Stages of Grief

Stages of Grief 

People grieve all over the world. They generally reserve their deepest mourning mostly for the same thing: the death of a loved one. Grief is powerful.

In her book “On Death and Dying”, Elisabeth Kubler-Ross examined what people go through when they discover that they have a terminal disorder. She said that they went through stages of grief. The named of theses stages have become part of the public conversation about grief:

• Denial: This is the first stage, when a person first hears about their disorder and pretty much refuses to believe it.
• Anger: This is the stage when it begins to sink in that the person is terminal, and it really makes them angry.
• Bargaining: This is when people try to negotiate their way out of the bad news. The bargaining can be directed at God, usually an attempt to stave off the inevitable.
• Depression: This is when the person understand that there's nothing he or she can do – nothing will stop the bad stuff from coming.
• Acceptance: This final stage is mostly an emotional white flag. It's often accompanied by a feeling of peace, however bittersweet it may be.

Not everyone experiences all five stages when they grieve – nor does everyone go through the stages in the described order when the stages were present. Some people flit between one stage and another, moving back and forth between them.

Kubler-Ross, more than anyone else, has put our grief responses to death and dying into the public discourse. That includes the research world, and because of that, we owe her a great debt. However she published her book in 1969, a time when our understanding of how the brain works was much more primitive that it is now.

Almost everybody suffers memory loss with aging. Almost everybody suffers from something we call refocusing problems with aging. There are ways to slow down the cognitive decline -or, better, to substantially delay the inevitable. Social interactions and exercise can slow the natural erosion of the aging brain.

 Sadly, memories are susceptible to degradation with time. A cemetary. Photo by Elena.

Happiness and Its Absence

Happiness and Its Absence

Nature is hardly the whole story regarding happiness, of course. Psychologist Martin Seligman says that set ranges are only part of the story – that a great deal of happiness includes environmental factors and choices that are completely under your control.

What research says makes you happy can be summarized in two sentences: Relationships make you happy. Money does not. One of the most potent surefire ways to sustain happiness in your life has to do with relating to other people – for example, cultivating and maintaining lots of friends. The more friends you have in your life, and the more you interact with them, the happier you are statistically likely to be.

Another aspect that science knows about making people happy is the amount of time people spend seeking out how to make other people happy. One of the greatest predictors of happiness turns out to be how outwardly focused you are on the needs of others, including volunteering and doing charity work. People who give out of the abundance of their heart are at lower risk for depression. They seem to receive as much as they give.

One counterintuitive idea concerns what does not make you happy: money. Pas a certain amount of income – enough to keep you our of poverty – more money doesn't make you statistically much happier. Millionaires are not substantially happier than even the lower middle class.

The absence of happiness is depression. Depression is serious; it can be life threatening. At its core, depression is an unusually negative reaction life. But it's not just feelings of being blue, which might occur, for example, after a divorce. And it's not just bereavement, which might occur, for example, after a death. Those are all normal reactions to life's hard events – not depression.

Depression involves a profound change in mood that explicitly affects a person's ability to function. There is often a chronic hopelessness associated with it. This type of hopelessness, which is described by an idea called learned helplessness theory, is usually accompanied by other changes in behaviors.

Sometimes, stress is our enemy. Some other times, stress responses are our evolutionary friends. Photo by Elena.

If you go down the depression road, you not only feel hopeless, but you also feel different. Your sleep habits often change; you either start getting too much or not enough. Your eating habits become altered. You lose the ability to focus and to make decisions. You quit enjoying things that used to bring you a tremendous amount of happiness. A hallmark is a loss of interest in sex.

Depression affects many people. About 17 percent of all Americans will experience it at some time in their lives. It also skews in the direction of gender. Upward of about 25 percent of all females experience depression (that statistic is an overall lifetime risk); upward of about 10 percent of all males will.

Depression also afflicts people in different ways. About 40 percent of anybody who suffers a major depressive illness do so exactly once, recover from it, and never get it again. About 50 percent of people who suffer a major depressive illness don't get that luxury: It will recur again after a period of recovery. About 10 percent of the people get depressed and never recover. This is called chronic depression.

There is a severity issue to contend with as well. Some people get severely depressed. Some people don't experience depression but deal regularly with something called dysthymia, which is a low-level depression that tends to stay with you for years. You wake up in the morning and are immediately persuaded that life sucks, and that low-level blue mood follows you throughout the day.

Dysthymia is not as intense as depression, but it is a mood disorder. And it's not all that uncommon. About 2.5 percent of all Americans will suffer from dysthymia at some point in their lives.

