Bereavement services are always at the busiest in the New Year. Where there are waiting lists, these get longer in January and February. It isn’t hard to come up with possible reasons. Empty places at Christmas meal tables, wistful memories of happier times and the loneliness which follows families coming together, all contribute towards heightened grief. On top of that, bad weather can make travel more difficult and long dark evenings of loneliness seemed to go on for ever. January and February can be depressing for anyone but when bereavement is added, grief related depression exacerbates the low mood.
Yet despite this pessimistic scenario, there is much we can do to help ourselves to lift our mood, whether or not this is accompanied by mourning a bereavement. It’s also helpful to remember that the Covid 19 pandemic has left us all grieving the loss of the life we had before, whether or not we have been bereaved. We are grieving for the changes in our lives, for jobs lost, for the thousands of dead on the nightly news, for friends and family we miss, hobbies interrupted, holiday plans ruined, weddings postponed, and many other cruel disconnections from how things were.
When my bereaved clients get stuck in their grief, unable to move forward, I am sometimes able to explain why they are stuck. This is often linked to their feelings, thoughts and behaviour. Stuck clients will say,
“I know why I’m stuck. I know that what I’m doing and how I’m being isn’t helping me, but I can’t do it any other way. What can I do?”
I say to them,
“The first thing to realise is that you have a choice about what you are doing and how you are being.”
It might be difficult to choose differently, it might feel impossible, an uphill journey that you feel too low to attempt. But it is a choice you have: to stay where you are or try something new.
The sad fact is that in January and February, the chances are that if you choose to stay where you are, you may go into a downward spiral of grief-related depression from which it can be hard to recover without professional help. On the optimistic side, if you choose to make small, one-day-at-a-time steps, you can quickly find yourself on an upward, rather than a downward spiral. Just as the lethargy and inactivity caused by your mood lowers your mood even further, baby steps lead to bigger steps. This leads to a feeling that you’re getting somewhere. You feel better and each step gets easier. Even better, science is on your side. Even baby steps, one day at a time steps, give you access to four wonderful chemicals.
The four magic substances are Dopamine, Serotonin, Oxytocin and Endorphin. You don’t have to take these as pills, because given half a chance, your own body will make them for you. I will explain what they do and how you can get your body to produce them. They all make you feel good in their own way.
Dopamine is known as the reward drug. That warm, satisfied feeling you get when you have achieved something, is dopamine in your brain having its effect. Bereaved people release dopamine when they recall happy memories of the loved-one they have lost.
Serotonin, also made in our brains, is the happy drug. It also helps regulate our sleep patterns. As fast as our brain makes it, it is reabsorbed, so as to regulate the amount we have and keep us in balance. Depressed people don’t have enough serotonin, so doctors prescribe antidepressants like Citalopram, to slow down the reabsorption. That group of antidepressants are called ‘Selective, Serotonin Reuptake Inhibiters’, or SSRIs.
Serotonin is made from an amino acid called tryptophan, which you get from a balanced diet. Tryptophan-rich foods include chicken, turkey, red meat, fish, milk and eggs. For vegans, tofu, oatmeal, nuts and beans.
You can increase your serotonin levels by thinking positively and going outside into bright light. Exercise helps, and a balanced diet may help too.
Oxytocin is sometimes called the love drug. It is produced in your brain and released into your bloodstream by your pituitary gland, which sits just under your brain and above the roof of your mouth. Oxytocin bonds us to other people. We release loads of it when we fall in love. New mums release it in labour and when breast feeding. However, it’s not just about babies and romance. Big tough rugby players, male and female, release it during a match. Stroking our pets and talking to them releases oxytocin – in us and in the pet. That’s why dogs look back at their humans so lovingly. When we are empathic to other people, we release oxytocin, and the person we are empathic to also gets a dose. That helps explain why people often come to love their counsellor. A hug releases oxytocin. Eye contact is the next best thing.
Endorphins are our natural opiate, for pain relief. When we are injured, our brain releases endorphins. Since both physical and emotional pain are experienced in the same brain region (the periaqueductal gray), perhaps we are flooded with endorphins to get us through the first few days of a bereavement. Maybe that explains the numb, “don’t feel anything” mood of early grief.
Strenuous exercise, which pushes us to our pain barrier, releases endorphins, which is why my Fitbit running and cycling friends feel good after an ‘outing’. They’ll also get a dopamine hit from having achieved a goal, and a serotonin hit from exercise and from being outdoors in sunlight.
For the couch potatoes amongst us, me included, we can also get our serotonin from laughter. But it has to be social laughter, that is, laughing along with others and sharing funny stories.
Scientists are still at the comparatively early stages of understanding these four brain chemicals, but they do seem to work together. Increase one, and the other three increase too. Sadly the reverse is also true.
To look at the choices between spiralling up or down, let’s invent two people. Let’s call them Rita and Imogen. Let’s follow their fictitious journey through the bleak midwinter. Both women, aged 57, were bereaved of much-loved husbands in the preceding April, so both had the potential to have grief-related depression (Any resemblance to real people etc.).
Rita had lived alone since her husband died. At first, her daughter Charlotte had phoned every day, but Rita thought that her tears were upsetting Charlotte, so she held them in and told Charlotte she was doing okay. The daily calls stopped, and Charlotte, with two young children and a responsible job many miles from Mum, took to making short, weekly calls on a Sunday evening. Mum always said she was “doing okay, just tired”.
