The Grieving Body

Mary-Frances O’Connor: We are all regulating each other’s physiology all the time. We are a system. We are a we. You know, it’s not just you and me. And by understanding how that gets revealed when half of the “we” is taken away, it helps us to understand what it means to have love, to be in a relationship with someone, to be a part of this “we.”

James Shaheen: Hello, I’m James Shaheen, and this is Life As It Is. I’m here with my co-host Sharon Salzberg, and you just heard Mary-Frances O’Connor. Mary-Frances is a professor of clinical psychology and psychiatry at the University of Arizona. And her research focuses on the physiological impact of grief. In her new book, The Grieving Body: How the Stress of Loss Can Be An Opportunity for Healing, she draws from her clinical research and her personal experience to explore the toll that loss takes on our bodies and what this can teach us on how to work with grief. In our conversation with Mary-Frances, we talk about how grieving can be thought of as a form of learning, the phenomenon of dying of a broken heart, how grief can teach us more skilled responses to suffering, and the challenges of rediscovering a sense of purpose in the wake of loss. So here’s our conversation with Mary-Frances O’Connor.

James Shaheen: So I’m here with psychologist Mary-Frances O’Connor and my cohost Sharon Salzberg. Hi Mary-Frances. Hi Sharon. It’s great to be with you both.

Mary-Frances O’Connor: Great to see you, James.

Sharon Salzberg: Hi.

James Shaheen: So Mary-Frances, we’re here to talk about your new book, The Grieving Body: How the Stress of Loss Can Be an Opportunity for Healing. So to start with, can you tell us a bit about the book and what inspired you to write it?

Mary-Frances O’Connor: I think there’s an obvious sort of academic story for me that I’ve been studying clinical psychology and neurobiology for, gosh, twenty-five years now. But maybe the less obvious story is that a lot of what I’ve learned comes through Buddhist teachings around embodiment, that embodiment is a part of how we are in the world. So many of those insights have helped me to understand loss, to understand how we react and maybe how we can react less when we’re really struggling, when we’re really facing overwhelming loss. So I think it’s somehow the combination of this academic background that’s very science reduction-y and also this sort of Buddhist philosophy that I’ve come to understand over time that’s helped me in my own personal life with loss. The book really digs into all of that, actually.

James Shaheen: Right. So you begin the book with the analogy of biking toward an intersection and realizing that you have no handbrakes. Can you walk us through this analogy?

Mary-Frances O’Connor: I love having good metaphors that I can hold on to, and embodied metaphors in particular are easy ones to connect with. So yeah, the idea is imagine yourself, you’re biking along on a lovely day, beautiful trees, you’re coming toward a city intersection, and you reach for your brakes to stop yourself, and there’s no handbrake. And you get that feeling in your body, like, “Oh no, what am I supposed to do?” And then it dawns on you that you’re on one of those beach cruiser bikes, and you have to pedal backwards to slow yourself down. And so you do that, and that’s fine, and you stop before the intersection. But the key here is you’ve gone through that experience. Your body has reacted to the fact that you can’t be in the world the way you’re used to functioning in the world. And I think the analogy then for people who are grieving is the millions of moments where they’re in a situation and they can’t respond the way they usually did when their loved one was a part of this world, and because they can’t respond that way, they have this little internal panic, and then they figure it out and they move forward. But regardless, their body has been exposed again to that bit of stress at that moment, and when this happens over and over again, our body really has to figure out how to absorb this and how to learn to live in this new world.

Sharon Salzberg: You say that grieving can be thought of as a form of learning, and it can also be an opportunity for healing. How so?

Mary-Frances O’Connor: I think what has struck me over many, many years of talking with bereaved participants in my research studies, and then of course, bereaved people in my own life, is that grief is just our natural response to loss. But over time, we really learn: What does it mean to live in the world without this person? What does it mean for my life that this person is not here? How do I live as a person who now has waves of grief that are often way more intense than I had imagined they would be?

And so thinking of grieving as a form of learning, I think, is such a useful lens, because we’ve all been learning, right? From the day we were born, we’ve been learning. So it makes it maybe a little more approachable, this thing that is happening in our life. And I also think it’s an opportunity. So this is another lens that we can think of. And I don’t mean an opportunity that you would want. I don’t mean that loss is something you would choose. If we had any choice in the matter, that would not be what we would choose. But I think when we can slow ourselves down, focus in on what we’re actually experiencing, what does grief feel like to you? It’s different from anyone else. What does it sound like? What do you hear? What do you think? What do you feel? What do you feel in your body? Those are really opportunities. In some ways, grief kind of turns the volume up on everything a little bit. And so by being able to listen to what is happening to you, it’s the opportunity to also learn how to respond to what’s happening in newer or more healthful or even just more intentional ways of responding.

Sharon Salzberg: So as one example of this, you say that during the grieving process, we can learn more skilled responses to suffering, which seems in a way the whole point of the Buddha’s teaching. So can you say some more about that?

Mary-Frances O’Connor: You know, even just the four noble truths—right from the get-go, the Buddha was very clear that there is going to be loss, right? There is suffering. And he points out some of the most difficult and universal losses that human beings experience with aging and death and so forth. And I think the idea is that the problem isn’t in the loss; the problem is in how we understand it, with the next noble truths about understanding that it simply is this way and to understand it not because we’re trying to get rid of it but to understand what it is to feel suffering is in and of itself liberating, right? It doesn’t mean it’ll go away, but it can transform our experience.

