost.

Dr. Mary-Frances O'Connor 58:38 Yes, exactly.

Andrew Huberman 58:39 But it doesn't, you can know-

Dr. Mary-Frances O'Connor 58:40 Yep.

Andrew Huberman 58:41 ... but the action systems, the go circuitry, if it were.

Dr. Mary-Frances O'Connor 58:45 All the subconscious processing, I should be, I'm doing the same motion of turning the key in the lock that I've always done, and now there's a hole in the room when I enter it, right?

Andrew Huberman 58:57 And it, often it still smells like them.

Dr. Mary-Frances O'Connor 58:59 I- Absolutely.

Andrew Huberman 59:00 And people, I think people really underestimate this thing-

Dr. Mary-Frances O'Connor 59:02 Yes.

Andrew Huberman 59:02 ... about smell-

Dr. Mary-Frances O'Connor 59:03 Yes.

Andrew Huberman 59:03 ... because it's operating at a, at an unconscious level all the time.

Dr. Mary-Frances O'Connor 59:06 Absolutely. Yes, bypassing-

Andrew Huberman 59:07 We're, like, bathing in somebody else's chemicals-

Dr. Mary-Frances O'Connor 59:09 Absolutely.

Andrew Huberman 59:10 ... and then they're gone-

Dr. Mary-Frances O'Connor 59:10 Yeah.

Andrew Huberman 59:10 ... and then it, it's, it starts dissipating-

Dr. Mary-Frances O'Connor 59:12 That's right.

Andrew Huberman 59:12 ... but it's still there for a while.

Dr. Mary-Frances O'Connor 59:14 Absolutely. So I think recognizing your grieving body has to figure out how to regulate again is one reason why support is so important. There's a, a study of, we were talking about earlier, before the podcast started, there's a study of primates where, you know, as with other primates, there's a lot of infant mortality, and in this observational study, there are troops, uh, that are being observed by scientists, and with the death of an infant primate, the mother will often carry that deceased infant, that baby monkey for a long time after their death and spend a lot of time looking at the infant. The mother doesn't groom. She doesn't try to nurse. She's not confused that the infant is alive, but what is interesting is she stops grooming herself during this time. Now that's actually medically risky for a primate because we know that grooming is so important to their health to get rid of parasites and such, and you know, usually in these troops, there's a really strict hierarchy. Who gets to groom who is, you know, the latest Kardashian show kind of thing. And during this time, when the mother is trying to understand what has happened to this infant, the rules go out the window. Any member of the troop can groom this mother.

Andrew Huberman 1:00:46 Mm-hmm.

Dr. Mary-Frances O'Connor 1:00:46 Now at some point, wide individual variation in how long the mother holds this infant, from days to months. Once she relinquishes the infant, the rules go back into effect. So she goes back to the troop, and now she participates in social life, in medical social life, in the way that she did before. I think the analogy here, in addition to every time I think about it, it just rips my heart a little bit, right? But the idea here is that it is all of our jobs to groom the berea- the mourning person, to care for them, to say, "Hey, how long has it been since you saw your doctor for your regular checkup? How long has it been since you had your mammogram or got your teeth cleaned?" Right? Often we've been caring for a loved one who's dying, and we're neglecting our own medical care.Because here's the thing, grief is the natural response. Our bodies are resilient. Many people are shocked by how much pain, physical pain, how they get a lump in their throat, or they feel like their chest is on fire when they're grieving. But actually our bodies are remarkably resilient. We do learn to re-regulate without this external pacemaker. But in those instances where the body isn't resilient enough to be able to do that, we need people around us supporting us. In a study in my own lab, we thought, well, probably this risk for a broken heart, this risk of dying of a heart attack isn't, you know, 24/7 equally risky. So we brought people into the lab and had them experience a wave of grief while they were hooked up to ECG and, and blood pressure and so forth. And what we saw was everybody's blood pressure goes up during a wave of grief. That's probably not too surprising. But what we saw was the people who when they walked in the door told us they were having the most intense grief, their blood pressure went up the most. And then in a replication study in Germany, we saw that their blood pressure didn't recover. So you can see that these waves of grief that our body and our mind and our brain have to learn how to, to cope with and then eventually to adapt to, those require a physical body that can sustain that. They require relationships that can support us and sustain that. And this is why I think support is so important even though it doesn't take away the pain of missing your person, right? Because we need every resource we can muster in the midst of this moment. Now, it does also mean that as much as we are missing our person and it feels so isolating to try and explain that there's a hole in the room when no one else can see that hole, it does help at some level to talk to this other person who is seeing a different hole in the room, who's also going through grief because we recognize grieving is a human experience and that you're not connected because you both miss the same person, but you are connected because you're both missing, right? And so I think that bereavement support can be incredibly helpful, um, to connect with others who are going through this same process. And frankly, you know, I don't recommend and, and some bereavement support groups actually prohibit, uh, dating relationships i- from a grief support group. But the reality is the people that we connect with are also people potentially that we develop stronger attachment bonds with. That's how community works, right? And so I think bereavement support can be incredibly important. We do know for the one out of 10 who develop a, a disordered grieving, who really are not showing any changes over time even though time is passing, those people might need very specific evidence-based psychotherapy intervention because we know that those, uh, those psychology interventions can get us back on a normal or typical grieving trajectory.

