When doing research for my last post about models of grief, it became clear that I needed to talk to an expert. Luckily, I knew just the one. In my first podcast episode, I talk with Dr. Saren Seeley about the neuroscience of grief. How does the brain adapt after loss? We discuss the “Gone but Everlasting” theory, how grieving is a learning process, and the surprisingly contentious climate around the study of grief. I so appreciate the humanity she brings to science and hope you’ll enjoy her company too. The lightly edited transcript of our conversation is below.

Chrissy Sandman (CS): Hello, Saren! Thank you for talking with me.

Saren Seeley (SS): Of course, I'm so happy to do this.

CS: Me too! I am so excited to talk with you. In particular, we have several interesting points of connection over the last nine or so years. So I'll go ahead and introduce you and then we can get into it.

So, Dr. Saren Seeley is here with me today. She's a postdoctoral research fellow in the psychiatry department at Mount Sinai's Icahn School of Medicine. She completed her PhD in Clinical Psychology at the University of Arizona under the mentorship of Dr. Mary-Frances O'Connor, where she conducted research on neuroscience of grief and trained as a clinician. She completed her clinical internship at the Pittsburgh VA Medical Center (my hometown!). And before then, she did her undergraduate studies at CUNY Hunter College in New York, which is where we met when I took over her job as a research assistant in the Regulation of Emotion of Anxiety and Depression (READ) lab there. And since then, we have sort of stayed in touch over email, usually when I was bugging you about different fMRI scanning methods and analysis over the years, and you've always been so generous to reply with such helpful and detailed responses. And then more recently, with the grief that I've been going through, I just so happened to pick up the book that was written by your grad school advisor that you are mentioned in the acknowledgement section of and I imagine some of the work you were doing in grad school is woven throughout the book. So I just thought that you would be the perfect person to talk to as I am getting interested in how we understand grief. What are the models that are out there, both in terms of what's empirically supported, and what we know about how people adapt and change after a loss of a loved one, but also what people resonate with and what's useful for people who are going through it themselves, which might be in a clinical setting, or just how people make sense of their experience. And the other aspect of what I wanted to talk with you about today is just how I feel you weave yourself into the work. And in some of the popular science communications I've read of yours, I just really admire how you've brought your own lived experience and perspective into understanding how we are humans studying the things that we go through, which I think - there’s been a shift - but in my experience, there's been a bit of a stigma or taboo about acknowledging that we as humans go through some of the things related to mental health, but we're also studying or are working with us as therapists.

SS: Absolutely. And that's one of the things that's been so nice for me by reading your Substack is a seeing how these ideas resonate with, you know, people who are not people in this very specific niche area, people are just coming to these ideas in the midst of having their own experiences of loss and grief. And then also, you know, the way that you can your writing connects your understanding of the science with what you're going through at that moment. That's been really beautiful to read. So I'm glad you're sharing that with the world.

CS: Thank you. Yeah, I think in particular, the the book I was referencing by Mary-Frances, as you call her, Dr. O'Connor is the the grieving brain which sort of came out right when I was going through it or, and so I think a lot of the concepts as I was reading the book about just the freshness of the loss, and I guess the befuddlement or like disbelief, or just like sort of confusion about you know that someone's no longer here and yet, there's some process that goes on that was like nothing I had experienced quite in that way before about the searching. And I just couldn't believe that that exact experience was being described in this book about how our brain continues to search for people that are no longer here. And exactly why that is based on different aspects of memory and learning, which I know is is a big part of your research right about about learning and grieving.

SS: Yeah, Mary-Frances and I have been working on our "Gone but also Everlasting" theory. That's kind of been our focus. I get to still work with her. Even since I've graduated, we're very close collaborators, which has been wonderful. We're both focusing on a little bit different things, aspects of this model. But really thinking about: Why do we have these weird experiences? Why does it feel like when we lose someone, we're kind of straddling these two worlds, one in which they exist, and one in which they don't? And how does our brain makes sense of that? And, you know, thinking about what do we know about attachment and how our brain encodes those attachments with people who are important to us?   That's one of the questions you'd asked is like, what, what is useful about, you know, this lens of understanding grief through the lens of the brain, and I certainly don't think it's the old way or even the best way. But it happens to be the way that A) I'm interested in and B) I actually have skills to do something about. But I think one of the things that offers is that it can help people understand some of these very weird, disorienting, bewildering experiences that they have. And often feeling like, "Is this happening just to me, is this you know, is this normal? Why am I having this experience, even though the logical part of my brain knows different information?" And I think that can at least hopefully offer some way of, I don't know, having a little bit more of a roadmap and way to orient to the world while you're having this really this experience of upheaval, in so many different ways.

CS: Yes. So I believe, like you mentioned, you and Dr. O'Connor put out this theory paper on grieving as a form of learning. So you just mentioned, there's a part of our brain that logically understands and then there's another part that maybe takes time to update. Could you tell us a little bit more about how grieving is learning?

