Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
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6 Toward a Biology of Grieving
6 Toward a Biology of Grieving
Pages 145-178
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From page 145... ...
However, the significance of these changes is not well understood. They may be primarily adaptive physiologic responses that in some persons become maladaptive and physiologically deleterious.
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From page 146... ...
This chapter reviews the many studies of prompt biological reactions to the stress of bereavement (x-ye and presents conceptualizations and promising leads but not confirming data on the implications of these particular physiologic changes for enduring health consequences (x-y-z) in human beings.
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From page 147... ...
Most important, animal studies provide new conceptual models for approaching an understanding of human bereavement. Examples are given in the section on social relationships as biological regulators and in Chapter 7.
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. Alm ess actlvlty-mactlvlty Preoccupation with image of deceased Tears Sighing respiration Muscular weakness Chronic background disturbance: lasting weeks to months Social withdrawal Decreased concentration Decreased attention Restlessness, anxiety Decreased or increased food intake Postures and facial expressions of sadness Illusions or hallucinations Depressed mood Decreased or increased body weight Sleep disturbance Muscular weakness Cardiovascular changes Endocrine changes Immunologic changes
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From page 149... ...
This pioneering study raised as many questions as it answered and gave an early indication of the complications that may arise in this kind of research. Current psychoendocrine studies at Yale measure plasma levels of pituitary prolactin and growth hormone, as well as cortisol, in recently bereaved subjects during interviews in which the loss experiences were reviewed.
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From page 150... ...
Such research would permit consideration of the relationship of immune function to bereavement and the possible relevance to clinical vulnerability. PROMISING RESEARCH APPROACHES Much less is known about the physiology of human bereavement than, for example, about the physiology of exercise or pregnancy.
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From page 151... ...
This basic knowledge will be useful in planning clinical studies of patients at risk because of preexisting disease such as asthma, pulmonary emphysema, coronary heart disease, or congestive heart failure. These conditions are most likely to be affected by the physiologic changes of acute distress waves.
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From page 152... ...
Sudden cardiac death, cardiac arrhythmias, myocardial infarction, and congestive heart failure are the most frequently mentioned conditions of that system associated with grief.72 This presents us with the clue that disturbances in autonomic cardiovascular regulation and in circulating catecholamines may be present in bereavement and may be exaggerated in patients with preexisting cardiovascular disease of the arteriosclerotic or hypertensive variety. Studies have shown that patients with congestive heart failures and with essential hypertensions and arrhythmias60 6i are particularly prone to exacerbation of their condition in response to threatened or actual loss of human relationships.
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From page 153... ...
Alternatively, substance abuse may be related to depression, a possibility discussed in the next section. clues from the Endocrinology and Biochemistry of Depression and Anxiety States Two well-delineated mental disorders, major depression and panic disorder, may share a common neurobiological substrate with the response to loss in the bereaved.
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From page 154... ...
Thus, only when beset by the significant psychological stress imposed by Toss of their peers were these animals responsive to the drug regimen. This complex interaction, in which events at the psychological level affect physiologic processes and where the physiology in turn alters psychological functioning, is a ubiquitous quality of primate psychobiology.
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Toward a Biology of Grieving / 155
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From page 156... ...
Secretion of other hormones also is altered by stressful situations. Testosterone decreases during stress.43 Sowers and colleagues74 found that physical and psychological stress related to diagnostic procedures and surgery was associated with decreased thyrotropin and thyroxine and with increased prolactin, growth hormone, cortisol, and luteinizing hormone, with no evident effect on follicle stimulating hormone.
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From page 157... ...
Psychiatric interviews, field observations, and measurements of 17-OHCS excretion in army recruits showed that Tow excretors had better defense mechanisms and that high excretors were less successful in dealing with the stress of basic training.66 Animal studies have shown that stress, especially uncontrolIable or inescapable shock, causes many changes in norepinephrine, epinephrine, and dopamine concentrations in peripheral blood and in different parts of the brainstem, hypothalamus, and limbic system.68 Although the link between these neuroendocrine substances and the hypothalamic-pituitary axis has not been completely elucidated, a relationship certainly exists. The "helpless-hopeless syndrome" seen in animal studies of inescapable shock situations appears to have special effects on endocrine activity that may have some potential relevance for studies of human stress, including bereavement.
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From page 158... ...
i5 Immune Changes Related to Endocrine Events. It is well known that adrenal cortical activity has the effect of reducing circulating lymphocytes and increasing thymic involution, resulting in diminished immune function.55 58 Riley and others have conjectured that an increase in adrenal cortical activity induced by stressful manipulation of experimental animals was causally related to an enhanced susceptibility to the growth of malignant tumors.64 65 Thymic involution and fewer circulating lymphocytes implicate T-cell deficiency as a possible factor in tumor susceptibility; hence Riley and others have shown tumor enhancement.
