Note: this post was inspired by the recent conversation I had with Soo Na Pak about grief and resilience.

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Now the music’s gone, but they carry on
For their spirit’s been bruised, never broken.
They will not forget, but their hearts are set
on tomorrow and peace once again.

Phil Coulter, The Town I Loved So Well¹

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When I was a boy and got hurt – falling off my bike, getting hit by a baseball in the ribs, a bruised ego – my father would say to me “you’ll have a lot more of those in your life, kid.” It really wasn’t the response I was looking for at the time, which I suppose was for sympathy. My guess is that he thought a bit of cold, hard reality would do me some good. I don’t know which parental approach is the correct one, but he was undoubtedly right that adversity and getting hurt never really stop, no matter how old we are. But after being knocked down, we do our best to get up again.

Unfortunately, we sometimes face challenging circumstances which greatly exceed falling off a bicycle – the death or loss of our loved ones, poverty, discrimination, debilitating disease or psychological trauma, famine, slavery, war, etc. Sometimes these things are chronic or even fatal, and should we be lucky enough to make it through to the other side of the tunnel, the pain can feel almost unbearable in the interim.

Nonetheless, our species is a resilient one, and we’ve endured a lot: plagues, population bottlenecks, and near extinctions (Ambrose, 1998). We’ve colonized every continent and a variety of ecosystems; created tools, science, and mega-cities (or, as someone once called them, “monkey hives”); domesticated other species; and even ventured into space. However, it’s unlikely that we’ll ever completely eradicate pain, whether physical or emotional. Writing about the pain of grief from an evolutionary perspective, John Archer suggested that it is the price we pay for love:

grief is a consequence of the way we form personal relationships. These involve representations of the loved one which affect every aspect of our lives, and which are resistant to attempts to change them. This motivating aspect of close relationships shows itself in terms of wanting to maintain contact and as jealousy, mechanisms which go back a long way in evolutionary history. But they have one drawback. The emotional and motivating responses which are essential for maintaining the relationship when the other is alive (felt as love) also operate when the loved one is no longer there (felt as grief): that is, when in functional terms they are futile. Grief, then, is the cost we pay for being able to love in the way we do” (Archer, 1999: 5).

I’ve written before that the connections we make with others are among life’s highlights, and that this is at least partly traceable to our origins as social primates. The flip side is that there is the risk of loss or rejection, which can cause real and enduring pain. For example, in one study of forty people who had an unwanted romantic break-up in the last six months (i.e., they were ’dumped’), viewing a photo of their ex-partner activated brain regions also found in physical pain sensation (Kross et al., 2011). If grief is the price we pay for love and the unwanted severing of relationships, it can be a steep one.

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Why Is Pain So Painful?

I watched you suffer a dull aching pain/ Now, you’ve decided to show me the same. (The Rolling Stones)

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We are emotional beings. At times, there can be so much pain in life that we try to imagine another world free from it. For my uncle’s funeral last month, my cousin asked if I could do a reading from the Book of Revelation during the Mass. Though I’ve long strayed from my Catholic roots, my uncle was a wonderful person and it was an honor to be asked to be part of the ceremony, so I accepted without hesitation. This is certainly one of the stranger parts of the Bible because it is essentially a hallucination about the end of the world, but there was something very human about this particular passage. Whoever wrote it imagined that there would be some plane of existence free from pain, at least for believers:

(God) will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away.”

One can find similar themes in other religions. Buddhism maintains that existence itself is suffering, and that its conquest requires the elimination of desire and attachment (unfortunately, an unattainable prescription for mortal animals like us). Is existence really that bad? Some level of pain is inevitable, but an interesting theoretical question is why does pain have to be so painful sometimes? Forty years after her horrific injuries at Trang Bang, Kim Phuc said that the physical and emotional pain that she faced as a girl were almost too much: “My heart was exactly like a black coffee cup. I wished I died in that attack with my cousin, with my South Vietnamese soldiers. I wish I died at that time so I won’t suffer like that anymore.” She is now 49 years old, and seems to have weathered that storm, but it took her a long time. In their book, Welcome to Your Brain, Sandra Aamodt and Sam Wang pointed to research that found that recovery from various major life traumas can take quite a while:

The life events most likely to have a lasting negative influence on people’s happiness include the death of a spouse, divorce, disability, and unemployment. In all these circumstances, people still adapt – their happiness is much more strongly affected right after the event and then moves back toward the baseline – but the adaptation is not complete. Even eight years after the death of a spouse, surviving partners remain less happy than they were when their spouse was alive” (Aamodt & Wang, 2008: 117).

