Question: How can someone move on from paralyzing grief?
Dr. Katherine Shear: I will say that we don't know too much about the brain in complicated grief, but we do have some hints that without really processing the loss, the brain remains in a state where there's a lot of activation of the rewards system in when the person is confronted with a reminder of the person who died. And that's more like what happens in a love relationship. So it's as though they just haven't moved beyond the acute grief state and they're still yearning and longing and wishing to – in a certain kind of way, it's kind of like the state you're in when you're falling in love. You know how you're always thinking about that person and wanting to be with them when you're not with them. So it's kind of like that, although there's some recognition there that the person isn't still there.
So it's kind of a great sadness and great yearning and longing that shows up in the brain, it looks like in the early studies. But we so far don't have a medication to really help that. We think that typical antidepressant medication helps a little. We don't know how much. In fact, we're just starting a brand new study to sort of see how much medication might help. But so far, it certainly isn't like a total answer. So you're saying, "Well what is the answer?" And it depends on when it is we're talking about. But if someone early on is having a lot of trouble and they can find someone in their life, someone that they are very close to who's still around and who's willing to kind of really talk to them a lot about what happened and be there for them, they need to try not to avoid what they're inclined to avoid. Now, someone who's going to develop complicated grief may not be able to do that on their own. So they may need to get professional help. But our work centers really very much on a psychotherapy approach to grief as opposed to a medication approach.
Question: What do you advise patients to gain from the grieving process?
Dr. Katherine Shear: It's hard to give someone advice about this. I think to let the natural process be as much as possible, that is to say not to try to think about what they should be feeling or what they should be doing beyond the issue of avoidance. I mean I think because sometimes there's a natural avoidance and I do think it's a good idea to try not to do that. But other than that, to let that natural process unfold, I think actually poets and novelists and those kinds of people do a better job telling us what happens when you do that. And often what happens is a deepening of our humanity and our ability to love and our ability to be empathic with other people deepens through that process. But I wouldn't advise someone to get there because you either do or you don't.
Recorded on November 3, 2009
Interviewed by Austin Allen