Mary-Frances O’Connor, The Grieving Body: How the Stress of Loss Can be an Opportunity for Healing (Harper One, 2025)

Summary

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Podcast Episode Summary

Podcast: New Books Network
Host: Renee Garfinkel
Guest: Dr. Mary-Frances O’Connor
Title: The Grieving Body: How the Stress of Loss Can be an Opportunity for Healing
Date: September 14, 2025

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Episode Overview

In this episode, Renee Garfinkel interviews psychologist and professor Dr. Mary-Frances O’Connor about her forthcoming book, The Grieving Body: How the Stress of Loss Can Be an Opportunity for Healing (Harper One, 2025). The conversation delves into the physical dimension of grief, exploring how loss impacts not only the brain and emotions but also the heart, immune system, hormones, and body as a whole. Dr. O’Connor brings both scientific rigor and compassionate insight to the discussion, sharing personal experiences and groundbreaking research on integrating grief into ongoing life and finding healing in the aftermath of loss.

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Key Discussion Points & Insights

1. The Opportunity in Grief

• Grief as Opportunity for Healing
  • Dr. O’Connor acknowledges the phrase can be “off putting” to those in fresh grief but explains:
    • "Grief really captures your attention… it’s making a home in your body and there is no getting around it." (03:08)
    • The “opportunity” lies in the forced attention to loss, allowing deep self-examination and integration, potentially leading to a form of healing.
• Grief’s demand for attention allows people to truly reckon with what the death of a loved one means, physically and emotionally, and to learn to incorporate these shifts into daily life.

2. What Happens to the Body During Grief?

• Physical Reactions & Metaphor
  • Dr. O’Connor compares grieving to riding a bike and suddenly losing the brakes—your body must adapt quickly to a new reality, causing physiological stress.
  • Physiological Effects:
    • Increased heart rate and blood pressure (typically normalizes after about six months for most).
    • Cortisol (stress hormone) remains elevated, often for longer, with downstream effects such as increased inflammation.
    • These changes impact individuals differently (e.g., worse arthritis, asthma flare-ups).
    • “Those changes… may look slightly different for each person.” (06:55)
• Physical Sensations
  • 90% of bereaved people report chest sensations.
  • Differentiation between “heartache” (expected adjustment) and actual “heartbreak,” which can be physically dangerous (increased risk of heart attack and stroke in first months/years).
    • “This is a medically risky time… we can intervene appropriately if we think, wow, I'm having pain now...” (07:33)

3. Sleep Disturbance in Grief

• Why Sleep is Disrupted
  • Elevated cortisol operates like constant caffeine—keeps nervous system activated.
  • Most people experience insomnia: difficulty falling, staying asleep, or early waking.
    • “It's a little bit like you're drinking coffee all the time... that makes sleep very difficult.” (09:28)
• Advice for Sleep Regulation
  • Main advice: wake up at the same time daily to re-establish circadian rhythm (even after poor sleep).
  • Avoid alcohol as a sleep aid, as it worsens sleep quality.

4. Distinguishing Grief from Depression

• Key Differences
  • Depression can accompany grief but is not inevitable.
  • Grief is focused on the loss (“waves” that come and go), while depression is a pervasive gloom that’s not limited to loss.
    • “If in grief, one is also able to tell a funny story... or feel love for other people... that's actually a sign of mental health.” (13:30)
  • Presence of positive emotions during waves of grief is normal and healthy.

5. Age, Life Stage, and Grief

• Personal account: Dr. O’Connor contrasts losing her mother at 26 (“a lot of stress…lack of certainty…disequilibrium”) with her father’s death years later, for which she was more emotionally prepared.
• Learning intentional self-soothing and acceptance between losses helped her experience grief more as a process than a crisis.
  • “When those waves of grief came, I was able to sort of recognize them and let them move through me… like a summer storm.” (17:05)
• Alludes to Buddhist concept of the “second arrow”—experiencing suffering about suffering (“the pain but not the pain about the pain”).

6. Neuroimaging and the “Grieving Brain”

• What Brain Scans Show
  • Scans of people grieving (reacting to photos of loved ones) activate memory, emotion, facial processing, and cardiac/autonomic regulation areas.
  • Most notably, yearning for the person (as measured by pre-scan interviews) is correlated with activity in a brain region crucial for bonding.
    • “The more yearning people told us they had, the more activity we saw in this area, encoding that wanting our loved one.” (20:37)
  • This validates attachment theory as a biological foundation for intense longing after loss.

