Once, while driving his car, Sherman Lee started sobbing so violently that he lost control of his muscles and had to pull over for fear of crashing. His whole body was subsumed in grief over a beloved pet who had died a month previously. He鈥檇 had panic attacks before, but this seemed different; he wasn鈥檛 just breathless, but filled with intense despair.
Looking back now, Lee says the episode felt like a grief attack, a term that was coined decades ago and is widely recognised within psychology, but hadn鈥檛 been rigorously researched. Last year, Lee, a psychologist at Christopher Newport University in Virginia and an expert on grief, co-published to better understand how to define them.
Lee鈥檚 research fits into a growing understanding of grief as a and experience. The 鈥渇ive stages of grief鈥� concept has long been and psychologists now emphasise that grief can last for years, affect both , and permeate every aspect of life. It is both intensely distressing and one of the most profound and intrinsically human experiences.
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Speaking to New 杏吧原创, Lee explains what he has uncovered about grief attacks, and the importance of understanding the myriad expressions of grief.
Vanessa Nirode: What are the different ways grief can manifest?
: Name any facet of a person鈥檚 life and I can show you where grief will express itself. Biologically, grief is shown in sleep behaviour or eating disturbances. A grieving person can have . If a couple鈥檚 been together for a very long period of time, there鈥檚 a good chance the after.
Psychologically, grief can produce strong emotions like yearning, sadness or anger. People become preoccupied with the person they lost, especially if it was a tragic death. A lot of people have hallucinations. In , 50 per cent of participants reported a sensation of a presence; one-third perceived hearing their voice.
Socially, people may avoid anything that triggers their memory of the person. Their lives get very small. They may avoid activities they used to do with the deceased. Or they may turn to coping through some form of substance abuse.
Spiritually, you can be angry at God, not believe in the things you used to believe in 鈥� a very big existential crisis.
This concept of a grief attack may not be familiar to many of us, but I believe it has been around for a while.
is a pioneer in grief therapy. She first explored the subject of grief attacks in 1991 [though she called them 鈥渟udden upsurges of grief鈥� at the time] and has written extensively about it based on clinical observations. In contrast, my colleagues and I identified and scientifically validated the symptoms using data drawn from large numbers of people.
So, what exactly is a grief attack?
We were able to identify four main characteristics: panic (which manifests with dizziness, shortness of breath and fear), yearning, despair and incoherent thinking. We also created a tool to recognise and evaluate the symptoms.
[Grief attacks] are different from 鈥渟tandard鈥� grief, as they include physical symptoms as well as emotional ones and at an intensity that usually comes on suddenly. We don鈥檛 yet know how common they are in terms of frequency, but they are mentioned, often by different names such as 鈥減angs鈥� or 鈥渟pasms鈥�, in many books and articles that I鈥檝e read. I think all this gives us an indicator that it鈥檚 relatively common.
The most significant thing is that this is a real condition, and as such can be scientifically studied and, if necessary, treated.
How are grief attacks different from panic attacks, and why make the distinction?
From a basic science perspective, it brings together two systems that are often studied separately: the fear system and the attachment system. Grief attacks look like a unique storm of these two systems occurring at around the same time, with sweating and shaking as manifestations of the fear system, and yearning thoughts as part of the attachment system.
When you have a grief attack, along with typical panic attack symptoms like shortness of breath and dizziness, you also experience acute grief symptoms such as yearning, irresistible crying and thoughts about the deceased. The intensity of these two things together makes it a unique class of human experience.
Do we know why some people experience them and others don鈥檛?
I would postulate that two main things might contribute.
Firstly, a person [might experience grief attacks if they have] , which is the fear that anxiety symptoms like a racing heart are physically harmful. For instance, if your heart races or you can鈥檛 breathe, some people interpret that as a threat to their life, so they get really scared and panicky. I happen to fall in this spectrum. We know that people who have anxiety sensitivity are five times more likely to be diagnosed with a panic disorder and, because grief attacks contain a panic attack component, it would follow that they are also more likely to experience grief attacks.