Andrew Huberman 1:05:27 I wanna talk about the somatic, the bodily aspect of, of this. We've been talking about the brain, which of course is connected to the body-

Dr. Mary-Frances O'Connor 1:05:34 Yeah.

Andrew Huberman 1:05:34 ...and vice versa, but, um, before I do that, I want to ask you a question, uh, about alcohol.

Dr. Mary-Frances O'Connor 1:05:43 Yeah.

Andrew Huberman 1:05:44 Uh, did an episode about alcohol a couple years ago and, um, I think I got a lot of people who wanted to stop drinking to stop drinking. I got some people who wanted to keep drinking, drinking a little less-

Dr. Mary-Frances O'Connor 1:05:54 Mm-hmm.

Andrew Huberman 1:05:54 ...and some people, uh, hate that episode-

Dr. Mary-Frances O'Connor 1:05:56 Mm-hmm.

Andrew Huberman 1:05:57 ...um, and keep drinking.

Dr. Mary-Frances O'Connor 1:05:57 (laughs)

Andrew Huberman 1:05:57 And my goal with that episode was not to change anyone's behavior, just to give them information.

Dr. Mary-Frances O'Connor 1:06:02 Yeah.

Andrew Huberman 1:06:04 I will be the last person to promote drinking-

Dr. Mary-Frances O'Connor 1:06:08 Mm-hmm.

Andrew Huberman 1:06:08 ...because we know it's basically not good for us despite the headlines that it might be.

Dr. Mary-Frances O'Connor 1:06:12 Mm-hmm.

Andrew Huberman 1:06:12 The mere disruption in sleep and microbiome probably explains, in my opinion, about 50% of the detrimental effect. But with that said, it is very customary in a lot of traditions that close to the, to the death, in the very early days and stages of grieving to actually promote alcohol use.

Dr. Mary-Frances O'Connor 1:06:32 Mm-hmm.

Andrew Huberman 1:06:32 And if I take an open-minded perspective to this, we know that alcohol at a low dose disinhibits us.

Dr. Mary-Frances O'Connor 1:06:39 Mm-hmm.

Andrew Huberman 1:06:39 It's why people start talking more. At a higher dose, it's more of a sedative.

Dr. Mary-Frances O'Connor 1:06:43 Mm-hmm.

Andrew Huberman 1:06:44 And we can all agree, I believe, that chronic alcohol use or continuing to drink to avoid one's feelings is just a bad idea.

Dr. Mary-Frances O'Connor 1:06:52 Mm-hmm.

Andrew Huberman 1:06:53 Anyone that disputes that is probably drinking while they do it. However, I am struck by the fact that so many traditions encourage the use of alcohol, and I wonder based on what you told us about the risk of heart attack-

Dr. Mary-Frances O'Connor 1:07:04 Mm-hmm.

