What Lies Beneath the Grief?
Beyond the Felt Sense
Neuroscience is not the end-all, be-all when it comes to understanding grief and loss, but it offers a growing body of research on how the brain and other bodily systems may respond. The brain is not the main character in every grief narrative; grief is a holistic experience shaped by the body, relationships, identity, culture, environment, and lived experience. Still, neuroscience may offer one perspective on how we perceive, process, and respond to a changed reality following a loss.
Several of the studies cited here focus on older adults, aging, bereaved participants, and people experiencing high or prolonged grief symptoms. Although some studies include individuals and families outside these groups, the existing research may not represent a sufficiently diverse range of people or lived experiences.
I’m also curious about what is available through research, articles, blog posts, podcasts, books, and other written works on grief and loss, especially work that explores how grief and loss intersect with identity, culture, relationships, and a person’s lived experience, as well as how they may affect people.
The brain coordinates processes essential to survival, bodily regulation, relationships, memory, attention, and participation in daily life. Grief may involve systems associated with emotional distress, physical pain, emotion regulation, attachment, memory, attention, and responses to potential threats. Research in this area remains ongoing. These systems are complex, and neuroscience cannot fully explain an individual’s lived experience, let alone the varied experiences of an entire group or culture surrounding grief and loss.
Grief, Trauma, and the Nervous System
Neuroscience may offer one limited perspective on why some experiences of grief feel physically and emotionally distressing or significantly disrupt a person’s life. Research suggests that grief may engage brain regions and systems involved in emotional distress, attachment, memory, emotion regulation, and responses to potential threats. Some of these regions also contribute to aspects of physical pain, but their activity is not specific to either grief or pain (Freed et al., 2009; Kakarala et al., 2020).
Grief may also be accompanied by nervous system responses that people or clinicians sometimes describe using terms such as fight, flight, freeze, fawn, or collapse. These terms may help some people describe their experiences, but they are not exhaustive, universally defined, or specific to grief. Some losses and experiences of grief may be traumatic; however, neither trauma language nor nervous system terminology can fully describe a person’s lived experience.
Polyvagal theory offers another way of conceptualizing how the nervous system may respond to experiences of safety and connection, protective mobilization, or withdrawal and shutdown. Within this framework, the vagus nerve is understood as part of the body’s response to relationships, surroundings, and perceived safety or threat. Some clinicians and individuals find this language helpful when exploring emotional and mental regulation. However, polyvagal theory is one framework rather than a complete or universally accepted explanation of the nervous system, trauma, grief, or lived experience (Grossman, 2023; Manzotti et al., 2024).
Grief can be overwhelming, and loss is often difficult to navigate. Neuroimaging offers another, more specific perspective. The anterior cingulate cortex, or ACC, is involved in several processes, including aspects of physical pain, emotional distress, attention, and emotion regulation. Some neuroimaging studies have observed activity in portions of the ACC during grief-related tasks or exposure to reminders of a deceased loved one. This may offer one perspective on why a loss can feel physically painful as well as emotionally distressing. However, activity in this region is not specific to grief, and findings vary across studies and ACC subregions (Freed et al., 2009; Kakarala et al., 2020).
Many theories, areas of research, and clinical frameworks contribute to how grief and loss are understood. Some overlap or offer complementary perspectives, while others differ substantially in their assumptions, language, and interpretations.
No single framework needs to fully explain the complexity of grief to offer something worth considering.
When Grief Is Felt in the Body
Grief is a whole-person experience. Inner and outer physical experiences can become deeply intertwined, making it challenging to separate emotions, thoughts, and bodily sensations, or to know what may be influencing what. Grief may be felt through changes in breathing, posture, movement, muscle tension, and physical pain. Fascia, the connective tissue found throughout the body, may also be involved in experiences of tension, movement, and pain. Current research does not establish that grief or emotions are literally stored within fascia, but the body’s responses are complex and interconnected (Weiss & Kalichman, 2021). This overlap may raise the question: “What is causing what?”