7. Attachment Theory: “Gone But Also Everlasting”

• Explains the tension in the grieving mind:
  • The memory system "knows" the loved one is gone; the attachment system retains an implicit assumption of permanence.
  • This neural mismatch creates emotional pain (waves of grief). Over time, people learn to maintain an internal relationship (a “continuing bond”) while accepting the physical absence.
  • "They can't both be gone and everlasting. The brain has to work out why..." (22:37)

8. Ambiguous Loss

• Loss where there’s no closure (missing person, dementia, etc.) is especially difficult because the brain can’t resolve the tension between absence and possibility of return.
• Supporting people through ambiguous loss involves balancing hope with present-focused, meaningful activity.
  • “It’s difficult to figure out how to be day to day when you can’t resolve these multiple possibilities.” (26:05)

9. Prolonged/Complicated Grief and its Treatment

• Terminology: “Prolonged grief” now preferred over “complicated grief.”
• Trajectory: Most people’s grief ebbs over time; about 10-20% experience little improvement (“flat line”) after a year.
• Intervention: Evidence-based therapies (e.g., Prolonged Grief Treatment, grief-focused CBT, narrative therapies) help by inviting people to face and integrate painful memories and emotions in a supportive context.
  • “We teach them to...be able to jump into a puddle that is grief and also to be able to jump out of it again.” (32:25)

10. Do Children Grieve Like Adults?

• Dr. O’Connor is not a child grief expert but affirms that:
  • Children definitely grieve, even infants show physical reactions to separation.
  • The process is based on attachment and separation, though children have fewer regulatory resources.

11. Secondary Grief and Self-Care for Helpers

• Exposure to others' grief can risk secondary trauma.
  • Finding meaning in the work and intentionally engaging with joy and new life helps balance the weight.
    • “Because I think about death and loss almost every day… it has provided an opportunity also for great meaning in my life.” (34:33)
  • Dr. O’Connor emphasizes the need to spend time with babies or in joyful situations to “counter the physical part of grief.” (36:17)

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Notable Quotes & Memorable Moments

• On opportunity in grief:
  "Grief really captures your attention… It's making a home in your body and there is no getting around it. And the opportunity part of that is that our attention is often…captured by lots of things… Grieving can be a moment where people feel like, oh no, I have to pay attention to this."
  — Dr. Mary-Frances O’Connor, (03:08)

• Metaphor for grieving:
  "You grab at the handlebars to push the brakes, but there's nothing there… your heart rate goes up and your muscles tense… In the absence of something we are used to having every day, I think many bereaved people feel this way."
  — Dr. Mary-Frances O’Connor, (04:58)

• On heartache vs. heartbreak:
  "It's both a moment where we have heartache, but we can also have heartbreak… we are at increased risk for fatal heart attack and stroke in those first months and even years of grieving."
  — Dr. Mary-Frances O’Connor, (07:33)

• On sleep and grief:
  "It's a little bit like you're drinking coffee all the time... that makes sleep very difficult… at least by setting that alarm, we're reminding our body there is a pattern here, There is a rhythm that you can find again."
  — Dr. Mary-Frances O’Connor, (09:28)

• Grief vs. depression:
  "Grief is really all about the loss. It's about this person who died. And depression, on the other hand, is kind of global...Grief also comes in waves… With depression, it's always there."
  — Dr. Mary-Frances O’Connor, (12:10)

• Personal growth through grief:
  "When those waves of grief came, I was able to sort of recognize them and let them move through me… like a summer storm."
  — Dr. Mary-Frances O’Connor, (17:05)

• On secondary trauma and meaning-making:
  "Because I think about death and loss almost every day… it has provided an opportunity also for great meaning in my life."
  — Dr. Mary-Frances O’Connor, (34:33)