Andrew Huberman 1:07:05 ...whether or not this is some attempt to lower blood pressure in the short term-

Dr. Mary-Frances O'Connor 1:07:09 Mm-hmm.

Andrew Huberman 1:07:09 ...and basically just keep the person from dying.

Dr. Mary-Frances O'Connor 1:07:11 Yeah.

Andrew Huberman 1:07:12 Is a drink or two, assuming you're of age and you're not an alcoholic, upon hearing the devastating news, is it the worst thing in the world?

Dr. Mary-Frances O'Connor 1:07:21 I will tell you a story which is that, so when my mother died, she was in our very tiny hometown in Montana. And in tiny towns, rural places like this, of course everyone knows what's going on. So the morning after my mom died, at about 1:00 in the morning, my best friend and I went downtown to a Mexican restaurant for breakfast.And the woman came by, who owned the place, came by the table and said, "Hey, I heard your mom was in the hospital. I'm so sorry." And I said, "Yeah, she, she died last night." And she said, "Oh, mija, what can I get you? Anything. What do you want?" And I said, "Can I have a beer?" (laughs) And she said, "Of course you can."

Andrew Huberman 1:08:04 Mm-hmm.

Dr. Mary-Frances O'Connor 1:08:05 And I had a beer for breakfast.

Andrew Huberman 1:08:06 Mm-hmm.

Dr. Mary-Frances O'Connor 1:08:08 I like to think of us as needing a big toolkit of strategies to deal with waves of grief, and that was the right tool in the toolkit at that moment. Now, if I had a beer for breakfast every day for the rest of my life, probably not so good for my liver, right?

Andrew Huberman 1:08:25 (laughs)

Dr. Mary-Frances O'Connor 1:08:26 And potentially for my job retention. But in that moment, it was the right tool.

Andrew Huberman 1:08:32 Mm-hmm.

Dr. Mary-Frances O'Connor 1:08:32 Do you see what I mean?

Andrew Huberman 1:08:33 Mm-hmm.

Dr. Mary-Frances O'Connor 1:08:34 So, it was also the right tool that I was sitting with my best friend, right? And I, that inhibition allowed me to cry right there in the middle of the restaurant. I think we have always found ways to interact with the body that may not make sense to us at some level, but probably when they are cultural ways, have come about for reasons. I don't have evidence for the things you were just saying, but the idea that it can bring people together who are feeling a little less inhibited so that they can talk about emotions and difficulties, the fact that it brings people together just to watch each other is vital. The fact that it impacts our cardiovascular system is important and here's what I would say about this. So, people think that dying of a broken heart is a metaphor. We look at, you know, uh, when Carrie Fisher died, her mom, Debbie Reynolds, died the next day, and we think, "Oh, isn't that a tragic, beautiful story?" This is a piece of evidence that we have known about from huge epidemiological studies, that the increased risk of all cause mortality is much higher in newly bereaved people. And my question is, why do we keep just proving it over and over? What are we going to do about it? In my own lab and then replicated later in a study in Australia, we did a, a, a proof of concept study. Now, to be very, very clear, this was not a randomized clinical trial and not at a level that would be, uh, worthy of using it as medical advice, but we said, "You know, when someone dies in the ICU, in the emergency department, in hospice, in a nursing home, the person standing next to them should become our patient." We know that their medical risk has just gone through the roof. So we gave aspirin, a baby aspirin to people in the first two weeks after the death of their loved one and looked at whether that was cardioprotective, which of course it was because we understand how aspirin works. Now, the reason we need big studies is to make sure that there isn't some negative side that we're, uh, that we would want to bar against, right? But my point here is if we know that bereavement is medically risky, if we know that we need to support the grieving body so that you can even get through those days and weeks and months so that you can start to restore a life again, what are we going to do about it? I think of it this way. Grief is not a disease. Grief is totally natural, but you know, pregnancy is not a disease. Pregnancy is totally natural, but no one would say it's not physiological. No one would say there aren't huge hormone shifts and that it is medically risky. So that for the vast majority of people who are pregnant, they're perfectly healthy, but we have whole systems of, of care in place to assess whether people are, are, are healthy during this period, and then if they're not, if we find gestational diabetes or hypertension, we know how to treat that and intervene for that person so that they can get through this transition period. What if it was the same with bereavement? Why at our bereavement support groups do we not also take their blood pressure to find out where they're at physically, in addition to teaching them the many coping skills they might use in addition to having a beer so that they can learn what grief is like and how to elicit support and ultimately how to adapt and develop a meaningful life that, that includes grief but includes all the other wonderful things in life as well.

