What grief does to your brain, and how to cope with it

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"Nothing really feels the same since she's been gone," my patient told me, tearing up. His wife of 30 years had died two months back. My patient felt his identity was connected with her, and he was struggling to figure out who he was without her.

"Grief is so tricky," he said. "You never know what cues, what things around you are going to set off a wave of memories and feelings. It's like an emotional sniper."

Losing someone important, whether because of death, breakup, relocation or some other development, can feel catastrophic. We are social creatures, and other people give us a sense of belonging, continuity and grounding. The abrupt nature of many separations can leave us exposed, weighing us down with feelings of aloneness and meaninglessness that can be all-consuming.

We feel this way because experiencing loss can lead to shifts in our biological systems. Understanding these changes, especially in our brain, can help us realize that healing from a loss can take time, and we need to be gentle with ourselves during the grieving process.

• How grief affects the brain

During grief, stress hormone levels increase, and brain activation patterns can change.

For instance, the "basal ganglia" - groups of neurons located deep within the lower portions of the brain - can become more activated.

These neurons are involved in establishing our habitual action patterns. They also help determine the reward and pleasure we obtain from certain relationships and will play a part in how we respond to separation from loved ones.

Since the basal ganglia encode our sense of closeness and feeling drawn to others, overactivity in this area in response to separation can drive us to try to reconnect through searching behaviors such as the urge to "go out and look" for them. As we may have associated loved ones with feelings of reward, their absence may cause us to crave them.

Importantly, there is some overlap between areas that encode our representation of ourselves and areas that encode representations of close others. Our brains don't entirely distinguish self and others; there can be a blurring between where we end and the other person begins, especially in intimate relationships.

As underlined by my patient, losing a loved one can make us feel as though a part of ourselves has been taken away. As a result, we have trouble recognizing who we are after the loss.

In the brain, there can be a disconnect between "episodic" or "autobiographical" memory areas (which register factual events and are informing us the person is gone) and "semantic" or "conceptual" memory areas (which register contextual information about our lives and are informing us that this person has been, and therefore should continue to be, a predictable part of our day-to-day existence). This information paradox can lead to what has been termed the "gone-but-also-everlasting" theory in grief.

• Getting stuck in grief

There are many ways in which we can become "stuck" in a grief cycle.

Our sense of pleasure and satisfaction can become so connected to specific individuals that it can seem impossible to do anything worthwhile unrelated to them. Whether listening to songs or watching movies both enjoyed or looking over photographs and mementos, we'd rather obtain some version of reward by engaging with these reminders (even if they also bring sorrow) than shift toward other activities that could be pleasurable but have no connection to the absent person.

Engaging in other activities can also invite guilt, as we may feel we are betraying the person by trying to move on. The more we feel "merged" with certain people, the harder it is to imagine a future without them, and this predicament can prolong the grief response.

Loss is an inevitable part of life, but its effects need not consume us. As we try to find healing, there are some important ideas to keep in mind during the grieving process.

• Avoid isolation

It can be easy to surround ourselves with reminders of the absent person, ruminating over the loss and avoiding engagement with anything unrelated to the relationship. It can be hard to think clearly (people can experience what has been termed "griever's fog"), and the thoughts we do have are often repetitive and torturous, such as "Why did this happen to me?" or "Could I have done anything different?"

We keep ourselves trapped in a relationship that has both ended and remains ongoing, though in painfully unchanging ways.

But hard as it might be, trying to connect with others pushes us to realize that there are other worthwhile relationships.

• Don't define yourself by the loss

When a relationship ends, what is lost is not only the predictability and comfort but also the feeling of being special and unique in someone else's mind.

A critical part of the grieving process is remembering that we have inherent value, which remains alive despite the other person's absence. Reclaiming our sense of worth can remind us that life goes on, even if the relationship does not.

• Remember that grief dictates its own course

There is no timeline for grief to end. People can put a lot of pressure on the grieving individual to move on, but only those in the relationship know what it meant.

We cannot eliminate all reminders of the absent person (nor would this necessarily be recommended). Reexperiencing grief is to be expected, especially around important dates and when interacting with reminders of people who are gone.

Being patient and compassionate with ourselves is crucial, and we need to avoid demanding a flight into health that outpaces a realistic and sustainable integration of our loss. Grief is individual and will take the time it needs.

Christopher W.T. Miller, MD, is a psychiatrist and psychoanalyst practicing at the University of Maryland Medical Center and an associate professor at the University of Maryland School of Medicine. He is the author of "The Object Relations Lens: A Psychodynamic Framework for the Beginning Therapist."

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