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Timestamps for Important Segments

| Segment | Timestamp | |-----------------------------------------------|------------------| | Introduction & main theme | 01:30 – 02:52 | | Grief as opportunity for healing | 02:55 – 04:49 | | Physiology of grief & metaphor | 04:58 – 07:25 | | Physical sensations of grief | 07:33 – 09:09 | | Sleep disruption & advice | 09:28 – 11:58 | | Grief vs. depression | 11:58 – 14:58 | | Grief at different life stages | 15:16 – 18:11 | | Neuroimaging & longing in the brain | 19:33 – 22:26 | | Attachment and the “gone but everlasting” | 22:37 – 25:04 | | Ambiguous/missing loss | 25:04 – 27:12 | | Prolonged/complicated grief & therapy | 27:21 – 32:39 | | Child and adolescent grief | 32:39 – 34:14 | | Therapist/secondary grief and self-care | 34:14 – 36:27 | | Episode close | 36:38 – 36:51 |

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Overall Tone & Concluding Notes

The conversation is warm, deeply empathetic, and scientifically grounded. Dr. O’Connor combines clear explanations of research with moving personal anecdotes and practical wisdom, demystifying the physical processes of grief while framing them as a universal and ultimately survivable—and even transformative—human experience.

As Dr. O’Connor summarizes her approach:
“…the work that I’m doing is important… it has provided an opportunity also for great meaning in my life.” (34:33)

This episode is essential listening for anyone seeking to understand the lived realities of grief, whether for themselves, loved ones, or their clients.

Transcript

[Dr. Mary Frances O'Connor]

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[Dr. Mary Frances O'Connor]

Welcome to the New Books Network.

[Renee Garfinkel]

Hello everyone and welcome to the Van Leer Institute series on Ideas. I'm your host, Renee Garfinkel. As part of our ongoing series on healing, I have the distinct Honor of welcoming Dr. Mary Frances O' Connor back to the program. Dr. O' Connor is a renowned psychologist, researcher, and professor in the Department of Psychology at the University of Arizona, where she specializes in the intersection of neuroscience, psychophysiology and grief. You may know her earlier book, the Grieving Brain, which helped us understand how the brain processes the loss of a loved one and why grieving feels the way it does. Now Dr. O' Connor takes us a step deeper into the body itself with her new and powerful book, the Grieving how the Stress of Loss Can Be an Opportunity for Healing. With clarity, scientific rigor, and deep compassion, Dr. O' Connor reveals how grief is not just emotional, it's profoundly physical. From the heart and immune system to our hormones and nervous system, she helps us understand how our bodies respond to loss and how, with awareness and support, they can also begin to heal. Mary Frances o', Connor, welcome to the podcast.

[Dr. Mary Frances O'Connor]

Oh, thank you so much for having me, Renee.

[Renee Garfinkel]

Mary Frances, you make a fascinating claim that grief can actually be an opportunity for healing. That might sound counterintuitive to someone in the depth of loss. Can you explain what you mean by that?

[Dr. Mary Frances O'Connor]

I can. Although you're absolutely right. Just that phrase for someone who's in acute grief can be very, very off putting. I debated a lot about whether to use the words opportunity and healing. And I think ultimately what I wanted to convey was my own experience. So in the book, I talk a lot about grief from my perspective as well as the patterns we see in science that look similar across people. But the idea is that grief really captures your attention. It really is making a home in your body and there is no getting around it. And the opportunity part of that is that our attention is often, you know, captured by lots of things in our world and our environment. Grieving can be a moment where people feel like, oh no, I have to pay attention to this. And because of that, it's an opportunity to understand how do we react to the death of a really beloved person? What does it mean that this person isn't walking around on the earth anymore? And then how do I manage incorporate these waves of grief and their physical consequences into my day to day life? And if we really develop a deeper understanding of how to integrate grief into ongoing life, I think that can be a healing, even a physical healing, to.

[Renee Garfinkel]

Integrate grief into our ongoing life. We'll get back to that. What is actually happening in our bodies when we grieve?

[Dr. Mary Frances O'Connor]