Sharon Salzberg: So your book focuses on how we can experience the suffering of grief physiologically, and I’m wondering how understanding grief as physiological can help us support the people in our lives who are suffering, who are grieving.

Mary-Frances O’Connor: We often forget that grief is physiological. You know, we think of grief as an emotion, and we think of people as reacting emotionally, or with their thoughts, or maybe even their behavior changes. But I think we forget that grief is also a bodily response, and I mean that quite literally in the sense that we know that, on average, blood pressure goes up a few millimeters of mercury for people in the first six months after a loss.

We know, on average, that people’s cortisol and stress hormones increase, in addition to the many feelings that many people have of “Oh, I don’t feel like eating anything.” That’s a physical response. Or “Gosh, I just cannot fall asleep now,” or “I wake up in the middle of the night.” These are also physical responses that are very, very common in grieving.

And I think, for me, by remembering that it is a physiological response, I think there’s a couple of things that that does. One is that it helps us to remember to care for our body and, for those around us who are bereaved, to really think about their body, right? Often when we’ve been caregiving for a loved one who’s died, all of our attention has been on the pharmacy trips and the questions for the doctor, and now is suddenly a moment where it is also necessary to focus on your own physical health, to remember, “Oh, gosh, I haven’t made a mammogram appointment in more than a year. I haven’t been to my regular doctor visit. I haven’t had blood work in forever.” And by supporting the body, we provide that cushion for us to sort of get through the learning curve, right? The body will help us to have those resources so that we can have waves of grief and have them not overwhelm us if we have more resources in the body. So I think that’s the primary way that I think about it. Can we care for the body as we’re going through this process? And that means compassion. Doesn’t it, right? That means how can we be compassionate for this body that’s absorbing a blow?

Sharon Salzberg: Do you think that that perspective could change what healthcare looks like for people who are grieving?

Mary-Frances O’Connor: I certainly am of the opinion, and I come from a hospice background, so that probably influences the way I think about this, where in hospice, with a dying patient, we think about all aspects, that pain could come about because of something physical, because of something emotional or spiritual or social. So similarly, I think about the idea that in our healthcare system, as soon as a person dies, when a patient dies, we know that the risk for mortality of the person standing next to that person who died increases exponentially in that moment. So, for a man whose wife dies, the risk of heart disease in the first six months is almost twice as likely to have a fatal heart attack as a man who remains married during that same period, which is just an unbelievable statistic, right? It’s a little less for women, but similarly a very large risk.

And so I think to myself as a health care provider, who my patient is could suddenly be shifted to the person standing next to the bed, to the wife or daughter or best friend or lover or whoever, the neighbor that brought this person in. They suddenly become a patient because their risk for mortality and morbidity has suddenly increased, and how can we as a healthcare system shift our attention to assessing their physical health, potentially following them if that’s useful for them and for us, and then intervening so that if they have a heart attack 24 hours later, have we put anything in place that might help us catch that?

James Shaheen: You know, Mary-Frances, you talk about the phenomenon of dying of a broken heart. So I think what you were just talking about, people who die in close proximity to each other. This happens even among animals, like it could happen with coupled birds or it can happen with dogs. So what can you say about this, this idea of dying of a broken heart? How is it that people actually die from this?

Mary-Frances O’Connor: For me, it reminds me of how they say grief is just another form of love, right? And what it really has taught me, because this is a fact, we’ve known this in very large data sets over many decades now, that this is a real phenomenon. What it really has taught me is that we aren’t actually individuals. Even physically, we aren’t individuals. What I mean by that is our regulation of our cardiovascular system doesn’t end at our skin. So we actually rely on our partner, on our friend, on these external pacemakers who are walking around in the world, right? Because when I get a hug, if I go home from work and get a hug from my partner, my heart rate decelerates. And I can tell you it will do that, and my brain knows it will do that, and I can even just look forward to it, and my brain has my heart rate decrease a little bit. We are all regulating each other’s physiology all the time. We are a system. We are a we. You know, it’s not just you and me. And understanding how that gets revealed when half of the “we” is taken away helps us to understand what it means to have love, to be in a relationship with someone, to be a part of this “we.”

James Shaheen: You know, I’ve found that often, when somebody is suddenly absent, say they die, I take on some of the activities they once did. I begin to emulate their behavior, which is a very strange compensatory response, but it nonetheless happens. And when I read about coregulation, I thought, “Ah, I’m not being coregulated, so I’ve taken it on myself.” It’s interesting.

Mary-Frances O’Connor: Yes, exactly.

Sharon Salzberg: So drawing from your research, you identify two core responses to the loss of a loved one and the loss of this coregulation, which are protest and despair. So I wonder if you can tell us about these responses?

Mary-Frances O’Connor: Listeners might know the work of attachment theorist John Bowlby, and he was a British psychiatrist who studied orphans from World War II and really tried to understand the behavior of these infants. You know, infants can’t tell you exactly what they’re thinking and feeling, right? So what he recognized were these two behavioral and physiological responses that infants had, and he named them protest and despair. What’s interesting is he paired up with a biologist who had seen exactly these patterns of response in animals as well, in birds, just as you were mentioning, James, the protest and despair responses.