The second factor is stress build-up, which can trigger panic attacks and make grief symptoms worse. If a person has compounding stress in their life, they are probably more likely to have a grief attack.
How long are people deeply affected by grief and grief attacks?
I think when we say 鈥渄eeply affected鈥�, what most people mean is how long grief is dysfunctional or extremely distressing. Grief researchers give it about six months. The latest (DSM) gives a whole year. After that, we start talking about .
The way I look at it, though, 鈥渄eeply affected鈥� means changing you in a fundamental way. I think it鈥檚 lifelong. Take C.S. Lewis. He about his experience of losing his wife. Many people can function, laugh and have fulfilling lives so that when you talk to them, you wouldn鈥檛 know that they lost something significant, but every time they paint or write, it鈥檚 there.
[Grief attacks] can occur anywhere along a course of one鈥檚 life post-loss, though they seem to [be] more frequent early on in the grief process.
Is there anything people can do to manage the experience of a grief attack?
We asked people how they coped, though we didn鈥檛 directly do any experiments. Our research suggests that those who allow the experience to come and go fare better than those trying to distract themselves or focus on some activity. It鈥檚 what mindfulness teaches us: don鈥檛 judge it, don鈥檛 fight it, just allow the experience to come because it will leave in a few minutes.
What do we know about how grief affects the brain and what happens in our brains during a grief attack?
Cognitive tests show that the more complicated and intense the grief experience is, the we see in memory and attention. A few in people with very severe grief. Also, , which could be reflected in brain volume. It also hits the brain area that deals with , as well as regions associated with .
During a grief attack, multiple areas of the brain activate at the same time. Because of the fear aspect, the is involved, similar to a fight-or-flight response. The [an area of the brain that regulates pain modulation and flight-or-freeze responses] kicks in because you yearn for that person to be back. The brain reward system鈥檚 , which searches for the person in a craving sort of way, gets triggered. And then there鈥檚 the , the pain centre of the brain, where the experience of pain and emotion come together. A grief attack is, essentially, a full-human-experience attack.聽
How can you know if grief or grief attacks are becoming worrying, as opposed to a natural process?
I think what we mean by 鈥渘atural鈥� is good: what is good or healthy grieving? Which, in a weird way, assumes that good has to be pain-free. You love someone and the natural consequence of that love is the pain that comes from disconnection. You have to deal with that pain until it subsides.
While grief attacks are disruptive enough to be scary, I wouldn鈥檛 say they鈥檙e worrisome or directly physically dangerous. After mine, I was scared enough that I didn鈥檛 want to drive [for] the rest of the day, but I did have enough control to pull over. I think most people [in our study] were the same way. Psychologically, they can feel like you鈥檙e losing control, which is scary, but not necessarily dangerous. At the same time, mental events are disruptive and real. We shouldn鈥檛 ignore them and people should ask for support if they need it.
You should seek a professional whenever you find that grief is too much to handle, when it impairs your ability to function.
It sounds like relatively few of us will experience a grief attack, but almost all of us will feel grief at some point in our lives. What is your advice for people in that situation?
For a lot of people, closure is important: rituals, a funeral, being able to have final words. Talking to people about the loss is helpful when trying to make sense and gain perspective. There is that physical movement, exercise and sport, are helpful for those mourning a loss. As well as combating loneliness and depression, exercise and sport can help with sleep problems, especially if you get exhausted enough to override your overthinking mind. Also, if you鈥檙e doing a sport, you鈥檙e not at home looking at pictures; you鈥檙e getting a temporary distraction. We all need a break from pain.
When you decide to seek out a professional, grief therapy is tailored for you individually. Because grief is a big thing. It鈥檚 never one thing. Many people might suggest , which deals with the thoughts and actions that give you problems. Let鈥檚 say what bothers you are the grief attacks. Then I would suggest acceptance-based therapies, which aim to teach you to let them happen and accept them, thus building psychological flexibility and a way to keep yourself grounded in the present. All of these are great therapies and approaches, but it鈥檚 hard to give a silver bullet for [grief]. It has many parts. I suggest trying to figure out the problems that you are having within that big thing.