Both depression and dysthymia are opposites of happiness. The interesting thing about depression is that these days it is very treatable. Taking advantage of mental health services if you are depressed is about the smartest thing you can do.

The biological origins of depression have been under investigation for decades, but it has yielded its secrets only grudgingly. We know that some types of depression involve an aberrant balance in the concentrations of neurotransmitters between specific neuronal circuits – specifically, their reuptake, which is where one neuron spits out a bevy of neurotransmitters to its neighbor during signal transfer. 

Reuptake is recycling. It's the process whereby neurotransmitters return to their origin. A change in the balance of this trafficking is thought to undergird the disorder. Depression is often called a chemical imbalance, in part because of this insight.

Progress is certainly being made. We've tried to learn about depression by examining closely the molecular mechanisms of the of the most prescribed classes of drugs: antidepressants. There are many kinds of antidepressants. One of the most popular classes of antidepressants is selective serotonin reuptake inhibitors (SSRIs). They appear to be inhibiting the reuptake process and, in so doing, make some people's moods substantially better.

There are many mysteries regarding what antidepressants may or may not reveal about the disorder. First, many antidepressants take a long time to exert their therapeutic effects. Six weeks is not unusual. Second, they don't work for everybody. A person often has to go through several antidepressant medications, or several concentrations of a single medication, before he or she arrives at an effective dose.

(From Your Best Brain, Course Guidebook, by Professor John J. Medina).

There are many practices known to reduce stress in the vast majority of people, from deep-breathing exercises to progressive muscle relaxation. Photo by Elena.

PERMA

PERMA

Many scientists have researched what sustains subjective well-being over years of life. Martin Seligman has codified his research, as well as findings from others, int a five-letter acrostic: PERMA, which stand for the five foundational elements people need to be experiencing to maximize their Subjective Well-Being (SWB):

Positive Emotion: To keep the dogs of depression away, you need to be regularly experiencing positive feelings and emotions, including pleasure, gratitude for the good things in your life, and hopefulness for the future. People with sustained SWB have a willingness to enjoy the present for its own sake.

Engagement: You should be regularly involved in meaningful activities, including feeling lost in a project. It should be so meaningful that you lose track of time, of where you are, and even of who you are.

Relationships: You should have many positive relationships with family and friends and be regularly interacting with them. Having many relationships is a powerful bulwark against depression.

Meaning: This is the argument to be in constant service to something that is larger than you are, including God, a cause, an idea, or a charity – something that continually forces you out of your own experiences and into the experiences of others. There is actually a prosocial twinge to this idea: Doing good for people by serving something larger than you is another way of doing good for yourself.

Accomplishment or achievement: The idea is to achieve some goal, creating a mastery over some skill in the service of that goal – something achievable so that a sense of accomplishment is explicitly experienced. Running a marathon, especially if you've never done before, is a good example. But this category is not asking you to burn yourself out; it is simply an appeal not to be listless or unfocused, both of which are often experienced by depressed people.

(From Your Best Brain, Course Guidebook, by Professor John J. Medina).

Though not as severe as depression, dysthymia can stay with you for years and is still considered a mood disorder. Photo by Elena.

Happiness

What Makes You Happy?

What is the mysterious substance of happiness? What is happiness to the human brain? What are characteristics and definitions of happiness? What makes people happy and what happens when it is absent and depression comes? What makes most of us happy over the long term?

Definitions and Nature/Nurture

What exactly does it mean to be happy? How do you distinguish it from contentment, satisfaction, or even pleasure? The truth is that we don't know. The words may all be describing something similar. That's another way of saying that semantic differences aren't necessarily biological ones. Words like “contentment” and “satisfaction” are separable phenomenon only if you don't look too closely, with “pleasure” probably having the most unique distinguishing characteristics from the happy pack.

The one characteristic that holds up well regardless of how you define happiness is that everybody seems to experience it differently. The concept is so dependent on individual experience that researches have come up with a different name; the word “happiness” is not generally used. More common are the words “subjective well-being” (SWB).

How does one define happiness in scientifically meaningful fashion? Doing so requires a great deal of asking people about their feelings. This is called self-report. Admittedly, basing research on self-report is not ideal because the data is not always reliable. There are researchers who think it's doable, though – and they get the definitions.

Interpersonal intelligence is the ability to understand, amongst other things, you own intellectual and emotional landscape. Photo of an Icelandic volcanic stone by Elena.

One such researcher is psychologist Ed Diener, who describes SWB as “people's cognitive and affective evaluations of their lives.” Diener has used this definition in a courageous attempt to codify the experience across the United States, th around the world, despite stout intellectual headwinds.