Well, there's an example, sort of a metaphor that I use at the very beginning of the book and I find that could be, you know, something tangible to hang on to. Metaphor can be helpful. So if it's okay, I'll just give it to you ever so briefly. Think of yourself cycling down the street. Beautiful day, lovely trees. You're on a city street and you see an intersection coming up and you think, oh, I should brake. So that you know the intersection has a red light. And so you grab at the handlebars to push the brakes, but there's nothing there. And so you grab again and your heart rate goes up and your muscles tense because you really need to stop. And then you remember that you have to cycle backwards. You know, this is a beach cruiser type bike and that's how you will stop. And you do stop and you do manage the situation. But the thing to notice is that your heart rate still went up and your muscles still tensed. Your body still had to make the effort to figure out how to handle this situation. In the absence of something we are used to having every day, I think many bereaved people feel this way, that they have to come at every situation with new eyes. And that's incredibly effortful for the body to try to figure out how to live life. Now because of that, what we know from research is that for most people, their heart rate goes up a little bit. Their blood pressure actually goes up a little bit, and the body is resilient. For the vast majority of us, even within about six months, we see that blood pressure come back to our baseline and heart rate. Our cortisol stress hormone remains elevated, often even longer than that. And of course, then this has downstream effects on other parts of our body. We see inflammation increase in people. And that can mean that for someone with rheumatoid arthritis, that's achier joints. But for someone who has asthma, that's more difficulty breathing. So the body is still an individual. Those changes that come about from this effortful trying to be in the world without our one and only may look slightly different for each person.

[Renee Garfinkel]

And there are physical sensations in grief that people sometimes misunderstand. Tell us about that.

[Dr. Mary Frances O'Connor]

There's a wonderful research study that just bothered to ask people, where do you feel grief in your body? And although many of us have described that experience, I think we might be surprised to know that over 90% of grieving people describe physical sensations in their chest associated with grief. And the important point here is that as our body is making this adjustment, is trying to live life in the absence of our beloved. It is both a moment where we have heartache, but we can also have heartbreak. Now, heartache is perhaps this natural adjustment that our body is making as we go through the learning curve of grieving. But we have to be cautious because this is a medically risky time. That is to say, we are at increased risk for fatal heart attack and stroke in those first months and even years of grieving. And so we have to pay attention. We can't avoid these sort of physical sensations so that we can intervene appropriately if we think, wow, I'm having pain now, or I'm also having difficulty breathing, or I'm showing other symptoms that suggest this means I really need to get to a hospital to support the grieving body as we go through this process.

[Renee Garfinkel]

And sleep is also a factor. When I think about my own experience of grieving. Sleep was just completely disrupted. Completely disrupted. Talk about that. And also how people can manage to manage their sleep when they're grieving.

[Dr. Mary Frances O'Connor]

Well, the aforementioned cortisol stress hormone. It's a little bit like you're drinking coffee all the time. And. And that cortisol is really Keeping our nervous system agitated. It's preparing us for whatever we need to deal with. But that makes sleep very difficult. And most people who are experiencing a profound loss describe insomnia. They either have difficulty falling asleep or staying asleep, or they wake earlier than they wanted to. And this persists for many people. There was a really great naturalistic study that just observed the sleep of widows over a period of a year. The good news is that it is a natural process. So for the vast majority of us, our sleep will return to its normal circadian rhythms if we support that adjustment. And what I mean by that is one way to help the circadian rhythm is to get up at the same time every day. Set an alarm for the time you want to get up, and then get up at that time, even if you've had a terrible night's sleep, even though you're going to feel groggy and off during the day, because that is a way of regulating the body. In the absence of our loved one, we have a lot of dysregulation. We don't know what to expect. We don't have our usual hug, you know, to soothe us. We're not brushing our teeth with our partner or getting that text before we go to sleep. And so at least by setting that alarm, we're reminding our body there is a pattern here, There is a rhythm that you can find again. So that's my top recommendation. The other thing that unfortunately people sometimes do, because I cannot say how unpleasant it is not to be able to find the refuge of sleep, but people will do things like drink alcohol in the evening, thinking that it will help them, and that might help people to fall asleep. But we know that alcohol itself disrupts sleep in the middle of the night. And so you want to try and reset your sleep system. So without introducing things that are actually going to upset it more.

[Renee Garfinkel]

People often think they're depressed when they experience grief. How can a clinician, or even the grieving person herself distinguish between them?

[Dr. Mary Frances O'Connor]

