Healing From Grief & Loss | Dr. Mary-Frances O'Connor
Here are the top 10 key takeaways from Dr. Mary-Frances O'Connor's groundbreaking research on the neuroscience of grief and how we can navigate loss more effectively.
1. Grief is the brain's response to attachment disruption
Grief fundamentally represents the natural response when our attachment system confronts an impossible situation. Our brains are wired with an implicit belief that attachment figures will always be there for us, and when someone is absent, the correct biological response is to search for them. However, death creates a unique circumstance where no amount of searching will reunite us with our loved one.
This creates what O'Connor calls the "gone but also everlasting" conflict. We consciously know the person has died, yet our attachment neurobiology continues operating under the assumption that they still exist somewhere. This contradiction between knowing they're gone while feeling they're everlasting generates waves of grief when we become aware of this conflict.
2. Dopamine drives the yearning at grief's core
The hallmark of grieving is yearning or pining, which are essentially forms of wanting. Neuroimaging research reveals that when bereaved individuals look at photos of their deceased loved ones, activity in the nucleus accumbens correlates directly with how much they report yearning for that person. This is the same brain region associated with reward learning and motivation.
O'Connor explains this isn't addiction but rather like physiological thirst. Just as we need water for survival and become obsessed with finding it when dehydrated, we need our attachment figures for survival. The dopamine system asks: "How much effort would you put in to see your loved one again?" This yearning represents our brain's attempt to motivate us to restore what feels like a severed part of ourselves.
3. Protest and despair are two essential grief responses
Grief involves two fundamental response patterns that John Bowlby identified: protest and despair. Protest represents the "go" response where we're energized to search, fight the reality, or take action to somehow reverse the loss. This might manifest as rumination, anger, or frantically trying to "fix" the situation through various means.
Despair represents the "no-go" response where we withdraw and stop searching. This isn't depression but rather the body's way of conserving energy when continued searching becomes futile. While many people fear despair, it serves the important function of stopping us from the metabolically costly process of endless searching.
Both responses are necessary for learning to live with loss. The key insight is that neither protest nor despair represents the end of the grief process. Integration requires moving through both states repeatedly as we gradually learn to adapt to our new reality.
4. Grief poses serious medical risks requiring support
The death of a loved one creates profound physiological stress that can be life-threatening. On the day a loved one dies, you are 21 times more likely to have a heart attack than any other day. In the first three months after losing a spouse, men are nearly twice as likely to suffer a fatal heart attack compared to married men.
These statistics reflect how deeply attachment affects our physiology. When we bond with someone, they become our external pacemaker for emotional and physiological regulation. Suddenly losing this regulation system forces our cardiovascular system to learn how to function independently again, which can overwhelm our body's capacity to adapt.
O'Connor advocates for treating bereavement like other major physiological transitions such as pregnancy. Just as we monitor pregnant women's health throughout their transition, we should monitor grieving individuals' physical health during their vulnerable period of learning to live without their attachment figure.
5. Cultural grief literacy has largely disappeared
Modern society lacks the grief literacy that historically helped people navigate loss. Traditional cultures provided clear frameworks through religious practices, rituals, and community support that explained where the dead go and how to maintain relationships with them. These systems offered structure for understanding intense grief emotions and provided modeling for appropriate responses.
Today, many people grieve without cultural scaffolding or community guidance. We've lost practices like sitting shiva, wakes, or other rituals that normalized grief while providing practical support. This leaves individuals to navigate intense physiological and emotional responses without understanding what's happening to them or how to cope.
The absence of grief literacy contributes to isolation and confusion during bereavement. People often feel like they're "going crazy" because they lack frameworks for understanding that their responses are normal and necessary parts of the grieving process.
6. Healthy grieving requires oscillation between states
Mental health during grief involves the capacity to oscillate between loss-focused emotions and restoration-focused activities. This dual-process model recognizes that adaptive grieving requires moving back and forth between directly confronting the pain of loss and engaging with the practical demands of rebuilding life.
Some days might involve crying while looking through photos and feeling overwhelmed by memories. Other days might focus on learning new skills like managing finances or maintaining social connections. The ability to shift between these states, rather than getting stuck in either one, indicates healthy adaptation.
This oscillation isn't about "getting over" grief but rather about developing flexibility in how we engage with both our loss and our ongoing life. People who can move fluidly between mourning their loved one and investing in present relationships demonstrate resilience in their grieving process.
7. Avoidance prolongs the grieving process
Attempting to shorten grief by avoiding reminders often has the opposite effect. When people avoid places, conversations, or activities that trigger grief, they prevent themselves from learning how to live in a world where their loved one is absent. This avoidance maintains the protest response and prevents the natural adaptation process.
The brain needs exposure to the new reality to update its expectations and responses. Just as exposure therapy helps with phobias, gradual exposure to grief triggers allows the nervous system to calibrate to the changed circumstances. Avoiding the hospital where someone died or never going through their belongings keeps the loss feeling fresh and unprocessed.
While avoidance provides temporary relief, it ultimately extends the period of intense grief. The only way to learn how to function in the new reality is to practice functioning in it, which requires facing the painful reminders rather than circumventing them.
8. Continuing bonds can be healthy and adaptive
Rather than "letting go" of deceased loved ones, healthy grief often involves transforming the relationship into an internal, ongoing connection. This might involve talking to them mentally, asking what they would think about current situations, or feeling their presence during important moments. These continuing bonds don't represent pathology but rather normal adaptation.
O'Connor describes how her relationship with her mother continues to evolve decades after her death. She can now appreciate her mother's perspectives in ways she couldn't when younger, and this internal relationship provides comfort and guidance. The key is developing this internal connection while still investing in relationships with living people.
The goal isn't to eliminate the attachment but to understand it differently. This person remains "everlasting" in your neural encoding while you simultaneously accept they cannot be present for new experiences. Both realities can coexist without conflict when properly integrated.
9. Rumination often masks underlying fears
The "would have, could have, should have" thoughts that plague many grieving people represent an infinite loop of self-blame and hypothetical scenarios. These ruminating thoughts often center on the belief that different actions could have prevented the death. However, pursuing answers to these questions proves futile because there are infinite variations of what might have been different.
This rumination often masks deeper fears about randomness and control. It can feel more bearable to believe we failed somehow than to accept that terrible things happen without reason or prevention. Guilt, while painful, provides a sense of control that pure randomness doesn't offer.
The solution isn't finding answers to these hypothetical scenarios but rather recognizing them as thoughts and developing skills to redirect attention. The question shifts from "Is this scenario true?" to "Is this thought pattern helpful for my ongoing life?" Learning to notice and interrupt rumination allows people to return to present-moment awareness and meaningful activities.
10. Contemplating mortality enhances appreciation for life
Rather than being morbid or depressing, regularly contemplating death can enhance gratitude and presence in daily life. When we acknowledge life's finite nature, ordinary moments gain increased significance and beauty. This awareness can motivate us to prioritize what truly matters and appreciate experiences we might otherwise take for granted.
Many spiritual and philosophical traditions incorporate death contemplation as a practice for living more fully. The recognition that time is limited can clarify values and encourage deeper engagement with relationships and meaningful activities. This isn't about becoming preoccupied with death but rather using mortality awareness as a tool for presence.
Huberman shares his practice of beginning relaxation sessions by imagining his final breath, which helps him appreciate the finite nature of each day. This contemplation doesn't create anxiety but rather generates renewed energy and focus for living authentically and purposefully.