Andrew Huberman 1:12:34 Yeah. A- amen to all of that. I was not aware of the medical risk of-

Dr. Mary-Frances O'Connor 1:12:38 Yeah.

Andrew Huberman 1:12:38 ... of being in grief or even adjacent-

Dr. Mary-Frances O'Connor 1:12:41 Yeah.

Andrew Huberman 1:12:41 ... to somebody in grief, but it makes perfect sense.

Dr. Mary-Frances O'Connor 1:12:44 Mm-hmm.

Andrew Huberman 1:12:44 Uh, you know, I mean, I've heard stories of people attending funerals where-

Dr. Mary-Frances O'Connor 1:12:51 Yes.

Andrew Huberman 1:12:51 ... the brother of-

Dr. Mary-Frances O'Connor 1:12:52 Yes.

Andrew Huberman 1:12:52 ... the deceased died at-

Dr. Mary-Frances O'Connor 1:12:54 Yes.

Andrew Huberman 1:12:54 ... the funeral weekend-

Dr. Mary-Frances O'Connor 1:12:55 At the funeral. That's right.

Andrew Huberman 1:12:56 ... or even at the funeral.

Dr. Mary-Frances O'Connor 1:12:57 Yeah.

Andrew Huberman 1:12:57 And you just go, "Oh my goodness." It's almost like, uh, beyond comprehension.

Dr. Mary-Frances O'Connor 1:13:00 That's right.

Andrew Huberman 1:13:01 But we now know there's a logical medical basis for this.

Dr. Mary-Frances O'Connor 1:13:04 That's right. Exactly, and, and here's the thing that's crazy, Andrew. Every time I do a podcast or I get interviewed by a reporter, everyone has a story like this. And so, I mean, honestly, insurance companies before the 1960s figured this into their actuarial tables. They knew that life expectancy in that time was short. And so if we've known for this long, what stops us from really caring for grieving people?

Andrew Huberman 1:13:38 So important.

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Andrew Huberman 1:15:28 I'm curious about compartmentalization. It's clear to me now that at least in this culture in the United States, we aren't taught how to grieve unless it's, you know, uh, part of our family or part of our religion. Uh, we aren't instructed how to grieve. There seems to be a- another, uh, set of contradictions in the world of psychology, health, self-help. Doesn't matter if it's the most woo, uh, sector of it-

Dr. Mary-Frances O'Connor 1:15:54 Mm-hmm.

Andrew Huberman 1:15:54 ... or the most, uh, reductionist medical sector of it and, and the conflicting message is this. On the one hand, feel your feelings.

Dr. Mary-Frances O'Connor 1:16:03 Mm-hmm.

Andrew Huberman 1:16:03 Bottling it up isn't good.

Dr. Mary-Frances O'Connor 1:16:05 Yeah.

Andrew Huberman 1:16:06 Raises your blood pressure, increases your risk of heart attack, aneurysm, makes you a miserable person to be around and to, including with yourself, et cetera.

Dr. Mary-Frances O'Connor 1:16:15 Mm-hmm.

Andrew Huberman 1:16:15 But then we also know we have to be functional.

Dr. Mary-Frances O'Connor 1:16:18 Mm-hmm.

Andrew Huberman 1:16:18 We can't dissolve into a puddle of our own tears 24 hours a day, seven days a week. Even if we're not a caretaker, we just can't.

Dr. Mary-Frances O'Connor 1:16:26 No.

Andrew Huberman 1:16:26 It's just, so, I can recall when I was a kid getting really devastating news, just-

Dr. Mary-Frances O'Connor 1:16:31 Yeah.