SS: Yeah, absolutely. So this theory is really trying to address the big questions like: Why does grieving take so long? Why is it so painful? Why do we continue to yearn for someone who has died even long after we know they're gone, and, you know, our brain may make predictions that they are still here that they're coming back.

And, and one of the key aspects of this theory in particular is that adaptation requires a person to reconcile these two conflicting streams of information that I mentioned, like this really firmly entrenched understanding and belief about the person as being alive and existing even when they're not in our immediate presence. And so that means the best prediction about them is when they're not here is that they're just somewhere else. They're coming back, we can go out and find them. But we also have these episodic memories or specific knowledge of the fact of their deaths. So I'm really curious about how do we learn over time to wait, the predictions based on this new model, this new information that we have more heavily than those based on the first model, the old model, given that the left given that that old model has been so strongly reinforced for so long, and that the new information that we have is usually information that we don't want things to be this way. So it can be really hard. It can be a very painful thing to accept the fact that those changes have occurred.

And so we're curious about what's happening in the brain when we successfully do manage to reconcile those two streams of information and, you know, integrate grief, which, ultimately allows us to create this meaningful life that honors our relationship with a person who died. But we're no longer stuck in that wanting something we can't have and then continually slamming up against the fact that they're not here. And so yeah, so this idea of greeting is a learning process is that we have to learn at multiple levels. And three of the ones that are important are that, you know, there's a lot of habit learning that has to be overcome. We have to develop the ability to predict the absence of the person who died as opposed to their presence, at least sort of in this physical plane.

And also developing ways to get your attachment and social support needs met, particularly when the person who died played a significant role in your life was as someone close to you. And so my interests in the of past couple of years - because I get very focused on details of things - Is like, okay, we're talking about learning, but like, that's like attention. In cognitive neuroscience, there's a million different types of learning. It's not a very specific term. And so what gets in the way of that? And so one of the directions that we're taking this "Gone but also Everlasting" theory that we've been working on is trying to use computational psychiatry or mathematical modeling of brain and behavior to try to use established formal models of learning that we have from cognitive neuroscience that are very well developed, like reinforcement learning. And can we use those to test out some of these ideas about what's happening in grief?

CS: Gone but everlasting.

SS: Yeah, "Gone but also Everlasting" is the name that - actually Mary-Frances came up with that. All credit goes to her for that one. Yeah, but it speaks to those dual streams of like: they're not here anymore, but their memory lives on and their impact lives on.

CS: Right.

SS: And we think that happens in that it's not just sort of a metaphor. I mean, our brains are changed by every experience that we have, and loving someone being loved by someone is an experience that changes our brain. We can't really cut open human brains, but some of the prairie vole research shows that there are specific neurons that fire specifically when the vole is approaching their partner that they're pair bonded to. And so that bond is literally encoded in our brains, which in some ways, is kind of a nice way to think about it. That is still there.

CS: And for anyone who hasn't taken Intro to Psychology classes, the way that a lot of the research on bonding and pair bonding and connection, is based on these cute prairie voles who have lifelong relationships with their partners.

SS: They are absolutely adorable. But my prairie vole colleagues tell me they also bite a lot.

CS: Yeah, but I mean, that's incredible, I think, that the physical matter changes as a result of the experience of being loved and loving. And when you were describing the grieving as a form of learning, I was just jotting down a couple of other things that stood out to me. You said, part of the the habit learning, I imagine would be.... just as you're going about your day, the ways that you might interact with someone who's gone. Those are automatic. And so when you think about, "This is the typical time on the weekend that I usually call my dad" or whatever that might be cued by things in your environment, such as, I don't know, Saturday morning coffee, or whatever the case is, and then that doesn't happen anymore. And so, just as you were saying, predicting absence. It's like, instead of predicting or expecting their presence, the thing to learn is their absence. Or expecting the absence. Is that one way of understanding it?

SS: Yeah, definitely. And so in terms like putting that in neuroscience terms, we can use the idea of prediction errors and how those help us learn. So, you know, when we're making decisions about things, we get feedback about the outcome. So we chose to go on this route versus this other route. Is the outcome of our choice, is that better or worse than expected? And so negative prediction errors are when something that is worse than expected. So you know if we reach for the phone expecting to call our loved one who died and then have that moment of realization, "Oh, that door is shut. I can't do that anymore." That's a big negative prediction error. And potentially that can be when those waves of grief occur that you experience. You're really confronted with that reality. Interestingly enough, the salience - or the sort of the strength and emotional content of a prediction error -  can drive learning. So when something is really acute and obvious. That is a big signal to us that we need to change our predictions, because this one is no longer working. And so the interesting thing about grief is, you know, it doesn't just take one time to have that prediction error and wave of grief. It really is something that you participate in, over and over and over again. And it's not necessarily a perfectly linear trajectory of like, those waves getting less over time. Sometimes they can be more, sometimes they can be less. But overall, most people do kind of integrate that new knowledge of the loss.

CS: Yeah, I think I'm almost imagining, like the process of learning over time, and then different knobs that might assist that learning that you can turn up or different knobs that you can turn down that might hinder the learning.

