Eight years ago this month, the man I was married to for two years (too short or too long?) went into coma following a freak swimming accident and remained comatose for five years before he died. That day marked the beginning of my journey through an uncharted sea of emotions. Now, eight years down the line, I am able to decipher the meaning and necessity of those emotions and I am able to contemplate, talk and write about them. After years of suffering, I realised that ‘grief’ would be one term that could describe all that I endured. Without discerning, I tried to manage my grief applying different methods including writing, praying and thinking ‘positively’ (which failed miserably), indulging in social causes, and so on. Of all the measures I tried, the one that enabled me to cope the best was my effort to understand the ‘physiology’, ‘anatomy’, ‘biochemistry’ and ‘psychology’ of grief as a distinct phenomenon.
Grief is defined as ‘intense sadness especially at the loss of a loved one’. This simplified definition of grief has its own limitations because grief is a complex and complicated response to the loss of something physical or abstract. Grief is immensely personal and highly individualised. It can be equated to fingerprints, which are unique to individuals.
Grief has turned out to be much more than all the predictive models or stages of grieving described so far. Elizebeth Kubler Ross introduced the Kubler Ross model of grief where she described the five stages of grief as denial, anger, bargaining, depression and acceptance. Her major assumption was that all people exposed to a life-changing event would go through these stages of grief. She proposed this model by observing people who were dying and did not include people who were grieving the loss of loved ones.
Later, large-scale research by George Bonnano showed there were inherent flaws in the Kubler Ross model because of its assumption that grief was the only natural response to any adverse life event. Bonnano and colleagues showed that many human beings exposed to potentially traumatic events in their lives never demonstrated permanent disruption in their lives. He proposed that resilience, recovery, chronic dysfunction and delayed trauma were the four different trajectories possible in response to an adverse life event. His work exposed the fact that, as a society we always underestimated the power of human resilience. He proposed that resilience was a trajectory distinct from recovery and it was more common than that was believed and only less than 10% of people failed to demonstrate it. He spoke of resilience thus: “The ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event, such as the death of a close relation or a violent or life-threatening situation, to maintain relatively stable, healthy levels of psychological and physical functioning”, as well as “the capacity for generative experiences and positive emotions.”
The term ‘resilience’ was derived from the Latin word ‘re’, meaning ‘back’, and ‘salire’, meaning ‘leap’. This word originated from the physical world and was used specifically in the context of metallurgy, where a ‘resilient metal’ was the one which bent back to its original shape when relieved of stress. Many have asked questions about the factors responsible for human resilience. The military and corporate worlds are specifically interested in answers to these questions. If at all certain biochemical or genetic factors are identified as responsible for resilience, then one could even think of ‘inoculating’ others with these factors for demonstrating greater resilience. Gary Stix wrote in Scientific American in 2011, “The debate has special urgency now as the U.S. Army begins a gargantuan training programme to inculcate resilience in more than a million soldiers and their families, perhaps one of the largest psychological interventions ever undertaken by a single institution.”
In response to an adverse event, levels of our stress hormones like cortisol rise and act on the hippocampus and the amygdala in the brain. Their continued action can cause more harm than good. In resilient people, after the initial elevation these hormones reach normal levels much faster than people who are not resilient. A number of other chemicals like neuropeptide Y and DeltaFos B have been linked to resilience. A gene named 5HTT rose to fame in 2006 when it was linked to the ability to demonstrate resilience. But soon evidence showed it was not appropriate to link such a gene to a complex characteristic like resilience.
It is a worthwhile exercise to think of the evolutionary perspective of grief. According to the theory of natural selection, any trait or characteristic persists because of some distinct advantage it offers for the survival of a species. Grief, with the effect that it has on the person who experiences it, is never a cost-effective emotion to be naturally selected. Is experiencing grief a useful phenomenon for our genes? Generally perception of pain, especially physical pain, is regarded as a negative phenomenon and most people desire a pain free life. But there are people who lack the ability to perceive pain since birth, termed as ‘congenital insensitivity to pain’. These people die early (contradictory to what we might like to believe) because perception of pain is needed to avoid accidents and trauma. Does grief really have a meaning beyond the personal suffering, in a larger perspective? If it does not have any particular meaning, are we justified in trying to formulate a treatment for grief by completely eliminating it? More research needs to be done before we find an answer to these questions about grief.
Like the cultural differences that exist in perceiving grief, individual responses also vary widely. It is a worthless exercise to classify grief as ‘natural’, ‘severe’ or ‘excessive’. Bonnano and his colleagues coined the term, ‘coping ugly’ to include all the unconventional methods people adopted to cope. Some people engage in ‘self-enhancing’ bias, which would border narcissism in other circumstances. There are different kinds of grievers who are identified as nomads, memorialists, normalisers, activists and seekers. At a given point of time, every grieving individual could be any one of these or a combination of these identities.
Hence, proposing a single strategy to make people resilient may not work and evidence points to the contrary. I believe we should give time for people to cope before attempting to ‘scientifically’ aid them because many a times such unwarranted ‘aid’ does more harm than good. And maybe we can be a bit less judgmental about the way people grieve. Some people would want to write, talk and expose their wounds (or even analyse grief as I am doing) so that it doesn’t hurt them anymore and would enable them to distance themselves from the event. Some people would never want to discuss it openly. One shoe-size will never fit everyone and as a society I guess we should give a chance to grieving individuals to try out the best shoes that fit them. Understanding and talking about grief as a process is essential in reducing the harm that we intentionally or unintentionally cause to other human beings who are grieving.
The author is a medical geneticist at the Nizam’s Institute of Medical Sciences, Hyderabad. Email: dhanyalakshmi@gmail.com