Andrew Huberman 1:16:32 ... it doesn't matter what the, what the news was-

Dr. Mary-Frances O'Connor 1:16:34 Yeah.

Andrew Huberman 1:16:34 ... but just devastating news for s- for any age-

Dr. Mary-Frances O'Connor 1:16:37 Yeah.

Andrew Huberman 1:16:37 ... but I think at that point I was, like, 16?

Dr. Mary-Frances O'Connor 1:16:40 Mm-hmm.

Andrew Huberman 1:16:40 It was like...

Dr. Mary-Frances O'Connor 1:16:42 Yeah.

Andrew Huberman 1:16:42 And I remember, like, my chest hurt.

Dr. Mary-Frances O'Connor 1:16:45 Yeah.

Andrew Huberman 1:16:45 My heart hurt.

Dr. Mary-Frances O'Connor 1:16:46 Yes.

Andrew Huberman 1:16:47 And I remember actively pushing it down.

Dr. Mary-Frances O'Connor 1:16:50 Yeah.

Andrew Huberman 1:16:50 And it's, I, I, I know how to do that, right? It's a skill.

Dr. Mary-Frances O'Connor 1:16:54 Yeah.

Andrew Huberman 1:16:54 An- and there was a while where I thought, that was a terrible thing to do. On the other hand, that's how you get up and go to work the next day.

Dr. Mary-Frances O'Connor 1:17:02 Yep.

Andrew Huberman 1:17:02 That's how you, when you run in a lab, you go to your lab, that's how you deal with life.

Dr. Mary-Frances O'Connor 1:17:06 Yeah.

Andrew Huberman 1:17:07 But the key is, of course, to be able to pop that lid and let the emotions out when you need to. So, in the context of the idea that emotions are in the head and emotions are in the body-

Dr. Mary-Frances O'Connor 1:17:16 Mm-hmm.

Andrew Huberman 1:17:16 ... something that I think everyone agrees on now.

Dr. Mary-Frances O'Connor 1:17:18 Yeah.

Andrew Huberman 1:17:20 What do we know about the way to let emotion out and through?

Dr. Mary-Frances O'Connor 1:17:24 Mm-hmm.

Andrew Huberman 1:17:25 And what do we know about healthy adaptive compartmentalization-

Dr. Mary-Frances O'Connor 1:17:29 Mm-hmm.

Andrew Huberman 1:17:30 ... as skills?

Dr. Mary-Frances O'Connor 1:17:30 Mm-hmm.

Andrew Huberman 1:17:31 And here I'm hoping that perhaps people can glean some tools, like, take an hour a day and let it wail.

Dr. Mary-Frances O'Connor 1:17:37 Mm-hmm. Mm-hmm.

Andrew Huberman 1:17:38 Take two hours a day and handle your stuff.

Dr. Mary-Frances O'Connor 1:17:42 Yeah. I think it is helpful to remember that emotions are actually the output. They're the product. It isn't so much that we have to figure out how to deal with emotions, although I will come back and say that differently in a moment. We have to figure out how to handle what physical and mental state resulted in those emotions. So what I mean by that is, if you are in a moment where everything in your body is in protest, you are amped up and you can't sit still, then working with your body, right? Maybe you are the person who needs to go for a run every day where that hasn't really been who you were before, right? Uh, on the other hand, maybe you're the person who needs to develop a yoga practice to figure out how to breathe through that amped up feeling and soothe yourself, physically soothe yourself so that you can bring your heart rate down, right? So those are two entirely different behaviors. But I can tell you, at the end of either of them, your body's gonna be in a different state and I bet your emotions are in a different state too, right? So there's one way to think about it which is coming at how do we handle the emotions but there's another way to come at it which is how do I handle all of the demands and resources I have? When demands and resources get out of balance, that's stress. So how do I increase the resources in my life? How do I reduce the demands in my life? 'Cause I am suddenly in a really difficult situation. So that's one way to think about it. We did an intervention study in my lab with widows and widowers where one arm, uh, received mindfulness training, another arm received progressive muscle relaxation which is sort of like-... learning a really fancy body scan. You contract and relax different muscle groups in your body, and you become aware of what that feels like to really understand what relaxation feels like, and then there was a wait list control group. And we did it because the progressive muscle relaxation was the control group. We thought mindfulness training would be very helpful. Turns out, mindfulness training was helpful, but progressive muscle relaxation was even more helpful for people's grief.

