Before and After Loss: A Neurologist’s Perspective on Loss, Grief and the Brain

Loss is traumatic.

It wasn’t until I experienced my husband’s death that I learned how disorienting, harrowing and perilous it is to lose people close to us. To lose something that is simply basic to who we are and how we make sense of our lives.

As a practicing neurologist, I thought I was prepared. But instead, I struggled. It took many months until I had a flash of insight- for the first time I saw my experience through the eyes of a neurologist. I realized that the problem wasn’t sorrow, it was a fog of confusion, disorientation, and delusions of magical thinking. This insight spurred me to study how loss affects the brain, and what I learned about emotional trauma became the basis for Before and After Loss: A Neurologist’s Perspective on Loss, Grief and Our Brain.

For people experiencing loss, I believe demystifying the experience is an important step toward healing. When we think about brain trauma, we usually think about physical injury. But we now understand that the emotional trauma of loss has profound effects on the mind, brain, and body. An especially pronounced example is the Broken Heart Syndrome where stress hormones result in abnormal heart movements and symptoms of chest pain and shortness of breath. This may result in an actual heart attack although more often than not, it resolves without lasting heart damage. Imaging studies of the brain show that the same brain regions are activated by both physical and emotional pain. These examples show the pervasive effects of traumatic loss.

The recent death of President George Bush less than 8 months following the loss of Barbara Bush also highlights the serious consequences of emotional trauma. In fact, there’s a pronounced increase in accidents, illness, and death of the surviving spouse in the year following loss. As our understanding of physical traumatic brain injury has expanded to include concussive sports injury, it’s time to expand the definition to include emotional traumatic brain injury. It wasn’t so long ago, that concussions (brief alterations of consciousness after a blow to the head) were considered harmless; athletes were routinely returned to the field after they appeared to recover from being dazed or unconscious. We now understand that although no injury is seen on MRI or CT scans of the brain, brain injury has occurred. In the same way, the emotional trauma of loss results in serious changes in brain function that endure.


How can we use this new understanding of emotional traumatic brain injury to promote healing and emotional restoration?

The brain kicks into action to protect us during traumatic experience. Imagine what would happen if we weren’t able to function during traumatic times. To sustain function and survival, the brain acts as a filter sensing the threshold of emotions and memories that we can and cannot handle. So the brain is especially active in managing the stress of traumatic loss. Recovery depends upon gradually reconnecting with suppressed memories- the emotions and memories that we’re not ready to face. Disturbing dreams by night and intrusive thoughts by day are evidence of traumatic memories that are buried in the subconscious, and were never properly integrated with past memories and emotions, our previous life experience.

To move forward, we need to find tools that will help us reconnect with suppressed memories.  Equally important is the need to find activities that are diverting to refresh the mind. Tools for reconnection may include journaling, faith-based practices, meditation, and seeing a counselor. Keeping a dream journal may gradually uncover repetitive themes. Mysterious at first- over time the symbols in our dreams begin to reveal themselves. For refreshment, try creative practices (art, music, dance) and the healing powers of the outdoors.

Even in the worst of times, it’s empowering to understand the basis for our experience of loss and to learn steps we can take to enhance recovery and healing. It’s true that healing will come with time, but post-traumatic growth requires insight.

Lisa M. Shulman, MD, is the author of Before and After Loss: A Neurologist's Perspective on Loss, Grief, and Our Brain and is a professor of neurology at the University of Maryland. She is the author or editor of numerous books on neurologic disorders, including Parkinson’s Disease: A Complete Guide for Patients and Families, 3rd edition. 

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