June 23, 2023 – Susan Whitmore lost her daughter Erika 20 years ago to a rare sinus cancer.
“I thought the grief was literally going to kill me,” she said. “People often don't talk about how physical grief is, but it's a shock to the whole being. When this grief hit me, I didn't know what to do with it.”
Whitmore, who later became a grief counselor herself, remembers considering, “I don't know how anyone can survive something like that.” Then she began to reflect on her situation. “Maybe I'll survive, but this kind of grief has to do something to my body – to my bones, it causes a heartbreaking, unrelenting pain that goes on day after day, week after week, month after month.”
The grief did take its physical toll. Whitmore began experiencing chest pains that turned out to be a symptom of hysteria attacks. “But I also had other physical experiences,” she said. She eventually developed an autoimmune disease and – now in her 70s – also suffers from hypertension.
“In my work as a grief counselor, I have learned that many people feel the pain of grief in their chest or their stomach, or both, and some describe it as 'an elephant standing on their chest.'”
“Grief pains” and blood pressure
Whitmore's experience and that of her patients is now backed up by science. A recent study has found that severe grief may cause a big increase in blood pressure, suggesting that grief could also be a risk factor for future heart problems.
Researchers on the University of Arizona studied 59 individuals who had lost a loved one up to now 12 months. Participants focused on feelings of separation and connection through “grief recall,” a 10-minute process wherein they were asked to explain a moment after they felt very lonely after the death of their loved one.
Lead creator Roman Palitsky said the study “used an interview in which the bereaved focused directly on their loss. It simulated, in a controlled laboratory setting, what might happen if someone experienced 'grief pain'” – that's, distress related to the loss.
At the time of the study, Palitsky was a doctoral student on the University of Arizona and is now director of spiritual health research projects on the Woodruff Health Sciences Center at Emory University in Atlanta.
The researchers measured blood pressure in the beginning of the experiment after which after the 10-minute grief recall interview and located that patients' blood pressure increased significantly after the interview.
“People's blood pressure increased during this interview, suggesting that these moments of intense grief have noticeable effects on the cardiovascular system,” Palitsky said. “We also found that those with the most severe grief had the greatest increase in blood pressure.”
He and his colleagues desired to conduct the study because grief is just not only emotional but in addition “has significant effects on physical health.” They desired to “find out whether the emotions of grief are responsible for some of these health effects” and hoped the outcomes would “help grieving individuals stay physically healthy by better understanding the riskier period of grief.”
One heart condition linked to grief is takotsubo cardiomyopathy — sometimes called “broken heart syndrome” — a “stress response that causes the heart to swell.” But researchers wanted to review something else: hypertension, which is more common and will contribute to the increased risk of heart attack and stroke that happens after a loss, Palitsky said.
Why does grief affect the guts?
There are several mechanisms that would explain why grief affects the guts, says Palitsky. “It's probably different mechanisms for different people. And it's important to remember that many people experience grief in different ways.”
People “may take less care of themselves, exercise less or drink more alcohol. They may feel isolated and lonely or become depressed. These are all risk factors,” he said.
Some people also experience an immune response that contributes to greater inflammation and poorer endocrine regulation. “But our study also points to the immediate acute effects of grief, which can be very emotionally intense and may play a role in acute cardiac events that are more common after the death of a loved one,” Palitsky said.
Glenn Levine, MD, professor of medication at Baylor College of Medicine and chief of the division of cardiology on the Michael E. DeBakey VA Medical Center in Houston, says grief is a “state of severe emotional distress” that may “lead to an increase in adrenaline hormone levels and, as a result, increased blood pressure and faster heart rate.”
Grief can even have “indirect effects, such as when patients do not take their medications regularly during times of distress and grief,” says Levine, who was not involved within the study.
When grief and trauma meet
An essential a part of grief is the trauma related to it, Whitmore said; not only the trauma of losing a loved one, but in addition the trauma of events which will have occurred before the loss. Trauma causes a physical stress response that may proceed to be triggered long after the event, resulting in post-traumatic stress disorder (PTSD).
“I suffer from severe post-traumatic stress disorder from watching Erika die, and at first I didn't know what it was. It haunted me and I kept reliving my daughter's illness, which made the physical part so much more exhausting and debilitating,” she said.
Not every death of a loved one is traumatic, although it will possibly be extremely painful and devastating, Whitmore said. “My mother died about 8 years ago at age 90. She had lived a full life and was unhappy at the end and her death was a blessing. I didn't need a therapist to heal.” That was very different from the lack of her daughter.
“So figure out if your loss has caused you trauma and find someone who can help you process that trauma,” Whitmore said.
Whitmore is the founder and CEO of griefHaven, a nonprofit organization that gives grief counseling and education. Among the various services offered are private support groups that focus on various kinds of loss — comparable to the lack of a parent, child or sibling — and are tailored to different ages and circumstances of death.
Coping with the physical effects of grief
Palitsky said that for most individuals, the experience of loss doesn't necessarily result in heart problems. “But we recommend that people do not skip regular doctor visits after the death of a loved one, even though it can be an overwhelming time in many ways.”
And remember to protect your mental and emotional health after the loss. “If you find yourself having a lot of trouble coping, it can be helpful to find a little extra support, whether that's staying close to loved ones or maybe seeing a therapist,” Palitsky said. “Protecting your mental health can help protect your heart, too.”