SS: Oh, I love that!

CS: And I think acceptance, like you mentioned, or in other words, allowing that emotional wave of grief to actually be felt and acknowledged and attended to. You're absorbing that learning. 

SS: Yeah, I love that idea of like knobs that turn up or down your, you know, things that facilitate or inhibit your learning. I think that's actually how I've really been coming to think about this. You know, I really try to... Grief is already so stigmatized, I really tried to be very careful in my language. Psychologists are sometimes bad about this. Like saying, like, "Oh, this person is failing to adapt." Like, that's, that's very...

CS: Not very compassionate.

SS: And yeah, I think that terminology of like… so if we assume that grieving is this process of learning that unfolds over time, there are things that can get in the way of that and there are things that can make that easier. So, yeah, I like that.

CS: Maybe this is a good segue into kind of the climate around the study of grief. So as I was mentioning to Saren, why I originally wanted to speak with you is to kind of check the temperature about what's going on amongst researchers in terms of how we talk about models of grief. I originally was sitting down to write my next post about models of grief and was interested in the most famous one that persists today, which is the Five-Stage Model of grief, developed by Elisabeth Kübler-Ross, who actually studied people who were about to die of terminal illness themselves and the stages that they went through. So these common stages, which I actually don't have memorized fully in order. So I think that's another interesting thing to note is just like: okay, people are familiar with that there are stages of grief - they probably involve anger, denial, bargaining, depression, acceptance. I think those are the ones, maybe in that order. I can fact check this later. But that idea to me never, just as a person, seemed all that controversial until I started really diving into the literature and how people have absolutely torn down this model in some pretty strongly worded academic papers by proponents of other models, which seem well- supported by science and have good stuff to offer too. But I just noticed, aside from the content of the actual models of grief, that there seems to be like a lot of contention or intensity around the debates about what models should we be using to understand grief. 

SS: We see that same level of contention and the debates that have been ongoing for years now about grief related disorders. And is there is there a place that we can say that this is a clinical disorder that's related to grief? Or is that medicalizing normal human experience? And I think a lot of these debates about prolonged grief disorder, about five stages, really taps into a the impact that grief has on us, and the fact that everybody probably has their own experience of grief that may be shaping how they're coming to this debate, either through themselves or someone that they're close to. And also that a lot of these debates come down to what is normal and human experience? And how do we define normal grief? And so a lot of the debates are coming out of saying, "This is helpful because it is a way that people can understand their experiences better or that we can support people better," versus, you know, saying, "No, that drawing this really clear boundary doesn't adequately capture the diversity and variability of grief experiences that people have and is too prescriptive."

So that is one of the concerns with the Five-Stage Model is that it presents people with this idea that in order to properly grieve, they must go through these stages in order. And that I don't think is helpful. But what I do think is helpful, and one of the reasons that this model is so sticky. I've worked in hospitals, and this is very popular with social workers, it seems like because A) like that roadmap, I mentioned. During a really weird, disconcerting, disorienting experience, it says, "This is what you're going to experience, then you're going to experience this, then you're going to experience this." And so you know, like, Okay, I have to get through this stage, this stage and this stage, and then there will be an end to that, and I know what's going to happen. And it also, I think, really allows people to feel validated and and experiencing some emotions, like anger or relief, that are very stigmatized, and not seen as acceptable. So I think, you know, thinking about not just like, what is the content or scientific premise of these models, but like, what function are these models serving in the lives of people who are grieving and the people who are trying to help them? There's like multiple layers going on.

CS: Yes! I remember, in grad school, one of our professors saying, "A model is only as good as it is useful." And that really stuck with me, because no theory or kind of abstraction is perfect is going to capture everyone's experience. It's just not. And I think that's what I was most interested in is like, what do people connect with? Like, why has this model hung around? And I enjoyed that part of The Grieving Brain book that kind of talks about one reason why this model has - why the Five-Stage Model is so popular - is because it gives people that roadmap. And also related to the heroic cycle, which I hadn't thought about that since middle school English class or whatever. Going through like a heroic Odyssey where you have, you know, trials and tribulations that you overcome, and then ultimately, succeed. And wouldn't that be nice if we could have something like that for grief? I think that is what people long for is a way to navigate it and come out victorious, almost. But it's perhaps not exactly like that. It's not something that can be finished.

SS: Yeah, I think it can set up expectations for what grief is going to look like or what it's going to feel like that then when those expectations are not met, can make someone feel like "Oh, I'm not doing this right." For some reason, at least in US Western culture, there are a lot of myths and like about what it looks like to "do grief right." There's one paper that is a survey showing that people think that expressing positive emotion within, I think it's one or two months of the loss, is inappropriate. But then like when you get to six months, expressing negative emotions is inappropriate. So it's just like grieving people can't win.

CS: Yeah.