The phrase “broken heart syndrome” may refer to Takotsubo cardiomyopathy, a heart condition that can be triggered by intense emotional or physical stress. Although many people recover, the condition can cause serious complications and requires medical evaluation. It is distinct from the more general physical pain or distress someone may experience while grieving (American Heart Association, 2024).
Grief may also be accompanied by changes in emotional and physical well-being. One study examined parents and siblings bereaved by the 2011 Utøya terror attack in Norway. Participants reported somatic symptoms, including fatigue and physical pain, as well as substantial rates of insomnia eight years after the attack. These findings come from a particular traumatically bereaved group and should not be generalized to everyone who is grieving (Nordström et al., 2024). Fatigue, physical pain, and insomnia may also occur during grief that is not connected to a traumatic event. However, these symptoms are not specific to grief and may have many contributing causes.
Some studies have observed differences in amygdala connectivity among bereaved participants, including associations between particular connectivity patterns and the severity or progression of grief symptoms. These findings represent associations within specific study populations and do not establish that the amygdala universally becomes overactive or functions differently during grief (Chen et al., 2020; Freed et al., 2009).
“Search and rescue” may resonate with some people as a metaphor for continuing to seek someone who is no longer physically present. What was once familiar, the person’s speech, scent, sound, touch, and presence, may still be expected or sought, even while someone consciously understands that the person has died. The brain, nervous system, and physical self may take longer to integrate the changed reality of the loss.
Grief Is Not One-Size-Fits-All
Grief is not a one-size-fits-all experience. Its effects, expressions, and meanings vary considerably among individuals, relationships, cultures, circumstances, and situations. Researchers have studied reward and attachment systems in the brain, including the nucleus accumbens. Some studies have associated activity or connectivity within reward and attachment systems with yearning and responses to reminders of the deceased. However, many of these studies have involved small samples or particular groups, including bereaved older adults and people experiencing high, complicated, or prolonged grief symptoms (Blair et al., 2022; Kakarala et al., 2020; O’Connor et al., 2008).
These findings offer preliminary perspectives on the relationships among attachment, yearning, and responses to reminders of the deceased. They do not establish that continuing to search for or expect to encounter someone who has died can be attributed to any single brain region, bodily sensation, nervous-system response, or physiological process.
These experiences may reflect the time and adjustment involved as the brain and body respond to the changed reality of an attachment and significant loss. They do not necessarily indicate a loss of contact with reality. Instead, the research may offer one perspective on why certain experiences occur as a person gradually integrates the felt reality of attachment with the changed reality of loss.
A Word on Prolonged Grief Disorder
Prolonged grief disorder is a recognized diagnosis with specific criteria, but it does not capture every person’s experience of grief and loss. For a prolonged grief disorder diagnosis, the death must have occurred at least 12 months earlier for adults or at least six months earlier for children and adolescents. Symptoms must cause clinically significant distress or impairment in daily life, exceed expected social, cultural, or religious norms, and not be better explained by another mental or medical condition.
You do not have to meet the diagnostic criteria to seek support for grief and loss.
However, when these criteria are met, they indicate a significant impact on a person’s well-being that is worth further evaluation. The disorder is characterized by persistent yearning or longing for the deceased and/or preoccupation with thoughts or memories of the deceased. Additional symptoms may include emotional numbness, disbelief about the death, identity disruption, and persistent difficulty reintegrating into life following the death of someone close (American Psychiatric Association, 2022).
Food for Thought
A grieving person may feel as though they are climbing a mountain while also pushing a rock uphill. Seeking practical means of survival in response to a loss and secondary losses, while continuing to navigate daily life with grief, can be just as important as attending to one’s emotional responses and physical reactions to grief. Priorities may shift, intersect, and change with the seasons of grief. Emotional processing matters, but so do practical survival, physical care, relationships, safety, and the secondary losses that often follow a significant loss.
