The biology of grief and the Lung according to TCM
The loss of someone we love is life-shattering, and few question the emotional toll it takes on us. The initial shock (even when the loss/death is anticipated) is followed by a complex constellation of emotions that can include sadness, anger, bitterness, guilt, worry, anxiety, distress and despair.
In her 1969 book, On Death and Dying, psychiatrist Elisabeth Kubler-Ross identified five stages of grief—denial, anger, bargaining, depression and acceptance—that people go through as they reckon with the reality of a terminal illness. These stages were later applied to family members and friends as they grieve the loss of a loved one. Today, there is growing recognition among experts that grief is a far more complex experience. In fact, the stages-of-grief model has largely been debunked, replaced with the understanding that each person's course of grief can vary widely.
Rather than being a linear progression of stages, grief is better thought of as a long and winding road, with set-backs, detours and dead-ends. Eventually, many people do find that time does help heal the wound—as they gradually adjust to the loss and the intensity of their grief slowly declines, they find other ways to experience meaning and enjoyment in their lives.
Yet for some people, grief does not subside. Rather, it becomes intractable. Studies suggest that about 10 percent of bereaved people do not experience any relief even after 6 –12 months. They remain stuck in what has been termed “complicated grief” —feeling overwhelmingly “trapped” by their loss, socially withdrawn, and utterly adrift. Often, grief impacts their identity and self-worth, redefining how they see themselves in the world and explain their own life story.
Importantly, grief isn’t just about death—there are many events in life that can trigger grief: a miscarriage, failing health, the mourning of an earlier / kinder time in your life, or the recognition that a dream we once had will not be achieved. Any one of these experiences can leave a deep and sorrowful injury that scars us profoundly and causes us to grieve.
The endangered body
Increasingly, medical science appreciates that the impact of grief extends beyond the psychological. It’s effect is also physical—“solid” if you will—transforming our body as much as it impacts our mind and spirit. There is a reason why we talk about being “heart sick”—how we think and feel has a very real impact on our bodies. In particular, grief stimulates the brain to send a cascade of stress hormones to the cardiovascular and immune systems that can ultimately change how those systems function. As a result, grief can increase the risk of certain diseases and even lead to death.
Psychologists at Rice University have reported clinical evidence of the links between grief, depression and changes to the immune and cardiovascular systems. In one study published in 2019, psychological assessments were administered to 99 bereaved people three months after the deaths of their spouses. Importantly, blood samples were also taken. Those who experienced higher levels of grief and depression were also found to have higher levels of the immune system’s markers for inflammation circulating in their blood stream. Chronic inflammation can contribute to cardiovascular disease, Type 2 diabetes, and even some cancers. A study published in 2012 found that those with higher scores on grief assessment tests also exhibited increased levels of cardiovascular clotting factors, raising the risk of developing blood clots. Finally, a meta-review of 20 research studies, published in 2020, found that people who scored higher on psychological measures of grief also had higher levels of certain stress hormones like cortisol and epinephrine. Over time, the chronic stress from prolonged grief can increase the risk of cardiovascular disease, diabetes, cancer, autoimmune conditions and depression.
Studies have shown that following the death of a spouse, people are more likely to report worse overall health, aggravated physical pain, and greater vulnerability to infection. Moreover, research among bereaved parents and spouses shows that in the first 3 months, they are nearly two times more likely to die than those not bereaved; after a year, they are 10 percent more likely to die.
The hurting brain
In addition to its emotional and psychological shock waves, grief can also have a profound effect on the brain. The fact is, grief takes up a lot of bandwidth in the brain, and after an emotional trauma, much of the brain is occupied in managing the stress associated with it. Our brains respond to grief by suppressing emotions and memories that we're not ready to handle. Such stress activates a remodeling of our neural pathways known as neuroplasticity. In the case of grief, disruptions in brain function manifest as confusion, disorientation, detachment and forgetfulness. It explains why the bereaved are often not as organized or attentive (and don't have as much cognitive flexibility) as usual. In fact, a 2016 study in the journal Neuroimage found that people who had persistent, intrusive grief experienced disrupted activity in the prefrontal cortex—as seen on functional MRI (fMRI) scans—during tasks that involved emotion processing.