SS: But yeah, what you were saying about models and their utility. As we were meeting with this researcher who published this preprint recently, a computational neuroscientist, who is getting into the area of grief. And I was, you know, making a reference to that statement, “All models are wrong, but some are useful.” He was saying, "I really like to put a spin on that and say: ‘All models are right, but some are useless.’" So it's really the idea of our models are not going to perfectly capture, especially in experience like grief. I mean, humans, for one thing, we're not just like six foot prairie voles. We have all this other stuff happening. And particularly when it comes to computational psychiatry, and we're trying to distill these experiences down to mathematical models and equations, this is not going to... like we're never going to come up with an equation that captures all of the different parameters and influences on grief. But I think, scientifically, where having a really well specified model can come in is it allows us to falsify our ideas and make more specific predictions, see if those predictions hold, see if they don't hold. A lot of ideas or theories and in psychology, you know, it's a lot of like, sort of fuzzy verbal descriptions.

And so in some ways, the work with the "Gone-But-Also-Everlasting" theory that I'm interested in is like: Okay, how do we make this really, like, testable? And so maybe we can that can help us distill down to like: Okay, this is the essential part of the model like, this other part of the model might be interesting or useful in some ways, but might not be essential to our understanding of some of the core processes that are going on. It's something I'm always thinking about when I'm doing this work is like, how is this going to be perceived by people who are going through grief or know, people are going through grief? And how could this be used or interpreted by, you know, people who are not necessarily in science or people who are in science?

I mean, I hope what people get out of this focus on learning in the brain is that grieving is a learning process that requires time and experience and a lot of both of those things. And it's really hard. And we need to respect and honor the effort that that takes and the time that that takes, and be compassionate with ourselves and with other people. For that time and experience that's needed. And, you know, it's something that you have to... yeah, it's, it's just going to take time. And it can't necessarily be like a one and done thing. One of the things I hear from participants most commonly that's really painful for them is like, feeling like people in their lives have expected them to move on. And they don't feel like moving on...that that is a thing. Like, how could they move on from this important thing that's had such an impact on their lives, both through the relationship and also the event of the death?

CS: Yeah, time and experience. And I think that if we're not interested in a one-size-fits-all prescriptive model of grief....It's complicated, right? Because we want to capture the varied human experience and it's not gonna look the same for everyone. But are there still commonalities and principles? And I think what you just said is it: We need experience and time. I've talked with family members about this, the sort of like "Everyone keeps telling me that there's no one way to grieve and it looks differently for everyone," which, at times, I've personally found both comforting, and a little bit frustrating, because it's sort of like, well, what am I supposed to do then? Or like, what does it look like? I think it's both. I think it's a dialectic of both, right? There probably are some commonalities, and it is gonna look different for everyone. And that is hard to hold both. 

SS: Yeah, I can see in some ways, I would feel like, you know, just being told, like, "Well go figure it out for yourself!"

CS: Yeah. But I guess that brings me to the Dual Process Model. I think it's one that is an alternative to the Five-Stage Model that has been more recently supported by research and is consistent with this idea of needing learning. And I think learning is almost like synonymous in a way with experience, like getting experience. Living. Continuing to live your life and experience your life. And I think there is something in there too. I mean, maybe this is my bias in terms of like, my own personal and research interests in acceptance and mindfulness-based approaches and compassion-based approaches of sort of allowing emotion to unfold even if it's uncomfortable. There's something about that, that seems important. So a long winded way of saying, Could you explain the Dual Process Model for us?

SS: Yeah! So there's a lot of different models that people have developed to try to understand and provide a framework for organizing grief and the experience of grief. There's also a Meaning-Making model by Robert Niemeyer, which has been pretty influential in some circles. But the Dual Process Model of coping with bereavement. This was developed by Margaret Stroebe and Hank Schut to describe how people come to terms with the death of a loved one. It really comes out of Cognitive Stress Theory. But it's also one of the first models to emphasize that healthy grief is variable across time. And also it needs to address these two different sources of stress, loss-oriented stressors and restoration-oriented stressors. So loss-oriented stressors, these are things that require a focus on the loss experience. So the process of thinking about and coming to terms with the reality of the loss, dealing with ruminations and intrusive thoughts, but also positive reminiscing and participating in personal or communal rituals to remain close to them. And like this idea that there are these stressors that you have to tackle that are related to loss, this comes from the idea of like this older idea of of grief work and tasks of grieving. The idea that somebody has to actively participate in confronting the reality that loss in order to adapt.

CS: So being in it? "Grief work" meaning you "should" be really reflecting on the person and like feeling sad. 