Andrew Huberman 1:20:31 So what does this practice look like? It's a, so you're tensing your fists and then relaxing then-

Dr. Mary-Frances O'Connor 1:20:35 Correct.

Andrew Huberman 1:20:35 ... forearms, then r-, so working through, uh, head to toe.

Dr. Mary-Frances O'Connor 1:20:38 Mm-hmm.

Andrew Huberman 1:20:39 Contracting for about how long? I'm just trying to get the rough contour of it.

Dr. Mary-Frances O'Connor 1:20:42 Yeah. It's a brief contraction.

Andrew Huberman 1:20:44 Mm-hmm.

Dr. Mary-Frances O'Connor 1:20:44 It's, you know, you can go online. There's really easy instructions. It's often done with a sort of guided-

Andrew Huberman 1:20:50 (laughs)

Dr. Mary-Frances O'Connor 1:20:51 ... uh, audio, um, to help you figure out, but the important part is also feeling what, what's the difference between my clenched fist and my relaxed fist? Oh, gosh, I didn't even realize I was, had so much muscle tension, right? So what's fascinating is people told us in any situation, I'm in the grocery store, I'm in a work meeting, I'm trying to fall asleep, I can use this tool now to help my body to get into a different state, and that helps my grief. Now, mindfulness training was effective, but not as effective as I said, and I think some of this is that we ha- you know, grieving is a form of learning. I'm not kidding about that. Your brain is busy (laughs) while you are grieving, and it might not be the right time to take up a new practice that requires a lot of concentration. If you do mindfulness, it can be very helpful. Anyway, the upshot of all that is on the one hand, it's not that we have to deal with emotions, because they are an output. We have to deal with our demands and our resources and, uh, developing a whole toolkit of ways to think about adapting in our life now. On the other hand, even specifically for waves of grief, having a toolkit of what to do with those emotions, I think you described it beautifully, Andrew, that we do have the capacity for suppression.

Andrew Huberman 1:22:20 Mm-hmm.

Dr. Mary-Frances O'Connor 1:22:21 And if you were about to walk into a pitch meeting, suppression is probably the way to go in that moment where suddenly your deceased child has popped into your head and thinking, "I am not gonna think about this right now. I am completely gonna pretend this has not happened, and I'm gonna do this pitch," right? But if it's your only strategy, then you don't have the learning process going on, right? That at another moment, you might be looking through a photo album and just be overcome with tears, but over time realize, "I can't say, stay in that puddle either. When I'm doing this, I need to," you know, if it was me, "I need to text my sister and tell her, 'You know, I'm looking at photos of Mom, and this is what I'm thinking about.'" And she'll text me some funny story about Mom or, or even just say, "Oh, man. I feel ya." And if my sister isn't available, then I'll text my best friend, right? Because in that moment, it is important to have that puddle. It's also important to know how to get out of the puddle again. And so, this is really a process of learning, how do I cope with these waves of grief? It's like being a basketball player. One possession after another after another. How am I gonna get through this possession? Each possession looks different. How am I gonna get through this possession with this constellation? What's the right skill to use right now?

Andrew Huberman 1:23:57 I think what you just said is, is so vitally important because I know for a number of years, the, um, the model was one in which grief progresses through some very standard stages of, um, disbelief, anger, acceptance, and no disrespect to, uh, was it, uh-

Dr. Mary-Frances O'Connor 1:24:13 Elizabeth Kubler-Ross.

Andrew Huberman 1:24:14 ... Kubler-Ross. Is there a theme of, um, of hyphenated names in her field?

Dr. Mary-Frances O'Connor 1:24:19 (laughs)

Andrew Huberman 1:24:19 So yeah, sorry. (laughs)

Dr. Mary-Frances O'Connor 1:24:19 Oh, that's funny.