Following emotional trauma, triggers in our environment such as daily reminders of loss, may repeatedly activate the body's fight-flight-or-freeze response. This can lead to a vicious cycle of distressing dreams and insomnia at night, and rumination and hypervigilance (a state of heightened awareness) by day. In this situation, the brain goes into overdrive, and we feel anxious and under threat.
Grief and its relation to the Lung in Chinese medicine
In the world of Chinese medicine, each of the major emotions is associated with a Yin-Yang pair of organs. Grief is strongly linked to the lungs and large intestine—organs that TCM defines as “Metal.” Consider that both of these organs fundamentally allow us to excrete that which we no longer require. In the case of the lungs, they take in oxygen-rich air and expel poisonous carbon dioxide. The large intestine helps process the sustenance that is no longer needed once our body (small intestine) has extracted the nutrients it needs from it.
This “cleansing” function of the lungs and large intestine isn’t just limited to the tangible production / disposal processes of the physical body. Our Metal organs also process emotions in the same way. When we experience grief, our mind-spirit produces emotions that are necessary for expression in a moment of loss. Importantly, these emotions are natural and healthy. But in many cases, the Qi of these emotions can become stuck, leaving us unable to move forward. It is not uncommon during times of physical or emotional crisis that the flow of Qi becomes blocked, resulting in prolonged pain and other symptoms that can be debilitating and unhealthy. Acupuncture and herbal medicine can help clear those blockages to rebalance and reinvigorate the Metal organs.
In my own clinic, I have treated numerous patients with chronic lung issues, asthma, habitual cough and debilitated immunity (as well as digestive issues and constipation, related to the large intestine "holding on") all linked to prior events of grief / loss. This parallels western research findings (although the mechanism of action is quite different) that show how grief makes us more susceptible to the common cold and flu, as persistently elevated levels of stress hormones reduce immunity and decrease our ability to fight off bacteria and viruses. Moreover, if someone has a physical lung-large intestine illness before the loss of a loved one, grief may likely worsen this existing condition.
Healthy ways to process grief
After the loss of a loved one, the sadness can be overwhelming. To reduce the chances of it turning into prolonged, complicated grief, consider some of the strategies below to help you get in touch with difficult emotions and restore your body-mind-spirit.
Focus on yourself. It's important to take care of yourself with healthy eating, drinking, exercising, meditation and sleeping habits. Not only do these things make us feel better, they can help us defuse anxiety and sadness, so that we are better able to look after ourselves and others who are grieving, too.
Keep a journal. Writing about your loss and feelings can be therapeutic because it allows for raw emotional expression without the filter of social constraints. It can also help you make sense of what you're going through and even give you a different perspective if you ask yourself: what do I want to learn from this experience?
Express yourself. Engaging in creative activities such as painting, music, photography, or dance can help you process grief, express your emotions, and regain joy.
Embrace new experiences. Whether you go to the theater, travel with friends, or a new sport or hobby, doing new things can give you a sense of meaning and pleasure in your life. Similarly, volunteering for a worthy cause—perhaps an organization or charity your loved one supported—can facilitate healing and promote a sense of purpose.
Surround yourself with supportive people. As human beings, we are wired for connection, so it's important to have at least one other person you can speak candidly to about your loss. We need others who can listen and comfort us to grieve well.
Arrange for counseling. After a loss, people shouldn't hesitate to reach out to a grief or bereavement counselor. Counseling is an opportunity to express your emotions without fear of judgment, which can allow you to process your emotions better.
Consider acupuncture. Because we can often feel “stuck” in our grief, acupuncture can be a very effective way to help us process and move through our grief, help the free flow of feelings, and re-establish the forward momentum of life. Acupuncture and herbal medicine can also help with insomnia, reduced appetite and energy, compromised immunity, and elevated stress often associated with grief.
Grief is a healthy, normal and necessary process of letting go. But ultimately, grieving isn't just about loss. It’s potentially about what we may gain as we reinvent ourselves and grow. If we take care of ourselves, surround ourselves with supportive people, look for new opportunities, and try to process the loss we've experienced, we can help ourselves reach a new emotional equilibrium. There is increasing recognition of a phenomenon known as post-traumatic growth, where people experience positive psychological, social or spiritual changes after emotional trauma. While it’s true that healing takes time, post-traumatic growth requires insight. As we acknowledge the impact our loved ones had on our lives and gain perspective on the difficult and unexpected turn our lives have taken, grief can even help us to consciously make meaningful choices as we go forward in life.