So let me just tell you ever so briefly. Here’s another embodied response, a good little story that will help cue what these are. So I don’t know if you’ve ever been in a grocery store and you look down and your toddler is not next to your leg, or you were a child and you looked up and those were not your parents legs that you were next to, right? So imagine that feeling right now, that just sheer panic of, “Oh, what? They’re missing. They’re gone.” And it’s a very energized feeling, isn’t it? You can physically feel what that’s like. Now imagine differently when you realize that they are gone forever and that feeling of, “Oh, no, they’re gone,” and how different that feels physically, how withdrawn and hopeless that feels.

And so these two responses, it’s not that we have one and then we have the other and then it’s over, right? This is a cycle as we learn. You know, every morning, the widow wakes up and thinks, “Oh, wait, my husband isn’t next to me in bed. Oh, that’s right. They’ve died.” So this goes on over and over again as we’re learning: What does it mean? How can I understand the world now?

So protest and despair have different physiological responses, and that’s part of why we see such difficulty in physical functioning. You know, it’s hard to digest your food or fall asleep when your body is doing these other important responses to loss. And what I find interesting, although Bowlby was not a Buddhist, as it turns out, it reminds me quite a lot of grasping and avoiding, right? So that protest of, “No, this hasn’t happened. This can’t be true. I’m not willing to believe that,” you know, and the activity around that, and also the clinging of “This has happened, and it is central to every single thing in my life, and my life will never be different, and I’m clinging to that despair.”

And what is fortunate is it’s so universal, even across species, that in many ways our brain and body knows what it’s doing. So we think of despair as a terrible, terrible thing. But despair resolves protest. You’re not going to go out looking for this person anymore. You’re not going to keep wailing for them to find you if you truly understand that they’re gone. And when that happens, that can be with a moment of despair: “Oh no, they are truly gone.” And so I think supporting despair and protest is important because it’s part of the learning process. And then despair leaves out hope, right? It leaves out the idea that “Yes, this will always be true, they’re not coming back, and my life won’t necessarily be like it is at this moment forever,” right? And it’s often hard to grab that hope in the moment when you’re in the midst of despair. Sometimes I say we can lend each other our hope: I don’t know what your life will look like in the future, but I know it will not look like this, and I’ll be here with you until we figure out what it’s going to be like.

Sharon Salzberg: So even though this is a cycle and therefore probably universal, do you think we have individual tendencies to spend more time, say, in protest or despair? It’s like, as I look at those pairs, I understand them both, I’ve experienced them both, but I really understand despair.

Mary-Frances O’Connor: Yeah, that’s right. Isn’t that interesting? And what’s so funny, so I do think there are individual characteristics in this of what’s our go-to response? What’s our habit? What’s the grooved path we’re used to emotionally responding to in responding to things, to losses? And for me, what I think is interesting is I quite often see if people cannot tolerate despair, if they cannot tolerate that feeling, if they can’t sit with that, they will return to protest. I can think of colleagues where they’re working 24/7, and they cannot allow the despair to happen for them, and so they’re in constant activity, or the marathon runner who won’t stop training, even though they have torn ligaments or whatever, because they cannot bear that feeling of despair, and so they choose protest in a sense instead. Now, I’m overgeneralizing here, but hopefully you get what I mean a little bit.

What we think of as mental health is being able to have moments of despair, being able to have moments of protest, being able to have moments of hope, and to allow all of those to be a part of our human experience without running away from them, without clinging to them. That oscillating through things as they arise, that is mental health. That is being human.

Sharon Salzberg: You give an example of your own experience of despair after your diagnosis with multiple sclerosis. Can you tell us a bit about what you’ve learned from that experience?

Mary-Frances O’Connor: I was diagnosed with multiple sclerosis while I was still in graduate school, toward the end of my time in graduate school, and fortunately, I’ve had a fairly benign version of multiple sclerosis. It runs in my family, so I would say in comparison. Nonetheless, it has brought its own challenges, and certainly, the diagnosis process itself was very terrifying with the idea that I didn’t know what the future looked like for me. I didn’t know if I’d be able to finish my PhD and do an internship and then the rigors of an academic job, and more than that, even, it made it vividly clear to me that we’re dependent on our physical bodies. You know, to be in this world is to have a physical body, and we have very little control over how that physical body plays its course, and the despair of not knowing both what my day-to-day functioning would be like, and also knowing that this physical body would come to an end. In my early twenties, none of my friends were talking about this, right? I was definitely on the far edge of these sort of existential thoughts. And honestly, it was Buddhist training and practice that helped me to learn to live with that uncertainty.

James Shaheen: So, Mary-Frances, you say that grief can also impact our hormones and how our body perceives and responds to stress. So can you say more about cognitive stress theory, especially in the context of loss?

Mary-Frances O’Connor: One of the ways that we’ve been talking about loss is this idea that we form a “we,” and what happens when part of that is taken away. How do we learn to regulate? How do we learn to function in the world in the absence of half of us? But another way to think about it is, as you describe, what in psychology we would call cognitive stress theory. And so, in this case, we think about the idea that on any given day, you have a plate full of things, a plate full of demands in your day, and you can think of the idea that loss is another added demand, another added stress to your plate. We know from research on lots of kinds of stressors, lots of things that get added to our plate, that when we recognize, “Holy cow, there are so many demands on me right now,” and we feel like our other plate—if you think of a scale, one plate is full of demands, the other plate of that scale is resources, the things that we have to meet those demands, and when those two are out of balance and we feel there are more demands than resources, that’s when we feel stress. We don’t have enough or we can’t muster enough to deal with the demands of our world. When that happens, we see the physiological response to that, right? Things like cortisol, which help us to use our energy, right? Cortisol literally is a hormone that helps us use our food in order to respond to demands of the world. And we see these changes in things like stress hormones, which then has all sorts of implications for our immune system and so forth. 