Diener created a test where you can score your happiness and compare your scores to other people's scores from all around the world. It's called the satisfaction with life scale, originally published in the “Journal of Personality Assessment”. You can find this instrument online. There are many variables that go into your subjective sense of well-being, so tests like these have to be taken with a grain of salt. As usual, there are both nature and nurture issues to consider.

A thermostat is a perfect metaphor for the nature side of happiness. Some psychologists believe that we are born with a happiness set point, or set range, like a thermostat in a home. If your happiness is normally high, but then your girlfriend breaks up with you, you will be down for a while.

But at some point your set range gets violated, your feelings get too “low”, and your mood alarm goes off. As a result, you turn on some SWB heat. Eventually, you return to your natural happiness temperature. If your happiness is too “high” - for example, if you win the lottery – the system works in reverse, eventually turning on some SWB air-conditioning. You return eventually to the same happiness you had before winning.

Happiness set points are conceived by some researchers as being more or less a permanent feature of your personality. That means that your set range is in part biologically determined – genetic, perhaps – which means that it's mostly concerned with how well you chose your parents.

There is evidence to suggest that these some psychologists might be on to something. Studies of twins reveal that the SWB scores are experienced alike, regardless of the environment in which the twins are raised.

(From Your Best Brain, Course Guidebook, by Professor John J. Medina).

Our intelligence is a form of self-awareness, whereby you understand your assets and limitations, your strengths and weaknesses. Photo by Elena.

The Brain

The Brain

What happens to specific regions in the brain when you feel anger and fear? Before you became angry and fearful, you had to determine if there was something to be angry and fearful, you had to determine if there was something to be angry and fearful about. This is the evaluation, appraisal, step, mediated in part by higher regions of the brain and in part by the amygdala.

The amygdala is an almond-shaped part of a larger complex called the limbic system. It looks like a small scorpion stuck in the middle of your head. The claws of this scorpion are the amygdalae. You have two amygdalae embedded into your brain, one on the left and one on the right.

The amygdala is the region most responsible for tagging a given sensory input with an emotional message. The amygdala helps generate emotional experiences and also helps in remembering them. It does this mostly unconsciously, out of sight of our awareness. Those talented claws take input from all five senses and return to the brain the beginnings of what may be a memorable emotional reaction.

When you experience anger and fear, signals are sent deep into your brain's interior, arriving at the thalamus, that egg-shaped structure in the middle of your brain that sits on the back of the scorpion. The signal is sent down two neural paths simultaneously once the thalamus is finished with it. One path goes directly to the amygdala, via a highway LeDoux calls the fast path. That may be the emotion part and mostly lies out of your awareness. But not for long.

The second signal is shuttled to the cortical regions necessary for you to consciously process your anger and fear. After visiting the cortex, those signals are routed back at the amygdala. That may be the feeling part – but because it has to visit more brain regions, it's a much slower signal. Not surprisingly, LeDoux calls it the slow pathway.

Emotions and their accompanying feelings have deep survival benefits. Illustration by Elena.

Because the fast pathway is obviously faster than the slow pathway, you may begin responding emotionally to something you see before you're consciously aware of even looking at it. But the emotion will be there when you do, thanks in large part to your amygdala.

This doubly stimulated almond is not alone in processing emotional responses. As the amygdala understands the meaning what you're seeing, it starts alerting some of its neurological neighbors. One neighbor that gets a lot of attention is the hypothalamus.

The hypothalamus lies beneath the thalamus. It's small and thin – only about one-tenth of an inch thick. But don't let its small size fool you. The hypothalamus is also involved in handling the big emotions processed by the rest of the brain, from feelings of stress to feelings of hunger. You can artificially stimulate it and derive feelings of pleasure. You may even feel like projecting your genes into the next generation.

The hypothalamus is not just for romantic and sexual pleasure, though. If you get into a fighting mood as you view something that makes you angry or afraid, you can blame that on the hypothalamus, too. It also controls body temperature, so if your blood begins to boil, you'll know why.

Many regions of the brain are involved as you generate emotional responses. Some of these regions, such as the hypothalamus, alert the rest of the body that some kind of important deliberations are occurring and it had better pay attention.

Many of those bodily processes create chemicals and electric signals that go back to the brain, forming feedback loops. These loops inform the brain about the body's reactions, which in turn modifies the brain's experience of emotions and feelings – and even the behaviors that flow from them. That's why the brain and body are both the cause and effect of emotion, settling the controversy, or at least providing nuance to it.

Many regions of the brain are involved when experiencing anger and fear. Illustration by Elena.