SS: Exactly, yeah. So you know, having emotions from loss is healthy. You need to have those. There are different ways to have them, but they serve a purpose. Even the ones that are really painful and may feel, you know, pretty debilitating, especially early on. Another loss oriented stressor is you also need to take time off from grief. So, grief is not only really taxing on your emotions and your mental health, but also physically on your body. There's cardiovascular stress, inflammatory and immune changes that are related to acute loss. So, you know, needing some times of avoidance or denial of that loss to give yourself a little bit of a break. So you can come back to the work of grief later. So you have these loss oriented stressors on one hand, and then the other hand you have these restoration oriented stressors, which role are things related to the process of reorienting to changes in the world that have occurred secondary to the bereavement so for example, common one is like interpersonal conflict. So family arguments or disagreement over what to do with a loved one stuff specifically like a parent when they have died, or like how funeral or burial arrangements should be handled. So having to navigate that conflict, that's a restoration-oriented stressor. Also, practical matters, like if the loved one was some was the person who handled the finances, or they were a caregiver or somebody who are major emotional support. One of the stressors is that you have to figure out what to do with the fact that they're no longer fulfilling that role that might require you to take on new responsibilities, learn new skills, cultivate other relationships where you can get those needs for closeness or support met. And then another sort of task on the restoration-oriented side could be thinking about how the absence of that person has changed your identity and like what that means for you going forward.

So I think one of the advantages of the Dual Process Model is that it captures stressors on both the looking back and looking forward side of things. And so key to the Dual Process Model is that both of these are important, and we need both in order to adjust to this world. So how do we attend to both? Well, the Dual Process Model says that we oscillate or move back and forth flexibly between these two. Sometimes we are crying, thinking about the loss and how much we miss the person. Sometimes we are, you know, figuring out like, "Okay, what do I do with all of these financial documents?" or "I used to be a daughter, like, who am I now that I no longer have a parent?" So this moving back and forth, this experience over time is what facilitates integrated grief or the ability to hold that both the past and the present. And things that might inhibit learning is getting really stuck on one of those sides or the other. And I can explain a little bit about that, but so I'm not monologuing, I'd love to hear your reflections.

CS: There's so much there. I think for me it's helpful to imagine the visual that goes along with this, which is a box on the left hand side, which is related to the loss-oriented, which my shorthand for understanding this is looking back for the past. And then on the right hand side, a box for restoration-oriented. Or kind of like, "What now, what next?" -  forward oriented. And then in between those two boxes, there's a bunch of jagged lines back and forth, back and forth, back and forth. And the oscillation between those two states is really central to the model, it seems. And it's so hard. So if anything, I think it's a little confusing, you know, it's a little less clear cut than like, oh, the five stages because it is messy in reality.

SS: Right! What is the timescale of the oscillations? How fast are you supposed to like, go back and forth? How much time do you spend in one versus the other? Do you have to have that, like an even 50/50 split?  This is a beautiful model, but like, what does this actually look like for someone to try to apply it to their life? I think having your reflections that is is really interesting hearing what that's like.

CS: I think one beautiful thing about it is the idea that we don't have to be really immersing ourselves or don't need to be or you know, the "shoulds" come in about how you should be grieving. You don't need to lock yourself away and like really force yourself to sit in this pool of grief all the time. That actually it is healthy and adaptive to give yourself a break. That's okay, too. And it's such a fine line, I think in all of psychology and in my own life and in clinical work with clients. It's just a fine line between avoidance that is pretty inflexible and can cause problems, so like totally avoiding any reminders of the loved one and like not talking about them or mentioning their name at family gatherings. You know, it can look like that a little bit. That might not be the type of avoidance you want to be engaging in. But on the other hand, that it is okay to dip your toe into it, and then allow yourself to like, watch a silly movie or like, do something new just randomly. You know, start a new tradition is okay. It doesn't have to always be what you did. But I think the balancing act of that...it is hard to imagine, in a way, it's like, it's very tricky, because you have to be present and constantly like sort of monitoring like, what is working and what is not working?

SS: Yeah, and I think what you're attending to at any given moment is also heavily influenced, like how adaptive that is, is heavily influenced by how attuned to your current context is it. So avoidance may be particularly helpful, like you might have times at work where you really need to shut it off and just not think about that so you can get other things that are important to you done. Another issue that the Stroebe and Schut address in some of their later publications on the Dual Process Model, that I think is useful when we're thinking about how do we apply this to actual humans, is this concept of overload. So these loss and restoration-oriented stressors are not the only stressors that we have going on in our life. And often, bereavement-related stressors can happen on top of a bunch of other unrelated life stressors. This could be like additional losses, it could be major life changes, a job that's already stressful, a move that had been planned. And any other kind of contexts that is putting stress in your life. There's at least one review paper that found that financial stress is actually a predictor of having a harder time adapting to a loss and potentially developing a grief related disorder. And so they make the good point that oscillation is not necessarily going to help with overload. And so when you are feeling overloaded, you have more of these stressors than you can handle. Those probably need a different approach.

CS: Right. In a way, it's a luxury to be able to let yourself fall apart in the more loss-oriented kind of way.

CS: A I think context is another major, major, major thing that probably influences so much very variability in terms of how grieving looks in the context of the death. I think that was something that I was thinking about when learning about the trajectories research. So to my understanding, this is a lot of the work that comes from George Bonanno's lab at Columbia, who really examined a lot of the work about how resilient people are on the whole after really terrible things happen. Whether it is a loss of a loved one, or I think a lot of the research that perhaps you know and are involved with since you're in New York, has come from what happened after 911 and how people responded to that event, for example. So if you could maybe fill us in a little bit more on that world of research: the trajectories. What does it mean to have a trajectory of grief or recovery?