The primary point here is that once we know that that’s how stress works, that we can divide it up in our head to demands and resources, we can think about ways to either reduce the demands of the world in ways that we might be able to—you can have cereal for dinner, and you’re not going to wither away from having cereal for dinner if that’s as much as you can do—and we also can think about how do we increase the resources. Who is it that we can turn to who really soothes us? Or is there a practice we can engage in that really restores our sense of calm? That could be going for a run, or that could be sitting in meditation, whatever that is for you. But I think, again, it’s just a useful model for how to think about what’s happening to us when we often feel very overwhelmed.

James Shaheen: Right. In addition to the stress of loss, you also discuss the stress of restoration—that is, the challenges of figuring out how to live a meaningful life without the person we’ve lost. So can you talk a bit about that process of what you refer to as restoration?

Mary-Frances O’Connor: It was interesting, James, when you said that about feeling like you sometimes take on doing the things that someone who has died was doing before. This is one thing that is often very meaningful for people: How can I carry forward the goals and values of this person who is no longer here? That feels like a very meaningful set of activities for people.

And so it may be a myriad of other ways that we find meaning again in life given that we have this knowledge now that life is fragile and uncertain and precious. And so when we talk about resources, it’s funny to think about the idea that restoring our life has resources as well. You know, we think about focusing on the loss and all of those emotions that people are going through around losses, say, in the fires or after the plane crashes, as we’re thinking about all the emotions and thoughts of what does it mean that this has happened in my life? And also, we talk about the restoration stressors: How do I live? How do I build? How do I find community again? All of those things that are a part of restoring our life, and both are stressful. What’s important is, again, being able to go back and forth between them, to not ignore the loss, to not ignore memorializing what that has meant, but to also not ignore facing the tasks that we have to do to restore life now.

In grief research, we call this the dual process model, focusing on the stress of loss and focusing on the stress of restoration and being able to go back and forth between them, but importantly, knowing more about how we can think about this. I think when we understand how human beings before us have thought about and talked about and interpreted loss, that’s a resource in and of itself. How we find meaning in life is something that Buddhism and other spiritual practices, philosophical practices, agricultural practices, whatever it is—those ways of understanding meaning in life, they take time, they change across our lifetime, but they are a resource as we try to cope with whatever comes our way.

James Shaheen: You mentioned meaning, and part of the restoration process is the rediscovery of a sense of purpose because all of us who have lost others know that feeling, “Oh, what’s the point?,” that despair phase that you described, which includes a loss of purpose, and it takes time and it can’t be forced. That’s why it’s so difficult when you see somebody trying to push someone to get better. In fact, it’s a process. So can you say more about this rediscovery of a purposeful life?

Mary-Frances O’Connor: I’m really glad you said that, James. I’m talking about loss right now from a third-person perspective, right? As a scientist, I look for patterns across people. Each individual person has their own fingerprint, right? They have to discover their own process. It can be helpful to understand studies of how has this happened in other situations, or on average, or what are the patterns we see? But it’s not the same as an individual who’s going through grieving, and that learning, that’s one person, right? So thinking about it that way, understanding that this process will take however much time it takes, there is no expiration date here, and in fact, there’s no end date. There’s no moment where grief is over. As human beings, we will have grief because we’ve had loss, and that will always be true. On the other hand, it also means that we become more familiar with what waves of grief are like. We become better at understanding how to manage them. And hopefully this sense of purpose is sort of a slow upward spiral. So it isn’t just time. If you were in a coma for a long time and you woke up, you wouldn’t be further along in the grieving process, right? It’s not just about time. It’s also about experience. One has to put oneself in new situations in the world that one is in now. You have to go out to dinner with your couple friends and see what it’s like now that your spouse is gone, knowing that it’s going to be really painful, and knowing that you’re going to need support from them. But the first time you go out to dinner, it may be truly awful, and you come home and you think, “Well, I just couldn’t stop thinking about my deceased spouse. That was awful. Why would I do that?” And then you do it again, and the second time you think, “That was awful. But that was an interesting book my friend mentioned at dinner. I should look into that” and the added piece of life around the grief that you have is this slow upward spiral of rediscovering purpose and meaning, and it takes great courage and hopefully lots of support.

James Shaheen: Yeah, it was very helpful for me to read that. I remember thirty years ago, somebody told me when I was in the depths, “It doesn’t go away, but it changes.” And that was helpful. That was allowing for space there.

