Ask Dr. Ceren: Complicated grief

Q: My sister passed away over two years ago, leaving my brother in law alone in Chicago. They were devoted to each other and had no children. In order to take care of my sister, my brother-in-law accepted an early retirement package three years ago leaving a high level administrative job. I think he misses his job and his co-workers.

He is quite competent around he house and can easily fend for himself. I call him several times a week and we e-mail each other daily with jokes and news. I wasn’t worried about him living alone because he is fairly young and healthy until yesterday when he told me he rarely goes out except to run household errands. He cried and said he is still mourning my sister. He said he misses her and he imagines she is still in the house with him. He keeps her photograph on the dining table and speaks to her at every meal. Is that weird? What can I do to help him?

A: It appears that your brother-in-law’s grief is unrelenting. He had a devoted, close relationship and the loss is striking. It is not weird to yearn for a missing loved one. Some people imagine the lost person is still there for them and does exist - at least in their memories. This may make him feel better or he wouldn’t’ be doing it. It may seem weird to others who have not experienced such an intense yearning.

People differ in the extent of time it takes for the grief process to lessen. Several factors may contribute to unremitting grief and there may be a variety of actions he can take to help foster the process. Perhaps the tight, nourishing relationship he and your sister enjoyed prevented him from developing other social outlets. It is not too late.

Some people in administrative positions find it difficult to accept suggestions made by others. They prefer to delegate. If he is receptive, you may ask him if he would consider putting his administrative skills to use by working as volunteer to a worthwhile cause, or an agency that he believes in. This would give him the opportunity to get out of the house where he can leave his memories, and to socialize with likeminded people interested in a particular cause. Perhaps your brother-in-law can offer his services to the organization involved with the illness that claimed your sister’s life.

John Walsh, whose child was missing and murdered started an important program to help find missing children. He had a strong cause and is a shining example to others.

There are grief groups available that may be helpful to him. Some people find such groups very beneficial. Sharing grief can be a good outlet and foster healing. Friendships can emerge, but your brother-in-law may not want to face letting go of your sister and may not be ready for a grief group. Like chicken soup, it may not help, but it doesn’t hurt to try it.

You may suggest he explore adult education courses. This would keep his mind busy and also bring him into contact with others.

According to a recent Washington Post report by Rob Stein, unrelenting grief affects about 15 percent of people who have lost a significant person.

Using brain-scanning technology, researchers have found a biological clue that may help confirm the existence of the syndrome and explain why it occurs. It demonstrates that there’s a difference in the brains of people who have unrelenting grief from those who don’t.

Researchers under Mary Francis O’Connor, at UCLA conducted functional magnetic resonance imaging (fMRI) on 11 women with complicated grief and compared them with 12 others who grieved more normally following the death of a mother or sister from breast cancer.

The scans show what parts of the brain are active at a given moment. Each woman was asked to look at a picture of her lost loved one, with words superimposed to remind her of the death, or at similar pictures of strangers.

“In all the women, the parts of the brain involved in physical and emotional pain activated only when they saw the pictures of their loved ones. But in the women experiencing complicated grief, another area also lighted up called the nucleus accumbens, a part of the brain’s reward system. This is the part of the brain involved in knowing that you want something. When people who are not adjusting well are having these sorts of thoughts about the person, they are experiencing this reward pathway being activated. They really are craving in a way that perhaps is not allowing them or helping them adapt to the new reality The same brain system is involved in other powerful cravings, such those that afflict drug addicts and alcoholics. They feel pleasure in thinking about the deceased. They are addicted to pleasurable memories.”

The findings may explain why antidepressants are generally ineffective for complicated grief because they affect a different brain system involving the neurotransmitter serotonin.