SS: What does grief or trauma, post-traumatic responses, what do those look like over time? And there have been a number of studies in you know, in grief, in different disorders. George Bananno's work was really influential in that his work was one of the first to really emphasize that....Okay, in psychology, we focus a lot on what's going wrong. So a lot of our focus has been on, "Oh, look at all of the terrible things that can happen to someone after they experience trauma," but not taking into account that actually the modal response to really devastating events is that people are okay, over time. And even in that short term, not everybody develops PTSD. Most people go on to, you know, they still experience grief, but it's not debilitating in their lives and they're still able to do things that they want and need to. I think that is where we get some of that perspective about like, "Okay, this is this learning and healing." This is a natural process that happens for most people. But there are places where it can get stuck, or there are things that can happen on top of it that inhibit it.

And so in grief research, one of the first, I believe to look at trajectories... It's very helpful in this work to have a group of people who've all been through the same event at the same time. So the Coconut Grove Fire was a fire at a nightclub in the early 1900s. And the researcher followed people who were in this or experienced the death of a loved one from it over time. And this was one of the first papers to show that people have very different, like, if you were to sort of draw out how they're doing over time, those lines look very different. Some look flat, some go down, and then go back up, and some go down and stay down. I think a lot of the trajectories research tends to find like three groups. My brain likes to call them mild, medium, and spicy. I think I got that from researcher. But essentially, that there's one group that does not have a severe psychological impact of whatever that event was. So they do okay in the short term and they continue doing okay in the long term. There's a group that's initially severely affected, but they do sort of rebound over time, they return to their normal baseline functioning. And there is a group that experiences a really hard time in the short term. And they continue to experience a really hard time.

One of the more recent papers looking at prolonged grief symptoms, after loss, looked up to over two years. And they found in that group of people whose functioning goes down and stays down, there's a subgroup of those who do slowly, very slowly get better. Like at 12 months, you can't see a difference, but at 27 months, you can. You get two classes of people. And so that [study] came out a few years ago, and that sort of made people think about: Okay, so if we're saying that you can diagnose grief-related disorder, which we're currently calling prolonged grief, I have thoughts on that. It's another topic. You know, maybe we need to ask is 12 months and appropriate timeframe? Do we need to look a little further out? So yeah, I think just you know, this trajectories work helps us understand the real variability that we see in individual responses after loss. And that sometimes that has to do with what you're seeing in the short term. But also sometimes that what you're seeing in the short term doesn't predict how someone's going to do in the long term.

CS: Yeah, and I think one study on trajectories was in the Lives of Older Couples dataset. So looking at mainly old white people in I think the Midwest.

SS: The majority of our populations in grief studies, very sadly.

CS: Yes...after the loss of a spouse. I found it very surprising that in addition to the three trajectories that you described, there was also a group in that particular study, where one spouse after the other one died, got better! They had been depressed, and then they were no depressed. And I think in that particular study, I was shocked at the percentages, it was like 10% of people. So you know, it's a particular sample that doesn't generalize to everyone. But I just found that to be really surprising. And I think I find the trajectories research on the whole very surprising because it's the vast majority of people, about I think over 60% in that particular study, who fit the more resilient trajectory where over time, they they didn't have long term, debilitating, I think depressive symptoms was the main way they measured that in that particular study. But I couldn't I kind of couldn't believe that.

SS: Yeah, I think that, you know, that goes back to context. Like I can imagine, you know, I don't recall or know exactly why people were doing better but you can certainly imagine If somebody's in a really bad relationship, or if somebody has a lot of really heavy duty caregiving responsibilities, that is severely impacting their mental health, then things could get better after that loss. Yeah, I think it's good to examine some of the assumptions we have about what we expect people to look like and how we expect them to react after loss.

CS: Yeah, so I think the heartening takeaway is that like, most people are adaptable and can change. And even for those, like you mentioned that maybe two years, it took two years like that's, you know, time and experience that they needed to then recover and adapt. And I think so much of it is cultural, too, because it reminds me, you know, I think just the messaging, we get around it is a whole other voice in the room. And we don't, typically in America, at least have traditions where you wear all black for a year, or have you know, that designated timeframe or space to do it. So then all those other questions creep in about, like, how should this be affecting me? And how for how long?

SS: And you had asked about clinical work in grief. And, you know, one of the things thinking about is, is some of that one question I get sometimes is, does everybody need therapy after grief? It might seem like that would be a good thing. This is a distressing experience, maybe you need professional help. But we actually find that what's really critical is social support. Some people might need to get through that through therapy. Like you mentioned, being able to validate people in experiences that are very normal, but can be not talked about or stigmatized, that they're experiencing or emotions that might seem unacceptable. For a lot of people, they might get that social support through existing relationships that they have.

