When a patient tells me they are grieving, I try to convey something that most people do not know and that most healthcare systems do not adequately acknowledge: grief is not primarily a psychological experience. It is a physiological one. The pain of loss is not metaphorical - it is neurological, cardiovascular, immunological. The exhaustion is not weakness. The physical symptoms are not imagined.
I say this because I regularly sit with grieving people who are bewildered by their own responses and sometimes deeply ashamed of them. Who expected to be sad and functional - to cry and carry on - and found instead that they cannot concentrate, cannot sleep, have chest pain, have a racing heart, keep forgetting things they have known for years. Who wonder if something is wrong with them beyond the loss.
Nothing is wrong with them. Their body is responding precisely as the human body was designed to respond to catastrophic loss. The question is what that response actually involves, and what helps.
What grief does to the body - the physiology
The heart - literally: Broken heart syndrome (Takotsubo cardiomyopathy) is a real, documented medical condition. A sudden emotional shock - including bereavement - can trigger a surge of stress hormones (primarily adrenaline and cortisol) that temporarily stuns the left ventricle of the heart, causing it to balloon and lose normal function. Symptoms are virtually indistinguishable from a heart attack: chest pain, shortness of breath, ECG changes. It is most common in post-menopausal women following acute emotional stress.
Takotsubo is almost always temporary - the heart function recovers within days to weeks. But it requires urgent assessment because it genuinely mimics a heart attack. If you develop chest pain in the context of acute grief, go to A&E. Do not assume it is stress.
Beyond Takotsubo, acute bereavement is associated with a significantly elevated risk of actual heart attack and stroke in the days and weeks following a loss. The risk is highest in the first 24 hours (approximately 21 times the baseline risk for heart attack in the hour after learning of a loved one's death).
The immune system: Grief measurably suppresses immune function. Studies from the 1970s onwards have consistently shown that bereaved people have reduced natural killer cell activity, reduced lymphocyte proliferation, and altered cytokine profiles. This translates to practical reality: bereaved people get more infections, take longer to recover from illness, and have higher rates of mortality from infectious disease.
Sleep: Grief profoundly disrupts sleep architecture. Difficulty falling asleep (a mind that cannot stop replaying memories or processing the loss), frequent waking, nightmares involving the deceased, and early morning waking with immediate awareness of the loss are all common. Sleep deprivation then compounds every other aspect of the grief experience - emotional regulation, cognitive function, immune function, pain threshold.
The brain: Grief activates brain systems in a way that is neurologically similar to addiction. Neuroimaging studies show that viewing photographs of the deceased activates both the anterior cingulate cortex (pain processing) and the nucleus accumbens (reward and craving). This simultaneous activation of pain and craving is part of what makes grief feel like yearning - a pulling toward what is no longer there.
The hippocampus - central to memory and spatial navigation - is particularly affected by grief. This is why bereaved people frequently report difficulty with memory, concentration, and even navigation. The phenomenon sometimes called grief brain or widow's fog is neurologically real.
Physical pain: The emotional pain of loss is processed in the brain using similar neural circuitry to physical pain. Social pain and physical pain are not entirely separate experiences neurologically. This is why grief physically hurts.
Case study: Farai's bereavement with complications
Farai, 52, lost his mother in Zimbabwe in April 2024. He was unable to travel for the funeral - work commitments and visa complications prevented it. He had not been home in four years.
He came to see me six months later presenting with what he described as stress and not coping. He was not sleeping. He was drinking significantly more than his baseline. He had lost 8kg. He was waking at 3am most nights and was unable to return to sleep.
He had not presented this as grief because, he told me, his mother had been ill for some time and he had expected her death. He thought he should have been more prepared.
There is a clinical myth that expected deaths are easier to grieve than sudden ones. It is not supported by evidence. Anticipatory grief - grieving during a terminal illness - runs in parallel with, not instead of, grief after the death.
Farai had several features that complicated his grief: geographical distance from the burial site and from family with whom grief would traditionally be processed collectively; inability to attend funeral rituals that are central to many African cultures; guilt about absence; and what grief researchers call disenfranchised grief - grief that does not receive social recognition. His colleagues did not know his mother had died. His grief had no social container.
We worked on the alcohol as a maladaptive coping mechanism (it reliably worsens sleep and grief). I referred him to a bereavement counsellor with experience of cross-cultural grief. We arranged a small ceremony with his family in the UK to acknowledge his mother's death in a context where he could be present.
"I thought I was supposed to have moved on by now," he told me. "Nobody in my world had even acknowledged that my mother died."
Grief in African communities - the cultural dimension
In many African cultures, grief is expressed collectively and demonstratively. Extended mourning periods, communal wailing, specific rituals that mark the stages of bereavement, and the understanding that grief is a community process rather than a private one are all features of traditional African approaches to loss.
The diaspora experience can strip these supports. People grieve in contexts where colleagues expect them to be functional after three days of compassionate leave. Where communal mourning rituals are impossible. Where death is thousands of miles away and the body was buried without them.
Conversely, in African cultural contexts where mental health discussion is stigmatised, grief that has progressed to clinical depression may be treated with prayer alone without recognition that professional support is also available.
Normal grief vs prolonged grief disorder
Normal grief is intense but variable. It comes in waves - periods of acute pain interspersed with periods of relative normality. It changes over time. The bereaved person can function, with difficulty. There is movement.
Prolonged Grief Disorder (PGD) - recognised in ICD-11 and DSM-5-TR since 2022 - is characterised by: persistent, relatively constant high-intensity grief beyond 12 months after the death; significant functional impairment in multiple life areas; inability to imagine a meaningful future; profound difficulty experiencing positive emotion; a sense of disbelief about the death persisting more than a year later.
PGD is not the same as depression (though they can coexist). It has specific treatments - Complicated Grief Treatment (CGT) and adapted CBT - that are more effective for PGD than standard depression treatment.
Seek support if: grief is significantly impairing daily functioning after several months; you are using alcohol or substances to manage grief; you have thoughts of wanting to be dead or of harming yourself.
Cruse Bereavement Care (cruse.org.uk) - helpline 0808 808 1677 - provides free bereavement support in the UK.
Sources: Shear MK, NEJM 2015 (Prolonged Grief Disorder); Eisenberger NI, Science 2003 (social and physical pain neural pathways); Buckley T et al, Journal of the American College of Cardiology 2010 (cardiovascular risk in bereavement); Bartrop RW et al, The Lancet 1977 (immunosuppression in bereavement); Maccallum F and Bryant RA, Journal of Abnormal Psychology 2018 (Complicated Grief Treatment); WHO ICD-11 - Prolonged Grief Disorder definition 2022.