We can have depression when we're grieving. So the death of a loved one is a risk factor for depression. And so it's important to know that depression is a possibility. If a person has had episodes of depression in the past, that puts them at increased risk for depression after a loss as well. But I think it's fairly recent scientific psychological understanding that depression is not common after the death of a loved one. And in fact, depression can be distinguished from grief and even profound grief, even grief that persists for a very long time. And probably the easiest Way to think about that is grief is really all about the loss. It's about this person who died. And depression, on the other hand, is kind of global. Depression isn't just, I feel so lonely since my loved one died, or I feel so much emotional pain since my loved one died. It's also, I feel so guilty that I haven't achieved the things in life that I should have, or I think that people don't really like me, or I think that I'm, you know, stupid or unlovable. There's sort of a global aspect to depression. Grief also comes in waves. That is its sort of typical natural form. And so when we have a wave of grief, we're suddenly sort of overcome with thoughts and feelings, sometimes sensations, or in the moment you can notice that you're having a wave of grief. And then that grief recedes. With depression, it's always there. It's always present in the background like a bad smell that just won't move. If in grief, one is also able to tell a funny story about your loved one who died because of a memory that it's brought up, or feel proud of how you cared for your loved one at the same time, or feel love for other people who are going through what you're going through, then the presence of other positive emotions at the same time as you're having really intense negative emotions, that's actually a sign of mental health. If it comes and goes and it isn't sort of in the driver's seat of your day to day life, that is more likely that it is typical grieving.

[Renee Garfinkel]

That's very helpful. Mary Frances, you experienced your own profound losses at two very different adult life stages. How do you think age or stage of maturity affects the process of grief in the body and in general?

[Dr. Mary Frances O'Connor]

My mother died when I was 26, and it was not unexpected. She had had breast cancer and metastases for 13 years. 26 is not as young as some people are, but it's pretty young in our lifespan in the modern world. And I didn't know a lot about death and loss then. It meant that I reacted, as many people do, by sort of ricocheting through my life and trying to stay busy. And I know now that there was a lot of stress in my body, a lot of disequilibrium in my mind, a lot of lack of certainty about how to be in the world. For me, this had a profound effect on my nervous system, on my immune system. And what I found was that I developed multiple sclerosis. Now I just need to be really clear, my mom's death did not cause the multiple sclerosis. I have a family history of it. It's very likely I would have developed it anyway. But it arose in this moment when my body was undergoing all this additional stress and I had to really learn quite intentionally how to soothe my body. What actually calmed me in moments where I was feeling anxiety or grief or yearning. And the irony was that when my father died about 10 years ago, it was a very different experience for me. Now, of course, I had studied grief and loss a lot during that time, but also I had practiced sitting quietly a lot in the intervening years. And it meant that I felt like I could be more present with him while he was going through that last difficult transition of terminal illness. But it also meant that when waves of grief came to me after he was gone, which of course they did. Knowing about grief doesn't make it go away. But when those waves of grief came, I was able to sort of recognize them and let them move through me kind of like. Kind of like a summer storm, and not be so upset and worried and anxious about the grief itself, but rather allowed my body to. To do what it needed to do to process this new world I was in.

[Renee Garfinkel]

So you avoided what the Buddhists called the second arrow. That is, you had the pain but not the pain about the pain.

[Dr. Mary Frances O'Connor]

That's it. The suffering that comes with pain. Exactly.

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[Renee Garfinkel]

Some of your most interesting findings for me come from the Neuroimaging studies tell us what it's like to look at the brain scans of people grieving. And what do you actually see?

[Dr. Mary Frances O'Connor]

You know, the brain isn't necessarily the first thing people think of when they, when they're thinking about loss and grief. But for me, I wanted to understand how is this an organ that sort of perceives the world and encodes our relationships, how is it processing what's happening? And so when people are in one of my neuroimaging studies, they bring me a photograph of the person who's died. And I show them that photograph while they're in the scan, and I show them the photograph of a stranger as well to sort of compare their brain activity. You know, we see all sorts of areas of the brain are of course, involved in a wave of grief. We have memory areas, we have emotion areas, we even have facial processing areas that show up. And interestingly, areas that are regulating our cardiac and autonomic systems are activated as we're looking at this photograph of our loved one having the grief reaction that we do. But perhaps the finding that has been most notable to me, and I think now to many others, is that in the second neuroimaging study that I did, I asked people in an interview beforehand how they were doing day to day as they came in to see me, how had the last few weeks been? And specifically how much had they been yearning for the person who died. And what was surprising was that there was an area of the brain, an area that we know is important in bonding both in animals and in humans. And this area, the more yearning people told us they had, the more activity we saw in this area, encoding that wanting our loved one. And it isn't to say that people who did not have as much yearning didn't show all sorts of activation in the brain they did like in their memories and so forth. But it's almost as though this desire for them to be back, almost a non acceptance that they aren't going to walk through the door again, is something we can actually see actively happening in the brain. And many people find that validating to know that there is sort of a reason or a neural substrate for what is happening and feels kind of ephemeral in the, in the mind.