But grief also changes our social network, the social environment we're in. So I had a research participant once who told me that like one of the really painful things for her about losing her husband was, she had this group of friends that used to like they were all couples, they would all go out on like this double or triple date, like once a week, and once her husband died, they stopped inviting her. And she was saying, like, "I think they're doing it because they think it would be too hard for me to sit there with other couples," or, you know, "It might be painful to talk about, but I actually really miss that. I would love to be there. I would love to, you know, be around other people who knew my husband and be able to talk about him and remember him." And it's unfortunate that there is so much discomfort about grief, both wanting to just and potentially wanting to distance yourself from someone who's going through something so hard, or, you know, in this in this case, like maybe thinking about the fact that their own husbands might die in the case of these couples and not wanting to think about that. But but also not knowing what to say or feeling like, I don't want to bring it up, because I don't want to make it worse. You're not going to remind the person that their loved one has died, they are probably very aware of that. It's not like they just forget, if you don't talk about it. I forget where I was going with that. Yeah, so the idea that, you know, the event of bereavement can ironically distance us from some of our social supports at the time that we need it most.

And that can be where therapy can be helpful. Either strategizing, like how do I talk to people in my life and let them know what how to support me better, or getting support if you don't have support from other contexts or, you know, learning to deal with thoughts that might get in the way of that experience. Like, a common thought is like, "If I allow myself to feel happy if I allow myself to stop grieving, it means I'm being disrespectful or disloyal, or somehow trivializing my relationship with that person. Like, if they really mattered to me, wouldn't I be upset all the time?" So, using CBT techniques can sort of challenge some of the thoughts, or how do you accept really difficult emotions without avoiding them and continue to do do things that are important to you? 

CS: Yeah. That's really interesting there about this idea of like an attachment to like, being actively grieving - not that grieving stops - but this idea of being in distress of mourning, and that that maintains your relationship to the person or loyalty to them. That is something I've also encountered clinically. And it's interesting. I think a lot of people's actually helpful response from friends and family is like, “Oh, well, that person that you lost would want you to be happy and would want you to move on.” And I actually think that’s meaningful. It's like, okay, your joy that you're still living out can be a dedication to the person you lost. 

And I think that's a part of the restoration-oriented end of things that I wanted to come back to about identity, and how figuring out who you are now in the absence of this other person is a process of, of creating again, or making meaning out of it. One thing that I have personally found helpful for that is sort of thinking about, like, you know, over the holidays and noticing the absence of my dad, who is a very fun loving, like, gregarious person, like, he would be the person like, you know, you walk in the door, and he asks, If you want, like some champagne, or you know, is very welcoming, and that way. And over Christmas, all of us were kind of like, obviously, down in the dumps, it was pretty fresh. But just noticing there wasn't someone to like usher along the events of the evening, as much. It wasn't like, okay, let's have like, drinks now. And like, cheers. And like, then we'll like have dinner like it like the just the transitions of the evening, I noticed were a little bit absent. And I was like, "I can do this!" I can be the person to like, not exactly fill his shoes, but like to step up in this moment and try to embody that quality of like, "Let's toast to being together and like everything we've been through" or you know, just like trying take on those qualities that I miss about him, myself. 

SS: That's such a lovely way to really bring the things that you learned from him in your relationship from him into the present and into your current relationships.

CS: Yeah, it's a work in progress, for sure. But I think that idea that like, joy or positive emotions... giving yourself permission to continue on with that is part of the grieving process too.

SS: Reminiscing is really important. Being able to share remembrances and revisit those times, not in the hopes that if we spend enough time there that somehow we will get into that counterfactual reality where the death didn't happen. But really saying this happened, this matters. I'm going to spend time thinking about and enjoying that this happened.

CS: Totally. I mean, there's been so many things that like... one thing that I do appreciate when I've been with my family since my dad died is that there have been times when someone but usually my sister or me or my mom would have said like, "Dad would have loved this thing." And like, of course, that put paints like a really bittersweet tone to it, but it's sort of just like, oh, that's what things feel like now. And like, I would rather feel all of it rather than like not doing anything that reminds me of him anymore. These are the examples that are coming to mind as I think about like what this oscillation means or like, I don't know think feel different, for sure. It's more mixed emotions a lot of the time.

SS: Yeah, it's that that flipside, like pain is the other side of love. You can't really have one without having the other.

CS: Well, this has been a lot of food for thought. Maybe I'll kind of move us into final thoughts. So I suppose, are there any other aspects of these models that you would want people to carry with them? Aside from what we've talked about - or even from what we've talked about - what are the takeaways? 

SS: I think one of the takeaways for me is just thinking about how learning happens. We don't unlearn things. Actually, Mary-Frances and I talk a lot about your your grad mentor's Inhibitory Learning [theory]. Like, you don't you don't unlearn things, but new learning has to happen on top of it. So I think that's, that's one important piece for me. And that really challenges the idea that in order to be healthy after loss or healthy adaptation means that you're detaching or that you're moving on.

Somehow, I think other aspects of models that I appreciate are, I think a lot of them converge on the idea that you don't have to lose your relationship or give up your relationship with that person. But the relationship has to change in a way that allows it to accommodate what is currently happening. And when that model cannot change, that's where we see problems. But you don't have to throw out your relationship with that person. You just need to... It needs to be a little bit different than it has been before.