Mary-Frances O’Connor: You have to be honest with people, right? Like, if you tell them it’s going to go away, they’re going to be disappointed. On the other hand, if you give the impression that it will always be like this pit of despair they’re in right now, that’s not accurate either, and that’s wholly depressing. So trying to convey the nuances of it will never be like this again and also it will not go away is pretty complex. But, you know, the last thing I’ll just say is that I find the physiology here to be quite useful as well. So there’s a Native American tradition in some Native nations where they will cut their braid off when a loved one dies. The symbolism of that I find so moving, and also the outward demonstration that you are a grieving person without having to say anything, I think, is a wonderful cultural message transmission. But the other thing I love about that is think how long it takes your hair to grow. No one says to you, “Why isn’t your hair growing faster?” You know, that’s just a natural process. That is how the body does what it does. And to some degree, I think of grieving in the same way. It will take the time it will take in your individual life and experience.

James Shaheen: You also write about ways that any loss also includes a loss of a part of ourselves, and part of accepting our grief includes accepting that we may not be able to function as our previous selves. Can you say more about this dynamic? You’re also saying goodbye to a part of yourself.

Mary-Frances O’Connor: Absolutely. If we focus on the idea that we’re not one person, that we really have formed this orbiting system of two bodies, it means that when a loved one has been amputated, that we’ve lost a part of ourselves as well. One of the easiest ways I think about this is even in our language. I think of myself as a daughter. My mother died when I was in my early twenties. But I would still use the word “daughter” to describe myself, but the word daughter implies there’s another person, right? The word “spouse” implies there’s another person somewhere. Even the word “best friend” implies that. But they’re words that we use to describe ourselves. And so this idea that who we are shifts when a loved one dies and that we don’t know what that even means that it has shifted. Am I a parent if my child has died? What do I say? How do I answer the question “Do you have children?” All of those difficulties are also understanding who am I now, given that this is the reality I’m living in. This is a piece of that opportunity for healing, to come to understand, “This is who I am, this is how I react, these are the skills that I have learned, this is the way I make meaning out of existence.” These are things that take time and courage and experience and are the authentic living that I think many of us want to be doing.

Sharon Salzberg: I really appreciate, James, your use of the phrase “any loss,” because to make explicit what I think has been really implicit and an underlying theme of this whole conversation is that we can experience profound loss and grief not only when a person has died but in a circumstance or life situation or big expectations or a diagnosis that comes our way. There’s so many instances. And so learning these skills is something that we need, I think, no matter what our personal kind of relationships are happening.

Mary-Frances O’Connor: That’s right. For me, the diagnosis was a real opportunity to be like, “Oh, this is a different kind of grief, but I still recognize it.” So even the protest and despair, like “But I can do everything every day that I set out to do; I’m just going to power through.” That was definitely an approach I had, which, let me tell you, was not super effective.But it was the sort of gut reaction that I had. Similarly, the despair of “I will never go on to become a professor,” which is very much about who I am, or I was seeing it as who I am. So that despair of “That will never happen now,” and that obviously wasn’t true either.

In sharing similarities across different parts of loss and often sharing that similarity of who we are, how we function, then you can see these analogies in some of the skills the way you were talking about, Sharon, that then we face even with good things. You get married, and you lose your single self, the person who could just jet off on the weekend without having to consult with anyone. So even though it’s a good thing, you want to be in this relationship, it can still be a loss, right? So it just feels like helpful ways, or helpful rubrics to think about what’s happening.

Sharon Salzberg: Thank you. So often in times of grief, it can be easy to fall into patterns of avoidance and rumination. I wonder if you can say more first about rumination, how we get stuck in our thoughts and how this can actually be a form of avoiding our experience.

Mary-Frances O’Connor: Rumination, I should just say, is those thoughts that go round and round and round in your head that you just can’t get rid of. They’re very focused on yourself, and often they’re very negative, and they’re also very typical when someone has had loss. The thoughts that go round and round and round are very common, so no one should feel like, “Am I crazy? What is happening?” This is part of how our mind responds when we have significant losses like this.

What’s interesting is over time, how do we think about those thoughts? Buddhism teaches us that thoughts will arise, and thoughts will melt away, and to the degree we can avoid getting stuck, to the degree we can avoid the stickiness of those thoughts, elaborating on the story, the more likely they are to release us, not so much us having to let them go but letting them release us. If we are then focused on the next moment, then a different set of things happens in the next moment. This requires practice. I think this is the whole point, that you have to practice to even understand what that process looks like of thoughts letting you go.

Interestingly, some grief researchers from the Netherlands developed what they call the rumination as avoidance hypothesis, and I think this is just kind of brilliant. So I’ll give you an example of thoughts that grieving people commonly have, which is what a friend whose son died by suicide described as the “would’ve, should’ve, could’ve” thoughts, right? This is, “I should have gotten them to the hospital sooner,” or “The doctor could have run another test and known,” and an infinite number of stories that our marvelous mind can come up with of how things could have turned out differently. And they just go round and round and round and round and are often associated with a lot of guilt or blame, sadness, yearning.

But here’s the interesting thing. If you think about it, all of those stories end in, “And then my loved one lived!” But your loved one didn’t live, right? And that is the reality that you are living in. So all of these stories that you can get caught up in, they’re not related to the world you are living in, and in fact, when we get caught up in the internal generation, in the internal stories, we actually miss what’s happening. We’re avoiding the real moments that are happening in the world, right? You don’t notice the barista gave you this really sweet smile for no reason, because you’re inside your own head, or you don’t notice, “Wow, that was an incredibly pink sunrise,” as I’m standing here in my kitchen, because you’re stuck in your own thoughts.