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From page 159... ...
. puages, warn acute stress Increasing the immune response and chronic stress decreasing it.~75 Stress such as steep deprivation has caused initial immunosuppression, followed by enhancement of the immune response.s~ In reviewing the positive and negative effects of stress on immune function in animals, Ader3 concluded that "in general.
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A cautionary note about interpreting measurements of immune function must be added, however, along with an argument for clinically relevant research involving human subjects. Assessment of T-cell or B-cell functions in vitro is of uncertain meaning in regard to actual vulnerability to infection.
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One approach, which has yet to be applied systematically, is the direct measure of immune functions in human beings in viva. For example, by skin testing two agents to which nearly everyone is sensitive {"allergic" J
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The simultaneous secretion of substances that suppress immune function may serve as a protection by transiently halting the immune response to a flood of antigens appearing from endogenous {proteolysis) or exogenous {injury)
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It should be noted that they are not mutually exclusive and may even be integrated eventually as data are obtained. Bexcavement as a Stressor As mentioned previously, the current information available on stress and health has been summarized in an Institute of Medicine report.~7 The physiologic responses to a range of external events viewed as stressfu]
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From page 164... ...
He described several situations of "stress" isuch as acute avoidance, sleep deprivation, and fasting in which the patterns of cortisol, norepinephrine, and epinephrine are different. Kuhn and his colleagues44 also observed different physiologic responses, as measured by omithine decarboxylase activity, in response to maternal separation and other types of stress in rats.
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From page 165... ...
. Agltatlon Vocalization S earching-inactivity Increased heart rate Increased cortisol Increased catecholamines Slow developing Decreased social Decreased body weight "despair" phase interaction, Sleep disturbance lasting hours decreased play Decreased rapid eye move or days Mouthing, rocking ment Hypo- or hyper- Increased arousals responsiveness Metabolic: Decreased or decreased core increased food temperature intake decreased oxygen Postures and facial consumption expressions of Cardiovascular: sadness decreased cardiac rate decreased resistance increased ectopic beats Endocrine: decreased growth hormone Immune: decreased T-cell activity
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From page 166... ...
There is an obvious similarity between these responses and the cognitive and perceptual disturbances seen in the chronic grief response, all TABLE 3 Responses to Disrupted Regulation of Homeostas~s Human StudiesJ Symptoms following sensory deprivation: Fluctuating concentration and attention Restlessness, anxiety Difficulty in ordering thoughts Decreased food intake Illusions and hallucinations Decreased body weight Sleep disturbance Muscular weakness Symptoms following jet travel across time zones: Decreased vigilance, decreased attention span Decreased appetite Sleep disturbance Malaise, fatigue Symptoms following work shift change: Decreased vigilance Cognitive impairment Insomnia Weakness, fatiguability Depression, hostility
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From page 167... ...
Study of the regulatory aspects of social relationships may eventually lead to some underst~nding of the mechanisms by which the presence or absence of social support systems modifies physiologic responses to stress and vulnerability to disease. Rhythms in the Endocrine and Immune Systems.
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From page 168... ...
Continuum As discussed in the section on promising research approaches, the phenomena of bereavement mirror to a considerable extent the symptoms and signs of depressive illness and share some aspects of anxiety states. Because overt depressive illness and, to a lesser extent, severe anxiety states are often precipitated by major Tosses, it seems reasonable to look for connections between bereavement and these two common psychiatric disorders.
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From page 169... ...
The epidemiology of bereavement suggests that cardiovascular and immune function may be substantially altered by grief. And there are enough similarities between grief and depression to merit a comparison of neuroendocrine and other biological changes in the two conditions.
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From page 170... ...
Do the patterns during bereavement parallel those in other situations in which "loss of control" is a prominent element? What types of physical and social environmental factors alter the intensity and time course of human physiologic responses?
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From page 171... ...
Survival and recovery of physiologic functions after early maternal separation in infant rats. Psychosomatic Medicine 15:475-480, 1975.
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Suppressed immune response in infant monkeys associated with maternal separation. Behavioral and Neural Biology 36:40-48, 1982.
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From page 173... ...
Pharmacologic control of the hormonally mediated immune response. In: Psychoneuroimmunology {Ader, A., edit.
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Suppression of lymphocyte stimulation following bereavement. fournal of the American Medical Association 250:374-399, 1983.
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From page 175... ...
Behavioral and physiological response of infant squirrel monkeys following weaning. Paper presented at American Society of Primatologists Meeting, East Lansing, Michigan, 1983.
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From page 177... ...
Monkeys ' Responses to Separation and Loss
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From page 178... ...
Because of the many parapets with human responses, researchers are studying nonhuman primates to better understand bereavement and howpre- and post-bereavement circumstances affect adjustment to Joss.
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