Andrew Huberman 1:24:20 Yeah, the, uh, um... Incredibly important work because it cracked open the awareness of grief-

Dr. Mary-Frances O'Connor 1:24:27 Yeah.

Andrew Huberman 1:24:27 ... as a process, both psychological and to some extent biological.

Dr. Mary-Frances O'Connor 1:24:30 Yeah.

Andrew Huberman 1:24:30 So we wanna, you know, pay respect to the people that opened up these fields, and yet as an outsider to the field, I can, uh, safely say-

Dr. Mary-Frances O'Connor 1:24:39 Mm-hmm.

Andrew Huberman 1:24:39 ... uh, 'cause my grants and papers don't rely on it, that I think, uh, work such as yours and your, uh, your colleagues have really expanded on that model to really show us that in many ways, it was important but not completely true in the sense that it's not disbelief then anger then acceptance. It might be all three at once, and then they get shuffled in a different order, and then there's a bunch of other things too.

Dr. Mary-Frances O'Connor 1:24:59 Yeah.

Andrew Huberman 1:24:59 And I think it's important, uh, for people to hear because that disbelief, anger, acceptance trajectory got so much press-

Dr. Mary-Frances O'Connor 1:25:06 Yeah.

Andrew Huberman 1:25:06 ... that we were kind of taught it in an- high school and elementary school.

Dr. Mary-Frances O'Connor 1:25:11 Mm-hmm.

Andrew Huberman 1:25:11 And it, and it needs some updating.

Dr. Mary-Frances O'Connor 1:25:12 Mm-hmm.

Andrew Huberman 1:25:13 Just like the notion that dopamine is pleasure needs some updating.

Dr. Mary-Frances O'Connor 1:25:16 Absolutely. So she published on Death and Dying in 1969. And you're right. It was groundbreaking, the idea that grief is more than sadness. And she did what all good scientists do initially. Sh- it was descriptive. She did clinical interviews, and she described, but it became a prescription, didn't it? Right? Those stages. And we know now, think how far science has come, right? We know now with longitudinal studies where we're looking at the same person over and over again, that we do see trajectories. So we see that acceptance increases over time. We see that yearning decreases over time. But that it's not linear, and that it's not, just as you say, it's not one stage and then you're done with that. I've had people say to me, "Well, it's been 20 years, but I haven't felt anger yet, so I don't think I'm done grieving," and I just, my heart goes out to them. It's not a prescription. And modern grief research tells us so much more, not just about what happens but why and how.

Andrew Huberman 1:26:19 Yeah. Sometimes I wonder if, um, despite the incredibly devastating experience that grief can be, whether or not people don't, um, allow themselves to feel okay.

Dr. Mary-Frances O'Connor 1:26:28 Yeah.

Andrew Huberman 1:26:29 I mean, earlier when you were talking about this, uh, this picture of this, this monkey holding-

Dr. Mary-Frances O'Connor 1:26:35 Yeah.

Andrew Huberman 1:26:35 ... its dead infant-

Dr. Mary-Frances O'Connor 1:26:36 Yeah.

Andrew Huberman 1:26:36 I confess, I, I, like, had a vi- like, a reaction.

Dr. Mary-Frances O'Connor 1:26:39 Yes.

Andrew Huberman 1:26:40 It's, um... And I think that it is a universal, one would hope, uh, human and animal reaction, the, the wail-

Dr. Mary-Frances O'Connor 1:26:49 Yes.

Andrew Huberman 1:26:49 ... of a mother that's lost her child.

Dr. Mary-Frances O'Connor 1:26:51 Absolutely.

Andrew Huberman 1:26:52 Or just an animal that wail.

Dr. Mary-Frances O'Connor 1:26:53 Yes.

Andrew Huberman 1:26:54 Whether or not it's a human animal-

Dr. Mary-Frances O'Connor 1:26:55 Mm-hmm.

Andrew Huberman 1:26:55 ... or a monkey or a dog, it's just, it's this, it- it's like a, it's gotta be some, forgive me for playing neuroanatomist here, but, teach neuroanatomy, it's gotta be some deep, deep, literally deep nerve path in the body.

Dr. Mary-Frances O'Connor 1:27:10 Yeah.