So you don’t get to have the moment-to-moment opportunities of human experience that we can have. And so I think the skills, the practices, the ways of thinking about the mind that Buddhism brings us can be ways to work with thoughts, to not allow thoughts to prevent us from experiencing the present moment and to not interfere with our experiencing the full range of emotions that could be happening moment to moment.

Sharon Salzberg: As one way of coming to terms with our avoidance, you discuss the importance of learning to be comfortable sitting in silence. I’m wondering if you can share a bit about your own experience of learning to be with your mind in silence.

Mary-Frances O’Connor: Well, it might not surprise you to hear that I love to talk. This has been true since I was a very small child. In fact, I remember writing—I write about this in The Grieving Body. I remember writing penalties in, I don’t know, the second or third grade: “I will not talk in class. I will not talk in class.” And what I came to discover over time was that talking fills the air. It fills my mind. It helps me to see, how’s everybody feeling? Is everybody OK?

When I was in high school, I chose not to get confirmed in the Catholic Church, and my mother very wisely said, “OK, but you have to have a religious community,” which, to her credit, given that she was a very strong Catholic, I thought was pretty impressive. So my closest friend in high school, her family was Quaker, so I asked her, “Well, what do you do on Sunday?” And she said, “Well, we sit in silence for an hour.” And I thought, “Well, if no one’s telling me what to say, I guess I can live with that.” So I would go to Quaker meetings, and I would sit in silence for an hour, and it was excruciating and fascinating. It made me tearful sometimes, which I couldn’t really understand why that would be true.

But the profound experience of just being with people who were together alone in their own minds was really life-altering, and what it meant was then, many, many years later, when I was introduced to Buddhist practice, that gave me more skills for how I could interact with my mind while sitting in silence, which was quite helpful and simply the process of sitting in silence, of becoming aware of my thoughts, of not being afraid, of being alone in my own mind, had a profound physical effect on me as well. If my response to having fatigue with the MS was to try and do more, the profound experience of sitting quietly gave my body a chance to relax and rest, and my body resting changed my thoughts. That was a remarkable discovery for me that, of course, then, is an ongoing practice to figure out what all that means and how to use that and how to enjoy that. But I am very grateful that these traditions both Quaker and Buddhist have offered us how to be in our own mind and body.

James Shaheen: Mary-Frances, you talk about how meditation can also change the ways we talk to ourselves, and you focus more specifically on how your inner dialogue about your pain has shifted through daily practice. So can you say more about this?

Mary-Frances O’Connor: I had the great fortune of having Al Kaszniak as my dissertation advisor.

James Shaheen: He’s the one who, his wife, Mary Ellen, introduced us.

Mary-Frances O’Connor: Yes, and I did not know when I was in graduate school that Al was a practicing Buddhist. But as his career went on and he retired from our university and became a Buddhist practitioner and then sensei and so forth, I was in touch with him and continued to learn from him then outside of academia. But it was actually during grad school that I became aware of the work of Shinzen Young, and it was very helpful in the early stages of my MS. One of my experiences was physical pains of the most bizarre variety. I used to describe, the best I could describe was sort of like my arms were twinkling. There’s probably not really a way for me to say it, but it was sometimes very painful. It was very distracting, and so it was very difficult to work when this was happening and so forth.

Through Shinzen’s work, I came to the realization that it might not have been the sensations themselves that were the problem. And so over time I started to really work with my inner dialogue. That’s a great way of describing it, James. When I would have the sensations, I would think to myself, “OK, you know what these are. This is an alarm that has been set off. But you know what these sensations are. They are because you have MS, and they’re not going to hurt you. This is simply how the MS plays out.”

Now, to be clear, I also took medication to help decrease the sensations. But more importantly, almost, was that I started to just sort of be like, “Oh, yes, I know what these are. They’re not alarming. I know why I’m having them. And that’s not going to kill me. Let me get back to whatever I was doing.” And I will tell you, obviously, it took months and months, but over time, it was much more like, “Oh, I know what that is, and now I can move on,” until it literally was like there was a radio playing in the background, that the sensations were there, but they were not a part of my focal attention anymore. And that inner dialogue shift was what shifted, much more so than the pains themselves. And that was a gift. That was definitely a gift from Buddhist philosophy and Buddhist practice.

James Shaheen: Right. You know, you say that meditation can also change how we show up for others, and you talk about your decision to attend a retreat with Roshi Joan Halifax on Being with Dying. Can you tell us about your experience on that retreat and how it changed your understanding of caregiving and compassion?

Mary-Frances O’Connor: Well, I mentioned that I come from a hospice background and I had been doing hospice work from when my mom had been terminally ill and then after her death for a number of years. But I recognized that it was very emotionally costly for me, so to speak. It was very difficult work. Al Kaszniak told me about Roshi Joan’s program at Upaya in Santa Fe called Being with Dying, and I thought this might be a way for me to be with other clinicians, other practitioners, and understand new ways to think about the work that I’m doing.

Now, the first half of that five-day retreat was in silence. So I can tell you, I did not yet have a daily practice, and that was pretty terrifying for me, the idea that I was going to meet a lot of people and not speak to them. Nonetheless, it was profoundly moving, and I learned a lot, and I’ve been back to Upaya so many times since then, but primarily this idea of being able to attune to one’s own distress when one is with another who is distressed, to be able to distinguish between them. This is the GRACE model that Rosha Joan and others, like Tony Back and so forth, teach.