Obviously, the loss of a spouse (or any close relationship) leaves an enormous void, but eight years is a long time to suffer a deficit of happiness. Other epidemiological studies show that the risk of mortality increases substantially soon after the death of a loved one. In one Finnish study of 158,000 married people, mortality increased for a range of causes following the death of a spouse, especially within the first six months (Martikainen & Valkonen, 1996). This effect was greater in men, and the authors suggested that this could be due to men depending more on their wives for care and social ties, or possibly that women were simply better at coping with loss.

Similarly, in an American study, Mostofsky et al. (2012) reported that the risk of myocardial infarction (heart attack) increased 21-fold within the first day of learning of the death of a significant person (e.g., spouse, child, parent, sibling, friend). This risk declined each subsequent day, but stayed elevated for at least a month. The authors speculated that there could be a number of causes for this, including depression, anger, anxiety, loss of sleep and appetite. Another factor may be something called “broken heart syndrome” (aka stress myocardiopathy), which is apparently a real phenomenon marked by an abnormal electrocardiograph and dysfunction of the left ventricle following sudden stress (Wittstein, 2007).

Elsewhere, I mentioned research showing that having strong friendships was one of the most important predictors of survival and longevity among the elderly. On the other hand, there is a tax on love and caring too much. Still, if I were offered a life free from grief and pain in exchange for forfeiting those connections, I wouldn’t take that deal. (Although that’s coming from a social primate who probably doesn’t know any better).

The Half-Life of Pain

My gears, they grind more each day/ And I feel like they’re going to grind away. (The Black Keys)

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If we could design a human from scratch, the duration (and intensity) of pain would probably be some of the first facets of our neurobiology that we’d like to rewire. Why not make a brain that could feel just enough pain to get the job done? Sprained ankle? Here’s just a twinge of pain – don’t walk on that for a while. Lost loved one? Broken heart? That stinks – you will definitely miss them, but you’d best not dwell on it for too long; you have things to do. For pain and grief, like many of our emotions, it seems the half-life is excessive and wasteful. Nature went overboard.

One likely reason that some of our emotions are so intense and persistent is that we are then forced to commit to them, to feel them genuinely, largely taking them out of conscious control. Nature did not half-ass our emotions:

Rage deters transgressors; guilt makes cheating painful for the cheat; envy represents self-interest; contempt earns respect; shame punishes; compassion elicits reciprocal compassion…And love commits us to a relationship” (Ridley, 1996: 142).

Grief is one of these emotions/drives, and it could be argued that so are others such as early stage romantic love or guilt. Ronald Ebens, the man who killed Vincent Chin in a famously racially charged case, apologized earlier this week, 30 years after the fact:

Nobody feels good about somebody’s life being taken, okay? You just never get over it. .Anybody who hurts somebody else, if you’re a human being, you’re sorry, you know…It’s something you never get rid of. When something like that happens, if you’re any kind of a person at all, you never get over it. Never.”

One might argue from a moralistic standpoint that anyone who takes the life of another person should feel some pain for the rest of their lives. That probably depends on circumstances, but the real question is why would nature do that? It’s not very good design. If guilt is installed in us to learn a lesson via pain, are three decades necessary to accomplish that? Of course, we are not designed, but cobbled together over millions of years of evolution tinkering with our genes.

According to Archer (1999), John Bowlby hypothesized that grief was not itself adaptive, but rather a byproduct of a strong desire for reunion when a relationship was severed for some reason other than death (distance, displacement, or some falling out). Under those circumstances, a relentless subconscious desire for reunion would be adaptive if the relationship was potentially meaningful or beneficial. Of course, with death, reunion is impossible, perhaps making grief a neurological ‘misfire’ for reunion. On the other hand, grief also draws sympathy from others (within limits), potentially increasing social support by strengthening old ties and forging new ones.

There are similar debates as to where depression falls on the pathology–byproduct–adaptation continuum. Some have hypothesized that depression could have been adaptive for our ancestors under certain circumstances in that it would force us to withdraw from social life to ruminate over our problems, and hopefully come up with solutions to them. A former colleague of mine at UMass Boston, Leakhena Nou, noted that in her research one of the most commonly reported stressors found in Cambodians in the U.S. was koucharang syndrome, which translates as “thinking too much” (also see Frye & D’Avanzo, 1994). Koucharang has been attributed largely to the Khmer Rouge period of genocide, and sounds very much like depression and rumination, though there are culturally specific attributes to this. The counterargument to depression being an adaption is that it is not very successful at problem solving, and it’s often excessive, futile, and sometimes fatal. However, depression and grief do not meet a traditional definition of adaptation. At best, they might be called “accommodations,” defined as suboptimal responses to environmental stresses which may help an individual survive but with “significant losses in some important functions” (Frisancho 1993: 7).

