Facts of Life
Grief: Coming to Terms with Loss Six Months After Sept. 11

The Issue
Recent mass exposure to violence and death has lent new impetus to understanding grief and mourning. Millions of Americans have been experiencing varying degrees of shock, numbness, anger and depression after directly or indirectly experiencing the fatal attacks of Sept. 11, 2001. Grief is a natural and temporary, if painful, part of people’s lives. However, deeper “complicated grief” can last for years or decades, causing intense mental suffering, physical health problems and even suicidal thoughts and actions.¹ Increasingly, interpersonal, social and biological aspects of grief are being integrated in research and practice to help people cope with and live through major loss.²

((Page 3))
The Biology of Grief
Grieving following bereavement takes its toll on the body as well as on the mind. Physical symptoms of grief include stomach pain, loss of appetite, intestinal problems, sagging energy levels and too much or too little sleep.

The relationship between bereavement and sleep has generated great interest among researchers as a factor in increased psychiatric and medical conditions and mortality. The strong link between sleep and the immune system suggests that disrupted sleep following bereavement can indirectly affect health by suppressing the immune system.

“Sleep is a vital element in overcoming grief,” says Martica Hall, Ph.D., assistant professor of psychiatry at University of Pittsburgh School of Medicine.

Grieving individuals experience more sick days and hospital admissions in the year following their loss than non-bereaved individuals, particularly where depression is a factor.¹³ In fact, depression is a significant contributor to disrupted sleep, whether the individual is bereaved or not. Intrusive thoughts and avoidance of reminders of the deceased that often accompany prolonged, more intense grief also impair the quality of sleep and health.

“Disrupted sleep is lighter, and studies show that the brain appears more ‘awake’,” says Hall. “We also see increased sympathetic nervous system activity during sleep, including changes in heart rate variability and adrenaline release that accompanies the ‘fight-or-flight’ syndrome.” These factors contribute to poor-quality sleep with resulting fatigue and vulnerability to poor health.

Younger people and those already showing symptoms of stress and depression are most at risk of health consequences following bereavement. Conversely, the most physiologically resilient individuals are those who have worked out effective coping strategies, have good social support networks and maintain a healthy sleep profile.¹³

While there are many variables based on age, expectations and other factors, sound physical and mental health before loss predicts that a grieving individual will cope more easily when loss takes place. “Re-establishing and maintaining regular eating and sleeping patterns is important to maintaining overall health,” says Hall.

1. Prigerson, H.G., Massachusetts Medical Society. (2002). Better bereavement: Coping with the death of a spouse. HealthNews consumer newsletter.

2. Strobe., et al (2001). Concepts and issues in contemporary research on bereavement. Handbook of bereavement research: Consequences, coping and care. (pp. 4-22). Washington, DC: American Psychological Association.

13. Hall, M., & Irwin, M., (2001). Physiological indices of functioning in bereavement. Handbook of bereavement research: Consequences, coping and care. (pp. 473-492). Washington, DC: American Psychological Association.