My interest was because of the passion I have for understanding the “how” and “why” of grief, as well as the loss I experienced with the death of my mother in my early 20s. As I was studying clinical psychology, it made it easier for me to have conversations with people who were grieving; I felt comfortable around them. Probably the combined personal experience and neuroscience degree made for a unique lens.

What we know from neuroscience is that when we love someone, the bond is encoded in our brain. This means there are physiological changes that happen because of this bonded relationship. After the death of a loved one, our mind must update its understanding of the world, and to do so, our brain has to update its physical coding of the bond. This means that as we learn about our new reality in the absence of this person, we must form new synaptic connections and even our genes may be expressed differently.

From human neuroimaging studies, we know that the yearning that accompanies loss is correlated with the amount of activity in a very specific part of the brain called the nucleus accumbens. This highlights the importance and strength of grief as a human experience because the brain devotes significant resources to creating bonds, maintaining relationships, reacting when separated from loved ones, and learning to create a meaningful life again after loss.

I worry about pathologizing any human experience by overdiagnosing disorders listed in the DSM, including difficulties with attention, problems with mood, or even just having a somewhat rigid personality. However, I think many people have misunderstood what Prolonged Grief Disorder (PGD) is. Most of us experience suffering when someone important in our lives dies. This is natural, and for most of us, waves of grief decline in intensity and frequency across the first year. 

At about a year, clinicians can begin to see that there is a very small group (less than 10 percent) who are not showing any change over time. After a year, their grief looks the same as it did in the first weeks. No one stops feeling grief after a year, but at that point, we can begin to see what trajectory people are on. For those who are not showing any change in their waves of grief, research predicts that they are not likely to show change in the future either. For those who are showing growing acceptance and change in their grief, even if their life is not restored to the way they would ultimately like it to be, they will likely continue on that trajectory of change.

Researchers have seen evidence for PGD in clinical science and neuroimaging studies. With its inclusion in the DSM, clinicians must learn to distinguish PGD from typical grief. Considering that we receive no education or training about grief in current psychology and psychiatry, receiving information about the distinctiveness of PGD could end up being a vast improvement in understanding how loss impacts us all.

Although sadness may be a part of grief, grief and depression are not the same thing. Major depression is a disorder where a person has low mood and several other symptoms, preventing them from functioning the way they would like to. Feeling depressed is not about a single situation, but rather a pervasive feeling. In contrast, grief typically comes in waves.

In Prolonged Grief Disorder (PGD), a different clinical disorder, the core of the experience is yearning: a preoccupation with thinking about a loved one or their death. Fortunately, what we know from research is that evidence-based, targeted psychotherapy can get people back on a typical trajectory of grieving.

Of course, a person can have both PGD and major depression, as a person can have both depression and anxiety. Careful research has shown that antidepressants are helpful if a bereaved person has depression, but they do not alleviate the yearning associated with PGD.

Although the experience of grief is universal, the expression of grief looks very different across cultures and periods of history. Therefore, we know that people do different things to process their grief, and some may not even call it that!

Because grief has many physical, emotional and spiritual aspects, words are sometimes not the right modality for people. This can make expression through art or movement more appropriate. Similarly, not everyone will cry, even when experiencing deep loss. In fact, in some cultures, professional funeral wailers are hired since there is often an expectation of crying, even when the bereaved family may not feel moved to do so at that time.