In trying to understand brain injury grief, I learned much about the neurophysiology of grief from Mary-Frances O’Connor’s book The Grieving Brain. One surprising thing I discovered is that our brains hold physical representations of the people in our lives and measure how close they are to us. That led me to think about how brain injury could impair that closeness dimension and damage our relationships with others and ourselves. Following is an adapted excerpt on this topic from my new book, Brain Injury, Trauma, and Grief: How to Heal When You Are Alone.
Mary-Frances O’Connor writes in The Grieving Brain that our brain creates maps of ourselves and others in the posterior cingulate cortex. These maps physically represent ourselves and the people in our lives. Even after they die, loved ones remain physically present in our brains. Kind of remarkable.
The posterior cingulate cortex is part of the limbic lobe, a deep brain structure that is involved in our emotional responses, memory, and other functions, which researchers continue to learn about. This cortex also encodes where a person is in our social space and their closeness dimension.
We know about space and time dimensions, but did you know closeness is a dimension? The right inferior parietal lobule measures distance and relative distances of objects or people in space, time, and closeness. It’s strange to think about how the brain can measure closeness and encode that measurement, but it does. It tells us who’s important in our lives, who we’re important to, and where they are in our social space.
When a person dies, they remain mapped in our brain. Our brain tries to marry the person being gone with its internal physical map and related closeness dimension and biases toward the map over the external reality. We know they’re dead, but our brain’s hardwired encoding of their existence creates the belief that they will return. To reconcile the existing brain map and closeness dimension with external reality, our brain decides we haven’t made enough of an effort to reach out to that person. It creates regret, guilt, and/or anger, social emotions that motivate us to go to the other person and bring them back so that external reality matches our brain’s physical mapping once again.
“It was because your loved one lived, and because you loved each other, that means when the person is no longer in the outer world, they still physically exist—in the wiring of the neurons of your brain.” —from The Grieving Brain
Funerals, condolences, and seeing our loved one’s dead body provide the physical proof needed to rewire the posterior cingulate cortex’s brain maps, thus re-synchronizing the belief with the knowing. Avoiding these actions or rituals delays re-synchronizing.
What happens, though, when brain injury damages the map of your loved one who is still alive? What happens when such an injury erases their closeness dimension and location in your social space? It would be like erasing their existence—the belief they exist—from your brain.
I think this may explain why, when anyone we know is out of our sight, they are out of our mind. But when they return and show themselves physically existent, it tells our brain that they do exist. How long they interact with us, and how much they help and comfort us, can determine if neurons will fire in a particular pattern, encoding a permanent map in our posterior cingulate cortex. But damage to the posterior cingulate cortex, and/or the right inferior parietal lobule, could impede creating brain maps of new people and prevent encoding their closeness dimension and mapping where they exist in our social space. Then, when the loved one leaves, they no longer physically exist either in front of us or perhaps in our brain’s wiring. As you can imagine, that would make forming new relationships difficult.
Since brain injury can damage one function but not another, we may retain brain maps of persons we knew in our lives prior to brain injury, only bits and pieces of those maps, or none at all. Even if previous brain maps remain, we may lose to injury their related closeness dimension and social space encoding. That could lead to knowing loved ones exist while losing a sense of closeness and certainty about where they are in our social space.
Damaged working, short-term, and facial recognition memory could also affect this encoding. As a result, we may neither believe a person is close nor remember they exist. And so, in a subconscious effort to keep them in our mind, we may develop a repetitive need to know where each loved one, or important-to-us person, is at all times. We may feel this need most acutely for those we depend on, such as mothers and health-care professionals, and people we’re trying to hang on to, such as siblings and best friends.
Another Reason to Receive Neurostimulation
Gradually, over the years, my brain has regained the belief, and the knowledge, that people in my life continue to exist when they’re out of sight. It remains difficult for me to feel a connection not only because of brain damage to these areas but also because of traumatic changes in our relationships. Even so, neurostimulation treatment returned to me the ability to have important-to-me people continue to exist in my mind when I haven’t seen them for a day or a week or a year.
Copyright ©2022-2023 Shireen Anne Jeejeebhoy