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What Is Brain Injury Grief?

Start by defining ambiguous and complicated grief and how the brain feels it.

Pierre Bamin/Unsplash
Pierre Bamin/Unsplash

I wrote previously on how researchers and clinicians have paid little attention to brain injury grief, its extraordinariness, and a stage in healing it. For my latest book Brain Injury, Trauma, and Grief: How to Heal When You Are Alone, I turned my attention to what happens to the brain during grieving to gain insight into how brain injury may create grief and affect the grieving process.

Some clinicians have characterized brain injury grief as ambiguous and/or complicated grief. But the problem with that is that injury itself affects the grieving process. The brain is a physical object and when that physical object is damaged, it cannot function in the usual way of ambiguous or complicated grief. For example, brakes on a car work to stop the car and save the occupant from harm. Similarly, grieving is a process neurons undergo to help the brain’s owner adjust and adapt to a profound loss. But just as damaged brakes judder the occupant and prolong the braking process, damaged neurons may also prolong the grieving process by years or decades, rendering it unrecognizable or “difficult to treat.”

I explore how brain injury grief differs from ambiguous and complicated in my book, setting off on this exploration by first defining ambiguous and complicated grief types and describing how our brains feel (experience) them. The following is an adapted excerpt from the book, Brain Injury, Trauma, and Grief:

Ambiguous Grief

Ambiguous grief occurs after a loss for which there is no closure or clear understanding. We cry without knowing why we cry. Our hearts bleed tears and our brains emotional pain without knowing why. Our souls find no finality in a grave or certain knowledge that a relationship is over either from death or a mutual parting of the ways.

Complicated Grief

Many years ago, some smart researchers interviewed over 1,500 adult couples and followed them as they aged and became widowed. Mary-Frances O’Connor, in The Grieving Brain, chronicled their findings. They developed a model of grieving. Almost two-thirds of the couples in their prospective study showed resilience. They grieved, but had no depressive symptoms. About 10 percent had chronic depression before their spouse’s death, which continued afterward. About 10 percent had chronic depression before but improved afterward. And about 10 percent developed chronic depression symptoms that had not substantially subsided by 18 months, although gradually did by 48 months. The researchers named this last group as having chronic grief.

A group of bereavement and trauma experts convened in 1997 to hammer out the primary symptoms of a grieving disorder. The symptoms are:

  1. Yearning for the deceased preoccupies the person.
  2. The loss causes traumatic symptoms.

Separately, psychologists Margaret Stroebe and Henk Schut of the University of Utrecht in the Netherlands developed the “dual process model of coping with bereavement.” Basically, a grieving person lives their everyday life, while experiencing both loss stressors and restoration stressors. They ricochet back and forth between everyday life, loss stressors, and restoration stressors. It’s like one moment you’re pouring cereal into your bowl, the next you’re sobbing all over your cereal, the next you’re learning how to clean the kitchen because that had always been your spouse’s job, the next you stall over the sink to weep, and then you hear the doorbell, dry your face, and answer the door for your ride to work, smiling at your co-worker.

We’re familiar with loss stressors; we’re living in them. Restoration stressors are things like having to learn how to pay your taxes after your spouse, who always took care of that, dies. At first, you struggle to learn. It feels hopeless; you’ll never learn how to fill in the byzantine forms. You storm and rage; you sit staring at the tax forms. Why did your spouse have to die and leave you with this crushing burden? But bit by bit, the forms reveal their secrets; you master paying taxes; and it becomes part of your everyday life.


The attachment bond to the dead creates a yearning for them. Nature wired our nucleus accumbens to create yearning in us when we’re separated from the person(s) we’re attached to. Like hunger and thirst, yearning is a motivation state, designed to drive us toward the necessities of life: food, water, and living in community, attached to other people. Those with complicated grief show greater activation of the nucleus accumbens than those with typical adaptation to grief. More activation equals greater yearning. Yearning creates a preoccupation with the deceased.

The brain requires evidence through our everyday experiences that its physical encoding needs to change, that the attached person is gone. When a person is stuck in complicated grief, they need help to rewire the brain and slowly adapt to their new life without the attached person in it.

Feeling Grief

When we stub our toe, nerve fibres send signals up to our sensorimotor cortex, which registers the pain sensation but doesn’t give us the qualia—the raw feeling—of pain. The anterior cingulate cortex, which is in front of the posterior cingulate cortex, does. This region directs our attention to what’s important and registers feelings of both physical and emotional pain in two separate but adjacent areas. The insula controls autonomic functions, plays a role in regulating the immune system, and is involved in basic survival needs.

When we lose someone, the anterior cingulate cortex co-activates with the insula to create the feeling of suffering. This co-activation doesn’t end as we heal our grief, but it lessens. You’ll be laughing with friends, watching a movie, when without warning, grief gushes a maelstrom of tears and heart pain. That’s normal. But healing grief leads to briefer and fewer of those moments.

Copyright ©2022-2023 Shireen Anne Jeejeebhoy


O'Connor, Mary-Frances.(2022). The Grieving Brain: The Surprising Science of How We Learn from Love and Loss. HarperOne.

Nakazawa, Donna Jackson. (2021). The Angel and the Assassin: The Tiny Brain Cell That Changed the Course of Medicine. Penguin Random House.

Alzheimer Society. (2019). Ambiguous Loss and Grief in Dementia. A resource for individuals and families.

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