CS: Yeah, so I'm just letting that sink in. That's a really nice connection to my own research in grad school. And I just think that's worth repeating: we don't unlearn things. We have to learn new things if we want to change. And so some some of that idea comes from my graduate mentor, Michelle Craske, who's done a lot of work on how do we overcome fears and anxiety disorders in particular. And how she has adapted exposure therapy to be consistent with the ways that we know that our brains learn best. And specifically that if we're not erasing our old fears, we actually can't get rid of them, we just have to learn enough new experiences to soak that in so that we can continue to move forward. 

Which I think is really interesting and I think has made me think of like other metaphors that are similar to this, that I've just, like, popped up through my mind about like, just in my own experience of when I've been feeling the worst, and like thinking about, like plants that I've forgotten to water, and how like, yeah, there will be like, you know, a part of the plant that then like looks a little scraggly for a time, but then you can water it again, and the new part on top will continue to grow. So it doesn't get rid of the part that has been through that really hard experience. But you have to kind of build on top of that or keep going. That was just one image that came to mind. I was also thinking of like, I don't know, just going to nature for other ideas like lizards who can regrow their tails. How does that work? Does it does the tail grow back in the same exact way? No! It probably will be a little smaller and like there's going to be evidence of what has happened to it still. But does that new new tail help it balance or do whatever tails do? Sure. So you can't erase what's happened, but you have to figure out how to continue. The new learning that has to occur.

SS: Absolutely. What is it been like for you reading all of these sort of like scientific potentially sort of dispassionate and debates about something that you are personally going through. Like at that moment? That might be a hard question.

CS: Well, I think it intersects with how I cope with things. Going an intellectual route is natural for me. And it's easier in some ways to be in that headspace. I think I have an insatiable curiosity for things. So I think a big part of me was like, this is interesting. And that made me want to read more about it. And I would say I didn't necessarily feel invalidated reading about all these different models. Moreso I was just sort of like, "Whoa, like, I'm stepping into a whole swirling, intense realm." And I think then at that point, I was, I was kind of like, okay, like, I want to take a step back now, because this is getting in the weeds of what I ultimately don't love about academia is like getting too carried away with like, what's "right" and kind of losing sight of like, what matters, at times. But like, I think it's, I'm most interested in marrying the two: What can we learn and study? And then what can we kind of take away that like, actually has heart to it? So that was my experience reading through the literature on this.  And I appreciated how you mentioned earlier, and so does Dr. Mary-Frances O'Connor, that neuroscience is one lens through which you can understand grief. It's certainly an interesting one. Like, that's kind of how I also got into [research]. Originally, I did more like fMRI research and have gone on to other ways of looking at psychology, but I just find it interesting. But it's certainly not the only or not the best way. It's one lens.

So I think it's so important to just be like, humble. I like have a really strong value of humility that I think I've developed - and I didn't always - but through the study of such heavy topics, I guess I would say that really like impact people's lives. It's like I think that's so important.

SS: Yeah, I really feel that especially coming to grief research as.... I have lived experiences of a whole lot of other things. Grief is like the one thing that significant loss is not something I actually have personal lived experience of contrary to like, a million other things I could be studying right now. So it's been really interesting to me to try to keep that humility in mind. I get a lot out of, you know, what do research participants say like, how do they describe their experience? How do people that I talk to describe their experience the philosophy like phenomenology papers about first person subjective nature of grief? Yeah, really coming to that and trying to think, at the end of the day, like all of this brain stuff is really cool. I think it's, I think it's interesting. I think it's useful. Not only just because the pursuit of knowledge and knowing stuff about the world is useful, but I think there are ways that it can be helpful. Especially because grief is this pretty small research area, at least in the neuroscience like relative to depression and or PTSD, being really like okay, what I say is going to probably be pretty influential. Because there's not a lot of like other voices and so really trying to I don't know hold all of my ideas lightly and be open to other perspectives.

CS: Yes, I think more more voices like that in the field of psychology or anything related to mental health is very needed. Well, it's been so lovely to talk with you about this. I found it very validating for you to email me and say like, yeah, it is complicated, like, thinking about all of these things. And I think like talking with you helped me understand. I think so many things, but I think I'm just left with like this idea of like, time and experience. “Time and new experience” is one of the phrases that's hanging around right now.

SS: Yeah, this has been so much fun to connect with you about this and about something that is not about fMRI troubleshooting! That's been especially fun. But also, yeah, just really, as I said before, I really value your your perspective as a scientist and a human being going through this.

CS: Thank you.

Thank you again to my guest Saren Seeley. You can find her work at sarenseeley.github.io including some really great science writing that she's done.

This podcast is for informational and educational purposes and is not intended to replace professional medical advice.

Thank you to Grant Carey for helping to mix and edit this episode. Music is the song "Escape" by Sandwoman, which you can find on your favorite streaming services. Thank you so much for listening, and see you next time.