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Hope and Resilience

“Remember, Red, hope is a good thing – maybe the best of things – and no good thing ever dies.” (The Shawshank Redemption)

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I once asked a Cambodian friend of mine – a working, widowed mother of four – how she managed her life. Her reply, which I won’t soon forget, was “If you can survive a genocide, you can pretty much handle anything.” We experience pain, but as the Phil Coulter song at the top of this page goes, we are often bruised but usually not broken beyond repair. On his blog, the anthropologist Melvin Konner wrote that:

One of the worst ideas in some past versions of psychodynamic psychology is that every bad thing that happens leaves an indelible mark on our minds, impairing us in some enduring way. The reality is that most trauma results in transient symptoms – resilience usually wins the day. Why?

Because if we hadn’t adapted ourselves to hard knocks during evolution, we wouldn’t have survived a single generation, much less hundreds of millennia. We take some things to heart; we grieve; we are afraid. Sometimes we have intrinsic emotional problems that require psychotherapy or medicine. But more often than not we bounce back, because that is what our evolution built into our psyches – the rebirth of positive mood, the hopeful gaze at the horizon, the leaning into the wind, the determined step forward into the future.”

In an anthropological  forum on what happiness means for our species, Carolyn Nordstrom relayed an anecdote highlighting the importance of humor under difficult circumstances:

Two Mozambican friends of mine who did not know each other ended up at my dinner table in Berkeley, along with a few local academics. To me, knowing Mozambique, their conversation was normal: they asked about their homes and families, enjoyed finding mutual acquaintances, and extended sympathy for loved ones harmed or killed in the war. Shortly thereafter, one made a joke on a neutral topic, and they both laughed together. The Westerners looked uncomfortable, and finally one asked: “How can you laugh at a time like this, when you’re talking about losing loved ones in war?” The two Mozambicans shared a knowing look, and one replied: “How can you not?” (Nordstrom 2012)

We have a lot of assets in our tool kit as a species: intelligence, love, the ability to eat diverse diets, flexible behaviors, and humor. The journey is not always pleasant, but we endure, fight on, and even smile when wounded. And still we rise.²

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Update (June 29, 2012): Mark Changizi wrote this interesting post on harnessing our pain for good.

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Footnotes

1) One of my favorite Irish songs, this is about “the Troubles” in Northern Ireland. I’ve always liked its non-partisan approach, and the simple themes of longing for peace and a return to the innocence of childhood before the outbreak of violence.

2) Words of wisdom from Maya Angelou.

3) I probably overdid it with the song quotes. I guess there’s a lot of pain (and resilience) floating out there in the ether.

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References

Aamodt, S., & Wang, S. (2008). Welcome to Your Brain: Why You Lose Your Car Keys but Never Forget How to Drive and Other Puzzles of Everyday Life (p. 240). Bloomsbury USA. (Link)

Ambrose, S. H. (1998). Late Pleistocene human population bottlenecks, volcanic winter, and differentiation of modern humans. Journal of Human Evolution, 34(6), 623-51. (Link)

Archer, J. (1999). The Nature of Grief: The Evolution and Psychology of Reactions to Loss (Google eBook) (p. 317). Psychology Press. (Link)

Frisancho, A.R. (1993). Human Adaptation and Accommodation. Univ of Michigan. (Link)

Frye, B. A., & D’Avanzo, C. (1994). Themes in managing culturally defined illness in the Cambodian refugee family. Journal of Community Health Nursing, 11(2), 89-98. (Link)

Kross, E., Berman, M. G., Mischel, W., Smith, E. E., & Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. PNAS, 108(15), 6270-5.  (Link)

Martikainen, P., & Valkonen, T. (1996). Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort. American Journal of Public Health, 86(8), 1087-93. (Link)

Mostofsky, E., Maclure, M., Sherwood, J. B., Tofler, G. H., Muller, J. E., & Mittleman, M. A. (2012). Risk of acute myocardial infarction after the death of a significant person in one’s life: the Determinants of Myocardial Infarction Onset Study. Circulation, 125(3), 491-6. (Link)

Nordstrom, C. (2012). Happiness (is not a warm gun). AA Vital Forum Topics: On Happiness. Barbara Rose Johnson, ed. American Anthropologist 114 (1). (Link)

Ridley, M. (1996). The Origins of Virtue. Penguin Books.

Wittstein, I.S. (2007). Broken heart syndrome. Cleveland Clinic Journal of Medicine 74 (Suppl 1) S17-S22. (Link)

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