The Science & Process of Healing from Grief

The episode opens with Andrew Huberman, who introduces himself as a professor of neurobiology and ophthalmology at Stanford School of Medicine, describing grief as a natural emotion most people experience that still mystifies them. He frames the central puzzle this way: sometimes the crushing weight of a loss is explained by how close the relationship was, but sometimes it is bewildering, because despite our best efforts we cannot shift our minds to accept that someone, or an animal, who was once so present is now gone.

The plan is to treat grief at both an emotional and a logical level, drawing on neuroscience and psychology from what he calls "just a few key laboratories." The core claim previewed here is that we map our experience of people in three dimensions: space (where people are), time (when people are), and closeness. On this account, those three dimensions establish close bonds, and they are what must be remapped and reorganized, emotionally and logically, when we lose someone.

He also describes moving through grief as requiring "a specific form of neuroplasticity," a reordering of connections within the brain and between brain and body, and promises tools for what psychologists and neuroscientists consider the healthiest way through grief. The intended audience is broad: people in mild, moderate or intense grief, and people experiencing no grief at all. He adds that the podcast is separate from his teaching and research roles at Stanford.

An early point concerns preparation. Huberman says there is a scientific literature showing that the psychological and biological state a person is in when a loss occurs strongly influences whether they end up in complicated or noncomplicated grief. In the transcript as given, he then describes "noncomplicated grief" as the form that is "very prolonged" and often needs substantial professional help. That conflicts with his later definition, in which complicated grief is the form that does not resolve, so the earlier wording reads as a slip.

The intensity and duration of grief, he says, scale with how close we were to someone. Learning that a familiar person from a coffee shop has died can be upsetting and disorienting, especially if you saw them recently and they seemed fine. But that differs greatly from losing a sibling, a parent or a child, after which places and things that once brought joy can instead bring intense sadness and a sense of loss.

Complicated and noncomplicated grief look very similar at first. The key difference he describes is that complicated grief, which he says occurs in about one in 10 people, does not seem to resolve even after a long time. He mentions tests that distinguish the two and says links are provided in the show notes, but he does not describe the tests in this part.

Grief is presented as a process with a beginning, a middle and an end. He believes that knowing where you are in that process helps, both to predict how long it will last and to hold the person or animal in memory while keeping your own capacity to function in life.

He separates grief from depression. The two can share symptoms such as loss of appetite, trouble sleeping and crying for no apparent reason, but he calls them distinctly different processes. As evidence he cites modern research showing that grief "rarely responds well to antidepressants," whereas depression often does. He says no studies by name here.

Rather, perhaps the best way to think about grief is that it is actually a motivational state. It is a yearning, it is a desire for something.

He complicates the obvious reading that the yearning is only to have the person back. He notes cases where a death brings relief, "because of where they happen to be in their life." He presents the motivational framing as the way scientists and psychologists now think about grief and its treatment.

The episode names a common myth: that everyone passes through fixed stages of grief. Huberman credits Elisabeth Kübler-Ross, author of "On Death and Dying," as a real pioneer in showing that grief has distinct stages. But he says modern psychology and neuroscience indicate that not everyone experiences all the stages, and people rarely move through them in order.

The five stages as described: denial, which in the Kübler-Ross model always comes first, a disbelief and refusal to accept the new reality; anger, in which the person accepts the loss but body and mind enter a motivated state; bargaining, or negotiating ("Well, if I had just done this," or, "If I'd called more"), which can blend with denial; depression, marked by questions such as "Why go on living?"; and acceptance, an internalization, emotional as well as cognitive, that the loss "has passed."

He points out that stages can be "blended or braided together, because emotions are complex." He also marks the anger stage as the first appearance of a theme he returns to: grief as a motivated state that involves action plans.

His criticism is aimed at how the model was received, not at the model itself. He says the stages "were sort of taken to be gospel for a long time." Neuroimaging, more detailed psychological evaluation and more researchers and clinicians in the field have since shown that much of what Kübler-Ross described holds true, but not always. He adds that grief varies with the kind of loss: old age, disease, whether suffering came first, suicide or other deaths, and losses that are not deaths, such as a breakup or even homesickness. He ends by saying researchers are not trying to discount her contributions, but that the field now has a better understanding and better tools.

To reframe grief, Huberman asks listeners to set aside, for about five minutes, the idea of grief as only sadness. He acknowledges that grief does involve sadness. His illustration is extreme thirst on a hot day, with a full, clean glass of water that always moves just out of reach no matter how hard you try to get it. Imagining this, he says, touches "into the experience of grief."

His evidence comes from fMRI, which estimates which brain areas are more active from blood flow, a measure that correlates with neural activity. He says these studies show that brain areas and circuits linked to motivation, craving and pursuit are among the main ones active in grief.

The paper he highlights is titled "Craving love? Enduring grief activates brain's reward center." Its first author is Mary-Frances O'Connor, a psychology professor at the University of Arizona whom he calls a world leader in the neuroscience of grief. He reports two findings. First, grieving people show more activity than nongrieving people in brain areas associated with actual physical pain. Second, people with complicated grief showed reward-related activity in the nucleus accumbens, a brain center where dopamine creates a motivated state. As he describes it, the reward finding is specific to complicated grief, not to grief in general.

Dopamine is about placing us into a state of desiring things and seeking things.

He extends this to addiction, hunger, reproduction and "every state in which we are reaching for something outside our immediate ability to give that thing to ourselves." In his view, grief is both pain and wanting. The dopamine involvement puts a person into an anticipatory, action-seeking state that he calls "center of mass forward," seeking to resolve the craving "even if we know that is impossible."

Explaining why the craving persists, Huberman says that understanding grief requires understanding how attachments are represented in the brain. Brain-imaging studies, and animal studies he says he will describe later, suggest that both forming attachments and breaking them in healthy ways are governed by three dimensions.

He defines a dimension using color. Red does not exist in the brain. Cells in the eye respond best to long wavelengths reflected off objects we perceive as red, and neurons in the brain represent the presence of red things in the environment. The brain likewise holds maps, or representations, of touch, sound and three dimensions that define our relationships to people, animals and things. When those people are nearby or reachable, motivation can work logically: we know the steps needed to find a mother, a sibling, a partner or a pet.

He admits this risks sounding "a little bit too reductionist" and asks why anyone would strip relationships of their complexity. His answer is that knowing these dimensions explains why inaccessibility hurts so much and why remapping takes time. The three dimensions are space, time and closeness, and he introduces an experiment that he says was actually carried out to show how they work together.