[Renee Garfinkel]

And that supports your approach using attachment theory to help explain physical reaction to loss.

[Dr. Mary Frances O'Connor]

Yes. So I think the idea is, well, in some ways I call it the gone but also everlasting theory, which is that we think of the brain as having one stream of information, but actually the brain, because it has these different parts can actually be responding to multiple streams of information. So on the one hand, in our memory system, we know that our loved one is gone. We were maybe there when they died, or we were at the memorial. We know the reality. We can tell you that they have died. At the same time, when we bond with our baby or the person we fall in love with, or many years of being siblings together, the attachment neurobiology comes with this implicit belief, you will always be there for me, and I will always be there for you. And you don't have to be in my presence for me to believe that. So I can go off to work and my partner can go off to work, and we know that we'll do everything in our power to come back together again. So they can't both be gone and everlasting. The brain has to work out why. Why are these two streams of information? And when they conflict, since they can't both be true, it creates this painful wave. Over time, we find a way to understand that our internal relationship with the person, our continuing bond, as psychologists call it, with the person, that can be maintained. We can continue to feel close with them because they are encoded in our brain. We physically carry them with us while simultaneously not expecting them to be physically present with us, not relying on them, and maybe relying on other living loved ones for getting that hug or helping us out in a situation. So finding a way through this learning curve of grieving to understand what is the world like now? Who am I without this other person walking around, and. And how do I navigate these waves of grief that will always happen, but that we can integrate into our ongoing life?

[Renee Garfinkel]

And so what happens in the case of ambiguous loss, where there is no body, when someone is swept away in a flood or kidnapped by Hamas terrorists on October 7 and believed to be dead?

[Dr. Mary Frances O'Connor]

Yes, ambiguous loss is very difficult for the brain, for the mind, for the spirit. And there are really sort of two forms of ambiguous loss. One is where the personality seems to be gone, but the person is still there. So we see this often with dementia, where you can't have the relationship with your. With your spouse or your. Or your parent that you had before, and yet you are still caring for them. And so there's this mismatch. The other form, as you said, is where we don't know what has happened to them. We also see this in the United States with missing and murdered indigenous people, which is a really widespread problem where families don't know where their native loved one is and what's happened to them. The Reason I think that ambiguous loss is so difficult is exactly because both sides, gone and everlasting, are sort of possible still in the realm of possibility. And so it's difficult to figure out how to be day to day when you can't resolve these multiple possibilities. And so I think that we are really in the midst, even in my own laboratory, of trying to understand what is most helpful for people in these difficult circumstances, finding ways to support their sense of hope without providing them a false narrative that will actually delay their being in the present moment and doing meaningful activities.

[Renee Garfinkel]

Now tell us a little about complicated grief and its long term health consequences.

[Dr. Mary Frances O'Connor]

So the word that psychology has sort of, the label that psychology and psychiatry has sort of settled upon because this is a recent area of, of research, is prolonged grief. So when you hear complicated grief, it now also means the same thing as prolonged grief, right?

[Renee Garfinkel]

I'm dating myself.

[Dr. Mary Frances O'Connor]

Oh, no, not at all. It's all very recent. I still end up finding myself saying complicated grief, since that was the common term not very long ago. I mostly say it. So it's easier for people to access information. For example, there's a wonderful website put out by Columbia University, and if you just Google or use it, do a web search for prolonged grief and Columbia University, you'll come up with a lot of information about what it is, both for clinicians, but also for grieving people themselves. Having said that, what is it? I think here it's helpful to make this distinction again between grief in the moment, a wave and grieving, or the trajectory we see over time of how grief changes as we go through that learning curve. So for the vast majority of us, grief goes up and down and up and down. I picture the stock market image. You know, you can have the worst day ever of trading, and at the end of the year, the stock market can still be up, right? So day to day we see this huge variability. And at the same time, for most people, research shows that we are in fact coming to greater acceptance, seeing fewer or less intense waves of grief over time, even though those never go away. Now that's the typical trajectory, but there are a very small group of people, maybe 1 in 5 or 1 in 10 bereaved people, where it's a flat line. There may be variability, but we're just not seeing a change in the trajectory of how they're doing across the first year. And once we've gotten through that first year, if we're not seeing much change in their having positive emotions and negative emotions, in their ability to connect with living loved ones in their ability to find anything meaningful. Then it's that at that point we start to know, we can predict they're not going to see a lot of improvement going forward either. And it importantly can be a moment where we say this is a time to provide more skills, to provide more opportunities for the person to talk about what's happened and learn other ways to integrate this ongoing grief into their life. And we have evidence based psychotherapy that has proven to be very effective in helping to get people back on the natural grieving trajectory, not to take their grief away, but to enable them to understand it in a new way that makes it less suffering.