Andrew Huberman 1:27:10 Because you just feel it everywhere.

Dr. Mary-Frances O'Connor 1:27:12 Yes.

Andrew Huberman 1:27:12 It's not like over here or over there. You don't hear it in your ears, you feel it down to your core.

Dr. Mary-Frances O'Connor 1:27:17 Yeah.

Andrew Huberman 1:27:18 And, um, and anything that deep is as, uh, primitive and-

Dr. Mary-Frances O'Connor 1:27:24 Yes.

Andrew Huberman 1:27:25 ... ancient and important as hunger, thirst, reproduction or anger.

Dr. Mary-Frances O'Connor 1:27:29 Foundational. Yes.

Andrew Huberman 1:27:30 So I think it's so important that you placed grief right up there on the shelf next to those primary drives-

Dr. Mary-Frances O'Connor 1:27:36 Yeah.

Andrew Huberman 1:27:37 ... and mentioned homeostasis.

Dr. Mary-Frances O'Connor 1:27:39 Yeah.

Andrew Huberman 1:27:40 The desire to stay in some ground where we're n- the seesaw isn't tilted-

Dr. Mary-Frances O'Connor 1:27:44 Yes.

Andrew Huberman 1:27:44 ... toward just complete collapse.

Dr. Mary-Frances O'Connor 1:27:46 That's right.

Andrew Huberman 1:27:47 And yet there are times when people are grieving and they find themselves laughing at something they hear-

Dr. Mary-Frances O'Connor 1:27:54 Yeah.

Andrew Huberman 1:27:55 ... maybe on a podcast.

Dr. Mary-Frances O'Connor 1:27:56 Mm-hmm.

Andrew Huberman 1:27:56 Or they find themselves attracted to a potentially new partner-

Dr. Mary-Frances O'Connor 1:28:00 Absolutely.

Andrew Huberman 1:28:01 ... despite the fact that they adored their spouse.

Dr. Mary-Frances O'Connor 1:28:03 Yes.

Andrew Huberman 1:28:04 And what's the permission piece?

Dr. Mary-Frances O'Connor 1:28:07 Yeah. Big time. You know, part of this is a cultural piece, right? Part of this is that we have, we joke about, you know, there's apparently a big book of rules about grief, uh, that no one can get ahold of, but people have very strong feelings on, right? And people will talk about how, "You know, I got hammered with the big book of grief rules today. Somebody told me I shouldn't be or I should be," fill in the blank. Believe me, it's hard enough as it is without expectations around you of whether you're doing it right, you know? At one level then, there's the social expectations. A woman contacted me about 10 days after her husband died, and she said, "I just am not sad, and I'm worried something's deeply wrong with me." She was an older woman. We did, like, a neuropsych evaluation and I did a clinical interview and so forth, and I said, "I think the reality is you're just okay." And she said, "Okay, that's what I thought, but I can't tell any of my friends that I'm not sad, because I'd be a pariah, you know?"

Andrew Huberman 1:29:23 They'll think she's a sociopath.

Dr. Mary-Frances O'Connor 1:29:24 People will think she's a sociopath. Instead, they had a wonderful relationship together. She knew that this was coming. She had a big, full life, and it was okay for her in that moment. So I think on the one hand, there's the social component about permission. It's gonna look different for each person. And most importantly, it's gonna look different than we think it will be. We try to anticipate what grief is gonna feel like, but because so much of attachment is below the level of consciousness, because our physiology is below the level of consciousness, it's not like we can know how we're gonna react. So the natural response is just the reacting, and then grieving is, over time, the way we react starts to feel more familiar. We start to develop better coping tools for the natural way we react. It's not that the grief goes away, it's that we come to understand it. We understand how to work with it. But the other piece is about permission, I think. Remember how I said you still have an ongoing internal relationship? I think people feel guilt about having joy, doing things that are fun, falling in love, connecting with people, going on a vacation, because at some level, there is a piece of them that believes, "My loved one is out there, is everlasting, and I'm choosing to do this instead of going to seek them out. I'm choosing to do this when they can't." And you can understand