What was just truly amazing was just a matter of months after I went to that retreat, my father had a heart attack. We had known that he would have heart complications eventually with the aging process he was in. I was able to go and be with him while he was dying, and I think one of the most profound moments in connecting those two things for me was that when I arrived in my little tiny hometown and went to his hospital room, I just sat with him. I just sat with him and let him know I was there. And what was incredible was I was able to calm my own distress so that I could just sit with him. We didn’t have to talk. Seeing his own relaxation, the pain relief, the embodied pain relief that came with my presence, my calm and available presence, was something that I would not have imagined was possible. Why would that create pain relief for him? I hadn’t given him a drug. And so that profound experience only could come about because I understood and had practiced these skills with Roshi Joan and that whole faculty at Upaya Zen Center.

Sharon Salzberg: In that vein, one meditation practice that you say you found helpful is loving-kindness, and you discuss the importance of offering love, even when we may feel like we have no love to give. I wonder if you could say more about that practice and how it’s informed your understanding of the grieving process.

Mary-Frances O’Connor: You know, when I was in my late teens, I fell in love for the first time, and the way I thought about it was that he had caused that, or that I fell in love because of him. Fast forward several decades, I realize now that love emanates from me. Yes, it is a unique chemistry of you and another person, but there’s also an element that is simply the emanating of that love from you. We learn to do that by loving individuals. We learn how that gets generated in us. We learn what it feels like to exude love, but it doesn’t actually require them. As it turns out, your own work, Sharon, has taught me so much about being able to sit and try to locate this emanating love inside oneself. And when you have that ability—that’s the wrong word. When you can find in the present moment the emanating of that love from you, it doesn’t matter whether your loved one is alive or dead, or here or there. Who they are and how they even feel about you is irrelevant because that love is being generated inside of you, and because exuding it has all sorts of benefits. It has physical benefits for me, the individual. It’s shifting the hormones and neurobiological patterns, and that’s a good thing. It’s also affecting every interaction that I have with the people around me when I’m exuding love. When I come on a podcast, I sometimes get nervous, and then I think, “Really, I’m just going to sit and love these people for however long we’re on, and then there’ll be some words too,” and that helps me a lot. I just have to locate that feeling of loving. In grieving, locating that feeling can be very difficult, but it’s still there.

Sharon Salzberg: That reminds me of how I actually began to be able to speak and give talks, which was not the case in my beginning teaching career. It was through the power of loving-kindness that things turned around, much to the relief of my colleagues who didn’t have to give all the talks anymore. So I also want to, just for a moment, talk about my experience of grief and how it’s often a kind of counter cultural experience because the ethic, the shared narrative of many cultures is like, “Cheer up,” or “Get over it.” And so I want to discuss the power of sharing our grief and how this can actually be an act of kindness and generosity in normalizing those feelings of loss.

Mary-Frances O’Connor: Yeah, in this moment in our history and in our culture, we interact with grief and grieving people in a specific way. But across history and across cultures, there is every possible way of expressing grief and responding to grieving people. I mean, the range is absolutely shocking. So the experience, I think, is quite universal. The expression and response are incredibly different at different moments and in different places. And we can see some themes, certainly. But for a long time, we have been in a sort of Western European, American, Australian “Don’t talk about it, cheer up,” kind of response, and “Get over it,” right? I think these are messages we really hear.

You know, I’m going to be perfectly honest. I’m acculturated the same way, right? I’ve talked with thousands of grieving people, and every so often I say something and I think, “Why did I say that? That was so dismissive.”

I think there are alternative ways to express and respond to grief, and what I found is that because it is such an individual experience and because, thankfully, at this moment in our culture, we don’t actually experience the death of a very close person as an individual very often, it’s unusual in some ways that I lost my parents so young, and so what this means is that when we come to the experience, if we’ve never heard anyone talk about their experience, their internal experience, we are so much the poorer for addressing loss ourselves.

I work with this group of opportunity youth, young people who are disconnected from work or school, often because of the juvenile justice system or foster system, and we realized that their lives often went off track because of the death of a loved one in their life, and we also realized that many of them had never talked about it at all to anyone. I don’t know how you understand what’s happening to you in grieving if you’ve never had the benefit of how another human being has thought about this experience. So to me, being able to share what we are feeling, how we’re making sense of it, the thoughts and chaos and feelings, bodily feelings, sharing that makes us all richer, and being able to sit and allow and support that person in whatever moment they’re in is such wealth, as we understand the human experience. So I think what I’m happy to say is I’ve been teaching psychology of death and loss at the university here since 1999, and I will say that our Western culture’s willingness to talk about grief and loss is definitely on a pendulum swing. We are more willing now than we have been in my career, for sure. So that’s something.

James Shaheen: Mary-Frances, you quote the psychologist Erich Fromm, who describes love not as a relationship to a specific person but as an attitude or orientation toward the world as a whole. So how can this understanding shift how we experience and express love, and what role can meditation play in opening us up to this kind of loving? I think here of loving-kindness meditation, for instance, as Sharon teaches it.

Mary-Frances O’Connor: Yeah, you know, that capacity to locate that love in us takes practice. It takes developing control over our attention. Where are we? Where are we focused? You know, it’s there. Can we find it? I think this gets back to this description I was giving of it emanating from us and, and much of my understanding about that came from Erich Fromm. The Art of Loving is a wonderful, wonderful book by him. The capacity to locate that feeling and amplify it, regardless of the context that you are in, regardless of how people are reacting to you, is a marvelous thing.