Art Therapy for Support
I support people who are grieving and living with loss. I offer a compassionate, creative space for navigating difficult and sometimes conflicting experiences, including relational trauma, emotional overwhelm, and life transitions. My work as an art therapist is grounded in the belief that trust, compassion, and the possibility of growth are essential parts of the therapeutic process.
There is no single way to grieve and no prescribed stage you must reach. If you are seeking support as you make sense of grief, loss, or a changed reality, art therapy can offer space for both art-making and conversation—especially when words alone do not feel like enough.
This article reflects my professional perspective and interpretation of the available research on grief and loss. It is intended for educational purposes and is not a substitute for individualized mental health or medical care.
When you feel ready, The 3 Brushes, LLC provides in-person art therapy for children and tweens, teens, and adults in Gaithersburg, Maryland. Explore my services or schedule a complimentary 20-minute consultation to consider whether this approach feels like a good fit.
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When words are not enough, support is still possible.
References
American Heart Association. (2024, May 31). Is broken heart syndrome real? https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/is-broken-heart-syndrome-real
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Blair, N.-O. P., Cohen, A. D., Ward, B. D., Claesges, S. A., Agarwal, M., Wang, Y., Reynolds, C. F., III, & Goveas, J. S. (2022). Ventral striatal subregional dysfunction in late-life grief: Relationships with yearning and depressive symptoms. Journal of Psychiatric Research, 156, 252–260. https://doi.org/10.1016/j.jpsychires.2022.10.031
Chen, G., Ward, B. D., Claesges, S. A., Li, S.-J., & Goveas, J. S. (2020). Amygdala functional connectivity features in grief: A pilot longitudinal study. The American Journal of Geriatric Psychiatry, 28(10), 1089–1101. https://doi.org/10.1016/j.jagp.2020.02.014
Freed, P. J., Yanagihara, T. K., Hirsch, J., & Mann, J. J. (2009). Neural mechanisms of grief regulation. Biological Psychiatry, 66(1), 33–40. https://doi.org/10.1016/j.biopsych.2009.01.019
Grossman, P. (2023). Fundamental challenges and likely refutations of the five basic premises of the polyvagal theory. Biological Psychology, 180, Article 108589. https://doi.org/10.1016/j.biopsycho.2023.108589
Kakarala, S. E., Roberts, K. E., Rogers, M., Coats, T., Falzarano, F., Gang, J., Chilov, M., Avery, J., Maciejewski, P. K., Lichtenthal, W. G., & Prigerson, H. G. (2020). The neurobiological reward system in prolonged grief disorder: A systematic review. Psychiatry Research: Neuroimaging, 303, Article 111135. https://doi.org/10.1016/j.pscychresns.2020.111135
Manzotti, A., Panisi, C., Pivotto, M., Vinciguerra, F., Benedet, M., Brazzoli, F., Zanni, S., Comassi, A., Caputo, S., Cerritelli, F., & Chiera, M. (2024). An in-depth analysis of the polyvagal theory in light of current findings in neuroscience and clinical research. Developmental Psychobiology, 66(2), Article e22450. https://doi.org/10.1002/dev.22450
Nordström, E.-E. L., Kaltiala, R., Kristensen, P., & Thimm, J. C. (2024). Somatic symptoms and insomnia among bereaved parents and siblings eight years after the Utøya terror attack. European Journal of Psychotraumatology, 15(1), Article 2300585. https://doi.org/10.1080/20008066.2023.2300585
O’Connor, M.-F., Wellisch, D. K., Stanton, A. L., Eisenberger, N. I., Irwin, M. R., & Lieberman, M. D. (2008). Craving love? Enduring grief activates the brain’s reward center. NeuroImage, 42(2), 969–972. https://doi.org/10.1016/j.neuroimage.2008.04.256
Weiss, K., & Kalichman, L. (2021). Deep fascia as a potential source of pain: A narrative review. Journal of Bodywork and Movement Therapies, 28, 82–86. https://doi.org/10.1016/j.jbmt.2021.07.007