[Renee Garfinkel]

Can you say a few words about that treatment?

[Dr. Mary Frances O'Connor]

Absolutely. There's a few different ones now that we've seen in the scientific research. Prolonged grief treatment is the one that comes out of Columbia University. Very helpful information there. But we also have just grief focused cognitive behavioral therapy. We also have evidence for some narrative based therapies. The idea, generally speaking, is that a few possibilities are happening. One is that because it is very painful, we are avoiding certain aspects of our experience, of our emotional experience, or of our thoughts or of our memories. And because we are avoiding these painful aspects, they don't get a chance to. Avoiding them sets us up for a situation where they actually persist more strongly. And so in the context of a therapeutic relationship, a kind and warm relationship, we provide opportunities for people to experience these feelings and thoughts and memories in a way that is manageable so that they don't catch us off guard or they don't teach us things about the world, like people don't really care about me or I'm weak or the future can never be joyful for me because I've had losses. And so by working with people in a structured way, we teach them to sort of, as my. My friend Julia Samuel says, to be able to jump into a puddle that is grief and also to be able to jump out of it again.

[Renee Garfinkel]

We've been talking about grief in adults. Both your research is done with adults and I'm assuming your practice is mostly adults. Do children grieve the same way as adults? Do they experience the same bodily experiences.

[Dr. Mary Frances O'Connor]

So I like to be so clear that I am not an expert on children or child grief. But having said that, we absolutely know that children grieve. And one of the easiest ways to think about this is even an infant knows when it is separated from its caregiver. And that infant has physiological reactions when it is separated from its caregiver. And it expresses those with Tears or anger or calling out. And so we can think of the idea that children's grief looks different, but it is based in that same attachment separation that happens to us as adults as well. It gets more complex as we're adults and we have more capacity for regulation than children do. But if people are interested, it is very clear that children are grieving. And we are developing a bigger and bigger knowledge base for what that looks like and how best to intervene.

[Renee Garfinkel]

Wonderful. Finally, Mary Frances, a great deal has been written about secondary trauma and secondary grief, the risk to therapists and other clinicians and people who are exposed to someone else's suffering. How do you protect yourself?

[Dr. Mary Frances O'Connor]

Yeah, I deal with grief almost every day. And I would say a couple of things about that. The first one is that because I think about death and loss almost every day, probably every day, it has provided an opportunity also for great meaning in my life. I feel like the work that I'm doing is important. Not important in an ego kind of way, but it's important for us to talk about this. And I provide, in some ways, an opportunity for people to do that. And it means that because of the fragility of this life that we're in, that I have a very sort of carpe diem, kind of take the bull by the horns, this is the life I get kind of attitude. And that's been tremendously helpful. At the same time, I also recognize in myself because doing self reflection is very important when you're dealing with a large number of people who are in difficult circumstances circumstances, or you yourself are in difficult circumstances. And I will say that I also make sure there is opportunity to spend time with joy and love. And so not too long ago, a friend, they had a newborn baby. And I asked if I could take care of this baby, you know, weekend mornings, because I just needed that time spent in life and joy and newness, since so much of my mental time and energy is spent in the. In the other side of life.

[Renee Garfinkel]

Yes. And there is also that physical part of the joy to counter the physical part of grief. You held the baby, and I needed.

[Dr. Mary Frances O'Connor]

To hold and smell the baby. Yes.

[Renee Garfinkel]

Right. And they let you do it. That's one of the wonderful things about babies.

[Dr. Mary Frances O'Connor]

They were delighted.

[Renee Garfinkel]

The book is the Grieving how the Stress of Loss can be an Opportunity for Healing. Thanks so much for talking with me today, Mary Frances.

[Dr. Mary Frances O'Connor]

Thank you, Renee. Thanks for bringing this conversation to people.

[Renee Garfinkel]

And thanks to our researcher, Bela Pasakov.