Is It Possible To Die Of Grief?

Enlarge this image toggle caption Chris Pizzello/AP Chris Pizzello/AP

The actress Debbie Reynolds' death just one day after her daughter, Carrie Fisher, died has led some to speculate that grief from the loss might have been a contributing factor. There was similar speculation when actress Brittany Murphy's husband, Simon Monjack, was found dead at just 39, several months after the sudden death of his wife.

It's a common theme in literature — 10 of Shakespeare's characters die of strong emotion — but is it actually possible to die of a broken heart?

The short answer is, maybe. A small study published in the New England Journal of Medicine in 2005 evaluated 19 patients who showed symptoms of cardiovascular dysfunction after sudden emotional stress, concluding: "Emotional stress can precipitate severe, reversible left ventricular dysfunction in patients without coronary disease." The condition, known as Broken Heart Syndrome, has been well-documented since this small study and is now recognized by the American Heart Association as occasionally fatal. It seems to primarily affect older women.

While this particular condition is quite rare, stress and strong emotions have long been known to elevate the risk of more common problems, like heart attack and stroke. Some reports have suggested Reynolds had stroke-like symptoms before she died.

Dr. Ilan Wittstein was lead author of the NEJM study and is a cardiologist at Johns Hopkins University. "It looked clinically like a heart attack," he says of the patients suffering Broken Heart Syndrome in his study. But, he adds, "Typically a heart attack is caused by a blockage in an artery, that develops a blood clot around it, and then blood flow to the heart is cut off. And what we saw in our patients was that they really didn't have any blockages in their arteries."

The good news is that the effect seems to be remarkably short-lived and treatable in most people. While heart attacks cause permanent damage to the heart muscle, the effect of Broken Heart Syndrome seems to be completely reversible. "Typically within a couple of weeks the heart muscle is back to normal again," Wittstein says. He adds that while the condition can be fatal, it usually isn't.

Wittstein thinks the physiological explanation involves the hormones your body produces when you're under significant stress: adrenaline and noradrenaline. "We think these stress hormones, when they're produced in large amounts, actually go to the heart and affect the very tiny blood vessels that surround the heart," triggering a temporary decrease of blood flow to the heart.

"As a result, the heart muscle is stunned," Wittstein says. "It can't function properly for a matter of days."

George Bonanno, a clinical psychologist who studies grief at Columbia University, says he is skeptical that grief had anything to do with Reynolds' death. "It's a little on the 19th century side to be saying she died of grief," he says. In most cases, after a loss, "we get on with our lives pretty quickly. I had argued, and I think the data supports, that we're kind of wired to do that."

Bonanno says sadness is adaptive: We have evolved to feel sad in the same way we evolved to feel cold.

"You don't need to feel cold," he says. "Your body will regulate its temperature as best it can, without you even knowing you're cold. But we evolved the feeling of cold later in evolution because it's instrumental." When you feel cold, you can often do something to help your body — by putting on a coat, going inside, or turning up the heat.

In the same way, Bonanno says, there must be a good reason humans evolved to feel sadness. "Being sad is very adaptive when you've had a major loss, because you're turning inward, because you're reflecting, because you're recalibrating," he says. "And all those things are all very important to do."

His work has also examined facial expressions, and how people who look sad invite sympathy. One theory is that by feeling and looking sad, we let the people around us know that we need their help.

But, like so many things, sadness might be "adaptive" only in moderation. Camille Wortman, a psychologist at Stony Brook University who studies grief and bereavement, is especially interested in cases where the loss of a loved one is very sudden or traumatic. She says there is a more extreme grief associated with the sudden loss of a child — even if that child is an adult — as was the case for Reynolds.

"The death of a child is absolutely devastating for a parent no matter when it occurs," Wortman says. "I don't think those people really bounce back the way we might think. I see them struggling for years and years with just an enormous hole in their heart, and an enormous sense of emptiness."

People do improve over time though, she says, provided they get the help and support that they need.

We may never know whether a sudden stun to the heart or any other manifestation of grief played a role in Reynolds' death. But Wittstein says the symptoms of Broken Heart Syndrome are very similar to that of a heart attack — chest pain and shortness of breath — and anyone experiencing these symptoms should seek medical attention.

As for the psychological and emotional aspects of grief, Bonanno and Wortman both say it's important not to be judgmental, of your own grief or that of others. There are many healthy ways to grieve, and Bonanno says, grief comes and goes in phases. Everyone's pace of healing is different.

"We don't stay in these states all day long, even though it may seem like we do," he says. "We go in and out of these states."

In his research coding facial expressions, Bonanno has found that the majority of people are able to laugh and smile when remembering things about a deceased spouse, even very soon after their death. "[They] might be crying one second, and then you'd get somebody genuinely laughing and smiling," Bonanno says. "You see people do this at funerals," he adds. Loved ones gather, and "most people are actually capable of interacting with them in a really meaningful way."