Rita had not kept up with friendships. Her husband had seemed enough. Every evening she closed the curtains at 5.00 pm, sat in front of the telly until late, and stayed in bed until 10.00 am. A supermarket delivered her shopping, so she hardly needed to go out at all. She snacked on high carb, low protein food and hardly ever cooked a nutritious meal for herself. As the winter took hold, Rita became a recluse. Some days she stayed in pyjamas all day. She had never been one for hobbies or reading. Facebook was something her husband had done sometimes, but she had never bothered with it. Her daughter had suggested telephone counselling with a charity. Rita tried it to please her daughter, but there were often long silences, and Rita told “the kind lady on the other end” that it wasn’t helping, and that she’d be okay thank you.
Cut off from sunlight and exercise, Rita’s serotonin levels dropped, and she became depressed, on top of her grief. She would lie awake at night thinking of her husband and of the cruel way he was taken from her. The same thoughts went round and round in her head, so that some nights, she hardly slept. On the days she couldn’t be bothered to get dressed, she felt bad about herself. Her dopamine levels dropped. Deprived of human contact and social laughter her oxytocin and endorphin levels dropped too. Rita was in a downward spiral.
When Imogen’s husband died during lockdown, she, like Rita, was now alone in the marital home. At first, she felt numb. She cried often. She left many things in the house unchanged, so that she could almost fool herself that Mark was coming back, although she knew he wasn’t. Her daughter Melanie Skyped every day and they cried together for this much-loved husband and father. The relief of the tears made her feel better. Nothing was bottled up. In her shared grief with Melanie, she felt a fresh bond, a new connection with her daughter that had, in the past, sometimes been weakened by petty family arguments which no longer mattered.
When Facebook was ‘invented’, Imogen traced old friends from the past, and had met up with some of them before the pandemic. As close as she had been to husband Mark, she had her own interests and own friendship network. Imogen shared her grief with any friends on Facebook who would listen. Some of her old friends were there for her, others disappointed her. Of those ‘friends’, Imogen said to herself,
“Fuck ‘em, I’ll make new friends.”
Imogen talked to strangers as well, by joining bereavement support groups on Facebook. She found that commenting empathically on other people’s sad stories, and offering her love and care to strangers, made her feel better. Empathy releases oxytocin, which lifted Imogen’s mood.
Early in her grief, Imogen had read somewhere, that routine is helpful, so she resolved to cook nutritious meals regularly. When she realised that watching the news was making her depressed and anxious, she decided to watch less of it. She read, she painted (an old hobby) and she dug the exercise bike out of the spare bedroom and dusted it down. She ‘treated herself’ to pyjama days, rather that just let them happen by default. Feeling good about the exercise bike, she took to a brisk walk every time the winter sun shone and quite often when it didn’t. She interspersed her honest but sad social media posts with ‘funnies’, sharing Facebook threads of laughter with friends and strangers. When she was offered a Zoom online support group for widows (“I HATE that word,” she said, “I’m still Mark’s wife.”), she was hesitant, but gave it a chance. For ten weeks she shared tears and laughter on her laptop screen with other men and women in the same boat, as each told stories about life with their partner. When the support group ended, she and the others, minus the support group facilitators, still met on Zoom. New friends, promising to meet up when the pandemic ended.
Imogen didn’t love her husband any less than Rita. Her grief at his death was equally powerful but she was learning to adapt and move forward. By choosing to take control of her life, by being honest about her feelings and by finding ways to take time out from her grief with activities and friendships, she set herself on an upward spiral. The exercise and the ‘sod it, why not sometimes?’ pyjama days, were dopamine-releasing choices in themselves, but Imogen rewarded her walks with a Cadbury’s cream egg as soon as they came into season. The exercise and the sunlight upped her serotonin, the shared laughter and social media exchanges, particularly the Zoom and Skype sessions, were good for her oxytocin and endorphin levels. Imogen was on an upward spiral, and the better she felt, the easier it got to make the effort.
Why do some, like Rita, find it hard to move forward whereas others, like Imogen, manage it well? A lot is to do with personality and resilience. Whilst some people are able to rise to the challenge of a life changed by tragedy, others are defeated by it. Insecure people cling to what they have lost, secure people adapt their love and take memories of their loved one into a new future. Not moving on and letting go, but moving forward together in a new, symbolic relationship. Some people equate prolonged and intense grief with a sign of love. “If I stop grieving, I will feel guilty for not loving them enough”. Would the person you have lost want you forever miserable, or would they wish a future for you? Some people fear that if they move forward, they will leave their love behind and forget the person, forget their smell, their voice. Most people find, to their delight, that moving forward brings the loved one close again.
A word about bereavement counselling. It won’t take away your grief. It won’t ‘make you better.’ However, I believe that it can, and should, help find ways of putting you on Imogen’s path, rather than staying in Rita’s place. I have helped many Ritas, by explaining the possible choices, the neuroscience behind the options, and encouraging baby steps. Once a client chooses a route to the upward spiral, nothing will stop the change.
If you are grieving a loss, of any kind, there is more in my second book.
Reference sources
Barraza, J., & Zak, P. (2009). Empathy toward strangers triggers oxytocin release and subsequent generosity. Annals of the New York Academy of Sciences, 1167(1), 182-189.
Dunbar, R. I., Baron, R., Frangou, A., Pearce, E., Van Leeuwen, E. J., Stow, J., … & Van Vugt, M. (2012). Social laughter is correlated with an elevated pain threshold. Proceedings of the Royal Society B: Biological Sciences, 279(1731), 1161-1167.
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 brain’s reward center. NeuroImage, 42(2), 969–972. https://doi.org/10.1016/j.neuroimage.2008.04.256
Young, S. N. (2007). How to increase serotonin in the human brain without drugs. Journal of psychiatry & neuroscience: JPN, 32(6), 394.