I had this very recent experience. I was at the gym the other day, just this past weekend actually, and I’d had some tension with my partner. It was a stressful week, and this, that, and the other had happened. As I was choosing the music to listen to while I rode on the recumbent bike, I chose a soundtrack from the time when he and I fell in love, and it was very intentional on my part. I thought, “I want to be back in the headspace that I was in when we were falling in love. I want to think about what’s happening now from where my neural networks were at the moment that we were falling in love.” Music helps you to do that sometimes, so I was listening to these songs, and I could find that just genuine loving place in me, and it shifted my inner conversation with him, my inner conversation with myself, certainly, because of being able to find that love. None of this happened with him present. This had nothing to do with the external him but everything to do with my capacity and then that capacity translating later into action and conversation.

James Shaheen: OK, Mary-Frances, unfortunately we’re running out of time, but I do want to squeeze in one more question. Certainly you have a spiritual practice, a Buddhist-inflected practice, at least, if not a Buddhist practice, and dealing with our mortality and loss is central to every spiritual tradition, or at least it figures prominently in every spiritual tradition, and there are ways of dealing with grief in those traditions. How has science added to your process? Not just your understanding intellectually, but how has it actually helped your process in grieving?

Mary-Frances O’Connor: Oh, what a wonderful question. So science by and large is very good at reductionism, right? It’s very good at me doing a study and discovering that IL-6, the inflammatory marker, is increased in bereaved people in the first year after loss. And that’s helpful because it gives us a different dharma door. This is how I think about it. As human beings, we are this dynamic network of thoughts and relationships and neural patterns and emotions and just this marvelous chaos of interacting parts. Science can be a door into understanding and leveraging some of those parts: If I reduce the inflammation in my body, it turns out my thoughts change, and my mood changes. If I sit in meditation, it turns out my inflammatory markers go down. Those, to me, feel like equally important and interesting parts of the puzzle. Some dharma doors are easier for some people than others.

For me, as a neuroscientist, translating some of our Buddhist philosophy of how the mind works into what modern-day neuroscientists would describe as attentions of processes of attention or concentration or translating them into the physiological processes of good epigenetic shifts when we feel love, that process of translation for me has been important, probably like people translating Sanskrit into English. It’s not going to be the same, but it’s going to give another group of people an entry into understanding our human experience. So I think that for me is how it has all worked together.

James Shaheen: That’s a great answer. For me, reading the book and learning a lot about the physiology of grief reminded me that grief has a life of its own. That was very important. So anything else before we go?

Mary-Frances O’Connor: Well, I just hope that what I find often is when I put these things into scientific terms, it feels very validating to people. I don’t think we should have to put them into scientific terms for them to be validated. But nonetheless, I think that does happen. And so, yeah, I would just encourage people to realize you’re more normal than you think as you’re grieving and you’re just on a curve, right? Nowhere that you are in this moment will be the moment that comes next.

James Shaheen: Mary-Frances O’Connor, thanks so much for joining. It’s been a pleasure. For our listeners, be sure to pick up a copy of The Grieving Body, available now. We like to close these podcasts with a short guided meditation, so I’ll hand it over to you, Mary-Frances.

Mary-Frances O’Connor: Thank you both, James and Sharon. It’s been wonderful to be in conversation with you. I’d like to just have us close with a shift in perspective that I talk about in the book but maybe in the form of a guided meditation.

So if you can just center yourself for a moment, wherever you are, listening to these words, to just feel the stillness in the eye of the storm for a moment, to feel your physical body as it pauses, to be aware of your mind. And if you would, I would ask you to think of the grieving body, to think of what it means to have a grieving body. How can you care for that grieving body? How can you be compassionate, kind, loving to that grieving body? How can you take care of it?

As you allow yourself to breathe, to slow the pace of your breathing, I wonder if you can shift your perspective. What does it mean to be a grieving body? How does that feel different?

Allowing your attention to go back to your breathing, allowing the deepening of your breathing, I might add one more perspective shift. What does it mean to hold a grieving body? Can you hold your body? Can you comfort yourself? Can you offer yourself loving-kindness, as you would offer loving-kindness to a wordless, motherless child? Not in what you say but simply in holding your grieving body.

And when you’re ready, allow your attention to return to the room that you’re in. Thanks to all of you for listening and to James and Sharon for bringing us all together.

James Shaheen: Thank you, Mary-Frances, and thank you, Sharon. You’ve been listening to Life As It Is with Mary-Frances O’Connor. Tricycle is a nonprofit educational organization dedicated to making Buddhist teachings and practices broadly available. We are pleased to offer our podcasts freely. If you would like to support the podcast, please consider subscribing to Tricycle or making a donation at tricycle.org/donate.  We’d love to hear your thoughts about the podcast, so write us at feedback@tricycle.org to let us know what you think. If you enjoyed this episode, please consider leaving a review on Apple Podcasts. To keep up with the show, you can follow Tricycle Talks wherever you listen to podcasts. Tricycle Talks and Life As It Is are produced by Sarah Fleming and The Podglomerate. I’m James Shaheen, editor-in-chief of Tricycle: The Buddhist Review. Thanks for listening!